Movement as Medicine: ICU Project Promotes Daily Mobilization
In the ICU at Cleveland Clinic Avon Hospital, clinical nurse Cheryl Mooney, BSN, RN, knows firsthand how crucial mobility is. She has cared for patients who risk further debilitation when they remain in bed and rely solely on passive range-of-motion movements performed by caregivers.
"Mobility touches every facet of life," Mooney explains. "From kidney and liver function to muscle and bone health, it matters across the board."
In 2023, Mooney partnered with Maria Mepham, PT, DPT, Avon Hospital Rehabilitation Services manager, to launch an ICU mobility initiative aimed at improving patient outcomes and shortening hospital stays.
Nurses take the lead
A year prior, Mooney and Mepham assembled an interdisciplinary team that included nurses, physical and occupational therapists, a speech-language pathologist, a physician assistant, and a respiratory therapist. Their focus was delirium management using the A2F ICU Liberation Bundle, which comprises six elements:
A — Assess, prevent and manage pain
B — Conduct spontaneous awakening and spontaneous breathing trials
C — Choose analgesia and sedation carefully
D — Assess, prevent and manage delirium
E — Promote early mobility and exercise
F — Engage and empower families
Mooney notes, "The team concentrated on what nurses could do to enhance care for critically ill ICU patients. We don’t control airway management or sedation, but nurses own the back end of the A2F bundle." After addressing delirium, the team shifted its emphasis to early mobilization and family involvement.
Caregiver and family tools
Avon Hospital uses the validated 6-clicks mobility score to assess functional mobility for patients in acute care settings, with nurses and physical therapists applying it. Mepham designed four groups of four exercises aligned with a patient’s 6-clicks score, ranging from caregiver-assisted activities for lower scores to exercises suitable for functionally independent patients with higher scores.
Originally, Mepham placed a list of exercises and instructions in a binder in each patient’s room. However, ICU Shared Governance Committee nurses suggested a hallway resource center where caregivers could access exercise groupings tailored to individual 6-clicks scores.
Mooney and Mepham also created mobility carts for each of the 12 ICU rooms. They sourced sturdy, drawer-filled carts from hospital storage and stocked them with essentials to promote movement: an exercise band, a gait belt, and a sand-filled PVC bar that shifts weight as it moves. A walker sits in every room, and a laminated
"Movement Is Medicine" card is affixed to each cart, explaining why mobility matters and offering tips for families to support movement.
"Families love it," Mooney says. "It gives them something practical to do while their loved one is hospitalized and makes them part of the care team. Our goal is to promote safe, daily movement whenever possible."
Education drives adoption
Understanding that education was key, the team produced a nurse-focused letter outlining the importance of early mobilization and practical guidance on involving families, accounting for varying patient acuities, and encouraging activities of daily living as forms of exercise.
Project updates were shared during morning huddles and governance meetings. Mepham and Nicole Kodman, OTR/L, senior occupational therapist, conducted ICU rounds to provide one-on-one education, review mobility cart contents, and demonstrate how to integrate these tools into nursing workflows.
Mooney emphasizes the value of collaboration across day and night shifts to secure buy-in and ensure seamless implementation.
The right choice for patient care
More than two years later, the mobility carts, exercise groups, and the overarching philosophy of treating mobility as medicine continue to drive ICU practice. Mooney describes the impact as multi-faceted:
Shorter ICU stays and increased bed availability for new patients
A fundamental improvement in daily patient care through proactive movement
Beyond metrics, Mooney frames mobility as a moral imperative. "These patients didn’t spend their lives lying flat, with caregivers doing everything for them. Each patient entered the ICU with a life, and they deserve a chance to return to that life. Mobility is one of our strongest tools to help them reclaim it."
