Metabolic Health in the Aging Female: Human Perspective

  • Alice S. Ryan


The incidence rates of overweight and obesity has increased dramatically over the last several decades and women with increased body fat and a sedentary lifestyle have a greater risk for cardiovascular disease, type 2 diabetes mellitus, hypertension, dyslipidemia, and certain cancers. This chapter provides a human perspective of obesity and aging, describes the cardiometabolic profile of postmenopausal women, presents a view of racial disparities in older women, and discusses the effects of aerobic and resistive exercise training on metabolic health in aging women. Finally, the chapter imparts some future research directions in the aging female.


Postmenopausal women Obesity Exercise Metabolism 



Dr. Ryan was supported by a VA Research Career Scientist Award, Veterans Affairs Merit Review Award, NIH grant R01-AG-030075, Mid-Atlantic NORC (DK072488), and the University of Maryland Claude D. Pepper Center (P30-AG-12583).


  1. 1.
    Nichols HB, Trentham-Dietz A, Egan KM, Titus-Ernstoff L, Holmes MD, Bersch AJ, Holick CN, Hampton JM, Stampfer MJ, Willett WC, Newcomb PA (2009) Body mass index before and after breast cancer diagnosis: associations with all-cause, breast cancer, and cardiovascular disease mortality. Cancer EpidemiolBiomarkers Prev 18:1403–1409Google Scholar
  2. 2.
    Cheng KK, Day NE (1996) Nutrition and esophageal cancer. Cancer Causes Control 7:33–40PubMedCrossRefGoogle Scholar
  3. 3.
    Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ (2003) Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. N Engl J Med 348:1625–1638PubMedCrossRefGoogle Scholar
  4. 4.
    Carmichael AR, Bates T (2004) Obesity and breast cancer: a review of the literature. Breast 13:85–92PubMedCrossRefGoogle Scholar
  5. 5.
    Flegal KM, Carroll MD, Ogden CL, Johnson CL (2002) Prevalence and trends in obesity among US adults, 1999–2000. JAMA 288:1723–1727PubMedCrossRefGoogle Scholar
  6. 6.
    Flegal KM, Carroll MD, Ogden CL, Curtin LR (2010) Prevalence and trends in obesity among US adults, 1999–2008. JAMA 303:235–241PubMedCrossRefGoogle Scholar
  7. 7.
    Van Itallie TB (1979) Obesity: adverse effects on health and longevity. Am J Clin Nutr 32:2723–2733PubMedGoogle Scholar
  8. 8.
    Ekelund LG, Haskell WL, Johnson JL, Whaley FS, Criqui MH, Sheps DS (1988) Physical fitness as a predictor of cardiovascular mortality in asymptomatic North American men. The lipid research clinics mortality follow-up study. N Engl J Med 319:1379–1384PubMedCrossRefGoogle Scholar
  9. 9.
    Lie H, Mundal R, Erikssen J (1985) Coronary risk factors and incidence of coronary death in relation to physical fitness. Seven-year follow-up study of middle-aged and elderly men. Eur Heart J 6:147–157PubMedGoogle Scholar
  10. 10.
    Wei M, Kampert JB, Barlow CE, Nichaman MZ, Gibbons LW, Paffenbarger RS Jr, Blair SN (1999) Relationship between low cardiorespiratory fitness and mortality in normal-weight, overweight, and obese men. JAMA 282:1547–1553PubMedCrossRefGoogle Scholar
  11. 11.
    Kushi LH, Fee RM, Folsom AR, Mink PJ, Anderson KE, Sellers TA (1997) Physical activity and mortality in postmenopausal women. JAMA 277:1287–1292PubMedCrossRefGoogle Scholar
  12. 12.
    Stampfer MJ, Hu FB, Manson JE, Rimm EB, Willett WC (2000) Primary prevention of coronary heart disease in women through diet and lifestyle. N Engl J Med 343:16–22PubMedCrossRefGoogle Scholar
  13. 13.
    Manson JE, Hu FB, Rich-Edwards JW, Colditz GA, Stampfer MJ, Willett WC, Speizer FE, Hennekens CH (1999) A prospective study of walking as compared with vigorous exercise in the prevention of coronary heart disease in women. N Engl J Med 341:650–658PubMedCrossRefGoogle Scholar
  14. 14.
