Supplementary Material for: Physical activity is inversely associated with clinical exacerbation in patients with Crohn's disease in remission - a prospective cohort study

Introduction: Physical activity (PA) is associated with improved quality of life in patients with Crohn’s disease (CD). However, evidence of its impact on the clinical course of the disease remains limited. We aimed to evaluate the association between PA and relapse incidence in patients with CD in clinical remission and its association with patient-reported outcome measures.
Methods: A prospective cohort study of adult patients with CD in clinical remission followed for one year or until relapse. At baseline, participants completed PA and nutritional questionnaires, and a patient-reported outcomes measurement information system. Multivariable Cox proportional hazards models assessed the association between PA and relapse risk, adjusted for confounders including fecal calprotectin.
Results: A total of 106 patients (mean age 37.9±13.9 years) were followed for 9.9±3.2 months, during which 23 (21.7%) experienced clinical relapse. PA at least twice a week was associated with a reduced risk of relapse (HR=0.26, 95% CI 0.09–0.79). Specifically, only aerobic activity was significantly associated with a reduced risk of relapse (HR=0.31, 95% CI 0.10-0.95). High-resistance PA was significantly associated with better quality of life parameters, including pain interference (P=0.013), sleep disturbance (P=0.040), physical function (P=0.029), and social roles (P=0.020). While aerobic PA showed benefit in physical function (P=0.016).
Conclusions: PA in general and specifically aerobic PA, is associated with a reduced risk of relapse in patients with CD in remission, while resistance PA is associated with a better quality of life. These findings highlight the importance of incorporating PA into CD management in remission state.