A Study Promoting Critical Illness Recovery in the Elderly

Inclusion Criteria: * Age ≥55 years old * Admission to Wake Forest Baptist Medical Center Medical Intensive Care Unit * Acute Hypoxic respiratory failure on mechanical ventilation for \<48 hours with a P:F ratio of \<300 (or equivalent S:F ratio) * Previously Functional (over past 3 months, as reported by proxy): Physical Function: Able to walk 4 m (with or without assistive device) Exclusion Criteria: * Neuromuscular Disease * Cardiopulmonary Arrest with return of spontaneous circulation \<6 hrs * Palliative Goals of Care; witholding life-sustaining therapy * Elevated Intracranial Pressure (\>20 mm Hg) * BMI\>45; absolute weight \>= 150 kg * Inability to cycle (including absent limbs, body length \<1.5m, body habitus not fitting the cycle, inflammatory arthritis, significant joint problems including inability to bend arms/legs; pelvic and/or LE fracture, LE bypass surgery) * Pregnancy * Unable to speak English * Use of continuous neuromuscular blockade * Temporary Pacemaker or Swan Ganz catheter or femoral ECMO catheter/IABP * Rhabdomyolysis with most recent CK \>5000 * Clinical diagnosis of dementia on medication * Moribund * Possible Exclusion: If the patient is on spine precautions, a discussion with the spine team will be necessary to determine eligibility for the study