From bedside to recovery: exercise therapy for prevention of post-intensive care syndrome

Abstract

Background As advancements in critical care medicine continue to improve Intensive Care Unit (ICU) survival rates, clinical and research attention is urgently shifting toward improving the quality of survival. Post-Intensive Care Syndrome (PICS) is a complex constellation of physical, cognitive, and mental dysfunctions that severely impact patients’ lives after hospital discharge. This review provides a comprehensive and multi-dimensional summary of the current evidence and practice of exercise therapy (ET) during and after an ICU admission to prevent and manage the various domains of PICS. The review aims to elucidate the evidence of the mechanisms and effects of ET in ICU rehabilitation and highlight that suboptimal clinical and functional outcomes of ICU patients is a growing public health concern that needs to be urgently addressed. Main body This review commences with a brief overview of the current relationship between PICS and ET, describing the latest research on this topic. It subsequently summarises the use of ET in ICU, hospital wards, and post-hospital discharge, illuminating the problematic transition between these settings. The following chapters focus on the effects of ET on physical, cognitive, and mental function, detailing the multi-faceted biological and pathophysiological mechanisms of dysfunctions and the benefits of ET in all three domains. This is followed by a chapter focusing on co-interventions and how to maximise and enhance the effect of ET, outlining practical strategies for how to optimise the effectiveness of ET. The review next describes several emerging technologies that have been introduced/suggested to augment and support the provision of ET during and after ICU admission. Lastly, the review discusses future research directions. Conclusion PICS is a growing global healthcare concern. This review aims to guide clinicians, researchers, policymakers, and healthcare providers in utilising ET as a therapeutic and preventive measure for patients during and after an ICU admission to address this problem. An improved understanding of the effectiveness of ET and the clinical and research gaps that needs to be urgently addressed will greatly assist clinicians in their efforts to rehabilitate ICU survivors, improving patients’ quality of survival and helping them return to their normal lives after hospital discharge.

From the Intensive Care Unit to Recovery: Managing Post-intensive Care Syndrome in Critically Ill Patients

“…However, it is worth noting that up to 80% of ICU patients do survive their stay. Consequently, there is a demand for investigating and advancing novel treatments such as exercise therapy administered using virtual reality and rehabilitating robots to prevent and address PICS [ 10 ].…”

“…The objective of exercise and rehabilitation treatment for ICU patients is to enhance physical well-being, restore functionality, and avoid impairment. During and after ICU admission, this approach has demonstrated its efficacy and safety in preventing and managing PICS [ 10 ]. Nevertheless, a significant constraint occurs since ICU patients frequently exhibit an inability and/or reluctance to engage in ET due to various reasons.…”

“…Nevertheless, a significant constraint occurs since ICU patients frequently exhibit an inability and/or reluctance to engage in ET due to various reasons. The integration of cutting-edge and new supplementary treatments, such as virtual reality, to enhance ET has produced favorable outcomes in effectively involving patients who might otherwise be uncooperative [ 10 ]. This delivery mode completely submerges the patient in a simulated environment that promotes active movement and has demonstrated efficacy in diminishing anxiety, delirium, and pain levels.…”

“…Exercise therapy is a highly effective preventive treatment for PICS and post-ICU outcomes. Targeting modifiable risk factors and implementing lifestyle changes can enhance patients' physical resilience and overall well-being [ 9 , 10 ]. Therefore, a comprehensive approach is needed to help patients return to their initial state, improve their quality of life, reduce healthcare costs, and foster long-term physical autonomy post-ICU discharge.…”