Exercise affects body composition in postmenopausal women. Reporter: Wang-Chen, Lin Adviser: Linda, Lin Poehlman (2002). Acta Obstet Gynecol Scand. 81(7) 603- 11 Asikainen et al (2004). Sports Med. 34(11) 753-778 Shore et al (2007). Phys Med Rehabil Clin N Am. 18 609-21
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Exercise affects body composition in postmenopausal women.
Exercise affects body composition in postmenopausal women.
Asikainen et al (2004). Sports Med. 34(11) 753-778
Shore et al (2007). Phys Med Rehabil Clin N Am. 18 609-21
Maria & Fiatarone (2000). Exercise, Nutrition, and the Older Woman.
Backgrounds
Woman occurs menopause at the average age in 50 years old. (USA)
(Notelovitz, 1989)
Woman can expect to live more than 1/3 life in the postmenopausal state. (USA) With an average life expectancy of 81 years
(Poehlman, 2002)
Approach of menopause is marked by Follicle stimulating hormone (FSH) Luteinizing hormone (LH) Estrogen levels
(Wise et al., 1989)
Climacteric
2-3 years in last menstrual period Endocrine symptoms
Intermittent hot flushes, bleeding irregularities
Nervous system disturbances Insomnia, nervousness, forgetfulness, irritability,
fluctuation in mood, depression, and a constant feeling of exhaustion
(Zador, 1997)
Postmenopausal vs. premenopausal woman
Resting metabolic rate (RMR) is the largest component of daily energy expenditure 50~75% of daily energy output
(Poehiman, 1990)
In women, the decline in RMR is most notable around the age of 50. with advancing age, 2~3% per decade
(Heymsfield, 1994) Lipolytic activity in the abdominal adipose tissue Activity of lipoprotein lipase in the femoral adipose
tissue (Rebuffe & Eldh., 1986)
Decreasing of energy expenditure in menopausal(Poehlman, 3002)
Menopause affects body composition
With remaining the same caloric intakes and outputs, this would contribute a 4~6 pound weight gain over one year. Primary reason → loss of fat-free weight → RMR Partially reason → physical activity levels
(estrogen & androgen levels after menopause)(Maria, 2002)
Suggested that estrogen depletion may be related to fat distribution. Increase fat of intra-abdominal region
(Haarbo, 1991)
Longitudinal study
6 years of follow up (but no change in weight) Resting metabolic rate (100kcal /day) Leisure time activity (103 kcal /day) Total body fat 2.5 kg Fat-free mass 3 kg Waist-to-hip ratio +0.04
(Poehiman et al., 1995)
Obesity in postmenopausal women
Interview urban homebound older women 5% underweight (BMI<18.5) 22% over weight (BMI: 25~30) 33% obese (BMI>30)
(Millen et al., 2001)
A common complaint among postmenopausal women is weight gain. Central obesity
(Thompson, ACSM, 2003)
Indicate that 44% of women are attempting to lose weight, with less than ½ of these women Reducing energy intake & exercise 150 min/wk≧
(Serdula, 1999)
Risk of menopause women
Why well body composition is important? Body fat
Gain weight, Change fat distribution, Obesity population Increasing risk
• Coronary heart disease (CHD) • Metabolic diseases • Breast cancer
Lean mass Aging → Muscle mass loss, Decrease muscle functions Aerobic fitness, muscle strength, balance, bone density
• Fall• Osteoporosis• Mortality
(Sowers et al., 1995)
The vicious circle of frailty
(Shore et al., 2007)
Treatment for postmenopausal women
Clinical program Hormone replacement therapy (HRT)
Dietary ≦ 30% calories from fat < 300 mg cholesterol ≧ 55% calories from total carbohydrates Nutritional supplementation alone had no effect on
