Mind-body therapies for menopausal symptoms: a systematic review

The impact of physical activity and exercise interventions on symptoms for women experiencing menopause: overview of reviews

BACKGROUND

Women experiencing problematic menopausal symptoms report lower health-related quality of life and greater healthcare use than women without symptoms. Not all women want to or are able to take hormone replacement therapy. Strengthening the evidence for menopause symptom-management options, including physical activity, improves agency for women.

AIM

This overview assesses effectiveness of physical activity and exercise interventions targeting women experiencing menopause symptoms.

METHODS

Medline, Embase, CINAHL, Scopus, The Cochrane Database of Systematic Reviews and Social Science Citation Index were searched (June 2023) for systematic reviews of physical activity and exercise interventions targeting women experiencing menopause. Reviews were assessed using AMSTAR-2 and a best-evidence approach to synthesis without meta-analysis (SWIM) was adopted. The protocol was registered on PROSPERO (CRD42022298908).

RESULTS

Seventeen reviews included 80 unique relevant primary studies with 8983 participants. There is evidence showing improvement of physical, urogenital, and total symptoms following yoga interventions. Evidence for vasomotor and psychological symptoms was inconclusive. Findings for aerobic exercise were inconclusive although there were some examples of beneficial effects on total and vasomotor symptoms. Evidence was very limited for other types of physical activity and impact on physical, sexual and urogenital symptoms.

CONCLUSION

There is some evidence that yoga, and to lesser extent, aerobic exercise may be beneficial for some menopause symptoms, but there is insufficient evidence to recommend a particular form of exercise. Current reviews categorise women on menopause status; broadening this to include ethnicity, income status, employment and other factors will allow better understanding of context for successful interventions.

Features, measurements, determinants, treatments, and outcomes of musculoskeletal symptoms in postmenopausal women: A scoping review

BACKGROUND

The literature lacks a consistent review of musculoskeletal symptoms in postmenopausal women.

AIM

To identify features, measurements, determinants, treatments, and outcomes of musculoskeletal symptoms in postmenopausal women.

METHOD

A scoping review was completed using six databases: Embase, Medline, Cochrane, CINAHL, Web of Science, and Scopus up to December 2022. Sixty-three articles were identified.

RESULTS

Musculoskeletal symptoms in postmenopausal women include somatic symptoms of non-specific origin, upper and lower limb symptoms, spinal pain, and decline in physical performance. Measurements were categorized into four groups: musculoskeletal symptoms for menopause, general musculoskeletal symptoms, menopause-specific quality of life, and general quality of life questionnaires. The determinants were grouped into four themes: demographics, physical determinants, psychosocial determinants, and lifestyle. Pharmacological interventions, supplementation options, and exercise regimens exist for postmenopausal women with musculoskeletal symptoms.

CONCLUSION

A comprehensive policy is needed to address musculoskeletal symptoms in postmenopausal women, promoting diverse treatments for improved quality of life.

Effects of mind-body exercise on perimenopausal and postmenopausal women: a systematic review and meta-analysis

IMPORTANCE

The increasing attention to the management of perimenopausal and postmenopausal women parallels the growth of the aging population. Although hormone therapy is commonly used to alleviate menopausal symptoms, it carries a potential risk of cancer. Recently, mind-body exercises have emerged as innovative approaches for improving menopausal symptoms and bone health. However, research findings have needed to be more consistent, highlighting the significance of this study's systematic review of mind-body exercise effects on perimenopausal and postmenopausal women.

OBJECTIVE

This study aims to evaluate the impact of mind-body exercises, including tai chi, yoga, Pilates, qigong, baduanjin, and mindfulness-based stress reduction, on bone mineral density, sleep quality, anxiety, depression, and fatigue among perimenopausal and postmenopausal women.

EVIDENCE REVIEW

Four electronic databases-PubMed, Embase, Cochrane Central Register of Controlled Trials, and Web of Science-were systematically searched from inception until July 2023. The search focused exclusively on randomized controlled trials to examine the impact of mind-body exercise interventions on perimenopausal and postmenopausal women. The methodological quality of the included studies was evaluated using the Cochrane Bias Risk Assessment tool.

FINDINGS

A total of 11 randomized controlled trials, comprising 1,005 participants, were included in the analysis. Traditional meta-analysis indicated that mind-body exercise significantly enhanced bone mineral density in perimenopausal and postmenopausal women compared with control groups, with a standardized mean difference (SMD) of 0.41 (95% CI, 0.17 to 0.66; P = 0.001, I2 = 7%). In addition, significant improvements were observed in sleep quality (SMD, -0.48; 95% CI, -0.78 to -0.17; P = 0.002, I2 = 76%), anxiety reduction (SMD, -0.80; 95% CI, -1.23 to -0.38; P = 0.0002, I2 = 84%), depressive mood (SMD, -0.80; 95% CI, -1.17 to -0.44; P < 0.0001, I2 = 79%), and fatigue (SMD, -0.67; 95% CI, -0.97 to -0.37; P < 0.0001, I2 = 0%).

CONCLUSIONS AND RELEVANCE

The findings of this meta-analysis demonstrate that mind-body exercise positively influences bone mineral density, sleep quality, anxiety, depression, and fatigue among perimenopausal and postmenopausal women.

Menopausal symptoms in midlife Singaporean women: Prevalence rates and associated factors from the Integrated Women's Health Programme (IWHP)

OBJECTIVE

Menopausal symptoms can substantially impact quality of life. We studied somatic, psychological, and urogenital symptoms and their associated factors.

DESIGN

Cross-sectional study of healthy midlife Singaporean women from three major Asian ethnic groups.

METHODS

In 2014-16, women aged 45 to 69 attending well-woman clinics at the National University Hospital Singapore completed the Menopause Rating Scale (MRS). Sociodemographic, reproductive, medical, anthropometric, body composition, and physical performance characteristics were assessed using validated questionnaires and strict protocols. We analysed sub-scales and total scores by median split, and adjusted odds ratios using multivariable logistic regression.

RESULTS

Of the 1054 eligible women, 62.6 % reported at least one moderate to extremely severe symptom. The top five menopausal symptoms were joint and muscle discomfort, sleep problems, vaginal dryness, physical and mental exhaustion, and hot flushes. Higher total scores on the MRS were associated with moderate disability (adjusted odds ratio: 9.80, 95 % confidence interval: 2.88-33.34), poorer self-rated health status (2.18, 1.60-2.97), menstrual irregularity at 25 years (1.63, 1.07-2.49), and slower chair stands (1.49, 1.09-2.03). Age ≥65 (0.54, 0.30-0.94) and a lower level of education (0.45, 0.26-0.76) had significant inverse associations with total MRS score.

