P011 Physical Activity Levels in Daily Life of Patients with Moderate-to-Severe Crohn's Disease Before and After Infliximab-Induced Remission.

Abstract

BACKGROUND: Although the role of physical activity (PA) in inflammatory bowel disease (IBD) patients is not well defined, several studies about its effect on disease’s etiology and activity have addressed this issue. In addition, Crohn’s disease (CD) patients seem to have a lower level of PA and this behavior is associated with disease activity. This study evaluated a cohort of patients with moderately-to-severely active CD submitted to anti-TNF therapy in order to compare the exercise capacity and physical activity in daily life before and after anti-TNF-therapy induced remission. It is hypothesized that CD patients who achieved anti-TNF-therapy-induced remission present significant improvement in the previous levels of exercise capacity and PA in daily life. METHODS: In this prospective longitudinal study conducted between March 2015 and June 2018, 44 adult outpatients with active CD were evaluated at two different moments: before infliximab (IFX) administration and 24 weeks after infliximab therapy. We included patients with CD, aged ≥ 18 years and under 65 years, with a 3-month history of active disease, defined as a Harvey-Bradshaw index (HBI) score of 8 or higher and a serum level of C-reactive protein of more than 5.0 mg per liter, with indication for anti-tumor necrosis factor alpha therapy, i.e. refractory disease unresponsive to conventional therapies or steroid-dependent and those presenting with aggressive disease or features of poor prognosis prediction, such as extensive bowel disease, complex fistulizing disease, or severe endoscopic lesion as defined by the presence of deep and extensive ulcers. Eligible patients received induction therapy consisting of intravenous injections of 5 mg/Kg of IFX at weeks 0, 2, and 6 followed by maintenance infusion (5 mg/Kg) at weeks 14 and 22. Participants were followed until week 24. Patients were evaluated for PA in daily life using accelerometer, exercise capacity, peripheral muscle strength, anthropometry, and body composition. The primary endpoint was an increase in the total number of steps/day in daily life at week 24 in CD patients achieving IFX-induced remission. Secondary endpoints included improvement in the shuttle walking test (SWT), the handgrip strength (HS), active time, and inactive time. RESULTS: Thirty-eight (86.4%) patients achieved infliximab-induced remission at the end of 24 weeks and presented a significant increment from baseline in number of steps taken of 1092 (7440 ± 2980 vs. 6348 ± 3177, respectively; P = 0.006). The inactive time was significantly reduced when compared to baseline period (454.2 ± 106.3 vs. 427.9 ± 97.8, respectively; P = 0.033). There was no difference in the distance walked before and after IFX therapy. CONCLUSION: Infliximab-induced remission followed by maintenance therapy has shown to be effective for increasing PA levels in daily life as shows by increase in the number of steps taken per day as well as by reduced inactive time on patients with moderately-to-severely active CD. Given the important role of PA for patients with CD, anti-TNF therapy may be useful therapeutic strategy along with targeted PA recommendations for increasing PA levels. Furthermore, strategies of treatment associated with an exercise program must be considered for this population.