# Exercise as it relates to Disease/Exercise prescription and nutrition for Crohn's disease

Crohn's Disease is a type of inflammatory bowel disease (IBD) that can affect any part of the gastrointestinal (GI) tract, from mouth to anus. It's not entirely sure what exactly causes Crohn's, but it is believed to be a combination of environmental and immunological factors, in already genetically susceptible people. The symptoms associated with Crohn's disease and IBD vary greatly between individuals. Some symptoms that can occur inside the GI tract are:
* Cramps and abdominal pain;
* Diarrhoea;
* Frequent bowel movements;
* Vomiting; and
* Weight loss (due to poor nutrition)
and symptoms outside the GI tract can include:
* Fever;
* Fatigue;
* Rashes and other skin conditions;
* Eye inflammation;
* Joint pain; and
* Osteoporosis

## Effects of Exercise on Crohn's Disease Patients

It has been found that patients diagnosed with Crohn's disease and IBD, have a reduction in muscle mass and aerobic fitness. This decrease in muscle tissue and aerobic fitness, has thought to be caused by deficiencies in diet, fatigue, reduction in physical activity (including social sports), and poor recovery.

### Exercise Advantages

Although every case of Crohn's disease can be significantly different depending on the individual, there have been no significant negative effects from exercise. All physiological effects from exercise that occur in the standard population are found to occur in Crohn's disease patients. Effects including cardiovascular, muscular, and skeletal benefits can be achieved. More importantly, due to possible nutritional deficiencies, any progressive exercise has shown to be effective in increasing "bone mineral density" (BMD) in Crohn's disease patients. As a long term solution, this increase in BMD can reduce the risk of osteoporotic fractures.

### Exercise Disadvantages

The only consistent negative effect found from exercising, is nutritional deficiencies. A poor diet pre and post-exercise, especially with intense strength and hypertrophy exercises, can result in poor recovery extending Delayed Onset Muscle Soreness (DOMS) and poor immune defence. There is an increase risk of zinc deficiencies in Crohn's disease patients, especially after exercise. A zinc deficiency in a Crohn's disease patient, leads to a loss of appetite and can potentially result in "anorexia". A loss of appetite during the recovery phase after exercise, can again not allow required nutrients to recover.

### Nutrition in Accordance to Exercise in Crohn's Disease Patients

Diet is seen to be the primary form of treatment for Crohn's Disease. Depending on the symptoms present, and during flare-ups, it is recommended that the patient have a low protein, low fibre diet. In saying that though, because symptoms are extremely individual some patients may not have to change their diet at all. With the increase in activity, just like any other person, an increase in nutrients will be required to aid recovery. This can be another disadvantage to heavy strength and hypertrophy training in some Crohn's disease patients. Some patients will also be unable to supplement crucial nutrients like protein, and some vitamins and minerals, as these supplements can irritate and flare up abdominal pain.

## Recommendations for Nutrition and Exercise

Crohn's disease patients should get to know the signs and symptoms that are individual to them, and what foods and supplements they can consume that doesn't make their symptoms worse. It is still recommended that patients exercise and their diet corresponds to the work load. Exercise can prescribed in accordance to the patients symptoms. The main recommendation is that during flare-ups, heavy strength and hypertrophy training are avoided as the patients diet is unlikely to be adequate to assist recovery.

## Reference List

* 1 2 3 4 5 6 7 8 9 10 11 Crohns & Colitis Australia. Retrieved September 26, 2013, http://www.crohnsandcolitis.com.au/about-crohns-and-colitis.php
* 1 2 3 Thornton, J. R.; Emmett, P. M.; Heaton, K. W. (1979). "Diet and Crohn's disease: Characteristics of the pre-illness diet". British Medical Journal. 2 (6193): 762–4. PMC 1596421. PMID 519184.
* 1 2 Jakobovits, J; Schuster, M. M. (1984). "Metronidazole therapy for Crohn's disease and associated fistulae". The American Journal of Gastroenterology. 79 (7): 533–40. PMID 6741906.
* 1 2 3 d'Incà, R; Varnier, M; Mestriner, C; Martines, D; d'Odorico, A; Sturniolo, G. C. (1999). "Effect of moderate exercise on Crohn's disease patients in remission". Italian Journal of Gastroenterology and Hepatology. 31 (3): 205–10. PMID 10379481.
* 1 2 3 Wiroth, Jean-Baptiste; Filippi, Jérôme; Schneider, Stéphane M; Al-Jaouni, Rima; Horvais, Nicolas; Gavarry, Olivier; Bermon, Stéphane; Hébuterne, Xavier (2005). "Muscle Performance in Patients with Crohnʼs Disease in Clinical Remission". Inflammatory Bowel Diseases. 11 (3): 296–303. doi:10.1097/01.MIB.0000160810.76729.9c. PMID 15735436.
* 1 2 3 Loudon, Colleen P.; Corroll, Victor; Butcher, Janice; Rawsthorne, Patricia; Bernstein, Charles N. (1999). "The effects of physical exercise on patients with Crohn's disease". The American Journal of Gastroenterology. 94 (3): 697–703. doi:10.1111/j.1572-0241.1999.00939.x. PMID 10086654.
* 1 2 Robinson, Richard J.; Krzywicki, Tara; Almond, Len; Al–Azzawi, Farook; Abrams, Keith; Iqbal, S.Javed; Mayberry, John F. (1998). "Effect of a low-impact exercise program on bone mineral density in Crohn's disease: A randomized controlled trial". Gastroenterology. 115 (1): 36–41. doi:10.1016/S0016-5085(98)70362-2. PMID 9649456.
* ↑ Burton, Deborah Anne; Stokes, Keith; Hall, George M (2004). "Physiological effects of exercise". Continuing Education in Anaesthesia, Critical Care & Pain. 4 (6): 185–8. doi:10.1093/bjaceaccp/mkh050.
* 1 2 3 4 O'Morain, C; Segal, A W; Levi, A J (1984). "Elemental diet as primary treatment of acute Crohn's disease: A controlled trial". BMJ. 288 (6434): 1859–62. doi:10.1136/bmj.288.6434.1859. PMC 1441790. PMID 6428577.
* 1 2 3 Harries, A.D.; Danis, V.; Heatley, R.V.; Jones, L.A.; Fifield, R.; Newcombe, R.G.; Rhodes, J. (1983). "Controlled Trial of Supplemented Oral Nutrition in Crohn's Disease". The Lancet. 321 (8330): 887–90. doi:10.1016/S0140-6736(83)91325-9. PMID 6132218.

## Further reading

* Crohn's and Colitis Australia
* Crohn's and Colitis Diet Recommendations
* WebMed Crohn's Disease