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Achtenberg M, Cibor D, Zwolińska-Wcisło M. Structured exercise in patients with inflammatory bowel disease: a literature review. PRZEGLAD GASTROENTEROLOGICZNY 2025; 20:36-40. [PMID: 40191507 PMCID: PMC11966504 DOI: 10.5114/pg.2025.148473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 04/27/2024] [Indexed: 04/09/2025]
Abstract
Many patients with inflammatory bowel disease (IBD) either do not respond or lose response to dedicated pharmacotherapy; therefore, physical exercise is gaining attention as a potential treatment adjunct. Recent research has highlighted the favorable relationship between physical activity and patient-reported outcomes. The reviewed studies suggest that structured exercise programs are safe and effective in the management of IBD. Yet the benefits of training trials need to be interpreted with caution due to the heterogeneity of the study methods and interventions, small sample sizes, and the absence of long-term follow-ups.
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Affiliation(s)
- Magdalena Achtenberg
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Dorota Cibor
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Małgorzata Zwolińska-Wcisło
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
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Severo JS, da Silva ACA, dos Santos BLB, Reinaldo TS, de Oliveira AM, Lima RSP, Torres-Leal FL, dos Santos AA, da Silva MTB. Physical Exercise as a Therapeutic Approach in Gastrointestinal Diseases. J Clin Med 2025; 14:1708. [PMID: 40095789 PMCID: PMC11899784 DOI: 10.3390/jcm14051708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2025] [Revised: 02/26/2025] [Accepted: 02/27/2025] [Indexed: 03/19/2025] Open
Abstract
Background/Objectives: Physical exercise can have significant consequences for the gastrointestinal tract, which is why there have been studies into its influence on the treatment of conditions such as colorectal cancer, inflammatory bowel diseases (IBD), and irritable bowel syndrome (IBS), being that there is epidemiological evidence that exercise has a protective effect against colon cancer. This review aims to demonstrate the mechanisms of action of physical exercise in the gastrointestinal tract, as well as the benefits of exercise in diseases associated with the digestive system, in addition to gathering training recommendations in treating different gastrointestinal diseases. Results: Physical exercise modulates gastrointestinal motility, permeability, immune responses, and microbiota composition, with both beneficial and adverse effects depending on intensity and duration. Regular moderate exercise is associated with improved quality of life in IBD and IBS, reduced colorectal cancer risk, and potential symptom relief in constipation. However, high-intensity exercise may exacerbate gastroesophageal reflux symptoms and increase the risk of gastrointestinal bleeding. While aerobic exercise has been extensively studied, the effects of resistance training on gastrointestinal health remain underexplored. Conclusions: New methodologies and techniques, such as molecular biology and the study of gastric receptors, have led to advances in understanding the gastrointestinal changes associated with physical exercise. These advances cover different exercise intensities and are being investigated in both experimental models and clinical studies.
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Affiliation(s)
- Juliana Soares Severo
- Graduate Program in Food Sciences and Nutrition, Metabolic Diseases, Exercise and Nutrition Research Group (DOMEN), Laboratory of Metabolic Diseases Glauto Tuquarre, Department of Biophysics and Physiology, Center for Health Sciences, Federal University of Piaui, Teresina 64049-550, PI, Brazil; (J.S.S.); (A.M.d.O.); (R.S.P.L.); (F.L.T.-L.)
| | | | | | - Thiago Sousa Reinaldo
- Multicenter Postgraduate Program in Physiological Sciences in Association with the Brazilian Society of Physiology, Federal University of Piauí, Teresina 64049-550, PI, Brazil;
| | - Aureliano Machado de Oliveira
- Graduate Program in Food Sciences and Nutrition, Metabolic Diseases, Exercise and Nutrition Research Group (DOMEN), Laboratory of Metabolic Diseases Glauto Tuquarre, Department of Biophysics and Physiology, Center for Health Sciences, Federal University of Piaui, Teresina 64049-550, PI, Brazil; (J.S.S.); (A.M.d.O.); (R.S.P.L.); (F.L.T.-L.)
| | - Rodrigo Soares Pereira Lima
- Graduate Program in Food Sciences and Nutrition, Metabolic Diseases, Exercise and Nutrition Research Group (DOMEN), Laboratory of Metabolic Diseases Glauto Tuquarre, Department of Biophysics and Physiology, Center for Health Sciences, Federal University of Piaui, Teresina 64049-550, PI, Brazil; (J.S.S.); (A.M.d.O.); (R.S.P.L.); (F.L.T.-L.)
| | - Francisco Leonardo Torres-Leal
- Graduate Program in Food Sciences and Nutrition, Metabolic Diseases, Exercise and Nutrition Research Group (DOMEN), Laboratory of Metabolic Diseases Glauto Tuquarre, Department of Biophysics and Physiology, Center for Health Sciences, Federal University of Piaui, Teresina 64049-550, PI, Brazil; (J.S.S.); (A.M.d.O.); (R.S.P.L.); (F.L.T.-L.)
| | - Armênio Aguiar dos Santos
- Department of Physiology and Pharmacology, Federal University of Ceará, Fortaleza 60430-270, CE, Brazil;
| | - Moisés Tolentino Bento da Silva
- Graduate Program in Pharmacology, Federal University of Piauí, Teresina 64049-550, PI, Brazil;
- Laboratory of Physiology, (MedInUP/RISE-Health)—Department of Immunophysiology and Pharmacology, School of Medicine and Biomedical Sciences, University of Porto, 4050-313 Porto, Portugal
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Wei W, Yan P, Zhang Y, Wang Q, Kang J, Liu P, Fu J, Li J, Yu K. Myopenia and body fat distribution in hospitalized ulcerative colitis patients: correlations with clinical characteristics and response to vedolizumab. Front Nutr 2024; 11:1411695. [PMID: 39758314 PMCID: PMC11695233 DOI: 10.3389/fnut.2024.1411695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 12/11/2024] [Indexed: 01/07/2025] Open
Abstract
Background Ulcerative colitis (UC) patients often suffer from impaired nutritional conditions. However, there are few studies focused on muscle loss in UC patients as well as its impact on therapeutic response. This study aimed to investigate the prevalence of myopenia in hospitalized patients with active UC, analyze the relationship between body composition including both skeletal muscle and fat with clinical characteristics, and explore the association between body composition and clinical response to vedolizumab. Methods A retrospective cohort study was conducted in hospitalized patients with active UC in Peking Union Medical College Hospital from November 2014 to October 2022. Computed tomography (CT) scans were used to measure skeletal muscle area, visceral fat area (VFA), subcutaneous fat area (SFA), and intramuscular fat infiltration at the third lumbar vertebrae (L3) level. These measurements were standardized by height (m) squared. Myopenia was defined as a skeletal muscle index (SMI) < 44.77 cm2/m2 for males and <32.50 cm2/m2 for females. The VFA/SFA ratio (VSR) served as an indicator of visceral obesity, while intramuscular fat infiltration was evaluated using the mean Hounsfield Unit (HU) value of the L3 skeletal muscle section. Results A total of 457 patients were enrolled. The prevalence of myopenia was 49.7% in this cohort. Female patients had significantly higher levels of subcutaneous fat and intramuscular fat but a lower level of visceral fat than male patients. SMI and mean HU showed positive correlations with serum albumin (ALB) and negative correlations with serum high-sensitivity C-reactive protein (hsCRP), whereas VSR showed the opposite trend. Among the 92 patients who received vedolizumab treatment, myopenia was significantly associated with a lower clinical response rate, and this association remained significant after adjusting for vedolizumab duration, ALB, and hsCRP (OR = 3.458, 95% CI 1.238-9.659, p = 0.018). Visceral obesity, defined as VSR ≥ 75th centile of gender-specific VSR, tended to diminish the clinical response rate but did not reach statistical significance. Conclusion This study underscores the significance of assessing body composition in UC patients. Optimizing body composition should be considered an integral component of managing UC patients in the future.
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Affiliation(s)
- Wei Wei
- Department of Clinical Nutrition, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Pengguang Yan
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yan Zhang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qiong Wang
- Department of Clinical Nutrition, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Junren Kang
- Department of Clinical Nutrition, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Pengju Liu
- Department of Clinical Nutrition, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jin Fu
- Department of Clinical Nutrition, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jingnan Li
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kang Yu
- Department of Clinical Nutrition, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Sun S, Chen J, Zheng M, Zhou M, Ying X, Shen Y, Hu Y, Ni K, Fan Y, Lv B. Impact of exercise on outcomes among Chinese patients with Crohn's disease: a mixed methods study based on social media and the real world. BMC Gastroenterol 2024; 24:441. [PMID: 39614151 PMCID: PMC11605885 DOI: 10.1186/s12876-024-03533-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 11/21/2024] [Indexed: 12/01/2024] Open
Abstract
OBJECTIVE The effects of exercise on the health of people with Crohn's disease (CD) remain unclear. This study aimed to explore the perspective of Chinese CD patients on exercise and the quantitative relationship between exercise and patient-reported outcomes. METHODS This study used a mixed methods design consisting of three components. (1) Big data were mined from social media, and latent Dirichlet allocation (LDA) was used to perform cluster analysis on topics related to physical exercise. (2) A seven-step Colaizzi process was used to conduct semistructured interviews to obtain in-depth information about exercise. (3) A cross-sectional study was performed to examine this relationship using the Global Physical Activity Questionnaire (GPAQ) and Patient-reported Outcome Measurement Information System (PROMIS). RESULTS LDA yielded a total of 1536 exercise-related posts; eight topics concerning CD patients were obtained through clustering (peer support, exercise therapy, diet, fatigue, exercise type, intestinal symptoms, body constitution and mental health), and 11 patients were interviewed to validate the results of LDA and explore the insight of Chinese CD. We identified two themes: the effects of exercise on people with CD and factors that promote and hinder exercise. A total of 119 patients with CD were surveyed. Considering confounding factors such as disease activity and medication, moderate-intensity recreational PA increased patients' physical function and improved anxiety, depression, fatigue, pain intensity, and pain impact (all p < 0.05). In contrast, high-intensity work may lead to anxiety, depression, fatigue, pain, and pain effects (all p < 0.001). In addition, sedentary behaviour may lead to depression (p = 0.006). CONCLUSION Patients with CD tend to seek guidance on exercise through social media, and they generally believe that exercise is beneficial, especially for their psychological and spiritual health, despite difficulties in exercising. Physical activity may be an important factor affecting patients' psychological health. Crohn's disease has a profound impact on mental and emotional health, reducing patients' quality of life. Exercise is a good habit that can enhance mental, emotional and social health, but there is currently no standard exercise program for patients with Crohn's disease. The exercise experience of Chinese patients with Crohn's disease can be helpful in formulating exercise plans.
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Affiliation(s)
- Shaopeng Sun
- Department of Gastroenterology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, China
| | - Jiajia Chen
- Department of Nursing, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), No. 54, Youdian Road, Shangcheng District, Hangzhou, 310003, Zhejiang Province, China.
| | - Mingxu Zheng
- Department of Gastroenterology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, China
| | - Mi Zhou
- Department of Nursing, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), No. 54, Youdian Road, Shangcheng District, Hangzhou, 310003, Zhejiang Province, China
| | - Xue Ying
- Department of Nursing, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), No. 54, Youdian Road, Shangcheng District, Hangzhou, 310003, Zhejiang Province, China
| | - Yanjie Shen
- Department of Gastroenterology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, China
| | - Yibo Hu
- Department of Gastroenterology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, China
| | - Keying Ni
- Department of Gastroenterology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, China
| | - Yihong Fan
- Department of Gastroenterology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, China
| | - Bin Lv
- Department of Gastroenterology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, China
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Pérez-Prieto I, Plaza-Florido A, Ubago-Guisado E, Ortega FB, Altmäe S. Physical activity, sedentary behavior and microbiome: A systematic review and meta-analysis. J Sci Med Sport 2024; 27:793-804. [PMID: 39048485 DOI: 10.1016/j.jsams.2024.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 05/18/2024] [Accepted: 07/02/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND The effects of physical activity and sedentary behavior on human health are well known, however, the molecular mechanisms are poorly understood. Growing evidence points to physical activity as an important modulator of the composition and function of microbial communities, while evidence of sedentary behavior is scarce. We aimed to synthesize and meta-analyze the current evidence about the effects of physical activity and sedentary behavior on microbiome across different body sites and in different populations. METHODS A systematic search in PubMed, Web of Science, Scopus and Cochrane databases was conducted until September 2022. Random-effects meta-analyses including cross-sectional studies (active vs. inactive/athletes vs. non-athletes) or trials reporting the chronic effect of physical activity interventions on gut microbiome alpha-diversity in healthy individuals were performed. RESULTS Ninety-one studies were included in this systematic review. Our meta-analyses of 2632 participants indicated no consistent effect of physical activity on microbial alpha-diversity, although there seems to be a trend toward a higher microbial richness in athletes compared to non-athletes. Most of studies reported an increase in short-chain fatty acid-producing bacteria such as Akkermansia, Faecalibacterium, Veillonella or Roseburia in active individuals and after physical activity interventions. CONCLUSIONS Physical activity levels were positively associated with the relative abundance of short-chain fatty acid-producing bacteria. Athletes seem to have a richer microbiome compared to non-athletes. However, high heterogeneity between studies avoids obtaining conclusive information on the role of physical activity in microbial composition. Future multi-omics studies would enhance our understanding of the molecular effects of physical activity and sedentary behavior on the microbiome.
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Affiliation(s)
- Inmaculada Pérez-Prieto
- Department of Biochemistry and Molecular Biology I, Faculty of Sciences, University of Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Spain.
| | - Abel Plaza-Florido
- Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Spain; Pediatric Exercise and Genomics Research Center, UC Irvine School of Medicine, United States.
| | - Esther Ubago-Guisado
- Instituto de Investigación Biosanitaria ibs.GRANADA, Spain; Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Spain
| | - Francisco B Ortega
- Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Spain; CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Granada, Spain; Faculty of Sport and Health Sciences, University of Jyväskylä, Finland.
| | - Signe Altmäe
- Department of Biochemistry and Molecular Biology I, Faculty of Sciences, University of Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Spain; Division of Obstetrics and Gynaecology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Huddinge, Stockholm, Sweden; Department of Gynaecology and Reproductive Medicine, Karolinska University Hospital, Huddinge, Stockholm, Sweden.
