Long- e m e ec o physical ac i i y on
heal h- ela ed quali y o li e among
menopausal women: a 4-yea ollow-up
s udy o a andomised con olled ial
Ki si Mansikkamäki,
1,2
Jani Rai anen,
1,3
Clas-Håkan Nygå d,
3
Eija Tomás,
4
Ree a Ru anen,
3
Rii a Luo o
1
To ci e: Mansikkamäki K,
Rai anen J, Nygå d C-H, e al.
Long- e m e ec o physical
ac i i y on heal h- ela ed
quali y o li e among
menopausal women: a 4-yea
ollow-up s udy o a
andomised con olled ial.
BMJ Open 2015;5:e008232.
doi:10.1136/bmjopen-2015-
008232
▸P epublica ion his o y o
his pape is a ailable online.
To iew hese iles please
isi he jou nal online
(h p://dx.doi.o g/10.1136/
bmjopen-2015-008232).
Recei ed 20 Ma ch 2015
Re ised 23 July 2015
Accep ed 28 July 2015
1
UKK Ins i u e o Heal h
P omo ion Resea ch,
Tampe e, Finland
2
Tampe e Uni e si y o
Applied Sciences, Tampe e,
Finland
3
School o Heal h Sciences,
Uni e si y o Tampe e,
Tampe e, Finland
4
Tampe e Uni e si y Cen al
Hospi al, Tampe e, Finland
Co espondence o
Ki si Mansikkamäki;
[email p o ec ed]
ABSTRACT
Objec i es: The aim o he s udy was o explo e he
long- e m e ec s o physical ac i i y in e en ion on
quali y o li e (QoL) 4 yea s a e an o iginal
andomised con olled ial (RCT).
Design: Coho s udy a e an RCT.
Se ing: 95 o he 159 women om he o iginal RCT
pa icipa ed in weigh , heigh and wais ci cum e ence
measu emen s, pe o med he UKK 2 km Walk Tes
and comple ed he SF-36 Heal h Su ey ques ionnai e.
Mul ile el mixed eg ession models we e pe o med in
o de o compa e he o iginal and cu en g oup in an
RCT se ing.
Pa icipan s: The e we e 159 pa icipan s in he
o iginal RCT; 2.5 yea s la e , 102 o he women
esponded o a ques ionnai e and 4-yea a e he ial,
he e we e 95 esponden s. The inclusion c i e ia in he
o iginal RCT we e: being symp oma ic, expe iencing
daily ho lushes, age be ween 40 and 63 yea s, no
using ho mone he apy now o in he pas 3 mon hs,
seden a y li es yle and ha ing las mens ua ed
3–36 mon hs ea lie .
Main ou come measu e: Heal h- ela ed QoL as
measu ed wi h he SF-36 ins umen .
Resul s: Women in he in e en ion g oup had a
signi ican ly highe p obabili y o imp o ed physical
unc ioning (OR 1.41; 95% CI 1.00 o 1.99) as
compa ed wi h women in he con ol g oup. In
addi ion, women in he in e en ion g oup had highe
odds o good ole unc ioning (OR 1.21; 95% CI 0.88
o 1.67), physical heal h (OR 1.33; 95% CI 0.96 o
1.84) and gene al heal h (OR 1.14; 95% CI 0.81 o
1.62), ela i e o women in he con ol g oup, al hough
he di e ences did no each s a is ical signi icance.
Conclusions: Women in he in e en ion g oup
showed posi i e long- e m e ec s on physical and
men al dimensions o QoL a e 4 yea s.
T ial egis a ion numbe : ISRCTN54690027.
INTRODUCTION
Many physiological and psychological signs
and symp oms occu in he li es o
middle-aged women.
1
A posi i e associa ion
be ween physical ac i i y (PA) and quali y o
li e (QoL) has been explo ed in many
s udies.
2–7
PA has been associa ed wi h lowe
a es o cogni i e and physical decline
among pos menopausal women.
8
In add-
i ion, PA appea s o ha e posi i e e ec s on
wo k abili y, bo h sho and long e ms.
9
Ho mone he apy (HRT) is widely used as
ea men o menopause symp oms, e en
hough exe cise has been deemed an
al e na i e op ion o alle ia ing hei symp-
oms and imp o ing QoL in midli e.
110
In
an 8-yea ollow-up s udy, PA has been ound
o be a significan ac o among menopausal
women who had s able weigh o we e
highly educa ed.
