The Impact of Long-Term Physical Activity Interventions for Overweight/Obese Postmenopausal Women on Adiposity Indicators, Physical Capacity, and Mental Health Outcomes: A Systematic Review
Table 1
Study descriptions and summary of results: randomized controlled trials in North American populations.
50–75 years, otherwise healthy, sedentary, BMI ≥ 25, women after menopause
12
173
PA intervention: 45 min of moderate-intensity aerobic exercise 5 days/week (incl. walking, bicycling, and aerobics). Participants attended at least three mandatory training sessions held at the facility supervised by an exercise psychologist for months 1–3. The remaining two sessions were to be done at home. In months 4–12, participants had to attend at least one session/week at the facility and exercise at home for the remaining days. Some resistance training was recommended. Control: 45 min stretching session once/week for the year.
Daily activity log to record type of exercise, duration, peak heart rate, and rating of perceived exertion for all sport and recreational activities. Questionnaires at baseline and 12 months, and Polar HR monitors.
Anxiety and depression: subscales from the Brief Symptom Inventory (BSI). Perceived stress scale: measures stress response to events from the last month.
No significant difference in mental health at 12 months between groups. No significant difference was found for anxiety and depression between groups at 12 months. Perceived stress did not differ significantly between groups at 12 months. Yet, perceived stress improved significantly among the control group between baseline and 12 months.
Maximal O2 uptake (cardiorespiratory fitness) measured with treadmill test. Anthropometry: weight, waist and hip circumference, total body fat and percentage of body fat, and lean body mass. Intra-abdominal and subcutaneous fat measured by medical scan
Exercisers significantly increased in maximal fitness compared to control group (). At the end of 12 months, exercisers decreased body weight (), body fat percentage (), intra-abdominal fat (), and subcutaneous fat in exercisers () compared to the control group. Waist circumference significantly decreased among exercisers compared to the control group (). No significant difference between exercisers and the control group in change in lean body mass after 12 months.
Mass mailing campaigns, media publicity, or community outreach prompted calls (American)
50–75 years, otherwise healthy, sedentary, BMI ≥ 25, women after menopause
12
204 (PA-only and control group)
PA intervention: 45 min of moderate-intensity aerobic exercise 5 days/week (walking/hiking, bicycling, and aerobics). Participants attended at least three mandatory training sessions held at the facility and supervised by an exercise psychologist. These sessions included use of treadmill, stationary bike, and other aerobic machines. The remaining two sessions were to be done at home. Some resistance training was encouraged to prevent injury. Within the first 7 weeks, PA sessions were 15 minutes at 60–70% observed maximal heart rate and gradually worked up to 70–85% where they continued for the duration of the study. Control: no change to habits or lifestyle.
Activity log to record type of exercise, duration, peak heart rate, and rating of perceived exertion. Use of Polar HR monitors and pedometer.
Anthropometry: body weight waist circumference Body composition: percentage body fat and lean body mass. Maximal fitness measured with treadmill test. Pedometer reading measured steps walked/week.
Among exercisers, body weight decreased significantly () compared to the control group. Waist circumference and percentage of body fat decreased significantly among exercisers compared to the control group ( and , resp.). Lean body mass did not differ significantly across the two groups. Exercisers were classified in 1 of 3 categories for further analysis: highly active (≥196 min/week physical activity), intermediate active (154–196 min/week), and low active (<154 min/week). Women in the highly active group lost the most weight () relative to the other groups and the controls. The same trend was found for BMI, waist circumference, percentage of body fat, maximal fitness, and change in pedometer steps/week. Hence, highly active exercisers demonstrated the largest change compared to all other exercise groups.
Maximal fitness measured with treadmill test. Depression and anxiety: Brief Symptom Inventory-18. Stress: Perceived Stress Scale.
Maximal fitness increased significantly in exercisers compared to controls after the 12 months (). Perceived stress, anxiety, and depression scores did not significantly change among exercisers compared to controls. Social support was nonsignificant between groups after the 12 months.
Ads in newspaper, radio, television, community events, and mass mail (American)
45–75 years, otherwise healthy, sedentary, BMI 25–43, women after menopause
6
464
PA intervention group 1: participants attended 4 training sessions/week which included cycling and treadmill expending 4 kilocalories per kilogram of body weight per week. Energy expenditure level is about 50%. PA intervention group 2: participants attended 4 training sessions/week which included cycling and treadmill expending 8 kcal per kg/week. Energy expenditure level is about 100% PA intervention group 3: participants attended 4 training sessions/week which included cycling and treadmill expending 12 kcal per kg/week. Energy expenditure level is about 150% All intervention groups experienced moderate-to-vigorous intensity activity. Groups differed by amount of time spent exercising. Control group: asked to maintain current lifestyle
Trainers documented progress. HR monitors and pedometers were used.
