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

Eight hospitals in the southwest of the Netherlands collaborate to provide high quality, uniform care for inflammatory bowel disease (IBD). To achieve this, a care pathway (CP) was implemented for treating IBD with biologics and small molecules (1). The CP is a decision-support tool that provides guidelines for medication prescribing, procedures, treatment adjustments, and recommendations for follow-up.

Aims & Methods

This study aimed to evaluate the effect of a CP on patient outcomes and healthcare utilization.
A longitudinal multicentre non-randomised cohort study with a baseline observation period (December 2020 – December 2021) and a follow-up period (March 2022 – March 2023) was conducted, in which adult patients with IBD treated with biologics or small molecules were included. Outcomes were collected according to the International Consortium for Health Outcomes Measurement (ICHOM) standard set from electronic health records or through validated questionnaires. Missing data were handled using single imputation nested within a bootstrap procedure. Effect of the CP on these outcomes were analysed with case-mix adjusted (generalized) linear mixed models.

Results

A total of 1,173 patients participated in the study, with the majority being female (55%) and a median age of 45 years (IQR 33-58). Most patients had Crohn's disease (64%). The CP was associated with a 0.22 increase on the ibd-control-8 score (β=0.22, p=0.28), and an increase on the probability of achieving endoscopic/radiologic (β=0.14, p=0.29), biochemical (β=0.18, p=0.22) and patient-reported remission (β=0.19, p=0.21). Probability of clinician-reported remission decreased slightly (β=-0.09, p=0.59). Emergency room visits (β=-0.36, p=0.13), hospital admissions (β=-0.41, p=0.10), and length of stay (β=-0.09, p=0.56) reduced, although these associations were not significant. The CP had no effect on quality of life (β=0.00, p=0.83), anaemia probability (β=-0.01, p=0.95) or on nutritional status (β=-0.01, p=0.34).

Conclusion

A CP for the management of IBD with biologicals and small molecules has clinically significant potential to reduce healthcare utilization, while improving patient-reported disease control, and disease remission. These results emphasize that clinical care pathways can improve care and reduce healthcare utilisation for complex diseases. However, the adherence to the CP and whether these results lead to a reduction in healthcare costs should be further investigated.

References

(1) van Linschoten R, van Leeuwen N, Nieboer D, Birnie E, Scherpenzeel M, Verweij KE, et al. Value-based care pathway for inflammatory bowel disease: a protocol for the multicentre longitudinal non-randomised parallel cluster IBD Value study with baseline period. (2044-6055 (Electronic))

Disclosure

Drs. Visser received a speaker fee from Lilly, Prof. Dr. van der Woude reports grants from Pfizer and Janssen and personal fees from AbbVie and Celltrion, Dr. van Noord reports personal fees from Janssen, Takeda, and Falk, Dr. West reports personal fees from AbbVie, Janssen, and Pfizer outside the submitted work.

Introduction

In the southwest Netherlands, hospitals collaborate to provide high quality, uniform care for inflammatory bowel disease (IBD). To achieve this, a care pathway (CP) was implemented for treating IBD with biologics and small molecules (1). The CP consists of protocols addressing different stages in IBD treatment, such as initiation and switching of therapy, frequency and type of follow-up. This study assessed the adherence to the CP and identified barriers and facilitators to its implementation.

Aims & Methods

A mixed-methods study was conducted. Quantitative data was used to evaluate the adherence to different protocols of the CP and was collected retrospectively from electronic health records (EHRs) from December 2020 until March 2023. Surveys and semi-structured interviews were used to identify barriers and facilitators, using the Extended Normalisation Theory. Surveys were sent to all healthcare providers and interviews were conducted with gastroenterologists, IBD-nurses, healthcare assistants, and IT-personnel.

