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Today we're talking about an important stage in every woman's life, menopause. If you're going through perimenopause or menopause and finding that you're exercise regime isn't working like it used to, then you must watch this episode because today we're joined by a world leader in female exercise and nutrition science, Dr. Stacey Sims, bestselling author of next level. Her groundbreaking work tailoring fitness regimes to suit the unique needs of women at all life stages has transformed the way that many women exercise during these years. In this episode, you'll learn how to make crucial adjustments to your exercise regime that will keep you fit through menopause and beyond.

Stacey, thank you for joining me today.

Thanks for having me on opposite ends of the world.

Absolutely. So I have to say there are very few people that I would wake up long before my normal wake up time in order to speak to. But you have been one of our most requested guests and it was a little hard to arrange, as you said, since you're in New Zealand, which is sort of a long way from everywhere. So I'm delighted to be able to do it.

Yes, thanks. I'm very honored that you woke up early and giving me the time.

So, Stacey, we have a tradition here on this podcast where we always start with a quick fire round of questions from our listeners. And we have some very strict rules, which are that you can give us a yes or a no. Or if you absolutely have to, you can give us a one sentence answer. Are you up for that?

All right, let's do it.

Brilliant. And we know that the more phds people have, the harder they find this. So we're going to give it a go.

Okay.

When thinking about exercise, are women the same as small men?

No.

See, it wasn't so hard.

Does menopause make it harder to keep your muscles strong?

Yes.

Can exercise help with common menopause symptoms.

Like hot flashes and mood swings?

Yes.

Should women keep the same fitness routine.

During menopause as compared to before?

No.

Is weight gain inevitable during menopause?

No.

And should women exercise on an empty stomach?

No.

All right.

And then finally, and you can have a couple of sentences. You don't need to just have a yes or no.

What's the most common misconception about exercise and menopause?

That women should do a lot of zone two, moderate intensity exercise.

And that's wrong.

That is pretty much the exact opposite of what they should be doing, I.

Guess maybe just to set the context. I'm 49, which means that a lot of my female friends have been talking about perimenopause and menopause. And I would say particularly over the last couple of years, because there's been a big shift, I think, about the way in which women are willing to talk about that more publicly. And I've said on this show before that I contrast that with my mother, for example, who never said a single thing about it. And I can't remember as a child anybody talking about menopause at all. So there's been this really big shift, which I think is really exciting and positive, but I think it also means not just for men like me, but I think for everybody, there's this extraordinary sort of gap of understanding and knowledge. And we had a lot of listeners contacting us saying that they're wanting to understand. They're obviously mainly in their forty s and fifty s, and they're saying beyond taking hormone replacement therapy, what else can we really do? And what is the latest science? Because there's such a lot of stuff out there that seems sort of not maybe very credible or contradictory.

And Stacey, as I've already said, you were one of our most highly requested guests because this is this topic that you study particularly, and this is why I got up so much earlier than I normally get up in order to be able to make this happen. Could we just start with what happens during menopause and then maybe take us into how that impacts a woman's physical fitness as well as just their body overall?

Yeah, for sure. I really like to start these off with defining what menopause is because people think menopause is this big range of time points. But when we talk about menopause, it's actually one day on the calendar and it's the one day that marks twelve months of no periods. The time after that, the day after that is postmenopause, and you have early and late postmenopause, and the time before that is perimenopause. And this is where we see all the symptomology and body composition changes and all the things that people typically say, oh, it's menopause. Perimenopause is the most interesting, I guess, time point of differentiation between how a man ages and how a woman ages because we see a lot of the aging and longevity literatures based on this linear trajectory of age.

So like a sort of steady change every year.

Yeah, exactly. But when we're looking at perimenopause women age very differently during this time period because it depends on how the ratios of estrogen progesterone start to shift. Because when we're in our reproductive years, we have primarily a regular cycle every 28 to 40 days. Then you have times when estrogen progesterone are low, and then you have ovulation. Estrogen 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 an ovulatory cycles. So 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. And these hormones are more than just reproductive hormones. They affect every system of the body. So if we think back to puberty and we have young girls who are notorious for having massive mood changes and body composition changes and problems sleeping and all the things that we talk about with puberty, we're on the other end of that as these hormones start to wind down.

