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Menopause Exercise: The Depression or Well-being Determinant?

Wonder if your menopause exercise prescription makes a difference? It turns out your hormone ride during menopause deems exercise more necessary than ever. Your hormones reveal more than your likelihood to store belly fat or hot flash.

Brand new research published in the Menopause Journal says your likelihood of being depressed or feeling positive lies in your physical activity level. The study addressed menopause, movement, and mental well-being.

One of 7 levels of physical activity was assigned to each subject:

  1. I do not move more than is necessary in my daily routines;
  2. I go for casual walks and engage in light outdoor recreation 1 to 2 times a week;
  3. I go for casual walks and engage in light outdoor recreation several times a week;
  4. Once or twice a week, I engage in brisk physical activity(eg, yard work, walking, cycling) that causes some shortness of breath and sweating;
  5. Several times a week (3-5), I engage in brisk physical activity(eg, yard work, walking, cycling) that causes some shortness of breath and sweating;
  6. I exercise several times a week in a way that causes rather strong shortness of breath and sweating during the activity;
  7. I do competitive sports and maintain my fitness through regular training.

Which level describes you?

Based on that you fall into one of these categories:

  • Low (1 to 3)
  • Medium (4 and 5)
  • High activity (6 to 7)

Subjects in the study with the highest level of activity had the lowest incidence of depression and the greatest sense of well-being.

That’s the bottom line.

What’s most interesting is that researchers measured not only self-reports of depression but hormone levels. So the study was both objective and subjective.

Given we’re in a time when positive mood, attitude, optimism are so important to how we get from day to day, this is just one more message to get moving.

There’s More

Menopause has historically been associated with negative feelings about aging and with greater incidence of depression than in younger women or same age men. The proper menopause exercise prescription, however clearly has the ability to change your well-being.

In fact, many women report that this is a time of great life satisfaction.

Menopause Exercise Rx

The high activity level word descriptions used in this study are exact descriptions of the High Intensity Interval Training and strength training to fatigue that are a necessity for women who want to flip 50 feeling not just well, but outright full of energy and vitality during and beyond COVID19.

Often when I talk about the After 50 Fitness Formula for Women, and a critical part of it — “Less Exercise, More Food” — inevitably an audience member will comment. She may say something like, “I’m so glad you said women over 50 need less exercise.”

I get nervous with that simple statement. Because like a recent podcast I created about “Moderate Exercise,” that is too open to interpretation.

So let me take some real estate in this post to get clear:

  • You are not a flower.
  • You are not delicate.

You absolutely need to push limits in your workouts – for seconds at a time. That’s true when you’re in good times and when you’re in COVID19.

You need moderate amounts of:

  1. High Intensity exercise that gets you breathless
  2. High Intensity strength training that takes you to muscular fatigue
  3. Fill in with low to moderate exercise that you love

It is #1 and #2 above that have the best opportunity to change your hormones for the better, and in doing so changes your mental well-being, your visceral belly fat, your hot flashes and night sweats, and reverses the effects of 179 genes associated with aging.

Careful Clarification

Advice to do less exercise is often interpreted as advice to do “light” exercise or following a doctor’s vague advice to “walk.” It’s not enough. And walking 3 or 4 miles a day as many women do in an effort to overcome weight or fat gains in menopause only makes matters worse. Greater volume of the same ineffective exercise will not get you better results.

Yes, you want less exercise. Less than you think, and of the right type (of intense exercise).

It’s true that if you’re just beginning you start with habits. We get you hooked and regular first. Yet, yes, you can do interval training when you start. COPD patients and asthma sufferers often do best with intervals. If they can you can. We simply apply a progressive plan for you.

Before you start intervals it may be appropriate for you to “restore before more.” If you’re already exhausted, suffering from mood swings, your first step is to restore yourself with rest, sleep, nutrients and movement, NOT exercise.

Menopause exercise is not a generic prescription for all women in menopause. It should be based on your unique condition now, your current hormone status (assessed by a fitness specialist by your signs & symptoms), and your personal preferences and schedule.

Yet, menopause exercise has the power to make this second half better than the first.

For Fitness Professionals: Offer Your Female Clients a “Hormone Balancing Exercise Prescription”

Gain the information, tools and resources needed to coach and train this steadily growing population with Debra’s online course with MedFit Classroom, Menopause Fitness Specialist.

Given the number of women who have not exercised previously, and the current void in proper hormone balancing exercise prescription, there exists numerous, lucrative opportunities for fitness professionals to positively impact the lives and health spans of a great many women still seeking answers.

Reprinted from flipping50.com with permission from Debra Atkinson.

