Research Article

The Effect of Early Mobilization Techniques on Meliorating Fatigue and Physical Activity Tolerance of Patients Admitted to Cardiac Intensive Care Units

Abstract

Background: Patients undergoing Coronary Artery Bypass Grafting (CABG) frequently experience fatigue and physical activity tolerance as post-operative complications. The early mobilization technique is one of the beneficial nursing intervention programs that amend patients' outcomes, intercept immobilization, and increase quality of life. This study aimed to assess the effect of the early mobilization (EM) protocol on fatigue and physical activity tolerance in patients who underwent CABG.
Methods: We designed this study as a quasi-experiment with a control group. Participants involved patients who underwent CABG at the Intensive Care Unit (ICU) of Tehran Shahid Modarres Hospital in Iran between April and September 2023. The study included 96 patients, with 48 patients each in the intervention and control groups. Two distinct time points were used to select intervention and control groups (the initial three months and the following three months). Both the control and intervention groups received standard hospital care, but the intervention group also received an EM protocol education. We dedicated three days to intervention education and employment: day 0 (immediately after extubation), day 1 (24 hours later), and day 2 (48 hours later). We collected data were using the Visual Analog Scale-Fatigue (VAS-F) and the Borg scale at two time points (day 0 and day 2). We performed a paired t-test, an independent sample t-test, and an ANCOVA  to analyse data.
Results: 56.3% of participants were men and 43.7% were women. The mean age of participants was 52.7±8.8. In both groups, hypertension (29.2%), hyperlipidemia (27.1%), and diabetes (20.8%) were the most prevalent CVD risk factors. The intervention group's mean fatigue decreased significantly on day 2 (4.40±0.94) compared to day 0 (6.65±1.12) while the mean PA tolerance increased significantly on day 2 (11.82±1.90) compared to day 0 (7.31%±1.20) (P<0.001). The control group did not experience any statistically significant intragroup changes (P>0.05). Significant intergroup changes were observed in the mean fatigue and PA tolerance values on day 2 (P<0.001) while there were no statistically significant intergroup changes in them on day 0 (P>0.05).
Conclusion: This study highlighted that early mobilization was an effective and safe inhibition program to meliorate fatigue and physical activity tolerance in CAD patients.

