Early rehabilitative exercise training in the recovery from pediatric burn.
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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 (VO2peak) 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 Nmkg, vs SOC, 106 9 Nmkg) and VO2peak (RET, 32 1 mLkgmin, vs SOC, 28 1 mLkgmin) 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.
