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

Table 3 Description and main findings of studies examining muscular strength and muscular endurance by isokinetic or isometric strength or endurance assessment on a dynamometer in patients with inflammatory bowel disease

Ref.	Study design, country	Sample size (n)	Sample features	CD, UC (n)	Female sex, (%)	Age in yr, mean (SD), mean (95%CI), or median (IQR)	Disease activity	Control group	Test protocol	Main findings, mean (SD), mean (95%CI), or median (IQR)
Lee et al[47], 2015	Cross-sectional study, United States	64	Recently diagnosed	64, 0	41%	12.8 (2.7)	Remission to mild active disease (n = 26), moderate-to-severe active disease (n = 38)	Healthy subjects (n = 264)	Isometric muscular strength dynamometry (Biodex): AD peak torque (20° plantar flexion)	AD peak torque: CD, 14.7 (10.1-18.8) ft/lbs; CG, 17.9 (11.2-24.8) ft/lbs; AD peak torque CD (remission-mild activity) = AD peak torque CG (P = 0.72); AD peak torque CD (moderate-to-severe activity) < AD peak torque CG (P = 0.05)
Lee et al[46], 2018	Prospective study, United States	138	With low bone density	138, 0	52%	14.2 (2.8)	Remission (n = 85), or mild (n = 46), or moderate-to-severe (n = 7) active disease	Healthy subjects (n = 264)	Isometric muscular strength dynamometry (Biodex): AD peak torque (20° plantar flexion)	AD peak torque Z-score1 (relative to age, sex, race, adjusted for tibia length): CD, -0.43 (0.90); AD peak torque CD < AD peak torque ref (P < 0.0001)
Geerling et al[50], 1998	Cross-sectional study, The Netherlands	32	With longstanding disease	32, 0	56%	40.0 (34.3-54.0)	Remission (n = 17) or active disease (n = 15)	Healthy age-matched and sex-matched CG (n = 32)	Isokinetic muscular strength dynamometry (Cybex II): KE and KF peak torque (60°/s, 180°/s)	KE peak torque: CD 60°/s, 123.1 (27.4) Nm; CD 180°/s, 81.5 (18.5) Nm; CG 60°/s, 136.5 (53.8) Nm; CG 180°/s, 88.7 (39.7) Nm; KE peak torque CD = KE peak torque CG (P = N/A); KF peak torque: CD 60°/s, 71.6 (22.3) Nm; CD 180°/s, 45.6 (15.2) Nm; CG 60°/s, 87.6 (33.4) Nm; CG 180°/s, 59.3 (31.9) Nm; KF peak torque CD (60°, 180°/s) < KF peak torque CG (P < 0.02, P < 0.05)
Geerling et al[52], 2000	Cross-sectional study, The Netherlands	69	Recently diagnosed	23, 46	52%	35.4 (13.6)	Remission (n = 61) or active disease (n = 8)	Healthy age-matched and sex- matched CG (n = 69)	Isokinetic muscular strength dynamometry (Cybex II): KE and KF peak torque (60°/s, 180°/s)	KE peak torque: N/A for total sample; CD 60°/s, 127.5 (33.4) Nm; CD 180°/s, 81.5 (25.7) Nm; CG for CD 60°/s, 142.4 (33.2) Nm; CG for CD 180°/s, 93.2 (37.2) Nm; UC 60°/s, 148.8 (44.6) Nm; UC 180°/s, 96.1 (30.7) Nm; CG for UC 60°/s, 155.7 (50.0) Nm; CG for UC 180°/s, 100.5 (38.4) Nm; KE peak torque CD and UC = KE peak torque CG (P = N/A); KF peak torque: N/A for total sample; CD 60°/s, 74.9 (23.5) Nm; CD 180°/s, 46.8 (25.3) Nm; CG for CD 60°/s, 86.8 (19.8) Nm; CG for CD 180°/s, 57.8 (22.0) Nm; UC 60°/s, 89.7 (31.9) Nm; UC 180°/s, 58.6 (21.3) Nm; CG for UC 60°/s, 98.5 (37.3) Nm; CG for UC 180°/s, 64.8 (30.4) Nm; KF peak torque CD and UC = KF peak torque CG (P = N/A)
Jensen et al[72], 2002	Follow-up study of Kissmeyer-Nielsen et al[42], Denmark	20	Patients who accepted follow-up 4-6 yr after J-pouch surgery	0, 20	60%	38 (9)	N/A	N/A	Isometric muscular strength dynamometry (Metitur): KE peak torque (60° knee flexion), AF peak torque (90° elbow flexion)	KE peak torque: UC preoperative, 475 (187) N; UC 4-6 yr postoperative, 532 (179) N (P = 0.080); AF peak torque: UC preoperative, 258 (93) N; UC 4-6 yr postoperative, 275 (83) N (P = 0.017)
Salacinski et al[48], 2013	Cross-sectional study, United States	19	≥ 1 small bowel resection and idiopathic musculoskeletal pain or weakness	19, 0	53%	44.2 (10.3)	Remission (n = 19)	Healthy age-matched and sex- matched CG (n = 19)	Isometric muscular strength dynamometry (customized): KE and KF peak torque (45° knee flexion)	KE peak torque/KE peak torque normalized to BW: CD, 75.2 (45.4) Nm/0.06 (0.03) Nm/kg; CG, 105.6 (40.7) Nm/0.07 (0.03) Nm/kg; KE peak torque CD < KE peak torque CG (P = 0.013, normalized to BW P = 0.039); KF peak torque/KF peak torque normalized to BW: CD, 27.2 (10.7) Nm/0.02 (0.01) Nm/kg, CG, 53.7 (27.3) Nm/0.09 (0.02) Nm/kg; KF peak torque CD < KF peak torque CG (P = 0.001, normalized to BW P = 0.022)
