Exercise affects body composition

Exercise affects body composition in postmenopausal women.

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

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

muscle mass.

Physical activity / Exercise Changing sedentary life style Aerobic exercise Strength exercise (Maria & Fiatarone, 2000)

Exercise for health for postmenopausal woman

Exercise can stimulate appetite and improve the absorption of nutrients.

(Shore et al., 2007)

Many exercise recommendations are benefits for postmenopausal women Morphological Musculoskeletal Motor Cardiorespiratory Metabolic

(Asikainen et al., 2004)

(Asikainen et al., 2004)

Walking

Aerobic EX

Resistance training

Walking

121 females Age: 48-63 yrsBMI< 32 kg/m2

Treadmill test protocol

BMI, Body mass, fat%, EX-HR, Energy expenditure

W155% VO2max

1500kcal

W245% VO2max

1000kcal

W355% VO2max

1000kcal

W455% VO2max

1500kcal

5 day/wk for 24 weeks(Min:15-20weeks)

(Asikainen et al., 2004)

24 wks of walking at moderate intensity improves VO2max & body composition

in slightly overweight sedentary women.

Walking trails

Subject Duration Training prescription Outcomes

Hamdorf

(1992)

80

(64y)

26wks 45min,

40-60% VO2max

3~5 d/wk

Body mass: NS

Fat%: NS

HR -7%

Ready

(1996)

79

(61y)

24wks 60min,

60%VO2max

3~5 d/wk

Weight: -0.6 kg

Fat%: -4.2%

VO2max: +14%

Brooke

(1997)

84

(64y)

1 year 20min, self-selected brisk pace

Body mass: + 0.9 kg

VO2max: + 2.1 ml/kg/min

BMD: + 0.2

Asikainen

(2002)

134

(57y)

15wks 30-60min, 65% VO2max (300kcal)

Weight: -1.2kg

Fat%: -2.1%

VO2max: +2.5 ml/kg/min

(Asikainen et al., 2004)

Benefits of walking exercise

Low drop-out rate, high attendance and low injury rate

Most of the studies used walking as the primary mode of exercise.

6 components of HRF (health-related fitness) Body composition, VO2max

BMD, BP, lipids, glucose

(Asikainen et al., 2004)

Aerobic exercise

33 femalesAge: 50-70 yrsBMI: 32 kg/m2

Treadmill test protocol

BMI, WHR, fat%, Fat mass, fat free mass, adipose tissue

Weight loss (WL)

Weight loss + Aerobic EX(WL+AEX)

WLRestrict 250-350 kcal/d

24hr dietary records

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

(Maria & Fiatarone, 2000)