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Optimizing lifestyle at the menopause

Optimizing lifestyle at the menopause. Irene Lambrinoudaki. Endocrinologist Associate Professor of Gynecological Endocrinology University of Athens, Greece. Women in Europe live on average 85 years. http://www.who.int accessed April 2015.

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Optimizing lifestyle at the menopause

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  1. Optimizing lifestyle at the menopause Irene Lambrinoudaki Endocrinologist Associate Professor of Gynecological Endocrinology University of Athens, Greece

  2. Women in Europe live on average 85 years http://www.who.int accessed April 2015

  3. Older women face on average 10 years of disability http://www.who.int accessed April 2015

  4. How is menopause connected to disability? The iceberg of menopause – related morbidities • Menopausal symptoms • Muscle atrophy • Sarcopenic obesity • CV risk factors • Bone loss • Cardiovascular disease • Osteoporosis • Frailty Cancer

  5. Risk management in menopause • Lifestyle modification • Medical treatment • Surgery • Healthy eating • Physical activity • Quit smoking

  6. Guallar-Castillon et al Nutr Metab Cardiovasc Dis 2010; Nettleton et al Atherosclerosis 2010, Liese et al Br J Nutr 2010, Nettleton et al Am J Clin Nutr 2009; Romaguera et al Am J Clin Nutr 2010, Lee et al Br J Nutr 2010

  7. Original aspect of Mediterranean diet: a combination of foods

  8. Mediterranean lifestyle today Communal meals (family, friends) Bach-Faiget al Public Health Nutrition 2011

  9. Weight loss BMI change Waist circ change Change in SBP Change in DBP

  10. Adherence to the Med diet is associated with lower cardiometabolic risk and CVD mortality

  11. Diet and cancer prevention

  12. Diet and cancer prevention

  13. Adherence to diet guidelines and cancer • WHI observational study • 65,838 postmenopausal women • Follow-up 12.6 years incidence mortality

  14. Diet and osteoporosis prevention Daily allowance • Calcium: 1000-1200mg elementary calcium • Vitamin D: 800 IU

  15. Diet for postmenopausal women to prevent sarcopenia Ensure adequate protein intake to avoid loss of muscle mass • 25-30gr of high quality protein per meal • Low proportion of carbohydrates (negative effect on protein turnover) • Poultry, eggs (the white) • Fish • Skimmed dairy products Protein sources Benton MJ . Curr Opin Endocrinol Diabetes Obes. 2013 Oct;20(5):412-9 Li Z, Heber D. Nutr Rev 2012;70:57–64.

  16. Exercise delays the aging process Regular physical activity is associated with 30% reduction of all-cause mortality in both healthy and patients with CVD Energy balance through integrated program of both healthy eating and exercise Positive health outcomes

  17. Protective effects of exercise on the cardiovascular system

  18. Independently of weight loss exercise improves • Triglycerides • LDL-c and HDL-c • Systolic BP • Diastolic BP • Waist girth Influence of a walking program on the metabolic risk profile of obese postmenopausal women. Roussel, Michel et al Menopause 2009; 16(3):566-575

  19. Exercise improves cardiovascular disease risk factors in community-based menopausal transition and early postmenopausal women in China. Intervention: moderate intensity aerobic/endurance exercise, 3 days / week , 45-60 min for 6 months Wu, Liping et al. Menopause 2014; 21:1263-1268

  20. Exercise against frailty Intervention: resistance training programme for 4 months Increase in muscle mass and strength, no change in weight *p < 0.05 betweenpre-andpostexcercise. ClinInterv Aging. 2013; 8: 1221–1228.

  21. Can exercise reduce body weight? Lifestyle change (diet + physical exercise) leads to sustained weight loss and reduced abdominal obesity, even after the completion of the intervention Stop of intervention WOMAN StudyWomen on the Move through Activity and Nutrition Kuller et al Obesity 2012

  22. EPIC: 217,000 participants > 50 years / 11 years follow-up • Women more inactive than men • Women from Greece, Italy and Spain most inactive • Women from the Netherlands and Denmark most active Ekelund U et al. Am J Clin Nutr. 2015 Mar;101(3):613-21

  23. EPIC study: 7.4% of all deaths could be averted if all inactivity was removed Ekelund U et al. Am J Clin Nutr. 2015 Mar;101(3):613-21

  24. EPIC study • Lean active: 40% lower mortality rate compared to lean inactive • Obese active: 20-30% lower mortality rate compared to obese inactive Ekelund U et al. Am J Clin Nutr. 2015 Mar;101(3):613-21

  25. Physical activity and cancer risk • 65,858 women in WHI observational study • Follow-up: 12.6 years • Women with the highest activity score: 17% lower cancer risk compared to women with the lower activity score Thomson Ca et al. Cancer Prev Res (Phila). 2014 Jan;7(1):42-53

  26. Physical activity and osteoporosis risk • All forms of exercise, including brisk walking confer benefit to the skeleton • Direct effect on bone strength • Indirect effect through increases in muscle mass • Reduction in the risk of falls (agility and balance improvement) Osteoporosis Prevention and Management: Nonpharmacologic and Lifestyle options. CHRISTIANSON, MINDY; SHEN, WEN; MD, MPH Clinical Obstetrics & Gynecology. 56(4):703-710, December 2013. DOI: 10.1097/GRF.0b013e3182a9d15a

  27. Physical activity recommendations Exercise acts as a drug; the pharmacological benefits of exercise Vina, F et al. Br J Pharmacol. Sep 2012; 167(1): 1–12.

  28. Intensity X Duration X Frequency = Score Total Cambridge Physical Activity Index for sports Evaluate your current exercise program by selecting your score for each category. Score Total = Intensity X Duration X Frequency

  29. Tennis, 60 minutes 3 times per week = 64 • Walking, 45 minutes, 3 times per week = 48 • Cycling, 20 minutes, 2 times per week = 27 Very good Fair Poor

  30. Exercise programmes for CV conditioning and muscle strengthening in menopause

  31. Sedentary behavior (too much sitting, avoiding routine daily activities such as stair climbing or walking) is an independent cardiometabolic risk factor apart from lack of exercise

  32. Take-home messages • Menopause is associated with obesity, sarcopenia, cardiovascular disease and osteoporosis • Lifestyle modifications can dramatically reduce the risk for these conditions • Women should consume whole grain products, fruits and vegetables and avoid red and processed meat • Physical activity should be incorporated in the daily routine and should include at least 150 minutes moderate activity or 75 minutes vigorous activity exercise per week

  33. Thank you very much for your attention!

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