4
Inc easing one’s le el o
PA du ing menopausal ansi ion and he
pos menopausal pe iod o a leas main ain-
ing he ecommended le el has also been
sugges ed o educe a ious psychological
symp oms.
11
We p e iously epo ed esul s om ou
menopausal heal h and PA in e en ion an-
domised con olled ial (RCT)
612
examining
ae obic aining, and imp o ed menopausal
and heal h- ela ed QoL among menopausal
women. Women in he in e en ion g oup
showed significan ly la ge dec ease in he
equency o nigh - ime ho flushes. These
S eng hs and limi a ions o his s udy
▪The co e s eng hs o he s udy a e i s p ospec-
i e s udy design and epea ed assessmen s o
physical ac i i y beha iou a se e al ime poin s
a e in e en ion.
▪Ou s udy unde lines he impo ance o physical
ac i i y du ing menopausal ansi ion.
▪The esponse a e (59.7%) was low and women
wi h an ad e se li es yle we e mo e likely o be
ound among non- esponde s.
Mansikkamäki K, e al.BMJ Open 2015;5:e008232. doi:10.1136/bmjopen-2015-008232 1
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findings we e based on in o ma ion collec ed h ough
mobile phone dia ies. Addi ionally, he dia ies poin ed o
be e sleep quali y among women in he in e en ion
g oup as compa ed o hose in he con ol g oup.
7
We
also epo ed ha he 6-mon h exe cise in e en ion had
e ec s on wo k abili y 2½ yea s a e he RCT.
9
The aim o he ollow-up s udy epo ed he e was o
explo e he long- e m e ec s o he PA in e en ion on
QoL 4 yea s a e he RCT.
MATERIALS AND METHODS
The s udy popula ion consis ed o a sample o women
who pa icipa ed in a ollow-up 4 yea s a e he begin-
ning o he ial, which was in 2009.
6
The in e en ion
s udy in 2009 was a RCT (ISRCTN54690027, h p://
www.con olled- ials.com/) in which he women we e
andomised in o an in e en ion and a con ol g oup.
C i e ia o inclusion in he in e en ion s udy we e:
being symp oma ic, expe iencing daily ho flushes, age
be ween 40 and 63 yea s, no using HRT now o in he
pas 3 mon hs, ha ing a seden a y li es yle (wi h ae obic
aining unde wice a week) and ha ing las mens u-
a ed 3–36 mon hs ea lie . Women who we e physically
ac i e (exe cising wo o mo e imes a week, a leas
30 min a a ime); whose body mass index (BMI) was
abo e 35 kg/m
2
; o who had co ona y hea disease,
o hopaedic o o he diseases p e en ing hem om
exe cising, we e excluded om he s udy. Fu he ,
women who we e using medica ion influencing hea
a e, o using β-blocke s, we e excluded, since hey
would ha e biased he esul s pe aining o hea a e.
Menopausal s a us was e ified ia assay o plasma
ollicle-s imula ing ho mone (FSH exceeding 30 IU/L).
Be o e he ial began, day ime and nigh - ime ho
flushes we e eco ded in a 2-week dia y, wi h he women
ins uc ed o eco d a sensa ion o wa m h, wi h o
wi hou concomi an swea ing, as a ho flush, and he
daily equency o ho flushes be o e he in e en ion
was es ima ed. Du ing he in e en ion, he numbe o
ho flushes, bo h day ime and nigh - ime, was calcula ed.
In o al, 159 women pa icipa ed in he s udy, and he
du a ion o he in e en ion was 6 mon hs.
6
The women in he in e en ion g oup engaged in
ae obic aining ou imes a week, wi h 50 min o exe -
cise each ime. They we e ins uc ed o exe cise a a
le el o abou 64–80% o maximal hea a e, whe eas
he women in he con ol g oup we e ins uc ed o keep
hei PA habi s unchanged. In he in e en ion g oup, a
leas wo PA sessions had o consis o walking o No dic
walking, while he o he sessions could include walking,
No dic walking, skiing, jogging, cycling, swimming, ae -
obics and/o gymnas ics. The in e en ion p ima ily
included walking because ea lie ials showed i o ha e
a ou able e ec s on heal h among menopausal and
pos menopausal women.
13
In o ma ion on ho flushes
and ae obic aining was collec ed ia mobile phone
ques ionnai es wice a day. Responses we e au oma ically
ans e ed o digi al o ma ia 3G echnology.
