Physical activity, muscle strength, and exercise capacity 3 months after severe sepsis and septic shock

• Published in: Intensive care medicine Vol. 41; no. 8; pp. 1433 - 1444
• Main Authors: Borges, Rodrigo Cerqueira, Carvalho, Celso R. F., Colombo, Alexandra Siqueira, da Silva Borges, Mariucha Pereira, Soriano, Francisco Garcia
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-08-2015; Springer; Springer Nature B.V
• Subjects: Accelerometry; Activities of Daily Living; Adult; Aged; Analysis; Anesthesiology; Cohort analysis; Cohort Studies; Critical Care Medicine; Emergency Medicine; Exercise; Female; Follow-Up Studies; Hospital patients; Hospitalization; Hospitals; Humans; Infection; Intensive; Intensive care; Intensive Care Units; Lung diseases; Male; Medical colleges; Medicine; Medicine & Public Health; Middle Aged; Mortality; Motor Activity - physiology; Muscle strength; Muscle Strength - physiology; Original; Pain Medicine; Pediatrics; Physical fitness; Pneumology/Respiratory System; Prospective Studies; Recovery of Function; Sepsis; Sepsis - physiopathology; Septic shock; Shock, Septic - physiopathology; Steroids; Walking; Brazil; Recovery of function; Sepsis; Muscle weakness; Physical activity; Intensive care unit; Survivors
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/s00134-015-3914-y

Purpose
To quantify the physical activity in daily life (PADL), muscle strength, and exercise capacity in the short and medium term in survivors of severe sepsis and septic shock.
Methods
Prospective cohort study with a follow-up from hospital admission to 3 months after hospital discharge. Seventy-two patients admitted to the ICU for severe sepsis or septic shock and a control group of healthy sedentary subjects (
n
 = 50) were enrolled. All patients had their PADL quantified by an accelerometer during their hospital stay and 3 months after. Exercise capacity and handgrip and quadriceps muscle strength were also evaluated.
Results
During hospitalization, patients spent the majority of their time inactive in a lying or sitting position (90 ± 34 % of daily time). Physical inactivity was partially reduced 3 months after (58 ± 20 % of daily time). However, the time patients spent walking was only 63 % of the time reported for healthy subjects. Patients also showed lower movement intensity when compared with controls (2.1 ± 0.3 vs 2.5 ± 0.4 m/s
2
). At hospital discharge, muscle strength and exercise capacity were approximately 54 % of the predicted value, and these parameters showed significant increase in patients 3 months after (70 % of predicted value). Multivariable analysis demonstrated that the use of systemic corticosteroids and hospitalization time negatively influenced quadriceps strength and exercise capacity at the time of hospital discharge.
Conclusion
Our results suggest that survivors of sepsis admitted to the ICU have a substantial reduction in physical activity, exercise capacity, and muscle strength compared to healthy subjects that persist even 3 months after hospital discharge.