Early Progressive Mobilization Research Articles

Assessing the impact of early progressive mobilization on moderate-to-severe traumatic brain injury: a randomized controlled trial.

Traumatic brain injury (TBI) is a major cause of neurodisability worldwide, with notably high disability rates among moderately severe TBI cases. Extensive previous research emphasizes the critical need for early initiation of rehabilitation interventions for these cases. However, the optimal timing and methodology of early mobilization in TBI remain to be conclusively determined. Therefore, we explored the impact of early progressive mobilization (EPM) protocols on the functional outcomes of ICU-admitted patients with moderate to severe TBI. This randomized controlled trial was conducted at a trauma ICU of a medical center; 65 patients were randomly assigned to either the EPM group or the early progressive upright positioning (EPUP) group. The EPM group received early out-of-bed mobilization therapy within seven days after injury, while the EPUP group underwent early in-bed upright position rehabilitation. The primary outcome was the Perme ICU Mobility Score and secondary outcomes included Functional Independence Measure motor domain (FIM-motor) score, phase angle (PhA), skeletal muscle index (SMI), the length of stay in the intensive care unit (ICU), and duration of ventilation. Among 65 randomized patients, 33 were assigned to EPM and 32 to EPUP group. The EPM group significantly outperformed the EPUP group in the Perme ICU Mobility and FIM-motor scores, with a notably shorter ICU stay by 5.9days (p < 0.001) and ventilation duration by 6.7days (p = 0.001). However, no significant differences were observed in PhAs. The early progressive out-of-bed mobilization protocol can enhance mobility and functional outcomes and shorten ICU stay and ventilation duration of patients with moderate-to-severe TBI. Our study's results support further investigation of EPM through larger, randomized clinical trials. Clinical trial registration ClinicalTrials.gov NCT04810273 . Registered 13 March 2021.

Just Keep MOVEN: An Evidence-Based Approach to Improving Outcomes in Patients Receiving Mechanical Ventilation

Just Keep MOVEN: An Evidence-Based Approach to Improving Outcomes in Patients Receiving Mechanical Ventilation

More is less: Effect of ICF-based early progressive mobilization on severe aneurysmal subarachnoid hemorrhage in the NICU.

Aneurysmal subarachnoid hemorrhage (aSAH) is a type of stroke that occurs due to a ruptured intracranial aneurysm. Although advanced therapies have been applied to treat aSAH, patients still suffer from functional impairment leading to prolonged stays in the NICU. The effect of early progressive mobilization as an intervention implemented in the ICU setting for critically ill patients remains unclear. This retrospective study evaluated ICF-based early progressive mobilization's validity, safety, and feasibility in severe aSAH patients. Sixty-eight patients with aSAH with Hunt-Hess grades III-IV were included. They were divided into two groups-progressive mobilization and passive movement. Patients in the progressive mobilization group received progressive ICF-based mobilization intervention, and those in the passive movement group received passive joint movement training. The incidence of pneumonia, duration of mechanical ventilation, length of NICU stay, and incidence of deep vein thrombosis were evaluated for validity. In contrast, the incidence of cerebral vasospasm, abnormally high ICP, and other safety events were assessed for safety. We also described the feasibility of the early mobilization initiation time and the rate of participation at each level for patients in the progressive mobilization group. The results showed that the incidence of pneumonia, duration of mechanical ventilation, and length of NICU stay were significantly lower among patients in the progressive mobilization group than in the passive movement group (P = 0.031, P = 0.004, P = 0.012), but the incidence of deep vein thrombosis did not significantly differ between the two groups. Regarding safety, patients in the progressive mobilization group had a lower incidence of cerebral vasospasm than those in the passive movement group. Considering the effect of an external ventricular drain on cerebral vasospasm (P = 0.015), we further analyzed those patients in the progressive mobilization group who had a lower incidence of cerebral vasospasm in patients who did not have an external ventricular drain (P = 0.011). Although we found 2 events of abnormally increased intracranial pressure in the progressive mobilization group, there was no abnormal decrease in cerebral perfusion pressure in the 2 events. In addition, among other safety events, there was no difference in the occurrence of adverse events between the two groups (P = 0.073), but the number of potential adverse events was higher in the progressive mobilization group (P = 0.001). Regarding feasibility, patients in the progressive mobilization group were commonly initiated 72 h after admission to the NICU, and 47.06% were in the third level of the mobilization protocol. We conclude that the ICF-based early progressive mobilization protocol is an effective and feasible intervention tool. For validity, more mobilization interventions might lead to less pneumonia, duration of mechanical ventilation and length of stay for patients with severe aSAH in the NICU, Moreover, it is necessary to pay attention over potential adverse events (especially line problems), although we did not find serious safety events.

