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

Nickels, M. R., Aitken, L. M. ORCID: 0000-0001-5722-9090, Barnett, A. G. , Walsham, J., King, S., Gale, N. E., Bowen, A. C., Peel, B. M., Donaldson, S. L., Mealing, S. T. J. & McPhail, S. M. (2020). Effect of in-bed cycling on acute muscle wasting in critically ill adults: A randomised clinical trial. Journal of Critical Care, 59, pp. 86-93. doi: 10.1016/j.jcrc.2020.05.008

Abstract

Purpose
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.

Materials and methods
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.

Results
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).

Conclusions and relevance
In-bed cycling did not reduce muscle wasting in critically ill adults, but this study provides useful effect estimates for large-scale clinical trials.

Publication Type:	Article
Additional Information:	© 2020. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/
Publisher Keywords:	Critical illness, Randomised control trial, Muscle wasting, Sarcopenia, Intensive, Care units, Early ambulation, Cycle ergometry
Subjects:	R Medicine > RT Nursing
Departments:	School of Health & Psychological Sciences > Nursing