Supporting Women Through Midlife

This month we are going to talk about how to support your female clients going through the transition in to menopause.

Contrary to what you may believe, the transition, from start to finish can take around 13 years, and many women will notice changes in their late 30’s and early 40’s. 52Yrs is the average age for menopause, but that is just the end point – menopause is defined as having gone 12mths or more without a period. This doesn’t just suddenly happen one day!

So if you are training women in their late 30’s and early 40’s, here’s what you can do (within scope) to help support their phase of life, reduce symptoms of menopause, and ensure they face this next chapter with confidence!

Exercise has a role in reducing menopause symptoms, and it is also one of the triggers for hot flushes, which affect 75% of women and can persist for 4-5 years¹; and are one of the most disconcerting and uncomfortable symptoms of the late phase of this transitional period. Hot flushes are a part of a larger group of symptoms called Vasomotor Symptoms which include night sweats, heart palpitations, and changes in blood pressure².

In one study, 12 weeks of moderate intensity aerobic exercise did not alleviate these symptoms, but did improve sleep quality, insomnia, and depression in midlife sedentary women³. However, strength training is a different story. In a systematic review completed this year, strength training did not just improve muscle strength, it also improved pelvic floor strength, physical activity in daily life, bone density, improved hormone and metabolic function, as well as stabilised heart rate, blood pressure, and reduced hot flashes⁴.

A variety of strength training options will improve her symptoms, she doesn’t have to lift heavy if she doesn’t want to! For example:

• One study had their participants performing home exercises with resistance bands, where they trained for an hour, twice a week, for 12mths, who gained results, but only if they were supervised⁵!
• One took them for a hike and used resistance band exercises with relaxation at the end⁶. This study was designed to see if they could load the bones in a similar way to HIIT training in a safe way for people who already have osteoporosis. They did 8mths of twice weekly, 30min sessions, 5 sets of 5 reps at 85% 1RM and another group did home based, low intensity strength exercise. Whilst the 5×5 program was more effective than the home based one, both program had high compliance, and both groups improved their bone and muscle mass, and overall health.
• Another use isometric exercise and mobility training⁷.
• One used high volume strength exercise (6 sets), and compared it to a low-volume strength exercise group (3 sets) . Both groups performed 8 exercises at 70% 1RM, 3x week, for 16 weeks. Both groups displayed a similar strength increase and fat decrease, however, the high volume group lost more size around their waist and also decreased total cholesterol⁸.

So, if you’re only seeing your midlife female clients once or twice a week, then resistance training is your priority to support them through this phase of life. However you can blend this with cardio, and use a variety of different tools, set, reps, and activities to load the bones and muscles, and still get positive health outcomes without sticking to a rigid 3×10 routine with iron only!

REDUCE their stress, don’t add to it!!

Now, before I start I want to acknowledge that exercise is very good for improving mood, sleep, resilience to lifestyle stress, and as a treatment for anxiety and depression⁹; but what you may not realise is that it’s not a cure-all for all mental health problems, and that there are specific considerations for women in mid-life.

Here are a couple of examples:

Number 1 – exercise only reduces stress if it’s something she likes¹⁰ – so not any exercise for any woman will do. You’re better off having a laugh and a silly session than you are with your 3×10 format if she hates 3×10 or is only doing it because she thinks she should.

Number 2 – even though there’s good research for HIIT training and mood/brain health, some women experience panic-attack-like symptoms¹¹, which reverse this effect. It’s better to move routinely than stop and start because your client is discouraged by the intensity.

Why does this matter?

Women generally experience more stress in their lives, particularly in this mid life period (by mean I which their 40’s, when most of them still have children at home)¹². Cortisol, our main stress hormone, is supposed to rise in the morning to get us up, and drop in the evening to allow for melatonin to rise and help us fall asleep. In women under chronic stress (aka motherhood), their cortisol will often remain high in the evening, which affects their sleep, contributes to systemic inflammation in the body, downward mental health, and heaps more; which further affects cortisol production, and so on – it’s a vicious cycle¹³!!

Now, without getting too technical and bogged down in the hormones, let me just say that cortisol is a major disruptive player in a woman’s cycle, and her cycle is indicative of her overall health. Prolonged periods of stress will also affect brain function, fertility, memory, learning, her immune system, her heart health, her gut, and her bowel health¹⁴. We need to be especially careful of hormonal balance for women in mid-life, as they are more vulnerable to hormone dysfunctions and imbalances¹⁵. It is no accident that the majority of women develop their autoimmune disease between 40 and 60 years old, nor that twice as many people with autoimmune disease are women¹⁶.

