Mastering the Menopause Transition: Exercise Strategies with Dr. Vonda Wright

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The energy to play full out at 100. As I started getting into perimenopause, I noticed some things. Maybe you can relate. I noticed that all of a sudden I could not recover from my workouts and I just couldn't work out as hard as I was used to doing. And at first I didn't connect the dots and thankfully I went to a dentist because my gums were bleeding and he said oh, that's your estrogen's lowered and boom, got the estrogen replaced and I was back hitting at the gym. But I've always wanted to dig into this subject about working out the musculoskeletal system, osteoporosis and menopause. And so I was so excited to find Dr. Vonda Wright. I started following her on Instagram and she has an amazing Instagram channel and was so intrigued because there are so few female orthopedic sports surgeons out there. She is one of the unicorns out there. She's also an author, a speaker, a researcher, and an innovator and her work really is the intersection of longevity, performance and orthopedics. So we are going to be digging into a lot of very cool stuff today. Everything from how to avoid a fall, what her ideal exercise regimen is for, this great formula that she gives for postmenopausal women, and much, much more. She has practiced in Lake Nona, which I was like, she lives literally an hour from me. So next time we do this, we'll do this in person. She's the founder and CEO of Precision Longevity and the host of Hot for your Health. Her ig handle is Rvanda Wright. And we're gonna put all of the show notes@jjvirgin.com DoctorVonda V O N D A and I will be right back with Dr. Vonda. Stay with.

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Dr. Vonda Wright, welcome to the show.

Thank you so much. You are a legend, my friend. It's an honor to be here.

Oh, stop it. I literally have been stalking you because I was like, this woman is a total unicorn and will have the most unique, incredible perspective on menopause because you are one of the few orthopedic surgeons out there. Like I said. Yeah, just, I actually don't know any other female orthopedic surgeons. I mean, how many are there?

You know what? When I started training, and at the time, there were 3%. So you know, try to find one of us. At this point, there are 6% attending surgeons, so still try to find one of us. We're making progress, but we are not at critical mass. And I think that's. That's important for women or anybody. But there is so much data, jj, that female surgeons have better outcomes, outcomes of our surgeries and care. So it's an important public health thing. Right.

Well, I was gonna say female managers, female founders. We could go on and on. It is interesting, though, because when you look in the integrative and functional medicine space, it's about 70% female. Oh, yeah, yeah. Because I have another business called Mindshare Collaborative, and it's where a lot of the integrative health people get together to collaborate. And it's 70% female because it follows the statistics. So I just think it's interesting because, you know, there's a lot that starts to shift as we go through perimenopause and beyond in terms of joint health. And I'm sure there's a lot you can see in your joints that could help you also with navigating menopause. So I was like, this is such a great perspective. So that's what I would love to do, is kind of look at this intersection and kind of go, what the heck does orthopedics and hormonal health have to do with one another?

Yeah, well, almost everything, jj, because, like, so, like, what we know now, it seems like we've been talking about this forever. People like you and I who talk about this all the time. But the fact of the matter is, there are still women in Monday, when they came into my clinic, I said, has anyone ever talked to you about your hormones? And they're like, no. What's that? Right. So there's still there. Seems in the little ecosystem we have, everybody's talking about it, but the fact of the matter is, in the country, nobody is talking about it. And only 7% of all women in the country are being prescribed hormone replacement therapy. So really? Yes, 7%. So, yeah. But when you ask me the question, what do hormones and the musculoskeletal system have to do with each other? And I say everything. It's because every sub tissue type of the musculoskeletal system. Right. All musculoskeletal tissues come from the same type of stem cell and then just differentiate whether it's bone, muscle, cartilage, fat. They all have common origins and they all have estrogen receptors. So every month, when our hormones fluctuate, our musculoskeletal system is affected. That's one of the reasons why young women have most of the ACL ruptures. It's why we see performance changes at different times in the month according to a woman's cycle. But when we get to the time of our lives that I'm in, where estrogen walked out the door, I mean, I'm so far postmenopausal, I can't even remember. But our estrogen receptors on our musculoskeletal system are left bare. And so, and I say this realizing that people have a really hard time with the perimenopause symptoms of hot flashes, night sweats, brain fog. But in general, those things will diminish with time. But for the musculoskeletal system, if we don't get in front of loss of muscle mass, loss of bone density, loss of our cartilage, chronic inflammation that causes disease, those are devastating and life changing. But here's the deal. Mostly preventable. If we just knew.

