JBUR 6011 No.

of Pages 8

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Available online at www.sciencedirect.com

ScienceDirect

journal homepage: www.elsevier.com/locate/burns

Assessing the effects of 6 weeks of intermittent

aerobic exercise on aerobic capacity, muscle
fatigability, and quality of life in diabetic burned
patients: Randomized control study

Walid Kamal Abdelbasset a,b, *, Nermeen Mohamed Abdelhalim a,c

a
Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam Bin
Abdulaziz University, Alkharj, Saudi Arabia
b
Department of Physical Therapy, Kasr Al-Aini Hospital, Cairo University, Giza, Egypt
c
Department of Physical Therapy, New Kasr El-Aini Teaching Hospital, Faculty of Medicine, Cairo University, Egypt

article info abstract

Article history: Background: Both burn and diabetes mellitus (DM) cause functional and psychosocial
Accepted 22 December 2019 disabilities. A low-cost and safe approach is greatly required to reduce these disabilities and
Available online xxx the effects of aerobic exercise have generated varied evidence to date. The aim of the study
was to explore the effects of 6 weeks of intermittent aerobic exercise (IAE) on aerobic
capacity, muscle fatigability, and quality of life (QoL) in diabetic burned patients (DBPs).
Keywords:
Methods: The study design was a prospective, single-blind, randomized controlled trial.
Burn
Between March 2018 and July 2019 thirty-six (22 males and 16 females) diabetic burned patients
Diabetes mellitus
were included in the study, their age ranged 35 55 years. They were clinically diagnosed with
Intermittent aerobic exercise
type 2 DM and total body surface area (TBSA) was 15 30%. The participants were randomly
Aerobic capacity
assigned to the IAE group (n = 18) and controls (n = 18). Aerobic capacity, muscle fatigability, and
Muscle fatigability
QoL were assessed initially and repeated after 6 weeks of intervention.
Quality of life
Results: Initial data demonstrated non-significant differences between the IAE and control groups
(p > 0.05). Comparing pre- and post-intervention outcomes showed significant improvement of
VO2max, muscle fatigability, QoL domains in the IAE group after 6 weeks intervention (p < 0.05)
and non-significant changes in the control group (p > 0.05). The IAE group showed statistically
significant improvement more than the control group in all outcome measures (p < 0.05).
Conclusions: 6 weeks of intermittent aerobic exercise is an effective alternative modality to
improve aerobic capacity, muscle fatigability, and QoL in DBPs. Adherence to intermittent
aerobic exercise should be practicable into mainstream clinical intervention for those patients.
© 2019 Elsevier Ltd and ISBI. All rights reserved.

Abbreviations: DM, diabetes mellitus; IAE, intermittent aerobic exercise; QoL, quality of life; DBPs, diabetic burned patients; TBSA, total
body surface area; ADL, activity daily living; BP, blood pressure; ICU, intensive care unit; BMI, body mass index; HbA1c, glycosylated
haemoglobin; WHO, World Health Organization; VO2max, maximum oxygen uptake; EMG, electromyography; MVC, maximum voluntary
contraction; B-BSHS, brief burns specific health scale.
* Corresponding author at: Department of Physical Therapy and Health Rehabilitation, college of Applied Medical Science, Prince Sattam Bin
Abdulaziz University, Alkharj, Saudi Arabia.
E-mail address: walidkamal.wr@gmail.com (W.K. Abdelbasset).
https://doi.org/10.1016/j.burns.2019.12.013
0305-4179/© 2019 Elsevier Ltd and ISBI. All rights reserved.

