women are among the most important foundations of the family and society ; and the health of the community depends to a large extent , on meeting the needs of this group . menopause is the cessation of menstruation resulting from loss of ovarian follicular function , which is a recognized physiological event in women 's lives . in addition to hormonal changes particularly reduction of estrogen levels with biological , psychological and social changes , a woman who has not experienced menstrual period within at least 12 months retrospectively is deemed to have entered the phase of menopause and the postmenopausal period starts from this moment . depending on the disorder of ovarian function and therefore , lack of estrogen in the postmenopausal period , symptoms such as hot flashes , irritability , sleeping disorders , fatigue , anxiety and loss of concentration are observed in the early period . risk of coronary artery disease and incidence rate of osteoporosis increase due to loss of protective effects of estrogen in the later period . if we assume menopause age as beginning at 50 , women spend one - third of their lives with the pathological changes they are exposed to in the postmenopausal period . earlier , the world health organization had reported that by 2003 there would be 1.2 billion women at and over age of 50 . therefore , although the menopause seems like a natural process , it is a period that must definitely be followed and treated . one of the aims of health for all in the 21st century is the improvement of the quality of life . as a physiological event , menopause has complications that influence women 's quality of life . several measures such as hormone therapy and non - pharmacological therapies are recommended to reduce menopausal symptoms and improve quality of life in this period . hormonal replacement treatment ( hrt ) is used as a standard therapy in menopausal treatment . the effect of exercise in preventing the postmenopausal symptoms as another aspect of treatment is widely accepted today . postmenopausal symptoms can be prevented significantly by encouraging the women over middle age to gain the habit of exercising regularly . prior research has showed that postmenopausal women living in cities are more sedentary . due to unbalanced and single type nourishment , weight gain is a common phenomenon in those living in rural areas . the weight increase , which depends on age , inactivity and hormone drugs used in menopause , is minimized by regular exercise and the burning of excess calories . in the literature , there are studies that research the effects of exercise on muscle strength , bone density and on the postmenopausal symptoms in the women in postmenopausal period . in addition , the studies in which the effects of exercises on quality of life is researched , is insufficient . in accordance , the objective of our study was to conduct an exercise program of 6 weeks and determine the changes on physical fitness levels and quality of life on postmenopausal women . our study is aimed to determine the effects of exercise on quality of life with a controlled exercise program of 8 weeks appropriate to the postmenopausal period . the inclusion criteria of this study were : 
 to have entered into the menopause naturally ( subjects stated that they had no operation during their lives)aged 45 - 65 old , to have been taking hrt for at least 1 year ( subjects received combined continuous 0.62 mg per day conjugated estrogen ( ce ) + 2.5 mg per day medroxy - progesterone acetate ( map)to have no health problems that may prevent from doing exercise and to have no high cardiac risk 
  to have entered into the menopause naturally ( subjects stated that they had no operation during their lives ) aged 45 - 65 old , to have been taking hrt for at least 1 year ( subjects received combined continuous 0.62 mg per day conjugated estrogen ( ce ) + 2.5 mg per day medroxy - progesterone acetate ( map ) to have no health problems that may prevent from doing exercise and to have no high cardiac risk exclusion criteria of this study were : 
 postmenopausal women who exercise its check list was incomplete . information about this study was provided to the subjects . before being accepted into the study , it was explained to them that , if they preferred not to continue , they could withdraw from the study any time . postmenopausal women were randomly allocated by means of a random number table to one of two groups . forty women in the first group were included into the 8-week aerobic exercise program and 40 women in the second group formed the non - exercise control group . the women in second group continued to take hrt and were not included in any exercise program . six different sub - sections of nph included different numbers of questions with different scoring ( physical mobility , pain , sleep , energy , social isolation and emotional reactions ) . each sub - section 's maximum cumulative score total should be 100 ( worst health ) and minimum 0 ( best health ) . the subjects were included in the exercise program for 8-week period with the frequency of 5 times a week . the program started with warming - up exercises consisting of stretching exercises and the 5-min low - intensity walking ; warming - up exercises were followed by a program starting with 20 min and increasing up to 40 min at the end of 8 weeks . this program included the exercise detailed below : bicycle for lower extremity endurance training for 5 to 15 min ; exercise on the step board for lower extremity endurance for 2 to 6 min ; posture exercises across a mirror for neck and back muscles ( 10 times ) ; strengthening exercises with isoflex bands ; free weights for back and abdominal muscles , pectoral , scapular muscles , and for upper - lower extremity muscles ; balance exercise with trampoline for balance training ; and flexibility exercise for pectoral , hamstring , gastro - cnemius - soleus , and back muscles . the exercise program was completed with cooling exercises consisting of 5-min low - intensity walk on the treadmill . the exercise program with sub - maximal intensity was applied to the cases and a borg scale was used in determining the intensity of the exercise . exercise intensity was regulated by progressively increasing the repeating number , duration and