Introduction

Physical inactivity is currently recognized as a global epidemic that necessitates collective action, and affects approximately 33% of the global population (1,2). Physical inactivity is known to be a significant risk factor for several gastrointestinal diseases such as colon cancer, metabolic dysfunction-associated steatotic liver disease, and inflammatory bowel diseases (3-5).

Aims & Methods

The aim of this study was to determine the beliefs, attitudes, and knowledge levels of gastroenterologists on Physical Activity (PA), and exercise. A survey was created by researchers to assess the beliefs, attitudes, and knowledge levels of gastroenterologists regarding PA, exercise, and healthy nutrition. Exploratory Factor Analysis (EFA) was conducted to simplify the survey interpretation by reducing the number of items into sub-dimensions and assessing construct validity. The internal consistency of each factor was assessed using Cronbach's alpha. Latent class analysis was conducted to categorize gastroenterologists' responses to items, identify positive and negative attitudes classes towards each factor.

Results

The study involved 143 gastroenterologists who were residents (30%), clinicians (29%), or academicians (41%). A majority of the gastroenterologists (78%) thought they had knowledge about physical activity and exercise. Following the provided brief information, this rate increased to 93%. Based on the participants' responses, EFA identified five factors in the questionnaire: i. effectiveness of PA and exercise; ii. necessity or harm of PA and exercise; iii. barriers to recommend exercise; iv. success in behavior change in patients; v. tendency to consult a physiotherapist or dietician. The responses to the five factors determined by EFA were categorized into two classes as positive and negative attitudes by latent class analysis (Table 1).The items showed high or satisfactory levels of internal consistency overall and for specific factors, ranging between 0.559 and 0.842. Although, 46% of the participants believed in the effectiveness of PA and exercise, 24% of them believed that PA was unnecessary or harmful. Three out of four gastroenterologists reported difficulty in prescribing exercise for patients with comorbidities. Additionally, they reported a rate of 81% for consulting their patients with a physiotherapist or a dietitian and a rate of 88% for achieving successful modification of patients' diet or exercise program. However, the reported rates for regularly or consistently seeking advice from a dietitian and physiotherapist were significantly different (respectively 36% and 76%; p<0.001).

Factors	Positive attitudes N (%)	Negative attitudes N (%)
Factor 1 Effectiveness of PA and exercise	66 (46)	77 (54)
Factor 2 Necessity or harm of PA and exercise	34 (24)	109 (76)
Factor 3 Barriers to recommend exercise	109 (76)	34 (24)
Factor 4 Success in behavior change in patients	126 (88)	17 (12)
Factor 5 Tendency to consult a physiotherapist or dietician	116 (81)	27 (19)

Conclusion

The gastroenterologists have an awareness on their lack of knowledge about lifestyle modifications, and also are willing to consult with physiotherapists, especially for the patients with comorbidities. Participation of gastroenterologists in training seminars on PA counseling and strengthening multidisciplinary collaboration may contribute to the improvement of health services.

References

1. Kohl 3rd HW, Craig CL, Lambert EV, Inoue S, Alkandari JR, Leetongin G, et al. The pandemic of physical inactivity: global action for public health. The lancet. 2012;380(9838):294-305.
2. Pratt M, Varela AR, Salvo D, Kohl III HW, Ding D. Attacking the pandemic of physical inactivity: what is holding us back? : BMJ Publishing Group Ltd and British Association of Sport and Exercise Medicine; 2020. p. 760-2.
3. Izquierdo-Gomez R, Martínez-Gómez D, Shields N, Del Rosario Ortola-Vidal M, Rodríguez-Artalejo F, Cabanas-Sánchez V. The role of physical activity in the association between disability and mortality among US older adults: a nationwide prospective cohort study. Geroscience. 2024.
4. Rector RS, Thyfault JP. Does physical inactivity cause nonalcoholic fatty liver disease? Journal of applied physiology. 2011;111(6):1828-35.
5. Gravina AG, Pellegrino R, Durante T, Palladino G, D’Onofrio R, Mammone S, et al. Inflammatory bowel diseases patients suffer from significant low levels and barriers to physical activity: The “BE-FIT-IBD” study. World Journal of Gastroenterology. 2023;29(41):5668.
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Introduction

Inflammatory bowel diseases (IBD), including Crohn’s disease and ulcerative colitis, are chronic conditions with alternating phases of flare-ups and remission. Due to the persistent and often severe course of these diseases, effective treatment significantly improves patients' daily activities and overall functioning. [1] Given the uncertain prognosis and the frequent disease progression despite pharmacotherapy, it is important to explore additional interventions that could support traditional treatments. While physical activity may provide both anti-inflammatory and functional benefits in IBD, data on its efficacy and safety during disease exacerbation remain scarce. [2] This pilot study is the first real-world investigation into the effects of a supervised physical exercise training in patients hospitalized due to IBD flare.

