Improving post-intensive care unit neuropsychiatric outcomes: Understanding cognitive effects of physical activity

Ramona O. Hopkins, Mary R. Suchyta, Thomas J. Farrer, Dale Needham

Research output: Contribution to journalReview article

Abstract

Critical illness and its treatment often result in long-term neuropsychiatric morbidities. Consequently, there is a need to focus on means to prevent or ameliorate these morbidities. Animal models provide important data regarding the neurobiological effects of physical activity, including angiogenesis, neurogenesis, and release of neurotrophic factors that enhance plasticity. Studies in noncritically ill patients demonstrate that exercise is associated with increased cerebral blood flow, neurogenesis, and brain volume, which are associated with improved cognition. Clinically, research in both healthy and diseased human subjects suggests that exercise improves neuropsychiatric outcomes. In the critical care setting, early physical rehabilitation and mobilization are safe and feasible, with demonstrated improvements in physical functional outcomes. Such activity may also reduce the duration of deliriumin the intensive care unit (ICU) and improve neuropsychiatric outcomes, although data are limited. Barriers exist regarding implementing ICU rehabilitation in routine care, including use of sedatives and lack of awareness of post-ICU cognitive impairments. Further research is necessary to determine whether prior animal and human research, in conjunction with preliminary results from existing ICU studies, can translate into improvements for neuropsychiatric outcomes in critically ill patients. Studies are needed to evaluate biological mechanisms, risk factors, the role of pre-ICU functional level, and the timing, duration, and type of physical activity for optimal patient outcomes.

Original languageEnglish (US)
Pages (from-to)1220-1228
Number of pages9
JournalAmerican journal of respiratory and critical care medicine
Volume186
Issue number12
DOIs
StatePublished - Dec 15 2012

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Keywords

  • Cognitive outcome
  • Critical illness
  • Depression
  • Early mobility
  • Physical rehabilitation

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

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