Introduction
Inflammatory bowel disease (IBD) is a chronic relapsing–remitting condition that impairs health-related quality of life (HRQoL), even in remission. Beyond physical symptoms, IBD is associated with anxiety, depression, and persistent fatigue, affecting up to 70% of patients during flares and 40% in remission1. Despite its impact, specific therapies for chronic fatigue in IBD are lacking. Physical exercise has shown benefits in other immune-mediated diseases2,3, but data in IBD are limited. A previous pilot study from our group showed that a 12-week supervised exercise programme improved fatigue, HRQoL, and fitness.4 To further investigate these findings in a larger cohort, this RCT was conducted.
Aims & Methods
In a multicentre, randomised trial, adults (18–67 years) with quiescent IBD and chronic fatigue (≥3 months; IBD-F section I ≥11) were randomised 1:1 to the intervention or control group. The intervention comprised a 12-week supervised intensive exercise programme with three personalised one-hour sessions per week, each consisting of 30 min of aerobic training and 30 min of resistance training and included cardiopulmonary exercise testing within the intervention group pre- and post-intervention. Controls received standard care and written advice about daily exercise. Primary outcomes were fatigue (IBD-F) and HRQoL (IBDQ) at 12 weeks. Secondary outcomes included anxiety and depression (PROMIS), sleep quality (PSQI), cardiorespiratory fitness, body composition, disease activity, adverse events and long-term effects on fatigue and HRQoL (6 and 12 months).
Results
In total, 100 patients were randomised. Of them, 95 participants completed the study and were included in the analysis (mean age 43.2 ± 11.5 years; 74% female; 62% CD, 36% UC, 2% IBD-U). Fatigue decreased more in the intervention group as compared to the control group (adjusted mean 36.5 ± 2.6 vs 45.3 ± 2.6; p = 0.014, respectively) and HRQoL increased more in the intervention group as compared to the control group (adjusted mean 175.6 ± 2.9 vs 166.6 ± 2.9; p = 0.024, respectively); both remained significant after Bonferroni correction. Longitudinal mixed-model analyses up to 12 months showed significant time-by-group interactions for IBD-F section 1 (p = 0.023) and IBDQ total (p = 0.037), while the interaction for IBD-F total was not statistically significant (p = 0.072). Anxiety (PROMIS-A) decreased (p = 0.030). Cardiorespiratory fitness improved in the intervention group compared with pre-intervention measurements (VO₂max p < 0.001, maximum power p < 0.001, heart rate recovery after 2 min p = 0.014) and body fat decreased (p = 0.024). Depressive symptoms (PROMIS-D) and sleep quality showed no significant group differences.
Conclusion
This 12-week personalised, supervised exercise programme improved fatigue and HRQoL in patients with quiescent IBD and chronic fatigue, and was additionally associated with improvements in anxiety and physical fitness. Benefits appeared to persist during follow-up, although the magnitude of effect attenuated over time. These findings support intensive exercise as a promising strategy for managing IBD-related fatigue.
References
- D'Silva A, Fox DE, Nasser Y, et al. Prevalence and Risk Factors for Fatigue in Adults With Inflammatory Bowel Disease: A Systematic Review With Meta-Analysis. Clin Gastroenterol Hepatol. 2022;20(5):995-1009.e7. doi:10.1016/j.cgh.2021.06.034
- Cramp F, Hewlett S, Almeida C, et al. Non-pharmacological interventions for fatigue in rheumatoid arthritis. Cochrane Database Syst Rev. 2013;2013(8):CD008322. Published 2013 Aug 23. doi:10.1002/14651858.CD008322.pub2
- Luo B, Xiang D, Ji X, et al. The anti-inflammatory effects of exercise on autoimmune diseases: A 20-year systematic review. J Sport Health Sci. 2024;13(3):353-367. doi:10.1016/j.jshs.2024.02.002
- van Erp LW, Roosenboom B, Komdeur P, et al. Improvement of Fatigue and Quality of Life in Patients with Quiescent Inflammatory Bowel Disease Following a Personalized Exercise Program. Dig Dis Sci. 2021;66(2):597-604. doi:10.1007/s10620-020-06222-5
Disclosure
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