Long-term physical activity and fitness after pediatric burns

Due to the pathophysiology of burns and the long periods of hospital stay, loss
of physical fitness after pediatric burn injury seems inevitable. Recovery of
physical fitness is an important prerequisite for the return to home, school
and age-specific activities. However, whereas achieving adequate levels of
physical activity and fitness is important on the short term, there is also a
growing understanding of the importance of maintaining certain levels of
physical activity and fitness throughout life to prevent disability and
morbidity later on in life. The first results of our longitudinal prospective
cohort study (RTPO 901), examining the course of physical activity and fitness
following pediatric burns during the initial six months after discharge, showed
that half of the children and adolescents with moderate to major burns did not
achieve healthy reference values of exercise capacity within six months. Some
of them did not even show improvement over time (Akkerman et al, submitted).
Furthermore, the majority of participants with burns across or adjacent to a
major joint (12/16) still had scar contractures limiting function six months
after discharge (Oosterwijk et al, submitted). These results emphasize the
importance of paying attention to their long term recovery. For this reason, we
aim to assess physical activity and fitness in all patients that were eligible
at the time of our former study (RTPO 901) five years after discharge.

Investigate the long-term recovery of physical activity and physical fitness
following pediatric burns, and link the results of former participants to their
scores obtained during the initial six months.

Cross-sectional assessment in addition to a former longitudinal prospective
cohort study (RTPO 901)

The risks and inconvenience of participation are kept as low as possible. All
physical fitness assessments are performed once. As an important component of
physical fitness, exercise capacity will be assessed with an exercise test on a
cycle ergometer. In stead of performing the usual exhaustive cardiopulmonary
exercise test, the Steep Ramp Test will be used. An important difference
between the SRT and usual cardiopulmonary exercise test is its duration: the
SRT takes between 2 and 3 min. excluding warm-up and cooling down. The SRT is
very well accepted by children , also if not healthy.
The risks for exercise tests are minimal. Before testing, each participant is
screened by way of an Exercise Pre-participation Screening form. In case of
contra-indications, a physician will be consulted and the participant may be
excluded from the exercise test. During the exercise test, the heart rate will
be supervised. The test will be stopped in case of abnormal values and
patterns. The other fitness assessments (muscular strength, body composition,
and flexibility) are safe and non-intensive. The physical fitness assessments
will take approximately 45 minutes and they will be scheduled in consultation
with the participant, if possible in combination with a routine follow-up
appointment.
Physical activity monitoring with an accelerometer is without risk and the
inconvenience of wearing the accelerometer is low, as it is a very small and
low-weight device, worn as a waistband. Filling out the questionnaires will
take approximately 30 minutes, and can be done during one week at the patients*
and/or parents* convenience.
In summary, risks are negligible and the burden of participation is minimal.

We will only ask the patients who were eligible at the time of our longitudinal
prospective cohort study (RTPO 901, n=53). This cohort allows us to assess
whether differences exist with regard to physical activity and fitness between
those who did participate in our former study and those who did not.
Furthermore, having previous data from our former participants makes it
possible to link these long term follow-up results to their scores during the
initial six months after discharge, and further examine the predictive value of
early physical assessment.

The group benefit mainly is improvement in the domain of individualized
rehabilitation and with that better physical functional outcomes for paediatric
burn patients in the (near) future. Children and their parents can benefit
individually by gaining insight in their current level of physical fitness and
being informed about the importance of a healthy active lifestyle, especially
following pediatric burns.