CONCLUSIONS

Menopausal symptoms were associated with disability, poorer health status, and weaker lower-body muscle strength. These data add to the limited Asian evidence and raise the profile of this important area of health.

Effectiveness of workplace-based interventions to promote wellbeing among menopausal women: A systematic review

Menopausal symptoms are known to affect quality of life and work productivity. This systematic review aimed to describe the range and effectiveness of workplace-based interventions for menopause. MEDLINE, PubMed, Embase, CINAHL, Cochrane Library, Web of Science, PsycINFO, EconLit, and SCOPUS were searched from the inception until April 2022. Quantitative interventional studies evaluating physical/virtual workplace-based interventions aiming to improve well-being, work, and other outcomes, that involved women in menopausal transition, or their line managers/supervisors were eligible for inclusion. Two randomized controlled trials and three uncontrolled trials, comprising 293 women aged 40-60 years and 61, line managers/supervisors, were included in the review. Results were narratively synthesized due to the heterogeneity of interventions and outcomes and we found that only a limited range of interventions have been evaluated for their ability to support women going through menopausal transition in the workplace. Self-help cognitive behavioural therapy (CBT); Raja yoga; and health promotion (involving menopause consultations, work-life coaching and physical training) improved menopausal symptoms significantly. Self-help CBT was associated with a significant improvement in mental resources for work, presenteeism, and work and social adjustment. Awareness programs significantly improved knowledge and attitudes of both employees and line managers/supervisors about menopause. The interventions have mostly been evaluated in small studies with selected populations but have improved menopausal symptoms and work outcomes. A customizable menopause wellbeing intervention package incorporating these evidence-supported interventions should be developed and implemented on a wider scale within organizations alongside robust evaluation of its effectiveness.

Qigong for mental health and sleep quality in postmenopausal women: A randomized controlled trial

BACKGROUND

Menopause is one of the stages in a woman's life that affects her psychological health, the most frequent being anxiety and depression. In addition, another problem related to this stage is the lack of sleep that causes a decrease in the quality of sleep. The purpose of this randomized controlled trial was to analyze the effectiveness of a Qigong exercise program on sleep quality, anxiety, and depression in Spanish postmenopausal women.

METHODS

A total of 125 women were randomly assigned to an experimental group (EG) (n = 63) that carried out a Qigong exercise program for 12 weeks, or a control group (CG) (n = 62), which did not perform any type of intervention. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) and anxiety and depression using the Hospital Anxiety and Depression Scale (HADS).

RESULTS

Women who underwent an intervention program experienced significant improvements for all measured variables, except for the use of sleeping medication and daytime dysfunctions that did not show any significant effect with respect to the group and group × time interaction.

CONCLUSIONS

After an intervention based on a BaDuanJin Qigong exercise program for 12 weeks, improvements were observed in sleep quality, sleep latency, sleep duration, sleep efficiency, sleep disturbances, the total score of the PSQI, anxiety and depression in postmenopausal Spanish women.

Anthropometric, biochemical and clinical parameters in climacteric yoga practitioners

OBJECTIVE

This study aimed to evaluate anthropometric, biochemical and clinical parameters in climacteric yoga practitioners.

METHODS

This study investigated 108 climacteric women. We recruited 28 women between 40 and 65 years old who started yoga practices in premenopause and had already practiced for at least 5 years. As controls, we selected 30 physical activity (PA) practitioners who had practiced for at least 5 years and 50 sedentary women in the same age range. We conduced anthropometric, biochemical and blood pressure measurements.

RESULTS

The yoga group had significantly lower fasting blood glucose than the PA practitioners and sedentary women. Yoga practitioners also had lower weight, body mass index, waist circumference, body fat percentage and waist-to-height ratio; higher levels of high-density lipoprotein cholesterol; lower levels of triglycerides, insulin, Homeostasis Model Assessment of Insulin Resistance, uric acid, apolipoprotein B and high-sensitivity C-reactive protein; and lower frequency of metabolic syndrome, lipid accumulation product, visceral adiposity index and systolic blood pressure than the sedentary women.

CONCLUSION

Yoga practitioners had lower glucose serum concentrations than the PA practitioners and sedentary women. Overall, the yoga group also had better anthropometric, biochemical and clinical variables than the other groups. Although further investigation is required, yoga practice in premenopause seems to be beneficial for women when they reach menopause.

Mind-body therapies for older adults with dementia: a systematic review and meta-analysis

PURPOSE

This systematic review of randomised controlled trials (RCTs) aimed to determine the effects of mind-body therapies (MBTs) among older adults with dementia.

METHODS

We searched five electronic databases (PubMed, PsycINFO, Web of Science, EMBASE, and the Cochrane Library) for publications investigating the effect of MBTs until July 14th, 2020. We included published peer-reviewed RCTs among participants with a mean age of 60 and above and a diagnosis of any dementia. Eligible studies included measurements for all types of health outcomes, including cognitive function, neuropsychiatric inventory, depressive syndromes, agitation, psychosocial status, and other health outcomes. Two investigators extracted data, the risk of bias for each study was evaluated through Review Manager, and statistical meta-analysis was performed using Stata.

RESULTS

A total of nine studies met the eligibility criteria, with full-text available for systematic review. Five of them, with 338 participants, were included in the meta-analysis. For most included RCTs of the review, the methodological quality was moderate. The meta-analysis showed that Tai Chi had a mild effect on global cognitive function (Mini-Mental State Examination, SMD = 0.40, 95% CI 0.10-0.70). Yoga and aromatherapy may also be beneficial for depression, and these three MBTs improved quality of life.

CONCLUSION

The current review suggested that MBTs may act as potential non-pharmaceutical approaches to improve certain health outcomes among older populations with dementia. Systematic review and meta-analysis registration: PROSPERO CRD42021198514.

Efficacy of group biofeedback treatment on hyperemesis gravidarum with psychosomatic symptoms diagnosed with the revised version of Diagnostic Criteria for Psychosomatic Research (DCPR-R): study protocol for a randomised controlled trial

INTRODUCTION

Hyperemesis gravidarum (HG) is a condition characterised by dehydration, electrolyte imbalance, lack of nutrition and at least 5% loss in body weight, occurring in the first half of pregnancy. The aim of this trial is to examine the efficacy of group biofeedback treatment on patients with HG with psychosomatic symptoms, which will be evaluated through the revised version of Diagnostic Criteria for Psychosomatic Research (DCPR-R).

