Background Despite being a stable component of burn rehabilitation at later stages of recovery, exercise training is not commonly provided during the acute phase of burns. A lack of evidence surrounding its efficacy and safety in severely burned adults has hampered its implementation in acute burn care. The aim of this study was to investigate the capacity of early exercise training to modulate parameters of postburn muscle wasting and quality of life. Methods Adults <65 years of age with burns ≥40% total burn surface area (TBSA) were randomly allocated to either receive early exercise (n = 29) in addition to standard care or standard care alone (n = 29). Early exercise involved resistance and aerobic training, which commenced as early as possible and lasted for a duration of 6 to 12 weeks, in line with burn center length of stay. Ultrasound-derived quadriceps muscle layer thickness (QMLT) and rectus femoris cross-sectional area (RF-CSA), lower limb muscle force, Eurocol Quality of Life-5 Dimensions and Burn Specific Health Scale Brief (BSHS-B) were assessed 6 and 12 weeks after baseline. Mixed models were fitted to compare between-group changes over time. Results A total of 58 adults [42 (95% confidence interval 40–45) years old; 40–94% TBSA range, 86% previously mechanically ventilated] participated in this study. Exercise commenced 7 days [IQR (interquartile range) 5–9] after burn center admission with an attendance rate of 93%. Allocation to the exercise group had a protective effect on the loss of muscle size from baseline to 6 weeks of follow-up (QMLT: β-coefficient: 0.05 cm, p = 0.010; RF-CSA: β-coefficient: 0.05 cm2, p = 0.045), and resulted in an improved recovery from 6 to 12 weeks (QMLT: β-coefficient: 0.04 cm, p = 0.01; RF-CSA: β-coefficient: 0.06 cm2, p < 0.001). Muscle force increased significantly more in the exercise group than in the control group (β-coefficient: 3.102 N, p < 0.001) between 6 and 12 weeks. Besides a marginally significant effect for the BSHS-B domains ‘affect’ and ‘interpersonal relationships’ between 6 and 12 weeks, no benefits were observed in the other assessed quality-of-life measures. No serious adverse events were reported in the exercise group. Conclusions The results of this study support the use of early exercise training as a feasible and efficacious therapeutic strategy to manage burn-related changes in muscle size and strength in adults with acute severe burn injury.

中文翻译：

---

严重烧伤后早期运动训练的影响：一项随机对照试验


背景 尽管运动训练是恢复后期烧伤康复的稳定组成部分，但在烧伤的急性期通常不提供运动训练。缺乏关于其在严重烧伤成人中的有效性和安全性的证据，这阻碍了其在急性烧伤护理中的实施。本研究的目的是调查早期运动训练调节烧伤后肌肉萎缩参数和生活质量的能力。方法 烧伤 <65 岁 ≥40% 总烧伤表面积 （TBSA） 的成年人被随机分配接受早期锻炼 （n = 29） 和标准护理或单独标准护理 （n = 29）。早期运动包括阻力和有氧训练，尽早开始并持续 6 至 12 周，与烧伤中心的住院时间一致。在基线后 6 周和 12 周评估超声衍生的股四头肌层厚度 （QMLT） 和股直肌横截面积 （RF-CSA） 、下肢肌肉力量、Eurocol 生活质量 5 维度和烧伤特定健康量表简报 （BSHS-B）。拟合混合模型以比较组间随时间的变化。结果 共有 58 名成年人 [42 （95% 置信区间 40-45） 岁;40-94% TBSA 范围，86% 以前机械通气] 参与了这项研究。烧伤中心入院后 7 天 [IQR（四分位距）5-9] 开始锻炼，出勤率为 93%。分配到运动组对从基线到 6 周随访的肌肉大小的损失有保护作用 （QMLT： β 系数： 0.05 cm，p = 0.010;RF-CSA：β系数：0.05 cm2，p = 0.045），并导致 6 至 12 周的恢复率提高（QMLT：β系数：0.04 cm，p = 0.01;RF-CSA： β系数： 0.06 cm2，p < 0.001）。在 6 至 12 周之间，运动组的肌肉力量增加明显多于对照组 （β 系数： 3.102 N，p < 0.001）。除了在 6 至 12 周之间对 BSHS-B 领域的“影响”和“人际关系”影响略有显著影响外，在其他评估的生活质量测量中没有观察到任何益处。运动组未报告严重不良事件。结论 本研究的结果支持使用早期运动训练作为一种可行且有效的治疗策略，以管理急性严重烧伤成人肌肉大小和力量的烧伤相关变化。