Effect of Pilates Exercises on Pulmonary Function, Respiratory Muscle Strength and Functional Capacity in Patients with Inhalation Injury after Flame Thermal Burn: A Prospective Randomized Controlled Trial

Background: Inhalation injury is an acute respiratory tract injury that occurrs by inhalation of smoke, toxic gases,
or steam. Early management is needed to reduce its mortality and morbidity. The purpose of this study was to
ascertain whether Pilates training could help burn patients with inhalation injury after flame thermal burn in
increasing pulmonary function, respiratory muscle strength, and functional ability.
Methods: In this prospective, randomized, controlled trial, sixty participants (26 males and 34 females) with
inhalation injury and deep partial-thickness flame burns of 30–40 % total body surface area (TBSA) were randomized
in blocks of four, with a 1:1 allocation ratio into two groups: Group A (Pilates Group); received Pilates
training plus conventional physical therapy program, and Group B (Control Group); received conventional
physical therapy program only. This study was conducted at the Faculty of Physical Therapy’s outpatient clinic,
Cairo University, 3 sessions/week for 12 weeks. The primary outcome measure was the forced vital capacity
(FVC) measured by a spirometer, while the secondary outcome measures were peak expiratory flow rate (PEFR),
forced expiratory volume in 1 s (FEV1), FEV1/FVC% assessed by a spirometer, strength of respiratory muscles
(maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP) assessed by the digital manovacuometer,
and the functional capacity evaluated by 6-Minute Walk Test (6-MWT).
Results: A two-way mixed-design MANOVA was used to analyze the results within and between groups. There
were no significant differences in demographic data between groups (P > 0.05). There were significant differences
in all variables after treatment in group A compared with group B; FVC (95 % CI: 0.38, 1.13) (P = 0.001),
FEV1 (95 % CI: 0.39, 0.97) (P = 0.001), FEV1/FVC % (95 % CI: 1.90, 17.19) (P = 0.02), PEFR (95 % CI: 0.47,
0.99) (P = 0.001), MIP (95 % CI: 5.12, 11.44) (P = 0.001), MEP (95 % CI: 2.57, 8.24) (P = 0.001), 6-MWT (95 %
CI: 27.22, 54.96) (P = 0.001), FVC (% predicted) (95 % CI: 3.58, 12.58) (P = 0.001), FEV1 (% predicted) (95 %
CI: 1.21, 11.11) (P = 0.02), PEFR (% predicted) (95 % CI: 1.33, 10.83) (P = 0.01), MIP (% predicted) (95 % CI:
2.26, 11.72) (P = 0.001) and MEP (% predicted) (95 % CI: 1.33, 10.37) (P = 0.01).
Conclusion: The current study demonstrated that a Pilates exercise program in addition to a traditional physical
therapy program for 12 weeks significantly improved the pulmonary function (FVC, FEV1, PEFR and FEV1/FEV),
strength of respiratory muscles (MIP and MEP), and functional capacity (6-MWT) in patients with inhalation
injury after flame burns. These results underscore the importance of including Pilates exercises in the rehabilitation
plan for burn patients with inhalation injury. Future studies are needed to evaluate the effect of Pilates
exercises on other degrees and TBSA of burn, long-term follow up, and to measure cardiopulmonary parameters.