Aims & Methods

This study aimed to evaluate the effects of an individualized, moderate-intensity, supervised physical exercise training on exercise tolerance, inflammation, and fatigue resistance in patients hospitalized due to IBD flare, and to explore baseline factors associated with greater benefit from the intervention. Patients were randomly assigned to an intervention group, receiving individual cycloergometer training during hospitalization, or to a control group without exercise. Both groups were well balanced at baseline, with no significant differences in demographic, clinical, or laboratory parameters. At both admission and discharge, all patients underwent standardized graded exercise tests to establish their exercise tolerance based on the lactate threshold and heart rate/power output response. Furthermore laboratory assessments, and the Functional Assessment of Chronic Illness Therapy – Fatigue (FACIT-F) questionnaire were conducted.

Results

A total of 22 patients were included in the study, with 13 patients in the intervention group and 9 patients in the control group. Although FACIT-F scores improved in both groups, the intervention group demonstrated a significantly greater improvement (median change –39 points; IQR –49 to –11; p = 0.014) compared to the control group (median change –25 points; IQR –52 to –6; p = 0.30). Baseline FACIT-F scores were significantly correlated with changes in heart rate response response during exercise: patients with greater baseline fatigue and poorer functional status experienced greater improvement in exercise tolerance (r = –0.62, p = 0.028). Platelet counts remained more stable in the intervention group (median change +10 ×10³/µl; IQR –65 to +45) compared to a significant increase in the control group (median +74 ×10³/µl; IQR +44.5 to +101.75; p = 0.046). In the intervention group, greater reductions in calprotectin were strongly correlated with more favorable heart rate responses during a graded exercise test (r = –0.92, p = 0.009).

Conclusion

Supervised training program during hospitalization for IBD flare was associated with improved fatigue resistance and more favorable inflammatory responses. Patients with worse baseline functioning obtained greater benefit in exercise tolerance. These findings support the feasibility and potential therapeutic role of individualized physical activity in acute IBD care and highlight the need for further investigation in real-world settings.

References

1. Farrell D, Artom M, Czuber-Dochan W, Jelsness-Jørgensen LP, Norton C, Savage E. Interventions for fatigue in inflammatory bowel disease. Cochrane Database Syst Rev. 2020 Apr 16;4(4):CD012005. doi: 10.1002/14651858.CD012005.pub2.
2. Achtenberg M, Cibor D, Zwolińska-Wcisło M. Structured exercise in patients with inflammatory bowel disease: a literature review. Gastroenterology Review/Przegląd Gastroenterologiczny. 2025;20(1):36-40. doi:10.5114/pg.2025.148473.

Disclosure

Magdalena Achtenberg has received lecture fees and/or travel grants from Ferring and Eli Lilly, unrelated to the present work. Tomasz Dziubyna has received travel grants from Fresenius, unrelated to the present work. Małgorzata Zwolińska-Wcisło, Dorota Cibor, Karolina Gazda, Magdalena Wyrzykowska, Piotr Kosieniak, Maria Wiśniewska, Jerzy A. Żołądź, Marcin Grandys and Joanna Majerczak declare no conflict of interest.

Introduction

Emerging epidemiologic evidence suggested that moderate-to-vigorous physical activity (MVPA) was associated with a lower risk of steatotic liver disease (SLD).¹ However, several issues remain unanswered. First, prospective association between PA and hepatic steatosis was less investigated, with few studies mainly in Western populations,^{2, 3} but not in Chinese populations. Second, since sedentary behavior and PA are interrelated and may jointly affect the health outcomes,⁴ a key concern is whether moderate-to-vigorous physical activity (MVPA) can mitigate the detrimental link between sedentary time and SLD. Moreover, PA was shown to affect the gut microbiome by altering the bile acid profile and promoting the production of metabolites such as short-chain fatty acids^5,6 with benefit to SLD in animal models.⁷ However, PA-related gut microbes and metabolites, as well as their associations with SLD risk were rarely investigated at the population level.

