Effects of Exercise Training on Resting Energy Expenditure and Lean Mass During Pediatric Burn Rehabilitation

Abstract

Objective Severe burns cause profound hormonal and metabolic disturbances resulting in hypermetabolism, reflected in extreme elevation of resting energy expenditure (REE) and extensive skeletal muscle catabolism. Aerobic and resistive exercise programs during rehabilitation have shown substantial benefits, although whether such training potentially exacerbates basal metabolism is unknown. We therefore examined the effects of exercise training upon REE during the rehabilitation of severely burned pediatric patients. Methods Children with 40% total body surface area (TBSA) burns and greater were enrolled on admission to our burn intensive-care unit to participate in a twelve-week, hospital-based exercise program (EX), or a home-based standard of care program (SOC), commencing six months post-injury. Results Twenty-one patients (7–17 years) were enrolled and randomized to SOC (n=10) or EX (n=11). Age, gender, and TBSA burned were similar. Mean change (± sd) in REE, normalized to individual lean body mass (LBM), was almost negligible between SOC and EX group patients (0.03 ± 17.40%, SOC vs. 0.01 ± 26.38%, EX). A significant increase in LBM was found for EX patients (2.06 ± 3.17%, SOC vs. 8.75 ± 5.65%, EX; p=0.004), which persisted when normalized to height (0.70 ± 2.39%, SOC vs. 6.14 ± 6.46%, EX; p=0.02). Peak torque also improved significantly more in EX patients (12.29 ± 16.49%, SOC vs. 54.31 ± 44.25%, EX; p=0.02), reflecting improved strength. Conclusion Exercise training significantly enhanced lean mass and strength, without observed exacerbation of post-burn hypermetabolism. We therefore advocate use of exercise conditioning as a safe and effective component of pediatric burn rehabilitation.

Morphological changes in distant muscle fibers following thermal injury in Wistar rats

“…Another recent study 7 analyzed the effects of a 12-week program of aerobic training combined with endurance exercise that was initiated seven weeks after thermal injury for children with lesions covering more than 40% of the body surface. The program was found to benefit these patients, as measured by clinical assessment of muscle loss.…”

“…Severe thermal injuries are typically followed by a catabolic state [2][3][4] . The catabolic response in skeletal muscle is the principle mechanism of protein loss in patients with thermal injuries, resulting in muscle weakness [5][6][7] that delays recovery and contributes to disease. Muscle loss additionally exposes these patients to neuromuscular complications that increase hospital stay and mortality.…”

Energy Metabolism in Burn Injury and Current Approaches to Determine the Energy Requirements

“…Bu patofizyolojik yanıt, kaslarda protein yıkımı ve yağsız vücut kütlesi kaybına yol açmaktadır. 7,16,19,20 Ciddi yanık yaralanmalarında artan sistemik enerji harcaması, şiddetli kas katabolizması ve artan enerji harcaması nedeni ile hem boy uzunluğu hem de vücut ağırlığında üç yıla kadar büyümede gecikme görülebilmektedir. 6,14,16,19 Ayrıca, enerji substratlarının yoğun kullanımı hastada bağışıklık sistemi yetersizliği, enfeksiyonlar, önemli azot kaybı, gecikmiş yara iyileşmesi, çoklu organ yetmezliği, uzun süreli hastanede kalış ve mortaliteye neden olabilen malnütrisyona yol aç-maktadır.…”

“…7,16,19,20 Ciddi yanık yaralanmalarında artan sistemik enerji harcaması, şiddetli kas katabolizması ve artan enerji harcaması nedeni ile hem boy uzunluğu hem de vücut ağırlığında üç yıla kadar büyümede gecikme görülebilmektedir. 6,14,16,19 Ayrıca, enerji substratlarının yoğun kullanımı hastada bağışıklık sistemi yetersizliği, enfeksiyonlar, önemli azot kaybı, gecikmiş yara iyileşmesi, çoklu organ yetmezliği, uzun süreli hastanede kalış ve mortaliteye neden olabilen malnütrisyona yol aç-maktadır. 4,17,20,21 Protein katabolizması, ağrı, ateş, mekanik ventilasyon, kortikosteroidler, vazoaktif ajanlar ve yara boyutu enerji tüketiminin artışına sebep olur iken; malnütrisyon, nöromusküler ajanlar enerji tüketi-mini azaltabilmektedir.…”

Inflammatory and growth factor response to continuous and intermittent exercise in youth with cystic fibrosis

“…Chronic pulmonary infection [3] and pancreatic insufficiency leading to malnutrition [4] can also result in reduced fat free mass. Exercise is a non-pharmacological approach to attenuating protein breakdown [5] and increasing fat-free mass in humans [6]. In healthy children, however, acute bouts of exercise are known to activate the same inflammatory mediators involved in the pathology of CF [1].…”