Exercise at Menopause: A Critical Difference

Margaret Burghardt, MD

Disclosures

Medscape General Medicine. 1999;1(3) 

In This Article

Hyperlipidemia and Exercise: Perimenopausal Benefits?

Of great concern are the alterations in lipid profile that women experience at the time of menopause and afterwards. Premenopausal women have greater protection from CVD than men, due in part to higher levels of the "good," high-density lipoprotein (HDL) cholesterol. Menopause marks a decline in estrogen and its heart-protective effects on HDL levels.

Wing and colleagues[7] found that decreases in HDL seemed dependent on menopausal status rather than weight gain. Women who became postmenopausal during the 3 years of the study had a lowering of HDL even if they lost weight. In their review, Taylor and Ward[33] reported that age-matched women who remain premenopausal do experience significant age-related increases in total cholesterol, low-density lipoprotein (LDL), and triglyceride levels, but HDL levels remain unchanged; as others have found, they noted that HDL declines with menopause.[33]

The question of whether exercise prevents this decline in HDL in perimenopausal women has not yet been answered. Owens and coworkers[40] did find that middle-aged women (aged 42 to 50 years) who reported higher activity levels (>=1000kcal per week) had higher total HDL cholesterol (HDL-C) levels than their less active counterparts. In a review of the effects of exercise on HDL levels in women, Taylor and Ward[33] concluded that "exercise should be prescribed for women for its numerous other benefits, but not with the specific independent goal of increasing HDL-C levels." A stronger statement can be made about physical activity and LDL, total cholesterol, and triglycerides. With age and menopause, women experience a rise in these lipid levels: One hypothesis is that diminished estrogen production may lower hepatic LDL receptor activity.[41] Estrogen administration does decrease LDL and total cholesterol and increases HDL-C. Perimenopausal women who are more physically active and gain less weight have lower elevations of LDL, total cholesterol, and triglycerides than their heavier, less active counterparts.[7]

Simkin-Silverman and associates[41] were able to demonstrate that a preventive approach to menopausal atherogenic changes and CHD risk can have a positive impact. Healthy premenopausal women were randomized to an intervention group aimed at decreasing total intake of saturated fat and cholesterol, preventing weight gain, and increasing activity levels. After 6 months, the intervention group showed significant decreases in total cholesterol, LDL, and triglycerides, as well as other CVD risk factors (eg, weight, waist-hip ratio, systolic and diastolic blood pressure, and serum glucose levels). This study illustrates that, at least over the short term, healthy women may be receptive to prevention focused on diminishing the adverse risk factors seen with menopause and aging.

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