|Year : 2018 | Volume
| Issue : 2 | Page : 118-122
Efficacy of Yoga Asana and Gym Ball Exercises in the management of primary dysmenorrhea: A single-blind, two group, pretest-posttest, randomized controlled trial
Veena Kirthika S1, K Padmanabhan2, Selvaraj Sudhakar3, S Aravind4, CR Praveen Kumar1, S Monika5
1 Department of Neuro Physiotherapy, Dr. MGR Educational and Research Institute University, Chennai, Tamil Nadu, India
2 Department of Ortho Physiotherapy, Dr. MGR Educational and Research Institute University, Chennai, Tamil Nadu, India
3 Department of Sports Physiotherapy, Dr. MGR Educational and Research Institute University, Chennai, Tamil Nadu, India
4 Department of Cardiopulmonary Physiotherapy, Dr. MGR Educational and Research Institute University, Chennai, Tamil Nadu, India
5 BPT Internee, Faculty of Physiotherapy, Dr. MGR Educational and Research Institute University, Chennai, Tamil Nadu, India
|Date of Web Publication||9-Apr-2018|
Department of Sports Physiotherapy, Faculty of Physiotherapy, Dr. MGR Educational and Research Institute University, Maduravoyal, Chennai - 600 095, Tamil Nadu
Source of Support: None, Conflict of Interest: None
Background: Primary dysmenorrhea (PD) is characterized by cramping lower abdomen pain that may radiate to the lower back and upper thigh and commonly associated with stress, headache, and diarrhea, and thereby decreases the quality of life. It occupies 20%–90% of the female population in reproductive age. Many conservative treatment methods such as yoga asana, physiotherapy through gym ball/therapy ball/Swiss ball exercises, etc., are available to treat them. More efficient among them is not known. Purpose: The aim is to compare the efficacy of yoga asana and gym ball/therapy ball/Swiss ball exercises in the management of female with PD. Methodology: A total of 30 female with PD were recruited by the simple random sampling to participate in this two group pretest-posttest, single-blinded randomized clinical study. Recruited female with PD were randomly allocated into two groups, Group A and Group B. Group A were provided with yoga asana for 60 s duration × 5 repetition/session/day × 3 days/week × 12 weeks. While Group B received set of gym ball exercises for 10 s hold ×12 times/set × 3 sets/day × 3 days/week × 12 weeks. Level of menstrual distress (MOOS Menstrual Distress Questionnaire [MDQ]) and pain scores (visual analog score ([VAS]) were documented at baseline and 12th week after intervention and analyzed. Results: Group B demonstrated significance difference (P < 0.05) in MDQ and VAS when compared to Group A. Conclusion: Twelve-week gym ball exercises have the sufficient potential to decrease level of menstrual distress and related pain among female with PD when compared to yoga asanas.
