Exercise and Hot Flashes and Other Menopause Symptoms

Real quick, before we dive into this episode, I have a little sleep secret I want to tell you about. Look, sleep is crucial for your fitness, but it's crucial for just plain old everyday life and function. And I find I sleep great unless I have a migraine. And I've had more than my fair share since perimenopause all the way through postmenopause. My secret weapon was Blue Sky CBD sleep gels. Each gel contains 25 milligrams of CBD and 25 milligrams CBN for deep restorative sleep. Something about it helps to reduce inflammation, which I believe for me was key in helping me get to sleep. But the biggest thing is so many of the over-the-counter solutions, whether for sleep or migraines, can ruin gut health, and liver health. Neither one of those did I want to be problematic for me. So this option is recommended by healthcare providers worldwide and backed by thousands of happy customers, many of whom come from our Flipping 50 community. There is zero THC, so it's non-habit-forming. It's made by a trusted family-owned company that we all can feel good about. Third-party tested for purity and potency. And if you're interested, you too can try a sample for just $6. But even better, you can get 30% off forever with discount code FLIPPING50. That's FLIPPING50. Just go to flipping50.com/blueskycbd. We'll put that link in the show notes and you'll find it everywhere on Flipping 50 at My Favorites. What are you waiting for? Good night. Even if you don't have hot flashes, stay with me on this one because this episode is equally about the science, dissecting the science, understanding the science, and eradicating science says as a cry for validity by influencers. Hot flashes are one of the most common symptoms of menopause, one of the most common obvious symptoms, shall we say that? And in this episode, I explore the relationship between exercise and hot flashes along with other menopause symptoms like muscle loss or fat increases. I'll share what 3 different studies found about exercise intensity as it relates to hot flashes and include some anecdotal information from 4 decades of working with women in midlife. At the end, I discuss a conversation about the flippant use of "studies say" and how a study you find, read, or someone shares may not be giving you any conclusive evidence that you want or need and what to do with that information.

I'm Debra Atkinson, and you're listening to Flipping 50. I started this podcast over a decade ago to answer questions about fitness and menopause and beyond before you know to ask them. The goal to help accelerate your results with the science and the practical application of proven protocols while living your best life. There's no more powerful health influencer in the world than a midlife woman.

It's not just you, but it's the 3 generations that you influence.

My unique 40-year career, including being a university senior lecturer in kinesiology, an industry subject matter expert, an international speaker, to founder of the first and the only exclusively made-for-menopause-and-beyond fitness membership in the world. Every week I interview experts behind the science of optimal hormone-balancing fitness and longevity and share answers to our community's questions so you can have the vitality and the energy you want, need, and deserve.

Okay, I'm going to dive right into this dissecting. So a 2024 study of 72 women in various stages of menopause, so that means pre, peri, and postmenopause, published in the Menopause Journal of the Menopause Society looked at the impact of minutes spent in 3 different exercise intensities. As you might guess, that is very low intensity, moderate intensity, or high or vigorous intensities, and what the impact was on body composition or relationship and on total menopause symptoms. More symptoms were associated with higher percent body fat Both percent body fat and vigorous exercise were significant predictors for total symptoms in all groups, pre, peri, and postmenopause. That is, the lower body fat percent and more time spent in high-intensity activity, the fewer or lower the number of reported total symptoms. Total menopause symptoms. Let me say that again, and I'll say it individually this time so it really sinks in. The lower your percent body fat— now we're talking within health ranges— the fewer total menopause symptoms. The more time spent in high-intensity activity, the lower total menopause symptoms. Now I wanna qualify that one. Now that doesn't mean we want you to go all hard all the time, high intensity and tons and tons of it. Just meant that in looking at all those women, the ones who were actually doing high intensity more than others or the most out of the group had fewer symptoms, right? And so researchers were able to draw that correlation. They concluded intense physical exercise that specifically helps improve percent body composition, or percent body fat as we record it, may also