Strengths and Limitations
weakness, IBD
MUCOSAL INFLAMMATION, DISEASE, REMISSION
Our study has several strengths. This study is the first to prospectively investigate the effects of a lifestyle intervention in pediatric IBD patients on a broad set of outcomes, which are never investigated before in this population. The program was well received, as reflected by the high training adherence, making this program feasible in a clinical setting. Whether patients were also adherent to the tailored diet advice, was hard to verify. A weakness of our study is the small study population, especially the control group (n = 7). Researchers in the study could not be blinded by following strict protocols and consulting a second reviewer when filling in the PCDAI/PUCAI questionnaires; this bias was minimized. Due to the invasive nature of the procedure, we did not measure mucosal inflammation by endoscopy before and after the intervention. A major limitation of our study is the prolonged control period due to the COVID-19 lockdown. Although we still executed the generalized estimation approach model to measure change during the control period versus the exercise period, comparing these periods is less accurate, as a 6-month control period leads to more intra-patient fluctuations, especially in a disease that is characterized by periods of remission and relapse.