Moderate continuous versus high-intensity interval training on gut dysbiosis and glucagon-like peptide hormone in irritable bowel syndrome

Marwa Saeed Mohamed Mansour Salama; Donia Mohamed El Masry; Alaa Mohamed El-Moatasem; Reham Assem Zeyada; Mona Ahmed Mohamed Abouelhassan; Nesreen Ghareeb Elnahas

doi:10.2478/advrehab-2026-0005

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Moderate continuous versus high-intensity interval training on gut dysbiosis and glucagon-like peptide hormone in irritable bowel syndrome

Advances in Rehabilitation

Volume 40 (2026): Issue 1 (March 2026)

By: Marwa Saeed Mohamed Mansour Salama , Donia Mohamed El Masry , Alaa Mohamed El-Moatasem , Reham Assem Zeyada , Mona Ahmed Mohamed Abouelhassan and Nesreen Ghareeb Elnahas

Open Access

|Mar 2026

Abstract

Introduction

Regular physical activity is critical in maintaining or restoring gut microbiota equilibrium, potentially ameliorating gut dysbiosis (GD) associated with obesity. Our objective is to evaluate and compare the impacts of moderate-intensity interval training (MICT) and high-intensity interval training (HIIT) on GD and glucagon-like peptide-1 (GLP-1) levels in patients with irritable bowel syndrome (IBS).

Materials and methods

Sixty-six participants diagnosed with IBS of both sexes with a body mass index (BMI) of 30–34.9 kg/m², 30–39 years, prediabetic status and a sedentary lifestyle were randomly and equally assigned into groups A (MICT + low FODMAP diet [LFD]), B (HIIT + LFD) and C (control; LFD only). The intervention lasted for 12 weeks, and training was performed on a treadmill. All groups underwent pre- and post-treatment assessments measuring serum GLP-1 concentrations, faecal short-chain fatty acids (SCFAs), IBS symptom severity (IBS severity scoring system [IBSSS]), quality of life (IBS-QoL questionnaire) and anthropometric parameters, including weight and height.

Results

Significant improvements in BMI, SCFA levels (acetate, propionate and butyrate), IBSSS and IBS-QoL scores (for all p < 0.001) were observed in Group A. In contrast, Group B exhibited significant increases in GLP-1 levels compared to the other groups (p < 0.001).

Conclusions

Both MICT and HIIT, when combined with an LFD, confer distinct benefits in managing IBS. MICT demonstrated superior effects on reducing BMI, improving SCFA profiles and alleviating symptom severity, while HIIT was more effective in enhancing GLP-1 secretion. These findings support the use of tailored exercise interventions based on individual therapeutic goals in IBS management.

