Effects of different duration exercise programs in children with severe burns

Abstract

Introduction Burns lead to persistent and detrimental muscle breakdown and weakness. Standard treatment at our institution includes a voluntary 12-week rehabilitative exercise program to limit and reverse the effects of increased muscle catabolism. In the present work, we investigated if different durations of exercise, 6 or 12 weeks, produce comparable improvements in muscle strength, body composition, and cardiopulmonary fitness. Methods We prospectively enrolled and randomized patients with ≥30% total body surface area (TBSA) burned to receive 6- or 12-weeks of exercise rehabilitation. Patients were evaluated for muscle strength, oxygen consumption capacity, and lean body mass at discharge (n = 42) and post exercise. After 6 weeks (n = 18) or 12 weeks (n = 24) of exercise training, leg muscle strength was assessed as peak torque per body weight using a Biodex Isokinetic Dynamometer. Oxygen consumption capacity, measured as peak VO2, was studied using a standard treadmill-based test, and lean body mass was determined using dual-energy X-ray absorptiometry. Results Significant improvements in muscle strength, peak VO2, and lean body mass were seen after 6 weeks of exercise training (p<0.001), with only significant improvements in peak VO2 being seen after 6 weeks more of training. Conclusion These data suggest that a 6-week rehabilitative exercise program is sufficient for improving muscle strength, body composition, and cardiopulmonary fitness in pediatric burn patients. However, continuation of at- or near-home cardiopulmonary training following the 6 weeks of at-hospital rehabilitation may be useful.

Burn Injury May Have Age-Dependent Effects on Strength and Aerobic Exercise Capacity in Males

“…41 However, our previous work has found that burned children do improve aerobic and strength capacities. [14][15][16][17][18][19][20][21] Further, our results have consistently shown that the burned men group responded to a greater degree than our burned children. It is not clear why there are differences, but we do show (in Figure 3 and Table 2) that the relative relationship between heart rate and oxygen uptake differs between groups.…”

“…Nonburned normative data for peak torque were obtained from our database and our previous published studies. [14][15][16][17][18][19][20] Data were analyzed and figures generated using GraphPad Prism (Version 6.0, La Jolla, CA, USA), with significance set at P < .05. All data are reported as mean ± SD.…”

“…This study builds on our previous work showing that a rehabilitative exercise program started immediately after discharge improves muscle strength, muscle endurance, and LBM in children with burn injury. [14][15][16][17][18][19][20][21] Why strength and aerobic exercise capacity are affected to a greater degree in boys than men is not entirely clear. We have previously reported that the cardiovascular response to submaximal exercise is diminished in burned children compared with nonburned age-or sex-matched children.…”

“…We have found that immediately following discharge, a rehabilitation exercise program improves muscle strength, endurance, and LBM. [14][15][16][17][18][19][20][21] The effectiveness of resistance training is influenced by multiple factors, including age, maturation, sex, and the frequency, duration, and intensity of the training program. 22 However, whether burn injury differentially affects exercise capacity and body composition in adults and children is unknown.…”

Propranolol and Oxandrolone Therapy Accelerated Muscle Recovery in Burned Children

“…The improvement seen in both groups after exercise supports the utility of RET in severely burned individuals. Although we did not have a non-exercising group to compare the data and account for the effect of time as patients convalesce, previous randomized studies suggest that improvements in muscle mass and strength in the first few months post burn injury are significantly augmented in patients who participate in an exercise program compared to those who do not (9, 13, 39).…”