Effect of Exercises on Central and Endocrine System for Pain Modulation in Primary Dysmenorrhea

Impact of traditional Chinese Baduanjin exercise on menstrual health among international female students studying in China: a randomized controlled trial

Background

Menstrual symptoms were the common complaints of international female students during the acculturation period, and the symptoms negatively affected the daily life and school performance of those women. The present study aimed to evaluate the effectiveness of the traditional Chinese Baduanjin exercise on reducing menstrual symptoms for international female students studying in China during the acculturation period.

Methods

We conducted a randomized controlled trial among 62 international female students who suffered menstrual symptoms during the first 6 months after arriving in China. The study was carried out at three campuses of the two largest universities in the capital of a province in south-central China from March to October 2021. After screening, participants were randomly assigned to a control or intervention group. The intervention group engaged in 24 weeks of Baduanjin exercise for at least 30 min per day. The menstrual symptoms, sociocultural adaptation, perceived stress, and sleep quality were evaluated at baseline, the 12th week, and the 24th week. The chi-square test or Fisher's exact test, paired sample t-test, and multivariate analysis of variance (MANOVA)were adopted to analyze the data using SPSS 25.0.

Results

Totally, 62 participants were enrolled in this study from 30 countries. Their mean age was 27.87 ± 5.58 years. None of the participants reported an adverse event. The results of the MANOVA test showed that the traditional Chinese Baduanjin exercise reduced the total score of MSQ among international female students (intervention: 47.83 ± 8.71 vs. control: 65.12 ± 16.86; F = 19.49, P < 0.01). In addition, the results of the MANOVA indicated statistically significant decreases in scores for the two subscales of MSQ: premenstrual symptoms (intervention: 17.07 ± 3.33 vs. control: 28.42 ± 7.56; F = 44.70, P < 0.01)and menstrual pain (16.03 ± 4.53 vs. 19.58 ± 5.14; F = 6.50, P < 0.05). Moreover, the results showed that traditional Chinese Baduanjin exercise reduced the scores of the sociocultural adaptation level, the perceived stress level, and sleep quality and improved the blood progesterone hormone and blood estrogen hormone.

Conclusion

Regular Baduanjin exercise is a safe, acceptable, and effective form of exercise to promote international female students' menstrual health, reduce stress levels, and improve sleep quality.

Trial registration

www.chictr.org.cn, Chinese Clinical Trial Registry: ChiCTR2300072376.

The Effect of Aviva Exercise Intervention on Pain Level and Body Awareness in Women with Primary Dysmenorrhea

Background and Objective: Primary dysmenorrhea (PD) is one of the most common clinical disorders in women of reproductive age. Our aim was to examine whether a twice-weekly thirty-minute Aviva exercise intervention could result in improvements in pain level and body awareness in patients with PD. Materials and Methods: In our prospective observational trial, the observation period included two consecutive menstrual cycles and the period of the next menstrual bleeding. The first menstrual bleeding period was the first measurement time (T1), the second was the second measurement time (T2), and the third was the third measurement time (T3) in a total of 78 volunteers. The primary endpoint was the change in the level of menstrual pain according to the Numeric Rating Scale (NRS) questionnaire between the intervention group (IG) and the control group (CG) at T1, T2, and T3. In this study, the secondary outcomes were the differences between the IG and CG regarding the different subscales of the Hungarian version of the Body Awareness Questionnaire (BAQ-H) at T1, T2, and T3; the Borg scale results of the IG; and adherence to the intervention. Statistical tests such as independent-sample t-tests, chi-square tests, Pearson's linear correlation coefficient, and repeated-measure ANCOVA were used for the analyses. Results: In total, 78 volunteers were enrolled: 40 persons in the IG and 38 in the CG. There was a significant change in the level of menstruation pain according to the NRS questionnaire between the IG and CG (p < 0.001). There was no significant difference between the IG and CG regarding the different subscales of the BAQ-H. Only in the case of the "Note responses or changes in body process" subscale of the BAQ-H was there a trend-like effect from the Aviva exercises (p = 0.086). Conclusions: The Aviva exercise could contribute to pain relief from PD. Regarding body awareness, no significant difference was found between the two groups. Due to the short detection period and prospective observational design, our results are preliminary and need to be confirmed in larger clinical trials.

