Research Article ISSN 2641-4295

Food Science & Nutrition Research

The Effect of Exercise on the Signs and Symptoms of Inflammatory Bowel

Disease
Lund Mariah, Carlson Max, Scallon Lily, Abeln Sarah, Lentz Mason, Kastello Gary Ph.D.* and
Hansen Kent Ph.D.*

*
Correspondence:
Gary Kastello, Winona State University, Maxwell Hall 363, 170 W.
8th St., Winona, MN, United States of America, 55987, Tel: 507-
457-5219; Fax: 507-457-2554.
Health, Exercise & Rehabilitative Sciences Department, Winona
State University, United States of America. Kent Hansen, Winona State University, Maxwell Hall 377, 170 W.
8th St., Winona, MN, United States of America, 55987, Tel: 507-
457-5217; Fax: 507-457-2554.

Received: 02 Jun 2022; Accepted: 05 Jul 2022; Published: 11 Jul 2022

Citation: Lund M, Carlson M, Scallon L, et al. The Effect of Exercise on the Signs and Symptoms of Inflammatory Bowel Disease. Food
Sci Nutr Res. 2022; 5(1): 1-8.

ABSTRACT
Introduction: Inflammatory Bowel Disease (IBD) generally describes several autoimmune disorders that involve
inflammation of the gastrointestinal tract, including Ulcerative Colitis (UC) and Crohn’s disease (CD). An
estimated 3.1 million Americans are affected by IBD. Although the inflammation caused by IBD mainly affects
the gastrointestinal tract, when IBD is exacerbated, the inflammation can become systemic. Consistent exercise is
theorized to reduce chronic inflammation and reduce signs and symptoms of IBD.

Objective: This meta-analysis aims to examine the effects of exercise on the signs and symptoms of IBD.
Methods: A literary search was conducted using Cochrane Library, PubMed, and Cinahl databases. Of the 1031
records identified, twelve articles met the inclusion criteria, with seven articles presenting data that could be meta-
analyzed. The reported data from the seven included articles were standardized to compare dependent variables
using the Stata17 statistical package. Pooled effect sizes and 95% confidence intervals were obtained through the
random-effects model. The results were used to examine the effects of exercise on C-reactive protein (CRP), fecal
calprotectin (FC), and IBD signs and symptoms related questionnaires.

Results: Signs and symptoms questionnaires were standardized and compared, resulting in a low risk of heterogeneity
of 0.00% (I2), an effect size of 0.02, 95% CI [–0.66 to 0.70], p=0.96. Biomarkers were pooled, standardized, and
compared, resulting in heterogeneity of 0.00% (I2) and an effect size of -0.48, 95% CI [–1.60 to 1.42], p=0.40.

Conclusions: These results suggest that exercise does not decrease signs and symptoms in IBD patients.

Keywords FC: Fecal Calprotectin; HBI: Harvey Bradshaw Index; UCAI:

