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Results of the preintervention and postintervention KMI scores for the three groups: control, passive stretching, and yoga. ‡ Comparison between the preintervention and postintervention time points for each group; # postintervention comparison of the groups ( P G 0.05). KMI, Kupperman Meno- 

Results of the preintervention and postintervention KMI scores for the three groups: control, passive stretching, and yoga. ‡ Comparison between the preintervention and postintervention time points for each group; # postintervention comparison of the groups ( P G 0.05). KMI, Kupperman Meno- 

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The practice of yoga has been proven to have positive effects on reducing insomnia. Studies have also shown its effects on reducing climacteric symptoms. To date, however, no studies that evaluate the effects of yoga on postmenopausal women with a diagnosis of insomnia in a randomized clinical trial have been conducted. The aim of this study was to...

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... session, she was asked to make it up on another day so that all of the participants would finish the study without a significant number of absences. The yoga sequence used was based on yogasana and some Tibetan techniques and is known as yoga HT for menopause. The technique uses stretching positions ( asanas ) along with strong and fast breathing, called bellows breathing ( bhastrika ). The practice ended with a directed relaxation. 29 The following questionnaires were used in the study: the BAI, which evaluates anxiety symptoms on four levels ranging from 0 (not at all) to 3 (severely); the BDI, which comprises 21 questions that assess depressive symptoms on a scale from 0 to 3, in which a higher score indicates more severe symptoms 30 ; the KMI, an instrument based on the weight/size addition of climacteric symptoms rated on a scale of mild, moderate, or severe 31 ; the ISI, a questionnaire that evaluates the last 2 weeks of sleep, in which a higher score indicates more severe insomnia 32 ; the MENQOL, 33 a questionnaire with 32 items scored from 0 (not at all bothered) to 6 (extremely bothered); and ISSL, which evaluates the physical and psychological symptoms related to stress levels in the last 24 hours (alert phase), the last week (resistance phase), or the last month (exhaustion phase). 34 A psychologist who was not involved in the study administered the questionnaires at the beginning of treatment and 4 months after the intervention. Overnight recording polysomnography was performed in the sleep laboratory using the Sleep Analyzing Computer, version 8.1 (Embla). The examination included an electro- encephalogram, an electromyogram of the submental and tibial regions, an electrooculogram, an electrocardiogram, measure- ments of oronasal airflow and thoracic-abdominal movement, and a recording of body position and oximetry. After the examination, a physician who specializes in polysomnography evaluated the sleep stages according to the criteria described by Rechtschaffen and Kales. 35 The respiratory events, awaken- ings, and periodic limb movements were analyzed according to the criteria established by the Committee of the American Academy of Sleep Medicine. 36 The volunteers slept in the laboratory two nights for data collection: one night before the intervention and one night 4 months later. The statistical program SPSS (version 17 for Windows) was used for the data analyses. Means and SDs were used to characterize the groups. A general linear model of repeated measures was used to investigate the effects on the scores of the questionnaires. Of the 213 women who initially contacted our service, 83 met the inclusion criteria and were referred for polysomnography. Of these, 22 volunteers were excluded for having an apnea-hypopnea index greater than 15. Before the intervention, some volunteers left after they had been allocated to the groups. One volunteer in the control group had no interest in the study and, therefore, did not begin the procedure. Six volunteers did not begin the group passive-stretching sessions: one was excluded because she began treatment with fluox- etine, one was not interested, two volunteers did not have the time availability, one volunteer had her period, and one volunteer had a health problem and began a treatment program that prevented her from remaining in the study. Nine volunteers in the yoga group did not begin the treatment because of the following reasons: three of them lived too far from the location where the procedure was conducted, three did not have the time availability, two had no interest, and one left without providing any justification. No adverse effects were reported for the procedures (Fig. 1). Forty-four volunteers enrolled in and completed the study. The passive-stretching group had a significantly lower score for the exhaustion phase of stress when compared with the control group, but not with the yoga group; however, no other differences were detected among the groups in the pretreatment stage (Table 1). The evaluation of the treatment effect for each group when the pretreatment and posttreatment stages were compared showed that the yoga group experienced major improvements in the parameters evaluated, including a significant reduction in their BAI, BDI, KMI, ISI, and MENQOL scores and in the three phases of stress (alert, resistance, exhaustion) evaluated by the ISSL. The passive-stretching group had a