Adapted physical activity as complementary treatment to alleviate the symptoms of endometriosis? The CRESCENDO program (inCRease physical Exercise and Sport to Combat ENDOmetriosis) – CRESCENDO

Recently, the French government reaffirmed its desire to better understand and fight against endometriosis via the national strategy against endometriosis (2022-2025), on the one hand, and its desire to actively participate in the promotion of physical activity and the reduction of sedentary behaviors, via the national strategy for sport and health (2019-2024), on the other hand. It is in this context that the CRESCENDO study and its adapted physical activity (APA) program makes sense.

Besides infertility, one of the most common symptoms of endometriosis is pelvic chronic pain. This pain can cause psychological distress and interpersonal difficulties. These factors affect patients quality of life (QoL). However, studies on the psychological and social consequences of endometriosis are scarce, few have investigated life-partners’ view of the disease and its consequences, and all adopt cross-sectional designs.
Research highlights the beneficial effects of APA, on chronic diseases. Thus, APA may have a beneficial effect on the symptoms and the psychological and social consequences of endometriosis. However, studies questioning the link between PA and endometriosis are rare. It is worth noticing that, in the specific context of endometriosis, the barriers and facilitators to the practice of PA are not clearly identified. Otherwise, due to their cross-sectional design, it is not possible for these studies to establish a causal link between PA and endometriosis. A randomized controlled trial is needed to test the effects of (A)PA on endometriosis and its consequences.

Our ambition for this original work is to fill these gaps in the existing literature and to allow a more comprehensive view of the phenomena at play in the relation between PA and endometriosis. To this end, we will seek to achieve 2 objectives:
1) to identify the perceived effects of the disease on different areas of patients' lives, specifically areas related to PA, and to examine the reasons why patients are or are not physically active using a mixed methodology (WP1).
2) to investigate the effects of an APA program delivered via videoconferencing which includes therapeutic patient education (TPE) on 3 primary outcomes: perceived pain, quality of life, and PA. A complementary aim is to determine its effect on psychosocial, motivational, and on physiological variables (WP2).
WP1 started in February 2022 and is still in progress. Self-report questionnaires, focus groups and semi-structured interviews were proposed to individuals who suffer or not suffer from endometriosis and their life-partner. In order to take gender into account, participants invited to participate were men, women or no gender.
The WP2 includes a pilot study and a main study. The latter will last 6 months. Patients will be randomly assigned to 4 groups: control group,TPE group, APA group, and TPE + APA group. All groups will receive a booklet explaining the benefits of PA on endometriosis and its symptoms, and including examples of exercises. The intervention will consist of a total of 6 TPE sessions on adopting or maintaining a physically active lifestyle, nutrition and endometriosis related-pain management and/or 1-3 sessions of APA per week.

We hypothesize that the CRESCENDO program could (H1) complement current treatments for endometriosis by increasing PA and reducing SED, reducing pain, increasing QoL, (H2) have beneficial effects on patients' physical, psychological and social health as well as physiological factors. Finally, a program combining APA+TPE will be more effective than one that offers these interventions separately (H3). In view of the expected benefits, we hope that the results of this study will lead to the generalization of the integration of APA and TPE into endometriosis care protocols. We think the use of videoconferencing to deliver APA programs would remove barriers to PA and facilitated the adoption or maintenance of a physically active and healthy l