Recap: Change how you exercise during menopause | Dr Stacy Sims

0:00Hello, and welcome to Zoe Recap, where each week we find the best bits from one of our podcast episodes to help you improve your health. Today, we're discussing fitness during menopause. Navigating the twists and turns of menopause can be a challenge. Hormone fluctuations bring about significant changes in your body, including how it responds to exercise. So how can you adjust your workout routine to best support your body through this change? Exercise physiologist Dr. Stacey Sims tells us how we can optimize fitness during this unique stage of life.

0:38When we're looking at perimenopause, women age very differently during this time period because it depends on how the ratios of estrogen and progesterone start to shift. Because when we're in our reproductive years, we have primarily a regular cycle every 28 to 40 days, and you have times when estrogen and progesterone are low, and then you have ovulation, estrogen and progesterone come up. You don't get pregnant. You shed the lining. So you have this cyclical pattern. And your body's really used to a certain amount of progesterone and estrogen. When we get into perimenopause, we start to have more and more anovulatory cycles.

1:18So if we're not ovulating, we don't produce progesterone. We're still producing estrogen. But because we don't have progesterone, the ratios of those two hormones are shifting. Some weeks where you have more estrogen and it would be akin to a normal menstrual cycle. But when you don't ovulate and you don't have the counter of progesterone to estrogen, that changes the way estrogen functions in the body. Estrogen acts on a woman like testosterone acts on a man when we're talking about lean mass. And we know that lean mass is one of the first things to go because there's a lot of women who say, you know what?

1:55I feel like I woke up squishy overnight. I don't know what happened. I've been doing the same things and all of a sudden I'm squishy. And it is really because when we look at estrogen, estrogen is really responsible for stimulating the satellite cell or that very basic muscle cell to grow and develop. It's also responsible for how strong two proteins come together. They're called actin and myosin and they cause a muscle contraction. Myosin and actin bond together and shorten the fibers, and that's what causes your muscle contraction. Estrogen is responsible for how strong myosin attaches to actin.

2:35So when we start to have different levels of estrogen, that combination of actin and myosin is thrown off. So we don't have as much strength because we can't stimulate the muscle fibers to contract as strong as they used to. So this is why women feel I'm not very strong anymore. Estrogen is really responsible for our strength and power and our muscle and we're losing it. Well, what do we do? We need to look at lifting heavy and people are very hesitant in this age bracket. I know because all of us grew up with the Jane Fonda cardiovascular, don't touch weights because you're going to bulk up. But it is so important for resistance training.

3:18It is the big rock here when we're talking about building muscle. But we can't go in and do like 10 reps of something or 15 reps of something because that's not the kind of stimulus that's going to allow us to build muscle. What I'm trying to do is I'm trying to create a central nervous system response. So if we think about muscle contraction, it's all driven by a nerve response. So if we are looking at going to the gym or not even to the gym to start off, because we're not looking at a training block here, we're not looking at a short burst of time, we are looking for the rest of our lives. So when we're talking about lifting heavy, it's relative.

4:01If you're not used to lifting and you've never done it before, then I don't want you to go to the gym tomorrow and try to deadlift 50 or 60 kilos, right? That's just going to set you up for injury. It's very intimidating for women who've never been in the gym to do that. What I do want you to do is I want you to learn to move. I want you to do mobility. I want you to learn how to squat properly. I want you to learn how to do some single leg deadlifts or standing on a single leg. I want you to learn how to step off a box and it doesn't have to be a high box, could be a stair and land properly. I want you to learn how to move first and you can work with a physio who can look at your sticky points.

4:46And this is also the time where you have an upcurrent of soft tissue injury and joint pain because of the way estrogen interacts with these parts of the body as well. So the first and foremost is people need to learn to move well. Once you know how to move well, then we can start adding load. So by adding load, it is doing an exercise. So I'll take deadlift because that's picking the bar off off the ground. So it's akin to picking groceries up to move. You want to be able to do three reps. So that's picking it up one down, two down, three down, and do that five times. But by the fifth time you do that, you might only be able to do one with proper form.

5:38That's what we're after. We're looking for fatigue. We're looking for that two failure with good form because what we're doing there is we're telling our nerves that we have to recruit a certain amount of muscle fibers quickly to be able to lift that load. So if we're having the central nervous system come in and say, I need to be able to recruit more muscle fibers. I need to activate all of these muscle fibers. They all have to coordinate. They all have to be able to contract at the same time to lift this heavy load. Then we also get the stimulus for building more muscle because we need more muscle to lift that load.

6:16So instead of estrogen telling muscle to grow and instead of estrogen telling myosin and actin to come together and be really strong to lift this load. We have a nerve response. So this is how we can build muscle and strength without the hormonal influence. The key thing you're saying here, I think, is that you need to be really focused on something that is really heavy. So you're describing something where you lift up the equivalent of these heavy grocery bags, which might be your deadlift. You're saying you do three of that, that already was hard. You have a little rest, you do it again, that's getting harder.

6:56You want to be able to do that five times. By the time you end up to the fifth try, you can't even do it three times. That's almost your test of whether this thing is heavy. And that is a sign that it is really heavy because otherwise, that's not very many times you're lifting. And what you're saying is that is really important because suddenly the loss of estrogen means that you did have these hormones that were really supporting, you know, your muscle maintenance and suddenly that's gone. And so unless you're doing this, you're going to basically be losing muscles where in fact, I think you're saying you really want to gain them for the benefits for the rest of your, in this sort of perimenopause and menopause state.

