A yoga & exercise randomized controlled trial for vasomotor symptoms: Effects on heart rate variability. Evidence-based review of therapies at the menopause. A pilot study of a Hatha yoga treatment for menopausal symptoms. Yoga of Awareness program for menopausal symptoms in breast cancer survivors: results from a randomized trial Menopausal quality of life: RCT of yoga, exercise, and omega-3 supplements. Effect of yoga on menopausal symptoms Effects of Yoga and Aerobic Exercise on Actigraphic Sleep Parameters in Menopausal Women with Hot Flashes. Yoga as a complementary treatment for smoking cessation: rationale, study design and participant characteristics of the Quitting-in-Balance study Comparison of yoga versus stretching for chronic low back pain: protocol for the Yoga Exercise Self-care (YES) trial Physiological and psychological effects of Hatha-Yoga exercise in healthy women. Yoga decreases insomnia in postmenopausal women: a randomized clinical trial
OBJECTIVES Heart rate variability ( HRV ) reflects the integration of the parasympathetic nervous system with the rest of the body . Studies on the effects of yoga and exercise on HRV have been mixed but suggest that exercise increases HRV . We conducted a secondary analysis of the effect of yoga and exercise on HRV based on a r and omized clinical trial of treatments for vasomotor symptoms in peri/post-menopausal women . DESIGN R and omized clinical trial of behavioral interventions in women with vasomotor symptoms ( n=335 ) , 40 - 62 years old from three clinical study sites . INTERVENTIONS 12-weeks of a yoga program , design ed specifically for mid-life women , or a supervised aerobic exercise-training program with specific intensity and energy expenditure goals , compared to a usual activity group . MAIN OUTCOME MEASURES Time and frequency domain HRV measured at baseline and at 12 weeks for 15min using Holter monitors . RESULTS Women had a median of 7.6 vasomotor symptoms per 24h .  Time and frequency domain HRV measures did not change significantly in either of the intervention groups compared to the change in the usual activity group . HRV results did not differ when the analyses were restricted to post-menopausal women . CONCLUSIONS Although yoga and exercise have been shown to increase parasympathetic-mediated HRV in other population s , neither intervention increased HRV in middle-aged women with vasomotor symptoms . Mixed results in previous research may be due to sample differences . Yoga and exercise likely improve short-term health in middle-aged women through mechanisms other than HRV Background and Objective The highest level of scientific evidence available for each therapy for menopausal symptoms was sought , for example , systematic review s of r and omised controlled trials ( RCTs ) . Results There is reasonable evidence that some symptoms are modified by lifestyle , for example , cessation of smoking , exercise , reduction of alcohol , diet and alleviation of psychosocial stress . No complementary medicine , for example , phytoestrogens , black cohosh , herbal or homeopathic medicines or complementary therapies , for example , acupuncture , yoga , chiropractic manipulation , reflexology or magnetic devices have a greater effect than the usual placebo effect seen in quality blinded RCTs . Some have potential side-effects . So-called ' bioidentical hormones ' have no evidence -base and potential for harm . None of the above therapies have evidence of efficacy and long-term safety . Selective serotonin and noradrenaline re-uptake inhibitors ameliorate vasomotor symptoms and sometimes menopausal depression better than placebo . The most effective therapy for menopausal ( oestrogen ) deficiency symptoms is oestrogen which is the main component of hormone replacement therapies ( HRT ) . Compared with placebo HRT is highly effective in relieving hot flushes , night sweats , dry vagina and dyspareunia . It also improved joint pains , sexuality and sleeplessness and reduced subsequent fractures in RCTs . The increased risk of oral HRT for thromboembolism is small around menopause , for those without thrombotic risk factors , and is not elevated with non-oral routes . Cardiovascular disease may be reduced when HRT is initiated near menopause . Breast cancer risk increases after several years with the use of oral HRT containing progestogens at an annual rate of 8/10 000 ( < 0.1 % ) . No increase in breast cancer risk was seen with oestrogen-only HRT OBJECTIVE To assess the feasibility and efficacy of a yoga treatment for menopausal symptoms . Both physiologic and self-reported measures of hot flashes were included . METHODS A prospect i ve within-group pilot study was conducted . Participants were 12 peri- and post-menopausal women experiencing at least 4 menopausal hot flashes per day , at least 4 days per week . Assessment s were administered before and after completion of a 10-week yoga program . Pre- and post-treatment measures included : Severity of question naire-rated menopausal symptoms ( Wiklund Symptom Check List ) , frequency , duration , and severity of hot flashes ( 24-h ambulatory skin-conductance monitoring ; hot-flash diary ) , interference of hot flashes with daily life ( Hot Flash Related Daily Interference Scale ) , and subjective sleep quality ( Pittsburgh Sleep Quality Index ) .  