The exercise timing hypothesis: can exercise training compensate for the reduction in blood vessel function after menopause if timed right?

Abstract As women enter menopause at mid‐life, oestrogen production ceases and its many beneficial effects on cardiovascular health are lost whereby the age‐related risk of cardiovascular disease is accelerated. Oestrogen acts via oestrogen receptors and can activate the oestrogen response element leading to upregulation of a number of proteins of importance for vascular health, including the vasodilator and anti‐atherogenic enzyme endothelial nitric oxide synthase and angiogenic factors. Hormone replacement therapy can to some extent counteract the loss of oestrogen although studies have shown that such treatment may only be effective if initiated soon after menopause, the so‐called timing hypothesis . An attractive alternative to hormone therapy is regular physical activity, as it is known that exercise induces many of the same cardiovascular health protective effects as oestrogen. Nevertheless, results from studies on the effect of physical activity on vascular function and cardiovascular health are inconsistent, with some studies showing a lack of effect of a physical activity programme and others showing a beneficial effect. The reason for this divergence is unclear but here we explore whether there may be a timing aspect also for exercise training, the exercise timing hypothesis , in which initiation of exercise interventions soon after menopause may be more effective than initiation many years after. The possibility that oestrogen‐related receptor‐α and oxidative stress may play a role in such a timing effect is discussed.