Menopause, Sleep, and Fitness: Training Menopausal Clients

A symptom of menopause is sleep problems. Hot flashes and sweating make it difficult to sleep. The National Sleep Foundation indicates 61% of menopausal women have sleep problems (www.sleepfoundation.org). This article will discuss ways to enhance sleep during menopause.
Proper sleep is critical for having the energy to exercise. We will talk about the benefits of low intensity exercise, such as yoga or Tai Chai, when sleep is poor, and energy is low.
In addition, osteoporosis risk increases following menopause, therefore strength training is a “must” for all menopausal clients. High-intensity, and low-intensity, resistance training increases and maintains bone density and increases muscle strength and balance (Petersen, Hastings, & Gottschall, 2017). Strength training exercises for menopausal clients will be reviewed.

Learning Objectives:

1. Identify ways to improve sleep for menopausal clients.
2. Prioritize the exercises that are essential for menopausal clients relating to bone mineral density, muscle strength, and training when energy is low.
3. Contrast the benefits of mind-body exercise such as Tai Chi and yoga.

Symptoms of Menopause

The physical symptoms of menopause include hot flashes, night sweats, chills, disrupted sleep, slower metabolism and weight gain, irregular periods, and lower energy (www.mayoclinic.org). Menopause can be a difficult and frustrating time for women because the hot flashes can make them feel suddenly hot. The skin may flush red and heart rate can increase. Then a woman may suddenly feel cold. Night sweats/hot flashes happen during sleep, and many times wake the women, causing disrupted sleep (www.webmd.com). A hot flash lasts an average of three minutes and almost always disrupts sleep, causing fatigue in the morning. (www.sleepfoundation.org). With a lack of sleep and fatigue, it is hard for a client to maintain her fitness.

Importance of Sleep for Fitness and Health

The most common symptoms of chronic poor sleep include irritability, memory loss, high blood pressure, headaches, and muscle aches. Without enough hours of restorative sleep, it’s harder to work, create, communicate, work-out, and maintain fitness (Alhola and Polo-Kantola, 2007).

Roehrs, et al., (2004) showed the importance of getting enough sleep in their research where they forced 8-hour sleepers to get 6-hours of sleep. This lack of sleep impaired performance the same as drinking 2 - 3 beers would. Getting 4 hours of sleep impaired performance the same as drinking 5 – 6 beers would.

Sleep Enhances Performance

Mah (2011) indicates sleep is an important factor in peak athletic and fitness performance, and that athletes may be able to enhance training and competition by maximizing the benefits of sleep. Walker and Stickgold (2006) indicate there is a relationship between sleep and consolidation of skill, memory and performance enhancement. Proper sleep helps fitness clients by enhancing performance, improving reaction time, increasing energy, and improved mood.

Tips to Enhance Sleep

There are many ways to enhance sleep during menopause. Advise clients to sleep in loose natural fiber (cotton) clothing to reduce heat accumulation, keep the bedroom cool with a temperature between 60 – 68 F, and maintain a regular sleep schedule.

One of the most important tips is no computer, cell phone or tablet 1.5 hours prior to bedtime. The LED light tells the brain to be awake and prevents sleepiness by suppressing the production of melatonin (sleep hormone). Limit caffeine, especially in the afternoon and evening. And limit alcohol, especially excessive consumption before bed.

Start to wind down 1 – 3 hours before bed time. Start a pre-sleep ritual to prepare the body and mind for sleep. And control for factors such as background noise, intrusive events, block out light by using black out curtains, use a reliable, regular, effective alarm clock (if using a cell phone put it on airplane mode), use a comfortable mattress and pillow, and make sure your house is safe and doors and windows are locked.

Osteoporosis

Osteoporosis risk increases following menopause. Osteoporosis is a condition that causes bones to lose density and become brittle and weak, increasing the risk of fractures in the thoracic vertebrae, hips, and wrists (www.mayoclinic.org). Since osteoporosis risk increases following menopause, strength training is a “must” for all menopausal clients. High and low intensity resistance training increases bone mineral density (BMD), muscle strength, and balance (Petersen, Hastings, and Gottschall, 2017).