reduce menopause symptoms. It can especially be helpful for perimenopausal women because those are, of those three groups, the ones generally reporting the majority of hot flashes. And that's not to say— some of you listening are thinking, but wait a minute— that's not to say that a woman in postmenopause doesn't you have hot flashes, that can happen. So this is not the first time that researchers have found these kinds of associations. In the previous podcast episodes and in my books, You Still Got It, Girl, or Hot Not Bothered, I've shared researcher comments to questions about whether exercise could mitigate menopause symptoms. The answer is by researchers. This is quote unquote not me saying it, but it was, yes, provided it's intense enough. Meaning, just exercising, you may say, well, I'm exercising, it's not working for me, which has been some, some commenters on social media posts to me that has been their response. But the question begs Are you doing high-intensity interval training? Are you really truly reaching muscular fatigue in your resistance training workouts? And the reason that may be so important is it could be related to— obviously, let's think about it. You go for a walk, you know, you're not going to generate a whole lot of body temperature from going from a walk of your own choice, self-selected pace. However, if you're going to do high-intensity interval training, if do that for very long, most of us are going to get a little sweaty. We're gonna work up some kind of sweat. We are going to get breathless. There's a big difference in the impact and effect of a lot of different systems. So your heating and cooling system, I like to call it your vasomotor control, and there is the likeness, right? Because that is what's going on. With your, your vasomotor control system. Some of that is genetic. You probably got it from your mother. Thanks, Mom. And what you need to know is she just didn't necessarily have hot flashes, but that may not mean she didn't pass on that— those genetics to you. And you have to think about— you've got to get used to having your body be able to cool itself in order for there to be some translation. But we've also seen this in other places where you have to reach this pinnacle place where you've got the muscle protein synthesis because you get enough or because you work hard enough. And we know that if you don't get over that hump or over that hill, you're not going to have the same results and we are not going to stimulate. So let's say Interval training can be very confusing for a lot of people, and a lot will find that they'll call— I'm going to jog a little bit and then I'm going to walk— that's interval training. And certainly it is, but it is not the high-intensity interval training where you get completely breathless and you do it within 15 to 30 seconds. And this is really important. I have this question come up, and sometimes people will say I saw this interval training session, I did it, and I didn't— it didn't work for me. I couldn't get breathless. So should I repeat it a second time? And the answer to that question is no. So that would just be a cumulative effect, and now we're turning it into endurance exercise. So if it doesn't get you breathless within 15, 30 seconds, and then you can completely recover and you can do it again, it's potentially just not a mode that is going to work for you. And that would be true for anyone. It's very similar to getting on a treadmill and you're, you're not used to walking fast, and so 3 miles per hour could be feeling fast for you. That might be your interval. But then later, when you're more fit, you're more conditioned, it may take for you to have to run, you know, at 5 or 6.0 miles per hour in order to reach that breathlessness. Now, somebody who's actually a runner is thinking, but that's only a 10-minute mile, that's my jog, right? And so on. So it's all relative to you, but you may be trying to do a movement that you're already over and above, and no amount of effort that you're going to do is going to cause that to actually get you breathless. Unless, for instance, you're dehydrated and you've got a ton of caffeine in your system and you're uber stressed, those things can change what gets you breathless. But on a good day, working at your capacity, you've got to choose movements and, and effort. Some of it is that, you know, there are boxing kinds of movements where you can just go through the motions. You're not going to work very hard. If you're punching and actually efforting in every single move, you're going to actually feel that., and it's going to have a very different result, not only on your breathlessness but on your muscle, your muscle tone, your core, the, the dynamics that have to happen, the bracing that occurs. All of that will change with the amount of effort, but it may be that no amount of effort is going to help you with knee lifts, for instance, get your heart rate up high enough to actually fall