The importance of exercise in perimenopause, menopause and postmenopause cannot be overstated. Exercise plays a pivotal role in managing menopausal symptoms such as weight gain, hot flushes, sleep disturbances, and mood swings. Exercise is also a crucial component of overall health and vitality.
During menopause, oestrogen levels begin to fluctuate and then naturally decline over time leading to a decrease in muscle mass (sarcopenia), bone mineral density, and strength. At the same time, it is associated with changes in body fat distribution. Postmenopausal women tend to have more visceral fat (i.e. fat surrounding the organs within the abdominal cavity) than premenopausal women, which poses serious health implications.
Exercising throughout menopause and in postmenopause helps aid in weight management, alleviate menopause symptoms, decrease the risk of non-communicable diseases (i.e. heart disease, diabetes type 2, and stroke), and improve overall mental and physical health.
What Causes Women to Gain Weight During Menopause?
There are several factors that cause women to gain weight during menopause, including hormone fluctuations, natural decrease in muscle mass and negative effects on mental health. Here we outline these factors in detail.
Fluctuations of Reproductive Hormones
One of the main causes is fluctuations in the levels of reproductive hormones, i.e. oestrogen and progesterone, as well as other hormones. Oestrogen, which is secreted by the ovaries during the reproductive period, plays a pivotal role in carbohydrate and lipid metabolism as well as body fat distribution. A decrease in oestrogen is associated with changes in body fat composition. Abdominal fat, for example, accounts for approximately 5 to 8% of total body weight in premenopausal women compared to postmenopausal women where it accounts for 15 to 20% of total body weight.
Decrease in Muscle Mass
Another factor that contributes to weight gain is a decrease in muscle mass. Total lean body mass (which includes muscle mass) is linked to basal metabolic rate (BMR), the rate at which the body uses energy while at rest. A decrease in muscle mass leads to a decrease in overall BMR. If adjustments are not made about caloric requirements, weight gain can occur.
Mental Health Implications
Menopause can also harm mental health, which may directly and/or indirectly contribute to weight gain. Poor quality sleep, stress, low mood, depression, anxiety, and panic attacks may increase levels of hormones that promote weight gain and concomitantly decrease hormone levels that promote weight loss (i.e. direct impact). Mental health challenges may also indirectly contribute to weight gain. For example, fatigue, low mood, depression, or lack of sleep may make it difficult for women to prioritise self-care, eat well, and lack the motivation to remain physically active during menopause.
Life pressures that occur around the time of menopause (i.e. work/financial stress, looking after children, or caring for elderly parents) can also increase stress levels, leading to weight gain. An increase in visceral fat is associated with an increased risk of various noncommunicable diseases, including heart disease, type 2 diabetes, breast cancer, and dementia. For these reasons, weight management in menopause is extremely important.
What are the Benefits of Exercise in Menopause?
Exercise has both physical and mental benefits and is important for overall health and well-being. The physical benefits of exercise include the maintenance and building of muscle mass, bone mineral density, and strength. Exercise can assist with maintaining a healthy body mass index as well as getting rid of abdominal fat, thus reducing the risk of developing certain long-term diseases associated with menopause (i.e. cardiovascular disease and osteoporosis). The mental benefits of exercise are that it aids in mood regulation and cognitive function. Other benefits of exercise include better sleep quality (in perimenopausal women), and management of other menopausal symptoms such as hot flushes.
How Does Exercise Assist with Weight Management?
There are numerous ways in which exercise can aid in weight management. Firstly, it increases energy expenditure which can help individuals maintain their current weight or even lose weight if they can achieve a calorie deficit. Exercise also helps to build and maintain lean muscle. Lean muscle mass is directly correlated with basal metabolic rate, i.e. the amount of energy your body requires to perform life-sustaining activities at rest. An increase in muscle can therefore make it easier to maintain body weight.
Can Exercise Help With Hot Flushes?
It seems counterintuitive that exercise would be able to reduce vasomotor symptoms such as hot flushes. Whilst the physiological mechanism behind vasomotor symptoms is not well understood, it is hypothesised that thermoregulatory and vascular dysfunction (caused by oestrogen deficiency) may be implicated.
Some research has shown that exercise improves thermoregulatory control mechanisms in menopausal women by decreasing core basal metabolic temperature. Cooling mechanisms, such as sweating and blood flow to the skin (for heat dissipation), are thus more efficient and start to occur at lower temperatures. Exercise has been shown to reduce the severity of hot flushes in menopausal women who exercise compared to women who remain sedentary.
Can Exercise Help With Mood and Alleviate Mood Swings?
Exercise has both mental as well as physical benefits. Exercise triggers the release of endorphins, neuropeptide molecules produced in the brain. These molecules block the perception of pain and promote feelings of happiness and well-being. Exercise is a proven, all-natural antidepressant, and research has indicated that as little as 30 minutes per day is effective in alleviating stress and anxiety. Exercise also improves sleep quality, which will also have a down-the-line positive effect on mood and energy levels.
What are the Best Exercises to Manage Menopause Symptoms?
Exercise programs for menopausal and postmenopausal women should include a variety of exercises that maintain and build lean muscle mass, improve cardiovascular and respiratory health, improve balance and flexibility, strengthen the pelvic floor, and reduce day-to-day stresses.
What Should Be Done Before Starting a New Exercise Regime?
Since fitness levels, health, and exercise preferences vary greatly between individuals, a tailored approach to exercise and fitness is required. It is always advisable to speak to a healthcare provider (particularly if there are any existing health concerns) or fitness expert before embarking on any new exercise program. Postmenopausal women should be encouraged to do exercises that are appropriate for their age, fitness level, and health status. These exercises should aim to reduce the risk of bone loss, osteoporotic fractures, and injury (i.e. falls). It is also important to take a gradual approach by slowly increasing the duration and intensity of each workout, as this allows the body to adapt and also reduces the risk of injury.
Exercise Recommendations for Managing Menopause Symptoms
As a general rule, women should aim to do about 30 minutes of exercise per day or 150 minutes of moderate-intensity exercise per week. The talk test can be used as a simple method to measure exercise intensity. For moderate-intensity, an individual should be able to talk (but not sing) during a workout.
Alternatively, if women are familiar with their heart rate ranges, this can be used to gauge exercise intensity (heart rate must be between 64% to 76% of maximum heart rate for moderate-intensity). Strength training should also be incorporated at least twice per week.
It is important to note that everybody is different and it is best to speak to a healthcare provider to establish what exercises are safe, how much exercise should be done, and what intensity is required for individual needs.
Exercise is essential for all individuals to remain strong, healthy and fit, but in older women, it has the additional benefit of managing menopause-related symptoms and challenges. Unlike medication which often targets a single variable, exercise can ‘fix’ many health-related issues. A combination of cardiovascular, strength, relaxation, and flexibility-type exercises can aid in weight management, bone health, overall strength, mood improvement, sleep regulation, alleviating hot flushes, and enhancing the overall quality of life in menopause and postmenopause. A unique program, tailored to the individual (in terms of both capability and preference), is recommended for optimal results.