Huang Da, Wan XiaoXiang, Xu Juan
School of Physical Education, Jiangxi University of Technology, Nanchang, China.
PLoS One. 2025 Aug 18;20(8):e0330301. doi: 10.1371/journal.pone.0330301. eCollection 2025.
Cardiopulmonary dysfunction in burn patients is typically caused by both the burn injury and smoke inhalation. Normally presenting with symptoms such as dyspnea, decreased exercise tolerance, decreased maximal heart rate, and decreased arterial oxygen saturation. It has been demonstrated that physical activity helps to increase cardiorespiratory fitness. The goal of this study was to determine whether physical activity can provide additional benefits to the recovery of cardiorespiratory fitness in burn patients by examining research on the topic of physical activity's ability to enhance cardiorespiratory fitness in burn patients.
The electronic databases Web of Science, PubMed, Embase, and Cochrane Library were searched from their inception until August 30, 2024. To contrast the efficacy of conventional rehabilitation with the benefits of physical exercise in conjunction with it. Revman 5.4 software was employed to conduct a meta-analysis, with peak oxygen consumption serving as the primary outcome indicator and the 6-minute walking test (6MWT), forced vital capacity (FVC)%, forced expiratory volume in the first second (FEV1)%, max heart rate (HRmax), and resting heart rate (RHR) serving as secondary outcome indicators. The literature's risk of bias was evaluated using the Cochrane Collaboration tool.
A total of 13 studies were incorporated into the meta-analysis, which involved 530 patients. The study results demonstrated that physical exercise combined with conventional rehabilitation significantly improved VO2Peak (MD = 4.91, 95% CI: 3.52-6.29, P < 0.001), 6MWT (MD = 37.11, 95% CI: 11.72-62.51, P = 0.004), FVC% (MD = 6.54, 95% CI: 4.9-8.17, P < 0.001), and FEV1% (MD = 8.27, 95% CI: 7.39-9.14, P < 0.001) in burn patients compared to conventional rehabilitation. Furthermore, there was no significant difference in the change in resting heart rate (RHR) (MD = 2.04, 95% CI: -2.71-6.78; P = 0.40) between the physical activity group and the control group, but there was a significant difference in the change in maximum heart rate (HR-max) (MD = 6.27, 95% CI: 1.75-10.97, P = 0.007). The results of the subgroup analysis of VO2peak indicate that resistance training combined with aerobic exercise (MD = 5.47, 95% CI: 4.81-6.13, P < 0.001) is more effective than aerobic exercise alone. In terms of single exercise duration, exercise lasting longer than 60 minutes (MD = 6.32, 95% CI: 4.49-6.16, P < 0.001) is more effective than exercise lasting less than 60 minutes. The improvement effects in adult burn patients (MD = 6.09, 95% CI: 3.7-8.48, P < 0.001) were superior to those in pediatric burn patients. The improvement effects in severe burn patients (MD = 5.66, 95% CI: 4.2-7.12, P < 0.001) were superior to those in moderate burn patients.
Our study results indicate that physical exercise, when combined with conventional rehabilitation, is more effective than conventional rehabilitation alone in improving cardiorespiratory fitness in burn patients. This is demonstrated by improvements in aerobic capacity, exercise performance, and respiratory function. The most effective approach may involve combining prolonged resistance with aerobic exercise. The certainty of the evidence assessed according to the GRADE guidelines was moderate and very low, with key factors such as publication bias, imprecision, and inconsistency leading to its downgrading.
烧伤患者的心肺功能障碍通常由烧伤和吸入烟雾共同引起。通常表现为呼吸困难、运动耐力下降、最大心率降低和动脉血氧饱和度降低等症状。已有研究表明，体育活动有助于提高心肺适能。本研究的目的是通过审查关于体育活动增强烧伤患者心肺适能这一主题的研究，来确定体育活动是否能为烧伤患者心肺适能的恢复带来额外益处。
检索电子数据库Web of Science、PubMed、Embase和Cochrane图书馆，检索时间从其创建至2024年8月30日。为了对比传统康复与体育锻炼相结合的益处。采用Revman 5.4软件进行荟萃分析，以峰值耗氧量作为主要结局指标，6分钟步行试验（6MWT）、用力肺活量（FVC）%、第1秒用力呼气量（FEV1）%、最大心率（HRmax）和静息心率（RHR）作为次要结局指标。使用Cochrane协作工具评估文献的偏倚风险。
共有13项研究纳入荟萃分析，涉及530例患者。研究结果表明，与传统康复相比，体育锻炼与传统康复相结合显著改善了烧伤患者的峰值摄氧量（MD = 4.91，95%CI：3.52 - 6.29，P < 0.001）、6MWT（MD = 37.11，95%CI：11.72 - 62.51，P = 0.004）、FVC%（MD = 6.54，95%CI：4.9 - 8.17，P < 0.001）和FEV1%（MD = 8.27，95%CI：7.39 - 9.14，P < 0.001）。此外，体育活动组与对照组在静息心率（RHR）变化方面无显著差异（MD = 2.04，95%CI： - 2.71 - 6.78；P = 0.40），但在最大心率（HR - max）变化方面存在显著差异（MD = 6.27，95%CI：1.75 - 10.97，P = 0.007）。峰值摄氧量亚组分析结果表明，抗阻训练与有氧运动相结合（MD = 5.47，95%CI：4.81 - 6.13，P < 0.001）比单纯有氧运动更有效。就单次运动持续时间而言，持续时间超过60分钟的运动（MD = 6.32，95%CI：4.49 - ６.16，P < 0.001）比持续时间少于60分钟的运动更有效。成年烧伤患者的改善效果（MD = 6.09，95%CI：3.7 - 8.48，P < 0.001）优于儿童烧伤患者。重度烧伤患者的改善效果（MD = 5.66，95%CI：4.2 - 7.12，P < 0.001）优于中度烧伤患者。
我们的研究结果表明，体育锻炼与传统康复相结合在改善烧伤患者心肺适能方面比单纯传统康复更有效。这体现在有氧运动能力、运动表现和呼吸功能的改善上。最有效的方法可能是将长时间抗阻训练与有氧运动相结合。根据GRADE指南评估的证据确定性为中等和非常低，诸如发表偏倚、不精确性和不一致性等关键因素导致了证据等级的降低。
