Menopause: The Journal of The North American Menopause Society
Vol. 16, No. 4, pp. 777/784
DOI: 10.1097/gme.0b013e318197122a
* 2009 by The North American Menopause Society
Exercise program affects body composition but not weight in
postmenopausal women
Miranda J. Velthuis, MSc,1,2 Albertine J. Schuit, PhD,3,4 Petra H.M. Peeters, MD, PhD,2
and Evelyn M. Monninkhof, PhD2
Abstract
Objective: The aim of this study was to investigate the effect of a 12-month moderate-to-vigorous exercise
program combining aerobic and muscle strength training on body composition among sedentary, postmenopausal
women.
Methods: A randomized controlled trial was conducted. A total of 189 sedentary postmenopausal women
(age 50-69 y, body mass index 22-40 kg/m2) were randomly assigned to an exercise (n = 96) or a control group
(n = 93). Study parameters measured at baseline, 4 months, and 12 months were as follows: body weight and body
height (body mass index), waist and hip circumference (body fat distribution), and dual-energy x-ray absorptiometry (total body fat and lean mass). Differences in changes in study parameters between exercise and control
group were examined with generalized estimating equations analysis.
Results: The exercise program did not result in significant effects on weight, body mass index, and hip
circumference. The exercise group experienced a statistically significant greater loss in total body fat, both absolute
(j0.33 kg) (borderline) as in a percentage (j0.43%) compared with the control group. In addition, lean mass
increased significantly (+0.31 kg), whereas waist circumference (j0.57 cm) decreased significantly compared with
the control group.
Conclusions: We conclude that a 12-month exercise program combining aerobic and muscle strength training
did not affect weight but positively influenced body composition of postmenopausal women. Affecting body fat
distribution and waist circumference may have important health implications because it is an independent risk
factor in obese but also in nonobese people. Therefore, this study gives further credence to efforts of public health
and general practitioners aiming to increase physical activity levels of postmenopausal women.
Key Words: Exercise intervention Y Body composition Y Body fat distribution Y Lean body mass Y
Postmenopausal women.
A
ging is associated with changes in body composition.
In general, lean mass decreases, and the amount of
body fat increases with age.1,2 These changes lead to
an increased risk of a variety of (chronic) diseases, such as
cardiovascular diseases, diabetes, and postmenopausal breast
cancer.3<5 In addition, levels of physical activity in women
decrease with age, which also lead to unfavorable changes
in body composition.1,6,7 Efforts to maintain or increase the
physical activity level may prevent unfavorable changes in
body composition in aging women.8 A systematic review of
Received September 4, 2008; revised and accepted November 25, 2008.
From the 1Comprehensive Cancer Center Middle Netherlands, Utrecht,
The Netherlands; 2Julius Center for Health Sciences and Primary Care,
Utrecht, The Netherlands; 3RIVM, National Institute for Public Health
and the Environment, Bilthoven, The Netherlands; and 4Institute for
Health Science, VU University, Amsterdam, The Netherlands.
Funding/support: The trial is sponsored by the Dutch Cancer Society
(KWF Kankerbestrijding, Project number: UU 2003-2793).
Financial disclosure/conflicts of interest: None reported.
Address correspondence to: Miranda J. Velthuis, MSc, Comprehensive
Cancer Center Middle Netherlands, PO Box 19079, 3501 DB Utrecht,
The Netherlands. E-mail: [email protected]
randomized controlled trials investigating the effects of
physical exercise in postmenopausal women showed that
physical exercise positively influences body composition in
approximately half of the studies.9 The best results were
accomplished in studies with overweight women, combining
physical exercise with a weight-reducing diet.9 This has been
confirmed in more recent studies examining the effects of
aerobic and muscle strength training in postmenopausal
women separately, in some studies combined with a weight
loss intervention.10<14 These studies showed in general that
aerobic training leads to a reduction in weight and total
body fat, whereas muscle strength training positively influences lean mass and total body fat. Based on these results
and on recommendations of the American College of Sports
Medicine, we expect that aerobic training combined with
muscle strength training will have the most beneficial effects
on body composition.15 As far as we know, this has been
studied in only three studies, which showed unanimously
positive effects of the exercise program on total body fat and
varying effects on body weight and lean mass.16<18 We aimed
to examine the effect of combined aerobic and muscle
strength trainingVa 12-month moderate-to-vigorous exercise
Menopause, Vol. 16, No. 4, 2009
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777
VELTHUIS ET AL
programVin Dutch postmenopausal women on body composition. We hypothesize that the amount of total body fat
will decrease, and lean mass will increase in women of the
exercise group relative to women of the control group. We
do not expect a decrease in body weight.
