Mechanism underlying the effectiveness of aerobic exercise on menstrual pain

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Background: Painful menstruation associated with lower abdominal pain without any pelvic abnormality is primary dysmenorrhea. The pathophysiology of primary dysmenorrhea is primarily linked to elevated levels of prostaglandins (PGs) resulting in uterine contractions causing pain. Physiological mechanisms underlying the effectiveness of pharmacological and non-pharmacological interventions including analgesics, acupuncture, spinal manipulation, Chinese herbs, and ginger-partitioned moxibustion for primary dysmenorrhea is available in literature. However, the underlying mechanism of aerobic exercise-induced alleviation of pain associated with primary dysmenorrhea is not known. Similarly, the dose-response effect of aerobic exercise on primary dysmenorrhea-associated pain is also not known. Objectives: (1) to identify the influence of aerobic exercise on prostaglandin (PGF2, PGE2, TXB2) levels in menstrual fluid of women with primary dysmenorrhea (2) to investigate the dose-response effect of aerobic exercise on pain and prostaglandin levels in women with primary dysmenorrhea Methods: Non-pregnant women in the age group 18-29 years, with regular menstrual cycles, and menstrual pain equivalent to or greater than 4 on a 0-10 Visual Analogue Scale (VAS) will be considered eligible to participate in the study. Sampling method: Convenience sampling Recruitment: Advertising will be done by posting study flyers around the University campus, waiting rooms of the PolyU University Health. The advertisement flyers will contain simple inclusion information as well as contact details of the principal investigator. Participants: Thirty women (10 healthy women and 20 women with primary dysmenorrhea) will be placed in three groups: Group 1: healthy control group; Group 2: high-intensity aerobic exercise (HIE) group and; Group 3: moderate-intensity aerobic (MIE) exercise group. Intervention: women in both exercise groups will complete supervised treadmill-based aerobic exercise for the first two days of menstruation for two menstrual cycles. High-intensity aerobic exercise: women in the HIE group will perform supervised treadmill-based aerobic exercise at an intensity of up to 50% MHR for the first five minutes (warm-up period), followed by 25 minutes of aerobic exercise at 70-85% of their maximum heart rate (MHR). Moderate-intensity aerobic exercise: women in the MIE group will perform 5-minute warm-up exercise similar to the HIE group followed by treadmill exercise for 25 minutes at 50-55% of their MHR. Assessment time points: pre-and-post intervention pain assessment and tampons collection will be done prior to and 30 minutes after completion of treadmill exercise on first two days of menstruation. Participants will be followed up for two menstrual cycles. Significance of the project: A better understanding of the mechanism underlying aerobic exercise-induced pain relief in primary dysmenorrhea would allow us to inform clinical practice and future research in the application of aerobic exercise. The proposed study will provide a scientific rationale for how aerobic exercise might alleviate the pain associated with primary dysmenorrhea. Pain is usually measured as a subjective phenomenon. This study is an initial effort to identify how biomarkers of pain in primary dysmenorrhea are influenced by aerobic exercise.

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