Exploring the gut-exercise link: A systematic review of gastrointestinal disorders in physical activity

The relationship between exercise and gastrointestinal (GI) health is complex and bidirectional. While moderate exercise generally promotes gut health by enhancing motility, reducing inflammation, and supporting microbial balance, intense or prolonged physical activity may exacerbate GI symptoms, particularly in individuals with pre-existing digestive disorders. A deeper understanding of this interplay is essential for optimizing both exercise performance and GI well-being.

To synthesize current evidence on exercise-related GI disorders, exploring the prevalence, mechanisms, risk factors, and management strategies associated with exercise-induced GI symptoms.

Following PRISMA guidelines, comprehensive searches of databases, including PubMed, Scopus, Web of Science, and EMBASE were conducted. Studies were included if they focused on exercise-induced GI disorders, encompassed randomized controlled trials, cohort studies, case-control studies, and cross-sectional designs, and addressed symptoms across various exercise modalities. Data were extracted and analyzed to identify patterns and implications for clinical and athletic practice.

A total of 231 studies met the inclusion criteria, highlighting both the benefits and risks of exercise on GI health. Regular moderate-intensity exercise, including activities such as walking, cycling, and yoga has been associated with improved GI function in conditions like gastroesophageal reflux disease, irritable bowel syndrome, inflammatory bowel disease, and constipation. These benefits are attributed to enhanced intestinal motility, reduced systemic inflammation, and improved gut barrier integrity. Additionally, exercise plays a role in regulating the gut-brain axis, with practices like yoga and Tai Chi demonstrating particular effectiveness in alleviating functional GI disorders. Conversely, high-intensity or prolonged exercise may contribute to symptoms such as nausea, diarrhea, and abdominal pain due to mechanisms like splanchnic hypoperfusion and increased intestinal permeability. Individual factors, including fitness level, dietary habits, hydration status, and underlying GI conditions, significantly influence the body's response to exercise.

Moderate-intensity exercise is a beneficial and well-tolerated intervention for promoting GI health, whereas high-intensity activities require careful monitoring, particularly in individuals with pre-existing GI disorders. Personalized exercise and dietary strategies are essential for balancing the benefits of physical activity with the risk of GI distress. Further research is needed to explore the long-term effects of exercise on gut microbiota composition and overall digestive health.