NON-HORMONAL MANAGEMENT OF THE MENOPAUSE: EXERCISE

Throughout life, exercise is important for the maintenance of bone mass and for a healthy heart and cardiovascular system. Looking after the heart and blood vessels pre-menopausally by taking adequate exercise and eating a sensible diet will provide a cushion of protection against cardiovascular problems which may increase at the menopause as oestrogen levels decline.

All forms of exercise are helpful. In the peri-menopause years muscle-strengthening exercises which concentrate on the large muscle groups (abdominals, back muscles and hamstrings) are particularly good. These are known as anaerobic (or isometric) exercises and, unlike aerobic exercise, they use little oxygen because the muscles move rapidly then stop. The Canadian 5BX programme (available from bookshops) is an example of anaerobic exercise.

For individuals with access to a gym, effective aerobic exercises might include walking on a treadmill or using an exercise bicycle. The treadmill and bicycle ergometer are ways of measuring fitness progress. The first calculation to gauge the initial level of fitness is the 'maximal oxygen intake' (VO2 max). V02 max is estimated from pulse rate measurements during a stationary bicycle test. Average values range from 25 to 45 millilitres per kilogram per minute, which regular exercise can increase by up to 30 per cent. The aim should be to maintain the VO2 max at an above-average level.

A personal programme can be devised which will allow the heart rate, during exercise, to be increased until the rate of 70-80 per cent of maximal rate can be maintained for 30 minutes, three or four times weekly. Maximal rate is calculated by subtracting the individual's age from 200. The type of aerobic exercise should be altered from time to time in order to reduce boredom and make the experience pleasurable; group activities such as square, ballroom and folk dancing are helpful and very enjoyable for some. Ideally, two sessions of muscular exercise and three or four sessions of aerobic exercise should be engaged in each week.

At the menopause it is wise to reduce any exercise which involves over-extending or overflexing the back (extension or flexion) to prevent any injury to the spine, which may have already been weakened. If osteoporosis is present exercise should be restricted to walking and swimming, the former with well-cushioned footwear. Structured walking is very beneficial - for example, take a time frame of 30-45 minutes each day or every second day and divide it into three equal phases of 10-15 minutes. Phase one is warm-up; phase two is the aerobic or cardiovascular phase, when the heart rate should be maintained at a level of 200 minus your age (check this by taking your pulse); phase three is the cool-down phase, when you return to the starting point at a slow pace. Everyday exercise is useful, too: shopping, exercising the dog, climbing stairs rather than taking a lift, walking instead of using buses or a car for short distances and so on.

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Women's health

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