Measles prevention; all about sarcoma; exercise for perimenopause: Upstate Medical University's HealthLink on Air for Sunday, May 4, 2025

Host Amber Smith: Coming up next on Upstate's "HealthLink on Air," an infectious disease doctor explains New York State's travel advisory regarding measles.

Elizabeth Asiago-Reddy, MD: ... The recommendation was specifically for areas of the United States where there is a current outbreak going on, and they left it open-ended, knowing that there would be the possibility of more than one location. ...

Host Amber Smith: A medical oncologist discusses sarcoma diagnosis and treatment.

Jade Homsi, MD: ... Receiving radiation therapy in the past could be a factor in developing sarcoma in the future. ...

Host Amber Smith: And an exercise physiologist talks about exercise to ease perimenopause symptoms.

Carol Sames, PhD: ... They were just concerned that there were symptoms that they were experiencing in this menopause transition that made it challenging to exercise. ...

Host Amber Smith: All that, and a visit from The Healing Muse, right after the news.

This is Upstate Medical University's "HealthLink on Air," your chance to explore health, science and medicine with the experts from Central New York's only academic medical center. I'm your host, Amber Smith.

On this week's show, a medical oncologist gives an overview of sarcoma. Then we'll learn how exercise can ease symptoms of perimenopause. But first, what you need to know about the threat of measles.

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air."

Because measles is such a contagious virus, it spreads and crosses borders easily. The New York State Department of Health recently issued a measles travel advisory, so I'm talking about that with Dr. Elizabeth Asiago-Reddy. She's chief of the division of infectious disease at Upstate.

Welcome back to "HealthLink on Air," Dr. Asiago-Reddy.

Elizabeth Asiago-Reddy, MD: Thank you for having me, Amber.

Host Amber Smith: This travel advisory is international and domestic. Do I understand correctly?

Elizabeth Asiago-Reddy, MD: Yes. It's because of the recent outbreaks within the U.S. that the domestic portion was added.

Host Amber Smith: So is it all states, or are there particular states to be careful about, and countries, too?

Elizabeth Asiago-Reddy, MD: The recommendation was specifically for areas of the United States where there is a current outbreak going on, and they left it open-ended, knowing that there would be the possibility of more than one location.

So we've been hearing about Texas. Internationally, the recommendation is very broad because we see outbreaks occurring periodically in various locations.

Host Amber Smith: Now, what are people recommended to do to make sure that they and their family members are protected against measles?

Elizabeth Asiago-Reddy, MD: So the first thing is understanding your vaccination history and the vaccination history of your family members, and going back to 1957. In that era, pre-1957, people are considered to be naturally immune because this is such a contagious virus. We did not have a vaccine available in that era, and so people were routinely infected with measles, so those individuals would be considered to be immune.

Then there are some periods where there's a gray zone, in between, the period from 1957 up until 1967, reason being that that's a time where vaccines were evolving. So there was some coverage, but not with the optimal vaccines. So individuals born in those time periods, it would be recommended, if you can access your vaccine records, to see what you have had, but there's a higher chance that you have not had an adequate vaccine.

And what we consider to be adequate vaccination is two doses of the modern ... in our country, it's the measles-mumps-rubella or measles-mumps-rubella-varicella vaccine. So you would want to check and see if you've had two doses. And then moving forward after 1967, increasing numbers of people have been adequately vaccinated all the way up until 1989, when definitively getting two doses was recommended.

So a lot of people were actually getting two doses. Like I myself, unfortunately, I have a distinct memory of getting vaccinated in kindergarten because I remember telling my parents that I didn't want to get vaccinated, and they told me I had to, but that was pre-1989. So many people were vaccinated in that era, but they may not have received that second dose.

So it's checking your vaccine history, and what the current travel recommendation says is that if you are unsure, or you know that you have not received two doses, that you would receive at least one dose at least three weeks prior to your travel, if you don't have time to get the two doses. So two doses should be separated by a month in between.

Host Amber Smith: Well, what do you do if you are unsure whether you were vaccinated as a baby, or you don't have your records? Would your pediatrician still have them? Or how would you find out?

Elizabeth Asiago-Reddy, MD: This is a challenge with us not having a national health care system, right, is that a lot of people do not have access to their records. So some people can rely, I think, adequately on their parents saying, "We absolutely got every vaccine that was recommended. You had regular pediatric care."

