Exercise and Heartburn

Exercise and Heartburn: Techniques to Alleviate Exercise-Induced Heartburn

Maintaining a healthy weight is an important part of managing heartburn for many people. The recommended guidelines from the American College of Sports Medicine and the American Heart Association suggest all healthy adults aged 18 to 65 years need moderate-intensity aerobic physical activity for a minimum of 30 minutes, five days each week, or vigorous-intensity aerobic physical activity for a minimum of 20 minutes, three days each week¹.

For some people, physical activity can aggravate the symptoms of heartburn. This association between heartburn and exercise has been described in medical literature for nearly twenty years² and what is regularly seen with exercise-induced heartburn, is the more intense the exercise, the worse the symptoms. Based on a study on esophageal reflux and symptoms in conditioned runners, cyclists, and weightlifters with established reflux disease, researchers hypothesized that the straining associated with many weightlifting exercises increases pressure in the abdomen and forces acid from the stomach into the esophagus to cause heartburn³.

Based on research, most people shouldn't hesitate to exercise simply because they have heartburn, but rather a re-evaluation of exercise techniques could be needed. Following are basic tips for people concerned about the association between exercise and heartburn:

Physical Activity

Minimize high-impact exercises - Although it doesn't have to be eliminated from your routine, a type of exercise, such as jogging, can increase chances of suffering from acid reflux in some individuals. Try low-impact exercises such as riding a bike or walking, which should produce fewer acid reflux symptoms
Pursue aerobic exercises - If you do suffer from heartburn and have noticed that your symptoms get worse with intense exercise, but want to continue exercising, it would be wise to pursue aerobic types of exercise such as swimming, cycling and dancing, instead of resistance exercises such as weightlifting
Avoid pressure on your abdominal muscles - Exercises such as crunches and sit-ups place added pressure on the abdominal muscles, which can aggravate acid reflux
Gravity - Positions that reverse the natural gravity of digestion, such as headstands, can trigger heartburn
Relax with yoga - Yoga has been shown to help in the reduction of stress, which can aggravate heartburn symptoms. Look for positions that don't place emphasis on abdominal muscles or reverse the natural gravity of digestion, such as the Corpse- and the Easy Pose, rather than positions such as the Boat- and the Firefly Pose
Strengthen with Pilates - Pilates exercises are shown to strengthen and develop flexibility of your abdominal muscles. By toning these muscles, you may help to reduce heartburn symptoms

Dietary

Hydration - To aid digestion, drink plenty of water before and during your exercise routine
Try weakened sports drinks - The high concentration of carbohydrates found in most sports drinks may contribute to heartburn. Most sports drinks provide between 60 to 100 grams of carbohydrates per liter. Try diluting this in quarter intervals to see if a 3/4 strength or a 1/2 strength solution decreases your heartburn. Watered-down solutions will also leave the stomach faster, providing more rapid hydration benefits
Control quantity - Decrease the size of portions eaten prior to or during exercise. Reflux is more likely to occur when there is a lot of food in the stomach
Limit foods that fan the flames - Certain foods and beverages are more apt to cause heartburn than others. Moderate intake of citrus fruits and juices, chocolate, onions, peppermint, spearmint, fatty or spicy foods and caffeinated or carbonated beverages
Pass up protein and fat pre-work out - Food that's consumed less than two hours before exercising has a huge impact on the occurrence of heartburn. Pre-workout meals should be high in carbohydrates and low in fat and protein. Reserve the protein-rich meal for after the workout when it's important to repair/rebuild muscles
Time your meals - Exercising on a full stomach is not advisable, largely because it increases intra-abdominal pressure, which contributes to heartburn. Wait at least two hours after a meal before exercising

Medication
Over-the-counter drugs used to treat heartburn have few side effects and are tremendously effective. Most individuals who use heartburn medication will experience no drug-induced side effects. Furthermore, research has shown that taking over-the-counter heartburn medication before exercising can significantly reduce the incidence and severity of exercise-related heartburn.

Consider the following treatment options:

Over-the-counter remedies

Antacids - Neutralize existing stomach acid through basic chemical reaction
H2 blockers - partially block production of acid in the stomach by inhibiting the action of histamine, a substance that stimulates secretion of stomach acid
Proton Pump Inhibitors - most effectively inhibit stomach acid production by deactivating the acid pumps in the stomach

Prescription medication

H2 blockers - available by prescription at a higher dose than their OTC counterpart
Proton Pump Inhibitors - available by prescription at higher doses than their OTC counterpart

Consult Your Healthcare Provider
If you continue to experience heartburn symptoms brought on, or made worse by exercise you should consult your healthcare provider to consider starting or changing medications.

¹ The American College of Sports Medicine and the American Heart Association Physical Activity and Public Health: Updated Recommendation for Adults. Circulation 2007;116;1081-1093; originally published online Aug 1, 2007.

² Clark CS, Kraus BB, Sinclair J, Castell DO. Gastroesophageal reflux induced by exercise in healthy volunteers. JAMA 1989 261;3599-01.

³ Collings KL, Pratt P, Rodriguez-Stanley S, Bemben M, Miner PB. Esophageal reflux in conditioned runners, cyclists, and weightlifters. Med Sci Sports Exerc 2003;35(5): 730-5.