Efficacy and safety of therapeutic exercise for primary dysmenorrhea: a systematic review and Meta-analysis

Yi Xiang ¹ Zengao Lu ^1* Zemin Yu ^2* Guanglin Ma ^1* Siqi Liu ^3* Yingkui Li ^1*

• ¹ China Wushu School, Beijing Sport University, Beijing, China
• ² School of Sports and Health, Shanghai University of International Business and Economics, Shanghai, China
• ³ School of Physical Education, Hunan Normal University, Changsha, China

Objective. A growing number of research papers have looked at the influence of exercise on pain severity in people with primary dysmenorrhea, but the findings have been inconsistent. The purpose of this research was to thoroughly evaluate the impact of exercise on pain severity in individuals with primary dysmenorrhea, as well as to find the best exercise regimen for these patents. Methods. All randomized controlled trials (RCTs) of exercise for patients with primary dysmenorrhea were searched in Embase, PubMed, Cochrane, Web of Science, EBSCO, and CINAHL database. The search time limit was set from the establishment of each database to 28 January 2025. The effect size was aggregated using the mean difference (MD) and 95% confidence interval (CI). The methodological quality of included studies was assessed using the Cochrane risk-of-bias tool. Meta-analysis, sensitivity analysis, and publication bias assessment were conducted using Stata 15, while network meta-analysis, SUCRA ranking, league plot, and meta-regression were performed using R 4.4.1.Results. A total of 29 studies met the inclusion criteria. Exercise significantly reduced VAS scores in primary dysmenorrhea (WMD = -2.62, 95% CI [-3.29, -1.95], p < 0.001). Subgroup analyses revealed greater efficacy with strength training (WMD = -1.76, 95% CI [-2.03, -1.48], p < 0.001), duration ≥ 8 weeks (WMD = -1.77, 95% CI [-1.87, -1.66], p < 0.001), frequency > 3 times/week (WMD = -1.60, 95% CI [-1.75, -1.45], p < 0.001), session length > 30 minutes (WMD = -2.20, 95% CI [-2.38, -2.02], p < 0.001), and total weekly time ≥ 90 minutes (WMD = -2.04, 95% CI [-2.19, -1.89], p < 0.001).Conclusion. Engaging in physical activity may reduce the intensity of discomfort encountered by individuals afflicted with primary dysmenorrhea, with strength training potentially emerging as the most efficacious alternative. The meta-analysis presents evidence that supports clinicians' advice to patients with primary dysmenorrhea, recommending that they exercise for a minimum of eight weeks, with sessions occurring more than three times weekly and lasting longer than thirty minutes each. The goal is to achieve a minimum weekly total of 90 minutes by increasing the frequency of workouts.