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Preserving Cardiovascular Health through Exercise: Timing is Crucial

A 2022 paper published in the Journal of Physiology proposes that beginning physical activity at or soon after menopause may be more effective in reducing cardiovascular risk compared to starting at a later stage in life.

Menopause, marked by the loss of estrogen, significantly increases the risk of cardiovascular events due to impaired vascular endothelial function, elevated blood pressure, and a higher susceptibility to atherosclerosis. Although vascular changes are an inherent part of chronological aging, they manifest more prominently in menopausal women, particularly in those who are physically inactive. Within a few years of menopause, women eliminate the risk advantage they had compared to men when they were younger. Cardiovascular disease is the leading cause of death among women.

In "The time is now: regular exercise maintains vascular health in ageing women," Tamariz-Ellermann and colleagues examine the timing of exercise initiation in women for preserving cardiovascular health. They suggest that keeping lifelong fitness is the most effective strategy. The second-best strategy is to start now! Initiating an exercise routine at the time of menopause may be more effective than starting later (see figure). Although the mechanisms of action of estrogen and exercise during pre-menopause, peri-menopause, and menopause are not fully understood, the researchers hypothesize that exercise can alleviate some of the cardiovascular impacts of reduced estrogen during menopause because both estrogen and skeletal muscle contraction (exercise) activate the same cellular pathway - that is, they both cause activation of the endothelial cell estrogen response element (ERE), albeit through different mechanisms. Activation of ERE in endothelial cells may enhance the regulation of vascular function by increasing nitric oxide availability, leading to blood vessel dilation and improved blood flow.

Although vascular benefits can be obtained at all ages, starting physical activity at or soon after menopause may be more effective than at a later point in life. This aligns with both intuition and scientific evidence. Intuition suggests that preventing decrements is easier than trying to regain lost vascular health. Scientific research has shown that the exercise pathway to activate ERE is more effective soon after menopause compared to later in menopause. Studies also show a significant increase in a critical protein involved in the exercise pathway to activate ERE in menopausal women following exercise training. Unfortunately, sedentary women show a decline in this crucial protein in the years after menopause.

In summary, lifelong fitness is the most effective way to preserve vascular health, but starting exercise near the time of menopause is the second-best strategy for maintaining cardiovascular health. Talk with your doctor about your cardiovascular risk factors to figure out the strategy that's right for you.

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