When, why and for whom there is a relationship between physical activity and menopause symptoms

Impact of symptoms, experiences, and perceptions of the menstrual cycle on recreational physical activity of cyclically menstruating individuals: A systematic review

OBJECTIVE

The menstrual cycle often presents barriers to participation in daily life activities, including physical activity (PA), which is a cornerstone of health and well-being. The purpose of this systematic review was to explore and summarize the impact of symptoms, experiences, and perceptions of the menstrual cycle on recreational PA (RPA), including sports, exercise and active recreation, in the general population.

METHODS

Six databases were searched for studies that investigated the impact of the menstrual cycle on PA among individuals who were cyclically menstruating, healthy, and not involved in professional sports training.

RESULTS

The search yielded 3025 studies that were screened for relevance and eligibility, resulting in 25 eligible studies, which were found to be of moderate-to-high quality following a quality and risk-of-bias assessment. Thematic synthesis of qualitative and quantitative data from the selected studies, constituting 16,557 adults and 3715 adolescents, identified the impact of menstrual symptoms on the physical and psychological capability to participate in RPA, social opportunity barriers to RPA (e.g., social pressure due to the sociocultural taboo against menstruation), as well reflective (knowledge) and automatic (habit) motivation on RPA behaviours.

CONCLUSION

The variability in menstrual symptoms and corresponding experiences suggested the need for an individualized approach to RPA promotion. Furthermore, this review highlighted the need to address the sociocultural taboo against menstruation, as well as improve the provision of knowledge and resources related to the menstrual cycle and RPA, in order to promote and facilitate RPA for cyclically menstruating individuals throughout the menstrual cycle.

The influence of habitual physical activity and sedentary behavior on objective and subjective hot flashes at midlife

OBJECTIVE

The purpose of this study was to evaluate relationships between physical activity, sedentary time, and hot flashes during both waking and sleeping periods using concurrent objective and subjective measures of hot flashes in midlife women.

METHODS

Women aged 45 to 55 years (n = 196) provided self-reported data on physical activity and underwent 24 hours of hot flash monitoring using sternal skin conductance. Participants used event marking and logs to indicate when hot flashes were perceived. Wake and sleep periods were defined by actigraphy. Mean ambient temperature and humidity were recorded during the study period. Generalized linear regression modeling was used to evaluate the effect of physical activity types and sedentary time on hot flash outcomes. Isotemporal substitution modeling was used to study the effect of replacing sedentary time with activity variables on hot flash frequency.

RESULTS

Modeled results indicated that increasing sitting by 1 hour was associated with a 7% increase in the rate of objectively measured but not subjectively reported hot flashes during sleep. Replacing 1 hour of sitting with 1 hour of vigorous activity was associated with a 100% increase in subjectively reported but not objectively measured waking hot flashes. There was little evidence for an effect of temperature or humidity on any hot flash outcome.

CONCLUSIONS

These data provide support for relations between sedentary time, physical activity, and hot flashes and highlight the importance of using objective and subjective assessments to better understand the 24-hour hot flash experience.

A study evaluating quality of life and factors affecting it before, during and after menopause

OBJECTIVE

To determine if quality of life (QoL) changes before, during and after menopause and whether these changes are linked to symptoms, demographics, and/or lifestyle factors.

METHODS

We undertook a cross-sectional online survey. We invited women aged between 35 and 60 years to complete the survey which included the Short-Form 36 (SF-36) generic quality of life measure, the menopause specific Utian-Quality of life (UQOL) measure, and questions about health and wellbeing, menopause symptoms and hormonal stage. The data were analysed with one-way ANOVA analysis and multivariate regression modelling.

RESULTS

279 women completed the survey. Most were aged between 51 and 55 years. In the unadjusted analysis there was a tendency for QoL to deteriorate from pre to peri to menopause and then increase slightly post menopause. This was however not significant in multivariate analysis. Multivariate analysis identified that lifestyle factors significantly influenced QoL. Regular exercise resulted in better QoL scores across a number of the UQol and SF-36 sub-scales. Being very overweight and having more menopause symptoms resulted in worse QoL.

CONCLUSIONS

Although there was a trend towards worse quality of life in the peri and menopause stages this was not significantly different in adjusted multivariate analyses. Those experiencing more symptoms had significantly worse QoL. Lifestyle factors may affect QoL, but the picture is not straightforward. It is promising that there was a trend toward improved QoL in the post-menopausal stage. These findings should inform education material and promote awareness of the menopause and its impact on QoL. (245).

The effects of music therapy on the psychological status of women with perimenopause syndrome

OBJECTIVE

Women experience many physical and psychological changes with the reduction of progesterone and estrogen as ovarian function gradually weakens. This study applied a music psychotherapy program as a nonpharmacological treatment method in addition to treatment using drugs such as hormone therapy for perimenopausal women.

METHOD

This study's pre-post, control-experimental research compared 20 women in the music psychotherapy experimental group and 20 in the cognitive behavioral therapy (CBT) control group. The perimenopausal women aged between 40 and 60 years experienced no menstrual period for 1 year. We provided eight sessions of music psychotherapy, including CBT, each lasting 60 minutes. The study period was 4 months from the time of recruitment.

RESULTS

The music therapy group showed a more significant decrease in the Menopause Rating Scale total (change over time, 9.2 points and 3.5 points, respectively; P = 0.008) and psychology subcategory (change over time, 6.5 points and 0.9 points, respectively; P = 0.004) of Menopause Rating Scale scores, compared with the CBT group. In addition, the music therapy group increased their quality of life psychological score, but the CBT group did not.

CONCLUSIONS

These results suggest that music therapy can help the psychological and emotional symptoms of perimenopausal women and is effective for treatment. The study result provides a therapeutic basis for developing treatments for nonpharmacological mediation.

Exogenous female sex steroid hormones and new-onset asthma in women: a matched case-control study

BACKGROUND

Evidence on the role of exogenous female sex steroid hormones in asthma development in women remains conflicting. We sought to quantify the potential causal role of hormonal contraceptives and menopausal hormone therapy (MHT) in the development of asthma in women.

METHODS

We conducted a matched case-control study based on the West Sweden Asthma Study, nested in a representative cohort of 15,003 women aged 16-75 years, with 8-year follow-up (2008-2016). Data were analyzed using Frequentist and Bayesian conditional logistic regression models.

RESULTS

We included 114 cases and 717 controls. In Frequentist analysis, the odds ratio (OR) for new-onset asthma with ever use of hormonal contraceptives was 2.13 (95% confidence interval [CI] 1.03-4.38). Subgroup analyses showed that the OR increased consistently with older baseline age. The OR for new-onset asthma with ever MHT use among menopausal women was 1.17 (95% CI 0.49-2.82). In Bayesian analysis, the ORs for ever use of hormonal contraceptives and MHT were, respectively, 1.11 (95% posterior interval [PI] 0.79-1.55) and 1.18 (95% PI 0.92-1.52). The respective probability of each OR being larger than 1 was 72.3% and 90.6%.

CONCLUSIONS

Although use of hormonal contraceptives was associated with an increased risk of asthma, this may be explained by selection of women by baseline asthma status, given the upward trend in the effect estimate with older age. This indicates that use of hormonal contraceptives may in fact decrease asthma risk in women. Use of MHT may increase asthma risk in menopausal women.

Physical activity and exercise for hot flashes: trigger or treatment?

IMPORTANCE AND OBJECTIVE

Hot flashes (HFs) are a prevalent feature of menopause. Hot flashes can be bothersome and affect quality of life. However, HFs have also been associated with the risk for cardiovascular disease. Therefore, providing current evidence on the effect of therapies to reduce HFs can help patients and providers with decision making. This review provides details on the scientific evidence to date related to the effect of physical activity (PA) and exercise to alter the HF experience in women.

METHODS

The PubMed database was searched between June 2020 and June 2022 for currently available evidence regarding the relation between PA and exercise and HFs. Our analysis included randomized control trials on exercise training, epidemiological studies, and studies evaluating acute exercise on the self-reported and objectively measured HF experience in addition to systematic reviews on the topic published as of June 2022.

