Exercise During Menopause: From Exhausted to Energized

Welcome to How Humans Heal. I'm really excited to introduce you to my friend. She's the pioneer for menopause fitness, and she's the founder of Flipping50. This is Deborah Atkinson. Thank you so much for joining us today.

Well, thanks for having me.

Oh, my gosh, of course. I mean, the thing is, is that you've been helping women to exercise based on their age, basically based on being in menopause for a long time, and now it's becoming way more popular, way more of a. Something that people are realizing is important. How does that feel to you to just be like, oh, my gosh, they finally realized it.

You know, it is so funny and coincidentally, serendipitously how it happens. I posted today the ruby slippers on my timeline because it's like, hello, I'm so glad we're finally here. They've always been there. All you had to do was click. And now we're getting there. So, so good, because it's at the spear right now in Vegas, and everybody's talking about the ruby slippers, right?

Yes, Everybody's talking about menopause. We're having.

Exactly.

Post it out. Menopause. And. And you know, people posting about how they're doing their estrogen, hormone replacement. And. And with you, it can be like, let's talk about how we should be exercising when we're over 50, because something's different about that. Please tell us, like, why? Because maybe a lot of women maybe don't realize, oh, my gosh, does is, you know, do I exercise the same before 50 as after 50 or before menopause as after menopause? What's the.

And generally, no, but your body will tell us. Your body will tell us whether you do or you don't, and you get the same results. So you could choose to. And some of us are just stubborn enough that we might try and keep trying, but eventually we get tired or we. We get injured or ill if we're trying something that's not working or we will find we're getting dissatisfied with the results that we're getting. So generally, you know, the whole thing is what I've always heard and so many trainers now are hearing and getting. Is that what I used to do doesn't work anymore, and it's like, I'm eating the same.

And you could be doing your same workout, whether it's strength or cardio and feeling like my muscles are not responding or something like that. Huh?

Absolutely. And the answer to that is, of course, because you've just hit the nail on the head in regard to the problem. You don't have the same hormones that you did when it worked. So it's just if we treat it like a, this is data. All we have to do is collect the data and let's respond to the data and make an informed decision about. Well, we know that isn't working. So where are we going to start to make the changes and, and we can win again. We actually can be as fit. And I know so many women honestly feel better now when they do turn it around and start exercising. Right. Compared to the way they were when they were 25 and 30 and certainly in this generation because many of us were probably over exercising, doing way more accumulative cardio than we needed to. And you know, if we're honest with ourselves, we were probably more tired than we admit. A little bit more Diet Coke, little bit more, you know, going through drive through to get those sugar free cones because they didn't count at all, you know? Yeah, I love it.

You're like, yeah, maybe I can just get this sugar free cone and, and like pretend I didn't have anything but right.

And, and get a little energy. Because we really didn't, we weren't, we weren't fit, I think and we all equated. If we're thinner, we must be fit and just. Let's just call bs. That's just not true. You should be the most energetic woman in a room. If you're exercising at your sweet spot right now, you should walk in and there should just be an air of energy about you and people's heads turn. Maybe you're not the most beautiful in the room, but I bet you're the most confident and most energetic if you're in your sweet spot.

That's a really great measure, you know, to be able to say, you know, when people say, how do I know if I did too little or too much? It's how you feel after. If your energy is good, then you're in the good for your body. But if you're ending up feeling tired, exhausted and perhaps in pain, I would think too after, then those are signs to me that you overdid it. What would be it for you? Few other signs that you overdid it.

Yeah. And so true. And so there you are, the princess of the master of stress herself. So that's exactly right. You know, I tell anybody, if you feel like after your exercise, whatever it is, you could lay down and take a nap, we have a problem. Houston, we need to just right away that should get you to stop. Because we are not 17 year olds in football doing two A days where, you know, it's summer training camp and in between practices we can go home and lay on the couch. Most of us don't have that kind of life. And nobody's going to feed you grapes while you lie on the couch. That's just not going to happen. So we need to be exercising. What I like to say is the mvp, the minimum viable physical exercise so that you can do life really well. Don't forget, it's not about the selfies you post in the gym. It's about, you know, are you doing the things you want to do with your kids, your grandkids, your travel, your spouse, your partner, your volunteer work or, or the work that you're doing. Literally that is your purpose in life. We should have plenty of energy and cognitive function should be sharper because we're exercising in the right mode.

I love that, I love that. Like, I love just painting this picture of here's what it looks like at the optimal and also here's what it, what you can look forward to. Maybe if someone's starting off and they haven't been exercising, then that sounds to me like, oh, I would look forward to that. Like you're really saying, hey, this is what it can look like. It doesn't have to look like torturing yourself and being in pain.