Debra Atkinson is the #youstillgotitgirl who is flipping 50 and changing the way thousands of women think about their second half. She’s the host of the Flipping 50 TV Show and the Flipping 50 podcast. As a master personal trainer, strength and wellness coach with over 30 years fitness industry experience, she works with women who are pro-aging with vitality and energy. She is an international fitness presenter, author of hundreds of articles and multiple books. Visit her website, flippingfifty.com





Benefits of Prenatal Massage

Prenatal Massage, Easing the Changes

What better way to show you are dedicated to giving this new life every advantage in the world than to arrange for a pregnancy massage from a specially certified therapist. Each session is designed to focus on the special needs of a mother-to-be as her body goes through the dramatic changes of the child-bearing year, which includes pregnancy, birth, and post-delivery. Massage provides a nurturing touch, which in turn, nurtures the life of your unborn child.

A woman’s body changes a great deal over nine months. Her weight increases, her breasts change, her blood pressure elevates, organs are compressed and pushed up, and the muscles in her abdomen become stretched and strained. Massage can help relieve pressure and tensions created by these changes.

Benefits of a Pregnancy Massage Include:

  • An opportunity for much-needed rest and relaxation
  • Balances hormones (relieving moodiness and nausea)
  • Increases fetal circulation
  • Reduces swelling
  • Relieves back and neck pain
  • Improves skin tone elasticity
  • Deepens maternal bonding
  • Enhances body awareness (making delivery easier)

Benefits of Massage After Birth

  • Post-delivery/Postpartum massage addresses the mother’s stress of carrying and caring for a newborn, speeds recovery and relieves sore muscles.
  • The childbearing year includes not only the three trimesters of pregnancy, but also during labor, and three months after delivery.
  • After delivery, a new mother must gradually regain her postural strength and pre-pregnancy state of of fitness. Your therapist will give you stretches and exercise you can do at home to help your body get back to normal.

How is Pregnancy Massage Special?

The mother-to-be is always carefully supported in several positions. When lying face-up, she is supported with the back lifted, to provide comfort and maximum circulation to the legs and the fetus. While in a side-lying position, special pregnancy pillows support the stomach, which allows the therapists to massage the back and hips. The belly is NEVER compressed by lying face down, nor is the belly left hanging through a hole in the massage table. These methods are less than ideal for the mother’s body and for fetal circulation.

Pregnancy massage addresses the profound changes a woman’s body experiences during the entire childbearing year. During the first months, massage can help her body balance changing hormones, which often cause morning sickness. During the Second Trimester, pregnancy massage addresses the upper and lower back pain that develops from the weight of the new baby. At the end of pregnancy, massage can relieve swollen feet and hands, numbness, hip, low back and sciatic pain. Pregnancy massage is also intended for the three months after the delivery to help the new mother regain abdominal strength, reduce soreness and relax muscle tension, and to offer a brief respite from the new duties of motherhood and caring for an infant

If you are in a “High Risk Maternity” category, or having any complications, you may still be able to have a massage, but you should definitely get medical clearance first. You should also call your therapist before your appointment to make sure they have a good understanding of what it takes to keep you safe and comfortable. Most Certified or Licensed massage therapists get instruction on working with Pregnant Mothers as part of their entry level massage education. However, there are additional classes available, and each therapist has varying levels of awareness and experience. We recommend finding a therapist that has an additional certification in Pregnancy or Prenatal Massage. Don’t be afraid to ask questions about the therapist qualifications, and what they’re going to do during the massage. While you’re receiving massage, continue to ask questions as they come up. If at any time during the massage it feels worse than a “hurts good” sensation, then it’s too much, and you should speak up. Your therapist should never encourage you to suffer through anything you don’t like during a session.

Kathy Flippin has been a Sports Massage Therapist since 1997 is the owner of Dynamic Touch Massage. Kathy’s passion is to offer excellent therapeutic massage, and educate her clients on how they can take the best care possible of themselves. Her clients include everyone from professional athletes to active grandmothers.



  1. Field, T. (1999). Pregnant Women Benefit From Massage Therapy. Journal of Psychosomatic Obstetrics and Gynaecology, Mar;20(1):31-8.
  2. Field, T. (2004). Massage Therapy Effects on Depressed Pregnant Women. Journal of Psychosomatic Obstetrics and Gynaecology, Jun;25(2):115-22.

Building Strength is an Important Component in a Prenatal Fitness Routine

You may have heard people warn that pregnant women shouldn’t raise anything over their heads or lift objects that are heavier than ten pounds when pregnant. These are warnings that still make the fitness trainer rounds when working with pregnant clients, yet these warnings aren’t based on science.  In fact, there’s no evidence for warning pregnant women to avoid lifting over their head unless it causes discomfort or balance issues, and the ten-pound limit is even more questionable, as ten pounds would be too heavy for some women and as easy as a feather for others.

It’s important to always remember that each pregnant woman has a specific fitness level and ability, so setting arbitrary limits is an ineffective way to provide guidelines for this population. In addition, when confronted with statements such as these, always review the research that supports the claim before implementing the information into your training guidelines.

