In April 2022, using simple random sampling, total of 2,076 women aged 45–55 years old in Chengdong Community, Fengshan Ecological Park Community and Bayi Community of Lianhuachi Street in Binhe Street, Lishi District, Luliang City were investigated by perimenopausal symptoms questionnaire. After the respondents signed the informed consent, the investigators used structured questionnaires to investigate the respondents. The questionnaire was designed with the question form method. To ensure the quality of the questionnaire, the questionnaire was filled out with detailed instructions and explanations from the investigators before filling in the questionnaire. After the informed consent of the respondents, the concerns of privacy disclosure and other aspects were eliminated, and the active cooperation of the respondents was obtained. For those with low education level who could not complete the questionnaire independently, the investigators read each item and the respondents checked the corresponding options after thinking independently. After the completion of the return are reviewed, the missing items face to face explanation and ask to fill back. A total of 974 women with anxiety, 839 women with depression and 1,505 women with insomnia (including the coexistence of three symptoms) were screened. According to the inclusion and exclusion criteria, 289 participants were finally identified, including 39 participants with anxiety only, 43 participants with depression only, 51 participants with insomnia only, 38 participants with anxiety and depression, 42 participants with anxiety and insomnia, 52 participants with depression and insomnia, and 24 participants with anxiety and depression and insomnia. The total number of patients with anxiety was 143, with an average age of 51.4 ± 4.7 years; the total number of patients with depression was 157, with an average age of 51.7 ± 4.3 years; and the total number of patients with insomnia was 169, with an average age of 52.2 ± 4.6 years. There was no significant difference between the ages of each group (F = 1.25, P = 0.29). Inclusion criteria: (1) Perimenopausal symptoms (menstrual disorders, vertigo, palpitations, headache, tinnitus, facial flushing, anxiety, depression, insomnia, etc.) in the past 6 months, in line with perimenopausal diagnosis. (2) Junior high school degree or above, have certain ability to read and understand words, be able to follow the command and be able to fill in the questionnaire independently. (3) Healthy and no history of skeletal-related diseases. (4) all study subjects had no relevant special training basis at the beginning of this training. (5) Voluntary participation in this study. Exclusion criteria: (1) Suffering from mental illness and severe vision, hearing impairment. (2) Patients with heart, lung, liver, kidney and other organ diseases and endocrine system diseases, malignant tumors. (3) Insomnia, anxiety and depression caused by various diseases, environmental changes and major changes. (4) Alcoholics and (or) psychoactive drugs, drug abuse or dependence.

All study subjects completed 16 times aerobics sessions over 8 weeks. On this basis, 113 individuals practiced self-practice ≥3 times/week, 97 individuals practiced 1–2 times/week, and 79 individuals did not practice self-practice. The number of patients with anxiety, depression, and insomnia disorders included in different self-practice frequencies is shown in Table 1. Comprehensive statistics: self-practice ≥3 times/week, 57 anxiety (39.86% of the total anxiety), 59 depression (37.58% of the total depression), 66 insomnia (39.05% of the total insomnia); self-practice 1–2 times/week, 49 anxiety (34.27% of the total anxiety), 52 depression (33.12% of the total depression), 57 insomnia (33.73% of the total insomnia); no self-practice, 37 anxiety (25.87% of the total anxiety), 46 depression (29.3% of the total depression), 46 insomnia (27.22% of the total insomnia). All subjects filled out a complete checklist before and after training.

All subjects completed a total of 16 group aerobics sessions over 8 weeks. After aerobics training intervention, anxiety, depression and sleep disorders of subjects were improved to varying degrees, SAS score, SDS score, PSQI score were significantly lower than before intervention, the score difference was statistically significant (P < 0.01) Table 2. Anxiety scores decreased in 119 of 143 (83.22%) anxiety subjects (P < 0.01); 132 of 157 (84.08%) depression subjects (P < 0.01); and 152 of 169 sleep disorder subjects (89.94%) (P < 0.01).

Among all 289 subjects who participated in the study, 261 had relief of symptoms, and the response rate reached 90.31%. Among them, those with only one symptom before the intervention were relieved after an 8-week aerobics training training intervention; those with both symptoms had a remission rate greater than 80%; and even those with both symptoms had a remission rate of more than 65% (Table 3).

On the basis of group practice, SAS score (P < 0.01), SDS score (P < 0.01) and PSQI score (P < 0.05) were significantly different after aerobics training intervention in patients who practiced autonomously ≥3 times a week, 1–2 times a week and those who did not practice autonomously. The higher the number of spontaneous exercises, the lower the anxiety, depression, insomnia scores (Table 4).

