Effects of early, combined endurance and resistance training in mechanically ventilated, critically ill patients: A randomised controlled trial
Neuromuscular weakness resulting in severe functional impairment is common in critical care survivors. This study aimed to evaluate effects of an early progressive rehabilitation intervention in mechanically ventilated adults at risk. This was a parallel, two-arm, assessor-blinded, randomised contro...
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| description | Neuromuscular weakness resulting in severe functional impairment is common in critical care survivors. This study aimed to evaluate effects of an early progressive rehabilitation intervention in mechanically ventilated adults at risk.
This was a parallel, two-arm, assessor-blinded, randomised controlled trial with 6-months follow-up that was conducted in a mixed ICU of an academic centre in Switzerland. Previously independent, mechanically ventilated, critically ill adults with expected critical care stay ≥72 hours (n = 115) were randomised to a control group receiving standard physiotherapy including early mobilisation or to an experimental group with early endurance and resistance training combined with mobilisation. Primary endpoints were functional capacity (6-Minute Walk Distance) and functional independence (Functional Independence Measure) at hospital discharge. Secondary endpoints including muscle strength were assessed at critical care discharge. Safety was monitored closely by standard monitoring and predefined adverse events.
Physiotherapy started within 48 hours of critical care admission while 97% of participants were still ventilated and 68% on inotropes. Compared to the control group (n = 57), the experimental group (n = 58) received significantly more physiotherapy (sessions: 407 vs 377, p |
| doi_str_mv | 10.1371/journal.pone.0207428 |
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This was a parallel, two-arm, assessor-blinded, randomised controlled trial with 6-months follow-up that was conducted in a mixed ICU of an academic centre in Switzerland. Previously independent, mechanically ventilated, critically ill adults with expected critical care stay ≥72 hours (n = 115) were randomised to a control group receiving standard physiotherapy including early mobilisation or to an experimental group with early endurance and resistance training combined with mobilisation. Primary endpoints were functional capacity (6-Minute Walk Distance) and functional independence (Functional Independence Measure) at hospital discharge. Secondary endpoints including muscle strength were assessed at critical care discharge. Safety was monitored closely by standard monitoring and predefined adverse events.
Physiotherapy started within 48 hours of critical care admission while 97% of participants were still ventilated and 68% on inotropes. Compared to the control group (n = 57), the experimental group (n = 58) received significantly more physiotherapy (sessions: 407 vs 377, p<0.001; time/session: 25min vs 18min, p<0.001) and had less days with sedation (p<0.001). Adverse events were rare (0.6%) and without consequences. There were no significant between-group differences in 6-Minute Walk Distance (experimental 123m (IQR 25-280) vs control 100m (IQR 0-300); p = 0.542) or functional independence (98 (IQR 66-119) vs 98 (IQR 18-115); p = 0.308). Likewise, no differences were found for the secondary outcomes, except a trend towards improved mental health in the experimental group after 6 months (84 (IQR 68-88) vs 70 (IQR 64-76); p = 0.023).
Early endurance and resistance training in mechanically ventilated, intensive care patients does not improve functional capacity or independence at hospital discharge compared to early standard physiotherapy but may improve mental health 6-months after critical care discharge.