Many women choose to continue their pre-pregnancy strength training program while they are pregnant, and most women may safely start strength training during their pregnancy as long as they are cleared for exercise by their healthcare provider. When developing a pregnant woman’s fitness program, you should take into account her current level of fitness and strength and pay close attention to how she feels during and after exercise. The key to maintaining a safe and effective routine is through consistent modification of the exercises for comfort as pregnancy progresses.

Strength training is an essential prenatal fitness component, providing the muscle power needed to compensate for posture adjustments and weight gain that occurs with pregnancy. Women who continue or even start a strength training routine during pregnancy can help prepare her body for all the lifting done with a new baby and reduce the risk of low back pain. Strength training has not been shown to pose any harm to either the fetus or the mother as long as these general guidelines are followed:

  • A gradual reduction in weight loads from pre-pregnancy will likely occur as the pregnancy progresses.
  • Women may continue their pre-pregnancy strength training routine (wt/reps/set) as long as they modify the exercises for comfort as pregnancy progresses.
  • If training causes muscle soreness during the pregnancy, it is recommended that overload be progressed by increasing the number of repetitions versus the resistance/wt.
  • Monitor exercise techniques carefully by mirror observation or supervision in order to correct for progressive postural changes that occur with advancing pregnancy. Improper lifting techniques may aggravate back problems and increase soft tissue injuries.
  • Avoid maximal static lifts. They may cause a sudden increase in cardiac output and blood pressure and employ the Valsalva maneuver. During the Valsalva maneuver, there is a significant diversion of blood from the internal organs (such as the uterus) to the working muscles.
  • Maximal lifts may also place extreme stress on the lumbar spine and other joint areas. Never overload an unstable or weakened joint.
  • Modify supine positions after the first trimester of pregnancy by using an incline board or wedge.
  • A strength-training workout involving all the major muscle groups should be performed three times per week, with a rest day between each muscle group training bout.
  • Machines, free weights, resistance bands, and body weight
  • are all options for building a strength training routine.
  • Remind client that she should exhale with the lift and avoid holding her breath or bearing down and straining as she lifts.
  • If a particular exercise continues to produces pain or discomfort are modification, it should be discontinued. If pain persists, the client should consult with her healthcare provider.

As always, all pregnant women should check with her healthcare provider before starting or continuing an exercise program during pregnancy.

Catherine Cram, MS started her company, Prenatal and Postpartum Fitness Consulting, in order to provide current, evidence- based guidelines maternal fitness guidelines to health and fitness professionals. She was a contributing author for the textbook, “Women’s Health in Physical Therapy” and co-authored the revision of “Exercising Through Your Pregnancy” with Dr. James Clapp.  Her company offers the certification course, “Prenatal and Postpartum Exercise Design” which provides continuing education credits for over 30 health and fitness organization, including ACSM, ACE, ICEA, and Lamaze.


Can a Pregnant Woman Safely Continue her Pre-Pregnancy Workout Routine?

A regular exercise routine has become a way of life for many women, and many choose to continue their exercise routines when they become pregnant.  Research in the field of maternal fitness has shown that exercise during a non-complicated pregnancy is healthy for both mom and baby and may help prevent or reduce some of the physical problems associated with pregnancy, labor, and delivery.

Although exercise is a positive addition to a healthy pregnancy, there are established guidelines that help ensure that a woman’s exercise program is safe and effective.  First and foremost, it is important for a pregnant woman to consult with her healthcare provider before starting any exercise program.  She should bring a list of questions regarding her exercise program and provide an overview of what type, intensity, frequency, and duration of exercise she would like to do.  This enables her healthcare provider to accurately assess whether the fitness program is appropriate for her pregnancy.

Each woman’s level of fitness and health is different, as is each pregnancy. There are several points to consider when choosing to continue a fitness program during pregnancy.  Some types of exercise are more easily continued during pregnancy, and common sense, safety, and comfort all play a role in deciding whether an activity should be part of a prenatal fitness program.

Choosing the type of exercise that will be safe and effective during pregnancy can be determined by reviewing the following points:

  • What activities does she enjoy or are skilled at doing?
  • Does the activity pose an increased risk of falls or blunt abdominal injury?
  • Is she able to do the activity without being compromised by balance and center of gravity changes?
  • Can the activity be easily modified as pregnancy progresses?
  • Does common sense conclude that this is a safe activity to continue during pregnancy?

Research on prenatal exercise has suggested that greater benefits are achieved by including sustained, weight-bearing exercises such as walking, running, stationary stepping/elliptical machine, or dance classes in a prenatal fitness program.  However, some women may not tolerate weight-bearing exercise during pregnancy and are more comfortable with non-weight bearing activities such as swimming and stationary biking.

There are several activities, such as scuba diving and water skiing, that are never safe to do during pregnancy.  Other activities, such as downhill skiing, horseback riding, and sports with a chance of abdominal impact may also be too risky for most women to continue during pregnancy.

