Exercise as it relates to Disease/Adolescents at risk of endometriosis - Does physical activity reduce the risk?
This is a critic of physical activity levels and how it relates to risks of Endometriosis article. This critic has been written as a university assignment for the University of Canberra for the unit: Health, Disease and Exercise.
The article: Vitonis, A., Maruti, S., Hankinson, S., Hornstein, M. and Missmer, S., 2009. Adolescent Physical Activity and Endometriosis Risk. Journal of Endometriosis, 1(3-4), p.157-163.
Endometriosis is a chronic menstrual health disorder. Endometriosis occurs when the existing tissue that is similar to the lining of the uterus occurs outside this layer and causes pain and/or infertility.  When the menstrual cycle begins in the menses cycle, the menstrual fluid flows outside of the body and usually lasts for three to five days. When Endometriosis is present the menstrual fluid travels backwards through the fallopian tubes and into the pelvis. An individual who has been diagnosed with Endometriosis can experience but are not limited to:
- heavy periods or irregular bleeding and bleeding between periodsor going to the toilet
- abdominal or pelvic pain before and during a period, when having sex or going to the toilet 
- bleeding from the bladder or bowel
Further on, additional problems that Endometriosis causes includes increase pain and increase chances of infertility.  The researchers of the current study designed the research to determine if physical activity levels of adolescents to reduce the risk of Endometriosis.
- Studies show that lifestyle changes including exercises levels can improve quality of life among Endometriosis Cancer survivors. 
- Studies support evidence relating to the positive properties that physical exercise have associated to it, and directly links it to Endometriosis.
- Risk factors for the disease have been identified including obesity, in which physical activity can reduce the obesity state of an individual. 
The Current Study:
What is the background to this research?
The current study background highlighted that one study that investigated the relationship between adolescents and physical activity.  The relationship highlighted that physical activity wasn’t associated with risk of Endometriosis. Although multiple case-control studies have illustrated a 40-80% reduction in risk of Endometriosis for adults who participated in physical activity.
Where is the research from?
The current study was conducted using data from Nurses’ Health Study II, and was performed at the Brigham and Women’s Hospital and Harvard Medical School in Boston, Massachusetts. The researchers were from various departments including, Department of Obstetrics, Gynaecology, and Reproductive Biology, Department of Medicine and the Department of Epidemiology. The article was published in the Journal of Endometriosis Vol. 1, which is a peer-reviewed medical journal.
What kind of research was this?
The current study was a prospective cohort study that investigated the effects of the average amount of time per week spent in a moderate and strenuous physical activity. The current study analysed the amount of exercise spent during three age periods.  As a base line, each activity had assigned a metabolic equivalent score (MET).
What did the research involve?
The research involved data collected from the Nurses’ Health Study II. The researchers reviewed the data every two years from 1989 through to 2001. The researchers condensed the data recorded into three age periods: ages 12-13, ages 14-17, and ages 18-22.  Additionally, a MET score was assigned to each activity and were summed to estimate a total activity level for the participants.
What were the basic results?
The results indicated that, in analyses of the individual activity types within each time period, only strenuous activity during ages 12-13 was associated with Endometriosis.  Interestingly, the greatest amount of the greatest amount of activity (≥80 MET-h/wk) with the least (<20 MET-h/wk). 
Multiple adjustment was made to simplify the data, the adjustments included age, calendar time, birth wright, age at menarche, parity, oral contraceptive use and body mass index. The results then acknowledged a 16% increase in the risk for Endometriosis when comparing the largest amount of exercise to the smallest during the age period of 12-12 and there were no associations for ages 14-17 or ages 18-22.
What conclusions can we take from this research?
This research was conducted early in teams of understanding the full extent of Endometriosis. What was significate was the continuous data updates over the 12 years the data was collected.
There was observed only one statistically significant association.Although the association may be due to chance, it may be that the early adolescent period is a critical time frame for endometriosis risk. 