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Sabir G, Abdelhady HA, Oumar Abakar A, Gangavarapu RR, Mahmud SA, Manandhar A, Malasevskaia I. The Potential Benefits of Exercise in Managing Inflammatory Bowel Disease: A Systematic Review. Cureus 2024; 16:e68948. [PMID: 39381484 PMCID: PMC11461038 DOI: 10.7759/cureus.68948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2024] [Accepted: 09/07/2024] [Indexed: 10/10/2024] Open
Abstract
Adults with inflammatory bowel disease (IBD) experience a significant decline in quality of life due to various symptoms. Exercise has emerged as a potential therapeutic approach to improve IBD management, but its effectiveness requires further investigation. This systematic review, adhering to PRISMA 2020 guidelines, explored the effects of exercise on IBD progression and its potential as a treatment in adults. A comprehensive search strategy was conducted across three databases and two registries from May 12, 2024, to May 22, 2024. Methodological rigor and potential bias were minimized through quality assessment using the Cochrane risk-of-bias tool 2 (RoB 2) for randomized controlled trials (RCTs), the Newcastle-Ottawa Scale (NOS) for cohort studies, and the Joanna Briggs Institute (JBI) critical appraisal checklist for studies evaluating the effectiveness of non-randomized interventions. This process yielded 12 high-quality studies for analysis. The review identified positive evidence from both RCTs and observational studies. Exercise interventions demonstrated improvements in cardiorespiratory fitness, disease activity, quality of life, and mental health in adults with IBD. Studies explored various modalities, including aerobic exercise, resistance training, and mind-body interventions. However, further research is needed to optimize exercise prescription and elucidate the underlying mechanisms of action. This review strengthens the evidence for exercise as a beneficial intervention for IBD patients. Personalized exercise programs based on individual needs hold promise for improved IBD management and patient outcomes. However, limitations exist due to study design variations and the need for long-term follow-up studies.
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Affiliation(s)
- Ghadeer Sabir
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Hala A Abdelhady
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Adoum Oumar Abakar
- Internal Medicine Clinical Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Internal Medicine, Universidad de Ciencias Medicas de La Habana, Havana, CUB
| | | | - Sayed A Mahmud
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Anura Manandhar
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Iana Malasevskaia
- Research and Development, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Obstetrics and Gynecology, Private Clinic "Yana Alexandr", Sana'a, YEM
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Minawala R, Faye AS. Sarcopenia as a Preoperative Risk Stratification Tool among Older Adults with Inflammatory Bowel Disease. ADVANCES IN GERIATRIC MEDICINE AND RESEARCH 2024; 6:e240003. [PMID: 38911683 PMCID: PMC11192537 DOI: 10.20900/agmr20240003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/25/2024]
Abstract
Sarcopenia, defined as a loss of muscle mass and function, is a physiologic factor that has been implicated as a predictor of adverse postoperative outcomes in many older adult populations. However, data related to sarcopenia in older adults with inflammatory bowel disease (IBD) remain limited. Older adults with IBD are particularly vulnerable to adverse postoperative outcomes, in part, due to muscle depletion from systemic inflammation, malnutrition, and reduced physical activity. However, few patients undergo routine muscle evaluation as a part of preoperative assessment. Moreover, cut-off values for measures of sarcopenia in the literature are modeled after non-IBD populations. The lack of standardized measures and values for sarcopenia in the IBD patient population has led to heterogenous findings and a paucity of preoperative risk stratification tools. Therefore, we aim to explore the scope of sarcopenia as a preoperative risk stratification tool among older adults with IBD.
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Affiliation(s)
- Ria Minawala
- Department of Medicine, NYU School of Medicine, New York, NY 10016, USA
| | - Adam S. Faye
- Inflammatory Bowel Disease Center, Division of Gastroenterology, Department of Medicine, NYU School of Medicine, New York, NY 10016, USA
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Sun SP, Chen JJ, Zheng MX, Fan YH, Lv B. Progress in research of exercise intervention in inflammatory bowel disease. WORLD CHINESE JOURNAL OF DIGESTOLOGY 2024; 32:339-346. [DOI: 10.11569/wcjd.v32.i5.339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
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Luo B, Xiang D, Ji X, Chen X, Li R, Zhang S, Meng Y, Nieman DC, Chen P. The anti-inflammatory effects of exercise on autoimmune diseases: A 20-year systematic review. JOURNAL OF SPORT AND HEALTH SCIENCE 2024; 13:353-367. [PMID: 38341137 PMCID: PMC11117003 DOI: 10.1016/j.jshs.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 01/08/2024] [Accepted: 01/16/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND The anti-inflammatory effect of exercise may be an underlying factor in improving several autoimmune diseases. The aim of this systematic review was to examine the evidence on the role of exercise training in mitigating inflammation in adolescents and adults with autoimmune disease. METHODS PubMed, Web of Science, and Embase databases were systematically reviewed for related studies published between January 1, 2003, and August 31, 2023. All randomized and non-randomized controlled trials of exercise interventions with autoimmune disease study participants that evaluated inflammation-related biomarkers were included. The quality of evidence was assessed using the Tool for the assEssment of Study qualiTy and reporting in EXercise scale and Cochrane bias risk tool. RESULTS A total of 14,565 records were identified. After screening the titles, abstracts, and full texts, 87 were eligible for the systematic review. These studies were conducted in 25 different countries and included a total of 2779 participants (patients with autoimmune disease, in exercise or control groups). Overall, the evidence suggests that inflammation-related markers such as C-reactive protein, interleukin 6, and tumor necrosis factor α were reduced by regular exercise interventions. Regular exercise interventions combined with multiple exercise modes were associated with greater benefits. CONCLUSION Regular exercise training by patients with autoimmune disease exerts an anti-inflammatory influence. This systematic review provides support for the promotion and development of clinical exercise intervention programs for patients with autoimmune disease. Most patients with autoimmune disease can safely adopt moderate exercise training protocols, but changes in inflammation biomarkers will be modest at best. Acute exercise interventions are ineffective or even modestly but transiently pro-inflammatory.
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Affiliation(s)
- Beibei Luo
- School of Exercise and Health, Shanghai University of Sport, Shanghai 200438, China; Shanghai Key Laboratory of Human Performance, Shanghai University of Sport, Shanghai 200438, China
| | - Dao Xiang
- Department of Diving and Hyperbaric Medicine, Naval Medical Center, Shanghai 200433, China; National Key Laboratory of Immunity and Inflammation, Naval Medical University, Shanghai 200433, China
| | - Xiaorong Ji
- School of Exercise and Health, Shanghai University of Sport, Shanghai 200438, China
| | - Xuan Chen
- School of Exercise and Health, Shanghai University of Sport, Shanghai 200438, China
| | - Rui Li
- School of Exercise and Health, Shanghai University of Sport, Shanghai 200438, China
| | - Shuxin Zhang
- School of Exercise and Health, Shanghai University of Sport, Shanghai 200438, China
| | - Yujun Meng
- School of Exercise and Health, Shanghai University of Sport, Shanghai 200438, China
| | - David C Nieman
- Human Performance Laboratory, Appalachian State University, North Carolina Research Campus, Kannapolis, NC 28081, USA.
| | - Peijie Chen
- School of Exercise and Health, Shanghai University of Sport, Shanghai 200438, China; Research Institute for Doping Control, Shanghai University of Sport, Shanghai 200438, China.
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Seaton N, Hudson J, Harding S, Norton S, Mondelli V, Jones ASK, Moss-Morris R. Do interventions for mood improve inflammatory biomarkers in inflammatory bowel disease?: a systematic review and meta-analysis. EBioMedicine 2024; 100:104910. [PMID: 38272759 PMCID: PMC10878994 DOI: 10.1016/j.ebiom.2023.104910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 11/23/2023] [Accepted: 11/28/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Psychoneuroimmunological mechanisms and the gut-brain axis appear relevant to disease activity and progression in Inflammatory Bowel Disease (IBD). A recent review showed no effect of psychological therapies on self-reported disease activity in IBD. This meta-analysis aims to establish whether interventions targeting mood outcomes (e.g., depression, anxiety and stress) impact inflammation levels in IBD and possible moderators of these effects. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. We searched five electronic databases and included randomised controlled trials where interventions targeted mood and assessed inflammatory outcomes pre- and post-intervention in adults with IBD. Independent reviewers screened studies, extracted data, and assessed methodological quality. Data were pooled to estimate standardised mean differences (SMDs) with 95% Confidence Intervals (CIs). A random-effects robust variance estimation accounted for studies measuring multiple biomarkers. Intervention type, mood as a primary or secondary outcome, effect on mood outcomes and IBD subtype were investigated as treatment effect moderators. Where there were sufficient biomarkers, individual meta-analyses were run (Pre-registration PROSPERO: CRD42023389401). FINDINGS 28 RCTs involving 1789 participants met inclusion criteria. Interventions demonstrated small, statistically significant effects on biomarkers (-0.35, 95% CI: -0.48, -0.22, p < 0.001) and medium effects on mood outcomes (-0.50, 95% CI: -0.73, -0.27, p < 0.001), without evidence of substantive heterogeneity or publication bias. Individual analyses showed small effects for improved faecal calprotectin (-0.19, 95% CI: -0.34, -0.03, p = 0.018) and C-Reactive Protein (-0.29, 95% CI: -0.47, -0.10, p = 0.002). Effect sizes were larger for psychological therapy interventions (compared with exercise or antidepressants) and when there was an effect (SMD ≥0.2) on mood. INTERPRETATION Treatments which address mood outcomes have beneficial effects on generic inflammation as well as disease-specific biomarkers (faecal calprotectin and C-Reactive Protein). Psychological interventions and interventions with larger treatment effects on mood accentuated the effect on biomarkers. More research is required to understand the biological or behavioural mechanisms underlying this effect. FUNDING The Medical Research Council and the National Institute for Health and Care Research (NIHR) Maudsley Biomedical Research Centre.
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Affiliation(s)
- Natasha Seaton
- Institute of Psychology Psychiatry and Neuroscience, King's College London, UK.
| | - Joanna Hudson
- Institute of Psychology Psychiatry and Neuroscience, King's College London, UK
| | - Sophie Harding
- Institute of Psychology Psychiatry and Neuroscience, King's College London, UK
| | - Sam Norton
- Institute of Psychology Psychiatry and Neuroscience, King's College London, UK
| | - Valeria Mondelli
- Institute of Psychology Psychiatry and Neuroscience, King's College London, UK
| | - Annie S K Jones
- Institute of Psychology Psychiatry and Neuroscience, King's College London, UK
| | - Rona Moss-Morris
- Institute of Psychology Psychiatry and Neuroscience, King's College London, UK
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Cullen JMA, Shahzad S, Kanaley JA, Ericsson AC, Dhillon J. The effects of 6 wk of resistance training on the gut microbiome and cardiometabolic health in young adults with overweight and obesity. J Appl Physiol (1985) 2024; 136:349-361. [PMID: 38059291 DOI: 10.1152/japplphysiol.00350.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 11/21/2023] [Accepted: 11/21/2023] [Indexed: 12/08/2023] Open
Abstract
Obesity is a known risk factor for the development of insulin resistance and other cardiometabolic disorders. Recently, the gut microbiome has been associated with obesity and subsequent health complications. Exercise has been regularly utilized as a therapeutic intervention to treat obesity and its associated comorbidities. This study examined the effects of a 6-wk resistance training exercise program (RT) on the diversity, composition, and metabolic pathways of the gut microbiome. Sedentary young adults (age 18-35 yr) with overweight and obesity (BMI 25-45 kg/m2) were recruited to participate in this randomized controlled trial. Participants were randomized to RT (n = 16), a 6-wk resistance training program (3 days/wk), or control (CT) (n = 16), a nonexercising control. Main outcomes of the study included gut microbiome measures (taxa abundances, diversity, and predicted function) and cardiometabolic outcomes [blood pressure (BP) and glucoregulation]. Increased abundances of Roseburia, a short-chain fatty acid (SCFA) producer were observed over 6 wk (W6) with RT compared with CT (group × week, P < 0.05, q < 0.25). RT also induced marginal alterations in predicted microbial metabolic and cell motility pathways compared with CT (group × week, P < 0.05, q < 0.25). However, RT did not significantly impact overall microbial diversity. Furthermore, RT resulted in higher quantitative insulin-sensitivity check index (QUICKI) and lower diastolic BP at W6 compared with CT [baseline (BL)-adjusted P < 0.05]. RT had mixed effects on the gut microbiome. Although RT increased abundances of Roseburia and induced minor changes in microbial pathways, it is important to consider these changes in the context of the overall stability observed in the microbiome composition.NEW & NOTEWORTHY Resistance training induces mixed changes in the gut microbiome, including an increase in the abundances of the Roseburia genus and minor alterations in microbial pathways. However, it is vital to interpret these changes in light of the broader context, where we observe stability in the overall microbiome composition. This stability may be attributed to the microbiome's resilience, demonstrating its capacity to withstand short-term physiological stressors.
