The efficacy of resistance training in addition to usual care for adults with acute burn injury: A randomised controlled trial

Gittings, Paul; Wand, Benedict M; Hince, Dana; Grisbrook, Tiffany L.; Wood, Fiona; Edgar, Dale W.

doi:10.1016/j.burns.2020.03.015

Cited by 11 publications

(10 citation statements)

References 71 publications

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“…Assessments were completed at these times including a baseline at the beginning (T1, T4), mid-point testing (T2, T5) and a final battery at the end (T3, T6) of each phase (Fig 2 ). A four week washout was prescribed between the phases to limit training residual effects on inflammatory markers affecting the control period results when participants performed the EX-CON cross-over [14].…”

Section: Outcome Measurementmentioning

confidence: 99%

“…However, there is an absence of well-designed randomised controlled trials (RCT) that have implemented structured exercise in those who have previously suffered a burn injury. Early evidence indicates that strength training undertaken by burn injury inpatients in the acute recovery phase can limit resting systemic inflammation [14]. However, little is known about the training effects on inflammation generated in individuals with a non-severe burn injury beyond the acute wound recovery period.…”

Section: Introductionmentioning

confidence: 99%

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Does exercise influence burn-induced inflammation: A cross-over randomised controlled feasibility trial

et al. 2022

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Background Burn injuries trigger a greater and more persistent inflammatory response than other trauma cases. Exercise has been shown to positively influence inflammation in healthy and diseased populations, however little is known about the latent effect of exercise on chronic inflammation in burn injured patients. The aims of the pilot study were to assess the feasibility of implementing a long duration exercise training program, in burn injured individuals including learnings associated with conducting a clinical trial in COVID-19 pandemic. Methods Fifteen participants with a burn injury between 5–20% total body surface area acquired greater than a year ago were randomised in a within-subject designed study, into one of two conditions, exercise–control or control–exercise. The exercise condition consisted of six weeks of resistance and cardiovascular exercises, completed remotely or supervised in a hospital gym. A comprehensive outcome measurement was completed at the initial, mid and end point of each exercise and control condition. To determine the success of implementation, the feasibility indicator for the data completeness across the comprehensive outcome battery was set at 80%. Results Half (49%) of eligible participants in the timeframe, were recruited and commenced the study. Six participants withdrew prior to completion and a total of 15 participants completed the study. Eight participants were randomised to the exercise-control and seven to the control exercise group. Five participants trained remotely and seven did supervised training. Three participants completed a mix of both supervised and remote training initiated due to COVID restrictions. Outcome measures were completed on 97% of protocolised occasions and 100% of participants completed the exercise training. Conclusions Conducting a long duration exercise training study on burn injured individuals is feasible using the described methods. The knowledge gained helps improve the methodology in larger-scale projects. Insights into the impact of COVID-19 on this clinical trial and success enhancing adaptations for the researcher, research practice and the participant, are presented.

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Section: Outcome Measurementmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Does exercise influence burn-induced inflammation: A cross-over randomised controlled feasibility trial

et al. 2022

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“…Therefore, it is beneficial to include resistance and strength training into an exercise rehabilitation program in burn individuals. Several studies in children [ 13 , 40 – 44 , 46 , 63 ], as well as in adults [ 112 – 114 ] with severe burns have shown the benefits of resistance training on muscle strength and LBM. However, it is important to teach the proper technique before starting a program, to prevent injuries.…”

Section: Exercise Rehabilitation Training Prescriptionmentioning

confidence: 99%

Rehabilitative Exercise Training for Burn Injury

et al. 2021

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Due to improvements in acute burn care over the last few decades, most patients with severe burns (up to 90% of the total body surface) survive. However, the metabolic and cardiovascular complications that accompany a severe burn can persist for up to three years post injury. Accordingly, there is now a greater appreciation of the need for strategies that can hasten recovery and reduce long-term morbidity post burn. Rehabilitation exercise training (RET) is a proven effective treatment to restore lean body mass, glucose and protein metabolism, cardiorespiratory fitness, and muscle strength in burn survivors. Despite this, very few hospitals incorporate RET in programs to aid the rehabilitation of patients with severe burns. Given that RET is a safe and efficacious treatment that restores function and reduces post burn morbidity, we propose that a long-term exercise prescription plan should be considered for all patients with severe burns. In this literature review, we discuss the current understanding of burn trauma on major organ systems, and the positive benefits of incorporating RET as a part of the long-term rehabilitation of severely burned individuals. We also provide burn-specific exercise prescription guidelines for clinical exercise physiologists.