DISCUSSION AND CONCLUSIONS

The majority of evidence from randomized control trials indicates that aerobic and resistance exercise training lead to a decrease in subjectively experienced HFs. The limited available studies on acute exercise indicate that a bout of moderate-intensity exercise may decrease objectively measured and self-reported HFs but acute increases in PA intensity above accustomed levels may influence subjective HF experience. Some evidence suggests that for those with depression, habitual PA may be an effective way to reduce HF symptoms. Weighing the available evidence, for people who experience HFs, engaging in regular moderate-intensity PA, including aerobic and resistance exercise, may be an effective therapy to reduce HFs and women should be counseled on the benefits of regular, moderate exercise. However, significant gaps in knowledge remain about the optimal exercise prescription, effectiveness for a diverse population, meaning of differences between objective and subjective experience, and mechanisms that lead to changes in HFs.

An umbrella systematic review of the effect of physical exercise on mental health of women in menopause

IMPORTANCE

The menopausal transition has been related to worsening mental health. The literature also points out that being physically active during menopause is associated with a favorable effect on climacteric symptoms, specifically on psychological aspects.

OBJECTIVES

The aims of the study are to analyze the effects of physical activity on mental health during menopause through an umbrella review and to evaluate the quality of the included Systematic Reviews and meta-analyses (MAs).

EVIDENCE REVIEW

A MeaSurement Tool to Assess Systematic Reviews was used to evaluate the methodological quality of the included studies and the Grading of Recommendations Assessment, Development and Evaluation was applied to assess the level of the evidence of the results. In addition, the effect size of the revised meta-analyses (MAs) was calculated.

FINDINGS

A total of 9 systematic reviews/MAs were included, published between 2014 and 2020. In the A MeaSurement Tool to Assess Systematic Reviews methodological quality assessment, 8 studies were classified as "high quality" and 1 as "low quality." In terms of quality of the evidence for each result through the Grading of Recommendations Assessment, Development and Evaluation classification, approximately 75% of the studies were classified as "moderate quality," 22.2% as "high quality," and 22.2% as "low quality," with the greatest bias concerning the high heterogeneity of the included studies. In addition, the studies showed low overlap. Despite the high heterogeneity, we can highlight the importance of the practice of physical activity by women in menopause, to prevent and/or reduce problems related to mental health.

CONCLUSIONS AND RELEVANCE

There was a positive effect of the interventions on depression, however, with no difference between durations (short or long). Regarding stress, the interventions applied did not show a positive effect. The studies that investigated depression linked to anxiety presented conflicting results.

Effectiveness of Educational Intervention Based on Transtheoretical Model on Physical Activity and Menopausal Symptoms

Introduction

Menopause is an inevitable part of women's lives. Physical activity as nonhormonal therapy can decrease the symptoms of menopause. This study is aimed at investigating the effect of educational intervention based on the transtheoretical model (TTM) on physical activity and menopausal symptoms of female clients of the health center in Pasargad City, Iran.

Methods

This quasi-experimental study was performed on 140 females admitted to health center of Pasargad City, Fars Province, Iran (intervention = 70 and control = 70). The data collection tool consisted of demographic data, menopause rating scale, international physical activities questionnaire, and TTM questionnaire (stages of change, processes of change, decision-making balance, and self-efficacy) that were completed before and two months after intervention. For intervention group, the educational program was implemented during 5 sessions of 50-55 min. Data were analyzed by SPSS 25 and by using Chi-square test, independent t-test, and paired t-test.

Results

After intervention, the mean scores of physical symptoms are sleep problems, muscle problems and discomfort, psychological symptoms, depression, irritability, and anxiety of intervention group decreased significantly post intervention (p < 0.001). Analysis showed that psychological symptoms, mental fatigue, somatic, and urogenital symptoms, and vaginal dryness increased 2 months after the intervention. Also, the mean score of cons, pros, decision balance, self-efficacy, consciousness raising, dramatic relief, environmental reevaluation, and self-reevaluation have significant changed in intervention group (p < 0.05). In addition, the top percent of progress can be seen in contemplation (31. 5%).

Conclusion

This study showed the effectiveness of educational intervention based on TTM to reduce menopausal symptoms and promote physical activity in postmenopausal women.

Predictive Factors for the Risk of Sexual Dysfunction in Climacteric Women: Population-based Study

BACKGROUND

It is known that sexual problems increase with age but little is known about the predictors of female sexual dysfunction (FSD) in Brazilian climacteric women.

AIM

To identify predictive factors for FSD in climacteric women.

METHODS

This is a cross-sectional population-based study carried out through a household survey.

OUTCOMES

The measures investigated were sociodemographic characteristics, depressive symptoms, level of physical activity, presence of FSD, self-rated health and sleep satisfaction.

RESULT

A total of 381 climacteric, sexually active women were included, with a mean age of 55.04 (±7.21) years. The prevalence of FSD was 38.3%. All variables investigated were associated with FSD (P < .05). In the final model, the predictors for FSD were low satisfaction with sleep (OR 4.20; 95% CI 2.32-7.62), advanced age (OR 1.04; 95% CI 1.00-1.08), low education level (OR 0.90; 95% CI 0.85-0.97) and having a partner (OR 0.35; 95% CI 0.16-0.76).

CLINICAL IMPLICATION

These aspects deserve attention from the health team to prevent and identify FSD early in life in climacteric women.

STRENGTHS & LIMITATIONS

This study support existing data about risk factors for FSD in climacteric women. However, it is not possible to attribute causality to any of the correlates identified, which is a limitation of cross-sectional studies.

CONCLUSION

Dissatisfaction with sleep, senility, insufficient income, low education, not having a partner, complaints of depression, and the worse perception of global health are predictive factors for FSD in climacteric women.

Psychological well-being of midlife women: a structural equation modeling approach

OBJECTIVE

Women experience menopause at approximately 50 to 52 years of age, when reproductive aging causes various somatic, psychological, and urogenital symptoms. Women's changing lifestyles and increasing lifespan make it difficult to pinpoint the factors affecting their well-being during menopause, warranting continuous research in this field. Therefore, this study developed a structural equation model, based on the transactional model of stress and coping, to test the significance of positive and negative factors associated with psychological health during menopause.

METHODS

This study validated a structural equation model based on the empirical data collected using a crosssectional study. We analyzed 300 questionnaire responses completed between May 15 and July 10, 2020, by South Korean middle-aged women (aged 45-60 y) who agreed to participate. The study's structural equation model used self-efficacy as an exogenous variable and perceived stress, menopausal management, self-compassion, menopausal symptoms, and psychological well-being as endogenous variables. Educational and economic levels were set as control variables.

RESULTS

We observed statistical support for 9 out of 10 hypotheses; the predictor variables had an explanatory power of 79.5% for psychological well-being. Self-efficacy was positively associated with the psychological wellbeing of middle-aged menopausal women and appeared to be mediated by perceived stress, menopausal management, menopausal symptoms, and self-compassion.

CONCLUSIONS

To improve the psychological well-being of middle-aged women, it is important to increase their self-efficacy and minimize stress. Moreover, managing menopausal symptoms and increasing self-compassion through effective coping may maximize psychological well-being.

VIDEO SUMMARY

http://links.lww.com/MENO/A933.

The association between physical activity and menopause-related quality of life

Background/aims

Menopause can cause drastic changes that trigger severe symptoms in women and, in turn, influence their quality of life. Many women no longer prefer hormone replacement therapy because of its potential adverse effects. Hence, it is crucial to establish alternate interventions to alleviate menopausal symptoms. The aim of this study was to estimate the relationship between quality of life and level of physical activity in menopausal women.

Methods

A total of 260 postmenopausal women were recruited in this cross-sectional study. The Menopause Rating Scale and International Physical Activity Questionnaire – Short Form were used to assess quality of life and physical activity respectively.