significant reduction only in the ISI score, whereas the control group had a small but significant reduction in the symptoms of the alert phase of stress (Tables 1 and 2). In evaluating only the posttreatment phase, the yoga group did not differ from the passive-stretching group in any of the parameters. It did, however, present significantly lower KMI, ISI, MENQOL, and ISSL resistance phase scores when compared with the control group. The ISI had a time  group interaction; that is, the three groups had simultaneously significant effects (Fig. 2). Figure 3 shows that both the yoga and the passive-stretching groups improved after treatment. However, only the yoga group presented with a significant difference in the ISI scores posttreatment when compared with the waiting-list control group, thus presenting with better results than the passive-stretching group. Figure 3 shows that there was a significant difference between the yoga and control groups in the posttreatment KMI scores. Regarding quality of life, a significant reduction can be observed in the MENQOL scores of the yoga group compared with the control group (Fig. 4). The polysomnography did not detect significant intergroup or intragroup differences. Sleep disorders are highly prevalent in menopause, affecting between 28% and 63% of women. 7,37 < 39 Insomnia is related to lower quality of life 40 and a higher frequency of comorbid- ities. 41,42 The present study found that yoga yielded the best results for reducing postmenopausal insomnia-related complaints. This is the first study in the literature that demonstrates the benefits of yoga for postmenopausal women diagnosed with insomnia. Many women discontinue HT because it is contraindicated or because they choose to after experiencing vasomotor symptoms. Many of them resort to alternative and complementary practices in their search for relief of their unpleasant symptoms. 43 Vasomotor symptoms are the most common complaint among climacteric women, and they are also the factor that most threatens their well-being. These symptoms can trigger a B domino effect, [ leading to other symptoms, such as insomnia and depression, and can negatively affect the quality of life of the women who experience them. 44 The results of the present study corroborate those of previous research, in which women who practiced yoga experienced a reduction in climacteric symptoms. 15,45 The MENQOL and the KMI scores showed significant posttreatment differences between the yoga group and the control group, and the yoga group showed significant improvement in their sleep and mental health, as assessed by analysis of pretreatment and posttreatment scores. Comparisons with the passive-stretching group showed no such effect. Carson et al 46 compared a yoga group with a wait-list control of women with breast cancer, a population whose climacteric symptoms are exacerbated and for whom HT is contraindicated. They observed a reduction in climacteric symptoms, which included severity and frequency of hot flashes, joint pain, fatigue, sleep disorders, and low vitality. Similar findings were found in a pilot study 17 in which a yoga sequence was used to treat menopausal symptoms in 12 women between 45 and 60 years old. The women in that study had a reduction in the symptoms of the menopausal transition, according to the Wiklund Symptom Checklist, and had improvements in quality of sleep (evaluated subjectively), sleep efficiency, sleep disorders, and global sleep quality, according to the Pittsburgh Quality of Sleep Index. Although those studies detected sleep pattern improvements, these interventions did not work with women diagnosed with insomnia. Cohen et al 18 reported a similar effect in a pilot study with women who had moderate-to-severe hot flashes. Our study also detected improvement in hot flashes and pain on the KMI and reduced ISI scores. The program was so successful that 75% of the volunteers continued doing yoga after the intervention. The sleep improvement in the studies mentioned above might be partially related to the symptoms presented by the volunteers in those studies (mainly vasomotor symptoms) because they may cause a worsening of sleep quality. 47 Two other studies have reported similar results related to the quality of sleep in the older individuals. Researchers have observed that, with regard to sleep parameters, a yoga group responded better than did both an ayurveda group (who ingested an Indian compound of medicinal herbs) and a wait- list control. 21 The yoga group also had improved sleep when compared with a group that performed physical exercise. 22 We hypothesize that the improvements our volunteers experienced were probably due to alterations in the central, autonomic, and neuroendocrine nervous systems. 48 < 50 Brown and Gerbarg, 51 in a comprehensive literature review, postu- lated a neurophysiological model for yoga’s treatment of stress, anxiety, and depression. According to the authors, there is an increase in autonomic tone and systems of response to stress, a reduction in chemoreflex sensitivity, an increase in the sensitivity of the baroreflex response, a predominance of the parasympathetic system via vagus nerve stimulation, a synchronization of the cortical areas mediated by the thalamic nuclei, a reduction in the cortical areas involved in executive functions, an activation of the limbic system, and an increase in the secretion of prolactin and oxytocin. Research conducted with a homogeneous sample of individuals from the military ...
