Scoping review on health-related physical fitness in patients with inflammatory bowel disease: Assessment, interventions, and future directions

Table 4 Description and main findings of studies examining the effect of physical activity and physical exercise training interventions on health-related physical fitness components in patients with inflammatory bowel disease

Ref.	Study design, country	Sample size, n	Sample features	CD, UC, IBD-U (n)	Female sex, (%)	Age in yr, mean (SD)	Disease activity	Healthy control group	Intervention, IG	Comparator, CG	HRPF components assessed	Effect on HRPF components
Mählmann et al[53], 2017	Pilot study, Switzerland	21	Pediatric patients	12, 7, 3	48%	13.88	Remission (n = 14) or active disease (n = 7)	Age-matched and sex-matched HC (n = 23)	Moderate-intensity aerobic exercise training with active video gameplay (n = 21), 5 sessions/wk (30 min) for 8 wk	N/A	Cardiorespiratory fitness with 6-min walk test (practical field test) at wk 8	Distance reached in 6 min increased in patients with active disease from 655 (95%CI: 542-769) m to 758 (95%CI: 610-906) m, and in patients in remission from 655 (95%CI: 542-769) m to 758 (95%CI: 610-906) m, and in CG from 678 (95%CI: 640-715) m to 727 (95%CI: 74-93) m, without between-group differences (P = N/A)
Trivić et al[54], 2022	Intervention study, Croatia	42	Pediatric patients	22, 18, 2	40%	N/A for total sample	Remission (n = 42)	N/A	Personalized home-based structured resistance training (n = 42), 3 sessions/wk for 6 mo	N/A	Body composition (LBM) with DEXA; muscular endurance 30 s sit-ups, push-ups, back extensions, squats, and holding a plank position for as long as possible (practical field tests), all at 6 mo	Improvement in LBM from 37.12 (SD: 1.43) kg to 38.75 (SD: 1.61) kg, (P = 0.012) but not in LBM z-score. Improvement in muscular endurance tasks: Number of sit-up repetitions from 19.32 (SD: 5.82) to 21.00 (SD: 6.53) (P = 0.024), back extension repetitions from 27.39 (SD: 12.09) to 38.27 (SD: 16.10) (P < 0.001), push-up repetitions from 17.37 (SD: 6.67) to 24.59 (SD: 7.58) (P < 0.001), squat repetitions from 22.10 (SD: 4.87) to 24.88 (SD: 6.23) (P < 0.001), and time holding the plank position from 81.0 (SD: 46.26) s to 114.34 (SD: 74.06) s (P < 0.001)
Loudon et al[60], 1999	Pilot study, Canada	16	Sedentary adult patients	16, 0, 0	83%	38.3 (7.5)	Remission or mild active disease (n = N/A)	N/A	Supervised indoor (group) walking program, 3 sessions/wk (of 20-35 min) for 12 wk	N/A	Cardiorespiratory fitness with CAFT step test (practical field test) at wk 12	Improvement in estimated VO2max from 30.6 (SD: 4.7) mL/kg/min to 32.4 (SD: 4.8) mL/kg/min (P = 0.0013)
Bottoms et al[61], 2019	Secondary analysis of Tew et al[59], United Kingdom	25	Adult patients	25, 0, 0	60%	N/A for total sample	Remission or mild active disease (n = N/A)	N/A	HIIT (n = 13) or MICT (n = 12), 3 sessions/wk for 3 mo	N/A	Cardiorespiratory fitness with CPET (gold standard test) at week 4, 8, and 12	Increase in WRpeak after HIIT from baseline to week 4 with mean difference of 20.5 (SD: 10.8) W (P = 0.03), and from week 4 to week 12 with 12.30 (SD: 6.32) W, (P = 0.02); No change in WRpeak after MICT
Cronin et al[56], 2019	Cross-over RCT, Ireland	17	Physically inactive adult patients	N/A for total sample	N/A for total sample	25 (6.5)	Remission (n = 17)	N/A	Combined aerobic and resistance exercise program (n = 13, of which 7 crossed-over), 3 sessions/wk (of 60 min) for 8 wk	Usual care (n = 7)	Body composition (body fat and lean tissue mass) with DEXA, cardiorespiratory fitness with Rockport 1-mile walk test (practical field test), all at week 8	Total body fat decreased in the IG with 2.1% (IQR: -2.15 to -0.45) but increased in the CG with 0.1% (IQR: -0.4-1), (P = 0.022); total lean tissue mass increased in the IG with 1.59 (IQR: 0.68-2.69) kg but decreased in the CG with 1.38 (IQR: -2.45-0.26) kg, (P = 0.003); improvement of estimated VO2max in the IG from 43.41 mL/kg/min to 46.01 mL/kg/min, (P = 0.03)
