The Impact of Physical Activity on Quality of Life for individualsLiving Endometriosis. A Systematic Review

Endometriosis; Quality of life; Physical health; Mental health; Physical activity; Physical exercise; Intervention; Movement behaviour interventions; Behaviour Intervention Country United Kingdom ELIGIBILITY CRITERIA Population Included Adults clinically diagnosed with endometriosis, assigned female at birth (18 years old and over) Excluded A healthy population, not clinically diagnosed with endometriosis, under 18 years old Intervention(s) or exposure(s) Included Physical And Psychosocial Approaches; Physical Exercises; Psychoeducation; Physical activity; Exercise; Non- Pharmacological Interventions; Behavior modification A repeated measures intervention with minimum 4 weeks of intervention application. Interventions that have a physical activity component. Excluded interventions that utilise pharmacology or surgical interventions during the intervention period. Interventions that don't have a physical activity component. Comparator(s) or control(s) Included PICO tags selected: Waiting list control; Usual Care; Placebo Study design Both randomized and nonrandomized study types will be included. Context Endometriosis is a chronic, lifelong condition that is considered untreatable however NHS management pathways promote laparoscopic surgeries and pain medication. However, these are quite invasive and disruptive management approach and there is limited literature on managing endometriosis symptoms via psychosocial and non-pharmacological interventions that are more person centered, and lifestyle prioritised. Furthermore, the chronic pain, fatigue and brain fog symptoms disrupt physical activity engagement with further disruptions due to surgery and medical interventions. Physical activity is an important protective health behaviour against morbidities therefore this paper aims to understand how physical activity can be used to support quality of life for those with endometriosis as an essential starting point for future research development. Therefore, interventions conducted in non-clinical settings that are lifestyle interventions will be included. Furthermore, there might be different stages of endometriosis classified within the participants, so long as participants are medically diagnosed by MRI or surgery all stages of endometriosis will be included due to heterogeneity of symptom severity not necessarily aligning with stage. TIMELINE OF THE REVIEW Date of first submission to PROSPERO 16 October 2025 Review timeline Start date: 1 June 2025. End date: 31 December 2025. Date of registration in PROSPERO 16 October 2025 AVAILABILITY OF FULL PROTOCOL Availability of full protocol A full protocol has been written and uploaded to PROSPERO. The protocol may be accessed through this link https://www.crd.york.ac.uk/PROSPEROFILES/42a1684879c07f28f286e26865aabdf5.pdf. SEARCHING AND SCREENING Search for unpublished studies Only published studies will be sought. Main bibliographic databases that will be searched The main databases to be searched are ASSIA - Applied Social Sciences Index & Abstracts, CLIB - The Cochrane Library, Embase - Embase via Ovid, Embase.com, MEDLINE, PsycInfo, PubMed, SSCI - Social Science Citation Index and Scopus. Other important or specialist databases that will be searched The use of searching software 'Research Rabbit AI' will help itentify any additional relevant peer reviewed published papers missing from the list above. Search language restrictions The review will only include studies published in English. Search date restrictions Databases will be searched for articles published from 1 January 2020, there are no search end date restrictions. Other methods of identifying studies Other studies will be identified by: looking through all the articles that cite the papers included in the review ("snowballing" or forward citation searching), looking through all the articles that cite the papers included in the review ("snowballing"), reference list checking and reference list checking (backward citation searching). Additional information about identifying studies 'Research Rabbit AI' Link to search strategy A full search strategy is available in the full protocol as described in the Availability of full protocol section Selection process Studies will be screened independently by at least two people (or person/machine combination) with a process to resolve differences. Other relevant information about searching and screening None DATA COLLECTION PROCESS Data extraction from published articles and reports Data will be extracted independently by at least two people (or person/machine combination) with a process to resolve differences. Authors will not be contacted for further information. Study risk of bias or quality assessment Risk of bias will be assessed using: ROBINS-I The Effective Public Health Practice Project (EPHPP) will be used to assess the quantitative element of studies quality. Data will be assessed by one person (or a machine) and checked by at least one other person (or machine). Additional information will not be sought from study investigators if required information is unclear or unavailable in the study publications/reports. Reporting bias assessment