International Journal of Colorectal Disease

, Volume 27, Issue 11, pp 1485–1491 | Cite as

Preoperative exercise capacity in adult inflammatory bowel disease sufferers, determined by cardiopulmonary exercise testing

  • J. M. Otto
  • A. F. O’Doherty
  • P. J. Hennis
  • K. Mitchell
  • J. S. Pate
  • J. A. Cooper
  • M. P. W. Grocott
  • H. E. Montgomery
Original Article

Abstract

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.

Keywords

Inflammatory bowel disease Crohn’s disease Ulcerative colitis Cardiopulmonary exercise testing Surgery 

References

  1. 1.
    Bernstein CN et al (2010) World Gastroenterology Organization Practice Guidelines for the diagnosis and management of IBD in 2010. Inflamm Bowel Dis 16(1):112–124PubMedGoogle Scholar
  2. 2.
    Baumgart DC, Sandborn WJ (2007) Inflammatory bowel disease: clinical aspects and established and evolving therapies. Lancet 369(9573):1641–1657PubMedCrossRefGoogle Scholar
  3. 3.
    Garcia Rodriguez LA et al (2005) Risk factors for inflammatory bowel disease in the general population. Aliment Pharmacol Ther 22(4):309–315PubMedCrossRefGoogle Scholar
  4. 4.
    Loftus EV Jr (2004) Clinical epidemiology of inflammatory bowel disease: incidence, prevalence, and environmental influences. Gastroenterology 126(6):1504–1517PubMedCrossRefGoogle Scholar
  5. 5.
    Carter MJ, Lobo AJ, Travis SP (2004) Guidelines for the management of inflammatory bowel disease in adults. Gut 53(Suppl 5):V1–V16PubMedCrossRefGoogle Scholar
  6. 6.
    Bernstein CN et al (2009) World Gastroenterology Organization Global Guidelines on Inflammatory Bowel Disease: a global perspective. Inflamm Bowel Dis 16(1):112–124Google Scholar
  7. 7.
    Older P et al (1993) Preoperative evaluation of cardiac failure and ischemia in elderly patients by cardiopulmonary exercise testing. Chest 104(3):701–704PubMedCrossRefGoogle Scholar
  8. 8.
    Older P, Hall A, Hader R (1999) Cardiopulmonary exercise testing as a screening test for perioperative management of major surgery in the elderly. Chest 116(2):355–362PubMedCrossRefGoogle Scholar
  9. 9.
    Snowden CP et al (2010) Submaximal cardiopulmonary exercise testing predicts complications and hospital length of stay in patients undergoing major elective surgery. Ann Surg 251(3):535–541PubMedCrossRefGoogle Scholar
  10. 10.
    Whipp BJ, Ward SA, Wasserman K (1986) Respiratory markers of the anaerobic threshold. Adv Cardiol 35:47–64PubMedGoogle Scholar
  11. 11.
    Ploeger HE et al (2011) Exercise capacity in pediatric patients with inflammatory bowel disease. J Pediatr 158(5):814–819PubMedCrossRefGoogle Scholar
  12. 12.
    ATS/ACCP (2003) ATS/ACCP Statement on cardiopulmonary exercise testing. Am J Respir Crit Care Med 167(2):211–77CrossRefGoogle Scholar
  13. 13.
    Wasserman K, Hansen JE, Sue DY, Stringer WW, Whipp BJ (2005) Principle of exercise testing and interpretation including pathophysiology and clinical applications, 4th edn. Lippincott Williams & Wilkins, PhiladelphiaGoogle Scholar
  14. 14.
    Beaver WL, Wasserman K, Whipp BJ (1986) A new method for detecting anaerobic threshold by gas exchange. J Appl Physiol 60(6):2020–2027PubMedGoogle Scholar
  15. 15.
    Gaskill SE et al (2001) Validity and reliability of combining three methods to determine ventilatory threshold. Med Sci Sports Exerc 33(11):1841–1848PubMedCrossRefGoogle Scholar
  16. 16.
    Midgley AW, McNaughton LR, Carroll S (2007) Effect of the VO2 time-averaging interval on the reproducibility of VO2max in healthy athletic subjects. Clin Physiol Funct Imaging 27(2):122–125PubMedCrossRefGoogle Scholar
  17. 17.
    Davis JA, Storer TW, Caiozzo VJ (1997) Prediction of normal values for lactate threshold estimated by gas exchange in men and women. Eur J Appl Physiol Occup Physiol 76(2):157–164PubMedCrossRefGoogle Scholar
  18. 18.
    Koch B et al (2009) Reference values for cardiopulmonary exercise testing in healthy volunteers: the SHIP study. Eur Respir J 33(2):389–397PubMedCrossRefGoogle Scholar
  19. 19.
    Field A (2005) Discovering statistics Using SPSS. Sage Publications, LondonGoogle Scholar
  20. 20.
    Perneger TV (1998) What's wrong with Bonferroni adjustments. BMJ 316(7139):1236–1238PubMedCrossRefGoogle Scholar
  21. 21.
