Don’t Be Like WALL-E: How Movement Supports Bone, Heart, and Pelvic Health After Menopause.

Pixar is brilliant.

I don’t just mean for the quality of animation and storytelling, the role their movies have played in my and many other childhoods. But rather, how detailed and thorough they can be with all aspects of their stories. My favorite example of this is WALL-E.

In that animated classic, humanity now lives on a ship in space and reside constantly in hover chairs, never touching the ground, performing labor, or exercising. One of those characters has a quick body scan and their skeleton shows up as this tiny little collection of bones floating in the sea of their body. Their body has absorbed all the stuff that should be bone and repurposed it. This leads to shenanigans and physical comedy later.

Why do I bring this up? Well, now that Menopause Awareness Month is behind us, it’s important to look ahead think about what we can do to address some of the health challenges that menopause brings. Women spend a third of their lives postmenopausal. Bone, cardiovascular, and pelvic health are 3 of the main areas where quality of life is most impacted and where lifestyle changes can be most beneficial.

🦴🦴 Bones 🦴🦴

Menopausal women are significantly more at risk of osteopenia and osteoporosis than their pre-menopausal counterparts. The human body is very much a “if you don’t use it, you lose it” kind of place. This is why I opened with WALL-E. The character from WALL-E and menopausal women have a similar skeletal issue in common. Their bodies are almost eager to take minerals and ions from their bones and put them to another use. This weakens bones and makes fractures, injuries, and health complications more likely. You need to signal to your body that your bones need all the materials and strength they can get.

Fun fact, bones likely originally evolved as chemical batteries, storing ions like calcium and phosphate for the body to draw on to continue functioning in times of scarcity. Your bones are the largest reservoir of buffering ions in your body. Because your body is constantly trying to keep your blood pH between 7.35-7.45 those ions are always on the verge of being dissolved to keep your blood pH stable. Without stressing your skeletal system properly, your body will weaken your bones. What does this look like?

Resistance exercise. No that does not mean you need to go to the gym and pump iron (but you absolutely can if you want to). There are so many ways to get resistance exercise at home with calisthenics (body weight exercise), resistance bands, or just things around your home to name a few. I mean, have you ever had to move a couch? Now, I’m not suggesting you deadlift your loveseat but even some body weight or wall squats, climbing the stairs or using a small step stool, taking that loaded bag of groceries and going for a couple laps around your residence before emptying it out can be forms of resistance exercise.

The keys are that it should be somewhat difficult and your muscles should burn a bit. That stress and load on your skeletal system signals to your body that resources are needed to keep your bones strong enough to handle what you put your body through. This reduces fracture risk while giving the added benefit of keeping you strong. I’ve never heard from a patient, “I wish I wasn’t so strong.” If you want to pick up children/grandchildren, lift that gallon of milk from the top shelf in the fridge, get onto and off the ground without help, or haul that basket of laundry without worrying about hurting yourself, resistance training is the key.

❤️❤️ Heart ❤️❤️

Cardiovascular disease (CVD) is the number one cause of death in the United States and of postmenopausal women worldwide. Before menopause women are substantially less likely than men to get CVD. After menopause, the risk is pretty much equal. There’s no way around it, staying active and getting at least 150 minutes of moderate intensity physical weekly is crucial to maintaining and improving functional mobility, quality of life, and reducing risk of CVD. What does “moderate intensity” mean? There’s an involved, technical definition and a quick shorthand.

The technical definition is 50%-70% of your maximum heart rate (HR), which can be roughly calculated as: 220 - your age. That means someone who is 50 years old would have a max heart rate of 170 with moderate intensity being between 85 and 119 beats per minute (bpm). With smart watches, smartphones, and fitness trackers it’s never been easier to track your heart rate, so this is much easier than it used to be.

The quick shorthand is that it should be kind of difficult to talk during the activity. If you can carry on a normal conversation, that’s not intense enough. If you’re gasping for air and can’t talk at all, that’s too intense. Imagine you’re at a wedding and have been dancing for several songs at a fast pace, not just two-stepping or swaying in place. You’d be a little sweaty, would need to take a break at some point, and talking would be a little labored as you caught your breath. This kind of activity can take many forms:

-            Brisk walking (especially outside)

-            Dancing

-            Light jogging

-            Playing a sport like pickleball or tennis

-            Biking

-            Gardening

Whatever the activity looks like, it should be enjoyable and sustainable. Don’t go from suddenly doing little to no activity to deciding you’re going to start biking 3 times a week, playing pickleball, and working with a personal trainer. That’s a great way to end up in a doctor or physical therapist’s office, unable to accomplish your goals. I’ve seen many people over the course of my career get discouraged in this exact scenario. It’s like exercise yoyo dieting: not built for long term success and very likely to fail. Pick something you like and stick to it. 

⚖️🌸💪 Pelvic Health ⚖️🌸💪

In quality of life surveys for menopausal women, pelvic health issues are often ranked as major contributors to reduced quality of life. Reduced sex drive, vaginal dryness, pain with sex, urinary incontinence, increased urinary urgency and frequency are common but less talked about effects of menopause. These fall under the umbrella of genitourinary syndrome of menopause (GSM). Again, women will on average spend a third of their lives postmenopausal. These women still want to have healthy and satisfying sexual relationships. Additionally, urinary dysfunction can be hugely disruptive to participation in usual activities. This is more than needing to know where the bathroom is at all times. I’ve had clients avoid trips, events, social gatherings, family functions, etc. due to concern that they might not make it to the bathroom in time, or that they might cough or laugh and leak. Some people I’ve worked with need to get up several times a night to go the bathroom. 1-2 times is fairly normal, but 4, 5, 6 times? Not only is it annoying but that significantly impacts the quality of sleep which just makes life in general harder.

The good news here is that pelvic physical therapy has routinely been shown to benefit all of these areas. Pelvic floor muscle training (PFMT) and education have routinely been shown to improve sexual function: arousal, climax, and satisfaction. PFMT has also been shown to reduce pain and discomfort with sex. The majority of postmenopausal women consider a satisfying sex life to be essential for their self-esteem and relationships with spouses or partners. Though it can be challenging to talk about, pelvic PTs are very experienced in having these conversations with compassion and discretion.

There are many possible reasons for the increase in urinary incontinence in women with GSM: reduced tissue blood flow and elasticity, thinning of bladder and vaginal walls, impaired involuntary muscle contractions with increased intra-abdominal pressure (eg leaking urine with sneezing, laughing, coughing, or forceful activity) for example. PFMT routinely improves all of these. Additionally, a pelvic PT can help with simple functional tips such as when and how to hydrate, how to manage intra-abdominal pressure in addition to improving pelvic floor muscle function, strength, relaxation, and control.

Pelvic PT can be started at any time and has little to no risk. There are other tools available such as vaginal moisturizers and hormone therapy which are fantastic tools to help address GSM. Moisturizers are typically available over the counter and hormone therapy is not. Hormone therapy is a gold standard treatment for GSM and is gaining in popularity but may not be best for all people at all times. Talk to your doctor.

Unbound Physio PLLC provides one-on-one pelvic health, balance, and orthopedic physical therapy in West Hartford and the Greater Hartford area.