Exercise In Menopause
The word menopause comes from the Greek meno meaning 'month' and pausis meaning 'ending'; literally, 'a pause in a lifecycle'. It is first thought to have been used by a French physician called Gardanne, who referred to it in 1812 as 'menepausie' and subsequently shortened it to 'menopause' in 1821.
The word menopause only actually refers to the actual date of the last natural period. However this can only be ascertained after a consecutive gap of 12 months from the last natural period. In addition, hormonal or symptomatic evidence of menopause is often required.
For most women in the Western world the menopause occurs between 45-55 years. In the UK the average age is 50.78 years and in the US it is 49.8 years. Interestingly, Black women have earlier onset of menopause than white women (US).
The biggest factors in onset of menopause are smoking and nutrition. Heavy smokers can reach menopause 2 years earlier than non-smokers. Malnourished women have earlier onset (about 10 years earlier) in developing countries. (Chronic infection and chronic illness are also believed to be significant factors here).
Exercise and training have no effect on the age at which menopause occurs. Even in the presence of exercise induced amenorrhea, specific hormone levels (which would be markedly elevated in menopause) are normal.
In order to understand how exercise and training can affect symptoms of menopause, it is first important to review the underlying physiological changes that accompany menopause, as well as changes and other related factors.
Normal Menstrual Cycle
Approximately each month the ovaries produce an egg ready for fertilisation. This happens under the stimulus and direction of the pituitary gland, which is situated at the base of the brain, a few inches behind the eyes. The ovary provides two main elements: the eggs which come pre-formed as graafian follicles, and the theca of the ovary in which the follicles are embedded and which is responsible for the production of the female sex hormones, oestrogen and progesterone.
Maximum follicular number is attained at approximately 20 weeks of pregnancy, at which time the female foetus has about 6 million graafian follicles. However, as a result of follicular atresia this number is reduced to about 2 million by birth (nature's own way of 'sorting the wheat from the chaff'). With cyclic ovulation during the normal menstrual cycle the number of follicles is down to between 10-50 thousand by menopause, of which very few are functioning or are functioning normally.
What Happens During Menopause
From 40 years onwards the supply of graafian follicles begins to become significantly low. The follicles may also mature more irregularly, (often more slowly), so that the time between cycles becomes longer or shorter. Progesterone levels can fall as ovulation does not always occur; and there may be cycles in which oestrogen levels are slightly reduced. Not surprisingly these fluctuating hormone changes can cause considerable instability, leading to many troublesome menopausal symptoms. This can be especially so in those who already suffer from pre-menstrual syndrome.
Symptoms Of Menopause
Physical - Oestrogen
A - Hot flushes
H - Aches & pains
M - Insomnia
B - Nightsweats
I - Palpitations
N - Anxiety
C - Vaginal dryness
J - Fatigue
O - Depression
D - Loss of libido
K - Bowel problems
P - Confusion
E - Difficulties with intercourse
L - Weight gain
Q - Panic attacks
F - Urinary symptoms
G - Skin changes
The Benefits Of Exercise
A, B, Women who exercise have fewer hot flushes than those who don't. Exercise vastly improves circulation and can make the body more tolerant of temperature extremes and better able to cool down quickly. Exercise also increases the amount of circulating oestrogen, therefore there is less chance of having a hot flush. (Nightsweats are the nocturnal equivalent of hot flushes).
C, E, F, Exercise improves circulation to pelvic area. Specific exercises such as kegel exercises increase the strength and tone of the pelvic floor muscles.
H, J, Co-ordination, balance, and stretching can reduce pain and stiff joints and fatigue (if caused by underused muscles and joints).
I, Aerobic exercise can reduce hypertension.
M, Aerobic exercise improves the quality of sleep.
N, O, Strenuous exercise promotes the release of endorphins (brain opiods similar to morphine. This can lift mood for around 8 hours.
P, Exercise reduces the loss of dopamine in the brain (a neurotransmitter that helps prevent the shaking and stiffness that comes with old age). A severe shortage results in the exaggerated tremors of Parkinson's disease. Therefore exercise can also prevent reaction times from slowing down.
Osteoporosis, often referred to as 'brittle bone disease' is the single most important health hazard for women past the menopause. It is even more common than heart disease, stroke, or breast cancer.
