Exercise Perceptions and Experiences in Adults With Crohn’s Disease Following a Combined Impact and Resistance Training Program: A Qualitative Study

Abstract Background Exercise is increasingly being recognized to counteract specific complications of Crohn’s disease (CD). The aim of this study was to explore exercise experiences and perceptions after engaging in a combined impact and resistance training program, involving both intervention and control group viewpoints. Methods Semistructured telephone interviews, involving a convenience sample of participants with CD (n = 41; aged 49.1 ± 12 years) were undertaken up to 6 weeks following completion of the program. Data were analyzed using thematic analysis. Results Four overarching themes emerged, along with 11 subthemes: (1) Lack of confidence and knowledge, fears surrounding physical ability and symptoms, coupled with issues not addressed as part of the healthcare pathway played a part in transitioning to inactivity; (2) Improvements in strength, mental well-being, physical fitness, fatigue, abdominal and joint pain, comorbidities, and self-management strategies were among the reported benefits of exercise participation; (3) Seeing progress, goal setting, enjoyment, and a peer-led program receiving support and advice increased motivation. Whereas work-related tiredness, other commitments, and self-directed exercise were reported as exercise barriers; (4) The intervention design was well received and the journey from start to finish was positively discussed, important considerations for future interventions and implementation strategies. Conclusions The study yielded novel perceptions on the transition to inactivity following receiving a diagnosis, physical and psychological benefits accruing from the intervention, and views on program design. Information that will provide an essential step in the development of implementing exercise guidelines into the clinical pathway and supporting individuals with self-management options.

[1]  Jeremy R. Townsend,et al.  Resistance Exercise Increases Gastrointestinal Symptoms, Markers of Gut Permeability, and Damage in Resistance-Trained Adults , 2022, Medicine and science in sports and exercise.

[2]  Kaelin C. Young,et al.  Exploring the Effects of Six Weeks of Resistance Training on the Fecal Microbiome of Older Adult Males: Secondary Analysis of a Peanut Protein Supplemented Randomized Controlled Trial , 2022, Sports.

[3]  L. Genton,et al.  Physical activity in inflammatory bowel disease: benefits, challenges and perspectives , 2022, Current opinion in clinical nutrition and metabolic care.

[4]  D. Monteiro,et al.  Enjoyment as a Predictor of Exercise Habit, Intention to Continue Exercising, and Exercise Frequency: The Intensity Traits Discrepancy Moderation Role , 2022, Frontiers in Psychology.

[5]  E. Cyarto,et al.  Effectiveness of Peer-Led Wellbeing Interventions in Retirement Living: A Systematic Review , 2021, International journal of environmental research and public health.

[6]  E. Bengoechea,et al.  A Systematic Literature Review of Peer-led Strategies for Promoting Physical Activity Levels of Adolescents , 2021, Health education & behavior : the official publication of the Society for Public Health Education.

[7]  K. Winters-Stone,et al.  “It was just for us”: qualitative evaluation of an exercise intervention for African-American couples , 2021, BMC Public Health.

[8]  M. Schultz,et al.  Physical Activity in Patients with Inflammatory Bowel Disease: A Cross-Sectional Study , 2021, Inflammatory Intestinal Diseases.

[9]  M. Buman,et al.  World Health Organization 2020 guidelines on physical activity and sedentary behaviour , 2020, British Journal of Sports Medicine.

[10]  Bryant H. Keirns,et al.  Exercise and Intestinal Permeability: Another Form of Exercise-Induced Hormesis? , 2020, American journal of physiology. Gastrointestinal and liver physiology.

[11]  G. Tew,et al.  Randomised clinical trial: combined impact and resistance training in adults with stable Crohn's disease , 2020, Alimentary pharmacology & therapeutics.

[12]  E. Tutton,et al.  A mixed-methods systematic review of patients' experience of being invited to participate in surgical randomised controlled trials. , 2020, Social science & medicine.

[13]  P. Bower,et al.  Why do patients take part in research? An overview of systematic reviews of psychosocial barriers and facilitators , 2020, Trials.

[14]  I. Boutron,et al.  The research burden of randomized controlled trial participation: a systematic thematic synthesis of qualitative evidence , 2020, BMC Medicine.

[15]  K. Hodge,et al.  Great Expectations: A Qualitative Analysis of the Factors That Influence Affective Forecasts for Exercise , 2020, International journal of environmental research and public health.

[16]  C. Selinger,et al.  Stigmatisation and resilience in inflammatory bowel disease , 2019, Internal and Emergency Medicine.

[17]  D. Monteiro,et al.  The bright and dark sides of motivation as predictors of enjoyment, intention, and exercise persistence , 2019, Scandinavian journal of medicine & science in sports.

[18]  G. Tew,et al.  Affective and enjoyment responses to 12 weeks of high intensity interval training and moderate continuous training in adults with Crohn’s disease , 2019, PloS one.

