Hypoxic Breath-Work Training for the Menopausal Female
AJ Fisher, MSc, CSCS
Inspired by the work of Maryon Stewart, who has helped women worldwide with her holistic approach to bettering the experience of menopause.
The Menopausal Experience
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The menopausal transition is laden with many changes, both mental and physical, many of which are stressors. Short-term stress, or good stress-eustress, results in a beneficial outcome as the body is able to adapt to it overtime. Distress, or bad stress, results from chronic stressors that the body is not able to adapt to and can lead to poor health, including chronic stress and inflammation. Many menopausal females experience distress through their menopausal phase due to the chronically elevated stressors on the body from the hormonal shifts.
Some opt for estrogen replacement therapy, but many choose to go untreated and sadly experience the daily negative consequences of going through these hormonal changes. For those who are seeking alternatives to hormone therapy, many do not know that there are natural practices, including dietary changes, that can be implemented to improve one’s experience, turning down or even eliminating the majority of menopause distress.
Those who are familiar with Maryon Stewart’s work have experienced the minimization of menopausal distress through her program. My own unique approach to helping the menopausal female is with a program that combines breath-work and exercise to achieve an improved mental and physical state to better endure menopausal stressors and even minimize or eliminate many of the stressors altogether.
Intermittent Hypoxic Training: an Introduction
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Intermittent Hypoxic Training (IHT) has been studied in the literature for almost a decade. It is a safe and effective protocol that includes lowering blood oxygen (SpO2) and has been shown to improve both the healthy and diseased state. Conditions that have shown improvement using hypoxic exercise include sarcopenia, hypertension, obesity, diabetes, osteoporosis, and chronic inflammatory issues. Hypoxic Training has been shown to improve multiple ailments that the menopausal female experiences.
Connecting the Dots with an at Home Approach, Accessible by All
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Hypoxic Training is traditionally performed by climbing to altitude or exposing oneself to a room with less oxygen than sea level. Neither of these approaches are accessible by all due to time or cost constraints. Therefore, using alternative methods to achieve safe hypoxia is necessary when considering this option as a therapeutic modality for treating menopause symptoms. Achieving hypoxia using controlled breathing has been studied in the literature for decades [Woorons et al., 2017] and is rising in popularity. Some extreme methods such as the Wim Hof method are appropriate for some, but might be too extreme for others.
The HYPOXiX Method is a breath-work exercise program, using the research supported Breathography Technique, is a technique that research has shown to create an endogenous hypoxic environment. This technique uses a combination of extended exhalations and short breath retentions to create an endogenous hypoxic environment, mimicking altitude exposure, in order to achieve elevations in factors in the body that respond to a low oxygen environment.
Furthermore, using controlled breathing in order to achieve safe levels of hypoxia during training provides the additional benefit of deep core strength and nervous system balancing, much needed in the menopausal period. The HYPOXiX Method has helped countless women with their physical and mental state during the menopausal transition. Intermittent Hypoxic Breathing (IHB) is a method studied in the research and is the pillar of the Breathography Technique and the HYPOXiX Method. Let’s take a closer look at how a combination of intermittent hypoxic breath-work and movement can help the common ailments of the menopausal female.
Hypoxic Breathing for Common Menopausal Ailments
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Inflammation
The menopausal transition is known to spike levels of inflammatory markers in the body [Abildgaard et al., 2020]. These pro-inflammatory cytokines that spike as a result of dropped estrogen, increase central adiposity and can have drastic effects on the health of the brain, muscle, and cardiovascular system. Hypoxic Training has been shown to decrease pro-inflammatory cytokines when combining low to moderate intensity exercise with hypoxia [Rybnikova et al., 2022]. Slow breathing has also been shown to reduce pro-inflammatory cytokines [Wang et al., 2021]. The combination of slow breathing and hypoxia could be an effective strategy for the menopausal female’s inflammation.