And that's such a great point. And so let's just shout out to, to all the trainers and health coaches for a moment and to everybody who's not exercising because honestly, you're right now you're a bigger part of the population. So if we're speaking to anybody who might be interested in tuning in because it was about exercise, chances are you're already exercising. So do, do a woman a favor, don't take her to coffee, take her for a walk or take her to the gym.

I love that, I love that. And I like what you're pointing out, which is it can be variety. What do you suggest with that? Because I think so many times when we do start to exercise or we think about starting to exercise, we think, oh, I'm gonna have to go to the gym for hours. And we sort of like, then we're just like, that's never gonna happen and give up. But you know, it isn't about eating, you know, eating or exercising. The same thing every day. Right. I mean, what do you suggest with variety for exercise?

Yeah, well, and I, I think what I use is, is kind of a venn Diagram. We use four different things to say, here's what you should do. But the first thing before we start worrying about drilling down to what's most beneficial or effective is if you go from low movement or no movement to moderate movement, you're getting it more frequently. The, the threshold and the benefits are tremendous. If we go from moderate to really exercise, we get a little bit more return. So just getting started, and let's not get picky about what it is. What do you like? Start there? You know, so if it's walking daily because it's easily accessible and, and hopefully you enjoy it and you get outdoors a little, there's probably more benefit to that. But, you know, I happen to know you ballroom dance. So if you'd rather take dance lessons and do something that masquerades, you know, the exercise that is happening behind the scenes, do it that way. Get started. If you tell me I want to age really optimal, at some point we're going to have a conversation about how are we protecting your muscle and your bone, and are you doing things also to protect your brain? The dancing would, would hit that, right? So there's lots of choreography. You're learning steps and remembering them. That's going to be great for your brain. But there are other things we probably want to do to also maximize or optimize your muscle and your bone density. But again, let's, let's be codependent. That's what a trainer really wants for you. We want you to be codependent. I want you to start, and I know you're going to get hooked and love it, and then we'll do more, but we don't need to do more before we start.

I love it. I love it. Right? It's like, because sometimes we do. We get ahead of ourselves in our head and then we don't do anything. So it's better to just take that first step and then know that we can trust that. Because this is so. I mean, you've been doing this for over 30 years, right?

This is.

I mean, this is not like a new thing for you. This has been your life, right?

Yeah. Right. And so it makes me dangerous, to tell you the truth. I'm dangerous, right? Because I take for granted that someone is just starting and they're. They're in a very different frame of mind. So every day I try to remind myself a beginner's mentality. You know, we just need to simplify it. And I think I. I just created a very short video the other day, and I said, I'm sorry. I apologize. On behalf of the entire fitness industry, I'd like to apologize because we've made it so difficult. And. And what you're hearing when you scroll online is that you should be lifting heavy and that you should be doing, you know, four or five days a week, and you should be jumping. And sometimes those workouts, it's going you 90 minutes a day because there's so many pieces to it. And all of a sudden, most people are like, number one, I don't have the time. Number two, I actually don't have the energy. And so number three, maybe I'm not even that interested. So, you know, we've made it so hard, and we just need to get back to. Let's just start with things we love. And if there's an activity you like to garden, let's build on what would make it easier for you to garden. Or can we plan another row so you have a little more gardening to do? We're getting you more active by doing that.

I love it. I love it because it's so true. It can start small. And I also find that with my patients, when they first come to see me, they may have nutrient deficiencies, like even postmenopausally, besides the low hormones, if they're not on hormone replacement, that's at good doses. They might also have, let's say, iron deficiency or B vitamin deficiency. And they. And very likely their cortisol's off. And I know you like to talk about cortisol, too. Cortisol's too high or too low. That's going to impact your exercise ability and your capacity. And so what I find is, as I walk women through, balancing their hormones, optimizing these nutrients, optimizing their adrenal function, all of a sudden, then they call me up and they say, Dr. Donnie, I'm feeling interested in exercising. And it's like out of nowhere they have this thought, and I'm like, okay, you're feeling better. That tells me your body's recovering and that you even feel like exercising.

Amen. And I think there's something too, that happens in menopause. And I found this when I was writing one of my books, that we have fewer dopamine receptors when we hit menopause, which means that even those who previously really enjoyed their exercise and were regulars may not getting. Be getting that feel good that they used to it. They're going, but they're kind of going through the motions. And there isn't that. That kind of escalation of, you know, really A good feel afterward. And it's not your fault. I think we have to get a little more creative and kind of combine it with movement and music and maybe going with a friend or in sunshine so that you can pull many things together that inspire serotonin or dopamine or oxytocin with your exercise to help amplify that feeling again.

