Physical activity and physical fitness in lymphoma patients before,during, and after chemotherapy: a prospective longitudinal study

Fatigue is a common and distressing symptom in cancer patients, especially in lymphoma patients. One hypothesized mechanism in the etiology of fatigue is a vicious circle between fatigue, physical inactivity, and deconditioning. However, the natural evolution of physical activity and physical fitness over the course of treatment is unknown. Therefore, the aim of this longitudinal study was to assess fatigue, physical activity, and physical fitness in lymphoma patients before, during, and after treatment. Fatigue was measured with the EORTC-QLQ-C30, physical activity with an accelerometer, and physical fitness with a maximal incremental cycle ergometer test, 6-min walking distance test, and muscle strength measurements. Differences between the three measurement moments and baseline differences between Hodgkin lymphoma and non-Hodgkin lymphoma, early and advanced disease, were analyzed. Twenty-nine patients were included. Functional exercise capacity and quadriceps force were impaired before the start of treatment (86?±?15 and 82?±?16 % of predicted value, respectively). Over the course of treatment, significant declines were found in hemoglobin, quadriceps force, handgrip force, and maximal oxygen uptake, while patients reported more fatigue (p values?<?0.016). Fatigue was significantly correlated with hemoglobin (r?=??0.49), physical activity (r?=?0.81), and physical functioning (r?=??0.44). Large interindividual variations were found. The present study partially confirmed the hypothesized vicious circle between fatigue, physical inactivity, and deconditioning. Further research with larger samples and longer follow-up is needed to identify factors associated with individual variation in the evolution of fatigue, physical activity, and physical fitness.     

Muscle performance and fatigue in compensated chronic liver disease

Abstract

Background: A common and debilitating symptom in patients with chronic liver disease is fatigue (CLD). Muscle dysfunction has been suggested to be a key mechanism of fatigue in CLD.

Objective: We aimed to evaluate fatigue and the potential association with muscle performance and physical activity in outpatients with CLD.

Methods: Two-hundred seventy outpatients with CLD were included, (52?±?15 years, mean?±?SD; 151 females) with autoimmune hepatitis (n?=?49), primary biliary cholangitis (n?=?45), primary sclerosing cholangitis (n?=?46), chronic hepatitis B (n?=?57) or C (n?=?73). Patients with a Child-Pugh >6 were excluded. The questionnaire Fatigue Impact Scale (FIS) was used to evaluate fatigue, and physical activity was evaluated through a self-reported level of physical activity. Muscle function was assessed with four muscle tests, walking speed, handgrip strength, standing heel-rise test (SHT) and ‘Timed Up and Go’ test (TUG).

Results: The median total FIS score was 30 (40% had FIS > 40, considered high-fatigue). Diminished muscle performance was observed in the SHT (% of predicted value: 53?±?26%) and with maximum grip strength (85?±?20%). The FIS score was significantly different between groups of CLDs (p?=?.004). In multivariate analysis the TUG (p?=?.001), SHT (p?=?.005), antidepressants (p?p?=?.001) were associated with fatigue (R²?=?29%). Subjects with higher levels of physical activity had lower FIS (p?Conclusions: In patients with CLD, fatigue was associated with low muscle performance and reduced level of physical activity, which could be a potential therapeutic target.     

Aerobic fitness, fatigue, and physical disability in systemic lupus erythematosus