Vascular Dysfunction
Menopausal women experience vascular dysfunction at higher frequencies, which puts these women at greater risk for vascular disease [Hildreth et al., 2018]. Hypoxic Training has been shown to improve vascular function and improve vascular disease through its ability to increase levels of nitric oxide systemically [Lavier et al., 2021]. Slow breathing practices have also been shown to increase levels of NO nitric oxide, which has a positive effect on the health of the vascular endothelium [Cyr et al., 2020; Li et al., 2023]. It could behoove the menopausal female to combine breath-work with exercise to reduce the risk of vascular dysfunction during menopause.
Sarcopenia
Sarcopenia is the natural loss of muscle with age and accelerates at a rapid pace when a female enters menopause due to the effect of estrogen on the muscle [Buckinx & Aubertin-Leheudre, 2022]. Hypoxic training has been shown to be a valid protocol for reducing sarcopenia with age due to its effect on increasing activation of fast twitch muscle fibers and increased glycolytic enzyme activity and metabolic stress with moderate intensity exercise [Jung et al., 2021]. Slow breathing has been shown to improve areas of the brain related to motor control [Lee et al., 2023]. Because motor control improves the quality of every exercise and muscle contraction, slow breathing could contribute to improvements in sarcopenia through a higher quality, controlled contraction of the working muscle with every exercise. Furthermore, slow breathing during exercise has been shown to decrease risk of muscle spasm and increase blood flow to the muscle because of the increased levels of carbon dioxide in the system; setting the stage for more activity and growth intra-muscularly [Migliaccio et al., 2023]. The menopausal female could benefit from combining breath-work and exercise to improve the drastic effects of sarcopenia during this transition.
Cognition
Cognitive impairments, including memory and reactive skills, are common symptoms amongst the menopausal population due to the decline in neuroprotective estrogen and a rise in inflammatory markers [Conde et al., 2021]. The menopausal woman is more at risk for cognitive decline, including dementia, because of the new cognitive environment laden with erratically fluctuating hormones [Sochocka et al., 2023]. Hypoxic Training has been shown to improve cognition on multiple levels because of significantly increased blood flow to the brain and upregulation of VEGF, vascular endothelial growth factor, and BDNF, brain derived neurotrophic factor, both having significant effects on increasing brain connectivity and neurogenesis, the growth of new neurons in the brain [Damgaard et al., 2023]. It is known that slowing the breath has the ability to not only lower blood oxygen, but also increase levels of carbon dioxide in the system, which increased blood flow to the brain [Battisti-Charbonney et al., 2011]. Increased cerebral blood flow (CBF) has been shown to a be a catalyst for improved functioning of the brain, including memory and reducing the symptoms of Alzheimer’s disease [Bracko et al., 2023]. The combination of hypoxic training and slow breath-work could have profound implications for the menopausal female suffering hormonal related brain dysfunction.
Blood Pressure
Blood pressure is known to rise during the menopausal transition due to changes in nitric oxide levels [Nair et al., 2021]. Because estrogen increases nitric oxide synthesis, drops in estrogen decrease circulating levels of nitric oxide. Hypoxic Training has been shown to increase nitric oxide levels in the body, lowering blood pressure and improving endothelial function [Muangritdech et al., 2020]. Lowering of nitric oxide systemically in the menopausal period also has an effect on skin health and appearance [Katsitadze et al., 2012]. Slow breathing has been shown in a number of studies to lower blood pressure and increase circulating levels of nitric oxide [Russo et al., 2017]. Both breath-work and hypoxic training are studied protocols for increasing levels of nitric oxide in the body for skin health and blood pressure/endothelial changes, both of which are known stressors in the menopausal phase.
Blood Glucose
Menopausal females are known to experience higher fasting blood glucose due to sleep disturbances and hormonal changes [Bermingham et al., 2022]. Hypoxic training is a well studied tool for effectively lowering blood glucose due to the heightened activity of anaerobic metabolism during exercise, which is known to improve blood sugar regulation [Soo et al., 2023]. Additionally, breath-work/apneas in combination with exercise have been shown to increase anaerobic activity during exercise, which has a positive effect on blood sugar regulation [de Asís-Fernández et al., 2022]. The menopausal female can benefit from both breath-work and hypoxic training for improvements in the known dysregulation of blood sugar in the menopausal period.