endurance amounts of the exercises with the borg scale follow - up . a paired sample t - test was used to compare the differences between before and after exercise at the same group and an independent sample t - test was used to compare the differences between the exercise and the control groups . anova test was used for more than 2 groups and chi - square test respectively for continuous and categorical data . for all analyses , postmenopausal women were randomly allocated by means of a random number table to one of two groups . forty women in the first group were included into the 8-week aerobic exercise program and 40 women in the second group formed the non - exercise control group . the women in second group continued to take hrt and were not included in any exercise program . six different sub - sections of nph included different numbers of questions with different scoring ( physical mobility , pain , sleep , energy , social isolation and emotional reactions ) . each sub - section 's maximum cumulative score total should be 100 ( worst health ) and minimum 0 ( best health ) . the subjects were included in the exercise program for 8-week period with the frequency of 5 times a week . the program started with warming - up exercises consisting of stretching exercises and the 5-min low - intensity walking ; warming - up exercises were followed by a program starting with 20 min and increasing up to 40 min at the end of 8 weeks . this program included the exercise detailed below : bicycle for lower extremity endurance training for 5 to 15 min ; exercise on the step board for lower extremity endurance for 2 to 6 min ; posture exercises across a mirror for neck and back muscles ( 10 times ) ; strengthening exercises with isoflex bands ; free weights for back and abdominal muscles , pectoral , scapular muscles , and for upper - lower extremity muscles ; balance exercise with trampoline for balance training ; and flexibility exercise for pectoral , hamstring , gastro - cnemius - soleus , and back muscles . the exercise program was completed with cooling exercises consisting of 5-min low - intensity walk on the treadmill . the exercise program with sub - maximal intensity was applied to the cases and a borg scale was used in determining the intensity of the exercise . exercise intensity was regulated by progressively increasing the repeating number , duration and endurance amounts of the exercises with the borg scale follow - up . a paired sample t - test was used to compare the differences between before and after exercise at the same group and an independent sample t - test was used to compare the differences between the exercise and the control groups . anova test was used for more than 2 groups and chi - square test respectively for continuous and categorical data . for all analyses , when these two groups were evaluated according to their physical characteristics , it was observed that they were homogeneous . as shown in table 1 , the average age of the subjects was 54.05  4.78 years with a range of 46 - 61 . furthermore , the number of years that they were menopausal , and the number of years that they were under hrt therapy was questioned as menopausal information and the answers were recorded . it was observed that these two groups were similar also in terms of menopausal characteristics . baseline demographic characteristics of subject as shown in table 2 , there was no statistically significant difference according to nhp indicating an improvement in the quality of life before exercise . mean quality of life scores in the exercise and control groups before exercise results from the survey [ see table 3 ] in the exercise group show significant decreases in the scales of all the items indicating that the quality of life had been improved according to six sub - items of the nhp . no significant changes were found in the quality of life in the control group at the end of 8 weeks . at the end of the 8 weeks , there was a statistically significant difference in the exercise group according to nhp indicating an improvement in the quality of life . menopause is a natural process that is seen in an average age of 50 , and women spend almost one - third of their lives in the postmenopausal period . the quality of life worsens in the postmenopausal period as a result of the physical , psychological and social problems that start with menopause . it is emphasized in many studies that in order to achieve the best results from hrt , this therapy should be combined with an exercise program . there are many studies indicating the negative effects of postmenopausal symptoms on quality of life . luis cobero , the president of spain gynecology and obstetrics association , had explained that the life qualities of postmenopausal women improve not only with hrt , but also with modifications in their diets , modifications in lifestyles , and regular physical activity . gzeloglu applied nhp in order to establish the effects of osteoporosis in 50 postmenopausal women and reported that quality of life impairment increased with the duration of postmenopausal period . gzeloglu emphasized that the reliability of nhp scale was rather high , and it could be used to evaluate the life quality of postmenopausal women . one intervention study concluded that fitness level and quality of life of postmenopausal women could be improved by a regular controlled exercise program of six weeks . elavsky found that physical activity and menopausal symptoms were related to physical self - worth and positive effect , and in turn , greater levels of physical self - worth and positive effect were associated with higher levels of menopause - related quality of life . it was found that life quality improved for all the sub - items of nhp in exercise group . we concluded that quality of life could be improved with regular and controlled exercise of 8 weeks in postmenopausal women . when it is considered that our cases were not geriatric , our study has the properties of a protective treatment for these cases . the long - term effects of exercise on quality of life of our cases can be evaluated provided that the habit of exercising can be achieved by these individuals as a lifestyle . studies that contain the data from this same group in subsequent years will be necessary for such an evaluation .