Table 1.

Selected studies of physical activity and vasomotor symptoms

Observational Studies
Reference	Study Design	Sample	Physical Activity Measure	Symptom Measure	Other Variables	Main Findings
Collins et al, 199511	Cross-sectional survey	Population-based sample of 1,324 Swedish women, 48 yrs old, varying menopausal status	Participation in regular exercise (yes/no)	Menopause Symptom Inventory (frequency of symptoms on scale of 1–5)	—	No relation between physical activity and vasomotor symptoms; inverse relation with negative mood, direct relation with well-being
Daley et al, 200715	Cross-sectional survey	1,206 British women, ages 46–55, from 10 general practices, based on purposeful sampling for location, level of deprivation and practice size	Regularly active or not based on stage of readiness for change in moderate intensity activity 3 or more times a week for 20 minutes of longer each time	Vasomotor symptoms and 8 other domains of heath related quality of life from Women’s Health Questionnaire	—	No relation between physical activity and vasomotor symptoms; inverse relation with depressed mood and somatic symptoms
Elavsky and McAuley, 200512	Cross-sectional survey	133 women, ages 44–60, varying menopausal status	Aerobics Center Longitudinal Study Physical Activity Survey	Menopause Symptom List (frequency and severity of 25 symptoms)	Self-esteem, life satisfaction	Significant inverse association between exercise frequency and frequency and severity of VMS, somatic and total symptoms
Gold et al, 20043, Gold et al, 20064	Prospective cohort study	3,302 racially/ethnically diverse women, ages 42–52, initially in pre- or early peri-menopause	Ordinal ranking of total activity, as measured by Kaiser Physical Activity Survey	Occurrence and frequency of VMS in past 2 weeks	BMI, health status, other confounders	No association between physical activity and VMS, either at baseline or over time
Guthrie et al, 199513	Cross-sectional survey	1,181 Australian women, ages 45–55, of varying menopausal status	MLTPA questionnaires, assessing frequency, duration and intensity of recreational activities in past year	Overall symptoms	BMI, self-rated health	No association between physical activity and vasomotor symptoms or psychological well-being; physical activity directly related to overall health
Guthrie et al, 200520	Prospective cohort study	438 Australian women, ages 45–55, pre-menopausal at baseline	Frequency of exercise on 7 point ordinal scale	Hot flash index based on frequency and severity in past 2 weeks, frequency and bother of somatic symptoms	Health status, BMI, menopausal status, other confounding variables	Daily exercise at baseline significantly associated with 49% lower risk of developing VMS during follow-up
Li and Holm 200324	Cross-sectional survey	239 post-menopausal women	Usual Physical Activity questionnaire	Women’s health Assessment scale	Use of hormone therapy	Non-significant trend for active women to report fewer symptoms than inactive women, within HT stratum (use/no use)
Moilanen et al, 201014	Population-based cross-sectional survey based on a national health examination survey	1,427 Finnish women, ages 45–64, varying menopausal status	Single ordinal question about level of recreational physical activity	Occurrence and bother of various vasomotor, somatic and mood symptoms	Lifestyle factors, medical conditions, other confounding variables	Low physical activity associated with significantly more psychological, somatic and vasomotor symptoms, relative to high physical activity, independently of confounders
Romani et al, 20098	Population-based cross-sectional survey	639 pre- or early-perimenopausal women from Baltimore	Three-level categorical variable regarding usual physical activity (light, moderate, or heavy) at work, home, and for recreation	Frequency, severity and duration of hot flashes	BMI	High level of physical activity associated with increased risk of moderate or severe hot flashes (OR = 2.88, 95% CI, 1.12-7.40 for moderate, OR = 4.16, 95% CI, 18.08, for heavy, p for trend = 0.02) relative to low level, and with non-significant increased risk for any hot flashes, daily hot flashes and hot flashes for more than a year
Slaven and Lee 1997106, Study I and Study II	Cross-sectional	220 Australian women of varying menopausal status in Study I; 47 Australian women of varying menopausal status who were regular exercisers for Study II	Regular exercise defined as participation in aerobic activity at least twice a week for 30 minutes a time for last 3 months; exercisers assessed immediately prior to work-out	Women’s Health Questionnaire	Profile of Mood States	Study I: No relation between physical activity and vasomotor symptoms; inverse relation with depressed mood, anxiety, fears, fatigue, tension, problems with memory and concentration, sexual dysfunction, sleep problems; direct relation with vigor and perceived attractiveness Study II: Fewer vasomotor and somatic symptoms reported following exercise class, independent of change in mood
