Harnessing the Gut-Muscle Axis: Nutritional Strategies to Improve Physiotherapy Outcomes

Abstract

The gut-muscle axis, a term that characterizes the bidirectional gut microbiota-skeletal muscle communication, is emerging as a prominent concept in the scientific literature. In this narrative review, this new concept is discussed in light of its critical significance to the practice of physiotherapy. The review begins by addressing the science underpinning the gut-muscle axis, with consideration given to how gut dysbiosis may result in systemic inflammation, inhibit muscle protein synthesis, and be responsible for anabolic resistance. The review identifies key mechanistic connections, for example, the generation of short-chain fatty acids (SCFAs) and the inflammatory consequences of endotoxemia. The review goes on to summarize different dietary approaches for influencing the axis, such as the intake of prebiotics, probiotics, dietary fiber, polyphenols, and high-protein diets. It proceeds to describe the impact of commonly prescribed drugs such as antibiotics, corticosteroids, and proton pump inhibitors (PPIs) on gut microbiota composition and muscle health. It also converts these scientific concepts into physiotherapy practices for physiotherapists, emphasizing their role in optimizing outcomes in rehabilitation, especially in sarcopenia, frailty, post-surgical recovery, and neuro-rehabilitation. The review integrates existing evidence, highlights the limitations that exist, and suggests a framework for future collaboration between physiotherapists and dietitians across disciplines. The long-term aim is to present sound advice and promote a "gut-first thinking" strategy to enhance muscular resilience and optimize patient recovery, thus positioning the physiotherapist at the vanguard of this integrated specialty.