The menopause: hormone replacement therapy decreases the risk of heart disease & bone loss & maintains muscle performance

The effect of HRT after the menopause

Hormone replacement therapy (HRT) after menopause is widely believed to counteract the increased risk of heart disease and bone loss which accompanies the loss of the female sex hormones, particularly oestrogen. And now new research from Finland suggests that HRT also plays a key role in maintaining post-menopausal muscle performance, which is good news for women in general and female athletes in particular. Even better is the implication that the benefits of HRT combined with high-impact physical training exceed those of either HRT or training alone.

This one-year study of 80 women aged 50-57 is the first randomised double-blind placebo-controlled trial - the gold standard of scientific research - to investigate the effects of HRT on muscle performance and muscle mass. The women were assigned to one of four groups: exercise; HRT; exercise-plus-HRT; and control.

The exercise groups embarked on a 12-month progressive physical training programme that included a twice-weekly supervised circuit training session and a series of exercises performed at home four times a week. The circuit training sessions varied, but all included three or four of the following: resistance exercises for the upper body; chest fly; latissimus pull down; military press; seated row; biceps curl. The home exercise programme was also designed as a circuit training routine, including skipping, hopping, drop jumping and exercises to strengthen the abdominal and lower back regions.

The control group took dummy tablets daily as did the exercise-only group, while the women in the two non-exercise groups were told to continue their normal daily routines without changing their physical activity levels.

Various measures of muscle performance and mass were taken before the start of the study and at six and 12 months. By six months 18 of the original participants had dropped out for a variety of reasons, leaving 62 spread across the four groups. By 12 months that number had been whittled down to 52. Key results were as follows:

Over the course of the study lean body mass increased in all except the control group;
Women in the exercise and HRT groups showed an increase in maximal isometric knee extension force after six months compared with the controls. But after 12 months of follow-up, only the exercise-plus-HRT group differed significantly from the controls;

Slight increases in vertical jumping height - an indication of muscle power production - were seen in both the exercise and HRT groups after six and 12 months when compared with the controls. But the differences were more marked in the exercise-plus-HRT group;
After 12 months, women in the HRT and exercise-plus-HRT groups showed increases in the muscle mass of their quadriceps and lower leg in comparison with the exercise-only and control groups. Again, the differences were most marked in the group combining exercise with HRT.

'The independent effect of HRT on skeletal muscle mass and performance is probably the most interesting finding in the present study,' comment the authors.

'The resultsÉ suggest that continuous administration of oestradiol/noretisterone acetate [a combined HRT preparation] has beneficial effects on muscle performance, muscle mass and muscle composition in early post-menopausal womenÉ The results also suggest that the effects of HRT combined with high-impact physical training may exceed those of the two treatments separately.'

Clin Sci (Lond) 2001 Aug 101(2), pp 147-57

Isabel Walker

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