Exercise Alleviates Depression in Postmenopausal Women

Exercise Alleviates Depression in Postmenopausal Women
Exercise Alleviates Depression in Postmenopausal Women

According to the American College of Obstetricians and Gynecologists (ACOG), an estimated 6,000 U.S. women reach menopause daily. By 2020, the number of women over age 55 is estimated to be 46 million.1 With increasing life expectancy, many women will spend up to 40% of their lives in the postmenopausal stage.1 Studies of women going through the menopausal transition (both peri- and postmenopause) show a high prevalence of depressive symptoms, with some studies suggesting an estimate as high as 45%.2 Given the ever-increasing numbers of postmenopausal women in the United States, it is essential to find ways to address depression in this population.

Postmenopausal depression is likely caused by several intersecting factors, including hormonal changes, psychosocial stressors, and a previous history of mood disorders — although even women with no history of mood disorders can experience new-onset depression during the menopausal transition.3

During perimenopause, gonadal steroid hormones diminish. These hormones affect membrane permeability and also stimulate the synthesis of neurotransmitters and the expression of receptors associated with depression.4 In particular, estrogen can modulate neurotransmitter turnover, enhancing the levels of serotonin and noradrenaline (norepinephrine). It also is involved in the regulation of serotonin receptor number and function.5 Diminishing estrogen levels can lead to a reduction in the levels of these neurotransmitters and receptors and may be responsible for the depressive symptoms associated with menopause.4,6

It is known that exercise improves depressive symptoms in the general population and has been found effective in augmenting pharmacologic management in severe depression.7,8 Exercise significantly contributes to enhancing the health and quality of life in older adults9 and preventing the appearance of adverse symptoms and the development of disease among postmenopausal women.10,11 Exercise may also constitute a powerful tool in combating depression in this population.

To investigate this hypothesis, Villaverde Gutierrez and colleagues12 studied the impact of exercise on depression and anxiety in 60 postmenopausal women, aged 60 to 70 years. For a six-month period, subjects were randomized either to an exercise program (N=30) or to a no-intervention control group (N=30).

During the first eight weeks, participants received two 50-minute exercise sessions weekly. Subsequently, sessions were extended to one hour and were offered three times weekly. During the first eight weeks, sessions were dedicated to aerobic exercise at a maximum heart-rate reserve of 50% to 70%. During weeks 8 through 12, muscle training was included, aimed at increasing stamina. During the remaining 12 weeks, all exercises were intensified to produce a workload of 60% to 85% maximum heart-rate reserve. Sessions were carried out in a group setting, with rhythmic background music, and were administered by experienced, trained sports monitors and supervised by physical activity and sports-science teachers.

In the exercise group, statistically significant improvements were observed in subjects with moderate and severe depression (18% and 22% respectively), as measured by the Brink and Yesavage Geriatric Depression Scale. No similar change was found in the control group. Subjects in the exercise group with moderate depression experienced a reduction in score of 2.26, compared to an increase in score of 0.06 of moderately depressed subjects in the control group (P<0.05). Those with severe depression experienced a reduction in score of 3.35, compared to a reduction of 0.38 of severely depressed subjects in the control group (P<0.01).

Subjects in the exercise group who were suffering from mild anxiety, as measured by the Hamilton Anxiety Scale, experienced a reduction in their score of 2.06, compared to 0.08 of subjects with mild anxiety in the control group (P<0.01); and subjects in the exercise group who were suffering from severe anxiety experienced a reduction in score of 1.74, compared to an increase of 0.64 in those with severe anxiety in the control group (P<0.05).

The researchers stated, "The mood changes undergone by the postmenopausal women in our study were sufficiently eloquent as to justify widespread promotion of the conclusion that exercise is a healthy habit and a promoter of lifestyle changes." They noted, "With aging, people tend to take progressively less exercise and it may be totally abandoned, especially among older women. Thus, it may be necessary to develop strategies aimed at overcoming present barriers, stimulating participation by women in programs of regular physical exercise." They concluded that exercise is a "highly useful instrument" for preventing or alleviating anxiety and depression after menopause.

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