METHODS AND ANALYSIS

In this single-blinded randomised controlled clinical trial, 68 patients with HG diagnosed with at least one psychosomatic syndrome according to DCPR-R and aged 18-40 years, will be recruited in a Chinese Maternal and Child Health Hospital. The sample will be randomised (1:1) into two arms: experimental group, which will undergo group biofeedback treatment, psycho-education and treatment as usual (TAU); and control group, which will undergo psycho-education and TAU only. The primary outcomes will be reduction of the frequency of psychosomatic syndromes, severity of nausea/vomiting, quality of life and heart rate variability. The secondary outcomes will include days of hospitalisation, repeated hospitalisation and laboratory investigations.

ETHICS AND DISSEMINATION

This study has received ethical approval from the Nanjing Medical University (No. 2019/491, granted 22 February 2019). All participants will be required to provide written informed consent. Study outcomes will be disseminated through peer-reviewed publications and academic conferences, and used to confirm a tailored biofeedback intervention for patients with HG with psychosomatic symptoms.

TRIAL REGISTRATION NUMBER

Chinese Clinical Trial Registry (ChiCTR2000028754).

Impact of Qigong exercises on the severity of the menopausal symptoms and health-related quality of life: a randomized controlled trial

ABSTRACTThe aim of the present study was to analyze the effects of a Qigong exercise program on the severity of the menopausal symptoms and health-related quality of life (HRQoL) of community-dwelling postmenopausal women. This was done by means of a randomized clinical trial with a sample of 125 women who were assigned to either a control (n = 62) or an experimental group (n = 63). The severity of their menopause-related symptoms and HRQoL were assessed through the Menopause Rating Scale (MRS) and the 36-item Short-Form Health Survey (SF-36) respectively, before and after the intervention period. The main findings of our study reveal significant improvement in the severity of menopausal symptoms at the somatic, psychological, and urogenital levels, as well as in the total score of the MRS. Additionally, participants assigned to the Qigong group experienced improvement in the general health, physical functioning, role-physical, bodily pain, vitality, and mental health domains of the 36-item Short-Form Health Survey, as well as in its physical component and mental component summaries. We can therefore conclude that, among Spanish postmenopausal women, a twelve-week Qigong exercise program has beneficial effects on the severity of menopausal symptoms and HRQoL.Trial registration: ClinicalTrials.gov identifier: NCT03989453..

Effect of Evening Primrose Oil on Postmenopausal Psychological Symptoms: A Triple-Blind Randomized Clinical Trial

OBJECTIVES

Psychological symptoms of menopause may impose a negative effect on the quality of life of menopausal women. Thus, the management of these symptoms can improve the quality of life and psychological health of such woman. The present study aimed to determine the effect of evening primrose on psychological symptoms in menopausal women.

METHODS

In this triple-blind randomized clinical trial, the effect of the evening primrose oil on postmenopausal psychological symptoms was investigated. The subjects were 100 menopausal women, referred to a healthcare center in Dastena city (Chaharmahal and Bakhtiari Province, Iran), who were randomly assigned to two groups. The intervention group used two 1 g pearls of evening primrose oil daily. The study instruments included a sub-scale of Menopause Rating Scale (MRS). Menopause data were analyzed using an independent t-test and Friedman test by the SPSS software. P values < 0.05 were considered statistically significant.

RESULTS

The two groups were balanced in demographic characteristics and psychological disorder severity before the intervention. The median (interquartile range) MRS score in the intervention group before the intervention and 2 and 4 weeks after the intervention were 11 (10-12), 6 (5-7), and 3 (2-4), respectively, and in the placebo, they were 11 (9-11), 10 (9-11), and 11 (10-12). A significant reduction was observed in the intervention group compared with the placebo group 2 and 4 weeks post-intervention.

CONCLUSION

The use of evening primrose oil can decrease postmenopausal psychological symptoms.

A study of mindfulness-based stress-reduction training effects on menopause-specific quality of life in postmenopausal women: A randomized controlled trial

OBJECTIVES

Physical and psychological changes in most postmenopausal women tend to lower their quality of life. Various medical/psychological interventions have been applied to improve the postmenopausal quality of life. This study set out to investigate the effect of Mindfulness Based Stress Reduction (MBSR) training on the Menopause-specific quality of life (MENQOL).

METHODS

This RCT was conducted on 66 postmenopausal women aged 47-62 in Iran. Participants were randomly assigned to either the MBSR or the control group. The menopause--specific quality of life was assessed in two groups via MENQOL questionnaire prior to, immediately and three months after the intervention.

RESULTS

The findings revealed a significant improvements in MENQOL (P < 0.001),as well as physical(P = 0.001), psychosocial(P = 0.001) and sexual(P < 0.001)dimensions of the intervention groups compared to the control group, immediately and 3 months after the intervention.

CONCLUSION

MBSR program can be safely applied to improve menopausal women's quality of life and curb the postmenopausal symptoms.

TRIAL REGISTRATION NUMBER

IRCT2015072523344N1.

A potential association of meditation with menopausal symptoms and blood chemistry in healthy women: A pilot cross-sectional study

Owing to hormonal changes, women experience various psychophysiological alterations over a wide age range, which may result in decreased quality of life as well as in increased risks of diseases, such as cardiovascular diseases. Although studies have been performed to research complementary methods, such as meditation, the research field still requires an adequate amount of studies for public health guidelines. This pilot cross-sectional study aims to investigate a potential association of meditation with menopausal symptoms and blood chemistry for healthy women. In this study, data of 65 healthy women (age range 25-67) including 33 meditation practitioners and 32 meditation-naïve controls were analyzed to compare the Menopausal Rating Scale scores and blood chemistry with 7 more dropouts in the blood chemistry. For blood chemistry, nine components including glucose (GLU) and high-density lipoprotein cholesterol (HDL) were measured. Two-way analysis of variance was performed by dividing the total participants into 2 groups: premenopausal and postmenopausal participants. Compared to the control group, the meditation group showed a trend of reductions in the Menopausal Rating Scale total score (P = .054) and its 2 subcomponents: depressive mood (P = .064) and irritability (P = .061). In HDL level, there was a significant interaction between group and menopausal state (P = .039) with following post hoc results: among the premenopausal participants, a significant increase in the meditation group compared to the control group (P = .005); among the control group, a significant increase in the postmenopausal compared to the premenopausal participants (P = .030). In GLU level, there was a mild interaction between group and menopausal state (P = .070) with following post hoc results: among the postmenopausal participants, a trend of increase in the control group compared to the meditation group (P = .081); among the control group, a significant increase in the postmenopausal compared to the premenopausal participants (P = .040). Our research suggests a potential association of practicing meditation with alleviations in menopausal symptoms and changes in blood chemistry, warranting further studies with a longitudinal study design and larger populations to understand the underlying causal relationships.

