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

Abstract

Skeletal muscle wasting and weakness are major complications of critical illness and underlie the profound physical and functional impairments experienced by survivors after discharge from the intensive care unit (ICU). Exercise‐based rehabilitation has been shown to be beneficial when delivered during ICU admission. This review aimed to determine the effectiveness of exercise rehabilitation initiated after ICU discharge on primary outcomes of functional exercise capacity and health‐related quality of life. We sought randomized controlled trials, quasi‐randomized controlled trials, and controlled clinical trials comparing an exercise intervention commenced after ICU discharge vs. any other intervention or a control or ‘usual care’ programme in adult survivors of critical illness. Cochrane Central Register of Controlled Trials, Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica Database, and Cumulative Index to Nursing and Allied Health Literature databases were searched up to February 2015. Dual, independent screening of results, data extraction, and quality appraisal were performed. We included six trials involving 483 patients. Overall quality of evidence for both outcomes was very low. All studies evaluated functional exercise capacity, with three reporting positive effects in favour of the intervention. Only two studies evaluated health‐related quality of life and neither reported differences between intervention and control groups. Meta‐analyses of data were precluded due to variation in study design, types of interventions, and selection and reporting of outcome measurements. We were unable to determine an overall effect on functional exercise capacity or health‐related quality of life of interventions initiated after ICU discharge for survivors of critical illness. Findings from ongoing studies are awaited. Future studies need to address methodological aspects of study design and conduct to enhance rigour, quality, and synthesis.

Muscle wasting and sarcopenia in heart failure and beyond: update 2017

“…The beneficial effect of resistance exercise training was also observed on sarcopenia and dynapenia in breast cancer patients receiving adjuvant chemotherapy . However, in a meta‐analysis review on the effectiveness of exercise rehabilitation after intensive care unit discharge on functional exercise capacity and health‐related quality of life was unable to find an overall effect on these parameters . A novel interesting therapy option is the use of neuromuscular electrical stimulation in HF patients.…”

Skeletal muscle wasting in chronic heart failure

“…87 An accelerometer-determined physical activity showed an independent, dose-response relationship with lean mass percentage and lower limb strength. 94 A novel treatment option in CHF patients is neuromuscular electrical stimulation, which has been deemed safe to use. 89 Interestingly, a significant plasticity of ageing skeletal muscle to adapt to resistancetype exercise training has been shown by transcriptomics after a 6 month training period including partial reversal of age-related changes in skeletal muscle gene expression.…”

Muscle wasting and sarcopenia in heart failure: a brief overview of the current literature

“…Foong et al studied 636 community-dwelling older adults with a mean age of 66 ± 7 years. 61 An interesting approach was presented by Chan et al who performed a randomized controlled trial of integrated care for patients with frailty and sarcopenia: 289 patients were randomized to one of two groups. Using accelerometer measurement, the authors found that physical activity intensity was positively associated with both lean mass percentage and lower limp strength in dose-response fashion.…”