Effect of physical exercise on esophageal motility in patients with esophageal disease

Abstract

The most common type of esophageal dysfunction associated with chest pain is gastroesophageal reflux, which may be induced by exercise. The effect of exercise on esophageal function has mainly been investigated in normal subjects or trained athletes. Few studies have investigated exercise and esophageal motility disorders. One hundred and thirty-five patients underwent ambulatory esophageal manometry and pH monitoring, before, during and immediately after moderate exercise. Patients were divided into four groups: Normal, nutcracker, diffuse spasm and gastroesophageal reflux disease (GERD). Ambulatory manometry and pH were monitored while exercising on a treadmill during which standardized boluses of water were administered. Nutcracker and diffuse spasm patients demonstrated a significant fall in esophageal wave amplitude during exercise compared to controls, which returned rapidly to pre exercise values after resting. There was no evidence of acid reflux in the non-reflux groups during exercise. Reflux was noted in 13 patients with GERD during exercise, none of whom had evidence of reflux at the onset of exercise. When these patients were classified by reflux type, the majority, 11 patients, were found to come from the combined or supine reflux group. Esophageal amplitude in nutcracker esophagus does not increase during moderate exercise. Moderate exercise provokes reflux in GERD patients with combined or supine reflux.

Upright Positive Expiratory Pressure Therapy and Exercise: Effects on Gastroesophageal Reflux in COPD and Bronchiectasis

“…The consistency of pace during walking may also be important. Ravi et al 20 found treadmill based walking at 1 km/h and 4.2 km/h associated with reflux events, although no analysis of BGT versus exercise time was undertaken, making comparisons with the current study limited. Despite this limitation, the need to maintain a continual speed on a treadmill, even at a slow rate, may have contributed to the raised frequency of reflux events.…”

“…Despite this limitation, the need to maintain a continual speed on a treadmill, even at a slow rate, may have contributed to the raised frequency of reflux events. 20 In contrast, participants in the current study were permitted to vary the pace during the 6MWT, according to their physical limitations. While the intensity of the 6MWT was likely to be limited by respiratory symptoms in some patients, the instructions for the test included directions to "cover as much distance as possible in 6 minutes."…”

“…First, meeting the diagnostic criteria for increased GER (DeMeester score Ͼ 14.72 and/or proximal RI Ͼ 0.9%) 29,30 may be important. Previous studies demonstrated that both steady paced and brisk treadmill walking were associated with increased reflux episodes in individuals with confirmed GER, 20 but not in healthy individuals without GER. 21 The small proportion of participants (10 with COPD, 12 with bronchiectasis) diagnosed with increased GER in the current study may account for the reduced frequency of reflux episodes during the 6MWT, compared to BGT.…”

“…Each 6MWT was performed in 6 minutes (12 min in total), while the time required for the complete GST protocol ranged from 8 to 13 min. Similar exercise protocols responsible for provoking reflux have been completed in Ͼ 15 min, 20,37 and exercise duration may be an important factor in inducing GER events during these activities.…”

“…11,20,21 Physical exercise incorporating lower and upper limb function is frequently applied in patients with COPD and patients with bronchiectasis, with the intensity based on standardized measures of submaximal endurance capacity and functional upper limb movements. 4,19,22 The impact of these exercise activities on GER events in these patient populations is unknown.…”