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：

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严重烧伤后早期运动训练的效果：随机对照试验


背景 尽管运动训练是烧伤康复后期康复的一个稳定组成部分，但在烧伤急性期通常不提供运动训练。由于缺乏关于其对严重烧伤成人的有效性和安全性的证据，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 将烧伤总面积 (TBSA) ≥40% 的 <65 岁成人随机分配到接受早期锻炼 (n = 29) 和标准护理或仅接受标准护理 (n = 29)。早期锻炼包括抗阻和有氧训练，尽早开始并持续 6 至 12 周，与烧伤中心住院时间一致。评估了超声衍生的股四头肌肌层厚度 (QMLT) 和股直肌横截面积 (RF-CSA)、下肢肌力、Eurocol 生活质量 5 维度和烧伤特定健康量表简介 (BSHS-B) 6 和基线后 12 周。拟合混合模型来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% 之前接受过机械通气]参与了这项研究。进入烧伤中心后 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 周随访期间的肌肉尺寸损失具有保护作用（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 周的恢复得到改善（QMLT：β 系数：0.04 cm，p = 0.01；RF-CSA：β 系数：0。06 cm2，p < 0.001)。 6 至 12 周期间，运动组的肌力比对照组显着增加（β 系数：3.102 N，p < 0.001）。除了在 6 至 12 周期间对 BSHS-B 领域“影响”和“人际关系”产生轻微显着影响外，在其他评估的生活质量指标中没有观察到任何益处。运动组没有报告严重不良事件。结论 这项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来控制成人急性严重烧伤烧伤相关的肌肉大小和力量的变化。