Effect of Aerobic Exercise on Sleep, Depression, and Quality of Life in Postmenopausal Women

Subjects and criteria

The present study was an experimental study design. The study was approved by the Delhi Pharmaceutical Sciences and Research University (DPSRU) School of Physiotherapy Research Committee. Potential participants were screened for eligibility. The inclusion criteria included being a PMW who was willing to participate and being 45–60 years old, having the onset of menopause for at least 2 years, having body mass index (BMI) in the range of 25–30 kg/m², being able to converse in Hindi or English, attending DPSRU outpatient department, and having Pittsburgh sleep quality index (PSQI) scores >5 and beck depression inventory (BDI) scores >11. The exclusion criteria included: Subjects with orthopedic or neurological problems that might affect their compliance to participate in the study, PMW taking sleeping pills, with a history of recent surgery, and the presence of systemic, respiratory, or cardiovascular disease.

Procedure

Following their enrollment in the trial, 50 PMW were given a thorough explanation, and their informed consent was obtained. Following baseline evaluations, individuals were randomized into two groups using a simple random sampling method: The experimental group (n = 25) undertook a daily regimen of scheduled, supervised aerobic exercise on a treadmill, whereas the control group (n = 25) walked regularly but unsupervised at home. Demographic data, sleep quality, QoL, and mental health were gathered using self-structured questionnaires completed in person. Every participant underwent baseline evaluations, and baseline, 3^rd, and 6^th week data were gathered after the protocol. Figure 1 shows flow of the study.

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Figure 1:

Flowchart of study.

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Outcome measures

PSQI: A widely used self-report tool for measuring sleep quality over a month. It has 19 items total that are divided into seven categories: Subjective quality of sleep, sleep latency, length, habitual efficiency of sleep, sleep disruptions, usage of sleep drugs, and dysfunction throughout the day. Higher scores indicate lower sleep quality overall. The total score, which runs from 0 to 21, helps assess overall sleep quality.^[8]

36-item Short-Form Survey (SF-36), an established tool, was used to assess QoL. Eight dimensions are covered by this questionnaire: social functioning, physical functioning, mental health, perceptions of general health, role limits resulting from emotional issues, role restrictions resulting from physical health, and physical pain. An established measure for a thorough evaluation of an individual’s well-being across multiple aspects is the SF-36. Each domain ranges from 0 to l00, l00 being the best score and 0 the worst.^[9]

BDI uses a 21-item scale with a score range of 0–13 to evaluate depressive symptoms. Elevated scores signify an increased level of depression.^[10]

BMI: The formula for calculating a person’s body composition is to divide their weight in kilograms by the square of their height in meters, or BMI. A higher BMI could indicate a larger fat percentage in the body.

Treatments

Data analysis

Values means, and standard deviations were computed through the use of Microsoft Excel and Statistical Package for the Social Sciences software version 24 for analysis of data. Statistical significance was attained when P <0.05. Between-group analysis employed the independent t-test, while within-group analysis utilized Repeated Measure two-way mixed-model analysis of variance (ANOVA) at various levels to assess the impact of aerobic exercise on study variables in the experimental and control groups. Further, the analysis involved pairwise comparisons with Bonferroni correction to scrutinize any statistically significant between-group differences in change scores from baseline to the final treatment session.

Mental health

The BDI scores of both groups showed significant reductions: The experimental group showed a noteworthy 55.6% improvement, indicating improved outcomes and the control group showed a 41.4% increase. Repeated measures ANOVA confirmed substantial changes in the BDI over time for both Control Group B (F[1.97, 47.40] = 215.23, P < 0.05) and Experimental Group A (F[1.16 28.03] = 112.40). Significant improvements were verified by post hoc analysis for both groups at weeks 3 and 6 (P < 0.01).

Body mass index (BMI)

The experimental group’s BMI differed significantly (6.8%) from that of the control group in terms of body composition. A significant reduction in BMI was observed over time for both groups in the repeated measures ANOVA. Experimental: F(1.37, 33.03) = 105.99; Control: F(1.48,35.58) = 96.41, P < 0.05, with gains evident from baseline to week 3 [Table 1].

Quality of life (QoL)

The result in Table 2 revealed significant improvements (P < 0.05) in almost all aspects of QoL (emotional problems, general health, energy/fatigue, social functioning, and physical functioning), exceptional emotional well-being, and pain.

