Exercise in patients with inflammatory bowel diseases: current perspectives

Abstract

Inflammatory bowel diseases (IBDs), including both Crohn’s disease (CD) and ulcerative colitis (UC), are chronic autoimmune diseases. Both CD and UC have relapsing and remitting courses. Although effective medical treatments exist for these chronic conditions, some patients do not respond to these traditional therapies. Patients are often left frustrated with incomplete resolution of symptoms and seek alternative or complementary forms of therapy. Patients often search for modifiable factors that could improve their symptoms or help them to maintain periods of remission. In this review, we examine both the published evidence on the benefits of exercise clinically and the pathophysiological changes associated with exercise. We then describe data on exercise patterns in patients with IBDs, potential barriers to exercise in IBDs, and the role of exercise in the development and course of IBDs. While some data support physical activity as having a protective role in the development of IBDs, the findings have not been robust. Importantly, studies of exercise in patients with mild-to-moderate IBD activity show no danger of disease or symptom exacerbation. Exercise has theoretical benefits on the immune response, and the limited available data suggest that exercise may improve disease activity, quality of life, bone mineral density, and fatigue levels in patients with IBDs. Overall, exercise is safe and probably beneficial in patients with IBDs. Evidence supporting specific exercise recommendations, including aspects such as duration and heart rate targets, is needed in order to better counsel patients with IBDs.

Health-Risk Behaviors and Chronic Conditions Among Adults with Inflammatory Bowel Disease — United States, 2015 and 2016

“…In addition, the prevalence of meeting neither aerobic nor muscle-strengthening physical activity guidelines was higher among adults with IBD, which might be an indication of severity of symptoms. Although there is no current exercise recommendation to adults with IBD, mild exercise in those with mild or moderate symptoms might not worsen disease symptoms ( 8 ). Furthermore, exercise might help build muscle mass, bone density, and improve sleep quality, and its benefits outweigh the risks for almost everyone.…”

The impact of tobacco smoking on treatment choice and efficacy in inflammatory bowel disease

“…59 Yet exercise may have a protective role in the development and course of IBD. The recent meta-analysis by Engels et al 60 examined 10 studies from 1990 to 2015 and found that high levels of exercise correlated with a reduced risk (RR, 0.63; 95% CI, 0.50-0.79) of CD in comparison with those with low exercise levels. Moreover, in a large prospective study of IBD patients in remission (1,308 CD and 549 UC/indeterminate colitis), higher levels of physical activity were associated with lower rates of active disease of CD (RR, 0.72; 95% CI, 0.55-0.94).…”

Opening a Window on Attention: Adjuvant Therapies for Inflammatory Bowel Disease

“…Low-to-moderate intensity physical activities have been proved to be safe and suitable that it was well tolerated by IBD patients especially those who were in remission and did note provoke subjective symptoms [ 78 ]. Moderate-intensity physical activity has beneficial effects on the gastrointestinal system.…”

“…Swimming and cycling are two effective aerobic exercises that can be beneficial with fewer gastrointestinal symptoms by the means of inflammatory modulation and apoptosis [ 10 , 78 ]. In addition, walking 20–30 min at 60% of maximal heart rate 3 days per week along with resistance training 2-3 times per week is advocated in many studies, and it may have the potential to decrease the risk of active disease at six months [ 79 , 85 , 86 ].…”