I'd actually never heard that analogy before.

Yeah. So when we're starting to see all these shifts and changes and people are trying to, unfortunately, exercise more or they're eating less or they're trying all these fad diets, it's not going to work, because it's not about metabolism per se. It's not about the strength of your contraction. It's about how these hormones are affecting the basic cell of the muscle fiber, how your body's responding to glucose, how insulin is responding. So we have to really look, take a pause and say, you know what? I need to find an external stress, primarily through exercise, that is going to cause the body to respond in the way these hormones used to allow the body to respond.

If I understand what you're saying is a lot of these changes are happening in this perimenopause, which is an extended period of time before menopause, where you're sort of saying it's a bit the reverse of what happened when you started to go through puberty. And because suddenly of these changes in the hormones, which were on this sort of regular cycle but now are sort of all over the place and changing your body has sort of been affected at the cellular level. And so the stuff that all just worked before just doesn't work in the same way. And then I think you're about to say, okay, what does that mean about what you should do differently?

Yeah, exactly. So as much as we hear the 150 minutes of moderate intensity activity, when we look at that kind of stress, because when we're exercising, we're putting our body under stress and we adapt to that stress, and that's how we become fitter and stronger. But at this point in time, that moderate intensity is too easy to be hard enough to invoke a change, and it's too hard to be easy enough to allow us to have more sympathetic or a parasympathetic drive. So allowing us to get into a relaxed state, to be able to sleep well, to destress. So when we start looking at those recommendations and looking specifically at perimenopausal women, it is very counterintuitive as a physiologist and looking at the research to have someone go in and do 150 minutes per week. So what we really need to do is taking a step back and saying, hey, you know what? When we look at estrogen, 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?

I 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. So 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. And we're also not getting that stimulus to have a strong contraction when we're doing those 150 minutes of moderate intensity activity.

I think your levels of estrogen, could you just explain, like, overall through this period, they are declining, but I think I understand also that they're quite variable. One of the things that's happening during perimenopause is that, and we've talked about this before in terms of even being able to test for whether you're in perimenopause, is that actually they're sort of all over the place. So I guess, is that right? And yes, when you're describing this weakness, does that mean that it's literally changing from morning to night depending upon my levels of estrogen? Or is this more just that over months and years, there's a change in the way that you're saying that your strength is being reduced.

So it's a very short effect. When we're having estrogen that's going all over the show, because it is going all over the show. There are some days or 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. So you're having these irregular patterns of estrogen, and the body is responding in kind by saying, I don't really know what to do with all of this estrogen when I don't have progesterone countering it, or all of a sudden I have progesterone, but it's not the same amount of estrogen and progesterone together to cause these effects. So if we think about as a squiggle versus two flat lines and a blip and then a big curve up, that's how our normal menstrual cycle is. But now when we're getting into perimenopause, we have squiggles like a three year old took a crayon and drew all over a graph. And it's like, here's what estrogen is.

Doing, and I'm guessing that's not ideal.

Not at all.

When does this start to happen?

On average, it can be as early as your mid 30s, but we really start to see an effect in our early forty s. And it might not become apparent, like in your actual menstrual cycle, but you're starting to notice that you can put weight on easily. Your sleep patterns are disrupted. And one of the typical case studies I like to describe this is a woman who's in her mid 40s, super stressed, can't sleep, irritable, putting weight on, goes to the doctor, says, I want to get my iron check. I don't know what's going on. I can't sleep. I have all these different mood changes. I'm really tired, but I'm wired. So you just can't get out of that deep fatigue. And the physician turns to them and says, well, you're a woman in your mid 40s who is mid career, you're just too stressed. So here's a serotonin reuptake inhibitor or some other medication. Take it and learn how to destress. But actually what's happening is perimenopause.

And that was like an antidepressant that you were describing, right? Is that right?

Right.

So they were saying, hey, I'm worried you're depressed, but actually they're just going through perimenopause.