German Clinical Trials Register (DRKS): DRKS00004347, registered on 10 September 2012.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0207428</identifier><identifier>PMID: 30427933</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Activities of Daily Living ; Adult ; Adults ; Aged ; Anesthesia ; Biology and Life Sciences ; Clinical trials ; Critical care ; Critical Care - methods ; Critical Illness - therapy ; Early Ambulation ; Exercise Therapy - methods ; Female ; Hospitals ; Humans ; Illnesses ; Intensive care ; Intensive Care Units ; Intervention ; Male ; Medical research ; Medicine ; Medicine and Health Sciences ; Mental health ; Middle Aged ; Muscle Strength ; Muscle Weakness - physiopathology ; Muscle Weakness - therapy ; Musculoskeletal system ; Older people ; Patients ; Physical therapy ; Physical training ; Quality of Life ; Randomization ; Rehabilitation ; Research and Analysis Methods ; Resistance Training ; Strength training ; Switzerland ; Therapy ; Training ; Treatment Outcome ; Ventilation ; Weaning</subject><ispartof>PloS one, 2018-11, Vol.13 (11), p.e0207428-e0207428</ispartof><rights>2018 Eggmann et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2018 Eggmann et al 2018 Eggmann et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c526t-ae7d6974207b670e28a0f3cfd2f65a5e4d555da7206615a534797154876f0f673</citedby><cites>FETCH-LOGICAL-c526t-ae7d6974207b670e28a0f3cfd2f65a5e4d555da7206615a534797154876f0f673</cites><orcidid>0000-0003-4742-4225 ; 0000-0002-7379-7343</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6235392/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6235392/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,2102,2928,23866,27924,27925,53791,53793,79600,79601</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30427933$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Fleckenstein, Johannes</contributor><creatorcontrib>Eggmann, Sabrina</creatorcontrib><creatorcontrib>Verra, Martin L</creatorcontrib><creatorcontrib>Luder, Gere</creatorcontrib><creatorcontrib>Takala, Jukka</creatorcontrib><creatorcontrib>Jakob, Stephan M</creatorcontrib><title>Effects of early, combined endurance and resistance training in mechanically ventilated, critically ill patients: A randomised controlled trial</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Neuromuscular weakness resulting in severe functional impairment is common in critical care survivors. This study aimed to evaluate effects of an early progressive rehabilitation intervention in mechanically ventilated adults at risk.
This was a parallel, two-arm, assessor-blinded, randomised controlled trial with 6-months follow-up that was conducted in a mixed ICU of an academic centre in Switzerland. Previously independent, mechanically ventilated, critically ill adults with expected critical care stay ≥72 hours (n = 115) were randomised to a control group receiving standard physiotherapy including early mobilisation or to an experimental group with early endurance and resistance training combined with mobilisation. Primary endpoints were functional capacity (6-Minute Walk Distance) and functional independence (Functional Independence Measure) at hospital discharge. Secondary endpoints including muscle strength were assessed at critical care discharge. Safety was monitored closely by standard monitoring and predefined adverse events.
Physiotherapy started within 48 hours of critical care admission while 97% of participants were still ventilated and 68% on inotropes. Compared to the control group (n = 57), the experimental group (n = 58) received significantly more physiotherapy (sessions: 407 vs 377, p<0.001; time/session: 25min vs 18min, p<0.001) and had less days with sedation (p<0.001). Adverse events were rare (0.6%) and without consequences. There were no significant between-group differences in 6-Minute Walk Distance (experimental 123m (IQR 25-280) vs control 100m (IQR 0-300); p = 0.542) or functional independence (98 (IQR 66-119) vs 98 (IQR 18-115); p = 0.308). Likewise, no differences were found for the secondary outcomes, except a trend towards improved mental health in the experimental group after 6 months (84 (IQR 68-88) vs 70 (IQR 64-76); p = 0.023).
Early endurance and resistance training in mechanically ventilated, intensive care patients does not improve functional capacity or independence at hospital discharge compared to early standard physiotherapy but may improve mental health 6-months after critical care discharge.
German Clinical Trials Register (DRKS): DRKS00004347, registered on 10 September 2012.</description><subject>Activities of Daily Living</subject><subject>Adult</subject><subject>Adults</subject><subject>Aged</subject><subject>Anesthesia</subject><subject>Biology and Life Sciences</subject><subject>Clinical trials</subject><subject>Critical care</subject><subject>Critical Care - methods</subject><subject>Critical Illness - therapy</subject><subject>Early Ambulation</subject><subject>Exercise Therapy - methods</subject><subject>Female</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Illnesses</subject><subject>Intensive care</subject><subject>Intensive Care Units</subject><subject>Intervention</subject><subject>Male</subject><subject>Medical research</subject><subject>Medicine</subject><subject>Medicine and Health Sciences</subject><subject>Mental health</subject><subject>Middle Aged</subject><subject>Muscle Strength</subject><subject>Muscle Weakness - physiopathology</subject><subject>Muscle Weakness - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Eggmann, Sabrina</au><au>Verra, Martin L</au><au>Luder, Gere</au><au>Takala, Jukka</au><au>Jakob, Stephan M</au><au>Fleckenstein, Johannes</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effects of early, combined endurance and resistance training in mechanically ventilated, critically ill patients: A randomised controlled trial</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2018-11-14</date><risdate>2018</risdate><volume>13</volume><issue>11</issue><spage>e0207428</spage><epage>e0207428</epage><pages>e0207428-e0207428</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Neuromuscular weakness resulting in severe functional impairment is common in critical care survivors. This study aimed to evaluate effects of an early progressive rehabilitation intervention in mechanically ventilated adults at risk.