Results

Women with higher levels of physical activity had fewer total menopausal, somato-vegetative and psychological symptoms (P<0.001); no differences were found in vasomotor and urogenital symptoms.

Conclusions

Women with low physical activity levels presented with greater menopausal symptoms. Regular physical activity can be recommended to alleviate symptoms following menopause, thereby improving quality of life.

Posttraumatic Stress Disorder and Likelihood of Hormone Therapy Use among Women in the Nurses' Health Study II: A 26-Year Prospective Analysis

BACKGROUND

Posttraumatic stress disorder (PTSD) is associated with higher risk of certain chronic diseases, including ovarian cancer, but underlying mechanisms remain unclear. Although prior work has linked menopausal hormone therapy (MHT) use with elevated ovarian cancer risk, little research considers PTSD to likelihood of MHT use. We examined whether PTSD was prospectively associated with greater likelihood of initiating MHT use over 26 years.

METHODS

Using data from the Nurses' Health Study II, with trauma and PTSD (symptoms and onset date) assessed by screener in 2008 and MHT assessed via biennial survey (from 1989), we performed Cox proportional regression models with women contributing person-years from age 36 years. Relevant covariates were assessed at biennial surveys. We considered potential effect modification by race/ethnicity, age at baseline, and period (1989-2002 vs. 2003-2015).

RESULTS

Over follow-up, 22,352 of 43,025 women reported initiating MHT use. For example, compared with women with no trauma, the HR for initiating MHT was 1.18 for those with trauma/1-3 PTSD symptoms [95% confidence interval (CI), 1.13-1.22] and 1.31 for those with trauma/4-7 PTSD symptoms (95% CI, 1.25-1.36; P trend < 0.001), adjusting for sociodemographic factors. Associations were maintained when adjusting for reproductive factors and health conditions. We found evidence of effect modification by age at baseline.

CONCLUSIONS

Trauma and number of PTSD symptoms were associated with greater likelihood of initiating MHT use in a dose-response manner.

IMPACT

MHT may be a pathway linking PTSD to altered chronic disease risk. It is important to understand why women with PTSD initiate MHT use.

Effectiveness of SaBang-DolGi Walking Exercise Program on Physical and Mental Health of Menopausal Women

Objective: We investigated the effectiveness of a 12-week SaBang-DolGi walking exercise program on the physical and mental health of menopausal women and aimed to provide the basic data needed to develop health promotion programs for the active and healthy aging of menopausal women. Materials and methods: The participants comprised 40 women aged 50–65 years who were divided into two randomly selected groups in training sessions (exercising group, n = 21 and control group, n = 19). A physical (grip, muscle and endurance) test and mental health test (simple mental health test II) were conducted using questionnaires with the aim of examining subjects’ physical and mental health before and after exercise. Results: After the intervention, the participants experienced positive changes in the physical dimension, with significant enhancements particularly in mental well-being and menopause-related health and subdomains. Controlled and regular exercise for 12 weeks was significantly correlated with a positive change in vitality and mental health. Conclusions: We found that the SaBang-DolGi walking exercise program helps to promote the physical and mental health of menopausal women who are exposed to the various stresses and depressions that accompany physical deterioration; the program was found to encourage active and healthy aging.

Women's views about physical activity as a treatment for vasomotor menopausal symptoms: a qualitative study

Background

Women commonly seek medical advice about menopausal symptoms. Although menopausal hormone therapy is the most effective treatment, many women prefer non-pharmacological treatments, such as physical activity. The effectiveness of physical activity has been inconclusive when assessed by randomised controlled trials, and it remains unclear how women feel about it as a possible treatment approach. The aim of the study was to explore symptomatic menopausal women’s views and experiences of physical activity as a treatment for vasomotor and other menopausal symptoms.

Methods

An in-depth qualitative study was embedded within a randomised controlled trial that assessed the effectiveness of physical activity as a treatment for vasomotor menopausal symptoms in previously inactive vasomotor symptomatic women. Participants were randomised to one of two physical activity interventions or a usual care group. Both physical activity interventions involved two one-to-one consultations, plus either supporting materials or access to physical activity support groups, over 6 months. Semi-structured interviews were conducted with 17 purposively selected participants from all three trial groups after they had completed trial follow-up. Interviews were audio recorded, transcribed verbatim, and analysed by constant comparison.

Results

All participants talked positively about physical activity as a treatment for their menopausal symptoms, with most reporting participation had improved their hot flushes and night sweats. They reported that they had experienced improved sleep, physical health and psychological well-being. Those who received the physical activity plus social-support intervention reported their ability to cope with their menopausal symptoms had improved. Many participants commented that they would prefer doctors to discuss physical activity as a possible treatment for their hot flushes and night sweats, before offering medication.

Conclusions

Based on the views and experiences of the women who participated in this study, healthcare professionals should continue discussing physical activity as a potential first treatment option with menopausal women. Furthermore, healthcare professionals should ensure they prepare, support, and encourage these women both physically and emotionally.

Trial registration

ISRCTN ISRCTN06495625 Registered 10/11/2010

The role of stress and self-efficacy in somatic and psychological symptoms during the climacteric period - Is there a specific association?

OBJECTIVES

To investigate the influence and specificity of sociodemographic and psychological factors on the perception of symptoms associated with menopause.

STUDY DESIGN

Data are based on a nationwide cross-sectional survey study in Germany. A representative sample of 1350 females aged 14-95 years was examined. Sociodemographic factors, perceived stress, and self-efficacy were assessed. Women were divided into three age groups (young women ≤ 44 years; perimenopausal women 45-60 years; older women ≥ 61 years), and the Menopause Rating Scale (MRS) was used over the entire life span.

MAIN OUTCOME MEASURES

Total score on the Menopause Rating Scale (MRS) and hot flushes/sweating assessed via the MRS.

RESULTS

The MRS total score increased with age. Both MRS total score and hot flushes were positively associated with perceived stress in all three age groups. The MRS total score was negatively associated with self-efficacy; for hot flushes, this association could be shown for perimenopausal women only. Furthermore, interaction effects between perceived stress and self-efficacy were found: in perimenopausal and older women, the association between perceived stress and the MRS total score was stronger the lower self-efficacy was. This interaction effect was not observed in younger women. No interaction effect was found in any age group for hot flushes.

CONCLUSIONS

Our data indicate that self-efficacy influences the severity of symptoms measured with the MRS. Interventions aimed to reduce stress and strengthen self-efficacy could lead to a lower symptom burden in perimenopausal women.

The effect of menopausal symptoms on the quality of life among postmenopausal Egyptian women

Objective: The current study aims to assess the prevalence of menopausal symptoms among postmenopausal Egyptian women and their effect on the quality of these women's lives.Study design: A cross-sectional study was carried out in a tertiary university hospital between January and December 2017. We enrolled 350 postmenopausal women aged 45-70 years. All women were interviewed using the Menopause-Specific Quality of Life (MENQOL) questionnaire after translation into the Arabic language by a certified translation expert. The Mann-Whitney test and the Kruskal-Wallis test were used to compare MENQOL item scores.Results: Low backache was the most common complaint among the study participants (86%). The sexual domain imposed the greatest impact on quality of life (mean = 3.12 ± 1.66), followed by physical (mean = 3.18 ± 0.92), psychological (mean = 3.08 ± 0.98), and vasomotor (mean = 3.01 ± 1.78) domains. Moreover, we found a significant positive moderate correlation between body mass index (BMI) and the total score (r = 0.689, p < 0.001). Multivariable linear regression analysis found that the best-fitting predictors for the MENQOL score were age (p < 0.001), BMI (p < 0.001), and exercise (p < 0.001).Conclusions: Physical symptoms were the most prevalent symptoms in this study. In general, older women, housewives, hand workers, less physically active women, and those of low socioeconomic status had poor quality of life.

