Exercise and IBD
Having IBD doesn’t limit you from exercising. In fact, regular exercise can help you manage your condition by reducing inflammation, increasing bone density, reducing anxiety, reducing symptoms of depression, improving sleep, and managing stress! Here we’ll cover some exercise basics and address some common concerns that come up when you have IBD.
How much exercise do I need?
All adults should engage in a mix of cardiovascular (e.g., walking, jogging) and resistance training (e.g., lifting weights, push-ups, yoga).
For cardiovascular exercise, aim for 150–300 minutes of moderate exercise each week or 75–100 minutes of vigorous exercise each week. This breaks down into 30–60 minutes, five days a week.
To gauge your intensity level, you can use the talk test. For moderate intensity, you can talk during the activity, but not sing. For vigorous intensity, you can say a few words but will need to pause for a breath for more than that.
For resistance training exercise, aim for muscle-strengthening activities on 2 or more days a week.
Exercising over 300 minutes each week can lead to a further reduction in the risk of cardiovascular disease, type 2 diabetes, and certain cancers.
What counts as cardiovascular (i.e, aerobic) physical activity?
Anything that gets your body moving counts!
Here are some examples of moderate-intensity activities:
- Walking briskly (2.5 miles per hour or faster)
- Swimming (for fun)
- Bicycling slower than 10 miles per hour (no hills)
- Tennis (doubles)
- Active forms of yoga (Vinyasa or power yoga)
- Ballroom or line dancing
- Hiking with a slight elevation gain
- General yard work (weeding, lawn mowing with push mower)
- Exercise classes like water aerobics
- Active video games
Here are some examples of vigorous-intensity activities:
- Jogging or running
- Swimming laps
- Tennis (singles)
- Bicycling faster than 10 miles per hour (or with hills)
- Jumping rope
- Heavy yard work (digging or shoveling)
- Hiking uphill or with a heavy backpack
- High-intensity interval training (HIIT)
- Exercise classes like vigorous step aerobics or kickboxing
You can mix and match activities to find a schedule that works for you!
There are some common concerns that may come up for people with IBD when they are thinking through or implementing their exercise routine.
Experiencing diarrhea while trying to exercise is one of the most common concerns among those with IBD. Even those who don’t have a GI disorder might experience diarrhea with exercise. Often this happens because blood is being redirected from your GI tract to the muscles that are being worked.
Try these tips for reducing this effect:
- Don’t eat right before you plan to exercise. Plan on at least 2 hours before eating and activity to give your system time to digest.
- Avoid caffeine before activity as it’s known to stimulate the digestive system to move more quickly.
- Avoid possible trigger foods for diarrhea like lactose-containing foods or greasy foods.
- Plan your workouts during the time of day you feel that symptoms are usually less (usually in the morning for many people).
- More intense exercise like running is more likely to trigger diarrhea. Stick with activities like walking or yoga if you are feeling more likely to have an increase in symptoms.
- Working out at home so you can quickly reach a bathroom if needed is always an option.
- If walking or running outside, try to plan your route so you have access to public bathrooms (or loop around your neighborhood several times so you can get back to your home quickly).
- Participate in exercise classes that have close bathroom access and excuse yourself if needed.
- Break up physical activity into smaller chunks throughout the day (three 10-minute sessions vs one 30-minute session).
There has been some concern that exercise may increase the risk of IBD flare-ups, but that hasn’t been found to be the case with most exercise. Some more intense and lengthy exercise, like training for triathlons, may cause a temporary increase in inflammation but has not been associated with relapse of IBD.
If you’re in an active flare, you can continue with physical activity by sticking to more restorative activities like walking, yoga, or Pilates. It’s also okay to give yourself permission to rest during this time.
Drinking consistently throughout the day is the key to staying hydrated, especially when you are planning to exercise. Regular fluid needs are somewhere between 2–3 liters (64–100 oz) and will increase if you are experiencing diarrhea and/or sweat heavily during exercising.
Keep a water bottle handy during exercise and sip throughout the activity.
If you are especially prone to dehydration, you can drink fluids that also contain electrolytes. Some good options are:
- Commercial oral rehydrating solutions like Pedialyte®, Dioralyte®, or DripDrop ORS
- Commercial electrolyte blends like Liquid IV® or Nuun Sport
- Coconut water (unsweetened)
- Homemade Oral Rehydrating Solution #1
- 1 liter water (34 oz)
- 1 cup orange juice (237 mL, 8 oz)
- 8 teaspoons sugar
- 1/2 teaspoon baking soda
- 1/2 teaspoon salt
- Combine and stir until well mixed and dissolved
- Homemade Oral Rehydrating Solution #2
- 4 cups water (~1 liter, 32 oz)
- ¾ tsp salt
- 6 tsp sugar
- Combine and stir until well mixed and dissolved
Note: Many sports drinks contain some electrolytes, but they also typically contain a lot of sugar or sugar alcohols that can trigger diarrhea.
Immediately post-surgery, your surgeon or another healthcare provider will let you know when you can expect to resume physical activity and will let you know when you are cleared to do so.
Having had abdominal surgery does not limit you from most activities once you have recovered, even if you have an ostomy! Discuss your personal plan with your doctor and/or a physical therapist for rebuilding strength in weakened muscles. They may also recommend you use ostomy/hernia support belts or other specialized equipment for weightlifting or contact sports.
Limited energy/ Fatigue
While it seems counterintuitive, regular exercise can help you improve your energy levels. This doesn’t mean you have to go for a 5-mile run when your energy is low!
Some tips to try:
- Start with more restorative activities like yoga or Pilates. You might not feel up to a run, but a gentle yoga practice might be more enticing.
- Still “show up” for scheduled exercise. If you planned for a 30-minute walk but don’t feel up to it, try to lace up your walking shoes and aim for 5 minutes. If you really aren’t feeling it, you can head home. Chances are once you have started, you realize you can go a little longer.
- Plan your exercise activity with a buddy. Chatting with a friend might help distract you from that low-energy feeling.
- Listen to audiobooks, music, or podcasts for some distraction if you prefer to go at it alone.
Regular exercise can potentially help reduce chronic pain. Work with a physical therapist if possible, as they will work with you to design a personalized routine to strengthen weaker muscles. Start very slowly, choosing low-impact activities that you can do for 5-10 minutes at a time. Some that may be easier on your body are walking, yoga, or swimming.
Note: Be sure to reach out to your healthcare provider or your Care Team before starting a new exercise routine. They may want you to limit certain activities or give you a specific target heart rate.
If you have other concerns about exercising with IBD or want help getting started, don’t hesitate to reach out to your Care Team for guidance!