The Impact of Long-Term Physical Activity Interventions for Overweight/Obese Postmenopausal Women on Adiposity Indicators, Physical Capacity, and Mental Health Outcomes: A Systematic Review

Exercise for peri- and postmenopausal women: Recommendations from synergistic alliances of women's medicine and health psychology for the promotion of an active lifestyle

Adopting healthy behaviors is a multifaceted and complex process that poses significant challenges for individuals. Despite awareness of the detrimental effects of certain behaviors on health, many individuals continue to engage in risky practices. Traditional medical advice and prescriptions, while well intentioned, often fall short in fostering lasting lifestyle changes. Although individuals may also have good intentions, solely relying on doctor's counsel does not ensure successful lifestyle adjustments. One primary reason for this limitation is the lack of specialized expertise in behavioral modification among gynecologists and healthcare providers. Health psychologists are specialized professionals capable of effectively guiding and assisting individuals in modifying health-related behaviors. Their expertise in behavior change strategies and psychological interventions proves invaluable in empowering individuals to embrace healthier lifestyles and contributes to people's well-being. This paper emphasizes the importance of collaborative efforts between medical professionals, such as gynecologists, and health psychologists to promote healthy behaviors among peri- and postmenopausal women and enhance women's health. By forging integrative alliances, they can develop comprehensive and tailored interventions. By bridging the gap between medical advice and behavior modification, this collaborative effort has the potential to ensure a more effective intervention process. This holistic approach not only addresses women's specific health needs but also fosters sustainable behavior change when promoting healthy behaviors among middle-aged women. The ultimate goal of such a synergy is to improve women's health outcomes and contribute to a healthier society overall.

Functional and Combined Training Promote Body Recomposition and Lower Limb Strength in Postmenopausal Women: A Randomized Clinical Trial and a Time Course Analysis

Encouraging healthy aging in postmenopausal women involves advocating for lifestyle modifications, including regular physical exercise like combined training (CT) and functional training (FT). Regarding this population, age-related alterations in body composition, such as decreased muscle mass and heightened adipose tissue, impact health. The aim of this study was to analyze the effects of FT and CT on body recomposition in postmenopausal women. About the methods, we randomly allocated 96 post-menopausal women to the FT, CT, or control group (CG). We measured body composition by bioimpedance and lower limb muscle strength by sit-to-stand test in five repetitions, respectively. The training protocol lasted 16 weeks, and we measured body composition and lower limb muscle strength every 4 weeks, totaling five assessments. Regarding results, we notice that both training groups increased lean mass from the 8th week of training. In addition, a reduction was observed in total fat percentage and an increase in appendicular lean mass from the 12th week of intervention. No differences were found for body mass. Furthermore, only the experimental groups increase muscle strength, starting from the 4th week of training. The conclusion was that FT and CT promote similar adaptations in body recomposition without affecting body mass in postmenopausal women.

The AHAWOMEN project: study protocol of a multi-design research for exploring HAPA predictors of exercise in postmenopausal women

BACKGROUND

The postmenopausal period can represent an opportunity for women to improve their health and well-being. The Active and Healthy Ageing in Women during early postmenopause (AHAWOMEN) study aims to identify the key determinants of an active lifestyle among middle-aged women, with a focus on the stages and the social-cognitive variables outlined in the Health Action Process Approach (HAPA) model, a theoretical framework for understanding health behaviour change. We expected that HAPA factors and processes of intention creation (motivational phase) and action adoption (volitional phase) will be significant predictors of exercise initiation and maintenance, supporting both the HAPA tenets and the efficacy of HAPA-based interventions.

METHODS/DESIGN

This study was approved by the authors' Institutional Review Committee. Postmenopausal women aged between 45 and 65 years will voluntarily participate. The participants will be allocated to one of three groups: Intervention-Initiators (n = 100, random allocation), Control-Sedentary (n = 100, random allocation) or Control-Active (n = 100, non-random allocation). The intervention group will engage in a supervised exercise programme lasting at least 3 months, supplemented with a HAPA-based intervention for behaviour change. The sedentary control group will not receive any intervention to change their physical activity, while the active control group will consist of women who are already regularly adhering to an active lifestyle. Study variables will be measured at baseline and postintervention phases, as well as at 1, 3, 6 and 12-month follow-ups. The predictors of exercise behaviour in the different phases of the behavioural change process will be explored and compared within and between groups throughout the study. These analyses will help identify the factors that determine the adoption of a healthy active behaviour. Additionally, the effectiveness of the model and the intervention for changing active behaviour will be evaluated.