The Role of Physical Exercise in Chronic Musculoskeletal Pain: Best Medicine-A Narrative Review

The aim of this paper is to provide a narrative review of the effects of physical exercise in the treatment of chronic musculoskeletal pain. Physical inactivity and sedentary behavior are associated with chronic musculoskeletal pain and can aggravate it. For the management of musculoskeletal pain, physical exercise is an effective, cheap, and safe therapeutic option, given that it does not produce the adverse effects of pharmacological treatments or invasive techniques. In addition to its analgesic capacity, physical exercise has an effect on other pain-related areas, such as sleep quality, activities of daily living, quality of life, physical function, and emotion. In general, even during periods of acute pain, maintaining a minimum level of physical activity can be beneficial. Programs that combine several of the various exercise modalities (aerobic, strengthening, flexibility, and balance), known as multicomponent exercise, can be more effective and better adapted to clinical conditions. For chronic pain, the greatest benefits typically occur with programs performed at light-to-moderate intensity and at a frequency of two to three times per week for at least 4 weeks. Exercise programs should be tailored to the specific needs of each patient based on clinical guidelines and World Health Organization recommendations. Given that adherence to physical exercise is a major problem, it is important to empower patients and facilitate lifestyle change. There is strong evidence of the analgesic effect of physical exercise in multiple pathologies, such as in osteoarthritis, chronic low back pain, rheumatoid arthritis, and fibromyalgia.

Analysis of the association between high workload and musculoskeletal pain in public school teachers according to physical activity level

BACKGROUND

A high workload has been associated with musculoskeletal pain in public school teachers. However, the hypothesis of the present study was that physical activity (PA) practice is able to attenuate this association.

OBJECTIVE

To analyze the associations between high workload with musculoskeletal pain according to PA levels in public school teachers.

METHODS

Teachers (n = 239) from 13 public schools were evaluated. Workload was assessed using a Likert scale in which teachers reported their perception of their work routine as: very low, low, regular, high, and very high. Musculoskeletal pain and PA were assessed using questionnaires. Multivariate logistic regression models were used to investigate the association of high workload with PA levels and musculoskeletal pain in different body regions, compared to participants with normal workload, adjusted by sex, age, and socioeconomic status.

RESULTS

A high workload was associated with higher chances of reporting pain in the wrists and hands (OR = 3.55; 95% CI = 1.27-9.89), knee (OR = 3.09; 95CI%  = 1.09-8.82), and feet and ankles (OR = 3.16; 95% CI = 1.03-9.76) in less active teachers. However, these associations were not observed in teachers considered more active.

CONCLUSION

PA practice is able to act as a good protector against musculoskeletal pain in teachers, even in individuals with a high workload.

Effects of therapeutic exercise in primary dysmenorrhea: an umbrella and mapping review

PURPOSE

Primary dysmenorrhea (PD) is 1 of the most prevalent gynecologic conditions. The main aim of this umbrella review was to assess the effects of therapeutic exercise (TE) on PD.

METHODS

A systematic search was carried out in PubMed, Embase, SPORTDiscus, CINAHL, and PEDro (December 10, 2022). The outcome measures assessed were menstrual pain intensity, menstrual pain duration, and quality of life. Methodological quality was analyzed using the AMSTAR and ROBIS scales, and the strength of evidence was established according to the advisory committee grading criteria guidelines.

RESULTS

Nine systematic reviews were included. The results showed that TE, regardless of the exercise model and intensity, has a clinical effect in improving menstrual pain intensity in women with PD with moderate quality of evidence. In addition, the results showed that TE has a clinical effect in improving the duration of menstrual pain in women with PD with a limited quality of evidence. However, the results are controversial on the improvement of quality of life in women with PD with a limited quality of evidence.

CONCLUSIONS

TE seems an effective option to implement in women with PD to improve the intensity and duration of menstrual pain. We cannot draw robust results for quality of life due to the low number of primary studies. More research in this field can help us establish more robust conclusions, as well as to assess whether there is one exercise model or intensity of training that is more effective than others.PROSPERO number: This review was previously registered in PROSPERO (CRD42022371428).

