Assessing The Effects of Exercise, Protein, and Electric Stimulation On Intensive Care Unit Patients Outcomes

Inclusion Criteria: * Age ≥ 45 years * Respiratory insufficiency requiring mechanical ventilation (MV) * ICU presentation \< 6 days * Patient or legally authorized representative able to provide written or witnessed verbal informed consent in English * All four limbs intact and mobile * Eligible for and able to participate in physical therapy * Pre admission Barthel Index \>70 Exclusion Criteria: * Acute kidney injury with a glomerular filtration rate \< 30 ml/min * Diagnosis of severe organ dysfunction including end stage liver disease or cirrhosis * Diagnosis of active cancer * Acute or chronic organ transplant rejection * Exceedingly high mechanical ventilator settings (FiO2\>60%, PEEP\>12) or alternative modes of mechanical ventilation (inverse ratio pressure control, airway pressure release ventilation) * Severe functional impairment or physical impairment to rehabilitation * On high dose vasopressor agents (\> 5mcg of norepinephrine or equivalent) * Liver function tests \> 2.5 x normal limits (normal reference ranges include AST between 10 and 40 units/L or ALT between 7 and 56 units/L) * Chronic dementia or cognitive impairment