Research from JAMA Internal Medicine — Comparison of Posthospitalization Function and Community Mobility in Hospital Mobility Program and Usual Care Patients — A Randomized Clinical Trial

Background: Bed rest and immobility in patients on mechanical ventilation or in an intensive care unit (ICU) have detrimental effects. Studies in medical ICUs show that early mobilization is safe, does not increase costs, and can be associated with decreased ICU and hospital lengths of stay (LOS).Objective: The purpose of this study was to assess the effects of an early mobilization protocol on complication rates, ventilator days, and ICU and hospital LOS for patients admitted to a trauma and burn ICU (TBICU).Design: This was a retrospective cohort study of an interdisciplinary quality-improvement program.Methods: Pre– and post–early mobility program patient data from the trauma registry for 2,176 patients admitted to the TBICU between May 2008 and April 2010 were compared.Results: No adverse events were reported related to the early mobility program. After adjusting for age and injury severity, there was a decrease in airway, pulmonary, and vascular complications (including pneumonia and deep vein thrombosis) post–early mobility program. Ventilator days and TBICU and hospital lengths of stay were not significantly decreased.Limitations: Using a historical control group, there was no way to account for other changes in patient care that may have occurred between the 2 periods that could have affected patient outcomes. The dose of physical activity both before and after the early mobility program were not specifically assessed.Conclusions: Early mobilization of patients in a TBICU was safe and effective. Medical, nursing, and physical therapy staff, as well as hospital administrators, have embraced the new culture of early mobilization in the ICU.

This statement summarizes the information available on specific exercise test protocols and outcome parameters used in patients with cystic fibrosis (CF) and provides expert consensus recommendations for protocol and performance of exercise tests and basic interpretation of results for clinicians. The conclusions were reached employing consensus meetings and a wide-band Delphi process. Although data on utility are currently limited, standardized exercise testing provides detailed information on physiological health, allows screening for exercise-related adverse reactions and enables exercise counselling. The Godfrey Cycle Ergometer Protocol with monitoring of oxygen saturation and ventilatory gas exchange is recommended for exercise testing in people 10 years and older. Cycle ergometry only with pulse oximetry using the Godfrey protocol or treadmill exercise with pulse oximetry - preferably with measurement of gas exchange - are second best options. Peak oxygen uptake, if assessed, and maximal work rate should be reported as the primary measure of exercise capacity. The final statement was reviewed by the European Cystic Fibrosis society and revised based on the comments received. The document was endorsed by the European Respiratory Society.

Exercise and physical activity have been recommended since the 1970s as important aspects of care for people with cystic fibrosis (CF). Benefits of an active lifestyle for these patients include improved pulmonary function, functional capacity, and quality of life and also decreased mortality. However, there are not currently any guidelines available to CF care centers regarding the type, amount or frequency of exercise, or habitual physical activity that should be performed to achieve these benefits. In addition, there is no guidance available about adapting physical activity and exercise for different ages or comorbidities common to CF. This document presents evidence-based recommendations from an international group of experts in the area of exercise for CF to guide practitioners toward the goal of regular, appropriate habitual physical activity, exercise and sports for all patients with CF. As lifespan for people with CF increases, it is important that regular physical activity is incorporated as part of daily care for a lifetime.

The aim of this position statement was to inform the choice of physical activity tools for use within CF research and clinical settings. A systematic review of physical activity tools to explore evidence for reliability, validity, and responsiveness. Narrative answers to "four key questions" on motion sensors, questionnaires and diaries were drafted by the core writing team and then discussed at the Exercise Working Group in ECFS Lisbon 2013. Our current position is that activity monitors such as SenseWear or ActiGraph offer informed choices to facilitate a comprehensive assessment of physical activity, and should as a minimum report on dimensions of physical activity including energy expenditure, step count and time spent in different intensities and sedentary time. The DigiWalker pedometer offers an informed choice of a comparatively inexpensive method of obtaining some measurement of physical activity. The HAES represents an informed choice of questionnaire to assess physical activity. There is insufficient data to recommend the use of one diary over another. Future research should focus on providing additional evidence of clinimetric properties of these and new physical activity assessment tools, as well as further exploring the added value of physical activity assessment in CF.