14
The
SF-36 Heal h Su ey ques ionnai e was used o measu e
heal h- ela ed QoL. This ques ionnai e has been ali-
da ed in Finland
15
and is known o be a eliable
measu e o QoL. I is composed o 36 i ems, add essing
eigh dimensions o QoL: physical unc ioning, physical
ole limi a ions, bodily pain, gene al heal h, i ali y,
social unc ioning, emo ional ole limi a ions and
men al heal h.
6
The sco es o each o he eigh dimen-
sions we e ans o med linea ly o a scale anging om
0 (maximal impai men ) o 100 (bes QoL).
6
The fi s ollow-up ques ionnai e was pos ed o he
pa icipan s 2½ yea s a e he in e en ion began, and
102 o he 159 women esponded. Resul s om his
ollow-up ques ionnai e ha e been epo ed in ea lie
wo k.
9
Fou yea s a e he beginning o he ial, he pa ici-
pan s (n=159) we e asked o ake pa in he second
ollow-up s udy. A e his eques , 95 o he women
esponded o he ques ionnai e and pa icipa ed in he
measu emen s. All he pa icipan s ga e w i en consen .
Weigh , heigh and wais ci cum e ence we e measu ed
wi h ligh weigh clo hing by s a o he UKK Ins i u e,
and he UKK 2 km Walk Tes was pe o med.
16
The pa -
icipan s comple ed he SF-36 Heal h Su ey ques ion-
nai e on heal h- ela ed QoL, a home.
15
In addi ion,
hey ca ied a Hookie accele ome e o a week, in
o de o measu e hei daily PA. Also, he women we e
asked o ake no es, in a 1 week dia y, abou he ype
and in ensi y o hei PA, and o no e he exe cise ime.
Specific ques ions ela ed o accele ome e use and he
UKK 2-km Walk Tes will be epo ed on in a sepa a e
a icle. In addi ion, he pa icipan s we e asked o use a
1 week dia y o no e he numbe o day ime and nigh -
ime ho flushes expe ienced, he ime hey ell asleep
and woke up, and hei judgemen o hei sleep
quali y. A flow cha o he pa icipan s’da a is shown in
figu e 1.
STATISTICAL ANALYSIS
The cha ac e is ics o he s udy popula ion a e desc ibed
bes in e ms o means and SEMs, o equencies and
pe cen ages ( able 1).
Mul ile el mixed e ec s logis ic eg ession models
we e cons uc ed o accoun o he wi hin-subjec co -
ela ion be ween ou ime poin s. The odds model was
used o analysis o he associa ion be ween he ou -
comes bo h on he physical dimensions (physical unc-
ioning; ole unc ioning, physical; eedom om pain;
and physical heal h) and on he psychological dimen-
sions ( ole unc ioning; emo ional; i ali y; emo ional
well-being; social unc ioning; gene al heal h; and
men al heal h) o e ime and be ween he in e en ion
e sus he con ol g oup. Mul ile el linea eg ession
models could no be used, because he dis ibu ions o
SF-36 a iables we e skewed o disc e e. Since he condi-
ions necessa y o he use o mul ile el o dinal logis ic
2Mansikkamäki K, e al.BMJ Open 2015;5:e008232. doi:10.1136/bmjopen-2015-008232
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eg ession models we e no me , hese models could no
be used ei he .
The mul ile el model o dicho omous ou come y
ij
a
ime i o pe son j can be exp essed as
logi {P ðyij ¼1jxij;
6
jÞ}¼b1þb2x2j þb3x3ij þb4x2jx3ij þ
6
j;
whe e x
2j
ep esen s g oup, x
3ij
ep esen s ime, x
ij
=(x
2j
,
x
3ij
)′is a ec o con aining bo h co a ia es, and ζ
j
is a
pe son-specific andom in e cep . This model allows o
a di e ence be ween g oups a baseline β
2
, and linea
changes in he log odds o ou come o e ime wi h slope
β
3
in he con ol g oup and slope β
3
+β
4
in he in e en-
ion g oup. The e o e, β
4
, he di e ence in he a e o
imp o emen (on he log odds scale) be ween g oups,
can be iewed as changing o e ime be ween g oups.
17
Also second-o de and hi d-o de unc ions o ime
we e included in he model, o es ing o whe he
a model wi h a non-linea e ec imp o ed he fi .
