Prevention and Management of Exercise-Associated Gastrointestinal Perturbations: Evidence-Based Guidelines for Practitioners

Background: Exercise can disturb various aspects of gastrointestinal integrity and function through pathophysiological mechanisms collectively termed exercise-induced gastrointestinal syndrome. These perturbations can lead to exercise-associated gastrointestinal symptom inconveniences that impact physical performance, may require medical intervention, and in severe cases can produce systemic responses leading to fatality. Athlete support practitioners require evidence-based prevention and management strategies for these conditions, yet the translation of research findings into practical guidance remains challenging due to individual variability and the complexity of underlying mechanisms. Methods: This position statement critically appraises the evidence base for prevention and management strategies addressing exercise-induced gastrointestinal syndrome and associated symptoms. A comprehensive review of peer-reviewed literature was conducted, synthesizing findings from sports nutrition, gastroenterology, and exercise physiology. Intervention strategies were systematically evaluated for evidence consistency and practical applicability, with recommendations graded according to strength of supporting evidence. Results: Strategies demonstrating mostly consistent beneficial outcomes include appropriate macronutrient intake (carbohydrate and protein) and maintenance of euhydration before and during exercise, dietary manipulation of fermentable oligosaccharides, disaccharides, monosaccharides, and polyols, and gut training or feeding tolerance adjustments for managing symptoms arising from functional gastrointestinal issues. Strategies showing promising but preliminary evidence include heat mitigation approaches and certain nutritional supplements such as prebiotics and phenols. Interventions associated with negative outcomes include low-carbohydrate high-fat diets, probiotic supplementation, pharmaceutical interventions, and feeding intolerances. Individual variability in responses to all interventions is substantial, necessitating personalized approaches. Conclusion: Athletes and practitioners are encouraged to undertake individualized gastrointestinal assessment during exercise to identify underlying causal and exacerbating factors. Evidence-based strategies should be adopted based on individual beneficial outcomes, while interventions with unclear or adverse outcomes should be avoided. Future research should prioritize understanding mechanisms underlying individual variability and developing validated assessment tools for personalized prescription.

کلیدواژه ها:

Exercise-induced gastrointestinal syndrome ، Gastrointestinal symptoms ، Sports nutrition ، FODMAP ، Gut training ، Athlete health