Monday, May 8, 2017

Counseling postmenopausal women on exercise

- Jennifer Middleton, MD, MPH

Exercise has many benefits for older women. In the current issue of AFP, "Health Maintenance in Postmenopausal Women" describes exercise's benefits regarding cardiovascular disease prevention and fall prevention. Exercise may also reduce the risk of cognitive decline in older women; one meta-analysis found that both aerobic and resistance training may help preserve executive function in women to a greater degree than either exercise modality does in men. Unfortunately, many older women do not regularly exercise, and knowledge of both common barriers and some strategies to overcome them may improve the effectiveness of our counseling.

Most studies examining barriers to regular exercise in older adults include both men and women; identified barriers include concerns about damaging joints, falling, and sustaining injuries. Older adults referred to aquatic therapy often feel uncomfortable wearing a bathing suit in public. Inclement weather is a commonly cited barrier, as is spending significant time caring for an ill partner. Some older women believe, too, that exercise is unnecessary at their age.

Older patients are often receptive to counseling about exercise, but physicians frequently don't initiate these conversations, possibly due to a lack of knowledge about how to do so. Exploring which of the above barriers might keep a patient from exercising is a good first step. Communicating the benefits of exercise to postmenopausal women and brainstorming how to incorporate it into their everyday lives can help with motivation and planning. Reassuring women that it can take some time to develop physical fitness, and that some initial muscle discomfort is normal, may help. Local exercise programs targeted to older adults may be more appealing to patients than attending classes with younger participants.

Providing an exercise prescription is another useful strategy. Last month's AFP article on "Exercise Prescriptions in Older Adults" reviews how to compose one: identify exercises and/or modalities of interest and provide specifics regarding frequency and intensity. A balanced exercise prescription should include aerobic, flexibility, and balance exercises. Including short- and long-term goals of an exercise program may increase patient engagement. This 2010 AFP article on "Physical Activity Guidelines for Older Adults" provides several examples of exercise modalities to consider along with a sample exercise prescription in Table 3. Cardiac stress testing is only needed for patients with established cardiovascular disease who wish to participate in vigorous activities. There are AFP By Topics on Geriatric Care (certainly not all postmenopausal women are geriatric, but some are) and Health Maintenance and Counseling if you'd like to read more.