into that category of high-intensity interval training. So just want you to realize that, yes, provided it's intense enough, no one can say, give you— here's a list of high-intensity moves, because— and look, you'll find it, I think I have released something on YouTube like that, a no equipment high-intensity interval training at home— but I can't do that very easily if I'm saying here's a low impact. So if it's impact, that becomes a little bit easier for more of us to get our heart rate up. But if there's no impact, now we've removed that movement from gravity or resistance of gravity, it's a little harder and more challenging to actually get the heart rate up. Okay, moving on. This is another 2024 study also published in Menopause Journal, and this is purely coincidence, but it showed that both moderate-intensity and resistance training exercise will decrease hot flash occurrence in some women and may be especially important to women who deal with depression. This analysis of randomized controlled trials— so it was more like a review of literature, so a review of several different randomized, which is good. So we want that randomized controlled trials. So many of the details were controlled We want that. We want all of that. In a study, they evaluated primarily moderate exercise. So the conclusion on that study isn't a comparison of low, moderate, or high intensity, but only a look at moderate exercise and subjective answers about hot flashes. So they ask the pool of those women who were subjects, so have you experienced fewer hot flashes. Now, probably if they're journaling that, keeping track of it, that's a legitimate answer. But that only worked for some women, right? So notice the comparison. In a comparison of high or low, moderate and high, high showed more result, more impact on body composition, more positive impact on total hot flashes, and there's a correlation there. In the moderate, it decreased hot flash occurrence in some women, but also there was a component there that hadn't been studied or talked about before, which was depression. So looking at moderate exercise and/or resistance training, both of them showed positive results, particularly in those women who hadn't been exercising previously. So go back just for a moment to that first study I mentioned of 72 women. Researchers also submitted an article that on— from that same study. And researchers will often do this. It's like multitasking, if you will. So while they've got these women, they may be looking at different kinds of results that they can report that don't all go into the same study, but they've got these women, they're going through it and, and they may look at, you know, what else can we— that is a complimentary piece of data. What else can we report on? They submitted an article based on that study, those 72 women that was published in the American College of Sports Medicine or ACSM. In that study, they looked at muscle size, muscle quality, and strength during menopause. They also looked at protein turnover changes as women progress through menopause, and all seemed to decline. Now, as you know, we talk very frequently here about the term muscle protein synthesis, because we're either— muscle protein synthesis could be said as muscle protein buildup versus muscle protein breakdown. Down. We're in one or the other, and it's— there's a very thin line. It's not a fence and you can't be on it. You're very likely not just maintaining. We're over here, we're over here, we're over here, we're over here, and we may be all of that even in the course of a day. So let's say you have a very small, short breakfast. You have not very much before you go do a challenging strength training workout. You get caught, you get delayed, you get— it's traffic, it's an errand you forgot you needed to run, and you don't come back and actually fuel again for, you know, several hours. The longer you go without food post-exercise, it's probably more important if you didn't have enough or much before you got started. The longer you're in that catabolic state, you're in breakdown. So remember, there's anabolic and catabolic states. Women who cross over that threshold of 40 tend to be more in an anabolic state because of lower levels of all of our hormones, but primarily estrogen is a stimulant for muscle. There are some who are contesting that whole fact, and I'm going to come to that in just a moment, but all of them seemed to decline. So Coming back to that, what we don't know, and what was pointed out very recently on a little social media banter by Dr. Stuart Phillips in his response to a post on Instagram to Mary Claire Haver's post regarding estrogen's impact on muscle, is the cause for these changes. What is the cause for protein turnover as they progress through menopause? What is the cause for the muscle size, quality, and strength during menopause declining? Is there evidence for causation? Is it estrogen goes down, so those things will go down?