This was a parallel, two-arm, assessor-blinded, randomised controlled trial with 6-months follow-up that was conducted in a mixed ICU of an academic centre in Switzerland. Previously independent, mechanically ventilated, critically ill adults with expected critical care stay ≥72 hours (n = 115) were randomised to a control group receiving standard physiotherapy including early mobilisation or to an experimental group with early endurance and resistance training combined with mobilisation. Primary endpoints were functional capacity (6-Minute Walk Distance) and functional independence (Functional Independence Measure) at hospital discharge. Secondary endpoints including muscle strength were assessed at critical care discharge. Safety was monitored closely by standard monitoring and predefined adverse events.
Physiotherapy started within 48 hours of critical care admission while 97% of participants were still ventilated and 68% on inotropes. Compared to the control group (n = 57), the experimental group (n = 58) received significantly more physiotherapy (sessions: 407 vs 377, p<0.001; time/session: 25min vs 18min, p<0.001) and had less days with sedation (p<0.001). Adverse events were rare (0.6%) and without consequences. There were no significant between-group differences in 6-Minute Walk Distance (experimental 123m (IQR 25-280) vs control 100m (IQR 0-300); p = 0.542) or functional independence (98 (IQR 66-119) vs 98 (IQR 18-115); p = 0.308). Likewise, no differences were found for the secondary outcomes, except a trend towards improved mental health in the experimental group after 6 months (84 (IQR 68-88) vs 70 (IQR 64-76); p = 0.023).
Early endurance and resistance training in mechanically ventilated, intensive care patients does not improve functional capacity or independence at hospital discharge compared to early standard physiotherapy but may improve mental health 6-months after critical care discharge.
German Clinical Trials Register (DRKS): DRKS00004347, registered on 10 September 2012.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>30427933</pmid><doi>10.1371/journal.pone.0207428</doi><orcidid>https://orcid.org/0000-0003-4742-4225</orcidid><orcidid>https://orcid.org/0000-0002-7379-7343</orcidid><oa>free_for_read</oa></addata></record> |
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| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2018-11, Vol.13 (11), p.e0207428-e0207428 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_2133412424 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Public Library of Science (PLoS) Journals Open Access; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Activities of Daily Living Adult Adults Aged Anesthesia Biology and Life Sciences Clinical trials Critical care Critical Care - methods Critical Illness - therapy Early Ambulation Exercise Therapy - methods Female Hospitals Humans Illnesses Intensive care Intensive Care Units Intervention Male Medical research Medicine Medicine and Health Sciences Mental health Middle Aged Muscle Strength Muscle Weakness - physiopathology Muscle Weakness - therapy Musculoskeletal system Older people Patients Physical therapy Physical training Quality of Life Randomization Rehabilitation Research and Analysis Methods Resistance Training Strength training Switzerland Therapy Training Treatment Outcome Ventilation Weaning |
| title | Effects of early, combined endurance and resistance training in mechanically ventilated, critically ill patients: A randomised controlled trial |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-04T10%3A19%3A10IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Effects%20of%20early,%20combined%20endurance%20and%20resistance%20training%20in%20mechanically%20ventilated,%20critically%20ill%20patients:%20A%20randomised%20controlled%20trial&rft.jtitle=PloS%20one&rft.au=Eggmann,%20Sabrina&rft.date=2018-11-14&rft.volume=13&rft.issue=11&rft.spage=e0207428&rft.epage=e0207428&rft.pages=e0207428-e0207428&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0207428&rft_dat=%3Cproquest_plos_%3E2133412424%3C/proquest_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2133412424&rft_id=info:pmid/30427933&rft_doaj_id=oai_doaj_org_article_b35138eed5bd4b2d8c812ffda8693492&rfr_iscdi=true |