OBJECTIVE: To measure aerobic fitness, muscle strength, fatigue, and physical disability in patients with systemic lupus erythematosus (SLE). METHODS: Ninety-three patients with SLE and 41 sedentary controls were recruited into the study. Aerobic fitness was assessed by monitoring peak and submaximal oxygen uptake, heart rate, duration of exercise, and perceived exertion during a treadmill-walking test. Strength was measured using voluntary isometric quadriceps contraction. Symptomatic measures included physical and mental fatigue, mood, sleep, and functional incapacity. RESULTS: Compared to sedentary controls patients with SLE had significantly reduced levels of aerobic fitness (mean VO2peak SLE patients, 23.2 ml/kg/min vs controls, 29.6 ml/kg/min; p < 0.001) and reduced exercise capacity (mean exercise duration SLE patients, 10.4 min vs controls, 13.1 min; p < 0.001). The SLE patients also had reduced muscle strength (mean maximum voluntary quadriceps contraction SLE patients, 298 N vs controls, 376 N; p = 0.003). Resting lung function was also significantly worse in the SLE patients (mean FEV, SLE patients, 2.6 l vs controls, 2.9 l; p = 0.002). Fatigue (p < 0.001), depressed mood (p < 0.001), poor sleep quality (p < 0.001), and functional incapacity (p < 0.001) were all significantly greater in the SLE patients. Linear regression models suggested that physical disability correlated with aerobic fitness (p < 0.001), fatigue (p = 0.005), body mass index (p = 0.01), and depression (p = 0.05) and that fatigue correlated with depression (p < 0.001). CONCLUSION: Patients with SLE were less fit with reduced exercise capacity, reduced muscle strength, more fatigue, and greater disability compared to sedentary controls. Treatments developed to manage depression and improve aerobic fitness should be considered in the overall treatment of fatigue and disability in SLE.     

Fatigue in a population-based cohort of patients with inflammatory bowel disease 20 years after diagnosis: The IBSEN study

Objective: Fatigue is a major concern for patients with ulcerative colitis (UC) and Crohn’s disease (CD), but evidence from population-based studies regarding fatigue in long-standing inflammatory bowel disease (IBD) patients is scarce. Our aims were to assess fatigue scores and the prevalence of chronic fatigue in IBD patients 20 years after diagnosis and to identify variables associated with fatigue in this cohort.

Methods: Twenty years after diagnosis, patients from a cohort with incident IBD were invited to a follow-up visit that included a structured interview, a clinical examination, laboratory tests and the Fatigue Questionnaire (FQ). Fatigue scores were obtained, and factors associated with fatigue were assessed via linear and logistic regression analyses.

Results: Of the 599 invited patients, 440 (73.5%) completed the FQ. Among those with active disease, we found significantly higher fatigue scores than among those with quiescent disease (fatigue scores: UC 17.1 versus 12.4, p?<?.001, and CD 17.5 versus 13.3, p?<?.001). The fatigue scores of those with quiescent disease were comparable with those of the reference population. Chronic fatigue was more frequent among IBD patients than in the reference population. Factors associated with fatigue included self-perceived disease activity, poor sleep quality, anxiety and depression.

Conclusion: At 20 years after IBD diagnosis, fatigue scores were higher and chronic fatigue was more frequent among IBD patients with active disease than in the reference population and among those with quiescent IBD. Subjectively perceived disease activity, sleep quality, anxiety and depression were associated with fatigue in IBD patients.     

Do physical activity levels influence the cardiovascular‐related physiological characteristics of postmenopausal women?

Aim: This study aimed to determine whether cardiovascular‐related physiological differences existed among postmenopausal women in relation to their physical activity levels. Methods: Participants were postmenopausal women (n= 101) resident in North Queensland. A self‐report questionnaire determined recent exercise history. Anthropometric and physiological measures were obtained. Participants also performed a six‐minute graded exercise test to determine cardiorespiratory fitness. Results: Compared with the women who exercised, those women who did not exercise had a lower level of cardiorespiratory fitness (P= 0.00) and higher resting diastolic blood pressure (P= 0.01), BMI (P= 0.00) and WHR (P= 0.02). Discriminant function analysis found that a combination of BMI and cardiorespiratory fitness discriminated between the two groups. Conclusions: Postmenopausal women who performed moderate‐intensity physical activity had more favourable cardiovascular‐related physiological characteristics. Health professionals should encourage more postmenopausal women to participate in moderate‐intensity activity to reduce the risk of cardiovascular disease.     

