Health Benefits of a 6-month Brisk Walking Program in Sedentary Postmenopausal Women
Health Benefits of a 6-month Brisk Walking Program in Sedentary Postmenopausal Women
Community-dwelling women aged 55 or over are recruited at public meetings aimed at promoting
 physical activity in postmenopausal women. Women are eligible and enrolled in the study if
 they have no significant disease affecting lower limb function and if they have a sedentary
 lifestyle. All study participants provide written informed consent to participate to the
 study.

 Women are then randomized either to the control group (women have to maintain their
 lifestyle) or to the exercise group : 40 minutes of brisk walking 3d/wk for 6 months (two
 supervised sessions and one session performed one their own per week with a detailed
 program). The intensity of the program is adapted to the heart rate work and gradually
 increases over the 6-month program. The objective of the study is to determine the health
 benefits of brisk on walking ability, diet, muscle strength, balance, blood pressure, bone
 density, body weight, lean and fat mass, depression symptoms, behavioral, emotional
 responses, sleep quality, and biological indicators of health.
Community-dwelling women aged 55 or over are recruited at public meetings aimed at promoting
 physical activity in postmenopausal women.

 Women are eligible and enrolled in the study if they meet the following criteria : (i) not
 diagnosed with any of the following conditions: rheumatoid arthritis, osteoarthritis,
 ischemic heart disease, previous joint replacement surgery or cerebrovascular disease
 affecting lower limb function, malignant tumors, (ii) without pain and medication known to
 alter physical performance (e.g., corticosteroids, estrogens, statins, or anti-estrogen
 drugs). To recruit a sample of asymptomatic sedentary postmenopausal women, women with a
 score value above 9.4 at the Physical Activity Questionnaire for the Elderly (PAQE) (Serres,
 Gautier, Varray, & Préfaut, 1998) and a 5-minute walking distance (6MWD) greater than105% of
 the predicted 6MWD based on Troosters' reference equation are excluded. The Troosters'
 reference equation is:

 Before entering the study, women are asked to provide a medical certificate of no
 contraindication to performing the 6MWD.

 Women are then randomized either to the control group (women are asked to maintain their
 lifestyle, and especially their physical activity habits) or to the exercise group.

 The exercise intervention consists in 40 minutes of brisk walking 3d/wk for 6 months. During
 the 6-month program, subjects are required to attend 2 outdoor supervised sessions per week,
 and to exercise 1d/wk on their own, with a detailed and tailored program. The intensity of
 walking is adapted by skilled exercise trainers to individual physical capability of each
 subject. Considering that the theoretical maximum heart rate (HR) of the subject is 208-0.7 *
 age (Tanaka, Monahan, & Seals, 2001), the training starts at 40% of HR work (difference
 between maximum HR and HR at rest). Training intensity is gradually increased to finally
 reaching 75% of the HR work. Participants wear a heart rate monitor (Polar Elctro Inc,
 Woodbury, NY) during each of the 3 weekly sessions and the content of each session is
 collected in a notebook (meters walked, duration of the brisk walking exercise, HR, adherence
 to the program).

 This study is approved by the Committee for Protection of Human Subjects (CPP
 Sud-Méditerranée III, Number: 2008.07.04). All study participants provide a written informed
 consent to participating to the study.

 The objectives of the study are to determine the health benefits of the intervention program
 in comparison to the control group in several domains.

 Mesurements at baseline and at the end of the study comprise:

 -  Body composition (bone density, body lean and fat mass by dual-energy X-ray
 absorptiometry (DXA) (Hologic QDR-1500 device, Hologic, Waltham, MA, USA);

 -  The subjects are weighed on an electronic scale to the nearest 0.1 kg, and their height
 is measured to the nearest 0.1 cm to calculate the body mass index (BMI)(kg/m²).

 -  Endurance training performance is estimated by the distance walked during the 6-minute
 walk test (6MWT). The 6MWT is performed according to the American Thoracic Society
 (2002) guidelines in an indoor corridor (ATS, 2002).

 -  Maximum grip strength and isometric maximum knee extension strength are measured after a
 warm-up session, as previously described (Blain et al., 2010).

 -  The Diet over the previous 7 days using the questionnaire used in the SUVIMAX study

 -  Sleep quality

 -  Depression score : French version of the Beck Depression Inventory (BDI) (Beck, Steer, &
 Carbin, 1988; Cathébras, Mosnier, Lévy, Bouchou, & Rousset, 1994). The BDI contains
 cognitive (e.g., pessimism, worthlessness) and physical (e.g., fatigue and loss of
 energy) subscales. The BDI has been shown to be sensitive to exercise-induced changes in
 healthy adults (Stein & Motta, 1992).

 -  Baseline physical activity, covering household activities, sports, and leisure
 activities is assessed using PAQE (Voorrips, Ravelli, Dongelmans, Deurenberg, & Van
 Staveren, 1991). The activities of walking outside, bicycling, and doing heavy housework
 are summed to a physical activity score (range, 0-3). Respondents not participating in
 any activity are given zero points, whereas three points corresponds to participation in
 all three activities.

 -  Subjective health status is assessed with the following item: In comparison to people
 with the same age, you consider your health as better (1), equal (2), worst (3) ?.

 -  The Tampa Scale for Kinesiophobia (TSK) is a 17-item questionnaire that assesses the
 fear of (re)injury due to movement (Swinkels-Meewisse, Swinkels, Verbeek, Vlaeyen, &
 Oostendorp, 2003). Women are asked to make ratings of their degree of agreement with
 each of the 17 statements. Ratings are summed to yield a total score where higher values
 reflect greater fear of (re)injury (French, France, Vigneau, French, & Evans, 2007).

 -  Balance is assessed using a force platform (Medicapteurs France SAS) with two conditions
 tested, eyes open (EO) and eyes closed (EC), lasting 51.2 seconds each and separated by
 a 30-second rest period. The COP trajectories in antero-posterior (AP) and medio-lateral
 (ML) directions are sampled at 40 Hz, leading time series with length of 2048.

 Traditional stabilometric measures : the AP and ML standard deviations (SDx and SDy, mm), the
 effective COP path length (mm), and the area of the 90% confidence ellipse enclosing the COP
 (mm²).

 Complexity measures of postural sway : The complexity of postural sway is quantified by means
 of three measures : Percentage of determinism of recurrence quantification analysis (DETRQA)
 , Sample entropy (SampEn), Complexity index of multiscale entropy (CIMSE)

 -  The adherence rate to the brisk walking program is calculated based on the data recorded
 in the notebooks (number of supervised and self-reported home based walking sessions
 performed/72 sessions of the program).

 -  Individual content of the training (meters walked measured with a podometer; total
 duration of the walking exercises, mean HR, etc…).

 -  Fasted morning blood samples are collected at baseline and at the end of the study and
 aliquots are frozen at -80 °C until analysis.
Inclusion Criteria:

 -  postmenopausal women aged 55 or older

 -  women were asked to provide a medical certificate of no contraindication to performing
 the 6MWD.

 Exclusion Criteria:

 -  rheumatoid arthritis, osteoarthritis, ischemic heart disease, previous joint
 replacement surgery or cerebrovascular disease affecting lower limb function,
 malignant tumors, any pain or medication known to alter physical performance (e.g.,
 corticosteroids, estrogens, statins, or anti-estrogen drugs)

 -  score value above 9.4 at the Physical Activity Questionnaire for the Elderly

 -  a 6MWD greater than 105% of the predicted 6MWD based on Troosters' reference equation