Effectiveness of a quality improvement strategy with implementation of a specific visual tool to promote ICU early mobilization

Early progressive mobilization is a safe strategy in the intensive care unit (ICU), however, it is still considered challenging by the inherent barriers and poor adherence to early mobilization protocol. The aim of this study was to evaluate the effectiveness of a quality improvement (QI) multifaceted strategy with implementation of a specific visual tool, the “mobility clock”, in reducing non-compliance with the institutional early mobilization (EM) protocol in adult ICUs. A single-center QI with a retrospective before-after comparison study was conducted using data from medical records and hospital electronic databases. Patients from different periods presented similar baseline characteristics. After the QI strategy, a decline in “non-compliance” with the protocol was observed compared to the previous period (10.11% vs. 26.97%, p < 0.004). The proportion of patients walking was significantly higher (49.44% vs. 29.21%, p < 0.006) and the ICU readmission rate was lower in the “after” period (2.25% vs. 11.24%; p = 0.017). The multifaceted strategy specifically designed considering institutional barriers was effective to increase out of bed mobilization, to reduce the “non-compliance” rate with the protocol and to achieve a higher level of mobility in adult ICUs of a tertiary hospital.

A NURSE-DRIVEN, FAMILY-ENGAGED EARLY MOBILITY PROGRAM IN THE CARDIAC INTENSIVE CARE UNIT

A NURSE-DRIVEN, FAMILY-ENGAGED EARLY MOBILITY PROGRAM IN THE CARDIAC INTENSIVE CARE UNIT

Study protocol for a two-center test of a nurse-implemented chronotherapeutic restoring bundle in critically ill children: RESTORE Resilience (R2)

Often, pediatric intensive care environments are not conducive to healing the sick. Critically ill children experience disruptions in their circadian rhythms, which can contribute to delayed recovery and poor outcomes. We aim to test the hypothesis that children managed via RESTORE Resilience (R2), a nurse-implemented chronotherapeutic bundle, will experience restorative circadian rhythms compared to children receiving usual care. In this two-phased, prospective cohort study, two separate pediatric intensive care units in the United Sates will enroll a total of 20 baseline subjects followed by 40 intervention subjects, 6 months to less than 18 years of age, requiring invasive mechanical ventilation. During the intervention phase, we will implement the R2 bundle, which includes: (1) a focused effort to replicate the child's pre-hospitalization daily routine, (2) cycled day-night lighting and sound modulation, (3) minimal yet effective sedation (RESTORE), (4) nighttime fasting with bolus enteral daytime feedings, (5) early progressive mobility (PICU Up!), (6) continuity in nursing care, and (7) parent diaries. Our primary outcome is circadian activity ratio post-extubation. We hypothesize that children receiving R2 will experience restored circadian rhythms as evidenced by decreased nighttime activity while in the PICU. Our exploratory outcomes include salivary melatonin levels; electroencephalogram (EEG) slow-wave activity; R2 feasibility, adherence, and system barriers; levels of patient comfort; exposure to sedative medications; time to physiological stability; and parent perception of being well cared for. This paper describes the design, rationale, and implementation of R2. Clinicaltrials.gov identifierNCT04695392.

Effect of Family Involvement in Patient Care on Preventing Intensive Care Units Acquired Weakness

Background: The Intensive care units acquired weakness detected in 30 to 50% of ICU patients leading to high morbidity and complication, family engaging family in early mobility process that reported benefits including reduced ICU-acquired weakness, improved functional recovery within the hospital, improved walking distance at hospital discharge and reduced hospital length of stay. This study aimed to Determine the effect of family involvement in patient care on preventing intensive care units acquired weakness. Methods: Quasi experimental research was conducted in surgical and general ICUs in the main Mansoura university and emergency hospitals, which included 60 adult newly ICU admitted patients. Tools: Three tools were used to collect the data of this study namely “Intensive care unit acquired weakness assessment”, “Early progressive mobility protocol” and “Patients’ family satisfaction with early mobility protocol involvement”. Results: Only 6.7% of the intervention group had a weakness at the end of the study with no significant difference (0.150) was found in muscle strength from the start and end of the study. While about a third of the control group (26.7%) had a weakness at the end of the study. A statistically significant difference (0.038) in muscle strength was found between intervention and control group. Furthermore, About two-thirds (70%) of patients' family members of the intervention group were satisfied by giving them a role in participation in their patient care. Conclusion: Critically ill patients whose families were involved in their mobility protocol had less intensive care units acquired weakness rates than those who were not. Recommendation: Evaluation of muscle strength should be a routine part of ICU examination. Family centered care concept should be adopted in ICUs by allocating them in daily activities involvement with enough support and cooperation