References

Hou K, Wu ZX, Chen XY, Wang JQ, Zhang D, Xiao C, et al. Microbiota in health and diseases. Signal Transduct Target Ther. 2022;7(1):135. doi: 10.1038/s41392-022-00974-4.
Open DOI Search in Google Scholar Back to article
Colella M, Charitos IA, Ballini A, Cafiero C, Topi S, Palmirotta R, et al. Microbiota revolution: how gut microbes regulate our lives. World J Gastroenterol. 2023;29(28):4368–83. doi: 10.3748/wjg.v29.i28.4368.
Open DOI Search in Google Scholar Back to article
Kim S, Seo SU, Kweon MN. Gut microbiota-derived metabolites tune host homeostasis fate. Semin Immunopathol. 2024;46(1):2. doi: 10.1007/s00281-024-01012-x.
Open DOI Search in Google Scholar Back to article
Zhang D, Jian YP, Zhang YN, Li Y, Gu LT, Sun HH, et al. Short-chain fatty acids in diseases. Cell Commun Signal. 2023;21(1):212. doi: 10.1186/s12964-023-01219-9.
Open DOI Search in Google Scholar Back to article
O'Riordan KJ, Collins MK, Moloney GM, Knox EG, Aburto MR, Fülling C, et al. Short chain fatty acids: microbial metabolites for gut-brain axis signalling. Mol Cell Endocrinol. 2022;546:111572. doi: 10.1016/j.mce.2022.111572.
Open DOI Search in Google Scholar Back to article
Portincasa P, Bonfrate L, Vacca M, De Angelis M, Farella I, Lanza E, et al. Gut Microbiota and short chain fatty acids: implications in glucose homeostasis. Int J Mol Sci. 2022;23(3). doi: 10.3390/ijms23031105.
Open DOI Search in Google Scholar Back to article
Hrncir T. Gut microbiota dysbiosis: triggers, consequences, diagnostic and therapeutic options. Microorganisms. 2022;10(3). doi: 10.3390/microorganisms10030578.
Open DOI Search in Google Scholar Back to article
Wang L, Alammar N, Singh R, Nanavati J, Song Y, Chaudhary R, et al. Gut microbial dysbiosis in the irritable bowel syndrome: a systematic review and meta-analysis of case-control studies. J Acad Nutr Diet. 2020;120(4):565–86. doi: 10.1016/j.jand.2019.05.015.
Open DOI Search in Google Scholar Back to article
Boulos M, Mousa RS, Jeries N, Simaan E, Alam K, Bulus B, et al. Hidden in the fat: unpacking the metabolic tango between metabolic dysfunction-associated steatotic liver disease and metabolic syndrome. Int J Mol Sci. 2025;26(7):3448. doi: 10.3390/ijms26073448.
Open DOI Search in Google Scholar Back to article
Acevedo-Román A, Pagán-Zayas N, Velázquez-Rivera LI, Torres-Ventura AC, Godoy-Vitorino F. Insights into gut dysbiosis: inflammatory diseases, obesity, and restoration approaches. Int J Mol Sci. 2024;25(17):9715. doi: 10.3390/ijms25179715.
Open DOI Search in Google Scholar Back to article
Napolitano M, Fasulo E, Ungaro F, Massimino L, Sinagra E, Danese S, et al. Gut dysbiosis in irritable bowel syndrome: a narrative review on correlation with disease subtypes and novel therapeutic implications. Microorganisms. 2023;11(10). doi: 10.3390/microorganisms11102369.
Open DOI Search in Google Scholar Back to article
Varghese S, Rao S, Khattak A, Zamir F, Chaari A. Physical exercise and the gut microbiome: a bidirectional relationship influencing health and performance. Nutrients. 2024;16(21). doi: 10.3390/nu16213663.
Open DOI Search in Google Scholar Back to article
Cataldi S, Bonavolontà V, Poli L, Clemente FM, De Candia M, Carvutto R, et al. The relationship between physical activity, physical exercise, and human gut microbiota in healthy and unhealthy subjects: a systematic review. Biology. 2022;11(3). doi: 10.3390/biology11030479.
Open DOI Search in Google Scholar Back to article
Aragón-Vela J, Solis-Urra P, Ruiz-Ojeda FJ, Álvarez-Mercado AI, Olivares-Arancibia J, Plaza-Diaz J. Impact of exercise on gut microbiota in obesity. Nutrients. 2021;13(11). doi: 10.3390/nu13113999.
Open DOI Search in Google Scholar Back to article
Bubnov R, Spivak M. Pathophysiology based individualized use of probiotics and prebiotics for metabolic syndrome: implementing predictive, preventive, and personalized medical approach. Advances in predictive, preventive and personalised medicine—microbiome in 3P medicine strategies. Cham: Springer International Publishing; 2023. p. 133–96.
Search in Google Scholar Back to article
