Athletic Aging: Weekly Workout

Leg Day Essentials - Part 2

Carla DiGirolamo, MD — Mon, 08 Jun 2026 10:46:03 GMT

Last week, we discussed the importance of quadriceps-focused training and highlighted the VMO squat as a valuable tool for building strength and preserving long-term function.

Today, I want to take the next step in that progression by introducing one of my favorite lower-body exercises: the Bulgarian split squat.

While traditional squats remain foundational, most real-world movement occurs one leg at a time.

Walking.
Climbing stairs.
Hiking.
Running.
Recovering balance after a stumble.

Even simple activities such as getting out of a car or stepping onto a curb require us to generate force primarily through a single leg.

This is where the Bulgarian split squat shines.

The Bulgarian split squat is a single-leg dominant exercise that combines many of the benefits of traditional squats with the additional challenges of balance, stability, and unilateral strength development.

For active adults, it may be one of the most effective exercises for maintaining lower-body function as we age.

Why Single-Leg Training Matters

Single-leg training helps develop:

Quadriceps strength
Hip strength and stability
Balance and coordination
Force absorption during landing and deceleration
Side-to-side symmetry

Research consistently demonstrates that lower-extremity strength and balance are important contributors to physical function, mobility, and fall prevention throughout adulthood.

As we reviewed in Leg Day Essentials - Part 1, the quadriceps remain particularly important because they contribute to:

Walking speed
Stair-climbing ability
Sit-to-stand performance
Overall mobility
Activities of daily living

Longitudinal studies suggest that declines in quadriceps strength closely parallel declines in physical function over time.

What Is a Bulgarian Split Squat?

The Bulgarian split squat is performed in a staggered stance with the rear foot elevated on a bench, box, or stable platform.

The front leg performs most of the work while the rear leg provides minimal assistance.

This allows substantial loading of the quadriceps while simultaneously challenging balance and stability.

The movement can be performed with:

Body weight
Dumbbells
Kettlebells
A barbell

Safety Considerations

Like any exercise, the Bulgarian split squat should be performed within your current strength, mobility, and balance capabilities.

Individuals with significant knee pain, acute lower-extremity injury, uncontrolled balance deficits, or severe hip or ankle mobility limitations may need to begin with modified variations.

Modifications

Balance is often the limiting factor rather than strength. If this is the case, add support with a stable object as seen in panel 3 below. As strength, balance, and confidence improve, progression to Bulgarian split squats may be possible!

During the exercise:

Keep the majority of your weight over the front leg
Maintain an upright torso
Allow the front knee to track naturally over the toes
Avoid collapsing inward through the knee
Move through a pain-free range of motion

Mild muscle fatigue and muscular discomfort are expected. Sharp joint pain is not.

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Warm Up

AMRAP 7 minutes (As many rounds as possible in 7 minutes) - low to moderate intensity

20 single-under jump rope or simulated jump rope
10 alternating lunges
10 (light) bent-over barbell or dumbbell rows

Movement Practice

Take 5-10 minutes to watch the video and test out various options for the single-leg squat. If none of these is an option for your abilities, check out the Movement alternatives below to find your best fit for this workout!

For the pull-ups, select the option that allows you to achieve 5 unbroken repetitions confidently but not easily.

Workout

Today’s workout is taken from an excerpt from the CrossFit Gymnastics Training course and from the CrossFit workout library, Workout 230428.

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

5 strict pull-ups
20 Bulgarian Split Squats (or your selected option) (total of 10 left and 10 right)
TIP: Depending on your option, you may choose to alternate legs each rep, or do small sets on one side before switching legs. Either way, ensure that you perform the same number of repetitions on both sides.
40 double-unders (or 80 single-unders or simulated jump rope)

So, why the pull-ups? It’s a sneaky way to further challenge the core muscles needed for the single-leg squat while allowing the legs to rest!

Movement alternatives

Lunge with forward lean (use dumbbells or body weight only) - do 5 or 10 repetitions before switching sides. TIP! Keep the front knee in line with the ankle - avoid tracking the knee over the toes
Walking or alternating lunge in place - body weight only, holding 2 dumbbells by your sides or holding a kettlebell in a “goblet” position at your chest.
For the pull-ups, sub any of the following:
- Rack (or seated) pull-ups
- Band or machine-assisted pull-ups
- Bent-over barbell or dumbbell rows

Cool Down

Team! This is not one to skip! Your legs are a skeletal muscle powerhouse - and this workout challenged them to a high level. In turn, this requires high-level recovery and it begins with tissue care. Your legs will thank you!

20-minute “follow-along” lower-body foam roll and stretch

Hughes VA, Frontera WR, Wood M, et al. Longitudinal muscle strength changes in older adults: influence of muscle mass, physical activity, and health. J Gerontol A Biol Sci Med Sci. 2001;56(5):B209-B217.

Liao KF, Ku YH, Lin LF, et al. Effects of unilateral versus bilateral resistance training on athletic performance measures: a systematic review and meta-analysis. Front Physiol. 2021;12:745199.

Gonzalez AM, Mangine GT, Fragala MS, et al. Resistance training improves single-leg stance performance in older adults. Aging Clin Exp Res. 2014;26(1):89-92.

Amin S, Baker K, Niu J, et al. Quadriceps strength and the risk of cartilage loss and symptom progression in knee osteoarthritis. Arthritis Rheum. 2009;60(1):189-198.

Papa EV, Dong X, Hassan M. Resistance training for activity limitations in older adults: a systematic review. Clin Interv Aging. 2017;12:955-961.

In case you missed it…..

Why are we all confused about cortisol? Is it good? Is it bad? Is it simply too much of a good thing? Dr Carla DiGirolamo MD, Women's performance endocrinologist, lays out the physiology, data, and practical applications of how cortisol affects our life and health.

No doubt you have seen Dr. Vonda in the news and on social media. She is an absolute force when it comes to promoting an empowering message about how women can thrive during midlife. Check out her new best-selling book “Unbreakable: A Woman’s Guide to Aging with Power”.

NOW TAKING NEW CLIENTS!

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

It is with great excitement that after more than 2 years of preparation, I have FINALLY launched my Telehealth Consultation Medical practice 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!

Leg Day Essentials - Part 1

Carla DiGirolamo, MD — Mon, 01 Jun 2026 10:46:04 GMT

Squatting is a foundational functional movement involving the largest muscles of the body. We have discussed them at length in this newsletter multiple times, which speaks to their importance.

The back squat is a balanced or posterior-chain dominant squat pattern that distributes load among the glutes, hamstrings, quadriceps, and spinal stabilizers. This movement pattern is excellent for total body strength, power production, athletic development, bone loading, and muscle mass preservation.

The quadriceps are important for stair descent, hiking downhill, landing mechanics, pickleball and tennis movement, skiing, running, and recovering balance. Quadriceps strength has been associated with:

Walking speed
Stair-climbing ability
Sit-to-stand performance
Overall mobility
Activities of daily living

Longitudinal data suggest that changes in quadriceps strength track closely with changes in physical function over time. Individuals who lose quadriceps strength tend to demonstrate greater functional decline.

Because squats are a complex movement that recruit muscles throughout most of the body, there is value in supplementing squat work with other, more isolated, quadriceps-dominant exercises.

According to the peer-reviewed literature, the benefits of quadriceps-dominant training include:

Improved physical function
Reduced risk of falls
Better knee health and reduced osteoarthritis burden
Improved force absorption and deceleration capacity
Enhanced gait performance

Today, I want to highlight a squat variation called the VMO Squat - also known as the “Quad squat”.

What Is a VMO Squat?

The VMO squat is a knee-dominant squat variation designed to increase quadriceps loading through increased forward knee translation and upright torso positioning.

How to Perform a VMO Squat

The movement can be performed with body weight, dumbbells, kettlebells, or barbells.

Setup

Elevate the heels using wedges, plates, or a slant board
Use a relatively narrow stance
Keep the chest upright
Allow the knees to travel forward naturally

Descent: Lower slowly while maintaining full foot contact, controlled knee tracking, and upright posture

Bottom Position: Descend only as deep as mobility, control, and comfort allow. You can set up a STABLE target such as a bench or a chair behind you to maintain your pain-free range of motion.

Safety Considerations

The VMO squat is not appropriate for everyone immediately.

Individuals with acute knee injury, significant patellofemoral pain, advanced osteoarthritis, meniscal irritation, or poor ankle mobility may need modifications or gradual progression.

Helpful strategies include:

Starting with body weight only
Using a reduced range of motion
Slowing the tempo
Holding onto support initially
Gradually increasing depth

Below are some examples of ALTERNATIVE quadriceps-dominant exercises that provide similar benefits of VMO squats are not accessible for you:

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Today’s workout will incorporate the VMO squat as a post-workout accessory. Accessory work can be a game-changer for enhancing the stimulus of your main workout block. For strength-building, consider incorporating this accessory 1-2x per week, progressively adding small amounts of load as tolerated over a 4-6 week period.

Warm-Up

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

10 Jumping Jacks
10 Air Squats

Workout

Part 1 - Lift Heavy

This workout is ideally performed with a heavier barbell taking it off the rack. If you do not have a barbell and are using dumbbells, do these repetitions as 2:2:1 tempo repetitions (2 count down, hold at the bottom for a 2 count, then rise for a 1 count). All 6 repetitions should be performed unbroken, building in weight across all 5 sets.

Every 2 minutes for 5 sets

6-6-6-6-6 (If you are doing tempo repetitions with dumbbells, perform 4 repetitions each set)

Heavy barbell Front Squat - 6 repetitions

TIP!: “Heavy” does not mean that you sacrifice mechanics! Watch the video and maintain the strictest of form and do not compromise safety! Some wiggle-room is allowed as fatigue sets in, but it should never get ugly.

(Alternative: Dumbbell Front Squat at a 2:2:1 tempo x 4 reps per set)

Part 2 - VMO Squat Accessory

Rest 5-7 minutes after completing part 1

If you have any knee or ankle discomfort, take a few minutes to use a chair, bench, or step to find the limits of your pain-free range of motion. Add some light load (kettlebell or dumbbell) if desired. If this movement is not accessible to you, consider one of the options above.

Every 2 minutes x 4 sets - Set a timer and on time zero, 2, 4, and 6 minutes, perform 8-10 repetitions. Use the remainder of the 2-minute interval to rest. All repetitions should be unbroken.

Cool-Down

15-minute Deep Stretch for Hips - Slow Flow Yoga sequence

Frontera WR, Hughes VA, Lutz KJ, Evans WJ. A cross-sectional study of muscle strength and mass in 45- to 78-year-old men and women. J Appl Physiol. 1991;71(2):644-650. doi:10.1152/jappl.1991.71.2.644

Bean JF, Kiely DK, LaRose S, Goldstein R, Frontera WR, Leveille SG. Are changes in leg power responsible for clinically meaningful improvements in mobility in older adults? J Am Geriatr Soc. 2010;58(12):2363-2368. doi:10.1111/j.1532-5415.2010.03155.x

Segal NA, Glass NA, Torner J, et al. Quadriceps weakness predicts risk for knee joint space narrowing in women in the MOST cohort. Osteoarthritis Cartilage. 2010;18(6):769-775. doi:10.1016/j.joca.2010.02.002

Øiestad BE, Juhl CB, Eitzen I, Thorlund JB. Knee extensor muscle weakness is a risk factor for development of knee osteoarthritis: a systematic review and meta-analysis. Osteoarthritis Cartilage. 2015;23(2):171-177. doi:10.1016/j.joca.2014.10.008

Skelton DA, Kennedy J, Rutherford OM. Explosive power and asymmetry in leg muscle function in frequent fallers and non-fallers aged over 65. Age Ageing. 2002;31(2):119-125. doi:10.1093/ageing/31.2.119

NOW TAKING NEW CLIENTS!

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

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!

In case you missed it…..

Tune in to my guest appearance with the awesome and amazing Selene Yeager where we review the latest medical literature addressing the the role of laboratory testing in managing menopausal hormone therapy.

Beyond the Kettlebell

Carla DiGirolamo, MD — Mon, 25 May 2026 10:45:50 GMT

This week, I want to build upon last week’s introduction to hip extension through the kettlebell swing with a slightly more complex movement that expands hip extension into a total body movement. Enter the sumo-deadlift high-pull.

Part deadlift, part explosive pull, and part conditioning tool, the SDHP combines lower-body power with upper-body coordination in a single movement pattern. When coached correctly and loaded appropriately, it can be an efficient way to train strength, muscular endurance, and metabolic conditioning simultaneously.

This movement also highlights something increasingly important with aging: the ability to generate force quickly and transfer that force efficiently through the body.

What Is the Sumo Deadlift High Pull?

The SDHP begins in a wide “sumo” stance with the hands gripping the weighted object (typically a barbell, kettlebell, or dumbbell) inside the knees. From the floor, the athlete drives through the legs and hips, stands explosively, then continues the momentum upward by pulling the elbows high and outside until the weight reaches approximately chest or collarbone height.

The movement is sequential:

Hip and knee extension
Force transfer through the trunk
Upper-body pull

Done correctly, the arms are not initiating the movement—the hips are.

The Mechanics: The power comes from the lower body

The SDHP is fundamentally a hip-dominant movement. The glutes, hamstrings, quadriceps, spinal erectors, core musculature, traps, and upper back all contribute.

The wider sumo stance changes the mechanics compared with a conventional deadlift. Research on sumo deadlift biomechanics demonstrates that the wider stance generally allows for:

A more upright torso
Reduced forward trunk lean
Shorter bar travel distance
Reduced lumbar shear stress compared with conventional pulling mechanics

How to find your sumo-width stance: Start with your squat stance with your feet at shoulder-width distance. Then, with each foot, move one heel-to-toe length wider.

For many women—particularly those with longer torsos, shorter arms, or good hip mobility—the sumo position may feel mechanically more comfortable than a narrow-stance deadlift.

The “high pull” portion adds an explosive upper-body component that recruits the traps, deltoids, rhomboids, and scapular stabilizers while demanding timing and coordination. The movement, therefore, becomes less about isolated strength and more about integrated athletic movement.

Physiologic Benefits for Midlife and Older Women

One of the most valuable aspects of the SDHP is that it trains multiple physiologic qualities simultaneously.

1. Power Production

Power—the ability to produce force quickly—declines earlier and faster than maximal strength with aging. That matters because power is closely tied to athletic performance, fall prevention, agility, and functional independence.

The SDHP trains rapid hip extension, similar to jumping, sprinting, or Olympic lifting derivatives, but often with a lower technical barrier.

2. Metabolic Conditioning

Because the SDHP uses large muscle groups across the entire body and can be cycled continuously, it creates a substantial cardiovascular and metabolic demand.

This makes it useful in interval-style conditioning workouts where maintaining muscle mass and power output are priorities—not just calorie burn.

3. Posterior Chain Strength

The posterior chain—glutes, hamstrings, spinal erectors, and upper back—is critically important for posture, sprinting, lifting capacity, and long-term musculoskeletal resilience.

Many mid-life women are quadriceps-dominant from years of running, cycling, or group fitness classes. Hip-dominant pulling patterns like the SDHP can help restore balance.

4. Coordination and Force Transfer

The SDHP teaches “core-to-extremity” force transfer: generating power from the lower body and transmitting it through a stable trunk into the upper body.

That quality is foundational not only in sport, but also in everyday athletic movement.

Important Safety Considerations

The SDHP is effective—but it is not universally appropriate for everyone.

