ABSTRACT
Context:
Throughout that process of menopause, a slew of health and fitness problems arise, all of which have a major effect on a woman’s standard of living. Health-related physical fitness has been described as an individual’s cardiac fitness (aerobic capacity), musculoskeletal fitness, and body composition.
Aim:
To investigate and compare the health and fitness of postmenopausal women in rural and urban Gurugram.
Settings and Design:
The postmenopausal women of Gurugram, both urban (n = 175) and rural (n = 175), who attended the outpatient department of SGT Hospital in the urban area and a house-to-house survey in the rural area, were the subjects of a cross-sectional survey that was carried out using interviews and a pretested semi-structured questionnaire. Levels of physical activity (PA) were assessed using the International PA Questionnaire (short form). The evaluation of body composition, which was the following step, included determining one’s body mass index, waist circumference, and waist–hip ratio. Six-minute Walk Distance Test was used to assess cardiopulmonary fitness. Through chair squat tests, sit-and-reach tests, and grip tests, researchers were able to measure the lower limb strength, flexibility, and upper limb strength of participants.
Results:
The mean age of subjects was 53.61 ± 5.08 years. Most commonly reported health problems were hypertension (31.3%), hyperlipidemia (21.2%), and diabetes (13.4%). Odds of urban women developing hypertension, hyperlipidemia, and myocardial infarction (MI) were found to be 0.61, 0.42, and 0.96 times higher than rural women. There was a statistically significant difference for the squat test, grip test, body composition parameters, and aerobic capacity; however, no statistically significant difference was seen for sit-and-reach test (P > 0.05).
Conclusions:
The current research shows that postmenopausal women living in metropolitan areas may face higher health risks since they are more prone to develop hypertension, hyperlipidemia, and MI. Furthermore, all fitness metrics – aside from flexibility – were higher for rural women. The results of the current study highlight the urgent need for health promotion initiatives to enhance the health and fitness of urban postmenopausal women.
KEYWORDS: Aerobic capacity, body composition, health-related fitness, musculoskeletal fitness, postmenopause
INTRODUCTION
Menopause can be defined as a juncture when women no longer have a consistent menstruation period. According to the World Health Organization (WHO), there will be around 1.2 billion women aged 50 and up by 2030. As a consequence, even though menopause looks to be a biological cycle, it is a time frame that must be watched closely and treated.[1] Throughout that process of menopause, a slew of well-being, fitness, and mental problems arise, all of which have a major effect on a woman’s standard of living, requiring a substantial portion of cause and effect. There is a difference in lifestyle, physical activity (PA) patterns, and socioeconomic factors in rural and urban areas which affect overall health as well as the standard of life of women.[2]
Health-related physical fitness has been described as an individual’s cardiac fitness (aerobic capacity), musculoskeletal fitness, and body composition. Various components of health-related fitness are strongly related to the overall health of an individual and low preponderance of long-term diseases. Loss of physical fitness is related to all-cause mortality, especially to cardiovascular diseases regardless of changes in body mass index (BMI).[3-5]
Physical health and fitness concerns of women in the postmenopausal phase of their life have not received considerable notice from researchers and policymakers in India. None of the health-care programs has directed any services toward this group. The purpose of the study was to investigate and compare the health and fitness of postmenopausal women in rural and urban Gurugram.
METHODOLOGY
A cross-sectional survey was conducted among postmenopausal women of urban (n = 175) and rural (n = 175) areas of Gurugram, attending the outpatient department of SGT hospital in the urban area and a house-to-house survey in rural areas, by interviews with the help of a pretested semi-structured standard questionnaire. It was conducted from May 2019 to March 2021. The study was approved by the Ethical Committee of the Faculty of Physiotherapy, SGT University vide Reference No SGTU/FOP/2019/72.
Women in Gurugram’s urban and rural postmenopausal populations, who have experienced natural menopause, are in the 40–65 age range, can ambulate independently, and are willing to participate in the study were included in the study. Subjects with exercise testing contraindications were excluded from the study, including those with a recent history of myocardial infarction (MI), unstable angina, and cardiac arrhythmia. Women on hormone replacement therapy, musculoskeletal or neurological conditions that would limit the participation of subjects during study tests were also excluded from the study. Informed consent was taken from candidates who fulfilled inclusion and exclusion criteria.