Please cite this article in press as: W.K. Abdelbasset, N.M. Abdelhalim, Assessing the effects of 6 weeks of intermittent aerobic exercise
on aerobic capacity, muscle fatigability, and quality of life in diabetic burned patients: Randomized control study, Burns (2020),
https://doi.org/10.1016/j.burns.2019.12.013
JBUR 6011 No. of Pages 8
2 burns xxx (2020) xxx
1. Introduction
Globally, burn injuries are accompanied by numerous com-
plications of different organs influence healthy persons.
Subsequently, the patients suffered from diabetes mellitus,
vascular disorders, peripheral neuropathies, and immune
deficiency may be subjected to great destructive effects on
their health [1].
In the past burns increased mortality rate and many burned
patients’ loss their activity of daily life (ADL) [2]. Currently,
advancement in management and care of burned patients
leads to increase survival rates, reduce complications, and
improve quality of life (QoL) [3]. Also, the improvement of
physical therapy rehabilitation plays a vital role in reducing
physical and functional deficits [4]. Diabetes mellitus (DM) is
the commonest metabolic disease which identified by high
glucose level in the blood as a result of insulin secretion
dysfunction, abnormal insulin effect, or both [5]. DM is similar
to burn injuries that impact negatively on different organs like
cardiovascular complications, peripheral neuropathies, and
impairments of immune system [6].
Diabetic burned patients (DBPs) may predispose to more
deteriorations and complications as diabetic angiopathy result
from damaged perfusion, diabetic immunodeficiency attends
to infection, the spread of sepsis, urinary tract infection [7],
cellulitis, renal failure [8], increased time spent in the hospital,
and many admissions to burn intensive care unit (ICU) [9].
Burns may also diminish lung function and reduce aerobic
capacity lasting for long times [10]. Also, burns have negative
effects on the cardiovascular system with more cardiac output,
less ventilation, and increase heart rate until two years after
burn injury [11]. There is an indirect relationship between the
onset of DM and aerobic capacity. Both physical activity and
aerobic capacity are independently accompanied by the
hazard of developing type 2 DM [12].
Burn injuries increase the basal metabolic rate with minimal
clinical effects and have been manifested for a long period with
large burns, probably lead to persistence of fatigue [13]. Fatigue
is intensely related to minor QoL and major work-related
disability, and the danger of acquiring moderate to severe
fatigue after burn injuries [14]. In diabetic patients, fatigue is
common with or without detective pathological disorders and is
correlated to decrease ADL [15]. Fatigue in DM may be because of
physiological factors such as hypo- or hyperglycemia, psycho-
logical factors such as depression or anxiety, or lifestyle
problems such as decreased physical activity or obesity [16].
Contribution in organized resisted or aerobic exercises
program has different effects, such as the decreased tendency
for surgical procedures to release hypertrophic scar, increased
muscle power and muscle bulk [17]. The definitive purpose of
physical therapy rehabilitation with burned patients is to aid in
returning functional capability [18]. Furthermore, exercises can
aid diabetic patients to improve aerobic capacity, increase muscle
power, enhance blood-glucose level, reduce insulin resistance,
decrease cholesterol level, and decrease blood pressure (BP) [19].
Prior studies have identified the efficacy of aerobic exercise on
aerobic capacity [20], ventilatory markers [21], psychological
conditions [22], and metabolic disorders [23] but particularly, no
previous studies examined its effects on the DBPs.
Please cite this article in press as: W.K. Abdelbasset, N.M. Abdelhalim, Assessing the effects of 6 weeks of intermittent aerobic exercise
on aerobic capacity, muscle fatigability, and quality of life in diabetic burned patients: Randomized control study, Burns (2020),
https://doi.org/10.1016/j.burns.2019.12.013
xxx
It would appear instinctive that diabetic patients who
suffer from burns would have worse prognosis than non-
diabetic patients. Despite a lack of experimental studies
struggling to evaluate the impacts of resisted and aerobic
exercises programs on DBPs, to the best of our knowledge,
