Aerobic exercise program on blood lipids in women between 40 and 55 years old

doi:10.4236/health.2013.58167

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Vol.5, No.8, 1236-1240 (2013) Health

http://dx.doi.org/10.4236/health.2013.58167

Aerobic exercise program on blood lipids in women

between 40 and 55 years old

Judith M. Rodríguez-Villalobos*, María de Jesús Muñoz-Daw, Rosa P. Hernández,

Martha Ornelas

Faculty of Physical Education and Sport Sciences, Chihuahua Autonomous University, Chihuahua, México;

*Corresponding Author: [email protected]

Received 24 May 2013; revised 25 June 2013; accepted 16 July 2013

tribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is prop-

erly cited.

ABSTRACT

Objective: Evaluate the effect of a physical ac-

tivity program on the blood lipid profile in wo-

men between 40 and 55 years old. Methods: 7

female participants from the city of Chihuahua,

Chihuahua, Mexico, on a program of moderate-

intensity physical activity lasting 4 months, eva-

luated before and af ter the implementation of the

program in the variables of total cholesterol,

triglycerides, LDL and HDL, as well as the athe-

rogenic index and cardiov ascular risk. Dat a were

analyzed with Student t test for related samples

with a significance level of 0.05. Results: Total

cholesterol levels and LDL in samples collected

after physical exercise program decreased sig-

nificantly compared to those collected before

the implementation of the exercise program,

while statistically, HDL and triglycerides did not

show significant changes. The atherogenic in-

dex and cardiovascular risk showed positive

trends, thus favoring that moderate intensity

aerobic exercise decreased cardiovascular risk

in women reaching the perimenopause period.

Keywords: Lipids; Menopause; Exercise; Therapy

1. INTRODUCTION

Cardiovascular diseases are the main causes of death in

women. Epidemiological studies show that menopause is

associated with the prevalence of cardiovascular diseases

[1]. In Mexican women, the average age of menopause

occurrence is 49 years, due to the loss of ovarian follicu-

lar activity [2].

The hormonal deprivation produces changes in the

lipid profile, increasing the quantity of total cholesterol

(TC), low density lipoprotein (LCL-C) [1,2] and de-

crease of high density lipoprotein (HDL-C) [3]. This mo-

dification in blood lipids is a risk factor in the contrac-

tion of atherosclerosis and other chronic degenerative

diseases; this was observed more frequently in the post-

menopausal period, causing deterioration in the quality

of life and increase of morbidity and mortality [2,4-6].

The lipid problem has been increasing in our country,

mainly in women who are older than 40 and to 69 years

old, presenting higher values than men of the same age

[7].

The most common treatments for women during this

period are hormonal and/or drug therapy, however, the

use of hormones as a monotherapy has not been evident

in these conditions [4]. New studies involve a multidis-

ciplinary approach in which the measures are directed to

reduce the risk factors for cardiovascular diseases in-

cluding obesity, abnormal blood lipids, hypertension, dia-

betes, smoking, sedentary lifestyle, genetic background

effects, stress and estrogen deficiency [1].

Physical activity is acquiring more and more impor-

tance in being incorporated as part of an integral treat-

ment. Benefits have been found in several studies, espe-

cially in lipids and other cardiovascular risk factors in

women in perimenopause stage [8-11]. Among the pub-

lished involvements there are still variations in the man-

ner of applying the physical activity. On one hand, the

level of intensity of the exercise has been given consid-

erable importance, finding different benefits in the body,

aerobic activity being the most recommended for the

reduction of lipids and strength exercises being recom-

mended for the management of osteoporosis [12-16].

Some studies concluded in favor of low-intensity exer-

cise [17], others focused on vigorous exercise [18]. On

the other hand, research such as Kraus argues that it is

not the intensity level but the amount of exercise that

J. M. Rodríguez-Villalobos et al. / Health 5 (2013) 1236-1240 1237

gets really beneficial results [19].

The present study proposes the implementation of a

program of moderate-intensity physical activity (indi-

vidually controlled), for an extended period of time, to

assess its effect on the lipid profile in women who are in

perimenopause stage. The study’s objective is to gener-

ate and verify effective strategies to supplement existing

treatment processes in the area of Chihuahua, Mexico.

2. METHODS

2.1. Design

Intervention study is with the same group as control.

The individuals were evaluated in lipid profile at the be-

ginning and the end of their physical activity program,

which 4 lasted months.

2.2. Subjects

7 volunteer women who responded to a campaign by

radio and press and who met the following inclusion cri-

teria: age between 40 and 55 years old, without diabetes,

with medical authorization to exercise and complete sat-

isfactorily at least 80% of the sessions of the program.

They attended an informative meeting and at the same

meeting signed a letter of voluntary participation and

answered the questionnaire Par-Q & You [20]. Partici-

pants were instructed to maintain their normal activities

in their daily lives. The research committee of the Fac-

ulty of Physical Education and Sport Sciences at the

Autonomous University of Chihuahua approved the re-

search.

