As part of Endo awareness month, we released a 10 minute podcast episode on Endometriosis and exercise - the best type of exercise if you have endo and how exercise can even be preventative for endo. 

Here is a link to that podcast episode, and below is a little recap of what was discussed. 

What is Endometriosis (Endo)?

10-15% of women of reproductive age have Endo. Almost 1 million Aussie women.

Endo is characterised by the growth of endometrial tissue (similar to the tissue lining your uterus) outside the uterine cavity. Usually in the pelvic cavity, however there have even been examples in the nasal cavity, brain etc. 

It is an inflammatory condition, and it takes on average 6.5 years to be diagnosed in Australia. 

The awareness around endo has definitely been growing recently - which is fantastic to see. But after researching for this episode it is clear we still have a long way to go...

Physical exercise and Endo

We took a look at this from 2 angles. The first being the exercise can have a preventative effect against endo. 

The second being what is the best type of exercise for someone with endo.

1. Exercise and its protective effect

Physical exercise may have a protective effect against endo. Regular physical exercise seems to have protective effects against diseases that involve inflammatory processes since it:

• induces an increase in the systemic levels of cytokines with anti-inflammatory and antioxidant properties; and 
• also acts by reducing estrogen levels. 

The main factor most studies seem to hold on to is that the protective effects of regular physical exercise have been widely described in the treatment of diseases involving inflammatory processes (such as type 2 diabetes and colon and breast cancer). Therefore the link is made that this could also be beneficial for endo. 

Here are some findings from some of the studies considered:

• A lower risk of endo for women who practiced regular exercise - a minimum of 2 h/week

• 2 to 4 hours per week of regular exercise decreases 65% chance of endometriosis
• Frequent and high-intensity activity reduced 76% of endometrioma risk

But it was noted that all these studies were observational in nature, and would benefit from controlled studies using validated instruments etc. 

Role of estrogen

One paper considered the involvement of estrogen - noting that endo is an estrogen-dependent condition. Physical activity may raise levels of sex hormone binding globulin (SHBG), which would lower bioavailable estrogens, - therefore hypothesising that physical activity is protective.

This paper further considered the fact that PA lowers insulin resistance, which has been linked to endo. It also found that when compared with women who did not regularly exercise, regular exercise was linked to a 40%–80% lower risk of endometriosis. 

2. If you have endo - what is the best exercise to do? 

Unfortunately there is no clear answer from my research on this. 

A study by Bergström et al. found that a 12-month exercise program reduced the intensity of pelvic pain associated with endometriosis. Similarly, Carpenter et al. found that physical exercise relaxed muscles of patients with endo, to help alleviate pain.  If pain is a factor in your endo, it is definitely worth exploring movement/exercise as a method of pain relief.

There is plenty of support out there for the positive impacts of "mind-body" style interventions, such as relaxation, movement, yoga, on overall well-being, reducing psychological distress,  of course helping to create a positive mental state, and decreasing pain. 

A big block for some women with endo is that they may be in a lot of pain - which can prevent you from exercising. It is at this stage that we consider it best to say - choose the movement that feels good for you. If you can focus on building muscle, gentle cardio - you don’t have to be jumping around smashing yourself on bootcamp style workouts if that doesn’t feel good on your body. 

However - drawing our own conclusions - looking at the benefits of building muscle around making the body more insulin sensitive, higher muscular strength and higher self-perceived fitness are significantly related with higher resilience to stress. Strength training can also over the longer term help decrease inflammation in the body. 

Choosing lower impact workouts - where you can stabilise and support your body, choose different movements depending on how you are feeling, and dialling down the intensity but still challenging your muscles is a great option for someone dealing with endo.

Risk of physical inactivity - women with endo

Some of the research shows that individuals with endometriosis might be at increased risk of physical inactivity, which is a risk factor for various co-morbidities. 

One study of 460 women with endo and a similar number without - those with Endo were exercising far less. This is understandable - noting the severe symptoms that some women can face, however it is important to understand the risks associated with this too. This is where it is again so important to urge women to find the style of movement that works for them. 

Alimba & endo

We may be biased, but we consider Alimba workouts to be a really exceptional option for women dealing with endo. The workouts can be totally tailored to suit you and your body on any given day, we provide plenty of stabilised options in class and a lot of our classes are mat based (aka. you aren't standing / up and down all class), and they also don't place unnecessary stress on your system. They can also be done from the comfort of your own home - which means you can literally do them in your pyjamas if it is one of those days! 

Check out our 14 day free trial and see if our workouts are a good fit for you here. 

Resources:

• Bonocher CM, Montenegro ML, Rosa E Silva JC, Ferriani RA, Meola J. Endometriosis and physical exercises: a systematic review. Reprod Biol Endocrinol. 2014 Jan 6;12:4. doi: 10.1186/1477-7827-12-4. PMID: 24393293; PMCID: PMC3895811.
• Claire Tourny, Ben-Moussa Amira Zouita, Samira El Kababi, Léa Feuillet, Ayoub Saeidi, et al.. Endometriosis and physical activity: A narrative review. International Journal of Gynecology and Obstetrics, 2023, ff10.1002/ijgo.14898ff. ffhal-04166276f
• Neumann RJ, Ahrens KF, Kollmann B, Goldbach N, Chmitorz A, Weichert D, Fiebach CJ, Wessa M, Kalisch R, Lieb K, Tüscher O, Plichta MM, Reif A, Matura S. The impact of physical fitness on resilience to modern life stress and the mediating role of general self-efficacy. Eur Arch Psychiatry Clin Neurosci. 2022 Jun;272(4):679-692. doi: 10.1007/s00406-021-01338-9. Epub 2021 Oct 7. PMID: 34622343; PMCID: PMC9095527.