Exercise will increase cortisol, but we have a few tricks to look after the hormones of a woman during mid-life. If you’re going to go hard (80% RPE and above), keep the session under 20min¹⁷ and use the extra time for relaxation-inducing activities or play. There is still an increase during moderate intensity exercise, but it is not as significant as high.

Strength training protocols that are low volume (3 sets or less), heavy weights (6 reps or less), with long rest intervals will not produce the stress response as acutely, and have the added bonus of getting a much greater bone and muscle mass response¹⁸.

Other ways you can reduce her stress during a session include:

• Get outside – simply seeing blue or green in nature (think the ocean, a river, or a mountainside) can reduce cortisol and calm her brain.
• Include meditation or mindfulness – there’s some early evidence that shows when you learn these skills the effects never wear off, even if you meditate less in the future¹⁹. Any mindfulness and/or meditation training is good, whether you spend 3 minutes or 30, but consistent practise is needed to create changes to the brain.
• Include deep breathing exercises in your session (diaphragmatic breathing) – this will have an immediate, cortisol reducing effect. Spending the last few minutes of your session performing breath work will lower her cortisol before sending her back in to everyday life²⁰.

Finally, I’ll say it again… make it FUN²¹. If she loves a circuit class, so be it. If she wants to walk along the beach with you, fine! From there she’ll be more receptive to any tweaks you’d like to make in her program.

Guide towards increasing whole proteins & fibrous foods; legumes got both!

As personal trainers we can’t prescribe eating plans or recommend supplements. This means that you have no opinion on hormone replacement therapy, or what “diet” is best for your mid-life clients (or you may have an opinion, but you don’t share or recommend without appropriate qualifications!).

However, we are well within scope when we guide towards whole foods.

For mid life women, weight gain around their middle becomes more of a concern (to some), and excessive weight will contribute to their risk of developing disease (particularly heart disease). Furthermore, this phase of life is often coupled with caring for families AND their parents at the same time, which can trigger disordered eating habits²².

We’ve already talked about stress, now lets talk about how a high(er) protein, alongside high(er) fibrous food intake can ease their transition and moderate their weight gain. Women between the ages of 40-65 years who consume a wide variety of actual foods (ie. Not out of packets or take away), including adequate vegetables, fruit, grains, oils and fats, had more grey matter and larger brain volume than those that didn’t, possibly protecting them against dementia (brain shrinkage precedes development of dementia)²³.

Current recommended daily intake in Australia is²⁴:

However, I’d like to go one step further and emphasise the importance of fibrous foods, particularly cruciferous vegetables and legumes (up to 9 serves a day instead of the RDI of 5), and here’s why…

1. Current evidence shows that low-fat, plant-based diets are associated with beneficial effects on body composition²⁵.
2. While caffeine, smoking, spicy foods, alcohol, tight clothing, stress/anxiety, and heat all contribute to an escalation of typical menopausal symptoms (such as hot flushes); soybeans, chickpeas, lentils, flaxseeds, whole grains, beans, fruits, and vegetables are associated with a reduction of frequency, intensity, and duration of symptoms²⁶. The cool thing about many of these foods is they contain plant oestrogens (called isoflavones), that help ease the hormone roller-coaster – in both directions. Isoflaveones both prop up oestrogen in the body when there is a deficit, and help excrete it through your faeces when you’ve got plenty due to the fibre.
3. The Mediterranean diet, along with other healthy habits, may be involved in prevention of bone, metabolic, and cardiovascular diseases in the postmenopausal period²⁷.

Encourage a Positive Mindset

Women have ENOUGH of the doom and gloom…

We’re told our period is a curse.

We’re told that the pain that comes with menstruation is “normal” – even if it’s severe and impacting our lives.

When we’re pregnant we’re “huge” and when we’re post natal our health needs ignored while beauty ideals are pushed on us – we’re told to “get our pre baby bodies back” but no mention or information about birth injury and incontinence (for example).

If we have daughters people shake their heads and wonder what we did wrong (this actually happened to me).

Let’s not add to that!

At the moment many peri menopausal women are living in a state of constant, low level anxiety about what the changes in their bodies. Their sold horror stories of hot flushes and haemorrhoids, they’re told their going to get fat and develop disease, all while being increasingly ignored by their communities.

