Does exercise influence inflammation after a burn injury?

INTERVENTION: A 6 week pulse of exercise: ‐ The resistance training (RT) regime will consist of six exercises targeting upper and lower major muscle groups. The RT intensity will be set at 3 sets of 10 repetitions. The resistance exercises will be progressive in nature whereby if a participant can perform an additional 2 repetitions in the final set for 2 consecutive sessions, the resistance will be increased by 5%. This progressive overload approach is widely used in resistance training programming to maximize the level of adaptation. ‐ Participants will complete 20 minutes of aerobic exercise (AE) utilizing a variety of exercise modes and equipment. Intensity for the AE will be prescribed at 70‐90% of age predicted HR max with the average HR recorded at the end of each aerobic session. ‐ Participants will complete 3, 60 minute gym sessions each week (consisting of the above), supervised by a senior physiotherapist in the Fiona Stanley Hospital burns gym. Participants have individualised programs. Participants may complete their programs in the gym at the same time, however there will not be formalised group training sessions. Feasibility: Participants may choose to undertake exercises at their local gym. If they do so, they will be, required to attend FSH at least once per week to enable appropriate progression of their exercises. Where this is not possible they will need to make contact with the supervising physiotherapist via phone to support appropriate progression of their exercise program. At a minimum, participants will need to be able to attend FSH for baseline measures, at the mid‐way point, three weeks, and at completion of program (6 weeks) for data collection. Exercise tracking software such as Microsoft Band will be utilised for both groups to quantif CONDITION: Burn induced inflammation; ; Burn induced inflammation Inflammatory and Immune System ‐ Other inflammatory or immune system disorders Injuries and Accidents ‐ Burns PRIMARY OUTCOME: TNF alpha ‐ TNF alpha assay[TNF alpha will be collected at baseline, mid‐way (3 weeks) and post intervention (6 weeks) for study periods 1 and 2 (i.e. the exercise and control conditions). ] SECONDARY OUTCOME: Fitness/activity: ; International Physical Activity Questionnaire ‐ the questionnaire will be completed by the participant [will be collected at baseline, mid‐way (3 weeks) and post intervention (6 weeks) for study periods 1 and 2 (i.e.both the exercise and control conditions).] Fitness/activity: ; Modified Chester step test ‐ participants step up and down a step in time with a beep. When they can no longer keep in time with the beep, the test is aborted and the level reached recorded. Heart rate and RPE Borg scale is recorded every minute. ; ; [Secondary outcomes will be collected at baseline, mid‐way (3 weeks) and post intervention (6 weeks) for study periods 1 and 2 (i.e.both the exercise and control conditions).] Fitness/activity: Wearable fitness tracker data ‐ participants will asked to wear the activity tracker when at a minimum from when they are awake to when they go to bed in order to collect their daily steps[will be collected at baseline, mid‐way (3 weeks) and post intervention (6 weeks) for study periods 1 and 2 (i.e.both the exercise and control conditions).] Functional (subjective) recovery: ; Quick Dash ‐ the questionnaire will be completed by the participant ; ; [will be collected at baseline, mid‐way (3 weeks) and post intervention (6 weeks) for study periods 1 and 2 (i.e.both the exercise and control conditions).] Physical: ; Grip strength ‐ assessed using a dynamometer ; INCLUSION CRITERIA: • greater than or equal to 5%TBSA burn injury • Time post injury, greater than or equal to 1 year • Male or female, greater than or equal to18 years old ; [Secondary outcomes will be collected at baseline, mid‐way (3 weeks) and post intervention (6 weeks) for study periods 1 and 2 (i.e.both the exercise and control conditions).] Functional (subjective): Lower limb functional Index ‐ the questionnaire will be completed by the participant[will be collected at baseline, mid‐way (3 weeks) and post intervention (6 weeks) for study periods 1 and 2 (i.e.both the exercise and control conditions).] Muscle Strength: assessed using a dynamometer ; [Secondary outcomes will be collected at baseline, mid‐way (3 weeks) and post intervention (6 weeks) for study periods 1 and 2 (i.e.both the exercise and control conditions).] Physiological: non‐invasive muscle mass bioimpedance spectroscopy (BIS). An impedimed BIS instrument will measure participants body mass by placing electrodes on intact skin on the hands and feet. [Secondary outcomes will be collected at baseline, mid‐way (3 weeks) and post intervention (6 weeks) for study periods 1 and 2 (i.e. the exercise and control conditions). ] Quality of Life: ; SF36‐ the questionnaire will be completed by the participant [Secondary outcomes will be collected at baseline, mid‐way (3 weeks) and post intervention (6 weeks) for study periods 1 and 2 (i.e.both the exercise and control conditions).] • Satisfactory self‐described health status (excluding burn injury) • Subject understands the proposed project, is able to consent to participation