Effects of exercise therapy on quality of life in patients with inflammatory bowel disease: a network meta-analysis

To systematically evaluate and compare the efficacy of exercise interventions represented in eligible randomized controlled trials in patients with inflammatory bowel disease (IBD), rank the evaluated modalities, and identify factors that may influence treatment outcomes.

We systematically searched PubMed, Web of Science, Sinomed, Cochrane Library, Embase, CNKI, and Wanfang for randomized controlled trials (RCTs) investigating exercise interventions in patients with IBD. Outcomes included health-related quality of life, disease activity, fatigue, and inflammatory biomarkers. Network meta-analysis (NMA) was conducted using Stata 16.0. For continuous outcomes, pooled effects were expressed as mean differences (MDs) or standardized mean differences (SMDs) with 95% confidence intervals (CIs), as appropriate. Study quality and risk of bias were assessed using RevMan 5.4. Confidence in network estimates was assessed using CINeMA, while certainty for outcomes synthesized by conventional pairwise meta-analysis was assessed using GRADE.

A total of 24 RCTs involving 1,557 patients and six exercise modalities were included. Compared with conventional therapy, continuous aerobic exercise (CAE) significantly improved quality of life (SMD = 1.15, 95% CI [0.29, 2.01]), while high-intensity interval training showed a favorable but imprecise effect. Yoga and high-intensity interval training significantly reduced disease activity, and Yoga also improved fatigue. High-intensity interval training reduced IL-6, whereas CAE and high-intensity interval training were associated with lower TNF-α. Yoga significantly reduced CRP and ESR. Subgroup analyses suggested that continuous aerobic exercise performed four times weekly for three months exhibited a relatively favorable ranking probability within the evidence network for quality-of-life improvement, though this relative position does not imply absolute clinical superiority. The fatigue, IL-6, and TNF-αnetworks contained only subsets of the six exercise modalities, and confidence in many comparisons was low or very low; these estimates and rankings should therefore be interpreted cautiously.

Exercise therapy may improve quality of life and related outcomes in patients with IBD. However, comparative rankings are limited to the modalities represented within each outcome network and are supported predominantly by low- or very-low-confidence evidence; clinical recommendations should therefore remain cautious. Larger, well-designed RCTs are needed to optimize exercise prescriptions.