Most Replayed Moment: This Is The Best Exercise Protocol For Women!

0:03I hear a lot about VO2 maxes, so I thought that we should all be driving our cardiovascular performance up to get a high VO2 max. Well, that's where the intensity is, yeah.

0:12Dr. Mary Claire Haver:That's only once a week. I mean, and correct me if I'm wrong, but my understanding after reading and watching everything is it doesn't take that much to build VO2 max. No, it doesn't. It's that high intensity that's a little bit uncomfortable where you're pushing at that max for, you know, about four minutes to build that VO2. In the sports science world, it's always been the 4x4, the Norwegian 4x4. Four minutes on, four minutes off, four minutes on, four minutes off. But that's not three days a week. No, not at all. Norwegian Protocol is once a week. Once a week at the most, right. And the other sprints, just to give you, I tend to give my examples because it makes it more real.

0:49But when I'm doing sprint intervals, I do it the 30 seconds on and then complete recovery, meaning I'm for 30 seconds, I'm taking my heart rate as high as I can get it. And then I'll completely recover, which takes me two to three minutes. I just happen to do it on a treadmill. But the reality is you can do it on anything. It's a heart rate function, not an apparatus function. So for me, on a treadmill, after I'm done warming up, you can't do it cold or you'll hurt something. after I'm done warming up because I'm a really short person. I punch the treadmill up to 11 and I am just working so hard I don't fly off the back.

1:35But that gets my heart rate up really high, about 186. Everybody's top heart rate is different. And then I completely recover. And I do that four times. It doesn't take that long. And you feel so good when you're done. So I can't run at the moment. This morning I did explosive kettlebell swings. Why can't you run at the moment? Torn hamstring and meniscus. So I can't run at the moment. Running is in. Run clubs have come in strong. It's back in. It's back in. Are you at all concerned with the fact that people are running all the time and doing resistance training less? Because running is cool now.

2:16It's how people date. They're not going to nightclubs anymore. It's like a sacrifice of other things. It's like we said about Pilates. You know, if all you do is running, then that is definitely not the best way to be. It's not the healthiest for your whole body. It's not that you're unhealthy, but we're really talking about how are we optimizing your body and your hormonal health for a variety of different goals. But also if we look very micro at running, 58 % of runners have a luteal phase defect. That means that the second half of their menstrual cycle is not going to be able to last as long as we want it to, likely due to what Stacey was talking about earlier, this relative energy deficiency coming back to the brain.

2:56The brain signals it not as strong to keep that corpus luteum, what happens after the follicle, alive. And a lot of women say, I still have my period, so I'm okay. But if we're using our cycle as a vital sign, we can actually say the ratio of energy balance is not great. And it's often because we're doing it at sacrifice of other things. So if you're doing the strength training three times a week and you're running however you're spacing out your other days, that's such a healthy balance. It's hard that you're going to be in a bad position with that. And you'll actually improve your running more so than if you were to run every day or every other day.

3:31Because if you're getting strong through full range of motion, then that feeds forward to better running economy. Then you can vary your pace without getting injured. but for people who are running every day and they're shuffling and they're getting stronger in their strong muscles and weaker in their weak muscles then it perpetuates this and they're in my clinic yeah people are very keen on doing marathons and half marathons at the moment and got a couple of friends that are doing a lot of marathons at the moment and they're very very very skinny oh welcome to my world of dexas yeah is that healthy i'm not even sure if that's that's the right question or one can judge from just looking but being extremely skinny in that regard being that sort of marathon runner physique there are some that are naturally predisposed to that right so naturally predisposed having really good running economy running biomechanics having a leaner body and this is what we were talking about the olympics earlier where you can see the ideal body type for that particular sport and then there are those like me who build muscle naturally it's pretty easy so I'd never be a skinny little runner and my running economy is a little bit off because of where I build muscle versus not so not everyone is meant to be a long distance runner and there are some that are meant to be long distance runners so if we're talking about your friends who are like super skinny are they economically viable for being a long distance runner possibly but we also have to look are they male or female what is their injury rate what is they're fueling.