The most controversial aspect of the movement is the top position, where the shoulders move into internal rotation with the elbows elevated. Some clinicians and coaches argue that this position may increase the risk of shoulder impingement in susceptible individuals.

This does not automatically make the movement “dangerous,” but it does mean exercise selection should match the individual.

Women with:

Existing shoulder impingement
Limited thoracic mobility
Poor shoulder internal rotation
Cervical discomfort
Poor trunk control under load

may not tolerate the movement well.

Technique errors also matter. Common problems include:

Pulling with the arms too early
Rounding the lumbar spine
Letting the bar drift away from the body
Excessively loading the shoulders rather than driving through the hips

For many women, lighter loads with crisp mechanics are far more effective than maximal loading.

If the SDLHP is not accessible to you in any of its modifications, the kettlebell swing in part 1 of this series is a fine substitution.

Practical Takeaway

The sumo deadlift high pull is best viewed as a power-conditioning movement—not simply a strength exercise.

When programmed intelligently, it can improve:

Hip power
Whole-body coordination
Work capacity
Posterior chain strength
Athletic movement quality

But like many explosive exercises, the benefit depends entirely on execution.

If the shoulders dislike the movement, there are excellent alternatives—including kettlebell swings, high pulls from hang positions, trap-bar pulls, or medicine-ball power work.

The goal is not to force a movement.

The goal is to preserve power, athleticism, and resilience as long as possible.

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Warm Up

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

7 up-downs
7 air squats
7 easy push-ups option

After the 7 minutes, perform 10 weighted good mornings. You can either use a barbell/PVC pipe or hold a light dumbbell or plate to your chest.

Movement Practice

If you are performing this movement for the first time, it is highly recommended to perform the mechanics of this movement without any weight (just your two hands or a PVC pipe, broomstick, or similar object). When you feel confident in the movement, add a light kettlebell (5-15 lbs) or empty barbell. As you continue feeling proficient, slowly increase the load.

Review the video links that follow before trying the SDLHP:

The first part of this movement is a deadlift. It is very important to get this part of the movement right to keep your lower back protected. Be sure to keep your back straight- your legs, glutes, and hamstrings are doing the lifting, NOT the muscles of the lower back.
Next, review the sumo deadlift high pull progression video paying close attention to the mechanics tips in the text.
Practice! At first, you may want to do a deadlift, pause, then the high pull. This is ok! As you practice and become more familiar with the movement, the two parts of the lift will flow together. Don’t pull too soon! Be sure you are fully extended at the hips (standing up straight) before pulling the bar up.
- The “shrug” then the “pull” happens the second the hips fully extend. When the hips are extended with some speed or “pop” this begins to move the bar upward which signals the start of the pull. The upper extremties simply guide the bar upward.

TIP! When setting up for the SDLHP, set your eye gaze to a point on the ground 10 ft in front of you. You do not want to be looking straight ahead as this will hyper-extend the neck. Keep the neck neutral by setting your gaze as above.

For the push-ups, the workout calls for the hand-release push-up, however a standard push-up with or without elevation can be substituted. The hand-release version has the added benefit of building strength at the lowest point of the movement (chest touching the floor), which is often a “weak spot” of upper body strength.

Below is a list of movement options. Take 5-10 minutes to find the option that is right for you. If you want to “Geek-out” on a deep dive into push-up variations and mechanics, check out this awesome article: A Fresh Take on the Lowly Push-Up from the CrossFit library.

Hand-release push-up
Strict push-up
Elevated push-up - The elevation can be slight with a couple of plates on the ground, it could be a flat bench, or a STABLE chair or table as in the video. If shoulder pain or mobility is an issue, performing push-ups against a wall is also an option.

TIP! If possible, avoid doing the push-ups with the knees on the floor. This disengages some of the core activation, which is a target of both the SDLHP and the push-up.

Workout

We have 3 levels of this workout today! Beginner, Intermediate, and Advanced

Beginner

5 rounds for time

8 SDLHP - Two hands only/PVC pipe/broomstick
8 elevated push-ups

Intermediate

8 rounds for time

10 SDLHP (10-35 lb kettlebell, 25-55 lb weighted barbell)
12 hand-release/elevated/strict push-ups

Advanced

8 rounds for time

10 SDLHP (65# barbell)
12 hand-release push-ups

Cool-Down

Let’s show our back, hips and hamstrings some love with this 7-minute follow-along stretch segment from Train FTW.

For your yoga fix, try this 15-minute yoga flow class from Five Parks Yoga

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

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!

Power, Conditioning, and Coordination - Part 1

Carla DiGirolamo, MD — Mon, 18 May 2026 10:45:52 GMT

Muscle power is essential during midlife and beyond. One of the greatest power-generators exists through hip extension.

Power declines with age - especially during the menopause transition - often faster than maximal strength. This matters because power is what allows strength to show up quickly.

Strength helps you lift.

Power helps you react, jump, accelerate, climb, catch yourself, and move dynamically.

How do we tap into this power reservoir? Enter the kettlebell swing.

The kettlebell swing is one of the most useful “bridge” movements in strength and conditioning: simple enough to learn with good coaching, but powerful enough to train strength, coordination, conditioning, and athletic power in one pattern.

Its value is that it trains hip extension—the ability to drive the hips forward forcefully—which underlies so many athletic and daily movements: climbing stairs, jumping, sprinting, hiking uphill, lifting from the floor, getting out of a chair, and generating whole-body power.

What Is the Kettlebell Swing?

The kettlebell swing is a ballistic hip-hinge movement. The bell travels backward between the legs as the hips flex, then forward as the hips extend explosively. In the classic shoulder-height swing, the bell rises to approximately chest or shoulder level—not because the arms lift it, but because the hips project force into the bell.

That distinction matters.

A good swing is not a squat with a front raise. It is a loaded hinge followed by rapid hip extension. Biomechanical research shows that kettlebell swings create a hip-hinge pattern with rapid muscle activation and relaxation cycles, involving substantial low-back and hip muscle activity.

The Mechanics: Hinge, Load, Snap, Float

The swing can be thought of in four phases:

1. Hinge: The hips move back while the spine stays neutral. The knees bend slightly, but the movement is not knee-dominant.

2. Load: The hamstrings, glutes, and posterior chain lengthen under tension as the bell moves behind the body.

3. Snap: The athlete drives the floor away and extends the hips powerfully.

4. Float: The bell rises from momentum. The arms guide the bell; they do not lift it.

This is why the swing is so useful as a teaching tool. It reinforces the difference between hip flexion/extension and squatting, and it teaches force transfer from the lower body through a braced trunk into the upper body.

Female-specific biomechanics research supports the idea that swing style and load influence hip extension demands. In trained young women, kettlebell mass and swing variation affected hip joint kinetics, reinforcing that the swing is meaningfully loaded through the hip when performed correctly.

Physiologic Benefits

The swing offers several benefits that are particularly relevant for active and athletic women in midlife and beyond.

Posterior chain strength. The glutes, hamstrings, spinal erectors, and upper back all contribute to the swing. This helps build strength in the muscles that support posture, lifting, running mechanics, and hip stability.
Power development. Because the bell accelerates through hip extension, the swing trains explosive strength in a relatively accessible way compared with Olympic lifts.
Metabolic conditioning. Kettlebell swings can create a significant cardiovascular demand. Research on the oxygen cost of kettlebell swings shows that they can be metabolically challenging, especially when performed in intervals.
Grip and trunk integration. The swing requires the hands, lats, trunk, hips, and legs to coordinate as one system. This makes it more “athletic” than many isolated machine-based exercises.
Functional carryover. The hinge-to-hip-extension pattern shows up everywhere: deadlifting, jumping, hiking, picking up heavy objects, and transitioning from low to high positions.

Safety and Movement Modifications

The swing is powerful, but it should be earned. Common errors include squatting the bell, lifting with the arms, overextending the lower back at the top, letting the bell drop too low, or losing trunk tension.

For beginners or anyone with back sensitivity, check out this kettlebell swing progression video. Start with a kettlebell deadlift, then a hike pass, then short sets of swings. The goal is crisp mechanics, not fatigue-driven volume.

Other movement modifications include:

Use a light kettlebell: Kettlebells are available in weights starting at 5 pounds.
Adjust the height of the swing: The “Russian" swing takes the bell to eye level, where the “American” Swing takes the bell overhead - this is an advanced level option. The swing can further be modified to swing to the level of the abdomen or chest.

Practical Takeaway

The kettlebell swing is foundational because it teaches one of the most important athletic skills: generating power from the hips.

For midlife women, this is not just about performance in the gym. It is about preserving the ability to move with strength, speed, confidence, and resilience in real life.

Before progressing to more complex movements, the kettlebell swing builds the base: hinge mechanics, hip extension, trunk stiffness, posterior-chain power, and whole-body coordination.

In Part 2 of this series, we will increase the complexity with the sumo-deadlift high-pull. Stay tuned!

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Today’s workout targets hip extension with the jump and the kettlebell swing. The overhead alternating lunge creates fatigue in the legs and targets core stability. There are several movement alternatives to choose from if any of these movements is not completely accessible to you. Enjoy!

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 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).

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 jumps for height. If you cannot tolerate any impact perform dumbbell or barbell thrusters.

** For this workout, the box step-up is not an optimal scale because the goal of this movement is to be “explosive” in the hip extension to train power in the muscles that execute this movement.

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.

References

McGill SM, Marshall LW. Kettlebell swing, snatch, and bottoms-up carry: back and hip muscle activation, motion, and low back loads. J Strength Cond Res. 2012;26(1):16-27. Available at: https://pubmed.ncbi.nlm.nih.gov/21997449/

Lake JP, Lauder MA. Kettlebell swing training improves maximal and explosive strength. J Strength Cond Res. 2012;26(8):2228-2233. Available at: https://pubmed.ncbi.nlm.nih.gov/22580981/

Farrar RE, Mayhew JL, Koch AJ. Oxygen cost of kettlebell swings. J Strength Cond Res. 2010;24(4):1034-1036. Available at: https://pubmed.ncbi.nlm.nih.gov/20300022/

Watts CQ, McCarty CW, Keogh JWL, et al. Effects of kettlebell load on joint kinetics and global lower-extremity biomechanics during the kettlebell overhead swing. Sports (Basel). 2022;10(12):203. Available at: https://pubmed.ncbi.nlm.nih.gov/36548707/

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

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!

Promoting Adaptation with Coordination, Skill, and Balance

Carla DiGirolamo, MD — Mon, 11 May 2026 11:58:15 GMT

Text within this block will maintain its original spacing when published

Hey Team! 
I just landed in Rhode Island after a 5-day stint that involved moving my son out of his dorm at UCF in Orlando, FL, followed by a cross-country drive. So this week, I have chosen a popular post from the archives to remind us that the road to fitness takes many forms. I hope you enjoy this re-post, and I'll be back next week with new content! 
Cheers!
-Dr. Carla

One of the most beautiful things about the Human condition is our ability to adapt to changing environmental conditions. This ability is one of the reasons why we have been in existence for the last 300,000 years! So, when we are training for overall fitness and longevity, we need to keep changing things up to keep our muscles, bones, and nervous system in a constant state of dynamic change and adaptation.

We sometimes experience the flip side of adaptation that causes frustration, and that is the fitness plateau. We have all been in that situation when we are working hard on a fitness program that used to work, but no longer does. Once we have done the troubleshooting and ruled out things like fueling imbalances and inadequate sleep and recovery, the next place to look is the program itself, and the last time you made any significant changes.

You may have noticed that in the Athletic Aging Weekly Workout Series, we don’t repeat workouts very often, unless it is a strength or performance retest of a “benchmark workout”. This is deliberate, keeping consistent with the principle of maintaining a constant state of adaptation. Not only is there variation in movements and energy systems (heavier lifts vs cardiovascular stimulation), but there is variation in intensity as well.

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This week’s workout mixes it up in all directions! There are movements that may be new to you, like the plank pull-through and the sit-through (a.k.a the hip escape in the Les Mills BodyCombat world), a full body focus, and a lower “zone 2” or “conversational intensity”.

Today’s session is a modification of an awesome workout from Train FTW. As always, if these movements are not accessible to you, there are modifications for every fitness level. Enjoy!

Warm-Up and Movement Practice

Cardio movement options include bike, row, and run. If these options are not accessible to you, substitute an easy stair climb/step-up or another cardio machine (i.e arc trainer, elliptical, etc.). Ideally, select two different options for the workout, however, it is fine to select just one option for all three rounds. These cardio segments are to be done at a lower intensity (zone 2) level that is “conversational”.

To warm up, select one cardio option and go for 50 seconds at an easy pace and 10 seconds at a hard pace for a total of 5 minutes.

Watch the movement demo videos below and select your movement options for the workout. Take 5-10 minutes to practice each movement and select weights as appropriate.

Plank pull-through or Plank Shoulder tap (Knees or toes for both options)
Dumbbell front rack walk
Sit-through or bear crawl
Over-under carry
Oblique twist (Option: no weight)
Duck walk - body weight (Advanced option: Duck walk holding a light to medium kettlebell) or Inchworm

Workout

3 rounds

3:00 Bike
1:00 Plank pull-through (Alternative: Plank shoulder tap)
100 ft double dumbbell front rack walk

1:00 rest

3 rounds

3:00 row
1:00 sit-through (Alternative: 100 ft bear crawl)
50 ft / 50 ft over-under carry

1:00 rest

3 rounds

3:00 bike
30-second weighted oblique-twist
50 ft duck walk (Alternative: 50 ft inchworm)

Cool Down

This is a really nice, gentle full-body stretch sequence to round out today’s workout. Even though it was a lower-intensity day, effective tissue care ends with a good stretch! #dontskiptheyoga

15-minute Full Body Stretch

A Hot Topic that Keeps Heating Up…..

When women come to see me struggling with performance in perimenopause and menopause, they are often concerned about their fluctuating or absent reproductive hormones and the chaos this creates.

But often it is not the reproductive hormone pathways that are creating the chaos - it’s the hormone pathways of the stress response system. Check out this podcast appearance with the awesome and amazing Selene Yeager, where we discuss how fueling and recovering are your best defense against a stress response system gone rogue!

NOW TAKING NEW CLIENTS!

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

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!

Plank Challenge

Carla DiGirolamo, MD — Mon, 04 May 2026 10:46:00 GMT

If there’s one movement that bridges the gap between performance, longevity, and injury prevention—it’s the plank.

At first glance, it looks simple. Static. Even passive.

But physiologically? The plank is anything but.

Plank variations offer one of the most efficient ways to build core strength, spinal stability, and movement resilience—all without excessive joint stress.

What the Plank Actually Trains

The “core” is not just your abs. It’s an integrated system of muscles that stabilize the spine and pelvis, including:

Transversus abdominis
Internal and external obliques
Rectus abdominis
Erector spinae
Pelvic floor and diaphragm

These muscles work together to control force transfer through the body, which is critical for everything from lifting weights to running to simply maintaining posture.

Planks train this system isometrically—meaning the muscles contract without changing length. That distinction matters.

Unlike dynamic core exercises, planks emphasize:

Endurance of stabilizing muscles
Neuromuscular coordination
Spinal control under sustained tension

Why Planks Matter for MidLife Women

As women move through perimenopause and menopause, several physiologic changes occur:

Loss of muscle mass (sarcopenia)
Decline in neuromuscular efficiency
Increased risk of low back pain and injury

Core stability becomes a limiting factor—not just strength.

Research consistently shows that core stabilization exercises like planks improve neuromuscular control and spinal stability, making them foundational in both performance training and rehabilitation settings (Hibbs et al., 2008).