Procedure
Collection of information using questionnaires
In the first phase of the study, a pretested semi-structured questionnaire was used to assess sociodemographic characteristics, health status (history of hypertension, diabetes, hyperlipidemia, thyroid, MI, use of medications, history of hospitalization, etc.), and lifestyle behaviors (i.e., diet, smoking, alcohol use, and PA) from the study subjects. A detailed description of the development of the questionnaire and its reliability and validity is previously published.[6] International PA Questionnaire (short form) was used to evaluate the PA levels of the subjects.[7]
Health fitness testing
A common measuring tape was used to measure the waist and hip circumferences in centimeter. Waist measurements of 102 cm for males and 88 cm for women were considered to be indicative of abdominal obesity. BMI (weight in kilograms divided by height in meters squared; kg/m2) was calculated using height and weight measurements. The BMI threshold for obesity was 30 kg/m2. Cardiopulmonary fitness was evaluated by six-minute Walk Distance Test (6MWD). The 6MWD equation was used to calculate the VO2 max of the subjects.[8]
Musculoskeletal fitness testing involved the assessment of lower limb strength, flexibility, and upper limb strength by chair squat test, sit-andreach test, and Grip test, respectively, as per the American College of Sports Medicine Criteria guidelines.[9] All subjects were advised to put on loose comfortable clothing and take their meals at least 2 h before exercise testing. Blood pressure, heart rate, and oxygen saturation of all subjects were regularly monitored with the help of a calibrated sphygmomanometer and pulse oximeter. A gap of 5 min was given between each test. All measurements were taken by the researcher and calibrated measuring tools were used.
RESULTS
Characteristics of the study participants
The mean age of the study subjects was 53.61 ± 5.08 years. The mean age and standard deviation for age at menopause were 48.10 ± 2.86 for urban women and 47.99 ± 3.003 for rural women. Sociodemographic characteristics and lifestyle behaviors are presented in Table 1.
Table 1.
Demographic details and personal history
| Variables | Categories | Total, n (%) |
|---|---|---|
| Age categories | Age range 40-50 | 133 (37.9) |
| Age range 51-60 | 176 (50.1) | |
| Age range above 60 | 41 (12.0) | |
| Age at menopause | 40–45 | 58 (16.57) |
| 46–50 | 229 (65.4) | |
| 51–55 | 62 (17.71) | |
| 56 above | 1 (0.28) | |
| Employment | Unemployed | 193 (55.0) |
| Part time | 76 (21.71) | |
| Full time | 81 (23.14) | |
| Occupation | Housewife | 193 (55.0) |
| Business | 31 (8.85) | |
| Service | 91 (25.9) | |
| Agriculture | 35 (10.0) | |
| Marital status | Married | 319 (91.95) |
| Divorced/widowed/single | 31 (8.85) | |
| Personal income | <10,000 | 17 (4.85) |
| 11,000–20,000 | 37 (10.57) | |
| 21,000–30,000 | 43 (12.28) | |
| 31,000–40,000 | 41 (11.71) | |
| >40,000 | 20 (5.71) | |
| No personal income | 129 (54.85) | |
| Type of family | Nuclear | 146 (41.72) |
| Joint | 204 (58.28) | |
| Number of children | None | 3 (0.9) |
| 1 | 62 (17.7) | |
| 2 | 199 (56.7) | |
| >2 | 86 (24.0) | |
| Education | Schooling | 185 (51.86) |
| Graduation | 145 (41.3) | |
| Postgraduation | 20 (5.7) | |
| House | Rented | 55 (15.71) |
| Personal | 295 (84.28) | |
| Alcoholism | No | 339 (96.85) |
| Yes | 11 (3.14) | |
| Smoking | No | 342 (97.71) |
| Yes | 8 (2.28) |
Medical history
Diabetes (13.4%), hyperlipidemia (21.2%), and hypertension (31.3%) were the three most frequently observed medical conditions. Compared to 26% of women in rural regions, 37% of urban women had a history of hypertension. In comparison to rural settings, 31% of postmenopausal women in cities had a history of hyperlipidemia. In urban areas, 72% reported regular medicine use, compared to 47.7% in rural areas. Compared to 19.3% of postmenopausal women in rural regions, 26.3% of those in urban areas had a history of hospitalization [Table 2].
Table 2.