The surrogate that we often use, and this is used for school, it's used for employment, is a blood test looking at antibody levels to measles. And so there are certain antibody levels that are considered to be adequate.

However, if you're not sure, a booster vaccine is the best option, and a booster vaccine is actually more optimal compared with checking on levels, if you're not sure, because those antibody levels don't give you the full picture of your immune status. And a booster vaccine is actually going to give you a better chance at becoming fully immune.

Host Amber Smith: But if you were born before 1957, you're considered immune, correct?

Elizabeth Asiago-Reddy, MD: Yes.

Host Amber Smith: If you were born between '57 and '67, that 10-year period, you need to consider whether you're going to need to get at least a booster, correct?

Elizabeth Asiago-Reddy, MD: Yep, and a lot of my patients have approached me and are taking that approach of going ahead and revaccinating and getting a booster vaccination, if they were born during that period of time.

Host Amber Smith: Now you mentioned MMR, so it's bundled together with mumps and rubella. Does it matter? I mean, we're not being told that we need mumps or rubella, but that's not a problem to go ahead and get, since it's bundled in the same shot?

Elizabeth Asiago-Reddy, MD: Correct.

And it has been bundled in the same shot ever since the modern measles era. It's been bundled for quite a long time. So, yes, that's the way to go.

We don't typically manufacture measles vaccines on their own, but many countries in the world do, just because some other countries have a situation more similar to our past measles situation, where mumps and rubella are acquired during childhood pretty universally. And so they're not necessarily required to have vaccination because mumps and rubella, the complications are actually worse in adults than they are in children. So natural infection, if you're going to be exposed to those as a child, is OK, so you may find that a broad only-measles vaccine by itself is available. In our country, we do bundle them, and that's fine.

For younger children, like I said, they're oftentimes being bundled as well with the varicella vaccine. Varicella vaccinates against chickenpox.

Host Amber Smith: So where do you go for the vaccine?

Elizabeth Asiago-Reddy, MD: If you have a primary care provider, that is your best bet, but there are now, especially recently with these advisories going out, there are more commercial pharmacies that are offering it as well.

So now, locally, we have Kinney's, Walgreen's are offering it, and you can make an appointment online. The health department offers the vaccine in some limited settings. So they offer it for children; basically, if they don't have a proper insurance option or a place to get it, they will provide it. There's a sliding-scale fee associated with that. That's a pretty nominal fee.

And then they also will offer it to adults who require it for admission to school. So for example, if you're going to Syracuse University, you are required to have either documentation of immunity or through the blood test that I was mentioning or an actual vaccine. So if you're a student who's greater than 19 years old, and you don't have a location to get it, you could get it at the health department.

Host Amber Smith: This is Upstate's "HealthLink on Air," with your host, Amber Smith. I'm talking with Upstate's chief of infectious disease, Dr. Elizabeth Asiago-Reddy, about measles protection.

Who should not get an MMR vaccine?

Elizabeth Asiago-Reddy, MD: Very few people, fewer than what is often feared. The biggest one is people with severe immune compromise, and that's something that would need to be discussed with a physician provider because, what does that mean for somebody to be severely immune-compromised?

I think we became more aware of that during COVID, but still, that's something you'd want to discuss with your health care provider as to whether you are indeed severely immune-compromised. Pregnancy actually is a contraindication (reason to avoid) at this point for the MMR vaccine, again, unless there's a significant discussion that's happened with your health care provider in a limited set of circumstances.

And then the, other one would be severe allergy. So if you're known to have an allergy to any of the components of the vaccine, you got the vaccine, you had a severe allergic reaction as a child, for example, that would be another contraindication.

Host Amber Smith: Well, let me ask you also, can you get the shot if someone in your household is pregnant or severely immune-compromised?

Elizabeth Asiago-Reddy, MD: Yep.

Host Amber Smith: You can. OK, that's important to know as well. The vaccines are so effective for people who have been vaccinated, but there are, like we're talking about, a small number of people with medical conditions who could not be vaccinated.

So with so many cases of measles in different communities, what do those people do to stay safe? Do face masks work and hand washing?

Elizabeth Asiago-Reddy, MD: Yeah, I just want to say first that this is the main reason why we still have vaccine mandates in some locations. So New York state does have vaccine mandates. This was put back in place again after a significant outbreak in New York City. And this is because there are individuals who are unable to protect themselves, and so it becomes a matter of it being not fair to exclude those individuals from an environment where they could be exposed to someone else who does have the ability to get vaccinated.

