Why move during Menopause?

Exercise and recreational movement are one of the best therapies for chronic stress, insomnia and building healthy adipose (or fat) tissue. Even better, research is showing that physical activity and exercise may have the same effects on your body and brain that estrogen has.[5][6][7][8][9][10]

The recommended amount of exercise and movement during menopausal transition is about 300 minutes per week (or about 40 minutes a day), just slightly different than for women in earlier stages of life.[11][12]

While that may seem like a lot, the activity doesn’t have to happen in one chunk. Multiple short amounts of movement totaling 40 minutes per day will suffice – and any movement you do will add up quickly!

Knowing all this, and knowing that good health has a positive impact on the transition into menopause, it is never too late to start increasing recreational movement and exercise and feeling the benefits!!

How to access exercise and recreational movement?

Accessing exercise and recreational movement can be as simple as adjusting your daily routine. Typically though, increasing your exercise and activity levels involves planning and accepting some moderate changes to your lifestyle.

If you find that you don’t have time to squeeze recreational activities into your day, remember, they don’t need to take up lots of time. Plan some short walks around your neighborhood or 10 minute blocks of stretching on your living room floor. Once a week, walk to the shopping center instead of driving. Be creative. If you take transit, get off one stop early and walk the extra distance.

Many women live in a movement-restricted environment, working long hours in a small work-space, or living in cramped housing. There are many free yoga and movement videos that can be completed on a mat with minimal or no extra equipment. If you need to get out of your work or living space, try joining a gym, a martial arts dojo, or a dance studio. Community centers, schools and the YWCA also have many facilities.

elder sufer lady with a board before entering the sea

What are the Options for Exercise and Recreational Movement?

Many women view ‘exercise’ as a formal activity like a boxercise class or a training session at the gym – this may be true, but that isn’t the only way to get your exercise. Consider mixing and matching some of these options:

Do this for at least 30 minutes each day, 5- 6 times a week. This can be as simple as walking briskly for one half hour. Other activities that will get your heart rate up include swimming, cycling, running/jogging, soccer, rugby, ultimate frisbee, tennis, shaking your booty to your favorite music or walking your dog.

Despite many women’s beliefs that this will make them bulky, it is just the opposite. Two weekly sessions of weight training can help to preserve your bone density and build and retain muscle mass. When you start, it is advised to work with a physiotherapist, kinesiologist or a specialized personal trainer to set appropriate and achievable goals and techniques. You may also want to get a bone density analysis before starting any weight training, especially if you have had low- impact fractures, if you are underweight, or if there is a family history of bone density issues.

If you believe exercise = sweat and that appeals to you, then two weekly sessions of HIIT is a good fit. HIIT will stimulate heart strength and circulatory conditioning. Jumping rope, rowing or skiing ergometers, sprinting, swim sprinting, martial arts, and tennis are some options. Have fun with thinking of ways to get a good sweat on!

Square dancing. Stand up paddle boarding. Indoor rock climbing. Orienteering. Dancing to music at your local nightclub. Grooving at live concerts. Belly dancing. Volunteering at the animal shelter walking dogs. Baling hay. Surfing. Scavenger hunting. Mall walking. The list is endless and can be completely tailored to your interests, your lifestyle and your budget.

The reality is that not everyone can do all activities. There are multiple options available if you have physical challenges like the following:

Try Pain Neuroscience Education (PNE), also known as therapeutic neuroscience education (TNE). Pain is, well, painful, and it can be debilitating, but you can adjust your sensitivity and response to it with PNE. PNE educates patients by describing the neurobiology and neurophysiology of pain and pain processing by the nervous system. PNE works most effectively if you can work with a trained clinician who can provide Motivational Initiative (MI) in combination. PNE is effective for chronic pain and fibromyalgia.[13][14][15][16]

Gliding sports are great for injured or painful knees. Try rollerblading, swimming, deep water running, water polo, paddling, and kayaking.

For almost every sport, there is an adaptive modification. These include (but are not limited to) adaptive skiing, swimming, cycling, rowing, nordic skiing, and kayaking. Some physio or rehab clinics have special equipment that can be used to support your body while gaining strength or undergoing gait training.

