Effects of Exercise in Patients With Ulcerative Colitis

Manchester Metropolitan University24 enrolled

Overview

The aim of this study is to investigate the effects of moderate to high intensity exercise on gut function and inflammatory markers in patients with Ulcerative Colitis (UC), and to compare them with individuals of matched age who do not suffer from Inflammatory Bowel Disease. Participants will be asked to complete 60 minutes of continuous cycling at a moderate to high intensity followed by a three hour recovery period. Gastrointestinal function will be measured using a non-invasive breath test. Blood samples will be collected at multiple time-points during the visit and these samples will be measured for markers of immune function and intestinal integrity.

There is limited research on the effect of exercise on patients with Ulcerative Colitis. The aim of this investigation is to study the acute effects of moderate to high intensity exercise on gut function in patients with Ulcerative Colitis and to compare them with individuals of matched age who do not suffer from Inflammatory Bowel Disease. Patients in remission from disease activity and age and gender matched healthy control participants will be recruited from the general population. Participants will attend the laboratory on two occasions. The first visit will last approximately one hour and will include an exercise test to determine peak oxygen uptake capacity (VO2peak) which is an indicator of cardiorespiratory fitness. The second visit will last for approximately four and a half hours and will consist of a 60 minute continuous cycle on a stationary cycle ergometer at an intensity of 65% VO2peak followed by a recovery period. Gastric emptying rate of a commercially available sports drink will be measured and blood samples will be collected at regular time-points throughout the visit and analysed for concentrations of inflammatory markers and intestinal integrity/function.

Study Type

INTERVENTIONAL

Allocation

NON_RANDOMIZED

Purpose

BASIC_SCIENCE

Masking

NONE

Enrollment

Eligibility

Sex: ALLMin age: 18 YearsMax age: 50 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: For ulcerative colitis patients; * Currently in remission of disease (asymptomatic at time of experiment) * Less than 3 periods of disease activity (periods of symptomatic activity) in the last 12 months * No history of surgery to alleviate condition severity * Taking regular standard medication for control of condition * Adult less than 50 years due to effects of exercise in older age * Non-smokers * Regular exercisers (determined via verbal discussion) For healthy controls; * No history of disease (as assessed by standard medical screening questionnaire) * Adult less than 50 years due to effects of exercise in older age * Non-smokers * Regular exercisers (determined via verbal discussion) Exclusion Criteria: For ulcerative colitis patients; * Currently in active period of disease (symptomatic at time of experiment) * More than 3 periods of disease activity (periods of symptomatic activity) in the last 12 months * History of surgery to alleviate condition severity * Taking non-standard medication for control of condition * Adult more than 50 years of age * Under 18 years of age * Smokers * Sedentary or not regularly physically active (determined via verbal discussion) For healthy controls; * History of disease (as assessed by standard medical screening questionnaire) * Adult more than 50 years of age * Under 18 years of age * Smokers * Sedentary or not regularly physically active (determined via verbal discussion)

Outcomes

Primary Outcomes

Change in inflammatory markers or hormones

Circulating concentrations of Interleukin-6, Tumor Necrosis Factor-alpha, C-reactive protein, glucagon like peptide 2

Time frame: 6 blood samples collected at baseline, 30 minutes of exercise (mid exercise), immediately post exercise bout, then every 60 minutes post exercise for 3 hours

Area under the circulating concentration versus time curve (AUC) of inflammatory markers or hormones

Responses of Interleukin-6, Tumor Necrosis Factor-alpha, C-reactive protein, glucagon like peptide 2

Time frame: 4.5 hours

Change in intestinal epithelial damage and permeability markers

Circulating concentrations of intestinal fatty acid binding protein and claudin-3

Time frame: 6 blood samples collected at baseline, 30 minutes of exercise (mid exercise), immediately post exercise bout, then every 60 minutes post exercise for 3 hours

Area under the circulating concentration versus time curve (AUC) of intestinal epithelial damage and permeability markers

Responses of intestinal fatty acid binding protein and claudin-3

Time frame: 4.5 hours

Change in exercise induced endotoxaemia markers

Circulating concentrations of plasma lipopolysaccharide

Time frame: 6 blood samples collected at baseline, 30 minutes of exercise (mid exercise), immediately post exercise bout, then every 60 minutes post exercise for 3 hours

Area under the circulating concentration versus time curve (AUC) of exercise induced endotoxaemia markers

Response of plasma lipopolysaccharide

Time frame: 4.5 hours

Gastric emptying rate half time and time of maximal emptying rate

Emptying rate of a commercially available sports drink from the stomach using the 13C breath test method

Time frame: 2 hours after ingestion of drink

Change in ratio of 13C/12C in breath samples

Gastric emptying profile of a commercially available sports drink from the stomach using the 13C breath test method

Time frame: 9 breath samples collected at baseline, then every 15 minutes after ingestion for 2 hours

Secondary Outcomes

Incidence and severity of gastrointestinal symptoms

10-point rating scale for gastrointestinal symptoms (Visual Analogue Scale modified). 19 item questionnaire with 5 subcategories (Overall gut discomfort, total gastrointestinal symptoms, upper gastrointestinal symptoms, lower gastrointestinal symptoms and other gastrointestinal symptoms). Scores for each item ranging from 0 (no symptom) to 10 (extremely severe symptoms causing exercise reduction, stopping, or complete withdrawal). Higher scores represent higher severity of symptoms.

Time frame: Immediately post-exercise bout and 3 hours post exercise.

Heart rate response

Heart rate telemetry

Time frame: Every 5 minutes during 60 minute cycle

Disparity of subjective exertion and objective cardiorespiratory parameters

Regression of ratings of perceived exertion (RPE; Borg scale, minimum value 6 representing no exertion, maximum value 20 representing maximal exertion. Higher scores represent higher perceived exertion) and cardiopulmonary exercise testing variables of oxygen uptake, carbon dioxide expiration, ventilatory threshold, volume of air expired, and tidal volume (all parameters measured in L/min).