METHODS
Between January 2005 and August 2005, 189 postmenopausal women were recruited through random selection out
of the municipality registries in Utrecht and surroundings
in the Netherlands. Postmenopausal women were eligible if
they (1) were aged between 50 and 69 years old; (2) were
sedentary (G2 h/wk in moderate sport/recreational activities
and not adherent to the international physical activity recommendation); (3) were non-smokers (at least 12 mo) and
not abusing alcohol or drugs; (4) were not planning to go on
a strict diet; (5) were not experiencing diabetes mellitus or
other endocrine-related diseases or any disease or disorder
(locomotor, optical, neurological, mental) that might impede
the participation in the exercise program; (6 ) had a body
mass index (BMI) between 22 and 40 kg/m2; and (7 ) had a
sufficient knowledge of the Dutch language. Additional inclusion criteria were formulated to address a second aim of
the study, that is, whether exercise affects sex hormone
levels; (8) had their last menses at least 12 months ago; (9)
had not been using hormone replacement or oral contraceptives in the past 6 months; (10 ) had not been diagnosed
with breast cancer in the past; (11) had not been diagnosed
with other types of cancer in the past 5 years; and (12) were
not currently using corticosteroids or A-blockers. Written
informed consent was obtained from each participant. All
procedures were approved by the ethical committee of the
University Medical Center of Utrecht. Details of the design
of the study have been published previously.19
Study design
This study was designed as a two-arm randomized controlled trial. Eligible women were enrolled by a study nurse
and were randomized into the exercise group or the control
group by a data manager. Allocation to the exercise or
control group was concealed. Randomization was blocked on
two categories of waist circumference: G92 and Q92 cm (cutoff level is based on the median value reported in similar
women20).
Intervention
The intervention consisted of a 1-year moderate to vigorous exercise program. The exercise program included
two supervised group sessions of 1 hour per week and an
additional home-based individual session of half an hour
per week.
The group exercise sessions were offered to groups of
approximately 15 to 20 women in six fitness centers in
Utrecht and surroundings. The sessions were supervised by a
qualified sports instructor who had experience in exercise
training in this age group. The sessions consisted of aerobic
training and muscle strength training. The group exercise
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Menopause, Vol. 16, No. 4, 2009
sessions started with a warm up of 10 minutes, followed
by 20 minutes of aerobic training, 25 minutes of muscle
strength training, and a cooling down of 5 minutes. The
aerobic training was performed at 60% to 80% of the agepredicted maximal heart rate. The maximal heart rate was
established as 220 minus the person’s age in years. Aerobic
training intensity was controlled by heart rate monitors and
was gradually increased during the first weeks. General
muscle strength training of back, lower, and upper extremities was performed at an intensity level of 60% of 1 repetition maximum measurement, 20 to 25 repetitions. Muscle
strength training of the abdomen was performed at an intensity level of 50% of 1 repetition maximum measurement, 30
to 40 repetitions. The first 4 weeks of the exercise program
were used for instruction of the muscle strength exercises.
Once a week, participants were asked to perform a
30-minute home-based individual exercise session. The
home-based individual exercise session was explained during
the group exercise sessions by the sport instructor and consisted of 30-minute brisk walking or cycling. The training
intensity was supposed to be moderate to vigorous (60%80% of maximal heart rate) and was controlled by heart rate
monitors. Participants were asked to keep an exercise log to
help them track the frequency, intensity (mean heart rate
and BORG score), and duration of the individual exercise
sessions. Procedures to promote adherence were as follows:
(1) use of group exercise sessions in combination with an
individual program, (2) personal feedback, (3) realistic individual goals that can be updated regularly, (4) use of exercise
logs, and (5) newsletters.
