Physical activity can help women before, during menopause

Host Amber Smith: Upstate Medical University in Syracuse, New York, invites you to be The Informed Patient, with the podcast that features experts from Central New York's only academic medical center. I'm your host, Amber Smith.

In the time leading up to menopause, researchers have noted a decline in physical activity in women.

That's unfortunate, as my guest will discuss, because physical activity can help ease some of the symptoms of perimenopause. Exercise physiologist Carol Sames is an educator in Upstate's College of Health Professions, where she teaches future physical therapists and physician assistants.

Welcome back to "The Informed Patient," Dr. Sames.

Carol Sames, PhD: Thanks so much, Amber. It's a pleasure to be here.

Host Amber Smith: A paper published recently by researchers in Ireland in the journal BMC Women's Health explored how active women were during the menopause transition.

So can you explain how they set up their research?

Carol Sames, PhD: Yes, so this was a different type of research. This was called descriptive research. Most of us are familiar with research that looks at differences amongst groups or possibly looks for relationships or associations, but in descriptive research, it's really based on describing a population.

And so in this particular study, they interviewed women. There were 12 women who had agreed to participate, and they asked them questions such as, what type of factors help you to be active? Did you notice that there was a reduction in your activity when you hit this menopause transition? And so, it was multiple interviews, and they were able to get a lot of in-depth information.

Host Amber Smith: So even though it was only 12 participants, it's considered relevant?

Carol Sames, PhD: Well, what it is, is it's considered at least a baseline to have an understanding, clearly in a group of just 12 women. It doesn't mean that this will expand to all women, but at least it gives the investigators an idea of what barriers are, what maybe some facilitators to physical activity are, and then they can take that information and then begin the transition to possibly research that looks at relationships or differences.

Host Amber Smith: Well, let's talk about the findings. What did these 12 women identify as barriers to physical activity?

Carol Sames, PhD: So they basically had four categories or groups of barriers. The first was the lack of a supportive environment, and that included things like:

A gym environment can be intimidating, especially if you feel like maybe you've lost some fitness.

Gyms can be intimidating.

A lot of gym facilities tend to be male dominated.

That possibly gyms don't have activities that maybe these women would find interesting.

There wasn't any lack of very specific menopause programming.

That most of the instructors were men.

That the gyms were located too far from their home, and that was problematic.

And also that a lot of the gyms are going to have a membership (fee), and that could be prohibitive. That was one of the big areas.

Another area was just life, the business of life and how we have to juggle demands. So most of these women were working at least part-time. Most were full-time. Most of them had children and/or aging parents. So we've kind of heard of our generation being kind of the sandwich generation where there's both children to take care of and potentially parents to take care of, and there's only so much time in the day. So there were these competing demands. These women had mentioned that they tended to put their family needs in front of their own needs, and that they didn't prioritize time for themselves.

The third category was that the women just felt that in their midlife, they felt like they were just not as physically capable as they had been when they were younger. They felt that there were a lot of activities that they couldn't participate in anymore. And they were related more to high-intensity type of activities, such as running, such as activities that were just more intense.

They were concerned about the aging process and becoming injured. They also expressed that they were reluctant to try new types of physical activity. For the few women that were engaged in physical activity regularly, even in this menopause transition, they felt that their performance had declined, so they kind of lost like "activity confidence." They had self-doubt that what they were doing was going to be beneficial for them.

And then the other big area was that they were just concerned that there were symptoms that they were experiencing in this menopause transition that made it challenging to exercise. So, things like weight gain. Their body shape had changed. They just felt that they didn't have motivation. they had reduced energy. They were tired, they were fatigued.

They also weren't sleeping well because there can be changes in temperature regulation. You've probably heard of hot sweats, night sweats, and so that was making sleeping more challenging, which made them feel like they were in a brain fog, or they were tired in the morning. Also some things going on where they felt more joint pain, muscle pain, headaches, migraines, and so they became conflicted with saying, "How can physical activity help me when I have all of these negative experiences and symptoms?"

