The overhead squat is one of the most technically demanding squat variations, and for good reason. Unlike a traditional squat, this movement requires coordinated mobility through the shoulders, upper back, hips, and ankles while the core works to maintain stability beneath an overhead load.

It’s a movement that reveals not only how well we move, but how effectively we control that movement.

How to Do the Overhead Squat

Start with a PVC pipe or broomstick before progressing to a barbell.

1. Stand with feet approximately shoulder-width apart and take a wide grip on the PVC pipe.

2. Press the pipe overhead with arms extended, maintaining active shoulder engagement.

3. Brace your core and begin squatting by bending at the hips and knees.

4. Keep the pipe balanced over your midfoot as you descend, maintaining a stable trunk and controlled spinal position.

5. Squat only as deeply as your mobility allows without compromising technique, then drive through your feet to return to standing.

Technique matters! Even experienced athletes benefit from reviewing the mechanics of this complex movement. Watch this overhead squat video tutorial before beginning today’s workout.

Make the Movement Your Own

The overhead squat is highly scalable. The goal isn’t necessarily to squat deeper or lift heavier, but to develop mobility and stability while maintaining excellent mechanics.

• Start with a PVC pipe or broomstick. Practice the movement without additional loading, focusing on shoulder positioning, trunk stability, and squat mechanics.

• Reduce the range of motion. Squat to a box or bench to establish a depth at which you can maintain proper overhead positioning.

• Try a single-arm overhead squat. A lightweight dumbbell allows each shoulder to move independently and introduces an additional anti-rotation challenge for the core.

• Progress to a barbell. Once mobility and control are consistent, begin with an empty barbell and gradually increase the load.

Bottom Line

For women navigating midlife and beyond, the overhead squat offers an opportunity to train several important components of physical performance simultaneously: joint mobility, postural control, core stability, and whole-body coordination.

The real value of this movement isn’t how much weight you can hold overhead. It’s the ability to maintain control and stability while moving through a challenging range of motion. Developing these qualities supports the movement capacity and strength we want to preserve as we age.

Today’s workout puts these principles into practice, combining overhead squats with dynamic kettlebell work and a dedicated core challenge.

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This workout is worth spending some time on. It is critical to watch the short video tutorial on performing the overhead squat - whether this is your first time doing this movement or if you are proficient. Technique can always be fine-tuned with a complex movement such as this.

Once you feel confident performing this movement, we bring it to life in today’s workout that focuses on shoulder, hip, and ankle mobility as well as core strength and shoulder stabilization.

Warm-Up

TABATA (20 seconds of work/10 seconds of rest) - 6 minutes.

Perform each movement sequentially until you have completed each round of 3 movements 4 times.

• Up-downs (20s work/10s rest), then..

• Push-ups (easy option) (20s work/10s rest), then..

• Jumping air squats (20s work/10s rest), then back to the Up-downs

After you finish the TABATA, perform 12 PVC Pass-throughs with your broomstick or PVC pipe.

Movement Practice

WATCH THIS VIDEO TUTORIAL ON THE OVERHEAD SQUAT!

If you have never done this movement before PLEASE use just a broomstick or PVC pipe. This is a COMPLEX MOVEMENT, so until you feel ultra-confident and consistent with superb form, stick with a broomstick or PVC pipe.

Take 5-10 minutes to practice the overhead squats - Try 3-5 sets of 5 repetitions until you feel confident in performing this movement in the workout.

If you are familiar with the overhead squat, please watch the video tutorial and fine-tune your technique using an empty bar. Add weight as appropriate maintaining solid technique.

Movement alternatives:

• Use a box to squat to as shown in the video tutorial above if you cannot achieve sound mechanics and bar/pipe/stick position in a full squat.

• Single arm overhead dumbbell squat. If the restriction of a broomstick/PVC pipe makes this movement difficult to achieve with good form, try a single-arm overhead squat instead. Start with a lightweight object and work up to a dumbbell during practice.

Take another 5-10 minutes to practice the movements in Workout Part 1 and select your kettlebell weight. Select a weight that allows you to perform 12 repetitions unbroken for all rounds. This is a moderate weight where the last 3-4 reps become challenging.

Workout

Part 1

AMRAP 12 minutes (As many rounds as possible in 12 minutes)

• 12 Kettlebell swings (overhead or eye-level) (Alternatives: double dumbbell swing or a single dumbbell swing keeping reps even between sides)

• 12 Overhead squats

• 24 Mountain Climbers (right + left = 1 repetition)

Part 2

Core TABATA - (20 seconds of work/10 seconds of rest) - 6 minutes.

Perform each movement sequentially until you have completed each round of 3 movements 4 times.

• V-Ups

• Oblique Twists - weighted

• Sit-ups (Ab mat style: Use an ab mat or rolled towel supporting your lower back. Alternatively, perform sit-ups with knees bent/feet anchored).

Cool-Down

15-minute Back Bending Yoga. Take 15 minutes to cool down and rebalance your back and front body.

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This just dropped….

Check out my latest piece with Crossfit.com where I make the case for CrossFit methodology as an effective training approach for menopausal women.

NOW TAKING MEDICAL CLIENTS FROM COLORADO, CONNECTICUT, AND NEW HAMPSHIRE!

..in addition to MA, NY, NJ, PA, CA, FL, OH

If you are an active woman or competitive midlife athlete who feels abandoned by mainstream medicine, I’m here for you!

Active and athletic midlife women have needs and risk profiles that are different from the general population. These needs often go unmet by the mainstream medical community due to a lack of understanding of fitness and sport and their impact on mid-life hormonal physiology or even a lack of acknowledgment that this dynamic exists.

To speak to this need, I launched my Telehealth Consultation Medical practice focusing on the Reproductive Endocrine needs and Menopausal Care for active, athletic, and high-performing women.

We put your health, fitness, and performance at the center of the equation so that you can achieve your healthiest, highest-performing self!

You will find all my service offerings on my website including a link to my calendar so that you can reserve your place in my schedule!

Throughout this series, we’ve explored how GLP-1 receptor agonists intersect with the physiologic demands of female athletes, from energy availability and fueling to the preservation of muscle, bone and athletic performance.

For women over 40, the hormonal and metabolic changes of the menopause transition add another layer of complexity to decisions about GLP-1 therapy. Understanding these changes is essential to balancing metabolic health with the demands of training and long-term athletic function.

Menopause changes the metabolic landscape

During perimenopause and menopause, declining estrogen levels contribute to changes in body composition, including increased visceral adiposity, as well as impacts on skeletal muscle mass and function, bone remodeling, and glucose regulation.

For some midlife women, GLP-1 receptor agonists may offer meaningful benefits when obesity or other metabolic indications are present. Improvements in weight, glycemic regulation and cardiometabolic risk can contribute to long-term health.

However, the clinical priorities of an athletic woman may extend beyond weight reduction.

Preserving skeletal muscle, supporting bone health, maintaining adequate energy availability and sustaining training capacity are equally important considerations.

And while the benefits of GLP-1 therapies have been demonstrated in several metabolic populations, studies specifically examining their use in menopausal athletes remain lacking.

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When body weight doesn’t tell the whole story

Body mass index (BMI) does not fully capture body composition or metabolic health, particularly in athletic populations. A normal BMI does not necessarily exclude metabolic dysfunction, just as a higher BMI does not necessarily reflect poor metabolic health.

However, identifying metabolic concerns and determining whether GLP-1 therapy is appropriate are separate clinical considerations. Most clinical trials supporting GLP-1 medications for weight management have enrolled relatively sedentary individuals with overweight or obesity, leaving important evidence gaps regarding their use in female athletes with normal metabolic function.

This distinction is particularly relevant when GLP-1 medications are being considered for body-composition optimization or athletic performance rather than established medical indications.

What about microdosing?

The growing interest in using very low doses of GLP-1 medications introduces another area of uncertainty.

The concept of “microdosing” is sometimes presented as a way to achieve modest appetite suppression or body-composition changes while potentially minimizing adverse effects.

However, there are no clinical trials establishing the safety or effectiveness of GLP-1 microdosing in normal-BMI athletes.

Evidence from lower-dose regimens studied in other populations cannot simply be extrapolated to lean, highly active women with different nutritional and physiologic demands.

Without these data, we cannot determine whether such approaches provide meaningful benefits or introduce risks that outweigh them.

An individualized approach for the midlife athlete

For an athletic woman considering or using GLP-1 therapy, the discussion should begin with the clinical indication and the individual’s broader health and performance goals.

Important considerations include metabolic health, body composition, training volume, nutritional intake, recovery, skeletal health and the potential for low energy availability.

When treatment is appropriately indicated, monitoring should extend beyond changes in body weight to include whether the individual is maintaining adequate fueling, strength, physical function and training capacity.

Resistance training, appropriate skeletal loading and sufficient protein and total energy intake remain important components of preserving muscle and bone health during midlife, but especially if an athlete has chosen to use GLP-1 therapy.

These principles are supported by broader exercise and nutrition research, although specific GLP-1 treatment and monitoring protocols for midlife female athletes have not been established.

The Bottom Line

GLP-1 receptor agonists represent an important advance in the treatment of obesity and metabolic disease. Their potential benefits should not be dismissed simply because a woman is physically active or participates in competitive athletics.

At the same time, athletic women have physiologic demands and performance goals that are not adequately represented in existing clinical trials.

The question is not whether GLP-1 medications are inherently good or bad for female athletes. It is whether their use has a clinical indication and how their potential benefits can be balanced with the demands of training, recovery, and long-term musculoskeletal health.

For women over 40, successful aging is not defined by body weight alone. It is reflected in the preservation of metabolic health, strength, skeletal integrity, and the physical capacity to continue doing the activities we value.

Beyond the scale, the goal is not simply to weigh less. It is to remain healthy, strong, and capable for the years ahead.

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This just dropped…..

Check out my latest article published with CrossFit.com where I review the current peer-reviewed literature about how menopause impacts muscles, bones, and metabolism, and what types of training have been shown to benefit women in this stage of life.

NOW TAKING MEDICAL CLIENTS FROM COLORADO, CONNECTICUT, AND NEW HAMPSHIRE!

..in addition to MA, NY, NJ, PA, CA, FL, OH

If you are an active woman or competitive midlife athlete who feels abandoned by mainstream medicine, I’m here for you!

Active and athletic midlife women have needs and risk profiles that are different from the general population. These needs often go unmet by the mainstream medical community due to a lack of understanding of fitness and sport and their impact on mid-life hormonal physiology or even a lack of acknowledgment that this dynamic exists.

To speak to this need, I launched my Telehealth Consultation Medical practice focusing on the Reproductive Endocrine needs and Menopausal Care for active, athletic, and high-performing women.

We put your health, fitness, and performance at the center of the equation so that you can achieve your healthiest, highest-performing self!

You will find all my service offerings on my website including a link to my calendar so that you can reserve your place in my schedule!

Sometimes, changing the challenge of a workout doesn’t require heavier weights, more repetitions, or different movements. Sometimes, all you need to change is the clock!

How Time Changes the Training Stimulus

Two common workout formats in functional fitness are:

• AMRAP (As Many Rounds As Possible): Complete as much work as possible within a fixed period of time.

• Interval-based training (EMOM-style): Begin a prescribed amount of work at regular intervals, resting during any time remaining before the next interval. Although EMOM traditionally means “Every Minute on the Minute,” intervals can be longer, such as every three, five, or seven minutes.

Even when the movements and weights are identical, changing the time structure can significantly alter how your body responds.

Exercise scientists distinguish between external load (the work performed) and internal load (the body’s physiological response, including heart rate, oxygen consumption, and perceived exertion).

Changing the clock can change the internal load without necessarily changing the external load.

Why This Matters

An AMRAP challenges your ability to sustain effort, manage fatigue, and maintain a consistent pace. Interval-based training incorporates planned recovery periods that can help preserve movement quality and manage accumulating fatigue.

Neither format is inherently better. Each creates opportunities to emphasize different aspects of fitness.

The Bottom Line

Progress isn’t always about doing more. It’s also about changing how you do the work.

Manipulating time and recovery is a simple way to introduce variety into training, challenge different physiological systems, and continue building fitness without constantly increasing weights or repetitions.

This week’s challenge: Same movements. Same weights. Two different time domains. Experience the difference for yourself!

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This week’s training this brings the time domain concept to life! We have two workouts. Try both this week, or do one this week and one next week.

Workout 1

Warm Up

AMRAP 7 (As many rounds as possible in 10 minutes). Perform each movement in sequence for as many rounds of all 4 movements as you can do in 7 minutes.

10 up-downs

10 air squats

10 ab mat or traditional sit ups

10 easy push-ups

Movement Practice

Movement options

• Row substitution: 10 burpees, 12 calorie air bike, 250m on the treadmill, 75 single under jumprope.

• Dumbbell Thruster substitution: 10 goblet squats (holding a weight), 10 squat jumps, 20 air squats

• V-Up substitution: Review the VIDEO for modifications of the V-up. Can also substitute the Ab Mat sit-up or traditional sit-ups.

Select weights/options that you can do the movements unbroken, EXCEPT for the V-ups. These are intended to be difficult with the need to break up the 24 repetitions.

Each round should take around 4-5 minutes to do, with 2-3 minutes of rest before the 7-minute interval finishes. Select your options accordingly.

Workout

E7MOM x 3 - EVERY 7 minutes x 3 sets. Set a clock for 7 minutes x 3 rounds. When the clock starts, perform each movement in sequence. Record your finish time. Rest for the remainder of the 7-minute interval. Repeat when the next interval clock starts.