AEX (3 times/wk)Treadmill, cycle ergometer, a track
45 min 50-60% HRR gradually progressed
6 months (Ryan et al., 2006)
Results
(Ryan et al., 2006)
Results
(Ryan et al., 2006)
(Ryan et al., 2006)
6 months of WL+AEX in obese postmenopausal women can improve glucose utilization & insulin sensitivity
Aerobic exercise trails
(Asikainen et al., 2004)
Subject Duration EX-Type Training prescription Outcomes
Hoplcins
(1990)
65
(65y)
12wks Aerobic dance &
stretching
50min,
low impact,
3 d/wk
Weight: NS
Fat%: -0.9%
Fitness: + 17%
King
(1991)
160
(57y)
1 year Jogging
Cycling
treadmill
40min,
48-64% VO2max,
3~ 5 d/wk
VO2max: +1.5-2.3 ml/kg/min
Fat%: NS
Shinkai
(1994)
32
(54y)
12wks Jogging
Cycling
swimming
45~60min,
50~60% VO2max,
3~4 d/wk
Weight: -6%
Fat%: -10%
VO2max: NS
Sipila
(2002)
80 1 year Circuit dance
High-impact,
4 d/wk
Fat%: NS
BMD: + 1.2%
Uusi
(2003)
164
(53y)
1 year Jumping
Stretching
60min, high-impact,
3 d/wk
BMC: +1.3~3.5%
Benefits of aerobic exercise
In conjunction with diverse aerobic exercise 7 components of HRF
VO2max, BP, body composition Muscle strength, endurance, flexibility and balance
It seemed aerobic exercise was more beneficial than walking.
Higher drop-out rate and injury rate than walking
(Asikainen et al., 2004)
Resistance training
40 femalesAge: 50-70 yrsBMI < 25 kg/m2
BMI, skinfold thickness, muscle mass, fat mass
Control Exercise
Continue usual life
2d/wk at high intensity training 80% of 1RM (hip, knee, lateral pull-down)
16 on Borg scale (back extension, abdominal flexion)3 sets of 8 repetitions
52 wk with 2wk off (1 yr)
(Nelson et al., 1996)
Results
(Nelson et al., 1996)
(Nelson et al., 1996)
1 year of resistance training can change body composition & improve leg muscle mass in older woman
Resistance training trailsSubject Duration Training prescription Outcomes
Sinaki
(1994)
68
(56 y)
2 years Back (sandbag)
Progressive 30% 1 RM,
10 rep, 5 d/ wk
BMD: NS
Strength: +72%
Nelson
(1996)
40
(60y)
5 ex, 80% 1 RM, 8 rep,
3 sets, 2 d/wk
BMD lumbar: +0.9%
Femoral: +1%
Kerr
(2001)
126
(60y)
2 years 9 ex, 8 rep, 3 sets, 3 d/wk
Progressive & cycling
BMD hip: +1.2%
Lumbar: NS
Forearm: NS
Bemben
(2000)
35
(51y)
24 wks 12 ex, 80% 1 RM, 8 rep or
40% 1 RM, 16 rep
3 sets, 3 d/wk
Weight: NS
Fat%: NS
Strength: + 20~40%
Cussler
(2003)
94
(55y)
1 year 8 ex, 70~80% 1RM,
6~8 rep, 2 sets,3 d/wk
BMD: + 1.3%
(Asikainen et al., 2004)
Benefits of resistance training
Resistance training was effective on bone & muscle fitness.
Strength training with weight machines High impact training can improve in balance and
motor control. Lower attendance and higher injury rate → not very
feasible
Low-load / high-repetition are more feasible
(Asikainen et al., 2004)
Exercise prescriptions
Recommends physical activity 30 min of moderate exercise, more days/wk (ACSM, 2003)
Walking Sedentary, obesity, chronic diseases Feasible way to start exercise
Aerobic exercise Start low impact Multiples of exercise types
Resistance training (professional instruction) Low-load, 40% 1 RM, 8-10 repetition, 3 sets Every other day to do Total muscle balance
(Asikainen et al., 2004)
Conclusions
The goal of exercise for postmenopausal women Lose weight and ultimately attain idea body weight Preserve lean body tissue, lose predominantly fat
mass, and preferentially visceral fat Improve quality of independence life
The behavior modification is most successful way to control weight & keep regular exercise Self-monitoring Counting calories Keep food and exercise diaries Charting weight loss