If you have health issues such as diabetes, cardiovascular, or metabolic disease, start by getting a thorough physical exam and then work closely with a qualified care provider (medical care providers, physiotherapists or physical trainers) to design an exercise program. Specific assessments, such as a PAR-Q assessment can inform your health team and provide guidance for them to develop a realistic program that suits your needs and your abilities. 

The Science

  • The similarities between the effects of estrogen and exercise training for women’s health have been revealed in recent research.
  • Exercise and estrogen both have anti-inflammatory effects throughout the body.
  • Exercise and estrogen both increase the number and health of “metabolic energy powerhouses”: organelles called mitochondria
  • Exercise and estrogen both strengthen bones and keep the immune system healthy.
  • Some researchers propose that the right kind and amount of exercise during perimenopause and post- menopause could counteract the effects of declining estrogen throughout a woman’s life.[17][18][19]

Estrogen regulates many of the important metabolic functions of organs, cells, and genes in most cells of the body beyond just sex and reproduction. All of our body’s biological systems work together to obtain food, eat and digest it, and turn it into chemical energy — this is the process of metabolism. Subsequently, metabolic energy can be used to repair tissue, provide movement, process information, allow reproduction, and give the immune system defense against pathogens. The interactions between metabolic control of your body, reproduction, and the function of the immune system need to be matched and  coordinated, a process sometimes called immunometabolism.[21][22]

Tissues and organs that are sensitive to estrogen also communicate with each other using a variety of different biochemical signaling molecules. A complex network of biochemical communication is involved in exercise response, and while these messages might be different they have an amazingly similar effect on health. Disruption of this communication network causes many of the unhealthy effects of aging.

Adipose (fat), muscle, and bone tissue, as well as cells of the immune system are all very sensitive and responsive to estrogen due to high levels of estrogen receptor proteins. Their functions often decline during and after the perimenopausal transition, and this is caused partly by the reduction and eventual disappearance of ovarian-generated estrogen. But the decline also stems from reduced physical activity in peri- and post- menopausal women. [23][24][25]

How comparable are the responses of  these tissues to estrogen and exercise? How does the loss of estrogen from menopausal transition reflect the loss of function from lack of physical inactivity? Read on!

Adipose tissue (AT)

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Adipose tissue (AT): energy storage, estrogen source, and inflammation source

AT (or fat tissue) gives women a reserve of energy to bear children, nurse them, work physically for long hours, and (throughout most of human history) migrate over vast distances. In a healthy premenopausal woman, subcutaneous fat is mainly stored in the hips, thighs, breasts and upper arms. Lesser amounts of AT are stored in the core of the healthy female body around the intestine, where it is called central adipose (CA), visceral adipose or trunk adipose (TA). Excess energy from food  is either “burned” as fuel for heat and used for energy and structure, or stored in adipose tissue.

The menopausal transition changes fat storage. Women in the menopausal transition can typically gain 10 – 15 pounds, mostly in the form of central adipose (CA) because of the menopausal transition loss of ovarian estrogen (aka estradiol), but also due to decreased physical activity and insomnia. [26][27][28]

Some people have a higher metabolic rate (high metabolism), meaning they readily burn excess food energy rather than storing it. Others have a low metabolism and tend to store food energy as AT. People with high metabolic rates have more tiny organelles called mitochondria inside their AT cells, which converts food energy into metabolic energy and heat. For most peri- and postmenopausal women, metabolic rates lower and this changes their fat storage. [29][30]

There are 2 types of AT cells: brown (BAT) and white (WAT). BAT cells contain more mitochondria than WAT cells and are specialized to burn excess energy and generate heat. They contain many small fat droplets and don’t store much molecular fat. BAT have little impact on inflammation. WAT cells on the other hand, contain a single large fat droplet and few mitochondria and are the main type of cell in CA visceral fat. WAT is specialized for storing energy as fat.[31] WAT cells are also pro-inflammatory: they release signal molecules that cause the immune system to be overactive. WAT inhibits insulin signaling and promotes insulin resistance that in turn causes dysfunctional blood glucose regulation.[32]