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And the truth is that there's not a lot of evidence to say that's true enough. And here's what we have to consider. Although many women will, will say that's happening to me. Like, I can't, can't seem to get the rewards for the work that I'm doing. Like, I'm lifting heavy, I'm doing the things. And there are a lot of things, by the way, to unpack there that usually there's a clue when we go through a lot of yes or no questions and I get, you know, no, well, I'm not doing that. Well, sometimes when I remember, you know, those kinds of things. Pretty much give us a clue into what it is that we need to do or we're not doing and why we're not getting the results we need. But it's not obvious. It's not intuitive to many women. We don't connect the dots all the time until you hit your head on the wall over and over again and realize, I need some help here. I'm not able to solve this by myself. So we have to ask, is there evidence for causation to say estrogen drops and so muscle will drop— quality, quantity, size, strength. There isn't, in that, you know, some women, if we pull together a pool, they're not doing hormone replacement, they are post-menopause, and they're able to maintain body composition, muscle size and strength. But lifestyle changes probably have to occur. There has to be a little more overcoming going on, maybe That means volume. And to explain volume, I've said it in many, many podcasts, but I'm going to repeat it for those of you who are regulars. Bear with me, but I get asked this very much. What do you mean by volume? When we're talking volume, we are talking about the number of sets you're doing for muscle groups and the weight that you're lifting. We're not talking about the number of repetitions, but by pure definition, As the weight gets heavier, the number of repetitions go down. And we're not talking about more days per week necessarily. We're talking about also allowing for recovery, in fact. So is the decline of muscle secondary to side effects that women experience during menopause, like insomnia, poor mood, depression, or anxiety, lack of motivation? We have fewer serotonin receptors during menopause. So if you're feeling like you've always been motivated to go exercise and maybe you're struggling with that a little bit now, you're not exactly as motivated as you always used to. You're not as diligent. You don't hold yourself to that same standard that I have to go, which, you know, in part is some look at as obsession, but others look at this is great discipline because we don't always feel like going and we definitely don't always find it convenient. We really do have to make time to do it. But if you've got insomnia, you're suffering from depression or anxiety as a result of some of those hormonal changes. A drop in the number of serotonin receptors means that it's gonna be harder to be in a good mood or want to go. You will also not quite get the buzz, the high that you used to, because in part that is serotonin. You don't have as many of those receptors, so you may not feel as good afterward. There are still some feel-good hormones, absolutely, but it may be feeling a little bit different, like there is never that elated feeling you used to have, conquer the world kind of thing. So if we combine some of those shifts not getting enough sleep. It's a reason enough for some of us not to feel like we're gonna get motivated to go exercise. You combine those things with a time crunch that we've got, so many of us have in midlife, or comfort or emotional eating that many of us will do when we're a little bit more stressed, a little bit more busy. We might guess that it's a combination of both. The hormone changes as well as, you know, all of the life situations around us. But repeatedly women will say, I haven't changed a thing, but my results have changed. I'm not getting results. And I think it's a multifaceted conversation. It's not a no or a yes answer that because estrogen declines, muscle automatically then declines in quality or quantity or strength. Strength? Not necessarily, but that would definitely be true if you didn't change what it was you were doing. So if you want to prove it right, you won't change a thing. But if you want to get better results, you're going to favor strength and resistance training, walking, but do a whole lot less of that moderate kind of exercise. Focus on the walking and the high intensity. But when we do intensity, we do small doses of it. The total amount of time per week that you might spend in high-intensity exercise might be 5 minutes. That's it. Like, if you do 5 different intervals lasting 30 seconds each, that's 2 and a half minutes, one session. In between that, you're resting and recovering. So the entire session, with a warm-up and a cool-down, is longer than that, of course, The high-intensity time is not— it's very, very short. So you've got to look at, am I changing things so this is true for me? So whether we're talking about exercise and hot flashes or we're talking estrogen and muscle loss, the one thing that emerges here is that so many variables could be at play. Even if the science is a randomized double-blind study which means even the researchers don't know which subjects are doing the thing and which are doing a placebo or control group until they are gone through all the statistics and they've looked at the data. That's the ideal, right? The researchers just know what methodology they're going to go through, but everything is done blind, so nobody gets special treatment. You don't premeditate what you expect or think that you're going to get. So