2.3. Variables

Independent variables: exercise program

The exercise program lasted a total of 66 sessions over

4 months, 4 times a week and 3 levels of intensity were

used, gradually increasing at each level. They started the

first 16 sessions at 40% of maximum heart rate, then

increased to 50% the following 16 sessions, and the last

sessions were programmed at 60%. The intensity at

which they should perform physical activity was deter-

mined based on their heart rate reserve calculated by the

Karvonen method [21], for this calculation we used the

age and resting heart rate of the subject taken with the

heart rate monitor after 10 minutes of remaining without

any physical effort, the equation was used as follows:

220 minus age, the heart rate at rest is then subtracted

from the result, and thus obtaining the so-called heart

rate reserve; this number is multiplied by the degree or

intensity that is going to be worked (40%, 50% or 60%),

and to the result of this multiplication, finally we add the

resting heart rate, and thus we obtain a heart rate at

which the person must maintain during a minimum of 20

minutes for each session, with variations of no more than

5 beats above and below it. Their beats per minute were

controlled using telemetric Polar heart rate monitors.

Dependent variable:

The variables observed were: lipid profile (total cho-

lesterol, triglycerides, low density lipoprotein, high den-

sity lipoprotein), the atherogenic index [22] (calculated

by dividing the total cholesterol by high density lipopro-

tein) and the cardiovascular risk index [23] (composed of

five components: age, total cholesterol, HDL-C, smoking

and blood pressure). Variables were also measured to

describe the general characteristics of the participants,

which were: estradiol level, hemoglobin, weight and

body mass index (BMI).

2.4. Procedure

In the beginning, participants were asked to provide a

medical authorization document to affirm that they could

exercise and were also asked to independently undertake

a blood test to determine the level of estradiol which was

issued by a certified laboratory, for women who still had

menstrual cycle, the sample was taken in the twenty-first

day of the menstrual cycle.

In the initial assessment overall variables were meas-

ured: body weight and height. A blood sample from the

antecubital vein was taken while fasting to determine the

lipid and hemoglobin profile; with the results of all these

assessments a file was made.

We proceeded to the implementation of the program in

which each session consisted of a warm up, between 10

and 15 min which included basic gymnastic exercises to

warm up the joints and stretch the muscles, the core con-

sisted of aerobic exercises for 30 to 40 min ranging from

in motion gymnastic moves, to floor exercises, and rou-

tines, with and without hand held weights, which did not

exceed 1 kg; the relaxation in the closing session lasted

between 5 and 10 min with relaxed breathing and stretch-

ing exercises. Heart rate was monitored every 5 minutes

making sure that in the core of each session people

maintained their heart rate according to the programmed

intensity.

At the end of four months, the lipid profile measure-

ments were performed again.

2.5. Instruments

The instrument used for the measurement of body

weight was a Torino brand scale and for the height it was

a standing stadimeter fixed to the wall, using for both the

technique of the International Society for the Advance-

ment of kinanthropometry. With these values were cal-

culated the BMI (weight /height2).

For the assessment of the blood sample, syringes or

vacuum extraction system were used in the measurement

J. M. Rodríguez-Villalobos et al. / Health 5 (2013) 1236-1240

1238

of the lipid profile. Blood was transferred to EDTA tubes

and before a refrigeration of 2 hours the plasma was

separated by centrifuging the tubes at 2500 rpm in a

clinical centrifuge (IEC C300). The quantifying of the

blood lipids was done by an automated analyzer (BTS-

370 Bio system plus) with reagents of Bio system and

enzyme-spectrophotometric techniques. HDL-C was meas-

ured before precipitation of Apo lipoprotein B (VLDL-C

and LDL-C) with phosphotungstate and magnesium ions

and before precipitating LDL-C with Polyvinyl sulfate

and subtracting the value of the supernatant cholesterol

of the total cholesterol.

The atherogenic index was obtained by dividing the

total cholesterol by the HDL-C. The Framingham scale

was applied to determine the cardiovascular risk index

which is divided into five sections which are age, total

cholesterol, HDL-C, smoking and blood pressure, the

sum of the scores on each of the sections of the scale, is

compared to the reference table, which results in the

percentage of possibility of having a heart attack within

10 years.

2.6. Data Analysis

Statistical analysis was performed using SPSS version

15.0, to calculate descriptive data of mean and standard

deviation for each variable. A comparison was perform-

ed between initial and final evaluations with t-test paired

samples with a significance level of 0.05.

3. RESULTS

We evaluated seven participants who met the inclusion

criteria including satisfactory completion of the physical

activity program with an attendance rate of over 80%.

At the time of starting the program, the average blood

estradiol was found to be 25.35 ± 35 pg/ml. One of the

values was above 100 pg / ml, another at 26 pg/ml and

the rest below; that is, 5 of the participants were in the

postmenopausal stage and two in menopause, the aver-

age age group was 48.14 ± 5.11 years, and had an aver-

age hemoglobin of 13.95 ± 1.72, the weight at the begin-

ning had a mean of 72.5 ± 10.04 kg and BMI was 28.42

± 2.99, without significant variation throughout the pro-

gram (Table 1).