Utilising the Risk of Bias for Missing Evidence Tool (ROB-ME) will support synthesis. Certainty assessment Certainty of findings will not be assessed OUTCOMES TO BE ANALYSED Main outcomes Main outcomes will report quality of life score changes and significance from base line following a physical activity intervention of at least 4 weeks within an endometriosis population. Main measures will be quality of life validated scales in addition to extending to menstrual measures that capture questionnaire point extending such as the MEDI-Q and EHP-30. Data for this outcome will be synthesised using standardised mean difference and reported P value's significance. Additional outcomes There are no additional outcomes. PLANNED DATA SYNTHESIS Strategy for data synthesis Due to the anticipated heterogeneity of the studies a Meta analysis is not proposed, a Narrative synthesis (Rai et al., 2020) will be undertaken. This method is inclusive, allows integration of qualitative and quantitative data from a wide variety of sources and can be more descriptive and interpretive than other review types, for example: to explore relationships in the data and between groups of studies pertaining to the research questions. The synthesis approach will be finalised based on suitability of the included studies and potential changes such as an interpretive thematic synthesis will be reported in the published study. CURRENT REVIEW STAGE Stage of the review at this submission Review stage Started Completed Pilot work ✓  ✓ Formal searching/study identification ✓  Screening search results against inclusion criteria ✓  Data extraction or receipt of IPD   Risk of bias/quality assessment   Data synthesis   Review status The review is currently planned or ongoing. Publication of review results

of the review will be published in English. REVIEW AFFILIATION, FUNDING AND PEER REVIEW Review team members Miss Kate Day (review guarantor and contact) ORCID: 0009-0003-3284-446X. University of Kent. England. No conflict of interest declared. Ms Sharon Manship. University of Kent. England. No conflict of interest declared. Dr Caroline Flurrey. University of West England. England. No conflict of interest declared. Named contact Miss Kate Day ([email protected]). ORCID: 0009-0003-3284-446X. University of Kent. England. Review affiliation University of Kent employees within the Centre of Health Services Studies in collaboration with the University of West England. Funding source Review has no specific/external funding but is supported by guarantor/review team (non-commercial) institutions. Peer review There has been no peer review of this planned review. ADDITIONAL INFORMATION Additional information Any changes from the protocol will be reported in the published paper. Review conflict of interest Declared individual interests are recorded under team member details.. No additional interests are recorded for this review. Medical Subject Headings Chronic Disease; Chronic Pain; Endometriosis; Exercise; Endometrium; Fatigue; Female; Humans; Mental Fatigue; Psychosocial Intervention; Quality of Life; Uterus SIMILAR REVIEWS Check for similar records already in PROSPERO PROSPERO identified a number of existing PROSPERO records that were similar to this one (last check made on 25 August 2025). These are shown below along with the reasons given by that the review team for the reviews being different and/or proceeding. Effectiveness of psychosocial interventions in endometriosis: A systematic review [published 13 February 2025] [CRD42025622067]. The review was acknowledged as similar but the authors opted to continue because there are differences in population, there are differences in intervention or comparator. The authors also noted: "Our review will only focus on physical behaviour interventions in relation to quality of life opposed to psychosocial interventions. Ours will provide more specific outcomes regarding managing physical activity and wellbeing with endometriosis." The effectiveness of psychological and psychosocial interventions for the pain interference in women with endometriosis: A systematic review [published 5 May 2025] [CRD420251034112]. The review was judged not to be similar The effectiveness of multi-component interventions on sleep quality for individuals with fibromyalgia: a systematic review [published 14 June 2022] [CRD42022290247]. The review was judged not to be similar PROSPERO version history Version 1.0, published 16 Oct 2025 Disclaimer The content of this record displays the information provided by the review team. PROSPERO does not peer review registration records or endorse their content. PROSPERO accepts and posts the information provided in good faith; responsibility for record content rests with the review team. The guarantor for this record has affirmed that the information provided is truthful and that they understand that deliberate provision of inaccurate information may be construed as scientific misconduct. PROSPERO does not accept any liability for the content provided in this record or for its use. Readers use the information provided in this record at their own risk. Any enquiries about the record should be referred to the named review contact PROSPEROInternational prospective register of systematic reviews