A likelihood- a io es was used o models’compa ison,
o iden i y he model fi ing bes . The pa ame e es i-
ma es we e p esen ed as ORs wi h 95% CIs.
The p opo ions o he physical and men al dimen-
sions o QoL by ime a e shown in figu es 1 and 2. The
ou comes o QoL dimensions we e classified in wo ca -
ego ies acco ding o medians. P opo ions o women
ha ing highe o equal sco e han median a e shown in
figu es. Highe sco e defines mo e a ou able heal h
s a e. The Wilson sco e me hod wi hou con inui y
co ec ion:
ð2np þz2+zffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffi
ðz2þ4npq)
p
2ðnþz2Þ;
whe e n deno es he sample size, p is a single p opo -
ion, q=1−p and z deno es he s anda d no mal de ia e
Figu e 1 Pa icipan low cha .
Mansikkamäki K, e al.BMJ Open 2015;5:e008232. doi:10.1136/bmjopen-2015-008232 3
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associa ed wi h a wo- ailed p obabili y α, was used o
calcula e he 95% CIs o he p opo ions in figu es 1
and 2.
18
The significance o all es s was de e mined o be a a
p alue <0.05, and da a analyses we e pe o med wi h
S a a S a is ical So wa e, Release 12 ( om S a aCo p LP,
College S a ion, Texas, USA).
In hese models, we used all a ailable esponses om
women e en i hey had no esponded o all poin s o
da a collec ion. As sensi i i y analyses, we pe o med
mul ile el mixed e ec s logis ic eg ession models also
o women who esponded o all ou ime poin s
(N=75). We also analysed he esul s by using only he
second ollow-up (wi hou 2.5 yea s ollow-up).
RESULTS
Mos o he pa icipan s (68%) we e employed o pa -
ime wo ke s (9%) when he in e en ion began. O e
he cou se o he 4 yea s, 7–20% o he women we e in
pa - ime employmen .
The women pa icipa ing in he 4-yea ollow-up
we e, on a e age, 58 yea s o age, and hei mean BMI
was 26–27 kg/m
2
. In he ollow-up, no significan
change in BMI was obse ed. The p opo ion o
women using HRT was highe a he 4-yea ollow-up
poin han be o e he in e en ion. In he ollow-up,
no significan di e ences we e obse ed in use o
blood p essu e and choles e ol medica ion. Use o
headache medicine and o he painkille s, seda i es and
sleeping pills, and an idep essan s, dec eased wi hin
he in e en ion g oup and also among hose in he
con ol g oup. The in e en ion and he ollow-up
showed inc eased use o i amins and mine al p epa a-
ions in he in e en ion g oup ( om 55.1% o 68.9%)
while in he con ol g oup hei use declined
( om 51.9% o 34.0%); hese esul s a e p esen ed in
able 1.
The women in he in e en ion g oup had a g ea e
likelihood o imp o emen on he a ious QoL dimen-
sions om baseline o he end o 4-yea ollow-up.
O e all, he esul s show ha women in he in e en ion
g oup sus ained hei imp o ed QoL mo e o en han
women in he con ol g oup did. Figu es 2 and 3show
he p opo ions obse ed o he physical and men al
dimensions o QoL.
Wi h he ollow-up measu emen s, we ound ha
women in he in e en ion g oup displayed an imp o e-
men in physical unc ioning (OR 1.41; 95% CI 1.00 o
1.99) when compa ed wi h he con ol g oup. Howe e ,
no significan di e ences we e obse ed be ween g oups
o he o he a iables, as is indica ed by able 2. Resul s
o men al dimensions o QoL did no each s a is ical
significance (shown in able 3).