Pittsburgh sleep quality index (PSQI)

Baseline PSQI ratings in this study did not show a significant difference between the experimental and control groups. Still, significant reductions were noted in both groups between the third and the end of the 6^th week, indicating improvements within the group. These results are in line with the study of Cai et al. When compared to the control group, group therapy-based aerobic exercise resulted in a substantial improvement in PSQI in the training group.^[11] Through a number of physiological mechanisms, aerobic exercise has a beneficial effect on sleep. Strong circadian rhythms and the promotion of sleep onset are established by hormonal management, which includes the release of cortisol and melatonin before and after exercise. Better sleep quality is also influenced by the release of endorphins, stress reduction, and metabolism management. Moreover, the amelioration of anxiety and depression symptoms brought on by exercise may indirectly improve general sleep patterns.

The results of this study are consistent with those of Buchanan et al., showing significant but moderate improvements in self-reported insomnia symptoms and sleep quality after aerobic exercise as opposed to routine activities.^[12] The results are consistent with Sternfeld et al., showing that although the changes were small, the exercise group reported higher improvements in subjective sleep quality (P = 0.01) and symptoms of insomnia^[13] (P = 0.03). Furthermore, the outcomes are consistent with Tadayon et al., showing that the intervention group significantly outperformed the control group in terms of improvements in subjective sleep quality, sleep latency, duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and dysfunction during the day after 12 weeks (P < 0.05). The intervention group’s overall sleep quality score was significantly greater than the control group’s.^[14]

Beck depression inventory (BDI)

The BDI scores in the present study significantly reduced from the beginning of the study to the end of the 6^th week. After 8 and 12 weeks, the intervention group’s anxiety and sleeplessness reduced, which is consistent with the findings of Abedi et al.’s study.^[15] By the 12-week point, the intervention group’s depression intensity had significantly diminished. The results also support the findings of Khoshnab and Nikseresht, which showed that interventional groups receiving medicine, exercise, or both had a significant reduction in depression-related variables.^[16]

Long-term aerobic activity may raise plasma concentrations of free tryptophan, which may impact its synthesis and release and account for the reported benefits in depression, according to a number of studies. The observed improvements in depression markers may be explained by the beneficial effects of aerobic exercise on physiological indices of the hypothalamic-pituitary-adrenal axis, such as enhanced brain release of beta-endorphins and monoamines, improved oxygen availability, and decreased stress.^[17]

Body mass index (BMI)

There was a significant difference in BMI between the experimental and control groups by 6.8% at the end of the intervention. Proposed mechanisms are engaging in aerobic activities which use energy from stored fat and glycogen to fuel the exercise, leading to weight loss over time. Consistent aerobic exercise can boost metabolic rate, which is particularly helpful for maintaining weight loss and improving overall body composition. While aerobic exercises primarily target cardiovascular fitness, they can also help preserve lean muscle mass. Preserving muscle is important during weight loss as muscles burn more calories than fat mass, thus supporting your overall efforts to improve BMI.^[13,18]

The results of a study that found that among overweight to obese PMW, moderate-to-vigorous aerobic exercise regimens led to clinically significant and important decreases in body weight and improvements in body composition provide support for the findings of this investigation.^[17]

Quality of life (QoL)

The present study showed improvements in nearly every area of QoL, in contrast to Akwa et al.’s study, which reported no significant differences in several parameters between the sedentary and activity groups of PMW before the experiment.^[19] Improvements were noted in the areas of pain, general health, social health, emotional stability, physical functioning, and general health. These findings are consistent with studies suggesting that QoL may differ depending on one’s geographic location and that QoL may be adversely affected by climacteric symptoms as opposed to menopause itself. While there are arguments that the physical, social, and psychological changes associated with menopause may negatively impact QoL, ethnic variety may also play a role in regional variations in QoL.

Furthermore, the results of this study align with the previous studies indicating that aerobic exercise is superior to resistance exercise in terms of modifying inflammatory cytokines and enhancing QoL in PMW.^[20,21] These findings corroborate those of a study by Nikpour and Haghani, highlighting the positive effects of a regular, controlled exercise program spread over 6 weeks on PMW’s QoL.^[22]