12 Calorie Row

10 Dumbbell thrusters

24 V-ups (ok to break up into smaller sets with brief rest in between)

10 dumbbell thrusters

12 Calorie Row

SCORE: Total time working (Log your finish time for each of the 3 rounds). The lower the number, the better the score!

…. for a different day, do the same warm-up and keep the same movement options that you did for the 7:00 interval workout. Now try it as an AMRAP!

AMRAP 15 (As many rounds as possible in 15 minutes)

12 Calorie Row

10 Dumbbell thrusters

24 V-ups (ok to break up into smaller sets with brief rest in between)

10 dumbbell thrusters

12 Calorie Row

SCORE: Total number of rounds and reps. ** See how it compares to you E7MOM workout!

Cool Down

Team… regardless of which workout you did, your body needs some post-workout love to help jump-start your recovery. Check out this 20-minute full-body, deep stretch and nervous system reset from Five Parks! #dontskiptheyoga

Full-Body 20-minute Deep Stretch Yoga from Five Parks

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This just dropped…..

Check out my latest article published with CrossFit.com where I review the current peer-reviewed literature about how menopause impacts muscles, bones, and metabolism, and what types of training have been shown to benefit women in this stage of life.

NOW TAKING MEDICAL CLIENTS FROM COLORADO, CONNECTICUT, AND NEW HAMPSHIRE!

..in addition to MA, NY, NJ, PA, CA, FL, OH

If you are an active woman or competitive midlife athlete who feels abandoned by mainstream medicine, I’m here for you!

Active and athletic midlife women have needs and risk profiles that are different from the general population. These needs often go unmet by the mainstream medical community due to a lack of understanding of fitness and sport and their impact on mid-life hormonal physiology or even a lack of acknowledgment that this dynamic exists.

To speak to this need, I launched my Telehealth Consultation Medical practice focusing on the Reproductive Endocrine needs and Menopausal Care for active, athletic, and high-performing women.

We put your health, fitness, and performance at the center of the equation so that you can achieve your healthiest, highest-performing self!

You will find all my service offerings on my website including a link to my calendar so that you can reserve your place in my schedule!

GLP-1 receptor agonists have transformed weight management, producing substantial reductions in body weight and improvements in metabolic health. But for the female athlete, an important question extends beyond how much weight is lost: What happens to the muscle, bone and other tissues that support athletic performance?

In Part 1, we explored how appetite suppression may affect energy availability when combined with training. This week, we’re examining the composition of weight loss and its potential implications for strength, skeletal health and performance.

While clinical trials provide valuable information about body composition during GLP-1 therapy, studies specifically examining performance outcomes in female athletes are lacking. Much of our understanding must therefore be extrapolated from populations with overweight, obesity or metabolic disease.

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Weight loss is not just fat loss

Weight loss generally includes both fat mass and lean mass. Lean mass includes skeletal muscle, but also water, organs and other nonfat tissues. This distinction matters because a reduction in lean mass does not necessarily represent an equivalent loss of functional muscle tissue.

Studies of GLP-1 receptor agonists have reported that lean mass may account for approximately 25–38% of total weight lost, although estimates vary by medication, population and measurement method.

For individuals with obesity, substantial fat loss can provide meaningful metabolic and functional benefits, even when accompanied by some lean mass reduction. However, the implications may differ for a normal-weight, highly trained athlete.

Skeletal muscle is essential for generating force, producing power, maintaining metabolic function and supporting movement. For an athlete, the question is not simply how much lean mass is lost, but whether that loss compromises muscle function, strength or the ability to train.

What about bone?

Bone is another important consideration, particularly during perimenopause and menopause. It continuously responds to mechanical loading, nutritional status and hormonal signals. Weight-bearing exercise and resistance training stimulate skeletal adaptation, while adequate energy availability supports bone remodeling.

Research examining GLP-1-associated weight loss has produced mixed findings. Some studies report reductions in bone mineral density and increased bone resorption, particularly with substantial weight loss. However, these findings do not establish that GLP-1 medications directly damage bone. Changes may reflect weight loss, reduced mechanical loading, nutritional factors or medication effects.

Interestingly, a randomized trial in adults with obesity found that combining exercise with liraglutide helped preserve bone mineral density compared with liraglutide treatment alone.

For midlife female athletes, this is particularly relevant because the menopause transition is already associated with accelerated bone loss. However, whether these findings translate directly to athletic women using GLP-1 medications remains unknown.

What does this mean for athletic performance?

Muscle and bone are not simply components of body composition. They are essential to athletic function.

Weight reduction may improve certain aspects of performance, particularly in activities where moving less mass provides a mechanical advantage. Conversely, losing functional muscle or inadequate fueling could compromise strength, power, recovery and training adaptations.

Weight loss alone cannot tell us whether athletic performance is improving, declining or remaining unchanged.

We currently lack studies examining GLP-1-associated changes in VO₂max, strength, power or sport-specific performance in female athletes. Consequently, we cannot assume that changes in body composition necessarily translate into improvements—or impairments—in athletic performance.

Why this matters after 40

For active women over 40, preserving muscle and bone becomes increasingly important as the hormonal changes of midlife influence body composition, skeletal health and physical function.

Resistance training, appropriate skeletal loading and adequate nutrition remain central strategies for supporting these tissues. For women using GLP-1 medications, sufficient protein and total energy intake may be particularly important when appetite is reduced.

Although these strategies are supported by broader exercise and nutrition research, specific protocols for midlife female athletes using GLP-1 receptor agonists have not been established.

The Bottom Line

GLP-1 receptor agonists can provide substantial metabolic and weight-management benefits when appropriately indicated. But for the female athlete, the quality of weight loss matters as much as the quantity.

A lower number on the scale may be beneficial, but it does not necessarily indicate improved athletic function. Changes in body composition must be considered alongside strength, recovery, performance and overall metabolic health.

For the midlife female athlete, the more meaningful question may be:

Am I preserving the strength, skeletal health and physical capacity that will allow me to keep doing what I love?

In Part 3, we’ll explore how menopause, metabolic health and individual clinical circumstances influence decisions about GLP-1 therapy in athletic women over 40.

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NOW TAKING MEDICAL CLIENTS FROM COLORADO, CONNECTICUT, AND NEW HAMPSHIRE!

..in addition to MA, NY, NJ, PA, CA, FL, OH

If you are an active woman or competitive midlife athlete who feels abandoned by mainstream medicine, I’m here for you!

Active and athletic midlife women have needs and risk profiles that are different from the general population. These needs often go unmet by the mainstream medical community due to a lack of understanding of fitness and sport and their impact on mid-life hormonal physiology or even a lack of acknowledgment that this dynamic exists.

To speak to this need, I launched my Telehealth Consultation Medical practice focusing on the Reproductive Endocrine needs and Menopausal Care for active, athletic, and high-performing women.

We put your health, fitness, and performance at the center of the equation so that you can achieve your healthiest, highest-performing self!

You will find all my service offerings on my website including a link to my calendar so that you can reserve your place in my schedule!

Hey Team! 
This week begins Part 1 of a 2-part series on the lunge! This movement is a foundational movement with many variations and benefits from building lower body strength to balance, and coordination.
Enjoy!
-Dr. Carla

The forward lunge is a foundational lower-body movement that challenges strength, balance, and coordination. Unlike a squat, where both feet remain planted, the forward lunge requires you to step forward, absorb your body weight, stabilize, and push back to your starting position.

This combination of strength and controlled movement makes the forward lunge particularly valuable for maintaining functional fitness as we age.

Why This Matters for Midlife Women

The forward lunge strengthens the quadriceps, glutes, and hamstrings while challenging the muscles responsible for hip and pelvic stability. It also develops eccentric strength—the ability of muscles to generate force while lengthening—as the body lowers into the lunge.

This controlled deceleration is important for everyday activities such as stepping down from a curb, navigating uneven terrain, and recovering balance when we unexpectedly step forward.

Because each leg works independently, lunges also challenge single-leg stability and help identify differences in strength and control between sides.

How to Perform the Forward Lunge

1. Stand tall with feet hip-width apart and your core engaged.

2. Take a comfortable step forward, keeping your feet approximately hip-width apart rather than in a straight line.

3. Bend both knees, lowering your body toward the floor while maintaining an upright, controlled torso.

4. Keep your front knee tracking in line with your toes and your front foot planted.

5. Push through your front foot to return to standing.

6. Repeat on the opposite leg.

Coaching tip: Focus on a controlled descent and a strong push back to standing. Quality of movement matters more than depth or speed.

Make the Movement Your Own

The forward lunge is easily adapted to your current strength, mobility, and training experience.

**Progress only when you can maintain good technique throughout the movement.

The Bottom Line

The forward lunge is more than a leg-strengthening exercise. It trains your body to absorb force, stabilize under load, and generate the strength needed to return to standing. These capabilities support confident movement in everyday life and provide a foundation for more demanding athletic activities.

Next week: We’ll turn our attention to the reverse lunge and explore how changing the direction of the step changes the movement’s demands.

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Today’s workout is taken directly from the CrossFit Archives. We will integrate two foundational functional movements: Lunging and carrying.

Building strength and capacity in these movements that we perform every day is integral to maintaining independence and vitality in the activities we love into our 80s, 90s, and beyond.

Warm Up

AMRAP 7 minutes - low to moderate, warm-up intensity

• 10 jumping jacks

• 10 Air squats

• 10 Mountain climbers (Right + Left = 1 repetition)

• 10 alternating lunges in place or walking lunges

Movement Practice

For the lunges, find a pain-free range of motion that you can do easily and confidently over this higher volume of repetitions. ** This is a body-weight lunge. No weight is prescribed for this workout.

For the dumbbell farmer carry, select a moderate weight and a distance that you can carry, stopping only once or twice during each Farmer Carry segment.

Workout

ADVANCED

3 Rounds for time

• 50 Lunges

• 200m Dumbbell Farmer Carry

If the volume of repetitions for this workout is not accessible today, try the BEGINNER option below, or try something in between!

BEGINNER

3 rounds for time

• 15 Lunges

• 100m Dumbbell Farmer Carry

Cool Down

The high volume of swings in this workout puts your hamstrings and posterior chain to work! Show your hard-working body some love with this 15-Min Deep Stretch & Release for Hips & Hamstrings.

Recovery during this stage of life is critically important! So PLEASE #dontskiptheyoga

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NOW TAKING MEDICAL CLIENTS FROM COLORADO, CONNECTICUT, AND NEW HAMPSHIRE!

..in addition to MA, NY, NJ, PA, CA, FL, OH

If you are an active woman or competitive midlife athlete who feels abandoned by mainstream medicine, I’m here for you!

Active and athletic midlife women have needs and risk profiles that are different from the general population. These needs often go unmet by the mainstream medical community due to a lack of understanding of fitness and sport and their impact on mid-life hormonal physiology or even a lack of acknowledgment that this dynamic exists.

To speak to this need, I launched my Telehealth Consultation Medical practice focusing on the Reproductive Endocrine needs and Menopausal Care for active, athletic, and high-performing women.

We put your health, fitness, and performance at the center of the equation so that you can achieve your healthiest, highest-performing self!

You will find all my service offerings on my website including a link to my calendar so that you can reserve your place in my schedule!

My Friends! 
This is a topic that has been getting a lot of attention in the athlete space, and we are going to review it here. My goal is to present you with unbiased, evidence-based information on this topic that cuts through all the social media noise. Join me for Part 1 of this 3-part series.
Enjoy! 
-Dr. Carla 

GLP-1 receptor agonists have transformed the treatment of obesity and metabolic disease. By acting on pathways involved in glucose regulation, gastric emptying and appetite, these medications can produce substantial weight loss and meaningful improvements in metabolic health.

But what happens when the person taking them is also an athlete?

That question is surprisingly difficult to answer. Despite the rapidly expanding use of GLP-1 receptor agonists, there are currently no published studies specifically investigating their use in female athletes. We also have no studies specifically examining normal-BMI athletes and no athlete-specific data addressing VO₂max, power, sport performance, body-composition optimization or the risk of Relative Energy Deficiency in Sport (RED-S).

Most of what we know comes from populations with overweight, obesity or diabetes—populations whose metabolic, nutritional and training demands may look very different from those of an active or competitive woman.

For the female athlete, one particular effect of these medications deserves more attention: appetite suppression.

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Training changes the energy equation

Exercise increases the body’s energy demands, and those demands rise with training volume, intensity and duration. For an athlete, energy needs can also fluctuate considerably from day to day depending on the training stimulus, making adequate and responsive fueling an important part of supporting both performance and recovery.

Normally, food intake can increase in response to those demands. But GLP-1–based medications are specifically designed to reduce appetite and increase satiety. They may also produce nausea, early fullness or other gastrointestinal symptoms that make eating more difficult.

For someone trying to lose weight, eating less is part of the therapeutic effect. For someone simultaneously asking her body to train, recover, build muscle and maintain bone, however, the equation becomes more complicated.

The concern isn’t simply weight loss. It is whether energy intake remains sufficient to support both exercise and normal physiology.

Enter energy availability

This is where the concept of energy availability becomes important.

Energy availability describes the amount of dietary energy remaining for normal physiologic functions after accounting for the energy expended during exercise. When intake becomes insufficient relative to training demands, an athlete can develop low energy availability (LEA).

Importantly, LEA doesn’t require an eating disorder or intentional food restriction. Athletes can simply under-fuel because training demands increase faster than food intake—or because appetite doesn’t adequately reflect how much energy they actually need.

