Introduction:
Up to 20% of adult people in the Western world are affected by gastroesophageal reflux disease (GERD), which is characterized by bothersome and recurrent symptoms of regurgitation or heartburn. GERD is linked to poorer health-related quality of life (HRQL), a higher risk of developing esophageal adenocarcinoma, and a significant financial burden on the patient and the public.
Being overweight, smoking, having a low socioeconomic status, and having the condition run in the family are known risk factors for GERD. Still, the potential role of physical activity is complex and intriguing. Although high levels of physical activity are known to cause reflux symptoms, they also have a number of benefits for overall health, and some research suggests that they may even help prevent GERD over the long term.
What Is GERD?
Gastroesophageal reflux disease (GERD) is the most common digestive disorder worldwide, with a North American prevalence of 18.1 to 27.8 %. Every adult will experience reflux symptoms at some point. The Montreal definition of GERD states that it is a condition characterized by aggravating symptoms and complications brought on by the reflux of stomach contents into the esophagus. The typical method for diagnosing GERD is based on the presence of the classic symptoms and the patient's reaction to acid suppression following an empiric trial. Due to its link to a lower quality of life and significant morbidity, GERD is a serious health concern.
Significant improvements in quality of life, such as reduced physical pain, increased vitality, social and physical function, and emotional well-being, have been linked to the effective treatment of GERD symptoms. Although GERD medications are not particularly expensive, treating GERD patients has been estimated to be 2-times as expensive as treating similarly situated people who do not have GERD. The higher morbidity among GERD patients and the higher cost of managing the complications of GERD that have been improperly treated are probably to blame for this cost disparity.
What Is the Relation Between Gastroesophageal Disease and Exercise?
Numerous studies have demonstrated that symptoms of the upper digestive tract (heartburn, regurgitation, and belching), which can occur in up to 58 percent of people, are common and depend on the level of physical activity performed. It is still unknown, though, how exercise affects its occurrence.
According to publications, there are three potential causes: gastroesophageal motor disorders brought on by decreased mesenteric blood flow, endocrine-metabolic changes, and elevated abdominal pressure linked to physical activity. Changes in the esophagogastric junction and the LES tone have both been considered as additional potential causes (hypotonia).
There have been relatively few recent evaluations of the effects of exercise training on patients with GERD. Most studies were conducted on athletes and healthy, asymptomatic individuals. According to the authors' theory, GERD patients experience symptoms and reflux episodes that are brought on by exercise more frequently and symptomatically than those that arise from their regular activities.
Elevated extrinsic gastric compression by surrounding adipose tissue and anatomical destruction of the gastroesophageal junction are two potential biological mechanisms underlying the increased risk of reflux in obese individuals. This is also considered to be the mechanism at play when reflux symptoms are brought on by exercise. Additionally, it has been suggested that physical activity may exacerbate GERD by altering esophagogastric motor function and reducing gastrointestinal blood flow.
On the other hand, exercise may strengthen the anti-reflux barrier by enhancing the striated muscles in the diaphragmatic crura. Additionally, different types and intensities of exercise may carry different risks for GERD. The findings from this study might be significant for the prevention and treatment of GERD and its complications, should the current results be confirmed in further research.
Numerous studies conducted recently have demonstrated that physical activity exacerbates GERD symptoms. While there is disagreement over the matter when it comes to routine activities like a simple walk, on the one hand, this correlation appears to be well established when performed at a demanding level. A light walk shortens the time the esophageal is exposed to acid from reflux medications and speeds up gastric emptying, according to research by Avidan et al. How exercise would affect the occurrence of reflux episodes is another aspect that is still up for debate.
What Are the Resistant Exercises for GERD?
The following regimen, which aims to give the LES some resistance training, eventually produces favorable results. In a kneeling position, the head is positioned below the stomach to provide resistance. This required that the food being swallowed be propelled upward. Individuals should start their breakfast and occasionally their lunch (a sandwich) while still in the exercise position. On a platform that was 6 feet and 12 inches high, they were instructed to kneel, take a typical mouthful, chew it as necessary, and get ready to swallow. A person should finish swallowing while resting their head on their hands, their forearms flat on the floor, and hands at their sides. With some practice, the patient might be able to start and finish swallowing.
What Are the Effects of Breathing Exercises on GERD?
Gastroesophageal reflux disease (GERD) has a multifactorial pathogenesis. The antireflux barrier's dysfunction and the inability to clear refluxate are directly correlated with the severity of abnormal reflux burden. One of the main parts of the esophagogastric junction, the crural diaphragm, is crucial in preventing gastroesophageal reflux. As a skeletal muscle, the diaphragm can be partially controlled voluntarily, and breathing exercises can help with dysfunction. Diaphragmatic breathing training (DBT) may help some GERD patients with their symptoms.
The mechanisms underlying gastroesophageal reflux can be clarified using the high-resolution esophageal manometry (HRM) technique, which is useful for evaluating antireflux barrier function. HRM can assist in identifying patient phenotypes that might benefit most from DBT, and HRM can even aid in administering respiratory physiotherapy to GERD patients. This systematic review aimed to assess the evidence supporting physiotherapeutic practices in treating GERD and to show how HRM may inform treatment plans with a respiratory physiotherapy component.
Conclusion:
The lower sphincter pressure does not affect the occurrence of GERD in patients with GERD during exercise, and overweight or mild obesity did not affect the occurrence of GERD during exercise. Higher intensity exercise, defined as EST with VO2 at 70% of predetermined levels, predisposes to episodes of GERD in patients with erosive GERD, whereas lower intensities do not. The LES resistance training exercise has many advantageous qualities. It might be a long-term fix because it treats the root of gastroesophageal reflux rather than just its symptoms. The exercise has little to no risk or expense, and many people may find it helpful.