Yoga classes included breathing techniques , postures , and relaxation poses design ed specifically for menopausal symptoms . Participants were asked to practice at home 15 min each day in addition to weekly classes . RESULTS Eleven women completed the study and attended a mean of 7.45 ( S.D. 1.63 ) classes . Significant pre- to post-treatment improvements were found for severity of question naire-rated total menopausal symptoms , hot-flash daily interference ; and sleep efficiency , disturbances , and quality . Neither 24-h monitoring nor accompanying diaries yielded significant changes in hot flashes . CONCLUSIONS The yoga treatment and study procedures were feasible for midlife women . Improvement in symptom perceptions and well being warrant further study of yoga for menopausal symptoms , with a larger number of women and including a control group Goal of workBreast cancer survivors have limited options for the treatment of hot flashes and related symptoms . Further , therapies widely used to prevent recurrence in survivors , such as tamoxifen , tend to induce or exacerbate menopausal symptoms . The aim of this preliminary , r and omized controlled trial was to evaluate the effects of a yoga intervention on menopausal symptoms in a sample of survivors of early-stage breast cancer ( stages IA – IIB ) . Material s and methods Thirty-seven disease-free women experiencing hot flashes were r and omized to the 8-week Yoga of Awareness program ( gentle yoga poses , meditation , and breathing exercises ) or to wait-list control . The primary outcome was daily reports of hot flashes collected at baseline , posttreatment , and 3 months after treatment via an interactive telephone system . Data were analyzed by intention to treat . Main results At posttreatment , women who received the yoga program showed significantly greater improvements relative to the control condition in hot-flash frequency , severity , and total scores and in levels of joint pain , fatigue , sleep disturbance , symptom-related bother , and vigor . At 3 months follow-up , patients maintained their treatment gains in hot flashes , joint pain , fatigue , symptom-related bother , and vigor and showed additional significant gains in negative mood , relaxation , and acceptance . Conclusions This pilot study provides promising support for the beneficial effects of a comprehensive yoga program for hot flashes and other menopausal symptoms in early-stage breast cancer survivors OBJECTIVE The purpose of this study was to determine the efficacy of 3 nonhormonal therapies for the improvement of menopause-related quality of life in women with vasomotor symptoms . STUDY DESIGN We conducted a 12-week 3 × 2 r and omized , controlled , factorial design trial . Peri- and postmenopausal women , 40 - 62 years old , were assigned r and omly to yoga ( n = 107 ) , exercise ( n = 106 ) , or usual activity ( n = 142 ) and also assigned r and omly to a double-blind comparison of omega-3 ( n = 177 ) or placebo ( n = 178 ) capsules . We performed the following interventions : ( 1 ) weekly 90-minute yoga classes with daily at-home practice , ( 2 ) individualized facility-based aerobic exercise training 3 times/week , and ( 3 ) 0.615 g omega-3 supplement , 3 times/day . The outcomes were assessed with the following scores : Menopausal Quality of Life Question naire ( MENQOL ) total and domain ( vasomotor symptoms , psychosocial , physical and sexual ) . RESULTS Among 355 r and omly assigned women who average age was 54.7 years , 338 women ( 95 % ) completed 12-week assessment s.  Mean baseline vasomotor symptoms frequency was 7.6/day , and the mean baseline total MENQOL score was 3.8 ( range , 1 - 8 from better to worse ) with no between-group differences . For yoga compared to usual activity , baseline to 12-week improvements were seen for MENQOL total -0.3 ( 95 % confidence interval , -0.6 to 0 ; P = .02 ) , vasomotor symptom domain ( P = .02 ) , and sexuality domain ( P = .03 ) scores . For women who underwent exercise and omega-3 therapy compared with control subjects , improvements in baseline to 12-week total MENQOL scores were not observed . Exercise showed benefit in the MENQOL physical domain score at 12 weeks ( P = .02 ) . CONCLUSION All women become menopausal , and many of them seek medical advice on ways to improve quality of life ; little evidence -based information exists . We found that , among healthy sedentary menopausal women , yoga appears to improve menopausal quality of life ; the clinical significance of our finding is uncertain because of the modest effect Objectives . To observe the effect of yoga on  menopausal symptoms  using a prospect i ve , r and omized , controlled and interventional study . Main outcome measures . Total Menopause Rating Scale ( MRS ) score and three subscale scores ( somatovegetative , psychological and urogenital ) were measured on day 1 and day 90 in the study group which performed yoga ( asana , pranayam and meditation ) under supervision for three months , and were compared with the control group that did not perform yoga .  