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... with strong and fast breathing, called bellows breathing ( bhastrika ). The practice ended with a directed relaxation. 29 The following questionnaires were used in the study: the BAI, which evaluates anxiety symptoms on four levels ranging from 0 (not at all) to 3 (severely); the BDI, which comprises 21 questions that assess depressive symptoms on a scale from 0 to 3, in which a higher score indicates more severe symptoms 30 ; the KMI, an instrument based on the weight/size addition of climacteric symptoms rated on a scale of mild, moderate, or severe 31 ; the ISI, a questionnaire that evaluates the last 2 weeks of sleep, in which a higher score indicates more severe insomnia 32 ; the MENQOL, 33 a questionnaire with 32 items scored from 0 (not at all bothered) to 6 (extremely bothered); and ISSL, which evaluates the physical and psychological symptoms related to stress levels in the last 24 hours (alert phase), the last week (resistance phase), or the last month (exhaustion phase). 34 A psychologist who was not involved in the study administered the questionnaires at the beginning of treatment and 4 months after the intervention. Overnight recording polysomnography was performed in the sleep laboratory using the Sleep Analyzing Computer, version 8.1 (Embla). The examination included an electro- encephalogram, an electromyogram of the submental and tibial regions, an electrooculogram, an electrocardiogram, measure- ments of oronasal airflow and thoracic-abdominal movement, and a recording of body position and oximetry. After the examination, a physician who specializes in polysomnography evaluated the sleep stages according to the criteria described by Rechtschaffen and Kales. 35 The respiratory events, awaken- ings, and periodic limb movements were analyzed according to the criteria established by the Committee of the American Academy of Sleep Medicine. 36 The volunteers slept in the laboratory two nights for data collection: one night before the intervention and one night 4 months later. The statistical program SPSS (version 17 for Windows) was used for the data analyses. Means and SDs were used to characterize the groups. A general linear model of repeated measures was used to investigate the effects on the scores of the questionnaires. Of the 213 women who initially contacted our service, 83 met the inclusion criteria and were referred for polysomnography. Of these, 22 volunteers were excluded for having an apnea-hypopnea index greater than 15. Before the intervention, some volunteers left after they had been allocated to the groups. One volunteer in the control group had no interest in the study and, therefore, did not begin the procedure. Six volunteers did not begin the group passive-stretching sessions: one was excluded because she began treatment with fluox- etine, one was not interested, two volunteers did not have the time availability, one volunteer had her period, and one volunteer had a health problem and began a treatment program that prevented her from remaining in the study. Nine volunteers in the yoga group did not begin the treatment because of the following reasons: three of them lived too far from the location where the procedure was conducted, three did not have the time availability, two had no interest, and one left without providing any justification. No adverse effects were reported for the procedures (Fig. 1). Forty-four volunteers enrolled in and completed the study. The passive-stretching group had a significantly lower score for the exhaustion phase of stress when compared with the control group, but not with the yoga group; however, no other differences were detected among the groups in the pretreatment stage (Table 1). The evaluation of the treatment effect for each group when the pretreatment and posttreatment stages were compared showed that the yoga group experienced major improvements in the parameters evaluated, including a significant reduction in their BAI, BDI, KMI, ISI, and MENQOL scores and in the three phases of stress (alert, resistance, exhaustion) evaluated by the ISSL. The passive-stretching group had a significant reduction only in the ISI score, whereas the control group had a small but significant reduction in the symptoms of the alert phase of stress (Tables 1 and 2). In evaluating only the posttreatment phase, the yoga group did not differ from the passive-stretching group in any of the parameters. It did, however, present significantly lower KMI, ISI, MENQOL, and ISSL resistance phase scores when compared with the control group. The ISI had a time  group interaction; that is, the three groups had simultaneously significant effects (Fig. 2). Figure 3 shows that both the yoga and the passive-stretching groups improved after treatment. However, only the yoga group presented with a significant difference in the ISI scores posttreatment when compared with the waiting-list control group, thus presenting with better results than the passive-stretching group. Figure 3 shows that there was a significant difference between the yoga and control groups in the posttreatment KMI scores. Regarding quality of life, a significant reduction can be observed in the MENQOL scores of the yoga group compared with the control group (Fig. 4). The polysomnography did not detect significant intergroup or intragroup differences. Sleep disorders are highly prevalent in menopause, affecting between 28% and 63% of women. 7,37 < 39 Insomnia is related to lower quality of life 40 and a higher frequency of comorbid- ities. 41,42 The present study found that yoga yielded the best results for reducing postmenopausal insomnia-related complaints. This is the first study in the literature that demonstrates the benefits of yoga for postmenopausal women diagnosed with insomnia. Many women discontinue HT because it is contraindicated or because they choose to after experiencing vasomotor symptoms. Many of them resort to alternative and complementary practices in their search for relief of their unpleasant symptoms. 43 Vasomotor symptoms are the most common complaint among climacteric women, and they are also the factor that most threatens their well-being. These symptoms can trigger a B domino effect, [ leading to other symptoms, such as insomnia and depression, and can negatively affect the quality of life of the women who experience them. 44 The results of the present study corroborate those of previous research, in which women who practiced yoga experienced a reduction in climacteric symptoms. 