Impact of exercise on pain perception in women with endometriosis: a systematic review.

INTRODUCTION Endometriosis is challenging to treat. It is a painful and chronic inflammatory disorder that impacts up to 10% of reproductive-aged women. Despite available surgical and medical treatment options, recurrence of symptoms is common. Available studies suggest that exercise may have a therapeutic effect on chronic inflammation and thereby on pain perception. This review evaluates if exercise can decrease pain perception in symptomatic endometriosis patients. MATERIAL AND METHODS This systematic review was conducted according to PRISMA by searching databases Medline and Embase to locate randomized controlled trial and observational studies. Risk of bias was investigated using the Cochrane Collaboration Tool for the Evaluation of Randomized Controlled Trials and the ROBINS-I quality assessment scale. Inclusion criteria were women of reproductive age, laparoscopically confirmed diagnosis of endometriosis and intervention of any type of exercise. All manuscripts were evaluated by two of the authors and in doubt a third author was consulted. This review was registered to Prospero on 14 November 2020 (CRD42020212309). RESULTS Six articles fulfilled the inclusion criteria and were included in this systematic review. Concerning exercise, two studies showed significant decrease in pain relief while the remaining studies showed either negative or no impact on pain relief. A meta-analysis could not be conducted due to considerable heterogeneity amongst the included studies. CONCLUSIONS The present review does not indicate any beneficial effect of exercise on pain in women with endometriosis. Thus, there is a need for randomized controlled trials with correct power calculation, well-defined study groups and training programs to be able to answer the question of whether exercise can improve the pain experience in patients with endometriosis.