Mind-body exercise boosts bone and mood in menopause

As populations age, more attention is falling on how to manage the symptoms and health risks that come with perimenopause and the years after it. Hormone therapy is commonly used to relieve menopausal symptoms, but the authors note it carries a potential risk of cancer, which makes non-drug options attractive. Mind-body exercises — practices that combine movement with attention and breathing, such as tai chi, yoga, Pilates, qigong, baduanjin and mindfulness-based stress reduction — have emerged as candidate approaches for both symptoms and bone health. Previous research findings have been inconsistent, which is exactly the situation a systematic review is designed to resolve.

The researchers systematically searched four electronic databases — PubMed, Embase, the Cochrane Central Register of Controlled Trials, and Web of Science — from inception until July 2023. They included only randomised controlled trials testing mind-body exercise interventions in perimenopausal and postmenopausal women. The outcomes of interest were bone mineral density, sleep quality, anxiety, depression and fatigue. Methodological quality of the included studies was assessed using the Cochrane risk of bias tool, and 11 trials comprising 1,005 participants made it into the analysis.

Compared with control groups, mind-body exercise significantly improved bone mineral density, with a standardised mean difference of 0.41 and notably consistent results across trials (I2 of 7%). Sleep quality also improved (SMD -0.48), as did anxiety (SMD -0.80), depressive mood (SMD -0.80) and fatigue (SMD -0.67, with an I2 of 0%). However, the heterogeneity between studies was high for several outcomes — 76% for sleep, 84% for anxiety and 79% for depression — meaning the trials disagreed considerably on how large those benefits were. All pooled effects reached statistical significance.

This meta-analysis pulls together a trial literature that had been inconsistent, and it lands on a positive answer across five different outcomes. The bone mineral density result is arguably the most striking, because gentle, low-impact practices are not what most people associate with bone adaptation, and that finding showed low heterogeneity. The high heterogeneity on the mood and sleep outcomes leaves open questions about which specific practice, at what frequency and for how long, drives the benefit. Head-to-head comparisons between modalities were not part of this analysis.

For women navigating perimenopause or the postmenopausal years, this is a reason to think practices like yoga, tai chi or Pilates may offer measurable benefits beyond relaxation — spanning bone health, sleep, mood and energy. It is also a reminder that the size of those benefits varied a lot between trials, so expectations should stay modest. Anyone weighing these approaches against or alongside medical options such as hormone therapy should discuss it with their clinician.