P531 Inflammatory bowel disease and fatigue: the effect of physical activity and/or omega-3 supplementation
A. McNelly1, I. Nathan1, M. Monti2, G. Grimble3, C. Norton*4, F. Bredin5, W. Czuber-Dochan4, S. Berliner6, M. Gay6, M. Darvell6, H. Terry6, A. Forbes7
1UCL, Centre for Gastroenterology and Nutrition, London, United Kingdom, 2UCL Hospitals Foundation Trust, GI Services Division, London, United Kingdom, 3UCL, Institute of Liver and Digestive Health, London, United Kingdom, 4Kings College London, Florence Nightingale Faculty of Nursing & Midwifery, London, United Kingdom, 5Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Gastroenterology, Cambridge, United Kingdom, 6Crohn’s & Colitis UK, St Albans, United Kingdom, 7Norwich Medical School/UEA, Gastroenterology, Norwich, United Kingdom
Fatigue is frequently reported by patients with inflammatory bowel disease (IBD), despite disease remission. However, no previous intervention trial has studied this symptom. We tested the effects on fatigue in IBD patients from individual advice to increase physical activity (PA) and/or supplementation with omega-3 fatty acids.
Design: a randomised controlled 2x2 factorial study compared change-from-baseline scores in intervention and control groups. Primary outcome: change in FACIT-F (Functional Assessment of Chronic Illness Therapy - Fatigue) score. Main secondary outcomes: change in fatigue survey scores including IBD-fatigue (IBD-F); PA by monitors (Actigraph, Pensacola, Florida, United States); adverse effects. Eligibility: IBD remission; ≤ 2 portions oily fish/week; ≤ 60 minutes moderate-vigorous PA/week; no comorbidities causing fatigue; no depression. Interventions: exercise advice (15-minute consultation) and fish oil supplement (2.97 g per day omega-3, ‘Take Omega 3’©, Edinburgh, United Kingdom); Controls: dietary consultation and placebo supplement. All patients received follow-up support (e-mail/telephone).
Over 640 IBD outpatients were screened: 74 of those eligible consented to inclusion and randomisation; 60 commenced the intervention; and 52 completed the study according to protocol. At baseline, the 4 groups did not differ significantly (gender, age, disease location or past IBD activity, level of PA, or FACIT-F score). The only effect on fatigue from the primary outcome: significant deterioration in FACIT-F score (95% CI -8.6 [-0.7]; p = 0.02) - was with omega-3 supplement. However, fatigue was significantly reduced in the exercise groups, measured by IBD-F score (95%CI -3.8 [-0.2]; p = 0.03). There were no significant interactions between effects of exercise and fish oil on fatigue, or consistent trends in fatigue or PA levels across the various measures between the 4 treatment groups. Only 1 treatment-related adverse event was reported (in exercise group), suggesting that neither exercise nor fish oil were associated with likelihood of occurrence of an adverse effect, including gastrointestinal symptoms.
The apparent worsening of fatigue with fish oil is unexplained. Exercise and fish oil, singly or in combination, were shown to be safe and generally well tolerated in IBD patients. There was no evidence of adverse exercise-related effects on gut-related symptoms, and some evidence of improvement in fatigue. Hence, regular moderate-vigorous exercise may provide self-management options in IBD-related fatigue.