Senior Lecturer in Sport and Exercise Science, School of Sport and Service Management, University of Brighton, Eastbourne, Brighton20 7SR, UKUnited Kingdom
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Menopause is characterized by marked changes in the circulating estrogen of the female body.1 As women age, progressively declines in ovarian function lead to a gradual reduction in estrogen secretion that ultimately ceases when menopause is reached. This transitional time is termed the perimenopausal period and it occurs approximately within one year of its commencement.2 The perimenopausal years are crucial for the future health of females as the observed hormonal alterations can lead to a number of psychophysiological changes that can increase the risk of disease if not prevented early.2 Specifically, during the perimenopausal years the diminished concentrations of estrogens, reduce their protective role on health and contribute to significant physiological disturbances.3 Adverse health effects such as reductions in fat-free mass (sarcopenia), accumulation of body fat and intra-abdominal visceral fat and associated adverse cardiovascular and metabolic impairments namely hypertension, atherosclerosis and insulin resistance are observed.
Keywords: sarcopenia; physiological
Open Journal PUBLISHERS Editorial Re-evaluating the Optimal Exercise for the Critical Peri and Postmenopausal Years * Ifigeneia Giannopoulou, PhD* Senior Lecturer in Sport and Exercise Science, School of Sport and Service Management, University of Brighton, Eastbourne, Brighton20 7SR, UK * *Corresponding author Ifigeneia Giannopoulou, PhD Senior Lecturer in Sport and Exercise Science, School of Sport and Service Management, University of Brighton, Eastbourne, Brighton20 7SR, UK; Tel. 01273 643731; E-mail: I.Giannopoulou@brighton.ac.uk Article information th th th Received: March 7 , 2019; Accepted: March 25 , 2019; Published: March 28 , 2019 Cite this article Giannopoulou I. Re-evaluating the optimal exercise for the critical peri and postmenopausal years. Obes Res Open J. 2019; 6(1): e1-e4. doi: 10.17140/OROJ-6-e014 enopause is characterized by marked changes in the circulat- aforementioned comorbidities very difficult and challenging and ing estrogen of the female body.1 As women age, progres- warrants further research on identifying the ideal treatment plan M sively declines in ovarian function lead to a gradual reduction in es- for this population. Particularly, preventive treatment plans during trogen secretion that ultimately ceases when menopause is reached. the perimenopausal years are deemed essential in slowing down This transitional time is termed the perimenopausal period and it or delaying the development of chronic mental and non-mental occurs approximately within one year of its commencement.2 The diseases later in life and increasing the well-being and quality of life perimenopausal years are crucial for the future health of females of older women.
as the observed hormonal alterations can lead to a number of psy- chophysiological changes that can increase the risk of disease if It is well established that exercise is an essential treatment not prevented early.2 Specifically, during the perimenopausal years plan for the prevention of chronic diseases in older women.10 A the diminished concentrations of estrogens, reduce their protec- number of research studies have demonstrated the central role that tive role on health and contribute to significant physiological dis- regular endurance exercise has on the health, well-being, and quali- turbances.3 Adverse health effects such as reductions in fat-free ty of life of older women by partly attenuating some of the physio- 11,12 mass (sarcopenia), accumulation of body fat and intra-abdominal logical changes occurring with aging. In healthy postmenopaus- visceral fat and associated adverse cardiovascular and metabolic al women, participation in moderate intensity continuous exercise impairments namely hypertension, atherosclerosis and insulin training alone has been shown to induce improvements in body fat resistance are observed.1 Consequently, there is a significantly in- and abdominal visceral adiposity, insulin resistance, lipid levels and creased risk in the development of obesity and its comorbidities inflammatory markers that can be further accelerated when exer- 13,14 namely cardiovascular disease and type 2 diabetes, that can reduce cise is combined with a balanced nutrition plan. In overweight the quality of life and dramatically increase the risk of mortality in and obese postmenopausal women, regular moderate-intensity older women.3 In conjunction with the aforementioned conditions, endurance exercise for 3-4 months has been well documented to significant impairments in cognitive