    Nicklas BJ, Penninx BW, Ryan AS, Berman DM, Lynch NA, Dennis KE (2003) Visceral adipose tissue cutoffs associated with metabolic risk factors for coronary heart disease in women. Diabetes Care 26:1413–1420PubMedCrossRefGoogle Scholar
  15. 15.
    Ryan AS, Nicklas BJ, Berman DM (2002) Racial differences in insulin resistance and mid-thigh fat deposition in postmenopausal women. Obes Res 10:336–344PubMedCrossRefGoogle Scholar
  16. 16.
    Ryan AS, Nicklas BJ (1999) Age-related changes in fat deposition in mid-thigh muscle in women: relationships with metabolic cardiovascular disease risk factors. Int J Obes Relat Metab Disord 23:126–132PubMedCrossRefGoogle Scholar
  17. 17.
    Goss AM, Gower BA (2012) Insulin sensitivity is associated with thigh adipose tissue distribution in healthy postmenopausal women. Metabolism 61:1817–1823PubMedCrossRefGoogle Scholar
  18. 18.
    Dube MC, Lemieux S, Piche ME, Corneau L, Bergeron J, Riou ME, Weisnagel SJ (2011) The contribution of visceral adiposity and mid-thigh fat-rich muscle to the metabolic profile in postmenopausal women. Obesity (Silver Spring) 19:953–959CrossRefGoogle Scholar
  19. 19.
    Huang G, Wang D, Zeb I, Budoff MJ, Harman SM, Miller V, Brinton EA, El Khoudary SR, Manson JE, Sowers MR, Hodis HN, Merriam GR, Cedars MI, Taylor HS, Naftolin F, Lobo RA, Santoro N, Wildman RP (2012) Intra-thoracic fat, cardiometabolic risk factors, and subclinical cardiovascular disease in healthy, recently menopausal women screened for the Kronos Early Estrogen Prevention Study (KEEPS). Atherosclerosis 221:198–205PubMedCrossRefGoogle Scholar
  20. 20.
    Lin KH, Liou TL, Hsiao LC, Hwu CM (2011) Clinical and biochemical indicators of homeostasis model assessment-estimated insulin resistance in postmenopausal women. J Chin Med Assoc 74:442–447PubMedCrossRefGoogle Scholar
  21. 21.
    Lovejoy JC, Champagne CM, de Jonge L, Xie H, Smith SR (2008) Increased visceral fat and decreased energy expenditure during the menopausal transition. Int J Obes (Lond) 32:949–958CrossRefGoogle Scholar
  22. 22.
    Soler JT, Folsom AR, Kaye SA, Prineas RJ (1989) Associations of abdominal adiposity, fasting insulin, sex hormone binding globulin, and estrone with lipids and lipoproteins in post-menopausal women. Atherosclerosis 79:21–27PubMedCrossRefGoogle Scholar
  23. 23.
    Ferrara CM, Lynch NA, Nicklas BJ, Ryan AS, Berman DM (2002) Differences in adipose tissue metabolism between postmenopausal and perimenopausal women. J Clin Endocrinol Metab 87:4166–4170PubMedCrossRefGoogle Scholar
  24. 24.
    Wing RR, Matthews KA, Kuller LH, Meilahn EN, Plantinga PL (1991) Weight gain at the time of menopause. Arch Intern Med 151:97–102PubMedCrossRefGoogle Scholar
  25. 25.
    Tchernof A, Despres JP (2000) Sex steroid hormones, sex hormone-binding globulin, and obesity in men and women. Horm Metab Res 32:526–536PubMedCrossRefGoogle Scholar
  26. 26.
    Phillips GB, Jing T, Heymsfield SB (2008) Does insulin resistance, visceral adiposity, or a sex hormone alteration underlie the metabolic syndrome? Studies in women. Metabolism 57:838–844PubMedCrossRefGoogle Scholar
  27. 27.
    Jayagopal V, Kilpatrick ES, Jennings PE, Holding S, Hepburn DA, Atkin SL (2004) The biological variation of sex hormone-binding globulin in type 2 diabetes: implications for sex hormone-binding globulin as a surrogate marker of insulin resistance. Diabetes Care 27:278–280PubMedCrossRefGoogle Scholar
  28. 28.
    Goodman-Gruen D, Barrett-Connor E (1997) Sex hormone-binding globulin and glucose tolerance in postmenopausal women. The Rancho Bernardo Study. Diabetes Care 20:645–649PubMedCrossRefGoogle Scholar
  29. 29.
