Structural and Functional Alterations in Postmenopausal women with insomnia: An MRI Study of Eight-Section Vajra Exercise Intervention Effects

Xiangbin Chen^1*Kun Wang²Xiaoying Xu³YUXI LI¹Yu Gao⁴Jiamin Yuan⁵Biyun Xu⁵Shijun Qiu^2,6*Fei Tan^5*Zhimin Yang^6,7*

• ¹The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
• ²First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China
• ³Guangzhou Yuexiu District Renmin Street Community Health Service Center, Guangzhou, China
• ⁴Second Clinical Medical College, Guangzhou University of Traditional Chinese Medicine, Guangzhou, Guangdong Province, China
• ⁵The Second Affiliated Hospital, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
• ⁶State Key Laboratory of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
• ⁷Guangdong Provincial Hospital of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China

Abstract 24 Background:Postmenopausal women exhibit heightened vulnerability to chronic insomnia due to 25 estrogen decline and age-related neural alterations. While non-pharmacological interventions are 26 preferred for long-term management, the neuroplastic mechanisms underlying exercise-based 27 therapies remain poorly characterized. 28 Methods:This study examines the effects of Eight-Section Vajra Exercise (ESVE) on brain structure 29 and function in postmenopausal women with insomnia (PMWI) using multimodal MRI. A 12-week 30 ESVE training program was completed by PMWI patients, followed by clinical assessments (PSQI, 31 ISI, PHQ-9, GAD-7, FSS, MoCA) and neuroimaging (fMRI and structural MRI). Data analysis 32 involved gray matter volume (GMV), ALFF/fALFF, ReHo, degree centrality (DC), and functional 33 connectivity (FC) using advanced MRI processing techniques (CAT12, SPM12, DPABI). Group 34 comparisons and correlations were adjusted for age, education, and intracranial volume. 35 Result:Among the 24 PMWI patients and 30 healthy controls (HCs), baseline measures showed 36 significantly worse sleep and mood scores in PMWI. Resting-state fMRI revealed reduced 37 ALFF/fALFF in the right precentral gyrus and decreased ReHo in sensorimotor areas. Changes in 38 functional connectivity (FC) were noted, with altered connections between precentral gyrus, temporal 39 and parietal regions. After 12 weeks of ESVE, 78.95% of PMWI patients were medication-free, with 40 post-treatment fMRI showing improved neural activity and connectivity, correlating with clinical 41 improvement. Exercise adherence positively correlated with sleep quality improvement (r = 0.508-42 0.594, P < 0.05). Responders showed significant improvements in sleep compared to non-responders 43 (P < 0.05). 44 Conclusion: ESVE alleviates postmenopausal insomnia through PreCG-centered sensorimotor-45 visual network reorganization, potentially compensating for estrogen-dependent neurocircuitry 46 vulnerabilities. Exercise-induced GMV increases in occipitotemporal regions suggest enhanced 47 sleep-related memory consolidation. Our findings indicate that ESVE is a potential neuromodulatory 48 intervention and identify PreCG-MOG connectivity as a promising biomarker for personalized 49 insomnia management.(Clinical trial registration number: ChiCTR2300078176, registered on 50 November 30, 2023, accessible at ChiCTR (http://www.chictr.org.cn).)