Table 2 Qualitative synthesis of studies examining the effects of structured exercise interventions in patients with IBD
Author | Subjects and design | Endpoints | Medication EG (CG) | Methods | Duration and frequency | Main findings | Adverse events | Level of evidence |
|---|---|---|---|---|---|---|---|---|
Robinson et al., [33] | 107 patients with CD, mild to moderate disease activity; block randomization (EG: n=53, CG: n=54) | BMD | All under steroid use | Home-based; floor-based, progressive low-impact dynamic resistance training | At least twice a week, with a min. of 10 sessions per month; 1 year | Fully compliant patients (14): BMD increased at the femoral neck (n.s.), the spine (n.s.), the Ward’s triangle (n.s.) and the trochanter major ([EG-CG] (95% CI) = 4.67 (0.86-8.48), p=.02) | Not reported | 2 |
D’Inca et al., [38] | 6 CD patients in remission; 6 healthy controls | Disease activity, various gastrointestinal parameters | Not reported | Cycling exercise | Cycle ergometer exercise at 60% of max. oxygen intake; once for 1 hour | No statistically significant effects on gastrointestinal parameters; no change in disease activity | None | 3 |
Loudon et al., [39] | 12 physically inactive patients with inactive or mildly active CD, no controls | Stress Index, HrQoL, disease activity, fitness, BMI | Prednisone n=4; 5-ASA n=5; 6-MP n=6; no medication n=2 | Supervised and unsupervised walking program (indoor track) | 3 sessions a week (20-35 min); 12 weeks | Significant improvements in IBD Stress Index (mean change study outset (29.2±15.4) to completion (19.5±10.8) p<.001), IBDQ (172±27 to 189±12, p=.01), HBI (5.9±5.0 to 3.6±3.1, p=.02), VO2max (30.6±4.7 to 32.4±4.8, p<.01), BMI (24.3±5.3 to 23.9±5.3, p=0.07) | None | 4 |
Candow et al., [40] | 12 CD patients, no controls; disease activity not specified | Disease activity, muscle strength | Not reported | Supervised resistance training (12 exercises) | 3 times a week over the course of 12 weeks, 3 sets, 8-10 repetitions; 60-70% of 1RM | Significant increase in muscle strength (p<.05); no change in disease activity (HBI) | None | 4 |
Elsenbruch et al., [34] | 30 UC patients in remission or low disease activity; randomized controlled trial | Neuroendocrine and cellular immune parameters, HrQoL, disease activity | 5-ASA n=8 (7); probiotics n=1 (3); ironsulfate n=0 (1) no medication n=6 (4) | Structured and supervised mind-body therapy (includes stress management training, moderate exercise, Mediterranean diet, cognitive behavioral techniques with focus on self-care strategies) | 60-hour program over a 10-week period (i.e. 6 h on 1 day every week) | Significant improvements in HrQoL (SF-36 short: psychosocial health sum score p<.05, mean change EG=7.2±10.7; mean change CG = 0.0±8.5) and IBDQ (bowel symptoms: d=0.52, p<.01); no statistically significant group differences in lymphocyte sub-set numbers or production of TNF α and RI | Not reported | 2 |
Gupta et al., [41] | 175 patients with different chronic conditions (n=18 with gastrointestinal problems including CD, disease activity not specified) | Anxiety scores | Not specified | Lifestyle intervention | Yoga, breathing exercise, mediation, stress management and nutrition education; 5+3 days with a two day break for weekend | No statistically significant change in anxiety levels (STAI) | Not reported | 4 |
Ng et al., [30] | 32 patients in remission or with mildly active CD, matched and randomized | HrQoL, disease activity, Stress Index | 5-ASA n=6 (6); no medication n=10 (10) | Independant walking program | 60% HRmax during exercise, 3 times a week over 3 month; 30 min per session | Significant improvements in IDB Stress Index (p<.05), disease related dysfunction (IBDQ) (p<.05) and reduction in HBI (p<.01) | None | 2 |
