Sports in IBD

My dear patients !

“Are you doing sports ?”

That is a question which you might be confronted with in my consultation hour. 

Sports, exercise, physical activity … that are in a way special issues.  Some patients consider it an important thing, others don´t. Some patients simply like it, others don`t. And maybe a lot of colleagues would not even bother  to ask their patients about it or even encourage them to it, if not demand it. 

And they would not even bother to say something like: “You should though!” when the answer to the question “Are you doing sports ?” is “no.”

I myself sometimes am not sure wether I am offending patients in a way by asking, even though I know how important physical activity and sports are. As if I went  too far in a way and would try to influence the patients privat life. Which anyone should live as they whish to.

Thinking about it it becomes clear that health is indeed a private issue. Yet the patients with inflammatory bowel disease, Crohn`s disease and ulcerative colitis are coming to my consultation hour to hear what I recommend in order to improve their situation and gain more health.   

And that`s why I started to talk about sports, especially with my young IBD patients. 

Maybe not even all of the doctors know: sports in IBD (inflammatory bowel disease, Crohn`sdisease and ulcerative colitis) – should I recommend it ?  Should patients do it ? Is it changing the IBD to better or worse ? Does it have positive or negative effects ?

Even though they could know. There has been research on that. 

[…]

I am honest. Where the […] are  I first started out differently.  I almost had started – way  more detailed than I am actually still doing it now – with all the limitations and relativizations. Which of course exist for this issue as well. 

Starting with:”The issue of physical activity and sports is hard to investigate…”

to: “it is not the same for every patient…”

to “…of course you as a patient with inflammatory bowel disease have other limitations when it comes to physical activity, exercise and sports than other patients”.

Which is true in an way.

And also the statement” On behalf of the effects of physical activity and sports  in IBD exist different research results” – is correct. 

But I rather want to write what encourages and motivates you to take action. And  set the right course towards more health with your inflammatory bowel disease.

That`s what physical acitivity and sports work perfectly well for.

sports in general and in particular...

In general: physical activity, exercise, sports have a positive effect – on everyone. We all know that. And when I talk to people (and I am not just reffering to my consultation hour now) whoever does sports recognizes it. 

People who are physically active, who are doing sports generally  have less infections. Physical activity and sports meanwhile are accepted as preventive for malignant diseases. And people who do sports are just in “better shape”. That has a lot of aspects, from “beeing a good mood” (simple as that), to a better resistance to stress to the fact, that the feeling for the own body improves, which improves the  body posture, which again improves … radiance and maybe even self-esteem.  

Phrases like”mens sana in corpore sano” or the slogan “sound mind sound body” relate not just to health as it comes or not, as one has it or not. It directly relates to a situation where you take action for your own health wether it`s physical or mental. 

And the general speaking is also of relevance for you as a patient with inflammatory bowel disease, Crohn`s disease or ulcerative colitis. To be  quite honest, in my consultaion hour I make the long story short. When patients ask:”can I do sports ?”—“do I have something special to consider ?”…”What should I avoid ?”, the answer is “Do it ! Because when you are doing sports already you know your body. Be alert, don`t be  overcautious, listen to your body, but sports and exercising are good for you!”

What you as a patient with inflammatory bowel disease should know and what you should be aware of is: physical activity, exercise, sports have a direct effect on inflammatory processes in your body. 

And I wrote here on this blog before: inflammation is the issue of inflammatory bowel disease, Crohn`s disease and ulcerative colitis 

People who practice physical exrercise or sports show a lower level of  inflammatory mediators in the blood.

That is just a sentence, but try to understand it and make it cristal clear what it means for you as a patient with inflammatory bowel disease.

And the other way around: when we do exercise, when we are physically active  or do sports there is a relaese of certain molecules from the muscle tissue which have an  antiinflammatory effect. Means: against inflammation. You have to move and even to work up the muscle though to reach the effect mentioned above. In other words: it must hurt a little. A 15 minute window shopping tour with shopping bags on each side won`t do even when you move your muscles doing that as well.  

That`s something I actually  had to learn myself, for a long time I recommended low to moderate intense endurance training like running or fast walking to my patients. But  not just endurance training  also muscle training has a positive effect on inflammatory processes and can have a positive effect on inflammatory bowel disease

... sports especially in IBD !

Now I wrote  some backround information and maybe one or the other of you might think : ” Yes, of course Dr. Weyrauch, physical activity and sports … influence on inflammation… very interesting. But that`s the theory. In real life in case of  my inflammatory bowel disease, my Crohn`s disease or my ulcerative colitis,  things are maybe a little more complex …”

First: They are not.

