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 and it becomes even more important during the menopause transition.
This is because the decline in oestrogen levels during menopause is associated with the loss of muscle mass and function, accelerating a muscle-wasting condition known as ‘sarcopenia’. (Cho et al, 2022).
But the other muscle that we tend to forget about with the decline in oestrogen, is the heart muscle. Research is consistent in reporting that the increased cardiovascular risk in menopause stems from the effects of changing physiology on the cardiovascular system due to ageing. [Tanaka, 2019].
These effects include the ‘stiffening’ of the cardiac and peripheral blood vessels, a condition called ‘vascular ageing’. [Nair et al, 2021]. This vascular or arterial stiffness is known to increase both blood pressure and cholesterol in women as they move through menopause. [Tamariz-Ellemann et al., 2022].
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 for women is multi-dimensional with around 7 determinants affecting women’s health as they age, including exercise.
But it’s not just any exercise.
The image below looks a little bit complicated doesn’t it? But it just shows that aerobic endurance exercise has the most beneficial effect on both heart and blood vessel health. (Tucker et al. 2022)
Furthermore, other newer research suggests that there is a catch for ageing women in that, when it comes to improving vascular (blood vessel) health and reducing the risk of coronary heart disease through exercise, then we need to be doing the type of exercise that mimics oestrogen’s protective role on the blood vessel network. (Tamariz-Elleman et al, 2022)
This type of exercise includes steady-state aerobic exercise as well as moderate resistance training with only one or at the most two, more vigorous workouts a week.
These types of exercise confer heart-health and skeletal muscle benefits to women including:
- improved dilation of the blood vessels.
- improved mitochondrial dynamics where energy is produced.
- improved capillarization (growth of capillaries) in skeletal muscle.
- activation of oestrogen receptors in muscles thereby supporting capillary growth which in turn improves oxygen delivery to muscles.
- reduction in arterial blood pressure and menopause-related hypertension in as little as 2-3 months.
- reduction in blood clot formation (thrombosis).
- improved platelet function to prevent clots.
Are your clients doing enough exercise, or are they doing too much?
The amount of exercise that women do as they transition through menopause matters. Some of your clients may feel too tired, or their joints are sore or they have no time nor motivation, so they’ve given up on it. Yes, I’ve been there too.
However, some of them may be doing too much, especially more vigorous exercise which is leaving them exhausted. With such an emphasis on heavy weight training for bone health as well as Cross-fit type workouts, it’s important to reflect on whether they are recovering from these workouts.
With the world going into a huge age shift, the United Nations announced in 2020, that they were naming 2020 to 2030, the Decade of Healthy Ageing.
For women, ageing starts in mid-life menopause and this is the period in our lives, when we have to be focused on our cardiac health and blood pressure management. Hence, understanding how much exercise confers cardiac health and vascular benefits is crucial.
That’s why I’m heartened that 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 critical window for implementing early intervention strategies to reduce CVD risk.‘ [Khoudary, Aggarwai, Beckle et el, p. e1, 2020].
Thanks to some of the studies that have emerged from the American Heart Association, we now know that there is a dose-response effect between 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 150-200 minutes of aerobic exercise per week. This is your starting point for improving heart health.
Aerobic exercise improves circulation and helps to dilate blood vessels – as Menopause HRT can achieve these benefits too, for your clients who cannot or don’t want to take hormone treatments, then don’t you think it’s important to think about their exercise too?
The right level of intensity can also make a difference to their 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. I outline these guidelines in the Menopause Weight Loss Coach Continuing Professional Development Course.
And yes, we can make a difference to our cardiac health and reduce the rate of vascular stiffness with the right amount and type of regular exercise.
It was during my doctoral studies that I became aware of the research by the UK’s Dr Kate Fitzpatrick, who studied the Hadza tribal women. There is very little heart disease in this population and they are known to walk for around 6-8km daily foraging for food. This is a great goal for all of our clients.
And no, I haven’t forgotten our muscles and the prevention of sarcopenia.
Strength training also imparts additional cardiovascular benefits, but the literature also states 2 sessions a week of moderate-intensity is ‘enough’.
Keep this in mind if your clients are doing lots of the barbell exercise classes each week and find that they aren’t recovering from these. Heavy weight training without sleeping well can lead to even more inflammatory changes in muscles and bones.
However, perhaps the most important exercise we can do each week, is to find ways to move naturally, remain flexible and to find the types and 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 increasing 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.
Therefore, helping your clients find and make time to get back into exercise is important. 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 aerobic exercise especially, 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). It’s little wonder that ‘Exercise is Medicine’ is there?
Heart health continues to be the number one health concern for women as they age. This is why I have such a focus on this in my Menopause Weight Loss Coach Professional Development Course.
If your clients have changing blood pressure, cholesterol, sore joints or aren’t sleeping and are putting on weight, then I hope you can join me sometime. Ignoring these issues impacts their ability to exercise and if they don’t get these issues sorted, then it may make their post-menopause ageing years tougher.
References:
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.
Chen Peng, Li Bo, Ou-Yang Ling. Role of estrogen receptors in health and disease. Frontiers in Endocrinology, 13, 2022.
Cho EJ, Choi Y, Jung SJ, Kwak HB. Role of exercise in estrogen deficiency-induced sarcopenia. J Exerc Rehabil. 2022 Feb 24;18(1):2-9.
Enmark E, Gustafsson JA. Oestrogen receptors – an overview. J Intern Med. 1999 Aug;246(2):133-8.
Kawecka-Jaszcz K, Czarnecka D, Olszanecka A, Rajzer M, Jankowski P. The effect of hormone replacement therapy on arterial blood pressure and vascular compliance in postmenopausal women with arterial hypertension. J Hum Hypertens. 2002 Jul;16(7):509-16. doi: 10.1038/sj.jhh.1001431.
Nair AR, Pillai AJ, Nair N. Cardiovascular Changes in Menopause. Curr Cardiol Rev. 2021;17(4):e230421187681. doi: 10.2174/1573403X16666201106141811.
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.
Tamariz-Ellemann A, Wickham KA, Nørregaard LB, Gliemann L, Hellsten Y. The time is now: Regular exercise maintains vascular health in ageing women. J Physiol. 2022 Oct 27.
Tanaka H. (2019). Antiaging Effects of Aerobic Exercise on Systemic Arteries. Hypertension. AHA 11913179.
Tucker, W., Fegers-Wustrow, I., Halle, M. et al. (2022). Exercise for Primary and Secondary Prevention of Cardiovascular Disease: JACC Focus Seminar 1/4,
Journal of the American College of Cardiology, 80 (11), 1091-1106.
ISSN 0735-1097, https://doi.org/10.1016/j.jacc.2022.07.004.
