Hey Friends! I'm excited to bring you this special edition of Athletic Aging where I team up with Dr. Heather Hausenblas, author of the substack publication "Wellness Discovery" to discuss the barriers for women to training with weights and resources for overcoming these barriers. Enjoy! -Dr. Carla

Picture a typical gym on a Tuesday morning. Every cardio machine taken — treadmills, ellipticals, bikes — almost all by women, logging miles at a steady, determined pace.

The weight room: different story. Mostly men.

The numbers confirm it. Only 27% of women in the U.S. meet the guideline for strength training — two days a week of lifting or resistance work. For men, it’s 35%. Not great either, but better.

It gets worse with age. Among women 18–44, about 34% hit the mark. Ages 45–64, that drops to 24%. Women 65 and older: 17%.

That’s backwards.

The years women need strength most — for bones, joints, balance, metabolism, independence — are the exact years they’re least likely to do it.

Why women avoid the weight room

It’s not desire.

In a recent study, 87% of women aged 40–60 said they wanted to strength train for bone health. 72% were open to lifting heavy.

It’s the environment.

They feel watched, talked down to, out of place. Unfeminine. Unqualified. So they stay on the treadmill.

What the science says

In 2025, researchers reviewed dozens of resistance-training programs for postmenopausal women. The findings were boring in the best way.

Strength training builds muscle, improves body composition, and preserves independence. The typical program wasn’t fancy — three sets, eight to ten reps, moderate-to-heavy loads. Leg press, chest press, rows, squats.

Not pink dumbbells. Not “toning.” Actual strength.

The “bulky” myth

Let’s kill this quickly. Women don’t have enough testosterone to get bulky from lifting. Building that kind of mass — on anyone — requires dedicated training, a caloric surplus, and often pharmaceutical help.

Women who lift actually get stronger, leaner, and more confident. Among older women who strength train, 90% report being satisfied with their bodies.

That’s not a small number.

What works

1. Lift heavy enough to feel it. This is the whole game. If the weight isn’t challenging, it isn’t doing much.

2. Eat like someone who trains. Muscle needs protein, carbs, and creatine.

3. Don’t do it alone. Women stick with strength training when they have support, coaching, and community. Isolation is where programs go to die.

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Where to start

The simplest entry point: a 6–8 week program with a trainer at a local gym. Learn the basics — squats, deadlifts, presses. Build confidence with load and form.

If that feels like too much, or cost or convenience is a factor, solid online options exist:

• Keys to Empowering Women in the Weight Room (Athletic Aging Archives)

• Athletic Aging Weekly Workout Series

• Empower by Dottir

The bottom line

Midlife doesn’t require women to become fragile. It requires them to become strong.

The science is clear: strength training isn’t optional.

It’s how we age on our feet.

Heather and Carla

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According to the WHO, clinically diagnosed depression affects 5% of the global population with a higher incidence among women (4% in men and 6% in women). Some project that depression will become the second leading cause of disability worldwide by 2030.

When I first read these statistics, my sense was that 6% of women worldwide seemed pretty low. But after digging a little deeper, I discovered that the observed rates of depression in perimenopause and menopause range between 20-40% according to the Massachusetts General Hospital Center for Women’s Mental Health. This is incredible to me when compared to a 6% incidence in all women worldwide.

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So what is it about this stage of life that is responsible for this mindblowing statistic?

• We are more established in our careers with increased responsibility and potentially more stress

• Children have left the home

• Aging parents

• Relationship adjustments

… and let’s not forget, our changing bodies!

One could argue that every stage of life has its stressors. In our younger years, we are climbing the ladder in our careers and paying our dues. We are raising our children - running every which way to soccer games and dance recitals while trying to juggle a job, a marriage, and a life, for that matter, without losing our identities in the process.

But this later stage of life is different because what comes with it are the most dramatic physical changes since the onset of puberty. This is no joke! Hot flashes, sleep disruption, brain fog, and anxiety that comes out of nowhere can shake even the most well-adjusted people. Then you go to your doctor, desperate for help, and you are met with a deaf ear or “solutions” that are not helpful. Now you feel even more alone. It’s a wonder that these depression statistics are not higher.

Making Sense of the Symptoms

Sometimes, it’s easier to navigate a difficult situation if you know exactly what you’re dealing with. If we know why something is happening, we can target our interventions to the root cause and “cut the beast off at the head”.

The most important thing to understand is that every woman experiences her hormonal physiology differently. Two hormonally balanced, regularly cycling, ovulatory women can experience their menstrual cycle very differently. For example, one of these woman may be debilitated by their premenstrual symptoms while others don’t even realize the period is coming. Pregnancy is another example. A woman experiencing a healthy, hormonally balanced pregnancy can have terrible morning sickness while another healthy woman will never experience nausea. The menopausal transition is no different. There is vast variation in how women experience this normal, but dramatic, transition and the key to navigating the often life-altering symptoms that accompany this transition is to target the physical manifestations of these hormonal changes.

Let’s get back to depression. There are several things that can impact mood during this stage of life:

• Life and relationship stressors as noted above

• Sleep disturbance. This is a huge player in the mood equation.

  • Urinary symptoms

  • Hot flashes

  • Racing thoughts

• Anxiety

• Energy imbalance. Overtraining/underfueling can cause irritable mood and sleep disturbance

• Sexual dysfunction such as low libido, vaginal dryness, painful sex can place strain on relationships and make us feel so woefully “inadequate’ as partners.

• Generalized, clinical depression

When I see clients with depressive symptoms, the first thing we do is break down and assess these factors above. Fortunately, there are great pharmacologic and non-pharmacologic interventions for all of these situations.

Sometimes, even if these factors have been optimized, depressive symptoms still exist, leaving women understandably feeling defeated. However, having gone through the process of addressing these issues without the desired outcome may lead to the realization that additional mental health assistance is needed.

Despite the major advances in the treatment of clinical anxiety and depression, there is still a societal stigma that does not always present a welcoming and non-judgmental environment for seeking this help. So what happens? We don’t talk about it and just try to push through it. Much like menopause! Similar societal stigmas and provider misconceptions about this stage of life have created barriers to women getting the help they need.

How Can I Find Help?

The approach to combatting depression and thriving during this stage of life is a holistic endeavor. It’s about physical health, mental health, our relationships with friends, family, and community, and the environment around us. Below are suggestions for how to tap into all of these things:

• Start journaling. Self-awareness is a very powerful tool for paving the way to better mental health. Symptom diaries can be incredibly helpful for identifying associations between symptoms, circumstances, and potential “triggers”.

• Find your community. Knowing that you are not alone and gaining support from other women experiencing the same things is a game-changer! My friend, Amanda Thebe, published an amazing book, “Menopocalypse”. It is so engaging because she shares her experience from the heart, connecting in such a way that you know that you are not alone. My other shout-out is to my friend, Selene Yeager and Feisty Menopause. This community has grown exponentially because of the life-changing support from the thousands of women in this community and the reputable and practical blog and podcast content.

• Consider a Coach. Health coaches and life coaches are fantastic resources that can help you see the “big picture” and identify specific areas where you might be struggling.

• Call your healthcare provider. There are so many pharmacologic tools to help alleviate the symptoms of the menopause transition as well as clinical depression and anxiety. But don’t settle! If you feel that your provider is dismissive or not hearing you, find another provider! There are definitely good, menopause-informed providers out there! You deserve to be heard and not to suffer.

Housekeeping….

The Navigate Menopause Course is back for Spring! Sign up today to secure your spot!

This amazing course collaboration with my friends and colleagues at Feisty dispels the confusion and busts the myths surrounding menopause and gives you the tools you need to empower yourself to take your menopause experience into your own hands. Click HERE to learn more!

Headaches are very common affecting ~48% of the population. Migraine, tension-type (TTH), and cluster headaches comprise 98% of all headaches. The World Health Organization (WHO) ranks migraine headaches as the second leading cause of disability in the world, particularly in women under the age of 50, with an estimated global prevalence of 15%.

Women experience headaches 3x more often than men which may be attributed to the hormonal fluctuations of the menstrual cycle, pregnancy, and menopause among other physiologic reasons.

It’s important to characterize headaches accurately as different types of headaches have different levels of risk of stroke and other complications. This is particularly important when considering hormonal contraception and menopausal hormone therapy (HT).

The risks and benefits associated with the use of menopausal hormone therapy (MHT) have been the subject of intense debate since the Women’s Health Initiative (WHI) study discontinued the estrogen/progestin arm of the study due to what was described as a “significant increase in the risk of breast cancer” in 2002. Since this time, providers and patients alike have expressed apprehension around the use of HT for this and various other reasons. Similarly, because some types of headaches impart a greater risk of stroke, this has also contributed to a sometimes overly cautious approach to MHT use.

The different subtypes and diagnostic criteria of headaches can lead to some confusion surrounding which types of headaches carry an increased risk of stroke versus those that do not. Migraine headaches, in particular, raise cause for concern as this type of headache is associated with an increased risk of stroke and other thrombotic (blood clot formation) events. But does that mean that hormone therapy and hormonal contraception are non-starters for anyone who suffers from migraine headaches? Absolutely not. As with any intervention, the decision needs to be informed by, a thoughtful, individualized risk/benefit assessment, rather than a “path of least resistance” approach where every woman who suffers from migraine headaches is painted with a broad brush stroke.

Today’s post is intended to empower you with the knowledge that you need to have that thoughtful discussion with your provider about the risks and benefits of hormonal treatments in the setting of your headache history so that you can make the decisions that are right for you!

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What is a Migraine Headache?

Migraine headache is a complex, genetically influenced, neurovascular disorder characterized by episodes of moderate-severe headaches, most often unilateral (one-sided) and often associated with nausea and light sensitivity.

The International Headache Society characterizes migraine headache into 3 subtypes:

• Migraine without aura (75% of migraine headaches)

  • Recurrent attack lasting 4-72 hours

  • Unilateral and pulsating

  • Moderate to severe intensity

  • Aggravated by physical activity

  • Nausea

  • Light and sound sensitivity

• Migraine with aura

  • Recurrent, fully reversible attacks lasting minutes

  • Unilateral

  • Associated with one or more of the following: Visual, sensory, speech/language, motor, and/or visual disturbance followed by headache and migraine symptoms.

• Chronic migraine

  • Occurs on 15 or more days in a month for more than 3 months

  • Migraine features noted on 8 or more days in a month

What “Triggers” a Migraine Headache?

There is a long list of potential migraine triggers, however, the most common ones occurring in more than 50% of migraine sufferers include:

• Stress (80%)

• Hormonal changes during menstruation, ovulation, and pregnancy (65%)

• Skipped meals (57%)

• Weather changes (53%)

• Excessive or insufficient sleep (50%)

Stroke Risk and Migraine Headache

It is widely known that Migraine headaches are associated with an increased risk of stroke. But how high is this risk, exactly? Are different types of Migraine headaches associated with higher stroke risk than others? The answers to these questions are very important to begin the risk/benefit assessment.

A note about understanding “Risk”:

“Relative risk” is when the incidence of an outcome of interest is compared between two scenarios (Outcome A is 10x greater than outcome B). “Absolute risk” is the actual frequency of the outcome of interest in the population (Outcome A occurs in 10 in every 10,000 people. Outcome B occurs in 1 in every 10,000 people).

So, if the use of MED A is associated with a “10x greater risk of X”, that sounds pretty horrible…. but if that risk translates into 10 cases of X in 10,0000 people, the risk of X in those taking MED A is 10/10,000 = 0.1%. Not so horrible! This may be a reasonable risk to take when your quality of life is impacted by your symptoms. This is one of the areas where the WHI got into trouble in their narrative surrounding breast cancer risk and HT.

A consensus statement published by the European Headache Federation (EHF) and the European Society for Contraception and Reproductive Health (ESC) describes the absolute risk of stroke in women aged 20-44 suffering from migraine headaches and using hormonal contraception in a meta-analysis of 63 studies. The risk of stroke in the various study populations is summarized as follows:

The baseline stroke risk in the female population aged 20-44, (-) hormones, (-) migraine history is 2.5/100,000.

• (+) hormonal contraception (-) migraine history is 6.3/100,000

• (-) hormonal contraception (+) migraine WITH AURA is 5.9/100,000

• (+) hormonal contraception (+) migraine WITH AURA is 36.9/100,000

• (-) hormonal contraception (+) migraine WITHOUT AURA is 4.0/100,000

• (+) hormonal contraception (+) migrainen WIHTOUT AURA is 25.4/100,000

It was also noted in this study that higher doses of ethinyl estradiol (the estrogen component of the hormonal contraceptive) are associated with higher stroke risk.

Unfortunately, there is no similar study that investigates these risks specifically in menopausal women with migraine headaches using MHT. However, it is reasonable to expect that these trends likely continue into menopause. However, one very important difference (besides age) is that MHT has much lower estrogen exposure than what is found in typical hormonal contraceptive pills and there are also bioidentical estradiol alternatives not commonly found in typical hormonal contraceptive pills. To determine whether these different doses and formulations impact stroke risk would need further investigation.

Approach to HT Use in Menopausal Women with Migraine Headaches

If you are a menopausal woman who suffers from migraine headaches and is considering HT, here are some important points to raise with your provider so that you can make a decision that is right for you.

• Is MHT effective for the symptoms or health concerns that you are experiencing (i.e. are the expected benefits of HT great enough to outweigh potential risks?)

