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

Paratz, Jennifer D. PhD; Stockton, Kellie BPhty; Plaza, Anita BPhty (Hons); Muller, Michael MMedSc; Boots, Robert J. PhD

Journal of Trauma and Acute Care Surgery: July 2012 - Volume 73 - Issue 1 - p 186–194
doi: 10.1097/TA.0b013e31824baa52
Original Articles

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 × 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.

LEVEL OF EVIDENCE Therapeutic study, level III.

From the Burns, Trauma and Critical Care Research Centre (J.D.P., K.S., A.P., M.M., and R.J.B.), University of Queensland, Brisbane, Australia; Department of Physiotherapy (A.P.), Royal Brisbane and Women’s Hospital, Queensland, Australia; The Professor Stuart Pegg Burns Unit (A.P. and M.M.), Royal Brisbane and Women’s Hospital, Queensland, Australia; and Department of Intensive Care Medicine (R.J.B.), Royal Brisbane and Women’s Hospital, Queensland, Australia.

Submitted: September 1, 2011, Revised: January 12, 2012, Accepted: January 17, 2012, Published online: May 30, 2012.

Supported by a Queensland Health Novice researcher grants and the Royal Brisbane and Womens Hospital Foundation.

Presented as a free paper at the 43rd Annual American Burn Association Meeting, April 1, 2011, Chicago, Illinois.

Address for reprints: Jennifer D. Paratz, FACP, PhD, Level 3 NHB, Department of Intensive Care Medicine, Royal Brisbane and Womens’ Hospital, Bowen Bridge Road, Herston, Queensland 4029, Australia; email

© 2012 Lippincott Williams & Wilkins, Inc.