{"paper_id":"32c5b527-ae2f-4c6f-a86f-4e4243771d3d","body_text":"Day, Kate, Manship, Sharon and Flurrey, Caronline (2025) The Impact of Physical \nActivity on Quality of Life for individuals Living Endometriosis. A Systematic \nReview.  The Impact of Physical Activity on Quality of Life for individuals Living \nEndometriosis. A Systematic Review . \nKent Academic Repository\nDownloaded from\nhttps://kar.kent.ac.uk/115348/ The University of Kent's Academic Repository KAR \nThe version of record is available from\nhttps://doi.org/CRD420251104341\nThis document version\nPublisher pdf\nDOI for this version\nLicence for this version\nUNSPECIFIED\nAdditional information\nVersions of research works\nVersions of Record\nIf this version is the version of record, it is the same as the published version available on the publisher's web site. \nCite as the published version. \nAuthor Accepted Manuscripts\nIf this document is identified as the Author Accepted Manuscript it is the version after peer review but before type \nsetting, copy editing or publisher branding. Cite as Surname, Initial. (Year) 'Title of article'. To be published in Title \nof Journal , Volume and issue numbers [peer-reviewed accepted version]. Available at: DOI or URL (Accessed: date). \nEnquiries\nIf you have questions about this document contact ResearchSupport@kent.ac.uk. Please include the URL of the record \nin KAR. If you believe that your, or a third party's rights have been compromised through this document please see \nour Take Down policy (available from https://www.kent.ac.uk/guides/kar-the-kent-academic-repository#policies). \n\n\nPrint Close\nPrint Close\nThe Impact of Physical Activity on Quality of Life for individuals\nLiving Endometriosis. A Systematic Review\nKate Day, Sharon Manship, Caroline Flurrey\nCitation\nKate Day, Sharon Manship, Caroline Flurrey. The Impact of Physical Activity on Quality of Life for individuals\nLiving Endometriosis. A Systematic Review. PROSPERO 2025 CRD420251104341. Available from\nhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420251104341.\nREVIEW TITLE AND BASIC DETAILS\nReview title\nThe Impact of Physical Activity on Quality of Life for individuals Living Endometriosis. A Systematic Review\nCondition or domain being studied\nEndometritis; Quality of Life; Health-Related Quality of Life; Non-Pharmacological Interventions; Physical activity;\nNon-Surgical Interventions; Physical Activity Level; Physical Exercises\nEndometriosis is a chronic whole-body condition caused by tissue similar to endometrium cells that line the womb\nand can cause multiple psychological and physical disruptive symptoms such as brain fog, chronic pain and\nfatigue.\nRationale for the review\nEndometriosis is a long-term health condition where tissue similar to the womb lining grows elsewhere in the body.\nThis can cause physical and mental symptoms such as chronic pain, fatigue, and brain fog that can be severe and\nunpredictable, often disrupting everyday life activities and significantly impact quality of life.\nAlthough NHS recommends regular physical activity (PA) for good health, people with endometriosis may find it\ndifficult to stay active due to symptom flare-ups. Over time, this may lead to reduced wellbeing and increase health\nrisks. Endometriosis is a condition that falls under women's health, an area of research that has historically been\nneglected. There is limited research on endometriosis affects physical activity engagement and it's impact generally\nand synthesised. Efforts to close knowledge gaps predominantly focused on pharmacological and surgical\ninterventions. However, it is still considered a lifelong and incurable condition, therefore, there is value in\nunderstanding lifestyle implications on endometriosis and overall wellbeing throughout their life course. Research\nneeds to close gaps regarding holistic, person centered approaches to managing quality of life and wellbeing living\nwith endometriosis co-currently with supporting protective health behaviors for health longevity.\nFindings will improve understanding of how and what physical activity interventions impact the quality of life for\nthose living with endometriosis, imperative to informing future intervention designs that are effective and\nappropriately adapted for those with endometriosis beyond pharmacological approaches.\nReview objectives\nHow effective are physical activity interventions for improving quality of life for those living with endometriosis?\nWhat physical activity interventions are most effective for improving quality of life within endometriosis populations?\nWhat key interventions components differences between intervention types, intensity, and length differ across\nquality of life outcomes within endometriosis populations?