A Brief but Important Distinction: Stability vs Movement

Planks are fundamentally different from dynamic core exercises like the kettlebell swing or hollow rocks. As an isometric exercise, the plank trains the core to resist movement—building sustained tension, spinal stability, and neuromuscular control. In contrast, dynamic movements involve repeated shortening and lengthening of muscle, emphasizing force production and movement efficiency.

Electromyographic research shows that isometric exercises like planks preferentially activate deep stabilizing muscles critical for spinal protection, while dynamic exercises generate higher peak forces but rely on that underlying stability to be performed safely (McGill, 2010; Ekstrom et al., 2007).

In practice, this means planks build the foundation, while dynamic core work expresses that strength through movement.

Why Isometric Strength Matters for Longevity

Isometric training—like planks—builds:

Postural strength
Joint stability
Tendon resilience
Time-under-tension endurance

Unlike repetitive flexion-based movements, planks:

Minimize excessive spinal loading
Train the body to resist unwanted motion (anti-extension, anti-rotation)
Reinforce safe mechanics under fatigue

This becomes increasingly important for reducing injury risk in both training and daily life.

The Power of Plank Variations

Here’s where planks become a true performance tool. Different variations shift demand across the core:

Research shows that these variations can increase muscle activation and neuromuscular demand, making them far more than a static hold.

How to Program Planks Effectively

For women over 40, the goal is not just “holding longer”—it’s building capacity with quality.

Start with:

20–30 second holds
2–4 sets

Progress by:

Increasing time (up to ~60 seconds)
Adding variations rather than just duration
Introducing instability or controlled limb movement

Key cue:

Think “brace and breathe,” not “hold your breath and survive.”

The Takeaway

Planks are not a filler exercise.

They are a high-value, low-risk, performance-enhancing tool—especially for women navigating the physiologic shifts of midlife.

They train what matters most:

Stability before power
Control before intensity
Endurance before output

Build the foundation well—and everything else gets stronger on top of it.

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Today’s workout has a “Plank Challenge” integrated into a combination of dynamic movements that target the core musculature in different ways.

Warm Up

If running, rowing, or biking, perform 3 minutes at an easy pace.

Then….

TABATA (20 seconds work/10 seconds rest) x 3 rounds (6 minutes total)

Up downs or jump rope
Air squats
Elevated Push ups (elevated or strict)
Ab mat or traditional sit Ups (knees bent, feet anchored)

Movement Practice

Watch the video links for the workout movements and alternatives and take 5-10 minutes to practice each movement in sequence for 4-6 repetitions at low intensity for 2 rounds. Select your options for the workout during this practice time.

Movement substitutions:

Run/Row substitution: 400m bike or10 up-downs or 60 single-under/30 double-under jump rope.
Dumbbell front squat substitution: Goblet squat with a single dumbbell or kettlebell or air squat.
Kettlebell swing substitution: double or single dumbbell swing, or 10 hip bridges with or without weight.

Workout

4 Rounds for time. Perform each movement in sequence. Note that there is 1 minute of rest between rounds.

200m run or row
10 dumbbell (2 dumbbells) front squats
10 strict or elevated push-ups
15 Kettlebell swings- eye level (advanced: overhead swing):
10 Hollow Rocks
Accumulate 1:00 plank hold
- If you need to rest before the minute is up, the rest DOES NOT count toward the 1 minute. Resume timing when you resume the plank until you have accumulated 1 full minute of plank time.
REST 1 minute

SCORE: Total time to complete the 4 rounds plus the 1 minute of rest in between rounds.

Cool-Down

Jump-start your recovery with this 20-minute deep stretch yoga sequence from Five Parks Yoga

McGill SM. Core training: evidence translating to better performance and injury prevention. Strength & Conditioning Journal. 2010;32(3):33–46. doi: 10.1519/SSC.0b013e3181df4521.

Ekstrom RA, Donatelli RA, Carp KC. Electromyographic analysis of core trunk, hip, and thigh muscles during 9 rehabilitation exercises. J Orthop Sports Phys Ther. 2007;37(12):754–762.

Hibbs AE, Thompson KG, French D, et al. Optimizing performance by improving core stability and core strength. Sports Med. 2008;38(12):995–1008.

McGill SM, Marshall LW. Kettlebell swing, snatch, and bottoms-up carry: back and hip muscle activation, motion, and low back loads. Journal of Strength and Conditioning Research. 2012;26(1):16–27. doi: 10.1519/JSC.0b013e31823a4063.

Calatayud J, Casaña J, Martín F, Jakobsen MD, Colado JC, Gargallo P, Juesas Á, Muñoz V, Andersen LL. Trunk muscle activity during different variations of the supine plank exercise. Musculoskeletal Science and Practice. 2017;28:54–58. doi: 10.1016/j.msksp.2017.01.011.

TAKING NEW CLIENTS!

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

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 online! Looking for a more Human encounter? Call Mary, my awesome and amazing assistant at 754-262-5674 (M-F 9a-5p ET)

In Case You Missed It…..

Check out this awesome podcast where the awesome and amazing Selene Yeager interviews Dr. Casey Francis, my personal Performance Physical Therapist from Pompano Beach, FL, about how this discipline of physical therapy can help women of all ages and athletic levels, but especially those in mid-life. Later in the show, I make a quick appearance to talk about my injury rehab and experience working with Dr. Casey.

Bodyweight Training: Strength, Simplicity, and Longevity

Carla DiGirolamo, MD — Mon, 27 Apr 2026 10:45:22 GMT

The masses (including myself) spend a lot of time discussing the benefits of weight training. As often happens when something goes viral, we can get caught up in an implied narrative that we need to DO THIS AT THE EXCLUSION OF everything else and lose sight of the other valuable fitness modalities that we have available to us.

Now, please make no mistake. There is no substitute for the stimulus we receive from weight training. But females are masters of physical adaptation, and our bodies crave variation to improve fitness. So the more variations we have, the more opportunities we have to supplement our weight training efforts with other modalities, and promote the adaptations required for fitness gains.

Enter body weight training.

Bodyweight training is having a well-deserved moment—and for good reason. For midlife women, it represents an effective, accessible, and sustainable way to build strength, preserve muscle, and support long-term health.

But to fully appreciate its value, we need to define it more broadly than most people do.

What Is Bodyweight Training?

Bodyweight training includes any exercise where your own body mass provides the primary resistance. While many people think of push-ups and squats, the reality is much more comprehensive.

A well-rounded bodyweight training system includes:

Strength movements: push-ups, pull-ups, squats, lunges
Locomotion: walking, running, hiking, stair climbing
Power-based movements: jumping, hopping, bounding, skipping
Isometric control: planks, wall sits, hangs
Multi-planar movement: lateral lunges, crawling, rotational patterns
Skill and control work: yoga flows, Pilates-based core training, balance work

Together, these movements train strength, power, coordination, mobility, and control—qualities that become increasingly important as we age.

Why Bodyweight Training Matters More After 40

As physiology shifts in midlife, our training priorities evolve. Bodyweight training aligns exceptionally well with what we need most.

It builds real-world strength
Bodyweight training improves your ability to move your own mass through space. Getting up from the floor, climbing stairs, catching yourself during a misstep—these are all expressions of functional strength.

It preserves lean muscle mass
Muscle loss (sarcopenia) begins as early as the fourth decade. Bodyweight exercises—especially when progressed appropriately—can provide sufficient resistance to stimulate and maintain muscle.

It supports bone health
Movements that involve impact—such as running and jumping—create mechanical loading that is particularly effective for maintaining bone density. This becomes critical in the peri- and postmenopausal years.

It enhances joint health and mobility
Bodyweight movements require joints to stabilize through natural ranges of motion while simultaneously producing force. This integrated demand supports both mobility and long-term joint resilience.

It improves neuromuscular coordination
Many bodyweight exercises are skill-based. Whether it’s controlling a pull-up, stabilizing in a plank, or transitioning through a yoga flow, these movements reinforce the connection between the nervous system and muscular system—an essential component of balance and fall prevention.

It emphasizes relative strength
Your ability to move your own body is one of the most meaningful indicators of function and longevity. Push-ups, pull-ups, and controlled squats often tell us more about real-world capability than machine-based strength measures.

A Complete System, Not Just a Few Exercises

One of the most common misconceptions is that bodyweight training is limited or “basic.” In reality, it is a highly adaptable and scalable system.

For example:

A push-up can range from a wall variation to a deficit or single-arm version
A squat can progress from a box squat to a single-leg squat
Jumping can evolve from low-impact step-offs to more dynamic, reactive movements
A plank can become a highly demanding full-body stability challenge

Even yoga and Pilates—often thought of as separate disciplines—fit naturally into this system by developing control, stability, and movement precision. These elements enhance the effectiveness of more strength- and power-based movements, creating a more complete and resilient athlete.

What Does the Research Show?

The literature consistently supports the benefits of bodyweight and resistance-based training, particularly in women and aging populations:

Bodyweight resistance exercises can produce significant improvements in strength and muscle hypertrophy, comparable to traditional resistance training when properly progressed
Resistance training improves muscle mass, metabolic health, and cardiovascular outcomes, all of which are critical for long-term health
Impact-based and resistance training strategies improve bone mineral density and physical function, especially in postmenopausal women
Calisthenics-based training enhances neuromuscular function, balance, and coordination, which are key for maintaining independence with age

Importantly, these adaptations remain robust well into midlife and beyond.

The Bottom Line

Bodyweight training is not a simplified version of training—it is a foundational system for strength, movement, and longevity that offers:

Functional, transferable strength
Preservation of muscle and bone
Improved balance and coordination
Scalability across all fitness levels
Minimal equipment with maximal return

But if I’m weight training 3-4x per week, how do I fit it all in???

If you have never lifted weights before, body-weight training can build a great base of functionality to help you hit the ground running when you start training with weights.
It adds variety to your weight training program. If the bench press is part of your weight training routine, you can add push-up sessions and their many variations to your routine. Having a separate day of plyometrics sprinkled into your sessions or isometrics on a de-load day fits nicely with any weight training routine, as does running, hiking, and other options in the locomotion category.
It also provides great options if you are de-loading (active recovery days or weeks), traveling, or pressed for time, because many body weight movements can be done with no equipment and minimal space.
Provides a wide variety of scalable options during injury recovery.

The key is to think beyond isolated exercises and instead embrace the full spectrum:
strength, power, locomotion, stability, and control.

Train your body to move well, not just lift well.

Because ultimately, the goal isn’t just fitness—it’s capability, resilience, and longevity.

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This week, we are featuring the classic, body-weight, CrossFit benchmark workout - “Cindy” and to that, I have added a twist with a locomotion movement of choice (walk with or without a weighted vest, run, bike, or row - or even swim if you are so inclined!)

Warm Up

3 minutes of your locomotion option of choice at an easy pace

then…

AMRAP 5 (As many rounds as possible in 5 minutes). Perform each movement in sequence for as many rounds and repetitions as possible in 20 minutes.

10 air squats
5 easy push-ups (Use an elevated push-up if strict push-ups are not accessible to you).
5 V-ups. See the linked video for modifications

Movement Practice

Select your options for the workout. For the air squats, be sure to identify your pain-free range of motion if you have knee or mobility issues. Set up a box or bench as a target, if needed. Otherwise, if you have no limitations, ensure that your hips break parallel and that you achieve this depth consistently.

Select your push-up option. If you cannot do strict push-ups easily, set up a stable box or bench at an elevation that allows you to do 5-10 unbroken repetitions confidently. ** Try to avoid doing push-ups from your knees, as this disengages the core muscles.

Select your pull-up option. Last week’s post, “Pull-Up Power,” reviewed the mechanics of the pull-up and the many options available for all fitness levels. Select an option where you can do 3-5 repetitions at a time confidently.

TIP! This is a very high-repetition volume workout. Fatigue will set in very quickly, so it is important to select movement options that you can do confidently and easily for several rounds. Take short rests as needed while pacing and as fatigue sets in. It is not unusual to be doing single repetitions at a time toward the end.

Workout

Pace yourself!

5 minutes of your locomotion choice at an RPE of 7-8. Note your total.

Proceed immediately into AMRAP 20 (As many rounds as possible in 20 minutes)

5 pull-ups (your selected option)
10 push-ups (your selected option)
15 Air squats

Immediately following the 20-minute AMRAP, go straight into another 5 minutes of your locomotion choice with the goal of meeting or exceeding your total prior to the AMRAP.

Your score: Total rounds and repetitions, including your locomotion total for both rounds.

MODIFICATION: If you wish to reduce the repetition volume, perform the AMRAP for 10 or 15 minutes instead of 20 minutes.

Cool Down

This workout was a long grind, so it deserves a thorough cool-down that helps return your stress response system back to baseline.

Try this 20-minute Quick Escape to “calm you down and reconnect you and yourself with your space”. Brough to you by Five Parks Yoga

REFERENCES

Kotarsky CJ, Christensen BK, Miller JS, Hackney KJ. Effect of progressive bodyweight squat training on muscle strength and hypertrophy. Int J Exerc Sci. 2018;11(3):965–978.
https://pmc.ncbi.nlm.nih.gov/articles/PMC10439966/

Kikuchi N, Nakazato K. Low-load bench press and push-up induce similar muscle hypertrophy and strength gain. J Exerc Sci Fit. 2017;15(1):37-42.
https://pubmed.ncbi.nlm.nih.gov/29541130/

Watson SL, Weeks BK, Weis LJ, Harding AT, Horan SA, Beck BR. High-intensity resistance and impact training improves bone mineral density and physical function in postmenopausal women (LIFTMOR trial). J Bone Miner Res. 2018;33(2):211–220.
https://asbmr.onlinelibrary.wiley.com/doi/10.1002/jbmr.3284

Nikander R, Sievänen H, Heinonen A, Daly RM, Uusi-Rasi K, Kannus P. Targeted exercise against osteoporosis: a systematic review and meta-analysis for optimising bone strength throughout life. BMC Med. 2010;8:47.
https://pubmed.ncbi.nlm.nih.gov/20663158/

Borde R, Hortobágyi T, Granacher U. Dose–response relationships of resistance training in healthy old adults: a systematic review and meta-analysis. Sports Med. 2015;45(12):1693–1720.
https://link.springer.com/article/10.1007/s40279-015-0385-9

Carter SE, Draijer R, Holder SM, Brown L, Thijssen DHJ, Hopkins ND. Breaking up sedentary time with calisthenics improves neuromuscular function: a randomized crossover study. Med Sci Sports Exerc. 2022;54(7):1155–1162.
https://pmc.ncbi.nlm.nih.gov/articles/PMC9653850/

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

This just dropped…..

Pull-Up Power

Carla DiGirolamo, MD — Sun, 19 Apr 2026 10:45:48 GMT

Why are pull-ups so hard?

Because they expose the gap between being strong and being able to use that strength.

A pull-up isn’t just an upper-body exercise—it’s a full-system demand. You’re lifting your entire bodyweight while coordinating your grip, shoulders, and core in a precise sequence. There’s no external load to scale down, no machine to guide you. It’s just you, your strength-to-weight ratio, and your ability to control it.

For many women—especially over 40—the challenge isn’t a lack of effort or even general fitness. It’s that pull-ups require something highly specific: relative strength, grip capacity, and scapular control working together. You can be strong in rows, consistent in your training, and still feel completely stuck when you hang from a bar.

That’s what makes pull-ups so frustrating—and so valuable.