The women who did no pa icipa e in he 2½-yea and
4-yea ollow-up s udies (N=47, 28.1%) we e younge a
baseline (53.0 yea s, in con as o 54.5 yea s), hey had a
highe BMI (28.0, in con as o 26.3) and hey we e
Table 1 Cha ac e is ics (mean and SEM o equency and pe cen age) o all pa icipan s
Baseline End o in e en ion 2½ Yea s 4 Yea s
INT CON INT CON INT CON INT CON
N 7881758050524550
Age, mean (SEM) 54.4 (0.42) 54.1 (0.41)
BMI, mean (SEM) 26.4 (0.45) 27.2 (0.50) 25.2 (0.53) 26.2 (0.62) 26.0 (0.56) 26.6 (0.79)
Use o medicine in he pas 7 days
Ho mone eplacemen he apy, N (%) 2 (2.6) 1 (2.8) 5 (6.7) 2 (2.5) 10 (20.4) 12 (24.5) 14 (31.1) 8 (16.0)
Blood p essu e and choles e ol medicine, N (%) 16 (20.5) 12 (14.8) 12 (18.8) 12 (17.9) 13 (26.5) 16 (32.7) 10 (22.2) 11 (22.0)
Headache medicine and o he painkille s,
seda i es and sleeping pills, and an idep essan s, N (%)
43 (55.1) 33 (40.7) 32 (50.0) 38 (56.7) 25 (51.0) 29 (59.2) 14 (31.1) 14 (28.0)
Vi amin and mine al supplemen s, N (%) 43 (55.1) 42 (51.9) 39 (60.9) 36 (53.7) 28 (57.1) 32 (65.3) 31 (68.9) 17 (34.0)
BMI, body mass index; CON, con ol; INT, in e en ion.
4Mansikkamäki K, e al.BMJ Open 2015;5:e008232. doi:10.1136/bmjopen-2015-008232
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egula smoke s mo e o en (27.3%, in con as o
12.0%) han he women who pa icipa ed in he
ollow-up s udy.
As sensi i i y analyses, we pe o med mul ile el mixed
e ec s logis ic eg ession models also o women who
esponded o all ou ime poin s (N=75). When hese
women wi h non-missing esponses we e aken in he
analyses, in e en ion women had significan ly highe
p obabili y o imp o ed men al heal h unc ioning (OR
1.96; 95% CI 1.13 o 3.40) as compa ed wi h con ol
women (no shown in he figu es o ables). Resul s
om he models including only 4-yea ollow-up
esponses wi hou 2.5 yea esponses we e simila o he
esul s in he cu en ables and figu es.
DISCUSSION
The physical exe cise in e en ion may ha e long- e m
posi i e e ec s on heal h- ela ed QoL among he g oup
o menopausal women expe iencing daily symp oms o
menopause. Women in he in e en ion g oup had a
highe p obabili y o imp o emen in physical unc ion-
ing dimension o QoL om baseline o he end o
4-yea ollow-up. Among a subsample o women who
esponded o bo h ollow-up s udies, significan esul s
be ween he g oups we e ound be ween men al heal h
dimensions. O e all, he esul s show ha women in he
in e en ion g oup sus ained hei imp o ed QoL on
bo h physical-heal h and men al-heal h dimensions
mo e o en han did women in he con ol g oup.
Findings om p e ious s udies ha e shown ha
ge ing physical exe cise is co ela ed wi h lowe es i-
ma es o he pe cei ed se e i y o symp oms and ha
exe cise mode a es he psychological symp oms asso-
cia ed wi h menopause.
19 20
Ou s udy is in line wi h
hese findings bo h in physical and men al dimensions.
A epo on an 8-yea popula ion-based ollow-up s udy
om Finland
4
s a es ha mo i a ion o inc ease one’sPA
du ing menopausal ansi ion migh be an explana o y
ac o connec ed wi h imp o ed QoL. Acco ding o ha
ollow-up s udy, women whose PA inc eased o emained
s able, had a highe p obabili y o imp o ed QoL han
women whose PA dec eased.
4
Ela sky
19
ound, in a longi-
udinal s udy o middle-aged women, ha PA was asso-
cia ed wi h sel -wo h and by his mechanism imp o ed
QoL. Fu he mo e, S ojano ska e al
1
ecen ly published
a e iew o he ole o PA in educing symp oms o
menopause. They conside ed bo h soma ic and psycho-
logical dimensions. On he basis o hei e iew, physical
exe cise has been p oposed as an al e na i e o HRT, o
imp o ing he QoL o menopausal women.
Ou s udy has i s limi a ions, in he esponse a e
(59.7%) and he ac ha women wi h an ad e se li e-
s yle we e mo e likely o be ound among non-
esponde s. All ini ial pa icipan s we e included in he
analyses, e en i hey did no pa icipa e o he end o
Figu e 2 P opo ions o he physical dimensions o quali y o li e (QoL) by ime. Ou comes o QoL dimensions we e classi ied
in o wo ca ego ies acco ding o medians. P opo ions o women ha ing highe o equal sco e han median a e shown. Highe
sco e de ines mo e a ou able heal h s a e.
