Physical Activity on Cardiorespiratory Fitness and Cardiovascular Risk in Premenopausal and Postmenopausal Women

A Systematic Review of Randomized Controlled Trials

Maitane Ruiz-Rios, MS; Sara Maldonado-Martin, PhD


Menopause. 2022;29(10):1222-1229. 

In This Article

Abstract and Introduction


Importance: The apparent cardioprotective effects of endogenous estrogens to prevent cardiovascular disease in premenopausal women are reduced with the loss of estrogen post-menopause. Cardiorespiratory fitness and cardiovascular risk factors are closely related to physical activity levels.

Objective: This study conducted a critical assessment of studies for health prevention that analyze the effects of physical activity programs on cardiorespiratory fitness and cardiovascular risk factors in women, comparing premenopausal and postmenopausal states, through a systematic review of randomized controlled trials.

Evidence Review: A computerized literature search was performed to include articles up until December 2021 in the following online databases: PubMed, Cochrane, Scopus, SportDiscus, and Web of Science. Regarding physical activity intervention, women of all ages were engaged. The PEDro scale and Oxford's evidence levels were used for the assessment of the risk of bias in the included articles.

Findings: Fourteen scientific articles met the inclusion criteria. Great variability was found in physical activity variables. All the studies found an improvement in at least one variable. The risk of bias was high, with all the articles obtaining a low methodological quality, except two with high methodological quality. Only one article considered the differences in the menopausal state observing the effects of physical activity intervention and highlighting the importance of physical activity in both states.

Conclusions and Relevance: To strengthen the evidence for the benefits of physical activity programs in women and to observe the effects depending on their menopausal state, there is an ongoing need for more rigorous randomized controlled trials of appropriate length and dose, with individualized exercise intensity.


Cardiovascular disease (CVD) is a major cause of morbidity and mortality for women (35% of total deaths), and it is associated with menopause among other well-established risk factors (eg, hypertension, dyslipidemia, diabetes, obesity, poor diet, sedentary lifestyle, inactivity, and smoking).[1] It has been hypothesized that the apparent cardioprotective effects of endogenous estrogens to prevent CVD in premenopausal women are reduced with the loss of estrogen after menopause.[2,3] However, menopausal hormone replacement therapy is not indicated for primary or secondary prevention of CVD.[1]

The fact that higher cardiorespiratory fitness (CRF) and physical activity (PA) patterns are inversely associated with CVD mortality is well documented.[4] Thus, CRF is promoted as a clinical vital sign and thus the need for its assessment.[4] This assertion highlights the potential impact on the survival of PA intervention,[5] meeting the international guidelines on PA (ie, 150–300 min/wk of moderate intensity, or 75 to 150 min/wk of vigorous intensity, or an equivalent combination of both intensities, plus muscle-strengthening activities).[6] It has recently been stated that regular exercise, especially at high intensity, leads to higher CRF, which is associated with a better lipoprotein particle profile in perimenopausal and late postmenopausal women.[7] However, the effect of menopause is still understudied, underrecognized, underdiagnosed, and undertreated globally.[1] Therefore, knowing the relevance of lowering cardiovascular risk factors (CVRFs) and increasing CRF to prevent the onset of CVD and the role of PA in this sense,[8–12] a study is needed that analyzes the results found in studies on this issue specifically in women. In addition, it seems necessary to distinguish the menopausal state when analyzing the effects of PA due to hormonal differences.[13] Therefore, this systematic review aimed to analyze the effects of PA programs on CRF and CVRF in women by comparing premenopausal and postmenopausal states.