Results

A total of 299 patients were included. Adherence to the CP regarding the documentation of travel plans and vaccination status improved after implementing the CP (15% pre-implementation vs. 33% post-implementation), as well as written communication with general practitioners (31% vs. 83%) and body weight registration (12% vs. 50%). Among patients switching medication, 25% had a repeated screening for HIV, tuberculosis, and hepatitis B and C documented if prior tests were over a year old. Post-implementation, scheduling outpatient visits were more closely aligned with CP recommendations across CP protocols (57% vs. 100%), as did blood test ordering (10% vs. 44%). Disease activity scoring with validated questionnaires remained low (7% vs. 21%).  Adherence to registering medication adherence, current smoking status, and side effects during annual outpatient visits remained low (18% vs. 40%).
Of 85 surveys, 42 were completed, and 11 interviews were conducted. Facilitators were improving collaboration between healthcare providers and the potential to standardise care. Barriers included the complexity of the use in EHRs, difficulty for healthcare providers to change their current routine, and the heterogeneity of IBD.

Conclusion

A CP for the treatment of IBD with biologics and small molecules has been implemented to improve IBD care, however, adherence appears to be challenging, partially contributed to the difficulty healthcare providers experience in changing their behaviour. The gradual improvement indicates that increased familiarity with the CP may enhance adoption. Discrepancies between performed and documented tasks in EHRs may also contribute to lower adherence rates, which could be improved by audit and feedback sessions.

References

1. van Linschoten R, van Leeuwen N, Nieboer D, Birnie E, Scherpenzeel M, Verweij KE, et al. Value-based care pathway for inflammatory bowel disease: a protocol for the multicentre longitudinal non-randomised parallel cluster IBD Value study with baseline period. (2044-6055 (Electronic))

Disclosure

Drs. Visser received speaker fees from Lilly outside the submitted work. Prof. Dr. van der Woude reports grants from Pfizer and Janssen and personal fees from AbbVie and Celltrion outside the submitted work. Dr. van Noord reports personal fees from Janssen, Takeda, and Falk outside the submitted work. Dr. West reports personal fees from AbbVie, Janssen, and Pfizer outside the submitted work.

Introduction

20-50% of patients with inflammatory bowel disease (IBD) experience chronic pain during remission (1-5). The clinical features of IBD patients with and without abdominal pain during remission remain unknown.

Aims & Methods

In a cross-sectional pilot study of IBD patients in remission, our aims were to assess patient recruitment, compliance, feedback to optimise the questionnaires for future use and to determine clinical features that distinguish patients with and without abdominal pain. Online validated questionnaires about disease activity, symptoms and psychological assessment were sent to participants of the UK IBD BioResource (total sample 30,000 patients). Inclusion and exclusion criteria of the IBD BioResource main cohort were applied. Descriptive statistics were used in all participants to assess disease status. Descriptive and inferential statistics were applied to all participants in remission.

Results

​2,050 patients were approached and 291 (14.2%) participated. 249 completed the study and 244 patients were included in the analysis. Technical problems, lack of understanding of the relevance of some questionnaires and their length were identified as factors which affected completion in 35 participants. 244 patients were full responders with 122 (50%) participants in remission, out of which 33 (27%) experienced chronic abdominal pain. Comparison of the remission groups with (N=33) versus without (N=89) chronic abdominal pain yielded higher scores in patients with pain for the following: use of azathioprine (p=0.021); patient health questionnaire 15 score (p<0.001); gastrointestinal symptoms rating scale total score (p<0.001); coping resources inventory health in general ((p=0.046); big five questionnaire neuroticism (p=0.019); highly sensitive person scale- short form total score (p=0.007); cognitive and behaviour responses questionnaire catastrophizing score (p=0.010); Pittsburgh sleep quality index poor sleeper (global score > 5, p=0.03).

