Table 1

Inclusion and exclusion criteria for study entry

Inclusion criteria	Exclusion criteria	Rationale for exclusion
>18 years old Requiring mechanical ventilation with actual or expected total duration of mechanical ventilation ≥48 hours Expected ICU stay ≥4 days after enrolment (to permit adequate exposure to the proposed intervention)	1. >96 continuous hours of mechanical ventilation before enrolment	Intervention most effective delivered early85
	2. Expected death or withdrawal of life-sustaining treatments within this hospitalisation	Patients unlikely to receive benefit
	3. No expectation for any nutritional intake within the subsequent 72 hours	Intervention intended to occur in addition to standard clinical nutritional intake
	4. Severe chronic liver disease (MELD score ≥20) or acute hepatic failure	Amino acid supplementation may be harmful in patients with severe liver disease
	5. Documented allergy to the amino acid intervention	Unable to receive proposed intervention
	6. Metabolic disorders involving impaired nitrogen utilisation	Unable to receive amino acid infusion
	7. Not ambulating independently prior to illness that leads to ICU admission (use of gait aid permitted)	Unable to perform outcome assessments
	8. Pre-existing primary systemic neuromuscular disease (eg, Guillain Barre)	May not benefit from proposed intervention (ie, different mechanism of muscle weakness)
	9. Neuromuscular blocker infusion (eligible once infusion discontinued if other inclusion criteria met)	Do not meet safety criteria for cycling intervention
	10. Intracranial or spinal process affecting motor function	May not benefit from proposed intervention (ie, different mechanism of muscle weakness)
	11. Pre-existing cognitive impairment or language barrier that prohibits outcomes assessment	Unable to perform outcome assessments
	12. Patients in hospital >5 days prior to ICU admission	Muscle weakness likely already established
	13. Lower extremity impairments that prevent cycling (eg, amputation, knee/hip injury)	Unable to receive proposed cycling intervention
	14. Remaining intubated for airway protection only	Less likely to have muscle weakness and benefit from the interventions
	15. Weight ≥150 kg	Exceeds maximum weight permitted for use of the cycle device
	16. Physician declines patient enrolment	Not appropriate to conduct trial
	17. Insufficient intravenous access	Need dedicated access for nutrition intervention for several hours a day
	18. Pregnant	Unknown effects in fetus
	19. Incarcerated	Vulnerable population

ICU, intensive care unit.