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Menopause and Exercise

Bushman, Barbara A. Ph.D., FACSM

ACSM'S Health & Fitness Journal: May/June 2013 - Volume 17 - Issue 3 - p 4–7
doi: 10.1249/FIT.0b013e31828cb232
DEPARTMENTS: Wouldn't You Like to Know?

I’m 52 years old, and my menstrual cycles stopped about 14 months ago. Although “the change” has been relatively uneventful, I do experience some hot flashes (during the day and at night) and I feel more irritable and moody. ’ve been relatively healthy to this point in my life, and I want to remain healthy for years to come. After consulting with my physician, I have elected not to use hormone therapy. Can exercise benefit me with regard to my health and fitness?

Barbara A. Bushman, Ph.D., FACSM, is a professor at Missouri State University. She holds four ACSM certifications: Program Director, Clinical Exercise Specialist, Health Fitness Specialist, and Personal Trainer. Dr. Bushman has authored papers related to menopause, factors influencing exercise participation, and deep water run training; she authored ACSM’s Action Plan for Menopause (Human Kinetics, 2005), edited ACSM’s Complete Guide to Fitness & Health (Human Kinetics, 2011) and promotes health/fitness at www.Facebook.com/FitnessID.

Disclosure: The author declares no conflict of interest and does not have any financial disclosures.

Q: I’M 52 YEARS OLD, AND MY MENSTRUAL CYCLES STOPPED ABOUT 14 MONTHS AGO. ALTHOUGH “THE CHANGE” HAS BEEN RELATIVELY UNEVENTFUL, I DO EXPERIENCE SOME HOT FLASHES (DURING THE DAY AND AT NIGHT) AND I FEEL MORE IRRITABLE AND MOODY. I’VE BEEN RELATIVELY HEALTHY TO THIS POINT OF MY LIFE, AND I WANT TO REMAIN HEALTHY FOR YEARS TO COME. AFTER CONSULTING WITH MY PHYSICIAN, I HAVE ELECTED NOT TO USE HORMONE THERAPY. CAN EXERCISE BENEFIT ME WITH REGARD TO MY HEALTH AND FITNESS?

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A: To answer your question very simply — YES, exercise is a benefit to women of all ages! The impact of physical activity and exercise is an area of much research, focusing on attaining maximal health benefits while realizing the potential interaction with menopausal changes for women. Valuable Internet resources covering general information on menopause and menopausal symptoms, bone health, and quality of life are found below:

Menopause (“month ending”) is the end of the monthly menstrual cycle. Many physical and hormonal changes occur in the time leading up to the last menstrual cycle, a stage of life referred to as perimenopause or the menopausal transition. Postmenopause refers to the period after menopause is verified. As you have experienced, the time frame immediately after the last menstrual period is when vasomotor symptoms (i.e., hot flashes, night sweats) are very likely (13).

Menopausal symptoms are unique to each woman. Hot flashes are one of the most common menopause-related issues, although the duration and intensity vary widely between women and within individuals at various points in time (7,21). Hot flashes typically cease without treatment, but there are no reliable methods to determine when that will occur (21). Although the exact mechanism is unclear, hot flashes seem to be caused by changes occurring in the hypothalamus. Normally, the hypothalamus helps to maintain a stable body temperature. During hot flashes, the hypothalamus mistakenly senses that a woman is too warm and, thus, brings about responses to cool her by dilating blood vessels to the skin. This dilation results in the red flushed skin and even sweating as the body attempts to rid itself of heat (22).

Some women report changes in mood, although the impact of menopause on mood is not completely understood (22). Vasomotor symptoms, both hot flashes and night sweats, may contribute to the potential impact changing estrogen levels may have on mood (4). The domino hypothesis (i.e., vasomotor symptoms disturb sleep and that, in turn, causes a negative mood) was examined in one study that tracked women during a 36-week period. Researchers concluded vasomotor symptoms and sleep disturbances may work both together and independently to worsen mood (4).

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Whether exercise itself exerts a positive effect on menopausal symptoms is an area of much research. In the Study of Women’s Health Across the Nation (SWAN), menopausal symptoms were more frequent among less active women, with a trend of increasing symptoms with decreasing activity (11). Because SWAN represents cross-sectional research, an association can be determined but not the direction of the relationship. In other words, the study cannot determine if women may feel better because they are active or women are less active because they have symptoms (11).

Researchers have endeavored to provide insight on this issue. In a recent study, previously sedentary women who participated in an aerobic training program for 6 months experienced a decrease in typical menopausal symptoms, including night sweats, mood swings, and irritability (19). Aerobic training resulted in lower scores for depressed mood and higher scores for attractiveness and improvements in cardiorespiratory fitness and lean muscle mass (17). Physical activity (walking or yoga) resulted in positive effects on menopause-specific quality of life and affect (i.e., measure of general happiness) (8). When a group of postmenopausal women participated in aerobic and calisthenic exercise program for 24 weeks, the women experienced significant reductions in hot flashes, night sweats, and various psychological symptoms, such as depressive mood and irritability (15).

