title: Effect of bending exercise on gastroesophageal reflux in symptomatic patients.
abstract: BACKGROUND
  Recumbency and bending are thought to provoke symptoms of reflux in patients with gastroesophageal reflux disease (GERD). The effect of exercise which involved bending and abdominal contractions was evaluated in symptomatic patients of GERD using continuous 24-hour ambulatory esophageal pH test.
  
  
  METHODS
  Twenty-five patients with GERD, confirmed by abnormal 24-hour esophageal pH study, performed exercise for 30 minutes consisting of 5 sessions of 6 minutes each. The exercise involved toe touching from supine, sitting and standing position of 2 minutes' duration each. Each 2 minutes' period included 8 repetitions of the same exercise of 15 seconds' duration. 24-hour esophageal pHmetry was done on day 1 without exercise and on day 2 with 30-minute exercise. Reflux time percent (RT%) pH <4 was compared between days 1 and 2 and 30 minutes before and during exercise.
  
  
  RESULTS
  Fourteen patients were upright refluxers and 11 patients were combined refluxers, which included 4 patients with supine reflux and 7 patients who refluxed both in supine and upright positions. The median (range) 24-hour RT% on day 1 and day 2 was 7 (5-40) and 7 (4-46), respectively (p=0.15). RT% during 30 minutes exercise compared with 30 minutes before exercise was 6.6 (0-60) and 0.0 (0.0-80) (p=0.02), respectively. In combined and upright refluxers, RT% during and before exercise was 13 (0-53) and 0.0 (0.0-42) (p=0.008), respectively and 0.0 (0-60) and 0.0 (0-80), (p=0.71), respectively. RT% between upright and combined refluxers during exercise was 0.0 (0-60) and 13 (0-53), respectively (p=0.004). The mean (SD) LES pressure in mmHg in combined and upright refluxers was 7 (2.9) and 19.6 (6.8), respectively (p=0.008). Esophagitis in combined and upright refluxers was seen in 8 patients (72.7%) and 2 patients (14.3%), respectively. Two patients (8%) developed symptoms during exercise.
  
  
  CONCLUSIONS
  Exercise which involves bending precipitates reflux in patients with moderate-to-severe GERD.
authors.affiliation: Department of Gastroenterology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India.
authors.forename: Jaswinder Singh
authors.initials: JS
authors.lastname: Sodhi
authors.forename: Showkat Ali
authors.initials: SA
authors.lastname: Zargar
authors.forename: Gul
authors.initials: G
authors.lastname: Javid
authors.forename: Mushtaq A
authors.initials: MA
authors.lastname: Khan
authors.forename: Bashir A
authors.initials: BA
authors.lastname: Khan
authors.forename: G N
authors.initials: GN
authors.lastname: Yattoo
authors.forename: Altaf
authors.initials: A
authors.lastname: Shah
authors.forename: G M
authors.initials: GM
authors.lastname: Gulzar
authors.forename: Abid
authors.initials: A
authors.lastname: Shoukat
mesh_terms: D000328:Adult; D016009:Chi-Square Distribution; D015444:Exercise / Q000502:physiology*; D005260:Female; D005764:Gastroesophageal Reflux / Q000503:physiopathology*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008365:Manometry; D018670:Monitoring, Ambulatory; D018709:Statistics, Nonparametric