Breathing Exercises Combined With Core Stabilization Exercises in Women With Primary Dysmenorrhea

August 5, 2026 updated by: University of Lahore

Primary dysmenorrhea is a common gynecological condition among women of reproductive age and is associated with pelvic pain, psychological distress, and reduced health-related quality of life. Although core stabilization exercises and breathing exercises have individually demonstrated beneficial effects, evidence regarding their combined effectiveness remains limited.

This randomized controlled trial aims to compare the effects of core stabilization exercises alone with breathing exercises combined with core stabilization exercises in women with primary dysmenorrhea. Forty-eight women aged 18-25 years will be randomly allocated to either the control group (core stabilization exercises) or the experimental group (breathing exercises combined with core stabilization exercises). Both groups will participate in supervised exercise sessions three times per week for eight weeks.

Outcome measures will include menstrual pain intensity, psychological status, and health-related quality of life, assessed using the Visual Analog Scale (VAS), Depression Anxiety Stress Scales-21 (DASS-21), and 12-Item Short Form Health Survey (SF-12) at baseline and Week 8.

The study will determine whether adding breathing exercises to core stabilization exercises provides greater clinical benefits than core stabilization exercises alone.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

Primary dysmenorrhea is one of the most common gynecological disorders affecting women of reproductive age and is characterized by recurrent menstrual pain that negatively affects physical, psychological, and social well-being. Exercise-based physiotherapy interventions have demonstrated beneficial effects in reducing pain and improving function; however, evidence regarding the combined use of breathing exercises and core stabilization exercises remains limited.

This randomized controlled trial is designed to compare the effectiveness of breathing exercises combined with core stabilization exercises versus core stabilization exercises alone in women with primary dysmenorrhea. A total of 48 eligible women aged 18-25 years will be randomly assigned to one of two groups.

The control group will receive core stabilization exercises, while the experimental group will receive breathing exercises combined with core stabilization exercises. Both groups will attend supervised exercise sessions three times per week for eight weeks.

Outcome measures will be assessed at baseline and Week 8. Menstrual pain intensity will be measured using the Visual Analog Scale (VAS), psychological status using the Depression Anxiety Stress Scales-21 (DASS-21), and health-related quality of life using the 12-Item Short Form Health Survey (SF-12).

Data will be analyzed using SPSS version 26. Independent-samples t-tests, paired-samples t-tests, and repeated-measures ANOVA will be used to compare outcomes within and between groups. The findings of this study will determine whether adding breathing exercises to core stabilization exercises provides greater improvements in pain intensity, psychological status, and quality of life than core stabilization exercises alone.

Study Type

Interventional

Enrollment (Actual)

48

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Pakistan
    • Punjab Province
      • Lahore, Punjab Province, Pakistan
        • The University of Lahore

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Female participants aged 18-25 years.
  • Clinical diagnosis of primary dysmenorrhea confirmed through medical history or self-report.
  • Baseline menstrual pain intensity of 4 or higher on the Visual Analog Scale (VAS).
  • Willing to participate and provide written informed consent.
  • Agree not to receive any additional treatment for dysmenorrhea during the study period.

Exclusion Criteria

  • Secondary dysmenorrhea caused by conditions such as endometriosis, adenomyosis, or uterine fibroids.
  • Pregnancy or childbirth within the previous six months.
  • Diagnosed pelvic floor disorders or chronic pelvic pain syndrome.
  • Severe psychological disorders or chronic pain conditions that may interfere with outcome assessment.
  • Premenstrual Dysphoric Disorder (PMDD).
  • History of pelvic surgery within the previous 12 months.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Active Comparator: Core Stabilization Exercises
Participants assigned to the control group will receive supervised core stabilization exercises three times per week for eight weeks. Each treatment session will last approximately 40 minutes.
Behavioral: Core Stabilization Exercises

Participants will perform a supervised core stabilization exercise program designed to improve trunk muscle strength, core stability, and pelvic stability. The intervention will be delivered three times per week for eight weeks, with each session lasting approximately 40 minutes.

Each session will begin with a 5-minute warm-up consisting of marching in place, torso rotations, side bends, cat-cow stretching, and hip circles.

The exercise program includes bicycle crunches (3 sets × 15 repetitions), abdominal curls (3 sets × 15 repetitions), standing trunk rotations (3 sets × 15 repetitions), side bends (3 sets × 15 repetitions), pelvic bridging (3 sets × 15 repetitions), and mountain climbers (3 sets × 15 repetitions). Rest intervals of 10-20 seconds will be provided between exercises.
Experimental: Breathing exercises combined with core stabilization exercises
Participants assigned to the experimental group will receive breathing exercises combined with the same core stabilization exercise program as the control group. Treatment sessions will be conducted three times per week for eight weeks, with each session lasting approximately 40 minutes.
Behavioral: Core Stabilization Exercises

Participants will perform a supervised core stabilization exercise program designed to improve trunk muscle strength, core stability, and pelvic stability. The intervention will be delivered three times per week for eight weeks, with each session lasting approximately 40 minutes.

