Inflammatory bowel diseases patients suffer from significant low levels and barriers to physical activity: The "BE-FIT-IBD" study

Abstract

Background: The place regular physical activity (PA) should occupy in managing patients with inflammatory bowel diseases (IBD) is unclear.

Aim: To assess PA levels and barriers in a southern Italian IBD population.

Methods: IBD patients with non-severe disease activity [assessed with partial Mayo score for ulcerative colitis (UC) and Harvey-Bradshaw index for Crohn's disease] were approached to receive an anonymous online questionnaire to assess PA levels using the International Physical Activity Questionnaire (IPAQ) and to assess disease activity as patient-reported outcomes 2 (PRO-2) and finally to assess habits, beliefs and barriers in conducting regular PA. Clinical, anthropometric and demographic data of patients were also collected. PA was expressed as continuous units of resting metabolic rate (Met) in min/wk. Three PA groups were identified: Inactive (< 700 Met min/wk), sufficiently active (700-2500 Met min/wk) and health enhancing PA (HEPA) (i.e., HEPA active, > 2500 Met min/wk) patients.

Results: Included patients (219) showed overall PA levels of 834.5 Met min/wk, with a large proportion (94, 42.9%) classified as inactive while only a minority (9, 4.1%) as health-enhancing PA. Patients without dyslipidaemia (P < 0.0001) or on biologics therapy (P = 0.022) showed better IPAQ scores in moderate activities. UC PRO-2 correlated negatively with IPAQ intense activities scores (τ = -0.156, P = 0.038). PRO-2 did not show notable sensitivity/specificity in predicting IPAQ inactivity (AUC < 0.6). IBD activity did not differ between active and inactive patients (P > 0.05). Active patients expressed the need to discuss PA with their gastroenterologist. Some barriers (e.g., diagnosis of IBD and fear of flare-ups after PA) are significantly more reported by inactive patients.

Conclusion: A significant rate of physical inactivity was recorded in this setting. IPAQ showed good feasibility. PA should be an element of discussion in IBD visits assessed quickly with non-invasive questionnaires.

Keywords: Crohn’s disease; Inflammatory bowel disease; International Physical Activity Questionnaire; Physical activity; Ulcerative colitis.

Figure 1

Flow chart summarizing the inclusion in the study patients, divided by type of inflammatory bowel disease and resulting physical activity levels. HEPA: Health enhancing physical activity; IBD: Inflammatory bowel disease; CD: Crohn's disease.

Figure 2

Physical activity levels in the main subgroups examined. A-D: Physical activity levels observed in males and females (A), patients with ulcerative colitis and Crohn's disease (B), patients on treatment and not on biologics (C), and, finally, patients physically active or inactive concerning baseline disease activity (D). Met: Metabolic rate; NS: Not significant.

Figure 3

Importance given by patients to discuss physical activity with their gastroenterologist, major sports played by them, and barriers to physical activity related to inflammatory bowel disease. A and B: The importance given by patients to discuss with their gastroenterologist physical activity stratified by physical activity level (A) and detailed by individual Likert scale score (B); C: Main sports stated by participants; D: Factors related to inflammatory bowel disease hinder regular physical activity.

Figure 4

Forest plot showing predictors analysis of physical inactivity analysis among clinical and demographic variables evaluated by binary logistic regression. CD: Crohn's disease; UC: Ulcerative colitis; OR: Odds ratio.