High Physical Activity Level May Reduce Menopausal Symptoms

Background and Objectives: Menopause is a normal physiological change occurring at a woman's mid-life. During this time, women experience vasomotor, physical and physiological problems, which reduce their quality of life. Many women are searching for different, alternative methods to reduce the severity of menopausal symptoms. Physical activity (PA) is one of the recommended methods to reduce menopausal symptoms. The purpose of this study was to investigate the association between specific domains (physical activity during leisure time, at work, during transportation and household activities) and the menopausal symptoms. Materials and Methods: We included 305 women aged 40-65 in the study. All participants were divided into three groups according to menopausal status. The research tools used were the International Physical Activity Questionnaire (IPAQ) to assess physical activity level in four domains and the Menopause Rating Scale (MRS) to assess the severity of menopausal symptoms. The data analysis was performed by Chi-square test and analysis of variance (ANOVA) with post hoc Tuckey test. Results: Menopausal stage was significantly associated with the total MRS score (p < 0.001) and specifically the urogenital and somato-vegetative subscores (p < 0.001). Physical activity was significantly associated (p < 0.001) with leisure time (according to IPAQ domains). Most postmenopausal women had high PA level (59.66%). Significantly less women with high PA levels had severe urogenital symptoms: 10.82% of participant with a low PA level, 11.15% with a moderate PA level and 4.26% with a high PA level (p = 0.046). Conclusions: Physical activity during leisure time is associated to menopausal symptoms in Polish women. Women with high and moderate PA levels have less severe menopausal symptoms compared to inactive women. Middle-aged women with low PA levels at work suffer from more severe somato-vegetative symptoms.

Sedentary lifestyle in middle-aged women is associated with severe menopausal symptoms and obesity

OBJECTIVE

The aim of the study was to evaluate the association between sedentary lifestyle and the severity of menopausal symptoms and obesity in middle-aged women.

METHODS

The Menopause Rating Scale, the Goldberg Anxiety and Depression Scale, and the Athens Insomnia Scale were administered to 6,079 Latin American women aged 40 to 59 years. Sedentary lifestyle was defined as fewer than three weekly, 30-minute periods of physical activity.

RESULTS

Sedentary women had more severe menopausal symptoms (total Menopause Rating Scale score: 9.57 ± 6.71 vs 8.01 ± 6.27 points, P < 0.0001) and more depressive symptoms (Goldberg), anxiety (Goldberg), and insomnia (Athens Scale) compared with non-sedentary women. They also had greater mean waist circumference (86.2 ± 12.3 vs 84.3 ± 1.8 cm, P < 0.0001) and a higher prevalence of obesity (20.9% vs 14.3%, P < 0.0001). Logistic regression analysis showed that both obesity (odds ratio [OR] 1.52; 95% CI, 1.32-1.76) and severe menopausal symptoms (OR 1.28; 95% CI, 1.06-1.53), including insomnia and depressive mood, were positively associated with a sedentary lifestyle. Having a stable partner (OR 0.85; 95% CI, 0.76-0.96), using hormone therapy (OR 0.75; 95% CI, 0.64-0.87) and having a higher educational level (OR 0.66; 95% CI, 0.60-0.74) were negatively related to sedentary lifestyle.

CONCLUSIONS

There was a high prevalence of sedentary lifestyle in this middle-aged Latin American female sample which was associated with more severe menopausal symptoms and obesity.

Use of the Menopause-Specific Quality of Life (MENQOL) questionnaire in research and clinical practice: a comprehensive scoping review

OBJECTIVE

The Menopause-Specific Quality of Life (MENQOL) questionnaire was developed as a validated research tool to measure condition-specific QOL in early postmenopausal women. We conducted a comprehensive scoping review to explore the extent of MENQOL's use in research and clinical practice to assess its value in providing effective, adequate, and comparable participant assessment information.

METHODS

Thirteen biomedical and clinical databases were systematically searched with "menqol" as a search term to find articles using MENQOL or its validated derivative MENQOL-Intervention as investigative or clinical tools from 1996 to November 2014 inclusive. Review articles, conference abstracts, proceedings, dissertations, and incomplete trials were excluded. Additional articles were collected from references within key articles. Three independent reviewers extracted data reflecting study design, intervention, sample characteristics, MENQOL questionnaire version, modifications and language, recall period, and analysis detail. Data analyses included categorization and descriptive statistics.

RESULTS

The review included 220 eligible papers of various study designs, covering 39 countries worldwide and using MENQOL translated into more than 25 languages. A variety of modifications to the original questionnaire were identified, including omission or addition of items and alterations to the validated methodological analysis. No papers were found that described MENQOL's use in clinical practice.

CONCLUSIONS

Our study found an extensive and steadily increasing use of MENQOL in clinical and epidemiological research over 18 years postpublication. Our results stress the importance of proper reporting and validation of translations and variations to ensure outcome comparison and transparency of MENQOL's use. The value of MENQOL in clinical practice remains unknown.

Physical activity and perceptions of stress during the menopause transition: A longitudinal study

The transition to menopause is a critical period of significant biopsychosocial change. The purpose of this study was to examine the influence of the transition to menopause and volume of physical activity on levels of perceived stress over five years in 102 healthy middle-aged women. Questionnaire and accelerometer data were analyzed using linear mixed models. Adjusting for age and body mass index, there were no significant effects of menopause status or time on perceived stress. Independent of menopause status, minutes per week of vigorous activity was associated with lower perceived stress in years 1 and 2 of the study.

The Relationship between Physical Activity and General Health among Menopausal Women in Ahvaz, Iran

Introduction

Most women experience significant changes in their general health status during menopause, which negatively affects their quality of life. Physical activity has also been shown to enhance quality of life. However, little is known about the effect of physical activity on women’s health during the menopausal transition. This study aimed to determine the relationship between physical activity and general health among menopausal women in Ahvaz, Iran.

Methods

This cross sectional study was carried out on 600 menopausal women using cluster random sampling during 2013–2014. Data collection tools were three questionnaires; women’s demographic characteristics, the Goldenberg’s questionnaire, and International physical activity questionnaire (IPAQ). Data were analyzed using descriptive and inferential statistics through SPSS version 19. The statistical tests were performed at the 95% confidence interval.

Results

There was a significant relationship between the total score of physical activity and physical health, social functioning, anxiety and depression (p<0.05), but no significant relationship was found between subscales related to physical activity and general health (p>0.05).

Conclusion

Physical activity is effective in improving general health in menopausal women. Proper training and effective interventions for regular physical activity can be important steps to promote the general health of menopausal women.

Longitudinal trajectories of physical activity in women using latent class growth analysis: The WIN Study

PURPOSE

This study aimed (1) to examine the longitudinal trajectories in objectively measured physical activity (PA); (2) to identify unknown (i.e., latent) subgroups with distinct trajectories; and (3) to examine the correlates of latent subgroups among community dwelling women.

METHODS

The study sample included a total of 669 women from the Women's Injury Study, a 5-year prospective cohort study conducted from 2007 in the Southwest Central region of the US. Pedometer-based step-count data across 18 consecutive months were fitted to a latent growth model (LGM) and a latent class growth model (LCGM). Baseline characteristics were regressed on latent class membership.

RESULTS

The longitudinal change in PA was best fit to a piecewise LGM with seasonal transitions. Significantly increased and decreased levels of PA were observed during the spring, fall, and winter, respectively (p < 0.001). Three latent subgroups with distinct PA trajectories were identified (low-active (46.8%), somewhat-active (41.3%), and active (11.9%)). Age and body fat percentage at the baseline significantly explained the likelihoods of being in low-active subgroup.

CONCLUSION

Seasonal variations in PA among women were observed but may not be practically significant. A relatively large portion of the sample showed low levels of PA for long periods. Intervention strategies should be considered for women who are overweight or obese, and aged >40 years old to promote PA during the life course.