• Have you been diagnosed with migraine headaches by a knowledgeable provider? Avoid self-diagnosis as characterizing headaches is complex and mis-characterization of your headache may lead to an inaccurate risk assessment.

• If you have been diagnosed with migraine headaches, It is important to know if your headaches are classified as WITH or WITHOUT aura. According to the data, stroke risk is higher when aura is present.

• Do you have any other risk factors for stroke? Obesity, smoking, high blood pressure, diabetes, chronic inflammation, and genetic predisposition are among the most common risk factors for stroke. The presence of other stroke risk factors in addition to a migraine headache history are additive and are important for risk assessment when considering further additional stroke risk incurred when using HT.

• Expert consensus suggests that transdermal HT may carry a lower stroke risk than oral HT.

• Estrogen dose matters for stroke risk. Use the lowest possible dose of HT that is effective for symptom relief.

• If multiple stroke risk factors exist, consider progestin-only HT such as a progesterone IUD or micronized progesterone as well as non-hormonal remedies that may be appropriate for symptom management.

• What if I used to have migraine headaches before menopause but no longer do now that I am menopausal? Again, data is sparse on this topic, but my personal opinion is that the underlying neurovascular physiology that led to the migraines in reproductive life still exists post-menopause. There may be fewer hormonal triggers and thus fewer headaches once menstrual cycles cease, however, the existing underlying physiology of the nerves and blood vessels may still pose an increased stroke risk.

It is important to appreciate the complexity of characterizing headaches accurately which can be very challenging for the generalist provider. If you are considering hormone therapy and are uncertain of your headache status/stroke risk profile, a neurologist or headache specialist can help ensure an accurate diagnosis. Consulting with a specialist may also lend some assurance to your generalist provider who is uncomfortable prescribing hormone therapy to patients with migraine headaches.

REFERENCES

Considerations for hormonal therapy in migraine patients: a critical review of current practice Romy van Lohuizena. Paungarttnerb J et al. Expert Review of Neurotherapeutics 2024, VOL. 24, NO. 1, 55–76.

Myocardial infarction, stroke, and cardiovascular mortality among migraine patients: a systematic review and meta-analysis. CYH N et al. J Neurol. 2022 May;269(5):2346–2358.

Migraine and cardiovascular disease: systematic review and meta-analysis. Schürks M et al. BMJ. 2009 Oct 27;339 (oct27 1):b3914.

Hormonal contraceptives and risk of ischemic stroke in women with migraine: a consensus statement from the European Headache Federation (EHF) and the European Society of Contraception and Reproductive Health (ESC). Sacco S et al. J Headache Pain. 2017 Oct 30;18(1):108.

Migraine Headache: Stat Pearls NIH Library of Medicine; Pescador MA et al. Treasure Island (FL): StatPearls Publishing; Jan 2024.

Housekeeping…..

I am so excited to announce my latest collaboration with Feisty with the debut of a 4-part series for the Feisty Women’s Performance Podcast called “Hormonal”. The awesome and amazing Selene Yeager and I team up to bring you the ESSENTIALS of what women of all ages should know about how hormones impact athletic performance, how to identify when something goes wrong, and how to work WITH your physiology rather than against it to achieve your performance potential.

Subscribe now to the Feisty Women’s Performance Podcast and gear up for Episode 1 which drops on April 15th!

As a menopause hormonal specialist who focuses on active and high-performing women, I am amazed (and saddened, quite frankly) by how so many women are being misdiagnosed or worse yet, completely blown off by their providers when they seek care for often debilitating symptoms during mid-life.

A typical situation is a menopausal woman in her mid-fifties sees her provider for symptoms of fatigue, poor mental and physical performance, sleep disturbance, mood changes, and a 10 lb weight gain despite “doing nothing differently”. Her provider may or may not do an evaluation and ultimately tells this woman either “You need hormone therapy” or “You’re just getting older”. She then, understandably, gets frustrated because she’s really suffering and doesn’t feel like pills are the answer. She schedules a visit with me and shares that she is a lifelong recreational runner training for the Boston Marathon - on 1200 calories per day. I ask if she shared this information with her provider and she responds “They never asked”.

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Scenarios similar to this are apparent in at least half of the active women whom I see for menopausal care. A major player leading to this problem is that the hormonal changes of menopause result in sometimes dramatic changes in body composition, which elicits the “knee-jerk” reaction to train more and eat less, try fad interventions such as “keto” or “intermittent fasting” - all of which further exacerbate the energy imbalance causing her symptoms. There is also not a lot of guidance on how to adjust nutrition to changing activity levels, activity types, injuries, or evolving health issues in the midlife female population.

What is Low Energy Availability (LEA)?

Simply defined, LEA occurs when there is an inadequate amount of energy available (EA) to support vital bodily functions after supplying physical activity/exercise. For the math geeks in the audience, the equation looks like this:

When LEA is prolonged and or severe (Relative Energy Deficiency in Sport: REDs), this can cause metabolic disturbance, injury, bone fractures, loss of or irregular menstrual cycles, sleep disturbance, brain fog, and poor performance among other long-term health issues.

This year, the International Olympic Committee (IOC) released its Consensus Statement on LEA and Relative Energy Deficiency in Sport (REDs). This statement includes an outstanding review of the latest research done on LEA and REDs as it relates to causes, short and long-term impact on the athlete, and describes a very useful tool (IOC REDs CAT2 three-step protocol) for trainers and providers to assess the degree of risk of LEA / REDs and plan interventions.

Below are two (among many) important points from the IOC 2023 Consensus statement:

1. Inadequate carbohydrate intake is a major contributor to LEA / REDs. The statement cites multiple studies in male and female endurance athletes that show that <3g carbohydrate/kg of body mass was associated with a deleterious impact on bone, immunity, and iron biomarkers and can accelerate the progression of LEA to REDs.

2. Seminal research in sedentary females identified 30 kcal/kg of fat-free body mass/day as a threshold below which perturbations in sex hormones and changes in bone turn-over markers were seen and that >/= 45 kcal/ kg of fat-free body mass is optimal for maintenance and growth.

   It’s important to note that these thresholds were determined in studies of sedentary females, which underscores the even greater caloric needs of active women and competitive/elite athletes.

Symptoms of LEA Look Just Like Symptoms of Perimenopause and Menopause

The overlap between the symptoms of the menopause transition and LEA can be challenging for providers - especially if they don’t ask about the patient’s training and fueling. If they do ask, they may not understand what “adequate” and “inadequate” fueling look like, as this is also a challenge for experts in the fitness industry. For this reason, publications like the IOC Consensus Statement above are critically important for healthcare providers and trainers alike.

Symptoms common to LEA, Perimenopause, and Menopause:

• Brain fog

• Irregular menstrual cycles

• Sleep disturbance

• Mood disturbance and irritability

• Poor mental and physical performance

• Lack of motivation

Impact of LEA on the Perimenopausal and Menopausal Woman

LEA has a unique impact on females as compared to males due to the evolutionary design of female hormone physiology to achieve and support pregnancy. This is evidenced by the need for adequate energy and fat composition for the initiation of puberty (reproductive competence) and the loss of menstrual cycles that often occurs when females are in a persistent state of LEA.

When LEA is persistent, activation of the stress response is persistent, which leads to inflammation, potential for injury, poor recovery, possible thyroid disturbance, and fat retention to preserve energy when energy intake is inadequate. This is why fasting > 12 hours shows no greater benefit than sound nutrition strategies that do not involve prolonged fasting and CAN EVEN BE HARMFUL in the non-obese, active, mid-life female population.

Unfortunately, there is little to no study of LEA and REDs specifically in the perimenopausal and menopausal populations, however, the published guidelines noted above can provide a starting point.

Approach to the Mid-life Female Experiencing Symptoms

• STEP 1 of the approach to symptoms in perimenopausal and menopausal women is to assess their energy balance! If you are a trainer, coach, or healthcare provider, the first thing to address is her training, physical activity, participation in sport, and her nutrition. The most “average appearing” individual could be a competitive athlete, so ask EVERYONE! A week or 2 of training and food logs can be very helpful for gaining an objective perspective of the client’s energy state.

• Carbohydrate management is challenging in midlife women because as hormones change, relative insulin resistance becomes apparent, in part, due to declines in muscle mass and function rendering glucose utilization by skeletal muscle less efficient. As we have learned above, adequate carbohydrate intake is critical to optimal energy balance however, should focus on high-quality carbohydrate sources, minimizing refined sugars, nutrient timing strategies where carbohydrate is available pre-and post-training, and concentrating carbohydrate intake earlier in the day.

• Adequate total energy is critical for energy balance, however, adequate macronutrients are also important. For mid-life women, protein intake needs priority as the changing hormones result in catabolism of muscle and bone, particularly in the first few years of menopause. Ensuring that there are sufficient “building blocks” to rebuild muscle following training or physical activity is essential for recovery.

• Lastly, the importance of effective recovery cannot be overstated. Because females are particularly sensitive to energy balance and stress response system activation, a comprehensive recovery regimen will help prepare the athlete for subsequent training sessions and avoid injury. Greater attention to warm-up and cool-down, tissue care with massage, foam rolling, mobility work, cold plunges, sauna, sleep, sound nutrition, and mindset work should be part of every training program.

My Training and Nutrition are Optimized, but I’m Still Having Symptoms

There is no doubt that optimal training and nutrition do not solve every symptom of menopause, however, it does lay the foundation for vitality, and longevity and for helping therapeutics work more effectively!

For those symptoms such as hot flashes, vaginal dryness, painful sex, urinary symptoms of menopause - and so many more - many hormonal and non-hormonal treatments are safe and effective. However, when the basic foundations of health are not addressed, the therapeutics alone may not provide the same efficacy of symptom relief.

The key to optimal health, vitality, and longevity requires a “team” approach with coordinated input from experienced fitness and nutrition experts and informed healthcare professionals. This model of women’s healthcare is finally emerging and is certain to be the next revolution in women’s health. Stay tuned!

Team!
In keeping with the core strengthening theme this week, today's post is all about one of the most underutilized, most versatile movements - rucking! This movement is easy, can be integrated into any training program at any level for any age group with an impressive list of health benefits! 
Enjoy!
-Carla

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On Monday we did some functional core training and discussed the importance of building a pillar of strength along the midline of the body for joint stability, fall prevention, and just powering up every movement we do. Today we are continuing to build our pillar of strength with one of my favorite movements - Rucking!

What is Rucking?

Rooted in military training, rucking is simply walking with a weighted backpack over varying distances and terrains.

Rucking can take on many forms. It can be a hike while carrying your gear on your way to a camping weekend or it can simply be putting ten pounds in a backpack when you take your dog for a walk. It can even be wearing a backpack while you are doing work around the house or the yard. Whatever your fitness level, age, or experience, all you need is a backpack and a weighted object.

Why Ruck?

• Rucking is a low-impact, weight-bearing exercise! That means it is great for your bones - especially at the spine and hip, where osteoporotic fractures can rear their ugly head!

• It is a great “Zone 2” activity. More attention has been paid to the benefits of Zone 2 training - working within 60-70% of your heart rate maximum (roughly defined as 220 minus your age). Low-intensity training is ideal for active recovery days and for cooling down after a more intense workout.

• Rucking builds core strength which benefits balance, and joint health, prevents falls, and provides stability for our movements of daily living.

• It’s an opportunity to get outside and connect with nature! So many experts have written on the mental health benefits of spending time outdoors.

• Rucking improves strength, endurance, and general fitness. Several research studies show that participants in rucking programs improved their muscle power and oxygen intake.

• Rucking is a great calorie burn! One can burn more than double the calories burned during a normal walk depending on your terrain and load.

No Fancy Equipment Needed

The great thing about rucking is that all you need is a backpack and a weighted object The weighted object doesn’t even need to be a dumbbell or a plate. It could be a gallon of milk, a book, or several books - anything around the house or yard will do.

Footwear. Anytime you are walking outside (or inside, for that matter), it’s important that your footwear has adequate traction to prevent slipping and falling - particularly if the ground surface is wet. A good pair of walking shoes is absolutely fine for rucking. If you are walking off of paved roads or on more complex terrain, consider trail sneakers.

Once you have been rucking for a while and you are ready to increase your loads to up to 20-30% of your body weight, a weighted vest is an alternative to a backpack that allows you to evenly distribute your weight between the front and back of your body. This is also a great alternative if you experience upper/lower back soreness when standing for long periods. Here is a LINK to the vest that I wear when I ruck. It holds up to 30 lbs of weight.

Integrating Rucking into Your Training Routine

• Start with 20 minutes or 1 mile. If this is your first time rucking, start with 5-10% of your body weight. The target frequency is once to twice weekly. You can progress this movement in several ways: Increase walking speed, add hills or more complex terrain, add distance, or increase the carrying weight. Lots of options here!

• Plan to ruck on an active recovery day. Keep the pace leisurely and the terrain simple.

• This is a great way to cool down after an intense workout. CrossFit workouts are often 15-20 minutes in length and of moderate to high intensity. I love to cool down from a workout like this by strapping on my weighted vest and taking a 20-minute ruck around my neighborhood, keeping the intensity no greater than zone 2.

• Rucking is a great “fall-back” if you had planned a training session that couldn’t happen due to unexpected events arising during the day. Instead of being frustrated that you cannot train the way you want to, grab your backpack, go out and tackle some hills, maybe go off-road, walk briskly, and be back in 20 minutes. You will return feeling refreshed with a sense that the training day wasn’t a total loss.

