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Original Research

Open Access

The effect of the addition of in-bed leg cycling using a MOTOmed device to standard rehabilitation on the length of mechanical ventilation: a randomized clinical trial

  • Jan Maca1,2,3
  • Chwalkova Iva4
  • Fiedorova Iva4
  • Knapkova Lucie4
  • Koci Marketa1,2
  • Nytra Ivana1,2
  • Kucerova Zuzana1,2
  • Zoubkova Renata1,4

1Department of Anesthesiology and Intensive Care Medicine, University Hospital Ostrava, 70300 Ostrava, Czech Republic

2Institute of Intensive Care and Emergency, Faculty of Medicine, University of Ostrava, 70300 Ostrava, Czech Republic

3Institute of Physiology and Pathophysiology, Faculty of Medicine, University of Ostrava, 70300 Ostrava, Czech Republic

4Department of Physiotherapy, University Hospital Ostrava, 70852 Ostrava, Czech Republic

DOI: 10.22514/sv.2022.024

Submitted: 05 November 2021 Accepted: 28 December 2021

Online publish date: 24 March 2022

*Corresponding Author(s): Jan Maca E-mail:


Successful weaning from mechanical ventilation (MV) belongs to the challenges in critical care. The study evaluated the effect of the addition of in-bed leg cycling using a MOTOmed device to standard rehabilitation on the length of MV. Randomized open-label clinical trial. Sixty-seven mechanically ventilated patients were random allocated in the in-bed leg cycling MOTOmed group (m-group) and the control group (c-group). The standard physiotherapy was carried out twice a day in both groups. The m-group received additional in-bed leg cycling rehabilitation using a MOTOmed device once daily. We included 20 patients in m-group and 19 in c-group in the final analysis. In the m-group, a non-significant reduction in both total length of MV (21.0 ± 9.78 vs. 24.4 ± 10.88 days, p = 0.915) and length of MV from randomization (5.4 ± 6.17 vs. 8.7 ± 8.00 days, p = 0.860) was observed. Both groups had significant muscle strength improvement (knee joint extension, handgrip). However, the m-group patients reached the same muscle strength level in a shorter time (8.70 ± 6.44 vs. 6.8 ± 4.3 days, p = 0.534). In our study, adding the MOTOmed device in-bed leg cycling to standard rehabilitation did not significantly reduce mechanical ventilation length in critically ill patients.


In-bed cycling; Rehabilitation; Mechanical ventilation; Critical care; Weaning

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Jan Maca,Chwalkova Iva,Fiedorova Iva,Knapkova Lucie,Koci Marketa,Nytra Ivana,Kucerova Zuzana,Zoubkova Renata. The effect of the addition of in-bed leg cycling using a MOTOmed device to standard rehabilitation on the length of mechanical ventilation: a randomized clinical trial. Signa Vitae. 2022.doi:10.22514/sv.2022.024.


[1] Topp R, Ditmyer M, King K, Doherty K, Hornyak J 3rd. The effect of bed rest and potential of prehabilitation on patients in the intensive care unit. AACN Clinical Issues. 2002; 13: 263–276.

[2] Schweickert WD, Hall J. ICU-acquired weakness. Chest. 2007; 131: 1541–1549.

[3] Deem S. Intensive-care-unit-acquired muscle weakness. Respiratory Care. 2006; 51: 1042–1052.

[4] De Jonghe B, Sharshar T, Lefaucheur JP, Authier FJ, Durand-Zaleski I, Boussarsar M, et al. Paresis acquired in the intensive care unit: a prospective multicenter study. The Journal of the American Medical Association. 2002; 288: 2859–2867.

[5] de Letter MCJ, Schmitz PIM, Visser LH, Verheul FAM, Schellens RLLA, Op de Coul DAW, et al. Risk factors for the development of polyneuropathy and myopathy in critically ill patients. Critical Care Medicine. 2001; 29: 2281–2286.

[6] Witt NJ, Zochodne DW, Bolton CF, Grand’Maison F, Wells G, Young GB, et al. Peripheral nerve function in sepsis and multiple organ failure. Chest. 1991; 99: 176–184.

