High-protein intake and early exercise in adult intensive care patients: a prospective, randomized controlled trial to evaluate the impact on functional outcomes

BMC Anesthesiol. 2021 Nov 13;21(1):283. doi: 10.1186/s12871-021-01492-6.


Background: We evaluated the efficacy of high protein intake and early exercise versus standard nutrition care and routine physiotherapy on the outcome of critically ill patients.

Methods: We randomized mechanically ventilated patients expected to stay in the intensive care unit (ICU) for 4 days. We used indirect calorimetry to determine energy expenditure and guide caloric provision to the patients randomized to the high protein and early exercise (HPE) group and the control group. Protein intakes were 1.48 g/kg/day and 1.19 g/kg/day medians respectively; while the former was submitted to two daily sessions of cycle ergometry exercise, the latter received routine physiotherapy. We evaluated the primary outcome physical component summary (PCS) score at 3 and 6 months) and the secondary outcomes (handgrip strength at ICU discharge and ICU and hospital mortality).

Results: We analyzed 181 patients in the HPE (87) and control (94) group. There was no significant difference between groups in relation to calories received. However, the amount of protein received by the HPE group was significantly higher than that received by the control group (p < 0.0001). The PCS score was significantly higher in the HPE group at 3 months (p = 0.01) and 6 months (p = 0.01). The mortality was expressively higher in the control group. We found an independent association between age and 3-month PCS and that between age and group and 6-month PCS.

Conclusion: This study showed that a high-protein intake and resistance exercise improved the physical quality of life and survival of critically ill patients.

Trial registration: Research Ethics Committee of Hospital São Domingos: Approval number 1.487.683, April 09, 2018. The study protocol was registered in ClinicalTrials.gov ( NCT03469882 , March 19,2018).

Keywords: Critical care; Indirect calorimetry; Outcome; Physical component summary; Protein; Resistance training.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Age Factors
  • Aged
  • Aged, 80 and over
  • Critical Illness / mortality
  • Diet, High-Protein*
  • Exercise Therapy / methods*
  • Female
  • Hand Strength / physiology
  • Hospital Mortality
  • Humans
  • Intensive Care Units*
  • Male
  • Middle Aged
  • Physical Therapy Modalities
  • Prospective Studies
  • Quality of Life
  • Respiration, Artificial*
  • Time Factors

Associated data

  • ClinicalTrials.gov/NCT03469882