Special Considerations when Training Older Women

This blog was instigated by a question in February which was from a woman who works with older women (60+). She’s interested in general recommendations and how to assess them so that her clients see the benefits of exercise. I couldn’t answer this one in one go… I needed to think about it because the topic is so big! However, I have narrowed it down to 8 recommendations, or things to look out for, which I think will bring the best benefits to your older female clients.

These recommendations are probably of higher consequence for post menopausal women, but it should be said that there’s plenty to do about them when a woman is in mid-life, and is even something we could be thinking about when she’s young – after all, she will be an older woman one day!!

Tendon and Ligament Health

Right now, I want you to run a quick audit of women over 40 in your client base… How many of them have shoulder problems??? or plantar fasciitis?? It’s a lot of them, isn’t it? And if you look at that cohort of women all together, it doesn’t matter what her posture is like, how long she’s been training, or how strong and stable she is, does it? Rotator cuff disease primarily affects women, and particularly post menopausal women, and it’s suspected that sex hormones (or lack thereof) are the reason why¹.

Now, most of your 40 year old women aren’t post menopausal yet, however, they are in a state of peri-menopause. This state is kind of like a hormonal roller coaster, with the ovaries shutting down, and other hormones flying high to compensate, with the occasional bursts of energy from the ovaries. When Oestrogen plays such a massive role in ligament and tendon suppleness², women will be more susceptible to tearing and spraining them during her periods of low oestrogen (which you won’t know when!). Conversely, they’ll also be at a higher risk of tendon and ligament injury then their Oestrogen is high, because she becomes wobbly. So when her levels are up and down in the peri menopausal period, we have to be careful with sudden changes of direction, end of range movement, and contact sports, because on any given day she might be wobblier than normal or stiffer than normal!

Menopause marks the 12 months without a period, and women’s Oestrogen levels stabilise, but at a much lower level than most of her life beforehand. This means that her ability to make muscle and bone is dramatically reduces, and the stiffness of her ligaments and tendons increases.

So, my first thing to look out for in older women is changes in her range of motion; or if she’s already post menopausal, treat her joints, particularly her shoulders, with care. Assessments for her shoulder health include:

• Standing posture assessments
• Shoulder stability (eg. With a ball against the wall, or a hula hoop)
• Shoulder mobility (eg. Wall angels, pilates arm circles on the roller)

On any given day, if these become part of your warm up, you may even be able to “see” when she’s stiffer or more lax, indicating where she’s at in her Oestrogen roller coaster!

Balance and Falls Prevention

This may be obvious for some of you, and is perhaps even a cliché, but falls prevention and staying strong and balanced is a primary concern for older women. There’s a few reasons why women are more at risk of falls, and fall related injury than men³:

1. They live longer, and as age advances so does risk.
2. Women are twice as likely to develop osteoporosis (low bone mineral density), making falls more consequential.
3. Women are more likely to develop sarcopenia (low muscle mass), making them less balanced, and less able to rise again once they do fall.
4. Women are more likely to live with chronic pain, frailty, depression, and other “co morbidity’s” which makes a fall more likely.

Now, a few stats for you that will complete this picture:

• The number one cause of frailty in the elderly is inactivity⁴
• Frailty increases the risk of fall, as well as injury from the fall (including death)⁵.
• The number one barrier to exercise for women in Australia is pelvic floor dysfunction⁶, and pelvic floor dysfunction is trainable, improvable, and even reversible in 80% of women⁷: https://youtu.be/U0FiJvfZclE
• Falls are the leading cause of injury hospitalisation (43%) and death (42%) in Australia, women making up 56% of hospitalisations and 53% of deaths⁸.
• Over half of all falls involve a fracture, with 24,000 more women than men breaking a bone⁹

So if pelvic floor dysfunction is preventing women from exercising, then we need to remove that obstacle first if we’re ever going to train her long term. Once she’s seeing a pelvic physio, then we need to prioritise:

• Functional balance: the kinds of balance that involve standing and moving about a place, slipping, and tripping.
  – test it and measure improvements with reactive tool such as the Blaze Pods (https://www.blazepod.com/), with timed single leg balance exercises, with length of rope she was able to walk along, or what level of difficulty (eg. Shut eye single leg).
  – train it by mimicking real life scenarios in a controlled and safe environment. Can she catch a ball while balancing on one leg? Can she still perform her lunge with you giving her a gentle shove on the shoulder at random intervals? Can she do steps up on a variety of levels and surfaces? Can she do all of the above holding uneven weights or standing barefoot on an uneven surface?
• Floor to standing patterns: because once she does fall, we want her strong enough to get herself back up again.
  – test it with kneel to standing patterns, the sit-down-stand-up test off the floor (https://www.prevention.com/fitness/fitness-tips/a20440531/the-stand-sit-test-that-predicts-longevity/ , https://youtu.be/cSzKx-pmues?si=ZeRS6JXwA99hMDT_ ), and burpees, because why not!!
• Heavy weights: for osteoporosis and sarcopenia prevention, these also go a long way for balance improvements and fall prevention. It’s the best tool we have for anti-aging, on all levels, including skin tone improvements and disease prevention¹⁰!
  – test it with your usual single RM assesments!

Just a side note, frailty doesn’t suddenly occur when you hit 80 years old. It begins from in our 20’s when we reach our peak bone mass. It is never too late to start working on your bone, muscle, and balance for women; it is also never too early! If you’re female and in your 40’s though, consider it as important as having dinner on the table every night, and make it as routine too.

Grip Strength & Longevity

Last week we touched on the sit-to-stand test and how it’s a measure of longevity. Another measure of longevity is grip strength.

However grip strength is also used as a bio marker for overall strength, upper limb function, bone mineral density, fractures, falls, malnutrition, cognitive impairment, depression, sleep problems, diabetes, multimorbidity, and quality of life. Grip strength can be used as a predictor in all-cause and disease-specific mortality, future function, bone mineral density, fractures, cognition and depression, and problems associated with hospitalization¹¹.

Yet women are often getting their husband’s to open jars as early as their 30’s, and gripping nothing larger than the weekly groceries fort he rest of their lives (which, to be honest, can be bloody heavy until the kids leave home!). So, perhaps more important than lifting heavy for women, is gripping heavy.

Any exercise that means she has to hold something heavy is ideal:

• Farmers carry’s
• Hanging exercises such as chin ups and knee raises
• Holding dumbells, containers, sandbags, kettlebells, Vipr’s, TRX, shopping bags, etc to do her weights

VARIETY is always good, have her hold things as often as possible, including everyday items, and resist repeating dumbells year in and year out! Women generally have smaller muscle mass overall, and the muscles in their forearms are some of the smallest in the body – making grip strength training even more important for women than men. Compound this fact with the other issue affecting more women than men, such as osteoporosis, fractures, hospitalisations as a result of falls, and dementia, and you have a solid argument for training grip strength as soon as possible, as hard as possible, for as long as possible, in your older female clients.

You can assess grip strength in 3 ways:

1. Time under tension: where they hold a specific weight for as long as possible (eg. Hanging from a bar – timed, or holding a 25kg dumbbell – timed)
2. Repetitions – Holding a weight for a number of reps
3. Absolute weight – What weight they’re holding for the same time, or number of reps

You can also purchase a specific grip strength measurement tool, and compare their results using the norms here: https://www.topendsports.com/testing/norms/handgrip.htm

On a side note, when we’re talking longevity, we’re not talking about living forever. We are talking about sharpening the curve to death; rather than getting sicker and sicker as we age, remaining healthy and active until we die, even if we die at the same age in both scenario’s.

Control the Controllable: Heart Disease and Heart Attack in Women

1 in 4 women will die of heart disease, and is second only to Dementia as the leading cause of death for women in Australia¹² More women, than men die of heart disease each year¹³. Nearly 3x as many women die of HD than breast cancer¹⁴. In Australia, 90% of women have one risk factor for HD, and 50% have two or more; the most common risks affecting women are high cholesterol, being overweight, and physical inactivity¹⁵ – THIS we can do something about!

“Heart disease” refers to several types of problems that affect the heart. The most common type of heart disease is coronary artery disease (CAD)¹⁶. Heart disease is also called cardiovascular disease, which is disease of the blood vessels.

