In-Bed Cycling Feasible for ICU Patients on Ventilation Interview with:

Michelle Kho, PT, PhD</strong> Canada Research Chair in Critical Care Rehabilitation and Knowledge Translation Assistant Professor School of Rehabilitation Science McMaster University

Dr. Michelle Kho

Michelle Kho, PT, PhD
Canada Research Chair in Critical Care Rehabilitation and Knowledge Translation
Assistant Professor
School of Rehabilitation Science
McMaster University What is the background for this study?

Response: Patients who survive the ICU are at risk for muscle weakness and can experience physical functional disability lasting 5 to 8 years after the ICU. From a study conducted in Belgium, patients who were randomized to receive cycling after being in ICU for 2 weeks walked farther at ICU discharge than those who did not. Other research supported physiotherapy starting within days of starting mechanical ventilation to improve functional outcomes. Our CYCLE research program combines these 2 concepts – Can we start cycling very early in a patient’s ICU stay, and will this improve functional outcomes post-ICU? What are the main findings?

Response: TryCYCLE was the first study in the CYCLE research program. In TryCYCLE, we determined it was safe and feasible to bike with mechanically ventilated medical surgical patients very early in their ICU stay. We enrolled 33 patients who could previously walk before they developed their ICU illness. ICU physiotherapists started 30 minutes of in-bed cycling within the first 3 days of ICU admission, while patients received mechanical ventilation. Our ICU cycles have a motor, and provide passive cycling or can allow patients to bike actively. Of 205 in-bed cycling sessions, 2% stopped early due to safety concerns; this was similar to or lower than other studies of early rehabilitation in the ICU. On average, patients cycled 9 km in the ICU before discharged to the hospital wards, which exceeded our expectations. What should readers take away from your report?

Response: It is safe and feasible for ICU physiotherapists to conduct in-bed cycling with patients receiving mechanical ventilation early in their ICU stay. What recommendations do you have for future research as a result of this study?

Response: Ultimately, we need to understand if early in-bed cycling with patients receiving mechanical ventilation improves patients’ outcomes post-ICU. This needs to be done with a randomized clinical trial (RCT). In TryCYCLE, we learned we could deliver early in-bed cycling in one centre. Next, we need to see if we can do in-bed cycling in multiple centres, in preparation for a future large scale randomized study. Our next study is the CYCLE Pilot RCT. Is there anything else you would like to add?

Response: We are grateful to the Canadian Institutes of Health Research, Canada Research Chairs, and the St. Joseph’s Healthcare Foundation for supporting TryCYCLE. Restorative Therapies (Baltimore, MD) loaned us 2 RT-300 supine cycles for our ongoing research with critically ill patients. Thank you for your contribution to the community.


TryCYCLE: A Prospective Study of the Safety and Feasibility of Early In-Bed Cycling in Mechanically Ventilated Patients
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, Canadian Critical Care Trials Group
Published: December 28, 2016

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Last Updated on December 31, 2016 by Marie Benz MD FAAD