The effects of exercise on energy expenditure and muscle function in severe burned patients.

Severe burned patients undergo rapid increases in metabolism (hypermetabolism) and increased energy expenditure caused by the initial inflammatory and humoral responses. These responses also elicit, on top of the bed rest period, a cascade of negative reactions leading to additional muscle wasting. Muscle wasting itself leads to insulin resistance and may have long-term health consequences. Some of these effects persist from the first few days following severe burn injury to as long as three years later after wound closing. Although insulin resistance is assumed to be triggered by several catabolic factors, an important contributor to insulin resistance is muscle wasting itself. Insulin-resistance, may eventually lead to diabetes mellitus and is a long-term complication of severe burn patients which has major implications for future morbidity and mortality. Physical exercise has been shown to affects both the metabolism as well as skeletal muscle function in oncology, cardiac patients, obstructive lung diseases and diabetic patients. In addition, physical exercise in critically-ill patients has also been shown to have beneficial effects on general health outcome parameters. Therefore, in the present study we will investigate the effects of severe burns [≥ 30 % total body surface area (TBSA)] on energy expenditure, hypermetabolism (especially insulin and glucose homeostasis) and muscle function (strength). Besides the fundamental research questions we will investigate the effect of an 8 week (3 times/week) rehabilitative exercise strength training on energy expenditure, hyper metabolism and muscle function. For the long-term effects we will investigate the Quality of Life (QoL) in patients undergoing such an additional rehabilitative program on top of standard-care. For this purpose we will use both general as well as burn specific questionnaires regarding QoL.

Keywords:INTENSIVE CARE, REHABILITATION, BURNS, METABOLISM (ENERGY)

Disciplines:Endocrinology and metabolic diseases, Orthopaedics, Physiology, Human movement and sports sciences, Rehabilitation sciences