Exercise affects body composition in postmenopausal women.   Reporter: Wang-Chen, Lin Adviser: Linda, Lin Poehlman (2002)....
Backgrounds <ul><li>Woman occurs menopause at  the average age in 50 years old. (USA) </li></ul><ul><ul><li>(Notelovitz, 1...
Climacteric <ul><li>2-3 years in last menstrual period </li></ul><ul><li>Endocrine symptoms   </li></ul><ul><ul><li>Interm...
Postmenopausal vs. premenopausal woman <ul><li>Resting metabolic rate (RMR) is the largest component of daily energy expen...
Menopause affects body composition <ul><li>With remaining the same caloric intakes and outputs, this would contribute a 4~...
Longitudinal study <ul><li>6 years of follow up  (but no change in weight) </li></ul><ul><ul><li>Resting metabolic rate  (...
Obesity in postmenopausal women   <ul><li>Interview urban homebound older women </li></ul><ul><ul><li>5% underweight (BMI<...
Risk of menopause   women <ul><li>Why well body composition is important? </li></ul><ul><li>Body fat </li></ul><ul><ul><li...
The vicious circle of frailty (Shore et al., 2007)
Treatment for postmenopausal   women <ul><li>Clinical program </li></ul><ul><ul><li>Hormone replacement therapy (HRT)  </l...
Exercise for health for postmenopausal woman <ul><li>Exercise can stimulate appetite and improve the absorption of nutrien...
(Asikainen et al., 2004) Walking Aerobic EX Resistance training
Walking 121 females Age: 48-63 yrs BMI< 32 kg/m 2 Treadmill test protocol  BMI, Body mass, fat%, EX-HR, Energy expenditure...
24 wks of walking at moderate intensity  improves VO 2max  & body composition  in slightly overweight sedentary women.
Walking trails (Asikainen et al., 2004) Body mass:  + 0.9 kg VO 2max :  + 2.1 ml/kg/min BMD:  + 0.2 20min, self-selected b...
Benefits of walking exercise <ul><li>Low drop-out rate, high attendance and low injury rate  </li></ul><ul><li>Most of the...
Aerobic exercise 33 females Age: 50-70 yrs BMI: 32 kg/m 2 Treadmill test protocol  BMI, WHR, fat%, Fat mass, fat free mass...
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) 60min, high-impact, 3 d/wk High-impact,  4 d/wk 45~60min,  50~60% VO 2max...
Benefits of aerobic exercise <ul><li>In conjunction with diverse aerobic exercise </li></ul><ul><li>7 components of HRF </...
Resistance training 40 females Age: 50-70 yrs BMI < 25 kg/m 2 BMI, skinfold thickness, muscle mass, fat mass Control  Exer...
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 trails (Asikainen et al., 2004) BMD hip: +1.2% Lumbar: NS Forearm: NS 9 ex, 8 rep, 3 sets, 3 d/wk Prog...
Benefits of resistance training <ul><li>Resistance training was effective on bone & muscle fitness. </li></ul><ul><li>Stre...
Exercise prescriptions  <ul><li>Recommends physical activity </li></ul><ul><ul><li>30 min of moderate exercise, more days/...
Conclusions <ul><li>The goal of exercise for postmenopausal women </li></ul><ul><ul><li>Lose weight and ultimately attain ...
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Exercise affects body composition

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Exercise affects body composition

  1. 1. 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.