Comparison of medical history
| Variable | Setting | Yes | No | χ 2 | P | OR 95% CI (Lower-Upper) | Significance |
|---|---|---|---|---|---|---|---|
| Hypertension | Urban | 64 | 111 | 4.41 | 0.035* | 0.61 (0.38-0.96) | Significant |
| Rural | 46 | 129 | |||||
| Hyperlipidemia | Urban | 53 | 120 | 10.61 | 0.001* | 0.42 (0.25-0.71) | Significant |
| Rural | 28 | 147 | |||||
| Thyroid | Urban | 11 | 164 | 0.369 | 0.543 | 1.28 (0.56-2.91) | NS |
| Rural | 14 | 161 | |||||
| MI | Urban | 6 | 169 | 6.139 | 0.015* (Fisher’s) | 0.96 (0.93-0.99) | Significant |
| Rural | 0 | 175 | |||||
| Cancer | Urban | 10 | 165 | 0.246 | 0.620 | 0.78 (0.30-2.04) | NS |
| Rural | 8 | 167 | |||||
| Diabetes | Urban | 25 | 150 | 0.241 | 0.623 | 0.85 (0.46-1.58) | NS |
| Rural | 22 | 153 | |||||
| Use of medications | Urban | 126 | 49 | 21.511 | 0.000** | 0.35 (0.22-0.55) | Significant |
| Rural | 84 | 91 | |||||
| Admitted to hospital | Urban | 46 | 129 | 2.4210 | 0.120 | 0.67 (0.40-1.11) | NS |
| Rural | 34 | 141 | |||||
| COPD | Urban | 6 | 169 | 0.10 | 0.75 | 0.82 (0.24-2.75) | NS |
| Rural | 5 | 170 |
*Significant (P<0.05). CI: Confidence interval, OR: Odd ratio, NS: Not significant, COPD: Chronic obstructive pulmonary disease, MI: Myocardial infarction
Health-related fitness
Table 3 compares the health-related fitness ratings of postmenopausal women from urban and rural areas. The squat test, grip test, BMI, waist circumference (WC), waist–hip ratio (WHR) 6MWD test, and aerobic capacity all showed statistically significant differences; however, the sit-and-reach test did not (P > 0.05).
Table 3.
Comparison of health fitness determinants
| Fitness tests | Group | Mean±SD | t | P |
|---|---|---|---|---|
| Squat test (n) | Urban | 11.67±3.87 | −2.31 | 0.021* |
| Rural | 12.61±3.73 | |||
| Sit-and- reach (cm) | Urban | 25.87±4.31 | −1.37 | 0.016 (NS) |
| Rural | 26.50±4.18 | |||
| Grip (lbs) | Urban | 51.87±7.25 | −8.89 | 0.000** |
| Rural | 57.31±3.58 | |||
| BMI (kg/m2) | Urban | 26.11±2.52 | 2.00 | 0.045* |
| Rural | 25.56±2.56 | |||
| WC (cm) | Urban | 37.29±4.13 | 2.71 | 0.007* |
| Rural | 36.13±3.92 | |||
| WHR (cm) | Urban | 0.880±0.05 | 3.04 | 0.086* |
| Rural | 0.867±0.02 | |||
| IPAQ score (MET’s) | Urban | 690.81±463.80 | −2.25 | 0.025* |
| Rural | 828.41±663.58 | |||
| 6MWD (m) | Urban | 387.32±44.95 | −3.248 | 0.001* |
| Rural | 402.81±44.38 | |||
| VO2 max (mL/kg/min) | Urban | 25.21±3.2 | −2.43 | 0.001* |
| Rural | 28.90±4.8 |
*Significant (P<0.05). SD: Standard deviation, NS: Not significant, BMI: Body mass index, WC: Waist circumference, WHR: Waist-hip ratio, IPAQ: International Physical Activity Questionnaire, 6MWD: 6 minute walk distance
DISCUSSION
The present study was done to investigate describe and compare health and fitness of postmenopausal women in urban and rural Gurugram. The current study’s stated mean age of study participants was 53.61 ± 5.08 years.
Urban women had greater rates of hypertension, hyperlipidemia, diabetes, MI, and medication use than rural women, showing that lifestyle-related disorders are more common in urban than in rural areas. Urban women have higher odds of developing hypertension, hyperlipidemia, and MI than rural women by 0.61 (95% confidence interval [CI]: 0.25–0.71), 0.42 (95% CI: 0.25–0.71), and 0.96 (95% CI: 0.93–0.99), respectively. Tandon et al.[10] cross-sectional’s investigation on postmenopausal women found that high blood pressure, diabetes, and hyperlipidemia were common in 56%, 21%, and 39% of the women, compared to 31%, 13%, and 23% in the current study.
