Exercise as it relates to Disease/Investigating the effects of Resistance Training on Crohn's disease clients regarding the prevention of early mortality

1.What is the background to this research?
Crohn’s Disease (CD) is an inflammatory bowel disease (IBD) where nutrients are not effectively absorbed in the digestive system which could lead to pain, discomfort, diarrhoea, malnutrition and a stoma (perforation of the bowel). This article conveys that Resistance Training (RT) may be a solution, by enabling microtears in the muscle allowing the body to repair itself and attain muscle and bone strength to prevent falling, osteoarthritis, osteoporosis and sarcopenia. Calcium is lost from exercise (eg. sweat), and with minimal absorption, calcium is stripped from bones to maintain blood calcium levels. Therefore physical activity contributes to bone loss.

Benefits from RT involve an increase in: neuromuscular connection, potential gut microbiome, muscle mass, movement control, cardiovascular health, cognitive abilities and reduced body pain. Other studies depict aerobic exercise to decrease susceptibility and inflammation of the bowel. To contrast, high intensity and prolonged exercise increases the stomach lining’s surface area, allowing large particles through causing a stoma. CD clients undergo a social and emotion toll, through discomfort and fatigue problems arising from a cytokine inflammation response.

2.Where is the research from?
Researchers Jones, Baker, Speight, Thompson and Tew conducted research from Northumbria University United Kingdom, and PROcare ApS Denmark; delving into the study between CD and RT. Jones and Baker have articles together and independently in the fields of RT and CD released in the last few years. Dr. Speight specialises in Inflammatory Bowel Disease (IBD). Working in Newcastle, Thompson studies IBD, CD and has published literature in the area since 1995. Professor Dr. Tew is an exercise scientist, focusing on CD in the last few years. The article states that there are no associated funding biases.

3.What kind of research was this?
The experiment was a blinded Randomised, Control Trial (RCT), which is a validated method of experimentation. Being blinded meant the participants did not know whether they were in the control group, or the experimental group. Randomised meant the clients were chosen at random based on who accepted the offer to participate. The article was published recently in an ongoing field of supporting literature.

4.What did the research involve?
Applicants had to have a mildly active disease indicated on the Crohn's Disease Activity Index (CDAI). All participants (male and female) were Caucasian (mean age 49) and were given the same care. The experiment was well described using a simple chart consisting of participants who were eligible, withdrew, randomised and were checked after 3 and 6 months .Supervised exercise frequented at the start (2+ sessions/week), less frequently toward the end, but participants were checked upon via telehealth phone call for motivation and support. Participants were given equipment needed for the exercises. Outcomes assessed include upper and lower body muscle function, body mass, stature, resting blood pressure and heart rate, quality of life questionnaire, fatigue (IBD fatigue scale), physical activity questionnaire and enjoyment scales and medications. Bone Mass Density (BMD) was tested at base line and 6 months only at hip and lumbar spine using Dual Energy X ray absorptiometry (DEXA) machine. This methodology was well laid out in detail, except for the specific exercises which were completed by the participants. The study could not be completely replicated because of non-specific targeted exercises being done, which impacts the results. Participants had no knowledge of which group they were in, thus proving internally valid. The data supplied in results were accurate and well described. The p-value was set at 0.05 and the statistics were well presented in tables, regarding the specific test and the result.

5.What were the basic results?
Muscle function outcomes increased significantly, along with grip strength as portrayed in the table and table summary. Also, a significant increase in lumbar spine and greater trochanter for the BMD for the experimental group. Findings were explained in the discussion and supported with connected evidence. The experimental group experienced positive effects of physical activity, reported in increased enjoyment of life results, which surprised researchers. The resting heart rate was lower in this group(-6bpm) understandably, given the adaptation to the exercise volume. Fatigue was overall lowered at the 6-month period. Participants in the control group had a slight deterioration in health; found in a case of light headedness, disease flare up and disease relapse. Supervised exercise had more participation than non-supervised.