Pharmacologic appetite suppression introduces another potential pathway to that mismatch.

When energy availability becomes sufficiently low, the body begins adapting to conserve resources. Research on LEA has demonstrated changes in endocrine signaling, impaired bone formation, altered substrate availability and reduced protein synthesis. Prolonged or substantial LEA can contribute to the broader clinical syndrome known as Relative Energy Deficiency in Sport, or RED-S, which can affect multiple physiologic systems as well as athletic performance.

This doesn’t mean that GLP-1 medications cause RED-S. We don’t have evidence demonstrating that.

But it does raise an important question.

What happens when pharmacologic appetite suppression is layered onto a physiology already vulnerable to inadequate energy availability?

Why this may matter even more after 40

For the midlife female athlete, adequate fueling becomes particularly important.

Maintaining skeletal muscle, supporting bone health and recovering from training are already priorities as women navigate the physiologic changes of perimenopause and menopause. The goal of training during this stage of life isn’t simply to burn calories. We are asking exercise to provide the mechanical and metabolic stimulus necessary to preserve—or ideally build—muscle, strength, power, cardiorespiratory fitness and skeletal resilience.

Those adaptations require resources.

An athlete can perform all the “right” training, but the body still needs sufficient energy and nutrients to respond to that stimulus. If appetite suppression makes it difficult to meet those needs, the intended benefit of training could potentially become harder to achieve.

That doesn’t mean that an athletic woman should never use a GLP-1–based medication. These medications can provide substantial health benefits when appropriately indicated.

It means that the therapeutic goal may need to look different in an athlete. The number on the scale cannot be the only outcome that matters.

The Bottom Line

GLP-1 medications and exercise are not inherently incompatible. But athletes bring a variable to the equation that traditional weight-loss studies weren’t designed to address: the energetic demands of training.

For the female athlete using a GLP-1–based medication, the important question isn’t simply, “Am I losing weight?”

It is also:

Am I eating enough to support the work I’m asking my body to do?

That means paying attention not only to weight, but also to fueling, recovery, training quality, strength, performance and other potential signs that energy availability may be inadequate.

And it leads us to the next question in this series: When weight is lost, what exactly are we losing?

In Part 2, we’ll look beyond the scale at what GLP-1–associated weight loss may mean for muscle, bone and athletic performance.

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NOW TAKING MEDICAL CLIENTS FROM COLORADO, CONNECTICUT, AND NEW HAMPSHIRE!

..in addition to MA, NY, NJ, PA, CA, FL, OH

If you are an active woman or competitive midlife athlete who feels abandoned by mainstream medicine, I’m here for you!

Active and athletic midlife women have needs and risk profiles that are different from the general population. These needs often go unmet by the mainstream medical community due to a lack of understanding of fitness and sport and their impact on mid-life hormonal physiology or even a lack of acknowledgment that this dynamic exists.

To speak to this need, I launched my Telehealth Consultation Medical practice focusing on the Reproductive Endocrine needs and Menopausal Care for active, athletic, and high-performing women.

We put your health, fitness, and performance at the center of the equation so that you can achieve your healthiest, highest-performing self!

You will find all my service offerings on my website including a link to my calendar so that you can reserve your place in my schedule!

Today’s featured movement is the Devil’s Press!

The Devil’s Press combines two familiar movements — a burpee and a dumbbell ground-to-overhead — into one full-body exercise.

It challenges strength, power, coordination and conditioning, all within a single repetition. And despite its intimidating name, it’s remarkably adaptable.

What is a Devil’s Press?

Starting with two dumbbells on the floor, you move into a burpee, return your feet toward the dumbbells, then use a powerful hip drive to bring both dumbbells overhead.

Think: Burpee + dumbbell ground-to-overhead.

The key is that the dumbbells aren’t simply pressed overhead. The hips and legs generate the power, while the trunk and upper body transfer and control that force.

Why does it matter for midlife women?

The Devil’s Press trains several qualities worth preserving as we age: strength, power, coordination and cardiovascular capacity.

It also incorporates two particularly functional skills — getting down to and back up from the floor and moving an external load overhead.

Because it uses large muscle groups and repeatedly moves the body through a large range of motion, it can create a substantial conditioning stimulus without requiring a long workout.

How to do it

Start standing over two dumbbells.

1. Hinge down and place your hands on the dumbbells.

2. Step or jump your feet back into a burpee.

3. Step or jump your feet forward.

4. Hinge at the hips and swing the dumbbells between your legs.

5. Drive through the hips and legs to bring both dumbbells overhead.

Think powerful hips — not an arm-dominant press.

Make It Your Own

You don’t have to start with the full Devil’s Press. Instead, build the pieces of the movement progressively.

Start with a bodyweight burpee to learn the floor transition. Next, add a kettlebell swing to introduce external load and hip-driven power. Then put the pieces together with two light dumbbells before gradually increasing the load as your technique, strength and confidence improve.

Burpee → Burpee + Kettlebell Swing → Light Devil’s Press → Heavier Devil’s Press

See the Make It Your Own graphic for the full progression.

Bottom Line

The Devil’s Press is more than a challenging conditioning exercise. It asks your body to get down to the floor and back up, generate power through the hips, move and stabilize a load overhead, and coordinate all of it while your heart rate is elevated.

Those are capabilities that matter well beyond the gym. Preserving the ability to move your own body, handle external loads, produce power and maintain control under physical demand supports both athletic performance now and physical independence later.

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Today’s workout combines functional skills, strength, and conditioning. As always, there are modifications for every fitness level or limitation. Enjoy this one - and don’t forget the foam rolling at the end!

Warm-Up

AMRAP 7 (as many rounds as possible at low intensity for 7 min)

· 5 burpees (Please see the linked video for variations for every fitness level)

· 10 alternating lunges (in place)

· 15 Air squats

· 20 single under jump rope, simulated jump rope, or lateral jumps over a line on the floor

Movement Practice

Watch the video link and practice the Devil’s Press or your selected option for 3-5 reps at a time. If you are using a kettlebell or two dumbbells, select a weight that is challenging but allows you to do the movement with confidence. Select a weight that allows you to do all 6 repetitions unbroken. Use 5-25# dumbbells depending on your skill and strength level.

For the alternating lunges, hold the same weights that you are using for the Devil’s Press either by your side or in the front rack position on your shoulders and perform 16 alternating lunges in place (or walking, if you prefer). If using both dumbbells is too heavy to complete the 16 repetitions unbroken, use a single dumbbell, or use no weight at all.

Workout

Perform each movement in sequence for 5 rounds (1 round = Devil’s Press, then pistols, then single unders)

5 Rounds for Time

· 6 Devils’ Press

16 Alternating weighted lunges

· 60 single unders (or 30 double-unders), 60 simulated jump rope, or 30 lateral jumps over a line

Cool Down

Take 5-10 minutes to Foam Roll wherever it feels good!

Share

NOW TAKING MEDICAL CLIENTS FROM COLORADO, CONNECTICUT, AND NEW HAMPSHIRE!

..in addition to MA, NY, NJ, PA, CA, FL, OH

If you are an active woman or competitive midlife athlete who feels abandoned by mainstream medicine, I’m here for you!

Active and athletic midlife women have needs and risk profiles that are different from the general population. These needs often go unmet by the mainstream medical community due to a lack of understanding of fitness and sport and their impact on mid-life hormonal physiology or even a lack of acknowledgment that this dynamic exists.

To speak to this need, I launched my Telehealth Consultation Medical practice focusing on the Reproductive Endocrine needs and Menopausal Care for active, athletic, and high-performing women.

We put your health, fitness, and performance at the center of the equation so that you can achieve your healthiest, highest-performing self!

You will find all my service offerings on my website including a link to my calendar so that you can reserve your place in my schedule!

Hey Team!
For the last few weeks, we have been taking a deep dive into the LIFTMOR trial. Today's post is the finale of this three-part series and kicks off our Thursday posts, dedicated to learning why we train the way we do, practical longevity-promoting tips, and anything else relevant to helping midlife women thrive. 
Enjoy!
-Dr. Carla

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For the past two weeks, we’ve been looking at the LIFTMOR trial and what it can teach us about exercise and bone health. First, we looked at the study itself: eight months of supervised high-intensity resistance and impact training improved bone mineral density in postmenopausal women with low bone mass. Then we explored why it worked—because bone doesn’t just need exercise; it needs a reason to adapt.

But there is one more important part of the LIFTMOR story: the benefits didn’t stop at the skeleton.

Stronger Bones. Stronger Women.

The LIFTMOR investigators didn’t measure bone density alone. They also looked at strength and physical function, and the changes were impressive. Women in the high-intensity resistance and impact training group increased leg strength by approximately 35% and back-extensor strength by approximately 36%. They also improved performance on measures including the timed-up-and-go, sit-to-stand, functional reach and vertical jump.

These measures may sound like research outcomes, but think about what they represent outside the laboratory: getting out of a chair, moving quickly and confidently, maintaining balance, producing power and controlling your body in space. These aren’t simply fitness metrics. They’re components of physical capacity, and maintaining that capacity becomes increasingly important as we age.

Bone Density Is Only Part of the Fracture Story

When we talk about osteoporosis, we understandably focus on the strength of the skeleton. But fractures don’t occur because of bone density alone. Many fractures occur because a vulnerable bone encounters a force it cannot tolerate, often during a fall.

That means preserving bone is important, but so is maintaining the physical abilities that may help us avoid the fall in the first place: strength, balance, coordination, reaction capacity and power. LIFTMOR was not designed or powered to demonstrate fewer falls or fractures, so we shouldn’t claim that it did. But its improvements in strength and physical function remind us why resistance training may matter well beyond what we see on a DXA scan.

We aren’t just trying to build a stronger skeleton. We’re trying to build a body capable of using it.

But What About Safety?

This is where an important nuance of LIFTMOR sometimes gets lost. The women in the study weren’t simply handed heavy barbells and told to start lifting. Participants were screened, they learned the movements, loads were progressed, technique mattered, and the sessions were closely supervised.

Across more than 2,600 supervised training sessions, the researchers reported only one minor adverse event. That’s reassuring, but it isn’t evidence that every woman with low bone mass should walk into a gym tomorrow and start deadlifting at 85% of her one-repetition maximum. The better lesson is that high-intensity training and appropriate training are not mutually exclusive. Heavy resistance training can be introduced thoughtfully, progressively and with appropriate instruction.

Don’t Copy the Program. Learn From the Principles.

You don’t need to reproduce the LIFTMOR protocol to learn from it. If you’re new to resistance training, your starting point may be learning a squat with your bodyweight, progressing to a goblet squat and eventually adding more load. If you’re already an experienced athlete, the challenge may be very different: continuing to progressively load movements rather than allowing years of training to become years of doing the same thing.

Impact can be scaled as well—from appropriately selected introductory jumping and landing drills to more demanding plyometric work in trained athletes. The movement changes, the load changes and the starting point changes, but the underlying principle doesn’t: give the body an appropriate challenge, allow it to adapt and then gradually ask it to do more.

The Bottom Line

Perhaps LIFTMOR’s greatest contribution isn’t simply showing us that postmenopausal women can improve bone density with high-intensity resistance and impact training. It’s challenging how we think about training as we age.

The goal isn’t simply to protect fragile bones by asking less of our bodies. It’s to appropriately prepare our bodies to do more—to build bone and muscle, develop strength, and preserve power and physical function. That means learning good movement, progressing thoughtfully and getting qualified guidance when needed.

Because ultimately, the goal of training isn’t simply a better number on a DXA scan.

It’s building the physical capacity to keep doing the things you want to do—for decades to come.

Share

NOW TAKING MEDICAL CLIENTS FROM COLORADO, CONNECTICUT, AND NEW HAMPSHIRE!

..in addition to MA, NY, NJ, PA, CA, FL, OH

If you are an active woman or competitive midlife athlete who feels abandoned by mainstream medicine, I’m here for you!

Active and athletic midlife women have needs and risk profiles that are different from the general population. These needs often go unmet by the mainstream medical community due to a lack of understanding of fitness and sport and their impact on mid-life hormonal physiology or even a lack of acknowledgment that this dynamic exists.

To speak to this need, I launched my Telehealth Consultation Medical practice focusing on the Reproductive Endocrine needs and Menopausal Care for active, athletic, and high-performing women.

We put your health, fitness, and performance at the center of the equation so that you can achieve your healthiest, highest-performing self!

You will find all my service offerings on my website including a link to my calendar so that you can reserve your place in my schedule!

Hey Team! 
Athletic Aging is getting a refresh! You will still receive the Weekly Workout post every week, which will have a streamlined focus on training to include a featured movement, practical coaching points, and the workout. On Thursdays, we'll go deeper into other topics such as the science of training, performance, and aging, with a particular focus on women at midlife and beyond. You will find these articles in the "Medical Updates" and  "Original Articles" categories, and as always, you can opt in/out of the content you would like to see. 
Enjoy!
-Dr. Carla

Physical asymmetry is part of being human. From handedness to the leg we naturally lead with, most of us have a side we favor—and some degree of difference in strength, mobility, balance, and coordination between sides is normal.

That’s one reason unilateral training—training one side of the body independently—can be so valuable. Rather than allowing the stronger or more coordinated side to compensate, unilateral movements ask each side to produce and control movement on its own. They can also reveal differences between sides that may be less apparent during bilateral movements.