15,45 The MENQOL and the KMI scores showed significant posttreatment differences between the yoga group and the control group, and the yoga group showed significant improvement in their sleep and mental health, as assessed by analysis of pretreatment and posttreatment scores. Comparisons with the passive-stretching group showed no such effect. Carson et al 46 compared a yoga group with a wait-list control of women with breast cancer, a population whose climacteric symptoms are exacerbated and for whom HT is contraindicated. They observed a reduction in climacteric symptoms, which included severity and frequency of hot flashes, joint pain, fatigue, sleep disorders, and low vitality. Similar findings were found in a pilot study 17 in which a yoga sequence was used to treat menopausal symptoms in 12 women between 45 and 60 years old. The women in that study had a reduction in the symptoms of the menopausal transition, according to the Wiklund Symptom Checklist, and had improvements in quality of sleep (evaluated subjectively), sleep efficiency, sleep disorders, and global sleep quality, according to the Pittsburgh Quality of Sleep Index. Although those studies detected sleep pattern improvements, these interventions did not work with women diagnosed with insomnia. Cohen et al 18 reported a similar effect in a pilot study with women who had moderate-to-severe hot flashes. Our study also detected improvement in hot flashes and pain on the KMI and reduced ISI scores. The program was so successful that 75% of the volunteers continued doing yoga after the intervention. The sleep improvement in the studies mentioned above might be partially related to the symptoms presented by the volunteers in those studies (mainly vasomotor symptoms) because they may cause a worsening of sleep quality. 47 Two other studies have reported similar results related to the quality of sleep in the older individuals. Researchers have observed that, with regard to sleep parameters, a yoga group responded better than did both an ayurveda group (who ingested an Indian compound of medicinal herbs) and a wait- list control. 21 The yoga group also had improved sleep when compared with a group that performed physical exercise. 22 We hypothesize that the improvements our volunteers experienced were probably due to alterations in the central, autonomic, and neuroendocrine nervous systems. 48 < 50 Brown and Gerbarg, 51 in a comprehensive literature review, postu- lated a neurophysiological model for yoga’s treatment of stress, anxiety, and depression. According to the authors, there is an increase in autonomic tone and systems of response to stress, a reduction in chemoreflex sensitivity, an increase in the sensitivity of the baroreflex response, a predominance of the parasympathetic system via vagus nerve stimulation, a synchronization of the cortical areas mediated by the thalamic nuclei, a reduction in the cortical areas involved in executive functions, an activation of the limbic system, and an increase in the secretion of prolactin and oxytocin. Research conducted with a homogeneous sample of individuals from the military who were given doses of melatonin 49 detected an increase in the levels of that hormone, which plays an important role in sleep and is a regulator of biological rhythms, in the group that had practiced yoga. 52 < 54 There are data to suggest that the practice of yoga leads to an increase in the brain concentrations of ...
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... ISI had a time  group interaction; that is, the three groups had simultaneously significant effects (Fig. 2). Figure 3 shows that both the yoga and the passive-stretching groups improved after treatment. However, only the yoga group pre- sented with a significant difference in the ISI scores posttreat- ment when compared with the waiting-list control group, thus presenting with better results than the passive-stretching group. ...
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... only the yoga group pre- sented with a significant difference in the ISI scores posttreat- ment when compared with the waiting-list control group, thus presenting with better results than the passive-stretching group. Figure 3 shows that there was a significant difference be- tween the yoga and control groups in the posttreatment KMI scores. Regarding quality of life, a significant reduction can be observed in the MENQOL scores of the yoga group compared with the control group (Fig. 4). ...

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... The characteristics of studies included in the review are shown in table 1. Overall, the systematic review comprised 295 individuals from three countries (Brazil, (15,33,34) United Kingdom (35) and United States of America), (36,37) who were aged 30 to 85 years (Table 1). In five studies, participant recruitment was based on a clinical diagnosis of insomnia (15,33,34,36,37) obtained via a structured interview conducted by a sleep medicine specialist, as per Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) (38) and/or International Classification of Sleep Disorders (ICSD-2) criteria. ...
... Overall, the systematic review comprised 295 individuals from three countries (Brazil, (15,33,34) United Kingdom (35) and United States of America), (36,37) who were aged 30 to 85 years (Table 1). In five studies, participant recruitment was based on a clinical diagnosis of insomnia (15,33,34,36,37) obtained via a structured interview conducted by a sleep medicine specialist, as per Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) (38) and/or International Classification of Sleep Disorders (ICSD-2) criteria. In the remaining study, enrollment was based on research diagnostic criteria and whether this tool was applied by a physician was not reported. ...
... Domains with higher risk of bias were blinding of participants and researchers, blinding of outcome assessment, allocation concealment and incomplete outcome data ( Figure 2). Generation of sequence of randomization: three studies failed to describe methods used for random sequence generation (15,33,36) and therefore had unclear risk of bias. The three remaining studies used stratified, block (35,37) or computer randomization and were classified as low risk of bias. ...
