The wiser woman: When menopause meets an exercise routine
Menopause is a critical time in a woman’s life. Due to the decline of estrogen production, various bio-physiological challenges seem to arise during this phase. Studies have reported an increased risk of osteoporosis and cardiovascular disease during this time. Besides, more than 60 per cent of women are affected by metabolic syndrome — central obesity, high blood pressure, high blood sugar, high serum triglycerides and low serum (HDL). Even though the advancement of hormonal replacement therapies can protect women from cardiovascular disease, the risk of side effects far outweighs the benefits.
Multiple studies have reported that exercise alone or combined with a proper nutritional plan can reduce waist circumference and LDL (low-density lipoprotein) in menopausal women. But when it comes to specifics of exercise it is unclear regarding the type of exercise that seems to be beneficial in this regard. Few studies have reported that resistance training exercises can improve lipid profiles in women, other studies have found yoga to have a positive influence on body composition and blood lipid profile. In contrast, a study also showed neither yoga nor walking improved body composition, reduced cardiovascular risk or increased bone mineral density. Furthermore, a couple of studies reported that resistance training did not seem to improve blood pressure in women with metabolic syndrome and provided no benefit to bone health in premenopausal women.
Exercise plays a vital role
The intensity, frequency, type, and duration can play an important role in the efficacy of any exercise on the reduction of physiological risk in menopausal women. Therefore, superficially looking at an abstract study can provide little information. For example, if the intensity or duration of any exercise intervention is not adequate then regardless of the type of exercise it will not have much impact. A recent metanalysis (combined data from several studies) that investigated randomised controlled trials (participants randomly allocated to groups) on the role of exercise in menopausal women found that exercise plays a vital role in reducing the risk of cardiovascular disease and improving quality of life.
A duration of 24 weeks of exercise seems to have significantly reduced triglyceride levels, body fat and waist circumference assist in lumbar spine bone mineral density. But the meta-analysis did not find a reduction in lipoprotein (LDL) levels. If we look into the interventions more closely, very few studies reported sample size estimation, adherence and drop-out rates. Most studies also did not report the randomisation procedure, which is an important aspect of any randomised trial study.
Also, a few studies did not report much information regarding the intensity and progression of the exercise intervention throughout the duration. Therefore, more information regarding the quality of the studies is warranted. There is no doubt that exercise can not only help with reducing physiological risks in menopausal women but can also help improve their overall health and fitness, but more practical solutions are required to gradually develop their fitness. In most cases, older (>50) men and women do similar exercises even though they have a very different physiological profile. Few practical solutions below for women during and after menopause.
Avoid generalised training plans: Most adult exercise programmes for both the genders tend to be similar. However, it should be noted that a woman’s heart and lungs are relatively smaller in size and the maximum amount of oxygen a woman can use to make fuel is 15-25 per cent lower than their male counterparts. Testosterone (even though it drops with age in men) also helps men because the sex hormone increases the production of red blood cells which carry oxygen to the working muscles.
Therefore, men can perform more work for a relatively longer duration than women, particularly when it comes to repeating high-intensity type work such as briskly climbing a flight of stairs. Also, there is a difference in fibre type, men tend to have greater fast-twitch fibre than women. Hence, men seem to have an advantage when it comes to rapid explosive tasks compared to women. Therefore, training regimens need to be tailored to women’s physiological profile.
Variety in cardiorespiratory/ cardiovascular fitness: Most women during or after menopause tend to do the same cardiorespiratory training throughout. For example, walking seems to be a common activity in this population. It is important to let the heart, lungs and oxygen supply to the working muscles to adapt through various training stimuli in order to provide an all-round cardiorespiratory development. For example, instead of just walking at the same pace every day, vary the pace or perform some incline (gradual increment- start with a low incline) walks now and then. Alternatively, use other modes such as high-intensity interval training (20-30s fast, 40-60s slow) on less weight-bearing equipment such as bike or X trainer. Build intensity and volume gradually over a while. Heart rate monitors can further individualise the training intensity.
Resistance training: Women after menopause seem to be at a higher risk when it comes to osteoporosis than men. Therefore, strengthening the skeleton system and increasing bone mineral density is very important. Resistance training programme supervised by a qualified person is a vital part of women’s overall health. A well-rounded full-body resistance training programme emphasising technique, with a particular focus on upper body, (women lose upper body strength faster than the lower body) along with adequate consumption of Vitamin D and calcium can do wonders.
Kaushik Talukdar is founder and CEO of Athlete Institute (www.athlete.institute). He is also a PhD scholar (exercise science) and the author of Sports Fit: Bridging the gap between research and practice
Yeh, M.L., Liao, R.W., Hsu, CC.,. Chung, Y.S., Lin, J.G. (2018). Exercises improve body composition, cardiovascular risk factors and bone mineral density for menopausal women: A systematic review and meta-analysis of randomised controlled trials. Applied Nursing Research
Sims, S & Yeager, S. (2016). ROAR: How to Match Your Food and Fitness to Your Unique Female Physiology for Optimum Performance, Great Health, and a Strong, Lean Body for Life