Thriving at 40+
Evidence based recommendations on exercise, nutrition and lifestyle for peri- and postmenopausal women.
About 80% of my clientele are women aged between 40 and 50. Most of the time they have the same common problems:
- inexplicable weight gain ever since they hit 40,
- stress and poor sleeping habits,
- time constraints when it comes to daily exercise,
- unhealthy eating patterns.
Now, you might be nodding along as you’re reading this. The truth is, there are many hormonal and metabolic changes happening in this life period, which is often described as perimenopause. This transitional period toward menopause holds many challenges and you might find that and the exercise and weight loss tools that you used in our 20s and 30s just might not be as effective in helping you reach your goals. In this article, I will give ideas on how to create a powerful exercise and nutrition routine, which can help tackle the difficulties of this life stage.
Fitness and exercise in different life stages
We go through phases of exercising in our adult life. Back in my early 20s I loved my university’s aerobics classes, when we would sweat together with my girlfriends in the tiny sports hall of our faculty. It was about burning calories, doing 3-minute plank holds, and countless donkey kicks to “build that booty”. We were all at a healthy weight, we maximum wanted to shed a few kilograms. It was about the community aspect of exercise.
Then later, when the sedentary lifestyle of being a student and poor eating habits caused me to gain a bunch of weight, I discovered the gym. Obviously, at first, I was only interested in the cardio machines since my focus was losing weight. I would run for an hour on the treadmill, while dieting on 1000 calories (which then I would overcompensate on the weekend by drinking and eating fast food). However, it worked. Somehow, I always maintained a healthy weight even if my methods were not healthy nor sustainable.
But what’s more important, I started enjoying going to the gym. Me, who was never good at any team sports, really liked the solitary nature of a gym workout. I would download sample workouts from fitness websites and do them with 1-3kg weights in the corner of the gym. And again, I could see myself getting stronger, having more muscle, and being more “toned”.
It wasn’t until my late 20s when I had the financial means of hiring a personal trainer who showed me how to do those exercises properly. From there on I became a “gym girl”. It became such a passion for me that I decided to pursue a career in fitness as a personal trainer. During my education as a personal trainer, I discovered that I did so many things wrong earlier in the pursuit of losing weight and being fit. Even now, as I continue to educate myself in exercise science, I realize things daily that have been taught to me wrong or what I had thought was true before has been debunked.
Now I’m 32 years old and I can already tell that the things that let me gain muscle and lose fat back in my early 20s would not work at this point in my life. As we get older, we become more sedentary, have less energy, and move a lot less. This leads to a lower energy output, thus if we keep eating the same way we will put on a few extra kilos. The same goes for exercise. As a result of our sedentary lifestyles, by the time we’re 30, we all have postural imbalances, musculoskeletal issues such as a bulging disk or a “bad knee”. It just makes sense that we cannot expect to jump into a high-intensity aerobics workout without any consequences. We must respect our limitations when it comes to exercise and choose exercises that improve and nourish our bodies instead of destroying it.
Exercises for women over 40 – aerobic exercise
The World Health Organization’s recommendations for physical activity for adults aged 18-64 years include 150-300 minutes of moderate intensity aerobic activity. Aerobic exercise refers to activities that use large muscle groups and can be continued for longer periods of time. For example, jogging is considered an aerobic exercise, while sprinting is an anaerobic exercise. Other examples include walking, biking, hiking, swimming. The benefits of aerobic exercise on cardiovascular health are well documented. A 2016 meta-analysis concluded that even a slight increase in physical activity can lead to significant improvements regarding cardiovascular outcomes and the risk of diabetes. According to their calculations, when an inactive person implements the WHO-recommended 150 minutes of moderate intensity exercise and 75 minutes of vigorous exercise weekly, their risk for cardiovascular mortality will be reduced by 23% and diabetes mellitus incidence by 26%, independent of body weight.
In addition, aerobic exercise can be a great tool in increasing calorie expenditure, thus minimizing midlife weight-gain, which can be a sore-spot for many peri-and postmenopausal women. Also, there’s evidence of a positive relationship between physical activity and mental health. Numerous studies have proven that exercise, especially lower intensity aerobic exercise (such as walking, biking, swimming) are proven to decrease stress and anxiety, lead to better sleep and cognitive improvement. A 2022 study inspected how meditation combined with aerobic exercise improved the mental wellbeing of teachers during the COVID-19 pandemic. The participants carried out two one-hour sessions each week for six weeks consisting of 30 minutes of mental and 30 minutes of aerobic exercises with a heart rate between 90 and 140. The study concluded that the combination of meditation and aerobic exercise had a more significant positive effect on mental health than each component individually could have. The study also found that participants’ overall well-being was positively affected by their ability to sleep better after having exercised.