Sternfeld et al, 199916	Case-control	Cases defined as women 48–52 years old, 3–12 months since LMP with frequent vasomotor symptoms (n = 82), controls same chronological and biological age without vasomotor symptoms (n = 89)	Activity score based on intensity of activity and frequency; separate scores for recreational, occupational and household activity	Case definition based on frequency of VMS	Psychological and somatic symptoms	No relation between physical activity and case status; activity attenuated relation between psychological and vasomotor symptoms
Van Poppel and Brown 200822	Prospective cohort study	3,300 mid-life women participating in 3rd and 4th surveys of the Australian Longitudinal Study on Women’s Health	Change in physical activity based on frequency, duration and intensity of usual physical activity	Vasomotor symptoms, somatic and psychological symptoms, total symptom score	Change in weight	No association between change in physical activity with total symptoms, fasomotor or psychological symptoms; significant, but modest, inverse association with somatic symptoms; weight gain associated with increased total, vasomotor and somatic symptoms and weight loss association with reduction in total and vasomotor symptoms
Whitcomb et al, 20079	Cross-sectional survey	512 peri- and post-menopausal women in Baltimore metropolitan area	Historical physical activity (frequency of participation in moderate and vigorous activities at different ages; activity at 35–39 used to examine long-term effects	History of frequency of hot flashes, summarized as any menopausal hot flashes, daily hot flashes and any moderate or severe hot flashes	History of HT, smoking, BMI	High activity associated with increased risk of moderate to severe hot flashes (adjusted OR = 1.77, p = 0.01) and daily hot flashes (OR = 1.77, p = 0.01), relative to minimal activity; those highly active during 5 year age period prior to LMP had increased risk for moderate to severe hot flashes and for daily hot flashes compared to minimal activity
Wilbur et al, 1990128	Cross-sectional	386 Australian women between ages 34–62 volunteering for bone density study, varying menopausal status	Energy expenditure in recreational, occupational, and housework activity, based on Minnesota Leisure Time Physical Activity survey (LTPA)	Kaufert and Syrotuik Symptom Index (VMS and general health symptoms)	Aerobic fitness	No relation between physical activity and vasomotor symptoms; inverse relation between recreational activity and somatic symptoms and other general health symptoms; direct relation between occupational activity and same outcomes
Aiello et al, 200410	RCT of exercise vs stretching controls	173 sedentary post-menopausal women, ages 50–75, 87 exercisers vs 86 in stretching control group	45 mins moderate-intensity exercise, 5 days/wk for 12 months, 3 months facility-based training and 9 months home-based training	Occurrence and severity of VMS and other symptoms, assessed at baseline, 3, 6, 9 and 12 months	Body fat, sex hormones	No significant differences in occurrence of symptoms; non-significant decrease in occurrence of memory problems in exercise group, non-significant increase in risk of moderate-severe hot flashes (OR = 2.8, 95% CI, 0.8-9.3)
Elavsky and McAuley, 200727	RCT of exercise vs yoga vs control	164 inactive, symptomatic women, ages 42–58, 63 to exercise, 62 to yoga and 39 to control	4 month walking program 3 times a week for an hour, intensity starting at 50% heart rate reserve (HRR), increased to 60–75% HRR; 4 month Iyengar yoga class 2 times a week for 90 mins/class	Greene Climacteric Scale	Fitness, body composition, affect, depression, Utian Quality of Life	Non-significant decreases in VMS in exercise and yoga groups relative to controls; significant increases in positive affect in exercise and yoga groups relative to controls; change in fitness was significant predictor of change in symptoms
Huang et al, 201025	RCT of behavioral weight loss program	338 overweight or obese women with urinary incontinence, 226 to intervention group and 112 to structured education control group	Based on Diabetes Prevention Program and Look AHEAD to achieve 7%–9% weight loss, physical activity goal was to increase to 200 minutes of moderate intensity exercise, mostly brisk walking	Bothersomeness of VMS and other symptoms, assessed at baseline and 56 months	Weight, waist circumference	Of those reporting any symptoms at baseline (n = 99 in intervention and n = 55 in control group), intervention resulted in more than a 2-fold likelihood of improvement in bother of flushing, relative to control group (OR = 2.3, 95% CI, 1.2-4.2), but this was attenuated to non-significance when adjusted for change in body size; decreases in weight and abdominal circumference significantly associated with improvement in reporting of hot flashes
