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

Table 1 Factors affecting the prevalence of gastrointestinal symptoms in exercise

Category	Factor	Description	Impact on GI symptoms	Examples
Physiological	Exercise intensity	High intensity reduces splanchnic blood flow, increasing GI ischemia and permeability	Nausea, vomiting, diarrhea, cramping, and GI bleeding	HIIT, marathon running
	Exercise duration	Prolonged exertion amplifies GI stress via dehydration and fatigue	Abdominal pain, bloating, and diarrhea	Ultra-marathons, triathlons
	Type of exercise	High-impact activities worsen mechanical GI stress	Increased symptoms in running vs swimming or cycling	Running (high risk), swimming (lower risk)
	Hydration status	Dehydration impairs gastric emptying and reduces perfusion	Nausea, cramps, and diarrhea	Inadequate fluid intake during long events
	Training status	Conditioning alters physiological adaptation to GI stress	Beginners, more bloating; elites, risk ischemic symptoms	Novice runners vs elite athletes
	Age and gender	Hormonal and neurochemical factors may increase symptom sensitivity	Females and younger individuals show higher GI symptom prevalence	Female endurance athletes, adolescent runners
Nutrition and hydration	Hydration status	Dehydration impairs gastric emptying and reduces perfusion	Nausea, cramps, and diarrhea	Inadequate fluid intake during long events
	Pre-exercise meal timing	Consuming meals or drinks close to exercise can lead to GI discomfort due to delayed digestion	Increased risk of bloating, cramping, and nausea	Eating a large meal 30 minutes before exercise
	Supplement use	Protein and carbohydrate supplements can cause GI distress, especially when consumed in large amounts	Diarrhea, bloating, and cramping are associated with supplement overuse	Excessive use of protein powders or carbohydrate gels

GI: Gastrointestinal; HIIT: High-intensity interval training.

Table 2 Summary of studies evaluating the effect of exercise on gastroesophageal reflux disease

Ref.	Type of article	Age of patients	Summary of study characteristics	Outcome
Djärv et al[96]	Population-based survey	40-79 years	Cross-sectional study assessing the association between PA and GERD in 4910 participants. PA frequency was categorized (low, intermediate, high), and analyses stratified by BMI. GERD was defined as heartburn or regurgitation at least once weekly	Intermediate PA decreased GERD risk among obese individuals (OR = 0.41, 95%CI: 0.22-0.77). No significant association found for non-obese individuals
Sodhi et al[97]	Clinical trial	Not specified	25 GERD patients confirmed by 24-hour pH monitoring performed a 30-minute bending exercise regimen. Esophageal reflux was assessed using 24-hour esophageal pH monitoring before and during exercise	Bending exercises significantly increased reflux time during exercise (P = 0.02). Reflux was more pronounced in combined refluxers than upright refluxers
Mendes-Filho et al[98]	Prospective clinical study	Not specified	39 GERD patients (29 with erosive GERD, 10 with non-erosive GERD) underwent ergometric stress testing with 24-hour pH monitoring. Lower esophageal sphincter pressure and BMI were assessed	High-intensity exercise exacerbated reflux in erosive GERD patients. Light or short sessions of PA had no impact on GERD, regardless of BMI
Yu et al[99]	Systematic review/meta-analysis		Meta-analysis of 33 studies with 242850 participants examining the association between PA and GERD risk. PA levels were stratified, and subgroup analyses (age, smoking status) were conducted	PA reduced GERD risk (RR = 0.80, 95%CI: 0.76-0.84). Older adults and smokers benefited the most. 150 minutes/week of PA reduced GERD risk by 72%
El-Serag et al[100]	Cross-sectional study	Mean age: 51.4 years	Examined the relationship between BMI, waist circumference, and GERD using 24-hour pH monitoring in 206 patients. Anthropometric measures and esophageal acid exposure were analyzed	BMI > 30 kg/m2 associated with increased esophageal acid exposure. Waist circumference partially mediated the effect of BMI on GERD risk
Karrfalt[102]	Case report	Not specified	This is a single patient case report describing a novel exercise for strengthening the lower esophageal sphincter. The exercise involves swallowing food while kneeling with the head lower than the stomach	After several months, the exercise eliminated GERD symptoms, with improvements sustained even after discontinuing the exercise regimen

GERD: Gastroesophageal reflux disease; BMI: Body mass index; OR: Odds ratio; CI: Confidence interval; PA: Physical activity; RR: Risk ratio.

