Background of Inflammatory diseases of the intestines affect more and more people, this is caused not only by genetic determinants but also by environmental conditions and lifestyle. Lack of physical activity may affect the symptoms of the disease and increase their intensity, therefore during the remission of the disease it is recommended to use training and physiotherapeutic techniques to reduce the symptoms, such as pain, fatigue or reduced quality of life. The below systematic review shows the impact of individual physical trainings and physiotherapeutic techniques on symptoms resulting from inflammatory bowel diseases

Angelika Szustka

Anna Ziółkowska

Bartłomiej Wrzesiński

Edyta Piechocka

Kamila Balcerska

Marta Bielejewska

Patrycja Łopatka

Paweł Wojtczak

Journal of Education Health and Sport

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Wrzesiński  Bartłomiej,  Piechocka  Edyta,  Wojtczak  Paweł,  Ziółkowska  Anna,  Szustka  Angelika,  Balcerska  Kamila,Bielejewska Marta,  Łopatka Patrycja.  The influence of physiotherapy on the treatment of inflammatory bowel diseases –  a shortoverview. Journal  of  Education,  Health  and  Sport.  2018;8(7):436-444.  eISNN  2391-8306.  DOIhttp://dx.doi.org/10.5281/zenodo.1325466http://ojs.ukw.edu.pl/index.php/johs/article/view/5749The journal has had 7 points in Ministry of Science and Higher Education parametric evaluation. Part b item 1223 (26/01/2017).1223 Journal of Education, Health and Sport eissn 2391-8306 7© The Authors 2018;This article is published with open access at Licensee Open Journal Systems of Kazimierz Wielki University in Bydgoszcz, PolandOpen Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium,provided the original author (s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non commercial license Share alike.(http://creativecommons.org/licenses/by-nc-sa/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited.The authors declare that there is no conflict of interests regarding the publication of this paper.Received: 25.06.2018. Revised: 30.06.2018. Accepted: 31.07.2018.The influence of physiotherapy on the treatment of inflammatory boweldiseases – a short overviewBartłomiej Wrzesiński1, b.wrzesinski@icloud.com ORCID : 0000-0002-4731-5371 Edyta Piechocka1, piechockaedyta@gmail.com ORCID : 0000-0002-6321-3236Paweł Wojtczak1, pawelwojtczak.prv@gmail.com ORCID : 0000-0003-0683-7007Anna Ziółkowska1, ziolkowska.anna94@gmail.com ORCID : 0000-0002-4068-1133Angelika Szustka, angelika.szustka@gmail.com ORCID : 0000-0002-1843-7134Kamila Balcerska, kamila.balcerska95@gmail.com ORCID : 0000-0002-5219-720XMarta Bielejewska, martabielejewska1995@gmail.com, ORCID : 0000-0002-3692-4315Patrycja Łopatka2, loppatka@gmail.com ORCID : 0000-0002-8137-65571Scientific Circle at the Department of Ergonomics and Physiology of Physical EffortCollegium Medicum UMK, Toruń, Bydgoszcz, Poland2Clinical Department of Oncological Surgery at the Oncological Hospital in BydgoszczAbstractBackground of Inflammatory diseases of the intestines affect more and more people,this  is caused not only by genetic  determinants but also by environmental  conditions andlifestyle. Lack of physical activity may affect the symptoms of the disease and increase their436intensity, therefore during the remission of the disease it is recommended to use training andphysiotherapeutic techniques to reduce the symptoms, such as pain, fatigue or reduced qualityof life. The below systematic review shows the impact of individual physical trainings andphysiotherapeutic techniques on symptoms resulting from inflammatory bowel diseases.Databases usedPubMed,  ResearchGate,  Google  Scholar  and  DOAJ were  searched  by  July  2018.  