By: Tanvi Maharaja
Women stand at a strategic, even precarious, point in their lives as they enter the phase of menopause. Beyond the annoying symptoms of hot flashes, vaginal dryness, and mood swings, there is one aspect of health that menopause touches upon that can greatly impact the quality of life: bone health. Sedentary menopausal women are at an increased risk of bone loss as large as 20% to 30% and their risk of fracture is about 40%. This is especially true for women whose dietary calcium intake does not meet prescribed nutritional guidelines, who are sedentary, and have not undertaken hormone replacement therapy (HRT).
Metcalfe et al. (2001) conducted a seminal study, famously known as the BEST study (Bone, Estrogen, Strength Training) to study the effects of a supervised, structured, community-based resistance training program to evaluate its effects on the bone health of post menopausal women. The exercise routine was simple, beginning with warm up, and building up to resistance of small and large muscle groups, followed by core strengthening, and stretching and balance exercises. This seems to be a well-rounded program that not only promotes bone health through increased loading, but also helps to improve neuromotor control which plays a key role in minimizing fall risk in high-risk individuals.
The other take-away from this study, which can be extrapolated to almost any exercise routine, is the setting of personal best, individualized goals, and maintaining exercise logs. This promotes a unique pathway to advancing personal exercise routines in a community setting. The community environment itself plays a significant role, working as a stress-buster, promoting social interaction, and adding the element of psychosocial support.
The results depicted 30% to 70% increase in muscle strength in women, with and without HRT. In only 12 months, bone health increased 2% more in women on the exercise program compared to a control group. Though this number may seem small, it is important to remember that this was only a one year study; cumulative effects in the long term may be even more substantial.
So, let us look at the recommended exercises. The seated leg press, seated row, back extension, lateral pull down, one-arm military press, and wall squats seem to target the big muscle groups through a high-load, low-repetition regime. Exercises should always be initiated under the supervision of a healthcare professional, with follow-up for customized progressions as needed.
Osteoporosis leads to a variety of complications, mostly related to fractures, including cardiac deconditioning, pressure ulcers and deep vein thrombosis from being immobilized, infections, cardiopulmonary complications, and loss of social interaction. Osteoporosis is managed through a multimodal management program consisting of nutritional changes or dietary recommendations, pharmacological intervention, and physical therapy. Resistance training in a group setting seems a very reasonable, cost-effective, simple, and efficient way to manage and prevent osteoporosis and related complications as proven by the study by Metcalfe et al. (2011).