Second: there has been research on that: Physical activity and sports can have a direct positive effect on the course of inflammatory bowel disease.

Admittedly there are different research results on  that. And of course: just with physical activity, exercise or sports we won`t  be able to treat your inflammatory bowel disease  And of course we won`t treat a flare by physical activity alone either. 

But we can stabilize your situation, we can stabilize remission, give you a more  positive wellbeeing. That`s something we can do. 

No…. 

That is something you can do. As a matter of fact you are the only one who can do it. 

Because physical activity and sports  will have an effect on your wellbeing and on your quality of life. On your body feeling, your satisfaction, all these things that are so important. 

What else is affected by physical activity and sports in case of inflammatory bowel disease  Crohn`s disaese and ulcerative colitis ?

Fatigue. Some of you might know and even have their own experience with it: in case of inflammatory bowel disease some patients feel lethargy, which makes life not easier for sure.

We don`t actually know where this fatigue symptomatic comes from. But there seems to be evidence that fatigue syndrome is at leats partially mediated by cytokines. And cytokines are nothing but mediators for inflammation. And we know fatigue can improve by physical acivity.

And Osteoporosis as well. I already wrote about it in the article on vitamin d. Patients with Crohn`s disaese and ulcerative colitis are endangered  for it. And what helps against osteoporosis is – you have guessed it already –  physical activity and sports

And to whom of you ( I think there are not many) who still think: yes, but…!

And I wrote that before: one of the most frequent sentences to inflammatory bowel disease is:

“The inflammatory bowel disaeses, Crohn`s disease and ulcerative colitis show an increasing number in the western countries or countries with western lifestyle.”

Western lifestyle is inactive lifestyle. A lack of physical activity is a parameter for western lifestyle.

... but how to start and how to do it ?

Ok, very good, you might think,. But…how ?!

What exactly is considered physical activity or exercise ? What should I do ?

I always tell my patients who do no exercise or sports at all:

Start with 30 minutes per day.”

And quite simple: 30 minutes every day straight walking. Conscious and planned, possibly on a certain point in time, for example right away in the morning to start your day or right after you come home. 

Not just any time in between thinking: I will go for a wolk and I will see how far I can get. Reserve extra time for physical activity, exercisesports. 

When you walk 30 minutes, breathing deeply, having a steady elevated heart rate whithout run out of breath it is a good start for “activity beginners”

How often ? Every day. At least !!) 4 times a week.

But actually every day.  

30 minutes every day. When you think about what you do in 30 minutes, for example when you come home in the evening. 30 minutes … you are  putting stuff around in your apartement, looking at your phone, switching on the TV, opening and closing the refridgerator twice – 30 minutes are over. 

Or – in case you have appointments in the afternoon or evening – start in the morning right away. 30 minutes less of sleep won`t make you too tired to manage your day. Quite the opposite – when you use the extra time for you, your wellbenig by moving your body.

And once you have started regular exercise, you will recognize the positive effect and be happy to develop your exercise.

30 minutes are my proposal, in literature or resaerch articles on that issue 20-60 minutes 5 x /  week are claimed. So don`t start below 20 minutes and don`t start under 4-5 x / Week. 

Muscle training is necessary twice a week to have the effect described above.

There are apps for exercise and trainings sessions with your own body weight. Small dumbbells do not cost that much. 

So when you make the decision to start physical activity and make it part of your life you can start right away. 

exercise as part of the therapy

For the “non-beginners” in physical activity and sports: when you do sports you know your body. You know how light exercise feels and how moderate or strong exrecise feels. Everything is ok. Even when you want to train for marathon – go for it. Have a good training program or a good personal trainer, be alert and watchfull. Actually there even has even been research on wether sports like half marathon, marathon or triathlon have an negative effect on IBD – they don`t. But of course you have to raise the level slowly and in a way your body can adapt to it. 

Yet all in all moderate  exercise is recommended.

And last not least: there is no medication  which is a contraindication for exercise. On no package insert it says: don`t be to active, don`t move to much, it might be harmfull. 

All of us, you as a patient and I and my colleagues as doctors should stop considering physical exercise, physical activity and sports as something optional, as a kind of hobby, which you might practice or not. It actually should be considered as part of the therapy.

We realy should change our way of thinking there. 

When we think and talk about the therapy of  inflammatory bowel disease , Crohn`s disease and ulcerative colitis and when we talk about it, we should not just talk about antibody therapy. Wether its apllication is i.v. or s.c. or how high the medication level in the blood is. We may talk about what else is benefitial for the course of disease.  And we as doctors should insist on the patients contributing to that. 

So in that sense: take care everybody. Start moving or stay active.

Best regards

Dr. med. Susanne Weyrauch

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