Ep 46: The most important exercises after menopause

Michael Dermansky Hi everyone and welcome to the show that helps you become more confident in your body so can keep doing the things you love. My name is Michael Demanski, I’m the Senior Physiotherapist and Managing Director at MD Health and I’ve got a special guest today, David Smith from Absolute Health and Performance. We have spoken on this topic, think this is the fourth time on the show, I’ve got to check but I’m pretty sure this is the fourth time we’re a conversation. Welcome to the show, it’s great to talk to you again because I know it’s always a fantastic conversation when we talk about different topics.

David Smith Yeah, no, thank you for having me again, Michael. And this one’s a very important one, and thankfully one that the world’s talking a lot more about. So it’s good to help inform a few more people.

Michael Dermansky the topic we’re talking about today is the most important exercise after menopause or during menopause, strength training. It’s something I think is very important and I know it’s two men talking about this topic as well but it’s still something we see on a daily basis that’s not done enough but can have a massive impact on people’s lives.

David Smith Yeah, 80 % of the Australian population are not getting the required strength work in and it just impacts you even more and more as you get older, particularly for women, so an important topic to talk about.

Michael Dermansky So let’s get into that first question as well. In both our centres we see many perimenopausal and menopausal women wanting to work on their fitness and their health. From your perspective, what’s the most important part of that health they need to work on and why?

David Smith In a short answer, it’s muscle strength because that just underpins everything else. When you’re younger, maybe it’s aesthetics, but we’re really talking about function and resilience. During perimenopause and menopause, women experience an accelerated loss of muscle mass, strength, know we’ve spoken about bone density in the past, due to the decline in estrogen and other factors. That loss doesn’t just affect how strong you feel, but it impacts metabolism, blood sugar control, joint health, balance, confidence, and we know more and more now how it’s impacting cognitive health. Muscle is essentially a metabolic and hormonal organ. The more muscle you have, the better you tolerate stress, the better you regulate your blood glucose, you protect your bone, ultimately it’s about maintaining independence as you age. Strength training is less about fitness and more about future-proofing your health, your energy, your quality of life. We see day in and day out at Absolute Health and Performance that the women who feel best long-term aren’t the ones that are chasing weight loss but they’re the ones that are getting stronger. So it’s muscle and strength. It underpins everything.

Michael Dermansky Well, let’s go back to that. mean, what’s the physiology behind what happens? You know, why do we lose muscle mass? Why is it so important to maintain that muscle mass as well? I mean, we’re going to talk about this between you and me here too. But from your perspective, what’s so important about maintaining muscle mass as well? You say it’s a metabolic organ. What does that mean to the person?

David Smith Yeah, so muscle is not an inert tissue that just moves your bones and gets you to stand up out of a chair. It’s very physically active day in, day out on metabolism, on processing byproducts, on processing good byproducts and bad byproducts. It plays a significant role in glucose metabolism. if pre-diabetes also becomes a risk as we get older, it’s a pretty critical role in that. And during menopause and the perimenopause obviously hormones change, recovery capacity changes and stress tolerance changes. Metamenopause is not just a reproductive transition but it’s a whole body neurological and metabolic shift and muscle plays a really critical role in that. That that low estrogen each doing means that women don’t respond to training stress is the same way they did in their 30s and 40s. You’re often less resilient to high volumes of moderate intensity work, more sensitive to poor sleep and slow recovery. And all these challenges physiologically, if you don’t have muscle to support it can can really, you know, backfire your quality of life. We see the approaches that women will then use when they’re having challenges, whether it be weight gain or energy is that they do more cardio or more high intensity efforts, more classes, and this can significantly backfire because of those other reasons without each student assisting. And you end up with increased fatigue and joint pain and stubborn weight gain. When you get older, training needs to become more intentional. It’s less about the volume and more about that really high quality strength work that stimulates that muscle and bone growth. because of the stress responses or the reduced ability to handle stress, you need to have more respect for recovery. And again, the more muscle you have, the easier life is, the easier it is to recover from things. And muscle plays a really important role in the types of conditioning that you should be doing at this stage of life, like the sprint interval work, short, sharp, and really hard. The goal isn’t about all the time training harder and just doing more volume, but it’s about training smarter, training better that’s gonna stimulate that muscle growth, because it impacts our brain, it impacts our heart, it impacts our bones, and everything else that we look for in quality of life.