DISCUSSION

This paper describes the rationale, development and methods used in the AHAWOMEN project. Supporting women who intend to become active can help them to translate their goals into sustainable action. Verifying that the HAPA predictions are applicable to postmenopausal women's adoption of exercise would provide the basis for designing effective interventions for promoting healthy and active ageing that are also tailored to the experiences of middle-aged women.

TRIAL REGISTRATION

ISRCTN16251361. Registration date: 01/06/2023 (retrospectively registered).

Impacto de los diferentes tipos de entrenamiento físico sobre la composición corporal en mujeres adultas con obesidad: una revisión bibliográfica

Introducción: La obesidad sigue siendo uno de los problemas más grandes de salud pública en todo el mundo. Se conoce que está asociada con una gran variedad de enfermedades; en mujeres obesas, aún se desconoce la forma idónea para realizar una adecuada prescripción física. Objetivo: revisar los tipos de entrenamientos físicos de ensayos controlados aleatorizados publicados en la base de datos PubMed entre los años 2015 a 2022 sobre los cambios en la composición corporal en mujeres adultas de 18 a 65 años con obesidad. Metodología: se utilizó a modo de filtro la “Herramienta de Evaluación de Calidad Validada para Estudios Cuantitativos”. Resultados: la búsqueda arrojó 586 artículos, de los cuales el 93.85% fueron eliminados; 6.14% pasaron por un filtro que dejó un total de 1.7%. Conclusión: en mujeres adultas con obesidad, se ha demostrado que todos los tipos de entrenamiento físico sirven para generar cambios en la composición corporal. Introduction: Obesity continues to be one of the biggest public health problems worldwide. It is known to be associated with a wide variety of diseases; in obese women, the ideal way to carry out an adequate physical prescription is still unknown. Objective: to review the types of physical training in randomized controlled trials published in the PubMed database between 2015 and 2022 on changes in body composition in adult women aged 18 to 65 with obesity. Methodology: the "Validated Quality Assessment Tool for Quantitative Studies" was used as a filter. Outcomes: the search yielded 586 articles, of which 93.85% were eliminated; 6.14% went through a filter that left a total of 1.7%. Conclusion: in adult women with obesity, it has been shown that all types of physical training serve to generate changes in body composition.

An exploratory study on excess weight gain: Experiences of Postmenopausal Women in Ghana

INTRODUCTION

Excess weight gain is a problem with a significant impact on health and quality of life as well as the consequent economic burden on human populations. While society advocates preference for excess weight gain, limited evidence exists concerning postmenopausal women's experiences in Ghana.

AIM

The current study explored the experiences regarding excess weight (overweight and obesity) gain among Ghanaian postmenopausal women in Bono East (Techiman) region.

METHODS

This is a qualitative exploratory descriptive study where anthropometric measurements [body mass index (BMI), waist-to-height ratio (WHtR) and waist-to-hip ratio (WHR)] were determined and participants who were identified with excess weight (obesity and overweight) were recruited to participate in a focus group discussion (FGD). Four focus group discussions were held and 24 postmenopausal women (>45 years) in Techiman took part. Discussions were audio-recorded and transcribed for thematic analysis.

RESULTS

From the qualitative analysis of the FGD, three major themes emerged from the study namely, (i) perception of body weight, (ii) measures to reduce body weight, and (iii) support to adhere to the weight management program. Sub-themes revealed that weight gained was viewed as the presence of diseases and admired by society as a culturally accepted body image. Diet-related changes, a combination of diet modification and physical activity, and weight management supplements emerged as measures to reduce excess weight. Support to adhere to the weight program included health education, access, affordable exercise facilities, and social support.

CONCLUSIONS

Sociocultural norms influence the image perception and acceptance of weight gain among postmenopausal women in Ghana, but there is an acknowledgment of the perceived negative health implications of such excess weight. Measures for weight reduction and support to adhere to the weight reduction programme require attention in Ghana.

Feasibility of Internet-Based Physical-Cognitive Exercise for Health Benefits of Middle-Aged Obese Women

INTRODUCTION

Obesity in middle-aged women markedly increases the risk for non-communicable diseases, neurodegenerative diseases, and physical and cognitive problems. Exercise, particularly combined physical-cognitive exercise, has been demonstrated to have beneficial effects on both physical and cognitive health. However, middle-aged women often face barriers to engaging in exercise, which include time constraints, lack of motivation, and enjoyment. Incorporating an exercise program into a technology-based intervention in the home environment may help overcome these barriers and promote health benefits. Therefore, this study aimed to assess the feasibility of home-based, physical-cognitive internet-based exercise for middle-aged obese women.

