While there are countless benefits of exercise, such as improvement in mood and sleep, lowering risk of chronic disease and maintaining healthy immunity, emerging research supports the benefit of regular exercise for regulating, enhancing and diversifying gut microbiota. Physical activity may help chronic gastrointestinal illnesses including irritable bowel syndrome (IBS), constipation and diverticular disease. This science-based articles takes a deep dive into the latest research with support from Orgain’s nutrition advisors, gut-health expert, Colleen Webb, MS, RDN, and sports dietitian, Kelly Jones, MS, RD, CSSD.
Personalized Exercise Prescription
Simply telling someone to exercise usually isn’t enough. Instead, a targeted set of instructions can help clarify exercise advice, and referral to resources can ensure compliance. Exercise is Medicine® (EIM), a global health campaign managed by the American College of Sports Medicine (ACSM), sets out to make physical activity assessment and promotion a standard in clinical care by connecting health care with evidence-based physical activity resources for everyone regardless of ability.7
EIM offers this advice for prescribing exercise to your clients:8
- Assess their current physical activity level.
- Provide specific exercise advice with type, intensity, and frequency guidelines.
- Refer them to programs, professionals, and self-directed ways to put the exercise advice into action.
Here is an overview of The Physical Activity Guidelines for Americans for adults:9
- Move more, sit less.
- For substantial health benefits, do at least 150 to 300 minutes of moderate-intensity or 75 to 150 minutes of vigorous intensity, or a combination of both, preferably spread throughout the week. Moderate intensity exercise is any activity that gets your heart beating faster, such as walking briskly, raking leaves, or playing doubles tennis. Vigorous intensity activity includes running, jogging, carrying groceries upstairs or shoveling snow.9
- Additional health benefits are gained by more than 300 minutes of moderate intensity exercise each week.
- For additional health benefits, do moderate or greater intensity muscle-strengthening activities involving all major muscle groups two or more days per week.
The World Health Organization (WHO) physical activity guidelines are similar and reiterate that some physical activity is better than none.10 Getting people to exercise regularly is another story, and it’s worthwhile for practitioners to address barriers and offer ways to get started. Sports dietitian and Orgain Nutrition Advisor, Kelly Jones MS, RD, CSSD, states, “If you tend to plan to exercise after work, but have a hard time following through, consider barriers. If you want to head to a gym or fitness class, but get stuck when you stop at home, start packing your workout clothes and a small snack so you can head right to your training session. If you exercise at home or outside, change into workout clothes before leaving work and have that snack with you, so you can flow right into exercise without any stopping points.”
Exercise and the Gut Microbiome
In addition to the well-known benefits of exercise for improvements in mood and sleep, lowering the risk of chronic disease and helping to maintain healthy immunity, emerging evidence points to a few different ways that exercise is proposed to help gut microbiota.11,12 Physical activity may be linked to increases in healthful phyla Firmicutes and Actinobacteria as well as the SCFA-producing genera from Firmicutes.6 In a study of 71 premenopausal women, aerobic fitness was linked to a lower proportion of harmful EreC (Eubacterium rectale-Clostridium coccoides).13 A study of 12 breast cancer survivors showed that cardiorespiratory fitness may be linked to improvements in gut microbial diversity.14
Although the underlying mechanism is not well understood, proposed mechanisms for improvements in certain bacteria due to exercise include decreased total colonic transit time, and long-term, regular physical activity shows positive effects on both constipation and rectosigmoid transit time.13
Gut health nutrition expert and Orgain Nutrition Advisor, Colleen Webb, MS, RDN, states, “We know from both animal and human studies that exercise can positively influence the composition and performance of the gut microbiota. We also know that exercise is protective against certain gastrointestinal conditions, including colon cancer and inflammatory bowel disease (IBD). Studies show that physical activity may reduce the risk of colorectal cancer by nearly 25%, and those with ulcerative colitis (a form of IBD) who report higher levels of physical activity are less likely to flare. Now we’re learning this positive relationship between exercise and gut health might have to do with exercise-induced changes in the gut microbiome. Remarkably, regular physical activity has been shown to increase butyrate production. This SCFA is incredibly important for gut health and has been shown to protect against both colon cancer and IBD. We still have lots to learn, such as what type of exercise is best, but for now, we have yet another reason to recommend regular physical activity to our patients.”