Table 3 Summary of studies on physical activity and cancer risk or outcomes

Ref.	Type of article	Age of patients	Summary of study characteristics	Outcome
Xie et al[114]	Meta-analysis		Systematic review/meta-analysis of 47 studies (5797768 participants) examining the relationship between PA and DSC risk using PRISMA guidelines	PA reduced DSC risk (RR = 0.82, 95%CI: 0.79-0.85), with significant effects for colon (RR = 0.81), colorectal (RR = 0.77), and gastric cancer (RR = 0.83)
Boytar et al[115]	Narrative review		Summarized research on exercise-induced gut microbiota changes and implications for CRC, focusing on the microbiota’s tumorigenic or protective effects	Exercise may promote anti-tumorigenic microbiota changes, reducing CRC risk. Mechanisms involve improved gut microbiota and decreased dysbiosis
Gerhardsson et al[116]	Longitudinal cohort study	mean: 47.2 years	14-year follow-up of 16477 Swedish participants examining PA and colon cancer risk. Adjusted for age, gender, domicile, and diet	Low PA increased colon cancer risk (RR = 3.6, 95%CI: 1.3-9.8). Rectal cancer risk not elevated. Mechanism: Prolonged stool transit increases carcinogen exposure
Jurdana[117]	Review		Overview of biological mechanisms linking PA to cancer risk reduction, focusing on inflammatory, hormonal, and immune responses	PA reduces cancer risk by lowering inflammation, insulin resistance, and improving microbiota. Moderate-to-vigorous PA intensity provides greatest protection
Spanoudaki et al[118]	Comprehensive review		Explored molecular mechanisms through which PA reduces cancer risk and improves outcomes, including effects on inflammation, hormones, immune function, and oxidative stress	Exercise reduces systemic inflammation, enhances immune function, and may slow tumor progression. Potential for integration into cancer care practices
Jung et al[121]	Meta-analysis of RCTs	mean: 55.4 years	Systematic review/meta-analysis of 7 RCTs (803 CRC survivors) examining effects of PA interventions on quality of life and fatigue	PA improved quality of life and PA levels. No significant effect on fatigue or BMI among CRC survivors
Koelwyn et al[122]	Review		Reviewed the impact of PA on the inflammation-immune axis and its role in cancer prevention and progression	PA favorably modulates immune components, reducing tumorigenesis. Exercise can serve as an adjunctive cancer treatment
Ciernikova et al[123]	Minireview		Examined the impact of diet and PA on gut microbiota in cancer patients. Discussed personalized interventions for gut health maintenance during treatment	PA may help restore gut homeostasis and enhance cancer therapy efficacy. Integration with diet may optimize treatment outcomes
Campbell et al[124]	Practice guideline		Updated exercise guidelines for cancer survivors. Included recommendations specific to cancer type and outcomes (e.g., anxiety, fatigue, and physical functioning)	Exercise is safe and beneficial for cancer survivors. PA improves fatigue, quality of life, and physical functioning. However, more research is needed for specific protocols

PA: Physical activity; DSC: Digestive-system cancer; RR: Risk ratio; CI: Confidence interval; CRC: Colorectal cancer; RCTs: Randomized controlled trials; BMI: Body mass index.