5:00And then for me, I'd want to see the dexas of the women that are just training long distance and super skinny, because most of the time we see a higher visceral fat in and around the organs as we're talking about, even though on the outside, like super lean, but they have a really high percentage of visceral fat because of the inflammation, the low energy intake, and most likely estradiol suppression. And that's the skinny fat thing you you talked earlier is there an evolutionary lens on this i always think about this when we're having these conversations like what what used to happen thousands of years ago if we talk about the evolutionary biological theories and there are a lot of sociologists that will counter what i'm getting ready to say so i'll apologize in advance when we look at original hunter-gatherer type communities the male body was designed to go out to find the calories the woman body was designed to stay and take care of the offspring and make sure that home was set.

5:58If it was low calorie, menstrual cycle would stop because you didn't want to reproduce in a time of low calories. Body fat would come on because there weren't a lot of calories. And so the equivocal in the time now is that I'm not eating enough or I'm burning more than I'm consuming? Exactly. So I'm in a calorie deficit in some way. Exactly. An energy deficit. So with a male body, and we see this, their brain and hypothalamus is not as sensitive to those nutrient deficits as much as a woman's body, because we have menstrual cycle and menstrual cycle function. A man will lean up and get more cognitively focused in times of low calorie intake.

6:37So this is what we see with fasting data and we see with restrictive diets. And that was, we need to bring it back to that biological lens. Low calorie, I have to go find the calories. I have to be fit to go find the calories. Low calories, I need to not have to eat as much. So I need to store fat and I can't have a baby because we don't have enough calories. And then stress? When we add modern stress onto that, that's a comprehensive addition of cortisol and addition of inflammation. And that also perpetuates body fat. I mean, like a stress 10 ,000 years ago would have been like a lion. Oh yeah, it's a lion.

7:12But it's exotic.

7:13Dr. Mary Claire Haver:Yeah. We had stress and this is a natural stress response. We have to have them to survive. But these were episodic stresses. Well, and your hormones would change for a very specific purpose that you would then go do. Your body would free up glucose from your liver. You're getting it ready in your bloodstream so you can go run from the lion. And then things would shift back to normal. And what's happening with chronic stress is you're getting all the hormone shifts because your body's really getting ready for the lion, except it's just that bad meeting you had. And then you're just sitting there longer and you're not using that glucose up.

7:45Exactly. Exactly. Are women increasingly overtraining? I think the problem in this country is not maybe in the women who are really intentional, maybe there are some that are overexercising. But if we look at a population, nobody is exercising enough. Exactly. I mean, I would take, people ask me all the time, tell me the first thing people need to do. I'm like, I'll take anything. I mean, I'll take getting off the couch with any method, whatever makes you happy. I'll say, get off the couch and do 10 air squats. Thank you. That's enough. Yeah, that's enough. It's resistance training. So in the crowd that's like, I'm going to invest in my health every day, that is not the majority of people.

8:27Yeah. That's my bubble. And the people who listen to your show, though, might be a different demographic, we have to acknowledge, right, than population of America. I mean, like a lot of people who listen to your show, Stephen, are interested in health and their body and achieving certain goals. And so certainly, you know, I have practiced fertility in North Carolina and in Austin. And I see a completely different patient population, you know, in Austin, Texas, which is a very fit area. Women are constantly overtraining. But to Stacey's point earlier about this maybe evolutionary what happens, women go into this hypothalamic dysfunction even before it's what we call like amenorrhea.

9:09Hypothalamic amenorrhea is essentially where the brain, where the hypothalamus is, shuts off, says can't reproduce right now, XYZ reason. No FSH and LH are coming out. You're not ovulating. You're not making estrogen. You're not going to get pregnant.

9:23Dr. Mary Claire Haver:So you're more likely to survive. Yeah. So it's a survival mechanism. Pregnancy is dangerous in hunter-gatherers. But modern medicine acts like you're perfect or it's turned off. And the reality is there's all these shades of gray in between where these different chronic stressors and your insulin resistance and your inflammation and your over-exercising and your under-fueling come in and make it so the hypothalamus is not responding correctly. And that's what we're trying to get people to intervene there before it gets too bad. And I see a large number of women who do fall into that zone where they are trying their hardest to be healthy.

