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Combined early in-bed cycling and intravenous amino acid supplementation does not improve 6-minute walk distance in patients with acute respiratory failure.

In a multicenter phase 2 RCT of 115 patients with acute respiratory failure, the intervention group received in-bed cycling (mean 40 min/d) and intravenous amino acid (total protein 1.9 g/kg/d) plus usual care, while controls received usual care alone (protein 0.9 g/kg/d). The median 6-minute walk distance at hospital discharge was similar between groups (108 m vs 95 m, P=0.51), and secondary outcomes also showed no significant differences.

Last updated: Jul 15, 2026•1 RCTs•📖 Read as article →

Evidence Score

Evidence Score44/100
Human RCT★★☆☆☆
Meta-analysis☆☆☆☆☆
Mechanism★★★★★
Safety★★★★☆
Confidencelow

Study Evidence

Study 1. Nutrition and Exercise in Critical Illness (NEXIS) trial: randomized trial of combined in-bed cycling and intravenous amino acid plus usual care.

observational

Needham DM, Files DC, Hough CL, Mayer KP, Ardren S, Fatima A, Jiang X, Day AG, Dinglas VD, Hiser SL, Kiyatkin ME, Khan A, Morris PE, Carson SS, Antkowiak M, Bakhru RN, Burns S, Nath SD, Gibbs KW, Gundel SJ, Kalema AG, Sturgill JL, Ventrone S, Heyland DK, Stapleton RD · American journal of respiratory and critical care medicine (2026)

Participants: N/A
Duration: Until hospital discharge with 6-month follow-up
Intervention: In-bed cycling exercise (45 min/d) plus intravenous amino acid supplementation (total protein intake 2.0-2.5 g/kg/d) plus usual care, initiated early in the ICU.
Outcome: 6-minute walk distance (6MWD) at hospital discharge; secondary outcomes included functional measures at ICU and hospital discharge and phone surveys at 6-month follow-up.
Effect Size: Median difference 10 m (95% CI, -75 to 84); P=0.51
Population: Patients with acute respiratory failure (ARF) in intensive care units (ICUs), median age ~55 years, 55% male, APACHE II ~24, >90% mechanically ventilated.

Result:

PubMed: 42438140DOI: 10.1093/ajrccm/aamag287

Mechanism Graph

In-bed cycling exercise and intravenous amino acid supplementation were initiated early in the ICU
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Intervention aimed to mitigate immobility and limited nutritional intake
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Primary outcome was 6-minute walk distance at hospital discharge
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No significant improvement in physical functioning was observed

Limitations

  • ⚠Enrollment was stopped early due to slow recruitment, reducing statistical power
  • ⚠The study was a phase 2 trial with a relatively small sample size (115 patients)

Frequently Asked Questions

What was the primary outcome of the NEXIS trial?▼

The primary outcome was the 6-minute walk distance (6MWD) measured at hospital discharge.

Did the intervention improve physical functioning in ICU patients?▼

No, the combined intervention of in-bed cycling and intravenous amino acid did not significantly improve 6MWD or any secondary outcomes compared to usual care alone.

Was the intervention safe?▼

Yes, the intervention appeared safe with no evidence of safety concerns, though enrollment was stopped early due to slow recruitment.

What was the protein intake in the intervention and control groups?▼

The intervention group received a total protein intake of 1.9 ± 0.6 g/kg/d, while the control group received 0.9 ± 0.6 g/kg/d.

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References

  1. 1.Needham DM, Files DC, Hough CL, Mayer KP, Ardren S, Fatima A, Jiang X, Day AG, Dinglas VD, Hiser SL, Kiyatkin ME, Khan A, Morris PE, Carson SS, Antkowiak M, Bakhru RN, Burns S, Nath SD, Gibbs KW, Gundel SJ, Kalema AG, Sturgill JL, Ventrone S, Heyland DK, Stapleton RD. "Nutrition and Exercise in Critical Illness (NEXIS) trial: randomized trial of combined in-bed cycling and intravenous amino acid plus usual care.." American journal of respiratory and critical care medicine, 2026. PMID: 42438140 DOI: 10.1093/ajrccm/aamag287
Disclaimer: This content is for educational purposes only and is not medical advice. Evidence scores reflect the quality and quantity of available research, not clinical recommendations. Always consult a healthcare professional before starting any supplement or intervention.