Early rehabilitative exercise training in the recovery from pediatric burn.
OBJECTIVE
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.
1Department 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.
Justin P
JP
Hardee
Craig
C
Porter
Labros S
LS
Sidossis
Elisabet
E
Børsheim
James A
JA
Carson
David N
DN
Herndon
Oscar E
OE
Suman
D015502:Absorptiometry, Photon; D000293:Adolescent; D000553:Ambulatory Care; D001823:Body Composition; D002056:Burns / Q000378:metabolism / Q000503:physiopathology / Q000534:rehabilitation*; D002648:Child; D005080:Exercise Test; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D053580:Muscle Strength / Q000502:physiology; D053581:Muscle Strength Dynamometer; D018482:Muscle, Skeletal / Q000033:anatomy & histology* / Q000502:physiology*; D009929:Organ Size; D010101:Oxygen Consumption; D020127:Recovery of Function; D013997:Time Factors; D019415:Torque