• Wearable technology can be a helpful adjunct to your rucking where you can track heart rate, maybe your “steps”, and level of strain or exertion. This data may be helpful as you monitor your progress over time.

No matter what your age or fitness level, elite athlete or sedentary, rucking is an activity that can be performed by anyone, anytime, and anywhere! Everyone needs lower-intensity training as part of their fitness program. Have fun with this activity and enjoy the many benefits to your health and well-being!

Housekeeping…..

NOW AT A NEW LOW PRICE! SIGN UP NOW WHILE THIS SALE LASTS!

I am so thrilled to announce the launch of my latest course contribution, Navigate Menopause with my friends and colleagues at Feisty! This AWESOME course dispels the confusion and busts the myths surrounding menopause and gives you the tools you need to empower yourself to take your menopause experience into your own hands.

ENROLLMENT STARTS MONDAY JANUARY 22nd! Click HERE to sign up! Space is limited and will be closed once course capacity has been reached.

Earlier this month, we discussed the relative insulin resistance of midlife in my post Understanding and Conquering the Relative Insulin Resistance of Midlife. We talked about how circulating estrogen and the estrogen receptors in muscle tissue change and how this leads to lower efficiency in managing blood sugar relative to our younger reproductive years. This leaves a greater excess of sugar in the bloodstream, unused by the tissues, to be stored as fat.

But that stubborn “belly fat” of midlife isn’t ALL about excess sugar, less estrogen, or calories in / calories out. Another key player in the belly fat equation is our friend (yes, our FRIEND) Cortisol - aka the “Stress response system”.

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Biological females are programmed by nature to be highly sensitive to energy availability. An adequate fat mass percentage is required for the onset of puberty. One of the most reliable signs of persistent low energy availability (LEA) during our reproductive years is the loss of regular menstrual cycles. The mechanisms by which energy availability influences female physiology include direct communication with the hypothalamus, which is the command center for not just the menstrual cycle, but also the stress response system.

So what happens when we become menopausal and the menstrual cycle is no longer in the equation? The stress response system becomes front and center as a key responder to energy availability and storage in the body. How is energy stored in the body? As glycogen in the skeletal muscles and liver and as … you guessed it… FAT.

There has been a lot of buzz over the hormone, “Cortisol”. I blogged about this in a recent post, Stop Demonizing Cortisol!. Cortisol is just one of MANY hormones and mediators of the stress response system. As circulating estrogen declines and menstrual cycles become less frequent, we lose a key “buffer” of resiliency in stress response activation and recovery while still maintaining that same sensitivity to energy availability. So when the body senses low energy availability through mediators such as leptin, ghrelin, and kisspeptin, the “alarm” is sounded to alert the stress response system to conserve energy by “hanging on” to fat storage, increasing the sensation of fatigue to slow the body down, if prolonged, thyroid function may be suppressed, among other adaptations. Brain fog and sometimes even depressive symptoms may also set in.

Key sensors of fuel and nutrient availability throughout the body (Kisspeptin, Leptin, Ghrelin) communicate with the stress response system. When fuel availability is persistently low, the stress response system is activated. When fuel and nutrients are adequate, the stress response system is in balance.

Here is how it often unfolds: We start down the midlife journey of perimenopause and notice a change in body composition - sometimes dramatically in a short period of time! Our “knee-jerk” reaction is to “eat less and train more”. Then we discover that what we used to do to lose that quick 5 - 10 lbs is no longer working. So we eat even less and train even more - and so the vicious cycle begins - the stress response system now thinks there is a worldwide famine and the body holds on to every last fat cell for dear life, dials down a whole bunch of bodily processes and then we feel like crap - and defeated. Sound familiar?

So what do we do now? This is where we roll up our sleeves and start working WITH our physiology - not against it. First, energy balance needs to be restored, but with a strategy that works with our perimenopausal/menopausal physiology:

• Pay closer attention to protein intake (0.7-1g of protein per pound of body weight).

• Ensure adequate total energy intake. According to the International Olympic Committee (IOC) 2023 Consensus Statement on REDs, a study was cited where 45 kcal/kg of fat-free mass (FFM)/day represents energy intake that supports maintenance and growth. So, for a 135 lb woman with 20% body fat (60 kg x 20% = 48 kg FFM), this equates to 2,160 kcal/day.

  It’s important to note that these are just guidelines and that each athlete’s goals and circumstances need to be considered when optimizing total energy requirements.

• Minimize refined sugar intake and focus more on high-quality carbohydrate sources. As we mentioned previously, insulin does not work as efficiently as it once did.

• Adequate carbohydrate intake - According to the International Olympic Committee (IOC) 2023 Consensus Statement on REDs, inadequate carbohydrate intake is a major contributor to a low energy availability (LEA) state and Relative Energy Deficiency in sport (REDs). What defines “adequate” varies with the type and volume of physical activity, however, the “danger zone” appears to be below 3g carbohydrate (CHO)/kg body weight/day. This threshold to the “danger zone” equates to 160g of carbohydrate for a 60 kg (135 lb)woman - and this is the lower end of carbohydrate need! For endurance and other competitive athletes, this need can exceed 7g CHO/kg/day.

  Again, it’s important to note that these numbers are just a guide and that each athlete’s circumstances need to be taken into account when optimizing carbohydrate intake.

• Avoid fasting for more than 12 hours (overnight from dinner to breakfast). Dr. Stacy Sims, renowned exercise physiologist, and nutrition scientist has blogged a lot on this topic stating that prolonged or intermittent fasting provides no potential benefits and potential for harm, particularly in active midlife women without obesity or metabolic disturbance.

• Avoid training fasted - Many people just don’t like to eat in the morning before training, but having no fuel on board after an overnight fast and then challenging the body with training will look like a “five-alarm fire” to your stress response system. Even consuming just a little something before training after an overnight fast will go a long way in reassuring your stress response system that there is fuel available to support this activity. A half of an apple with some nut butter or hard-boiled egg is sufficient to get you started. Whole food shakes that you prepare yourself (free of any refined sugar) are also a great option.

• Nutrient timing - Put simply, the body wants fuel when it needs it, and the times of increased need are before, during, and after training. Ensuring that there is fuel available within 1 hour of a workout, during workouts that are > 1 hour in length, and within an hour after training will, again, reassure the stress response system that fuel is available.

Mother Nature has programmed within females an incredible capacity to adapt to physical training and sport, as evidenced by our innate ability to adapt to the profound physical demands of pregnancy across the entire spectrum of poor to good health.

But to unlock this potential, we need to work WITH our physiology and not fight AGAINST it. By understanding how the physiology of the menopause transition works, we are better equipped to thrive within these changes and live our healthiest lives full of vitality into our 8th, 9th, and even 10th decades!

Housekeeping…..

I am so thrilled to announce the launch of my latest course contribution, Navigate Menopause with my friends and colleagues at Feisty! This AWESOME course dispels the confusion and busts the myths surrounding menopause and gives you the tools you need to empower yourself to take your menopause experience into your own hands.

ENROLLMENT STARTS MONDAY JANUARY 22nd! Click HERE to sign up! Space is limited and will be closed once course capacity has been reached.

One of the most common things my midlife clients struggle with is weight gain. “The things that worked before just don’t work anymore” is the mantra of so many during this phase of life. They visit their healthcare provider with concerns about “waking up in someone else’s body”. The doc runs some tests - thyroid levels, blood sugar studies, and insulin - and all the results come back in the normal range. “Great news!” says their doc. “There’s no problem. You’re just getting older”. End of story.

Many of you who have heard me on various podcasts know that I’m not a fan of the notion that hormone testing reflects the entirety of the Human experience as many “practitioners” would have you believe. The relative insulin resistance of midlife is a perfect example. One does not have to meet the criteria for “pre-diabetes” or metabolic syndrome for there to be real changes for which there are interventions. Isn’t the goal of medical care to prevent these things in the first place rather than just send you away until you actually become diabetic?

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This is where understanding what’s happening inside your body during the various phases of hormonal life keeps you one step ahead of mainstream medicine. Today we will discuss the phenomenon of relative insulin resistance - the physiologic changes to energy utilization occurring in your body as a result of the normal hormonal changes of midlife - and how to mitigate the effects of these changes so that you can be your healthiest self.

Your Body on Carbs

In a nutshell, carbohydrate is consumed in the diet, digested and absorbed as glucose (among other simple carbohydrates), and utilized as fuel by the tissues in the body. Excess glucose that is not used is stored as glycogen in the liver and muscles, but also as fat. The hormone, “insulin”, is secreted by the pancreas in response to glucose entry into the bloodstream. Insulin drives glucose into the cells so that the cells can use the glucose as fuel to carry out their functions. The “efficiency” of insulin function is impacted by cycling estrogen and estrogen receptors on the surface of cells.

The two bodily systems that use the greatest amount of blood glucose are the brain and skeletal muscle - the voluntary muscles that move our bodies. During midlife, there is a decrease in cycling estrogen and estrogen receptor presence on the surface of skeletal muscle cells. As the ovarian hormonal cycles change and become irregular, there is less circulating estrogen. As a result, muscle mass, strength, and power decline along with the efficiency of the muscle’s ability to utilize blood glucose through insulin-mediated pathways.

A prominent player in cellular and insulin efficiency is an intracellular organelle called the mitochondria: the “batteries” that supply energy to cells. Below is an excerpt from my course Menopause Health and Fitness Specialist Course through MedFit Classroom that explains the science behind how skeletal muscle function is impacted by changes in estrogen and its receptors.

As we just mentioned, when blood glucose is not used as fuel, the excess is stored as fat. When the hormonal changes of midlife reduce the efficiency of glucose utilization by skeletal muscle, the result is a greater excess of unused glucose and increased storage of fat which results in changes in body composition.

Your End-Run Around Relative Insulin Resistance

There are three basic approaches to mitigating the impact of the hormonally-driven changes in how our bodies manage glucose. Resistance training (particularly weight training), nutrition, and neuroendocrine activation.

Resistance Training

If you want your muscles to use more glucose, then you need to increase the activity of those muscles. This looks different for different individuals. If you are sedentary, then starting with walking for 30 minutes 4-5 times per week is a great start! From there, add a weighted backpack, then maybe add some hills or even hiking trails. Simultaneously, engage a personal trainer for 6 weeks and become familiar with weight training. If you are an endurance athlete, make friends with the barbell. If you are a powerlifter, explore different ways to stimulate the muscles that add cardiovascular stimulation like combining running segments with heavy deadlifts. The point is, no matter what your fitness level or expertise, there are new and exciting ways to increase the functional capacity of your skeletal muscle.

Why does this work? The Human body is an amazing machine designed for survival. Mother Nature has programmed redundancies within our physiologic systems to promote longevity. We discussed the impact of our cycling reproductive hormones on how our muscles utilize blood glucose. Fortunately, other physiologic pathways facilitate glucose entry into the muscle cells that depend less on cycling hormones, most notably, the GLUT4 pathway. GLUT4 is a glucose transporter protein that works with muscle contraction to transport glucose into the cells. So when we stimulate muscle contraction through resistance training, this activates the GLUT4 pathway to facilitate the entry of glucose into the cells to be used as fuel, leaving less excess to be stored as fat.

Nutrition

We have discussed how glucose enters the cells of our tissues through pathways involving insulin and GLUT4 and how unused, excess glucose is stored as fat. In this section, we will discuss the other important part of this equation, which is the load of glucose that enters the bloodstream by way of the foods we eat.

Glycemic Index - The glycemic index is a measure of how much a carbohydrate source will increase blood sugar over 2 hours from the time of consumption. There are low, medium, and high glycemic index foods with a great description in this resource from Healthline. A lower glycemic index reflects lower blood sugar following consumption and a higher index reflects greater increases in blood sugar. This is important because the glycemic index reflects the glucose “load” on the systems (such as insulin and GLUT4) that need to shuttle the glucose into the cells. When the glucose load is greater, the systems can become overloaded, leaving more excess to be stored as fat. When the load is less, insulin and GLUT4 can better “keep up” with transporting glucose into the cells for use as fuel leaving LESS excess to be stored as fat.

By focusing on carbohydrate sources with a lower glycemic index and minimizing those with a higher glycemic index, you can effectively decrease the glucose load that insulin and other glucose transport pathways see and thus more efficiently use carbohydrates as fuel and minimize the excess that is stored as fat.

Neuroendocrine Adaptation

Adaptation is the ability of the body to adjust or “make familiar” movements or tasks that we undertake. This is a coordinated effort by the muscles, joints, metabolic, and endocrine processes all driven by the master puppetier we know as the Nervous System!

Because Mother Nature designed Humans for survival, our ability to adapt to physical stimuli and physical tasks is powerful! When we stimulate the muscles repetitively in the same way for an extended period of time, the body doesn’t need to work as hard to manage the load or task and effectively switches into “Auto-pilot”. This is great for elite athletes where the tasks that their sports require become second nature through adaptation.

However, from the standpoint of muscle physiology, they crave something more! This is why we train differently in the off-season: to keep the muscles guessing and thus contantly adapting to become fitter, faster and stronger so that we can crush it on game day! To learn more about this incredible phenomenon, check out Neuroendocrine Adaptation: Your End-Run Around the Menopause Transition.