METHODS

A total of 33 middle-aged obese women were enrolled in the study. Participants performed an intervention for 60 min/day, 3 days/week for 3 months. Feasibility outcomes (adherence, adverse events, physical performances, obesity parameters, and enjoyment of the program) were measured.

RESULTS

Average exercise adherence was 91.67%, and no adverse events were reported in this feasibility study. At the end of the training period, body weight and BMI were significantly decreased compared to baseline. As for physical performances, both cardiorespiratory fitness and lower limb muscle power were significantly improved at post-training when compared to baseline. Furthermore, the participants experienced a high level of exercise enjoyment, and it was maintained over the 3-month training period.

CONCLUSION

These findings suggest that home-based, internet-based physical-cognitive exercise was safe and feasible for reducing obesity parameters, improving physical function, maintaining enjoyment over the course of training, and facilitating adherence to exercise in middle-aged obese women.

Psychophysiological Adaptations to Yoga Practice in Overweight and Obese Individuals: A Topical Review

Physical activity has been documented as a foundational approach for weight management and obesity, improving several cardiometabolic and mental health indices. However, it is not clear whether yoga practice can induce beneficial improvements in anthropometric and body composition parameters, performance, metabolic health, and well-being among overweight/obese people. The aim of this topical review was to catalog training studies examining the psychophysiological responses to yoga interventions in order to detect which outcomes have been investigated, the research methods applied, and the conclusions. The inclusion/exclusion criteria were met by 22 published articles involving 1178 (56% female) overweight/obese participants. This brief review on yoga-induced adaptations demonstrates that this widely used meditative movement activity can meaningfully improve the vast majority of the selected markers. These beneficial alterations are focused mostly on various anthropometric and body composition variables, cardiovascular disease risk factors, physical fitness parameters, quality of life, and stress in previously inactive overweight/obese individuals. Instead, yoga-based physical exercise interventions investigating anxiety, depression, mood state, exercise enjoyment, affect valence, and adherence were limited. Further research should focus on the yoga intervention configuration and potential mechanisms behind favorable changes in various psychophysiological indices through large-scale, rigorously designed randomized controlled trials implementing long-term interventions in overweight/obese individuals.

Thermotherapy as an alternative to exercise for metabolic health in obese postmenopausal women: focus on circulating irisin level

Irisin is a myokine caused by exercise that improves insulin resistance and weight loss. However, under unfavorable conditions such as air pollution, and during the pandemic, outdoor activities are uncomfortable. Therefore, in this study, the effect of heat therapy (half bath 42 ± 0.5°C for 30 min) on irisin circulation levels as an exercise alternative for middle-aged obese women after menopause was investigated. Subjects were 33 women aged 49.54 ± 6.04 years, with parameters of height, 160.12 ± 4.33 cm, weight, 69.71 ± 7.52 kg, body surface area 1.73 ± 0.13 m², body mass index, 27.19 ± 3.40 kg/m². The results suggest that circulating irisin levels showed a significant increase after one-time thermotherapy (TH-1). However, the increase in circulating irisin levels after 15 treatments (TH-15, 5 days/week, 3 weeks) was significantly varied. The level of adiponectin, which increases fatty oxidation to reduce fatty deposition, increased significantly at TH-1, but further increased at TH-15, which was significantly different from the level of TH-1. In addition, the basic serum free fatty acid (FFA) level was significantly increased at TH-15 compared to TH-1. Significant differences were also found in the lipid profile (body mass index, waist circumference, and % body fat). Thermotherapy can significantly increase the tympanic temperature and induce changes in circulating irisin and adiponectin levels. Thus, it resulted in positive changes in FFA and lipid profiles. Therefore, repeated thermotherapy is effective in increasing circulating irisin levels in postmenopausal obese women.

Cognitive Benefits of Physical Exercise, Physical-Cognitive Training, and Technology-Based Intervention in Obese Individuals with and without Postmenopausal Condition: A Narrative Review

Obesity and estrogen deprivation have been identified as significant risk factors for cognitive impairment. Thus, postmenopausal conditions when paired with obesity may amplify the risks of developing dementia. Physical exercise has been recommended as a primary treatment for preventing obesity-related comorbidities and alleviating menopausal symptoms. This narrative review aimed to summarize the effects of exercise on cognition in obese individuals with and without menopausal condition, along with potential physiological mechanisms linking these interventions to cognitive improvement. Research evidence has demonstrated that exercise benefits not only physical but also cognitive and brain health. Among various types of exercise, recent studies have suggested that combined physical-cognitive exercise may exert larger gains in cognitive benefits than physical or cognitive exercise alone. Despite the scarcity of studies investigating the effects of physical and combined physical-cognitive exercise in obese individuals, especially those with menopausal condition, existing evidence has shown promising findings. Applying these exercises through technology-based interventions may be a viable approach to increase accessibility and adherence to the intervention. More evidence from randomized clinical trials with large samples and rigorous methodology is required. Further, investigations of biochemical and physiological outcomes along with behavioral changes will provide insight into underlying mechanisms linking these interventions to cognitive improvement.