Long-Term Effects of Mind-Body Exercises on the Physical Fitness and Quality of Life of Individuals With Substance Use Disorder-A Randomized Trial

Background: Mind-body exercises (MBE) are sequences of low to medium-intensity activities that benefit healthy performers physically and mentally. In contrast to the unmodified application of traditional tai chi, qi gong, or yoga in the healthy population, MBEs are typically tailored for individuals with substance abuse disorder (SUD). Despite numerous applications in practice, the detailed effects of tailor-made MBEs for SUD are unclear. Objectives: This study aimed to analyze and compare changes in the physical fitness and quality of life of individuals with SUD that underwent conventional or tailor-made MBEs. Methods: A total of 100 subjects obtained from the Shanghai Mandatory Detoxification and Rehabilitation Center with SUD were randomly assigned into two groups. The subjects in the experimental group (n = 50) practiced tailored MBE for 60 min a day, five times a week, for 3 months. The subjects (n = 50) in the control group were treated with conventional rehabilitation exercises with the same intervention protocol. The outcomes of fitness and quality of life for drug addiction were measured at the beginning and after 3 and 6 months by a questionnaire (QOL-DA). A two-way repeated measure analysis of variance was applied to compare the difference of treatments in the two groups. Results: Statistically significant differences for the experimental group were found in systolic (p < 0.01, η² = 0.124) and diastolic blood pressure (p < 0.01, η² = 0.097), pulse (p < 0.01, η² = 0.086), vital capacity (p < 0.05, η² = 0.036), flexibility (p < 0.01, η² = 0.143), and aerobic endurance (p < 0.01, η² = 0.165). Results of the QOL-DA showed statistically significant differences between the experimental and control groups in total score (p < 0.01, η² = 0.158) with greater effects on the former. Conclusions: This study provided evidence that tailored MBE could lead to remarkable effects with regard to blood pressure, vital capacity, flexibility, and aerobic endurance in comparison with conventional rehabilitation methods. Clinical Trial Registration: ChiCTR-IPR-14005343.

[The effect of a polarity intervention on the insomnia and anxiety in middle-aged Quebec women]

Many symptoms of menopause may contribute to poor sleep and insomnia. These symptoms may also be associated with anxiety and affect the quality of women’s lives. The purpose of this study was to assess the effectiveness of a polarity therapy on insomnia and anxiety for women aged 40 to 60 years old. Forty-seven women participated in this experimental study. The participants were randomly assigned to the experiment group (n = 25)—receiving 4 sessions on polarity—or to the control group (n = 22)—receiving information on healthy sleep habits. Data were collected during the pre-test and the post-test using the Morin Insomnia Severity Index and the Spielberger State-Trait Anxiety Inventory (FormY). A significant difference was found between the groups and the measurement time with respect to insomnia scores (F = 28,66 ; p < 0,0001) and anxiety scores (F = 14.14; p < 0.0001). Women who received the polarity intervention showed a significant decrease in the severity of their insomnia and of their state of anxiety compared to those in the control group during post intervention. The polarity intervention was effective in reducing the women’s symptoms of insomnia and anxiety in the middle-aged women.

Long-Term Effects of Tai Chi Intervention on Sleep and Mental Health of Female Individuals With Dependence on Amphetamine-Type Stimulants

Previous studies provide evidence that Tai Chi (TC) can reduce the symptoms of sleep problems and be of benefit for the rehabilitation of substance abusers. In this study, we investigated if TC practice can improve sleep quality and mood of females who are dependent on amphetamine-type stimulant (ATS). Eighty subjects were randomly assigned to TC intervention and standard care (SC) for 6 months. We applied analysis of variance on repeated-measure with the year of drug dependence as the covariate to test the changes of the self-rated Pittsburg Sleep Quality Index (PSQI), Self-Rating Depression Scale (SDS), as well as fitness after 3 and 6 months. Relapse investigation was conducted by checking the database of China's National Surveillance System on Drug Abuse and that of the Shanghai Drug Control Committee's illicit drug dependents. Our investigation focused on the relapse of participants who had undergone and completed treatment in the Shanghai Mandatory Detoxification and Rehabilitation Center in 2015. The result showed that the PSQI scores of sleep duration [F_{(2, 92)} = 9.86], need for sleep medications [F_{(2, 92)} = 36.44] and daytime dysfunction [F_{(2, 92)} = 5.15] were found to have a significant difference by time × group interaction after 6 months. SDS showed no significant difference between the two groups; however, the score of SDS in TC decreased after 6-month intervention, and no changes were observed in SC. Pulse rate had significantly decreased in the TC group compared with the SC group after 6 months. 9.5% (4) ATS dependents in TC and 26.3% (10) ATS dependents in SC were found to have relapsed. Our result suggested that TC had positive effects on sleep quality, depression and fitness. Long-term study demonstrated that TC may be a cheap and potential supplementary treatment for ATS-dependent individuals. TC may also be considered as an alternative exercise to escalate abstinence for ATS-dependent females.

CLINICAL TRIAL REGISTRATION

ChiCTR-IPR-14005343 chictr. org.cn.

Reducing Anxiety and Improving Academic Performance Through a Biofeedback Relaxation Training Program

The aim of this study was to analyze the influence of a biofeedback relaxation training program on anxiety and academic performance. The program consisted of five biofeedback sessions coupled with three training activities focused on deep breathing, guided imagery, and muscle relaxation. The participants were second-year psychology undergraduates from the University of the Basque Country (UPV/EHU, northern Spain). The experimental group comprised 152 students (M _age  = 19.6, SD = 0.74; 74% women) and the control group 81 students (M _age   = 19.4, SD = 0.92; 71% women). Results showed that after participating in the program, students in the experimental group had lower levels of anxiety and increased academic performance. Furthermore, they scored lower on anxiety and higher on academic performance in comparison with the control subjects. This suggests that the inclusion of biofeedback training programs in educational contexts could be a way of reducing anxiety and improving academic performance. It may also deepen our understanding of the dynamic interplay between psychophysiological, cognitive, and emotional processes.