7:36Is that right, Stacey? Yes. And it is incredibly difficult to build muscle. So one of the biggest myths out there is that if I lift like that, Stacey, I'm going to get super bulky. That is almost impossible if you are perimenopause into postmenopause. So if we look at like train by Joan or train with Joan, she's a woman who's very inspirational in this space. She was almost obese when she's in her 60s, pre-diabetic, not healthy at all. Her daughter has been a personal trainer for most of adult life. So she got to this crossroads and she turned to her daughter and said, I don't want to go on medication.

8:18I need you to make me healthy. So now you fast forward 15 years and she is deadlifting on a regular basis, 80 to 100 kilos. She's bench pressing 50 and she looks amazing and she's super strong, but she is not bulky. If you are really wanting to put that bulk on, you have to do no cardiovascular work. You have to be in the gym for hours at a time every day, and you have to eat a lot. And I don't think women listening to this podcast for most general population is going to put that time and commitment in. You're saying that for a lot of people, there's actually a concern that actually I'm going to look in this way.

9:03I don't want to look and say you put all these muscles on and you're saying truthfully, it's not much of a concern. Exactly. And it's driven by a lot of our sociocultural constructs, right? So if you're going to go join a gym and you're a woman and you walk in and you say, hey, I want to get fit. I want to join your gym. The person who's taking you through the membership person is going to say, first, how much weight do you want to lose? And this is the list of our group classes. And there's the cardiovascular equipment. if you're a guy who comes in and says hey i want to get fit and i want to get healthy what can you do for me they'll say okay well how much weight do you want to put on muscle wise right and here's the trainer if you want a trainer and here's the squat rack and all the weights and go through all the hammer strength equipment it's just an automatic thing so we're conditioned to think that women need to gravitate to cardio to get the fit tone body that they want and men should be in the weight room, which is an automatic barrier when someone like me goes in and says, hey, wait, no, women need to be in the weight room.

10:09We need to be lifting. We're not going to get bulky. We're not going to turn into the Hulk. But it is so incredibly important for longevity. It's incredibly important for glucose control because the more muscle you have, the better you have blood sugar control. We see how it changes the diversity of our gut microbiome. So it improves brain health. and yes, you're going to look better. You're going to get some definition. You're going to be stronger. And it's just so important to break that sociocultural idea that women shouldn't be in the weight room because they're delicate flowers. I think we get a lot of questions from our listeners.

10:50Actually, men and women saying that the gym is really intimidating and particularly they're thinking about the idea of going over to the place where the weights are, which by the way, I understand because I think it's quite intimidating. when I go into somewhere new, because you can see these people hanging around with enormous muscles. And that feels quite scary as opposed to going on some sort of group class or treadmill or something like that. And so I think that is definitely true. What is your advice for anyone who is maybe, and I think you already talked about, first of all, learning to move, but let's say they've done that part, but they're maybe still feeling intimidated about the idea of going to the gym because they feel like they're not at that, maybe they don't feel good enough about themselves and they're not confident.

11:35What's your advice? The next step forward for that is a lot of women through COVID found the love for working out at home, right? So if we're looking at someone who doesn't have a history of lifting, wants to get more involved in it, learning how to move, then there are plenty of apps and online coaching and programs that we can turn to. If you want the group dynamic, you can go to something like Les Mills because they have strength development classes on demand or virtual classes that you can join. Then you can also look at someone like Haley Happens Fitness, where she is specific to training women 40 plus from beginners all the way through.

12:16So there's some really fantastic resources as that step to be in the comfort of your own home, getting direction and not having to have a lot of equipment. You can have a dumbbell and a kettlebell, or you can have a backpack that you're putting home things in to add some weight. So there's definitely that stepping stone to do the resistance training without actually having to front up and say, oh gosh, I need a trainer to go into the weight room kind of as my guardian in the weight room to show me what to do. I mean, I've been in a weight room since I was 16 for my sporting history, but I too can walk into a foreign place and knowing what the gym culture is and walk back and feel intimidated.

13:00And I am way older than 16 now, let's put it that way. So I completely understand that fear is real, but it's understanding how your body moves, becoming confident in your movements and looking at these stepping stones of how do I incorporate this resistance training in if I know I'm not going to go to the gym. And one of the good things about COVID is it opened up this whole parameter of how am I going to do my exercises when I can't get to a gym or I'm locked down and I can't get outside. So there's an influx of really fantastic resources out there. I think that's fantastic. I know, you know, the one thing I've also heard a number of other guests talk about exercise outside of this space talk about is, you know, often, you know, getting a trainer even for a short period of time for somebody who's new to this can be really great because it helps you to understand the things you're describing about how to move, gives you the confidence, can help you to understand what to do.

13:57And certainly at a personal level, I would say that was sort of transformational for me as someone who had never set foot in a gym basically until they were probably 40. That really enabled that transition, which I would have found very difficult otherwise. But of course it has a cost. But I think as you're thinking about what you're describing, this is for the rest of your life and the impact that it has on your health. I think that's also something potentially to think about. Yeah. And I mean, I've done some work with lower socioeconomic classes where there are women who are experiencing the same thing, like menopause is the aging thing.

14:33It doesn't discriminate. So we have women who are wanting to get healthy, but they cannot afford to go to a gym. They have kids, right? So they don't have of childcare, but we can go to a playground, right? We can go to a playground and we can use the equipment there as some resistance training. You have monkey bars for pull-ups. You have cargo nets for being able to pull yourself up and over. You have the seesaw that you can do with your kid. You can use it as kind of a jumping squat. So there's lots of things that we can do on a playground that incorporates the physical activity that we want that is also free.

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