Crohn disease and ulcerative colitis are two types of inflammatory conditions of the bowel. Crohn disease affects segments of the intestinal tract, characterized by exacerbations and remissions. Ulcerative colitis can affect the entire colon, which produces ongoing problems with diarrhea and bleeding. Both conditions have genetic and immunologic causes, with most occurrences in young adults. Individuals with these conditions may have limited endurance due to ongoing problems with fatigue and malnutrition. Abdominal and joint pain may also limit an individual's ability to participate in regular exercise programs.1,2 The effects of exercise on the IBD process has not been clearly determined.
Comorbidities to Consider
These conditions are associated with osteoporosis, arthralgias, and inflammatory conditions, but they are not characterized by a specific form of arthritis.
Keys to Examination of Clients
Recommended Baseline Testing of Fitness Levels
Tests of aerobic fitness using walking or stationary bicycling are the most appropriate methods for assessment.2
Resistive strength testing may also be performed if the client chooses to incorporate resistive exercises in the exercise program.
Assess for spinal and extremity ranges of motion and muscle length tests for the client with a history of arthralgias or ankylosing spondylitis.
Type: Walking, cycling, weight training1,3
Intensity: Start at low intensities or self-paced walking
Frequency: Three times per week
Clients with IBD experience periods of exacerbations that will preclude or limit their participation in an exercise program. During exacerbations, clients may need intermittent rest during the day to conserve energy and decrease bowel motility.1 Clients with IBD may be at risk for overexertion if they overestimate their work capacities.3 Clients can add other aerobic and resistive exercises as they progress their program. Resistive exercise, especially for the lower extremities, consisting of squatting, stepping, and lunging exercises are useful for improving tolerance to daily activities.4 Individuals with IBD should be encouraged to participate in low-intensity recreational activities and to increase their exercise durations and frequencies while maintaining low to moderate intensities with aerobic and resistive exercise. Clients who have undergone moderate to extensive resection of the colon will be restricted from any high-intensity exercises.5
RN. Exercise and inflammatory bowel disease. Can J Gastroenterol 22(5):497–504, 2008.
C. Exercise and Crohn's disease: Speculations on potential benefits. Can J Gastroenterol 20(10):657–660, 2006.