there have been no studies to date assessing aerobic capacity,
muscle fatigability, and QoL in DBPs. It is a great challenge to
physical therapists who handling with DBPs to find appropri-
ate exercises program to restore functional abilities and to
improve QoL. The aim of this study was to explore the effects of
6 weeks intermittent aerobic exercises on aerobic capacity,
muscle fatigability, and QoL in DBPs.
2. Material and methods
2.1. Subjects
The study design was a prospective, single-blind, randomized
controlled trial. Between March 2018 and July 2019, thirty-six
DBPs were included in the study in the tertiary hospital of Cairo
University, their age ranged 35 55 years. They were clinically
diagnosed with type 2 DM (glycosylated haemoglobin (HbA1c)
6.5%) based on the recommendations of world health
organization (WHO) [24] and total body surface area (TBSA)
was 15 30% measured by rule of nines, depth of burn (partial
to full-thickness burn), causes of burn (flame, scald, chemical),
surgical procedures (none, split-thickness skin graft, full-
thickness skin graft), and with a minimum of 4 months after
burn injuries with traditional physical therapy program until
complete recovery. Avoiding type II error, the patients were
randomly allocated to two equal groups, 18 in each group. Any
patient who suffered from burns in head, neck, perineum,
hands, and feet, inhalation injury, psychiatric disorders,
paralysis, and congenital anomalies was excluded. Before
initiating the study, each patient was well-versed about the
study procedures and signed an inscribed informed consent.
The proposal of the study was approved by the localized
research ethical committee of the Cairo University Hospitals
(number PT-018-029) complying with the Helsinki Declaration.
2.2. Sample size and randomization
This present study decided a sample size of thirty-one patients
using G* power 3.0.10 software (University Dusseldorf, Dus-
seldorf, Germany) with 80% power, 0.05 margin of error, and 0.5
effect size. Hence, this study comprised thirty-six patients to
account for a 20% drop-out. The thirty-six patients were
assigned into two groups. The allocation was performed before
intervention by a blinded physiotherapist who was not aware
of the study procedure using a random number generating
table. The first group (n = 18) received intermittent aerobic
exercise (IAE) while the second group (n = 18) did not conduct
the IAE program as a control.
2.3. Assessment
2.3.1. Initial assessment
Demographic and clinical features of the study participants
including age, gender, body mass index (BMI), glycosylated
JBUR 6011 No. of Pages 8
burns xxx (2020) xxx
haemoglobin (HbA1c), TBSA, depth of burn, causes of burn,
surgical intervention and the period after burn injuries were
recorded before initiating the study. Aerobic capacity, muscle
fatigability, and QoL were initially assessed and repeated after
6 weeks at the end of the study intervention.
2.3.2. Aerobic capacity
All patients conducted a progressive exercise test on the
treadmill (COSMED, Rome, Italy) in accordance with the Bruce
protocol treadmill stress test to collect the maximum oxygen
uptake (VO2max) using the proper VO2max formula for non-
athletes [25]. Each patient was encouraged to provide maximal
effort throughout the test.
2.3.3. Muscle fatigability
Quadriceps intermittent fatigue test was performed using
Electromyography (EMG) (Dantec Keypoint Focus 6 chan-
nels, Natus medical incorporated, Pleasanton, USA). The
position of the patient was straighter back with hip flexion of
90 and knee flexion of 60 . Normal values had been
previously developed [26]. Before initiating the assessment,
patients instructed to perform 5 s quadriceps sub maximum
isometric contractions (warming-up) to be acquainted with
soundtrack commendations and visual feedback. After
warming-up, patients were instructed to perform 3 maxi-
mum voluntary contractions (MVC) 30 s separately. Then the
neuromuscular assessment was executed initiating with 5 s
MVCs overlaid with one hundred Hz (Db100) and ten Hz (Db10)
doublet and tracked after 2 s (relaxation) by two potential
doublets transmitted 4 s separately. The second MVC was
performed after 15 s rest with overlaid doublet tracked after 2
s by 1 potential doublet in the muscle during relaxation. After
this initial neuromuscular assessment, the patients were
instructed to conduct the fatigue assignment which com-