Table 4 Summary of studies on physical activity and gallbladder health

Ref.	Type of article	Age of patients	Summary of study characteristics	Outcome
Shanmugam et al[128]	Review		Examined PA’s effects on lipid metabolism, gallbladder motor function, bile acids, and gallstone risk. Focused on hepatobiliary-gut axis and metabolic inflammation	PA positively influences lipid metabolism, reduces gallstone risk, and improves gallbladder motility
Ye et al[129]	Narrative review		Reviewed 15 articles on PA and cholelithiasis. Included cohort studies and Mendelian randomization analyses. Highlighted protective effects of PA and knowledge gaps	Regular PA has a protective effect on gallstone formation and is independently associated with lower cholelithiasis risk
Molina-Molina et al[130]	Review		Discussed PA effects on the hepatobiliary-gut axis, including bile acids, gut microbiota, and inflammatory responses. Focused on NAFLD and gallstone disease	PA benefits metabolic disorders like NAFLD and gallstone disease by improving bile acid circulation and reducing inflammation
Franczyk et al[131]	Narrative review		Reviewed aerobic exercise’s impact on HDL levels, lipid profiles, and antioxidant properties. Analyzed PA types, intensities, and durations	Aerobic exercise improves HDL quality and functionality, reduces LDL, and lowers triglycerides, benefiting lipid metabolism
Shephard[132]	Systematic review		Analyzed 67 articles on PA and gallbladder health, including gallstone risk and cancer. Examined acute and chronic PA effects on gallbladder motility	PA reduces gallstone risk and may lower gallbladder cancer risk. Effects on gallbladder motility remain unclear
Bulut and Karabulut[133]	Comparative study	Mean age: 45 years	Investigated effects of breathing exercises on recovery quality, anxiety, and sleep in patients undergoing laparoscopic cholecystectomy	Breathing exercises improved sleep quality, reduced anxiety, and enhanced recovery quality after gallbladder surgery
Misciagna et al[134]	Case-control study	Mean age: 49 years	Population-based study with 100 gallstone cases and 290 controls. Analyzed diet, PA, and gallstone risk using logistic regression	PA is inversely associated with gallstone risk. A diet rich in animal fats and refined sugars increases gallstone formation risk

PA: Physical activity; NAFLD: Non-alcoholic fatty liver disease; HDL: High-density lipoprotein; LDL: Low-density lipoprotein.

Table 5 Summary of studies on physical activity and irritable bowel syndrome

Ref.	Type of article	Age of patients	Summary of study characteristics	Outcome
Nunan et al[137]	Cochrane systematic review	Adults ≥ 18 years	Analyzed 11 RCTs with 622 participants. Compared physical activity (yoga, treadmill, mixed interventions) with usual care or other interventions for IBS symptoms, quality of life, and abdominal pain	Physical activity may improve IBS symptoms but not quality of life or abdominal pain. Evidence certainty is very low due to high risk of bias
Johannesson et al[138]	RCT	Median: 45 years (28-61)	Long-term follow-up (3.8-6.2 years) of 39 patients after physical activity intervention. Assessed IBS symptom severity, quality of life, fatigue, depression, and anxiety	Physical activity reduced IBS symptom severity and improved psychological symptoms over long term
Riezzo et al[140]	RCT	mean: 51.9 ± 7.8 years	12-week moderate-intensity aerobic exercise program in 40 IBS patients. Assessed gastrointestinal symptoms, psychological parameters, and quality of life before and after intervention	Aerobic exercise reduced abdominal pain, bloating, and stress. Improved psychological well-being and quality of life
D’Silva et al[142]	RCT	mean: 45.4 ± 14.0 years	8 weeks of virtual Hatha yoga were compared with an advice-only control group in 79 IBS patients. Assessed IBS symptom severity, quality of life, anxiety, fatigue, and stress	Yoga significantly reduced IBS symptoms and improved quality of life, fatigue, and stress. No significant differences found between groups post-intervention
Kim et al[144]	RCT	Not specified	12-week aerobic exercise program for psychiatric inpatients. Assessed changes in CTT and fitness parameters	Aerobic exercise significantly improved colonic transit time and physical fitness in psychiatric inpatients
Schumann et al[145]	Systematic review	Not specified	Analyzed 6 RCTs (273 patients) comparing yoga with conventional treatment for IBS. Evaluated bowel symptoms, quality of life, anxiety, and mood	Yoga significantly decreased bowel symptoms, IBS severity, and anxiety. Improvements in quality of life were also noted
Radziszewska et al[147]	Narrative review	Not specified	Reviewed effects of nutrition, physical activity, and supplementation on IBS. Discussed the role of aerobic exercise, probiotics, and dietary interventions like low FODMAP diet	Physical activity alleviates IBS symptoms and improves mental well-being. Probiotics and low FODMAP diet offer additional benefits
Naliboff et al[148]	Single-arm intervention study	53 women, 15 men (varied)	Assessed 8-week MBSR program in 68 IBS patients. Evaluated IBS symptoms, quality of life, and anxiety using a mindfulness questionnaire	MBSR improved IBS symptoms, quality of life, and GI-specific anxiety. Present-moment focus and awareness were key to symptom improvement

