Exercise and Quality of Life in Women with Menopausal Symptoms: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Abstract
:1. Introduction
2. Materials and Methods
2.1. Search Strategy
2.2. Selection Criteria
- (1)
- Participants: studies of women with at least one menopausal symptom due to the natural decline of reproductive hormones, comprehensive cancer treatment program, hysterectomy, and/or premature ovarian failure were included. Studies of menopausal women that did not mention any menopausal symptoms as inclusion criteria were excluded;
- (2)
- Intervention and control groups: studies comparing exercise with no active treatment were included. In the present study, exercise was defined as a planned, structured, repetitive, and purposeful subcategory of physical activity, aimed at the maintenance or improvement of one or more components of physical fitness [35]. There were no restrictions on the frequency and duration of the intervention as well as whether exercises were supervised by instructors or self-delivered. Studies in which exercises were combined with non-exercise methods were excluded because these combined methods possibly influence the actual effect of exercise on QoL in women with menopausal symptoms. We also excluded studies in which the control groups performed active non-exercise interventions such as MHT and cognitive behavior therapy. In addition, we excluded studies where both the intervention and the control groups performed exercises (i.e., aerobics vs. resistance training);
- (3)
- Outcomes: QoL scores of both the intervention and the control groups must be provided;
- (4)
- Only RCTs of humans published in English were included. Publications in commentary, editorial, or review form were excluded;
- (5)
- Studies with unavailable full texts were excluded.
2.3. Screening Data
2.4. Data Extraction
2.5. Risk-of-Bias Assessment
2.6. QoL Outcomes
2.7. Meta-Analysis
3. Results
3.1. Study Selection
3.2. Characteristics of Included Studies
3.3. General Health QoL Outcomes
3.4. Menopause-Specific QoL Outcomes
3.5. Subgroup Analyses
3.6. Risk-of-Bias Assessment
3.7. Publication Bias
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
Appendix A
Population | Outcomes | Intervention | Study Design |
---|---|---|---|
Menopause Climacteric Hot flash Night sweat Vasomotor symptom | Quality of life Life quality Value of life Quality of well-being QoL HRQoL HRQL QWB | Exercise Physical activity Yoga Tai Ji Qi Gong Aerobics Sport Pilates Movement Walking Swimming Running Training Dancing Climbing | Randomized controlled trials Controlled clinical trials Trials Randomly Randomized Groups RCTs |
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QoL Questionnaire | Abbreviation | Type 2 | QoL Domain 3 | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
General Health | Menopause-Specific | ||||||||||
General | Physical | Psychological | Social | Vasomotor | Sexual | Urinary | Somatic | Total Symptoms | |||
Global QoL [37] | GQOL/VAS 1 | G | P | - | - | - | - | - | - | - | - |
36-Item Short-Form Health Survey [38] | SF-36 | G | P | P | P | P | - | - | - | - | - |
World Health Organization QoL—Brief Version [39] | WHOQOL-BREF | G | - | P | P | P | - | - | - | - | - |
Utian QoL [40] | UQOL | S | P | - | N | - | - | - | - | - | - |
Menopause-Specific QoL [41] | MENQOL | S | - | N | N | - | N | N | - | - | - |
International Consultation on Incontinence Questionnaire (Short Form) [42] | ICIQ-SF | S | N | - | - | - | - | - | - | - | - |
King’s Health Questionnaire [43] | KHQ | S | N | - | - | - | - | - | N | - | - |
Sexual Activity Questionnaire [44] | SAQ | S | - | - | - | - | - | P | - | - | - |
Greene Climacteric Scale [45] | GCS | S | - | - | - | - | N | N | - | N | N |
Women’s Health Questionnaire [46] | WHQ | S | - | - | - | - | N | N | - | N | - |
Hot-Flash-Related Daily Interference Scale [47] | HFRDIS | S | - | - | - | - | N | - | - | - | - |
Hot Flash Rating Scale [48] | HFRS | S | - | - | - | - | N | - | - | - | - |
Bristol Female Lower Urinary Tract Symptoms [49] | BFLUTS | S | - | - | - | - | - | - | N | - | - |
Functional Assessment of Cancer Therapy for Endocrine Subscale [50] | FACT-ES | S | - | - | - | - | - | - | - | - | P |
Study | Participant | Country | Dropout Rate | Intervention | Frequency 1 | Duration 1 | Control | QoL Questionnaire | Result |
---|---|---|---|---|---|---|---|---|---|
Mercier et al. [24] | 32 women with GSM; ≥55 years old | Canada | 9.4% (3/32) | PFMT; Supervised and home-based (n = 32) | Supervised: 1 b/w, 60 min/b Home-based: 5 d/w | 12 w | None (n = 0) | ICIQ-VS | QoL and sexual function of women with GSM improved after the intervention. |
Bertotto et al. [25] | 49 postmenopausal women with urinary symptoms; 50–65 years old | Brazil | 8.2% (4/49) | PFMT: contraction (n = 15) | 2 b/w, 20 min/b | 4 w | No treatment (n = 14) | ICIQ-SF | The PFMT group exhibited significant increases in ICIQ-SF scores. |
Ngowsiri et al. [26] | 54 menopausal women with menopausal symptoms; 45–59 years old | Thailand | 7.4% (4/54) | Rusie Dutton dance of 16 yoga-like postures; Supervised (n = 24) | 3 b/w, 90 min/b | 13 w | Provided a handbook (n = 26) | MENQOL | There was a significant improvement in all MENQOL domains in the experiment group and between the two groups. |
