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Exercise and Crohn's disease (CD)

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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