Early Mobility for Critically Ill Patients: Building Staff Commitment Through Appreciative Inquiry.

Immobility contributes to many adverse effects in critically ill patients. Early progressive mobility can mitigate these negative sequelae but is not widely implemented. Appreciative inquiry is a quality improvement method/change philosophy that builds on what works well in an organization. To explore whether appreciative inquiry would reinvigorate an early progressive mobility initiative in a medical intensive care unit and improve and sustain staff commitment to providing regular mobility therapy at the bedside. Secondary goals were to add to the literature about appreciative inquiry in health care and to determine whether it can be adapted to critical care. Staff participated in appreciative inquiry workshops, which were conducted by a trained facilitator and structured with the appreciative inquiry 4-D cycle. Staff members' attitudes toward and knowledge of early progressive mobility were evaluated before and after the workshops. Performance of early progressive mobility activities was recorded before and 3 and 10 months after the workshops. Sixty-seven participants completed the program. They rated the workshops as successfully helping them to understand the importance of early progressive mobility (98%), explain their responsibility to improve patient outcomes (98%), and engender a greater commitment to patients and the organization (96%). Regarding mobility treatments, at 3 months orders had improved from 62% to 88%; documentation, from 52% to 89%; and observation, from 39% to 87%. These improvements were maintained at 10 months. Participation in the workshops improved the staff's attitude toward and performance of mobility treatments. Appreciative inquiry may provide an adjunct to problem-based quality improvement techniques.

Integrating Safe Patient Handling and Early Mobility: Combining Quality Initiatives.

Safe Patient Handling and Mobility (SPHM) programs reduce staff injuries from lifting and repositioning patients. Early Mobility programs improve many patient-centered outcomes. Reframing SPHM equipment as mobilization tools can help safely mobilize hospitalized patients to their highest abilities. Combining SPHM and Early Mobility programs is logical, but to date, no one has articulated the process of integration. A quality improvement process was developed at the Phoenix Veterans Affairs Health Care System to integrate an Early Exercise and Progressive Mobility initiative in the intensive care unit into an ongoing SPHM program using the Iowa Model for Evidence-Based Implementation. Integration of these programs was possible through extensive collaboration between stakeholders throughout planning, implementation, and refinement phases. Interdisciplinary Early Exercise and Progressive Mobility simulation training, standardized assessment, communication of patient status, and appropriate equipment use facilitated staff confidence to safely mobilize patients. Successful integration of Early Exercise and Progressive Mobility and SPHM was achieved at the Phoenix Veterans Affairs Health Care System.

Role of early progressive mobilization protocol on outcomes of mechanically ventilated patients with pneumonia

Introduction Mobilization targets include upgrading respiratory function by improving ventilation/perfusion matching, increasing lung capacity, improving secretion clearance, reducing the hazards of immobility, improving levels of consciousness, improving functional independence, improving cardiovascular status, and improving psychological well-being. Objectives The aim of the study was to determine the effect of early mobilization of mechanically ventilated patients with pneumonia on morbidity (facilitating weaning, hospital stay, incidence of muscle weakness, and incidence of delirium) and mortality. Patients and methods This comparative randomized single-blinded study enrolled 70 adult mechanically ventilated patients of both sexes having pneumonia. They were categorized into two groups according to applying the mobilization protocol: mobilization group and control group. Before starting the protocol, the participants were subjected to history taking, complete physical examination, neurological examination (Glasgow Coma Scale and muscle power), full laboratory and radiological investigations. Initiation of stepwise progressive mobilization protocol after 24 h of intubation was done, and respiratory and hemodynamic stability were assessed. Results The first group (mobilization group) included 35 patients, in whom mobilization protocol was applied, and second group (control group) included 35 patients, in whom no protocol was applied. The mobilization group showed less ventilator days, ICU stay, and hospital stay. Moreover, they showed improvement in the static compliance, hypoxic index, and Sequential Organ Failure Assessment score (SOFA score) values in comparison between the first and last day of the study in each group. They showed less incidence of delirium and less mortality at days 7 and 28 in comparison with the control group. Conclusions The mobilization intervention is a feasible and safe intervention and offers improvement in multiple outcomes for patients with pneumonia such as reduction of the duration of mechanical ventilation, ICU stay, hospital stay, delirium, and mortality and improvement of muscle power and lung compliance.

