Menopausal women: perceiving continuous power through the experience of regular exercise

Promoting adherence to bone-loading exercises in postmenopausal women with low bone mass

BACKGROUND

We recently completed a parent study (Bone Loading Exercises versus Risedronate on Bone Health in Post-menopausal Women [NIH# R01NR015029]) examining bone-loading exercises to prevent bone loss in postmenopausal women with low bone mass. Forty-three million US women have low bone mass and increased risk for fractures. Bone-loading exercises (weight-bearing and resistance training) can preserve bone mass and decrease risk of fractures. However, multiple barriers prevent women from exercising and adherence rates are low.

PURPOSE

This secondary analysis of the parent study (a) examined barriers specific to women participating in bone-loading exercises; (b) described effectiveness of self-efficacy strategies used in the parent study for increasing confidence in knowledge and reducing barriers; and (c) applied study findings and principles of self-efficacy and self-regulation in development of guidelines for promoting adherence to exercises.

METHODS

Seventy-two women were randomized to the exercise group and completed 12 months of exercises. Instruments for self-efficacy were completed at 2 weeks and barriers interference at 6 months. Percent adherence was measured as the number of exercise sessions attended divided by the number prescribed.

RESULTS

In the 12-month study, average adherence to exercises was 58.9%. Lower adherers reported lack of self-regulation skills such as "lack of time" as the most frequent barriers to exercise.

IMPLICATIONS FOR PRACTICE

Guidelines developed included promotion of skills for self-regulation (such as regulation of time) as well as self-efficacy to improve adherence rates. Nurse practitioners may be the most motivated of all providers to use guidelines promoting exercise for women in their clinical practice.

Meanings of Menopause

Attitudes and sociocultural perceptions provide the context within which women experience menopause. Cultural influences greatly affect how women perceive and manage their menopausal symptoms. Cultures may be categorized based on way of life, including traditional, immigrant, and modern. Varying perceptions and symptom experiences are described, including modifiable and nonmodifiable factors that affect the level of distress women feel with menopause. Helping women actively participate in management of menopausal symptoms including self-care strategies will contribute to feelings of control of menopausal symptoms and overall health. By using the highest levels of evidence regarding management of menopause, becoming familiar with the cultural and psychosocial influences of menopause and then empowering women to make decisions regarding management, health care providers can improve their care of perimenopausal and menopausal women.

Adherence to exercise and affective responses: comparison between outdoor and indoor training

OBJECTIVE

Postmenopausal women, despite their increased cardiovascular risk, do not meet physical activity recommendations. Outdoor exercise bouts induce more positive affective responses than the same indoor exercise. Outdoor training could therefore increase exercise adherence. This study aims to compare the long-term effects of outdoor and indoor training on affective outcomes and adherence to exercise training in postmenopausal women.

METHODS

In a 12-week randomized trial, 23 healthy (body mass index, 22-29 kg/m) postmenopausal women (aged 52-69 y) were assigned to either outdoor training or indoor training and performed three weekly 1-hour sessions of identical aerobic and resistance training. Adherence, affective valence (Feeling Scale), affective states (Exercise-Induced Feeling Inventory), and rating of perceived exertion were measured during exercise sessions, whereas depression symptoms (Beck Depression Inventory) and physical activity level (Physical Activity Scale for the Elderly) were assessed before and after the intervention.

RESULTS

After 12 weeks of training, exercise-induced changes in affective valence were higher for the outdoor training group (P ≤ 0.05). A significant group-by-time interaction was found for postexercise tranquility (P ≤ 0.01), with a significant increase outdoors and a significant decrease indoors (both P ≤ 0.05). A time effect was revealed for positive engagement, which decreased across time in the indoor group (P ≤ 0.05). Adherence to training (97% vs 91%) was significantly higher outdoors (P ≤ 0.01). Between baseline and week 12, depression symptoms decreased and physical activity level increased only for the outdoor group (P ≤ 0.01 and P ≤ 0.05, respectively).

CONCLUSIONS

Outdoor training enhances affective responses to exercise and leads to greater exercise adherence than indoor training in postmenopausal women.

Factors influencing adherence to regular exercise in middle-aged women: a qualitative study to inform clinical practice

BACKGROUND

About half of women decrease their regular exercise during middle age. Concurrently, they experience a reduction in basal metabolic rate and loss of lean muscle as they transition to menopause. The combined effects place these women at increased risk for body weight gain and associated co-morbidities. Further research is required to better assess their barriers to regular exercise and to develop more applied knowledge aimed to improve the applicability of clinical interventions aimed at this population. The main aim of this study was to identify enablers and barriers influencing adherence to regular exercise in middle-aged women who exercise.

METHODS

An interpretive description qualitative study was conducted using individual interviews. The two key questions were focused on planning to engage in physical activity and succeeding or planning to engage in physical activity and not succeeding. Inductive content analysis was used.

