title: Effects of a comprehensive lifestyle modification program on quality-of-life in patients with ulcerative colitis: a twelve-month follow-up.
abstract: OBJECTIVE
  To analyze the effects of a comprehensive lifestyle modification program on health-related quality-of-life, psychological distress, and clinical parameters in patients with ulcerative colitis (UC) 3- and 12 months after completion of the program.
  
  
  METHODS
  Sixty patients with UC in clinical remission or with low disease activity were randomly assigned to an intervention group or a usual-care control group. Comprehensive lifestyle modification consisted of a structured 60-h training program over a period of 10 weeks which included stress management training, psychoeducational elements, and self-care strategies. Quality-of-life, psychological distress, and clinical disease activity were assessed with standardized questionnaires (Inflammatory Bowel Disease Questionnaire (IBDQ); the MOS Short-Form 36 (SF-36); the Brief Symptom Inventory (BSI), and the Colitis Activity Index (CAI)) at baseline, and 3 months and 12 months after comprehensive lifestyle modification.
  
  
  RESULTS
  Three months after comprehensive lifestyle modification, patients in the intervention group showed significantly greater improvement in the SF-36 scale physical function (p=0.0175), and a significantly greater reduction in anxiety scores, measured with the BSI (p=0.0294). Use of relaxation techniques was a significant predictor of improvement in the psychological sum score after 3 months of therapy (p=0.034). Though 80% of patients with an initial IBDQ score <170 in the intervention group showed an improvement of >16 points after 3 months, no significant effects of the intervention were found on the IBDQ scales, or on clinical disease parameters, including CAI scores, self-assessed disease activity, hospitalizations, or medical consultations.
  
  
  CONCLUSIONS
  These results are consistent with possible short-term benefits of a comprehensive lifestyle modification program on some aspects of quality-of-life and emotional well-being, but no effects were discernable 12 months after completion of therapy. Comprehensive lifestyle modification had no effect on clinical disease variables. The generalizability of these data is limited because of the inclusion of patients with a relatively low disease activity who were interested in integrative medicine.
authors.affiliation: University of Duisburg-Essen, Kliniken Essen Mitte, Germany. jost.langhorst@gmx.de
authors.forename: Jost
authors.initials: J
authors.lastname: Langhorst
authors.forename: Twyla
authors.initials: T
authors.lastname: Mueller
authors.forename: Rainer
authors.initials: R
authors.lastname: Luedtke
authors.forename: Ulla
authors.initials: U
authors.lastname: Franken
authors.forename: Anna
authors.initials: A
authors.lastname: Paul
authors.forename: Andreas
authors.initials: A
authors.lastname: Michalsen
authors.forename: Manfred
authors.initials: M
authors.lastname: Schedlowski
authors.forename: Gustav J
authors.initials: GJ
authors.lastname: Dobos
authors.forename: Sigrid
authors.initials: S
authors.lastname: Elsenbruch
mesh_terms: D000328:Adult; D003093:Colitis, Ulcerative / Q000188:drug therapy / Q000503:physiopathology* / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012648:Self Care; D013315:Stress, Psychological