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Effect of Circuit Training on Menopausal Symptoms and Quality of Life
Abstract
Objective: To determine the effect of an 8-week circuit training program on menopausal symptoms and quality of life (QOL).
Study Design: Pre- to posttest of convenience.
Background: Because of recent findings regarding the adverse effects of hormone therapy, nonpharmacological treatments are being explored for managing menopausal symptoms and decreased QOL associated with this transitional period. Several studies have demonstrated the benefits of aerobic or resistance exercises on the menopausal population.
Methods and Measures: Twelve perimenopause and postmenopausal women (mean age, 54.8 years) underwent an 8-week circuit training program at a local fitness center in southern New Jersey. Menopausal symptoms and QOL were monitored via pre- and posttest administration of the Menopause Specific Quality of Life Intervention Questionnaire (MENQOL-Intervention). Physical activity level was evaluated using Baecke's Questionnaire of Habitual Physical Activity. Muscular strength, endurance, and flexibility were evaluated using physical tests. Anthropometric measurements were recorded to assess body composition.
Results: Statistical significance was observed in the physical domain of the MENQOL-Intervention (P [SUPERSCRIPT EQUALS SIGN] .008) but not in the vasomotor, psychosocial, and sexual domains. An increase in muscle strength, endurance, and flexibility was observed post-circuit training for each of the modified Push-up Test (P [SUPERSCRIPT EQUALS SIGN] .04) and Sit and Reach Test (P [SUPERSCRIPT EQUALS SIGN] .006). However, statistical significance was not seen in the other physical tests: curl-up, body fat percentage, and Baecke's Questionnaire.
Conclusion: Circuit training may be a helpful strategy for menopausal women who experience menopausal symptoms and decreased QOL. Physical therapists treating menopausal women should consider circuit training as an intervention or lifestyle recommendation.
... With a total number of eleven articles under analysis, five out of the eight RCTs were two-armed trials [20,22,23,26], two were three-armed [21,24] and one had four arms [27]. Four RCTs were conducted in Asia (two in Iran, one in China, and one in Thailand) [20][21][22][23], four in America (two in the USA, two in Brazil, and one in Canada) [24,25,[28][29][30] and two in Europe (both in the Netherlands) [25,27]. A total of 1548 women were selected for participation in the 11 studies included in this systematic review. ...
... Pelvic floor muscle (PFM) exercises, either alone [20,21,25] or combined with resistance exercises [28] or physiotherapy treatment [25,30] were the most widely used type of activity. Other studies employed aerobic exercises alone [23,24] or together with resistance exercises [29] or cognitive-behavioral treatment including relaxation exercises. The latter were also employed as an individual intervention [27]. ...
... Two articles involved mind-body interventions such as yoga [24] and Rusie Dutton [22], and one performed on women with pelvic organ prolapse employed a silicone pessary [25]. The duration of the interventions was 12 weeks except for those authored by Ngowsiri et al. [22] (13 weeks), Mastrangelo et al. [29] (8 weeks), Panman et al. [26], whose studies on women with pelvic organ prolapse reached 24 months, and Schvartzman et al. [25], who did not describe the exact duration of the intervention (simply reporting five one-hour sessions). The dropout rate was 20.99% (325/1548 participants). ...
During the menopausal period, sexual dysfunction is associated with the development or worsening of psychological conditions, causing deterioration in women’s mental health and quality of life. This systematic review aims to investigate the effects of different exercise programs on sexual function and quality of sexual life related to menopausal symptoms. With this purpose, a systematic literature search was conducted in PubMed, CINAHL, Scopus, Web of Science, and Cochrane Plus. A total of 1787 articles were identified in the initial search and 11 prospective studies (including 8 randomized controlled trials) were finally included. The most commonly recommended training programs are based on exercising pelvic floor muscles, as they seem to have the largest impact on sexual function. Mind–body disciplines also helped in managing menopausal symptoms. However, as far as the most traditional programs were concerned, aerobic exercises showed inconsistent results and resistance training did not seem to convey any benefits. Although positive effects have been found, evidence supporting physical exercise as a strategy to improve sexual function and quality of sexual life related to menopausal symptoms is limited, and further studies on this topic are needed.
... Numerous studies have indicated that CRT is an effective intervention for improving quality of life, reducing body fat, increasing mean power output, elevating maximum oxygen consumption, amplifying maximum pulmonary ventilation, and improving functional capacity. These improvements are associated with enhancements in both cardiovascular and muscular strength and endurance (19,20,21,22). ...
... The current ndings support previous studies that have documented elevations in VEGF levels following endurance, resistance or combined training (2,15,16,17,19,20,21,22,31,32). In contrast, Landers-Ramos et al (2014) did not report signi cant change in VEGF after acute aerobic training (26). ...
Background
Angiogenesis is a beneficial process leading to capillary enhancement, which can trigger in response to physical training.
Aims
The present study aimed to investigate the changes in physiological factors involved in angiogenesis in response to circuit or traditional resistance training.
Methods
Following the pre-test, Thirty-six healthy sedentary students (age: 21.1 ± 2.3 years; height: 172.7 ± 5.1 cm) were randomly divided into Circuit Resistance Training (CRT) (4 circles/3 times a week/8 weeks circuit performance/50–55% 1 Repetition Maximum; n = 12), Traditional Resistance Training (TRT) (8 repetition/3 set/3 time per week/8 weeks of same movements with 75% 1RM followed by 2 minutes break between the sets; n = 12) and the control group (n = 12). We examined the responses of Vascular Endothelial Growth Factor (VEGF), plasma level of growth hormone (GH), and basic Fibroblast Growth Factor (bFGF).