Because when you train for a pull-up, you’re not just building muscle. You’re developing the kind of integrated strength that carries over into everything: posture, shoulder health, and long-term functional independence.

And it often starts with something surprisingly simple… your grip.

Grip strength is more than a limiting factor in pull-ups—it’s a powerful biomarker. Large cohort studies have shown that lower grip strength is associated with increased risk of functional decline, frailty, and even all-cause mortality. In other words, your grip isn’t just about your hands—it reflects global neuromuscular health.

Pull-ups uniquely integrate grip strength with upper body pulling mechanics, making them one of the most efficient ways to train both simultaneously.

From the literature, developing pulling strength and grip capacity contributes to:

Improved shoulder stability and reduced injury risk
Greater bone density through mechanical loading
Preservation of lean mass (critical in preventing sarcopenia)
Enhanced metabolic health
Maintenance of functional independence

The Path to Your First Pull-Up

Think of this as building a system—not just a single movement.

1. Find your baseline

Before you begin, it’s important to see where your baseline is for the full movement.

First, test your grip. From a stable, pull-up bar set-up, try a dead hang. If you are unable to hang with your full body weight, that’s ok! Proceed to the next step below.

Second, as soon as you are able, set up as many resistance bands as you need from a stable pull-up bar set-up or set up a pull-up assist machine at a high level of assistance.

Review the VIDEO with close attention to movement mechanics. Try your first pull-up.

If a pull-up bar set up is not accessible, a second option is the seated pull-up using a lower bar with a squat rack or bench press set up. The same movement mechanics for the hanging pull-up can be applied to the seated barbell pull-up.

The benefit of the seated pull-up is that you can assist the pull-up with your lower body as much or as little as you need. Once you have developed the ability to do a seated pull-up, you can move to band-assisted pull-ups from a pull-up bar.

2. Develop The Movement

Foundational Strength: Movements such as Lat pulldowns (progressively heavier), Seated or single-arm rows, or barbell rows, performed over the full range of motion with controlled tempo.
Grip Strength: The dead hang is the most effective way to build grip strength for this movement. Ideally, hang from a high bar. Start with 5-10 seconds and work up to 45-60 seconds. Do this for 2-3 sets with 1 minute of rest in between 2-3x per week.
Eccentric Training (Negative Repetitions): Jump or assist yourself to the top of the movement with the chin over the bar. Hold for 1-2 seconds, then lower your body with less assistance over 3-5 seconds. Perform 3-5 repetitions for 2-3 sets twice per week.
Eccentric training is well-supported for improving strength and tendon resilience
Develop Scapular Control
The scapular muscles are a group of muscles that stabilize and control the shoulder blades against the rib cage, creating the foundation for a strong and efficient pull-up. Scapular pull-ups (initiate from the shoulders, not the arms). Perform these with arms completely extended. Perform 5-10 repetitions for 2-3 sets 1-2 times per week.
Cue: “pull your shoulder blades into your back pockets”

Building Pull-Up Capacity

Once you can execute a pull-up -whether assisted or unassisted - with solid mechanics, it’s time to build capacity!

The two accessory segments below help to build capacity (volume) of pull-ups and pull-up stamina - the number of pull-ups in a set unit of time. Each of these accessories takes <10 minutes to do and can be added on at the beginning or end of most training days.

Accessory 1: EMOM (every minute on the minute) x 8 minutes, perform X pull-ups. Set a timer. At the start of the first minute, perform your chosen number of repetitions. Rest until minute 2 starts. Perform the same number of repetitions. Rest until minute 3 starts, and so on, until you have completed 8 minutes.

Select a set number of repetitions between 5 and 10 that you can confidently perform within a 1-minute interval with plenty of rest from the time you finish the repetitions until the next minute begins. Be conservative! You will be doing 8 sets of these. A suggestion would be 5 repetitions to start.

Accessory 2: EMOM (Every minute on the minute). Start a timer. At 0:00, perform 1 pull-up. Rest for the remaining minute. At 1:00, perform 2 pull-ups. Rest for the remaining minute. Continue adding 1 repetition each minute until you cannot complete the number of repetitions in the 1-minute interval.

This is a very different stimulus from Accessory 1. If you are able to complete 10 minutes, then next time start with 2 repetitions and add 2 with each minute. Alternatively, if your pull-ups are assisted, use less assistance (ex - a thinner band).

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This week’s workout is a pull-up mini-workout that you can add on to other training or do on its own 2-3 times in a week.

Warm Up

10 arm circles forward, 10 arm circles backward
10 swing both arms crossing in front of the body
10 vertical arm swings (one arm up and one arm down, alternating)
5 shoulder rolls backward, 5 shoulder rolls backward.
10 scap push-ups (From knees or toes)
Hold Child’s Pose for 5 breaths with arms extended over head
Thread the needle stretch - 5 seconds each side, repeat twice

Movement Practice

Set up your pull-up station using the guidelines in this post.
Test your dead hang. Record how many seconds you can hold on until you need to let go.
Perform 10 scap pull-ups. If you need to break this up into 2 sets of 5 repetitions, that is ok too!

Rest 2-5 minutes before beginning the workout.

Workout

Select a pull-up option that allows you to do 5 repetitions confidently in 15-20 seconds.

EMOM 8 (Every minute on the minute for 8 minutes)

Set a timer and perform 5 pull-ups. Rest for the remainder of the minute. Repeat when the next minute turns.

Training Notes:

The goal is to do all sets unbroken. If you are unable to do this, repeat this workout next week and try to make progress until you can do all sets unbroken.
If you can do all sets unbroken, you have 3 options for your next session:
- If doing assisted pull-ups, reduce the assistance
- Add repetitions. Try 6 or 7 repetitions per minute at your next session.
- Perform Accessory 2 above and test your stamina!
Create a document or notebook log for your workouts. Make progress each week by adding repetitions, reducing assistance, or trying Accessory #2.
Take 5 minutes to integrate the other elements described in the Develop The Movement section above into your other training days 2-3 times per week.

Cool Down

There’s nothing like a great shoulder stretch on a shoulder-heavy day! Jump-start your recovery with a little shoulder love from Five Parks Yoga

20-minute Neck and Shoulder Tension Release

Dickie JA, Faulkner J, Barnes MJ, Lark SD.
Electromyographic analysis of muscle activation during pull-ups with different techniques. Journal of Electromyography and Kinesiology. 2017;32:30–36.
https://www.sciencedirect.com/science/article/abs/pii/S1050641116302978

Snarr RL, Esco MR.
Electromyographical comparison of a traditional, suspension, and towel pull-up. Journal of Human Kinetics. 2017;59:5–13.
https://pmc.ncbi.nlm.nih.gov/articles/PMC5548150/

Lehman GJ, Buchan DD, Lundy A, Myers N, Nalborczyk A.
Variations in muscle activation levels during traditional lat exercises. Journal of Strength and Conditioning Research. 2004;18(4):703–707.
https://pmc.ncbi.nlm.nih.gov/articles/PMC449729/

Kibler WB, Sciascia A, Uhl TL, Tambay N, Cunningham T.
Electromyographic analysis of specific exercises for scapular control in early phases of shoulder rehabilitation. American Journal of Sports Medicine. 2008;36(9):1789–1798.
https://pubmed.ncbi.nlm.nih.gov/18469224/

This just dropped…..

Check out this awesome podcast where the awesome and amazing Selene Yeager interviews Dr. Casey Francis, my personal Performance Physical Therapist from Pompano Beach, FL, about how this discipline of physical therapy can help women of all ages and athletic levels, but especially those in mid-life. Later in the show, I make a quick appearance to talk about my injury rehab and experience working with Dr. Casey.

TAKING NEW CLIENTS!

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

Similar But Different

Carla DiGirolamo, MD — Mon, 13 Apr 2026 10:45:51 GMT

Strength training is an effective pathway toward longevity. Squats, deadlifts, overhead shoulder press, and bench press are the four primary lifts that are foundational for any strength program.

An example of a typical strength session is is 5 sets of 5 repetitions of overhead shoulder presses, with approximately 2-3 minutes of rest in between sets to allow sufficient recovery for the next set. This type of session is one involving a single modality, and is effective for building strength, preserving bone, balance, and core strength.

Let’s consider what happens when we add a second, completely different movement modality - such as 400m run - immediately after each shoulder press set. The shoulders still rest for a similar period of time, but adding the run is a total game-changer.

When we add the run to this lift, the rapid shifts between strength and cardio modalities require a process called Neuroendocrine adaptation — the process by which exercise stimulates the nervous system and hormonal pathways that make us stronger and fitter.

This becomes especially important for midlife women, when the hormonal changes at this stage of life are creating a challenge for maintaining muscle strength, mass, and power and a decline in bone density. The right training stimulus helps the body activate powerful adaptive pathways independant of these changing hormones to help mitigate these losses during this stage of life.

The Body Uses Three Energy Systems

All physical activity draws from three metabolic pathways:

• Phosphocreatine system – fuels explosive efforts lasting ~10 seconds (heavy lifts, jumps, sprints)

• Glycolytic system – fuels hard efforts lasting ~30 seconds to a few minutes

• Oxidative system – fuels lower-intensity activity lasting several minutes or longer

A typical strength session utilizes a single energy system - most often, the phosphocreatine system.

When we add a second modality, such as a 400m run, taking approximately 1 1/2 - 2 minutes to complete, this requires the glycolytic energy system. Switching back and forth from the phosphocreatine to the glycolytic systems for 5 rounds adds en entirely different stimulus to the training session.

Why This Matters

Switching energy systems increases demand across multiple systems at once:

• the nervous system adjusts motor recruitment
• the cardiovascular system increases oxygen delivery
• the metabolic system shifts fuel sources
• the endocrine system releases hormones that support performance and recovery

Because the body must coordinate all of these responses repeatedly, the neuroendocrine stimulus becomes more complex.

Research shows workouts that combining strength and metabolic work often produce larger hormonal and metabolic responses — signals that drive adaptation.

The Takeaway

Both workouts are valuable — but they train different qualities of fitness.

Traditional strength training builds force and structural strength.

Mixed workouts that combine lifting and cardio challenge the body’s ability to transition between energy systems.

For women navigating the hormonal challenges to the musculoskeletal system, incorporating both approaches helps maintain strength, metabolic health, and long-term athletic capacity.

Because the body doesn’t just adapt to the exercises we perform.

It adapts to the challenges we ask it to solve.

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So let’s try it!

Warm Up

TABATA 20 seconds of work / 10 seconds of rest x 8 rounds. Perform each movement in sequence for a total of 4 rounds.

High-knee run - Perform for 20 seconds, then rest for 10 seconds, then…
Easy push-up - Perform for 20 seconds, then rest for 10 seconds… and so on for all movements.
Plank shoulder tap (From knees or toes)
Air squat

Movement Practice

Review the shoulder press video and review form and mechanics. Select your options for the workout. Using either a barbell or dumbbells, select a heavier shoulder press weight that you can complete for 5 unbroken repetitions where is starts to become challenging at the 3rd or 4th repetition.

For the run, select a distance that you can run at an RPE (rate of perceived exertion) of ~ 7 out of 10 for 1 1/2 to 2 minutes. If running is not accessible to you, an 800m stationary bike or 400m row are also options. An eliptical or stair climber would also work at the prescribed intensity for 1 1/2 - 2 minutes.

Workout

Part 1

5 rounds for time

Perform each movement in sequence until you complete both movements for 5 rounds.

5 Shoulder Press
400m run

Part 2 - core kicker

TABATA 20 seconds Work / 10 seconds rest - total 8 min. (4 rounds of each exercise)

How to: Work through each movement sequentially. Set a timer or the TABATA option on the SmartWOD app for 20s work/10s rest x 8 min. Perform 20 seconds of sit-ups / 10 seconds of rest, then 20 seconds of hollow rocks / 10 seconds of rest, then 20 seconds of oblique twists / 10 seconds of rest, then a 20-second superman hold / 10 seconds of rest, then back to the sit-ups for a total of 4 rounds of all movements in 8 min.

AB Mat Sit-ups
TIP! Roll up a bath or beach towel and place it under your lower back for the ab mat.
Oblique Twist
Hollow rock
Superman Hold

Cool-Down

Both Parts 1 and 2 of this workout target the core muscles in vastly different ways. Take the time to cool down, recharge and jump-start your recovery with this 12- minute core static stretching segment.

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

The Power of the Pause

Carla DiGirolamo, MD — Mon, 06 Apr 2026 10:45:49 GMT

Building strength during perimenopause and menopause is hard - heck, even just maintaining the muscle mass of our 20s and 30s is challenging. So we need to be smart about our strategies.

Strength training - especially at this age - goes beyond doing the reps. HOW we do those reps is where we can find those strategies that can help us move past the plateaus and even into a new dimension of strength that involves stability, nervous system coordination, and body control.

When we perform movements that involve a concentric (muscles shorten while producing force) and an eccentric phase (muscles lengthen while producing force), the point at which the direction of the movement changes is often the weakest part of the movement.

Let’s consider the squat.

From a standing position, the eccentric phase is the descent as you “sit down” into the squat. At the bottom of this position, the direction changes, and the concentric phase of the movement involves the quadriceps, hamstrings, and gluteal muscles to shorten and contract to elevate you from the bottom back to a standing position. The transition from lowering to rising involves what exercise scientists call the stretch-shortening cycle (SSC).

As one descends into a squat, muscles and tendons store elastic energy. It’s like when you load a slingshot by pulling tension on the elastic band. This increasing force can be released as power output during the concentric phase, “assisting” in that change of direction as you rise up from the bottom of the squat. This tension creates elastic rebound or a “bounce” which provides momentum to assist in the change in direction from descending to rising out of the squat.

Because the muscles can depend on this elastic energy or “bounce” to generate force out of the bottom of the squat, the muscles are often weaker in their ability to generate their own force independent of that elastic recoil from this position of transition at the bottom. This relative weakness can create instability, limiting the muscular force that can be generated from this bottom position.

One of the simplest—and most effective—tools to build strength at this vulnerable point at the bottom of the squat is the Pause Squat.

What is the Pause Squat?

A pause squat is exactly what it sounds like: instead of immediately driving out of the bottom of a squat, you pause for 1–3 seconds at the bottom position before standing up. This brief pause removes momentum from the stretch-shortening cycle. As a result, the lifter must generate force primarily through active muscular contraction rather than elastic recoil. This is the central reason pause squats feel significantly harder—even when the load is lighter.

While this variation is commonly used by powerlifters and Olympic weightlifters, pause squats may actually be even more valuable for aging athletes who want to maintain strength, power, and joint health.

What’s The Benefit?

Builds concentric strength - When a controlled pause is added at the bottom of the squat, the muscles must sustain high tension in the most mechanically disadvantaged portion of the squat. This can help build lower-body power for strength sports and field-based athletics.

Training in these deep joint angles is particularly valuable for maintaining strength across the full range of motion of the hips and knees—an important factor for maintaining functional movement capacity with aging, so that you don’t need 3 grandchildren to help you out of your chair when you are in your 80s.

Enhance Neuromuscular Strength Adaptations - A controlled pause between the eccentric and concentric phases increases the neuromuscular demand of the lift.

Muscular work requires not just contracting muscle fibers, but also coordinated signalling from the nerves that “wire” these muscles to perform.

Targeting the nervous system enhances the effectiveness of the strength adaptations for gaining strength in this position.

