Research Therapies

Exercise

“Exercise can be used like a vaccine to prevent disease and a medication to treat disease. If there were a drug with the same benefits as exercise, it would instantly be standard of care.”

– Robert Sallis, MD, Chairman of Exercise is Medicine (a program developed by the American Medical Association)

Regular exercise is undoubtedly one of the easiest and most effective ways to improve your odds of living a long, healthy life. Scientists and health practitioners have long considered it the fountain of youth in regard to aging, and the wonderful thing is that it is essentially free. Over the years, countless scientific studies have linked regular exercise to numerous physical and mental benefits that extend long into old age. Given all we know about how good exercise is for you, it truly is a wonder that so many Americans still live a sedentary lifestyle.

All of us at Food Rx, who care deeply about those of you living with IBD, would like to make the following appeal: if you are currently neglecting your body’s need for regular activity – and you are not in the middle of a flare-up that would physically prevent you from strenuous movement – please consider talking with your doctor about beginning an exercise program. It is one of the most important conversations the two of you will have.

Those of us with IBD have a much higher risk of developing colon cancer than the general population, and physical exercise has been shown to greatly reduce the risk of developing colon cancer.[1,2,3] If you are living with IBD, regular exercise can help offset your increased risk.

We probably don’t need to tell anyone what exercise is. It likely plays some role in your life, even if you aren’t always aware of it. The textbook definition of exercise, for those of you that are interested, is “any bodily activity that enhances or maintains physical fitness and overall health or wellness.” Exercise can take many forms, and for some of us that might be morning walks with a spouse. For others, it might be competing in an Ironman Triathlon. Regardless of the form our exercise takes, the physical and emotional benefits are undeniable.

Regular physical exercise has scientifically been linked to many health benefits, including reduced risk of many diseases. Skeptics often suggest that the reason these studies show strong correlation between fitness and health is because the exercisers are already healthy to begin with. The reality, though, is that study after study has shown the same positive correlation between exercise and health, even when the study participants are all healthy to begin with.[4] There is simply no disputing the evidence: exercise gives you the best chance to staying younger longer, keeping your brain sharp, and your body healthy well into old age.

Writing in the Archives of Internal Medicine, two geriatricians, Dr. Marco Pahor of the University of Florida and Dr. Jeff Williamson of Winston-Salem, N.C., state definitively that “…today it is recognized that virtually all of the diseases and conditions that lead to physical disability in older adults have as part of their etiology a component of personal lifestyle choices (eg, physical inactivity) in addition to biological aging and environmental exposure.”[5] In other words, if you choose to live a physically inactive lifestyle, you are willfully exposing yourself to a higher risk of chronic disease.

A number of the key benefits of exercise are outlined below:

  • Better health into your later years
  • Reduced cognitive impairment over time
  • Lower risk for cardiovascular disease, diabetes, stroke, arthritis, and obesity
  • Lower risk of various types of cancer, including colon, breast, and lung
  • Improved psychological wellbeing and reduced stress
  • Lower risk of depression and higher self-esteem

Selected References

[1] Lee, I.M. Physical activity and cancer prevention—data from epidemiologic studies. Medicine & Science in Sports & Exercise. 2003; 35: (11), 1823–27.

[2] Wolin et al. Physical activity and colon cancer prevention: a meta-analysis. British Journal of Cancer, 2009.

[3] Landro, Lauren. The Hidden Benefits of Exercise: Even Moderate Physical Activity Can Boost the Immune System and Protect Against Chronic Diseases.” The Wall Street Journal. Jan 1, 2010.

[4] Sun, Qi et al. Physical activity at midlife in relation to successful survival in women at age 70 years or older. Arch Intern Med. 2010;170(2):194-201.

[5] Williamson, J., et al. Evidence regarding the benefits of physical exercise. Arch Intern Med. 2010;170(2):124-125.

Why We Recommend It for IBD Patients

We want to be crystal clear here: if you are at the height of an IBD flare-up, we do not necessarily recommend physical exercise. If you are experiencing severe symptoms of the disease, we advise a patient to immediately discuss treatment options with their doctor.