Pelvic Floor
The menopausal female can be at greater risk of developing pelvic floor weakness due to the declining estrogen and associated receptors in the pelvic floor musculature [Pandey, M. & Batra, A., 2022]. Although this is the case, it has been shown that menopausal women can achieve the same pelvic floor strength outcomes when comparing those inside and outside the menopausal phase [Tosun et al., 2023]. Focused breath training in conjunction with pelvic floor training has been shown to not only increase activation of the pelvic floor, but also back stabilizing muscles that aid in injury prevention [Talasz et al., 2022]. Furthermore, because hypoxic training has been shown to increase strength more effectively than normoxic training, using a combination of controlled breathing and hypoxic training could increase the efficacy of the post-menopausal female’s pelvic floor strength training efforts [Guardado et al., 2020].
Body-Fat
Body-fat volume and redistribution, including increased levels of central adiposity, are known battles amongst the menopausal population [Kodoth et al., 2022]. Exercising in a hypoxic environment has been shown to not only increase levels of body-fat loss, but also decreases waist circumference more effectively [Shi et al., 2014]. Slow breathing has been shown to increase weight loss due to balance of the autonomic nervous system [Sato et al., 2010]. The autonomic nervous system becomes distressed and imbalanced in as many as 67% of menopausal women [Yalamudi, 2017]. Therefore, taking an approach to fat-loss from a nervous system angle could be more effective than other approaches during menopause using a breath-work and exercise protocol.
HRV, heart-rate variability
Pertaining to the aforementioned autonomic nervous system dysfunction in the area of menopausal fat-loss, these imbalances are also destructive on several other areas of the menopausal mental and physical self. Heart-rate variability (HRV) represents the variation of the heart-beat between each beat of the heart and is representative of the health of the autonomic nervous system. A more rigid heart-beat with no variation will show a low HRV score, which is indicative of poor health. A flexible heart-beat with a lot of variation in the tempo of beats, will show a high HRV score, indicative of health and longevity. It is known that menopausal women experience big decreases in HRV scores during this transition phase that puts them at greater risk for both mental and physical ailments that are associated with low HRV scores [Ramesh et al., 2022]. Not only has hypoxic training been shown to improve HRV scores, but slow breathing is at the forefront of therapeutic modalities for increasing activity of the parasympathetic nervous system and raising HRV scores [Lizamore et al., 2016; Chaitanya et al., 2022]. The combination of the two could be life-changing for the menopausal female.
Osteoporosis
Osteoporosis becomes a greater risk factor for the menopausal population due to the effects of estrogen on bone metabolism [Cheng et al., 2022]. Resistance training has been shown to improve bone density in the menopausal female. Hypoxic training has been shown to improve bone metabolism [Camacho-Cardenosa et al., 2019]. Because slow breathing has the ability to improve motor control, contributing to greater frequency and intensity of exercise, hypoxic breathing could be a successful strategy for menopausal women to integrate into a properly designed plan [Lee et al., 2023].
Cholesterol
The menopausal female is likely to experience elevated cholesterol, specifically an increased LDL and decreased HDL profile [Inaraja et al., 2020]. Many studies have shown hypoxic training to reduce LDL greater than normoxic training [Timon et al., 2022]. Furthermore, slow breathing has the potential to improve blood lipids due to the regulation and increases of nitric oxide when controlling the breath [Hogg & Kalyanaraman, 1998; Russo et al., 2017]. Slow breathing combined with hypoxia has potential in the world of cholesterol health in the menopausal female.
Cardiovascular Health
Raj et al [2023] showed a clear correlation between declining cardiovascular health and the menopausal female, linking estrogen as having a protective effect on the heart. Therefore, a heightened focus on cardiovascular health is essential during the menopausal period. Hypoxic training has been shown to improve heart health on many levels, including lessening the degree of a cardiovascular event [Rybnikova et al., 2022]. Furthermore, because of the beneficial effects of slow breathing on HRV, which has a known positive effect on cardiovascular health, integration of a slow breath with intermittent hypoxia could be a sound protocol for the menopausal female [Tiwari et al., 2021].
