İrritabl Bağırsak Sendromunda Fiziksel Aktivite ile Hasta Özellikleri, Semptomlar, Yaşam Kalitesi ve Depresyon İlişkisi – Kesitsel Bir Çalışma

Abstract

Amaç: İrritable Bağırsak Sendromu (İBS) olan hastalarda fiziksel aktivite düzeyi ile hasta karakteristiği, gastrointestinal semptomlar, yaşam kalitesi ve depresyonla ilişkisini incelemektir.

Gereç ve Yöntemler: Seksen İBS hastası (42 kadın, 38 erkek) çalışmaya dahil edildi. IBS alt tipleri, demografik ve klinik özellikleri, gastrointestinal semptomlar (Gastrointestinal Semptom Değerlendirme Ölçeği), yaşam kalitesi [İrritable Bağırsak Sendromu Yaşam Kalitesi Ölçeği (IBS-QoL)] depresyon (Beck Depresyon Ölçeği) ve fiziksel aktivite düzeyi [Uluslararası Fiziksel Aktivite Anketi (IPAQ)] değerlendirildi. Abdominal ağrısı şiddeti görsel analog skala (VAS) ile değerlendirildi.

Bulgular: İBS alt tiplerinin demografik ve klinik özellikleri [İBS-konstipasyon (İBS-K)=36, İBS-diare (İBS-D)=20, İBS-mikst (İBS-M)=24] benzerdi (p>0,05). Abdominal ağrı şiddeti VAS-ortalaması 5.81±1.92 idi. Katılımcıların çoğu (>%90) minimal düzeyde aktif ve inaktifti. IBS-M grubu IBS-K grubuna göre daha kötü kişilerarası ilişkilere sahip (p=0.006) ve daha depresifti (p=0,020). Fiziksel aktivite ve hasta karakteristiği arasında anlamlı bir ilişki yoktur (p>0,05). Fiziksel aktivite düzeyleri tüm katılımcılarda semptomlar (r=-0,508) ve yaşam kalitesi (r=0,467) ile orta düzeyde, depresyon (r=-0,284) ile zayıf korelasyon gösterdi (p<0,05). Fiziksel aktivite İBS-K, IBS-D, IBS-M alt tiplerinde semptom şiddeti ile negatif (r=-0,421-(-0,596); p=0,011, p=0,006, p=0,009), yaşam kalitesi ile pozitif ve orta düzeyde korelasyon gösterirken (r=0,415-0,568; p=0,006, p=0,009, p=0,044, respectively), depresyon ile anlamlı bir korelasyon göstermedi (p>0,05).

Sonuç: IBS hastalarının fiziksel aktivite düzeyi düşüktür. Semptomların şiddeti ile depresyon ve fiziksel aktivite düzeyleri arasında negatif korelasyon gözlenirken, yaşam kalitesi tüm katılımcılarda pozitif korelasyon gösterdi.

Keywords

• Abdominal ağrı
• fiziksel aktivite
• gastrointestinal semptom
• konstipasyon
• irritable bağırsak sendromu

Physical Activity and Its Relationship with Patient Characteristics, Symptoms, Quality of Life, and Depression in Irritable Bowel Syndrome-A Cross-Sectional Study

Abstract

Aim: To investigate physical activity and its relationship with symptoms, quality of life (QoL), and depression in patients with Irritable Bowel Syndrome (IBS).

Material and Methods: Eighty IBS patients (42 female, 38 male) were included. Subtypes of IBS, patient characteristics, symptoms (Gastrointestinal Symptom Rating Scale), QoL [Irritable Bowel Syndrome Quality of Life Scale (IBS-QoL)], depression (Beck Depression Scale), and physical activity (International Physical Activity Questionnaire (IPAQ)) were assessed. Abdominal pain severity was evaluated with visual analogue scale (VAS).

Results: The demographic and clinical characteristics of the IBS subtypes (IBS-constipation [IBS-C]=36, IBS-diarrhea [IBS-D]=20, IBS-mixed [IBS-M]=24) were similar (p>0.05). The mean of abdominal pain VAS was 5.81±1.92. Most of the participants were minimally active (n=44, 55%) and inactive (n=29, 36.3%). IBS-M had worse interpersonal relationships (p=0.006) and was more depressed (p=0.020) than the IBS-C. Patient characteristics did not show a significant correlation with physical activity (p>0.05). Physical activity had a moderate correlation with symptoms (r=-0.508, p<0.001) and QoL (r=0.467, p<0.001), and had a weak correlation with depression (r=-0.284, p=0.001) in all participants. Physical activity had a moderate negative correlation with symptom severity (r=-0.421-(-0.596); p=0.011, p=0.006, p=0.009) and a positive moderate correlation with QoL (r=0.415-0.568; p=0.006, p=0.009, p=0.044), but no significant correlation with depression (p=0.106-0.357) in IBS-C, IBS-D, and IBS-M subtypes, respectively.