Michael Dermansky I mean it’s a metabolic active tissue. Muscle is your body’s storage of protein. So when all the enzymes, the hormones that we have as well, all of them require protein to be able to be present and to be able to do things as well. And so if you don’t have good amount of muscle mass as well, your body is going to look for these reserves. It’s going look for these reserves about reserves and trying to grab them when it needs to as well. if less you have, the less you have the ability to repair. And so it’s going to change the way your body functions as well. The other thing that David said as well about pre-IbDs as well, your muscle mass is one of the only things we have in terms of controlling our glucose tolerance. So we can eat different things as well. That’s going to affect how much coming in and coming out, but muscle has sensors on the core, glute force sensors. And so they, what they do is they grab insulin and glucose and they pull it out of the bloodstream as well.

And so there’s two things that affect that too. So as you grow more muscle mass as well, you’ll normally have more volume where those glute force sensors can be, but there’s more of them on the muscle as well, and they’re more effective. So the biggest thing we have the ability to control in terms of our glucose, my memory tells me glucose tolerance is our ability to control to some degree how much muscle mass we have. because that allows more of the glute force senses to be there to be able to do their job properly and improve our glucose tolerance. As we lose more muscle mass, that goes down. So ability to metabolise becomes less. So it makes it even harder to be able to do things, to be able to lose weight because you can’t metabolise as well. So we can’t control our blood sugars as well.

David Smith And. The amino acids that have been bought, you know, the breakdown of muscle tissue is critical for when we get sick, when we get ill. You know, as we get older, it’s not a gradual decline. You’re to have these very large events. There’s high risks of cancers and a range of different chronic diseases. And your ability to tolerate and survive and get through those things is directly related to your amount of lean mass and therefore amino acids that can help you to provide the fuels to whether you’re dealing with chemotherapy therapy or surviving burns or even getting over the common cold. The muscle is so critical for so many different reasons.

Michael Dermansky Absolutely. I mean, in terms of what David’s talking about too. So your body doesn’t say like there’s 23 essential amino acids, amino acids as well. Your body says all proteins have a certain volume of each one of those. And so when it goes and says, okay, I’m going to make this protein, I don’t have this Lego block. So I’m just going to use this Lego block. It doesn’t work that way. If it doesn’t have a Lego block, it just stops. And so then it goes to where’s my reserves of Lego blocks, my muscle mass.

And it just breaks it down because it’s important to have enzymes, have hormones and so forth as well. And so the less muscle mass you have, the less ability you have to create these as well. It has to keep breaking down your reserves. It makes you more more vulnerable. And this is why adequate protein intake is so important, especially as you get older. And two, that we have the stimulus for those areas to grow. When we do strength training, it gives the body a stimulus to grow. I am asking you to do more than you’re capable of doing. I need to go and change.

You can still do that in the 90s. No good reason why you can’t. Your body will still respond to stress and change. But we have to then provide the right stimulus, which is the appropriate amount of strength training, to be able to make that change. So we have those reserves so your body can actually function properly.

And the other thing that we’re talking about into the estrogen as well, estrogen has a direct effect of the volume of your tendons. So the way muscles attach on the bone is not directly through tendons. So tendons take load and so forth. What estrogen does is makes those cells in those tendons bigger. It brings fluid into them too. As you start to go through perimenopause and menopause, the amount of estrogen becomes less. So those tendons become thinner.

And so their ability to tolerate load, which is what David was talking about in terms of recovery, becomes less. So this is why hip problems are really common in perimenopausal women because the tendons are thinner so that you can cope with it, can cope with it. Now the tendons are thinner as they take the same amount of load, it can’t tolerate it the same way. So tendinopathy is super common in perimenopausal and penopausal women as well. And then what’s a classic advice? Oh, it’s sore. I’d better rest. Tendons they become even thinner with rest. And so it becomes a self-fulfilling prophecy that makes it even harder to recover. Because you have a thinner tendon that can’t tolerate load. Then you rest it, the muscle becomes thinner, the tendon becomes thinner. You start to load it again, it doesn’t get any better, it gets worse then. And then the classic on top of that too, I think we do a cortisol injection into that and see how you go. Cortisol injection is a catabolic steroid. It breaks tissues down. brings it into the bloodstream. It’s released with adrenaline so that you can run away from the dinosaurs. And so it’s meant to actually give you fuel to be able to then run away. You just didn’t do it even further. And so then you’re making it harder and harder and harder and harder as well. And so they start with hormonal changes, then they change further with activity as well. And it makes it harder to able to tolerate load and be able to do more things as well. So these are, there are cascading effects of things that all come together at the time.