Gao C, Wei J, Lu C, Wang L, Dong D, Sun M. A new perspective in intestinal microecology: lifting the veil of exercise regulation of cardiometabolic diseases. Gut Microbes. 2024;16(1):2404141. doi: 10.1080/19490976.2024.2404141.
Open DOI Search in Google Scholar Back to article
Ribichini E, Scalese G, Cesarini A, Mocci C, Pallotta N, Severi C, et al. Exercise-induced gastrointestinal symptoms in endurance sports: a review of pathophysiology, symptoms, and nutritional management. Dietetics. 2023;2(3):289–307. doi: 10.3390/dietetics2030021.
Open DOI Search in Google Scholar Back to article
Al-Beltagi M, Saeed NK, Bediwy AS, El-Sawaf Y, Elbatarny A, Elbeltagi R. Exploring the gut-exercise link: a systematic review of gastrointestinal disorders in physical activity. World J Gastroenterol. 2025;31(22):106835. doi: 10.3748/wjg.v31.i22.106835.
Open DOI Search in Google Scholar Back to article
Rojas-Valverde D, Bonilla DA, Gómez-Miranda LM, Calleja-Núñez JJ, Arias N, Martínez-Guardado I. Examining the interaction between exercise, gut microbiota, and neurodegeneration: future research directions. Biomedicines. 2023;11(8). doi: 10.3390/biomedicines11082267.
Open DOI Search in Google Scholar Back to article
Bycura D, Santos AC, Shiffer A, Kyman S, Winfree K, Sutliffe J, et al. Impact of different exercise modalities on the human gut microbiome. Sports (Basel). 2021;9(2). doi: 10.3390/sports9020014.
Open DOI Search in Google Scholar Back to article
Lavin KM, Coen PM, Baptista LC, Bell MB, Drummer D, Harper SA, et al. State of knowledge on molecular adaptations to exercise in humans: historical perspectives and future directions. Compr Physiol. 2022;12(2):3193–279. doi: 10.1002/cphy.c200033.
Open DOI Search in Google Scholar Back to article
Suryani D, Subhan Alfaqih M, Gunadi JW, Sylviana N, Goenawan H, Megantara I, et al. Type, intensity, and duration of exercise as regulator of gut microbiome profile. Curr Sports Med Rep. 2022;21(3):84–91. doi: 10.1249/jsr.0000000000000940.
Open DOI Search in Google Scholar Back to article
Han Y, Quan H, Ji W, Tian Q, Liu X, Liu W. Moderate-intensity continuous training and high-intensity interval training alleviate glycolipid metabolism through modulation of gut microbiota and their metabolite SCFAs in diabetic rats. Biochem Biophys Res Commun. 2024;735:150831. doi: 10.1016/j.bbrc.2024.150831.
Open DOI Search in Google Scholar Back to article
Hailu GN, Gebremariam MM, Meles HA. The role of exercise in alleviating irritable bowel syndrome (IBS) symptoms: addressing diagnostic challenges and management shortcomings. Egypt J Intern Med. 2025;37(1):32. doi: 10.1186/s43162-025-00424-x.
Open DOI Search in Google Scholar Back to article
Morariu ID, Avasilcai L, Vieriu M, Lupu VV, Morariu BA, Lupu A, et al. Effects of a low-FODMAP diet on irritable bowel syndrome in both children and adults - a narrative review. Nutrients. 2023;15(10). doi: 10.3390/nu15102295.
Open DOI Search in Google Scholar Back to article
Li C, Li J, Zhou Q, Wang C, Hu J, Liu C. Effects of physical exercise on the microbiota in irritable bowel syndrome. Nutrients. 2024;16(16). doi: 10.3390/nu16162657.
Open DOI Search in Google Scholar Back to article
Jayasinghe M, Karunanayake V, Mohtashim A, Caldera D, Mendis P, Prathiraja O, et al. The role of diet in the management of irritable bowel syndrome: a comprehensive review. Cureus. 2024;16(2):e54244. doi: 10.7759/cureus.54244.
Open DOI Search in Google Scholar Back to article
Yin Y, Guo Q, Zhou X, Duan Y, Yang Y, Gong S, et al. Role of brain-gut-muscle axis in human health and energy homeostasis. Front Nutr. 2022;9:947033. doi: 10.3389/fnut.2022.947033.
Open DOI Search in Google Scholar Back to article
Thomas-Dupont P, Velázquez-Soto H, Izaguirre-Hernández IY, Amieva-Balmori M, Triana-Romero A, Islas-Vázquez L, et al. Obesity contributes to inflammation in patients with IBS via complement component 3 and C-reactive protein. Nutrients. 2022;14(24). doi: 10.3390/nu14245227.
Open DOI Search in Google Scholar Back to article
