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How Should Your Exercise Plan Change After Menopause?

Last week, we looked at some of the problems that the genitourinary syndrom of menopause (GSM) can cause when you ride a bicycle (or Peleton) and discussed ways to mitigate the problems. This week will be examine some of the other ways that menopause can complicate your cycling (and all exercise for that matter).

The physiological changes experienced during menopause likely explain why you're no longer in front on group rides, get repeatedly beaten in the sprints when you used to be the fastest, and are now the last one up the hill when you used to lead the charge. But training harder is not the correct response. I empathize with you - it was the correct answer for most of our lives and change is hard. But there are work-arounds for some of these changes that can help you stay strong and healthy.

In addition to GSM, menopausal women experience loss of muscle mass and strength, reduction in height and increased risk of fracture due to osteoporosis, poorer temperature regulation, higher levels of inflammation leading to joint pain and anemia, impaired gut performance, decreased ability to utilize proteins, loss of some ability to manage cortisol, sluggish blood vessel dilation/constriction, looser tendons and ligaments, decreased pain tolerance, disrupted sleep, increased anxiety and depression, and a weakened pelvic floor. All of those issues have a negative impact on athletic performance and increase injury risk. In good news, we know some ways to compensate for the changes we see in menopause. Sure...we may have to accept that we aren't the same athlete as we were 20 years ago, but for most of us, we learned that well before menopause when we saw slower race times between age 20 and age 40 that couldn't be blamed on menopause.

The role of estrogen and progesterone in the body is complicated and not yet completely understood. We know that there are receptors for both hormones found throughout the body, not only in reproductive organs and tissues. Estrogen and/or progesterone receptors can be found in the cardiovascular, nervous, immune, and musculoskeletal systems. The interplay of the sex hormones with other hormones, neuropeptides, and neurotransmitters throughout the body impacts physiological functions as varied as appetite, temperature regulation, bone and muscle growth, mood control, and blood pressure, among many others. The inability of menopause hormone therapy (MHT) to reverse all of the effects of menopause suggests that the effects of menopause are multi-factorial and not solely caused by decreased estrogen and progesterone. There are hormonal and non-hormonal treatments and therapies that may alleviate some of the most significant menopausal changes that impact our ability to exercise and perform at the level we would like.

Sleep Disruption

Sleep disturbances like trouble falling asleep, frequent awakenings, and/or early morning awakening, are common to menopausal women. The inability to sleep impacts every aspect of life - women experience more irritability, more brain fog, higher levels of depression and anxiety, and fatigue that makes it difficult to get through the day. Hot flashes and night sweats often can be blamed for some of the sleep issues. Some women are aware of night sweats since they wake up drenched in sweat, but others have fewer symptoms but wake up nonetheless. Hot flashes and night sweats are treated effectively by MHT. There also are effective non-hormone therapies that can be used.

If your sleep disruptions are not relieved by treating your hot flashes/night sweats, you should check your sleep routine. Are you sleeping in a cool, dark room? Are you avoiding rich foods and alcohol in the hours before bed? Did you stop your caffeine intake before noon? Are you waking up because you are hungry? If so, try consuming a casein (not whey) protein shake before bed. Casein is a protein that can keep you sated through the night. Have you tried taking a couple of deep breaths when you get into bed to signal your nervous system to relax? You can also try adding tart cherry juice, which raises melatonin levels in your body, or using a melatonin supplement. Melatonin is normally released in your body to signal you to go to sleep. For all sorts of reasons,including changes during menopause, natural circadian rhythms sometimes don't stimulate melatonin appropriately. Be careful with supplements since too much melatonin can cause a rebound effect that will keep you awake and leave you sluggish in the morning. I recommend starting with a dose not higher than 1 mg taken 30-60 minutes before bed.