Fewer daily steps are associated with greater cartilage oligomeric matrix protein response to loading post-ACL reconstruction

Aberrant joint loading contributes to the development of posttraumatic knee osteoarthritis (PTOA) following anterior cruciate ligament reconstruction (ACLR); yet little is known about the association between joint loading due to daily walking and cartilage health post-ACLR. Accelerometer-based measures of daily steps and cadence (i.e., rate of steps/min) provide information regarding daily walking in a real-world setting. The purpose of this study was to determine the association between changes in serum cartilage oligomeric matrix protein (COMP; %∆COMP), a mechanosensitive biomarker that is associated with osteoarthritis progression, following a standardized walking protocol and daily walking in individuals with ACLR and uninjured controls. Daily walking was assessed over 7 days using an accelerometer worn on the right hip in 31 individuals with ACLR and 21 controls and quantified as mean steps/day and time spent in ≥100 steps/min. Serum COMP was measured before and following a 3000-step walking protocol at a preferred speed. %∆COMP was calculated as a change in COMP relative to the prewalking value. Linear regressions were used to examine associations between daily walking and %∆COMP after adjusting for preferred speed. Fewer daily steps (ΔR²  = 0.18, p = 0.02) and fewer minutes spent in ≥100 steps/min (ΔR²  = 0.16, p = 0.03) were associated with greater %∆COMP following walking in individuals with ACLR; no statistically significant associations existed in controls (daily steps: ΔR²  = 0.03, p = 0.47; time ≥100 steps/min: ΔR²  < 0.01, p = 0.81). Clinical significance: Individuals with ACLR who engage in less daily walking undergo greater %ΔCOMP, which may represent greater cartilage degradation or turnover in response to walking.

Psychophysiological Adaptations to Pilates Training in Overweight and Obese Individuals: A Topical Review

The prevalence of overweightness and obesity has been documented as a major public health issue since it has increased at an alarming rate worldwide. Structured physical exercise programs have been reported as an essential strategy for preventing, managing, and treating obesity, inducing critical improvements in various physiological and psychological markers. However, it is unclear whether Pilates training can elicit positive changes in body composition, physical fitness, cardiometabolic health, and well-being among overweight and obese populations. The purpose of this topical review was to catalog studies investigating the physiological and psychological adaptations to Pilates training in order to identify what outcomes have been assessed, the research methods used, and the results. The inclusion/exclusion criteria were met by 14 published articles involving 582 participants (83% female) who were overweight or obese. The present topical review on Pilates training-induced adaptations shows that this widely used exercise type can significantly improve the majority of the selected indicators. These beneficial changes are frequently focused on anthropometric parameters, body composition, glucose, and lipid metabolism, as well as blood pressure in sedentary overweight or obese women. Specialized equipment-based Pilates interventions and trials investigating various mental health indices were limited. Further research is warranted in this area, emphasizing the Pilates training configuration and potential mechanisms behind positive alterations in several psychophysiological markers through large-scale randomized controlled trials with superior methodological quality, implementing long-term interventions in various populations that are overweight and obese.

Psychological Adaptations to High-Intensity Interval Training in Overweight and Obese Adults: A Topical Review

Regular exercise has been reported as a fundamental piece of the management and treatment puzzle of obesity, playing a vital role in numerous psychological indicators. However, it is unclear whether high-intensity interval training (HIIT) can improve critical psychological health markers such as adherence, exercise enjoyment, affective responses, health-related quality of life, anxiety, and depression in overweight and obese adults. The purpose of this topical review was to catalogue studies investigating the psychological responses to HIIT in order to identify what psychological outcomes have been assessed, the research methods used, and the results. The inclusion/exclusion criteria were met by 25 published articles investigating either a traditional, single-component (84%) or a hybrid-type, multi-component (16%) HIIT protocol and involving 930 participants with overweight/obesity. The present topical review on HIIT-induced psychological adaptations shows that this popular exercise mode, but also demanding for the masses, can meaningfully increase the vast majority of the selected mental health-related indices. These improvements seem to be equal if not greater than those observed for moderate-intensity continuous training in overweight and obese adults. However, further research is needed in this area, focusing on the potential mechanisms behind positive alterations in various psychological health parameters through larger samples and high-quality randomized controlled trials.