Pedometer measures steps/day. Fitness measures: peak maximal fitness, peak relative fitness per min, and maximal power output, measured with treadmill test. Weight, body fat percentage, and waist circumference
After the 6 months, there were no significant differences on steps per day across all the groups. For all 3 fitness measures, each exercise dose had a significantly higher impact compared to the control group ( for each group). There was no significant difference in weight or body fat percentage. Waist circumference was significantly smaller in all 3 exercise groups compared to the control group ( for each). The dose of exercise has an incremental effect on the results.
Ads in local community and team recruitment in minorities communities (American)
430
Quality of life (QOL): Medical Outcomes Study Short Form Health Survey (SF-36) that measures physical (4 subscales) and mental (4 subscales) QOL body weight. Maximal O2 uptake (cardiorespiratory fitness) measured with cycling test.
A significant dose-response effect of exercise on QOL was found for 3 of 4 subscales of physical health (i.e., physical functioning, role limitations due to physical problems, and general health perception) and 4 of 4 scales of mental health (role limitations due to emotional problems, social functioning, vitality, and mental health). Post hoc analysis demonstrated that the 12 kcal per kg/week group significantly improved QOL compared to the controls. The 4 kcal per kg/week group significantly improved general health, vitality, and mental health. Body weight and maximal fitness had no effect on QoL outcomes.
Ads in local community and team recruitment in community (American)
464
Maximal O2 uptake (cardiorespiratory fitness) measured with cycling test.
A significant difference in maximal aerobic fitness was found for all pairwise treatment group comparisons except 4 kcal per kg/week versus 8 kcal per kg/week.
52–62 years, otherwise healthy, sedentary, BMI 25–39.9, women after menopause
48
508
Intervention: 150 minutes per week of moderate-intensity activity similar to brisk walking. Participant contact was extensive and included 40 group visits in first year, 12 monthly visits in years 2 and 3, and no visits in year 4. Visits included a 400-meter walk as fast as possible and physical activity follow-up questionnaire Control: health education group received 6 lectures in year 1 and then quarterly thereafter but was not instructed to change lifestyle.
Evaluated at 6 months and then annually using 400-meter walk test and MAQ interview-administered questionnaire by specialists. Daily diary was used to log PA every day and monitor adherence.
400-meter walk: 10 laps along a hallway with cones set 20 m apart at a pace that could be maintained the whole duration. Leisure time physical activity (LTPA): measured with subscale of Modifiable Activity Questionnaire (MAQ) which assessed leisure activity over the year Body composition: measure with weight, BMI, waist circumference, and body fat mass.
The exercise group had significantly lower 400-meter walk times compared to the control group (). While the exercisers walk time decreased, the control group had no significant change in walk times after the 48 months. Exercisers also had significantly decreased body weight, BMI, waist circumference, and trunk fat mass compared to the control group (). For the exercise group, increased LTPA and decreased body weight, BMI, waist circumference, and whole body fat mass were significantly associated with reductions in 400 m walk time from baseline to 48 months (all ).
Targeted mailings, posters, brochures, and media campaigns (Canadian)
50–74 years, otherwise healthy, sedentary, BMI 22–40, women after menopause
12
320
Intervention: participants were instructed to complete 45 min of moderate-to-vigorous intensity aerobic exercise 5 days/week. Within the first 3 months, subjects gradually worked up to 70–80% of their heart rate reserve and then remained at 70–80%. Three mandatory sessions/week were held at the facility with specialized trainers. The remaining 2 sessions were home-based. A warm-up and cool-down of 5–10 minutes were encouraged and carried out at the facility training sessions. Control: asked to maintain current lifestyle.
Daily exercise log and Polar HR monitors.
Maximal fitness was measured with a treadmill test. Energy intake and adiposity measured with intra-abdominal and subcutaneous fat via medical scan. Weight, BMI, waist and hip circumference, body fat, percentage of body fat, and lean body mass were measured using X-ray scans.
Maximal fitness increased significantly more in exercisers compared to controls (). Mean energy intake decreased among controls relative to exercisers (). The mean decrease in adiposity between baseline and 12 months was significantly greater in exercisers compared to controls (). Weight, BMI, waist circumference, hip circumference, percentage of body fat, and abdominal fat area all significantly decreased among exercisers compared to the control group. Lean body mass was not significantly different among exercisers and the control group (). Lean body mass did not change for exercisers and decreased slightly for the control group.