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Affiliation(s)
- John M A Cullen
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, Missouri, United States
| | - Shahim Shahzad
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, Missouri, United States
| | - Jill A Kanaley
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, Missouri, United States
| | - Aaron C Ericsson
- Department of Veterinary Pathobiology, University of Missouri, Columbia, Missouri, United States
| | - Jaapna Dhillon
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, Missouri, United States
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12
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Cullen JMA, Shahzad S, Dhillon J. A systematic review on the effects of exercise on gut microbial diversity, taxonomic composition, and microbial metabolites: identifying research gaps and future directions. Front Physiol 2023; 14:1292673. [PMID: 38187136 PMCID: PMC10770260 DOI: 10.3389/fphys.2023.1292673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/07/2023] [Indexed: 01/09/2024] Open
Abstract
The gut microbiome, hosting a diverse microbial community, plays a pivotal role in metabolism, immunity, and digestion. While the potential of exercise to influence this microbiome has been increasingly recognized, findings remain incongruous. This systematic review examined the effects of exercise on the gut microbiome of human and animal models. Databases (i.e., PubMed, Cochrane Library, Scopus, and Web of Science) were searched up to June 2022. Thirty-two exercise studies, i.e., 19 human studies, and 13 animal studies with a minimum of two groups that discussed microbiome outcomes, such as diversity, taxonomic composition, or microbial metabolites, over the intervention period, were included in the systematic review (PROSPERO registration numbers for human review: CRD42023394223). Results indicated that over 50% of studies found no significant exercise effect on human microbial diversity. When evident, exercise often augmented the Shannon index, reflecting enhanced microbial richness and evenness, irrespective of disease status. Changes in beta-diversity metrics were also documented with exercise but without clear directionality. A larger percentage of animal studies demonstrated shifts in diversity compared to human studies, but without any distinct patterns, mainly due to the varied effects of predominantly aerobic exercise on diversity metrics. In terms of taxonomic composition, in humans, exercise usually led to a decrease in the Firmicutes/Bacteroidetes ratio, and consistent increases with Bacteroides and Roseburia genera. In animal models, Coprococcus, another short chain fatty acid (SCFA) producer, consistently rose with exercise. Generally, SCFA producers were found to increase with exercise in animal models. With regard to metabolites, SCFAs emerged as the most frequently measured metabolite. However, due to limited human and animal studies examining exercise effects on microbial-produced metabolites, including SCFAs, clear patterns did not emerge. The overall risk of bias was deemed neutral. In conclusion, this comprehensive systematic review underscores that exercise can potentially impact the gut microbiome with indications of changes in taxonomic composition. The significant variability in study designs and intervention protocols demands more standardized methodologies and robust statistical models. A nuanced understanding of the exercise-microbiome relationship could guide individualized exercise programs to optimize health. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=394223, identifier CRD42023394223.
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Affiliation(s)
- John M A Cullen
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, MO, United States
| | - Shahim Shahzad
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, MO, United States
| | - Jaapna Dhillon
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, MO, United States
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13
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Wang J, Tong S, Niu Y, Lu B. Attitude and influencing factors on exercise in patients with moderately to severely active inflammatory bowel disease: a qualitative study. BMJ Open 2023; 13:e080084. [PMID: 38114281 DOI: 10.1136/bmjopen-2023-080084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2023] Open
Abstract
OBJECTIVES To explore the attitudes towards exercise, factors influencing exercise and exercise-related needs of patients with moderately to severely active inflammatory bowel disease. DESIGN A qualitative phenomenological research. SETTING The study was conducted at a comprehensive tertiary hospital in Suzhou, China, which is a secondary care facility. PARTICIPANTS The study included 17 participants who met specific inclusion criteria: aged between 16 and 70 years, diagnosed with inflammatory bowel disease and in a state of moderate to severe disease activity. Participants were required to be capable of clear self-expression and provide voluntary consent. Exclusion criteria included the presence of cancer or severe physical illness, cognitive impairment or mental illness. INTERVENTIONS Semistructured interviews were used to collect data. RESULTS The exercise experiences of participants with moderate to severe inflammatory bowel disease yielded three themes: attitudes towards exercise, factors influencing exercise and exercise-related needs. CONCLUSION The majority of participants had negative attitudes towards exercise during periods of moderate to severe activity, largely influenced by disease activity, symptom management, inadequate knowledge of exercise and uncertainty about the value of exercise. Of particular note, professional guidance was generally recognised as stimulating a willingness to exercise positively, and participants demonstrated a strong need for professional guidance. Therefore, it is recommended that clear exercise guidelines for inflammatory bowel disease be constructed to ensure that patients receive safe and effective guidance to develop a healthy lifestyle in order to maximise the benefits of exercise.
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Affiliation(s)
- Jing Wang
- School of Nursing, Suzhou Medical College of Soochow University, Suzhou, Jiangsu, China
| | - Shuping Tong
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Yuehong Niu
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Bingqing Lu
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
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14
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CHANG YH, SHUN SC, CHEN MH, CHANG YF. Feasibility of Different Exercise Modalities for Community-Dwelling Residents With Physical Inactivity: A Randomized Controlled Trial. J Nurs Res 2023; 31:e301. [PMID: 37883059 PMCID: PMC11812666 DOI: 10.1097/jnr.0000000000000578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 04/14/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Exercise interventions can promote health, but they can be difficult to implement. Moreover, no consensus has been reached regarding which exercise modality promotes the most significant improvement in metabolic health. PURPOSE This feasibility study was conducted to (a) determine the implementation efficacy of supervised and home-based exercise interventions by investigating their respective rates of intervention adherence, adherence to targeted intensity, attrition, and adverse events and (b) explore the preliminary efficacy of 12-week exercise programs among aerobic exercise, aerobic exercise combined with resistance exercise, and high-intensity interval training on body composition, anthropometric parameters, and lipid profiles for community-dwelling residents with physical inactivity. METHODS This randomized controlled trial was conducted from April to October 2020. Seventy-two sedentary participants aged 40-70 years were enrolled and randomized into one of four groups: 12-week aerobic exercise, aerobic exercise combined with resistance exercise, high-intensity interval training, and control. The three exercise groups performed at least moderate-intensity supervised exercise twice a week and home-based exercise once a week, whereas the control group maintained their usual daily activities. The target variables, including body composition, anthropometric parameters, and lipid profiles, were measured before and after the 12-week intervention. RESULTS The intervention adherence rates were 74.01%-87.54% for the supervised exercise group, 64.98%-83.90% for the home-based exercise group, and 82.65%-92.65% for the target exercise intensity group. The attrition rate ranged from 12.50% to 17.65%, and no adverse events were reported in any of the exercise groups. Preliminary efficacy data show the reductions in body weight (95% CI [0.01, 1.20], p = .048) and low-density lipoprotein (95% CI [2.76, 30.32], p = .02) were greater in the exercise groups than the control group, although the intergroup differences were not significant. CONCLUSIONS/IMPLICATIONS FOR PRACTICE Body weight and low-density lipoprotein may be efficiently reduced in a 12-week period using any of the three exercise modalities with at least 82.65% adherence to moderate-intensity exercise and 70.84% adherence to exercising 3 times a week.
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Affiliation(s)
- Yu-Hsuan CHANG
- PhD, RN, Assistant Professor, Department of Nursing, National Tainan Junior College of Nursing, Tainan, Taiwan
| | - Shiow-Ching SHUN
- PhD, RN, Professor, Institute of Clinical Nursing, College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Min-Hsin CHEN
- MS, Assistant Professor, General Education Center, National Tainan Junior College of Nursing, Tainan, Taiwan; and Doctoral Student, National Taiwan Sport University, Taoyuan, Taiwan
| | - Yin-Fan CHANG
- MD, Assistant Professor, Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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15
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Hart NH, Wallen MP, Farley MJ, Haywood D, Boytar AN, Secombe K, Joseph R, Chan RJ, Kenkhuis MF, Buffart LM, Skinner TL, Wardill HR. Exercise and the gut microbiome: implications for supportive care in cancer. Support Care Cancer 2023; 31:724. [PMID: 38012463 DOI: 10.1007/s00520-023-08183-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 11/12/2023] [Indexed: 11/29/2023]
Abstract
PURPOSE Growing recognition of the gut microbiome as an influential modulator of cancer treatment efficacy and toxicity has led to the emergence of clinical interventions targeting the microbiome to enhance cancer and health outcomes. The highly modifiable nature of microbiota to endogenous, exogenous, and environmental inputs enables interventions to promote resilience of the gut microbiome that have rapid effects on host health, or response to cancer treatment. While diet, probiotics, and faecal microbiota transplant are primary avenues of therapy focused on restoring or protecting gut function in people undergoing cancer treatment, the role of physical activity and exercise has scarcely been examined in this population. METHODS A narrative review was conducted to explore the nexus between cancer care and the gut microbiome in the context of physical activity and exercise as a widely available and clinically effective supportive care strategy used by cancer survivors. RESULTS Exercise can facilitate a more diverse gut microbiome and functional metabolome in humans; however, most physical activity and exercise studies have been conducted in healthy or athletic populations, primarily using aerobic exercise modalities. A scarcity of exercise and microbiome studies in cancer exists. CONCLUSIONS Exercise remains an attractive avenue to promote microbiome health in cancer survivors. Future research should elucidate the various influences of exercise modalities, intensities, frequencies, durations, and volumes to explore dose-response relationships between exercise and the gut microbiome among cancer survivors, as well as multifaceted approaches (such as diet and probiotics), and examine the influences of exercise on the gut microbiome and associated symptom burden prior to, during, and following cancer treatment.
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Affiliation(s)
- Nicolas H Hart
- Human Performance Research Centre, INSIGHT Research Institute, University of Technology Sydney (UTS), Moore Park, NSW, 2030, Australia.
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia.
- Cancer and Palliative Care Outcomes Centre, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia.
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia.
- Institute for Health Research, University of Notre Dame Australia, Fremantle, WA, Australia.
| | - Matthew P Wallen
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
- Institute for Health and Wellbeing, Federation University, Ballarat, VIC, Australia
| | - Morgan J Farley
- Human Performance Research Centre, INSIGHT Research Institute, University of Technology Sydney (UTS), Moore Park, NSW, 2030, Australia
- School of Human Movement and Nutrition Sciences, The University of Queensland, St. Lucia, QLD, Australia
| | - Darren Haywood
- Human Performance Research Centre, INSIGHT Research Institute, University of Technology Sydney (UTS), Moore Park, NSW, 2030, Australia
- Mental Health Division, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
- Department of Psychiatry, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Alexander N Boytar
- School of Human Movement and Nutrition Sciences, The University of Queensland, St. Lucia, QLD, Australia
| | - Kate Secombe
- The University of Queensland Diamantina Institute, Faculty of Medicine, The University of Queensland, St. Lucia, QLD, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Ria Joseph
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Raymond J Chan
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
- Cancer and Palliative Care Outcomes Centre, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | - Marlou-Floor Kenkhuis
- Department of Medical BioSciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Laurien M Buffart
- Department of Medical BioSciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tina L Skinner
- Human Performance Research Centre, INSIGHT Research Institute, University of Technology Sydney (UTS), Moore Park, NSW, 2030, Australia
- School of Human Movement and Nutrition Sciences, The University of Queensland, St. Lucia, QLD, Australia
| | - Hannah R Wardill
- School of Biomedicine, University of Adelaide, Adelaide, SA, Australia
- Supportive Oncology Research Group, Precision Cancer Medicine, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
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16
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Lund K, Knudsen T, Kjeldsen J, Nielsen RG, Juhl CB, Nørgård BM. The IBD-FITT study - moderate-intensity exercise for patients with inflammatory bowel disease with moderate disease activity: an open-label randomized controlled trial. Trials 2023; 24:742. [PMID: 37986021 PMCID: PMC10659067 DOI: 10.1186/s13063-023-07781-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 11/06/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND Inflammatory bowel disease (IBD), Crohn's disease, and ulcerative colitis are chronic autoimmune lifelong diseases with fluctuating activity over time. The treatment includes medical therapy and surgery, however, there is no definite cure. Therefore, the quest for new and supplementary treatment options is imperative to improve patients' general health and quality of life. Physical activity and exercise have been suggested to be elements in both the prevention and supplementary treatment of IBD; however, this is based on limited underpowered trials. Thus, the role of exercise as a treatment option still has to be settled. We aim to investigate the effect of a 12-week exercise intervention in adult patients with moderately active IBD on three categories of outcomes (1) disease-specific health-related quality of life (IBDQ); (2) general health status of the patients, i.e., waist circumference, disease activity by clinical scorings systems (Harvey Bradshaw Index, Simple Clinical Colitis Activity Index), blood pressure, blood lipids, and non-disease specific quality of life (EQ5D) scores; and (3) explorative outcomes on biomarkers (C-reactive protein and fecal calprotectin) plus different biomarkers of immunology (cytokine panel). METHODS We will apply a superiority design in this open-label randomized clinical trial including 150 patients equally allocated to intervention and usual care. The intervention will be based on a 12-week aerobic exercise program and will include two supervised exercise sessions of 60 min per week, combined with one weekly home training session. We have defined a moderate exercise level as 60-80% of patients' maximum heart rate. The patients in the intervention group will also be offered an online video lesson of 15-25 min on lifestyle guidance, and the same online video lesson will be offered in the comparator group. Questionnaires on quality of life will be forwarded electronically both at inclusion and at the end of the study, and the patients will have blood samples, and fecal samples for calprotectin at baseline, weeks 4 and 8, as well as after 12 weeks (study end). DISCUSSION This will be a clinical trial investigating the effect of exercise on patients with Crohn's disease and ulcerative colitis. This trial will add to the evidence on the possible effect of exercise and might clarify whether exercise can benefit as a supplementary treatment addendum. Thus, the trial may provide a new patient-active disease management approach. TRIAL REGISTRATION ClinicalTrials.gov NCT04816812. Date of first registration: March 23, 2021.
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Affiliation(s)
- Ken Lund
- Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark.
- Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Torben Knudsen
- Department of Medicine, Hospital of Southwest Jutland, Esbjerg, Denmark
- Department of Regional Health Science, Center Southwest Jutland, University of Southern Denmark, Esbjerg, Denmark
| | - Jens Kjeldsen
- Department of Medical Gastroenterology S, Odense University Hospital, Odense, Denmark
- Research Unit of Medical Gastroenterology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Rasmus Gaardskær Nielsen
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
- Research Unit of Pediatrics, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Carsten Bogh Juhl
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Department of Physiotherapy and Occupational Therapy, University of Copenhagen, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - Bente Mertz Nørgård
- Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark
- Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Bjelica M, Walker RG, Obeid J, Issenman RM, Timmons BW. A Pilot Study of Exercise Training for Children and Adolescents With Inflammatory Bowel Disease: An Evaluation of Feasibility, Safety, Satisfaction, and Efficacy. Pediatr Exerc Sci 2023; 35:239-248. [PMID: 37487583 DOI: 10.1123/pes.2022-0012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 01/10/2023] [Accepted: 02/13/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND Children with inflammatory bowel disease (IBD) experience extraintestinal side effects including altered body composition, impaired muscle strength, and aerobic capacity. Exercise training may remedy these issues. PURPOSE To assess the feasibility, safety, participant satisfaction, and efficacy of a training program for youth with IBD. METHODS Children with IBD completed 16 weeks of training (2 supervised + 1 home sessions per week). Feasibility was assessed by tracking recruitment, adherence, and compliance rates. Safety was assessed by tracking symptoms and adverse events. Posttraining interviews gauged satisfaction. Circulating inflammatory markers, body composition, muscle strength, aerobic fitness, and habitual physical activity were measured at baseline, midtraining (8 wk), and posttraining. RESULTS Eleven youth were recruited and 10 completed the study. Participants adhered to 28 (1) of 32 prescribed supervised sessions and 8 (4) of 16 prescribed home sessions. There were no adverse events, and overall feedback on training was positive. Posttraining, we observed an increase in lean mass (+2.4 [1.1] kg), bone density (+0.0124 [0.015] g·cm-2), aerobic fitness (+2.8 [5.7] mL·kg LM-1· min-1), and vigorous physical activity levels (+13.09 [8.95] min·h-1) but no change in inflammation or muscle strength. CONCLUSION Supervised exercise training is feasible, safe, and effective for youth with IBD and should be encouraged.
