Physical Activity and Menopause

 

Menopause is bad.

Exercise is good. 

More exercise is the solution!

Is that it?

It’s not quite that simple, although most things you will read will tell you that any form of physical activity is helpful. There is a lot of truth to it. Physical activity at any age is beneficial and for women during mid-life exercising carries additional substantial health benefits. The menopausal transition is associated with many health risk factors such as increased risk for cardiovascular disease, osteoporosis, decreased bone mineral density, metabolic syndrome, and musculoskeletal symptoms. Exercise prescriptions for those health risks are the same as for non-menopausal women.

However, according to my research, not all forms of physical activity are of equal benefit in helping with menopause symptoms. In fact, some forms of exercise can exacerbate certain types of symptoms such as hot flashes and insomnia.

I believe that it is important to pick the type of exercise depending on your symptoms rather than just exercise to exercise.

So how do you know which exercise is best for you? You start by reading this blog 🙂 To help you find your way through the labyrinth of research that is out there, I’ve consolidated the findings of the last 20 years of research on this topic so you don’t have to.

First I want to highlight the overall benefits of exercising regardless of symptoms:

Increases:

• Benefits brain function and functional capacity
• Increases beta endorphins
• Quality of Life
• Strength and balance
• Increased Bone Mineral Density
• Increase in quality and length of sleep
• Maintenance of healthy BMI
• Self-perceived physical condition
• Sport competence
• Body image & physical self-worth

Decreases

• Vasomotor Symptoms
• Somatic & psychological symptoms
• Depression (1 exercise session/week = 22% reduction)
• Osteoporosis
• Body Mass Index
• Musculoskeletal symptoms
• Cardiovascular Disease (50% reduction)
• Overall mortality (20% reduction)

Exercise has many benefits but can also be stressful on the body

Too much exercise and/or intensity can:

• Decrease sleep quality and length, which in turn is correlated with adverse physiological and psychological outcomes
• Increase circulating cortisol levels, which can lead to increased abdominal fat (read last week’s post for more info on this)
• Have negative effects on thermoregulation as it causes substantial increases in metabolic heat production and core temperature (during exercise, metabolic heat production can increase by ten to twenty-fold and recent studies suggest that hot flashes are triggered by small elevations in core body temperature)
• Moderate intensity appears to have the most benefits
  • Highest menopause-specific quality of life
  • Lowest number of symptoms
  • Increased sleep, energy, confidence, mood

The following exercise guidelines are specific to helping you with menopause symptoms as well as increased quality of life throughout the menopausal transition. These recommendations do not apply to overall physical health.

Type of Exercise 

Endurance/aerobic training best for increased sleep

Strength training for body image, strength, body aches

Yoga for vasomotor (VMS) symptoms and overall menopause-specific quality of life (Hatha yoga for cognitive function (memory, concentration)

Walking at ~3-3.5 mph for anxiety and depression

Duration & Intensity

• Moderate Intensity (60-70% Target HR)
• Min. 3 x week (more days = decreased severity of symptoms)
• Programs lasting at least 12 weeks

Special Considerations

• Keep body core temperature at comfort level to avoid increases in VMS
• Focus on activities that are enjoyable to you. Forcing yourself through workout regimens that you dislike can have negative effects on quality of life. I hear too many people say: “I think I should run more” and my question to them is “Why? Do you like running?”. “No, but it’s good for you”. Really? Is it? I don’t believe in doing things just because someone said they’re good, especially in regards to exercise. If you don’t like it, you won’t stick to it. It’s as simple as that. And when it comes to working out, consistency is the key. So find activities that you truly enjoy. Not only will you continue doing them and reap the physical and mental benefits but doing things you love will help you reduce stress and keep off that unwanted meno-pod (if you don’t know what a meno-pod is, you have to read last week’s post).

Have a comment or question? Leave me a note on the blog or tweet me @doctorluque

Stay happy and healthy

– Dr. Maria

All information is based on peer-reviewed research. I usually add a reference list of all the articles I read to put together an article but this one would be way too long. If you’re interested in finding out more about specific research articles used for this blog, contact me.

The Dreaded Menopod – Menopausal Belly Fat

The most common concern I hear from women in their 40’s and 50’s is increased belly fat. It isn’t weight gain that they are mostly upset about but where it’s deposited…right around the belly button.