  2. 2. Backgrounds <ul><li>Woman occurs menopause at the average age in 50 years old. (USA) </li></ul><ul><ul><li>(Notelovitz, 1989) </li></ul></ul><ul><li>Woman can expect to live more than 1/3 life in the postmenopausal state. (USA) </li></ul><ul><ul><li>With an average life expectancy of 81 years </li></ul></ul><ul><ul><ul><li>(Poehlman, 2002) </li></ul></ul></ul><ul><li>Approach of menopause is marked by </li></ul><ul><ul><li>Follicle stimulating hormone (FSH) </li></ul></ul><ul><ul><li>Luteinizing hormone (LH) </li></ul></ul><ul><ul><li>Estrogen levels </li></ul></ul><ul><ul><ul><li>(Wise et al., 1989) </li></ul></ul></ul>
  3. 3. Climacteric <ul><li>2-3 years in last menstrual period </li></ul><ul><li>Endocrine symptoms </li></ul><ul><ul><li>Intermittent hot flushes, bleeding irregularities </li></ul></ul><ul><li>Nervous system disturbances </li></ul><ul><ul><li>Insomnia, nervousness, forgetfulness, irritability, fluctuation in mood, depression, and a constant feeling of exhaustion </li></ul></ul><ul><ul><ul><li>(Zador, 1997) </li></ul></ul></ul>
  4. 4. Postmenopausal vs. premenopausal woman <ul><li>Resting metabolic rate (RMR) is the largest component of daily energy expenditure </li></ul><ul><ul><li>50~75% of daily energy output </li></ul></ul><ul><ul><li>(Poehiman, 1990) </li></ul></ul><ul><li>In women, the decline in RMR is most notable around the age of 50. </li></ul><ul><ul><li>with advancing age, 2~3% per decade </li></ul></ul><ul><ul><li>(Heymsfield, 1994) </li></ul></ul><ul><ul><li>Lipolytic activity in the abdominal adipose tissue </li></ul></ul><ul><ul><li>Activity of lipoprotein lipase in the femoral adipose tissue </li></ul></ul><ul><ul><li>(Rebuffe & Eldh., 1986) </li></ul></ul><ul><li>Decreasing of energy expenditure in menopausal </li></ul><ul><ul><li>(Poehlman, 3002) </li></ul></ul>
  5. 5. Menopause affects body composition <ul><li>With remaining the same caloric intakes and outputs, this would contribute a 4~6 pound weight gain over one year. </li></ul><ul><ul><li>Primary reason -> loss of fat-free weight -> RMR </li></ul></ul><ul><ul><li>Partially reason -> physical activity levels </li></ul></ul><ul><ul><li>(estrogen & androgen levels after menopause) </li></ul></ul><ul><ul><li>(Maria, 2002) </li></ul></ul><ul><li>Suggested that estrogen depletion may be related to fat distribution. </li></ul><ul><ul><li>Increase fat of intra-abdominal region </li></ul></ul><ul><ul><li>(Haarbo, 1991) </li></ul></ul>
  6. 6. Longitudinal study <ul><li>6 years of follow up (but no change in weight) </li></ul><ul><ul><li>Resting metabolic rate (100kcal /day) </li></ul></ul><ul><ul><li>Leisure time activity (103 kcal /day) </li></ul></ul><ul><ul><li>Total body fat 2.5 kg </li></ul></ul><ul><ul><li>Fat-free mass 3 kg </li></ul></ul><ul><ul><li>Waist-to-hip ratio +0.04 </li></ul></ul>(Poehiman et al., 1995)
  7. 7. Obesity in postmenopausal women <ul><li>Interview urban homebound older women </li></ul><ul><ul><li>5% underweight (BMI<18.5) </li></ul></ul><ul><ul><li>22% over weight (BMI: 25~30) </li></ul></ul><ul><ul><li>33% obese (BMI>30) </li></ul></ul><ul><ul><li>(Millen et al., 2001) </li></ul></ul><ul><li>A common complaint among postmenopausal women is weight gain. </li></ul><ul><ul><li>Central obesity </li></ul></ul><ul><ul><li>(Thompson, ACSM, 2003) </li></ul></ul><ul><li>Indicate that 44% of women are attempting to lose weight, with less than ½ of these women </li></ul><ul><ul><li>Reducing energy intake & exercise ≧150 min/wk </li></ul></ul><ul><ul><ul><li>(Serdula, 1999) </li></ul></ul></ul>
