// Menopause and Exercise

by Lisa Westlake

Technically, menopause means the end of menstruation and reproduction. It is a point in time, formally marked as 12 months after the last period.

Statistically, it occurs between the ages of 40 and 58 years with the median age being 51.4 years. The main symptoms occur as a consequence of the peri-menopause, defined as the menopause transition years, when the endocrinological and clinical features such as weight gain, hot flashes, mood changes, insomnia, fatigue and memory problems occur.

The mean age of onset is 47.5 years, and the process lasts approximately four years.

For the women involved however, technicalities and statistics are far outweighed by the physical and psychological elements of menopause. Yet again they are undergoing a time of significant change and the symptoms and emotions that go hand-in-hand with this hormonal flux can have a variety of implications in their day-to-day life, mood and physical ability. Women vary dramatically in their response to menopause; some feel overwhelmed by the side effects, physical symptoms and low mood, while others have minimal complications and feel quite liberated.

Exercise can play an important role during menopause by maintaining fitness, assisting with weight management, decreasing musculoskeletal complications and boosting morale and mood. An understanding of menopause and the exercise implications is important for fitness professionals designing programs or classes for women at this stage of their lives. The main symptoms of menopause are a consequence of decreasing levels of oestrogen, which is no longer produced by the ovaries. This causes changes in skin, body shape, facial hair and increased predisposition to various conditions. Each woman’s experience is unique. Some of the possible symptoms are listed below.

Changes associated with oestrogen deficiency

Vasomotor: Hot flushes, dizziness, palpitations, headaches, fainting. These vary individually and may be exacerbated by hot weather, alcohol, stress and temperature changes. Night sweats can lead to fatigue.
Urogenital: Possible dryness, soreness, increased urinary frequency and urgency, incontinence.
Connective tissue: Possible aches and pains, increased risk of bladder prolapse, skin changes.
Psychological: 25 to 50 per cent of women experience altered mood, anxiety, fatigue or loss of drive.
Body shape: Tendency to gain weight in these years regardless of hormonal change. Decreased BMR (Basal Metabolic Rate) and altered fat distribution, tending more towards the mid section.
Musculoskeletal changes: Tendency towards increased weight, decreased muscle mass, joint changes and decreased bone density.
Increased risk of associated conditions: Osteoporosis (and associated postural problems), osteoarthritis, cardiovascular disease, stroke, non-insulin-dependent diabetes mellitus (NIDDM) in those who gain weight.

Benefits of exercise during menopause

Exercise is important for women at every stage of their lives, and is arguably even more so when they are undergoing the menopause, as it can:
• Improve/maintain cardiovascular fitness.
• Preserve or improve muscle mass.
• Assist weight control and metabolism.
• Stabilise or improve bone density.
• Decrease risk of associated conditions.
• Decrease physical problems.
• Improve reaction time and balance.
• Assist psychological health and self esteem.

Exercise considerations during menopause

• Women are encouraged to continue exercising, with modifications to suit any specific symptoms or limitations.
• Women can enjoy a range of individual and general group fitness programs.
• Participating in a variety of exercise styles decreases the risk of repetition injury and helps maintain interest in fitness.

Cardiovascular training

At least 30 minutes of weight bearing activity, three to four times per week, is beneficial for assisting bone density.

The style and intensity of the activity will be determined by pre-existing fitness and physical ability. Modify to low impact in the presence of any weight bearing musculoskeletal or pelvic floor/continence concern.

Strength conditioning

Resistance training is beneficial during menopause, assisting the maintenance of both strength and bone density. Women can continue or commence strength training/resistance classes, but may require modification to accommodate for musculoskeletal complaints.

Attention to technique and form is vital. Commence with low load and high reps. Load can be increased as appropriate but be careful to avoid heavy loads that encourage breath holding or valsalva moves (forcibly exhaling against a closed airway) as these will stress the already vulnerable pelvic floor muscles.

Important inclusions

When programming for women going through menopause it is important to include specific exercises that will help them combat some of the possible problems.

Pelvic floor

Encourage women to do three good sets of pelvic floor exercises every day and always include them in your training session or class. We need our pelvic floor to be strong in all positions, so vary the position you practice it in; sitting, standing, kneeling, lying. We use our pelvic floor for long periods of time, as well as quick contractions when we laugh, cough or jump, so it is necessary to practice both long holds and quick lifts.

Thus one pelvic floor set might be five to ten quick lifts while sitting and the next might be a slow lift and hold for five to ten breaths. Always be sure to relax unwanted muscles, such as the gluteals, during pelvic floor training.

Core stability

With altered body shape and postural vulnerability, it is certainly a time to encourage core awareness and recruitment. Include core control in all cues and exercises.

Posture

Musculoskeletal changes and increased risk of osteoporosis make posture an important focus. Include postural cues and plenty of posterior muscle strengthening, especially rhomboids, posterior shoulder, latissimus dorsi and extensor training.

Balance

Balance training is valuable for enhancing proprioception, righting reactions and balance as well as confidence and decreasing risk of falls and injury.

Flexibility

Mobility and flexibility within comfort is important to maintain muscle length and range of movement.

Fun

While women may come to you during menopause for weight management, strength and fitness, it is well worth remembering the psychological benefits of exercise. Creating a fun, interactive, social situation will certainly enhance the experience and success of your class or program.

Working with women at this stage of their life is very rewarding. With appropriate information, nutrition, exercise and attitude menopause can be turned around to be seen as a fresh time of freedom and independence when women can feel empowered and energised.


Lisa Westlake, BAppSc (physio)

Lisa has worked in the health and fitness industry for over 20 years. Australian Fitness Network named her Author of the Year in 2009, Presenter of the Year in 2003 and Fitness Instructor of the Year in 2000. Through her business, Physical Best, Lisa combines physiotherapy and fitness to create classes and programs for a variety of ages, levels and abilities, and is well known for her work in developing the Fitball program in Australia. Visit www.physicalbest.com for more details.


NETWORK • SUMMER 2009
• PP38-39