Exercise and GERD

Gastroesophageal reflux disease (GERD) is a significant public health concern, impacting approximately one third of the population in the United States. GERD is characterized by the flow of acid from the stomach back into the esophagus, causing symptoms or potentially tissue damage after repeated or prolonged exposure. Most often, symptoms present as heartburn, a burning sensation behind the breastbone radiating to the neck or throat, or regurgitation, the sour or bitter taste of acidic fluid. Atypical symptoms such as cough, hoarseness, asthma, laryngitis, or chest pain may present, sometimes delaying diagnosis and proper treatment, and some may even present asymptomatic (Locke, 2019). If left untreated, GERD can lead to permanent tissue damage, Barrett’s esophagus, and cancer. Potential risk factors for GERD symptoms include smoking, pregnancy, heredity, obesity/overweight, hiatal hernia, and diet. For some, exercise may cause symptoms. The relationship between exercise and gastroesophageal reflux disease (GERD) is a double-edged sword in that for some it improves symptoms and for others it can exacerbate them.

In many cases, GERD results from relaxation or improper closing of the lower esophageal sphincter (LES). The esophagus is a long tube that is located behind the trachea and connects the pharynx, or throat, to the stomach. At the top, it has an upper esophageal sphincter (UES), which is a group of muscles that are used to control food when swallowing and to prevent food from going down the trachea. The LES is a group of muscles located at the bottom of the tube where the esophagus meets the stomach, functioning as a one-way valve to keep stomach acid contents from travelling in reverse.

Depending on the individual, exercise may improve GERD symptoms or it may precipitate them. Being overweight is a risk factor for having GERD due to pressure buildup on the stomach from adipose tissue. For those who are overweight, a 10% reduction in weight has been shown to reduce GERD symptoms (Colorito, 2018). One 2016 study of participants with general or abdominal obesity showed that a reduction in BMI of greater than 2 kg/m2 and a decreased abdominal circumference of greater than 5 cm resulted in improved GERD symptoms (Park et al., 2016). Still, GERD may occur in even the fittest of individuals. A 2016 study examining the possible mechanisms by which symptoms may occur in runners found that running caused transient LES relaxations that more often lead to GERD episodes than at rest, possibly due to increased abdominal pressure, decreased contractions of the esophagus, body movement, and changes in the shape of the area where the esophagus meets the stomach (Herregods et al., 2016).

Gulping air when breathing during exercise and high-impact exercises that restrict body movement and put pressure on the abdomen, work against gravity (e.g., hanging upside down), or result in bending for long periods of time may worsen GERD symptoms. Such exercises include running, sprinting, weightlifting, gymnastics, cycling, jumping rope, and stair-climbing (McDermott, 2017).

If GERD or heartburn symptoms are something you experience with or without exercise, please consult a doctor or medical professional. Regardless, the benefits of exercise on overall health are significant, and dietary changes and losing extra weight are often common lifestyle recommendations (McDermott, 2017). Some other lifestyle changes known to reduce GERD symptoms include:

• Remove triggers from the diet (e.g., spicy foods, fatty foods, chocolate, alcohol, etc.)
• Quit smoking
• Avoid laying down or exercising for 2-3 hours after eating (If you must eat before exercising, be mindful whether it is something easily digestible.)
• Eat smaller meals and consider a slower pace
• Elevate the head of the bed at night
• Avoid exercises that cause gravity to work against you, such as planks (laying flat), hinges, or declined movements (Munson, 2020)
• Avoid exercises that put increased pressure on the abdomen such as crunches
• Reduce the amount of liquid prior to or during exercise and avoid using a straw (The extra fluid in the stomach sloshing around could increase abdominal pressure. Do stay hydrated but perhaps reconsider filling up on that pre-workout; the gist is, just take it easy on the liquids to keep them from coming back up as reflux.)
• Avoid tight-fitting clothing that may put pressure on the abdomen

Listen to your body and be mindful of its needs. In addition to a medical professional consult, it may be wise to swap out workouts for exercises that are low-impact. Such exercises may include, walking, light jogging, swimming, stationary biking, or yoga (McDermott, 2017). There are over-the-counter medications that may aid GERD symptoms. Please consult a doctor for an assessment and to discuss the proper medical plan that would be best for you. If you are working with a personal trainer and are experiencing symptoms, please let them know so that they can tailor workouts to best fit your needs.