In osteoporosis there is a reduction in both the amount of the connective tissue and the mineral content of the bone. The loss of bone mass reduces its strength and increases the likelihood that the bone will break when pressure is put on it.
Some experts restrict the term osteoporosis to describe low bone density where fractures have already occurred, and use the term osteopenia to describe women who have bones with low density, but have not suffered fractures.
Bone contains specialised cells called osteoblasts that renew, repair, and lay down new bone. The activity of these cells is controlled mainly by hormones, including oestrogen, which is thought to increase the repair and renewal rate of bone. If oestrogen levels fall, bone is not replaced as efficiently. A fall in oestrogen levels therefore leads to bone disintegration.
Exercise is one of the few known means of stimulating new bone formation. The amount of weight-bearing exercise (such as brisk walking or jogging) relates directly to increased bone mass. Bones can be strengthened to resist the effect of oestrogen depletion during the post-menopausal years. Ideally some form of exercise should be taken daily or every other day; see below for details of exercises especially chosen to be of benefit during the menopause and post-menopause.
Risks Of Exercise
Women with specific medical diseases should undertake and continue exercise programmes under the guidance of their physician and exercise specialist. The importance of pre-exercise medical health screening in identifying and eliminating contraindications to exercise cannot be emphasised strongly enough.
- Cardiovascular disease: Although regular aerobic exercise reduces the risk of cardiovascular disease, those who have a history of coronary artery disease are at greater risk for myocardial ischaemia and infarction during exertion.
- Musculoskeletal disease: Those with existing musculoskeletal disease may be at risk of injury to specific muscles, bones, or joints. E.g. Women with osteoarthritis should exercise uninvolved joints and women with osteopenia should avoid subjecting affected bones to excessive force.
- Other diseases e.g. : Women with diabetes mellitus will require modification to both their medication and exercises programmes.
Suitable Activities & Exercise Recommendations
Choose aerobic activities that employ large muscle groups and that are consistent and rhythmic in nature, such as brisk walking, jogging, cycling, swimming, dancing, and low impact aerobic classes. Ideally you should aim to do some form of exercise daily (such as walking) or every other day, especially if one of your goals is weight loss. Clearly there are greater benefits to be had with the more exercise that is performed. However, even exercising only twice a week has a protective effect (Caplan et al, 1993).
Mix activities for variety and maximum benefit. For example, although swimming is an excellent form of exercise it is non-weightbearing, and therefore by itself is not an effective way to counteract the effects of osteoporosis. If for example your weekly exercise regimen consists of 3 x 30 minutes swimming then substitute one of those sessions for 30-40 minutes of brisk walking or 20-30 minutes jogging.
It is important to include activities that require some degree of skill, balance, and co-ordination. Golf, tennis, yoga, tai chi, and badminton are all good examples. Finally it should be emphasised that all activities should be preceded by a warm up and finished with an extended stretching period (in which each stretch is held for a minimum of 30 seconds).
The following workout is suggested to compliment your existing aerobic activities and features exercises that will be of particular benefit for both menopausal and post-menopausal women. The workout should be performed 2-3 times per week, although if you are new to exercise than once a week is fine to begin with. Many of the exercises use 'bodyweight' as a form of resistance, which means that you can do the workout on holiday, in a hotel room, and so on.
Elements of this workout may be unsuitable for those with low back or knee injuries. These workouts have been designed on the basis that there are no underlying injuries or medical contraindications. If you are uncertain about any aspect of this workout or are new to exercise you should consult your physician before participation in this or any other exercise programme.
Time Repetitions Sets
- WARM UP At least 15 min
- Step ups 10-20 each 2-3
- Squats 12-20 2-3
- Single step ups 12-20 2-3
- Tricep dips 8-12 2-3
- Press ups 8-12 2-3
- Abdominal crunches 8-20 2-3
- Pelvic tilts 5-10 each type 2-3
- Ab crunch + p.tilt 8-20 2-3
- Cat stretch Hold 10 seconds 2-3
- Arm/leg lifts 8-15 2-3
* Kegel exercises See below
How To Perform The Exercises Correctly
Choose from at least 15 minutes of brisk walking or jogging.
- Simply step up and down off a step approximately 8" height (e.g. the bottom step on a staircase).
- Repeat 10-20 times on each leg; perform 2-3 sets.
