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Pelvic PainWorkoutCPPNCT07810218

Personalized Exercise Recommendations for Chronic Pelvic Pain Using Reinforcement Learning

A study testing Reinforcement Learning (RL)-Based Personalized Exercise Recommendations and Generic Exercise Recommendation in people with Pelvic Pain and Endometriosis, run by Icahn School of Medicine at Mount Sinai at 1 site in United States.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

WorkoutCPP is a pilot study evaluating the feasibility of a personalized exercise recommendation system for individuals with chronic pelvic pain disorders (CPPDs). The study uses reinforcement learning (RL), a type of artificial intelligence that adapts recommendations over time based on each participant's reported… Read more about this study

Who is it for?
Ages 18 to 55 years, women only
Conditions the study is for
Pelvic Pain, Endometriosis, Chronic Pelvic Pain
What is being tested?
Reinforcement Learning (RL)-Based Personalized Exercise Recommendations and Generic Exercise Recommendation
Could I receive a placebo?
No, everyone receives an active treatment
How many people
45 participants
Where
1 siteUnited States
Study dates
6 Feb 2026to Aug 2027
Phase
Interventional
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 55 years
  • Women only
  • No healthy volunteers
  • Adult

Who may be able to join

  • Self-reported CPPD (e.g., endometriosis, adenomyosis, fibroids, etc.) based on clinician diagnosis
  • Aged 18-55 years.
  • Ownership of an iOS or Android smartphone.
  • Willingness to self-track daily symptoms, exercise activities, and self-management behaviors using a smartphone research app.
  • Willingness to wear an activity tracker for the study duration.
  • Willingness to follow exercise recommendations from a smartphone research app, provided no adverse symptoms occur.
  • Ability to read and write in English sufficient to understand study materials and communications.
  • At least intermittently physically active (e.g., ≥30 minutes of walking twice per week).

Who cannot join

  • Absolute contraindications to PA (e.g., recent myocardial infarction, complete heart block, acute congestive heart failure, unstable angina, or uncontrolled severe hypertension, BP ≥180/110 mm Hg).
  • More than two "Yes" responses on the Physical Activity Readiness Questionnaire (PAR-Q) (16) without physician clearance.
  • Major life events expected during the next 10 weeks (e.g., pregnancy, planned surgery, or extended travel likely to interfere with participation).
  • Current or planned pregnancy within the next 6 months.
  • Having given birth in the past 6 months or currently nursing.
  • Inability to wear an activity tracker or use the app for the study duration.
  • Complete inactivity (i.e., <60 minutes of moderate-intensity PA per week).

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

Ipek Ensari, PhD contact

631-565-1829

ipek.ensari@mssm.edu

United States1 site, 1 recruiting
  • Icahn School of Medicine at Mount Sinai

    New York, New York, 10029

    Ipek Ensari, PhD, 631-565-1829, ipek.ensari@mssm.edu

    Gerard M Ona, MD, 347-835-8115, GerardAnneAprilOna@mssm.edu

    Recruiting

Other trials in United States

About this study

Official title: WorkoutCPP: A Pilot Series of N-of-1 Trials Evaluating RL-Generated Adaptive Exercise Recommendations for Pelvic Pain Management

WorkoutCPP is a pilot study evaluating the feasibility of a personalized exercise recommendation system for individuals with chronic pelvic pain disorders (CPPDs). The study uses reinforcement learning (RL), a type of artificial intelligence that adapts recommendations over time based on each participant's reported pain levels, symptom burden, and exercise compliance. Participants receive daily exercise recommendations that alternate between standard, non-personalized guidance and personalized, RL-generated recommendations across four 2-week phases, allowing within-person comparison of outcomes under each condition. The primary hypothesis is that an RL-based adaptive recommendation system is feasible to deliver in a CPPD population.

