Combined exercise tops the table for menopause sleep

Poor sleep is one of the most common and disruptive complaints of the menopause transition, and many women want an option that does not involve medication. Exercise is routinely recommended, yet the evidence on which type of exercise actually helps has been contradictory. Trials have tested everything from aerobic sessions to yoga-style mind-body practice, usually against a control group rather than against each other. This analysis set out to rank five exercise modalities directly, so that advice could move beyond a vague instruction to simply move more.

The researchers searched five English-language and three Chinese databases for randomised controlled trials published up to July 2024, ending up with 31 trials in perimenopausal and postmenopausal women. They then ran a network meta-analysis, a technique that combines direct and indirect evidence so exercise types can be ranked even when trials never compared them head-to-head. Five exercise modalities were compared for their effect on sleep quality, with the certainty of each finding graded. Effects on quality of life were assessed as well.

Combined exercise came out on top of the rankings with a ranking score of 93.5%, followed by flexibility exercise at 76%; aerobic exercise and mind-body exercise also significantly improved sleep quality. The certainty of the evidence was moderate for combined and mind-body exercise but only low for flexibility and aerobic exercise. Benefits were larger in women aged 55 or under, in those with sleep disorders and in women from Asia. The top-ranked exercise types also showed a positive effect on quality of life.

The result fits the broader picture that exercise helps sleep, but it adds a ranking that previous one-to-one comparisons could not provide. Because many of the comparisons are indirect, the ordering should be held loosely, especially where certainty was graded low. It also remains unclear what dose, frequency and duration of each modality works best, a question the authors flag for future trials. Why women from Asia appeared to benefit more is another open question the analysis cannot answer.

For a woman struggling with sleep through perimenopause or after menopause, this is a reason to think exercise in general, and programmes combining different types of training in particular, can meaningfully improve sleep quality. The finding that women with existing sleep disorders saw larger benefits suggests the people who need help most may have the most to gain. None of this pins down an exact routine, and the evidence behind some modalities is weaker than others, so the direction is encouraging rather than definitive.