Even women that don’t gain weight, see changes in where the fat is deposited. Is it an evil magic trick? I’ve heard it being called the belly bagel, spare tire, jelly center, and my favorite the menopod. Regardless of its name, it’s unwanted and you want to know how to get rid of it. Can you get rid of it or are you doomed to everlasting belly fat increases? Well, let’s break down why it happens and I’ll give you some ideas on what you can do.

Aging 

As we age, it is normal to see some weight gain. This is not something unique to women but women do see a larger increase in abdominal fat. In fact,  the prevalence of abdominal obesity in women in 2008 was 65.5% for women aged 40-59 years. So you’re not alone in this experience. Many different factors play a role in this. Changing hormone levels, loss in muscle mass, decreased activity level, and increased caloric intake, are just a few.

Estrogen

This is the queen bee of all hormones and sadly, this is the one that you’re being robbed off during menopause. Why is this such a big deal? Because she controls everything!! Estrogen plays a role in endocrine, immune, and neurologic systems. That’s why when it’s taken away, many women feel symptoms ranging from hot flashes to forgetfulness, depression and insomnia. One of the biggest connections of estrogen on increased belly fat is its relationship to cortisol. Ahhh, there it is, one of the biggest baddest buzz words in the health industry right now.

If you believe what you read in headlines, this is the one to blame for everything. If it’s out of control, you lose, but to control it seems impossible. Is it? How is estrogen related to it and how does it play a role in belly fat?

Cortisol deserves an entire article by itself (which will come soon) so here is the condensed version on why cortisol is so important to your menopod.

Cortisol is:

• “ Cortisol regulates energy by selecting the right type and amount of substrate (carbohydrate, fat or protein) that is needed by the body to meet the physiological demands that is placed upon it.” (5)
  • Energy production, exercising, eating, and under stress
  • This chronic stress can cause excess fat storage deep in the abdomen (visceral fat)
    • Deep abdominal fat has greater blood flow and four times more cortisol receptors. That’s why when there is too much cortisol in your body, it goes right to your belly.
  • It naturally is higher in the morning when you wake up and tapers down as the day goes on
  • When the body remains under constant stress, cortisol levels remain high regardless of time of day

Estrogen – Cortisol Connection 

Estrogen has anti-cortisol properties, which helps the body counteract some of the negative effects of cortisol. So as estrogen starts disappearing, so do its cortisol-fighting superpowers. This means that if your body was able to handle some of the excess day-to-day stress before, it may not be able to handle it quite as well now, which translates into excess belly fat.

What can you do?

• Chill out!!
  • This is the most important thing you can do
  • Eliminate little, unimportant things that drive you crazy. This is unnecessary stress.

• In my case, every time I feel like getting stressed out over some inconsiderate driver on the road, I say to myself “menopod alert, menopod alert…not worth it!!”. It helps :)
• Stress will always be a part of life. Learning how to cope with it, is essential to controlling weight gain, belly fat, and overall health and well-being.

• Resistance training
  • Don’t wait!
    • It is easier to maintain than to try and lose weight during menopause
    • Nobody knows exactly when menopause starts. It can be as early as mid-30’s to late 50’s.
    • Being active before midlife has advantages as it can contribute to entering menopause with lower BMI, higher bone density, lower fat mass, higher lean body mass.
  • Muscle mass decreases with age for every person, not just women. However, this decrease is accelerated in women as they transition through menopause.

• Mindful exercises such as yoga, Tai Chi, meditation
  • it can help with stress reduction as well as other psychological symptoms, such as anxiety and depression

• Eat healthy and adjust your caloric intake to your energy output
  • if you’re not working out as much as you did before, you can’t eat like you did

As we age, we are faced with many physical changes that affect us not only physically but also psychologically and emotionally. As women, those changes are exacerbated during menopause. Understanding these changes is a key factor in being able to overcome these challenges and transition happily through menopause. In regards to increased belly fat, you must remember that weight gain doesn’t happen overnight and it doesn’t start with menopause.

Don’t wait until you’re unhappy with your body…live healthy now!

Exercise, eat well, find a good balance between work and personal life, and enjoy the smaller things in life. Most importantly, don’t let inconsiderate drivers give you a menopod! 🙂

Stay tuned for next week’s blog post when I will cover cortisol and other hormones in a bit more detail.