Reinforce Technical Consistency - Pause squats also provide a unique benefit for movement quality. When athletes pause at the bottom of a squat, they must maintain:

Core bracing
Balanced foot pressure
Stable knee tracking
Proper hip positioning

Research on resistance-training assessment techniques demonstrates that imposing a pause reduces variability in squat performance and improves the reliability of strength measurements.

In other words, the pause forces athletes to reproduce the same bottom position each repetition, reinforcing consistent movement mechanics, which also helps to prevent injury.

Provide a Strong Stimulus With Slightly Lighter Loads

Another practical advantage of pause squats is that they create a demanding strength stimulus without requiring maximal loads.

Since the movement removes the stretch reflex and elastic energy contribution, athletes often train with lighter weights while still achieving high muscular demand.

For athletes focused on long-term training sustainability, this can mean:

Lower cumulative joint stress
Reduced spinal loading
Improved recovery between sessions

An Important Note about “The Bottom”

Because squatting is a movement that involves mobility at the hip, knee, and ankle joints, many are limited in how deep into the squat they can go.

Here is where it becomes important to carefully review squat mechanics and types of squats that feel good for you, and find your pain-free range of motion. For a detailed tutorial about squat mechanics and finding your pain-free range of motion, check out this Athletic Aging post from the archives": The Key to Stronger Squats.

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Welcome to Leg Day!

Today’s workout dials in on the Pause Squat using “tempo” to control the descent into the bottom of the squat, then holding the pause at the bottom for 3 seconds, then rising.

Warm up

Set your timer to 5 min or the SmartWOD app to TABATA 20/10 x 5 min. Start with the jumping air squats for 20 seconds then 10 seconds rest, then 20 seconds of mountain climbers, 10 seconds of rest and then back to the jumping air squats, alternating movements until you have completed each movement for a total of 5 rounds.

TABATA 20 second work/10 seconds rest x 10 rounds (total of 5 min)

Jumping air squats
Mountain climbers: (Alternative: Bicycle Crunch)

Movement Practice

This is just as much of a core stabilizer workout as it is a leg strength and mobility workout. This workout is ideally done with a straight bar, however can also be done with dumbbells or kettlebells.

Movement Options:

Barbell: Back squat or Front squat.
Dumbbells: Use two dumbbells or kettlebells as a front squat, or you can use a single dumbbell or kettlebell as a goblet squat.
No weight: If squats are a challenge, then the air squat is a fantastic option where you will receive every bit of the same benefit as using weight.

Pick a set of moderate to heavy dumbbells (or barbell) that you can do all reps unbroken. Descend for a count of 3, hold for a count of 3 at the bottom, then rise for a count of 1.

Workout

Part 1

Every 3 minutes x 5 rounds - 4 unbroken repetitions of your choice of Tempo Squat with a 3-second pause at the bottom.

Set a clock for EMOM (every 3 minutes x 5 sets) or set a clock and on minutes 0:00, 3:00, 6:00, 9:00, and 12:00, start the 4 repetitions. Rest for the remainder of time until the next interval starts.

4-4-4-4-4

Part 2

HAMSTRING ACCESSORY

3 Rounds

10 Weighted Good Mornings
20 banded hamstring curls

*If you do not have a resistance band, ankle weights or securing a light dumbbell between your feet will also work. If no equipment, try 20 bodyweight glute bridges.

Cool Down

Your legs received a lot of attention today so lets show them some love and jump-start their recovery with this 20-minute “Love Your Legs” yoga segment from Five Parks Yoga. #dontskiptheyoga

Cormie P, McGuigan MR, Newton RU.
Developing maximal neuromuscular power: Part 1—biological basis of maximal power production. Sports Medicine. 2011;41(1):17–38.
https://doi.org/10.2165/11537690-000000000-00000

Cormie P, McGuigan MR, Newton RU.
Developing maximal neuromuscular power: Part 2—training considerations for improving maximal power production. Sports Medicine. 2011;41(2):125–146.
https://doi.org/10.2165/11538500-000000000-00000

Fukutani A, Kurihara T.
Evidence for muscle cell-based mechanisms of the stretch-shortening cycle. Frontiers in Physiology. 2021;12:648708.
https://doi.org/10.3389/fphys.2021.648708

Martínez-Cava A, Hernández-Belmonte A, Courel-Ibáñez J, et al.
Effect of pause versus rebound techniques on neuromuscular and functional performance after prolonged velocity-based training. International Journal of Sports Physiology and Performance. 2021;16(7):927–933.
https://doi.org/10.1123/ijspp.2020-0627

McBride JM, Blow D, Kirby TJ, et al.
A comparison of kinetic and electromyographic variables during the squat and box squat. Journal of Strength and Conditioning Research. 2010;24(12):3193–3199.
https://doi.org/10.1519/JSC.0b013e3181e2e79a

Pallarés JG, Sánchez-Medina L, Pérez CE, et al.
Imposing a pause between the eccentric and concentric phases increases reliability of isoinertial strength assessments. Journal of Sports Sciences. 2014;32(12):1165–1175.
https://doi.org/10.1080/02640414.2014.889844

TAKING NEW CLIENTS!

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

The Menopause Muscle Continuum….

Does the menopause transition directly impact muscle health and physiology?

This has been the subject of some very intense discussion recently. Join me and the awesome and amazing Selene Yeager for Hit Play Not Pause Episode 253 where we take a deep dive into the science behind this debate.

Barbells vs Dumbbells: Which is Better?

Carla DiGirolamo, MD — Mon, 30 Mar 2026 10:45:43 GMT

Weightlifting is an important training element for optimal health and longevity. But what’s better? Barbells or dumbbells?

The truth is, both have their place in any weight training program. We have seen so many times in this newsletter how changing just one small thing about a movement can completely change the stimulus of the workout.

This week, we are going to illustrate how performing a front squat with dumbbells vs a barbell changes the impact of a training session. But first, let’s discuss how the different mechanics of these weight options train the body differently as it relates to the front squat.

Barbell vs Dumbbell Front Squats

What the Research Suggests About the Training Stimulus

For athletes and active adults, the front squat is one of the most effective lower-body strength exercises. But the implement used—barbell vs dumbbells (often as a goblet or double-dumbbell front squat)—changes the mechanical demands and training stimulus. While direct head-to-head trials are scarce, several peer-reviewed biomechanical and electromyography (EMG) studies help explain how these variations differ.

Load Potential and Strength Adaptation

The primary difference between barbell and dumbbell front squats is load capacity.

A barbell allows significantly greater external loading because the weight is distributed across the shoulders rather than limited by grip strength or arm fatigue. Higher loads produce greater neuromuscular stimulus and strength adaptation in the by increasing activation of the hip and thigh musculature compared with lower loads.

Training implication

Barbell front squats are generally favored when the goal is:

maximal strength
progressive overload
hypertrophy of the quads and glutes

Muscle Activation Patterns

EMG studies consistently show that squats strongly activate the quadriceps, glutes, hamstrings, and spinal stabilizers regardless of barbell or dumbbell variation. As compared to back squats, front squats shift emphasis toward the quadriceps and trunk stabilizers due to a more upright torso.

When a load is held in front of the body (as with dumbbells or goblet squats), several changes occur:

Increased grip and upper-body contribution

Unlike a barbell resting on the shoulders, dumbbells require sustained grip and arm involvement.

These factors mean that dumbbell front squats distribute work across more muscle groups, though often with less absolute lower-body loading.

Stability and Motor Control

One consistent finding in squat biomechanics research is that free-weight movements require greater stabilizer activation than guided movements.

Dumbbell front squats amplify this effect because:

The load is divided into two independent implements (ie. 2 dumbbells)
The center of mass is less stable
Arm fatigue can influence posture

This leads to greater demands on the trunk, shoulders, and stabilizing musculature.

For many lifters, this creates a training effect closer to a whole-body coordination exercise rather than a purely maximal strength movement.

Practical Training Differences

The Big Takeaway

Both variations are valuable—but they deliver different types of stimulus.

Barbell front squat

maximizes lower-body strength and hypertrophy through heavier loading.

Dumbbell front squat

increases stability, posture control, and whole-body coordination.

For many athletes over 40, the two variations work best together:

Barbell front squat → primary strength lift
Dumbbell front squat → accessory movement reinforcing posture, mobility, and core stability.

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Now, on to today’s workout! This session is a modification of a Mahem-inspired workout that I did at CrossFit Pompano Beach (that left me curled up in my own sweat on the floor after the barbell version) this past week.

The featured movement is the front squat paired with bar (or dumbbell) -facing burpees. The burpees add the element of fatigue, which further challenges the muscular mechanics of the front squat. If you have access to a barbell and are proficient with barbell front squats, this is the way to go today. Later in the week, try this workout again, but with dumbbells, and experience the difference!

The bar-facing burpee is an important nuance to this workout, adding a more labored flow to these repetitions as compared to standard burpees or lateral burpees over the bar, where you can stay low and get a good rhythm going. Not today!

Warm Up

AMRAP 8 (As many rounds as possible for 8 minutes)

5 up downs
5 high-knee run (or march) in place (Right + Left = 1 repetition)
10 Air Squat
10 mountain climbers (Right + Left = 1 repetition)
5 inchworms to easy push-up

Movement Practice

Take 5-10 minutes to select your weights and movement options for the workout. Select a weight for the front squat that allows you to do the rounds of 15 and 12 in no more than 2 sets.

Movement options:

Front squat options: If shoulder mobility prohibits holding two dumbbells or a barbell at your shoulders, choose a single (heavier) kettlebell or dumbbell to hold at your chest goblet-style. If all you have are light weights, increase the repetitions by 5 each round.
Bar facing burpee options: If jumping is an issue, you may step over the bar. You could also do an up down followed by a step over the bar if a full burpee is not accessible to you.

Workout

HOW TO: Perform 15 front squats, then 15 bar-facing burpees, then do 12 front squats and 12 bar-facing burpees, and so on until you complete the repetition scheme.

For time:

15 - 12 - 9 - 6 - 3

Front squat (Barbell or dumbbell)
BAR-FACING (or dumbbell-facing) Burpees ( HOW TO: See VIDEO. Place the bar or dumbbell on the floor horizontally in front of you.

NOTE: This workout is meant to be a higher intensity, done in less than 12 minutes.

Barbell version weight suggestions:

Advanced: male/female 135#/95#
Intermediate: male/female 95#/65#

Cool Down

Although this was a short workout, it was an intense one that taxed your musculoskeletal AND nervous systems. So let’s show your body some love and jump-start your recovery!

15-minute Quad Release Yoga

…. and if you missed last week’s accessory workout and need a little more today, try a few sets of the Turkish Get-Up!

Yavuz HU et al. Kinematic and electromyographic activity changes during maximal loaded squats. Journal of Human Kinetics. 2017.

Schwanbeck S et al. A comparison of free-weight squat to Smith machine squat using electromyography. Journal of Strength and Conditioning Research. 2009.

Straub RK et al. A biomechanical review of the squat exercise. International Journal of Sports Physical Therapy. 2024.

Martínez-Cava A et al. Effect of external load on muscle activation during the squat. European Journal of Sport Science. 2023.

Wei W et al. Effects of progressive body-weight versus barbell squat training. Scientific Reports. 2023.

TAKING NEW CLIENTS!

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

The Menopause Muscle Continuum….

Does the menopause transition directly impact muscle health and physiology?

Accessory Magic

Carla DiGirolamo, MD — Mon, 23 Mar 2026 10:45:53 GMT

Sometimes the most productive part of our training lies outside the main training session.

Accessory work, which may target strength, skill practice, or mobility, is performed before and or after the main training session. This is typically lower-intensity work focusing on technique and skill-building. When thoughtfully programmed in the context of the workout of the day or for the week or month ahead, accessory work can be what moves the needle toward advancing your physical abilities and longevity.

If there’s one movement I wish more active women over 40 would incorporate into their training, it’s the Turkish Get-Up (TGU).

Not because it’s flashy. Not because it’s heavy. But because it quietly builds the kind of strength that keeps you athletic for life.

What is the Turkish Get-Up?

The Turkish Get-Up is a multi-planar, full-body movement that takes you from lying on the floor to standing—while holding a weight overhead—and then back down again.

In the research literature, it’s described as a 7-stage movement pattern that begins in a supine position, progresses to standing, and then reverses back to the floor .

What makes it unique is that it’s not just a strength exercise—it’s a movement sequence that integrates:

A press
A roll
A sit-up
A bridge
A lunge
And a stand

All in one controlled repetition.

How to Perform the Turkish Get-Up

While the full movement has nuance, the general flow looks like this:

Start lying on your back with one knee bent and a weight pressed overhead.
Roll up onto your elbow, then your hand.
Lift your hips and sweep your leg underneath into a half-kneeling position.
Stand up while keeping the weight stable overhead.
Reverse every step back down to the floor.

For a demonstration and instruction, check out the VIDEO below:

The key is slow, deliberate movement, maintaining control and alignment throughout.

This is not a “conditioning” exercise—it’s a precision-based strength skill.

IMPORTANT! If you have never attempted this movement before, start by holding something light, such as a shoe or a can of soup. It’s important to become confident in the movement pattern before adding weight.

Why Should We Do This?

During the hormonal and musculoskeletal changes of mid-life, our focus now must include additional priorities:

Joint integrity
Stability
Movement quality

The Turkish Get-Up checks every one of those boxes:

Builds True Functional Strength

Unlike isolated exercises, the TGU trains the body as a connected system. Research on kettlebell training shows that movements like the TGU improve functional strength, neuromuscular coordination, and full kinetic chain activation .

This translates directly to:

Better lifting mechanics
More resilient movement patterns
Stronger carryover to real life and sport

Enhances Core Stability

The TGU is essentially a moving plank under load.
Your core is working the entire time—not to create movement, but to resist it. This “anti-rotation” demand builds a more functional, spine-protective core than traditional ab exercises.

Improves Shoulder Health and Longevity

The Turkish Get-Up trains the shoulder in a unique way:

Isometric stability (holding weight overhead)
Through multiple planes of motion
While the body moves underneath it

Studies show the TGU significantly challenges shoulder musculature and emphasizes coordinated activation across movement phases, which can help

Reduce injury risk
Improve overhead strength
Maintain long-term joint health

Develops Balance, Coordination, and Body Awareness

The TGU is not just physical—it’s neurological. You have to think, sequence, and control each phase. That builds:

Proprioception (body awareness)
Intermuscular coordination
Movement confidence

Research highlights improvements in balance, flexibility, and coordinated strength with Turkish Get-Up training.

As we move through mid-life, this becomes critical—not just for performance, but for fall prevention and long-term independence.

Restores Mobility While Building Strength

Most mobility work is passive.
Most strength work is rigid.

The Turkish Get-Up does both—simultaneously.

It improves mobility in:

Hips
Thoracic spine
Shoulders

While reinforcing strength and control through those ranges.

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Today’s workout targets muscle stamina - the ability of muscles to move lighter weight over longer periods of time. These are higher-volume movements that engage different muscle groups, introducing cardiovascular endurance fatigue to increase difficulty. We conclude with some accessory work - The Turkish Get-Up

Scoring: Record your APPROXIMATE reps per 1 min round during your 1 minute of rest – not during the working rounds! … and if you don’t want to count and just stay in a mental zone, then no scorekeeping is necessary!

Warm Up

TABATA 20 sec of work/10 sec of rest. Perform each movement in sequence for a total of 6min, 4 rounds of each set of 3 movements.

