Programa de fisioterapia adaptado a personas hospitalizadas por anorexia nerviosa que presentan desnutrición severa

Zusammenfassung

Objectives: 1) To know the effectiveness of physiotherapy treatments based on adapted physical exercise for weight restoration, muscle strength and increased quality of life in anorexia nervosa (AN) inpatients with severe undernutrition; 2) To test an Adapted Physiotherapy Program in AN inpatients with severe undernutrition (ANIPAP) to improve muscle strength, peak-expiratory-flow (PEF) and quality of life. Methods: Two studies were conducted: 1) Systematic review; y 2) Clinical trial 1) Bibliographic search in databases: Medline, PubMed, PEDro, PsycInfo, Cochrane Library plus, Nursing and Allied Health database, Scopus, Web of Science from inception until November 2021. The articles selected were clinical trials with physiotherapy treatment, including physical exercise, in patients with AN. 2) Hospitalized patients for severe AN with BMI < 15, in the experimental group (EG), received the ANIPAP, three times/week, for four weeks. Both the EG and the control group received hospital treatment that did not included exercise. With both groups, evaluations were carried out before and after, and at two and three weeks after starting treatment: of muscle strength with the manual muscle test (MMT), peak-expiratory-flow (PEF) and quality of life with SF-36 test. Results: 1) 496 articles were examinate, and eight articles, of six studies, were selected following the inclusion criteria. The studies include 176 patients with AN (85.02%), showing an increase in different physical, psychological, and quality of life variables. The interventions had no adverse or negative effects. 2) 26 patients participated in the study, 100% female gender, mean age 22,21 (SD 8,83). After four weeks the results shows an improvement of the muscle strength in 13 of 14 muscular groups analysed, in EG at final evaluation, with differences between axial muscles and distal muscles [F (1.80) = 17.4319, p < 0.0001, η2 = 0.1540] final evaluation p = 0.0079; proximal muscles and axial muscles [F (1.76) = 17.5952, p = 0.00007, η2 = 0.1640] final evaluation p = 0.0019; between proximal muscles vs distal muscles: MMSS [F (1.76) = 16.110, p = 0.0001, η2 = 0.1227] final evaluation p = 0.0008 and MMII [F (1.80) = 32.7815, p < 0.0001, η2 = 0.2307] final evaluation p = 0.00006; improvement of PEF [F (1.20) = 5.4974, p = 0.0295, η2 = 0.1995] EG 426.67 (SD 84.78) vs CG 330.91 (SD 56.47) final evaluation p = 0.007; and improvement vitality scale of SF-36 test [F (1.22) = 6.8249, p < 0.05, η2 = 0.1974] EG 69.17 (SD 21.20) vs CG 43.75 (SD 22.17) final evaluation p = 0.0089. Conclusion: 1) The six studies analysed shows that physiotherapy, exercise or adapted physical activity can improve the weight, BMI, muscle strength, eating attitude and quality of life in AN patients. 2) The ANIPAP improve muscle strength, PEF and vitality of AN inpatients with severe undernutrition after four weeks of intervention, and does not interfere with weight recovery or BMI, being safe for patients with severe AN during their hospitalization.