At Food Rx, we recommend using dietary modification or a medication regimen recommended by your doctor to get your symptoms under control before beginning a rigorous exercise program of any kind. But once you are feeling well enough to begin working out, we believe it is critical to exercise regularly to enjoy the many health benefits it provides, which include: reduced risk of colon cancer, a strengthened immune system, improved mental health, the prevention of depression, the improvement or maintenance of positive self-esteem, and the potential enhancement of an individual’s body image. [1,2,3,4,5,6,7,8]

You should be aware that individuals with ulcerative colitis or Crohn’s disease involving the colon are at a greater risk of developing colon cancer.[9] Although the incidence of colon cancer in IBD patients appears to be declining over time – a welcome sign! – some studies still suggest that the disease increases your likelihood of developing this type of cancer by as much as five times.[10]

The risk of developing colon cancer increases after someone has had the disease for 8 years or more, at which point colonoscopies should be performed every 1 to 2 years as a precautionary measure.[9] But we don’t want you to live in fear of cancer either. The reality is that more than 90 percent of IBD patients will never develop cancer, despite our increased risk.[10] Still, we recommend routine exercise as another precautionary measure.

Selected References

[1] Lee, I.M. Physical activity and cancer prevention—data from epidemiologic studies. Medicine & Science in Sports & Exercise. 2003; 35: (11), 1823–27.

[2] Wolin et al. Physical activity and colon cancer prevention: a meta-analysis. British Journal of Cancer, 2009.

[3] Landro, Lauren. The Hidden Benefits of Exercise: Even Moderate Physical Activity Can Boost the Immune System and Protect Against Chronic Diseases.” The Wall Street Journal. Jan 1, 2010.

[4] Nieman, DC. Current perspective on exercise immunology. Curr Sports Med Rep. 2003; Oct;2(5):239-42.

[5] Colcombe, S. et al. Fitness effects on the cognitive function of older adults: a meta-analytic study. Psychological Science. 2003; 14:125-130.

[6] Dunn, A.L., et al. The DOSE study: A clinical trial to examine efficacy and dose response of exercise as treatment for depression. Controlled Clinical Trials. 2002; 23 (5): 584–603.

[7] Callaghan, P. Exercise: A neglected intervention in mental health care? Journal of Psychiatric and Mental Health Nursing. 2004; 11: 476–83.

[8] McAuley, E., et al. Physical activity, self-esteem, and self-efficacy relationships in older adults: A randomized controlled trial. Annals of Behavioral Medicine. 2000; 22 (2):131–39.

[9] Crohn’s & Colitis Foundation of America. Colorectal Cancer. 2009.

[10] WebMD. Inflammatory Bowel Disease and Colon Cancer. 2010.

Examining the Science

Compared to other complementary therapies for IBD, more research has been conducted specifically examining the link between exercise and Crohn’s disease and ulcerative colitis.

A number of published studies have suggested that regular exercise may not only improve the patient’s quality of life, but also reduce the symptoms of the disease. A recent meta-analysis published in the The Journal of Sports Medicine and Physical Fitness reviewed 7 studies on exercise and IBD and concluded that exercise seems to reduce symptoms of the disease, while simultaneously improving the patient’s quality of life indicators.[1] However, the authors noted that there wasn’t sufficient evidence linking exercise to heightened immune function in individuals with IBD (the results of the studies were mixed).

Three additional studies published in the last few years also support the use of low intensity exercise to improve both the quality of life and symptoms of individuals living with IBD.[2,3,4] One of these studies looked at a population of sedentary patients living with Crohn’s disease. The patients were put on a low-intensity exercise program consisting of three 30 minute walks weekly. After 12 weeks, the patients demonstrated statistically significant improvements in IBD Stress Index, IBDQ score, and Harvey Bradshaw Simple Index – all measures of disease activity.[2]

It should be noted, though, that these studies did not find any correlation between exercise and the onset of IBD, meaning the jury is still out on whether exercise can help prevent IBD and bolster immune function in patients with IBD. More research is needed in this area. Also, most of the studies identified low-intensity exercise as being associated with disease improvement. The available research does not support the use of strenuous physical activity to control disease symptoms.

Selected References

[1] Packer, N. et al. Does physical activity affect quality of life, disease symptoms and immune measures in patients with inflammatory bowel disease? A systematic review. The Journal of Sports Medicine and Physical Fitness. 2010; 50(1): 1-18.

