Menopause and Exercise: Linking Pathophysiology to Effects | Insight Medical Publishing
Metabolic bone diseases; Muscle strength; Sarcopenia; Body mass index Thus , the present study had the objective to identify the relationship among BMD. body composition with age were examined in white women to determine the relationship ofbody cell mass to menopause and of body fat to bone mass. There. Decreased lean body mass and muscle loss by decreased muscle protein . correlation between follicle stimulating hormone (FSH) and bone resorption has.
Vagal tone increases as a response to aerobic exercise training [ 77 ]. With exercise training, hour urinary norepinephrine decreases, possibly due to increased vagal tone [ 24 ].
The influence of stress hormones such as cortisol and catecholamines that could precipitate hot flushes may be counteracted by parasympathetic activation during exercise training [ 24 ].
Higher endorphin levels decrease the frequency and amplitude of LH levels and regulate gonadotropin-releasing hormone GnRH levels [ 31 ]. Such effects are postulated to stabilize the thermoregulatory centre and reduce the incidence of VMS [ 2431 ]. In women who exercise regularly, the habituation to increased heat and sweating, feeling good and the distraction provided by exercise may contribute to less reporting of hot flushes [ 24 ].
As high body mass index [ 78 ], and increased adipose tissue may exacerbate VMS by possibly increasing insulation and reducing heat dissipation [ 19 ], exercise, by decreasing adipose tissue and body mass index could improve VMS [ 31 ]. Osteoporosis Exercise has the potential to improve bone mass and reduce the fracture risk in postmenopausal women.
The positive effects of exercise regimens vary widely although physical activity of any type improves bone health [ 79 ]. High-impact loading, low repetition exercises are favored to low-impact loading, high repetition exercises [ 80 ]. As peak load is the most important factor affecting bone mineral density BMD [ 82 ], resistance training exercises are the best to improve or maintain bone mass.
Resistance training programs, regardless of intensity and frequency, are effective in improving BMD of proximal femur and lumbar spine, although not effective in improving the total body BMD [ 83 ]. A Cochrane review of 43 RCTs has shown that lower limb resistance training exercises are the most effective type to improve BMD of the neck of femur, confirming that benefits are site-specific [ 84 ].
Aerobic exercises, especially walking, appear to be the most common and preferred exercise in older adults, but they have limited potential in improving bone mass as they provide minimal loading on the skeleton. A review of 12 trials of aerobic training concluded that aerobic exercises retard bone loss without significant improvements of BMD [ 80 ]. A significant reduction in biochemical markers of bone resorption was observed following 60 minutes of brisk walking, which supports this finding [ 85 ].
Muscle contractions during exercise increase mechanical stresses on bone which in turn enhance the fluid shear forces which are translated into biochemical signals that induce osteogenesis.
Combining aerobic exercises such as walking with high impact exercises such as jogging or stepping are therefore recommended to optimize benefits. Whole body vibration WBV exercise is an alternative for older postmenopausal women, intolerant to other forms of exercise.
Acute vibration stimuli transmitted to bone and muscle produce an osteogenic response by changing the flow of bone fluid through direct bone stimulation or indirectly through neuromuscular activation, increasing bone mass and strength. Most studies have shown that WBV is effective in increasing or preventing a decline in BMD [ 80 ], except for a few studies reviewed by Cheung and Giangregorio demonstrating no benefit [ 81 ].
Conclusions Most health problems in women after midlife are linked to the declining estrogen levels, contributed to by physical inactivity, dietary deficiencies, and other changes associated with ageing. These lead to adverse outcomes such as release of inflammatory mediators, enhanced vascular reactivity, endothelial proliferation, narrowed thermoneutral zone of hypothalamus, fat redistribution, visceral adiposity, sarcopenia, increased CVD risk and accelerated bone loss, contributing to health problems in postmenopausal women.
Physical activity and exercise training are beneficial in postmenopausal women as they exert positive influences on the pathophysiology of menopause-related health problems, especially body composition changes, increased CVD risk and osteoporosis. The benefits occur through diverse mechanisms, e. An exception is VMS, which is unique to menopausal transition. Exercise appears to have no consistent benefit in alleviating VMS, but VMS is self-limiting and is not associated with serious health consequences.
The optimal type of exercise for each condition varies. Resistance training preferentially increases muscle and bone mass, promotes strength development and improves functional capacity, whereas aerobic exercise is more beneficial for the reduction of CVD risk.Menopause and Arthritis - Joint Pain Caused by Menopause
Thus postmenopausal women should be encouraged to participate in multicomponent exercises combining aerobic exercise and resistance training. Table 1 shows the characteristics of the sample. Table 2 shows these results. Discussion Highlight the mechanisms that predispose older postmenopausal women at risk of fractures may corroborate to create more efficient preventive strategies to prevent this.