Conclusion: IBS patients had low levels of physical activity. There were negative correlations between symptom severity and depression and physical activity levels, while QoL demonstrated a positive correlation in all participants.

Keywords

• Abdominal pain
• constipation
• gastrointestinal symptoms
• irritable bowel syndrome
• physical activity

References

1. Camilleri M. Management of the irritable bowel syndrome. Gastroenterology. 2001;120(3):652-68. doi:10.1053/gast.2001.21944.
2. Lacy BE, Pimentel M, Brenner DM, Chey WD, Keefer LA, Long MD, et al. ACG clinical guideline: management of irritable bowel syndrome. Am J Gastroenterol. 2021;116(1):17-44. doi:10.14309/ajg.0000000000001036.
3. Ünsal NE, Akbulut G, Gülşen M. Effects of fiber or probiotic yogurt supplementation on intestinal barrier integrity in constipation-predominant irritable bowel syndrome. Gulhane Med J. 2024;66(4):176-84. doi:10.4274/gulhane.galenos.2024.05900.
4. Defrees DN, Bailey J. Irritable bowel syndrome: epidemiology, pathophysiology, diagnosis, and treatment. Prim Care. 2017;44(4):655-71. doi:10.1016/j.pop.2017.07.009.
5. Tetali B, Suresh S. Management of irritable bowel syndrome: a narrative review. Transl Gastroenterol Hepatol. 2024;21;9:26. doi:10.21037/tgh-23-96.
6. Fukui A, Naito Y, Kamada K, Takagi, T. The role of microbiota in the pathophysiology of irritable bowel syndrome. In: Kamiya T, Fukudo S, editors. Irritable bowel syndrome [Internet]. Singapore: Springer; 2024. p. 43-50. doi:10.1007/978-981-97-8410-3_5.
7. Cho HS, Park JM, Lim CH, Cho YK, Lee IS, Kim SW, et al. Anxiety, depression and quality of life in patients with irritable bowel syndrome. Gut Liver. 2011;5(1):29. doi:10.5009/gnl.2011.5.1.29.
8. Mönnikes H. Quality of life in patients with irritable bowel syndrome. J Clin Gastroenterol. 2011;45 Suppl:S98-101. doi:10.1097/MCG.0b013e31821fbf44.