Mansikkamäki K, e al.BMJ Open 2015;5:e008232. doi:10.1136/bmjopen-2015-008232 5
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he in e en ion o he 2.5-yea ollow-up s udy. The
esul s o he s udy showed a endency owa ds inc eased
QoL, al hough he e we e no s a is ically significan
di e ences o any co es on he physical and men al
dimensions o QoL be ween he g oups. Ou findings
a e simila o hose om a la ge mul ie hnic olun ee
Table 2 Mul ile el mixed e ec s logis ic eg ession, ORs and 95% CIs o physical dimensions o QoL
Physical unc ioning Physical ole unc ioning F eeness om pain Physical heal h
N 159 159 159 159
G oup
baseline
0.52 (0.17 o 1.61) 0.84 (0.33 o 2.12) 0.58 (0.22 o 1.54) 0.72 (0.28 o 1.81)
Time 1.03 (0.10 o 11.1) 0.93 (0.75 o 1.17) 1.07 (0.85 o 1.34) 0.97 (0.77 o 1.22)
G oup× ime 44.7 (1.45 o 1374)* 1.21 (0.88 o 1.67) 1.25 (0.90 o 1.73) 1.33 (0.96 o 1.84)
Time
2
0.86 (0.19 o 3.82)
G oup× ime
2
0.11 (0.01 o 0.91)*
Time
3
1.04 (0.82 o 1.32)
G oup× ime
3
1.41 (1.00 o 1.99)*
*p<0.05.
Figu e 3 P opo ions o men al dimensions o quali y o li e (QoL) by ime. Ou comes o QoL dimensions we e classi ied in o
wo ca ego ies acco ding o medians. P opo ions o women ha ing highe o equal sco e han median a e shown. Highe sco e
de ines mo e a ou able heal h s a e.
6Mansikkamäki K, e al.BMJ Open 2015;5:e008232. doi:10.1136/bmjopen-2015-008232
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coho o pos menopausal women, in which sel -
epo ed PA was, o he mos pa , s able o e 8 yea s
o ollow-up. The e was app oxima ely 0.3 me abolic
equi alen (MET) o ac ual g ow h in ec ea ional PA
pe yea ×8 yea s=2.4 MET h/week, which ep esen ed
30 min o b isk walking in his case.
21
Loss- o- ollow-up analysis showed di e ences be ween
pa icipan s and hose los o ollow-up. Non- esponding
women di e ed om esponding women in hei weigh ,
age and smoking s a us. Responden s we e ligh e , olde
and we e less o en egula smoke s han non- esponding
women. These di e ences migh ha e had an e ec on
he findings in he ollow-up s udy. I all o he o iginal
pa icipan s had been s udied, he di e ences be ween
he g oups migh ha e been la ge . When limi ing he
analyses o women esponding o bo h ollow-up mea-
su emen s, he esul s di e ed. Explana ion o his may
be due o he ac ha conscien ious women esponding
o ques ionnai es may ha e benefi ed e en mo e om
a ailable suppo o be physically ac i e. A ollow-up s udy
in i sel can be conside ed an in e en ion, p oducing a
non-di e en ial suppo o he o iginal g oups in he
RCT.
The co e s eng hs o he s udy epo ed he e a e i s
p ospec i e s udy design and epea ed assessmen s o PA
beha iou , which made i possible o examine he di e -
ences be ween g oups in he ollow-up.
17
Many s udies
ha e desc ibed PA pa e ns h ough he lens o c oss-
sec ional da a, while ewe s udies ha e examined
changes be ween se e al ime poin s a e an in e en-
ion. PA has been epo ed o dec ease wi h age,
22
bu
con a y findings ha e also been epo ed. Ea lie , ou
esea ch g oup published he finding
6
ha women in
menopausal ansi ion shi ed hei beha iou in he
o he di ec ion. The e o e, inc eased PA could be
explained by highe mo i a ion o li es yle changes
du ing he menopausal ansi ion. In a longi udinal
s udy by Smi h-DiJulio e al,
23
he esea che s ound ha
a woman’s sense o con ol, o he li e and sa is ac ion
wi h i , and he abili y o make use o he a ailable social
suppo , p edic ed g ea e well-being du ing meno-
pause. This is consis en wi h ou findings, as we
obse ed imp o emen in i ali y, emo ional well-being
and men al heal h du ing he ollow-up, e en hough
he esul s did no each a le el o s a is ical significance.