Experiences of menopause, self-management strategies for menopausal symptoms and perceptions of health care among immigrant women: a systematic review

OBJECTIVE

To systematically review the published literature relating to experiences of menopause, self-management strategies for menopausal symptoms and health-care needs among immigrant women.

METHODS

A systematic literature search of English-language publications was performed using Medline, Embase, PsychInfo, Cinahl and Scopus. Twenty-four papers reporting on 19 studies met our inclusion criteria and investigated immigrant women's experiences of menopause and/or their self-management strategies for menopausal symptoms and/or their perceptions of menopause-specific health care.

FINDINGS

Of the 19 studies, 15 reported symptoms experienced during the menopausal transition. Three studies included questions regarding self-management strategies for menopausal symptoms and four enquired about perceptions of menopause-specific health care. Although the heterogeneity of the studies makes comparison difficult, their findings are broadly consistent. Immigrant women reported more vasomotor symptoms and other physical symptoms and poorer mental health than non-immigrant women. The few studies that investigated self-management strategies for menopausal symptoms found that these were influenced by culture and those that assessed perceptions of menopause-specific health care found that they were mostly dissatisfied with the care they had received.

CONCLUSION

More research is needed to improve understanding of how immigrant women manage the menopausal transition and how to provide culturally relevant menopause-specific health care.

Yoga Offers Cardiovascular Protection in Early Postmenopausal Women

CONTEXT

Postmenopause, an estrogen deficient state comes with increased incidence of cardiovascular diseases (CVDs). Yoga has been described as having a beneficial effect on heart rate variability (HRV), a marker for cardiac autonomic activity which can assess cardiovascular risk, in various populations.

AIM

the aim of the study was to study the effect of 3-month long Yoga practice on HRV in early postmenopausal women.

SETTINGS AND DESIGN

A prospective longitudinal study of 67 women within 5 years of menopause between 45 and 60 years of age attending menopause clinic of Department of Gynaecology, Sucheta Kriplani Hospital fulfilling inclusion and exclusion criteria and consenting were enrolled for the study.

SUBJECTS AND METHODS

HRV of 37 cases (Yoga group) and 30 controls (non-Yoga group) was recorded pre and 3-month postintervention.

STATISTICAL ANALYSIS USED

GraphPad Prism Version 5 software was used. Values are a mean and standard error of mean. Statistical significance was set up at P < 0.05.

RESULTS

In HRV, frequency domain analysis showed a significant fall in low frequency (LF) in normalized units (nu) and LF: high frequency (HF) ratio and significant rise in HF in nu in the Yoga group (depicting parasympathetic dominance) against a significant rise in LF (nu) and LF: HF ratio and significant fall in HF (nu) in non-Yoga group (indicating sympathetic dominance). Time domain analysis showed a significant decrease in Standard Deviation of NN intervals in Non-Yoga group against nonsignificant changes in Yoga group indicating deterioration in parasympathetic activity in non-Yoga group.

CONCLUSIONS

Three-month long Yoga practice improved HRV in early postmenopausal women significantly and has the potential to attenuate the CVD risk in postmenopausal women.

Yoga for menopausal symptoms-A systematic review and meta-analysis

OBJECTIVES

To systematically review and meta-analyze the effectiveness of yoga for menopausal symptoms.

METHODS

Medline (via PubMed), the Cochrane Central Register of Controlled Trials, and Scopus were screened through to February 21, 2017 for randomized controlled trials (RCTs) comparing the effects of yoga on menopausal symptoms to those of no treatment or active comparators. Standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated. Two authors independently assessed risk of bias using the Cochrane risk of bias tool.

RESULTS

Thirteen RCTs with 1306 participants were included. Compared with no treatment, yoga reduced total menopausal symptoms (SMD=-1.05; 95% CI -1.57 to -0.53), psychological (SMD=-0.75; 95% CI -1.17 to -0.34), somatic (SMD=-0.65; 95% CI -1.05 to -0.25), vasomotor (SMD=-0.76; 95% CI -1.27 to -0.25), and urogenital symptoms (SMD=-0.53; 95% CI -0.81 to -0.25). Compared with exercise controls, only an effect on vasomotor symptoms was found (SMD=-0.45; 95% CI -0.87 to -0.04). Effects were robust against selection bias, but not against detection and attrition bias. No serious adverse events were reported.

CONCLUSION

Yoga seems to be effective and safe for reducing menopausal symptoms. Effects are comparable to those of other exercise interventions.

Integrative Women's Health

This article addresses the common women's health concerns of menopause-related symptoms, premenstrual syndrome, and chronic pelvic pain. Each can be effectively addressed with an integrative approach that incorporates interventions such as pharmaceuticals, nutraceuticals, mind-body approaches, acupuncture, and lifestyle modification.

Mind-body interventions for vasomotor symptoms in healthy menopausal women and breast cancer survivors. A systematic review

Mind-body therapies are commonly recommended to treat vasomotor symptoms, such as hot flushes and night sweats (HFNS). The purpose of this systematic review was to evaluate the available evidence to date for the efficacy of different mind-body therapies to alleviate HFNS in healthy menopausal women and breast cancer survivors. Randomized controlled trials (RCTs) were identified using seven electronic search engines, direct searches of specific journals and backwards searches through reference lists of related publications. Outcome measures included HFNS frequency and/or severity or self-reported problem rating at post-treatment. The methodological quality of all studies was systematically assessed using predefined criteria. Twenty-six RCTs met the inclusion criteria. Interventions included yoga (n = 5), hypnosis (n = 3), mindfulness (n = 2), relaxation (n = 7), paced breathing (n = 4), reflexology (n = 1) and cognitive behavioural therapy (CBT) (n = 4). Findings were consistent for the effectiveness of CBT and relaxation therapies for alleviating troublesome vasomotor symptoms. For the remaining interventions, although some trials indicated beneficial effects (within groups) at post-treatment and/or follow up, between group findings were mixed and overall, methodological differences across studies failed to provide convincing supporting evidence. Collectively, findings suggest that interventions that include breathing and relaxation techniques, as well as CBT, can be beneficial for alleviating vasomotor symptoms. Additional large, methodologically rigorous trials are needed to establish the efficacy of interventions on vasomotor symptoms, examine long-term outcomes and understand how they work.