In my experience, taking up an aerobic exercise routine (for example jogging) is one of the first things people associate with when it comes to overall health and fitness. It might be because it’s accessible, there is no need for special equipment or a place to train, it can be done almost anywhere, anytime. However, studies, for example this 2016 review, have shown that people tend to largely overestimate their times spent with physical activity and underestimate the times spent sedentary. The study found that this was significantly more apparent when it came to self-reporting of vigorous physical activity. For example, we tend to have a skewed perception of the duration and the intensity of exercise. You might be going on a 20-minute jog in the park twice a week thinking that you’ve done enough for your health, but barely reaching 4-5000 steps each day as opposed to the recommended 10,000 steps/day. Although some studies have revealed that the 10,000 steps approach is arbitrary and does not necessarily meet the WHO guidelines for physical activity, I like to use it with my clients, because it is fairly objective and quite easy to implement. It also holds a sense of accountability. Imagine, you just got home from a long day at work, chilling on the couch, then you check your activity tracker/pedometer and see you’ve only done 3000 steps. The chances that you want to see that number go up will be higher than if you wouldn’t have an objective tool to measure your activities. Also, I’ve heard many times from clients that they’re active during the day, they walk a lot or they’re “running around” all day. Then they start using a pedometer and find out they massively overestimate their times spent “running around” and get on average 5-6000 steps. For this reason, I strongly recommend sedentary clients to track their steps and aim for an increase of 2-4000 steps compared to their current step-count. This method does not only increase their time spent with physical activity, but it is also more sustainable than sticking to a more vigorous exercise routine.
Exercises for women over 40 – strength training
In addition to aerobic exercise, the WHO recommends muscle-strengthening activities at moderate or greater intensity on 2 or more days a week for added health benefits. One of the greatest added benefits of resistance training is its ability to improve bone mineral density, thus reducing the risk of fractures caused by osteoporosis. Osteoporosis is a chronic disease that affect one in every three women over the age of 50. It is an extremely common condition and those who suffer from it are more susceptible to fractures caused by slipping and falling. Inadequate physical activity is a known modifiable risk factor, but recommendations tend to be vague about how different forms of exercise impact bone density (some having greater benefits than others).
A 2020 study looked at different exercise modalities including resistance training, Pilates and Tai-chi and found that the best exercise regimen for post-menopausal osteoporotic women is one that combines weight-bearing exercises with posture correction and balance.
Although there is evidence that weight bearing, high impact exercises such as running, jumping and dancing can be effective in strengthening bone structures, they can put a lot of stress on the joints especially in overweight or obese individuals. For them, weight bearing, low impact exercises, such as walking or stair climbing is recommended. However, strength training or resistance training can be a beneficial addition to these routines, since strength training does not only increase bone mineral density, but it also increases lean muscle mass which results in a higher metabolic rate and bigger calorie expenditure.
In addition, non-impact exercises such as yoga, Pilates or tai-chi can improve posture and balance, which is critical in terms of lowering the probability of falling and injuring oneself.
A well-balanced exercise routine for peri-and postmenopausal women could look like this:
Nutrition recommendations for managing weight before and during menopause
According to a 2022 article of the British Nutrition Foundation, dietary changes can help the management of common menopausal symptoms, “including vasomotor symptoms (hot flushes; night sweats), changes in bodyweight and composition, psychological symptoms (depression; anxiety; cognitive changes), sleep disturbances, joint pain, skin changes and urogenital symptoms”. There’s evidence that a diet rich in fruits, vegetables, whole grains, legumes, and healthy fats may improve negative symptoms of menopause. The study also showed examples of randomized control trials, in which both a lower-fat vegan and a Mediterranean diet led to weight loss and reduction of symptoms. These diets share two important characteristics: a focus on omega-3 fatty acid intake (such as almonds, flaxseeds, walnuts) and the consumption of mostly plant foods.