Transcutaneous Tibial Nerve Stimulation for Primary Dysmenorrhea: A Protocol for a Randomized Controlled Trial

Primary dysmenorrhea (PD) is a painful menstruation that can persist for the duration of a woman's fertile life. Non-steroidal anti-inflammatory drugs, hormonal therapy, physiotherapy techniques, etc., are the main treatments. The main objective of this study is to evaluate the effectiveness of transcutaneous posterior tibial nerve stimulation (TTNS) in PD patients. The study will consist of a single-blind randomized clinical trial, parallel-assigned with two arms. Women with PD (18-43 years) with regular menstrual cycles and at least 4 points in VAS will be randomly divided into experimental (TTNS) and placebo (simulated stimulation) groups during 12 treatment sessions (1 session/week) and several follow-ups: monthly during treatment and 1, 3 and 6 months after. Maximum and mean pain intensity, pain duration, pain severity, number of anti-inflammatory drugs, quality of life, sleep quality, overall improvement, treatment satisfaction and secondary effects will be measured once a month every 6 months and at 3 and 6 months. The Student's t-test for independent samples or the Mann-Whitney U test will be used. The literature shows effective physiotherapeutic techniques for PD in the short term, which do not act on causes and have limitations. The TTNS technique can be used in transcutaneous and percutaneous modalities, with similar effectiveness, but the transcutaneous causes less discomfort. TTNS modulates pain, and long-term benefits could be achieved at low cost and without patient discomfort.

The Sprint-Interval Exercise Using a Spinning Bike Improves Physical Fitness and Ameliorates Primary Dysmenorrhea Symptoms Through Hormone and Inflammation Modulations: A Randomized Controlled Trial

Dysmenorrhea with high prevalence has been categorized as primary dysmenorrhea (PD) and secondary dysmenorrhea due to differences in pathogenesis. A significant number of reproductive females suffering from monthly menstruation have to deal with negative impacts on their quality of life, work/study productivity, activities, and social relationships. In addition to medical treatment, exercise has been recognized as a complementary and alternative strategy for disease prevention, alleviation, and rehabilitation. This study aimed to investigate the potential effects of exercise on the severity of primary dysmenorrhea, physiological modulation, and physical fitness. Participants consisted of university students who were enrolled in the study and divided into a non-PD (Control) and a PD group based on recruiting criteria, the latter being randomly assigned to either an untreated dysmenorrhea group or a dysmenorrhea group that underwent 10 weeks of high intensity interval training (HIIT) exercise (Dysmen and DysmenHIIT, respectively). The DysmenHIIT group used spinning bikes and the training intensity was validated by heart rate monitors and BORG rating of perceived exertion. Forms containing participant information (premenstrual symptoms, menstrual distress, and a Short Form McGill Pain Questionnaire) as well as physical fitness, biochemical variables, hormone and prostaglandin (PGE2 and PGF2α) levels were assessed before and after the exercise intervention. After intervention, premenstrual symptoms (anger, anxiety, depression, activity level, fatigue, etc.), menstrual distress symptoms (cramps, aches, swelling, etc.), and pain severity were shown to be significantly mitigated, possibly through hormone (estradiol, prolactin, progesterone, and cortisol) modulation. Furthermore, high-sensitivity C-reactive protein (HsCRP), PGE2 and PGF2α levels were also down-regulated, resulting in the amelioration of uterine contraction and inflammation. Participants' physical fitness, including cardiovascular endurance and explosive force, was significantly improved after HIIT. The 10-week HIIT spinning bike exercise used in this study could be employed as a potential and complementary treatment for PD symptoms alleviation and considered as part of an educational health plan for promoting women's health. However, the effects of HIIT utilizing different exercise methods and accounting for different age populations and secondary PD warrant further investigation.

Uncovering the effects and mechanism of Danggui Shaoyao San intervention on primary dysmenorrhea by serum metabolomics approach

Danggui Shaoyao San (DSS) is a well-known prescription for relieving primary dysmenorrhea (PD) of women in China. However, its pharmacological mechanism has not been thoroughly uncovered. Here, an integrative UPLC-Q-TOF-MS-based serum metabolomics approach coupled with multivariate data analysis has been proposed to investigate the effects and mechanism of DSS on estradiol benzoate and oxytocin-induced PD rats. 31 potential biomarkers of PD were screened and identified, mainly involving phenylalanine, tyrosine and tryptophan biosynthesis, glycerophospholipid metabolism, primary bile acid biosynthesis, and the occurrence of PD could destroy biological homeostasis in vivo by monitoring these pathways. After DSS treatment, 18 identified different metabolites were restored to the nomal state in varying degrees and could be potential biomarkers contributing to the treatment of DSS. These findings implyed that DSS exhibited a therapeutic effect on PD rats through regulating multiple abnormal pathways. Of note, this study discovered some potential biomarkers related to PD for the first time, such as L-tyrosine, glycocholic acid, citric acid, palmitoylcarnitine, cholesterol. It preliminarily proved the pathophysiology of PD and action mechanisms of DSS on PD, and provided a novel insight into the effectiveness of DSS on PD.