Among the anxious subjects, 56 (98.25%) were relieved of symptoms and accounted for 47.06% of the total remissions in 57 subjects who practiced autonomously ≥3 times/week; 38 (77.55%) were relieved of symptoms and accounted for 31.93% of the total remissions in 49 subjects who practiced autonomously 1–2 times/week; and 25 (67.57%) were relieved of symptoms and accounted for 21.01% of the total remissions in 37 subjects who did not practice autonomously.

Of the depressed subjects, 58 (98.31%) had symptom relief and accounted for 46.4% of the total remissions in 59 subjects who practiced autonomously ≥3 times/week; 41 (78.85%) had symptom relief and accounted for 32.8% of the total remissions in 52 subjects who practiced autonomously 1–2 times/week; and 26 (56.52%) had symptom relief and accounted for 20.8% of the total remissions in 46 subjects who did not practice autonomously.

Among the subjects with sleep disorders, 66 subjects (100%) achieved symptom relief with spontaneous practice ≥3 times/week, accounting for 44.9% of the total remission; 51 subjects (89.47%) achieved symptom relief with 57 subjects (89.47%) with spontaneous practice 1–2 times/week, accounting for 34.69% of the total remission; and 30 subjects (65.22%) achieved symptom relief with 46 subjects (20.41%) without spontaneous practice.

The remission rates of anxiety, depression and sleep disorder symptoms were significantly different in subjects with different frequency of spontaneous practice, and the remission rates of the three symptoms were significantly higher in those with spontaneous practice ≥3 times/week than in those with spontaneous practice 1–2 times/week and those without spontaneous practice (P < 0.01); the remission rates of the three symptoms were significantly higher in those with spontaneous practice 1–2 times/week than in those without spontaneous practice (P < 0.01; Table 5).

Perimenopause represents a delicate transitional period of female life during which physical, emotional, psychological, and social changes mark the progression of women from fertile life to climaterium or reproductive loss, withwide sexual fluctuations until the onset of hypergonadotropic hypogonorrhea (22). It is generally 45–55 years of age and is an important stage in the transition of women from middle to old age. Although neuroendocrine changes during the menopausal transition are varied and complex, the central biological event during this period is gradual ovarian failure, both in the number of follicles and in the quality of oocytes. Because ovarian function gradually deteriorates, causing dysfunction of the hypothalamic-pituitary-ovarian endocrine axis and decreased estrogen levels, about two-thirds of women experience varying degrees of perimenopausal symptoms (23–25). For example, autonomic dysfunction symptoms (palpitations, vertigo, headache, insomnia, tinnitus; skin paresthesia, etc.) (26–28) and psycho-psychological symptoms (irritability, anxiety, depressed mood; memory loss, cognitive decline; depression, inability to self-control mood, etc.) (29–31) as well as cardiovascular system symptoms (menopausal pseudo angina symptoms such as palpitations, chest tightness, precordial discomfort; menopausal hypertension due to emotional instability, poor sleep, dysphoria, etc.) (32–35) directly affect women’s physical and mental health and well-being. Investigations have shown that adult females have 41% higher insomnia rates than males (36). Before puberty, there is no male-to-female difference in the prevalence of insomnia, but with menstruation, the rate of insomnia increases dramatically in women, 2.5 times that in men (37). Before and after natural menopause, the incidence of insomnia disorder in women increased significantly compared with that before menopause. According to the National Women’s Health Study (SWAN), the prevalence of sleep disorders increases with age. The prevalence of sleep disorders varies from 16 to 42% in premenopausal women, 39 to 47% in perimenopausal women, and 35 to 60% in postmenopausal women (38). Lee et al. (39) stated that perimenopausal sleep problems are distinct from other causes of sleep disorders and are mainly characterized by: difficulty falling asleep, frequent awakenings at night, early morning awakenings, and inability to sleep after awakening. In addition to sleep disorders, women entering the perimenopausal period experience a range of neuropsychiatric changes due to alterations and dysregulation of the body’s associated endocrine function, causing psychological dysfunction, mainly manifested as depression and anxiety, and often both symptoms coexist (40). A survey of epidemiology in China showed that perimenopausal women experienced anxiety in 81.58%, mild to moderate anxiety in 68.42%, depression in 85.09%, and mild to moderate depression in 73.68% (41). Mehrnoush et al. (42) showed that menopause is not a high-risk period for mental illness but causes psychological problems, the most common of which are anxiety and depression, which impair their ability to cope with events in daily life and work, and reduce the quality of life of women. Herson et al. (43) have shown that women not only have an increased risk of depression and anxiety during the perimenopausal and menopausal transition (MT) periods, but also experience higher severity of depressive symptoms during the perimenopausal period compared with before and after menopause. The latest Australian mental health data show that mental illness is more prevalent in women than in men, and that women who develop major depression are twice as likely as men (44). However, recurrent endocrinological changes before and after menopause may be responsible for the higher risk of depression from adolescence to old age in women than in men (45). The term anxiety is commonly used to describe a wide variety of symptoms and may include features of various anxiety disorders, such as panic disorder (e.g., sudden feelings of unexplained fear) or generalized anxiety (e.g., excessive and uncontrollable worry, irritability), or physical symptoms, such as shortness of breath and rapid heartbeat. Relatively few studies have been conducted on the relationship between anxiety and menopause (46). However, studies have shown that the menopausal transition is a time of increased risk for the onset or worsening of anxiety symptoms (47), and studies have also demonstrated a significant increase in anxiety symptoms in the perimenopausal period (48).