prised ten intermittent sets of submaximal isometric
contraction (5 on/5 off) initiating first set with 10% MVC
and elevated each set with 10% MVC until failing to perform
the task. When the patient impotent to sustain the reached
force >2.5 s for five sec after ending the set 10-contraction
post-ten minutes of recovery, the same neuromuscular
assessment was repeated.
2.3.4. Quality of life
The validated brief burns specific health scale (B-BSHS) was
used to assess QoL in the DBPs. B-BSHS is 40-item generic
questionnaire that assesses QoL in 9 dimensions (simple
abilities, hand function, heat sensitivity, interpersonal rela-
tionships, work, treatment of regimens, affect, sexuality, and
body image)regarding the physical and psychosocial difficul-
ties.The B-BSHS is consisted of 5 points of severity ranged from
0 (extreme) to 4 (none) at all items [27,28]. The mean value of
domain score was recorded and the higher scores regard a
better health condition.
2.4. Intervention
All participants of the study groups were commended to
regularly undergo home exercise for 6 weeks. The quantifiable
obligation of frequently and properly undergoing the home
exercise was clearly detailed to each participant.
Please cite this article in press as: W.K. Abdelbasset, N.M. Abdelhalim, Assessing the effects of 6 weeks of intermittent aerobic exercise
on aerobic capacity, muscle fatigability, and quality of life in diabetic burned patients: Randomized control study, Burns (2020),
https://doi.org/10.1016/j.burns.2019.12.013
xxx 3
2.4.1. Exercise program
The aerobic exercise group conducted 6 weeks intermittent
aerobic exercise (IAE) at moderate intensity, according to the
guidelines of cardiovascular prevention [29]. The program was
comprised of three weekly sessions for 6 weeks; each session
was continued for nearly 40 min. The exercise intensity was
organized by distance and time covered. Each session was
commenced with 5 10 min warm-up at 50 60% of maximum
heart rate (maxHR). IAE comprised of 30 min of training/
relaxation. Each participant was instructed to run for two
minutes at a workload intensity of 70% of the velocity at
maximum oxygen uptake, followed by one-minute relaxation.
This process was iterated during the session period for almost
30 min. Over the period of the study program, the intensity of
exercise was gently elevated every two weeks in accordance
with the patient’s ability under supervision of an experienced
and specialized physiotherapist.
2.5. Statistical analysis
All data were collected and analyzed using SPSS software
version 25 (IBM Corp, Armonk, NY, USA). Descriptive statistics
were used to examine the demographic and clinical character-
istics of the study participants. The Kolmogorov Smirnov test
was utilized to assess the normally distribution of the collected
data. The student's t-test was used to assess the changes of the
normal distributed data (unpaired t-test for intergroup and
paired t-test for intragroup) while the Wilcoxon test was used
to assess the changes of the non-normal distributed data. Data
were analyzed as a mean  standard deviation. The significant
level was accepted at a p-value <0.05.
3. Results
The present study screened 44 consecutive patients for
eligibility in this randomized control study. Eight of these
patients were not assigned for allocation (5 did not encounter
the inclusive criteria and 3 denied to conduct the study
program). Fig. 1 detailed the flow chart of the study. The mean
values of the initial data were analyzed and demonstrated
non-significant differences between the IAE and control
groups (p > 0.05) as detailed in Table 1.
Comparing between pre- and post-intervention outcomes
showed significant improvement of the mean values of
VO2max, muscle fatigability, B-BSHS domains in the IAE group
after a 6-wee intervention (p < 0.05) whereas non-significant
changes for any outcome were demonstrated in the control
group (p > 0.05) as detailed in Table 2. Comparison between the
IAE and control groups at the end of the study intervention, the
IAE group showed statistically significant improvement more
than the control group in all outcome measures (p < 0.05) as
detailed in Table 3.
4. Discussion
The aim of the study was to investigate the effects of 6 weeks of
IAE on aerobic capacity, muscle fatigability, and QoL in DBPs
hypothesizing that IAE could improve those measures in DBPs.
JBUR 6011 No. of Pages 8

