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INTRODUCTION


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According to the research conducted on Menopause in 1990s,the WHO defined

menopause as a time of a womans life when reproductive capacity ceases. The

ovaries stop functioning and their production of steroid and peptide hormones falls.

Dharwad, Vaidya et.al further elaborated that it is a phase when she no longer

experiences menstruation, technically her body begins to produce less and less

progesterone and estrogen and eventually her periods cease. Menopause typically

occurs in a womans late 40s to early 50s.

The rise in heart rate during exercise is considered to be due to the combination

of parasympathetic withdrawal and sympathetic activation whereas the fall in

heart rate immediately after exercise is considered to be a function of

reactivation of parasympathetic nervous system.


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Christopher R.Col stated that a delayed decrease in the heart rate

during the first minute after graded exercise, which may be areflection of decreased vagal activity, is a powerful predictor of

overall mortality.

However, Eugene H.Blackstone emphasised on the fact that the

heart rate recovery after submaximal exercise was a powerful

predictor of mortality in a population based cohort of adults

without clinically evident cardiovascular disease.

Very few studies have been conducted to study these importantautonomic system parameters in elderly women after

submaximal exercise effort as menopause approaches.


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AIMS AND OBJECTIVES

To study the effect of menopause on Rate pressure product,

Heart rate recovery, and peak expiratory flow rates in women

with sub-maximal exercise testing.


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STATEMENT OF QUESTION

Does menopause have any effect on cardiopulmonary

parameters in women ?


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HYPOTHESIS

H1:

There is a significant effect of menopause on rate pressure

product, heart rate recovery, and peak expiratory flow rate in

women subjected to sub-maximal exercise testing.

H0:

There is no significant effect of menopause on rate pressure

product, heart rate recovery, and peak expiratory flow rates in

women subjected to sub-maximal exercise testing.


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METHODOLOGY


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STUDY DESIGN:

Observational

SAMPLE SIZE: Total 60 subjects divided in 2 groups :

Group A 30 non menopausal women

Group B 30 post-menopausal women


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INCLUSION CRITERIA:

Women of age group 40-607.

Women with no menstrual

periods for 12 consecutive

months.

Normal BMI8.

EXCLUSION CRITERIA:

Smokers9

Uncontrolled Diabetics8

Uncontrolled Hypertensive8

Cancer patients8

Recent post-operative cases8

Women on HRT

10

Osteoporosis10

Hysterectomy10

Peri-menopausal women


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OUTCOME MEASURES

Rate Pressure Product (R.P.P)

Distance covered on 6MWT (6MWD)

Peak expiratory flow rate (PEFR)

Heart rate recovery(HRR)


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INSTRUMENTATION :

Wrights Peak flow meter

Stethoscope

Sphygmomanometer

Actitrainer solution-Polar Wearlink heart monitor

strap

Stop-watch.


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PROTOCOL/PROCEDURE


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60 women as per inclusion criteria were recruited for the study

Purpose of study was explained to the subject

Informed consent was taken

The subjects were divided in two groups according to the

gynaecological history

__________________________________________

Group A Group B

(non-menopausal women) ( Post menopausal women)

N=30 N=30


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The subject was allowed to be seated at rest in a chair for at least 10

min before the test was started. Pre-assessment of the subjects was

done and the Heart rate , Respiratory rate, Blood pressure and PEFR

were noted.

A 6MWT was conducted according to the ATS Guidelines and post

sub-maximal exercise parameters in terms of H.R, B.P, R.R,

RPE,6MWD and PEFR was noted.

Immediately after exercise the subject was made to sit on a chair and

heart rate recovery data was obtained at 1 min, 2 min and if required

at 3 min.


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Instruments used in the research study


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Subject performing PFT


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RESULTS


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Variable Non menopausal Post menopausal

Number 30 30

Age (years) 44.33 2.06 54.53 2.92

Weight (kg) 62.07 3.68 59.8 4.54

Height (cm) 159.4 4.05 158.03 4.8

BMI (kg/m2) 24.42 .9849 23.97 1.62

Resting SBP (mmHg) 119.27 8.03 121.5 9.48

Resting DBP (mmHg) 76.93 5.27 78.96 5.68

RPP at rest 8.51 .83 8.64 .92

PEFR at rest ( ) 4.93 1.25 4.85 1.37

Table 1: Physical and cardiopulmonary parameters of the subjects studied


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RPP *

1000

Mean + SD t P value

Group A Group B

Pre test

8.51

.8328

12.52

1.02

-.822 .477

Post test

8.64

.9235

12.75

1.12

-.948 .265

Table 2: Result of the mean& the t-test of Rate Pressure Product of both

the Groups on 6 MWT

0

2

4

6

8

10

12

14

Pre test Post Test

RPP*1000

Group A

Group B

Graph 1: Result comparing the mean ofRate Pressure Product of both Group

on 6MWT


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PEFR

(l/mint)