Impact of training modes on fitness and body composition in women with obesity: A systematic review and meta-analysis

OBJECTIVE

This study aimed to assess the effectiveness of different exercise modalities and determine the optimal exercise prescription for improving cardiorespiratory fitness, body composition, and metabolic health of women with obesity.

METHODS

A systematic review of randomized controlled trials (RCTs) published between January 1988 and October 2020 was conducted. The RCTs were screened using the following inclusion criteria: 1) participants: women aged 18 to 65 years with BMI > 30 kg/m² and without comorbidities; 2) intervention: exercise; 3) comparison: non-intervention control; and 4) outcomes measures: cardiorespiratory fitness (maximal oxygen consumption), body composition (i.e., body weight, percentage body fat), and/or metabolic measures (i.e., blood pressure, cholesterol).

RESULTS

A total of 20 RCTs with a total of 2,062 participants were included. Although the results showed that any form of exercise was more effective than control, improvements in fitness and body composition were modest. Aerobic exercise (vigorous and moderate intensity) appeared most promising for improving fitness and body weight, whereas low-load resistance training resulted in the largest improvements in body fatness.

CONCLUSIONS

In women living with obesity, aerobic exercise was consistently effective in improving fitness and body composition. Although both resistance training and combined exercise interventions appear promising, more research is needed to evaluate their efficacy and determine an optimal exercise prescription for this population.

Effect of different types of regular exercise on physical fitness in adults with overweight or obesity: Systematic review and meta-analyses

This systematic review examined the effect of exercise training interventions on physical fitness in adults with overweight or obesity and compared the effectiveness of different types of exercise training. Four electronic databases were searched. Articles were included if they described randomized controlled trials of exercise training interventions and their effect on maximal oxygen consumption or muscle strength in adults with overweight or obesity. Changes in outcome parameters were analyzed using random effects meta-analyses for different training types (aerobic, resistance, combined aerobic plus resistance, and high-intensity interval training). Eighty-eight articles satisfied the inclusion criteria of which 66 (3964 participants) could be included in the meta-analyses. All training types increased VO_2max (mean difference 3.82 ml/min/kg (95% CI 3.17, 4.48), P < 0.00001; I² = 48%). In direct comparisons, resistance training was less effective in improving VO_2max than aerobic training, HIIT was slightly more effective than aerobic training, and no difference between aerobic and combined aerobic plus resistance training was found. For muscle strength benefits, incorporation of resistance exercise in the training program is indicated. Exercise training increases VO_2max and muscle strength in adults with overweight or obesity. Differences between training types should be weighed with other needs and preferences when health professionals advise on exercise training to improve physical fitness.

Effect of exercise training on psychological outcomes in adults with overweight or obesity: A systematic review and meta-analysis

This study systematically identified the effects of exercise on multiple psychological outcomes among adults with overweight/obesity, also assessing whether these effects differed across exercise types, genders, age, and body mass index (BMI) categories. Pubmed, Web of Science, PsychInfo, and SportDiscus were searched up to October 2019 for peer-reviewed papers assessing exercise training effects on psychosocial outcomes in adults with overweight/obesity. Thirty-six articles, 32 randomized controlled trials (RCTs), were included in this review. Most interventions were supervised (65%), ranging between 6 and 76 weeks (median = 12). Sixteen psychological outcomes were studied. Exercise induced positive changes in quality of life but did not reduce depression. Large effect sizes were observed on quality of life's physical component, but exercise was also able to improve vitality and mental health. Most psychological outcomes (e.g., body image, anxiety, and perceived stress) are poorly studied, evidencing either conflicting or null exercise effects. Exercise self-efficacy and autonomous motivations were also consistently improved. Exercise types and gender seem to moderate exercise psychological effects. Exercise training programs might lead to positive changes in some psychological outcomes, especially in quality of life, in adults with overweight and obesity, but more studies, with greater systematization in program characteristics, and longer follow-ups are still required to allow more solid conclusions.

Effectiveness of martial arts exercise on anthropometric and body composition parameters of overweight and obese subjects: a systematic review and meta-analysis

Background

Obesity is considered a top public health concern, and its prevalence is growing every day. Thus, interventions to address this problem should be encouraged and further studied. In this regard, the aim of this review was to summarize the evidence of martial arts interventions to evaluate their effectiveness on the anthropometric and body composition parameters of overweight and obese subjects.

