- Learn the process of the female menstrual cycle and how it is affected with the onset of menopause,
- Discover the hormonal imbalances at play with menopause and what hormones can help to counteract that, and
- Learn the programming strategies that can be manipulated and what gears and goals to target when training the menopausal client.
On average there is a 16-year span in a woman’s life where the fundamental and biological rhythms of her hormones can fluctuate; a transitional time in life labeled menopause. This transition leaves a woman standing in front of an open freezer plagued with hot flashes; endlessly looking for her keys which she holds in her hand; trying to button up the tight pants worn the day before, but now unable to fit into; and questioning every motive she started the day with. Menopause is estimated to affect 39 million women in the United States based on its age range, and about 2 million more will reach menopause years annually in the coming year (Luque, 2012). The expected age range for a female to go through menopause is 42-58 years (Wikipedia, 2012), and although the age is important, we must define what this transition period actually means for a female, their symptoms, and exercise programming.
The term menopause is often used to describe three distinct stages in a woman’s life: Premenopause, Perimenopause, and Postmenopause. Premenopasue is the time when menstruation is normal. Perimenopause is when menstruation becomes more infrequent, a stage that includes the year following the final period. Postmenopause is the time when the ovaries have stopped functioning and the menstruation has ceased for at least 12 months (Luque, 2012). In this article, we will be using the word “menopause” while referring to the perimenopause stage.
The Female Menstrual Cycle
In order to first understand what is happening during menopause, one must start by grasping the foundations of the female menstrual cycle. In the normal female cycle, the ovaries produce estradiol, testosterone, and progesterone in a cyclical pattern under the control of FSH and luteinizing hormone (LH), which are both produced by the pituitary gland (Wikipedia, 2012). This cycle can be seen in a series of steps laid out in this chart:
In short, the hypothalamus releases follicle-stimulating hormone (FSH), which triggers the ovaries to begin to increase the release of estrogen (aka - estrodial). There is a period of time that this takes place and the levels of estrogen rise relative to progesterone levels, which is the time where the uterine lining is growing and thickening (Teta, 2009). After the first 2 weeks of the cycle, around 14 days, the ovaries release an egg, and the pituitary gland is then stimulated to release luteinizing hormone (LH). This then triggers the release of progesterone and testosterone. This change in hormones helps to prepare the uterus to become more granular and will allow a fertilized egg to become implanted. If the egg is not fertilized, it will die and the woman will have her period (Shier, 2000).
Hormones of Perimenopause
As a female ages, and the cycle of life determines they are no longer capable of bearing children, the pituitary gland is triggered to release an increased amount of FSH, which then triggers a greater production of estrogen. This causes the beginnings of the female perimenopausal cycle to start, and hormonal imbalances follow.
With the onset of an increased amount of FSH, the ovaries release a greater amount of estrogen. This excess amount is seen to the body as an internal stress. Stress is an ever constant in the modern world, and when the body encounters stress it increases the production of cortisol. This is not a good thing for women in menopause because in order to make cortisol, the body will use progesterone (Teta, 2009). When progesterone is taken away to make cortisol, there becomes an imbalance within the symbiotic relationship that estrogen and progesterone have in order to maintain a natural and stable menstrual cycle.
With excess estrogen, there becomes a need for more cortisol. In order to create cortisol, the body steals progesterone (Teta, 2009). When the 14th day of the menstrual cycle comes along, and now there is not enough progesterone to balance out the excess estrogen the female’s cycle becomes sporadic, causing spotting, irregular bleeding, discomfort, and even what could be misconstrued as a missed period. And when all is said and done, the imbalance of hormones leaves the female with a system filled with cortisol, which can have pivotal effects on weight gain, tissue degradation, and protein synthesis. Furthermore, these hormonal imbalances are accompanied by a host of other symptoms including: hot flashes, mood swings, forgetfulness, irritability, and depression to name a few. Understanding these changes will require the fitness professional to take a more in-depth look at what type of training would most benefit the female during this time in her life, that doesn’t exacerbate the hormonal imbalances.
