Exercise training for improving outcomes post burns: a systematic review and meta-analysis

Mr Orlando Flores1, Dr. Zephanie Tyack2, Dr. Kellie  Stockton3, Dr. Robert Ware4, Dr. Jennifer Paratz1,5

1Burns, Trauma & Critical Care Research Centre. The University of Queensland, Brisbane, Australia, 2Centre for Children’s Burns and Trauma Research, Child Health Research Centre. The University of Queensland, Brisbane, Australia, 3Physiotherapy Department, Children’s Health Queensland, Brisbane, Australia, 4Menzies Health Institute Queensland, Griffith University, Brisbane, Australia, 5Rehabilitation Science, Griffith University, Brisbane, Australia


Introduction: A systematic review and meta-analysis was performed to determine the effectiveness of different modalities of exercise and to evaluate the safety of exercise-based interventions post-burns.

Methods: Six databases were searched from inception to December 2016. Relevant authors, key journals and reference lists of included studies were hand searched. Articles reporting on exercise interventions in patients post-burn, and considering physical, physiological or psychological outcomes were considered. Two authors independently screened 2,253 records with 19 articles meeting inclusion criteria. The quality of the evidence was assessed at the study level and at the outcome level.

Results: There were no significant differences post exercise training in VO2 peak (g=0.99; 95% CI -0.4 to 2.4: p=0.18), resting energy expenditure (g=-0.51; 95% CI -1.99 to 0.97: p=0.5) and muscle strength (g=0.51; 95% CI -0.03 to 1.05: p=0.07) between the groups. Evidence suggested exercise had a beneficial effect on body composition (g=0.59; 95% CI 0.05 to 1.14: p=0.03), need for surgical release of contractures (Risk Ratio=0.34; 95% CI 0.2 to 0.7; p=0.004) and health-related quality of life. However, a lack of evidence existed regarding the safety of exercise training post-burns. Unbiased effect size estimators (pooled Hedges’s g) with 95% confidence intervals were calculated if there were two or more trials with homogenous outcomes.

Conclusions: Limited evidence suggests that exercise has a beneficial effect on physical and physiological outcomes in patients post-burn. Further trials using high quality methodology are required, with focus on reporting of adverse events, health-related quality of life and psychological outcomes.


Orlando Flores is a PhD candidate in the last stage of his doctoral research project.
His thesis aimed to understand the role of different interventions in the management of metabolic changes occurring post burn injuries.