Exercising Safely with Inflammatory Bowel Disease

Regular exercise can be of tremendous benefit in helping manage symptoms and improve the quality of life for those living with Inflammatory Bowel Disease (IBD). Many people avoid exercising as it is sometimes difficult to find the motivation and energy to be active when you are not feeling well. This is understandable given the day-to-day changes in symptoms and energy levels that come with managing IBD. 

Exercise is any movement that makes your muscles work and requires your body to burn calories. Exercise affects every major body system and organ within the body, including the cardiovascular, pulmonary, muscular,  integumentary, and immune systems. The body’s response to exercise varies greatly depending on factors related to your health and the specific exercise being performed.

It can be confusing to know how to exercise safely to maximize its benefits without going too far to induce a flare-up of symptoms. Below are some tips and ideas to help you get started on an exercise routine and to help determine the best activity type and level for your body.  

 Best Types of Exercises for Those with IBD 

Walking, cycling, swimming, and/or water exercise classes, yoga, pilates, and lightweight resistance training are great low-impact activities that are easier on your joints. Even activities such as dancing can be a great way to get in some cardio exercise and move your body.  These low-impact activities move each joint through the available range of motion and should be pain-free. This gentle movement helps to lubricate the joint surface, prevent stiffness, and encourage deep breathing which can be helpful for pain management.  

Where to Begin?

Cardiovascular, flexibility, and strengthening exercises are all very important for maintaining the optimal functioning of our bodies. If you have been fairly inactive, start slowly with some walking and light stretching. Slowly build up to doing some light strength training as your body can tolerate. The goal is to be able to incorporate all three of these types of exercise into your routine several times a week. Here are some simple tips to incorporate these exercises into your daily exercise regime.  

Yoga / Flexibility Exercises  

If you have been fairly inactive due to your symptoms, yoga and flexibility exercises are a great starting point. Yoga is relatively low impact but can also increase muscle strength and stamina. Yoga incorporates gentle whole-body stretches. Many stretches can be done lying down on your bed if it is difficult to get to floor level. You can also consider chair yoga in a seated position. The internet is a great place to find some simple videos of yoga instruction for beginners. Just start slow and ease into the stretches to see how your body responds.

‍Walking 

Walking is also a good starting point because it is a great cardio exercise, but not intense enough to stimulate stress hormones, so it is less likely to cause an exercise-induced flare-up of symptoms. Begin by walking for 5 minutes on level surfaces at a pace that is comfortable for you. Gradually increase the speed until you are walking briskly and you feel your heart rate rise a bit. Aim to reach a pace where you are breathing harder than normal, but you can still carry on a conversation. Keep a log of how many minutes you can keep up this pace. Bring your pace back down for a cool down to let your heart rate decrease back to the resting rate. Each week, add 2-3 minutes to your walking time until you can maintain that pace for 30-45 minutes for 4-5 days a week. If you can tolerate this walking program for 8-10 weeks without a worsening of symptoms, you can progress your walking further by walking on a slight incline or by continuing to increase your speed.  

Strength Training  

Working with weights or resistance bands has many benefits for our body to help us live a longer and healthier life. It improves muscle health which causes lasting improvements in our functional capacity and reduction of inflammation. Activating your muscles by doing light strengthening can also relieve pressure on joints leading to a reduction in knee, hip, shoulder, and back pain. 

Start slow with lighter weights and higher repetitions when you are introducing weights. Slowly work your way up to help minimize stress on your joints. Start with doing 2-3 sets of 10 or 12 reps at a very comfortable low weight. Over time when it starts to feel easier, increase the weight by 1-2 lbs. The last few repetitions of a set should feel slightly challenging but you should still be able to maintain correct posture without compensating by using poor body mechanics.  

Strength training can also be done without any equipment. Many great body weight-resisted exercises can be challenging enough to help improve muscle and core strength. Squats, lunges, push-ups, and planks are examples of great strengthening exercises that can be done anywhere and don’t require any equipment.  When it comes to strength training, if you are unsure of where to start or what exercises to do, I would recommend consulting with a Physical Therapist. They will be able to assess your areas of weakness and give you some personalized tips on the best starting point to ensure you are using the correct form to decrease the risk of injury.  

