Physical Activity and Exercise Improve Quality of Life in Endometriosis: A Systematic Review Original paper
Researched by:
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Giorgos Aristotelous
ID
Giorgos Aristotelous
Read MoreGiorgos — BSc, MSc. Giorgos is an exercise scientist whose training and professional practice sit at the intersection of human performance, clinical health, and emerging microbiome science. He holds a BSc in Sports Science & Physical Education from Aristotle University (2012) and an MSc in Exercise & Health from Democritus University (2016), where his graduate work explored physiological adaptations to training across the lifespan. Now in his 15th year of practice, Giorgos pairs evidence-based coaching (ACSM-CPT, NSCA, USA Weightlifting) with a research-driven interest in how physical activity, body composition, and musculoskeletal integrity shape—and are shaped by—host–microbiome dynamics.
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Women’s Health
Women’s Health
Women’s health, a vital aspect of medical science, encompasses various conditions unique to women’s physiological makeup. Historically, women were often excluded from clinical research, leading to a gap in understanding the intricacies of women’s health needs. However, recent advancements have highlighted the significant role that the microbiome plays in these conditions, offering new insights and potential therapies. MicrobiomeSignatures.com is at the forefront of exploring the microbiome signature of each of these conditions to unravel the etiology of these diseases and develop targeted microbiome therapies.
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Endometriosis
Endometriosis
Endometriosis involves ectopic endometrial tissue causing pain and infertility. Validated and Promising Interventions include Hyperbaric Oxygen Therapy (HBOT), Low Nickel Diet, and Metronidazole therapy.
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Giorgos Aristotelous
Read More
Researched by:
-
Giorgos Aristotelous
ID
Giorgos Aristotelous
Read More
Microbiome Signatures identifies and validates condition-specific microbiome shifts and interventions to accelerate clinical translation. Our multidisciplinary team supports clinicians, researchers, and innovators in turning microbiome science into actionable medicine.
Giorgos Aristotelous
What was reviewed?
This systematic review and meta-analysis evaluated the effectiveness and safety of physical activity (PA) and exercise as adjunctive therapies for women with endometriosis. The authors synthesized data from six randomized controlled trials (RCTs) comprising 251 participants to determine whether structured exercise interventions could alleviate symptoms such as pain, poor quality of life, pelvic floor dysfunction, and bone loss. Despite methodological heterogeneity and incomplete reporting in several studies, a meta-analysis of two RCTs was feasible and focused on the impact of exercise on three domains of the Endometriosis Health Profile-30 (EHP-30): pain, control and powerlessness, and emotional well-being.
Who was reviewed?
The review population consisted of women aged 16 to 51 years with diagnosed endometriosis. Three RCTs required laparoscopic confirmation of endometriosis, while others did not disclose diagnostic criteria. Participants included women with varying disease severity, some with chronic pelvic pain or prior surgical or hormonal treatments. Interventions ranged from Hatha yoga and progressive muscle relaxation to aerobic and resistance exercises, virtual reality (VR) training, and telehealth-based exercise programs.
Most important findings
Across the included trials, physical activity and exercise were generally well-tolerated and resulted in meaningful improvements in multiple domains relevant to endometriosis:
| Outcome | Finding |
|---|---|
| Quality of life | Meta-analysis showed significant improvements in pain (WMD -20.22), control and powerlessness (WMD -23.07), and emotional well-being (WMD -14.35). |
| Pain reduction | Studies showed reduced daily pain levels in yoga groups and improvements in VAS pain scores, though some did not reach statistical significance. |
| Mental health | Progressive muscle relaxation and supervised exercise improved mental health scores on SF-36 and EHP-30 scales. |
| Pelvic floor dysfunction | Exercise had positive, though inconsistently significant, effects on dyspareunia and related symptoms. |
| Bone mineral density | One study found that exercise mitigated GnRH agonist-induced femoral neck bone loss. |
Key implications
This review highlights that physical activity and structured exercise interventions can significantly enhance quality of life, particularly by alleviating pain and improving emotional well-being, for women with endometriosis. The findings suggest that exercise may serve as a complementary, non-pharmacologic therapy with systemic anti-inflammatory and neuromodulatory effects. However, the evidence base remains limited by small sample sizes, inconsistent outcome measures, short follow-up durations, and variable intervention types. The review underscores the urgent need for large-scale, standardized RCTs evaluating patient-centered outcomes using validated tools to better characterize optimal exercise modalities and dosing strategies in endometriosis care.
Endometriosis
Endometriosis involves ectopic endometrial tissue causing pain and infertility. Validated and Promising Interventions include Hyperbaric Oxygen Therapy (HBOT), Low Nickel Diet, and Metronidazole therapy.