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Affiliation(s)
- Mila Bjelica
- Department of Pediatrics, McMaster University, Hamilton, ON,Canada
| | - Rachel G Walker
- Department of Pediatrics, McMaster University, Hamilton, ON,Canada
| | - Joyce Obeid
- Department of Pediatrics, McMaster University, Hamilton, ON,Canada
| | - Robert M Issenman
- Division of Pediatric Gastroenterology, McMaster University, Hamilton, ON,Canada
| | - Brian W Timmons
- Department of Pediatrics, McMaster University, Hamilton, ON,Canada
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18
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Demers K, Bak MTJ, Bongers BC, de Vries AC, Jonkers DMAE, Pierik MJ, Stassen LPS. Scoping review on health-related physical fitness in patients with inflammatory bowel disease: Assessment, interventions, and future directions. World J Gastroenterol 2023; 29:5406-5427. [PMID: 37900583 PMCID: PMC10600796 DOI: 10.3748/wjg.v29.i38.5406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 09/06/2023] [Accepted: 09/12/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND Reaching the Selecting Therapeutic Targets in Inflammatory Bowel Disease-II (STRIDE-II) therapeutic targets for inflammatory bowel disease (IBD) requires an interdisciplinary approach. Lifestyle interventions focusing on enhancing and preserving health-related physical fitness (HRPF) may aid in improving subjective health, decreasing disability, or even controlling inflammation. However, ambiguity remains about the status and impact of HRPF (i.e. body composition, cardiorespiratory fitness, muscular strength, muscular endurance, and flexibility) in IBD patients, hindering the development of physical activity and physical exercise training guidelines. AIM To review HRPF components in IBD patients and the impact of physical activity and physical exercise training interventions on HRPF. METHODS A systematic search in multiple databases was conducted for original studies that included patients with IBD, assessed one or more HRPF components, and/or evaluated physical activity or physical exercise training interventions. RESULTS Sixty-eight articles were included. No study examined the complete concept of HRPF, and considerable heterogeneity existed in assessment methods, with frequent use of non-validated tests. According to studies that used gold standard tests, cardiorespiratory fitness seemed to be reduced, but findings on muscular strength and endurance were inconsistent. A limited number of studies that evaluated physical activity or physical exercise training interventions reported effects on HRPF, overall showing a positive impact. CONCLUSION We performed a scoping review using a systematic and iterative approach to identify and synthesize an emerging body of literature on health-related physical fitness in patients with IBD, highlighting several research gaps and opportunities for future research. Findings of this review revealed a gap in the literature regarding the accurate assessment of HRPF in patients with IBD and highlighted important methodological limitations of studies that evaluated physical activity or physical exercise training interventions. This scoping review is a step towards performing studies and systematic reviews in the future, which was not possible at present given the heterogeneity in endpoints and designs of the available studies on this topic. Future well-designed studies are required to determine the optimal training paradigm for improving HRPF in patients with IBD before guidelines can be developed and integrated into the therapeutic strategy.
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Affiliation(s)
- Karlijn Demers
- Department of Surgery, Maastricht University Medical Center+, Maastricht 6229 HX, Netherlands
- Department of Internal Medicine, Division of Gastroenterology-Hepatology, Maastricht University Medical Center+, Maastricht 6229 HX, Netherlands
- Department of Internal Medicine, Division of Gastroenterology-Hepatology, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht 6229 ER, Netherlands
- Department of Surgery, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht 6229 ER, Netherlands
| | - Michiel T J Bak
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center Rotterdam, Rotterdam 3015 GD, Netherlands
| | - Bart C Bongers
- Department of Surgery, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht 6229 ER, Netherlands
- Department of Nutrition and Movement Sciences, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht 6229 ER, Netherlands
| | - Annemarie C de Vries
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center Rotterdam, Rotterdam 3015 GD, Netherlands
| | - Daisy M A E Jonkers
- Department of Internal Medicine, Division of Gastroenterology-Hepatology, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht 6229 ER, Netherlands
| | - Marieke J Pierik
- Department of Internal Medicine, Division of Gastroenterology-Hepatology, Maastricht University Medical Center+, Maastricht 6229 HX, Netherlands
- Department of Internal Medicine, Division of Gastroenterology-Hepatology, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht 6229 ER, Netherlands
| | - Laurents P S Stassen
- Department of Surgery, Maastricht University Medical Center+, Maastricht 6229 HX, Netherlands
- Department of Surgery, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht 6229 ER, Netherlands
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19
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Mc Gettigan N, Allen K, Saeidi R, O’ Toole A, Boland K. A systematic review of the effect of structured exercise on inflammation and body composition in inflammatory bowel disease. Int J Colorectal Dis 2023; 38:143. [PMID: 37227593 PMCID: PMC10212817 DOI: 10.1007/s00384-023-04437-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/09/2023] [Indexed: 05/26/2023]
Abstract
PURPOSE Given the substantial risk of treatment failure in inflammatory bowel disease (IBD), adjuvant therapies may play a role in disease management. We aim to carry out a systematic review to examine the effects of structured exercise on the inflammatory response in patients with IBD. Our secondary aim is to examine the effect of structured exercise programmes on body composition given both an increase in visceral obesity and the presence of sarcopenia have deleterious effects on outcomes in IBD. METHODS A systematic review was carried out following the Methodological Expectations of Cochrane Intervention Reviews (MECIR) manual and the Cochrane Handbook for Systematic Reviews of Interventions. Title/Abstract and MeSH Terms were used to search for relevant studies. RESULTS In total, 1516 records were screened for eligibility, and 148 records were reviewed for eligibility, of which 16 were included and a further 7 studies were identified from hand searching references. Four studies included body composition outcomes, and 14 studies reviewed the inflammatory response to exercise. CONCLUSION Further studies of adequate duration are required to include patients with more active disease to demonstrate an inflammatory response to exercise. Body composition measurements including muscle mass and visceral adiposity may play a key role in response to medical therapy in IBD and should be included as exploratory outcomes in future studies. A meta-analysis was not carried out due to the significant heterogeneity amongst studies.
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Affiliation(s)
- Neasa Mc Gettigan
- Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
- Department of Gastroenterology, Beaumont Hospital, Dublin, Ireland
| | - Kathryn Allen
- Department of Gastroenterology, Beaumont Hospital, Dublin, Ireland
| | - Reza Saeidi
- Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
- Department of Gastroenterology, Beaumont Hospital, Dublin, Ireland
| | - Aoibhlinn O’ Toole
- Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
- Department of Gastroenterology, Beaumont Hospital, Dublin, Ireland
| | - Karen Boland
- Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
- Department of Gastroenterology, Beaumont Hospital, Dublin, Ireland
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20
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Gold SL, Raman M, Sands BE, Ungaro R, Sabino J. Review article: Putting some muscle into sarcopenia-the pathogenesis, assessment and clinical impact of muscle loss in patients with inflammatory bowel disease. Aliment Pharmacol Ther 2023; 57:1216-1230. [PMID: 37051722 DOI: 10.1111/apt.17498] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 03/20/2023] [Accepted: 03/21/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND Sarcopenia, a loss of skeletal muscle mass or function, affects up to 50% of patients with inflammatory bowel disease (IBD) and is associated with poor clinical outcomes including increased hospitalizations, need for surgery and post-operative complications. Despite the high prevalence and clinical significance of sarcopenia in patients with IBD, few patients undergo routine muscle evaluation. AIM The goal of this study was to review the mechanisms of sarcopenia in patients with IBD and understand novel modalities to assess and treat impaired muscle mass or function. METHODS Pubmed and Cochrane databases were searched including articles published up to February 2023 utilizing the following keywords: "inflammatory bowel disease", "IBD", "Crohn's disease", "ulcerative colitis", "sarcopenia", "myosteatosis", "muscle health", and "frailty". RESULTS The pathogenesis of sarcopenia in IBD is not well defined, however, there is evidence supporting the role of malabsorption, reduced protein intake, chronic inflammation, dysbiosis, decreased physical activity, medication effects and hormone signaling from visceral adiposity. Traditional sarcopenia assessment techniques include direct measurements on cross sectional imaging. However, given the time, cost and radiation exposure associated with cross sectional imaging, new bedside tools are now available to estimate muscle mass, including assessment of grip strength, mid upper arm circumference and body composition utilizing bioelectrical impedance analysis. In addition, novel biomarkers for assessing muscle mass and techniques utilizing point of care ultrasound have been proposed to make sarcopenia evaluation more streamlined in the IBD clinic. CONCLUSION Sarcopenia is associated with poor clinical outcomes independent of IBD activity and therefore muscle health should be assessed in all IBD patients at routine intervals. Future studies to better our understanding of the pathophysiology as well as most effective management of sarcopenia in IBD will help guide clinical care and reduce disease related complications.
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Affiliation(s)
- Stephanie L Gold
- The Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Maitreyi Raman
- Department of Medicine, University of Calgary, Calgary, Canada
| | - Bruce E Sands
- The Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ryan Ungaro
- The Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - João Sabino
- Department of Gastroenterology and Hepatology, University Hospital Leuven, Leuven, Belgium
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21
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Boytar AN, Skinner TL, Wallen RE, Jenkins DG, Dekker Nitert M. The Effect of Exercise Prescription on the Human Gut Microbiota and Comparison between Clinical and Apparently Healthy Populations: A Systematic Review. Nutrients 2023; 15:nu15061534. [PMID: 36986264 PMCID: PMC10054511 DOI: 10.3390/nu15061534] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 03/16/2023] [Accepted: 03/17/2023] [Indexed: 03/30/2023] Open
Abstract
This study systematically reviewed all human longitudinal exercise interventions that reported changes in the gut microbiota; frequency, intensity, duration and type of exercise were assessed to determine the influence of these variables on changes to the gut microbiota in both healthy individuals and clinical populations (PROPERO registration: CRD42022309854). Using PRISMA guidelines, trials analysing gut microbiota change with exercise interventions were included independent of trial randomisation, population, trial duration or analysis technique. Studies were excluded when microbiota abundance was not reported or when exercise was combined with other interventions. Twenty-eight trials were included, of which twelve involved healthy populations only and sixteen involved mixed or clinical-only populations. The findings show that participation in exercise of moderate to high-intensity for 30-90 min ≥3 times per week (or between 150-270 min per week) for ≥8 weeks is likely to produce changes in the gut microbiota. Exercise appears to be effective in modifying the gut microbiota in both clinical and healthy populations. A more robust methodology is needed in future studies to improve the certainty of the evidence.
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Affiliation(s)
- Alexander N Boytar
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Tina L Skinner
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Ruby E Wallen
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD 4072, Australia
| | - David G Jenkins
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD 4072, Australia
- School of Health, University of the Sunshine Coast, Maroochydore, QLD 4558, Australia
- Applied Sports Science Technology and Medicine Research Centre, Swansea University, Wales SA1 8EN, UK
| | - Marloes Dekker Nitert
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, QLD 4072, Australia
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22
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Sebastian S, Segal JP, Hedin C, Pellino G, Kotze PG, Adamina M, Campmans-Kuijpers M, Davies J, de Vries AC, Casbas AG, El-Hussuna A, Juillerat P, Meade S, Millán M, Spinelli A. ECCO Topical Review: Roadmap to Optimal Peri-Operative Care in IBD. J Crohns Colitis 2023; 17:153-169. [PMID: 36055337 DOI: 10.1093/ecco-jcc/jjac129] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Despite the advances in medical therapies, a significant proportion of patients with inflammatory bowel diseases [IBD] require surgical intervention. This Topical Review aims to offer expert consensus practice recommendations for peri-operative care to optimize outcomes of IBD patients who undergo surgery. METHODS A multidisciplinary panel of IBD healthcare providers systematically reviewed aspects relevant to peri-operative care in IBD. Consensus statements were developed using Delphi methodology. RESULTS A total of 20 current practice positions were developed following systematic review of the current literature covering use of medication in the peri-operative period, nutritional assessment and intervention, physical and psychological rehabilitation and prehabilitation, and immediate postoperative care. CONCLUSION Peri-operative planning and optimization of the patient are imperative to ensure favourable outcomes and reduced morbidity. This Topical Review provides practice recommendations applicable in the peri-operative period in IBD patients undergoing surgery.