even if that true with a large pool. So we know that there's a good subject pool. 72 is fair, right? But we'd love to see it over 100, you know. And sometimes larger studies generally are review of literature or they're polls and surveys, and so they're a little bit less scientific. It's reliant on somebody's measuring, reporting, and/or in a large review of literature, many studies are done and there are nuances that are different about each and every one of them. So it makes it hard to collectively say, well, we're going to look at, you know, these 52 studies. And yes, that looks at a lot of individuals. However, it doesn't— every single one of them is slightly different. The protocol was shorter or longer, the number of days a week they did something was shorter or longer. So all of those changes make it hard to draw a conclusive Answer: if your hormones have changed, we have to change the exercise, though that one is certain. And nutrition and more diligent sleep habits— we've got to change all of those things, or generally it's not going to work. We know that, right? So you have different conditions, you're not going to do the same thing. If medications become important to you, or they are now, then we also have to look at micronutrients a a little bit closer because they're depleted by every prescription or any over-the-counter medication that we might take on a regular basis, right? So they're, they're doing their good, but there's always a negative side effect that comes into play for them. If you don't absorb micronutrients, meaning your gut health needs some attention, you don't have optimal muscle or strength building blocks. So yes, those are the essential amino acids that need to be broken down, but all foods need to be broken down in order for you to absorb the micronutrients as well. A couple of things have come out of this banter back and forth between Dr. Mary Claire Haver. She's the author of The New Menopause, and she was recently on Oprah. You may recognize her name. And Dr. Stuart Phillips, whose, whose name comes up if research is being done on protein and/or longevity. He is out of McMaster University in Canada, and he's been on the show once, maybe twice. And, you know, he's fantastic with regard to research. What really came out of this though is the type of studies that influencers share matters. And even they may not dig into whether they've shared something that's a review of literature, whether it's a double-blind randomized control study, or it's a narrative, which is really the professionals', the researchers', opinions about a topic. They may not know what that means or explain it to you. So what is the interpretation that helps you make decisions on changes that you may want to consider or that reinforces what you are doing, that you want to stay on that track. I think the only real thing an influencer is sharing, unless they share the actual science with you, is what works for me. That's all fair, right? For, for any influencer to say, you know, I'm 56 and what worked for me is this. Then it's true, it's real, it's authentic. But for someone to say, you know, research says this is exactly what we need to do, without saying what is the research, and, and without us asking what kind of research— and we will unpack this a little bit more in a future episode. Dr. Stuart Phillips has been gracious enough to come back on and be a guest in in part to help break down how do I know if a study— if I go to PubMed, for instance, meaning you, if you go to PubMed, you don't know it's a peer-reviewed journal unless you actually click to that journal and you find out how are submissions made. They should be made to an advisory board who chooses to allow them to be published or not be published. So they're literally peer-reviewed, but many studies that appear in PubMed are not that. So you really need to do your homework and due diligence. It's not just as easy as it might sound, but then we can get into the nuances of, is it a narrative or is it a randomized double-blind control study that really checks off all the boxes? Or is it a review of literature? And where are the limitations in that? So it is helpful to break things down, and I'd love to hear from you in this podcast. What we plan to do a little bit more of regularly is to take studies, break them down— who were the subjects, what actually happened, and what were the results— so that you understand, was it a review of literature, was it a longitudinal study? Was it self-report? What kind of data can we take from that? So usually if I share something and I'm talking about, you know, this was very recently I shared something about the 10 air squats every 45 minutes, and that was a study done on adolescents. So adolescent girls and boys, but they were obese. And so I made the reveal that, yes, this is true. And it was a fairly small pool, but I think it's a hopeful way to take away the thing we share with anyone obese is the insulin resistance. So in midlife, where we also were dealing with that, breaking up sedentary time was the biggest takeaway. The realization that maybe doing it regularly, 45 minutes or every 45 minutes, that's what the study was, or every hour consistently. And even though it might take 10 seconds to do 10 air squats, had great value. So I will share all of that with you, but I'd love to hear this. The last thing that I take from this is it's time for us to train an army of menopause fitness specialists in every fitness club and every health center, university, and behind every online program. Someone should understand the physiology of exercise, the physiology of menopause, be able