New research shows exercise can reduce the risk of stroke after menopause

Regular exercise could reduce the risk of stroke in post-menopausal women, according to new research partly undertaken in Swansea.

The pilot study, which will now be followed by a more extensive, longer-term trial, suggested that the greatest benefits were to those women who exercised during or shortly after the menopause rather than many years later.

The study team, including Professor Adrian Evans of the Welsh Centre for Emergency Medicine Research at Morriston Hospital, has now published its findings in the prestigious American Journal of Physiology.

“A vascular disease such as stroke is more common as you get older,” said Professor Evans. “But the incidence of stroke is higher in post-menopausal women than in men of a similar age and we are not sure why that is.

“One of the reasons, it is thought, is that before they go through the menopause, the oestrogen – the hormones – have a protective effect. Post-menopause, the oestrogen level is significantly reduced.

“And when they go through the menopause, they get an immune inflammatory response, which may produce abnormal clotting and changes in their blood flow, which in turn could cause a stroke.”

As well as the Morriston centre, the study involved experts from the University of Copenhagen and Brock University in Ontario, Canada.

It involved the recruitment of a small number of women, divided between those who had undergone the menopause five or fewer years previously and those who were menopausal for 10 or more years.

They were given an eight-week programme of regular intensive exercise and the effect on their cardiovascular health was measured – including blood clotting properties using a biomarker developed at Morriston.

Professor Evans is Director of the Welsh Centre for Emergency Medicine Research, developed with Swansea University and one of the leading units of its kind in the UK and Europe.

Its research is heavily focused on the relationship between blood flow and coagulation and their effects in acute vascular inflammatory diseases such as stroke, which is a common and debilitative illness seen in patients in the Emergency Department.

The centre has produced more than 100 publications and developed collaborations not just across the UK but with world-leading international centres in New Zealand, the United States and Denmark.

One of the menopause study’s co-authors, Professor Ylva Hellsten, leads the internationally renowned cardiovascular research group at the University of Copenhagen.

She is a world expert on the effects of exercise and blood flow in health and vascular disease.

“The study demonstrates that the eight weeks of aerobic training improves aerobic fitness, markers and cardiovascular health and reduces markers indicating the risk of blood clots,” said Professor Hellsten.

“The study also shows a discrepancy between groups. The markers of thrombotic risk were reduced in women who recently had entered menopause but not in those in menopause for more than 10 years.

“One explanation for this finding could be a higher level of vascular low-grade inflammation observed in the older women.

“Our findings suggest that although postmenopausal women benefit from aerobic training regardless of age, more beneficial gains may be achieved for women who begin exercising at, or soon after, menopause.”

What is not yet known is whether late post-menopausal women would get the same benefits by exercising for longer.

This will form part of a much larger follow-up study involving around 200 women over a much longer period of time.

“What our biomarker has helped establish is that exercise does make a difference, but it needs a much bigger study with a lot more patients,” said Professor Evans.

Swansea Bay consultant stroke physician Peter Slade commended the work of Professor Evans and his team.

“Stroke affects many people every day and can result in significant lifelong difficulties,” he said.

“Understanding what can be done to reduce the risk of stroke and who would benefit from interventions such as exercise training is critical to reducing the impact of stroke.

“Therefore research such as this is key in enhancing our understanding of what advice we should be giving to our patients.

“In Swansea Bay we are fortunate to benefit from the knowledge, skills and experience of the Welsh Centre for Emergency Medicine Research.

“Local participants can be included in important research studies such as this – ensuring that the knowledge obtained from groundbreaking trials is relevant to our local population.

“Over the years research performed by the centre has enhanced our understanding of the mechanisms of stroke and helped shape how we treat our patients.”