Menopause and risk for obesity: how important is physical activity?

Physical activity on cardiorespiratory fitness and cardiovascular risk in premenopausal and postmenopausal women: a systematic review of randomized controlled trials

IMPORTANCE

The apparent cardioprotective effects of endogenous estrogens to prevent cardiovascular disease in premenopausal women are reduced with the loss of estrogen post-menopause. Cardiorespiratory fitness and cardiovascular risk factors are closely related to physical activity levels.

OBJECTIVE

This study conducted a critical assessment of studies for health prevention that analyze the effects of physical activity programs on cardiorespiratory fitness and cardiovascular risk factors in women, comparing premenopausal and postmenopausal states, through a systematic review of randomized controlled trials.

EVIDENCE REVIEW

A computerized literature search was performed to include articles up until December 2021 in the following online databases: PubMed, Cochrane, Scopus, SportDiscus, and Web of Science. Regarding physical activity intervention, women of all ages were engaged. The PEDro scale and Oxford's evidence levels were used for the assessment of the risk of bias in the included articles.

FINDINGS

Fourteen scientific articles met the inclusion criteria. Great variability was found in physical activity variables. All the studies found an improvement in at least one variable. The risk of bias was high, with all the articles obtaining a low methodological quality, except two with high methodological quality. Only one article considered the differences in the menopausal state observing the effects of physical activity intervention and highlighting the importance of physical activity in both states.

CONCLUSIONS AND RELEVANCE

To strengthen the evidence for the benefits of physical activity programs in women and to observe the effects depending on their menopausal state, there is an ongoing need for more rigorous randomized controlled trials of appropriate length and dose, with individualized exercise intensity.

Associations of cardiorespiratory fitness with cardiovascular disease risk factors in middle-aged Chinese women: a cross-sectional study

Background

High levels of physical activity (PA) and cardiorespiratory fitness (CRF) are each associated with a favorable cardiovascular disease (CVD) risk profile. However, the relationship between CRF and obesity is still inconsistent across studies, and there has been no thorough exploration of the independent contribution of CRF to different CVD risk factors in Chinese women. This study investigated the relationship between CRF and CVD risk factors in 40–49 year old women in Beijing.

Methods

The study included 231 urban-dwelling asymptomatic 40–49 year old women. Body mass index (BMI), body fat percentage (BF%), blood glucose, blood lipids, blood pressure, and pulse wave velocity (PWV) were measured at rest. Cycle ergometer exercise tests were conducted to assess CRF as indicated by maximal oxygen uptake (VO_2max). Participants were categorized into three CRF levels (low, moderate and high).

Results

High CRF level was associated with significantly less BF%, lower PWV, and higher weekly physical activity compared with low and moderate CRF (P < 0.05). Compared to high CRF, the odds ratios for having ≥3 main CVD risk factors (overweight, hypertension, and dyslipidemia) in low and moderate CRF were 2.09 (95% CI: 1.48-2.94) and 1.84 (95% CI: 1.29-2.62), respectively. The proportion of participants with clinical ST segment depression and prolonged QTC interval during cycle ergometer testing was significantly higher in women with low CRF.

Conclusions

Overall, Chinese middle-aged women demonstrated a moderate level of CRF. CRF was independently associated with CVD risk factors, including overweight, hypertension, dyslipidemia, arterial stiffness, and abnormal ECG during exercise, with the least fit women exhibiting the highest number of CVD risk factors.

Effects of the menopausal transition on energy expenditure: a MONET Group Study

Objectives

Factors that influence weight gain during the menopausal transition are not fully understood. The purpose of this study was to investigate changes in energy expenditure (EE) across the menopausal transition.

Methods

One hundred and two premenopausal women (age: 49.9 ± 1.9 yrs; BMI: 23.3 ± 2.2 kg/m²) were followed for 5 years. Body composition (DXA), physical activity EE (accelerometer), resting EE and thermic effect of food (indirect calorimetry) were measured annually.

Results

Total EE decreased significantly over time in postmenopausal women (P < 0.05), which was mostly due to a decrease in physical activity EE (P < 0.05). Although average resting EE remained stable over time in postmenopausal women, a significant increase, over the 5-year period, was noted in women who were in the menopausal transition by year 5 (P < 0.05). Finally, the time spent in moderate physical activity decreased and the time spent in sedentary physical activity increased during the menopausal transition (P < 0.05).

Conclusion

These results suggest that menopausal transition is accompanied with a decline in EE mainly characterized by a decrease in physical activity EE and a shift to a more sedentary lifestyle.

Health education intervention in early and late postmenopausal Brazilian women

AIM

To identify aspects of health in postmenopausal Brazilian women using a health-related educational program provided by a multidisciplinary team as part of the primary care approach for early and late postmenopausal symptoms.