Participants in the control group were requested to retain
their habitual exercise pattern. Participants in the exercise
and control group were asked to maintain their usual diet.
Habitual exercise patterns or physical activity levels were
measured with the Modified Baecke Questionnaire at the start
of the study and at 12 months (end of the study). The
Modified Baecke Questionnaire designed by Voorrips et al21
is developed to measure habitual physical activity in older
women. The questionnaire includes questions about work,
household activities, sports, and leisure time activities, over
the past year.
Food intake was measured with a food frequency questionnaire at the beginning of the study and after 12 months.22,23
This questionnaire consists of 74 questions about dietary
habits in the past month.
Outcome measurements
At baseline, after 4 months, and after 12 months of intervention, participants visited the research unit of the Julius
Center for the measurement of body composition and aerobic
capacity. Sociodemographic information and information about
reproductive factors, smoking, and medical history was obtained by a self-constructed questionnaire at baseline.
Body weight and height (to the nearest 0.5 kg and 0.5 cm,
respectively) were measured while the participants wore light
clothes and no shoes using an analogue balance (SECA) and
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EXERCISE PROGRAM AMONG POSTMENOPAUSAL WOMEN
wall-mounted tape measure. The BMI was calculated as weight
in kilograms divided by height in meters squared (kg/m2).
Body fat distribution was measured by waist and hip circumference. Waist circumference (to the nearest 0.1 cm) was
measured standing midway between lower ribs and iliac
crest. Hip circumference (to the nearest 0.1 cm) was measured standing, over the buttocks. All measurements were
taken in duplicate and averaged.
Total body fat (kg, %) and lean mass were determined by
using a whole-body dual-energy x-ray absorptiometry scan
(Lunar, Prodigy). A three-compartment model estimated fat
mass, lean tissue, and bone mineral content. The standard soft
tissue analysis was performed using software supplied by the
manufacturer.
Aerobic capacity was assessed by the Fit Test program, a
submaximal test on a Life Fitness cycle ergometer based
on the Ästrand Rhyming Protocol.24 The Fit Test program
is a reproducible measure of submaximal work capacity.19
During the test, the participant pedaled for 5 minutes using
a relatively consistent cadence with an intensity of 60% to
85% of the age-predicted maximal heart rate (220 j age).
Once a steady state was obtained, the program calculated a
VO2max based on the participant’s weight, age, sex, obtained
resistance, and steady-state heart rate.
Statistical analyses
Baseline characteristics were reported as means T SD or as
percentages of the study groups. For both the exercise and
the control groups, we computed the percentage change from
baseline in body measurements and maximal oxygen consumption at 4 and 12 months. To determine differences in
changes in body composition and maximal oxygen consumption between exercise and control groups, we performed
repeated measurement analyses using generalized estimating
equations from SAS version 9.1 (SAS Institute Inc, Cary,
NC), a longitudinal data analysis technique.25,26 This analysis
technique is suitable to investigate the Bcourse[ of the outcome variable over time and to compare the development
between study arms. In all models, the outcome variable
(ie, body composition or maximal oxygen consumption at
0, 4, and 12 mo) was analyzed as a dependent variable
using group (1, exercise group; 0, control group) as a key
independent variable adjusted for the baseline body composition measurement. Primary analysis was an intentionto-treat analysis. To analyze the impact of differences in
energy intake between the study groups, we also performed
generalized estimating equations analyses, with change in
total energy intake during the study period as an additional
covariate. In addition, we assessed whether BMI at baseline
modified the intervention effect by performing stratified
analyses (intention to treat), using the definitions of the World
Health Organization (normal weight: 22-25 kg/m2, overweight: Q25 kg/m2).
We also performed a per-protocol analysis including participants of the exercise group who attended 70% or more of
the group exercise sessions, participants of the control group
who retained their habitual exercise pattern, and participants of
the exercise and control group who maintained their usual diet.