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Tips to Incorporate Exercise as Part of Your Daily Routine

1. ‍Find an enjoyable activity.  Exercising should be a positive experience which will enhance the health benefits. Find an exercise partner with similar goals who can go walking with you and support you on your health journey. Consider a small group class for added socialization which could help with exercise motivation.  Seek out some fun low-impact classes at a local center that you can do at your own pace. Even dancing counts as cardio exercise and can help improve your stamina and balance.  
2. Go at your own pace. Exercise does not need to be all or nothing. If your goal is 30 minutes of walking a day, it is ok to break that time up into smaller chunks of time so it can be less intimidating. Aim for 10 minutes of walking, 3 times a day if that is more manageable.  Being consistent is more important than the duration or intensity. ‍
3. Listen to your body. It is important to pay attention to your body’s changing needs and tolerance levels to exercise. If you are feeling run-down and finding it hard to get out of bed, it is okay to keep your activity level to a minimum. Consider some simple stretching on those days.  If you are extremely sore or in pain after a workout, reduce the amount of weight or intensity until you find a comfortable balance.‍
4. Plan ahead. Certain medications can impact your ability to exercise so make sure to discuss with your doctor if there is a better time of day to time your exercise based on your medication routine. If you are concerned about needing to use a restroom frequently during your workout,  plan to walk a pre-planned route where you know where restrooms are located. Or stick to walking around your block so you are never too far from home. 
5. Capitalize on the days when you are feeling good.  Use your better days to challenge yourself a bit more than normal. Add in an extra few minutes of a particular exercise or aim to do a few additional repetitions of a strengthening exercise.  Those in remission can safely perform moderate-intensity exercises, so take advantage of these times to increase your goals or try a new activity. Improvements you make during these times will help you keep up your strength during a flare-up. 
6. ‍Hydrate. Part of a healthy lifestyle that includes exercise is to ensure your body is getting adequate nutrition, especially hydration. Frequent diarrhea in IBD can cause a person to become dehydrated more easily so it is important to stay well hydrated throughout the day, and especially during exercise.  ‍
7. Keep a journal of your daily activities. Keep track of the length and type of exercise you did and how you felt. You may start to see some patterns emerge to help you figure out when you feel the best and have the most energy. This will help guide you to determine what exercises are best or when you may have done too much.  

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Exercising During a Flare

It is ok to continue exercising during periods of increased symptom flare-ups, however, you may want to decrease the intensity and focus on low-impact activities like walking and yoga. You shouldn’t try to do your usual workout and push through the fatigue and weakness. Listen to your body and rest when it is telling you it needs it. Discuss with your doctor about any new or exacerbated symptoms you’re experiencing to rule out a flare. You may want to incorporate more rest days in between workouts to allow your body to recover. Whether your flare was a few days, weeks, or months, it is important to slowly return to your normal workout routine and not jump right back into a higher intensity.

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Exercising Post-Surgery

Those recovering from surgery should always consult with their healthcare team to ensure a safe return to normal activity levels. You may have activity limitations or lifting restrictions for some time following surgery.   Once you get clearance from your doctor,  it is important to go slow when returning to an exercise program following abdominal surgery. Walking will be the best starting point as it is low impact and low intensity. Slowly build up the abdominal muscles focusing on gentle exercises where your spine maintains a neutral position.  Sit-ups or crunches can be uncomfortable and may put too much strain on your belly area. Always consult with your doctor if you wish to resume weight lifting or any sports participation to ensure a safe return.

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Starting a regular exercise program can be hard, especially when you are dealing with a chronic, unpredictable condition  Remember that improving your health and functioning through exercise should be considered a marathon, not a sprint. Make sure to take the time to figure out what exercise and what intensity is best for you, set realistic goals for yourself, and always celebrate your progress. 

Liz Hoobchaak, PT, DPT, CNPT, CAHNS, is a Physical Therapist, specializing in orthopedics and sports medicine, and an Integrative Autoimmune Nutrition Therapist focusing on Inflammatory Bowel Disease. Liz works with individuals with various autoimmune conditions by helping them manage chronic symptoms through proper nutrition and lifestyle changes.