Searchengines include terms such as physiotherapy, exercises and IBD.KeywordsExercise, physiotherapy, IBD, Crohn diseaseIntroductionInflammatory diseases of the intestines affect about 1.4 million people and most oftenoccur in people before 30 years of age. Symptoms of IBD vary from person to person andmay change over time. Common symptoms associated with inflammatory bowel disease arepain, fatigue, decreased quality of life, diarrhea and bloody stools. The pain may affect theabdominal region or occur parenterally, e.g. back pain or peripheral joints. During the diseaseactivity, pain affects 50-70% of patients with inflammatory bowel disease [4, 6, 10, 12]. Themost  common  factors  causing  IBD  are  genetic,  environmental  and  intestinal  bacteriaimbalances. The two most common inflammatory bowel diseases are ulcerative colitis (IBD)and Crohn's disease (CD). Currently, the incidence rate for IBD in Europe is estimated at 24.3per 100,000 people [10, 12, 15].Lesniewski  Crohn's  disease is  one  of  the  two major  inflammatory  diseases  of  theintestines. The etiology of the disease is unknown. Its occurrence is estimated at 1-5 / 100,000people. During the treatment of the disease, surgical interventions may occur, most often inthe case of stenosis of the intestine, abscess and internal fistula [1, 10, 14]. Symptoms of thisdisease depend mainly on the distribution and severity of the disease. Typical symptoms are:diarrhea,  abdominal  pain,  anal  bleeding,  anorexia  and  weight  loss.  In  addition,  you mayexperience:  arthralgia,  arthritis,  purulent  dermatitis  and  iritis  [14,  15].Ulcerative  colitis  is  a  chronic  idiopathic  disease.  It  is  characterized  by continuousinflammation of the mucous membrane, which begins in the rectum and expands to its furtherpart. Common symptoms include: bloody diarrhea, abdominal pain and sometimes parenteral437symptoms. The purpose of therapy in this case is to initiate and maintain remission of thedisease and improve the quality of life. Depending on the place of occurrence, the incidencerate for this disease varies from 0.5 to 31.5 cases per 100,000 a year. The incidence is lower indeveloping countries [12, 15]During the treatment of inflammatory bowel diseases, it has been shown that physicaltreatments and physiotherapy are a good way of treating side effects. Exercise improves thequality of a patient's life and physical health. Exercises are usually used for 20-60 min, 2-5times a week with complementary resistance exercises 2 times a week. The intensity of therecommended exercises is moderate. These exercises, in addition to reducing the discomfortof the disease, also increase muscle mass, prevent the occurrence of osteoporosis which is aserious complication inflammatory bowel diseases [10,13].Data SourcesWe searched the PubMed, Google Scholar, Researchgate and DOAJ up June 2018 withoutlanguage restrictions  for full  papers reporting study with the serach terms:  physiotherapy,IBD, exercise.  References  lists  of the orginal  articles  fund Turing research was reviewedmanualny and cross checked. A Total of 8 articles were indentified by these searchers (FigureI)438DiscussionInflammatory bowel disease is a chronic, recurrent and inflammatory disorder of thegastrointestinal tract and includes both Crohn disease and ulcerative colitis. In most patients,this disease is usually diagnosed in the first two decades of life (between 13-18 years of age)and its occurrence is relatively higher in developing countries. The etiology of this disease isunknown and consists of many factors among others: genetic determinants or the environment439Literature search:PubMed: 28Google Scholar: 13600ResearchGate: 52DOAJ: 14Research after duplicationremoved:N=1070Exclussion-not Animals-only patient withIB-other dissease-not childrenN=8[15]. The risk increases also in the case of smoking a poor diet or lack of physical activity.Studies show, however, that there is no one standard training for patients with inflammatorybowel  disease,  and  the  goal  for  this  type  of  disease  is  to  prevent  harmful  physiologicalchanges resulting from a long stay in bed or a sedentary lifestyle [4]. With regard to thisassumption, it is important to find the right intensity of exercise for these patients. In theirstudies, Ng and Klare showed that training 3x a week with an intensity of 50% -60% in theform of gait affects the setting of the quality of life of patients [5, 8]. As Klare described, thisvalue among respondents increased by 