Creatine supplementation and physical training in patients with COPD: A double blind, placebo-controlled study

Study objectives

Patients with chronic obstructive pulmonary disease (COPD) have low exercise capacity and low content of high energetic phosphates in their skeletal muscles. The aim of the present study was to investigate whether creatine supplementation together with exercise training may increase physical performance compared with exercise training in patients with COPD.

Design

In a randomized, double-blind, placebo-controlled study, 23 patients with COPD (forced expiratory volume in one second [FEV₁] < 70% of predicted) were randomized to oral creatine (n = 13) or placebo (n = 10) supplementation during an 8-week rehabilitation programme including exercise training. Physical performance was assessed by Endurance Shuttle Walking Test (ESWT), dyspnea and leg fatigue with Borg CR-10, quality of life with St George’s Respiratory Questionnaire (SGRQ). In addition, lung function test, artery blood gases, grip strength test, muscle strength and fatigue in knee extensors were measured.

Results

COPD patients receiving creatine supplementation increased their average walking time by 61% (ESWT) (p < 0.05) after the training period compared with 48% (p = 0.07) in the placebo group. Rated dyspnea directly after the ESWT decreased significantly from 7 to 5 (p < 0.05) in the creatine group. However, the difference between the groups was not statistically significant neither in walking time nor in rated dyspnea. Creatine supplementation did not increase the health related quality of life, lung function, artery blood gases, grip strength and knee extensor strength/fatigue.

Conclusions

Oral creatine supplementation in combination with exercise training showed no significant improvement in physical performance, measured as ESWT, in patients with COPD compared with exercise training alone.     

Coping is excellent in Swiss Children with inflammatory bowel disease: Results from the Swiss IBD cohort study

BackgroundInflammatory bowel disease (IBD) starting during childhood has been assumed to impair quality of life (QoL) of affected children. As this aspect is crucial for further personality development, the health-related quality of life (HRQOL) was assessed in a Swiss nationwide cohort to obtain detailed information on the fields of impairment.MethodsData were prospectively acquired from pediatric patients included in the Swiss IBD Cohort Study. IBD activity was evaluated by PCDAI and PUCAI. The age adapted KIDSCREEN questionnaire was evaluated for 110 children with IBD (64 with Crohn's disease 46 with ulcerative colitis). Data were analyzed with respect to established reference values of healthy controls.ResultsIn the KIDSCREEN index a moderate impairment was only found for physical wellbeing due to disease activity. In contrast, mental well-being and social support were even better as compared to control values. A subgroup analysis revealed that this observation was restricted to the children in the German speaking part of Switzerland, whereas there was no difference compared to controls in the French part of Switzerland. Furthermore, autonomy and school variables were significantly higher in the IBD patients as compared to controls.ConclusionsThe social support for children with IBD is excellent in this cohort. Only physical well-being was impaired due to disease activity, whereas all other KIDSCREEN parameters were better as compared to controls. This indicates that effective coping and support strategies may be able to compensate the burden of disease in pediatric IBD patients.     

Differences in pulmonary and extra-pulmonary characteristics in severely versus non-severely fatigued recipients of allogeneic hematopoietic stem cell transplantation: a cross-sectional,comparative study

Objectives: Fatigue is a common symptom in allogeneic-hematopoietic stem cell transplantation (allogeneic-HSCT) recipients. However, effects of severe fatigue on pulmonary functions, blood cells, dyspnea, muscle strength, exercise capacity, depression and quality of life (QOL) in allogeneic-HSCT recipients are still unknown. Therefore, to compare pulmonary functions, blood levels, dyspnea, muscle strength, exercise capacity, depression, and QOL between allogeneic-HSCT recipients according to fatigue severity and to determine predictors of severe fatigue were aimed in the current study.

Methods: Twenty-four severe-fatigued (Fatigue Severity Scale score ≥36) (40.08?±?12.44years) and 25 non-severe-fatigued (36.20?±?13.73years) allogeneic-HSCT recipients were compared. Blood levels, pulmonary functions (spirometer), dyspnea (Modified Medical Research Council Dyspnea scale), exercise capacity (6-minute walk test), depression (Beck Depression Inventory-II), QOL (European Organization for Research and Treatment of Cancer QOL Questionnaire), respiratory (mouth pressure device) and peripheral muscle strength (dynamometer) were evaluated.

