A scoping review of passive exercise in healthy subjects and ICU patients
CCCF ePoster library. Chen J. 11/12/19; 283446; EP85
Jennifer Chen
Jennifer Chen
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Topic: Systematic Review, Meta-Analysis, or Meta-Synthesis

Chen, Jennifer1; Fiorini, Kyle2; Zhou, Shijie2; Martin, Claudio2; McIntyre, Chris1,2; Ball, Ian2,3; Slessarev, Marat1,2
Departments of Medical Biophysics1, Medicine2, and Epidemiology and Biostatistics3, Western University, London, Ontario

INTRODUCTION: Early mobilization of intensive care unit (ICU) patients has been found to decrease patients' hospital and ICU length of stay [1], decrease delirium duration [2], and increase ambulation distance at hospital discharge [3]. These early mobilization studies often combine the use of both passive and active exercise [2–4], with passive mobilization used when patients are unable to actively participate. Although early mobilization has been deemed to be safe and feasible in ICU patients [4, 5], few studies in ICU cohorts focus solely on passive exercise. Given the critically ill nature of these patients, it is important to have a comprehensive understanding of early passive exercise and its dosage on hemodynamic, metabolic, perfusion, and patient outcomes, and to contextualize the responses of ICU patients when compared to healthy subjects, to guide its application in ICU settings.
OBJECTIVES: 1) To determine common methodologies used to conduct early passive mobilization studies in ICU patients and healthy subjects, and 2) To identify commonly measured outcome parameters following passive exercise
METHODS: We conducted a search of Ovid Medline and Embase to identify potentially relevant articles. We included studies that reported global hemodynamic parameters, measures of cerebral perfusion and cardiac function, local limb blood flow, and clinical outcomes in adult ICU patients and healthy subjects. We extracted the following data from each study: primary objective, study design, patient population assessed, modality of passive exercise used, protocol of passive exercise implemented, hemodynamic parameters, metabolic parameters, cerebral blood flow/perfusion parameters, measures of cardiac function, local blood flow, and clinical outcomes.
RESULTS: Most studies on passive exercise were conducted in healthy subjects, with only eight of fifty-two studies including ICU cohorts. In both healthy and ICU cohorts, a wide variety of passive exercise modalities were used with the most common two modalities being passive cycling and passive leg movement. Passive exercise in ICU patients was primarily conducted in the supine and semi-recumbent positions, while studies in healthy subjects were mainly conducted in upright, seated positions. Protocols used in both healthy and ICU subjects varied greatly in intensity, duration and frequency, and lacked a standardized method for determination of exercise dose in either cohorts. In healthy subjects, hemodynamic and metabolic responses were heterogeneous, and remained so even when accounting for age, sex, modality, and exercise dosage. Passive exercise in ICU patients did not elicit changes in mean arterial pressure, however, the remainder of hemodynamic and metabolic findings were either heterogeneous or inconclusive due to the small number of studies that reported these outcomes, and no ICU studies have yet reported outcomes on cardiac function nor brain perfusion.
CONCLUSIONS: Dosage of passive exercise remains yet to be standardized, in either healthy subjects or ICU patients. Furthermore, impact of passive exercise on organ function and long-term outcomes in ICU patients is poorly understood. Given the increased interest the use of early passive exercise in ICUs, along with heterogeneity of hemodynamic responses we have seen in both healthy and ICU subjects, it is important to further investigate the impact that passive exercise and its dosage will have on outcomes in ICU patients.

1. Needham DM, Korupolu R, Zanni JM, et al (2010) Early physical medicine and rehabilitation for patients with acute respiratory failure: a quality improvement project. Arch Phys Med Rehabil 91:536–542. https://doi.org/10.1016/j.apmr.2010.01.002
2. Schweickert WD, Pohlman MC, Pohlman AS, et al (2009) Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet 373:1874–1882. https://doi.org/10.1016/S0140-6736(09)60658-9
3. Burtin C, Clerckx B, Robbeets C, et al (2009) Early exercise in critically ill patients enhances short-term functional recovery. Crit Care Med 37:2499–2505. https://doi.org/10.1097/CCM.0b013e3181a38937
4. Kho ME, Molloy AJ, Clarke FJ, et al (2019) Multicentre pilot randomised clinical trial of early in-bed cycle ergometry with ventilated patients. BMJ Open Respiratory Research 6:e000383. https://doi.org/10.1136/bmjresp-2018-000383
5. Pires-Neto RC, Kawaguchi YMF, Hirota AS, et al (2013) Very Early Passive Cycling Exercise in Mechanically Ventilated Critically Ill Patients: Physiological and Safety Aspects - A Case Series. PLOS ONE 8:e74182. https://doi.org/10.1371/journal.pone.0074182

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