Results
Both of CRT and TRT protocols resulted in significant increases in post-test compared to pre-test, in VEGF (p = 0.00), GH (p = 0.04), and bFGF (p = 0.00). In addition, the magnitude of changes in VEGF and GH were significantly greater than the control group in post-test (p = 0.03, and 0.001, respectively). In addition, there was a strong correlation between absolute value of GH and VEGF (r = 0.74 and r = 0.71) following CRT (p = 0.01) and TRT (p = 0.02).
Conclusions
This study demonstrated that CRT and TRT might enhance angiogenesis through increase in VEGF, bFGF and GH.
... These benefits have also been demonstrated in postmenopausal women. [16][17][18][19][20] Experts recommend exercise for health promotion and menopause symptoms relief, yet evidence supporting these associations has been limited to date, 7 necessitating studies such as that reported here. ...
... It can be argued that the improvements in flexibility observed here potentially resulted in the increased HRQoL scores. 18,26,27 In particular, it is possible that the improvements observed in the subdomains General health status and Ageing and health (and potentially even those in the Mental well-being domain) were partly due to enhanced flexibility. ...
Objectives:
This study explored the multidimensional outcomes that resulted from the adherence to regular exercise among previously sedentary postmenopausal women. The exercise was managed through a supervised, multicomponent, adapted approximately 20-week program in a suited health promotion intervention.
Methods:
A multigroup, mixed-design study with between-group (intervention, sedentary, and active women) and within-subject measures (baseline, postintervention, and 3- and 12-month follow-ups) was conducted using intention-to-treat methodology. The Cervantes Scale assessed health-related quality of life (HRQoL), and several indicators of cardio-metabolic status and fitness were also assessed.
Results:
After the intervention, the participants experienced positive changes in short and long-term physical and mental health, with significant enhancements in several HRQoL dimensions, particularly mental well-being and menopause-related health and subdomains. Improvements were maintained or continued (eg, mental well-being) throughout the period, leading up to the 12-month follow-up. These outcomes were accompanied by significant improvements in cardio-metabolic status and fitness, including weight, body mass index, cardio-respiratory fitness, and flexibility.
Conclusions:
Our findings parallel previous empirical evidence showing the benefits associated with regular exercise, and add evidence to the association of positive outcomes in HRQoL with improvements in cardio-metabolic health and fitness status after the adoption of an active lifestyle.
... These benefits have also been demonstrated in postmenopausal women. [16][17][18][19][20] Experts recommend exercise for health promotion and menopause symptoms relief, yet evidence supporting these associations has been limited to date, 7 necessitating studies such as that reported here. ...
... It can be argued that the improvements in flexibility observed here potentially resulted in the increased HRQoL scores. 18,26,27 In particular, it is possible that the improvements observed in the subdomains General health status and Ageing and health (and potentially even those in the Mental well-being domain) were partly due to enhanced flexibility. ...
Background:
This study explored multidimensional outcomes that were derived from the adherence to regular exercise among previously sedentary postmenopausal 45-64 years old women who engaged in a ~20-week exercise programme.
Methods:
A RCT with between-group (intervention and control women) and within-subject measures (baseline, postintervention and 3-month and 12-month follow-ups) wasconducted. HRQoL and several indicators of cardio-metabolic status and fitness were assessed.
Results:
After the intervention, the participants experienced a positive change in their short and long-term physical and mental health, with significant enhancements in several HRQoL dimensions, particularly mental well-being (23.3% of change) and menopause-related health and subdomains (17.0% of change) (p < .01). Improvements were maintained or continued (e.g., mental well-being) overtime. These outcomes were accompanied by significant improvements in cardio-metabolic status and fitness, including weight, BMI, cardio-respiratory fitness and flexibility (up to 16.2% of change, p < .05). After the intervention, the IG exhibited better HRQoL than the CG at each of the measurement phases. Between-group differences were also observed for some indicators of cardiovascular health and flexibility.
Conclusions:
Our findings addevidenceon the association ofpositive outcomes on HRQoL with improvements in cardio-metabolic health and fitness status after the adoption of an active lifestyle.
... This implies that the 6-week circuit training program among the apparently healthy adult females did not statistically improve their overall quality of life. This result was inconsistent with the study by Teoman et al. [27], which found a statistical significance in the QOL of menopausal women taking hormone therapy using the CT program; and also in the study by Mastrangelo et al. [28], which found a significant improvement in the quality of life of the experimental group after circuit training exercise. ...
Aim: The aim of this study was to assess the effect of a 6-week circuit training on the cardiovascular endurance and quality of life of an apparently healthy adult female population. Methodology: This study adopted a pre and post-test experimental design. A total of 60 adult females who were randomly selected into experimental group and control group participated in the study. The variables for this study were obtained using a proforma which contained the anthropometric parameters, respiratory rate, mean arterial pressure, heart rate, maximum oxygen consumption, partial oxygen saturation, hip circumference and waist-hip ratio. The stations of exercises used included jumping lunges, curtsy lunges, torso rotation, knee raise claps, abdominal twist or knee combo, kick raise. Data were analyzed using descriptive analysis and paired t-test. Continuous variables were reported in tables as mean± Standard deviation (SD). Original Research Article Ikenna et al.; JALSI, 23(3): 1-8, 2020; Article no.JALSI.56286 2 Results: Findings from the study showed that there was a significant difference (P<.05) in partial oxygen saturation, respiratory rate, mean atrial pressure, maximal oxygen consumed, and heart rate. No significant effect was found in the domains of the quality of life of the experimental group. Conclusion: Circuit training has positive effects towards improvement of cardiovascular endurance and maintenance of functional quality of life (QOL). It is therefore necessary for circuit training to be encouraged as a strategy that can be used among young female adults.
