Practice Recommendations for Resistance Exercise in the Acute Phase After Burns: State of the Science

Background: Resistance exercise is a cornerstone of rehabilitation after burn; however prescription of resistance-based exercise during acute adult burn recovery remains empiric and experience-based, varying widely between centres. To understand the contemporary evidence available to guide strength training prescription acutely after burn injury, we conducted a narrative review. Methods: PubMed, PEDro and the supplementary literature were searched for English, Dutch, French and German language human studies evaluating structured resistance training in adult burn populations. Studies eligible for inclusion were: (1) those conducted on humans (no animal or in vitro studies were included); (2) those that investigated the effects of a structured resistance exercise intervention initiated acutely after burn; and (3) those including combined aerobic exercises. The key practical and clinical considerations were timing, dose, monitoring, safety, and outcome selection. Results: After screening, a total of three full-text studies were reviewed. High-quality trials were scarce: three randomised controlled trials implemented structured resistance exercise during the inpatient phase. Study protocols, burn severity, and endpoints were heterogeneous and many functional and quality-of-life outcomes were underpowered. Discussion: There is evidence from multiple independent studies that early, supervised resistance-focused training commenced acutely post-injury is feasible and generally well tolerated, with positive signals for attenuation of muscle wasting and improvements in functional outcomes. Although the evidence base remains limited, the consistency of findings across available studies conducted in different settings and populations increases confidence in these recommendations presented herein. Conclusion: Combining available evidence and reflecting unique, burn-specific constraints, this review presents a revised framework for prescription of resistance training, emphasising individualisation and flexibility and session-by-session progression guided by clinical status and perceived exertion.