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      Recent evidence exploring the associations between physical activity and menopausal symptoms in midlife women: perceived risks and possible health benefits

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          Abstract

          Although the health benefits of physical activity are well established, the prevalence of midlife women accumulating sufficient physical activity to meet current physical activity guidelines is strikingly low, as shown in United States (U.S.) based surveillance systems that utilize either (or both) participant-reported and device-based (i.e., accelerometers) measures of activity. For midlife women, these low prevalence estimates may be due, in part, to a general lack of time given more pressing work commitments and family obligations. Further, the benefits or “ reward” of allocating limited time to physical activity may be perceived, by some, as too distant for immediate action or attention. However, shifting the health promotion message from the long term benefits of physical activity to the more short-term, acute benefits may encourage midlife women to engage in more regular physical activity. In this article, we review the latest evidence (i.e., past 5 years) regarding the impact of physical activity on menopausal symptoms. Recent studies provide strong support for the absence of an effect of physical activity on vasomotor symptoms; evidence is still inconclusive regarding the role of physical activity on urogenital symptoms (vaginal dryness, urinary incontinence) and sleep, but consistently suggestive of a positive impact on mood and weight control. To further advance this field, we also propose additional considerations and future research directions.

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          Most cited references60

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          Increased visceral fat and decreased energy expenditure during the menopausal transition.

          This study assessed longitudinal changes in body composition, fat distribution and energy balance in perimenopausal women. We hypothesized that total fat and abdominal body fat would increase at menopause due to decreased energy expenditure (EE) and declining estrogen, respectively. Observational, longitudinal study with annual measurements for 4 years. Healthy women (103 Caucasian; 53 African-American), initially premenopausal. During follow-up, lack of menstruation for 1 year and follicle-stimulating hormone >30 mIU ml(-1) defined a subject as postmenopausal. Fat and lean mass (dual-energy X-ray absorptiometry), visceral (VAT) and subcutaneous abdominal fat (SAT) (computed tomography), dietary intake (4-day food record), serum sex hormones and physical activity (tri-axial accelerometry). Twenty-four hour EE was measured by whole-room calorimeter in a subset of 34 women at baseline and at year 4. Body fat and weight increased significantly over time only in those women who became postmenopausal by year 4 (n=51). All women gained SAT over time; however, only those who became postmenopausal had a significant increase in VAT. The postmenopausal group also exhibited a significant decrease in serum estradiol. Physical activity decreased significantly 2 years before menopause and remained low. Dietary energy, protein, carbohydrate and fiber intake were significantly higher 3-4 years before the onset of menopause compared with menopause onset. Twenty-four hour EE and sleeping EE decreased significantly with age; however, the decrease in sleeping EE was 1.5-fold greater in women who became postmenopausal compared with premenopausal controls (-7.9 vs -5.3%). Fat oxidation decreased by 32% in women who became postmenopausal (P<0.05), but did not change in those who remained premenopausal. Middle-aged women gained SAT with age, whereas menopause per se was associated with an increase in total body fat and VAT. Menopause onset is associated with decreased EE and fat oxidation that can predispose to obesity if lifestyle changes are not made.
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            Effects of exercise on sleep.

            Historically, perhaps no daytime behavior has been more closely associated with better sleep than exercise. The assumption that exercise promotes sleep has also been central to various hypotheses about the functions of sleep. Hypotheses that sleep serves an energy conservation function, a body tissue restitution function, or a temperature down-regulation function all have predicted a uniquely potent effect of exercise on sleep because no other stimulus elicits greater depletion of energy stores, tissue breakdown, or elevation of body temperature, respectively. Exercise offers a potentially attractive alternative or adjuvant treatment for insomnia. Sleeping pills have a number of adverse side effects and are not recommended for long-term use, partly on the basis of a significant epidemiologic association of chronic hypnotic use with mortality. Other behavioral/cognitive treatments are more effective for chronic insomnia treatment, but difficult and costly to deliver. By contrast, exercise could be a healthy, safe, inexpensive, and simple means of improving sleep.
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              Changes in body composition in women over six years at midlife: ovarian and chronological aging.

              Understanding the menopause association with body weight is important because excess weight increases risk for stroke, incident cardiovascular disease, cardiovascular mortality, and all-cause mortality among the middle-aged. The objective of this study was to examine chronological age and ovarian age and consider how these could influence body size and composition in midlife women. The Study of Women's Health Across the Nation is a longitudinal, community-based study. This report uses data from the Michigan Study of Women's Health Across the Nation site. Participants were 543 premenopausal or early perimenopausal African-American and Caucasian women aged 42-52 yr at baseline examination. Waist circumference, fat mass and skeletal muscle mass, from bioelectrical impedance, were assessed in seven annual serial measures. Annual FSH values were assayed by ELISA. The final menstrual period was defined retrospectively after 12 months of amenorrhea. There was an absolute cumulative 6-yr increase in fat mass of 3.4 kg and a 6-yr decrease in skeletal muscle mass of approximately 0.23 kg. There was an absolute cumulative 6-yr increase of approximately 5.7 cm in waist circumference. The (log)FSH change was positively correlated with (log)(fat mass) change. Waist circumference increased over the time period, but 1 yr after final menstrual period, the rate of increase slowed. Fat mass continued to increase with no change in rate. Both time (chronological aging) and ovarian aging contributed to substantial changes in body composition (fat and skeletal muscle mass) and waist circumference. These changes have important ramifications for establishing a metabolic environment that can be healthy or unhealthy.
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                Author and article information

                Contributors
                +512-391-2525 , Kelley.P.Gabriel@uth.tmc.edu
                Journal
                Womens Midlife Health
                Womens Midlife Health
                Women's Midlife Health
                BioMed Central (London )
                2054-2690
                11 August 2015
                11 August 2015
                2015
                : 1
                : 1
                Affiliations
                [1 ]GRID grid.468222.8, Division of Epidemiology, Human Genetics and Environmental Sciences, , University of Texas Health Science Center at Houston: School of Public Health -- Austin Regional Campus, ; Austin, TX USA
                [2 ]School of Public Health, Austin Regional Campus, 1616 Guadalupe Street, Suite 6.300, Austin, TX 78701 USA
                [3 ]GRID grid.267308.8, ISNI 0000000092062401, Michael & Susan Dell Center for Healthy Living; University of Texas Health Science Center in Houston, ; Houston, TX USA
                [4 ]GRID grid.280062.e, ISNI 0000000099577758, Division of Research, , Kaiser Permanente Northern California, ; Oakland, CA 94612 USA
                Article
                4
                10.1186/s40695-015-0004-9
                6214216
                30766688
                cabc413a-a8c5-4cf8-8752-cda1261f5699
                © Pettee Gabriel et al. 2015

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 16 April 2015
                : 22 June 2015
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100000880, Michael and Susan Dell Foundation;
                Award ID: ᅟ
                Award Recipient :
                Categories
                Review
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                © The Author(s) 2015

                physical activity,menopause,midlife,women
                physical activity, menopause, midlife, women

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