RESULTS

Fifty-three women interviewed were aged 40-62 years and experiencing mild to moderate menopausal symptoms. Six broad themes influencing adhering to regular exercise were: routine, intrinsic motivation, biophysical issues, psychosocial commitments, environmental factors, and resources. Common sub-themes were identified as enabling factors: daily structure that incorporated physical activity (broad theme routine), anticipated positive feelings associated with physical activity (intrinsic), and accountability to others (psychosocial). Other common sub-themes identified as barriers were disruptions in daily structure (routine), competing demands (routine) and self-sacrifice (psychosocial).

CONCLUSIONS

The most common barrier middle-aged women describe as interfering with adhering to regular exercise was attributable to the demands of this life stage at home and with others. Lack of time and menopausal symptoms were not identified as the common barriers. To support women to adhere to regular exercise, healthcare professionals should consider a narrative approach to assessing barriers and focus on enablers to overcoming identified barriers.

Understanding osteoporosis and fractures: an introduction to the use of qualitative research

BACKGROUND

Qualitative research has been recognized in recent years as a field of inquiry used to understand people's beliefs, attitudes, behaviors, culture or lifestyle. While quantitative results are challenging to apply in everyday practice, the qualitative paradigm can be useful to fill in a research context that is poorly understood or ill-defined. It can provide an in-depth study of interactions, a way to incorporate context, and a means to hear the voices of participants. Understanding experiences, motivation, and beliefs can have a profound effect on the interpretation of quantitative research and generating hypotheses. In this paper, we will review different qualitative approaches that healthcare providers and researchers may find useful to implement in future study designs, specifically in the context of osteoporosis and fracture.

METHODS

We will provide insight into the qualitative paradigm gained from the osteoporosis literature on fractures using examples from the database Scopus. Five prominent qualitative techniques (narratives, phenomenology, grounded theory, ethnography, and case study) can be used to generate meanings of the social and clinical world.

DISCUSSION AND CONCLUSION

We have highlighted how these strategies are implemented in qualitative research on osteoporosis and fractures and are anchored to specific methodological practices. We focus on studies that explore patient psychosocial experiences of diagnosis and treatment, cultural boundaries, and interprofessional communication. After reviewing the research, we believe that action research, that is not frequently used, could also effectively be used by many professions to improve programs and policies affecting those dealing with osteoporosis issues.

Cross-cultural study: experience, understanding of menopause, and related therapies in Australian and Laotian women

OBJECTIVE

The aim of this study was to investigate and compare symptom experiences, beliefs, attitudes, and understanding of menopause and menopausal therapies in Australian and Laotian women.

METHODS

This was a cross-cultural, questionnaire-based study involving 108 women (56 Australian women and 52 Laotian women aged 40-65 y) attending outpatient clinics in Australia and Laos. Descriptive statistics and univariate analysis were conducted using Student's t test or Mann-Whitney U test, where appropriate.

RESULTS

Psychological symptoms, depression, vasomotor symptoms, and sexual dysfunction were significantly higher in Australian women compared with Laotian women (P < 0.05). Australian women perceived the meaning of menopause as aging (57%), whereas most Laotian women reported not knowing what menopause meant to them (81%). Australian women's fears about menopause included weight gain (43%), aging (41%), and breast cancer (38%), whereas Laotian women reported not knowing about potential menopausal problems (85%). Exercise (55%), education and awareness (46%), and improving lifestyle (41%) were reported by Australian women as being effective in alleviating menopausal symptoms, with only 21% reporting not knowing what was effective compared with 83% of Laotian women. Many women reported not knowing the risks/benefits of hormonal therapies (50% of Australian women and 87% of Laotian women) and herbal therapies (79% of Australian women and 92% of Laotian women). General practitioners were the most common source of menopause information for both Australians (73%) and Laotians (67%).

CONCLUSIONS

Sociocultural factors influence women's perception of menopause. Psychological symptoms, sexual dysfunction, and vasomotor symptoms are more commonly reported by Australian women than by Laotian women. Women have a limited understanding of the risks/benefits of menopausal therapies, and culturally appropriate education is needed.

"We are always asked; 'where are you from?'": Chilean women's reflections in midlife about their health and influence of migration to Sweden

AIM

This study explored how Chilean immigrant women living in Sweden perceived and related their life situations and health status during midlife to their migration experiences.

METHOD

Three focus group discussions (FGDs) were performed with 21 middle-aged Chilean women (40-60 years) who had lived in Stockholm for at least 15-20 years. In-depth interviews were held with three key informants. A combination of manifest and latent content analysis was performed to structure and categorize the tape-recorded and transcribed data.

FINDINGS

Three main themes emerged from the data: (i) Chilean women's reflections about migration and resettlement; (ii) Health during midlife; perceptions of Chilean women living in Sweden; and (iii) Strategies to manage their lives and to gain social acceptance and position. The Chilean women reflected about the discrimination they had met in the Swedish society and within the health care system along with health changes they had had during midlife. They connected some of their health related problems to their hardships of migration. They also expressed confusion about the health care they had received in Sweden including conflicting and mistrusting relationship with some health care providers. Important for their way of coping with their own health seemed to be a recognition of their own space, level of independence, self-acceptance and awareness of power relationships.

