From the field to the brain: the benefits of exercise for women’s brain health

By Louise Schindler

The success of the Lionesses in recent years is having an impact well beyond the pitch; the FA is reporting increased uptake in female teams across all age groups. It’s therefore inevitable that the sport and industry around the players also needs to raise its game! A quick trawl of the football media sees discussions around kit designed specifically for the female body, coaching approaches that build on female psychology, and performance research that recognises the specifics of female health and physiology. August 2023 saw the launch of the FIFA Women’s Health, Wellbeing and Performance Project, an initiative that aims to improve awareness, research, and education in all areas of women’s football. In this blog, the ‘Football on the Brain’ project will take a closer look at women’s health and exercise.  

Note: Here, we use the term ‘women’ to include women, individuals who menstruate, and those experiencing menopause. However, not all menstruating or menopausal individuals identify as women, and not all women experience menstruation or menopause.   

Beyond mood swings and hot flushes: understanding premenstrual syndrome and menopause  

Premenstrual syndrome (PMS) and menopause are two physiological events marked by significant hormonal changes. These changes do not only have an impact on the body, but also affect the brain and mind. During PMS and menopause, many women suffer from mood swings, or experience difficulties with their memory, attention, and problem-solving abilities. While there are medicines that mitigate the impact of PMS and menopause, regular exercise can also play an important role in reducing the effects of these hormonal changes.   

Women generally experience menstrual cycles for about 40 years of their life. This monthly cycle, driven by hormonal fluctuations, prepares the body for a potential pregnancy. The cycle involves stages like the follicular phase, ovulation, and the luteal phase, each of which is marked by distinct changes in the female sex hormones, including in oestrogen and progesterone (Image 1). Just before menstruation, in the luteal phase, the levels of these hormones drop, which is thought to be associated with various physical and emotional symptoms – PMS! – that generally disappear a few days after the start of menstruation. While it is thought that a sensitivity to changing hormone levels is involved in PMS, it is still not clear why the drop in hormone levels causes these specific symptoms. Whatever the cause, it is acknowledged that participation and performance in football is undoubtably affected.  

Image 1. The menstrual cycle. (Created by Louise Schindler)

PMS is a term that often appears in the media and is frequently used as a punchline or dismissed as an excuse. However, for women experiencing PMS, it can have a major impact on their well-being. Around 4 in 5 women are affected to some extent by PMS [1], with common psychological symptoms including mood swings, irritability, and bouts of depression or anxiety. Some women also experience cognitive difficulties, such as poor concentration, finding it hard to make decisions, or being more forgetful. The severity and combination of these symptoms can vary a lot between individuals and from one cycle to another. A small number of women may even experience a severe form of PMS known as premenstrual dysphoric disorder (PMDD), which can involve extreme symptoms of depression and anxiety.  

Menopause, meanwhile, marks the end of the reproductive phase in a woman’s life and is confirmed after 12 consecutive months without menstruation, on average around the age of 51. A few years before the last menstrual period, women enter perimenopause, where hormonal fluctuations become common, and oestrogen and progesterone reduce to low levels. It is well-known that this phase can have physical symptoms such as hot flushes and skin changes, but there is less awareness of the psychological impacts. These can include ‘brain fog’, worsening memory, and slower mental speed, as well as mood disturbances such as irritability, depression, and stress [2]. While it is thought that the decrease in levels of oestrogen and progesterone during this time can lead to these symptoms, other factors may also play a role. For example, many menopausal women experience sleep disturbances, which can contribute to fatigue, mood disturbances, or cognitive difficulties. No matter what the cause, impact won’t just be felt off the pitch, footballer performance is also going to be affected. 

The science behind the sweat: how exercise can improve mood and cognition   

Treatments for psychological symptoms of both PMS and menopause are most effective with a personalised, multi-faceted approach. This can include medications such as hormonal contraceptives or antidepressants, or psychological support like cognitive behavioural therapy. The good news is that lifestyle changes, such as regular exercise, can also have positive effects on symptoms. Physical activity, like football, is associated with a range of health benefits, including improvements in mood and cognitive function. It was shown to reduce both physical and psychological PMS symptoms in studies comparing women who exercise more with those who exercise less, and in controlled experiments assigning women to exercise or not to exercise for several months [3, 4, 5]. Similarly, menopausal women with higher levels of exercise reported fewer or less severe psychological symptoms such as anxiety or depression, compared to women with lower levels of exercise [6].  

Exercise can improve mood through the release of endorphins (feel-good hormones) and neurotransmitters (chemical messengers in the brain) like dopamine and serotonin, as well as the reduction of the stress hormone cortisol [7]. What is still unclear is which duration, type, and intensity of exercise has the best effects on hormone-related mood [5]. However, in studies including both men and women, even one session of 10-30 minutes was found to have mood-boosting benefits [8]. Additionally, substantial research has been done on the benefits of aerobic exercises like walking, running, cycling, or swimming, but resistance training like Pilates or mindfulness-based exercise like yoga can also improve mood symptoms [8].  

