key: cord-0064374-e10trpi6
authors: Scheffers, L; van den Berg, L E; Pijnenburg, M W; Utens, E M; Dieleman, G C; van der Ploeg, A T; Helbing, W A; Escher, J C
title: P515 A 12-week tailored physical training program including dietary advice in children with Inflammatory Bowel Disease: a randomized crossover trial
date: 2021-05-27
journal: J Crohns Colitis
DOI: 10.1093/ecco-jcc/jjab076.637
sha: 539938c8c3c39f15250cd61eff83e7ef6bbc4272
doc_id: 64374
cord_uid: e10trpi6

BACKGROUND: Inflammatory Bowel Disease (IBD) is a chronic inflammatory disease of the gastrointestinal tract. Recently, physical activity has been suggested to improve the quality of life and course of disease in adult IBD patients. The aim of this study was to investigate physical functioning in paediatric IBD patients and to determine the effects of a tailored 12-week lifestyle intervention including a physical training program. METHODS: Figure 1 shows our study design and measurements. The tailored 12-week lifestyle intervention consisted of 3 strenuous physical training sessions a week and dietary advice. Effects on exercise capacity, endurance, physical activity levels, disease activity, quality of life, and fatigue were measured in paediatric IBD patients. Mild disease activity was defined as a PCDAI between 10 - 27.5 or PUCAI between 10 - 34. [Image: see text] RESULTS: Sixteen paediatric IBD patients (median age 15 [9 - 17]) were included, 13 patients successfully completed the training program, 2 patients are still participating. At baseline, most patients had mild disease activity (n=9). Patients had reduced exercise capacity (76.8%±17.7% of predicted PeakVO(2) , and reduced physical activity levels as shown by 80.3%±7.4% of measured time being spent in sedentary activity. PCDAI/PUCAI scores decreased significantly over the intervention period (13.8±11.7 vs. 3.65±4.5, P=0.002). Fecal calprotectin also decreased significantly (400 [18–3089] vs. 128 [20–2704], P=0.041). All patients but one had no changes in medical regimens before or during the lifestyle intervention that could have influenced disease activity. After the 12-week lifestyle intervention period, 9 out of 13 patients were in clinical remission. Maximum walked distance increased significantly (503±69 vs. 540±77 meters, P=0.001), although PeakVO(2) and percentage of time spent in moderate-to-vigorous activity did not. Patients improved on overall quality of life measured by the Impact III questionnaire (+2.4 points, p=0.017). The Child Health Questionnaire showed a significant improvement on the child-reported physical functioning scale and on 5 parent-reported scales of quality of life. Child-reported fatigue measured by the PedsQol MFS did not improve significantly, parents-reported fatigue did. No changes were found on mentioned outcomes during the control period. After baseline measurements, the COVID-19 lock-down period started, possibly affecting normal daytime activities of the patients during the lifestyle intervention period. CONCLUSION: A 12-week tailored physical training program including dietry advice is safe and beneficial for paediatric IBD patients and may contribute to better control of inflammation.