Exercise, as a low-cost, uncomplicated, and non-invasive non-pharmacologic therapy, not only helps prevent and improve many health problems, such as lowering blood pressure, enhancing cardiovascular fitness, losing weight, and preventing chronic diseases, such as cancer, diabetes, hypertension, obesity, osteoporosis, musculoskeletal pain, and neurodegenerative diseases (Parkinson’s disease, Alzheimer’s disease, and amyotrophic lateral sclerosis, etc.) (49, 50), but also helps improve mental disorders (such as anxiety and depression) and reduce the risk of morbidity (51). In otherwords, exercise promoteswell-being and enhancing mood. Studies have shown that working out and other forms of physical activity have irreplaceable promoting effects on human physical and mental health (52).

Studies have shown that the use of exercise to treat major depression has been recommended in some clinical guidelines (53), suggesting that exercise improves overall health, including depressive symptoms inwomen in their middle-aged and olderyears, according to a recent meta-analysis (54). Similar findings were obtained by Roh (55), where a 16-week Pilates exercise program resulted in significant relief of depressive symptoms in older women. For anxiety, adults over the age of 50 with high levels of physical activity report lower levels of anxiety symptoms and status (56). In a recently published meta-analysis, itwas found that programmed exercise, at a low-to-moderate intensity for at least sixweeks, seems to improve symptoms of mild to moderate anxiety in middle-aged and elderlywomen (57). In addition, Li et al. (58) showed that a 3-month fitness running exercise intervention (3 times/week, 50–70% maximum heart rate) resulted in a significant improvement in depression in depressed women, as shown by a significant decrease in depression handsome selection scale scores, self-rating depression scale scores, and depression 90-item symptom checklist scores. A study by Tiller (59) of Australian women showed that women who were less than the recommended 2.5 h of moderate exercise per week continued to experience higher rates of anxiety and depression. Aibar-Almazán et al. (60) analyzed the effects of Pilates based exercise program on sleep quality, anxiety, depression, and fatigue in postmenopausal women aged 60 years and older living in Spanish communities, and showed that 12-week Pilates exercise intervention had beneficial effects on their sleep quality, anxiety, depression, and fatigue. Specifically, all Pittsburgh Sleep Quality Index (PSQI) domains aswell as in the PSQI total score were significantly improved, and Hospital Anxiety and Depression Scale (HADS) score and fatigue severity scale were significantly reduced. Poor sleep quality is strongly associated with a low level of physical activity among postmenopausalwomen (61). Cai et al. (62) study showed,traditional exercise training programs, such as aerobics, it has been shown to positively affect on sleep quality in postmenopausal women, presented as10-week moderate- to high-intensity step aerobics training program (40–45 min/times, 3 times/week, 10 weeks, intensity of 75–85% of the heart rate reserve)can enhance the quality of sleep and increase the melatonin levels in sleep-impaired postmenopausal women, and a systematic review and meta-analysis of randomized controlled trial concluded that programmed exercise enhance sleep quality among middle-aged women (63). Tadayon et al. (64) also found improvements in both the Pittsburgh Sleep Quality Index total score and domains among postmenopausal women after twelve weeks of pedometer-based walking. Newton et al. (65) randomized controlled studies performed showed that, postmenopausal women with insomnia were randomly assigned to either yoga classes, exercise at home, or their usual activity. They found that, compared to usual activity, women assigned to yoga saw improvements in their sleep quality and sleep disorders, both domains of Pittsburgh Sleep Quality Index. Buchanan et al. (66) studie showed that, 12 weeks of yoga or aerobic exercise can makelate transition and postmenopausal women aged 40–62 years with hot flashes Significant improvement in sleep stability, mean total sleep time markedly increased,mean wake after sleep onsetmarkedly decreased, mean coefficient of variationfor number of long awakenings >5 min markedly decreased. Curi et al. (67) reported improvements in Pittsburgh Sleep Quality Index total score, use of sleeping medication, and sleep latency after 16 weeks of intervention with Pilates exercises in women aged 60 years and over. Gulia and Sreedharan (50) confirmed the research on post menopausal subject, after administering the 24 weeks of yoga-nidra practice and exercise module protocol, there was remarkable elevation in mood both on waking up and entire day from 5th week onward. Mood shifted toward a happier state. Latency to sleep decreased after 4 weeks, while total sleep time improved only after 16 weeks of dual management strategy.