Methods

A systematic literature search was conducted on January 26, 2020 using the PubMed, Medline, Lilacs, Cochrane, and Scielo databases. Reference lists of eligible articles and relevant reviews have also been examined. All randomized clinical trials on martial arts that evaluated the anthropometric and body composition parameters of overweight and obese subjects were included, and a narrative synthesis of eligible studies was conducted in accordance with PRISMA guidelines. The Downs & Black checklist was used to assess the quality of the studies. This review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (identifier CRD42018086116).

Results

A total of 82 articles were identified from the initial search strategy. A further 2 articles were identified from the review of relevant bibliographies. Six studies encompassing 258 participants who were overweight or obese were included. Four studies reported Tai Chi practice, one study reported Kung Fu exercise, and another study reported martial arts exercise. The examined meta-analyses did not reveal significant benefits from martial arts practice over control groups after the experiment period for body mass index (− 1.34 kg/m²; 95% CI: − 2.72, 0.05), waist circumference (1.41 cm; 95% CI: − 0.72, 3.54) and percentage of body fat (− 0.75%; 95% CI: − 5.58, 4.08).

Conclusion

The scarcity, heterogeneity, short intervention time, small sample size, and significant methodological limitations of the available studies do not allow to conclude whether martial arts are effective in the anthropometric and body composition parameters of overweight and obese individuals. This study highlights the need for more research to assess the benefits of martial arts for overweight and obese individuals.

Physical discomfort intolerance as a predictor of weight loss and physical activity in a lifestyle modification program

This study examined physical discomfort intolerance (DI) as a baseline predictor of weight loss and physical activity outcomes, and assessed whether changes in DI during the initial phase of weight loss prospectively predicted long-term treatment outcomes among adults enrolled in a group-based lifestyle modification program for obesity. DI was measured at baseline and 6 months, and weight and accelerometer-measured physical activity were assessed at baseline, 6 months, and 12 months. Baseline DI was not related to weight loss or physical activity at either timepoint. Change in DI during the first 6 months of treatment was not related to concurrent (i.e., 6-month) weight loss and physical activity, but was significantly predictive of weight loss and physical activity at 12 months. Assessing early changes in DI may help to identify individuals at risk for suboptimal outcomes. Future research should evaluate behavioral weight loss interventions designed to target DI.

A qualitative assessment of health behaviors and experiences during menopause: A cross-sectional, observational study

OBJECTIVES

A qualitative research study was performed to assess the health and lifestyle behaviors of middle-aged women during the menopause transition, as well as to inform the development of interventions designed to combat menopause symptoms and improve quality of life during and after menopause.

STUDY DESIGN

Data were collected from 1611 women via a 21-item questionnaire distributed electronically. Only women who self-reported age ≥40 years and who were either peri-menopausal or post-menopausal were included in the analyses.

OUTCOME MEASURES

Women responded to questions about their health behaviors and experiences during menopause, including use of hormone replacement therapy (HRT), symptom ratings, and use of diet/lifestyle, exercise, and holistic remedies to relieve menopause symptoms.

RESULTS

More than 80% of women were interested in a structured lifestyle program to alleviate menopause symptoms, with 72% of these women wanting targeted strategies for weight loss or weight maintenance. Insomnia and hot flashes were the most severe symptoms reported. Although HRT is a well-established treatment of menopausal symptoms, more than 60% of women denied use of HRT, stating that they 'never considered HRT' as a treatment option or 'preferred to not take HRT'. Most women (65%) did not feel prepared for menopause.

CONCLUSIONS

Women do not feel prepared for menopause and report interest in a structured lifestyle program containing weight-loss and weight-maintenance strategies to combat menopause symptoms.

Association of physical activity with age-related changes in muscle echo intensity in older adults: a 4-year longitudinal study

Ultrasonic echo intensity (EI), an easy-to-use measure of intramuscular fat and fibrous tissues, is known to increase with aging. However, age-related changes in EI have not been examined in a longitudinal design. The objective of this study was to investigate 4-yr longitudinal changes in the EI of the quadriceps femoris in older adults, based on difference in physical activity (PA). This study included 131 community-dwelling older adults with a mean age of 72.9 ± 5.2 yr. Subcutaneous fat thickness (FT), muscle thickness (MT), and EI of the quadriceps femoris were measured by ultrasound. Isometric knee extensor strength was also measured. PA was assessed using a questionnaire at baseline, and participants were classified into the high or low PA groups. In 4 yr, a significant decrease in FT, MT, and strength was observed in both groups ( P < 0.05), whereas a significant decrease in EI was observed only in the high PA group ( P < 0.05). Multiple linear regression analyses revealed that the difference in PA was a significant predictor of 4-yr changes in MT (β = 0.189, P = 0.031) and EI (β = -3.145, P = 0.045) but not in the body mass index, FT, or strength adjusted for potential confounders. The present findings suggest that greater PA has a positive effect on longitudinal changes in the MT and EI of the quadriceps femoris in older adults. In addition, greater PA may contribute to a future decrease in EI, and an increase in EI may not occur in 4 yr, even in older adults with lesser PA. NEW & NOTEWORTHY Our results suggest that greater physical activity (PA) may mitigate future changes in muscle thickness and echo intensity (EI). A decrease in EI over 4 yr was observed in older adults with greater PA, and an increase in EI was not observed, even in older adults with smaller PA. Several cross-sectional studies demonstrated an increase in EI with aging. Additionally, the results of our longitudinal study suggest that an age-related increase in EI may be moderated after the old-age period.