I love that so much because I just actually told this story on Sean Stevenson's podcast, and I said, you know, I set all these big goals for 50. I was telling you offline about my 50th birthday party with Dr. Sarah Gottfried and Dr. Anna Kubeca, and then I just kind of started coasting. I was like, coasting along, not thinking about these things. And I started to really look at the statistics for muscle loss as we age. I think the up to 1% per decade or per year each decade after 30 is scary, but the loss of strength and power is scarier. And so I started kind of saying, vonda, oh, I'm cool. I go to the gym, I lift. But I wasn't challenging myself. I was sort of like. And then I kind of went, wait a minute, stop it. These statistics are based on the average person who's doing some walking and kind of calling it in after this. We don't have to go this way. So knowing what could happen, what are your. Like, what's happening behind the scenes? Why are we losing that muscle? You know, why could we be losing bone? Let's paint the picture of why it's happening. And then I'd love to go into how we make ourselves not that.

Yeah. So if we want to talk about, maybe we should. Maybe we can start by talking about inflammation and the two things that people show up in my clinic most frequently about, because muscle and bone loss are silent until, you know, it's happening. Women come in with, you know, the ever popular frozen Shoulder. And this was my primary symptom at 47, total body pain such that I could barely get out of bed. And I'd always been an athlete. So I'm usually in control of my body and I'm like, what is going on? Well, the chronic inflammation that happens when estrogen walks out the door is because estradiol is an incredible anti inflammatory and works to inhibit the release of cytokines. Like, you know, things like we read about tumor necrosis factor alpha, right? All the inflammatory things. Estrogen is a damper to that. So without it, our body becomes grossly inflamed. The same kind of reaction happens in our muscles. Our muscles contain estrogen receptors and without estrogen sitting in them, there is increased loss of the normal age related loss of type 2 muscle fibers, which is our power fibers, our explosive, which keeps us able to jump out of the way of charging lions, traffic and whatever. So there's that with age, it's one of the cinequinone of aging, but without estrogen it's worse, right? And without muscle mass, then we become metabolically less healthy because muscle is critical in glucose metabolism. We also, gosh, muscle is just so important. Without estrogen in place, we stop replicating muscle derived stem cells. Now something that I don't, that isn't widely known is for most of my career at the University of Pittsburgh, I actually participated in a muscle stem cell lab. At the time, we just called them muscle derived stem cells. Now they're called satellite cells, which sit in the basement, the lower basement membrane, if you will, of muscle. But if you want to rejuvenate your health and rejuvenate muscle stem cells, all you have to do is contract skeletal muscle. So everything you've been teaching people for years is not only about physique and being strong, but it's actually about the longevity of your stem cells. And without estrogen, that stops. But probably I'm a bone doctor. One of the most critical factors that I talk about is that without the regulation of estrogen, we rapidly lose our bone density. And bone is not just the structural thing that holds us up. So I have this on my desk. This is a femur. I talk. Here's my bone example. I know I'm just that geeky, but we just think of it as that scary Halloween skeleton thing. But actually, bone is a master communicator. Bone communicates with muscle. They work together in one ecosystem. And you don't know you're losing your bone at a rate of 20% over your perimenopause until what happens? We fall and break. We start shrinking, our bones start aching. So, gosh, I could jg, I could go on and on. But these are just examples of how critical estrogen sitting in the receptors are.

Yeah, I remember. I actually remember being at the gym and going, what the heck? Just like you said. You were getting out of bed in the morning, and I was like, what is going on? Because I just couldn't recover, like, doing the same workout. I'm like, I can't do this. What is it? And thankfully, because I didn't put it together and then I went over to my dentist and for a cleaning, I go, man, every time I floss, my gums bleed. And they're like, oh, low estrogen. I'm like, oh, what?

They knew that?

Yep.

I'm so proud of them.

I know. And it was a guy too. I'm like, he's right. I mean, very, very impressive.

Yeah.

However, I did tear my ACL when I was 17 and then completely severed it at 22.

Oh, no.

When you said the ACL thing, I'm like, yep, got that. Yep. And so I think most women don't think about estrogen as so important for building muscle. Like, you just don't. You think testosterone. You don't realize that. Nope, not for women. For women, you gotta have that estrogen in there. So I'm glad that you brought that up. I'd love to just back up on the bone density. One of my theories is if we've got good muscle, you know, if we're building muscle, that bone density is a lagging indicator of not having enough muscle mass. And in a perfect world, I'd love to see it that we are starting to look at DEXA scans when girls.

Are in their teens.

What are you recommending for looking at this and tracking skeletal muscle mass and bone density and when, et cetera.

You know what I'm seeing now, jg, My day job is as an orthopedic sports doctor. So I've worked with active young women my entire career. And I was the head doctor for several Division 1 schools. And so what we see is that let's just talk about bone. So we just a little biology. We stop laying down bone, meaning building bone around 30ish. Right. So after 30, we're either maintaining or when we lose our estrogen, losing. Unless we're really active in trying to rebuild.

So.

