Int J Sports Med 2016; 37(07): 505-515
DOI: 10.1055/s-0042-103157
Review
© Georg Thieme Verlag KG Stuttgart · New York

The Case for Increased Physical Activity in Chronic Inflammatory Bowel Disease: A Brief Review

R. J. Shephard
1   University of Toronto, Faculty of Kinesiology & Physical Education, Brackendale, Canada
› Author Affiliations
Further Information

Publication History



accepted after revision 03 February 2016

Publication Date:
26 April 2016 (online)

Abstract

Regular physical activity reduces the risk of colon cancer, but there is little information on the merits of such activity in the prevention and management of chronic inflammatory bowel disease (CIBD). The present systematic review thus documents current levels of habitual physical activity and aerobic and muscular function in CIBD, and examines the safety, practicality and efficacy of exercise programmes in countering the disease process, correcting functional deficits and enhancing quality of life. A systematic search of the Ovid/Medline database from January 1996 to May 2015 linked the terms physical activity/motor activity/physical fitness/physical training/physical education/training/exercise/exercise therapy with Crohn’s disease/colitis/ulcerative colitis/inflammatory bowel disease, supplementing this information by a scanning of reference lists and personal files.

12 of 16 published studies show a low level of habitual physical activity in CIBD, with sub-normal values for aerobic power, lean tissue mass and muscular strength. 3 of 4 studies suggest physical activity may reduce the risk of developing IBD, and 11 interventions all note that exercise programmes are well tolerated with some decreases of disease activity, and functional gains leading to an increased health-related quality of life. Moreover, programme compliance rates compare favourably with those seen in the treatment of other chronic conditions. More information on mechanisms is needed, but regular moderate aerobic and/or resistance exercise improves the health status of patients with CIBD both by modulating immune function and by improving physical function. A regular exercise programme should thus become an important component in the management of CIBD.

