Exercise for chronic pelvic pain in pre-menopausal women: a systematic review and meta-analysis

In women, chronic pelvic pain (CPP) is recurrent or constant pain in the pelvis, lower abdominal region, and female organs that persists for longer than 6 months. Exercise has been effective for other chronic pain conditions and could potentially be effective for CPP. The objective was to evaluate if exercise is more effective than no intervention, minimal intervention or usual care for improving pain and quality of life (QOL) in the short, medium, and long-term in women of reproductive age with ongoing CPP of gynaecological or urological origin. Short-term pain was the primary endpoint. This was a systematic review with meta-analysis. Four databases were searched. Title/abstract, full-text screening, data extraction and risk of bias assessment were conducted by two independent authors. Risk of bias was measured using the Cochrane risk of bias 2.0 tool. For pain, scales were converted to a standardised 0 to 10 scale, with a smallest clinically worthwhile effect of 1.5 points. For QOL, scales were converted to a Standardised Mean difference (SMD). Random effects meta-analyses were used, and GRADE syntheses were performed. We identified 9319 records. Six studies ( n = 333) were included. All studies were high risk of bias. Two studies included yoga as an exercise modality, while the remaining used multiple exercise types. Comparators included advice, medication, or usual care. For pain, the evidence was very uncertain that exercise was better than the comparator and the effect was clinically worthwhile in the short- (MD: -2.74, 95%CI: -3.70 to -1.78, 4 studies) and long-term (MD: -3.38, 95%CI: -4.80 to -1.96, 2 studies). For QOL, the evidence was very uncertain that exercise was better than the comparator in the short- (SMD: 0.64, 95%CI: 0.08 to 1.19, 3 studies) and long-term (SMD: 1.12, 95%CI: 0.36 to 1.89, n = 31, 1 study). No studies investigated medium-term pain or QOL. The evidence was very uncertain for exercise on short-and long-term pain and QOL. Studies with low risk of bias are required to confirm these effects and to determine if any specific exercise modality is more effective. The protocol was pre-registered in Open Science Framework on May 31st, 2024 (https://doi.org/10.17605/OSF.IO/FA3CR).