Efficacy of mind–body therapies and exercise‐based interventions on menopausal‐related outcomes among Asian perimenopause women: A systematic review, meta‐analysis, and synthesis without a meta‐analysis

Effects of jazz dance and concurrent training on psychological variables in menopausal women: A randomized controlled trial

PURPOSE

To analyze the effect of two 16-week interventions with jazz dance and concurrent training compared to a control group on anxiety, depression, stress, mood, and the perspective of aging in menopausal women, after 1-month, post-intervention, and at the 6-month follow-up.

METHODS

70 post-menopausal women (53.19 ± 3.39 years) randomized into 3 groups:intervention group with Jazz Dance (JD); intervention group with Concurrent Training (CT), and Control Group (CG). Both interventions lasted 16 weeks, with 60-min classes, JD with a frequency of two weekly classes, and CT three times a week. The intensity of the JD was progressive and according to the frequency of beats per minute of the songs. In CT, the aerobic an initial intensity of 60% of HRmax, reaching 90%, and resistance the volume of sets and loads increased progressively throughout the intervention. Questionnaires related to symptoms of anxiety and depression (Hospital Anxiety and Depression Scale); stress (Perceived Stress Scale); mood (Brunel Mood Scale); and aging perspective (Sheppard Inventory) were applied. Intention-to-treat (ITT) and protocol adherence analysis were performed.

RESULTS

In the protocol analysis, the JD showed improvements in anxiety and depressive symptoms after 1-month, which remained at the follow-up. The TC presented reduced anxiety and depressive symptoms after 16 weeks, which also remained at the follow-up. Considering stress, the CT showed improvements at all times and the JD post-intervention. As for mood, the CT presented reduced anger, mental confusion, and fatigue only after 1-month, and both exercise groups presented increased vigor at all times.

CONCLUSION

Both interventions were beneficial, however dance showed immediate results for anxiety and depression, and concurrent training for stress. Considering mood, concurrent training was more effective for anger, mental confusion, and fatigue, while both interventions were effective for vigor.

REGISTRATION

Brazilian Clinical Trials Registry (REBEC) RBR - 87ndrv.

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.

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.

Effects of exercise on sleep in perimenopausal women: A meta-analysis of randomized controlled trials

Whether an exercise intervention has significant effects on improving the sleep quality in perimenopausal women is controversial. This review explores different ways of exercise interventions (intervention item, intervention period, intervention frequency, and intervention duration of each time) on the improvement of sleep in perimenopausal women. Based on the PICOS method, two researchers independently searched the PubMed database, Excerpta Medica database (EMBASE), Cochrane Library database, Web of Science (WoS) database, Chinese National Knowledge Infrastructure (CNKI) database, Wanfang database and VIP database, evaluated the literature quality using the Cochrane system evaluation manual, and performed a meta-analysis of the included literature. A total of 12 randomized controlled trials involving 1493 subjects were included in the study. Exercise intervention items included yoga, walking, fitness Qigong, and aerobic exercise. The meta-analysis showed that exercise could effectively improve sleep in perimenopausal women (SMD = -0.44, 95%CI (-0.66, -0.22), P < 0.00001), and had significant effects on the sleep quality and insomnia symptoms in perimenopausal women. Subgroup analysis showed that fitness Qigong with a period of 10 to 12 weeks, a frequency of more than 3 times a week, and a duration of each time of 30 to 60 min was the most effective in improving sleep.

The effects of physical activity on depression and quality of life in Chinese perimenopausal women

BACKGROUND

Women are more likely to experience depressive symptoms and poor quality of life (QoL) during perimenopause. The effectiveness of physical activity (PA) in perimenopause on mental well-being and health outcomes has been frequently reported. This study aimed to investigate the mediating effect of PA on the relationship between depression and QoL in Chinese perimenopausal women.

METHODS

A cross-sectional study was performed, and participants were recruited through a multistage, stratified, probability proportional to size sampling method. Depression, PA, and QoL were measured by Zung Self-rating Depression Scale, Physical Activity Rating Scale-3, and World Health Organization Quality of Life Questionnaire. The direct and indirect effects of PA on QoL were analyzed by PA in a mediation framework.