Symptoms of a heart attack vary between men and women, and women are more likely to have “non-typical” symptoms such as heartburn… Heart Attack symptoms in women are subtle as compared to the symptoms in men¹⁷. Uncomfortable pressure, squeezing, fullness or pain in the centre of your chest. It lasts more than a few minutes, or goes away and comes back¹⁸.

1. Pain or discomfort in one or both arms, the back, neck, jaw or stomach.

2. Shortness of breath with or without chest discomfort.

3. Abdominal discomfort, crushing abdominal pain, nausea, or vomiting – often confused with a virus or the flu.

4. Other signs such as breaking out in a cold sweat, dizziness, or lightheadedness.

5. Unusual fatigue

6. As with men, women’s most common heart attack symptom is chest pain or discomfort. But women are somewhat more likely than men to experience some of the other common symptoms, particularly shortness of breath, nausea/vomiting and back or jaw pain.

Emotional stress can play a big role in triggering heart attack symptoms in women. It has also been noted that women tend to have the symptoms often when resting or even while sleeping.

When training women, either at risk or living with Heart Disease, your goal is to control the controllable. Aim to Reduce the Risks you CAN control, for example^{19 20}:

• Waist to Hip ratio – measure her waist at the smallest place, and her hips at the largest, then use the calculator to work out risk: https://www.thecalculatorsite.com/health/whr-calculator.php . In women, we’re looking for a ration of 0.8 or lower²¹.
• Smoking – reducing the number she smokes a day will improve her risk of developing heart disease.
• Eating habits – Eating a diet packed full of healthy fats, whole grains (not processed – with their jackets on!), fruits, vegetables, and whole proteins²². Processed foods have the opposite effect on risk, and while personal trainers cannot prescribe eating plans within scope, you can guide towards whole food choices.
• Alcohol – limit to one per day.
• Stress: long-term psychological, emotional, or physical stress raises your risk of heart disease. If you have heart disease, long-term stress also makes you more likely to have a heart attack. Stress includes emotionally upsetting events, especially involving anger, and can be a trigger for heart attack. Stress also may indirectly raise your risk of heart disease if it makes you more likely to smoke, eat unhealthy foods, or less likely to exercise.
• Blood pressure – Personal Trainers should be taking blood pressure when a client first joins the gym, and we can take it periodically afterwards if our clients are older or have other risk factors.
• High cholesterol; and triglycerides – You’ll have to refer out tot heir doctor to get these tested.
• Diabetes – Eating a low GI diet can help keep their blood sugar under control, and lower their risk of heart disease at the same time. Low GI foods are often unprocessed, whole foods too²³!
• Metabolic syndrome: this is the name for a group of risk factors that happen together and are related to their metabolism. Having metabolic syndrome doubles your risk of heart disease and is more common in women than men. You have metabolic syndrome if you have any three of these five risk factors:
  – Waist measurement of more than 88cm
  – Triglyceride level greater than 150 mg/dL (milligrams per deciliter)
  – HDL cholesterol less than 50 mg/dL
  – Blood pressure of 130/85 mmHg (millimeters of mercury) or higher
  – Blood glucose greater than 110 mg/dL after fasting for at least eight hours

If you have metabolic syndrome, you can still take steps to control your risk factors.

• Depression increases your risk of developing cardiovascular diseases, and can be improved with appropriate exercise²⁴. Any exercise, movement, or activity that the client enjoys will do²⁵; yoga, martial arts, aerobic training, weights, dance, or classes. There is cardiac and mental health benefit no matter what the intensity or exercise modality.
• Sleep apnea – If your client is not sleeping well, for a prolonged period of time, it may be appropriate to refer them to their GP to investigate why.
• C-reative protein: C-reactive protein (CRP) is made by the body and released into the blood in response to swelling. Swelling (or inflammation) is how your body reacts to heal infections or cuts. Swelling can also happen over time in response to high stress levels or poor eating habits. Swelling for infections or cuts will raise your CRP levels for a short time, but swelling that continues for a long time may mean your arteries are damaged, which puts you at risk for heart disease. Their doctor will have to test for this.
• Physical activity & Exercise – Exercise recommendations for CHD are 30-60 minutes per day, 3-5 days per week, of both aerobic and resistance training²⁶.To reduce heart attack risk, cardio (aerobic) exercise is most often promoted as the exercise of choice for improving heart health. However, lifting weights for less than an hour a week can also reduce your risk for a heart attack or stroke by 40 to 70 percent, as well as increase your functional strength, bone density, and balance²⁷. If this is you, start lifting weights 2-3 times a week for 20-60 minutes, and build up to a heavy intensity (about 80% of what you can lift once, or 8-12 repetitions) over time.Aerobic training can include sports, walking, swimming, or anything that gets you warm and is rhythmical.

