Menopause and Fitness

The menopause transition is different for everyone. However, a common frustration is increased weight around the middle, loss of muscle tone, and loose/dry skin, but underneath it all, our cardiovascular health and bone density may be at risk. Menopause means increased risks of developing heart disease, diabetes and osteoporosis. Heart disease is contingent on many other factors, which are outside the scope of this wiki, but it’s extremely important to lose weight, eat healthy, quit smoking, lower blood pressure and cholesterol, and control blood sugars.

This guide offers a starting point for those who are interested in maintaining/building bone and getting healthier in the process. While exercise is only one component of preventing bone loss, we must also consider a calcium rich diet, and Vitamin D, while limiting caffeine, tobacco and alcohol. Menopause Hormone Therapy (MHT/HRT) is also recommended as the most effective treatment for preventing bone loss and reducing risk of hip fractures by 30-50%.

Fitness is a huge industry and we cannot include every aspect, however this fitness wiki provides a quick outline of the basics to get started, specifically:

Balance
Cardio
Strength training
Yoga/Pilates

How much exercise do we need?

According to a number of health resources (Centers for Disease Control and Prevention, The American Heart Association, and Department of Health and Human Services) adults need least 150 minutes of moderate aerobic activity, or 75 minutes of vigorous aerobic activity every week, with the optimum goal of 300 minutes per week. This amounts to 21-42 minutes of moderate exercise, or 11-21 minutes of vigorous exercise every day, or approximately 30 minutes of moderate physical activity every day. Also incorporating moderate-to-high-intensity muscle strengthening (resistance/weights) at least 2 days per week.

Aerobic exercise is cardio (brisk walking, running, cycling, dancing, swimming, tennis)

Muscle strengthening includes lifting weights, using resistance bands, push-ups, planks, carrying/lifting heavy things

Moderate intensity is easily defined by using the ’talk test’, which means you can talk, but not sing while doing the activity.
Vigorous intensity is when you cannot say more than a few words without pausing for a breath.

Exercise doesn’t always have to be for a long duration, or too rigorous (it takes much longer for our muscles to recover in menopause). It is important to build/maintain muscle which helps prevent bone loss, and practice balance to prevent falls. Dr. Stacy Sims, an exercise physiologist and nutritional scientist suggests the best exercises for women going through the different stages of menopause are, “lift heavy shit - carefully. Do high intensity interval training and plyometrics (jump training). Up your protein. Do less volume and more intensity. Recover longer.”

Visceral fat and metabolic syndrome

According to the American Heart Association Waist size predicts heart attacks better than BMI, especially in women

Knowing your waist circumference is helpful to assess risk for heart disease, diabetes and stroke. The best way to do this is to measure your waist circumference. Even for those with healthy weight and BMI, menopausal women carry more fat around the waist.

According to the Mayo Clinic, to correctly measure your waist circumference: (you can find visual charts online)

Stand and wrap a tape measure around your waist, just above your hipbones
Make sure the tape is horizontal around the waist
Keep the tape snug around relaxed belly, but not compressing the skin
Measure your waist just after you breathe out

The National Institutes of Health indicates that a waist circumference of >88 cm (35") is abdominal obesity.

Each 1cm (0.4") over that increases cardiac disease by 2%. A reduction of 5cm (2") lowers the risk of heart disease by 15%

Knowing weight circumstance also helps to determine a condition called Metabolic Syndrome, which is also increased by menopause. It is diagnosed when at least 3 of 5 conditions are present:

Waist circumference greater than 88 cm (35")
High triglyceride level (or taking meds to lower it)
Low HDL (or taking medication to treat)
High blood pressure (or taking medication to lower)
High blood sugar (or taking medication to treat)

Knowing these levels are important so talk to your doctor about these specific tests.

The good news is that we have the ability to significantly lower these risks. We can take steps to lose weight, exercise, and take medications to treat any abnormal conditions. We cannot specifically target one area of our body to lose and/or strengthen. Exercise does not target visceral fat, so no amount of crunches will affect this. To effectively lower waist circumference, we must consume fewer calories overall. Your body will decide how and where to lose the fat.