RESULTS
Baseline characteristics of both groups are presented in
Table 1. Exercise and control groups were comparable with
respect to age (mean, 59 y), waist circumference (mean,
88 cm), hip circumference (mean, 102 cm), lean mass (mean,
42 kg), maximal oxygen consumption (mean, 24 mL/kg
per m2), and physical activity level (mean score Modified
Baecke Questionnaire 9.7 points). However, despite randomization, baseline differences occurred for time since last
menses, weight, BMI, total body fat (% and kg), and total
energy intake.
In total, 183 participants (97%) completed the study, 95
(99%) of the exercise group and 88 of the control group
(95%) (Fig. 1). During the study period, the physical activity
level scored on the Modified Baecke Questionnaire increased
in exercisers on average with 6.17 points (95% CI, 5.76 to
6.58) compared with 1.51 points (95% CI, 1.10-1.93) in controls.27 Mean total energy intake declined during the study
period in the controls with 445.1 kJ/day (95% CI, 515.5 to
374.8) compared with 26.6 kJ/day (95% CI, j97.0 to 43.8)
in the exercisers.27 Compared with the control group, participants in the exercise group had a statistical significant loss
in total body fat, both absolute (j0.33 kg), although
borderline significant, and in a percentage (j0.43 %)
(Table 2). Adjustment for energy intake changes during the
study period did not influence the results (loss in total body
fat, j0.28 kg [j0.61 to 0.05]; j0.38% [j0.69 to j0.08]).
The percentage total body fat of the exercise group declined
during the first 4 months (j1.43%) and declined further
TABLE 1. Baseline characteristics
Age, mean T SD, y
Time since last menses,
mean T SD, y
Body composition, mean T SD
Weight, kg
Body mass index, kg/m2
Waist circumference, cm
Hip circumference, cm
Total body fat, %
Total body fat, kg
Lean mass, kg
Calculated maximal oxygen
consumption, mean T SD,
mL kgj1 minj1
Physical activity, median, range
Modified Baecke
Questionnaire score
Household score
Sport score
Leisure score
Total energy intake,
mean T SD, kJ/d
a
n = 95.
b
n = 90.
c
n = 92.
Exercise group
(n = 96)
Control group
(n = 93)
58.9 T 4.6
8.9 T 6.3a
58.4 T 4.2
9.9 T 6.2b
73.6
26.6
88.3
102.2
39.8
28.3
42.3
24.0
T
T
T
T
T
T
T
T
8.2
2.9
8.2
5.1
4.5a
5.7a
3.9a
2.8
8.3 (0.5-27.1)
2.3 (0.5-3.0)
0.0 (0.0-10.7)
5.3 (0.0<24.7)
7,817.9 T 1,946.2a
74.8
27.3
88.2
102.8
40.9
29.9
42.1
24.0
T
T
T
T
T
T
T
T
10.8
3.6
9.3
7.1
5.8
8.0
4.2
3.4c
8.8 (0.8-32.5)
2.2 (0.8-3.0)
0.0 (0.0-4.1)
5.5 (0.0-29.6)
8,096.5 T 1,788.0
Menopause, Vol. 16, No. 4, 2009
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779
VELTHUIS ET AL
FIG. 1. Sample selection, allocation and follow-up. FU, follow-up.
during the remaining 8 months of training to j2.19%
(Fig. 2A). The percent of total body fat in the control group
increased during the first 4 months (+0.81%), followed by a
decrease (12 mo: 0.00%).
Furthermore, women allocated to the exercise group experienced a statistically significant decrease in waist circumference (j0.57 cm) and an increase in lean mass (+0.31 kg)
compared with the control group. Lean mass of the exercise
group mainly increased in the first 4 months of training
(+0.76%) and stabilized in the next months (12 mo: +0.71%).