Circulation Changes

As you begin to exercise, your body responds by increasing blood flow to your muscles via dilation (relaxation) of your blood vessels. In menopause, blood vessels do not respond as well to the signals because of changes in their structure. Studies demonstrate arterial stiffening and endothelial dysfunction get markedly worse once a woman reaches menopause. With regard to exercise, that means it may take menopausal women longer to get their muscles warmed up. Plan ahead to include a longer warmup prior to your workout or race. And schedule a cool down: pedal easy for 10-15 minutes after your workout to give your body a chance to react to the decreased demands.

Nitric oxide (NO) causes blood vessel dilation, which increases blood flow. The scientific data is mixed about the effects of supplementation. But you might try adding a supplement and/or eating more foods containing L-arginine (dairy products, red meat, fish and poultry) and L-citrulline (watermelon.) L-arginine and L-citrulline supplementation increase NO levels because L-arginine is directly involved in NO synthesis and L-citrulline acts as an L-arginine precursor. One study found that menopausal women taking watermelon supplements reduced their arterial stiffness. Some studies identify a more beneficial result from using supplements containing both L-arginine and L-citrulline. Based on current research, a recommended dose is 3–6 grams per day of L-citrulline or 8 grams per day of citrulline malate. Doses of L-arginine used in studies vary widely, but a good starting level is 3-6 grams per day - don't exceed 9 grams per day. When choosing your supplement, make sure to pick products that don't contain a long list of ingredients or claim a proprietary formula. It's much more difficult to know exactly what's in the bottle and what effect it will have, since nitric oxides supplements, like all other supplements, are not regulated by the FDA to ensure safety and efficacy. L-arginine and L-citrulline are considered safe, but they may cause gastrointestinal disturbances, headache, heartburn, and heart palpitations at high doses. Nitric oxide supplements may interfere with certain medications, such as blood pressure and diabetes medication, so talk with your doctor before you start taking it. Beetroot juice, which contains nitrates, can also increase NO. Drink the equivalent of the juice of two beets every day.

After exercise, women's blood tends to pool in the skin, which drops blood pressure and reduces blood flow to the exercised muscle. Have you ever found yourself lightheaded after a hard race/workout? That's the blood pressure drop. When you stop exercising without an adequate cool down, the heart loses the pumping assistance of the muscles. With blood vessels dilated and no return pumping action, blood quickly pools in the extremities, causing your blood pressure to drop. Cold water immersion can help get blood back to your core after a workout and restore circulation into the muscles. If you want to try cold plunges, shoot for 3 minutes submerged to your neck in water approximately 59 degrees. Get out for 2 minutes and repeat. Women don't need the water to be any colder because women shiver at a higher temperature than men and are more sensitive to cold.

During exercise, your body also increases blood flow to the the skin surface for cooling. The slow response of blood vessels to the increased need contributes to menopausal women not cooling as well. This results in their core temperatures during exercise rising quicker and staying higher. Aerobic performance is impaired when core temperature is higher. In a study of women of all ages, menopausal women sweated the least, were least thirsty, and most overheated. Sauna treatments might help. Their use can mitigate some of the effects of menopause by modifying your thermoregulation systems so hot temperatures feel less oppressive. Studies show this works best if you visit the sauna immediately after exercising. Using the sauna after exercise can induce an increase in your number of red blood cells (needed to carry oxygen through your body) and plasma volume which leads to an increased stroke volume with less cardiac effort. Essentially, it can give you more aerobic power.

Muscle Mass and Strength

Older women lose muscle mass and strength as a consequence of aging, but the rate of loss increases in menopausal women compared with men. Estrogen may be directly involved in muscle metabolism through estrogen receptors found on skeletal muscle. Also, estrogen plays a role in regulating carbohydrate and lipid metabolism by relieving muscle glycogen and prompting lipid oxidation, which could influence skeletal muscle composition in postmenopausal women. The loss of estrogen in menopausal women also leads to a decrease in skeletal muscle stem cells, the precursor cells for muscle, as a result of programmed cell death, which estrogen protects against in pre-menopausal women. Other studies have shown reduced force generation (strength) as well as poor recovery to muscle injury in menopausal women.

