Published online Aug 21, 2019. doi: 10.3748/wjg.v25.i31.4493
Peer-review started: April 3, 2019
First decision: June 10, 2019
Revised: July 5, 2019
Accepted: July 19, 2019
Article in press: July 19, 2019
Published online: August 21, 2019
Inflammatory bowel disease (IBD), encompassing Crohn’s disease and ulcerative colitis, may influence physical health and functionality due to a variety of disease-related factors such as abdominal pain, altered bowel habits, fatigue, and arthralgias or indirect factors such as time spent on medical visits, treatments, or hospitalizations. Psychological factors and self-perception of wellness may also contribute. Physical activity and exercise in the context of IBD has been increasingly explored, although data is overall limited.
Exercise is a fundamental element for promoting general health among children and youth, including those with chronic diseases. While exercise can contribute to improvement in IBD symptoms, disease activity, and health-related quality of life, the disease may also restrict physical activity. Additionally, youths’ exercise habits prior to IBD diagnosis are infrequently considered. This survey was conducted to better understand the impact of pediatric IBD diagnosis on exercise and sports participation, considering both patient and parent perspectives.
The main objective of our study was to assess patient-reported exercise and sports participation both before and after IBD diagnosis. We sought to explore the particular factors affecting exercise and sports participation. Patients were asked about primary motivations and limitations for participation, and parents were asked to rank various barriers. Additional aims were to compare patient and parent perspectives on performance desire, perceived aerobic capacity, and the role of exercise in IBD. We obtained patient-reported activity levels using a functional activity scale.
Consecutive IBD outpatients (aged 10-18 years) and their parents completed parallel voluntary surveys. Survey questions explored past and current participation in various sports types, including non-organized physical play, organized sports, and competitive sports, across a range of academic years (elementary school through college). A validated, patient-reported functional activity scale, the Hospital for Special Surgery Pediatric Functional Activity Brief Scale (HSS Pedi-FABS) was used as a metric to assess children’s activity levels.
There were 149 completed surveys (75% response rate) with mean participant age of 16.5 years [standard deviation (SD) = 4.0] and mean age at IBD diagnosis of 11.8 years (SD = 3.4). Most patients (77%) were diagnosed within 12 mo of symptom onset. Current athletic participation was reported in 65% across 65 sports. Participation was greatest before (40%) rather than after (32%) IBD diagnosis, with no reported change in 28%. IBD negatively impacted play/performance in 45% but did not change play/performance in 44%. IBD treatment improved patients’ desire to exercise (70%) and subjective capacity for aerobic exercise (72%). Patients and parents agreed that IBD subjects demonstrate normal capacity for aerobic exercise (0.40, 95%CI: 0.22-0.58) and that treatment improved both participatory desire (0.33, 95%CI: 0.12-0.54) and capacity for aerobic exercise (0.52, 95%CI: 0.31-0.71). Almost all (99%) viewed exercise as healthy, and most encouraged its practice. IBD patients demonstrated normal mean HSS Pedi-FABS activity scores.
This study demonstrates that most patients with IBD remain active in exercise and sports, with only a small decrease in participation following diagnosis. Most of our pediatric IBD patients look favorably on the role of exercise and are currently involved and continue to partake in a variety of physical activities, with mean activity levels comparable to American youth. Treatment positively impacts participatory desire and aerobic capacity.
The presentation of IBD in youth may be a particularly challenging scenario as a lifelong condition with unpredictable periods of flare and remission. Focusing treatment strategies toward the goal of maintaining physical play or returning to exercise and sports may be a promising approach that encourages children and parents in the continued pursuit of various activities that can foster physical, mental and psychosocial aspects of health. Future studies are needed to establish physical activity targets in IBD patients based on individual disease factors and course.