Scoping review on health-related physical fitness in patients with inflammatory bowel disease:Assessment,interventions,and future directions

BACKGROUND Reaching the Selecting Therapeutic Targets in Inflammatory Bowel Disease-II(STRIDE-II)therapeutic targets for inflammatory bowel disease(IBD)requires an interdisciplinary approach.Lifestyle interventions focusing on enhancing and preserving health-related physical fitness(HRPF)may aid in improving subjective health,decreasing disability,or even controlling inflammation.However,ambiguity remains about the status and impact of HRPF(i.e.body composition,cardiorespiratory fitness,muscular strength,muscular endurance,and flexibility)in IBD patients,hindering the development of physical activity and physical exercise training guidelines.AIM To review HRPF components in IBD patients and the impact of physical activity and physical exercise training interventions on HRPF.METHODS A systematic search in multiple databases was conducted for original studies that included patients with IBD,assessed one or more HRPF components,and/or evaluated physical activity or physical exercise training interventions.RESULTS Sixty-eight articles were included.No study examined the complete concept of HRPF,and considerable heterogeneity existed in assessment methods,with frequent use of non-validated tests.According to studies that used gold standard tests,cardiorespiratory fitness seemed to be reduced,but findings on muscular strength and endurance were inconsistent.A limited number of studies that evaluated physical activity or physical exercise training interventions reported effects on HRPF,overall showing a positive impact.CONCLUSION We performed a scoping review using a systematic and iterative approach to identify and synthesize an emerging body of literature on health-related physical fitness in patients with IBD,highlighting several research gaps and opportunities for future research.Findings of this review revealed a gap in the literature regarding the accurate assessment of HRPF in patients with IBD and highlighted important methodological limitations of studies that evaluated physical activity or physical exercise training interventions.This scoping review is a step towards performing studies and systematic reviews in the future,which was not possible at present given the heterogeneity in endpoints and designs of the available studies on this topic.Future well-designed studies are required to determine the optimal training paradigm for improving HRPF in patients with IBD before guidelines can be developed and integrated into the therapeutic strategy.

Prehabilitation prior to intestinal resection in Crohn’s disease patients:An opinion review

Patients with Crohn’s disease(CD)are at a considerable risk for intestinal surgery.Approximately 25%of patients with CD will undergo an intestinal resection within 10 years of diagnosis.Postoperative complications after CD surgery have been reported in 20%-47%of the patients.Both general and CD-related risk factors are associated with postoperative complications,and comprise non-modifiable(e.g.,age)and potentially modifiable risk factors(e.g.,malnutrition).Prehabilitation focuses on the preoperative period with strategies designed to optimize modifiable risk factors concerning the physical and mental condition of the individual patient.The aim of prehabilitation is to enhance postoperative recovery and return to or even improve preoperative functional capacity.Preoperative improvement of nutritional status,physical fitness,cessation of smoking,psychological support,and critical revision of preoperative use of CD medication are important strategies.Studies of the effect on postoperative outcome in CD patients are scarce,and guidelines lack recommendations on tailored management.In this opinion review,we review the current evidence on the impact of screening and management of nutritional status,physical fitness,CD medication and laboratory values on the postoperative course following an intestinal resection in CD patients.In addition,we aim to provide guidance for individualized multimodal prehabilitation in clinical practice concerning these modifiable factors.