Risk factors you can’t control:

• age
• menopause (increases risk significantly)
• family history
• race and ethnicity
• pregnancy history

It’s never too late to start an exercise program or increase physical activity. In fact, combined with a healthy diet, it’s the best choice you can make for your heart health²⁸.

Dementia Prevention with diet, movement, connection, and novelty

Right now in Australia, dementia is the leading cause of death for women, and it’s not because they live longer. Changes to women’s brains actually start occurring in mid-life. Twice as many women than men are affected by dementia, and women are also affected differently to men, with more severe symptoms. ^{29 30}. So, as professionals in the health industry, we have to say that brain health is mighty important for our clients, particularly our female ones!

While we don’t have a cure, or even good treatments for dementia, there are heaps of things we can do to reduce our risk, slow the onset of the disease, and slow it’s progression – of which EXERCISE is a vital component. While menopause is a risk factor for developing dementia, not everyone who goes through menopause develops it, so it’s clear there are other factors at play.

Here are some things to get you started in reducing your client’s risk of dementia today, or contributing to her overall brain health³¹:

• Guide her towards reducing her alcohol consumption. Alcohol use disorders (ie. 2 drinks or more per day) is linked with increased early onset dementia risk, however just one drink per day has a positive effect on risk³²!
• Reduce and even quit smoking if possible.
• Reduce exposure to air pollutants. This is harder if you live in a big city have a garage with a door directly in to your home, however there are little things you can do to improve the quality of air within your house, including:
  – Plants. Although it’s hard to quantify exactly how many you need, having a variety of species and around 2 mid-size plants per 9m2 of floor space in your home is a good start (yes, that is a lot)³³.
  – Air purifiers. You can look at different kinds and how to choose here: https://appliancesradar.com/best-home-air-purification-system/
• Look after your head. Head trauma increases your risk of developing dementia, so if you play footie or are at risk of bumping your head in other ways – wear a helmet or other protection!
• Prioritise sleep, but at the same time, reduce your sedative and sleeping tablet use. Instead, create calming rituals and use herbal sleep supports.
• Guide towards Mediterranean or whole food diets, and away from processed “western” style diets. The Mediterranean Diet and MIND Diets (like the Mediterranean but with specific blood-pressure-lowering elements) lower other health factors that contribute to the risk of developing dementia such as high blood pressure, inflammation, diabetes, obesity, and heart disease³⁴. Conversely, if you follow a “western” diet, one that is high in red meat, saturated fats (like butter, or deep fried foods), saturated fats, and sugar (even if you don’t eat desserts, packaged foods such as breakfast cerals have as much sugar as desserts do!) is associated with a higher risk of developing dementia³⁵.

How women can prevent dementia: https://youtu.be/g-0yWB9M9K4

Root cause of Alzheimers and how to prevent it: https://youtu.be/C2QtgsVuxH0

It’s not too late for anyone to start exercising, even if they have dementia already³⁶. Whether you’re a man or woman, if you are physically fit, you have a 50% less risk of developing dementia compared to those who aren’t fit, and, crucially, it doesn’t matter how long you’ve been in good shape for – if you get fit now, after 40 years of inactivity, you’ll still reap the protective benefits.

The best kinds is high(ish) intensity aerobic exercise, and the fitter your body is, the better your brain will get. This means that the aerobic exercise must increase your heart rate to the point where you’re out of breath – but you don’t have to go “all the way” and max it out. An intensity of around 7 or 8 out of 10 is sufficient, and achieving that level of intensity in bursts is also beneficial.

It’s important that trainers incorporate short bursts in to our sessions for older women, however resist the urge to make the whole session excruciatingly hard – more is not better for brain health!

