Physical Activity for Disease Prevention & Healthy Gut Microbiome

A 2017 Czech study1 looked at the importance of exercise for maintaining optimal health, preventing/treating chronic diseases, and ensuring the well-being of our gut microbiota.

Effective & low-cost prescriptions

Movement is a basic factor of life and the importance of regular physical activity is both a very effective and cheap means of preventing and treating most non-communicable diseases.

When you go to visit your doctor, he or she should consider prescribing suitable physical activity as part of the first line of treatment.

How much exercise is enough?

The minimum* amount of physical activity with proven effects in primary prevention of chronic diseases is relatively low:

  • 150 minutes of moderate physical activity, or
  • 75 minutes of high intensity exercise per week, or
  • a combination of the two.

*See below for Dr Greger’s view on how much daily exercise we need.

What’s the simplest & safest form of exercise?

The simplest and safe way of physical activity is walking:

  • at least 10 000 steps/day, or
  • 6 000 steps/day on top of daily activities

Using FITT  to keep fit

The FITT model2  is a more sophisticated way of prescribing physical activity that already requires a stress test. A 2015 study3 looked at the use of FITT for stroke recovery.

Non-communicable diseases and exercise

People with the following physiological conditions have been seen to benefit from exercise:

  • those at risk of atherosclerosis4 or the following manifestations of atherosclerosis:
    • coronary artery disease5
    • post-stroke6
    • peripheral artery disease7
    • chronic heart failure8
  • lung disease:
    • COPD9
    • asthma10
  • metabolic diseases:
    • type 2 diabetes11
    • obesity12
    • osteoporosis13
    • rheumatologic diseases14
    • prostate cancer15 16

Psychological benefits of exercise

Regular exercise has been shown to improve outcomes/symptoms in the following ways:

  • improvement of cognitive function17
  • reduction of depression18
  • reduction of anxiety19
  • reduction of addictions20

Gut microbiome and exercise

Recently, it has been shown21 22 23 24 that exercise also changes the gut microbiome25 .

Myokine magic

One of the mechanisms thought to contribute to the beneficial effect of exercise is so-called “exercise factors”, namely myokines. These are one of several hundred cytokines (any of a number of substances, such as interferon, interleukin, and growth factors, which are secreted by certain cells of the immune system and have an effect on other cells). They are produced and released by muscle cells (myocytes) in response to muscular contractions.

A 2014 review26 looked at the current understanding of the positive effects of exercise-induced myokines on metabolic diseases. An earlier study27 discussed IL-6 (Interleukin 6 is an interleukin that acts as both a pro-inflammatory cytokine and an anti-inflammatory myokine, and in humans is encoded by the IL6 gene). This was the first myokine discovered, although many more have since been identified. The authors suggested that myokines may be involved in mediating the health-beneficial effects of exercise and that these in particular are involved in the protection against chronic diseases associated with low-grade inflammation such as diabetes and cardiovascular diseases. The gut microbiome is affected by exercise, being that it is linked to pretty much all systems within the body.

A February 2015 review28 looked at the proposal that physical exercise is able to modify gut microbiota, and thus that this could be another factor by which exercise promotes well-being, since gut microbiota appears to be closely related to health and disease. they review recent findings on gut microbiota modification by exercise, proposing several mechanisms by which physical exercise might cause changes in gut microbiota. Figures 1 and 2 are diagrams from their report.

A June 2017 study29 demonstrated that exercise-trained mice had altered gut microbiota compared with non-exercised mice. The exercise resulted in “…an attenuated response to chemical colitis, evidenced by reduced colon shortening, attenuated mucus depletion and augmented expression of cytokines involved in tissue regeneration.”  They concluded that: “…Exercise-induced modifications in the gut microbiota can mediate host-microbial interactions with potentially beneficial outcomes for the host.”  This study and a subsequent study on human subjects is discussed in more detail in a Natren article30 .


