Concurrent nutrition and physical rehabilitation interventions for patients with critical illness

The effects of either physical rehabilitation or nutrition on outcomes in patients with critical illness are variable and remain unclear. The potential for the combination of exercise and nutritional delivered concurrently to provide benefit is provocative, but data are only emerging. Herein, we provide a summary of evidence from 2023 and 2024 on combined physical rehabilitation and nutrition during and following critical illness.

While latest trials on physical rehabilitation alone reported conflicting findings, recent nutrition trials found no difference between higher and lower protein delivery and even suggested harm in patients with acute kidney injury. In 2023 and 2024, we identified four studies (one randomized controlled trial) combining physical rehabilitation and nutrition (mainly protein supplementation) within the ICU setting. Overall, these suggested benefits, including reduction of muscle size loss, ICU acquired weakness, delirium, and improved mobility levels, although these benefits did not extend to mortality and hospital length of stay. No recent trials combining physical rehabilitation and nutrition for patients after ICU were identified.

Current insights on combined physical rehabilitation and nutrition suggest improved clinically relevant outcomes, but further investigations across the continuum of care of patients with critical illness are warranted.