Oxidative stress and immune system analysis after cycle ergometer use in critical patients

Abstract

OBJECTIVE:The passive cycle ergometer aims to prevent hypotrophy and improve muscle strength, with a consequent reduction in hospitalization time in the intensive care unit and functional improvement. However, its effects on oxidative stress and immune system parameters remain unknown. The aim of this study is to analyze the effects of a passive cycle ergometer on the immune system and oxidative stress in critical patients.METHODS:This paper describes a randomized controlled trial in a sample of 19 patients of both genders who were on mechanical ventilation and hospitalized in the intensive care unit of the Hospital Agamenom Magalhães. The patients were divided into two groups: one group underwent cycle ergometer passive exercise for 30 cycles/min on the lower limbs for 20 minutes; the other group did not undergo any therapeutic intervention during the study and served as the control group. A total of 20 ml of blood was analysed, in which nitric oxide levels and some specific inflammatory cytokines (tumour necrosis factor alpha (TNF-α), interferon gamma (IFN-γ) and interleukins 6 (IL-6) and 10 (IL-10)) were evaluated before and after the study protocol.RESULTS:Regarding the demographic and clinical variables, the groups were homogeneous in the early phases of the study. The nitric oxide analysis revealed a reduction in nitric oxide variation in stimulated cells (p=0.0021) and those stimulated (p=0.0076) after passive cycle ergometer use compared to the control group. No differences in the evaluated inflammatory cytokines were observed between the two groups.CONCLUSION:We can conclude that the passive cycle ergometer promoted reduced levels of nitric oxide, showing beneficial effects on oxidative stress reduction. As assessed by inflammatory cytokines, the treatment was not associated with changes in the immune system. However, further research in a larger population is necessary for more conclusive results.

Acute effect of passive cycle-ergometry and functional electrical stimulation on nitrosative stress and inflammatory cytokines in mechanically ventilated critically ill patients: a randomized controlled trial

“…According to well-established methods by Franc¸a et al (11), the blood was stored and transported in three 4-mL vacutainer blood collection tubes (Vacutainer s , Brazil) containing dipotassium ethylenediamine tetraacetic acid in a refrigerated container to the Laboratório de Imunologia Keizo Asami, Federal University of Pernambuco. The blood samples were diluted in 10-mL Falcon tubes for nitrosative stress analysis by determining nitric oxide (NO) production in cells (monocytes) and assessing immune response parameters, including cytokines tumor necrosis factor (TNF)-a, interferon gamma (IFN-g), interleukin 6 (IL-6), and interleukin 10 (IL-10), which were assessed by plasma count (11).…”

“…This dye was used to count cells and assess their viability. Based on the count, the concentration of 1 Â10 6 cells was standardized for each mL of culture medium (11).…”

“…The control group underwent no therapeutic intervention during the study period and were subject to physiotherapy at the ICU in other periods. The lower limb PCE group performed lower limb ergometry using the cycle ergometer (Flex Motor with sensor; Cajumoro, Brazil) with 30 rotations programmed per min for 20 min, according to the protocol of Franc¸a et al (11) (Figure 1).…”

Recent Advances in Pulmonary Rehabilitation for Patients in the Intensive Care Unit (ICU)

“…13,14 The mechanisms underlying the effects of EM have been examined in a few studies. 15,16 For example, it has been reported that the average ratio of interleukin-6 (IL-6) to IL-10 improves after low levels of passive physical activity in patients with prolonged critical illness. 15 However, we must take into account the peculiarities of the patient population and the time to the first mobilization.…”

Functional Electrical Stimulation‐Assisted Cycle Ergometry in Critically Ill. Protocol of Randomised Controlled Trial

“…There are several ways to deliver more effective physical exercise therapy to patients who are sedated and mechanically ventilated. For example physical exercise can be delivered effectively and safely by passive supine cycling on a bicycle ergometer [15,18,[28][29][30]. More recently, electrical neuromuscular stimulation (NMES) has been developed to mimic active exercise in patients, who lack voluntary muscle activity [31][32][33][34][35][36][37][38][39].…”