Time-Efficient Inspiratory Muscle Strength Training for Reducing Sympathetic Activity and Improving Sleep in Midlife Women

/ABSTRACT Vasomotor symptoms (hot flashes) associated with menopause consist of rapid and intense sweating, peripheral vasodilation, and an exaggerated feeling of internal heat. Over 70% of women experience hot flashes at some point during menopause, which significantly impacts day to day life. Furthermore, hot flash frequency is related to increased risk of hypertension, cardiovascular disease (CVD), sleep, and mood disorders--even when controlling for traditional cardiovascular disease risk factors (obesity, hypertension, lipids, etc.). For the purposes of this application, we will define neurovascular function as a concept that encompasses sympathetic outflow, the responses of blood vessels to neurotransmitters released by the sympathetic nerves and the intrinsic properties of the vascular endothelium and smooth muscle. In this context, neurovascular function is critically important to women’s health and aging. Neurovascular function, including elevated sympathetic control of blood pressure, has been implicated the positive relationship between hot flashes and cardiovascular disease. Further, nocturnal awakenings during hot flashes are associated with increases in sympathetic activity. As such, the overall goal of this application is to assess the impact of a high-resistance inspiratory strength muscle on sympathetic nerve activity and sleep in postmenopausal females with hot flashes. Aim 1 will determine if 6 weeks of high-resistance inspiratory muscle strength training reduces sympathetic nerve activity in postmenopausal females with hot flashes. Aim 2 will establish whether 6 weeks of high-resistance inspiratory muscle strength training will improve sleep through reductions in nocturnal awakenings due to reduced hot flash frequency in postmenopausal females with hot flashes. Importantly, this work will provide objective mechanistic evaluation of autonomic and neurovascular function in midlife women including those undergoing menopause. Understanding how the neurovascular physiology of women relates to hot flashes will inform hypertension and cardiovascular disease (CVD) treatment and prevention options, as the presence of hot flashes are a CVD risk factor beyond traditional CVD risk factors and as such, is likely to be an important determinant for a woman’s health. Thus, these studies will begin working toward the Applicant’s long-term goal of developing interventions to reduce the incidence of cardiovascular disease in women with hot flashes. Finally, this work will provide pilot data that complement the Applicant’s intellectual and technical skills for future work to improve cardiovascular health in women with menopausal hot flashes. Project Number: 1R21AG101515-01 | Fiscal Year: 2026 | NIH Institute/Center: National Institute on Aging (NIA) | Principal Investigator: Sarah Baker | Institution: MAYO CLINIC ROCHESTER, ROCHESTER, MN | Award Amount: $439,258 | Activity Code: R21 | Study Section: Special Emphasis Panel[ZRG1 RCCS-W (81)] View on NIH RePORTER: https://reporter.nih.gov/project-details/11356357