Exercise at Menopause: A Critical Difference

Margaret Burghardt, MD

Disclosures

Medscape General Medicine. 1999;1(3) 

In This Article

Exercise Prescription for Health

In the study by Simkin-Silverman and colleagues,[41] walking was the main physical activity of choice. Almost any regular, habitual physical activity is beneficial. Leon and associates[36] showed that a reduction in CHD mortality in middle-aged men is seen with moderate leisure-time physical activity, with little further improvement in risk profile noted with vigorous activity levels. A daily energy expenditure of 150 to 250kcal is thought to equal this moderate activity. This equates to 30 to 60 minutes daily of predominantly light-intensity (eg, walking and bowling) and moderate-intensity (eg, swimming, dancing, and gardening) activities. More investigation is needed to identify optimal exercise programs for older women.

Modest activity levels that do not have significant impact on maximal aerobic capacity are nonetheless considered adequate for cardioprotection and bone maintenance.[10] This is important from a public health standpoint. Since perimenopausal and postmenopausal women are relatively inactive overall, they may be more likely to comply with a program of moderate exercise than with a vigorous program that has an inherent increased risk of injury. Activities that are enjoyable and that are promoted within the context of a healthy lifestyle have a greater tendency to be maintained.

Table I outlines the American College of Sports Medicine (ACSM) recommendations for an exercise prescription for health and fitness.

In a recent position paper, the ACSM supported current evidence pointing toward strength training as the exercise mode of choice to maintain and prevent falls, stating, "The optimal program for older women would include activities that improve strength, flexibility, and coordination, [which] may indirectly but effectively decrease the incidence of osteoporotic fractures by lessening the likelihood of falling."[42]

The components of an exercise program should directly relate to the end goals (eg, CHD protection, improved cardiovascular fitness, decreased vasomotor symptoms, weight loss, increased muscle strength, and improved balance and flexibility). The pre- or postmenopausal woman should be assessed for risk factors for disease or injury prior to initiating an exercise program or increasing her activity level. The ACSM outlines guidelines for exercise testing prior to participation in an exercise program (Table II).[43]

All programs should incorporate counseling about appropriate warm-up and cool-down, as well as appropriate equipment and potential injuries. All women should be encouraged to stop cigarette smoking, and discussions should include information about the association between smoking and earlier onset of menopause, earlier estrogen depletion, and osteoporosis.[34]

It is important for women to participate in exercise that is enjoyable, easily integrated into their weekly routine, and safe, from the standpoint of risk of exercise-induced injuries as well as from dangers attributable to the exercising environment (surroundings, time of day, isolation, etc). Group activities provide safety, social interaction, and a more structured routine for the participants. Women interested in beginning a regular exercise program could enlist the help of local recreation staff and perhaps the medical community to devise programs and to secure environs (eg, school gyms and playing fields after-hours, meeting halls, etc.). Local policing units could be made aware of the routes of after-dark walking or outdoor-exercise groups. Traditionally, older women have encountered more barriers to exercise than the rest of the population. They should be encouraged rather than deterred from attempts to perform regular physical activity and to maintain their functional independence and well-being.

There must be recognition in society that physical activity is a vital component of a healthy lifestyle and essential for disease prevention. The average woman will live at least 25 years beyond menopause, and during these years, regular physical activity can improve her quality of life, general health, and sense of well-being.

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