SCIENTIFIC AND CLINICAL RATIONALE FOR MULTIDISCIPLINARY REHABILITATION IN INFLAMMATORY BOWEL DISEASES: SYNERGY OF PHYSICAL ACTIVITY, KINESIOTERАPY, AND BALNEOTHERAPY

Abstract

Introduction. The current strategy for managing patients with inflammatory bowel disease (IBD) is shifting toward a multidisciplinary approach, where non-pharmacological methods become an integral part of therapy. Physical rehabilitation is considered not merely an auxiliary tool but an instrument of pathogenetic influence on disease activity and patients’ quality of life. The purpose. To systematize scientific evidence regarding the effectiveness of physical exercise, kinesioterаpy, and balneotherapy in the complex treatment of IBD, as well as to reveal the biomedical mechanisms of their action at the systemic and molecular levels. Results and discussion. The article provides a detailed analysis of the key therapeutic pathways of physical activity. It describes the immunomodulatory effect resulting from the secretion of anti-inflammatory myokines (IL-6, IL-10) by skeletal muscles, which shifts the balance toward classical anti-inflammatory signaling. A significant impact on barrier function is observed through the restoration of intestinal epithelial integrity and the strengthening of tight junctions, leading to a 30–40% reduction in systemic endotoxemia (LPS) levels. Furthermore, there is an increase in microbiota biodiversity and stimulation of the growth of butyrate-producing bacteria that synthesize short-chain fatty acids. Changes in psycho-emotional status occur through a reduction in cortisol levels and the activation of endorphin synthesis, resulting in a 30–45% decrease in manifestations of depression and anxiety. Systematic reviews and RCTs confirm that regular structured exercise contributes to a 25–40% reduction in disease activity and a 15–25% increase in bone mineral density, which is critical for the prevention of osteoporosis in IBD. Balneotherapy and specific forms of kinesioterаpy allow for the effective correction of intestinal dyskinetic disorders and a reduction in pain syndrome. Conclusions. The integration of individualized physical activity programs and balneotherapy into clinical protocols is an evidence-based method for achieving stable remission and preventing systemic complications. The rehabilitation program must be adapted to the phase of the disease (remission, mild, or active flare-up).