Let’s look at who we are talking to in our own businesses, our own marketing as an example. In my instagram feed, I rarely see a woman between the ages of 40 and 80. The ones under 40 are celebrated for their weight loss, their “before and afters”, and the ones over 80 because they’re doing something we don’t see very often. Between the ages of 40 and 80 we’re redundant unless we’re being sold a pill that’ll magically make us look younger or to manage our menopause symptoms.

Here’s the thing – just a little bit of education – like the bits we’ve already discussed this month – gives POWER back to the woman. She gets to choose whether or not she’s going to eat chickpeas or continue with her glass of wine (for example), and she understands the consequences of each choice. The fact is, this time of life is entirely manageable for many women, in fact, it’s a liberating time of life where she’s no longer being held to unrealistic beauty ideals (unless she is, but that’s another story).

Our job is to build her up. It’s to show happiness and beauty and health isn’t always 20 years old, blonde, and skinny. It’s to give her power over her body through education, exploration, and respect. The peri menopausal period is a time of change – not necessarily bad change – and our role in supporting women through this period is to bring out the positives, to help build on her feelings of worth, to boost her self esteem, and to be the one person in her life that shows her how amazing she is!

Capel-Alcaraz AM, García-López H, Castro-Sánchez AM, Fernández-Sánchez M, Lara-Palomo IC. The Efficacy of Strength Exercises for Reducing the Symptoms of Menopause: A Systematic Review. J Clin Med. 2023 Jan 9;12(2):548. doi: 10.3390/jcm12020548. PMID: 36675477; PMCID: PMC9864448. 

2Medical News Today (2020) What are the Symptoms of Menopause medicalnewstoday.com, retrieved 4^th August 2023 from https://www.medicalnewstoday.com/articles/317801

3Sternfeld B, Guthrie KA, Ensrud KE, LaCroix AZ, Larson JC, Dunn AL, Anderson GL, Seguin RA, Carpenter JS, Newton KM, Reed SD, Freeman EW, Cohen LS, Joffe H, Roberts M, Caan BJ. Efficacy of exercise for menopausal symptoms: a randomized controlled trial. Menopause. 2014 Apr;21(4):330-8. doi: 10.1097/GME.0b013e31829e4089. PMID: 23899828; PMCID: PMC3858421.

4Capel-Alcaraz AM, García-López H, Castro-Sánchez AM, Fernández-Sánchez M, Lara-Palomo IC. The Efficacy of Strength Exercises for Reducing the Symptoms of Menopause: A Systematic Review. J Clin Med. 2023 Jan 9;12(2):548. doi: 10.3390/jcm12020548. PMID: 36675477; PMCID: PMC9864448.

5 Watson SL, Weeks BK, Weis LJ, Harding AT, Horan SA, Beck BR. High-Intensity Resistance and Impact Training Improves Bone Mineral Density and Physical Function in Postmenopausal Women With Osteopenia and Osteoporosis: The LIFTMOR Randomized Controlled Trial. J Bone Miner Res. 2018 Feb;33(2):211-220. doi: 10.1002/jbmr.3284. Epub 2017 Oct 4. Erratum in: J Bone Miner Res. 2019 Mar;34(3):572. PMID: 28975661.

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7Martinho NM, Silva VR, Marques J, Carvalho LC, Iunes DH, Botelho S. The effects of training by virtual reality or gym ball on pelvic floor muscle strength in postmenopausal women: a randomized controlled trial. Braz J Phys Ther. 2016 Mar 22;20(3):248-57. doi: 10.1590/bjpt-rbf.2014.0148. PMID: 27437716; PMCID: PMC4946841.

8Nunes PR, Barcelos LC, Oliveira AA, Furlanetto Júnior R, Martins FM, Orsatti CL, Resende EA, Orsatti FL. Effect of resistance training on muscular strength and indicators of abdominal adiposity, metabolic risk, and inflammation in postmenopausal women: controlled and randomized clinical trial of efficacy of training volume. Age (Dordr). 2016 Apr;38(2):40. doi: 10.1007/s11357-016-9901-6. Epub 2016 Mar 17. PMID: 26984105; PMCID: PMC5005909.

9Sosnoski, Karen (2022) Stressed? Here’s How Exercise Could Help phychcentral.com, retrieved 15^th August 2023 from https://psychcentral.com/stress/exercise-helps-keep-stress-at-bay#exercise-and-the-brain

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