[7] Tepper M, Rakic S, Haas JA, Woittiez AJJ. Incidence and onset of critical illness polyneuropathy. The Netherlands Journal of Medicine. 2000; 56: 211–214.

[8] Khan J, Harrison TB, Rich MM, Moss M. Early development of critical illness myopathy and neuropathy in patients with severe sepsis. Neurology. 2006; 67: 1421–1425.

[9] Ali NA, O’Brien JM, Hoffmann SP, Phillips G, Garland A, Finley JCW, et al. Acquired weakness, handgrip strength, and mortality in critically ill patients. American Journal of Respiratory and Critical Care Medicine. 2008; 178: 261–268.

[10] Camargo Pires-Neto R, Fogaça Kawaguchi YM, Sayuri Hirota A, Fu C, Tanaka C, Caruso P, et al. Very early passive cycling exercise in mechanically ventilated critically ill patients: physiological and safety aspects - a case series. PLoS One. 2013; 8: 74182.

[11] Zhang L, Hu W, Cai Z, Liu J, Wu J, Deng Y. et al. Early mobilization of critically ill patients in the intensive care unit: a systematic review and meta-analysis. PLoS One. 2019; 14: 0223185.

[12] Bailey P, Thomsen GE, Spuhler VJ, Blair R, Jewkes J, Bezdjian L, et al. Early activity is feasible and safe in respiratory failure patients. Critical Care Medicine. 2007; 35: 139–145.

[13] Kho ME, Damluji A, Zanni JM, Needham DM. Feasibility and observed safety of interactive video games for physical rehabilitation in the intensive care unit: a case series. Journal of Critical Care. 2012; 27: 219. e1–219.e6.

[14] Morris PE, Goad A, Thompson C, Taylor K, Harry B, Passmore L, et al. Early intensive care unit mobility therapy in the treatment of acute respiratory failure. Critical Care Medicine. 2008; 36: 2238–2243.

[15] Schweickert WD, Pohlman MC, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. The Lancet. 2009; 373: 1874–1882.

[16] Nickels MR, Aitken LM, Barnett AG, Walsham J, King S, Gale NE, et al. Effect of in-bed cycling on acute muscle wasting in critically ill adults: a randomized clinical trial. Journal of Critical Care. 2020; 59: 86–93.

[17] Santos LMH, Novaes APL, Dantas FMNA, Ribeiro LC, Castro CMMBD, França EETD. Acute effect of passive cycloergometry on the cardiovascular system and respiratory mechanics of critically ill patients: a randomized controlled trial. Fisioterapia em Movimento. 2019; 32: e003232.

[18] Medical research council. Aids to the Investigation of Peripheral Nerve Injuries (War Memorandum No. 7). 1976. Available at: (Accessed: 09 October 2020).

[19] Informa Markets – Healthcare MOTOmed letto2 legs/arms for early mobilization and in the intensive care. 2020. Available at: https: // 11 October 2020).

[20] Yu L, Jiang JX, Zhang Y, Chen YZ, Shi Y. Use of in-bed cycling combined with passive joint activity in acute respiratory failure patinets receiving mechanical ventilation. Annals of Palliative Medicine. 2020; 9: 175–181.

[21] Machado ADS, Pires-Neto RC, Carvalho MTX, Soares JC, Cardoso DM, Albuquerque IMD. Effects that passive cycling exercise have on muscle strength, duration of mechanical ventilation, and length of hospital stay in critically ill patients: a randomized clinical trial. Jornal Brasileiro De Pneumologia. 2017; 43: 134–139.

[22] Baldwin CE, Paratz JD, Bersten AD. Muscle strength assessment in critically ill patients with handheld dynamometry: an investigation of reliability, minimal detectable change, and time to peak force generation. Journal of Critical Care. 2013; 28: 77–86.

[23] Silva APP, Maynard K, Cruz MR. Effects of motor physical therapy in critically ill patients: literature review. Revista Brasileira de terapia intensiva. 2010; 22: 85–91.

[24] Lai CC, Chou W, Chan KS, Cheng KC, Yuan KS, Chao CM, et al. Early mobilization reduces duration of mechanical ventilation and intensive care unit stay in patients with acute respiratory failure. Archives of Physical Medicine and Rehabilitation. 2017; 98: 931–939.

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