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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 9  |  Issue : 16  |  Page : 59-64

Comparative efficacy of core strengthening and stretching exercises on systemic and quality-of-life symptoms in adolescent college students with primary dysmenorrhea


Department of Physiotherapy, College of Medicine, University of Lagos, Lagos, Nigeria

Date of Submission01-Aug-2019
Date of Decision06-Apr-2020
Date of Acceptance21-May-2020
Date of Web Publication26-Nov-2020

Correspondence Address:
Dr. Ayoola Ibifubara Aiyegbusi
Department of Physiotherapy, College of Medicine, University of Lagos, Lagos
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/nnjcr.nnjcr_36_19

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  Abstract 


Background: Dysmenorrhea is one of the most common complaints among adolescents affecting the quality of life (QoL) of many women in their reproductive years resulting in absenteeism and missed classes. Prior studies had concluded that various forms of exercises are effective non-pharmacological methods of managing the pain associated with primary dysmenorrhea (PD). There is however a dearth of studies on the effect of these exercises on systemic symptoms. This study investigated the effect of core strengthening and stretching exercises on pain and systemic symptoms in undergraduate college students with PD. Materials and Methods: Thirty female college students aged 16 years and above participated in the study. The respondents' pain, systemic, and QoL symptoms were assessed using a self-administered standard questionnaire pre- and postintervention of core strengthening and stretching exercises. Data were analyzed using descriptive statistics (bar chart, pie chart, frequency, mean, standard deviation, and percentage) and inferential statistics (Mann–Whitney U-test and Wilcoxon signed-rank test) at statistically significant difference (P = 0.05). Results: There were no statistically significant (P > 0.05) differences in the values of the frequency and severity of symptoms between the two groups. There were however significant (P < 0.05) differences in the pre- and postintervention values of the systemic and QoL symptoms in the core strengthening group unlike the stretching group. Conclusion: It is concluded from this study that though both forms of exercises were effective in significantly reducing pain, core strengthening exercises appeared to have better effects in managing the systemic and QoL symptoms associated with PD.

Keywords: Core strengthening, exercise, pain intensity, primary dysmenorrhea, quality of life, stretching


How to cite this article:
Aiyegbusi AI, Adeagbo CA, Uwem-Umoh SI. Comparative efficacy of core strengthening and stretching exercises on systemic and quality-of-life symptoms in adolescent college students with primary dysmenorrhea. N Niger J Clin Res 2020;9:59-64

How to cite this URL:
Aiyegbusi AI, Adeagbo CA, Uwem-Umoh SI. Comparative efficacy of core strengthening and stretching exercises on systemic and quality-of-life symptoms in adolescent college students with primary dysmenorrhea. N Niger J Clin Res [serial online] 2020 [cited 2021 Jan 24];9:59-64. Available from: https://www.mdcan-uath.org/text.asp?2020/9/16/59/301641




  Introduction Top


Primary dysmenorrhea (PD), defined as a severe painful cramping sensation in the lower abdomen, is the most common cyclic pelvic pain affecting the quality of life (QoL) with a reported incidence of 20% and 90% in different societies.[1],[2] The pain usually begins around the time that menstruation commences and is usually described as sharp, intermittent, spasm of the abdominal muscles and adductors of the thigh and pain over the legs and lower back and also over the suprapubic area.[3] There are many associated systemic symptoms such as vomiting, nausea, fatigue, diarrhea, and heavy flow on the 1st and 2nd days of the menstrual cycle with or without mild fever which according to Hailemeskel et al.[4] is not life-threatening but leads to absenteeism and significantly affects the QoL. It is often associated with restriction of activity and absence from school or work, resulting in high health burden and socioeconomic loss. In many countries, PD is the leading cause of recurrent short-term school and work absenteeism in young girls and women.[5]

The management of PD usually involves the use of analgesics, combined estrogen/progesterone oral contraceptive pills, and non-steroidal anti-inflammatory drugs which are the most commonly used.[6],[7] These reduce menstrual pain by affecting the level of prostaglandins; however, their side effects include nausea, breast tenderness, intermenstrual bleeding, dizziness, drowsiness, and hearing and visual disturbances.[2]

The non-pharmacological treatment includes exercise, complementary or alternative medicine, transcutaneous electrical nerve stimulation, and heat therapy.[7],[8],[9] Physical exercises such as aerobics and stretching exercises have been suggested as a non-pharmacological approach for the management of symptoms as it is widely thought that exercise reduces the frequency and/or the severity of dysmenorrhea syndrome.[10],[11] A prior study had shown that women who took part in regular, moderate, aerobic exercise had fewer pain episodes and behavioral changes than non-exercisers during period cycles.[2]

