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Rehabilitation Management of Intensive Care Unit-acquired Weakness (ICU-AW): A Narrative Review Nazir, Arnengsih; Anggraini, Gabriela
Surabaya Physical Medicine and Rehabilitation Journal Vol. 6 No. 1 (2024): SPMRJ, FEBRUARY 2024
Publisher : Faculty of Medicine, Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/spmrj.v6i1.42513

Background: Intensive Care Unit-acquired weakness (ICU-AW) is one of the most common neuromuscular disorders affecting intensive care unit (ICU) patients' outcomes and clinical course. ICU-AW is found in 30-50% of patients and increases to 67% in sepsis-critically ill patients. Prolonged ICU stay, the difficulty of weaning from the ventilator, higher hospitalization costs, and an increase in mortality, as well as long-term morbidity, are associated with ICU-AW. ICU-AW causes skeletal muscle weakness, including respiratory muscles, which results in complications that continue even years after being discharged from the hospital. Aim: To describe the rehabilitation management of ICU-AW and provide the information needed clinically to manage these patients. Methods: The authors reviewed all types of articles without time filtering using PubMed and Google Scholar databases with "ICU-AW”, "ICU-related weakness”, "rehabilitation”, and "early mobilization” used as keywords. Results: Rehabilitation management can be done as early as possible, beginning while the patient is still in the ICU. Early mobilization programs require teamwork consisting of doctors, therapists, and nurses. Physical activity and early mobilization in the ICU must be carried out with consideration for safety. Monitoring patient safety before and during mobilization is an essential factor to be considered. Any mobilization program should be the decision of the ICU care team. Implementation of rehabilitation programs and early mobilization improves outcomes for patients with ICU-AW and should be continued until the follow-up period. Conclusion: The rehabilitation management aiming at preventing and treating ICU-AW should be done since the patient was still in the ICU and under careful consideration of safety aspects.

Secondary Prevention Program through Hybrid Tele-Cardiac Rehabilitation using a Combination of Vigorous-intensity Interval Training and Low-Intensity Home-based Exercise in Patient with Refractory Angina Post-Percutaneous Coronary Intervention Nazir, Arnengsih; Anggraini, Gabriela; Nurhalizah, Hana Athaya
Surabaya Physical Medicine and Rehabilitation Journal Vol. 6 No. 2 (2024): SPMRJ, AUGUST 2024
Publisher : Faculty of Medicine, Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/spmrj.v6i2.50150

Background: Refractory angina (RA) refers to symptoms lasting >3 months due to reversible ischemia occurring with coronary artery disease, which cannot be controlled by increased medical therapy or revascularization including percutaneous coronary intervention (PCI). It may result in a significant impact on patient outcomes such as exercise limitation, biopsychosocial disorders, and decreased quality of life. Participation of patients with RA in cardiac rehabilitation (CR) reduces angina frequency and increases exercise capacity. Exercise-based CR also improves endothelial function, reduces oxidative stress and arterial stiffness, and improves myocardial perfusion. CR is also known as a secondary prevention program with the main goal to help patients return to their normal activities by increasing their functional capacity and preventing long-term complications. Case illustration: A 64-year-old male has undergone PCI and experienced RA. This patient was given a CR program to increase his functional capacity as a secondary prevention of cardiovascular disease through a center-based combined with a home-based CR program. Aerobic exercise given was hospital-based vigorous-intensity interval training and low-intensity home-based exercise. Problems found were refractory angina that often appeared during activity, and low cardiorespiratory endurance or muscular fitness. Angina symptoms and hand grip strength improved after 2 weeks, even though muscular fitness classification was still poor. During the program, he could achieve the exercise heart rate target without any symptoms. After 4 weeks, hand grip strength and physical activity were improved, and an exercise test revealed no symptoms during the test, appropriate hemodynamic response, and good fitness classification. However, there were still frequent VES with couplet episodes, so the patient was still classified as high-risk stratification. Although risk stratification was still high, the patient was allowed to enter phase III CR, with the prescription of moderate-intensity aerobic, low-intensity resistance, flexibility, and breathing exercises. These exercises were given based on recommendations for the average adult to maintain his level of physical activity and promote lifelong healthy behavior. Conclusion: Hybrid tele-cardiac rehabilitation through a combination of vigorous-intensity interval training and low-intensity home-based exercise in a patient with refractory angina post-PCI improved functional capacity as a key component for the prevention of long-term cardiac or non-cardiac complications.

