A recent review published in the Journal of Clinical Medicine illuminates the complex relationship between physical activity and digestive diseases, revealing both the benefits and risks associated with various intensities of exercise on the gastrointestinal (GI) system. The study, highlighted by The American Journal of Managed Care (AJMC), underscores that while moderate exercise can significantly enhance GI health and overall quality of life, high-intensity exercise may pose risks—especially for individuals already dealing with digestive conditions such as inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) (AJMC).
For many Thais, digestive disorders are a growing concern, paralleling global trends tied to increasingly sedentary lifestyles and dietary changes. The typical Thai diet, rich in diverse vegetables and spices, traditionally supported gut health, but the growing prevalence of fast food and processed snacks has made digestive issues such as constipation, reflux, and even colorectal cancer more common. The new research offers hope, confirming that adopting a habit of regular, moderate exercise—such as walking, cycling, or low-impact aerobics—can promote gut motility, relieve constipation, and lower long-term risks of serious GI illnesses. It also adds nuance by warning that overdoing high-intensity exercise, as seen in marathoners or those who engage in prolonged strenuous activity under the hot Thai sun, may actually trigger reflux, diarrhea, or even intestinal bleeding in those with pre-existing conditions.
The review explains that exercise impacts the GI tract through several mechanisms: improving intestinal motility (how quickly food moves through the digestive system), altering gut permeability (how easily substances pass through the intestinal wall), modulating immune responses, and shifting the makeup of gut microbiota. According to the review, “adjusting exercise intensity and frequency to maximize benefits without worsening gastrointestinal symptoms is essential in all these conditions” (Journal of Clinical Medicine; AJMC). Moderate exercise, the authors note, “improves motility, reduces constipation risk, and supports gut health through neuroendocrine changes and increased vagal tone,” alluding to the calming effect that exercise has on the nervous system and, in turn, on the gut.
Physical inactivity has become a global epidemic, contributing to around 5.5% of all deaths annually, and placing people at greater risk of over 25 chronic diseases, including those impacting the digestive system. Thai public health guidelines, in line with World Health Organization standards, recommend at least 150 minutes of moderate exercise or 75 minutes of vigorous exercise each week; benefits continue to increase with greater activity volume, even something as simple as walking more than 7,000 steps per day (AJMC). The Thai saying “เดินทีละก้าว ก้าวไปสู่สุขภาพดี” (one step at a time leads to good health) certainly holds true in this context.
One of the review’s key findings is the distinction between moderate and high-intensity exercise. While moderate activity brings metabolic and anti-inflammatory advantages, extreme or prolonged physical exertion—such as intensive Muay Thai training, marathon running, or triathlons in the Thai climate—can precipitate GI symptoms. These range from mild nausea and diarrhea to, in severe cases, reduced blood flow to the gut (intestinal ischemia), inflammation, and a temporary breakdown in the gut’s protective barrier. Factors including dehydration and the use of certain medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs) often taken by athletes, can amplify this risk (AJMC; Frontiers in Sports and Active Living).
The review also highlights emerging science around the gut microbiome—the trillions of bacteria that influence not just digestion, but also immunity, inflammation, and even mood. Exercise can beneficially reshape microbial diversity, leading to improved digestive outcomes, though the type and amount matter. Unfortunately, the impact of resistance training on the GI system is less well understood, an area the authors describe as ripe for future research.
Expert perspectives reinforce the review’s balanced message. Dr. Jose Severo, one of the review’s authors, notes, “Moderate exercise is a low-cost, accessible, and effective intervention for a range of GI diseases, especially pivotal for non-communicable disease prevention across Asia.” Thai gastroenterologists echo this, with Dr. Chanya Thongdee from King Chulalongkorn Memorial Hospital remarking, “We see many patients improve their IBS or constipation symptoms simply by adopting walking or yoga three to five times a week—แต่การออกกำลังกายที่หักโหมอาจกลับกลายเป็นส่งผลร้ายได้.”
The impact of these findings in Thailand could be transformative. Many Thais are already enthusiastic participants in group exercises in parks, temple grounds, and through national campaigns such as “ออกกำลังกายเพื่อสุขภาพ.” For those suffering chronic digestive issues, such as in Bangkok’s densely populated neighborhoods or among elderly rural populations with limited mobility, tailored, moderate physical activities could significantly alleviate symptoms and improve quality of life. But the message of caution is equally important: more is not always better, especially for those with a history of GI trouble.
Digestive diseases—ranging from reflux, IBS, IBD, to liver and pancreatic disorders—affect the gastrointestinal tract, including organs such as the stomach, small and large intestine, liver, and pancreas (Wikipedia). In Thai society, diet, stress, and lifestyle are deeply intertwined. The blend of traditional eating patterns and modern, more sedentary habits means GI health is a pressing public health matter. Thai herbal remedies for digestion abound, but integrating exercise into daily life offers additional, science-backed protection.
Looking to the future, the study’s authors call for more research, particularly on how resistance training and novel interventions—such as whole-body vibration therapy, now being trialed in Crohn’s disease patients (PubMed)—might benefit those with specific GI conditions. Digital health solutions and prehabilitation (pre-surgical optimization with exercise and nutrition) are also showing promise in boosting digestive and overall health outcomes (PubMed).
For now, the take-home message is clear: Thai readers seeking better gut health should aim for regular, moderate physical activity, listen to their bodies, and consult medical professionals before embarking on intensive training, especially if they have a history of digestive disease. Community support, accessible public spaces, and culturally sensitive health education are key to translating this research into lasting change.
For practical steps, Thais can start simply: take daily walks in the cool hours of morning or after the heat subsides, join local aerobics groups, practice gentle yoga, or participate in traditional activities like รำวง (ramwong dance). Those with existing digestive conditions are advised to discuss exercise plans with their doctors to find the right balance. Ultimately, ยิ่งขยับ ยิ่งแข็งแรง—the more we move, the healthier our gut, and the brighter our future.
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