9. Kopczyńska M, Mokros Ł, Pietras T, Małecka-Panas E. Quality of life and depression in patients with irritable bowel syndrome. Prz Gastroenterol. 2018;13(2):102-8. doi:10.5114/pg.2018.75819.
10. Chao W-C, Huang J-C, Young S-L, Wu C-L, Shih J-C, Liao L-D, et al. Interplay of yoga, physical activity, and probiotics in irritable bowel syndrome management: a double-blind randomized study. Complement Ther Clin Pract. 2024;57:101892. doi:10.1016/j.ctcp.2024.101892.
11. Bong-Gil S. [Physical activity improves gastrointestinal motility-Benefit of physical activity on Colonic transit time: Study on increasing physical activity and gastrointestinal tract activity] [PhD Dissertation]. Seoul: Seoul National University Graduate School; 2018. Korean.
12. Johannesson E, Simrén M, Strid H, Bajor A, Sadik R. Physical activity improves symptoms in irritable bowel syndrome: a randomized controlled trial. Am J Gastroenterol. 2011;106(5):915-22. doi:10.1038/ajg.2010.480.
13. Lustyk KM, Jarrett ME, Bennett JC, Heitkemper MM. Does a physically active lifestyle improve symptoms in women with irritable bowel syndrome? Gastroenterol Nurs. 2001;24(3):129-37.
14. Johannesson E, Ringström G, Abrahamsson H, Sadik R. Intervention to increase physical activity in irritable bowel syndrome shows long-term positive effects. World J Gastroenterol. 2015;21(2):600-8. doi:10.3748/wjg.v21.i2.600.
15. Lustyk MK, Jarrett ME, Bennett JC, Heitkemper MM. Does a physically active lifestyle improve symptoms in women with irritable bowel syndrome? Gastroenterol Nurs. 2001;24(3):129-37. doi:10.1097/00001610-200105000-00007.
16. Nuttall FQ. Body mass index: obesity, BMI, and health: a critical review. Nutr Today. 2015;50(3):117-28. doi:10.1097/NT.0000000000000092.
17. Lewis SJ, Heaton KW. Stool form scale as a useful guide to intestinal transit time. Scand J Gastroenterol. 1997;32(9):920-4. doi:10.3109/00365529709011203.
18. Turan N, Aştı TA, Kaya N. Reliability and validity of the Turkish version of the Gastrointestinal Symptom Rating Scale. Gastroenterol Nurs. 2017;40(1):47-55. doi:10.1097/SGA.0000000000000177.
19. Uran BNO, Karadakovan A, Vardar R, Bor S. Psychometric properties of the irritable bowel syndrome quality of life scale in Turkey. J Hepatol Gastroint Dis. 2016;2(3):1-7. doi:10.4172/2475-3181.1000137.
20. Hisli N. Beck Depresyon Envanteri’nin geçerliği üzerine bir çalışma. Psikoloji Dergisi. 1988;6(22):118-22.
21. Saglam M, Arikan H, Savci S, Inal-Ince D, Bosnak-Guclu M, Karabulut E, et al. International physical activity questionnaire: reliability and validity of the Turkish version. Percept Mot Skills. 2010;111(1):278-84. doi:10.2466/06.08.PMS.111.4.278-284.
22. Revicki DA, Wood M, Wiklund I, Crawley J. Reliability and validity of the Gastrointestinal Symptom Rating Scale in patients with gastroesophageal reflux disease. Qual Life Res. 1997;7:75-83. doi:10.1023/a:1008841022998.
23. Chahal-Kummen M, Blom-Høgestøl I, Eribe I, Klungsøyr O, Kristinsson J, Mala T. Abdominal pain and symptoms before and after Roux-en-Y gastric bypass. BJS Open. 2019;3(3):317-26. doi:10.1002/bjs5.50148.
24. Park JM, Choi M-G, Kim YS, Choi CH, Choi SC, Hong SJ, et al. Quality of life of patients with irritable bowel syndrome in Korea. Qual Life Res. 2009;18(4):435-46. doi:10.1007/s11136-009-9461-7.
25. Drossman D, Morris CB, Hu Y, Toner BB, Diamant N, Whitehead WE, et al. Characterization of health related quality of life (HRQOL) for patients with functional bowel disorder (FBD) and its response to treatment. Am J Gastroenterol. 2007;102(7):1442-53. doi:10.1111/j.1572-0241.2007.01283.x.
26. Ratner B. The correlation coefficient: Its values range between+ 1/− 1, or do they? J Target Meas Anal Mark. 2009;17(2):139-42. doi:10.1057/jt.2009.5.
27. Nilsson D, Ohlsson B. Gastrointestinal symptoms and irritable bowel syndrome are associated with female sex and smoking in the general population and with unemployment in men. Front Med (Lausanne). 2021;8:646658. doi:10.3389/fmed.2021.646658.
28. Helvaci MR, Tonyali O, Yaprak M, Algin MC, Abyad A, Pocock L. Irritable bowel syndrome, chronic gastritis, smoking, depression, haemorrhoids and urolithiasis. Middle East Journal of Nursing. 2019;13(2):29-34.
29. Kibune-Nagasako C, García-Montes C, Silva-Lorena SL, Aparecida-Mesquita M. Irritable bowel syndrome subtypes: clinical and psychological features, body mass index and comorbidities. Rev Esp Enferm Dig. 2016;108(2):59-64. doi:10.17235/reed.2015.3979/2015.