High Interval Intensity Training in Patients with Left Atrial Myxoma Al Mungiza, Berthy; Prabowo, Tertianto; Nazir, Arnengsih
Mutiara Medika: Jurnal Kedokteran dan Kesehatan Vol. 25 No. 1 (2025): January
Publisher : Universitas Muhammadiyah Yogyakarta

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.18196/mmjkk.v25i1.22804

Myxomas are common benign cardiac tumors that can cause life-threatening events. A case of left atrial myxoma, which induced acute myocardial infarction (AMI) and stroke, is very rare. Patient with concomitant cardiac disease and stroke have lower aerobic capacity than patients with cardiac disease or stroke alone. Here, we report a case presented on 41 years old male patient who diagnosed acute myocardial infarction (AMI) and ischemic stroke (IS) which were induced by left atrial myxoma. He came for phase II cardiac rehabilitation (CR) after underwent surgery with fatigue complaint when he walked more than 500 meters and climbed one floor of stairs. A four weeks comprehensive CR was given to this patient, including a supervised high-intensity interval training (HIIT), thrice a week. This report showed that HIIT can improves functional capacity (FC) and quality of life in patients who suffered left atrial myxoma which induced AMI and IS.

Improving Pulmonary Function and Functional Ability through Pulmonary Rehabilitation in Patients with Pleural Effusion: A Literature Review Nazir, Arnengsih; Anggraini, Gabriella; Clementius, Brandon; Nurhalizah, Hana Athaya; Sutiono, Agung Budi
Jurnal Respirasi Vol. 11 No. 2 (2025): May 2025
Publisher : Faculty of Medicine Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/jr.v11-I.2.2025.191-200

Introduction: Pleural effusion (PE) is characterized by reduced lung distensibility and expansion, resulting in decreased lung volume. Pleural effusion patients often experience respiratory symptoms that impair quality of life (QoL) and daily activities. Pulmonary rehabilitation (PR) has been developed to enhance functional capacity, alleviate symptoms, improve exercise tolerance, and reduce health service utilization. However, data on the specific implementation and benefits of PR in PE patients are limited. Methods: This literature review synthesized data from a search using Public Medline (PubMed), Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Google Scholar databases. The search was based on keywords relevant to study objectives and comprised various article types, ranging from review papers to original research. Articles with titles and abstracts relevant to the study objectives proceeded to a full-text evaluation. Results: A narrative review discussing PE from pathology to rehabilitation management was formulated from 12 articles that elucidated various aspects of functional impairment in PE patients and 24 sources that discussed rehabilitation management. Conclusion: Rehabilitation interventions, especially mobilization programs and lung expansion techniques, have shown effectiveness in improving pulmonary function and functional activities. Data regarding the role of inspiratory muscle training and aerobic exercise specific to PE remain limited. Given the functional impairments associated with PE, both before and after the removal of pleural fluid, PR programs are crucial in improving symptoms, pulmonary function, and overall functional ability in these patients.

Airway Mucus Hypersecretion in Chronic Obstructive Pulmonary Disease Patients: From Basic Pathophysiology to Rehabilitation Approaches Nazir, Arnengsih; Brandon Clementius
Surabaya Physical Medicine and Rehabilitation Journal Vol. 7 No. 1 (2025): SPMRJ, FEBRUARY 2025
Publisher : Faculty of Medicine, Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/spmrj.v7i1.64771