And, it's important that vaccine rates reach 95% for it to be fully effective in protecting those individuals who are unable to be vaccinated. So really, the best protection for people who can't get a vaccine is that everyone around them is vaccinated. That's called herd immunity. So when you reach a certain point, you are diminishing the likelihood that somebody who is unable to be vaccinated or wouldn't respond to the vaccine, you're diminishing the likelihood that they would ever even come in contact with the virus.

Otherwise, measles has some similarities to COVID in that it's an aerosolized, airborne virus. So if you're going to try and prevent it by means other than vaccination, it really does require masking, isolation, optimally that would be masking isolation of the individual who's infected, right?

Masks, we know, do offer protection for the people who are not infected as well. And the level of protection is going to depend on the type of mask that you're wearing. Measles is a little bit different than COVID in that it is higher likelihood, we believe, of being transmitted through surface exposure as well.

So COVID, it looks like, really is very much primarily a respiratory virus, not so much one that you get by touching a surface and putting your hands to your mouth. Measles is both, so measles is all the above. It is really one of, if not the most, contagious virus known to humans. So you can get it by any of those means.

And so yes, you can, wash your hands, avoid contact with surfaces, wear a mask, but it can be difficult to avoid exposure due to the high level of contagiousness.

Host Amber Smith: So if people have already traveled, and now they're concerned about possible measles exposure, what are the symptoms to watch out for?

Elizabeth Asiago-Reddy, MD: Yes, measles has a couple of different stages that we refer to. The first one is the incubation period. Incubation means that the virus is inside somebody's body, it's replicating, but you actually don't have any symptoms, so you don't realize.

And that is about two weeks for measles, which is long and can make it difficult, right? Because two weeks after your vacation, you're on and about your life. You're not even thinking about your vacation anymore, probably, right? But it could be harboring inside of you.

Then we have the prodrome. So the prodrome is that phase where you have started to develop symptoms, but you don't yet have the classic rash, OK? So the symptoms could easily be confused with other types of illnesses, but there are some kind of classic features. And, in measles, it's considered to be the three C's, so that is cough, coryza and conjunctivitis. Cough, we know what that is. Coryza is a runny nose, just so that you can get it into the three C's, and then conjunctivitis is redness of the eye. So those three things together are kind of a classic part of that prodrome.

And that prodrome lasts for about three to five days before the rash appears. You may get a rash inside your mouth, which can show up actually before the generalized rash does, that consists of white spots inside the mouth. And then the generalized rash appears. And what we always learned in school when looking at the different types of rashes is that measles classically appears like somebody dumped a bucket of paint over the individual who was infected, so it tends to start from the face, going down.

Host Amber Smith: Are you contagious during incubation and all the way through?

Elizabeth Asiago-Reddy, MD: You're contagious about a day before the prodrome appears, so about four days or five days before the rash appears, and then for four days after the rash is present.

For people who are severely immune-compromised or who have ongoing symptoms, where normally about four days after the rash comes out, you expect your fevers to be going away. If the fever is continuing, the patient's not getting better, then we also worry that those individuals may continue to be contagious.

Host Amber Smith: Well, let's talk about the treatment for measles. Since the virus is so contagious, I'm assuming people who are infected need to be isolated. Is that right?

Elizabeth Asiago-Reddy, MD: Yes. Isolation is critical.

If they're in a hospital environment, they need to go into an airborne isolation room. That's the highest level of isolation in the hospital, typically, and then if they're at home, then what you would want is, ideally, the individual would self-isolate. If this is a child who requires a caregiver, then, ideally, that caregiver would be vaccinated. Otherwise, they would certainly be at extremely high risk of also contracting measles.

Host Amber Smith: Is there any medication or anything that you can give the person to help them get through measles?

Elizabeth Asiago-Reddy, MD: So vitamin A is the one that we've been hearing a lot about, as per the recommendations that have come out recently.

Vitamin A: It is especially important for young children, and especially young children living in environments where they actually may be deficient in vitamin A. The data are somewhat controversial. This is not a slam dunk. There have been some studies that have shown vitamin A to be efficacious in promoting recovery from measles, so not dying from measles in resource-limited settings in children less than 2 years of age. But not all studies have shown that. But those are really the people who are going to benefit the most from vitamin A.