									Isometric muscular endurance dynamometry (customized): Slope of median VL and RF muscle activation frequency measured with EMG during 60-s submaximal (60% of maximum) contraction (45° knee flexion)	RF fatigue rate: CD, -0.069 (0.06) Hz/s; CG, -0.142 (0.09) Hz/s; RF fatigue rate CD < FR fatigue rate CG (P = 0.015); VL fatigue rate: CD, -0.028 (0.042) Hz/s; CG, -0.027 (0.085) Hz/s; VL fatigue rate CD = VL fatigue rate CG (P = 0.969)
van Langenberg et al[30], 2014	Cross-sectional study, Australia	27	N/A	27, 0	56%	43 (38, 48)	Remission (n = 19) or active disease (n = 8)	Healthy age-matched and sex-matched CG (n = 22)	Isometric muscular strength dynamometry (Biodex): KE peak torque (60° knee flexion)	KE peak torque: CD 60°, 148.8 (130, 168) Nm; CG 60°, 133.6 (111, 156) Nm; KE peak torque CD = KE peak torque CG (P = 0.29)
									Isometric muscular endurance dynamometry (Biodex): Fatigue rate as decrement of KE peak torque from maximal peak torque (repetition 2 or 3) to peak torque at the end of 30 maximal contractions (at 60° knee flexion)	KE fatigue rate: CD, -5.2 (-8.2, -2.2) Nm/min; CG, -1.3 (-3.9, 1.4) Nm/min; KE fatigue rate CD > KE fatigue rate CG (P = 0.047)
Zaltman et al[49], 2014	Case-control study, Brazil	23	Sedentary	0, 23	100%	43.9 (10.0)	Remission (n = 8), mild (n = 9), or moderate (n = 5), or severe (n = 1) active disease	Healthy age-matched, sex-matched, and BMI-matched CG (n = 23)	Isometric muscular strength dynamometry (IsoTeste): KE peak torque (angle N/A)	KE peak torque: UC, 38.6 (4.4) Kgf; CG, 41.0 (1.1) Kgf; KE peak torque UC < KE peak torque CG (P = 0.012)
Subramaniam et al[79], 2015	Prospective study, Australia	19	Starting with IFX	19, 0	42%	33.2 (10.7)	Active disease (n = 19)	N/A	Isokinetic muscular strength dynamometry (Cybex/HUMAC Norm): KE peak torque (30°/s, 60°/s, 90°/s)	KE peak torque1: CD 30°/s left leg, 166.5 (93.4) Nm, right leg 184.8 (96.6) Nm; CD 60°/s left leg, 172.8 (103.5) Nm, right leg 183.5 (116.4) Nm; CD 90°/s left leg, 128.5 (55.9) Nm, right leg 139.4 (54.4) Nm
Vogelaar et al[28], 2015	Cross-sectional study, The Netherlands	20	With fatigue (n = 10), without fatigue (n = 10)	15, 5	50%	37.3 (11.4)	Remission	Reference values	Isokinetic muscular strength dynamometry (Biodex): KE and KF peak torque (60°/s, 180°/s)	KE peak torque: N/A for total sample; IBD with fatigue 60°/s, 107.1 (25.4) Nm; IBD with fatigue 180°/s, 60.7 (12.3) Nm; IBD without fatigue 60°/s, 123.7 (38.0) Nm; IBD without fatigue 180°/s, 73.5 (21.4) Nm; KE peak torque IBD with and without fatigue < KE peak torque ref (P = N/A); KF peak torque: N/A for total sample; IBD with fatigue 60°/s, 51.7 (14.3) Nm; IBD with fatigue 180°/s, 31.1 (8.0) Nm; IBD without fatigue 60°/s, 63.0 (20.1) Nm; IBD without fatigue 180°/s, 38.9 (14.2) Nm; KF peak torque IBD with and without fatigue < KF peak torque ref (P = N/A)
Jones et al[51], 2020	RCT, United Kingdom	47	N/A	47, 0	68%	49.3 (13.0)	Remission (n = 31) or mild active disease (n = 16)	Healthy age-matched, sex-matched, PA-matched, BMI-matched, and ethnicity-matched CG (n = 33)	Isokinetic muscular strength dynamometry (Biodex): KE peak torque (60°/s, 180°/s), EF peak torque (60°/s, 120°/s)	KE peak torque1: CD 60°/s, 72.6 (33.3) Nm; CD 180°/s, 46.2 (23.0) Nm; CG 60°/s, 94.6 (46.6) Nm; CG 180°/s, 60.1 (34.9) Nm; KE peak torque CD < KE peak torque CG (P = 0.001, P = 0.011); EF peak torque1: CD 60°/s, 25.4 (11.2) Nm; CD 120°/s, 22.3 (9.1) Nm; CG 60°/s, 26.0 (12.4) Nm; CG 120°/s, 22.2 (11.2) Nm; EF peak torque CD = EF peak torque CG (P = 0.664, P = 0.747)

¹Baseline values are shown.

95%CI: 95% confidence interval; AD: Ankle dorsiflexor; AF: Arm flexor; BMI: Body mass index; BW: Body weight; CD: Crohn’s disease; CG: Control group; EF: Elbow flexor; EMG: Electromyography; IBD: Inflammatory bowel disease; IFX: Infliximab; IQR: Interquartile range; KE: Knee extensor; KF: Knee flexor; N/A: Not available; PA: Physical activity; RCT: Randomized controlled trial; RF: Rectus femoris; ref: Reference; SD: Standard deviation; UC: Ulcerative colitis; VL: Vastus lateralis.