Aims: The purpose of this study was to assess the effectiveness of a smartphone app (MyHealthyGut) in helping adults selfmanage celiac disease or gluten intolerance and improve their gut health. Methods: Adults diagnosed with celiac disease or gluten intolerance (N ¼ 115) were randomized into two groups: experimental group 1 (had access to the app for a one-month period) or wait list control (WLC). After one month, WLC participants were given one-month access to the app (experimental group 2). An online questionnaire was administered to assess (a) user satisfaction with the app and (b) changes in the following patient-reported outcomes: adherence to a gluten-free diet, quality of life (QoL), self-regulatory efficacy, and feelings of depression and anxiety. Generalized estimating equations were used to assess changes in the outcome variables over time between the groups. Results: Participants reported high levels of app usability, were satisfied with features of the app, and felt that the app was best suited for people newly diagnosed with celiac disease. Participants in the experimental groups reported improvements in adherence, gastrointestinal symptoms (experimental group 1 only), QoL, self-regulatory efficacy (experimental group 2 only), anxiety (experimental group 1 only), and depression (experimental group 2 only). Experimental group 1 and the WLC group reported significantly worse adherence after using the app based on the Celiac Dietary Adherence Test, which was in contrast to the accidental and purposeful measures of gluten consumption and symptoms for experimental group 1 but consistent with reports of accidental and purposeful gluten consumption and symptoms for the WLC group. Conclusions: Based on feedback from the participants, the app may be best suited for individuals newly diagnosed or struggling with celiac disease or gluten intolerance. After using the MyHealthyGut app for a one-month period, adults with celiac disease reported improvements in psychosocial outcomes. Further iterations of the app are needed to meet the needs of this population better. MyHealthyGut is the first evidence-based app designed to help people with celiac disease or gluten intolerance.

This study assessed the feasibility and benefits of high intensity interval training (HIIT) plus lifestyle education among inactive adults with celiac disease. 41 participants were randomized to receive the intervention (HIIT+) for 12-weeks or waitlist control (WLC). Testing was completed at baseline, immediately post- and 3-months post-intervention. Generalized estimating equations were used to assess changes in the outcome variables over time between the groups. Mean percent of age-predicted maximum heart rate was 97.9% and average rating of perceived exertion (RPE) was 6.33 (out of 10) during HIIT intervals. Following the intervention, the HIIT+ group showed enrichment in relative abundance of Parabacteroides and Defluviitaleaceae_UCG¬_011 while WLC showed enrichment in relative abundance of Roseburia intestinalis, Klebsiella and Adlercreutzia. A unique set of taxa were differentially abundant between the groups at 3-months post-intervention. HIIT+ participants experienced a reduction in resting heart rate (-6.6 bpm) immediately post-intervention compared to WLC. Further research is needed to establish an optimal HIIT protocol that may improve VO2max and metabolic syndrome biomarkers. Findings from this pilot study provide preliminary evidence that a HIIT+ intervention is feasible for inactive adults with celiac disease and leads to favourable changes in resting HR alongside potentially beneficial shifts in gut microbiota. Trial registration number: ClinicalTrials.gov number NCT03520244 Novelty • High intensity interval training leads to potentially beneficial changes in the gut microbiota of adults with celiac disease. • A high intensity interval training exercise intervention is feasible and well tolerated for patients with celiac disease.

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