30. Farzaneh N, Ghobaklou M, Moghimi‑Dehkordi B, Naderi N, Fadai F. Effects of demographic factors, body mass index, alcohol drinking and smoking habits on irritable bowel syndrome: a case control study. Ann Med Health Sci Res. 2013;3(3):391-6. doi:10.4103/2141-9248.117958.
31. Cañón M, Ruiz AJ, Rondón M, Alvarado J. Prevalence of irritable bowel syndrome and health-related quality of life in adults aged 18 to 30 years in a Colombian University: an electronic survey. Ann Gastroenterol. 2016;30(1):67-75. doi:10.20524/aog.2016.0093.
32. Gulewitsch MD, Enck P, Hautzinger M, Schlarb AA. Irritable bowel syndrome symptoms among German students: prevalence, characteristics, and associations to somatic complaints, sleep, quality of life, and childhood abdominal pain. Eur J Gastroenterol Hepatol. 2011;23(4):311-6. doi:10.1097/MEG.0b013e3283457b1e.
33. Vanuytsel T, Tack JF, Boeckxstaens GE. Treatment of abdominal pain in irritable bowel syndrome. J Gastroenterol. 2014;49(8):1193-205. doi:10.1007/s00535-014-0966-7.
34. Heitkemper M, Cain KC, Shulman R, Burr R, Poppe A, Jarrett M. Subtypes of irritable bowel syndrome based on abdominal pain/discomfort severity and bowel pattern. Dig Dis Sci. 2011;56:2050-8. doi:10.1007/s10620-011-1567-4.
35. Chowdhury SR, Safwath SA, Ghosh DK, Mahmuduzzaman M, Saha M, Alam MJ, et al. Evaluation of socio-demographic and lifestyle factors among subtypes of irritable bowel syndrome. J Shaheed Suhrawardy Med Coll. 2017;9(1):6-9. doi:10.3329/jssmc.v9i1.37251.
36. Mandiola-Palma C, Leiva C, Moya-Salazar MJ, Goicochea-Palomino EA, Contreras-Pulache H, Moya-Salazar J. Healthy habits, physical activity, stress, and food consumption trends in Chilean adults with irritable bowel syndrome during the COVID-19 pandemic. Int J Environ Res Public Health. 2024;21(5):533. doi:10.3390/ijerph21050608.
37. Sadeghian M, Sadeghi O, Hassanzadeh Keshteli A, Daghaghzadeh H, Esmaillzadeh A, Adibi P. Physical activity in relation to irritable bowel syndrome among Iranian adults. PLoS One. 2018;13(10):e0205806.38. doi:10.1371/journal.pone.0205806.
38. Ahmad MN, Thnaibat OM. Can physical exercise help people with irritable bowel syndrome? How substantial is the evidence? Health, Sport, Rehabilitation. 2023;9(4):94-110. doi:10.58962/HSR.2023.9.4.94-110.
39. Peters HP, De Vries W, Vanberge-Henegouwen G, Akkermans L. Potential benefits and hazards of physical activity and exercise on the gastrointestinal tract. Gut. 2001;48(3):435-9. doi:10.1136/gut.48.3.435.
40. Muscatello MRA, Bruno A, Scimeca G, Pandolfo G, Zoccali RA. Role of negative affects in pathophysiology and clinical expression of irritable bowel syndrome. World J Gastroenterol. 2014;20(24):7570-86. doi:10.3748/wjg.v20.i24.7570.
41. Sibelli A, Chalder T, Everitt H, Workman P, Windgassen S, Moss-Morris R. A systematic review with meta-analysis of the role of anxiety and depression in irritable bowel syndrome onset. Psychol Med. 2016;46(15):3065-80. doi:10.1017/S0033291716001987.
42. Roohafza H, Bidaki EZ, Hasanzadeh-Keshteli A, Daghaghzade H, Afshar H, Adibi P. Anxiety, depression and distress among irritable bowel syndrome and their subtypes: an epidemiological population based study. Adv Biomed Res. 2016;5(1):183. doi:10.4103/2277-9175.190938.
43. Pereyra F, Bustos Fernández LM, Schlottmann F, Zamora R, Marconi A, Steinberg L, et al. Prevalence of extra‐intestinal symptoms according to irritable bowel syndrome subtype. Neurogastroenterol Motil. 2024;36(7):e14796. doi:10.1111/nmo.14796.
44. Farzaneh N, Ghobakhlou M, Moghimi-Dehkordi B, Naderi N, Fadai F. Anxiety and depression in a sample of Iranian patients with irritable bowel syndrome. Iran J Psychiatry Behav Sci. 2013;7(1):30-6.
45. Hu Z, Li M, Yao L, Wang Y, Wang E, Yuan J, et al. The level and prevalence of depression and anxiety among patients with different subtypes of irritable bowel syndrome: a network meta-analysis. BMC Gastroenterol. 2021;21(1):23. doi:10.1186/s12876-020-01593-5.
46. Roshanaei-Moghaddam B, Katon WJ, Russo J. The longitudinal effects of depression on physical activity. Gen Hosp Psychiatry. 2009;31(4):306-15. doi:10.1016/j.genhosppsych.2009.04.002.
47. de Mello MT, de Aquino Lemos V, Antunes HKM, Bittencourt L, Santos-Silva R, Tufik S. Relationship between physical activity and depression and anxiety symptoms: a population study. J Affect Disord. 2013;149(1-3):241-6. doi:10.1016/j.jad.2013.01.035.