10:01But what they are choosing to do is actually having a negative impact on their hormonal health and how their brain is interpreting their hormones. And it's very rare to see that in a man. Meaning the number one reason why I will see low testosterone is purely because many men are taking testosterone or because of other exogenous factors like marijuana use. It is very rarely my brain is not sending out the signals to cause my testicles to make testosterone. I like to frame it where women are under recovering, not over training. So if we're under recovery, then it makes it more acceptable to fuel.

10:36And I always want to bring it back to it doesn't matter. Like because I come from high performance, I'm going to use those words where it's like you're not recovering enough. We want to focus on recovery on these days. We want to make sure that you're eating and fueling around. So it's never overtraining. It's always under the balance is wrong. They're not.

10:54Dr. Mary Claire Haver:So what do you say to all the voices on social media that are just yelling at mostly women and telling them it's just a matter of willpower and you don't have the body composition you deserve? Well, you swipe left and don't talk to those people. But that's me, right? I'm talking to the woman in Ohio who's feeling defeated and stumbles across someone screaming at her on the internet that her body composition that she's not happy with is her fault. I hate that because it's a construct of society, right? Especially Western society. This is where we have to educate. It's not your fault. These are the things that have come into play and lined up to create this situation.

11:35But now we have tools to offer you to take one step out of that situation. And let's see how many more steps we can get you away from the situation to improve your health. And are the rules of exercise slightly different once you've entered perimenopause? So this is where we really need to look at how we can use exercise and some environmental stress to create a really strong adaptive stress and really strong recovery stress.

12:03Dr. Mary Claire Haver:Stacy, can you explain adaptive stress? Because I'm thinking of the 10 ,000 people who follow me who will be like. Who have no idea what adaptive stress is. So if I go and I do some resistance training, some heavy lifting, I want to create a stress on my body that's going to then have a signaling cascade to repair the muscle in a stronger way than when I've heard. Because lifting the muscle damages the muscle? Yes, and it creates a series of feedback mechanisms that make it repair stronger than when you first went in. So that's an adaptive stress. And we're looking at what levels of stress we can put, so it's a training stress, or what levels of stress we can use through exercise to really, really create an environment that improves our health.

12:53So if we talk about sprint interval training, the 30 seconds on and the two to three minute recovery, The reason why we want that super high-end stress of our heart rate is it then creates eventual epigenetic change. So it's that environment that's going to create a change within the muscle that's going to allow that GLUT4 protein that I mentioned earlier to open up and have glucose come in, reducing insulin resistance. Also, with that really high, high heart rate, we're having a lot of stress on the muscle that's going to release some myokines, which are little hormone signals that then will go to the liver and say, wait a second, we don't need to store visceral fat.

13:32We need to create non-esterified fatty acids, which can then go into our skeletal muscle to be used in the mitochondria as fuel. So we want to have the stress that's strong enough to create these cascades of feedback mechanisms to improve our overall health. If we stay in that moderate intensity zone, we aren't creating a strong enough stress to create that signaling. What are we doing? We are exacerbating inflammation. We're exacerbating cortisol. Now, cortisol isn't the demon, but when we have an elevation of it, and especially in perimenopause, when we're sympathetically driven and we already have a higher level of baseline cortisol, if we are continuously in this modern intensity zone, We never get a signal to allow that to drop.

14:19So if we're looking at polarizing, which is top, top end and low recovery end, then with the top end, we get the signal cascade of improving body comp, improving insulin sensitivity, as well as getting growth hormone and testosterone responses, which then feed back to drop cortisol. So am I right in thinking the solution, if I'm perimenopausal, is to do high-intensity interval training for short periods of time? So we look at the quality of the training, not the volume of the training. So if we're in our reproductive years, then yes, you can do the moderate intensity stuff because you have estrogen and some of our other hormone feedback signals that are going to drop cortisol.

