Menopause specific workouts - evidence based or misinformation?

Discover how embracing exercise in menopause isn't about one-size-fits-all solutions but about tuning into what makes you feel your best

Hiya 🦐! I’m Amy from The Subsnack. I chat about health and fitness through a weight inclusive, non BS lens helping you to navigate fitness free from fads, trends & misinformation. It’s all about fitness deinfluencing over here.

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Menopause workout programs have taken the social media fitness world by storm recently, with celebrities like Davina McCall being more vocal about fitness routines to address the unique needs of individuals going through perimenopause and menopause. In many ways, her advocacy and public sharing of her own experiences have helped bring attention to the benefits of exercise during menopause, making workouts more popular among those in these stages of life.

However, with this rise in ‘awareness’ also comes issues.

A commentary from RAND emphasises that historically, medical sciences have treated men and women as interchangeable subjects, with a bias towards men's health in funding and research. This approach neglects the unique health issues faced by women (and those navigating as non binary and trans), missing out on crucial scientific exploration and potential returns on investment. Diseases that predominantly affect ovary holders are dramatically underfunded, and even a slight increase in funding for this type of health research could unlock significant economic and health benefits​.

The Menopause Research & Education Fund also notes that despite the universal experience of menopause for those born with ovaries, the amount of money spent on menopause research is minimal. In the UK, less than 3% of the National Institute for Health Research's budget is allocated to studies related to menopause. This gap in knowledge and funding impacts the management of symptoms and the understanding of long-term health effects​.

Cue the snack oil.

The lack of comprehensive research into menopause creates fertile ground for a "snake oil effect," where the vacuum of validated medical advice and treatments is filled with a plethora of unverified, overhyped solutions. In this environment, products and remedies promising miraculous relief from menopausal symptoms can proliferate unchecked, appealing to the desperation of those seeking relief. Without rigorous scientific studies to separate effective treatments from baseless claims, individuals are left navigating a maze of potentially ineffective, misleading, or even harmful "cures."

The fitness industry is no different. Over the weekend I had an email from Girls Gone Strong - a personal training education company that claims to be evidence based and trial blaze for woman’s health. The email contained this:

Is there such a thing as a menopause-specific training program? And how is this supposed to differ from other training programs? That’s what this deep dive will look to establish.

The claim of this programs, and many others like it, is that it is designed for safety and maximum effectiveness (that takes into account all of the physiological changes that happen during menopause). Going as far as to say it is as ‘close to a magic pill’ as you can get. Which kind of makes my skin crawl a little bit.

It takes many hours to read and digest these research papers so for the price of buying me an expensive coffee, you can support this publication. Or alternatively - join my fitness community where we will be going over this research together on Tuesday - but a much more updated piece as this Substack was originally written and researched March 2024.

What is menopause?

Menopause marks the end of a woman's menstrual cycles, signifying the end of reproductive age, typically occurring between ages 45 and 55. It involves stages like perimenopause, where symptoms start due to fluctuating hormone levels, including hot flashes and sleep disturbances; menopause itself, confirmed after 12 months without a menstrual period; and post menopause, which refers to the years after menopause, where symptoms may ease but health risks linked to decreased hormone levels increase.

After menopause, women face increased health risks due to the decline in protective hormone levels, such as oestrogen. These risks include heart disease, osteoporosis, urinary tract infections, and urinary incontinence. Of course, weight gain. Changes in blood pressure, cholesterol, and triglycerides also contribute to these risks.

Research on exercising in menopause

Interestingly, non of the more recent big review papers mention anything to do with specific exercises and generally conclude that exercise - in general - continues to be good for our health even when huge physiological shifts are happening. But just for shits and giggles, here’s what some of them have to say.

This study (one of the most up to date and comprehensive) looked at how strength training helps women going through menopause. They checked out 12 studies with 817 women and found that regular strength training really does help improve things like muscle strength, physical activity, bone health, and even some hormonal changes when compared to doing nothing or other types of exercises. However, to keep these benefits, the exercises need to be kept up over time. They also found that more intense workout sessions are especially good for bone health and muscle strength. Other studies agree, showing that strength training can make a big difference in managing menopause symptoms.

This study highlights some challenges in researching the effects of strength training on menopausal women, such as few high-quality studies and various inconsistencies across the research. It suggests that future research should aim for larger, more uniform study designs to better understand the benefits of strength exercises. Despite these limitations, this review adds valuable insights into how strength training could support menopausal women, indicating a promising area for further exploration.

This review concludes that strength training is beneficial for improving menopause symptoms that affect muscle performance in general, physical activity, bone density and hormonal and metabolic responses such as heart rate, blood pressure and hot flashes.

BUT In terms of the appropriate type of strength training, the evidence is still unclear given that the same benefits are achieved by various types of exercises and with various accessory methods.

This detailed analysis from 2020 found that exercise benefits bone density in different areas of the body for postmenopausal women, but results vary based on exercise type and when in menopause the exercise occurs. It challenges previous research, suggesting exercises might be more effective in early rather than late post-menopause for bone health. The review calls for future research to standardise exercise types to better understand their benefits during menopause, noting that the complexity of how exercises affect bone density makes it hard to draw broad conclusions from meta-analyses.

The review highlights several limitations in current studies on exercise and bone density in postmenopausal women, including a small number of high-quality studies, risk of bias, lack of participant and therapist blinding, variability in study designs, and the diverse exercise protocols used. These factors make it challenging to draw firm conclusions about the best types of exercises for bone health during menopause.

