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Trial registered on ANZCTR

Registration number

ACTRN12620000237987

Ethics application status

Approved

Date submitted

14/02/2020

Date registered

25/02/2020

Date last updated

16/06/2022

Date data sharing statement initially provided

25/02/2020

Date results provided

14/07/2021

Type of registration

Prospectively registered

Titles & IDs

Public title

Does exercise influence inflammation after a burn injury?

Scientific title

Does exercise influence burn induced inflammation?

Secondary ID [1]

None

Universal Trial Number (UTN)

U1111-1248-0980

Trial acronym

Linked study record

Health condition

Health condition(s) or problem(s) studied:

Burn induced inflammation

Condition category

Condition code

Inflammatory and Immune System

Other inflammatory or immune system disorders

Injuries and Accidents

Burns

Intervention/exposure

Study type

Interventional

Description of intervention(s) / exposure

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 quantify activity when not at FSH. Physitrack app will be utilised by participants to record the exercise sessions they complete, in order to monitor adherence to the exercise sessions.
- It is a cross over trial. Participants will be initially randomised into either the control or exercise group. There will be a 4 week 'wash out' period between the control and exercise condition. The control condition will be asked to continue on with their normal activity, which will be tracked with activity monitors.

Intervention code [1]

Treatment: Other

Intervention code [2]

Rehabilitation

Comparator / control treatment

The study is a cross over trial, so each participant will complete and be monitored through a 6 week pulse of exercise and 6 week 'control' period where they continue with their normal daily routine. There will also be a 4 week rest period between the 2 different conditions (exercise and control).

Control group

Active

Outcomes

Primary outcome [1]

TNF alpha - TNF alpha assay

Timepoint [1]

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 [1]

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.

Timepoint [1]

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).

Secondary outcome [2]

Physical:
Grip strength - assessed using a dynamometer

Timepoint [2]

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).

Secondary outcome [3]

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.

Timepoint [3]

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).

Secondary outcome [4]

Functional (subjective) recovery:
Quick Dash - the questionnaire will be completed by the participant

Timepoint [4]

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).

Secondary outcome [5]

Quality of Life:
SF36- the questionnaire will be completed by the participant

Timepoint [5]

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).

Secondary outcome [6]

Muscle Strength: assessed using a dynamometer

Timepoint [6]

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).

Secondary outcome [7]

Fitness/activity:
International Physical Activity Questionnaire - the questionnaire will be completed by the participant

Timepoint [7]

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).

Secondary outcome [8]

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

Timepoint [8]

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).

Secondary outcome [9]

Functional (subjective): Lower limb functional Index - the questionnaire will be completed by the participant

Timepoint [9]

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).

Eligibility

Key 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
• Satisfactory self-described health status (excluding burn injury)
• Subject understands the proposed project, is able to consent to participation

Minimum age

18 Years

Maximum age

No limit

Sex

Both males and females

Can healthy volunteers participate?

Key exclusion criteria

• Acquired or pre-existing neurological injury or disease conditions which influence the capacity to complete future exercise or walking program eg nerve injury or multi-trauma; spinal cord injury, CVA / central nervous system lesions; Patients with no fixed address.
• Intellectually challenged patients
• Non – English speaking
• Pregnant Women
• Cancer
• Unstable cardiac conditions

Study design

Purpose of the study

Treatment

Allocation to intervention

Randomised controlled trial

Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)

Allocation is not concealed

Methods used to generate the sequence in which subjects will be randomised (sequence generation)

Simple randomisation will be utilised to determine which arm of the cross over trial the participants complete first. I.e wither the control or the exercise condition

Masking / blinding

Open (masking not used)

Who is / are masked / blinded?

Intervention assignment

Crossover

Other design features

Phase

Not Applicable

Type of endpoint/s

Efficacy

Statistical methods / analysis

This is a pilot and feasibility study planned to be completed in the FWF fellowship period (1 year). Current assumptions to estimate the sample size for this study, relates to data available from burn patient chronic TNF alpha levels, which were used to inform the assumptions of the calculation. If we had enough funding a sample size of 85 patients (allowing for 15% loss to follow up) would be required to achieve 80% power to detect a change in TNF alpha, with alpha set at 5% and with an effect size of 0.3. However, this is a pilot study (aim to recruit 20 participants), where we will aim to hone the assumptions relating to the sample size to achieve definitive study outcomes and improve the strength of future grant applications to fund other components of this trial.