Yeah. And it's not really depression because we see that the antidepressant medications are one of the most over prescribed medications, because when a woman goes in in her early to mid 40s, there isn't really an answer for what is perimenopause. What are the symptomology? We know that med students aren't taught anything about it, so menopause specialists have to actually go out and seek that additional education and qualification. There's maybe an hour taught in med schools on perimenopause, menopause. But it's just what's happening from a reproductive standpoint, not about symptomology, not about what do we do about it, how do we have conversations about it. So most physicians are very much unaware until they have a pharmaceutical sales agent that comes in and says, you're going to have a whole bunch of women coming in. Here's menopause hormone therapy, and this is what you should give to them.

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This is quite shocking, really, isn't it, Stacey? I mean, it's not the first time that I've heard people talk about this, but given that women are slightly more than half the population and they all go through this, I am always stunned when we start to talk about this about, I think here, interestingly, you're talking about how it's under taught. But also I think what we've seen.

A lot is also understudied, absolutely understudied. And I mean, we look across the board of all women's healthcare, there's a significant gender gap in data, and we know that.

And Stacey, just before we start to talk more about how the know what sort of exercise and how the exercise can help, I think a lot of people, listeners, will be like, why does exercise have anything to do with dealing with menopause symptoms at all? That seems really counterintuitive. I understand that doing some exercise is good for my long term health. I think that everybody's heard and makes sense. But surely if I'm going through perimenopause, then the only thing that I could really do is to try and supplement my hormone. So how does exercise fit in at all? Before you start to explain more about how you shift it, why does that have anything to do with this conversation?

It is an external stress, and our bodies are designed to really look to adapt to our environment. So we adapt to heat, we adapt to cold, we adapt to sitting. We're attuned to sitting. And so we're starting to see postural changes and new injuries from sitting so much. We're seeing incidences of all cause mortality from sitting so much, because our bodies are evolving and adapting. So when we're looking at exercise, it is a very simple message to say, yeah, we need to move more, but we have to be specific. Why? Because we need to invoke a response to build lean mass. We need to invoke a response to maintain and build our bones. We need to invoke a response that's going to help with our serotonin and our norepinephrine. And those two are tightly tied to hot flashes or hot flushes, vasomotor symptoms. We also, again, want to invoke a stress that's going to change our gut microbiome because we see a significant decrease in the diversity, especially in late perimenopause. And this is directly attributable to that body composition shift. So if we're looking at how are we going to stop all of these things that are happening, or how are we going to empower ourselves to control those things that are happening and move through it, it's through specific modalities of exercise.

Got it. So you're saying lots of different ways in which the exercise can help, part of which is directly through building more muscle. If I understood rightly, is that what you mean when you say lean mass?

Yes.

And bones upon your bones and bones. But also, and I think, hopefully, you're going to take us through. You're saying it can also have some impact on symptoms like hot flashes. Could you explain what really is that? And then I would love to understand how that happens.

So, a hot flash is this feeling of intense heat that rises up and comes up over the face, the arms, the hands, and invokes a massive sweating response. And then it's subsequently followed by an intense shivering because there's a disconnect in how the hypothalamus, or your brain, is reading your core temperature. So initially, it was thought, oh, well, it's because your blood vessels aren't as responsive to the way that blood flows through and how you can contract and dilate blood vessels. But as I was saying, we see it's more neurotransmitter related. So we're looking at brain and brain health and what's happening there, because the hypothalamus in the brain is very sensitive to temperature and appetite. And when we start seeing how serotonin has a role in this and norepinephrine has a role in this, when we have a misstep of serotonin, meaning that we aren't producing as much, or we're having a time in our brain where our neurons are really sensitive to serotonin, that's driven by the fluctuation of estrogen. So estrogen coming up a lot will make your brain super sensitive to serotonin. Estrogen not coming up or dropping off will make it not as sensitive.

And then when we have norepinephrine coming in. So this is more of your calming, like, antiarenaline hormone coming in. It counters serotonin. And so now your brain is like, wait a second. I need to speed myself up. I need to be able to fight or flight here. So it's not that adrenaline sympathetic drive, but it's your hypothalamus saying, I need to rev everything up because something's going to happen here. I don't know what, but the brain is telling me I need to rev everything up. And so that's what instigates this hot flash is your hypothalamus is perceiving a bit of a threat from this misstep in your neurotransmitters. So then all of a sudden, you have it going, okay, we need to boost everything. Everything starts to boost up. You get this incredible sensation of heat that comes up and over the body, and then the hypothalamus is like, hey, wait a second, now I'm too hot. I better start trying to offload this heat, and you get a shiver response.

