MAINTAINING STRENGTH Weight-bearing and at least moderate-impact exercise should be part of your regime.
Considering what has been going on in the world, it may have slipped your notice that March 8 was International Women’s Day. Not me of course, but surely there are still a few dinosaurs out there.
London’s Mayor, Sadiq Khan, didn’t miss it. Instead, he used the day to pledge that staff at City Hall who are going through the menopause will be facilitated with flexible working time. Mr Khan also promised temperature-controlled offices to make it ‘as comfortable as possible’ for women experiencing symptoms like hot flushes and anxiety. The stated goal is to ensure those with menopausal symptoms get the same support as if they had any other symptoms.
I assume most people know that the menopause is when a woman stops having periods and can no longer naturally conceive children. This is a natural part of ageing that usually occurs somewhere between 45 and 55 years of age, as the body’s oestrogen levels decline.
Typically, the menopause is a gradual process, taking months or even years. The most common symptoms include hot flushes, night sweats, difficulty sleeping, reduced libido and low mood or anxiety. But there are other, more physio-related, symptoms that we will discuss here.
Mitigating the risks
Lower oestrogen levels are associated with loss of bone density and skeletal muscle mass. In short, muscles get weaker and the risk of developing osteoporosis increases significantly after menopause.
What does that mean to the individual? Firstly, muscle weakness can affect exercise tolerance and falls risk, while osteoporosis increases the risk of fracture because of a fall. Are we joining the dots?
Is there anything you can do to mitigate those risks? Of course there is. As we all know, prevention is better than a cure, so while the menopause can’t be prevented, being in good physical shape both before and after menopause tends to translate as having lower risks down the line. I’m not talking about body building, gym-bunny shape, so much as being sufficiently physically active.
Muscles and bones both respond to load and stress, so to have strong muscles and good bone density, you need to load them both. This translates to weight-bearing, and at least moderate-impact, exercise.
It’s important to make this point, because often low-impact exercise is seen as an inherently good thing, when that isn’t always the case. Lowering impact tends to mean reducing the load through muscle and bone, and thus not stimulating bone production or muscle strength.
I often cite the example of my landlady in Ecuador many years ago. She had been given a diagnosis of osteopenia; low, but not critically low, bone density. She was advised to hire a housekeeper and avoid any exercise to reduce her risk of fracture – simultaneously increasing her risk of developing osteoporosis and cardiovascular disease and eventually increasing her falls risk. It’s an extreme example, and one that could be partly explained by a poorer healthcare system, but it’s also a trap worth avoiding.
Impact and strength
What to do then? Well, at the risk of sounding like a broken record, it is worth going back to the World Health Organisation guidelines on exercise and looking past the cardiovascular exercise at the recommendations for strength exercises.
The guidelines state that all adults should do muscle-strengthening activities at moderate or greater intensity that involve all major muscle groups on two or more days a week. For those over 65, there is the additional recommendation of doing ‘varied multicomponent physical activity that emphasises functional balance and strength training at moderate or greater intensity, on three or more days a week, to enhance functional capacity and to prevent falls’.
In short, if you are at risk of weakness, osteoporosis and falls, you should be aiming for more exercise, not less.
This can include anything from kettlebells or yoga at the gym to tennis or tai chi. As long as the movement is varied, there is some load through bones and muscles and you’re enjoying yourself, you’re on the right track.
Which brings us back to Sadiq Khan. Unfortunately, all we can do to help is offer temperature-controlled rooms. But that’s men for you. Instead I can offer the suggestion that you remain as active as possible, include impact and strength exercises and try to enjoy yourself as you do.
Andrew O’Brien is a chartered physiotherapist and the owner of Wannarun Physiotherapy and Running Clinic at Westport Leisure Park. He can be contacted on 083 1593200 or at www.wannarun.ie.