MRS has been design ed to measure health-related quality of life of ageing women . It consists of 11 symptoms and three subscales . Results . It was observed that on day 1 the scores in both the groups were comparable . On day 90 , the scores in the yoga group showed a reduction in score on all the subscales , which was statistically significant . No significant difference was noted in the control group . Conclusion . Yoga is effective in reducing menopausal symptoms and should be considered as alternative therapy for the management of menopausal symptoms STUDY OBJECTIVES To determine effects of yoga and aerobic exercise compared with usual activity on objective assessment s of sleep in midlife women . METHODS Secondary analyses of a r and omized 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 r and omized 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 Background Tobacco smoking remains the leading preventable cause of death among American women .  Exercise has shown promise as an aid to smoking cessation because it reduces weight gain and weight concerns , improves affect , and reduces nicotine withdrawal symptoms and cigarette craving . Studies have shown that the practice of yoga improves weight control , and reduces perceived stress and negative affect . Yoga practice also includes regulation of breathing and focused attention , both of which may enhance stress reduction and improve mood and well-being and may improve cessation outcomes . Methods / Design This pilot efficacy study is design ed to examine the  rates of cessation among women r and omized to either a novel , 8-week Yoga plus Cognitive Behavioral Therapy ( CBT ) smoking cessation intervention versus a Wellness program plus the same CBT smoking cessation intervention . Outcome measures include 7-day point prevalence abstinence at end of treatment , 3 and 6 months follow up and potential mediating variables ( e.g. , confidence in quitting smoking , self-efficacy ) . Other assessment s include measures of mindfulness , spirituality , depressive symptoms , anxiety and perceived health ( SF-36 ) . Discussion Innovative treatments are needed that address barriers to successful  smoking cessation among men and women . The design chosen for this study will allow us to explore potential mediators of intervention efficacy so that we may better underst and the mechanism(s ) by which yoga may act as an effective complementary treatment for smoking cessation . If shown to be effective , yoga can offer an alternative to traditional exercise for reducing negative symptoms that often accompany smoking cessation and predict relapse to smoking among recent quitters . Trial Registration Clinical Trials Background Back pain , one of the most prevalent conditions afflicting American adults , is the leading reason for using complementary and alternative medicine ( CAM ) therapies . Yoga is an increasingly popular " mind-body " CAM therapy often used for relieving back pain and several small studies have found yoga effective for this condition . This study will assess whether yoga is effective for treating chronic low back pain compared with self care and exercise and will explore the mechanisms responsible for any observed benefits . Methods / Design A total of 210 participants with low back pain lasting at least 3 months will be recruited from primary care clinics of a large healthcare system based in Seattle . They will be r and omized in a 2:2:1 ratio to receive 12 weekly yoga classes , 12 weekly conventional therapeutic exercise classes of comparable physical exertion , or a self-care book . Interviewers masked to participants ' treatment group will assess outcomes at baseline and 6 , 12 and 26 weeks after r and omization . Primary outcomes will be back-related dysfunction and symptom bothersomeness . In addition , data will be collected on physical measurements ( e.g. , flexion ) at baseline and 12 weeks and saliva sample s will be obtained at baseline , 6 and 12 weeks . Information will be collected on specific physical , psychological , and physiological factors to allow exploration of possible mechanisms of action through which yoga could relieve back pain and dysfunction . The effectiveness of yoga will be assessed using analysis of covariance ( using general estimating equations - GEE ) within an intention-to-treat context . If yoga is found effective , further analyses will explore whether yoga 's benefits are attributable to physical , psychological and /or physiological factors . Conclusions This study will provide the clearest evidence to date about the value of yoga as a therapeutic option for treating  chronic back pain  , and if the results are positive , will help focus future , more in-depth , research on the most promising potential mechanisms of action identified by this study .Trial registration This trial is registered in Clinical Trials.gov , with the ID number of NCT00447668 Hatha-Yoga has become increasingly popular in western countries as a method for coping with stress . However , little is known about the physiological and psychological