Core strengthening exercises on the other hand allow for isolation and strengthening of core muscle groups, thus preparing them to handle daily forces of normal biomechanics, even when the body is under the stress of the menstrual cycle.[11] The negative effects of dysmenorrhea on an individual's psychological status usually result in sleeplessness and missed classes.[4] among female adolescents causing them to resort to self-medication[5] that provide varying degrees of pain relief but with some of them having serious clinical implications.[12] Studies have established the efficacy of both stretching and core strengthening exercises in significantly reducing pain associated with PD.[13] There is however a dearth of studies on the comparative efficacy of both forms of exercises on systemic and QoL symptoms which usually results in absenteeism and missed classes. The essence of this study was thus to investigate the comparative efficacy of stretching and core strengthening exercises in managing the symptoms of pain as well as systemic and QoL symptoms associated with PD in a population of adolescent college undergraduates.


  Materials and Methods Top


Participants

This study involved thirty female undergraduate students of a medical school in Nigeria who were above 16 years of age.[7] Female students who never experienced dysmenorrhea and those with secondary dysmenorrhea were excluded from the study. Participants who had musculoskeletal or neuromuscular problems and those who used contraceptive pills were also excluded from the study.

The ethical approval for the study was sought and obtained from the institutional Health Research and Ethics Committee and informed consent was sought and obtained from the participants.

The participants were recruited based on the inclusion and the exclusion criteria and those who met the inclusion criteria were randomly assigned to either the core strengthening exercise group or the stretching exercise group. Each participant received her respective treatment three times a week, 20 min for each exercise session giving a total of 60 min a week for 4 weeks to cover two menstrual cycles. The sample size was calculated using Cohen's formula[14] and determined to be 30 (15 in each group). Initially, 33 participants were recruited, but 30 participants eventually completed the study.

Materials/instruments which were adapted from Dr. Guy Abraham's Menstrual Symptom Questionnaire[15] were used to assess pain intensity, systemic symptoms, and health-related QoL.

Description of instrument

This was a structured self-administered close-ended questionnaire which consists of the following sections:

  • Section A: This section collected information of the participant's sociodemographic background which included the age at menarche
  • Section B: Information on the dysmenorrhea experience of the participants including the frequency and severity was documented
  • Section C: This section included a variety of options to determine the extent of the impact of dysmenorrhea and its effect on the activities of daily living and QoL.


Scoring pattern

Total frequency rating

The frequency of occurrence of symptoms was scored as follows:

A score of 0 was given if symptoms did not occur, 1 – <3 h, 2 – lasted 3–7 h, 3 – lasted an entire day, and 4 – lasted several days.

Average severity rating

A score of 0 was given if the symptom was not noticeable, 1 – if the symptom was slightly bothersome (mild symptoms), 2 – for the moderately bothersome symptom, 3 – for the severely bothersome symptom that interferes with activities of daily living, and 4 – for the very severely bothersome symptom (unable to cope and prevents normal lifestyle).[8]

Interventions

The interventions were given by two research assistants who were each blinded to the details of the intervention the other group was getting.

Group A: Strengthening exercises

First core strengthening exercise

Curl up

The participants were instructed to lie supine and mild knee flexed and clasp both hands behind the head and move the body toward the knee for 5 s and the exercise was repeated for ten times.[2]

Second core strengthening exercise

Pelvic bridging

The participants were asked to lie supine and with the knee flexed and then raise the pelvis upward till the comfort then hold that position for 5 sec and the exercise was repeated for ten times.[2]

Third core strengthening exercise

Planking

The participants were requested to lie prone and then by putting the weight on elbows and toes lift the body upward hold this position for 5 sec and the exercise was performed for five times.[2]

Fourth core strengthening exercise

Cat and Camel

The participants were requested to prone kneel and then take a deep breath from the nose while making hump in the back (cat) and breathe out from the mouth while curving the spine (camel) for 5 s and the exercise was performed for ten times.[2]

Group B: Stretching exercises

First stretching exercise

The participants were requested to stand and raise one heel off the floor, then repeat the exercise with the other heel alternatively. The exercise was performed for twenty times.[4]

Second stretching exercise

The participants were asked to stand and bend the trunk forward from the hip joint so that the shoulders and back were positioned on a straight line and the upper body was placed parallel to the floor for 5 s and repetitions were ten times.[4]

Third stretching exercise

The participants were asked to spread their feet shoulder width, place trunk and hands in forward stretching mode, then completely bend her knees and maintain a squatting position; duration of this position was 5 sec, and the subject then raised her body and repeated the same movements for ten times.[4]

Fourth Stretching Exercise: The participants were asked to spread her feet wider than shoulder width. Then, the subject was asked to bend and touch left ankle with her right hand while putting her left hand in a stretched position above her head so that the head was in the middle and her head was turned and looked for her left hand; this exercise was repeated for the opposite foot with the same method. The exercises were repeated alternatively ten times for each side of the body.[4],[9]

Data analysis

The data collected from this study were summarized using descriptive statistics of frequency, mean, median, mode, standard deviation, and percentage.

