Benefits and limitations of physical activity in pediatric patients with inflammatory bowel diseases
Authors: Dvoran Pavol , Kosorínová Daniela , Suchá Pavlína , Havlíčeková Zuzana , Michnová Zuzana , Bánovčin Peter 
Published: January 2024

Summary: Introduction: Inflammatory bowel diseases (IBDs) are a group of diseases including Crohn’s disease, ulcerative colitis and unclassified IBD. They are chronic, immune-mediated inflammatory diseases of the gastrointestinal tract. Due to their extraintestinal manifestation, they are considered to be systemic diseases. IBD has a negative impact on health-related quality of life. The treatment is life-long and may be accompanied by side effects. Low-intensity activity of moderate duration is sufficient to elicit improvements in fitness, decrease stress, and improve symptoms. In this study, the relationship between physical activity and IBD development and course is described. Aims: To assess the relationship between physical activity and exercise capacity and the severity and course of IBD. Methods: Probands with IBD and healthy controls underwent pulmonary function testing (PFT) and cardiopulmonary exercise testing (CPET). The results were compared between these two groups; in the IBD group, the results were correlated with disease activity parameters as well. In the IBD group, the probands were encouraged to perform regular physical activity. After 0.5–1 year, they underwent another CPET. Their exercise capacity development was objectively assessed and it was correlated with their IBD development. Results: Forty-one children were included in the study. Twenty of them were healthy controls, while 21 comprised the IBD patient group. These probands underwent the PFT and CPET. When comparing healthy controls and IBD patients, significant differences were found in peak oxygen uptake and peak work rate. In the IBD group, a negative correlation was found between peak work rate and C-reactive protein concentration. In faecal calprotectin, a significant correlation was found only in the subgroup with ulcerative colitis – the negative correlation with peak oxygen uptake and partial pressure of CO2 in exhaled air in the peak of the exercise. PCDAI correlated positively with ventilatory index, peak dead space and tidal volume ratio but negatively with peak work rate, work rate at the time of anaerobic threshold, peak oxygen uptake and oxygen uptake efficacy slope. In PUCAI, we found a positive correlation with CO2 ventilatory uptake at the time of anaerobic threshold and negative correlations with peak oxygen uptake and oxygen uptake efficacy slope. In further CPET in the IBD group, a significant decrease was found in faecal calprotectin and PCDAI or PUCAI; there were also positive correlations between PCDAI/PUCAI changes and resting heart rate changes. The negative correlation was found in the correlation with the changes in peak oxygen uptake, metabolic index and ventilatory equivalent for CO2 at the time of anaerobic threshold. Conclusion: These results suggest that regular recreational physical exercise positively impacts IBD. When adhering to treatment recommendations, doing sport professionally is also possible. Key words: inflammatory bowel diseases – physical activity