TABLE 1. Comparison of patients with inflammatory bowel disease with chronic pain and without chronic pain in remission
Variable	Chronic pain (n=33)	No chronic pain (n=89)	p-value*
Sample	Mean ± SD or N (%)	Mean ± SD or N (%)
Use of azathioprine	12 (36.64%)	15 (16.85%)	0.021
PHQ15 score	8.67 (±3.76)	5.09 (±4.0)	<0.001
GSRS total score	2.06 ±0.48	1.52 ±0.54	<0.001
BFQ neuroticism	4.63 (±0.85)	4.25 (±0.82)	0.019
HSPSF total score	4.00 (±0.81)	3.50 (±0.91)	0.007
CBRQ catastrophizing score	4.64 (±3.63)	2.78 (±2.84)	0.010
*Applied tests were either chi-square, Fisher’s exact, Fisher-Freeman-Halton Exact test, independent t-test or Mann-Whitney U test Abbreviations: IBD= inflammatory bowel disease, SD= standard deviation, N=number, PHQ15= Patient health questionnaire 15, GSRS= Gastrointestinal symptoms rating scale, BFQ= Big five questionnaire, HSPSF= Highly sensitive person scale - short form, CBRQ= Cognitive and behavioural responses questionnaire

Conclusion

Rectifiable factors affecting recruitment and compliance were identified. Differences in symptoms and psychological characteristics exist in patients with IBD in remission with and without chronic abdominal pain. Further research is warranted to translate these preliminary findings into meaningful and personalised holistic treatment options for IBD patients with chronic pain.

References

1. Zeitz J, Ak M, Müller-Mottet S, Scharl S, Biedermann L, Fournier N, et al. Pain in IBD Patients: Very Frequent and Frequently Insufficiently Taken into Account. PLoS One. 2016;11(6):e0156666.
2. Sweeney L, Moss-Morris R, Czuber-Dochan W, Meade L, Chumbley G, Norton C. Systematic review: psychosocial factors associated with pain in inflammatory bowel disease. Aliment Pharmacol Ther. 2018;47(6):715-29.
3. Schirbel A, Reichert A, Roll S, Baumgart DC, Büning C, Wittig B, et al. Impact of pain on health-related quality of life in patients with inflammatory bowel disease. World J Gastroenterol. 2010;16(25):3168-77.
4. Norton C, Czuber-Dochan W, Artom M, Sweeney L, Hart A. Systematic review: interventions for abdominal pain management in inflammatory bowel disease. Aliment Pharmacol Ther. 2017;46(2):115-25.
5. Farrokhyar F, Marshall JK, Easterbrook B, Irvine EJ. Functional gastrointestinal disorders and mood disorders in patients with inactive inflammatory bowel disease: prevalence and impact on health. Inflamm Bowel Dis. 2006;12(1):38-46.

Disclosure

Maike Engelmann-Kewitz: No conflict of interest.
Iman Khwaja: No conflict of interest.
Kazuya Takahashi: No conflict of interest.
Dr. Miles Parkes: No conflict of interest.
Prof. Christine Norton: Consultancy: Pfizer; Lecture fees: Merck, Takeda, Tillotts, Janssen.
Prof. Ailsa Hart: No conflict of interest.
Dr. David Bulmer: No conflict of interest.
Prof. Qasim Aziz: Takeda pharmaceuticals and Classado pharmaceuticals.

Introduction

A key feature of IBD pathogenesis is response dysregulation of both the innate and adaptive immune system^1,2. Hence specific inflammatory protein profiles may be a promising biomarker approach for diagnosis and personalized therapy in IBD. Serum proteome of IBD, particularly in multi-ethnic Asian patients, remains less defined.

Aims & Methods

We aim to investigate the systemic inflammatory protein profiles in multi-ethnic Asian patients with IBD and compare them to healthy controls.
The study cohort was made up of 92 patients with IBD (50.0% Ulcerative colitis (UC), 43.5% Crohn's disease (CD), 6.5% Unclassified IBD)), and 42 control subjects, who are asymptomatic patients undergoing screening colonoscopy with no endoscopic pathology. Serum protein profiling was performed using the Olink Target 96 Inflammation assay. A partial-least square discriminant analysis was undertaken to identify additional discriminative inflammatory proteins. Univariate t-test analyses, with false discovery rate correction, were also performed to identify proteins unique to either UC or CD.