Results: Symptom QOL-subscale and depression scores were significantly higher; peripheral muscle strength, global health status, and functional QOL-subscales scores were lower in severe-fatigued recipients (p?<?0.05) whose exercise capacity was clinically (28.85?m) decreased. Blood levels, pulmonary functions, dyspnea, and respiratory muscle strength were similar in groups (p?>?0.05). 42.4% of the variance in severe fatigue was explained by symptom QOL-subscale score and corticosteroid use after HSCT (p?<?0.001).

Conclusions: Impairments in peripheral muscle strength, QOL, exercise capacity, and depression are more prevalent among severe-fatigued recipients. Moreover, poorer QOL and corticosteroid use after HSCT are most important predictors of severe fatigue. Effects of comprehensive exercise programs and psychosocial support for severe-fatigued recipients in late post-engraftment period should be investigated.     

Physical Inactivity in Pulmonary Sarcoidosis

Purpose

Reduced physical activity in many chronic diseases is consistently associated with increased morbidity. Little is known about physical activity in sarcoidosis. The aim of this study was to objectively assess physical activity in patients with pulmonary sarcoidosis and investigate its relationship with lung function, exercise capacity, symptom burden, and health status.

Methods

Physical activity was assessed over one week in 15 patients with pulmonary sarcoidosis and 14 age-matched healthy controls with a tri-axial accelerometer (ActivPal™) and the International Physical Activity Questionnaire (IPAQ). All participants underwent pulmonary function tests, 6-min walk test (6MWT) and completed the Fatigue Assessment Scale (FAS), Medical Research Council (MRC) Dyspnoea Scale and the King’s Sarcoidosis Questionnaire (KSQ).

Results

Patients with sarcoidosis had significantly lower daily step counts than healthy controls; mean (SD) 5624 (1875) versus 10,429 (2942) steps (p < 0.01) and a trend towards fewer sit-to-stand transitions each day (p = 0.095). Only two patients (13%) self-reported undertaking vigorous physical activity (IPAQ) compared to half of healthy individuals (p < 0.01). Daily step count was significantly associated with 6MWT distance in sarcoidosis (r = 0.634, p = 0.01), but not with forced vital capacity (r = 0.290), fatigue (r = 0.041), dyspnoea (r = −0.466) or KSQ health status (r = 0.099–0.484). Time spent upright was associated with fatigue (r = −0.630, p = 0.012) and health status (KSQ Lung scores r = 0.524, p = 0.045), and there was a significant correlation between the number of sit-to-stand transitions and MRC dyspnoea score (r = −0.527, p = 0.044).

Conclusion

Physical activity is significantly reduced in sarcoidosis and is associated with reduced functional exercise capacity (6MWD). Fatigue, exertional symptoms and health status were more closely associated with time spent upright and the number of bouts of physical activity, as compared to step counts. Further studies are warranted to identify the factors that determine different physical activity profiles in sarcoidosis.

     

Poor physical fitness,and impaired early insulin response but late hyperinsulinaemia,as predictors of NIDDM in middle-aged Swedish men

