Fitness During Menopause: Your Comprehensive Guide on how to stay strong and healthy in midlife and beyond
A common concern of women is how to continue exercising during menopause so they can stay strong and healthy in midlife and beyond.
Menopause is a natural phase of a woman's life, marking the end of her reproductive years, and typically occurs between the ages of 45 and 55. As we all know, exercise is an important step in maintaining wellness at every stage of a woman's life, but it is especially advantageous after menopause.
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The physical and emotional symptoms that can occur during menopause can include:
weight gain
mood swings
decrease in muscle mass
and decreased bone density
The good news? Menopause symptoms can be eased by having a solid exercise program.
As a woman in midlife myself, I know how important it is to make fitness a priority. For those who are currently not exercising, I want you to know it’s never too late to start taking care of your body.
In this comprehensive guide, we will explore the importance of fitness during menopause, offer menopause work-out tips, and provide insights how staying active during menopause is not only necessary but vitally important.
Everyone is always looking for a “magic pill” to either lose weight or get healthy. Although it is never just one thing, I really do think of exercise as that “magic pill” as it can improve almost all health issues and plays a huge role in easing symptoms and restoring some balance to a woman's changing body during menopause and beyond. Women going through menopause often feel like they lost control of their bodies and the things that once worked for them, are no longer working.
Exercise can help you take back control of your body and your mindset.
Understanding Menopause
Before diving into fitness strategies, let's briefly discuss what menopause entails and the symptoms you can expect during menopause.
Hormonal changes during menopause: Menopause typically occurs in a woman's mid-40s to mid-50s and is characterized by the cessation of menstruation. Menopause is characterized by a decrease in the production of estrogen and progesterone, two key hormones responsible for regulating the menstrual cycle and maintaining various aspects of female health. This hormonal shift triggers a range of physical and emotional changes.
Common symptoms of menopause: Menopause symptoms can vary greatly among women but often include hot flashes, night sweats, mood swings, sleep disturbances, and vaginal dryness. Additionally, many women experience changes in body composition, such as weight gain and a redistribution of fat to the abdominal area.
Health Concerns during menopause: Beyond the symptoms, menopause can also bring about health concerns. Decreased estrogen levels can lead to a higher risk of osteoporosis and heart disease. Changes in blood sugar regulation can lead to pre-diabetes and type 2 diabetes.
The Benefits of Exercise During Menopause
Regular exercise during menopause can provide a multitude of benefits that help counteract the challenges of this phase:
Hormonal Changes: Menopause brings significant hormonal fluctuations, particularly a decrease in estrogen levels. This hormonal shift can lead to weight gain, loss of muscle mass, and changes in fat distribution. Regular exercise can help mitigate these effects.
Weight Management: The hormonal changes during menopause can contribute to weight gain, particularly around the belly. Exercise can help the body’s natural tendency to gain weight by increasing muscle mass which will help boost metabolism and burn calories.
Mental Health: Hormonal fluctuations can impact mood and mental well-being during menopause. Exercise triggers the release of endorphins, which are natural mood lifters, helping to reduce stress and combat mood swings, anxiety, and depression.
Bone Health: Estrogen plays a crucial role in maintaining bone density, and its decline during menopause can lead to a higher risk of osteoporosis. Weight-bearing exercises and strength training can help strengthen bones, prevent aches and pains or future injuries.
Cardiovascular Health: Heart disease risk increases with age and during menopause. Regular aerobic exercise can improve heart health by lowering blood pressure, reducing cholesterol levels, prevention of type 2 diabetes, and enhancing overall cardiovascular fitness.
Improved Sleep: Many menopausal women experience disrupted sleep patterns. Engaging in regular physical activity can promote better sleep quality and help alleviate insomnia.
Less aches and pains: Moving your body is shown to decrease pain for people with osteoarthritis and lower back pain, both of which are common complaints with many of my menopausal and older clients.
Exercise Recommendations During Menopause
Below are the types of exercise to prioritize during menopause.
1. Strength Training: Women who are menopausal do not just lose muscle mass, but also have a significant decrease in overall strength and power because of the drop in estrogen that occurs. This is why strength training is the one of the most important aspects of fitness during menopause and I will spend the most time discussing it. As we age, we lose bone and muscle mass. Strength training can help slow and reverse that process. We lose 3-8% of muscle mass every decade after the age of 30! This decline is even higher after age 60. And, inactivity can accelerate the severity of muscle loss.
Building strength and loading your bones through resistance exercises increases your body’s ability to create stronger bones to prevent the onset of osteoporosis. This happens because of the multi-directional stress that is placed on the joints and the muscles and this loading process triggers cell activity in the bones to create more bone mineral density, hold on to the bone mineral that we have, and improve all of our skeletal system. Sarcopenia is the progressive loss of age related lean muscle mass which is a natural part of aging and strength training is essential in preventing it. This study looks at the “Relationship between postmenopausal osteoporosis and the components of clinical sarcopenia”.