Wow. I've sort of got this mental image sort of in your brain of this thermostat, and then you're saying in perimenomore, suddenly it's been yanked all the way to the right, and then almost immediately yanked all the way to the left and back. And that obviously does not sound like a very pleasant place to be.

No. So one of the better analogies I can put out there for people who are allergic to bees, and there are a lot of people allergic to bees. When you get stung and you're having an anaphylactic reaction, where you feel that hot sensation of nerve pain coming up, and then you feel that huge flush that comes on with the start of an anaphylactic response, that's exactly what a hot flush is like. But with a hot flush or hot flush, you have intense sweating that comes with it. With anaphylactic, you don't. But it's that same beginning sensation of that just building of heat that just overwhelms.

Well, I think, as usual, I feel at this point in the podcast, you've depressed most of the audience that has not yet got into this, but feels that it's in front of them made people who are going through this feel like at least somebody's listening to me. But yes, it really is miserable. So I would love to talk to. Okay, so what can you do? And I think, how can exercise have some impact on the set of symptoms that you're talking about?

Yeah. So I am painting a dire picture because nobody really understands what perimenopause is. Right? So if we understand what's going on, then it makes what I'm going to say next about exercise, it actually makes sense. So if I'm talking about how 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. It is the big rock here when we're talking about building muscle. But we can't go in and do like ten 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. If 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. 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. And 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. That'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.

So 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. You want to be able to do that five times by the time you end up to the fifth try. Like, 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 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. Is that right, Stacey?

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 and a 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 her adult life. So she got to this crossroads and she turned to her daughter and said, I don't want to go on medication. I 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 I don't want to look at so I can 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 a trainer, if you want a trainer, and here's the squat rack and all of 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.

We 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, actually, 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 and going on some sort of group class or a 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 maybe they don't feel good enough about themselves and they're not confident.

What'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. So 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 from 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. And 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 the one thing I've also heard a number of other guests talk about exercise outside of this space. Talk about is often 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. And 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. 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. It 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 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, and 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.

Now, Stacey, in your book, you talk about three different types of exercise, and at this point, we talked a lot about lifting heavy. But I think there were two other things in there that you said are really important for women at this stage in their life.

Yeah, and this is the polarization aspect, where we're talking about high intensity work. We're talking about high intensity interval training and a subset of that that's called sprint interval training.

Explain what that means.

Definitely. So when we hear the buzzword of hit or high intensity interval training, we think of things like a 45 minutes boot camp where someone's taking you through all these circuit exercises and your heart rate's high, you're completely gassed. Or you might think of a class like orange theory or F 45 or Crossfit all these kind of things. We're talking about high intensity. That is not what I'm talking about. When I'm talking about high intensity interval training, I'm talking about 30 minutes at the most with the warm up and cooldown. And in that you have maybe one to four minutes where you're getting your heart rate up to around 80% to 90% of your max, or on a rating of perceived exertion of one to ten. With ten being max, you're looking at about a seven or an eight for that interval. And then you have one to four minutes of recovery where you're bringing your body down to a really easy state before you hit the next one. And most people can, when they start off, might do one interval of two minutes and they're like, oh, that was so hard, I can't do another one.

And that's fine because we want to build up, but we don't want it to be 45 minutes where your heart rate is at 70% or your rating of perceived exertion is at an eight or nine. But in reality, it's the fatigue that's invoking that, because then you're squarely in that moderate intensity again. And what happens with moderate intensity is it increases cortisol. Now, some cortisol is good, but when we're in perimenopause, we are already in a very, what we call, sympathetically driven state. So that means we're tired but wired. Our baseline cortisol is elevated. And when our baseline cortisol is elevated, we have a stimulus to put on fat, keep residual inflammation, bloating, can't sleep, can't come down, can't relax. So if we're doing true high intensity interval training and we're polarizing where we're hitting those intervals, that's that 80% or more, and then the recovery aspect is 50% or less. So you're really going hard when you're supposed to go hard. Going super easy when you're supposed to go easy, you have a subsequent rebound response after exercise, where your body reduces cortisol, increases growth hormone, increases testosterone, and those things help with reparation.

