Bachmann
Exercise: not a panacea G Bachmann Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA Linked article: This is a mini commentary on AJ Daley et al., pp. 565–75 in this issue. To view this article visit http:// dx.doi.org/10.1111/1471-0528.13193. Published Online 21 January 2015. Menopausal women suffering from distressing vasomotor symptoms are often offered a laundry list of nonprescription interventions. The ‘todo’ list of these interventions associated with the effective management of hot flushes include keeping iced water close by and sipping it at the start of a hot flush, dressing in layers, keeping the ambient temperature in the cold range in living and sleeping spaces, avoiding spicy food, limiting the consumption of alcohol and caffeinated beverages, using cotton nightclothes and bedlinen, keeping away from smokers (and not personally smoking), not wearing tight clothing, using herbs such as black cohosh, red clover, dong quai, ginseng, kava, and evening primrose, having the menopause haircut (shaved at the nape of the neck, covered over with longer hair), wearing melatonin skin patches, sleeping on chill pillows, practicing relaxation techniques and paced breathing, engaging in yoga, using massage, taking supplements such as vitamin E and B complex, using ibuprofen, and. . .EXERCISE! And not only is exercise considered one of the ways a woman can keep hot flushes man-
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ageable, but also in the media, specific exercises are often recommended, such as walking, swimming, dancing, and bicycling. But, as Daley et al. report, the list of remedies may have to be reduced by one: their data do not support an exercise prescription as an intervention to ameliorate or eliminate hot flushes. Clearly, exercise is not a panacea and should not be prescribed for every symptom and condition that a patient has. For menopausal women, especially those with osteoporosis, some high-impact physical activities may actually put the patient at increased risk of harm, especially risk of fracture. Women who engage in some sports also increase their risk of sustaining anterior cruciate ligament (ACL) tears of the knee and ankle sprains, which in themselves are seen more commonly in women than men. Recent data from the Atherosclerosis Risk in Communities (ARIC) study also suggest that exercise may not be an effective intervention for all people with type–II diabetes either (Klimentidis et al. Diabetologia 2014; 57: 2530–4). But putting risks aside, the benefits of physical activity on cardiovascular and musculoskeletal
health, weight, and overall wellbeing are well documented. There also are recent data reporting that recreational activity may have a preventive effect against the risk of breast cancer after menopause (Fournier et al. Cancer Epidemiol Biomarkers Prev 2014; DOI: 10.1158/1055-9965.EPI14-0150). Data from 59 308 postmenopausal women (2155 of whom had invasive breast cancers), on average 8.5 years postmenopause, show that women who recently engaged in recreational physical activity levels of ≥12 metabolic equivalent task-hours (MET–h)/week had a lower risk of invasive breast cancer than women with lower levels of activity (hazard ratio, HR 0.90; 95% confidence interval, 95% CI 0.82–0.99): clearly an important reason for clinicians to prescribe regular exercise to their menopausal patients. Daley et al. sum up their findings with a strong take-home message: although exercise has many benefits, it should not be recommended as a therapy for menopausal patients who request management of vasomotor symptoms.
Disclosure of interests No conflicts to disclose. &
© 2015 Royal College of Obstetricians and Gynaecologists
Exercise: not a panacea G Bachmann Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA Linked article: This is a mini commentary on AJ Daley et al., pp. 565–75 in this issue. To view this article visit http:// dx.doi.org/10.1111/1471-0528.13193. Published Online 21 January 2015. Menopausal women suffering from distressing vasomotor symptoms are often offered a laundry list of nonprescription interventions. The ‘todo’ list of these interventions associated with the effective management of hot flushes include keeping iced water close by and sipping it at the start of a hot flush, dressing in layers, keeping the ambient temperature in the cold range in living and sleeping spaces, avoiding spicy food, limiting the consumption of alcohol and caffeinated beverages, using cotton nightclothes and bedlinen, keeping away from smokers (and not personally smoking), not wearing tight clothing, using herbs such as black cohosh, red clover, dong quai, ginseng, kava, and evening primrose, having the menopause haircut (shaved at the nape of the neck, covered over with longer hair), wearing melatonin skin patches, sleeping on chill pillows, practicing relaxation techniques and paced breathing, engaging in yoga, using massage, taking supplements such as vitamin E and B complex, using ibuprofen, and. . .EXERCISE! And not only is exercise considered one of the ways a woman can keep hot flushes man-
576
ageable, but also in the media, specific exercises are often recommended, such as walking, swimming, dancing, and bicycling. But, as Daley et al. report, the list of remedies may have to be reduced by one: their data do not support an exercise prescription as an intervention to ameliorate or eliminate hot flushes. Clearly, exercise is not a panacea and should not be prescribed for every symptom and condition that a patient has. For menopausal women, especially those with osteoporosis, some high-impact physical activities may actually put the patient at increased risk of harm, especially risk of fracture. Women who engage in some sports also increase their risk of sustaining anterior cruciate ligament (ACL) tears of the knee and ankle sprains, which in themselves are seen more commonly in women than men. Recent data from the Atherosclerosis Risk in Communities (ARIC) study also suggest that exercise may not be an effective intervention for all people with type–II diabetes either (Klimentidis et al. Diabetologia 2014; 57: 2530–4). But putting risks aside, the benefits of physical activity on cardiovascular and musculoskeletal
health, weight, and overall wellbeing are well documented. There also are recent data reporting that recreational activity may have a preventive effect against the risk of breast cancer after menopause (Fournier et al. Cancer Epidemiol Biomarkers Prev 2014; DOI: 10.1158/1055-9965.EPI14-0150). Data from 59 308 postmenopausal women (2155 of whom had invasive breast cancers), on average 8.5 years postmenopause, show that women who recently engaged in recreational physical activity levels of ≥12 metabolic equivalent task-hours (MET–h)/week had a lower risk of invasive breast cancer than women with lower levels of activity (hazard ratio, HR 0.90; 95% confidence interval, 95% CI 0.82–0.99): clearly an important reason for clinicians to prescribe regular exercise to their menopausal patients. Daley et al. sum up their findings with a strong take-home message: although exercise has many benefits, it should not be recommended as a therapy for menopausal patients who request management of vasomotor symptoms.
Disclosure of interests No conflicts to disclose. &
© 2015 Royal College of Obstetricians and Gynaecologists
