Efeitos do exercício progressivo em cicloergômetro na arquitetura muscular do quadríceps femoral de pacientes críticos: ensaio clínico randomizado

Abstract

Muscle wasting is a commum problem in patients in intensive care unit (ICU), in this context, ciclyng exercise has been used for prevent of muscular atrophy in these patients. Considering these aspects, the purpouse of this present study is evaluate the effects that progressive ciclyng exercise on muscle architecture of quadriceps femoris in critically ill patients. Was performed a randomized clinical trial with blinded assessor. Were included patients of both genders, ≥ 18 years old, in the first 24 hours of mechanical ventilation (MV), with at a deep level of sedation and hemodynamically stable. The patients was randomly divided in control group (CG) was receive conventional physical therapy and intervention group (IG) was receive conventional physical therapy and engaging in progressive cycling exercise. Cycling exercise was realized during 30 minutes, initially in continuously and passively (classified patients with RASS – 4) and after in actively (classified patients with RASS 0). Primary outcome was muscle thickness of the quadriceps femoris. Secondary outcomes was rectus femoris cross-sectional area, vastus intermedius and rectus femoris echo intensity, peripheral muscle strength during ICU stay, gait speed and muscle strenght of the legs in hospital discharge and quality of life 3 months after hospital discharge. In the CG there were significant reduction of -0.5 cm in muscle thickness of the quadriceps femoris (p<0.005) and -2.7cm² in rectus femoris cross-sectional area (p=0.003). Rectus femoris echo intensity in patients in the CG was significantly higher when compared IG (34.9; P<0.001). Peripheral muscle strength show significant increase in the IG of 7.2 points (p<0.005) in the MRC score and CG of 4.3 points (p<0.005). There were no differences between groups in vastus intermedius echo intensity, gait speed, muscle strength of the legs and quality of life. Progressive cycling exercise preserves muscle thickness of the quadriceps femoris, rectus femoris cross-sectional area and rectus femoris muscle quality. Exercise program and conventional physical therapy preserves vastus intermedius quality and improve peripheral muscle strength in critically ill patients.