Association of self-care status with some relevant factors in middle-aged women in their early menopausal stage

BACKGROUND

Through self-care, people can solve their health-related problems through increasing their awareness and correcting their lifestyles.

OBJECTIVES

To determine the association of self-care status with some relevant factors in Kashanian middle-aged women in their early menopausal stage.

METHODS

This is a cross-sectional study on 351 women in the age range of 45-60 years. Women were selected based on cluster sampling method from the individuals at health-care centers in Kashan, Iran. Researcher-constructed questionnaire on self-care was used. The validity and the reliability of the questionnaire were calculated. The information gathering method was questionnaire completion by the study participants or interview with them. Collected data were analyzed with SPSS 16 software. T-test, ANOVA, Spearman correlation, and linear regression analysis were applied.

RESULTS

The mean (±standard deviation) of the self-care score was 108.14 ± 20.43. Self-care scores were weak in 13.92%, intermediate in 71.02%, and good in 15.06%. Regression analysis showed that the mean of self-care was significantly higher in those with higher educational level of women's (P = 0.045) and their spouses (P = 0.001). Women who were covered by insurance also showed higher self-care; in addition, there was no significant relationship between self-care and participants' job, spouses' jobs, marital status, marital satisfaction, economic satisfaction, number of children, number of households, and type of accommodation (P > 0.05).

CONCLUSION

The results indicate that self-care is inadequate and that the level of education of couples and insurance coverage has a positive effect on the level of self-care in postmenopausal women. To promote self-care in old age, education and empowerment can be considered.

Recruitment Strategies for a Randomised Controlled Trial Comparing Fast Versus Slow Weight Loss in Postmenopausal Women with Obesity-The TEMPO Diet Trial

Current research around effective recruitment strategies for clinical trials of dietary obesity treatments have largely focused on younger adults, and thus may not be applicable to older populations. The TEMPO Diet Trial (Type of Energy Manipulation for Promoting optimal metabolic health and body composition in Obesity) is a randomised controlled trial comparing the long-term effects of fast versus slow weight loss on body composition and cardio-metabolic health in postmenopausal women with obesity. This paper addresses the recruitment strategies used to enrol participants into this trial and evaluates their relative effectiveness. 101 post-menopausal women aged 45–65 years, with a body mass index of 30–40 kg/m² were recruited and randomised to either fast or slow weight loss. Multiple strategies were used to recruit participants. The total time cost (labour) and monetary cost per randomised participant from each recruitment strategy was estimated, with lower values indicating greater cost-effectiveness and higher values indicating poorer cost-effectiveness. The most cost-effective recruitment strategy was word of mouth, followed (at equal second place) by free publicity on TV and radio, and printed advertorials, albeit these avenues only yielded 26/101 participants. Intermediate cost-effective recruitment strategies were flyer distribution at community events, hospitals and a local tertiary education campus, internet-based strategies, and clinical trial databases and intranets, which recruited a further 40/101 participants. The least cost-effective recruitment strategy was flyer distribution to local health service centres and residential mailboxes, and referrals from healthcare professionals were not effective. Recruiting for clinical trials involving postmenopausal women could benefit from a combination of recruitment strategies, with an emphasis on word of mouth and free publicity via radio, TV, and print media, as well as strategic placement of flyers, supplemented with internet-based strategies, databases and intranets if a greater yield of participants is needed.

Physical activity levels and hepatic steatosis: A longitudinal follow-up study in adults

BACKGROUND AND AIM

This study aimed to evaluate the impact of physical activity (PA) on the course of hepatic steatosis (HS) in adults.

METHODS

Hepatic steatosis status (ultrasonography) and PA levels were evaluated in 5860 subjects at baseline and after approximately 2.5 years (range: 19-50 months). At follow up, possible exposures to different PA levels were those who remained inactive, became inactive, became active, and remained active. After follow up, subjects were then classified according to the four possible states (outcomes): "remained without HS," "developed HS" (subjects without HS at baseline), "remained with HS," or "reverted HS."