  8. 8. Risk of menopause women <ul><li>Why well body composition is important? </li></ul><ul><li>Body fat </li></ul><ul><ul><li>Gain weight, Change fat distribution, Obesity population </li></ul></ul><ul><ul><li>Increasing risk </li></ul></ul><ul><ul><ul><li>Coronary heart disease (CHD) </li></ul></ul></ul><ul><ul><ul><li>Metabolic diseases </li></ul></ul></ul><ul><ul><ul><li>Breast cancer </li></ul></ul></ul><ul><li>Lean mass </li></ul><ul><ul><li>Aging -> Muscle mass loss, Decrease muscle functions </li></ul></ul><ul><ul><li>Aerobic fitness, muscle strength, balance, bone density </li></ul></ul><ul><ul><ul><li>Fall </li></ul></ul></ul><ul><ul><ul><li>Osteoporosis </li></ul></ul></ul><ul><ul><ul><li>Mortality </li></ul></ul></ul><ul><ul><ul><li>(Sowers et al., 1995) </li></ul></ul></ul>
  9. 9. The vicious circle of frailty (Shore et al., 2007)
  10. 10. Treatment for postmenopausal women <ul><li>Clinical program </li></ul><ul><ul><li>Hormone replacement therapy (HRT) </li></ul></ul><ul><li>Dietary </li></ul><ul><ul><li>≦ 30% calories from fat </li></ul></ul><ul><ul><li>< 300 mg cholesterol </li></ul></ul><ul><ul><li>≧ 55% calories from total carbohydrates </li></ul></ul><ul><ul><li>Nutritional supplementation alone had no effect on muscle mass. </li></ul></ul><ul><li>Physical activity / Exercise </li></ul><ul><ul><li>Changing sedentary life style </li></ul></ul><ul><ul><li>Aerobic exercise </li></ul></ul><ul><ul><li>Strength exercise </li></ul></ul>(Maria & Fiatarone, 2000)
  11. 11. Exercise for health for postmenopausal woman <ul><li>Exercise can stimulate appetite and improve the absorption of nutrients. </li></ul><ul><ul><li>(Shore et al., 2007) </li></ul></ul><ul><li>Many exercise recommendations are benefits for postmenopausal women </li></ul><ul><ul><li>Morphological </li></ul></ul><ul><ul><li>Musculoskeletal </li></ul></ul><ul><ul><li>Motor </li></ul></ul><ul><ul><li>Cardiorespiratory </li></ul></ul><ul><ul><li>Metabolic </li></ul></ul><ul><ul><ul><li>(Asikainen et al., 2004) </li></ul></ul></ul>
  12. 12. (Asikainen et al., 2004) Walking Aerobic EX Resistance training
  13. 13. Walking 121 females Age: 48-63 yrs BMI< 32 kg/m 2 Treadmill test protocol BMI, Body mass, fat%, EX-HR, Energy expenditure W1 55% VO 2max 1500kcal W2 45% VO 2max 1000kcal W3 55% VO 2max 1000kcal W4 55% VO 2max 1500kcal 5 day/wk for 24 weeks (Min:15-20weeks) (Asikainen et al., 2004)
  14. 14. 24 wks of walking at moderate intensity improves VO 2max & body composition in slightly overweight sedentary women.
  15. 15. Walking trails (Asikainen et al., 2004) Body mass: + 0.9 kg VO 2max : + 2.1 ml/kg/min BMD: + 0.2 20min, self-selected brisk pace 1 year 84 (64y) Brooke (1997) Weight: -1.2kg Fat%: -2.1% VO 2max : +2.5 ml/kg/min 30-60min, 65% VO 2max (300kcal) 15wks 134 (57y) Asikainen (2002) Weight: -0.6 kg Fat%: -4.2% VO 2max : +14% 60min, 60%VO 2max 3~5 d/wk 24wks 79 (61y) Ready (1996) Body mass: NS Fat%: NS HR -7% 45min, 40-60% VO 2max 3~5 d/wk 26wks 80 (64y) Hamdorf (1992) Outcomes Training prescription Duration Subject
  16. 16. Benefits of walking exercise <ul><li>Low drop-out rate, high attendance and low injury rate </li></ul><ul><li>Most of the studies used walking as the primary mode of exercise. </li></ul><ul><li>6 components of HRF (health-related fitness) </li></ul><ul><ul><li>Body composition, VO 2max </li></ul></ul><ul><ul><li>BMD, BP, lipids, glucose </li></ul></ul>(Asikainen et al., 2004)
  17. 17. Aerobic exercise 33 females Age: 50-70 yrs BMI: 32 kg/m 2 Treadmill test protocol BMI, WHR, fat%, Fat mass, fat free mass, adipose tissue Weight loss (WL) Weight loss + Aerobic EX (WL+AEX) WL Restrict 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)
  18. 18. Results (Ryan et al., 2006)
  19. 19. Results (Ryan et al., 2006)
  20. 20. (Ryan et al., 2006) 6 months of WL+AEX in obese postmenopausal women can improve glucose utilization & insulin sensitivity
