Rehabilitation guide
Leaving intensive care is not the end of recovery but the beginning. Many people still face weakness, fatigue, loss of appetite, sleep problems, forgetfulness or nightmares for months after going home. These are common and usually ease over time. This guide explains what you can expect, how you can support your recovery and six gentle exercises you can start at home.
In a UK survey answered by 4,943 patients, 3 or 12 months after intensive care 46% of participants had symptoms of anxiety, 40% depression and 22% post-traumatic stress. Two thirds of those with one of these symptoms also had at least one of the others.
The UK’s national guideline (NICE) recommends an early, individually tailored and frequently reviewed rehabilitation programme for every patient at risk after intensive care. According to the guideline, patients should be given information about possible physical and psychological problems, a supported self-directed rehabilitation manual lasting at least 6 weeks after leaving intensive care should be considered, and a face-to-face functional assessment should be carried out 2–3 months after discharge. Referral to a specialist is recommended if recovery is slower than expected or new problems arise.
Evidence on how exercise affects recovery after intensive care is still limited: a Cochrane review of 6 trials could not reach a firm conclusion because the quality of the evidence was very low. Even so, national guidelines see movement and rehabilitation as a core part of recovery.
Exercises at home
These movements are gentle examples for the first weeks after you return home; the rehabilitation programme you were given comes first. Start with someone nearby, reduce the number of repetitions depending on how tired you are, and increase a little each day.
Sit upright and place your hands on your lower ribs. Breathe in slowly through your nose, deeply enough to feel your ribs widen to the sides, hold for 2–3 seconds and breathe out slowly through your mouth. If you have phlegm, cough once or twice afterwards.
5 breaths, several times a dayLying or sitting, move your ankles up and down. This supports blood flow in the legs and can be done even while you are not very mobile.
20 repetitions, every hourLie or sit with your legs straight. Tighten the muscle at the front of your thigh to press the back of your knee into the bed, hold for 5 seconds and relax.
10 reps, 3 times a daySit upright on a chair. Slowly straighten your knee and tighten the muscle at the front of your thigh, hold for 3 seconds, then lower.
10 reps on each legUse a sturdy chair with armrests. Lean forward and push up with your hands to stand, then sit down with control. Have someone with you; rest when you get tired.
Start with 5 repetitions and build up to 10Start with short walks around the house; use a stick or walking frame if needed. Increase the time or distance a little each day, and sit and rest when you get tired.
Start with a few minutes and build up graduallyIt varies a great deal from person to person. According to a UK hospital’s patient leaflet, full recovery can take 6–12 months and most problems ease within months. In a study following 109 people (median age 45) who had survived severe lung failure, even after 5 years the distance walked in 6 minutes was on average 76% of the expected value; yet 77% of those who had been working had returned to work.
Severe illness, long periods in bed and some treatments can weaken the muscles quickly. According to an American Thoracic Society guideline, about a quarter of people on a ventilator for a long time develop widespread, lasting weakness throughout the body. This weakness can delay coming off the ventilator and prolong the hospital stay. Muscle strength comes back over time with gradually increasing activity and exercise.
Yes, they are common. Memories of the confusion (delirium) experienced in intensive care can be dream-like or nightmarish and can get mixed up with real events. According to an NHS leaflet, vivid dreams and unexpected memories are normal reactions to a traumatic experience and ease over time. If you are still struggling a month after getting home, talk to your doctor.
The evidence is not yet clear. In a Cochrane review of exercise programmes after leaving intensive care, 3 of the 6 trials covering 483 people found results in favour of exercise capacity, but the quality of the evidence was very low and it could not be concluded that exercise works. Even so, the UK’s national guideline (NICE) recommends an individually tailored, regularly reviewed rehabilitation programme for everyone at risk.
Poor appetite, feeling full quickly and changes in taste are common. One NHS leaflet recommends 2–3 snacks between meals, foods high in energy and protein, nutritional supplement drinks if needed and 6–8 glasses of fluid a day. If you find swallowing difficult, you can try softer foods.
Yes. ICUsteps, a UK charity set up for intensive care patients and their relatives, stresses that relatives also carry a significant psychological burden, both after discharge and after a bereavement. Support for your family also helps your own recovery.
For breathing and relaxation, see the physiological sigh; for muscle loss, the sarcopenia guide; and to measure your progress, the 6-minute walk test.
In situations marked “emergency”, call 112:
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