Highlight
– In a multinational randomized 2 × 2 factorial trial (n=266), resistance training (RT) started in the ICU and continued until discharge significantly improved discharge physical function (SPPB and 6MWD), increased muscle mass and strength, reduced patient‑reported fatigue and psychological symptoms, and was associated with lower 6‑ and 12‑month mortality.
– β‑hydroxy‑β‑methylbutyrate (HMB) produced only modest improvements in phase angle and fatigue and did not enhance the effects of RT; no interaction between RT and HMB was detected.
– Results support integrating structured resistance exercise into early rehabilitation for selected critically ill patients; routine HMB supplementation is not supported by these findings.