Exercise for bone health

Muscle strengthening/weight bearing and resistance exercises are the best for our bone health. Weight bearing forces us to work against gravity. This includes walking, hiking, jogging, climbing stairs, playing tennis and dancing. Resistance and strength training includes using hand weights, resistant bands, and even our own body weight.

Getting started

Before starting any exercise program, it is important to discuss with your doctor
If possible, consider hiring a personal trainer for customized programs and to ensure you are using correct form
Ensure you have proper equipment for the activity you want to do (appropriate footwear, hand/free weights, strength bands, exercise ball, yoga mat)
Start slowly, consider a simple, moderate routine to start
Make adjustments as needed (adjust weight, repetitions)
Increase resistance and intensity progressively
Incorporate some form of exercise every day (stretching, balance, cardio, lifting weights)

Balance

Another consideration is that between the ages of 50 and 70, we lose about 30% of our muscle strength, putting us at risk for falls. We can help minimize this risk by building more muscle mass, but also practising balance every day which helps strengthen our core and prevent falls. Balancing can be done anytime throughout the day; it’s a simple as standing one leg.

Balance exercises

Start off slowly, holding onto something (back of a chair) if necessary to start. As balance improves, you can increase the challenge by letting go of the chair, holding the position longer, adding more movement to the pose, and closing your eyes.

Standing up and sitting down from a chair without using your hands
Standing with your weight on one leg and raising the other leg to the side or behind you
Putting your heel right in front of your toe like walking an imaginary tightrope

Recommendation: Ten Best Balance Exercises, from Physical Therapist

Cardio

Brisk walking, running/jogging, dancing, tennis. Swimming and cycling are also excellent for cardio while reducing the impact on joints, however these activities are not as effective at building/maintaining bone.

Walking / Hiking

Brisk walking and hiking are excellent forms of cardio (getting that heart rate up) and are also weight-bearing exercises beneficial for bones. To make them more challenging, walk with weights (hand-held, ankle-bands, or add extra weight in a backpack). Shorter/brisker walks are better at bone building, so instead of a one-hour moderately-paced walk, consider breaking it up into three twenty-minute brisk walks, or two thirty-minute walks.

Recommendations: see workout links below

Strength training (weights, body-weight and resistance)

Researchers from Australia were the first to demonstrate that post-menopausal women can not only stop bone density loss, but a can actually reverse it by lifting heavy weight. Prior to this, studies showed that lifting weights did not work to stop or reverse osteoporosis. These researchers later discovered it was because the women test subjects weren’t lifting heavy enough. Researchers worried that if post-menopausal women with severe osteoporosis lifted weights that are too heavy, they would fracture their bones. However, since that time, their Lifting Intervention for Training Muscle and Osteoporosis Rehabilitation (LIFTMOR) trial determined that twice-weekly, 30-minute high-intensity resistance and impact training (HiRIT) is effective at enhancing bone (particularly in the spine, pelvis and thigh bones), while improving stature and fall prevention.

Their four recommended fundamental resistant exercises in this LIFTMOR trial, proven to be superior for enhancing bone:

Deadlift or Deadlift with handweights (5 sets of five repetitions)
Overhead or Shoulder Press or Shoulder Press with handweights (5 sets of five repetitions)
Back squat (5 sets of five repetitions)
Jumping pullups

Recommendations: do the four exercises above, and/or find variations on these exercises within the workout links below

Jumping for bone health

Jumping exercises are very effective at increasing bone mineral density. If knees allow, try skipping rope.

Yoga / Pilates

Yoga and Pilates are beneficial for stretching, balance, flexibility, mobility

Recommendation: Trifecta Pilates

Sample Program: Exercises for Osteoporosis of the Hip includes 5 variations of hip raise exercises, plus chair squats, jump squats and single leg squats using a stability ball