“I can’t believe how much more energy I have now” mentioned Kate in an email to me with a photo of her beaming smile from the Outer Hebrides in Scotland. “We’ve been hiking, swimming and kayaking for the past two weeks – it’s unbelievable how little energy I had in the past before doing your programme.”
In 1998, John Rowe and Robert Kahn, wrote a paper on ‘Successful Ageing’. This provided a summary of one of the very first studies on the health of older people in America. When the MacArthur Foundation Study of Aging in America began in 1987, I was a girl in my teens about to leave high-school and venture out into the world and go nursing. Kate in the image above, was venturing into a career in teaching in the UK. Neither of us knew what was in store for us as we moved into menopause and our own ageing. Nor did we realise how menopause would rob us of our energy and joint health and therefore, our ability to remain active.
Ageing research has really only gathered momentum over our lifetime – the last 50+ years. In their foundation study, Rowe and Kahn identified the maintenance of physical activity throughout life and maintenance of social, intellectual connectedness as the two most outstanding common features of the lifestyles of their subjects. These characteristics were more prominent than particular dietary patterns or the use of dietary supplements.
The thing is, this stance hasn’t changed today.
In women’s health and ageing research, the maintenance of physical activity throughout life as well as social connectedness form the pillars of ‘health’ as we age. ‘Healthy ageing’ therefore, is multi-dimensional but as I found in my own doctoral studies, there are numerous women positioning their ‘successful ageing’ in doing hours and hours of exercise each week. I talk about this in my online Masterclass on Menopause (it’s 2 hours long but you can pause me anytime – so read about it on my website when you can).
But how much exercise do we really need to do for our changing cardiovascular risk as we age? Have you thought about this – even if you are sedentary?
I had this exact discussion with a lady in her early 60s this week. She was fascinated to hear about this programme. “My cholesterol has just gone sky-high” she mentioned, “and even though I’m in my 60’s I still get hot flushes, but I’m doing all this exercise and training for events but it’s almost making my flushes worse. I haven’t lost a jot of weight, despite the training and exercise. It’s so disheartening.”
“But are you sleeping?” I asked. She looked at me enquiringly.
“If you are doing lots of exercise and not sleeping, then you have become like an over-trained athlete and your ancient female hormones are laying down fat around your belly, liver and heart, to protect you. That’s because we are built to survive. So, if you aren’t sleeping, then your circadian rhythm and thyroid will be all out of balance. Your hot flushes will get worse but more importantly, your cardiac risk changes. And with the changes to your muscles, including your cardiac muscle, you don’t recover as well as you used to. You are an ‘older woman’ but still training like an athlete – so you either have to focus on your recovery better if you like to compete, or find the exercise that better suits your changing heart, muscles and bone health as you age.”
I don’t know how many times I’ve had this conversation. It seems to be a conversation that is missing in women’s ageing and exercise education when it comes to understanding the powerful connection between our menopause transition and cardiovascular disease risk prevention. That’s why I’m heartened that new research from the American Heart Association (2020) is finally catching up with the powerful link between our menopause transition and changing cardiac health. I’ve mentioned it for years!
‘Over the past 20 years, longitudinal studies of women traversing menopause have contributed significantly to our understanding of the relationship between the menopause transition and cardiovascular disease (CVD) risk … the menopause transition offers a crictical window for implementing early intervention strategies to reduce CVD risk.’ [Khoudary, Aggarwai, Beckle et el, p. e1, 2020].
It’s about time this was bought to our attention and I’ve written about this in numerous blogs and talk about it in my Masterclass and in my programmes. And yes, your age that you go into natural menopause is deemed important by this new study. If you had an early puberty (under 11 years old) then you may enter menopause earlier than the average global age of 51.3 yrs). If you are underweight then your risk of entering early menopause increases too. Earlier onset of menopause (when periods have ceased) is also associated with increased cardio-vascular disease risk.
So, if you are an avid exerciser and thinner and you are in menopause, then please, keep an eye on your cardiac health. Talk to your Doctor about this and get your blood pressure checked regularly – especially if you aren’t sleeping. Whether you are overweight or underweight, not sleeping is another high marker of the changing risk for Cardio-vascular disease as you move through menopause as well. If you look on my blog page, you will find numerous articles about the connection between menopause and your worsening sleep.
I was reminded of this during the week. When I asked the lady I was talking to if she knew about what exercise to do for her heart health, she said that it had never been mentioned. Whilst I didn’t explain that we are at increased risk for fat accummulating around our heart as we move into post-menopause (this is called paricardial fat) and that this new study suggests that high oestrogen levels can influence this, including the oestradiol from HRT, I did have a conversation with her about the right amount of exercise to do for our changing heart health as we move through menopause. As I have found myself, not many exercise professionals understand that, like our muscles, our heart is changing in function and size as we age too.
Health and wellbeing in later life is not just about maintaining physical and mental health, but also about creating an environment that enables us to live our life to the full.
With the world going into a huge age shift, this is why the United Nations announced in 2020, that they were naming 2020 to 2030, the Decade of Healthy Ageing. And ageing starts in mid-life. For women this means our menopause transition and whist exercise matters as we age, the question is ‘how much?’ and ‘how hard?’ Thank to the studies that have emerged from the American Heart Association, we now know that there is a dose-response effect wth exercise and cardiovascular disease prevention.