Maybe we can talk a little bit about all the benefits of exercising. Like what? What? Because I know that we're. You mentioned bone health, muscles, all of that, but do you have some of that info right at your fingertips of, like, what are all of the amazing reasons that exercise is a good thing for us over 50?

Well, if we can flip and we could talk to. We can Talk to over 50 for men and women. But we could also say, what if we were to list all of the symptoms of menopause?

And then we can simply say, exercise actually can reverse or prevent or reduce those signs and symptoms. So we're talking overall weight gain that happens with estrogen decline. So optimizing body composition. More muscle generally means less fat. Chasing fat loss, however, not necessarily going to get you the same result. Chasing muscle might just get you both.

Better bone density, certainly reduction of falls. So one of the things that I always think about when women are saying, I need more bone density because my DEXA is really low, and I'm like, well, let's work on that. But let's also work on getting you stronger and improving your stability so you don't fall and we don't have to find out. You know, that would be good, right?

So that would be very good, right?

So we need agility, and we don't know that. We don't necessarily put our hand up and say, I need agility. We say, I need bone density. But agility is what helps us right Ourself when slips and trips happen, and they happened when we were 20, we just didn't even. We weren't phased by them because we had those reaction skills. We lose fast twitch muscle fiber twice as quickly as we do slow if we don't do anything about it because simply of age. And those are those things that make us be able to take our foot from the accelerator to the break really quickly to grab a child that's going to put themselves in harm's way to catch ourselves if we take a toe into the curb or catch it on a rug so we don't go down. So we need those things. We need power. And exercise will help get you power when you're using the right kind power at 85 to us will be necessary to get us out of the chair. Right. Potentially even off the toilet. So, you know, it's relative. Right now that might mean jumping, that might mean hopping over a puddle or a toy or a Lego before you step on it on the floor. But when we're older, it will mean simply mobility around our own house and hopefully we won't slow down. So we say that about 85 year olds, maybe for all of us, it'll not happen until 95 or 100 that we're worried about that if we're exercising correctly. But the other piece, three major pieces we worry about muscle, bone and brain health. So muscle is directly correlated with dementia and Alzheimer's risk. The more muscle you have, the less likelihood you will be. Like a third less likely you will be to develop Alzheimer's. So, yeah. And that comes back to blood sugar and women who hit menopause. So generally in our early 40s, it begins to happen. Some women notice it earlier, some women not till later that we've got more blood sugar issues. We see the weight coming on. Do y we have the belly fat even if we didn't have the weight increase. That is all related to insulin resistance. When estrogen comes down, our blood sugar control isn't as good. And so we have to watch the carbs. But we often don't get that memo until it's a little bit too late. That wine, carbs, sugar, not necessarily our best friend. So the more muscle we have, muscle acts like a blood sugar sponge. So it pulls it out of the bloodstream, locks it in and stores it for energy for the next time you're gardening, the next time you're going for a walk, or the next time you're lifting weights or bike riding. So you've got more muscle, you have bigger bank to put that blood sugar away. And the other place that it would go if not would be to your liver, which is not where we want it, or to your hips and thighs and arms in places we don't love it.

I talk about it that way too, like really helping people to understand that there's only so many options the body has when we have extra blood sugar around. If it's not going into a cell, the liver has to decide, what am I going to do with it? Do I store it in the liver, which leads to fatty liver? That's not good. Do we store it in your waist and your hips? You're like, no, thank you. So you really would rather it go into your muscles so the Liver doesn't have to make that decision.

Amen.

I love it. So I'm wondering because I know that you teach all kinds of classes online. I want to hear about that because I want people to be able to know how you can help them. Because this is like something where I'm hoping people are like, hey, this is something I want to do now. This is something I want help with.

You know, the number one thing, the biggest anchor of all programs that we do are strength training programs. And I mentioned earlier, I refer to it as the mvp. You know, I could design a four day a week program for strength training, but I don't. We design based on twice weekly and we try to, let's just get people doing the twice weekly. And what we find is so many women have been unsuccessful before they come to us because other programs are asking three days a week or four days a week or more, heaven forbid. And I don't know where the recovery part of that equation decision is, but if we can do two, we have flexibility. Like if I can't get it in on Monday, I just move it to Tuesday. It's not a big deal. When you start getting all fancy and doing split routine where upper body one day, lower body another, or really body parts per day, you miss a day or two, you're totally off and you're.

You can't figure out where to catch back up, right?

