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Table 1 Selected studies of physical activity and vasomotor symptoms (includes hot flashes and night sweats)

From: Recent evidence exploring the associations between physical activity and menopausal symptoms in midlife women: perceived risks and possible health benefits

Reference Sample Physical activity measure Menopausal symptom measure Other measures Detailed findings Summarized findings: observed association
Null Positive Negative Mixed
Cross-sectional studies  
Canário et al. 2012 [27] Population-based sample of 370 women from Natal, Brazil aged 40-65 International Physical Activity Questionnaire with three categories of classification: sedentary, moderately active and very active (vigorous) Blatt–Kupperman Menopausal Index with three categories of classification: mild (≤19), moderate (20–35), or severe (>35) Socio-demographic and behavioral characteristics Bivariate analysis revealed a statistically significant inverse association between physical activity and hot flashes    x  
Haimov-Kochman et al. 2013 [28] 151 healthy women aged 45–55 who attended the menopause clinic at the Hadassah Hebrew University Medical Center (Jerusalem, Israel) Physical activity was quantified by self-reported frequency of exercise (1–7 times a week), and categorized into 3 groups: 1–2; 3–4; 5–7 times per week The Greene climactic scale, estimates include total score. Subscores for psychological, somatic/physical, sexual, and vasomotor symptoms also reported Demographic, anthropometric, and lifestyle (behavioral) variables There was no association between physical activity frequency and the vasomotor subscale x    
Kandish et al. 2010 [29] Female employees at a Mid-Western University were invited to participate in an on-line survey. The analytic sample included 196 women aged ≥40 years that did not smoke or use hormone therapy Usual physical activity per week reported via 30 min intervals of aerobic and strength activity. Intensity of activity was reported as mild, moderate, or heavy Usual daily frequency and severity (10-point scale, ranging from ‘very mild’ to ‘very severe’) of hot flashes were ascertained Socio-demographic characteristics, alcohol and caffeine consumption Adjusted analyses, suggested higher frequency of aerobic physical activity significantly increased the frequency of hot flashes. Yet, higher intensity of aerobic physical activity was associated with decreased frequency and severity of hot flashes     x
Mansikkamäki et al. 2015 [30]a Random sample of 5000 women born in 1963 was obtained from the Finnish Population Register Centre. Analytic sample included 2606 women aged 49 years old that responded to a postal survey in 2012 A single item pertaining to usual exercise (frequency and duration) per week during past 12-months. Women were classified as ‘active’ if they reported ≥ 150 min per week of moderate intensity or ≥75 min of vigorous intensity, with strength training and balance training Women’s Health Questionnaire addressing nine domains of physical and emotional experiences, including vasomotor symptoms Socio-demographic factors, anthropometrics, self-rated health In the unadjusted models, inactive women had a higher odds of vasomotor symptoms (POR 1.19; 95 % CI: 1.03–1.36). However, after adjustment for BMI and education level, results were no longer statistically significant x    
Moilanen et al. 2010 [31] Participants drawn from Finnish Health 2000 Study (n = 7,977), data collection included a home interview, 3 self-administered questionnaires, and a clinical exam. Analytic sample included 1427 women, ages 45–64; known menopausal status) who completed the home interview, first questionnaire Physical activity was assessed via a single item on the questionnaire, “How much do you exercise or strain yourself physically in your leisure time” with four response options ranging from ‘sedentary’ (reading, watching television) to ‘competitive sports’. Participants were classified based on low, moderate, and high physical activity Severity of general symptoms, including vasomotor symptoms, were assessed via two items on the questionnaire Socio-demographics, health behaviors, anthropometrics, menopausal status and hormone therapy use Low active women reported significantly more vasomotor symptoms (β = 0.18; 95 % CI: 0.10, 0.27) than the high active group after adjustment for baseline age, menopausal status, education, chronic disease, and hormone therapy use    x  
