Exercise and Menopause
The interactions between exercise and menopause provide insight into how to best manage health during this stage of a woman’s life.
Menopause is classified by the cessation of a woman’s menstrual cycle, and the conclusion of the stage of life where they are able to bear children. This is accompanied by reductions in ovarian hormone production (estrogen and progesterone). Not only is exercise safe during this stage of life, but it can help to counter many of the negative age related changes a woman will experience. Here, we discuss these changes, and how exercise can help to improve health during menopause.
- Hot flushes: Shivering, sweating and reddening of the skin lasting up to ten minutes. These usually over the space of one to two years.
- Changes to menstrual cycle: Irregular periods leading up to menopause followed by complete cessation of the menstrual cycle at the onset of menopause.
- Vaginal dryness.
In addition to these general symptoms, there are a raft of factors that can all be managed or negated by exercise. These include
- Changes in sleep patterns.
- Mood changes.
- Lack of energy.
- Joint and soft tissue stiffness and pain.
- Weight gain.
- Changes in sex drive.
- Heart disease.
Changes to the Body With Age:
By identifying the changes to the body with age, we can use exercise as a method of countering these negative effects.
- Decreased strength.
- Decreased muscle mass.
- Percentage of SLOW twitch muscle fibres increases.
- Reductions in the number and size of muscle fibres.
- Nervous system responses slow.
- Relative body fat increases.
- Reduced bone mineral density
Benefits of Exercise for the Menopausal Woman:
Osteoporosis and Low Bone Mineral Density:
Osteoporosis is a progression of osteopenia, a progressive loss of bone mineral density and mass with age. This becomes an issue, as bone strength and the ability to resist a fracture (two key functions of bone) are closely correlated with bone mass.
Osteopenia is classified as greater than one standard deviation below young-normal levels, while osteoporosis is greater than 2.5 standard deviations below young-normal levels.
A natural loss in bone mineral density is experienced with age, though menopause in women can accelerate this loss due to the estrogen withdrawal. This hormone change increases the rates of bone resorbtion, causing a negative relationship between bone formation and resorbtion. This leads to greater levels of osteoporosis and associated fractures in this demographic.
Aside from an estrogen deficiency, several additional factors increase losses in bone mineral density:
- Increased age
- Family history
- Low body weight
- Premature menopause
- Prolonged premenopausal amenorrhea
- Low testosterone levels in men
- Lack of physical activity
- Chronic smoking
- Excessive alcohol consumption
- Low dietary calcium
- Certain medications (bone loss as a side effect)
Fractures are a major problem in individuals with low bone mineral density. This is due to two main reasons. Firstly, wedge fractures in the thoracic spine can cause a deformity whereby the shoulders are rounded forwards. This shifts the centre of gravity outside the base of support (feet) increasing the risk of a fall. The second reason for the increase in fractures is quite simply the reduced strength of bone, so if a fall does occur, a fracture is more likely.
The major limitation to exercise is the presence of a previously attained fracture. This causes an obvious impairment in functional capacity and locomotor ability. Changes in posture can also cause an increased falls risk.
The initial benefit of exercise for an elderly osteoporotic population is the reversal of deconditioning caused by the condition itself. The condition itself does not cause any adverse effects on the exercise response.
Aside from these general effects, the benefits of exercise are twofold:
Resistance based exercise can slow the age related decline in bone mass, thus reducing the progression from healthy bone mineral density, to osteopenia, and then osteoporosis.
Increases in muscle strength and proprioception can improve balance and stability, thus reducing the chance of falls, and therefore fractures.
Aside from exercise there are several strategies for the treatment and prevention of low bone mineral density. Medications can be used to slow the resorbtion of bone, while hormone replacement therapy can combat the deleterious effects of hormone loss during menopause. Calcium and vitamin D supplementation can also slow the loss of bone mineral density.
Human growth hormone is vital some numerous functions in the body, including:
- The growth, production and regeneration of cells within the body.
- Increased calcium absorbtion and lay done of minerals within the skeletal system.
- Increases in lean muscle mass.
- Increases in the oxidation (burning) of fat.
Improves glucose sensitivity (combatting type two diabetes): The effect of exercise on blood glucose levels, and therefore type two diabetes as a whole is considerable.
Benefits include: The prevention of the disease in individuals currently undiagnosed; Improvement in the control of blood glucose levels; Improved insulin sensitivity, leading to a reduced requirement for insulin based medication; Reduction in body fat resulting in increased insulin sensitivity; Reduced chance of developing cardiovascular disease, a common partner to diabetes; Stress reduction, therefore balancing hormone levels and contributing to healthy blood glucose levels.
