Exercise overcomes muscle weakness following on trauma and critical illness

Abstract

Injuries related to trauma are often seen in South Africanintensive care units. Systemic inflammation and the development of sepsislead to prolonged intensive care unit and hospital stay. The effects of critical illness and immobility on the human body are not always well-understood. This review article explains the pathogenesis of muscle weak-ness due to inflammation and identifies the role of exercise prescription incounteracting impairments that may be identified in survivors of traumaduring and after hospital stay.

Safety and potential benefits of physical therapy in adult patients on extracorporeal membrane oxygenation support: a systematic review

“…Several protocols of progressive mobilization have been recommended both to rehabilitate (12) and to maintain muscle strength and mass. (13) In this context, physical therapy (PT) is used to reduce the deleterious effects of immobility, stimulate peripheral blood flow, produce anti-inflammatory cytokines, and increase insulin activity and glucose uptake in muscle tissues. (13) However, although the number of studies involving critically ill patients has been increasing, few studies to date have analyzed the safety and potential benefits of PT in adult patients on ECMO support, given the risk of cannula displacement or fracture during cannulation procedures, potentially leading to adverse events.…”

“…(13) In this context, physical therapy (PT) is used to reduce the deleterious effects of immobility, stimulate peripheral blood flow, produce anti-inflammatory cytokines, and increase insulin activity and glucose uptake in muscle tissues. (13) However, although the number of studies involving critically ill patients has been increasing, few studies to date have analyzed the safety and potential benefits of PT in adult patients on ECMO support, given the risk of cannula displacement or fracture during cannulation procedures, potentially leading to adverse events. To date, one systematic review was conducted to determine the potential advantages and safety of multimodal PT protocols to improve motor and respiratory function, combined with VV ECMO.…”

Physiological Responses to Passive Exercise in Adults Receiving Mechanical Ventilation

“…32 Activity can decrease insulin resistance and increase muscle utilization of glucose. 4,32 Possibly, repeated sessions of passive exercise not only decrease blood glucose levels and insulin requirements in critically ill patients but also decrease IL-6 levels. The relationship between mobilization, IL-6 levels, blood glucose levels, and insulin requirements in critically ill patients should be explored further.…”

“…Supports were padded to prevent skin breakdown, and a stabilizing device at the knees prevented lateral rotation at the knee or hip. A handheld device was used to set the number of flexionextension repetitions per minute (range, [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] and the degree of flexion (range, 0º-95º). As an additional safety measure, each CPM machine had a resistance alarm that halted movement.…”

“…1,2 Immobility and the inflammatory process both diminish muscle mass and strength, changes that can prolong need for mechanical ventilation, extend hospital stay, and complicate recovery, and adversely affect the quality of life in critical ill patients. 3,4 Progressive mobilization interventions, from passive and active range of motion, to dangling, standing, or lift transfer to a chair, and ambulation, [5][6][7] have been recommended as an approach for minimizing muscle weakness after a critical illness. 8 Mobilization is hypothesized to preserve muscle strength and mass by improving blood flow, stimulating production of anti-inflammatory cytokines, and enhancing insulin activity and glucose uptake in muscle.…”