Featured Movement: Single-Arm Overhead Walking Lunge

Today’s featured movement takes that concept a step further. Holding a dumbbell overhead in one hand while walking through alternating lunges creates an intentionally asymmetric load.

How to do it: Hold a dumbbell overhead with one arm extended and your shoulder stable. Step forward into a lunge, keeping your torso tall and the weight controlled overhead. Drive through the front foot to step into the next lunge. Complete the prescribed distance with one arm overhead, then switch sides.

Your legs produce the movement while your trunk and shoulder stabilizers work to maintain position and control the load. Balance, coordination, mobility, and muscular endurance all come along for the ride.

Make the Movement Your Own

One of the goals of the Athletic Aging Weekly Workout Series is to make fitness accessible for all skill levels and limitations. That’s why every post provides scaled options so that you can “Make the movement your own”.

Don’t be surprised if one side feels different from the other. The goal isn’t perfect symmetry. The goal is building strength and control on both sides.

Choose the version that meets you where you are today—from an unweighted overhead walking lunge to a lighter object, dumbbell, or heavier load. The goal is to preserve the intent of the movement while matching the challenge to your current strength, mobility, experience, and training goals.

The Bottom Line

For women at midlife and beyond, maintaining strength, balance, coordination, mobility, and the ability to stabilize a load matters both inside and outside the gym - especially when it comes to reducing the risk and impact of a fall. Unilateral training challenges several of these qualities at once while helping us continue to build strength on each side independently.

Whether you’re beginning to exercise, returning after time away, or looking for an additional performance edge, there’s a version of this movement for you.

Make the movement your own—then make it strong.

Now let’s train.

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Warm Up

AMRAP 7 (As many rounds as possible in 7 minutes)

• 20 single-under jump rope (or simulated jump rope) -for a low-impact option: 20 high-knee march in place (R+L = 1 rep)

• 20 alternating lunge in place (left + right = 2 reps)

• 6 plank alternating shoulder taps (Knees or toes)

Once you have finished the 5-minute AMRAP, follow along with this anterior pelvic tilt stretch sequence from Train FTW. This is important! This sequence will help warm up the flexibility required for the overhead walking lunge.

• Pre-workout stretch (follow along - 7 minutes): Anterior pelvic tilt sequence

Movement Practice

Take 5-10 minutes to test out your weights and select your options for the workout. Choose a weight that allows you to do the lunges unbroken while maintaining good form.

Movement options:

• Substitutions for double unders: Single unders, simulated jump rope, or 1 minute of lateral steps over a line or use of an agility ladder with quick feet as a low impact option if jumping is not available to you.

• Single arm overhead lunge options: Use no weight with arm extended straight overhead, for weight lighter than a dumbell, hold an object such as a shoe, can of beans or other small object overhead.

TIP! Be mindful of the body position achieved in the anterior pelvic tilt sequence. Engaging these same muscles in the overhead lunge will lend great stability, and core engagement and will protect your lower back.

Workout

Part 1 - 7-minute Core Activation - Follow along from Train FTW

Part 2 - AMRAP 15 (As many rounds as possible in 15 minutes)

• 50 single unders (30 double-unders or simulated jump rope, or 1-minute agility ladder work)
  25-ft walking overhead lunge, right arm (or 10 alternating lunges in place)
  25-ft walking overhead lunge, left arm

• 10 plank alternating shoulder taps (right + left = 2 repetitions)

Cool Down

Finish up today’s workout with a 15-minute yoga stretch sequence to release the hips and hamstrings and return your energy systems to baseline.

Yoga to release the hips and hamstrings - 15 minutes

Share

This just dropped…..

You did the workout, you ate “clean,” and your body still isn’t responding the way it used to. So what changed? In this episode, I sit down with Dr. Carla DiGirolamo, a double Board-Certified Obstetrician/Gynecologist and Reproductive Endocrinologist specializing in caring for active and high-performing women, to unpack what’s really happening to active women’s bodies in mid-life and beyond.

We get into why hypothyroidism can be misdiagnosed because of chronic underfueling, what LEA and RED-S are (and why most doctors have never heard of them), hot takes on microdosing GLP-1s and muscle/bone loss for midlife women, and how HRT, testosterone therapy, and IUDs actually fit together. This isn’t a decline — it’s a detour, and it comes with a new playbook.

NOW TAKING MEDICAL CLIENTS FROM COLORADO, CONNECTICUT, AND NEW HAMPSHIRE!

..in addition to MA, NY, NJ, PA, CA, FL, OH

If you are an active woman or competitive midlife athlete who feels abandoned by mainstream medicine, I’m here for you!

Active and athletic midlife women have needs and risk profiles that are different from the general population. These needs often go unmet by the mainstream medical community due to a lack of understanding of fitness and sport and their impact on mid-life hormonal physiology or even a lack of acknowledgment that this dynamic exists.

To speak to this need, I launched my Telehealth Consultation Medical practice focusing on the Reproductive Endocrine needs and Menopausal Care for active, athletic, and high-performing women.

We put your health, fitness, and performance at the center of the equation so that you can achieve your healthiest, highest-performing self!

You will find all my service offerings on my website including a link to my calendar so that you can reserve your place in my schedule!

Last week, we introduced the LIFTMOR trial, a landmark study demonstrating that supervised high-intensity resistance and impact training could safely improve bone mineral density and physical function in postmenopausal women with low bone mass.

But perhaps the most important lesson from LIFTMOR isn’t simply that lifting weights is good for bone.

It’s that the stimulus matters.

Bone is listening to how you move

Bone may look like an inert structural framework, but it is living, metabolically active tissue that is constantly being remodeled.

When we place force on the skeleton, bone bends and deforms ever so slightly. Cells within bone sense these mechanical strains and translate them into biological signals that can influence the balance between bone formation and resorption. This process is broadly known as mechanotransduction.

In other words, our bones are paying attention to the forces we place upon them.

But here’s the important part:

Not all loading sends the same signal.

Bone appears particularly responsive to loading that is relatively high in magnitude, applied rapidly, or different from the loading it routinely experiences. Because bone adapts to habitual activity, repeatedly exposing it to the same relatively modest forces may eventually provide less stimulus for further adaptation.

To give bone a reason to become stronger, we generally need to challenge it beyond what it has already learned to tolerate.

This is what made LIFTMOR different

The LIFTMOR investigators didn’t simply tell women to “exercise more.”

They created a very specific mechanical stimulus.

Participants performed heavy compound resistance exercises—including the deadlift, back squat and overhead press—at greater than 80–85% of their one-repetition maximum (1RM). These movements generate substantial muscular forces that are transmitted through the skeleton.

The program also incorporated impact loading through jumping chin-ups followed by drop landings, adding a different type of rapid skeletal loading.

The result was a training program deliberately designed to give bone a strong and unusual mechanical signal.

After eight months, women performing the high-intensity program increased lumbar spine bone mineral density by approximately 2.9%, while the low-intensity comparison group lost about 1.2%. At the femoral neck, bone density was essentially maintained in the high-intensity group while declining by approximately 1.9% in the comparison group.

That distinction matters.

What about walking?

Walking is excellent exercise. It supports cardiovascular health, mobility, metabolic health, mental well-being and overall physical activity—and I would never suggest giving it up.

But walking and resistance training are not interchangeable when our goal is specifically to stimulate bone.

Because our skeleton becomes accustomed to the forces it experiences regularly, walking may not provide a sufficiently novel or high-magnitude stimulus to substantially increase bone density, particularly at clinically important sites such as the hip and spine.

That doesn’t make walking ineffective.

It means different forms of exercise accomplish different things.

The takeaway for midlife women

As we move through perimenopause and menopause, preserving bone becomes increasingly important. This is also why simply asking, “Am I exercising enough?” may not be the most useful question.

Instead, consider asking:

“Am I giving my bones a sufficient reason to adapt?”

That doesn’t mean everyone should immediately put a heavily loaded barbell on her back. High-intensity resistance training requires appropriate technique, progressive loading and, particularly for women with osteoporosis or other medical or orthopedic considerations, appropriate supervision.

But the principle applies at every level.

Start where you are. Learn the movements. Build strength. Progress the load. And continue giving your body a reason to adapt.

That may be one of the most valuable lessons LIFTMOR has given us about exercise and bone health.

Subscribe now

Warm-Up

AMRAP 7 (As many rounds as possible in 7 minutes). Perform each movement in sequence for as many rounds as you can in 7 minutes.

• 10 Air squats

• 10 alternating lunges (in place) – body weight

• 20 single-under jump rope or simulated jump rope.

Movement Practice

Test out 15-20 sec of each movement sequentially for 2 rounds. Use this time to select your options/rep numbers for the workout. Select a lighter thruster weight where you can do 15-20 reps in 30-45 seconds. Plan to work between 30-45 sec each minute and rest for the remaining 15-30 sec. Your score at the end is the number of reps you accomplish. So pick rep numbers/movement options and do your best to stick to them!

Workout

EMOM 30 (Every minute on the minute for 30 minutes)

HOW TO: Perform 30-50 single-under jump rope (30-45 seconds), rest for the remainder of the minute. Then perform 30-45 seconds of dumbbell thrusters, rest 15-30 seconds, then perform 30-45 seconds of box jumps, rest 15-30 seconds, then start again with the jump rope. Continue moving through all three movements in sequence, every minute on the minute for a total of 30 minutes. Pace yourself! This is a long grind!

Minute 1 – 30-50 single-under jump rope or simulated jump rope reps. (Advanced option: 35 double-under jump rope)

• Option: 30 jumping jacks or high-knee run in place (R+L = 1 rep)

Minute 2 – 15-20 dumbbell thrusters

• Option: Grounded air squat

Minute 3 – 8-12 Box jumps

• Option: weighted box step-ups (Alternative: Body weight box step-up)

See you on the other side!

Cool Down

Show your body some love and jump-start your recovery with this 20-minute gentle yoga stretch sequence from Five Parks.

Share

This just dropped…..

You did the workout, you ate “clean,” and your body still isn’t responding the way it used to. So what changed? In this episode, I sit down with Dr. Carla DiGirolamo, a double Board-Certified Obstetrician/Gynecologist and Reproductive Endocrinologist specializing in caring for active and high-performing women, to unpack what’s really happening to active women’s bodies in mid-life and beyond.

We get into why hypothyroidism can be misdiagnosed because of chronic underfueling, what LEA and RED-S are (and why most doctors have never heard of them), hot takes on microdosing GLP-1s and muscle/bone loss for midlife women, and how HRT, testosterone therapy, and IUDs actually fit together. This isn’t a decline — it’s a detour, and it comes with a new playbook.

NOW TAKING MEDICAL CLIENTS FROM COLORADO, CONNECTICUT, AND NEW HAMPSHIRE!

..in addition to MA, NY, NJ, PA, CA, FL, OH

If you are an active woman or competitive midlife athlete who feels abandoned by mainstream medicine, I’m here for you!

Active and athletic midlife women have needs and risk profiles that are different from the general population. These needs often go unmet by the mainstream medical community due to a lack of understanding of fitness and sport and their impact on mid-life hormonal physiology or even a lack of acknowledgment that this dynamic exists.

To speak to this need, I launched my Telehealth Consultation Medical practice focusing on the Reproductive Endocrine needs and Menopausal Care for active, athletic, and high-performing women.

We put your health, fitness, and performance at the center of the equation so that you can achieve your healthiest, highest-performing self!

You will find all my service offerings on my website including a link to my calendar so that you can reserve your place in my schedule!

Hey Team! 
This week, I want to feature one of the most important randomized controlled trials for menopausal women - the LIFTMOR Trial. "Lifting heavy" is not just the latest social media tagline - it is the foundation of our longevity - and the evidence supports it! 
I hope you enjoy this summary and this week's workout! 
Cheers!
-Dr. Carla

Women with osteopenia or osteoporosis have traditionally been advised to exercise cautiously and avoid heavy lifting. The landmark LIFTMOR trial challenged that approach by asking an important question: Can postmenopausal women with low bone density safely lift heavy enough to stimulate stronger bones?

What was the LIFTMOR trial?

LIFTMOR stands for Lifting Intervention for Training Muscle and Osteoporosis Rehabilitation. This randomized controlled trial included 101 postmenopausal women with an average age of 65. All had osteopenia or osteoporosis at the hip, spine, or both.

The women were assigned to one of two programs performed twice weekly for eight months:

• A supervised, 30-minute high-intensity resistance and impact training program

• A home-based, low-intensity exercise program emphasizing mobility, balance, and light resistance

The high-intensity program centered on four movements: the deadlift, back squat, overhead press, and a jumping chin-up with a drop landing.

After an initial period focused on learning proper technique, the three resistance exercises were performed for five sets of five repetitions at greater than 80–85% of one-repetition maximum. In practical terms, these were genuinely heavy loads—not light weights performed for many repetitions.

What did the researchers find?

After eight months, lumbar-spine bone mineral density increased by approximately 2.9% in the high-intensity group. In contrast, the low-intensity group lost about 1.2%.

At the femoral neck, bone density was essentially maintained in the high-intensity group, increasing by approximately 0.3%, while the control group lost approximately 1.9%. Preventing the expected decline at the hip may itself be an important benefit.

The high-intensity group also demonstrated favorable changes in femoral-neck cortical thickness. Cortical bone forms the strong outer shell of bone and contributes substantially to the hip’s ability to tolerate loading.

More than stronger bones

LIFTMOR also produced substantial improvements in physical function. Leg and back-extensor strength increased by approximately 35–36%, and participants improved their sit-to-stand ability, functional reach, mobility, and vertical-jump performance.

