Exercising severely ill patients earlier improves recovery

A study examining the health and recovery benefits of early exercise in hospitalised patients with life-threatening illness or injury will lead to future trials of early mobilization (EM) programs in intensive care units (ICU).

Melbourne researchers are examining the feasibility and benefits of early exercise programs in Australia and New Zealand (ANZ) hospitals in collaboration with researchers from Johns Hopkins University in the US, where the benefits of light exercise have been shown to reduce the length of sedation and hospital stay, and improve functional independence and recovery.

The Trial of Early Activity and Mobilization (TEAM), led by Dr Carol Hodgson from The Australian and New Zealand Intensive Care Research Centre at Monash University, will inform a trial of ventilated intensive care patients to evaluate how EM influences long-term survival and recovery.

One of the largest investigations of exercise in critically ill patients, the observational study will obtain data from 12 different ICU’s in Australia and New Zealand, and will recruit 200 ventilated ICU patients expected to be connected to a mechanical ventilator for a minimum of two days.

“Previously intensive care patients have been left in bed for long periods. As a result, they suffer muscle atrophy, weakness and they take a long time to recover. This study is allowing us to better understand how carefully supervised rehabilitation, as opposed to continuous sedation and bed rest, can improve recovery,” Dr Hodgson said.

“Unfortunately we do not believe early mobilization is commonly used in Australia and New Zealand and ICU patients, who are mechanically ventilated for more than 48 hours, are not mobilised out of bed with active weight-bearing exercise.

“Early mobilization can be conducted safely and could significantly better the long-term recovery of very ill people such as those traumatically injured in car accidents or victims of debilitating illness such as influenza.”

Dr Hodgson said using physiotherapists as part of an ICU multidisciplinary team to focus on early rehabilitation, and changing ICU culture and teamwork to introduce EM into routine care could be important contributions to patients’ recovery after critical illness in the future.

The TEAM is the first stage of a research program investigating the benefits of EM, defined as the intervention of physical therapy and the use of specialised exercise equipment, such as a stationary bicycle that allows patients to exercise while lying down, immediately after patients stabilise, frequently within the first 48-hours after admission.

If the pilot study is successful, researchers will apply for national funding to conduct a multi-centre study to evaluate whether EM has a benefit on long-term survival, functional outcomes and quality of life.

The TEAM study is endorsed by the Australian and New Zealand Intensive Care Society (ANZICS) Clinical Trials Group and is funded by the Intensive Care Foundation.

The TEAM investigators comprise of ICU specialists including doctors, nurses and physiotherapists.

 Monash University.