What do we know about exercise and endometriosis?
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The answer is, unfortunately not a lot in detail (1). The literature explains endometriosis as a chronic inflammatory condition usually causing symptoms of pelvic pain, painful periods, painful intercourse, bladder, and bowel dysfunction, infertility, and fatigue. These symptoms often lead to secondary concerns such as a sensitive nervous system and/or mental health conditions. 
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Now, what we do know is that the literature DOES support exercise to improve symptoms of pain, fatigue, a sensitive nervous system, and mental health conditions. It also supports exercise as a good tool to improve inflammation, improve flexibility and release endorphins.  
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So, lets shift the mindset away from focusing on exercise improving endometriosis and focus more on how exercise can improve the symptoms of endometriosis. 

‍1.  Start slow
‍Hands up if you’re a boom/bust kind of person. One minute you are exercising 5 days a week and the next you’re not exercising at all. We are aiming for LONG term, SUSTAINABLE habit changes. This may mean that you start off with one exercise session per week and see how you feel. The goal is to slowly increase to a level that works with your lifestyle BUT also improves your symptoms. Ways to increase the amount you are exercising include the number of sessions you are doing, the length of the session or the intensity of the session. Do not increase all three in the same week, increasing one at a time is more than enough.  

‍2.  It doesn’t need to be formal
‍Who hear feels time is the biggest barrier?In a world where everything is moving at a fast pace, it feels like there isn’t a spare hour to make it to the gym or a class BUT don’t let that be the reason you stop exercising. I am a big fan of incidental movement, particularly as a start for exercising. This may mean parking your car for work at a carpark that’s a bit further away, walking to get your lunch instead of going to the café in your building or taking the stairs. Squeezing in 15-20 minutes of extra walking a day can make a significant difference for minimal effort.

3. Trial and error
‍You did it, you signed up to the yoga class down the road, finished work early and popped on your new yoga clothes ready to become zen. The class finishes after 45 minutes, and you realise you didn’t enjoy it. BUT everyone says yoga is the best form of exercise? Unfortunately, yoga isn’t for everyone or maybe it was just that yoga class, style or teacher is not right for you. Just like running isn’t for everyone. The reason we have so many different types of exercise if because everyone has different likes, and everyone’s body responds differently. It is all well and good to say yoga provides the most benefit in terms of relaxation, stretch, muscle strength and endurance BUT what if you dread going? Have a think about what you have liked in the past and be prepared to trial a few different things. If you don’t like it, or you have a flare, don’t shy away from exercise, it just means let’s try a different format. Weights, running, walking, yoga, Zumba, swimming; they all have their place. It is just what works for you! 

4.  Lean in for support
‍Doing it alone sometimes feels harder.Finding a gym buddy, booking into a class or walking with a friend may make it easier to be accountable AND more enjoyable to exercise. Scheduling in a regular catch up with someone makes it more likely that you will go, more enjoyable once you are there and makes it more likely you will continue to exercise. How good does it feel to not only catch up with a friend BUT also tick off a thirty-minute walking session, and no judgement if that also ends with a coffee or tea! Or attending a Zumba class and having a dance with a friend to shake out all the stress of the week. Have a chat to those around you, you never know if they also need the boost to get started.

5.  Does it make you smile?
‍This is my favourite question to ask . How often would you go to the gym if you didn’t enjoy it? How often would you go to the beach for a swim if you hated getting your hair wet? Like the trial-and-error statement above, whatever you choose to do, it should make you smile. This doesn’t mean when you are at the5km mark of your 10km run and your hamstrings are on fire that you must be beaming BUT rather when you finish your run or when you stop midway through your run to look at the ocean, you smile and think “wow, look at me go!” OR it means when you are curled up in child’s pose, you smile a little at the relaxation you feel. OR you walk out of a spin class, sweaty but grinning at your jelly legs trying to cross the road. Stop for a minute after you have exercised, including walking for your lunch at the café down the road, and think, “go me, I moved my body today!!”

But what if it makes me flare?
‍This is a question that is asked a lot and something I want to touch on as flares can create a lot of fear. While we can sometimes correlate a pain flare to an aggravating factor such as exercise, we can’t always definitively call it cause and effect. It is important to recover from your flare using the tools you have (heat, medication, rest, stretching etc.) and trial the exercise again on a “good” day IF this exercise makes you smile or you enjoy it. If you didn’t enjoy it AND it made you flare, that’s ok, let's learn from that, recover, and try something else. Remember exercise is a broad category including many different forms of movement. You just need to find what works for you AND improves your symptoms the most.