RESULTS

After multivariate adjustments, individuals without HS that became or remained physically active were less likely to develop HS compared with those who remained physically inactive (odds ratio = 0.75, P = 0.04 and 0.75, P = 0.03, respectively). Among those with HS at baseline, becoming and remaining physically active beneficially improved the HS status (odds ratio = 0.64, P = 0.01 and 0.66, P = 0.01, respectively). However, the significance was lost when adjusted for changes in body mass index.

CONCLUSION

Higher levels of PA were associated with prevention and treatment of HS, with evidence of effect mediation by changes in body mass index.

Objectively Measured Physical Activity in Patients After Anterior Cruciate Ligament Reconstruction

BACKGROUND

Returning to a healthy level of physical activity is among the most commonly discussed clinical goals for patients recovering from anterior cruciate ligament reconstruction (ACLR). However, physical activity has not been objectively measured in this population.

PURPOSE

To investigate differences in the mean time (min/d) spent in moderate-to-vigorous physical activity (MVPA) as well as the daily step count (steps/d) between patients who underwent ACLR and matched controls. A second purpose was to investigate relationships between MVPA and objective assessments of the daily step count and Tegner and Marx activity scales.

STUDY DESIGN

Cross-sectional study; Level of evidence, 3.

METHODS

Physical activity was assessed using ActiGraph accelerometers in 33 participants with a history of primary unilateral or bilateral ACLR (mean time from surgery, 27.8 ± 17.5 months; range, 6-67 months) as well as in 33 healthy controls (matched on age, sex, and activity level). Participants wore the accelerometer for 7 days and completed the International Knee Documentation Committee subjective form and the Tegner and Marx activity scales. Independent t tests were used to determine differences in each dependent variable per group.

RESULTS

Patients who underwent ACLR spent less time in MVPA (ACLR: 79.37 ± 23.95 min/d; control: 93.12 ± 23.94 min/d; P = .02) and had a lower daily step count (ACLR: 8158 ± 2780 steps/d; control: 9769 ± 2785 steps/d; P = .02) compared with healthy matched controls. However, the Marx (ACLR median: 11.0 [interquartile range (IQR), 7-14]; control median: 12.0 [IQR, 8-13]; P = .85) and Tegner (ACLR median: 6.0 [IQR, 5-8]; control median: 7.0 [IQR, 6-8]; P = .12) scores did not differ between the groups, and no relationships were observed between objectively measured physical activity and scale measures ( P > .05), except for a moderate relationship between the Tegner score and daily step count in the ACLR group ( r = 0.36, P = .04). Only 24% of patients who underwent ACLR met the guideline of 10,000 steps per day compared with 42% of controls.

CONCLUSION

Patients who underwent ACLR spent less time in MVPA and had a lower daily step count compared with highly matched controls (age, sex, and activity level) with no history of knee injuries. This was true despite being similar in activity levels, which brings into question the utility of the Tegner and Marx activity scales.

Long-term effects of a weight loss intervention with or without exercise component in postmenopausal women: A randomized trial

The aim of this study was to determine the long-term effects of a weight loss intervention with or without an exercise component on body weight and physical activity. Women were randomized to diet (n = 97) or exercise (N = 98) for 16 weeks. During the intervention, both groups had achieved the set goal of 5-6 kg weight loss. All women were re-contacted twelve months after study cessation for follow-up where body weight and physical activity were measured (PASE questionnaire and ActiGraph accelerometer). At follow-up, body weight and physical activity (measured by the PASE questionnaire and accelerometer) were measured again. At follow-up, both mainly exercise (- 4.3 kg, p < 0.001) and diet (- 3.4 kg, p < 0.001) showed significantly reduced body weight compared to baseline. Both the mainly exercise and diet group were significantly more physically active at one year follow-up compared to baseline (PASE: + 33%, p < 0.001 and + 12%, p = 0.040, respectively; ActiGraph: + 16%, p = 0.012. and + 2.2%, p = 0.695 moderate-to-vigorous activity, respectively). Moreover, the increase in physical activity was statistically significantly when comparing exercise to diet (+ 0.6%, p = 0.035). ActiGraph data also showed significantly less sedentary time in mainly exercise group compared to baseline (- 2.1%, p = 0.018) and when comparing exercise to diet (- 1.8%, p = 0.023). No significant within group differences were found for the diet group. This study shows largely sustained weight loss one year after completing a weight loss program with and without exercise in overweight postmenopausal women. Although the mainly exercise group maintained more physically active compared to the diet group, maintenance of weight loss did not differ between groups.