Kemmler et al, 200432	RCT to reduce menopause related bone loss	137 women, ages 48–60 and 1–8 years post-menopause with low BMD; analysis based on 50 in exercise group, 31 in control group who completed study	264 months of exercise 4/wk (2 facility-based group exercise and 2 home-based individual training), 25 minutes/session, including warm-up, endurance, jumping, strength and flexibility exercises	Frequency of hot flashes, other somatic and mood symptoms	Bone density, strength, endurance, blood lipids	Hot flashes improved in both groups with no significant between group difference; improvements in mood and insomnia in exercise group significantly different from no change in control group; significant improvements in fitness, BMD, and blood lipids
Lindh-Astrand et al, 200328	RCT	75 sedentary, naturally post-menopausal women, ages 48–63 with VMS	12 weeks of exercise classes twice a week for 60 minutes, plus additional session on own	Daily frequency and severity of VMS for two weeks at beginning and at end of 12 weeks, plus baseline and follow-up for for one week monthly during extended 24 week follow-up	Kupperman Index, quality of life, mood and general psychological wellbeing	Non-significant decrease in number and severity of hot flashes in exercisers from baseline to 12 weeks; significant pre-post declines in symptom scale
McAndrew et al, 200931	RCT designed to test three different approaches to promotion of physical activity	280 inactive, healthy women, 113 with symptoms at follow-up	12 month three arm design with one arm addressing stage and processes of change in physical activity behavior with tailored feedback (n = 95) vs, educational booklet based on social cognitive theory (n = 93) vs health-related print material on sleep and nutrition (control, n = 92)	MENQOL, administered at month 12 follow-up visit	Self-reported physical activity, depression, exercise self-efficacy, stress	Change in physical activity not associated with VMS; change in PA inversely associated with total symptoms, psychosocial and physical symptoms
Moriyama et al, 200829	2 by 2 RCT of exercise and estrogen therapy	44 hysterectomized women	6 months of moderate aerobic exercise for3 hrs/wk plus hormone therapy (n = 9), exercise and placebo (n = 11), HT and no activity (n = 14) and placebo and no activity (n = 11)	Kupperman index	Health-related quality of life (SF-12)	All groups had declines in symptoms; physical activity significantly associated with increases in physical functioning and decreases in bodily pain relative to no activity, regardless of drug or placebo assignment
Villaverde-Gutierrez et al, 200630	Quasi-experimental (random group assignment, pre-post differences	48 sedentary Spanish women, ages 55–72	12 month program of endurance (50–85% maximum HR), strengthening, flexibility and relaxation exercises, twice a week in supervised classes (n = 24) vs control group (n = 24)	Kupperman Index	Health-related quality of life	Significant decrease in severe symptoms from 50% to 37.5% in exercise group and significant increase in control group; significant improvement in HRQOL in exercise group but decrease in controls
Ueda, 200426	Non-randomized intervention	35 sedentary, symptomatic Japanese women, ages 40–60, 20 in intervention group vs 15 in control group	12 week exercise and menopause education program of one 90 minute class/wk (30 minute lecture, 60 minutes of either aerobic or resistance exercise), plus aerobic exercise twice a week on own	Kupperman index	Quality of life, attitudes towards exercise	22.5% decrease in overall Kupperman index in treatment group vs no change in controls, p<0.5; 32% decrease psychosomatic symptoms in treatment group vs 3% increase in controls, p<.05; non-significant decrease in VMS in intervention group vs control group
Wilbur et al, 200523	RCT	173 sedentary, healthy Caucasian and African American women, ages 45–65	24 week home-based moderate intensity walking program (50– 74% maximal HR), 4 times/week for 30 minutes at a time (n = 97) vs control (n = 66)	Frequency, severity and bother of VMS and other symptoms	BMI	Significant improvement in symptoms in both groups with no differences between groups; adherence to intervention led to significant improvement in sleep symptoms relative to controls