Inferential statistics used was Mann–Whitney U-test and Wilcoxon signed-rank test. All analyses were performed using the Statistical Package for the Social Sciences (SPSS) version 22 at a significant level of 0.05 (IBM Corporation, North Castle Drive, Armonk, NY, USA).


  Results Top


The mean age of the participants was 22.5 ± 1.74 years and menarche mean age was 13.2 ± 3.04 years. There were no statistically significant (P > 0.05) differences in the values of the frequency and severity of symptoms between the two groups. [Table 1] and [Table 2] show the mean frequency and severity of pain intensity, systemic symptoms, and QoL preintervention and postintervention in participants who received core stretching exercises, while [Table 3] and [Table 4] show the information for participants who received strengthening exercises and [Table 5] and [Table 6] depict the postintervention values between the two groups.
Table 1: Comparison between baseline and intervention (within group) of systemic symptoms using Wilcoxon signedrank test in the stretching group

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Table 2: Comparison between baseline and intervention (within group) of the quality of life using Wilcoxon signedrank test in the stretching group

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Table 3: Comparison between baseline and intervention (within group) on the systemic symptoms using Wilcoxon signed-rank test in the strengthening group

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Table 4: Comparison between baseline and intervention (within group) of the quality of life using Wilcoxon signedrank test in the strengthening group

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Table 5: Comparison between stretching and strengthening exercises on systemic symptoms using Mann-Whitney U-test using mean difference

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Table 6: Comparison between stretching and strengthening exercises on quality of life using Mann- Whitney U-test using mean difference

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  Discussion Top


Considering the fact that a recent randonmized control trial (RCTs) had established the efficacy of both stretching and core strengthening exercises in significantly reducing the symptom of pain-associated PD when compared with controls,[13] this comparative study was carried to determine the efficacy of both forms of exercises on the systemic and QoL symptoms associated with PD, though a prior study by Blakey et al.[16] had concluded that there were no relationships between doing exercises and dysmenorrhea. On the contrary, a recent systemic review and meta-analysis had actually concluded that clinicians can inform women of the effectiveness of physical activity in the treatment of PD.[17] Our study showed a statistically significant difference in frequency and severity of dysmenorrhea (P = 0.001) after intervention in both core strengthening and stretching exercise groups in line with the findings of prior studies.[2],[18],[19]

It is however known that the symptoms of PD go beyond pain and also include systemic symptoms which negatively affect the QoL of the student resulting in absenteeism and missed classes. Our results showed a significant reduction in the frequency and severity of dysmenorrhea and associated systemic symptoms in many of the domains in both the groups. There were statistically significant (P = 0.001) differences in symptoms of QoL after intervention in both core strengthening and stretching exercise groups, just like the reports of a similar study in Turkey.[20] There were no statistically significant differences in the baseline values in all the domains between the two groups. Comparing the effects of core strengthening exercises and stretching exercises, it showed no statistically significant differences in the frequency and severity of symptoms experienced by participants in all the domains in both the groups postintervention. It thus appears that both were equally effective in consonance with a prior study by Saleh et al.[2] who concluded that either active stretching or core strengthening exercises were easy and non-pharmacological methods for managing PD.

Although there were no statistically significant differences postintervention in the frequency and severity of symptoms between the two groups in all the domains, a closer look at the within-group analyses showed that core strengthening exercises significantly improved many of the systemic and QoL symptoms except for depression and upper backache. Stretching exercises on the other hand had no significant impact on the frequency and severity of the symptoms of nausea, vomiting, and dizziness in addition to upper backache and depression. This may be explained by the fact that weakness of the muscles of the lumbar spine results in its inability to handle functional stress with consequent pain throughout the abdomen, low back, or thighs. Core strengthening exercises thus allow the small intrinsic muscles around the lumbar spine to be strengthened and conditioned for greater performance enabling them to handle daily forces of normal biomechanics, even when the body is undergoing the stress of the menstrual cycle.[21]


  Conclusion Top


It is concluded from this study that though both forms of exercises were effective in significantly reducing pain, core strengthening exercises appeared to have better effects in managing the systemic and QoL symptoms associated with PD.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Yassin SA. Herbal remedy used by rural adolescent girls with menstrual disorders. J Am Sci 2012;8:467-73.  Back to cited text no. 1
    