Do I do that? Do I do this? Do I double, you know, and definitely not your body. You can't catch up like that. And the thing to remember is you're not behind, right? If you needed the rest or you were gone, you were doing life. That's why we're working out in the first place. Let's not forget that. And if you were ill, your body's workout was getting better. So you're not behind because you were that it's just now you're coming back in. It's easy to plan around life when you just have two to do. And generally people who do two sometimes then later will say, you know, should I do more? And sometimes it is beneficial as we are postmenopausal, not pre or perimenopausal, but postmenopausal. And generally for most women that's somewhere over 60. We actually do need a little more volume and that might be another set for each muscle group. And you're just extending your workout for a few minutes. But for some women that's adding the third day a week. And, and it by then we have the energy.

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Women in perimenopause, as you well know, much more of a roller coaster. And they're kind of going up and down and kind of feel good sometimes than not. And because they're on that roller coaster, it's so unpredictable that just like, let's do the basics. So we're holding onto the muscle that otherwise we could easily lose during perimenopause. And then once the hormones stabilize, whether you do HRT or you decide not to, it doesn't matter, but it's more stable then post menopause you can actually do more and tolerate it better.

Wow, that's so interesting. And I love this like this strategy of saying, okay, we're definitely going to want to have muscle at 85, but that doesn't mean you just do nothing and then start trying to catch up at 85. That's not a good plan.

Oh, but, but I have to tell you, anybody who's listening or whose parents are 85, a very recent study took two groups of older adults. One was the older and they were 65 to 75 and the other was 85 plus. They had them both. Do I believe it was 10? It might have been 12. So don't, don't quote me on that. A 10 week strength training program. At the end of that they looked at what were the changes and what difference was there between the two groups. They both, both groups increased in their strength, they increased in their lean mass and the 85+ group actually made more progress relatively. Right. So weight per weight, they didn't necessarily lift the same weight, but relative to the other group, they made More progress. So it's very possible there are no non responders. So if you have, even if you're.

Older already and you haven't been exercising, it's not too late to start. Just start wherever age you are. My mom is 83 and I have to tell you, she's really been doing amazing with her exercise. Like she, she goes to the gym, she has a trainer, she's doing strength training. And this is a, my mom never exercised earlier in her life. Like when I was a kid, I did not see her exercising, but now she's doing her strength training at least two or three times a week. And so I'm so excited hearing this from you. I'm going to tell her that. And you know what, I, what comes to mind for me is like I, I would worry that maybe not all trainers know how to work with someone who's over 60. Is that, is that something people should keep in mind?

It is absolutely something they should keep in mind. And I think any nuance, you know that there is. So menopause fitness is one of those, you know, you can change your title, your, your profile in Instagram in about 10 seconds. So have you all noticed in the last six months there are suddenly lots of menopause fitness coaches? They did not get a weekend certification, you know, and if they only got a weekend certification, you should still say, wait, wait, wait a minute, it's going to take a little longer. And so coming from a university background, I taught for 15 years in the Department of Kinesiology, PE majors. People who wanted to be trainers, gym owners, fitness instructors, pre pt, pre med students came through our program and inevitably, so I know what they know when they come out of a four year degree and I know the rush. So four year degrees. Universities are also businesses by the way. We sign contracts with parents saying we'll get them out in four years and if we taught them everything they needed to know, they'd still be there today, you know, so they only get the basics because there's so much to learn about the physiology, the kinesiology of the human body that you know, we never once in 15 years. And this was this, these were the courses I taught. Never once did I mention the word menopause. Never once did I mention the word hormone fitness. The only moment it slipped into the conversation would be one semester for 10 minutes we would tell them what osteoporosis was.

And very rough guidelines being taught about fitness.

Trainers are not being taught about menopause fitness.

That's a four year degree. And in basic certification, I also am what's called a subject matter expert, meaning I write the exam questions for personal trainers, health coaches, fitness instructors, and medical exercise specialists. Zero mention in a basic certification. The words that are given to us as we sit down at those meetings to write those questions or filter them is, remember, this is just for entry level trainers. What's the minimum information they need to enter the field?

Well, now, now that there's more women in menopause, that's gonna, I, hopefully gonna become minimum education for trainers. But it's important for people to know like probably what do you suggest they do if they're seeking out to have like a, like an in person trainer, what should they be asking them?

You should be asking, yeah, great question. So you should be asking questions like, how many women in menopause have you worked with? And what would be different about the program that you have planned for me in menopause versus what you might do with a male? What would you do differently for me if I were in post menopause versus perimenopause? And I think you're looking for that moment where you know you're going to play a criminal minds profiler and see if they flinch, see if they're making it up or they actually have a good answer. And I think in both counts, you know, if somebody is willing to admit I don't know the answer to that, but I will find the answer to that. I, I'd say that's a better answer than trying to bluff their way through it.

Yeah. Yeah, good. That's very helpful to just know. Okay, how can I ask about this? And then it's important to ask that there are differences and, and yet to also know that you offer training programs online. So that's an option too for people, wherever they are.