Summary In a prospective population-based study of middle-aged Caucasian men, performed in Malmö, Sweden, specifically designed to evaluate physical fitness, early and late insulin response as predictors of non-insulin-dependent diabetes mellitus (NIDDM), 4,637 non-diabetic men underwent oral glucose tolerance tests at the ages of 48 and 54 years. At the baseline examination, physical fitness was measured in terms of lung vital capacity and oxygen uptake during ergometry; early insulin response in terms of the 40-min insulin increment during an oral glucose tolerance test (a correlate of acute insulin response to an intravenous glucose tolerance test), and late insulin response were measured in terms of the 2-h insulin value during the oral glucose tolerance test (a correlate of glucose disposal during euglycaemic clamp testing). Of the subjects studied 116 developed NIDDM (0.4% annually), and when compared with non-diabetic men at baseline, they were found to have an 11% higher mean body mass index (p<0.001), a higher frequency of family history of diabetes (31 vs 18%, p<0.001), 16% lower mean physical activity index (p<0.05), 16% lower mean estimated maximal oxygen uptake (p<0.001), 10% lower mean vital capacity (p<0.001), 26% lower 40-min to total insulin response ratio (p<0.001), and a 2.7 times higher mean 2-h insulin value during an oral glucose tolerance test (p<0.001). Regression analysis (using Cox's proportional hazards model) showed both low vital capacity, and impaired early insulin response but late hyperinsulinaemia to be independent predictors of NIDDM, in addition to body mass index and fasting blood glucose level (p=0.05–0.0001). Among subjects with impaired glucose tolerance at baseline (44 of 278 developed NIDDM), fasting glucose level alone predicted diabetes in this model. The findings suggest that in this age group in a Caucasian population, not only does insulin resistance precede glucose intolerance and NIDDM, but also loss of early insulin response indicating impaired beta-cell function to be an early feature of the process culminating in diabetes. As both physical fitness [which correlates inversely with late insulin response (r=–0.42, p<0.0001)], and the level of physical activity were shown to correlate with diabetes development in this large series, measures to correct these adverse features should be included in future strategies for preventing NIDDM.Abbreviations OGTT Oral glucose tolerance test - NGT normal glucose tolerance - IGT impaired glucose tolerance - NIDDM non-insulin-dependent diabetes mellitus - BMI body mass index - IVGTT intravenous glucose tolerance test     

Physical Activity Patterns in Patients in Different Stages of Chronic Obstructive Pulmonary Disease

It has previously been suggested that exercise capacity is decreased in COPD and that it is associated with degree of disease. The reduced exercise capacity may plausibly be due to low levels of physical activity in this patient group. The aim of the present study was to assess exercise capacity and physical activity in different stages of COPD and to examine the associations between exercise capacity, pulmonary function and degree of physical activity. A total of 44 COPD patients and 17 healthy subjects participated in the study. Exercise capacity was assessed using the 6-minute walking test and physical activity was assessed using an accelerometer worn all waking hours during 7 days. Mean exercise capacity was significantly lower in COPD patients compared with healthy subjects. Mean physical activity level and time spent at least moderately active were significantly lower in patients with moderate and severe COPD compared with healthy subjects while no differences in time spent sedentary were observed between the study groups. Pulmonary function, mean physical activity level and time spent at least moderately physically active were significantly associated with exercise capacity in the patients. We conclude that patients with moderate and severe COPD are less physically active compared with healthy subjects. Furthermore, mean physical activity level and physical activity of at least moderate intensity are positively associated with exercise capacity in COPD, while time spent sedentary is not, which stresses an important role of physical activity on exercise capacity in these patients.     

不同运动剂量干预对衰弱老年人健康状况的影响

目的探讨不同运动剂量干预对衰弱老年人肌力、体适能及睡眠状况的效果。方法招募符合纳入标准的衰弱老年人88例,随机将其分为对照组、小量中强度组、小量大强度组和大量大强度组,每组22例。对照组无任何针对性身体训练干预,3个干预组按设计方案进行相应的运动量和强度的下肢抗阻运动。分别在干预前、干预12周后评估老年人的下肢肌力、体适能及睡眠状况。结果对照组干预前后下肢肌力、体适能及睡眠状况差异均无统计学意义(P>0.05);小量中强度组、小量大强度组和大量大强度组干预前后各指标均有改善(P<0.05或P<0.01)。小量大强度组和大量大强度组的下肢肌力、6 min步行距离、30 s坐站次数、总睡眠时间均明显优于小量中强度组(P<0.01)。结论抗阻运动可以有效改善衰弱老年人的肌力、体适能和睡眠状况,运动量和运动强度都有利于衰弱老年人肌力、体适能、睡眠指标的改善,但是强度是影响上述健康指标的主要因素。     

The effects of a 16-week aerobic exercise programme on cognitive function in people living with HIV