Ou esul s may be gene alised o menopausal women
ha ing daily asomo o symp oms, such as ho flushes o
sleep p oblems, acco ding o he inclusion c i e ia in
he o iginal RCT.
6
O e all, ou s udy unde lines he
impo ance o PA du ing menopausal ansi ion. In add-
i ion, i suppo s he assump ion ha menopause can be
seen as a window o oppo uni y, since i may mo i a e
women o modi y hei li es yle. Menopausal women
should be encou aged o pa icipa e in egula exe cise
and suppo ed in his endea ou h ough de elopmen
o easily implemen ed home-based exe cise p og ammes
o inco po a ion o PA p og ammes in o public-heal h
ini ia i es.
10
Table 3 Mul ile el mixed e ec s logis ic eg ession, ORs and 95% CIs o men al dimensions o QoL
Emo ional ole unc ioning Vi ali y Emo ional well-being Social unc ioning Gene al heal h Men al heal h
N 159 159 159 159
G oup
baseline
1.74 (0.72 o 4.18) 1.93 (0.82 o 4.57) 2.50 (0.86 o 7.28) 1.46 (0.60 o 3.55) 1.04 (0.33 o 3.25) 1.98 (0.77 o 5.13)
Time 1.25 (1.00 o 1.57)* 1.28 (1.03 o 1.58)* 1.31 (1.03 o 1.67)* 1.10 (0.89 o 1.36) 0.98 (0.78 o 1.24) 1.29 (1.03 o 1.63)*
G oup× ime 0.93 (0.67 o 1.29) 0.97 (0.71 o 1.33) 1.02 (0.72 o 1.44) 1.05 (0.77 o 1.43) 1.14 (0.81 o 1.62) 0.97 (0.70 o 1.35)
*p<0.05.
QoL, quali y o li e.
Mansikkamäki K, e al.BMJ Open 2015;5:e008232. doi:10.1136/bmjopen-2015-008232 7
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CONCLUSION
Women in he in e en ion g oup showed posi i e long-
e m e ec s on physical and men al dimensions o QoL
a e 4 yea s. Menopause is a window o oppo uni y o
inc easing PA and he eby u u e QoL. This finding is
impo an , since an inc ease in PA may be associa ed
wi h a lowe u u e disease bu den.
Acknowledgemen s Biomedical labo a o y scien is s Ulla Hakala, Ulla
Honkanen and Si ke Rasinpe ä; esea ch assis an Ta u Helenius; and Ka iina
Ojala, MSc, o he UKK Ins i u e labo a o y, pe o med all he measu emen s
o he esea ch and handled con ac wi h he pa icipan s. Anna She l
pe o med language edi ing.
Con ibu o s KM and RL p epa ed he i s e sion o he manusc ip . JR was
esponsible o he s a is ical analyses. C-HN, ET and RR pa icipa ed in
d a ing he manusc ip and ha e app o ed he inal e sion.
Funding Financial suppo o he ollow-up s udy was ecei ed om he
Juho Vainio Founda ion (Finland), he Pi kanmaa Compe i i e Resea ch Fund
(Tampe e, Finland) and he Academy o Finland.
Compe ing in e es s None decla ed.
Pa ien consen Ob ained.
E hics app o al The s udy was g an ed e hics app o al by he Pi kanmaa
Hospi al Dis ic E hics Commi ee, Tampe e, Finland.
P o enance and pee e iew No commissioned; ex e nally pee e iewed.
Da a sha ing s a emen The e a e some da a om he ques ionnai es ha a e
unpublished bu all da a conce ning he measu emen s a e published.
Open Access This is an Open Access a icle dis ibu ed in acco dance wi h
he C ea i e Commons A ibu ion Non Comme cial (CC BY-NC 4.0) license,
which pe mi s o he s o dis ibu e, emix, adap , build upon his wo k non-
comme cially, and license hei de i a i e wo ks on di e en e ms, p o ided
he o iginal wo k is p ope ly ci ed and he use is non-comme cial. See: h p://
c ea i ecommons.o g/licenses/by-nc/4.0/
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o a andomised con olled ial
menopausal women: a 4-yea ollow-up s udy
heal h- ela ed quali y o li e among
Long- e m e ec o physical ac i i y on
Ree a Ru anen and Rii a Luo o
Ki si Mansikkamäki, Jani Rai anen, Clas-Håkan Nygå d, Eija Tomás,
doi: 10.1136/bmjopen-2015-008232
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