make changes or adopt positive behaviours. Activity may have an additional benefit for these women in promoting

a greater sense of self-esteem and self-efficacy leading to greater success in changing behaviours.

Mental health The benefits of activity on mental health are well documented and evidenced and are as important during the peri-menopause and menopause. Activity and exercise can reduce the risk of and severity of mental health problems such as depression, stress and anxiety together with a potential reduction of mood swings (11).

Quality of life It is equally important for women to continue with activity after the menopause to help maintain or improve physical functioning and quality of life. Strength and balance training will help to improve confidence and reduce the risk of falling, while aerobic activity will help maintain a healthy lipid profile and cardiovascular function (11,12,13,14).

Menopause symptoms Research indicates that age 40 may be a pivotal time for women to adopt positive health behaviours, perhaps due in part to the looming menopause. Starting at this age, or younger, also assists in making these changes permanent and appears to offer not only protective benefits for the effects of menopause but also a reduction in symptoms (11).

RECOMMENDED ACTIVITY The recommendations for activity for peri-menopausal, menopausal and post-menopausal women are similar to the general activity guidelines for adults from the Chief Medical Officer (15). However there are additional recommendations for women over 50 or post-menopause that need to be taken into account when planning exercise (16).

Aerobic activity Women should aim for 30 minutes a day on at least five days per week, or 150 minutes per week. This should be at a moderate level – aim to be working at a higher rate than normal activity, equivalent to a brisk walk pace or 5 on the

As many of the documented effects of menopause take place in the peri-menopause – that is the years leading up to cessation of periods – it makes sense for women aged 35 and over to start, or maintain, some form or regular exercise and activity as early as possible in order to reduce some of these effects

CR10 Rating of Perceived Exertion scale. For women who are starting activity or who experience significant or uncomfortable symptoms, building up to 30 minutes in 10 minute bouts of activity is recommended. Women who are already active may choose to do 20 minutes of vigorous activity at least three times per week.

Muscular strength and endurance Twice weekly sessions of resistance training are recommended and should utilise a whole body approach of eight or more exercises and 8-12 repetitions of each exercise. Resistance can take the form of machines, weights, body weight or bands and should be heavy enough to challenge using up to 12 repetitions.

Bone boosting Some form of bone loading activity is also recommended (5,8) and this can take the form of high intensity aerobics, weight bearing exercise, resistance exercise or walking up and down hills. There do not appear to be significant benefits from low to moderate intensity walking (5), however walking for more than three hours per week may be associated with a lower hip fracture risk and potentially contribute to lower falls risk.

For women diagnosed with osteoporosis, the American College of Sports Medicine recommends the following guidelines to help

Drug

TABLE 1: MEDICATIONS – THE BENEFITS AND SIDE EFFECTS Action

Hormone replacement therapy (HRT)

Anti-hypertensive

Selective oestrogen receptor modulators (SERMs)

Calcitonin

Calcium/vitamin D Bis-phosphonates

Reduce long term effects of decreased oestrogen levels

Reduces night sweats and hot flushes

Mimics action of oestrogen. Reduce vertebral fracture risk

Lowers circulating calcium Nutrient supplementation

Bind to bone matrix to prevent reabsorption of bone cells. Decrease fracture risk

Side effects

Hypertension, weight gain, thrombosis, headaches, depression

Dry mouth, drowsiness, depression, fluid retention

Due to the increased risk of osteoporosis the following medications may also be used:

Leg cramps, swollen ankles, feet and hands, flu like symptoms

GI upset, tingling hands GI upset

Diarrhoea, nausea, abdominal pain, headache, muscle/bone pain

18

The REPs Journal 2011;21(June):15-22