De Souza Tajiri et al., [42] | 19 patients (CD: n=10, UC: n=9), no controls; disease activity not specified | Thigh circumference, bodyweight, quadriceps strength, HrQoL | Not reported | Progressive resistance training | Knee extension; first 4 weeks: 50% 1RM, 3 sets of 12 repetitions; last 4 weeks: weekly increase of load by 10% until 80% of max. load | Significant improvements in quadriceps strength (greater than 40%, p<.001), IBDQ (mean changes baseline 156.3±29.0 to post 180.5±24.2, p<.001). No statistically significant changes in thigh circumference and bodyweight | None | 4 |
Gerbarg et al., [36] | 25 patients with mild to moderate IBD, randomized | Psychological and physical symptoms (HrQoL), inflammatory markers | No medication n=5; all other mixed medications (biologics, immunosuppressive; corticosteroids; mesalamines) | EG: 9 hours administered Breath-Body-Mind Workshop (BBMW) (breathing, Qigong, mediation) CG: 9 hours educational seminar (ES) (information about IBD and its treatment) | EG: BBMW and 26 weeks homebased, self-administered sessions, every day for 20 min | No between group differences IBDQ (mean change EG= 12.57±15.85, mean change CG= -1.73±19.91; p=.08); Significant changes in CRP (median change EG: baseline 1026.0 to post 730.0; p=.01; median change CG: 8590.0 to 7180.0, p=.39) but not in FCP (median change EG: baseline 216.3 to post 155.9, p=.78; median change CG: 157.8 to 341.5, p=.59), | None | 2 |
Klare et al., [37] | 30 patients with mild to moderate IBD, randomized controlled trial | HrQoL, disease activity, BMI | Prednisolone n=4 (1); budesonide n=3 (2); mesalazine n=3 (5); ASA/5-MP n=3 (5) | Supervised outdoor running program for untrained people | Moderate intensity, equated by BMI; 3 times a week for 10 weeks | Significant improvements of IBDQ social dimension ([EG-CG] (95% CI) = 4.4 (0.6-8.2), p=.03); no changes in disease activity (CDAI: [EG-CD] (95% CI) = -3.7 (-35.8-29.3, p=.81; RI: [EG-CG] (95% CI) = -0.2 (-2,6-2.3), p=.88); BMI ([EG-CG] (95% CI) = 0.4 (0.0-0.9), p=.08) or laboratory results (Lc: [EG-CG] (95% CI) = -0.7(-2.3-0.9), p=.39; CRP: [EG-CG] (95% CI) = 0.0 (-0.3-0.2), p=.88; FCP: [EG-CG] (95% CI) = -25.3 (-433.6-383.0), p=.90 | None | 2 |
Sharma et al., [7] | 87 patients (CD: n=36, UC: n=51) in clinical remission, randomly allocated to EG or CG | Stress Index, anxiety, cardiovascular autonomic functions, immune markers | “all treated with maintenance dose of mesalamines and azathriopine” (p.103) | Supervised Yoga intervention (physical postures, pranayama, meditation) | 1 hour a day for 8 weeks | No statistically significant group differences in any outcome parameter (overall), but significant differences within the UC groups (EG and CG) in State (mean change baseline from 38.9±8.9 to post 32.8±8.2, p=.01) and Trait (mean change from 49.5±8.7 to 41.2±8.2, p=.001) anxiety levels (STAI); fewer UC patients reported arthralgia (p<.05) | Not reported | 2 |
Hassid et al., [43] | 10 patients (CD n=7, UC n=3), no controls; disease activity not specified | Disease activity | Not reported | Different types of intensive exercise: marathon (1), half-marathon (5), long bicycle ride (>45 miles) (3), triathlon (1) | Once | No statistically significant change in disease activity (HBI and SCCAI); no abnormally elevated FCP | None | 4 |
Cramer et al., [35] | 77 UC patients, randomly assigned; in remission | HrQoL, disease activity | Biologics n=4 (6); immunosuppressive n=0 (1); thiopurines n=10 (10); mesalazine n=30 (28); probiotics n=5 (1) | Supervised traditional hatha yoga intervention (EG); two self-care books - without instructions for using - providing general information on UC (CG) | 90 min weekly over a period of 12 weeks | Significant increase of HrQoL after 12 weeks (IBDQ: [EG-CG] (95% CI) = 14.7 (2.4-26.9), p=.02) and after 24 weeks ([EG-CG] (95% CI) = 16.4 (2.5-30.3), p=.02); disease activity (RI: [EG-CG] (95% CI) = -1.2 (-0.1-[-2.3]), p=.03) | None | 2 |