- Stand with feet hip width apart, stomach in, knees unlocked, straight back.
- Squat down to between 60(-90( keeping the knees behind the toes. Repeat 12-20 times; perform 2-3 sets.
Alternatively perform sets of step ups and squats simultaneously 2-3 times for a more difficult workout.
Single step ups
- Using the same step as above, keep the whole of the right foot placed on the step whilst you step up and down with the left leg. Try to keep the right knee behind the toes when you step down and do not lock out the left knee.
- Change legs and repeat.
- Repeat 12-20 times on each leg; perform 2-3 sets.
- Sit on the edge of a sofa or chair, holding on with the arms by your sides and the knuckles facing forwards.
- Move your body off the chair, keeping your back vertical to the chair and your legs straight.
- Lower your body from the elbows no more than 90(, ensuring that they stay pointed directly behind you.
- Push yourself up using your triceps, breathing out.
- Repeat 8-12 times; perform 2-3 sets.
Alternatively perform sets of single step ups and bench dips simultaneously 2-3 times for a more difficult workout.
- On hands and knees, straight back, stomach in, hands slightly wider than shoulder width apart. Cross the ankles and lift the feet off the floor.
- Pivoting the body forward from the knees, slowly lower the chest towards the floor keeping the back straight. Take 3-5 seconds to do this.
- Breathe out and push up, again pivoting from the knees rather than bending at the waist, take only 1 second to do this.
- Repeat 8-12 times; perform 2-3 sets.
To make the exercise more difficult, increase the distance between the hands and knees so that the body becomes straighter ('3/4' press ups as opposed to '1/2' press ups).
- Lie on back, knees bent, stomach in, pelvic tilt, hands behind head.
- Keeping a consistent gap between the chin and the chest, lift up to 45( maximum, breathing out. (The low back must remain in contact with the floor at all times).
- Hold for one second then lower. Repeat 8-20 times; perform 2-3 sets.
One of the most beneficial exercises as it helps maintain abdominal tone and stretches the low back muscles.
- Lie on back, knees bent, stomach in.
- Contract the gluteal muscles (not low back) and the abdominals, raising the pelvis off the ground without the aid of the back or legs. The low back should remain in contact with the floor at all times .
- Perform sets of long contractions (hold 5 seconds) and sets of smaller, faster contractions (hold 2 seconds). Start with 5-10 repetitions for each type; perform 2-3 sets.
Alternatively perform sets of abdominal crunches and pelvic tilts simultaneously 2-3 times for a more difficult workout.
Ab crunch + p.tilt
- Literally a combination of the abdominal crunch and pelvic tilt. Performed together so that both the head and the low back lift off the floor at the same time for a greater emphasis on the abdominal muscles.
- Hold position for one second before lowering. Repeat 8-20 times; perform 2-3 sets.
Alternate arm/leg lifts
- On all fours, stomach in, pelvic tilt.
- Simultaneously lift one arm from the shoulder and opposite leg from the hip up to the level of your body maintaining position 1.
- Hold for 1 second breathing out. Repeat 8-15 times on the same side.
- Perform on the other side; until 2-3 sets on each side.
- On all fours, pelvic tilt and stomach in so that the low back rounds up towards the ceiling as high as you can.
- Hold for 10 seconds breathing normally.
- Relax, but do not let the low back arch at all. Perform 2-3 sets.
* Kegel exercises
Kegel exercises or pelvic floor exercises are vitally important, but have not been included in the workout as these are best performed throughout the day rather than in a set workout. You may remember performing these exercises if you have ever been pregnant or given birth. Whilst general exercise will increase and improve the circulation to the pelvic area, kegel exercises will help to increase muscular strength and endurance to the pelvic floor muscles. One of the most important benefits is a reduction in the occurrence of 'stress' incontinence, whereby a cough, sneeze, or laugh can cause an embarrassing episode of 'leaking'. To perform kegel exercises correctly:
- Do not stop the flow of urine. Instead, locate the pelvic floor muscles by either trying to grip an imaginary inserted tampon, or by sitting on a seat and contracting the pelvic floor so that the genitalia lifts off the seat.
- Perform sets of long contractions (hold 5 seconds) and sets of smaller, faster contractions (hold 1 second). Start with 2 sets of 5 repetitions for each type, at least 2-3 times daily.