The Effects of Exercise upon Symptoms and Quality of Life in Patients Diagnosed with Irritable Bowel Syndrome: A Randomised Controlled Trial

A. J. Daley; C. Grimmett; L. Roberts; S. Wilson; M. Fatek; A. Roalfe; S. Singh

doi:10.1055/s-2008-1038600

International Journal of Sports Medicine, Table of Contents

Int J Sports Med 2008; 29(9): 778-782
DOI: 10.1055/s-2008-1038600

Behavioural Sciences

The Effects of Exercise upon Symptoms and Quality of Life in Patients Diagnosed with Irritable Bowel Syndrome: A Randomised Controlled Trial

A. J. Daley¹ , C. Grimmett² , L. Roberts¹ , S. Wilson¹ , M. Fatek³ , A. Roalfe¹ , S. Singh⁴

¹Primary Care and General Practice, University of Birmingham, Birmingham, United Kingdom
²Health Behaviour Unit, University College London, London, United Kingdom
³Warneford Hospital, City Central CMHT, Oxford, United Kingdom
⁴Good Hope Hospital, Good Hope Hospital, Sutton Coldfield, United Kingdom

Abstract

While it seems intuitively appealing to promote participation in regular exercise in the management of irritable bowel syndrome, limited randomised controlled trial evidence exists to support this recommendation. We examined the feasibility and effects of an exercise intervention upon quality of life and irritable bowel symptoms using a randomised controlled trial methodology. Patients with a clinically confirmed diagnosis of irritable bowel syndrome according to Rome II criteria were randomised to either an exercise consultation intervention or usual care for 12 weeks. Outcomes included irritable bowel specific quality of life, symptoms (total symptoms, constipation, diarrhoea and pain) and exercise participation. The recruitment rate of eligible patients identified from hospital records was 18.3 % (56/305). Analyses revealed no differences in quality life scores between groups at 12-week follow-up. The exercise group reported significantly improved symptoms of constipation (mean difference = 10.9, 95 % CI = − 20.1, − 1.6) compared to usual care at follow-up. The intervention group participated in significantly more exercise than usual care at follow-up (mean difference = 21.6, 95 % CI = 9.4, 33.8). Recruitment of eligible patients into this study was possible but rates were low. Findings highlight the possibility that exercise may be an effective intervention for symptom management in patients with irritable bowel syndrome; this may be particularly the case for constipation predominant patients.

