The EXERCISE trial

The intervention cohort will receive an intensive rehabilitation protocol commencing during their ICU stay. The intervention protocol will consist of an exercise regimen based on performance of the baseline ‘MUSCLE’ test. Exercises will include sitting out of bed, sit to stand exercise with or without assistance, marching on the spot and active shoulder elevation. These exercises are based on pilot data obtained from an Australia wide questionnaire (Skinner et al 2008) obtained prior to study commencement. For participants unable to sit out of bed, active and active assisted upper and lower limb exercises will be performed. The use of a tilt table or standing frame may be employed. Treatment in the ICU will involve exercise for up to a total of fifteen minutes per day for each participant. Exercise will increase to twice daily once they are able to be disconnected from the ventilator for > 4 hours. Once discharged to the general ward the physiotherapist will continue and progress an intensive rehabilitation program. Exercise will be progressed according to performance on the 6 MWT, calculating 6 minute walk work or if able, a submaximal V02 test . The physiotherapist will treat each participant twice daily aiming to exercise for 30min at each session with gradual progression toward one 60min exercise session until discharge from hospital. Upon discharge home participants will be booked to commence their outpatient program (one 60 minute session offered three times a week). Exercise at home in the form of a walking program will be encouraged on days not attending the program. Ward and out patient exercise classes will comprise functional, resistance and aerobic components with intensity set using the modified Borg scale. Primary outcome measures will be undertaken at baseline, 8-10 weeks post hospital discharge and 6 and 12 months post ICU discharge. The intervention group will also be assessed pre and post outpatient program.