Structured physical activity interventions as a complementary therapy for patients with inflammatory bowel disease – a scoping review and practical implications

Abstract

Background Patients with Inflammatory Bowel Disease (IBD) also suffer from a wide range of additional disorders, which may be caused by the disease, the side effect of the medication, or a lack of physical activity (PA). This results in reduced physical and psychological wellbeing. However, as known from other chronic diseases exercise could be utilized as supportive therapy for IBD patients. Main goals of this article are (a) collecting data of the effects structured physical activity interventions have on validated clinical parameters of IBD and health related symptoms, (b) developing activity recommendations for this clientele. Methods A scoping review was conducted, searching for relevant articles published until May 2018, which investigated the effects of structured exercise interventions in IBD patients. The heterogeneity of the outcomes and the interventions did not support a quantitative synthesis thus, a qualitative discussion of the studies is provided. Results After reviewing 353 records, 13 eligible articles were identified. Five studies investigated aerobic exercise, three studies resistance exercise, three studies mind-body therapies and two studies yoga. The quality of the studies is mixed, and the duration is rather short for exercise interventions. Only few studies assessed validated IBD activity markers or inflammatory biomarkers. Nevertheless, the patients showed an increase in fitness, bone mineral density (BMD), quality of life and a decrease of IBD induced stress and anxiety. No severe adversial events were reported. Conclusion Even though the evidence is limited the application of exercise interventions in IBD patients can be assumed to be safe and beneficial for the patients‘ overall-health, and IBD specific physical and psychosocial symptoms. But there is still a high demand for more thoroughly conducted studies, focussing on important clinical outcome parameters.

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

“…Fatigue is a common and burdensome symptom in people with CD, even for those in clinical remission. 35 136 (21) 126 (15) 129 (14) 132 (20) 131 (16) 127 (18) Diastolic blood pressure (mmHg) 81 (13) 75 (11) 76 (9) 75 (9) 76 777 (10) Resting heart rate (beats/min) 79 (10) 73 (8) 75 (11) 80 (11) 79 (12) 82 (11) IBDQ total score 183 (23) 191 (20) 187 (23) 166 (25) 162 (26) 166 ( Although not a primary focus of this study, we also observed that the exercise programme had a beneficial effect on generic health-related quality of life assessed using the EQ-5D utility index (Table 4).…”

“…10,11 Empirical evidence on the effects of exercise in CD is sparse, with only a handful of intervention studies, all of which have focused on modes of exercise that are sub-optimal for improving bone health (eg walking, cycling, yoga). 12 Only one RCT has investigated the effect of exercise on BMD, but the intervention was a low-impact resistance training, ie not a specific bone-loading programme. 13 To address this evidence gap, we conducted an RCT called PROTECT (PROgressive resistance Training Exercise and Crohn's disease Trial), which aimed to evaluate the effects of a 6-month combined impact and resistance training programme on BMD and muscle function in adults with CD.…”

Repeated prolonged moderate-intensity walking exercise does not appear to have harmful effects on inflammatory markers in patients with inflammatory bowel disease

“…Patients experience barriers to exercise due to IBD-related limitations such as fatigue, diarrhea, joint pain, weakness and fear for symptom exacerbation [4]. However, small prospective studies showed that low-intensity exercise appears to be safe and well tolerated with minimal risk of symptom exacerbation in patients in remission or with mildly active disease [2,5,6]. Moreover, a large observational study showed that patients in remission with higher exercise levels were significantly less likely to develop active disease after 6 months follow-up [7].…”

Irisin attenuates intestinal injury, oxidative and endoplasmic reticulum stress in mice with L-arginine-induced acute pancreatitis

“…Physical exercise can favorably influence outcomes of patients with inflammatory bowel disease[43-46]. Voluntary exercise increased irisin levels and attenuated experimental colitis in high fat diet-fed mice[47].…”