Moving vibrantly in to midlife and beyond
As women in our 30s, 40s and 50s, the prospect of aging seems to frighten many of us. There is an association between getting older and becoming slower, weaker and less able. But what if there was something we could do to prevent these things? What if it was possible to feel vibrantly alive and healthy throughout the second half of our lives?
There is compelling evidence to show that movement is one of our most powerful allies in the pursuit of long term health and happiness. This is because movement actively protects our bodies from the effects of aging and hormonal decline.
With this article I hope to illustrate how we can use movement to reduce our risk of developing some of the most common health conditions that women typically face as they go through midlife and beyond. By doing so we can live the second half of our lives to the fullest.
Full disclosure – this isn’t a quick read! So grab yourself a cup of tea, get comfy and take ten minutes to join me. And if you don’t have time, use the bold text to read the key points, and choose the sections of most interest to you.
The statistics
We are living longer than ever before but unfortunately more of those years are being spent in poor health.[i] A 2022 report in to the ‘state of aging’ in the UK, revealed that musculoskeletal disorders, mental disorders and diabetes are responsible for the most years spent in poor health for adults aged 50-69.[ii] On average, “women experience their first major ill health condition when they are only 55 years old; in the poorest places when only 47 [years old].”[iii]
The good news is that many of these health conditions are preventable. According to official data, non-communicable diseases (such as cardiovascular disease, cancers, chronic respiratory disease and diabetes) cause around 89% of deaths in the UK.[iv] These diseases are, “to a significant extent, preventable and the costs, in human, social and economic terms, are largely avoidable.”
Importantly, physical inactivity is one of the four most significant modifiable risk factors for these preventable diseases, alongside tobacco use, the harmful use of alcohol and unhealthy eating.[v]
Movement as health insurance
It is empowering to know that poor health is not inevitable. Whilst some risk factors are out of our control (such as genetics, gender, place of birth, etc.), we can all make changes now to protect our current and long term health. Movement is a form of ‘health insurance’ open to us all, and one which can significantly increase the quality of our longer lives.
The benefits of exercise can be seen at any age, and it is never too late to start. However, the effects of aging and hormonal decline which become apparent in our 30s mean that movement becomes vital from this stage in our lives. Through movement, we can mitigate these effects, and develop our bodies’ resilience and strength.
Let’s start by considering what is occurring in our bodies as we move through our 30s, 40s and 50s and how exercise can lessen and in some cases reverse these changes.
Bones and Joints
From the age of 35 we start to lose bone mineral density and bone mass, at a rate of 1% per year, increasing to 3-5% post menopause.[vi] Declining levels of oestrogen, reduced mineral content and water levels affect our bones and the elasticity of our connective tissue, joint lubrication and cartilage strength.
The rate at which our bones break down overtakes the rate at which they rebuild. Around 10% of a woman’s bone mass is lost in the first 5 years post menopause, which increases our risk of osteoporosis – a condition which weakens our bones and makes them more liable to break.[vii] The National Osteoporosis Society report that 1 in 2 women over 50 years of age will break a bone due to osteoporosis.[viii]
Extensive research shows that regular exercise and physical activity increase bone density and slow down the effects of aging upon our bones. It has been stated that “if women were to participate in exercise for 20 minutes, four times per week, over a period of 10 years before the onset of menopause, osteoporosis would be unlikely to happen.”[ix] Equally promising is the finding that “older adults who exercise for at least one hour every day reduce their risk of fracturing a hip by 50%.”[x]
Muscles
As with our bones and joints, age-related changes occur to our muscles too. We reach peak muscle mass around the age of 30, after which time we progressively lose muscle at around 5% per decade, with this loss speeding up in our 60s and 70s. In addition to a decrease in muscle mass we also see changes in the muscle tissue itself, which has a negative effect upon muscle strength, power, endurance, elasticity and repair time.[xi]
In terms of slowing down the loss of muscle mass, strength training has proven highly effective. It is possible for people to not only mitigate muscle loss but to actually increase lean muscle tissue and strength well in to their 70s! Indeed, “exercise slows down, and in some instances, reverses the aging process.”[xii]
A 2021 report argued that “both early development of strength capacity and lifetime engagement in resistance training are important to slow the typical rate of decline with age” and stated that “adults can ‘bend the ageing curve’ with long-term participation in resistance training.” Their report, “examining the trajectory of strength in almost 250,000 [participants] aged over 55 showed substantial increases in strength with maintenance occurring over time, in contrast to the expected decrease in strength that would happen with ageing.” The report concluded that “the increase and maintenance associated with strength training compared to the natural decline over time demonstrates the importance of early and continued engagement in effective strength training for older adults.”[xiii]
One area of particular concern for women as we age is our pelvic floor. 1 in four women suffer with pelvic floor disorder (with symptoms such as incontinence and prolapse), including 26% of women aged 40-59. The prevalence of which increases with age due to the number of births a woman has had and the decrease in muscle strength with age.[xiv] The good news is that, as with our other muscles, we can exercise our pelvic floor.This can be done by performing pelvic floor contractions either independently or as part of a Pilates class. And in the case of more severe prolapse, women’s health physiotherapists can help.