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Affiliation(s)
- Shaji Sebastian
- IBD Unit, Hull University Teaching Hospitals, Hull, UK
- Hull York Medical School, University of Hull, Hull, UK
| | - Jonathan P Segal
- Northern Hospital Epping, Melbourne, Australia
- University of Melbourne, Parkville, Melbourne, Australia
| | - Charlotte Hedin
- Department of Medicine, Karolinska Institutet, Solna, Stockholm, Sweden
- Gastroenterology Unit, Department of Gastroenterology, Dermatovenereology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - Gianluca Pellino
- Department of Advanced Medical and Surgical Sciences, Universitá degli Studi della Campania 'Luigi Vanvitelli', Naples, Italy
| | - Paulo Gustavo Kotze
- Colorectal Surgery Unit, Pontificia Universidade Católica do Paraná [PUCPR], Curitiba, Brazil
| | - Michel Adamina
- Department of Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Marjo Campmans-Kuijpers
- Department of Gastroenterology and Hepatology, University Medical Centre Groningen, Groningen, the Netherlands
| | - Justin Davies
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Annemarie C de Vries
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Ana Gutiérrez Casbas
- Gastroenterology Department, Hospital General Universitario de Alicante, ISABIAL and CIBERehd, Alicante, Spain
| | - Alaa El-Hussuna
- OpenSourceResearch organisation (osrc.network), Aalborg, Denmark
| | - Pascal Juillerat
- Clinic for Visceral Surgery and Medicine, Inselspital, University Hospital of Bern, Bern, Switzerland
| | - Susanna Meade
- Department of Gastroenterology, Guy's and Saint Thomas' Hospitals NHS Trust, London, UK
| | - Monica Millán
- General Surgery, Colorectal Unit, Hospital Universitari i Politecnic La Fe, Valencia, Spain
| | - Antonino Spinelli
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS Humanitas Research Hospital, Milan, Italy
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23
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Wei H, Yuan Z, Ren K, Jin Y, Ren L, Cao B, Zhou Y, Chen L. Body Composition in Inflammatory Bowel Disease. ARCHIVES OF IRANIAN MEDICINE 2023; 26:172-175. [PMID: 37543940 PMCID: PMC10685726 DOI: 10.34172/aim.2023.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 02/25/2023] [Indexed: 08/08/2023]
Abstract
Inflammatory bowel disease (IBD) is associated with body composition changes, which are associated with clinical prognosis, response to therapy, and quality of life in IBD patients. Therefore, it is critical to review the body composition distribution in IBD, summarize the potential factors affecting body composition distribution, and take steps to improve the body composition distribution of IBD patients as early as possible. In the current review, we searched PubMed via keywords 'inflammatory bowel disease', or 'IBD', or 'Crohn's disease', or 'CD', or 'ulcerative colitis', or 'UC', and 'body composition'. Malnutrition and sarcopenia are common in IBD patients and are associated with the clinical course, prognosis, and need for surgery. Disease activity, reduced nutrition intake, vitamin D deficiency, and intestinal dysbiosis are factors contributing to changed body composition. Early use of biological agents to induce remission is critical to improving body composition distribution in IBD patients, supplementation of vitamin D is also important, and moderate physical activity is recommended in IBD patients with clinical remission.
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Affiliation(s)
- Hongyun Wei
- Department of Gastroenterology, Affiliated Hospital of Qingdao University, Qingdao, Shandong 266000, P.R. China
| | - Ziying Yuan
- Department of Gastroenterology, Affiliated Hospital of Qingdao University, Qingdao, Shandong 266000, P.R. China
| | - Keyu Ren
- Department of Gastroenterology, Affiliated Hospital of Qingdao University, Qingdao, Shandong 266000, P.R. China
| | - Yanchun Jin
- Department of Gastroenterology, Affiliated Hospital of Qingdao University, Qingdao, Shandong 266000, P.R. China
| | - Linlin Ren
- Department of Gastroenterology, Affiliated Hospital of Qingdao University, Qingdao, Shandong 266000, P.R. China
| | - Bin Cao
- Department of Gastroenterology, Affiliated Hospital of Qingdao University, Qingdao, Shandong 266000, P.R. China
| | - Yuanyuan Zhou
- The Fourth Department of the Digestive Disease Center, Suining Central Hospital, Suining, Sichuan 629000, P.R. China
| | - Linlin Chen
- The Fourth Department of the Digestive Disease Center, Suining Central Hospital, Suining, Sichuan 629000, P.R. China
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24
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Ordille AJ, Phadtare S. Intensity-specific considerations for exercise for patients with inflammatory bowel disease. Gastroenterol Rep (Oxf) 2023; 11:goad004. [PMID: 36814502 PMCID: PMC9940700 DOI: 10.1093/gastro/goad004] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 11/02/2022] [Accepted: 12/22/2022] [Indexed: 02/22/2023] Open
Abstract
The rising prevalence of inflammatory bowel disease (IBD) necessitates that patients be given increased access to cost-effective interventions to manage the disease. Exercise is a non-pharmacologic intervention that advantageously affects clinical aspects of IBD, including disease activity, immune competency, inflammation, quality of life, fatigue, and psychological factors. It is well established that exercise performed at low-to-moderate intensity across different modalities manifests many of these diseased-related benefits while also ensuring patient safety. Much less is known about higher-intensity exercise. The aim of this review is to summarize findings on the relationship between strenuous exercise and IBD-related outcomes. In healthy adults, prolonged strenuous exercise may unfavorably alter a variety of gastrointestinal (GI) parameters including permeability, blood flow, motility, and neuro-endocrine changes. These intensity- and gut-specific changes are hypothesized to worsen IBD-related clinical presentations such as diarrhea, GI bleeding, and colonic inflammation. Despite this, there also exists the evidence that higher-intensity exercise may positively influence microbiome as well as alter the inflammatory and immunomodulatory changes seen with IBD. Our findings recognize that safety for IBD patients doing prolonged strenuous exercise is no more compromised than those doing lower-intensity work. Safety with prolonged, strenuous exercise may be achieved with adjustments including adequate hydration, nutrition, drug avoidance, and careful attention to patient history and symptomatology. Future work is needed to better understand this intensity-dependent relationship so that guidelines can be created for IBD patients wishing to participate in high-intensity exercise or sport.
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Affiliation(s)
- Andrew J Ordille
- Department of Biomedical Sciences, Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Sangita Phadtare
- Department of Biomedical Sciences, Cooper Medical School of Rowan University, Camden, NJ, USA
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25
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An Irish Multi-Centre Study of Behaviours, Attitudes and Barriers to Exercise in Inflammatory Bowel Disease, a Survey from the Patient’s Perspective. GASTROINTESTINAL DISORDERS 2022. [DOI: 10.3390/gidisord4040029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background: Physical activity (PA) in inflammatory bowel disease (IBD) has many potential favourable outcomes including anti-inflammatory effects, improvement in quality of life and improvements in patient body composition. It is recognised that patients with IBD have a significantly decreased exercise tolerance. Aim: 1. To assess physical activity levels, behaviours and barriers to PA in IBD. 2. To assess the likelihood of patients with IBD to engage in a community-based exercise programme. 3. To examine the presence of body image concerns in IBD. Method: Patient surveys were distributed in Beaumont and Connolly Hospitals between October and December 2021. Descriptive statistics, Chi-squared testing and Pearson’s correlations were completed using Minitab. p < 0.05 denoted statistical significance. Results: Data were recorded for a total of 203 patients. Out of all patients, 62% (n = 126) had Crohn’s disease (CD). Over half of the cohort were male (n = 115). Mean weight among females was 75 kg and 83 kg among males. Exercise behaviours: Out of all patients, 71% exercise regularly, on average for 59 min, 3.2 days/week. Walking was the most common form of PA (74%). A post-diagnosis change in exercise behaviour was found in 66% with three-quarters exercising less. The primary barrier to exercise was fatigue (54%). Female gender (p = 0.007) and age < 45 years (p = 0.02) were associated with body image dissatisfaction reported in 62% of patients. Conclusion: These data demonstrate the patient-reported impact of IBD on patient participation in PA. Concerns regarding body image were common and associated with gender and age. A feasibility study of a physician-derived exercise programme in patients with active IBD is underway in Beaumont Hospital to determine the effect on patient response to therapy, inflammation and body composition outcomes (NCT05174754).
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26
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Jones K, Kimble R, Baker K, Tew GA. Effects of structured exercise programmes on physiological and psychological outcomes in adults with inflammatory bowel disease (IBD): A systematic review and meta-analysis. PLoS One 2022; 17:e0278480. [PMID: 36454911 PMCID: PMC9714897 DOI: 10.1371/journal.pone.0278480] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 11/17/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Exercise has been suggested to counteract specific complications of inflammatory bowel disease (IBD). However, its role as a therapeutic option remains poorly understood. Therefore, we conducted a systematic review and meta-analysis on the effects of exercise in IBD. METHODS Five databases (MEDLINE, Embase, CINAHL, CENTRAL and SPORTDiscus) and three registers (Clinicaltrials.gov, WHO ICTRP and ISRCTN) were searched from inception to September 2022, for studies assessing the effects of structured exercise of at least 4 weeks duration on physiological and/or psychological outcomes in adults with IBD. Two independent reviewers screened records, assessed risk of bias using the Cochrane Risk of Bias (RoB 2.0) and ROBINS-I tools, and evaluated the certainty of evidence using the GRADE method. Data were meta-analysed using a random-effects model. RESULTS From 4,123 citations, 15 studies (9 RCTs) were included, comprising of 637 participants (36% male). Pooled evidence from six RCTs indicated that exercise improved disease activity (SMD = -0.44; 95% CI [-0.82 to -0.07]; p = 0.02), but not disease-specific quality of life (QOL) (IBDQ total score; MD = 3.52; -2.00 to 9.04; p = 0.21) when compared to controls. Although meta-analysis could not be performed for other outcomes, benefits were identified in fatigue, muscular function, body composition, cardiorespiratory fitness, bone mineral density and psychological well-being. Fourteen exercise-related non-serious adverse events occurred. The overall certainty of evidence was low for disease activity and very low for HRQOL as a result of downgrading for risk of bias and imprecision. CONCLUSIONS Structured exercise programmes improve disease activity, but not disease-specific QOL. Defining an optimal exercise prescription and synthesis of evidence in other outcomes, was limited by insufficient well-designed studies to ascertain the true effect of exercise training. This warrants further large-scale randomised trials employing standard exercise prescription to verify this effect to enable the implementation into clinical practice. REGISTRATION This systematic review was prospectively registered in an international database of systematic reviews in health-related research (CRD42017077992; https://www.crd.york.ac.uk/prospero/).
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Affiliation(s)
- Katherine Jones
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom
- Department of Sport, Exercise and Rehabilitation, University of Northumbria at Newcastle, Newcastle Upon Tyne, United Kingdom
| | - Rachel Kimble
- Division of Sport and Exercise Science, School of Health and Life Sciences, University of the West of Scotland, Blantyre, United Kingdom
| | - Katherine Baker
- Department of Sport, Exercise and Rehabilitation, University of Northumbria at Newcastle, Newcastle Upon Tyne, United Kingdom
| | - Garry A. Tew
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom
- York St John University, Lord Mayor’s Walk, York, United Kingdom
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27
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Impact of an exercise program in children with inflammatory bowel disease in remission. Pediatr Res 2022:10.1038/s41390-022-02362-8. [PMID: 36319697 PMCID: PMC9628325 DOI: 10.1038/s41390-022-02362-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 09/20/2022] [Accepted: 10/17/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND The aim of our study was to investigate the impact of a structured exercise program on bone mineral density (BMD) and body composition parameters in children and adolescents with IBD in remission. METHODS Patients were recruited to participate in a 6-month exercise program. Total body less head (TLBH) dual energy X-ray absorptiometry (DXA) was used to measure BMD. The same method was used to assess fat mass (FM) and lean body mass (LBM) at baseline and at the completion of the program. RESULTS Based on the baseline and endpoint TBLH DXA measurements, a total of 42 study participants (25 boys; aged 15.3 ± 2.08 years) experienced an increase in BMD (from 0.959 ± 0.023 g/cm2 to 0.988 ± 0.025 g/cm2, p < 0.001) and LBM (from 37.12 ± 1.43 kg to 38.75 ± 1.61 kg, p = 0.012). Age- and sex-based BMD Z-score increased significantly (from -0.35 ± 0.15 to -0.28 ± 0.17, p = 0.020), whilst LBM Z-score did not significantly change (from -1.78 ± 0.23 to -1.71 ± 1.49, p = 0.908). CONCLUSIONS There was a significant improvement in BMD, age- and sex-based BMD Z-score, and LBM amongst study participants. Subgroup analysis showed that patients with CD and male study participants experienced significant improvement in all parameters, whilst patients with UC and IBD-U and female patients experienced improvement solely in BMD. IMPACT STATEMENT Children and adolescents with IBD, regardless of disease activity, are under increased risk of secondary osteoporosis and lean body mass deficits. A 6-month home-based structured exercise program leads to a significant improvement in bone mineral density and lean body mass. Exercise therapy should be explored as a potentially adjacent to standard treatment modalities.
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28
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Zhong F, Xu Y, Lai HY, Yang M, Cheng L, Liu X, Sun X, Yang Y, Wang J, Lv W, Huang C. Effects of combined aerobic and resistance training on gut microbiota and cardiovascular risk factors in physically active elderly women: A randomized controlled trial. Front Physiol 2022; 13:1004863. [PMID: 36338472 PMCID: PMC9631483 DOI: 10.3389/fphys.2022.1004863] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 09/28/2022] [Indexed: 12/03/2022] Open
Abstract
Background: Exercise can modulate gut microbiota and lower the risk of cardiovascular disease (CVD). However, the association between exercise-induced changes in gut microbiota and CVD risk have not been investigated. Objective: This study determined the effects of exercise training on CVD risk and gut microbiota in physically active elderly women and whether exercise-induced gut microbiota changes were associated with CVD risk. Methods: An 8-week randomized controlled trial was conducted with 14 elderly women assigned to exercise group (n = 8) or control group (n = 6). Physical function, sarcopenic obesity, and metabolic syndrome were evaluated as components of CVD risk. Gut microbiota composition was determined using 16S rRNA gene sequencing. Repeated-measures analysis of variance was used to examine intra-group and inter-group differences. Results: A significant group × time interaction was observed for chair sit-and-reach (F = 8.262, p = 0.014), single-leg standing with eyes closed (F = 7.340, p = 0.019), waist circumference (F = 6.254, p = 0.028), and body fat mass (F = 12.263, p = 0.004), for which the exercise group showed improved trends. The exercise group exhibited significant improvements in skeletal muscle mass (p = 0.041) and fasting blood glucose (p = 0.017). Regarding gut microbiota, a significant interaction was observed for the class Betaproteobacteria (F = 6.822, p = 0.023) and genus Holdemania (F = 4.852, p = 0.048). Conclusion: The 8-week exercise training improved physical function, lowered CVD risk, and modulated relative abundance of gut microbiota associated with CVD in physically active elderly women.
