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Early rehabilitative exercise training in the recovery from pediatric burn
Justin P Hardee1, Craig Porter, Labros S Sidossis
11Department of Exercise Science, University of South Carolina, Columbia, SC; 2Metabolism Unit, Shriners Hospitals for Children, Galveston, TX; 3Department of Surgery, University of Texas Medical Branch, Galveston, TX; 4Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX; and 5Shriners Hospitals for Children, Galveston, TX.
Insights
Early outpatient exercise training significantly improves muscle mass and function in severely burned children. This rehabilitative exercise training (RET) enhances lean body mass and peak aerobic fitness compared to standard care.
Area of Science:
- Pediatric Rehabilitation
- Burn Injury Recovery
- Muscle Physiology
Background:
- Severe burns lead to significant muscle mass loss and functional deficits.
- Early intervention post-discharge is crucial for optimizing recovery outcomes in pediatric burn patients.
Purpose of the Study:
- To evaluate the impact of early outpatient rehabilitative exercise training (RET) versus standard of care (SOC) on muscle mass, function, and fractional synthetic rate in severely burned children.
- To determine if RET can mitigate long-term muscle loss and functional impairment following severe burns.
Main Methods:
- Forty-seven children with severe burns (≥40% TBSA) were randomized to 12 weeks of SOC or RET post-hospital discharge.
- Lean body mass (LBM) was assessed using DXA; muscle function via Biodex dynamometry; and peak aerobic capacity (V˙O2peak) via treadmill testing.
- Mixed-muscle fractional synthetic rate was measured using stable isotope infusion in a subset of patients.
Main Results:
- RET significantly improved relative peak torque and V˙O2peak compared to SOC.
- RET led to greater increases in whole-body and leg LBM from discharge to 12 months post-burn.
- While muscle fractional synthetic rate decreased in both groups, no significant differences were found between RET and SOC.
Conclusions:
- Early outpatient rehabilitative exercise training is an effective strategy to enhance muscle mass and improve physical function in children recovering from severe burns.
- RET initiated at hospital discharge offers significant benefits for long-term recovery of muscle mass and function.
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 a 12-wk standard of care rehabilitation (SOC, n = 23) or rehabilitative exercise training (RET, n = 24) immediately after hospital discharge. Dual-energy x-ray absorptiometry was used to assess lean body mass (LBM) at discharge, posttreatment, and 12 months post-burn. Muscle function was evaluated with a Biodex Isokinetic Dynamometer, and peak aerobic fitness (V˙O2peak) was measured using a modified Bruce treadmill protocol posttreatment. Stable isotope infusion studies were performed in a subset of patients (SOC, n = 13; RET, n = 11) at discharge and posttreatment to determine mixed-muscle fractional synthetic rate.
Results:
Relative peak torque (RET, 138 ± 9 N·m·kg, vs SOC, 106 ± 9 N·m·kg) and V˙O2peak (RET, 32 ± 1 mL·kg·min, vs SOC, 28 ± 1 mL·kg·min) were greater at posttreatment with RET compared with those with SOC. In addition, RET increased whole-body (9% ± 2%) and leg (17% ± 3%) LBM compared with 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 posttreatment in both groups (6.9% ± 1.1% per day vs 3.4 ± 0.4% per day); 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 after severe burn injury.
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