Hormonal Effects of Exercise
Exercise is a catabolic activity, meaning that the body will breakdown complex substances into simpler substances to be used as energy to move and take on the stress of exercise. Exercise as stress will have physical, chemical, and emotional components to it, and those outcomes will be affected by the intensity and duration at which it is performed (Borer, 2003). Therefore, the intensity and duration of exercise selection will have dramatic effects on the chemical by-products (hormones) released during and after exercise, which affects how to program for a female in menopause.
For a female going through menopause, the imbalance of hormones during the menstrual cycle causes a dramatic rise in cortisol in the system, which leads to an increase of blood volume for inflammatory response, protein degradation, and muscle and connective tissue breakdown (Borer, 2003). Considering the symptoms related to menopause, where there is a loss of bone-mineral density, strength, and increase fat deposition; there couldn’t be a more pivotal time to find exercise programming that helps to combat excess cortisol, build lean tissue, and increase energy expenditure.
Although cortisol plays a permissive role in a number of vital processes necessary for adaptation to stress and survival (Borer, 2003), its role can also have detrimental effects on program success. During exercise corticotropin releasing factor (CRF) releases corticotropin (ACTH), which stimulates cortisol (Seyle, 1976). The obvious, and already stated, is that exercise is stress, and stress releases cortisol; which means that all exercise will release cortisol, but the intensity and duration will have an effect on the amount of cortisol released.
The most common form of exercise that one will participate in is something continuous and/or steady state. Yet research shows us that, continuous steady state intensity exercise bouts lasting over 15-30 minutes give a 150% increase in cortisol secretion (Borer, 2009). For a female in menopause this could halt any form of progress in weight loss, and only make the symptoms they are experiencing feel ten times worse.
So, what type of exercise helps to combat cortisol release? Other research states, the negative feedback of plasma cortisol over CRF and ACTH release is altered by intense exercise and other types of stress. A 10 minute bout of intermittent exercise at 90% VO2max reduces the steroid negative feedback over ACTH secretion (Petrides et al. 1994). To further support the findings of negative cortisol feedback during exercise, and to help a fitness professional determine how to program for menopausal females, it is necessary to dive further into what other types of hormones and research can lend a hand in developing quality programs.
Exercise performed at specified intensities above the anaerobic threshold, stimulate the release of a hormone known to help with skeletal muscle (and skeletal) hypertrophy, this hormone is known as Growth Hormone (GH). GH is released in a dose-dependant fashion at exercise intensities above the anaerobic threshold and with a delay with respect to the onset of exercise. (VanHelder et al., 1984). In further support of the anaerobic benchmark our menopausal exerciser is reaching for, is the research coming from Romijn in 1993. At exercise intensities above 80% VO2Max, catecholamine, GH, and glucagon reach their highest plasma concentrations (Romijn et al., 1993).
There it is… the golden ticket! Not seeing it yet?
VO2Max percentages keep showing up.
What’s unique about the research is that there are correlating heart rate gears to every VO2max, and by using biofeedback devices the fitness professional receives millisecond by millisecond intensity of each individual client and can map it to their specific exercise intensity needs. Therefore, if a fitness professional can see their menopausal client’s heart rate, they can assess whether or not the exercise intensity and duration will map hormonally to their needs.
The Five Gears
PTA Global has developed a priceless tool backed by proven science and research, which helps fitness professionals map exercise intensities to individuals and their goals (Hopson, 2009). For the menopausal female, in the case of cortisol and growth hormone, exercising at the right intensities could mean the difference between weight loss and weight gain. The PTA Global Tool, Gears & Goals found in their online certification & bridging course, easily shows a fitness professional how to map exercise intensities to a person’s goal.
In the chart below, is a portion of the tool called The Gears, and is critical to understanding correlating VO2Max to individual performance.
Each individual person has 5 gears. Those 5 gears coincide with heart rate percentages, and that heart rate percentage correlates to a specific VO2Max. Expanding further, each gear is analogous to a specified fuel source, whether that is aerobic or anaerobic. The heart rate percentage is the millisecond-by-millisecond feedback that can be seen and measured during exercise, and can be manipulated through the acute variables within the program to obtain the desired response for the client.
