Written by Dr Kirsty Hedding, The Menopause Hub Menopause Society Certified Practitioner, MBChB (UCT), MPhil (EM) (UCT)
Exercise has long been a fundamental component of being healthy. However, for women in particular, it has largely been seen as a tool to either ‘look a certain way’ or manage their weight. The idea that only certain exercises are beneficial has also contributed to this negative image.Exercise or movement should instead be explored and celebrated as a means to improve our health and wellbeing. It is one of the most powerful tools we can use to remain healthy and prevent disease, but also challenge ourselves and feel great.
This is important for anyone as they age, but particularly for women as they transition through menopause. The menopause transition can be one of the most challenging periods in a woman’s life.1 This is due to the wide variety of symptoms they can experience at this time from physical to mental.1 These symptoms can vary in severity, duration and most importantly how they impact her daily life, and ultimately her future.1,2,3
While symptoms and management of menopause have gained more attention recently, there is still not enough awareness of the health consequences associated with being post-menopausal. Post-menopausal women are at higher risk for certain diseases, particularly cardiovascular disease and osteoporosis.1
• Did you know that 1 in 4 women die from heart disease and stroke?4
• Did you know that coronary heart disease (atherosclerotic heart disease) results in twice as many deaths in women as breast cancer?1
• Did you know that around 25% of women will have developed osteoporosis by the time they are 80 years old?1
• Did you know that 20% of women who sustain a hip fracture will die as a result? For those that survive, most will be left with some form of disability, requiring long-term care and possibly the inability to live independently.1
While hormone replacement therapy (HRT) can play an important role in both treating the symptoms and helping prevent diseases caused by the lack of oestrogen, our day-to-day lifestyle is as pivotal.1 Things like smoking, obesity and excessive alcohol consumption can all impact a woman’s risk of developing ischaemic heart disease, diabetes, and a variety of cancers, most especially breast.1 Given that a lot of these factors are within our control, relying on HRT alone would be unwise, especially as not everyone is able to use it. So how can movement help women during the menopause transition?
1) Reducing severity of symptoms: although the studies done in this regard are small and limited, women who were more physically active during this period, reported less severe symptoms, particularly vasomotor symptoms (hot flushes/night sweats).3 It is thought that this may be attributable to the endorphins exercise creates and how that influences a woman’s physiology in a positive manner improving sensitivity to pain and hot flushes.3 However, the size of this effect may vary between individuals. Other evidence suggests that regular sustained aerobic exercise (like swimming) has the most benefit in reducing these symptoms.1
2) Improved sleep: regular moderate to vigorous exercise can help sleep by reducing the time it takes to fall asleep as well as improving the quality of sleep.3 Improved sleep results in less fatigue during the day, an improvement in mood and a greater chance of repeating regular exercise.1 Good sleep can also help women make better food choices during the day.
3) Reducing stress: movement reduces stress through enjoyment, time to oneself or through connection with a community.3,4 Also, depending on the type of exercise you participate in, it can bring you closer to nature which often has a calming effect.5
4) Improvement in mood symptoms: Irritability, low mood and mild depression is common during menopause.6 Exercise can be as effective as some medications at treating this. It additionally helps improve your self-esteem, which in turn improves overall well-being.3 How does exercise help prevent disease?
• Exercise stresses our bones by applying force to them, either through impact (like running) or through the muscles exerting a force on them through pulling. This in turn forces the bone to adapt and become stronger, reducing the likelihood of a fracture.
• Exercise can assist with increasing muscle mass which both enhances our metabolism, helping with weight maintenance.
• Movement assists with strengthening our balance, which will prevent a fall, and possible broken hip.1 Exercising with a focus on balance is particularly important for women over the age of 65 years.4
• Mobility and strong muscles enable us to remain active and independent for as long as possible.1
• It can strengthen the heart and cardiovascular system, allowing it to function at an optimal level.4
• Daily exercise can help lower blood pressure in women with high blood pressure, decreasing it by up to 5-7mmhg. This ultimately helps to decrease the risk of developing strokes or heart attacks.5
• Atherosclerosis, which results in cerebrovascular disease, is thought to be worsened by chronic inflammation, and exercise has been shown to play a role in decreasing inflammatory markers and preventing vascular endothelial dysfunction.7
• Obesity increases a person’s risk for chronic diseases, like diabetes as an example.1 The menopause transition is known to be associated with significant weight gain, although studies have attributed this to age and lifestyle, not specifically menopause. Although once again small, studies that looked at women who did regular physical exercise during menopause, were found to gain the least amount of weight.8
Understanding the benefits of exercise in more detail can help motivate women to add movement to their lives both during the menopause transition and afterwards. Yet, it must be said that for many women, the very idea of ‘exercise’ can be completely overwhelming. This can be for many external reasons like shift work, long commutes or family responsibilities. Most importantly, the menopause itself contributes significantly to fatigue, lack of motivation and pain, all of which can prevent women from doing something. Encouraging movement isn’t to undermine the experience women go through during this time, but rather to help fuel their ‘why’ to do something worthwhile.
So where can you start?
1) Chat to your healthcare provider about what exercise is safe for you and/or would be of most benefit to you. This is particularly important if you have medical conditions or physical limitations that may make certain exercises risky.
2) Movement comes in a variety of shapes and sizes, so pick something that brings you joy. You get to choose what this looks like and it will be unique for every woman.
3) Start small and increase slowly. the recommended time by the World Health Organisation (WHO) for aerobic exercise is 150 minutes of moderate exercise per week.1 Breaking this into chunks of ten minutes at a time still provides the benefit, so don’t be intimidated by the overall amount.
4) Consistency is key, rather than an all or nothing approach.
5) Factor in failure and be kind to yourself when you skip a day.
6) In time, try to incorporate all forms of exercise: aerobic, balance of exercises (particularly over the age of 65), resistance training and mobility.
Movement has the power to add considerable value to our lives, particularly in women experiencing menopause. Women who are just starting their movement journey, stand the most to gain. Rather than being intimidated by it, it can be seen as an opportunity for discovery, adventure, health and even growth. Our health after all, is one of our most important assets to living a life we love.
References available on request
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