# The Feasibility Of High-Intensity Interval Training and Moderate-Intensity Continuous Training Crohn's disease Patient

< Exercise as it relates to Disease
This Wikibooks page is a critical appraisal of the research article "High-intensity interval training and moderate-intensity continuous training in adults with Crohn's disease: A pilot randomised controlled trial" by Tew. G.A. et.al (2019). From the BMC Gastroenterology.

## What is the Background to this Research?

Crohn’s disease (CD) is an inflammatory bowel disease that impacts the patient’s immune system from functioning effectively. Due to an inflammatory response from the digestive tract, the walls of the digestive tract are damaged and therefore causing symptoms such as abdominal pain and diarrhoea. Crohn’s disease can be influenced by genetic components, environmental factors, etc. CD patients also suffer from bone mineral loss and therefore are included into the moderate to high risk factor for individuals exercising. Exercise is recommended as it can help patient’s cope with symptomatic issues such as fatigue, faecal calprotectin, inflammation, and mental health.
There are controversies surrounding the topic of exercise involving Crohn’s disease patients as they provide a moderate to high risk. It was outlined in a pilot trial as too high of a level of intensity of exercise may cause heartburn and diarrhoea and other acute gastrointestinal bleeding issues, and is particularly prevalent in endurance runners.
This paper entails the feasibility of two exercise modules test Crohn’s disease patients exercising at a high-intensity interval training level and at a moderately-intense continuous training level. Relating to current research, it investigates how intense and how much exercise a Crohn’s disease patient can do without exacerbating their symptoms. This research provides insight and a reliable foundation for future expansions of research into exercise with Crohn’s disease patients, as the majority of current research only reflects low-intensity exercise.
* According to a prospective multi-centre cross-sectional study done by K Gatt et.al, they found that
* According to a pilot study by Hassid, found that12 athletes that partook in running, marathon, half marathon, bicycle rides, and triathlon events has no significant increase of faecal calprotectin that would put them in a critical state in their CDAI score

## Where is the Research From?

This research article was published by the reputable journal publisher, BMC Gastroenterology. Although, it is a reasonably new source, this journal is highly accepted as a reputable per-reviewed source and covers technology, gastroenterology, and the medicines categories.
Recruitment was taken from 3 private hospitals in England. The exercise modules were conducted at the University of Winchester by Garry.A. Tew. The data was analysed at the University of New York, York’s Trials Unit. The paper was funded by the Living with IBD Research Programme at Crohn’s and Colitis UK, and continued testing for as long as they were funded for. It was noted that the source of funding had no influence on the outcome and analysis of the results.
The authors have a reputable background. Specifically, Garry a Tew who has 86 research papers, investigating the effects of exercise-based programs on specific communities or health diseases. Professor Tew’s fellow co-authors; Dr Jones, Dr Leighton, Dr Bottoms, Dr Carpenter, Dr Anderson have done 3 other papers which embark on further research into Crohn’s disease and the effectiveness and quality of life from exercising with CD.

## What Kind of Research Was This?

This research article is stated as a three-arm pilot randomised trial. Participants were randomly assigned to the High-intensity interval group, moderate-intensity continuous group, and parallel, a usual-care as the continuous group to standardise results collected. A pilot study is the necessary preliminary trial to then further expand upon to a randomised controlled trial which is the gold standard of studies. Due to the delivery of the programs, it would be evident to the participants which intervention they were in. Other pilot trial investigations found indications of lean mass generation with high and moderate exercise, correlations of higher quality of life, and without exacerbating any symptoms. The authors disclosed that there were no conflicts of interests.

## What Did the Research Involve?

· The trial consisted of 53 participants being randomised into 3 separate armed programs. of the 36 sessions, 8 out of 12 participants completed 24 sessions.
· Limitations of the study includes the self-reported measures
· As stated in the paper the number of participants were minimal however, this pilot study does create opportunity for research to account for these numbers and expand the research based on this study
· The methodology could have been reduced to a 2-arm study, this point was also mentioned in the paper to limit difficulty of recruiting participants
· The program could have also included more variations of high-intensity and moderate-intensity exercises. This will ensure that
· There were several limitations to this research paper:
- Heart rate and peak oxygen uptake was recorded throughout the trial to identify peak power output
- Endoscopies weren’t used to evaluate the degree of inflammation in the gastrointestinal tract
- There was room for bias as the follow-up procedure,
- Interview feedback did provide evidence of participants having an overall enjoyment for the program
EXERCISE INTERVENTIONS :
| Control Group | Participants proceed for the next 3 months with their own usual care |
| High-Intensity Interval Training | Warm-up: 5-minutes at 15% peak power output Session: 1-minute bouts at 90% peak power output 1-4 weeks: 148W 9-12 weeks: 173W Cool-down: 3-minutes at 15% peak power output |
| Moderate-Intensity Continuous Training | Warm-up: 5-minutes at 15% peak power output Session: 30-minutes at 35% peak power output 1-4 weeks: 50W 9-12 weeks: 54W Cool-down: 3-minutes at 15% peak power output |

