Physical exercise improves physical function in burn patients: a systematic review and meta-analysis

doi:10.12307/2026.016

Abstract

Abstract: OBJECTIVE: Some studies have shown that physical exercise can effectively improve knee extensor strength and cardiorespiratory function in burn patients; some studies have also shown that physical exercise is not effective in improving respiratory function in burn patients. Improvement effects of physical exercise on physical functions (muscle function, walking function, cardiopulmonary function, and lean body mass) of burn patients were evaluated by a systematic evaluation and meta-analysis.
METHODS: Based on databases including Web of Science, PubMed, Embase, Cochrane Library, CNKI, WanFang, and the Chinese Biomedical Database, literature on the improvement of physical function in burn patients through physical exercise was searched using subject headings and free terms. With muscle function, walking ability, cardiopulmonary function, and lean body mass as the primary outcome measures, a meta-analysis was conducted to compare the efficacy of physical exercise with traditional physical therapy or conventional care methods.
RESULTS: A total of 38 papers were included, of which 26 papers were included in the meta-analysis, involving 1 658 patients. Meta-analysis results showed that: (1) Physical exercise significantly enhances the knee extensor strength of the dominant leg in burn patients (mean difference [MD]=8.34, 95% confidence interval [CI]: 6.95-9.72, P < 0.000 01), increases quadriceps strength, peak oxygen uptake, forced vital capacity and maximum ventilation volume in 1 second, and resting heart rate (standardized mean difference [SMD]=4.41, 95% CI: 2.52-6.30, P < 0.000 01; MD=4.91, 95% CI: 3.52-6.29, P < 0.000 01; MD=5.86, 95% CI: 0.09-11.63, P=0.05; MD=6.90, 95% CI: 2.93-10.87, P=0.000 7; MD=5.03, 95% CI: 1.45-8.61, P=0.006), and improves the 6-minute walking distance, gait parameters, and total lean body mass (MD=45.29, 95% CI: 24.7-65.89, P < 0.0001; SMD=7.84, 95% CI: 6.05-9.63, P < 0.000 01; MD=2.47, 95% CI: 2.01-2.93, P < 0.000 01). (2) The subgroup analysis results indicated that the improvement in knee extensor strength of the dominant leg may be better in children than in adults and better in the extra-heavy group than in the heavy group. Improvement in the 6-minute walking distance is better in children than in adults, and higher degree of burn indicates better improvement effects, with no difference from the control group for < 12 weeks. Peak oxygen uptake may be better in adults and severe burn groups than in children and moderate burn groups, resistance combined with aerobic exercise modalities may be better than aerobic exercise alone, and exercise duration > 60 minutes may be better than < 60 minutes.
CONCLUSION: Physical activity is effective in improving physical function in burn patients, as evidenced by improvements in muscle strength, walking ability, cardiorespiratory fitness, and lean body mass. The quality of evidence recommended for all indicator results is moderate or below, with imprecision and inconsistency being the main factors for downgrading. Therefore, more high-quality randomized controlled trials are needed in the future to verify the reliability of the results.

Key words: physical exercise, resistance exercise, aerobic exercise, burn patients, dysfunction, physical function, muscle function, cardiorespiratory function, rehabilitation effect, systematic evaluation, meta-analysis

CLC Number:

Chen Qiang, Wu Wenjuan, Jiang Shuhua, Huang Da. Physical exercise improves physical function in burn patients: a systematic review and meta-analysis[J]. Chinese Journal of Tissue Engineering Research, 2026, 30(5): 1269-1281.