Qualitative assessment of information and decision support needs for managing menopausal symptoms after breast cancer

PURPOSE

For breast cancer (BrCa) survivors, premature menopause can result from conventional cancer treatment. Due to limited treatment options, survivors often turn to complementary therapies (CTs), but struggle to make informed decisions. In this study, we identified BrCa survivors' CT and general information and decision-making needs related to menopausal symptoms.

METHODS

The needs assessment was informed by interpretive descriptive methodology. Focus groups with survivors (n = 22) and interviews with conventional (n = 12) and CT (n = 5) healthcare professionals (HCPs) were conducted at two Canadian urban cancer centers. Thematic, inductive analysis was conducted on the data.

RESULTS

Menopausal symptoms have significant negative impact on BrCa survivors. Close to 70 % of the sample were currently using CTs, including mind-body therapies (45.5 %), natural health products (NHPs) and dietary therapies (31.8 %), and lifestyle interventions (36.4 %). However, BrCa survivors reported inadequate access to information on the safety and efficacy of CT options. Survivors also struggled in their efforts to discuss CT with HCPs, who had limited time and information to support women in their CT decisions. Concise and credible information about CTs was required by BrCa survivors to support them in making informed and safe decisions about using CTs for menopausal symptom management.

CONCLUSIONS

High quality research is needed on the efficacy and safety of CTs in managing menopausal symptoms following BrCa treatment. Decision support strategies, such as patient decision aids (DAs), may help synthesize and translate evidence on CTs and promote shared decision-making between BrCa survivors and HCPs about the role of CTs in coping with menopause following cancer treatment.

A Systematic Review of Relaxation, Meditation, and Guided Imagery Strategies for Symptom Management in Heart Failure

BACKGROUND

Pain, dyspnea, fatigue, and sleep disturbance are prevalent and distressing symptoms in persons with advanced heart failure. Although many lifestyle and self-care interventions have been developed to control heart failure progression, very few studies have explored treatments exclusively for symptom palliation. Cognitive-behavioral strategies may be effective treatment for these symptoms in advanced heart failure.

OBJECTIVE

A systemic review was conducted to describe the effect of cognitive-behavioral strategies on pain, dyspnea, fatigue, and sleep disturbance in patients with heart failure.

METHODS

CINAHL, Medline, and PsychINFO were searched from inception through December 2014. Articles were selected for inclusion if they tested a cognitive-behavioral strategy using a quasi-experimental or experimental design, involved a sample of adults with heart failure, and measured pain, dyspnea, fatigue, sleep disturbance, or symptom-related quality of life. The 2 authors evaluated study quality, abstracted data elements from each study, and synthesized findings.

RESULTS

Thirteen articles describing 9 unique studies met criteria and were included in the review. Five studies tested relaxation strategies, 3 tested meditation strategies, and 1 tested a guided imagery strategy. Of the 9 studies, 7 demonstrated some improvement in symptom outcomes. Relaxation, meditation, guided imagery, or combinations of these strategies resulted in less dyspnea and better sleep compared with attention control or usual care conditions and reduced pain, dyspnea, fatigue, and sleep disturbance within treatment groups (pretreatment to posttreatment). Symptom-related quality of life was improved with meditation compared with attention control and usual care conditions and improved pre- to post-guided imagery.

CONCLUSIONS

Studies exploring cognitive-behavioral symptom management strategies in heart failure vary in quality and report mixed findings but indicate potential beneficial effects of relaxation, meditation, and guided imagery on heart failure-related symptoms. Future research should test cognitive-behavioral strategies in rigorously designed efficacy trials, using samples selected for their symptom experience, and measure pain, dyspnea, fatigue, and sleep disturbance outcomes with targeted symptom measures.

An evidence map of the effect of Tai Chi on health outcomes

BACKGROUND

This evidence map describes the volume and focus of Tai Chi research reporting health outcomes. Originally developed as a martial art, Tai Chi is typically taught as a series of slow, low-impact movements that integrate the breath, mind, and physical activity to achieve greater awareness and a sense of well-being.

METHODS

The evidence map is based on a systematic review of systematic reviews. We searched 11 electronic databases from inception to February 2014, screened reviews of reviews, and consulted with topic experts. We used a bubble plot to graphically display clinical topics, literature size, number of reviews, and a broad estimate of effectiveness.

RESULTS

The map is based on 107 systematic reviews. Two thirds of the reviews were published in the last five years. The topics with the largest number of published randomized controlled trials (RCTs) were general health benefits (51 RCTs), psychological well-being (37 RCTs), interventions for older adults (31 RCTs), balance (27 RCTs), hypertension (18 RCTs), fall prevention (15 RCTs), and cognitive performance (11 RCTs). The map identified a number of areas with evidence of a potentially positive treatment effect on patient outcomes, including Tai Chi for hypertension, fall prevention outside of institutions, cognitive performance, osteoarthritis, depression, chronic obstructive pulmonary disease, pain, balance confidence, and muscle strength. However, identified reviews cautioned that firm conclusions cannot be drawn due to methodological limitations in the original studies and/or an insufficient number of existing research studies.

CONCLUSIONS

Tai Chi has been applied in diverse clinical areas, and for a number of these, systematic reviews have indicated promising results. The evidence map provides a visual overview of Tai Chi research volume and content.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42014009907.

Sleep and menopause: a narrative review

OBJECTIVE

Our overall aim-through a narrative review-is to critically profile key extant evidence of menopause-related sleep, mostly from studies published in the last decade.

METHODS

We searched the database PubMed using selected Medical Subject Headings for sleep and menopause (n = 588 articles). Using similar headings, we also searched the Cochrane Library (n = 1), Embase (n = 449), Cumulative Index to Nursing and Allied Health Literature (n = 163), Web of Science (n = 506), and PsycINFO (n = 58). Articles deemed most related to the purpose were reviewed.

RESULTS

Results were articulated with interpretive comments according to evidence of sleep quality (self-reported) and sleep patterns (polysomnography and actigraphy) impact as related to reproductive aging and in the context of vasomotor symptoms (VMS; self-reported), vasomotor activity (VMA) events (recorded skin conductance), depressed mood, and ovarian hormones.