Exercise and the Microbiome-Gut-Brain Axis
The microbiome-gut-brain axis is a complex system of communication and processes where the composition of the gut microbiota influences both the gastrointestinal (GI) and central nervous systems (CNSs).6,15 Considering this intricate connection, psychological and gastrointestinal distress can occur when the gut microbiome is compromised. Furthermore, the vagus nerve, which is central to this axis, can be activated and altered in patients with gastrointestinal and psychological disorders. While more research is needed, the proposed improvements in gut microbiota due to exercise may be through influence on this vagal microbiome-gut-brain axis.6
Within the gut-brain-microbiome axis, one avenue by which the gut microbiome engages in bidirectional signaling with the brain is through the manipulation of bile acids. Bile acids are produced by the gut and metabolized by the gut microbiota, which are shown to alter metabolic receptors and signaling. Physical activity may improve the gut microbiome through modification of bile acids.15
A systematic review of seven studies supports the beneficial role of physical activity on the gut microbiome of older adults. Possible mechanisms of action include changes in the gut environment through alteration of bile acids and increased production of SCFAs. The results did not determine which type of exercise was most effective nor the gut bacterial taxa, or classification of bacteria, that are most responsive to exercise.16 Regular moderate-intensity aerobic exercise prevents brain volume loss associated with aging and increases brain volume in the areas responsible for attention, memory and cognition.17
GI Health and Symptom Management with Exercise
Physical activity may help chronic gastrointestinal illnesses including irritable bowel syndrome (IBS), constipation and diverticular disease.18,19 Exercise helps prevent colon cancer and polyps.20,21 A proposed mechanism by which regular physical activity helps gastrointestinal health includes decreased visceral fat and the release of pro-inflammatory cytokines, thereby reducing oxidative stress, inflammation and impairments of immune function.18,21
A systematic review of 14 randomized controlled trials of patients with IBS found that GI symptoms, quality of life and anxiety were improved with exercise, showing that exercise might be a feasible and effective treatment approach.24 A study of 101 university students showed that an increase in daily steps from 4000 to 9500 steps resulted in a 50% reduction in mild symptoms including recurrent abdominal pain or discomfort.25
For people with IBD such as Chron’s disease and ulcerative colitis, exercise can be helpful in managing inflammation, and may play a role in preventing the development of IBD.18,22 Fatigue is a common complaint with IBD sufferers often impacting their ability to lead a fulfilling life. Regular physical activity is linked to reduced fatigue and improved quality of life.23
For those with mild to moderate IBD, exercise isn’t shown to aggravate the disease. It’s clear that exercise guidelines for patients with IBD need clarification since current exercise guidelines for healthy individuals may not apply to this population, and the safety of higher intensity exercise in patients with severe, active disease is not known.18
Putting Exercise Recommendations in Action
The use of exercise as an adjunct to chronic disease management is an underused opportunity for improving overall wellbeing.2 Any amount of physical activity counts and breaking up activity into small chunks throughout the day can be a great way to start.11 Jones says, “Lose the all or nothing mentality. A 20-minute walk, inside or outside, or using exercise bands in your office is better than nothing. It’s important to implement goals for physical activity that fit your lifestyle, work obligations, and individual considerations for productivity. What works for someone else may not work for you. I recommend prioritizing fitness before starting the workday.” She also suggests encouraging clients to start where they are, use what they have, and do what they can.
Since nutrition has a major impact on fitness and overall health improvement, it’s important to fuel with healthy foods pre and post exercise routines. Orgain offers a wide variety of delicious, high-quality nutrient-dense options, including their Clean Protein Shakes, which contain 20 grams of grass-fed protein and Plant Protein Shakes, containing 20 grams of plant protein. With the convenience of a twist cap, both offer easy on-the-go nutrition to meet a variety of dietary needs and preferences.