David Smith Yeah, absolutely. It’s not just about muscles and bones. It’s so much that goes on at this stage of life.

Michael Dermansky Yeah. And I just want to touch on strength training in terms of, as you said, effects of cognitive inability. When you do strength training, there is a 70 % effect on risk of strokes and heart problems as well. Because what strength training does is improves the calibre of the thin blood vessel cells called the endothelial cells. They are super, super, super, super important of the quality of the blood vessels and whether they form plaques or not. So endothelial health is a major, major part of heart health. Strength training has a direct response on that. You don’t work on it, it affects the quality of those blood vessels as well.

David Smith It’s often not our cardiovascular health that catches us out later in life.

Michael Dermansky No, no, it doesn’t. Yeah, absolutely. It’s that thin, small blood vessel health. That also makes a massive difference as well. And this is why strength training is so, important as well. We used to think, cardio, cardio, cardio for blood vessel health. Actually, strength training makes a bigger difference.

David Smith absolutely.

Michael Dermansky You talked about the importance of recovery after training. Why and what does that even look like?

David Smith as I said, in midlife, especially during menopause, with the reductions in oxygen, your ability to tolerate stress is reduced and adaption happens after training, not during it. And training is a stress and the recovery process is where all these benefits happen from. With menopause, there’s often poor sleep, stages of life, there’s a high work pressures, caring roles. particularly perimenopause, the hormonal fluctuations and if training is just layering on stress for the sake of stress without enough recovery, you’re not going to get fitter. You’re not going to put on that muscle tissue that you need. You’ll feel flatter. You’re more inflamed. You’re more exhausted. Obviously adequate sleep is number one and it can be a very big limiter for people going through perimenopause due to the all too common sleep disruptions. You’ve already highlighted the critical impacts of protein intake to make sure it’s enough to support muscle pair, which is often under dosed, particularly in women later in life.

Then it’s about how you structure your weeks as well. You need to space your sessions properly. It’s not about high intensity, high volume strength training every day. It’s spaced appropriately to allow recovery. You need to look at low intensity movements, know, just walking, doing some mobility, doing some stretching stuff that feels regenerative. And then on the more macro level, you need to consider deloads and auto regulation. So lighter sessions, lighter days, lighter weeks when needed. And it needs to be well planned out. know, recovery is not a passive process. it should be a really strategic part of your program as important as what sets and what reps and what exercises you’re doing. It’s where does the rest and where does recovery take place in your weeks, in your months, in your years.

Michael Dermansky It’s interesting how the shift has happened in the last 10 years that we’ve really learned about the importance of recovery. And the best athletes in the world do not do volume, volume, volume, volume, volume. They actually adequately plan their recoveries that are important as well. mean, the most famous case of that is Ron James as well. He’s got one of the careers in NBA history as well because his recovery is so… so so planned so when you know sorry

David Smith million dollars a year I hear he spends on it. A million dollars a year I hear he spends on his Just Use recovery processes.

Michael Dermansky Just recovery was I’ve heard that I’ve heard the same thing as well. But I mean, what does that mean in his life? And million dollars he spends is, you know, 200 million dollars as well. It’s a very, very different balance equation as well. But it’s not a passive process because as you said, when you exercise, you create a stimulus, you give your body a reason to change. You’re trying to go a little bit beyond what its capabilities are and and muscles and tendons and connect to show that a breakdown. That’s what you want. And then you need.

David Smith It’s $200 million on the other side of it.