[1] Sattartabar B, Ajam A, Pashang M, Jalali A, Sadeghian S, Mortazavi H, et al. Sex and age difference in risk factor distribution, trend, and long-term outcome of patients undergoing isolated coronary artery bypass graft surgery. BMC Cardiovasc Disord. 2021;21:1-10.
[2] Oshvandi K, Pakrad F, Saleh RM, Rabiei MAS, Shams A. Post-operative symptoms and complications in patients having undergone coronary artery bypass graft in Hamadan: A descriptive cross-sectional study. Jundishapur J Chronic Dis Care. 2020;9(4).
[3] Yayla A, Özer N. Effects of early mobilization protocol performed after cardiac surgery on patient care outcomes. Int J Nurs Pract. 2019;25(6):e12784.
[4] Amini M, Zayeri F, Salehi M. Trend analysis of cardiovascular disease mortality, incidence, and mortality-to-incidence ratio: results from global burden of disease study 2017. BMC Public Health. 2021;21:1-12.
[5] Alradwan I, Al Fayez N, Alomary MN, Alshehri AA, Aodah AH, Almughem FA, et al. Emerging Trends and Innovations in the Treatment and Diagnosis of Atherosclerosis and Cardiovascular Disease: A Comprehensive Review towards Healthier Aging. Pharmaceutics. 2024;16(8):1037.
[6] Roth GA, Mensah GA, Johnson CO, Addolorato G, Ammirati E, Baddour LM, et al. Global burden of cardiovascular diseases and risk factors, 1990-2019: update from the GBD 2019 study. J Am Coll Cardiol. 2020;76(25):2982-3021.
[7] Kim H, Bae SH, Lim S-H, Park J-H. Predictors of health-related quality of life after coronary artery bypass graft surgery. Sci Rep. 2022;12(1):16119.
[8] Marzoog BA, Alexandrovich KO, Nikolaevich TM, Vladimirovich KS. Post-Coronary Artery Bypass Graft Complications; Potential Causes and Risk Factors. medRxiv. 2023:2022.12.29.22284005.
[9] Ogul B, Ergin G. Examination of Chronic Fatigue in Patients with Coronary Artery Bypass Graft Surgery. J Basic Clin Health Sci. 2020;4(2):168-73.
[10] Ma H, Huang S, You M, Yang J, Zong R, Zhang C. Effect of Early Rehabilitation Exercise on Lower Limb Function and Psychological State After Coronary Artery Bypass Grafting: A Randomized Controlled Trial. Heart Surg Forum. 2024.
[11] Kinas SB, Bilgic S. Impact of breathing exercises in patients who had open heart operation on respiratory function and exercise tolerance. Aust J Adv Nurs. 2024;41(1):10-20.
[12] Li L, Piao JJ, Shang Z. Fatigue and physical activity in post-CABG patients: the parallel mediation model of kinesiophobia and self-efficacy: a prospective multicentre and cross-sectional study in China. BMJ Open. 2024;14(6):e082576.
[13] Muliantino MR, Herawati T. Benson's Relaxation for Fatigue Patient with Coronary Artery Disease. Caring Indones J Nurs Sci. 2020;2(1):63-9.
[14] de Almeida E, de Almeida J, Landoni G, Galas F, Fukushima J, Fominskiy E, et al. Early mobilization programme improves functional capacity after major abdominal cancer surgery: a randomized controlled trial. Br J Anaesth. 2017;119(5):900-7.
[15] Kanejima Y, Shimogai T, Kitamura M, Ishihara K, Izawa KP. Effect of early mobilization on physical function in patients after cardiac surgery: a systematic review and meta-analysis. Int J Environ Res Public Health. 2020;17(19):7091.
[16] Paton M, Lane R, Hodgson CL. Early mobilization in the intensive care unit to improve long-term recovery. Crit Care Clin. 2018;34(4):557-71.
[17] Karimi N, Hasanvand S, Beiranvand A, Gholami M, Birjandi M. The effect of Aromatherapy with Pelargonium graveolens (P. graveolens) on the fatigue and sleep quality of critical care nurses during the COVID-19 pandemic: A randomized controlled trial. Explore (NY). 2024;20(1):82-8.
[18] Ozyemisci-Taskiran O, Batur EB, Yuksel S, Cengiz M, Karatas GK. Validity and reliability of fatigue severity scale in stroke. Top Stroke Rehabil. 2019;26(2):122-7.
[19] Lee I-M, Sesso HD, Oguma Y, Paffenbarger RS Jr. Relative intensity of physical activity and risk of coronary heart disease. Circulation. 2003;107(8):1110-6.
[20] Daneshmandi H, Choobineh AR, Rajaee-Fard A-R. Validation of Borg's RPE 6-20 scale in male industrial workers of Shiraz city based on heart rate. Jundishapur Sci Med J. 2012;11(1):1-10.
[21] Fagevik Olsén M, Becovic S, Dean E. Short-term effects of mobilization on oxygenation in patients after open surgery for pancreatic cancer: a randomized controlled trial. BMC Surg. 2021;21:1-12.
[22] Rezaei-Adaryani M, Ahmadi F, Asghari-Jafarabadi M. The effect of changing position and early ambulation after cardiac catheterization on patients' outcomes: a single-blind randomized controlled trial. Int J Nurs Stud. 2009;46(8):1047-53.
[23] Herisson F, Godard S, Volteau C, Le Blanc E, Guillon B, Gaudron M, et al. Early sitting in ischemic stroke patients (SEVEL): a randomized controlled trial. PLoS One. 2016;11(3):e0149466.
[24] da Costa Torres D, Dos Santos PMR, Reis HJL, Paisani DM, Chiavegato LD. Effectiveness of an early mobilization program on functional capacity after coronary artery bypass surgery: A randomized controlled trial protocol. SAGE Open Med. 2016;4:2050312116682256.
[25] Li Z, Zhou L, Li M, Wang W, Wang L, Dong W, et al. Early mobilization after pancreatic surgery: A randomized controlled trial. Surgery. 2024;176(4):1179-88.
Files
IssueArticle in Press QRcode
SectionResearch Article(s)
Keywords
Cardiac surgery early mobilization fatigue physical activity post‐operative CABG

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Arab Shahraby M, Sedighi L, Sanaei N, Nasiri M. The Effect of Early Mobilization Techniques on Meliorating Fatigue and Physical Activity Tolerance of Patients Admitted to Cardiac Intensive Care Units. Arch Anesth & Crit Care. 2025;.