Here are a few tips for keeping a prenatal exercise routine safe:

  • Pregnant women need to add 300 calories to their daily food intake to meet the needs of pregnancy. If she is physically active, she may need to increase that amount if she’s not gaining weight normally. The number of extra calories needed depends on the intensity and duration and frequency of the exercise program.  It is important to drink 8-10 cups of water each day and increase that amount during hot and humid weather.
  • Exercise in heat and humidity can be dangerous. It is safest to exercise in an air-conditioned facility during the summer months. If she does choose to exercise outdoors during warm weather, she should avoid the high heat times between 11:00 am and 4:00 pm and reduce intensity and duration to prevent overheating.
  • She should frequently monitor herself during exercise for signs of overheating, such as dizziness, faintness, or nausea. Drinking plenty of water before, during, and after exercise to replace the fluids lost will help prevent dehydration and overheating. Hot tubs and saunas may cause core temperature to rise to unsafe levels and should be avoided.

A simple method for monitoring intensity level during prenatal exercise is to assess how hard the exercise feels.  A pregnant woman should feel that her exercise level is moderate to somewhat hard.  If she feels out of breath or is unable to talk (termed the “talk test”), she is working at too high a level and should decrease intensity or stop and rest. Her exercise level should feel challenging but not so difficult that she feels exhausted during and/or afterward.

Self-assessment is one of the best ways for a pregnant woman to monitor her exercise program and assure herself that her activity level is safe. A pregnant woman should review the following questions several times each month and follow up with her healthcare provider if she experiences any problems.

  • Do you and your healthcare provider feel that you are gaining weight normally?
  • Do you feel well physically and mentally?
  • Are you able to comfortably follow your exercise program without pain, exhaustion, or problems following exercise?
  • Do you experience chronic or extreme exhaustion?
  • If you are at the point in pregnancy where you are consistently feeling fetal movement, have you noticed any change in the pattern or amount of your baby’s movements?
  • Does your baby move at least two times within 20-30 minutes following exercise?
  • Was your last abdominal fundal height measurement (a measurement of fetal growth) or ultrasound assessment within normal limits, and is your baby progressing normally at each medical check?
  • Does your healthcare provider have any concern regarding the health of your pregnancy?

Pregnant women who continue a challenging level of exercise need to be aware of signs or symptoms that indicate overwork, such as an elevated resting heart rate, frequent illness, lack of weight gain, depression and chronic exhaustion.   She should decrease or stop her exercise program during illness, when fatigued, under excessive stress or if experiencing any complications with her pregnancy.

Prenatal exercise should enhance pregnancy and help to make a woman’s postpartum recovery smoother.  The best advice for the athletic woman who wants to continue her fitness program during pregnancy is to use common sense, listen to her body, and enjoy all the challenges and changes this incredible experience offers.

Catherine Cram started her company, Prenatal and Postpartum Fitness Consulting, in order to provide current, evidence- based guidelines maternal fitness guidelines to health and fitness professionals. She was a contributing author for the textbook, Women’s Health in Physical Therapy and co-authored the revision of Exercising Through Your Pregnancy with Dr. James Clapp.  Her company offers the certification course, “Prenatal and Postpartum Exercise Design” which provides continuing education credits for over 30 health and fitness organization, including ACSM, ACE, ICEA, and Lamaze.

postnatal exercise

Tips on Postpartum Exercise Programming for the Fitness Professional

Many women post-pregnancy are very eager to rejoin the exercise world and at least resume the physical activities they once enjoyed prior to pregnancy. More and more women are seeking out fitness professionals or exercise programs to help them lose the baby weight and engage in safe and effective exercises. Many women understand the toll pregnancy and childbirth took on their bodies and they are ready and willing to seek out professional advice. Working with the postpartum client has benefits for both the trainer and the client. I encourage those who treat this population to get as much education in this area so you can better serve their needs.

Once you begin your journey caring for the postpartum client, there are several important factors to consider when beginning exercise program design.

First, remember she gave birth. Look at birth like any client who is rehabilitating from any type of injury or surgery. The postpartum phase is typically the first 12 months after having a baby but can be longer if a woman is nursing.

Second, consider how long it has been since exercise has been part of her regular routine. Even if she exercised regularly during pregnancy, she probably was limiting the intensity compared to her pre-pregnant self. Keeping that in mind, it may feel like for you (and her) that you are working on a beginner level as you begin.

Third, it’s really important to know the type of birth the woman had and how it affected her pelvic floor muscles. Obviously for vaginal birth pelvic floor prolapse, vaginal tearing or possible Pubic Symphosis diastasis could have occurred. For women who have gone through a cesarean (C-section), the abdominal muscles have been affected through the incision made into the abdominal wall and uterus.

Fourth, it is vital to understand the fitness level of the woman prior to pregnancy and the activities in which she participated. The fitness level or prior activities or sports in which she participated could shape the type of recommended exercises in her program.

Finally, consider any injuries or medical history that may affect her current fitness especially if she has been inactive or just returning back into exercise. Many of this information may be obtained in your initial meeting or phone consultation. You can use a PAR-Q (Physical Activity Readiness Questionnaire) to access this information. I suggest customizing the Par-Q to be very postpartum specific and asking detailed questions about pregnancy and delivery before you begin treatment.

