Quantification of an Exercise Rehabilitation Program for Severely Burned Children: The Standard of Care at Shriners Hospitals for Children®—Galveston

Abstract

Currently, there are no clear guidelines for the implementation of rehabilitative exercise training (RET) in burned individuals. Therefore, we quantified the training logs for exercise intensity, frequency, and duration of 6 weeks of this program to develop a basic framework for outpatient RET in patients recovering from severe burns. Thirty-three children (11 female, [mean ± SD] 12 ± 3 years, 145 ± 18 cm, 40 ± 11 kg, 49 ± 31 BMI percentile) with severe burns (49 ± 15% total body surface area burned, with 35 ± 22% third-degree burns) completed our 6-week resistance and aerobic exercise training program. Cardiorespiratory fitness (peak VO2), strength, power, and lean body mass (LBM) were measured before and after RET. Outcome measures were analyzed as a relative percentage of values in age- and sex-matched nonburned children (11 female, 12 ± 3 years, 154 ± 20 cm, 49 ± 22 kg, 56 ± 25 BMI percentile). At discharge, burned children had lower LBM (77% of age-sex-matched nonburn values), peak torque (53%), power (62%), and cardiorespiratory fitness (56%). After 6 weeks of training, LBM increased by 5% (82% of nonburn values), peak torque by 18% (71%), power by 20% (81%), and cardiorespiratory fitness by 18% (74%; P < .0001 for all). Quantification of data in exercise training logs suggested that physical capacity can be improved by aerobic exercise training performed at five metabolic equivalents (>70% of peak VO2) at least 3 days/week and 150 minutes/week and by resistance training performed at volume loads (reps × sets × weight) of 131 kg for the upper body and 275 kg for the lower body for 2 days/week. We present for the first time the quantification of our RET and provide clear exercise prescription guidelines specific to children with severe burn injury.

Sildenafil Recovers Burn-Induced Cardiomyopathy

“…Additionally, other work has demonstrated that PDE5 inhibition restores catecholamine responsiveness and partially reverses contractile dysfunction [45]. A burn stimulates much higher levels adrenergic proteins [46] and catecholamines [47] in the circulation. Given the interaction between these two systems, further study is needed to further define the interactions between these two pathways in burn-induced cardiac dysfunction.…”

The effects of short bouts of ergometric exercise for severely burned children in intensive care: A randomized controlled trial

“…Rehabilitation programs following discharge showed improved lean body mass of severe burn survivors included resistance training. 6,8,20,21 Our exercise protocol only included an aerobic type of exercise. The absence of resistance exercise in this intervention may explain the lack of lean mass retention or accretion in the exercising subjects.…”

Comparison of Six-Minute Walk Test and Modified Bruce Treadmill Test in Paediatric Patients With Severe Burns: A Cross-Over Study

“…For constant improvement in exercise capacity, an exercise intensity between 65% and 95% peak HR, that corresponds to 70–80% peak VO 2 , should be attained. Notably, Rivas et al ( 22 ) showed that children with burns have an attenuated peak HR compared with non-burned children, suggesting that formulas developed by others to predict peak HR values for the purpose of estimating exercise intensity (% peak HR) may not be a valid approach in burned populations. Therefore, they suggest that an exercise stress test is needed for obtaining peak HR values for the estimation of exercise intensity for prescription purposes in burned patients.…”

“…It would address validity; however, it would also add cost to the testing. Notably, the aforementioned study by Rivas et al ( 22 ) provided regression equations that can be used to predict percent VO 2 based on percent peak HR and be useful for prescribing appropriate exercise intensity (i.e. percent peak VO 2 ).…”