Tips for Resistance Training for Menopausal Clients

Osteoporosis affects three primary areas of the body: 1) thoracic vertebrae, 2) head of the femur, and 3) wrist. As such, resistance training must be focused on increasing bone mineral density of these three areas, especially the thoracic spine. The mechanism of increasing BMD is the muscle pulling on a tendon which pulls on bone, through mechanical loading, stimulating bone formation and retaining calcium in the bones that are bearing the load. Use only neutral spine loading exercises, avoiding trunk flexion and lateral flexion (Betz 2005).

Some of the most important exercises include the following:

• Standing or Seated Cable Row – using cable machines or rubber resistance. This is focused resistance for the thoracic spine and as such, the movement is shoulder horizontal abduction or shoulder extension, depending on how high or low the elbows are. Teaching cues: maintain neutral spine and “squeeze” scapula together.
• Standing or Seated Chest Press – using machines or rubber resistance. This is focused resistance for the wrists. Teaching cues: maintain neutral spine and perform shoulder horizontal adduction.
• Front Plank on elbows and toes, or elbows and knees. It is of the utmost importance to monitor a clients’ spine to make sure it is neutral. This is a focused exercise for the core.
• Back Plank on Shoulders with feet on a BOSU. Neutral spine loading is a must.  This is a focused exercise for the spine extensors.
• Lunges with or without external weight. This is a focused exercise for the femur. Holding weights in hands.
• Seated Leg Press. A focused exercise for the femur. Teaching cue is not to go past 90 degrees of knee flexion and never lock the knees in full extension.
• Squats with or without external weight. If the client wants to add weight to the squat, it may be a best practice to have her hold weights in her hands rather than perform back squats. This will mimic more real life lifting activities.

Tai Chi and Yoga for the Menopausal Client

Innes, Selfe, and Vishnu (2010) conducted a review of literature on mind-body exercises for menopausal symptoms. The exercises included: yoga and/or meditation-based programs, Tai Chi, and other relaxation practices, including muscle relaxation and breath-based techniques, relaxation response training, and low frequency sound-wave therapy. Eight of the nine studies using yoga, Tai Chi, and meditation-based programs showed improvement in over-all menopausal symptoms and night sweats/flashes, six of seven studies showed improved mood and sleep with yoga-based programs, and four studies reported reduced musculoskeletal pain. Results from the remaining nine trials suggest that breath-based and other relaxation therapies also show promise for alleviating menopausal symptoms and night sweats/hot flashes.

References

Alhola, P., and Polo-Kantola, P. (2007) Sleep deprivation: Impact on cognitive performance, Neuropsychiatric Disease and Treatment, 3(5): 553–567.

Avis, N.E. et al., (2001) Longitudinal study of hormone levels and depression among women transitioning through menopause. Climacteric, 4(3):243-249.

Betz, S. Modifying Pilates for Clients with Osteoporosis. IDEA Fitness Journal, https://www.ideafit.com/fitness-library/modifying-pilates-for-clients-with-osteoporosis, Retrieved June 22, 2018.

Innes, K. E., Selfe, T. K. and Vishnu, A. (2010) Mind-body Therapies for Menopausal Symptoms: A Systematic Review, Maturitas, 66(2): 135–149.

Menopause: Signs and Symptoms, https://www.mayoclinic.org/diseases-conditions/menopause/symptoms-causes/syc-20353397 , Retrieved June 23, 2018.

National Sleep Foundation, https://sleepfoundation.org/sleep-topics/menopause-and-sleep , Retrieved June 21, 2018.

Petersen, B.A., Hastings, B., and Gottschall, J. S. (2017) Low load, high repetition resistance training program increases bone mineral density in untrained adults, Journal of Sports Medicine and Physical Fitness, 57(1-2):70-76.

Roehers, T.A., et al. (2004) Ethanol and Sleep Loss: A “Dose” Comparison of Impairing Effects, Sleep 26(8):981-985.