Take it to Heart

Learn how exercise can be an essential part of preventing the #1 killer of men and women; heart disease

Exercise at any age is beneficial. From the neighborhood walker to the seasoned marathoner there are benefits for all. However, during the time around menopause it becomes particularly important. So why now, from menopause and beyond is exercise so crucial? The simple answer is AGING. What a word. If there is a fountain of youth I'm sure it takes sneakers to get there. The myth that women are not as vulnerable as men to
heart disease stems from the unique protective effect of estrogen.

Estrogen, one of the two major female hormones, plays a role not only in ovulation, menstruation, and pregnancy but in heart disease as well. Estrogen appears to protect premenopausal women from coronary artery disease (CAD) and heart attack, but the exact mechanism is not quite known. With the decrease of the protective effect of estrogen, one becomes vulnerable to this disease.

After the onset of menopause, there is an increase in total plasma cholesterol, higher levels of triglycerides and very low-density lipoprotein(VLDL) cholesterol - the very dense "bad cholesterol", and generally slightly lower levels of high-density lipoprotein(HDL) - the "good" cholesterol. The incidence of cardiovascular disease increases rapidly following menopause and has been thought to be largely explained by these lipid and lipoprotein changes.

Fat and cholesterol in the bloodstream turn the blood into a heavier substance that is more difficult for the heart to push through the arteries and to the smaller blood vessels. Excess cholesterol obstructions in the arteries causes the heart to work even harder, and can end up blocking the blood supply and may contribute to a heart attack.

Many people are unaware that heart disease is the leading cause of death for American women as well as men. There is a general misconception that women are somewhat immune to this disease. But nearly half of the approximately 500,000 Americans who die of heart attacks each year are female.

Although women lag ten years behind men in developing heart disease, after the age of sixty-five, women's risk of heart attack is nearly as high as men's. In addition, the survival rate for women with heart disease is significantly lower than it is for men.

Many women live long lives with healthy hearts. It's interesting to look at some of the risk factors that can be controlled through lifestyle choices.

High fat consumption
Cigarette smoking
Excessive alcohol
High blood pressure
Family history

Let's look at inactivity a little bit closer. In 1992 the American Heart Association (AHA) declared lack of exercise to be a major risk factor for heart disease, as significant as smoking, high cholesterol, and high blood pressure. The association had long said that inactivity raises risk, but found recently that scientific evidence had grown strong enough to list lack of exercise as a major risk factor. The AHA states that even modest physical activity could lower a sedentary person's risk of heart disease.

Several studies have confirmed the protective benefit of physical activity and heart health in the menopausal years. They suggest that physical activity in both men and women appear to protect them from cardiovascular disease. It has been shown that people with high level of activity had lower weight, blood pressure, triglycerides, low-density lipoprotein cholesterol, fasting insulin. These intervention studies tend to be more dramatic in men than in the postmenopausal woman.

A study by Lindheim, M.D. et al. assessed the effects of a six month moderate exercise program with and without oral estrogen replacement (ERT) on levels of lipids and lipoproteins in postmenopausal women. There were four groups, (1) exercise alone, (2) ERT alone, (3) ERT plus exercise, (4) and the control group who did not exercise or take ERT. The exercise groups participated in aerobic activity, treadmill walking and stationary bike riding three days a week for 30 minutes. Estrogen therapy alone had the greatest beneficial effect on lipids and lipoproteins. However, it was found that exercise alone resulted in a significant reduction in cholesterol, triglycerides, and LDL cholesterol with an increase in the HDL-LDL ratio. The ERT plus exercise group did not demonstrate an added improvement in lipid metabolism. The physical fitness levels increased in the exercise groups, but not in the control group or the estrogen-alone treated women.

An aerobic exercise program is recommended to strengthen your cardiovascular system. Aerobic activity are exercises that use the major muscles of the body for a sustained period of time. These include, weight-bearing exercises such as - walking, running, hiking, cross-county skiing; and non-weight -bearing exercises such as swimming and biking just to mention a few. The optimal duration is at least 30 minutes for 3-5 days a week. If
this sounds like a lot of time, don't get discourage. The American College of Sports Medicine now recommends that is also acceptable to break the half hour up into shorter bouts of 10 minutes.

For a woman in her menopausal years, it is now a time to re-evaluate her present state of physical fitness. Are you meeting the requirements for heart healthy living? Does your routine include muscle strengthening exercises to promote muscle strength, bone density and good posture? Flexibility exercise to decrease muscle soreness and aid in relaxation?

It is recommended that you do get a physical exam by your health care provider prior to embarking on an exercise program. It's helpful to get a baseline of your physical fitness through testing by a trained exercise physiologist to monitor your progression. Being physically fit is a lifelong endeavor. We may be living longer but it is certainly the quality of these years that are of importance. Something is better than nothing. So start
today. It can make the world of difference.

Written by: Lisa Hoffman, M.A.
Excerpts from her book: Better Than Ever: The 4-Week WorkOut Program for Women Over 40