Read the detailed description

Chronic pelvic pain disorders (CPPDs) are associated with high symptom burden and reduced quality of life. Physical activity (PA) and exercise have emerged as a promising non-pharmacological approach for symptom management. However, optimal exercise type, intensity, and timing for pain management vary substantially across individuals, supporting the need for personalized adaptive approaches (Ensari et al., 2022, Krasny-Pacini et al., 2017). This study will enroll participants will a CPPD diagnosis into a remote, 9-week study to evaluate the feasibility of RL-based personalized exercise to non-personalized, standard recommendations. Enrollment is rolling, with participants entering the study on a continuous basis. Each participant's start date, and their 9-week intervention period, is determined by their baseline interview date. A baseline interview upon enrollment is scheduled with an exercise physiologist to review the participant's initial exercise list and provide exercise safety information, as well as overview use of the study App. Participants can choose to stay in the study for 2 additional weeks to make up any weeks with inadequate adherence. Study outcomes are measured daily over the course of the intervention period. Daily App-based tracking items assess pain and other symptoms, exercise behavior, perceived effect and feedback to the recommendation, menstrual status, and recommendation compliance. Fitbit trackers simultaneously track participants' objectively-estimated PA. A reinforcement learning (RL) agent implemented in Meier et al. 2023 as the middleware platform generates daily personalized exercise recommendations delivered via a research mobile phone application (Hirten et al., 2023, Meier et al., 2023). Participant-reported perceived effect of each exercise recommendation is used by the RL agent to calculate reward. Participants serve as their own controls, allowing for within-person comparison under the two conditions (Krasny-Pacini et al., 2017). Primary outcomes for the study include standard study feasibility metrics (e.g., adherence, retention). Secondary outcomes focus on RL agent performance and learning over time. Participant safety will be monitored throughout the study, in accordance with the institutional review board.

This work was supported by the Digital Health Partnership (DHP), a collaboration between the Hasso Plattner Institute, Data4Life, the Windreich Department of Artificial Intelligence and Human Health, the Hasso Plattner Institute for Digital Health at Mount Sinai, and The Charles Bronfman Institute for Personalized Medicine at the Icahn School of Medicine at Mount Sinai.

Being tested
Reinforcement Learning (RL)-Based Personalized Exercise Recommendations, Generic Exercise Recommendation
Keywords
Mobile health, Reinforcement learning, Physical activity, N-of-1 trial, exercise, personalized, intervention
Medical subject headings
Pelvic Pain, Endometriosis, Motor Activity

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Reinforcement Learning (RL)-Based Personalized Exercise RecommendationsBehavioural

    Daily exercise recommendations (using type, intensity, and duration) are generated by a contextual bandit reinforcement learning agent, based on the implementation described in Meier et al. 2023. Recommendations are personalized using each participant's initially generated list of exercises based on their physical ability and resources available, as well as contextual daily factors including pain symptoms, prior exercise compliance, and their feedback to the previous exercise recommendation.

  • Generic Exercise RecommendationBehavioural

    Participants receive exercise recommendations from a standardized, set list of exercise recommendations that are based on USDHHS physical activity guidelines (Piercy et al., 2020). Recommendations are not personalized based on participant contextual information and do not adapt over the course of the study.

Study groups in NCT07810218
Study groupRoleWhat they receive
RL-based personalized phaseExperimentalParticipants will receive RL-generated personalized exercise recommendations, which are generated using the list from the initial participant intake form indicating their capacity and resources for carrying out various modalities and intensities of physical activity. The RL agent learns from the participant feedback to update the update the subsequent recommendations.
Receives: Behavioral: Reinforcement Learning (RL)-Based Personalized Exercise Recommendations
Standard (Generic) Exercise ArmActive comparatorParticipants will receive standardized, non-personalized exercise recommendations based on the U.S. Physical Activity Guidelines, in 2-week blocks. This comparison will serve as the "active control" arm to which the experimental RL arm will be compared. This type of control condition was selected to provide a more rigorous test of the experimental condition.
Receives: Behavioral: Generic Exercise Recommendation

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Exercise Recommendation Adherence Rate

    Exercise recommendation adherence rate is calculated by the proportion of daily exercise recommendations completed over the course of the intervention. A higher exercise adherence rate indicates that participants are completing their given exercise recommendations at higher frequencies.

    Measured: At 9 weeks at study completion

  2. Participant Retention Rate

    Participant retention rate is the proportion of enrolled participants completing study participation until the end of intervention. A higher retention rate indicates that participants complete the 9-week intervention period at higher frequencies.

