Physical Training and Healthy Diet Improved Bowel Symptoms, Quality of Life, and Fatigue in Children with Inflammatory Bowel Disease

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 VO2) was the primary endpoint; all others were secondary endpoints. Results: Fifteen patients (median age 15 [IQR: 12-16]) completed the program. At baseline, peak VO2was reduced (median 73.3% [58.8-100.9] of predicted). After the 12-week program, compared to the control period, peak VO2did 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.