Aims & Methods

We investigated the association between PA and the SLD risk in a cohort of 2,942 adults from the Anhui Liver Disease Study (ALDS), in which PA and SLD were measured using a validated self-reported questionnaire and transient elastography, respectively. In a subset of ALDS (n=330), we further identified gut microbial changes and serum metabolites related to MVPA assessed by accelerometer, and examined their associations with SLD risk. Fecal samples for 16S ribosomal RNA sequencing were collected twice (1-year apart) to evaluate 1-year microbial changes, targeted metabolomics analysis of baseline serum samples was performed using liquid chromatography tandem mass spectrometry, while PA was measured using a wrist-worn accelerometer for 3 consecutive days at baseline. Cox and Logistic regression models were used to calculate hazard ratios (HRs) and odds ratios (ORs) with 95%CIs, respectively.

Results

From 2020 to 2025, 565 SLD cases were newly diagnosed. MVPA levels were inversely (per 1-SD increase HR=0.91, 95%CI: 0.83–0.99) and sedentary hours were positively associated with the risk of SLD (HR=1.13, 95%CI: 1.03–1.24). Relative to long-low group (i.e., participants with long sedentary time and low MVPA level), HRs (95%CIs) for SLD risk were 1.00 (0.78–1.28), 0.93 (0.73–1.19), and 0.75 (0.58–0.97) for long-high, short-low, and short-high group, respectively. The α-diversity decreased in the low MVPA group (p=0.024) and the β-diversity changed in both low and high MVPA groups (all p=0.001). We identified 14 microbial genera whose relative abundance significantly changed in low or high MVPA group (all p_FDR<0.05). Among these genera, Proteus and Synergistes were associated with both low and high MVPA but in opposite directions, and were associated with SLD with ORs (95%CIs) of 1.15 (1.01–1.32) and 0.91 (0.78–1.06), respectively. Targeted metabolomics showed an inverse association between MVPA and serum L-Valine (β=-0.068, p_FDR=0.031), which was positively related to SLD risk (OR=16.40, 95%CI: 2.67–111.94). Significant correlations were also found between PA-associated microbial genera and L-Valine.

Conclusion

MVPA may modify gut microbial diversity and composition, as well as serum metabolite levels, and is associated with lower SLD risk, whereas sedentary behavior is associated with higher SLD risk.

References

[1] European Association for the Study of the Liver . Electronic address eee, European Association for the Study of D, European Association for the Study of O, et al. EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). J Hepatol 2024;81:492-542.
[2] McDonough DJ, Mathew M, Pope ZC, et al. Aerobic and Muscle-Strengthening Physical Activity, Television Viewing, and Nonalcoholic Fatty Liver Disease: The CARDIA Study. Journal of Clinical Medicine 2023;12.
[3] Liu M, Ye Z, Zhang Y, et al. Accelerometer-derived moderate-to-vigorous physical activity and incident nonalcoholic fatty liver disease. BMC Medicine 2024;22.
[4] Ekelund U, Tarp J, Steene-Johannessen J, et al. Dose-response associations between accelerometry measured physical activity and sedentary time and all cause mortality: systematic review and harmonised meta-analysis. Bmj 2019;366:l4570.
[5] Penney N, Barton W, Posma JM, et al. Investigating the Role of Diet and Exercise in Gut Microbe-Host Cometabolism. mSystems 2020;5.
[6] Campaniello D, Corbo MR, Sinigaglia M, et al. How Diet and Physical Activity Modulate Gut Microbiota: Evidence, and Perspectives. Nutrients 2022;14.
[7] Chen J, Vitetta L. Gut Microbiota Metabolites in NAFLD Pathogenesis and Therapeutic Implications. Int J Mol Sci 2020;21.

Introduction

Patients with inflammatory bowel disease (IBD) tend to be less physical active, whilst maintaining an active lifestyle has been associated with enhanced disease control, diminished fatigue, and improved quality of life (1,2,3).

Aims & Methods

This study aims to evaluate the feasibility and potential impact of a specially designed exercise program for IBD patients.
Patients with IBD participated in a 16-week exercise program based on their individual fitness level, between March and June 2023. All outcomes were measured before and after the program. Body composition included, BMI, muscle mass and fat percentage. Physical fitness was based on performance of the Fundamental Motor Skills. Effect on quality of life, fatigue and disease control was assessed using validated questionnaires. For statistical analyses, a paired t-test or Wilcoxon matched paired rank test was used.

Results

In total 32 patients were included in the exercise program. Mean age was 50.1 years (SD 12.3), 37.5% were male, and 50% had Crohn’s disease (Table 1). The full program was completed by 84.4% of all patients, and average rating of the program was 8.6 out of 10. After 16 weeks, muscle mass improved compared to baseline (P=0.020) and fat percentage decreased (P=0.003). Physical fitness improved significantly; lower body strength and coordination (P=0.006), flexibility (p=0.002), speed and endurance (P<0.001). Quality of life improved with on average 8 points on the Inflammatory Bowel Disease Questionnaire. The program significantly improved fatigue scores (P=0.013). Disease control showed no significant improvement after the program.

