Author(s): VENTH, L., HEINRICH, C., BEHRINGER, M. , Institution: GOETHE UNIVERSITY FRANKFURT , Country: GERMANY, Abstract-ID: 2200

INTRODUCTION:
Endometriosis is a chronic inflammatory, estrogen-dependent disease affecting approximately 10% of women of reproductive age. The most prevalent symptoms include pelvic pain, infertility, dysmenorrhea and dyspareunia. As physical activity can modulate systemic inflammation and hormonal pathways implicated in endometriosis, it may represent a promising non-pharmacological strategy to reduce pain and symptom severity, enhance psychological well-being, and improve overall quality of life. This study aimed to map how the effect of Physical Activity has been investigated in endometriosis and to characterize study designs and implemented Physical Activity modalities.
METHODS:
The scoping review was conducted following PRISMA-ScR guidelines. Electronic databases (PubMed and Google Schoolar) were searched from inception to January 2025. Additionally, the AI-assisted search tool ASTA (Allen Institute for Artificial Intelligence) was used to identify potentially relevant studies.
Studies investigating habitual Physical Activity, structured exercise, or physiotherapy in individuals with endometriosis were included. Data were charted and clustered by study design and Physical Activity modality.

RESULTS:
24 studies were included. Evidence was clustered into: systematic reviews with meta-analysis (k = 5), narrative reviews (k = 6), randomized controlled trials (k = 2), non-randomized interventional studies (k = 2), observational studies (k = 5), qualitative studies (k = 1), animal models (k = 2) and case study (k = 1). Physical Activity modalities included multimodal supervised exercise (k = 6), pelvic floor muscle training (k = 5), yoga/mind–body interventions (k = 10), aerobic/endurance training (k = 14) and resistance training (k = 7). Most human studies were cross-sectional and relied on self-reported Physical Activity. RCTs primarily examined structured exercise or physiotherapy rather than habitual Physical Activity behavior.
CONCLUSION:
Current evidence is heterogeneous and primarily derived from observational studies or from evidence synthesized in reviews. While several Physical Activity modalities are associated with improvements in pain and quality of life, findings are inconsistent due to methodological variability. None of the included studies differentiated between specific exercise modalities in a direct comparative design.
Physical activity appears promising as an adjunct strategy in endometriosis management. However, evidence remains heterogeneous and largely non-experimental. High-quality trials targeting habitual physical activity behaviour or structured exercise programs are needed to inform clear and clinically applicable recommendations.