The Feasibility of High-Intensity Interval Training in Patients with Intensive Care Unit-Acquired Weakness Syndrome Following Long-Term Invasive Ventilation

Abstract

Background Intensive care unit-acquired weakness syndrome (ICUAWS) can be a consequence of long-term mechanical ventilation. Despite recommendations of early patient mobilisation, little is known about the feasibility, safety and benefit of interval training in early rehabilitation facilities (ERF) after long-term invasive ventilation. Methods and Results We retrospectively analysed two established training protocols of bicycle ergometry in ERF patients after long-term (> 7 days) invasive ventilation (n = 46). Patients conducted moderate continuous (MCT, n = 24, mean age 70.3 ± 10.1 years) or high-intensity interval training (HIIT, n = 22, mean age 63.6 ± 12.6 years). The intensity of training was monitored with the BORG CR10 scale (intense phases ≥ 7/10 and moderate phases ≤ 4/10 points). The primary outcome was improvement (∆-values) of six-minute-walk-test (6 MWT), while the secondary outcomes were improvement of vital capacity (VCmax), forced expiratory volume in 1 s (FEV1), maximal inspiratory pressure (PImax) and functional capabilities (functional independence assessment measure, FIM/FAM and Barthel scores) after 3 weeks of training. No adverse events were observed. There was a trend towards a greater improvement of 6 MWT in HIIT than MCT (159.5 ± 64.9 m vs. 120.4 ± 60.4 m; p = .057), despite more days of invasive ventilation (39.6 ± 16.8 days vs. 26.8 ± 16.2 days; p = .009). VCmax (∆0.5l ± 0.6 vs. ∆0.5l ± 0.3; p = .462), FEV1 (∆0.2l ± 0.3 vs. ∆0.3l ± 0.2; p = .218) PImax (∆0.8 ± 1.1 kPa vs. ∆0.7 ± 1.3pts; p = .918) and functional status (FIM/FAM: ∆29.0 ± 14.8pts vs. ∆30.9 ± 16.0pts; p = .707; Barthel: ∆28.9 ± 16.0 pts vs. ∆25.0 ± 10.5pts; p = .341) improved in HIIT and MCT. Conclusions We demonstrate the feasibility and safety of HIIT in the early rehabilitation of ICUAWS patients. Larger trials are necessary to find adequate dosage of HIIT in ICUAWS patients.

A Case of Short- Term Intensive Care Unit-Acquired Weakness Post-Renal Graft Nephrectomy after Liver and Kidney Transplant

“…It has been reported that long-term admission in ICU enhance neuromuscular weakness, however no literature proves that on short-term admission especially those who underwent many procedures and was in ICU many times within short period inbetween procedures [1][2][3][4][5]. Our case underwent two surgeries in short time.…”

“…It has been reported in many articles that intensive care unit can acquired weakness in many patients especially those who are critically ill in ICU [1][2][3][4][5]. Many factors can be classified as risk factors, include gender, APACHE score, average medical research council score, number of days of ICU stay and number of days of mechanical ventilation [6][7][8].…”

Putting It All Together: An Evidence-Based Guide to High-Intensity Interval Exercise Prescription for Patients With Complex Comorbidities

“…In addition, evidence shows that these programs are effective in varying clinical contexts, including home and intensive care units. [27][28][29] Low-volume, high-intensity interval exercise programs, although shorter in overall length, still improve overall function, strength, aerobic capacity, and physiological biomarkers. Overall training time is less than 15 minutes (not including warmup or cool down), and a starting interval time of 30 seconds has been recommended to provide increased flexibility for progression/regression in response to patient needs.…”

Costly immunometabolic remodelling in disused muscle buildup through physical exercise

“…Regular exercise is known to not only increase muscle strength, power and functional capacity but also is plausible to regulate immunometabolism 92‐96 . To date, studies investigating the effects of short‐term exercise programmes (3‐7 days) on the improvement of muscle functionality during hospitalization have shown an increase in muscle strength, power and functional capacity 97‐103 …”

“…[92][93][94][95][96] To date, studies investigating the effects of short-term exercise programmes (3-7 days) on the improvement of muscle functionality during hospitalization have shown an increase in muscle strength, power and functional capacity. [97][98][99][100][101][102][103] Mechanic stimuli, such as muscle contraction during exercise, activate both the alpha-adrenergic (α-AR) and beta-adrenergic receptors (β-AR). However, α-AR activation is more prominent in the skeletal muscle, stimulating vasoconstriction of inactive muscles, to drive energetic substrates and increase oxygen supply to active muscle groups.…”