Zeid W, Ezzeldeen E, Khattab M, Ahmed S, Abdo M. Effect of vitamin D3 (cholecalciferol) supplementation on gastrointestinal symptoms in patients with irritable bowel syndrome attending El-Mahsama family practice center, Ismailia, Egypt: a randomized clinical trial. Al-Azhar Intern Med J. 2020;1(7):37–42. doi: 10.21608/aimj.2020.32333.1254.
Open DOI Search in Google Scholar Back to article
Hou X, Chen S, Zhang Y, Sha W, Yu X, Elsawah H, et al. Quality of life in patients with irritable bowel syndrome (IBS), assessed using the IBS-quality of life (IBS-QOL) measure after 4 and 8 weeks of treatment with mebeverine hydrochloride or pinaverium bromide: results of an international prospective observational cohort study in Poland, Egypt, Mexico and China. Clin Drug Investig. 2014;34(11):783–93. doi: 10.1007/s40261-014-0233-y.
Open DOI Search in Google Scholar Back to article
Mytinger M, Nelson RK, Zuhl M. Exercise prescription guidelines for cardiovascular disease patients in the absence of a baseline stress test. J Cardiovasc Dev Dis. 2020;7(2):15. doi: 10.3390/jcdd7020015.
Open DOI Search in Google Scholar Back to article
Li Y, Zhao W, Yang Q. Effects of high-intensity interval training and moderate-intensity continuous training on mitochondrial dynamics in human skeletal muscle. Front Physiol. 2025;16:1554222. doi: 10.3389/fphys.2025.1554222.
Open DOI Search in Google Scholar Back to article
Mostafavi Abdolmaleky H, Zhou JR. Gut microbiota dysbiosis, oxidative stress, inflammation, and epigenetic alterations in metabolic diseases. Antioxidants. 2024;13(8):985. doi: 10.3390/antiox13080985.
Open DOI Search in Google Scholar Back to article
Bianco A, Russo F, Franco I, Riezzo G, Donghia R, Curci R, et al. Enhanced physical capacity and gastrointestinal symptom improvement in Southern Italian IBS patients following three months of moderate aerobic exercise. J Clin Med. 2023;12(21). doi: 10.3390/jcm12216786.
Open DOI Search in Google Scholar Back to article
Dalton A, Mermier C, Zuhl M. Exercise influence on the microbiome-gut-brain axis. Gut Microbes. 2019;10(5):555–68. doi: 10.1080/19490976.2018.1562268.
Open DOI Search in Google Scholar Back to article
Skrzydło-Radomańska B, Prozorow-Król B, Cichoż-Lach H, Majsiak E, Bierła JB, Kosikowski W, et al. The Effectiveness of synbiotic preparation containing lactobacillus and bifidobacterium probiotic strains and short chain fructooligosaccharides in patients with diarrhea predominant irritable bowel syndrome - a randomized double-blind, placebo-controlled study. Nutrients. 2020;12(7). doi: 10.3390/nu12071999.
Open DOI Search in Google Scholar Back to article
Gevers D, Kugathasan S, Denson Lee A, Vázquez-Baeza Y, Van Treuren W, Ren B, et al. The treatment-naive microbiome in new-onset Crohn's disease. Cell Host Microbe. 2014;15(3):382–92. doi: 10.1016/j.chom.2014.02.005.
Open DOI Search in Google Scholar Back to article
Motiani KK, Collado MC, Eskelinen JJ, Virtanen KA, Löyttyniemi E, Salminen S, et al. Exercise training modulates gut microbiota profile and improves endotoxemia. Med Sci Sports Exerc. 2020;52(1):94–104. doi: 10.1249/mss.0000000000002112.
Open DOI Search in Google Scholar Back to article
Fani M, Mostamand J, Fani M, Chitsaz N, Feizi A. The effect of aerobic exercises among women with mild and moderate irritable bowel syndrome: a pilot study. J Bodyw Mov Ther. 2019;23(1):161–5. doi: 10.1016/j.jbmt.2018.02.003.
Open DOI Search in Google Scholar Back to article
Groenendijk DW, Witteman BJ, Mulder BC. The experiences of female IBS patients concerning physical activity as treatment modality: a qualitative study. Qual Health Res. 2022;32(11):1690–700. doi: 10.1177/10497323221110109.
Open DOI Search in Google Scholar Back to article
Allen JM, Mailing LJ, Niemiro GM, Moore R, Cook MD, White BA, et al. Exercise alters gut microbiota composition and function in lean and obese humans. Med Sci Sports Exerc. 2018;50(4):747–57. doi: 10.1249/mss.0000000000001495.
Open DOI Search in Google Scholar Back to article
Huang L, Li T, Zhou M, Deng M, Zhang L, Yi L, et al. Hypoxia improves endurance performance by enhancing short chain fatty acids production via gut microbiota remodeling. Front Microbiol. 2022;12:820691. doi: 10.3389/fmicb.2021.820691.
