Images of disease: A study in irritable bowel syndrome and the effect of treatment

The effect of physical activity on symptoms in IBS has not been studied.The aim of this study was to test the effect of increased physical activity on fatigue, depression, anxiety and GI-symptoms in IBS.Methods: 94(20M) patients with IBS were prospectively included in the study.According to the Rome II criteria 23(9M) patients had diarrhea predominance, 20(2M) constipation and 51(9M) patients had alternating bowel habits.The subjects were randomised to a control group (35F/12M) or a training group (39F/8M).All patients completed the Fatigue Impact Scale(FIS), the Hospital Anxiety and Depression Scale(HADS), the Gastrointestinal Symptom Rating Scale (GSRS) and the IBS severity scoring system consisting of IBS-score and Extra colonic-score.The patients underwent a sub-maximal cycle ergometer test to calculate the maximal oxygen uptake at inclusion and 12 weeks later.The controls were encouraged to continue their usual lifestyle and they had a supportive telephone contact with a physiotherapist once a month.The training group was encouraged by a physiotherapist to increase their level of physical activity.They were encouraged to preform any activity that would improve their oxygen uptake.The results are presented as median, percentile 10 and 90.Results: The IBS-score in the training group was 292(133-371) at start and 230(104-370) after 12 weeks, p<0.001.In the controls it was 278(148-378) at start and 264(133-386) at 12 weeks, p=NS.The Extra colonic-score in the training group was 183(96-326) at start and 163(55-270) at 12 weeks, p=0.02.In controls it was 184(73-319) at start and 174(74-339) after 12 weeks, p=NS.The training group showed a significant improvement in GSRS in the subscale Indigestion, that was 4.2(2.2-5.2) at start and 3.6(1.7-5.0) at 12 weeks, p=0.02 and in the subscale Constipation it was 3.0(1.2-5.6) at start and 2.3(1.0-5.4) at 12 weeks, p=0.05.There were no significant changes in the control group or in any other GSRS subscale.No significant changes were observed in the FIS in neither of the groups.In the HADS, the subscale depression in the training group was 4.0(1.0-10.5)at start and 4.0(0.5-9.0) at 12 weeks, p=NS.In the controls it was 6.0(1.5-11.5)at start and 6.0(1.0-9.0) at 12 weeks, p=0.04.Improvement of the oxygen uptake was shown only in the training group and it was 2.37(1.50-3.28)l/minuteat start and 2.50(1.773.31)l/ minute at 12 weeks, p=0.04.Conclusion: Increased physical activity is associated with symptom improvement in IBS but does not reduce fatigue or depression and anxiety in patients with IBS.Advice regarding increased physical activity could be given to IBS patients.