We do. And we actually train the trainer. So we have the flipping 50 menopause fitness specialists. Since 2018, we've been training trainers in our framework so that they, you know, I'm one person, we're one program. My voice won't resonate with everyone. And we need people on, on the floor. In gyms, we get asked every day by women. Do you have a trainer who's trained on your directory in Kansas City or in Bloomington, Indiana? You know, so we're getting asked all the time. So shout out to trainers and health coaches or those that you know who are now is the time. And they're looking for people who they know have a reputable training.

Oh, that's awesome. Well, I'll definitely be Sharing with this episode ways that people can reach out to you for all of these purposes, whether they want to be part of a program or if they perhaps are a health coach or trainer and they want to get certified in menopause fitness, then that's the place to go to get certified. Because that makes sense to me that you know, to have to go to where the best education is so then you can offer that to your clients. Because it's, it's, to me it's really obvious that there is now way we're really breaking open this mystery of menopause. Right. Like it is all over the place and that's not going to go away. What do you think?

No, I think we're just seeing the tip of the iceberg. I, and, and maybe that was, I was fortunate enough to be. I'm a 1964 year old baby. Right. So the, the, the people that I was training were generally 10 and 20 years older. They were the boomers. So I watched them. I was really doing research before I knew I was doing research. So I didn't actually flip and exclusively cater to women in menopause until 30 years into my career. And you know, it was them who laid the foundation and said, we're not like, we're not going to take this laying down. We're, you know, this is not okay that my doctor says, well, welcome to menopause. They were like, I want some better answers. And so it was them that actually, you know, created the demand for we need something better here. It's the voices that we've needed to hear. And now I think this next layer of women is taking it further. And you know, thank goodness for people like Oprah and you know, conversations at the FDA that now we're all getting privy to and realizing I wasn't given that choice.

Right, exactly, exactly. And, and I'm wondering if like, as women are realizing this and they're starting, you know, they're starting to do their. Now they're like, okay, I need to be exercising. I need this need to be something that we get help with and you know, just being able to continue that conversation and continue that education.

Yeah. So I'm curious. Oh, what, what you suggest for just, you know, what women's next steps should be and even, do you have any example cases of women who've been through your program and what their transformation was as they started to implement this?

You know, I think some of the best stories that I can tell were women who were in their late 60s or 70 when they came into our program. So that's not necessarily typical. We've got, you know, ages. So women go into perimenopause, average age, you know, around 40. It's different for all of us. But between 45 and 70 is probably the majority of the females that are in our community. But when we've had a couple of women, so Jennifer is one who comes to mind and significant weight loss, you know, and it's life changing for someone to understand this is no longer calories in, calories out equation and that we're, we're needing to feed our hormones just far differently in order to get the results that we want. So whether it's weight loss and indirectly it's. That comes from muscle gains, strength, gains agility. You know, the last thing you think of is, you know, somebody being frail and falling. We think of somebody teeny, tiny, you know, and very small and, and shrunken and shriveled and. And yet falls are happening younger and younger for women who are not fit and not strong. But in Jennifer's case, you know, she was a larger size woman. You also don't want to fall. It's dangerous to fall when you're significantly overweight as well and almost more so you're not going to recover from that. So we have, you know, she lost 100 pounds and hit that number during the pandemic. So I'm very proud of that. And in another instance, similarly, a woman reversed her bone loss at home during the pandemic. So just to prove, you know, do you need to go to a gym? For many of you who are intimidated by the answer is no. And I think the pandemic proved to us we need to have an at home option. And I think you've always needed one because we're. Life is busy those mornings when you're, you're rushing around and you don't have time to commute to the gym and use it, you know, you only have one or the other. Do it at home in your pajamas and, and then move on with your day. And you can check that box called consistency that trumps intensity every time.

Oh, I love that you're saying this. First of all, I do my exercise at home. I was like, yeah, like who? You know, just the travel time to and from the gym. It takes up so much time. But also then I can just focus. I'm not distracted with everything going on at the gym.

True.

And so I'm one of those people who loves exercising from home.

I also go to Pilates, Pilates studio and I go to the ballroom dancing studio, but I do daily with exercise from home. I wanted to ask you one of the things that I'm always intrigued by because I find it works really well for my body is shorter spurts. Like instead of saying, oh, you need to do 45 minutes, I'm like, hey, what if I do 10 or 15 minutes? That's much more likely to fit in my schedule and it feels better to my body. Is there something to that?

