Frequency of Chronic Gastrointestinal Distress in Runners: Validity and Reliability of a Retrospective Questionnaire

Abstract

Gastrointestinal (GI) symptoms may affect up to 90% of competitors during endurance races. Studies have typically assessed GI symptoms retrospectively or only over an acute timeframe, and information on the validity and reliability of the questionnaires employed is lacking. This investigation aimed to estimate the frequency of GI distress experienced by runners over 30 days and to establish the validity and reliability of a retrospective GI symptom questionnaire. Runners (70 men, 75 women) recorded GI symptoms with a prospective journal for 30 days. Retrospective GI symptom data were then collected after the 30-day period on two occasions within one week. GI symptoms were rated on a 0-10 scale. Descriptive statistics for GI symptoms are reported as medians (interquartile ranges) because of nonnormal distributions. Men and women experienced at least one GI symptom on 84.0% (59.8-95.1%) and 78.3% (50.0-95.2%) of runs, respectively. Moderate-to-severe GI symptoms (score of ≥5) were experienced on 13.8% (6.7-37.3%) and 21.7% (5.3-41.2%) of runs for men and women. Spearman's rho correlations between journal ratings and retrospective questionnaire ratings ranged from 0.47 to 0.82 (all p < .001), although they were highest when journal ratings were quantified as mean 30-day values (all rho ≥ 0.59). Reliability of the retrospective questionnaire ratings was high (rho = 0.78-0.92; p < .001). In comparison with tracking GI symptoms with a daily journal, retrospective questionnaires seem to offer a convenient and reasonably valid and reliable method of quantifying GI symptoms over 30 days.

Prevalence, Severity and Potential Nutritional Causes of Gastrointestinal Symptoms during a Marathon in Recreational Runners

“…Numerous potential factors may explain the large variance in reported symptoms such as the mode, duration or intensity of exercise, environmental conditions, nutritional intake, type of assessment tool, and method used to classify a “symptom”. For example, studies have used 4, 9, 10, and 11-point scales, each with differing vernacular, to quantify GIS [ 2 , 3 , 4 , 5 ]. Positive responses, of any magnitude, including those that do not affect performance, could be seen to overestimate the prevalence of symptoms, or may lead to erroneous conclusions regarding symptom severity.…”

Dietary Patterns in Runners with Gastrointestinal Disorders

“…Endurance athletes often experience a wide range of exercise-induced GIS [3], with running often being associated with the most prominent increases in GIS [2]. Here we find that runners with underlying gastrointestinal conditions were at a heightened risk of exerciseinduced GIS as compared to control runners.…”

“…Running is one of the most strenuous forms of exercise on the gastrointestinal (GI) tract [1], with prevalence of gastrointestinal symptoms (GIS) exceeding 80% in several studies [2][3][4]. Exercise-induced stress occurs due to adaptations in two physiological pathways affecting the integrity and function of the GI tract [1].…”

“…Exercise at low intensity appears to be beneficial in managing symptoms experienced by both IBS and IBD [10][11][12]. Conversely, as the intensity and duration of the exercise increases, exercise-induced GIS are often exacerbated, at least in healthy runners [2,3]. Unfortunately, evidence pertaining to the impact of high-intensity physical activity on an already compromised GI integrity and function in athletes with chronic GI disorders is scarce.…”

‘I think I’m gonna hurl’: A Narrative Review of the Causes of Nausea and Vomiting in Sport

“…While estimates vary with the type of sport, intensity of exercise, duration of exercise, and survey methodology, the majority of athletes, particularly endurance athletes, experience some GI issues during exercise [1,2]. For example, in a recent study of 145 endurance runners, men and women experienced at least one GI symptom on 84.0% and 78.3% of their training runs over a period of 30 days [3]. Moderate-to-severe GI symptoms (score of ≥5 on a 0–10 scale) were less common but still fairly prevalent (13.8% and 21.7% of runs for men and women, respectively).…”