Heart health
The cardiovascular system shows a decline of 30% from 30 to 70 years of age. The heart is after all a muscle.
Alongside the age related changes, declining oestrogen levels, leading up to and following the menopause, also affect our heart health. Women’s health expert, Dr. Louise Newson, explains that this is because “oestrogen helps to protect our arteries by reducing the build up of fatty plaques that can cause the arteries to narrow, meaning that blood and oxygen can’t reach our vital organs.” The good news is that “with regular exercise maximum oxygen consumption can be maintained at high levels. It has been shown that active 60 year olds have a higher oxygen uptake that sedentary 20 year olds.“[xv]
Dr Angela Maas, expert in female cardiology, states that “prevention is the cornerstone for avoiding cardiovascular disease […] In women more than men it has been shown that heart attacks, heart failure and strokes can be prevented with a healthy lifestyle and by treating risk factors properly.”[xvi]
It’s clear that regular exercise is highly effective at preventing the onset of cardiovascular disease, high blood pressure and diabetes, but exercise is also an integral part of treating these conditions. The long term effects of exercise for those with high (or normal) blood pressure, is a lowering of blood pressure and an increase in cardiovascular fitness.[xvii]
Brain health
Just as our muscles, bones and hearts are affected by aging and hormonal decline, so too are our brains. Dr Lisa Mosconi – professor of neuroscience and director of the Women’s Brain Initiative – attributes “the loss of a key protective element in the female brain” and an acceleration of the aging process to the hormonal changes which occur during the menopause transition. Indeed, when comparing brain scans of pre and post-menopausal women, we see substantially lower brain metabolism in the latter, with up to 30% reduced brain activity.[xviii]
Adopting a healthier lifestyle in the years leading up to and around menopause can significantly improve menopause symptoms and dramatically reduce future Alzheimer’s risk. Mosconi provides compelling evidence for this in her book ‘The XX Brain’. Physical activity is chief amongst the lifestyle interventions she recommends for preventing cognitive decline and dementia. She describes exercise as ‘a muscle building, stress busting, endorphin releasing memory enhancer and time reverser’ which ‘turns down inflammation, increasing our defences against a variety of diseases, not the least of which is Alzheimer’s.’
Considering the latest statistics, released in 2020, which reveal that dementia and Alzheimer’s disease are the leading cause of death for females in the UK,[xix]this is of enormous significance.
“The undeniable boon that physical exercise brings to brain function is evident on multiple fronts” Mosconi writes. She describes two studies done in the USA, which considered the impact of fitness levels upon brain health. The studies revealed that those with a higher level of fitness showed significant increases in brain size, “specifically in the memory centres of the brain”, and “very low rates of future dementia.”[xx]
Weight gain
Weight gain is something which many women struggle with from peri to post menopause.
Increased weight and abdominal obesity (fat around the middle) are associated with the hormonal and metabolic changes of the menopause. Fluctuating and declining levels of hormones not only change the way that fat is distributed around our bodies but they also increase our feelings of hunger, can negatively affect our mood, stress levels and decrease motivation. All of which can lead to decreased self-esteem and body confidence, which, for many of us, leads to comfort eating, reaching for high sugar and high fat foods, and no inclination to exercise. And so the vicious cycle begins.
Whilst totally understandable, if we continue to gain weight then we may eventually find ourselves struggling with obesity. In the UK over 60% of women aged 35 and over are classed as obese.[xxi] Unfortunately, obesity can increase a woman’s risk of developing various disorders such as insulin resistance, cardiovascular disease, metabolic syndrome, type 2 diabetes and cancer. So, what can we do about this?
