Adding walking exercise to the bowel cleansing procedure results in better colonic cleansing without increasing patient discomfort and should be recommended as part of routine colonoscopic bowel preparation in ambulatory outpatients, physicians in South Korea report.
“Adequate bowel preparation is one of the most difficult aspects of colonoscopy,” Dr. Hyun Soo Kim and colleagues note in their report in the American Journal of Gastroenterology for September 5. A key barrier to successful colonoscopy is inadequate bowel cleansing, with poor preparation increasing the risk of missed lesions, complications and a prolonged procedure time.Based on animal studies showing that exercise improved defecation, Dr. Kim, from Yonsei University Wonju College of Medicine in Seoul, and colleagues theorized that walking exercise would improve colonic cleansing. For their prospective study, they randomly assigned patients to walking exercise (n = 182) or to a nonexercise group (n = 174), with both groups drinking 2.5 to 3 L of polyethylene glycol solution (PEG).Those randomized to the walking exercise group were instructed to drink 250 mL of PEG and then walk at least 5 minutes at intervals of 10 minutes until they had finished consuming the PEG. Those in the nonexercise group drank 250 mL of PEG every 10 minutes, resting in between.Significantly more patients in the exercise group had excellent or good preparations (40.7% versus 25.3% in the nonexercise group. Multivariate analysis also showed that walking improved the proportion of satisfactory colonic cleansing (odds ratio 2.06; p = 0.003), regardless of the presence of constipation.Subgroup analysis showed walking to be of additional benefit in patients younger than 65 years old and in patients without obesity or a past history of abdominal or gynecologic surgery. Therefore, the authors advise, “walking exercise for colonoscopic bowel preparation should be recommended primarily for younger nonobese ambulatory patients without a history of abdominal or gynecological surgery.”(Source: Am J Gastroenterol 2005;100:1964-1969: Reuters Health: Oncolink: October 2005.)