Examining the Impact of Aerobic and Core Exercises on Primary Dysmenorrhea in High School Females

Dysmenorrhea, derived from ancient Greek, translates to 'difficult monthly flow' and refers to painful cramps during menstruation, a common cause of pelvic pain. The pain, often in the lower abdomen, results from uterine pressure exceeding 60 mmHg. Symptoms include suprapubic pain, radiating discomfort, nausea, diarrhea, and headache, impacting quality of life. Etiology involves factors like age at menarche, heavy flow, lifestyle, and medical conditions.

Dysmenorrhea is categorized as primary (without underlying pathology) or secondary (due to conditions like endometriosis). Its prevalence is high in adolescence, affecting daily life, school, and health. Research aims to assess how aerobic and core exercises influence pain and quality of life in adolescent females (14-18 years). Participants are randomly assigned to study and control groups, exploring the potential benefits for health, well-being, and academic performance.

Dysmenorrhea, which begins approximately 1-2 years after the start of menstruation in women, continues until the 40s, although it shows its effects more in adolescent female students between the ages of 18-25. Dysmenorrhea pain, which is seen intermittently in the form of contractions and cramps, is usually in the middle of the highest intensity value. It is also emphasized that dysmenorrhea has important economic consequences. It has been reported that the total healthcare costs of patients with primary dysmenorrhea are greater than the healthcare costs of women without dysmenorrhea. In Japan, the total healthcare costs of patients with primary dysmenorrhea were reported to be 2.2 times greater than the healthcare costs of women without dysmenorrhea after adjusting for baseline characteristics. Although dysmenorrhea is not a life-threatening condition, it can cause a significant burden on individuals and communities, greatly affecting quality of life and well-being. Both aerobic and core exercises reduce the severity of dysmenorrhea, especially at young ages. It has been proven that core exercises are an effective non-pharmacological method to reduce pain and are a cost-free pain-reducing practice. Aerobic exercises are exercises that increase cardiopulmonary endurance capacity by activating the circulatory and respiratory systems through rhythmic and dynamic contraction of large muscle groups. In this study, a brisk walking program, which is a type of aerobic exercise, will be created for adolescent students and its effects on primary dysmenorrhea will be evaluated. Studies on this subject have concluded that aerobic exercise has an effect on some menstrual symptoms of adolescent high school female students, and that dysmenorrhea and heavy menstrual bleeding can be controlled or prevented by performing these exercises regularly and continuously. Secondly, it has also been found that aerobic exercises are positively related to the information processing efficiency, attention, memory and cognitive control of adolescents. Although there is limited evidence, it is thought that physical activity can have a positive effect on improving academic performance, cognitive abilities and mental functions in children. It has also been reported that aerobic exercises have a protective effect against the risk of diseases (childhood obesity, asthma, etc.) by keeping the heart rate and weight control low and improving cardiovascular health. Regular aerobic exercises, especially in adolescents; It leads to hormonal changes by increasing functional work capacity, daily life activity level and quality of life in individuals with systematic diseases and reducing psychological stress. These hormonal changes include the fact that aerobic exercises increase the release of endorphins. Increased endorphin release causes an increase in pain threshold. For this reason, by reducing dysmenorrhea pain with the aerobic and core exercises will use in the study; It is aimed to increase the quality of life of high school-aged adolescents by increasing the duration of class attendance, drug-free pain control, desire to study, socialization and exam success, and to improve adolescent health with applications in the field of physiotherapy. The core can be defined as the trunk or the region that provides the connection between the legs and arms. This region, which is mentioned as the central region of the body, is the point where the stabilization of the abdominal, paraspinal and gluteal muscles, consisting of the muscles, nerves, skeleton and other connective tissues that form the spine, pelvis, abdominal cavity and upper structures, is critical for optimal performance and is also defined as the lumbopelvic region. Core exercises are; These are exercises that include exercises to train the muscles that control and stabilize the movements of the abdominal, lumbar and gluteal regions. Core exercises are exercises that help increase muscle balance and strength. These exercises play an active role in ensuring that muscles move correctly. Strengthening the core area is important not only for sports performance but also for maintaining proper body posture. These exercises aim to control balance, improve upper extremity functions, ensure proper posture, increase stabilization, and minimize pain in the pelvic and abdominal areas. The reason why investigators chose this topic is that although there are studies in the literature evaluating the effects of core and aerobic exercises separately on dysmenorrhea, there are no studies on the effects of these two exercises on dysmenorrhea with a combined program. In addition, as the negative effects of menstrual pain on high school-age young people are seen as a normal problem, this causes an increase in the number of primary dysmenorrhea cases, an increase in the use of pharmacological supplements, and a negative impact on the psychological and social quality of life.

Eligibility Criteria:
Inclusion Criteria:

* Be nulliparous (have not given birth) and be between the ages of 14-18.
* Volunteer to participate.
* Have no active sexual life.
* Have a regular menstrual cycle.
* Report a pain intensity of 5 or above on the Visual Analog Scale (VAS).
* Have a Body Mass Index (BMI) between 19 and 24.9.
* Not have polycystic ovary syndrome or undergone any surgical operation related to female diseases.
* Not engage in regular exercise.
* Not have any chronic, systemic, neurological, or endocrinological diseases.

Exclusion Criteria:

* Participate in tele-rehabilitation and exercise diary for less than 3 days.
* Use an intrauterine device.
* Have taken pharmacological supplements in the last 3 months or during the study tracking period (due to reasons such as flu, COVID, etc.).
* Have any physical impediment restricting physical activity.