RCTs: Randomized controlled trials; IBS: Irritable bowel syndrome; CTT: Colonic transit time; FODMAP: Fermentable oligosaccharides, disaccharides, monosaccharides and polyols; MBSR: Mindfulness-based stress reduction; GI: Gastrointestinal.

Table 6 Summary of studies on physical exercise and inflammatory bowel disease

Ref.	Type of article	Summary of study characteristics	Outcome
Bilski et al[149]	Review	Reviewed relationships between exercise and IBD (Crohn’s disease and ulcerative colitis). Examined mesenteric fat’s role, adipokine regulation, and myokine-mediated anti-inflammatory effects	Exercise may protect against IBD onset and reduce inflammation through myokines. Further research needed to establish exercise regimens for IBD management
Khalili et al[150]	Prospective cohort study	Evaluated long term effect of exercise on the risk of developing IBD in 194711 women for 5 years	Physical activity was inversely associated with risk of Crohn’s disease but not of ulcerative colitis
Wang et al[151]	Meta-analysis of 7 studies	Examined the association between physical activity and IBD	High physical activity was associated with a significantly lower Crohn’s disease risk in Europeans only. No significant association between physical activity and the risk of ulcerative colitis
Engels et al[152]	Review	Examined benefits, barriers, and safety of exercise in IBD. Focused on immune response, bone mineral density, fatigue, and quality of life improvements in patients with mild-to-moderate IBD	Exercise is safe and may improve IBD symptoms, fatigue, and quality of life. Evidence on specific exercise recommendations remains limited
Holik et al[153]	Cross-sectional study	Studied the effect of daily physical activity on the activity of IBDs in therapy-free adult patients	Daily physical activity was associated with more IBDs remission persistence in patients not taking therapy
Legeret et al[154]	Case control study	Studied the effects of a single bout and chronic moderate-intensity exercise on IBD-related inflammatory markers and exercise capacity among children with IBD and healthy controls	While a single bout of exercise increases albumin, RBCs, and WBCs, long-term moderate-intensity exercise reduces inflammatory markers (ESR, CRP and thrombocytes) in children with IBD
Narula and Fedorak[155]	Review	Discussed potential of exercise to counter IBD-related complications (e.g., bone loss, psychological distress, and immune dysregulation). Identified gaps in consistent evidence for protective effects	Exercise improves psychological health, bone density, and stress management but must be tailored to patient-specific limitations and disease activity
Ordille and Phadtare[156]	Review	Analyzed intensity-specific exercise effects on IBD outcomes, including inflammation, immune modulation, and microbiome changes. Addressed safety of high-intensity exercise for IBD patients	Low-to-moderate exercise benefits IBD symptoms. High-intensity exercise may alter microbiome and immunity but requires individualized safety precautions

IBD: Inflammatory bowel disease; RBCs: Red blood cells; WBCs: White blood cells; ESR: Erythrocyte sedimentation rate; CRP: C-reactive protein.

Table 7 Summary of studies on physical activity and diverticular disease

Ref.	Type of article	Age of patients	Summary of study characteristics	Outcome
Strate et al[159]	Prospective cohort study	40-75 years (males)	Analyzed 47228 men over 18 years in the health professionals follow-up study. Assessed the relationship between physical activity (MET-h/week) and diverticulitis or diverticular bleeding	Vigorous physical activity reduced risk of diverticulitis (RR = 0.66) and diverticular bleeding (RR = 0.61). Non-vigorous activity had no effect
Peery et al[160]	Cross-sectional study	Not specified	Analyzed 539 individuals with diverticulosis and 1569 controls using colonoscopy data. Investigated associations between constipation, dietary fiber, and diverticulosis	Constipation and low dietary fiber intake were not associated with increased risk of diverticulosis
Williams[164]	Prospective cohort study	≥ 50 years (men/women)	Followed 9072 men and 1664 women from the national runners’ health study for 7.7 years. Assessed the relationship between running distance, cardiorespiratory fitness, and diverticular disease	Vigorous physical activity (e.g., running > 8 km/day) reduced risk of diverticular disease by 48%. Better 10-kilometer performance also reduced risk by 68%

MET-h: Metabolic equivalent of task hours; RR: Risk ratio.