19%, compared to the group of people who registeredan improvement in the quality of life in 8% [5].Sheth, Gerberg and Gupta have shown thataerobic exercises, learning proper breathing techniques and yoga have a positive effe  ct onthe side effects associated with inflammatory bowel diseases [1, 3, 11]. It has been shown thatthe  use  of  yoga  interventions  and  breathing  training  for  10  days  every  day,  reducesinflammation, improves the quality of life and regulates blood pressure [3, 11]. In contrast,aerobic exercises  used together  with resistance  exercises  at  the level  of 50-60% intensityreduce pain and improve the peristalsis of the digestive system. Pitche, in turn, showed in hisresearch that osteopathic techniques are an effective method to alleviate pain and improve thequality of life. Applied 3 times (each session after 15 consecutive days) reduced the feeling oftiredness and discomfort associated with IBD [2].440Autor Tytuł Rok Grupa badanaInterwencja WnioskiSandeep Sheth,M [1]Crohn's disease and physical activity2017 A 50 year oldman with pain in the spine due to Crohn's diseaseExercise 4 times a week for 12 weeks- aerobic exercises-Training exercises on the treadmill - about 10 minutes- resistance classes with anintensity of 50-60%-Improving the quality oflife- Reduction of fatigue symptoms- Reduction of painPiche T at al. [2]Osteopathy decreases theseverity of IBS-like symptoms associated with Crohn's disease in patients in remission.2014 38 patients with CD during remission. Patients wererandomly divided 2/1Group 1- 25 peopleGroup 2- 13 peopleThree sessions of osteopathy on the 15th, 30th and 45th day of the studyThree sessions reduced the severity of CD-related symptoms, such as abdominal pain and discomfortGerbarg PL et al.The Effect ofBreathing, Movement and Meditation (…)2015 29 patients with inflammatorybowel disease between 18-85 years of age. Patients were randomly assigned to two groups (study and control group). 12 men and 17 women participated in the study.The study group was subjected to a two-day workshop where participants were taught 4 breathing, movement andmeditation techniques. Every week, subjects were subjected to a follow-up session. The control group participated in In the study group there was an improvementin the symptoms of the disease i.e.: reduction of pain, improvementof the qualityof life, reduction of the inflammatorymarker441lectures on IBD and its treatmentKlare P [5] The impact of ten-week physical exercise program2015 30 patients with mild or moderate inflammatorybowel disease. Patients weredivided into two groups. 1group - tested, 2 control groupThe study group has beensubjected to exercisesControl group - no control exercisesExercises wereused 3 times a week for 10 weeksIn patients undergoing physical exercise, an improvementin the qualityof life was observedJones P [6] Exercise Decreases Risk of Future Active (…)2015 People over 18 years of age recruited by means of the CCFA e-mail. Patientswere at the time of remission of the disease. 1308 patientswith CD and 549 patients with ulcerative colitisMeasurement of physical exertion during remission and after 6 monthsIn patients with CD in remission, a high level of physical activity reduces the risk of active diseaseJohannessonE.[7]Exercise and IBS; no pain no gain2011 Study group: 37 patients undergoing physical trainingControl group: 3 patients without any interventionIn the study group, 12-week physical training was used, with physiotherapistcontrol 1-2 times a monthIn the study group, physical activity improves sleep quality,quality of life, oxygen intake and reduces fatigue.Ng V.