The role of physical exercise in the treatment of IBS

Enrique Rey, Department of Digestive Diseases, Hospital Clínico San Carlos, School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria San Carlos, Madrid, Spain

Physical exercise is widely recommended for improving health in the population. Patients suffering from IBS frequently look for advice regarding changes in lifestyle. This review focuses on the evidence behind the potential benefit and harms of physical activity over the GI tract, its specific influence on pathophysiological mechanism, and the effects of physical exercise on IBS symptoms and outcome. From a pathophysiological perspective, mild to moderate regular exercise contributes to regulate autonomous nervous system imbalance and modifies the inflammatory status, mechanisms that may benefit IBS patients. Few clinical trials have been reported with easily self-directed physical exercise (e.g. walking, running...), but most suggest a clinical benefit of mild to moderate exercise, improving bowel and extradigestive symptoms associated with IBS. Positive results have been observed also with yoga or other physical activities that required specific skills or knowledge. Most clinical guidelines are in favor of physical exercise recommendation. Finally, recommendation is adopted by many doctors in clinical practice, and many patients do follow the recommendation in long term follow up. Taken into consideration all perspectives, recommendation of at least 30 min walking 4 days weekly is easy to provide in a busy clinic, easy to be followed by patients, is associated with a better general health, and may improve IBS symptoms, without any recognized deleterious effect.

Keywords: Irritable bowel syndrome. Physical exercise. Evidence-based recommendation. Lifestyle.