Can Exercise Help Manage Inflammatory Bowel Disease?

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A systematic review found that different types of exercise, such as aerobic workouts and strength training, can improve fitness, disease symptoms, mental health and overall quality of life among patients with inflammatory bowel disease (IBD). Although the results are promising, investigators say more research is needed to figure out the best exercise plans and understand how exercise helps with IBD.

Common symptoms of the condition include diarrhea, abdominal pain, fatigue and weight loss, and up to 60% of patients report musculoskeletal issues such as muscle degeneration and osteoporosis.

“Despite recent advancements in the treatment of IBD using novel biological and immunomodulating therapies, many IBD patients do not achieve remission and often suffer from numerous adverse effects of long-term medication,” wrote a team of investigators led by Ghadeer Sabir, MD, associated with the California Institute of Behavioral Neurosciences & Psychology. “Hence, many patients resort to alternative medicine and lifestyle changes to help achieve remission.”

Investigators are now exploring the potential of exercise as a therapeutic approach for managing IBD—among other chronic diseases—although research is still in its infancy.

The review assessed the effects of exercise on the progression of IBD as well as its potential as a treatment option for patients. Investigators conducted a comprehensive search of three databases and two registries in May 2024. They used a variety of quality assessment tools to minimize potential bias and ultimately 12 high-quality studies were included in the analysis. Eligible studies were published after the year 2000, involved adult patients with confirmed IBD and included outcomes related to IBD progression, such as changes in symptoms, using validated scoring systems. The types of exercises evaluated included resistance training, aerobic exercise and mind-body modalities.

Although the studies varied in their sample sizes, treatment durations, follow-up periods, interventions and outcomes, most studies examined the relationship between physical activity and disease activity using questionnaires and objective assessments.

One study found high-intensity interval training (HIIT) improved cardiorespiratory fitness compared with moderate-intensity continuous training among patients with Crohn's disease, although both groups had improvements in disease activity. Another trial reported significant improvements in IBD-related stress and quality of life among a group of patients that underwent a three-month walking program. Similarly, patients participating in a 10-week running program saw quality of life improvements across all dimensions, including social, emotional, systemic and bowel. A cohort study revealed that higher self-reported physical activity levels were linked to a lower risk of disease flare-ups in patients with IBD over a six-month period.

Mind-body interventions that included stress management and relaxation techniques were also shown to improve not only the mental health and quality of life of patients, but also inflammatory markers.

Ultimately, the studies demonstrated physical activity can improve disease quality, inflammation, cardiorespiratory fitness and quality of life among patients with IBD. These findings were comparable to previous systematic reviews assessing this connection.

Investigators said the strengths of the study lie in their comprehensive approach to understanding the effects of exercise on disease management coupled with effectively minimizing potential publication bias. Additionally, the generalizability of the findings was improved by including studies that incorporated a wide range of population and settings.

“By addressing these gaps [in research], the review contributes to the development of tailored, evidence-based exercise interventions aimed at optimizing patient outcomes and improving holistic IBD management, thereby serving as a foundation for future research in this area,” investigators concluded.