Telerehabilitation-based Exercise Training in Constipated Patients

Constipation is the problem of insufficient defecation caused by individual factors and is defined as less than three defecations per week according to health professionals. In chronic constipation, decreased frequency of defecation, hard stool, feeling of incomplete excretion of feces and straining are seen. From a biopsychosocial point of view, it negatively affects the health-related quality of life of the individual and is a health problem seen at a high rate in the society (Lembo and Camilleri 2003, Talley 2004). This situation is seen as a result of aging and affects women 2-3 times more than men (Huang et al. 2017). The incidence of constipation is seen at a rate of 22-40% in our country, in other nations is seen at a rate varies between 2 and 34%. (Kasap and Bor 2006, Uysal et al. 2010). Its etiology is multifactorial; It may occur as a result of metabolic disorders, drugs used, stress, perianal dysfunctions and other reasons (Heidelbaugh et al. 2021).

While pharmacological treatment agents such as laxatives, chlorine channel activators and osmotic agents are used in the treatment of chronic constipation, lifestyle recommendations including diet, probiotics and physical activity are also used. In some chronic cases, surgical methods are preferred (Leung et al. 2011). Some of the physiotherapy interventions used in the management of constipation are: Biofeedback, tens, interference flow and exercise (LaCross et al. 2022). It is reported that especially exercise is effective in reducing the symptoms of constipation (Gao et al. 2019).

In a study examining the effects of exercise and patient education on constipation, it was reported that regular walking for 20-30 minutes a day for 12 weeks could improve constipation symptoms (Yi et al. 2014). It has been found that 150 minutes of moderate-intensity exercise per week is effective in reducing constipation symptoms, while aerobic exercise performed less than 140 minutes/week does not reduce symptoms of constipation (De Schryver et al. 2005). It is also reported that individuals who receive defecation training are successful in managing their constipation symptoms (Ruitong Gao et al. 2019). Therefore, it is thought that lifestyle education and exercise may be effective in the management of constipation symptoms.

It has been specified that three out of every four people in the society do not have sufficient physical activity level, and especially 54% of individuals between the ages of 15-19 and over 55 are sedentary. This sedentary lifestyle and decreased physical activity may cause constipation by negatively affecting the colonic transit time (Active Living Association 2010, De Schryver et al. 2005). It has been reported that the exercise and nutrition program reduces the use of laxatives while eliminating the symptoms of constipation in patients (Ceren Orhan et al 2015). Similarly, daily moderate-intensity exercise was found to reduce constipation symptoms by 44% in women (Dukas et al. 2033).

Lack of exercise may predispose the individual to neurological diseases or musculoskeletal disorders. As a result, symptoms of abdominopelvic dyssynergia and constipation occur over time. In the treatment, it is aimed to optimize the motor coordination of the abdominal and anal muscles (Wilson 2020, Grimes 2022). Physiotherapists are effective in organizing the muscles and directing the internal pressure with the help of exercise methods in these dysfunctions. Thus, colonic transition is facilitated; while the rectum contracts, the anal sphincters can relax in time (De Schryver et al 2005).

In addition, the use of exercise programs that provide vibration in the abdominal region can cause contractions in the abdominal muscles.It is thought that this may be effective in reducing the symptoms of constipation by inducing colonic movements (Peters HP and De Vries 2001).

Physiotherapy and rehabilitation interventions, especially exercise therapy, are recommended in the treatment of constipation. However, individuals who live in remote or rural areas or cannot allocate time for such treatments due to factors such as working conditions, workplace permission problems, time and distance may find it difficult to access treatment. A possible solution in this context is to provide remote rehabilitation services with the help of telerehabilitation technology (Russell 2009). Telerehabilitation is the provision of remote rehabilitation service with the help of digital technology. Through such services, education can be provided to the patients and family members. In addition, telerehabilitation may include patient evaluation, diagnosis, treatment and follow-up of the prognosis. Thanks to tele-rehabilitation, patients living in geographically disadvantaged areas have the opportunity to access rehabilitation. As a result, the burden on the health system is reduced and time and transportation costs are saved for the patient.It may also provide additional benefits related to rehabilitation in patients' own occupational and social environments (Russell et al. 2011). As far as investigators know, there is no study on telerehabilitation enforcement in the management of constipation in the literature.