Changes in Menopausal Risk Factors in Early Postmenopausal Osteopenic Women After 13 Months of High-Intensity Exercise: The Randomized Controlled ACTLIFE-RCT

Abstract

The menopausal transition is a critical period in women’s lives. Exercise might be the most promising non-pharmaceutic intervention to address the large variety of risk factors related to the pronounced estradiol decline during peri- and early-postmenopause. The aim of this study was to determine the effect of an 18-month multipurpose exercise program on risk factors and symptoms related to the menopausal transition. Fifty-four women 1–5 years postmenopause with osteopenia or osteoporosis were randomly assigned 1) to a high impact weight-bearing/high-intensity/velocity resistance training group (EG: n=27) exercising three times a week or 2) to an attendance control group (CG: n=27) that performed low-intensity exercise once a week. Both groups were supplemented with cholecalciferol and calcium. The primary study endpoint was bone mineral density (BMD) at lumbar spine (LS) and total hip, secondary outcomes were lean body mass (LBM), total and abdominal body percentage, metabolic syndrome Z-Score (MetS-Z), menopausal symptoms and muscle strength and power. Due to COVID-19, the study was stopped after 13 months. We observed significant effects for BMD-LS (EG: 0.002±.018 versus CG: −.009±0.018 mg/cm2, p=0.027) but not for BMD total hip (EG: −0.01±.016 versus CG: −.009±0.020 mg/cm2, p=0.129). LBM improved significantly in the EG and decreased in the CG (0.39±1.08 vs −0.37±1.34 kg, p=0.026). Total and abdominal body fat improved significantly in the EG and was maintained in the CG (−1.44±1.49 vs −0.02±1.55 kg, p=0.002 and -1.50±2.33 vs 0.08±2.07 kg, p=0.011). Significant effects in favor of the EG were also determined for menopausal symptoms (p=0.029), hip/leg extension strength (p<0.001) and power (p<0.001). However, changes of the MetS-Z did not differ significantly (p=0.149) between EG and CG. In summary, with minor exceptions, we demonstrated the effectiveness of a multipurpose exercise protocol dedicated to early-postmenopausal women on various risk factors and complaints related to the menopausal transition.

Keywords:

• multipurpose exercise
• bone mineral density
• early postmenopause

Acknowledgment

The present work was performed in (partial) fulfillment of the requirements for obtaining the degree “Dr. rer. biol. hum” for the first author.

This study is one of the intellectual outputs of the project “ACTLIFE-Physical activity the tool to improve the quality of life in osteoporosis people” and had grant support from the European Union’s Erasmus Plus Sport program under grant agreement No. 2017-2128/001-001. We further acknowledge support by Deutsche Forschungsgemeinschaft and Friedrich-Alexander-University Erlangen-Nürnberg within the funding program “Open Access Publishing”. However, the funding sources had no role in the design of this study nor its execution, analyses, interpretation of the data, or decision to submit results.

Data Sharing Statement

The data that support the findings of this study are available from the corresponding author (MH), upon reasonable request.

Author Contributions

All authors contributed to data analysis, drafting or revising the article, have agreed on the journal to which the article will be submitted, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

Conceptualization: all authors significantly contribute to the conceptualization of the study.

Data curation: MH, MS, MG, WK

Formal analysis: MH, MK, WK

Investigation: MH, SvS, MS, MG, WK

Methodology: MH, MK, WK

Project administration: MH, MS

Resources: all authors significantly contributed to gain resources for the project.

Supervision: MH, SvS, MS, MG, WK

Validation: MH, MK, WK⁷⁹

Visualization: not applicable

Writing – original draft: MH, WK

Writing – review and editing: all authors significantly contribute to writing, review and editing.

Disclosure

The authors report no conflicts of interest in this work.