P0863 The effect of intensive physical exercise on fatigue and quality of life in patients with quiescent inflammatory bowel disease: a multicentre randomised controlled trial (ENERGIZE-IBD trial)

Abstract Background Inflammatory bowel disease (IBD) is a chronic relapsing–remitting condition that impairs health-related quality of life (HRQoL), even in remission. Beyond physical symptoms, IBD is associated with anxiety, depression, and persistent fatigue, affecting up to 70% of patients during flares and 40% in remission1. Despite its impact, specific therapies for chronic fatigue in IBD are lacking. Physical exercise has shown benefits in other immune-mediated diseases2,3, but data in IBD are limited. A previous pilot study from our research group of a 12-week supervised exercise programme improved fatigue, HRQoL, and fitness4. This study, a randomised controlled trial, was needed to validate these findings. Methods In a multicentre, randomised trial, adults (18–67 years) with quiescent IBD and chronic fatigue (≥3 months; IBD-F section I ≥ 11) were randomised 1:1 either or control group. The intervention comprised a 12-week supervised exercise programme with three one-hour personalised sessions per week of 30 min aerobic training and 30 min resistance training and included cardiopulmonary exercise testing pre- and post-intervention. Controls received standard care and written advice about daily exercise. Primary outcomes were fatigue (IBD-F) and HRQoL (IBDQ) at 12 weeks. Secondary outcomes included anxiety and depression (HADS), sleep quality (PSQI), cardiorespiratory fitness, body composition, disease activity, and adverse events. Results In total, 100 patients were randomised. Of them, 93 participants completed the study and were included in the analysis (mean age 43.5 ± 11.4 years; 73% female; 61% CD, 37% UC, 2% IBD-U). Fatigue decreased more in the intervention group as compared to the control group (adjusted mean 36.5 ± 2.6 vs 45.3 ± 2.6; p = 0.014, respectively) and HRQoL increased more in the intervention group as compared to the control group (adjusted mean 175.6 ± 2.9 vs 166.6 ± 2.9; p = 0.024, respectively), both remaining significant after Bonferroni correction. Anxiety (HADS-A) decreased (p = 0.02). Cardiorespiratory fitness improved in the intervention group as compared to pre-intervention measurements (VO2max p < 0.001, maximum power p < 0.001, heart rate recovery after 2 min p = 0.014) and body fat decreased (p = 0.024). Depressive symptoms (HADS-D) and sleep quality showed no group differences. Conclusion This 12-week personalised, supervised exercise programme significantly reduced fatigue and improved HrQoL in patients with quiescent IBD and chronic fatigue. Significant improvements were also observed in anxiety and physical fitness. Exercise could be an effective strategy for managing IBD-related fatigue. References: 1. D’Silva A, Fox DE, Nasser Y, et al. Prevalence and Risk Factors for Fatigue in Adults With Inflammatory Bowel Disease: A Systematic Review With Meta-Analysis. Clin Gastroenterol Hepatol. 2022;20(5):995-1009.e7. doi:10.1016/j.cgh.2021.06.0342. 2. Cramp F, Hewlett S, Almeida C, et al. Non-pharmacological interventions for fatigue in rheumatoid arthritis. Cochrane Database Syst Rev. 2013;2013(8):CD008322. Published 2013 Aug 23. doi:10.1002/14651858.CD008322.pub23. 3. Luo B, Xiang D, Ji X, et al. The anti-inflammatory effects of exercise on autoimmune diseases: A 20-year systematic review. J Sport Health Sci. 2024;13(3):353-367. doi:10.1016/j.jshs.2024.02.0024. 4. van Erp LW, Roosenboom B, Komdeur P, et al. Improvement of Fatigue and Quality of Life in Patients with Quiescent Inflammatory Bowel Disease Following a Personalized Exercise Program. Dig Dis Sci. 2021;66(2):597-604. doi:10.1007/s10620-020-06222-5 Conflict of interest: Mr. Hendriks, Joris: No conflict of interest Oomkens, Dorien: No conflict of interest Van Berlo, Jole: No conflict of interest Van Erp, Liselot W.: No conflict of interest Dijkstra-Heida, Wendy: No conflict of interest Wisse, Jolien: No conflict of interest Liem, Camilo: No conflict of interest Kapelle, Laurens: No conflict of interest Kokshoorn, Arjan: No conflict of interest Römkens, Tessa: No conflict of interest Tan, Adriaan: No conflict of interest Van Dop, Willemijn: No conflict of interest Duijvestein, Marjolijn: Grant: Speaking fees from Bristol Meyers Squibb, Takeda, Galapagos, Janssen, Dr. Falk, Advisory board fees from Abbvie, Bristol Meyers Squibb, Celltrion, Galapagos/Alfasigma, Janssen, Takeda Grant/Research support: Pfizer, Bristol Meyers Squibb, Galapagos, Alfasigma, Janssen, Lilly Wahab, Peter J.: No conflict of interest Groenen, Marcel J.M.: No conflict of interest