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Importance: Women often experience physiological and functional changes in their health during midlife. Identifying women who have clinically important improvements in physical health and function and evaluating the factors associated with these improvements can identify intervention targets at midlife., Objective: To identify factors associated with improvements in physical health and function among women during midlife., Design, Setting, and Participants: Participants were part of the Study of Women's Health Across the Nation (SWAN), a diverse cohort of US women early in midlife, and followed up annually for up to 21 years between 1996 and 2017. Analyses were based on visit 8 (2004-2006) through visit 15 (2015-2017). Statistical analysis was conducted from October 2021 to March 2023., Exposures: Sociodemographic indicators, health status measures, and comorbidities measured at visit 8., Main Outcomes and Measures: The main outcome was a clinically important (≥5 points) improvement in the physical component score (PCS) of the 36-item Short-Form Health Survey between visit 8 and visit 15., Results: Of the 1807 women (at visit 8: mean [SD] age, 54.5 [2.7] years; 898 [50%] White participants) in SWAN who qualified for analysis, 265 (15%) experienced a clinically important improvement in PCS over a median of 11.1 years (IQR, 10.9-11.4 years). Factors associated with improvement in PCS included no financial strain (odds ratio [OR], 1.73; 95% CI, 1.18-2.52), no sleep disturbances (OR, 1.43; 95% CI, 1.05-1.96), no osteoarthritis (OR, 1.42; 95% CI, 1.01-1.99), and having a higher physical activity score (OR, 1.17; 95% CI, 1.00-1.37) as assessed at visit 8. Women who had a higher PCS at visit 8 (OR, 0.84; 95% CI, 0.83-0.86), who had a higher body mass index (OR, 0.95; 95% CI, 0.93-0.97), or who were taking more medications (OR, 0.93; 95% CI, 0.88-0.98) had lower odds of an improved PCS., Conclusions and Relevance: This cohort study of women in midlife suggests that approximately 15% of women experienced clinically important improvements in health and function over an 11-year period. Several potentially modifiable factors associated with improvements may inform women of variables to target for future interventions.

Background: The menopausal transition (MT) poses an increased risk for major depression (MD), but not for all women. Current and past stress are toxic risk factors for depression throughout life. The MT may be a time of increased sensitivity to stress, especially among women with a lifetime history of major depressive disorder (MDD). We evaluated whether women who experienced childhood maltreatment (CM) or current stressful events or ongoing problems were at increased risk for MD during the MT., Methods: At the Pittsburgh site of the Study of Women's Health Across the Nation, 333 midlife women were interviewed approximately annually over 15 years with the Structured Clinical Interview for the Diagnosis of DSM-IV Axis I Disorders and provided health and psychosocial data including the Childhood Trauma Questionnaire. Repeated measures logistic regression analyses were conducted separately for women with and without lifetime MDD at study entry., Results: Among women with lifetime MDD, CM, but not current stress, interacted with menopausal status to increase the risk for MD during postmenopause (ORs ranged from 2.71 to 8.04). All stressors were associated with increased odds of MD. Among women without lifetime MDD, current stress was related to risk for MD, but the effect did not vary by menopausal status., Conclusions: Women with MDD prior to midlife and who experienced CM were at greatest risk for MD after the MT. Women without prior MDD were at increased risk for MD during peri- and postmenopause. Healthcare providers should monitor women at risk for MD even after the MT.

Objective: To examine depressive symptoms during postmenopause and the contribution of depressive symptom trajectories before the final menstrual period (FMP) and psychosocial/health factors to postmenopause depressive symptoms., Methods: Longitudinal analysis of depressive symptoms (Center for Epidemiologic Studies-Depression scale) collected every 1 to 2 years from 1996 to 2017 from 1,551 midlife women in the Study of Women's Health Across the Nation for a median follow-up of 19.0 years. Latent class growth analysis identified depression trajectories from baseline to FMP. Multivariable random effects (woman as random effect) linear or logistic regression models were conducted., Results: Women had higher odds of reporting high depressive symptom score (≥16) during postmenopause than when they were premenopausal (OR = 1.49, 95% CI, 1.09-2.04), but not when perimenopausal. Three pre-FMP trajectories were identified: Group 1 (47.7%), consistently low scores, Group 2 (39.9%), moderate scores below the high depressive symptom threshold, and Group 3 (12.4%), consistently high scores. Both the moderate (OR = 2.62, 95% CI, 1.89-3.66) and high score (OR = 6.88, 95% CI, 4.72-10.02) groups, compared with the consistently low group, had significantly higher postmenopausal depressive symptom scores. Other pre-FMP variables associated with high postmenopausal depressive symptoms were: higher odds of childhood trauma/maltreatment, poor role physical, high anxiety symptoms, sleep problems, high vasomotor symptoms, and lower odds for chronological aging and lower social support., Conclusions: Compared with premenopause, postmenopause remains a period of increased risk for higher depressive symptoms, especially for women with pre-FMP depressive symptoms. Pre-FMP depressive symptom trajectories are highly predictive of postmenopause depressive symptoms independent of health and psychosocial factors., Competing Interests: Financial disclosure/conflicts of interest: H.M.K. (NIA), H.J. (NIA, NCI), J.T.B. (NIA, NIMH), and N.E.A. (NIA, NCI) report grants from NIH during the period of the study. H.J. reports the following additional disclosures: Grants: Merck, Pfizer; Consulting: NeRRe/KaNDy, Eisai, Jazz, Bayer; Spouse: Arsenal Biosciences employee; Merck Research Labs equity; Tango equity. A.B.C. and Y.C. declared no conflicts of interest or financial involvement (including employment, fees, share ownership) or affiliation with any organization whose financial interests may be affected by material in the manuscript, or any other conflicts of interest which might potentially bias it., (Copyright © 2022 by The North American Menopause Society.)