Aim: An adult female population that appeared to be in good health was included in this study to assess the effects of a six-week circuit training programme on cardiovascular endurance and quality of life. Background: People going through menopause are looking for ways to improve their quality of life and alleviate symptoms, and hormone medication has a lot of side effects, therefore people are looking towards non-pharmacological approaches. Several studies have shown that aerobic and resistance training have positive effects on women going through menopause. Method: The study included 44 menopausal women who were randomly allocated to either a group that trained using circuit training for six weeks or a control group that had regular physiotherapy for the same amount of time. We tracked BMI before and after the intervention, along with cardiorespiratory fitness indicators such as heart rate, oxygen saturation, blood pressure, and the distance covered in a six-minute walk test. Additionally, we administered the Menopause-Specific Quality of Life questionnaire. Statistical Analysis Used: We used INSTAT 3.06, a statistical programme, and an unpaired t-test to analyze the data. Results: The study found that menopausal women’s cardiovascular endurance and quality of life were both greatly enhanced by the six-week circuit training programme. “There was no statistically significant change between the pre- and post-intervention values of the body mass index or the Menopause-Specific Quality of Life scores, however, there was a difference in the cardiorespiratory indicators and physical symptoms in quality of life. Conclusion: Circuit training has the potential to alleviate menopausal symptoms and improve the quality of life for women going through menopause. Physical therapists treating menopausal women might think about using circuit training as an intervention.
Recognition of the physiological and psychological concerns associated with menopausal women is described. A review of the current literature regarding these conditions (vasomotor responses, insomnia, sarcopenia, osteoporosis, obesity, cardiovascular conditions, metabolic concerns, and psychological concerns) and how exercise impacts the conditions are discussed. Considerations of exercise for menopausal women are presented. General exercise programming and exercise adherence preferences are reviewed with recommendations for a variety of exercise types, exercise progressions, and exercise programming to meet the needs of the menopausal woman to improve overall health and well-being.
Objective:
The Menopause-Specific Quality of Life (MENQOL) questionnaire was developed as a validated research tool to measure condition-specific QOL in early postmenopausal women. We conducted a comprehensive scoping review to explore the extent of MENQOL's use in research and clinical practice to assess its value in providing effective, adequate, and comparable participant assessment information.
Methods:
Thirteen biomedical and clinical databases were systematically searched with "menqol" as a search term to find articles using MENQOL or its validated derivative MENQOL-Intervention as investigative or clinical tools from 1996 to November 2014 inclusive. Review articles, conference abstracts, proceedings, dissertations, and incomplete trials were excluded. Additional articles were collected from references within key articles. Three independent reviewers extracted data reflecting study design, intervention, sample characteristics, MENQOL questionnaire version, modifications and language, recall period, and analysis detail. Data analyses included categorization and descriptive statistics.
Results:
The review included 220 eligible papers of various study designs, covering 39 countries worldwide and using MENQOL translated into more than 25 languages. A variety of modifications to the original questionnaire were identified, including omission or addition of items and alterations to the validated methodological analysis. No papers were found that described MENQOL's use in clinical practice.
Conclusions:
Our study found an extensive and steadily increasing use of MENQOL in clinical and epidemiological research over 18 years postpublication. Our results stress the importance of proper reporting and validation of translations and variations to ensure outcome comparison and transparency of MENQOL's use. The value of MENQOL in clinical practice remains unknown.
We employed a whole body magnetic resonance imaging protocol to examine the influence of age, gender, body weight, and height on skeletal muscle (SM) mass and distribution in a large and heterogeneous sample of 468 men and women. Men had significantly ( P < 0.001) more SM in comparison to women in both absolute terms (33.0 vs. 21.0 kg) and relative to body mass (38.4 vs. 30.6%). The gender differences were greater in the upper (40%) than lower (33%) body ( P < 0.01). We observed a reduction in relative SM mass starting in the third decade; however, a noticeable decrease in absolute SM mass was not observed until the end of the fifth decade. This decrease was primarily attributed to a decrease in lower body SM. Weight and height explained ∼50% of the variance in SM mass in men and women. Although a linear relationship existed between SM and height, the relationship between SM and body weight was curvilinear because the contribution of SM to weight gain decreased with increasing body weight. These findings indicate that men have more SM than women and that these gender differences are greater in the upper body. Independent of gender, aging is associated with a decrease in SM mass that is explained, in large measure, by a decrease in lower body SM occurring after the fifth decade.
In a pilot study for the European Prospective Investigation into Cancer and Nutrition (EPIC) a modification of the Baecke questionnaire on physical activity was tested for repeatability and relative validity in a population of 134 men and women aged 20-70 years.
For the assessment of repeatability Pearson's correlation coefficients and percentages of agreement after classification in tertiles were computed between administrations of the questionnaire at baseline, and after 5 and 11 months. Relative validity was determined by comparing the questionnaire to a four times repeated 3-day activity diary.
Repeatability after 5 and 11 months was good, with test-retest correlation coefficients between 0.65 and 0.89 for main sections of the questionnaire. The percentages of agreement, exceeding chance (Cohen's kappa) were 57% and 56% for men (at 5 and 11 months respectively) and 41% and 46% for women. The correlations with the diaries were 0.56 in men and 0.44 in women. Agreement apart from chance between classification in tertiles for both methods was 35% for men and 10% for women.
