title: Combining nutrition and exercise to optimize survival and recovery from critical illness: Conceptual and methodological issues.
abstract: Survivors of critical illness commonly experience neuromuscular abnormalities, including muscle weakness known as ICU-acquired weakness (ICU-AW). ICU-AW is associated with delayed weaning from mechanical ventilation, extended ICU and hospital stays, more healthcare-related hospital costs, a higher risk of death, and impaired physical functioning and quality of life in the months after ICU admission. These observations speak to the importance of developing new strategies to aid in the physical recovery of acute respiratory failure patients. We posit that to maintain optimal muscle mass, strength and physical function, the combination of nutrition and exercise may have the greatest impact on physical recovery of survivors of critical illness. Randomized trials testing this and related hypotheses are needed. We discussed key methodological issues and proposed a common evaluation framework to stimulate work in this area and standardize our approach to outcome assessments across future studies.
authors.affiliation: Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, Ontario, Canada. Electronic address: dkh2@queensu.ca.
authors.forename: Daren K
authors.initials: DK
authors.lastname: Heyland
authors.affiliation: Division of Pulmonary and Critical Care Medicine, University of Vermont, Burlington, VT, USA.
authors.forename: Renee D
authors.initials: RD
authors.lastname: Stapleton
authors.affiliation: Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada.
authors.forename: Marina
authors.initials: M
authors.lastname: Mourtzakis
authors.affiliation: Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, WA, USA.
authors.forename: Catherine L
authors.initials: CL
authors.lastname: Hough
authors.affiliation: Sticht Center on Aging, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Morris
authors.affiliation: Center for Translational Research in Aging and Longevity, Department of Health & Kinesiology, Texas A&M University, College Station, TX, USA.
authors.forename: Nicolaas E
authors.initials: NE
authors.lastname: Deutz
authors.affiliation: John Hopkins Bloomberg School of Public Health, Department of Biostatistics, Baltimore, MD, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Colantuoni
authors.affiliation: Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, Ontario, Canada.
authors.forename: Andrew
authors.initials: A
authors.lastname: Day
authors.affiliation: Department of Agriculture, Food & Nutritional Sciences, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Carla M
authors.initials: CM
authors.lastname: Prado
authors.affiliation: Division of Pulmonary and Critical Care Medicine and Department of Physical Medicine and Rehabilitation, John Hopkins Medicine, Baltimore, Maryland, USA.
authors.forename: Dale M
authors.initials: DM
authors.lastname: Needham
mesh_terms: D016638:Critical Illness / Q000534:rehabilitation*; D004032:Diet; D015444:Exercise; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D018908:Muscle Weakness / Q000534:rehabilitation; D009468:Neuromuscular Diseases / Q000534:rehabilitation; D015596:Nutrition Assessment; D009752:Nutritional Status; D011788:Quality of Life; D012121:Respiration, Artificial
keywords: Clinical trials; Enteral nutrition; Exercise; Outcomes research; Parenteral nutrition; Rehabilitation