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Meta-Analysis
. 2021 Jan;51(1):113-124.
doi: 10.1007/s40279-020-01348-y.

The Effects of Exercise on Indirect Markers of Gut Damage and Permeability: A Systematic Review and Meta-analysis

Sarah Chantler  1   2 , Alex Griffiths  3 , Jamie Matu  4 , Glen Davison  5 , Ben Jones  3   6   7   8   9 , Kevin Deighton  3
Affiliations
Meta-Analysis

The Effects of Exercise on Indirect Markers of Gut Damage and Permeability: A Systematic Review and Meta-analysis

Sarah Chantler et al. Sports Med. 2021 Jan.

Abstract

Aim: Exercise appears to cause damage to the endothelial lining of the human gastrointestinal tract and elicit a significant increase in gut permeability.

Objective: The 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.

Methods: PubMed, 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.

Results: A 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.

Conclusions: These 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).

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Conflict of interest statement

There are no competing or conflicting interests for any of the authors in the planning, preparation and writing of this manuscript.

Figures

Fig. 1
Fig. 1
Flow chart of study selection [24]
Fig. 2
Fig. 2
Forest plot of standardised mean differences (means ± 95% confidence intervals [CIs]) for studies evaluating the influence of an acute exercise bout on concentrations of plasma i-FABP. The solid circle represents the ES (mean ± 95% CI) for the model. Dagger: studies with multiple arms with similar environmental conditions that have been combined to prevent overpowering of the study; (1, 2) represent studies with multiple arms that were analysed separately
Fig. 3
Fig. 3
Forest plot of standardised mean differences (means ± 95% CIs) for studies evaluating the influence of an acute exercise bout on the ratio of Lactulose and Rhamnose or Lactulose and Mannitol in the urine (disaccharide/monosaccharide). The solid circle represents the ES (mean ± 95% CI) for the model. ǂ, Studies with multiple arms with similar environmental conditions that have been combined to prevent overpowering of the study; a,b, represents different studies from the same author published in the same year; (1, 2) represents studies with multiple arms that were analysed separately; → shows value outside of the figure area and can be found in the raw data in the supplementary material
Fig. 4
Fig. 4
Summary of the risk of bias for all studies using the Cochrane tool [24]
See this image and copyright information in PMC

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