15:02It's going to allow your body to recover and repair. And what makes quality training? What is quality training? So this is your polar. So you have a very specific session that you're going to do. So for Vonda, it's your 30 seconds on as hard as possible, two to three minutes recovery. Do that four times at your session. Okay, I'm going to try and summarize this. See if this is a test. See if I understood all of this stuff. So if I do a lot of volume, but I play in that sort of medium intensity range, I'm basically just like stressing out my body in all the worst ways. Exactly. Like the inflammation.

15:35It's just not good for my body necessarily. If I don't do vigorous enough exercise, then that's also bad because nothing's going to break and therefore build. Nothing's going to adapt. Nothing's going to grow. If I do it for long periods of time, really anything for long periods of time, that's also stress. But the key thing to do is to do shorter, higher intensity exercise that will cause my body to adapt, but won't put it into that inflamed, stressful state. And you also have to pepper in some lower intensity work. So this is your flexibility so that you have recovery. You're getting blood flow circulating.

16:18You're tapping into some mitochondrial work so that you are still getting benefit of exercise, but it's not in that modern intensity. So that's what we mean by polarizing. So if we were to talk in like the zones talk that everyone talks is out there, right? What is zones? So if we're talking about heart rate and the way that your body works, we have zone one, which is just sitting around. We're in zone one. We're in zone one. I'm fine. Zone two is the bro science kind of thing where you're like, let's, let's work in this zone two area where we're working. I was in zone two when you were talking about menstrual cycle.

16:55That's it. Your heart rate's elevated. You still a little bit have a conversation. For women, it's good for recovery, stress release. For men, it's good to improve metabolic flexibility. We're looking at zone three, four. That's the area you want to stay out of unless you're specifically training for something that requires you to be there. So that would be your half marathons, your endurance races, that kind of stuff. Everyone wants to stay out of zone? Three, four. During training. Oh, okay. Fine. Because that's the medium range, right? Yeah, that's medium range. So you want to jump into zone five, hang around for?

17:33Five, six. Yeah. Okay, a couple of minutes and then get out of there. Yeah. But in a week, this is, yeah, it's across the week. Let's just be clear. So two to four days a week, you should be lifting progressively to lift heavy, meaning heavier weights, fewer reps, right? One compound lift a day plus the augmentative lifts that go behind it, right? So you're warming up first, then you're going to do one lift, and then you're going to do your jumping or your balance work. The other days of the week, you will do preferably low intensity doing anything. Walking briskly down the New York street could count as that.

18:14It's continuous motion. And then a couple days a week, add in your sprint intervals, your really high zone five, six, high intensity. And then when you've got that, you can add in your four by four VO2 max on one of the other days because it sounds like a lot. But when I work with non-pro athletes, I layer on behaviors. Absolutely. Because if I say all of this at once, nobody's going to do anything. Always describe it as we have these pillars, right? First, we have to nail sleep. Doesn't matter who you are. You have to. Same. Because you cannot.

18:55Dr. Mary Claire Haver:It's non-negotiable. Yeah, you cannot invoke any kind of metabolic or body composition change without adequate sleep. Also improves stress resilience. Then we look at nutrition and physical activity. The behaviors that go with both of those are somewhat independent. You have some people that are more motivated to do physical activity and some people are more motivated to change nutritional habits. Most of the time, they're two different personalities. So we have to look at what comes next. And then we also have, which isn't lesser importance, but often neglected, is the mindfulness and community.

19:26So this is being out in nature. It's connecting with friends. It might be going to a group exercise class. It might be just having coffee. But that is really, really important for parasympathetic and whole being life. Stress response.

19:39Dr. Mary Claire Haver:Exactly. So there's a new book coming out called Joy Span. I don't know if you've spoken with her. So she's a gerontologist and works with the very elderly. And she has a very specific, you know, what determines who's going to kill it in that last decade of life. And that community part, using your brain, you know, having interactions with human beings seems to be the key. And if you don't keep that going through this 40s, 50s, 60s, when you get to 70 and 80, you're not going to have a great end of your life. And what about the last phase then? So if someone's post-menopausal, does their exercise recommendations change at all?

