Physical activity and weight gain and fat distribution changes with menopause: current evidence and research issues

Purpose: At the onset of menopause a woman's body weight reaches its maximum. For any given subsequent body weight there is an increase in relative body fat and abdominal fatness with advancing age. The increased body fatness and abdominal fat distribution are associated with a high incidence of cardiovascular disease and certain cancers, particularly breast cancer. The aim of this analysis was to assess the role of physical activity for weight gain and changes in fat distribution occurring with menopause. Methods: A systematic review based on a Medline search was conducted. Results: According to cross-sectional observational studies postmenopausal women with high levels of physical activity have lower body fat and abdominal fat. Longitudinal studies show that physically active women are less likely to gain body fat and abdominal fat after menopause than sedentary women (Evidence category C). There are very few randomized controlled trials (RCT) comparing exercise with no intervention, and diet with diet plus exercise, and the results do not allow a firm conclusion as to whether physical activity may prevent or limit the gain of total fat and abdominal fat after menopause, or whether it may be effective as part of an obesity treatment program. Conclusions: There is a need for RCT to evaluate the effect of increased physical activity and fitness as a tool for prevention of the changes in body composition associated with menopause and aging in normal weight women. The efficiency of different programs of exercise training as a treatment option in postmenopausal women with existing overweight and obesity should be investigated. RCT should have the appropriate design and size and use accurate methods to assess exercise compliance, body composition, and intra-abdominal adipose tissue.