High levels of cardiovascular fitness and physical activity are associated with higher levels of cognitive function in people with HIV, thus, they may reduce the risk of developing HIV-associated neurocognitive disorder (HAND). This study aimed to investigate the effects of a 16-week aerobic exercise intervention on cognitive function in people with HIV. Eleven participants living with HIV were recruited into the study. Participants were randomised into either an exercise group (n?=?5), that completed a 16-week aerobic exercise programme training, 3 times per week (2 supervised sessions and one unsupervised session) or a control group (n?=?6) that received no intervention. Outcomes measured included cognitive function (Montreal cognitive assessment (MOCA) and the Trail making tests A and B), aerobic fitness (modified Bruce protocol), sleep quality (Pittsburgh sleep quality index; PSQI) and physical activity levels (seven-day accelerometry). At baseline, higher levels of moderate physical activity were positively correlated with higher MOCA scores and levels of aerobic fitness were negatively associated with Trail A scores (P?=?0.04 and P?=?0.001 respectively). However, exercise training did not induce any significant improvements in cognitive function or aerobic fitness. The overall mean adherence rate to the exercise programme was 60%. In conclusion, in the present study a 16-week aerobic exercise intervention did not affect the cognitive function of participants with HIV. It is likely that longer intervention periods and/or higher adherence rates to exercise might be needed for an aerobic exercise programme to be effective in improving cognitive function in a cohort with no baseline cognitive impairments.     

The association between physical function and lifestyle activity and exercise in the health, aging and body composition study

Objectives: To determine whether older adults who exercise demonstrate higher levels of physical function than those who do not exercise but are physically active throughout the day. Design: Cross‐sectional examination of baseline data from the Health, Aging and Body Composition (Health ABC) study. Setting: Health ABC field centers in Pittsburgh, Pennsylvania, and Memphis, Tennessee. Participants: Three thousand seventy‐five well‐functioning black and white men and women aged 70 to 79. Measurements: Physical activity and exercise were assessed using a modified leisure‐time physical activity questionnaire. Participants were classified as inactive (reporting <1,000 kcal/wk of exercise activity and ≤2,719 kcal/wk of total physical activity), lifestyle active (reporting <1,000 kcal/wk of exercise activity and >2,719 kcal/wk of total physical activity), or exerciser (reporting≥1,000 kcal/wk of exercise activity). Physical function measures included the Established Populations for the Epidemiologic Studies of the Elderly (EPESE) battery, the Health ABC battery, a 400‐m walk test, and isokinetic strength testing of the knee extensors. Results: The lifestyle active and exerciser groups had similar total activity levels (men: 6,135 kcal/wk and 6,734 kcal/wk, respectively; P=.108; women: 5,695 kcal/wk and 5,854 kcal/wk, respectively; P=.335). When examining lower extremity performance in relation to physical activity, a progressive trend was evident, with the inactive individuals most likely to have impaired performance on the EPESE battery (men: 33.7%, 24.3%, and 19.1%, P<.001; women: 49.9%, 37.3%, and 28.4%, P<.001; inactive, lifestyle active, and exerciser, respectively). Progressive trends of similar magnitude were present for the Health ABC battery, time to walk 400 m, and knee extensor strength. In multivariate linear regression, those in the inactive and lifestyle active groups had poorer scores on the Health ABC performance battery than individuals in the exercise group after controlling for demographic factors and prevalent disease (men: inactive β=?0.27, P<.001, lifestyle active β=?0.07, P=.032; women: inactive β=?0.23, P<.001, lifestyle active β=?0.07, P<.059). After controlling for demographic factors and prevalent disease, the lifestyle active and exercisers had similar proportions of functionally limited older persons (scoring <10 on the EPESE battery). Conclusion: Older adults who participate in 20 to 30 minutes of moderate‐intensity exercise on most days of the week have better physical function than older persons who are active throughout the day or who are inactive. Any type of physical activity is better than no activity for protection against functional limitations, but exercise confers greater benefit for physical capacity.     