These data show that repeatability is good and relative validity as compared to an activity diary is moderate but well within the range of values found in other studies. The questionnaire is more valid in men than in women.
Osteoporosis is one of the most common skeletal disorders affecting postmenopausal women. The purpose of this study was to investigate whether a 24-week program of aerobic high-impact loading exercise was beneficial for enhancing physical fitness and bone mineral density (BMD) in osteopenic postmenopausal women. Forty-three postmenopausal women aged 48-65 years participated in this study. The BMD of the spine (L2-L4) and right femoral neck of each woman was below 1 SD of the mean of premenopausal women, as examined by dual X-ray absorptiometry. The assignment of subjects into exercise or control group was not randomized but based on each subject's anticipated compliance to the 6-month long exercise program. Twenty-two subjects joined the exercise group and attended the training programs and 21 served as the control group. Exercise programs included treadmill walking at an intensity above 70% of maximal oxygen consumption (VO2max) for 30 minutes, followed by 10 minutes of stepping exercise using a 20-cm-high bench. The program was conducted three times per week for 24 weeks. Physical fitness measurements included testing of flexibility, muscular strength and endurance, body composition, and cardiopulmonary fitness. The results showed that the quadriceps strength, muscular endurance, and VO2max in the exercise group had significant improvements, whereas no improvement was found in any of the physical fitness parameters in the control group. The BMD of the L2-L4 and the femoral neck in the exercise group increased 2.0% (P > 0.05) and 6.8% (P < 0.05) and those in the control group decreased 2.3% (P < 0.05) and 1.5% (P > 0.05), respectively. In conclusion, aerobics combined with high-impact exercise at a moderate intensity was effective in offsetting the decline in BMD in osteopenic postmenopausal women.
Growing evidence indicates that physical exercise can prevent at least some of the negative effects on health associated with early menopause. Here we determine the effects of intense exercise on physical fitness, bone mineral density (BMD), back pain, and blood lipids in early postmenopausal women.
The study population comprised 50 fully compliant women, with no medication or illness affecting bone metabolism, who exercised over 26 months (exercise group [EG]), and 33 women who served as a nontraining control group (CG). Two group training sessions per week and 2 home training sessions per week were performed in the EG. Both groups were individually supplemented with calcium and cholecalciferol. Physical fitness was determined by maximum strength and cardiovascular performance. Bone mineral density was measured at the lumbar spine (dual-energy x-ray absorptiometry [DXA] and quantitative computed tomography [QCT]), the proximal femur (DXA), and the forearm (DXA). In serum samples taken from a subset of the study participants, we determined bone formation (serum osteocalcin) and resorption (serum cross-links) markers as well as blood lipid levels. Vasomotor symptoms related to menopause and pain were also assessed.
After 26 months, significant exercise effects determined as percentage changes compared with baseline were observed for physical fitness (isometric strength: trunk extensors [EG +36.5% vs CG +1.7%], trunk flexors [EG +39.3% vs CG -0.4%], and maximum oxygen consumption [EG +12.4% vs CG -2.3%]); BMD (lumbar spine [DXA L1-L4, EG +0.7% vs CG -2.3%], QCT L1-L3 trabecular region of interest [EG +0.4% vs CG -6.6%], QCT L1-L3 cortical region of interest [EG +3.1% vs CG -1.7%], and total hip [DXA, EG -0.3% vs CG -1.7%]); serum levels (total cholesterol [EG -5.0% vs CG +4.1%] and triglycerides [EG -14.2% vs CG +23.2%]); and pain indexes at the spine.
General purpose exercise programs with special emphasis on bone density can significantly improve strength and endurance and reduce bone loss, back pain, and lipid levels in osteopenic women in their critical early postmenopausal years.
Controlled single-group pretest/posttest design.
The purpose of this study was to determine if a 6-week neuromuscular training program designed to decrease the incidence of anterior cruciate ligament (ACL) injuries would improve single-limb postural stability in young female athletes. We hypothesized neuromuscular training would result in an improvement in postural stability, with the greatest improvement taking place in the medial-lateral direction.
Balance training has become a common component of programs designed to prevent ACL injury. Rehabilitation programs can improve postural stability following ACL injury and reconstruction; however, there is limited information available which quantifies improvement of postural stability following neuromuscular training designed to prevent ACL injuries in a healthy population.
Forty-one healthy female high school athletes (mean age, 15.3 years; age range, 13-17 years) participated in this study. Single-limb postural stability for both lower extremities was assessed with a Biodex Stability System. The neuromuscular training program consisted of three 90-minute training sessions per week for 6 weeks. Following the completion of the training program, each subject was re-evaluated to determine change in total, anterior-posterior, and medial-lateral single-limb stability. Two-way analysis of variance models were used to determine differences between pretraining and posttraining and between limbs.
The subjects showed a significant improvement in single-limb total stability (P = .004) and anterior-posterior stability (P = .001), but not medial-lateral stability (P = .650) for both the right and left lower extremity following training. In addition, the subjects demonstrated significantly better total postural stability on the right side as compared to the left (P = .026).
A 6-week neuromuscular training program designed to decrease the incidence of ACL injuries improves objective measures of total and anterior-posterior single-limb postural stability in high school female athletes.
Menopause may induce a phase of rapid decreases in bone mineral density, aerobic fitness, muscle strength, and balance, especially in sedentary women. The purpose of this study was to examine the effects and feasibility of an exercise program of 1 or 2 bouts of walking and resistance training on lower-extremity muscle strength (the force-generating capacity of muscle), balance, and walking performance in women who recently went through menopause.