Article
Full-text available
Objective: To systematically review the effects (benefits and harms) of different types of physical exercise on insomnia outcomes in adult populations with no mood disorders. Objective and subjective sleep outcomes and related mismatches were analyzed. Methods: Systematic review and meta-analysis. Quality of evidence was also examined. Results: Six studies including 295 participants with insomnia diagnosis were selected. Yoga, Tai Chi, resistance exercise and aerobic exercise were used in protocols with different duration, intensity and frequency. Studies involved different populations, including inactive or sedentary individuals, older adults and postmenopausal women. Physical exercise improved subjective sleep quality (very low quality of evidence) and reduced insomnia severity (high quality of evidence). Conclusion: Findings suggest individualized physical exercise must be addressed to design optimal protocols, with standardized type, duration, intensity, and frequency. For the time being, physical exercise may be considered an alternative and/or ancillary therapeutic modality for patients diagnosed with insomnia. Physical exercise can be used to improve subjective complaints, but not objective sleep outcomes.
... Other studies on menopausal symptoms and sleep quality had yoga periods of 4 weeks (Fara et al., 2019), 8 weeks (Chattha et al., 2008), 12 weeks (Jorge et al., 2016), and 16 weeks (Afonso et al., 2012). However, most of these studies did not compare the effects of yoga on menopausal symptoms across menopause statuses or explore their relationship with sleep quality in Indonesian women. ...
... Physiologically, yoga exercises help reduce oxygen consumption in women by stabilizing their heart rate and blood pressure (Cohen et al., 2007); an unstable heart rate and blood pressure are common in menopausal women. Our results are consistent with those of studies reporting that yoga effectively reduces menopausal symptoms in perimenopausal women after 8 weeks (Chattha et al., 2008) and in postmenopausal women after 12 weeks (Jorge et al., 2016) and 16 weeks (Afonso et al., 2012). Our study revealed a significant decrease (which occurred slowly and consistently) in the menopausal symptoms of premenopausal women who practiced yoga; however, sleep quality did not change significantly (Table 3). ...
Article
Full-text available
This randomized controlled trial investigated the effects of yoga on menopausal symptoms and sleep quality across menopause statuses. Participants were randomly assigned to either the intervention or control group (n = 104 each), and those in the intervention group practiced yoga for 20 weeks. The participants completed the following questionnaires: The Depression, Anxiety, and Stress Scale; Multidimensional Scale of Perceived Social Support; Menopause Rating Scale; and Pittsburgh Sleep Quality Index. The results revealed that yoga effectively decreased menopausal symptoms, with the strongest effects noted in postmenopausal women (mean ± standard deviation: 14.98 ± 7.10), followed by perimenopausal women (6.11 ± 2.07). Yoga significantly improved sleep quality in postmenopausal and perimenopausal women after controlling for social support, depression, anxiety, stress, and menopausal symptoms (p < 0.001). However, yoga did not affect sleep quality in premenopausal women. Overall sleep quality significantly improved in postmenopausal (p < 0.001) and perimenopausal women (p < 0.001). Our data indicate that yoga can help decrease menopausal symptoms, particularly in perimenopausal and postmenopausal women, and improve their health.
... Afonso et al. compared Yoga with passive stretching and no intervention, showing a reduction of subjective insomnia severity with Yoga. PSG details are not reported but are described as not different between groups [36]. In two other studies, actigraphy was used to measure sleep, and no objective effect was observed with Yoga. ...
Article
Full-text available
Background: Chronic insomnia disorder (CI) is a prevalent sleep disorder that can lead to disturbed daytime functioning and is closely associated with anxiety and depression. First-choice treatment is cognitive behavioral therapy (CBT-I). Other mind-body interventions, such as Tai-chi and Yoga, have demonstrated subjective improvements in sleep quality. The purpose of this study was to assess the efficacy of Yoga for improvement of subjective and objective sleep quality as well as measures of anxiety, depression, sleepiness, and fatigue in patients with CI. Methods: Adults with CI were prospectively included in this single group pre-post study. Baseline assessments included home polysomnography (PSG), 7-day actigraphy, and questionnaires (Pittsburgh Sleep Quality Index questionnaire (PSQI), Hospital Anxiety Depression scale (HADS), Epworth Sleepiness Scale (ESS), Pichot fatigue scale (PS)). Patients practiced Viniyoga, an individualised Yoga practice with daily self-administered exercises, for 14 weeks. Assessments were repeated at the end of Yoga practice. Results: Twenty-one patients completed the study. Objective sleep measurements revealed no change in PSG parameters after Yoga practice, but a decrease in arousals on actigraphy (p < 0.001). Subjective symptoms improved for all questionnaires (PSQI, p < 0.001; HAD-A, p = 0.020, HAD-D, p = 0.001, ESS, p = 0.041, PS, p = 0.010). In univariate correlations, decrease in PSQI was associated with increase in sleep stage N3 (p < 0.001) on PSG. Conclusions: We have demonstrated a positive impact of individualized Yoga practice on subjective parameters related to sleep and daytime symptoms in CI, resulting in fewer arousals on actigraphy. Yoga could be proposed as a potentially useful alternative to CBT-I in CI, as it is easy to practice autonomously over the long-term. However, given the design of the present study, future prospective controlled studies should first confirm our results. Trial registration: ClinicalTrials.gov identifier: NCT03314441 , date of registration: 19/10/2017.
