Work package 2: The study of women before and after the menopausal transition – University of Copenhagen

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Work package 2

The study of women before and after the menopausal transition

Work package-leader: Ylva Hellsten

Work package 2 will evaluate the potential of physical activity to counteract known health related risk factors (e.g. cardiovascular function, metabolism, bone density) as well as psychological and sociological stress factors associated with the menopausal phase. Furthermore, by subsequent psycho-social intervention we will assess whether professional coaching is an efficient strategy to improve motivation and adherence to regular physical activity in post menopausal women.

BackgroundTil toppen

In middle aged women, the menopausal transition is associated with a 60% increased risk of developing the metabolic syndrome (i.e. central obesity, insulin resistance, increased blood pressure and dyslipidemia). This may also partially explain the apparent acceleration in cardiovascular disease (CVD) after menopause, CVD being the primary cause of death for women in westernized countries (Carr et al 2003; Park et al 2003).

Apart from physiological changes, women in this phase of life are confronted with several psychological and sociological challenges that can influence their self-concept and well-being (Gibbs et al 2012; Lopata et al 2003). The adverse physiological changes in this period have been related to loss of estrogens and since hormonal replacement therapy has been shown to induce negative side effects (Rossouw et al 2006), alternative management strategies are needed. Physical activity induces many of the same health related effects as estrogen (Faulds et al 2012; Novella et al 2012; Pedersen et al 2006) and could thereby counteract the increased risk of metabolic syndrome in postmenopausal women.

Overall aimTil toppen

We wish to determine if physical activity can be used as a physiological intervention to oppose the increase in health risk factors associated with the menopausal phase and hence improve health (physical, mental as well as social well-bring) of these women. Furthermore, by subsequent psycho-social interventions we will assess whether coaching can be used to promote motivation and adherence to regular physical activity in post menopausal women.

HypothesesTil toppen

  • Physical activity during early post menopause will counteract the adverse effects of estrogen loss on insulin sensitivity, cardio-vascular function, bone mass density and body composition.
  • Physically active women before and during menopause will show a more positive selfconcept, higher quality of life and lower anxiety and depression levels than women who are inactive.
  • Physical activity helps to cope with the sociological challenges of the menopause: The active women (particularly in response to team sport) will have more social contacts and a higher degree of self-esteem, well-being and empowerment than the members of the control group.
  • By coaching interventions in post menopausal women it is possible to positively influence motivation for and adherence to regular physical activity.

Til toppenDesign and methods

Thirty pre- and 120 post- menopausal women (age: 45-57 yrs, BMI: 19-30) will be included in a multivariable, rigidly controlled intervention study for 5 month, followed by a two year follow up period. Their menopausal status is evaluated based on self-report and hormonal levels. The participants are compared with regard to health (physical, mental as well as social wellbring) before and after (3, 10, 22, and 34 months) a 3 month training intervention (either same training as in WP1). Thirty post menopausal women will afterwards undergo two forms for coaching intervention (3 month group coaching vs. motivational interviewing) to improve motivation for and adherence to physical activity (Miller et al 2002; Stelter et al 2011). All subjects will undergo basic physiological, psychological and sociological evaluations allowing for comparison of women between the different work packages. Furthermore, fifteen participants in each group undergo in depth evaluation to obtain mechanistic physiological, qualitative psychological and sociological insight. In depth physiological procedures include measurement of bone density, cardio-vascular function, insulin sensitivity, muscle and fat tissue biopsies and microdialysis. Molecular signaling mechanisms will be studied by the use of methods already existing in the research group or via development in WP5.

ReferencesTil toppen

Carr MC. The emergence of the metabolic syndrome with menopause. J Clin Endocrinol Metab 88: 2404-2411, 2003.

Park YW, Zhu S, Palaniappan L, Heshka S, Carnethon MR and Heymsfield SB. The metabolic syndrome: prevalence and associated risk factor findings in the US population from the Third National Health and Nutrition Examination Survey, 1988-1994. Arch Intern Med 163: 427-436, 2003.

Gibbs Z, Lee S and Kulkarni J. What factors determine whether a woman becomes depressed during the perimenopause? Arch Womens Ment Health 15: 323-332, 2012.

Lopata HZ and Levy JA. Social problems across the life course. Lanham, Md: Rowman & Littlefield Publishers., 2003.

Rossouw JE. Implications of recent clinical trials of postmenopausal hormone therapy for management of cardiovascular disease. Ann N Y Acad Sci 1089: 444-453, 2006.

Faulds MH, Zhao C, Dahlman-Wright K and Gustafsson JA. The diversity of sex steroid action: regulation of metabolism by estrogen signaling. J Endocrinol 212: 3-12, 2012.

Novella S, Dantas AP, Segarra G, Medina P and Hermenegildo C. Vascular Aging in Women: is Estrogen the Fountain of Youth? Front Physiol 3: 165, 2012.

Pedersen BK and Saltin B. Evidence for prescribing exercise as therapy in chronic disease. Scand J Med Sci Sports 16 Suppl 1: 3-63, 2006.

Miller WR and Rollnick SP. Motivational interviewing. Guilford Press, 2002.

Stelter R, Nielsen G and Wikman J. Narrative-collaborative group coaching develops social capital - A randomized control trial and further implications of the social impact of the intervention. Coaching: An international Journal of Theory, Research and Practice 4: 123-137, 2011.

Til toppenResearchers

Researchers, work package 2