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Affiliation(s)
- Fei Zhong
- Department of Sports and Exercise Science, Zhejiang University, Hangzhou, China
| | - Yongjin Xu
- Department of Sports and Exercise Science, Zhejiang University, Hangzhou, China
| | - Hsin-Yi Lai
- Department of Neurology and Research Center of Neurology in Second Affiliated Hospital, Key Laboratory of Medical Neurobiology of Zhejiang Province, and Interdisciplinary Institute of Neuroscience and Technology, Zhejiang University School of Medicine, Hangzhou, China
- Key Laboratory for Biomedical Engineering of Ministry of Education, College of Biomedical Engineering and Instrument Science, Zhejiang University School of Medicine, Hangzhou, China
- Department of Neurology of Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Min Yang
- School of Public Health, Zhejiang University, Hangzhou, China
| | - Lei Cheng
- MOE Key Laboratory of Biosystems Homeostasis and Protection, College of Life Sciences, Zhejiang University, Hangzhou, China
| | - Xinger Liu
- Kunshan Old Companion Home Care Service Agency, Kunshan, China
| | - Xiaomin Sun
- Department of Nutrition and Food Safety, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
- Global Health Institute, Xi’an Jiaotong University Health Science Center, Xi’an, China
- Faculty of Sport Sciences, Waseda University, Saitama, Japan
| | - Yi Yang
- Department of Sports and Exercise Science, Zhejiang University, Hangzhou, China
| | - Jian Wang
- Department of Sports and Exercise Science, Zhejiang University, Hangzhou, China
- Center for Psychological Sciences, Zhejiang University, Hangzhou, China
| | - Wen Lv
- Department of Neurology of Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Cong Huang
- Department of Sports and Exercise Science, Zhejiang University, Hangzhou, China
- Department of Medicine and Science in Sports and Exercise, Tohoku University Graduate School of Medicine, Sendai, Japan
- *Correspondence: Cong Huang,
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29
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Mc Gettigan N, Hanley M, Skelly F, Dowling J, Dunne R, Morrin MM, McCaffrey N, O'Toole A, Boland K. Impact of a physician-led exercise programme on quality of life, muscle mass and clinical response in inflammatory bowel disease patients during induction with disease-modifying therapy: a study protocol. BMJ Open Gastroenterol 2022. [DOI: 10.1136/bmjgast-2022-000959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
IntroductionBiologic and small-molecule therapies have revolutionised the treatment of moderate-to-severe inflammatory bowel disease (IBD). A significant proportion of patients experience early or delayed treatment failure. Patients with IBD with greater visceral obesity are less likely to respond to biologics. Sarcopenia has been identified as a predictor of disease severity and need for rescue therapy in acute severe ulcerative colitis. The aim of this study is to assess the feasibility of a physician-derived exercise programme in patients with IBD commencing biologic or small-molecule therapy in addition to the effect on physical fitness, body composition and objective measures of quality of life, fatigue scores and disease activity.Methods and analysisThis is a randomised controlled feasibility study comparing the effects of a physician-derived exercise programme and standard medical care (biologic/small-molecule therapy) with standard care alone in patients with moderate to severe IBD. Patients with IBD in the intervention group will undergo a structured exercise programme for 20 weeks. Both IBD groups will carry out body composition, disease activity and quality-of-life assessments at baseline, week 12 and week 26. The primary objective is to assess the feasibility of the physician-derived exercise programme in patients with IBD commencing disease-modifying therapies. Secondary endpoints include a change in cardiorespiratory fitness, disease activity/inflammation, fatigue, health-related quality of life outcomes and body composition between the two IBD groups. Exploratory endpoints include validation of anterior thigh ultrasound for sarcopenia screening, assessment of proinflammatory cytokines and markers of immunometabolism.Ethics and disseminationThis study has received ethical approval from the Beaumont Hospital Ethics committee on 22 October 2021 (reference number 21/21). Data generated or analysed during this study will be published as an article and supplementary appendix in relevant medical journals. The data will also be presented at national and international conferences.Trial registration numberNCT05174754.
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Mareschal J, Douissard J, Genton L. Physical activity in inflammatory bowel disease: benefits, challenges and perspectives. Curr Opin Clin Nutr Metab Care 2022; 25:159-166. [PMID: 35238803 DOI: 10.1097/mco.0000000000000829] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF THE REVIEW Physical activity is gaining significative interest in the field of inflammatory bowel disease (IBD). In the light of the most recent publications, the present review aims to describe the level of physical activity in adult patients with IBD; describe the current body of evidence on the benefits of physical activity and discuss the challenges and perspectives related to physical activity in this population. RECENT FINDINGS Recent studies showed that IBD patients tend to be less active than healthy people. There is growing evidence of a positive impact of physical activity on mortality, quality of life, fatigue, body composition, strength and physical performance. The direct benefits of physical activity on clinical remission and disease activity have recently been observed only in Crohn's disease. Limitations to physical activity related to the disease, such as gastrointestinal and psychological symptoms, need to be considered in this population. Finally, no guidelines are available and there is no evidence regarding the effects of combined physical activity and nutritional support. SUMMARY Although physical activity seems beneficial and safe for IBD patients, future studies are needed to clearly define recommendations in this population.
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Affiliation(s)
- Julie Mareschal
- Lennard-Jones Intestinal Rehabilitation Unit, Department of Nutrition and Dietetics, St Mark's Hospital, London, UK
- Clinical Nutrition Unit
- Abdominal Surgery Division, Geneva University Hospitals, Geneva, Switzerland
| | - Jonathan Douissard
- Abdominal Surgery Division, Geneva University Hospitals, Geneva, Switzerland
- Lennard-Jones Intestinal Rehabilitation Unit, Department of Colorectal Surgery, St Mark's Hospital, London, UK
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Nishida Y, Hosomi S, Fujimoto K, Nakata R, Itani S, Ohminami M, Nadatani Y, Fukunaga S, Otani K, Tanaka F, Nagami Y, Taira K, Kamata N, Ohfuji S, Fujiwara Y. Effect of the Coronavirus Disease 2019 Lockdown on Lifestyle Factors in Japanese Patients with Inflammatory Bowel Disease. Intern Med 2022; 61:1329-1336. [PMID: 35228418 PMCID: PMC9152850 DOI: 10.2169/internalmedicine.8825-21] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective To examine the effect of the coronavirus disease 2019 (COVID-19) lockdown on lifestyle factors and psychological stress in patients with inflammatory bowel disease (IBD). Methods A retrospective study was conducted on patients with IBD in Japan 2 months after the initiation of the first state of emergency (June 16 to August 21, 2020). A self-reported questionnaire was used to collect data, and lifestyle factors and psychological stress levels before and after the state of emergency were compared. Patients Patients with IBD who were followed up regularly at Osaka City University Hospital from June 16 to August 21, 2020, were included and were classified into elderly (≥65 years old) and non-elderly groups (<65 years old). Results The study sample comprised 451 responders (241, ulcerative colitis; 210, Crohn's disease; 0, COVID-19). The sleep duration increased, whereas the exercise, working, and walking durations decreased during the COVID-19 lockdown. The proportion of patients with psychological stress due to COVID-19, those with an inability to exercise, and those staying indoors increased significantly during COVID-19 lockdown. Lifestyle factors changed more markedly in non-elderly patients, those who were more stressed due to COVID-19, those with the inability to exercise, and those staying indoors during COVID-19 lockdown. Among elderly patients, no significant changes were identified in stress-causing factors. Conclusion The COVID-19 lockdown affected lifestyle factors and psychological stress in patients with IBD, particularly non-elderly patients. These findings may be helpful in suggesting favorable lifestyle changes for patients with IBD.
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Affiliation(s)
- Yu Nishida
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Japan
| | - Shuhei Hosomi
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Japan
| | - Koji Fujimoto
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Japan
| | - Rieko Nakata
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Japan
| | - Shigehiro Itani
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Japan
| | - Masaki Ohminami
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Japan
| | - Yuji Nadatani
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Japan
| | - Shusei Fukunaga
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Japan
| | - Koji Otani
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Japan
| | - Fumio Tanaka
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Japan
| | - Yasuaki Nagami
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Japan
| | - Koichi Taira
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Japan
| | - Noriko Kamata
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Japan
| | - Satoko Ohfuji
- Department of Public Health, Osaka City University Graduate School of Medicine, Japan
| | - Yasuhiro Fujiwara
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Japan
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The Influence of Aerobic Type Exercise on Active Crohn’s Disease Patients: The Incidence of an Elite Athlete. Healthcare (Basel) 2022; 10:healthcare10040713. [PMID: 35455890 PMCID: PMC9027520 DOI: 10.3390/healthcare10040713] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/07/2022] [Accepted: 04/10/2022] [Indexed: 02/04/2023] Open
Abstract
A lifestyle factor which contributes to the remission of Crohn’s disease (CD) is physical activity. The effect seems to positively impact the disease’s symptoms, improving the quality of life, especially on patients in remission. Due to the lack of clinical studies about the effects of physical activity on active CD patients, the purpose of the present case study was to record the influence of swimming training (aerobic type of exercise) on an athlete with active CD. In this study participated a 22-year-old male, who is an elite swimmer and who was diagnosed in 2019 with CD. The research was conducted over the last three years (2019–2022). Both the athlete and doctor consented to the clinical examinations by the author. According to the present study, immediate medical examination and the prescription of anti-TNF-α therapy is probably the most appropriate solution for someone who is diagnosed with CD symptoms. Moreover, patient participation in any sport activity is discouraged because of the potential danger of exacerbation of the symptoms. Therefore, for the sake of patient safety, physical activity should only be encouraged when the disease is in remission.
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The Combination of Intestinal Alkaline Phosphatase Treatment with Moderate Physical Activity Alleviates the Severity of Experimental Colitis in Obese Mice via Modulation of Gut Microbiota, Attenuation of Proinflammatory Cytokines, Oxidative Stress Biomarkers and DNA Oxidative Damage in Colonic Mucosa. Int J Mol Sci 2022; 23:ijms23062964. [PMID: 35328382 PMCID: PMC8955215 DOI: 10.3390/ijms23062964] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/03/2022] [Accepted: 03/04/2022] [Indexed: 12/16/2022] Open
Abstract
Inflammatory bowel diseases (IBD) are commonly considered as Crohn's disease and ulcerative colitis, but the possibility that the alterations in gut microbiota and oxidative stress may affect the course of experimental colitis in obese physically exercising mice treated with the intestinal alkaline phosphatase (IAP) has been little elucidated. Mice fed a high-fat-diet (HFD) or normal diet (ND) for 14 weeks were randomly assigned to exercise on spinning wheels (SW) for 7 weeks and treated with IAP followed by intrarectal administration of TNBS. The disease activity index (DAI), grip muscle strength test, oxidative stress biomarkers (MDA, SOD, GSH), DNA damage (8-OHdG), the plasma levels of cytokines IL-2, IL-6, IL-10, IL-12p70, IL-17a, TNF-α, MCP-1 and leptin were assessed, and the stool composition of the intestinal microbiota was determined by next generation sequencing (NGS). The TNBS-induced colitis was worsened in obese sedentary mice as manifested by severe colonic damage, an increase in DAI, oxidative stress biomarkers, DNA damage and decreased muscle strength. The longer running distance and weight loss was observed in mice given IAP or subjected to IAP + SW compared to sedentary ones. Less heterogeneous microbial composition was noticed in sedentary obese colitis mice and this effect disappeared in IAP + SW mice. Absence of Alistipes, lower proportion of Turicibacter, Proteobacteria and Faecalibacterium, an increase in Firmicutes and Clostridium, a decrease in oxidative stress biomarkers, 8-OHdG content and proinflammatory cytokines were observed in IAP + SW mice. IAP supplementation in combination with moderate physical activity attenuates the severity of murine colitis complicated by obesity through a mechanism involving the downregulation of the intestinal cytokine/chemokine network and oxidative stress, the modulation of the gut microbiota and an improvement of muscle strength.
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Mc Gettigan N, O'Toole A, Boland K. “Role of exercise in preventing and restoring gut dysbiosis in patients with inflammatory bowel disease”: A letter to the editor. World J Gastroenterol 2022; 28:878-880. [PMID: 35317102 PMCID: PMC8900572 DOI: 10.3748/wjg.v28.i8.878] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 11/10/2021] [Accepted: 01/20/2022] [Indexed: 02/06/2023] Open
Abstract
Exercise-induced changes of the microbiome in inflammatory bowel diseases (IBD) is a promising field of research with the potential for personalized exercise regimes as a promising therapeutic adjunct for restoring gut dysbiosis and additionally for regulating immunometabolic pathways in the management of IBD patients. Structured exercise programmes in IBD patients of at least of 12 wk duration are more likely to result in disease-altering changes in the gut microbiome and to harness potential anti-inflammatory effects through these changes along with immunometabolic pathways.
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Affiliation(s)
- Neasa Mc Gettigan
- Department of Gastroenterology, Beaumont Hospital, Dublin D09V2N0, Leinster, Ireland
- School of Medicine, Royal College of Surgeons, Dublin D02YN77, Ireland
| | - Aoibhlinn O'Toole
- Department of Gastroenterology, Beaumont Hospital, Dublin D09V2N0, Leinster, Ireland
- School of Medicine, Royal College of Surgeons, Dublin D02YN77, Ireland
| | - Karen Boland
- Department of Gastroenterology, Beaumont Hospital, Dublin D09V2N0, Leinster, Ireland
- School of Medicine, Royal College of Surgeons, Dublin D02YN77, Ireland
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Baker KA, Miller TD, Marino FE, Hartmann TE. The exercise-induced inflammatory response in inflammatory bowel disease: A systematic review and meta-analysis. PLoS One 2022; 17:e0262534. [PMID: 35120159 PMCID: PMC8815877 DOI: 10.1371/journal.pone.0262534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 12/28/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND This study investigated selected inflammatory responses to acute and chronic exercise in individuals with inflammatory bowel disease (IBD). METHODS A systematic review and meta-analysis was conducted on all relevant exercise-based intervention publications with IBD participants. The study included articles that utilised a broad range of acute and chronic exercise interventions, with inflammatory biomarkers measured and symptoms documented, both pre- and post-exercise for those with IBD. The search was limited to studies published in English, the use of human participants, and primary studies, with no restrictions on date of publication or participant's age. Articles were retrieved through the electronic databases: PubMed, SPORTDiscus, and Scopus. This study adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. RESULTS Six inflammatory markers were included in the meta-analysis which consisted of five studies. Exercise interventions resulted in no significant difference in IL-6 (SMD = -0.09; 95% CI = -0.49, 0.30; P = 0.64), TNF-α (SMD = 0.08; 95% CI = -0.31, 0.48; P = 0.68), CRP (SMD = -0.04; 95% CI = -0.58, 0.50; P = 0.89), IL-17 (SMD = 0.15; 95% CI = -0.45, 0.76; P = 0.62), leukocytes (SMD = 0.40; 95% CI = -0.53, 1.33; P = 0.40) or lymphocytes (SMD = 0.32; 95% CI = -0.33, 0.97; P = 0.33), thus, indicating exercise may have no effect on inflammatory markers in IBD. Bowel symptoms improved following regular moderate exercise that incorporated stress management. CONCLUSION Heterogeneity among the identified literature may have led to exercise interventions being ineffective in reducing inflammation. Although the limited number of eligible studies may reduce the reliability of results, it emphasises the need for additional research in this domain. Importantly, no adverse symptomatic responses to exercise indicate that exercise is safe for IBD patients.