Although there is a lack of evidence to directly link to increasing physical activity that can then reduce the risk of developing Endometriosis.  There were some limitations with the study, the most noticeable one included the lack unmeasured variables. Theses variable nowadays can be measure however when the original data was collected these variables can be compromised by the problem of missing data. 
The current study explores the lack of evidence given to relate physical activity directly to reducing the risk of Endometriosis. Although physical activity has multiple positive outcomes that adolescents will benefit from, including but not limited to:
- Reduced body weight 
- Reduce fatigue 
- Increase endorphins
- Increased mental capacity/awareness
Physical activity may not have a direct link with reducing the risk of Endometriosis, although it can help with symptoms and improve pain. Additional resources below are supplied in regards to more information/ advice for Endometriosis.
For further information on Endometriosis and the benefits of exercise read the following:
- Endometriosis: https://www.endometriosisaustralia.org/about-endo
- Signs and Symptoms of Endometriosis: https://www.health.qld.gov.au/news-events/news/signs-symptoms-endometriosis
- Endometriosis Cancer: https://www.thewomens.org.au/health-information/womens-cancers-pre-cancers/endometrial-cancer
- Endometriosis and the benefits of physical activity: https://endometriosisnews.com/endometriosis-and-exercise/
- Support Groups in Australia: https://www.endometriosisaustralia.org/support-groups
- Australian Government, Department of Health. 2020. What We’Re Doing About Endometriosis. Available at: <https://www.health.gov.au/health-topics/chronic-conditions/what-were-doing-about-chronic-conditions/what-were-doing-about-endometriosis?utm_source=health.gov.au&utm_medium=callout-auto-custom&utm_campaign=digital_transformation>
- Australia, E., 2020. What Is Endometriosis?. Endometriosisaustralia.org. Available at: <https://www.endometriosisaustralia.org/about-endo>
- Vitonis, A., Maruti, S., Hankinson, S., Hornstein, M. and Missmer, S., 2009. Adolescent Physical Activity and Endometriosis Risk. Journal of Endometriosis, 1(3-4), p.157-163.
- Courneya, K., Karvinen, K., Campbell, K., Pearcey, R., Dundas, G., Capstick, V. and Tonkin, K., 2005. Associations among exercise, body weight, and quality of life in a population-based sample of endometrial cancer survivors. Gynecologic Oncology, 97(2), pp.422-430.
- Signorello, L., Harlow, B., Cramer, D., Spiegelman, D. and Hill, J., 1997. Epidemiologic determinants of endometriosis: A hospital-based case-control study. Annals of Epidemiology, 7(4), pp.267-274.
- Lindemann, K., Vatten, L., Ellstrøm-Engh, M. and Eskild, A., 2009. The impact of BMI on subgroups of uterine cancer. British Journal of Cancer, 101(3), pp.534-536.
- Kaaks R, Lukanova A, Kurzer MS. 2002. Obesity, endogenous hormones, and endometrial cancer risk: a synthetic review. Cancer Epidemiol Biomarkers. 11(12):1531-1543.
- Fox-Wasylyshyn, S. and El-Masri, M., 2005. Handling missing data in self-report measures. Research in Nursing & Health, 28(6), pp.488-495.
- Deforche, B., De Bourdeaudhuij, I. and Tanghe, A., 2006. Attitude toward physical activity in normal-weight, overweight and obese adolescents. Journal of Adolescent Health, 38(5), pp.560-568.
- Bell, S., Audrey, S., Gunnell, D., Cooper, A. and Campbell, R., 2019. The relationship between physical activity, mental wellbeing and symptoms of mental health disorder in adolescents: a cohort study. International Journal of Behavioral Nutrition and Physical Activity, 16(1)
- Vouloumanou, E.K., Rafailidis, P.I. and Falagas, M.E., 2012. Current diagnosis and management of infectious mononucleosis. Current opinion in hematology, 19(1), pp.14-20.