[19]  G. Huber,et al.  Structured physical activity interventions as a complementary therapy for patients with inflammatory bowel disease – a scoping review and practical implications , 2019, BMC Gastroenterology.

[20]  Brian Caulfield,et al.  Patient Involvement With Home-Based Exercise Programs: Can Connected Health Interventions Influence Adherence? , 2018, JMIR mHealth and uHealth.

[21]  Jana G Hashash,et al.  A comprehensive review and update on Crohn's disease. , 2017, Disease-a-month : DM.

[22]  P. Gibson,et al.  Systematic review: exercise‐induced gastrointestinal syndrome—implications for health and intestinal disease , 2017, Alimentary pharmacology & therapeutics.

[23]  I. Monteiro,et al.  Diagnosis and management of inflammatory bowel disease in children , 2017, British Medical Journal.

[24]  Kelly K. O’Brien,et al.  Experiences participating in a community-based exercise programme from the perspective of people living with HIV: a qualitative study , 2017, BMJ Open.

[25]  Geir Egil Eide,et al.  Effective behaviour change techniques for physical activity and healthy eating in overweight and obese adults; systematic review and meta-regression analyses , 2017, International Journal of Behavioral Nutrition and Physical Activity.

[26]  G. Tew,et al.  Physical Activity Habits, Limitations, and Predictors in People with Inflammatory Bowel Disease: A Large Cross-sectional Online Survey , 2016, Inflammatory bowel diseases.

[27]  J. Ogden,et al.  A qualitative study of patients’ experience of living with inflammatory bowel disease: A preliminary focus on the notion of adaptation , 2016, Journal of health psychology.

[28]  P. Gibson,et al.  Sleep and physical activity measured by accelerometry in Crohn's disease , 2015, Alimentary pharmacology & therapeutics.

[29]  J. Schölmerich,et al.  Extraintestinal manifestations and complications in IBD , 2013, Nature Reviews Gastroenterology &Hepatology.

[30]  N. Gale,et al.  Using the framework method for the analysis of qualitative data in multi-disciplinary health research , 2013, BMC Medical Research Methodology.

[31]  A. Poullis,et al.  Inflammatory bowel disease and exercise: results of a Crohn's and Colitis UK survey , 2013, Frontline Gastroenterology.

[32]  J. Kolkman,et al.  Review article: the pathophysiology and management of gastrointestinal symptoms during physical exercise, and the role of splanchnic blood flow , 2012, Alimentary pharmacology & therapeutics.

[33]  C. Abraham,et al.  Systematic review of reviews of intervention components associated with increased effectiveness in dietary and physical activity interventions , 2011, BMC public health.

[34]  James C. Griffiths,et al.  A Quality Standard , 2009 .

[35]  R. Fedorak,et al.  Exercise and inflammatory bowel disease. , 2008, Canadian journal of gastroenterology = Journal canadien de gastroenterologie.

[36]  R. Rodríguez-Merlo,et al.  Extraintestinal manifestations of Crohn's disease: prevalence and related factors. , 2006, Revista espanola de enfermedades digestivas : organo oficial de la Sociedad Espanola de Patologia Digestiva.

[37]  R. Sartor Mechanisms of Disease: pathogenesis of Crohn's disease and ulcerative colitis , 2006, Nature Clinical Practice Gastroenterology &Hepatology.

[38]  M. Ro̸rth,et al.  The impact of supervised exercise intervention on short-term postprogram leisure time physical activity level in cancer patients undergoing chemotherapy: 1- and 3-month follow-up on the body & cancer project , 2006, Palliative and Supportive Care.

[39]  R. Baldassano,et al.  Extraintestinal manifestations of inflammatory bowel disease. , 2005, Minerva gastroenterologica e dietologica.

[40]  L. Spencer,et al.  Qualitative data analysis for applied policy research , 2002 .

[41]  S. Hanauer,et al.  Prevalence of nonadherence with maintenance mesalamine in quiescent ulcerative colitis , 2001, American Journal of Gastroenterology.

[42]  D. Martines,et al.  Effect of moderate exercise on Crohn's disease patients in remission. , 1999, Italian journal of gastroenterology and hepatology.

[43]  E. L. Persons,et al.  Ankylosing Spondylitis , 1955, GP.

[44]  P. Christos,et al.  Exercise and Self-Reported Limitations in Patients with Inflammatory Bowel Disease , 2015, Digestive Diseases and Sciences.

[45]  J. Payer,et al.  The prevalence and risk factors for osteoporosis in patients with inflammatory bowel disease. , 2013, Bratislavske lekarske listy.

[46]  E. Szigethy,et al.  Inflammatory bowel disease. , 2011, Pediatric clinics of North America.

[47]  T. Takken,et al.  The effects of acute and chronic exercise on inflammatory markers in children and adults with a chronic inflammatory disease: a systematic review. , 2009, Exercise immunology review.