Vitamin A for older children and adults, there's really very little evidence that it is particularly helpful. As long as it's given in a reasonable dose, it's unlikely to be harmful, but some people can take it to an extreme and give too much Vitamin A, which has its own sets of risks associated with it.

Aside from that, treatment for measles is largely supportive. So just like any febrile illness caused by a virus, it is "tincture of time" (letting it run its course), anti-fever agents like Tylenol, and then, after that, if the patient is extremely ill and hospitalized with pneumonia, there is an antiviral called Ribavirin, which can be used, but that would not be used outside of very severe cases.

Host Amber Smith: We've heard of children dying from measles during these outbreaks recently. Is it pneumonia that they die from? What makes measles become deadly?

Elizabeth Asiago-Reddy, MD: Yeah, it did appear from the available information about the two cases where children have died in Texas recently, that those children did die of pneumonia.

So the three major complications that you could see after a typical course of measles would be diarrhea, pneumonia and encephalitis, with pneumonia and encephalitis being the most likely to be deadly. And encephalitis is inflammation of the brain. So that would present more like confusion, headaches, that type of a picture.

Host Amber Smith: Well, this is really important information, and I thank you for making time to share it.

Elizabeth Asiago-Reddy, MD: Absolutely. Thank you for having me.

Host Amber Smith: My guest has been Dr. Elizabeth Asiago-Reddy, the chief of infectious disease at Upstate. I'm Amber Smith for Upstate's "HealthLink on Air."

Sarcomas are cancers that arise in bones, muscles, tendons and other connective tissue -- next, on Upstate's "HealthLink on Air."

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air."

Cancers that arise in bones, muscles, tendons and other connective tissues are called sarcomas. Today, I am talking with Dr. Jade Homsi, who specializes in the care of patients with sarcomas. He's the chief of the division of hematology and oncology at Upstate.

Welcome to "HealthLink on Air," Dr. Homsi.

Jade Homsi, MD: Thank you. Thank you for having me.

Host Amber Smith: Are sarcomas new cancers, or have they spread from cancers that originated elsewhere in the body?

Jade Homsi, MD: Sarcomas are actually new cancers, so they could start in different areas in the body, and they do have the potential themselves to spread to other areas in the body, and not to be confused with other cancers that can also spread to other areas in the body.

Host Amber Smith: So where are most sarcomas found?

Jade Homsi, MD: So sarcomas are, probably easier to think about it, they're divided into two major categories. The first one is the soft-tissue sarcoma, and the second one is the bone sarcoma. So just based on the name itself, you can tell where it starts.

So the soft tissue sarcoma starts in the soft tissue, and that's usually muscle, blood vessels, fatty tissues. And the bone sarcomas start usually in the bones and the cartilage around the bones as well.

Host Amber Smith: Who is most at risk for this? Adults, children, men, women?

Jade Homsi, MD: Anybody, everybody is at risk to have a sarcoma.

There's no specific patient population that tends to have more likelihood to get sarcomas. Indeed, with the exception of some very rare genetic syndromes, where we can see some patients having more sarcomas than others.

Going back to the two categories, as far as bone sarcomas, that's the one that is more common in children. As far as the soft-tissue sarcomas, and when we say soft-tissue sarcomas, we mean things like liposarcoma, leiomyosarcoma, pleomorphic sarcoma. These are all terms that can be used to describe one thing, which is sarcoma. And these tend to be more common in older patients.

In general, males may have higher likelihood to get a sarcoma, compared to females, but again, every disease -- I probably didn't mention, but sarcomas tend to be, or tend to describe, multiple diseases, so each one of these diseases could have a higher likelihood in men or women and different age population.

Host Amber Smith: Well, other than genetic risks, are there other factors that would increase someone's risk for developing sarcoma?

Jade Homsi, MD: There are, and the one that we know the most about is radiation. Receiving radiation therapy in the past could be a factor in developing sarcoma in the future. And that's a very interesting thing we face, or we deal with, where a cancer patient could receive radiation therapy to treat that cancer, and, many years later, they could present with sarcoma in the area where they received the radiation.

Other things, such as different chemicals, have been associated with some type of sarcomas, (also) viruses, most specifically herpesvirus, and that's specifically to one type of sarcoma, called Kaposi sarcoma, associated with a specific herpesvirus. The last thing that tends to, or may, be a little more controversial is the idea of a trauma or chronic inflammation in the area. That has been an area of studies and also research looking for the possibility of a chronic inflammation in one area of the body, or trauma in that area of the body, leading to the development of sarcoma.

