Supervised exercise rehabilitation in survivors of critical illness: A randomised controlled trial

Abstract

Objectives: To investigate the impact of a six-week supervised exercise programme on cardiopulmonary fitness, balance, muscle strength and anxiety and depression in patients who have been discharged home from hospital following an intensive care unit length of stay of greater than 48 h. To investigate patients' perceptions of a six-week supervised exercise programme delivered at three months post hospital discharge. Design: A single centre parallel, randomised controlled trial. Setting: Outpatient department of a university teaching hospital in the UK. Participants: Sixty adult survivors of critical illness, at three months post-hospital discharge. Intervention: A six-week individually prescribed and supervised exercise program, with associated advice to home exercise modification. Twice weekly exercise sessions were individualised to participant's functional status and included cardiopulmonary, balance and strengthening exercises. Follow up at seven weeks, six months and 12 months. Outcome measures: Six-Minute Walk Test, BERG balance test, grip strength and Hospital Anxiety and Depression Scale. A pre-designed survey was used to explore patient perceptions of the programme. Results: Sixty participants (n ¼ 30 received allocated programme in both control and treatment groups) were randomised. Loss to follow up resulted in n ¼ 34 participants for intention to treat analysis at 12 months follow up (leaving n ¼ 19 in control group, n ¼ 15 in treatment group). Median participant age at enrolment was 62 years (interquartile range: 49-72), with a median intensive care unit length of stay of nine days (interquartile range: 4-17). No significant differences were found for the Six-Minute Walk Test at any time point (p > 0.05). Anxiety levels and balance were significantly improved in the treatment group at 12 months (p ¼ 0.006 and p ¼ 0.040, respectively). Conclusions: Further research is needed into appropriate interventions and outcome measures, target patient populations and timing of such intervention post-hospital discharge.

Rehabilitation to enable recovery from COVID-19: a rapid systematic review

“…Four high quality RCTs and one qualitative study [17] , [18] , [19] , [20] , [21] involving 659 participants evaluated exercise interventions. Four included participants who were aged 65 and over [18] , [19] , [20] , [21] . No adverse events were recorded in two trials [18] , [19] and one reported a tracheostomy issue.…”

“…Four included participants who were aged 65 and over [18] , [19] , [20] , [21] . No adverse events were recorded in two trials [18] , [19] and one reported a tracheostomy issue.…”

“…Lau et al [17] and Battle et al [18] evaluated six-week outpatient exercise programmes. Lau reported improvements in the six-minute walk test (6MWT).…”

“…These inconclusive findings may be due to the high loss to follow-up (42%; 26/62) resulting in an underpowered study. In addition, Lau et al [17] included a younger population (in their 30 second) with SARS whereas Battle [18] included an older sample (median 62 years; IQR 49 to 72) with medical/surgical conditions.…”

Determinants of Depressive Symptoms at 1 Year Following ICU Discharge in Survivors of ≥ 7 Days of Mechanical Ventilation

“…Physical rehabilitation following critical care is an ongoing area of research, and although there is current limited evidence supporting the benefits of structured programs, the impact on psychological outcomes offers a new focus of study. [28][29][30] When considering depressive symptoms, attributing causality to functional dependence is challenging. 31 The association between mental health and self-reported physical limitations was previously examined by Ruo et al, 32 showing correlation between worse mental health scores and worse self-reported physical functioning following adjustment for measured physical performance identified.…”