Another benefit is that muscle burns more calories than fat. So as we lose muscle, our body doesn’t burn as many calories which contributes to the increase in fat weight during menopause. Because of these changes in body composition during menopause (less lean muscle and increase in body fat, especially around the middle), adding more muscle is a good thing!
Strength training exercises can help build muscle, preserve bone density, improve function, change body composition, improve mood, improve balance, make you strong and so much more. The focus should be on getting stronger, not the number on the scale. Because strength training has such a significant impact on your health and fitness, I recommend planning your week around your strength training sessions first, and then fitting in other movement and exercise around it.
So, what strength training exercises should you be doing during menopause?
There is a lot of confusing information out there about what we should be lifting during midlife. Should we be lifting super heavy? Should we do a high or low amount of repetitions (reps)? Should we superset? How many days a week should we lift? Let me break it down for you the best I can.
There are basically 2 lines of thought on strength training. Some experts encourage strength-focused training, which is heavy weight and low reps (less than 6 reps). And, other experts encourage hypertrophy training which generally involves higher reps and lower weight.
It seems that more experts are recommending that lifting very heavy for menopausal women is the way to go, however, the most current research on menopause and strength training shows that using lighter weights for more reps can still produce similar gains in hypertrophy and strength as lifting heavier weights as long as you lift > 30% of your 1 Rep Max (1RM) and that you work close to failure.
Overall, the research is in agreement that menopausal women should perform strength training at least 2 times per week that engage all of the major muscle groups of the body. And, that you should not lift the same muscle group on consecutive days as your muscles need rest in order to recover.
Let's take a closer look at the specific strength training recommendations for menopause
Heavy weight/low reps: A popular term being used on social media right now, especially for menopausal women, is Lift Heavy Shit. Experts are recommending that menopausal women should be lifting very heavy weight using compound exercises for less than 6 reps. Dr. Stacy Sims is a leading researcher, author, global expert in female physiology and training specializing in menopausal women and she recommends lifting very heavy which she describes as: “3-5 exercises, 3-5 repetitions, 3-5 sets, with 3-5 minutes of recovery between and with no super setting between”.
Although women often shy away from lifting heavy for fear of getting too bulky, lifting heavy can make you stronger and leaner without adding size. Since it is difficult enough during menopause to build muscle, we shouldn’t worry about getting bulky. This is an excellent program for athletes and women without any injuries.
However, if you are new to lifting or have any injuries, I would not recommend starting off with lifting heavy. You should start off lighter and build up slowly over time. It’s important to make sure that you're lifting weights with proper form, good movement and no pain. It is difficult to get stronger and develop muscle definition when you have pain. I want you to build your muscles up without tearing the rest of your body down.
Higher reps/lighter weights (but still heavy enough): Research also shows that with lower load resistance training, a high level of effort AND if you work close to muscle failure, you can increase muscle size and strength. The load needs to be at least 50% of your 1 rep max (1RM), and needs to be performed 2-3 times per week with 3-4 sets per exercise. I personally consider this still lifting heavy, but with higher reps.
For example, a rep range of 8-12 reps with a high level of effort and working close to muscle failure which means feeling fatigued and like you can not complete more than 1-3 reps at the end of the set in good form. This same study showed that super high reps and not working to failure will not give you those same benefits, which is why I don’t recommend doing resistance exercises with super high repetitions (>30 reps) which help with endurance, but not strength as studies show that high reps is not sufficient for muscle growth.
Supersets: Superset training combines multiple exercises back to back with little to no rest between them, but then a longer rest between the sets. It allows you to target more muscles in a shorter amount of time which keeps your total work-out time shorter which is beneficial for menopausal women and keeps cortisol lower. I personally love supersets since I like to keep my work-outs on the shorter side with my busy life.
The number of repetitions in a superset of exercises can vary widely based on your fitness goals.. However, a common approach is to perform 8 to 12 repetitions of each exercise within a superset. This range helps to promote muscular endurance and hypertrophy (muscle growth).
My final thoughts on weight and reps for strength training during menopause:
Many of my clients ask me how much weight they should lift and what is heavy enough. Keep in mind that the term “heavy” is relative to each individual person’s body. So, my general rule is that you should be lifting a weight that is heavy enough that you feel fatigued and struggling on the last couple of repetitions of each set of exercises, but still executing in good form. I don’t recommend lifting to complete failure as I have seen too many injuries that way.
Regarding the number of repetitions, it's crucial to discover a routine you can stick to. For many individuals without access to a gym, lifting very heavy weights at home can be challenging. However, opting for lighter weights and higher reps (typically 8-12) with intense effort can lead to notable muscle gains. This strategy enhances exercise accessibility and promotes regular workouts, which can be especially advantageous for those with joint concerns or minimal home gym equipment.
