This study tested the hypothesis that participation in a rehabilitation exercise program following hospital discharge would increase the level of physical activity in burned children than that seen in free-living nonburned children. Thirty-one severely burned children (12 ± 3 years, 144 ± 18 cm, 42 ± 17 kg, 48 ± 12% TBSA burns) were matched to 31 nonburned children (12 ± 3 y, 147 ± 17 cm, 45 ± 15 kg) based on age and sex. Pedometers were used to track minutes and steps in burned children during their exercise rehabilitation and nonburned children under free-living conditions (healthy control). We found that the average minutes of activity per day was lower in burned children (56 ± 25minutes) than in nonburned children (74 ± 28 minutes, P < .05). However, no difference was detected for average steps per day or week or maximal minutes in 1 day or week. At discharge, burn children had peak torque and mean power values that were 61% of nonburned values, and exercise training improved these by 27 and 28%, respectively (88 and 89% of nonburned values; each P ≤ .0001). Likewise, cardiorespiratory fitness at discharge was 72% of nonburned values, and exercise training improved fitness by 10% (82% of nonburned values, P < .05). Percentage TBSA burned was inversely associated with steps (r = -0.54, P = .001) and minutes of activity (r = -0.53, P = .002), accounting for 28-29% of the variability in burned children. These results show that, at discharge, burned children are capable of matching steps of physical activity levels seen in nonburned healthy children. Physical activity monitoring may be a viable option for continued improvement of physical exercise capacity when burned children are under free-living conditions.

The burn injury does not have sex-dependent effects on LBM or exercise capacity in severely burn injured children. Differences in relative peak VO and peak HR suggest the need for burn specific exercise programs for improving the efficacy of a rehabilitation program.

BackgroundChildren with severe burn injury sometimes undergo exercise training as part of their rehabilitation. Others have reported that females have a 50% increased risk of death from burn injury compared to males. However, whether exercise capacity and exercise induced training adaptations differ between boys and girls is unknown.PurposeThis project tested the hypothesis that girls with burn injury would have lower strength and aerobic exercise capacity compared to burned boys, and that exercise training rehabilitation (RET) adaptations would likewise differ between groups.MethodsSeverely burned girls (n=25) and boys (n=26) were matched for age, body morphology (means±SD; 13±3 yrs, 150±15 cm, 53±14 kg; each P≥0.71) and for burn injury (54±20% total body surface area burn, P=0.82). Strength (peak torque) and cardiorespiratory fitness (peak VO2) were normalized to lean body mass (LBM) and analyzed as a relative percentage of age‐sex matched non‐burned children (girls 13 yrs, n=25, boys 13 yrs, n=26). Submaximal oxygen uptake (VO2) and heart rate (HR) were expressed as a percentage of peak values and compared to their sex‐ matched non‐burned counterpart during the first 4 stages of the modified Bruce protocol. At discharge (DC) and after an aerobic and resistance rehabilitation exercise training (RET) program, 2‐way factorial ANOVA assessed interaction and main effects of group × time for peak exercise and group × stage for submaximal exercise, with significance set at P<0.05.ResultsGirls had longer length of hospital stay (41±23 vs. 29±13 days, P=0.02). At DC and post‐RET, LBM was lower in burned and increased similarly after RET (DC 87.3% of non‐burned values, post‐RET 92.8%; Main effect, Time P=0.017). Peak torque was not different at DC and increased similarly after RET in both groups (DC, 56±17; after RET, 77±20%; Main effect, Time P<0.0001). Likewise, the improvement in peak VO2 was not different from DC to after RET between both groups (DC, 54±12 to RET, 67±13%; Main effect, Time; P<0.0001). Burned children exercise at greater percentage of their peak VO2 and peak HR during submaximal exercise compared to non‐burned children (Interaction, Group × Stage, P<0.0001; see Figure 1).ConclusionThese data indicate that the initial burn injury at DC or after RET does not have sex‐dependent effects on LBM, submaximal or peak exercise capacity. Exercise capacity is improved after exercise training but remains lower than non‐burned children. Differences in relative peak VO2 and peak HR may suggest the need for burn specific exercise programs for improving the efficacy and progress of a rehabilitation exercise program.Support or Funding InformationThis study was supported in part or totally by awards from NIH P50‐GM060338, NIH R01‐GM56687, R01 HD049471, 3R01HD049471‐12S1, SHC 84080, 71008, 84090, NIDILRR 90DP0043‐01‐00This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.