Metabolic Rate
The menopausal female fights against a declining RMR (resting metabolic rate) and must take extra strides in the areas of physical activity and nutrition to combat weight gain from a lowered metabolism [Hodson et al., 2014]. Hypoxic training has been shown in countless studies to have a positive impact on RMR [Woods et al., 2017]. Breathing exercises have also been shown to increase resting metabolic rate and increase oxygen efficiency [Yong et al, 2018]. The menopausal female who is struggling with a lowered resting metabolism could employ hypoxic breathing to raise her metabolic rate.
Mitochondrial Dysfunction
Rybnikova et al. [2022] presents the research that supports hypoxic training as a tool for mitochondrial health. Because menopausal females suffer mitochondrial dysfunction, which sets the stage for neuroinflammation and dementia risk, integrating a practice that has been shown to improve this area is vital [Conde et al., 2021]. Slow breathing exercises have been shown to have an effect on oxidative stress, affecting the health of the mitochondria [Li et al., 2023]. Therefore, the combination of breath-work and hypoxic training is a feasible tool for improving a menopausal female’s mitochondrial function.
Leptin Resistance
Leptin, a satiety, lipid-derived hormone, has been shown to be elevated, contributing to leptin and insulin resistance, in menopausal women [Huang et al., 2017]. Leptin resistance contributes to fat gain because hunger is uncontrolled, leading to higher caloric intake than required for weight maintenance. Hypoxic training has been shown to an effective mediator of the hunger hormones, both leptin and ghrelin, the latter of which is the hormone that expresses hunger [Bagińska et al., 2024; Lu et al., 2016]. Furthermore, performing slow breath-work has been shown to improve brain frequencies and contribute to higher quality sleep, which has a positive impact on the hunger hormones. Including slow breathing could contribute to an improved relationship with hunger in the menopausal female’s transition [Jerath et al, 2019]. The combination of hypoxic training and breath-work could be a successful protocol for the menopausal female.
Lung Capacity
Menopausal females experience a decline in lung function, including lung capacity [Lim et al., 2020]. It is known that a hypoxic training protocol can improve lung function, including lung capacity, due to the adaptations of the lungs in response to a low oxygen environment [Bagińska et al., 2024]. Lung capacity is significantly enhanced with a breath-work protocol due to the adaptations of the lungs in response to changes in frequency, intensity, duration, and volume of air [Hamasaki, 2020]. Lung capacity is associated with longevity, and especially because this can diminish with menopause, it is of vital importance to maintain lung capacity, which hypoxic and breath training could improve [Schünemann et al., 2000].
Cortisol Stress
Women during the menopausal transition tend to experience heightened cortisol levels, representative of a general increase in activity of stress and the integrative functioning of the hypothalamic-pituitary-adrenal (HPA) and the hypothalamic-pituitary-ovarian (HPO) axes [Woods et al., 2009]. High physical activity has been shown to reduce symptoms of menopause, but the menopausal female should be careful to not chronically elevate cortisol lest symptoms exacerbate [Dabrowska et al., 2019; Obaya et al., 2023]. Both breath-work and hypoxic training have been shown to have a cortisol reducing effect both during, immediately after, and long thereafter exercise. Controlling the breath during exercise has been shown to have a significant effect on the reduction of post exercise cortisol spikes [Obaya et al., 2023]. Additionally, hypoxic training has been shown to improve the testosterone to cortisol ratio, which represents a more optimal hormonal exercise environment for the menopausal female, who might be dealing with higher chronic stressors than pre-menopausal [Czuba et al., 2022]. Integration of a hypoxic breath-work protocol is a valid option for the menopausal female looking to improve her body’s stress due to heightened cortisol levels.
Conclusion
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Intermittent hypoxic breathing in conjunction with exercise presents itself as an alternative therapy for improving many of the ailments that the menopausal female experiences during her transition into the post-menopausal period. The HYPOXiX Method is a protocol that combines breath-work with exercise, integrating the benefits of hypoxic training and breath-work into a progressive exercise program. Learn the HYPOXiX Method for free at Hypoxix.fitness, where the combination of Breathography Breathing with the Ab-Ribbon keeps you connected to your breath during functional training. Connecting to the breath during exercise has been shown to increase strength, fat-loss, stress, and longevity. The menopausal female looking to improve these areas can benefit greatly from a breath-work and exercise protocol to better her experience of menopause.
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