When properly prescribed, physical activity is an inexpensive and universal medication with minimal side effects, except feeling well and improving our health. And our gut microbiota benefits from it, ideally when combined with an optimally healthy diet.

The Czech authors refer to exercise as our “home pharmacy” that we always have with us. But, as with any medication, you have to use it in order to reap its benefits.

The last word goes to Dr Michael Greger. He has very clear views on how much exercise we should ideally have and recommends 90 minutes of moderate-intensity activity, such as brisk (four miles per hour) walking or 40 minutes of vigorous activity (such as jogging or active sports) each day.31

Below is a video32 where he explains why this is important.

He has also produced a podcast33 on the subject of exercise.


  1. [Physical activity – the Holy Grail of modern medicine?] Tuka V, Daňková M, Riegel K, Matoulek M. Vnitr Lek. Fall 2017;63(10):729-736. Review. Czech. PMID: 29127758. []
  2. The FITT Principle (model or formula) is a great way of monitoring your exercise program. The acronym FITT outlines the key components of an effective exercise program, and the initials F, I, T, T, stand for: Frequency, Intensity, Time and Type. … Time …refers to the time you spend exercising or how long you exercise for. []
  3. Does Aerobic Exercise and the FITT Principle Fit into Stroke Recovery? Sandra A. Billinger, Pierce Boyne, Eileen Coughenour, Kari Dunning, Anna Mattlage. Curr Neurol Neurosci Rep. Author manuscript; available in PMC 2016 Jan 1. Published in final edited form as: Curr Neurol Neurosci Rep. 2015; 15(2): 519. doi: 10.1007/s11910-014-0519-8 PMCID: PMC4560458. []
  4. Oman Med J. 2009 Jul; 24(3): 173–178. doi: 10.5001/omj.2009.34. PMCID: PMC3251175. PMID: 22224180. Atherosclerosis and Physical Activity. Ali Al-Mamari. []
  5. Effects of continuous vs interval exercise training on oxygen uptake efficiency slope in patients with coronary artery disease. D.M.L. Prado, E.A. Rocco, A.G. Silva, D.F. Rocco, M.T. Pacheco, P.F. Silva, V. Furlan. Braz J Med Biol Res. 2016; 49(2): e4890. Published online 2016 Feb 5. doi: 10.1590/1414-431X20154890. PMCID: PMC4742972. []
  6. The feasibility of an acute high-intensity exercise bout to promote locomotor learning after stroke. Charalambous CC, Helm EE, Lau KA, Morton SM, Reisman DS. Top Stroke Rehabil. 2018 Mar;25(2):83-89. doi: 10.1080/10749357.2017.1399527. Epub 2017 Nov 5. PMID: 29105605. []
  7. Clinical impact of exercise in patients with peripheral arterial disease. Novakovic M, Jug B, Lenasi H. Vascular. 2017 Aug;25(4):412-422. doi: 10.1177/1708538116678752. Epub 2016 Nov 9. Review. PMID: 28256934. []
  8. Curr Treat Options Cardiovasc Med. 2017 Oct 9;19(11):87. doi: 10.1007/s11936-017-0585-8. Therapeutic Targets for the Multi-system Pathophysiology of Heart Failure: Exercise Training.
    Van Iterson EH, Olson TP2. []
  9. Aerobic Exercise Training in Very Severe Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis. Paneroni M, Simonelli C, Vitacca M, Ambrosino N. Am J Phys Med Rehabil. 2017 Aug;96(8):541-548. doi: 10.1097/PHM.0000000000000667. Review. PMID: 28099192. []
  10. Designing a physical activity intervention for children with asthma: a qualitative study of the views of healthcare professionals, parents and children with asthma