Considering all of these factors, lets now look at how to exercise safely and effectively following delivery.

Procede Gently

Start with basic range of motion exercises and corrective, posture-based movements that will help her body begin to feel restored. A little movement goes a long way.

Get to Know Her Limitations

As with other injuries, or surgeries, childbirth is comparable for your client as her body is still healing, hormones are still adjusting that affect range of motion, core is weak and most women are sleep deprived for months after giving birth. With this in mind, her balance and equilibrium are affected. Careful of movements that change position briskly or go from standing to lying.

Establish Realistic Expectations

Develop reasonable exercise goals for your client. Along with her physical health, mental health is also affected.
Exercise is directly linked in helping to prevent postpartum depression, however, setting fitness goals may create anxiety or worsen her mental state, so be sensitive to this. Start with manageable times to exercise during the week. As the client become stronger you can increase the number of days you exercise per week in addition to the exercise intensity.

Create a Supportive Network

Connecting clients who are going through similar life experiences may help motivate them to exercise more regularly and in a small group setting the cost is usually less per person and more efficient for the trainer for the hour. This may also help give the client additional accountability.

Teach Sustainable Lifestyle Habits

Help your client embrace this journey as a marathon rather than a sprint. Explain that the baby weight will come off but the end goal is to do this safely and cautiously. You must be ready to advise on sustainable, healthy eating habits and adapt if the woman is nursing.


Danielle Spangler has been a fitness professional for over 20 years. Danielle is the creator of “Coremom” (Corrective Obstetrical Related Exercises) for purposes of creating a pre and postnatal small group-training program in a variety of fitness facilities. Danielle’s goal is to train other qualified fitness professionals and group exercise instructors on teaching pre and postnatal small group exercise classes using her method. Visit her website, daniellespangler.com


What Happened During the Pandemic

The Perfect Pandemic Storm? 

The average weight gain during the pandemic was 1.5 pounds per month, according to a recent study in the Journal of the American Medical Association. As of May 2021, that’s 20 lbs. The results were gathered by monitoring smart scale users with Bluetooth technology. Subjects were male and female smart scale owners with a mean age of 51.

What Happened? 

Shelter in place (SIP) orders combined with stockpiles of pantry items, ample take-out and door-to-door delivery. Additionally, many found themselves with either a household of varied food wants and needs, serving up a daily meal dilemma, or in isolation lending to depression and anxiety. Neither scenario made it easy to adopt or stick to routine healthy dietary habits.

Researcher Suggestions

From the results, researchers suggest a need to mitigate our present post-pandemic conditions with dietary interventions and physical activity.

As aforementioned, the study included both men and women. Women at age 51, however, have another challenge. Women reach menopause at the average age of 51.3. During the latter stages of perimenopause and early postmenopause, there is an accelerated rate of loss of both muscle and bone. The loss is experienced when there is a sharp decline of estrogen and a corresponding increase of cortisol.

Show Me the Muscle

While average weight gain was the reported data in this study, changes in body composition weren’t included. This author suggests we may safely assume this was fat weight and not muscle. There is a need for both exercise and nutrition interventions.

There is also a potential need to identify solutions to sleep disruption and stress (as cortisol can have a negative impact on fat storage and muscle breakdown). Sleep disruption is common for women in menopause and often accompanies stress or anxiety, of which the pandemic provided an abundance.

Hormonal Contributing Factors

Testosterone and growth hormone also decline with age and levels will suffer more in women who experience unresolved insomnia during menopause. These two hormones are produced in the greatest amounts during deep sleep cycles, which menopausal women may reach with less frequency or for shorter durations. 

Women who were in late-stage perimenopause, early-stage post menopause window during the pandemic have the greatest potential for devastating disability. This is especially true if they weren’t strength training with adequate intensity. We may see these effects in a decade if losses of muscle and bone are not mitigated. 

Sarcopenia, a significant loss of muscle and strength, is experienced by 42% of women by the time they reach 65. This is true in normal times, without a 14+ month decrease in adequate exercise stimulus. Sarcopenia results in frailty, greater risk of falls, and with bone loss also occurring at accelerated rates during menopause, fracture risk is higher. 

Compounding Problems

Pre-existing obesity or that stemming from weight gain during the pandemic coupled with sarcopenia provides an even more severe condition known as sarcopenic obesity. Both obesity and sarcopenia are independent risks for disability. In adults diagnosed with both, there is a 2.5-fold increased risk of disability. 

Inadequate Stimulus

When hormone levels offered a stimulus for muscle decline, there must be some other stimulus to replace it. 

Remember the shortage of dumbbells early in the pandemic? While Peleton sales skyrocketed and walking increased for many, access to the type of anaerobic strength training that has the biggest pro-aging benefits for women in midlife required creativity. For those not familiar with strength training, or not online due to connectivity or comfort, muscle and bone loss awareness and solutions are warranted.