Study Objectives: Examine the association between trajectories of self-reported insomnia symptoms and sleep duration over 13 years with objective physical function., Methods: We utilized data from 1,627 Study of Women's Health Across the Nation participants, aged 61.9 ± 2.7 years at the end of the 13-year follow-up. Latent class growth models identified trajectories of insomnia symptoms (trouble falling asleep, frequent night-time awakenings, and/or early morning awakening) and sleep duration over 13 years. Physical function tests were performed at the end of the 13-year period: 40-ft walk, 4-m walk, repeated chair stand, grip strength, and balance. Multivariable regression analyses examined each physical function measure according to the insomnia symptom or sleep duration trajectory group., Results: Five insomnia symptom trajectories and two sleep duration trajectories were identified. Women with a consistently high likelihood of insomnia symptoms and women with a decreased likelihood of insomnia symptoms (i.e. improving) had slower gait speed (3.5% slower 40-ft walk [consistently high], 3.7% slower 4-m walk [improving]; each p ≤ .05) than those with a consistently low likelihood of insomnia symptoms. In contrast, women with a steep increase in the likelihood of insomnia symptoms over time and women with persistent insufficient sleep duration had lower odds of having a balance problem (odds ratio [OR] = 0.36 and OR = 0.61, respectively; each p < .02) compared to those with a consistently low likelihood of insomnia symptoms and those with persistent sufficient sleep duration, respectively., Conclusion: These results suggest that women's sleep during midlife has important implications for maintaining physical function during the transition into older adulthood., (© Sleep Research Society 2021. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

To determine the cross-sectional associations of accelerometer-measured time spent in physical activity intensity categories (sedentary, low and high light intensity, or moderate to vigorous intensity physical activity (MVPA) with physical performance outcomes [stair climb ascent, 40 foot walk test, and short physical performance battery (SPPB)] in older women and examine differences by race/ethnicity. Data were from 1,256 Study of Women's Health Across the Nation (SWAN) participants [aged 64.9 (2.7) years at Visit 15 (2015-16); 54.1% non-White]. Three sets of adjusted multivariable linear or logistic regression models were built to test the study objectives using the backward elimination approach to identify relevant covariates. In the full analytic sample, a 10 min increment in MVPA was related to faster performance on the stair climb [β = -0.023 (95% CI: -0.04, -0.005) seconds] and 40 foot walk test [β = -0.066 (95% CI: -0.133, -0.038) seconds], and a 9% lower odds [OR: 0.91; 95% CI: 0.87, 0.96; p = 0.004] of limitations based on the SPPB. Statistically significant differences by race/ethnicity were found for the stair climb ascent time as MVPA was associated with better performance for White, Chinese, and Japanese participants while high light intensity physical activity, but not MVPA, was deemed beneficial in Black women. Findings from the isotemporal substitution models were consistent. Findings further support the importance of MVPA on physical performance outcomes in older women. Further research is needed to examine the complex associations between physical (in)activity and physical performance outcomes by race/ethnicity to provide more targeted recommendations., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2021 The Author(s).)

Purpose: To examine physical activity (PA) patterns from pre- to post-diagnosis, and compare these changes to women without breast cancer. To determine pre-diagnosis predictors of PA change, post-diagnosis, in breast cancer survivors (BCS)., Methods: Data were from 2314 Study of Women's Health Across the Nation (SWAN) participants, average age of 46.4 ± 2.7 years at baseline (1996-1997). In Pink SWAN, 151 women who reported an incident breast cancer diagnosis over 20 years were classified as BCS; the remaining 2163 women were controls. LOESS plots and linear mixed models were used to illustrate and compare PA changes (sports/exercise [primary measure] and total PA) from pre- to post-diagnosis (or corresponding period) in BCS versus controls. Adjusted linear regression models were used to determine pre-diagnosis predictors of at-risk post-diagnosis PA change patterns (consistently low and decreased PA)., Results: No differences in pre- to post-diagnosis PA (or corresponding period) were observed in BCS versus controls. Among BCS, the odds of at-risk post-diagnosis PA change patterns was 2.50 (95% CI 0.96-6.48) times higher for those who reported sleep problems at ≥ 50% (compared to 0%) of pre-diagnosis visits and 3.49 (95% CI 1.26-9.65) times higher for those who were overweight or obese at all (compared to no) pre-diagnosis visits. No other statistically significant predictors were noted., Conclusions: Age-related declines in PA were not amplified by a breast cancer diagnosis. Given the beneficial role of PA across the cancer control continuum, efforts to increase or maintain adequate PA, post-diagnosis, should be continued., Implications for Cancer Survivors: While age-related physical activity declines were not amplified breast cancer diagnosis, efforts to identify breast cancer survivors at increased risk for post-diagnosis physical activity declines (or maintenance of low activity) may be a high-yield strategy to improve prognosis and quality of life.

