Quality of Life Is Associated With Wearable-Based Physical Activity in Patients With Inflammatory Bowel Disease: A Prospective, Observational Study

Patients with inflammatory bowel disease (IBD) are at risk of an impaired quality of life (1,2). In a recent meta-analysis, quality of life was poorer during active disease and presumably poorer in patients with Crohn's disease (CD) (3). Health-related quality of life (HRQoL) of patients with CD is consistently determined by markers of disease activity, including work disability, evidence of intestinal inflammation, number of relapses, biological treatment, and hospitalization rate (4). Early on, studies on the general population have investigated the impact of physical activity on quality of life. Data from the Health Survey for England show that high levels of activity are associated with better HRQoL and that this link is particularly found using objective measures as compared to surveys (5). The implications of physical activity in patients with IBD have been investigated with respect to both exercise programs and habitual physical activity. After early studies were intended to verify the safety of exercise in IBD (6), there is now good evidence that exercise programs are well tolerated in IBD, and some studies even reported a decrease in disease activity (reviewed in (7)). Habitual physical activity, however, may represent an aspect which is more meaningful for everyday life in patients with IBD, and furthermore, not all patients are amenable to exercise programs (8). From the available literature, it can be concluded that the level of habitual physical activity found in patients with IBD is invariably lower than that of controls and below the current minimum recommendations for general health (7). In most studies, physical activity was quantified using surveys (9,10), which may be prone to reporting bias. Evidence from studies with objective measures of physical activity, such as wearable devices, is sparse and often focuses on a selected patient group, such as IBD in remission, pediatric patients, or CD alone (11,12). The present prospective, cross-sectional study was devised to analyze habitual physical activity in adult CD and ulcerative colitis (UC) patients using accelerometry as an objective measure. Taking into account the range of different IBD activity states, patients were stratified into groups including patients with active and quiescent disease for each disease entity. The main objective of this study was to investigate the link between habitual physical activity and disease-specific quality of life in IBD.