The first thing to understand is that menopausal weight gain and increased abdominal obesity are due to a reduction in energy expenditure and dietary changes, as opposed to menopause itself. It is empowering to understand that weight gain during the menopause transition is not therefore inevitable, but rather something we can prevent through healthy food choices and movement.
“Sedentariness rather than menopause is associated with increased risk of overweight/obesity, abdominal obesity and the metabolic syndrome”, which “supports the combined use of dietary measures and physical activity” as a means of reducing this.[xxii] According to a 2008 study, increasing physical activity and encouraging healthy dietary choices in the early perimenopausal years “prevent weight and visceral fat gain in menopausal transition.”[xxiii]
Movement can help us to manage our weight by increasing the number of calories we burn – both during exercise and by increasing our basal metabolic rate. Strength-based exercise increases our lean muscle mass, which has a beneficial effect on our ability to burn calories (our metabolic rate) but also upon our body composition. Furthermore, studies in to long term maintenance of weight loss, found that in people who have successfully lost weight, those who are more active are significantly more likely to keep the weight off than those who are inactive.[xxiv]
What type of movement is most beneficial?
My initial answer to this question is: the one that you most enjoy and which you are most likely to do. Nevertheless, when it comes to mitigating the effects of aging and hormonal decline in women, there are two types of movement which are particularly beneficial. These are:
- Weight bearing activity: This is where your feet and legs support your weight. Some examples of weight bearing exercise are: brisk walking and hiking, jogging, aerobics, tennis, skipping and dancing. They are aerobic in nature so they get your heart beating faster, your breath working harder, increase your temperature and (if you do them long enough) make you sweat.
AND
- Strength exercise: This is where you work against a resistance – be it your own body weight, or using resistance bands or hand held weights). Examples of strength exercise include lifting weights, press ups, squats, Pilates, physically demanding gardening like digging, and working with resistance bands.
How much movement do we need to reap the benefits?
The World Health Organisation (WHO) suggest that women between the ages of 18 and 64 should do:
- At least 150-300 minutes of moderate-intensity aerobic physical activity;
OR
at least 75-150 minutes of vigorous-intensity aerobic physical activity;
OR
an equivalent combination of moderate- and vigorous-intensity activity throughout the week.
AND
- Muscle-strengthening activities at moderate or greater intensity that involve all major muscle groups on 2 or more days a week.[xxv]
N.B. For women beyond 64 years, it is recommended that we include balance and flexibility work too. In my opinion, these are beneficial for everyone, regardless of age.
The benefits gained from meeting these guidelines is compelling. A large review of 28 trials found improvements in several measures of fitness in early postmenopausal women who engaged in moderate walking everyday along with weekly resistance training. Improvements related to musculoskeletal fitness, motor fitness, cardiorespiratory fitness, metabolic fitness, bone strength, weight and body fat.[xxvi] Subsequent studies and literature reviews have supported these findings,along with improvements in body pain, mental health, perceived quality of life, levels of intra-abdominal fat, and bone mineral density.[xxvii]
How to personalise these guidelines:
The key thing to remember here is that what is easy and enjoyable for one woman may be a huge challenge to another. So, meet yourself where you are. For someone who doesn’t currently exercise the guidelines may seem intimidating and unachievable. Whereas, a very active woman may easily exceed these amounts. Let’s break it down in to some examples:
If you don’t currently exercise at all then start by considering what types of weight bearing and strength based exercise you enjoy (or would like to try) and base what you do around those. Remember that you don’t need to meet the amounts overnight. You can build up to achieving them.
As an example for a complete beginner, it might be that you start by committing to spending less time sitting still throughout the day, in addition to taking a 15 minute brisk walk 5 days a week, and look to increase the length of time you spend walking by 5 minutes each week until you are walking for a minimum of 45 minutes every time. Perhaps keep things fun by also dancing around the house to your favourite music one evening. In order to achieve your strength based exercise each week, you might attend a Pilates class once a week and on another day spend 15 minutes at home doing some basic strength exercises using your body weight (eg. step ups on the stairs in your house, press ups against the kitchen counter top, and bicep curls using household items).
My advice is to try as many different types of exercise as you can in order to find the things you most enjoy. The things you end up enjoying might really surprise you. I certainly never thought I would love boxing and lifting heavy weights but I get such a buzz from them! And whilst they aren’t doable every day, my other love is brisk walking outdoors in nature, which provides a nice contrast to my resistance work and is something I can do every day.