Effectiveness of a Bundled Intervention Including Adjunctive Corticosteroids on Outcomes of Hospitalized Patients With Community-Acquired Pneumonia

Community-acquired pneumonia remains a leading cause of hospitalization, mortality, and health care costs worldwide. Randomized clinical trials support the use of adjunctive corticosteroids, early progressive mobilization, antibiotic switching rules, and dietary interventions in improving outcomes. However, it is uncertain whether implementing these interventions will translate into effectiveness under routine health care conditions. To evaluate the effectiveness of a bundle of evidence-supported treatments under conditions of routine care in a representative population hospitalized for community-acquired pneumonia. A double-blind, stepped-wedge, cluster-randomized clinical trial with 90-day follow-up was conducted between August 1, 2016, and October 29, 2017, in the general internal medicine service at 2 tertiary hospitals in Melbourne, Australia, among a consecutive sample of patients with community-acquired pneumonia. The primary analysis and preparation of results took place between May 14 and November 25, 2018. Treating clinical teams were advised to prescribe prednisolone acetate, 50 mg/d, for 7 days (in the absence of any contraindication) and de-escalate from parenteral to oral antibiotics according to standardized criteria. Algorithm-guided early mobilization and malnutrition screening and treatment were also implemented. Hospital length of stay, mortality, readmission, and intervention-associated adverse events (eg, gastrointestinal bleeding and hyperglycemia). A total of 917 patients were screened, and 816 (351 women and 465 men; mean [SD] age, 76 [13] years) were included in the intention-to-treat analysis, with 401 patients receiving the intervention and 415 patients in the control group. An unadjusted geometric mean ratio of 0.95 (95% CI, 0.78-1.16) was observed for the difference in length of stay (days) between the intervention and control groups. Similarly, no significant differences were observed for the secondary outcomes of mortality and readmission, and the results remained unchanged after further adjustment for sex and age. The study reported higher proportions of gastrointestinal bleeding in the intervention group (9 [2.2%]) compared with the controls (3 [0.7%]), with an unadjusted estimated difference in mean proportions of 0.008 (95% CI, 0.005-0.010). This bundled intervention including adjunctive corticosteroids demonstrated no evidence of effectiveness and resulted in a higher incidence of gastrointestinal bleeding. Efficacy of individual interventions demonstrated in clinical trials may not necessarily translate into effectiveness when implemented in combination and may even result in net harm. ClinicalTrials.gov identifier: NCT02835040.

Percieved barriers to early progressive mobilization in the ICU: Multidisciplinary perspectives in an underserved population

Early progressive mobilization is the initiation of movement when a patient is hemodynamically stable, adequately oxygenated, and minimally able to participate. Early progressive mobilization has been linked to decreased morbidity and mortality as inactivity has a profound adverse effect on the brain, skin, skeletal muscle, pulmonary and cardiovascular systems. Literature supports early progressive mobilization and physical therapy as a safe and effective intervention that can have a positive impact on functional outcomes. While the benefits of early progressive mobilization in the intensive care unit have been well documented in recent years, many intensive care units are unable to effectively integrate early progressive mobilization into their daily practice. Therefore, the purpose of this project was to determine whether an educational intervention on the Early Progressive Mobilization Protocol at an urban intensive care unit in Las Vegas, Nevada affected knowledge of, skill in, and attitudes toward implementation of the protocol in practice, as well as to determine whether there was a difference in reported compliance scores among various disciplines. A pre-test survey designed to examine these variables and the reported compliance with the Early Progressive Mobilization protocol was administered. Educational sessions were provided to participants on the Early Progressive Mobilization Protocol after the pre-test. A post-test was administered after the educational session to determine the educational impact on the identified variables. Data analysis was completed using frequency distributions. Valuable insight was gained on the potential impact of targeted educational intervention. Further study is warranted to assess the effects of routine training in intensive care units with similar protocols.