Physical activity, evaluation of menopause, life satisfaction and influence tactics in marriage of perimenopausal women

<b>Background</b><br /> Domination of the biomedical approach to menopause may imply creation of negative attitudes to the phenomenon, and at the same time negatively affect women’s life satisfaction and behaviour in the family. It is assumed that physical activity may be a defensive factor, as this type of activity may reduce the intensity of menopause symptoms. The aim of the research was to determine the relation between menopause evaluation, life satisfaction and tactics of influence employed in marriage by women who differ in involvement in physical exercise.<br /> <br /> <b>Participants and procedure</b><br /> The research was conducted among 90 women, at the age of 45-55: 45 physically active women and 45 women who do not engage in any physical activity. The following research methods were used: the Menopause Evaluation Scale, the Satisfaction With Life Scale (SWLS) and the Questionnaire of Influence in Close Relations of Women and Men.<br /> <br /> <b>Results</b><br /> Positive evaluation of menopause was related to involvement in physical exercise as well as to a stronger tendency to use positive strategies of exerting influence on one’s spouse. The research also showed a slight correlation between life satisfaction and involvement in physical exercise. Negative evaluation of menopause was related to avoiding physical activity. <br /> <br /> <b>Conclusions</b><br /> Physical activity is more frequently related to a positive attitude towards menopause and the use of more positive tactics of exerting influence on one’s spouse, and slightly positively conducive to one’s life satisfaction level.

Prevalence and severity of menopause symptoms and associated factors across menopause status in Korean women

OBJECTIVE

The present study investigated the prevalence and severity of menopause symptoms experienced by Korean women aged 44 to 56 years and their associated factors.

METHODS

A cross-sectional study was performed on 2,201 women aged 44 to 56 years in health checkup centers between November 2012 and March 2013. The 29-item Menopause-Specific Quality of Life Questionnaire was used to assess vasomotor, psychosocial, physical, and sexual symptoms related to menopause. The guidelines for the classification of reproductive aging stages proposed at the Stages of Reproductive Aging Workshop were used. Multivariable linear regression analyses were performed to identify factors associated with severity of menopause symptoms.

RESULTS

Among participants, 42.6% were premenopausal, 36.7% were perimenopausal, and 20.7% were postmenopausal. Although physical symptoms were the most severe menopause symptoms experienced by premenopausal and perimenopausal women, postmenopausal women reported sexual symptoms as the most bothersome. The mean scores for each domain increased from the premenopausal period through the postmenopausal period (P for trend < 0.001). The regression model revealed that age (for vasomotor and sexual symptoms) and obesity (for vasomotor and physical symptoms) were significantly associated with severity of menopause symptoms (P < 0.05). Physically active women had fewer severe physical symptoms related to menopause than inactive women.

CONCLUSIONS

Postmenopausal women experience the most severe symptoms. Obesity and physical activity are the main modifiable factors associated with symptom severity. Further studies are needed to examine the effects of physical activity promotion and weight control interventions on preventing menopause symptoms in Korean women.

Twelve-week exercise training and the quality of life in menopausal women - clinical trial

INTRODUCTION

The menopause transition is associated with decreased health functioning. About 80-90% of women experience mild to severe physical or physiological menopause-related complaints per year when approaching menopause. Physical activity may reduce some climacteric symptoms and improve the quality of life.

AIM OF THE STUDY

Aim of the study was to investigate the influence of a 12-week training programme on the quality of life (QoL) in menopausal-aged women living in a rural area.

MATERIAL AND METHODS

Participants were 80 women aged 40-65 years and divided into two randomly selected groups in training sessions (exercising group, n = 40 and control group, n = 40). SF36 was used to assess the quality of life in both groups before and after 12 weeks. Exercising women participated in training session 3 times a week. Each 60-minute exercise session included warming-up exercises, walking, stretching, strengthening exercises with an elastic band and cooling down exercises.

RESULTS

A non-significant positive difference in all SF36 domains in the exercising group was observed. The results of the study showed a statistically significant higher QoL in the exercising group compared to the control group after 12-week training in two domains: vitality and mental health. The improvement in the quality of life in the study group was 0.19 points (role limits - physical domain, least change) and 4.96 (vitality domain, most change).

CONCLUSIONS

Controlled and regular exercise for 12 weeks was significantly correlated with a positive change in vitality and mental health. Sedentary women should consider modification of their lifestyle to include physical activity as it leads to improvement of their quality of life.

Effect of aerobic exercise and nutrition educationon quality of life and early menopause symptoms:A randomized controlled trial

The aim of the authors in this randomized controlled study was to assess the effect of exercise and nutrition education on quality of life and early menopausal symptoms. This trial was conducted in east Azerbaijan Province, Iran, during the period from 2013 to 2014 with 108 women allocated into one of four groups (n = 27 in each group) by block randomization. The interventions received by the three intervention groups were: nutrition education, aerobic exercise, or exercise plus nutrition education. The control group did not receive any intervention. The Greene and MENQOL menopause symptom scales were completed before and at 8 and 12 weeks after the intervention. The mean Greene score was significantly lower than the control group in the exercise (adjusted mean difference: -5.1) and exercise plus nutrition groups (-8.0) at the end of week 8 and in the nutrition (-4.8), exercise (-8.7), and exercise plus nutrition (-13.2) groups at the end of week 12. Also, the mean MENQOL score was significantly lower than the control group in the exercise (-8.3) and exercise plus nutrition groups (-13.8) at the end of week 8 and in the nutrition (-6.6), exercise (-13.5), and exercise plus nutrition (-22.1) groups at the end of week 12. Nutrition education with aerobic exercise can improve quality of life.

Association between physical activity and depressive symptoms: midlife women in SWAN

INTRODUCTION

The relation of physical activity (PA) and positive mood has been the focus of considerable research, which were primarily cross-sectional. This study was done to evaluate the relation between PA and high depressive symptoms across time and to examine whether being physically active attenuates the risk of depressive symptoms in midlife women.

METHODS

The present study is a longitudinal observational study on the menopausal transition in a multiethnic population. Ten years of data on 2891 women were analyzed. The participants were women from seven geographic areas nationwide, age 42-52 yr at baseline, still menstruating, and not using exogenous reproductive hormones. PA was measured with the Kaiser Permanente Physical Activity Scale. The main outcome measure, depressive symptoms, was assessed with the Center for Epidemiological Studies Depression Scale (CES-D), with primary outcome of CES-D score of 16 or higher.

RESULTS

In mixed effect logistic regression models adjusted for covariates, compared with inactivity, PA meeting PA guidelines (approximating public health guidelines) and PA below PA guidelines were each associated with lower risk of high depressive symptoms (CES-D score of 16 or higher) (odds ratio, 0.52; 95% confidence interval, 0.40-0.70; and odds ratio, 0.81; 95% confidence interval, 0.67-0.98, respectively] across 10 yr. Being married, Japanese and Hispanic ethnicity, current smoking, reporting very upsetting life events, using antidepressive medications, having hot flashes, and high body mass index were all positively associated with high depressive symptoms, whereas high social support was negatively associated.

CONCLUSIONS

Higher PA was associated with lower levels of depressive symptoms persistently over 10 yr, independent of potential confounders. Our findings suggest that reaching moderate-intensity PA levels during midlife may be protective against depressive symptoms.

Sexual Function and Exercise in Postmenopausal Women Residing in Chalous and Nowshahr, Northern Iran

Background

The sexual function of menopausal women is influenced by several factors.

Objectives

We aimed to investigate the association between exercise and sexual function among postmenopausal women residing in Northern Iran.

Patients and Methods

Using a multistage, randomized sampling method, 405 postmenopausal women, aged 40 to 65 years, were recruited to participate in this population-based, cross-sectional study. The female sexual function index (FSFI) questionnaire and a researcher-designed questionnaire were completed by every subject.

Results

Overall, 61% of the women reported having experienced sexual dysfunction, and 53.6% reported that they had not performed any kind of exercise within the last 6 months; among those who did exercise, the most common form was walking (79.8%). The FSFI total scores (P = 0.013), as well as the scores in the lubrication (P = 0.007) and pain (P < 0.001) domains, were significantly lower for the women who performed exercises other than walking compared to those who only walked or who did not exercise at all. The frequency of weekly exercise had a positive correlation with the scores in the lubrication (r = 0.18, P = 0.014) and orgasm (r = 0.146, P = 0.045) domains. The logistic regression analysis demonstrated that the chances of reduced sexual desire were decreased by 80.2% (P = 0.044) with every unit increase in the frequency of weekly exercise.