Table 8 Studies related to exercise-induced gastrointestinal bleeding

Ref.	Type of article	Age of patients included	Summary of study characteristics	Outcome
Papantoniou et al[9]	Review	Not specified	Explored GI bleeding in athletes, linking it to splanchnic hypoperfusion, NSAIDs, and mechanical trauma. Discussed nutrition, hydration, and medication as preventive measures. Endoscopy highlighted for diagnosis	GI bleeding in athletes is often self-limited but can impact performance. Prevention includes gut training and reducing NSAIDs use
Zaffar et al[82]	Case report	21-year-old male	Ischemic colitis in a soccer player following vigorous physical activity. Diagnosed via colonoscopy showing ischemic changes	Symptoms resolved with supportive care and hydration
Moses[165]	Review	Not specified	Examined visceral ischemia-mediated GI bleeding during prolonged exercise. Highlighted hemorrhagic gastritis and colitis as common lesions	GI bleeding is usually transient and reversible. Cimetidine showed potential for recurrent cases, but most therapies are unclear
Baska et al[166]	Prospective Study	Not specified	Assessed GI bleeding during a 100-mile ultramarathon using stool tests. 85% showed occult blood post-race. Symptoms included nausea and diarrhea	Exercise-related lower GI bleeding linked to physical stress, with symptoms correlated to fecal blood positivity
Rodríguez de Santiago et al[167]	Case report	30-year-old male	A cyclist with intense training presented with melena due to gastric ulcers caused by vigorous exercise. Diagnosed via endoscopy and treated with proton pump inhibitors	Exercise-induced gastric ulcers resolved with medication and moderated physical activity
Schaub et al[168]	Case report	33-year-old male	Reported ischemic colitis in a marathon runner with post-race bloody diarrhea. A colonoscopy showed ischemic mucosal lesions	Ischemic colitis is caused by reduced intestinal blood supply during intense exercise
Cooper et al[169]	Case report	33-year-old female	Described erosive gastritis and GI bleeding in a runner. Blood loss confirmed by 51Cr-labeled red cells. Symptoms resolved with cessation of exercise and H2-receptor antagonist therapy	Exercise-induced gastritis and bleeding are reversible with treatment or reduced activity
Halvorsen et al[171]	Prospective study	Not specified	Studied marathon runners for fecal occult blood. 13% tested positive post-race, with no overt bleeding or anemia	GI bleeding is common but asymptomatic in marathoners
McCabe et al[172]	Prospective study	Not specified	Evaluated 125 marathon runners for GI bleeding using stool occult blood tests. 23% converted to positive post-race	GI bleeding correlated with long-distance running
Choi et al[173]	Prospective study	16-19 years	Investigated GI mucosal damage in long-distance runners via endoscopy. Found gastritis in all, esophagitis in 6, and gastric ulcers in 1 participant	GI mucosal damage is prevalent in competitive runners

GI: Gastrointestinal; NSAIDs: Non-steroidal anti-inflammatory drugs; H2: Histamine-2; 51Cr: Chromium-51.