They help decrease some of that deep visceral abdominal fat or that minnow pot that people talk about getting that belly fat. So there's a feedback mechanism that goes on that your muscles are talking to the fat and saying, hey, you know what? We don't need you. We don't need you. Fat go away. We need to be able to make our muscles really strong. We need to be able to overcome this interval stress. And so it feeds forward to having better body composition, better muscle morphology, meaning your muscle function. And then when we're looking at it from a sleep point of view, because you've done this really polarized training, then when it's time to go to bed, you have an increase in what we call your parasympathetic drive. And that's what we need to get into a deep sleep. So if we do this maybe twice a week, then we end up with better sleep patterns, better messaging to our body for increasing our lean mass and decreasing our body fat.

So, Stacey, I think everybody listening to this is saying, oh, so this is the exercise that really does cut down my belly fat, as per like the ad you see across the Internet everywhere. That sounds pretty good, but I didn't really understand at this point what it was. Could you give us an example?

So if we're looking at high intensity interval training, I'll take it for someone who is more fitness class based. So we could talk about it as being every minute on the minute you're doing five burpees and the rest of that minute you're recovering and you do that five times. Or we can talk about it as you're on a bike erg or a rowing erg, and you're going to hold a steady state for two minutes and then you're going to just get into a nice relaxed pace for three minutes, maybe four minutes, really recover, and then do the two minutes again. And you won't do that any more than four to five times. When you're super fit, when you're first starting out, it's a very short amount of time where you're doing that high intensity work. Then when we get into what we call sprint interval training, I'm not talking about running sprints. That's the misconception. Everyone's like, I can't run. I can't sprint. Sprint interval training is all about 30 seconds or less, going as hard as possible. So you're hitting that nine to ten on a rating of perceived exertion. You feel like you're going to throw up at the end, but then you're fully recovering.

So you might be walking down a hill that you've just tried to sprint up, or you might pedal really lightly on a bike erg, or you might walk around the room after you've done 32nd of burpee or thrusters or some other kind of movement that you might be working on in the gym. So your recovery time might be two to three minutes, bringing everything down, because we want to be completely ready to go for that next 30 seconds. So it's really intense exercise. It's really high intense exercise, but the benefits for that is then we end up with better blood vessel control, which helps reduce hot flash responses as well. We have epigenetic change within the muscle, so this means that we're changing the muscle itself to be able to pull more glucose in without insulin. So it helps with that insulin resistance that comes with perimenopause. And again, we have that subsequent post exercise response that then allows us to drop cortisol and increase our parasympathetic responses. So that means better sleep. People are like, how do I do sprints? It's been so long since I've gone that hard. How do I do sprints?

It is something that you want to phase in. So maybe after you've done 20 minutes of resistance training, you do a couple of box jumps. So that might be three or four box jumps, and that takes 20 or 30 seconds. You're going from the floor and you're jumping up on top of a box, so it's a squat jump up, or maybe you're just doing squat jumps in place, where you're squatting down and jumping up, squatting down, jumping up, because then you're getting some bone stimulus as well. So it's all about, how hard can I go for those 30 seconds? One of the other things I like are battle ropes. If you've been in the gym, then you've seen the battle ropes. They're the long, really heavy ropes and people are just trying to create a wave with them. It's a total body, really hard exercise. You try to do that for 20 or 30 seconds, you're completely gassed. So that's another way to think about it.

And Stacey, on the sprint interval training, again, you're looking to do, like, 30 seconds of this, then rest, and again, this is four or five times. And that has achieved the objective.

Yes. And at this point, it's all about intensity, it's not about volume, because I hear women all the time who come from an endurance background, meaning that they've run marathons or half marathons, or they really love their spin classes, or they're used to going to the gym for an hour and a half and they're saying, how am I going to get these body composition changes I want? If you're telling me I really only have to work hard for two minutes, it's not about the time, it's about the intensity and the physiological response. Your body has to that intensity.

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Okay, back to the show. What's the minimum that I need to do to have an impact? So, like, how often do I need to do that? Is that something that I could do at home for people where actually their time is a really big challenge, what would your message be to them?

