Effect of in-bed cycling on acute muscle wasting in critically ill adults: A randomised clinical trial

• Published in: Journal of critical care Vol. 59; pp. 86 - 93
• Main Authors: Nickels, Marc R., Aitken, Leanne M., Barnett, Adrian G., Walsham, James, King, Scott, Gale, Nicolette E., Bowen, Alicia C., Peel, Brent M., Donaldson, Samuel L., Mealing, Stewart T.J., McPhail, Steven M.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2020; Elsevier Limited
• Subjects: Atrophy; Care units; Critical care; Critical illness; Cycle ergometry; Early ambulation; Ergometry; Hospitals; Illnesses; Intensive; Intervention; Medical research; Mortality; Muscle wasting; Patients; Quality of life; Randomised control trial; Sarcopenia; Ultrasonic imaging; Ventilators; Critical illness; Sarcopenia; Care units; Muscle wasting; Intensive; Randomised control trial; Cycle ergometry; Early ambulation
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2020.05.008

To examine whether in-bed cycling assists critically ill adults to reduce acute muscle wasting, improve function and improve quality of life following a period of critical illness. A single-centre, two-group, randomised controlled trial with blinded assessment of the primary outcome was conducted in a tertiary ICU. Critically ill patients expected to be mechanically ventilated for at least 48 h were randomised to 30 min daily in-bed cycling in addition to usual-care physiotherapy (n = 37) or usual-care physiotherapy (n = 37). The primary outcome was muscle atrophy of rectus femoris cross-sectional area (RFCSA) measured by ultrasound at Day 10 following study enrolment. Secondary outcomes included manual muscle strength, handgrip strength, ICU mobility score, six-minute walk test distance and health-related quality of life up to six-months following hospital admission. Analysis included the 72 participants (mean age, 56-years; male, 68%) who completed the study. There were no significant between-group differences in muscle atrophy of RFCSA at Day 10 (mean difference 3.4, 95% CI -6.9% to 13.6%; p = .52), or for secondary outcomes (p-values ranged p = .11 to p = .95). In-bed cycling did not reduce muscle wasting in critically ill adults, but this study provides useful effect estimates for large-scale clinical trials. anzctr.org.au Identifier: ACTRN12616000948493. •In-bed cycling did not reduce acute muscle wasting in critically ill patients in this study.•In-bed cycling did not improve strength, function and quality of life in this study.•Larger-scale studies are required to evaluate the effectiveness of in-bed cycling.