These are the most studied, or reported, factors to be associated with sarcoma.

Host Amber Smith: How are sarcomas typically discovered?

Jade Homsi, MD: There isn't just one sign or symptom to suggest that someone has a sarcoma, and that makes it more challenging to diagnose.

Many times we have patients, or we see patients, where they've had a delayed diagnosis of their sarcoma due to the vague signs and symptoms of the disease. And so the most common ones, if we were to try to be aware of some of these signs and symptoms, is usually a lump or a mass that is growing in one area of the body, or a lump that was not there, and now, we can feel a lump.

Also, pain is another type of symptoms that we see sometime with sarcoma, as well as sometimes abdominal swelling. Some sarcomas start in the abdomen, and deep in the abdomen. And sometimes patients come to the office and say, "My waist size has increased significantly," and that could be also an indication of something going on.

Host Amber Smith: So how quickly do the sarcomas grow?

Jade Homsi, MD: So again, going back to what we started with, that sarcoma is multiple diseases, it's different diseases, it's not just one. And so based on what specific disease we're talking about or what specific type of sarcoma we are referring to, how rapid the growth of sarcoma could be determined.

So we do have some types of sarcomas, and I would mention some types of liposarcoma, and that's the sarcoma of the fatty tissue, could grow very slowly. And many times we could just observe patients with that condition over time and only intervene if we see significant growth.

However, some other types of sarcomas, like the more aggressive types that we see with, what we call sometimes pleomorphic sarcoma, some types of  leiomyosarcomas, these are the types where we can see a rapid growth of the sarcoma. And that sometimes can carry higher risk of a spread of the disease. These tend to be a more aggressive type of sarcomas.

Host Amber Smith: This is Upstate's "HealthLink on Air." with your host, Amber Smith. I'm talking with the chief of hematology and oncology at Upstate, Dr. Jade Homsi.

So what tests might be done to diagnose sarcoma?

Jade Homsi, MD: So there's not really one test to diagnose sarcoma.

As I mentioned before, some people with genetic syndromes, very rare syndromes like Li-Fraumeni syndrome or Gardner syndrome, could have a higher potential to have sarcomas. And these could be monitored closely by their primary care physician and other types of health care providers.

However, once we are suspicious that there is a sarcoma, or we think a sarcoma is what someone has, then we tend to diagnose that initially with imaging testing. And these include CT scans, and these are the scans that look inside the body, in the organs. An MRI is another one that we also use. A PET scan sometimes can be used to further evaluate the spread of the sarcoma.

Eventually, we do need to be able to diagnose a sarcoma. We will need to have what we call a tissue diagnosis, meaning we need some kind of a tissue from that mass or from that suspicious lesion to be examined under the microscope. And usually, that type of testing requires very specialized equipment and personnel to be able to read the results of that tissue biopsy.

Host Amber Smith: Let's talk about treatment options. How do you decide which is the best course for a particular patient?

Jade Homsi, MD: I feel like this is maybe a little more related to also the type of the sarcoma and also how rapidly a sarcoma is growing.

Most of the time we tend to make these decisions in what we call a multidisciplinary team approach. And that's where different specialists are involved in making the treatment decisions. So once we make that diagnosis, usually it's a team approach that involves surgeons, radiation oncologists, as well as medical oncologists.

The treatment is most of the time focused, as I said, on the type of sarcoma, the stage of sarcoma, the type of symptom, and how rapidly the growth of the sarcoma has been or is. Also what determines the type of treatment we choose sometimes could be dependent on the patient. The patient's physical condition and other medical problems could play a role in determining that the best approach or the best treatment we recommend to treat the sarcoma.

Host Amber Smith: So it could include surgery and/or radiation and/or chemotherapy?

Jade Homsi, MD: Correct, correct. Many sarcoma treatments involve the combination of these three modalities, and that's why having a team approach and having very good communication between the team members addressing and treating cancer is really what we recommend for these kinds of very complicated cancer to treat.

Host Amber Smith: What about things like immunotherapy or targeted therapies? Are those used with sarcomas very often?

Jade Homsi, MD: Immunotherapy is a newer treatment that has become available in the past few years and is something that we now use in many types of cancers.