 
  • References

  • 1 Abitbol V, Roux C, Chaussade S, Guillemant S, Kolta S, Dougados M, Couturier D, Amor B. Metabolic bone assessment in patients with inflammatory bowel disease. Gastroenterology 1995; 108: 417-422
  • 2 Baumgart DC, Sandborn WJ. Inflammatory bowel disease: clinical aspects and established and evolving therapies. Lancet 2007; 369: 1641-1657
  • 3 Bechtold S, Alberer M, Arenz T, Putzker S, Filipiak-Pittroff B, Schwarz HP, Koletzko S. Reduced muscle mass and bone size in pediatric patients with inflammatory bowel disease. Inflamm Bowel Dis 2010; 16: 216-225
  • 4 Bilski J, Brzozowski B, Mazur-Blaly A, Sliwowski Z, Brzozowski T. The role of physical exercise in inflammatory bowel disease. Biomed Res Internat 2014; 2014: 429031
  • 5 Bøggild H, Tūchsen F, Ǿrhede E. Occupation, employment status, and chronic inflammatory bowel disease in Denmark. Int J Epidemiol 1996; 25: 630-637
  • 6 Boot AM, Bouquet J, Krenning EP, de Muink Keizer-Schrama SM. Bone mineral density and nutritional status in children with chronic inflammatory bowel disease. Gut 1998; 42: 188-194
  • 7 Brevinge H, Berglund B, Bosaeus I, Tölli J, Nordgren S, Lundholm K. Exercise capacity in patients undergoing proctocolectomy and small bowel resection for Crohn’s disease. Br J Surg 1995; 82: 1040-1045
  • 8 Bryant R, Ooi S, Schultz C, Goess C, Grafton R, Hughes J, Lim A, Bartholomeusz FD, Andrews JM. Low muscle mass and sarcopenia: common and predictive of osteopenia in inflammatory bowel disease. Aliment Pharmacol Therap 2014; 41: 895-906
  • 9 Candow D, Rizzi A, Chillibeck PD, Worobetz L. Effect of resistance training on Crohn’s disease. Can J Appl Physiol 2002; 27: S7-S8
  • 10 Capristo E, Mingrone G, Addolorato G, Greco AV, Gasbarrini G. Metabolic features of inflammatory bowel disease in a remission phase of the disease activity. J Intern Med 1996; 243: 339-347
  • 11 Chan SS, Luben R, Olsen A, Tjonneland A, Kaaks R, Teucher B, Lindgren S, Grip O, Keym T, Crowe FL, Bergmann MM, Boeing H, Hallmans G, Karling P, Overvad K, Palli D, Masala G, Kennedy H, van Schalk F, Bueno de Mesquita B, Oldenburg B, Khaw KT, Riboli E, Hart AR. Body mass index and the risk for Crohn’s disease and ulcerative colitis: Data from a European prospective cohort study (The IBD in EPIC study). Am J Gastroenterol 2013; 108: 575-582
  • 12 Chen Y, Noble E. Is exercise beneficial to the inflammatory bowel diseases? An implication of heat shock proteins. Med Hypoth 2009; 72: 84-86
  • 13 GBD Mortality and Causes of Death Collaborators. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study, 2013. Lancet 2015; 385: 117-171
  • 14 Cook MD, Martin SA, Williams C, Whitlock K, Wallig MA, Pence BD, Woods JA. Forced treadmill exercise training exacerbates inflammation and causes mortality while voluntary wheel training is protective in a mouse model of colitis. Brain Behav Immun 2013; 33: 46-56
  • 15 Crumbock SC, Loeb SJ, Fick DM. Physical activity, stress, disease activity and quality of life in adults with Crohn’s disease. Gastroenterol Nurs 2009; 32: 188-195
  • 16 Cucino C, Sonnenberg A. Occupational mortality from inflammatory bowel disease in the United States, 1991–1996. Am J Gastroenterol 2001; 96: 1101-1105
  • 17 D’Incà R, Varnier M, Mestriner C, Martines D, D’Odorico A, Sturniolo GC. Effect of moderate exercise on Crohn’s disease patients in remission. Ital J Gastroenterol Hepatol 1999; 31: 205-210
  • 18 D’Incà R, Varnier M, D’Odorico A, Sturniolo GC. Exercise and inflammatory bowel disease: Immunological aspects. Exerc Immunol Rev 2000; 6: 43-53
  • 19 Daley AJ, Grimmett C, Roberts L, Wilson S, Fatek M, Roalfe A, Singh S. The effects of exercise upon symptoms and quality of life in patients diagnosed with irritable bowel syndrome: A randomized controlled trial. Int J Sports Med 2008; 29: 778-782