4 burns xxx (2020) xxx xxx

Fig. 1 – The flow chart of the study.

The results of the current study showed that aerobic capacity,
muscle fatigability, and functional & psychosocial domains of
B-BSHS were significantly improved in DBPs when compared
with that of a matched control group.
The combination of burns with DM leads to a high
morbidity rate. DM has considered a risk factor affecting
burns trauma because of disturbed sensation as polyneurop-
athy and decreased acuity of vision as retinopathy. These
issues may denote that diabetic patients may not distinguish
and/or stay away from sources of burns. Therefore, they are
more vulnerable to critical burn injuries with various compli-
cations that require special management with intensive
rehabilitation programs [30].
The dissipation of thermal energy through different skin
layers depends on the thermal conductivity and vasodilatation
of the affected tissues [31]. Previous studies established that
DM is characterized by decreasing transmissions of thermal
energy to the adjacent skin tissues besides little hyperaemic
reactions [32]. The reduction of the thermal conductivity with
diabetic patients results from the thin dermis, thick hypoder-
mis, and impairment of the heat-regulating center [33].
The present study demonstrated that aerobic exercises
play a vital role in physical therapy rehabilitation for DBPs. By
contributing in 6 weeks of IAE at moderate intensity, there was
improvement of Vo2max, MVC, and B-BSHS. Hence, DBPs who
joined the IAE program are more likely to get QoL advantages
such as improved physical and psychosocial difficulties that
are critical in restoring ADL. Additionally, IAE has various
possible impacts, such as increased heat sensitivity, interper-
sonal relationships, and work capability.
The preceding studies assessed the influences of aerobic
exercises on burned patients [34] and diabetic patients [35]
separately. In agreements with our results, one of the previous
studies within burned patients reported that decreasing in
exercise capabilities characterized by lowering Vo2max than
normal before the treatment intervention [36]. Suman et al.,
showed that burned patients after thermal injury suffered
from disturbances in cardiopulmonary system and reported
an enhancement in exercise performance, treadmill training
time, balance, and stability of burned patients after 12 weeks of
aerobic training and conventional exercises. The improve-
ment of Vo2max and Berg Balance Scale (BBs) in the study
group paralleled to the sham group that may result from more
blood supply to muscles owing to maximum cardiac output,
increased vascularization and activity of the oxidative enzyme
[37].
Earlier studies have indicated the critical association
between aerobic capacity and the occurrence of type 2 DM
independent of physical fitness rates [12,38]. Numerous of
underlying mechanisms may be implicated by the

Please cite this article in press as: W.K. Abdelbasset, N.M. Abdelhalim, Assessing the effects of 6 weeks of intermittent aerobic exercise
on aerobic capacity, muscle fatigability, and quality of life in diabetic burned patients: Randomized control study, Burns (2020),
https://doi.org/10.1016/j.burns.2019.12.013
JBUR 6011 No. of Pages 8

burns xxx (2020) xxx xxx 5

Table 1 – Initial data of the study.

Variables IAE group (n = 18) CG (n = 18) p-Value
Gender (M/F) 12/6 14/4 0.46
Age (years) 47.8  6.2 46.3  6.7 0.49
BMI (kg/m2) 27.3  2.5 26.8  2.3 0.54
HbA1c (%) 6.8  1.2 7.1  1.3 0.48
Medications od DM n(%)
Metformin 11(61) 12(67) 0.72
Gliptins 8(44) 5(28)
Statins 7(39) 8(44)
Total burn area (TBSA%) 26.4  3.5 25.7  4.1 0.58
Causes of injury n (%)
Flame 7(39) 5(28) 0.83
Scald 8(45) 9(50)
Chemical 3(16) 4(22)
Depth of burn n (%)
Partial thickness 5(28) 4(22) 0.84
Full thickness 7(39) 6(33)
Partial and full thickness 6(33) 8(45)
Skin graft (yes/no n (%)) 11(61)/7(39) 13(72)/5(28) 0.48
Time since burn (months) 5.7  1.4 6.2  1.7 0.34
VO2max (mL/kg 1/min 1) 27.46  3.32 25.82  3.26 0.14
Quadriceps muscle MVC (Nm) 167.6  43.14 178.3  47.52 0.48
B-BSHS
Simple abilities 3.04  0.81 3.15  0.83 0.69
Hand function 3.19  0.65 3.21  0.71 0.93
Heat sensitivity 1.62  0.92 1.59  0.88 0.92
Interpersonal relationship 3.21  0.71 3.32  0.67 0.64
Work 2.41  0.87 2.45  0.94 0.89
Treatment regimens 3.14  0.83 3.11  0.84 0.91
Affect 3.19  0.57 3.13  0.52 0.74
Sexuality 3.32  0.64 3.35  0.62 0.89
Body image 2.23  1.41 2.25  1.37 0.99

IAE: intermittent aerobic exercise; CG: control group; BMI: body mass index; HbA1c: glycosylated haemoglobin; DM: diabetes mellitus; TBSA:
total body surface area; VO2max: maximum oxygen uptake; MVC: maximum voluntary contraction; B-BSHS: brief-burn specific health scale.

