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Preoperative exercise capacity in adult inflammatory bowel disease sufferers, determined by cardiopulmonary exercise
J M Otto1, A F O'Doherty, P J Hennis
1The Portex Unit, UCL Institute of Child Health, Guilford Street, Archway Campus, N19 5LW, London, England, UK. james.otto@ucl.ac.uk
Insights
Adults with inflammatory bowel disease (IBD) show reduced aerobic exercise capacity. Cardiopulmonary exercise testing revealed a lower anaerobic threshold in Crohn's disease patients compared to other groups, indicating impaired exercise capacity.
Area of Science:
- Gastroenterology and Hepatology
- Cardiology
- Exercise Physiology
Background:
- Aerobic exercise capacity is known to be impaired in pediatric inflammatory bowel disease (IBD) patients.
- The impact of IBD on aerobic exercise capacity in adults remains largely unknown.
- Fistula presence in IBD may further compromise exercise capacity.
Purpose of the Study:
- To assess anaerobic threshold (AT) in adult IBD patients using cardiopulmonary exercise testing (CPET).
- To compare AT in IBD patients with reference values and patients undergoing elective colorectal surgery.
- To investigate if fistula presence exacerbates AT reduction in IBD.
Main Methods:
- Cardiopulmonary exercise testing (CPET) was conducted on 414 adult patients awaiting abdominopelvic surgery (November 2007 - December 2010).
- Anaerobic threshold (AT) values were compared against gender-specific population reference values.
- Statistical analyses included Mann-Whitney U test, unpaired t tests, and analysis of covariance (ANCOVA) adjusting for age and sex.
Main Results:
- Adjusted AT values were significantly lower in Crohn's disease (CD) patients compared to colorectal cancer (11.4 ± 3.4 vs 13.2 ± 3.5 ml.kg(-1).min(-1), p = 0.03) and other colorectal disease groups (12.6 ± 3.5 ml.kg(-1).min(-1), p = 0.03).
- Combined AT for Ulcerative Colitis (UC) and CD patients was reduced compared to population reference values (p < 0.05).
- The study did not report specific findings regarding fistula presence and AT reduction.
Conclusions:
- Adult patients with Crohn's disease exhibit a reduced anaerobic threshold compared to surgical controls, even after adjusting for age and sex.
- The findings suggest impaired aerobic exercise capacity in adult IBD patients.
- The underlying mechanisms contributing to the reduced AT in IBD require further investigation.
Background And Aims:
Aerobic exercise capacity appears impaired in children with inflammatory bowel disease (IBD). Whether this holds true in adults with IBD is not known. Using cardiopulmonary exercise testing (CPET), we assessed anaerobic threshold (AT) in such patients comparing data with reference values and other elective surgical patients. We also sought to confirm whether the presence of a fistula further reduced AT.
Methods:
CPET was performed between November 2007 and December 2010 on patients awaiting abdominopelvic surgery. Gender-specific normal reference values were used for comparison. Unadjusted comparison between two groups was made using Mann-Whitney U test and by unpaired t test. Data were adjusted by analysis of covariance, using age and sex as covariates. Differences between patients' observed values and reference values were tested using paired t tests.
Results:
Four hundred and fourteen patients (234 male) were studied (mean ± SD age, 56.6 ± 16.4 years; weight, 74.2 ± 15.6 kg). Adjusted AT values in Crohn's disease (CD) were lower than colorectal cancer (11.4 ± 3.4 vs 13.2 ± 3.5 ml.kg(-1).min(-1), p = 0.03) and for all other colorectal disease groups combined (12.6 ± 3.5 ml.kg(-1).min(-1), p = 0.03). AT of Ulcerative colitis (UC) and CD patients together were reduced compared to population reference values (p < 0.05).
Conclusion:
After adjusting for age and sex, CD patients had a reduced AT compared to patients with colorectal cancer and other colorectal disease groups combined. The pathogenesis of this low AT remains to be defined and warrants further investigation.
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