Michael Dermansky need that to recover. your body will then make those adaptations when you rest. So that 24, 48 hours afterwards as well is where your body during that sleep time will say, hang on, I’ve got to build more stuff onto this to be able to cope with better loads. So the reason why you rest is so that when you exercise in the next time, we can go that little bit further. And the time after just a little bit further to keep pushing you on that boundary line. If you don’t have that rest period as well, there’s volume, volume, volume, volume, it plateaus. We just, we haven’t had the ability to change that we can actually push you more the next time.

David Smith Yeah, it needs to be a very well planned progressive overload. It’s not just about more all the time as well because as I you are more sensitive to the stresses, you are less influential to the adaptions of exercise, there’s less room for error. You do need to be a little bit smarter about your planning with regards with what does your training load, volume, everything look like and when you are planning your recovery processes.

Michael Dermansky That’s right. Yes. Yeah, absolutely. So as you said, have those days where, you know, this is a day where you just do walking. Today, it’s not a passive recovery. It’s doing something, but it allows just fluid to move through the joints. joints need fluid to move through them by movement as well. You have adequately planned your recovery food after that too, because you need to be able to nutrients to be able to fuel that recovery and growth as well. And all of that needs to be, you can’t just, you know, I’ll just eat something as well. having adequate amounts of protein as well. Ideally, the recommendation these days are at every meal so that you have the ability to recover all the time as well. As you said, stretches, just those easier load-de-load days, they’re not you being slack, it’s you thinking about what you need to do to be the best next time. And the other thing that you talked about David is that listen to your body. If your body tells you, am not right on this day to do this load, then you back it off. You’re not doing less that day. You’re not being slapped. If your body’s telling you, you know what, today I lifted 50 kilos, but I don’t feel that way today. It’s okay to go down to 40, 30, whatever that needs to be that day so that your body has the right load on the day and we’re not then pulling you backwards from an injury. should never have happened in the first place.

David Smith We adapt to internal stress responses, not the load on the bar. that can change. You chase a stress outcome for the training sessions and don’t worry about what the number looks like.

Michael Dermansky Yeah. So just listen again, we’re having a fantastic discussion today with David Smith from Absolutely Healthy Performance as well. We’re talking about a very important topic that two of us see every single day on a very regular basis, the importance of exercise after menopause and why strength training is such an important part of that too. We’ve talked about the physiological effect, we’ve talked about the metabolic effect. talking about the importance of recovery and both having that as a regular part of what you do and as a plant part of it too because those two parts, stress and recovery, are equal parts of an important training program as well. So if you’re a client in your mid-50s, you’ve put on weight that you don’t like, you’ve that you’ve gone to the doctor and said you’re pre-diabetic and you’re always tired. What does a great exercise routine look like? And what are realistic time frames of change that you can think of, David?

David Smith Yeah, I it’s a challenging time of life as you get older and diabetes and other risks are more prevalent and it’s not about just trying a harder problem, pull your socks up, but getting the right systems and structures in place is important. at a high level, need to be doing that, we always talk about. Strength training, at least two to three times a week, should be full body, should be emphasized large compound lifts, it doesn’t need to be fancy, it doesn’t look to look good on social media. It needs to be progressive but conservative to respect the fact that you’re fatigued as well. You want to do low intensity aerobic work and that’s most days and I just mean it doesn’t need to be structured, just walking and playing with the kids, just having fun. This is really important because it can support insulin sensitivity and also can calm a stressed nervous system.

When you build appropriate capacity, don’t straight away, but really short bursts, higher intensity efforts, but as I it’s going to be very well spaced with respect to the tea that we’ve spoken about previously. But time efficiency is key. At that stage of life, things are really busy. You need to be able to fit this all in and ultimately probably three to four hours a week total of everything fitting in there, not 10. You don’t have these unlimited opportunities. But that can create huge changes. two to four weeks, you most likely will have better energy. It’ll definitely impact sleep. probably already start to feel less joint pain, less discomfort and aches and pains. By six to 12 weeks, that’s when you probably actually start to see the realistic strength gains because we’re then having strength change, potentially putting down new muscle tissue, we’re likely to see some improvements in your glucose control, which is obviously for this individual pre-diabetic, very critical. And you can start to impact the waist measurements and the things that you said this person was unhappy about.

