{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T07:03:30Z","timestamp":1789715010086,"version":"4.0.1"},"reference-count":36,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T00:00:00Z","timestamp":1779408000000},"content-version":"vor","delay-in-days":21,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100012166","name":"National Key Research and Development Program of China","doi-asserted-by":"publisher","award":["2021YFC2701800"],"award-info":[{"award-number":["2021YFC2701800"]}],"id":[{"id":"10.13039\/501100012166","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100012166","name":"National Key Research and Development Program of China","doi-asserted-by":"publisher","award":["2021YFC2701805"],"award-info":[{"award-number":["2021YFC2701805"]}],"id":[{"id":"10.13039\/501100012166","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Nursing in Critical Care"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Most critically ill children in the paediatric intensive care unit (PICU) are immobilised. Prolonged immobilisation in the PICU negatively affects children's physical health outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>The aim of the study was to evaluate the effectiveness of an early progressive exercise (EPE) intervention to improve the PICU\u2010acquired muscle weakness and to assess the safety of the EPE intervention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>A single\u2010centre pre\u2010 and post\u2010intervention design was adopted. The intervention was the EPE starting within 48\u201372\u2009h after PICU admission. Primary outcome was the 7\u2010day difference of right rectus femoris muscle cross\u2010sectional area (RRMCSA). Secondary outcomes were the 7\u2010day difference of right rectus femoris muscle thickness (RRMT), the 7\u2010day difference of the right thigh leg circumference, length\u2010of\u2010stay, functional status score (FSS) and the incidence of intervention\u2010related adverse events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Included were 29 children in the pre\u2010intervention group and 32 children in the post\u2010intervention group who did not require mechanical ventilation during PICU admission. The 7\u2010day difference of RRMCSA in the post\u2010intervention group was smaller than in the pre\u2010intervention group, (\u22120.13\u2009\u00b1\u20090.13\u2009cm\n                      <jats:sup>2<\/jats:sup>\n                      versus \u22120.28\u2009\u00b1\u20090.10\u2009cm\n                      <jats:sup>2<\/jats:sup>\n                      ,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). The RRMT at 7\u2010day was also smaller in the post\u2010intervention group (\u22120.08\u2009\u00b1\u20090.09\u2009cm versus \u22120.23\u2009\u00b1\u20090.08\u2009cm,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). FSS of the post\u2010intervention group was significantly lower than that of the pre\u2010intervention group (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05). Differences in right thigh circumference, and length\u2010of\u2010stay were not observed between both groups. Children in the post\u2010intervention group completed a total of 224 exercise sessions (completion rate 99.2%). No adverse events were observed.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>EPE slowed muscle atrophy and was safe and feasible in children without mechanical ventilatory support in the PICU. Further research needs to confirm early rehabilitation on short\u2010term and long\u2010term physical health outcomes after PICU discharge.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Relevance to Clinical Practice<\/jats:title>\n                    <jats:p>PICU nurses should consider using early progressive exercise in critically ill children in the PICU and have parents involved in these early rehabilitation programmes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>\n                      Chinese Clinical Trial Registry\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"https:\/\/www.chictr.org.cn\/indexEN.html\">https:\/\/www.chictr.org.cn\/indexEN.html<\/jats:ext-link>\n                      number: ChiCTR2100047629\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/nicc.70521","type":"journal-article","created":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T12:21:26Z","timestamp":1779452486000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Muscle Changes in Critically Ill Children Following an Early Progressive Exercise in the Paediatric Intensive Care Unit: A Pre\u2010 and Post\u2010Intervention Study"],"prefix":"10.1111","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9568-2873","authenticated-orcid":false,"given":"Shaodan","family":"Qi","sequence":"first","affiliation":[{"name":"Children's Hospital of Fudan University  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuxia","family":"Yang","sequence":"additional","affiliation":[{"name":"Children's Hospital of Fudan University  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Hu","sequence":"additional","affiliation":[{"name":"Children's Hospital of Fudan University  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weijie","family":"Shen","sequence":"additional","affiliation":[{"name":"Children's Hospital of Fudan University  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hao","family":"Zhou","sequence":"additional","affiliation":[{"name":"Children's Hospital of Fudan University  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8087-6461","authenticated-orcid":false,"given":"Jos M.","family":"Latour","sequence":"additional","affiliation":[{"name":"School of Nursing and Midwifery, Faculty of Health University of Plymouth  Plymouth UK"},{"name":"The Curtin School of Nursing Curtin University  Perth Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4868-1602","authenticated-orcid":false,"given":"Weiming","family":"Chen","sequence":"additional","affiliation":[{"name":"Children's Hospital of Fudan University  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9048-3509","authenticated-orcid":false,"given":"Ying","family":"Gu","sequence":"additional","affiliation":[{"name":"Children's Hospital of Fudan University  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,22]]},"reference":[{"key":"e_1_2_16_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000000250"},{"key":"e_1_2_16_3_1","doi-asserted-by":"publisher","DOI":"10.5492\/wjccm.v6.i2.124"},{"key":"e_1_2_16_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000001476"},{"key":"e_1_2_16_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000003622"},{"key":"e_1_2_16_6_1","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.00019.2021"},{"key":"e_1_2_16_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-025-08186-4"},{"key":"e_1_2_16_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0b013e318232da75"},{"key":"e_1_2_16_9_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijms21217840"},{"key":"e_1_2_16_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.physio.2019.12.004"},{"key":"e_1_2_16_11_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0037-1601424"},{"key":"e_1_2_16_12_1","first-page":"177","article-title":"The Effects of Early Progressive Exercise on ICU\u2010Acquired Weakness: A Meta\u2010Analysis","volume":"52","author":"Zhao G. 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