When working with clients or patients with irritable bowel syndrome (IBS), it’s important to remember that stress is a major driver of symptom onset and severity. The proper diet often can prevent or ease symptoms, but high levels of stress can interfere with even the best dietary strategies. Adding regular exercise to IBS treatment plans can help clients in a variety of ways.
Benefits of Exercise
Exercise can reduce stress by stimulating the release of endorphins, leading to a greater sense of calm and well-being. From a more general perspective, regular physical activity also can increase strength and cardiovascular fitness, leading to improvements in overall health and longevity. This increased fitness may help clients feel stronger and more capable of handling painful IBS flares. In addition, studies have shown that exercise can improve overall IBS symptom severity. In a 2011 study, the group of IBS patients who increased their exercise levels experienced a significant decrease in IBS symptoms, while the control group experienced worsening of symptoms.
What Type of Exercise Is Most Helpful?
The type, duration, and intensity of exercise depend on individual clients and their overall state of health and fitness. For those in good general health, IBS imposes few limitations. However, during a period of intense abdominal discomfort, high impact and high intensity exercise, such as running, soccer, CrossFit, or heavy weight lifting, may cause greater discomfort and is best avoided until the client is feeling better.
The IBS subtype clients have also may affect the type of exercise that works best for them. Individuals with IBS-C (constipation predominant) may benefit from more intense or endurance exercise, as it can speed up intestinal transit time and relieve constipation. However, individuals with IBS-D (diarrhea predominant) may find that some of these same gut changes can be problematic. Endurance exercise, such as distance running, can cause increased gastrointestinal (GI) distress due to increases in gut permeability that result from reduced gut blood flow. Changes in nutrient absorption and gastric emptying time also can result, which can make endurance athletes more susceptible to cramping and diarrhea. Foods that often are consumed during long training bouts, such as energy gels and chews that are high in fructose or contain caffeine, also can exacerbate IBS. Thus, it’s important to counsel clients appropriately regarding low-FODMAP fueling sources. Kate Scarlata, RDN, has a great e-booklet on foods for FODMAP-sensitive athletes.
During an IBS flare, gentle or low-impact activities such as walking, yoga, light cycling, tai chi, or swimming can help reduce stress and improve fitness. Encourage clients to get outdoors for exercise as well, as the effects of daylight and external environmental cues have been shown to improve mood and reduce anxiety.
Yoga has been the focus of several recent studies in the area of GI health. One study showed that individuals with inflammatory bowel disease experienced improved quality of life and reduced symptoms with weekly yoga sessions. Another study compared yoga with the low-FODMAP diet and found that twice-weekly yoga was nearly as effective for reducing IBS symptom severity as the low-FODMAP diet. A scientific review article evaluated yoga practice for IBS sufferers and noted that the improvements in symptoms and quality of life gained from yoga practice also may lead to reduced need for medications, fiber supplements, and probiotics.
Exercise is an important tool in IBS management and ensuring overall quality of life. Clients should check with their doctors before beginning any exercise program, choose the type of activity that best fits their symptoms and lifestyle, and fuel and hydrate well for best results.
— Diana Reid, MPH, RD, is known as The Global Dietitian. She provides nutrition counseling and consulting services both in the United States and Luxembourg and spends part of the year in each country. Diana focuses on the area of gastrointestinal health and has been trained by Monash University and King’s College London in implementing the low-FODMAP Diet. She blogs on her website and writes regularly for FODMAP Everyday, and you can follow her on Facebook, Instagram, and Twitter.