You know, I think we do specific programs. So in our, our battery of programs, we've got 12, 12 week programs and come up with so many because it's almost inevitable, you know, I'm looking at the title of your book behind you, but it is almost when, not if, that women in midlife are going to get hit by life and. And if not their hormones, it's almost always hormones. And caregiving comes up a job, a move, a relationship change, something happens. And women just get so much on their plate. And what we have to remember is that although controlled and a good hormetic stressor, exercise is something we can take up and down while life, we may not be able to turn the dial. Sometimes things are just at that volume for the moment. But exercise, we can respond to it. And so for a lot of women, we do short ones that are like 20 to 30 minutes long and we have a reset program that is 15 and 20 minutes long for exactly that reason. So like, you've got a lot going on. You don't need just more. And to check the box of I did the bootcamp today or that's what it says. So I have to do that because it comes back to where we started. You're supposed to feel good from it. And even though maybe, yes, we'd like you to get a little bit more volume, we have to first feel good when we finish. We. If we don't feel good, we're not going to get more fit if we're exhausted, were injured, or were, you know, some other way, you know, not functioning right. Exactly.

Happens so often. We like, because we're so used to pushing ourselves harder, right? We're like, I can do it, I can push it. I'm gonna make myself.

We do.

And then we end up backfiring and then we have to find a way to start again. So it is, it's way better to be like, let me start in small steps and be successful and build on that.

Yeah, absolutely true. And we're so good at doing all the things. But the one fitness component that most women Skip. And we are terrible at is recovery and recovery as we get older. Between intense or harder exercise is the time when we get fit. And that really wasn't taught to us really well. Or maybe all of us played hooky on that day. We missed that less, you know, because we've always thought the more I exercise, the fitter I'll get and we could get away with that. But honestly, again, we probably would have been more fit and more energetic had we not because we need the recovery. When you work hard enough, you also need to recover hard enough. And so recovery days might be. These are the days you go for a walk or you ballroom dance. You don't do the strength training but, but you want to find that balance of okay, here's a hard day, here's a moderate, here's an easy day. Oh, hard day again. Your body then is ready for it and you will work at your capacity. So you won't just. It feels hard because anything feels hard if you're tired. But we want it to actually be your heart.

I love that and thank you so much for sharing those stories. That's so inspiring because right now, of course, so many people are going toward the weight loss medications to be like, okay, if I need to lose weight, let me. And, and I don't know how much, you know, you want to get into that, but if you have an opinion on that. But I to me as a naturopathic doctor hearing like, wow, if we create an exercise routine that not only improves your health, but you end up losing weight that you wanted to or needed to lose, that's a win win. And it's something you can maintain going forward that's going to have long lasting benefit. If we can do it that way, how wonderful. But tell me what you think about sort of like the latest. What's going on with weight loss?

Yeah, great question. So about a year and a half ago, I was on a panel in front of a large fitness association, a global conference with some physicians who were giving their side. And I was coming from it as a fellow fitness profess, you know, and I looked at it not in the way I think people thought. I think it, it is an opportunity for people in the fitness professional. I think it's got its place and I've seen people who come into it who have tried everything and who are not getting it from the lifestyle changes that they have honestly made. And, and then it can be very helpful in tandem with that.

So it's about how to combine, you know, so if you're Choosing, okay, I need to do a GLP1 agonist, for example, and create an exercise routine.

Right. We just absolutely don't want to lose that muscle. And it's. We're seeing that, but I don't think at the extreme we thought we were going to. I, I think there is a small portion of people who are using this like a. I mean, it's almost turning into an anorexic. You know, thin people are trying to get thinner and don't actually take care of themselves and do the exercise. And that is a whole different, you know, ball of wax. And we don't want to get into that. But when somebody starts and maybe needs to lose significant weight, even at. Even so that they can get moving so they can take some pressure off of their joints and then get moving, I think that also is a vehicle. But the goal should always be that you're getting some lifestyle education on the importance of eating protein and getting the resistance training in so that we're not losing muscle mass. And we start from day one tracking that. Not just weight, but we are tracking body composition specifically to know if we're losing weight, are we losing the right weight, and are we working to maintain that lean muscle mass, because that, that is your metabolism in the future. We've heard this, but metabolic health can be worse if you lose weight, and a large portion of that is muscle.

