The Impact of Exercise on Perimenopause

Menopause is different for each woman. Although the average age of natural menopause is 52, some women start the transition as soon as their early 40s. Chances are you have or will have clients who fit this profile. Are you aware of the unique challenges this population faces? Can you provide these women with the best coaching and training possible?

Middle-aged women often do not realize they are going through perimenopause, and consequently its symptoms confuse them. This is where you, as a trusted fitness professional, can provide information to ease the transition and make the experience a positive one. This article looks at menopause research and the benefits of exercise in relation to managing symptoms and improving quality of life (QOL) in perimenopausal women. (Note: For the purpose of this article, the term menopause will refer to perimenopause.)

The Role of Physical Activity

Menopausal women face challenges such as hot flashes, night sweats, insomnia and irritability, to name just a few. These symptoms—alone or combined—can compromise quality of life.

During menopause the role of physical activity becomes important, not only because of the plethora of symptoms that menopause produces, but also because it increases the risk for cardiovascular disease, osteoporosis, decreased bone mineral density, musculoskeletal symptoms, depression and obesity—specifically through an increase in central adiposity and visceral fat mass (Freeman 2010; Guthrie et al. 2004).

One study states that as many as 60% of perimenopausal women are overweight (Milewicz, Bidzinska & Sidorowicz 1996). Multiple studies examining the association between obesity and menopausal symptoms have shown that women with an elevated body mass index (BMI) report more severe symptoms than women with a healthy BMI and that obese women are at greater risk for depression (Fern├índez-Alonso et al. 2010). In addition, sarcopenia, or age-related muscle and strength loss, is expedited in menopausal women—owing to the decline in estrogen—and is exacerbated by low levels of physical activity.

There is compelling research highlighting the health benefits of physical activity for middle-aged women. These benefits include not only improvements in brain function and functional capacity (muscle strength, muscle quality and balance) but also relief from somatic and psychological symptoms like anxiety and depression. Physical activity positively impacts menopausal symptoms and helps maintain a healthy BMI.

Intensity and Physical Activity

There is overwhelming evidence of a dose-response relationship between physical activity and health benefits, meaning that the higher the intensity and frequency of the activity, the greater the health benefits (Leitzman et al. 2007).

However, this dose-response relationship might not be applicable for menopause-specific QOL (MENQOL). Recent research results indicate that moderate—rather than vigorous—physical activity has the most positive effect on menopause symptoms and MENQOL. One study revealed that women who participated in moderate-intensity physical activity reported higher MENQOL and a lower total number of symptoms than women who engaged in either low- or high-intensity physical activity (Luque 2011). This study also indicated that physical activity had a significant effect on hot flashes, sweating, weight gain, bloating, frequent urination and intimacy issues. For all of these variables, women with low physical activity levels reported the highest frequency of symptoms and greatest discomfort.

Another recent study concluded that women who participated in moderate exercise were twice as energized and confident (Elavsky et al. 2012). Moreover, a few studies evaluating the impact of different levels of physical activity on mood have shown that moderate exercise—not high-intensity exercise—enhances mood. For less active individuals, mood states are significantly worse during higher-intensity physical activity (Moses et al. 1989).

Exercise Program Design for Menopausal Clients

Need to create a workout program for a woman in menopause? Consider these suggestions:

• Keep exercise level at a moderate intensity (target heart rate = 50%–70% or 4–8 MET).
• Keep body temperature at client’s comfort level to avoid increase in vasomotor symptoms.
• Add cardiovascular, Pilates and/or meditation components to improve QOL.
• Add resistance training and Pilates to increase bone mineral density and help maintain a healthy BMI.
• Encourage clients to exercise 60 minutes a day for a minimum of 12 weeks to garner the best results.

For more research about exercise and menopause, plus a full reference list, please see “Training Through the Transition” in the online IDEA Library or in the November–December 2012 issue of IDEA Fitness Journal.