Comparative Effectiveness of Different Exercises for Reducing Pain Intensity in Primary Dysmenorrhea: A Systematic Review and Network Meta-analysis of Randomized Controlled Trials

Background: Studies have demonstrated that exercise can mitigate the intensity of menstrual pain in primary dysmenorrhea, but the most effective type of exercise remains unclear. The objective of this systematic review and network meta-analysis was to evaluate the effectiveness of different exercise regimens in reducing pain associated with primary dysmenorrhoea. Methods: Randomized controlled trials investigating the relationship between menstrual pain and exercise were selected from major electronic databases until February 2, 2024. The primary outcome was the effect of exercise on pain intensity measured by the mean difference on a 10-cm visual analogue scale at 4 and 8 weeks after intervention. The secondary outcome was the difference in risk of dropout at 8 weeks. The study protocol was registered as INPLASY202330050. Results: This systematic review and network meta-analysis included 29 randomized controlled trials, which involved 1808 participants with primary dysmenorrhea. Exercise interventions included relaxation exercise, strength training, aerobic activity, yoga, mixed exercise, and the Kegel maneuver. Relaxation exercise was the most effective in reducing menstrual pain in 4 weeks (− 3.56; 95% confidence interval: − 5.03 to − 2.08). All exercise interventions were effective in reducing menstrual pain at 8 weeks, with reductions ranging from − 3.87 (95% CI − 5.51 to − 2.22) for relaxation exercise to − 2.75 (95% CI − 4.00 to − 1.51) for yoga, compared to the control group. Relaxation exercises were found to have a significantly lower dropout risk (− 0.11; 95% CI − 0.20 to 0.02), while none of the exercise types was associated with a higher dropout risk than the control group. Conclusion: All exercise interventions were effective in reducing menstrual pain in primary dysmenorrhea after 8 weeks of intervention. However, relaxation exercise was found to be the most effective intervention at 4 and 8 weeks and had the lowest risk of dropout. Graphical Abstract: (Figure presented.)