Physical activity as an ally in endometriosis

Update 2025.

Endometriosis is a common chronic inflammatory disease (affecting 1 in 10 women), often associated with severe and debilitating pelvic pain, fertility problems, and fatigue. In addition to conventional medical and surgical treatments, adapted physical activity (APA) is emerging as a complementary approach with potential beneficial effects on pain, quality of life, and fatigue. Recently, more and more clinical results have been published on this topic, and this article will bring you up to date on the subject.

Below, we review the disease, standard treatment modalities, the current state of knowledge on the effects of exercise, plausible physiological mechanisms, and recent studies and projects. For more details on the context of the disease, its etiology, and current treatments, we invite you to (re)read our Preuve à l'Appui de Juin 2024 (in French).

1. What is Endometriosis?

Endometriosis is characterized by the presence of tissue similar to the endometrium outside the uterine cavity (ovaries, pelvic peritoneum, fallopian tubes, sometimes further). It affects a significant proportion of menstruating individuals of reproductive age and primarily causes:

• Pelvic pain (often cyclical), severe dysmenorrhea;

• Dyspareunia (pain during intercourse), digestive or urinary pain depending on location;

• Chronic fatigue and impact on daily life;

• Fertility issues for some patients.

Management should be multidisciplinary (analgesics, hormonal treatments to suppress cycles, conservative or radical surgery depending on the case, psychological support, and physiotherapy).

2. What does recent research show about physical activity and endometriosis?

Recent literature converges on the idea that physical activity and supervised exercise programs can improve certain symptoms: reducing pain intensity, improving quality of life, decreasing fatigue, and benefiting mental health. Recent findings include:

• A systematic review and meta-analysis published in PLOS One in February 2025 summarizes the available controlled trials and concludes positive effects of physical activity/exercise on pain and quality of life in women with endometriosis, while noting methodological heterogeneity among studies.

• Small pilot trials and RCTs (8–12 week multimodal programs, lumbopelvic therapeutic exercise, yoga, moderate aerobic training) show feasible and safe clinical improvements, although sample sizes remain limited.

In short, the evidence is promising but requires larger randomized trials with standardized interventions to make firm recommendations..

3. Why might physical activity provide relief?

Several biological and psychosocial mechanisms plausibly explain the beneficial effect of exercise:

• Systemic anti-inflammatory effects: regular exercise modifies cytokine profiles (increased anti-inflammatory mediators), which may reduce chronic inflammation associated with endometriotic lesions.

• Improvement of musculoskeletal and pelvic floor function: lumbopelvic strengthening, mobilization of visceral adhesions, improved proprioception and exercise tolerance contribute to reducing musculoskeletal and central pain.

• Neuro-modulatory effect on pain: exercise stimulates endogenous analgesia pathways (endorphins, central modulation) and improves sleep and mood.

• Psychosocial effect: activity, group support, self-efficacy, and reduction of anxiety/depression contribute to better quality of life.

  
  

4. Recommended modalities

Tested interventions often combine: moderate aerobic endurance exercises, overall muscle strengthening, targeted lumbopelvic work, stretching, breathing, and mind-body approaches (yoga). Adapted physical activity (APA) — individualized, progressive, and supervised — is the preferred format.

On the occasion of the European Week for Endometriosis Awareness in March 2025, the French Ministry of Sports published the guide “En mouvement avec l’endométriose” (“Moving with Endometriosis”). This guide highlights the importance of adapted physical activity for improving the well-being of affected women.

The French national guide (available for download HERE) provides practical recommendations (frequency, types of exercises) and emphasizes adaptation to painful flare-ups. It was drafted within the framework of the National Sport-Health-Wellbeing Resource Center, with contributions from Colin Charrier (Director - Coordinator of Adapted Physical Activity, Maison Sport Santé SPORACTIO), Carole Maître (Gynecologist, Sports Physician at INSEP, Vice-President of the CNOSF Medical Commission), Sandrine Gruda (high-level basketball player and entrepreneur), Luce Poulain (athlete at Maison Sport Santé SPORACTIO), and Fabrice Dugnat (Sports-Health Officer, Ministry of Sports).

5. Recent advances in research: physical activity as a therapeutic lever

In recent years, research on physical activity in endometriosis has accelerated, with large clinical trials, structured national projects, and official recommendations integrating exercise as a complementary therapeutic approach.

5.1. Key French projects

CRESCENDO: A large-scale national project funded by the ANR, CRESCENDO aims to evaluate a comprehensive adapted physical activity program coupled with patient therapeutic education (ETP). It includes wide recruitment across several French centers and involves multidisciplinary teams. Preliminary results show good feasibility, favorable adherence, and positive symptom evolution, particularly regarding pain and quality of life.