... Two of these articles had been conducted in India 25,26 and four in United States of America. [27][28][29][30] The Menopausal Quality of Life Questionnaire (MENQOL) was used in three studies [26][27][28] to assess women's quality of life and the World Health Organization Quality of Life-BREF in the other three. 25,29,30 To assess the effect of yoga on women's quality of life, the yoga sessions were 60 to 90 min long in all six studies, while the duration of these sessions varied in other studies from 20 and 30 min to 75 min, and in most included studies, the sessions were held once or twice per week. ...
... Two of these articles had been conducted in India 25,26 and four in United States of America. [27][28][29][30] The Menopausal Quality of Life Questionnaire (MENQOL) was used in three studies [26][27][28] to assess women's quality of life and the World Health Organization Quality of Life-BREF in the other three. 25,29,30 To assess the effect of yoga on women's quality of life, the yoga sessions were 60 to 90 min long in all six studies, while the duration of these sessions varied in other studies from 20 and 30 min to 75 min, and in most included studies, the sessions were held once or twice per week. ...
... 25,29,30 To assess the effect of yoga on women's quality of life, the yoga sessions were 60 to 90 min long in all six studies, while the duration of these sessions varied in other studies from 20 and 30 min to 75 min, and in most included studies, the sessions were held once or twice per week. 25,27,29,30 Table 2 presents the details of the studies conducted on the effect of yoga on women's quality of life. ...
Article
Introduction The quality of life in menopausal women is considered to be an important health issue in different societies and one of the main objectives of health care in this period. This study aimed to investigate the effects of yoga on improving the quality of life in menopausal women. Method English databases of Google Scholar, Science Direct, PubMed, Scopus, and Cochrane Library were searched to access related articles using keywords of menopause, quality of life, and yoga. Furthermore, Persian equivalents of the same keywords were searched in databases of Google Scholar, SID, and Magiran, in addition to a combination of the keywords. The search interval was from the inspection to January 2020. The quality of the included studied was assessed based on CONSORT 2017 checklist. Results Out of 120 articles found in the databases, six articles entered the study based on the inclusion criteria and were investigated for intervention methods and consequences. The results indicated the positive impact of yoga on the quality of life in menopausal women. Conclusion Considering the effects of yoga on the symptoms and quality of life in menopausal women, it is suggested that this low-cost method be used to improve their quality of life and health.
... Sleep hygiene education, mindfulness, yoga, weight loss programs, and changing the color temperature of workplace fluorescent lighting were not effective in improving both insomnia symptoms and presenteeism. These interventions can improve subjective insomnia symptoms, but they do not improve objective insomnia symptoms or are unknown [21,22,37,38]. It remains unclear whether these interventions improve functioning in daily life due to insomnia symptoms. ...
Article
Full-text available
Background Sleep problems interfere with work performance. Decreased work productivity due to health problems is defined as presenteeism. Although empirical data on the improvement of presenteeism by sleep interventions have been published, a systematic review elucidating whether there is a difference in the improvement of presenteeism across various types of sleep interventions has not yet been published. This systematic review of studies aimed to clarify which sleep interventions are more likely to be effective in improving presenteeism. Methods The electronic databases PubMed, PsycINFO, and MEDLINE were used to perform a literature search (the start and end search dates were October 20, 2019, and March 11, 2020, respectively). A combination of terms such as “employee*,” “sleep,” “insomnia,” and “presenteeism” was used for the search. Both randomized and non-randomized control trials were included in this systematic review. Results Six types of sleep interventions were identified, including cognitive behavioral therapy for insomnia (CBT-I), sleep hygiene education, yoga, mindfulness, weight loss program, and changing the color temperature of fluorescent lights in the workplace. Only CBT-I improved both sleep problems and presenteeism compared with a control group. The results of this review also show that there is heterogeneity in the measurement of presenteeism. Conclusions The results of this systematic review suggested that CBT-I could be adapted for workers with sleep problems and presenteeism. We discussed whether CBT-I improved both sleep problems and presenteeism compared with other interventions. In addition, methods for measuring presenteeism in future research are proposed.
... Yoga also motivated the young adults to be more active outside of yoga, increased their physical ability to be active, and served as a complement to an active lifestyle. Moreover, the effect on sleep found in this study is consistent with yoga research demonstrating the positive effect of yoga on insomnia in postmenopausal women (Afonso et al., 2012). Still unknown, is if there are specific types of yoga or yoga instruction that make it more likely for this type of transference to occur. ...
Article
Full-text available
The purpose of this study was to explore how yoga impacts body-related thoughts, feelings, perceptions and attitudes, well-being, and self-care behaviors in a sample of middle-aged women who regularly engage in yoga in their communities. The sample included 22 women; 10 self-identified as beginners or novices and 12 self-identified as experienced in yoga. Interpretive phenomenological analysis guided the data collection, analysis, and interpretation. Four key themes were identified around the topics of: supportive yoga environment, mindfulness, self-care behaviors, and body-related perceptions. Results highlight potential elements of yoga that can support positive body-related experiences in middle-aged women.