Menopausal women can mitigate some of the effects of reduced estrogen on muscles by lifting heavy weights and adding a type of high intensity interval training (HIIT) called sprint intervals (SITs) to their training plans. Stacy Sims, author of Next Level, notes that “power and speed training are essential elements in a postmenopausal woman’s training arsenal.” Data shows that HIIT causes muscle growth, increases production of human growth hormone and testosterone (which aid in muscle growth), stimulates release of vascular endothelial growth factor (which makes your blood vessels more responsive), increases the number of mitochondria (the energy powerhouse in muscle cells), improves cardiovascular function and the ability of the body to use oxygen, improves insulin sensitivity, reduces belly (visceral) fat, lowers fasting blood glucose levels, reduces stress by reducing cortisol levels, and can make you "smarter" by prompting release of brain-derived neurotropic factor (BDNF) which aids brain health.

Integrate SITs 1-2x per week during your rides (or runs or crossfit workouts). One option is to warm up, go as hard as you can for 10 seconds, recover for 10 seconds, and repeat. Aim to do 3 sets of 6-8 repetitions, but start with one set. This workout is harder than you might initially think. Make sure you have an adequate cooldown. Another option is to warm up, find a hill, then pedal at your maximum while standing for 30 seconds, recover as you coast downhill, pedal at maximum while seated for 30 seconds, recover as you coast downhill, and repeat. Start with 5-6 repetitions and add another 1-2 sets once you get used to it. Be sure to do a quality cooldown since this workout will push your body well into the red zone.

Lift weights 2-3x per week. Your muscles need the challenge that heavy weights afford to counteract the natural muscle loss that menopausal women experience. Choose exercises that use multiple large muscle groups, like squats, lunges, step-ups, renegade rows, deadlifts, and overhead press. Aim for 3 sets of 6-8 repetitions with as much weight as you can safely manage. Make sure you start with lower weights until you are confident in your ability to complete the movement.

Managing Stress

In pre-menopausal women, estrogen assists with keeping cortisol low. Cortisol, the body's stress hormone, works at receptors in virtually every system in the body. Cortisol plays an important role in the body's flight-or-fight response (the sympathetic nervous system - SNS) by keeping energy levels high when the body perceives a threat. Cortisol also slows functions that would be nonessential or harmful in a fight-or-flight situation - it reduces immune system response and suppresses the digestive system, the reproductive system and growth processes. Cortisol also helps control your sleep-wake cycle. High levels of cortisol, particularly chronically high levels, can result in weight gain, high blood sugar/diabetes, high blood pressure, excessive hair growth, muscle weakness, and bone fractures.

The effects of exercise on cortisol appear to be related to the duration and intensity. In general, the body reacts to exercise as it does any stressor - by activating the SNS, including cortisol release. Medium intensity exercise with a lot of volume, the kind that filled the bulk of our pre-menopausal training plans (e.g., 2-3 hour long rides), causes cortisol to increase in proportion to the intensity and duration of the exercise. Menopausal women no longer have estrogen to help with management of the cortisol so baseline levels rise if women keep doing the bulk of their training like they did before menopause. The result is increased abdominal fat, loss of lean muscle, and increased risk of stress fractures. Low intensity exercise, on the other hand, causes little or no rise in cortisol. I need to reiterate that low intensity, in this setting, is very should feel like you're out for a joy ride, not a workout. High intensity exercise increases cortisol, but for a short period of time because the effort is short. The best way for a menopausal woman to manage her cortisol while achieving her training goals is to polarize her training. Instead of filling the schedule with medium efforts, alternate extraordinarily easy workouts with incredibly hard, short ones. And once or twice a week, go out and do that medium intensity long ride that you love.Importantly, you must keep your easy workouts easy. Do not let them become medium intensity! You cannot add HIITs without substituting easy workouts for medium intensity ones or you will see negative effects.

Physiological changes observed during menopause can negatively impact your ability to exercise. But, with a few changes in your training routine, you can overcome most of those impacts and continue to see desired increases in your performance throughout your menopausal years.

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