Physical Activity in Patients with Inflammatory Bowel Disease: A Cross-Sectional Study

08 Sep 2021


Inflammatory bowel diseases (IBD), which incorporate Crohn’s disease (CD), ulcerative colitis (UC), and inflammatory bowel disease-unclassified (IBD-U), are chronic, systemic, and undulating inflammatory conditions affecting primarily the gastrointestinal tract of patients. The global incidence of IBD has been rising steadily in recent years, and a study conducted in southern New Zealand by Coppell et al. showed a peak incidence of IBD of 29.8/100,000 people. While the exact mechanism and cause of IBD are unknown, it is thought to incorporate 4 key elements: genetic predisposition, environmental triggers, abnormal immune response, and gut microbiome changes.

Many patients with IBD suffer from significant fatigue, depression and anxiety, and a reduced health-related quality of life (HRQoL) because of the impact the symptoms of the disease can have on their life. The level of their psychological well-being does not always correlate with the severity of their disease. For example, Aluzaite et al. reported that while 83% of patients with active IBD experience fatigue, up to 44% of patients whose disease is in remission can also suffer from significant fatigue. It is clear that just treating IBD with current medical management is ineffective at improving patient’s psychological well-being, and this is directing researchers to investigate other options such as increasing physical activity.

Physical activity is defined as any bodily movement produced by skeletal muscles resulting in energy expenditure. Regular physical activity has been shown to significantly improve health in the general “healthy” population in numerous ways including decreasing blood pressure, body weight, and bone loss, as well as improving sleep quality and immune response. Exercise is well known to improve psychological well-being, including reducing depression and anxiety levels, fatigue, and stress. In patients with IBD, habitual exercise has been found to increase the time spent in remission, improve gastrointestinal permeability, and improve HRQoL.

While the numerous health benefits from regular exercise are well known, the level of physical activity engagement worldwide is poor, with only 50% of the general population meeting the current physical activity guideline of 150 MET-mins/week. The majority of studies worldwide report that patients with IBD are also not meeting the recommended physical activity levels, but the level of physical activity in patients with IBD in New Zealand is currently unknown.

Therefore, the primary objective of the study was to investigate current physical activity levels in a cohort of participants with IBD in Dunedin, New Zealand. Secondary objectives included assessing participants’ attitudes and preference towards exercise and investigating any relationship between physical activity levels and quality of life, depression, anxiety, fatigue, and disease activity.


This study investigated the current physical activity levels of patients with IBD in Dunedin, New Zealand, and further assessed their attitudes and preferences towards exercise. While there is growing knowledge of exercise habits of patients with IBD worldwide, to our knowledge, this study is the first of its kind to be undertaken in New Zealand. Participants’ characteristics in this study matched those of previous studies in New Zealand investigating incidence rates of IBD, indicating a reasonably representative group of patients involved.

Exercise Participation

Two-thirds of participants in this study met current international guidelines on physical activity. Despite their illness and perceived barriers, participants in this study were more physically active compared to the general population worldwide. While WHO recommend 150 min of moderate physical activity a week at a minimum, for additional health benefits, they also recommend increasing their moderate-intensity aerobic physical activity to 300 min per week. In addition, there are no specific IBD guidelines of levels of participation in physical activity but significant benefits of exercise are known in patients with IBD. Therefore, even if patients with IBD are meeting minimum physical activity levels, clinicians could aim to encourage patients to increase activity levels to achieve further potential health benefits. This study was a separate analysis of a physical activity intervention study, and therefore it is expected that the majority of participants would be physically active. This phenomenon was also documented by Loudon et al., who showed subjects who volunteer for an exercise study are often more motivated to participate in physical activity than those who choose not to. Therefore, the high level of physical activity in this cohort of patients with IBD is to be anticipated but may limit its generalizability to the wider IBD population.

