Exercise during Menopause

Written By Ryan Janjuha

Brief Description

Both cardiovascular fitness and muscular strength decline with age in women and especially during the menopause (around the age of 50). This is thought to be due to natural declines in oestrogen production, which acts to preserve strength and function(1, 2). Declining oestrogen function also impacts bone density, which increases the risk of osteoporosis.

Many physical and psychological changes are brought about due to changes in circulating oestrogen. During menopause, this can include changes in mood, cognition, sleep, vasomotor (e.g. hot flashes), genitourinary and muscular functionality.

This fact-file aims to provide information for post-menopausal women looking to improve overall functionality, fitness and muscular strength, as well as offer some evidence-based suggestions for other bothersome signs/symptoms.

Evidence Base

  • Any form of exercise – aerobic, resistance training (RT) or combined can improve cardiovascular fitness in post-menopausal women (129 studies, n=7,141 women)(3). Additionally, any form of exercise can reduce markers of inflammation and up-regulates adiponectin (energy boosting hormone)(4).

  • Combined exercise can significantly improve risk factors for metabolic syndrome (name of a group of conditions that contribute to heart disease and diabetes)(5, 6).

  • RT and combined training can improve handgrip strength, but only RT is able to improve upper body strength(3). Strength training can also improve hormonal, metabolic markers, blood pressure and frequency/intensity of hot flushes(7).

  • For muscular hypertrophy (building muscle size), a systematic review of 14 randomised studies found, high volume (more reps) resistance training (HVRT) was more effective than low-volume resistance training (LVRT)(8).

  • Other forms of physiotherapy, such as: reflexology, yoga, walking, and or aromatherapy massage can improve symptoms of insomnia and/or depression (n=31 studies on different exercise modalities on mood/sleep)(9).

  • Exercise improves bone mineral density at the lumbar spine (n=85 studies), femoral neck (n=31 studies) and the total hip (n=30 studies)(10).

  • Training frequency – 2 or more sessions per week is more likely to improve bone mineral density than <2 sessions. Longer training sessions also enhances this effect. Try to aim for at least 3 sessions per week for a year at least(11).  

References:

  1. Critchlow AJ, Hiam D, Williams R, Scott D, Lamon S. The role of estrogen in female skeletal muscle aging: A systematic review. Maturitas. 2023;178:107844.

  2. Divaris E, Anagnostis P, Gkekas NK, Kouidi E, Goulis DG. Early menopause and premature ovarian insufficiency may increase the risk of sarcopenia: A systematic review and meta-analysis. Maturitas. 2023;175:107782.

  3. Khalafi M, Sakhaei MH, Habibi Maleki A, Rosenkranz SK, Pourvaghar MJ, Fang Y, et al. Influence of exercise type and duration on cardiorespiratory fitness and muscular strength in post-menopausal women: a systematic review and meta-analysis. Front Cardiovasc Med. 2023;10:1190187.

  4. Khalafi M, Malandish A, Rosenkranz SK. The impact of exercise training on inflammatory markers in postmenopausal women: A systemic review and meta-analysis. Exp Gerontol. 2021;150:111398.

  5. Tan A, Thomas RL, Campbell MD, Prior SL, Bracken RM, Churm R. Effects of exercise training on metabolic syndrome risk factors in post-menopausal women - A systematic review and meta-analysis of randomised controlled trials. Clin Nutr. 2023;42(3):337-51.

  6. Ferreira L, Abrantes C, Alves ME, Moreira C, Moreira H. Effects of exercise programs on cardiorespiratory fitness and arterial stiffness on postmenopausal women: A systematic review study. Maturitas. 2024;181:107917.

  7. Capel-Alcaraz AM, García-López H, Castro-Sánchez AM, Fernández-Sánchez M, Lara-Palomo IC. The Efficacy of Strength Exercises for Reducing the Symptoms of Menopause: A Systematic Review. J Clin Med. 2023;12(2).

  8. Nunes PRP, Kassiano W, Castro ESP, Camilo BF, Cristina-Souza G, Vieira-Souza LM, et al. Higher volume resistance training enhances whole-body muscle hypertrophy in postmenopausal and older females: A secondary analysis of systematic review and meta-analysis of randomized clinical trials. Arch Gerontol Geriatr. 2024;124:105474.

  9. Lialy HE, Mohamed MA, AbdAllatif LA, Khalid M, Elhelbawy A. Effects of different physiotherapy modalities on insomnia and depression in perimenopausal, menopausal, and post-menopausal women: a systematic review. BMC Womens Health. 2023;23(1):363.

  10. Mohebbi R, Shojaa M, Kohl M, von Stengel S, Jakob F, Kerschan-Schindl K, et al. Exercise training and bone mineral density in postmenopausal women: an updated systematic review and meta-analysis of intervention studies with emphasis on potential moderators. Osteoporos Int. 2023;34(7):1145-78.

  11. Zitzmann AL, Shojaa M, Kast S, Kohl M, von Stengel S, Borucki D, et al. The effect of different training frequency on bone mineral density in older adults. A comparative systematic review and meta-analysis. Bone. 2022;154:116230.

Ryan Janjuha
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