Exercise as it relates to Disease/Beneficial effects of exercise for individuals suffering Crohn's disease

What is Crohn's Disease?
Crohn’s disease (CD), categorized under a broader group of illnesses known as inflammatory bowel disease (IBD), is a chronic inflammatory disease of the gastrointestinal system. Evidence suggests that CD is a large cause of morbidity within Australia, and it is estimated that 50 people per 100,000 are suffering this chronic disease. CD commonly effects people within their 20s and 60s and may also affect any portion of the alimentary tract, from the mouth to the anus, most commonly:
 * Ileum and Cecum - 40% of CD cases
 * Small Intestine - 30% of CD cases
 * Colon - 25% of CD cases

=== Signs/Symptoms ===
 * Cramps/Abdominal pain
 * Diarrhea
 * Weight loss
 * Fatigue
 * Muscle weakness

Causes of Crohn's Disease
The main cause of Crohn’s disease is unclear although a number of possible causes have been suggested including: A number of these possible causes of CD could be preventable, including:
 * Genetics - pro-inflammatory and anti-inflammatory markers
 * Microbial infection - microbial balance disrupted
 * Immunology - abnormalities of the immune system
 * Environment - smoking etc.
 * Diet
 * Vasculature
 * Psychological factors

Comorbidities
A number of comorbidity’s are associated with Crohn’s disease, mainly caused by medications, malabsorption, cell changes, lesions and intestinal blockages These include: Patients who suffer comorbidities have a decreased quality of life, but prevention is possible.
 * Osteoporosis and osteopenia
 * Depression
 * Reduced skeletal muscle mass and strength and
 * Cancer

Common Treatments
There are a number of treatments currently used to manage the symptoms associated with CD, including:
 * Medication - which is dependent on: the stage of the disease (active or remissive) and the level of severity (mild to severe)
 * Surgery: surgery is used to rectify problems including stricture, obstruction, fistulae
 * Complementary and Alternative Treatments: including probiotics, prebiotics and acupuncture.
 * Diet and lifestyle changes: quit smoking etc.
 * Exercise: Aerobic and Resistance training

Exercise
Recent research suggests that physical activity is now being recommended to a large number of people suffering from chronic illnesses, including CD. The positive effects associated with physical activity have the potential to improve an individual’s physical condition and quality of life. The table below illustrates some of the potential benefits physical activity possesses for individuals with Crohn’s disease.

Recommendations
To determine physical activity for individuals suffering from CD including the type, frequency, intensity and duration, more research is needed to understand the exact benefits provided. However, recent evidence suggests there appears to be two main types of exercise that are beneficial for individuals with CD: aerobic activity and muscular resistance training. The following recommendations refer to the ideal training for maximum efficiency at reducing the signs and symptoms of Crohn’s Disease.

Aerobic Exercise:  Resistance Exercise: 
 * 2–3 days per week for 20–30 minutes at low intensity
 * Exercises can include walking, cycling, swimming and low impact aerobics
 * Progression: increase to most days of the week when comfortable
 * 2–3 days per week completing 2-3 sets, 8-12 repetitions
 * Exercises that utilize the major muscle groups of the trunk and legs
 * Exercises completed at 50% 1RM (moderate intensity)
 * Exercises can include the use of elastic bands and free weights
 * Progression: increase repetitions performed at 60% 1RM

==Limitations and Considerations == It is important to note that exercise programs should be individualised and when planning an exercise routine, it is also essential to consider the physical limitations a CD patient may be suffering including:
 * Dehydration -  due to the high rate of diarrhea, fluid intake is essential (1-2 L per day).
 * Age - important factor that influences physical ability.
 * Severity of disease -  the severe cases of CD experience a number of symptoms which make exercise difficult.
 * Medications - side effects may inhibit a patient from exercising comfortably.
 * Lack of Motivation - due to depression and negative self-image.
 * Comorbidities - several comorbidities are associated with CD and may inhibit exercise further.
 * Improving compliance - it is suggested that Crohn's patients participate within supervised exercise sessions or group activities.