Keywords: Dysmenorrhea, exercise, physical therapy techniques, physiotherapy, yoga
|How to cite this article:|
VeenaK, Padmanabhan K, Sudhakar S, Aravind S, Praveen Kumar C R, Monika S. Efficacy of Yoga Asana and Gym Ball Exercises in the management of primary dysmenorrhea: A single-blind, two group, pretest-posttest, randomized controlled trial. CHRISMED J Health Res 2018;5:118-22
|How to cite this URL:|
VeenaK, Padmanabhan K, Sudhakar S, Aravind S, Praveen Kumar C R, Monika S. Efficacy of Yoga Asana and Gym Ball Exercises in the management of primary dysmenorrhea: A single-blind, two group, pretest-posttest, randomized controlled trial. CHRISMED J Health Res [serial online] 2018 [cited 2021 May 8];5:118-22. Available from: https://www.cjhr.org/text.asp?2018/5/2/118/229593
| Introduction|| |
Dysmenorrhea is pain during menstruation. It is estimated that 16%–93% of women suffer from dysmenorrhea in reproductive age. It is a most common menstrual disorder and is classified into primary and secondary based on the absence or presence of an underlying cause. Usually, secondary dysmenorrhea is associated with an existing underlying pelvic pathology. Primary dysmenorrhea (PD) is also known as painful period or menstrual cramps, which causes pain during menstrual cycle. It usually begins around the time when menstruation begins. The pain is usually in the pelvis or lower abdomen, which may radiate into low back and upper thigh. Other symptoms include diarrhea, headache, stress, and nausea. Absenteeism is a result of dysmenorrhea in college-going and working young females. One of the causes of PD is excessive level of prostaglandins hormones. Prostaglandins released during menstruation and childbirth makes uterus to contract which cause pain during menstrual cycle and also affects those with heavy irregular menstrual cycle, those who attain menarche before 12 years of age, or one with less body weight.,
Medical management of PD is with nonsteroidal anti-inflammatory drugs such as ibuprofen, mefenamic acid, and naproxen  and are effective in relieving pain but has side effects such as nausea, dyspepsia, peptic ulcer, etc. Nonpharmacological treatments such as physical therapy, yoga, heating pad, massage, etc., are shown to be effective., Physical therapy to the abdominal and pelvic floor muscles helps to stretch and strengthen the muscle. Other techniques such as taping and aerobics are also used for the participants with PD which effectively could reduce pain and discomfort. Few studies have shown that certain yogic exercises the stress and pain of dysmenorrhea was controlled. Posture such as cat pose, tiger pose, cobra pose, and bow pose, fish pose if practiced regularly help to stretch and strength the back and pelvic floor muscle and has positive effect in female with PD.
As there are various treatment techniques available, there is a need for a standard treatment protocol, which will have good results in terms of pain reduction and improving the quality of life. This study is intended to compare two different type of intervention, namely, yoga asana and gym ball exercises to treat female with PD.
| Methodology|| |
Recruitment and allocation
This study protocol was approved by the university research and ethics committee (ACS/2016/67), and this study was done strictly in accordance with the guidelines of Helsinki Declaration, revised 2013. This study was conducted between October 2016 and March 2017. A total of 30 female with PD were recruited by the simple random sampling (random number tables from standard statistics book) to participate in this two group pretest-posttest, single-blinded randomized clinical study. The participants were blinded to the study. After the demographics, recruited female with PD were randomly divided into two groups, Group A and Group B, with by block randomization. There were five blocks, with the matrix design of 6 × 5, where 6 being rows. Each block contained 6 chits (3 chits for each group), totaling 30. The participants were allotted to the group based on the randomly chosen chit. Once the block was allotted, next row block was opened. Thus, an equal number of participants was assigned to each group over time. Group A received yoga asana's and Group B received set of gym ball exercises. Both the group received the interventions for 12-week period, totaling 36 sessions. The first session was performed under supervision and other at their home without supervision. The Consolidated Standards of Reporting Trials  flow chart describing the details of the study is displayed in [Figure 1].
|Figure 1: Consolidated Standards of Reporting Trials diagram describing the study flow|
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Yoga asanas in Group A
Three asanas, Ustrasana [camel pose, [Figure 2]a, Janusirsasana [head-to-knee forward bend, [Figure 2]b, and Dhanurasana [bow pose, [Figure 2]c were prescribed to female with PD in Group A. Each single session consists of each of the above asanas for 60 s duration × 5 repetitions with 20 s rest between them and normal breath rate, without holding breath/session. They performed single session/day × 3 days/week × 12 weeks. The first session of yoga asanas was demonstrated and supervised by qualified person who have more than 5 years' experience in practicing yoga.
|Figure 2: Female with primary dysmenorrhea performing three asanas, Ustrasana (camel pose, a), Janusirsasana (head-to-knee forward bend, b), and Dhanurasana (bow pose, c)|
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Gym ball/therapy ball/Swiss ball exercises in Group B
Knee tucks [Figure 3]a and [Figure 3]b, hamstring curls [Figure 3]c and [Figure 3]d back extension [Figure 3]e and [Figure 3]f exercises in gym ball/therapy ball/Swiss ball were prescribed to female with PD. Each exercise was given for 10 s hold × 12 times/set × 3 sets/day × 3 days/week × 12 weeks.
|Figure 3: Female with primary dysmenorrhea performing three gym ball exercises, knee tucks (a and b), hamstring curls (c and d), and back extension exercises, (e and f)|
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Both the group were measured for their level of menstrual distress (MOOS Menstrual Distress Questionnaire [MDQ]) and pain (visual analog scale [VAS]) between Group A and Group B at baseline and 12th-week postintervention.
