Exercise in Burn Survivors

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Abstract Within the United States, 500,000+ individuals are enduring the long-term consequences of severe burn injuries covering 20% or more of their body surface area, with upwards to 11,000 individuals experiencing such an injury per year. These burn injuries can severely compromise body temperature regulation, owing to permanent impairments in the primary thermoeffectors necessary to dissipate heat, namely profoundly blunted skin blood flow and sweating responses in the injured skin. We propose that this heat intolerance deters burn survivors from participating in physical activity, including activities of daily living, necessary to avoid the adverse cardiovascular and metabolic sequela of a sedentary lifestyle. Consistent with hypothesis, years after the injury burn survivors have a very low aerobic capacity; greater all-cause mortality rates; greater hospitalization days for circulatory diseases; and suffer from greater incidences of ischemic heart disease, heart failure, diabetes, and cerebrovascular disease (including stroke) relative to matched non-burned cohorts. The primary goal of this project is to identify modalities to attenuate excessive elevations in skin and core body temperatures during physical activity in well-healed burn survivors. The implementation of such modalities will eliminate heat intolerance as a barrier to participation in activities that are necessary to improve/maintain cardiovascular health in this vulnerable population. Two specific aims will be addressed: Aim 1 will investigate whether increased skin wetness, with and without accompanying fan use, will restore otherwise impaired evaporative cooling of well- healed burn survivors, with the extent of that improvement predicated on the environmental conditions and the percentage of body surface area burned. Aim 2 will develop and validate a personalized prediction model which informs the burn survivor of the safety (or lack thereof) to participate in physical activity based upon her/his unique physiological characteristics and the prevailing environmental conditions. This model will be ported into a smartphone application that will be freely distributed to the burn survivor community, their families, and their caregivers. The expected outcomes of this work will culminate in new modalities/technologies directed towards promoting physical activity in burn survivors by eliminating heat intolerance as a deterrent to performing such activities. Specifically, the obtained knowledge and the associated smartphone application will help burn survivors realize important benefits of being physically active, including reduced cardiovascular risk and associated reductions in morbidity and mortality, improved quality of life, a greater ability to work and perform functions of daily living, and enhanced independence as they age.