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Table 4 Selected studies of physical activity and sleep quality and/or sleep disturbances

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



Physical activity measure

Menopausal symptom measure

Other measures

Detailed findings

Summarized findings: observed association





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 insomnia


x (insomnia)


Casas et al. 2012 [38]a

48 month follow-up data from the Women on the Move through Activity and Nutrition (WOMAN) Study. The analytic sample included 393 postmenopausal women, aged 62 ± 3 years

Modifiable Activity Questionnaire (past year version). Participants were also classified as high or low active based on sample-determined median (11.8 METhrwk−1)

Pittsburgh Sleep Quality Index (PSQI)

Socio-demographic factors, anthropometrics, hormone therapy status, cardiovascular risk factors

Bivariate analysis suggest that sleep quality and duration did not vary in participants classified as high vs. low active

x (sleep quality & duration)


Lambiase et al. 2013 [39]

Sub-sample of 52 Study of Women’s Health Across the Nation (SWAN) participants (Pittsburgh site only) attending the 10th annual visit (2008–09)

Kaiser Physical Activity Survey, including four indices of physical activity: (a) household/ caregiving, (b) occupational, (c) active living, and (d) sport/exercise activity. Each index was calculated as the average score (ranged from 1 to 5)

Minimitter Actiwatch-64 (dominant wrist) and sleep diary. In the diary, participants reported times in and out of bed and number of awakenings

Demographic factors, medical history, medication use, and health behaviors

Participants with higher physical activity levels reported better sleep quality and recorded fewer nighttime awakenings



Participants were also asked to report their global sleep quality in the past month on a 4-point scale (very bad to very good)

Reported physical activity was not significantly associated with objectively-determined sleep estimates

Kline et al. 2013 [40]

339 participants from the Study of Women’s Health Across the Nation (SWAN) Sleep Study, an ancillary study located at 4 of 7 SWAN clinical sites (Chicago, IL; Detroit Area, MI; Oakland, CA; Pittsburgh, PA). Data were collected from 2003–05

Kaiser Physical Activity Survey, including four indices of physical activity: (a) household/ caregiving, (b) occupational, (c) active living, and (d) sport/exercise activity. Each index was calculated as the average score (ranged from 1 to 5). Recent (KPAS scores from preceding SWAN visit) and historical (2–4 KPAS assessments in the 5–6 years prior to the SWAN Sleep Study) physical activity estimates were created. Participants were further classified as, “consistently active”, “inconsistent/ moderate” or “consistently inactive” based on the historical estimates

In-home polysomnography (PSG), daily sleep diaries, and the Pittsburgh Sleep Quality Index (PSQI)

Sociodemographic factors, medication use, menopausal status, vasomotor symptoms and other health behaviors

Higher sports/exercise index scores were significantly related with greater sleep quality and continuity (via diary) and greater sleep depth (PSG). Those with a higher sports/exercise index had a significantly lower odds of meeting diagnostic criteria for insomnia. The associations with the household or active living index were not statistically significant


x (sleep quality)


Mansikkamäki et al. 2015 [30]

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 sleep problems

Socio-demographic factors, anthropometrics, self-rated health

There was no difference in reported sleep problems in active vs. inactive

x (sleep problems)


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 reported sleeping problems from baseline to 3- and 6-months


x (sleep problems)


Randomized controlled studies


Kline et al. 2012 [58]a

437 sedentary, overweight/obese participants from the Dose–response to Exercise in postmenopausal Women (DREW) Study, randomized to no exercise (n = 102), 50 % (n = 155), 100 % (n = 104), or 150 % (n = 103) of the NIH Consensus Panel physical activity recommendations

Exercise Training Groups: The supervised exercise program (3–4 times per week) included aerobic activity at varying doses (i.e., 4-, 8-, or 12- kcal per kilogram of body weight per week (KKW). For the 1st week all exercise training groups expended 4 KKW. Then, the 8- and 12- KKW groups increased energy expenditure by 1 KKW until they reached the appointed dose

Medical Outcomes Study (MOS) Sleep Scale was used to assess sleep quality during the previous 4-weeks. A modified Sleep Problems Index (SPI) was also used to assess overall sleep quality. SPI scores >25 were used to indicate significant sleep disturbance

Socio-demographic factors, anthropometric measures, medication use, health behaviors, diet, cardiorespiratory fitness, heart rate variability

After adjustment: (1) a significant effect of the intervention was found with reported sleep quality, (2) a linear dose–response effect was found with reported sleep quality across treatment groups, (3) compared to the control group, the exercise groups all had a lower odds of having significant sleep disturbance, and (4) the odds of having significant sleep disturbance decreased across increasing exercise doses


x (sleep quality)

x (sleep disturbances)


Mansikkamäki et al. 2012 [59]a

176 inactive women, aged 40–63 years with no current or recent (<3 months) hormone therapy use, and 6 to 36 months since last menstruation

Exercise Program: aerobic training, 4 times per week for 50 min each time for 6-months. Participants were asked to include at least 2 sessions of walking or Nordic walking per week

Reported sleep was obtained via 1-item included on a mobile phone administered questionnaire. Participants responded to the question, “how well did you sleep last night” via 5 response options ranging from poor to good

Socio-demographic factors, health behaviors, anthropometrics

Sleep quality improved significantly more in the exercise vs. control group. The odds for sleep improvement were 2 % in the exercise group compared to −0.5 % in the control group. Women randomized to the intervention also reported significantly fewer hot flushes disturbing their sleep than the control group


x (sleep quality)


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 exertion every 5–10 min

Sleep quality and sleep disturbances were ascertained via the Pittsburgh Sleep Quality Index (PSQI) and insomnia symptoms were collected using the Insomnia Severity Index (ISI)

Socio-demographics, anthropometrics, daily diaries assessing vasomotor symptoms, health history, and anxiety

After 12-weeks, compared to the usual activity group, exercise group participants reported greater improvement in sleep quality and insomnia symptoms


x (sleep quality)

x (insomnia symptoms)

  1. aPhysical activity dose reflective of 2008 Physical Activity Guidelines for Americans [3]