RESULTS

1100 perimenopausal women participated in the study. PA mainly plays partial mediating roles in the relationship between depression and physical (ab = -0.493, 95 % CI: -0.582 to -0.407; ab = -0.449, 95 % CI: -0.553 to -0.343) and psychological (ab = -0.710, 95 % CI: -0.849 to -0.578; ab = -0.721, 95 % CI: -0.853 to -0.589; ab = -0.670, 95 % CI: -0.821 to -0.508) domains of QoL. Additionally, intensity (ab = -0.496, 95 % CI: -0.602 to -0.396; ab = -0.355, 95 % CI: -0.498 to -0.212) and duration (ab = -0.201, 95 % CI: -0.298 to -0.119; ab = -0.134, 95 % CI: -0.237 to -0.047) intermediated the relationship between moderate-to-severe depression and physical domain; frequency (ab = -0.130, 95 % CI: -0.207 to -0.066) only had a mediation influence between moderate depression and physical domain; intensity (ab = -0.583, 95 % CI: -0.712 to -0.460; ab = -0.709, 95 % CI: -0.854 to -0.561; ab = -0.520, 95 % CI: -0.719 to -0.315), duration (ab = -0.433, 95 % CI: -0.559 to -0.311; ab = -0.389, 95 % CI: -0.547 to -0.228; ab = -0.258, 95 % CI: -0.461 to -0.085), and frequency (ab = -0.365, 95 % CI: -0.493 to -0.247; ab = -0.270, 95 % CI: -0.414 to -0.144) all interceded between the psychological domain and all levels of depression, except for the frequency between severe depression and psychological domain; in terms of social relationship and environment domains, intensity (ab = -0.458, 95 % CI: -0.593 to -0.338; ab = -0.582, 95 % CI: -0.724 to -0.445), duration (ab = -0.397, 95 % CI: -0.526 to -0.282; ab = -0.412, 95 % CI: -0.548 to -0.293), and frequency (ab = -0.231, 95 % CI: -0.353 to -0.123; ab = -0.398, 95 % CI: -0.533 to -0.279) were mediators only on mild depression.

LIMITATIONS

The cross-sectional study and self-reported data are major limiting factors.

CONCLUSION

PA and its components partially mediated the association between depression and QoL. Suitable prevention methods and interventions for PA may improve the QoL for perimenopausal women.

Effects of concurrent exercise on health-related quality of life in middle-aged women

OBJECTIVE

This study aimed to evaluate the influence of a 16-week concurrent exercise program on health-related quality of life in middle-aged women.

METHODS

A total of 150 middle-aged women from the FLAMENCO project (age range 45-60 years) were randomized into a counseling (n = 75) or an exercise (n = 75) group. The exercise group followed a 16-week (3 days/week, 60 min/session) concurrent exercise program (aerobic + resistance training). The counseling group attended conferences on a healthy lifestyle. Participants' health-related quality of life was assessed with the EuroQol plus, a visual analog scale and the 36-item Short Form Health Survey (SF-36), where greater values indicate a better health-related quality of life.

RESULTS

The visual analog scale increased by 9.0% in the exercise group, whereas it only increased by 3.5% in the counseling group (p = 0.040). The SF-36 physical function, physical role, bodily pain, vitality and emotional role increased by 5.5%, 11.3%, 10.8%, 9.6% and 8.9%, respectively, in the exercise group, whereas these only increased by 0.6%, decreased by 0.7% and increased by 1.4%, 3.8% and 0.6% in the counseling group (all p < 0.05).

CONCLUSIONS

Our results suggest that a 16-week concurrent exercise program adapted for midlife women improved their health-related quality of life.

CLINICALTRIALS.GOV IDENTIFIER

NCT02358109. Date of registration: 05/02/2015.