CONCLUSIONS

Predominantly, the menopausal transition conveys poor sleep beyond anticipated age effects. Perceptions of sleep are not necessarily translatable from detectable physical sleep changes and are probably affected by an emotional overlay on symptoms reporting. Sleep quality and pattern changes are mostly manifest in wakefulness indicators, but sleep pattern changes are not striking. Likely contributing are VMS of sufficient frequency/severity and bothersomeness, probably with a sweating component. VMA events influence physical sleep fragmentation but not necessarily extensive sleep loss or sleep architecture changes. Lack of robust connections between perceived and recorded sleep (and VMA) could be influenced by inadequate detection. There is a need for studies of women in well-defined menopausal transition stages who have no sleep problems, accounting for sleep-related disorders, mood, and other symptoms, with attention to VMS dimensions, distribution of VMS during night and day, and advanced measurement of symptoms and physiologic manifestations.

Effects of Meditation versus Music Listening on Perceived Stress, Mood, Sleep, and Quality of Life in Adults with Early Memory Loss: A Pilot Randomized Controlled Trial

BACKGROUND

Older adults with subjective cognitive decline (SCD) are at increased risk not only for Alzheimer's disease, but for poor mental health, impaired sleep, and diminished quality of life (QOL), which in turn, contribute to further cognitive decline, highlighting the need for early intervention.

OBJECTIVE

In this randomized controlled trial, we assessed the effects of two 12-week relaxation programs, Kirtan Kriya Meditation (KK) and music listening (ML), on perceived stress, sleep, mood, and health-related QOL in older adults with SCD.

METHODS

Sixty community-dwelling older adults with SCD were randomized to a KK or ML program and asked to practice 12 minutes daily for 12 weeks, then at their discretion for the following 3 months. At baseline, 12 weeks, and 26 weeks, perceived stress, mood, psychological well-being, sleep quality, and health-related QOL were measured using well-validated instruments.

RESULTS

Fifty-three participants (88%) completed the 6-month study. Participants in both groups showed significant improvement at 12 weeks in psychological well-being and in multiple domains of mood and sleep quality (p's≤0.05). Relative to ML, those assigned to KK showed greater gains in perceived stress, mood, psychological well-being, and QOL-Mental Health (p's≤0.09). Observed gains were sustained or improved at 6 months, with both groups showing marked and significant improvement in all outcomes. Changes were unrelated to treatment expectancies.

CONCLUSIONS

Findings suggest that practice of a simple meditation or ML program may improve stress, mood, well-being, sleep, and QOL in adults with SCD, with benefits sustained at 6 months and gains that were particularly pronounced in the KK group.

Yoga increased serum estrogen levels in postmenopausal women-a case report

OBJECTIVE

This case report aimed to evaluate 4 months of yoga practice on the quality of life (QOL) and estradiol levels of two postmenopausal women.

METHODS

Participants were clinically healthy postmenopausal women, with follicle-stimulating hormone levels greater than or equal to 30 mIU/mL and a body mass index lower than 30 kg/m. The participants practiced yoga for 4 months in two 1-hour sessions per week.

RESULTS

The participants exhibited an abnormal estrogen-level increase after 4 months of yoga practice and showed QOL improvements.

CONCLUSIONS

In some cases, yoga practice can affect the female neuroendocrine system, increasing estrogen and improving QOL.

Reduction in menopause-related symptoms associated with use of a noninvasive neurotechnology for autocalibration of neural oscillations

OBJECTIVE

Increased amplitudes in high-frequency brain electrical activity are reported with menopausal hot flashes. We report outcomes associated with the use of High-resolution, relational, resonance-based, electroencephalic mirroring--a noninvasive neurotechnology for autocalibration of neural oscillations--by women with perimenopausal and postmenopausal hot flashes.

METHODS

Twelve women with hot flashes (median age, 56 y; range, 46-69 y) underwent a median of 13 (range, 8-23) intervention sessions for a median of 9.5 days (range, 4-32). This intervention uses algorithmic analysis of brain electrical activity and near real-time translation of brain frequencies into variable tones for acoustic stimulation. Hot flash frequency and severity were recorded by daily diary. Primary outcomes included hot flash severity score, sleep, and depressive symptoms. High-frequency amplitudes (23-36 Hz) from bilateral temporal scalp recordings were measured at baseline and during serial sessions. Self-reported symptom inventories for sleep and depressive symptoms were collected.

RESULTS

The median change in hot flash severity score was -0.97 (range, -3.00 to 1.00; P = 0.015). Sleep and depression scores decreased by -8.5 points (range, -20 to -1; P = 0.022) and -5.5 points (range, -32 to 8; P = 0.015), respectively. The median sum of amplitudes for the right and left temporal high-frequency brain electrical activity was 8.44 μV (range, 6.27-16.66) at baseline and decreased by a median of -2.96 μV (range, -11.05 to -0.65; P = 0.0005) by the final session.

CONCLUSIONS

Hot flash frequency and severity, symptoms of insomnia and depression, and temporal high-frequency brain electrical activity decrease after High-resolution, relational, resonance-based, electroencephalic mirroring. Larger controlled trials with longer follow-up are warranted.

Mind-body practices for patients with cardiac disease: a systematic review and meta-analysis

BACKGROUND

Due to new treatment modalities in the last decades, a decline in cardiovascular deaths has been observed. There is an emerging field of secondary prevention and behavioural programmes with increased interest in the use of mind-body practices. Until now, these have not been established in cardiovascular disease treatment programmes.

DESIGN

We performed a systematic review and meta-analysis of the available evidence on the effectiveness of mind-body practices for patients with diagnosed cardiac disease.

METHODS

We included randomized controlled trials (RCTs), published in English, reporting mind-body practices for patients with diagnosed cardiac disease. EMBASE, MEDLINE, Pubmed, Web of Science, The Cochrane Central Register of Controlled Trials and PsycINFO were searched up to July 2013. Two reviewers independently identified studies for inclusion and extracted data on study characteristics, outcomes (Quality of Life, anxiety, depression, physical parameters and exercise tolerance) and quality assessment. Standardized effect sizes (Cohen's d) were calculated comparing the outcomes between the intervention and control group and random effects meta-analysis was conducted.

RESULTS

We identified 11 unique RCTs with an overall low quality. The studies evaluated mindfulness-based stress reduction, transcendental meditation, progressive muscle relaxation and stress management. Pooled analyses revealed effect sizes of 0.45 (95%CI 0.20-0.72) for physical quality of life, 0.68 (95%CI 0.10-1.26) for mental quality of life, 0.61 (95%CI 0.23-0.99) for depression, 0.52 (95%CI 0.26-0.78) for anxiety, 0.48 (95%CI 0.27-0.69) for systolic blood pressure and 0.36 (95%CI 0.15-0.57) for diastolic blood pressure.