This matters because fracture risk is influenced by more than bone density. Strength, balance, mobility, and the ability to recover from a misstep can all affect the likelihood of falling—and whether a fall results in injury.

Was heavy lifting safe?

Across more than 2,600 supervised training sessions, only one training-related adverse event occurred: a mild lower-back muscle strain. The participant returned to training and completed the program. No training-related fractures or serious injuries were reported.

These findings are reassuring, but they require context. Participants were carefully screened, the exercises were introduced gradually, and every high-intensity session was closely supervised by qualified professionals. The study was also too small to prove that the program prevents fractures or is safe for every woman with osteoporosis.

The Bottom Line

The LIFTMOR trial helped overturn the assumption that women with low bone density should train only with light weights. Its message is not simply “lift heavy.” It is:

With appropriate screening, progressive loading, excellent technique, and qualified supervision, postmenopausal women can train at high intensity—and may meaningfully improve bone density, strength, and physical function.

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Everyone loves a good heavy day! There’s something very satisfying about moving heavier loads for lower repetitions. But this isn’t your typical “heavy day” where we do 5 sets of 5 and we’re done. Today, we integrate two movements - the dumbbell push press and the front squat. But we don’t stop there - we have a new movement called the “dumbbell bear crawl” performed between rounds of lifting. This movement requires coordination, balance, shoulder stabilization, and core strength, complementing the muscles targeted by the lifts and adding some unexpected intensity!

Movement practice

Take 5-7 minutes to watch the videos, practice the movements, and select your workout weight. Select one set of dumbbells to use for the push press, front squat, and the dumbbell bear crawl. The push press will be what limits the weight selection. This is a heavier weight that you can perform 5 push press repetitions where the movement becomes challenging at rep 3.

Next, watch the video and practice the bear crawl, starting without weight and then adding the dumbbells. For bear crawl modifications, check out this post from the Athletic Aging Archives: Strong on All Fours. If the dumbbell bear crawl is not accessible to you, forego the dumbbells (or use a second, lighter set) and do a simple bear crawl.

Workout

Perform 2 dumbbell push presses, 2 front squats, and a 25-foot dumbbell bear crawl. Then perform 4 push presses, 4 front squats, and a 25-foot dumbbell bear crawl, and so on until you finish the repetition scheme. Your last movement should be the 25-foot dumbbell bear crawl. As the sets get larger and fatigue sets in, break up the sets into smaller sets with a few breaths of rest in between.

A trick to help keep moving efficiently is to make a point to pick up the dumbbells before you really want to at the end of each short rest interval.

For Time:

2 - 4 - 6 -8 -10

• Dumbbell Push press

• Dumbbell Front squat

Perform a 25-foot dumbbell bear crawl (or simple bear crawl or other modification) after each round of push presses and squats using the same set of dumbbells used for the lifts. Alternatively, you can perform the bear crawl without weight. Click HERE for more bear crawl modifications

Cool Down

Your core is going to need some love after this workout. Jump-start your recovery with this 15-minute full-body stretch sequence.

Yoga Full-Body Stretches for Tension and Sore Muscles

Share

This just dropped…..

You did the workout, you ate “clean,” and your body still isn’t responding the way it used to. So what changed? In this episode, I sit down with Dr. Carla DiGirolamo, a double Board-Certified Obstetrician/Gynecologist and Reproductive Endocrinologist specializing in caring for active and high-performing women, to unpack what’s really happening to active women’s bodies in mid-life and beyond.

We get into why hypothyroidism can be misdiagnosed because of chronic underfueling, what LEA and RED-S are (and why most doctors have never heard of them), hot takes on microdosing GLP-1s and muscle/bone loss for midlife women, and how HRT, testosterone therapy, and IUDs actually fit together. This isn’t a decline — it’s a detour, and it comes with a new playbook.

NOW TAKING MEDICAL CLIENTS FROM COLORADO, CONNECTICUT, AND NEW HAMPSHIRE!

..in addition to MA, NY, NJ, PA, CA, FL, OH

If you are an active woman or competitive midlife athlete who feels abandoned by mainstream medicine, I’m here for you!

Active and athletic midlife women have needs and risk profiles that are different from the general population. These needs often go unmet by the mainstream medical community due to a lack of understanding of fitness and sport and their impact on mid-life hormonal physiology or even a lack of acknowledgment that this dynamic exists.

To speak to this need, I launched my Telehealth Consultation Medical practice focusing on the Reproductive Endocrine needs and Menopausal Care for active, athletic, and high-performing women.

We put your health, fitness, and performance at the center of the equation so that you can achieve your healthiest, highest-performing self!

You will find all my service offerings on my website including a link to my calendar so that you can reserve your place in my schedule!

The strict shoulder press and the push press are movements that start with weight at the shoulders and finish overhead.

But what happens between those two positions makes them very different exercises — and both deserve a place in an Athletic Aging toolbox.

THE STRICT PRESS: Build the engine

In a strict shoulder press, the lower body stays quiet. No dip. No drive. No help from the legs.

The shoulders and arms have to do the work.

The strict press primarily trains the deltoids and triceps, while the upper back and trunk stabilize the body, and the shoulder blade must move appropriately as the arm travels overhead.

Because you can’t borrow momentum from your legs, the strict press is an excellent way to develop upper-body pressing strength and control.

Think: STRENGTH + CONTROL

THE PUSH PRESS: Connect the engine to the whole system

Now add the legs.

The push press begins with a short, controlled dip of the knees and hips followed by an explosive leg drive. That force travels from the floor, through the legs and trunk, into the arms and ultimately into the weight overhead.

Your shoulders are still working — but they are now part of a coordinated, whole-body movement.

That changes the training stimulus.

The push press develops power, coordination, and force transfer between the lower and upper body. It also allows you to move more weight than you typically could with a strict press.

Think: POWER + INTEGRATION

SAME FINISH. DIFFERENT JOB.

Strict Press
No assistance from the legs
Greater emphasis on upper-body strength
Slower, controlled force production
Requires trunk stability and overhead control

Push Press
Legs initiate the movement
Integrates lower and upper body
Develops speed and power
Trains coordinated force transfer through the body

Neither is the “better” exercise.

They simply ask your body to solve the same problem — getting something overhead — in different ways.

HOW TO DO THEM

For both movements, begin standing tall with the weight at shoulder level. Brace your trunk and keep the weight balanced over your base of support.

Strict Press:
Without bending your knees, press the weight overhead until your arms are extended. Finish with the weight stacked over your shoulders and body — not drifting forward.

Push Press:
Make a shallow, controlled dip by bending the knees and hips slightly while keeping your torso upright. Drive forcefully through the floor, extend the legs and use that momentum to help send the weight overhead. Finish in the same strong overhead position.

MAKE IT YOUR MOVEMENT

You don’t need a barbell — or a heavy weight — to benefit from either exercise

• Dumbbells — allow each arm to find a comfortable pressing path
• Lighter weights — practice mechanics before adding load
• Seated strict press — reduces lower-body contribution and balance demands
• Reduce the range of motion — work within the range you can control comfortably

And if an overhead position causes pain, don’t force it. Shoulder mobility, previous injuries, and individual anatomy can all influence which pressing variation feels best.

WHY TRAIN BOTH?

As we get older, maintaining strength matters. Maintaining power matters, too.

• The strict press develops the strength to produce force with the upper body.

• The push press teaches the body to generate force quickly and transfer it efficiently through multiple joints and muscle groups.

One builds the pieces. The other teaches the pieces to work together.

Strength gives us capacity.
Power and coordination teach us how to use it.

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Today’s workout provides the opportunity to practice the strict shoulder press and the push-press with accessory work before the main training set, followed by the push-press alternating with a cardiovascular stimulus.

Warm-Up

AMRAP 5 (As many rounds as possible in 5 minutes)

• 10 Up-downs

• 10 Mountain climbers (Right + left - 1 repetition)

Movement Practice

Today’s movement practice is an Accessory segment where you will practice the strict and push press movements.

To appreciate the greatest benefit from this accessory, watch the demo videos above for these two movements and pay close attention to the mechanics of these movements.

Select a light weight to start, building incrementally over the 3 sets.

Accessory Work

3 sets

5 strict press + 5 push press: Perform 5 strict presses, then without putting the weight down, go straight into the 5 push presses.

Rest 2 minutes between sets.

Workout

TIP! Break up the sets of dumbbell push presses into 2-3 sets. If you can do them unbroken, you have gone too light! (Recommended weights: 15lb dumbbells (beginner) to 35# dumbbells (advanced).

For Time:

• 21 Dumbbell Push Press

• 30 Calorie Row

• 15 Dumbbell Push Press

• 21 Calorie Row

• 9 Dumbbell Push Press

• 15 Calorie Row

Movement Options:

Substitute a kettlebell swing (eye level or if advanced, swing to overhead) if no access to a rower or jumping air squats if no access to a rower.

Cool-Down

Jump-start your recovery with this 15 minute Quick Escape Yoga sequence from Five Parks Yoga

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Housekeeping…

This is something you don’t want to miss. Check out this workshop featuring the awesome and amazing sports psychologist, Erin Ayala! Register HERE

NOW TAKING MEDICAL CLIENTS FROM COLORADO, CONNECTICUT, AND NEW HAMPSHIRE!

..in addition to MA, NY, NJ, PA, CA, FL, OH

If you are an active woman or competitive midlife athlete who feels abandoned by mainstream medicine, I’m here for you!

Active and athletic midlife women have needs and risk profiles that are different from the general population. These needs often go unmet by the mainstream medical community due to a lack of understanding of fitness and sport and their impact on mid-life hormonal physiology or even a lack of acknowledgment that this dynamic exists.

To speak to this need, I launched my Telehealth Consultation Medical practice focusing on the Reproductive Endocrine needs and Menopausal Care for active, athletic, and high-performing women.

We put your health, fitness, and performance at the center of the equation so that you can achieve your healthiest, highest-performing self!

You will find all my service offerings on my website including a link to my calendar so that you can reserve your place in my schedule!

If you want one movement that trains almost everything at once, the dumbbell thruster is hard to beat.

At its simplest, a thruster combines two familiar movements: a squat and an overhead press. Put them together, and the legs, hips, core, shoulders, and arms have to work as one coordinated system.

And your heart and lungs quickly get involved too.

Why Thrusters?

The dumbbell thruster develops several qualities that matter as we age:

• Lower-body strength from the squat

• Upper-body strength from the overhead press

• Power as the legs and hips drive the dumbbells upward

• Core stability while transferring force from the lower to upper body

• Coordination as multiple joints work together

• Cardiovascular fitness when repetitions are performed continuously

That combination makes the thruster remarkably efficient: strength, power, and conditioning in the same movement.

How To:

• Hold a dumbbell in each hand at shoulder height, with your feet approximately squat-width apart.

• Descend into a squat while keeping your torso controlled and your feet firmly planted.

• Then stand aggressively.

• As you extend your knees and hips, use that momentum to help drive the dumbbells overhead. Finish standing tall with the weights controlled overhead, then return them to your shoulders and begin the next repetition.

• Think: Squat → Drive → Press.

The movement should feel connected—not like a squat followed by a completely separate shoulder press.

You don’t need heavy dumbbells—or even a full-depth squat—to get the benefits of a thruster.

• Two dumbbells: Adjust the load.
  The traditional thruster uses a dumbbell in each hand, but you choose the weight. Lighter dumbbells reduce the strength requirement while preserving the full movement pattern.

• Box or bench thruster: Adjust the depth.
  Find your pain-free squat range of motion. Use a box or bench as a TARGET (not to sit down, but to define your pain-free squat depth), then drive up and press. This provides a consistent target for squat depth and can make the movement more accessible when mobility, balance, or joint tolerance is a consideration.

• Ball thruster: Lighten the overhead load.
  Swap the dumbbells for a basketball, soccer ball, or weighted medicine ball held at the chest. Squat, drive through the legs, and press the ball overhead. This maintains the symmetrical, full-body movement pattern while allowing you to substantially reduce the overhead load.

• Ball + toss: Add some power—and fun.
  Use a lightweight ball and, instead of stopping at the press, use your leg drive to propel the ball upward with a small toss. Catch, reset, and repeat. Less overhead load allows you to move faster, adding an element of speed, power, coordination, and play.

Different tools. Same purpose.

The goal isn’t to perform someone else’s version of a thruster. It’s to find the version that allows your body to squat, drive, push, stabilize, and work hard..

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Today’s workout integrates the dumbbell thruster (or your selected modification) with a run. This workout will raise your heart rate while targeting full-body strength and power.

This is a highly efficient workout as it take you only ~20 minutes. Consider this workout while traveling or on a day when you are pressed for time. It will not disappoint!

Warm Up

AMRAP 5 min (As many rounds as possible in 5 minutes at low intensity)

• 1:00 Run, Row or Up Downs

• 10 Air Squats

• 5 Dumbbell strict press (light)

Movement Practice

Watch the dumbbell/barbell thruster movement video in the Feature Movement section and be mindful of keeping good form and mechanics with the thruster. Select a challenging weight that is moderately heavy that you can complete the 12 repetitions in 1-2 sets. Fatigue will set in particularly in the last 2 rounds, so it is ok to break up the thrusters into 2-3 sets as needed.

Tip! A great way to manage fatigue but keep moving is to slow the pace of your repetitions.

Workout – Part 1

5 Rounds for Time (1 round = run then thrusters)

• 400m Run, Row, or 800m bike (If no ability to run, row, or bike - try 20 burpees!)

