Effect of Physical Activity on Menopausal Symptoms among Urban Women DEBORAH B. NELSON', MARY D. SAMMEL 3 , ELLEN W. FREEMAN 2 , HUI LIN 5 , CLARISA R. GRACIA 4 , and KATHRYN H. SCHMITZ 3 1 Department of Piiblic Health and Obstetrics and Gynecology, Temple University, Philadelphia, PA; 2 Departments of Obstetrics and Gynecology and Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA; 3 Department of Biostatistics and Epidemiology and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA; 4 Division of Reproductive Endocrinology and Infertility, Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, Philadelphia, PA; and 5 Center for Research in Reproduction and Women's Health, University of Pennsylvania School of Medicine, Philadelphia, PA ABSTRACT NELSON, D. B., M. D. SAMMEL, E. W. FREEMAN, H. LIN, C. R. GRACIA, and K. H. SCHMITZ. Effect of Physical Activity on Menopausal Symptoms among Urban Women. Med. Sci. Sports Exere., Vol. 40, No. 1, pp. 50-58, 2008. Purpose: To determine whether physical activity, measured by expended kilocalories per week (kcal-wk-1), decreases the risk of menopausal symptoms among African American and Caucasian women. Methods: Level of physical activity and menopausal symptoms, including hot flashes, depression, anxiety, stress, and vasomotor, physiological, and somatic symptom summaries were measured in 401 women during an 8-yr period. Tertiles of physical activity at each assessment were defined as kilocalories per week: top third (?: 1450 kcal-wk- 1 ), middle third (< 1450 to 644 kcal.wk- 1 ), and bottom third (< 644 kcal-wk-1). Regression models were used to estimate the independent effect ofphysical activity at each time period on menopausal symptoms after adjusting for covariates and hormone levels. Results were also stratified by race, smoking status, and menopausal status. Results: Overall, only perceived stress was related to level of physical activity, with women in both the middle and top tertiles of physical activity reporting lower mean levels ofstress compared with women in the lowest tertile of activity. In the analysis by menopausal stage, active postmenopausal women continued to report lower mean levels of anxiety, stress, and depressive symptoms compared with inactive postmenopausal women. We did not find an association between level of physical activity and reports of hot flashes, even after adjusting for the variability in the hormonal changes. Conclusions: Among a cohort of community-dwelling women, high levels of physical activity were related to lower levels of stress during an 8-yr follow-up period. In addition, levels of anxiety, stress, and depression were lowest among physically active postmenopausal women compared with inactive women in the same menopausal grouping. Key Words: KILOCALORIES, DEPRESSION, ANXIETY, STRESS enopausal symptoms are experienced by the majority of women as they move through the menopausal transition, and they are a common reason for seeking medical attention during this phase of life (19,15). More recently, women have been seeking alternative therapies for menopausal symptoms, including increasing or maintaining a high level of physical activity. Physical activity has been proposed as an intervention for preventing or attenuating menopause-related vasomotor symptoms as well as other psychological symptoms such Address for correspondence: Deborah B. Nelson, Ph.D., Department of Public Health, College of Health Professions, Temple University, Phila- delphia, PA 19122; E-mail: dnelson@temple.edui. Submitted for publication May 2007. Accepted for publication August 2007. 0195-9131/08/4001-0050/0 MEDICINE & SCIENCE IN SPORTS & EXERCISEz_ Copyright © 2007 by the American College of Sports Medicine DOI: I0.1249/mss.0b013e318159dIe4 as anxiety and depression, but, to date, the evidence regarding the benefit of physical activity is varied (7,24,36). Current studies examining the usefulness of physical activity in preventing or attenuating vasomotor symptoms have been mixed, and the number of studies assessing the role of physical activity on other symptoms, such as de- pression, stress, and anxiety, has been minimal (2,29,35,39). Daley et al. (5) and others have examined the role of current physical activity among women of menopausal age; they report higher quality-of-life scores, but they did not find a reduction in vasomotor symptoms among physically activ- ity menopausal-aged women (5,6,7,16,24). In a recent, small, randomized clinical trial, Villaverde-Gutierrez et al. (37) found an improvement in quality-of-life scores, and they report menopausal symptoms among women assigned to the experimental activity group consistently of a 12- month program of cardiorespiratory, stretching, muscle- strengthening, and relaxation twice at week. Other studies have examined activity level before the final menstrual period and have also produced conflicting reports. Stemfeld et al. (34) examined reported physical activity before the 50