Workouts in the ICU

October 11, 8:58 PMSF Fitness ExaminerJim Evans

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Critically ill patients probably won’t be jogging around the hospital halls in the foreseeable future, but critical care experts at Johns Hopkins are suggesting that light exercise might help to boost their recovery.

In a new report reported by Johns Hopkins Medicine (http://www.hopkinsmedicine.org/) and published in the journal Critical Care Medicine (journals.lww.com/ccmjournal/), critical care specialist and senior researcher Dale Needham, M.D., Ph.D. and his colleagues describe how muscle-strengthening exercises can combat muscle wasting in critically ill patients. More than 400 patients in The Johns Hopkins Hospital’s medical ICU were treated with special exercises during the past year.

“ICU-related muscle weakness is the number one factor in prolonging a patient’s recovery and delaying their return to a normal life, including work and recreational activities,” says Needham.

Physical therapy exercises including electrical stimulation, walking, and even in-bed cycling using a specially designed device attached to the end of the bed have been the primary means of exercise.

Long periods of bed rest, even for short periods lasting only a few days, can lead to significant muscle weakness and, in some cases, patients have lost as much as 5 percent per week of leg muscle mass.

“Bed rest often only compounds the problem and makes it worse,” says critical care expert Eddy Fan, an instructor at Hopkins who collaborates on research with Needham. Fan has had one patient lose as much as 60 pounds during an ICU stay of several weeks. “Many patients are already weak when they arrive in the ICU, having been sick for a while, and having dropped weight as a result of poor appetite,” he says. “So they are often starting from a personal low point when they get here, and the lack of physical activity only hastens their decline. Early physical therapy is helping us to fix this problem,” he adds. “It really is changing the way we practice critical care medicine in the ICU.”

Since the introduction of exercise in the ICU, average stays in Hopkins Hospital’s medical intensive care unit have dropped by more than 20 percent, and patients are leaving the hospital sooner, stronger and happier.