[8] Low –intensity exercise  improves quality of life(…)2007 32 patients participated in the study. They were divided into groups: test In the study group participants had to train in the form of walking3 In the study group there was a significant improvementin the quality442and control groupstimes a week for three months, 30 minutes a dayof life without exacerbating the symptoms of the disease.Gupta N [11]Effect Of yoga based lifestyle Intervention on state and trait anxiety2006 175 patients, including 98 men and 77 women between 19-76.There were 18 CD patients in the study group, the control groupconsisted of 50 patientsYoga, meditation, stress management, nutrition. Patients were subjected to intervention for a period of 10 daysStudies have shown a reduction in stress symptoms in CD patients and reduced blood pressure.ConclusionsPhysical  exercises  used  in  IBD  patients  reduce  the  symptoms  of  the  disease:  weakness,fatigue, pain in the joints and abdomen and increase the quality of life. The best therapeuticeffects as noted are brought by aerobic and endurance exercises combined with resistanceexercises at  the level  of 50-60% intensity,  applied 3 times a week. Very good effects  onreducing  pain  were  also  demonstrated  in  the  case  of  osteopathic  and  yoga  techniques.However, further studies are needed to confirm this review.Literature1. Sheth S.M, Khan M.A, Vyas P.H, Vyas J.N, Crohn's disease and physical activity, Journalof Mahatma Gandhi Institute of Medical Sciences, 2017; 22(1), 31-33.2.Piche  T, Pishvaie  D, Tirouvaziam  D, Filippi  J, Dainese  R, Tonohouhan  M, DeGalleaniL, Nébot-Vivinus MH, Payrouse JL, Hébuterne X, Osteopathy decreases the severity of IBS-like symptoms associated with Crohn's disease in patients in remission,Eur J GastroenterolHepatol.2014; 26(12), 1392-1398.3.  Gerbarg  PL, Jacob  VE, Stevens  L, Bosworth  BP, Chabouni  F, DeFilippis  EM, WarrenR, Trivellas  M, Patel  PV, Webb  CD, Harbus  MD, Christos  PJ, Brown  RP, Scherl  EJ,  TheEffect of Breathing, Movement, and Meditation on Psychological and Physical Symptoms andInflammatory Biomarkers in Inflammatory Bowel Disease: A Randomized Controlled Trial,Inflamm Bowel Dis, 2015; 21(12), 2886-2896.4434. Zeits J, Ak M, Muller-Muttet S, Scharl S, Biedermann L, Fournier N, Frei P, Pittet V, ScharlM,  Fried  M,  Rogler  G,  Vavrica  S,  Pain  in  IBD Patients:  Very  Frequent  and FrequentlyInsufficiently Taken into Account, Plos one, 2016; 10(1371).5. Klare P, Nigg J, Nold J, Haller B, Krug AB, Mair S, Thoeringer CK, Christle JW, SchmidRM, Halle  M, Huber  W,  The impact  of  a  ten-week  physical  exercise  program on health-related quality of life in patients with inflammatory bowel disease: a prospective randomizedcontrolled trial, Digestion,2015; 91(3), 239-247.6. Jones P.D, Kappelman M.D, Martin Ch.F, Chen W, Sandler R. S, Long M.D,  ExerciseDecreases Risk of Future Active Disease in Patients with Inflammatory Bowel Disease inRemission, Inflamm Bowel Dis, 2015; 21(5), 1063-1071.7.  Johannesson  E,  Simren  M,  Strid  H,  Exercises  and  IBS:  no  pain,  no  gain,  Am  JGastroenterol 2011;106:915–922.8.Ng V, Millard W, Lebrun C, Howard J,  Low-intensity exercise improves quality of life inpatients with Crohn's disease, Clin J Sport Med. 2007; 17(5):384-8.9. Shephard R.J,  The Case for Increased Physical Activity in Chronic Inflammatory BowelDisease: A Brief Review, Int J Sports Med. 2016, 37(7); 505-515.10.Silva B.C, Lyra A.C, Rocha R , Santana G.O, Epidemiology, demographic characteristicsand prognostic predictors of ulcerative colitis,World J Gastroenterol. 2014 Jul 28; 20(28):9458–9467.11. Gupta N, Kher Sh, Shama R, Bulani R.L, Effect of yoga based lifestyle intervention onstate and trait ankiety, Indian J Physiol Pharmacol 2006; 50 (1) : 41–47.12. Cosnes J, Smoking, Physical activity, nutrition and life style: Enwiromental factors andtheir impast on IBD, 2010;28:411–417.13. Narula N, Fedorak RN,  Exercise and inflammatory bowel disease,  Can J Gastroenterol.2008 May; 22(5): 497–504.14. Ng V, Millard W, Lebrum C, Howard J, Exercise and Crohn’s disease: Speculations onpotential benefits, Can J Gastroenterol, 2006, 20(10):15. Ye Y, Pang Z, Chen W, Ju S, Zhou Ch, The epidemiology and risk factors of inflammatorybowel disease, Int J Clin Exp Med. 2015; 8(12): 22529–22542.444

The influence of physiotherapy on the treatment of inflammatory bowel diseases – a short overview

The influence of physiotherapy on the treatment of inflammatory bowel diseases – a short overview

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