Objective: This narrative review aimed to describe the pathophysiology of mucus accumulation and mucus expectoration disorders, rehabilitation assessments, and airway clearance techniques in chronic obstructive pulmonary disease (COPD) patients. Methods: Articles were searched using relevant keywords in PubMed, Google Scholar, and CINAHL databases. Article searches were carried out without limiting the article types or year of publication. Only full-text articles in English and Indonesian were included for data synthesis. Results: COPD causes physiological and structural changes in the airway including stiffness of the airway wall, impaired mucociliary clearance, and decreased cough ability due to respiratory muscle dysfunction. These changes then lead to mucus hypersecretion and mucus accumulation problems resulting in impaired airway clearance and worsened lung function. A rehabilitation assessment is important to assess cough ability and its impact on daily activities and quality of life. Various airway clearance techniques are used to reduce or eliminate airway occlusion and increase expiratory airflow and lung volume. Successful airway clearance can be supported by knowledge of the mechanisms by which mucus accumulates so that appropriate management can be provided. Conclusion: COPD causes airway stiffness, impaired mucociliary clearance, and weakened cough due to respiratory muscle dysfunction, leading to mucus accumulation and worsened lung function. Airway clearance techniques aim to remove obstructions, improve expiratory flow, and enhance lung volume. Understanding mucus accumulation mechanisms is crucial for optimizing airway clearance management based on patient needs.

Effects of High-Intensity Interval Training on Cardiovascular Function and Risk Factors, Functional Impairments, and the Quality of Life in Coronary Artery Disease Patients: A Narrative Review Nazir, Arnengsih; Biben, Vitriana; Gunanegara, Aggi; Clementius, Brandon
Jurnal Kardiologi Indonesia Vol 45 No 4 (2024): Online First - Indonesian Journal of Cardiology April-June 2021
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.1751

Background: Coronary artery disease (CAD) causes damage to the cardiovascular system that leads to functional and quality of life (QoL) deterrence. Cardiac rehabilitation (CR) aims to improve cardiorespiratory fitness (CRF) to prevent disease progression and its risk factors. Aerobic exercise (AE) causes different physiological effects depending on the applied intensity. High-intensity interval training (HIIT) is being developed because of better effectivity than moderate-intensity continuous training (MICT). Even so, HIIT has not been prescribed generally. This review aimed to describe the effects of HIIT on cardiovascular function and risk factors, functional impairments, and the QoL. Methods: Articles were searched using PubMed and CINAHL databases with the keywords “high-intensity interval training”, “cardiac rehabilitation”, “exercise-based cardiac rehabilitation”, and “coronary artery disease”. Results: Twenty-two articles were found and used to explain sub-topics. Discussion: HIIT improves ventricular function, LVEF, heart contractility, and endothelial function which further improve systolic and diastolic blood pressure. Improvement in cardiovascular risk factors was better in HIIT compared to AE in lower intensities. Studies recommend HIIT for CAD patients due to significant cardiovascular adaptation in this exercise. Compared to MICT, most studies found that HIIT is better at improving CRF. HIIT also positively affects cognitive and affective functions. Research on the impact of HIIT on functional activity and QoL is still limited. However, one study found no differences in physical activity level and QoL in groups given HIIT or MICT. Conclusion: In CAD patients, HIIT is considered an alternative exercise that is more time-efficient than continuous exercise.

Clinical and Functional Outcomes of COVID-19 Survivors After Hospitalization Nazir, Arnengsih; Putri, Salsabila S S; Bashari, Muhammad Hasan
Kesmas Vol. 18, No. 5
Publisher : UI Scholars Hub

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Coronavirus disease 2019 (COVID-19) causes various clinical manifestations during acute infection and at the post-acute phase with persistent symptoms called long COVID. It occurs in mild and moderate to severe cases which require hospitalization. In patients needing hospitalization, especially intensive care unit admission, the risk of long COVID increases. Many hospitalized patients exhibited more symptoms in 60 days after the illness than non-hospitalized patients. This review aimed to identify the clinical and functional outcomes in COVID-19 survivors after hospitalization. The articles in the PubMed database published in 2019-2021 were reviewed and found 20 be eligible. The clinical outcomes were the appearance or persistence of general and multi-organ symptoms, nutritional disorders, and decreased lung function. The functional outcomes found were decreased muscle strength, physical, psychological, and cognitive functions, increased disability and dependencies, as well as decreased vocational status and quality of life. The incidence of each outcome could not be determined due to the variety of methods used to examine and present outcomes. To conclude, COVID-19 causes long-term clinical and functional outcomes that need to be identified to prevent and manage long-term physical and functional disorders.