The subjects were 134 women who recently went through menopause. The study was a 15-week, randomized, controlled trial with continuous and fractionated exercise groups. The outcomes assessed were lower-extremity muscle strength, balance, and walking time over 2 km. Feasibility was assessed by questionnaires, interviews, and training logs.
One hundred twenty-eight women completed the study. Adherence to the study protocol was 92%. Both continuous and fractionated exercise groups improved equally in lower-extremity muscle strength and walking time but not in balance. Almost 70% of the subjects considered the program to be feasible. Two daily walking sessions caused fewer lower-extremity problems than did continuous walking.
Brisk walking combined with moderate resistance training is feasible and effective. Fractionating the walking into 2 daily sessions is more feasible than continuous walking.
The purpose of the study was to determine the effect of long-term exercise on coronary heart disease, osteoporotic risk factors, and physical fitness parameters in postmenopausal women. Forty early postmenopausal women (age 55.1 +/- 3.3 years) with no medication or illness affecting bone metabolism exercised (high impact aerobic, multilateral jumps, multi-set resistance exercise) for 50 months (EG), while 28 women (age 55.5 +/- 3.0 years) served as a nontraining control (CG). Both groups were supplemented with calcium and cholecalciferol. Bone mineral density (BMD) was measured at the lumbar spine, hip, and forearm by dual energy x-ray absorptiometry. Blood lipids were determined using serum samples, and body composition was determined using the bioimpedance technique. Further, maximum isometric strength was determined (Schnell M3, Schnell Trainer). The BMD at the lumbar spine (+1.0%, p = 0.037) and the total hip (-0.3%, p = 0.194) were maintained in the EG, while significant (p < 0.001) decreases were observed in the CG (lumbar spine -3.2; total hip -2.3%). Differences between both groups were significant (p < 0.001). Significant differences between EG and CG were also observed, respectively, for total cholesterol (-6.1 vs. +3.5%, p = 0.008), HDL-cholesterol (+14.1 vs. -7.1%, p = 0.007), triglycerides (-10.2 vs. +27.5%, p = 0.002), body fat (-3.3 vs. +1.3%, p = 0.041), and waist-hip-ratio (-3.5 vs. +0.2%, p > 0.001). Maximum isometric strength significantly (p < 0.001) increased in the EG, while strength parameters decreased in the CG (-0.5 to -6.4%). Thus, the study demonstrated that multipurpose high-intensity exercise programs significantly affect relevant menopausal risk factors and, therefore, may be individually considered as an alternative to hormone replacement therapy.
A case is made for estrogens to be the first-choice therapy for the prevention and treatment of osteoporosis in women below the age of 60 years. Estrogens produce a dose-related increase in bone density and also, by their effect on collagen, have a beneficial effect not only on the bone matrix but the intravertebral disc. Bisphosphonates do not have that effect upon the disc. Estrogens are also associated with other beneficial effects upon mood, vasomotor symptoms, pelvic atrophy, sexuality and quality of life. The data from the Women's Health Initiative (WHI) study are used as a justification for not using estrogens but the neglect of estrogen therapy by physicians antedated this and other studies by many years. Subsequent publications from the WHI study show that hormone replacement therapy, particularly estrogens alone, is not associated with the excess side-effects found in the older population. The substantial but non-significant decrease in heart attacks, breast cancer and mortality in women under the age of 60 taking estrogens alone should persuade the advisory bodies to revise their judgment on the benefits and safety of hormone replacement therapy in this population.
The original Physical Activity Readiness Questionnaire (PAR-Q) offers a safe preliminary screening of candidates for exercise testing and prescription, but it screens out what seems an excessive proportion of apparently healthy older adults. To reduce unnecessary exclusions, an expert committee established by Fitness Canada has now revised the questionnaire wording. The present study compares responses to the original and the revised PAR-Q questionnaire in 399 men and women attending 40 accredited fitness testing centres across Canada. The number of subjects screened out by the revised test decreased significantly (p < .05), from 68 to 48 of the 399 subjects. The change reflects in part the inclusion of individuals who had made an erroneous positive response to the original question regarding high blood pressure. There is no simple gold standard to provide an objective evaluation of the sensitivity and specificity of either questionnaire format, but the revised wording has apparently had the intended effect of reducing positive responses, particularly to the question regarding an elevation of blood pressure.
The peri- and postmenopausal woman experiences physiologic changes of aging that include alterations in hormone levels. Research has shown that the perimenopausal and postmenopausal woman can benefit significantly from exercise, whether endurance or strength training. Exercise can improve the quality of life and attenuate some of the physiologic changes associated with aging. Additionally, exercise can ameliorate the decline in fitness and bone, prevent chronic disease, and promote functional independence. Women who exercise regularly throughout life are physiologically 20 to 30 years younger than their sedentary counterparts. Fitness is a lifetime endeavor that has many positive benefits. Weightbearing activities are especially important as bone loss increases in the perimenopausal phase of life. Women should perform aerobic exercise 3 to 7 days per week for 15 to 60 minutes at 65% to 70% HRreserve. Strengthening exercises should be done 2 to 3 days per week at 40% to 80% 1RM with appropriately selected exercises. An exercise program should be functional and enjoyable. There is no better motivation to exercise than having a partner to work out with and keep the motivation alive. Most important, age itself is not a deterrent to exercise.
This study tested the safety and the effects of circuit resistance training (CRT) on peak upper extremity cardiorespiratory endurance and muscle strength in chronic survivors of paraplegia due to spinal cord injury.