[2] Goodhand, J. et al. Management of stress in inflammatory bowel disease: a therapeutic option? Expert Rev Gastroenterol Hepatol. 2009;3(6):661-79.

[3] Neeraj, N. et al. Exercise and inflammatory bowel disease. Can J Gastroenterol. 2008; 22(5): 497–504.

[4] Ng, V. et al. Exercise and Crohn’s disease: speculations on potential benefits. Can J Gastroenterol. 2006; 20(10): 657–660.

Exercising In Practice

The available research supports the use of low to moderate intensity exercise to help control the symptoms of IBD and to improve quality of life. Unfortunately, there is no simple formula to determine how much exercise is enough for someone living with IBD. Walking programs, moderate running, weight training and similar exercise regimens are likely to have a therapeutic benefit. More strenuous activities, such as long-distance running or endurance sports, may prove to be too much for some patients with IBD.

All of us are unique, and the way one person’s body responds to exercise may be different than another’s. Some may be able to tolerate more strenuous exercise and feel perfectly fine. We highly recommend discussing any potential exercise program with your doctor, as he or she will be able to advise you on an appropriate starting point.

And after you begin your exercise program, pay close attention to what your body is telling you. If it feels like you are pushing your body too hard, you probably are. Scale back your routine and see if your condition improves.

Things to Consider

Always talk to your doctor before beginning any new exercise program. They can help you plan a safe routine and ensure you aren’t overdoing it right off the bat. Besides the obvious strain exercise places on the individual with IBD, there is an inherent risk of bodily injury with some movements.

Your doctor will be able to properly instruct you on the correct way to perform various exercises. Make sure to tell your doctor about any previous injuries you have had, or any additional diseases you may be suffering from. All of these factors can play a role in the selection of a practical, safe, and effective workout routine.

Selected Bibliography (the original full list)

(1) Lee, I.M. Physical activity and cancer prevention—data from epidemiologic studies. Medicine & Science in Sports & Exercise. 2003; 35: (11), 1823–27.

(2) Wolin et al. Physical activity and colon cancer prevention: a meta-analysis. British Journal of Cancer, 2009.

(3) Landro, Lauren. The Hidden Benefits of Exercise: Even Moderate Physical Activity Can Boost the Immune System and Protect Against Chronic Diseases.” The Wall Street Journal. Jan 1, 2010.(4) Sun, Qi et al. Physical activity at midlife in relation to successful survival in women at age 70 years or older. Arch Intern Med. 2010;170(2):194-201.

(5) Williamson, J., et al. Evidence regarding the benefits of physical exercise. Arch Intern Med. 2010;170(2):124-125.

(6) Nieman, DC. Current perspective on exercise immunology. Curr Sports Med Rep. 2003; Oct;2(5):239-42.

(7) Colcombe, S. et al. Fitness effects on the cognitive function of older adults: a meta-analytic study. Psychological Science. 2003; 14:125-130.

(8) Dunn, A.L., et al. The DOSE study: A clinical trial to examine efficacy and dose response of exercise as treatment for depression. Controlled Clinical Trials. 2002; 23 (5): 584–603.

(9) Callaghan, P. Exercise: A neglected intervention in mental health care? Journal of Psychiatric and Mental Health Nursing. 2004; 11: 476–83.

(10) McAuley, E., et al. Physical activity, self-esteem, and self-efficacy relationships in older adults: A randomized controlled trial. Annals of Behavioral Medicine. 2000; 22 (2):131–39.

(11)Crohn’s & Colitis Foundation of America. Colorectal Cancer. 2009.

(12)WebMD. Inflammatory Bowel Disease and Colon Cancer. 2010.

(13) Packer, N. et al. Does physical activity affect quality of life, disease symptoms and immune measures in patients with inflammatory bowel disease? A systematic review. The Journal of Sports Medicine and Physical Fitness. 2010; 50(1): 1-18.

(14) Goodhand, J. et al. Management of stress in inflammatory bowel disease: a therapeutic option? Expert Rev Gastroenterol Hepatol. 2009;3(6):661-79.

(15)Neeraj, N. et al. Exercise and inflammatory bowel disease. Can J Gastroenterol. 2008; 22(5): 497–504.

(16) Ng, V. et al. Exercise and Crohn’s disease: speculations on potential benefits. Can J Gastroenterol. 2006; 20(10): 657–660.