Figures/Tables 11

2.2 纳入研究的基本特征纳入文献的时间跨度为2001-2024年，涉及1 658例患者，其中试验组886例、对照组772例，患者群体包含了儿童与成人。所纳入研究中的运动干预均在训练有素物理治疗师的监督指导下完成。运动形式包括抗阻+有氧运动(15篇)[22-24，32-33，36，38，46，49-50，52-56]，单纯抗阻运动(5篇)[41-43，45，57]，单纯有氧运动(5篇)[30，37，39，44，60]，其他训练形式包括：自行车或跑步机[29，40，61-62]、瑜伽[47]、普拉提[31]、气功[48]、游戏[34，51]、功能性训练[35，58-59]、核心力量训练[63]。纳入文献的基本信息见表1。 2.3 文献质量评价 Cochrane偏倚风险评估结果显示：随机分配中，低风险文献为14篇，20篇为不清楚，4篇为高风险；分配隐藏中，11篇为低风险，23篇为不清楚，4篇为高风险；患者和治疗师施盲中，2篇为低风险，2篇为不清楚，34篇为低风险；结果评估施盲中，9篇为低风险，23篇为不清楚，6篇为高风险；结果数据不完整重，37篇为低风险，1篇为高风险；选择性报告中，38篇为低风险；其他偏倚中，30篇为低风险，8篇为高风险，见图3。 2.4 Meta分析结果 2.4.1 肌肉功能分析 18项研究报告了体育锻炼对烧伤患者肌肉功能改善结果[22-23，32-34，38，41-43，46，49-50，52-53，55-57，61]，10项研究报告了273例患者膝关节优势腿伸肌变化，测量单位为峰值扭矩[22-23，32，34，43，46，50，53，55-56]，其中2项研究因测量单位不同和基线数据缺失被排除[46，56]，最终8项研究被纳入Meta分析[22-23，32，34，43，50，53，55]。合并效应量后发现(I2=0%，P=0.65)，表明研究无异质性，采用固定效应模型进行分析，Meta分析结果显示(MD=8.34，95%CI：6.95-9.72，P < 0.000 01)，见图4A，表明相较于单独采用传统康复治疗，体育锻炼联合传统治疗方式能够改善烧伤患者优势腿膝关节伸肌力量。 6项研究报道了股四头肌力量变化[33，38，41-42，49，57]，合并效应量后发现(I2=94%，P < 0.000 01)，表明研究高度异质性，采用随机效应模型进行分析，Meta分析结果显示(SMD=4.41，95%CI：2.52-6.30，P < 0.000 01)，见图4B，表明体育锻炼改善股四头肌力量的效果优于单独传统康复。在其余肌肉力量方面，3项研究报道了握力变化[49，52，57]，2项研究报道了髋关节和膝关节屈肌力量[43，52]，2项研究报道了下肢爆发力与总做功力[38，41]，研究结果表明，参加体育锻炼的干预组在该方面的改善效果均显著优于对照组。在肌肉形态方面，3项研究报道了股四头肌厚度与大小[42，52，61]，结果表明体育锻炼的效果显著。 2.4.2 上下肢功能分析在下肢活动功能中，10项研究通过6 min步行距离指标报道了烧伤患者运动耐受力变化[29，31，35-36，38，47，57，60-62]，其中3项研究数据无法提取[35-36，62]，最终7项研究被纳入Meta分析[29，31，38，47，57，60-61]。合并效应量后发现(I2=86%，P < 0.000 01)，提示研究高度异质性，采用随机效应模型进行分析，Meta分析结果显示，体育锻炼联合传统治疗方式能够有效改善烧伤患者运动耐受力(MD=45.29，95%CI：24.70-65.89，P < 0.000 1)，见图5A。4项研究报道了步态参数变化[40-43]，合并效应量后发现(I2=96%，P < 0.000 01)，提示研究高度异质性，采用随机效应模型进行分析，Meta分析结果显示，体育锻炼能够有效改善烧伤患者步态参数(SMD=7.84，95%CI：6.05-9.63，P < 0.000 01)，包括与步态特征相关的步幅(SMD=7.72，95%CI：2.52-12.92，P=0.004)、步长(SMD=4.97，95%CI：1.42-8.52，P=0.006)、速率(SMD=8.05，95%CI：4.42-11.68，P < 0.000 1)，对节奏无无明显改善作用(SMD=20.69，95%CI：-0.92-42.30，P=0.06)，见图5B。 2.4.3 心肺功能分析 18项研究报道了体育锻炼改善心肺功能相关结果[22-24，29-31，34，37，39，44，46-47，49-50，54-56，60]，13项研究报道了峰值摄氧量变化[22-23，30，34，39，44，46-49，50，55-56]，其中2项研究因无法提取数据被排除[46，49]，最终9项研究被纳入Meta分析[22-23，30，34，39，44，50，55-56]，合并效应量后发现(I2=66%，P=0.001)，显示研究中度异质性，采用随机效应模型进行分析，Meta分析结果显示，体育锻炼能够有效改善烧伤患者的有氧能力(MD=4.91，95%CI：3.52-6.29，P < 0.000 01)，见图6A。4项研究报道了用力肺活量变化[24，29，31，60]，合并效应量后发现(I2=86%，P < 0.000 1)，提示研究高度异质性，采用随机效应模型进行分析，Meta分析结果显示体育锻炼能够有效改善烧伤患者的用力肺活量(MD=5.86，95%CI：0.09-11.63，P=0.05)，见图6B。5项研究报道了1 s最大通气量变化[24，29，31，47，60]，合并效应量后发现(I2=97%，P < 0.000 01)，显示研究高度异质性，采用随机效应模型进行分析，Meta分析结果显示体育锻炼能够有效改善烧伤患者1 s最大通气量(MD=6.90，95%CI：2.93-10.87，P=0.000 7)，见图6C。4项研究报道了最大心率变化[39，44，56，60]，合并效应量后发现(I2=32%，P=0.21)，提示研究低异质性，采用固定效应模型进行分析，Meta分析结果显示，体育锻炼未明显改善烧伤患者最大心率(MD=3.28，95%CI：-0.70-7.27，P=0.11)，见图6D。2项研究报道了静息心率变化[39，56]，合并效应量后发现(I2=23%，P=0.27)，提示研究无异质性，采用固定效应模型进行分析，Meta分析结果显示，体育锻炼能改善烧伤患者静息心率(MD=5.03，95%CI：1.45-8.61，P=0.006)，见图6E。此外，与心肺功能相关的指标中，WON等[24]发现抗阻运动能有效改善烧伤患者的咳嗽峰值流量及最大吸气压；ELNAGGAR等[44]发现渐进式有氧运动改善烧患者的分钟通气量、氧脉冲和吸入氧的通气当量；?INAR等[37]发现有氧运动能有效改善炎症标志物，如中性粒细胞-淋巴细胞比率、血小板-淋巴细胞比率和淋巴细胞-单核细胞比率。 2.4.4 瘦体质量分析 10项研究单独报道了烧伤患者总瘦体质量变化[22-23，32-34，41，46，50，53，57]，合并效应量后发现(I2=0%，P=0.97)，显示研究无异质性，采用固定效应模型进行分析，Meta分析结果显示体育锻炼可明显改善烧伤患者总瘦体质量(MD=2.47，95%CI：2.01-2.93，P < 0.000 01)，见图7A。2项研究报道了瘦体质量指数变化[55-56]，合并效应量后发现(I2=0%，P=0.95)，提示研究无异质性，采用固定效应模型进行分析，Meta分析结果显示体育锻炼未能明显改善烧伤患者瘦体质量指数(MD=-0.19，95%CI：-0.68-0.30，P=0.44)，见图7B。5项研究报告了腿部瘦体质量[22-23，34，41，46]，合并效应量后发现(I2=0%，P=0.90)，提示研究无异质性，采用固定效应模型进行分析，Meta分析结果显示体育锻炼可有效改善烧伤患者腿部瘦体质量(MD=1.17，95%CI：0.54-1.80，P=0.000 3)，见图7C。4项研究报告了躯干瘦体质量[22-23，34，46]，合并效应量后发现(I2=0%，P=0.99)，提示研究无异质性，采用固定效应模型进行分析，Meta分析结果显示体育锻炼未有效改善烧伤患者躯干瘦体质量(MD=0.51，95%CI：-0.14-1.16，P=0.12)，见图7C。3项研究报"