Table 1. Baseline characteristics

		Overall (n=32)
Mean age, y (SD)		50.1 (12.3)
Male		12 (37.5)
Smoking	Current	3 (9.4)
Physical activity, d (IQR)a,b	Light / Moderate / High	4 (2-7) / 2 (1-4) / 1 (0-2)
Diagnosis	Crohn's disease	16 (50)
	Ulcerative Colitis	16 (50)
Median diagnosis age, y (IQR)		34.5 (25-47.3)
Abdominal surgery (Yes)		10 (31.1)
Stoma (Yes)		2 (6.3)

Note: data are described as numbers (percentages) unless stated otherwise.
Abbreviations: CD, Crohn's disease; d, days; IQR, interquartile range; n, number; SD, standard deviation; UC, ulcerative colitis; y, year.
^a Physical activity is based on the patients who filled in the questionnaire (n=25)
^b Physical activity is categorized in light, moderate and high. Light is walking. Moderate is cycling, exercising at a low intensity level. High exercise is working out or dancing.

Conclusion

This pilot study shows that a specially designed exercise program is feasible and has a positive effect on IBD patients. These findings underline the importance of physical activity in IBD patients and can be used as an initial step towards integrating an exercise program in standard IBD care.

References

1. Fagan G, Osborne H, Schultz M. Physical Activity in Patients with Inflammatory Bowel Disease: A Cross-Sectional Study. Inflamm Intest Dis. 2021;6(2):61-9.
2. Agrawal T, Acquah I, Dey AK, Glassner K, Abraham B, Blankstein R, et al. Prevalence of cardiovascular risk factors in a nationally representative adult population with inflammatory bowel disease without atherosclerotic cardiovascular disease. Am J Prev Cardiol. 2021;6:100171.
3. Mareschal J, Douissard J, Genton L. Physical activity in inflammatory bowel disease: benefits, challenges and perspectives. Curr Opin Clin Nutr Metab Care. 2022;25(3):159-66.

Disclosure

Conflicts of interest: N. Van de Pol, E.H. Visser, D. Leemreis-van Noord, and V. de Jonge have nothing to declare; C.J. van der Woude has received grants from ZonMW, Falk and Pfizer, has received consulting fees from Janssen, Galapagos, and Pfizer, has received payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Ferring and AbbVie and had leadership roles in the European Crohn's & Colitis organisation, United European Gastroenterology council and the Dutch Association for Gastroenterology (NVGE); A.C. de Vries has served on advisory boards for Takeda, Janssen, Bristol Myers Squibb, Abbvie, Pfizer, and Galapagos and has received unrestricted research grants from Takeda, Janssen, and Pfizer outside the submitted work; R.L. West has received payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Ferring, Pfizer, Galapagos, AbbVie and Janssen.

Introduction

Physical activity (PA) is associated with improved quality of life in patients with Crohn’s disease (CD). However, there is limited evidence of its impact on the clinical course of the disease and the separate effects of aerobic and anaerobic-resistance PA.

Aims & Methods

We aimed to evaluate the association between PA and the incidence of relapse in patients with CD in clinical remission and to assess the role of PA in patients with CD using patient-reported outcome measures (PROMs), with separate analyses for PA type. A prospective cohort study of adult patients with CD in clinical remission followed for one year or until relapse according to the Harvey Bradshaw Index. At baseline, participants completed a detailed PA questionnaire, nutritional questionnaires, and a patient-reported outcomes measurement information system (PROMIS). Multivariable Cox proportional hazards models were used to assess the association between PA and relapse risk, adjusted for confounders, including dietary factors and fecal calprotectin levels.

Results

A total of 106 patients (mean age 37.9 ± 13.9 years) were included and followed for 9.9±3.2 months, during which 23 (21.7%) experienced clinical relapse. PA at least twice a week was associated with a reduced risk of relapse (HR = 0.26, 95% CI 0.09–0.79). Specifically, only aerobic activity was significantly associated with a reduced risk of relapse (HR = 0.31, 95% CI 0.10-0.95). High-resistance PA was significantly associated with better quality of life parameters, including pain interference (P=0.013), sleep disturbance (P=0.040), better physical function (P=0.029), and enhanced social roles (P=0.020). While aerobic PA showed benefit in physical function (P=0.016).

Conclusion

PA in general and specifically aerobic PA, is associated with a reduced risk of relapse in patients with CD in remission. Additionally, resistance PA is associated with a better quality of life. These findings highlight the importance of incorporating PA into the management of CD in remission state.

Disclosure

None