Results

Participants with IBD were younger (42.0 (±14.7) in UC, 43.2 (±15.1) in CD, p<0.01), with greater representation of South Asian ethnicity (32.5% amongst UC, 19.6% amongst CD, p<0.01) and males (75.0% amongst UC, 69.6% amongst CD, p=0.03), as compared to controls.
We found 18 proteins were differentially abundant amongst IBD patients (p<0.05). Half (n=9) of these inflammatory proteins (AXIN-1, CD8A, CXCL1, EN-RAGE, FGF-23, HGF, IL17A, OSM, TGF-alpha) were elevated in both UC and CD. The other six proteins were elevated only in patients with UC (4E-BP1, CCL11, IL-18R1, IL-20, MMP-10, TRANCE). Of the remaining three, two were less abundant in patients with CD (DNER, SCF) and TNF was elevated only in patients with CD. Of interest, three immunoproteins were differentially abundant in participants with either UC or CD (i.e. CCL11, MMP10, TRANCE).

Molecular functions	Both UC and CD	UC only	CD only	UC vs CD
Cytokine mediated signaling (GO:0019221)	IL17A CXCL1 OSM HGF	CCL11 TRANCE IL20	TNF	CCL11 TRANCE
Positive regulation of protein kinase B signaling (GO:0051897)	FGF23 HGF OSM TGF-alpha	TRANCE	SCF* TNF	TRANCE
Immune response (GO:0006955)	CD8A CXCL1 IL17A OSM	IL-18R1 TRANCE		TRANCE
Inflammatory response (GO:0006954)	CXCL1 EN-RAGE IL17A	CCL11 IL-18R1	TNF	CCL11
MAPK cascade (GO:0000165)	FGF-23 HGF TGF-alpha		SCF* TNF
Others	AXIN1^	MMP-10# 4E-BP1$	DNER*@	MMP-10#

Table1: List of immunoproteins differentially abundant (p<0.05) in varying IBD subtypes, grouped by their key common molecular functions. *indicates that the immunoprotein of interest to be less abundant compared to controls. ^AXIN1 functions - Activation of protein kinase (GO:0032147), WNT signaling process (GO:0016055). ^#MMP-10 function - extracellular matrix organization (GO:0030198). ^$4E-BP1 function - TOR signaling (GO:0031929). ^@DNER function - Notch receptor processing (GO:0007220).

Conclusion

Our pilot study in a multi-ethnic Asian population found distinctive serum protein profile in IBD patients. While some protein changes were shared in both UC and CD, other changes were specific for either UC or CD, suggesting different disease pathways in these two IBD subtypes. We reaffirmed that inflammatory proteins, such as EN-RAGE³, MMP-10⁴ and OSM⁵, were differentially abundant in IBD, consistent with previous reports in predominantly Caucasian cohorts. Further studies with large sample sizes would be required to validate these biomarkers for IBD activity, and prognosis for biologic therapy response.

References

1. Neurath MF. Cytokines in inflammatory bowel disease. Nat Rev Immunol. 2014 May;14(5):329-42.
2. Mahida YR. The key role of macrophages in the immunopathogenesis of inflammatory bowel disease. Inflamm Bowel Dis. 2000;6:21–33.
3. Foell D, Kucharzik T, Kraft M, et al. Neutrophil derived human S100A12 (EN-RAGE) is strongly expressed during chronic active inflammatory bowel disease. Gut 2003;52:847-853.
4. Fonseca-Camarillo G, Furuzawa-Carballeda J, Martínez-Benitez B, et al. Increased expression of extracellular matrix metalloproteinase inducer (EMMPRIN) and MMP10, MMP23 in inflammatory bowel disease: Cross-sectional study. Scand J Immunol. 2021 Jan;93(1):e12962.
5. Sare Verstockt, Bram Verstockt, Kathleen Machiels, et al. Oncostatin M Is a Biomarker of Diagnosis, Worse Disease Prognosis, and Therapeutic Nonresponse in Inflammatory Bowel Disease. Inflamm Bowel Dis. 2021 Oct 18;27(10):1564-1575.