In regards to the lipid profile, the initial average blood

cholesterol was 217.86 ± 27.8 mg/dl and after the pro-

gram, there appeared a mean difference of 35.57 ± 25.62

mg/dl, being a statistically significant change with a P

value less than 0.01. Triglycerides data showed no sig-

nificant differences, based on a mean value of 228.5 ±

168.78 mg/dl, the average difference was 57.18 ± 92.97

mg/dl (Table 2).

The LDL-C in the beginning was at an average of

172.0 ± 34.5 mg/dl and after 4 months of the program

there appeared significant differences with a P value less

than 0.02, with the mean difference of 28.24 ± 25.33

mg/dl. In HDL-C, we found no significant changes, with

the initial average of 35.5 ± 3.48 mg/dl and the mean

difference was −0.63 ± 6.56 mg/dl (Table 2).

The atherogenic index in the beginning was 6.2 ± 1.1

on average; the mean difference found was 1.04 ± 1.39

not being statistically significant. The cardiovascular risk

index calculated with the Framingham scale, in the be-

ginning, was on average 2.28 ± 2.36, the mean difference

in the end was 1.00 ± 1.82, with no significant differ-

ences between evaluations (Table 3).

Table 1. Descriptive data of mean and standard deviation for the general variables.

Variable N Mean Standar Deviation

Age (years) 7 48.14 5.11

Estradiol (pg/ml) 7 25.35 35.00

Hemoglobin (g/dl) 7 13.95 1.72

Weight (kg) 7 72.50 10.04

Body Mass Index (kg/m2) 7 28.42 2.99

Table 2. Starting Mean, mean differences and significance of lipid profile.

Variable Pre-Test (Mean ± SD) Mean of Differences (d ± SD) P

Total Cholesterol (mg/dl) 217.86 ± 27.84 35.58 ± 25.62 0.01

LDL-C (mg/dl) 172.10 ± 34.58 28.24 ± 25.34 0.03

HDL-C (mg/dl) 35.58 ± 3.48 −0.63 ± 6.57 0.81

Triglyicerids (mg/dl) 228.54 ± 168.78 57.18 ± 92.98 0.15

J. M. Rodríguez-Villalobos et al. / Health 5 (2013) 1236-1240 1239

Table 3. Starting Mean, mean differences and significance for atherogenic indices and cardiovascular risk.

Variable Pre-Test (MEAN ± SD) Mean of Differences (d ± SD) P

Atherogenic index 6.19 ± 1.14 35.58 ± 25.62 0.09

Cardiovascular risk index 2.29 ± 2.36 57.18 ± 92.98 0.19

4. DISCUSION

The participants reached a minimum of 80% atten-

dance, maintaining during the programmed sessions a

moderate intensity level, to obtain changes in the lipid

profile.

The average age of the group of women who partici-

pated in the physical activity program agrees with the

average Mexican woman marks of the official Mexican

standard for the treatment of menopause. According to

the estradiol blood values calculated in the study, 5 of

them are in post-menopausal stage, being the reference

point of less than 25 pg/ml.

The research focused on improving blood lipid levels,

it was observed after 4 months that the total cholesterol

reached 182.3 ± 23.3 mg/dl, a value that is within sug-

gested range according to the National Cholesterol Edu-

cation Program US [24]. Similarly, LDL-C, significantly

decreased, with a final value of 143.9 ± 26.4 mg/dl but is

still above the suggested range. The HDL-C, however,

remained constant and triglycerides did not change sig-

nificantly, which also occurred in the study of Janssen

(2002) [13], who applied aerobic exercise combined with

a diet and found no relationship between exercise, weight

loss, decreased body fat and HDL-C, triglycerides and

glucose.

On the other hand, the cardiovascular risks, deter-

mined by the Framingham scale showed a decrease of

10% in probabilities of getting a coronary problem with-

in 10 years [24]. The same happened with the athero-

genic index, which had a tendency to decrease although

not significantly. In both measurements, the cause ap-

pears to be that the HDL-C remained relatively constant

and well below the minimum required (>60 mg/dl ac-

cording to the NIH, 2002) [24].

The following considerations are: 1) The inclusion of

a representative sample of women located in both pre

and post-menopausal stage; 2) Following the diet me-

ticulously; 3) Adding anthropometric measurements to

estimate the distribution of body mass and weight since

BMI alone may not be a good estimator of lipid risk.

Consequently, it is suggested to include at least the

measuring of waist circumference, which reflects on the

lowering of visceral fat, and can relate most to the lipid

changes.

5. CONCLUSION

In this study, an aerobic exercise program of moderate

intensity appeared to give benefits on the lipid profile of

women in perimenopause who participated voluntarily in

the city of Chihuahua, Chihuahua, resulting in a signifi-

cant decrease in total cholesterol and LDL-C, but the

HDL-C and triglycerides were not changed significantly.

Considering the positive impact on the cardiovascular

risk index and atherogenic index, the program may give

rise to more widespread similar studies, and even pro-

mote its direct use in health centers as part of the strate-

gies for treatment of this cluster of the population.

6. ACKNOWLEDGEMENTS

This study was produced with material and financial resources of the

Faculty of Physical Education and Sport Sciences at the Autonomous

University of Chihuahua, Mexico.

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