A) Procedures for evaluation:~The practical section of the study will be undertaken in 8 weeks (2 sessions a week). Measurement will be taken before the start of treatment program then after the end of 8 weeks treatment program in the following manner:~Laboratory investigations for TNFα and MDA: Blood samples will be collected after an 8-12 h overnight fasting. For each sample, 5 mL of blood will be drawn. Serums will be frozen at -20 °C immediately and then stored at -80 °C until further laboratory analyses were carried out.~Bristol stool form scale: The patients will record all bowel movements and its consistency~Irritable bowel syndrome symptom severity score (IBS-SSS) will be used to measure severity of IBS symptoms~The hospital anxiety and depression scale will be used to assess depression and anxiety~IBS-quality of life (IBS-QOL): will be used to assess QOL impairment in IBS.~Modified Fatigue Impact scale (MFIS): was developed to assess the perceived impact of fatigue on a variety of daily activities.~B-Treatment procedures:~All patients in both groups will be instructed to follow low FODMAP diet. Group (A) Patients in this group will participate in an 8-week Pilates exercise program, 2 times per week for 16 sessions, and will follow low FODMAP diet. Warming up and cooling down stretches for 5 minutes will be considered before and after exercise for the safety of the patients.~Group (B) Each patient will follow low FODMAP diet only for 8 weeks.~C)Data analysis: Statistical analysis will be performed through the statistical package for social studies (SPSS) version 24 for windows. Descriptive statistics will be conducted to describe the data. Mixed-Model ANOVA will be used to determine the within-group changes and the between-group difference. The level of significance for all statistical tests will be set at p<0.05.
purpose: to investigate the effect of pilates exercises on patients with irritable bowel syndrome. Methods fifty patients with IBS will be recruited and randomly assigned into two groups , group A and group B. Patients in both groups will receive a Low FODMAP diet ,but group A will receive additional pilates exercises. All patients will be evaluated pre and post treatment for Laboratory investigation for (TNFα and MDA),Bristol stool form , Irritable bowel syndrome symptoms ,quality of life, anxiety and depression and Fatigue.