Each session will begin with a 5-minute warm-up consisting of marching in place, torso rotations, side bends, cat-cow stretching, and hip circles.

The exercise program includes bicycle crunches (3 sets × 15 repetitions), abdominal curls (3 sets × 15 repetitions), standing trunk rotations (3 sets × 15 repetitions), side bends (3 sets × 15 repetitions), pelvic bridging (3 sets × 15 repetitions), and mountain climbers (3 sets × 15 repetitions). Rest intervals of 10-20 seconds will be provided between exercises.

Behavioral: Breathing Exercises Combined with Core Stabilization Exercises

Participants will receive supervised breathing exercises combined with the standard core stabilization exercise program. The intervention will be delivered three sessions per week for eight weeks, with each session lasting approximately 40 minutes.

The breathing exercise component will last approximately 8 minutes and will include the following techniques:

  • Diaphragmatic Breathing: Participants will inhale deeply through the nose while allowing the abdomen to expand and then exhale slowly through the mouth.
  • 4-7-8 Breathing: Participants will inhale through the nose for 4 seconds, hold their breath for 7 seconds, and exhale slowly through the mouth for 8 seconds.
  • Alternate Nostril Breathing (Nadi Shodhana): Participants will perform alternate nostril breathing by inhaling and exhaling through alternate nostrils in a controlled sequence.
  • Guided Relaxation with Slow Breathing: Participants will perform slow, controlled breathing while focusing on whole-body relaxation.

The breat

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Change from Baseline in Menstrual Pain Intensity
Time Frame: Baseline, Week 8
Menstrual pain intensity assessed via the Visual Analog Scale (VAS). Scores range from 0 mm to 100 mm. Higher scores indicate greater pain intensity.
Baseline, Week 8

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Change from Baseline in SF-12 Physical Component Summary Score
Time Frame: Baseline, Week 8
Physical health-related quality of life assessed via the SF-12 Physical Component Summary (PCS) score. Scores range from 0 to 100. Higher scores indicate better physical health.
Baseline, Week 8
Change from Baseline in SF-12 Mental Component Summary Score
Time Frame: Baseline, Week 8
Mental health-related quality of life assessed via the SF-12 Mental Component Summary (MCS) score. Scores range from 0 to 100. Higher scores indicate better mental health.
Baseline, Week 8
Change from Baseline in DASS-21 Depression Subscale Score
Time Frame: Baseline, Week 8
Depression symptoms assessed via the Depression subscale of the DASS-21. Scores range from 0 to 42. Higher scores indicate greater severity of depressive symptoms.
Baseline, Week 8
Change from Baseline in DASS-21 Anxiety Subscale Score
Time Frame: Baseline, Week 8
Anxiety symptoms assessed via the Anxiety subscale of the DASS-21. Scores range from 0 to 42. Higher scores indicate greater severity of anxiety symptoms.
Baseline, Week 8
Change from Baseline in DASS-21 Stress Subscale Score
Time Frame: Baseline, Week 8
Stress symptoms assessed via the Stress subscale of the DASS-21. Scores range from 0 to 42. Higher scores indicate greater severity of stress symptoms.
Baseline, Week 8

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

University of Lahore

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

  • Mustain M, Shela M, Tri Y, Witriani W, Hussein M, editors. The Effect of Deep Breathing Relaxation Techniques on Reducing Dysmenorrhea Pain in Adolescent Girls at The Indah 43 Dormitory in Cemani Village. Proceeding of International Conference on Science, Health, And Technology; 2024. 17. Chodon L, Samuel J. Lalramzawni (2024) Core Stability Exercise on Low Back Ache, Back Endurance and Health Related Quality of Life in Primary Dysmenorrhea-A Single Group Experimental Study. Indian Journal of Science and Technology. 2024;17(24):2494-8. . Martire FG, Piccione E, Exacoustos C, Zupi E. Endometriosis and adolescence: the impact of dysmenorrhea. Journal of clinical medicine. 2023;12(17):5624. . Itani R, Soubra L, Karout S, Rahme D, Karout L, Khojah HM. Primary dysmenorrhea: pathophysiology, diagnosis, and treatment updates. Korean journal of family medicine. 2022;43(2):101.

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

October 18, 2025

Primary Completion (Actual)

December 20, 2025

Study Completion (Actual)

April 15, 2026

Study Registration Dates

First Submitted

July 24, 2026

First Submitted That Met QC Criteria

August 5, 2026

First Posted (Actual)

August 7, 2026

Study Record Updates

Last Update Posted (Actual)

August 7, 2026

Last Update Submitted That Met QC Criteria

August 5, 2026

Last Verified

November 1, 2025

More Information

Terms related to this study

Keywords

Other Study ID Numbers

  • MSWH-PD-001

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

IPD Plan Description

no plans to share IPD due to institutional policy and participants confidentiality.

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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