to understand and comprehend it. So stick around if that's you, if you have any interest at all in becoming a Flipping 50 Menopause Fitness Specialist and you're tired of maybe guessing for yourself, your clients, and, you know, watching a lot of quote-unquote bro science applied to women without ever considering— we have never asked questions about pelvic floor on health intake forms in the fitness industry. That dawned on me just a few years ago. We changed it immediately behind the scenes of Flipping 50. We've never considered from ovulation to the luteal phase, a change in nutrition, a change in the exercise that a woman does might serve her in reducing her injury, increasing or enhancing her performance, and/or getting better results. If you're just an average Jill wanting results, we never suggested a woman test her muscle mass at 25 or her bone at 30 when she's peaking to compare to later. And many of you have heard, if you are a regular listener, this is on the docket. It for my now daughter-in-law. So before we could get it done, she actually is going to become first the mother of my first grandchild. So once she's in the clear postpartum, we intend to have her do a DEXA scan so that we know where she's at. She is, um, 30— she will be 31 in a couple months, but she's right there Right? Peak muscle mass. It would've been great to do it before this child because I, if you're not aware, if there is any problem with lack of bone building materials, the baby, the fetus will get it. So the mother may lose bone density during pregnancy. If you've had multiple pregnancies, that could affect your later life bone density. If your nutrition sufficiency wasn't there during pregnancy. So something to think about. The baby's always going to win, and, and that is just preservation of life. But those things are really important. If that's news to you, again, as a trainer or a health coach or a want-to-be, there's no prerequisite. You don't already have to have a training certification. You do need to go through the program program, you actually can come in, you can become a coach and start earning money in several ways right away. No need to build a platform, no need to build a website. You can actually use our programs and platforms and coach your clients through them. So if you want to know how to create a comprehensive exercise prescription that supports, not worsens, things like insomnia, prediabetes, insulin resistance, low libido, low bone mass, body and specifically belly fat, exercise, hot flashes, night sweats, and more than 7 other key changes in exercise prescription that help a woman arrive at menopause, thrive through menopause, and enhance her longevity, reach out to me right now. We're opening the enrollment for the Flipping 50 Menopause Specialist, and this is an amazing opportunity to join the program, not only get the knowledge you need, but the business growth and mindset, the coaching that you— you should not be a wise broke trainer or health coach like so many of your peers. The number of trainers has jumped from 250,000 not very long ago to 750,000 in the last decade. The number of health coaches has grown from zero to hundreds of thousands in a very few short years, yet few of those are making a profit, let alone a living. It's a hobby, and if that's what you want it to be, I think that works. But if that's not what you set out to be, it doesn't need to. The revenue reported in these industries is largely the money invested to gather more and more certifications by the coaches themselves. That's not what we're after. You're building websites, you're building apps, they're posting on social, and they're unfortunately failing. But you don't have to if you're interested in becoming a coach. If you start from the beginning with education as your marketing, you skip the guessing, you skip the hype, the salesy, sleazy feeling fake. Anybody can copy that and does the copycat GPT copy. You don't have to be an MBA with experience in sales or marketing, but you do need to have a formula and a blueprint that has worked not just for me to go from zero to six-figure months, but you need it proven over and over again with our fitness specialists since 2018. We have a big stable, but we'd like to grow it. We'd like specialists in every state, in every gym, in every health center out there, as well as online. If you want to do online business exclusively or as a hybrid, there's a place for you, and we need more voices. Look, there are over 38 38 billion women in the world— or 38 million women, sorry— 1.1 billion women in the world needing help going through menopause. And every single woman on the planet goes through it, and she's not getting the help yet that she needs. Be ahead of the curve. We'll put the details in the show notes. You can get started, or you can book a discovery call with me so that we can talk about it. What are you waiting for? Let's start Flipping 50 today.

Thank you so much for listening. To listen and access a decade of episodes and the show notes, visit flipping50.com, where you'll be able to find all of our prior episodes. And I made it easy for you to make the most of your listening time by selecting 5 specific areas. Most commonly high priorities for our community and giving you top 10 lists if you let me know you'd love them. If you know a midlife woman or a soon-to-be one who wants to optimize her midlife energy and time with the right exercise and lifestyle changes and a mindset shift about just what is possible, share this podcast with her, and I thank you. There is no more powerful powerful health influencer in the world than you, midlife woman.