The Perfect Storm for Fitness Professionals


For personal trainers and fitness pros, this truly is a perfect storm. It’s an opportunity for a legacy of impact on a female demographic that touches three generations. Her young adult children, friends and life partners, and parents & in-laws. Household decisions and health habits are influenced most by her. No one else has as much influence on health as she does. 

The unnecessary devasting disability that could result for those who’ve gained and sustained significant weight during the pandemic can be avoided. Fitness pros who take proactive measures to educate, publicize, and offer positive solutions for behavior change can be a part of reversing this significant health risk.

Debra Atkinson is the #youstillgotitgirl who is flipping 50 and changing the way thousands of women think about their second half. She’s the host of the Flipping 50 TV Show and the Flipping 50 podcast. As a master personal trainer, strength and wellness coach with over 30 years fitness industry experience, she works with women who are pro-aging with vitality and energy. She serves on the MedFit Education Foundation Advisory Board, is an international fitness presenter, and author of hundreds of articles and multiple books. Visit her website, flippingfifty.com

Check out Debra’s online course with MedFit Classroom, Menopause Fitness Specialist.


  • Lin AL, Vittinghoff E, Olgin JE, Pletcher MJ, Marcus GM. Body Weight Changes During Pandemic-Related Shelter-in-Place in a Longitudinal Cohort Study. JAMA Netw Open. 2021;4(3):e212536. doi:10.1001/jamanetworkopen.2021.2536
  • Front. Endocrinol., 21 May 2020 | https://doi.org/10.3389/fendo.2020.00332

13 Reasons the Right Exercise Matters More in Menopause

During menopause, you’re more susceptible to negative effects of stress. Avoid the wrong exercise (that will worsen stress) and do the right exercise and you can reduce or eliminate symptoms of menopause. There are at least 84 symptoms associated with menopause. This short list of 13 pesky symptoms can be supported by the right exercise.

Hot Flashes (and Night Sweats)

Hot Flashes are potentially the most well-known and most-associated signs of menopause, affecting approximately 50% of menopausal women. They are a sudden sensation of feverish heat that spreads through your body.

Why they occur for some women and not for others, or why they may happen occasionally or for a time and then be gone, is not clearly understood. Vasomotor control is the reason behind why you might experience them when a girlfriend doesn’t when both your hormones may fluctuate.

Night Sweats are excessive sweat that occur during the night. They can contribute to sleep disruption and daytime fatigue or anxiety. That of course, is not the jackpot you want. Both hot flashes and night sweats are believed in part due to fluctuating or low estrogen levels.

Exercise can help this menopause symptom if it’s the right exercise. 

Women who are more fit, with better body composition, and who exercise with adequate intensity experience up to 62% less frequent and or intense hot flashes. What you need to beware of is your tendency to jump to conclusions about how to reach higher fitness levels. Longer and “more” exercise is not the answer. Due to this fast-paced life and your midlife status, the rules have changed.

In midlife, in 2021 and beyond, if you’re still playing the exercise game according to 1980 rules, you will lose.

Will You?

The variability of progesterone related to amount of estradiol had the greatest correlation with hot flash occurrence in more than one study. Increased progesterone variability was associated with decreased hot flashes. Though there’s not much that can be done to influence the variability in your progesterone levels. However, you can exercise to optimize your natural progesterone. Namely, keep stress (cortisol) in check.

Simply start with a smart plan according to your status right now. (More tips below). Ultimately,  include high-intensity intervals at the duration, frequency, and time of day that supports you instead of throwing you under the bus.

Did you know that if the only time you can exercise is late day and you push through high intensity, instead of losing weight you could set off a cascade of events that cause you to gain? The right exercise at the right time of day is a must.


Fatigue is that sluggish, always-tired feeling doesn’t go away with a good night’s sleep. You feel unproductive, moody and this fatigue can cause what’s known as wired-and-tired feeling. You desperately want to get a good night’s sleep and shake it but can’t. For some women, this is like period week fatigue only it doesn’t go away.

Extended periods of fatigue can be signs you’ve just been pushing through, using caffeine or sugar or both to serve you short term. If you rely on external substances too long, that false energy you borrow is going to catch up to you in the end and you will pay back that debt.

If you rely on external substances too long, that false energy you borrow is going to catch up to you in the end and you will pay back that debt.

So, what do you do when menopause fatigue hits and your calendar says HIIT? Or Long run? You rest. You can’t build fitness on a false foundation. Fake it till you make it doesn’t work with your midlife fitness. Plan the work. Work the plan. Override the calendar and rest if your workouts or your sleep, appetite, mood, or digestion is suffering.

An entire chapter in You Still Got It, Girl! Is dedicated to Rest & Recovery. Oh, there are chapters on exercise and on sleep too but Rest & Recovery is something few of us learned to do well. Now? We have to pay attention.

