Functioning beyond pediatric burns : physical activity, fatigue, and exercise capacity up to 5 years post burn

Burns generally affect physical fitness. This is mainly due to the bodily response to burns (profound and sustained stress response, increase in resting metabolism, muscle wasting), but also due to the relatively long periods of bed rest and inactivity during hospitalization. In addition, burn scars can lead to functional impairments. This thesis aimed to gain insight in the recovery of physical fitness and activity in children and adolescents with burns. This is essential to better determine rehabilitation needs beyond discharge from the burn center. Habitual physical activity and perceived fatigue were assessed 1-5 years after burn injury. The majority of children did not met global physical activity recommendations and symptoms of fatigue were present in part of the population. In addition, the course of exercise capacity was analyzed during the initial six months after discharge. Half of the children achieved healthy levels of exercise capacity within six months. The other half did not and these children were therefore considered ‘at risk’ for diminished functioning and adverse (long-term) health outcomes. Remarkably, burn severity did not predict levels of physical activity, perceived fatigue, or exercise capacity. Instead, preliminary results showed that early assessment of exercise capacity with the Steep Ramp Test can help to identify those who will need additional rehabilitation support beyond discharge. Further elaboration of these important new insights is essential to facilitate tailored care.