告了手臂瘦体质量[22-23，46]，合并效应量后发现(I2=0%，P=0.76)，提示研究无异质性，采用固定效应模型进行分析，Meta分析结果显示体育锻炼未有效改善烧伤患者手臂瘦体质量(MD=0.24，95%CI：-0.48-0.96，P=0.51)，见图7C。 2.4.5 亚组分析为探寻不同运动方式、运动剂量对不同烧伤群体的干预效果，此次研究通过对主要结局指标进行亚组分析，包括膝关节伸肌力量、6 min步行距离、峰值摄氧量，划分的依据包括、运动形式、运动周期、单次运动时间，群体划分依据为年龄、烧伤程度。在膝关节伸肌力量指标中，因研究采用的干预手段方法类似，因此，无法通过干预剂量中的干预时间及周期进行亚组分析。通过年龄及烧伤程度进行亚组分析，划分依据分别为群体(< 18岁为儿童组与≥18岁为成人组)，烧伤面积(> 50%为特重度烧伤，30%-50%为重度烧伤组)。通过对年龄与烧伤面积亚组划分发现研究存在一致性。儿童组(188例)同为特重度烧伤组[22-23，32，34，50，53]，成人组(85例)为重度烧伤组[43，55]，儿童组(特重度烧伤组)Meta分析结果显示，体育锻炼可显著提升烧伤患者膝关节伸肌力量(MD=8.73，95%CI：7.25-10.21，P < 0.001)；成人组(重度烧伤组)Meta分析结果显示，体育锻炼可显著提升烧伤患者膝关节伸肌力量(MD=5.38，95%CI：1.35-9.41，P=0.009)，见表2。在6 min步行距离指标中，通过年龄进行亚组划分，儿童组(83例)Meta分析结果显示[29，38，57]，体育锻炼可显著提升烧伤患者6 min步行距离(MD=80.32，95%CI：8.32-152.41，P=0.03)；成人组(175例)Meta分析结果显示[31，47，60-61]，体育锻炼可显著提升烧伤患者6 min步行距离(MD=36.18，95%CI：13.88-58.49，P < 0.001)。根据干预周期划分≥12周组(188例)和< 12周组(100例)[31，38，47， 57，60]，≥12周组Meta分析结果显示，体育锻炼可显著提升"