In three to six months, your life could be completely different. Meaningful body composition change, Improve confidence and consistency ultimately, you know, if you by that time you should have a great routine set and that is more important than anything else And yeah, you can there’s a real chance you can have those reduced health with maskers where there’s an opportunity to reverse that pre-diabetic diagnosis like it’s not a Stuck thing you can do things to change that The key is you’re not chasing fast waist loss, but you’re chasing Metabolic health the weight gain plays a role and of course needs to be addressed but if that becomes your sole focus, generally you’re going to be doomed to failure. But look, in six months time that person could dramatically change their life.

Michael Dermansky I think the time frames you’re talking about here is super important because you don’t go to the gym once, twice and expect to get great outcomes as well. Those are realistic time frames. think three to six months is a very important figures because it’s amazing how fast three months passes, but it’s amazing how fast you think it’s going to take at the start. Oh my God, three months so far away, but it’s not. Once you start setting up a routine, takes about a month to sort of get a routine right. But once you get into a routine, that three months goes like a flash. And your life is so different three months down the track than it is at very start. As you said, David, it’s not hours and hours of training. It’s half an hour, half an hour, half an hour, and then some walking in between as well as a good quality rest. And three months later, you’re looking back and like, I was worried about this three months ago and now this is my life and I do feel a lot better and I can do more and I’ve got the more capacity and then you can do spontaneous activity with your kids and not ever think about it and it’s huge but three you know minimum three months as you said three six months because it takes that long to build our muscles well and especially because the rates a bit slower you know the first six weeks seven weeks of exercise program your neurological adaptations you haven’t actually built the muscle much yet you’ve got more water in the cells you’ve got more efficient cells. You’ve got more nerves that have gone into the muscle groups that make them work more effectively, but the muscle mode hasn’t grown yet. It’s just too early. And then at three months, you start to see that growth and a continual growth so that your metabolism improved because those glute force sensors is more often as well. Your muscle mass is better around the joints. can take more load. You know, they’re really good and really proper timeframes as well. And so when you have those numbers in mind, I’m going to build a routine. I’m going be consistent. Amazingly happened without worrying about the day to day changes in my life. Really, really big change as well. You might see stuff at the start or the beginning. Um, particularly if you done things in your product, tech, tech is more adequate and your sleep better, but they’re not what you’re really looking for that three to six months change. There, there are really healthy, healthy timeframes that you can really see good changes. It’s going to make a big difference in the long term for into years in the future rather than short term problem you think you’re dealing with at the time.

Biggest barriers. What stops people and women in their 50s and 60s seeking help and doing regular repudiate exercise? Because I hear both sides of people, ones that are consistent and the ones that just struggle to keep consistency. What do you hear and what can they do about it?

David Smith Yeah, there’s lots of things at play there. Over the last 20 years, we’ve interviewed a lot of women in this demographic because we want to help them and for us to understand better, we’re never going to personally go through that stage. That’s important. But I think number one is fear. And under that, can be fear of injuries, fear of being judged. Think about women in their 50s and 60s now. They grew up in the aerobics era. Stripes are thin, cardio only, the gym is not their place. That sort of ingrained narrative can be really hard to overcome. For anyone as we get older, there’s always that fear that they’ve left it too late. Lots of conflicting information, diet cultures, it’s a nightmare to navigate. The social media extremes and influences, selling things that they shouldn’t be selling. You you’re told just eat less, move more, it’s that simple.

By the time you’re in your 50s and 60s, you’ve probably had some bad experiences, know, over training, you’ve had pain, you’ve had injury. know particularly for women, you’ve just been ignored and dismissed, gaslit. And I think ultimately there’s this big identity shift that takes place, you know, maybe they don’t recognize their body anymore. The loss of confidence and trust in themselves. lose our physical self-efficacy at the fastest rate in our midlife. And without self-efficacy, the drive for action is diminished, and so nothing takes place.

So what stops most women is not this motivation element, but it’s uncertainty. They don’t know what’s safe, they don’t know what works anymore, who to trust. But I think ultimately if we can help educate people in doing things like this, women feel educated, if they feel supported and seen, then the consistency takes care of itself and when consistency starts to layer on, that’s when no matter what age you are, you can start to have great success in your health changes and putting on muscle and getting stronger and feeling better in yourself.

