BACKGROUND AND PURPOSE:

• In this Cochrane review, Armour et al. (Cochrane Database of Systematic Reviews, 2019) evaluated the effectiveness and safety of exercise for primary dysmenorrhea

METHODS:

• Systematic review and meta-analysis
• Data sources
  • Cochrane Gynaecology and Fertility specialized register, CENTRAL, MEDLINE, Embase, PsycINFO, AMED and CINAHL (from inception to July 2019)
  • Two clinical trial databases (ClinicalTrials.gov and WHO Trials Registry) and hand-searched reference lists and previous systematic reviews
• Inclusion criteria
  • RCTs that included women with moderate-to-severe primary dysmenorrhea, randomized to exercise vs
    • No treatment | Attention control (“amount of time spent and attention received from the research team are matched to the intervention group, e.g. a lecture series on self-care for period pain”) | NSAIDs| OCPs
• Exercise definition: “Physical activity characterized by using planned and structured repetitive movements to increase or maintain physical fitness”
  • Most studies included asked women to exercise three times per week, for about 45 to 60 minutes, throughout the month
• Data synthesis and analysis
  • Two reviewers independently selected the studies, assessed bias, and extracted data
  • Study authors were contacted for missing information
  • GRADE criteria used for study quality assessment
• Primary outcomes
  • Menstrual pain intensity
  • Adverse events
• Secondary outcomes
  • Overall menstrual symptoms | Usage of rescue analgesic medications | Restriction of daily life activities | Absence from work or school and quality of life

RESULTS:

• Meta-analysis: 10 trials 754 women
  • 9 of the 10 studies compared exercise with no treatment, and 1 study compared exercise with NSAIDs
  • No studies compared exercise with attention control or with the oral contraceptive pill
• Studies used low-intensity exercise (stretching, core strengthening or yoga) or high-intensity exercise (Zumba or aerobic training)
  • None of the included studies used resistance training

Exercise vs No Treatment

• Exercise may have a ‘large’ effect on reducing menstrual pain intensity compared to no exercise (low- quality evidence)
  • Standard mean difference (SMD) -1.86 (95% CI -2.06 to -1.66; n = 632)
  • Clinically significant difference (Corresponds to a 25 mm reduction on a 100 mm visual analogue scale [VAS])
• Adverse events: Uncertain if there is any difference in adverse events between treatment and control
• For other outcomes, uncertain if exercise is of benefit for the following due to very low-quality evidence
  • Overall menstrual symptoms (e.g., back pain or fatigue)
  • Improvement in mental quality of life
  • Improvement in physical quality of life
• No studies reported on changes in daily life activities or absence from work/school

Exercise vs NSAIDs

• Uncertain if exercise, when compared with mefenamic acid, was of benefit due to very low-quality evidence for the following
  • Menstrual pain intensity
  • Use of rescue analgesic medication
  • Absence from work or school
• Studies did not report
  • Adverse events | Overall menstrual symptoms | Restriction of daily life activities | Quality of life

CONCLUSION:

• Exercise may relieve pain intensity associated with dysmenorrhea
  • Reduction is likely clinically significant
• Unclear whether exercising for less time or less frequently would have the same effect as that described in most studies (45 to 60 minutes, 3 times per week)
• Insufficient evidence to determine if exercise provides benefit vs NSAIDs

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Learn More – Primary Sources:

Exercise for dysmenorrhea

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