Menopause Exercise Plan: Preserve it Easy and Efficient

What is a menopausal person supposed to do when it comes to exercise? The opinions coming from every direction on the internet are mixed, especially as this entire phase of life has become its own industry (according to a McKinsey report, treating symptoms is potentially a $350 billion market). Much of the advice is not backed by science. And often the loudest and worst guidance is coming from influencers and celebrities with no credentials or expertise.

Although more medical professionals and scientists are getting closer to the truth about what kinds of exercise routines will benefit women in midlife the most, all things menopause remain understudied. On the upside, the tide is turning. As part of President Joe Biden’s recent executive order on advancing women’s health research and innovation, the National Institutes of Health pledged $200 million for research on the impact of menopause on heart, brain, and bone health, for example.

But it will take time—and much more funding. As Christine Yu, author of Up to Speed: the Groundbreaking Science of Women Athletes, writes, “If we want people to be prepared and supported during and after the menopause transition, we need more research on active and athletic middle-aged populations. A lot more research.”

Why exercise is important in menopause

In the meantime, one thing is certain: exercise takes on a new level of importance for people in perimenopause (the years, usually in your 40s, leading up to menopause as reproductive hormone levels rise and fall, causing symptoms that can include hot flashes, brain fog, and anxiety), menopause (when you’ve gone 12 months without a period, around age 51), and post-menopause (from menopause until the end of life).

No matter if you’ve been an athlete your entire life or you’re just now dipping your toe into a fitness routine, we know that movement is key to longevity.

“Even if you wait until menopause to start exercising, it will increase your lifespan and your quality of life.”—Abbie Smith-Ryan, PhD

“Our risk for cardiovascular disease and diabetes significantly increases in perimenopause,” says Abbie Smith-Ryan, PhD, a professor, physiologist, and sport nutrition researcher at the University of North Carolina. “But even if you wait until menopause to start exercising, it will increase your lifespan and your quality of life. It’s the one way to actually help ourselves.”

Where to begin and what to do is often what prevents middle-aged women from sticking to a consistent plan. Not to mention making time for it—this age group has a lot of demands placed on it, from career to kids to aging parents and more. We asked a few women and a couple of experts for advice, based on experience and research. Here’s what we know.

What a simple and effective menopause workout plan looks like

1. First: Get clear about why you’re exercising

As we age and our hormones fluctuate, women often gain weight around their abdomens, but might also notice body composition changes in other places. Declining estrogen levels on their own aren’t necessarily to blame. Our lifestyle changes (we may become less active), our genetics might come into play, and as fat increases we are simultaneously losing muscle mass. Nutrition and shifting sleeping patterns in menopause can also contribute to body changes.

Add in a healthy dose of diet culture and women often turn to exercising and eating less in order to try to lose weight. But experts suggest that the goal of weight loss alone isn’t the best objective if you’re hoping to sustain your fitness routine for the long term (neither is depriving yourself of the nutrition and calories you need to function). It’s better to think of fitness as a means to a lot of important ends at this stage:

• better brain and cardiovascular health
• living independently with a higher quality of life for longer
• avoiding injuries and fractures with a stronger musculoskeletal system
• mitigate some less-desirable symptoms, like sleep disruption and hot flashes

Exercise for menopausal women is also a source of empowerment.

Erin Hennessy, 50, a communications consultant who works in higher education, didn’t think much about fitness until her 40s. After she quit smoking, she decided to start moving, so she built up to running about 5 miles on a treadmill a few times a week. When she relocated from Washington, D.C., to New Jersey, closer to her family, she noticed a gym about two blocks away from her new home. It had a different vibe than those she had tried in D.C.—she saw people of all sizes, as well as other women her age. She didn’t feel intimidated while working out there. So she signed up for some personal training.

“I think it was sort of tied to my father’s declining health, but I decided, I’m 50 and I need to get serious about some stuff here,” Hennessy says. “I acknowledge the privilege that I have to afford the gym, the trainer, and have the time. It has been the thing that has absolutely changed the way I think about fitness and also the way I think about my body.”

It’s important to Hennessy that she’s able to take care of her home and her dog, keep up with her 12-year-old nephew, and help her family when needed, too. The program her trainer has created for her allows her to achieve those goals.

