2024-03-12 09:26:20
Pelvic pain and fatigue are the most recurring symptoms of endometriosis, this chronic condition characterized by the presence of endometrial tissue outside the uterine cavity; the endometrium being the mucous membrane which lines the inside of the uterus and which is shed during menstruation.
But endometriosis is also frequently associated with digestive disorders, neuropathic pain (which is pain relating to an injury or dysfunction of the nervous system, particularly when this pain is intense and persistent), and pain during sexual intercourse. , or even infertility.
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Endometriosis is today a major public health issue given its consequences on the lives of those affected and the number of women affected, almost 10% of them.
The repercussions of this disease can be debilitating and affect all areas of the lives of those affected. The phenomenon can be exacerbated by the chronicity of symptoms which, for some women, are not limited to the period of menstruation. They can be chronic, occurring during premenstrual syndrome, at the time of ovulation, etc.
Questioning the benefits of physical activity in endometriosis
We already know that practicing physical activity is beneficial in reducing chronic, neuropathic pain and associated inflammatory processes.
Doing physical exercise also improves physical and mental well-being in chronic pain sufferers but also in people suffering from other pathologies such as cancers.
This is why it is possible to think that in the context of endometriosis, physical activity might also improve quality of life as well as painful symptoms. These assumptions are reinforced by the evidence of reduction of inflammatory markers and a reduction of lesions in animal studies. But these conclusions in animals cannot be extrapolated to humans. This is why studies in women are necessary.
To our knowledge, a dozen studies have been carried out to study the effects of physical activity and exercise on pelvic pain and the physical and mental well-being of people with endometriosis. Although a positive effect on pain management and improvement of anxiety-depressive symptoms was observed, the results of these studies do not unequivocally demonstrate the benefits of physical activity on this disease.
Pain, stress and anxiety: main obstacles to practice
In terms of physical activity, women with endometriosis are less active. This might be explained by the fact that they are more exposed to symptoms of anxiety and depression, that they have more difficulty managing stress and that they are more sensitive to physical pain than others.
The combination of all these factors, combined with the fear of amplifying pain through movement, tends to lock people with endometriosis into a vicious cycle of sedentary lifestyle. In other words: when a person is doubled over in pain, the first instinct is not to do physical activity!
The CRESCENDO program on sports practice and endometriosis
We conducted a study, called the CRESCENDO program, to “increase sport and exercise to combat ENDOmetriosis”. In the first part of this study we conducted a questionnaire survey of 470 people (mean age of 31 years, standard deviation of 10 years). Nearly half of them (47%) had endometriosis.
The results of the questionnaire revealed no differences in levels of light (e.g. walking), moderate (e.g. jogging) and vigorous (e.g. trail running or sprinting) physical activity between women with endometriosis and those who are not.
However, other differences were highlighted. Women with endometriosis show greater motivation towards physical activity, that is, they have internalized the fact that physical activity can be beneficial. They do not think that the activity might present a danger to them.
However, they perceive themselves as not being free to practice when they want (low behavioral control). Their state of health appears to be the most important obstacle to their practice. They have a higher score for frustration of needs for competence and social proximity. In other words, when they do physical activity, they feel more incompetent and rejected by others.
Likewise, when asked, they think that sick women, like themselves, lack interest and skills for physical activity. Side effects are also a hindrance. Analgesics (or painkillers), for example, can cause stomach problems, nausea, headaches, vomiting, fatigue, dizziness, and changes in blood pressure. As for hormonal therapy, it can cause sleep problems, anxiety, depression and joint pain.
First results to be confirmed on fatigue, well-being and pain
We then built and tested our program on ten female volunteers by offering them several types of adapted physical activities, practiced at different intensities.
Sessions focused on mobility and stretching (i.e. so-called “gentle” activities) seem to have more benefits on pain compared to sessions of muscle strengthening or cardiovascular activities. But the latter two gave better results when practiced together to improve fatigue and well-being.
In summary, the overall results (all types of activities combined) suggest a significant improvement in pain and a trend towards improvement in fatigue and well-being. Each person seems to react differently in terms of perception and tolerance to pain depending on the types of effort and sessions, but also depending on the time of the cycle, the day or other factors not taken into account in our analysis.
Regardless, the results showed no harmful effects of physical activity for people with endometriosis. Reducing pain is therefore a crucial issue in the objectives of supporting endometriosis through physical activity.
These conclusions subsequently made it possible to improve the CRESCENDO program and to propose a larger-scale study, a study still in progress.
For now, focus on mobilizing the pelvis and softening
Although the practice of physical activity may seem impossible or even counterintuitive to a person who experiences painful symptoms and fatigue, such as in endometriosis, it can be advised and encouraged, provided that this physical activity is personalized and adapted to pain and physical fitness.
Postures to relieve endometriosis pain and periods proposed by Géraldine Escriva-Boulley, researcher at the University of Haute-Alsace
As for people affected by this pathology, who feel little or no pain, including during practice, they can do all types of activities without limitation or particular contraindication.
However, “gentle” and non-impact activities, around the mobilization of the pelvis and flexibility, as in certain gentle yoga practices (Yin and Hatha yoga), are to be favored during peaks and periods of pain.
Exercising regularly can help combat inflammation that can damage the peripheral and central nervous systems and make you more vulnerable to chronic pain. In some cases, chronic inflammation can notably lead to tissue damage and tissue deterioration, most often due to an inappropriate immune response.
The objective is therefore to maintain movement on a daily basis as much as possible, to establish modular routines depending on the symptoms, by observing yourself and getting to know yourself as you practice.
Be supported by health and physical activity professionals
If necessary, each person can be supported by health professionals (gynecologists, midwives, etc.) as well as physical activity professionals (adapted physical activity teachers, physiotherapists, etc.) to resume, adapt or co-construct routines personalized.
More and more “gentle” activities, in person or in live videos, are also offered by associations, sports halls, sports instructors or even certified teachers in certain disciplines such as yoga.
The CRESCENDO program received funding from the French Association for the Fight once morest Endometriosis EndoFrance. It is also supported by the National Research Agency (ANR), which funds project-based research in France. The ANR’s mission is to support and promote the development of fundamental and finalized research in all disciplines, and to strengthen the dialogue between science and society. To find out more, consult the ANR website.
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