Open DOI Search in Google Scholar Back to article
Chen S, Shen C, Zeng X, Sun L, Luo F, Wan R, et al. Energy metabolism and the intestinal barrier: implications for understanding and managing intestinal diseases. Front Microbiol. 2025;16:1515364. doi: 10.3389/fmicb.2025.1515364.
Open DOI Search in Google Scholar Back to article
Nikolaki MD, Kasti AN, Katsas K, Petsis K, Lambrinou S, Patsalidou V, et al. The low-FODMAP diet, IBS, and BCFAs: exploring the positive, negative, and less desirable aspects - a literature review. Microorganisms. 2023;11(10). doi: 10.3390/microorganisms11102387.
Open DOI Search in Google Scholar Back to article
Farup PG, Rudi K, Hestad K. Faecal short-chain fatty acids - a diagnostic biomarker for irritable bowel syndrome? BMC Gastroenterol. 2016;16(1):51. doi: 10.1186/s12876-016-0446-z.
Open DOI Search in Google Scholar Back to article
Duncan SH, Belenguer A, Holtrop G, Johnstone AM, Flint HJ, Lobley GE. Reduced dietary intake of carbohydrates by obese subjects results in decreased concentrations of butyrate and butyrate-producing bacteria in feces. Appl Environ Microbiol. 2007;73(4):1073–8. doi: 10.1128/aem.02340-06.
Open DOI Search in Google Scholar Back to article
Magzal F, Shochat T, Haimov I, Tamir S, Asraf K, Tuchner-Arieli M, et al. Increased physical activity improves gut microbiota composition and reduces short-chain fatty acid concentrations in older adults with insomnia. Sci Rep. 2022;12(1):2265. doi: 10.1038/s41598-022-05099-w.
Open DOI Search in Google Scholar Back to article
Dombrowski SU, Knittle K, Avenell A, Araújo-Soares V, Sniehotta FF. Long term maintenance of weight loss with non-surgical interventions in obese adults: systematic review and meta-analyses of randomised controlled trials. BMJ. 2014;348:g2646. doi: 10.1136/bmj.g2646.
Open DOI Search in Google Scholar Back to article
Sales KM, Reimer RA. Unlocking a novel determinant of athletic performance: The role of the gut microbiota, short-chain fatty acids, and “biotics” in exercise. J Sport Health Sci. 2023;12(1):36–44. doi: 10.1016/j.jshs.2022.09.002.
Open DOI Search in Google Scholar Back to article
Wewege M, van den Berg R, Ward RE, Keech A. The effects of high-intensity interval training vs. moderate-intensity continuous training on body composition in overweight and obese adults: a systematic review and meta-analysis. Obes Rev. 2017;18(6):635–46. doi: 10.1111/obr.12532.
Open DOI Search in Google Scholar Back to article
Hu M, Kong Z, Shi Q, Nie J. Acute effect of high-intensity interval training versus moderate-intensity continuous training on appetite-regulating gut hormones in healthy adults: a systematic review and meta-analysis. Heliyon. 2023;9(2):e13129. doi: 10.1016/j.heliyon.2023.e13129.
Open DOI Search in Google Scholar Back to article
Matos VA, Souza DC, Santos VO, Medeiros ÍF, Browne RA, Nascimento PR, et al. Acute effects of high-intensity interval and moderate-intensity continuous exercise on GLP-1, appetite and energy intake in obese men: A crossover trial. Nutrients. 2018;10(7):889. doi: 10.3390/nu10070889.
Open DOI Search in Google Scholar Back to article

Articles in this issue

DOI: https://doi.org/10.2478/advrehab-2026-0005 | Journal eISSN: 1734-4948

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Language: English

Page range: 69 - 86

Submitted on: Jun 25, 2025

Accepted on: Nov 7, 2025

Published on: Mar 31, 2026

Published by: University of Physical Education in Warsaw

In partnership with: Paradigm Publishing Services

Publication frequency: 4 issues per year

Keywords:

irritable bowel syndrome,

gut microbiota,

glucagon-like peptide-1,

exercise therapy,

high-intensity interval training

Related subjects:

Medicine,

Clinical medicine,

Physical and rehabilitation medicine,

Rheumatology,

Cardiology,

Sports and recreation,

Sports and recreation, other

© 2026 Marwa Saeed Mohamed Mansour Salama et al., published by Józef Piłsudski University of Physical Education in Warsaw
This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

Volume 40 (2026): Issue 1 (March 2026)