Patients with prolonged ICU stays are at a considerable risk for anxiety, depression, and long-term psychological sequelae.

Therapeutic walks, structured supervised patient transfers to outdoor settings, have emerged as part of humanized care for critically ill patients in the ICU.

In Argentina, the implementation of a multidisciplinary therapeutic outing program was associated with psychological benefits in patients with prolonged admissions to the ICU. According to a study published in Critical Care, the intervention was safe for appropriately selected patients and focused on a historically underexplored aspect of the ICU: patient emotional well-being.

Humanizing ICU

“We are interested in studying therapeutic walks because survival alone is not enough. What matters is how patients live afterward,” said Daniela Gilgado,  licensed physical therapist specializing in critical care at Sanatorio Anchorena San Martín and Hospital Donación Francisco Santojanni, Buenos Aires, Argentina, and one of the authors of the study.

Speaking with Medscape’s Spanish edition, she said, “An ICU stay can be extremely stressful. We believe that reducing this impact by making hospitalization less traumatic may improve functional recovery and quality of life and help prevent psychological sequelae such as posttraumatic stress.

Gilgado added that “since the opening of Sanatorio Anchorena San Martín, therapeutic walks have been part of routine ICU practice. The intervention allowed patients to access a garden adjacent to the unit, providing an outdoor space with natural light and contact with nature. Family members are encouraged to participate actively during the process.”

Study Design and Safety

The prospective study included 41 patients between 2023 and 2024 (median age, 58 years; median APACHE II score, 9; median ICU length of stay, 14 days). Patients were admitted to the ICU of a private medical center primarily for abdominal conditions (22%), cardiac surgery (19.5%), and coma (14.6%). Before participating in therapeutic walks, 73% required invasive mechanical ventilation for a median of 7 days.

The eligibility criteria included the ability to safely begin physical rehabilitation or mobilization, as well as cardiovascular, respiratory, and neurologic stability.

Each therapeutic walk lasted a median of 25 minutes and was supervised by a multidisciplinary team including ICU physicians, nurses, physical therapists, and psychologists. Clinical parameters, equipment issues, and complications were systematically recorded.

Mood and perceived general health status were assessed before and after the intervention using a numerical scale, along with symptoms of anxiety and depression measured using the Hospital Anxiety and Depression Scale.

Measurable Psychological Benefits

The study documented statistically significant improvements in pre- and post-therapeutic walk on perception of mood (PRE, 6; POST, 7; P < .001), general health status (PRE, 6; POST, 7; P = .007), anxiety (PRE, 6.8; POST, 5.7; P = .016), and depressive symptoms (PRE, 6.6; POST, 5.5; P = .004), confirming the beneficial effects on psychological status. No major adverse events occurred. Minor events included pulse oximeter failure and accidental removal of a peripheral line, none affecting clinical status.

“Seeing these results was very gratifying for us,” Gilgado said. “On the one hand, we quantitatively confirmed a clinical perception we had observed in practice. On the other, it was deeply satisfying to see how a humanized, patient-centered intervention can produce real, measurable benefits during their stay in ICU.”

The research “also reinforces the importance of continuing to explore strategies that consider the critically ill patient in a more comprehensive way,” he added.

External Perspective

Rubén Fernández, MD, intensive care physician and deputy director of quality and patient safety at Hospital Español de Mendoza, Mendoza, Argentina, was not involved in the study. He said that despite limitations such as sample size, the findings represent “a meaningful contribution to ICU medicine in Argentina and Latin America.”

“This work is relevant for several reasons,” Fernández said. “It approaches the patient holistically, not focused solely on physiological parameters, and incorporates psychological and emotional aspects. It also demonstrates that therapeutic walks in ICUs are feasible and safe. Importantly, it comes from a local, albeit private, center with resources likely comparable to many institutions in the region.”

Why Do Therapeutic Walks Help?

Mood improvements were more pronounced in participants with worse baseline emotional status, highlighting the importance of targeting patients experiencing greater emotional distress during critical illness.

Proposed mechanisms include neurobiological changes promoted by mobilization, environmental stimulation, reconnection with natural settings, and strengthened family bonds.

Beyond immediate mood improvement, reductions in anxiety and depression suggest broader psychological benefits associated with restored dignity, a sense of recovery, and relief from the emotional burden of prolonged hospitalization.

Gilgado said, “What is most moving is seeing the emotional response of patients and families to something as simple as being outdoors, feeling the sun or the wind.” “For patients with prolonged hospitalizations, these moments are enormous and often elicit relief, joy, or even tears.”

Families sometimes requested photographs to capture the moment, reflecting the importance of preserving meaningful memories during critical illness.

Fernández added that the results obtained in the research “are truly remarkable” in terms of improvement in perceived mood and reduction of anxiety and depressive symptoms.

“I think it confirms something we intuitively suspected: Restoring dignity and connection with the outside world to our patients has a real and measurable impact on their well-being, which should motivate us to action,” he emphasized.

Barriers and Future Implementation

Fernández noted that therapeutic walks are uncommon in most ICUs in Argentina. “I would estimate that fewer than 15% of ICUs in the country implement them systematically and in a protocolized manner,” he said.

Gilgado noted that in Argentina and the rest of the world, there is a positive paradigm shift, with critical care units increasingly incorporating these types of humanized care initiatives.

He suggested that broader implementation could be promoted through initiatives led by the Argentine Society of Intensive Care, although at his institution, such outings are currently used only for motor rehabilitation.

Gilgado emphasized that launching a therapeutic outing program requires appropriate infrastructure, standardized protocols, careful planning, and trained staff. “For these reasons, feasibility must be evaluated at each center because it involves substantial human and physical resources, interdisciplinary coordination, and dedication of time,” she said.

Barriers identified by Fernández include a strong biomedical care culture, fear of complications, lack of infrastructure, heavy workload, and absence of standardized national protocols.

“Indeed, in countries such as the United States, the United Kingdom, the Netherlands, Australia, and some Nordic countries, early mobilization and therapeutic walking are much more widespread. However, it is important to recognize that even in those countries, the path has not been easy, and implementation varies significantly between centers,” Fernández remarked.

According to Gilgado, the reception of these therapeutic outings by various professionals at her center has been excellent, with a good willingness to participate, but she considered that the key lies in carrying them out in a planned and protocolized manner.

A Call to Action

“Standardizing procedures not only improves communication among team members but also streamlines the process, reduces variability in practice, and helps prevent unwanted events. This allows therapeutic interventions to be seamlessly integrated into the unit’s routine, ensuring both safety and benefit for patients,” she added.

Fernández noted that reception among his fellow intensivists may still be somewhat mixed because a majority of professionals likely recognize the benefits of the intervention but face fears and doubts regarding its safety. Nevertheless, in his role as director of quality and patient safety, he agreed that with proper precautions, these therapeutic approaches are safe.

As a final message, Fernández encouraged critical care units interested in implementing these patient-centered initiatives to take the first step.

“These fears may be legitimate, but safety should not stand in the way of innovation, and with the use of well-designed protocols and multidisciplinary work, we can provide quality care to our patients,” he concluded.

The authors and Fernández reported having no relevant conflicts of interest.

This story was translated from Medscape’s Spanish edition.