Introduction

Chronic fatigue (CF) is prevalent among patients with ulcerative colitis (UC) and Crohn's disease (CD), but the influence of the disease activity is not established.

Aims & Methods

The primary aim of this study was to evaluate the prevalence and probability of chronic fatigue (CF) in patients with CD and UC one year after diagnosis, stratified by different measures for disease remission (symptomatic, biochemical, endoscopic, and histological). Additionally, we aimed to evaluate factors associated with chronic fatigue among patients in endoscopic/radiological remission.

Patients ≥18 years with CD and UC were recruited from the Inflammatory Bowel Disease South-Eastern Norway (IBSEN III) study, a population-based, observational inception cohort. Fatigue was assessed using Fatigue Questionnaire (FQ), and CF was defined as a dichotomized score of ≥4 with a duration of ≥6 months. Only patients with complete FQ data, without history of colectomy, were eligible for inclusion. Binary logistic regression analyses were used to examine the probability of CF for various indicators of remission, including i) symptomatic remission (Harvey–Bradshaw index score <5 for CD and Simple Clinical Colitis Activity Index score <3 for UC), ii) biochemical remission (Fecal calprotectin ≤ 250 µg/g), iii) endoscopic/radiological remission (Mayo endoscopic score 0 in UC, and endoscopically verified absence of inflammation combined with normal intestinal MRI/CT in CD), and iv) histological remission (normal histology in all mucosal biopsies). Additionally, in patients with endoscopic/radiological remission, associations between CF and selected clinical factors were evaluated using binary logistic regression analysis.

Results

In total, 711/1416 patients with CD or UC diagnosis were included (CD: 33.8%, UC: 66.2%). Among them, 619 (87.1%) underwent colonoscopy, intestinal MRI/CT and/or fecal calprotectin testing. Prevalence of CF stratified by different indicators of remission is presented in table 1. In univariate binary logistic regression analysis regarding measures for disease remission, the probability of CF was only significantly reduced in patients with UC in symptomatic remission (OR: 0.48 (0.30, 0.77), p=0.003). Among patients with CD and UC in endoscopic/radiological remission (n=181), CF was independently associated with current biological treatment (OR: 2.92 (1.002, 8.49), p=0.05) and sleep disturbance (OR: 6.23 (2.03, 19.14), p=0.001) in multivariate logistic regression.

Table 1: Prevalence of chronic fatigue among CD and UC patients with different measures for remission one year after diagnosis
Abbreviations and table legends: CD: Crohn’s disease. UC: Ulcerative colitis. Symptomatic remission: Simple Clinical Colitis Activity Index (SCCAI) score <3 for UC / Harvey–Bradshaw index (HBI) score <5 for CD. Biochemical remission: Fecal calprotectin ≤ 250 µg/g. Endoscopic/radiological remission: Mayo endoscopic score 0 in UC and absence of intestinal disease on endoscopy and/or intestinal MRI/CT in CD. Histological remission: normal histology in all mucosal biopsies.
	CD (% (n/n total))	UC (% (n/n total))
Symptomatic remission	33.6 (51/152)	30.0 (85/283)
Biochemical remission	33.3 (25/75)	34.6 (62/179)
Endoscopic/radiological remission	40.4 (21/52)	33.3 (33/99)
Histological remission	36.8 (14/38)	35.0 (28/80)

Conclusion

The probability of CF one year after diagnosis was not associated with either low fecal calprotectin level, normal endoscopic/radiological examinations, or normal histology. Among patients with UC, but not CD, symptomatic remission was associated with a reduced probability of CF. For patients in endoscopic/radiological remission, CF was independently associated with sleep disturbances and current biological treatment.

Disclosure

All authors report no conflict of interest.

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.