So if I have to prioritize, I say minimum is preferably three days a week of resistance training. And then one of the things that I like for really programming for time crunch people is to either warm up or at the beginning of a resistance training session with my sprints or I use it as a finishing set. So if you're looking at, okay, I want to do some squats and I don't have a lot of time, I'm going to do some squats with a heavy backpack because that's what I have available for in my garage. Well, you finish the squat sets with your heavy backpack and then you're going to do some squat jumps. So we're going to do 30 seconds of squat jumps. Go as hard as you can for 30 seconds, two minutes, start to do some mobility, some recovery, and then you do it again. So, done and dusted in your garage in 30 minutes. So it's a way of compounding those exercises to be very time efficient without the drive to the gym, without separating it out, without having to make that actual time commitment to go to do something because, yeah, we don't have a lot of time now.

There is not a lot of time in midlife because there's so many other things.

And Stacey, do you have any resources you'd like to point anyone to? If someone was thinking, that's really interesting, I'd like to do what Stacey just described?

Yeah. So, like I've said before, Haley happens fitness. She has some of these type of programs. Annie Torstader from the CrossFit world also has these. Our book has a really good, I say, hour because I'm a team. Our book has some really fantastic examples of how to set up a program. Our menopause course does as well. So it takes you through everything, like what to do, how to structure it, and then, of course, there are some personal trainers or coaches that you can tap into for one or two sessions, just investing into one or two sessions to get an idea of how you would structure a lifting session with some sprints. So there's lots of different ways of going about it. And for women who love to walk. My sister is a few years older than me, and her thing is she loves to walk, wants to get the steps in. So instead of her just doing her usual route, I've had her mix it up where I'm like, okay, we're going to do what we call the, quote, burpee mile, where you're going to do your steady state walking, but in that, you're going to increase your pace and then you go really slow.

I don't want you to have any time point longer than two minutes. That's the same pace. So she's varying her pace in the first mile. Then she gets to a park, she does five burpees, five jumping air squats, and then she gets back into her walking. So she's outside. She's doing what she loves, but she's structuring it to work for her body at this point. There's ways of working and incorporating this into things that you're already doing without that extra step of it's too hard. I have to go to the gym. I have to learn these things.

Stacey, I know. There was one other thing that popped out to me in the book, which is something I can't even really pronounce, which is pliometric training. What is this and why do you recommend it?

So, plyometrics, we see in the elite athlete world all the time. So this is jump training per se, but it's really about getting that explosive movement and teaching the muscles to contract and really explode in a movement. So we typically talk about box jumps or jumping lunges or any kind of activity that has a jump factor in it. But like I said, this is also the point of time where people are like, oh, my knees, my hips, I can't jump. So this is where we're looking at a really fast explosive movement instead. So it can be something like kettlebell swings, or we're looking at plio push ups against the wall, where you are pushing against the wall, pushing off and then catching yourself again. So you have a little bit of an impact. So we're looking at that. Explosive movement off the wall can be med ball slams or medicine ball slams, where you're taking a heavier medicine ball, you're picking it up over your head and you're slamming it down. So you're having an explosive movement down. So it doesn't have to be jumping per se, but it's all about the fast explosive movement.

And this, again, is really important for metabolic control and for bone. We need that impact for that bone mineral density.

Got it. So it's the impact part of it in particular, which you're saying is really important. We haven't talked a lot about this, but I think everybody listening, certainly, who's going through this, aware about potential bone density decreases. And this is one of the ways.

That you fight it.

Yes, it is. And I have a good friend and a colleague here who is a bone researcher, and she, through her research, has found ten minutes, three times a week of jumping can even just be jump roping, or can just be jumping on the spot where you're landing more with stiff leg instead of bent knees. How we've always been taught to absorb that impact in the skeleton and that takes women who are osteopenic into normal bone density over the course of twelve weeks. So just that impact three times a week is super important and that can also be part of your high intensity work. If you're thinking about jump training as ten minutes three times a week, that can be your high intensity work. So they do overlap. When you're looking at how am I improving my metabolic, blood sugar control, insulin, but also working for my bones, it's that high intensity impact.