    Russell Jago, Aidan Searle, A John Henderson, Katrina M Turner
    BMJ Open. 2017; 7(3): e014020. Published online 2017 Mar 24. doi: 10.1136/bmjopen-2016-014020
    PMCID: PMC5372067. []
  11. Regular Physical Exercise as a Strategy to Improve Antioxidant and Anti-Inflammatory Status: Benefits in Type 2 Diabetes Mellitus. Edite Teixeira de Lemos, Jorge Oliveira, João Páscoa Pinheiro, Flávio Reis. Oxid Med Cell Longev. 2012; 2012: 741545. Published online 2012 Aug 13. doi: 10.1155/2012/741545 PMCID: PMC3425959. []
  12. The Effects of Exercise Training in Addition to Energy Restriction on Functional Capacities and Body Composition in Obese Adults during Weight Loss: A Systematic Review. Clint T. Miller, Steve F. Fraser, Itamar Levinger, Nora E. Straznicky, John B. Dixon, John Reynolds, Steve E. Selig. PLoS One. 2013; 8(11): e81692. Published online 2013 Nov 25. doi: 10.1371/journal.pone.0081692. PMCID: PMC3884087. []
  13. Too Fit To Fracture: outcomes of a Delphi consensus process on physical activity and exercise recommendations for adults with osteoporosis with or without vertebral fractures. L. M. Giangregorio, S. McGill, J. D. Wark, J. Laprade, A. Heinonen, M. C. Ashe, N. J. MacIntyre, A. M. Cheung, K. Shipp, H. Keller, R. Jain, A. Papaioannou. Osteoporos Int. Author manuscript; available in PMC 2016 Nov 8.
    Published in final edited form as: Osteoporos Int. 2015 Mar; 26(3): 891–910. Published online 2014 Dec 16. doi: 10.1007/s00198-014-2881-4. PMCID: PMC5101068. []
  14. Perceived Barriers, Facilitators and Benefits for Regular Physical Activity and Exercise in Patients with Rheumatoid Arthritis: A Review of the Literature. Jet J. C. S. Veldhuijzen van Zanten, Peter C. Rouse, Elizabeth D. Hale, Nikos Ntoumanis, George S. Metsios, Joan L. Duda, George D. Kitas. Sports Med. 2015; 45(10): 1401–1412. Published online 2015 Jul 29. doi: 10.1007/s40279-015-0363-2
    PMCID: PMC4579262. []
  15. Prostate Cancer []
  16. Physical Activity and Prostate Cancer: An Updated Review. Shephard RJ. Sports Med. 2017 Jun;47(6):1055-1073. doi: 10.1007/s40279-016-0648-0. Review. PMID: 27844337. []
  17. The Influence of Exercise on Cognitive Abilities. Fernando Gomez-Pinilla, Charles Hillman. Compr Physiol. Author manuscript; available in PMC 2014 Mar 13. Published in final edited form as: Compr Physiol. 2013 Jan; 3(1): 403–428. doi: 10.1002/cphy.c110063. PMCID: PMC3951958. []
  18. Exercise Leads to Better Clinical Outcomes in Those Receiving Medication Plus Cognitive Behavioral Therapy for Major Depressive Disorder. Joanne Gourgouvelis, Paul Yielder, Sandra T. Clarke, Hushyar Behbahani, Bernadette Ann Murphy. Front Psychiatry. 2018; 9: 37. Published online 2018 Mar 6. doi: 10.3389/fpsyt.2018.00037. PMCID: PMC5845641. []
  19. Exercise as Treatment for Anxiety: Systematic Review and Analysis. Gregory L. Stonerock, Benson M. Hoffman, Patrick J. Smith, James A. Blumenthal. Ann Behav Med. Author manuscript; available in PMC 2016 Aug 1. Published in final edited form as: Ann Behav Med. 2015 Aug; 49(4): 542–556. doi: 10.1007/s12160-014-9685-9. PMCID: PMC4498975. []
  20. Impact of Physical Exercise on Substance Use Disorders: A Meta-Analysis
