Rehabilitation strategies in post menopausal women: a systematic review and meta-analysis of randomized trials

Women undergo progressive musculoskeletal, cardiovascular, and metabolic changes during menopause that usually end up in less functional capacity, compensatory balance impairment, and reduced quality of lives. The further decrease of estrogen levels heightens the risk of osteoporosis, sarcopenia, and cardiovascular disease, rendering them more vulnerable to functional deterioration because they will all occur after menopause. Recently, rehabilitation and physical exercise-based approaches are recommended as nonpharmacological solutions to fix these health problems. Nevertheless, evidence appears to be inconsistent across studies. The natural evolution of musculoskeletal, cardiovascular, and metabolic changes during the menopause in women is associated with poor functional ability, poor balance, and poor quality of life. This further reduction in the hormone estrogen increases the risk for osteoporosis, sarcopenia, and cardiovascular disease, putting females in a postmenopausal state at higher threat levels for functional decline. Rehabilitation and exercise-based intervention strategies are commonly prescribed as nonpharmacological ways of combating these health issues. The research evidence seems conflicting among different studies, though.

This systematic review was aimed to detect the effect in the study about rehabilitation and exercise-based interventions on functional performance, musculoskeletal health, cardiovascular outcomes, balance, the health and quality of life of postmenopausal women.

Systematic review and Meta-Analysis based on randomised controlled trials.

Randomised controlled trials published between 2015 and 2025 were found by searching electronic resources such as PubMed, Scopus, PEDro, the Cochrane Library, and Google Scholar. The Cochrane Risk of Bias-2 tool was used to assess bias risk, and the PEDro scale was used to evaluate methodological quality.

In total, 20 randomized controlled trials have been included for quantitative synthesis, with particular studies pooling to contribute to each meta-analysis. The exercise-based rehabilitation interventions showed considerable improvements in vasomotor symptoms. The meta-analysis indicated a large pooled effect favouring exercise interventions under a random-effects model (SMD = -0.862; 95% CI -1.154 to -0.570; p < 0.001; I² = 0.34%), suggesting a high level of consistency across studies. However, exercise did not show any significant pooled effect concerning the following variables: body mass index (SMD = -0.729; 95% CI -1.754 to 0.297; p = 0.163; I² = 94.68%), blood pressure (SMD = 0.186; 95% CI -0.204 to 0.577; p = 0.347; I² = 25.16%), or physical performance outcomes (SMD = -0.483; 95% CI -1.238 to 0.272; p = 0.209; I² = 90.24%). Heterogeneity was substantial for BMI and physical performance outcomes and, thus, varied by intervention type, intervention duration, and outcome measures between studies. Generally, exercise and rehabilitation interventions showed the most consistent and clinically relevant outcomes in terms of reducing vasomotor symptoms in postmenopausal women, while effects on metrics such as anthropometry, cardiovascularity, and physical performance varied across interventions.

Postmenopausal women can benefit from rehabilitation and exercise therapy; these are evidence-based nonpharmacological approaches for improved physical functioning, cardiovascular health, and quality of life.