title: Systematic review of early exercise in intensive care: A qualitative approach.
abstract: BACKGROUND
  Practice guidelines recommend early physical therapy in intensive care units (ICU). Feasibility, safety and efficacy are confirmed by growing evidence-based data.
  
  
  OBJECTIVE
  To perform a qualitative systematic literature review on early exercise in ICUs, focused on the subject areas of "how to do", "for which patients" and "for what benefits".
  
  
  METHODS
  Articles were obtained from the PubMed, Google Scholar, Physiotherapy Evidence Database (PEDro), Embase, CINAHL, CENTRAL, Cochrane and ReeDOC databases. The full texts of references selected according to title and abstract were read. Data extraction and PEDro scoring were performed. Consort recommendations were used for the drafting of the systematic review, which was declared on the Prospero website.
  
  
  RESULTS
  We confirm the feasibility and safety of early exercise in the ICU. Convergent evidence-based data are in favour of the efficacy of early exercise programs in ICUs. But the potential benefit of earlier program initiation has not been clearly demonstrated. Our analysis reveals tools and practical modalities that could serve to standardize these programs. The scientific literature mainly emphasizes the heterogeneity of targeted populations and lack of precision concerning multiple criteria for early exercise programs.
  
  
  CONCLUSIONS
  Changes in the professional culture of multidisciplinary-ICU teams are necessary as concerns early exercise. Physical therapists must be involved and their essential role in the ICU is clearly justified. Although technical difficulties and questions remain, the results of the present qualitative review should encourage the early and progressive implementation of exercise programs in the ICU.
authors.affiliation: Physical Medicine and Rehabilitation Department, Clermont-Ferrand University Hospital, 58, rue Montalembert BP 69, 63003 Clermont-Ferrand cedex 1, France.
authors.forename: Hélène
authors.initials: H
authors.lastname: Laurent
authors.affiliation: Physical Medicine and Rehabilitation Department, Clermont-Ferrand University Hospital, 58, rue Montalembert BP 69, 63003 Clermont-Ferrand cedex 1, France.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Aubreton
authors.affiliation: Department of Sport Medicine and Functional Explorations, Clermont-Ferrand University Hospital, 58, rue Montalembert BP 69, 63003 Clermont-Ferrand cedex 1, France; Inra UMR 1019, CRNH-Auvergne, 63000 Clermont-Ferrand, France.
authors.forename: Ruddy
authors.initials: R
authors.lastname: Richard
authors.affiliation: Physical Medicine and Rehabilitation Department, Clermont-Ferrand University Hospital, 58, rue Montalembert BP 69, 63003 Clermont-Ferrand cedex 1, France.
authors.forename: Yannael
authors.initials: Y
authors.lastname: Gorce
authors.affiliation: Physical Medicine and Rehabilitation Department, Clermont-Ferrand University Hospital, 58, rue Montalembert BP 69, 63003 Clermont-Ferrand cedex 1, France.
authors.forename: Emilie
authors.initials: E
authors.lastname: Caron
authors.affiliation: Physical Medicine and Rehabilitation Department, Clermont-Ferrand University Hospital, 58, rue Montalembert BP 69, 63003 Clermont-Ferrand cedex 1, France.
authors.forename: Aurélie
authors.initials: A
authors.lastname: Vallat
authors.affiliation: Physical Medicine and Rehabilitation Department, Clermont-Ferrand University Hospital, 58, rue Montalembert BP 69, 63003 Clermont-Ferrand cedex 1, France.
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Davin
authors.affiliation: Perioperative Medicine Department, University Hospital of Clermont-Ferrand, 1, place Lucie-et-Raymond-Aubrac, Clermont-Ferrand cedex 1, France. Electronic address: jmconstantin@chu-clermontferrand.fr.
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Constantin
authors.affiliation: Physical Medicine and Rehabilitation Department, Clermont-Ferrand University Hospital, 58, rue Montalembert BP 69, 63003 Clermont-Ferrand cedex 1, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Coudeyre
mesh_terms: D003422:Critical Care / Q000379:methods*; D004434:Early Ambulation / Q000379:methods*; D005081:Exercise Therapy / Q000379:methods*; D006801:Humans
keywords: Activity; Early exercise; Intensive care unit; Mobilization; Physical therapy; Systematic review