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Affiliation(s)
- Kelly A. Baker
- School of Allied Health, Exercise and Sport Sciences, Charles Sturt University, Bathurst, New South Wales, Australia
| | - Timothy D. Miller
- School of Allied Health, Exercise and Sport Sciences, Charles Sturt University, Bathurst, New South Wales, Australia
| | - Frank E. Marino
- School of Allied Health, Exercise and Sport Sciences, Charles Sturt University, Bathurst, New South Wales, Australia
| | - Tegan E. Hartmann
- School of Allied Health, Exercise and Sport Sciences, Charles Sturt University, Bathurst, New South Wales, Australia
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Abedpoor N, Taghian F, Hajibabaie F. Physical activity ameliorates the function of organs via adipose tissue in metabolic diseases. Acta Histochem 2022; 124:151844. [PMID: 35045377 DOI: 10.1016/j.acthis.2022.151844] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 01/04/2022] [Accepted: 01/04/2022] [Indexed: 12/15/2022]
Abstract
Adipose tissue is a dynamic organ in the endocrine system that can connect organs by secreting molecules and bioactive. Hence, adipose tissue really plays a pivotal role in regulating metabolism, inflammation, energy homeostasis, and thermogenesis. Disruption of hub bioactive molecules secretion such as adipokines leads to dysregulate metabolic communication between adipose tissue and other organs in non-communicable disorders. Moreover, a sedentary lifestyle may be a risk factor for adipose tissue function. Physical inactivity leads to fat tissue accumulation and promotes obesity, Type 2 diabetes, cardiovascular disease, neurodegenerative disease, fatty liver, osteoporosis, and inflammatory bowel disease. On the other hand, physical activity may ameliorate and protect the body against metabolic disorders, triggering thermogenesis, metabolism, mitochondrial biogenesis, β-oxidation, and glucose uptake. Furthermore, physical activity provides an inter-organ association and cross-talk between different tissues by improving adipose tissue function, reprogramming gene expression, modulating molecules and bioactive factors. Also, physical activity decreases chronic inflammation, oxidative stress and improves metabolic features in adipose tissue. The current review focuses on the beneficial effect of physical activity on the cardiovascular, locomotor, digestive, and nervous systems. In addition, we visualize protein-protein interactions networks between hub proteins involved in dysregulating metabolic induced by adipose tissue.
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Affiliation(s)
- Navid Abedpoor
- Department of Sports Physiology, Faculty of Sports Sciences, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran.
| | - Farzaneh Taghian
- Department of Sports Physiology, Faculty of Sports Sciences, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran.
| | - Fatemeh Hajibabaie
- Department of Physiology, Medicinal Plants Research Center, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran.
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37
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Gut Microbiota, Microbial Metabolites and Human Physical Performance. Metabolites 2021; 11:metabo11110716. [PMID: 34822374 PMCID: PMC8619554 DOI: 10.3390/metabo11110716] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/12/2021] [Accepted: 10/16/2021] [Indexed: 01/02/2023] Open
Abstract
Trillions of microbes inhabiting the gut modulate the metabolism of the host. Cross-sectional studies have reported associations between physical performance and the gut microbiota (GM). Physical activity seems to increase GM diversity and the abundance of certain health-beneficial microbes. We reviewed the evidence from longitudinal studies on the connection between physically active lifestyle or long-term exercise interventions and the GM. We made literature searches using databases of Web of Science and PubMed Medline to collect human studies showing or not the associations between the GM and exercise. Many controversies exist in the studies. However, the longitudinal studies show that frequently, medium-intensity endurance exercise has yielded most beneficial effects on the GM, but the results vary depending on the study population and exercise protocol. In addition, the literature shows that certain microbes own the potency to increase physical activity and performance. Generally, a physically active lifestyle and exercise associate with a “healthy” GM. However, in previously sedentary subjects, the exercise-induced improvements in the GM seem to disappear unless the active lifestyle is continued. Unfortunately, several studies are not controlled for the diet. Thus, in the future, more longitudinal studies on the GM and physical performance are needed, with detailed dietary information.
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Graungaard S, Geisler L, Andersen JR, Rasmussen HH, Vinter-Jensen L, Holst M. Personalized exercise intervention in HPN patients - A feasibility study. Clin Nutr ESPEN 2021; 45:420-425. [PMID: 34620349 DOI: 10.1016/j.clnesp.2021.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/08/2021] [Accepted: 07/11/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Physical health status may be predictive of readmissions, psychological health and mortality in patients with short bowel syndrome. AIMS This study aimed to investigate the feasibility and effect of an individualized exercise intervention and secondary, oral nutrition intake counseling on Timed-Up-and-Go (TUG) and 30 s Chair Stand Test (CST) as well as body-composition and EuroQol (EQ)-5D-5L, in patients with chronic intestinal failure (IF) type III receiving HPN and/or fluid therapy. METHODS A 12-week individualized exercise intervention consisting on three weekly home based sessions, and nutrition counselling focusing on protein intake and reducing high stoma output, was performed. Weekly follow-up by phone was done on motivation to exercise. RESULTS The study invited 71 patients, 44 accepted the invitation (62%), 37(52%) were included, and 31 (84%) completed the intervention. The exercise intervention was well tolerated. TUG improved from 8.9(SD 5.5) to 7.7(SD 3.8) (p = 0.033). CST improved by four repetitions (<0.001∗). A statistical, however not clinically relevant improvement was seen in muscle mass. No improvement was seen in (EQ)-5D-5L total, but insignificantly (p = 0.055) for physical function only. Protein intake improved by 10.6 g/day (p = 0.008). CONCLUSIONS A 12 weeks individualized exercise intervention showed very feasible and beneficial in HPN patients. Physical function improved statistically and clinically, and oral protein intake improved. QoL overall did not improve, however COVID-19 was an uninvited partner throughout the study period, which may have influenced general QoL. As only 62% accepted the invitation to participate, home based exercise intervention may not apply to all patients.
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Affiliation(s)
- Signe Graungaard
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Rolighedsvej 26, DK-1958 FC, Copenhagen, Denmark.
| | - Lea Geisler
- Centre for Nutrition and Intestinal Failure, Department of Gastroenterology, Aalborg University Hospital, Aalborg, Denmark.
| | - Jens R Andersen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Rolighedsvej 26, DK-1958 FC, Copenhagen, Denmark.
| | - Henrik Højgaard Rasmussen
- Centre for Nutrition and Intestinal Failure, Department of Gastroenterology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
| | - Lars Vinter-Jensen
- Centre for Nutrition and Intestinal Failure, Department of Gastroenterology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
| | - Mette Holst
- Centre for Nutrition and Intestinal Failure, Department of Gastroenterology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
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McGing JJ, Radford SJ, Francis ST, Serres S, Greenhaff PL, Moran GW. Review article: The aetiology of fatigue in inflammatory bowel disease and potential therapeutic management strategies. Aliment Pharmacol Ther 2021; 54:368-387. [PMID: 34228817 DOI: 10.1111/apt.16465] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 09/30/2020] [Accepted: 05/20/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Fatigue is the inability to achieve or maintain an expected work output resulting from central or peripheral mechanisms. The prevalence of inflammatory bowel disease (IBD) fatigue can reach 86% in active disease, persisting in 50%-52% of patients with mild to inactive disease. Fatigue is the commonest reason for work absence in IBD, and patients often report fatigue burden to be greater than that of primary disease symptoms. Relatively few evidence-based treatment options exist, and the aetiology is poorly understood. AIM To review the available data and suggest a possible aetiology of IBD fatigue and to consider the efficacy of existing management strategies and highlight potential future interventions. METHODS We reviewed fatigue-related literature in IBD using PubMed database. RESULTS Disease related factors such as inflammation and pharmacological treatments negatively impact skeletal muscle and brain physiology, likely contributing to fatigue symptoms. Secondary factors such as malnutrition, anaemia, sleep disturbance and psychological comorbidity are potential determinants. Immune profile, faecal microbiota composition and physical fitness differ significantly between fatigued and non-fatigued patients, suggesting these may be aetiological factors. Solution-focused therapy, high-dosage thiamine supplementation and biological therapy may reduce fatigue perception in IBD. The effect of physical activity interventions is inconclusive. CONCLUSIONS A multimodal approach is likely required to treat IBD fatigue. Established reversible factors like anaemia, micronutrient deficiencies and active disease should initially be resolved. Psychosocial intervention shows potential efficacy in reducing fatigue perception in quiescent disease. Restoring physical deconditioning by exercise training intervention may further improve fatigue burden.
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Affiliation(s)
- Jordan J McGing
- School of Medicine, University of Nottingham, Nottingham, UK.,Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, UK
| | - Shellie Jean Radford
- School of Medicine, University of Nottingham, Nottingham, UK.,National Institute of Health Research Nottingham Biomedical Research Centre (NIHR), Nottingham University Hospitals and University of Nottingham, Nottingham, UK
| | - Susan T Francis
- Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, UK.,National Institute of Health Research Nottingham Biomedical Research Centre (NIHR), Nottingham University Hospitals and University of Nottingham, Nottingham, UK
| | - Sébastien Serres
- School of Life Sciences, University of Nottingham, Nottingham, UK
| | - Paul L Greenhaff
- National Institute of Health Research Nottingham Biomedical Research Centre (NIHR), Nottingham University Hospitals and University of Nottingham, Nottingham, UK.,MRC Versus Arthritis Centre for Musculoskeletal Ageing Research, National Institute for Health Research (NIHR), Nottingham Biomedical Research Centre, School of Life Sciences, University of Nottingham, Nottingham, UK
| | - Gordon W Moran
- School of Medicine, University of Nottingham, Nottingham, UK.,National Institute of Health Research Nottingham Biomedical Research Centre (NIHR), Nottingham University Hospitals and University of Nottingham, Nottingham, UK
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Bastiaanssen TFS, Cussotto S, Claesson MJ, Clarke G, Dinan TG, Cryan JF. Gutted! Unraveling the Role of the Microbiome in Major Depressive Disorder. Harv Rev Psychiatry 2021; 28:26-39. [PMID: 31913980 PMCID: PMC7012351 DOI: 10.1097/hrp.0000000000000243] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Microorganisms can be found in virtually any environment. In humans, the largest collection of microorganisms is found in the gut ecosystem. The adult gut microbiome consists of more genes than its human host and typically spans more than 60 genera from across the taxonomic tree. In addition, the gut contains the largest number of neurons in the body, after the brain. In recent years, it has become clear that the gut microbiome is in communication with the brain, through the gut-brain axis. A growing body of literature shows that the gut microbiome plays a shaping role in a variety of psychiatric disorders, including major depressive disorder (MDD). In this review, the interplay between the microbiome and MDD is discussed in three facets. First, we discuss factors that affect the onset/development of MDD that also greatly impinge on the composition of the gut microbiota-especially diet and stressful life events. We then examine the interplay between the microbiota and MDD. We examine evidence suggesting that the microbiota is altered in MDD, and we discuss why the microbiota should be considered during MDD treatment. Finally, we look toward the future and examine how the microbiota might become a therapeutic target for MDD. This review is intended to introduce those familiar with the neurological and psychiatric aspects of MDD to the microbiome and its potential role in the disorder. Although research is in its very early days, with much yet to be the understood, the microbiome is offering new avenues for developing potentially novel strategies for managing MDD.
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Sigurdsson GV, Schmidt S, Mellström D, Ohlsson C, Karlsson M, Lorentzon M, Saalman R. Physical exercise is associated with beneficial bone mineral density and body composition in young adults with childhood-onset inflammatory bowel disease. Scand J Gastroenterol 2021; 56:699-707. [PMID: 33945377 DOI: 10.1080/00365521.2021.1913759] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Patients with inflammatory bowel disease (IBD) have an increased risk of compromised bone mineral density (BMD) and body composition. There are limited data on the physical exercise (PE) habits of patients with childhood-onset IBD and on the associations between PE and BMD and body composition. PATIENTS AND METHODS In total, 72 young adults with childhood-onset IBD and 1341 normative young adult controls answered questionnaires regarding PE [hours/week (h/w)] in the last 12 months. BMD and body composition were measured with dual x-ray absorptiometry (DXA) and presented as age- and gender-adjusted Z-scores for BMD, skeletal muscle index (SMI, the weight of lean mass in arms and legs/m2), and percentage body fat (Fat %). RESULTS A total of 41 (57%) patients with IBD engaged in PE during the previous 12 months, as compared to 913 (68%) of the controls (p = .053). Sedentary patients had significantly lower median BMD, SMI, and Fat % Z-scores than the controls with corresponding PE habits (all p < .05). In contrast, highly active (>4 h/week) patients had total body BMD, SMI, and Fat % in the same range as the controls with corresponding PE levels (p = .151, p = .992, and p = .189, respectively), albeit with lower BMDs in the spine (p = .007) and femoral neck (p = .015). Using multiple regression analyses, a diagnosis of childhood-onset IBD was independently associated with inferior BMD and body composition, regardless of the amount of PE. CONCLUSION Physical exercise is associated with beneficial bone mineral density and body composition in patients with IBD despite the negative effects of the disease.