For more resources on exercise for sedentary patients, older patients, or those with chronic conditions, check out the Exercise is Medicine® Rx for Health series from the American College of Sports Medicine.
1 Justine M, Azizan A, Hassan V, Salleh Z, Manaf H. Barriers to participation in physical activity and exercise among middle-aged and elderly individuals. Singapore Med J. 2013 Oct;54(10):581-6. doi: 10.11622/smedj.2013203. PMID: 24154584.
2 Fagan G, Osborne H, Schultz M. Physical Activity in Patients with Inflammatory Bowel Disease: A Cross-Sectional Study. Inflamm Intest Dis. 2021;6(2):61-69. doi: 10.1159/000511212.
3 World Health Organization. Physical Inactivity. Available at: https://www.who.int/data/gho/indicator-metadata-registry/imr-details/3416#:~:text=People%20who%20are%20insufficiently%20physically,of%20the%20week%20(10), accessed 4/7/2022.
4 Telle-Hansen VH, Holven KB, Ulven SM. Impact of a Healthy Dietary Pattern on Gut Microbiota and Systemic Inflammation in Humans. Nutrients. 2018 Nov 16;10(11):1783. doi: 10.3390/nu10111783. PMID: 30453534; PMCID: PMC6267105.
5 Gwak MG, Chang SY. Gut-Brain Connection: Microbiome, Gut Barrier, and Environmental Sensors. Immune Netw. 2021;21(3):e20. Published 2021 Jun 16. doi: 10.4110/in.2021.21.e20.
6 Dalton A, Mermier C, Zuhl M. Exercise influence on the microbiome-gut-brain axis. Gut Microbes. 2019;10(5):555-568. doi: 10.1080/19490976.2018.1562268. Epub 2019 Jan 31. PMID: 30704343; PMCID: PMC6748614.
7 Exercise is Medicine. American College of Sports Medicine. Available at: https://www.exerciseismedicine.org/, accessed 4/6/2022.
8 Exercise is Medicine. American College of Sports Medicine. Health Care Providers Making a Difference in Your Health Care Setting. Available at: https://www.exerciseismedicine.org/eim-in-action/health-care/health-care-providers/, accessed 4/6/2022.
9 Health.gov. Physical Activity Guidelines for Americans, 2nd edition. Available at: a href=”https://health.gov/our-work/nutrition-physical-activity/physical-activity-guidelines/current-guidelines” target=”_blank”>https://health.gov/our-work/nutrition-physical-activity/physical-activity-guidelines/current-guidelines, accessed 4/6/2022.
10 Bull FC, Al-Ansari SS, Biddle S, Borodulin K, Buman MP, Cardon G, Carty C, Chaput JP, Chastin S, Chou R, Dempsey PC, DiPietro L, Ekelund U, Firth J, Friedenreich CM, Garcia L, Gichu M, Jago R, Katzmarzyk PT, Lambert E, Leitzmann M, Milton K, Ortega FB, Ranasinghe C, Stamatakis E, Tiedemann A, Troiano RP, van der Ploeg HP, Wari V, Willumsen JF. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med. 2020 Dec;54(24):1451-1462. doi: 10.1136/bjsports-2020-102955. PMID: 33239350; PMCID: PMC7719906.
11 Exercise is Medicine. American College of Sports Medicine. Being Active for a Better Life. Available at: https://www.exerciseismedicine.org/wp-content/uploads/2021/04/EIM_Rx-for-Health_Being-Active-for-a-Better-Life.pdf, accessed 4/6/2022
12 Codella R, Luzi L, Terruzzi I. Exercise has the guts: How physical activity may positively modulate gut microbiota in chronic and immune-based diseases. Dig Liver Dis. 2018 Apr;50(4):331-341. doi: 10.1016/j.dld.2017.11.016. Epub 2017 Nov 28. PMID: 29233686.