This 2023 paper concludes that both resistance training and HIIT are effective exercise modalities for managing the physiological changes associated with menopause. The combination of these exercise forms, possibly alongside medical therapies like HRT, offers a comprehensive approach to mitigating the negative impacts of menopause on women's health. The review also included resistance band workouts, tai chi, and yoga, concluding that all of them were beneficial.

These findings underscore the versatility and effectiveness of various exercise modalities in promoting health and wellness among postmenopausal women, offering several options that can be tailored to individual preferences, capabilities, and health goals.

Girls gone wrong?

I think the most frustrating thing about the 12 week menopause strength training program is how is seems legit evidence based.

It gives 10 references to make you think, cool. There’s evidence. But only two of those references have anything to do with menopause. One of them is about pelvic floor muscle training (which is a good idea you should do that) and the other review they included ends by saying ‘no consensus was found on the most effective training frequency, intensity, or duration for optimizing bone mineral density changes, indicating a need for further research.’

Overall, this analysis underscores the complexity of designing optimal resistance training protocols for improving BMD in postmenopausal women, pointing to a need for personalised exercise programs that consider individual health status, baseline activity levels, and specific goals.

The absolute audacity to include that as a reference in a menopause specific training program. Face palm.

What’s more, is the warm up itself is so unnecessarily complicated and long.

If you’re short on time, looking at just this warm up isn’t going to help. It is completely unnecessary. Don’t get me started on foam rolling and fucking connection breath.

Working out during menopause

Look, exercise is good for us and research consistently shows that to be true for most of the life stages, from being little kiddos running around in the play ground to being old fuckers with a purple rinse plodding around Tesco.

Exercise can support our bodies in a variety of ways.

This review found that regular exercise significantly boosts how happy and confident people feel before and after menopause. It highlights an important area that hasn't been much discussed before: how exercise affects the mental and physical health of those going through menopause.

Think of exercise during this chapter of life as your personal feel-good journey - just like it should be in any other life stage.

Forget the idea of "menopause-specific" workouts—they're definitely not a thing. Find what makes you tick. Consider what goals spark excitement, how much time you're eager to spend, and the resources you've got at your fingertips. It's all about tailoring your moves to fit your joy and lifestyle.

Dive into activities that you’re interested in.

I’d love you to share this with someone if you found it useful. Thanks

Further reading for coaches and nerds

Shojaa M, von Stengel S, Kohl M, Schoene D, Kemmler W. Effects of dynamic resistance exercise on bone mineral density in postmenopausal women: a systematic review and meta-analysis with special emphasis on exercise parameters. Osteoporos Int. 2020 Aug;31(8):1427-1444. doi: 10.1007/s00198-020-05441-w. Epub 2020 May 12. PMID: 32399891; PMCID: PMC7360540.

Kemmler W, Shojaa M, Kohl M, von Stengel S. Effects of Different Types of Exercise on Bone Mineral Density in Postmenopausal Women: A Systematic Review and Meta-analysis. Calcif Tissue Int. 2020 Nov;107(5):409-439. doi: 10.1007/s00223-020-00744-w. Epub 2020 Aug 12. PMID: 32785775; PMCID: PMC7546993.

Capel-Alcaraz AM, García-López H, Castro-Sánchez AM, Fernández-Sánchez M, Lara-Palomo IC. The Efficacy of Strength Exercises for Reducing the Symptoms of Menopause: A Systematic Review. J Clin Med. 2023 Jan 9;12(2):548. doi: 10.3390/jcm12020548. PMID: 36675477; PMCID: PMC9864448.

Sternfeld B, Guthrie KA, Ensrud KE, LaCroix AZ, Larson JC, Dunn AL, Anderson GL, Seguin RA, Carpenter JS, Newton KM, Reed SD, Freeman EW, Cohen LS, Joffe H, Roberts M, Caan BJ. Efficacy of exercise for menopausal symptoms: a randomized controlled trial. Menopause. 2014 Apr;21(4):330-8. doi: 10.1097/GME.0b013e31829e4089. PMID: 23899828; PMCID: PMC3858421.

Nguyen TM, Do TTT, Tran TN, Kim JH. Exercise and Quality of Life in Women with Menopausal Symptoms: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Int J Environ Res Public Health. 2020 Sep 26;17(19):7049. doi: 10.3390/ijerph17197049. PMID: 32993147; PMCID: PMC7579592.

Marsh ML, Oliveira MN, Vieira-Potter VJ. Adipocyte Metabolism and Health after the Menopause: The Role of Exercise. Nutrients. 2023 Jan 14;15(2):444. doi: 10.3390/nu15020444. PMID: 36678314; PMCID: PMC9862030.

Kulak A, Toros T, Ogras EB, Etiler IE, Bagci E, Gokyurek B, Bilgin U. The Impact of Sustainable Exercise on Self-Efficacy and Life Satisfaction in Women before and after Menopause. Behav Sci (Basel). 2023 Sep 12;13(9):759. doi: 10.3390/bs13090759. PMID: 37754037; PMCID: PMC10525491.

https://www.rand.org/pubs/commentary/2022/02/underfunding-of-research-in-womens-health-issues-is.html

https://www.nature.com/immersive/d41586-023-01475-2/index.html