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Affiliation(s)
- Gudmundur Vignir Sigurdsson
- Department of Pediatrics, Institute of Clinical Sciences, The Sahlgrenska Academy at University of Gothenburg and Queen Silvia's Children's Hospital, Gothenburg, Sweden
| | | | - Dan Mellström
- Centre for Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Claes Ohlsson
- Centre for Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Department of Drug Treatment, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Magnus Karlsson
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics, Lund University and Skåne University Hospital, Malmo, Sweden
| | - Mattias Lorentzon
- Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Region Västra Götaland, Geriatric Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.,Mary MacKillop Institute for Health Research, Melbourne, Australia
| | - Robert Saalman
- Department of Pediatrics, Institute of Clinical Sciences, The Sahlgrenska Academy at University of Gothenburg and Queen Silvia's Children's Hospital, Gothenburg, Sweden
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Barton W, Cronin O, Garcia‐Perez I, Whiston R, Holmes E, Woods T, Molloy CB, Molloy MG, Shanahan F, Cotter PD, O’Sullivan O. The effects of sustained fitness improvement on the gut microbiome: A longitudinal, repeated measures case-study approach. TRANSLATIONAL SPORTS MEDICINE 2021; 4:174-192. [PMID: 34355132 PMCID: PMC8317196 DOI: 10.1002/tsm2.215] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 10/23/2020] [Accepted: 11/11/2020] [Indexed: 01/01/2023]
Abstract
The athlete gut microbiome differs from that of non-athletes in its composition and metabolic function. Short-term fitness improvement in sedentary adults does not replicate the microbiome characteristics of athletes. The objective of this study was to investigate whether sustained fitness improvement leads to pronounced alterations in the gut microbiome. This was achieved using a repeated-measures, case-study approach that examined the gut microbiome of two initially unfit volunteers undertaking progressive exercise training over a 6-month period. Samples were collected every two weeks, and microbiome, metabolome, diet, body composition, and cardiorespiratory fitness data were recorded. Training culminated in both participants completing their respective goals (a marathon or Olympic-distance triathlon) with improved body composition and fitness parameters. Increases in gut microbiota α-diversity occurred with sustained training and fluctuations occurred in response to training events (eg, injury, illness, and training peaks). Participants' BMI reduced during the study and was significantly associated with increased urinary measurements of N-methyl nicotinate and hippurate, and decreased phenylacetylglutamine. These results suggest that sustained fitness improvements support alterations to gut microbiota and physiologically-relevant metabolites. This study provides longitudinal analysis of the gut microbiome response to real-world events during progressive fitness training, including intercurrent illness and injury.
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Affiliation(s)
- Wiley Barton
- APC Microbiome IrelandNational University of IrelandCorkIreland
- Animal and Grassland Research and Innovation Centre, Teagasc, MooreparkFermoyIreland
- Department of Food BiosciencesTeagasc Food Research Centre, MooreparkFermoyIreland
| | - Owen Cronin
- APC Microbiome IrelandNational University of IrelandCorkIreland
- Department of MedicineNational University of IrelandCorkIreland
| | - Isabel Garcia‐Perez
- Division of Integrated Systems Medicine and Digestive DiseasesDepartment of Surgery and CancerFaculty of MedicineImperial College LondonLondonUK
| | - Ronan Whiston
- APC Microbiome IrelandNational University of IrelandCorkIreland
- Department of Food BiosciencesTeagasc Food Research Centre, MooreparkFermoyIreland
| | - Elaine Holmes
- Division of Integrated Systems Medicine and Digestive DiseasesDepartment of Surgery and CancerFaculty of MedicineImperial College LondonLondonUK
| | - Trevor Woods
- Human Performance LaboratoryDepartment of Sport and Physical ActivityNational University of IrelandCorkIreland
| | | | - Michael G. Molloy
- APC Microbiome IrelandNational University of IrelandCorkIreland
- Department of MedicineNational University of IrelandCorkIreland
| | - Fergus Shanahan
- APC Microbiome IrelandNational University of IrelandCorkIreland
- Department of MedicineNational University of IrelandCorkIreland
| | - Paul D. Cotter
- APC Microbiome IrelandNational University of IrelandCorkIreland
- Department of Food BiosciencesTeagasc Food Research Centre, MooreparkFermoyIreland
| | - Orla O’Sullivan
- APC Microbiome IrelandNational University of IrelandCorkIreland
- Department of Food BiosciencesTeagasc Food Research Centre, MooreparkFermoyIreland
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Davis SP, Crane PB, Bolin LP, Johnson LA. An integrative review of physical activity in adults with inflammatory bowel disease. Intest Res 2021; 20:43-52. [PMID: 33472342 PMCID: PMC8831770 DOI: 10.5217/ir.2020.00049] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 12/12/2020] [Indexed: 11/17/2022] Open
Abstract
Adults with inflammatory bowel disease (IBD) search for self-management strategies to manage their symptoms and improve their quality of life (QOL). Physical activity (PA) is one of the self-management strategies widely adopted by adults with IBD. This integrative review aimed to synthesize the evidence on health outcomes of PA in adults with IBD as well as to identify the barriers to engaging in PA. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), published literature was searched to identify the articles that addressed PA in adults with IBD. Twenty-eight articles met the inclusion criteria. Many of the reviewed studies used the terms of PA and exercise interchangeably. Walking was the most common PA reported in the studies. The findings from the majority of the reviewed studies supported the benefits of moderate-intensity exercise/PA among adults with IBD. The reviewed studies noted the following positive health outcomes of PA: improvement in QOL, mental health, sleep quality, gastrointestinal symptoms, fatigue and cardiorespiratory fitness. More importantly, participation in PA reduced the risk for development of IBD and the risk for future active disease. The findings from the reviewed studies highlighted the following barriers to engage in PA: fatigue, joint pain, abdominal pain, bowel urgency, active disease and depression.
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Lamers CR, de Roos NM, Bongers CCWG, Ten Haaf DSM, Hartman YAW, Witteman BJM, Hopman MTE. Repeated prolonged moderate-intensity walking exercise does not appear to have harmful effects on inflammatory markers in patients with inflammatory bowel disease. Scand J Gastroenterol 2021; 56:30-37. [PMID: 33211989 DOI: 10.1080/00365521.2020.1845791] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND OBJECTIVES The role of exercise in the management of inflammatory bowel disease (IBD) is inconclusive as most research focused on short or low-intensity exercise bouts and subjective outcomes. We assessed the effects of repeated prolonged moderate-intensity exercise on objective inflammatory markers in IBD patients. METHODS In this study, IBD patients (IBD walkers, n = 18), and a control group (non-IBD walkers, n = 19), completed a 30, 40 or 50 km walking exercise on four consecutive days. Blood samples were taken at baseline and every day post-exercise to test for the effect of disease on exercise-induced changes in cytokine concentrations. A second control group of IBD patients who did not take part in the exercise, IBD non-walkers (n = 19), was used to test for the effect of exercise on faecal calprotectin. Both IBD groups also completed a clinical disease activity questionnaire. RESULTS Changes in cytokine concentrations were similar for IBD walkers and non-IBD walkers (IL-6 p = .95; IL-8 p = .07; IL-10 p = .40; IL-1β p = .28; TNF-α p = .45), with a temporary significant increase in IL-6 (p < .001) and IL-10 (p = .006) from baseline to post-exercise day 1. Faecal calprotectin was not affected by exercise (p = .48). Clinical disease activity did not change in the IBD walkers with ulcerative colitis (p = .92), but did increase in the IBD walkers with Crohn's disease (p = .024). CONCLUSION Repeated prolonged moderate-intensity walking exercise led to similar cytokine responses in participants with or without IBD, and it did not affect faecal calprotectin concentrations, suggesting that IBD patients can safely perform this type of exercise.
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Affiliation(s)
- Carlijn R Lamers
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands.,Department of Gastroenterology and Hepatology, Hospital Gelderse Vallei, Ede, The Netherlands
| | - Nicole M de Roos
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | - Coen C W G Bongers
- Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Yvonne A W Hartman
- Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ben J M Witteman
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands.,Department of Gastroenterology and Hepatology, Hospital Gelderse Vallei, Ede, The Netherlands
| | - Maria T E Hopman
- Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
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Papadimitriou K. Effect of resistance exercise training on Crohn's disease patients. Intest Res 2020; 19:275-281. [PMID: 33207853 PMCID: PMC8322027 DOI: 10.5217/ir.2020.00043] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 09/07/2020] [Indexed: 12/22/2022] Open
Abstract
Crohn’s disease (CD) is observed with increased levels of cytokines which cause inflammation in many parts of the digestive tract. Aerobic exercise contributes to the reduction of the intestine’s inflammation and increases the quality of life. Another type of exercise that shows research interest about its effects on CD symptoms is the resistance exercise (RE). The aim of the study was to review the influence of RE on CD patients. The study’s literature was collected from PubMed and Scholar databases. According to the results, the main phase of a RE training program must have a gradual increase of intensity (60%–80%) and resting periods of 15–30 seconds after each exercise, and 2–3 minutes between exercises. Also, CD patients who were in remission improved the muscle strength and quality of life via their participation in RE training program. However, the secretion of interleukin-6 in both CD and RE contributes in various physiological mechanisms setting a contradictory role in the effectiveness of RE at the disease’s inflammatory situation. So, the use of RE training in CD patients needs more research for safer participation.
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Affiliation(s)
- Konstantinos Papadimitriou
- Laboratory of Evaluation of Human Biological Performance, School of Physical Education and Sport Science, Aristotle University of Thessaloniki, Thessaloniki, Greece
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How strong is the evidence that gut microbiota composition can be influenced by lifestyle interventions in a cardio-protective way? Atherosclerosis 2020; 311:124-142. [PMID: 32981713 DOI: 10.1016/j.atherosclerosis.2020.08.028] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 08/09/2020] [Accepted: 08/25/2020] [Indexed: 02/06/2023]
Abstract
Alterations in composition and function of the gut microbiota have been demonstrated in diseases involving the cardiovascular system, particularly coronary heart disease and atherosclerosis. The data are still limited but the typical altered genera include Roseburia and Faecalibacterium. Plausible mechanisms by which microbiota may mediate cardio-protective effects have been postulated, including the production of metabolites like trimethylamine (TMA), as well as immunomodulatory functions. This raises the question of whether it is possible to modify the gut microbiota by lifestyle interventions and thereby improve cardiovascular health. Nevertheless, lifestyle intervention studies that have involved modifications of dietary intake and/or physical activity, as well as investigating changes in the gut microbiota and subsequent modifications of the cardioprotective markers, are still scarce, and the results have been inconclusive. Current evidence points to benefits of consuming high-fibre foods, nuts and an overall healthy dietary pattern to achieve beneficial effects on both gut microbiota and serum cardiovascular markers, primarily lipids. The relationship between physical exercise and gut microbiota is probably complex and may be dependent on the intensity of exercise. In this article, we review the available evidence on lifestyle, specifically diet, physical activity and smoking as modifiers of the gut microbiota, and subsequently as modifiers of serum cardiovascular health markers. We have attempted to elucidate the plausible mechanisms and further critically appraise the caveats and gaps in the research.
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Di Palo DM, Garruti G, Di Ciaula A, Molina-Molina E, Shanmugam H, De Angelis M, Portincasa P. Increased Colonic Permeability and Lifestyles as Contributing Factors to Obesity and Liver Steatosis. Nutrients 2020; 12:564. [PMID: 32098159 PMCID: PMC7071468 DOI: 10.3390/nu12020564] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 02/10/2020] [Accepted: 02/18/2020] [Indexed: 02/07/2023] Open
Abstract
Intestinal permeability (IP) is essential in maintaining gut-metabolic functions in health. An unequivocal evaluation of IP, as marker of intestinal barrier integrity, however, is missing in health and in several diseases. We aimed to assess IP in the whole gastrointestinal tract according to body mass index (BMI) and liver steatosis. In 120 patients (61F:59M; mean age 45 ± SEM 1.2 years, range: 18-75), IP was distinctively studied by urine recovery of orally administered sucrose (SO, stomach), lactulose/mannitol ratio (LA/MA, small intestine), and sucralose (SA, colon). By triple quadrupole mass-spectrometry and high-performance liquid chromatography, we measured urinary recovery of saccharide probes. Subjects were stratified according to BMI as normal weight, overweight, and obesity, and answered questionnaires regarding dietary habits and adherence to the Mediterranean Diet. Liver steatosis was assessed by ultrasonography. IP at every gastrointestinal tract was similar in both sexes and decreased with age. Stomach and small intestinal permeability did not differ according to BMI. Colonic permeability increased with BMI, waist, neck, and hip circumferences and was significantly higher in obese than in lean subjects. As determined by logistic regression, the odds ratio (OR) of BMI increment was significantly higher in subjects in the highest tertile of sucralose excretion, also after adjusting for age and consumption of junk food. The presence of liver steatosis was associated with increased colonic permeability. Patients with lower score of adherence to Mediterranean diet had a higher score of 'junk food'. Intestinal permeability tended to increase in subjects with a lower adherence to Mediterranean diet. In conclusion, colonic (but not stomach and small intestinal) permeability seems to be linked to obesity and liver steatosis independently from dietary habits, age, and physical activity. The exact role of these last factors, however, requires specific studies focusing on intestinal permeability. Results should pave the way to both primary prevention measures and new therapeutic strategies in metabolic and liver diseases.
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Affiliation(s)
- Domenica Maria Di Palo
- Clinica Medica “A. Murri”, Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, 70124 Bari, Italy; (D.M.D.P.); (A.D.C.); (E.M.-M.); (H.S.)
- Department of Soil, Plant and Food Sciences, University of Bari Aldo Moro, 70124 Bari, Italy;
| | - Gabriella Garruti
- Section of Endocrinology, Department of Emergency and Organ Transplantations, University of Bari “Aldo Moro” Medical School, 70124 Bari, Italy;
| | - Agostino Di Ciaula
- Clinica Medica “A. Murri”, Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, 70124 Bari, Italy; (D.M.D.P.); (A.D.C.); (E.M.-M.); (H.S.)
| | - Emilio Molina-Molina
- Clinica Medica “A. Murri”, Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, 70124 Bari, Italy; (D.M.D.P.); (A.D.C.); (E.M.-M.); (H.S.)
| | - Harshitha Shanmugam
- Clinica Medica “A. Murri”, Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, 70124 Bari, Italy; (D.M.D.P.); (A.D.C.); (E.M.-M.); (H.S.)
| | - Maria De Angelis
- Department of Soil, Plant and Food Sciences, University of Bari Aldo Moro, 70124 Bari, Italy;
| | - Piero Portincasa
- Clinica Medica “A. Murri”, Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, 70124 Bari, Italy; (D.M.D.P.); (A.D.C.); (E.M.-M.); (H.S.)
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