Effects of Cessation of a Structured and Supervised Exercise Conditioning Program on Lean Mass and Muscle Strength in Severely Burned Children

doi:10.1016/j.apmr.2007.09.002

Archives of Physical Medicine and Rehabilitation

Volume 88, Issue 12, Supplement 2, December 2007, Pages S24-S29

https://doi.org/10.1016/j.apmr.2007.09.002 Get rights and content

Abstract

Suman OE, Herndon DN. Effects of cessation of a structured and supervised exercise conditioning program on lean mass and muscle strength in severely burned children.

Objective

To determine whether the benefits of exercise by burned children are maintained 3 months after the exercise program is concluded.

Design

Randomized, controlled prospective study.

Setting

Pediatric burn hospital.

Participants

Twenty severely burned children with a 40% or greater total body surface area burn, with main outcome measures completed before exercise training, immediately after 12 weeks of exercise training (intervention), and 12 weeks after training ended.

Intervention

Randomization into a 12-week standard rehabilitation program at home (n=9) or a 12-week standard hospital rehabilitation program supplemented with an exercise-training program beginning 6 months after burn injury (n=11).

Main Outcome Measures

Assessment of lean body mass (LBM) using dual-energy x-ray absorptiometry and of leg isokinetic muscle strength at a speed of 150°/s were done before, after the 12-week rehabilitation and exercise training program, and 3 months after the exercise program was completed (12mo postburn). The effects of exercise on the dependent variables were analyzed by repeated-measures analysis of variance. If we found a significant overall effect of time and/or intervention, we did a post hoc test for multiple comparison (Holm-Sidak). Results are expressed as mean ± standard error.

Results

The mean percentage increase in LBM and muscle strength was significantly greater in the exercise group (6.4%±1.9%, 40.7%±8.6%, respectively) than in the no-exercise group (1.9%±2.6% vs 3.4%±4.5%, respectively). Three months after cessation of the exercise program, LBM remained relatively unchanged in the no-exercise group (3.5%±1.8%). In contrast, LBM in the exercise group increased significantly (10.7%±4.8%, P=.03). In addition, muscle strength further increased by 17.9%±10.1% in the exercise group versus 7.2%±3.4% in the no-exercise group, although neither percentage increase was significant (P=.08 for exercise vs P=.61 for no exercise). Absolute values in LBM and muscle strength for both groups at 12 months postburn continued to be below historical or concurrent age-matched, nonburned children.

Conclusions

Participation in an exercise program resulted in a greater improvement in LBM and muscle strength in the exercise group than in the no-exercise group. Three months after the exercise training ended, there were persistent mild-to-moderate increases in LBM and muscle strength. Absolute levels continued to be below previously reported nonburned, age-matched values, however, which underscores the need for continued exercise to improve LBM and muscle strength in severely burned children.

Section snippets

Burned Subjects

We randomized severely burned children, ages 7 to 18 years, into either a no-exercise group or an exercise group. We only enrolled patients with 40% or more total body surface area (TBSA) burned, as assessed by the “rule of nines” method,¹⁶ during excision surgery in the acute phase of injury. Patients were excluded if they had 1 or more of the following: leg amputation, anoxic brain injury, psychologic disorders, quadriplegia, or severe behavior or cognitive disorders. The parent or legal

Results

We enrolled 20 burned children (17 boys, 3 girls) in the study and assessed their 1-year complete longitudinal data. Eleven exercise patients and 9 no-exercise patients were tested at 6 and 9 months postburn, and at 3 months after the supervised and structured exercise program ended. The age range for both groups was 7 to 18 years (13.4±1.8y for the no-exercise group vs 11.8±1.5y for the exercise group, P=.30). There were no differences at 6 months postburn between the groups in age, percentage

Discussion

Our results indicate that there was an increase in muscle strength and LBM in the exercise group after 12 weeks of exercise, whereas in the no-exercise group, both muscle strength and LBM remain relatively unchanged. Three months after the cessation of supervised and structured training, LBM increased significantly only in the exercise group. In contrast, further increases in muscle strength in both groups were not significant. When expressed in absolute values, between-group comparisons of

Conclusions

We report here the benefits of a supervised and structured exercise program relative to a home exercise prescription. In addition, there is a continued improvement in these benefits 3 months after the structured and supervised exercise program is stopped. Further studies are needed to determine what type of exercise maintenance program is optimal in maintaining or further improving LBM and muscle strength in burned children. Such studies should also assess how to best improve nutritional habits

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Each of the interventions had a positive effect on height, weight, body composition, or muscle strength. The decision to initiate an intervention should be made on a case-by-case basis following careful consideration of the benefits and risks. In future research, it is important to evaluate the heterogeneity of intervention effects and whether participation in an intervention allowed pediatric burn patients to reach the physical and functional status of healthy peers.
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To describe the pattern of hand functional recovery in the first six months following the discharge of children with burn injury, and to identify the predictors affecting this recovery.
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: Supported by the National Institute for Disabilities and Rehabilitation Research (grant no. H133A70019), the National Institutes of Health (grant nos. P50 GM06338, KO1-HL70451), and Shriners Hospitals for Children (grant nos. 8760, 8480).

: No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated.

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Original articleEffects of Cessation of a Structured and Supervised Exercise Conditioning Program on Lean Mass and Muscle Strength in Severely Burned Children

Abstract

Objective

Design

Setting

Participants

Intervention

Main Outcome Measures

Results

Conclusions

Section snippets

Burned Subjects

Results

Discussion

Conclusions

Crit Care Clin

Surgery

Determinants of skeletal muscle catabolism after severe burn

Ann Surg

Resistance exercise maintains skeletal muscle protein synthesis during bed rest

J Appl Physiol

Prolonged bed rest decreases skeletal muscle and whole body protein synthesis

Am J Physiol

Social competence and behavioral problems of pediatric survivors of burns

J Burn Care Rehabil

The role of bone densitometry in the diagnosis and management of the severely burned patient with bone loss

J Clin Densitometry

Mortality determinants in massive pediatric burnsAn analysis of 103 children with ≥80% TBSA burns (≥70% full-thickness)

Ann Surg

Effects of a 12-wk resistance exercise program on skeletal muscle strength in children with burn injuries

J Appl Physiol

Effect of exogenous growth hormone and exercise on lean mass and muscle function in children with burns

J Appl Physiol

Inclusion of resistance exercise in a multidisciplinary outpatient treatment program for preadolescent obese children

South Med J

Structured exercise circuit program for burn patients

J Burn Care Rehabil

Use of burn intensive care unit gymnasium as an adjunct to therapy

J Burn Care Rehabil

The effects of detraining on power athletes

Med Sci Sports Exerc

Effect of reduced training on muscular strength and endurance in competitive swimmers

Med Sci Sports Exerc

The effects of strength training and detraining on children

J Strength Condition Res

Original article
Effects of Cessation of a Structured and Supervised Exercise Conditioning Program on Lean Mass and Muscle Strength in Severely Burned Children