Exercise in Burn Survivors: Cooling Modalities
Condition: Burn Injury
MeSH terms: Burns
Study type: Interventional

Summary: 
      This project will identify the efficacy of cooling modalities aimed to attenuate excessive
      elevations in skin and internal body temperatures during physical activity in well-healed
      burn survivors. The investigators will conduct a randomized crossover design study.
      Non-burned control subjects, subjects who experienced burns covering ~20% to 40% of their
      body surface area, and subject having burns >40% of their body surface area will be
      investigated. Subjects will exercise in heated environmental conditions while receiving the
      following cooling modalities: no cooling, fan only, skin wetting only, and a combination of
      fan and skin wetting.
    

Detailed description: 
      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. The investigators 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. This project 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.
    

Intervention name(s): Cooing Modalities
Intervention type(s): Other
Intervention description(s): Subjects will exercise for 60 minutes in the indicated environmental condition while being exposed to each of the following cooling modalities: no cooling, fan only, skin wetting only, and a combination of a fan and skin wetting.
A fan will be a commercially available fan will be directed to the research subject throughout the exercise bout.
Skin wetting will be performed by spraying water onto the well-healed grafted skin throughout the exercise bout.
A combination of a fan and skin wetting will be performed by simultaneously applying both cooling modalities throughout the exercise bout.
Allocation: Randomized
Intervention model: Crossover Assignment
Intervention model description: The investigators will conduct a randomized crossover design study. Burn survivors and non-burned individuals, will each perform four bouts of 60-min of exercise trials with each bout incorporating the following cooling strategy: A) a control trial, B) skin wetting only trial, C) fan only trial, and D) a combination of skin wetting with a fan trial. Subjects will perform these four bouts under one of the following environmental conditions (24 deg C, 30 deg C, and 38 deg C). A subject will only be required to perform exercise across all four cooling modalities for a given environmental temperature (i.e., four exercise bouts); each will not be required to perform exercise across all combinations of environmental temperatures and cooling modalities (i.e., 12 exercise bouts).
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: skin graft; thermoregulation; burn survivor; 3rd degree burn injury; human