Key Points for Combatting Midlife Relative Insulin Resistance

• Get moving! The first step to using more glucose as fuel and storing less as fat is to move those muscles. For the sedentary, walking, backpacking, and hiking are great ways to start.

• If you have never trained with weights, another great place to start is a group “boot camp” style fitness class. Find one at your local gym and sign up with a friend! My favorite group class for getting started with weights is Les Mills BodyPump.

• Any level of athlete can benefit from a 4-6 week training program with a trainer or strength coach to gain some basic skills and techniques from basic to more advanced movements depending on your fitness level/familiarity.

• Incorporate resistance/weight training at least 2-3x per week.

• No equipment, no problem! Push-ups and their many variations are fantastic for anyone of any fitness level to add mass, strength, and power to the muscles of the upper body.

• Take an inventory of your carbohydrate intake and using the resources in this LINK, identify carbohydrate sources and potential substitutions that can move the needle toward lower glycemic index choices.

• Nutrient timing is a strategy where carbohydrate intake is timed within an hour before training and within an hour after when the muscles are “looking” to fuel movement during the workout and then looking to replenish glycogen stores in the liver following a training session.

• Most importantly, be consistent, but be patient! It’s about progress, not perfection. Every little bit you can do has benefits.

For 20 years I have been practicing medicine and I have never been more baffled over how mainstream medicine misses the boat on the very foundation of good health: nutrition, physical fitness, and mental health. The frustration rings loud when I see patients and clients talk about how their healthcare provider “just doesn’t get it”. Midlife women experiencing menopausal symptoms are constantly dismissed with the “shrug" and “you’re getting older” with the undertone that screams “Just deal with it” and neglecting the very simple nutrition and movement strategies that can be game-changers.

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The other frustration I hear is from the competitive athletes. These are the women who meet the American Heart Association guidelines for “150 minutes of moderate-intensity exercise per week” by Wednesday and are told by their providers that they should “slow down” and “avoid intensity”. For the record, only 20% of the population actually meets those AHA guidelines, which underscores the abysmal job the medical community is doing to promote physical activity in the general population. But somehow, despite these well-known recommendations from the AHA, the 50-year-old competitive female athlete who is meeting and exceeding these guidelines is met with apprehension and in some cases contempt.

We haven’t even broached the subject of the barbell. More and more data in the medical literature supports resistance training for bone health, but squats, deadlifts, cleans, and bench presses are met with “you don’t need to do that crazy stuff - walking is just fine”. Now, I’m not demonizing walking. Everyone can benefit from walking, but it only scratches the surface of the benefits compared to what can be achieved with weight training.

It’s no wonder women are intimidated by the barbell - the negative messaging is everywhere despite the mountain of evidence for the long list of benefits of doing these types of lifts - not just for bone health, but for muscle health, metabolism, and joint health, to name a few. And these lifts are safe when you learn to do them correctly! Just like any other athletic endeavor -once you learn the proper mechanics and safety considerations, these activities can be enjoyed for the long term.

How did we get here?

So why does this “abyss” between the worlds of medicine and wellness exist? My personal opinion is that it is a matter of not having enough time to be good at everything. As knowledge in medicine and fitness advances, it can become overwhelming for any one provider to keep up with everything. As a result, providers become more specialized and focus their expertise in a more limited area. An example of this is the field of Obstetrics and Gynecology (OBGYN). Generations ago, the OBGYN doc did it all. They delivered babies, served as primary care physicians, dealt with infertility, incontinence, and menopause. Today, there is a separate subspecialty for every one of these areas: the obstetrical hospitalist who delivers babies, the urogynogolist specializing in incontinence, the Certified Menopause Practitioner, the infertility specialist - and the list goes on.

We can extend this idea to the “specialty” of nutrition, fitness, and wellness. In defense of my medical colleagues, they just don’t have the time or expertise to even begin to gain the proficiency of a personal trainer, nutritionist, strength, or triathlon coach. So what we have, are these medical and wellness “specialties” living in their own “silos”, isolated from one another. What’s missing is the means to integrate these “silos” into a functional, interdisciplinary team approach to optimal health for females.

A New Medical Model Emerges

Over the last decade, the need for an integrative approach to healthcare has been appreciated by some medical providers and wellness professionals. Functional Medicine providers are ahead of the curve as compared to their Allopathic counterparts in placing more emphasis on lifestyle and environmental factors as the foundation of care, as compared to a “pill to solve every ill”.

The fitness industry has also moved toward breaking down the walls of the silos. In 2017, Greg Glassman, the Founder and former CEO of CrossFit recruited physicians who are part of CrossFit communities from all over the world to come together to create an entity with the mission of “curing chronic disease” with the foundational principles of sound nutrition and physical fitness rooted in “constantly varied functional movement at high intensity” and eating “meat and vegetables, nuts and seeds, some fruit, little starch, and no sugar”.

As one of the physicians who was recruited, this experience was one of the most inspirational things I have ever done in my career. As part of this recruitment, physicians participated in a weekend-long training for the CrossFit Level 1 trainer credential at “The Ranch” in Aromas, California - where the CrossFit “movement” was started in the early 2000s. We trained with some of the most elite trainers in the industry and shared our passions as physicians who wanted to make a difference off the beaten path of the “pill for every ill”.

I met physicians who were already integrating wellness and medicine into their medical practice by having their medical “office” as part of their gym or facility. We created a “network” of providers with their locations and contact information as a referral base so that fitness professionals and providers have a resource to refer their clients for this more comprehensive approach to good health. Sadly, we need more of these practices to meet the needs of our patients and clients who are continually let down by “mainstream medicine”.

The biggest shout-out, however, goes to my colleagues at Wild Health, where they have this integration down to a science! The keystones of the Wild Health model are precision medicine with an extensive genetic assessment to help personalize care. Every client has a lead physician and a health coach with access to various specialty consultants, such as myself, for more specialized care in hormonal issues, immunology, and the like. This model is a true representation of the integrated approach so sorely needed in medicine and wellness today.

Now it’s my turn

It is with great excitement that I announce the upcoming launch of my medical practice in the fall of 2024 specializing in “Reproductive endocrine care for active and high-performing women from puberty through menopause”. This is the first Women’s tele-healthcare specialty concierge practice of its kind that integrates cutting-edge medical practice with individualized fitness and wellness resources through the Health and Wellness Concierge (HWC).

The HWC is composed of a team of “Concierges” who are highly credentialed and experienced in coaching active women and elite female athletes of all ages and athletic backgrounds. Every patient chooses a “Concierge” who helps connect them to the resources they need to achieve their health, wellness, and performance goals. The HWC program also provides clients with exclusive discounts on products and services from some of the most esteemed names in the fitness and wellness industry.

To start, I will be accepting patients for medical consultation who reside in Massachusetts, New York, New Jersey, Ohio, and Florida, with additional states to be added as demand increases. If you do not live in these states but need help, I also offer non-medical and performance consultations to provide guidance and suggestions that you can take to your healthcare providers, coaches, and trainers for further discussion. There will also be “membership access” to the HWC for non-medical clients.

The Future

Despite the challenges that Women’s healthcare faces, there is a clear trend in the right direction. As the Title IX generation is entering a stage of life with years of wisdom and experience behind them, the trailblazing continues. We are more aware. We ask questions. We question what doesn’t make sense and empower ourselves with the resources we need to thrive and leave the “status quo” of past generations behind us. Just like Title IX changed the landscape of women’s sport forever, this same generation will also change women’s healthcare forever! Game on!

Now Hiring….

Coaches and trainers!!!!! I am looking for a Coach/Trainer who resides in the New York /New Jersey metro area to be a member of my HWC Concierge Team! I am looking for experienced individuals who:

• Are passionate about helping women thrive

• Have experience coaching/training women of all ages

• Ideally have some special training/experience with mid-life women

Some details about the opportunity:

• Independent contractor relationship

• Connect HWC Clients to the resources they need to achieve their wellness goals with an opportunity to promote your own services if they meet the needs of the client.

• Promotion on the Carla DiGirolamo, MD medical practice website as a member of the Concierge Team with opportunities to promote (for FREE) your profile/business, podcasts, and the like.

• Bonus opportunities for performance excellence and client satisfaction

• Become a part of this growing and collaborative Concierge Team! We have 3 amazing Coaches from Massachusetts, Florida, and Ohio already on board!

If you are interested in learning more about this opportunity, please email me at julygirl00719@gmail.com

Team! 
We are hearing so much about "Zone 2 training" lately that it's sometimes difficult to make sense of it all. This post puts a different "spin" on the application of zone 2 training and how to execute it to revitalize your mind and body when they are not necessarily on the same page... and don't forget to check out the exciting announcement in the Housekeeping section at the end!
Cheers!
-Carla

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Have you ever had one of those days (or weeks) where your mind was craving a soul-crushing workout but your body wasn’t havin’ it? This week I found myself grappling with that very dilemma.

If you are like me, training is what keeps you sane. The conflict arises when the mind wants and needs one thing, but the body is just not on board, leading to mental frustration and potentially self-loathing.

Life and work stress had me by the throat these last 2 weeks and all I wanted to do was achieve a mental reset with a workout that spiked my endorphins to the moon and had me rolling on the ground to collect my soul afterward. But with some long OR coverage days, < 6 hours of sleep every night, and being off of my eating schedule, my body said “no way” to the soul-crusher workout.

So now what do I do? Fortunately, my amazing Coach @erika_snyder_ assigned me a Zone 2, CrossFit-style workout from Train FTW in my weekly coaching notes. But before we dive into this incredible workout and its benefits, below is a quick primer on heart rate zones and finding your Zone 2.

What is Zone 2 Training?

There are 5 heart rate “zones” based on the percentage of one’s “maximum” heart rate, an indicator of the maximum output the athlete’s body can produce.

An athlete’s maximum heart rate varies among sports and physical activities, but there are generally 3 ways one can estimate their maximum heart rate:

• [ 220 – Age ] – most common method

• [ 207 – 0.7 x Age ] – more precise for people over the age of 40

• [ 211 – 0.64 x Age ] – another method used for generally active people

The 5 heart rate “Zones” as a percentage of calculated maximum heart rate are as follows:

• Zone 1 - 50-60% - recovery

• Zone 2 - 60-70% - building aerobic capacity, fat burning

• Zone 3 - 70-80% - building aerobic capacity and muscle strength

• Zone 4 - 80-90% - anaerobic threshold

• Zone 5 - 90-100% - anaerobic, sprint/power for short duration

How do I know that I am in Zone 2?

Ideally, an accurate heart rate monitor like a Wahoo or a Whoop! strap can identify your Zone 2 so that you can familiarize yourself with what zone 2 “feels like” to you. But if using technology is not preferable, below are some more subjective indicators:

• The “Talk test” - The level at which you cannot speak a 15-word sentence without stopping or slowing down. At rest or in zone 1 (casual walk), you can speak long sentences without pausing to breathe. In Zone 2, your breathing is such that you need to slow the phrase or take a breath in the middle.

• The “Breath test” - This was a cue suggested by my coach but assumes you have unobstructed nasal breathing. You are in Zone 2 if you can perform the exercise breathing through your nose. Once you start mouth-breathing, you are in a higher heart rate zone.

TIP! Your Zone 2 will differ depending on the physical activity. A pro cyclist will have a lower heart rate at a higher capacity on a bike, but if she were to do a weight-training circuit, she may hit her zone 2 at a lower capacity. Engaging in Zone 2 training across different physical activities will build aerobic capacity across a wider range of physical challenges.

I approached this workout begrudgingly. I was not in the mood for Zone 2 - I wanted Zone 5. But, this was a long workout - 50 minutes - that had some very challenging movements that I had not done before. I could accept the challenge of the restraint it would require to stay within zone 2 for an extended period of time. So I was game. Erika’s “cue” for this workout was to “feel good” and that means “.. this hurts a little but I could do it forever”.

That cue was gold! Not only did I find that feel-good place, but I could get lost in it. Having multiple movements to keep track of and new movements to learn and practice kept my mind off of the chaos of life and allowed me to focus on the present moment in the workout. This was a full-body effort that targeted mobility, core, and lower-body strength and included 3 slow and steady endurance movements that kept my heart rate out of the stratosphere. By the end, it was a sweat-fest! My body felt great and my mind was energized!

The workout: A modification of a workout inspired by Train FTW. You can find instructional videos for these movements on Train FTW on YouTube

Looking back on this, I appreciated a sense of “cumulative” intensity. I essentially took the intensity of a “soul-crushing” 20-minute CrossFit workout and instead, spread it out over 50 minutes. This achieved what my mind was craving but in a way that my battered body could still achieve. It was the perfect solution that kept me sane, physically and mentally challenged, yet kind to my body at the same time.

Benefits of Zone 2 Training

• Reduces the risk of diabetes, heart disease, and certain cancers, according to the CDC

• Increases the number and efficiency of mitochondria (The “batteries” that supply power to cells and tissues).

• Improves insulin sensitivity

• Improves muscle utilization of glucose through insulin-dependent and independent metabolic pathways.

• Improved conditioning and efficiency of cardiac (heart) muscle.