It's also well-recognised that exercise can have a beneficial effect on cognitive performance [9]. Exercise can also improve brain function in a more practical sense. It releases a crucial protein that promotes the survival and growth of brain cells, especially in brain areas associated with learning and memory, and may lead to improvements in memory and problem-solving [10]. Regular exercise can also lead to better sleep, which in turn improves concentration and memory. Therefore, in menopausal women struggling with sleep, exercise may be a way to improve both sleep and cognitive function [11].  

Although limited research has been done on the effect of exercise on cognition in women with PMS or who are transitioning menopause specifically, substantial evidence suggests that both regular exercise and short bursts of activity boost cognitive test performance in adults aged over 50 [12]. Additionally, greater amounts of exercise have been linked to a reduced risk of developing cognitive impairment [12]. Exercise could therefore help cognitive symptoms experienced in both PMS and menopause, though it remains crucial for women with severe symptoms to seek advice from a licensed medical professional to ensure they receive proper care and interventions.   

Moving your body is good for your mental well-being  

Hormonal changes in specific phases of women’s lives, such as the premenstrual phase or menopause, undeniably influence psychological states. It is unsurprising that during these phases, women often experience significant challenges to their well-being. Regular exercise can improve both mood and cognition, and might therefore be a useful strategy to combat these symptoms. While the research has not yet reached a consensus about what type, duration, or intensity of exercise is best during these phases, what seems to matter the most is moving our bodies regularly, in ways that we enjoy.  

So, whether you are a lapsed player or new to the sport, joining a football team is good for the female body and the brain. Meanwhile, it will be interesting to see if initiatives such as FIFA’s Women’s Health, Wellbeing and Performance Project have an impact across the game, and conversations about female health in the game really do become normalised.  

References  

[1] Schoep, M. E., Nieboer, T. E., van der Zanden, M., Braat, D. D., & Nap, A. W. (2019). The impact of menstrual symptoms on everyday life: a survey among 42,879 women. American journal of obstetrics and gynecology, 220(6), 569-e1.  

[2] Santoro, N., Roeca, C., Peters, B. A., & Neal-Perry, G. (2021). The menopause transition: signs, symptoms, and management options. The Journal of Clinical Endocrinology & Metabolism, 106(1), 1-15.  

[3] Pearce, E., Jolly, K., Jones, L. L., Matthewman, G., Zanganeh, M., & Daley, A. (2020). Exercise for premenstrual syndrome: a systematic review and meta-analysis of randomised controlled trials. BJGP open, 4(3).  

[4] Saglam, H. Y., & Orsal, O. (2020). Effect of exercise on premenstrual symptoms: A systematic review. Complementary therapies in medicine, 48, 102272.  

[5] Sanchez, B. N., Kraemer, W. J., & Maresh, C. M. (2023). Premenstrual Syndrome and Exercise: A Narrative Review. Women, 3(2), 348-364.  

[6] Hybholt, M. (2022). Psychological and social health outcomes of physical activity around menopause: A scoping review of research. Maturitas, 164, 88-97.  

[7] Basso, J. C., & Suzuki, W. A. (2017). The effects of acute exercise on mood, cognition, neurophysiology, and neurochemical pathways: A review. Brain Plasticity, 2(2), 127-152.  

[8] Chan, J. S., Liu, G., Liang, D., Deng, K., Wu, J., & Yan, J. H. (2019). Special issue–therapeutic benefits of physical activity for mood: a systematic review on the effects of exercise intensity, duration, and modality. The Journal of psychology, 153(1), 102-125.  

[9] Erickson, K. I., Hillman, C. H., & Kramer, A. F. (2015). Physical activity, brain, and cognition. Current opinion in behavioral sciences, 4, 27-32.  

[10] Liu, P. Z., & Nusslock, R. (2018). Exercise-mediated neurogenesis in the hippocampus via BDNF. Frontiers in neuroscience, 52.  

[11] Sewell, K. R., Erickson, K. I., Rainey-Smith, S. R., Peiffer, J. J., Sohrabi, H. R., & Brown, B. M. (2021). Relationships between physical activity, sleep and cognitive function: A narrative review. Neuroscience & Biobehavioral Reviews, 130, 369-378.  

[12] Stillman, C. M., Esteban-Cornejo, I., Brown, B., Bender, C. M., & Erickson, K. I. (2020). Effects of exercise on brain and cognition across age groups and health states. Trends in neurosciences, 43(7), 533-543.  

Photo via Canva