• 12 Dumbbell or barbell thrusters (moderate weight where you can perform the thrusters in 1-2 sets).

  ** Goal Time: <20 min

**If you are new to fitness, substitute a brisk walk for the run and air squats for the thrusters.

Workout Part 2 - Core Accessory

Accumulate 5 min of a hollow hold.

Hollow Hold

• Every time you break, pause the clock and do 20 Mountain Climbers (R+L = 1 repetition) ….then continue on that 5 min clock and go back to the hollow hold until you have completed a total of 5 min in the hollow hold position!

Cool Down:

5 min Yoga: Leg and Hip Stretch

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Housekeeping…

This is something you don’t want to miss. Check out this workshop featuring the awesome and amazing sports psychologist, Erin Ayala! Register HERE

NOW TAKING MEDICAL CLIENTS FROM COLORADO, CONNECTICUT, AND NEW HAMPSHIRE!

..in addition to MA, NY, NJ, PA, CA, FL, OH

If you are an active woman or competitive midlife athlete who feels abandoned by mainstream medicine, I’m here for you!

Active and athletic midlife women have needs and risk profiles that are different from the general population. These needs often go unmet by the mainstream medical community due to a lack of understanding of fitness and sport and their impact on mid-life hormonal physiology or even a lack of acknowledgment that this dynamic exists.

To speak to this need, I launched my Telehealth Consultation Medical practice focusing on the Reproductive Endocrine needs and Menopausal Care for active, athletic, and high-performing women.

We put your health, fitness, and performance at the center of the equation so that you can achieve your healthiest, highest-performing self!

You will find all my service offerings on my website including a link to my calendar so that you can reserve your place in my schedule!

The overhead squat is exactly what it sounds like: a squat performed while holding a load overhead. But don’t let the barbell version fool you. You don’t need to lift heavy—or even use a weight—to benefit from this movement.

The overhead squat asks a lot of the body at once: lower-body strength, shoulder and thoracic mobility, core stability, balance, coordination, and control.

Why It Matters in Midlife

Maintaining muscle and bone strength matters as we get older—but so does maintaining our ability to move well.

The overhead squat challenges several qualities that become increasingly important in midlife:

• Lower-body strength

• Overhead mobility

• Trunk stability

• Balance

• Proprioception.

And because the upper and lower body must work together, it trains the body as an integrated system rather than a collection of individual muscles.

How to Do It

Stand with your feet approximately shoulder-width apart and extend your arms—or a light object—overhead. Brace your core, keep your arms reaching upward and the load positioned over the middle of your foot, then sit your hips down between your legs.

Descend only as far as you can while maintaining the overhead position and good control, then drive through your feet to stand.

***Depth and load come after good movement.

Make It Your Movement

The overhead squat isn’t all-or-nothing. Keep the overhead component, then scale the load, range of motion, or complexity to meet your body where it is today.

• Arms-only overhead squat: Reach both arms overhead—or just one—and squat only as deeply as you can maintain the position.

• PVC/broomstick overhead squat: Practice the full movement with essentially no external load.

• Box overhead squat: Use a box or bench to limit depth while maintaining the overhead position.

• Single-dumbbell overhead squat: Hold a light dumbbell in one hand overhead, adding load and an asymmetric stability challenge.

• Barbell overhead squat: Progress to the traditional movement when mobility, stability, and control allow.

Safety

Shoulder, wrist, hip, knee, ankle, or back limitations may require modification. Never force range of motion simply to make the movement “look right.”

Identify your pain-free range of motion and choose the variation that allows you to move comfortably and with control.

Bottom Line

You don’t have to be young, exceptionally flexible, or an experienced lifter to train the overhead squat.

Start with the version you can do well. Then build from there.

The goal isn’t a perfect barbell overhead squat.

The goal is to keep building a body capable of doing more.

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This week’s workout is a 2-part effort integrating the overhead squat (or your chosen variation). The second part is a core finisher that will help you appreciate how much your core muscles were working during the overhead squat segment.

Warm-Up

TABATA (20 seconds of work/10 seconds of rest) - 6 minutes.

Perform each movement sequentially until you have completed each round of 3 movements 4 times.

• Up-downs (20s work/20s rest), then..

• Push-ups (easy option) (20s work/20s rest), then..

• Jumping air squats (20s work/20s rest), then back to the Up-downs

After you finish the TABATA, perform 12 PVC Pass-throughs with your broomstick or PVC pipe.

Movement Practice

WATCH THIS VIDEO TUTORIAL ON THE OVERHEAD SQUAT!

If you have never done this movement before PLEASE use just a broomstick or PVC pipe. This is a COMPLEX MOVEMENT, so until you feel ultra-confident and consistent with superb form, stick with a broomstick or PVC pipe.

Take 5-10 minutes to practice the overhead squats - Try 3-5 sets of 5 repetitions until you feel confident in performing this movement in the workout.

If you are familiar with the overhead squat, please watch the video tutorial and fine-tune your technique using an empty bar. Add weight as appropriate maintaining solid technique.

Movement alternatives:

• Use a box to squat to as shown in the video tutorial above if you cannot achieve sound mechanics and bar/pipe/stick position in a full squat.

• Single arm overhead dumbbell squat. If the restriction of a broomstick/PVC pipe makes this movement difficult to achieve with good form, try a single-arm overhead squat instead. Start with a lightweight object and work up to a dumbbell during practice.

Take another 5-10 minutes to practice the movements in Workout Part 1 and select your kettlebell weight. Select a weight that allows you to perform 12 repetitions unbroken for all rounds. This is a moderate weight where the last 3-4 reps become challenging.

Workout

Part 1

AMRAP 12 minutes (As many rounds as possible in 12 minutes)

• 12 Kettlebell swings (overhead or eye-level) (Alternatives: double dumbbell swing or a single dumbbell swing keeping reps even between sides)

• 12 Overhead squats (or your selected option)

• 24 Mountain Climbers (right + left = 1 repetition)

Part 2

Core TABATA - (20 seconds of work/10 seconds of rest) - 6 minutes.

Perform each movement sequentially until you have completed each round of 3 movements 4 times.

• V-Ups

• Oblique Twists - weighted

• Sit-ups (Ab mat style: Use an ab mat or rolled towel supporting your lower back. Alternatively, perform sit-ups with knees bent/feet anchored).

Cool-Down

15-minute Back Bending Yoga. Take 15 minutes to cool down and rebalance your back and front body.

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NOW TAKING MEDICAL CLIENTS FROM COLORADO, CONNECTICUT, AND NEW HAMPSHIRE!

..in addition to MA, NY, NJ, PA, CA, FL, OH

If you are an active woman or competitive midlife athlete who feels abandoned by mainstream medicine, I’m here for you!

Active and athletic midlife women have needs and risk profiles that are different from the general population. These needs often go unmet by the mainstream medical community due to a lack of understanding of fitness and sport and their impact on mid-life hormonal physiology or even a lack of acknowledgment that this dynamic exists.

To speak to this need, I launched my Telehealth Consultation Medical practice focusing on the Reproductive Endocrine needs and Menopausal Care for active, athletic, and high-performing women.

We put your health, fitness, and performance at the center of the equation so that you can achieve your healthiest, highest-performing self!

You will find all my service offerings on my website including a link to my calendar so that you can reserve your place in my schedule!

One of my goals for Athletic Aging is to make functional movement training accessible for all fitness levels.

How many times do we see fitness influencers and online training programs performing various movements where we say “There’s no way I can do that”.

My goal with these posts is to take these seemingly inaccessible movements and creatively scale them so that they become accessible for all fitness levels, but retain the same benefits as the original movement.

This week we will focus on the bear crawl.

It may look like a children’s movement, but don’t let it fool you. It challenges strength, stability, coordination, and cardiovascular fitness all at once—making it one of the most efficient full-body movements you can add to your training.

Unlike many traditional exercises that isolate one muscle group, the bear crawl requires your shoulders, core, hips, and legs to work together while coordinating opposite arm and leg movements. That combination makes it a valuable exercise whether you’re training for CrossFit, recreational sports, or simply staying capable and resilient as you age.

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Why It Matters

Although research specifically in midlife women is limited, studies of quadrupedal movement training have demonstrated improvements in movement quality, shoulder and core activation, mobility, energy expenditure, and even aspects of proprioception and cognitive flexibility. The bear crawl doesn’t just build strength—it teaches your body to move well.

Benefits include:

• Improved core and shoulder stability

• Better coordination through contralateral movement

• Increased mobility and movement quality

• Moderate-to-vigorous cardiovascular stimulus

• A fun way to challenge your body in a completely different way

How to Perform the Bear Crawl

Start with your hands directly under your shoulders and your knees under your hips. Lift your knees one to two inches off the floor while maintaining a neutral spine and engaged core. Move forward by stepping your right hand and left foot together, followed by your left hand and right foot. Keep your movements slow, controlled, and deliberate rather than rushing through the exercise.

Movement Progressions

Whether you’re just getting started or looking for a greater challenge, there is a version of the bear crawl that can meet you where you are.

Use Caution If...

• You have significant wrist or shoulder pain or limited mobility.

• You’re recovering from an upper extremity injury.

• You’re in the second or third trimester of pregnancy, when changes in balance and joint stability may require modifications.

• Excess abdominal weight changes your center of gravity and places excessive stress on the wrists or shoulders.

Bottom Line

We spend our first year of life learning to crawl—but we don’t stop benefiting from that movement pattern simply because we learn to walk.

The bear crawl develops strength, stability, coordination, and conditioning in a way that few exercises can. Whether you’re beginning with a Bird Dog or progressing to a Dumbbell Bear Crawl, this movement offers a scalable way to build the kind of fitness that carries over into both sport and everyday life.

References

Buxton JD, et al. Front Sports Act Living. 2022.

Buxton JD, et al. J Strength Cond Res. 2020.

Pachava SR, Yadav D. Asian Pac J Health Sci. 2021.

Matthews MJ, et al. Hum Mov Sci. 2016.

Eckart AC. ACSM’s Health & Fitness Journal. 2023.

Today’s workout integrates the Bear Crawl with lower-body strength and cardiovascular stimulation. All it requires is a set of dumbbells and a little bit of space. Enjoy!

Warm-Up

Low-intensity walk, jog, or bike for 5-10 minutes

TABATA - 20 seconds of work and 10 seconds of rest. Do each movement in sequence for a total of 6 minutes (each round of the three movements, 4 times)

• Up-Downs (20 seconds work, 10-sec rest)

• Mountain Climbers (20 seconds work, 10-sec rest)

• Jumping air squats (20 seconds work, 10-sec rest)

Movement Practice

Take 5-10 minutes to watch the videos, practice, and select your movements/weights for this workout.

For the front squats, select dumbbells at a moderate weight that will allow you to do the 10 repetitions in 1-3 quick sets. Use one of these dumbbells for the burpee lateral jump over a dumbbell.

Practice the Bear Crawl or its modifications and select your option for the workout.

Movements

• Burpee lateral jump (or step) over a single dumbbell

• Dumbbell front squat

• Bear Crawl (or the following modifications)

  • Bear Crawl hold for 30 seconds

  • Bear Crawl march (right hand/left foot alternating with left hand/right foot) for 30 seconds

  • High plank hold for 30 seconds

  • Advanced option: If you are proficient with the Bear Crawl, try the dumbbell Bear Crawl.

Workout

5 Rounds for Time

• 10 Burpee lateral jump (or step) over a dumbbell

• 10 Dumbbell Front squats

• 50-foot Bear Crawl (modify distance as needed).

SCORE: Amount of time it takes to complete 5 rounds of all 3 movements.

Cool-Down

Finish this training day and jump-start your recovery with this 25-minute Stretch and Release Restorative Yoga class from Five Parks Yoga

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Check out my latest podcast guest appearance on Modern Menopause. Morven, Dr. Robyn, and I dive into the biggest myths keeping women from training hard in perimenopause and menopause. We discuss cortisol, carbohydrates, testosterone, joint pain and injuries, and the best place for women to start who might feel like they’re losing their mojo.

You can find the episode on your favorite podcast platforms:

• YouTube

• Spotify

• Apple

NOW TAKING MEDICAL CLIENTS FROM COLORADO, CONNECTICUT, AND NEW HAMPSHIRE!

..in addition to MA, NY, NJ, PA, CA, FL, OH

If you are an active woman or competitive midlife athlete who feels abandoned by mainstream medicine, I’m here for you!

Active and athletic midlife women have needs and risk profiles that are different from the general population. These needs often go unmet by the mainstream medical community due to a lack of understanding of fitness and sport and their impact on mid-life hormonal physiology or even a lack of acknowledgment that this dynamic exists.

To speak to this need, I launched my Telehealth Consultation Medical practice focusing on the Reproductive Endocrine needs and Menopausal Care for active, athletic, and high-performing women.

We put your health, fitness, and performance at the center of the equation so that you can achieve your healthiest, highest-performing self!

You will find all my service offerings on my website including a link to my calendar so that you can reserve your place in my schedule!

My Friends!

This week I need to recharge my batteries and just chill. Like so many clients whom I see, I am running in so many directions being a doc, performance consultant, mom of a 19-year-old college student, wife, and recreational athlete - that I forget where I am. My advice to my clients is always to take time for “you” and recharge. Prioritize your mental well-being and dial down the madness because if you don’t, it will catch up to you.

