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Exercise and inflammatory bowel disease (IBD)

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Inflammatory bowel disease (IBD) is an umbrella term for two separate autoimmune pathologies: ulcerative colitis (UC) and Crohn’s disease (CD), both of which cause chronic inflammation of the gastrointestinal tract (1).

A number of studies suggest that structured exercise programmes may be an effective non-pharmacological treatment option to counteract IBD manifestations and complications (2).

Exercise is a non-pharmacologic intervention that advantageously affects clinical aspects of inflammatory bowel disease (IBD), including disease activity, immune competency, inflammation, quality of life, fatigue, and psychological factors (1):

  • exercise functions as a significant tool in modulating the inflammatory changes and subsequent health-related outcomes in IBD
  • reductions in pro-inflammatory cytokines, alterations of the gut microbiota, and improvements in health-related quality of life appear to be outcomes of both low-to-moderate- and high-intensity exercise interventions in IBD patients

A systematic review and meta-analysis found that there was low certainty evidence that structured exercise interventions of at least 4 weeks’ duration reduce disease activity symptoms (2):

  • was very low certainty that there was no clear change between exercise training and usual care in disease-specific QOL, however, a narrative review suggests exercise may be beneficial

A more recent systematic review and meta-analysis found (3):

  • individuals with high physical activity levels had a 22% and 38% reduced risk of developing CD in the cohort studies and case-control studies, respectively, compared with individuals with low physical activity levels
  • risk for incident UC was 13% lower in the high vs low physical activity level groups in the cohort studies, but the reduction in the case-control studies did not reach statistical significance.
  • quality-of-evidence assessment found no serious limitations in the cohort studies but serious limitations in the case-control studies due to a high risk for bias and significant heterogeneity

Reference:

  1. Ordille AJ, Phadtare S. Intensity-specific considerations for exercise for patients with inflammatory bowel disease. Gastroenterol Rep (Oxf). 2023 Feb 20;11:goad004. doi: 10.1093/gastro/goad004
  2. Jones K, Kimble R, Baker K, Tew GA. Effects of structured exercise programmes on physiological and psychological outcomes in adults with inflammatory bowel disease (IBD): A systematic review and meta-analysis. PLoS One. 2022 Dec 1;17(12):e0278480.
  3. Tiong HT et al. Physical Activity is Associated with a Decreased Risk of Developing Inflammatory Bowel Disease: A Systematic Review and Meta-analysis, Journal of Crohn's and Colitis, 2024;, jjae053,

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