and mood state are observed improve body mass index, body composition and insulin sensitiv- in the peri and postmenopausal years, further increasing the risk ity.15 In type 2 diabetic obese postmenopausal women, moderate 4-6 of morbidity and mortality in older women.4-6 An increased preva- intensity endurance exercise can induce significant improvements lence of anxiety and depression and cognitive declines such as loss in glycemic control, Hemoglobin A1c and inflammatory markers of concentration, memory and a high risk of developing dementia primarily due to reductions in intra-abdominal visceral adipos- 16-18 and Alzheimer’s disease have been noted, recognizing menopause ity and increases in exercise capacity. While, in hypertensive not only as a reproductive but also as a neurological transitional postmenopausal women there is strong evidence to support the 7-9 state.7-9 These effects are exacerbated by the declines in physical important role of endurance exercise on reducing cardiovascular activity participation and low exercise compliance observed in risk factors through significant improvements in blood pressure, 19,20 older women. The complex and multifaceted pathophysiology of autonomic tone, baroreflex sensitivity and oxidative stress. Fi- the peri and postmenopausal years, makes the treatment of the nally, studies on the effects of regular endurance exercise on mood cc Copyright 2019 by Giannopoulou I. This is an open-access article distributed under Creative Commons Attribution 4.0 International License (CC BY 4.0), state in women during the menopausal transition, demonstrate fat mass and improvements in cardiometabolic risk factors in post- significant improvements in depressive symptoms and reduction menopausal women after HIIE training. Finally, Egelund et al35 in menopause-related anxiety and mood disorders after endurance studied the effects of HIIE on early postmenopausal women and 4,21 exercise training.4,21 found marked improvements in cardiac function in terms of sys- tolic and diastolic function after 12 weeks of cycle interval training. Despite the accumulated evidence on the effects of en- durance exercise on the postmenopausal years, there is a scarcity The effects of HIIE on the perimenopausal years is large- of data on the effects of exercise on the critical time period of the ly understudied. In younger overweight and obese women, HIIE perimenopausal years. The limited studies conducted demonstrate has been shown to be a potentially more effective mode of exercise the promising effects of endurance exercise training on the health compared to continuous exercise, in terms of time-efficiency and and exercise capacity of perimenopausal women but also stress the perception of effort while significantly improving aerobic fitness, need for more studies to be conducted in this understudied popula- blood glucose and lipid levels.36 In a recent study that our research 11,22-25 tion. In the few studies that have been conducted, it is evident group conducted investigating the effects of an acute bout of in- that moderate-intensity endurance exercise primarily in the form terval exercise on psychophysiological adaptations in overweight of walking can induce significant improvements in body weight, perimenopausal women, we found that one acute bout of HIIE body fat, aerobic fitness and overall exercise capacity in perimeno- alone was effective in inducing significant improvements in the sys- 11,23 pausal women. Moreover, endurance exercise has been shown tolic and diastolic blood pressure of this population. Moreover, to induce significant improvements in independent cardiovascular it led to improvements in mood, exercise enjoyment and exercise risk factors such as glucose and lipid levels and overall quality of tolerance, especially when combined with high carbohydrate versus 22,24,25 life in pre and perimenopausal women. However, no research high protein pre-exercise feedings, while no changes were noted in studies have investigated the effects of exercise on the mood and cognitive capacity.37 Further, in unpublished preliminary data from cognitive state of perimenopausal women, leaving a gap in the lit- our research group, we have found that one bout of interval exer- erature on a crucial time period for women’s mental health. There cise can induce similar fat oxidation rates and exercise enjoyment is an urgent need to conduct more research studies on the peri- compared to continuous exercise in a group of overweight peri- menopausal years in order to identify optimal lifestyle treatment menopausal women, mimicking the findings of an earlier study in plans that can prevent the development of mental and non-mental younger women where 7 sessions of HIIE over a two-week period health problems at an early stage.