Some ideas to achieve this:

• Hill or stair repeats on your daily walk
• Some kind of interval training in the gym, for example the assault bike for 20sec on 10 sec off, or 2min of 1min off, or, like they did in the studies, 4min on 3min off…
• 2-10 burpees in between sets of weights
• Sports like football, OzTag, or netball, where there are bursts of high activity followed by bursts of waiting or lower intensity.

You can measure your fitness and risk by using the Norwegian Univerity of Science and Technology calculators here: https://www.ntnu.edu/cerg/vo2max .

You can also start challenging your female client’s brains and perceptions in your training. Ways of incorporating cognitive training in to your sessions, and help prevent or slow the onset of dementia include³⁷:

1. Novelty and change – such as travel, different forms of exercise, art classes, or variation in your routine (and they don’t have to be huge variations, either, try changing your daily walking route!)
2. Gratitude and positive thinking – this is trainable, and a gratitude journal is a great start, but simply asking your client what their favourite par of any session is will start the trend towards positive change.
3. Games that challenge memory, problem solving, and reasoning – such as crosswords, puzzles, and specific brain training games on your phone³⁸. In your sessions, this might look like building a fortress out of tyres, or playing a physical game like hand ball or “tips”
4. Learning a new skill – such as a language, instrument, or craft. In our sessions this may look more like learning “proper technique” for a deadlift.

Other things that will help our female client’s brains:

• Love and socialising – group training is potent for this!
• Stress reduction – or the ability to “come down” after stressful intervals, so make sure you’ve got some kind of calming cool down routine in your session plans!
• Power Plate! New research has concluding that Whole Body Vibration, delivered by Power Plate, increased cerebral blood flow and enhanced cognitive function in patients with a pre-clinical stage of dementia (mild impairment)³⁹.

What all this boils down to, for you in your sessions, is VARIETY. Resist the urge to get stuck in single planes of motion and re-using your favourite weights machines week in and week out. Instead, incorporate games, spontaneity, and different tools into your training programs. This doesn’t have to take up the entire session, but there should always be an element of surprise, play, or “different” in every session.

Keep an eye on Osteoporosis…

Osteoporosis literally means ‘bones with holes’; it is a condition where bones become thin, weak and fragile. Once in this condition, a minor bump or accident can lead to fracture, chronic pain, disability and even premature death. Osteopenia, or low bone density, is a condition when bone mineral density is lower than normal but not low enough to be classified as osteoporosis⁴⁰. There are very few, if any “symptoms” of Osteoporosis, but the impact on a woman’s health can be catastrophic if it goes diagnosed.

The condition occurs when the bone loses minerals faster than it can replace them (such as calcium).

Out of all people living with Osteoporosis in America, 80% are women⁴¹. In Australia the numbers are 29% of all women compared to 10% of all men over 75 years old. There’s a number of reasons for this:

• Contraceptive pill at a young age – before bones are fully formed⁴², or prolonged oral contraceptive use.

• Women’s relatively smaller mass makes it harder to build bones in her bone-building years.

• Women’s relatively smaller mass and differing hormonal profile means they don’t build as much muscle mass, which puts force through the bones.

• Women/girls to date haven’t been encouraged to lift heavy, power lift, or participate in sport at the same rate as men/boys. There are female-specific barriers to exercise that include feeling like they “don’t belong” in the weights room. Physical inactivity, especially through their teens and early twenties will increase their risk of developing osteoporosis.

• Women are at higher risk of developing autoimmune and inflammatory bowel conditions, which in turn increase risk of developing Osteoporosis. Sometimes it is the medications used to treat things like thyroid disease or an overactive thyroid, rheumatoid arthritis, chronic liver or kidney disease; or simply the condition affects the body’s ability to absorb nutrients (such as Chron’s disease, coeliac disease, and inflammatory bowel conditions).

• Women who lose their menstrual cycle through poor or inadequate nutrition or over exercising are also at a higher risk of developing Osteoporosis prematurely⁴³. For this reason, Osteoporosis awareness has to start with young women, especially if they’re athletic (but not necessarily athletes).

Osteoporosis is not an “old woman” disease – it is a consequence of many other diseases, medications, and lifestyle choices. However, it becomes more imperative to start training to mitigate the condition when your clients are female, and approaching menopause. That said, it’s never too late to start weight bearing, muscle and bone building exercise. In the very least, it can slow the progression of the disease, and at best it can reverse it.