Table 9 The relation between exercise and constipation

Ref.	Type of article	Age of patients included	Summary of study characteristics	Outcome
Bakonyi et al[176]	Experimental study (rats)	Middle-aged rats	Investigated effects of voluntary exercise on GI motility, spatial memory, intestinal eNOS/Akt levels, and microbiome composition	Exercise improved spatial memory and increased intestinal Akt and Bifidobacteria but did not affect GI motility
Gao et al[178]	Systematic review, meta-analysis	Adults with constipation	Analyzed effects of aerobic and anaerobic exercise on constipation symptoms from 9 RCTs involving 680 participants	Exercise significantly improved constipation symptoms, especially with aerobic activities like walking and qigong
Dolk et al[179]	Experimental study	Patients with puborectalis paradox	Evaluated effects of yoga techniques on defecation patterns in patients with puborectalis dysfunction using EMG	Training improved EMG activity in one patient but did not lead to clinical improvement for most participants
Cui et al[181]	Systematic review of cohort studies	119426 participants	Examined the relationship between physical activity and constipation in a systematic review of 13 cohort studies	Higher PA levels reduced constipation risk (RR = 0.69). Benefits were pronounced in Asian and Oceanian populations and among women

GI: Gastrointestinal; eNOS: Endothelial NO synthase; Akt: Protein kinase B; RCT: Randomized controlled trial; EMG: Electromyography; PA: Physical activity; RR: Risk ratio.

Table 10 Exercises contraindicated in specific gastrointestinal diseases

Gastrointestinal disease	Contraindicated exercises	Reason for contraindication	Recommended modifications
GERD	High-impact activities (e.g., running, jumping); core exercises involving bending or lying flat; vigorous activities post-meal	Increases intra-abdominal pressure, relaxing the LES and exacerbating reflux; promotes acid reflux during activity	Opt for moderate-intensity aerobic exercises (e.g., walking, cycling); avoid exercising on a full stomach
Peptic ulcers	High-intensity exercises (e.g., heavy lifting, vigorous core exercises)	Increases abdominal pressure, aggravating symptoms such as pain and nausea; can impair healing of gastric mucosa	Engage in low-impact activities (e.g., walking, swimming); avoid exercising in dehydrated conditions
GI cancer	Strenuous or prolonged endurance exercises; high-impact activities during active treatment	Exacerbate fatigue, reduce nutrient absorption, and impair recovery during chemotherapy/radiation	Low-intensity activities (e.g., walking, stretching); gradually increase exercise intensity post-treatment
Gallbladder diseases	High-intensity workouts during active inflammation or gallbladder attacks	Increase bile production and aggravate symptoms such as bloating and pain	Resume moderate-intensity activities gradually post-recovery
IBS	Vigorous exercises, especially during flare-ups; intense abdominal workouts	Worsen bloating, cramping, or diarrhea by over-stimulating gut motility	Start with low to moderate-intensity aerobic exercises (e.g., walking)
IBD	High-impact or strenuous exercises during active flares	Increase inflammation and exacerbate fatigue or symptoms	Perform light stretching, yoga, or Tai Chi during flare-ups
Diverticular disease	High-impact or abdominal-straining exercises during acute diverticulitis	Worsen inflammation or increase pressure on diverticula	Focus on low-impact exercises (e.g., yoga, walking) during recovery
GI bleeding	Prolonged endurance activities (e.g., marathon running); high-impact sports	Increase mucosal injury and worsen bleeding through ischemia or mechanical trauma	Engage in gentle, low-impact exercises (e.g., walking, Tai Chi) during recovery
Constipation	None contraindicated; focus should be on avoiding inactivity	Inactivity can worsen constipation by slowing gut motility	Include aerobic exercises (e.g., walking, jogging) and core strengthening (e.g., yoga, Pilates)

GERD: Gastroesophageal reflux disease; LES: Lower esophageal sphincter; GI: Gastrointestinal; IBS: Irritable bowel syndrome; IBD: Inflammatory bowel disease.

Table 11 Summarizes the recommended exercises for specific gastrointestinal diseases