“It’s not crazy feats of strength, but I do these things like carry a bag of rock salt for my mom or lift the dog into the tub and remember that’s why I go to the gym,” she says. “Not because I want to be a certain weight or look a certain way, but because I want to be able to, as a single woman, take care of myself and take care of my family.”

2. Focus on building and maintaining muscle mass

If the Instagram algorithm has caught on to the fact that you’re a woman over 40, you’ve probably heard the phrase “lift heavy sh*t.” It’s everywhere. And for good reason—for this age group, lifting weights provides a lot of benefits.

We lose about 10 percent muscle mass during perimenopause alone, according to a study¹ of 144 women ages 30 to 70, published in 2021. Losing muscle can also result in bone loss (and fractures), heart disease, and insulin resistance or diabetes. But what does “lifting heavy” actually mean for somebody who’s never lifted weights before?

Alyssa Olenick, PhD, exercise physiologist, sports nutritionist, and a coach based in Maryland, says that the advice to “lift heavy” is relative to the person, as well as the type of exercise that person is doing. If you’re a beginner, you might want to start with body-weight resistance training before you start lifting any weights at all.

Olenick recommends two days per week targeting 4 to 6 exercises, with a range of 5 to 12 repetitions per exercise, on a variety of machines (or with dumbbells, kettlebells, or resistance bands) that target different areas of the body, including chest, shoulders, back, quads, hamstrings, and glutes. It’s best, if you have the resources, to have a trainer at a gym teach you correct form, to avoid injuries. You can also search for online resources (Well+Good has many) that will help you get going, or hire an online coach, like Olenick.

“Do everything at a 6 out of 10 effort to get used to moving through the range of motion, the new movement patterns, and just gaining confidence,” Olenick says. “As you progress, a great way to know if you’re putting enough weight on the bar, the machine, or lifting the right dumbbell is if you have to focus to complete the lift. Do you feel like you actually need a minute or two to rest and recover between the sets?”

Olenick offers advice for resistance training at home on her Youtube channel and gives an example of two days of workouts to get started:

Day 1:

Day 2:

• Deadlift/hinge exercise: 2 to 3 sets of 8 to 15 reps @ 6 to 8/10 effort
• Back/pull exercise: 2 to 3 sets of 8 to 15 reps @ 6 to 8/10 effort
• Chest/press exercise: 2 to 3 sets of 8 to 15 reps @ 6 to 8/10 effort
• Squat/quad exercise: 2 to 3 sets of 8 to 15 reps @ 6 to 8/10 effort
• Core: 2 to 3 sets of 8 to 15 reps @ 6 to 8/10 effort

Hennessy works with her trainer twice a week and she also does yoga to help with flexibility and mobility. Now that she’s familiar with the gym equipment, how much she can lift, and how many reps to do, she judges success by the increases in weight she’s lifting and pushing.

“We’re doing machines, circuits, and kettlebells—all of these things that I didn’t think I had any business attempting to use,” Hennessy says. “I think it is an absolute game-changer for women at this stage of our lives.”

3. Cardio counts—and HIIT helps

Confusion abounds about the place the running and other forms of cardio exercise have in the fitness plans of women in perimenopause and menopause. Smith-Ryan and Olenick agree that it still serves a purpose for this age group—especially if it’s something a person enjoys doing. Any form of exercise that you look forward to and will do consistently is an asset (but add two or three strength-training sessions each week to the mix, too).

“Cardio is not making you fat, and it’s not causing ‘menopause belly’ or any of those things. But sometimes we just need to shift away the overall percentage each week that we’re spending exercising to add in more of that lifting,” Olenick says. “And then make that cardio a little bit more intentional.”

“Cardio is not making you fat, and it’s not causing ‘menopause belly’ or any of those things.”—Alyssa Olenick, PhD

Because high interval training or sprint interval training requires a higher power output, it can help with muscle preservation. If you have a history of doing mostly moderate-effort endurance training, keep that in the mix but shift a bit more of it to high intensity interval training (HIIT) to get the most benefit from the time you’re putting into exercising.

Smith-Ryan recently led a group of researchers to explore the relationship between physical activity, body composition, and menopause symptoms, which was published² in April in the journal Menopause. A group of 72 women were divided into pre-menopause, perimenopause, and post-menopause groups. The findings included evidence that vigorous activity (like high intensity interval training) helped mitigate some menopause symptoms, because this form of exercise can offset some age-related muscle loss.