    Dongshi Wang, Yanqiu Wang, Yingying Wang, Rena Li, Chenglin Zhou. PLoS One. 2014; 9(10): e110728. Published online 2014 Oct 16. doi: 10.1371/journal.pone.0110728. PMCID: PMC4199732. []
  21. Exercise-induced stress behavior, gut-microbiota-brain axis and diet: a systematic review for athletes. Allison Clark, Núria Mach. J Int Soc Sports Nutr. 2016; 13: 43. Published online 2016 Nov 24. doi: 10.1186/s12970-016-0155-6. PMCID: PMC5121944 []
  22. Gut Microbiota Modification: Another Piece in the Puzzle of the Benefits of Physical Exercise in Health? Begoña Cerdá, Margarita Pérez, Jennifer D. Pérez-Santiago, Jose F. Tornero-Aguilera, Rocío González-Soltero, Mar Larrosa. Front Physiol. 2016; 7: 51. Published online 2016 Feb 18. doi: 10.3389/fphys.2016.00051. PMCID: PMC4757670. []
  23. The Effect of Diet and Exercise on Intestinal Integrity and Microbial Diversity in Mice. Sara C. Campbell, Paul J. Wisniewski, Michael Noji, Lora R. McGuinness, Max M. Häggblom, Stanley A. Lightfoot, Laurie B. Joseph, Lee J. Kerkhof. PLoS One. 2016; 11(3): e0150502. Published online 2016 Mar 8. doi: 10.1371/journal.pone.0150502. PMCID: PMC4783017. []
  24. The Crosstalk between the Gut Microbiota and Mitochondria during Exercise. Allison Clark, Núria Mach. Front Physiol. 2017; 8: 319. Published online 2017 May 19. doi: 10.3389/fphys.2017.00319. PMCID: PMC5437217. []
  25. The difference between microbiome and microbiota can be a little confusing. Some researchers use the term ‘microbiota’ to mean the microbes found within a specific environment and the term ‘microbiome’ to mean the collection of microbial genomes in an environment. This is a useful differentiation since it can then indicate whether a paper has fully sequenced the genomes of the microbes it is examining or whether it has just identified them by 16S rRNA or culturing. However, over time many researchers have started to use these words interchangeably so it is not uncommon to see the word microbiome used in a paper where the author has identified the bacteria present in an environment but hasn’t sequenced their genomes. []
  26. Integr Med Res. 2014 Dec;3(4):172-179. doi: 10.1016/j.imr.2014.09.007. Epub 2014 Oct 5.
    Exercise-induced myokines in health and metabolic diseases. So B, Kim HJ, Kim J, Song W. []
  27. J Appl Physiol (1985). 2005 Apr;98(4):1154-62. The anti-inflammatory effect of exercise. Petersen AM1, Pedersen BK. []
  28. Front Physiol. 2016 Feb 18;7:51. doi: 10.3389/fphys.2016.00051. eCollection 2016. Gut Microbiota Modification: Another Piece in the Puzzle of the Benefits of Physical Exercise in Health?
    Cerdá B, Pérez M, Pérez-Santiago JD, Tornero-Aguilera JF, González-Soltero R, Larrosa M. []
  29. Exercise training-induced modification of the gut microbiota persists after microbiota colonization and attenuates the response to chemically-induced colitis in gnotobiotic mice. J. M. Allen, L. J. Mailing, J. Cohrs, C. Salmonson, J. D. Fryer, V. Nehra, V. L. Hale, P. Kashyap, B. A. White & J. A. Woods. Taylor & Francis Online. Received 05 Jun 2017, Accepted 23 Aug 2017, Accepted author version posted online: 01 Sep 2017, Published online: 22 Sep 2017. []
  30. Exercise May Positively Change the Makeup of Bacteria in Your Gut []
  31. Dr Greger on Exercise. []
  32. How Much Should You Exercise? []
  33. Dr Greger Podcast – How Much Exercise is Enough? []