Since 1980, the American College of Cardiology (ACC) and American Heart Association (AHA) have translated scientific evidence into clinical practice guidelines with recommendations to improve cardiovascular health. Fortunately, these guidelines now look at both men and women differently. This is important. We aren’t men and nor do we age the same way that males do. Observational studies have reported decreased numbers of Coronary Heart Disease (CHD) events in subjects who perform regular aerobic activity.
There is a dose-response relationship between CHD and aerobic physical activity, and even 1 hour of walking per week is associated with lower risk, but the ideal is 150 minutes of aerobic exercise as your starting point for improving heart health. Aerobic exercise helps your circulation and helps to dilate your blood vessels. All necessary factors in reducing blood pressure.
The right level of intensity can make a difference to your ageing blood vessels in post-menopause.
The American College of Sports Medicine (ACSM) reports that individuals should engage in 30 minutes or more of moderate-intensity physical activity on most (preferably all) days of the week.
As I explain in my 12 week Rebuild My Fitness programme, intensity reflects the rate of energy expenditure during such activity. In terms of ‘how hard to exercise’ then it depends on how much time you have.
Most of the literature supports exercising at a level whereby you are only just out of breath, as compared to completely out of breath. If you are working-out to exhaustion then this cannot be sustained for long.
But you want to sustain the activity for between 30-60 minutes, so this is when more vigorous activity with some rest intervals are often promoted in fitness classes. These are called HIIT – High Intensity Interval Training. But whilst huffing and puffing is good for us, you only need around 2 sessions a week of shorter, more vigorous HIIT sessions. I know many women who do more than this and then wonder why they feel exhausted all the time and don’t lose their weight.
Strength training also imparts additional cardiovascular benefits, but the literature also states 2 sessions a week is ‘enough’. Keep this in mind if you are doing lots of the barbell exercise classes each week.
Perhaps the most important exercise we can do each week, is to find ways to also move naturally, remain flexible and to find the levels of exercise that give us ‘pleasure’. Social Scientists, Cassandra Phoenix and Noreen Orr, suggest that exercising for pleasure is the forgotten dimension in women’s health and ageing (Phoenix & Orr, 2014). I would tend to agree. There is a lot of emphasis on performance and pain over pleasure with many exercise workout prescriptions, yet, it is well known in health behaviour and ageing research that we are more motivated to engage in activity when we enjoy it.
The other issue that is forgotten about is how tough it is for women to be active when their joints and muscles are sore. That’s why low impact exercise is best as well as increasng flexibility – this is now known to help reduce blood pressure as we age (Ko, Deprez et al, 2020). Stretching more, also helps our breathing and posture, as well as lowering the chronic stress hormone, cortisol.
Regular physical activity using large muscle groups, such as walking, running, or swimming, produces cardiovascular adaptations that increase our exercise capacity, endurance, and skeletal and heart muscle strength. Finding time to get back into exercise if you have let it go over the years is important for our health as we age. Habitual physical activity has been researched extensively and prevents the development of coronary artery disease (CAD) and reduces symptoms in patients with established cardiovascular disease.
There is also evidence that exercise reduces the risk of other chronic diseases, including type 2 diabetes, osteoporosis, obesity, depression, and cancer of the breast and colon (Thompson, Buchner, Pina et al, 2004). There’s little wonder that ‘Exercise is Medicine’.
However, as I reiterated to the lady I was talking to this week, my concern is that too much higher intensity activity is not necessarily a good thing for women in menopause if they aren’t sleeping. If you aren’t sleeping, then you aren’t recovering. As such, your heart disease risk increases with the accumulation of inflammation and like an over-trained athlete, you run the risk of worsening immune health.
American Heart Association (2004). Evidence-Based Guidelines for Cardiovascular Disease Prevention in Women. Arteriosclerosis, Thrombosis, and Vascular Biology, 24:e29–e50
Bowling, A., & Dieppe, P. (2005). What is successful ageing and who should define it?. BMJ (Clinical research ed.), 331(7531), 1548–1551.
El Khoudary, S., Aggarwai, A. et al. (2020). Menopause Transition and Cardiovascular Disease Risk: Implications for Timing of Early Prevention: AHA Scientific Statement. Circulation, 142, e1 – e27.
Ko J., Deprez D., Shaw K., Alcorn J., Hadjistavropoulos T., Tomczak C., Foulds H., & Chilibeck P. (2020). Stretching is Superior to Brisk Walking for Reducing Blood Pressure in People With High-Normal Blood Pressure or Stage I Hypertension. J Phys Act Health. Dec 18;18(1):21-28.
Moreau, K. L., & Hildreth, K. L. (2014). Vascular aging across the menopause transition in healthy women. Advances in vascular medicine, 2014, 204390. https://doi.org/10.1155/2014/204390.
Rowe J. & Kahn R. (1997). Successful Aging, The Gerontologist, 37, (4), 433–440.
Tanaka, H. (2019). Antiaging Effects of Aerobic Exercise on Systemic Arteries. Hypertension, 74: 237–243
Thompson, P., Buchner, D., Piña, I. et al (2003). Exercise and Physical Activity in the Prevention and Treatment of Atherosclerotic Cardiovascular Disease. Circulation, 107 (24), 3109-3116