However, in sarcoma, the data, or the studies, that were done looking at immunotherapy in sarcoma have not been always successful. So sometimes we've seen some good results with immunotherapy, but these results have not been always consistent. So choosing immunotherapy for sarcoma, the decision has always been made based on the testing that we do on the tissue to tell us if a sarcoma could be responsive to immunotherapy or not.

And also the type of the sarcoma that we're dealing with. Some types of sarcoma tend to be more responsive to immunotherapy than others, and that's where we would use that kind of modality.

As far as targeted therapy, it's something that's been used in some types of sarcomas, depending on also finding the target or identifying a target, because targeted therapy, as the term may tell you, is something that is based on inhibiting a target that is involved in the development and the spread and the growth of the sarcoma. So having that as the background to targeted therapy, it's only when we know of a target that could be involved where we just recommend doing a targeted therapy.

Host Amber Smith: How long does treatment typically take and how might a person's life be impacted during the treatment?

Jade Homsi, MD: So the treatment can take a long time. And also, there are, what I would say, maybe different intents to the treatment. So in early-stage sarcoma, or the early stages of sarcomas, the intent of the treatment is, hopefully, to achieve a cure, meaning to get rid of the cancer and, eliminating any risk of the cancer, hopefully, coming back with the additional treatment that we offer.

However, when the sarcoma is in more of an advanced stage, or what we call metastatic, meaning it has spread to other places and organs, then the intent of the treatment is usually palliative, meaning to, hopefully, stop the sarcoma from growing, maybe shrink it, but we are not able to cure it. And the treatment may be ongoing for as long as the patient can tolerate the treatment. And the decision on the duration, on the type of the treatment, could be different from one patient to another.

Host Amber Smith: How likely is it that there would be a recurrence of another sarcoma or the same sarcoma coming back?

Jade Homsi, MD: So it really depends on the sarcoma we are dealing with, and that's usually determined by the stage.

So the more advanced the stage, the higher the likelihood of the sarcoma to come back, to return. The stage is usually determined by mostly two things, which is the size -- the larger the size, the higher the chances of the sarcoma returning. Also something we call the grade. The grade is how the cells look under the microscope and how fast they're dividing. And so the higher the grade, the sarcoma is also the higher likelihood of the sarcoma returning.

Host Amber Smith: Does having a sarcoma raise a person's risk of other cancers, like in an organ or a blood cancer?

Jade Homsi, MD: Usually what raises the risk of having other cancer is really the treatment for the sarcoma.

So, as I mentioned, radiation itself, which is a treatment that is used in treating sarcoma, can cause cancer itself in the future. Some of the chemotherapy that we use to treat sarcoma also can cause cancer later on, many years after the treatment and after receiving the chemotherapy. An example of that is things like leukemia, for example, we see after the use of chemotherapy, and that usually happened years after completing chemotherapy.

Host Amber Smith: Well, Dr. Homsi, I thank you so much for making time to tell us about sarcomas. Thank you.

Jade Homsi, MD: Thank you. Appreciate it.

Host Amber Smith: My guest has been Dr. Jade Homsi, the chief of the division of hematology and oncology at Upstate.

I'm Amber Smith for Upstate's "HealthLink on Air."

Next on Upstate's "HealthLink on Air" -- how exercise can help with perimenopause.

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air."

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 "HealthLink on Air," 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 "HealthLink on Air," with 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.

I'm Amber Smith for Upstate's "HealthLink on Air."

And now, Deirdre Neilen, editor of Upstate Medical University's literary and visual arts journal, The Healing Muse, with this week's selection.

Deirdre Neilen, PhD: Mitchell Solomon, a poet from San Francisco, uses the structural form of a duplex in his graveyard visit entitled "Engraved."

-- a duplex after Jericho Brown

A mossed tombstone never read

Angry, drunk, better off

Better off lost to time -- permanent

Monument for a man eaten away

A no-longer-man is eaten away

By fungus and maggots and spirits and snow

snow buries insects leaves fungus grass,

Piles high and covers the path

Covers this epitaph, conceals

Engravings in untouched silk

Roughened ilk, empty-eyed praying,

To resist the horrors of thunder

A man no longer exists under

A mossed tombstone never read

Host Amber Smith: This has been Upstate's "HealthLink on Air," brought to you each week by Upstate Medical University in Syracuse, New York.

If you missed any of today's show, or for more information on a variety of health, science and medical topics, visit our [email protected].

Upstate's "HealthLink on Air" is produced by Jim Howe, with sound engineering by Bill Broeckel and graphic design by Dan Cameron.

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