Physical therapy in the ICU appears to confer significant benefit in improving quality of life, physical function, peripheral and respiratory muscle strength, increasing ventilator-free days, and decreasing hospital and ICU stay. However, further controlled trials of better quality and larger sample sizes are required to verify the strength of these tentative associations.

Implementation of early physical rehabilitation can improve self-reported physical function and induce systemic anti-inflammatory effects.

Background Patients with sepsis syndromes in comparison to general intensive care patients can have worse outcomes for physical function, quality of life and survival. Early intensive care rehabilitation can improve the outcome in general Intensive Care Unit (ICU) patients, however no investigations have specifically looked at patients with sepsis syndromes. The 'i-PERFORM Trial' will investigate if early targeted rehabilitation is both safe and effective in patients with sepsis syndromes admitted to ICU. Methods/Design A single-centred blinded randomized controlled trial will be conducted in Brisbane, Australia. Participants (n = 252) will include those ≥ 18 years, mechanically ventilated for ≥ 48 hours and diagnosed with a sepsis syndrome. Participants will be randomised to an intervention arm which will undergo an early targeted rehabilitation program according to the level of arousal, strength and cardiovascular stability and a control group which will receive normal care. The primary outcome measures will be physical function tests on discharge from ICU (The Acute Care Index of Function and The Physical Function ICU Test). Health-related quality of life will be measured using the Short Form-36 and the psychological component will be tested using The Hospital Anxiety and Depression Scale. Secondary measures will include inflammatory biomarkers; Interleukin-6, Interleukin-10 and Tumour Necrosis Factor-α, peripheral blood mitochondrial DNA content and lactate, fat free muscle mass, tissue oxygenation and microcirculatory flow. Discussion The 'i-PERFORM Trial' will determine whether early rehabilitation for patients with sepsis is effective at improving patient outcomes with functional and physiological parameters reflecting long and short-term effects of early exercise and the safety in its application in critical illness. Trial Registration Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12610000808044

Objective: To explore motivations, self-regulation barriers, and strategies in a multi-ethnic Southeast Asian population with overweight and obesity. Design: Qualitative design using semi-structured face-to-face and videoconferencing interviews. Data was analyzed using thematic framework analysis and constant comparison method. Setting: Specialist weight management clinic. Participants: 22 participants were purposively sampled from 13 April to 30 April 2021. Median age and BMI of the participants was 37.5 (interquartile range [IQR] = 13.3) and 39.2 kg/m2 (IQR = 6.1) respectively. 31.8% were men, majority had a high intention to adopt healthy eating behaviors (median = 6.5; IQR = 4.8-6.3) and 59% of the participants had a medium level of self-regulation. Results: Six themes and fifteen subthemes were derived. Participants were motivated to lose weight by (1) the sense of responsibility as the family’s pillar of support and (2) to feel “normal” again. We coupled self-regulation barriers with corresponding strategies to come up with four broad themes – (3) habitual overconsumption – mindful self-discipline; (4) proximity and convenience of food available – mental tenacity; (5) momentary lack of motivation and sense of control – motivational boosters; (6) overeating triggers – removing triggers. We highlighted six unique overeating triggers namely trigger activities (e.g. using social media); eating with family, friends, and colleagues; provision of food by someone; emotions (e.g. feeling bored at home, sad and stressed); physiological condition (e.g. premenstrual syndrome); and the time of the day. Conclusions: Future weight management interventions should consider encompassing participant-led weight loss planning, motivation boosters, and self-regulation skills to cope with momentary overeating triggers.