Movement Practice

Take 5-10 minutes to run through all the movements in sequence for 5-7 reps to find your options for the workout. Select an option that you can sustain for the entire minute. You will use pacing to control speed and level of fatigue. The goal is to move smoothly from one movement to the next, efficiently accumulating repetitions, as each minute turns.

The strategy for approaching this workout is to utilize pacing the speed of repetitions to accumulate as many repetitions as possible. The challenge for this workout is to be working for the ENTIRE minute of each interval. There is a 1:00 rest interval after the 4 x 1-minute movement intervals. The series is a total of 20 minutes.

Workout

4 Rounds

1:00 Dumbbell or Barbell Thruster
1:00 Ab mat sit-up
1:00 Walking or in place alternating lunge
1:00 Burpees
1:00 rest

Score = total number of reps:

Accessory Work - Practice the Turkish Get-Up. Review the video carefully for technique and proper mechanics.

2 rounds

3 repetitions of the Turkish Get-Up on each side

Rest 1:00 between rounds

Cool Down

Team, you all worked hard today, so lets show your body some love and jump-start your recovery with thi 12-minute lower back and hip release sequence.

Liebenson C, Shaughness G. The Turkish get-up. J Bodyw Mov Ther. 2011;15(1):125–127.
https://pubmed.ncbi.nlm.nih.gov/21147428/

St-Onge E, et al. A descriptive analysis of shoulder muscle activities during the Turkish get-up exercise. J Bodyw Mov Ther. 2019.
https://pubmed.ncbi.nlm.nih.gov/30691756/

Shaw T, et al. Clinical application of the Turkish Get-Up to an acute phase rehabilitation program: A case report. J Bodyw Mov Ther. 2020;24(1):84–88.
https://pubmed.ncbi.nlm.nih.gov/31563381/

Ayash A, Jones MT, Hettler J. Kettlebell Turkish Get-Up: Training tool for injury prevention and performance enhancement. Int J Athl Ther Train. 2012;17(4):8–13.
https://journals.humankinetics.com/view/journals/ijatt/17/4/article-p8.xml

TAKING NEW CLIENTS!

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

The Menopause Muscle Continuum….

Does the menopause transition directly impact muscle health and physiology?

Time Will Tell!

Carla DiGirolamo, MD — Mon, 16 Mar 2026 10:45:45 GMT

You have probably gathered that I love simplicity. IMHO, some of the most effective fitness and longevity hacks lie in the simplest things!

In the Athletic Aging Weekly Workout series, we have explored different movement types, different weight and repetition schemes, and isometric and dynamic movements.

Today, we are going to manipulate something else that is exquisitely simple, and that is, time!

How the Time Domain Changes the Stimulus

In functional training, we often see the same workout structured in different time formats. Two of the most common are:

AMRAP (As Many Rounds As Possible) within a fixed time
EMOM (Every Minute(s) on the Minute), where work begins at the top of each minute

At first glance, these workouts may look identical. The same exercises, the same loads, and even the same total potential volume might be programmed. But research suggests that the structure of time and rest alone can meaningfully change the physiological stimulus of a workout.

The Physiology of the Clock

Exercise scientists often distinguish between external load and internal load.

External load: the measurable work performed (reps, sets, weight, distance).
Internal load: how the body responds (heart rate, lactate, oxygen consumption, perceived exertion).

When we change the time domain of a workout, we often keep the external load the same, but we change the internal load.

A recent study examining high-intensity functional training compared two workouts that used the same movements and similar total volume but were structured differently: one performed for time and the other as an EMOM session.

The results were striking. The “for time” structure produced:

Higher heart rate
Greater oxygen consumption
Higher blood lactate
Higher ratings of perceived exertion

In contrast, the EMOM version produced a lower metabolic and cardiovascular strain, likely because the built-in rest intervals prevented fatigue from accumulating as quickly.

The clock changed the physiological demand of the workout even though the exercises were the same.

Different formats can be used strategically

AMRAP-style workouts

Improve work capacity
Build metabolic conditioning
Challenge pacing and mental resilience

EMOM-style workouts

Maintain technique under fatigue
Manage joint stress and recovery
Allow higher-quality repetitions

Changing these formats across training weeks can create variety in stimulus without constantly increasing load or volume.

So, sometimes the smartest programming change isn’t heavier weights or different movements—it’s simply changing the clock.

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This week, we have 2 workouts to try! Same movements, same repetitions, same weights and options. But what changes over these two workouts is the time domain. Try these two workouts on separate days and see if you feel the difference!

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

Smith JS, et al. The physiological responses to volume-matched high-intensity functional exercise protocols with varied time domains. Front Physiol. 2025.
Maté-Muñoz JL, Lougedo JH, Barba M, et al. Cardiometabolic and Muscular Fatigue Responses to Different CrossFit® Workouts. J Sports Sci Med. 2018;17(4):668-679.
Buchheit M, Laursen PB. High-intensity interval training, solutions to the programming puzzle: Part I: cardiopulmonary emphasis. Sports Med. 2013;43(5):313-338.
Buchheit M, Laursen PB. High-intensity interval training, solutions to the programming puzzle. Part II: anaerobic energy, neuromuscular load and practical applications. Sports Med. 2013;43(10):927-954.
Feito Y, Heinrich KM, Butcher SJ, Poston WSC. High-Intensity Functional Training (HIFT): Definition and Research Implications for Improved Fitness. Sports. 2018;6(3):76.

TAKING NEW CLIENTS!

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

This Just Dropped……

Hard Conversations in the Menopause Transition: Hormones, Testing, GLP-1s and what’s “Ideal” Now

This week we welcome back our resident reproductive endocrinologist and menopause specialist, Dr. Carla DiGirolamo, for another candid conversation. We pull back the curtain on Carla’s own menopause experience—how she navigates her symptoms, what she’s learned, and what she practices herself. We also dig into the hard conversations so many of us are having as we navigate this ever-evolving space, and how years of working closely with active midlife women have shaped her thinking on hormone therapy, GLP-1 medications, testosterone, hormone testing, and what actually moves the needle for athletic women in the transition.

Grip Gone Wild

Carla DiGirolamo, MD — Mon, 09 Mar 2026 10:45:52 GMT

Grip strength has received a lot of attention in recent years because it is a reliable marker of overall muscle strength. I posted on this back in 2022: Grip Strength as a Marker of Vitality in Mid-Life Women. Poor grip strength is associated with low bone mineral density (BMD), depression, anxiety, sleep quality, fractures, diabetes, falls, and malnutrition.

More recently, however, grip strength has also been shown to be associated with overall longevity and resilience.

What is Grip Strength and Why is it Important?

Grip strength is the maximum force generated by the muscles of the hand and forearm when gripping or squeezing an object. In research and clinical settings, grip strength is most commonly measured using a hand dynamometer, which quantifies the force produced during a maximal squeeze.

Over the past several years, grip strength has increasingly been referred to in the geriatric and sports-medicine literature as a potential “vital sign” of aging. This reflects the growing body of evidence linking hand grip strength not only to muscle health, but also to overall longevity and resilience.

Large cohort studies across multiple populations have demonstrated that lower grip strength is associated with higher risk of cardiovascular disease, disability, hospitalization, and all-cause mortality. One particularly influential analysis from the Prospective Urban Rural Epidemiology (PURE) study showed that grip strength was a stronger predictor of cardiovascular and all-cause mortality than systolic blood pressure (Leong et al., The Lancet, 2015). Subsequent studies have continued to confirm this association in both men and women across multiple age groups.

More recent research has expanded on these findings by showing that grip strength may also reflect overall biological aging, not just muscle health, capturing the integrated function of multiple systems, including:

Skeletal muscle
Nervous system signaling
Metabolic health
Cardiovascular health
Bone density
Physical activity patterns

For this reason, several geriatric societies now recommend routine grip strength testing as part of functional assessments in adults over 50.

How is Grip Strength Measured?

Grip strength is measured by a hand-held device called a dynamometer. This instrument is used in the research setting, by physical therapists and other clinicians. But these devices are also available for home use. The CAMRY Dynamometer is a highly reliable device that is sold on Amazon for about $30.

What Should Grip Strength Be?

Researchers studying aging and functional capacity often relate grip strength to the ability to perform common daily tasks that allow people to live independently. This table is often used in the Longevity and Gerontology space and is supported by the current literature.

Grip Strength and Functional Independence

References

Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age and Ageing. 2019;48(1):16–31. doi:10.1093/ageing/afy169.

Simard J, Chalifoux M, Fortin M. Could questions on activities of daily living estimate grip strength of older adults living independently in the community? Journal of Aging Research. 2012;2012:427028. doi:10.1155/2012/427028.

Morera A, et al. Handgrip strength and work limitations: a prospective cohort study of adults aged 50 years and older. Maturitas. 2023.

Vaishya R, et al. Hand grip strength as a proposed vital sign of health. Journal of Clinical Orthopaedics and Trauma. 2024.

Tomkinson GR, et al. International normative reference values for handgrip strength in adults. Journal of Sport and Health Science. 2024.

Mathiowetz V, Kashman N, Volland G, Weber K, Dowe M, Rogers S. Grip and pinch strength: normative data for adults. Journal of Hand Surgery. 1985;10(5):109–112.

How Do I Build Grip Strength?

The goal for us as active and athletic women is not simply to stay above the frailty thresholds. Instead, the goal is to maintain a strength reserve well above the level required for daily tasks.

This reserve matters because strength declines naturally with age, and especially during menopause. Building and maintaining higher levels of strength in midlife helps preserve functional independence decades later.

Here are some examples of activities that help build this reserve:

Farmer’s carries
Deadlifts
Pull-ups or assisted pull-ups
Rows
Kettlebell swings

These movements challenge grip strength while also building whole-body strength and resilience.

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… and on that note, let’s get to this week’s workout!

This week’s training is another modification of a Mahem-inspired workout that I did at CrossFit Pompano Beach. It’s a “grippy” one! I could barely hold on to my jumprope by the end! This workout taps into the synergism we get when we combine movements together to build this very important grip strength!!! Enjoy!

Warm Up

Movement Practice

Take 10 minutes to select your options for the workout. Watch the linked videos to review proper mechanics. Select a moderately heavy kettlebell weight where you can do all 10 swings unbroken. For the farmer carry, choose a weight that you can carry continuously, stopping only once or twice for a brief rest. If you can do the entire 100 meters without rest, the weight is too light!

Movement options:

If no jump rope, do a simulated jump rope holding 2 objects (ex-, thick magic marker)
If no ab mat, roll up a towel and put behind your back and perform the ab mat sit up or do standard sit ups with bent-knees and anchored feet.
If no kettlebell, do a double dumbbell swing

Workout

AMRAP 20 (As many rounds as possible in 20 minutes). Perform each movement in sequence for as many rounds as possible in 20 minutes.

70 single-under jump rope (or 35 double-under jump rope)
25 ab mat sit-ups (or standard bent-knee sit-ups)
12 air squats
10 Kettlebell swings (unbroken) (Beginner: swing to eye-level; Advanced: swing to overhead)
100 meter farmer carry (2x kettlebells or dumbbells. Suggested weight: 20 pounds)

SCORE: Number of rounds and repetitions performed in 20 minutes.

Cool Down

This was a very intense workout, so it deserves a thorough cool-down to help your parasympathetic nervous system (“rest and digest”) return your stress response system to baseline.

Here is an “11-minute Yoga Quickie” for your hands, wrists, and forearms, and a 20-minute total body yoga deep stretch to help jump-start your recovery!

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

This Just Dropped……

Hard Conversations in the Menopause Transition: Hormones, Testing, GLP-1s and what’s “Ideal” Now

Strengthen Your "Spring"

Carla DiGirolamo, MD — Mon, 02 Mar 2026 11:45:46 GMT

Some of the greatest “gems” in physical fitness are the simplest things. Jumping rope is a functional movement we have been doing since we were children, and a wealth of research has demonstrated the benefits of jumping rope for musculoskeletal health:

Provides a bone-loading stimulus that is favorable for bone mineral density
Improved cardiovascular fitness in time-efficient doses

But there is another level of musculoskeletal benefit that gets less attention, and that is the “Stretch-shortening cycle” a.k.a. your built-in “spring”.

When you land from a jump:

Muscles and tendons lengthen slightly (eccentric phase)
Elastic energy is briefly stored
You immediately rebound upward (concentric phase)

This rapid “load → release” sequence improves neuromuscular coordination and lower-limb stiffness — qualities linked to athleticism and functional performance across the lifespan (Markovic & Mikulic, 2010; Ramirez-Campillo et al., 2023).

Why this matters after 40

Tendon stiffness and power decline faster than maximal strength
Light plyometric work helps maintain elastic efficiency
Short ground contact times stimulate bone and connective tissue

Jump rope trains this spring system in a controlled, repeatable way. A jump rope is an inexpensive piece of equipment that fits easily in your gym bag (or your purse) and can be performed with minimal space.

But what if I can’t jump rope?

Jumping - even the smallest distance off the ground - has benefits. If you don’t have a rope (or the coordination), a simulated jumprope (and other rope-free modifications) are beneficial (see below).

How to Jump Rope

Mechanics

Hold hands slightly in front of the hips.
Jump a few inches off the ground, keeping torso upright and body straight.
Spin wrists so that the rope passes under the feet once with every jump.

For women over 40, this “small bounce” strategy:

Reduces joint stress
Maintains tendon reactivity
Preserves impact stimulus for bone without excessive load

Mechanical Progression for Beginners

If someone hasn’t jumped in years:

Step 1: March in place while turning rope
Step 2: Low pogo hops without rope
Step 3: 10–20 second rope intervals

This allows connective tissue adaptation before higher volumes.

Muscle Groups Primarily Involved

Jump rope emphasizes:

Calves (gastrocnemius & soleus)
Achilles tendon
Quadriceps
Glutes (stabilization)
Core musculature (anti-extension stability)
Intrinsic foot muscles

Because the movement is repetitive and elastic, it also enhances:

Proprioception
Ankle stiffness
Intermuscular coordination

These qualities are strongly associated with power maintenance and fall resilience in aging populations.

Rope-Free modification options:

Why Mechanics Matter for Bone and Connective Tissue

Bone responds to:

Strain magnitude
Strain rate
Novel loading patterns

Jump rope provides repeated low-amplitude loading at relatively high strain rates — a stimulus shown in impact-exercise literature to support bone health when appropriately dosed.

However, tissue adaptation takes time. Tendons adapt more slowly than cardiovascular fitness — which is why conservative progression is key in midlife athletes.

Purchasing a Jump Rope

Having a favorable experience with jumping rope requires the right equipment.

Step 1 - Select your rope based on your skill level and training goals
Step 2 - Be sure to size your rope appropriately! This is KEY to productive rope-training. The links below all have guides to sizing your rope.

For beginners:

Training ropes

Budget-friendly beginner ropes

More experienced athletes may prefer a speed rope for higher-volume jump rope training and double-under practice. RPM speed ropes are my personal favorite and is what I use for my workouts

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Today’s workout is a modification of a Mahem-inspired workout I did at CrossFit Pompano Beach. It is a simple couplet that involves jumping rope and the dumbbell push-press. In addition to the benefits of jumping rope, the push press targets core and upper-body strength, and hip extension. When the push-press is performed under the fatigue of the jump rope segment, this further builds strength and resilience. Enjoy!

Warm Up

AMRAP 8 (As many rounds as possible in 8 minutes0

10 jumping jacks (Low impact option: March in place)
10 Air squats
10 Mountain Climbers (right + left = 1 repetition)
5 Easy push-ups
10 Good Mornings

Movement Practice

Take 5-10 minutes to select your weights and practice your options for the workout.