• Greater oxygen capacity and longevity

Now, before we put 5 days of zone 2 training into our schedule, hold up! Zone 2 training certainly has its place, but women - especially midlife women - need other things too. We need resistance training that pushes the margins of our abilities to stimulate our muscles and bones. We need sprint and high-intensity interval training (HIIT) for our cardiovascular and nervous systems. We need mobility, active recovery, and mindset work to return our stress response system back to baseline. So although Zone 2 training is important, it is just one important piece of an effective fitness program. A recent blog post by Dr. Stacy Sims What Women Need to Know About Zone 2 Training puts this point in perspective.

Today, I have come out the other side of 2 weeks of nonstop madness and now I am ready for that 20-minute soul-crusher! So the take-home message here, is that including zone 2 activities in your training is not a compromise on “intensity”, it is a necessary part of it - for the body and the mind. So when you are feeling discouraged because your body and mind are in different places, give a workout like this a try and keep it in your back pocket for those challenging times.

References:

The Athlete Blog - 3 Ways to Calculate Maximum Heart Rate and Why it’s Needed

Levels - Metabolic Insights: The Metabolic Benefits of Slow, Steady Zone 2 Exercise by Greg Presto and Dominic D’Agostino, Ph.D.

Housekeeping…..

If you are an Endurance athlete you don’t want to miss this!!!

STRONG. by Feisty is back! This time, with a special focus on the strength-training needs of endurance athletes and some new coaching and community activities with world-class triathlete and coach Lynda Rowan! For a limited time, October 25th - November 1st, here’s what you get:

• 7 modules that cover everything from mindset and goal setting to injury prevention, nutrition, and strength training considerations by life phase

• A mobility routine to help you stay injury-free when lifting

• Nutrition guidelines for before, during, and after strength training sessions

• Guidelines to help you with any gym setup

• An exercise library of over 40 demo videos created for women by women

• A 16-week adaptable training program 

• A weekly community check-in with a certified endurance coach (November-January)

• Networking sessions to help you find accountability partners or groups 

• Opportunities to win fun prizes when you complete community challenges

• Off-season cohort pricing: $149.

Are you ready to up your game? Learn more and sign up HERE.

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Practicing What I Preach

As a reproductive endocrinologist specializing in women’s performance, I encounter women on a regular basis struggling to thrive within their changing hormonal life stages, the demands of their careers, family life, and athletic pursuits.

This is especially true of my midlife clients transitioning into and beyond menopause. This is the time of life when parents are aging, kids are driving and going off to college, they hold the highest positions in their careers, and are still competitive in sport. With age, experience, and wisdom, we have become master multi-taskers!

But it’s a double-edged sword. This level of “life management mastery” is not always welcomed by this new hormonal paradigm where the protections afforded by our menstrual cycles against a constantly taxed stress response system have taken a permanent vacation. What we are left with are mood swings we don’t understand, anxieties we never had before, and in many cases waking up in a body and mind that is unrecognizable on so many levels.

A major focus of helping women thrive at this time of life is optimizing muscle, bone, cardiovascular, and metabolic health because these areas are significantly impacted by the menopausal transition. But this is just one part of the equation. There is another dimension that often gets lost and that is headspace.

It’s so easy to get “caught up in the weeds” of our everyday lives. We strive to be the best in our careers, and our sports, to be the best moms, wives, and partners. We support the world on our shoulders because we can and that is what we do best. Until it’s not.

Just like we can overtrain our bodies, we can also overtrain our minds. This can be very insidious. There are no “lab tests” that can tell us that we are hitting the mental “red zone”. But yet, the mind-body connection is so powerful - and can drive so many of our physiologic processes without us even realizing it. Not only does our mental headspace dramatically impact our physical being, but it also impacts our quality of life - and isn’t that what it’s all about in the end?

I learned this the hard way this summer. I am guilty of all that defines mental overtraining despite the fact that I am an expert in menopausal health and fitness and spend my days guiding my clients on the path to thriving. What I quickly learned is that just because I’m an expert in this area doesn’t mean that I have my own sh*t together.

My realization came after spending 2 weeks in my Narragansett, Rhode Island home and leaving this paradise exhausted, cranky, and frankly, a bit angry, but not sure at what or with whom. This was a wake-up call because I wait all year for these 2 weeks in July and I left it feeling miserable. So, I kept swimming against this riptide until I arrived at August for our family vacation on Lake Winnipesaukee in New Hampshire. I was at the point where I said “Enough is enough. I’m not making the same mistake during this vacation”. For the first time in my post-graduate career, I unplugged - really unplugged - and it hit home when my husband said to me “I don’t remember the last time you took a vacation day”. Truth is, I didn’t either. When I think back, the last vacation when I truly unplugged was on our honeymoon in 2002.

Everything was put on hold this week. Instead of training, I went out hiking, biking, and kayaking. I did not post any new content for Athletic Aging other than my vacation pic at the Lake - and you all were so understanding and my blog lived to see another day! I put my work for the STRONG course by Feisty Media on hold - and it still got out on time! It was the most amazing vacation! I was there for my family and myself. I started a morning meditation routine and this has been a game-changer that I continue to do to start my day. My WHOOP! strap thought I died and went to Heaven! It truly was an enlightening experience and it was so impactful, I made a vow to myself to take this lesson forward, be true to it, and share what I learned with others!

Tips for achieving your “mental reset”

RED FLAG ALERT: If you leave your vacation feeling, exhausted and cranky, you need to do something different.

• Communicate with friends, family, and coaches. Others can often see things in you that you are not aware of.

• Plan a time to unplug and commit to it. Set expectations for those people and entities with whom you have obligations.

• Take a step back and prioritize what will “live to see another day” if you set it aside, and be honest! If you are a control freak like me, you think that the world will implode if you set ANYTHING aside. Check your ego at the door, take a big exhale, and now make that priority list. When I did this, I realized that I could put EVERYTHING aside for just one week - and the Earth is still managing to orbit around the sun!

Helpful Resources

• Committing to a regular meditation practice was pivotal in achieving my mental reset. I signed up for Headspace. This app is great because it caters to newbies to meditation like myself, has a variety of areas of focus, and the guided meditations are short and manageable even during my busiest days or while traveling.

• WHOOP: Podcast No. 12: Andy Puddicombe, Buddhist Monk and Co-Founder of Headspace

• The Benefits of Mindfulness and How to Practice It

• Benefits of Meditation and How to Get Started

Full disclosure: I used to be one of those people in my younger years who made fun of (secretly) the yogis and the meditators. I always thought this stuff was very woo woo and I can still hear my Father’s mantra of diminishing emotion and pushing through at all costs. Well, Dad (may he rest in peace) never went through menopause. So, my friends, if I can put my ego aside, so can you! Take your time to reset. You deserve it and you will come out stronger and happier than ever!

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Before you say to yourself "this isn't for me" or "I can't do pull-ups" think again! "Pulling" is a universal, functional movement that we do every day and training with pulling movements is a very effective way to build upper body strength, mobility and stability surrounding the shoulder joint - for every day living and for taking  your physical performance to another level.  No matter what your age, ability or fitness level, this post IS for you!
Enjoy!
-Carla

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Functional fitness, by definition, involves movements that we do to “function” in our everyday lives. These include squatting, pulling, pushing, deadlifting (ex -picking up a bag of groceries), and pressing, to name a few. CrossFit methodology was built upon constantly varied, functional movement.

If you subscribe to the Athletic Aging Weekly Workout, then you have experienced functional movements at work and, hopefully, have observed benefits for your personal fitness and overall physical functioning.

A foundational functional movement that many find very challenging and intimidating is hanging from a bar and pulling the body up to reach the chin over the bar. This is known as a “pull-up”. There are many modifications of this movement with different ways to grip the bar and with varying levels of assistance with a machine or resistance band. In whatever way this movement is performed, there are tremendous benefits for building upper body strength that involve the coordination of several muscle groups to successfully execute the movement.

Why this is important for midlife women:

1 - Builds muscle strength during a time of life when strength declines.

2 - Increases shoulder stability during a time of life when joints become less stable.

3 - Improves grip strength which declines with age. Grip strength is a marker of vitality in midlife women. Poor grip strength is associated with sarcopenia (severe loss of muscle mass and strength), reduced mobility and quality of life.

A recent post in the National Academy of Sports Medicine (NASM) blog written by Kinsey Mahaffee highlights the pull-up and chin-up in a comprehensive review of movement mechanics, benefits, how to stay safe and avoid injury in her post “Chin-Ups vs. Pull-Ups: The Difference, The Benefits & The Muscles Worked”.

Today, we will focus on a variety of pulling movements that suit any level of fitness or ability and how to perform these movements safely and avoid injury.

Pull-ups versus Chin-ups: What’s the difference?

• Pull-ups are performed by gripping the bar with the hands positioned shoulder-width apart and palms facing away from you. They predominantly target the muscles of the upper back (lats, rhomboids, and traps) and the back of the shoulders (posterior deltoids).

• Chin-ups are performed by gripping the bar with the hands positioned just inside shoulder width with the palms facing toward you. They predominantly target the muscles of the upper/outer back (lats and teres major) and posterior deltoids, but they also heavily recruit the biceps muscles, which takes some of the workload off of the back muscles.

Which is better? Neither! Both of these movements will build upper body strength effectively, just a little differently. Incorporation of both of these movements into your training will provide greater versatility to your upper body strengthening than simply sticking to just one or the other.

• For a video demonstration of proper mechanics for the pull-up, click HERE

• For a video demonstration of the proper mechanics for a chin-up, check out the video embedded in the NASM blog post linked HERE.

What if I can’t do a Pull-up or Chin-up?

Not to worry! There are many modifications and alternatives that offer the same benefit as the strict form of these movements. Check out the modifications link above for even more options.

• Band-assisted pull-up: If you are unable to pull your full body weight above the bar, a resistance band can help! Use a thicker band for more assistance and a thinner band for less. Your gym may also have a pull-up “machine” with a platform you stand on where you can “set” the amount of assistance.

• Jumping pull-ups: This is another great alternative to strict pull-ups that targets the same muscles but does not require pulling your entire weight from a hanging position. The “jump” takes much of this load off, but still requires the recruitment of these same muscles to finish with your chin above the bar.

• Ring rows: This is an AMAZING alternative to pull-ups because you can make them as easy or as difficult as you need. For an easier pull, position the body more upright. For a more challenging pull, position the body closer to parallel with the floor. For an even greater challenge, you can even elevate your feet on a stable box or bench.

  Rings are relatively inexpensive and can be easily attached to a doorway pull-up attachment with no worry about height. Order a pair HERE.

What if I am concerned about injury?

Pull-ups and the many modifications described above can be done safely whether you have never tried this movement before or if you are recovering from an existing injury. Here are the main points to consider:

• Establish stability and strength surrounding the shoulder joint before starting a pull-up program: There are lots of great exercises for the small muscles that stabilize the shoulder - Y and T raises, Cuban Presses, scapular push-ups, and many others. My personal favorite shoulder strengthening system is Crossover Symmetry. I can vouch for this system personally because it saved me from shoulder surgery. If you have shoulder pain, another great resource is The Ready State, by renowned physiotherapist, Kelly Starrett.

• Prioritize sound mechanics: When learning these movements, team up with a trainer who can supervise your technique until you are confident in performing the exercise unsupervised. If you are familiar with the movements, watch the demonstration videos for a refresher. Another great tool is to video yourself so that you can share it with your trainer who can provide feedback or view it yourself and compare it with the video demonstrations.

• Pain-free range of motion and load: If you struggle with shoulder pain, first and foremost, seek evaluation by a healthcare provider to determine if medical intervention is necessary. Experiment with the different options presented here and find an option, range of motion, and level of assistance (band or machine) that allows you to perform the movement pain-free. Then build upon this movement with proper progressions maintaining pain-free movement with sound mechanics as you increase the difficulty.

• Don’t overdo it. Shoulder and elbow pain and injury are often a result of overuse with inadequate recovery. If you are new to this movement, focus on it no more than twice per week. Once you become accustomed to this training, build your volume and movement progressions ensuring that you recover adequately with mobility work, tissue care (massage) proper nutrition, and adequate sleep.

Whether you are an elite athlete or beginner, young, midlife, or elderly, there is a wide range of options that will provide the same benefits as strict pull-ups. So don’t let this movement intimidate you! Level up your fitness, strength, joint stability, and upper body conditioning - safely and effectively!

Resistance training involves applying load to the muscles and bones by systematically manipulating variables such as the amount of load or weight, repetition range, the volume of repetitions, frequency, rest periods, exercise selection, the order in which the exercises are performed, and the velocity of muscle actions.

The benefits of resistance training for mid-life women are becoming more well-known and include the maintenance of muscle and bone mass, metabolism, and increased physical self-confidence and vitality, to name a few. When we discuss resistance training, some say that training with high repetitions with low weight is best - others promote heavy weights with fewer repetitions. The truth is that both are important! We can achieve increases in muscle strength, mass, and power through a wide variety of training paradigms.

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Hypertrophy, Strength, and Power

Building muscle mass (hypertrophy) and building muscle strength are not the same thing. Hypertrophy refers to the mass or size of the muscles. Strength refers to the amount of load or weight that can be moved. Muscle power is the amount of load that can be moved in a given time period. All of these elements are important for muscle and bone health, athletic performance, and longevity and require variations in training to achieve all three.

In midlife - particularly at the time of menopause - females experience a decline in muscle mass and power due to declining circulating estrogen and tissue estrogen receptors that result in loss of muscle mass, a shift from fast-twitch type II skeletal muscle fibers (power-generating fibers) to slow-twitch type I fibers (endurance fibers) and reduced efficiency of the muscle cells to generate energy for contraction and for cellular repair.