Safety and potential benefits of physical therapy in adult patients on extracorporeal membrane oxygenation support: a systematic review.

Scientific and technological advances, coupled with the work of multidisciplinary teams in intensive care units, have increased the survival of critically ill patients. An essential life support resource used in intensive care is extracorporeal membrane oxygenation. Despite the increased number of studies involving critically ill patients, few studies to date have demonstrated the safety and benefits of physical therapy combined with extracorporeal membrane oxygenation support. This review identified the clinical outcomes of physical therapy in adult patients on extracorporeal membrane oxygenation support by searching the MEDLINE®, PEDro, Cochrane CENTRAL, LILACS, and EMBASE databases and by manually searching the references of the articles published until September 2017. The database search retrieved 1,213 studies. Of these studies, 20 were included in this review, with data on 317 subjects (58 in the control group). Twelve studies reported that there were no complications during physical therapy. Cannula fracture during ambulation (one case), thrombus in the return cannula (one case), and leg swelling (one case) were reported in two studies, and desaturation and mild vertigo were reported in two studies. In contrast, improvements in respiratory/pulmonary function, functional capacity, muscle strength (with reduced muscle mass loss), incidence of myopathy, length of hospitalization, and mortality in patients who underwent physical therapy were reported. The analysis of the available data indicates that physical therapy, including early progressive mobilization, standing, ambulation, and breathing techniques, together with extracorporeal membrane oxygenation, is feasible, relatively safe, and potentially beneficial for critically ill adult patients.

Early Progressive Mobilization of Patients with External Ventricular Drains: Safety and Feasibility.

Early mobilization of critically ill patients has been shown to improve functional outcomes. Neurosurgery patients with an external ventricular drain (EVD) due to increased intracranial pressure often remain on bed rest while EVD remains in place. The prevalence of mobilizing patients with EVD has not been described, and the literature regarding the safety and feasibility of mobilizing patients with EVDs is limited. The aim of our study was to describe the outcomes and adverse events of the first mobilization attempt in neurosurgery patients with EVD who participated in early functional mobilization with physical therapy or occupational therapy. We performed a single-site, retrospective chart review of 153 patients who underwent placement of an EVD. Hemodynamically stable patients deemed appropriate for mobilization by physical or occupational therapy were included. Mobilization and activity details were recorded. The most common principal diagnoses were subarachnoid hemorrhage (61.4%) and intracerebral hemorrhage (17.0%) requiring EVD for symptomatic hydrocephalus. A total of 117 patients were mobilized (76.5%), and the median time to first mobilization after EVD placement in this group of 117 patients was 38h. Decreased level of consciousness was the most common reason for lack of mobilization. The highest level of mobility on the patient's first attempt was ambulation (43.6%), followed by sitting on the side of the bed (30.8%), transferring to a bedside chair (17.1%), and standing up from the side of the bed (8.5%). No major safety events, such as EVD dislodgment, occurred in any patient. Transient adverse events with mobilization were infrequent at 6.9% and had no permanent neurological sequelae and were mostly headache, nausea, and transient diastolic blood pressure elevation. Early progressive mobilization of neurosurgical intensive care unit patients with external ventricular drains appears safe and feasible.

Patient views regarding the impact of hydrotherapy on critically ill ventilated patients: A qualitative exploration study

BackgroundIntensive Care Unit Acquired Weakness can be mitigated by early activity and progressive mobilization. Hydrotherapy enables patients to work on their recovery in a very early stage. This may lead to higher levels of self-efficacy, subsequently higher activity-rates and faster functional recovery. Hydrotherapy might positively affect the regaining of control, hope and trust. Our aim is to explore patient perspective regarding the impact of hydrotherapy on critically ill ventilated patients. MethodsThis qualitative exploration study adopted an interpretative phenomenological approach using in-depth, face to face, semi-structured interviews. Questions covered: pre-admission physical activity, perception of hydrotherapy, affection to water, positive and negative experiences and feelings towards the recovery process. Interviews were analyzed using thematic analysis. ResultsTwelve patients were enrolled, of which eight could be interviewed. After analyzing, five main themes were found: experiencing consequences of critical illness, feeling safe in the water, being able to move, positive experiences relating to hydrotherapy and experiencing a turning point. ConclusionsHydrotherapy seemed to help patients regain control and belief in their recovery. Patients experienced exercising in water as a turning point in their recovery process. This study encourages to continue providing hydrotherapy to critically ill ventilated patients and may stimulate future research.