Blood pressure,physical fitness and physical activity in 17-year-old Danish adolescents

Abstract. Objective. To test the relationship between physical activity and physical fitness, and the relationship between these variables and the primordial risk factor blood pressure (BP). Design. A cross-sectional study of all Danish pupils in the same grade at ‘gymnasium’ (the Danish upper secondary school). Setting. Tests and questionnaires were administered by physical education and biology teachers according to a prescribed scheme. Subjects. Study subjects were 13810 adolescents with a mean age of 17.1 years. Physical activity, smoking habits, and physical performance were measured in 4862 boys and 6573 girls. Blood pressure was measured in 2474 boys and 3535 girls. No difference was found in BP, physical activity and fitness variables between this group and a representative group of Danish school children at the same age. Main outcome. Blood pressure and health-related physical performance such as strength, muscle endurance, flexibility and maximal oxygen uptake (VO_2max) estimated from heart rate at submaximal workload were measured. Sports activity, other physical activity and smoking habits were assessed by questionnaires. Results. There was a negative relationship between BP and VO_2max up to the 50% percentile (50 ml min^?1 kg^?1) in boys and up to the upper 80–90% percentile (45 ml min^?1 kg^?1) in girls. In a multiple regression model with BP as dependent variable, VO_2max related highly significant, also after adjustment for body weight and physical activity (P < 0.001). Other performance variables only explained a small part of the variance in BP. No relationship was found between BP and total physical activity or sports activity. Conclusion. In the adolescent population VO_2max related negatively to BP after adjustment for body weight, physical activity, other fitness measures and sex, but physical activity or other fitness measures did not relate. Lower blood pressure was found with higher VO_2max until levels of 50 and 45 ml min^?1 kg^?1 in boys and girls, respectively.     

Risk of impaired nutritional status and flare occurrence in IBD outpatients

BackgroundInflammatory bowel disease (IBD) patients are at risk of an impaired nutritional status. The impact thereof on the IBD relapse risk is clinically relevant, though sparsely investigated.AimThe aim was to explore the association between an impaired nutritional status risk and the occurrence of disease flares in IBD outpatients participating in a longitudinal telemedicine study.MethodsIBD outpatients were recruited from the myIBDcoach study cohort, with one year clinical follow-up. Through myIBDcoach, a telemedicine tool, patients reported on disease activity and risk of impaired nutritional status (i.e. Short Nutritional Assessment Questionnaire >1 and/or BMI < 18.5 kg/m²) every one to three months. Data was analysed by generalized estimating equation modelling.ResultsIn total, 417 patients were included. During follow-up, 49 patients (11.8%) flared after initial clinical remission and 53 patients (12.7%) showed an increased risk of impaired nutritional status. The risk of impaired nutritional status was associated with flare occurrence (OR 2.61 (95% CI 1.02–6.69)).ConclusionsThe risk of an impaired nutritional status was associated with subsequent flares in IBD outpatients. This emphasizes the importance of monitoring disease activity in IBD patients at risk of impaired nutritional status.     

Fatigue in patients with primary sclerosing cholangitis

Background: The occurrence of fatigue in primary sclerosing cholangitis (PSC), its impact on quality of life and the role of concomitant inflammatory bowel disease (IBD) and coexisting irritable bowel syndrome (IBS) is unexplored. Methods: Ninety‐three patients with PSC, associated with IBD in 80% of cases and 77 patients with IBD alone, were enrolled in the study. The patients completed the following questionnaires: the Fatigue Impact Scale (FIS), the Psychological General Well‐Being Index (PGWB), the Gastrointestinal Symptom Rating Scale (GSRS), the Beck Depression Inventory (BDI) and diagnostic criteria for IBS. Questionnaire data were related to liver tests and the latest liver biopsy in the PSC patients. Two sex‐ and age matched controls from the general population (GP) were assigned to each PSC patient and these controls completed the FIS and the BDI. Results: Total fatigue score did not differ significantly between patients with PSC and IBD alone. Median total fatigue score among GP subjects was 39 (13–72), which was higher than in PSC (19 (6–52) (P?=?0.02)) and in IBD patients (19 (5–35) (P?Conclusions: Fatigue in patients with PSC is related to depression but not to the severity of the liver disease. Both the PSC and IBD patients had lower total fatigue scores than subjects from the general population. This argues against fatigue as a specific symptom of PSC and IBD patients.     