Conclusions

More frequent exercise will improve the sexual function of post-menopausal women.

Long-term effect of physical activity on health-related quality of life among menopausal women: a 4-year follow-up study to a randomised controlled trial

OBJECTIVES

The aim of the study was to explore the long-term effects of physical activity intervention on quality of life (QoL) 4 years after an original randomised controlled trial (RCT).

DESIGN

Cohort study after an RCT.

SETTING

95 of the 159 women from the original RCT participated in weight, height and waist circumference measurements, performed the UKK 2 km Walk Test and completed the SF-36 Health Survey questionnaire. Multilevel mixed regression models were performed in order to compare the original and current group in an RCT setting.

PARTICIPANTS

There were 159 participants in the original RCT; 2.5 years later, 102 of the women responded to a questionnaire and 4-year after the trial, there were 95 respondents. The inclusion criteria in the original RCT were: being symptomatic, experiencing daily hot flushes, age between 40 and 63 years, not using hormone therapy now or in the past 3 months, sedentary lifestyle and having last menstruated 3-36 months earlier.

MAIN OUTCOME MEASURE

Health-related QoL as measured with the SF-36 instrument.

RESULTS

Women in the intervention group had a significantly higher probability of improved physical functioning (OR 1.41; 95% CI 1.00 to 1.99) as compared with women in the control group. In addition, women in the intervention group had higher odds of good role functioning (OR 1.21; 95% CI 0.88 to 1.67), physical health (OR 1.33; 95% CI 0.96 to 1.84) and general health (OR 1.14; 95% CI 0.81 to 1.62), relative to women in the control group, although the differences did not reach statistical significance.

CONCLUSIONS

Women in the intervention group showed positive long-term effects on physical and mental dimensions of QoL after 4 years.

TRIAL REGISTRATION NUMBER

ISRCTN54690027.

Effects of physical exercise on health-related quality of life and blood lipids in perimenopausal women: a randomized placebo-controlled trial

OBJECTIVE

This study aims to evaluate the treatment effects of physical exercise on menopausal symptoms in middle-aged female medical staff experiencing perimenopausal syndrome.

METHODS

A total of 157 female medical staff aged 40 to 55 years and with a Kupperman index score of 15 points or higher were randomized 1:1 into an intervention group (n = 78) or a control group (n = 79). Women in the intervention group were asked to perform aerobic physical exercise (walking with strides) three times a week or more, whereas those in the control group continued as normal. Measurements were taken at baseline and on weeks 4, 8, and 12, with total Kupperman index score, scores on individual elements of the scale, weight, and waist circumference recorded. In addition, fasting blood glucose, triglycerides, total cholesterol, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol were recorded at baseline and on week 12. The effects of physical exercise therapy on perimenopausal syndrome were evaluated by comparing changes in these parameters between the control group and the intervention group.

RESULTS

Fifty-four and 57 women completed all three follow-ups in the intervention and control groups, respectively. On week 12, the mean (SD) change in total Kupperman index score (-9.23 [6.23]) from baseline to week 12; the mean (SD) changes in individual scores for paresthesia (-1.08 [1.51]), insomnia (-1.00 [1.46]), irritability (-1.00 [1.34]), joint or muscle pain (-0.75 [0.74]), fatigue (-0.56 [0.75]), headache (-0.54 [0.75]), formication (-0.38 [0.66]), and sexual life (-0.62 [1.71]); and the mean (SD) changes in total cholesterol (-0.76 [0.63] mmol/L) and triglycerides (-0.20 [0.50] mmol/L) were significantly higher in the intervention group than in the control group (P < 0.05). In the intervention group, total Kupperman index score, weight, body mass index, waist circumference, triglycerides, and total cholesterol were significantly lower on week 12 compared with baseline (P < 0.05).

CONCLUSIONS

Physical exercise can substantially reduce menopausal symptoms and improve blood lipid status and body weight.

Using the common sense model of self-regulation to understand the relationship between symptom reporting and trait negative affect

BACKGROUND/PURPOSE

Based on the Common Sense Model of Self-Regulation, we examined if the relationship of trait NA to physical symptom reporting was moderated by life events and illness representations.

METHODS

This relationship was examined using a cross-sectional dataset of 554 elderly adults.

RESULTS

A significant three-way interaction demonstrated that individuals who reported the greatest severity of physical symptoms were higher in trait NA, and reported more life events and a chronic illness history.

CONCLUSIONS

The results of this study are consistent with the hypothesis that individual high on trait NA who have a history of a chronic illness have illness representations with both disease specific physical symptoms and symptoms from other causes, such as emotional distress. This may complicate the care of medical conditions for these patients.

Exercise for vasomotor menopausal symptoms

BACKGROUND

Evidence suggests that many perimenopausal and early postmenopausal women will experience menopausal symptoms; hot flushes are the most common. Symptoms caused by fluctuating levels of oestrogen may be alleviated by hormone therapy (HT), but a marked global decline in its use has resulted from concerns about the risks and benefits of HT. Consequently, many women are seeking alternatives. As large numbers of women are choosing not to take HT, it is increasingly important to identify evidence-based lifestyle modifications that have the potential to reduce vasomotor menopausal symptoms.

OBJECTIVES

To examine the effectiveness of any type of exercise intervention in the management of vasomotor symptoms in symptomatic perimenopausal and postmenopausal women.

SEARCH METHODS

Searches of the following electronic bibliographic databases were performed to identify randomised controlled trials (RCTs): Cochrane Menstrual Disorders and Subfertility Group Specialised Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (Wiley Internet interface), MEDLINE (Ovid), EMBASE (Ovid), PsycINFO (Ovid), the Science Citation Index and the Social Science Citation Index (Web of Science), the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (Ovid) and SPORTDiscus. Searches include findings up to 3 March 2014.

SELECTION CRITERIA

RCTs in which any type of exercise intervention was compared with no treatment/control or other treatments in the management of menopausal vasomotor symptoms in symptomatic perimenopausal/postmenopausal women.

DATA COLLECTION AND ANALYSIS

Five studies were deemed eligible for inclusion. Two review authors independently selected the studies, and three review authors independently extracted the data. The primary review outcome was vasomotor symptoms, defined as hot flushes and/or night sweats. We combined data to calculate standardised mean differences (SMDs) with 95% confidence intervals (CIs). Statistical heterogeneity was assessed using the I(2) statistic. We assessed the overall quality of the evidence for main comparisons using GRADE (Grades of Recommendation, Assessment, Development and Evaluation) methods.

MAIN RESULTS

We included five RCTs (733 women) comparing exercise with no active treatment, exercise with yoga and exercise with HT. The evidence was of low quality: Limitations in study design were noted, along with inconsistency and imprecision. In the comparison of exercise versus no active treatment (three studies, n = 454 women), no evidence was found of a difference between groups in frequency or intensity of vasomotor symptoms (SMD -0.10, 95% CI -0.33 to 0.13, three RCTs, 454 women, I(2) = 30%, low-quality evidence). Nor was any evidence found of a difference between groups in the frequency or intensity of vasomotor symptoms when exercise was compared with yoga (SMD -0.03, 95% CI -0.45 to 0.38, two studies, n = 279 women, I(2) = 61%, low-quality evidence). It was not possible to include one of the trials in the meta-analyses; this trial compared three groups: exercise plus soy milk, soy milk only and control; results favoured exercise relative to the comparators, but study numbers were small. One trial compared exercise with HT, and the HT group reported significantly fewer flushes in 24 hours than the exercise group (mean difference 5.8, 95% CI 3.17 to 8.43, 14 participants). None of the trials found evidence of a difference between groups with respect to adverse effects, but data were very scanty.

AUTHORS' CONCLUSIONS

Evidence was insufficient to show whether exercise is an effective treatment for vasomotor menopausal symptoms. One small study suggested that HT is more effective than exercise. Evidence was insufficient to show the relative effectiveness of exercise when compared with HT or yoga.