The right exercise when you’re fatigued could be no exercise. We need to remember what it’s like to just move more and rest well.

Low Libido

Libido is your overall sexual drive or desire for sexual activity. It’s influenced by biological, psychological, and social factors. It’s not just that you may feel dry and a lack of interest thanks to hormone shifts. If you’re experiencing fatigue and other menopause symptoms like weight gain and belly fat, you don’t feel sexy or want to be seen or touched.

One of my first Flipping 50 TV episodes was dedicated to low libido and what you can do about it. It’s partially due to changing hormones. But a lot of midlife women don’t realize that the exercise they’re doing (or not doing) is also destroying libido.

The right exercise will boost your testosterone. The wrong exercise kills it and the mood, girlfriend. Simply said, from the boardroom to bedroom this hormone is important. Last, exercise that gets your hips moving increases blood flow there and so it’s not all intense. Whether it’s dancing for you or it’s Pilates or Yoga is up to you.

Make this flip: Stop the endurance exercise and get on the short, intense train. Plus? If your partner snores? You may need to just have play dates together and sleep separately or the libido will keep being a problem. Sleep deprived and sexy don’t belong in the same sentence.

Sleep Disorders & Insomnia

Sleep disorders & Insomnia are often brought on by night sweats. Anxiety & Depression (below) can also be to blame. If your mind just won’t shut down and quiet when your body is crying for relief from fatigue, there are things you can do. If you think of your symptoms as little messengers something isn’t quite right, it may not just be hormones. Or it may be that your hormones will be helped by some gentle shifts.

It may be a micronutrient deficiency showing up. After all, at midlife, several things may be catching up to you. Have you had a less-than-5-star diet? Are you pretty passionate about your coffee and your wine both? Have you neglected your exercise? Just review your last month and get honest. If “busy” got in the way of you exercising and your regular routine is now a random one, get back on it if only for sleep. Truth is just 10 minutes of exercise can boost sleep by 33% according to a poll by National Sleep Foundation.

It could also be exposure to EMFs (too many screens, electronics) in your lifetime or at least right now. Our bodies weren’t made to handle all of this.

There are about 20 different things you can do (and stop doing) to support sleep. Try them sequentially, not randomly and adjusting until you’ve eliminated each one or find it works is something most of us struggle to do on our own. “I’ve tried everything,” too often means I’ve randomly tried this and that for a while.

The right exercise to help with sleep depends on how you’re currently sleeping.

The Short List

Menopause Symptoms Lessened or Eliminated by (Proper) Exercise

  • Hot flashes
  • Fatigue
  • Night Sweats
  • Libido
  • Sleep Disorders
  • Weight Gain
  • Incontinence
  • Muscle Tension
  • Osteoporosis
  • Insomnia
  • Anxiety
  • Depression
  • Belly fat

Weight Gain

If you’ve experienced weight gain, I have good and bad news for you. First, you can do something about it. Second, menopause is not to blame. Hormone fluctuation may have caused sudden weight gain. But often at a deeper level there is some behavior change that either did or needs to happen.

You may, as I did, find yourself in a perfect storm. Everything that happened for me in 2019 put me in a place of toxin exposure (hormone disruption), physical and emotional stress (hormone imbalance x 2), and related time and financial stress (hormone disruption). By the end of the year I’d gained 10 lbs. Now, at first glance, it’s possibly reasonable. However, I was training for an Ironman (that’s 140.2 miles of swimming, biking, and running in a day).

Endurance activity has the potential to throw women in midlife (and others) under the bus with adrenal fatigue and it certainly did me. I’d successfully trained for 7 prior to it, with excellent health (albeit, I modified my protocol intentionally for optimum training as opposed to volume).

During menopause, what you’ve been able to get away with until then, you may not.

Depression & Anxiety

Depression & anxiety are mood disorders more common among women than men. Dropping estrogen can negatively influence production of neurotransmitters (brain hormones) like dopamine and serotonin that regulate mood. Combined declining levels of progesterone and estrogen make it hard to restore happiness after incidence of sadness or anxiety.

During the pandemic if you’ve had a little more struggle with this, though perfectly natural and normal with a decrease in our social connections, as a woman in midlife you may struggle a bit more than you would have going through this say 10 years ago.

What can you do? Mood boosting exercise is a big part. Get outdoors and move and lift weights. Both are associated with increase in serotonin, and reductions in anxiety & depression.

Belly Fat

Belly fat didn’t make many “common symptom lists.” For over 90% of the women I’ve worked with belly fat is a big complaint, whether or not they’ve gained weight. Fat deposits tend to favor the belly.

There are two types of belly fat, visceral fat and muffin top or the pinch-an-inch type.

Visceral belly fat is internal around your organs. Muffin top is that spare tire, often in front and back for women.

The two types of fat respond to exercise differently. The right exercise for targeting menopausal visceral belly fat is high intensity interval training. Altering exercise to include high intensity intervals a few times a week can be enough. However, the muffin top requires more. You’ve got to do intervals and cut out your extra-curricular carb intake.