Key words

exercise - quality of life - IBS - constipation - diarrhoea

Full Text

References

1 Cohen S, Kamarck T, Mermelsstein R A. A global measure of perceived stress. J Health Social Behav. 1983; 24 386-396
2 Colwell L J, Prather C M, Phillips S F, Zinsmeister A R. Effects of an irritable bowel syndrome educational class on health-promoting behaviours and symptoms. Am J Gastroenterol. 1998; 93 901-905
3 Department of Health .At least five a week: Evidence on the impact of physical activity and its relationship to health, 2004. www.dh.gov.uk. Date accessed 11/01/06.
4 Donald I P, Smith R G, Cruikshank J G, Elton P A, Stoddart M E. A study of constipation in the elderly living at home. Gerontology. 1985; 31 112-118
5 Drossman D, Corazziari E, Talley N J, Thompson W G, Whitehead W E. Rome II: The functional gastrointestinal disorders: diagnosis pathophysiology and treatment: a multinational consensus. McLean, VA; Degnon Associates 2000: 351-432
6 Everhart J E, Go V L, Johannes R S, Fitzsimmons S C, Roth H P, White L R. A longitudinal survey of self-reported bowel habits in the United States. Dig Dis Sci. 1989; 34 1153-1162
7 Godin G, Shephard R J. A simple method to assess exercise behaviour in the community. Can J Appl Sports Sci. 1985; 10 141-146
8 Hungin A P, Whorwell P J, Tack J, Mearin F. The prevalence, patterns and impact of irritable bowel syndrome: An international survey of 40 000 subjects. Aliment Pharmacol Ther. 2003; 17 643-650
9 Jones J, Boorman J, Cann P, Forbes A, Gomborone J, Heaton K, Hungin P, Kumar D, Libby G, Spiller R, Read N, Silk D, Whorwell. British Society of Gastroenterology guidelines for the management of the irritable bowel syndrome. Gut. 2000; 47 ii1-iii19
10 Jones R, Lydeard S. Irritable bowel syndrome in the general population. BMJ. 1992; 304 87-90
11 Keeling W F, Harris A, Martin B J. Orocecal transit during mild exercise in women. J Appl Physiol. 1990; 68 1350-1353
12 Kim H S, Park D H, Kim J W, Jee M G, Baik S K, Kwon S O, Lee D K. Effectiveness of walking exercise as a bowel preparation for colonoscopy: A randomised controlled trial. Am J Gastroenterol. 2005; 100 1964-1969
13 Kinnunen O. Study of constipation in a geriatric hospital, day hospital, old people's home and at home. Aging. 1991; 3 161-170
14 Kirk A, Mutrie N, MacIntyre P, Fisher M. Increasing physical activity in people with type 2 diabetes. Diabetes Care. 2003; 26 1186-1192
15 Klauser A G, Peyerl C, Schindlbeck N E. Nutrition and physical activity in chronic constipation. Eur J Gastroenterol Hepatol. 1992; 4 227-233
16 Koloski N A, Talley N J, Huskic S S, Boyce P M. Predictors of conventional and alternative health care seeking for irritable bowel syndrome and functional dyspepsia. Aliment Pharmacol Ther. 2003; 17 841-851
17 Loudon C P, Correll V, Butcher J, Rawsthorne P, Bernstein C N. The effects of physical exercise on patients with Crohn's disease. Am J Gastroenterol. 1999; 94 697-703
18 Lowther M, Mutrie N, Scott E M. Promoting physical activity in a socially and economically deprived community: a 12-month randomised control trial of a fitness assessment and exercise consultation. J Sports Sci. 2002; 20 577-588
19 Maxton D G, Morris J, Whorwell P. Improving clinical trials in irritable bowel syndrome: Some practical aspects. Eur J Gastroenterol Hepatol. 1992; 4 337-341
20 Meshkinpour H, Selod S, Movahedi H, Nami N, James N, Wilson A. Effects of regular exercise in the management of chronic idiopathic constipation. Dig Dis Sci. 1998; 43 2379-2383
21 Oettle G J. Effects of moderate exercise on bowel habit. Gut. 1991; 32 941-944
22 Office of the Deputy Prime Minister (OPDM) .The English Indices of Deprivation 2004: Summary (revised). ODPM, United Kingdom. www.communities.gov.uk/pub/443/Indicesofdeprivation2004summaryrevisedPDF154Kb_id1128443.pdf. Date accessed 15 February 2006.
23 Patrick D L, Drossman D A, Frederick I O, DiCesare J, Puder K L. Quality of life in persons with irritable bowel syndrome: Development of a new measure. Dig Dis Sci. 1998; 43 400-411
24 Peters H P, De Vries W R, Vanberge-Henegouwen G P, Akkermans L M. Potential benefits and hazards of physical activity and exercise on the gastrointestinal tract. Gut. 2001; 48 435-439
25 Roberts L M, Wilson S, Singh S, Roalfe A K, Greenfield S. Gut-directed hypnotherapy for irritable bowel syndrome: piloting a primary care-based randomised controlled trial. B J Gen Pract. 2006; 56 115-121
26 Sullivan S N, Wong C, Heidenheim P. Does running cause gastrointestinal symptoms? A survey of 93 randomly selected runners compared with controls. N Z Med J. 1994; 107 328-331
27 Taylor A H. Physical activity, anxiety and stress. Biddle SJH, Fox K, Boutcher SH Physical Activity and Psychological Well-Being. London; Routledge 2000: 10-45
28 Tuteja A, Talley N, Joos S K, Woehl J V, Hickam D H. Is constipation associated with decreased physical activity in normally active subjects?. Am J Gastroenterol. 2005; 100 124-129
29 Vickers A J, Altman D G. Analysing controlled trials with baseline and follow up measurements. BMJ. 2001; 323 1123-1124
30 Wilson S, Roberts L, Roalfe A, Bridge P, Singh S. Prevalence of irritable bowel syndrome: A community survey. B J Gen Pract. 2004; 54 495-502

Dr. Amanda J. Daley

University of Birmingham
Primary Care and General Practice

Clinical Sciences Building, Edgbaston

B15 2TT Birmingham

United Kingdom

Phone: + 0 12 14 14 37 62

Fax: + 0 12 14 14 37 62

Email: a.daley@bham.ac.uk