  • 20 Dubner SE, Shults J, Baldassano RN, Zemel BS, Thayu M, Burnham JM, Herskovitz RM, Howard KM, Leonard MB. Longitudinal assessment of bone density and structure in an incident cohort of children with Crohn’s disease. Gastroenterology 2009; 136: 123-130
  • 21 Elsenbruch S, Langhorst J, Pokirowa K, Müller T, Luedtke R, Franken U, Paul A, Spahn G, Michalsen A, Janssen CE, Schedlowski M, Dobos GJ. Effects of mind-body therapy on quality of life and neuroendocrine and cellular immune functions in patients with ulcerative colitis. Psychother Psychosom 2005; 74: 277-287
  • 22 Filippi J, Al-Jaouni R, Wiroth JB, Hébuterne X, Schneider SM. Nutritional deficiencies in patients with Crohn’s disease in remission. Inflamm Bowel Dis 2006; 12: 185-191
  • 23 Fraser GM, Niv Y. Six patients whose perianal and ileocolic Crohn’s disease improved in the Dead Sea environment. J Clin Gastroenterol 1995; 21: 217-219
  • 24 Geerling BJ, Badart-Smook A, Stockbrügger RW, Brummer RJ. Comprehensive nutritional status in recently diagnosed patients with inflammatory bowel disease compared with population controls. Eur J Clin Nutr 2000; 54: 514-521
  • 25 Geerling BJ, Badart-Smook A, Stockbrügger RW, Brummer RJ. Comprehensive nutritional status in patients with long-standing Crohn disease currently in remission. Am J Clin Nutr 1998; 67: 919-926
  • 26 He C, Bassik MC., Moresi V, Sun K, Wei W, Zou Z, An Z, Loh J, Fisher J, Sun Q, Korsmeyer S, Packer M, May HI, Hill JA, Virgin HW, Gilpin C, Xiao G, Bassel-Duby R, Scherer PE, Levine B. Exercise-induced BCL2-regulated autophagy is required for muscle glucose homeostasis. Nature 2012; 481: 511-515
  • 27 Hlavaty T, Toth J, Koller T, Krajcovicova A, Oravcova S, Zelinkova Z, Huorka M. Smoking, breastfeeding, physical inactivity, contact with animals, and size of the family influence the risk of inflammatory bowel disease: A Slovak case – control study. United Eur Gastroenterol J 2013; 1: 109-119
  • 28 Hoffman-Goetz L, Spagnuolo PA, Guan J. Repeated exercise in mice alters expression of IL-10 and TNF-a in intestinal lymphocytes. Brain Behav Immun 2008; 22: 195-199
  • 29 Jahnsen J, Falch JA, Mowinckel P, Aadland E. Body composition in patients with inflammatory bowel disease: a population-based study. Am J Gastroenterol 2003; 98: 1556-1562
  • 30 Johannesen E, Simrén E, Strid H, Bajor A, Sadik R. Physical activity improves symptoms in irritable bowel syndrome: A randomized controlled trial. Am J Gastroeneterol 2011; 106: 915-922
  • 31 Jones PD, Kappelman MD, Martin CF, Chen W, Sandler RS, Long MD. Exercise decreases risk of future active disease in patients with inflammatory bowel disease in remission. Inflamm Bowel Dis 2015; 21: 1063-1071
  • 32 Kasimay O, Guzel E, Gemici A, Abdyll A, Sulovari A, Ercan F, Yegen BC. Colitis-induced oxidative damage of the colon and skeletal muscle is ameliorated by regular exercise in rats: the anxiolytic role of exercise. Exp Physiol 2006; 91: 897-906
  • 33 Khalili H, Ananthakrishnan AN, Konigeti GG, Liao X, Higuchi LM, Fuchs CS, Spiegelman D, Richter JM, Korzenik JR, Chan AT. Physical activity and risk of inflammatory bowel disease: prospective study from the Nurses’ Health Study cohorts. Br Med J 2013; 347: f6633
  • 34 Klare P, Nigg J, Nold J, Haller B, Krug AB, Mair S, Thoeringer CK, Christie JW, Schmid RM, Halle M, Huber W. The impact of a ten-week physical exercise program on health-related quality of life in patients with inflammatory bowel disease: A prospective randomized controlled trial. Digestion 2015; 91: 219-247
  • 35 Klaus J, Armbrecht G, Steinkamp M, Brückel J, Rieber A, Adler G, Reinshagen M, Feisenberg D, von Tirpitz C. High prevalence of osteoporotic vertebral fractures in patients with Crohn’s disease. Gut 2002; 51: 654-658