Pimenta et al. 2011 [32] Community-based sample of 243 women (Lisbon, Portugal) that reported vasomotor symptoms in the past month; aged 42–60 years old Physical exercise was assessed using reported frequency and duration of exercise sessions per week. Summary scores were computed using the mean frequency and duration values Menopause Symptoms’ Severity Inventory was used to assess the frequency and intensity of night sweats through classification on a 5-point Likert scale which ranged from ‘never’ to ‘daily’ and from ‘not intense’ to ‘extreme intensity’. Severity for each symptom was computed as the mean frequency and intensity values Socio-demographic characteristics, health and menopausal related variables and lifestyle factors Physical exercise was not associated with perceived severity of hot flashes or night sweats x    
Tan et al. 2014 [33] 305 Turkish (District of Izmir) menopausal women who went to their primary care physician between August and October 2009 International Physical Activity Questionnaire (IPAQ)-short version. Women were classified as: low, moderate, or high active Turkish version of the Menopause Rating Scale (MRS), which includes 11 items assessing assess somato-vegetative, psychological and urogenital symptoms; scores range from ‘not present’ to ‘very severe’ Socio-demographic factors, health behaviors, anthropometrics There was no difference in the reported frequency of hot flashes/night sweating by physical activity groups x    
Short-term (≤30 days) Longitudinal Studies  
Elavsky et al. 2012 [41] Community-dwelling midlife women (N = 121; age range, 40–60 years) not using hormone therapy for at least 6 months. Prospective monitoring across a 15-day period. The analytic sample included 92 participants that reported a menopausal-related vasomotor symptom (i.e., night sweats or hot flashes) within the last 2 weeks To examine the acute effects of PA, participants attended a second visit during week 1, where they completed a 30-min moderate intensity exercise bout. Daily PA was also assessed objectively using an ActiGraph (GT1M) accelerometer placed over the participants’ nondominant hip for 15 consecutive days Hot flash and night sweat data were collected using Purdue Momentary Assessment platform in which participants self-reported hot flashes and night-sweats in real-time using a personal digital assistant (PDA). Objective data were obtained via skin conductance monitoring (Biolog Hot Flash Monitor), a battery-powered, portable device. Participants wore the monitor for 24 h, twice during data collection. In addition to continuous monitoring, participants were asked to flag perceived events Basic demographic and health history information. Psychological symptoms through questionnaires An acute bout of moderate-intensity of aerobic exercise decreases both reported and objective and subjective hot flashes     x
There was no significant change in night sweats as a result of the acute exercise bout
Daily physical activity was not associated with reported hot flash frequency. Yet, less fit women reported more hot flashes on days when they engaged in more moderate-intensity physical activity than usual
The associations between daily PA and night sweats were not reported
Elavsky et al. 2012 [42] 24 symptomatic peri- and post-menopausal women not on HT were picked from volunteers who responded to advertisements Participants used accelerometers across a menstrual cycle or for 30 days if postmenopausal. Accelerometer count data were classified as % time sedentary, and in light, moderate and vigorous 2intensity physical activity (Matthews cutpoints) Daily HFs were reported using an electronic PDA across one menstrual cycle or 30 days Socio-demographic and health history. Psychosocial questionnaires, including depression, chronic stress, and anxiety. Reproductive hormones via blood draw The association between physical activity and hot flashes was statistically significant in half the participants (n = 10 of 20). Same day, as well as cross-lagged (effects of previous day’s physical activity on hot flashes the next day), were examined. Yet, the direction and magnitude of the association varied across participants     x
Prospective cohort studies  