Although expected, this high level of physical activity contradicts previous literature which indicated patients with IBD participate in less physical activity than the general population worldwide. Interestingly, studies employing written questionnaires have found similarly unexpectedly high levels of physical activity in patients with IBD. The IPAQ-short form has reported good reliability, but it is also reported to over-estimate physical activity levels by up to 173% when compared with an accelerometer. A plausible reason for this discrepancy relates to each participant using their own interpretation of what constituted moderate or vigorous physical activity, even when further information was provided, to answer the IPAQ, thus creating a difference between the reported and actual level of physical activity. Therefore, further studies may need to employ both accelerometers and self-reported questionnaires to fully assess physical activity levels of patients with IBD.

To further investigate what factors may influence physical activity, we investigated the correlation between physical activity levels and physical and psychological well-being. For patients with UC, physical activity levels were independently correlated with HRQoL scores. This aligns with previous research highlighting this relationship. As previously shown in New Zealand, in patients with CD, higher fatigue levels were clearly correlated with lower levels of physical activity, similar to previous studies. When investigating disease activity parameters, only CRP was independently correlated with physical activity levels in patients with UC.

Physical Activity Attitudes and Barriers

The majority of participants in this current study reported that they felt that their IBD had limited the amount of exercise they can partake in. Other research has reported similar results, indicating that IBD affects perception around exercise capacity and fitness. Common reasons for the limitation in exercise mentioned in previous studies – fatigue, abdominal pain, and trouble controlling bowels – were prominent for our study participants. In addition, it is unclear if the levels of reported barriers described here are still evident in patients with IBD who are not as physically active. Further studies could be employed to investigate this and should aim to ensure a cohort of patients with a broad range of physical activity levels is recruited.

Overall, participants with IBD indicated a preference towards low-impact types of exercise, such as walking, as opposed to high-impact types, such as running or playing sports. This result aligns with previous research. One reason for this may relate to a known extra-intestinal manifestation of IBD – joint arthralgia. Joint arthralgia can make high-impact activities considerably painful and was shown to be a significant barrier to exercise in this study. Interestingly, participants who felt that their disease activity impacted their ability to exercise had higher levels of fatigue and worse HRQoL than those who did not feel their disease affected their ability to exercise. This may reflect an interplay between physical activity levels, disease barriers, and psychological well-being in patients with IBD which could be further explored.

Unexpectedly, there was a lack of correlation between reported barriers and participation levels in physical activity. Even patients who are more physically active than the expected general population experience high perceived levels of barriers to exercise. Furthermore, a higher proportion of patients with active disease reported that their IBD limited their ability to exercise when compared to those with disease in remission. However, there was no difference in physical activity participation between the 2 disease severity levels.

In part, this could relate to patients’ self-efficacy regarding participation in physical activity. Perhaps patients with active disease have lower self-efficacy in relation to participation in physical activity than those with disease in remission. Indeed, researchers have illustrated that participants with low self-efficacy often have higher perceived barriers to exercise. This itself may result in a thought pattern that they are not capable of participating in high levels of exercise due to their level of active disease and symptoms associated with this, even though they are participating in as much physical activity as those in remission. Indeed, this relationship has been previously reported by Tew et al. who also noted that with increasing disease activity levels, patients’ barriers to exercise also increased. Therefore, improving disease activity will have a significant benefit on patient perception of exercise capacity and reduce barriers to physical activity, thereby allowing participants to engage in more physical activity.


This study indicated that this cohort of patients with IBD in New Zealand participated in higher levels of physical activity than the general population and other IBD populations around the globe, but still experience similarly high levels of barriers to physical activity. In addition, patients with active disease show a clear dissociation between perceived ability to exercise and actual ability to exercise in this cohort. This study adds further evidence of the relationship between physical activity levels and fatigue in patients with IBD. This shows that future studies should be focussing on physical activity as a way of improving the well-being of patients with IBD – especially fatigue, anxiety, and depression. As a clinician, even when engaging with patients who are physically active, our job should be to congratulate, reassure, and reinforce activity levels while also supporting patients to continue to overcome barriers and encourage them to maintain, if not increase, their level of physical activity.

Original source here.