CONCLUSIONS

Mind-body practices have encouraging results for patients with cardiac disease. Our review demonstrates the need for high-quality studies in this field.

Meditation as a therapeutic intervention for adults at risk for Alzheimer's disease - potential benefits and underlying mechanisms

Alzheimer's disease (AD) is a chronic, progressive, brain disorder that affects at least 5.3 million Americans at an estimated cost of $148 billion, figures that are expected to rise steeply in coming years. Despite decades of research, there is still no cure for AD, and effective therapies for preventing or slowing progression of cognitive decline in at-risk populations remain elusive. Although the etiology of AD remains uncertain, chronic stress, sleep deficits, and mood disturbance, conditions common in those with cognitive impairment, have been prospectively linked to the development and progression of both chronic illness and memory loss and are significant predictors of AD. Therapies such as meditation that specifically target these risk factors may thus hold promise for slowing and possibly preventing cognitive decline in those at risk. In this study, we briefly review the existing evidence regarding the potential utility of meditation as a therapeutic intervention for those with and at risk for AD, discuss possible mechanisms underlying the observed benefits of meditation, and outline directions for future research.

Alternatives to hormone therapy for hot flashes: many choices but science is lacking

CLINICAL SCENARIO

A 51-year-old postmenopausal third-grade teacher requests help for her hot flashes. She finds them especially troubling as she stands in front of her class and starts sweating. Although one student offers her tissues, others make fun of her--disrupting the class. Her sleep is interrupted several times a night. She refuses to use any form of estrogen because her mother died of breast cancer at the age of 60 years. Perhaps alternative therapies can help her.

Effectiveness of a modified version of the applied relaxation technique in treatment of perimenopausal and postmenopausal symptoms

BACKGROUND

Awareness of the risks associated with hormone therapy for menopausal symptoms has sparked a global decline in this treatment. Alternative treatments to relieve menopausal symptoms are therefore required. The applied relaxation (AR) technique has proven to be successful for symptom amelioration, but requires participation in 12 weekly classes. The purpose of this study was to determine the effectiveness of a modified relaxation version (MR) of AR for treatment of hot flashes, night sweats, and sleep disturbances.

METHODS

We conducted a12-week, randomized, parallel, open-label, controlled trial in perimenopausal and postmenopausal women visiting the menopausal clinic. Participants were randomly assigned to an MR or AR group. The MR group (n=36) received a single session of (MR) training and the AR group (n=35) received conventional 12-week training. Participants were instructed to practice the techniques daily at home for 12 weeks. The main outcome was the measure on the severity scale and frequency of hot flashes, night sweats, and sleep disturbances.

RESULTS

All participants completed the study. Total severity scores in both groups decreased after 12 weeks, but there was no difference between the groups (P=0.93). The severity score for hot flashes in the MR group decreased more than in the AR group (P=0.02). The severity scores for night sweats and sleep disturbances decreased in both groups. The frequency of hot flashes, night sweats, and sleep disturbances were also decreased in both groups.

CONCLUSION

A shorter, modified version of the AR was equally effective or slightly better than the conventional AR for the relief of hot flashes, night sweats, and sleep disturbances in perimenopausal and postmenopausal women. Recommendations for future research include confirmatory studies and trials with larger samples.

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.

Mind–Body Therapies for Sleep Disturbances in Women at Midlife

Multiple factors contribute to sleep disturbances in women at midlife. Poor sleep is a common occurrence in women transitioning through midlife and is associated with significant morbidity. Factors that are known to disturb sleep in women at midlife include vasomotor symptoms, nocturia, sleep apnea, and stress. Stress in particular has a significant impact on sleep. Various treatments, pharmacologic and nonpharmacologic, are available to treat sleep disturbances. One nonpharmacologic option includes mind-body medicine, which encompasses several therapies. Practices within this realm have been shown to moderate the experience of stress and help restore sleep quality. Each woman’s experience of disturbed sleep and transition through midlife is unique. By having a broad awareness of all evidence-based therapeutics, the clinician is able to present a diverse set of options for women at midlife who are affected by poor sleep.

Overview of systematic reviews: yoga as a therapeutic intervention for adults with acute and chronic health conditions

Objectives. Overview the quality, direction, and characteristics of yoga interventions for treatment of acute and chronic health conditions in adult populations. Methods. We searched for systematic reviews in 10 online databases, bibliographic references, and hand-searches in yoga-related journals. Included reviews satisfy Oxman criteria and specify yoga as a primary intervention in one or more randomized controlled trials for treatment in adults. The AMSTAR tool and GRADE approach evaluated the methodological quality of reviews and quality of evidence. Results. We identified 2202 titles, of which 41 full-text articles were assessed for eligibility and 26 systematic reviews satisfied inclusion criteria. Thirteen systematic reviews include quantitative data and six papers include meta-analysis. The quality of evidence is generally low. Sixteen different types of health conditions are included. Eleven reviews show tendency towards positive effects of yoga intervention, 15 reviews report unclear results, and no, reviews report adverse effects of yoga. Yoga appears most effective for reducing symptoms in anxiety, depression, and pain. Conclusion. Although the quality of systematic reviews is high, the quality of supporting evidence is low. Significant heterogeneity and variability in reporting interventions by type of yoga, settings, and population characteristics limit the generalizability of results.

Relaxation practice for health in the United States: findings from the National Health Interview Survey

Despite the popularity of relaxation practices as mind-body therapy in the United States, little is known about those who practice these techniques. Using cross-sectional data from the 2007 National Health Interview Survey Alternative Medicine Supplement, this study examined potential correlates of engagement in relaxation practices, including sociodemographic characteristics, health behaviors, medical conditions, physical activity, drinking, smoking, and prayer for health. Individuals who engaged in relaxation practices were less likely to be older, male, Hispanic, high income, or residents in the South and Midwest. They were more likely to be college-educated, uninsured, and have one to two chronic conditions. Those with higher psychological distress and with asthma and pulmonary diseases practiced relaxation techniques more than individuals without these conditions. Findings suggest that relaxation practice is associated with lifestyles habits such as regular physical activity and prayer for health. Thus, relaxation practice has the potential to enhance health behaviors and lifestyle change.