Mild Exercise Reduces Negative Effects of Prolonged Bed Rest in the ICU

Researchers at Johns Hopkins Hospital (JHH; Baltimore, MD, USA) described several muscle-strengthening exercises that can be introduced early into the treatment plans of critically ill patients. The researchers, which included two physical therapists, used the exercises in treating over 400 patients in The JHH medical ICU during 2009. The patients underwent electrical stimulation to strengthen leg muscles, walked around the ICU, and even cycled while lying in bed using a specially designed device attached to the end of the bed.

In neuromuscular electrical stimulation, electrical pads are placed on the skin over three major muscle groups in each leg, with low-voltage electrical impulses inducing muscle contractions that may mimic mild exercise. Three patients at the JHH have used the pads for half-hour, twice daily exercise sessions as part of the devices' clinical testing. The research team is still tracking recovery times, but note that studies in patients who were not critically ill have demonstrated that the technique keeps muscles from weakening.

For the walks, the patients remained connected to their ventilators, heart monitors, and other equipment while using a standard walker. A nurse and physical and respiratory therapists accompanied and monitored the patient, stopping for rest periods as needed. Walking sessions, including rest breaks, usually lasted half an hour; the team also developed a special walker called the "Mover Aid," with a built-in seat for patients who need to sit and rest, which also includes a wheeled pole to hold a ventilator and ICU monitoring equipment.

The motorized stationary bicycle affixed to the ICU bed has also been used by over a dozen patients at JHH, some sedated and others wide-awake. The patients pedaled for as much as 20 minutes per day. The researchers claimed that since the introduction of early mobility practices in the ICU, average stays in the JHH ICU have dropped by as much as two days (more than 20%). The study was published in the September 21, 2009, issue of the journal Critical Care Medicine.

"ICU-related muscle weakness is the number one factor in prolonging a patient's recovery and delaying their return to a normal life, including work and recreational activities," said senior author Dale Needham, M.D., Ph.D. "Our ICU patients are telling us that they want to be awake and moving. Gone are the days when we should only think of critically ill patients on complete bed rest.”

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