    Ding EL, Song Y, Malik VS, Liu S (2006) Sex differences of endogenous sex hormones and risk of type 2 diabetes: a systematic review and meta-analysis. JAMA 295:1288–1299PubMedCrossRefGoogle Scholar
  30. 30.
    Davis SR, Robinson PJ, Moufarege A, Bell RJ (2011) The contribution of SHBG to the variation in HOMA-IR is not dependent on endogenous oestrogen or androgen levels in postmenopausal women. Clin Endocrinol (Oxf) 77:541–547CrossRefGoogle Scholar
  31. 31.
    Brand JS, van der Tweel I, Grobbee DE, Emmelot-Vonk MH, van der Schouw YT (2011) Testosterone, sex hormone-binding globulin and the metabolic syndrome: a systematic review and meta-analysis of observational studies. Int J Epidemiol 40:189–207PubMedCrossRefGoogle Scholar
  32. 32.
    Joffe HV, Ridker PM, Manson JE, Cook NR, Buring JE, Rexrode KM (2006) Sex hormone-binding globulin and serum testosterone are inversely associated with C-reactive protein levels in postmenopausal women at high risk for cardiovascular disease. Ann Epidemiol 16:105–112PubMedCrossRefGoogle Scholar
  33. 33.
    Liao CH, Li HY, Yu HJ, Chiang HS, Lin MS, Hua CH, Ma WY (2012) Low serum sex hormone-binding globulin: marker of inflammation? Clin Chim Acta 413:803–807PubMedCrossRefGoogle Scholar
  34. 34.
    Maggio M, Ceda GP, Lauretani F, Bandinelli S, Corsi AM, Giallauria F, Guralnik JM, Zuliani G, Cattabiani C, Parrino S, Ablondi F, Dall'aglio E, Ceresini G, Basaria S, Ferrucci L (2011) SHBG, sex hormones, and inflammatory markers in older women. J Clin Endocrinol Metab 96:1053–1059PubMedCrossRefGoogle Scholar
  35. 35.
    Pelleymounter MA, Cullen MJ, Baker MB, Hecht R, Winters D, Boone T, Collins F (1995) Effects of the obese gene product on body weight regulation in ob/ob mice. Science 269:540–543PubMedCrossRefGoogle Scholar
  36. 36.
    Halaas JL, Gajiwala KS, Maffei M, Cohen SL, Chait BT, Rabinowitz D, Lallone RL, Burley SK, Friedman JM (1995) Weight-reducing effects of the plasma protein encoded by the obese gene. Science 269:543–546PubMedCrossRefGoogle Scholar
  37. 37.
    Ryan AS, Egan JM, Habener JF, Elahi D (1998) Insulinotropic hormone glucagon-like peptide-1-(7–37) appears not to augment insulin-mediated glucose uptake in young men during euglycemia. J Clin Endocrinol Metab 83:2399–2404PubMedCrossRefGoogle Scholar
  38. 38.
    Lee SW, Jo HH, Kim MR, You YO, Kim JH (2012) Association between metabolic syndrome and serum leptin levels in postmenopausal women. J Obstet Gynaecol 32:73–77PubMedCrossRefGoogle Scholar
  39. 39.
    Iwamoto J, Takeda T, Sato Y, Matsumoto H (2011) Serum leptin concentration positively correlates with body weight and total fat mass in postmenopausal Japanese women with osteoarthritis of the knee. Arthritis 2011:580632PubMedCrossRefGoogle Scholar
  40. 40.
    Ben Ali S, Jemaa R, Ftouhi B, Kallel A, Feki M, Slimene H, Kaabachi N (2011) Relationship of plasma leptin and adiponectin concentrations with menopausal status in Tunisian women. Cytokine 56:338–342PubMedCrossRefGoogle Scholar
  41. 41.
    Jurimae T, Jurimae J, Leppik A, Tafeit E, Kums T (2010) Relationships between adiponectin, leptin, and blood lipids in physically active postmenopausal females. Am J Hum Biol 22:609–612PubMedCrossRefGoogle Scholar
  42. 42.
    Scherer PE, Williams S, Fogliano M, Baldini G, Lodish HF (1995) A novel serum protein similar to C1q, produced exclusively in adipocytes. J Biol Chem 270:26746–26749PubMedCrossRefGoogle Scholar
  43. 43.