Estrogen can trigger the transformation of WAT into BAT, creating anti-inflammatory effects. Likewise, exercise improves adipose health by improving mitochondrial function and promoting the ‘browning’ of WAT and reducing inflammation. Thus exercise appears to mimic the effects of estrogen.[33]

Skeletal muscle

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Skeletal muscle: movement and bone strength

The muscle that contracts, relaxes, and moves your skeleton is a very large organ that stores energy in the form of a molecule called glycogen. Muscle is always remodeling itself in response to physical loads put on it. Muscle mass and muscle strength depend on balancing the creation and breakdown of muscle proteins, and this balance is controlled by both estrogen and exercise levels. [34] When muscle is not exercised, it loses strength and structure, a process called sarcopenia. [35][36]

The effects of estrogen on muscle strength in humans is understood mainly through the impact of lowering estrogen levels during the menopausal transition; muscle mass and strength decline quickly compared to muscle mass and strength in premenopausal women. Hormone therapy given to women to increase their estrogen to pre-menopausal levels was shown to increase the synthesis of muscle-contraction proteins, slowing the decline of muscle mass and strength. [37][38][39][40]

Exercise, including weight training, can reduce or compensate for the perimenopausal decline of muscle mass and strength. [41][42][43][44]

Adipose tissue and muscle communicate, or cross-talk, when CA sends pro-inflammatory signals. This leads to muscle degradation and dysfunctional muscle mitochondria. Inflamed muscle cells respond by sending out signals that feedback to the CA This spiral of physical aging effects is called “inflammaging”. [45][46]

Bio-chemical cross-talk also happens between muscle and bone. When exercised, skeletal muscle releases signaling molecules called myokines onto the bones where they attach.[47] Some myokine signaling stimulates bone building and reduces bone break-down. In response bone cells release signaling molecules called osteokines to muscle, which completes the feedback loop and helps to strengthen the muscle.

One type of myokine that interacts with adipose stimulates energy expenditure by AT, improves glucose tolerance, and reduces adiposity and inflammation. It is thought to be released from muscle tissue when it is stimulated with exercise. [48]  There is a specific myokine, called myostatin, that actually suppresses muscle and bone building, but its release can be suppressed by exercise. [49] It seems that myostatin levels are also sensitive to estrogen, which decreases the manufacture and release of myostatin in some muscle, thereby resulting in the building of more muscle. [50]

Bone

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Bone: the dynamic human infrastructure

Bone, like muscle, is a dynamic tissue that is constantly remodeling in response to physical stresses placed on it. Bone is also a storage tissue, storing calcium and phosphorus needed in the rest of the body. Loss of ovarian estrogen during peri- and post- menopause can lead to irreparable bone break- down and fragility. [51][52]

Weight-bearing activity is necessary to keep bones strong and reduce low-impact fractures in perimenopausal and post-menopausal women. However there is conflicting scientific evidence about what types of exercise and movement are best for maintaining good bone strength. The best evidence to date suggests that weight-bearing activity, in particular weight lifting with lower repetitions and heavier weights, is the best activity for bone retention. [53] However, older bodies need gentler versions of most exercises, tailored to the fitness level and joint health of the individual – overly aggressive exercise can cause more harm than good. [54][55][56]

Hormone Therapy (HT) with estrogen clearly supports bone health in perimenopausal and post-menopausal women.[57][58][59] Estrogen supports bone health by decreasing bone resorption (bone break down and material recycling). Osteoblasts are bone cells that help retain bone structure by secreting a collagen matrix which becomes mineralized. Osteoblasts are sensitive to, and regulated by estrogen. The chemical signaling between estrogen and osteoblasts is complex and not fully understood. However, pro- inflammatory cytokines in the immune and adipose systems are suppressed by estrogen and in estrogen’s absence, bone resorption accelerates.[60]

Immune system

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Immune system: protects and defends the body from pathogens

The human immune system is very sensitive and responsive to the hormone estrogen.[61] (Taneja, 2018). Estrogen enhances the body’s ability to make antibodies and resist infection. A trade-off is that  disruptions of estrogen signaling, like menopausal transition, can trigger hyper-immune responses and autoimmune diseases in people genetically susceptible to them. (Desai and Brinton, 2019). Moderate levels of exercise are known to enhance immune system function and decrease systemic inflammation in mid- life and older women.[62] ( Brown, 2017).

