Collaborating with exercise physiologists may be key to patient mobility

Sept. 9, 2019
Research finds critically ill patients maintained or increased their level of activity after early mobility interventions with an exercise physiologist

Exercise physiologists can play a key role in efforts to provide safe and effective early mobilization in intensive care units (ICUs), according to new research published in American Journal of Critical Care (AJCC).

Exercise physiologists have historically practiced in clinical settings, such as sports medicine and rehabilitation, but they are gaining visibility in hospitals as members of interdisciplinary clinical teams. Their focus on improving a patient’s strength, endurance, exercise and mobility make them an ideal team member to manage early mobility for critically ill patients.

“Exercise Physiologists: Key to Providing Early Mobilization in the Intensive Care Unit” reports the results of a three-month initiative to introduce exercise physiologists as mobility specialists in three medical-surgical ICUs at Baylor St. Luke’s Medical Center in Houston. During the study period, patients received a minimum of one treatment session per day with an exercise physiologist.

Exercise physiologists mobilized 82 percent of patients admitted to the ICUs during the study period. The remaining 18 percent of patients either did not meet the mobilization or safety criteria or were unavailable because of a medical or surgical procedure. In contrast, a prior study in the same ICUs found that only 8 percent of patients were mobilized by physical therapists.

Almost all of the 216 patients (97 percent) in the study population maintained or increased their level of activity after receiving the early mobilization intervention led by an exercise physiologist. Using a 12-point scale to quantify the level of mobilization activity, the researchers documented an average 1.6 point change in activity level among the study population.

The researchers encountered adverse events during less than 1 percent of mobility sessions with the exercise physiologists.

“ICU clinicians and hospital staff have long been frustrated by the immobility dilemma and, despite research about the benefits of mobility, critically ill patients often remain on bed rest for too long,” said co-author Claudia DiSabatino Smith, PhD, RN, NE-BC. “Our study demonstrates that adding exercise physiologists to the interdisciplinary team can drive early, aggressive and progressive ICU patient mobility.”

As part of a broader delirium prevention effort that included early mobility, the academic medical center hired three exercise physiologists to work 40 hours a week. Prior to working with patients for three months, they received approximately eight weeks of discipline-specific didactic education and structured hands-on ICU training.

The exercise physiologists worked closely with other members of the interdisciplinary team to develop an evidence-based mobilization program that incorporated best practices for all patients who met intensivist-generated criteria for ICU mobilization. They worked under the direction of a registered nurse/delirium coordinator, and the intensivist and the patients’ assigned registered nurses, in addition to collaborating with patient care assistants, respiratory therapists and physical therapists.

Each participating ICU also received special durable medical equipment, including a sit-to-stand mechanical lift device, bedside stationary bicycles with adjustable resistance, hydraulic sit-to-stand walkers, rolling walkers with seats, and thoracic walkers with specialized hooks from which to hang wires, tubes and drains. Researchers also supplied gait belts, free weights and flexible TheraBands for active resistance exercise.