Well, it’s time that I take my own advice! My family and I are enjoying this week in Wakefield, New Hampshire at this beautiful home we are renting on Pine River Pond. I have committed to minimizing my time on technology and just soaking up all that Mother Nature has to offer.

See you all next week! … and don’t forget to carve out time for YOUR bad-ass selves!

Cheers!
-Dr. Carla

PS. Scroll down to check out a new podcast guest appearance that just dropped, and don’t forget to check out the Weekly Workout archives for a treasure trove of past workouts.

Subscribe now

This just dropped….

Check out my latest podcast guest appearance on Modern Menopause. Morven, Dr. Robyn, and I dive into the biggest myths keeping women from training hard in perimenopause and menopause. We discuss cortisol, carbohydrates, testosterone, joint pain and injuries, and the best place for women to start who might feel like they’re losing their mojo.

You can find the episode on your favorite podcast platforms:

• YouTube

• Spotify

• Apple

NOW TAKING MEDICAL CLIENTS FROM COLORADO, CONNECTICUT, AND NEW HAMPSHIRE!

..in addition to MA, NY, NJ, PA, CA, FL, OH

If you are an active woman or competitive midlife athlete who feels abandoned by mainstream medicine, I’m here for you!

Active and athletic midlife women have needs and risk profiles that are different from the general population. These needs often go unmet by the mainstream medical community due to a lack of understanding of fitness and sport and their impact on mid-life hormonal physiology or even a lack of acknowledgment that this dynamic exists.

To speak to this need, I launched my Telehealth Consultation Medical practice focusing on the Reproductive Endocrine needs and Menopausal Care for active, athletic, and high-performing women.

We put your health, fitness, and performance at the center of the equation so that you can achieve your healthiest, highest-performing self!

You will find all my service offerings on my website including a link to my calendar so that you can reserve your place in my schedule!

Hey Team! Running has been front and center in my own training lately as I completed my very first road race: The 54th Annual Blessing of the Fleet Road Race in Narragansett, Rhode Island. Although I certainly wasn't breaking any records, it revealed some incredible new opportunities for me to take my fitness to the next level. 

I hope you enjoy these next few posts on this movement that has gone from being my nemesis to my greatest fitness opportunity. 
Enjoy! -Dr. Carla 

You’ll find many posts about hip extension in Athletic Aging because it is one of the most fundamental movement patterns we perform—from everyday living to athletic performance.

When you think about improving your running, what comes to mind?

• Better shoes?

• More miles?

• Speed work?

Probably not hip extension. Yet every stride depends on it.

The squat is an excellent illustration of hip extension. As we descend into the bottom of a squat, the hips hinge and the angle between the torso and thighs becomes more closed, or flexed. As we stand, that angle opens, or extends.

Now imagine a squat jump. The gluteal muscles, hamstrings, and quadriceps contract rapidly and in sequence to extend the hips, generating enough force to lift the body off the ground.

Running relies on this same movement pattern.

One way to think about running is as a series of controlled single-leg jumps, with each stride requiring the body to generate force and briefly become airborne. Each stride requires the coordinated extension of the hip, knee, and ankle—a movement known as triple extension.

Hip extension is the first link in that chain.

During push-off, the gluteal muscles and hamstrings generate force through the hip while the knee and ankle extend in sequence, helping propel the body forward. Efficient runners don’t simply move their legs faster—they transfer force into the ground more effectively. Hip extension plays a central role in making that happen.

This doesn’t mean that more hip extension automatically creates better running. Running economy depends on many factors, including cadence, posture, coordination, lower extremity stiffness, and force production. But without adequate strength and power at the hips, the push-off phase becomes less efficient and less force is available to propel the body forward.

For active adults, maintaining hip strength and power isn’t just about running. It also helps preserve stride quality, uphill walking ability, hiking performance, and the ability to accelerate when life unexpectedly asks you to.

If you’d like to learn more about the role of hip extension in running mechanics, check out these two articles: Improving Running Efficiency: Hip Extension and How Does Hip Extension Affect Your Running Technique?

Bottom Line

Every running stride begins with a powerful push into the ground. While many factors contribute to efficient running, hip extension is one of the fundamental movement patterns that helps generate forward propulsion.

Running may look effortless, but every stride is powered by a coordinated sequence of movements that begins at the hips. Understanding that simple concept can change the way you look at running—and the way you train for it.

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This week’s workout develops hip extension through three movements: the kettlebell swing, box jump, and push press. As you watch the demo videos, pay attention to what they have in common. Although they look very different, each relies on the same powerful movement pattern—rapid hip extension—to generate force.

Warm Up

AMRAP 7 (As many rounds as possible in 7 minutes)

• 10 up-downs

• 10 air squats

• 10 easy push-ups (knees, toes or elevated on a stable box, bench or chair)

Movement Practice

Take 5-10 minutes to review the workout movement videos and options below and select your weights and movements for the workout.

The prescribed workout weight “RX” is noted below the workout for reference. These weights are for more advanced athletes. If you are a beginner or intermediate athlete, select movement options and weights that you can perform confidently where each set of 10 repetitions can be performed in no more than 2 sets with a brief rest in between. Once you have selected your weights/options, practice 3-5 repetitions of each movement in the order written in the workout to be sure you are comfortable with the flow between movements.

Movement options

• Push Press (Alternative: dumbbell push press)

• Kettlebell Swing (American) (Alternative: Swing to eye level; If no kettlebell, - Double dumbbell swing

• Box Jump - (Alternative: Weighted box step-ups or dumbbell thrusters).

Workout

AMRAP 20 (As many rounds as possible in 20 minutes)

• 10 Push presses

• 10 Kettlebell Swings

• 10 Box jumps

Score: Number of completed rounds and repetitions.

(RX for women 75# barbell, 35# kettlebell, 20-inch box jump)

TIP! Manage fatigue by slowing down your repetitions. This allows you to achieve some “rest” while continuing to accumulate repetitions.

*Be sure to document your movement options and weight choices so that you can replicate the workout for your “re-test”.

Cool Down

As an expert in the hormonal physiology of the stress response system, I cannot overstate the importance of a thorough cool-down after an intense fitness benchmark workout. Yoga is my go-to because it promotes whole-body flexibility and mobility care as well as calming the mind and increasing the vagal tone needed for our stress response system to return to baseline.

Indulge yourself in this 15-minute full-body stretch yoga sequence to jumpstart your recovery! #dontskiptheyoga

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This just dropped…..

Could you have PCOS and not know it? You sure can, says reproductive endocrinologist and menopause specialist Dr. Carla DiGirolamo, who is hopeful that the recent renaming of the condition from “polycystic ovary syndrome” (PCOS) to “polyendocrine metabolic ovarian syndrome” (PMOS) will help raise awareness—and improve care. This episode breaks down what PMOS actually is, why the new name matters, and how this androgen‑driven metabolic condition shows up across the lifespan, from irregular cycles and fertility struggles to increased cardiometabolic risk, especially once you hit the menopause transition. We also cover treatment options including metformin, inositol, and compelling new research on GLP‑1 receptor agonists, plus what all of this means for active midlife women when it comes to fueling, Reds/LEA risk, resistance training, and long‑term glucose control.

NOW TAKING MEDICAL CLIENTS FROM COLORADO, CONNECTICUT, AND NEW HAMPSHIRE!

..in addition to MA, NY, NJ, PA, CA, FL, OH

If you are an active woman or competitive midlife athlete who feels abandoned by mainstream medicine, I’m here for you!

Active and athletic midlife women have needs and risk profiles that are different from the general population. These needs often go unmet by the mainstream medical community due to a lack of understanding of fitness and sport and their impact on mid-life hormonal physiology or even a lack of acknowledgment that this dynamic exists.

To speak to this need, I launched my Telehealth Consultation Medical practice focusing on the Reproductive Endocrine needs and Menopausal Care for active, athletic, and high-performing women.

We put your health, fitness, and performance at the center of the equation so that you can achieve your healthiest, highest-performing self!

You will find all my service offerings on my website including a link to my calendar so that you can reserve your place in my schedule!

Most exercises challenge us evenly.

A barbell squat loads both legs equally. A bench press uses both arms together.

But life rarely does.

You carry a suitcase in one hand. Reach overhead to place luggage in an overhead bin. Walk across uneven ground while carrying groceries. Catch yourself after a stumble on one leg before the other.

These everyday moments require your body to stabilize against forces that want to pull you out of position—not simply produce force.

That ability to resist movement is one of the hallmarks of functional strength, and it becomes increasingly important as we age.

One of the simplest—and most effective—ways to train it is the single-arm farmer carry, also known as the suitcase carry.

What is the suitcase carry?

The suitcase carry is exactly what it sounds like: hold a dumbbell or kettlebell in one hand at your side and walk.

Because the weight is carried on only one side, your body naturally wants to lean toward it. Your core, hips, shoulders, and legs must work together to keep you upright.

This is known as asymmetrical loading. Rather than simply producing force, your muscles learn to resist unwanted movement—an essential skill for both athletic performance and everyday life.

Why it matters

Research shows that asymmetrical exercises can improve much more than strength alone. They challenge the muscles responsible for posture and stability while enhancing balance, coordination, and single-leg control.

The suitcase carry also develops grip strength, which has emerged as one of the strongest indicators of healthy aging and long-term physical function.

Perhaps most importantly, asymmetrical training exposes side-to-side differences that often go unnoticed during traditional bilateral exercises. Identifying and improving these imbalances can enhance movement efficiency and reduce unnecessary compensation patterns.

Whether you’re hiking, lifting a grandchild, carrying groceries, or simply navigating uneven ground, these are the qualities that help you move with confidence.

How to perform it

• Stand tall holding a dumbbell or kettlebell in one hand.

• Keep your shoulders level and your eyes forward. Brace your abdominal muscles gently and imagine balancing a book on your head.

• Walk with slow, controlled steps without leaning toward or away from the weight.

• Continue until you notice your posture beginning to change, then switch hands and repeat.

**Quality matters far more than distance or weight.

Safety considerations and scaling

Start with a weight that allows you to maintain perfect posture throughout the carry.

If balance is a concern, begin by simply holding the weight while standing before progressing to walking.

As your strength improves, increase the load before increasing the distance.

Other excellent examples of asymmetrical training include:

• Single-kettlebell step-ups

• Single-arm overhead press

• Offset front squats

• Single-arm rows

• Single-arm overhead lunges

• Front-rack and overhead carries

The principle remains the same: don’t let the weight pull you out of position.

Bottom line

Life isn’t symmetrical. Neither should your training be.

Adding asymmetrical movements to your workouts teaches your body to stay balanced, stable, and resilient while performing the tasks you encounter every day.

The suitcase carry may be one of the simplest exercises in the gym, but don’t let its simplicity fool you.

Sometimes the movements that look the easiest are the ones preparing us best for real life.

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This week we are “doubling down” on building functional capacity by developing the strength, skill, and stability that allow us to carry loads in multiple ways. Today’s workout targets core and shoulder strength and stability, inserts a component of coordination and balance and challenges these movements under the fatigue of short, high-intensity sprint segments.

Warm Up

AMRAP 7 (As many rounds as possible in 7 minutes). Perform all three movements in sequence for as many rounds of the three movements as you can on a 7 minute clock.

• 5 Burpees (Watch the linked video for options for all skill levels)

• 10 Mountain Climbers (Right + Left = 1 repetition)

• 10 Air squats

Once you have completed the 7-minute AMRAP, perform this follow-along core-activation sequence from Train FTW.

Movement Practice

Take 5-10 minutes to choose your weights/options for the workout.

All but the suitcase carry require 2 dumbbells. Choose the same weight for all carries where you can carry the dummbells for 100m with no more than 1-2 stops along the way to rest.

For the sprints, see the options below for the sprint intervals. As the name implies, this is a SPRINT, meaning that this is a short duration of high intensity (RPE of 8-9) for 30-45 seconds. Choose one modality for all the sprints or try more than one! Choose your own adventure! Whatever you choose, bring your A-Game to every sprint interval.

Movement options

• Sprint (30-45 seconds at RPE 8-9): 200m row or run, 400m bike, 75 single-under (35 double-under) jump rope, or 15 burpees

• Carries: For best results, perform all carries as prescribed. However, if overhead shoulder mobility limits you, substitute the bear crawl and/or the Farmer’s Carry for the overhead carries.

Workout

200m Sprint (row or run, 400m bike, jump rope, or 15 burpees)

50 m Suitcase Carry (SINGLE DUMBBELL)

200m Sprint

50 m Double Dumbbell Overhead Carry

200m Sprint

50 m Front Rack Carry

200m Sprint

50m Waiter Carry (Switch arms after the first 25 yards)

200m Sprint

50 m Bear Crawl (For an advanced level option, bear crawl with your 2 dumbbells)

Cool Down

Show your shoulders some love and jump-start your recovery with this 15 minute shoulder and upper body yoga sequence. #dontskiptheyoga

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This just dropped…..

Could you have PCOS and not know it? You sure can, says reproductive endocrinologist and menopause specialist Dr. Carla DiGirolamo, who is hopeful that the recent renaming of the condition from “polycystic ovary syndrome” (PCOS) to “polyendocrine metabolic ovarian syndrome” (PMOS) will help raise awareness—and improve care. This episode breaks down what PMOS actually is, why the new name matters, and how this androgen‑driven metabolic condition shows up across the lifespan, from irregular cycles and fertility struggles to increased cardiometabolic risk, especially once you hit the menopause transition. We also cover treatment options including metformin, inositol, and compelling new research on GLP‑1 receptor agonists, plus what all of this means for active midlife women when it comes to fueling, Reds/LEA risk, resistance training, and long‑term glucose control.

