J Pediatr Gastroenterol Nutr. 2023 Aug 1;77(2):214-221.doi: 10.1097/MPG.0000000000003816. Epub 2023 May 3.

Linda Elisabeth Scheffers ^1 2 3 4, Iris K Vos ¹, E M W J Utens ^5 6 7, G C Dieleman ⁵, S Walet ⁸, J C Escher ¹, L E M van den Berg ^3 4; Rotterdam Exercise Team

Author information

¹From the Department of Paediatric Gastroenterology, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands.

²the Respiratory Medicine and Allergology, Department of Paediatrics, University Medical Center, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands.

³the Department of Paediatrics, Center for Lysosomal and Metabolic Diseases, Erasmus MC, Rotterdam, Netherlands.

⁴the Department of Paediatric Cardiology, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands.

⁵the Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands.

⁶Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, Netherlands.

⁷the Department of Child and Adolescent Psychiatry, Amsterdam University Medical Center/Levvel, Amsterdam, Netherlands.

⁸the Division of Dietetics, Department of Internal Medicine, Erasmus MC, Rotterdam, Netherlands.

Abstract

Objectives: Physical activity programs have been suggested as adjunctive therapy in adult inflammatory bowel disease (IBD) patients. We assessed the effects of a 12-week lifestyle intervention in children with IBD.

Methods: This study was a randomized semi-crossover controlled trial, investigating a 12-week lifestyle program (3 physical training sessions per week plus personalized healthy dietary advice) in children with IBD. Endpoints were physical fitness (maximal and submaximal exercise capacity, strength, and core stability), patient-reported outcomes (quality of life, fatigue, and fears for exercise), clinical disease activity (fecal calprotectin and disease activity scores), and nutritional status (energy balance and body composition). Change in maximal exercise capacity (peak VO 2 ) was the primary endpoint; all others were secondary endpoints.

Results: Fifteen patients (median age 15 [IQR: 12-16]) completed the program. At baseline, peak VO 2 was reduced (median 73.3% [58.8-100.9] of predicted). After the 12-week program, compared to the control period, peak VO 2 did not change significantly; exercise capacity measured by 6-minute walking test and core-stability did. While medical treatment remained unchanged, Pediatric Crohn's Disease Activity Index decreased significantly versus the control period (15 [3-25] vs 2.5 [0-5], P = 0.012), and fecal calprotectin also decreased significantly but not versus the control period. Quality of life (IMPACT-III) improved on 4 out of 6 domains and total score (+13 points) versus the control period. Parents-reported quality of life on the child health questionnaire and total fatigue score (PedsQoL Multidimensional Fatigue Scale) also improved significantly versus the control period.

Conclusions: A 12-week lifestyle intervention improved bowel symptoms, quality of life, and fatigue in pediatric IBD patients.