What do you tell women about the importance of exercise as they age?
I have two truths that I always tell them. The first is that any exercise is better than nothing. So, stay active. Whether you’re doing intentional exercise or you’re just going out to garden, just moving is good for our bodies. The second truth is that it’s never too late to start. With menopause specifically, it’s a life event, a window of time in our developmental process of aging. So, it’s really important for women to consider engaging in physical activity and hopefully also some purposeful exercise.
What does some of the research show?
The studies in animals are intriguing. If you put rodents in cages that have a running wheel, the animals are extremely active. They might run three, four, six miles a day. In female rodents, if you remove their ovaries, their willingness to move – the amount of time they spend in their running wheel – goes down. It doesn’t go down by just 5, 10 or 15%. It goes down by 50, 60, 70%. Their desire to move just plummets. But if you give them estrogen, they are right back in their running wheel. So, what that tells us is that estrogen is an important biological regulator of spontaneous activity. The same thing is observed in male rodents when their testes are removed.
In human models, where we can lower estrogen of premenopausal women to postmenopausal levels, we see a similar phenomenon. When we suppress ovarian activity, the activity levels in women tend to go down. But when we give the estrogen back, these women tend to maintain higher physical activity levels. So that’s one of the factors we believe contributes to the increased propensity to gain weight with menopause.
That’s why I say that any physical activity is good – maybe exercising with a friend, just meeting for a walk or going to the gym to lift some weights. It’s worthwhile to schedule it into your day to make sure you attend to keeping your physical activity levels up.
With the losses in bone density and muscle mass, what are the benefits of incorporating weight training, or resistance training, into your exercise regimen?
I don’t think it’s appreciated in the medical or scientific communities that menopause accelerates the rate of muscle loss. We know it accelerates bone loss, but in our studies, we show that there’s also an accelerated loss of lean mass. We don’t really have a disease that’s associated with the loss of skeletal muscle – like the loss of bone is associated with the risk for osteoporosis – but muscle mass and strength are very important for maintaining functional independence with aging.
So, menopause and perimenopause are times where we should be paying attention to preserving, if not increasing, muscle mass and muscle function. Muscles are attached to bone. One way to make sure you’re helping your bone health is by working on your muscle health.
In women, as they age, because of the loss of muscle mass and strength, sometimes their independence is jeopardized much sooner than it should be. Just the ability to stand up from a chair, or to get up off the floor, is difficult. Doing practical types of resistance exercise, using your own body weight, can be of benefit. Also, going to the gym and pumping some iron is a good way to help preserve muscle mass.
Do you have any suggestions on how women can best recover from exercise?
Listen to your body, basically. You don’t want to do the same thing day in and day out. We know that with increasing age, we can still adapt to the stress of exercise and to other stresses, but it takes us longer to adapt, which means we have to build in some recovery time.
When I started my science career 40 years ago, it was believed that one of the things we lost with aging was the ability to adapt to exercise. It was largely believed that after you got to 60, exercise didn’t really pay off. But that was because the studies back then didn’t push hard enough. They treated older adults with kid gloves.
When we do push people – and you can do this safely – the body can adapt. We can become stronger. We can increase our cardiovascular fitness with appropriate exercise intervention.
What do you notice about the ways women change their exercise habits as they age?
I don’t know that there’s much research on this, but as an observation, the older we become, the less we engage in certain things. We tend to become very uni-directional. We walk. We walk in one direction, and we stop doing things that cause us to twist or step sideways or backwards. It’s really important to do a variety of activities as we get older.
I encourage people to get engaged in lifetime activities – whether it’s tennis or pickleball or golf. Things that make you move in different ways and use different muscles.
Are there ways women can alleviate symptoms of depression, or mood shifts, by exercising?
This is another area where we don’t really know why, but there are observational studies that show exercise improves mental health and cognitive function, specifically. Different people will experience different mental and cognitive benefits from exercise. But in general, physical exercise is also a mental exercise. Your brain is engaged when you’re doing these things. So, improving your physical health can also improve your mental health.
How should women be thinking about adjusting their diet in conjunction with exercise?
When you’re just sitting or sleeping, there are bodily processes that still require energy – this is known as resting metabolic rate. What we see is the amount of energy that you burn when you’re just at rest decreases when we suppress ovarian function, and it decreases by roughly an equivalent of 50 calories a day of energy. Now, that doesn’t seem like much, but if you had that decrease in your metabolic rate and didn’t make any other changes, you didn’t eat less or exercise more, that disruption in energy balance would equate to gaining a pound of fat about every three months.
About 15 years ago, there was a cohort study that tracked about 100 women as they went through the menopause transition. It was one of the few prospective observational studies that actually measured physical activity. Instead of just asking people how active they were – we all tend to over-report that – they had them wear activity monitors for a week out of every year. They showed that over about three or four years of that early menopause transition, measured physical activity levels decreased by about 50%. They also gave them a questionnaire about how much they were eating. This showed that the women had decreased how much they were eating by almost a third, and they were still gaining weight.
So, attention to your behaviors, both how much you’re moving and how much you’re eating, is really important during the menopause transition. Some women can sail through menopause, never gain an ounce, much less 10 pounds, and feel great. We don’t understand why some women experience some symptoms, or why some are at greater risk for gaining weight. But I don’t think that’s unexpected, given that the symptoms of fluctuating hormone levels in perimenopausal women are also variable.
Do you recommend women engage a personal trainer as they move into midlife, or are there simple ways they can perform regular exercise at home?
Well, again, anything is better than nothing, and it’s never too late to start. Those are the two key things. But not everybody can afford a personal trainer. If you can, it’s a great way to have accountability. I think in terms of what best to look for – whether it be a trainer or online classes – it’s whatever you are going to do that’s best for you. If you hate bicycling, don’t plan to ride a bike. Find something you like.
If you want to follow the recommended guidelines, you should get at least 150 minutes a week of cardio-type or aerobic-type of exercise at moderate intensity. If you do very vigorous activity, you probably get the benefit with about 75 minutes a week of activity. And then the other recommendation is at least two days a week of resistance-type exercises.
