The Effects of Oxandrolone and Exercise on Muscle Mass and Function in Children With Severe Burns

Abstract

OBJECTIVES-Severe burns are associated with a significant loss of muscle and strength. Studies have reported that oxandrolone improves lean body mass in muscle-wasting conditions. Also shown previously in burned children is that an exercise program increases lean body mass and muscle strength. We hypothesized that oxandrolone, in combination with exercise, would increase lean body mass and muscle strength in severely burned children more than oxandrolone alone or exercise alone.METHODS AND PATIENTS-Fifty-one burned children (≥40% total body surface area burned) were randomly assigned to receive oxandrolone alone (0.1 mg/kg per day orally; n = 9), oxandrolone and exercise (n = 14), placebo and no exercise (n = 11), or placebo and exercise (n = 17). Administration of oxandrolone was started at discharge and continued until 1 year after burn. The 12-week exercise training program was started 6 months after burn. Serum hormones, lean body mass, muscle strength, and peak cardiopulmonary capacity were assessed at 6 (baseline) and 9 months after burn. Data were analyzed using a 1-way analysis of variance, and significance was set at P < . 05. RESULTS-The mean percentage of change or increase in weight and lean body mass in the oxandrolone and exercise group was significant compared with placebo and exercise, as well as with the oxandrolone alone group or placebo and no exercise group. Furthermore, lean body mass was significantly improved in the oxandrolone and exercise, oxandrolone alone, and placebo and exercise group compared with the group only receiving placebo. Muscle strength significantly increased in oxandrolone and exercise, placebo and exercise, and the oxandrolone alone group when compared with the placebo and no exercise group. The peak cardiopulmonary capacity was significantly higher in both exercise groups. Insulin-like growth factor 1 was significantly increased in the oxandrolone alone group compared with placebo and exercise and placebo and no exercise. Both exercise groups showed significant changes in insulin-like binding-protein-3 when compared with groups without exercise.CONCLUSIONS-Oxandrolone, in combination with exercise, is beneficial in severely burned children, thus improving their rehabilitation. Keywordsburns; exercise; hormones; lean mass; oxandrolone Severe burns are physically and psychologically catastrophic. Severely burned children have an elevated resting energy expenditure, whole body catabolism, and muscle weakness, which are worsened by prolonged bed rest and physical inactivity. 1,2Address correspondence to Oscar E. Suman, PhD, Children's Wellness and Exercise Center, Shriners Hospitals for Children, 815 Market St, Galveston, TX 77550. E-mail: oesuman@utmb.edu. The authors have indicated they have no financial relationships relevant to this article to disclose. NIH Public Access Author ManuscriptPediatrics. Author manuscript; available in PMC 2008 May 5. Published in final edited form as:Pediatrics. 2007 January ; 119(1): e109-e116. NIH-PA Author ManuscriptNIH-PA Autho...

The Pathophysiologic Response to Severe Burn Injury.

“…However, we have reported that an exercise program implemented at the 6-month postburn time point significantly improves physical function. [22][23][24] We would like emphasize that the present cohort study is heterogeneous because we included, in our cohort study, male and female patients with the latter containing both preand post-menarche patients, patients with and without inhalation injury, patients with and without infection/sepsis, patients with and without multi-organ failure, and patients who died and did not die. We did not eliminate patients with inhalation injury, sepsis, and multiple organ failure and death to smoothen out the trajectory of change of the variables measured because we wanted to achieve a large patient cohort to perform robust statistics.…”

“…Strength testing was conducted using a Biodex System-3 dynamometer (Shirley, NY) as previously published. [22][23][24] Values of peak torque were calculated by the Biodex software system. The highest peak torque measurement between the two trials was selected.…”

“…Peak torque was corrected for gravitational moments of the lower leg and the lower arm. [22][23][24] To determine peak oxygen consumption, patients underwent a standardized treadmill exercise test on day two using the modified Bruce protocol as part of their standard clinical outpatient evaluation. Heart rate and oxygen consumption were measured and analyzed using methods previously described.…”

“…Heart rate and oxygen consumption were measured and analyzed using methods previously described. [22][23][24] …”

Therapeutic Approaches to Combatting Hypermetabolism in Severe Burn Injuries

“…This suggests that O 2 consumption out-paces ATP production post-burn injury. Since a majority of the oxygen consumption and 90% of ATP production in respiring cells occur inside the mitochondria [72], metabolism may be normalized by interventions restoring mitochondrial function. Porter et al have shown in a cohort of adults with large burns that skeletal muscle mitochondrial function is altered, where the coupling of oxygen consumption to ATP production is diminished [14], suggesting that skeletal muscle mitochondrial thermogenesis increases in burn patients.…”