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“…In particular, resistance and aerobic forms of exercise, as anabolic, anti-hyperglycemic and anti-inflammatory stimuli, are used effectively in many other health and disease states, including critical illness, to counteract muscle wasting and associated outcomes [ 29–32 ]. In the burn population, preliminary evidence of exercise-induced improvements in inflammation, glycemic control and markers of muscle metabolism have been reported [ 33–37 ]. Readers are referred to a recent review by Dombrecht et al .…”

Section: Introductionmentioning

confidence: 99%

“…As part of the current practice of burn care, however, resistance and aerobic exercise are rehabilitation components that are often reserved for a time when they are perceived as safer and more comfortable for burn patients, and when there is less interference from open wounds, pain and grafting surgery [ 21 ]. Recent evidence supporting the inclusion of resistance and/or aerobic exercise during the acute phase in adult burn patients is based on studies with predominantly non-severe burn injuries [ 33 , 38 ]. However, it is the severe burn population with the highest risk of muscle wasting in whom exercise training during the acute phase of burns could be most beneficial, yet, also in whom its efficacy in adult patients has not been studied as a counteracting strategy.…”

Section: Introductionmentioning

confidence: 99%

Effects of early exercise training following severe burn injury: a randomized controlled trial

Schieffelers,

Ru,

Dai

et al. 2024

Burns &Amp; Trauma

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Background Despite being a stable component of burn rehabilitation at later stages of recovery, exercise training is not commonly provided during the acute phase of burns. A lack of evidence surrounding its efficacy and safety in severely burned adults has hampered its implementation in acute burn care. The aim of this study was to investigate the capacity of early exercise training to modulate parameters of postburn muscle wasting and quality of life. Methods Adults <65 years of age with burns ≥40% total burn surface area (TBSA) were randomly allocated to either receive early exercise (n = 29) in addition to standard care or standard care alone (n = 29). Early exercise involved resistance and aerobic training, which commenced as early as possible and lasted for a duration of 6 to 12 weeks, in line with burn center length of stay. Ultrasound-derived quadriceps muscle layer thickness (QMLT) and rectus femoris cross-sectional area (RF-CSA), lower limb muscle force, Eurocol Quality of Life-5 Dimensions and Burn Specific Health Scale Brief (BSHS-B) were assessed 6 and 12 weeks after baseline. Mixed models were fitted to compare between-group changes over time. Results A total of 58 adults [42 (95% confidence interval 40–45) years old; 40–94% TBSA range, 86% previously mechanically ventilated] participated in this study. Exercise commenced 7 days [IQR (interquartile range) 5–9] after burn center admission with an attendance rate of 93%. Allocation to the exercise group had a protective effect on the loss of muscle size from baseline to 6 weeks of follow-up (QMLT: β-coefficient: 0.05 cm, p = 0.010; RF-CSA: β-coefficient: 0.05 cm2, p = 0.045), and resulted in an improved recovery from 6 to 12 weeks (QMLT: β-coefficient: 0.04 cm, p = 0.01; RF-CSA: β-coefficient: 0.06 cm2, p < 0.001). Muscle force increased significantly more in the exercise group than in the control group (β-coefficient: 3.102 N, p < 0.001) between 6 and 12 weeks. Besides a marginally significant effect for the BSHS-B domains ‘affect’ and ‘interpersonal relationships’ between 6 and 12 weeks, no benefits were observed in the other assessed quality-of-life measures. No serious adverse events were reported in the exercise group. Conclusions The results of this study support the use of early exercise training as a feasible and efficacious therapeutic strategy to manage burn-related changes in muscle size and strength in adults with acute severe burn injury.

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The efficacy of resistance training in addition to usual care for adults with acute burn injury: A randomised controlled trial

Cited by 11 publications

References 71 publications

Does exercise influence burn-induced inflammation: A cross-over randomised controlled feasibility trial

Does exercise influence burn-induced inflammation: A cross-over randomised controlled feasibility trial

Rehabilitative Exercise Training for Burn Injury

Effects of early exercise training following severe burn injury: a randomized controlled trial

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