Randomised clinical trial: combined impact and resistance training in adults with stable Crohn's disease

Abstract

Summary Background Crohn's disease (CD) is a predisposing factor for bone loss and muscle dysfunction, which could lead to osteoporotic fractures and physical disability, respectively. Aim To assess the effect of 6 months of combined impact and resistance training on bone mineral density (BMD) and muscle function in adults with CD. Methods In this randomised controlled trial, 47 adults with stable CD were assigned to exercise (n = 23) or control (n = 24) groups and followed up for 6 months. The exercise group received usual care plus a 6‐month combined impact and resistance training programme, involving three, 60‐minute sessions per week and a gradual tapering of supervision to self‐management. The control group received usual care alone. The primary outcomes were BMD (via dual energy X‐ray absorptiometry) and muscle function (measures of upper and lower limb strength and endurance) at 6 months. Results At 6 months, BMD values were superior in the exercise group with statistical significance at lumbar spine (adjusted mean difference 0.036 g/cm2, 95% CI 0.024‐0.048; P < 0.001), but not at femoral neck (0.018 g/cm2, 0.001‐0.035; P = 0.059) or greater trochanter (0.013 g/cm2, −0.019 to 0.045; P = 0.415) after correcting for multiple outcomes. The exercise group also had superior values for all muscle function outcomes (P < 0.001; unadjusted mean differences ranging 22.6‒48.2%), and lower fatigue severity (P = 0.005). Three exercise‐related adverse events were recorded: two instances of light‐headedness and one of nausea. Conclusions The intervention improved BMD and muscle function in adults with CD and appears as a suitable model of exercise for reducing future risk of osteoporotic fractures and disability. Trial registration: ISRCTN11470370.

Sarcopenia, Severe Anxiety and Increased C-Reactive Protein Are Associated with Severe Fatigue in Patients with Inflammatory Bowel Diseases

“…Concerning anti-TNF therapies, adalimumab was reported have no effect on fatigue in a Cochrane meta-analysis and data about vedolizumab were too limited to perform any sub-analysis. 36 Thus, their efficacy in relieving fatigue is still questionable, and our study is in line with this interpretation. 36 Consistent to what is reported in literature, we did not observe that severe fatigue was more frequent in subjects with active IBD (as defined by fecal calprotectin), but we found a higher risk in subjects with abnormal CRP, in keeping with the observation of higher levels of inflammatory mediators in subjects experiencing fatigue and depression.…”

“…36 Thus, their efficacy in relieving fatigue is still questionable, and our study is in line with this interpretation. 36 Consistent to what is reported in literature, we did not observe that severe fatigue was more frequent in subjects with active IBD (as defined by fecal calprotectin), but we found a higher risk in subjects with abnormal CRP, in keeping with the observation of higher levels of inflammatory mediators in subjects experiencing fatigue and depression. 40 The study design does not allow to evaluate the inference of a causal relation between sarcopenia and fatigue.…”

“…46 In the second study the intervention was composed of three sessions of 60 minutes of strength exercises for 26 consecutive weeks, resulting in an improvement in quality of life and lumbar bone mineral density, and a decrease of fatigue perception measured with the IBD-F questionnaire. 36 Fatigue resulted significantly related with all the examined psychological variables, confirming its connection on patient's mental wellbeing. Subjects experiencing fatigue were more likely to have abnormal anxiety and depression scores, sleep disorders and to have lower quality of life scores (whose prevalence in our sample was of the 73%).…”

“…35 Evidences on its cause, prevalence and management are still uncertain. 36 Thus, this study was performed in order to increase our understanding on the prevalence of fatigue in patients with IBD and, at the same time, explore factors that might be associated with it. In particular, we evaluated whether muscle mass reduction could play a role in determining fatigue, in addition to the previously mentioned features.…”

“…This finding is consistent with the literature concerning strategies to treat fatigue: physical activity has already been identified as a valid therapeutic intervention for different cancers 43,44,45 and two exploratory studies showed promising effects in subjects affected by IBD. 46,36 In the first study, investigators prescribed individual advice to increase physical activity by 30%, with some suggestion of the efficacy of this intervention. 46 In the second study the intervention was composed of three sessions of 60 minutes of strength exercises for 26 consecutive weeks, resulting in an improvement in quality of life and lumbar bone mineral density, and a decrease of fatigue perception measured with the IBD-F questionnaire.…”