烧伤患者6 min步行距离(MD=57.83，95%CI：26.52-89.13，P < 0.001)；< 12周Meta分析结果显示，体育锻炼未能显著提升烧伤患者6 min步行距离(MD=33.5，95%CI：-2.46-69.47，P=0.07)。根据烧伤程度划分成中度组[29，47，57]、重度组[31，61]、特重度组[38，60]，中度组Meta分析结果显示，体育锻炼可显著提升烧伤患者6 min步行距离(MD=23.74，95%CI：3.84-43.99，P=0.02)；重度组Meta分析结果显示，体育锻炼可显著提升烧伤患者6 min步行距离(MD=54.17，95%CI：27.89-80.44，P < 0.001)；特重度组Meta分析结果显示，体育锻炼可显著提升烧伤患者6 min步行距离(MD=86.33，95%CI：35.81-136.85，P < 0.001)，见表2。在峰值摄氧量指标中，主要进行年龄、烧伤程度、锻炼时间、锻炼类型亚组划分。根据年龄划分为儿童组(413例)[22-23，34，44，50，56]、成人组(121例)[30，39，55]，儿童组Meta分析结果显示，体育锻炼可显著提升烧伤患者峰值摄氧量(MD=3.67，95%CI：2.81-4.53，P < 0.001)；成人组Meta分析结果显示，体育锻炼可显著提升烧伤患者峰值摄氧量(MD=6.09，95%CI：3.70-8.48，P < 0.001)。根据烧伤程度划分为中度组(82例)[39，44]、重度组(452例)[22-23，30，34，50，55-56]，中度组Meta分析结果显示，体育锻炼可显著提升烧伤患者峰值摄氧量(MD=2.71，95%CI：1.27-4.15，P=0.002)；重度组Meta分析结果显示，体育锻炼可显著提升烧伤患者峰值摄氧量(MD=5.66，95%CI：4.20-7.12，P < 0.001)。根据锻炼时间划分为≥60组(402例)[22-23，30，50，55-56]、< 60 min组(122例)[34，39，44]，≥60 min组Meta分析结果显示，体育锻炼可显著提升烧伤患者峰值摄氧量(MD=6.32，95%CI：4.49-8.16，P < 0.001)；< 60 min组Meta分析结果显示，体育锻炼可显著提升烧伤患者峰值摄氧量(MD=3.60，95%CI：2.73-4.46，P < 0.001)。根据锻炼类型划分为抗阻联合有氧运动组(482例)[22-23，50，55-56]、单独有氧组(152例)[30，34，39，44]，抗阻联合有氧组Meta分析结果显示，体育锻炼可显著提升烧伤患者峰值摄氧量(95%CI：4.81-6.13，P < 0.001)；单独有氧组Meta分析结果显示，体育锻炼可显著提升烧伤患者峰值摄氧量(MD=4.71，95%CI：2.26-7.16，P < 0.001)，见表2。 2.5 敏感性分析为检测Meta分析结果的可靠性，通过逐条剔除的方式对主要4个结果(优势腿伸肌力量、6 min步行距离、峰值摄氧量、瘦体质量)进行敏感性分析。优势腿伸肌力量指标中逐个剔除任一研究后得到(MD=6.10-8.71，I2=0%，95%CI：2.39-10.13，P均< 0.001)，表明优势腿伸肌力量整体研究结果具备一定的稳定性；6 m步行距离指标中逐个剔除任一研究后得到(MD=39.42-58.68，I2=81%-89%，95%CI：15.65-91.63，P均< 0.001)，表明6 min步行距离整体研究结果具备一定的稳定性；峰值摄氧量指标中逐个剔除任一研究后得到(MD=4.27-5.07，I2=39%-69%，95%CI：2.82-6.78，P均< 0.001)，表明峰值摄氧量整体研究结果具备一"

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