The effect of Protein Provision and Exercise Therapy on Patient‐Reported and Clinical Outcomes in ICU Survivors: A Systematic Review

Background
Intensive Care Unit (ICU)-survivors deal with long-term health problems, which negatively affect their quality of life (QoL). Nutritional and exercise intervention could prevent the decline of muscle mass and physical functioning which occurs during critical illness. Despite the growing amount of research, robust evidence is lacking.

Methods
For this systematic review, Embase, Pubmed, and CENTRAL databases were searched. The effect of protein provision (PP) or combined protein and exercise therapy (CPE) during or after ICU-admission on QoL, physical functioning, muscle health, protein/energy intake, and mortality was assessed compared to standard care.

Results
4957 records were identified. After screening, data extraction was performed for 15 articles (nine randomized controlled trials and six non-randomized studies). Two studies reported improvements in muscle mass, of which one found higher independency in activities of daily living. No significant effect was found on QoL. Overall, protein targets were seldom met and often below recommendations.

Conclusion
Evidence for the effect of PP or CPE on patient-reported outcomes in ICU-survivors is limited due to study heterogeneity and lack of high quality studies. Future research and clinical practice should focus on adequate protein delivery with exercise interventions to improve long-term outcomes.

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