    Maeda K, Okubo K, Shimomura I, Funahashi T, Matsuzawa Y, Matsubara K (1996) cDNA cloning and expression of a novel adipose specific collagen-like factor, apM1 (AdiPose Most abundant Gene transcript 1). Biochem Biophys Res Commun 221:286–289PubMedCrossRefGoogle Scholar
  44. 44.
    Arita Y, Kihara S, Ouchi N, Takahashi M, Maeda K, Miyagawa J, Hotta K, Shimomura I, Nakamura T, Miyaoka K, Kuriyama H, Nishida M, Yamashita S, Okubo K, Matsubara K, Muraguchi M, Ohmoto Y, Funahashi T, Matsuzawa Y (1999) Paradoxical decrease of an adipose-specific protein, adiponectin, in obesity. Biochem Biophys Res Commun 257:79–83PubMedCrossRefGoogle Scholar
  45. 45.
    Ryan AS, Berman DM, Nicklas BJ, Sinha M, Gingerich RL, Meneilly GS, Egan JM, Elahi D (2003) Plasma adiponectin and leptin levels, body composition, and glucose utilization in adult women with wide ranges of age and obesity. Diabetes Care 26:2383–2388PubMedCrossRefGoogle Scholar
  46. 46.
    Lee JA, Kim JW, Kim DY (2012) Effects of yoga exercise on serum adiponectin and metabolic syndrome factors in obese postmenopausal women. Menopause 19:296–301PubMedCrossRefGoogle Scholar
  47. 47.
    Rajpathak SN, Kaplan RC, Wassertheil-Smoller S, Cushman M, Rohan TE, McGinn AP, Wang T, Strickler HD, Scherer PE, Mackey R, Curb D, Ho GY (2011) Resistin, but not adiponectin and leptin, is associated with the risk of ischemic stroke among postmenopausal women: results from the Women’s Health Initiative. Stroke 42:1813–1820PubMedCrossRefGoogle Scholar
  48. 48.
    Yamauchi T, Kamon J, Waki H, Terauchi Y, Kubota N, Hara K, Mori Y, Ide T, Murakami K, Tsuboyama-Kasaoka N, Ezaki O, Akanuma Y, Gavrilova O, Vinson C, Reitman ML, Kagechika H, Shudo K, Yoda M, Nakano Y, Tobe K, Nagai R, Kimura S, Tomita M, Froguel P, Kadowaki T (2001) The fat-derived hormone adiponectin reverses insulin resistance associated with both lipoatrophy and obesity. Nat Med 7:941–946PubMedCrossRefGoogle Scholar
  49. 49.
    Yamauchi T, Kamon J, Minokoshi Y, Ito Y, Waki H, Uchida S, Yamashita S, Noda M, Kita S, Ueki K, Eto K, Akanuma Y, Froguel P, Foufelle F, Ferre P, Carling D, Kimura S, Nagai R, Kahn BB, Kadowaki T (2002) Adiponectin stimulates glucose utilization and fatty-acid oxidation by activating AMP-activated protein kinase. Nat Med 8:1288–1295PubMedCrossRefGoogle Scholar
  50. 50.
    Tomas E, Tsao TS, Saha AK, Murrey HE, Zhang CC, Itani SI, Lodish HF, Ruderman NB (2002) Enhanced muscle fat oxidation and glucose transport by ACRP30 globular domain: acetyl-CoA carboxylase inhibition and AMP-activated protein kinase activation. Proc Natl Acad Sci USA 99:16309–16313PubMedCrossRefGoogle Scholar
  51. 51.
    Berman DM, Rodrigues LM, Nicklas BJ, Ryan AS, Dennis KE, Goldberg AP (2001) Racial disparities in metabolism, central obesity, and sex hormone-binding globulin in postmenopausal women. J Clin Endocrinol Metab 86:97–103PubMedCrossRefGoogle Scholar
  52. 52.
    Fried SK, Tittelbach T, Blumenthal J, Sreenivasan U, Robey L, Yi J, Khan S, Hollender C, Ryan AS, Goldberg AP (2010) Resistance to the antilipolytic effect of insulin in adipocytes of African-American compared to Caucasian postmenopausal women. J Lipid Res 51:1193–1200PubMedCrossRefGoogle Scholar
  53. 53.
