Comparison between a standard and a modified early mobilization protocol on oxidative stress and inflammatory parameters in patients with sepsis

Oliveira, Danielle Cristina Alves; Francisqueti-Ferron, Fabiane Valentini; Coelho, Marina Melo; Lima, Ana Karla de Loiola Gomes; Oliveira, Gabriela; Ferron, Artur Junio Togneri; Correa, Camila Renata; Ronchi, Carlos Fernando

doi:10.1590/fm.2025.38129

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Original Article • Fisioter. Mov. 38 • 2025 • https://doi.org/10.1590/fm.2025.38129 linkcopy

Comparison between a standard and a modified early mobilization protocol on oxidative stress and inflammatory parameters in patients with sepsis

Comparação entre um protocolo de mobilização precoce padrão e um modificado sobre estresse oxidativo e parâmetros inflamatórios em pacientes com sepse

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction: Oxidative stress is considered a promoter of negative outcomes, including severe myopathy, especially in critical care patients. Early mobilization is the application of physical activity as early as possible to avoid the deleterious bed rest effects.

Objective: To evaluate the effect of early mobilization protocol on oxidative stress and inflammatory parameters in patients with sepsis.

Methods: Prospective study conducted in critical patients divided in control group (CG) and intervention group (IG). Lactate, procalcitonin, Medical Research Council sum score, inflammatory and oxidative stress parameters were obtained before and after protocol. Statistical comparisons among groups for continuous variables were performed using parametric and non-parametric tests.

Results: EM increased Medical Research Council sum score and reduced lactate (IG: initial 5.40 ± 3.44, final 2.02 ± 0.92; CG: initial 4.64 ± 4.99, final 1.90 ± 0.90, p > 0.05); procalcitonin (IG: initial 43.30 ± 39.20, final 8.01 ± 8.13; CG: initial 33.10 ± 33.70, final 14.00 ± 14.80, p > 0.05); oxidative stress (protein carbonylation: IG: initial 4.82 ± 1.00, final 3.52 ± 0.82, p < 0.05; CG: initial 3.32 ± 0.86, final 2.54 ± 0.49, p > 0.05; malondialdehyde: IG: initial 5.57 ± 1.77, final 2.72 ± 1.30, p < 0.05; CG: initial 3.84 ± 2.61, final 4.84 ± 2.11, p > 0.05); and inflammation (TNF-α IG: initial 6.14 ± 2.28, final 4.85 ± 1.10, p < 0.05; CG: initial 7.98 ± 3.37, final 7.08 ± 3.33, p > 0.05).

Conclusion: It is possible to conclude that the modified early mobilization protocol used in this study was effective to reduce oxidative stress and inflammation in sepsis patients.

Keywords:
Early mobilization; Physiotherapy; Oxidative stress; Critical care; Sepsis

Characteristics	Intervention group (n = 8)	Control group (n = 10)	p-value
Gender (%)
Male	75.00	60.00	-
Female	25.00	40.00	-
Age - median (range)	55.53 (37.5 – 58.5)	62.51 (36.0 – 71.0)	0.424
Education (%)
Elementary school incomplete	20.00	33.33	-
Elementary school complete	20.00	16.67	-
High school incomplete	0.00	16.67	-
High school complete	40.00	33.33	-
Higher education complete	20.00	0.00	-
Marital status (%)
Married	60.00	83.33	-
Single	20.00	16.67	-
Divorced	20.00	0.00	-
Average income (%)
1 to 3 minimum salaries	100	83.33	-
Above 4 minimum salaries	0.00	16.67	-
Admission diagnosis (%)
Stab wound	20.00	0.00	-
Pancreatitis	20.00	16.67	-
Acute abdomen	40.00	50.00	-
Cholecystectomy	0.00	33.33	-
Appendicitis	20.00	0.00	-
Need for tracheostomy	20.00	16.67	-
Sepsis type (%)
Sepsis	0.00	33.33	-
Septic shock	100	66.60	-
Infectious focus (%)
Pulmonary	20.00	0.00	-
Abdominal	80.00	100	-
Simplified Acute Physiology Score (%)*	72.00 ± 13.00	50.00 ± 33.00	0.337
Intensive care unit (days)*	17.20 ± 9.20	19.66 ± 17.31	0.782
Sedation time (days)*	4.43 ± 2.64	4.00 ± 2.13	0.766
Hospital time (days)*	47.60 ± 29.24	60.50 ± 29.72	0.489
Mechanical ventilation time (days)*	10.40 ± 5.85	10.66 ± 17.47	0.975

	Intervention group (n = 8)	Control group (n = 10)	p-value*
Initial MRC-SS	0.00 (0.00 – 0.00)	0.00 (0.00 – 0.00)	0.314
Final MRC-SS	36.50 (0.00 – 54.00)	18.50 (0.00 – 44.00)	0.545
p-value**	0.019	0.063
Inicial lactate (mmol/L)	5.40 ± 3.44	4.64 ± 4.99	0.719
Final lactate (mmol/L)	2.02 ± 0.92	1.90 ± 0.90	0.261
p-value**	0.017	0.127
Inicial procalcitonin (ng/mL)	43.3 ± 39.2	33.10 ± 37.10	0.397
Final procalcitonin (ng/mL)	8.01 ± 8.13	14.00 ± 14.80	0.448
p-value**	0.024	0.214
Initial TNF-α (pg/mL)	6.14 ± 2.28	7.98 ± 3.37	0.142
Final TNF-α (pg/mL)	4.84 ± 1.10	7.08 ± 3.33	0.055
p-value**	0.049	0.571
Inicial IL^-1 (pg/mL)	3.13 ± 3.64	4.16 ± 3.44	0.213
Final IL^-1 (pg/mL)	4.87 ± 2.76	3.77 ± 0.62	0.228
p-value**	0.268	0.741
Inicial PC (nmol/mg protein)	4.82 ± 1.00	3.32 ± 0.86	0.004
Final PC (nmol/mg protein)	3.52 ± 0.82	2.54 ± 0.49	0.007
p-value**	0.048	0.051
Initial MDA (nmmol/mg protein)	5.57 ± 1.77	3.84 ± 2.61	0.136
Final MDA (nmmol/mg protein)	2.72 ± 1.30	4.84 ± 2.11	0.005
p-value**	0.011	0.183

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Note: Data presented as mean ± standard deviation.