Dumbbell Push Press: Review the linked video for proper form and mechanics. Select a weight where you can do 7-10 repetitions confidently and unbroken.

Jump Rope

Alternatives:

No rope? Do a simulated jump rope
Too many reps? Reduce the jump rope repetitions by 1/3 to 1/2.

Workout

How To: Perform 21 dumbbell push presses, then 100 single unders (it is ok to break up larger sets into 2-3 smaller sets with a few breaths of rest in between). Then perform 18 push presses and 90 single unders, then 15 push-presses and 80 single unders, and so on, until you have completed the repetition scheme.

For Time

Dumbbell Push Press
21 - 18 - 15 - 12 - 9 - 6
Single Under Jump Rope
100 - 90 - 80 - 70 - 60 - 50
Advanced option: Double Unders: 50 - 45 - 40 - 35 - 30 - 25

Cool Down

We can never overstate the need for an effective cool-down to jump-start your recovery - especially after an intense session like this one. Show your legs and shoulders some love with these two, 10-minute stretch sequences. #dontskiptheyoga

10-minute Yoga for Calves and Shins

10-minute Shoulder Stretch

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

This Just Dropped……

Hard Conversations in the Menopause Transition: Hormones, Testing, GLP-1s and what’s “Ideal” Now

HIIT with a Twist

Carla DiGirolamo, MD — Mon, 23 Feb 2026 11:45:22 GMT

We spend a lot of time (and for good reason) talking about strength training. This week, I want to review something equally important for health, longevity, and performance: high-intensity interval training (HIIT).

What Is HIIT?

HIIT is a form of cardiovascular exercise that alternates:

Short bursts of near-maximal effort
With periods of low-intensity recovery or rest

A typical HIIT session may involve working at:

≥80–90% of maximum heart rate
or ≥85% of VO₂max

for intervals lasting from ~30 seconds to several minutes, repeated multiple times.

Unlike steady-state endurance exercise, HIIT produces repeated metabolic stress that stimulates muscular and cardiovascular adaptations in a relatively short amount of time.

How HIIT Works: The Physiology

1. Improved Mitochondrial Function

Mitochondria are the “batteries” that power all of the cells in our body. During exercise, mitochondrial function is critical for effectively meeting the physical challenge.

HIIT activates cellular signaling pathways that stimulate mitochondrial biogenesis — essentially increasing both the number and function of mitochondria in muscle cells.

This improves:

Aerobic energy production
Fat oxidation
Metabolic flexibility

(Burgomaster et al., 2008; Gibala et al., 2012)

2. Increased Skeletal Muscle Glucose Uptake

HIIT improves insulin sensitivity through:

Increased GLUT-4 transporter expression (Estrogen INDEPENDANT pathway)
Enhanced glycogen (storage form of glucose) storage capacity
Improved muscle capillary density

3. Reduction in Visceral Adipose Tissue

Visceral fat — the deep abdominal fat that tends to increase during perimenopause — is strongly associated with:

Cardiovascular disease
Chronic inflammation
Metabolic syndrome

HIIT increases:

Catecholamine release
Growth hormone response
Lipolytic enzyme activity

leading to increased mobilization of fatty acids from visceral adipose tissue.

4. Improved Cardiovascular Efficiency

HIIT improves:

Stroke volume (The amount of blood the heart pumps with each beat)
Endothelial (lining of the blood vessels) function
VO₂max

often more effectively than moderate-intensity continuous training.

Implications for Hormone Health

Glucose Control: Randomized controlled trials show that postmenopausal women can significantly improve peripheral insulin sensitivity after ~12 weeks of high-intensity exercise training — to the same extent as premenopausal women.

Body Composition: Randomized trials in postmenopausal women demonstrate that HIIT performed three times per week for 12 weeks produces:

Significant reductions in total body fat
Greater reductions in visceral adiposity than moderate continuous training
Improvements in inflammatory markers

Heart Health: HIIT improves cardiovascular efficiency often more effectively than moderate-intensity continuous training. This is especially important because menopause is associated with accelerated decline in cardiorespiratory fitness and increased cardiovascular risk.

Worried About “Cortisol”? - Don’t. To make gains in your physical fitness, you need to push limits. This requires activation of your “fight or flight” response system (Sympathetic Nervous System) - This is what Mother Nature designed this endocrine system to do for the survival of the Human race. But what’s essential is the cool-down and recovery. To learn more about the truth behind cortisol and why it’s your friend, check out: Stop Demonizing Cortisol from the Athletic Aging archives.

References

Burgomaster, K. A., Howarth, K. R., Phillips, S. M., Rakobowchuk, M., MacDonald, M. J., McGee, S. L., & Gibala, M. J. (2008).
Sprint interval training increases muscle oxidative capacity and endurance performance in humans. The Journal of Physiology, 586(1), 151–160.
https://pubmed.ncbi.nlm.nih.gov/17991697/

Gibala, M. J., Little, J. P., Macdonald, M. J., & Hawley, J. A. (2012).
Physiological adaptations to low-volume, high-intensity interval training in health and disease. The Journal of Physiology, 590(5), 1077–1084.
https://pubmed.ncbi.nlm.nih.gov/22289907/

Ramos, J. S., Dalleck, L. C., Tjonna, A. E., Beetham, K. S., & Coombes, J. S. (2017).
The impact of high-intensity interval training versus moderate-intensity continuous training on vascular function: A systematic review and meta-analysis. Journal of Clinical Endocrinology & Metabolism.
https://pubmed.ncbi.nlm.nih.gov/28953212/

Nunes, P. R. P., Martins, F. M., Souza, A. P., et al. (2019).
Effect of high-intensity interval training on body composition and inflammatory markers in obese postmenopausal women: A randomized controlled trial. Menopause, 26(3), 256–264.
https://pubmed.ncbi.nlm.nih.gov/30277921/

Weston, K. S., Wisloff, U., & Coombes, J. S. (2014).
High-intensity interval training in patients with lifestyle-induced cardiometabolic disease: A systematic review and meta-analysis. British Journal of Sports Medicine, 48(16), 1227–1234.
https://pubmed.ncbi.nlm.nih.gov/24144531/

Dupuit, M., Maillard, F., Pereira, B., et al. (2020).
Effect of high-intensity interval training on body composition in women before and after menopause: A meta-analysis. Experimental Physiology, 105(9), 1470–1490.
https://pubmed.ncbi.nlm.nih.gov/32613697/

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This week’s workout is a modification of a Mahem-inspired sequence that I did, myself, at CrossFit Pompano Beach. It is a classic HIIT workout with 1:15 - 1:30 of near maximal effort work with 1:00 of rest in between, for 7 rounds. I did this workout earlier this week

But here’s the twist: The movements that achieve this stimulus also build bone (plyometrics), muscle power (box jump), and nervous system coordination (double unders) - this is not just sprint intervals on a bike or other singular movement. While monostructural (single movement) HIIT is effective, coordinating different movements that target strength and plyometrics adds another level of stimulus.

The box height and weights noted in the workout section are designed for the intermediate to advanced athlete. As always, there are movement options for all fitness levels, so pick what works best for you.

Warm Up

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

5 Up downs
10 Mountain climbers (right + left = 1 repetition)
10 Air squats
20 single under jump rope (or movement substitution)
10 good mornings (no weight) -** You should feel your hamstrings engaging.

Movement Practice

Movement Substitutions

Box jumps - Substitute jumping air squats or dumbbell thrusters (moderately weight where the 7 repetitions can be done unbroken)
Kettlebell swings - Substitute single or double dumbbell swing. Swing to eye level (Russian swing) instead of overhead (American swing).
Double unders - Substitute 45 single unders or 5 burpees

** The working rounds are SPRINTS. These are near maximal effort at an RPE 8-9. When selecting your options, ensure that the time it takes to do 1 round of the workout is no longer than 1:20.

Take 5-10 minutes to select your movement options. Select options where the goal is to complete all sets unbroken for all 7 rounds. (Except for some occasional trip-ups on the jump rope).

Workout

7 Rounds

7 box jumps (20-24 inches)
14 kettlebell swings (25-35 lbs, American swing)
21 or 28 double unders

Rest 1:00 between sets

SCORE: Total time (including rest) to complete all 7 rounds.

Cool Down

Because HIIT workouts require multiple rounds of near-maximal effort, your musculoskeletal, cardiovascular, and nervous systems will be firing on all cylinders. I cannot overstate how ESSENTIAL an effective cool-down is for recovery, stress management, and staying safe from injury. Enjoy this 25 minute restorative yoga stretch session from Five Parks

25-minute Stretch and Release Restorative Yoga by Five Parks

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

This Just Dropped……

Hard Conversations in the Menopause Transition: Hormones, Testing, GLP-1s and what’s “Ideal” Now

Strength Training Made Simple

Carla DiGirolamo, MD — Mon, 16 Feb 2026 11:45:25 GMT

Weight training has never been more important than during midlife. There is a wealth of research and evidence of the benefits for bone, muscle, and metabolic health during a time of our lives when the effects of hormonal changes impact so many aspects of our health.

The LIFTMOR randomized controlled trial, published in 2017 in the Journal of Bone and Mineral Research by a group from Queensland, Australia, is a high-quality study in menopausal women in their 60s that demonstrates the benefits of heavier, basic lifts such as deadlifts, squats, overhead presses, and high-impact jumps. Study subjects showed improvements in bone mineral density, physical functioning, and a favorable impact on posture and fracture risk.

For many, however, barriers exist to implementing this type of training into one’s regular exercise routine. Access to equipment and instruction on proper form requires cost, time, and resources. Many women of this generation today have never even picked up a barbell, so there is also an intimidation factor.

What can be helpful is a segway to gain confidence with moving weight. Something that is accessible, easy to use at home, and scalable for every fitness level - even for competitive athletes who are proficient with heavy lifts, who want to add variety and coordinated performance benefits to their resistance training.

Enter the kettlebell.

What Is a Kettlebell?

A kettlebell is a cast-iron or steel weight shaped like a cannonball with a single handle. Unlike a dumbbell, the center of mass sits below and behind the handle. This “offset load” changes how the body must stabilize and control the weight.

Because of this design, kettlebells:

Challenge grip and forearm strength
Increase demand on the core and stabilizing muscles
Allow for smooth, ballistic (dynamic, explosive) movements
Flow naturally between exercises

The shape enables movements like swings, cleans, snatches, and Turkish get-ups—patterns that blend strength and athleticism rather than isolating single muscles.

Evidence-Based Benefits of Kettlebell Training

Strength and Explosive Power: Kettlebell swing training has been shown to significantly improve maximal strength and lower-body explosive performance. (Lake & Lauder, 2012). Because power declines earlier and more rapidly than maximal strength with age, incorporating ballistic hip-dominant movements like swings may be especially valuable for women over 40 who want to preserve athleticism.

Importantly, these improvements can occur without maximal barbell loading, offering a joint-friendly way to train force production.

Cardiovascular Fitness: Kettlebells can simultaneously challenge the muscular and cardiovascular systems. Short-interval ballistic training can elevate heart rate quickly, providing a time-efficient conditioning stimulus without repetitive impact stress.
Musculoskeletal Health and Pain Reduction: A randomized controlled trial examining kettlebell training in working adults demonstrated improvements in strength alongside reductions in neck, shoulder, and low back pain (Jay et al., 2011). When properly coached, kettlebell movements emphasize hip-driven mechanics and trunk stability, which may contribute to improved movement efficiency and resilience.
Functional Capacity and Healthy Aging: In older adults (ages 59–79), progressive hardstyle kettlebell training improved grip strength and multiple functional performance measures, with high adherence and monitored safety (Meigh et al., 2022). Grip strength in particular is strongly associated with overall health and longevity, making loaded carries and dynamic kettlebell work especially relevant for long-term vitality.

For the Advanced Athlete

For the advanced athlete, kettlebells offer more than general fitness—they provide a powerful tool for refining force production, work capacity, and movement efficiency.

Ballistic lifts like heavy swings and snatches train rapid hip extension and rate of force development, qualities that underpin sprinting, cutting, and jumping performance. Because kettlebells allow for unilateral and offset loading (e.g., single-arm swings, rack carries, bottoms-up presses), they expose and correct asymmetries while increasing anti-rotational core demand.

Advanced athletes can also manipulate density (more work in less time), complex sequencing (clean → squat → press), and double-kettlebell variations to create high neuromuscular demand without the joint stress of maximal barbell loading. This makes kettlebells an excellent adjunct during in-season training, deload phases, or when preserving power with lower orthopedic cost is a priority.

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OK! So let’s get into it. This week’s workout features (you guessed it) the kettlebell! We will use the kettlebell in 2 ways. First, with the kettlebell swing, and second, with the goblet walking lunge - and in between sets, your cardio movement of choice.

Here are some options for all fitness levels:
If running is not accessible to you, rowing (same distance as prescribed) and stationary bike (double the prescribed distance) may be substituted.
If no equipment, substitute 40 up-downs for the 800m run and 20 up-downs for the 400m run.
If this volume of repetitions is not accessible to you or you are a beginner, cut all repetitions and distances in half.
If you do not have a kettlebell, substitute a dumbbell.

Warm Up

Run, bike, or row for 5 minutes. Each minute: :50 easy and :10 hard/fast. If you choose the up-down option, perform 20 easy-paced repetitions

Movement Practice

Select your movement options for the workout and practice 30 seconds of each movement in the sequence of the workout below at a low-intensity pace. Select a kettlebell or dumbbell that you can confidently perform 15 repetitions unbroken. Use that same kettlebell/dumbbell for the walking lunges. Alternatively, you can omit the weight for the lunges.

Movement Demo Videos:

Up-Down
Kettlebell Swing (Beginner/Intermediate: Swing to eye level. Advanced: Swing to the overhead position)
Dumbbell Swing
Walking Lunge - Perform the walking lunge holding the dumbbell/kettlebell to your chest like a “goblet”. An alternative is to omit the additional weight and perform the lunge with body weight only. No space? Instead of the walking lunge, you can stand in one place and step forward, alternating sides, with an alternating lunge.

Workout

Perform each movement in sequence until you have completed all 5 segments. Move at a steady pace breaking up sets as needed to maintain movement efficiency without tapping out too early!

For Time

800-meter run
60 kettlebell swings
400-meter run
60 kettlebell walking lunges
800-meter run

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

Falatic, J. A., et al. (2015). Effects of kettlebell training on aerobic capacity. Journal of Strength and Conditioning Research, 29(7), 1943–1947.

Jay, K., et al. (2011). Kettlebell training for musculoskeletal and cardiovascular health: A randomized controlled trial. Scandinavian Journal of Work, Environment & Health, 37(3), 196–203.

Lake, J. P., & Lauder, M. A. (2012). Kettlebell swing training improves maximal and explosive strength. Journal of Strength and Conditioning Research, 26(8), 2228–2233.

McGill, S. M., & Marshall, L. W. (2012). Kettlebell swing, snatch, and carry biomechanics. Journal of Strength and Conditioning Research, 26(1), 16–27.

Meigh, N. J., et al. (2022). Effects of hardstyle kettlebell training in older adults. BMC Geriatrics, 22, 286.

This Just Dropped……

Hard Conversations in the Menopause Transition: Hormones, Testing, GLP-1s and what’s “Ideal” Now

TAKING NEW CLIENTS!

