Physical activity may reduce anxiety in patients with mild and quiescent inflammatory bowel disease (IBD), according to a new systematic review from researchers at the University of Manitoba.

The meta-analysis assessed eight trials published between 2011 and 2023 that evaluated physical activity as an adjunctive therapy for IBD. The investigators found that although the evidence does not support physical activity as a means of improving health-related quality of life, symptoms of anxiety were reduced in those with mild IBD (standardized mean difference, −0.35).

For Banke Oketola, the lead author and a PhD candidate at the University of Manitoba in Winnipeg, one of the main conclusions of the review was that more high-quality trials are needed. “We found very few trials that looked into physical activity for people with Crohn’s or ulcerative colitis,” Oketola told Medscape Medical News.

The meta-analysis was published in the Journal of the Canadian Association of Gastroenterology on August 10.

Persistent Symptoms

Types of IBD include Crohn’s disease and ulcerative colitis: two lifelong gastrointestinal conditions that also entail persistent extraintestinal symptoms such as fatigue and joint pain. The review included seven randomized controlled trials and one additional trial, which together included almost 400 participants. The included trials were limited to patients with IBD that was in remission or was mild, because patients with active IBD may not be able to perform physical activity to the same extent as those with mild illness. Adjunctive physical activity was found to be safe for IBD patients across all studies reviewed.

The primary outcome was health-related quality of life. The investigators also examined fatigue, joint and abdominal pain, stress, anxiety, and depression as secondary outcomes. They found no evidence that physical activity improved health-related quality of life. Physical activity was effective in reducing anxiety, however. Data for the remaining symptoms were inconclusive.

Physical activity for patients with IBD is complicated by the fact that the condition and its medications result in persistent symptoms that may make physical activity more difficult. Crohn’s disease and ulcerative colitis are also associated with decreased muscle mass.

Given these restrictions, said Oketola, researchers aim to discover what type of physical activity is best for providing the benefits of exercise to patients with IBD without worsening symptoms such as fatigue and joint or abdominal pain.

Type of Activity

The studies reviewed included a range of activities, such as yoga, aerobic exercise, and resistance training. Owing to the lack of a standardized definition of physical activity in the research, the intensity and type of activity were not consistent across the trials.

When the investigators began the study, they hoped to identify activities that would help for each persistent symptom. “We know that not all physical activity will work for all symptoms,” said Oketola. But given the available research, the best type of physical activity for IBD symptoms remains unclear.

In addition, the investigators note in their analysis that the trials lack objective measures of the amount of physical activity performed, and there is the possibility of bias. For example, the design of some trials may have introduced selection bias favoring participants who already value the benefits of physical activity.

“We need more randomized controlled trials,” said Oketola, who hopes that the review will increase awareness and funding for future studies on IBD.

Uncertainty Remains

Commenting on the study for Medscape, Grigorios Leontiadis, MD, PhD, professor of gastroenterology at McMaster University and vice president for clinical affairs at the Canadian Association of Gastroenterology, commended the review’s methodology.

Dr Grigorios Leontiadis

Regarding the conclusions of the analysis, Leontiadis noted that uncertainty remains about the effects of physical activity in people with IBD. “The devil is in the details,” he said. While these details are outside of the scope of the review, the specific effects of different types of physical activity likely vary, and the type of activity may need to be tailored to patients.

In addition, Leontiadis noted that some of the studies included in the review lacked the context needed to fully address the role of exercise for patients with IBD, such as their interest or their history with exercise. To make confident conclusions, “we need better studies, not more studies,” said Leontiadis.

For clinical implementation, he said the review is “necessary but not sufficient.” Given the heterogeneity and limitations of the included trials, a panel would need to take other factors into account, such as patient perspectives, to create guidelines.

J Can Assoc Gastroenterol. Published August 10, 2023. Full text

Gwendolyn Rak is a health reporter for Medscape and Univadis based in Brooklyn, New York.

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