Stay happy & healthy

 – Dr. Maria

References:

1. Davis, et al. (2012) Understanding weight gain at menopause. Climacteric 15;419-429. doi: 10.3109/13697137.2012.707385
2. Sammel, et al (2003). Weight gain among women in the late reproductive years. Family Practice, 20: 401-409. doi: 10.1093/fampra/cmg411
3. Lovejoy, J. C., Champagne, C. M., De Jonge, L., Xie, H., & Smith, S. R. (2008). Increased visceral fat and decreased energy expenditure during the menopausal transition. International Journal of Obesity, 32(6), 949-58. doi:http://dx.doi.org/10.1038/ijo.2008.25
4. Epel, E. S. (1997). Can stress shape your body? stress and cortisol reactivity among women with central body fat distribution. (Order No. 9930948, Yale University). ProQuest Dissertations and Theses, , 96-96 p. Retrieved from http://search.proquest.com/docview/304388219?accountid=28844. (304388219).
5. Maglione-Graves, C., Kravitz, L., Schneider, S. (no date). Cortisol Connection: Tips on Managing Stress and Weight. http://www.unm.edu/~lkravitz/Article%20folder/stresscortisol.html

The “M” Word – Let’s Talk Menopause

We’ve all heard about menopause, but what really is it? When does it start? How long does it last? How will I know if I’m in menopause? What are the symptoms? Does everyone have the same symptoms? These are just a few of the many common questions that I’m asked on a regular basis. This natural phase in every woman’s life is still a big mystery surrounded by misinformation, confusion, and yes, quite a bit of secrecy. In the next few installments of this series, I will address hormone replacement therapy, alternative therapies, the role of nutrition & physical activity, and any questions you may have. Let’s blow the top off this taboo topic – let’s talk menopause!

Menopause has morphed from an experience that only a small percentage of women lived through to a natural part of every woman’s life today. At the turn of the 20th century, women were not expected to live past 50. Now life expectancy for women is 78 years of age. If you’re a woman in your 20’s or 30’s, you might ask yourself: why should I care? I’m way to young for this. Well, I hate to be the bearer of truth but the reality is that you will eventually go through it; so you might as well be educated.

The fact is that 75% of all women will experience hot flashes and night sweats, and many experience insomnia, weight gain, and irritability. Menopause symptoms can be debilitating for many women, often appearing before they realize hormonal changes have begun to take place. Women don’t expect to experience these symptoms in their mid-thirties, but it happens all the time. Yet an alarming number of women still think they don’t have to “worry” about menopause until their 50s. Don’t wait! Educate yourself early. So let’s start with the basics: what is menopause?

The Menopausal Transition Defined
Menopause is not a singular event but rather a transition lasting on average 3.8 years. It is often described in three phases: premenopause, which is the time when menstruation is normal, to perimenopause, which is the time when menstruation becomes more infrequent and also includes the one year after the final period, after which postmenopause begins, which is defined as the time in a women’s life when the ovaries stop functioning and menstruation has ceased for at least 12 consecutive months. You’re also considered postmenopausal if the ovaries were surgically removed or were damaged during chemotherapy. (Note: a hysterectomy, where only your uterus is removed, does not affect your ovaries or menopause). For a more detailed breakdown of the adult female reproductive life , the most recent Stages of Reproductive Ages Workshop (STRAW) is a great resource (Harlow, et al., 2012). It provides guidance on the different stages, their lengths, characteristics, and signs. Although there is no exact test to determine perimenopause, STRAW also provides guidelines for hormone levels that play a role in determining the stages in the menopausal transition. The most common hormone used for determination of perimenopause is the Follicle Stimulating Hormone (FSH), with levels greater than 25 IU/L indicating decline in ovarian function and beginning of perimenopause. As estrogen drops, FSH climbs to kickstart the follicle cycle and make up for the lack in estrogen.

Symptoms – oh no!
Menopausal symptoms are often summed up to hot flashes and night sweats although that couldn’t be further from the truth. Both hot flashes and night sweats are symptoms of menopause but there are many more, often subtle symptoms, that are not commonly attributed to the menopausal transition but are indeed symptoms linked to declines in ovarian function.
Menopausal symptoms fall into four categories to include vasomotor, psychosocial, physical, and sexual.