Rehabilitation Management to Improve Respiratory Function in Severe and Critical COVID-19 Survivors: A Literature Review Wijaya, Sergio Aldira; Nazir, Arnengsih; Nusjirwan, Rama
Kesmas Vol. 18, No. 5
Publisher : UI Scholars Hub

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Effects of a Combination of Resistance and Aerobic Exercise on Cardiorespiratory Fitness, Muscular Fitness, and Body Composition in a High-risk Patient with Inflammatory Cardiomyopathy, Potentially Malignant Arrhythmia, and Morbid Obesity Nazir, Arnengsih; Miguna, Vindy Margaretha; Goesasi, Rachmat Zulkarnain; Tanuwidjaja, Deta
Surabaya Physical Medicine and Rehabilitation Journal Vol. 8 No. 1 (2026): SPMRJ, FEBRUARY 2026
Publisher : Faculty of Medicine, Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/spmrj.v8i1.52276

Cardiomyopathy with concomitant heart failure and potentially malignant arrhythmia in patients with morbid obesity and mild restrictive lung disease causes significant functional impairment. Low-grade systemic inflammation accompanies the presence of these diseases. A 48-year-old woman undergoing phase II cardiac rehabilitation complained of easy fatigue. Cardiac rehabilitation consisting of moderate-intensity continuous training (MICT) 3 times 60 minutes with treadmill, arm, and leg ergometer, and resistance training was given. During MICT, the patient developed bigeminy without subjective complaint. After 6 weeks of exercise, an increase in VO2 max predicted by a 6-minute walking test (14.33 to 16.67), improvement in physical activity (low to moderate activity), and improvement in fatigue severity scale (43 to 27) were seen. Muscular fitness was also improved; muscle thickness showed an average increase of 0.25 centimeters with an increase in muscle strength. Body composition (2% decrease in body fat percentage and 4-level decrease in visceral fat) was also noted. Previous studies found that exercise increases VO2 max, improves endothelial function, and improves myocardial reserve flow. Muscle fiber adaptations also occur and include increased cross-sectional area of muscle, selective hypertrophy of fast-twitch fibers, decreased or maintained mitochondrial number and capillary density of muscle, and possible changes in energy sources. Combined exercise results in higher peak work capacity and VO2 peak than resistance or aerobic exercise alone. Although precautions must be taken due to the high risk of cardiovascular events as seen in this case, combined aerobic and resistance exercises can be prescribed to increase cardiorespiratory and muscular fitness and improve body composition.

Early Rehabilitation for the Prevention and Management of Pleural Empyema: A Narrative Review Nazir, Arnengsih; Prananta, Marietta Shanti; Rachmi, Ami; Ferjuniko, Vecky
Jurnal Respirasi Vol. 12 No. 1 (2026): January 2026
Publisher : Faculty of Medicine Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/jr.v12-I.1.2026.71-80

Introduction: Parapneumonic effusions (PPE) can progress to pleural empyema (PE), a severe condition associated with increased morbidity and mortality. Pleural empyema impairs lung function due to pleural inflammation, fluid accumulation, and restricted diaphragm movement. Patients with severe PPE and PE often require intensive care, where prolonged immobilization and mechanical ventilation further exacerbate respiratory decline. Early rehabilitation (ER) has shown promise in reducing complications associated with prolonged intensive care unit (ICU) stays, but its role in preventing PE remains unclear. This review aimed to assess the impact of ER on PE prevention and on clinical outcomes. Methods: A literature search was conducted using PubMed and Google Scholar, focusing on original research and case reports related to PE, ICU care, and ER interventions. Only full-text English articles were included. Results: Ten studies met the inclusion criteria, comprising four original research articles and six case reports. Early rehabilitation, including respiratory physiotherapy, early mobilization, and targeted exercises, has been shown to enhance lung expansion, prevent atelectasis, and reduce postoperative pulmonary complications. It also improved oxygenation, secretion clearance, functional capacity, and psychological well-being. Patients receiving structured ER programs had shorter hospitalizations and better overall outcomes. Conclusion: Early rehabilitation plays a crucial role in mitigating respiratory complications in critically ill patients by reducing the incidence of PE, improving pulmonary mechanics, and preventing pleural adhesions. While further large-scale studies are needed, current evidence supports integrating ER into ICU protocols to optimize respiratory function, enhance recovery, and improve quality of life in patients at risk of PE.

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