The control group showed a decrease in lean mass during the
first 4 months, which diminished after 12 months (j0.83%
and j0.48%, respectively) (Table 2; Fig. 2B). Adjusting for
energy intake slightly attenuated the increase in lean mass
that remained statistically significant (0.29 kg [95% CI, 0.09 to
0.49 kg]). In addition, aerobic capacity of the exercise group
significantly improved compared with that of the control
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Menopause, Vol. 16, No. 4, 2009
group (+0.36 mL kgj1 minj1 [95% CI, 0.10 to 0.62]). The
intervention, however, showed no effect on weight, BMI, and
hip circumference.
We also analyzed the intervention effect in normal weight
(BMI 22-25 kg/m2; total n = 61) and overweight (BMI
Q25 kg/m2; total n = 128) women. Intervention effects on
percentage total body fat and percentage lean mass were
more evident in normal weight women than in overweight
women. In normal weight women, participants in the exercise
group had a statistically significant loss in percent total body
fat compared with the control group (intervention effect,
j0.75% [95% CI, j1.30 to j0.19]) and statistically significant increase in lean mass (intervention effect, +0.49 kg
[95% CI, 0.17 to 0.81]). In overweight women, participants
in the exercise group also experienced a decrease in percent
total body fat (intervention effect, j0.29% [95% CI, j0.66
to 0.09]) and an increase in lean mass (intervention effect,
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EXERCISE PROGRAM AMONG POSTMENOPAUSAL WOMEN
TABLE 2. Body measurements (mean) at baseline, 4 months, and 12 months and difference between exercise
and control group: intention-to-treat analysis
Baseline,
n = 96/93
4 mo,
n = 95/89
12 mo,
n = 95/88
% Change,
0-4 mo
% Change,
0-12 mo
Weight, kg
Exercise
73.63
73.13
72.97
j0.68
j0.90
Control
74.82
74.51
74.48
j0.41
j0.45
2
Body mass index, kg/m
Exercise
26.62
26.39
26.37
j0.86
j0.94
Control
27.32
27.14
27.25
j0.66
j0.26
Waist circumference, cm
Exercise
88.28
87.13
87.89
j1.30
j0.44
Control
88.19
87.78
88.75
j0.46
+0.63
Hip circumference, cm
Exercise
102.24
101.52
101.48
j0.70
j0.74
Control
102.75
102.42
102.53
j0.32
j0.21
Total body fat, %
Exercise
39.78
39.21
38.91
j1.43
j2.19
Control
40.92
41.25
40.92
+0.81
0.00
Total body fat, kg
Exercise
28.32
27.84
27.51
j1.69
j2.86
Control
29.88
30.03
29.72
+0.50
j0.54
Lean mass, kg
Exercise
42.34
42.66
42.62
+0.76
+0.71
Control
42.10
41.75
41.90
j0.83
j0.48
Calculations of mean values are based on the available data: 94 to 96 participants of the exercise group and 86 to 93 participants
Intervention effect,
0-12 mo (mean, 95% CI)
j0.06 (j0.46 to 0.33)
j0.04 (j0.19 to 0.11)
j0.57 (j1.13 to j0.01)
0.02 (j0.08 to 0.11)
j0.43 (j0.74 to j0.13)
j0.33 (j0.66 to 0.0045)
0.31 (0.12 to 0.49)
of the control group.
+0.20 kg [95% CI, j0.03 to 0.42]) compared with the
control group, although effects were smaller and nonsignificant (Fig. 3A, B).
One hundred thirty-seven participants (72%) were included in the per-protocol analysis. Sixty women (63%)
allocated to the exercise group attended at least 70% of the
group exercise sessions and also turned up at the follow-up
measurements. Seventy-seven women (83%) allocated to the
control group did not start a formal weight loss or exercise
program during the study period and turned up at the followup visits. The per-protocol analysis showed stronger intervention effects compared with the intention-to-treat analysis
(Table 3). Differences in favor of the exercise group were
found for total body fat, both absolute (j0.60 kg) and in
percentage (j0.66%), lean mass (+0.30 kg), and waist circumference (j1.03 cm). In addition, the per-protocol
analysis showed a significant decrease in hip circumference (j0.63 cm) and a borderline significant decrease of
BMI (j0.18 kg/m2). The per-protocol analysis also showed
that the aerobic capacity of the exercise group was significantly improved compared with that of the control group
(+0.44 mL kgj1 minj1 [95% CI, 0.12 to 0.76]).
