Exercise in Burn Survivors

摘要 在美国，超过50万人正在忍受严重烧伤的长期后果。 覆盖20%或更多的体表面积，多达11，000人经历过这种伤害 每一年。这些烧伤会严重损害体温调节，由于永久性的 散热所需的主要热效应器受损，即皮肤血液严重钝化 受伤皮肤的流动和出汗反应。我们认为这种热耐受性阻止了烧伤幸存者 参与身体活动，包括日常生活活动，以避免不良反应。 久坐不动的生活方式导致的心血管和代谢后遗症。与假设一致，受伤多年后 烧伤幸存者的有氧能力非常低;全因死亡率更高;住院天数更长 循环系统疾病;缺血性心脏病，心力衰竭，糖尿病， 和脑血管疾病（包括中风）。的首要目标 该项目是为了确定减少皮肤和核心体温过度升高的方式， 身体活动在良好愈合的烧伤幸存者。这种方式的实施将消除热量 不耐受是参与改善/维持心血管健康所必需的活动的障碍 在这个弱势群体中。将解决两个具体目标：目标1将研究皮肤是否增加 潮湿，有和没有伴随风扇的使用，将恢复否则受损的蒸发冷却良好， 治愈烧伤幸存者，改善程度取决于环境条件和 烧伤的体表面积百分比。Aim 2将开发和验证个性化预测模型， 根据她/他的情况，告知烧伤幸存者参加体力活动的安全性（或缺乏安全性） 独特的生理特征和当时的环境条件。该模型将被移植到 一个智能手机应用程序，将免费分发给烧伤幸存者社区，他们的家人， 照顾者这项工作的预期成果将最终产生新的模式/技术， 通过消除热不耐受来促进烧伤幸存者的身体活动， 活动具体来说，获得的知识和相关的智能手机应用程序将有助于燃烧 幸存者意识到身体活动的重要益处，包括降低心血管风险， 相关的发病率和死亡率降低，生活质量提高，工作和执行能力增强 日常生活功能，并随着年龄的增长而增强独立性。

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.