2. Cardiovascular Exercise during menopause: Aerobic exercise is essential for maintaining overall cardiovascular health, fitness, longevity, and decreasing the risk of heart disease. According to recommendations by the U.S. Department of Health and Human Services, adults need at least 150 minutes a week of light-moderate intensity of aerobic exercise, in addition to muscle-strengthening exercises twice a week. This equates to a 30 minute walk five times a week. A basic check for the intensity of your workout is to do a Talk Test: for moderate intensity (zone 2) workouts, you should be able to talk comfortably, but you should be working hard enough that you aren't able to sing as you work out. One of the best moderate-intensity activities for women is walking.
The key is to find something you enjoy so you can stay consistent. Walking, jogging, biking, rowing, swimming, water aerobics are all good options. If you're a beginner, start with 10-15 minutes a day and gradually increase the intensity and duration over time. Something is always better than nothing.
3. High-Intensity Interval Training (HIIT) during menopause: HIIT is generally used as an umbrella term for high-intensity interval training. Specifically, HIIT is short sharp bursts of activity followed by longer slower activity or rest. HIIT training often incorporates jump training or plyometrics. This type of high-impact training helps your bones get stronger and maintains bone density. Plyometrics helps improve muscle power. Research shows that HIIT is very effective in changing body composition, improving blood glucose control, increasing insulin sensitivity, as well as cardiovascular function.
HIIT also includes sprint interval training (SIT). SIT is different from HIIT as in that SIT is working as hard and as fast as you can at maximum intensity for short intervals (30 seconds or less) and longer rest between sets. Whereas HIIT is a submaximal effort (about 80% of your max heart rate) for 1-4 minutes with a variable rest period. For both, HITT and SIT, your total work time is less than 20 minutes.
But, what if you can’t jump or your body can’t perform HIIT?
Many women who are peri- and postmenopausal have aches and pains and issues with their joints. If you are dealing with an injury, have chronic joint pain, or are new to exercise, this is not the time to add in HITT workouts. As a physical therapist and someone who has multiple joint issues myself, I know that my body doesn’t always allow me to perform HIIT-type exercises. You need to listen to your body but also know that implementing some plyometric work is really going to benefit your body. For my clients, I emphasize that strength needs to come first before you add high-impact exercises. And, there are ways you can still perform high-intensity workouts without them being high-impact, which can stress the muscles and joints. It’s about finding the right modifications that work for your body and do lower reps and sets.
Here are some examples of HIIT work-outs, which includes plyometrics and SIT training. Make sure you warm-up for 5-10 minutes with light cardio and mobility exercises. And, cool down after with mobility and stretching exercises
Jumping rope or jumping jacks: 3 sets of 1 minute with 30 seconds rest in between
Stair sprints or step-ups: 3 sets of 30-60 seconds with 30 seconds rest in between
Squat Jumps: Stand up straight with your feet hip-distance apart. Keeping your arms bent, lower your body into a squat, ideally so that your hips are parallel with or below your knees. Propel your body up and off the floor, bringing your arms above your head toward the ceiling. Land softly on the balls of your feet, with your arms bent, but use that momentum to power your next jump. Start with 5-10 reps with 30 seconds rest between sets and work up to 20 reps. 3 sets.
Lunges: Alternating legs, jumping to switch legs. 30-45 seconds on: 30 seconds of rest.
Upper body plyometrics: Medicine ball throws, wall slams, floor slams, squat to throw. Even though you are working the upper body, it will still have a positive effect on your bones and metabolism.
Sprint intervals (SIT): For 15-30 seconds go as hard as you can on a bike, assault bike, a rowing erg, elliptical or running, and then a super slow recovery for 1-2 minutes. You would repeat this 4 times and could work up to 10 times.
To review, a minimum of twice a week of full body strength training is still the most important.. But, if you are able, you should incorporate 1-2 sessions of HIIT per week into your routine. Learn more about HIIT during menopause here.
4. Active Recovery and Mobility during menopause: On days when you are not strength training, instead of doing absolutely nothing, I recommend active recovery days and mobility exercises. Here are some examples:
Gentle yoga, pilates or stretching exercises (30-60 minutes). These are all low impact and easy on our joints, as well as helpful for reducing stress.
Walking or gentle cycling (30-60 minutes) of low intensity cardio to help with active recovery.
Foam Rolling to help with muscle recovery and mobility.
Go for a hike with friends or family. Just enjoy the day and play.
Part of recovery is making sure you get enough sleep. Make it a priority.
Here is a fun mobility challenge to try called the Sit-and-Rise Test. The goal of this challenge is to assess if you have good range of motion in your hips, good strength in your legs and core,and your balance and coordination.