Association between physical activity and menopausal symptoms in perimenopausal women

BACKGROUND

Physical activity may be an effective way of preventing or attenuating menopause-related symptoms, and it has been shown to improve quality of life in menopausal women. However, there have been some inconsistencies regarding between exercise and menopausal symptoms, and study investigating this association has been scarce in Korea. In this study, the association between physical activity and menopausal symptoms in perimenopausal women in Korea was assessed.

METHODS

This cross-sectional observational study was conducted between November 2012 and March 2013. In total, 2,204 healthy women aged 44-56 years were recruited from a healthcare center at the Kangbuk Samsung hospitals for investigating women's attitudes towards menopause. To investigate the influence of physical activity on perimenopause-associated symptoms, 631 perimenopausal women were selected for this study. Their physical activity levels were assessed using the International Physical Activity Questionnaire (IPAQ) short form. The Menopause-specific Quality of Life (MENQOL) questionnaire was used to assess menopause-related symptoms.

RESULTS

The study participants were, on average, 48.5 ± 2.7 years old and had a mean body mass index of 22.8 ± 3.1 kg/m2. The total MENQOL score and the psychosocial and physical subscores exhibited U-shaped trends in relation to the level of physical activity. Multiple linear regression analysis adjusted for confounding variables showed that perimenopausal women who performed moderate physical activity reported significantly lower psychosocial (β = -0.413, P = 0.012) and physical symptoms (β = -0.445, P = 0.002) than women who performed low physical activity. By contrast, a high level of physical activity did not influence the MENQOL total score and subscores relative to the low activity group. In addition, no associations were observed between physical activity and the vasomotor and sexual symptoms in any group.

CONCLUSIONS

Moderate level of physical activity was associated with reduced psychosocial and physical menopause symptoms in perimenopausal Korean women. Although these findings must be confirmed by prospective longitudinal studies, they suggest that physical activity may improve the symptoms of menopause, thereby increasing quality of life.

Effect of physical exercise on changes in activities of creatine kinase, cytochrome c oxidase and ATP levels caused by ovariectomy

The reduction in the secretion of ovarian hormones, principally estrogen, is a consequence of menopause. Estrogens act primarily as female sex hormones, but also exert effects on different physiological systems including the central nervous system. The treatment normally used to reduce the symptoms of menopause is the hormone therapy, which seems to be effective in treating symptoms, but it may be responsible for adverse effects. Based on this, there is an increasing demand for alternative therapies that minimize signs and symptoms of menopause. In the present study we investigated the effect of ovariectomy and/or physical exercise on the activities of energy metabolism enzymes, such as creatine kinase (cytosolic and mitochondrial fractions), pyruvate kinase, succinate dehydrogenase, complex II, cytochrome c oxidase, as well as on ATP levels in the hippocampus of adult rats. Adult female Wistar rats with 90 days of age were subjected to ovariectomy (an animal model widely used to mimic the postmenopausal changes). Thirty days after the procedure, the rats were submitted to the exercise protocol, which was performed three times a week for 30 days. Twelve hours after the last training session, the rats were decapitated for subsequent biochemical analyzes. Results showed that ovariectomy did not affect the activities of pyruvate kinase, succinate dehydrogenase and complex II, but decreased the activities of creatine kinase (cytosolic and mitochondrial fractions) and cytochrome c oxidase. ATP levels were also reduced. Exercise did not produce the expected results since it was only able to partially reverse the activity of creatine kinase cytosolic fraction. The results of this study suggest that estrogen deficiency, which occurs as a result of ovariectomy, affects generation systems and energy homeostasis, reducing ATP levels in hippocampus of adult female rats.

Efficacy of exercise for menopausal symptoms: a randomized controlled trial

OBJECTIVE

This study aims to determine the efficacy of exercise training for alleviating vasomotor and other menopausal symptoms.

METHODS

Late perimenopausal and postmenopausal sedentary women with frequent vasomotor symptoms (VMS) participated in a randomized controlled trial conducted in three sites: 106 women randomized to exercise and 142 women randomized to usual activity. The exercise intervention consisted of individual facility-based aerobic exercise training three times per week for 12 weeks. VMS frequency and bother were recorded on daily diaries at baseline and on weeks 6 and 12. Intent-to-treat analyses compared between-group differences in changes in VMS frequency and bother, sleep symptoms (Insomnia Severity Index and Pittsburgh Sleep Quality Index), and mood (Patient Health Questionnaire-8 and Generalized Anxiety Disorder-7 questionnaire).

RESULTS

At the end of week 12, changes in VMS frequency in the exercise group (mean change, -2.4 VMS/d; 95% CI, -3.0 to -1.7) and VMS bother (mean change on a four-point scale, -0.5; 95% CI, -0.6 to -0.4) were not significantly different from those in the control group (-2.6 VMS/d; 95% CI, -3.2 to -2.0; P = 0.43; -0.5 points; 95% CI, -0.6 to -0.4; P = 0.75). The exercise group reported greater improvement in insomnia symptoms (P = 0.03), subjective sleep quality (P = 0.01), and depressive symptoms (P = 0.04), but differences were small and not statistically significant when P values were adjusted for multiple comparisons. Results were similar when considering treatment-adherent women only.

CONCLUSIONS

These findings provide strong evidence that 12 weeks of moderate-intensity aerobic exercise do not alleviate VMS but may result in small improvements in sleep quality, insomnia, and depression in midlife sedentary women.

Daily physical activity and hot flashes in the Study of Women's Health Across the Nation (SWAN) Flashes Study

OBJECTIVE

To examine the role of physical activity in menopausal hot flashes.

DESIGN

Physiologic hot flash monitor and activity monitor over two 48-hour periods, with self-report in an electronic diary.

SETTING

Community.

PATIENT(S)

51 midlife women.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

Physiologically detected hot flashes and reported hot flashes with and without physiologic corroboration.

RESULT(S)

Competing models conceptualize physical activity as a risk or protective factor for hot flashes, but few studies have examined this relationship prospectively using physiologic measures of hot flashes and physical activity. When physiologic hot flashes, reported hot flashes, and reported hot flashes without physiologic corroboration were related to activity changes using hierarchic generalized linear modeling, adjusting for potential confounders, hot flash reports without physiologic corroboration were more likely after activity increases, particularly among women with higher levels of depressive symptoms. No other types of hot flashes were related to physical activity.

CONCLUSION(S)

Acute increases in physical activity were associated with increased reporting of hot flashes that lacked physiologic corroboration, particularly among women with depressive symptoms. Clinicians should consider the role of symptom perception and reporting in relations between physical activity and hot flashes.

To exercise, or, not to exercise, during menopause and beyond

Menopausal symptoms in women can be severe and disruptive to overall quality of life. Hormone replacement therapy, is known to be effective in ameliorating symptoms, however, reporting of side effects has resulted in alternative treatment options. Exercise has been assessed as an alternative treatment option for alleviating menopausal symptoms, including, psychological, vasomotor, somatic and sexual symptoms. Here we report the effects of physical activity and exercise on menopause symptoms in menopausal women.

Effects of mind-body therapies on symptom clusters during the menopausal transition

AIMS

Although most women experience symptom clusters during the menopausal transition and early postmenopause, investigators reporting clinical trial effects for hot flushes often omit co-occurring symptoms. Our aim was to review controlled clinical trials of mind-body therapies for hot flushes and at least one other co-occurring symptom from these groups: sleep, cognitive function, mood, and pain.

METHODS

An experienced reference librarian performed an extensive search of PubMed/Medline, CINAHL Plus, PsycInfo, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Web of Science, EMBASE, AMED, and Alt-Health Watch for randomized controlled trials reported in English between 2004 and July 2011. Of 1193 abstracts identified, 58 trials examining effectiveness of therapies for hot flushes and at least one additional co-occurring symptom of interest were identified.