The modulation of the immune system is very complex and not fully mapped. It isn’t understood how all of the signaling pathways sensitive to estrogen or physical exercise are brought together to impact the immune system. To date, we do know that a woman’s immune functions can be improved with consistent physical activity and training. Exercise remains critical to help improve symptoms of menopausal transition [63][64] (Brown, 2017).

Estrogen and Exercise Do Similar Things For Your Adipose, Muscle, Bone and Immune Systems

Your body will adapt to the challenging loss of estrogen during menopausal transition. However some of these changes can be balanced by exercise and physical activity. So go get moving!

Estrogen vs Exercise

 Estrogen
Moderate ExerciseDecreased estrogenLow Exercise
Muscle and Strength
Increase muscle size and strengthIncrease muscle size and strength

Decrease muscle size and strength (sarcopenia)Decrease muscle size and strength
(sarcopenia)
Mitochondrial Function (Number and energy yield)




IncreaseIncreaseDecreaseDecrease
Central Adipose/ BMI

Decrease
DecreaseIncreaseIncrease
BoneIncrease Bone density and strengthIncrease Bone density and strengthDecreases bone density and strength (osteopenia)
Decreases bone density and strength
(osteopenia)
Systemic Inflammation

Anti- inflammatoryAnti- inflammatoryPro- inflammation
Pro- inflammation
Chronic Stress (mental)
ReduceIncrease
Healthy glucose and lipid regulation (Metabolic regulation and health)
IncreaseIncreaseDecreaseDecrease

Statistics

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Minutes a day total of multiple short movement sets will suffice!

0

‘No Pain, No gain’ : Time to get a new mantra because it just isn’t true. Go at your own pace and enjoy yourself.

0

Number of 6 times per week you should move for at least 30 minutes. Pick something you enjoy!

MYTH

It is trite but true – if you have time to look at this website, you have time to move.  Really! Make a list of 5-minute time pockets in your day where you can break from your work screen, social media (or family) and move around. Build walking or cycling into your commute.

MYTH

Beauty is in the eye of the beholder!  The variety of colours, shapes and sizes of people is what makes the adventure of being human and observing the world interesting.  You have a choice with how you move.

MYTH

It’s just the opposite. Exercise is an absolutely critical part of your overall health, mental as well as physical. Put your physical and mental health first! Even if you feel silly when you are learning a new skill, who cares? One of the treasured parts of growing older is letting go of concerns about ‘what others think’. And if you still feel silly, choose to be active early in the morning or late at night when you will have less of an audience.

MYTH

It just isn’t true. Go at your own pace and enjoy yourself. If you have a trainer, make sure they are compassionate, qualified and willing to listen to you so you can tailor a program that suits you and keeps you engaged.

That’s ok! There is no need to damage yourself or push yourself beyond your comfort zone. Try non-weight bearing exercises such as swimming, water polo (yes!), synchronized-swimming, aquacise, deep- water running, cycling, rollerblading, or try low- impact tai- chi and martial arts. Enjoy some gentle daily stretching exercises.

Muscle development and bone density will improve regardless of your size. Recreational movement and exercise do not need to be about losing weight. Resistance exercise, with or without aerobic exercise, can help reduce the health problems linked to obesity. Concentrate on having fun!65

Exercise is like colour. There is more than one type! So you may hate purple, but thankfully there are lots of other colours you can paint your kitchen! The beauty of movement is that it comes in so many forms. With a bit of positive self-talk, give yourself permission to try new things. There is something out there that you can do AND enjoy! Dance, learn creative American sign language, try circus events like juggling, bandaloop aerial silks, and unicycling. And of course, there are always hoola-hoops! ….whatever it takes to move and have fun.

If you hate exercise, first identify what exactly it is you hate. If it’s sweating on a bicycle in the heat while the seat bruises your delicate bits, then…don’t cycle. If it’s squeezing into tights to do an aerobics class then…don’t wear tights and don’t do aerobics.

