Menopausal Duration and Relative Skeletal Muscle Index Predict Metabolic Inflexibility During Walking in Postmenopausal Women with Overweight/Obesity

Menopause predisposes a diminished capacity to alter oxidative substrate during exercise - a risk factor for cardiometabolic diseases (CMD). Since walking behavior influences CMD, identifying factors associated with substrate use during walking may inform strategies to attenuate risk. This study assessed changes in lipid (ΔFATox) and carbohydrate (ΔCHOox) oxidation during walking and identified physiological predictors.

Methods: Thirty-six women (64 ± 7 y; body mass index [BMI]: 29.5 ± 4.9 kg/m ² ) completed a treadmill task (0.9 m/s, 0% grade) with indirect calorimetry to quantify oxygen uptake (V̇O ₂ ) kinetics, ΔFATox, and ΔCHOox. Exercise capacity was assessed via a 6 min walk test. Body composition, including relative skeletal muscle index (RSMI), was assessed using dual-energy X-ray absorptiometry.

Results: ΔFATox was correlated with age ( r = -0.465, P = 0.004), menopausal duration ( r _s = 0.478, P = 0.004), BMI ( r _s = 0.398, P = 0.028), RSMI ( r = 0.531, P = 0.001), and excessive postexercise V̇O ₂ ( r _s = 0.430, P = 0.009). ΔCHOox was correlated with O ₂ deficit ( r _s = 0.500, P = 0.002). Menopausal duration, RSMI, and recovery V̇O ₂ mean response time explained the most variance in ΔFATox (adjusted r ² = 0.534, P < 0.001). Menopausal duration, visceral adipose tissue mass, and O ₂ deficit explained the most variance in ΔCHOox (adjusted r, ² = 0.371, P < 0.001).

Conclusion: Age and menopausal duration were associated with reduced ΔFATox during walking. Menopausal duration was the strongest exploratory predictor of metabolic inflexibility. RSMI outperformed exercise capacity and V̇O ₂ uptake kinetics in predicting ΔFATox during walking.