Back in 1998, American Gerontologist, John Rowe and Academic, Robert Kahn, wrote a paper called ‘Successful Ageing’. I remember reading it one day during my studies. Sitting in the University library feeling overweight, exhausted and probably, at the time, rubbing my knees, nothing about my ageing felt ‘successful’ at all.
However the paper, gave me hope. It provided a summary of one of the very first studies on the health of older people in America, looking at dimensions of ‘successful’ ageing. Whilst criticisms of it’s narrowed perspective ultimately arrived in academic circles, it served to open the door to better understanding of how people age-well. In women’s health and ageing research, the maintenance of physical activity throughout life is important. But not necessarily the type and amount that some women are led to believe is ‘good for them’.
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.
Sharon in the photo below, would also have been starting her career. 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 medications and supplements which seem to dominant menopause symptom relief these days.
In women’s health and ageing research, the maintenance of physical activity throughout life as well as social connectedness form some of the pillars of ‘health’ as we age. ‘Healthy ageing’ therefore, is multi-dimensional and from my studies, I learnt that there are around 7 determinants of healthy ageing for women as they age.
However, as I discovered 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 recently. “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 you are in menopause or post-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.
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 also 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. However, what fascinates me, is that studies on menopausal and post-menopausal Hadza tribal women show that there is very little heart disease and they are known to walk for around 6-8km daily foraging for food as they walk. A great goal for all of us.
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’ is there?
The month of July is the mid-year MyMT™ POST-MENOPAUSE Transform Me weight loss sale
For the first time ever I have a promotion aimed at women in post menopause. As part of my focus on the last of the Baby-boomer generation and the first of the Gen-X women, I’ve also added in FREE BONUS MODULES on women’s heart health, gut health and joint health. If we don’t get these areas sorted in our post-menopause years, then it may make our ageing a bit tougher.
Heart health continues to be the number one health concern for women as they age. If you have changing blood pressure, cholesterol, sore joints or you just can’t sleep and are putting on weight, then I hope you can join me, so look out for my emails over the next month if you are on my database and in your post-menopause years.z
American Heart Association (AHA), Khoudary et al., (2020). Menopause Transition and Cardiovascular Disease Risk: Implications for Timing of Early Prevention
A Scientific Statement From the American Heart Association. Circulation. 142:e506–e532
Bowling, A., & Dieppe, P. (2005). What is successful ageing and who should define it?. BMJ (Clinical research ed.), 331(7531), 1548–1551.
Phoenix C. & Orr, N. (2014). Pleasure: a forgotten dimension of physical activity in older age. Soc Sci Med. 115:94-102. doi: 10.1016/j.socscimed.2014.06.013. Epub 2014 Jun 11.
Pontzer H, Raichlen DA, Wood BM, Emery Thompson M, Racette SB, Mabulla AZ, Marlowe FW. (2015). Energy expenditure and activity among Hadza hunter-gatherers. Am J Hum Biol. 27(5):628-37. doi: 10.1002/ajhb.22711.
Santos-Parker JR, LaRocca TJ, Seals DR. (2014). Aerobic exercise and other healthy lifestyle factors that influence vascular aging. Adv Physiol Educ. 38(4):296-307. doi: 10.1152/advan.00088.2014.
Sinatra, S. (2011). The Sinatra Solution: Metabolic cardiology. Laguna Beach, California: Basic Health Publ.
Tanaka H. (2019). Antiaging Effects of Aerobic Exercise on Systemic Arteries. Hypertension. AHA 11913179.