  • 36 Klein I, Reif S, Farbstein H, Halak A, Gilat T. Preillness non dietary factors and habits in inflammatory bowel disease. Ital J Gastroenterol Hepatol 1998; 30: 247-251
  • 37 Koek GH, Verleden GM, Evenpoel P, Rutgeerts P. Activity related increase of exhaled nitric oxide in Crohn’s disease and ulcerative colitis: a manifestation of systemic involvement?. Respir Med 2002; 96: 530-535
  • 38 Lakatos PL, Lakatos L. Risks for colorectal cancer in ulcerative colitis: Changes, causes and management srategies. World J Gastroenterol 2008; 14: 3937-3947
  • 39 Lee N, Radford-Smith G, Taaffe D. Bone loss in Crohn’s disease: exercise as a potential countermeasure. Inflamm Bowel Dis 2005; 11: 1108-1118
  • 40 Lees CW, Barrett JC, Parkes M, Satsangi J. New IBD genetics: common pathways with other diseases. Gut 2011; 60: 1739-1753
  • 41 Loudon C, Corroll V, Butcher J, Rawsthorne P, Bernstein CN. The effects of physical exercise on patients with Crohn’s disease. Am J Gastroenterol 1999; 94: 697-703
  • 42 Lustyk KB, Jarrett ME, Bennett JC, Heitkemper MM. Does a physically active lifestyle improve symptoms in women with irritable bowel syndrome?. Gastroeneterol Nurs 2001; 24: 129-137
  • 43 Mack DE, Wilson PM, Gilmore JC, Gunnell KE. Leisure-time physical activity in Canadians living with Crohn’s disease and ulcerative colitis. Population-based estimates. Gastroenterol Nurs 2011; 34: 288-294
  • 44 Martinez ME, Heddens D, Earnest DL, Bogert CL, Roe D, Einspahr J, Marshall JR, Alberts DS. Physical activity, body mass index, and prostaglandin E2 levels in rectal mucosa. J Natl Cancer Inst 1999; 91: 950-953
  • 45 Mayer R, Wong WD, Rothenberger DA, Goldberg SM, Madoff RD. Colorectal cancer in inflammatory bowel disease: a continuing problem. Dis Col Rectum 1999; 42: 343-347
  • 46 Miossec P. IL-17 and Th17 cells in human inflammatory diseases. Microbes Infect 2009; 11: 625-630
  • 47 Nathan I, Norton C, Czuber-Dochan W, Forbes A. Exercise in individuals with inflammatory bowel disease. Gastroenterol Nurs 2013; 36: 437-442
  • 48 Ng V, Millard W, Lebrun C, Howard J. Low-intensity exercise improves quality of life in patients with Crohn’s disease. Clin J Sports Med 2007; 17: 384-388
  • 49 Nguyen T, Ploeger HE, Obeid J, Issenman RM, Baker JM, Takken T, Parise G, Timmons BW. Reduced fat oxidation rates during submaximal exercise in adolescents with Crohn’s disease. Inflamm Bowel Dis 2013; 19: 2659-2665
  • 50 Ojerskog B, Hällström T, Kock NG, Myrvold HE. Quality of life in ileostomy patients before and after conversion to the continent ileostomy. Int J Colorectal Dis 1988; 3: 166-170
  • 51 Pedersen BK, Febbraio M. Muscle as an endocrine organ; focus on muscle-derived IL-6. Physiol Rev 2008; 88: 1379-1406
  • 52 Pérez CA. Prescription of physical exercise in Crohn’s disease. J Crohn’s Colitis 2009; 3: 225-231
  • 53 Persson PG, Leijonmarck CE, Bernell O, Hellers G, Ahlbom A. Risk indicators for inflammatory bowel disease. Int J Epidemiol 1993; 22: 268-272
  • 54 Ploeger H, Obeid J, Nguyen T, Takken T, Issenman R, de Greef M, Timmons B. Exercise and inflammation in pediatric Crohn’s disease. Int J Sports Med 2012; 33: 673-679
  • 55 Robinson RJ, al-Azzawi F, Iqbal SJ, Kryswicki T, Almond L, Abrams K, Mayberry JF. Osteoporosis and determinants of bone density in patients with CD. Dig Dis Sci 1998; 43: 2500-2506
  • 56 Rocch A, Benchimol EI, Bernstein CN, Bitton A, Feagan B, Panaccione R, Glasgow KW, Fernandes A, Ghosh S. Inflammatory bowel disease: a Canadian burden of illness review. Can J Gastroenterol 2012; 26: 811-817
  • 57 Saxena A, Fletcher E, Larsen B, Baliga MS, Durstine JO, Fayad R. Effect of exercise on chemically-induced colitis in adiponectin deficient mice. J Inflamm 2012; 9: 30
