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Table 2 Qualitative synthesis of studies examining the effects of structured exercise interventions in patients with IBD

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

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
  1. 5-ASA: 5-Aminosalicylic Acid; 6-MP: 6-Mercatopurine; BMD: Bone mineral density; BMI: body mass index; BBMW: Breath-Body-Mind Workshop; CD: Crohn’s Disease; CDAI: Crohn’s Disease Activity Index; CG: Control Group; EG: Experimental Group; FCP: fecal calprotectin; HBI: Harvey and Bradshaw Index; HrQoL: Health related Quality of Life; IBD: Inflammatory Bowel Disease; IBDQ: Inflammatory Bowel Disease Questionnaire; Lc: Leucocyte count; min: minutes; n.s.: not significant; 1RM: One-Repetition-Maximum; RI: Rachmilewitz Index; SCCAI: Simple Clinical Colitis Activity index; STAI: State and Trait Anxiety Inventory; UC: Ulcerative Colitis