Condition	Recommended exercises	Benefits	Precautions
GERD	Moderate-intensity aerobic (e.g., walking, cycling); yoga and Tai Chi	Reduce intra-abdominal pressure; improve digestion and weight management; reduce stress	Avoid high-impact activities; avoid bending/lying flat post-meal; exercise on an empty stomach
Peptic ulcers	Moderate-intensity aerobic (e.g., walking, swimming); yoga	Promote circulation and healing; reduce stress; support weight management	Avoid high-intensity or abdominal-straining exercises; avoid exercise immediately post-meal
GI cancer	Aerobic (e.g., walking, cycling); resistance training; stretching and relaxation	Reduce recurrence risk; support immune function; improve mental health and reduce fatigue	Tailor programs to treatment stage; gradually increase intensity post-treatment
Gallbladder disease	Aerobic (e.g., walking, cycling); low-intensity resistance training	Improve bile flow; reduce abdominal fat; enhance recovery post-surgery	Avoid high-intensity exercise during inflammation; gradually resume activity post-surgery
IBS	Aerobic (e.g., swimming, walking); yoga and Tai Chi; strength training	Improve gut motility; reduce stress and abdominal pain; balances gut microbiota	Avoid overexertion or dehydration; tailor exercises to individual symptoms
IBD	Aerobic (e.g., walking, cycling); yoga and Tai Chi; weight-bearing exercises	Reduce inflammation; enhance gut barrier function; alleviate fatigue	Avoid high-intensity activities during flare-ups; maintain hydration and consult a healthcare provider
Diverticular disease	Aerobic (e.g., walking, jogging); low-impact exercises; yoga	Improve gut motility; reduce inflammation and constipation; promote recovery post-diverticulitis	Avoid high-intensity or abdominal-straining exercises during active disease
GI bleeding	Gentle aerobic (e.g., walking, yoga); low-impact stretching	Improve circulation and recovery; support gut microbiota health; reduce systemic inflammation	Avoid high-intensity activities; consult a provider before initiating exercises post-bleeding
Constipation	Aerobic (e.g., walking, swimming); yoga; core strengthening	Enhance gut motility; promote regular bowel movements; reduce bloating and abdominal discomfort	Ensure adequate hydration; start with moderate-intensity exercises
Celiac disease	Aerobic (e.g., walking, cycling, and swimming); yoga and Pilates; strength training	Reduce inflammation; promote gut motility; improve nutrient absorption post-gluten exposure	Avoid high-intensity exercise during active inflammation; ensure proper hydration and nutrition to support recovery

GERD: Gastroesophageal reflux disease; GI: Gastrointestinal; IBS: Irritable bowel syndrome; IBD: Inflammatory bowel disease.

Table 12 Exercises that improve gastrointestinal health

Exercise type	Key benefits	Specific impacts on gastrointestinal health
Aerobic exercises, e.g., walking, jogging, cycling, swimming, and dancing	Improve gut motility and intestinal blood flow; enhance digestion and nutrient absorption; reduce inflammation	Regulate bowel movements and prevents constipation; reduce IBS symptoms and bloating; increase gut microbiota diversity (Bifidobacterium, Faecalibacterium)
Resistance training	Enhance abdominal muscle strength; improve insulin sensitivity and digestive efficiency; reduce bloating	Support abdominal muscles; reduce symptoms of bloating and discomfort; indirectly improve GI health by reducing metabolic disorders
Yoga	Stimulate digestion through gentle twists; promote relaxation and reduce stress; improve intestinal motility	Alleviate IBS and GERD symptoms; reduce bloating, cramping, and discomfort; enhance digestive function through improved blood flow to intestines
Pilates	Strengthen abdominal muscles; enhance core strength and flexibility; promote better oxygenation to the gut	Improve abdominal muscle function and gut motility; reduce bloating and indigestion; alleviate stress-induced GI symptoms
Tai Chi	Promote relaxation and balance; enhance gut circulation; reduce stress	Improve gut-brain axis functioning; relieve IBS symptoms like bloating and cramping; promote regular bowel movements and better digestion
Walking	Enhance intestinal motility; improve circulation to digestive organs; reduce stress	Prevent constipation; regulate bowel movements; improve conditions like IBS and acid reflux by reducing stress-induced symptoms
Cycling	Promote blood flow to GI organs; enhance cardiovascular health; regulate bowel movements	Improve gut motility; reduce constipation; alleviate IBS symptoms
High-intensity interval training	Improve gut motility; aid in fat loss, reducing abdominal fat; enhance nutrient absorption	Boost gut health in moderation; excessive intensity may trigger GI distress, so careful monitoring is necessary

IBS: Irritable bowel syndrome; GI: Gastrointestinal; GERD: Gastroesophageal reflux disease.