Osteoporosis and osteopenia (less than optimal but not quite to the 2.5 Standard Deviations from optimal bone that is osteoporosis) are both growing concerns for midlife and older women.

For good reason. Bone loss on average can be between 1-3% of total bone density per year if you’re not doing something about it.[Resistance weight training has the greatest positive influence on bone density. High impact weight-bearing exercise is second. The emergence of vibration therapy also contributes to bone density. However, vibrational therapy has to be combined with function stability movement for optimal prevention of falls and fractures.]

During the 3-5 years around a woman’s menopause bone losses can accelerate to 3-5% loss annually.

What’s the answer, or rather, what’s the answer while you’re at home, opting not to go to the gym during the pandemic? At the gym using the leg press, chest press, and seated row for strength will help most to load your hips, wrists, and spine. At home focus on squats, lunges, bent over row and chest press.

You’ve been conditioned to believe any exercise is better than no exercise. During menopause the right exercise for each woman is unique.

Reprinted from flipping50.com with permission from Debra Atkinson.

Debra Atkinson is the #youstillgotitgirl who is flipping 50 and changing the way thousands of women think about their second half. She’s the host of the Flipping 50 TV Show and the Flipping 50 podcast. As a master personal trainer, strength and wellness coach with over 30 years fitness industry experience, she works with women who are pro-aging with vitality and energy. She is an international fitness presenter, author of hundreds of articles and multiple books. Visit her website, flippingfifty.com













Why Women Need to Lift Weights

Traditionally speaking, when it comes to exercise, men have dominated the lifting weights world. This occurred mainly due to men being allowed to participate in sporting activities while women were not allowed to because it was not considered “lady like” and it was illegal. However, times have changed, as women are no longer looked at as being inferior to men; and it is safe, appropriate and very normal for them to exercise, particularly lift weights.

Here are a few reasons why women say they do not need to lift weights and my answer to their concern.

It Will Make Me Look Bulky

While this is a very legit concern, it is typically not true. In order for a woman (or man) to look “bulky”, they will have to do what is called a lot of “volume” in their workouts. Volume is the number of weight, repetitions, sets and exercises done in order to achieve mass or bulk.

If a woman follows the recommended numbers of days of weight lifting/week by ACSM (2-3 days/week, lifting weights for all the major muscles using 1-2 sets of 8-12 reps), they will not get bulky

Lifting Weights Does Not Help Me Burn Calories

Weight lifting has a high metabolic (ability to burn calories) rate. As a result, the more lean muscle a woman has, the less likely she is to gain weight and the easier it is to keep the weight off. Muscles are like the gas in our cars. The gas is used by the engine and keep the car moving.  Having muscle, by lifting weights, allows your body to keep moving and consistently fight off fat gains.

There is No Benefit For Me to Lift Weights

There are tons of benefits of women lifting weights! They include weight loss, improved mood and well-being, better posture and prevention of osteoporosis. These four are all major concerns for most women and lifting weights helps with all of them!

I Only Need to do Cardio to Be Healthy

While doing cardio activities (i.e. running, swimming, elliptical, spin class, etc.) is beneficial for the heart, it does not put the necessary stress on the bone and muscular system that our bodies crave. We were designed in a way that our muscles were meant to be moved beyond just walking and typing on a computer! While cardio is a great way to burn calories, oftentimes, it will burn away muscle because it is a catabolic activity. Lifting weights help to balance that out. 

Do I Really Need to Start Lifting Weights?

Yes, YOU do! I recommend that a woman looking to start lifting weights seek out professional help. A certified personal trainer is well qualified to provide safe and proper advice for her.

Also, I recommend home DVD workout programs such Power 90, Slim in 6 and Chalene Extreme that have all proven to help women strength train properly.

Weight training is important for everyone to do. It helps with posture, weight loss, prevention of osteoporosis and other metabolic diseases. It does not require a lot to do it, so why not incorporate two days/week for 30 minutes or less to lifting weights!

Maurice D. Williams is the owner of Move Well Fitness in Bethesda, MD, and Assistant Professor of Health & Human Performance at Freed-Hardeman University.  He is a NASM Master Instructor and Master Trainer,  and is also certified with NASM as a Corrective Exercise Specialist, Performance Enhancement Specialist, Senior Fitness Specialist & Weight Loss Specialist, and as a Certified Strength and Conditioning Specialist by NSCA.


Pregnancy and Childbirth During Unprecedented Times

Being pregnant and having a baby is stressful on its own. Now imagine being pregnant and delivering a baby during a global pandemic. Being a mother myself and treating pregnant women and new mothers, I recognize this population struggles with support, proper healthcare (especially postpartum), isolation and they may have limited resources at their disposal. It is important to understand that for many of these women the unexpected turn of events, has left them disappointed and it has affected the entire pregnancy and postpartum experience affecting both their mental and physical health.