The impact of an adaptation course on health-related quality of life and functional capacity of patients with inflammatory bowel disease

Abstract

Background: Inflammatory bowel disease (IBD) has a substantial impact on patients health-related quality of life (HRQoL). In this study, we examined the impact of adaptation courses on HRQoL, psychological well-being, depression and number of sick-leave days of IBD patients.

Methods: The study recruited 142 IBD patients attending an adaptation course of 5–12 days. The courses were specially designed for IBD patients and included multidisciplinary information about IBD, peer support, group activities and encouragement for adequate physical exercise. The participants completed the study questionnaire at the beginning and the end of the course and after six and 12 months of follow-up. HRQoL was assessed with the generic 15-dimensional (15D) tool and depression with Beck’s Depression Inventory (BDI). Utilization of health care services and work absenteeism was also assessed. Visual analog scales were used for assessing psychological functioning.

Results: 15D, BDI scores and scores describing psychological well-being were significantly better at the end of the course when compared to baseline (15D 0.82 vs. 0.84, p?p?p?=?.01). No significant change in health care utilization or number of sick-leave days was observed.

Conclusion: Adaptation training appears to have a positive impact on the psychological well-being of IBD patients. Peer support appears to be an important factor.     

The immediate effect of physical activity on standing balance in healthy and balance‐impaired older people

Objective: To determine if standing balance was affected by moderate levels of physical activity in healthy young, healthy older and balance‐impaired older adults. Methods: Thirty‐one healthy young, 33 healthy older and 22 balance‐impaired older adults took part. Centre of pressure (COP) motion was measured before and immediately after participants undertook 14 minutes of self‐paced, moderate intensity physical activity. Results: All groups responded in a similar manner. Following the physical activity circuit, mediolateral COP displacement and standard deviation of mediolateral COP position increased by 5% and 17%, respectively. Anteroposterior COP displacement and COP standard deviation, and total COP displacement, did not change. All changes were small compared with the magnitude of the group differences. Conclusions: A small increase in fall risk may exist immediately following physical activity and older people may need to exercise caution following moderate intensity bouts of physical activity to prevent falling.     

Lower extremity mobility limitation and impaired muscle function in women with ulcerative colitis

Background and aimFatigue, weakness and musculoskeletal manifestations are associated with IBD. An impaired nutritional status and a reduced physical activity can contribute to these clinical outcomes, impacting quality of life and increasing disability. This study aims to assess muscle strength and lower limb physical performance in female UC patients, taking into consideration disease activity, body composition and habitual physical activity.MethodsA case-control study was performed including 23 UC female outpatients and 23 age- and BMI-matched healthy women as controls. Quadriceps strength (QS), handgrip strength (HGS), physical performance based measures (five repetitions sit-up test and 4 meter gait speed test), body composition (bioelectrical impedance analysis, anthropometry), and habitual physical activity (HPA) levels were assessed.ResultsUC group had decreased QS (− 6%; P = 0.012), slower sit-up test (− 32%; P = 0.000), slower gait speed (− 17% P = 0.002) and decreased HPA level (− 30%, P = 0.001) compared with controls. No difference in HGS was observed between groups. Logistic regression showed that UC was an independent factor for decreased QS and slower sit-up test, while HPA was a protective factor for impaired gait speed. Multivariate linear regression showed that BMI was independently associated with an improved QS and slower sit-up test in the UC group.ConclusionWomen with UC had decreased lower limb strength and mobility limitations, which were associated with BMI and the level of physical activity. Early evaluation of nutritional status and performance of the lower limbs could identify UC patients with pre-clinical disability who may benefit from earlier health lifestyle modifications.