Exercise Recommendations For Irritable Bowel Diseases

Gillian White, MSc, Ph.D. (Candidate), University of Toronto, Graduate Department of Exercise Sciences

Irritable Bowel Diseases (IBD) include ulcerative colitis (UC) and Crohn’s Disease (CD) and are autoimmune diseases characterized by chronic inflammation of the lining of the gastrointestinal system. UC affects the lining of the large intestine in which chronic inflammation can cause sores (ulcers) in this part of the digestive tract, while the chronic inflammation associated with CD affects the deeper tissues of the large intestine. Both can result in abdominal pain and cramping, diarrhea/constipation, blood in stool, and ulcers and can lead to more serious gastrointestinal complications including obstructed bowel, anal fissures, and colon cancer. Other more general symptoms include fatigue, unintended weight loss, bone mineral loss (osteopenia/osteoporosis), pain and swelling in eyes, joints, or skin, and malnutrition.

Figure 1. From Sharif et al. 2017 shows the immune effects of exercise. While exercise has an acutely pro-inflammatory effect (i.e. short-term), its chronic effects (long-term) are anti-inflammatory, helping to reduce rheumatic flare-ups and symptoms of auto-immune illnesses.

Physical Activity

Physical activity has been shown to reduce the risk of both UC and CD, although the effect is greater for CD (Persson et al.,1993; Khalili et al., 2013). Exercise can reduce disease progression and diarrhea symptoms, effects that are associated with lower pro-inflammatory signaling (Hoffman-Goetz et al., 2010). It may also reduce the risk of developing secondary illnesses associated with the primary IBD, such as ankylosing spondylitis, osteoporosis, and colon cancer. No studies have specifically measured the effects of exercise on pain, fatigue, or sleep quality in people with IBD but these symptoms in other autoimmune diseases tend to improve with regular physical activity.

Summary of Recommendations:

General Recommendations: >20 minutes of physical activity daily.

Best exercise: HIIT – 4×4 minutes x 85-95% HR_max with 3 minutes of rest at 70% HR_max done 2-3x/week.

Other exercise:

Aerobic – 25-35 minutes of moderate intensity aerobic activity (55-75% HR_max) done 3-4x/week

Resistance – 25-35 minutes of resistance training with progressive loads and focus on large muscle groups (i.e. lunges, squats etc.). Start with lower weight and higher repetitions (12-15 reps) for the first 4 weeks and gradually increases to higher weight with lower repetitions (8-10 reps).

Benefits: Lower pain symptoms, improved joint function, increased cardiovascular fitness, and lower risk secondary illnesses like heart disease (RA), osteoporosis (IBD), depression (Fibromyalgia). Track overall fitness improvements with a smart fitness watch!

Cautions: When fatigue is high, lower intensity aerobic exercise may be more suitable. A gentle routine on a yoga mat is recommended, for instance. For IBD, if surgical resection of intestines >10cm, high intensity exercise should be avoided.

Related Article: 4 Areas Of The Brain That Benefit From Exercise

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