Mean + SD t P value

Group A Group B

Pre test 5.76 +

1.42

5.68 +

1.51

.20 .660

Post test 4.84 + 1.2 4.82 +

1.37

.169 .586

Table 3: Comparing the mean&Result of the t-test of PEFR of bothGroup after 6 MWT

0

2

4

6

8

10

12

14

Pre test Post Test

PEFR

Group A

Group B

Graph 2: Result comparing the

mean of PEFR of both Group On 6MWT


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Variabl

e

Mean + SD t P value

Group A Group B

6MWD 564.33

+ 40.23

538.33

+ 45.8

2.336 .023

RPE*

4.833*

+ .36

4.5* +

.4

.339 .736

HRR 29 + 2.8

29.1 +

3.87

-.190 .850

Table 4: Comparing the mean& the result of the t-test of

cardiopulmonary variables postsix-minute walk

56.433

4.833

29

53.833

4.5

29.1

6MWD*10 (mts)

RPE *

HRR

POST TEST

Group B Group A

Graph 3: Comparing the mean post test

cardio pulmonary variables on 6MWT


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The results reveals a significant difference in betweengroups in the 6 minute walk distance (P< 0.05). Thenon menopausal women covered a significantly greater

mean distance of 564.33 + 42.23 than the postmenopausal women who covered a mean distance of538.33 + 45.8 in comparison.


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DISCUSSION


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At menopause, hormone levels do not always decline uniformly,but fluctuate. With an advancement in chronological stage the

visible signs of aging begin to appear. In the last years, the 6MWT has become one of the most

popular clinical exercise test for evaluating functional capacity.The test has close similarities to activities of daily living and canbe performed by many elderly, frail, and severely limitedpatients who could not be evaluated by standard maximalsymptom-limited exercise tests, as are cardiac patients afterrecent major surgery.

One of the primary measures of this test is 6-min walk distance,

but during the 6MWT data can also be collected about thepatients blood oxygen saturation and perception ofdyspneaduring exertion. The 6MWT can also be used to measurefunctional status and for epidemiologic purposes.


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There was also a strong association between decreasingexercise capacity and an abnormal value for heart raterecovery in both men and women. A reduction in the heartrate of 12 beats per minute after the cessation of exercise wasused as the definition of a low value for the recovery of theheart rate.

As studied by Christopher R.Cole et.al, a low value for heart-

rate recovery after exercise testing, which has been previouslyshown to be a marker of decreased vagal activity, was found tobe a powerful and independent predictor of the risk of death.

The mean HRR in the first minute in both non and post-menopausal groups in our study was 29 + 2.82 and 29.16 + 3.87

respectively. However no significant difference was found inbetween the non and post menopausal women aftersubmaximal exercise testing.


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The results of our study demonstrates a significantdecrease in the distance walked on sub-maximal

exercise testing, which support the studies that suggestthat menopause effects the exercise capacity of women.

The 6MWD of healthy subjects range from 400 to 700m.The mean distance covered by both the groups in ourstudy falls in this range i.e. the non-menopausal womencovered a significantly greater mean distance of 564.33+42.23 than the post-menopausal women who covered amean distance of 538.33+ 45.8 in comparison.

Magdalena et.al conducted a study on pre and post-

menopausal women indicating that BMI,if not withinnormal limits i.e overweight (obesity), is a risk factor forhealth.


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In the present study, BMI was within the normallimits, where the baseline variables in both the groupsdid not show any significant difference.

The study can be further extended on the assessmentand comparison of the cardiovascular parameters onsubmaximal exercise testing in post menopausalwomen with BMI within normal limits and overweightcategories.


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The study conducted by Medical research Society in2001 very well supports the above where it has beenobserved that , in post-menopausal women, muscleperformance, muscle mass and muscle compositionare improved by HRT and also that the beneficialeffects of HRT combined with high-impact physicaltraining may exceed those of HRT alone.

It is also well known that menopause is accompaniedby an increased incidence of cardiovascular diseaseand changes in bone metabolism, and that hormonereplacement therapy (HRT) has potential benefits inreducing cardiovascular risk and bone loss .


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CONCLUSION


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There is no significant effect of early menopause onrate pressure product, heart rate recovery, and peakexpiratory flow rates in elderly women subjected to

sub-maximal exercise testing. However, the results ofour study demonstrates a significant decrease in thedistance walked on sub-maximal exercise testing inthe women of early menopause.


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THANK YOU!!!

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