High intensity exercise induces similar improvements in diastolic function in age matched pre and post‐menopausal women
Authors: Egelund Jon 
Published: November 2023

Background

Premenopausal women benefit from a reduced incidence of cardiovascular disease relative to age‐matched men; however, cardiovascular function declines more rapidly in postmenopausal women. Although a primary role for estrogen in this cardio‐protection has been proposed, the protective role of estrogen supplementation varies substantially depending on the timing of initiation and dose and supplementation may even increase cardiovascular risk. Physical activity induces many of the same health‐related effects as estrogen, and physical activity could, therefore, be used in the prevention and treatment of menopause‐associated alterations in cardiovascular function. Despite this putative effect of physical activity, estrogen has been suggested to be essential for training‐induced improvements in cardiovascular function

Methods

36 post‐menopausal (PM; age: 53.1 ± 3.0 (mean ± SE) years) women with maximal oxygen uptake (VO2max) of 30.9 ± XX mL min−1·kg−1 and 36 pre‐menopausal (PRM; age: 49.1 ± 2.2 years) women with VO2max of 31.1 ± XX mL min−1·kg−1 women participated in the study. None of the subjects were in hormone replacement therapy or were taking oral contraceptives. All subjects in PRM were menstruating regularly, whereas subjects in PM had not experienced a menstrual cycle during the previous 12 months but were less than 5 years past their final menstrual period. Menopausal status was verified by measurements of hypothalamic and reproductive hormones in the blood. All subjects were habitually inactive (less than 1 h of moderate‐intensity exercise per week), had normal resting electrocardiography, were nonsmokers, and none of the subjects in either group had been diagnosed with osteoporosis, cardiovascular disease, renal dysfunction, insulin resistance, diabetes or hypercholesterolemia. The study was carried out in accordance with the guidelines contained in the Declaration of Helsinki and was approved by the local Ethics Committee of Copenhagen and Frederiksberg communities Region H (H‐1–2012‐150).

Echocardiography was conducted before and after 12 weeks of high intensity exercise (80%HRmax) performed on a bike three times per week The echocardiographic examinations where performed either by and experienced sonographer or the first author. The examinations where recorded with VIVID E9 ultrasound machine (GE) and the Analysis of the Echocardiographic examinations where performed with EchoPAC PC V.113.

Results

MV E/A ratio increased by 13±3 and 9±3 % in PM and PRM, respectively, with no difference between groups. However, at baseline, the MV E/A ratio tended to be lower in PM compared to PRM (1.19±0.04 vs. 1.29±0.05; p=0.09).

Conclusion

These results demonstrate that high intensity training induces comparable improvements in diastolic function in recent PM and PRM. This finding indicates that the hormonal changes associated with the early postmenopausal phase do not impair the beneficial effect of exercise on cardiac function. Moreover, the E/A ratio tended (p=0.09) to be lower in PM at baseline, indicating that the menopausal transition might lead to unfavorable changes in cardiac function.