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Exercise improves symptom control in IBS

Clinical Question:
Does regular exercise improve symptoms in patients with irritable bowel syndrome?

Bottom Line:
In this small and somewhat underpowered randomized trial, exercise appears to improve symptoms in patients with irritable bowel syndrome (IBS). (LOE = 1b-)

Reference:
Johannesson E, Simrén M, Strid H, Bajor A, Sadik R. Physical activity improves symptoms in irritable bowel syndrome: a randomized controlled trial. Am J Gastroenterol 2011;106(5):915-922.  [PMID:21206488]

Study Design:
Randomized controlled trial (nonblinded)

Funding:
Government

Allocation:
Concealed

Setting:
Outpatient (specialty)

Synopsis:
To date, there have been no randomized trials of exercise as a treatment for IBS. These Swedish researchers identified 162 patients who met the Rome II criteria for IBS, 102 of whom were not already actively exercising and agreed to participate. The median age of participants was 33 years (range = 17 - 67 years), and 89% were women. Allocation was appropriately concealed, although the study was not masked once it began. Analysis was both per protocol and by intention to treat, with 75 patients completing the study (11 dropped out before the first session, 16 at a later point). The intervention was quite minimal: a phone call from a physical therapist once or twice a month encouraging patients to exercise. Several standard surveys including the IBS Severity Scoring System, the IBS Quality of Life score, the Short Form (36) Health Survey, and the Fatigue Impact Scale were used to evaluate the effect of exercise at baseline and after 12 weeks. The IBS Severity Score improved significantly more in the physical activity group (37 points more in the intention-to-treat analysis, 46 more in the per-protocol analysis), a difference which is of borderline clinical significance. There were also significant improvements in physical role and physical function subscales of the IBS Qualify of Life score. The general trend across all scales and outcomes was for modest improvements in the physical activity group compared with the usual care group. The percentage with a clinically significant improvement in the IBS Severity Score was 43% in the physical activity group and 26% in the control group (P = .07).

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