Programming for the Menopausal Client
Given that the menopausal client would benefit greatly by performing “intermittent exercise at 90% VO2Max” and “Growth Hormone is stimulated at exercise intensities above the anaerobic threshold” (around 70% VO2Max or greater), a workout program consisting of intervals would be ideal. These intervals would need to be programmed so that the client reaches heart rate percentages greater than 75% during intense periods of the exercise(s) and then recovers below 65% and repeats this throughout the workout.
For example, most training sessions are 60 minutes in duration, and contain a warm-up, a goal-based workout, and then a cool-down. A typical warm-up for a 60-minute session lasts for 10-15 minutes getting the tissues warm and ready to move and accept load. The goal-based portion of the workout last for approximately 30-35 minutes, and can be arranged in multiple ways to allow for interval training. One easy way would be to set up 3 circuits of 3 exercises. Within each circuit each exercise will be assigned a heart rate percentage gear, and organized in an order that allows for intensity to recovery. Exercise 1 in circuit one can have the goal of getting the heart rate to Gear 2, or 60-70% HR. Exercise 2 in circuit one can have the goal of getting the heart rate to Gear 3, or 70-80% HR. Exercise 3 in circuit one can have the goal of getting the heart rate to Gear 4, or 80-90% HR. All exercises are to be performed for 1 min each, meaning that each set of the circuit lasts for 3 minutes. To perform 3 sets of circuit one, with a 1-minute rest in between sets, means each circuit will take 12 minutes, and collectively includes target heart rate intervals and is programmed for recovery. Completing 3 circuits in this manner would allow the goal-based workout portion to last for 36 minutes in duration. The workout is then followed by a 10-15 minute cool-down, and the entire session has been accounted for.
To view a sample of what this would look like for a menopausal client, take a look at this video:
A Symphony of Hormones
In women, hormone levels change through their lifetime, and for the most part, their bodies have the ability to adjust. But at any time after menstruation starts, and especially when a female starts perimenopause, the shifts in their sex hormones may become too extreme or happen too quickly for their body to manage them. In a way their hormones are more like a big orchestra than solo instruments (Women to Women, 2013). It’s finding the right symphony between hormones that allows the female to become balanced.
Exercising at the right intensities can provide the body with the environment to thrive and create balance through the chemical by-products produced. Maximizing on intermittent bursts, and interval training, with intensities that hit above the anaerobic thresholds and include recovery time will be key for programming success within menopause.
- Borer, K. (2003) Exercise Endocrinology Champaign, IL: Human Kinetics
- Hopson, S (2009) PTA Global Online Personal Training Certification: Energy System Development Modules www.ptaglobal.com
- Luque, M. PhD (2012) Training Through the Transition: What does current research say about the effects of physical activity on perimenopause? IDEA Fitness Journal (Nov-Dec 2012) Vol. 9 Number 10 pp. 41-47
- Petrides, et al. (1994) Exercise-induced activation of the hypothalamo-pituitary-adrenal axis: marked differences in the sensitivity to glucocorticoid supplementation. Journal of Clinical Endocrinology and Metabolism, 77, 377-383
- Romijn, et al. (1993) Regulation of endogenous fat and carbohydrate metabolism in relation to exercise intensity and duration. American Journal of Physiology, 265, E380-E390
- Seyle, H. (1974). Stress without distress. Philadelphia: Lippincott.
- Shier, D. et al. (2000) The Essentials of Human Anatomy and Physiology Boston, MA: McGraw-Hill Companies pp.535-537
- Teta, J. (2009) Female Hormones and Fat Loss: Estrogen, progesterone, menses and fat burning. Retrieved 1/30/2012 from: http://blog.metaboliceffect.com/?p=570
- VanHelder, et al (1984) Effect of anaerobic and aerobic exercise of equal duration and work expenditure on plasma growth hormone levels. European Journal of Applied Physiology, 52, 255-257.
- Wikipedia (accessed 2/12/12) Menopause Retrieved from: http://en.wikipedia.org/wiki/Menopause
- Women to Women (accessed 5/3/2013) 16 Most Common Symptoms of Menopause Retrieved from: http://www.womentowomen.com/menopause/16mostcommon