Effect of physical activity on sleep in women experiencing vasomotor symptoms during menopause: a systematic review and meta-analysis

Abstract

Hot flashes and night sweats, common vasomotor symptoms (VMS) during menopause, are strongly associated with poor sleep quality and disorders. Physical activity is proposed as a strategy to improve menopausal health and sleep outcomes. This systematic review and meta-analysis synthesizes and evaluates evidence on the relationship between physical activity and sleep parameters in women experiencing VMS. Comprehensive searches were conducted in October 2024 across multiple databases, including MEDLINE/PubMed, Cochrane Library, and EMBASE, alongside manual backward and forward searches. Randomized controlled trials (RCTs) investigating physical activity or exercise interventions and their effects on subjective and objective sleep outcomes in women with VMS were included. The risk of bias was assessed using the revised Cochrane RoB 2 tool, and data were pooled for meta-analysis. Nine studies with a total of 1579 participants were analyzed. Physical activity interventions did not significantly improve sleep quality (-0.03 [-1.23, 1.18]; P = 0.96; I² = 78 %) or insomnia (-1.65 [-3.52, 0.21]; P = 0.08; I² = 0 %) but produced minor improvements in sleep problems (-0.08 [-0.16, -0.00]; P = 0.04; I² = 0 %). Despite concerns regarding bias, none of the studies were classified as high-risk, supporting result reliability. The findings suggest heterogeneity in the effects of physical activity on sleep, influenced by intervention-specific factors like type, frequency, intensity, timing, and duration. Environmental variables may also moderate these outcomes, highlighting the complexity of sleep regulation and the need for tailored approaches to improve sleep in menopausal women. Review protocol is registered in PROSPERO: CRD42024599593.

Keywords: Climacteric; Exercise; Hot flashes; Sleep wake disorders; Women's health.