Darren was diagnosed with ulcerative colitis at age 28. He was very fit and active throughout his childhood, adolescence and early adulthood and was playing competitive GAA at club level in the year when he first started to experience symptoms such as abdominal pain and diarrhoea.
Ultimately, the extent and severity of his ulcerative colitis worsened despite various courses of conservative medical management, including multiple short-term courses of steroids and biologic drugs. After a period of four months as an in-patient, there was an escalation in disease classification for Darren. By the start of month six he had lost so much weight that he now fulfilled many of the criteria that determined "frailty" as a diagnosis in the elderly. In severe cases such as this, the course of ulcerative colitis can be a shocking deterioration in quality of life for the patient and supporting loved ones. Ultimately, Darren was advised by his medical team to have his colon removed, in order to avoid further, potentially fatal complications.
Prior to the onset of his first symptoms Darren weighed 98kg and was playing competitive intermediate football. The week before his surgery (14 months later) he weighed 51kg. His surgeon, gastroenterologist, clinical nurse specialist and close loved ones encouraged Darren to make the difficult decision to opt for surgery. This helped save his life. Despite the gravity of this situation, only three weeks after the successful surgery, he was discharged from hospital. He was now medically stable and had regained nearly 2kg. As such he was effectively finished with the acute phase of medical management for his condition, but he was emaciated, physically de-conditioned and had lost confidence in his ability to perform even the most basic of tasks.
For example, he was genuinely concerned about walking to the shops – for a number of reasons. He felt his balance had deteriorated significantly. He had developed a fear of falling and was conscious that his bone density had disimproved as a result of some of the necessary, but aggressive medical management. His energy levels were so low that he wasn't sure if he could make it back from the shops. This was a particularly challenging period for a previously fit, healthy and independent young adult. Despite being determined to regain strength, he did not feel comfortable going to a gym, where he felt self-conscious about his new stoma and plastic ostomy bag. He also felt he would be working alone with little idea of what was appropriate in terms of exertion. So, a clinical and graduated exercise programme would now become a key part of Darren's treatment plan post surgery.
How did Darren’s exercise programme help his ulcerative colitis?
Like many patients who go through acute medical management, Darren was discharged from hospital without any specific long-term plan to regain his strength levels. He was reassured by his medical team that his strength and energy levels would return in due course. But, he felt a greater sense of urgency to regain his strength and independence and was motivated to make up for lost time. However he did not know where to start.
In the same way Darren’s medical treatment was highly specific and personalised, he now needed an exercise intervention that was similarly precise. Initially, the exercise plan gave him some weekly targets based around recommended heart rate zones, duration of exercise, frequency and intensity. In the early stages it was important to monitor exertion closely and regular communication with Darren was a key feature. Furthermore, restoration of his gait and balance was an early target in his rehabilitation, and as such this was prioritised. This phase included a neuromotor component which involved balance, agility and co-ordination games. Darren celebrated being able to get up and down off the floor like a winning championship goal for his club team.
His condition improved significantly in the following months whereby he graduated to a strength and conditioning programme to include weight training and high intensity aerobic interval (HIT) training. He still has follow-up management with his medical team. They developed a great relationship over the course of this issue and he particularly enjoys seeing their reaction to his improving health and strength levels.
The benefits of exercise with . . .
. . . prostate cancer
. . . atrial fibrillation
. . . ulcerative colitis