Although, aging is one of the most important risk factors for osteoporosis, recent studies have demonstrated that the most fractures in postmenopausal women occur in subjects with normal BMD or osteopenia [ 166 ]. With respect of this, the present study evaluated the relationship between BMD, anthropometric characteristics, years of postmenopausal, strength, muscle mass and the performance on functional tests in up 10 years postmenopausal women.
The osteoporosis is a multi-factorial bone diseases and it is controversial in the literature what are the anthropometric and physical characteristics that most influence BMD [ 1017 ].
Relationship of menopause to skeletal and muscle mass.
The mechanical load may lead to bone strengthening with mobility-induced weight-bearing stress [ 3 ]. Thus, our results are in accordance to previous studies that demonstrated that weight loss may increase the bone turnover, suggesting that body weight enhances the differentiation of osteoblasts and increase osteoblastic bone formation besides attenuates osteoclastic activity [ 13141518 ]. Previous studies suggested that low weight or BMI might be an important risk factor for lower BMD [ 2410161719 ], pelvis and femur fractures [ 6 ] and the correlation is stronger over time for nonhispanic whites [ 18 ].
In this context, the femoral neck BMD varies each 0.
Menopause and Exercise: Linking Pathophysiology to Effects
In addition, previous studies suggested that fat mass is associated with whole body BMD in older women, independent of lean mass [ 15 ]. The relationship between body composition and endocrine control is related to the production of peripheral gonadal hormones by adipose tissue. With respect to this, in obese subjects this hormonal changes may affect bone turnover and BMD, protecting the adverse effects of estrogen deficiency after menopause [ 31014 ] and attenuating the bone loss.
The leptins, the adipokine most studied in relation to bone, increase proliferation and differentiation of osteoblasts and they also regulate osteoclast development. Additionally, the secretion of boneactive pancreatic beta cell hormones like insulin, indirectly, amylin and preptin also seems more prevalent in obesity and they are direct stimulators to osteoblast growth and inhibiting osteoclastic bone resorption [ 1021 ].
Other authors suggest that the weight body is significantly correlated with skeletal muscle mass because heavier subjects require greater muscle mass for movement and would be expected to have more muscle [ 919 ]. Consistent with the statement that lower strength or low muscle mass or RSMI may induce a lower contraction and mechanical stress on bone, a lower osteogenic stimulus in osteocytes resulting in a lower BMD development and possible higher risk of osteoporotic fracture in elderly people [ 461322 - 24 ].
In addition previous observational data suggested that increasing lean mass could constitute a preventive measure against bone loss and possibly musculoskeletal aging [ 213 ]. Additionally it is unclear which measure should be used to sarcopenia [ 722 ], associated to the fact that decrease of muscle mass by itself seems an inconsistent predictor of mobility limitation [ 7 ] or functional ability [ 25 ]. The present study did not find correlation between physical performance and RMSI.
Consistent with some authors, modest reductions in skeletal muscle mass with aging do not cause functional impairment and disability [ 26 ], however others have demonstrated the clinical risk factors as a indicate of low BMD and fracture [ 27 ].
Regarding TUG test, the results are similar to those expected for the same age [ 12 ]. These functional performance results may be explained by the fact that the evaluated women did not present sarcopenia. Our sample did not meet the muscle mass criteria below 5. Previous studies supported the idea that intervention strategies designed to preserve muscle mass should be initiated by the fifth decade of life, because although the prevalence of sarcopenia increased from the third to sixth decades of life, it remained relatively constant thereafter [ 29 ].
Our data corroborate the studies about the effect of weight and BMI on BMD, however it is important to emphasize that higher BMI is significantly associated with a number of comorbidities, including asthma, emphysema, diabetes, reduced physical activity, co-medications, increased risk of falls, higher morbidity and economic costs associated with fractures because of a greater risk of non-union, postoperative complications, comorbidities, and slower rehabilitation [ 32432 ,].
Furthermore, the BMI and hip fracture seems to have nonlinear correlation. Although the lower BMI is a higher risk factor for fracture, the higher BMI not seems a higher protect factor comparing with normal BMI, thus obesity should not be a protective factor for hip fracture risk [ 33 ]. Additionally, the increased prevalence of overweight in older US women appears unlikely to be accompanied by a significant reduction in osteoporosis prevalence [ 26 ] suggesting that protective factors to avoid BMD decrease should be further studied and recommendations on the benefits of BMI should be cautious for post-menopausal women.
Finally, the screening and prevention of bone loss and a specific orientation about weight body in younger postmenopausal women may be an effective way to prevent or delay fractures in postmenopausal women.
Although the menopause occurs around 50 years old and the rate of BMD loss accelerates in the peri-menopause and in the first yeas after menopause [ 10 ], the women before 60 or 65 years old do not meet current national guidelines for osteoporosis treatment [ 1034 - 38 ]. Understanding the influence of different body composition on BMD or on fractures, as well as the importance of increasing lean mass as a strategy for preventing bone loss seem relevant.