Table 2 – The differences of mean values pre- and post- intervention for IAE and control groups.

Variables IAE group (n = 18) CG (n = 18)

Pre- Post- p-Value Pre- Post- p-Value

HbA1c (%) 7.6  1.2 5.0  0.4 0.04 7.1  1.3 6.9  1.2 0.63
VO2max (mL/kg 1/min 1) 27.46  3.32 38.71  4.1 <0.001 25.82  3.26 27.2  3.33 0.22
Quadriceps muscle MVC (Nm) 167.6  43.14 232.4  51.2 0.002 178.3  47.52 189  45.6 0.49
B-BSHS
Simple abilities 3.04  0.81 3.72  0.99 0.03 3.15  0.83 3.09  0.81 0.83
Hand function 3.19  0.65 3.67  0.23 0.006 3.21  0.71 3.24  0.69 0.89
Heat sensitivity 1.62  0.92 3.12  0.65 <0.001 1.59  0.88 1.63  0.91 0.89
Interpersonal relationship 3.21  0.71 3.77  0.32 0.004 3.32  0.67 3.29  0.64 0.89
Work 2.41  0.87 3.23  0.52 0.002 2.45  0.94 2.51  0.97 0.85
Treatment regimens 3.14  0.83 3.84  0.45 0.003 3.11  0.84 3.08  0.81 0.91
Affect 3.19  0.57 3.71  0.33 0.002 3.13  0.52 3.11  0.55 0.91
Sexuality 3.32  0.64 3.82  0.35 0.006 3.35  0.62 3.41  0.64 0.77
Body image 2.23  1.41 3.24  0.71 0.011 2.25  1.37 2.33  1.4 0.86

IAE: intermittent aerobic exercise; CG: control group; HbA1c: glycosylated haemoglobin; VO2max: maximum oxygen uptake; MVC: maximum
voluntary contraction; B-BSHS: brief-burn specific health scale.

advantageous impact of high peak VO2 on controlling blood
glucose levels. Prior studies have demonstrated that there
was a reduced amount of type I muscle fiber and the density
of capillaries [39], high level of fat constituent in muscle
fibers [40], and increased ratio of glycolytic and oxidative
enzyme that combined with low insulin tolerance [41].
Additionally, there is a proof that the aerobic exercise
program improves the density of skeletal muscle
capillaries and consequently increases muscular oxidative
capability [42].

Please cite this article in press as: W.K. Abdelbasset, N.M. Abdelhalim, Assessing the effects of 6 weeks of intermittent aerobic exercise
on aerobic capacity, muscle fatigability, and quality of life in diabetic burned patients: Randomized control study, Burns (2020),
https://doi.org/10.1016/j.burns.2019.12.013
JBUR 6011 No. of Pages 8

6 burns xxx (2020) xxx xxx

Table 3 – Post-intervention differences between IAE and control groups.

Variables IAE group (n = 18) CG (n = 18) p-Value
HbA1c (%) 5.0  0.4 6.9  1.2 0.04
VO2max (mL/kg 1/min 1) 38.71  4.1 27.2  3.33 <0.001
Quadriceps muscle MVC (Nm) 232.4  51.2 189  45.6 0.01
B-BSHS
Simple abilities 3.72  0.99 3.09  0.81 0.04
Hand function 3.67  0.23 3.24  0.69 0.02
Heat sensitivity 3.12  0.65 1.63  0.91 <0.001
Interpersonal relationship 3.77  0.32 3.29  0.64 0.01
Work 3.23  0.52 2.51  0.97 0.01
Treatment regimens 3.84  0.45 3.08  0.81 0.01
Affect 3.71  0.33 3.11  0.55 0.01
Sexuality 3.82  0.35 3.41  0.64 0.02
Body image 3.24  0.71 2.33  1.4 0.02

IAE: intermittent aerobic exercise; CG: control group; HbA1c: glycosylated haemoglobin; VO2max: maximum oxygen uptake; MVC: maximum
voluntary contraction; B-BSHS: brief-burn specific health scale.

