A LIFETIME OF FITNESS: Exercise in the Perimenopausal and Postmenopausal Woman

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In Western culture, successful aging means appearing to be physically unaffected by the aging process. The appearance of youth is achieved with anti-aging creams, cosmetic surgery, and exercise. A person's age need not be a limiting factor in living an active, productive life. Georgia O'Keefe continued to paint until she was 99 years old, and Betty Friedan in her 80s is still an influential author on women's roles. Women are looking for ways to enter the second half of life and minimize the chronic health conditions that characterize “old age.” The terms perimenopause and postmenopause are defined several different ways in the literature. For this article, we will use the World Health Organization's (WHO's) definition of postmenopause as the time after the final menstrual cycle.60

Unlike the menopausal phase, the onset of the perimenopausal phase does not have a clear physiologic marker. For the purposes of this article, perimenopause will be defined as shortened menstrual cycles, missed menses, irregular bleeding, and vasomotor symptoms just before menopause.39 This loss of a woman's reproductive life is significant both physically and culturally.

This article briefly discusses some common medical problems for perimenopausal and postmenopausal women such as bone loss, dehydration, osteoarthritis, symptomatology of menopause, and pelvic floor dysfunction. Research studies conducted on women only will be cited, unless otherwise stated. This article continues with the benefits of aerobic and strength training and concludes with recommendations for starting an exercise program, including certain guidelines to follow to ensure safety and beneficial results. Although exercise is an excellent therapeutic modality, treatment of specific conditions or recommended drug therapy will not be addressed in this article.

Section snippets

COMMON PROBLEMS IN THE PERIMENOPAUSAL AND POSTMENOPAUSAL WOMAN

The number of chronic medical and orthopedic conditions increases with age, leading to increased risk of mobility impairments and disability. Because of this increase, there is a significant need for improved health care and disease prevention targeted at groups of young and middle-age people. Decreases in circulating estrogen in the postmenopausal years can bring higher risks of osteoporosis and cardiovascular disease.58 Additionally, lifestyle choices, such as diet, lack of exercise, and

BARRIERS TO EXERCISE

Difficulty initiating a regular exercise program can be problematic regardless of age. The older woman, however, may have additional physical constraints or psychologic factors to overcome before beginning an exercise program. The problems discussed in the previous section can also become barriers to exercise for the older woman.

BENEFITS OF EXERCISE

The following sections are intended to provide a summarized review of the benefits of different types of exercise training. Each modality includes general benefits of training supported by research.

EXERCISE PRESCRIPTION

A sedentary lifestyle can lead to devastating consequences, such as increased risk of disease and functional decline. In later life, movements are guided by the conservation of energy. Perimenopausal and early postmenopausal years are a time of transition when a well-rounded healthful exercise program can set the stage for successful aging. Assuming that a woman is not exercising, her premenopausal strength is greater than it will be at any time in the future. Late-life independence is

SUMMARY

The peri- and postmenopausal woman experiences physiologic changes of aging that include alterations in hormone levels. Research has shown that the perimenopausal and postmenopausal woman can benefit significantly from exercise, whether endurance or strength training. Exercise can improve the quality of life and attenuate some of the physiologic changes associated with aging. Additionally, exercise can ameliorate the decline in fitness and bone, prevent chronic disease, and promote functional

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    Address reprint requests to Tanya A. Miszko, MS, 300 River Road, Department of Exercise Science, Athens, GA 30602–6554

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