The purpose of this study was to evaluate the effectiveness of resistance training performed either 2 days/week or 3 days/week. One hundred and seventeen sedentary volunteers were randomly assigned to one of the two training groups or a control group. Twenty-two men (27 +/- 5 years) and 22 women (26 +/- 5 years) trained for 10 weeks. Twenty-five men (26 +/- 5 years) and 22 women (24 +/- 5 years) trained for 18 weeks. Twenty-six subjects served as controls and did not train. Training consisted of a single set of variable resistance bilateral knee extensions performed to volitional fatigue with a weight load that allowed seven to ten repetitions. Prior to and immediately following training, isometric strength was evaluated at 70, 85, 100, 115, 130, 145, 160, and 171 degrees of knee extension with a Nautilus knee extension tensiometer. All groups who trained showed a significant increase in peak isometric strength when compared with controls (P less than 0.01). Groups that trained 3 days/week increased peak isometric strength (10 weeks = 21.2%; 18 weeks = 28.4%) to a greater extent (P less than 0.05) than groups that trained 2 days/week (10 weeks = 13.5%; 18 weeks = 20.9%). We conclude that resistance training 2 days/week significantly improves knee extension isometric strength; however, the magnitude of strength gain is greater when training is performed 3 days/week. These data indicate that the adult exerciser (18 to 38 years) training 2 days/week may derive approximately 80% of the isometric strength benefits achieved by those training 3 days/week.

The present study evaluated the effect of limited range of motion (ROM) variable resistance training on full ROM strength development. Twenty-eight men and 31 women were randomly assigned to one of the three training groups (A, B, AB) or a control group (C). A, B, and AB performed variable resistance bilateral knee extension exercise 2 (N = 25) or 3 (N = 19) d.wk-1 for 10 wk with an amount of weight that allowed one set of 7-10 repetitions. Group A trained in a ROM limited to 120 degrees to 60 degrees of knee flexion. Group B trained in a ROM limited to 60 degrees to 0 degrees of knee flexion. Group AB trained full ROM. Prior to and immediately following training, isometric knee extension strength was evaluated at 9 degrees, 20 degrees, 35 degrees, 50 degrees, 65 degrees, 80 degrees, 95 degrees, and 110 degrees of knee flexion with a Nautilus knee extension tensiometer. Reliability coefficients for repeated measurements of isometric strength at multiple joint angles were high (r = 0.86-0.95, P less than 0.01; SEE = 23.1-37.2 N.m). Compared to the control group, all training groups improved in isometric strength (P less than 0.01 at each angle tested except for group A at 9 degrees and 20 degrees of knee flexion and group B at 95 degrees of flexion. Isometric strength gains for group AB were similar throughout the full ROM. Isometric strength gains for the limited ROM trained groups were greater in the trained ROM than in the untrained ROM (P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

To investigate the influence of different bioelectrical impedance (BI) analyzers on the prediction of body composition from bioelectrical resistive impedance (R), 146 healthy white adults (73 men; 73 women) were studied at two independent laboratories: The University of Florida (UF) and the USDA, San Francisco. Whole body R was measured on each subject with three different BI analyzers. AT UF analyzers were: Valhalla Scientific model 1990-A (VH), RJL Systems model BIA-101 (RJL), and Medi-Fitness model 1000 (MF). At USDA analyzers were: VH, RJL, and Bioelectrical Sciences model 200Z (BES). The largest difference in R (36 ohms, P ⩽ 0.01) was noted between BES and VH at USDA. When applied to current BI prediction equations, the observed differences among analyzers resulted in differences in predicated % fat of up to 6.3% although most comparisons among mean values (79%) showed differences below 3%. Crossvalidation of the selected BI prediction equations with hydrostatistically determines body composition using the different R values revealed total errors of prediction (E) ranging from 3.6 to 9.8% fat. The prediction equations were most accurate when used with data collected on the same instrument that was to used to develop the equation (E = 3.6 to 5.3% fat). These findings indicate that different analyzers can be a significant source of variation when predicting body composition from R. To minimize this source of variation, it is recommended that BI prediction equations be used with the same type of instrument as that with which they were developed., (Copyright © 1989 Wiley-Liss, Inc., A Wiley Company.)