Gibson et al. 2014 [43] Analytic sample included Study of Women’s Health across the Nation (SWAN) participants (n = 51); Pittsburgh site, only. At enrollment (1996–97), participants were aged 42–52 years old. Hot flashes were assessed in 2008–09 PA was measured using accelerometer-derived activity counts from the Biolog monitor. The mean activity count in the 10 min before a hot flash were classified as “pre-flash” physical activity. The other data were classified as “control” physical activity. Habitual physical activity assessed via the Kaiser Physical Activity Survey (KPAS) Self-reported hot flashes were assessed using a portable electronic diary. Physiologically detected hot flashes were measured using Biolog sternal skin conductance monitors Socio-demographic and health behavior information, anthropometrics, depression & anxiety There was no relationship of daily physical activity with physiologic hot flashes, self-reported hot flashes, or physiologically monitored hot flashes (not confirmed by self-report). Yet, higher habitual PA, higher BMI, more depressive symptoms and anxiety were associated with higher levels of self-reported hot flashes not corroborated by a physiologic hot flash     x
Gjelsvik et al. 2011 [44] Analytic sample included 2229 women aged 40–44 years, randomly selected from national survey in Hordaland County, Norway. Baseline data were collected in 1997–98 and follow-up occurred every second year and continued to 2010 A short follow-up questionnaire included items pertaining to physical exercise. Participants were classified as inactive based on <1 h hard activity and/or <2 A short follow-up questionnaire included items pertaining to the reported frequency (‘daily’ to ‘never/almost never’) and burden (‘very much’ to ‘not bothered’) Sociodemographic factors, health behaviors, menopausal status and symptoms When compared to inactive women, women with >3 h of hard exercise per day were 1.5 times (1.1–1.9) more likely to report daily hot flashes   x   
de Azevedo Guimaraes et al. 2011 [45] 120 Brazilian women aged 45–59 years old volunteered for the 12-week study (recruited through work or other institutions) Habitual PA was assessed through the short form of the International PA Questionnaire (IPAQ); Participants were classified as: maintained <30 min/day, maintained or increased to 30–60 min/day, or maintained or increased to >60 min/day Hot flashes were assessed using the Kupperman Menopausal Index Socio-demographic factors, anthropometrics, menopausal status and symptoms, and QOL Women classified in the highest active group (maintained or increased to 60 min per day) had reported significantly fewer hot flashes after 12-weeks than the other two active groups after adjustment for baseline values    x  
104 women completed the 12-week study.
Non-randomized intervention studies  
Karacan, 2010 [50]a 112 women aged 46–55. The analytic sample included 65 participants that regularly participated in the 3- and 6-month exercise program The 6-month exercise program included aerobic activity (75–80 % heart rate capacity) with calisthenics for 3 days a week for 55 min each session The menopause rating scale (MRS) was composed of 11 items assessing menopausal symptoms divided into three groups: psychological, somatic-vegetative and urogenital Physical characteristics (height, weight, and age at menopause), resting heart rate and blood pressure, lower back flexibility, hand grip strength, and body composition (skin folds) There was a significant decrease in hot flushes and night sweats from baseline to 6-months    x  
Randomized controlled trials  
Agil et al. 2010 [51] 42 Turkish postmenopausal women (aged 45–60 years old) who agreed to participate in the 8-week study after presenting to the Department of Obstetrics and Gynecology (Bayindir Hospital) between March and December 2009. Participants were randomly assigned to the aerobic or resistance training group Aerobic and Resistance Groups: Supervised sessions 3 × per week. The resistance group used elastic belt; no other details provided for either group Vasomotor symptoms were assessed using the Menopause-specific Quality of Life Questionnaire (MENQOL) Socio-demographics and health behaviors Both the aerobic and resistance groups had a significant reduction in vasomotor symptoms following the exercise program.    x  
Luoto et al. 2012 [52]a 176 Finnish white women were recruited for the study by newspaper advertisements. The analytic sample included 154 inactive participants were randomly assigned to the exercise (n = 74) or control group (n = 77) that completed the 6-month study protocol Exercise Group: Unsupervised aerobic training intervention; 4 × per week at 64–80 % maximal heart rate for 50 min each time Hot flashes were assessed via the Women’s Health Questionnaire (primary). Hot flashes were also collected 2 × per day using a mobile phone-administered questionnaire Socio-demographic factors, anthropometrics, and menopausal symptoms WHQ assessed hot flashes did not differ by group x    
There was no group x time differences in daily reported daytime hot flashes.
