Systematic Reviews
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 14, 2025; 31(22): 106835
Published online Jun 14, 2025. doi: 10.3748/wjg.v31.i22.106835
Exploring the gut-exercise link: A systematic review of gastrointestinal disorders in physical activity
Mohammed Al-Beltagi, Nermin Kamal Saeed, Adel Salah Bediwy, Yasser El-Sawaf, Akram Elbatarny, Reem Elbeltagi
Mohammed Al-Beltagi, Department of Pediatrics, Faculty of Medicine, Tanta University, Tanta 31511, Al Gharbia, Egypt
Mohammed Al-Beltagi, Department of Pediatrics, University Medical Center, King Abdulla Medical City, Arabian Gulf University‎, Manama 26671, Bahrain
Nermin Kamal Saeed, Medical Microbiology Section, Department of Pathology, Salmaniya Medical Complex, ‎Governmental Hospitals, Manama 12, Bahrain
Nermin Kamal Saeed, Medical Microbiology Section, Department of Pathology, Royal College of Surgeons in Ireland-Bahrain, Busaiteen 15503, Muharraq, Bahrain
Adel Salah Bediwy, Department of Pulmonology, Faculty of Medicine, Tanta University, Tanta 31527, Al Gharbia, Egypt
Adel Salah Bediwy, Department of Pulmonology, University Medical Center, King Abdulla Medical City, Arabian Gulf University, Manama 26671, Bahrain
Yasser El-Sawaf, Department of Tropical Medicine, Faculty of Medicine, Tanta University, Tanta 31527, Al Gharbia, Egypt
Yasser El-Sawaf, Department of Gastroenterology, University Medical Center, King Abdulla Medical City, Arabian Gulf University, Manama 26671, Bahrain
Akram Elbatarny, Department of Pediatric Surgery, Faculty of Medicine, Tanta University, Tanta 31527, Al Gharbia, Egypt
Reem Elbeltagi, Department of Medicine, Royal College of Surgeons in Ireland-Medical University of Bahrain, Busaiteen 15503, Muharraq, Bahrain
Co-first authors: Mohammed Al-Beltagi and Nermin Kamal Saeed.
Author contributions: Al-Beltagi M and Saeed NK contributed to manuscript drafting and made contributions equally as co-first authors; Al-Beltagi M conceptualized and designed the study, supervised the narrative review process, and coordinated author collaboration; Saeed NK conducted literature searches and data extraction, provided microbiological expertise related to gastrointestinal health; Bediwy AS offered clinical expertise in pulmonology and its relevance to systemic inflammation, assisted in data analysis, and participated in manuscript review and editing; El-Sawaf Y provided insights into tropical and gastroenterological diseases, supported the interpretation of findings, and reviewed the manuscript for clinical accuracy; Elbatarny A contributed pediatric surgical expertise, provided input on gastrointestinal conditions in pediatric populations; Elbeltagi R assisted in reviewing the methodology, contributed to drafting specific sections, and ensured consistency in data presentation and discussion; Al-Beltagi M, Saeed NK, and Elbatarny A contributed to manuscript revision. All authors reviewed and approved the final manuscript and agreed to be accountable for all aspects of the work, ensuring its accuracy and integrity.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mohammed Al-Beltagi, MD, PhD, Chief Physician, Professor, Department of Pediatrics, Faculty of Medicine, Tanta University, No. 1 Hassan Radwan Street, Tanta 31511, Al Gharbia, Egypt. mbelrem@hotmail.com
Received: March 9, 2025
Revised: April 27, 2025
Accepted: May 27, 2025
Published online: June 14, 2025
Processing time: 96 Days and 5.2 Hours
Abstract
BACKGROUND

The relationship between exercise and gastrointestinal (GI) health is complex and bidirectional. While moderate exercise generally promotes gut health by enhancing motility, reducing inflammation, and supporting microbial balance, intense or prolonged physical activity may exacerbate GI symptoms, particularly in individuals with pre-existing digestive disorders. A deeper understanding of this interplay is essential for optimizing both exercise performance and GI well-being.

AIM

To synthesize current evidence on exercise-related GI disorders, exploring the prevalence, mechanisms, risk factors, and management strategies associated with exercise-induced GI symptoms.

METHODS

Following PRISMA guidelines, comprehensive searches of databases, including PubMed, Scopus, Web of Science, and EMBASE were conducted. Studies were included if they focused on exercise-induced GI disorders, encompassed randomized controlled trials, cohort studies, case-control studies, and cross-sectional designs, and addressed symptoms across various exercise modalities. Data were extracted and analyzed to identify patterns and implications for clinical and athletic practice.

RESULTS

A total of 231 studies met the inclusion criteria, highlighting both the benefits and risks of exercise on GI health. Regular moderate-intensity exercise, including activities such as walking, cycling, and yoga has been associated with improved GI function in conditions like gastroesophageal reflux disease, irritable bowel syndrome, inflammatory bowel disease, and constipation. These benefits are attributed to enhanced intestinal motility, reduced systemic inflammation, and improved gut barrier integrity. Additionally, exercise plays a role in regulating the gut-brain axis, with practices like yoga and Tai Chi demonstrating particular effectiveness in alleviating functional GI disorders. Conversely, high-intensity or prolonged exercise may contribute to symptoms such as nausea, diarrhea, and abdominal pain due to mechanisms like splanchnic hypoperfusion and increased intestinal permeability. Individual factors, including fitness level, dietary habits, hydration status, and underlying GI conditions, significantly influence the body’s response to exercise.

CONCLUSION

Moderate-intensity exercise is a beneficial and well-tolerated intervention for promoting GI health, whereas high-intensity activities require careful monitoring, particularly in individuals with pre-existing GI disorders. Personalized exercise and dietary strategies are essential for balancing the benefits of physical activity with the risk of GI distress. Further research is needed to explore the long-term effects of exercise on gut microbiota composition and overall digestive health.

Keywords: Exercise; Gastrointestinal health; Gut-brain axis; Irritable bowel syndrome; Inflammatory bowel disease; Exercise-induced gastrointestinal disorders; Gut microbiota

Core Tip: This systematic review explores the complex relationship between exercise and gastrointestinal (GI) health, highlighting the dual effects of physical activity. Moderate-intensity exercises like walking and yoga promote intestinal motility, reduce systemic inflammation, and enhance gut barrier integrity, benefiting conditions like gastroesophageal reflux disease, irritable bowel syndrome, inflammatory bowel disease, and constipation. Conversely, high-intensity or prolonged exercise can exacerbate GI symptoms, such as nausea and diarrhea, due to splanchnic hypoperfusion and increased intestinal permeability. Individual responses vary based on fitness level, dietary habits, and underlying GI conditions, emphasizing the need for personalized exercise and dietary strategies. This systematic review underscores moderate exercise as a safe, effective intervention for optimizing GI health.