FIG. 2. (A) Total body fat (%) at baseline, 4 months, and 12 months.
(B) Lean mass (kg) at baseline, 4 months, and 12 months.
DISCUSSION
An exercise program combining aerobic training and
muscle strength training resulted in favorable effects on total
body fat, lean mass, and waist circumference in postmenopausal women. The program did not result in weight loss or
a smaller hip circumference.
In our study, there was no intervention effect on body
weight. This might be explained by the fact that women in
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781
VELTHUIS ET AL
FIG. 3. (A) Total body fat (%) at baseline, 4 months, and 12 months of participants with a body mass index (BMI) of 25 kg/m2 or greater and a BMI of 22
to less than 25 kg/m2. (B) Lean mass (kg) at baseline, 4 months, and 12 months of participants with a BMI of 25 kg/m2 or greater and a BMI of 22 to less
than 25 kg/m2.
the exercise group experienced an increase in lean mass.
Because muscle mass is more dense and heavier than the
body fat that is lost, body weight may not rapidly
change.28<30 Our results are consistent with previous studies
on the effects of a combined aerobic and muscle strength
training program in postmenopausal women, although previous studies showed stronger effects.16<18 Two studies
showed fat losses of 1.23% and 1.4 kg after only 12 weeks
of intervention, respectively;16<18 whereas another 12-month
intervention study showed a loss of 1.4 kg.17 These studies
resulted in weight losses in the exercise group of 0.47, 1.3,
and 10.3 kg, respectively, compared with 0.66 kg in our
study.16<18 One of these studies included a weight loss
program in the intervention, which might explain the larger
reductions in fat mass and body weight.18 In another study,
strength training was recommended, but not required; sub-
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Menopause, Vol. 16, No. 4, 2009
sequently women in the exercise group were engaged
primarily in aerobic activities.17,31 The minimal attention to
strength training probably led to minimal increases in lean
mass, which did not counteract the weight loss due to fat loss.
This might partly explain the larger reduction in body weight
in this study.
Furthermore, two of these studies were conducted among
overweight women, whereas we included women with a BMI
between 22 and 40 kg/m2 (mean, BMI 27 kg/m2).17,18 One
might hypothesize that in overweight women, a greater
reduction in fat mass as a result of physical exercise might
be expected, although we were not able to corroborate this
hypothesis because we found stronger effects in normal
weight women. This was probably caused by a larger reduction in energy intake in our overweight participants of the
control group: they reduced their energy intake during the
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EXERCISE PROGRAM AMONG POSTMENOPAUSAL WOMEN
TABLE 3. Body measurements (mean) at baseline, 4 months, and 12 months and difference between exercise
and control group: per-protocol analysis
Baseline,
n = 60/77
4 mo,
n = 60/77
12 mo,
n = 60/77
% Change,
0-4 mo
% Change,
0-12 mo
Weight, kg
Exercise
73.25
72.71
72.38
j0.74
j1.19
Control
74.12
73.92
74.26
j0.27
+0.19
2
Body mass index, kg/m
Exercise
26.34
26.11
26.02
j0.87
j1.21
Control
27.19
27.06
27.35
j0.48
+0.59
Waist circumference, cm
Exercise
87.83
86.54
86.98
j1.47
j0.97
Control
87.39
87.25
88.61
j0.16
+1.40
Hip circumference, cm
Exercise
102.23
101.41
101.25
j0.80
j0.96
Control
102.17
102.00
102.51
j0.17
+0.33
Total body fat, %
Exercise
39.70
39.09
38.62
j1.54
j2.72
Control
40.79
41.03
40.88
+0.59
+0.22
Total body fat, kg
Exercise
28.08
27.59
27.04
j1.75
j3.70
Control
29.47
29.65
29.61
+0.61
+0.48
Lean mass, kg
Exercise
42.24
42.58
42.56
+0.80
+0.76
Control
41.81
41.60
41.78
j0.50
j0.07
Calculations of mean values are based on the available data: 60 participants of the exercise group and 75 to 77 participants of the
study period (mean reduction of 624 kJ compared with
179 kJ in our overweight exercise group), and a smaller
difference in effect was observed. In addition, in the exercise
group, the adherence to the exercise program of overweight
compared with normal weight women was lower: 79% versus
89% received the intervention as assigned and showed up for
the follow-up measurements. This difference in effect between normal weight and overweight women should be interpreted cautiously because this finding was based on subgroup
analyses and could be due to chance.
