Effects of Aerobic Exercise in the Intensive Care Unit on Patient-Reported Physical Function and Mental Health Outcomes in Severely Burned Children—A Multicenter Prospective Randomized Trial

Abstract

Severe burns are life-altering and can have lasting effects on patients’ physical and mental health. Alterations in physical function, changes in appearance, and psychological disturbances resulting from severe burns are especially concerning in children, as they are still in the early stages of identity formation. Exercise in the nonburn population has been shown to improve quality of life and result in better physical and mental status. However, the effect of early exercise on the quality of life in pediatric burn patients requires more research. Methods: Forty-eight children between the ages of seven and seventeen with ≥30% total body surface area (TBSA) burn were randomized in a 1:2 fashion to receive treatment with standard-of-care (SOC) or standard-of-care plus exercise (SOC+Ex). Surveys administered at admission and discharge collected patient-reported information regarding physical and mental health outcomes. The results are given as means +/− standard deviation. Significance was set at p < 0.05. Results: The average age of the SOC and SOC+Ex groups were 12 ± 3 and 13 ± 4 years, respectively. The average %TBSA burned in the SOC and SOC+Ex groups were 54 ± 17 and 48 ± 14, respectively. The SOC+Ex group averaged 10 ± 9 exercise sessions (range of 1 to 38 sessions) with an attendance rate of 25% (10 sessions out of 40 BICU days). Both groups demonstrated significant improvement in patient-reported physical and mental outcomes during hospital admission (p < 0.05) However, additional exercise did not exhibit any additional benefits for measured levels. Conclusions: Our recommendation is for all pediatric patients in the BICU to continue with the SOC and consult with their physician over the benefits of additional aerobic exercise. This study suggests that perhaps there is potential for increasing the amount of exercise that can be administered to pediatric burn survivors beyond SOC as we did not find aerobic exercise to be of any harm to any patients if it is performed properly and under supervision.

Effects of early exercise training following severe burn injury: a randomized controlled trial

“…This is particularly relevant given that family visits were entirely prohibited in line with COVID19-related measures. The observed lack of effects in the other assessed quality-of-life parameters is in line with previous reports of early exercise in adults [ 38 , 39 ] and children [ 91 ]. Besides being underpowered to detect effects, another methodological aspect that could explain the lack of efficacy in the quality-of-life domain is that our exercise training protocol was designed to achieve maximum metabolic modulation.…”

Intervención fisioterapéutica en pacientes con quemaduras, una revisión narrativa

“…Debido al hecho de que las hospitalizaciones relacionadas con quemaduras graves suelen ser prolongadas, un retraso en el inicio del ejercicio permite el desarrollo de una atrofia muscular significativa y la consiguiente reducción de la capacidad de función física. Estudios anteriores han demostrado que actualmente no existe un estándar de atención bien definido con respecto al inicio de programas de ejercicio en la UCI (22).…”

“…No hay evidencia de daño a los pacientes que participan en un programa temprano de entrenamiento de resistencia después de una lesión por quemadura (24), ni tampoco parece haber ninguna evidencia de que la movilización cause daño a los injertos de piel y sustitutos de la piel en pacientes quemados fuera de una UCI (21). Una vez que el paciente ha recibido el alta médica de la UCI o Unidad de Quemados debe continuar con su rehabilitación enfocado en prevención y el tratamiento de cicatrices y el alivio de la contractura articular y ejercicios de entrenamiento aeróbico (22).Tanto el entrenamiento interválico combinado con entrenamiento continuo aumenta significativamente la capacidad cardiorrespiratoria en niños con quemaduras graves hasta 24 meses después de la lesión, Se debe ofrecer a los niños una combinación adecuada de intensidad, estimulación y duración del ejercicio, según corresponda, para aliviar posibles problemas de aburrimiento (25).…”