COMMENTARY

Does Exercise Improve Symptoms of IBS?

David A. Johnson, MD

Disclosures

February 24, 2011

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Hello, I'm Dr. David Johnson, Professor of Medicine and Chief of Gastroenterology at the Eastern Virginia Medical School. Our patients with irritable bowel syndrome (IBS) are typically treated with advice for a high-fiber diet, and potentially a number of other food changes, but do we talk to them about exercise? Probably not, but perhaps we should, so suggests a provocative study that was just published online in the American Journal of Gastroenterology.[1] The basis for this is that, we know that exercise has physiologic advantages for some other painful conditions, such as fibromyalgia, and even for conditions such as depression.

Exercise has other physiologic advantages as well. It increases colonic motility, transit time, and transitive intestinal gas. Exercise doesn't seem to affect the symptomatic complaints of bloating, but it does change gas transit, so exercise may have an advantage in some patients who have IBS. It makes scientific sense, so investigators from Sweden recruited 102 patients who had well-established IBS for an open-label, prospective study. Patients were randomly assigned to a physical activity group (12 weeks of moderate to vigorous exercise) or a control group (maintaining their same lifestyle). The exercise was defined by the Swedish Public Health Ministry as 3 episodes per week, 20-60 minutes of moderate to vigorous exertion.

The patients were given a pre- and post-cycling test (a "quiz") to see if they actually complied with their exercise program. Patients seemed to be very adherent to their exercise programs, but nonetheless, the primary endpoint was improvement in IBS symptoms severity score (IBS-SSS), a validated instrument. Score changes of 50 made a difference in terms of significance. They found that patients who had the most significant change in fitness had a significant improvement in their overall IBS-SSS. The P value was .003.

There were no differences in stool quality or characteristics or symptoms like bloating. Quality of life was not different, but their physical and cognitive skills were improved; and they had an improvement in their overall IBS-SSS.

Where does this leave us? This study was somewhat small, and had a high dropout rate -- 13 and 14 dropouts, respectively, in the exercise group and the no-exercise group so that does limit the application. However, an intention-to-treat analysis was conducted, which strengthens the analysis. Questions remain about the study's relatively small size and high dropout rate.

The application to your practice, for the short-term, is that exercise makes sense, and it's very easy to do. I try and sell physical activity as something that is good not just for IBS, but globally. Interestingly, the exercise activities that were used in this study were things that you would routinely recommend: cycling, walking, swimming, and jogging, (and in a study from Sweden) Nordic walking. These are fairly standard activities -- we're not talking about heavy weight-lifting -- we're just talking about routine activities.

Why would exercise be beneficial for IBS? Questions remain to be answered, and more study is needed to validate these findings; for example, whether the endogenous endorphins released by exercise are of benefit in treating a patient's symptoms. We know that exercise may also improve one's ability to sleep and correct sleep abnormalities. So tell your patients to put on their jogging shoes, and get working. It's a simple thing to offer to your patients. I'm Dr. David Johnson, thanks for listening.

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