When considering the link that has been made between malnutrition and injury, it is especially important to assess the energy and nutrient intake in a population that is more susceptible to injury—menopausal and postmenopausal women. More specifically, the decline in estrogen levels that accompany menopausal transitions has been linked to decreased muscle mass, low bone density, obesity, increased risk of cardiovascular disease, and various other health complications. Each of these factors significantly increases risk for injury, even among those who do not participate in high level activities or strenuous exercise. While there are inevitable physiological changes that occur with menopause, there are also lifestyle modifications that can be used to minimize their effect and aid in injury prevention. 

NUTRITION

Maintaining a nutrient-rich and balanced diet is integral during each phase of life. While “healthy eating” varies depending on the individual and their specific nutritional needs, there are a few basic principles that can help guide the process. Please consult a registered dietitian or licensed professional for specific nutrition advice.

CARBOHYDRATES
The American Heart Association recommends consuming more whole grains than refined grains in your diet. Refined grains often contain lots of added sugars and lack nutrients and vitamins necessary for bodily functions. On the other hand, whole grains are a great source of dietary fiber, which improves blood cholesterol levels and decreases risk for heart disease, stroke, obesity, and Type 2 diabetes. They also contain vitamins that are essential in forming new cells, oxygenating the blood, regulating the thyroid, and maintaining a healthy immune system. Examples of each include:

• Refined grains: white bread, white rice, crackers

• Whole grains: whole grain bread, brown rice, oatmeal, popcorn

PROTEIN
The amino acids in protein provide building blocks to restore bone and muscle tissue, maintaining their strength and reducing risk for falls, fractures and disability. Examples of protein sources include:

• Greek yogurt

• White fish like tilapia, cod, haddock

• Chicken breast

• Tofu

• Peanuts

• Lentils

• Beans

• Soy milk

FAT
In general, dietary fats should make up around 20-35% of your daily calories, with the majority if not all coming from unsaturated fats. Unsaturated fats are essential to our diet and can aid in lowering cholesterol, reducing inflammation, stabilizing our heart rhythm, and supporting brain and body functions. Examples of a serving of unsaturated fat include:

• 1 tablespoon of extra virgin olive oil

• A handful of nuts

• ⅓ of a medium avocado

• 6 oz of cooked fish

CALCIUM, VITAMIN D, MAGNESIUM
There are 3 vitamins and minerals that work together to regulate bone health, initiate blood clotting, conduct nerve impulses, contract and relax muscles, maintain heart rhythm, and release hormones. Those are calcium, vitamin D, and magnesium. Some great sources of each include:

• Calcium: milk, yogurt, cheese, kale, broccoli, bok choy, calcium fortified foods 

• Vitamin D: canned tuna or salmon, egg yolks, mushrooms, cheese, vitamin D-fortified foods like breakfast cereals, milk, orange juice, and fat spreads

• Magnesium: spinach, almonds, pumpkin seeds, black beans, soy milk, peanut butter, and dark chocolate

EXERCISE

While proper nutrition can help us manage bone density, muscle mass, and cardiovascular health, its effects are twofold when paired with regular exercise. While consistent aerobic activity like walking has been shown to improve lower body strength and protect against cardiovascular diseases, is it really enough to maintain bone density and full body strength in menopausal individuals? 

Some studies say maybe not. 

While aerobics are a necessary form of exercise for maintaining cardiovascular health and longevity, many forms of aerobic activity do not appropriately challenge upper or lower body strength in menopausal populations. In fact, most cardiovascular exercise does not produce any significant change in upper body muscle mass or bone density when compared with resistance training in menopausal women. Even activities like dancing, running, walking, and tennis—which have been shown to strengthen the bones and musculature in the lower body—do not strengthen these areas to the same degree as when paired with resistance training. 

STRENGTH TRAINING
The CDC suggests that one should strength train at least two times per week, incorporating exercises that work all of the major muscle groups of the body such as the legs, hips, back, chest, core, shoulders, and arms. Now, what kind of resistance training can provide these full body benefits?

• Lifting weights

• Resistance exercise with elastic bands

• Machine exercises

• Body weight exercises (squats, lunges, push ups, pull ups, planks, etc.)

In women who cannot perform high-impact exercise, such as those with osteoporosis or other health concerns, recommendations suggest low-impact aerobics like walking, elliptical machines, step machines, and so on paired with light upper and lower body resistance training. Osteoporotic individuals should generally avoid activities with greater fall-risk such as training on slippery surfaces or participating in step aerobics. They should also be mindful of activities with repeated or resisted trunk flexion like sit-ups or toe touches, which could increase risk for spinal fracture. 

In general, those with specific health considerations should consult their physician before creating an individualized exercise plan. 

BALANCE
As we know that the decline in estrogen during menopause precipitates a decline in muscle mass and function, this places menopausal women at increased risk for impaired balance and falls. Thus, balance training plays an integral role in fall prevention and should be included in a well-rounded exercise program. Some ideas for balance exercises to incorporate into your weekly routine include:

• T’ai chi

• Yoga

• Static balance: tree pose, lunge hold, standing on uneven surfaces

• Dynamic balance: single leg marches, single leg squat, side leg raises, RDLs, weight shifting, tandem walking

Overall, a comprehensive exercise program for postmenopausal women should include endurance exercise (aerobic), strength exercise, and balance exercise. Each of these is effective in maintaining health and resilience in postmenopausal women and, in combination, can provide great variety in one’s movement to stave off injury and disability.

REFERENCES

1. American Heart Association (2024)

2. American Heart Association (2017)

3. Erdélyi, et al. (2023)

4. Khalafi, et al. (2023)

5. Liu, et al. (2017)

6. Mishra, et al. (2011)

7. Saunders & Smith (2010) 

8. Smith-Ryan, et al. (2020)

9. Turnagöl, et al. (2021) 

10. Walsh, et al. (2023)