    Measured: At 9 weeks at study completion

Secondary outcomes (1)
  1. Reinforcement Learning Agent Action Entropy Over Time

    Entropy of the reinforcement learning (RL) agent's action probability distributions is calculated at each decision point throughout the study period. Entropy ranges from a minimum of 0 (the agent selects a single action with certainty) to a maximum of log(K), where K is the number of distinct recommendation actions available to the agent at that decision point (maximum entropy occurs when the agent assigns equal probability to all available actions). Decreasing entropy over time indicates increasing model confidence and more consistent personalized recommendation patterns. Higher entropy indicates greater uncertainty in the agent's decision making. This outcome will be evaluated for the entire duration of the intervention based on the daily data.

    Measured: At 9 weeks at study completion

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted9 Sep 2026
  2. Study start6 Feb 2026
  3. Primary completionAug 2027 (estimated)
  4. Study completionAug 2027 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Other
Allocation
Randomised
Intervention model
Crossover
Model description
N-of-1 randomized crossover design in which each participant serves as their own control, randomized 1:1 to one of two intervention sequences (ABAB or BABA), alternating between RL-generated personalized exercise recommendations (active arm) and standard generic recommendations (control arm) across multiple 2-week blocks within the 9-week study period. First week is treated as a baseline week where participants get accommodated to the study App and procedures, as well as RL agent warm-up.
Masking
Single blind
Who is masked
Participant
Enrolment
45 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07810218
Sponsor's protocol ID
STUDY-23-00721
Acronym
WorkoutCPP
Status last verified
Sep 2026
First submitted
3 Sep 2026
Last updated
9 Sep 2026
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No: Individual participant data will not be shared, in order to protect participant privacy and confidentiality, consistent with the IRB guidelines and informed consent form under which participants were enrolled.

Publications

  • Ensari I, Lipsky-Gorman S, Horan EN, Bakken S, Elhadad N. Associations between physical exercise patterns and pain symptoms in individuals with endometriosis: a cross-sectional mHealth-based investigation. BMJ Open. 2022 Jul 18;12(7):e059280. doi: 10.1136/bmjopen-2021-059280.

    PubMed 35851021
  • Piercy KL, Troiano RP, Ballard RM, Carlson SA, Fulton JE, Galuska DA, George SM, Olson RD. The Physical Activity Guidelines for Americans. JAMA. 2018 Nov 20;320(19):2020-2028. doi: 10.1001/jama.2018.14854.

    PubMed 30418471
  • Hirten RP, Danieletto M, Landell K, Zweig M, Golden E, Orlov G, Rodrigues J, Alleva E, Ensari I, Bottinger E, Nadkarni GN, Fuchs TJ, Fayad ZA. Development of the ehive Digital Health App: Protocol for a Centralized Research Platform. JMIR Res Protoc. 2023 Nov 16;12:e49204. doi: 10.2196/49204.

    PubMed 37971801
  • Krasny-Pacini A, Evans J. Single-case experimental designs to assess intervention effectiveness in rehabilitation: A practical guide. Ann Phys Rehabil Med. 2018 May;61(3):164-179. doi: 10.1016/j.rehab.2017.12.002. Epub 2017 Dec 15.

    PubMed 29253607
  • Rabbi M, Aung MS, Gay G, Reid MC, Choudhury T. Feasibility and Acceptability of Mobile Phone-Based Auto-Personalized Physical Activity Recommendations for Chronic Pain Self-Management: Pilot Study on Adults. J Med Internet Res. 2018 Oct 26;20(10):e10147. doi: 10.2196/10147.

    PubMed 30368433

Questions about this trial

What is this clinical trial studying?

A study testing Reinforcement Learning (RL)-Based Personalized Exercise Recommendations and Generic Exercise Recommendation in people with Pelvic Pain and Endometriosis, run by Icahn School of Medicine at Mount Sinai at 1 site in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 8 inclusion and 7 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 9 Sep 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Ipek Ensari, PhD (631-565-1829, ipek.ensari@mssm.edu), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Exercise Recommendation Adherence Rate (time frame: At 9 weeks at study completion). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT07810218, which also lists 5 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 9 Sep 2026.

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