According to a meta-analysis by Anchala et al. in 2014, 33% of Indians in urban areas and 25% in rural areas have hypertension.[11] Similar to the current study, the prevalence was higher in urban women. This can be related to lifestyle variables and individual behaviors (alcohol, cigarettes, and sedentary lifestyle) that have emerged as a result of fast urbanization as well as economic expansion in the urban sector as opposed to rural. Given India’s growing urbanization and the potential association between urbanization and the three conditions that make up the metabolic syndrome – hyperlipidemia, diabetes, and hypertension – urban inhabitants have a higher risk of getting the condition than those who live in rural areas.
In the current study, body composition analysis was performed by estimating BMI, WC, and WHR in accordance with accepted WHO guidelines. Overall, we discovered that urban inhabitants had a higher likelihood of having higher BMI, WC, and WHR. These findings corroborate the majority of the research, which contends that obesity rates are often greater among urban individuals than rural ones. Obesity and cardiovascular risk factors, lipid metabolism, and poor glucose metabolism are all intimately connected. The findings of the current study are comparable to those of studies by Ranasinghe et al. and Pandey et al., which demonstrated that urban women had higher body composition values than rural women.[12,13] However, the findings conflict with those of research by Bojar et al. and Khokhar et al., where higher BMI was reported in rural women compared to Urban.[14,15]
Urban people are more prone to be physically inactive, sedentary, and to engage in inferior eating, smoking, and drinking habits. As a result, there may be a link between these changes in body composition and chronic disease. It is essential to note that, in the current study, residents in rural areas reported greater PA levels than those in urban areas. In addition, the researchers hypothesize that the fact that a significant portion of the study’s rural women worked in agriculture may have contributed to better body composition results.
Cardiorespiratory fitness is an objective sign that can be used in clinical settings as both a diagnostic and predictive health indicator. According to the equation provided by Burr et al., the 6MWD equation was utilized in the current investigation to compute VO2 max.[8] The results revealed a considerable disparity between urban and rural women’s cardiac fitness. An increased risk for heart illnesses is significantly correlated with lower functional capacity. It makes sense to hypothesize that the variations in daily PA were responsible for the differences in aerobic work capacity.
Musculoskeletal fitness was evaluated in this study using a battery of fitness tests. The Moratalla-Cecilia et al. study[16] employed a similar protocol to the one used in the current study. Results revealed that postmenopausal women from rural areas had considerably higher scores for both upper and lower limb muscle strength. According to authors, this might be because they put in more physical work and engagement than urban women do. The sit-and-reach test used in this study, which examined lower body flexibility, did not reveal any appreciable variations. This discrepancy might be brought about by the more demanding and extensive physical activities of living in the rural cohort. This discrepancy might be brought about by the more demanding and extensive physical activities of living in the rural cohort. Both the greater hip fracture incidence and the lower muscle strength in urban people may be related. When comparing background characteristics from various populations, it is essential to use accurate normative data, which is further highlighted by the discrepancies between the urban and rural groups.