The research also showed that those who maintained the same amount of body fat going into menopause, the percentage of body fat shifted higher because they were losing muscle. In essence, Smith-Ryan says, our focus shouldn’t be so much on losing fat, but gaining muscle.

“Lifting weights is amazing and every woman should do it, but realistically it takes resources and knowledge,” Smith-Ryan says. “HIIT works no matter how old you are or how much body fat you have—it really stimulates muscle.”

If you’re new to HIIT, you can start with walking for one minute “on” (at a pace where you wouldn’t be able to talk to anybody or hold the pace for more than a minute) and one minute “off” (a recovery pace) for a total of 10 minutes. As you adapt to that workout, progress from there by extending the “on” periods and keep the “off” at one minute, as well as making the total workout longer.

Over time, play around with the intervals and the speed (advance to running, if you can, or you can translate the same kind of workout to an elliptical, bike, or swimming, for example) to maximize the benefits. Or add in hills to the intervals to stimulate more exertion.

“You actually see adaptations really quickly, especially if you’ve never trained before,” Smith-Ryan says.

4. Remember: You’re never too old

Jennifer Cooke, 61, who works in higher education in Washington, D.C., had been an avid runner throughout her 40s, completing marathons and ultra-marathons. She assumed she’d always be fit. Then 50 hit—and her routine started evaporating. She got married around this time, entered menopause, and on top of her career, she was dealing with elder care and eventually losing her father. Hot flashes and stress kept her up at night. Running wasn’t fitting into her life as consistently as it once had.

“That lack of sleep just kind of erodes a lot of things—your motivation and your drive to get up and get out there,” Cooke says. “I don’t think it was deliberate. It kind of creeps up on you. I was just never quite able to make it back over that hump to where it’s a pleasure to be running, even if it’s hard.”

Cooke took up ballroom dancing and swimming to stay active, but still missed running. So she turned to local coaches from Run Farther and Faster for one last-ditch effort to get back to it.

“I had just turned 60 and I had honestly started to feel like this is just what it’s like to get old—I had frozen shoulder for a year, a knee problem, and these things just set you back,” Cooke says. “I needed to take control—running and exercise is the panacea for so many things, like the idea that you put in the work and things do improve.”

In the past year, her coaches helped Cooke gradually rebuild her running routine, as well as add in some strength training. In April she successfully ran a 10-mile race. “I just want to be in a good, healthy mental and physical state as I can be going into old age,” she says.

Olenick emphasizes that there is always benefit to exercising or coming back from a long hiatus, whether you’re in your 40s, 50s, 60s, or older.

“There’s benefit across our entire lifespan,” she says. “You can still get stronger and gain muscle. It is never too late.”

The research backs that up. A position statement from the National Strength and Conditioning Association, published in the Journal of Strength and Conditioning Research³, says that for older adults, research has demonstrated that we can benefit from resistance training at any age—and that it’s a powerful way to combat strength loss, frailty, mobility issues, chronic disease, and improve psychological well-being.

Cooke concurs and has some advice, too.

“Start slow, but be consistent. It’s pushing too hard, too soon that leads to setbacks,” she says. “And congratulate yourself every time you’re doing it, because it’s not easy. The fact that you’re doing it is worth giving yourself a pat on the back.”

How to progress once you’ve nailed the basics

After you’ve nailed down that consistency and gotten into a menopause workout plan that works, don’t be afraid to progress when it starts feeling easy—your body will adapt to the workouts you’re doing, so in order to keep building fitness, you’ll need to lift heavier and add new stimuli.

And remember: Exercise is just one piece of the menopause puzzle (albeit a large piece). If you have questions about how you’re feeling or what’s going on with your body, talk to a trusted healthcare provider before you fall prey to the many potions and supplements that are pushed on perimenopausal and menopausal people.

And if you get derailed from your foray into fitness, don’t give up. It happens to everybody. Just ease back into it and remember why you started in the first place.

“Get comfortable with the idea of being flexible and that not every week is going to be the same,” Olenick says. “But be honest with yourself about whether you’re personally choosing to cut corners versus life is really getting in the way. Keep showing up at whatever the 100 percent is that you can give that day.”