Research Faculty Spotlight: Manda Keller-Ross, PT, DPT, PhD

Manda Keller-Ross, PT, DPT, PhD, is an assistant professor in the University of Minnesota Medical School’s Division of Physical Therapy and Rehabilitation Science within the Department of Family Medicine and Community Health. Dr. Keller-Ross’s research specialties include aging, cardiovascular health, and women’s health. We spoke with her to learn more about her vital work.

How did you come to decide on a career in practicing and teaching physical therapy?

I was actually influenced to study physical therapy both personally and professionally. My mom was a nurse, and when I was in high school, before I even knew what a physical therapist was, she would say, “you would be a really good physical therapist.” She would come home with different aches and pains, and I would massage or stretch her muscles.

Later, when I went to college and did my undergraduate degree here at the University of Minnesota, I started doing research. I happened to land a research position in a lab within physical therapy and worked with Dr. LaDora Thompson. She was interested in muscle biology, aging, and diabetes. She had an animal research lab, and I would come into the lab once or twice a week and do research with her.

We talked about different schools that I would apply to, and I ended up going to Marquette University for my physical therapy degree because it was in Milwaukee, closer to my family.

While I was in school for my doctor of physical therapy (DPT) degree, I started working as a teaching assistant for exercise physiology courses. During the end of my DPT degree, I started conducting research in Dr. Sandra Hunter’s laboratory focused on neuromuscular physiology and realized that my true passion was research. Because of my love for both teaching and research, I continued my education and started working on my PhD, after obtaining my DPT.

Can you share a bit about the cardiovascular research and rehabilitation lab? How did that get started?

I started the lab in 2015. The goal was to be an integrative physiology lab that focused on how blood pressure was regulated during rest and exercise as well as how it changes with aging. In particular, blood pressure regulation is a very sophisticated process, with the main objective to maintain homeostasis within the body.

There are multiple factors and physiological reflexes that assist our body in regulating blood pressure. This is really important because if blood pressure goes down for any reason, we need mechanisms in place to bring it back up. Alternatively, we are exposed to different stressors throughout our life that can result in elevated blood pressure and thus hypertension, which can lead to cardiovascular diseases and subsequently heart failure.

Our lab focuses primarily on the autonomic nervous system and vascular system, which are both important modulators of blood pressure. In women, after menopause, hypertension and cardiovascular diseases increase substantially, and we are studying how menopause influences autonomic and vascular blood pressure regulation as potential contributors to this increased risk.  

What are some projects you are currently working on?

What we currently know is that, if we're looking at a younger population, men generally have a greater prevalence of hypertension compared with women. But once women reach menopause, the risk of hypertension in women surpasses that of men. Thus, we have three major projects that we're working on with the idea to understand the contribution of menopause vs. age to the greater hypertension and cardiovascular disease risk.

Menopause is the cessation of sex hormone production (i.e., estrogens and progesterone) from the ovaries that occurs with the end of the menstrual cycle. We are interested in how the loss in sex hormones influence autonomic and vascular function. Autonomic function is the balance of sympathetic (fight or flight) and parasympathetic (rest or digest) function. In our lab, we use a technique called microneurography, which utilizes a really small, high impedance electrode advanced within a peripheral nerve to provide us with direct information about the sympathetic nervous system.

We also do some vascular measures, such as vascular conductance and endothelial function, to determine if vascular function changes with menopause. Along with the loss of sex hormones, women often experience menopause symptomology, such as vasomotor symptoms (hot flushes and night sweats) and sleep difficulty, among others, which can also provide insight to cardiovascular disease risk. For example, if we look at the epidemiology literature, it suggests that women who have more frequent and severe hot flushes are at greater risk for hypertension and cardiovascular disease.

Thus, one of our studies induces hot flushes and then measures the physiological response to that hot flush such as sympathetic nerve activity, beat-by-beat blood pressure and heart rate. This work is funded by the NIH and led by one of my graduate students, William Stokes. Mr. Stokes is conducting foundational work to understand whether the physiological response to the hot flush is contributing to the greater risk of hypertension.

We also have a collaborative study that has just started, led by one of my graduate students, Dr. Chowdhury Tahsin, on how short sleep and impaired sleep quality, often experienced by menopausal women, influences autonomic and vascular function. If we're not getting sleep, this can contribute to higher blood pressure, hypertension, and heart disease.

Dr. Emma Lee, a postdoctoral fellow in my lab, has a NIH F32 that is studying how the age of menopause can influence autonomic and vascular function. Her study is suggesting that in younger women who completed menopause premature or early, blood pressure and sympathetic activity may be elevated, which may result in vascular dysfunction as these women age. We have some longitudinal studies in the near future that will be able to directly test this hypothesis.

Finally, as we know exercise is an important lifestyle modification for cardiovascular disease prevention, Miguel Anselmo, a second-year PhD student in my lab, is interested in how exercise influences the menopause experience and how exercise can directly influence autonomic and vascular function to reduce the cardiovascular disease risk profile.

My students and postdoctoral fellow are in the trenches of it all and doing a lot of hard groundwork.

Why is physical therapy such a vital part of overall healthcare and what role do you see it playing in overall health?

In terms of my work, the biggest impact that we can make is validating symptomology—how it may play a role in their exercise or physical therapy prescription and educating women about the cardiovascular disease risk after menopause. It is important for women to know that musculoskeletal aches and pains can also be a symptom of menopause. If they are experiencing vasomotor symptoms, night sweats and also not sleeping, this can make their symptoms worse. Thus, if we are treating women in the 45-to-55 age range, then we want to be asking them questions related to whether they are experiencing menopausal symptoms. This can sometimes be hard because, as a society, we are still not comfortable with talking about menopause.

So, one of the things that I try to educate our physical therapy students on is the idea that they impact their patient’s healthcare by educating them on menopausal symptoms, such as the ones already discussed, but also can include anxiety, depression, genitourinary, and sexual dysfunction. These symptoms can impact how people move, and that is what physical therapy is all about—how we're physically moving in this world. These discussions can significantly impact a patient’s ability to undergo rehabilitation, move in a different way or how they may see themselves.

We did a study at the Minnesota State Fair back in 2019, where we assessed menopause symptoms, women’s perceptions on current treatments and how they chose to treat their menopausal symptoms. The number one item that came out of this study was that women used exercise, which included physical therapy, to treat their menopause symptoms.

I think we forget how important exercise is and that exercise is medicine. We are always looking for that poly-pill or some supplement that is going to slow aging, make us feel better, lower blood pressure, etc. When we look at all of the studies on how we are impacted by exercise and rehabilitation, it’s clear that exercise is key for anti-aging, reducing cardiovascular disease risk as well as improving overall health and well-being.

That's one of the important things that we as physical therapists can do is advocate for exercise in all of our patients, whether it's menopause symptomology relief-related or rehabilitation from an orthopedic or neurological injury.

What do you think will be some of the advances that we'll see in physical therapy in the future?

Physical therapy has branched out into so many different areas. For example, we have a strong presence in education, research, wound care, cardiac rehabilitation as well as the use of virtual reality and wearable devices in rehabilitation settings. It is exciting times for the physical therapist, and I am hopeful that with my work as well as my colleagues’ work in this area, we can increase awareness of the importance of menopause and menopause-related symptomology to rehabilitation and the physical and mental well-being of our patients.