C-Reactive Protein, Exercise, Fecal Calprotectin, Inflammatory Ulcerative Colitis Activity Index; IBDQ: Inflammatory Bowel
Bowel Disease, Physical Activity. Disease Questionnaire; IPAQ: International Physical Activity
Questionnaire; PMayo: Partial Mayo Index; CDAI: Crohn's
Abbreviations Disease Index; P-SCCAI: Patient Simple Clinical Colitis Activity
IBD: Inflammatory Bowel Disease; CRP: C-Reactive Protein; Index.
Food Sci Nutr Res, 2022 Volume 5 | Issue 1 | 1 of 8
Introduction signs and symptoms of IBD were integrated to form the current
According to the Mayo Clinic, Inflammatory Bowel Disease meta-analysis. The extant literature demonstrates that exercise
(IBD) is a disorder that involves chronic inflammation of the is associated with an improvement in the quality of life for IBD
gastrointestinal tract [1]. The most common types of IBD are patients; however, little is known about the effects of exercise
Ulcerative Colitis (UC) and Crohn's Disease (CD). Both conditions on both systemic inflammation, and signs & symptoms in IBD
can lead to a myriad of intolerable signs and symptoms such as patients.  
malnutrition, abdominal pain, fatigue, and ulcers. The Centers for
Disease Control and Prevention estimate that over 3 million U.S. Inflammatory Bowel Disease is a chronic inflammatory disease
adults have been diagnosed with Inflammatory Bowel Disease [2]. of the gastrointestinal (GI) tract. The two primary forms of this
disease are Ulcerative Colitis and Crohn's Disease. Ulcerative
Although the exact etiology of IBD is still unknown, it has been Colitis is characterized by inflammation and ulcerations along the
well established that patients diagnosed with IBD have elevated superficial lining of the descending large intestine, sigmoid colon,
inflammatory biomarkers such as Fecal Calprotectin (FC) and and rectum. Crohn's Disease, in turn, is defined by inflammation
C Reactive Protein (CRP) [3-5]. Due to the unknown cause of of the superficial and deeper layers of the entire digestive tract,
IBD, symptoms are typically treated with varying interventions, specifically the colon and ileum of the small intestine. The
including diet restrictions, anti-inflammatory medications, and inflammation involved in IBD damages the intestines resulting in
invasive surgery [1,6]. These interventions along with the side malnutrition, abdominal pain, fatigue, and ulcers which often lead
effects from IBD often elicit malnutrition as diets can be low in to other symptoms such as diarrhea, cramping, blood in the stool,
vitamin D and calcium, anti-inflammatory medications have been reduced appetite, and decreased weight [1].
shown to alter metabolic turnover of some nutrients within the
body, intestinal inflammation decreases absorption, and associated Although IBD initially causes local inflammation of the GI tract, it
diarrhea excretes nutrients. Good nutrition is often key in bodily can lead to extraintestinal or systemic inflammation [9].
health, making it difficult for IBD patients to see remission [7].
With the needs of IBD sufferers in mind, there may be potential The main inflammatory marker molecules in IBD are Fecal
benefits from exercise training as it can increase nutrient availability Calprotectin (FC) and C - reactive protein (CRP). In response to
and is less invasive than current interventions. Another benefit of continuous damage within the bowel, white blood cells (WBC)
exercise training is the known decrease in chronic inflammation. invade the impaired area. First, neutrophils release calprotectin
Therefore, exercise training as a potential intervention may reduce which will translocate to the gastrointestinal tract and can be
inflammatory biomarkers of IBD as exercise has been shown to measured in feces as a local biomarker, Fecal Calprotectin [1,6].
reduced chronic inflammation. Determining if exercise will reduce Subsequently, macrophage’s present themselves after the initial
IBD biomarkers and signs & symptoms of IBD thereby minimizing stages of inflammation as a more chronic systemic response.
need of more invasive procedures is of importance for improved Macrophage’s release interleukin signaling molecules, which
health of IBD patients. travel to the liver and stimulate synthesis of CRP [6]. Both CRP
& Calprotectin can be used to quantify IBD inflammatory activity
The specific aim of this meta-analysis is to determine if exercise is objectively. Systemic inflammation results from the release of pro-
a feasible intervention to alleviate inflammation, as well as signs inflammatory cytokines and the chronic activation of the innate
and symptoms of IBD. immune system. Inflammation is a response to injury or any
foreign pathogen within the body and is stimulated to attack non-
Literature Review self-pathogens. Evidence suggests that food particulate, viruses, or
A systematic review is a research method utilized for analyzing other bacteria translocating across the GI lumen may irritate the
data from numerous studies conducted on similar research topics. lower parts of the digestive system initiating the acute non-specific
Rather than depending on results from isolated studies, a meta- immune response. The response is a set of vascular, molecular,
analysis combines results from multiple independent studies with and cellular events that are designed to clean out cellular debris