Thank you, Stacey. We're coming towards the end, but I did want to come back to one of the questions at the beginning, which I know is quite controversial, and I know there's not actually agreement even across the scientists in our scientific advisory board, which is about exercise before or after eating. And I think I asked you about, what about women exercising while fasting. And in a previous episode, actually, we discussed the study of exercise while fasting in men, which showed positive results. What do women need to know about this? And does menopause affect it?

So when we look at fasted training for women, we see that they end up with the opposite results than what we see in men with fasted training. And when we look at the impacts of fasted training, it comes down to the hypothalamus again. So when we're looking at nutrient density for women, we see we need more carbohydrate, and our hypothalamus is sensitive to the lack of nutrition, where we have two areas in the brain for women that produce kiss peptin neurons. So kiss peptin is a gene and expresses within the brain to say, yeah, okay, I can have a really robust endocrine system, and I can have appetite control, or I won't. So we have two areas in the brain for women, but only one in men. And the reason for that is women have menstrual cycles, and we have a greater demand of endocrine health than men. So if we start something fasted and we start exercising fasted, the hypothalamus perceives that as a threat because it's more sensitive in women than it is in men. So after four days of this kind of fasted training, we end up with a decrease in our thyroid function.

We start to see a decrease in the amount of thyroid that's being produced and the ability for the body to use it. The other thing is when we do fasted training, we end up with higher baseline cortisol, and we stay in this catabolic state, and that's that breakdown state. So when women do fasted training, I often ask, why are you doing that? Because the first thing to go is your lean mass, and we're already trying to preserve it, and we're already having a struggle to keep it. And the hypothalamus is going to tell the body to break it down because it wants to use it for the sum of its parts when we hit peri and postmenopause, specifically perimenopause, when we already have that elevation in cortisol, and then we start doing fasted training, it compounds that, and it also compounds the body's response to put on more visceral fat. So it's counterintuitive. When we're trying to decrease that visceral fat and we're trying to increase our lean mass, we see in postmenopausal women that if we do fasted training in the short term, we see a decrease in our fat mass, but we also see a significant decrease in our lean mass.

Again, it's because the hypothalamus is saying, we need some fuel here, and the first thing to go is lean mass. We don't see that with men again, because the aging trajectory for men is different than women and the responses are different. So the fasted training is one of the things I really want to push back on for all these women are like my doctor says I should do fasted training for mitochondrial health and to lose weight. It's based on male data. We look at female data, different story.

I'll admit I didn't understand all the details, but I think your message is really clear and I think ties back to something we talk a lot about at Zoe, about how personalized this is. You're talking about one of the variations, right. Is are you a man or a woman? We see a lot of other variation. And as always, I think we end up saying in many, many areas, there's remarkably little research where you've done, like, proper randomized control trials and understand the difference we're at. Time, I would like to try and do a little wrap up. Please correct me where I've got this wrong. It got a bit complex in places, so I may well have got this a little bit wrong, but let me try and just give a sort of high level summary of what was a really brilliant conversation. So I think we started by saying that although we talk about menopause, that actually a lot of the changes that are happening from women are in this sort of long period of perimenopause before. And often they can be starting to happen before. Women are actually even really aware of the fact that they're having these hormonal changes.

And therefore, it's already starting to impact the way that maybe you might be putting on weight or that you're feeling like you're losing muscle. So this is actually potentially hitting a lot of women, even in their, you know, maybe even in their early 40s, that there are a whole series of symptoms that happen through menopause. You explained, for example, about hot flashes. And the way that we now understand this is really sort of driven by the brain and the control of it. And you gave a rather terrifying description of what it is like to go through it, which I think is quite powerful if you're a man like me, and you're not going to experience that yourself. And then basically explained that exercise can have this really powerful impact because it's sort of replacing some of the benefits of estrogen to be able to effectively sort of fight back against a lot of these changes.

But it's not easy.

And critically, the sort of exercise that many women have been doing up until this point is no longer really going to have the positive effect and equally well, if you haven't been doing exercise and you're listening to this and saying you want to do it, if you just go and do maybe like, the standard exercise you're told to do, like, move more may actually have very limited benefits, whereas I think you described sort of these three components that really can have an impact. The first, which I think you're saying is the most important, is heavy weights. And I think for a lot of people, that's a lot heavier than they probably would think about doing because you were describing something where you pick it up three times, that's really heavy and you can't do that five times. So whatever that weight is for you, that's what you need to do. And of course, as you do more of it, that will get heavier and heavier, that it's something that you need to be doing for the rest of your life. This is not just like a temporary thing for a year or two through this period.