Recruitment

Recruitment status

Completed

Date of first participant enrolment

Anticipated

31/03/2020

Actual

24/08/2020

Date of last participant enrolment

Anticipated

1/10/2020

Actual

5/04/2021

Date of last data collection

Anticipated

30/07/2021

Actual

30/06/2021

Sample size

Target

Accrual to date

Final

Recruitment in Australia

Recruitment state(s)

Recruitment hospital [1]

Fiona Stanley Hospital - Murdoch

Recruitment postcode(s) [1]

6150 - Murdoch

Funding & Sponsors

Funding source category [1]

Charities/Societies/Foundations

Name [1]

Fiona Wood Foundation

Address [1]

11 Robin Warren Drive
Murdoch, WA 6150

Country [1]

Australia

Primary sponsor type

Hospital

Name

Fiona Stanley Hospital

Address

11 Robin Warren Drive, Murdoch, WA 6150

Country

Australia

Secondary sponsor category [1]

None

Name [1]

Address [1]

Country [1]

Ethics approval

Ethics application status

Approved

Ethics committee name [1]

South Metropolitan Health Service Human Research Ethics Committee

Ethics committee address [1]

South Metropolitan Health Service Executive
 Level 2, Education Building, Fiona Stanley Hospital
 14 Barry Marshall Parade 
 MURDOCH Western Australia 6150

Ethics committee country [1]

Australia

Date submitted for ethics approval [1]

06/12/2019

Approval date [1]

13/05/2020

Ethics approval number [1]

EC00265

Summary

Brief summary

The primary aim of the study will be to longitudinally analyse the effect a 6-week pulse of exercise has on the level of inflammatory biomarkers including TNF alpha and a multiplex of other cytokines at different times frames (>1year) after burn. A cross-over trial will be conducted with participants randomised to either an exercise or control condition in the first phase. In the second phase participants will cross over into the alternate condition e.g phase 1 exercise condition participants will change over to the control condition in phase 2. Outcome measurement and blood sampling time points will be pre-intervention, at 3 weeks after commencement of intervention/control and then at 6 weeks (completion of study period 1). These will then be repeated in study period 2 at the same time points. Evidence suggests that exercise directly influences inflammation and immune function therefore we hypothesize the chronic inflammatory load after burn injury will decrease after 6 weeks of exercise.

Trial website

Trial related presentations / publications

Public notes

Contacts

Principal investigator

Name

Dr Pippa Kenworthy

Address

Fiona Stanley Hospital
11 Robin Warren Drive, Murdoch, WA 6150

Country

Australia

Phone

+61 0432795838

Fax

pippa.kenworthy@health.wa.gov.au

Contact person for public queries

Name

Pippa Kenworthy

Address

Fiona Stanley Hospital
11 Robin Warren Drive, Murdoch, WA 6150

Country

Australia

Phone

+61 0432795838

Fax

pippa.kenworthy@health.wa.gov.au

Contact person for scientific queries

Name

Pippa Kenworthy

Address

Fiona Stanley Hospital
11 Robin Warren Drive, Murdoch, WA 6150

Country

Australia

Phone

+61 0432795838

Fax

pippa.kenworthy@health.wa.gov.au

Data sharing statement

Will individual participant data (IPD) for this trial be available (including data dictionaries)?

Yes

What data in particular will be shared?

Investigators outside of the Department of Health will have access to the final study dataset with identification only by unique study number i.e de-identified. Trial results will be made publicly available through a series of peer reviewed journal articles.

When will data be available (start and end dates)?

December 2020 for the de-identified data set and September 2022 for published manuscripts
All data will be available for 7 years after publication

Available to whom?

As above - Investigators outside of the Department of Health will have access to the final study data set with identification only by unique study number i.e de-identified. Trial results will be made publicly available through a series of peer reviewed journal articles.

Available for what types of analyses?

To achieve the aims in the approved proposal; for future studies requiring the data set

How or where can data be obtained?

Access subject to approvals by Principal Investigator
Pippa.Kenworthy@health.wa.gov.au

What supporting documents are/will be available?

Doc. No.	Type	Email	Other Details
6877	Study protocol	Pippa.Kenworthy@health.wa.gov.au	Access subject to approvals by Principal Investiga... [More Details]
6878	Statistical analysis plan	Pippa.Kenworthy@health.wa.gov.au	Access subject to approvals by Principal Investiga... [More Details]
6879	Informed consent form	Pippa.Kenworthy@health.wa.gov.au
6880	Clinical study report	Pippa.Kenworthy@health.wa.gov.au
6881	Ethical approval	Pippa.Kenworthy@health.wa.gov.au

Results publications and other study-related documents

Documents added manually

No documents have been uploaded by study researchers.

Documents added automatically

Source	Title	Year of Publication	DOI
Embase	Does exercise influence burn-induced inflammation: A cross-over randomised controlled feasibility trial.	2022	https://dx.doi.org/10.1371/journal.pone.0266400

N.B. These documents automatically identified may not have been verified by the study sponsor.

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