similar dependent variables to statistically determine the practical or pathogens to initiate repair. Acute inflammation is seen as a
response a particular intervention elicits. This calculated effect normal response following an injury resulting in increased blood
from a meta-analysis is deemed more reliable than isolated studies. creatine kinase (CK) and CRP. Whereas the effects of chronic
Gene V Glass, an American statistician, described how the need for gastrointestinal inflammation can be observed with an increase
meta-analysis is evident due to the rapid growth of the literature on in these inflammatory molecules as well as fecal calprotectin
a myriad of topics with dichotomous findings [8]. due to ongoing GI injury. While additional chronic immune
system activation may complete the response to the speculated
Integrating and analyzing findings from different sources gives foreign invader, there still exists no known specific causes of
the meta-analysis a paramount role in providing appropriate IBD. However, there are risk factors for developing this disease,
recommendations on a particular intervention. This method including tobacco use, obesity, appendectomy, oral contraceptives,
of investigation is a systematic approach offering reliable, diet, antibiotic use, genetics, and ethnicity. These risk factors are
objective, and, most importantly, reproducible results. Multiple associated with chronic injury to the gastrointestinal tract, which
independent studies investigating the effects of exercise on the are associated with the inflammatory response.
Food Sci Nutr Res, 2022 Volume 5 | Issue 1 | 2 of 8
Inflammatory Bowel Disease is most commonly treated through systemic subcategory measures total body symptoms associated
anti-inflammatory medical interventions, which consist of with IBD, such as fever and weight loss. Other subjective
corticosteroids and aminosalicylates, but these medications questionnaires that are included in the current study are: Pediatric
have many side effects [1]. An intervention with fewer side Ulcerative Colitis Activity Index (PUCAI), International Physical
effects consists of exercise as it has routinely been utilized as a Activity Questionnaire (IPAQ), partial MAYO index (PMAYO),
countermeasure for inflammatory-related damage in IBD patients. Pediatric Crohn's Disease Activity Index (PCDAI), Patient Simple
Interestingly, isolated bouts of exercise appear to initiate an acute Clinical Colitis Activity Index (P-SCCAI), Harvey Bradshaw
inflammatory response [10,11]. As an example, in the Brown et Index (HBI), and Crohn's Disease Activity Index (CDAI). These
al. 2015 review IL-6 increased (pre 1.1 ± 0.6 vs post-ex 2.7 ± 1.0 subjective measurements are significant in better understanding
g/ml, p ≤ 0.05). Though an isolated bout of exercise is known to disease states in patients with IBD. Increases in patient reported
cause inflammation, an investigation by Beavers et al., suggests IBDQ scores and are favorable, while decreases in reported HBI
that chronic exercise training leads to physiologic adaptation and CDAI scores are deemed a positive outcome.
evidenced by lower levels of inflammatory biomarkers [12]. The
reviewed data suggests that an inverse relationship exists between Review of the literature suggests that there may be positive effects
markers of chronic systemic inflammation and exercise training, from exercise training on inflammation, and signs & symptoms
supported by a 37 percent decreased likelihood for elevated resting of IBD that suggest exercise training is a beneficial intervention.
levels of C-Reactive Protein (CRP) after exercise training an The benefits include lower pro-inflammatory biomarkers (CRP &
average of three days a week for nine months. Consistent physical FCP) and improved signs & symptom questionnaire scores. The
activity has been suggested to reduce adipose tissue, decrease specific aim of this review is to determine if exercise training is an
white blood cells, increase antioxidant activity, and increase the effective countermeasure for both the inflammation and the signs
body’s capability to resist damage which are additional factors & symptoms experienced in IBD patients.
that may lead to the reduction in systemic inflammation [13].
Another recent systematic review of twenty-seven studies by Methods  
G.L Rose et al. investigated the effects of aerobic and resistance Literature search
exercise on chronic inflammation in a healthy adult population. The research team conducted a solely electronic literature review
It was determined that a significant pooled ES was observed using Cochrane Library, PubMed, and Cinahl databases. Searches
for higher- versus lower-intensity exercise on diminishing CRP were conducted on March 19th, 2021, using the search terms
concentrations, in studies of middle-aged adults (ES=-0.412, Inflammatory Bowel Disease AND Exercise, Inflammatory Bowel
95% CI=-0.821– -0.004, p = 0.048) or interventions >9 weeks Disease AND Motor Activity, Inflammatory Bowel Disease AND
in duration (ES=-0.520, 95%CI=-0.882–-0.159, p = 0.005). Exercise Therapy, Inflammatory Bowel Disease AND Physical
Conclusions found that exercise duration greater than 9 weeks in Activity. Articles included in this analysis were published between
middle-aged adults improved inflammatory levels [14]. January 1st, 2000, and March 19th, 2021.