FALSE

Adaptive physical activity and recreation are available. Try adaptive skiing (Nordic or downhill), water sports, cycling, kayaking, and paddle boarding. Wheelchair orienteering is a sport that can be done in teams or solo, urban or countryside. Find a physiotherapy clinic in your area that specializes in creating movement plans for people with mobility limitations.

MYSTERY

Estrogen is a “super regulator” of metabolism and energy, especially in women. During the menopausal transition, and post- menopause, estrogen declines to a very low level. Recent evidence shows that exercise mimics the effects of estrogen.

Why enquire about movement therapy?

Increase

movement and decrease chronic stress!

Increase

your movement and increase the healthy glucose and lipid regulation in your body!

Decrease

adipose tissue with moderate exercise and movement!

Decrease

in estrogen causes a decrease in muscle size and strength. Get moving and try out resistance training!

Compiled References

  1. Minkin, M.J. (2019) Menopause: Hormones, Lifestyle and Optimizing Aging. Obstet Gynecol Clin N Am 46 501–514 https://doi.org/10.1016/j.ogc.2019.04.008
  2. World Health Organization (2007). Women, aging and health : a framework for action: focus on gender.
  3. Kalache A, and Kickbusch I. (1997). A global strategy for healthy ageing. World Health, 1997, 4:4–5.
  4. Dugan, S.A., Pettee, G., Lange- Maia, B., Karvonen- Gutierrez, C. (2018) Physical activity and physical function: moving and aging. Obstet Gynecol Clin North Am. 2018 December ; 45(4): 723–736. doi:10.1016/j.ogc.2018.07.009
  5. Pratali L, Mastorci F, Vitiello N, Sironi A, Gastaldelli A, Gemignani A (2014). “Motor Activity in Aging: An Integrated Approach for Better Quality of Life”. International Scholarly Research Notices. 2014: 257248. doi:10.1155/2014/257248. PMC 4897547. PMID 27351018.
  6. Erickson KI, Hillman CH, Kramer AF (August 2015). “Physical activity, brain, and cognition”. Current Opinion in Behavioral Sciences. 4: 27–32. doi:10.1016/j.cobeha.2015.01.005. S2CID 54301951.
  7. Schuch FB, Vancampfort D, Rosenbaum S, Richards J, Ward PB, Stubbs B (2016). “Exercise improves physical and psychological quality of life in people with depression: A meta-analysis including the evaluation of control group response”. Psychiatry Res. 241: 47–54. doi:10.1016/j.psychres.2016.04.054. PMID 27155287. S2CID 4787287.
  8. Mandolesi, Laura; Polverino, Arianna; Montuori, Simone; Foti, Francesca; Ferraioli, Giampaolo; Sorrentino, Pierpaolo; Sorrentino, Giuseppe (2018). “Effects of Physical Exercise on Cognitive Functioning and Wellbeing: Biological and Psychological Benefits”. Frontiers in Psychology. 9: 509. doi:10.3389/fpsyg.2018.00509. PMC 5934999. PMID 29755380.
  9. Vieira-Potter, V.J., Zidon, T.M., and Padilla, J. (2015) Exercise (and estrogen) Make Fat Cells “Fit” Exerc Sport Sci Rev. July ; 43(3): 172–178. doi:10.1249/JES.0000000000000046.
  10. Maunil K. Desai, M.K. and Roberta Diaz Brinton2,3 (2019) Autoimmune Disease in Women: Endocrine Transition and Risk Across the Lifespan Frontiers in Endocrinology. doi: 10.3389/fendo.2019.00265 Apr 29;10:265 doi: 10.3389/fendo.2019.00265
  11. Dugan, S.A., Pettee, G., Lange- Maia, B., Karvonen- Gutierrez, C. (2018) Physical activity and physical function: moving and aging. Obstet Gynecol Clin North Am. 2018 December ; 45(4): 723–736. doi:10.1016/j.ogc.2018.07.009
  12. Mishra, N. et al. (2011) Exercise beyond menopause: Dos and Don’ts. J Midlife Health. 2011 Jul-Dec; 2(2): 51–56. doi: 10.4103/0976-7800.92524