13 Yang Y, Shi Y, Wiklund P, Tan X, Wu N, Zhang X, Tikkanen O, Zhang C, Munukka E, Cheng S. The Association between Cardiorespiratory Fitness and Gut Microbiota Composition in Premenopausal Women. Nutrients. 2017; 9(8):792. https://doi.org/10.3390/nu9080792.
14 Paulsen, J.A., Ptacek, T.S., Carter, S.J. et al. Gut microbiota composition associated with alterations in cardiorespiratory fitness and psychosocial outcomes among breast cancer survivors. Support Care Cancer 25, 1563–1570 (2017). https://doi.org/10.1007/s00520-016-3568-5.
15 Cryan JF, O’Riordan KJ, Sandhu K, Peterson V, Dinan TG. The gut microbiome in neurological disorders. Lancet Neurol. 2020 Feb;19(2):179-194. doi: 10.1016/S1474-4422(19)30356-4. Epub 2019 Nov 18. PMID: 31753762.
16 Ramos C, Gibson GR, Walton GE, Magistro D, Kinnear W, Hunter K. Systematic Review of the Effects of Exercise and Physical Activity on the Gut Microbiome of Older Adults. Nutrients. 2022 Feb 5;14(3):674. doi: 10.3390/nu14030674. PMID: 35277033; PMCID: PMC8837975.
17 Stanley J. Colcombe, Kirk I. Erickson, Paige E. Scalf, Jenny S. Kim, Ruchika Prakash, Edward McAuley, Steriani Elavsky, David X. Marquez, Liang Hu, Arthur F. Kramer, Aerobic Exercise Training Increases Brain Volume in Aging Humans, The Journals of Gerontology: Series A, Volume 61, Issue 11, November 2006, Pages 1166–1170, https://doi.org/10.1093/gerona/61.11.1166.
18 Engels M, Cross RK, Long MD. Exercise in patients with inflammatory bowel diseases: current perspectives. Clin Exp Gastroenterol. 2017;11:1-11. Published 2017 Dec 22. doi: 10.2147/CEG.S120816.
19 National Institute of Diabetes and Digestive and Kidney Diseases. Treatment for diverticular disease. Available at: https://www.niddk.nih.gov/health-information/digestive-diseases/diverticulosis-diverticulitis/treatment, accessed 4/8/2022. 20 American Cancer Society. Can colorectal cancer be prevented? Available at: https://www.cancer.org/cancer/colon-rectal-cancer/causes-risks-prevention/prevention.html, accessed 4/8/2022.
21 Oruç Z, Kaplan MA. Effect of exercise on colorectal cancer prevention and treatment. World J Gastrointest Oncol. 2019;11(5):348-366. doi:10.4251/wjgo.v11.i5.348.
22 Davis SP, Crane PB, Bolin LP, Johnson LA. An integrative review of physical activity in adults with inflammatory bowel disease. Intest Res. 2022 Jan;20(1):43-52. doi: 10.5217/ir.2020.00049. Epub 2021 Jan 22. PMID: 33472342; PMCID: PMC8831770.
23 Radford SJ, McGing J, Czuber-Dochan W, Moran G. Systematic review: the impact of inflammatory bowel disease-related fatigue on health-related quality of life. Frontline Gastroenterol. 2020 Jan 24;12(1):11-21. doi: 10.1136/flgastro-2019-101355. PMID: 33489066; PMCID: PMC7802486.
24 Zhou C, Zhao E, Li Y, Jia Y, Li F. Exercise therapy of patients with irritable bowel syndrome: A systematic review of randomized controlled trials. Neurogastroenterol Motil. 2019 Feb;31(2):e13461. doi: 10.1111/nmo.13461. Epub 2018 Sep 19. PMID: 30232834.
25 Hamaguchi T, Tayama J, Suzuki M, et al. The effects of locomotor activity on gastrointestinal symptoms of irritable bowel syndrome among younger people: An observational study [published correction appears in PLoS One. 2020 Dec 17;15(12):e0244465]. PLoS One. 2020;15(5):e0234089. Published 2020 May 29. doi:10.1371/journal.pone.0234089