Ten men with chronic neurologically complete paraplegia at the T5-L1 levels participated in the study. Subjects completed 12 wk of CRT, using a series of alternating isoinertial resistance exercises on a multi-station gym and high-speed, low-resistance arm ergometry. Peak arm ergometry tests, upper extremity isoinertial strength testing, and testing of upper extremity isokinetic strength were all performed before and after training.
None of the subjects suffered injury from exercise training. Significant increases were observed in peak oxygen consumption (29.7%, P < 0.01), time to fatigue (P < 0.01), and peak power output during arm testing (P < 0.05). Significant increases in isoinertial strength for the training maneuvers ranged from 11.9% to 30% (Ps < 0.01). Significant increases in isokinetic strength were experienced for shoulder joint internal rotation, extension, abduction, adduction, and horizontal adduction (Ps < 0.05).
Chronic survivors of paraplegia safely improve their upper extremity cardiorespiratory endurance and muscle strength when undergoing a short-term circuit resistance training program. Gains in fitness and strength exceeded those usually reported after either arm endurance exercise conditioning or strength training in this subject population.
We investigated the effect of an 8 week circuit training (CT) program, combining aerobic and resistance exercise, on indices of glycemic control, cardiorespiratory fitness, muscular strength and body composition in 16 subjects (age 52 +/- 2 years) with type 2 diabetes using a prospective randomised crossover protocol. Submaximal exercise heart rate and rate pressure product were significantly lower after training (P<0.05), whilst ventilatory threshold increased (11.8 +/- 0.7 vs 13.8 +/- 0.6 ml kg(-1)min(-1), P<0.001). Muscular strength also increased with training (403 +/- 30 to 456 +/- 31 kg, P<0.001), whilst skinfolds (148.7 +/- 11.5 vs 141.1 +/- 10.7 mm, P<0.05), % body fat (29.5 +/- 1.0 vs 28.7 +/- 1.1%, P<0.05) and waist:hip ratio (99.2 +/- 1.5 vs 97.9 +/- 1.4%, P<0.05) significantly decreased. Concurrently, peak oxygen uptake (P<0.05) and exercise test duration (P<0.001) increased following training, whilst glycated hemoglobin (P<0.05) and fasting blood glucose (P<0.05) decreased. CT is an effective method of training that improved functional capacity, lean body mass, strength and glycemic control in subjects with type 2 diabetes.
To study the relative contribution of osteoporosis and falls to the occurrence of symptomatic fractures in postmenopausal women.
Retrospective survey of current osteoporosis in relation to falls and fractures in the preceding year.
Patients of general practitioners of the area around a Belgian university.
A total of 2649 consecutive postmenopausal women (mean age, 61y; range, 45-91y).
Not applicable.
Current bone density measurements (single-photon absorptiometry in the forearm) were analyzed in relation to self-reported incidence of falls and fractures in the preceding year.
Osteoporosis was found in 15% of the patients, 19% reported 1 or more falls during the preceding year, and 1.8% had a fracture during the preceding year. The age-adjusted risk for a fracture in the past 12 months for a 1 standard deviation decrease in bone density was 1.9 (95% confidence interval [CI], 1.4-2.5; P<.01). Adjusted risk for age, bone density, and body mass index (BMI) for a fracture in the past 12 months in patients who reported a fall was 6.0 (95% CI, 3.1-11.5; P<.001). Compared with women without osteoporosis and without a fall, women with osteoporosis without a fall had an age- and BMI-adjusted fracture risk of 2.8 (95% CI, 0.6-12.8; P<.10), and women with osteoporosis and a fall had an adjusted-fracture risk of 24.8 (95% CI, 6.9-88.6; P<.0001).
Falls are a major contributing factor to the occurrence of symptomatic fractures in postmenopausal women, independent of and additive to the risk attributable to age and osteoporosis.
This article analyzes physical symptoms experienced by mid-age Australian women in different stages of the menopause transition. A total of 8,623 women, aged 45 to 50 years in 1996, who participated the mid-age cohort of the Australian Longitudinal Study on Women's Health, completed Survey 1 in 1996 and Survey 2 in 1998. Women were assigned to 1 of 6 menopause groups according to their menopausal status at Surveys 1 and 2, and compared on symptoms experienced at Surveys 1 and 2, adjusted for lifestyle, behavioral and demographic factors. At Survey 1, the most commonly reported symptoms were headaches, back pain, stiff joints, tiredness, and difficulty sleeping. Perimenopausal women were more likely than premenopausal or postmenopausal women to report these symptoms. Hot flushes and night sweats were more common among postmenopausal women. Compared with those who remained premenopausal, women who were in the early stages of menopause or perimenopausal were more likely to report tiredness, stiff joints, difficulty sleeping, and hot flushes at Survey 2. Women who remained perimenopausal were also more likely to report back pain and leaking urine. Compared with premenopausal women, odds ratios for night sweats increased for women in consecutive stages of the menopause transition and remained high in the postmenopausal women.
Despite decades of accumulated observational evidence, the balance of risks and benefits for hormone use in healthy postmenopausal women remains uncertain.
To assess the major health benefits and risks of the most commonly used combined hormone preparation in the United States.
Estrogen plus progestin component of the Women's Health Initiative, a randomized controlled primary prevention trial (planned duration, 8.5 years) in which 16608 postmenopausal women aged 50-79 years with an intact uterus at baseline were recruited by 40 US clinical centers in 1993-1998.
Participants received conjugated equine estrogens, 0.625 mg/d, plus medroxyprogesterone acetate, 2.5 mg/d, in 1 tablet (n = 8506) or placebo (n = 8102).
