What factors are associated with improved physical health and function during midlife among women?

In a recent study published in the JAMA Network Open, researchers performed a cohort study using data from the Study of Women’s Health Across the Nation (SWAN) study to identify interventional targets that could bring in clinically relevant improvements in the physical health and function of women in their early midlife and the factors associated with these improvements.

Study: Physical and Behavioral Factors Associated With Improvement in Physical Health and Function Among US Women During Midlife. Image Credit: MonkeyBusinessImages/Shutterstock.com

Background

SWAN, a multi-center, community-based cohort study, was conducted among a diverse cohort of US women in their early midlife recruited from across seven sites in the United States of America (USA) between 1996 and 2017, and follow-up for SWAN lasted up to 21 years.

Identifying intervention targets that could improve clinically relevant physical health and function in women in their early midlife could help them age successfully. Successful aging is typically studied among older women, though its physical health and function trajectories are apparent as early as midlife.

For instance, several previous studies have found that physical health and functional limitations commence during midlife for women. These are generally related to chronic conditions that develop before or during midlife.

Contrastingly, some works have shown a highly dynamic nature of functional status and physical health during midlife, raising the possibility of improvisations during this time.

So, while several static and modifiable factors influence aging, their early identification could decrease mortality among older adults through prompt and timely interventions.

About the study

In the present study, researchers selected 1,807 women from SWAN who were in the age group of 42 to 52 years, who experienced one or more menstrual cycles, did not take hormone therapy in the prior three months, had an intact uterus, one or more ovaries, and self-identified as belonging to Hispanic, White, Japanese, Chinese or Black race/ethnicities,

They assessed a clinically significant improvement in the physical component score (PCS) (≥5 points) for these women using a 36-item Short-Form Health Survey between visits eight and 15. Further, the researchers performed data analyses between SWAN visits eight and 15, i.e., in two batches from 2004-2006 and 2015-2017, and statistical analysis between October 2021 and March 2023.

Results

Over 11 years of follow-up, nearly 15% of women experienced clinically significant improvements in health and function.

Despite lower baseline PCS, women were inclined to improve, suggesting that midlife represents a highly dynamic phase when physical health and functioning could improve even among those with already poor functional health. However, these associations became increasingly insignificant among those with a high baseline PCS.

The study findings demonstrated that women with improved PCS had multiple symptoms at the study initiation, i.e., at visit eight. By visit 15, these symptoms resolved in many women, suggesting their resolution might be related to improvements in physical health and function.

Further, the authors noted an association between the PCS at the start of follow-up and study covariates.

The researchers also identified several factors associated with improved physical health and function in women in their midlife, such as less financial burden, lower body mass index (BMI), fewer medications, fewer sleep disturbances, high physical activity levels, and no osteoarthritis.

Prior studies found that a higher BMI and pre-existing health conditions were associated with a lower PCS. This study also identified factors associated with clinically relevant physical health and functional improvements in middle-aged women.

Even a modest prevalence of scope for improvement suggested that health and function are highly pliable to amendment during midlife. Thus, identifying factors related to functional improvements could be leveraged as potential interventional targets, and women with poorer health and function might be given more support in midlife.

Conclusions

The findings of the present cohort study showed that midlife is an important but small time window in which there is a lot to learn about what events are associated with the fluctuating health status of women and intervene and improve their overall physical health.

The study also uncovered several factors related to improvements in overall physical health and function, including good physical health, fewer sleep disturbances & medications, no financial stress, no osteoarthritis, lower body mass index (BMI), and higher physical activity levels.

Since health status fluctuates during midlife, the study results could help develop interventional strategies to support health- and function-related improvements in women in their midlife.