What women want? Exercise preferences of menopausal women
Introduction
Many menopausal aged women experience vasomotor symptoms. In the past, hormone replacement therapy (HRT) was frequently used to mange these symptoms, but many women are now reluctant to use it and doctors are more cautious about prescribing HRT due to reports linking its use to adverse health outcomes [1], [2]. This has led to an increased need to evaluate alternative or non-pharmacological interventions. One intervention that has gained some attention is exercise, although evidence supporting its effectiveness has been equivocal. Both the Royal College of Obstetricians and Gynaecologists in the United Kingdom [3] and the North American Menopause Society [4] have advised that exercise is considered for symptom management, despite the fact there is little evidence from randomised controlled trials (RCTs) to directly support this advice. The Cochrane Library systematic review of exercise in the management of vasomotor symptoms [5] was unable to make any recommendations due to a lack of trials and concluded there was a need for a high quality definitive RCT before any conclusions could be made.
At present however, it is not appropriate to design and undertake a robust RCT. There is limited evidence about whether exercise would be an acceptable treatment to symptomatic menopausal women; and if so, what potential sources of assistance or support to become active would be preferred, and what type(s) of exercise would be appealing and/or efficacious. There is limited information [6] on whether these women would be prepared to consider exercise as treatment, and whether doctors are currently recommending exercise as treatment. The feasibility and acceptability of exercise as a treatment for women with (HF/NS) may not be similar to other groups of women because exercise typically causes acute responses, such as heat and perspiration, the very symptoms these women are trying to avoid. Moreover, it is also possible that exercise may exacerbate HF/NS, rather than prevent or reduce them. This might be true particularly for overweight/obese women who may be at increased risk for HF/NS [7].
Finding ways of successfully increasing exercise participation levels is a complex issue. The Medical Research Council (MRC) in the UK [8] has highlighted the importance of ‘accumulating wisdom from empirical evidence’ in their framework for development and evaluation of RCTs for complex interventions to improve health care. The MRC have also commented that it is essential to clarify, as far as possible, the important components of an intervention before embarking on a definitive RCT. In the context of exercise interventions, issues such as the frequency, timing and methods of organising and delivering components are likely to be critical in determining the subsequent effectiveness of an intervention. In addition, efforts to promote exercise are likely to be most effective if they address the needs and interests of the target group since it is unlikely that ‘one size will fit all’. A more comprehensive understanding of preferred activities and sources of assistance should improve efforts to foster increased exercise and minimise attrition in subsequent intervention studies in menopausal women.
The primary purpose of this study was to provide a comprehensive assessment of the exercise programme preferences of menopausal women, focussing on those experiencing vasomotor symptoms. In addition, it was important to investigate whether menopausal women were prepared to consider exercise as a treatment for HF/NS if advised to do so by their doctor or another health professional. Lastly, we aimed to examine the potential variability between current exercise levels, BMI and HF/NS.
Section snippets
Patients and procedures
There are 71 practices within the sampling primary care trust (PCT). Half (n = 35) of practices in the PCT were approached; 9 (26%) agreed to participate and 1 later withdrew their interest due to other practice commitments. Thus, participants were recruited from eight general practices in urban and suburban location in the West Midlands, UK that varied in geographical location, proportion of listed patients from ethnic minority groups, Index of Multiple Deprivation (IMD) [9] score and practice
Distribution of the study questionnaire
The distribution of IMD rank scores showed that of women invited to participate in the study, 32.6% (n = 904) lived in quartile one (most deprived communities), 16.0% (n = 443) in quartile two, 24.0% (n = 665) in quartile three and 27.5% (n = 764) in quartile four (least deprived) score areas.
Characteristics of the study population
The response rate was 61.0% (n = 1693/2776). The mean age of respondents was 50.3 years (SD = 2.8), of whom 35.0% were premenopausal, 14.2% perimenopausal, 39.0% were postmenopausal, with the remainder of unknown
Discussion
Our data show that most menopausal women would choose physical activity interventions to be delivered by fitness advisors in the form of one-to-one consultations, which is broadly consistent with studies involving other populations, such as cancer patients [11], [12]. Indeed, many successful exercise trials [13], [14] have used a one-to-one exercise consultation approach. Exercise promoting DVD was also a popular choice amongst participants.
It was interesting to note that all of the telephone
Contributions
AD conceived the study design, performed data collection, drafted the manuscript and performed the statistical analyses. All authors commented on the design of the study questionnaire. All authors read and approved the final manuscript.
Competing interests
The authors declare they have no competing interests.
Funding
Amanda Daley is supported by a National Institute for Health Research Senior Research Fellowship (Career Scientist Award). The views expressed in this publication are those of the authors and not necessarily those of the NHS, The National Institute for Health Research or the Department of Health.
Provenance and peer review
Peer review was directed independently of Margaret Rees (one of the authors and Editor in Chief of Maturitas) by Prof Martina Doeren.
Ethical approval
This study was approved by the South Birmingham Local Research Ethics Committee.
Acknowledgement
We would also like to thank the practices that agreed to assist with the study and those patients who returned their questionnaires.
References (28)
- et al.
Active Mothers Postpartum: a randomized controlled weight-loss intervention trial
Am J Prev Med
(2009) - et al.
Telephone counseling for physical activity and diet in primary care patients
Am J Prev Med
(2009) - et al.
Physical activity preferences, preferred sources of assistance, and perceived barriers to increased activity among physically inactive Australians
Prev Med
(1997) - et al.
Physical exercise and vasomotor symptoms in postmenopausal women
Maturitas
(1998) - et al.
Change in use of hormone replacement therapy after the report from the women's health initiative: cross sectional survey of users
BMJ
(2003) - et al.
Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women's Health Initiative randomised controlled trial
JAMA
(2002) - Royal College of Obstetricians and Gynaecologists. Scientific Advisory Committee. Alternatives to HRT for the...
Treatment of menopause-associated vasomotor symptoms: position statement of The North American Menopause Society
Menopause
(2004)- et al.
Exercise for vasomotor menopausal symptoms
Cochrane Database Syst Rev
(2007) - et al.
Exercise participation, body mass index and health-related quality of life in menopausal aged women
BJGP
(2007)
Relation of demographic and lifestyle factors to symptoms in a multi-racial/ethnic population of women 40–55 years of age
Am J Epidemiol
Designing and evaluating complex interventions to improve health care
BMJ
A psychological analysis of menopausal hot flushes
Br J Clin Psychol
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