The second thing you talked about was this sprint interval training, which I misunderstood as sprinting around. But actually what you're describing is this very short period of time when you're doing something very intense and sort of shooting. You describe, like eight out of time, eight out of ten effort. But you also said, like, I practically feel sick. So I would describe that as ten out of ten effort because I'm not a sports person. So you're like, basically, I want to die at this point. I want to stop, recover for a little while, do it again. And that actually, when you first start, you might only be able to do.

That once or twice, but ultimately you're.

Saying you actually want to do that. So you could maybe do it four or five times, but no more. So you're pushing yourself really hard for a very short period of time and stopping. And I think you described a lot of different ways you could do that. Interestingly, doesn't require weights, actually. There are lots of things you could just do at home, jumping up and down and things like that that are going to wipe you out really fast. And that that is profoundly different, for example, than what people talk about as high intensity training, which goes on for 45 minutes. And it's a lot more about wearing you out. And that, interestingly, for women who have been really into these exercises, you're sort of saying, actually, you need to rethink some of this because you may not be getting the best exercise for your body. And then the third thing you talked about, pliometric training, if I managed to say that, right, which is above all about explosive movement. So you said jump training is how people think about it, but if you can't jump, there's other ways you can do it. But in particular that what you're trying to add is impact into your body because that has impact on your bones and is going to fight this challenge about losing bone density.

And we didn't talk a lot about this in this episode, but I think we know from other episodes that that's one of these big risks that can happen later in life as a woman. And so this is one of the ways I think you were talking about directly fighting that risk.

Yes. Fantastic. A plus.

Brilliant. And so final thing I would say was, I think for a lot of listeners in this period of life, because I said, I have a lot of friends who are in this world, you can do this even if you have got very limited availability. And you said, look, obviously you're going to say you should be doing this all the time, but I think you were, if your time is limited, if you managed to do this two or three times a week, where you could both combine resistance training and this sort of sprint, you could do the entire thing within 30 minutes, that is achievable. And that, though, you're saying is like, you need to find that time in your life as an investment in your health if you really want to fight what is a pretty profound change.

Exactly. Very well done.

Thank you, Stacey. That was really interesting. We will definitely put links in the show notes for people who want to follow up. I hope we can convince you to come back and I hope we can convince you to spend some more time actually with Zoe as we think about helping people who are going through Zoe membership to understand how they could apply this alongside changes to their diet, because I think there are a lot of people who are listening to. So if you're listening to this point in the podcast, you are probably interested in this topic. And I think understanding how to combine these shifts in exercise along with food is, I think we see from the data, like, pretty profound in terms of reducing the symptoms that you're feeling and therefore also impacting your long term health.

Absolutely. What's the expression we always hear is you can't outrun a bad diet. And it's so true, you have to have them work together.

I like that very much. Stacey, thank you so much. I know it's got quite late in New Zealand now. Thank you so much for joining us.

Thanks for having me. It's been great.

I really enjoyed my conversation with Stacey today.

I hope that we answered many of.

Your questions about how to tailor your.

Exercise during perimenopause and menopause. Of course, nutrition also plays a huge part in keeping you healthy during your menopause years. If you're looking for more than general advice, you might want to consider becoming a Zoe member. As a listener to this podcast, you've already discovered how complex nutrition is and.

What a huge impact it can have on your health.

With Zoe as your health coach, you will get personalized, sciencebacked advice and support.

On exactly how to change what you.

Eat, tailored to your unique body to help you feel better now and to live healthier for many years to come. To learn more about Zoe and get 10% off your membership, simply go to zoe.com podcast. I'm your host, Jonathan Wolf. Zoe Science nutrition is produced by yellow huings Martin and Richard Willen. As always, the Zoe Science and Nutrition podcast is not medical advice. It's for general information, informational purposes only. If you have any medical concerns, please consult your doctor. See you next time.