Long-term effect of physical activity on health-related quality of life among menopausal women: a 4-year follow-up study to a randomised controlled trial

Effects of Physical Exercise on Symptoms and Quality of Life in Women in Climacteric: A Systematic Review and Meta-Analysis

Background/Objectives: Climacteric is a period of hormonal changes in women characterised by physical, emotional, and interpersonal alterations. This period is divided into two phases: perimenopause (the period from the appearance of the first symptoms to the arrival of menopause) and postmenopause (up to approximately 64 years of age). The progression of symptoms varies for each woman and can negatively affect self-esteem and quality of life. One of the most commonly used tools to reduce these negative effects is the performance of different types of physical exercise. The objective of this review was to summarise the research on the effects of both aerobic and strength exercises in women during the transition from perimenopause to postmenopause. Methods: This systematic review and meta-analysis was conducted according to the PRISMA 2020 guidelines. Initially, 1995 articles published in PubMed, Scopus and Web of Science between January 2014 and June 2024 were identified. From these articles, two researchers separately selected eight randomised controlled trials and compared the effects of aerobic and strength exercises with no activity. The risk of bias in the included articles was assessed using the Cochrane Risk of Bias tool for randomised clinical trials. Results: Most of the trials reported that both types of exercise, when performed in a controlled and regular way, have beneficial effects on the vitality and mental health of women in climacteric, increasing their general quality of life. A meta-analysis revealed that aerobic exercise improved the symptoms of menopause, although studies that support the effect of aerobic exercise on vasomotor symptoms are lacking. Resistance exercise was shown to strengthen muscles, increase bone density, and protect against osteoporosis. Conclusions: Physical exercise is a safe and nonpharmacological option that has positive effects on the health of women in climacteric.

The impact of physical activity and exercise interventions on symptoms for women experiencing menopause: overview of reviews

BACKGROUND

Women experiencing problematic menopausal symptoms report lower health-related quality of life and greater healthcare use than women without symptoms. Not all women want to or are able to take hormone replacement therapy. Strengthening the evidence for menopause symptom-management options, including physical activity, improves agency for women.

AIM

This overview assesses effectiveness of physical activity and exercise interventions targeting women experiencing menopause symptoms.

METHODS

Medline, Embase, CINAHL, Scopus, The Cochrane Database of Systematic Reviews and Social Science Citation Index were searched (June 2023) for systematic reviews of physical activity and exercise interventions targeting women experiencing menopause. Reviews were assessed using AMSTAR-2 and a best-evidence approach to synthesis without meta-analysis (SWIM) was adopted. The protocol was registered on PROSPERO (CRD42022298908).

RESULTS

Seventeen reviews included 80 unique relevant primary studies with 8983 participants. There is evidence showing improvement of physical, urogenital, and total symptoms following yoga interventions. Evidence for vasomotor and psychological symptoms was inconclusive. Findings for aerobic exercise were inconclusive although there were some examples of beneficial effects on total and vasomotor symptoms. Evidence was very limited for other types of physical activity and impact on physical, sexual and urogenital symptoms.

CONCLUSION

There is some evidence that yoga, and to lesser extent, aerobic exercise may be beneficial for some menopause symptoms, but there is insufficient evidence to recommend a particular form of exercise. Current reviews categorise women on menopause status; broadening this to include ethnicity, income status, employment and other factors will allow better understanding of context for successful interventions.

Energy cost of walking in older adults: accuracy of the ActiGraph accelerometer predictive equations

BACKGROUND/OBJECTIVES

Various accelerometer equations are used to predict energy expenditure (EE). On the other hand, the development of these equations and their validation studies have been conducted primarily without including older adults. This study assessed the accuracy of 8 ActiGraph accelerometer equations to predict the energy cost of walking in older adults.

SUBJECTS/METHODS

Thirty-one participants with a mean age of 74.3 ± 3.3 yrs were enrolled in this study (20 men and 11 women). The participants completed 8 walking activities, including 5 treadmill and 3 self-paced walking activities. The EE was measured using a portable indirect calorimeter, with each participant simultaneously wearing the ActiGraph accelerometer. Eight ActiGraph equations were assessed for accuracy by comparing the predicted EE with indirect calorimetry results.

