Table 2.
Modality of Exercise | Proposed Exercise Protocol * | Suggested Candidates |
---|---|---|
Prehabilitation |
Proposed duration: 60 min per session, daily while on ECMO. |
|
Early mobilization |
Awake patients with level of consciousness
Proposed duration: 60 min per session, 5 times per week while on ECMO. |
|
NMES |
|
All patients on ECMO support, especially patients with lower level of consciousness. |
* Selection of exercises (in-bed or out-of-bed, passive or active) should be individualized for each patient according to his/her consciousness level, functional status and disease severity. Workload, number of repetitions and number of sets in strength training depend on the physical status of each patient: 1 to 3 sets of 8 to 10 repetitions of 5 active range for patients with better physical status and 3 to 5 sets of 8 to 10 repetitions of 5 passive range for patients with worse physical status or disability for active rehabilitation is suggested. Workload should be based on the 1 RM test for active exercises (40–60% of the 1 RM test) if feasible. Moderate intensity of aerobic exercise training, either on a cycle ergometer or a treadmill, aimed for 12–13 on the Borg scale is suggested for prehabilitation or early mobilization in patients with higher severity and lower functional capacity while moderate to slightly high intensity is suggested for early mobilization in patients with better functional status. Inspiratory muscle training should be prescribed once or twice daily, with 3–5 sets of 6 inspiratory efforts at the intensity of 30–60% of maximum inspiratory pressure progressively increased. ECMO, extracorporeal membrane oxygenation; NMES, neuromuscular electrical stimulation; ICU-AW, intensive care unit acquired weakness; MAP, mean arterial pressure; SAP, systolic arterial pressure; HR, heart rate.