These changes in skeletal muscle also impact metabolism. Skeletal muscle is the body’s second highest utilizer of blood glucose, second only to the brain. With the decline in muscle mass, the hormone, insulin, needs to work harder to help the muscles use blood sugar to fuel movement. This can lead to a state of relative insulin resistance and if severe, can lead to diabetes, obesity, and metabolic syndrome (high blood pressure, high cholesterol, diabetes).

Goals of Training

Considering these changes that accompany mid-life, it’s important to keep the following goals in mind for athletic performance as well as longevity and vitality.

Hypertrophy. Muscle mass is the foundation upon which muscle strength is built. To be strong, muscle mass is needed. Mass is also important for the metabolism of blood sugar and optimizing the function of insulin.

Strength. The ability to move weight is important for activities of daily living as well as for many competitive sports or high-performance occupations. Yard work, moving boxes or furniture, carrying groceries, and even rising from a chair require muscle strength. This is where hypertrophy and strength diverge. One can be strong without an over-abundance of muscle mass, and an over-abundance of muscle mass does not necessarily correlate with overall strength.

Power. The ability to move a load over time is defined as muscle power. Greater loads over a shorter time yield the greatest power. The nervous system now enters the equation because the ability to react to a stimulus in a coordinated way instantaneously requires a coordinated effort between the skeletal muscles and the nervous system. Some examples include tripping and breaking your fall, evading an obstacle, and team sports such as rugby, Olympic powerlifting, and CrossFit to name a few.

Resistance Training - Getting Started

In general, it is well-accepted that lower load, higher repetitions, and thus a greater duration of time under tension increase local muscular endurance. Conversely, greater loads, lower repetitions, and thus shorter times under tension are more effective for increasing muscular strength. However, in untrained women, lower weights at higher repetitions have been shown to build hypertrophy and strength.

For clients of all ages who are new to weight training, starting with lower weights and focusing on sound mechanics of movement is the goal. Engraining those good habits with higher repetition schemes will familiarize the untrained athlete with safe movement patterns, stimulate hypertrophy and strength, and build confidence upon which to advance their training.

PLUG: As a former Les Mills BodyPump instructor, I experienced firsthand the benefits of a higher repetition/lower weight strategy for introducing weight training to untrained (and trained) individuals in a safe, fun, and friendly group setting. I would highly recommend checking out a class at your local gym or through Les Mills On Demand.

Resistance Training - Building upon Your Foundation

Once you are familiar with and practiced in the basic movements of weight training (squats, deadlifts, bench press, and shoulder press), there are many ways to advance your training to achieve your training goals.

When designing resistance training programs, there are multiple variables that can be adjusted to achieve a given stimulus, depending on training objectives. We can adjust load (or weight), the number of repetitions, the tempo of the repetitions, the range of motion, and work-to-rest ratios. In the CrossFit world, we add another dimension by pairing short endurance activities or other complimentary movements with weightlifting segments to challenge moving load under fatigue.

What is repetition tempo?

Tempo: Refers to the timing of eccentric (muscle lengthening ie “lowering into a squat”) and concentric (muscle shortening ie “rising from the squat”) phases of movement.

Examples:

Squat: 1/1 = 1 second eccentric (lower) and 1 second concentric (rise) = total 2-second repetition time

Squat with a pause at the bottom: 2/1/1 = 2-second eccentric, pause for 1 second at the bottom and 1 second concentric - total 3-second repetition time.

Training for Hypertrophy - A meta-analysis of studies reviewed by Mang et al in the ACSM Health and Fitness Journal reports a wide range of repetitions (3-35 repetitions) and repetition tempo durations (0.5 - 8 seconds) are effective for building muscle mass. Below are two of my personal favorites, but there are a number of possible variations:

1. Squats. Every 2:00 (E2:00) on the 2-minute mark, perform 10 repetitions for 5 sets. Tempo: 1/1 at 50-60% of 1 repetition maximum (1RM).

2. Squats. Every 3:00 on the 3-minute mark, 7 repetitions for 5 sets. Tempo 2/1/1.

Training for Strength - Mang et al also report that the collective literature supports lower repetition ranges and higher load for increasing muscular strength. Below is an example of a program designed by my amazing Coach, Erika Snyder, to help me increase my strength. For strength building with lower repetitions/heavier weights, it is important to allow enough recovery (3-5 minutes) between sets.

• Week 1 - E4:00 1 set of 5 repetitions (1/1 tempo) x 3 rounds at 65%/75%/85% of 1RM

• Week 2 - E4:00 1 set of 3 repetitions (1/1 tempo) x 3 rounds at 70%/80%/90% 1RM

• Week 3 - E4:00 1 set of 5 reptitions (1/1 tempo) at 75% 1RM, 1 set of 3 repetitions at 85% 1RM and 1 set of 1 repetition at 95% 1RM

• Week 4 - De-load week: E3-4:00, 1 set of 5 repetitions (1/1 tempo) x 3 rounds at 40%/50%/60% 1RM

• Week 5 - Heavy single re-test. Warm Up with 2 sets of 3 repteitions and 2 sets of 2 repetitions (3 minutes between sets) at 50%-75% 1 RM. E4:00, 1 repetition E4:00 x 3 rounds at 85%/95%/100+% 1RM (all at 1/1 tempo).

  If you do not know your 1RM, that’s ok! The goal is to complete the repetitions above unbroken with the heaviest load you can do while maintaining safe and solid movement mechanics.

Interestingly, a study by Wescott et al. showed that super-slow tempos (repetitions lasting more than 10 seconds each) have also been shown to be effective for increasing strength. Some examples include 1 set of 8-12 repetitions with a tempo of 4/1/2 was effective. Another study group performed 1 set of 4-6 repetitions with a tempo of 4/10 and reported increases in strength.

Training for Power - Muscular power equates to force x velocity, which is the ability to move heavier weight in a short period of time. Logically, if we think about repetition tempo, shorter time intervals will generate greater power. For the eccentric (lengthening) phase, 1-2 second durations generate greater barbell velocity and power when compared to longer durations. During the concentric (shortening) phase, rapid (<1 second) durations generate the greatest power. However, there is evidence that muscle power can be increased over the long term with 2/2 repetition tempos.

Putting it all together

The end goal of resistance training is to support our muscles and bones for athletic training, sport, high-performing professions, and longevity into our 8th, 9th, and even 10th decades! These activities are complex and require muscle mass, strength, and power and thus our training programs should reflect these goals. Due to the overlap in programming that may effectively train more than one of these elements at a time, a wide variety of movement repetitions, tempos, and loads can be utilized.

Constantly varying these metrics and even adding complementary movements to a resistance program as is done in CrossFit, adds an additional level of nervous system stimulation and thus greater challenges to physical adaptation and greater levels of fitness. Lastly, the culmination of these efforts results is in the activities themselves. We train in the gym for the activities we engage in outside of the gym, and this comprehensive strategy will keep you performing at your best in your sport and in life for years to come.

References

Mang Z et al. The Ultimate Guide for Selecting Repetition Tempos; ACSM Health and Fitness Journal May/June 2023

Women Need Strength for Life - Dr. Stacy Sims

Dinyer TK et al. Low-Load vs. High-Load Resistance Training to Failure on One Repetition Maximum Strength and Body Composition in Untrained WomenJ Strength Cond Res 2019 Jul;33(7):1737-1744.

Ribeiro AS et al. Effects of Traditional and Pyramidal Resistance Training Systems on Muscular Strength, Muscle Mass, and Hormonal Responses in Older Women: A Randomized Crossover Trial J Strength Cond Res 2017 Jul;31(7):1888-1896.

Wescott et al. Effects of regular and slow speed resistance training on muscle strength J Sports Med Phys Fitness 2001;41(2): 154-8

My Friends!
The magic of the fitness journey of mid-life is the opportunity to seek new frontiers, goals and challenges. The physical changes that come with age - and even worldwide pandemics - serve as opportunities to expand our fitness horizons in ways we otherwise never would have, had we not been faced with these challenges. Today I share my personal journey as a CrossFitter who is taking on her fitness nemesis - running! 
Enjoy!
-Carla

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The “Master’s” population (age 35+) is the most rapidly growing demographic in the CrossFit world. In fact, in 2021 two new age divisions were added for men and women age 60-64 and age 65+, and just a side note, 60% of CrossFitters are women.

“CrossFit” is defined as “constantly varied functional movement at high intensity”. What that translates into is a fitness program with an expansive repertoire of physical movements programmed in various combinations to achieve a multitude of training stimuli. But one of the best things about CrossFit is that it can be scaled for any level of fitness or physical limitation, lending accessibility to many demographics. The high variability, range of physical skills, and mental grit prepare the athlete for just about any type of physical encounter. Basically, CrossFit is training for whatever life throws your way.

It’s no wonder it has caught on in the older population. Varied and scaleable training is exactly what we need to face the physical challenges of aging, prevent chronic disease, improve physical mobility, and maintain quality of life. This type of training is particularly good for mid-life women. Weight training and plyometrics support metabolism, muscle, and bone health, and opportunities for high-intensity interval training support cardiovascular health.

So at age 45, I drank the Kool-Aid, took my fitness to a whole different level, and became a more resilient, well-rounded athlete than I was in my 20s and 30s. I became a student of the methodology and earned my Level 1 Credential as a CrossFit Trainer shortly thereafter. The foundational principles that really resonate with me are that “fitness happens beyond the margins of our experiences” - which basically means moving outside your comfort zone and “training your weaknesses” to become a more diverse athlete.

Fast forward about 8 years. I’m still drinking the CrossFit Kool-Aid but along the way met an amazing athletic population in the endurance world. I have had the pleasure of meeting women who became triathletes in their 50s, an 81-year-old who is still competing in triathlon and so many others. Being inspired by these women motivated me to take on my fitness nemesis since childhood - endurance running!

Being a typical CrossFitter, I shudder at the 1800m runs that one commonly sees in the workout of the day (WOD). So “endurance” running for me was any run lasting longer than 5 minutes. Yes, I’m serious.

My amazing coach @erika_snyder_ imparted the value of “running headfirst into your weaknesses” and I felt, what better way to do that than to venture into the endurance world!

This journey has been fun and I’m managing 5K distances without a problem, but I would now like to get faster and maybe log even longer distances. So Erika recommended a fantastic running coach to give me some guidance on how to achieve this next level. Enter “Hill training”!

As a physician, trainer, and menopausal athlete, I have read - and posted - on the benefits of high-intensity interval training. Dr. Stacy Sims and others have blogged about this extensively. We see this type of training in CrossFit all the time in “monostructural” workouts where the WOD could simply be a progression of rowing intervals with different ratios of work and rest. Some workouts have combinations of movements such as thrusters, deadlifts, or push-ups in 2-3 min sequences with 1-2 minutes of rest in between. So how different could hill training be?

In a sentence, hill training felt like I was on a different fitness planet. Running in and of itself has taken me so far out of my comfort zone that I sometimes forget where that zone is, so adding hill training to the running fun has been HARD - but AMAZING!

After a gruelling hill-training session on my neighborhood “Heartbreak Hill” (ironically, 2 miles from the starting line of the Boston Marathon), I messaged my friend, Selene Yeager to whine about it. She quickly reminded me how good this is for me - and for any other menopausal woman and pointed me in the direction of her blog “The Magic of Hill Training for Menopause”.

This is a great read and even though conceptually, I felt like I should know this, this type of training is in a category all its own - and I didn’t realize this until I experienced it for myself.

There are many ways to start hill training. Selene’s blog has a great description of this, but some quick highlights including my own experience are as follows.

First, you need to find a moderately steep hill that you can run for quick spurts. Second, make sure you warm up properly with some dynamic stretching (I like the Modified Hinshaw warm-up from TFW) and some quick, easy jogging intervals on flat ground for about 5 minutes. Warm-up is key!! Don’t skip it!

One approach is to start with intervals ranging from 10 - 30 seconds of running uphill with 1-2 minutes of walking/rest in between depending on your fitness level and running experience. My coach suggested 3 min intervals of hill repeats, running up, and a slow jog down with 3 minutes of rest in between each 3-minute interval. This is really hard, and I’m struggling with it, but I’m managing and improving every time I try!

As difficult as this new fitness journey is, I feel invigorated seeing real improvements the longer I stick with it. For me, this mid-life fitness journey is about becoming the most resilient, well-rounded athlete that I can be to support this next half of my life.

As a first-time CrossFitter at age 45, I expanded my fitness horizon to include Olympic lifting, gymnastics, plyometrics, and the soul-crushing classic CrossFit benchmark workouts (see “Meet Fran” from earlier this week). The aches and pains of age and menopause drove me to mobility work and yoga - and now I can do headstands and control my body in ways I never could before. Mindfulness practice and breathwork are new for me and so powerful for helping me overcome self-doubt and bring my cortisol response back to baseline. This path to aging is difficult terrain - but if you are willing to get your hands dirty and turn over a few rocks, you’ll find real opportunities and new paths that you may never have considered before!

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I have never been the most tech-savvy. I was still using paper maps 5 years after the GPS became mainstream. The iPhone 6 had debuted before I parted with my Blackberry and just 2 years ago I learned how to post on Instagram. Wearable technology is no different. I always felt like "I don't need a device to tell me I didn't sleep well last night".