The anti-inflammatory adaptation to consistent exercise training The literature search results were compiled into one master list of
has been cited within the literature for both healthy populations 1,031 articles. The research team reviewed each article on the list
and individuals with chronic disease. An additional systematic in groups of 2-3 to determine acceptance based on primary and
review by Hammonds et al, determined that exercise reduced CRP, secondary inclusion criteria. Inclusion criteria were established
a systemic marker of inflammation in healthy adults and those before the articles were thoroughly reviewed. The designs
with cardiovascular disease [15] (standardized mean difference of included studies were randomized controlled trials, cross-
−0.53 mg/L; 95% CI, −0.74 to −0.33). In summary, a single bout sectional, correlational, and quasi-experimental designs. Through
of exercise elicits an acute inflammatory response. Consistent this process, a total of twelve articles met all the inclusion criteria,
repeated bouts of exercise offer physiologic adaptation, which however, five studies that met all inclusion criteria were excluded
reduces markers of chronic inflammation [16-18]. This adaptation because data was not reported in means and standard deviations.
offers potential as an inflammatory countermeasure to reduce both Attempts were made to contact the authors to obtain data in this
inflammation and signs & symptoms of IBD. form; however, attempts were unsuccessful. This process resulted
in seven articles remaining for the final review (Figure 1).
Along with the objective blood markers of inflammation (CRP,
FC) for IBD, many subjective questionnaires quantify IBD signs Inclusion criteria
& symptoms. The frequently utilized Irritable Bowel Disease Primary inclusion criteria: human study, exercise or physical
Questionnaire (IBDQ) assesses health-related quality of life in IBD activity as an independent variable, study participants diagnosed
patients. The questionnaire is broken down into four subcategories: with IBD, Ulcerative Colitis, or Crohn's Disease. The following
emotional, social, bowel, and systemic. The emotional subcategory objective dependent variables were selected as secondary
evaluates the psychological conditions that may worsen in patients inclusion criteria to assess IBD signs, C-Reactive Protein (CRP) or
with IBD, particularly in flare-ups. The social subcategory Fecal Calprotectin (FC). Additional secondary inclusion criteria
measures IBD effects on a patient's societal functioning. The bowel included assessment tools for subjective signs & symptoms of IBD:
subcategory assesses the intestinal symptoms of patients, and the Harvey Bradshaw Index (HBI), Ulcerative Colitis Activity Index
Food Sci Nutr Res, 2022 Volume 5 | Issue 1 | 3 of 8
(UCAI), Inflammatory Bowel Disease Questionnaire (IBDQ), used to compare biomarker data. As FC and CRP are in different
International Physical Activity Questionnaire (IPAQ), Partial units, µg/g and mg/L respectively, the research team converted to
Mayo Index (PMayo), Crohn's Disease Activity Index (CDAI), gain ± standard deviation so a comparison could be made.
or Patient Simple Clinical Colitis Activity Index (P-SCCAI).
The study participants were individuals diagnosed with IBD. The The pooled gain score, standard deviation, and inverse variance
primary investigated exercises included walking, running, and weight was entered into STATA-17. STATA-17 determined the
resistance training. The intensity of each exercise intervention was effect size (95% CI) and weight (%) of each study as well as the
classified as low, moderate, or vigorous, defined by each study. heterogeneity (I2) of the combined study variable variance.