NOW TAKING MEDICAL CLIENTS FROM COLORADO, CONNECTICUT, AND NEW HAMPSHIRE!

..in addition to MA, NY, NJ, PA, CA, FL, OH

If you are an active woman or competitive midlife athlete who feels abandoned by mainstream medicine, I’m here for you!

Active and athletic midlife women have needs and risk profiles that are different from the general population. These needs often go unmet by the mainstream medical community due to a lack of understanding of fitness and sport and their impact on mid-life hormonal physiology or even a lack of acknowledgment that this dynamic exists.

To speak to this need, I launched my Telehealth Consultation Medical practice focusing on the Reproductive Endocrine needs and Menopausal Care for active, athletic, and high-performing women.

We put your health, fitness, and performance at the center of the equation so that you can achieve your healthiest, highest-performing self!

You will find all my service offerings on my website including a link to my calendar so that you can reserve your place in my schedule!

Strength helps us move.

Power helps us move quickly.

And as we age, power declines faster than strength, making it one of the most important qualities to train if we want to remain athletic for decades to come.

The box jump is one of the simplest ways to develop lower-body power. Far more than “jumping onto a box,” it teaches the body to produce force rapidly through explosive hip extension while improving coordination, balance, and confidence.

Why It Matters

For active women, power training offers benefits that extend well beyond the gym.

Research shows explosive training can improve:

• Lower-body power and rate of force development

• Balance and neuromuscular coordination

• Functional performance in daily activities

• Athletic performance for hiking, pickleball, tennis, skiing, CrossFit®, and running

How to Perform the Box Jump

• Stand facing a stable box with your feet about hip-width apart.

• Begin with a small hip hinge while swinging your arms naturally behind you. Drive explosively through the hips, knees, and ankles, using your arms to help generate upward momentum.

• Land softly with your entire foot on the box, knees tracking over your toes and hips slightly bent to absorb the landing. Stand fully before stepping back to the floor under control.

The goal isn’t to jump onto the highest box possible—it’s to move with speed, control, and confidence.

Safety & Modifications

Power training should always match your current abilities.

If jumping isn’t appropriate yet, perform step-ups instead. Focus on a strong, controlled drive through the working leg, and progress by adding a dumbbell or kettlebell as your strength improves.

You can also adjust the challenge by changing the height of the target. Start with a single 45-pound bumper plate or a short stack of plates before progressing to a low box and eventually a standard-height box.

Choose a height that allows you to land softly without having to pull your knees excessively toward your chest. If your landing becomes noisy or your technique deteriorates, reduce the height or return to stepping until your power and confidence improve.

Remember: quality always comes before height.

The Bottom Line

The box jump isn’t about proving how fearless you are.

It’s about preserving one of the physical qualities we lose most rapidly with age: power.

Whether you’re stepping onto a plate or confidently jumping to a higher box, you’re training the same movement pattern. Progress gradually, prioritize good mechanics, and remember:

The goal isn’t the highest box. It’s building the power to keep doing the things you love for decades to come.

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I was inspired to write about the box jump this week because I have spent some time doing them at my own CrossFit gym, CrossFit Peacedale. It has reminded me of what a key longevity hack this simple movement is, because it targets power and plyometrics in one, simple movement and is infinitely scalable for every fitness level. Enjoy this week’s workout!

Warm Up

AMRAP 7 Perform each movement in sequence for as many rounds of the 3 movements as you can in 7 minutes.

• 10 air squats

• 10 light kettlebell swings

• 10 box step-ups

Movement Practice

Take 5-10 minutes to select weights/options and practice the movements you will do for the workout. Select options/weights that allow you to confidently do 5-10 repetitions unbroken.

For the box jump, select a STABLE box or stack of plates at a height where you can confidently jump and move at a steady pace with only a couple of breaths of rest after 5-10 repetitions. For experienced athletes, the suggested box height is 20 inches (50 cm).

If jumping onto an object at any height is a limitation, perform box step-ups instead. You can choose to hold a pair of light dumbbells or kettlebells for some extra intensity, or simply use your body weight.

For the kettlebell swing, select a moderately heavy weight and swing to eye level (“Russian”-style swing). For experienced athletes, the recommended kettlebell weight is 35 lbs (16kg).

For the single arm overhead alternating lunge. Select a weight that allows you to do 10 total repetitions (5 each side) unbroken. If this movement is new to you or challenging, select a light object to hold overhead such as a shoe or a can of beans. Holding a single arm in this position is more important than the weight used. For experienced athletes, the recommended dumbbell weight is 20-25lbs (12-14kg)

Movement Alternatives

Box jump alternative: Squat jump for height is a great option if you can jump but are not comfortable jumping onto an object. Otherwise, a box step-up as described above is another appropriate scale.

Kettlebell swing alternative: Double dumbbell swing. If you have a barbell and are proficient with Olympic weightlifting, substitute a hang power clean.

Single arm overhead alternating lunge: If holding a single arm without weight overhead is not accessible to you, perform the alternating lunges holding a single dumbbell by your side, switching arms as needed.

Workout

AMRAP 16 (As many rounds as possible in 16 minutes)

Repetition scheme: 2-4-6-8…. and so on adding 2 repetitions per round.

HOW TO: Perform 2 box jumps, 2 overhead lunges, 2 kettlebell swings, then 4 box jumps, 4 overhead lunges, 4 kettlebell swings, then 6 box jumps, and so on. Continue with as many rounds as you can on a 16-minute clock. Your score is the total rounds and repetitions. (Ex: completed the round of 14 and 15 repetitions into the round of 16.)

• Box jumps

• Single overhead dumbbell alternating lunges (Switch arms as needed. Alternate legs with each repetition)

• Kettlebell swings

Cool Down

Show your hips and legs some love with this 20-minute Yoga Flow for Hips from Yoga with Adriene. The best results gained from training start with recovery. #dontskiptheyoga.

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NOW TAKING MEDICAL CLIENTS FROM COLORADO, CONNECTICUT, AND NEW HAMPSHIRE!

..in addition to MA, NY, NJ, PA, CA, FL, OH

If you are an active woman or competitive midlife athlete who feels abandoned by mainstream medicine, I’m here for you!

Active and athletic midlife women have needs and risk profiles that are different from the general population. These needs often go unmet by the mainstream medical community due to a lack of understanding of fitness and sport and their impact on mid-life hormonal physiology or even a lack of acknowledgment that this dynamic exists.

To speak to this need, I launched my Telehealth Consultation Medical practice focusing on the Reproductive Endocrine needs and Menopausal Care for active, athletic, and high-performing women.

We put your health, fitness, and performance at the center of the equation so that you can achieve your healthiest, highest-performing self!

You will find all my service offerings on my website including a link to my calendar so that you can reserve your place in my schedule!

Your thyroid hormone levels are low.

You’re exhausted. Recovery has slowed. Your workouts suddenly feel harder than they should, and you’re cold more often than everyone else around you.

The obvious conclusion?

Your thyroid must be failing.

Not necessarily.

In Part 1 of this series, we explored Hashimoto’s thyroiditis—an autoimmune disease in which the thyroid gland gradually loses its ability to produce thyroid hormone. But there is another form of hypothyroidism that is remarkably common in female athletes, particularly those with persistent low energy availability (LEA) or Relative Energy Deficiency in Sport (RED-S).

In this situation, the thyroid gland isn’t diseased or under attack by the immune system. Instead, the entire hypothalamic-pituitary-thyroid (HPT) axis adapts to chronic energy deficiency by intentionally reducing thyroid hormone production. The result is a hypothyroid state—but one that reflects a coordinated survival response rather than thyroid gland failure.

Understanding that distinction changes everything.

Your Body Is Built to Adapt

One of the most remarkable features of human physiology is its ability to prioritize survival.

When energy intake consistently fails to match the demands of training, the brain begins making difficult decisions about where calories should—and shouldn’t—be spent. Processes that are essential for immediate survival continue, while those that require substantial energy but are not immediately necessary begin to slow.

You’ve seen this adaptation before.

The reproductive system suppresses ovulation, leading to menstrual irregularities or amenorrhea. Bone remodeling slows, resting metabolic rate declines, and the thyroid axis responds in exactly the same way. Rather than maintaining a high metabolic rate, the brain deliberately reduces thyroid hormone production to conserve energy.

This isn’t a mistake—it’s an adaptation.

Why Thyroid Hormone Falls

Triiodothyronine (T3) is the body’s most metabolically active thyroid hormone. It helps regulate resting metabolic rate, mitochondrial function, heat production, skeletal muscle adaptation, protein turnover, and exercise performance.

When energy becomes scarce, maintaining high T3 concentrations is metabolically expensive. Instead, the body lowers T3 production, reducing energy expenditure and allowing available calories to be directed toward vital organs.

Researchers often refer to this physiology as low-T3 syndrome, non-thyroidal illness syndrome, or euthyroid sick syndrome. In female athletes, it represents an adaptive endocrine response to prolonged energy deficiency rather than an intrinsic disease of the thyroid gland.

The goal isn’t to maximize performance.

The goal is survival.

Why Athletes Feel the Difference

Although this adaptation is protective, it comes at a cost.

Reduced thyroid hormone availability slows many of the physiologic processes that athletes depend upon.

Women may notice:

• Persistent fatigue

• Reduced exercise tolerance

• Slower recovery between workouts

• Feeling unusually cold

• Declining endurance

• Reduced training capacity

• Difficulty maintaining previous performance

• Abnormal menstrual cycles, including infrequent or absent periods

At the cellular level, thyroid hormones act as permissive regulators of skeletal muscle adaptation. They support mitochondrial function, muscle protein turnover, and the metabolic remodeling required for training adaptations. When thyroid hormone availability decreases, these processes become less efficient—not because the body is malfunctioning, but because it is intentionally conserving energy.

Many athletes describe this simply as feeling “flat.” The body has shifted from optimizing performance to preserving energy.

The Misdiagnosis Trap

This distinction becomes critically important in clinical practice.

A female athlete presents with fatigue and declining performance. Laboratory testing reveals a low T3 concentration, and the immediate assumption is often hypothyroidism.

Before concluding that the thyroid gland is failing, however, clinicians must ask a more important question:

Why is thyroid hormone low?

In Hashimoto’s thyroiditis, the thyroid gland cannot produce adequate hormone because autoimmune inflammation progressively destroys normal thyroid tissue.

In low energy availability, the thyroid gland is structurally normal. The brain is simply asking it to produce less hormone as part of a coordinated effort to conserve energy. Although the laboratory findings may appear similar, the underlying physiology is fundamentally different—and different physiology requires different treatment.

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Why Thyroid Hormone Replacement Isn’t the Answer

One of the greatest pitfalls is treating adaptive hypothyroidism with progressively higher doses of thyroid hormone while failing to address the underlying energy deficit.

If inadequate fueling persists, the body continues signaling that energy must be conserved. Replacing thyroid hormone alone does not correct the physiologic stress driving the adaptation and may expose athletes to unintended consequences, including accelerated bone loss and an increased risk of stress fractures—particularly concerning in women who may already have compromised bone health from RED-S.

The goal is not simply to normalize laboratory values. It is to restore adequate energy availability.

Hashimoto’s vs. Adaptive Hypothyroidism

Although both conditions result in reduced thyroid hormone availability, they arise for entirely different reasons.

Importantly, these conditions are not mutually exclusive.

An athlete with Hashimoto’s may also be under-fueling. When this occurs, autoimmune hypothyroidism and adaptive suppression of the thyroid axis coexist, there can be even more significant implications for immune function, performance, and overall health.

The Bigger Picture

This concept extends well beyond the thyroid.

Low energy availability doesn’t selectively affect one hormone. It reshapes the entire endocrine system.

The reproductive axis suppresses ovulation. The thyroid axis lowers metabolic rate. Stress hormones rise. Bone metabolism slows. Viewed individually, these hormonal changes appear abnormal. Viewed together, they tell a remarkably coherent story.

The body is adapting.

Key Insights

• Low thyroid hormone does not always indicate thyroid gland disease.

• In female athletes, chronic low energy availability can produce an adaptive hypothyroid state that conserves energy.

• The underlying physiology—not simply the laboratory values—determines the appropriate treatment.

• Restoring adequate energy availability addresses the root cause of adaptive hypothyroidism and supports long-term health, recovery, and athletic performance.

Your body isn’t working against you.

It’s doing exactly what it evolved to do.

The goal isn’t simply to normalize thyroid hormone levels. The goal is to create an environment where your body no longer needs to conserve energy—and can once again prioritize strength, recovery, performance, and long-term health.

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TAKING NEW PATIENTS!

If you are an active woman or competitive midlife athlete who feels abandoned by mainstream medicine, I’m here for you!

It’s time that Women’s Healthcare caught up to the trailblazing generation of active, athletic, and high-performing midlife females!

My telehealth consultation practice does exactly that by focusing on the Reproductive Endocrine needs and Menopausal Care for active, athletic, and high-performing women.

Active and athletic midlife women have needs and risk profiles that are different from the general population. These needs often go unmet by the mainstream medical community due to a lack of understanding of fitness and sport and their impact on mid-life hormonal physiology or even a lack of acknowledgment that this dynamic exists. We put your health, fitness, and performance at the center of the equation so that you can achieve your healthiest, highest-performing self!

You will find all my service offerings on my website, including a link to my calendar so that you can reserve your place in my schedule!