CONCLUSIONS
The current research shows that postmenopausal women living in metropolitan areas may face higher health risks since they are more prone to develop hypertension, hyperlipidemia, and MI. Furthermore, all fitness metrics aside from flexibility were higher for rural women. The results of the current study highlight the urgent need for health promotion initiatives to enhance the health and fitness of urban postmenopausal women. Poor health fitness can lead to chronic diseases and poor quality of life in postmenopausal women. Health-care providers and policy-makers in India should concentrate on this group of illnesses and include them in their plans. The most effective strategy to lessen the load is to focus on preventive treatment. Professional organizations should organize public awareness campaigns and community service projects. Healthy nutrition practices, such as encouraging foods high in calcium, nutritional supplements, such as Vitamin D supplements, frequent aerobic and resistance exercise, and supporting a healthy lifestyle, are all things that should be done. Participation in a complete fitness program will promote healthy aging and, as a result, lower the burden of disease in our communities.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
REFERENCES
- 1.Teoman N, Ozcan A, Acar B. The effect of exercise on physical fitness and quality of life in postmenopausal women. Maturitas. 2004;47:71–7. doi: 10.1016/s0378-5122(03)00241-x. [DOI] [PubMed] [Google Scholar]
- 2.Mohan I, Gupta R, Misra A, Sharma KK, Agrawal A, Vikram NK, et al. Disparities in prevalence of cardiometablic risk factors in rural, urban-poor, and urban-middle class women in India. PLoS One. 2016;11:e0149437. doi: 10.1371/journal.pone.0149437. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Hsu WH, Chen CL, Kuo LT, Fan CH, Lee MS, Hsu RW. The relationship between health-related fitness and quality of life in postmenopausal women from Southern Taiwan. Clin Interv Aging. 2014;9:1573–9. doi: 10.2147/CIA.S66310. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Moolman JA. Unravelling the cardioprotective mechanism of action of estrogens. Cardiovasc Res. 2006;69:777–80. doi: 10.1016/j.cardiores.2006.01.001. [DOI] [PubMed] [Google Scholar]
- 5.Monteleone P, Mascagni G, Giannini A, Genazzani AR, Simoncini T. Symptoms of menopause –Global prevalence, physiology and implications. Nat Rev Endocrinol. 2018;14:199–215. doi: 10.1038/nrendo.2017.180. [DOI] [PubMed] [Google Scholar]
- 6.Kalra S, Ajmera P, Yadav J, Sindhu B, Pawaria S, Pal S. Development of a reliable and valid questionnaire to identify factors affecting health of postmenopausal women in selected areas of Gurugram India. J Clin Diagn Res. 2021;15:YC01–5. [Google Scholar]
- 7.Craig C, Marshall A, Sjostrom M, Bauman A, Lee P, Macfarlane D, et al. International physical activity questionnaire-short form. J Am Coll Health. 2017;65:492–501. [Google Scholar]
- 8.Burr JF, Bredin SS, Faktor MD, Warburton DE. The 6-minute walk test as a predictor of objectively measured aerobic fitness in healthy working-aged adults. Phys Sportsmed. 2011;39:133–9. doi: 10.3810/psm.2011.05.1904. [DOI] [PubMed] [Google Scholar]
- 9.American College of Sports Medicine. ACSM's guidelines for exercise testing and prescription. Philadelphia: Lippincott Williams &Wilkins; 2013. [DOI] [PubMed] [Google Scholar]
- 10.Tandon VR, Mahajan A, Sharma S, Sharma A. Prevalence of cardiovascular risk factors in postmenopausal women: A rural study. J Midlife Health. 2010;1:26–9. doi: 10.4103/0976-7800.66993. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11.Anchala R, Kannuri NK, Pant H, Khan H, Franco OH, Di Angelantonio E, et al. Hypertension in India: A systematic review and meta-analysis of prevalence, awareness, and control of hypertension. J Hypertens. 2014;32:1170–7. doi: 10.1097/HJH.0000000000000146. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12.Ranasinghe C, Shettigar PG, Garg M. Dietary intake, physical activity and body mass index among postmenopausal women. J Midlife Health. 2017;8:163–9. doi: 10.4103/jmh.JMH_33_17. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 13.Pandey RM, Gupta R, Misra A, Misra P, Singh V, Agrawal A, et al. Determinants of Urban-rural differences in cardiovascular risk factors in middle-aged women in India: A cross-sectional study. Int J Cardiol. 2013;163:157–62. doi: 10.1016/j.ijcard.2011.06.008. [DOI] [PubMed] [Google Scholar]
- 14.Khokhar KK, Kaur G, Sidhu S. Prevalence of obesity in working premenopausal and postmenopausal women of Jalandhar District, Punjab. J Hum Ecol. 2010;29:57–62. [Google Scholar]
- 15.Bojar I, Raczkiewicz D, Sarecka-Hujar B. Depression, metabolic syndrome, serum TSH, and Vitamin D concentrations in rural and urban postmenopausal women. Medicina (Kaunas) 2020;56:511. doi: 10.3390/medicina56100511. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16.Moratalla-Cecilia N, Soriano-Maldonado A, Ruiz-Cabello P, Fernández MM, Gregorio-Arenas E, Aranda P, et al. Association of physical fitness with health-related quality of life in early postmenopause. Qual Life Res. 2016;25:2675–81. doi: 10.1007/s11136-016-1294-6. [DOI] [PMC free article] [PubMed] [Google Scholar]