The collected demographic and outcome measures were assessed for their normality using Shapiro–Wilk test. As the data follow normal distribution, all the descriptive were expressed in mean ± standard deviation. Paired t-test was adopted to find out the differences within Group A and Group B for pre- and postintervention changes, whereas independent t-test was used to compare the changes in mean values of MDQ and VAS between Group A and Group B at baseline and end of 12-week intervention. The data were analyzed using statistical software, statistical package for the social science (SPSS), IBM SPSS version 20.0 (IBM Corp., Armonk, NY, USA). The P ≤ 0.05 was considered to be statistically significant.
| Results|| |
Thirty females with PD were recruited for the study. Among them 6 were married, sexually active and remaining 24 were unmarried females. The demographic characteristic of the female with PD recruited were displayed in [Table 1]. The demographic characteristics were elaborated in [Table 1]. There exists no significant difference between the two groups. Between the session and group comparison at baseline and end of 12 weeks exercise intervention for the outcome measures MDQ [Figure 4] and VAS [Figure 5] were displayed. Both the group demonstrate minimal clinical important difference (MCID) in VAS (12 mm). However, only the group B demonstrated MCID in MDQ (difference in total score of 50 ± 10).
|Table 1: Demographic characteristic of the females recruited with primary dysmenorrhea recruited in Group A and Group B|
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|Figure 4: Mean MOOS Menstrual Distress Questionnaire score at baseline and end of 12th-week intervention between Group A and Group B|
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|Figure 5: Mean visual analog scale score at baseline and end of 12th-week intervention between Group A and Group B|
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| Discussion|| |
Pain in general has a disabling nature and makes dysmenorrhea stressful, and it becomes an important irritating factor in the life of lots of women. Some women remain to continue work with the support of analgesics., Few studies were done to replace medications by physical therapy in PD. This study was conducted on 30 participants with two groups of 15 each. Group A was intervened with Yoga therapy such as Ustrasana, Janusirsasana, and Dhanurasana. Ustrasana helps in relieving menstrual cramps by stretching the anterior aspect of trunk, and also by strengthening the back region. It improves the flexibility of spine also improve posture. Janusirsasana stimulates the reproductive organs and therefore menstrual pains are reduced. It stretches groin and hamstrings. This asana also relieves headaches, anxiety, and fatigue. It also cures insomnia. Dhanurasana stimulates the uterus and relieve back pain during menstruation. It stretches the muscles of the posterior aspect of trunk, ankles, and groin. Dhanurasana also increases blood flow to the uterus and keeps the body relaxed.
Group B was intervened with gym ball/therapy ball/Swiss ball exercises such as knee tucks, hamstring curls, and back extension. Hamstring curls using Swiss ball helps to strengthen gluteus maximus, gluteus minimus, and gluteus medius muscles. It also strengthens the abdominal muscles such as, transverse abdominis, internal oblique, and external oblique. It also improves blood supply and nutrient supply to the lower abdomen and lower back region which helps to relieve menstrual cramps. Back extension in Swiss ball builds strength and stability in lower back, gluteus, and hamstrings. It stretches and strengthens the core muscles by improving the blood supply, which helps to reduce the menstrual pain. Knee tucks in Swiss ball help to strengthen the muscle around the abdomen, legs, arms, and back region. It also improves balance, stability, and blood supply which helps to ease menstrual pain.,
The findings of this study suggest that there is a beneficial effect of physiotherapy intervention through gym ball/therapy ball/Swiss ball exercise on PD symptoms. According to the result of this study, Swiss ball exercises and yoga therapy reduce the pain intensity and diminish the level of menstrual distress in female with PD. This was also supported by the recent researchers.,,,, However, the females in Group B who received exercises with gym ball/therapy ball/Swiss ball had a better reduction in pain and disability when compared with Group A participants treated with Yoga therapy.