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

The Shoulder is a System - not just a Joint

Carla DiGirolamo, MD — Mon, 09 Feb 2026 11:45:16 GMT

The shoulder is often described as the most complex joint in the human body, but that framing misses the bigger picture. The shoulder is not just a joint—it is part of an integrated system designed to transfer force from the ground and core through the torso and into the arms. In that sense, the shoulder truly is the gateway to upper-body performance.

Importantly, the shoulder itself is not built for stability. It is built for mobility, relying on stability generated elsewhere in the body. When that system is functioning well, the shoulder joint moves freely and efficiently. When it is not, the joint often becomes the place where pain, irritation, or loss of performance shows up.

How the Shoulder System Works

True shoulder strength does not originate at the shoulder. It depends on coordinated contributions from several regions working together:

Thoracic spine mobility allows the upper back to extend and rotate, creating space for the arm to move overhead without compression.
Rib cage positioning influences how the shoulder blade sits and moves on the torso, affecting force transfer and breathing mechanics.
Scapular control provides a dynamic base for the arm, allowing load to be distributed rather than concentrated at the joint.
Core force production generates power that is transmitted outward to the upper extremities.

When these components are aligned, the shoulder joint can do what it does best—move. When one or more of these pieces degrade, the shoulder is often forced to absorb stress it was never designed to handle alone.

This is why shoulder symptoms so often appear without a clear injury. The joint hasn’t failed—the system supporting it has quietly lost capacity.

Why Pain Shows Up at the Shoulder

Research in sports medicine consistently shows that shoulder pain is frequently associated with changes in movement coordination, strength distribution, and load tolerance—not just tissue damage. Loss of thoracic mobility, diminished trunk strength, or altered scapular mechanics can all shift stress toward the shoulder joint.

Over time, the shoulder becomes the “weak link” not because it is weak, but because it is being asked to stabilize and generate force without adequate support. This explains why imaging findings often poorly correlate with symptoms, and why rest alone rarely resolves persistent shoulder issues.

A more useful question than “What’s wrong with my shoulder?” is often:
“What part of the system is no longer doing its share of the work?”

Why this is Important for Mid-life Women

At mid-life, the hormonal changes of the menopause transition and the effects of aging, can lead to decreased muscle mass, strength, and power - and yes, this includes the muscles of the shoulder and its supporting structures. This hormonal transition also drives changes in the character of the tendons and ligaments (they become stiffer and lax), which can result in a degree of destabilization of the shoulder joint. Keeping your shoulder system healthy can mitigate the effects of these changes, keeping your upper body strong, vital, and at peak performance into the later decades of life.

Tips for Optimizing Your Shoulder System

Performance Physical Therapy: This can be a game-changer! They can do an assessment of your specific limitations and prescribe exercises targeting what parts of your “shoulder system” need help. What is a Performance PT? Learn more HERE.

Crossover Symmetry - This is a structured, resistance-band-based training method designed to rehabilitate and enhance shoulder performance by focusing on the scapular stabilizers and rotator cuff muscles.

Train within a “Pain-free range of motion” - When starting physical therapy or any shoulder mobility program, working within a pain-free range of motion is critical. As you start moving the shoulder system and supporting structures more efficiently, your range of motion will continue to improve!

Nutrition and Recovery - Providing the nutritional building blocks and recovery environment is essential for re-building your shoulder system. Adequate carbohydrates, protein, healthy fats, sleep, and tissue care (sauna, cold plunge, body work/massage) create the fertile environment needed for these interventions to take root.

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This week’s workout targets the shoulder system in many different ways. We have kettlebell swings for a strong core, dumbbell thrusters for overhead stability, push-ups for upper body strength, and dumbbell rows for posterior strength and scapular activation. As a closer, jump-start your recovery with a neck and shoulder-focused yoga sequence. Enjoy!

Warm-Up

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

Movement Practice

Take 5-10 minutes to practice all four movements to find your weights/options where you can perform 10 repetitions of all movements unbroken and move with confidence.

For the push-ups, choose either the strict or elevated push-up option. For optimal core engagement, avoid doing push-ups from your knees.

As fatigue sets in, break up the larger sets into smaller ones with only a few breaths of rest before starting again. By the last few rounds you may be doing reps one or two at a time - that’s ok! This is supposed to get really hard toward the end.

Workout

Perform 15 kettlebell swings, then 15 dumbbell thrusters, then 15 push-ups, then 15 bent-over rows, then perform 12 kettlebell swings, 12 thrusters, and so on until you have performed all 4 movements through the entire repetitions scheme.

For Time:

15 - 12 - 9 - 6 - 3

Kettlebell Swings (modification: Swing to eye level instead of overhead. If no kettlebell, try 12 mountain climbers -R+L = 1 repetition)
Dumbbell thrusters
Strict push-up or Elevated Push-up
Bent over dumbbell or barbell rows

Cool-Down

Help your upper body recover with this 10 min neck and shoulder-focused yoga sequence from Five Parks

This Just Dropped……

Hard Conversations in the Menopause Transition: Hormones, Testing, GLP-1s and what’s “Ideal” Now

TAKING NEW CLIENTS!

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

Move Your Body, Protect Your Brain - It's that Simple

Carla DiGirolamo, MD — Mon, 02 Feb 2026 11:45:24 GMT

As a hormone and menopause specialist, concerns about cognitive health, dementia risk, and the role of hormone therapy (HT) in this equation are front and center in many conversations with my Clients. In mid-life, we are at that age where we are watching our parents age, and many are deteriorating from dementia. The fear that this is also our fate is real, and for some, overwhelming.

For about a decade now, the debate has raged on about whether hormone therapy can prevent cognitive decline. The current consensus of the American and British Menopause Societies (2022 Consensus Statements) is that women with premature menopause (menopause before age 40) appreciate cognitive benefit from HT. Benefits are equivocal for the symptomatic population within 10 years of natural menopause onset, < age 60, and for the older population, HT for cognitive health skews toward potential detriment when HT is initiated over the age of 60 in the general population.

What is often overlooked is the evidence for the benefits of exercise for cognitive health and dementia prevention and even in the treatment of mild cognitive impairment (MCI). Regular movement helps your muscles, metabolism, joints, and mood. What many don’t realize is that exercise is one of the most powerful evidence-based strategies we currently have to support brain health, slow age-related cognitive decline, and possibly reduce the risk of dementia and Alzheimer’s disease.

Here’s what we know:

How Exercise Benefits the Brain

1. It Changes the Brain’s Structure

Physical activity increases the size of the hippocampus, the part of the brain responsible for learning and memory. It also increases gray and white matter in cognitive regions, helping preserve brain volume with age.

2. It Improves Brain Chemistry

Exercise stimulates the release of Brain-Derived Neurotrophic Factor (BDNF) — a growth factor that supports neuron survival, learning, memory, and brain plasticity. Higher levels of BDNF are linked to better cognitive function and lower risk of neurodegeneration.

3. It Reduces Inflammation

Exercise has anti-inflammatory effects that extend into the central nervous system. Lower inflammation is associated with improved cognitive performance in older adults.

4. It Improves Mood and Stress Resilience

Even a single bout of exercise can enhance executive functions (like planning and attention), reduce stress, and boost mood — all of which support cognitive functioning.

Dementia Risk Reduction

A 2023 meta-analysis found that regular exercise may reduce the risk of dementia and Alzheimer’s disease by significant amounts, with higher activity levels associated with lower risk.

Longitudinal research also suggests that higher cardiorespiratory fitness is linked with reduced dementia risk later in life.

Mild Cognitive Impairment (MCI)

MCI — a transitional stage between normal aging and dementia — represents a key window for early intervention. Studies show that exercise, especially when combined with cognitive strategies, improves global cognition and slows decline in people with MCI.

What to Do: Practical Training Recommendations

Here’s how to structure your fitness program for brain health:

✔️ Aerobic Training

Mix forms and intensities:

Low-intensity endurance: brisk walking, cycling, swimming
High-intensity interval training (HIIT): short bursts of vigorous effort followed by recovery

Aim for at least 150 minutes per week of moderate-to-vigorous aerobic activity — the same guidelines that benefit heart health also support brain health.

✔️ Strength & Resistance Training

Though less studied than aerobics, emerging evidence supports including strength work:

Heavy resistance (low reps)
Hypertrophy training (moderate weight, higher reps)

Resistance training may enhance memory, learning, and aspects of executive function important for daily independence.

✔️ Mixed & Functional Training

Combining aerobic and resistance movement in a session engages your nervous system, supports neuroendocrine adaptation, and increases overall fitness.

✔️ Consider Multidomain Programs

Exercise paired with cognitive training may yield greater improvements in cognition for individuals with MCI than exercise alone.

So, my friends, our best, science-backed intervention for empowering our brain health is right in front of us! So with that, let’s get into this week’s workout!

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Today’s workout is 25 minutes, with something to do every minute on the minute. The first minute is 15 burpees, the second minute is 25 kettlebell swings, the 3rd and 4th minutes are maximum calories on the assault bike or the rower and the 5th minute is REST!

This workout has an endurance focus with intensity intervals as well as a strength component with the kettlebell swings. We also have “just move” options if you prefer to keep the intensity low to moderate. Either way, your brain is benefiting!

Warm Up

3-minute easy bike, row, or jog

TABATA - 20 seconds of work and 10 seconds of rest. Perform each movement in sequence until you have completed all 3 movements 4 times (Total 6 minutes)

Movement Practice

Take up to 10 minutes to select your kettlebell weight and movement options for the workout. This is a lighter to moderate-weight kettlebell where it may be realistic to do 25 repetitions unbroken for the first few rounds but where you may need to break it up into 2 quick sets in the later rounds.

Workout

EMOM 25 (Every minute on the minute for 25 minutes

Minute 1: 15 burpees (see the linked videos for variations for all skill levels)
(Option: scale the burpees to a number that you can just barely do in 50 seconds and strive to hold onto this number for all 5 rounds).
“Just Move” Option: 50 seconds of burpees (or variation) or up-downs at a comfortable pace)
Minute 2: 25 kettlebell swings (eye level)
(Option: double or single dumbbell swing).
“Just Move” Option: 50 seconds of weighted hip bridges at a comfortable pace.
Minutes 3 and 4: Maximum calorie/meter bike, run, or row (or max jumping jacks or jump rope reps if no cardio equipment)
“Just Move” Option: 1 min and 50 second brisk walk or alternating lunges at a comfortable pace
Minute 5 - REST

Go back to the burpees for your next round until you have completed 5 rounds.

Your Score: Maximum calories/meters accumulated through the 5 rounds.

TIP! If you are doing this workout “as written”, pace yourself! 25 minutes is a long time, even with a minute of rest each round. Consider working at a little slower pace each minute and performing the repetitions in 45-50 seconds rather than coming out with your hair on fire and doing the repetitions at higher intensity for less time. This will get difficult FAST!

Cool Down

Cooking down is CRITICAL today! If you did this as written, your stress-response system is firing on all cylinders, and now you need to re-establish equilibrium and return the system to baseline. Try this 20-minute gentle yoga stretch sequence. If you can do this outside, soaking in all that nature has to offer, that is ideal.

Also consider some foam rolling, a cold plunge, sauna, breathwork, or short (or long) meditation. Lastly, but certainly not least, EAT AND HYDRATE! A critical part of recovery is replenishing your glycogen stores and water loss and rebuilding muscles with high-quality protein.

Alizadeh Pahlavani H. Exercise therapy to prevent and treat Alzheimer’s disease: systematic review and meta-analysis. Front Aging Neurosci. 2023.

Wu J, Huang C. Resistance exercise improves cognitive function in older adults: systematic review and meta-analysis. Front Psychiatry. 2025.

Brown BM, et al. Physical activity and cognitive decline: meta-analysis of prospective cohort studies. Mayo Clin Proc. (Classic review on exercise reducing dementia risk).

Montero-Odasso M, et al. Effects of exercise and cognitive training on MCI cognition: the SYNERGIC Trial. JAMA Netw Open. 2023.

Sáez de Asteasu ML, Izquierdo M. The role of exercise in mild cognitive impairment and dementia. Nutritional Aging Rev. (Mini-review on exercise as a therapeutic strategy).

Physical Exercise & BDNF modulation: Exercise increases brain-derived neurotrophic factor and cognitive function. Experimental & Clinical Evidence Review.

A Candid Conversation about Hormone Therapy - hosted by Selene Yeager

The messages we see and hear about hormone therapy are often head spinning, as headlines seemingly say one thing and guidelines say another. Medical experts themselves spend days arguing on Instagram. And women are left wondering how to make the best decisions for their health and well being. We feel it, too. So this week, host Selene Yeager opens up about her own journey through menopause and hormone therapy and has a sit down, candid conversation with the podcast’s resident hormone specialist Dr. Carla DiGirolamo to get to the root of the confusion and discuss what women should consider as they’re sorting through all the information coming their way.

TAKING NEW CLIENTS!

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

Plyometric Functional Training - Another Longevity Hack

Carla DiGirolamo, MD — Mon, 26 Jan 2026 11:45:26 GMT

Plyometric training is exercise that teaches your muscles to produce force quickly by using a quick “load and explode” action. Some examples include jump rope, box jumps, running, and racquet sports, to name a few.

When we think about plyometric training, we often first think about bone health. It’s well documented that plyometric activities can help stimulate bone in a way that helps mitigate bone loss.

However, plyometric training has other benefits besides promoting bone health. A more understated benefit is in building muscle power. Power is defined as Force x Distance/time, or “fast force production”, which is tightly linked to stair climbing, getting up from the floor, and fall risk. Plyometrics uniquely target the stretch-shortening cycle (rapid “load → explode”), training neuromuscular speed and producing brief, high bone-loading impacts that typical steady cardio often doesn’t deliver.

During midlife, changes in estrogen exposure to our muscles due to declining ovarian estrogen production, shifting estrogen receptors within muscle cells, and the general effects of aging all result in a decline in muscle power, along with muscle strength and overall mass. For a deeper dive, check out Muscle Hypertrophy, Strength, and Power: The Keys for Thriving in Midlife.

Longevity is a complicated equation, but the musculoskeletal system is front and center. Here’s how plyometrics fits in:

Bone Health: Modest but meaningful improvements (hip/spine and bone quality)
Muscle Power & Function: “Faster strength” that transfers to real-life stair climbing and getting up from the floor or from a chair.
Balance / Fall-risk: Plyometric exercises build static/dynamic balance with the potential to redice fall risk in older populations by training rapid force production and reactive control.
Safety & Feasibility: Programming matters. High-impact jumping isn’t appropriate for everyone—with caution required in those with osteoporosis, recent fractures, significant joint pathology, or medical complexity. Fortunately, plyometric movements are highly scalable from pogo hops and easy jump rope to box jumps and hurdle hops, depending on one’s abilities and limitations.

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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.

New Year Special!

$100 off Health and Wellness Concierge Membership (Code 2026100)

$50 off Concierge Upgrade for current Clients who are not in the Concierge program (Code 202650).

*** Present your code to Mary, my awesome and amazing assistant, when you request your appointment. Valid for the month of January.

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

Women go on hormone therapy to manage peri/menopause symptoms and feel better. But sometimes to their surprise, they feel worse. Or some symptoms go away while others pop up. That’s because of the hormones! We have hormone receptors all over our body and whenever we switch up the signals they’re receiving, whether through the menopause transition itself or through the hormones we use, they’re going to respond to those changes, and sometimes not in the way we want. Most side effects are manageable with time or by dialing in delivery methods and/or doses. It’s just important to know what to expect. We talk all about it this week with our resident menopause specialist Dr. Carla DiGirolamo.