  21. 21. Aerobic exercise trails (Asikainen et al., 2004) 60min, high-impact, 3 d/wk High-impact, 4 d/wk 45~60min, 50~60% VO 2max , 3~4 d/wk 40min, 48-64% VO 2max , 3~ 5 d/wk 50min, low impact, 3 d/wk Training prescription Fat%: NS BMD: + 1.2% Circuit dance 1 year 80 Sipila (2002) BMC: +1.3~3.5% Jumping Stretching 1 year 164 (53y) Uusi (2003) Weight: -6% Fat%: -10% VO 2max : NS Jogging Cycling swimming 12wks 32 (54y) Shinkai (1994) VO 2max : +1.5-2.3 ml/kg/min Fat%: NS Jogging Cycling treadmill 1 year 160 (57y) King (1991) Weight: NS Fat%: -0.9% Fitness: + 17% Aerobic dance & stretching 12wks 65 (65y) Hoplcins (1990) Outcomes EX-Type Duration Subject
  22. 22. Benefits of aerobic exercise <ul><li>In conjunction with diverse aerobic exercise </li></ul><ul><li>7 components of HRF </li></ul><ul><ul><li>VO 2max , BP, body composition </li></ul></ul><ul><ul><li>Muscle strength, endurance, flexibility and balance </li></ul></ul><ul><li>It seemed aerobic exercise was more beneficial than walking. </li></ul><ul><li>Higher drop-out rate and injury rate than walking </li></ul>(Asikainen et al., 2004)
  23. 23. Resistance training 40 females Age: 50-70 yrs BMI < 25 kg/m 2 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)
  24. 24. Results (Nelson et al., 1996)
  25. 25. (Nelson et al., 1996) 1 year of resistance training can change body composition & improve leg muscle mass in older woman
  26. 26. Resistance training trails (Asikainen et al., 2004) BMD hip: +1.2% Lumbar: NS Forearm: NS 9 ex, 8 rep, 3 sets, 3 d/wk Progressive & cycling 2 years 126 (60y) Kerr (2001) BMD lumbar: +0.9% Femoral: +1% 5 ex, 80% 1 RM, 8 rep, 3 sets, 2 d/wk 40 (60y) Nelson (1996) BMD: NS Strength: +72% Back (sandbag) Progressive 30% 1 RM, 10 rep, 5 d/ wk 2 years 68 (56 y) Sinaki (1994) BMD: + 1.3% 8 ex, 70~80% 1RM, 6~8 rep, 2 sets,3 d/wk 1 year 94 (55y) Cussler (2003) Weight: NS Fat%: NS Strength: + 20~40% 12 ex, 80% 1 RM, 8 rep or 40% 1 RM, 16 rep 3 sets, 3 d/wk 24 wks 35 (51y) Bemben (2000) Outcomes Training prescription Duration Subject
  27. 27. Benefits of resistance training <ul><li>Resistance training was effective on bone & muscle fitness. </li></ul><ul><li>Strength training with weight machines </li></ul><ul><li>High impact training can improve in balance and motor control. </li></ul><ul><ul><li>Lower attendance and higher injury rate -> not very feasible </li></ul></ul><ul><li>Low-load / high-repetition are more feasible </li></ul>(Asikainen et al., 2004)
  28. 28. Exercise prescriptions <ul><li>Recommends physical activity </li></ul><ul><ul><li>30 min of moderate exercise, more days/wk (ACSM, 2003) </li></ul></ul><ul><li>Walking </li></ul><ul><ul><li>Sedentary, obesity, chronic diseases </li></ul></ul><ul><ul><li>Feasible way to start exercise </li></ul></ul><ul><li>Aerobic exercise </li></ul><ul><ul><li>Start low impact </li></ul></ul><ul><ul><li>Multiples of exercise types </li></ul></ul><ul><li>Resistance training (professional instruction) </li></ul><ul><ul><li>Low-load, 40% 1 RM, 8-10 repetition, 3 sets </li></ul></ul><ul><ul><li>Every other day to do </li></ul></ul><ul><ul><li>Total muscle balance </li></ul></ul>(Asikainen et al., 2004)
  29. 29. Conclusions <ul><li>The goal of exercise for postmenopausal women </li></ul><ul><ul><li>Lose weight and ultimately attain idea body weight </li></ul></ul><ul><ul><li>Preserve lean body tissue, lose predominantly fat mass, and preferentially visceral fat </li></ul></ul><ul><ul><li>Improve quality of independence life </li></ul></ul><ul><li>The behavior modification is most successful way to control weight & keep regular exercise </li></ul><ul><ul><li>Self-monitoring </li></ul></ul><ul><ul><li>Counting calories </li></ul></ul><ul><ul><li>Keep food and exercise diaries </li></ul></ul><ul><ul><li>Charting weight loss </li></ul></ul>(Maria & Fiatarone, 2000)
  30. 30. Thank You!
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