Background: One of the most effective anti-inflammatory agents in ulcerative colitis (UC) are glucocorticosteroids (GCS), which block the release of arachidonic acid, prevent the formation of inflammatory mediators, have an immunomodulatory effect, affect tissue fibrinolysis, which leads to a decrease in inflammation and bleeding of the mucous membrane. However, in 9-16% of patients UC, hormone resistance develops. Objective: to establish the dependence of hormonal resistance on the frequency of GCS courses for 12 months without taking into account the starting dosage of GCS. Methods: 96 patients with moderate to severe UC (Truelove-Witts) who received several courses of GCS. Males 51 (53.1%), females 45 (46.9%). The median age was 34±4.2 years. The duration of the anamnesis was from 3 to 7 years (Me 4 years). Patients were divided into three groups depending on the frequency of GCS courses for 12 months without taking into account the starting dosage of GCS. Group 1-st (n=30) received ≤1 course of GCS for 12 months for UC exacerbation, group 2-nd (n=34)-1-2 courses of GCS, group 3-rd (n=32)-3 ≥ courses of GCS. The frequency of hormone resistance (HR) was compared in groups of patients. Results: Among 96 patients with UC, HR was established in 12 (12.5%) patients. In group 1 of UC patients who received less than 1 course of GCS for 12 months for UC exacerbation, patients with HR were 1 (3.3%), in group 2-2 (5.9%) patients with HR, in group 3-9 (28.1%) patients with HR. When comparing groups 1-st and 2-nd, it was found that the incidence of HR in both patients who received 1-2 courses of GCS for 12 months did not differ (OR-1.813; 95% CI 0.156 -21.057; p>0.05). When comparing the 1-st and 3-rd groups showed that the incidence of HR in patients who received 3 or more courses of corticosteroids within 12 months is significantly higher than in patients who received ≤1 course of corticosteroids within 12 months (OR-0.088; 95% CI, 0.010-0.747; p<0.05). When comparing the 2-nd and 3-rd groups showed that the incidence of HR in patients who received more than 3 courses of corticosteroids within 12 months also has a tendency to a higher risk of development of HR than the patients receiving 2 or fewer courses of corticosteroids within 12 months (OR-0.160; 95% CI, 0.032-0.810; p<0.05).

The frequency of courses of glucocorticosteroid therapy for exacerbation of the disease for 12 months affects the risk of developing hormone resistance in patients with ulcerative colitis.

A 12-week tailored physical training program including dietary advice in children with Inflammatory Bowel Disease: a randomized crossover trial activity has been suggested to improve the quality of life and course of disease in adult IBD patients. The aim of this study was to investigate physical functioning in paediatric IBD patients and to determine the effects of a tailored 12-week lifestyle intervention including a physical training program. Methods: Figure 1 shows our study design and measurements. The tailored 12-week lifestyle intervention consisted of 3 strenuous physical training sessions a week and dietary advice. Effects on exercise capacity, endurance, physical activity levels, disease activity, quality of life, and fatigue were measured in paediatric IBD patients. Mild disease activity was defined as a PCDAI between 10 -27.5 or PUCAI between 10 -34. Results: Sixteen paediatric IBD patients (median age 15 [9 -17]) were included, 13 patients successfully completed the training program, 2 patients are still participating. At baseline, most patients had mild disease activity (n=9). Patients had reduced exercise capacity (76.8%±17.7% of predicted PeakVO 2 , and reduced physical activity levels as shown by 80.3%±7.4% of measured time being spent in sedentary activity. PCDAI/PUCAI scores decreased significantly over the intervention period (13.8±11.7 vs. 3.65±4.5, P=0.002). Fecal calprotectin also decreased significantly (400 [18-3089] vs. 128 [20-2704], P=0.041). All patients but one had no changes in medical regimens before or during the lifestyle intervention that could have influenced disease activity. After the 12-week lifestyle intervention period, 9 out of 13 patients were in clinical remission. Maximum walked distance increased significantly (503±69 vs. 540±77 meters, P=0.001), although PeakVO 2 and percentage of time spent in moderate-to-vigorous activity did not. Patients improved on overall quality of life measured by the Impact III questionnaire (+2.4 points, p=0.017). The Child Health Questionnaire showed a significant improvement on the child-reported physical functioning scale and on 5 parent-reported scales of quality of life. Child-reported fatigue measured by the PedsQol MFS did not improve significantly, parents-reported fatigue did. No changes were found on mentioned outcomes during the control period. After baseline measurements, the COVID-19 lock-down period started, possibly affecting normal daytime activities of the patients during the lifestyle intervention period. Conclusion: A 12-week tailored physical training program including dietry advice is safe and beneficial for paediatric IBD patients and may contribute to better control of inflammation.

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