written by Erin Gamble, RCEP, PTA, PMA-CPT
What is menopause?
Menopause commonly refers to the time both before and after a woman’s last menstrual period. It is diagnosed when a woman has not had a menstrual period for 12 months. The stage immediately prior to menopause is referred to as “peri-menopause” and the time following menopause is referred to as “post-menopause.”
Menopause and changing hormone levels can last for more than 10 years and women may experience fluctuating hormone levels. The hormonal changes can be responsible for disruptions which may include hot flashes, sleep disruption, weight gain, loss of libido, short-term memory impairment, increased anxiety, fatigue, depression and mood swings, joint/muscle aches and pains, vaginal changes, osteoporosis, and cardiovascular disease. Most of these can be lessened with an effective exercise program.
How can we manage the symptoms?
Research has verified the positive effects of exercise and physical activity on reducing menopausal symptoms. The positive outcomes resulting from regular exercise and/or physical activity programs include increased cardiovascular fitness, improvements in body composition, decreased anxiety and depression, and enhanced feelings of well-being. Additionally, exercise and/or physical activity has, in some cases, been shown to decrease feelings of fatigue and chronic muscle pain, improve quality and duration of sleep, and increase or minimize loss of bone density.
What can we do?
Activities such as brisk walking, cycling or water aerobics that elevate your heart rate and break a sweat while still able to carry on a conversation improve cardiovascular fitness.
Starting an exercise program can be difficult, especially during a time when hormonal fluctuations result in a variety of physiological and psychological changes. The key is to remember that the main goal is to boost your health and minimize any symptoms brought about by natural body changes. It is important to choose activities that you enjoy.
The American College of Sports Medicine recommends 30 minutes a day, five days a week (or 150 minutes per week). Even short bouts of exercise lasting at least 10 minutes can be accumulated toward the 30-minutes-per-day goal. In addition to cardiovascular exercise, strength training two times a week with at least eight exercises of 8 to 12 repetitions working the whole body can result in positive outcomes (Garber et al, 2011).
For cardiovascular and strength training exercises, make sure to increase the amount of exercise gradually, starting with realistic amounts and moving toward achieving the minimum recommendations. Of course, exercising more than the minimum recommendations is helpful in minimizing symptoms of menopause. More is better!
Recent research has suggested that adding High Intensity Interval Training (HIIT) to an exercise regimen can provide even more improvement in bone density, body composition and regulation of mood. Once a consistent exercise regimen has been established, try adding one day of a higher intensity activity but for less time. For example, after a 5-10 minute warm up, ramp up your intensity for 1-2 minutes then back down to a moderate level for 3-5 minutes and keep repeating throughout the exercise bout. For the higher intensity, push yourself so you may have a harder time talking or work your way up to this level. One recent study published in the journal Menopause suggested 10 one-minute bouts of HIIT could lead to quick improvement in cardiopulmonary function for postmenopausal women (Klonizakis et al, 2014). For more information on HIIT, check out this online resource, http://www.acsm.org/docs/brochures/high-intensity-interval-training.pdf.
It is important to consult your physician on a regular schedule as peri-menopause approaches and work with him or her to balance the changing needs of your body. Be sure to use exercise to help manage complications brought about by this life change.
written by Hiromi Ozawa, DPT, CSCS, PMA-CPT
I am just like you. I have experienced pain and injuries in the past which restricted me from working out. When I played competitive softball in Japan while growing up, I had multiple injuries from fracture to muscle tear in both LE and UE. So, this is what I used to do.
I experience pain in my body --> wait and see if the pain goes away in a couple of weeks --> if the pain does not go away, I take over the counter pain medication, such as Tylenol or Advil, etc. --> if pain persists with movement or disrupts my activity or sleep --> I seek a medical consultation. There are many professionals that can help me with “pain” from the Western Medicine practitioners to the Eastern Medicine practitioners. Sound familiar? Is this what you do too?
Being a physical therapist who has been seeing people with orthopaedic injuries for the past 12 years, I realize that our profession has had a "near-sighted" approach to our treatment patterns. Moreover, this "near-sighted" approach blinded us how we can serve our communities to keep moving better.
As much as this “near-sighted” approach is important, a “far-sighted” approach is much needed in our profession for the communities. While my experience increased as a PT, many of my patients/clients have revealed what I was missing: the Critical Point.
The Critical Point is, “Is each joint stacked up evenly as the body is designed to be?” How many of us has never experienced injuries, pain or “off”ness (“something is off” in my body”)? I must say it is small number of the population can say “never had anything.”
The human body, especially in the study of human movement (Kinesiology), takes the path of least resistance. Our scientists call it “efficient” movement. “Efficient movement” does not necessarily mean “optimal movement” for the body. The body adapts well to the environment to which we are exposed. The history of injuries is a very important piece to the puzzle of muscle imbalance.
So What is the key stone of our skeleton?
My answer is PELVIS / SI joint.
Imagine you are playing with wooden blocks (like you did when you are a kid?!?!). You create two columns and create an arch to connect the two. You place a key stone like a roman arch on the top to complete the arch. The key stone is your pelvis. The weight loads evenly from the top of the arch.
Imagine when this key stone does not fit. The arch will be disrupted and everything below must accommodate for what happens to the arch to keep the balance.
Imagine when some of the blocks on the columns are not stacked evenly, the arch must adjust to the unevenness of the two columns.
Imagine the space between the blocks is your joint and it does not fit right when you are just standing.
So, what does this mean?
Joint congruency is the best health you can provide for your joint. Muscle imbalance will be restored more efficiently if our joints are moving the way they are designed to and the joint congruency is restored.
Preservation of our joint starts when we are young, but it is not too late to restore the joint congruency when you are older. Usually, in this case, the pain decreases with activity.
I have seen many patients with osteoarthritis of hip, knee and ankle joints. When I hear uneven wear and tear of the cartilage, I must wonder why and how the uneven wear and tear happened in the joints.
Many of our patients come to see us at Nexus with multiple diagnoses. Based on our experiences working with our patients, many injuries / pain that our patients have had in the past is oftentimes related to the pain that they are currently experiencing, and when the joint alignment is restored, the way we move changes closer to the optimal movement. The best clinician has the eyes that can “zoom-in” and “zoom-out” based on our patients’ needs.
This is the “far-sighted” treatment approach to preserve our joints as long as we can and age well.
At the end, we just want to age well…
Hiromi Ozawa, DPT, CSCS, PMA®-CPT