    Conway JM, Yanovski SZ, Avila NA, Hubbard VS (1995) Visceral adipose tissue differences in black and white women. Am J Clin Nutr 61:765–771PubMedGoogle Scholar
  54. 54.
    Lovejoy JC, de la Bretonne JA, Klemperer M, Tulley R (1996) Abdominal fat distribution and metabolic risk factors: effects of race. Metabolism 45:1119–1124PubMedCrossRefGoogle Scholar
  55. 55.
    Nicklas BJ, Toth MJ, Goldberg AP, Poehlman ET (1997) Racial differences in plasma leptin concentrations in obese postmenopausal women. J Clin Endocrinol Metab 82:315–317PubMedCrossRefGoogle Scholar
  56. 56.
    Ryan AS, Nicklas BJ, Elahi D (1996) A cross-sectional study on body composition and energy expenditure in women athletes during aging. Am J Physiol 271:E916–E921PubMedGoogle Scholar
  57. 57.
    Ryan AS, Muller DC, Elahi D (2001) Sequential hyperglycemic-euglycemic clamp to assess beta-cell and peripheral tissue: studies in female athletes. J Appl Physiol 91:872–881PubMedGoogle Scholar
  58. 58.
    Nicklas BJ, Ryan AS, Katzel LI (1999) Lipoprotein subfractions in women athletes: effects of age, visceral obesity and aerobic fitness. Int J Obes Relat Metab Disord 23:41–47PubMedCrossRefGoogle Scholar
  59. 59.
    Lynch NA, Nicklas BJ, Berman DM, Dennis KE, Goldberg AP (2001) Reductions in visceral fat during weight loss and walking are associated with improvements in VO (2 max). J Appl Physiol 90:99–104PubMedGoogle Scholar
  60. 60.
    Ryan AS, Nicklas BJ, Berman DM, Dennis KE (2000) Dietary restriction and walking reduce fat deposition in the midthigh in obese older women. Am J Clin Nutr 72:708–713PubMedGoogle Scholar
  61. 61.
    Ryan AS, Nicklas BJ, Berman DM (2006) Aerobic exercise is necessary to improve glucose utilization with moderate weight loss in women. Obesity (Silver Spring) 14:1064–1072CrossRefGoogle Scholar
  62. 62.
    Ryan AS, Ortmeyer HK, Sorkin JD (2012) Exercise with calorie restriction improves insulin sensitivity and glycogen synthase activity in obese postmenopausal women with impaired glucose tolerance. Am J Physiol Endocrinol Metab 302:E145–E152PubMedCrossRefGoogle Scholar
  63. 63.
    Nicklas BJ, Dennis KE, Berman DM, Sorkin J, Ryan AS, Goldberg AP (2003) Lifestyle intervention of hypocaloric dieting and walking reduces abdominal obesity and improves coronary heart disease risk factors in obese, postmenopausal, African-American and Caucasian women. J Gerontol A Biol Sci Med Sci 58:181–189PubMedCrossRefGoogle Scholar
  64. 64.
    Ryan AS, Nicklas BJ, Berman DM, Dennis KE (2000) Dietary restriction and walking reduce fat deposition in the midthigh in obese older women. Am J Clin Nutr 72:708–713PubMedGoogle Scholar
  65. 65.
    Nicklas BJ, Wang X, You T, Lyles MF, Demons J, Easter L, Berry MJ, Lenchik L, Carr JJ (2009) Effect of exercise intensity on abdominal fat loss during calorie restriction in overweight and obese postmenopausal women: a randomized, controlled trial. Am J Clin Nutr 89:1043–1052PubMedCrossRefGoogle Scholar
  66. 66.
    Brinkley TE, Ding J, Carr JJ, Nicklas BJ (2011) Pericardial fat loss in postmenopausal women under conditions of equal energy deficit. Med Sci Sports Exerc 43:808–814PubMedCrossRefGoogle Scholar
  67. 67.
    Ryan AS, Pratley RE, Elahi D, Goldberg AP (1995) Resistive training increases fat-free mass and maintains RMR despite weight loss in postmenopausal women. J Appl Physiol 79:818–823PubMedGoogle Scholar
  68. 68.
    Asikainen TM, Kukkonen-Harjula K, Miilunpalo S (2004) Exercise for health for early postmenopausal women: a systematic review of randomised controlled trials. Sports Med 34:753–778PubMedCrossRefGoogle Scholar
  69. 69.