Moilanen et al. 2012 [53]a 176 Finnish white women were recruited for the study by newspaper advertisements. The analytic sample included 154 inactive participants were randomly assigned to the exercise (n = 74) or control group (n = 77) that completed the 6-month study protocol Exercise Group: Unsupervised aerobic training intervention; 4 × per week at 64–80 % maximal heart rate for 50 min each time The frequency of night sweats were collected 2 × per day using a mobile phone- administered questionnaire Socio-demographic factors, anthropometrics, and menopausal symptoms The prevalence of night sweats decreased pre- to post- intervention    x  
Newton et al. 2014 [54]a Women aged 40–62 recruited from 3 sites in US (IN, CA, WA) and randomly assigned to a 12-week yoga (n = 107), exercise (n = 106), or usual activity (n = 142) group. Participants were and also randomly assigned to the omega-3 (n = 177) or placebo (n = 178) group. Participants were followed for 12-weeks Yoga Group: Supervised: 1 × per week for 90 min; Unsupervised: 6 × per week for 20 min Frequency and intensity of vasomotor were recorded in daily diaries by the participants. VMS bother was rated each day on a scale ranging from 1 ‘none’ to 4 ‘a lot’. Baseline frequency was calculated from the mean number of vasomotor symptoms reported in a 24-h period during the 14 days prior to the 1st visit. Vasomotor frequency during weeks 6 and 12 were computed similarly using the corresponding diaries Socio-demographics, anthropometrics, daily diaries assessing vasomotor symptoms, sleep quality, health history, and anxiety After 12-weeks, based on intent-to-treat analysis, yoga had no effect on vasomotor frequency or bother when compared to usual activity x    
Usual Activity: Instructed to follow usual physical activity plan; asked not to initiate yoga or a new exercise regimen.
Reed et al. 2014 [55]a Women aged 40–62 recruited from 3 sites in US (IN, CA, WA) and randomly assigned to a 12-week yoga (n = 107), exercise (n = 106), or usual activity (n = 142) group. Participants were and also randomly assigned to the omega-3 (n = 177) or placebo (n = 178) group. Participants were followed for 12-weeks Yoga Group: Supervised: 1 × per week for 90 min; Unsupervised: 6 × per week for 20 min Menopausal Quality of Life Questionnaire (MENQOL; range, 1–8) is a 29-item assessment of menopause-related QOL. Total score and 4 domain-specific scores (vasomotor, physical, psychosocial, & sexual functioning). Frequency of vasomotor symptoms were also assessed via daily diaries Socio-demographics, anthropometrics, daily diaries assessing vasomotor symptoms, sleep quality, health history, and anxiety After 12-weeks, compared to the usual activity group, yoga group participants had significant improvements in vasomotor symptoms (as reported via MENQOL). There was no difference in pre- to post- vasomotor symptoms between the exercise and usual activity groups     x
Exercise Group: Supervised: 3 × per week, 50–60 % HRR during month 1, 60–70 % HRR during months 2 & 3
Usual Activity: Instructed to follow usual physical activity plan; asked not to initiate yoga or a new exercise regimen
Sternfeld et al. 2014 [56]a Women aged 40–62 recruited from 3 sites in US (IN, CA, WA) and randomly assigned to a 12-week yoga (n = 107), exercise (n = 106), or usual activity (n = 142) group. Participants were and also randomly assigned to the omega-3 (n = 177) or placebo (n = 178) group. Participants were followed for 12-weeks Exercise Group: Supervised: 3 × per week, 50–60 % HRR during month 1, 60–70 % HRR during months 2 & 3. Possible modes included, treadmill, elliptical trainer, or stationary bicycle. Trained staff recorded heart rate, workload, and perceived 7 exertion every 5–10 minutes Frequency and intensity of vasomotor were recorded in daily diaries by the participants. VMS bother was rated each day on a scale ranging from 1 ‘none’ to 4 ‘a lot’. Baseline frequency was calculated from the mean number of vasomotor symptoms reported in a 24-h period during the 14 days prior to the 1st visit. Vasomotor frequency during weeks 6 and 12 were computed similarly using the corresponding diaries Socio-demographics, anthropometrics, daily diaries assessing vasomotor symptoms, sleep quality, health history, and anxiety After 12-weeks, compared to the usual activity group, exercise group participants had no change in frequency or burden of vasomotor symptom, compared to the usual activity group x    
  1. aPhysical activity dose reflective of 2008 Physical Activity Guidelines for Americans [3]