Abstract
AimExercise appears to cause damage to the endothelial lining of the human gastrointestinal tract and elicit a significant increase in gut permeability.ObjectiveThe aim of this review was to determine the effect of an acute bout of exercise on gut damage and permeability outcomes in healthy populations using a meta-analysis.MethodsPubMed, The Cochrane Library as well as MEDLINE, SPORTDiscus and CINHAL, via EBSCOhost were searched through February 2019. Studies were selected that evaluated urinary (ratio of disaccharide/monosaccharide excretion) or plasma markers [intestinal Fatty Acid Binding Protein (i-FABP)] of gut permeability and gut cell damage in response to a single bout of exercise.ResultsA total of 34 studies were included. A random-effects meta-analysis was performed, and showed a large and moderate effect size for markers of gut damage (i-FABP) (ES 0.81; 95% CI 0.63–0.98; n = 26; p < 0.001) and gut permeability (Disaccharide Sugar/Monosaccharide Sugar) (ES 0.70; 95% CI 0.29–1.11; n = 17; p < 0.001), respectively. Exercise performed in hot conditions (> 23 °C) further increased markers of gut damage compared with thermoneutral conditions [ES 1.06 (95% CI 0.88–1.23) vs. 0.66 (95% CI 0.43–0.89); p < 0.001]. Exercise duration did not have any significant effect on gut damage or permeability outcomes.ConclusionsThese findings demonstrate that a single bout of exercise increases gut damage and gut permeability in healthy participants, with gut damage being exacerbated in hot environments. Further investigation into nutritional strategies to minimise gut damage and permeability after exercise is required. PROSPERO database number (CRD42018086339).
Highlights
Increased gut permeability and gut endothelial damage have been observed in a variety of gastrointestinal and metabolic disorders [1, 2]
Multiple arms of certain studies with different environmental conditions resulted in a higher number of conditions for intestinal Fatty Acid Binding Protein (i-FABP) (n = 26) and disaccharide/monosaccharides ratios were grouped together (DS/MS) (n = 17) in the meta-analysis compared to total studies
Across the 34 included studies we observed a large and moderate effect size for increases in gut damage and gut permeability in response to a single bout of exercise, respectively. These findings support the current hypothesis that a bout of exercise is likely to induce damage to the endothelial lining and increase gut permeability in healthy people when compared with a resting control trial
Summary
Increased gut permeability and gut endothelial damage have been observed in a variety of gastrointestinal and metabolic disorders [1, 2]. Exercise has been shown to cause increased gut damage and gut permeability in healthy participants [3]. Decreased gut perfusion contributes to epithelial injury and alterations in endothelial tight junctions [3]. Further damage may come as a result of reperfusion post-exercise, which increases gut permeability. It is hypothesised that this cascade may increase gut symptoms, impair nutrient absorption and possibly increase in the risk of illness, with some preliminary evidence in support this [4, 5], all of which contribute negatively to wellbeing. At this point, robust evidence to support the full hypothesis is currently lacking
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