Vasomotor symptoms (VMS)
About 75% of women experience VMS
Hot flushes, night sweats, sweating

Psychosocial
Anxiety, impatience, poor memory, depression (prior depression is the highest risk factor for subsequent depression)

Physical
Body aches, fatigue, insomnia, weight gain, changes in skin appearance, migraines

Sexual
Vaginal dryness, painful intercourse, avoiding intimacy, lack of sexual desire

In addition, reduced levels of neurotransmitters (serotonin, dopamine, oxytocin) can cause changes in brain function and behavior, and declines in cognitive function, mood, and memory.

I know, I know, this all sounds very scary and depressing but this article is not designed to scare you into expecting the worst. Its purpose is to inform you of changes that will happen and that can come in all forms and intensities. Every woman is different; some women experience all symptoms to the extreme but there are also women that don’t experience any symptoms at all. It is impossible to predict what your experience will be. My goal is to equip you with the knowledge to be able to identify changes that are attributable to the menopausal transition and how to successfully and hopefully happily transition through this time in your life. Let’s start this conversation.

Have a comment or question? Leave me a note on the blog or tweet me @doctorluque

Stay happy and healthy
– Dr. Maria Luque

“Older women need 1-hour workouts to fend off flab” Really?

A while ago, the headline in the local newspaper stated: “Older women need 1-hour workouts to fend off flab”  Wow!

The first time I heard about it, someone merely mentioned that there was an article about a study that said that middle-aged women have to workout 1 hour per day to be able to keep their weight constant. The more I heard about it, the more dramatic and gloomy it got. By the end, pretty much if you were a woman 54-years and older, you would have to workout like a maniac for 1 hour per day or be doomed to a future of constant weight gain. Who has time to workout that much? I don’t think I can do that! Well, I might as well don’t bother!…..Panic!!!

Neverfear… Of course I couldn’t help myself but dig a little deeper, find the actual research paper, read the findings from the source itself and find out if the results of this study really that drastic.

So here are my findings:

The actual research paper, Physical Activity and Weight Gain Prevention, was published 24 March 2010 in the Journal of the American Medical Association. The study was conducted over 13 years and involved 34 079 healthy US women with a mean age of 54.2 years. The goal of the study was “to examine the association or different amounts of physical activity with long-term weight changes among women consuming a usual diet”

Physical activity was defined as recreational activities to include walking, hiking, jogging, running, bicycling, aerobic exercise, dance, use of exercise machines, yoga, stretching, toning, tennis, squash, racquetball, and swimming. There is no mention of what “usual diet” means, so one can make an educated guess that it consists of the USDA’s dietary guidelines, but as I said, the research paper does not specify.

There are two main findings of the study:

(1) The rate of weight gain in this study was 2.6 kg (roughly 5 lbs) over 13 years. (I don’t want to take away from the importance of minimizing weight gain, but the impression I got from the hearsay, was that unless you workout for 1 hour per day, your weight will be out of control. 5 lbs over 13 years is definitely not out of control)

(2) Physical activity (consisting of 60 min/day of moderate-intensity physical activity) was associated with less weight gain only for women with a BMI of <25. For overweight participants, physical activity was not associated with less weight gain. (Translation: those women that took care of themselves before their 50’s had much more success)

So what does that mean for you? Are you doomed to endless weight gain unless you become an exercise fanatic? Absolutely not!!

Short version:

The key is how you treat your body throughout life not at a specific age! Eat healthy and don’t wait until 54 to start exercising! J If you take care of yourself throughout your life and incorporate good health behaviors into your daily life, you have nothing to worry about.

The slightly longer version:

–       Weight gain happens when more calories are consumed than used, no matter the gender and age. With age, activity levels tend to decrease, which demands a decrease in caloric consumption. If that doesn’t happen, you will gain weight!

–       Age-related loss of muscle, also called sarcopenia, affects everyone and causes our metabolism to slow down. Less muscle = less calories burned. This highlights again the importance of resistance training in combating muscle wasting and keeping your body working as efficient as possible.

 

Healthy nutrition and regular physical activity are a MUST –

No matter your age or gender!

Be good to your body and it will be good to you!!!

 

 

Reference:

Lee, I-M., Djousse, L., Sesso, H.D., Wang, L., Buring, J.E. (2010). Physical Activity and Weight Gain Prevention. JAMA, (303)12; 1173-1180.