effects of yoga practice . We measured heart rate , blood pressure , the hormones cortisol , prolactin and growth hormone and certain psychological parameters in a  yoga practicing group and a control group of young female volunteers reading in a comfortable position during the experimental period . There were no substantial differences between the groups concerning endocrine parameters and blood pressure . The course of heart rate was significantly different , the yoga group had a decrease during the yoga practice . Significant differences between both groups were found in psychological parameters . In the personality inventory the yoga group showed markedly higher scores in life satisfaction and lower scores in excitability , aggressiveness , openness , emotionality and somatic complaints . Significant differences could also be observed concerning coping with stress and the mood at the end of the experiment . The yoga group had significant higher scores in high spirits and extravertedness Objective 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 r and omized clinical trial have been conducted . The aim of this study was to evaluate the effect of yoga practice on the physical and mental health and climacteric symptoms of postmenopausal women with a diagnosis of insomnia . Methods Postmenopausal women not undergoing hormone therapy , who were 50 to 65 years old , who had an apnea-hypopnea index less than 15 , and who had a diagnosis of insomnia were r and omly assigned to one of three groups , as follows : control , passive stretching , and yoga . Question naires were administered before and 4 months after the intervention to evaluate quality of life , anxiety and depression symptoms , climacteric symptoms , insomnia severity , daytime sleepiness , and stress . The volunteers also underwent polysomnography .  The study lasted 4 months . Results There were 44 volunteers at the end of the study . When compared with the control group , the yoga group had significantly lower posttreatment scores for climacteric symptoms and insomnia severity and higher scores for quality of life and resistance phase of stress . The reduction in insomnia severity in the yoga group was significantly higher than that in the control and passive-stretching groups . Conclusions This study showed that a specific sequence of yoga might be effective in reducing insomnia and menopausal symptoms as well as improving quality of life in postmenopausal women with insomnia
A recent cross-sectional analysis in the multiethnic Study of Women ’s Health Across the Nation found that 53 % of the participants used some form of CAM ( excluding diet , vitamins , exercise , and prayer ) and that rates of use generally did not vary by menopausal status or by presence of vasomotor symptoms .
Significant improvements were also found in sleep quality ( P = 0.02 ) and
I n the wake of serious health concerns raised by the Women ’s Health Initiative and Heart and Estrogen/ progestin Replacement Study clinical trials , prescriptions for hormone therapy have declined dramatically , leaving many women without effective treatment for menopausal symptoms .
Several nonhormonal pharmacologic therapies have shown promise for reducing vasomotor symptoms , including selective serotonin reuptake inhibitors , gabapentin , and clonidine .
However , most are only modestly effective , and all have side effects that may limit their use .
A number of herbal therapies are marketed to women as being safe and effective in reducing menopausal symptoms , including phytoestrogens , black cohosh , dong quai , evening primrose oil , and red clover .
Still , interest in nonhormonal and particularly in complementary and alternative medicine ( CAM ) therapies for menopausal symptoms remains strong .
The term yoga is derived from the Sanskrit term yuj , meaning Bto yoke^ or Bto unite,^ and the goal of yoga has been described as uniting the body and mind to achieve enlightenment .
Yoga has become increasingly popular outside of India , with a 2008 survey of 5,050 people estimating that 7 % of US adults practice yoga .
Clinical trials have also demonstrated many potential health benefits of yoga , including reductions in blood pressure , dyslipidemia , and insulin resistance .
Although the exact mechanisms of hot flashes remain unknown , physiologic studies have demonstrated that heightened sympathetic nervous system activity plays an important role .
Small uncontrolled studies have shown that yoga increases heart rate variability and decreases oxygen consumption , heart rate , and blood pressure , all indicative of decreased sympathetic activity .
In addition to its biological effects , yoga may also have beneficial psychological effects that could lead women to find physical symptoms less bothersome and /or help them to cope better with changes during menopause .
In this issue of Menopause , Chattha and colleagues report results from one of the largest published trials of yoga for menopausal symptoms .
Despite the increasing popularity of yoga , a yoga intervention requiring 60 minutes of supervised instruction five times per week may not be practical for many Western women .