Association of Recreational Physical Activity with Gut Microbiota Diversity and Composition, and Symptom Burden in Crohn’s Disease: A Cross-Sectional Study

This study aimed to investigate the potential benefits of physical activity (PA) on patient-reported outcomes (PROs) in individuals with Crohn's disease (CD) and to examine whether these benefits are associated with gut microbiota. This cross-sectional study included 251 patients with CD from two inflammatory bowel disease centers in China. Participants with CD provided information on their health background, PA, and PROs using the Global Physical Activity Questionnaire (GPAQ) and the Patient-reported Outcome Measurement Information System (PROMIS). Part of participants also provided a single fecal sample for analysis. Latent profile analysis (LPA) was conducted to categorize individuals with CD into classes based on PROs. Metagenomic sequencing was then performed, followed by bioinformatics assessment of taxonomy and diversity metrics. LPA identified two PRO patterns: low and high symptoms. Univariate and multivariate analyses indicated that disease activity and sedentary behavior were risk factors for symptom severity, whereas recreational PA, rather than work-and travel-related PA, and income served as protective factors (all p<0.05). After controlling for age, gender, disease activity level, and other covariates, recreational PA explained microbiome diversity in patients with CD (p=0.016). The gut microbiota diversity (alpha or beta) significantly varied between patients with CD and low and high levels of recreational PA (all p<0.05). A total of 29 dominant gut microbial taxa, including Oscillospiraceae, Ruminococcus, and Eubacterium rectale, have been identified as associated with recreational PA and primarily function in the butyric acid metabolism pathway. Promoting the incorporation of recreational PA as an indicator of healthy lifestyle management for CD may improve patients' subjective psychological and mental well-being, while also preserving intestinal microbial diversity. Recreational PA is associated with favorable patient-reported outcomes and increased diversity of gut microbiota in CD, supporting its inclusion in lifestyle management strategies.