Abstract
Crohn's disease (CD) is a predisposing factor for bone loss and muscle dysfunction, which could lead to osteoporotic fractures and physical disability, respectively. To assess the effect of 6months of combined impact and resistance training on bone mineral density (BMD) and muscle function in adults with CD. In this randomised controlled trial, 47 adults with stable CD were assigned to exercise (n=23) or control (n=24) groups and followed up for 6months. The exercise group received usual care plus a 6-month combined impact and resistance training programme, involving three, 60-minute sessions per week and a gradual tapering of supervision to self-management. The control group received usual care alone. The primary outcomes were BMD (via dual energy X-ray absorptiometry) and muscle function (measures of upper and lower limb strength and endurance) at 6months. At 6months, BMD values were superior in the exercise group with statistical significance at lumbar spine (adjusted mean difference 0.036g/cm2, 95% CI 0.024-0.048; P<0.001), but not at femoral neck (0.018g/cm2, 0.001-0.035; P=0.059) or greater trochanter (0.013g/cm2, -0.019 to 0.045; P=0.415) after correcting for multiple outcomes. The exercise group also had superior values for all muscle function outcomes (P<0.001; unadjusted mean differences ranging 22.6‒48.2%), and lower fatigue severity (P=0.005). Three exercise-related adverse events were recorded: two instances of light-headedness and one of nausea. The intervention improved BMD and muscle function in adults with CD and appears as a suitable model of exercise for reducing future risk of osteoporotic fractures and disability. ISRCTN11470370.
Highlights
People with Crohn’s disease (CD) have an increased risk of osteoporosis and osteoporotic fractures compared with the general population.[1]
A 2016 Guideline/Consensus paper from the European Crohn’s and Colitis Organisation (ECCO) stated that weight-bearing exercise, stopping smoking, and maintaining adequate dietary calcium (1g/day) may help to prevent bone loss in inflammatory bowel disease;[4] few prospective trials of preventative interventions have been conducted in this increasedrisk group
In this randomised controlled trials (RCTs) involving adults with quiescent or mildly-active CD, the offer of a combined impact and resistance exercise programme with gradual tapering of supervision to independent practice improved Bone mineral density (BMD) and muscle function at 6-month follow-up compared with usual care control
Summary
People with Crohn’s disease (CD) have an increased risk of osteoporosis and osteoporotic fractures compared with the general population.[1]. Load intensity is one of the most important training variables, with guidelines and evidence syntheses indicating that adults should undertake a combination of impact activities (e.g. jumping) and high-intensity resistance training to optimise bone health.[7,8,9] Resistance training can improve muscle mass and function,[8] which may be of importance in CD where low muscle mass and strength is common and predictive of osteopenia/osteoporosis.[10,11]
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