It wasn't just that I was tech-challenged. There was "the numbers thing".  For much of my career, I have been surrounded by data and am quite comfortable interpreting it.  But I also had this habit of attaching "self-worth" to certain numbers- such as the workout timer in the CrossFit box, the weights on the barbell, whether I could do the CrossFit WOD “Rx”, my USTA tennis ranking and the list goes on.

Through years of time spent with my amazing coach, @Erika_Snyder, we worked on this- much like many others try to change their relationship with the scale or their pant size. But I wasn't quite there yet. I asked Erika what she thought about using a “wearable” and one thing she said really resonated with me. "I don't need yet another set of numbers to tell me how imperfect I am". This hit home, so I put the WHOOP! strap idea on the back burner.

About a year later, I was in a much better place with my relationship with numbers. Through COVID and some major shoulder issues, my work with Erika focused on process, mechanics, pain-free movement, and rebuilding from the ground up so that I could rock my push-ups again and make gains with my heavy lifts. Even the legendary strength coach, Mike Burgener spoke about the benefits of using subjective measures such as rate of perceived exertion (RPE) as an alternative to set numbers (i.e. percentages of the 1 rep maximum) during a recent interview with Morning Chalk Up.

As a result of shifting my focus and experiencing tremendous results, I became much more comfortable letting go of the attachment to numbers. I also had a new fitness goal, which was to increase my aerobic capacity so I could become a better runner.

As a “sprint interval” type of athlete who always lived comfortably in the anaerobic energy systems, aerobic capacity was a clear deficiency that I saw as my “Next Frontier” beyond age 50, while still staying balanced in my heavy lifting and CrossFit training. The goal was (and is!) to become competitive again in singles tennis and to participate in the CrossFit Open and possibly other recreational-level CrossFit competitions.

So with a specific fitness goal in mind and being in a much better place with “the numbers thing”, I pulled the WHOOP! strap off the back burner and took the plunge. Excited about my new purchase and my “Next Frontier”, I wanted to learn as much as I could about it before I started using it.

Like a neon sign, this article caught my eye: "Does your wearable data make you anxious? Here’s how to change that”. I suddenly didn’t feel so ridiculous anymore. Data obsession is really a thing! It was the best first article to read because it helped me frame my relationship with my WHOOP! strap and exactly how I was going to use this data.

As with any relationship, it starts with boundaries. First, the WHOOP! strap will not be defining my day. WHOOP calculates recovery as soon as it detects that I am awake. But I ignore the alert “Your Recovery has been Processed” until I have had time to be up and about and assess for myself how recovered I feel. I complete my WHOOP! activity journal for the day prior and then look at my recovery data. Depending on the feedback, it may validate my choice of an active recovery day or reassure me that the long run is a good idea. If it has me in the “green” but I feel like crap, I let how I feel dictate the day and wonder what other factors are at play that WHOOP! may not be picking up on.

Self-awareness, not self-deprecation. Herein lies the crossroad. I could look at this data in two ways. WHOOP! says I’m 90% recovered but I feel like crap. Rather than letting WHOOP! tell me that I’m going to push to the moon and call me a “slacker” for feeling otherwise, I instead will say, “Ok. There’s a discrepancy. Why is that? What else is happening in my life that WHOOP! is not picking up on?”. Approaching data discrepancies this way raises self-awareness of the environment around you rather than creating a negative judgment based on “a number”.

The point is, WHOOP! does not tell me how I should feel, or what I should do. All it does is add color and insight into my own best judgment and how various workouts, stress, sleep and other environmental factors impact my physiology.

What have I learned about myself? Fast forward 4 months later.

• Even a leisurely run with a low RPE jacks my HR into zone 5 (90-100% max HR) for most of the run. This taught me that I need to spend more time in zones 2 and 3 for long distances to build my aerobic capacity. It did not teach me that I suck at running.

• Big squat days require more recovery - so, I added yoga, foam-rolling, and an earlier bedtime on those days. It did not teach me that I suck at squatting.

• Long zone 2 and 3 days are very well-tolerated and the next day I can usually go all-out with CrossFit training. This has helped me arrange my workouts for the week.

• Emotional stress has a huge impact on my recovery. During the day I add some breathwork if I’m feeling stressed. However, when my son, Nick, got his driver’s license, there was not enough breathwork in the world that I could do to manage the stress (We just survived our first week!). So I reached out to friends and of course, Erika, for support. I learned that it’s ok to ask for help.

• I get my most restorative sleep early in the night. When I need extra recovery, I go to bed earlier. Because at 4am I’m awake no matter what time I go to bed.

• Red wine is kryptonite. Prosecco is not. (Thank goodness!)

Framing the relationship that I was going to have with my wearable and setting the terms upfront before starting to use it was key for not letting the numbers get the best of me. Knowing that I control how I use the data rather than the data controlling me was the end result of this strategy.

No matter what technology you use to gather data, make that device your friend, not your enemy. If you are not yet ready for that “friendship” take some time to arrive at a better place. Had I purchased the WHOOP! strap before I was ready, it would have been a disaster. Fortunately, with the help of a great Coach and my willingness to look at myself objectively, I developed the self-awareness to realize this.

A 3-step approach. All these resources -whether it’s a wearable device, lifting class, trainer, coach, or social media group - serve as the “toolbox” to your fittest, healthiest self. The beauty of it is that there is a treasure trove of resources for whatever you need. Step one starts with self-awareness of what you need (even if it means seeking help to figure out what you need). Step 2 is making these resources your friend, not your enemy. Step 3 is the realization that you, singularly, are in control of your fitness destiny.

The Monologue

Like many of you, my head spins with the mountain of information about anything and everything on the internet - and women’s health is no exception. Having some expertise in women’s health, fitness, and hormone health, I take very seriously the responsibility of bringing objective and accurate information to my patients, clients, and subscribers of my publications, and followers on social media. This is quite a task when you have so many outlets of information with no single source that is universally complete or, in some cases, even reliable.

In my quest for objectivity and accuracy, I evaluate the medical literature for its strengths and limitations and look for consistency and evidence-based information in those whom I follow on social and mainstream media. Then I check this information against more than 20 years of training and experience as a women’s health physician, scientist, athlete, and fitness professional.

A very disturbing trend that I have noticed is the demonization of many naturally-occurring things that are essential for our health and well-being. Let’s start with the sun. Media culture stoked the fear of the All Mighty within us if we didn’t wear 50+ sunblock from dawn until dusk - until we realized that this was increasing the rate of vitamin D deficiency. Shocker. Fat and “cholesterol” were demonized as the nail in the coffin for developing cardiovascular disease, strokes, and heart attacks - until we learned that this may just be a small piece of a much bigger puzzle and that refined sugar may actually be a bigger culprit. Then if it wasn’t enough to demonize refined sugar, the cultural think tank decided to demonize all carbohydrates - feeding into the toxic diet culture that sadly pervades society today.

But the latest in these destructive narratives is the demonization of cortisol - a hormone necessary for Human life - and this notion that mid-life women should avoid physical intensity because “cortisol is bad” is one of the most misguided and destructive narratives polluting our media outlets. Today’s post is going to make the case against this narrative.

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What is Cortisol?

Cortisol is a steroid hormone that is produced by two glands that sit atop the kidneys called the adrenal glands. These glands produce many different hormones that control physiologic hemostasis (balance) and are essential for life. Cortisol is one such hormone produced during the stress response, a.k.a the “fight-or-flight” response, which is orchestrated by the Sympathetic Nervous System (SNS).

The SNS response was designed by nature to fight against threats to our survival. This could be a bear in the woods, a famine, or threats to our personal well-being. In a more civilized society, this system is also activated during an athletic event, saving a victim from a burning building, or the classic CrossFit workout “Murph” on Memorial Day. This response has been conserved through evolution from our earliest primate ancestors and is a key player in the continued survival of our species.

If you want to learn more about the stress response, check out these two video excerpts: Stress Response Part 1 and Stress Response Part 2 taken from my course, Menopause Health and Fitness Specialist.

Myth-Buster Alert: Excess cortisol is NOT stored as fat! This is a biochemical impossibility.

It doesn’t take a chemistry degree to see that these structures are not much alike, and thus conversion from one to the other is like making gravity go sideways.

Cortisol and Fitness

The activation of the SNS, and thus the cortisol response, is essential for maintaining and improving physical fitness. There is no way around this. Gains in fitness are had beyond the margins of our experience, and that requires working hard and pushing limits which cannot occur without activation of the SNS and transient increases in cortisol. For a deep dive into this concept, check out this previous post in Athletic Aging: Neuroendocrine Adaptation - Your “End-Run” Around the Menopause Transition

Mid-life is the time when the contribution of estrogen to maintaining muscle and bone mass declines and thus impacts overall metabolic health, fracture risk, and longevity. The need for physical fitness is thus of critical importance as a woman enters this stage of life to stave off the physical decline that inevitably accompanies these hormonal changes.

Navigating the Female Stress Response

The SNS response in females is directly linked to the reproductive system and her overall physiology as part of arguably THE most powerful evolutionarily conserved pathway to promote the survival of the female and her offspring. Because of this link between the stress response and female physiology, this interplay needs to be carefully navigated.

The notion that mid-life women are singularly sensitive to stress is flawed based on biological fact because an “unchecked” stress response can wreak havoc at every stage of a woman’s life.

At the start of puberty, when the stress response goes unchecked, menstrual cycle onset can be delayed and lack of menses impacts the development of peak bone mineral density -one of the single, greatest risk factors for osteoporosis and fracture later in life.

During reproductive age, the unchecked stress response can lead to menstrual cycle dysregulation, impaired bone mineral density development, and the ability to conceive. Given that there is a finite period in a woman’s life for child-bearing, infertility can be a big deal.

Lastly, in perimenopause and menopause, the unchecked stress response can result in elevated blood sugar, high blood pressure, low bone mass, decreased cognitive function, body composition changes, and accelerated aging. Check out this post from March 2022: “Just Deal With It” is Not an Option which is a review of a research study showing the benefits of managing menopausal symptoms for its effect on lowering cortisol levels.

Reconciling the Narrative

One could argue that the points made in the last section “Navigating the Female Stress Response” proves the point that “cortisol and stress are bad”. On the contrary. The fact that the cortisol response is apparent in every stage of a woman’s life is a testament to its necessity. What’s “bad” is letting this response go “unchecked” - not just in mid-life, but in every stage of a woman’s life.

The goal, is that we, as educated women, athletes, health care providers and fitness professionals should focus not on avoiding this powerful hormonal pathway integral to our fitness and survivial, but rather managing it.

This starts with awareness and identifying the variables that prevent the return of the stress response to baseline after a life or physical stressor. Transient stress is what builds fitness. Chronic stress - when the system does not return to baseline - it what is meant by an “unchecked” stress response.

Once we identify the variables, we focus on nutrition, breathwork, meditation, yoga, tissue care, appropriate warm-up and cool-down, balancing training and fueling, to name just a few. I highly recommend this blog post from my friend and rock star writer, Selene Yeager “Are You Overtraining?” which beautifully illustrates this point.

The resources for managing the stress response are readily available. We just need to make a point of prioritizing them as part of our daily rituals and fitness strategies. This is critical not just for women in mid-life, but for maximizing women’s health and performance during every stage of their lives.

So rather than running from a physical response that is integral to our very existence, let’s instead learn about it, embrace it, and work within it rather than against it. That, my friends, in my humble opinion, is one of the greatest keys to achieving your peak performance potential and your healthiest, most vital self!

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Housekeeping…….

I had the privilege of being a guest on two amazing podcast episodes that dropped last week. Enjoy!

Inside Sports Nutrition Podcast: Hormones and Female Physiology with Dr. Carla DiGirolamo - Ep. #69 – Dina Griffin/Bob Seebohar

Fit Womens Weekly Podcast: Should Workouts Change As You Get Older? Dr. Carla DiGirolamo Breaks It All Down - Kindal Boyle

My Friends, 

Bone health stands shoulder to shoulder with cardiovascular health in importance for maintaining quality of life, longevity and independance. 

There is a wealth of well-done, high-quality scientific study investigating the role of dietary and supplemental calcium and vitamin D in maintaining bone health and reducing fracture risk. However, the findings of these studies are conflicting. 

Today we objectively review both sides of this debate and help you make the best decisions for yourself!
Enjoy!
-Carla

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Why We Care

Declining bone health has emerged as a very close “second” to cardiovascular disease in the major causes of loss of function, independence, quality of life, and mortality in women over age 50.

Beginning just before menopause onset, the average rate of bone loss is 2% per year. This rate of loss continues for 5 to 10 years, resulting in an average of 10% to 12% loss in bone mineral density (BMD) in the spine and hip, then leveling off to a loss of 0.5% per year. By age 80 years, women have lost an average of 30% of their peak bone mass.

When bone loss is extensive (technically defined as BMD 2.5 standard deviations below the average, Caucasian, young adult reference population), it can lead to osteoporosis, a disease characterized by low bone mineral density and disrupted bone architecture.

The most devastating potential consequence of osteoporosis is fracture, which can lead to a rapid decline in health, loss of mobility and independence, and even increased mortality. Among Caucasian adults in the USA aged 50 years and older, about 50% of women and 20% of men will experience an osteoporotic fracture in their remaining lifetime.