Improves immune system function.
Improves cognitive function.
Increases Cardiorespiratory Function:
Reductions in estrogen levels can be associated with increased metabolic risks. Exercise:
- Causes favourable changes to cholesterol levels, increasing high HDL while reducing LDL and triglycerides.
- Reduces the risk of high blood pressure, heart attacks, and stroke. Research shows that cardiorespiratory based training may elicit a drop in both systolic and diastolic blood pressure, and reduces the expected increase in blood pressure in individuals predisposed to hypertension. For these reasons, exercise is effective as both a stand alone, and adjunct treatment for the condition.
Reduces Levels of Depression:
Research has shown sedentary populations have higher levels of depression, suggesting a link between physical inactivity and this debilitating disease. This improvement can be attributed to an increase in general wellbeing, through increases in energy levels, alertness and the ability to think clearly, and a reduction in fatigue, anger and tension. Exercise also encourages social interaction, further developing positive psychological health. As discussed in relation to anxiety, one of the biggest factors psychological factors is the fact that exercise acts as a ‘time out’ from any events which may cause, stress, anxiety or depression. It is this distraction that has the greatest psychological effect.
Reduces Levels of Anxiety:
Specific to anxiety, the benefits of exercise can be separated into two categories, short term acute effects from a single bout of exercise, and longer term chronic benefits from a sustained exercise program. The short term benefits are temporary, though important none the less. It has been speculated that the biggest reason for this short term reduction in anxiety levels is the distracting effect of exercise. If you are exercising, you have less time to worry about the stressors which lead to anxiety. In addition, changes in blood chemicals and reductions in tension contribute to this short term effect. This short term exercise benefit has been found to last up to 24 hours. A longer term exercise program creates longer term changes, with not only a reduction in stress, but improvements in the ability to deal with stress. Reductions in resting heart rate and lower levels of stress hormones in the blood contribute to this long term change. These effects last long beyond the 24 hour benefits of a one-off bout of exercise, and eventually lead to permanent reductions in anxiety. A combination of both short and long term factors makes exercise an effect method of preventing, treating and controlling stress and anxiety.
Poor lower limb strength and balance are the two highest predicators of falls. Exercise targets both variables. In addition, the increases in bone mineral density resulting from weightbearing exercise mean that even when falls do occur, the likelihood of a fracture is reduced.
An Effective Aid to the Treatment of Breast Cancer:
The research on the effects of exercise on cancer is currently growing at a considerable rate. Effort is being put into the investigation of exercise as a prevention for cancer. This has been suggested for several major forms, including lung, prostate, breast and colon cancers. The biggest benefit of exercise for cancer patients though is the effect on the immune system, the ability to maintain functional abilities through treatment and an improvement of mood and quality of life. In essence, exercise increases the body’s coping resources and aids them in dealing with cancer. More specifically, exercise plays a major role in reversing the negative effects of various exercise treatments. Many treatments increase the risk of such conditions as coronary artery disease, hypertension, diabetes and hyperlipidemia. Exercise combats these side effects at every step.
Alzheimer’s Disease and other dementias:
Although these conditions are more commonly experienced in later stages of life, they should remain a consideration for menopausal women. The major benefits of exercise for this class of conditions are the increase in functionality participants can experience, and the enjoyment the exercise brings. Depression and other psychological conditions are commonly associated with Alzheimer’s. Exercise helps to counter this by encouraging social interaction, further developing positive psychological health.
Exercise Recommendations for the Menopausal Woman:
The vast majority of the risk factors and side-effects of menopause can be countered by an intelligently prescribed exercise program. In fact, in most cases of menopause, there are no major changes that need to be made to a pre-menopausal exercise program. Priority should be given to resistance based and load bearing exercise (lifting free weights), and intensity should be prioritised in cardiovascular based exercise. The general CrossFit style prescription of constantly varied, functional movements performed at high intensity is as applicable for menopausal women as it is for a general population.
Dan Williams is the Director of Range of Motion and leads a team of Exercise Physiologists, Sports Scientists, Physiotherapists and Coaches. He has a Bachelor of Science (Exercise and Health Science) and a Postgraduate Bachelor of Exercise Rehabilitation Science from The University of Western Australia, with minors in Biomechanics and Sport Psychology.