In-Bed Cycling May Be Viable Exercise for ICU Patients

Patients in a hospital Intensive Care Unit (ICU) could recover more quickly by exercising using a bicycle during their stay.

In-bed cycling sessions for ICU patients, even those who are critically ill or mechanically ventilated, was demonstrated to be safe in a study by researchers at McMaster University in Ontario, Canada. Lead author Michelle Kho, an assistant professor with the School of Rehabilitation Science, said most people are under the impression that ICU patients are not well enough for physical movement.

“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,” said Kho, who is also a physiotherapist at St. Joseph’s Healthcare Hamilton in Ontario.

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Patients who leave the ICU are at high risk for muscle weakness and disability. Muscle atrophy and weakness starts within days of a patient entering the ICU.

By using a cycling exercise, the patient’s legs, especially the hip flexors which are most vulnerable to bed rest, stay strong. The exercise can have patients leaving the ICU happier and healthier, while possibly helping to decrease the cost of critical care for the health care system.

“Our TryCYCLE study builds on this previous work and finds it is safe and feasible to systematically start in-bed cycling within the first four days of mechanical ventilation and continue throughout a patient’s ICU stay,” Kho said.

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Kho and her team conducted a study of 33 patients in the ICU between October, 2013 and August, 2014. Patients were 18 years of age or older, receiving mechanical ventilation, and walking independently before entering the ICU.

The ICU treatment included 30 minutes of cycling with a 1-minute cool-down period using a motorized stationary bicycle affixed to the bed for six days a week. The cycling was in addition to any routine physical therapy the patients had and lasted the duration of the patients’ stays to a maximum of 28 days.

Researchers found that cycling within the first four days of mechanical ventilation for patients with stable blood flow is safe and feasible. The patients started cycling within the first three days of entering the ICU and cycled an average of 9 kilometers, or almost five and a half miles, during their stay.

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The participants started with passive cycling at a rate of five revolutions per minute, but if patients initiated active cycling, then the physical therapist promoted active participation. Low resistance was used during active cycling, and patients were allowed to cycle at a self-selected rate. The participants surprised the researchers, Kho said.

“Patients’ abilities to cycle during critical illness exceeded our expectations,” she said.

The study listed the absence of a control group as a limitation. With no control group present, the group could not determine if the cycling improved patient outcomes compared to usual care.

Kho said more research is needed to determine whether cycling with critically ill patients improves their physical function and that the next step is to have several ICUs start the cycling study in a randomized trial.