Effects of walking exercise on bowel preparation in patients undergoing colonoscopy: evidence from systematic review and meta-analysis

The effectiveness of walking exercise on the bowel preparation before colonoscopy: a single blind randomized clinical trial study

BACKGROUND AND AIM

Bowel preparation is a crucial factor affecting the diagnostic accuracy of colonoscopy, and few randomized control trials evaluated enhancement in bowel preparation. In this study, we aimed to evaluate the effectiveness of walking exercises on bowel preparation before a colonoscopy procedure.

METHODS

The present study is a single-blind randomized controlled trial involving 262 patients scheduled for colonoscopy procedures. These patients were randomly assigned to two groups: an intervention group (n = 131) and a control group (n = 131). In the intervention group, participants followed a predetermined plan that included the consumption of specific liquids and foods, bisacodyl pills, polyethylene glycol powder, and a regimen of walking exercises in preparation for their colonoscopy. Conversely, individuals in the control group followed the same regimen but were not instructed to engage in walking exercises. On the day of the colonoscopy, both groups were assessed for their level of physical activity using a foot counter. Additionally, an experienced gastroenterologist evaluated and compared the bowel preparation between the two groups using the Boston Bowel Preparation Scale (BBPS).

RESULTS

The number of footsteps recorded in the two groups exhibited a significant difference (P < 0.001). Although there was no statistically significant difference between the intervention and control groups in terms of mean BBPS scores (6.26 ± 1.9 vs. 6.29 ± 1.9, P = 0.416), individuals who took more than 6900 steps had significantly higher BBPS scores compared to those with fewer than 6900 footsteps (6.62 ± 1.8 vs. 5.92 ± 1.9, P = 0.003).In the univariate analysis, BBPS was found to be significantly associated with individuals under the age of 50 (OR: 2.45, 95% CI: 1.30-4.61, P = 0.006) and smoking status (OR: 0.41, 95% CI: 0.17-0.94, P = 0.043). In the multivariate analysis, the relationship between BBPS and age below 50 and smoking remained significant (OR: 2.50, 95% CI: 1.30-4.70, P = 0.005, and OR: 0.38, 95% CI: 0.16-0.93, P = 0.034, respectively).

CONCLUSION

A higher number of footsteps taken especially more than 6900 can significantly enhance bowel preparation; however, walking exercise as an intervention before colonoscopy is not significantly associated with BBPS. Also, older people and smokers seem to have fewer benefits from walking exercises for bowel preparation.

TRIAL REGISTRATION

ISRCTN32724024 (Registration date:22/08/2018).

A Systematic Review of Exercise Therapy for Bowel Preparation: Evidence to Guide Practice

This systematic review aims to evaluate (1) the effectiveness of exercise therapy in bowel preparation for colonoscopy, and (2) the characteristics of exercise programs for bowel preparation. Systematic searches were done in PubMed, EMBASE, the Cochrane Library, Web of Science, and CINAHL from inception to November 2022. Randomized controlled trials and quasi-experimental studies assessing the efficacy of exercise during bowel preparation were included in this review. Two reviewers independently assessed the methodological quality using a modified Downs and Black checklist. A narrative synthesis was conducted. A total of five studies (1,109 participants) were included in this review. In all eligible studies, the characteristics of the exercise programs varied and included mainly two types of exercise (walking and yoga), various amount of exercise (3,000-10,000 steps or 0.5-1.9 hours), and two exercise timing (during and 1 hour after taking the laxative). Available evidence indicated that exercise therapy is effective in improving the quality of bowel preparation. However, there was insufficient high-quality evidence to conclude the effects on procedure-related indicators, adverse events, and willingness to repeat preparation. Exercise should be recommended as an important part of routine bowel preparation for patients undergoing colonoscopy to improve the quality of bowel preparation. More rigorous studies focusing on the effects on procedure-related indicators, adverse events, and willingness to repeat preparation are needed. To ensure the effectiveness and safety of the intervention, it is critical to establish a standard, well-structured exercise program for bowel preparation.

Effect of simulation-based teaching on nursing skill performance: a systematic review and meta-analysis

Objective

To summarize and produce aggregated evidence on the effect of simulation-based teaching on skill performance in the nursing profession. Simulation is an active learning strategy involving the use of various resources to assimilate the real situation. It enables learners to improve their skills and knowledge in a coordinated environment.

Methods

Systematic literature search of original research articles was carried out through Google Scholar, Medline, and Cochrane Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases. Studies conducted on simulation-based teaching and skill performance among nursing students or clinical nursing staff from 2010 to 2019, and published in the English language, were included in this study. Methodological quality was assessed by Joanna Briggs Institute, and the risk of bias was also assessed by Cochrane risk of bias and the risk of bias assessment tool for non-randomized studies (ROBINS-I) checklists.

Results

Initially, 638 titles were obtained from 3 sources, and 24 original studies with 2209 study participants were taken for the final analysis. Of the total studies, 14 (58.3%) used single group prep post design, 7 (29.1%) used high fidelity simulator (HFS), and 7 (29.1%) used a virtual simulator (VS). Twenty (83.3%) studies reported improved skill performance following simulation-based teaching. Simulation-based teaching improves skill performance among types of groups (single or double), study regions, high fidelity (HF), low fidelity (LF), and standard patient (SP) users. But the effect over virtual and medium fidelity simulators was not statistically significant. Overall, simulation-based teaching improves the skill performance score among the experimental group (d = 1.01, 95% confidence interval [CI] [0.69–1.33], Z = 6.18, P < 0.01, 93.9%). Significant heterogeneity and publication bias were observed during the pooled analysis.

Conclusions

Simulation did improve skill performance among the intervention groups, but the conclusion is uncertain due to the significant heterogeneity. The large extent of difference among original research has necessitated the development of well-defined assessment methods for skills and standardized simulation set-up for proper assessment of their effects.

Darmmotilitätsstörungen bei Multimorbidität: zwischen Obstipation und Diarrhö

Diagnostische Strategie Die Rom-IV-Kriterien für die primäre chronische Obstipation helfen, zwischen kurzfristigen Beschwerden und einem chronischen Beschwerdebild zu unterscheiden 1. Im Allgemeinen finden sich in der Altersgruppe der Hochbetagten mehrere Ursachen für eine Störung der Defäkation. Anamnese und Beachtung von Red Flags neben einem geriatrischen Basisassessment ermöglichen es, die Ursachen einzugrenzen. Die Unterscheidung zwischen einer Low-Transit-Obstipation und normaler Darmfunktion kann die therapeutische Konsequenz entscheidend beeinflussen.

Therapeutische Möglichkeiten Bei der medikamentösen Intervention werden osmotische Abführmittel, stimulierende Abführmittel, Zäpfchen und Einläufe mit unterschiedlichen Zusätzen in erster Linie weiterhin sehr häufig verwendet. In zweiter Linie können das Prokinetikum Prucaloprid und seit einigen Jahren Methylnaltrexoniumbromid als ein Vertreter der peripher wirkenden µ-Opioid-Rezeptor-Antagonisten Anwendung finden 2 3. Faserreiche Ernährung vermehrt die Stuhlmasse und präbiotische Zusatzkost kann das Mikrobiom günstig beeinflussen. Zusätzliche Ballaststoffe haben wahrscheinlich keinen Nutzen bei schwerer Verstopfung, insbesondere bei Patienten mit Low-Transit-Obstipation oder Defäkationsstörungen. Bei Vorbereitungen auf Koloskopien scheint eine zusätzliche Bewegungsaktivierung positive Effekte auf die Qualität der Darmreinigung zu haben 4.