Impact of aerobic exercise on cardiovascular and mental health in postmenopausal women: a systematic review and meta-analysis

IMPORTANCE: The climacteric period, particularly the postmenopausal phase, presents significant risks to women's cardiovascular and mental health due to hormonal changes. Effective interventions are needed to address these challenges and improve clinical outcomes. OBJECTIVE: To evaluate the effects of aerobic exercise on cardiovascular parameters (systolic blood pressure, diastolic blood pressure, lipid profile, and triglycerides) and psychological outcomes (depression and anxiety) in postmenopausal women. EVIDENCE REVIEW: In this systematic review with meta-analysis, four databases (PubMed, Embase, SportDiscus, and PsycINFO) were searched from inception to December 18, 2024. Randomized controlled trials (RCTs) assessing aerobic exercise interventions in postmenopausal women were included. Study selection, data extraction, and risk-of-bias assessments (using RoB 2) were performed by two independent reviewers, with discrepancies resolved by a third. Certainty of evidence was evaluated using GRADE. FINDINGS: The review included 61 RCTs with 4,100 women (2,356 exercise and 1,744 control). Aerobic exercise reduced systolic blood pressure by 4.5 mm Hg (95% CI: -6.5 to -2.4) and diastolic blood pressure by 2.4 mm Hg (95% CI: -3.8 to -1.1). high-density lipoproteincholesterol increased by 2.4 mg/dL (95% CI: 1.0 to 3.8), while low-density lipoprotein cholesterol and triglycerides decreased by 3.6 mg/dL (95% CI: -6.1 to -1.1) and 7.7 mg/dL (95% CI: -11.9 to -3.5), respectively. No significant effect was found for total cholesterol. Aerobic exercise reduced anxiety scores by 0.2 SDs (95% CI: -0.3 to -0.03), but the effects on depression were not statistically significant. CONCLUSION AND RELEVANCE: Aerobic exercise significantly improves cardiovascular health by reducing blood pressure, low-density lipoprotein cholesterol, and triglycerides, while increasing high-density lipoprotein cholesterol in postmenopausal women. Its positive effects on anxiety highlight its role in addressing mental health. These findings support aerobic exercise as a recommended intervention to mitigate health risks in this population and emphasize the need for further research on long-term, hard outcomes.