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Research

Physical activity and risk of inflammatory bowel disease: prospective study from the Nurses’ Health Study cohorts

BMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f6633 (Published 14 November 2013) Cite this as: BMJ 2013;347:f6633
  1. Hamed Khalili, attending physician1,
  2. Ashwin N Ananthakrishnan, attending physician, assistant professor1,
  3. Gauree G Konijeti, clinical and research fellow1,
  4. Xiaomei Liao, research scientist2,
  5. Leslie M Higuchi, attending physician3,
  6. Charles S Fuchs, attending physician, professor56,
  7. Donna Spiegelman, professor2,
  8. James M Richter, attending physician, associate professor1,
  9. Joshua R Korzenik, attending physician, assistant professor4,
  10. Andrew T Chan, attending physician, associate professor16
  1. 1Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston MA 02114, USA
  2. 2Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
  3. 3Division of Gastroenterology and Nutrition, Children’s Hospital Boston and Harvard Medical School, Boston, MA, USA
  4. 4Division of Gastroenterology, Brigham and Women’s Hospital, Boston, MA, USA
  5. 5Department of Adult Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
  6. 6Channing Laboratory, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
  1. Correspondence to: A T Chan achan{at}partners.org
  • Accepted 22 October 2013

Abstract

Objective To examine the association between physical activity and risk of ulcerative colitis and Crohn’s disease.

Design Prospective cohort study.

Setting Nurses’ Health Study and Nurses’ Health Study II.

Participants 194 711 women enrolled in the Nurses’ Health Study and Nurses’ Health Study II who provided data on physical activity and other risk factors every two to four years since 1984 in the Nurses’ Health Study and 1989 in the Nurses’ Health Study II and followed up through 2010.

Main outcome measure Incident ulcerative colitis and Crohn’s disease.

Results During 3 421 972 person years of follow-up, we documented 284 cases of Crohn’s disease and 363 cases of ulcerative colitis. The risk of Crohn’s disease was inversely associated with physical activity (P for trend 0.02). Compared with women in the lowest fifth of physical activity, the multivariate adjusted hazard ratio of Crohn’s disease among women in the highest fifth of physical activity was 0.64 (95% confidence interval 0.44 to 0.94). Active women with at least 27 metabolic equivalent task (MET) hours per week of physical activity had a 44% reduction (hazard ratio 0.56, 95% confidence interval 0.37 to 0.84) in risk of developing Crohn’s disease compared with sedentary women with <3 MET h/wk. Physical activity was not associated with risk of ulcerative colitis (P for trend 0.46). The absolute risk of ulcerative colitis and Crohn’s disease among women in the highest fifth of physical activity was 8 and 6 events per 100 000 person years compared with 11 and 16 events per 100 000 person years among women in the lowest fifth of physical activity, respectively. Age, smoking, body mass index, and cohort did not significantly modify the association between physical activity and risk of ulcerative colitis or Crohn’s disease (all P for interaction >0.35).

Conclusion In two large prospective cohorts of US women, physical activity was inversely associated with risk of Crohn’s disease but not of ulcerative colitis.

Footnotes

  • Contributors: HK conceived and designed the study; acquired the data; carried out the statistical analysis; interpreted the data; and drafted the manuscript. He is guarantor. ANA, GK, and CSF acquired the data and critically revised the manuscript. XL and DS analysed and interpreted the data and critically revised the manuscript. LMH acquired the data and critically revised the manuscript for important intellectual content. JMR conceived and designed the study; acquired the data; and critically revised the manuscript. JRK conceived and designed the study and critically revised the manuscript. ATC conceived and designed the study; analysed and interpreted the data; drafted the manuscript; and critically revised the manuscript.

  • Funding: This study was funded by National Institute of Health grants: R01 CA137178, R01 CA050385, P01 CA87969, P30 DK043351, K23 DK099681, K08 DK064256, K24 098311, and K23 DK091742. ATC is a Damon Runyon Cancer Research Foundation clinical investigator. HK is supported by a career development award from the American Gastroenterological Association and by the National Institute of Diabetes and Digestive and Kidney Diseases (K23 DK099681). LMH is supported by the National Institute of Diabetes and Digestive and Kidney Diseases (K08 DK064256). ANA is a member of the scientific advisory board for Prometheus and Janssen. JMR is a consultant for policy analysis. ATC has served as a consultant for Bayer Healthcare, Millennium Pharmaceuticals, Pfizer, and Pozen.

  • Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organization for the submitted work; no financial relationships with any organizations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

  • Ethical approval: This study was approved by the institutional review board at the Brigham and Women’s Hospital.

  • Data sharing: Data, the statistical code, questionnaires, and technical processes are available from the corresponding author at achan@partners.org.

  • Transparency: The lead author (the manuscript’s guarantor) on behalf of all authors affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/3.0/.

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