A Cochrane review [Abstract] 1 10 studies involving a total of 754 subjects. Exercise included low-intensity exercise (stretching, core strengthening or yoga) or high-intensity exercise (Zumba or aerobic training). Exercise reduced menstrual pain intensity compared to no exercise (standard mean difference (SMD -1.86, 95% CI -2.06 to -1.66; 9 RCTs, n=632; low-quality evidence). This SMD corresponds to a 25 mm reduction on a 100 mm visual analogue scale (VAS) and is likely to be clinically significant. There appeared to be some evidence that exercise reduced the Moos' Menstrual Distress Questionnaire (MDQ) score during the menstrual phase (mean difference (MD) -33.16, 95% CI -40.45 to -25.87; 1 RCT, n=120). There was no clear difference in pain reduction when exercise was compared with mefenamic acid (MD -7.40, 95% CI -8.36 to -6.44; 1 RCT, n=122).
A meta-analysis 2 included 15 RCTs totaling 1681 participants. Pooled results demonstrated effect estimates for physical activity vs comparators for pain intensity (on visual analog scale -1.89 cm , 95% CI -2.96 to -1.09; 11 trials) and pain duration (-3.92 hours; 95% CI -4.86 to -2.97). Heterogeneity for both of these results was high and only partly mitigated by subgroup analysis.
Comment: The quality of evidence is downgraded by heterogeneity and potential reporting bias.
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