Best Evidence Summary on Early Exercise for Prevention of ICU-Acquired Weakness: An Evidence-Based Synthesis

Xi Bai,1,2,* Chunmei Gu,2,3,* Yanli Li,4 Xiaobo Jin,3 Jinmei Liu,5,* Chuan Guo1,5,* 1Chengdu Medical College, Chengdu, Sichuan, 610500, People’s Republic of China; 2Sichuan Provincial Key Laboratory of Philosophy and Social Sciences for Intelligent Medical Care and Elderly Health Management, Chengdu, Sichuan, 610500, People’s Republic of China; 3Department of Intensive Care Unit, Chengdu Eighth People’s Hospital (Geriatric Hospital of Chengdu Medical College), Chengdu, Sichuan, 610500, People’s Republic of China; 4Department of Nursing, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, 610500, People’s Republic of China; 5The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, 610500, People’s Republic of China*These authors contributed equally to this workCorrespondence: Chuan Guo, Chengdu Medical College, Chengdu, Sichuan, 610500, People’s Republic of China, Email [email protected] Jinmei Liu, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, 610500, People’s Republic of China, Email [email protected]: This study systematically aimed to identify and synthesize the highest-quality available evidence regarding the preventive impact of early exercise interventions on intensive care unit acquired weakness (ICUAW) in critically ill adults.Methods: Utilizing the evidence-based 6S model, we conducted a comprehensive literature review across multiple databases. The review concentrated on evidence related to early exercise in intensive care unit (ICU) patients, specifically evaluating early assessment strategies, risk management, appropriate intensity and prescription of exercise interventions, safety considerations, and the role of multidisciplinary collaboration. The literature search was performed from database inception to April 30, 2025. Two independent researchers evaluated literature quality and extracted data, systematically synthesizing evidence from studies that met predefined inclusion criteria.Results: A total of 24 studies were included: 6 clinical guidelines, 8 randomized controlled trials, 7 systematic reviews, and 3 expert consensus statements. Taken together, current evidence converges on a key practice approach that integrates routine early assessment of muscle strength and functional status, risk-stratified and progressively advanced exercise, individualized titration of exercise intensity and frequency according to hemodynamic stability and level of consciousness, explicit safety thresholds and stopping criteria, and delivery by a coordinated multidisciplinary team of nurses, physicians, and rehabilitation professionals.Conclusion: This review synthesizes high-quality evidence supporting the use of targeted early exercise interventions to prevent intensive care unit–acquired weakness (ICUAW), thereby providing an evidentiary foundation for clinicians to develop individualized intervention plans and to improve both short-term clinical outcomes and long-term recovery in critically ill ICU patients. Future research should, within a multidisciplinary team framework, conduct large-scale, multicenter cohort studies to determine the optimal initiation timing and dosage of early exercise, with the ultimate aim of further reducing the incidence of ICUAW and optimizing patient prognosis.Trial Registration: This study was based on the evidence summary reporting specifications of the Fudan University Center for the Evidence-based Nursing, the register name is “Best evidence summary on early exercise for the prevention of ICU-acquired weakness in critically ill patients”, the registration number is “ES20257998”. Keywords: critically ill patients, intensive care unit-acquired weakness, exercise, evidence summary, prevention