Physical activity for gallstones.
Article Type: Clinical report
Subject: Exercise (Methods)
Gallstones (Diagnosis)
Gallstones (Care and treatment)
Physical fitness (Management)
Author: Murphy, Kathleen
Pub Date: 03/22/2011
Publication: Name: Australian Journal of Medical Herbalism Publisher: National Herbalists Association of Australia Audience: Academic Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2011 National Herbalists Association of Australia ISSN: 1033-8330
Issue: Date: Spring, 2011 Source Volume: 23 Source Issue: 1
Topic: Event Code: 200 Management dynamics Computer Subject: Company business management
Geographic: Geographic Scope: Australia Geographic Code: 8AUST Australia
Accession Number: 254971779
Full Text: Banim P, Luben R, Wareham N et al. 2010. Physical activity reduces the risk of symptomatic gallstones: a prospective cohort study. Eur J Gastroenterol Hepatol 22;983-8.

Asymptomatic gallstones are present in 10-15% of the adult European population and each year approximately 2% of these will develop symptoms. Gallstones present with severe abdominal pain and certain complications including cholangitis and pancreatitis and can be fatal. Most gallstones are composed of cholesterol with their formation dependent on three pathophysiological mechanisms: super saturation of the bile with cholesterol, the formation of cholesterol micro crystals and gallbladder stasis.

Exercise reduces plasma triglycerides and insulin levels, both of which lead to a lower cholesterol saturation of the bile. Exercise has a prokinetic effect on the gut and increases cholecystokinin levels which stimulates gallbladder contractility and prevents bile stasis.

This study aimed to investigate the relationship between physical activity and symptomatic gallstones using a questionnaire validated against physiological parameters. A total of 25 639 men and women aged 40-74 years were recruited into the European Prospective Investigation of Cancer, Norfolk (EPIC-Norfolk) from 1993 to 1997.

At recruitment participants completed self administered questionnaires recording information on physical activity at work, home and during recreation (including the intensity and duration) and the number of flights of stairs climbed per day. From this a four level activity index was derived: inactive, moderately inactive, moderately active and active. Information at recruitment into EPIC-Norfolk was also recorded on medical history, medication, parity, weight, smoking and diet, including alcohol consumption. Body mass index (BMI) at recruitment was measured at a health check by a nurse. Only a single measure at baseline was taken of physical activity and other risk factors.

The cohort was monitored for the development of incident gallstone disease until June 2007, a follow up period of up to 14 years after recruitment. Cases of gallstones were excluded if participants had a history of gallstones, or developed gallstone disease within 18 months of recruitment.

The risk of gallstones after 5 years of follow up was significantly lower in the most active group compared with the inactive group, regardless of sex, after adjusting for covariates (HR=0.27, 95% confidence interval; CI=0.12-0.61).

The main finding of this study was that the highest level of physical activity was associated with a statistically significant 70% decreased risk of developing symptomatic gallstones at 5 years. The amount of physical activity in the highest category is equivalent to exercising for 1 hour a day if employed in a sedentary job. These findings should be considered for future studies investigating the etiology of gallstones to indicate the importance of considering physical activity as a preventative and treatment parameter.

Kathleen Murphy mnhaa
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