## What Were the Basic Results?

· Peak oxygen uptake was significantly improved in the HIIT program in contrast to the MICT program when tested for the baseline to 3 months retest protocol.
- Peak oxygen uptake increased in the 3-months post program by 2.4 mL/kg/min for the HIIT group and 0.7mL/kg/min for the MICT
· All exercise trials took place on a cycle ergometer. The high intensity and moderate intensity programs both started off with a 5-minute warm up at 15% peak power output (determined via baseline cardiopulmonary testing), with a 3-minute cool down session also at 15% peak power output.
- The HIIT session lasted for 28 minutes and consisted of 1-minute bouts of 90% peak power output and interspersed 1-minute bouts at 15% peak power output
- The MICT session went for 38 minutes and only consisted of a 30-minute cycle at 35% peak power output.
* Maximum heart was 92% for HIIT and 68% for MICT
* Self-reported decreases in inflammatory responses and less frequent bowel movements were noted.

## What Conclusions Can We Take From This Research?

* High intensity interval training in comparison to moderate continuous training have both provided insight to being beneficial for Crohn’s disease patients to partake in both activities.
* The HIIT and MICT exercise interventions improved those participants peak oxygen uptake within the 3 months of the program.
* The CDAI score decreased for HIIT participants and increased slightly for the MICT, however both scores are still considered as asymptomatic remission.
* Majority of patients reported that their intervention improved the quality of their life without causing CD symptoms and inflammation. There were also statements made how the trial motivated them to continue with the regime.
* There were a couple of adverse-events that were due to the exercise interventions. It was reported that their CDAI scores were increased in disease activity, which returned back to the baseline measure within 1 week. However, it would be beneficial if a randomised controlled trial further expanded upon the safety of higher intensities of exercise on CD patients
* Several participants were interested in doing variations of high-intensity exercises. A pilot trial provided evidence that a high-intensity muscle-focused program is feasible and safe for CD patients.

## Practical Advice

* For future research, it would be best to investigate using patients that didn’t previously have private institute benefits as healthcare is not accessible to all and therefore is potentially a whole different case for non-private hospital patient friendly

## References

* 1 2 3 4 5 6 7 Tew. G.A. et. al. (2019). 'High-intensity interval training and moderate-intensity continuous training in adults with Crohn's disease: a pilot randomised trial. BMC Gastroenterol 19, 19. https://doi.org/10.1186/s12876-019-0936-x
* ↑ Health Direct. (2020) 'Crohn's Disease'. Australian Government, Department of Health and Aged Care.
* ↑ Jones. K. et al. (2020). 'Randomised clinical trial: combined impact and resistance training in adults with stable Crohn's disease'. Wiley Online Library. Alimentary Pharmacology & Therapeutics vol 52, issue 6, pg 964-975. https://doi.org/10.1111/apt.16002
* 1 2 Seeger. W.A. et al. (2020). 'Moderate endurance and muscle training is beneficial and safe in patients with quiescent or mildly active Crohn's disease'. Sage journals vol 8, issue 7. https://doi.org/10.1177/2050640620936383
* ↑ Peters. H.P.F. et al. (2001). 'Potential benefits and hazards of physical activity and exercise on the gastrointestinal tract. Gut vol 48, issue 3, 435-439
* ↑ Sci Journal. (2022). 'BMC Gastroenterology Impact Factor & Key Scientometrics'. Sci Journal
* ↑ Abbott. J.H. (2014). 'The distinction between randomized clinical trials (RCTs) and preliminary feasibility and pilot studies: What they are and are not'. Journal of Orthopaedic & Sports Physical Therapy vol 44, issue 8, 555-558. doi:10.2519/jospt.2014.0110
* ↑ Barnes.M.J. et al. (2019). 'P026 Relations between physical activity, diet, and body composition in perdiatric patients with inflammatory bowel disease'. Inflammatory Bowel Diseases vol 25, issue supplement_1, page S13. https://doi.org/10.1093/ibd/izy393.030
* ↑ Zaltman.C. et al. (2014). 'Progressive resistance training improves muscle strength in women with inflammatory bowel disease and quadriceps weakness'. Journal of Crohn's and Colitis, Vol 8, Issue 12, Pages 1749-1750. https://doi.org/10.1016/j.crohns.2014.09.001