DESIGN

A prospective cohort was formed with 69 postmenopausal women; they were divided into groups corresponding to early (n = 32) and late postmenopause (n = 37) through gynecological and clinical evaluations. We administered the Kuppermann-Blatt Menopausal Index and the Women's Health Questionnaire before and after health education instructions.

RESULTS

The average age for the onset of menopause was 47.9 years (n = 69). Fifty women (72.5%) in this study had completed their primary education, 78.3% (n = 54) performed manual labor, and 60.9% (n = 42) showed concomitant chronic illnesses. After attending a series of health-related presentations, the mean weight of the women was reduced by 3.54% in early postmenopausal women (p < 0.001) and by 2.06% in the late postmenopausal group (p < 0.001). The mean abdominal circumference was reduced by 1.75% (p < 0.001) in the early postmenopausal group. In addition, the total score in the Kuppermann-Blatt Menopausal Index decreased by 34.38% in the early and by 33.33% in the late postmenopausal groups. According to the Women's Health Questionnaire, there was a decrease in the domain Depressive mood by 0.839 to 0.700 (p < 0.001) in the early and by 0.814 to 0.648 (p < 0.001) in the late postmenopausal groups.

CONCLUSION

Regardless of improving menopausal symptoms and anthropometric parameters, the effects of the multidisciplinary team activities in early postmenopausal women may be similar to those in late postmenopausal women.

Dietary and lifestyle predictors of age at natural menopause and reproductive span in the Shanghai Women's Health Study

OBJECTIVE

Modifiable factors predicting the onset of menopause, a transition with important implications for women's health, have not been fully characterized. We evaluated the impact of dietary, lifestyle and reproductive factors on age at natural menopause and reproductive span in Chinese women.

DESIGN

Study participants were Chinese women aged 40 to 70 who experienced natural menopause and participated in a population-based, prospective study, the Shanghai Women's Health Study (N = 33,054). Dietary intake at the baseline survey was assessed by food-frequency questionnaire. Regression (beta) coefficients, calculated by multivariable linear regression, were used to estimate the effects of dietary, lifestyle, and reproductive patterns on age at menopause and the number of reproductive years, adjusting for potential confounding factors.

RESULTS

Early menarche, younger age at first live birth, older age at last live birth, longer duration of breast-feeding, and higher parity were associated with longer reproductive years (Ptrend < 0.01 for all). Higher body mass index at age 20, mid-life weight gain, and leisure-time physical activity during adolescence and adulthood predicted later menopause and longer reproductive span (Ptrend < 0.01 for all). Total intake of calories, fruits, and protein was positively associated with later menopause (Ptrend < 0.05 for all) and longer reproductive span (Ptrend < 0.05), except for carbohydrates (Ptre(nd) = 0.06), and long-term tea consumption predicted longer reproductive span (Ptrend = 0.03). Vegetable, fat, soy, and fiber intakes did not significantly affect reproductive span or age at menopause. Smoking was inversely associated with both early age at menopause and shorter reproductive span (Ptrend < 0.01).

CONCLUSIONS

In addition to reproductive factors, intake of fruits and protein, smoking, tea consumption, lifetime patterns of physical activity, and weight gain influenced the onset of menopause and/or reproductive span in Chinese women.

Beneficial effects of conjugated linoleic acid and exercise on bone of middle-aged female mice

Conjugated linoleic acids (CLA) are a group of polyunsaturated fatty acids that has recently been shown to have several beneficial effects on different diseases, including prevention of bone loss. The important feature of CLA is to reduce fat mass, thereby reducing body weight significantly. Although loss of body weight is known to increase bone loss, there is increasing evidence that CLA maybe beneficial to bone. Another factor that can reduce body weight is exercise (EX). It is well established that moderate EX stimulates bone formation. In this study, we analyzed the changes in bone using pQCT densitometry in middle-aged C57Bl/6 mice fed CLA (0.5%) and/or exercised. Twelve-month-old mice were divided into the following groups: group 1, corn oil, sedentary (CO SED); group 2, corn oil, exercise (CO EX); group 3, CLA, sedentary (CLA SED); and group 4, CLA, exercise (CLA EX). Mice were maintained in the respective experimental regimens for 10 weeks, after which mice were scanned using DEXA and killed. The lumbar vertebrae, femur, and tibia were analyzed using pQCT densitometry. CLA, when given alone or in combination with EX, significantly reduced body weight and increased lean mass. CLA treatment also significantly increased bone mass. Further, additional increase in bone mass was observed in mice treated with a combination of CLA and EX in almost all the bone sites analyzed. We conclude that CLA, when consumed as a dietary supplement along with moderate treadmill EX, significantly increases bone mass in middle-aged female mice.