High levels of physical activity are associated with a reduced likelihood of depressive symptoms in postmenopausal women

Depressive symptoms in postmenopausal women are a significant concern, but studies evaluated their relationship with menopausal symptoms and physical activity are limited. This cross-sectional study used the scale of the 9-item Patient Health Questionnaire (PHQ-9) and the modified Kupperman Index (KMI) to investigate the relationship between depressive symptoms, menopausal symptoms, and physical activity in postmenopausal women in Hunan Province, using cluster random sampling, and face-to-face interviews with women aged 50-64 years. The moderate (aOR = 2.242, 95 percent CI [1.646-3.052], P < .001) and severe menopausal symptoms (aOR = 3.654, 95 percent CI [1.754-7.611], P = .001), and low-level physical activity (aOR = 1.380, 95 percentCI [1.023-1.826], P = .035) may increase the risk of depressive symptoms. High levels of physical activity were associated with a decreased likelihood of depressive symptoms, but only when participants had no complaints of menopausal symptoms (aOR = 0.375, 95 percent CI [0.161-0.877], P = .024). This study provides a new result for the mental health of postmenopausal women and provides a reference for further related research.

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.

The structure of menopausal syndrome: Using network analysis to understand unique symptomatic relationships

OBJECTIVE

To explore the network structure underlying the symptoms of menopausal syndrome and to identify the central and bridge symptoms of menopause among middle-aged women.

METHODS

This is a cross-sectional survey study conducted in the Chinese community with a total of 1829 women aged 40-65 years. The Menopause Rating Scale (MRS) was used to assess the menopausal syndrome, including somato-vegetative, psychological, and urogenital subdomains. The network analysis was performed to determine the central and bridge symptoms of menopause.

RESULTS

In the network of menopausal symptoms, anxiety, vaginal dryness, depressive mood, and irritability were the most central symptoms. Depressive mood, anxiety, and vaginal dryness were also detected as the bridge symptoms. The estimated network between the symptoms had good stability (CS-strength = 0.75 and CS-edge = 0.75).

CONCLUSION

The present network analysis provided unique insights into the inner structure of menopausal symptoms. Psychological symptoms should be considered as the core symptoms in developing relevant interventions to improve the health and well-being of middle-aged women.

Association of objectively measured physical fitness with health-related quality of life of mid-life women: the FLAMENCO project

OBJECTIVES

This study aimed to explore the association of physical fitness with health-related quality of life (HRQoL) in mid-life women and to examine the potential independent association of physical fitness components with the physical and mental components from the 36-Item Short-Form Health Survey (SF-36) in this population.

METHODS

This cross-sectional study comprised 183 mid-life women from southern Spain who participated in the FLAMENCO project. Body composition was measured through an impedanciometer, a stadiometer, and dual-energy X-ray absorptiometry. Physical fitness was objectively measured with the Senior Fitness Test battery (cardiorespiratory fitness, flexibility, and dynamic balance/agility) plus handgrip strength (muscle strength). The SF-36 questionnaire was used to assess HRQoL of the participants.

RESULTS

All the physical fitness components were associated with the SF-36 physical function (all p < 0.05) except for lower-body flexibility. The rest of the physical fitness components showed associations with most of the SF-36 dimensions (all p < 0.05). Dynamic balance/agility and upper-body flexibility were independently associated with the SF-36 physical component scale, explaining 15% and 17% of the SF-36 physical component scale, respectively. Any physical fitness component showed independent associations with the SF-36 mental component scale.

CONCLUSIONS

Greater physical fitness levels are associated with better HRQoL of mid-life women. Dynamic balance/agility and upper-body flexibility were the strongest independent physical fitness components associated with the SF-36 physical component scale.

Harmful traditional health practices used by Syrian refugee women in Turkey

OBJECTIVE

The aim of this descriptive study was to determine the traditional health practices used by Syrian refugee women in Turkey.

METHODS

A survey was carried out among Syrian refugee women in the Turkish province of Hatay, which has experienced heavy immigration. The study sample consisted of 75 married Syrian women over the age of 18. Questionnaires were completed during face-to-face interviews and took approximately 60 min.

RESULTS

All the women (100%) reported using a traditional health method in pregnancy; almost all had used a traditional health method during childbirth and the postpartum period (both 98.7%), and to treat a vaginal infection (92.0%) and induce an abortion (93.3%); most used a traditional method of contraception (85.3%).

CONCLUSION

Some of the reported known and used methods are harmless or beneficial to women's health. Some, however, can negatively affect women's health in terms of infection, bleeding and toxicity. In order to eliminate potentially harmful traditional health practices, it is recommended that Syrian refugee women receive health education.