title: Effects of community-based exercise in children with severe burns: A randomized trial.
abstract: OBJECTIVE
  To counteract long-lasting muscle break down, muscle weakness, and poor physical fitness resulting from severe burns, we recommend a 12-week in-hospital exercise training rehabilitation program. Unfortunately, this in-hospital training program requires time away from home, family, school or work. This study was undertaken to evaluate an alternative exercise rehabilitation strategy involving a 12-week community-based exercise training rehabilitation program (COMBEX) carried out at or near the patient and caretaker's home.
  
  
  METHODS
  Pediatric patients (7-18 years) with ≥ 30% of total body surface area (TBSA) burns were randomized to participate in COMBEX (N=12) or an outpatient exercise program (EX) at the hospital (N=22). Both programs were started after hospital discharge and consisted of 12 weeks of progressive resistive and aerobic exercise. COMBEX was performed in community fitness centers near the patients' home. Endpoints were assessed at discharge (pre-exercise) and after the 12-week program. Primary endpoints were lean body mass (dual energy X-ray absorptiometry), muscle strength (isokinetic dynamometry), and peak aerobic capacity (indirect calorimetry).
  
  
  RESULTS
  Demographics, length of hospitalization, and TBSA burned were comparable between groups (P>0.05). Both groups exhibited a significant (P ≤ 0.01 for all) increase (mean ± SEM) in lean muscle mass (EX: 6.9 ± 1.7%; COMBEX: 6.5 ± 1.1%), muscle strength (EX: 67.1 ± 7.0%; COMBEX: 49.9 ± 6.8%), and peak aerobic capacity (EX: 35.5 ± 4.0%; COMBEX: 46.9 ± 7.7%). Furthermore, the magnitude of these increases were not different between groups (P>0.12).
  
  
  CONCLUSIONS
  Both EX and COMBEX are efficacious in improving lean mass, strength, and cardiopulmonary capacity in severely burned children.
authors.affiliation: Department of Surgery, University of Texas Medical Branch, Galveston, TX, United States; Shriners Hospitals for Children, Galveston, TX, United States.
authors.forename: Raquel
authors.initials: R
authors.lastname: Peña
authors.affiliation: Department of Developmental Nutrition, Physical Activity and Energy Metabolism, University of Arkansas for The Medical Science, Little Rock, AR, United States; Arkansas Children Hospital Research Institute, Little Rock, AR, United States.
authors.forename: Leybi L
authors.initials: LL
authors.lastname: Ramirez
authors.affiliation: Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and University of Texas Southwestern Medical Center, Dallas, TX, United States.
authors.forename: Craig G
authors.initials: CG
authors.lastname: Crandall
authors.affiliation: Division of Burns, Trauma, and Critical Care, Department of Surgery University of Texas Southwestern, Dallas, TX, United States.
authors.forename: Steven E
authors.initials: SE
authors.lastname: Wolf
authors.affiliation: Department of Surgery, University of Texas Medical Branch, Galveston, TX, United States; Shriners Hospitals for Children, Galveston, TX, United States.
authors.forename: David N
authors.initials: DN
authors.lastname: Herndon
authors.affiliation: Department of Surgery, University of Texas Medical Branch, Galveston, TX, United States; Shriners Hospitals for Children, Galveston, TX, United States. Electronic address: oesuman@utmb.edu.
authors.forename: Oscar E
authors.initials: OE
authors.lastname: Suman
mesh_terms: D000293:Adolescent; D001830:Body Surface Area; D002056:Burns / Q000503:physiopathology / Q000534:rehabilitation*; D002648:Child; D003153:Community Health Services / Q000379:methods*; D005081:Exercise Therapy / Q000379:methods*; D017079:Exercise Tolerance / Q000502:physiology; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D053580:Muscle Strength / Q000502:physiology; D010101:Oxygen Consumption / Q000502:physiology; D010809:Physical Fitness / Q000502:physiology; D015599:Trauma Severity Indices; D016896:Treatment Outcome
keywords: Community-based exercise program; Exercise program; Lean body mass; Muscle strength; Peak aerobic capacity; Rehabilitation; Standard of care