Effect of exercise intervention on chronic primary pelvic pain syndrome: A network meta-analysis

This network meta-analysis evaluates the comparative effectiveness of different exercise interventions for managing chronic primary pelvic pain syndrome (CPPPS) in men. We assessed their impact on the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) total score, including its pain, urinary symptoms, and quality of life subscales, and examined potential improvements in maximum urinary flow rate (Q_max). Using data from randomized controlled trials (RCTs), we identified the most effective exercise therapies to address current uncertainties in treatment prioritization and provide clinically actionable insights. Our findings aimed to guide evidence-based practice and highlight priority areas for future research in CPPPS management.

We systematically searched 8 major Chinese and international databases for RCTs published up to July 2025. Two reviewers independently screened studies and assessed quality using the Cochrane Risk of Bias 2.0 tool and the Confidence in Network Meta-Analysis framework. A frequentist network meta-analysis was conducted with Stata/MP 18 to calculate mean differences (MDs) with 95% confidence intervals (95%CIs), and interventions were ranked by surface under the cumulative ranking curve (SUCRA) values.

Fifteen RCTs with a total of 1736 patients were included in the analysis. Most exercise-based interventions outperformed standard medical care (SMC). Of these, pelvic floor muscle training combined with pelvic floor muscle electrical stimulation (PFMT+PFMES) produced the greatest reduction in the NIH-CPSI (MD = -25.34; 95%CI: -30.03 to -20.65; SUCRA = 100%), with consistent superiority in the pain (MD = -10.76; 95%CI: -12.69 to -8.83; SUCRA = 100%) and quality of life (MD = -7.20; 95%CI: -10.87 to -3.53; SUCRA = 98.9%) subdomains. PFMES alone was most effective for urinary symptoms (MD = -5.64; 95%CI: -10.16 to -1.12; SUCRA = 91.2%), while PFMT+Squat also showed notable benefits, ranking just below PFMT+PFMES and PFMES. For Q_max, all exercise interventions combined with SMC showed a trend towards improvement, although results were not statistically significant. Overall, the certainty of evidence was rated as low to moderate.

Exercise-based interventions, particularly PFMT+PFMES and PFMES, demonstrated clear advantages over SMC in improving NIH-CPSI and its subdomains. These approaches may represent valuable components of comprehensive management for CPPPS. Future high-quality trials with extended follow-up are needed to strengthen the evidence base and determine their long-term effects on patient-reported outcomes.