It's so important. So to say, you know, say you're in a weight loss plan or potentially using a weight loss medication. We want to be monitoring to make sure you don't just lose all your muscle and having an exercise routine or consistent plan where you're maintaining your muscle too, so that you can maintain the health going forward from there, too. I love that. I love that concept. Thank you for sharing that. And, and I think that's really going to help a lot of people. I love that you also touched on bone loss and preventing bone loss and falls, because I see that so much in my practice as well. When bone loss starts to happen and women are thinking, wait a minute, I don't really want to have to be on a medication for osteoporosis. What else can I do? And we've known for a long time from research that weight bearing exercise helps tell our bones to stick around and not to prevent bone loss. But I think the thing that a lot of times we don't realize is how dangerous falling is. That oftentimes as we age, when a person falls is when they end up up having a fracture in the hospital in the rehab. And it can be really hard to recover. I've helped patients recover from that, so I know how difficult it can be. It can be done, but we want to try to prevent it if at all possible. And so I love that you shared how when we can do the right amount of strengthening, we can actually be preventing bone loss and preventing falls by getting that agility or flexibility, that balance, our balance back.

Totally agree. And I think the other thing that probably is worth saying is often women are getting that diagnosis that, you know, you're sitting in there and somebody's reading that scan and you're hearing you have osteopenia, you have osteoporosis. And. And sometimes women are just downright insulted and shocked, like, wait a minute, I've been active. I don't deserve this. You know, in many cases. But almost everybody suddenly has some fear and wonders what should I be doing? And we're afraid to move still. Back when in 1995, I started lecturing on osteoporosis and osteopenia and I had to define it. I had to write it on the chalkboard and define it for people because it wasn't a household word. And we did think back then, once you're diagnosed, you know, bubble wrap, you know, we're just, you know, be very.

Careful because you don't want to break something.

Exactly. And some of that still lingers. So remember, anything that got on the Internet is still there. So you're going to bring things up and Chat GPT is scraping the Internet. So some of that will be pulled up by Chat GPT. And so don't, don't just give your life away to that. But we now know since about 2015 and beyond mind it's become the norm in studies on bone density that we can reverse bone loss as long as we are efforting enough. And even going from not lifting weights to lifting light weights and going from then lighter weights to moderate and from moderate to heavier. And we all have to go through that progression. And you personally may find a place where that's, I can't go anymore because maybe my arthritis is getting in the way. And you'll know where that safe window is for you without putting yourself at risk. But we do want to find it and you know, it. It matters that there are other things. There are like four different ways that you can work on bone density and. And then a fifth that is really not talked about as much. But we need to look at diet, make sure we're absorbing all the good things that we're eating, so that sometimes can be the problem. But walking, weight bearing, that is helpful in moving around every day. So just we're countering gravity when we're doing that. So sitting down, not as beneficial as standing. Walking is more beneficial than. Than standing, you know, and hopping, if you can do that. And so there's a continuum always that we're on, but the more you move throughout the day, the more you're doing your bone good, even doing yoga. So Dr. Lauren Fishman came up with a study in 2016 that proved 12 minutes of yoga poses, and there's a specific battery a day increased bone density in a longitudinal study by 1% every year for seven years. So not just 1% in the first year, but 1% every year. So, yeah, so. So people who think, I can't do impact and I can't do heavy. Can you do yoga? And it's not down an upward facing dog. You're just stepping into poses and holding them. That was it. So it's just a different way of resisting gravity. And so again, there's a, there's a, I can do this versus can't. And then it is jumping. If you can do jump training, there's a whole continuum. So for those who are thinking I have prolapse or I have bone on bone, I'm not supposed to jump, or I had knee replacement, my surgeon doesn't want me to mess up that pretty work. You know, there are lots of reasons people can't jump, but can you stomp your feet going up or down stairs? That helps. So there are all kinds of things along the continuum that if you can't actually jump, there may be something where you can get a little more bone density than simply walking. And then it's lifting. And the answer really is as heavy as you safely can.

Amazing. Thank you so much for that. I absolutely see my patient's bone density not only stabilize, but improve over the years. It's so cool to be able to. I'm sure you've maybe seen this too. Like now I have patients who I've been working with for over 20 years, and I can see that their bone density improved. And part of it was through exercise in addition to diet and so on and so abs. I'm so glad you mentioned that. Like, forget this idea that you can't do anything about it or you only can do it with medications. No, you can absolutely help not only prevent osteoporosis, but to recover your bone density. It's so cool. And I was going to mention that along another one of those perimenopausal things, but also something that my patients deal with a lot because I work a lot with women with high risk HPV and abnormal pap smears and postmenopausal. We have these. The vaginal, you know, usually could be low estrogen causing vaginal issues and, or other kind of pelvic floor issues. And you were just mentioning how sometimes then you have to be careful with jumping. But I mean, does that come into play as well when you're teaching women how to exercise over 50 and over 60? Like, like, are you taking into account this pelvic floor area? Yeah.

