Impairment of muscle strength and functional capacity in patients with inflammatory bowel disease: An integrative review

Abstract

Introduction: Inflammatory bowel disease (IBD)—primarily represented by Crohn's disease and ulcerative colitis—has repercussions that can extend beyond the gastrointestinal tract and compromise patients' physical condition. Notable alterations include reduced muscle strength, sarcopenia, diminished physical performance, and impaired functional capacity—factors that can affect the functionality and clinical course of these individuals. Objective: To analyze available scientific evidence regarding alterations in muscle strength and functional capacity in patients with inflammatory bowel disease. Methods: This is an integrative literature review of a qualitative and descriptive nature, conducted via searches in the PubMed, SciELO, and Virtual Health Library (VHL) databases. Studies addressing muscle strength, handgrip strength, functional capacity, physical performance, physical fitness, and sarcopenia in patients with IBD were considered. Results: Initially, 67 records were identified. After removing 17 duplicates, 50 studies underwent screening, of which 30 were selected for eligibility assessment. Ultimately, 9 studies met the established criteria and formed the review's sample. The analyzed studies identified alterations in muscle strength and functional capacity in patients with IBD, although they differed regarding the populations evaluated, methodological designs, and the instruments used to measure these outcomes. Findings included reduced handgrip strength, a high prevalence of muscle weakness and sarcopenia, poorer performance on functional tests, and impaired cardiorespiratory fitness. Handgrip dynamometry, gait speed, the six-minute walk test, and the sit-to-stand test were among the primary instruments used for functional assessment. Some studies also demonstrated associations between muscle impairment, disease activity, nutritional status, and clinical outcomes. The single intervention study included showed favorable results regarding specific components of functional capacity and physical performance. However, this finding stems from a limited portion of the included evidence and does not allow for generalizable conclusions regarding the effects of exercise on patients with IBD. Indeed, these findings derive from a specific and small subset of the included evidence, meaning the benefits of exercise cannot be considered a uniform outcome across the body of studies analyzed. Conclusion: Patients with inflammatory bowel disease may exhibit impaired muscle strength and functional capacity, demonstrating that the disease's impact is not limited to gastrointestinal manifestations. Objective assessment of strength and physical performance can aid in identifying functional impairments and planning individualized therapeutic strategies. However, the heterogeneity of the methods and populations studied underscores the need for further research utilizing standardized assessments and longitudinal follow-up.