Resumen de Early Rehabilitative Exercise Training in the Recovery from Pediatric Burn.
Justin P. Hardee, Oscar E. Suman, Craig T. Porter, Labros S. Sidossis, Elisabet Borsheim, David N. Herndon, James A. Carson
AB 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[spacing dot above]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[middle dot]m[middle dot]kg-1, vs SOC, 106 +/- 9 N[middle dot]m[middle dot]kg-1) and V[spacing dot above]O2peak (RET, 32 +/- 1 mL[middle dot]kg-1[middle dot]min-1, vs SOC, 28 +/- 1 mL[middle dot]kg-1[middle dot]min-1) 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.
