The complex relationship between physical activity and fatigue with socioeconomic status, and mental health factors in individuals with ibd

BACKGROUND We aimed to assess to what extent socioeconomic status (SES) and elevated symptoms of anxiety and depression predict low physical activity (PA), and high fatigue among individuals with IBD METHODS Participants from the University of Manitoba IBD Research Registry completed a cross-sectional survey pertaining to fatigue, IBD symptoms, PA, and mental health. The International Physical Activity Questionnaire,.the Modified Fatigue Impact Scale (MFIS)) Generalized Anxiety Disorders-7 and, Patient Health Questionnaire scales were used. Disease activity was defined by the Inflammatory Bowel Disease Symptom Inventory. RESULTS Among those who were fatigued (MFIS >38) more were <63 years of age (63% vs. 49%, P <0.001), reported education of high school level or less (34% vs. 27%, P = 0.03), had low household income <$50,000 (24% vs.16%, P <0.01), were not in a relationship (25% vs. 18%, P <0.001), and were current smokers (16% vs. 7%, P <0.0001). The odds of low SES were greater for those who participated in low PA (OR = 2.75,95%CI = 1.8–4.3), low PA and were fatigued (OR = 3.05,95%CI = 1.7–5.3), and low PA excluding fatigue (OR = 2.28,95%CI = 1.3–3.9). Low SES was not significantly associated with fatigue (P = 0.08), particularly after removing PA observations (OR = 1.00,95%CI = 0.47–1.97). After adjusting for demographic and clinical factors, the odds of being fatigued were greater among those with elevated anxiety [aOR = 14.4,95%CI = 9.4–22.4], depression [aOR = 39.6,95%CI = 24.1–67.2], and active disease [aOR = 6.9,95%CI = 4.8–9.97]. The results did not change when removing low PA from the analysis. CONCLUSIONS Low SES was a main driver of engaging in low PA (and not high fatigue). Anxiety and/or depression and active disease were drivers of high fatigue (and not low PA).