... Different from traditional physical exercise, mind-body exercise, characterized by gentle and slow exercise with the coordination of the body and breath (22), has received recent attention in scientific research. Varied literatures suggest that mind-body exercise (e.g., yoga, tai chi, qigong) also had beneficial effects for general health and sleep (23)(24)(25). Overall, exercise intervention shows potential superiority and promising development among non-pharmacological treatments for ameliorating insomnia and improving sleep quality, which require wider practice and application in the future. ...
... All studies were published between 1995 and 2019, involving 1,806 participants. The majority of studies included mixed-gender groups, seven studies focused on women only and, of these, one involved post-partum women (34), and five involved peri-or post-menopausal women (24,25,38,39,43). For exercise types, 13 trials performed physical exercise, and 11 trials performed mind-body exercise. ...
... Total duration of exercise programs ranged from 2 to 12 months with respective frequency and length of sessions. Of these 22 articles, subjective sleep quality was assessed in 14 studies with the PSQI scale, in four studied with the ISI scale (20,25,27,43), and in two studies with the ESS scale (28,33). Six studies physiological sleep conditions by the use of Actigraphy (27-29, 35, 39, 41). ...
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Study Objectives: We conducted a meta-analysis to assess the effects of different regular exercise (lasting at least 2 months on a regular basis) on self-reported and physiological sleep quality in adults. Varied exercise interventions contained traditional physical exercise (e.g., walking, cycling) and mind–body exercise characterized by gentle exercise with coordination of the body (e.g., yoga). Methods: Procedures followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Systematical searches were conducted in three electronic databases (PubMed, Embase, and Web of Science) for relevant research that involved adult participants without pathological diseases receiving exercise intervention. The search strategy was based on the population, intervention, comparison, and outcome study design (PICOS) framework. The self-reported outcomes included varied rating scales of Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), and Epworth Sleepiness Scale (ESS). Subgroup meta-analyses of PSQI scores were conducted based on type of exercise, duration of intervention, and participants' age and gender. The physiological outcomes were measured by Actigraph. All meta-analyses were performed in a fixed or random statistic model using Revman software. Results: Twenty-two randomized controlled trials were included in the analysis. The overall analysis on subjective outcomes suggests that exercise interventions significantly improved sleep quality in adults compared with control interventions with lower PSQI (MD −2.19; 95% CI −2.96 to −1.41), ISI (MD −1.52; 95% CI −2.63 to −0.41), and ESS (MD −2.55; 95% CI −3.32 to −1.78) scores. Subgroup analyses of PSQI scores showed both physical and mind–body exercise interventions resulted in improvements of subjective sleep to the same extent. Interestingly, short-term interventions (≤3 months) had a significantly greater reduction in sleep disturbance vs. long-term interventions (>3 months). Regarding physiological sleep, few significant effects were found in various sleep parameters except the increased sleep efficiency in the exercise group vs. control group. Conclusions: Results of this systematic review suggest that regular physical as well as mind–body exercise primarily improved subjective sleep quality rather than physiological sleep quality in adults. Specifically, self-reported sleep quality, insomnia severity, and daytime sleepiness could be improved or ameliorated with treatment of exercise, respectively, evaluated by PSQI, ISI, and ESS sleep rating scales.
... Additionally, all participants who inhaled lavender had increased vigor and a feeling of rest on the day after exam. 4 During the menopausal transition, reduced estrogen can produce vasomotor symptoms that worsen sleep quality. 16 , 22 Improvements in these symptoms have already been observed with the use of medications 42 or with the use of CIM, such as yoga 43 and meditation. 44 In our study, AG participants showed a significant decrease in total MRS score and in the somato-vegetative domain over time. ...
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Background: To evaluate the effect of Lavandula angustifolia essential oil inhalation on sleep and menopausal symptoms in postmenopausal women with insomnia. Participants: 35 postmenopausal women with a clinical diagnosis of insomnia were included, 17 in Aroma Group (AG) and 18 in Placebo Group (PG). Methods: In this double-blind, randomized controlled trial, PG participants inhaled sunflower oil and AG participants inhaledLavandula angustifolia essential oil, for 29 days. Both groups received sleep hygiene guidelines before the intervention and weekly follow-up during it. Evaluations were performed before and after intervention. All statistical analyses and intention-to-treat test were performed in SPSS 22. Sleep quality (Primary outcome) was measured by Pittsburgh Sleep Quality Index. Secondary outcomes were polysomnography data, severity of insomnia, anxiety and depression symptoms, and postmenopausal symptoms. Results: There were no significant differences between groups after intervention in the primary outcome (P = 0.22; effect size=0.69); however, a tendency of improvement in wake after sleep onset (WASO) was observed (P = 0.07; effect size=0.81; B = 42.2). Both groups presented better sleep quality over time (AG P < 0.001; PG P = 0.011). AG participants showed a significant decrease in sleep onset latency (P = 0.001), depression levels (P = 0.025), hot flashes (P < 0.001), postmenopausal symptoms (P < 0.001) and, in polysomnography data, increased sleep efficiency (P = 0.002) compared to baseline. Conclusion: Although no significant differences were observed between groups, our data presented a tendency of improvement in WASO. Moreover, AG participants had enhanced overall sleep pattern, quality and sleep efficiency. Weekly follow-up and sleep hygiene instructions were essential for both groups to show improvement in almost all outcomes. Clinical trial registration: Brazilian Registry of Clinical Trials, www.ensaiosclinicos.gov.br, RBR-5q5t5z.
