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CDC: IBD Patients are Falling Short on Exercise, Sleep
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Certain health-risk behaviors, psychological distress and chronic conditions are more prevalent among adults with inflammatory bowel disease, which clinicians should be aware of to better manage patients with the condition, according to a new Morbidity and Mortality Weekly Report from the CDC.
Of note, IBD patients were more likely than adults without IBD to have insufficient sleep and exercise, were twice as likely to experience serious psychological distress, and more likely to suffer from comorbid chronic conditions like cardiovascular disease, respiratory disease, cancer, arthritis, weak or failing kidneys, liver conditions and especially ulcers, which were nearly five times as common. They were also more likely to have quit smoking, but less likely to have never smoked.
To evaluate the prevalence of health-risk behaviors and chronic conditions in this patient population relative to the general public, CDC researchers collected data on a nationally representative sample from the 2015 and 2016 National Health Interview Survey (NHIS).
During this period, about 3.1 million adults in the U.S. had ever been diagnosed with IBD. The prevalence was higher among:
- older vs. younger adults (1.7% for those older than 45 years vs. 0.5% for those aged 18-24 and 1% for those aged 25-44);
- women vs. men (1.5% vs. 1%);
- non-Hispanic whites (1.4%) vs. non-Hispanic blacks (0.6%) or other non-Hispanic races (0.8%);
- those with less than a high school education vs. those with at least a bachelor’s degree (1.6% vs. 1.1%);
- those who were divorced, separated or widowed vs. those who were married or cohabitating (2.3% vs. 1.1%);
- those who were unemployed (1.6% vs. 1.1%);
- those born in the U.S. (1.3% vs. 0.8%); and
- those who lived in small vs. large metropolitan areas (1.4% vs. 1.1%).
“The prevalence of IBD did not differ significantly among groups defined by health insurance coverage type or region of residence,” the investigators wrote.
Patients with IBD also showed significantly higher prevalence of:
- being former smokers (26% vs. 21%), though they were less likely to have never smoked (55.9% vs. 63.5%);
- failing to meet aerobic and muscle-strengthening activity guidelines (50.4% vs. 45.2%);
- sleeping less than 7 hours per day on average (38.2% vs. 32.2%); and
- experiencing serious psychological distress (7.4% vs. 3.4%);
“No statistically significant difference was detected in the prevalence of binge drinking or BMI category between the two groups,” the investigators wrote.
Additionally, almost all the chronic conditions evaluated — except for diabetes — were significantly more common among patients with IBD, including:
- cardiovascular disease (19.2% vs. 12%);
- respiratory disease (27.3% vs. 16.6%);
- cancer (13.7% vs. 8.1%);
- arthritis (36.3% vs. 21.1%);
- weak or failing kidneys (4.5% vs. 1.8%);
- any liver condition (5.2% vs. 1.7%); and
- ulcer (26% vs. 5.5%).
“Adults with IBD who have mild to moderate disease activity should be encouraged to consult their clinicians about their exercise engagement,” investigators concluded. “Clinicians should be aware of potential adverse health consequences of the health-risk behaviors that are more prevalent among adults with IBD, such as having insufficient sleep. Because certain chronic conditions are more prevalent among adults with IBD, disease management might involve multidisciplinary clinical care.” – by Adam Leitenberger
Disclosures: The authors report no relevant financial disclosures.
Perspective
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Miguel Regueiro, MD
The CDC report on IBD is interesting and there are some notable findings that are important for patients with Crohn’s disease and ulcerative colitis. Namely, sleep duration and exercise were lower and psychological stress was higher in IBD patients. We see this regularly in our patients in the clinic and this report outlines nicely these findings in a population based audit study.
It is known that proper sleep is important for physical and mental restoration, healing and tissue repair. Additionally, exercise has benefit for cardiovascular health but also decreases stress, improves sleep and may have an impact on decreasing inflammation. Psychosocial stress is common in IBD and we know that patients with higher stress, depression and anxiety have poorer quality of life and worse disease.
The critical piece that is not currently known is what comes first, ie, the “chicken and the egg.” Meaning, do patients with IBD have poor sleep, exercise and psychological stress due to their Crohn’s disease or ulcerative colitis, or were these factors somehow contributory to their IBD? It is not known, but my sense is that there could be a combination.
Regardless, and as stated in the CDC report, it is an important part of IBD management to have patients adhere to good sleep hygiene and at least 7 to 8 hours of sleep, exercise regularly and manage stress. I realize that achieving these goals is not always possible or practical, but working with the health care team on these aspects of care is important. There are centers, such as the University of Pittsburgh Medical Center IBD Total Care program, that take a whole person medical home approach to these patients and focus on diet, exercise, sleep counseling and stress management. While these measures do not cure IBD, often we see improvement in the disease and overall well-being when patients engage in these healthy lifestyle activities.
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