Equation 1.1
Weighted Average =
n = sample size
X = Intervention mean, dependent variable

Equation 1.2, Hedges G with Pooled Standard Deviation

Coding
Articles used in the meta-analysis were uploaded into a shared excel
file and coded based on; dependent variables, subject traits, and
exercise characteristics. The coding table is shown below (Figure 2).
Figure 1: Starting with 1031 studies, this figure shows how the research
team systematically excluded studies based on established criteria
presented in figure 2. Of the 1031 articles, 12 met inclusion criteria, but 5
did not present data in a usable format.

Statistical Analysis
To analyze the diverse data reported, dependent variables were
standardized & pooled to combine the results of individual studies
into an overall effect on a standardized scale.

For studies that included a comparison of more than two groups, the
IBD diagnosed groups (remission and active disease) were pooled
to compare diseased vs. non-diseased subjects. Weighted average
and Standard Deviation were calculated by adjusting the means
and SD with the group population then dividing by the population
sample size (Equation 1.1). This process was repeated for both
pre-and post-data. Cohens D was converted to Hedges G estimate
to accurately obtain the pooled standard deviation and effect size
in studies with varied sample sizes. Hedges G accounts for small
sample size when calculating the overall gain (equation 1.2). The
process was then repeated to compare the control and intervention Figure 2: CDAI- Crohn’s Disease Activity Index, HBI- Harvey
Bradshaw Index, PUCAI- Pediatric Ulcerative Colitis Activity Index,
groups and determine the overall effect of the intervention per
IBDQ- Inflammatory Bowel Disease Questionnaire, IPAQ- International
study. To allow for varied questionnaire signs and symptoms scale Physical Activity Questionnaire, PCDAI- Pediatric Crohn’s Disease
direction, health improvement was uniformly adjusted to a positive Activity Index, P-SCCAI- Patient Simple Clinical Colitis Activity Index,
gain and detriment in health a negative gain. The IBDQ was the FC- Fecal Calprotectin, CRP- C-Reactive Protein. Primary and secondary
only questionnaire included that has a higher score interpreted as an criteria for the inclusion of journals for review.
improvement in health. All other questionnaires interpreted lower
scores as an improvement in health and a higher score as a detriment Bias prevention
in health. Therefore, the IBDQ was the only survey tool that did The researchers conducted searches using three databases: Cochrane
not require scale direction adjustment allowing for gain score Library, PubMed, and Cinahl. Cochrane Library was included as
comparison on a standardized scale. The same standardization was this database includes unpublished research and dissertations to
Food Sci Nutr Res, 2022 Volume 5 | Issue 1 | 4 of 8
prevent publication bias. These specific databases were used to Discussion
provide peer-reviewed, trustworthy, and high-quality articles. The meta-analyzed questionnaire data (Figure 3) is not statistically
Confirmation bias is the tendency for researchers to interpret significant suggesting that exercise does not alter signs &
results that adhere to pre-existing beliefs. Attempts to minimize symptoms of IBD. With full homogeneity across our studies and
confirmation bias included a mitigated focus on the statistical the effect size of 0.02 CI [-0.66, 0.70] for questionnaire results and
significance of individual studies and including articles in which -0.48 CI [-1.60, 0.64] for biomarker results, this contradicts our
the hypothesized outcome was not achieved. hypothesis that physiologic adaptation to exercise will diminish
signs and symptoms of IBD.
Results
Six of the seven studies utilized sign & symptom assessment Three of the seven reviewed articles analyzed systemic
questionnaires. The overall effect size of the exercise intervention inflammatory biomarker concentrations and yielded dichotomous
on signs & symptoms of IBD (questionnaire) results are: 0.02 CI results. Both Tew et al. & Jones et al. analyzed FC in Crohn's
[–0.66, 0.70], p=0.96. The heterogeneity T2 was 0.00, indicating disease patients resulting in no significant change following
full homogeneity across all study results (Figure 3). exercise intervention lasting 6 months. Conversely, Legeret et
al. found a decrease in CRP following two months of moderate
Of the seven studies, three reported inflammatory biomarkers exercise in pediatric patients diagnosed with IBD. In that study
results. The overall effect size and 95% confidence interval of the baseline CRP concentrations of the pooled remission & active
combined CRP and FC results is –0.48 CI [-1.60, 0.64], p=0.40. disease group significantly decreased from 3.64 ± 5.08 g/dl to 0.75
The heterogeneity T2 was 0.00%, as presented in (Figure 4). ± 0.856 g/dl p-value = 0.02. The current analysis yielded one study

Figure 3: CI- confidence interval, IBDQ- Inflammatory Bowel Disease Questionnaire, P-SCCAI- Pediatric Simple Clinical Colitis Activity Index,
HBI- Harvey Bradshaw Index, CDAI- Crohn’s Disease Activity Index. Results reported in effect size [95% confidence interval] and weight between
studies. Statistics were calculated using the data analysis software STATA17.