RESULTS

Eight trials (ten publications) examined relaxation, yoga, or exercise. Physical activity/exercise trials (six) yielded mixed results; only one significantly reduced hot flushes and mood symptoms. Of two relaxation therapy trials, only mindfulness-based stress reduction training reduced sleep and mood symptoms and had within-group treatment effects on hot flushes. Yoga (one trial) significantly reduced hot flushes and improved cognitive symptoms more than exercise, and also had within-group effects on sleep and pain symptoms.

CONCLUSIONS

Studies of mind-body therapies for hot flushes increasingly measure multiple symptom outcomes, but few report treatment effects in ways that allow clinicians to consider symptom clusters when prescribing therapies. Future studies need to measure and report results for individual symptoms or group like symptoms together into subscales rather than use subscales with mixed dimensions. Trials with larger numbers of participants are essential to allow evaluation of these therapies on multiple co-occurring symptoms.

Menopausal symptoms and physical activity in multiethnic groups of midlife women: a secondary analysis

AIMS

To explore the effect of diverse types of women's physical activity on menopausal symptoms among multiethnic groups of midlife women in the USA.

BACKGROUND

Although physical activity is one of the most widely used non-pharmacological methods for managing menopausal symptoms, there is a paucity of clinical guidelines for women and healthcare providers because the relationship between physical activity and menopausal symptoms has been found inconsistent in previous studies.

DESIGN

A secondary analysis of the data from a lager Internet survey study conducted in 2008-2010.

METHODS

A total of 481 midlife women among four ethnic groups were selected from the original study. The data were collected using the Kaiser Physical Activity Survey and the Midlife Women's Symptom Index. Bivariate correlation analyses and hierarchical multiple regression analyses were used to analyse the data.

RESULTS/FINDINGS

The household/caregiving activity index was positively associated with the prevalence scores of the psychological symptoms in both non-Hispanic Asians and non-Hispanic African Americans. The increased sports/exercise activity index was negatively associated with the severity scores of the physical symptoms in both Hispanics and non-Hispanic Whites. The occupational activity index and the active living activity index significantly predicted the severity scores of the psychosomatic symptoms in Hispanics and non-Hispanic African Americans, respectively.

CONCLUSION

Nurses who take care of multiethnic groups of midlife women who experience menopausal symptoms should be aware of diverse types of women's physical activities within the cultural context.

Physical activity and health during the menopausal transition

The benefits of regular physical activity are well established, but evidence for a protective effect against the adverse health consequences accompanying the menopausal transition is limited. This article reviews that evidence, concluding that more physical activity is generally associated with fewer somatic and mood symptoms. Physical activity seems to minimize weight gain and changes in body composition and fat distribution experienced at midlife and might attenuate the rapid bone density loss that occurs. Given these benefits, clinicians treating perimenopausal women should encourage their patients to follow guidelines for physical activity (≥150 minutes a week of moderate-intensity activity).

Exercise for vasomotor menopausal symptoms

BACKGROUND

Evidence suggests that many perimenopausal and early postmenopausal women will experience menopause symptoms, hot flushes being the most common. Symptoms caused by fluctuating levels of oestrogen may be alleviated by HRT but there has been a marked global decline in its use due to concerns about the risks and benefits of HRT; consequently many women are now seeking alternatives. As large numbers of women are choosing not to take HRT, it is increasingly important to identify evidence based lifestyle modification interventions that have potential to reduce vasomotor menopausal symptoms.

OBJECTIVES

To examine the effectiveness of any type of exercise intervention in the management of vasomotor menopausal symptoms (hot flushes and night sweats) in perimenopausal and postmenopausal women.

SEARCH STRATEGY

Searches of the following electronic bibliographic databases were performed to identify randomised controlled trials (RCTs): Cochrane Menstrual Disorders and Subfertility Group Specialised trials register; Cochrane Library (CENTRAL) (Wiley Internet interface), MEDLINE (Ovid), EMBASE (Ovid), PsycINFO (Ovid), Science Citation Index and Social Science Citation Index (Web of Science), CINAHL (Ovid) and SPORT Discus. Searches included dates up until 16-24 March 2010.

SELECTION CRITERIA

RCTs in which any type of exercise intervention were compared no treatment/control or other treatments in the management of menopausal vasomotor symptoms in symptomatic perimenopausal/postmenopausal women.

DATA COLLECTION AND ANALYSIS

Six studies were deemed eligible for inclusion. Three authors independently extracted data from eligible studies. Three meta-analyses according to comparator the group were performed.

MAIN RESULTS

In the comparison of exercise versus no treatment/control (three studies), the non-significant effect size Standardised Mean Difference (SMD) for vasomotor symptoms was -0.14 (95% CI: -0.54 to 0.26); SMD was -0.04, -0.25, -0.38. For the analysis of exercise versus HRT (three studies), the non-significant SMD was 0.49 (95% CI: -0.27 to 1.26); SMD across studies was 0.13, 0.19 and 1.52, with all studies favouring HRT. In the comparison of exercise versus yoga (two studies), the non-significant SMD was -0.09 (95%CI:-0.64 to 0.45); SMD was -0.37 and 0.19. All comparisons were based on small samples. One small study reported data that could not be included in the meta-analysis; in this study hot flush scores were significantly lower in the exercise plus soy milk group (83%) than soy milk only group (72%).

AUTHORS' CONCLUSIONS

The existing studies provided insufficient evidence to determine the effectiveness of exercise as a treatment for vasomotor menopausal symptoms, or whether exercise is more effective than HRT or yoga.

Exercise for vasomotor menopausal symptoms

BACKGROUND

Evidence suggests that a high proportion of perimenopausal and early postmenopausal women will experience some menopause symptoms, hot flushes being the most common. The effects caused by falling levels of estrogen may be alleviated by hormone replacement therapy (HRT) but there has been a marked global decline in the prescription and use of HRT due to concerns about the risks and benefits of HRT; consequently many women are now seeking alternatives. As large numbers of women are choosing not to take HRT, it is increasingly important to identify evidence based lifestyle modifications, which can have a positive effect on menopausal symptoms.

OBJECTIVES

To examine the effectiveness of any type of exercise intervention in the management of vasomotor menopausal symptoms (hot flushes and night sweats) in perimenopausal and postmenopausal women.

SEARCH STRATEGY

Searches of the following electronic bibliographic databases were performed to identify randomised controlled trials: The Cochrane Library (CENTRAL) (Wiley Internet interface) 2006 Issue 2, MEDLINE (Ovid) 1966-May week 4 2006, EMBASE (Ovid) 1980-week 21 2006, PsycINFO (Ovid) 1967-May week 5 2006, Science Citation Index and Social Science Citation Index (Web of Science) 1900-June 2006 and 1956-June 2006 respectively, CINAHL (Ovid) 1982-May week 4 2006, SPORT Discus (ERL WebSPIRS) 1830-2006/04.

SELECTION CRITERIA

Randomised controlled trials (RCTs) in which any type of exercise intervention was compared to other treatments or no treatment in the management of menopausal vasomotor symptoms in symptomatic perimenopausal and postmenopausal women.

DATA COLLECTION AND ANALYSIS

Nineteen reports were deemed potentially eligible, but of these only one met the inclusion criteria and three authors independently extracted data from this trial.

MAIN RESULTS

Only one very small trial, which compared exercise with HRT, was available for inclusion in this review. Based on within-group analyses the study authors concluded that both interventions were effective in reducing vasomotor symptoms. Between-group trial analyses conducted by reviewers showed that the HRT group experienced significantly fewer hot flushes compared to the exercise group at follow-up.

AUTHORS' CONCLUSIONS

Only one very small trial involving symptomatic women has assessed the effectiveness of exercise in the management of vasomotor menopausal symptoms. Exercise was not as effective as HRT in this trial. We found no evidence from randomised controlled trials on whether exercise is an effective treatment relative to other interventions or no intervention in reducing hot flushes and or night sweats in symptomatic women. No conclusions regarding the effectiveness of exercise as a treatment for vasomotor menopausal symptoms could be made due to a lack of trials.