E-CYCLE: Clinical trial of in-bed cycling in elderly, mechanically-ventilated patients

Read more about the project here.

Patients in the intensive care unit (ICU) are the sickest in hospital, and often need advanced life support such as breathing machines. Survivors of critical illness are typically very weak and disabled. Up to one in four have severe leg weakness impairing their quality of life for as long as five years after ICU discharge. Older adults are particularly at risk of weakness, and can lose up to 4% leg strength per day due to bed rest.

The main goal of this research program was to see if patients who needed a breathing machine recovered faster if they received early in-bed cycling than those who did not. In-bed cycling uses special equipment that attaches to a patient’s hospital bed, allowing them gentle leg exercise while in the ICU. Before doing a larger study, we conducted a study in three ICUs with different characteristics to understand if the same in-bed cycling very early in a patient’s ICU stay could be delivered similarly. 

Older adult patients (65 years) admitted to the ICU who needed a breathing machine and were expected to survive their ICU stay were eligible. Patients received one of two treatments: (1) in-bed cycling plus routine physiotherapy (PT) or (2) routine PT alone. Patients were assigned to either treatment in a manner similar to flipping a coin. All patients received treatments and had their strength tested by specially trained physiotherapists.

Prior to this research program, no researchers had specifically studied early rehabilitation in the ICU in older adults. Our research studied the use of early in-bed cycling in the ICU in older adults and how it affected issues important to them (e.g., walking, quality of life). As the demand for breathing machines in Canadian ICUs is expected to increase by 106% for people over 60 years between 2000 and 2026, studies like this will be helpful to reduce the impact of weakness and improve quality of life in older ICU survivors.

Dr. Michelle Kho, PhD, PT is an Assistant Professor in the School of Rehabilitation Science, Faculty of Health Sciences at McMaster University. She is also an Adjunct Assistant Professor in the Department of Physical Medicine and Rehabilitation at Johns Hopkins University in Baltimore, MD.  Dr. Kho completed her BHSc in Physiotherapy at McMaster, and BSc and MSc in Kinesiology at the University of Waterloo. She holds a PhD in Health Research Methodology from McMaster University, where she also completed a postdoctoral CIHR research fellowship. As a physiotherapist, she also cares for patients in the St. Joseph’s Healthcare ICU in Hamilton. Dr. Kho is leading a clinical research program of early in-bed cycling in mechanically ventilated patients to improve patient outcomes. Her research interests include novel early rehabilitation strategies to reduce weakness in ICU patients, knowledge translation, research methodology (systematic reviews, practice guidelines), and health services and outcomes research.