If finding the time to exercise is your biggest obstacle then it might be useful to compare what you currently do with the recommended amounts and consider the most time-effective ways to make up the deficit. Is it easier for you to find an hour three times a week or to find half an hour every day? What might you need to change or even stop doing in order to make time? Can you combine exercise with an existing commitment (like meeting a friend for a walk instead of coffee). Is it a question of getting up earlier a few times a week, or committing to finish work at a certain time? It may not be easy initially, but once you have established a routine, it becomes habit. And as we all know, habits are hard to break!
For some women, especially those who have always been very active, the physical changes which occur as a result of aging and hormonal decline may mean that you are no longer able to exercise at the same level you previously were, or perhaps your weight and body shape are changing after years of being the same. This can be psychologically very hard to take, especially for those who have performed competitively (whether that be against yourself or others). It may lead to a resolution to exercise more in order to try and ‘get back’ to where we were. But this can lead to burnout and injury. What’s more, the changes in our cortisol levels (stress hormone) during this menopause transition years mean that over exercising will only increase our levels of stress, leading to you feel worse rather than better.
Intense exercise can be counterproductive if you are already suffering from acute stress. Exercise is after all, a stressor. When exercise is the only stress upon the body, the body is able to adapt and become stronger through a process of progressive overload, but if you exercise at an intense level on top of an existing mountain of other stresses then the body will not respond in this way. Instead, your performance level and potential to develop strength is compromised and speed of recovery impaired.
If you are in this situation, try to meet yourself with compassion. What would you say to a friend in your situation? Cut yourself some slack and consider how you could change your exercise schedule and content to create a new and different stimulus. If you have always been a Spin addict for example, perhaps now is the time to challenge yourself with weights, and move to jogging or hiking for your cardio fill? Ask yourself, what other forms of exercise could still give you the buzz, the challenge and the physical benefits without the stress?
Beyond the physical benefits:
For many women, their mid-30s to late 50s will coincide with a great many challenges. In addition to going through the menopause, many women in this age bracket will also be: reaching the most demanding stage of their career; have young and teenage children; and, have aging parents who are starting to become ill and possibly require care. What’s more, they will likely be trying to balance all of this under the pressure which society places upon us – as women – to look a certain way. Stress and mental ill health are therefore, wholly understandable.
Fortunately “another significant benefit of regular physical activity is enhanced mental health, including protection against the onset of depressive and anxiety symptoms and disorders, reductions in existing symptoms of depression, anxiety and distress, and enhanced feelings of well-being”. This is understandable when we consider that exercise increases levels of feel good dopamine, serotonin, and endorphins, and improves self-efficacy and self-esteem. Indeed, “studies consistently show that physical activity is directly related to positive mood, vigor, and general well-being and inversely related to negative symptoms, such as depression, anxiety, and perceived stress.” [xxviii]
When it comes to relieving stress, gentle to moderate exercise can be particularly beneficial. Many people find walking in nature and practicing Yoga especially effective when it comes to de-stressing. Both of these things provide the chance for you to clear your mind, bring your awareness to your breath, and to the movement of your body. We are then able to slow down and lengthen our breath which activates the parasympathetic nervous system – the body’s natural relaxation response.
Your ‘Part-Two’
The second half of our lives provides an opportunity for us to look back on our lives to date and consider what is truly important to us now. Hopefully, it is a time when we learn to prioritise our own wellbeing. Movement – in whatever form it takes – can become a new and integral aspect of your identity. It may become a key part of your ‘you time’. It can open the door to a new social circle if that’s something you want. Or perhaps, you crave a new challenge and exercise can provide this for you?
Wherever you find yourself, embrace a form of movement that enriches your life and you will reap the benefits for years to come.