Host Amber Smith: Now, everything you just described, these women were Irish, in Ireland.

Carol Sames, PhD: Yes.

Host Amber Smith: But it sounds like you could have been describing American women as well.

Carol Sames, PhD: Yes. When we hit that perimenopause and then menopause transition to menopause, we're talking about hormonal changes, primarily estrogen and progesterone.

And that's going to affect us, regardless of where we're living and nationality, and they're kind of like the major symptoms that women will experience.

Host Amber Smith: Now the study examined factors that could make physical activity attractive to women. Can you explain what some of those factors were?

Carol Sames, PhD: Absolutely. The authors described these as facilitators, and so the one was this idea of a community, a group, a fraternity, that we are all experiencing this change in life. And it's easier when you have a group of individuals who are supportive. So really they were talking about other women, where they felt that they could be supported, they could talk about some of these symptoms.

They could talk about, "What what have you done. What has been your experience?" Just to have that, that group support, that empathy. And they also said that, if being engaged with other women who were going through similar experiences was helpful for developing a commitment to others. And so that commitment could be help to increase physical activity.

Host Amber Smith: Did it talk about any types of specific exercises that are better than others, maybe?

Carol Sames, PhD: They described the activities that they liked, but of course that's diverse. A lot of the women said they liked the idea of having a group of women, like group classes where other women were experiencing menopause symptoms, going through menopause. That it was probably best, if women were not active, to start with lower-intensity activities, of course, walking being one of the primary activities.

They said that some women might have to make modifications. They can't think, "Well, 20 years ago I was doing this, and now I'm still going to be able to do this." So this idea that I need to adapt. Maybe if they had access to a pool. A pool is "un-weighing." Water is un-weighing -- when water is chest high, you weigh about 50% to 70% of your body weight, like it's un-weighed -- and that could alleviate some of those heat symptoms and also those kind of aches and pains that women were describing.

Host Amber Smith: This is Upstate's "The Informed Patient" podcast. I'm your host, Amber Smith.

I'm talking with exercise physiologist Carol Sames from Upstate's College of Health Professions about the benefits of exercise in the time leading up to menopause.

What are the menopause symptoms that can be managed with physical activity, and what type of physical activity is best for each of those?

Carol Sames, PhD: So I'm going to start with: The physical activity guidelines are for everyone, whether we, for women, if they're perimenopausal or going through the menopause transition or post-menopausal. So the guidelines are 150 minutes per week of moderate-intensity activity, and that's activity where we can talk, we can carry on a conversation, or 75 minutes a week of more vigorous activity, where you're really not going to be able to carry on a conversation, or a combination of both. And resistance training, or strength training, two times a week.

And so when you look at the symptoms, physical activity can be beneficial for all the symptoms. So some of the primary concerns are, "I'm going to gain weight," "I'm going to have some changes in body shape."

We know that women tend to start to store a little bit more fat tissue in kind of the stomach/abdominal area. Well, activity can burn off calories. We can also work on strength training.

If you look at energy, tiredness, fatigue, we already know that physical activity can help to reduce those symptoms.

If you look at anxiety or depression, again, physical activity.

Brain fog and cognitive changes -- physical activity increased blood flow to the brain.

Sleep difficulties can also be helped with physical activity. However, I wouldn't want to do strenuous physical activity right before bedtime because that would most likely delay falling asleep.

Joint pain, aches and pains, increasing strength, working on range of motion.

I know one particular area that my physician never told me about was pelvic floor physical therapy because there is, some pelvic floor dysfunction that can occur. Also, if a woman has had children, you can run into, like, bladder dysfunction. And I certainly know I experienced some of those symptoms, and I wish I would've known that pelvic floor physical therapy exists because that certainly would've helped me.

Confidence: Nothing improves confidence like being with a group and starting to be active and starting to feel the changes, and I'm feeling stronger. I'm feeling better.

