Effect of supervised aerobic exercise rehabilitation on physical fitness and quality-of-life in survivors of critical illness: an exploratory minimized controlled trial (PIX study)

Abstract

BackgroundEvidence is limited for the effectiveness of interventions for survivors of critical illness after hospital discharge. We explored the effect of an 8-week hospital-based exercise-training programme on physical fitness and quality-of-life.MethodsIn a parallel-group minimized controlled trial, patients were recruited before hospital discharge or in the intensive care follow-up clinic and enrolled 8–16 weeks after discharge. Each week, the intervention comprised two sessions of physiotherapist-led cycle ergometer exercise (30 min, moderate intensity) plus one equivalent unsupervised exercise session. The control group received usual care. The primary outcomes were the anaerobic threshold (in ml O2 kg−1 min−1) and physical function and mental health (SF-36 questionnaire v.2), measured at Weeks 9 (primary time point) and 26. Outcome assessors were blinded to group assignment.ResultsThirty patients were allocated to the control and 29 to the intervention. For the anaerobic threshold outcome at Week 9, data were available for 17 control vs 13 intervention participants. There was a small benefit (vs control) for the anaerobic threshold of 1.8 (95% confidence interval, 0.4–3.2) ml O2 kg−1 min−1. This advantage was not sustained at Week 26. There was evidence for a possible beneficial effect of the intervention on self-reported physical function at Week 9 (3.4; −1.4 to 8.2 units) and on mental health at Week 26 (4.4; −2.4 to 11.2 units). These potential benefits should be examined robustly in any subsequent definitive trial.ConclusionsThe intervention appeared to accelerate the natural recovery process and seems feasible, but the fitness benefit was only short term.Clinical trial registrationCurrent Controlled Trials ISRCTN65176374 ().

Effectiveness of an exercise programme on physical function in patients discharged from hospital following critical illness: a randomised controlled trial (the REVIVE trial)

“…Our study has several limitations; only a small proportion of patients screened and survived to hospital discharge were recruited (7.8%), which has implications for generalisability of the findings, although this is similar to the recruitment rate in the other rehabilitation studies following hospital discharge in this population 5 8. Identification of which patients will benefit most from an exercise intervention based on baseline status has not yet been explored in the critical care population.…”

“…Other studies with supervised programmes have demonstrated some benefit,3 5 7 whereas a home-based study that did not incorporate a high level of supervision was unable to demonstrate improved outcomes 8. Supervision or support may be an important component of rehabilitation as it has been suggested that exercise can be difficult for people to perform without feedback about their performance or help to modify and progress the exercises 40…”

Clinical guideline and recommendations on pre‐operative exercise training in patients awaiting major non‐cardiac surgery

“…The ideal scenario may be a blurring of the lines between prehabilitation and enhanced recovery, such that one programme leads into the next, punctuated by surgery, with minimal interruption. This idea is particularly appealing in the case of exercise, where evidence suggests that early postoperative exercise rehabilitation enhances the recovery of functional status [57,58]. There is some evidence that the pre-operative period may represent a more appropriate time than the postoperative period to implement an intervention [59]; however, further research is needed to determine if a combination of prehabilitation plus early rehabilitation is superior to prehabilitation alone.…”

Exercise rehabilitation following intensive care unit discharge for recovery from critical illness: executive summary of a Cochrane Collaboration systematic review

“…Four studies reported rates of withdrawal, which ranged from 0% to 26.5% in control groups and from 8.2% to 27.6% in intervention groups . The quality of evidence for the effect of the intervention on withdrawal was low.…”