Laura has just returned from the doctor with a clear diagnosis: at 51 years old, following more than a year since her last period, she has just begun the postmenopause stage. Her doubts assail him, but above all she worries regarding osteoporosis. Her doctor has indicated to her the characteristics of this period and the importance of physical exercise and having an active life, but how does this affect her bones and what can she do to compensate for the negative effect of menopause on her her health?
In this phase there is a decrease in the production of female sex hormones (estrogen and progesterone). Particularly, estradiol has a beneficial effect on bone health and, therefore, menopause contributes to the loss of bone mineral density in an accelerated manner. It is called osteopenia and, in the more advanced stages, the bone can lose greater density and its structure might deteriorate until it causes osteoporosis (porous bone), or even a bone fracture.
For this reason, the role of physical exercise is essential as a tool to prevent and reverse osteoporosis. Studies show that physical exercise is favorable when it comes to preventing fractures and reducing the number of falls, especially when its supervision is focused on the bone regions most affected by the loss of bone mineral density in the lumbar area: the head and neck of the femur and hip region; These are, in turn, the areas most likely to suffer an osteoporotic fracture.
Scientific research has shown moderate benefits of physical exercise on bone mineral density in the lumbar region, femur and hip in postmenopausal women, regardless of bone status or menopausal phase. Likewise, there is a favorable effect, regardless of the type of exercise (aerobic, strength or combined) that is performed when it comes to improving the level of bone mineral density.
The effect of exercise on bone mineral density loss may be more beneficial in the early stages of menopause compared to later stages. The studies are clear in this sense: people who do impact activities and strength training have losses in bone mineral density between 1% and 3% less than people who do not exercise; and the benefits are greater if progressive strength exercises are incorporated, especially in the lower body.
However, there are certain physical activities that are not as favorable due to the lack of stimulation on the bone, so they will not produce the same benefits as the activities indicated above. Although aerobic training can be beneficial for other aspects of health, swimming or cycling is not recommended if the goal of training is to improve bone health.
On the other hand, current scientific evidence is indicating a possible negative effect associated with the consumption of contraceptives for long periods, especially those based solely on progestogens. If you have reached menopause and have taken contraceptives for a long time, exercising is essential for bone health.
For all those reasons, these are the most recent recommendations, set out in 2022 in the UK Consensus Statement on physical activity and exercise for osteoporosis:
To increase your bone strength:
Introduce impact exercises.
- Type of activity: progress from activities that involve a mild impact (walking, marching, climbing stairs, Nordic walking, etc.) to those that involve a moderate impact (low jumps, skippingjogging, zumba, racquet sports, team sports, etc.). It is important to include variety of movement (changes of direction, speeds, etc.).
- Frequency and quantity per week: most days. 20 minute sessions are enough. If you are already introducing moderate impacts (jumps, jogs or changes of direction), 50 impacts are enough.
Introduce strength exercises:
- Type of activity: you must introduce strength training, preferably with weights, for both the upper and lower limbs. Spine and hip extension exercises are especially important, and so is progressing in loads.
- Frequency and quantity per week: 2-3 times per week and 3-4 sets per exercise are sufficient. Building muscle mass will benefit bone health.
- Exercise intensity: make a progression in the loads. First, prioritize technique and try to work with loads of up to 80-85% (high loads).
Introduce exercises that challenge balance
Specific strength and balance training can prevent falls, a very important factor in avoiding fractures.
- Type of activity: specific balance exercises or activities such as tai chi, dance, yoga or pilates.
- Frequency and quantity per week: 2-3 times a week. But if you have had a fall, the recommendation is to do them daily.
Introduce postural exercises and strength exercises in the abdominal region (‘core’):
- Type of activity: exercises coreespecially focused on spinal erectors. Other types of activity that contribute to this goal are swimming, yoga and Pilates.
- Frequency and quantity: 2-3 days per week.
However, the level of bone mineral density of the person who begins the training program must be taken into account to include some exercises or others, since the training design is different for a person who already has osteoporosis or for a person who has a correct level of bone mineral density. Therefore, it is always advisable to have a physical activity and exercise professional for the correct guideline and supervision of the program.
Exercising is a fundamental part of our health, especially if we enter that new phase of life where menopause tests us. We must respond with movement and life.