Figure 4: CI- confidence interval. Results reported in effect size [95% confidence interval] and weight between studies. Statistics were calculated using
the data analysis software STATA17.
Food Sci Nutr Res, 2022 Volume 5 | Issue 1 | 5 of 8
demonstrating a significant reduction in systemic inflammation traditional medical interventions for IBD to observe the best
measuring blood CRP (Legeret, 2019). Potential mechanisms for possible health benefits as literature suggests quality of life and
reduced CRP concentrations could be due to the decrease in tissue overall wellbeing improve with exercise [23].
cytokine activity [19]. The remaining two studies, Tew et al.
(2019) & Jones et al. (2015), determined that no significant change Limitations
occurred in the inflammatory marker FC response. The limitations of this study were inevitable. IBD is a highly
variable disease, with many uncontrollable factors affecting this
Literature on the effects exercise has on FC in IBD patients is study. Twelve articles met the inclusion criteria; however, five of
limited because of the small number of studies performed utilizing the articles could not be used in Stata17 due to the presentation
exercise intervention and measuring the specific parameters of data as medians. Attempts were made to get the appropriate
utilized in the current meta-analysis. However, a recent cohort data, but we were unable to obtain the needed data for this subset
study investigated the effects of intense exercise on twelve IBD of studies. Meta-analyses require data in means and standard
patients. Results suggest that exercise training did not alter FC deviations, odds ratios, or correlations. Therefore, the limited
in IBD patients [20]. FC is not a commonly measured exercise number of quality studies is a limitation.
induced biomarker because healthy individuals should have little
to none in fecal samples. Nevertheless, FC is a good indicator of Other study limitations included differing modes and durations
change in those with IBD as concentration rises and falls with of exercise intervention, adherence to the program, intensity of
disease severity. The absence of consistent change in FC observed exercise performed, and study sizes. A wide variety of exercise
in the literature may be due to the high specificity of FC, the modes is expected but using one or two modes would be more
rarity of measurement in healthy individuals within CN groups, effective for comparison to decrease statistical variance. For further
the inability to reach a theorized exercise threshold for optimal research, choosing more cohesive interventions using similar
benefit, and its localization in the GI tract [21]. These factors may exercise programs between studies could improve statistical power
limit the patient’s ability to reach the most beneficial physiologic of analysis. The search criteria allowed for many different modes
adaptations that may improve both inflammatory markers and of exercise but limited the research to what was encompassed in the
signs and symptoms of IBD. specific wording of the search. Specific types of exercise that did
not use the general terms of exercise or physical activity in the title
Exercise training has many beneficial effects, including a were not included. For instance, yoga and other excluded exercises
reduction in markers of systemic inflammation. This trend is seen could provide a larger number of articles included in the study,
for both healthy and unhealthy individuals as a reduction in risk of which would result in a more inclusive meta-analysis. Future studies
mortality, chronic disease, and premature death [22]. However, the could use more descriptive search terms and inclusion criteria to
overall effect on individuals diagnosed with IBD remains unclear. obtain more data such as specific types of exercise which could
The current meta-analysis demonstrates that exercise does not include yoga or high intensity interval training (HIIT). Along with
decrease the signs and symptoms of inflammatory bowel disease. descriptive search terms affecting types of exercise and intensity,
the wide variance of intensities from walking to HIIT made it