The primary outcome was coronary heart disease (CHD) (nonfatal myocardial infarction and CHD death), with invasive breast cancer as the primary adverse outcome. A global index summarizing the balance of risks and benefits included the 2 primary outcomes plus stroke, pulmonary embolism (PE), endometrial cancer, colorectal cancer, hip fracture, and death due to other causes.
On May 31, 2002, after a mean of 5.2 years of follow-up, the data and safety monitoring board recommended stopping the trial of estrogen plus progestin vs placebo because the test statistic for invasive breast cancer exceeded the stopping boundary for this adverse effect and the global index statistic supported risks exceeding benefits. This report includes data on the major clinical outcomes through April 30, 2002. Estimated hazard ratios (HRs) (nominal 95% confidence intervals [CIs]) were as follows: CHD, 1.29 (1.02-1.63) with 286 cases; breast cancer, 1.26 (1.00-1.59) with 290 cases; stroke, 1.41 (1.07-1.85) with 212 cases; PE, 2.13 (1.39-3.25) with 101 cases; colorectal cancer, 0.63 (0.43-0.92) with 112 cases; endometrial cancer, 0.83 (0.47-1.47) with 47 cases; hip fracture, 0.66 (0.45-0.98) with 106 cases; and death due to other causes, 0.92 (0.74-1.14) with 331 cases. Corresponding HRs (nominal 95% CIs) for composite outcomes were 1.22 (1.09-1.36) for total cardiovascular disease (arterial and venous disease), 1.03 (0.90-1.17) for total cancer, 0.76 (0.69-0.85) for combined fractures, 0.98 (0.82-1.18) for total mortality, and 1.15 (1.03-1.28) for the global index. Absolute excess risks per 10 000 person-years attributable to estrogen plus progestin were 7 more CHD events, 8 more strokes, 8 more PEs, and 8 more invasive breast cancers, while absolute risk reductions per 10 000 person-years were 6 fewer colorectal cancers and 5 fewer hip fractures. The absolute excess risk of events included in the global index was 19 per 10 000 person-years.
Overall health risks exceeded benefits from use of combined estrogen plus progestin for an average 5.2-year follow-up among healthy postmenopausal US women. All-cause mortality was not affected during the trial. The risk-benefit profile found in this trial is not consistent with the requirements for a viable intervention for primary prevention of chronic diseases, and the results indicate that this regimen should not be initiated or continued for primary prevention of CHD.
The main purpose of this study was to analyze the impact of a 1-yr resistance-training program on body composition and muscle strength in postmenopausal women, and to describe the impact of hormone replacement therapy (HRT) on body composition changes, with and without exercise. Secondarily, we wanted to study dose-response relationships between measures of program compliance and changes in primary outcomes.
Subjects were postmenopausal women (40-66 yr) randomly assigned to an exercise (EX) group (N = 117) and a nonexercise group (N = 116). The EX group participated in a 1 yr trainer-supervised resistance-training program, 60-75 min.d-1, 3 d.wk-1. Lean soft tissue (LST) and fat tissue (FT) changes were measured by dual-energy x-ray absorptiometry and strength by one-repetition maximum testing.
Significant (P < 0.001) gains in LST were observed for women who exercised, regardless of HRT status, whereas women who did not exercise lost LST (P < 0.05) if they were not taking HRT, and gained LST (P = 0.08) if they were on HRT. The only significant FT losses were observed for women who exercised while on HRT (P < 0.05). Strength increases were observed at all sites (P < 0.001). Total weight lifted by subjects in their training sessions was a significant predictor of changes in LST (P < 0.001) and strength (P < 0.01).
Resistance and weight-bearing exercise significantly changed total and regional body composition in postmenopausal women by increasing LST in all women and decreasing FT in women on HRT. Hormone therapy showed no independent effects on body composition, but it protected nonexercising women from losses in LST. The lean and muscle strength changes observed were partially dependent on the volume of training, as expressed by attendance and total weight lifted in 1 yr of training.
This study was designed to determine the effect of exercise on the physical fitness level and quality of life in postmenopausal women. 81 volunteer postmenopausal women who entered the menopause naturally and have been taking hormone replacement treatment (HRT) were divided randomly into two groups: exercise (n=41) and control (n=40).
Physical fitness tests and the Nottingham Health Profile (NHP) were used to assess physical fitness and quality of life in both groups, both before and after 6 weeks. The study group participated in an exercise programme, which was composed of sub-maximal aerobic exercises for a 6-week period 3 times a week. The statistical analyses were done by paired samples t-test and independent samples t-test.
At the end of 6 weeks exercise period, when the two groups were compared after the exercise period, we found statistically significant differences in strength, endurance, flexibility and balance parameters in the exercise group (P<0.05). There was also a statistically significant change in the exercise group for the NHP indicating an improvement in the quality of life (P<0.05).
In this study, it was concluded that the fitness level and quality of life on postmenopausal women could be improved by a regular and controlled exercise programme of 6 weeks.
To assess if regular physical exercise or oral oestradiol therapy decreased vasomotor symptoms and increased quality of life in previously sedentary postmenopausal women.
A prospective, randomised trial at a University Hospital.
75 postmenopausal, sedentary women with vasomotor symptoms were randomised to: exercise three-times weekly over 12 weeks (15 women), oral oestradiol therapy for 12 weeks (15 women) and 45 women to three other treatment arms. Results from the exercise and oestradiol groups are presented here. The effects on vasomotor symptoms and wellbeing were assessed with logbooks and validated questionnaires.