5. Balance and Stability training during menopause: As we age, falls are more common, and this can begin occurring during menopause. Studies indicate women begin experiencing falls as early as their 40’s.
Balance exercises improve stability and can help prevent falls by improving your coordination and body awareness. Try simple exercises, such as standing on one leg while brushing your teeth for 30 seconds and work up to 60 seconds and then try with your eyes closed. You can also try standing up from a seated position without using your hands or try it just standing on 1 leg. Yoga, Tai Chi and Pilates are all good choices for improving your balance and stability.
For those of you who want to try a fun, but challenging balance test, give this a try. It’s called the Old (wo)Man Challenge. If you are on Instagram and want to film yourself and post, please feel free to tag me (@coretotalwellness).
6. Pelvic floor exercises: It would be wrong of me not to mention pelvic floor exercises when I’m discussing fitness during menopause because women are more susceptible to pelvic floor dysfunction during menopause. The reason for this is as estrogen levels decline, your pelvic floor muscles can weaken, which can result in bladder leakage, incontinence, vaginal pain, and pelvic organ prolapse. If you are experiencing any of these symptoms, you should seek out a women’s health physical therapist who can help. In some circumstances, Hormone Therapy can make a big difference as well, but please discuss this with a medical doctor.
Menopause Fitness Tips:
Stay Consistent: Consistency is essential for long-term success. Establish a routine that fits your lifestyle, that you enjoy, and then stick to it.
Start slow and build up slowly: It’s important to ease into your workout routine to avoid injuries. Begin with lighter weights and low-impact exercises and then gradually build up as your body gets stronger and accustomed to the movements.
Listen to Your Body: Pay attention to how your body feels and responds to exercise. Preventing injuries should be a top priority during your workout. If you experience pain, discomfort, or unusual symptoms, it's crucial to modify your routine or seek guidance from a physical therapist or other healthcare professional.
Mobility: Prior to lifting weights, it’s important to warm up with specific mobilization and range of motion exercises to properly prepare the body for lifting. Mobility exercises allow you to learn how to move properly and prepare the tendons and ligaments for heavier loads. Here is a quick dynamic mobility warm-up for a lower body work-out for you to try:
Hydration: Given the increased likelihood of hot flashes, sweating and weight gain, staying well-hydrated is essential. Drink plenty of water before, during, and after your workouts. In general, you should be drinking at least half your body weight in ounces daily. For better hydration, try adding electrolytes. I love the brand LNMT.
Nutrition: A balanced diet is crucial for overall health. But, this is the time to prioritize protein. If you are not getting enough protein, you can not build muscle! Read that again. As we age, we lose muscle and gain fat. Think of a marbled steak and that is what is happening to our muscles as we age. It is called sarcopenia and even if you are not gaining weight, our muscles are changing and they need protein, particularly the amino acid leucine for regulating muscle growth. Rich sources of leucine include eggs, fish, meat, whey protein and soy protein. If you are new to tracking protein or not sure you are getting enough, I usually recommend that you try and consume 100 grams a day to start. Make sure you are also getting the right nutrients to support your exercise regimen, including calcium, Omega 3’s and vitamin D for muscle growth and bone health. Here is a systematic review and some supportive research on these nutrients in postmenopausal women.
Mind-Body Connection: Practices like meditation and mindfulness can complement your fitness routine by reducing stress and enhancing mental well-being. Breathing techniques can help you move from a high cortisol state (fight or flight) into your parasympathetic nervous system (rest and digest state) which reduces stress and can help manage menopausal symptoms. One simple breathing technique to try is called Box Breathing. It is a four-step breathing technique in which you breathe in through your nose slowly for a count of 4 seconds, hold your breath for a count of 4 seconds, and slowly exhale through your mouth for 4 seconds. Repeat several times until you feel re-centered and calm. Pilates and Yoga are both great options for mind-body connection exercises.
Staying Active During Menopause: Final Thoughts
I realize that I've presented a significant amount of important information to you. But, if you want to keep it super simple, I would recommend just focusing on moving your body at least 30 minutes a day (walking) and doing at least 2 days of full-body strength training exercises a week. If you can throw in some HIIT-type exercises 1-2 times a week that would be ideal. Menopause is indeed a transformative phase in a woman's life, but it doesn't have to be synonymous with a decline in health or fitness.
By prioritizing regular exercise, you can mitigate many of the symptoms and health risks associated with menopause. Remember that it's never too late to start or adapt your fitness journey to this new stage of life. I truly believe that the goal is to stay strong, fit and mobile as we age. If you are looking for some extra support during this phase of life, I would love to support you on your journey. And, if you have any questions, please reach out to me. I can help you with specific guidance during menopause, including strength and nutrition information.