20:19We like to start the habits early and continue them through. If you haven't started, it's not too late. As we're seeing like with Liftmore and some other of the older age resources coming out, it's never too late to start. We just have to be very careful of how you start to have support and phase you in to these different exercise modalities. Is it the same exercises though? Meaning? You know, the three days a week, the mobility, the strength.

20:45Dr. Mary Claire Haver:I am firmly postmenopausal and I am doing all these things. But it's different. People always ask me, what does heavy lifting mean? Right. It's relative. It's relative. My heavy is not going to be Stacey's heavy. Or I should say it the other way. Stacey's very heavy is not going to be my heavy. In Liffmore, the authors describe the one rep max. And so one rep max is like, safely, what is the heaviest you can do one rep? You know, so for a bicep curl, what is the heaviest weight I can do? One to fail, you know, I'm going to fail after this one. And for me, that was about 20 pounds. With good form.

21:21Dr. Mary Claire Haver:Exactly, safely with good form. And so I could nail 20. And so then they took them down to about 70, 80 % of that, which for me was about 15, 16 pounds. So that you can usually do about five reps before you hit failure. And that is what they consider lifting heavy. And that seemed to really resonate with my followers to understand what that meant. And there's so many women that underestimate their strength. See them and they gravitate towards the 10-pound dumbbells. It's like, put that away. Go to the next one. Do a couple of lifts with that. And then ideally, I want you to put that away and pick up the next one because that's going to challenge you.

22:01because women have been so conditioned to do 10 to 15 reps to get, quote, toned and not really put in the work they need to to build muscle and to get the benefit out of strength training. And I'm always telling women, you're underestimating yourself in so many facets. Don't cheat yourself with the strength training as well. Because people have to remember what we're training for now. It's different than I had a woman recently say, I was taught to do biceps curls five pounds 30 times. Well, after 30 times, not only are you bored, but you'll probably be at failure 30 times. That will build endurance.

22:39I am training to be as strong as possible. And when I have strength down, then I start playing with tempo so that I could replace some of the explosive muscle fibers that I'm going to lose over time. To your point, Wanda, I've just been writing my book in Cape Town, as I told you before we started recording. and one of the studies that I read about while I was writing the book was a study done by some a guy called Hal Hirschfeld and his colleagues where they asked they put people in these MRI scanners and they asked them to think about a famous celebrity and then they asked them to think about themselves today and then they asked them to think about themselves in 10 years time and in 10 years time the same brain regions lit up as if they were thinking about the celebrity which kind of led them to conclude that in our brain we almost see our future selves as a bit of a stranger yes that's right and so when we think about long-term planning this is in part why a lot of this advice is often most effective when it's put in the context of like short-term performance or cognitive benefits because we really do struggle to like care about ourselves at 90 yeah and we i think we all kind of think we can just figure it out later i think what's

23:49Dr. Mary Claire Haver:different for women, especially in menopause, is because we're also taking care of our parents in so many ways. You know, we're in this like raising kids, going through our own hormonal upheaval, and then watching our mothers, our grandmothers, our aunts age. And we, the way society is set up, women become the caretakers of their parents, generally the oldest daughter. And I have to give full credit to my sister who lives in the same town as my mom and as a nurse. So she really is bearing the brunt of taking care of mama because I'm living this life. So thank Thank you, Leah, if you're watching.

24:19Dr. Mary Claire Haver:It is such a tremendous stress, you know. And so our motivation, my sister and I, is like, we don't want to do this to our daughters. Yeah, exactly. The other thing I want to bring in is the brain health component, right? We talk about Alzheimer's and dementia. And one of the reasons I really preface doing high-intensity work is the lactate production. because we're finding more and more research coming out showing that part of the development of dementia and Alzheimer and the plaque is a misstep in brain metabolism. So when we're looking at brain metabolism and the brain uses a lot of glucose, it also uses lactate.