cycling exercise for critically ill and mechanically ventilated patients
in the intensive care unit (ICU) is considered safe and feasible.
cycling helps patients to strengthen their leg muscles while they are
confined to bed.
Patients in the intensive care
unit (ICU) may benefit greatly from early cycling while still in bed. It will
help them recover faster. The study was conducted by a research team from McMaster University and
St. Joseph's Healthcare Hamilton.
study gives a green signal to safely start in-bed cycling sessions with the
critically ill, mechanically ventilated patients, early into their ICU
‘In-bed cycling among critically-ill patients, helps them recover more quickly by strengthening their muscles and improving the overall health.’
is a life support system that helps patients to breath when they cannot breathe on
their own. It either supports breathing or completely controls breathing
depending on the patient's condition. Uses
- Supply oxygen to lungs
- Get rid of carbon dioxide
- Ease breathing
- Control breathing in patients who have serious
injury or illness that causes breathing to stop
"People may think that ICU patients
are too sick for physical activity, but we know that if patients start in-bed
cycling two weeks into their ICU stay, they will walk farther at hospital
discharge," says the study's lead author Michelle Kho, an assistant
professor in the School of Rehabilitation Science at McMaster University and
physiotherapist at St. Joseph's Healthcare Hamilton.TryCYCLE
new study termed as "TryCYCLE",
builds on the findings that it is
safe to start in-bed cycling sessions in patients admitted to the ICU, within
four days of mechanical ventilation and it would be beneficial if the exercise
is continued for the entire stay.
TryCYCLE is the first among
a series of studies that will determine the effects of early
in-bed cycling with critically ill patients. What ICU Admission Does to the Body
Patients who survive their ICU stay are
at high risk for:
- Muscle weakness that starts within days of ICU admission
- Muscle atrophy
The intensive care acquired muscle
weakness is also known as neuromuscular weakness.
This problem affects more than half of the adults admitted to the ICU for more
than a week.
The muscle weakness becomes
apparent when an attempt is made to wean the patient from the ventilator.
another frequent problem observed in patients in the Intensive Care Units. The
term describes the disorder in the structure and in the function of the muscle,
caused by a reduction in the muscle mass.
The incidence rates range from
25-90 % in patients with prolonged hospitalization.
The main cause for this is bed rest
and immobilization. It mainly affects the musculoskeletal, cardiovascular and
A primary goal of treatment for the
patients in the ICU is prevention of muscle weakness and wasting as it helps to
reduce the time spent in ICU and finally improves the quality of patients'
Testing the Effects of In-Bed
The research team
studied the effects of cycling on ICU admitted patients for over a year.
They included 33 patients aged 18
years or older for their study. The patients needed mechanical ventilation and
walked independently, prior to their admission.
A special motorized stationary
in-bed cycling equipment was used for the study.
The exercise included 30 minutes of supine cycling for six days a week, using the bicycle affixed to the bed.
team found that early cycling within the first four days of admission
among mechanically ventilated patients with stable blood flow is safe and feasible.
Patients started cycling within the
first three days of ICU admission and cycled about 9 km on an average during their ICU stay.
"Patients' abilities to cycle
during critical illness exceeded our expectations," says Kho.
Benefits of Cycling Among
The general health advantages of
cycling as an exercise for healthy individuals are manifold-
Strengthening of muscles-
Cycling helps to strengthen and tone muscles of the thighs and calf.
helps in controlling diabetes. The muscles use the glucose in the blood for
energy and thus reduces the amount of sugar in blood.
Pain & Stress Management-
is considered as a 'releasing' exercise
Releasing exercises help alleviate physiological issues like pain and
psychological issues like tension and stress.
helps in burning calories and shedding weight.
Reduces cancer risk-
who undertook moderate to high physical activity in their early and middle ages
reduced their risk of cancer.
The advantages of cycling among the
critically ill are two-fold:
- It causes speedy recovery among patients
- Alleviates the high cost for the health care
system, associated with critical care.
Cycling targets the legs,
especially the hip flexors. These muscles are most affected
during bed rest. By
strengthening these muscles,
the overall health improves and
patients may go home sooner, stronger and happier.
More research is
needed to determine if this early cycling with critically ill patients improve
their physical function.
The next step is
to start the in-bed cycling study in a pilot randomized trial in
many hospital ICUs.
The TryCYCLE study was funded by
the Canadian Institutes of Health and was published
in the journal PLOS ONE
. Intensive Care Unit Statistics
more than 5.7 million patients are admitted
to intensive care units (ICUs)
20% of acute care admissions
are to an ICU and up to 58% of emergency department
admissions result in an ICU admission.
to the American Hospital Association's 2014 annual survey, all acute care
hospitals have at least one intensive care unit (ICU), and approximately 55,000 critically ill patients
are cared for each day.
2006 to 2010, the number of critical care beds in the United States increased
15%, from 67,579 to 77,809.
- Michelle E. Kho, Alexander J. Molloy, France J. Clarke, Daana Ajami, Magda Mccaughan, Kristy Obrovac, Christina Murphy, Laura Camposilvan, Margaret S. Herridge, Karen K. Y. Koo, Jill Rudkowski, Andrew J. E. Seely, Jennifer M. Zanni, Marina Mourtzakis, Thomas Piraino, Deborah J. Cook, 'Canadian Critical Care Trials Group. TryCYCLE: A Prospective Study of the Safety and Feasibility of Early In-Bed Cycling in Mechanically Ventilated Patients.' PLOS ONE, (2016) DOI: 10.1371/journal.pone.0167561
- Mechanical Ventilation - (http://www.thoracic.org/patients/patient-resources/resources/mechanical-ventilation.pdf)
- Health Benefits of Cycling - (https:www.organicfacts.net/health-benefits/other/health-benefits-of-cycling.html)
- A stronger approach to weakness in the intensive care unit - (https:www.ncbi.nlm.nih.gov/pmc/articles/PMC1065060/)
- Muscle Atrophy in Intensive Care Unit Patients - (https:www.ncbi.nlm.nih.gov/pmc/articles/PMC4315632/)