Effects of Yoga and Aerobic Exercise on Actigraphic Sleep Parameters in Menopausal Women with Hot Flashes

Abstract

Study Objectives: To determine effects of yoga and aerobic exercise compared with usual activity on objective assessments of sleep in midlife women. Methods: Secondary analyses of a randomized controlled trial in the Menopause Strategies: Finding Lasting Answers for Symptoms and Health (MsFLASH) network conducted among 186 late transition and postmenopausal women aged 40-62 y with hot flashes. Women were randomized to 12 w of yoga, supervised aerobic exercise, or usual activity. The mean and coefficient of variation (CV) of change in actigraph sleep measures from each intervention group were compared to the usual activity group using linear regression models. Results: Baseline values of the primary sleep measures for the entire sample were mean total sleep time (TST) = 407.5 ± 56.7 min; mean wake after sleep onset (WASO) = 54.6 ± 21.8 min; mean CV for WASO = 37.7 ± 18.7 and mean CV for number of long awakenings > 5 min = 81.5 ± 46.9. Changes in the actigraphic sleep outcomes from baseline to weeks 11-12 were small, and none differed between groups. In an exploratory analysis, women with baseline Pittsburgh Sleep Quality Index higher than 8 had significantly reduced TST-CV following yoga compared with usual activity. Conclusions: This study adds to the currently scant literature on objective sleep outcomes from yoga and aerobic exercise interventions for this population. Although small effects on self-reported sleep quality were previously reported, the interventions had no statistically significant effects on actigraph measures, except for potentially improved sleep stability with yoga in women with poor self-reported sleep quality. Keywords: actigraphy, exercise, insomnia symptoms, menopause, variability, vasomotor symptoms, yoga Citation: Buchanan DT, Landis CA, Hohensee C, Guthrie KA, Otte JL, Paudel M, Anderson GL, Caan B, Freeman EW, Joffe H, LaCroix AZ, Newton KM, Reed SD, Ensrud KE. Effects of yoga and aerobic exercise on actigraphic sleep parameters in menopausal women with hot flashes.

Effect of yoga on sleep quality and insomnia in women with sleep problems: a systematic review and meta-analysis

“…Of the 19 RCTs that were included in Table 1, six RCTs included healthy participants [56][57][58][59][60][61], including nurses [57], teachers [58], and women in the menopausal transition period or postmenopausal period [56,[59][60][61]. Other 13 RCTs included breast cancer patients undergoing treatment [62][63][64][65], breast cancer patients who had completed treatment [13,[66][67][68], type 2 diabetes mellitus patients [69], fibromyalgia patients [70], knee osteoarthritis patients [71], restless leg syndrome patients [72], and patients experiencing dysfunctional uterine bleeding [73].…”

“…Study participants were recruited from hospitals [57, 63-67, 69, 73], outpatient clinics [61,62] and schools [58]. The process of recruitment also included using purchased lists and health-plan enrollment files [56,59] and multiple other mechanisms, including flyers, newspaper advertisements, web-based announcements, brochures, public health departments, tumor registry systems, and doctor referrals [13,60,68,71,72]. One study did not reveal the source from which participants were recruited [70].…”

“…Of the 19 included studies in Table 1, three reported using Iyengar Yoga [13,60,72]; two reported using Hatha Yoga [68,71]; two reported using Tibetan Yoga [61,64]; two reported using Restorative Yoga [66,67]; one reported using Vini Yoga [56]; one reported using Yoga Relaxation with MindSound Resonance Technique [58]; one reported using yoga breathing exercise in warm water [70]; and only seven RCTs revealed yoga programs with postures, breathing, relaxation or mediation, without defining the specific style of yoga [57,59,62,63,65,69,73]. All RCTs included yoga postures in their yoga intervention; 16 RCTs included yoga breathing; 15 RCTs included yoga relaxation; 12 RCTs included meditation; and 7 RCTs included all contents with postures, breathing, relaxation, and meditation for the yoga intervention group [57,59,63,65,67,69,73].…”

“…All studies evaluated outcomes directly at the end of interventions. All studies assessed the subjective or objective measurements of sleep quality: 16 RCTs used the PSQI; three RCTs used the ISI [59,61,67]; one RCT used PSG [61]; and two RCTs used actigraphy [56,64]. Safety-related events were reported in two RCTs only [59,68].…”

Effect of yoga on sleep quality in women: a systematic review and meta-analysis

“…Nineteen full-text articles with 1832 participants were included in the qualitative synthesis. One RCT had unique measurements of sleep quality that could not be compared with other RCTs in the meta-analysis [46]. Finally, 18 fulltext articles with 1646 participants met the inclusion criteria and were included in the meta-analysis.…”