Such a great question. And I realized probably eight years ago that here I was 32, 33 years into a career and had taught at a university, had gone through all the certifications myself and had had this membership and done all of this health history intake over and over and over again. Never once ever had I or instructed trainers who worked for me to ask a woman about her pelvic floor. Never. It's not standard until now. I mean, it really needs to be. It's now on our intake forms we ask women, do you ever feel this? Do you ever feel that? We go through the battery of questions on pelvic health care and we do, of course, start with number one. One of the best and easiest ways that you can improve your pelvic floor health is by breathing properly while you're exercising. So if you go to go to Pilates, you've already got a natural in to what is good and proper breathing and helpful and you're way ahead. But that is one of the things we do talk about and, and it often comes up. But we also urge women to say, look, you know, if this is something that no one else, you haven't brought it up with anyone else because women are almost surprised when we ask that question because no one else has, except maybe their ob gyn. But an ob GYN often doesn't associate it with exercise for them and open the door to that conversation. So we are now suggesting if you never had this conversation, it's common, it's not normal what you're dealing with. Try a pelvic floor or pelvic health physical therapist and just go and see what you'll learn.

Absolutely. There's so much we can do to help women with the vaginal area and the pelvic floor in general. And it's so important. It's so important because it is something that is a reality as we're aging and, and a Lot of times women have been hesitant to bring it up or who to ask. So I love that you're opening up the conversation and being like, hey, you can talk to me about your pelvic floor and we can make sure that your exercise is helping with your pelvic floor strength instead of just completely ignoring it.

Absolutely, yeah. You know, it's just one of those things. You probably are not talking with your partner necessarily really openly, but it's not something you want to bring up with your best friend over coffee either. So it's like, like when do we have that conversation?

Absolutely, absolutely. And it's, and at the same time, like, I, I feel like it's when we are, when women are introducing exercise into their daily routine, their weekly routine, that it actually helps there as we've talked about, helps your body in so many ways, but it also helps the immune system protect against things like high risk HPV and, and abnormal cells or cancer caused by this virus. So I always emphasize and include exercise and movement as part of my HPV protocol because I see that it helps women to protect themselves from hpv. And so that's why I'm so glad to be sharing all of your wisdom today, Deborah. Thank you so much. So that women can be like, okay, what do I need to know about exercise? I use an acronym in this book. In the master stress book, I use the acronym care. C for clean eating, A for adequate sleep, E for or A or C C for clean eating, A for adequate sleep, R for recovery activities. And E for exercise is actually in the acronym of care. Beautiful women who've been learning from me know that and they're like, so this is why I'm so glad to be like, here's an amazing resource to help them help you with your exercise. Thank you so much, Deborah. Is there anything else you would like to share that's just helping women know that this how to get started on this path.

You know, I think the biggest thing is if not for you, do it for those three generations that you influence. Because I think each and every one of us, we're leaving a legacy. So it's looking at, do you like the legacy you're leaving? You know, I, I have sons and boy dogs even, but I now have a daughter in law. And so it's changing, you know, the way I'm thinking. It's like, so her, her test after postnatal partum is a bone scan, right? So that we can know where is she when she's 30. Because if we all knew where we were we would have a better idea of how far have I gone from my peak bone density. But we can look now for her, where she's at and when it's in front of us like that, we're going to think about it proactively for much longer in our lives. So, you know, who do you influence and what kind of a legacy do you want to leave?

Ah, that's beautiful. That's really beautiful. Because we do. The people who are around us are going to observe us and what are we doing and, and for them to know that that's a normal part of our activities and our routine, you know, like if it should be just as, just like the others I mentioned, the sleeping, the eating and the movement, it has to, in the recovery time that you mentioned, it all has to be there. That's part of being human. But we don't. Even though there is PE in elementary school, I don't know that we really figured out from then, from school how to integrate exercise into our schedule. So I'm so glad for your encouragement with this.

Yeah. So PE, by the way, don't get me started. So they're supposedly bringing back the president's physical fitness test and I just.

So storm the troops, storm the schools. I don't know that that's going to do any good. But my one argument for that, I think the attempt and the thought behind it is right. I don't think the result will get what we want.

Yeah, I agree. I agree. And I think the more we can just demonstrate from home, like here's how we do physical activity, movement, taking care of our body, that's gonna be more long lasting. Like you said, the legacy of how to take care of ourselves throughout our lives.

Totally agree.

Oh my gosh. Well, it's been so wonderful to talk this all through with you. Thank you so much for joining us here at How Humans Heal. And I'll make sure everyone knows how to stay in touch with you or get in touch with you to learn more. And thanks everyone for listening in. If you don't already subscribe, I welcome you to subscribe to How Humans Heal so you don't miss the next episode. I'll see you all soon. I look forward to talking to you soon too. Deborah. Thank you.

Thanks for listening to How Humans Heal. If you like, if you liked this episode, leave a rating and a review. And for more resources, visit drdani.com.