It is widely known that exercise at high-intensity is a
common reason for muscular fatigability for the sake of
metabolic and neuronal issues. Intermittent exercise program
allows high-intensity exercise for a prolonged time more than
continuous exercise training, as oxygen is returned, phospho-
creatine is refilled moderately and metabolites of the muscle
are expelled during the recovery stages [43]. Bogdanis et al.
reported that retrieving of maximum output and muscular
production of phosphocreatine after 30 s fast running looks to
happen similarly. Conversely, no one was fully regained after 6
min of exercise training sessions [44]. Finally, because of
physiological regaining during recovery stages between the
intervals, intermittent exercise training helps to do the greater
capacity of training with least muscular fatigability than
continuous exercise training which continually increased
central stress and peripheral structures [45].
Paratz and colleagues reported that, after wound recovery,
subjects who contributed in aerobic exercise training involving
three times per week for an hour session suggestively
improves their muscle power and exercise functioning (shuttle
test) compared to pre-treatment and compared to a control
group of patients. A new feature of this trial was that aerobic
exercise training was also correlated to enhanced QoL, as well
as, the benefits of diminished muscular fatigue and improved
the muscular endurance [46].
It is important to highlight that T2DM was assessed in the
present study using HbA1c test because of its high sensitivity
and specificity to diagnose T2DM compared to oral glucose
tolerance test (OGTT) which used to diagnose gestational
diabetes [24,47,48].
Our study have some strengths. Firstly, the six weeks of IAE
appear to be acceptable and feasible for DBPs. Secondly,
objective measurements were used to assess aerobic capacity
and muscle fatigability. Finally, this study demonstrated a high
response rate of the study participants. On the other hand, it has
some limitations. The main limitation of the study is the
quadriceps intermittent isometric fatigue test which does not
exactly regard the usual patients' activity. Whereas, the present
study approved that the recorded VO2max is accompanying
with endurance and force of quadriceps muscle. Therefore, the
role of peripheral muscles may illustrate the lowered aerobic
capacity in DBPs. Other limitations, the present study missed
long term follow-up and home exercise of was not supervised.
Further studies are required to assess neuromuscular functions
and muscle fatigue related to functional activities not related to
MVCs with a view to explain the effects of neuromuscular
dysfunction on the usual activities of the patient.
5. Conclusions
The present study findings revealed that 6 weeks of IAE is an
effective alternative modality that improves aerobic capacity,
muscle fatigability, and QoL in DBPs. Adherence to IAE should
be practicable into mainstream clinical intervention for those
patients.
Funding
No agency granted funding for this study.
Conflicts of interest
The authors declare that no competing interests concern the
publishing of the study.
Acknowledgement
The authors gratefully acknowledge all patients for their
involvement and obligation throughout the study. The authors
also would like to thank the deanship of scientific research,
Prince Sattam bin Abdulaziz University.
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Please cite this article in press as: W.K. Abdelbasset, N.M. Abdelhalim, Assessing the effects of 6 weeks of intermittent aerobic exercise
on aerobic capacity, muscle fatigability, and quality of life in diabetic burned patients: Randomized control study, Burns (2020),
https://doi.org/10.1016/j.burns.2019.12.013
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Please cite this article in press as: W.K. Abdelbasset, N.M. Abdelhalim, Assessing the effects of 6 weeks of intermittent aerobic exercise
on aerobic capacity, muscle fatigability, and quality of life in diabetic burned patients: Randomized control study, Burns (2020),
https://doi.org/10.1016/j.burns.2019.12.013