Exercise and Physical Therapy in IBD Care: What a 2026 Review Suggests

For people living with inflammatory bowel disease, conversations with gastroenterologists typically centre on medication, endoscopy findings, and managing flares. Exercise and physical therapy rarely come up. A 2026 clinical review published in Current Treatment Options in Gastroenterology asked whether that should change, and synthesised emerging evidence on the benefits of structured physical activity for IBD patients, particularly older adults and those preparing for bowel surgery.

What the Review Examined

The review (pubmed:42529538) focused on structured exercise and physical therapy as components of IBD care for older adults. Older adults with IBD represent a growing share of the patient population, and the review authors argue they face a compounding challenge: the simultaneous burden of aging, chronic gut inflammation, malnutrition, and physical inactivity often compounds into functional decline that worsens health across multiple dimensions.

The purpose of the review was to synthesise the available evidence and offer practical guidance for clinicians looking to incorporate exercise and physiotherapy into IBD care. The review describes this as early-stage evidence. Findings are promising but the evidence base is still developing, and the authors use appropriately cautious language throughout.

IBD and the Body Beyond the Gut

The NHS describes IBD as a group of long-term conditions causing inflammation in the digestive system, with Crohn's disease and ulcerative colitis as the two main forms. Beyond gut symptoms, IBD can cause what clinicians call extraintestinal manifestations (EIMs): complications that affect organs and systems outside the digestive tract.

Joint problems are among the most common EIMs. Arthropathy associated with IBD can involve the large peripheral joints of the legs and arms, or the spine. Fatigue is another frequent companion, stemming from a combination of inflammation, anaemia, disrupted sleep, and the psychological weight of a chronic condition. For older patients with IBD, these challenges can stack on top of age-related processes such as sarcopenia (loss of muscle mass and strength) and frailty, creating a compounding burden that limits daily function.

What the 2026 review highlights is that this combination, while clinically familiar, has not historically prompted a systematic clinical response in terms of exercise prescription and physiotherapy referral.

What Early Evidence Suggests About Exercise

The review reports that initial studies suggest structured exercise and physical therapy may significantly improve several of the musculoskeletal EIMs described above, including joint pain, fatigue, sarcopenia, and frailty, with outcomes comparing favourably to standard care alone.

This framing matters. The evidence base is still early. The word "suggest" and the phrase "initial studies" appear deliberately in the review's language, reflecting a literature of encouraging signals from relatively small studies rather than a completed body of large randomised controlled trials. Patients and clinicians should hold these findings with appropriate caution about how firmly they can be applied in individual cases.

What the review characterises as well established, however, is the general safety and accessibility of exercise as an intervention. Structured exercise and physiotherapy are described as low-cost and low-risk, with potential benefits spanning multiple domains, from musculoskeletal function to fatigue, mood, and overall physical capacity. For many IBD patients who have been implicitly cautious about physical activity (often out of concern about triggering a flare), this framing is worth noting.

Preparing for Surgery: The Case for Prehabilitation

For IBD patients who are facing planned bowel surgery, the review highlights a specific and particularly relevant area: prehabilitation.

Prehabilitation refers to a structured programme of preparation before a planned operation, typically combining physical exercise, nutritional support, and psychological preparation. The idea is that entering surgery in better physical condition leads to better recovery outcomes. The 2026 review reports evidence suggesting that multimodal prehabilitation strategies may significantly reduce severe postoperative complications and shorten hospital stays in older patients undergoing IBD-related surgery.

IBD-related surgery includes colectomy, resection of portions of the bowel, pouch formation, and, in a significant number of cases, stoma creation. Whether a stoma is to be permanent or temporary, the operation is a major surgical event, and recovery is meaningfully influenced by the patient's physical condition going in.

For someone preparing for surgery that may result in an ileostomy or colostomy, a prehabilitation programme might include:

• Graded walking or aerobic activity to improve cardiovascular fitness and reduce sarcopenia
• Targeted physiotherapy exercises to strengthen the muscles involved in recovery
• Nutritional support, particularly adequate protein intake, to reduce postoperative muscle loss
• Psychological preparation for both the surgery and, where relevant, adjustment to life with a stoma

The review frames these not as optional extras but as clinically meaningful components of the surgical pathway. While prehabilitation is more established in colorectal cancer surgery, its application in IBD surgery is an active area of growing interest.

A Gap Between Evidence and Practice

One of the most striking observations in the review concerns the persistent gap between available evidence and actual clinical practice. The authors note that most gastroenterologists report feeling inadequately equipped to counsel patients about physical function limitations, and that exercise and physiotherapy consequently remain underutilised in IBD care.

Gastroenterology consultations are typically structured around symptom management, medication optimisation, and endoscopic monitoring. Physical activity levels, exercise capacity, and physiotherapy referral can fall outside the regular scope of these conversations, particularly in busy outpatient settings. Patients may not raise the topic, and clinicians may not routinely screen for functional decline.

The review aims in part to address this by providing evidence-based assessment tools and physiotherapy referral pathways that gastroenterologists can incorporate into routine practice. This reflects a push toward a more integrated model of IBD care, one that attends to the whole patient rather than focusing exclusively on gastrointestinal disease control.

What This Means for IBD Patients

For people living with IBD, the review's main message is that exercise and physical therapy may have more to offer than has traditionally been communicated in clinical settings. If fatigue, joint pain, or reduced physical capacity are part of day-to-day experience with IBD, these are not simply background conditions to accept. They may be areas where appropriate, guided physical activity could make a meaningful difference.

The word "appropriate" matters here. IBD patients have genuine reasons to be thoughtful about activity, particularly during active flares or periods of severe symptoms. The early evidence the review synthesises comes from structured, supervised programmes, not ad hoc physical activity during acute illness. The type, intensity, and timing of exercise in IBD needs to be tailored to individual circumstances, and that is precisely where physiotherapy input is valuable.

For people preparing for IBD surgery, whether for the first time or as part of a planned subsequent procedure, asking a care team about prehabilitation options is a reasonable and evidence-informed step. The review suggests that better physical conditioning and nutritional status before the operation may meaningfully improve outcomes after it.

A Conversation Worth Starting

The 2026 review ultimately calls for a conversation that is not yet happening often enough: the integration of structured exercise and physical therapy into standard IBD care, particularly for older adults and those approaching surgery. The evidence is described as early and promising. The interventions are low-risk. And the functional decline that IBD patients, especially older adults, can experience is real and potentially modifiable.

If you have IBD and physical activity or physiotherapy has not come up in your care, the review's findings give you a starting point for raising it with your gastroenterologist or IBD nurse. If you are approaching bowel surgery, asking about prehabilitation options before the operation may be one of the most practical preparations you can make.