Integrating a Mobility Champion in the Intensive Care Unit.

In recent years, early progressive mobilization programs have become mainstays in intensive care units (ICUs). Significant evidence exists that early mobility programs decrease length of stay, reduce time on the ventilator, and decrease the development of delirium in ICU patients. Yet, current literature still describes many barriers to performing early mobility, such as the time required, staffing pressures, and increased workload. Our critical care leaders found that defining and implementing a dedicated mobility champion team member was successful in improving the effectiveness of our early mobility program. This article describes how to define the mobility champion role, consider options for the person in the role, and integrate this new role into the ICU team.

Sustainability of a nurse-driven early progressive mobility protocol and patient clinical and psychological health outcomes in a neurological intensive care unit

ObjectivesTo determine sustainable impact of an early progressive mobility protocol on mobility level and clinical outcomes. Design/MethodsProspective, longitudinal, comparative study using three time points (pre-, immediate post-intervention and 12-month post-intervention sustainability). Analyses included comparative statistics and multivariable modelling. Data were collected by clinical nurses, from administrative databases. Psychological health data were collected using a valid, reliable tool. SettingPatients treated in a 22-bed Neurological Intensive Care Unit of a quaternary-care medical centre. Outcome measuresHighest mobility level, length of stay, mortality, discharge disposition, quality metrics and psychological profile including depression, anxiety, and hostility. ResultsAmongst 260 pre-intervention, 377 post-implementation, and 480 twelve-month post-implementation patients (N = 1117) walking increased post-implementation and was sustained at the eight-month assessment, p < .001. After multivariable adjustment, unit and hospital length of stay and psychological distress were reduced compared to the pre-early mobility programmes (all p < .001). There were no differences in discharge disposition (i.e., home vs skilled nursing facility), mortality or quality metrics. ConclusionOngoing implementation of an early mobility programme in a neurological intensive care environment led to sustained improvement in patients’ level of mobility, length of unit and hospital stay, depression, anxiety and hostility levels.

It's all about that base, part 2

In Brief In the first part of our 2016 series, we began sharing the Duke Raleigh Clinical Scene Investigator (CSI) Academy team's journey through change management while developing an early progressive mobility (EPM) initiative using the analogy of building a house to ensure successful culture change. In this second part, we discuss the initiative's go-live process. In this second part of our AACN Clinical Scene Investigator series, the team at Duke Raleigh Hospital takes its early progressive mobility initiative live.

Want to create lasting change? It's all about that base.

The American Association of Critical-Care Nurses (AACN) created the Clinical Scene Investigator (CSI) Academy for nurses at the bedside to develop leadership and innovation skills to create and sustain lasting change that positively impacts patient outcomes. In our 2015 three-part series, we explored how to redefine "nonproductive" time, change leadership, and the formation of the Massachusetts CSI Nursing Delirium Collaborative. In this first part of our 2016 series, we share the Duke Raleigh CSI Academy team's journey through change management while creating an early progressive mobility (EPM) initiative.

Cardiovascular prevention and rehabilitation for patients with ventricular assist device From exercise therapy to long-term therapy Part I: exercise therapy

In the present context of an aging population, limited donor heart availability, improved reliability of mechanical cardiac support and improved patient outcomes, ventricular assist device (VAD) options to support end-stage heart failure patients are rapidly expanding. In addition, both the smaller size and lighter weight of the pumps now produced and early evidence that these third generation devices may be associated with lower risk of infection and right ventricular failure will probably lead to greater physician and patient acceptability. This is the first of a two-part review on the role of cardiovascular prevention and rehabilitation in patients with VAD. In this first part, we will discuss the role of exercise therapy in VAD patients, while the second will focus on long-term management. One of the prerequisites for use of a VAD--whether permanent (as destination therapy) or semi-permanent (as an alternative to heart transplantation)--is that exercise capacity, although not normal, must be adequate for daily life activities. An intensive multidisciplinary rehabilitation program has the potential to increase exercise performance and improve the quality of life of VAD patients. Both early progressive mobilization and exercise training may improve the overall condition of VAD patients, and favorably impact their clinical course.