Early Rehabilitative Exercise Training in the Recovery from Pediatric Burn

Abstract

PURPOSE The purpose of this study was to determine the effects of early outpatient exercise on muscle mass, function, and fractional synthetic rate in severely burned children. METHODS Forty-seven children with ≥40 % total body surface area burn performed 12-weeks standard of care rehabilitation (SOC: N=23) or rehabilitative exercise training (RET: N=24) immediately following hospital discharge. Dual-energy X-ray absorptiometry was used to assess lean body mass (LBM) at discharge, post-treatment, and 12 months post-burn. Muscle function was evaluated with a Biodex Isokinetic Dynamometer and peak aerobic fitness (VO2peak) measured using a modified Bruce treadmill protocol post-treatment. Stable isotope infusion studies were performed in a subset of patients (SOC: N=13; RET: N=11) at discharge and post-treatment to determine mixed-muscle fractional synthetic rate. RESULTS Relative peak torque (RET: 138 ± 9 N · m · kg−1 vs SOC: 106 ± 9 N · m · kg−1) and VO2peak (RET: 32 ± 1 ml · kg−1 · min−1 vs SOC: 28 ± 1 ml · kg−1 · min−1) was greater post-treatment with RET compared to SOC. In addition, RET increased whole-body (9 ± 2%) and leg (17 ± 3%) LBM compared to SOC. Furthermore, the percentage change in whole-body (18 ± 3%) and leg (31 ± 4%) LBM from discharge to 12 months post-burn was greater with RET compared to SOC. Muscle fractional synthetic rate decreased from discharge to post-treatment in both groups (6.9 ± 1.1% · d−1 vs 3.4 ± 0.4% · d−1); however no differences were observed between treatment groups at each time-point. CONCLUSIONS Early outpatient exercise training implemented at hospital discharge represents an effective intervention to improve muscle mass and function following severe burn injury.

Effects of whole-body vibration exercise on bone mineral content and density in thermally injured children

“…Our findings lend support to our previous reports and those of others on the benefits of exercise training on muscle strength and LM in burned children [8, 9, 11] [27, 28]. The finding that exercise significantly increased whole-body, but not regional LM, is not surprising given the short duration of the study.…”

“…The exercise protocol is detailed elsewhere[8–11]. Briefly, the 6-week program consisted of progressive resistance exercise and aerobic conditioning that lasted from 30 minutes to 1 hour.…”

“…Briefly, the 6-week program consisted of progressive resistance exercise and aerobic conditioning that lasted from 30 minutes to 1 hour. This exercise prescription, which is based upon recommendations by the American College of Sports Medicine, enhances aerobic fitness and muscle strength in children recovering from burns [8–11]. The progressive resistance exercise protocol was carried out 3 days a week and consisted of 8 exercises: bench and shoulder press, leg press, knee curls, bicep curls, triceps presses, heel raises, and abdominal curls.…”

The Role of Exercise in the Rehabilitation of Patients with Severe Burns

“…We were able to show that RET initiated at this early time point after injury resulted in greater accrual of lean mass than SoC. Further, aerobic fitness and strength were greater in the RET group than the SoC group at 6 months post burn (14). The greater accrual of lean body mass was maintained in the RET group at 12 months post injury, suggesting that alterations in body composition achieved through early RET are maintained at one year post burn.…”

Body Composition Changes in Severely Burned Children During ICU Hospitalization*

“…Countering the loss of lean mass is extremely important since loss of 40% of lean mass loss has been shown to dramatically increase mortality rate [36]. Moreover, reducing loss of whole-body muscle has been demonstrated to provide faster and more efficient recovery [37–39]. …”