Resistance Training for Menopausal Women - A Systematic Review

The medical community is paying attention!

As the medical and fitness communities learn more about the physiology of the changes during the menopause transition, resistance training is a subject that is gaining much attention!

This Systematic Review was performed by a team in Brazil and published in the journal Menopause ahead of print in October 2022. This study reviews the current literature investigating the “benefits and harms” of resistance training in menopausal women.

A summary of the findings of this study are below with my editorial commentary to follow.

Resistance training for post-menopausal women: systematic review and meta-analysis

Martins Sa KM, Resende da Silva G, Martins UK, Colovati MES, Crizol GR, Riera R, Pacheco RL, Martimbianco ALC

October 2022 Menopause: The Journal of the North American Menopause Society - e-pub ahead of print.

Goal of the Study

Assess the effects (benefits and harms) of resistance training in postmenopausal women.

Methods

An extensive literature review was undertaken and 12 randomized control trials (RCT) were included in the analysis and assessed for bias pertaining to blinding, randomization, and incomplete outcome data. The GRADE approach was used to integrate bias calculations and assess the certainty of the evidence.

(GRADE is a systematic approach to rating the certainty of evidence in systematic reviews and other evidence syntheses.)

Results

• 12 RCTs were found range in unclear to high levels of bias. Using the GRADE approach, evidence certainty was graded as low to very low.

• RCTs were published between 2008-2020 and included 452 menopausal women. Most participants had no comorbidities and were not taking hormone therapy (HT).

• Compared with no exercise, up to 16 weeks of resistance training promoted an improvement in functional capacity, bone mineral density and reduction in hot flash frequency.

• Between groups, there was no difference in abdominal circumference or body mass index (BMI).

• When compared to aerobic exercise, resistance training may result in a reduction of hot flash frequency and fat mass with no difference in quality of life and BMI.

• No serious adverse events were reported.

Author’s Conclusions

• This review of 12 RCTs suggests that resistance training may improve postmenopausal symptoms and functional capacity.

• Because the GRADE approach revealed low to very low certainty of evidence, further RCTs with higher quality methodology and better reporting are needed.

• Health practitioners should take an individualized approach to resistance training in their patients taking into account previous exercise history, physical capacity and adaptation period.

In My Humble Opinion…..

I find it refreshing that menopause health investigators are paying attention to resistance training in light of the physiologic changes common to mid-life women resulting in declining muscle mass and function, osteoporosis, weight gain, and the like. I applaud the authors for demonstrating how incomplete the body of research is regarding the impact of resistance training in menopausal women and that better studies are needed in this area.

What continues to puzzle me is why would any practitioner NOT recommend physical exercise for all menopausal women? The benefits of exercise - resistance training, HIIT training and the like - are well known as outlined in a brilliant review by Grindler and Santoro (Menopause and Exercise, Menopause 2022; 22(12) pp 1351-1358).

Even if we could design the perfect RCT with no bias or confounders that shows that exercise does not help hot flashes, would we then tell our patients “exercise won’t help your hot flashes so there is no point in doing it”? Of course not… because every other health benefit of exercise is clear and well-accepted.

While we embrace studies that explore the benefits of exercise in this population, we must keep a clear perspective that exercise is a lifestyle whose benefits are as sure as the sunrise every day. Just like smoking cessation is an automatic recommendation -exercise should be the same.