The most reliable way to diagnose osteoporosis is to measure bone density with a dual-energy absorptiometry scan or DEXA. A DEXA scan is a short, painless scan that measures the density of your bones. You should ask your client to talk to their GP if you think they should get one, not refer one yourself. They can look up your closest location here: https://dexascan.com/locations/australia/

In Australia, you will qualify for a Medicare rebate for if you:

• have previously been diagnosed with osteoporosis
• have had one or more fractures due to osteoporosis
• are aged 70 years or over
• have a chronic condition, including rheumatoid arthritis, coeliac disease or liver disease
• have used corticosteroids for a long time.

It is possible to have a DXA scan performed if you do not fit the criteria for the Medicare rebate, but there will be an out-of-pocket cost associated with the scan⁴⁴. If your client is between 40-90 years of age, they can assess their risk of osteoporotic fracture by completing the Fracture Risk Assessment Tool, developed by the University of Sheffield⁴⁵: https://www.sheffield.ac.uk/FRAX/tool.aspx?country=31

If you’re training mid-life women, it would be wise to prescribe weight bearing exercise (which is any exercise where the client is working against gravity), heavy weights and impact (but controlled) movements. Plyometric exercise like skipping and box jumps are excellent ways to load the skeletal system, however they are also high risk of falls and fracture if the client has Osteopenia or Osteoporosis. It is safer to load the skeletal system with weights and low impact exercise, such as walking if they’ve been diagnosed with either.

If you have access to outside, around 10 minutes, twice a day in the sun is all the client needs to get adequate Vitamin D, and studies show that sunscreen has minimal impact on Vitamin D levels over time⁴⁶. Glass will filter the UV light so is not as effective. 90% of your Vitamin D comes from the sun.

I say it again… THE PELVIC FLOOR

After menopause, a female body’s soft tissues are less elastic, which can effect the pelvic floor and posture. Women tend to become more rigid through their torso, which can add downward pressure to the pelvic floor group of muscles. This occurs because oestrogen directly affects the structure and function of bone, muscle, tendon and ligaments⁴⁷.

With the decline in oestrogen at menopause, women will also experience a rapid decrease in muscle mass and strength, and will be more at risk of muscle injury⁴⁸. This includes the pelvic floor muscles, which may have already experienced injury during pregnancy or birthing her babies, or it may be an underlying issue caused by chronic coughing or constipation⁴⁹.

All this means that menopause is a risk factor for developing stress urinary incontinence, prolapse, and other pelvic dysfunctions.

However, pelvic dysfunction does not always need strength training. The menopause transition can often make the muscles, tendons, and ligaments of the pelvis stiffer and less responsive⁵⁰. So, when we’re recommending pelvic floor training in this population, what we mean is:

1. Get an internal examination by a pelvic health physio, and follow their recommendations.

2. If she’s long long, lax, or de-trained pelvic floor muscles – strength train them.

3. If she’s got tight, locked, or stiff pelvic floor muscles – relaxation and mobility for the pelvic floor.

4. If she has pelvic floor injury, including scars, nerve damage, etc. then follow the physio’s recommendations and keep and eagle-eye out for red flags, conservative approach is best here.

5. Get her reassessed regularly to ensure that in the very least, your movement prescription isn’t making things worse, and at best, is improving it!

Exercise is the most effective lifestyle strategy for anti-aging and anti-disease, but the number one barrier to exercise in Australian women is pelvic floor dysfunction⁵¹. If you’re training peri-to-post menopausal women, than an intricate knowledge of the pelvic floor muscles is necessary to ensure their long-term participation in your program.

As personal trainers, we can’t physically assess the pelvic floor, which is why working with a pelvic physio is so important. We can, however, ASK about symptoms, watch for behaviours (such as “just in case” visits to the loo), and create an open and educated environment with which these issues can be discussed.

Guide Toward Higher Fibre Intake

Fibre has an Oestrogen regulation role I women of all ages, as one of the ways we can dispose of excess Oestrogen is through our faeces (and sweating, incidentally). However, we are guiding towards increasing fibre for other reasons too, number 1 – high fibre intake decreases breast cancer risk¹!

