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Introduction: Severe burn trauma damages resting and exercise cardiac function that may affect long term cardiovascular health. The implementation of rehabilitation exercise training (RET) soon after hospital discharge improves cardiorespiratory fitness; however, it does not fully restore aerobic capacity and presents large inter-individual variability. We tested the hypothesis that the inter-individual variability of aerobic capacity for responders (R) compared to nonresponders (NR) would differ for exercise frequency and intensity., Methods: Thirty-three children (11 female, [mean±SD] 12 ± 3 years, 145 ± 18 cm, 40 ± 11 kg, 49 ± 31 BMI percentile) with severe burns (49 ± 15 % total body surface area burned, with 35 ± 22 % third-degree burns) completed a 6-week RET program. Cardiorespiratory fitness (peak VO 2 ) was measured before and after RET. Frequency (session days/week), intensity (% peak heart rate), time (min/session), and volume (min/week) were compared between responders and non-responders. Significance was set at p < 0.05., Results: Sixty-four percent of the study population improved peak VO2 after RET whereas 36 % showed no improvements. Using a 2-way factorial ANOVA (group [G] × week [WK]), we found that exercise frequency and session time were similar and increased slightly over 6 weeks between R and NR (main effect for WK; P < 0.002). Exercise volume was significantly lower on week 2 for NR compared to R (G × WK interaction, P < 0.028). Exercise intensity over 6-weeks was significantly lower in the NR compared to the R group (G × WK interaction, P < 0.022)., Conclusions: Exercise intensity and volume may be important contributors for improving the interindividual response to exercise training for peak VO 2 . These data suggest that the appropriate dose-response requirement for exercise intensity may be > 80 % peak heart rate and exercise volume of > 150 min per week. Further understanding of the exercise prescription will provide insights important for cardiovascular rehabilitation in children with severe burns., Subject Code: Inter-individual Variability, Exercise, Pediatrics, Exercise Training., Competing Interests: Declaration of Competing Interest All authors have read and agree to the publication of the manuscript, and that the manuscript has not been submitted elsewhere. The authors have no conflict of interest., (Copyright © 2024 International Society of Burns Injuries. All rights reserved.)

Background: A national database is used to evaluate pediatric burn survivor outcomes, but the generalizability to the United States pediatric burn injury population is unclear, as only 60% of enrollees are U.S. residents. An increased understanding of population similarities and differences between residents of the United States and residents of Mexico treated in the United States within this database will help determine its ability to extrapolate., Objective: Assess the generalizability of a national burn database to the U.S. pediatric burn injury population., Design: This retrospective cohort study analyzed pediatric enrollees in a burn database. Data were stratified into children who were residents of the United States or Mexico at time of injury and grouped by age into <5 years, 5-10 years, and >10 years., Setting: Not applicable., Participants: A total of 2043 children enrolled in the database from 1998 to 2020., Interventions: Not applicable., Main Outcomes Measured: Determination of similarities and differences between gender, injury etiology, total body surface area injured, length of stay, and place of injury between the two groups., Results: Both groups showed an increased incidence of burn injury among males as they aged. In U.S. residents, the most frequent etiology in patients <5 years was scald (292 [53.6%]), followed by fire/flame (157 [28.8%]). In residents of Mexico, fire/flame burns were more frequent in all ages and electric burns were more common among children >5 years. In both groups, outdoor injuries became more common as children aged. Children from Mexico had larger burns and longer lengths of hospital stay than children from the United States across all ages., Conclusion: Differences between U.S. and Mexico groups were likely attributable to children with more severe burns being transferred to the United States for care, whereas those with low-severity burns were treated locally. This suggests that children from Mexico in the database were not representative of the pediatric burn injury population of the United States or Mexico more broadly and caution should be used before generalizations are made using this database., (© 2024 The Author(s). PM&R published by Wiley Periodicals LLC on behalf of American Academy of Physical Medicine and Rehabilitation.)

Introduction: An area of rehabilitation research in burns is the impact of co-morbidities on disease trajectory. Obesity is a comorbidity of increasing public health concern, but its role remains controversial regarding burn injury and physical recovery. Our aim was to evaluate the association between body mass index (BMI) categories as a measure of obesity at discharge and self-reported physical function (PF) during recovery of adult burn survivors., Methods: This is a retrospective study on data collected by four major US burn centers, which contribute to the Burn Model System National Database. The data included BMI obtained at hospital discharge and self-reported PF-mobility, using the PROMIS measures assessed at 6, 12, and 24 months after burn. Subjects were classified into weight status categories based on BMI: underweight (BMI <18.5), normal weight (18.5 ≤ BMI <25), overweight (25 ≤ BMI <30), obesity class 1 (30 ≤ BMI <35), obesity class 2 (35 ≤ BMI <40), and obesity class 3 (BMI ≥40). Mixed-effects linear regression models were used to assess the association between BMI categories and PF scores over time, adjusted for patient and injury characteristics., Results: A total of 496 adult burn patients aged 47 ± 16 years were included, with mean total body surface area (TBSA) burned of 18 ± 19 % and mean BMI at discharge of 28 ± 7 kg/m2. PROMIS PF scores significantly improved over time in the recovery phase after burn (time effect, p < 0.001). Compared to overweight burn patients, normal-underweights exhibited lower PF score by an average of 4.06 units (p = 0.001) but scores increased linearly by an estimated 0.17 units per month (p = 0.01) over the 24 months after discharge. Similarly, compared to overweight burn patients, class 1 obese reported lower PF score by a mean 2.67 units (p = 0.07) but PF increased linearly by 0.15 units per month (p = 0.07) over the 24 months after discharge. These findings were independent of the effects of age at discharge, sex, TBSA burned, and hand and leg burn., Conclusion: Being overweight was associated with improved and faster recovery of PF scores compared to normal, underweight, and obese burn patients during long-term recovery. Hence, our data suggests that long-term recovery and restoration of PF in adult burn survivors is not compromised by a small excess in body weight., Competing Interests: Declaration of Competing Interest The authors report no conflicts of interest other than SEW is the Editor of this journal., (Copyright © 2024 Elsevier Ltd and International Society of Burns Injuries. All rights reserved.)

This article presents information on the benefits of exercise in counteracting the detrimental effects of bed rest, and/or severe burns. Exercise is key for maintaining physical function, lean body mass, metabolic recovery, and psychosocial health after major burn injuries. The details of an exercise training program conducted in severely burned persons are presented, as well as information on the importance of proper regulation of body temperature during exercise or physical activity. The sections on exercise and thermoregulation are followed by a section on the role of exercise in scarring and contractures. Finally, gaps in the current knowledge of exercise, thermoregulation, and contractures are presented., (Copyright © 2023 Elsevier Inc. All rights reserved.)