Changes in fatigue, health-related fitness, sleep quality, mental health, gastrointestinal complaints and sexual function after a multimodal supervised therapeutic exercise program in women with endometriosis unresponsive to conventional therapy: A secondary analysis of a randomized controlled trial

Abstract

Abstract Objective To explore the impact of ‘Physio-EndEA’, a multimodal 9-week supervised exercise intervention, on fatigue, health-related physical fitness, sleep quality, mental health, gastrointestinal complaints, and sexual function in women with endometriosis unresponsive to conventional therapy. Methods This randomized controlled trial included 31 patients randomly allocated to the ‘Physio-EndEA’ group (n = 16) or the control group (n = 15). The primary outcome, fatigue, was evaluated using the Piper Fatigue Scale (PFS). Secondary outcomes included health-related physical fitness [lumbar strength (back dynamometer), lumbar flexibility (Schöber test), body balance (Flamingo test) and cardiorespiratory fitness (6-minute walking test, 6MWT)], sleep quality (Pittsburgh Sleep Quality Index, PSQI), anxiety and depression (Hospital Anxiety and Depression Scale, HADS), digestive complaints (Gastrointestinal quality of life index, GIQLI), and sexual function (Female sexual function index, FSFI). Outcomes were measured at baseline, post-intervention, and at one year. Statistical (between-group analyses of covariance) and clinical effects were analyzed by intention-to-treat. The study was registered with ClinicalTrials.gov #NCT03979183. Results After the intervention and at 1 year, the ‘Physio-EndEA’ group showed significantly improved fatigue compared with the control group, with large size effects (d > 0.80). Post-intervention improvements were also observed in the intervention group for lumbar strength, cardiorespiratory fitness, anxiety, depression, and digestive complaint scores. Improvements in cardiorespiratory fitness, anxiety and digestive complaints were maintained at the 1-year follow-up. Conclusions A 9-week supervised multimodal therapeutic exercise program is effective in ameliorating a broad range of endometriosis-related impairments, suggesting that ‘Physio-EndEA’ is a promising strategy for reducing symptom burden in women with endometriosis unresponsive to conventional treatment. Keywords Endometriosis Exercise Rehabilitation Fatigue Physical fitness Mental health Sleep quality