Jayabharathi et al. [27] | 260 women with menopausal symptoms; 45–55 years old | India | 2.3% (6/260) | Yoga; Supervised and home-based (n = 128) | Supervised: 5 consecutive days: 2 b/d, ~45 min/b; Later: 2 d/w Home-based: 35–40 min/d | 18 w | No intervention (n = 126) | WHOQOL-BREF | A statistically significant difference between the study group and the control group was observed in terms of all domains of QoL. |
Avis et al. [28] | 54 menopausal women with ≥4 hot flashes/day; 45–58 years old | USA | 20.4% (11/54) | Integral yoga Supervised and home-based qualified DVD for self-practice (n = 15) | Supervised: 1 b/w, 90 min/b Home-based: 3 b/w, 15 min/b | 10 w | Waitlist (n = 14) | SF-36 HFRDIS VAS | Yoga can act as a behavioral option which helps in reducing hot flashes. There was no advantage of yoga over other types of exercise. |
Pereira et al. [29] | 45 postmenopausal women with urinary symptoms; 53–73 years old | Brazil | 8.9% (4/45) | PFMT: contraction; Supervised by a physical therapist (n = 15) | 2 b/w, 40 min/b | 6 w | No intervention (n = 15) | KHQ | Several positive results of PFMT in treatment for urinary leakage, pelvic floor muscle pressure, and QoL were observed. |
Luoto et al. [30] | 176 menopausal women with daily hot flashes; 40–63 years old | Finland | 12.5% (22/176) | Unsupervised aerobic training (n = 74) | 4 b/w, 50 min/b | 24 w | 1–2 lectures/ month; 60–75 min (n = 80) | SF-36 WHQ | Women in the intervention group had significantly higher SF-36 scores in mental health than those in the control group. |
Duijts et al. [31] | 422 breast cancer patients with menopause symptoms; 48.2 ± 5.6 years old | The Netherlands | 16.6% (70/422) | Home-based, self-directed exercise program; Assisted by a physiotherapist (n = 104) | Home-based: 150–180 min/w | 12 w | Waitlist (n = 103) | SF-36 HFRS SAQ FACT-ES BFLUTS | There were significant differences in improvement for menopause symptoms, SAQ, and SF-36 between the intervention and the control group. |
Elavsky et al. [32] | 164 sedentary women with menopausal symptoms; 42–58 years old | USA | 24.4% (40/164) | (1) Walking: supervised; (n = 63) (2) Iyengar yoga: supervised (n = 62) | (1) 3 b/w; 60 min/b; (2) 2 b/w; 90 min/b | 16 w | Waitlist (n = 39) | UQOL GCS | The yoga and walking interventions showed positive effects on menopause-specific QoL. |
QoL Domain | No. Studies | No. Participants (Exercise) | No. Participants (Control) | SMD (95% CI) | p-Value | Heterogeneity 1 I2; χ2; p-Value |
---|---|---|---|---|---|---|
PFMT | ||||||
General | 2 | 30 | 29 | 0.76 (−0.40 to 1.92) | 0.20 | 78%; 4.52; 0.03 |
Yoga | ||||||
General | 2 | 76 | 53 | −0.07 (−0.46 to 0.33) | 0.74 | 12%; 1.14; 0.29 |
Physical | 3 | 167 | 166 | 1.39 (0.19 to 2.59) | 0.02 | 93%; 29.31; p * |
Psychological | 4 | 228 | 205 | 0.76 (−0.3 to 1.81) | 0.16 | 95%; 63.01; p * |
Sexual | 2 | 85 | 65 | −0.36 (−1.18 to 0.46) | 0.39 | 81%; 5.39; 0.02 |
Vasomotor | 3 | 100 | 79 | −0.37 (−1.15 to 0.4) | 0.34 | 82%; 11.18; p ** |
Study | RandomIzation Process | Deviations from Intended Interventions | Missing Outcome Data | Measurement of the Outcome | Selection of the Reported Result | Overall |
---|---|---|---|---|---|---|
Mercier et al. [24] | Low | Some concerns | Low | Low | Low | Some concerns |
Bertotto et al. [25] | Low | Some concerns | Some concerns | Some concerns | Low | Some concerns |
Ngowsiri et al. [26] | Some concerns | Some concerns | Some concerns | Some concerns | Low | Some concerns |
Jayabharathi et al. [27] | Low | Some concerns | Low | Some concerns | Low | Some concerns |
Avis et al. [28] | Some concerns | Some concerns | Some concerns | Some concerns | Low | Some concerns |
Pereira et al. [29] | Low | Some concerns | Low | Some concerns | Low | Some concerns |
Luoto et al. [30] | Low | High | Some concerns | Some concerns | Low | High |
Duijts et al. [31] | Low | Some concerns | Low | Some concerns | Low | Some concerns |
Elavsky et al. [32] | Low | Some concerns | Some concerns | Low | Low | Some concerns |
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Nguyen, T.M.; Do, T.T.T.; Tran, T.N.; Kim, J.H. Exercise and Quality of Life in Women with Menopausal Symptoms: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Int. J. Environ. Res. Public Health 2020, 17, 7049. https://doi.org/10.3390/ijerph17197049
Nguyen TM, Do TTT, Tran TN, Kim JH. Exercise and Quality of Life in Women with Menopausal Symptoms: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. International Journal of Environmental Research and Public Health. 2020; 17(19):7049. https://doi.org/10.3390/ijerph17197049
Chicago/Turabian StyleNguyen, Thi Mai, Thi Thanh Toan Do, Tho Nhi Tran, and Jin Hee Kim. 2020. "Exercise and Quality of Life in Women with Menopausal Symptoms: A Systematic Review and Meta-Analysis of Randomized Controlled Trials" International Journal of Environmental Research and Public Health 17, no. 19: 7049. https://doi.org/10.3390/ijerph17197049