    Orsatti FL, Nahas EA, Maesta N, Nahas-Neto J, Burini RC (2008) Plasma hormones, muscle mass and strength in resistance-trained postmenopausal women. Maturitas 59:394–404PubMedCrossRefGoogle Scholar
  70. 70.
    Walts CT, Hanson ED, Delmonico MJ, Yao L, Wang MQ, Hurley BF (2008) Do sex or race differences influence strength training effects on muscle or fat? Med Sci Sports Exerc 40:669–676PubMedCrossRefGoogle Scholar
  71. 71.
    Hanson ED, Srivatsan SR, Agrawal S, Menon KS, Delmonico MJ, Wang MQ, Hurley BF (2009) Effects of strength training on physical function: influence of power, strength, and body composition. J Strength Cond Res 23:2627–2637PubMedCrossRefGoogle Scholar
  72. 72.
    Melnyk JA, Rogers MA, Hurley BF (2009) Effects of strength training and detraining on regional muscle in young and older men and women. Eur J Appl Physiol 105:929–938PubMedCrossRefGoogle Scholar
  73. 73.
    Ryan AS, Ivey FM, Hurlbut DE, Martel GF, Lemmer JT, Sorkin JD, Metter EJ, Fleg JL, Hurley BF (2004) Regional bone mineral density after resistive training in young and older men and women. Scand J Med Sci Sports 14:16–23PubMedCrossRefGoogle Scholar
  74. 74.
    Treuth MS, Hunter GR, Kekes-Szabo T, Weinsier RL, Goran MI, Berland L (1995) Reduction in intra-abdominal adipose tissue after strength training in older women. J Appl Physiol 78:1425–1431PubMedGoogle Scholar
  75. 75.
    Binder EF, Yarasheski KE, Steger-May K, Sinacore DR, Brown M, Schechtman KB, Holloszy JO (2005) Effects of progressive resistance training on body composition in frail older adults: results of a randomized, controlled trial. J Gerontol A Biol Sci Med Sci 60:1425–1431PubMedCrossRefGoogle Scholar
  76. 76.
    Kemmler W, von Stengel S, Engelke K, Haberle L, Mayhew JL, Kalender WA (2010) Exercise, body composition, and functional ability: a randomized controlled trial. Am J Prev Med 38:279–287PubMedCrossRefGoogle Scholar
  77. 77.
    Kim C, Kong S, Laughlin GA, Golden SH, Mather KJ, Nan B, Edelstein SL, Randolph JF Jr, Labrie F, Buschur E, Barrett-Connor E (2012) Endogenous sex hormone changes in postmenopausal women in the diabetes prevention program. J Clin Endocrinol Metab 97:2853–2861PubMedCrossRefGoogle Scholar
  78. 78.
    Wieczorek-Baranowska A, Nowak A, Michalak E, Karolkiewicz J, Pospieszna B, Rutkowski R, Laurentowska M, Pilaczynska-Szczesniak L (2011) Effect of aerobic exercise on insulin, insulin-like growth factor-1 and insulin-like growth factor binding protein-3 in overweight and obese postmenopausal women. J Sports Med Phys Fitness 51:525–532PubMedGoogle Scholar
  79. 79.
    Wang X, Nicklas BJ (2011) Acute impact of moderate-intensity and vigorous-intensity exercise bouts on daily physical activity energy expenditure in postmenopausal women. J Obes Pii:342431Google Scholar
  80. 80.
    Lavoie ME, Faraj M, Strychar I, Doucet E, Brochu M, Lavoie JM, Rabasa-Lhoret R (2012) Synergistic associations of physical activity and diet quality on cardiometabolic risk factors in overweight and obese postmenopausal women. Br J Nutr 9:1–10Google Scholar
  81. 81.
    Baan CA, Stolk RP, Grobbee DE, Witteman JC, Feskens EJ (1999) Physical activity in elderly subjects with impaired glucose tolerance and newly diagnosed diabetes mellitus. Am J Epidemiol 149:219–227PubMedCrossRefGoogle Scholar
  82. 82.
    Amati F, Dube JJ, Coen PM, Stefanovic-Racic M, Toledo FG, Goodpaster BH (2009) Physical inactivity and obesity underlie the insulin resistance of aging. Diabetes Care 32:1547–1549PubMedCrossRefGoogle Scholar
  83. 83.
