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Effect of exercise on symptoms of premenstrual syndrome in low and middle-income countries: a protocol for systematic review and meta-analysis
  1. Pratik Pokharel1,2,3,
  2. Juwel Rana4,5,
  3. Jude Moutchia2,3,
  4. Shreeshti Uchai2,3,
  5. Aldiona Kerri2,3,
  6. Patricia Lorena Luna Gutiérrez6,
  7. Rakibul M Islam7
  1. 1Forum for Health Research and Development, Dharan, Nepal
  2. 2School of Health and Related Research, The University of Sheffield, Sheffield, UK
  3. 3École des hautes études en santé publique (EHESP), Paris, France
  4. 4Department of Public Health, North South University, Dhaka, Bangladesh
  5. 5Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst, Massachusetts, USA
  6. 6Escuela Andaluza de Salud Pública, Granada, Spain
  7. 7Women’s Health Research Program, Monash University, Melbourne, Victoria, Australia
  1. Correspondence to Pratik Pokharel; pokharelpratik1921{at}


Introduction Premenstrual syndrome (PMS) has the potential to affect the quality of life adversely. Published guidelines recommend the use of exercise as part of the first-line management interventions for PMS. However, the published evidence related to the effectiveness of physical activity and PMS is inconclusive. This review will assess the effectiveness of exercise-based interventions in reducing PMS in women screened or diagnosed with PMS in low and middle-income countries, where the prevalence of PMS is high.

Methods and analysis Electronic databases will be researched, including Embase, Cochrane Central Register of Controlled Trials, MEDLINE, PsycINFO, Web of Science, and Google Scholar. All the studies published until March 2020 will be included. A standardised data extraction form will be used adapted from the Cochrane Handbook of Systematic Reviews of Interventions. Included articles will be assessed using the risk of bias tools based on study design. Data will be analysed using Review Manager V.5.3. The inverse-variance random-effects method will be used to report the standardised mean difference. A meta-analysis will be used only if studies are sufficiently homogenous. A narrative synthesis will be undertaken when studies are heterogeneous. Methodological heterogeneity between studies will be evaluated by considering the study types. Statistical heterogeneity will be tested using the I2 test. Subgroup analyses may be performed only for the primary outcome in case of sufficient studies. Sensitivity analysis will be conducted to assess the impact of intervention excluding studies without randomisation and studies with a high risk of bias. Funnel plots will be used to assess the potential reporting bias and small-study effects only when there are more than 10 studies included in the meta-analysis.

Ethics and dissemination This study does not require ethical approval, as the review is entirely based on published studies. The results will be published and/or will be presented at a pertinent conference.

PROSPERO registration number CRD42020163377.

  • community gynaecology
  • protocols & guidelines
  • epidemiology
  • public health
  • pain management

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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  • Contributors PP is the guarantor of this review and conceived the review. PP, JR, RMI and JM designed the review further while PP and RMI contributed to the development of the search strategy. PP, JM, SU, AK and PLLG were involved in the initial draft of the manuscript. JR and RMI were involved in subsequent draft manuscript reviews. All authors edited, modified and approved the final version of this protocol. All authors will contribute equally to data extraction, synthesis and drafting of the final review.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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