... 1 The British Association of Psychopharmacology suggests that the first indication for insomnia should be cognitive behavioral therapy. 13 The use of complementary and integrative practicessuch as mindfulness meditation, 14 exercise, 15 and yoga 16 -are increasingly being encouraged, with some positive results being reported in relation to reducing the symptoms of insomnia. The current research team has investigated the effects of complementary practices in postmenopausal women who have insomnia, with significant positive results. ...
... The current research team has investigated the effects of complementary practices in postmenopausal women who have insomnia, with significant positive results. 14,16,17 One recent possible nonpharmacological approach that has been suggested is based on the use of probiotics in relationship to the gut-brain axis. Scientific focus on this area has been increasing because of the suggested importance of enteric microbiota in relation to many aspects of health. ...
Context: According to the criteria of the International Classification of Sleep Disorders (ICSD-3), it is estimated that the prevalence of insomnia in the general population varies between 6.6% and 12%. Insomnia is a sleep disturbance related to a reduction in the quality or quantity of satisfactory sleep. Among the available treatments, there are both pharmacological and non-pharmacological approaches. One recent possible non-pharmacological approach that has been suggested is based on the use of probiotics and the gut-brain axis. There has been increasing scientific focus on this area because of the suggested importance of enteric microbiota in relation to many aspects of health. It has been proposed that probiotics can be used to interact with the intestinal environment to benefit individuals suffering from a variety of conditions. In relation to sleep, some studies have indicated that gamma-amino butyric acid (GABA) produced by the intestinal microbiota may influence the central nervous system (CNS) through the vagus nerve and have an influence on sleep. In this sense, Lactobacillus is one of the major GABA producing bacteria in the gut microbiota. Objective: Our hypothesis is that supplementation with Lactobacillus as a probiotic might improve sleep pattern and quality, acting as an ally in the treatment of insomnia. Design: In the present study, a search was conducted in Pubmed and Google Scholar databases, looking for articles with themes related to probiotics, intestinal microbiota and sleep. Results: No clinical trials were found that evaluated the effect of probiotics for sleep disorders in humans.Conclusions • Research and clinical use of probiotics have been growing due to their health benefits in several areas. In addition, the use of probiotics for sleep and emotional disorders, such as insomnia, stress, anxiety and depression, is gaining space. This way, future research can help developing complementary treatments for people with insomnia and other sleep disorders.
... 70 Furthermore, yoga practice has also been reported to be helpful in primary insomnia, 71 and it was shown to improve sleep in elderly people, 72 cancer patients, 73 and women with menopausal symptoms. 74 However, European guidelines for the diagnosis and treatment of insomnia 14 do not recommend yoga for the treatment of insomnia because of poor evidence. ...
Article
Introduction Prevalence of insomnia is higher in females and increases with higher age. Besides primary insomnia, comorbid sleep disorders are also common, accompanying different conditions. Considering the possible adverse effects of commonly used drugs to promote sleep, a nonpharmacologic approach should be preferred in most cases. Although generally considered first‐line treatment, the nonpharmacologic approach is often underestimated by both patients and physicians. Objective To provide primary care physicians an up‐to‐date approach to the nonpharmacologic treatment of insomnia. Methods PubMed, Web of Science, and Scopus databases were searched for relevant articles about the nonpharmacologic treatment of insomnia up to December 2020. We restricted our search only to articles written in English. Main message Most patients presenting with sleep disorder symptoms can be effectively managed in the primary care setting. Primary care physicians may use pharmacologic and nonpharmacologic approaches, while the latter should be generally considered first‐line treatment. A primary care physician may opt to refer the patient to a subspecialist for refractory cases. Conclusions This paper provides an overview of current recommendations and up‐to‐date evidence for the nonpharmacologic treatment of insomnia. This article emphasizes the importance of cognitive‐behavioral therapy for insomnia, likewise, exercise and relaxation techniques. Complementary and alternative approaches are also covered, e.g., light therapy, aromatherapy, music therapy, and herbal medicine.