    Rothman KJ (1990) No adjustments are needed for multiple comparisons. Epidemiology 1(1):43–46PubMedCrossRefGoogle Scholar
  22. 22.
    Brevinge H et al (1995) Exercise capacity in patients undergoing proctocolectomy and small bowel resection for Crohn's disease. Br J Surg 82(8):1040–1045PubMedCrossRefGoogle Scholar
  23. 23.
    Nancey S et al (2008) Serum interleukin-6, soluble interleukin-6 receptor and Crohn's disease activity. Dig Dis Sci 53(1):242–247PubMedCrossRefGoogle Scholar
  24. 24.
    Umehara Y et al (2006) Serum proinflammatory cytokines and adhesion molecules in ulcerative colitis. Hepatogastroenterology 53(72):879–882PubMedGoogle Scholar
  25. 25.
    Robson-Ansley PJ et al (2004) Acute interleukin-6 administration impairs athletic performance in healthy, trained male runners. Can J Appl Physiol 29(4):411–418PubMedCrossRefGoogle Scholar
  26. 26.
    Narula N, Fedorak RN (2008) Exercise and inflammatory bowel disease. Can J Gastroenterol 22(5):497–504PubMedGoogle Scholar
  27. 27.
    Rawsthorne P et al (1999) An international survey of the use and attitudes regarding alternative medicine by patients with inflammatory bowel disease. Am J Gastroenterol 94(5):1298–1303PubMedCrossRefGoogle Scholar
  28. 28.
    Tirdel GB et al (1998) Metabolic myopathy as a cause of the exercise limitation in lung transplant recipients. J Heart Lung Transplant 17(12):1231–1237PubMedGoogle Scholar
  29. 29.
    Mitsui T et al (2002) Chronic corticosteroid administration causes mitochondrial dysfunction in skeletal muscle. J Neurol 249(8):1004–1009PubMedCrossRefGoogle Scholar
  30. 30.
    Schakman O et al (2009) Mechanisms of muscle atrophy induced by glucocorticoids. Horm Res 72(Suppl 1):36–41PubMedCrossRefGoogle Scholar
  31. 31.
    Elsenbruch S et al (2005) Effects of mind-body therapy on quality of life and neuroendocrine and cellular immune functions in patients with ulcerative colitis. Psychother Psychosom 74(5):277–287PubMedCrossRefGoogle Scholar
  32. 32.
    Ng V et al (2007) Low-intensity exercise improves quality of life in patients with Crohn's disease. Clin J Sport Med 17(5):384–388PubMedGoogle Scholar
  33. 33.
    Langholz E et al (1994) Course of ulcerative colitis: analysis of changes in disease activity over years. Gastroenterology 107(1):3–11PubMedGoogle Scholar
  34. 34.
    Mowat C et al (2011) Guidelines for the management of inflammatory bowel disease in adults. Gut 60(5):571–607PubMedCrossRefGoogle Scholar
  35. 35.
    Munkholm P et al (1995) Disease activity courses in a regional cohort of Crohn's disease patients. Scand J Gastroenterol 30(7):699–706PubMedCrossRefGoogle Scholar
  36. 36.
    Card T, Hubbard R, Logan RF (2003) Mortality in inflammatory bowel disease: a population-based cohort study. Gastroenterology 125(6):1583–1590PubMedCrossRefGoogle Scholar
  37. 37.
    Blair SN et al (1989) Physical fitness and all-cause mortality. A prospective study of healthy men and women. JAMA 262(17):2395–2401PubMedCrossRefGoogle Scholar
  38. 38.
    Ba'ath ME et al (2007) Surgical management of inflammatory bowel disease. Arch Dis Child 92(4):312–316PubMedCrossRefGoogle Scholar
  39. 39.
    Nguyen SQ et al (2009) Laparoscopic resection for Crohn's disease: an experience with 335 cases. Surg Endosc 23(10):2380–2384PubMedCrossRefGoogle Scholar
  40. 40.
    Carlisle J, Swart M (2007) Mid-term survival after abdominal aortic aneurysm surgery predicted by cardiopulmonary exercise testing. Br J Surg 94(8):966–969PubMedCrossRefGoogle Scholar
  41. 41.
    Wilson RJ et al (2010) Impaired functional capacity is associated with all-cause mortality after major elective intra-abdominal surgery. Br J Anaesth 105(3):297–303PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • J. M. Otto
    • 1
  • A. F. O’Doherty
    • 1
  • P. J. Hennis
    • 1
  • K. Mitchell
    • 1
  • J. S. Pate
    • 1
  • J. A. Cooper
    • 2
  • M. P. W. Grocott
    • 1
    • 3
  • H. E. Montgomery
    • 4
  1. 1.The Portex UnitUCL Institute of Child HealthLondonUK
  2. 2.Cardiovascular GeneticsBHF LaboratoriesLondonUK
  3. 3.Integrative Physiology, Clinical and Experimental SciencesUniversity of SouthamptonSouthamptonUK
  4. 4.UCL Institute for Sport, Exercise and HealthLondonUK

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