However, before you send your client off to take a hundred supplements, we want to clarify that their goal is simply to get the 5 serves of veggies and 2 serves of fruit, recommended by Eat For Health in Australia². More is not necessarily better in this case, however most of your clients will be woefully under the recommended intake!

These same guidelines recommend post menopausal women drop their carbohydrate intake to 4 serves and to eat whole grains only (not refined like pasta and bread). This equates to roughly 11 serves of fibrous foods daily, including vegetables, fruit, whole grains (like rice), and legumes. Moving towards a plant-based (but not vegetarian) eating lifestyle has significant, positive effects on both preventing and mitigating body composition, blood pressure, heart disease, cholesterol levels, bone fracture risk, and diabetes³.

It’s worthwhile re-iterating that too much fibre is not the goal, as this can lower Oestrogen levels which is not ideal for a post menopausal woman⁴. Getting ENOUGH is the goal, and VARIETY is key. Think of the colours and types of veggies, legumes, fruits, and grains as feeding material for your gut microbiota. The more different kinds you eat, the more variety you have in your gut, and the better protection they’ll offer from diseases such as cancer, heart disease, and metabolic disease (amongst others!)⁵.

Eating enough fibre is also associated with better bowel health; including reduced risk of a range of chronic diseases including Crohns and specific, digestive tract cancers⁶. With menopause being such a massive health event in a woman’s life, in and of itself a risk of developing many of these diseases, it makes sense to guide towards things that reduce risk.

So, in summary, gradually guiding towards 5 serves of vegetables, 2 serves of fruit, and 4 serves of whole grains (including legumes) is the goal, with 1 serve being around 1 cup (to keep it simple). This should be done gradually if she hasn’t been eating enough fibre to date – simple switches such as replacing toast for breakfast with oats, and increasing the size of the salad on her dinner plate, will make huge, life-long positive impacts on her health⁷.

Are They Eating Enough? – Particularly Protein

Women as they age need to modify their eating habits for optimal health, but too often, especially after a lifetime of being told smaller is better, they’re restricting calories to lose weight rather than simply modifying their habits. Unfortunately, this is a recipe for future frailty, and a very difficult way to lose and maintain weight loss. It is better for older women to eat plenty of foods, but from slightly different sources to what they ate before menopause.

Women who are transitioning or have transitioned through menopause will reduce their carbohydrates by one serve a day, and pick up their protein by one serve a day. This looks like a palm-of-the-hand sized protein serve at every meal, plus a protein shake or bar or high protein snack (like boiled eggs, beef jerky, etc). While the generic advice for women is 0.8g of protein per kilo of bodyweight, per day – active women, especially those in the peri-to-post menopause need 1.7-2.4g per kilo of body weight, per day (for those of you who like macros).

These recommendations are from Eat for Health and Dr Stacy Simms. Most women will guess they’re eating enough protein, but I like 2-3 days of diarising to be sure. Once she’s eating her recommended fibre, there’s very little room for restricting the foods she loves and the occasional treat!

This is a thriving, nourished mindset that will serve her well in her relationship with food and her body going in to post-menopause life!

So there you have it, eight special considerations when training women mid-life and beyond:

1. Tendon and Ligament Health
2. Balance and Falls Prevention
3. Grip Strength and Longevity
4. Control the Controllable to Prevent Heart Disease
5. Dementia Prevention; Brain Health
6. Keep and Eye on Osteoporosis
7. Guide towards Optimal Fibre Intake
8. Ensure They’re Eating Enough – Particularly Protein

Any you would add??? Feel free to DM or email me here!

Like this? Perhaps you’d also like to join hundreds of other trainers who are up-levelling their offering to their female clients with our Women’s Health Mentorship! Or, take your understanding of Women’s Physiology to a deeper level with the 10-Week Applied Women’s Physiology and Training Course for Personal Trainers!

If you’d like a personal trainer who has these skills, you can look up your closest one here.

REFERENCES

1Longo, U.G., Mazzola, A., Carotti, S. et al. The role of estrogen and progesterone receptors in the rotator cuff disease: a retrospective cohort study. BMC Musculoskelet Disord 22, 891 (2021). https://doi.org/10.1186/s12891-021-04778-5

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