CONCLUSION

The results illuminate the importance of awareness of influence of gender and socio-cultural aspects, power relationships and communication skills among health care providers on women's health. Complementary interventions to the biomedical paradigm are needed and should be addressed in Swedish health staff educational programmes as well as in clinical training.

Effect of pre-pregnancy body size on postpartum weight retention

OBJECTIVE

to understand postpartum weight retention among women of different body sizes at pre-pregnancy, and to explore factors influencing this weight retention.

DESIGN

a comparative, descriptive study. Pre-pregnancy body mass indices (BMIs) were determined from hospital records. Dependent variables were measured by self-report questionnaires.

SETTING

a 3,900-bed medical centre in northern Taiwan that delivers approximately 4,000 children each year.

PARTICIPANTS

a systematic sample of 810 women who had delivered children at a medical centre. In total, 602 valid questionnaires were collected.

FINDINGS

the average pre-pregnancy and six month postpartum BMIs were 21.5 [standard deviation (S.D.)=3.32] and 22.48 (S.D.=3.39), respectively. Overweight (OW) and obesity (OB) increased from 18.27% before pregnancy to 27.57% at six months postpartum. Gestational weight gain (GWG) was 14.36, 14.37, 13.07 and 11.15kg among women in the underweight (UW), normal weight (NW), OW and OB groups, respectively; and six month postpartum weight retention was 3.32, 2.57, 1.67 and -0.29kg. GWG was the most significant predictor of postpartum weight change across groups.

KEY CONCLUSIONS

women with different body sizes at pre-pregnancy have common and specific risks for postpartum weight retention.

IMPLICATIONS FOR PRACTICE

individualised interventions should be developed to manage postpartum weight for women of different body sizes. Interventions should establish criteria for GWG and provide strategies to improve body image and modify lifestyle. The overall goal should be to manage postpartum weight gain and to promote women's health.

Factors associated with menopausal symptoms and their relationship with the quality of life among Turkish women

OBJECTIVES

The aim of this study was to investigate factors associated with menopausal symptoms and their relationship with the quality of life among Turkish women.

METHODS

This is a cross-sectional study and included 886 women. Data were collected with a questionnaire including questions about demographics and independent variables tested, the Menopause Symptom Checklist and The MOS 36-Item Short Form Health Survey.

RESULTS

The mean age of the women included in the study was 48.62 years (standard deviation (S.D.)=5.75, range: 40-60 years). Of all women, 32.1% were premenopausal, 23.9% perimenopausal and 44.2% postmenopausal. Stepwise multiple regression analyses, performed to determine factors associated with menopausal symptom score, revealed 12 statistically significant variables which increased the strength of the model. These variables were as follows in the order of their contribution to the strength of the model: health problems, recent life stresses, being a primary school graduate, absence of relaxation methods, number of pregnancy, financial problems, tea consumption, inadequate and unbalanced nutrition, coffee consumption, age, being a secondary school graduate and dissatisfaction in marriage. Besides, there was a significant and moderately negative relation between total menopausal symptom scores and quality of life scores.

CONCLUSIONS

A large number of factors were associated with experiencing menopausal symptoms and menopausal symptoms had negative effects on the quality of life among Turkish women. Stress management and health promoting practices should be incorporated into menopausal care programs to improve health and quality of life of middle-aged women.

Self-concept and menopause among mid-life women: a survey in southern Taiwan

The purpose of this study was to understand the self-concept of community women in southern Taiwan during mid-life and its relationship with menopause symptoms. Women between 45 and 55 years of age were selected by simple cluster random sampling process from a name list obtained from the Household Registrar Office in one city of southern Taiwan. A total of 266 women were enrolled. The Chinese version of the Tennessee Self-Concept Scale and Greene Climacteric Symptom Scale were used for assessment.

RESULTS

(1) (a) 92.5% of women's total self-concept scores were within normal range; (b) the scores of the physical self-concept, psychological self-concept, and academic attainment self-concept in women with higher educational levels were significantly higher than those in women with lower educational levels; (c) among six subscales, only the score of the psychological self-concept of those women with a history of using hormone replacement therapy (HRT) was significantly lower than that in women who had never taken any. (2) Women with chronic disease history and with a history of using HRT (no. 54) showed significantly more menopause symptoms (physiological and psychological). (3) (a) Stepwise regression analysis showed that the physical self-concept, family self-concept and academic attainment self-concept were the best predictors for menopause symptoms (both psychological and physiological) for pre-menopausal women; (b) for peri- and post-menopausal women, only physical self-concept could significantly predict psychological and physiological symptoms. Our findings suggest that self-concept is an important factor for mid-life women to adjust to their menopause.