Some studies have also suggested that isoflavones (a phytoestrogen most found in soybeans, tofu, chickpeas, and lentils) can help mitigate menopausal symptoms, although evidence is inconsistent. Nonetheless, soybeans are a great protein source in diets low in animal proteins (for example vegetarian and vegan diets) and their consumption can be beneficial for other reasons, including lowering dietary cholesterol, increasing protein intake for muscle building or ethical reasons).
Women approaching menopause very often experience sudden weight gain, especially in the abdominal region, which can cause insecurities and body-image issues. Although weight gain, body fat redistribution and decreased muscle mass are all natural consequences of reproductive aging, calorie-restricted diets and a focus on macronutrient composition may help slow the process down. There’s some observational evidence that a reduced carbohydrate diet may help decrease menopausal weight gain. Other studies pointed out that a calorie-restricted diet decreased incidents of uncontrolled or emotional eating, however, the long-term effect on weight loss and eating behaviors in uncertain. As well as managing weight gain, a healthy diet can also help reduce anxiety and cognitive decline, as well as improve sleep quality.
However, if you’re just starting your weight-loss journey, remember it’s a marathon, not a sprint! Aim for sustainable, long-term healthy eating habits that help you lose AND maintain a healthy bodyweight and a healthy relationship with food. It can be very confusing and daunting to implement all the healthy eating advice you receive. My top suggestions are the following:
1. Find out your Total Daily Energy Expenditure. It is the number of calories you need to consume to maintain your current weight. It is a number influenced by many factors, the most prevalent are your basal metabolic rate, daily activity, and thermic effect of food. There are online calculators that you can use to find this number.
2. Determine your calorie deficit. If you need to lose weight to fall under a healthy BMI, you need to be in a calorie deficit (you need to burn more calories than you consume). To “burn” 1 kg of fat the body uses 7,700 calories. A healthy speed of weight loss is maximum 1kg/week, which equals to a deficit of 3850 calories weekly (550kcals/day). Your calorie deficit will be your TDEE-550 calories. Remember, this is a very broad recommendation, for specific weight loss advice, it is always beneficial to work 1-1 with a professional.
To get into your calorie deficit, you have many options, however, my preferred methods are calorie counting and the plate method. I choose these methods in my nutrition coaching because I find them less restrictive than others (such as low-carb, keto, paleo etc.). There is room for flexibility and less chance of developing a disordered relationship with food. For calorie counting there are multiple websites and apps in which you can track your food intake. In my opinion, calorie tracking is the most punctual in terms of achieving weight loss goals. It comes down to calories-in and calories-out. However, if you realize that calorie counting is not something that you are willing to do, the plate method can be a good alternative.
Source: https://diabetes.org/healthy-living/recipes-nutrition
According to the plate method we should fill half of our plate with non-starchy vegetables, the size of our palm should be protein, the size of our fist should be carb sources and starchy vegetables (grains, potatoes, corn). The size of our thumb should be the amount of healthy fats (oils, nuts, and seeds). This method can teach you the appropriate portion sizes for all three macronutrients.
And lastly, my +1 recommendation when it comes to changing your diet is focusing on addition rather than what you need to take away. Being in a calorie deficit can be uncomfortable and can lead to feeling deprived. You might need to put aside your favorite foods (pizza, chocolate, ice-cream etc.) and focus on more nutrient-dense foods. In my opinion, building your diet around low calorie, nutrient-dense foods that will keep you full and satisfied and adding “fun foods” in moderation to fit your daily calorie goals.
Examples can be adding fruits and vegetables to each meal. Having lean proteins in each of your meals (meat, fish, eggs, low-fat dairy, whey protein). Adding high-protein vegetables to your meals such as beans, lentils, and tofu. Having oats and whole grains as opposed to white bread, pastas, and rice.
The main takeaways
Women face many challenges when they enter their 40s and 50s. Menopausal transition can already be a difficult period, and finding the PERFECT exercise and nutrition routine may put an even greater mental burden on us. My intention was to give a hands-on, easy to follow exercise and nutrition guide that is backed by scientific evidence. However, the “perfect” exercise and nutrition regimen looks different for everyone, and you need to consider your own capabilities and limitations when it comes to exercise and diet. As a rule of thumb, you should build up your routines gradually by adding small, sustainable habits. In certain situations, it might be beneficial to work one-on-one with a professional to make sure your lifestyle change is carried out in a safe and sustainable manner.