As an aerobic exercise, aerobics with its enthusiasm, rhythm, movement stretch, beautiful and powerful, giving people booming, spiritual quality, free driving force, so that exercisers and ornaments can feel the beautiful realm of the combination of aerobics and beauty. It is very rich in physical exercise and mental health care value, with popularity, the characteristics of the whole people, suitable for the diverse needs of Chinese public fitness, but also an important part of the national fitness exercise. Completing a set of aerobics is equivalent to doing a thorough whole body movement. Aerobics can improve and improve the motor function of muscle fibrous tissue, joint tissue and bone. Mass aerobics can also be flexibly arranged for different objects, different purposes of exercisers (such as weight loss, strong waist, body, etc.). For example: middle-aged and elderly aerobics, adolescent aerobics, young children aerobics, pregnant women aerobics, warm-up aerobics, body aerobics, rhythm aerobics, weight loss aerobics, free-hand aerobics, device aerobics, body parts aerobics and so on. Moreover, mass aerobics strictly follow the physiological law of sports load from small to large, movement from simple to complex; intensity from weak to strong, gradually increase load, and gradually decrease when reaching and maintaining a certain negative. In short, mass aerobics can enhance physical fitness, improve body shape, change mental outlook and temperament, purify the mind, give people beauty edification. According to the researchers, women participating in mass aerobics can not only maintain a positive and optimistic emotional state and improve mood, but also have a certain intervention effect on depression and anxiety. Beautiful and cheerful music rhythm, lively and happy body movements can maximize the enthusiasm and vitality of people, so that the tired mind can be effectively relaxed, physical and mental regulation. For women who concentrate on exercise, under the guidance of professional coaches, they can not only get systematic fitness exercise, enhance self-confidence, but also enhance sense of honor and collectivism, which helps to establish a good interpersonal relationship. In this study, after 8 weeks of aerobics training, the anxiety, depression and sleep status of perimenopausal women were significantly improved, indicating that aerobics training can be used as a relatively safe and easy to operate training method to improve the anxiety, depression and sleep problems of perimenopausal women. The results of this study also showed that those who had only one symptom of anxiety, depression and insomnia before the intervention, all symptoms were significantly relieved after the intervention. The remission rate was more than 80% when the two symptoms existed before intervention. Even those with the three symptoms at the same time had a remission rate of over 65 percent. It indicates that even if the symptoms are more complicated and the disease is more serious, the 8-week aerobics training can also significantly alleviate. According to the frequency of self-practice after class, it was found that the more the number of self-practice of aerobics training, the lower the SAS score, SDS score and PSQI score, indicating that the number of training, frequency and amount of training can affect the intervention effect. Further statistics showed that anxiety was relieved by 98.25%, depression was relieved by 98.31%, and sleep disorder was relieved by 100% for those who exercised by themselves more than 3 times a week. The remission rates of anxiety, depression and sleep disorders were 77.55, 86.54, and 92.98% for those who practiced by themselves 1–2 times a week. However, the relief rates of the three symptoms were 67.57, 60.87, and 71.74% for those who only relied on collective training and did not exercise by themselves, showing significant differences between the groups, indicating that even short-term concentrated calisaerobics training can also play a positive role in alleviating anxiety and depression symptoms and improving sleep.