APHYLIDOL: Funded by the Foundation for Endometriosis Research, this project explores the effect of an adapted physical activity program integrating a biopsychosocial dimension. By focusing on body awareness, pain perception, and psychological factors, APHYLIDOL aims to clarify how physical activity modifies the relationship between body, movement, and pain. Early methodological feedback highlights the importance of supervision, individualized pacing, and strategies centered on body confidence.

5.2. Other recent clinical studies: growing evidence

Physio-EndEA / PhysioENDeA (2023–2025)

This landmark randomized controlled trial evaluated a supervised multimodal therapeutic program (lumbopelvic mobility, targeted strengthening, aerobic exercise, relaxation). Results show:

• Significant reduction in pain (pelvic, abdominal, lumbopubic)

• Improved quality of life

• Increased physical capacities (lumbar strength, endurance)

• Reduced fatigue

These findings provide one of the most robust levels of evidence for the benefit of supervised programs. The protocol has also been integrated into the Blueback Physio system to allow in-session execution with direct feedback on deep abdominal muscle activation.

Tennfjord et al., 2024 – RCT exercise + PFMT

This randomized trial compared education alone versus education + supervised training combining general physical activity and pelvic floor muscle training (PFMT). Participants in the “exercise + PFMT” group showed:

• Significant reduction in genitopelvic pain

• Improved pelvic floor muscle control

• Overall functional improvement

This study highlights the importance of pelvic care in deep pain associated with endometriosis.

Xie et al., 2025 – Meta-analysis (PLOS ONE)

This meta-analysis, including six RCTs (251 participants), confirmed:

• Moderate but significant pain reduction

• Improved quality of life

• Generally superior effects for supervised, multimodal, or strength-inclusive programs

However, protocol heterogeneity highlights the need for more standardized trials.

Other recent contributions

Several complementary studies showed benefits on:

• Fatigue (Salinas-Asensio et al., 2025, Physio-EndEA follow-up)

• Pain and mobility via yoga, relaxation, and mind-body exercises

• Pelvic floor control via supervised PFMT

• Body awareness and stress management related to chronic pain

5.3. Synthesis

Current evidence converges on several robust conclusions:

• Supervised exercise is superior to unsupervised exercise, particularly for pelvic pain.

• Multimodal programs (mobility + strengthening + aerobic + PFMT + relaxation) are most effective.

• Regularity, individual adaptation, and progression strongly influence outcomes.

• Physical activity improves not only pain but also:

  • Fatigue

  • Functionality

  • Quality of life

  • Body awareness

  • Stress and pain perception

Nonetheless, more research is needed focusing on:

• Intervention heterogeneity (type, duration, intensity) and evaluation criteria: need for multicenter standardized RCTs.

• Sample size: many studies are pilot/exploratory; larger trials are necessary.

• Biological measures: coupling clinical evaluations with biomarkers (inflammation, cytokine profile) to better understand mechanisms. (CRESCENDO includes such measures.)

  
  

Conclusion

Adapted physical activity appears to be a promising complementary strategy to reduce pain, improve quality of life, and combat fatigue in individuals with endometriosis. Early evidence is encouraging; recent French projects (CRESCENDO, APHYLIDOL), the national guide Moving with Endometriosis, and controlled trials like Physio-EndEA show that research is being structured to produce practical and scientifically robust recommendations.

Bibliography and useful links

Institutional guides and documents

• Direction des Sports, Sporactio, & Ministry of Sports. (2023). En mouvement avec l’endométriose: Guide national d’activité physique adaptée. French Government.

Randomized trials

• Artacho-Cordón, Á., et al. (2023). Effect of a multimodal supervised therapeutic exercise program on quality of life and pain in women with endometriosis: A randomized clinical trial. Archives of Physical Medicine and Rehabilitation.

• Tennfjord, M., et al. (2024). General exercise combined with pelvic floor muscle training in women with endometriosis. BMC Women’s Health.

• Salinas-Asensio, M., et al. (2025). Effects of a multimodal exercise program on fatigue and physical function in women with endometriosis. European Journal of Obstetrics & Gynecology.

Systematic review and meta-analysis

• Xie, Q., et al. (2025). Effects of physical exercise on endometriosis symptoms: A systematic review and meta-analysis. PLOS ONE.

National programs

• ANR CRESCENDO. (2023–2025). National research program on physical activity and endometriosis.

• Foundation for Endometriosis Research. (2023–2025). Project APHYLIDOL.