Early in-bed cycling for mechanically ventilated patients in the intensive care unit (ICU) is safe and may improve physical functioning for patients when discharged from hospital, according to the results of the CYCLE trial – the largest ICU rehabilitation device trial.
Critically ill patients frequently develop muscle weakness during their stay in the ICU. Known as ICU-acquired weakness, this often develops as a secondary disorder while patients are being treated for other life-threatening conditions.
Physiotherapy during and after an ICU stay aims to combat muscle weakness and improve post-hospital discharge physical functioning, such as walking.
The aim of the CYCLE trial was to study the impact of early in-bed cycling in combination with typical ICU physiotherapy versus typical ICU physiotherapy alone. Researchers enrolled 360 patients across 16 locations in Canada, the United States, and Australia.
On average, patients in the CYCLE trial biked for 27 minutes per session, with a median of 1 km per session. At St. Joseph’s Healthcare Hamilton, researchers enrolled 41 patients into the study, half of whom were randomized to the cycling plus usual physiotherapy group. Together they cycled a distance 170.8 km from their hospital beds, which is approximately the distance from Hamilton to Orillia, ON.
Dr. Michelle Kho, a physiotherapist and researcher at St. Joseph’s Healthcare Hamilton and associate professor in the School of Rehabilitation Science at McMaster University, led the international trial.
“While we found that there was no difference in physical function scored at 3 days post-ICU discharge, we did find that at hospital discharge, some patients who received additional cycling reported having better function, which was evident based on their improved performance,” said Dr. Kho, principal investigator of the CYCLE trial. “It was pleasing to see that patients in both groups improved with treatments led by ICU physiotherapists.”
“More broadly, when CYCLE is considered with 29 other cycling trials and just over 3,100 patients, we found that cycling in the ICU improved physical function at ICU discharge, decreased hospital length of stay by at least 1 day, and was not associated with adverse safety events,” said Dr. Heather O’Grady, CYCLE co-investigator.
Photo: Dr. Kho (seated far left), Dr. O’Grady (standing sixth from right) and the CYCLE trial team members at St. Joseph’s Healthcare Hamilton.
“Considering all of the evidence, in-bed cycling can offer patients more variety to have a head start at recovery upon hospital discharge,” added Dr. Kho.
The results of the CYCLE trial were published in NEJM Evidence on June 12, 2024, and simultaneously presented by Dr. Kho and her team at the 2024 Critical Care Reviews Meeting in Belfast, Northern Ireland.