Physical exercise interventions for endometriosis-related pain symptoms in randomized controlled trials: A systematic review and meta-analysis

Endometriosis is clinically associated with chronic inflammatory process, pain, and poor quality of life. Exercise has a broad spectrum of action in the prevention and therapeutic of a wide range of diseases. The present study has the proposal to investigate whether exercise interventions possess beneficial impact on pain outcome on endometriosis. A comprehensive systematic literature search of Pubmed/MEDLINE, Cochrane, Embase, and Web of Science databases was conducted (from May 2024 to April 2025), for randomized, controlled (control non-exercised groups), exercise trials involving individuals with endometriosis diagnosis. The risk of bias was assessed by Rob 2 tool, the quality and reporting of exercise interventions by TESTEX scale, and the certainty of evidence by GRADE system. Four studies were included in the analysis. Despite presenting a high risk of bias, an overall positive effect of physical exercise interventions relative to the non-exercised controls was observed (SMD 95% = −1.017 (−1.355 to −0.679); p < 0.001) regarding general pain (primary outcome) related to endometriosis. With respect to specific pain types related to endometriosis symptomatology (secondary outcome), physical exercise interventions were able to significantly reduce catastrophizing pain and pelvic pain, but not dyschezia, dysmenorrhea, dyspareunia, or dysuria. These results could be important for the clinical care of women with endometriosis-related chronic pain. However, given the heterogeneity, high risk of bias, and low quality of the included studies it can be challenging to draw reliable conclusions. This data unveils the promising potential applicability of exercise for health promotion in patients with pain resulting from endometriosis.