\nKeywords\nEndometriosis; Quality of life; Physical health; Mental health; Physical activity; Physical exercise; Intervention;\nMovement behaviour interventions; Behaviour Intervention\nCountry\nUnited Kingdom\nELIGIBILITY CRITERIA\nPopulation\nIncluded\nAdults clinically diagnosed with endometriosis, assigned female at birth (18 years old and over)\nExcluded\nA healthy population, not clinically diagnosed with endometriosis, under 18 years old\nIntervention(s) or exposure(s)\nIncluded\nPhysical And Psychosocial Approaches; Physical Exercises; Psychoeducation; Physical activity; Exercise; Non-\nPharmacological Interventions; Behavior modification\nA repeated measures intervention with minimum 4 weeks of intervention application.\nInterventions that have a physical activity component.\nExcluded\ninterventions that utilise pharmacology or surgical interventions during the intervention period.\nInterventions that don't have a physical activity component.\nComparator(s) or control(s)\nIncluded\nPICO tags selected: Waiting list control; Usual Care; Placebo\nStudy design\nBoth randomized and nonrandomized study types will be included.\nContext\nEndometriosis is a chronic, lifelong condition that is considered untreatable however NHS management pathways\npromote laparoscopic surgeries and pain medication. However, these are quite invasive and disruptive\nmanagement approach and there is limited literature on managing endometriosis symptoms via psychosocial and\nnon-pharmacological interventions that are more person centered, and lifestyle prioritised. Furthermore, the chronic\npain, fatigue and brain fog symptoms disrupt physical activity engagement with further disruptions due to surgery\nand medical interventions. Physical activity is an important protective health behaviour against morbidities therefore\nthis paper aims to understand how physical activity can be used to support quality of life for those with\nendometriosis as an essential starting point for future research development. Therefore, interventions conducted in\nnon-clinical settings that are lifestyle interventions will be included. Furthermore, there might be different stages of\nendometriosis classified within the participants, so long as participants are medically diagnosed by MRI or surgery\nall stages of endometriosis will be included due to heterogeneity of symptom severity not necessarily aligning with\nstage.\nTIMELINE OF THE REVIEW\nDate of first submission to PROSPERO\n16 October 2025\nReview timeline\nStart date: 1 June 2025. End date: 31 December 2025.\nDate of registration in PROSPERO\n16 October 2025\nAVAILABILITY OF FULL PROTOCOL\nAvailability of full protocol\nA full protocol has been written and uploaded to PROSPERO. The protocol may be accessed through this link\nhttps://www.crd.york.ac.uk/PROSPEROFILES/42a1684879c07f28f286e26865aabdf5.pdf.\nSEARCHING AND SCREENING\nSearch for unpublished studies\nOnly published studies will be sought.\nMain bibliographic databases that will be searched\nThe main databases to be searched are ASSIA - Applied Social Sciences Index & Abstracts, CLIB - The Cochrane\nLibrary, Embase - Embase via Ovid, Embase.com, MEDLINE, PsycInfo, PubMed, SSCI - Social Science Citation\nIndex and Scopus.\nOther important or specialist databases that will be searched\nThe use of searching software 'Research Rabbit AI' will help itentify any additional relevant peer reviewed\npublished papers missing from the list above.\nSearch language restrictions\nThe review will only include studies published in English.\nSearch date restrictions\nDatabases will be searched for articles published from 1 January 2020, there are no search end date restrictions.\nOther methods of identifying studies\nOther studies will be identified by: looking through all the articles that cite the papers included in the review\n(\"snowballing\" or forward citation searching), looking through all the articles that cite the papers included in the\nreview (\"snowballing\"), reference list checking and reference list checking (backward citation searching).\nAdditional information about identifying studies\n'Research Rabbit AI'\nLink to search strategy\nA full search strategy is available in the full protocol as described in the Availability of full protocol section\nSelection process\nStudies will be screened independently by at least two people (or person/machine combination) with a process to\nresolve differences.\nOther relevant information about searching and screening\nNone\nDATA COLLECTION PROCESS\nData extraction from published articles and reports\nData will be extracted independently by at least two people (or person/machine combination) with a process to\nresolve differences.\nAuthors will not be contacted for further information.\nStudy risk of bias or quality assessment\nRisk of bias will be assessed using: ROBINS-I\nThe Effective Public Health Practice Project (EPHPP) will be used to assess the quantitative element of studies\nquality.\nData will be assessed by one person (or a machine) and checked by at least one other person (or machine).\nAdditional information will not be sought from study investigators if required information is unclear or unavailable in\nthe study publications/reports.\nReporting bias assessment\nUtilising the Risk of Bias for Missing Evidence Tool (ROB-ME) will support synthesis.