Aerobic Exercise for Primary Dysmenorrhea

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Objectives: (1): To evaluate the effectiveness of high-intensity aerobic training (HIAT) on pain intensity, absenteeism, and academic performance among university students with primary dysmenorrhea. (2): To investigate the physiological mechanism(s) underlying aerobic exercise-induced analgesia in w...

Objectives: (1): To evaluate the effectiveness of high-intensity aerobic training (HIAT) on pain intensity, absenteeism, and academic performance among university students with primary dysmenorrhea. (2): To investigate the physiological mechanism(s) underlying aerobic exercise-induced analgesia in women with primary dysmenorrhea. (3) Compare the cost-effectiveness of HIAT against that for usual care to treat pain associated with primary dysmenorrhea. Design and subjects: A mixed-methods study, including a cross-over RCT, and semi-structured focus groups, alongside economic evaluation, will be conducted using 130 women with primary dysmenorrhea. Interventions: Women will randomly allocated into high-intensity aerobic training (HIAT) or wait-list control (WLC) groups. Participants in the HIAT group will receive supervised treadmill training for the first 12 weeks of the trial. Following a four-week washout period the cross-over period will begin during Week 16, and the participants initially randomised to the WLC group will receive the HIAT regimen from Weeks 14-28. Participants initially randomized to HIAT group will be instructed not to engage in exercise during the remainder of the study period (i.e. Weeks 14-28). Outcome measures: Pain intensity, absenteeism from university, academic performance, concentration, dysmenorrhea daily diary, and salivary progesterone and prostaglandin F2-alpha levels in saliva. The EQ-5D-3L will be used to determine the QoL for the HIAT and WLC groups. Data analysis plan: A preliminary test using the independent samples t-test and a two-sided Student's unpaired t-test will be performed to rule out carryover effects and identify the within-participant differences in outcome variables between the study periods, respectively. Treatment effects will be evaluated using an ANOVA with a mixed-effects model considering the longitudinal repeated measures, including the effects of time within each study group and the interaction between time and intervention. The mediation effects will be assessed using the Sobel test. The EQ-5D responses will be converted into utility scores to estimate the gain or loss of quality-adjusted life-years (QUALYs). The seemingly unrelated regression (SUR) analyses will be used to estimate the total cost differences (?C) and effect differences (?E). Qualitative data will be analysed using the process of thematic analysis.

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