Physical activity and gastro-oesophageal reflux

Roy J. Shephard

Abstract


Objective: The performance of many athletes is impaired by gastro-oesophageal reflux (GER), and if this reflux is repeated frequently, the regurgitation of the acid contents of the stomach into the oesophagus can cause the condition of gastro-oesophageal reflux disease (GERD), with inflammation, haemorrhage and even cancerous change in the cells lining the oesophagus. This article thus reviews the impact of acute exercise, regular habitual physical activity and competitive sport upon the risks of GER and GERD. Methods: A systematic Ovid/Medline search of the literature from 1996 to 2015 paired the terms physical activity/motor activity, exercise, and training/physical education with gastro-esophageal reflux and esophageal regurgitation; this information was supplemented by a review of reference lists, related articles listed on Pub Med and Google Scholar, and material obtained from the author's personal files. Results: Moderate exercise usually has no effect upon the likelihood of GER, although some studies have shown a small decrease in the volume and/or duration of reflux. However, GER is increased in a substantial proportion of individuals during athletic events and bouts of vigorous aerobic exercise at intensities >70% O2max. Exercise that causes body oscillation (such as running), an increase of intra-abdominal pressures (as seen for instance in weight-lifting), and bending or adoption of the prone position (as in surfing) seem particularly liable to cause GER. The effects of regular, moderate physical activity are less certain, since almost all reports to date have been based upon questionnaires rather than objective monitoring of oesophageal pH; nevertheless, 8 of13 studies have concluded that regular moderate physical activity reduces the risk of GER. Conclusions: Very vigorous exercise increases the immediate risk of GER, and if such episodes recur frequently, there are serious dangers to health. The risk of reflux for the average person seems to be reduced by lifestyle changes, particularly control of obesity and regular moderate physical activity. Athletes who are severely affected by acid reflux may require treatment with proton pump inhibitors, although such medication is not always effective

Keywords


Barrett's disease; Epigastric pain; Heart burn; Lifestyle; Obesity; Oesophageal motility; Oesophageal pH; Oesophageal sphincter

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ISSN: 19206216