RESULTS

All equations resulted in an overall underestimation of the EE across the activities (bias −1 to −1.8 kcal·min⁻¹ and −0.7 to −1.8 metabolic equivalents [METs]), as well as during treadmill-based (bias −1.5 to −2.9 kcal·min⁻¹ and −0.9 to −2.1 METs) and self-paced (bias −1.2 to −1.7 kcal·min⁻¹ and −0.2 to −1.3 METs) walking. In addition, there were higher rates of activity intensity misclassifications, particularly among vigorous physical activities.

CONCLUSIONS

The ActiGraph equations underestimated the EE for walking activities in older adults. In addition, these equations inaccurately classified the activities based on their intensities. The present study suggests a need to develop ActiGraph equations specific to older adults.

Can Resistance Exercise Be a Tool for Healthy Aging in Post-Menopausal Women with Type 1 Diabetes?

Due to improvements in diabetes care, people with type 1 diabetes (T1D) are living longer. Studies show that post-menopausal T1D women have a substantially elevated cardiovascular risk compared to those without T1D. As T1D may also accelerate age-related bone and muscle loss, the risk of frailty may be considerable for T1D women. Exercise and physical activity may be optimal preventative therapies to maintain health and prevent complications in this population: They are associated with improvements in, or maintenance of, cardiovascular health, bone mineral density, and muscle mass in older adults. Resistance exercise, in particular, may provide important protection against age-related frailty, due to its specific effects on bone and muscle. Fear of hypoglycemia can be a barrier to exercise in those with T1D, and resistance exercise may cause less hypoglycemia than aerobic exercise. There are currently no exercise studies involving older, post-menopausal women with T1D. As such, it is unknown whether current guidelines for insulin adjustment/carbohydrate intake for activity are appropriate for this population. This review focuses on existing knowledge about exercise in older adults and considers potential future directions around resistance exercise as a therapeutic intervention for post-menopausal T1D women.

The relationship between physical and mental health: A mediation analysis

There is a strong link between mental health and physical health, but little is known about the pathways from one to the other. We analyse the direct and indirect effects of past mental health on present physical health and past physical health on present mental health using lifestyle choices and social capital in a mediation framework. We use data on 10,693 individuals aged 50 years and over from six waves (2002-2012) of the English Longitudinal Study of Ageing. Mental health is measured by the Centre for Epidemiological Studies Depression Scale (CES) and physical health by the Activities of Daily Living (ADL). We find significant direct and indirect effects for both forms of health, with indirect effects explaining 10% of the effect of past mental health on physical health and 8% of the effect of past physical health on mental health. Physical activity is the largest contributor to the indirect effects. There are stronger indirect effects for males in mental health (9.9%) and for older age groups in mental health (13.6%) and in physical health (12.6%). Health policies aiming at changing physical and mental health need to consider not only the direct cross-effects but also the indirect cross-effects between mental health and physical health.

Menopause and Exercise Intolerance

Central adiposity and weight gain are common among postmenopausal women. Because of the metabolic changes that many postmenopausal women experience, there can be a decrease in exercise tolerance related to the loss of potent estrogens. This can lead to the development of insulin resistance and endothelial dysfunction. Despite the challenges that exercise intolerance may pose for some postmenopausal women, evidence suggests that regular exercise and caloric restriction are crucial for weight management after menopause.

Effect of aerobic exercise and nutrition educationon quality of life and early menopause symptoms:A randomized controlled trial

The aim of the authors in this randomized controlled study was to assess the effect of exercise and nutrition education on quality of life and early menopausal symptoms. This trial was conducted in east Azerbaijan Province, Iran, during the period from 2013 to 2014 with 108 women allocated into one of four groups (n = 27 in each group) by block randomization. The interventions received by the three intervention groups were: nutrition education, aerobic exercise, or exercise plus nutrition education. The control group did not receive any intervention. The Greene and MENQOL menopause symptom scales were completed before and at 8 and 12 weeks after the intervention. The mean Greene score was significantly lower than the control group in the exercise (adjusted mean difference: -5.1) and exercise plus nutrition groups (-8.0) at the end of week 8 and in the nutrition (-4.8), exercise (-8.7), and exercise plus nutrition (-13.2) groups at the end of week 12. Also, the mean MENQOL score was significantly lower than the control group in the exercise (-8.3) and exercise plus nutrition groups (-13.8) at the end of week 8 and in the nutrition (-6.6), exercise (-13.5), and exercise plus nutrition (-22.1) groups at the end of week 12. Nutrition education with aerobic exercise can improve quality of life.