    Chen YL, Huang CY, Lee SD, Chou SW, Hsieh PS, Hsieh CC, Huang YG, Kuo CH (2009) Discipline-specific insulin sensitivity in athletes. Nutrition 25:1137–1142PubMedCrossRefGoogle Scholar
  84. 84.
    DiPietro L, Dziura J, Yeckel CW, Neufer PD (2006) Exercise and improved insulin sensitivity in older women: evidence of the enduring benefits of higher intensity training. J Appl Physiol 100:142–149PubMedCrossRefGoogle Scholar
  85. 85.
    Mason C, Foster-Schubert KE, Imayama I, Kong A, Xiao L, Bain C, Campbell KL, Wang CY, Duggan CR, Ulrich CM, Alfano CM, Blackburn GL, McTiernan A (2011) Dietary weight loss and exercise effects on insulin resistance in postmenopausal women. Am J Prev Med 41:366–375PubMedCrossRefGoogle Scholar
  86. 86.
    Ryan AS, Hurlbut DE, Lott ME, Ivey FM, Fleg J, Hurley BF, Goldberg AP (2001) Insulin action after resistive training in insulin resistant older men and women. J Am Geriatr Soc 49:247–253PubMedCrossRefGoogle Scholar
  87. 87.
    Hurlbut DE, Lott ME, Ryan AS, Ferrell RE, Roth SM, Ivey FM, Martel GF, Lemmer JT, Fleg JL, Hurley BF (2002) Does age, sex, or ACE genotype affect glucose and insulin responses to strength training? J Appl Physiol 92:643–650PubMedGoogle Scholar
  88. 88.
    Ryan AS, Pratley RE, Goldberg AP, Elahi D (1996) Resistive training increases insulin action in postmenopausal women. J Gerontol A Biol Sci Med Sci 51:M199–M205PubMedCrossRefGoogle Scholar
  89. 89.
    Guadalupe-Grau A, Fuentes T, Guerra B, Calbet JA (2009) Exercise and bone mass in adults. Sports Med 39:439–468PubMedCrossRefGoogle Scholar
  90. 90.
    Gomez-Cabello A, Ara I, Gonzalez-Aguero A, Casajus JA, Vicente-Rodriguez G (2012) Effects of training on bone mass in older adults: a systematic review. Sports Med 42:301–325PubMedCrossRefGoogle Scholar
  91. 91.
    Howe TE, Shea B, Dawson LJ, Downie F, Murray A, Ross C, Harbour RT, Caldwell LM, Creed G (2011) Exercise for preventing and treating osteoporosis in postmenopausal women. Cochrane Database Syst Rev:CD000333Google Scholar
  92. 92.
    Elavsky S (2009) Physical activity, menopause, and quality of life: the role of affect and self-worth across time. Menopause 16:265–271PubMedCrossRefGoogle Scholar
  93. 93.
    Hammar M, Berg G, Lindgren R (1990) Does physical exercise influence the frequency of postmenopausal hot flushes? Acta Obstet Gynecol Scand 69:409–412PubMedCrossRefGoogle Scholar
  94. 94.
    Gold EB, Sternfeld B, Kelsey JL, Brown C, Mouton C, Reame N, Salamone L, Stellato R (2000) Relation of demographic and lifestyle factors to symptoms in a multi-racial/ethnic population of women 40–55 years of age. Am J Epidemiol 152:463–473PubMedCrossRefGoogle Scholar
  95. 95.
    Thurston RC, Sowers MR, Sternfeld B, Gold EB, Bromberger J, Chang Y, Joffe H, Crandall CJ, Waetjen LE, Matthews KA (2009) Gains in body fat and vasomotor symptom reporting over the menopausal transition: the study of women’s health across the nation. Am J Epidemiol 170:766–774PubMedCrossRefGoogle Scholar
  96. 96.
    Moilanen JM, Aalto AM, Raitanen J, Hemminki E, Aro AR, Luoto R (2012) Physical activity and change in quality of life during menopause—an 8-year follow-up study. Health Qual Life Outcomes 10:8PubMedCrossRefGoogle Scholar

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© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.VA Research Service, VA Maryland Health Care System, GRECC, Division of Gerontology and Geriatric Medicine, Department of MedicineUniversity of Maryland School of MedicineBaltimoreUSA

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