Headaches and migraines: Certainly, if I have a migraine, I'm probably not going to go out and be active. But in association with some women needing , medication, that can also reduce the occurrence.

So really when we talk about activity, it really can check off many of the symptoms that are associated with menopause and that menopause transition.

Host Amber Smith: Now some women take hormone replacement therapy. Does that have an impact on what they're able to do or what they should do?

Carol Sames, PhD: Hormone replacement therapy, of course, has been controversial, and I always say that it's really best to kind of talk to your health care provider, depending on what your particular family risk is and the severity of the symptoms.

Hormone replacement therapy can be very beneficial. The decision has to be made between the woman and her health care professional. But yes, when you talk to women who have started hormone replacement therapy, they will talk about some of these symptoms dissipating.

So, again, it's that check and balance.

Host Amber Smith: Some women were active when they were younger, and others have not done a lot of exercise in their lives. Are both likely to see benefits by becoming active?

Carol Sames, PhD: Absolutely. The body doesn't necessarily know whether I've been active for 40 years, or I haven't.

Because the nice thing about activity is you can start it at any age. Any body type. Certainly there could be specific health conditions that I might need to modify what I'm doing, but activity, if we look at the benefits that are associated with being active: anybody, any body type, any age.

Again, we might need to make some modifications, but, the American Medical Association has a whole area of research called Exercise Is Medicine, and it really is. The body was meant to move, and we need to move it. We just need to find the ways that work for us to move the body.

Host Amber Smith: Experts often suggest starting slow if you're beginning an exercise routine.

So what sorts of things do you suggest women start with if they don't have much of a background in being physically active?

Carol Sames, PhD: Just adding activity into their daily life. I think sometimes we get this idea that exercise has to be hard, and it has to be something that is going to make me sweat profusely, and I'm going to be sore the next day.

And that's not true. The body just needs to be moving. So it could be things like, if I'm taking my children to a practice, can I walk around while they're practicing? Is it possible? Can I, if it's possible, take stairs, can I park further away in a parking lot? It doesn't necessarily have to be something that is planned and scheduled.

Can I be active around my home? spring is coming. There's always outdoor activities and outdoor work that needs to be done. Are those the things that I can do? I don't need to go to a gym. You have a body. You can do strength training with a wall, a chair and your body. there are days when I just don't have time to go to the gym or go do something, and I will walk laps.

If the weather's really bad around my house, it may be somewhat boring, but I can do that. And then I'll do something like clean out a closet, and I get some strength training involved with that. So I think sometimes we think, "I need to have 30 minutes, and I don't have 30 minutes."

Do you have five minutes? Five minutes counts. It all adds up.

And I think the other thing is it's really important to do something that you at least somewhat enjoy. Why buy a stationary bike if you absolutely don't like to stationary bike? It's just going to be a waste of money.

So I think it's really important to say what works for you? What is the best time for you? Is it early in the morning, before possibly your responsibilities start, before you have to go to work, before there's children's activities? What do you like and where can it fit into your day? And I think again, it's really more about us understanding that the body needs to move, and there's all different ways we can move the body.

It doesn't have to be in a class. It doesn't have to be me driving somewhere. It can just be me moving.

Host Amber Smith: Well, Dr. Sames, thank you so much for making time to talk with us about this.

Carol Sames, PhD: Thank you. It was my pleasure.

Host Amber Smith: My guest has been exercise physiologist Carol Sames from Upstate's College of Health Professions.

"The Informed Patient" is a podcast covering health, science and medicine, brought to you by Upstate Medical University in Syracuse, New York, and produced by Jim Howe, with sound engineering by Bill Broeckel and graphic design by Dan Cameron.

Host Amber Smith: Find our archive of previous episodes at upstate.edu/informed.

If you enjoyed this episode, please invite a friend to listen. You can also rate and review "The Informed Patient" podcast on Spotify, Apple Podcasts, YouTube or wherever you tune in.

This is your host, Amber Smith, thanking you for listening.