Device-measured moderate-to-vigorous physical activity and prognosis of inflammatory bowel disease
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Importance
Evidence on physical activity recommendations for inflammatory bowel disease (IBD) patients is limited, with concerns about high-intensity activity.
Objective
To investigate the associations of accelerometer-measured moderate-to-vigorous physical activity (MVPA) with bowel resection risk and mortality among individuals with IBD.
Design, setting, and participants
This longitudinal cohort study collected data from 1,303 UK Biobank participants with IBD diagnosis and device-measured physical activity from 2013 to 2015, with follow-up data examined until 2022.
Exposures
MVPA was classified based on data measured by wrist-worn accelerometers over a 7-day period. MVPA patterns were defined as inactive (< 150 minutes/week), active weekend warrior (≥ 150 minutes/week, ≥50% of total MVPA achieved in 1-2 days), and regularly active (≥ 150 minutes/week, not active weekend warrior).
Main Outcomes and Measures
The bowel resection was identified through operational records from hospital inpatient data of the National Health Service. Deaths were documented through linkage to the national death register. Associations were estimated using multivariable Cox regression models and nonlinearity was assessed by restricted cubic spline.
Results
During a median follow-up of 7.8 years, 56 incident bowel resection cases and 86 deaths were documented. After multivariable adjustment, participants in the highest tertile of MVPA duration had lower risks of bowel resection (HR, 0.44; 95% CI, 0.22-0.86) and mortality (HR, 0.49; 95% CI, 0.27-0.89) compared to those in the lowest tertile. MVPA duration is linearly associated with bowel resection (P non-linear = 0.13) while its dose-response relationship with mortality plateaus at approximately 58 min/day (P non-linear = 0.02). Regarding MVPA patterns, the active weekend warrior pattern was inversely associated with bowel resection risk (HR, 0.28; 95% CI, 0.12-0.65), the regularly active pattern was inversely associated with both bowel resection risk (HR, 0.37; 95% CI, 0.19-0.69) and mortality (HR, 0.53; 95% CI, 0.31-0.91) compared to the inactive.
Conclusion and relevance
Longer accelerometer-measured MVPA was associated with reduced bowel resection risk and mortality. The regularly active pattern may be the optimal choice for individuals with IBD, while the active weekend warrior pattern still provides health benefits compared to being inactive.
