Early Bicycle Exercise Safe for ICU patients

Early bicycle exercise by mechanically ventilated patients in the hospital intensive care unit (ICU) may help them recover more quickly, according to a new study.

Researchers at St. Joseph's Healthcare (St. Joe’s; Hamilton, Canada), McMaster University (Hamilton, Canada), Johns Hopkins University (JHU, Baltimore, MD, USA), and other institutions conducted a prospective cohort study in 33 patients receiving mechanical ventilation who walked independently pre-ICU internment. The intervention included 30 minutes of in-bed supine cycling six days a week in the ICU. The main outcome was cycling termination, with a secondary safety outcome that included catheter or tube dislodgements.

Cycling began a median of three days after ICU admission, with the patients receiving five cycling sessions of 30 minutes per session, cycling an average total of nine kilometers during their ICU stay. During the 205 total cycling sessions, 73% of the patients were receiving invasive mechanical ventilation, vasopressors were being taken by 2.9% of study participants, sedative or analgesic infusions were taken by 37.6% of the patients, and 2% were under dialysis. Cycling termination was infrequent, and no device dislodgements occurred. The study was published on December 28, 2016, in PLOS One.

“People may think that ICU patients are too sick for physical activity, but we know that if patients start in-bed cycling two weeks into their ICU stay, they will walk farther at hospital discharge,” said lead author physiotherapist Michelle Kho, PhD, of the school of rehabilitation science at McMaster University and St. Joe’s. “…it is safe and feasible to systematically start in-bed cycling within the first four days of mechanical ventilation and continue throughout a patient's ICU stay.”

In-bed cycling is a promising early intervention for critically ill patients that provides a low-intensity movement that allows spontaneous participation in activity (with rest breaks) in severely deconditioned patients. Commercially available devices provide three possible activity modes: passive (fully motorized, no patient initiation), active-assisted (partially initiated by the patient), or active (fully initiated by the patient). The intervention helps prevent or reduce muscle mass loss and minimize strength losses, helping to improve long-term outcomes in ICU survivors.

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St. Joseph's Healthcare
McMaster University
Johns Hopkins University