\nCertainty assessment\nCertainty of findings will not be assessed\nOUTCOMES TO BE ANALYSED\nMain outcomes\nMain outcomes will report quality of life score changes and significance from base line following a physical activity\nintervention of at least 4 weeks within an endometriosis population. Main measures will be quality of life validated\nscales in addition to extending to menstrual measures that capture questionnaire point extending such as the\nMEDI-Q and EHP-30. Data for this outcome will be synthesised using standardised mean difference and reported P\nvalue's significance.\nAdditional outcomes\nThere are no additional outcomes.\nPLANNED DATA SYNTHESIS\nStrategy for data synthesis\nDue to the anticipated heterogeneity of the studies a Meta analysis is not proposed, a Narrative synthesis (Rai et\nal., 2020) will be undertaken. This method is inclusive, allows integration of qualitative and quantitative data from a\nwide variety of sources and can be more descriptive and interpretive than other review types, for example: to\nexplore relationships in the data and between groups of studies pertaining to the research questions. The synthesis\napproach will be finalised based on suitability of the included studies and potential changes such as an interpretive\nthematic synthesis will be reported in the published study.\nCURRENT REVIEW STAGE\nStage of the review at this submission\nReview stage Started Completed\nPilot work ✓  ✓\nFormal searching/study identification ✓ \nScreening search results against inclusion criteria ✓ \nData extraction or receipt of IPD  \nRisk of bias/quality assessment  \nData synthesis  \nReview status\nThe review is currently planned or ongoing.\nPublication of review results\nResults of the review will be published in English.\nREVIEW AFFILIATION, FUNDING AND PEER REVIEW\nReview team members\nMiss Kate Day (review guarantor and contact) ORCID: 0009-0003-3284-446X. University of Kent. England.\nNo conflict of interest declared.\nMs Sharon Manship. University of Kent. England.\nNo conflict of interest declared.\nDr Caroline Flurrey. University of West England. England.\nNo conflict of interest declared.\nNamed contact\nMiss Kate Day (k.day-398@kent.ac.uk). ORCID: 0009-0003-3284-446X. University of Kent. England.\nReview affiliation\nUniversity of Kent employees within the Centre of Health Services Studies in collaboration with the University of\nWest England.\nFunding source\nReview has no specific/external funding but is supported by guarantor/review team (non-commercial) institutions.\nPeer review\nThere has been no peer review of this planned review.\nADDITIONAL INFORMATION\nAdditional information\nAny changes from the protocol will be reported in the published paper.\nReview conflict of interest\nDeclared individual interests are recorded under team member details.. No additional interests are recorded for this\nreview.\nMedical Subject Headings\nChronic Disease; Chronic Pain; Endometriosis; Exercise; Endometrium; Fatigue; Female; Humans; Mental Fatigue;\nPsychosocial Intervention; Quality of Life; Uterus\nSIMILAR REVIEWS\nCheck for similar records already in PROSPERO\nPROSPERO identified a number of existing PROSPERO records that were similar to this one (last check made on\n25 August 2025). These are shown below along with the reasons given by that the review team for the reviews\nbeing different and/or proceeding.\nEffectiveness of psychosocial interventions in endometriosis: A systematic review [published 13 February\n2025] [CRD42025622067]. The review was acknowledged as similar but the authors opted to continue\nbecause there are differences in population, there are differences in intervention or comparator. The authors\nalso noted: \"Our review will only focus on physical behaviour interventions in relation to quality of life opposed\nto psychosocial interventions. Ours will provide more specific outcomes regarding managing physical activity\nand wellbeing with endometriosis.\"\nThe effectiveness of psychological and psychosocial interventions for the pain interference in women with\nendometriosis: A systematic review [published 5 May 2025] [CRD420251034112]. The review was judged not\nto be similar\nThe effectiveness of multi-component interventions on sleep quality for individuals with fibromyalgia: a\nsystematic review [published 14 June 2022] [CRD42022290247]. The review was judged not to be similar\nPROSPERO version history\nVersion 1.0, published 16 Oct 2025\nDisclaimer\nThe content of this record displays the information provided by the review team. PROSPERO does not peer review\nregistration records or endorse their content.\nPROSPERO accepts and posts the information provided in good faith; responsibility for record content rests with\nthe review team. The guarantor for this record has affirmed that the information provided is truthful and that they\nunderstand that deliberate provision of inaccurate information may be construed as scientific misconduct.\nPROSPERO does not accept any liability for the content provided in this record or for its use. Readers use the\ninformation provided in this record at their own risk.\nAny enquiries about the record should be referred to the named review contact\nPROSPEROInternational prospective register of systematic reviews","source_license":"CC0","license_restricted":false}