OBJECTIVE: Despite the suggested benefits of exercise training in the
prevention and management
of chronic diseases, few data exist regarding the safety of exercise
in Crohn's disease and whether or not exercise may have beneficial effects
on patients' health. We performed a pilot study to evaluate
the effects of regular light-intensity exercise on sedentary patients
with Crohn's disease. METHODS: Sedentary patients with inactive or mildly
active Crohn's disease were eligible for the study. A
thrice-weekly, 12-wk walking program was supervised, although if subjects
could not attend the
group walking sessions they were allowed to walk on their own. Logbooks
of performance were
maintained, and individual exercise heart rate goals were established.
Measures performed at
baseline and at study completion included the Inflammatory Bowel Disease
Stress Index, the
Inflammatory Bowel Disease Quality of Life Score, the Harvey and Bradshaw
Simple Index, the
Canadian Aerobic Fitness Test, VO2 Max, and body mass index (BMI).
RESULTS: Twelve
subjects completed the 12-wk exercise program. Subjects walked an average
of 2.9 sessions/wk, at an average of 32.6 min/session, and for an average
distance of 3.5 km/session. Statistically
significant improvements at study end were seen by all measures, with
a trend toward reduction in
BMI. No patient's disease flared during the study. CONCLUSIONS: Sedentary
patients with
Crohn's disease can tolerate low-intensity exercise of moderate
duration without an exacerbation of symptoms. Twelve weeks of walking was
adequate to elicit psychological and physical improvements and did not
adversely affect disease activity.
EFFECT OF A LOW-IMPACT EXERCISE PROGRAM ON BONE MINERAL DENSITY IN CROHN'S
DISEASE: A RANDOMIZED CONTROLLED TRIAL.
Robinson RJ, Krzywicki T, Almond L, al-Azzawi F, Abrams K, Iqbal SJ,
Mayberry JF. Gastrointestinal Research Unit, Leicester General Hospital,
England. Gastroenterology 1998 Jul;115(1):36-41
BACKGROUND & AIMS: Physical exercise increases bone mineral density
(BMD) in healthy young adults and slows the rate of bone loss in later
life. The aim of this randomized controlled trial was to investigate
the effect of exercise on BMD in patients with Crohn's disease. METHODS:
A total of 117 patients with Crohn's disease were randomized to a control
group or a low-impact exercise program of increasing intensity. BMD (g/cm2)
was measured at baseline and 12 months at the hip and spine (L2-L4) by
dual energy x-ray absorptiometry. RESULTS: Nonsignificant gains in BMD
occurred at the hip and spine in the exercise group compared with controls
(P > 0.05). In fully compliant patients, BMD increased by 3.54% (7.95%)
at the femoral neck, 2.97% (7.7%) at the spine, 4.1% (10.26%) at Ward's
triangle, and 7.77% (8.2%) at the greater trochanter. Compared with controls,
gain in BMD at the greater trochanter was statistically significant (difference
in means, 4.67; 95% confidence interval, 0.86-8.48; P = 0.02). Increases
in BMD were significantly related to the number of exercise sessions completed
(femoral neck; r = 0.28; 95% confidence interval, 0.10-0.45; P = 0.04).
CONCLUSIONS: Progressive low-impact exercise is a potentially effective
method of increasing BMD in Crohn's disease. If sustained, the increases
in BMD may reduce the risk of osteoporotic fracture.
EXERCISE CAPACITY IN PATIENTS UNDERGOING PROCTOCOLECTOMY AND SMALL BOWEL
RESECTION FOR CROHN'S DISEASE.
Brevinge H, Berglund B, Bosaeus I, Tolli J, Nordgren S, Lundholm K.
Department of Surgery, Sahlgrenska Hospital, University of Goteborg, Sweden.
Br J Surg 1995 Aug;82(8):1040-5
The effect of proctocolectomy and small bowel resection on working capacity
has not been assessed objectively in previous research. Twenty-nine patients
with Crohn's disease were investigated with
cycle ergometry and a questionnaire, following proctocolectomy with
and without small bowel
resection. Maximal exercise load is known to correspond well with working
capacity, particularly
when account is taken of body composition and metabolic variables.
Maximal exercise load was
reduced marginally (by 9 per cent) in patients without small bowel
resection and by 22 per cent in patients with moderate small bowel resection
(15-30 per cent resection). Patients with extensive bowel resection (more
than 50 per cent) had a 40 per cent reduction in the maximal exercise load.
This reduction in maximal exercise load was greater than predicted
when accounting for reduction in muscle mass. All patients had a normal
oxygen uptake including resting energy expenditure. Urinary sodium and
magnesium excretion was low in the group with moderate bowel resection,
whereas the extensively resected patients were malnourished and had a reduced
body cell mass. The authors conclude that the significantly reduced working
capacity was of multifactorial origin secondary to malabsorption. However,
the patients seemed unaware of the degree of their diminished working capacity.
This reduced capacity makes it unlikely that they would be able to perform
any labour involving high energy consumption at the level of 500-700 W,
and this inability was reflected by a high rate of unemployment among
the patients.
RISK INDICATORS FOR INFLAMMATORY BOWEL DISEASE.
Persson PG, Leijonmarck CE, Bernell O, Hellers G, Ahlbom A. Department
of Epidemiology, Karolinska Institutet, Stockholm, Sweden. Int J Epidemiol
1993 Apr;22(2):268-72
We investigated the association between different risk indicators and
inflammatory bowel disease in
a case-control study based on the population of Stockholm County during
1980-1984. Information
on physical activity, oral contraceptives, some previous diseases and
childhood characteristics was
collected using a postal questionnaire for 152 cases of Crohn's disease,
145 cases of ulcerative
colitis, and 305 controls. The relative risk (RR) of Crohn's disease
was inversely related to regular physical activity and estimated at 0.6
(95% CI: 0.4-0.9) and 0.5 (95% CI: 0.3-0.9) for weekly and daily exercise,
respectively. Having psoriasis prior to the inflammatory bowel disease
was associated with an increased relative risk of Crohn's disease (RR =
2.9, 95% CI: 1.1-7.9). Use of oral contraceptives was associated with an
increased RR of 1.7 for both Crohn's disease and ulcerative colitis. Crohn's
disease confined to the colon and total ulcerative colitis at diagnosis
were most strongly associated with oral contraceptives.