  • 58 Shephard RJ. Physical activity, training and the immune response. Carmel, IN: Benchmark Publications; 1997
  • 59 Sonnenberg A. Occupational distribution of inflammatory bowel disease among German employees. Gut 1990; 31: 1037-1040
  • 60 Sørensen VZ, Olsen BG, Binder V. Life prospects and quality of life in patients with Crohn’s disease. Gut 1987; 28: 382-385
  • 61 Sylvester FA, Leopold S, Lincoln M, Hyams JS, Griffiths AM, Lerer T. A two-year study of persistent lean tissue deficits in children with Crohn’s disease. Clin Gastroenterol Hepatol 2009; 7: 452-455
  • 62 Szalai Z, Svász A, Nagy I, Puskás A, Kupai K, Király A, Berkó AM, Pósa A, Strifler G, Baráth Z, Nagy LI, Szabó R, Pávó I, Muriasits Z, Gyöngyösi M, Varga C. Anti-Inflammatory effect of recreational exercise in TNBS-induced colitis in rats: Role of NOS/HO/MPO system. Oxidat Med Cell Longev 2014; 2014: ID 925981
  • 63 Terzić J, Grivennikov S, Karin E, Karin M. Inflammation and colon cancer. Gastroenterology 2010; 138: 2101-2104
  • 64 Tjellesen L, Nielsen PK, Staun M. Body composition by dual-energy X-ray absorptiometry in patients with Crohn’s disease. Scand J Gastroenterol 1998; 33: 356-360
  • 65 Valentini L, Schaper L, Buning C, Hengsterman S, Koernicke T, Tillinger W, Guglielmi FW, Norman K, Buhner S, Ockenga J, Pirlich M, Lochs H. Malnutrition and impaired muscle strength in patients with Crohn’s disease and ulcerative colitis in remission. Nutrition 2008; 24: 694-702
  • 66 van Langenberg DR, Della Gatta P, Hill B, Zacharewicz E, Gibson PR, Russell AP. Delving into disability in Crohn’s disease: Dysregulation of molecular pathways may explain skeletal muscle loss in Crohn’s disease. J Crohn’s Colitis 2014; 8: 626-634
  • 67 van Langenberg DR, Della Gatta P, Warmington SA, Kidgell DJ, Gibson PR, Russell AP. Objectively measured muscle fatigue in Crohn’s disease: Correlation with self-reported fatigue and associated factors for clinical application. J Crohn’s Colitis 2014; 8: 137-146
  • 68 Watters C, Wright SJ, Robinson RJ, Kryzywicki T, Almond L, Shevlin M, Mayberry JF. Positive and negative wellbeing as predictors of exercise uptake in Crohn’s disease: An exploratory study. Psychol Health Med 2001; 6: 293-299
  • 69 Werkstetter KJ, SB-D Pozza, Filipiak-Pittrof B, Schatz SB, Prell C, Bufler P, Koletzko B, Koletzko S. Long-term development of bone geometry and muscle in pediatric inflammatory bowel disease. Am J Gastroenterol 2011; 106: 988-998
  • 70 Werkstetter KJ, Ulrich J, Schatz SB, Prell C, Koletzko B, Koletzko S. Lean body mass, physical activity and quality of life in paediatric patients with inflammatory bowel disease and in healthy controls. J Crohn’s Colitis 2012; 6: 665-673
  • 71 Winther KV, Jess T, Langholz E, Munkholm P, Binder V. Survival and cause-specific mortality in ulcerative colitis: follow-up of a population-based cohort in Copenhagen County. Gastroenterology 2003; 125: 1576-1582
  • 72 Wiroth J-B, Filippi J, Schneider SM, Al-Jaouni R, Horvais N, Gavarry O, Bermon S, Hébuterne X. Muscle performance in patients with Crohn’s disease in clinical remission. Inflamm Bowel Dis 2005; 11: 296-303
  • 73 Wiskin AE, Wooton SA, Hunt TM, Cornelius VR, Afzal NA, Jackson AA, Beattie RM. Body composition in childhood inflammatory bowel disease. Clin Nutr 2011; 30: 112-115
  • 74 Zaltman C, Braulio VB, Outeiral R, Nunes T, de Castro CL. Lower extremity mobility limitation and impaired muscle function in women with ulcerative colitis. J Crohn’s Colitis 2014; 8: 529-535
  • 75 Zoli G, Katelaris PH, Garrow J, Gasbarrini G, Farthing MJ. Increased energy expenditure in growing adolescents with Crohn’s disease. Dig Dis Sci 1996; 41: 1754-1759