The major strengths of our study were the large sample
size (N = 189), the randomized design, and the relatively
long duration of 1 year of the supervised exercise program.
This gave women of the exercise group the opportunity to
incorporate physical exercise into their lifestyle habits.
Furthermore, attendance to the exercise sessions was good,
despite the long duration. Sixty-three percent of the women
allocated to the exercise group attended at least 70% of the
group exercise sessions. This also emphasizes the feasibility
of moderate to vigorous exercise programs for sedentary,
postmenopausal women.
One-year changes in body compositionVtotal body fat
(kg) and lean mass (kg)Vfound in our exercise group
(j2.86% and 0.71%, respectively) counteract the 1-year
change in total body fat and lean mass that might be expected
due to aging in older white women (+0.5% and j0.6%
[trunk lean soft tissue], respectively).32 A reduction in total
body fat might reduce chronic disease risk in these women,33<35
and an increase in lean mass seems to be protective for
osteoporotic fractures36 and metabolic syndrome.37 Furthermore, a recently published study showed that both general and
abdominal adiposity are associated with higher risks of death
in obese as well as in nonobese men and women. Moreover,
abdominal obesity is an established risk factor for coronary
Intervention effect,
0-12 mo (mean, 95% CI)
j0.43 (j0.87 to 0.02)
j0.18 (j0.35 to j0.01)
j1.03 (j1.69 to j0.37)
j0.63 (j1.09 to j0.18)
j0.66 (j1.01 to j0.31)
j0.60 (j0.98 to j0.22)
0.30 (0.11 to 0.50)
control group.
heart disease.38,39 Several epidemiological studies showed that
abdominal obesity is more important than body weight to
reduce chronic disease risks in postmenopausal women39<41
which underlines the relevance of our findings. Therefore,
postmenopausal women should be encouraged to perform
aerobic and muscle strength training at least two times a week.
Effects of aerobic and muscle strength training on body fat and
lean mass might be increased by combining it with a reduction
in energy intake (diet). Adherence to the exercise program,
especially in overweight women, might be further increased
by adding a cognitive behavioral intervention. The benefit of
adding diet or a cognitive behavioral intervention to a longlasting exercise program combining aerobic and muscle
strength training on body composition should be studied in
future studies in postmenopausal overweight women.
CONCLUSIONS
Our data show that a combined aerobic and muscle
strength program in postmenopausal women is able to reduce
fat mass, to increase lean body mass, and to reduce waist
circumference, although weight and BMI are not affected.
Effects on body fat distribution and waist circumference may
have important health implications because they are independent risk factors in obese and nonobese people.38 Therefore, this study gives further credence to efforts of public
health and general practitioners aiming to increase physical
activity levels of postmenopausal women.
Acknowledgments: We thank all participating women. Furthermore, we gratefully acknowledge Manon de Leeuw, Anneloes van
Diemen, Claire Nollen, Karin Menninga, Lizeth Vendrig, Lara
Heuveling, Jose Drijvers, Joke Metselaar, and Fien Stern for their
contribution to the inclusion and follow-up of the participants. We
thank the following sport centers for their participation in the study:
Health Club Fysio Physics IJsselstein; Better Bodies Health Club,
Menopause, Vol. 16, No. 4, 2009
Copyright @ 2009 The North American Menopause Society. Unauthorized reproduction of this article is prohibited.
783
VELTHUIS ET AL
Bilthoven and Zeist; Maxifit Europe, Houten; Body Business,
Utrecht; and Physiotherapy Center Basten-Kries, Soest. Finally, we
thank all sport instructors for their dedication to the study.
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