Written by Nicola Wilkinson, Women’s Health Coach
References:
[i] UKActive Report ‘Life in our Years: Unlocking physical activity participation for older adults’ 2021 https://www.ukactive.com/reports/life-in-our-years/
[ii] The State of Aging 2022 Report. Centre for Aging Better. The State of Ageing 2022 | Centre for Ageing Better (ageing-better.org.uk)
[iii] The All Party Parliamentary Group (APPG) Longevity Report ‘Levelling Up Health’, April 2021 https://appg-longevity.org/levelling-up-health
[iv] Annex C: Data on the distribution, determinants and burden of non-communicable diseases in England. Office for Health Improvement and Disparities, 2021. https://www.gov.uk/government/publications/nhs-health-check-programme-review/annex-c-data-on-the-distribution-determinants-and-burden-of-non-communicable-diseases-in-england
[v] UK Parliamentary publication: The Long Term Sustainability of the NHS and Adult Social Care; Chapter 6. Report of Session 2016-17 – published 5 April 2017 – HL Paper 151 https://publications.parliament.uk/pa/ld201617/ldselect/ldnhssus/151/15109.htm#_idTextAnchor106
[vi] Exercise for Older Adults Course Manual. YMCAfit 2013.
[vii] Dr Louise Newson. Preparing for the Peri-menopause and Menopause. Penguin Life Expert Series. Published 2021.
[viii] https://theros.org.uk/what-we-do/media-centre/media-toolkit/
[ix] Exercise for Older Adults Course Manual. YMCAfit 2013.
[x] Exercise for Older Adults Course Manual. YMCAfit 2013.
[xi] Exercise for Older Adults Course Manual. YMCAfit 2013.
[xii] Exercise for Older Adults Course Manual. YMCAfit 2013.
[xiii] UKActive Report ‘Life in our Years: Unlocking physical activity participation for older adults’ 2021 https://www.ukactive.com/reports/life-in-our-years/
[xiv] Dr Juan Michelle Martin, Lecture ‘Pelvic Health Postpartum to Menopause’, delivered as part of The 3rd Age Woman course by Burrell Education.
[xv] Exercise for Older Adults Course Manual. YMCAfit 2013.
[xvi] Dr Angela Maas, ‘A Woman’s Heart’, Aster, 2020.
[xvii] Exercise for Older Adults Course Manual. YMCAfit 2013.
[xviii] Dr Lisa Mosconi, ‘The XX Brain’, Allen & Unwin, 2020.
[xix] https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/causesofdeath/articles/leadingcausesofdeathuk/2001to2018#uk-leading-causes-of-death-by-age-group
[xx] Dr Lisa Mosconi, ‘The XX Brain’, Allen & Unwin, 2020.
[xxi] The State of Aging 2022 Report. Centre for Aging Better. The State of Ageing 2022 | Centre for Ageing Better (ageing-better.org.uk)
[xxii] P.M. Spritzer & K. Oppermann, ‘Weight gain and abdominal obesity at menopause’, Letters to the Editors, Climacteric, 2013, Volume 16, p.292.
[xxiii] Lovejoy JC, Champagne CM, de Jonge L, Xie H, Smith SR. Increased visceral fat and decreased energy expenditure during the menopausal transition. Int J Obes (Lond). 2008 Jun;32(6):949-58. doi: 10.1038/ijo.2008.25. Epub 2008 Mar 11. PMID: 18332882; PMCID: PMC2748330.
[xxiv] Cox CE. Role of Physical Activity for Weight Loss and Weight Maintenance. Diabetes Spectr. 2017 Aug;30(3):157-160. doi: 10.2337/ds17-0013. PMID: 28848307; PMCID: PMC5556592.
[xxv] https://www.who.int/news-room/fact-sheets/detail/physical-activity
[xxvi] Asikainen TM, Kukkonen-Harjula K, Miilunpalo S. Exercise for health for early postmenopausal women: a systematic review of randomised controlled trials. Sports Med. 2004;34(11):753-78. doi: 10.2165/00007256-200434110-00004. PMID: 15456348.
[xxvii] Nguyen TM, Do TTT, Tran TN, Kim JH. Exercise and Quality of Life in Women with Menopausal Symptoms: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Int J Environ Res Public Health. 2020 Sep 26;17(19):7049. doi: 10.3390/ijerph17197049. PMID: 32993147; PMCID: PMC7579592.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7579592/
Sternfeld B, Dugan S. Physical activity and health during the menopausal transition. Obstet Gynecol Clin North Am. 2011 Sep;38(3):537-66. doi: 10.1016/j.ogc.2011.05.008. PMID: 21961719; PMCID: PMC3270074. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3270074/
[xxviii] Sternfeld B, Dugan S. Physical activity and health during the menopausal transition. Obstet Gynecol Clin North Am. 2011 Sep;38(3):537-66. doi: 10.1016/j.ogc.2011.05.008. PMID: 21961719; PMCID: PMC3270074.