Michael Dermansky I think that’s the biggest thing that you just talked about is that fear and anxiety of you know, what do I start? What do I do? Am I going to be judged? You know, I feel invisible and you know, there’s no one, no one’s gonna believe this into me as well. And you know, and the shame of what, know, I put on weight, I don’t have good control over this as well. I don’t have time for myself and you know, I shouldn’t be able to know better. I’ve been told that it lets them do and do more, but I’m doing that and I don’t know what’s going on. that’s a really tough psychological circle to navigate around. Yeah, very demotivating as well, but as you said, if you have good quality professionals looking after you as well and form a good, consistent routine, the rest of it starts to take care of itself. Because your body will respond to all of it quickly. You have to do it, it, and your body will just adapt.

David Smith very demotivating. Daniel to do this alone.

Michael Dermansky So it’s a really big deal. yeah, often get advice from people that know what they’re doing. They’ve got experience in exercise physiology, strength conditioning. I mean, I’m a physio and that’s our area of expertise as well. So if you have a good quality professional that you trust, that helps you set up a regular routine of a good quality training and realistic timeframes. the results will take care of themselves without having to worry about the session by session by session change, which is a guaranteed way of filing that.

David Smith People always underestimate what they can achieve in three to six months but significantly underestimate what they can achieve in ten years. You need to be thinking long term.

Michael Dermansky Yeah, absolutely. You look back in six months and think, that was me then and now, it’s me now. All was very doable, but realistic timeframes, consistency, consistency, consistency. Can’t emphasize that enough because that is the biggest gain. And then you’ll see change as well. it’s nothing wrong with seeking professional help. And sometimes it does take a few you goes to find the right person as well. Some people joke great with me, some people joke great with David, some people they won’t like me, they won’t like David and that’s okay. You know, we’ve lived through that too, we’re okay, our ego’s fine. Yeah, exactly. And there’s nothing wrong with that too, if you find something you can trust that’s giving you a good structured routine and allowed you to form consistency, the changes will happen as well.

David Smith Okay, thick skin, yeah.

Michael Dermansky without having to overthink it and make it a little complicated. Before we finish up any other comments you want to talk about this really important topic that luckily is being talked about more and we understand a lot more than we did 10-15 years ago.

David Smith Yeah, look at this. It’s menopause is not the beginning of this drastic decline that’s inevitable. it’s a transition that requires a different strategy, of course, there’s different training approaches and things you need to be more respectful for. but yeah, look, I run regular webinars on the topic and the audience member put it better than I ever can. So obviously someone that’s experienced in themselves will deliver a much better message. And I think the way this woman framed it is that you need to stop chasing to get back or fighting to get back to an old version of yourself. yourself, you’re old buddy, but focus on creating a different, stronger and better version. She described herself as like, I’m finding my version 2.0 and that’s a better place to be.

Michael Dermansky Yeah, and you know, it’s interesting because we have a lot of clients now, but the first time they started in their lives doing strength training is in their 50s and their 60s as well. And the crazy part about it is that they’re finding they’re fitter, stronger, and they can do more in their lives in their 60s than they could in their 30s and 40s. Because now they’re much more deliberate about what they’re doing. They’re much more structured about it too. So they’re not chasing, as you said, who they were and doing more and more volume.

They’re listening to their bodies and all that, consistency to do its job. And their life is better for it too. It is wonderful to think about that you’re in your 50s, 60s and 70s, you can have a better life than you could in your 30s and 40s. And we wouldn’t have had that in the It’s amazing. Yeah, it’s lovely to think about. And I’ve seen on a daily basis in the last 25 years that people in their 60s and 70s are doing more and having better lives.

David Smith That’s a good thought, isn’t it? I’m in my mid-40s, it’s lovely to think about.

Michael Dermansky than they did in their 30s. And so it’s just being smarter and very deliberate about what you do will make a big, difference. David, thank you very much for your time as well. It’s always a fantastic conversation as well because the information is great and it means we’re getting a very important message out to the public.

David Smith It’s always a pleasure Michael and yeah obviously a very important topic that impacts 51 % of the population. So pretty important to help them, educate them and obviously get in touch with us. We’re here to support them.

Michael Dermansky Great. Thanks for your time David as well. I’m sure we’ll be talking on another topic soon in the future.

David Smith Absolutely. Thanks Michael.