This study had few limitations. First, the generalizability of the results among married and unmarried females might be slightly affected due to the unequal distribution of married and unmarried females (1:4). Second, the unavoidable human error during isometric contraction (hold for 10 s/11 s/09 s) or maintaining in particular asana position (60s or 20s rest) might have crept during the intervention. However, this could be common between both the groups which nullifies the error during comparison. Third, the sample size, n = 30 used in this study was not estimated by sample size calculation. This was just an arbitrary value, which might affect the extrapolation of the results. Nevertheless, this was the first study to estimate the efficacy of yoga asana and gym ball exercises in the management of PD. Future studies should be drafted with adequate sample size (after sample size calculation) and maintaining power of the study >80% to minimize type II error.
| Conclusion|| |
Twelve weeks gym ball exercises have the potential to decrease the level of menstrual distress and related pain among female with PD when compared with yoga asana.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
De Sanctis V, Soliman A, Bernasconi S, Bianchin L, Bona G, Bozzola M, et al.
Primary dysmenorrhea in adolescents: Prevalence, impact and recent knowledge. Pediatr Endocrinol Rev 2015;13:512-20.
Weissman AM, Hartz AJ, Hansen MD, Johnson SR. The natural history of primary dysmenorrhoea: A longitudinal study. BJOG 2004;111:345-52.
Omidvar S, Bakouei F, Amiri FN, Begum K. Primary dysmenorrhea and menstrual symptoms in indian female students: Prevalence, impact and management. Glob J Health Sci 2016;8:53632.
Polat A, Celik H, Gurates B, Kaya D, Nalbant M, Kavak E, et al.
Prevalence of primary dysmenorrhea in young adult female university students. Arch Gynecol Obstet 2009;279:527-32.
Federação Brasileira das Associações de Ginecologia e Obstetrícia. Primary dysmenorrhea: Treatment. Rev Assoc Med Bras (1992) 2013;59:413-9.
Proctor M, Farquhar C. Diagnosis and management of dysmenorrhoea. BMJ 2006;332:1134-8.
Rakhshaee Z. Effect of three yoga poses (cobra, cat and fish poses) in women with primary dysmenorrhea: A randomized clinical trial. J Pediatr Adolesc Gynecol 2011;24:192-6.
World Medical Association. World medical association declaration of Helsinki: Ethical principles for medical research involving human subjects. JAMA 2013;310:2191-4.
Moos RH. The development of a menstrual distress questionnaire. Psychosom Med 1968;30:853-67.
Kelly AM. The minimum clinically significant difference in visual analogue scale pain score does not differ with severity of pain. Emerg Med J 2001;18:205-7.
Ju H, Jones M, Mishra G. The prevalence and risk factors of dysmenorrhea. Epidemiol Rev 2014;36:104-13.
Mahvash N, Eidy A, Mehdi K, Zahra MT, Mani M, Shahla H. The effect of physical activity on primary dysmenorrhea of female university students. World Appl Sci J 2012;17:1246-52.
Aboushady RM, El-saidy TM. Effect of home based stretching exercises and menstrual care on primary dysmenorrhea and premenstrual symptoms among adolescent girls. IOSR Journal of Nursing and Health Science 2016;5:10-7.
Tsai SY. Effect of yoga exercise on premenstrual symptoms among female employees in taiwan. Int J Environ Res Public Health 2016;13:pii: E721.
Yang NY, Kim SD. Effects of a yoga program on menstrual cramps and menstrual distress in undergraduate students with primary dysmenorrhea: A Single-blind, randomized controlled trial. J Altern Complement Med 2016;22:732-8.
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