Key messages

• The benefits and risks of exercise therapy in treating delirium compared to no treatment or usual care are unclear due to the lack of robust evidence. Exercise therapy could help reduce the duration of delirium, shorten stays in intensive care units and may produce no harmful side effects. However, more research is necessary in this area.

• Future studies should aim to confirm these findings and investigate whether exercise therapy can improve quality of life, lessen the severity of delirium, and boost cognitive function (how a person learns, remembers, and makes sense of information). They should also compare exercise therapy to other treatments, such as medications.

What is delirium?

Delirium is a common condition that many patients in intensive care units experience. The exact reason for this is not completely clear. Patients in the intensive care unit may show changes in their usual mental state, have trouble paying attention, think in a disorganised way, or have altered levels of awareness. All these usually happen within hours or days of admission to the ICU and change or worsen rapidly, all without a medical reason. For patients, delirium in the intensive care unit can affect their treatments and recovery. For families of patients, delirium in the intensive care unit can cause anxiety, fear, feelings of helplessness or perturbation, requiring reassurance that delirium is a common occurrence in this setting and is only temporary.

How is delirium in the intensive care unit treated?

We can treat delirium in the intensive care unit through a mix of non-drug methods and medications. The non-drug approaches focus on creating a supportive environment that helps patients recover more effectively. These include making sure they know what time it is and where they are, encouraging visits from family, ensuring they get enough sleep, managing any pain they might have, and promoting gentle movement to help them stay active and regain their independence. It is also important to avoid using physical restraints and to limit sedatives, as these can make symptoms worse. When medications are necessary, doctors may prescribe antipsychotics to help manage severe agitation or distress. However, these medications are used carefully and only when needed.

What did we want to find out?

We wanted to find out if exercise therapy is better than standard care, no treatment, or medication for improving the following.

• How long delirium lasts for people in intensive care units.

• The quality of life for patients with delirium who receive exercise therapy.

• Whether it helps reduce the overall time spent in the hospital, the time in the intensive care unit, and the rates of death.

• If there are any negative side effects from exercise therapy.

What did we do?

We searched for studies that investigated exercise therapy versus standard care, no treatment, or medication in people who were hospitalised in the intensive care unit and developed delirium.

We compared and summarised the studies' results and rated our confidence in the evidence based on factors such as study methods and sizes.

What did we find?

We found four studies involving 491 people with delirium who were hospitalised in an intensive care unit. These studies compared the benefits of exercise therapy versus usual care or no treatment. No study compared exercise therapy with medication.

Exercise therapy may help reduce the duration of delirium and probably shortens the time spent in intensive care units. Exercise therapy may produce no harmful side effects. However, none of the studies investigated quality of life or severity of delirium. None of the included studies compared exercise therapy with medications.

What are the limitations of the evidence?

We have little confidence in the evidence about using exercise therapy to reduce the duration of delirium with no unwanted side effects because not all the studies provided data about everything that we were interested in, it is possible that people in the studies were aware of which treatment they were getting, and the evidence is based on few cases.

Our confidence in the evidence supporting the use of exercise therapy for the treatment of delirium for improving intensive care unit length of stay is only moderate. This uncertainty arises from concerns that people in the studies may have known which treatment they were receiving. Additionally, not all studies provided data on all aspects we were interested in.

How up to date is this evidence?

The evidence is up to date to 12 July 2024.