In contrast, other studies have suggested that the relationship between physical activity and hot flashes may not be favorable. One study found that women with higher levels of physical activity tended to have increased odds of moderate or severe hot flashes, although there was not a relationship between daily hot flashes or hot flashes for more than 1 year (23). Exercise did not decrease the risk of having menopause symptoms in previously sedentary overweight women engaged in a 12-month moderate-intensity exercise program (i.e., no beneficial effect of exercise when compared with a nonexercising group of women); however, there was a trend for an increased risk of moderate to severe hot flashes at the 1-year mark in a small number of women (1). These results may be influenced by the population studied. Although overweight women may have fewer hot flashes because of greater estrogen production in peripheral tissues, the increase in core temperature caused by exercise, coupled with insulation of increased fat, may have been involved with triggering hot flashes in this group of overweight women (1).

Various characteristics may influence the relationship between exercise and hot flashes. In one study, an acute bout of moderate-intensity exercise decreased hot flashes, but overweight and late perimenopausal women had smaller reductions in hot flashes compared with normal-weight women and those in early perimenopause and postmenopause (9). Overall physical activity was not associated with the frequency of hot flashes, although lower fit women reported a higher frequency of hot flashes when performing more moderate-intensity activity on a given day. The researchers suggest that cardiorespiratory fitness may be a differentiating factor, highlighting the importance of regular sustained physical activity (9).

When considering overall health and wellness, quality of life seems to be a benefit of physical activity. In an 8-year study, perimenopausal and postmenopausal women with higher education who increased their physical activity and maintained a stable body weight reported improvement in quality of life (18). The researchers acknowledge that the relationship between physical activity and quality of life during menopause is complex and likely involves physiological and/or psychological factors (18). Regardless, the study results support the hypothesis that menopause may provide a window of opportunity during which time women may be motivated to make lifestyle modifications, including increasing physical activity (18).

Although there may not be perfect clarity related to the relationship between vasomotor symptoms and exercise, there is strong evidence for the value of physical activity for women throughout the life span. Consider the toll of heart disease. Heart disease is the leading cause of death for women in the United States, accounting for one in every four female deaths (14). Physical activity can play a role in decreasing risk factors for heart disease. For example, moderate levels of activity seem to be beneficial in preventing undesirable lipoprotein changes and weight gain (12). Even as little as 30 minutes per day of moderate-intensity activity (e.g., brisk walking) can provide cardioprotection (3), and higher levels of activity likely will provide added benefits (12). Many benefits of exercise and physical activity have been found, including (19):

* lowering blood pressure

* improving lipoprotein profile, C-reactive protein, and other heart disease biomarkers

* enhancing insulin sensitivity

* playing a role in weight management

This is in addition to delayed all-cause mortality and a decreased risk of developing coronary heart disease, stroke, type 2 diabetes, and some forms of cancer (10).

In addition to heart heath, bone health also is a concern for women throughout the life span. Peak bone mass occurs by a woman’s 30s and is followed by gradual bone loss. Bone loss accelerates a few years before menopause (∼2% annually); the accelerated loss ends 3 to 4 years after menopause (bone loss slows to ∼1% to 1.5% annually) (20). Most cases of osteoporosis occur in postmenopausal women, and the prevalence increases with age (20). A number of lifestyle factors are associated with risk of low bone mineral density and fracture, including poor nutrition and insufficient physical activity. For a more extensive examination of bone health, see the 2004 Position Stand from ACSM (16), “Physical Activity and Bone Health,” at http://journals.lww.com/acsm-msse/Fulltext/2004/11000/Physical_Activity_and_Bone_Health.24.aspx. For more menopause-specific information, see the 2010 Position Statement of the North American Menopause Society (20), “Management of Osteoporosis in Postmenopausal Women” at http://www.menopause.org/publications/clinical-practice-materials/position-statements-other-reports. Adequate intake of calcium and vitamin D is recognized as important for bone health (20). Active weight bearing and strength-training exercises also can benefit bone (16,20). To affect areas of the skeleton often involved in osteoporotic fractures, the North American Menopause Society recommends targeting the large extensor muscles of the back, the hip flexors and extensors, and muscles of the thigh, upper arm, and forearm. Maintaining muscle strength, agility, and balance reduces fall risk (20). The value of a comprehensive exercise program to promote healthy bone cannot be overstated.

Although the health benefits of a complete exercise program for women are supported by research (5), unfortunately, many women are not active and activity levels decrease with age (see Figure). Your question highlights the opportunity women have to develop an exercise program that has the potential to impact health and fitness as well as quality of life. A comprehensive exercise program includes activities that target cardiorespiratory fitness, muscular fitness, body composition, flexibility, and neuromotor fitness (2,6). For additional information, see the ACSM Position Stand (10) “Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory, Musculoskeletal, and Neuromotor Fitness in Apparently Healthy Adults: Guidance for Prescribing Exercise” found at http://journals.lww.com/acsm-msse/Fulltext/2011/07000/Quantity_and_Quality_of_Exercise_for_Developing.26.aspx.

Menopause is a time of change. Although hormonal changes tend to be at the center of attention, women also need to be aware of the development of chronic conditions such as heart disease and osteoporosis. The benefit of exercise related to reduction of vasomotor symptoms has not been universally demonstrated; various factors may influence the responses noted in research studies, including body weight, fitness level, and even typical hot flash frequency and reporting methods. Research more clearly supports the beneficial effect of exercise for menopausal women related to quality of life and mood. In addition, research is very supportive of the benefits of regular exercise for both heart and bone health. Thus, whether considering potential benefits related to menopausal symptoms or taking into account the opportunity to decrease the risk of chronic diseases, making a renewed commitment to increase one’s level of physical activity is one very positive change!

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