Author(s): ECKERT, K., SCHNABEL, R., KOEPPEL, M., ADAMEK, H.E., Institution: IST UNIVERSITY OF APPLIED SCIENCES, Country: GERMANY, Abstract-ID: 1716

INTRODUCTION:
Fatigue, a strong persistent tiredness that cannot be improved by sleep or rest, is one of the most common symptoms for patients with Inflammatory Bowel Disease (IBD). A recent meta-analysis identified a moderate effect (SMD = 0.54) of structured physical training (PT) on fatigue across multiple indications [1]. In IBD patients the effect of PT on fatigue is under investigated and was not considered in the mentioned meta-analysis. We hypothesize that an individualized, structured PT might be an effective approach for patients with IBD suffering from fatigue.
METHODS:
To account for the heterogeneity of IBD patients, a series of 4 single case trials (n-of-1 trial) with wthdrawl design was conducted. To increase the validity, the study consisted of 2 sequences, in total 2 interventional and 2 control phases, 4 weeks each, 16 in total. PT consisted of resistance training with training machines and cardio training on an ergometer. The PT sessions took twice a week during I-Phases. Patients were asked to rate their fatigue daily (N=112 measurements / person) in 3 different dimensions (physical, emotional, mental) on a numeric-analog-scale from 0 to 10.
RESULTS:
The posterior distribution for the time effect displays a mean of 0.010 (90%-HDI= -0.042, 0.558), indicating that physical fatigue will slightly increase during the C-period with a probability of 69%. The posterior distribution of the time-condition interaction is characterized by a mean of -0.017 (90%-HDI= -0.065, 0.029), indicating that there is a probability of 76% that the average patient would benefit from PT regarding physical fatigue.
Posterior distribution for time effect displays a mean of 0.026 (90%-HDI= -0.023, 0.071), emotional fatigue will slightly increase during the C-period with a probability of 85%. Posterior distribution of time-condition interaction, mean of -0.043 (90%-HDI= -0.077, -0.009), indicating that there is a probability of 97% that the average patient will benefit from PT in regards to emotional fatigue.
Posterior distribution for time effect displays a mean of 0.024 (90%-HDI= -0.025, 0.069), mental fatigue will slightly increase during the C-period with a probability of 83%. Posterior distribution of time-condition interaction, mean of -0.042 (90%-HDI= -0.076, -0.012), indicating that there is a probability of 98% that the average patient will benefit from PT regarding to mental fatigue.
CONCLUSION:
N-of-1 trials are a systematic approach where the intervention is applied in a randomized order and thus results in evidence of much higher quality. The results show that PT can be an effective treatment for IBD patients suffering from fatigue. In future studies, relevant clinical parameters should be analysed in addition to the subjective assessment of the effects.
1. Barakou, I. et al. Effectiveness of physical activity interventions on reducing perceived fatigue among adults with chronic conditions: a systematic review and meta-analysis of randomised controlled trials. Sci Rep 13, 14582 (2023).