Note: Rates of bone loss and fracture differ among ethnic groups. Caucasians are cited here because current clinical reference ranges are based on the Caucasian population.

What We Know

Childhood and adolescence are critical periods for building bone mass, particularly for females, where 40-50% of their bone mass is achieved in the early teen years. Peak bone mass is achieved in the early 20s. High peak bone mass is a protective factor against the development of osteoporosis later in life.

Genetic factors appear to account for 60-80% of total adult bone mass. Substantial contributions are made by multiple factors that include nutrition, physical activity, smoking, chronic illness, and medications that can impact bone mass.

Adequate calcium and vitamin D intake are among many essential components for building peak bone mass earlier in life including protein, magnesium, phosphorous, potassium, and fluoride are required to support bone formation. Adequate calcium and vitamin D intake is also important during adult life for minimizing bone density loss after peak mass had been achieved.

The Controversies

Because of the importance of calcium and vitamin D for bone health across all age groups, a wealth of studies surrounding calcium and vitamin D intake as well as supplementation has emerged through the decades, particularly in the area of osteoporosis prevention and treatment in menopausal women.

Historically, calcium supplementation has been recommended for menopausal women with “inadequate intake from dietary sources alone”. Two of the leading authorities on bone health, the North American Menopause Society (NAMS) and the Bone Health and Osteoporosis Foundation issued position statements in 2021 and 2022, respectively. Both organizations are aligned in their recommendations based on the “review of the available evidence and expert opinion” that calcium supplementation is recommended in menopausal women “not meeting the daily targets” of 1200mg of elemental calcium daily through dietary sources alone. These recommendations are based on some compelling data from large, randomized control trials (RCTs), observational studies, and meta-analyses.

However, more recently, compelling evidence from additional randomized controlled trials and meta-analyses has shown conflicting results and has called these recommendations into question.

A recent review in Clinical Interventions and Aging by Kelvin Li et al at Tulane University very objectively summarizes the evidence on both sides of this controversy as it pertains to fracture risk, osteoporosis, cardiovascular disease, and kidney stones, among other conditions. Below are a few of the pertinent points:

• Osteoporosis: Although many studies show a beneficial effect of calcium supplementation on bone mineral density and fracture risk, several other large studies have shown increases in fracture risk at doses in excess of 1100mg daily and doses <750 IU daily.

• Cardiovascular Disease: There is some evidence that dietary calcium and supplementation <1000mg daily in Chinese and European populations has a protective effect on cardiovascular disease. However multiple large RCTs, meta-analyses, and prospective studies have demonstrated an increase in cardiovascular disease and events in individuals consuming >1000mg of calcium daily.

• Kidney Stones: Calcium supplementation has been associated with an increased risk of kidney stones in many studies. However, other studies show that adequate dietary calcium intake has beneficial effects on kidney stone formation.

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Why the Confusion?

• Two major determinants of bone mineral density and fracture risk are genetic predisposition and peak bone mass. These are very difficult to quantify and thus difficult to incorporate into study analysis. This issue, in my opinion, could be the biggest reason for such disparity in the results of even the most well-done studies.

• There may be a “therapeutic window” of calcium intake (dietary or supplemental) that has favorable effects with unfavorable effects living outside the therapeutic window.

It is important to be aware that just because calcium intake is important for bone health one cannot, therefore, conclude that taking calcium supplements will be beneficial. Dietary intake of calcium is different from supplemental intake in absorption and bioavailability. Claims that supplemental calcium is equivalent to dietary intake are simply wrong.

• The published “target intake” may not be applicable to all populations. Do healthy athletic women who strength-train regularly require the same amount of calcium to maintain healthy bones as sedentary women with chronic disease? Does the use of MHT impact these recommendations? Questions such as these remain unanswered.

Deciding if Calcium Supplementation is Right for You

Assessing risks and benefits: When data are inconsistent, we are left with expert opinion on the interpretation of the data and the best way forward. You will see many compelling and valid arguments on both sides of the debate. This is healthy and a good thing!

Below are my suggestions based on my assessment of this data and how I approach this question for myself as an athletic 52-year-old menopausal woman.

• Listen to all sides of the debate with an open mind. Choosing one “camp” over the other leaves out a valuable perspective.

• Assess your risk/benefit equation. One tool that is available and well-studied is the FRAX tool for assessing 10-year risk of osteoporotic fracture. This tool is far from perfect as it does not take into account physical activity or nutritional calcium intake, but it is a start!

• If you are menopausal with no fracture history, request a bone density scan (DEXA scan). Current guidelines recommend that all postmenopausal women have a DEXA scan at age 65. This recommendation has borne some criticism. The average age of menopause onset in America is 52. Bone loss rapidly declines at menopause onset. Waiting until age 65 leaves more than a decade of bone loss before the need for intervention is evaluated. If you have suffered a fracture at any age, consider bone density testing.

• Discuss your risk/benefit profile with your healthcare provider. Given the wide range of physical systems (bone, cardiovascular, kidney, and gut health) that are involved, your healthcare provider is best suited for this discussion.

• Assess your own calcium intake. This knowledge will be important for your personal decision-making and discussions with your provider.

• If you decide to use supplementation, do not exceed the 1000-1200mg recommendations for combined daily intake from food and supplements. When studies have shown detrimental effects, many times higher intakes were used by the study subjects. More is NOT better!

• If you do not get much sunlight, consider vitamin D supplementation. The best source of vitamin D is the sun and inadequate vitamin D levels have been associated with a variety of health risks. But if you live in areas of the world where sunlight is scarce during certain seasons, you may want to consider vitamin D during those times.

What do I do for myself? I do not take calcium supplements, but I take 1000 IU of Vitamin D daily in the winter months. I consume dairy products with a daily intake of 800-1000mg of dietary calcium. I have no other health issues, and perform a variety of weight-bearing exercises as part of my training. My mother has osteoporosis. However, at age 93, she has never sustained a fracture (despite defying my desparate pleas for her to stop shoveling snow!)

Navigating these decisions when there is no clear answer is difficult, but not uncommon - particularly in the area of menopausal medicine. But through self-awareness, education, and discussions with your healthcare provider, you will undoubtedly arrive at the decision that is right for you!

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References

NAMS POSITION STATEMENT Management of osteoporosis in postmenopausal women: the 2021 position statement of The North American Menopause Society; Menopause: The Journal of The North American Menopause Society Vol. 28, No. 9, pp. 973-997. 2021.

The clinician’s guide to prevention and treatment of osteoporosis M. S. LeBoff et. al. Osteoporosis International 33:2049–2102. 2022.

Maximizing bone mineral mass gain during growth for the prevention of fractures in adolescents and the elderly. Rizzoli R et al. Bone 46(2):294–305. 2010.

The good, the bad, and the ugly of calcium supplementation: a review of calcium intake on human health. Kelvin Li et. al. Clin Interv Aging. 13: 2443–2452. 2018

My Friends! 
Welcome to Part 2 of Understanding the Stress Response! Here we will discuss the importance of recovery after our stress response is activated - either by a predator, tough training cycle or life stress. This video excerpt from the Menopause Health and Fitness Specialist Course provides specific strategies for maximizing recovery. 
Enjoy!
-Carla

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In our last post, Understanding the Stress Response - Part 1, we reviewed the key pathways of the endocrine and nervous systems that are responsible for the Human response to a threat. In today’s post, we will discuss strategies for returning the system to baseline once the threat is resolved.

This “back end” of the stress response, which is returning the various systems involved in the stress response to baseline, is one that we often struggle with and this can have grave consequences. In female athletes of reproductive age, the “threat” perceived by the body can be in the form of over-training and under-fueling. When this situation is ongoing, the body senses a “famine” and works to conserve “fuel” by dialing down metabolic processes and turning off the reproductive system. This continual activation of the Fight or Flight response can lead to bone loss and poor performance in female athletes of all ages.

In perimenopausal and menopausal women, there is a heightened sensitivity to the activation of the stress response due to declining estrogen levels and greater difficulty returning the system to baseline. This is a challenging time of life because training intensity is required to keep the heart and muscles healthy, however, more attention needs to be paid to recovery efforts, such as tissue care, adequate fueling, sleep, and mindset work.

When activation of the stress response is ongoing without adequate recovery, this can lead to an increased risk of developing health problems such as physical injury, elevated blood sugar, high blood pressure, low bone mass, decreased cognitive function, and accelerated aging.

In this excerpt from the Menopause Health and Fitness Specialist Course, we will discuss some specific strategies for returning the stress response to baseline and maximizing your recovery.

The official launch of this course is TODAY! REGISTER HERE FOR THIS FREE WEBINAR at 1pm EST and get your coupon for 50% off the price of the course. Can’t join live? No problem! All registrants receive a recording via email and a 50% off coupon.

My Friends!
The stress response is an integral player in female athletic performance, health and longevity. Harnessing this pathway is the key to unlocking your physical potential - but before we can manage it, we must understand how it works. This is part 1 of this series where we learn the basics of the physiology of the stress response and its impact on reproductive age and menopausal women.  
Enjoy!
-Carla

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The stress response is one of the most primal and powerful Human responses to the environment and is the front-line defender of survival from a threat. The physiology of this response involves a complex interplay between the endocrine (hormonal) and nervous systems.

How the female body responds to activation of the stress response changes throughout the stages of her life. During reproductive age, the neuro-endocrine response to stress has a direct suppressive effect on the menstrual cycle. This is a highly conserved, evolutionary mechanism that protects females from procreation during times when there is famine or threats to safety. During the menopausal years, chronic stress more dramatically impacts a wide range of physiologic processes and increases the risk of developing health problems such as elevated blood sugar, high blood pressure, low bone mass, decreased cognitive function, and accelerated aging.

Today I’m presenting another excerpt from my new course to be launched on January 26th through MedFit Education Foundation, “Menopause Health and Fitness Specialist Course” where I discuss how the stress response impacts the menstrual cycle. This course will be replacing the current Menopause Fitness Specialist Course.

For more information on how these hormonal pathways are involved in the response to physical training, check out this post from June 2022 Athletic Aging Neuroendocrine Adaptation - Your "End-Run" Around the Menopause Transition

In Part 2 of this series, we will discuss the neuroendocrine pathways involved in recovery from training and stress. Stay tuned!

My Friends.... 
All I can say is that I wish my make-up looked as good as this sleeping beauty's! But this post is less about make-up and more about sleep. 

There is a lot of great advice for those who have difficulty falling asleep. But what about those of us who wake up at 3am for the day? This is Part 1 of a 2-part series on sleep where we begin with a strategy that works wonders for my own 3am wake-up call!
-Carla

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Sleep is critical for recovery from our day, our workouts, and life, in general, and is a HUGE issue so for so many, particularly mid-life women.

Some great advice on the basics of good sleep hygiene is readily available in the information abyss:

• Keep your bedroom cool and dark

• Have your last meal at least 2 hours before bedtime

• Turn off the tech (screen time/TV) at least an hour before bedtime

• Create a bedtime routine

• Avoid stimulants after noontime

• Relaxation techniques and meditation can be helpful

• Avoid strenuous exercise before bedtime.

But what if you are like me and have no trouble falling asleep (sometimes with tech in-hand!) but it’s that 3am ill-defined aura that heralds the impending hot flash that wakes me like a bullhorn which then triggers a run of the day’s To-Do list, replaying a disturbing scene from Game of Thrones and about 50 other random thoughts about nothing special… AND that incredibly annoying song that I just can’t get out of my head.

But I found a strategy that beats this more than 90% of the time and, for me, was a game-changer! Check out this clip from my upcoming course, Menopause Health and Fitness Specialist Course set to launch through the MedFit Education Foundation in January 2023 for a quick primer on getting better sleep and my personal strategy to beat that 3am wake-up call.

Note: My course will be replacing the current Menopause Fitness Specialist Course.

So, the take-home message for this strategy is that you need to divert the mind to things other than the spiraling thoughts. So when the thoughts start, I will try any or all of these things to divert my mind away from them:

• Play a song that I like in my head and focus on the song and away from the thoughts

• Meditation and breathwork (I love the Calm app)

• Think of 5 things in your present moment that make you happy and why (ex - I love my pillow because…)

My Friends... 
I am very excited to announce the launch of the Menopause Health and Fitness Specialist Course in January 2023 through the MedFit Education Foundation. In the coming weeks I will be sharing excerpts from this course, so be sure to subscribe below so you can see the latest and greatest topics in menopause health and fitness. 
Enjoy!
-Carla

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The “gut” as defined by the stomach and the intestinal tract, is a multi-organ system involved in digestion. It has its own complex network of nervous system innervation and in recent years, has been characterized as a separate division of the autonomic nervous system, which is the involuntary system involved in the stress response (“fight or flight”) and the parasympathetic system (“rest and digest”). The complex interplay of these neural networks puts the gut in the center of the systems that promote our very survival.

Within the gut is a population different bacterial subtypes known as the “gut microbiome”. These bacteria function in digestion, management of inflammation, production of vitamins B and K, body composition, sleep, immunity, mental wellness, exercise performance and estrogen regulation.

Optimizing gut health becomes particularly important during the menopause transition when estrogen levels and receptor function are changing.

To learn more about the relationship between the gut microbiome and estrogen function, check out this excerpt from the Menopause Health and Fitness Specialist Course that I will be launching through the MedFit Education Foundation in January 2023. The course will replace the current Menopause Fitness Specialist Course.