Ten women fulfilled 12 weeks of exercise. The number of flushes was rather unchanged in five women and decreased to 28% (range 18-42%) of baseline in the other five women. Five of the ten women continued to exercise another 24 weeks, thus in all 36 weeks. The mean number of flushes decreased by about 50% in these five women (from 6.2/24 to 3.2 flushes/24 h at 36 weeks). In the same group a score made as the product of reduction in number and severity of flushes decreased by 92% at 12 weeks, 75% at 24 weeks and 72% at 36 weeks compared with baseline. In the estrogen group flushes decreased from 8.4 to 0.8 (P<0.001) after 12 weeks of therapy and remained at this level after 36 weeks. Well-being according to different measurements improved significantly in both groups, albeit more markedly in the estrogen group.
Apart from many other health benefits regular physical exercise may decrease vasomotor symptoms and increase quality of life in postmenopausal women, but this has to be further evaluated scientifically. Exercise should be introduced gradually to ensure compliance.
To develop the 1996 MENQOL questionnaire further with advice regarding summary score computation, missing-data management, readability, recall period and assessment of the vasomotor domain reliability and construct validity. To develop a modified version, the MENQOL-Intervention questionnaire, for use where certain treatment side effects could negatively impact the quality of life.
MENQOL-Intervention modifications involved the addition of three items to the physical domain. For both questionnaires, psychometric property assessment was embedded in two randomized controlled trials of menopause interventions. Test-retest reliability and Cronbach's alpha were computed for all domains as was construct validity of the vasomotor domain for both questionnaires.
The vasomotor intraclass correlation coefficient was 0.73 for the MENQOL-Intervention over 1 week and 0.78 for the MENQOL over 1 month. The altered physical domain of the MENQOL-Intervention questionnaire continued to show strong test-retest reliability and Cronbach's alpha consistent with the MENQOL. The MENQOL-Intervention demonstrated excellent face validity with high construct validity for the vasomotor domain of 0.78-0.80. For both instruments, comparisons of the vasomotor domains to hot flash scores, although statistically significant, were only moderate at 0.56 and 0.49.
Both the MENQOL and the MENQOL-Intervention questionnaires show strong psychometric properties. We recommend using the MENQOL-Intervention questionnaire where intervention side effects might negatively impact a woman's quality of life. For both questionnaires, a summary score can be calculated.
This article examines published evidence from longitudinal studies of the menopausal transition that address the following questions: (1) Which symptoms do women report during the perimenopause, and how prevalent are these symptoms as women traverse the menopausal transition? (2) How severe are symptoms and for how long do they persist? (3) To what do women attribute their symptoms, and do their attributions match findings from epidemiologic studies of community-based populations? (4) How significant are these symptoms in women's lives? Data from published longitudinal studies were examined for evidence bearing on each of these questions. Only vasomotor symptoms, vaginal dryness, and sleep disturbance symptoms varied in prevalence significantly across menopausal transition stages and postmenopause in >1 population studied. A minority of women report severe symptoms. Given the limited follow-up data available, it is unclear how long symptoms persist after menopause. Women attribute their symptoms to a variety of biologic and psychosocial factors, and their attributions correspond well to those correlates identified in epidemiologic studies of community-based populations. The significance of symptoms for women's lives remains uncertain. The impact of symptoms during the perimenopause on well-being, role performance, adaptation to demands of daily living, and quality of life warrants additional study. The appraisal of the consequences of perimenopausal symptoms by women from different ethnic groups will be enhanced significantly as a result of the Study of Women's Health Across the Nation (SWAN) and other studies in progress.
Menopause signifies the permanent cessation of ovarian function and the end of a woman's reproductive potential. A universal experience in women's aging, it is the culmination of some 50 years of reproductive aging--a process that unfolds as a continuum from birth through ovarian senescence to the menopausal transition and the postmenopause. The menopausal transition is known to play a major role in the etiology of many symptoms common in middle age and may contribute to chronic conditions and disorders of aging such as osteoporosis and cardiovascular diseases. However, the mechanisms underlying ovarian senescence and the occurrence of various short- and long-term biological and psychological sequelae are poorly understood. Progress in researching reproductive aging and the menopause has been impeded by the lack of a staging system based on meaningful, reliable, and objective criteria for staging reproductive aging and specifying menopause-related status. Current nomenclature is described and its limitations are discussed. Specifically, contemporary terminology lacks the sensitivity and specificity needed to operationally define a woman's reproductive status in the continuum of reproductive aging. A number of proposed staging systems are currently being evaluated for their suitability in identifying appropriate demarcations across the span of reproductive aging. Further research and a better understanding of the menopausal transition are necessary to establish the validity, practicality, and acceptability of these proposed staging systems.
Menopause is a physiologic transition and is assuming an increasing importance as the demographic bulge moves through this phase. The transition takes place over several years. It is characterized by depletion of the ovarian follicles, decreasing inhibin leading to increases in follicle-stimulating hormone and loss of the menstrual cycle, accompanied by decreased estradiol production and typical symptoms. The role of hormone therapy in menopause has shifted from preventive use to a limited role in symptom management, for which it remains the most effective intervention. There is good evidence from observational and randomized trials of an increased risk of breast cancer in women on estrogen plus a progestin, compared with those on estrogen alone. There are insufficient data to be able to determine if there are clinically important differences between various progestins and progesterone with respect to breast cancer risk, nor between different regimens. Even relatively short-term exposure to unopposed estrogen will increase the risk of atypical endometrial hyperplasia or cancer; women who have their uterus should be using a progestational agent. Lifestyle changes at menopause are important and effective for preventive health. Recent evidence suggests that the discordance between epidemiologic studies with respect to cardiovascular outcomes and the Women's Health Initiative randomized controlled trial (WHI RCT) data might be attributable in large part to the older age of women enrolled in the WHI.