A TRIAL OF EARLY IN-BED CYCLING VERSUS STANDARD RESPIRATORY THERAPY FOR PREVENTING ICU-ACQUIRED WEAKNESS IN MECHANICALLY VENTILATED PATIENTS: A RANDOMIZED CONTROLLED TRIAL

Authors

DOI:

https://doi.org/10.71000/cent2y50

Keywords:

Critical Care, Intensive Care Unit, Mechanical Ventilation, Muscle Atrophy, Muscle Strength, Rehabilitation, Randomized Controlled Trial

Abstract

Background: Intensive care unit–acquired weakness is a common complication in mechanically ventilated patients, leading to significant muscle atrophy, reduced strength, delayed ventilator liberation, and impaired functional recovery. Conventional respiratory therapy alone is often insufficient to prevent early skeletal muscle loss, highlighting the need for proactive interventions. Early mobilization strategies, including in-bed cycling and neuromuscular electrical stimulation, have emerged as potential approaches to preserve muscle mass and improve functional outcomes.

Objective: To evaluate whether early in-bed cycling combined with neuromuscular electrical stimulation is more effective than standard respiratory therapy in preventing muscle loss and preserving strength and functional independence in mechanically ventilated adult patients.

Methods: A randomized controlled trial was conducted in a South Punjab ICU, enrolling 60 adult patients requiring mechanical ventilation for more than 48 hours. Participants were randomly assigned to an intervention group receiving daily in-bed cycling plus neuromuscular electrical stimulation or a control group receiving standard respiratory therapy. Quadriceps muscle thickness was measured using ultrasound, muscle strength was assessed via the Medical Research Council sum score, and functional outcomes were evaluated using the ICU Mobility Scale and ventilator-free days. Data were analyzed using independent and paired t-tests for normally distributed continuous variables, with p < 0.05 considered significant.

Results: Patients receiving the intervention demonstrated significantly smaller reductions in quadriceps thickness (−1.1 ± 0.6 mm vs −3.5 ± 0.8 mm, p < 0.001) and higher MRC scores at ICU discharge (46.2 ± 6.1 vs 39.4 ± 6.8, p = 0.001) compared with controls. Functional outcomes were also improved, with higher ICU Mobility Scale scores (7.2 ± 1.6 vs 5.3 ± 1.8, p = 0.003) and more ventilator-free days (18.4 ± 4.2 vs 14.1 ± 4.9, p = 0.004). No adverse events related to the intervention were reported.

Conclusion: Early in-bed cycling combined with neuromuscular electrical stimulation effectively preserves muscle mass, enhances strength, and improves functional recovery in mechanically ventilated ICU patients. These findings support the integration of proactive neuromuscular interventions into critical care practice to mitigate ICU-acquired weakness.

Author Biographies

  • Nafeesa Ishfaq, Kohat University of Science and Technology, Kohat, Khyber Pakhtunkhwa, Pakistan.

    Lecturer & Clinical Physical Therapist, Department of Physical Therapy, Kohat University of Science and Technology, Kohat, Khyber Pakhtunkhwa, Pakistan.

  • Muhammad Shakir Khan, Riphah International University, Islamabad, Pakistan.

    Physical Therapist, Faculty of Rehabilitation and Allied Health Sciences, Riphah International University, Islamabad, Pakistan.

  • Tooba Rauf, Bahria Active, Bahria Town, Rawalpindi, Pakistan.

    Physical Therapist, Physio & Rehab Department, Bahria Active, Bahria Town, Rawalpindi, Pakistan.

  • Fatima Shabbir , Bahria Active, Bahria Town, Rawalpindi, Pakistan.

    Physical Therapist, Physio & Rehab Department, Bahria Active, Bahria Town, Rawalpindi, Pakistan.

  • Akash Arish, Bahria Active, Bahria Town, Rawalpindi, Pakistan.

    Physical Therapist, Physio & Rehab Department, Bahria Active, Bahria Town, Rawalpindi, Pakistan.

  • Iqra Fatima, Riphah International University, Islamabad, Pakistan.

    Physical Therapist, Faculty of Rehabilitation and Allied Health Sciences, Riphah International University, Islamabad, Pakistan.

  • Akif Saeed Ch, Hope Family Clinic & Rehab, Faisalabad, Pakistan.

    Director Medical Services & Research, Hope Family Clinic & Rehab, Faisalabad, Pakistan.

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Published

2025-10-26

Issue

Vol. 3 No. 10 (2025): Vol. 3 No. 10 (October 2025)

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Articles

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Copyright (c) 2025 Nafeesa Ishfaq, Muhammad Shakir Khan, Tooba Rauf, Fatima Shabbir , Akash Arish, Iqra Fatima, Akif Saeed Ch (Author)

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