6.What conclusions can we take from this research?
The conclusion portrayed CD participants increased BMD and muscle function by RT. Therefore RT is suitable for preventing fractures from falling and age-related diseases such as sarcopenia and osteoporosis, osteoarthritis etc. Accuracy was measured using a DEXA scanner and multiple muscle strength and functionality tests. The basic level of prescription (PROTECT system) was sufficient to incur positive results. Fatigue was an influential setback, which affected personal and work-life balance. More exercise increased mobility and strength of muscles which lead to less fatigue and more daily activity. The written conclusion may have limitations and does not guarantee the prevention of diseases, due to genetic variation and differences in Basal Metabolic Rate. However, to disregard the findings altogether is untrue due to its supported evidence in the field. Greater understanding on CD with RT could come from other demographics and more control of food and lifestyle factors. DEXA did not consider bone quality (microarchitecture) ,or composition.

7.Practical advice
When RT CD clients, show caution to prescribing load and volume, due to abdominal inflammation during exercise. Supervision portrays accountability and allows clients to be motivated and inspired. When home exercising, limitations need to be known beforehand, so effort is made to minimise injury and further illness. Group exercise with the CD community is good for monitoring intensities of exercise with supervision and minimal risk involved. During COVID-19 online classes are a viable method of exercise. When prescribing a routine, progressively apply resistance and load when the client feels applicable, considering necessary fatigue and energy levels due to lifestyle, behaviour and motivation. Prescription should be individualised.

8.Further information/resources
Other materials suggest that even low grades of impact exercise can also stimulate the growth of BMD in CD clients. RT can help and promote overall good health in CD clients who suffer from bowel inflammation due to exercise. Some benefits of exercise can even promote better gut health and alleviate discomfort in CD. Further research is needed to consolidate findings among different demographics. Research could be done into a correlation between the mind – gut axis with CD and RT.

9.References
1.[https://onlinelibrary.wiley.com/doi/10.1111/apt.16002 Jones K, Baker K, Speight RA, Thompson NP, Tew GA. Randomised clinical trial: combined impact and resistance training in adults with stable Crohn's disease. Alimentary pharmacology & therapeutics. 2020;52(6):964-75].

2.[https://academic.oup.com/ecco-jcc/article/3/4/225/471064?login=true Perez Pérez CA. Prescription of physical exercise in Crohn's disease. Journal of Crohn's and Colitis. 2009;3(4):225-31.]

3.[https://journals.lww.com/acsm-csmr/Fulltext/2012/07000/Resistance_Training_is_Medicine__Effects_of.13.aspx Westcott WL. Resistance training is medicine: effects of strength training on health. Current sports medicine reports. 2012;11(4):209-16].

4.[https://www.sciencedirect.com/science/article/pii/S0016508598703622 Robinson RJ, Krzywicki T, Almond L, Al–Azzawi F, Abrams K, Iqbal SJ, et al. Effect of a low-impact exercise program on bone mineral density in Crohn's disease: a randomized controlled trial. Gastroenterology. 1998;115(1):36-41].

5.[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8322027/ Papadimitriou K. Effect of resistance exercise training on Crohn’s disease patients. Intestinal Research. 2021;19(3):275].

6.[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4319130/ Minderhoud IM, Samsom M, Oldenburg B. Crohn’s disease, fatigue, and infliximab: is there a role for cytokines in the pathogenesis of fatigue? World journal of gastroenterology: WJG. 2007;13(14):2089].

7.[https://www.sciencedirect.com/science/article/pii/S0140673604176708 Rothwell PM. External validity of randomised controlled trials:“to whom do the results of this trial apply?”. The Lancet. 2005;365(9453):82-93].

8.[https://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-021-01739-z Lamers CR, de Roos NM, Koppelman LJM, Hopman MTE, Witteman BJM. Patient experiences with the role of physical activity in inflammatory bowel disease: results from a survey and interviews. BMC Gastroenterology. 2021;21(1)].