With 95% confident intervals of the questionnaire data [–0.66, difficult to compare studies. Not only does exercise intervention
0.70], and biomarker data [-1.60, 0.64], the hypothesis that and intensity have possible effects on IBD, but diet and stress
exercise reduces inflammation and signs & symptoms of IBD is influence symptoms of IBD. Patients are often referred to different
not supported. The null hypothesis that exercise does not affect diets such as a low FODMAP diet to improve symptoms along
inflammation or signs and symptoms of IBD is accepted with no with traditional medical intervention [24]. Another limitation in
change in IBD activity between control and intervention groups the studies reviewed was the lack of control in participants' diets
within the meta-analysis. during exercise intervention, thereby confounding interpretation
of any independent exercise effect. Similar to diet, stress also has a
Given the literature suggests that acute bouts exercise increases profound impact on disease activity. The reviewed studies did not
inflammatory markers. The thought that exercise exacerbates control for stress levels which could further confound any possible
inflammation, or signs and symptoms of IBD is also not supported. exercise effect on IBD.
An exacerbation or flare-up could be due to various factors such as
stress and diet. IBD patients that report “feeling better” following The analyzed studies grouped participants into disease state levels
exercise training could be contributed to psychosocial or quality based on biomarker activity, these groupings include remission,
of life improvements, independent of potential physiological active state, mild state IBD, or no history of IBD. The grouping of
improvements that were not characterized in this review. Both patients differed between studies as some had less specific, wider
increases and decreases in disease state may be due to other factors range categories such as grouping all diseased subjects and non-
not analyzed by the studies reviewed. Therefore, since current diseased subjects whereas some studies had specific and narrow
results suggest that there is no improvement of signs and symptoms categories with defined parameters. The most common disease
of IBD and that exercise does not exacerbate IBD demonstrated states in the analyzed 7 articles are remission or mildly active IBD.
by acceptance of the null hypothesis, providers working with Future studies could investigate exercise effects across similar IBD
IBD patients should encourage exercise in conjunction with the grouping/categories. Exercise effects may exist in only certain
Food Sci Nutr Res, 2022 Volume 5 | Issue 1 | 6 of 8
disease states however this cannot be determined given the lack of Reported Limitations in Patients with Inflammatory Bowel
consistency across the extant literature. Disease. Digestive Diseases and Sciences. 2016; 61: 215-220.
8. Glass GV. Primary, Secondary, and Meta-Analysis of
Various intervention lengths for each study were also used, which Research. Educational Researcher. 1976; 5: 3-8.
may have influenced biomarker and questionnaire results. Out of
9. Vavricka SR, Schoepfer A, Scharl M, et al. Extraintestinal
the 7 studies analyzed the interventions ranged from 4 days to 6
months. The biomarker and questionnaire results may have had a Manifestations of Inflammatory Bowel Disease. Inflammatory
significant change due to the varied intervention lengths. Adherence Bowel Diseases. 2015; 21: 1982-1992.
to exercise is another limitation as at-home programs relied on 10. Brown WMC, Davison GW, McClean CM, et al. A Systematic
self-reporting of adherence which is notoriously unreliable. With Review of the Acute Effects of Exercise on Immune and
methodological differences between studies there were varied Inflammatory Indices in Untrained Adults. Sports Medicine.
participant sizes and subsequently, effect sizes from each study. 2015; 1: 35.
Six out of the 7 studies analyzed had under 40 participants whereas 11. Simmons R, Doma K, Sinclair W, et al. Acute Effects of
1 of the studies had close to 2,000 participants. Another significant Training Loads on Muscle Damage Markers and Performance
limitation that cannot be excluded is participant withdrawals due in Semi-elite and Elite Athletes: A Systematic Review and
