Crohn’s Disease And Physical Activity

What is Crohn’s disease?

Crohn's disease is a type of auto-immune irritable bowel disease that causes the immune system to attack the  healthy tissue of the digestive tract. Unlike some types of irritable bowel disease, it is a lifelong condition that causes inflammation of the bowel and can affect any part of the gastrointestinal (GI) tract. However,  it is most  commonly found in the colon and small intestine. It can have chronic long-lasting episodes of inflammation portrayed as  redness, painful swelling and sores along the digestive tract. The inflammation can interfere with the digestive system's ability to absorb nutrients and egest waste.  When inflammation is present this is called a ´flare up´ or described as the disease being ‘active´ and when he inflammation is less pronounced or absent, this is known as ´remission´.

Symptoms

As Crohn´s disease affects the functioning of the digestive tract, many of the signs and symptoms of the disease are related to this.  For example, people  with the disease may suffer acute abdominal pain as one of the main symptoms along with signs  relating to the poor absorption of nutrients.   

Figure: Symptoms of Crohn’s Disease

Created by Aastha Malik

Signs your doctor can observe and diagnose may include: 

• Iron deficiency (anaemia) 
• Osteoporosis  
• Kidney stones 
• Malnutrition

Should you exercise with Crohn’s disease?

In general yes, UNLESS one is in the middle of a flare-up and suffering from acute onset of symptoms. 

Exercise is beneficial to individuals who have Crohn’s disease. Although, during a ‘flare up’, exercise may be too difficult due to fatigue and other symptoms of the disease.  However, exercise during remission periods can contribute to maintaining control of thecondition . Studies carried out on animals, demonstrate that stress can cause an immune response, increasing  inflammation in the digestive tract. 

Exercise can help to relieve stress and anxiety, potentially aid in  keeping Crohn’s in remission. Keeping active, can help improve one’s  overall health and physical fitness.  This can help in  combating  the effects of frequent periods of inactivity  brought about by  Crohn’s symptoms.

What kind of exercise is best?

According to the Canadian Journal of Gastroenterology¹ low intensity exercise can benefit individual’s with crohn’s disease.  Low intensity exercise include activities like walking, swimming, yoga and cycling and jogging at a light and steady pace.  The problem with high intensity exercise, where exercise is more vigorous,is that it may actually exacerbate an individual’s Crohn’s symptoms and make them want to defecate. It is suggested that this might be because it causes the gastrointestinal tract to have an immune response and decrease in pressure waves so there is less resistance to colonic flow and the amount of time it takes for waste to transit. 

This means that symptoms may increase for some individuals when doing high intensity exercise such as HIIT (high intensity interval training), so it may be better to replace this with resistance training (using weights or resistance) or impact training such as doing squats or jumps. Low intensity exercise has not been shown to exacerbate symptoms so the individual gets all the benefits of exercise, without the symptoms.  These benefits can include improved circulation and heart health, increased bone density (which can be reduced in individuals with Crohn’s), and can reduce stress and have general positive psychological and immune effects.

What to watch out for?

When an individual is experiencing a flare up of Crohn’s, it might be better to avoid exercise until symptoms improve and inflammation is reduced. It is unlikely that exercise will be appealing to them anyway, as they may feel fatigued and symptoms may limit activity. Each person will experience Crohn’s differently so need to determine when exercise can help and when they might need to rest instead. When doing exercise some symptoms should be taken seriously such as dizziness, abdominal pain or diarrhea and exercise should be ceased immediately.   

When to contact a doctor?

An individual with Crohn’s disease should always consult their doctor before starting on any new exercise programmes if they are concerned that it may exacerbate symptoms in any way. If they experience serious symptoms such as abdominal pain and it gets worse, or the pain spreads to the chest then it is important to contact a GP.

Conclusion

Exercise is generally more likely to have positive effects on the quality of life of an individual with Crohn’s disease. It can have many benefits for different parts of the body and its systems. There is some evidence² that regular low intensity exercise can decrease the risk of future flare-ups.