ORIGINAL ARTICLE   Free access

European Journal of Physical and Rehabilitation Medicine 2020 December;56(6):756-63

DOI: 10.23736/S1973-9087.20.06274-7

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Very early exercise tailored by decisional algorithm helps relieve discomfort in ICU patients: an open-label pilot study

Hélène LAURENT ^{1, 2} ✉, Sylvie AUBRETON ², Aurélie VALLAT ², Bruno PEREIRA ³, Bertrand SOUWEINE ⁴, Jean-Michel CONSTANTIN ⁵, Emmanuel COUDEYRE ^{1, 2}

¹ Unit of Human Nutrition (UNH), University of Clermont Auvergne, National Institute for Research on Agriculture (INRAE), Clermont-Ferrand, France; ² Service of Physical and Rehabilitation Medicine, Clermont-Ferrand University Hospital, Clermont-Ferrand, France; ³ Center for Clinical Research and Innovation (DRCI), Clermont-Ferrand University Hospital, Clermont-Ferrand, France; ⁴ Service of Medical Resuscitation, Clermont-Ferrand University Hospital, Clermont-Ferrand, France; ⁵ Service of Surgical Resuscitation, Clermont-Ferrand University Hospital, Clermont-Ferrand, France

BACKGROUND: Existing algorithms do not allow for setting up finely tuned progression or intensity for exercise training in intensive care units (ICUs).
AIM: We aimed to assess the feasibility and tolerance of a very early exercise program tailored by using decisional algorithm that integrated both progression and intensity.
DESIGN: Open-label pilot study.
SETTING: ICU.
POPULATION: Thirty adults hospitalized in ICU.
METHODS: Once a day, patients performed manual range of motion, cycloergometry, and functional training exercises. The progression and intensity of training were standardized by using the constructed algorithm. The main outcome, discomfort on a 0-100 Visual Analog Scale, was assessed before and after each exercise session. Secondary outcomes were muscle strength, ICU length of stay and adverse events related to exercise.
RESULTS: Overall, 125 exercise sessions were performed. Discomfort during exercise sessions decreased significantly by the fifth session (P=0.049). Early exercise sessions were feasible and did not produce major adverse events.
CONCLUSIONS: We confirmed the safety and feasibility of very early exercise programs in ICUs. Early exercise tailored by using a decisional algorithm helps relieve the discomfort of ICU patients.
CLINICAL REHABILITATION IMPACT: In everyday practice, the use of decisional algorithms should be encouraged to initiate and standardize early exercise in ICUs.

KEY WORDS: Algorithms; Exercise; Intensive care units; Physical therapy modalities; Exercise tolerance