resulted in marked elevations in whole body and skeletal muscle fatty acid oxidation.38 It is important to note that the improvements High-intensity interval exercise (HIIE) has recently seen in our group of perimenopausal women with HIIE were emerged as a favourable exercise modality for clinical populations achieved in approximately half the exercise duration compared to with obesity, type 2 diabetes and cardiovascular disease leading continuous exercise, suggesting significant practical training appli- to comparable or even faster improvements in exercise capacity, cations for this population, given that “lack of time” is the most 26-29 body composition and cardiometabolic health parameters. Spe- commonly cited barrier to regular exercise participation. Research cifically, similar or faster improvements in exercise capacity, insulin on the effects of long-term HIIE have also shed some light on the resistance, blood pressure and cardiac function have been docu- potential advantageous effects of this mode of exercise for older mented in older clinical populations with metabolic syndrome, car- women. Seidelin et al39 recently demonstrated improvements in diovascular disease and type 2 diabetes when training with HIIE aerobic capacity in late pre-menopausal women after intermittent 29,30 compared to continuous exercise. In older male and female exercise training for 12 weeks. Moreover, the group of Mandrup et obese populations, HIIE has been documented to have similar al12 reported that a 3-month high-intensity aerobic training inter- effectiveness with moderate intensity continuous exercise across vention induced similar levels of improvements in cardiovascular all body composition measures but in a more time-efficient way, disease and type 2 diabetes risk factors in pre-menopausal women. by requiring less than 40% training time compared to continuous Finally, Egelund et al35 showed that a 12-week HIIE intervention exercise.27 Furthermore, HIIE has been reported to lead to similar on pre-menopausal women led to significant positive adaptations enjoyment and exercise adherence levels in overweight and obese in cardiac function such as left ventricle mass and left atrial end- older males and females with continuous exercise, demonstrating diastolic and end-systolic volumes.40 More evidence is required to the important role that it might have on exercise compliance in this further investigate and establish the effectiveness of HIIE on the population.31 However, limited evidence exists on the effects of perimenopausal years, especially in terms of neurological and cog- HIIE on the exercise capacity and health on the specific high-risk nitive health disturbances in this population.41 time periods of peri and menopause. In postmenopausal women, 16-weeks of HIIE have been shown to lead to greater weight loss It is evident that additional investigations are needed to and improvements in body composition compared to continuous assess the effects of exercise on the critical perimenopausal years. moderate intensity exercise in healthy postmenopausal women32 Perimenopause offers the unique opportunity for chronic disease and greater reductions in intra-abdominal adiposity in obese post- risk reduction in women at an early stage, prior to menopause, at 12,33,34 menopausal type 2 diabetic women. Moreover, Mandrup et which time point the development of chronic diseases is accen- al12 has demonstrated significant improvements in body composi- tuated.42 More studies need to be conducted on clinical exercise tion as observed by increases in lean body mass and reductions in modalities such as high-intensity interval exercise clinical proto- cols that can optimally counteract the effects of menopause on 11. Gao HL, Gao HX, Sun FM, Zhang L. Effects of walking on women’s health and reduce the risk of developing mental health- body composition in perimenopausal and postmenopausal wom- related comorbidities. Re-evaluating the optimal exercise mode for en: a systematic review and meta-analysis. Menopause. 2016; 23(8): this population could lead to a more effective exercise prescription 928-934. doi: 10.1097/GME.0000000000000627 that could enhance exercise adherence and enjoyment while allow- ing women to exercise in a more time-efficient manner compared 12. Mandrup CM, Egelund J, Nyberg M. Effects of high-intensity to the traditionally prescribed exercise programs. training on cardiovascular risk factors in pre-menopausal and post- menopausal women. Am J Obstet Gynecol. 2017; 216(4): 384.e1-384.