to an IBD flare up. It is unethical to make a subject complete a Meta-analysis. Sports Medicine. 2021; 51: 2181-2207.
study. With these withdrawals, data on exercise and IBD flareups
is lost. This may eliminate exercise data with poor outcomes. No 12. Beavers KM, Brinkley TE, Nicklas BJ. Effect of Exercise
animal studies were included in this study. Animal studies are Training on Chronic Inflammation. Clinica Chimica Acta.
generally very well controlled and could offer further insight into 2010; 411: 785-793.
exercise effects on IBD. Many mice and rat studies were reviewed 13. Woods JA, Wilund KR, Martin SA, et al. Exercise,
in the initial search but had to be excluded as they did not meet the Inflammation, and Aging. Aging and Disease. 2012; 3: 130-
inclusion criteria. 140.
14. Rose GL, Skinner TL, Mielke GI, et al. The Effect of Exercise
Conclusion Intensity on Chronic Inflammation: A Systematic Review and
This meta-analysis examined the effects of exercise training on Meta-Analysis. Journal of Science and Medicine in Sport.
inflammatory markers, and signs & symptoms of patients with 2021; 24: 345-351.
Inflammatory Bowel Disease. The included studies demonstrated
15. Hammonds TL, Gathright EC, Goldstein CM, et al. Effects
that exercise training does not improve inflammation or the signs
& symptoms of IBD. Exercise is a safe engagement for IBD of Exercise on C-Reactive Protein in Healthy Patients and in
patients without risk of exacerbation of symptoms. Patients with Heart Disease: A Meta-Analysis. Heart & Lung.
2016; 45: 273-282.
Acknowledgements 16. Albert MA, Glynn RJ, Ridker PM. Effect of Physical Activity
The research team would like to thank and acknowledge Dr. David on Serum C-Reactive Protein. The American Journal of
B. Wilson, Professor, Criminology, Law and Society at George Cardiology. 2004; 93: 221-225.
Mason University for assistance throughout this study. 17. Flynn MG, McFarlin BK, Markofski MM. The Anti-
Inflammatory Actions of Exercise Training. American Journal
References of Lifestyle Medicine. 2007; 1: 220-235.
1. Inflammatory Bowel Disease (IBD)-Symptoms and causes. 18. McFarlin BK, Flynn MG, Campbell WW. Physical Activity
Mayo Clinic. Status, But Not Age, Influences Inflammatory Biomarkers
2. Inflammatory Bowel Disease (IBD)- Data and Statistics. and Toll-Like Receptor 4. The Journals of Gerontology Series
Centers for Disease Control and Prevention. A: Biological Sciences and Medical Sciences. 2006; 61: 388-
3. Vermeire S, Van Assche G, Rutgeerts P. Laboratory markers in 393.
IBD: Useful, Magic, or Unnecessary Toys. Gut. 2016; 55: 426-431. 19. Solem CA, Loftus EV, Tremaine WJ, et al. Correlation of
4. Vermeire S, Van Assche G, Rutgeerts P. C-Reactive Protein C-reactive protein with clinical, endoscopic, histologic,
as a Marker for Inflammatory Bowel Disease. Inflammatory and radiographic activity in inflammatory bowel disease.
Bowel Diseases. 2004; 10: 661-665. Inflammatory Bowel Diseases. 2005; 11: 707-712.
5. Khaki-Khatibi F, Qujeq D, Kashifard M, et al. Calprotectin 20. Kasapis C, Thompson PD. The Effects of Physical Activity
in Inflammatory Bowel Disease. Clinica Chimica Acta; on Serum C-Reactive Protein and Inflammatory Markers.
International Journal of Clinical Chemistry. 2020; 510: 556-565. Journal of the American College of Cardiology. 2005; 45:
6. Kozuch PL, Hanauer SB. Treatment of Inflammatory Bowel 1563-1569.
Disease: A Review of Medical Therapy. World Journal of 21. Pathirana WGW, Chubb SP, Gillett MJ, et al. Faecal
Gastroenterology. 2008; 14: 354-377. Calprotectin. The Clinical Biochemist Reviews. 2018; 39: 77-
7. DeFilippis EM, Tabani S, Warren RU, et al. Exercise and Self- 90.
Food Sci Nutr Res, 2022 Volume 5 | Issue 1 | 7 of 8
22. Mora JC, Valencia WM. Exercise and Older Adults. Clinics 24. Popa SL, Pop C, Dumitrascu DL. Diet Advice for Crohn's
in Geriatric Medicine. 2018; 34: 145-162. Disease: FODMAP and Beyond. Nutrients. 2020; 12: 3751.
23. Hassid B MD, Lamere B MPH, Kattah M MD, et al. Effect
of Intense Exercise on Inflammatory Bowel Disease Activity.
American Journal of Gastroenterology. 2016; 111: 312-328.

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