Physical Exercise in IBD

Inflammatory Bowel Disease (IBD), including both Crohn’s disease and ulcerative colitis, can prevent us from maintaining an exercise routine due to the symptoms it causes: abdominal pain, fatigue, or diarrhea make normal body movement difficult, leading many patients to avoid any type of training.

However, research shows that moderate exercise can be beneficial.

The National Institute on Aging recommends four types of exercise to improve physical health: endurance, strength, balance, and flexibility. The key for patients with IBD is to find one or two types of exercise that meet these requirements and the recommended intensity level.

1.-Can I do strength training?

Strength training involves exercises where muscles work against progressive resistance using weights, bands, or body weight. It consists of exercises that improve muscle strength and endurance through resistance. For people with IBD, incorporating strength training can offer numerous benefits:

• Improve muscle mass, often reduced due to chronic inflammation or corticosteroid use.
• Increase metabolism, helping better weight control.
• Improve overall functional fitness.
• Strengthen the immune system, helping reduce inflammation or its severity.
• Reduce stress and anxiety, key factors in preventing inflammation.
• Provide an anti-inflammatory effect.

Regular movement and moderate exercise help reduce inflammation and improve gut microbiota diversity, strengthening the connection between the gut, brain, and immune system. A 2020 study found that exercise influences the gut microbiome (the bacteria living in the intestine), making it more diverse and healthier, leading to the release of fewer inflammatory agents both during and after exercise, which is key in regulating inflammation in patients with IBD.

Additionally, the gut-brain connection is strengthened with appropriate physical activity, increasing the amount and regulation of neurotransmitters that control how and when inflammation occurs. For the same reasons, exercise also improves mental health.

Moderate aerobic activity for at least 30 minutes, 3 to 5 times per week, has been shown to reduce inflammation, particularly in the colon and other areas of the gastrointestinal tract. Since patients with ulcerative colitis /UC) typically experience colon inflammation, this type of exercise is especially beneficial.

It is very important to start slowly, respect your body’s pace, and gradually increase intensity.

Your body may react differently depending on your current health status and symptoms. During flare-ups, it is best to reduce or stop exercise.

During remission phases, you can begin training 2 to 3 times per week, performing full-body exercises using light weights or resistance bands, focusing on mastering proper technique before increasing loads. It is important to rest 1 to 2 days between sessions.

Aumenta gradualmente el peso y la intensidad a medida que ganes fuerza y confianza. Asegúrate de realizar los ejercicios de fuerza con la técnica adecuada para evitar lesiones.

Patients with IBD should focus on exercises that strengthen the core: abdominal and lower back areas. A strong core supports the abdominal region, which can be essential for symptom control, body stability, posture improvement, and reduce abdominal pressure, thereby relieving some symptoms. Strength training with light to moderate weights is recommended for Crohn’s disease patients (CD) to strengthen the pelvic floor and core muscles, supporting digestive and excretory functions. Make sure to perform exercises with proper technique to avoid injuries.

2.-Low-impact exercises

Although strength training is beneficial, high-impact exercises may not always be suitable for people with IBD. You can start with low-impact strength exercises that minimize stress on the joints and digestive system.

Choose exercises that are gentle on your body and adaptable depending on how you feel. Use equipment such as resistance bands and dumbbells that allow controlled movements.

Controlled, low-impact exercises are essential to avoid digestive or joint discomfort and can provide effective muscle activation without excessive strain.

Some examples include:

• Bodyweight squats.
• Light dumbbell lifts.
• Resistance bands for arms and legs.
• Stationary cycling or walking.

3.-Listen to your body

For exercise to have a positive effect, it is essential to listen to your body. Your energy levels and symptoms may vary, so it is important to adapt your workouts accordingly. If you notice increased discomfort or fatigue, it may be a sign to reduce intensity or modify your routine.

In these cases, you can change exercises, shorten workout duration or frequency, or even skip a session if needed.

Keeping a training journal can help track your sessions, symptoms, and energy levels, allowing you to identify patterns and adjust your plan.

4.-Rest whenever you need

Did you know muscles grow during rest? Rest is essential, especially for people with IBD, whose bodies are constantly repairing tissues affected by inflammation.

Rest and recovery are fundamental components of any training routine. Strength training stresses muscles, so adequate recovery time is necessary. Overtraining can worsen symptoms.

Include 1 to 3 rest days per week and include active recovery activities in your routine, such as gentle stretching or yoga to promote relaxation and flexibility, or meditation and try to get 7 to 8 hours of sleep a day.

5.-Focus on nutrition and hydration

Whilst healthy people need to pay attention to their nutrition for a workout to be effective, patients with IBD must pay particular attention to their diet. Proper nutrition and hydration play a crucial role in supporting your strength training efforts and your general health. Try to follow a balanced diet:

• A high protein intake to repair and build muscle.
• Consume healthy fats to manage inflammation.
• Include oats, brown rice, or boiled potatoes as a sustained energy source.

Plan your meals around your training sessions. A very important tip is to eat a light snack around 30 to 60 minutes before training and once finished, have a meal high in protein and carbohydrates to replenish your energy

Staying hydrated is equally important, as dehydration can affect digestive health and physical performance.

6.-Consult professionals

Given the specific challenges of IBD, working with healthcare professionals and fitness experts can provide you with valuable information and personalized recommendations. A physiotherapist or trainer with experience of working with people with chronic conditions can help you design a programme tailored to your needs and limitations.

7.-Embrace flexibility and adaptability

Flexibility is key when it comes to managing IBD and doing strength training. Be prepared to adapt your workouts depending on how you feel each day. The goal is to maintain a consistent routine that supports your health without compromising your well-being.

Have a variety of exercises at your disposal that you can switch between depending on your symptoms and energy levels. This ensures you have options to keep moving even on the toughest days.

If you live with IBD, don’t let the condition stop you from enjoying the benefits of strength training. With the right approach and support, you can build strength, improve your fitness and empower yourself on your journey to wellbeing.

References

• Lazaridis, N., et al. (2020). Exercise-induced modulation of gut microbiota and systemic inflammation. Frontiers in Physiology.
• Valdes, A. M., et al. (2018). Role of the gut microbiota in nutrition and health. BMJ.
• National Institute on Aging. (n.d.). Exercise and Physical Activity: Your Everyday Guide. Pitocchelli-Schwartzman, S. (2024)
•  IBD & Exercise. KDPT Fitness Blog.
• https://evinature.com/blog/gut-health/strength-training-for-grounded-gut-health-during-the-holidays/