Intensive exercise after thermal injury improves physical, functional, and psychological outcomes

BACKGROUND: Although exercise programs after burns are considered a standard of care, there is limited evidence for efficacy in adult patients. This study aimed to investigate the effects of an exercise program on physical, functional, and quality of life measures. METHODS: A quasi-experimental controlled trial was instituted after final grafting. Both groups completed stretching, and the intervention group underwent a supervised high-intensity (80% maximal heart rate and 70% three repetition maximum) combined aerobic or resisted exercise program for 6 weeks, with outcome measures at baseline, 6 weeks, and 3 months by a blinded assessor. Analysis was by intention to treat. RESULTS: Thirty patients (24 men) with a mean age of 34.3 years (+/- 13.1 years) and mean total body surface area 42.9% (+/- 13.3%) were enrolled. Inequalities at baseline (age and total body surface area %) were adjusted statistically. A between within repeated measures analysis of variance found significant group x time effects between the groups. Mean change scores from baseline to 12 weeks between control and intervention groups, respectively, were strength (kg): quadriceps (17.5 vs. 66.87), latissimus dorsi (6.07 vs. 27.82), right (4.86 vs. 14.86) and left (7.26 vs. 16.83) hand grip; fitness: peak oxygen consumption (L/min; 0.11 vs. 0.93) and shuttle walk distance (m; 168.93 vs. 459); function: lower extremity function score (8.87 vs. 27.31) and QuickDash (-5.7 vs. -23.98); and health-related quality of life: Burns-Specific Health Scale-Abbreviated (-7.64 vs. 35.13). There were no adverse events during either testing or training. CONCLUSION: A high-intensity cardiovascular or resisted exercise program resulted in significant improvements in functional, physical, and psychologic measures and should be mandatory for all burns patients. Larger multicenter trials with longer follow-up periods are required. (J Trauma Acute Care Surg 2012;73: 186-194. Copyright (C) 2012 by Lippincott Williams & Wilkins) LEVEL OF EVIDENCE: Therapeutic study, level III.