Tew et al[59], 2019	Pilot RCT, United Kingdom	36	Adult patients	36, 0, 0	53%	36.9 (11.2)	Remission (n = 32) or mildly active disease (n = 4)	N/A	HIIT (n = 13) or MICT (n = 12), 3 sessions/wk for 3 mo	Usual care (n = 11)	Cardiorespiratory fitness with CPET (gold standard test) at 3 mo	Change in VO2peak from 27.3 (SD: 7.7) mL/kg/min to 29.7 (SD: 8.2) mL/kg/min after HIIT. Change in VO2peak from 28.7 (SD: 8.6) mL/kg/min to 29.3 (SD: 6.6) mL/kg/min after MICT. Change in VO2peak from 28.6 (SD: 10.0) mL/kg/min to 28.5 (SD: 9.2) mL/kg/min after usual care. Mean change in VO2peak from baseline to 3 mo relative to the usual care was greater following HIIT than MICT (+2.4 vs +0.7 mL/kg/min) (P = N/A)
Jones et al[51], 2020	RCT, United Kingdom	47	Adult patients	47, 0, 0	68%	49.3 (13.0)	Remission (n = 31) or mild active disease (n = 16)	Age-matched, sex-matched, PA-matched, BMI-matched, and ethnicity-matched HC (n = 33)	Combined impact and resistance exercise training (n = 23), 3 sessions/wk (of 60 min) for 6 mo	Usual care (n = 24)	Muscular strength and endurance with isokinetic dynamometry (gold standard test) as well as with HGS, chair-stand test, and arm-curl test (practical field tests), all at 6 mo	Improvement of all muscular strength and endurance tests in the IG compared to the CG: mean difference KE peak torque 60°/s, 22.4 (95%CI: 12.1-32.8) Nm; KE peak torque 180°/s, 16.8 (95%CI: 9.0-24.5) Nm; EF peak torque 60°/s, 6.8 (95%CI: 3.9-9.6) Nm; EF peak torque 180°/s, 6.3 (95%CI: 3.3-9.3) Nm; HGS, 8.3 (95%CI: 6.2-10.5) kg; Chair-stand test, 4 (95%CI: 3-6) repetitions; arm-curl test, 7 (95%CI: 5-8) repetitions; All P < 0.001
Seeger et al[58], 2020	Pilot RCT, Germany	45	Adult patients	45, 0, 0	63%	N/A for total sample	Remission or mild active disease (n = N/A)	N/A	Moderate endurance training (n = 17, only n = 9 were analyzed), or moderate muscle training (n = 15, only n = 13 analyzed), 3 sessions/wk (of 30-40 min) for 12 wk	Usual care (n = 13)	Muscular strength with HGS and isometric HHD (practical field tests) at week 12	Improvement of HGS and QS in both endurance training IG (P = 0.01, P = 0.035) and muscle training IG (P = 0.01, P = 0.002), while HGS decreased and QS did not change in CG (P = 0.01, P = 0.23)
Van Erp et al[57], 2021	Pilot study, The Netherlands	25	Adult patients with severe fatigue	21, 3, 1	40%	45 (2.6)	Remission (n = 25)	N/A	Aerobic and progressive resistance training, 3 sessions/wk (of 60 min) for 12 wk	N/A	Cardiorespiratory fitness with a CPET (gold standard test) at week 12	No significant change in VO2max. A significant change in WRpeak from 2.4 (SD: 0.5) W/kg to 2.7 (SD: 0.5) W/kg (P = 0.002)
Zhao et al[55], 2022	RCT, China	28	Adult patients with low nutritional risk state [RT + WP intervention (n = 15), RT + placebo intervention (n = 13)]	N/A	31%	44.1	Remission (n = 3), or mild (n = 12), moderate (n = 9), or severe (n = 4) active disease	N/A	Unsupervised resistance training (n = 28), 3 sessions/wk for 8 wk		Muscular strength with HGS and muscular endurance with 3-m walk speed and 5-time chair-stand-test (all practical field tests), all at week 8	HGS changed from 36.7 (SD: 10.8) kg to 42.6 (SD: 8.4) kg in the RT + WP group and from 31.7 (SD: 12.6) kg to 32.9 (SD: 12.5) kg in the RT + placebo group. 3-m walk speed changed from 1.0 (SD: 0.3) m/s to 0.9 (SD: 0.1) m/s in the RT + WP group and from 1.1 (SD: 0.2) m/s to 1.0 (SD: 0.2) m/s in the RT + placebo group. Time to perform the 5-time chair-stand test changed from 7.0 (SD: 1.5) s to 6.2 (SD: 1.4) s in the RT + WP group and from 6.6 (SD: 1.6) s to 6.2 (SD: 1.3) s in the RT + placebo group. All are not statistically significant (P = N/A)

95%CI: 95% confidence interval; BMI: Body mass index; CAFT: Canadian aerobic fitness test; CD: Crohn’s disease; CG: Control group; CPET: Cardiopulmonary exercise test; DEXA: Dual-energy X-ray absorptiometry; EF: Elbow flexor; HC: Healthy controls; HGS: Handgrip strength; HHD: Hand-held dynamometry; HIIT: High-intensity interval training, HRPF: Health-related physical fitness; IBD-U: Inflammatory bowel disease unclassified; IG: Intervention group; IQR: Interquartile range; KE: Knee extensor; LBM: Lean body mass; MICT: Moderate-intensity continuous training; N/A: Not available; PA: Physical activity; QS: Quadriceps strength; RCT: Randomized controlled trial; RT: Resistance training; SD: Standard deviation; UC: Ulcerative colitis; VO₂max: Maximal oxygen uptake; VO₂peak: Oxygen uptake at peak exercise; WP: Whey protein; WRpeak: Work rate at peak exercise.