Table 4.

Summary of randomised controlled trials of combined nutrition and physical activity interventions on muscle mass, strength or function

Author, year, country	Population	Timing	Intervention	Comparator	Muscle mass, strength or functional outcome	Results
Zhou, 2022, China [93••]	150 pts, adm to ICU for the first time, expected ICU stay ≥72 h, conscious enough to respond (n = 50 pts per group)	<24 h	2 intervention arms: EM: early mobilisation (20-30 min 2×/day within 24 h) EMN: early mobilisation as per EM group + early nutrition (within 48 h of ICU adm)	Standard care: routine rehabilitation exercise and nutrition support	Primary: ICU-AW (MRC sum score <48) at ICU discharge Secondary: muscle strength from MRC sum score Barthel Index	Lower rates of ICU-AW in intervention groups, mean (95% CI), control vs intervention: 16 (7.2–29) % vs EM: 2 (0.1–10.6) % vs EMN: 2 (0.1–10.6) %; p = 0.005 MRC sum score did not differ between groups, mean (95% CI), control vs intervention: 60 (56.5–60) % vs EM: 60 (59.8–60) % vs EMN: 60 (60–60) %; p = 0.225 Improved Barthel Index with interventions mean (95% CI), control vs intervention: 57.5 (38.8–70) % vs EM: 70 (50–81.3) % vs EMN: 70 (55–80) %; p = 0.008
De Azevedo, 2021, Brazil [94••]	181 pts, MV, expected ICU stay >3 d		Nutrition guided by indirect calorimetry + high protein intake (including supp PN), cycle ergometry exercise 2×/d	Routine physiotherapy, standard nutrition provision	Primary: SF-36 PCS at 3 months and 6 months Secondary: ICU-AW defined by HGS ICU discharge	Better SF-36 PCS at 3 monts with the intervention, median (IQR), control vs intervention: 0.00 (0.00–37.0) vs 24.4 (0.00–49.12); p = 0.01 Better SF-36 PCS at 6 months with the intervention, median (IQR), control vs intervention: 0.00 (0.00–55.1) vs 33.63 (0.00–71.61); p = 0.01 No difference in HGS ICU-AW, n (%), control vs intervention: 26 (46.4%) vs 16 (28.5%); p = 0.05