2.
Saleh HS, Mowafy HE, El Hameid AA. Stretching or core strengthening exercises for managing primary dysmenorrhoea. J Women's Health Care 2016;5:295.  Back to cited text no. 2
    
3.
Mohamed NS, Elsayed AM. Menstrual pattern among university students. IOSR J Nurs Health Sci (IOSR-JNHS) 2016;5:36-42.  Back to cited text no. 3
    
4.
Hailemeskel S, Demissie A, Assefa N. Primary dysmenorrhea magnitude, associated risk factors, and its effect on academic performance: Evidence from female university students in Ethiopia. Int J Women's Health 2016;8:489-96.  Back to cited text no. 4
    
5.
Banikarim C, Middleman AB, GeVner M, Hoppin AG. Primary Dysmenorrhoea in Adolescents; 2011. Available from: http://www.uptodate.com. [Last accessed on 2017 Jun 15].  Back to cited text no. 5
    
6.
Harel Z. A contemporary approach to dysmenorrhoeal in adolescents. Paediatric Drugs 2002;4:797-805.  Back to cited text no. 6
    
7.
Smelter A, Bare G, Hinkle AM, Cheever DA. Behavioural management of primary dysmenorrhoeal. Ann Afr Med J 2009;5:86-92.  Back to cited text no. 7
    
8.
Smith PR, Kaunitz MA. Patient Information: Painful Menstrual Periods (Dysmenorrhoea); 2007. Available from: http://www.uptodate.com/patients. [Last retrieved on 2017 Jun 15].  Back to cited text no. 8
    
9.
Brown J, Brown S. Exercise for dysmenorrhoea. Cochrane Database Syst Rev 2010; CD004142. doi: 10.1002/14651858.CD004142.pub2.  Back to cited text no. 9
    
10.
Sanyal S, Ray S. Variation in the menstrual characteristics in adolescents of West Self-management in Primary Dysmenorrhoea: Toward Evidence-based Education. Life Sci J 2011;8:13-8.  Back to cited text no. 10
    
11.
Abd El-Hameed NA, Mohamed MS, Ahmed HN, Ahmed ER. Assessment of dysmenorrhea and menstrua hygiene practices among adolescent girls in some nursing schools at EL-minia governorate. Egypt J Am Sci 2016;7:216-23.  Back to cited text no. 11
    
12.
Dorn LD, Negriff S, Huang B, Pabst S, Hillman J, Braverman P, et al. Menstrual symptoms in adolescent girls: Association with smoking, depressive symptoms, and anxiety. J Adolesce Health 2009;44:237-43.  Back to cited text no. 12
    
13.
Kaur M, Bains BS, Ramachandran B, Rao BK, Nayak SR. Role of combined exercise on primary dysmenorrhea pain among girls: A quasi-experiment. J Physiother Res 2018;8:88-93.  Back to cited text no. 13
    
14.
Cohen J. A power primer. Psychol Bull 1992;112:155-9.  Back to cited text no. 14
    
15.
Abraham GE. Nutritional factors in the etiology of the premenstrual tension syndromes. J Reproduc Med 1983;28:446-64.  Back to cited text no. 15
    
16.
Blakey H, Chisholm C, Dear F, Harris B, Hartwell R, Daley AJ, Jolly K. Is exercise associated with primary dysmenorrhea in young women? BJOG 2010;117:222-4.  Back to cited text no. 16
    
17.
Matthewman G, Lee A, Kaur JG, Daley AJ. Physical activity for primary dysmenorrhea: A systematic review and meta-analysis of randomized controlled trials. Am J Obstetrics Gynecol 2018;219:255.e1-20.  Back to cited text no. 17
    
18.
Vaziri F, Hoseini A, Kamali F, Abdali K, Hadianfard M, Sayadi M. Comparing the effects of aerobic and stretching exercises on the intensity of primary dysmenorrhoea in the students of universities of Bushehr. J Fam Reproduc Health 2015;9:238.  Back to cited text no. 18
    
19.
Gamit Kristina S, ShethMegha S, Vyas Neeta J. The effect of stretching exercise on primary dysmenohrrea in adult girl's. Int J Med Sci Public Health 2014;3:549-51.  Back to cited text no. 19
    
20.
Onur O, Gumus I, Derbent A, Kavgusuz I, Simavli S, Urun E. Impact of home-based exercise on quality of life of women with primary dysmenorrhea. SAJOG 2012;18:15-8.  Back to cited text no. 20
    
21.
Kaur S, Kaur P, Shanmugam S, Kang MK. To compare the effect of stretching and core strengthening exercises on primary dysmenorrhoea in young females. IOSR J Dent Med Sci 2014;13:22-32.  Back to cited text no. 21
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]



 

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