Effect of vitamin D supplementation and isokinetic training on muscle strength, explosive strength, lean body mass and gait in severely burned children: A randomized controlled trial.
OBJECTIVE
To determine the effects of vitamin D (VD) supplementation and isokinetic training on muscle strength, explosive strength (counter movement jump) (ES), lean body mass (LBM) and gait parameters in severe pediatric burn.


METHODS
Forty-eight burned children with circumferential lower extremity burns covering 40-55% of the total body surface area (TBSA), aged 10-16 years (Mean±SD 13.01±1.75), were randomized into the standard of care (n=16), isokinetic (n=17) and VD (n=15) groups. Unburned children (n=20) served as matched controls. All burned children received 12 weeks of routine physical therapy program (RPTP). In addition, the isokinetic group received isokinetic training for the quadriceps dominant limb 3 times per week at angular velocity 150°/s, and the VD group received the isokinetic training plus an oral daily dose of vitamin D31000 IU (Cholecalciferol). The primary measures, assessed at baseline and 12 weeks, included quadriceps strength by isokinetic dynamometer, ES, LBM by dual-energy X-ray absorptiometry (DEXA) and gait parameters by GAITRite system.


RESULTS
The VD and isokinetic groups showed significant improvement in quadriceps strength, ES, LBM and gait parameters compared with the standard of care, and VD group show significant improvement in the VD level as compared with the other groups. The outcome measures (and percent of improvement where applicable) for the VD, isokinetic and standard of care are as follows: quadriceps strength, 85.25±0.93Nm (85%), 64.25±0.93 (36%) and 51.88±1.31Nm (12%); stride length, 94.00±2.69 (7%), 110.60±2.87 (25%) and 139.56±2.57 (60%); step length, 67.26±2.45 (72%), 55.25±2.49 (43%) and 43.76±1.34 (18%); velocity, 133.94±1.65 (82%), 99.94±1.65 (35%) and 80.11±1.91 (9%); and cadence, 140.63±1.36 (68%), 132.63±1.36 (58%) and 90.35±1.32 (9%), VD level 43.33±7.48 (75%), 24.77±7.38 (5%) and 25.63±8.39 (4%) respectively.


CONCLUSIONS
VD supplementation combined with exercise training significantly increased muscle strength, ES, LBM, gait and VD level in severely burned children.
Department of Surgery, Faculty of Physical Therapy, Cairo University, Giza, Egypt. Electronic address: anwarandsafa@yahoo.com.
Anwar Abdelgayed
AA
Ebid
Department of Growth and Developmental Disorders in Children and its Surgery, Faculty of Physical Therapy, Cairo University, Giza, Egypt.
Shamekh Mohamed
SM
El-Shamy
University of Alexandria, Alexandria, Egypt; Umm Al-Qura Medical Center, Umm Al-Qura University, Saudi Arabia.
Maysa Abbas
MA
Amer
D000293:Adolescent; D000704:Analysis of Variance; D001835:Body Weight / Q000502:physiology*; D002056:Burns / Q000188:drug therapy / Q000534:rehabilitation*; D016022:Case-Control Studies; D002648:Child; D002762:Cholecalciferol; D019587:Dietary Supplements; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D005684:Gait / Q000502:physiology*; D006801:Humans; D035002:Lower Extremity / Q000502:physiology; D008297:Male; D053580:Muscle Strength / Q000502:physiology*; D018482:Muscle, Skeletal / Q000502:physiology; D014807:Vitamin D / Q000627:therapeutic use*; D014815:Vitamins / Q000627:therapeutic use*
D014815:Vitamins; D014807:Vitamin D; D002762:Cholecalciferol
Gait; Isokinetic; Pediatric burn; Rehabilitation; Vitamin D