But that's assuming we build bone in the first place. Because I don't know about you, but when I was growing up, I was Always an athlete. I had irregular periods. My fat was very low. And so I may have gone six months without a period. And because I was a dancer, I'm like, okay, I'm getting away with something. What I was doing was not laying down enough bone. So I get many women now who come to me. I had a 28 year old who broke her hip not because she was doing crazy stuff, but because she had never laid down enough bone. And so, yes, when we look at studies of college women, because now at this point, we do DEXA scans on freshmen coming into collegiate programs, we find a lot of young women who just never laid down bone because we've been fed the lie that women have to be teeny tiny at all times, right. And starve ourselves and not eat enough protein. So we must lay down bone across our youth. So when do I think that we should get DEXA scans? I'm hesitating because I get so passionate about it. DEXA scans as a baseline. Well, if your mother is shrinking, if your grandmother broke her hip, if you have taken prednisone because of another illness your whole life, if you ever sleep smoked, if you have fallen and fractured, now's the time. Whether that's 30, definitely by 40. I think we need baseline DEXA scans by 40. But, you know, scientists will tell us that DEXA scans are not the end all, be all, because the other factor that goes into fracture, which is why we care. One of the reasons we care about bones is their resilience, their ability to. To resist stress and strain and not falling. So it's not only building bone in our youth, figuring out our bone status and being very aggressive about that. Just because insurance won't pay for a DEXA scan before we're 65. That's not the final answer, which is.

Obscene, by the way. Like, that's obscene.

Right? What are we trying to figure out then, when it's nearly too late to do anything about it?

Eggs scrambled at that point, right?

Yes. Yes, you're so right. We need to do it early. We can buy DEXA scans. Some gyms, some. Some imaging places will do it for as low as $99. So you just have to. I say, you know, people are like, but I have health insurance. Why should I pay? Because you should. And number two, even if we can't afford it, let's save our $7.18 coffee money a day, which, you know, expensive homemade coffees. Just save it for 10 days and go save your bones. So that's me being very like, let's get in front of this people. Because bones are silent until they break, and then they scream at you. And it's one of the main reasons women die.

I know the statistics on it. I'd love you to share. Those are just crazy.

So one in two women, 50%, one of us, you or I will have.

I don't think you or I are gonna be.

But if there are two women in a room and they were looking at each other, this is what they used to say to us in medical school. Look to your right, look to your left. One of you will not be finishing. Look to your right, look to your left. One of you will have a fracture when you fall and break a hip like this bone I just happen to have in my office. When you break your femoral neck, 50% of the time, you will not return to pre fall function, meaning you won't be living in the house where you raised your kids. You won't be driving a car. All the things we value in our independence. And here's the kicker. 30% of the time, we die from our fractures. Here's a real story that was told to me yesterday. I am still taking trauma call. I don't. You know, at this late age in my career, you'd think I'd be done, but I'm not. So. So this is how it happens. There was a woman who came in who was 89 years old. Is 89 years old, and she was independent. Her son, who's in his high 60s, almost 70, lives in New York. She lives here in Florida. And she independent. Drives her car, takes. Goes to social clubs, drives her girlfriends around because they don't have licenses. And she does. She fell and she was so fragile without knowing it. She broke her pelvis in four places. She tried to break her fall, held out her arm, broke her shoulder, broke her scapula, broke multiple ribs. She is in such bad shape from fractures and she's in the icu that because it's so painful when you break bones, that her family decided because there was so little that could be done with that many fractures, that despite her previous independence, they send her to hospice to recover. This is not an atypical story. We go along. We go along until we break something, and then 30% of us die. And so if we can get in front of this at a young age, not only by all the things, I'm sure we'll talk about how to build bone, but how to build muscle as the support agent. We do not have to become frail old women dying from tragic Stories like I just told you. And that's not hyperbole. I don't want your audience to think I just came up with this wild story that is every single day in every emergency room in this country.

Yes. So let's do our part to stop that. And when I look at it, part of it is of course improving bone mineral density. But I think a lot of the things that you would do to improve muscle are going to. Well, everything that you do to improve muscle improves bone mineral density. Like I'm a big, big fan of do squats, do overhead presses, load the spine, load the hips. And I love rucking. But when I think about the risk for falling and you think about, okay, as we're aging, we're losing fast twitch muscle fiber, we're losing that agility, that power. It makes me think we have to design our training programs very differently to really focus on training. I always say you don't train to get better at training. You train to get better so that when you're out in the wild and you have to move quickly or do something or catch yourself, you can. So what are your recommendations for building muscle when you're menopausal? Menopause? Postmenopausal?

Postmenopausal. So, I mean, there's two areas I'd like to cover with that. If people have listened to me at all, they know that I like people to live as heavy as they can. Now, if you are just starting out, you've never picked up anything but a little pink weight and don't really feel confident. It is totally okay to start with body weight. Get the motions down. Move your body through the squat motion, the deadlift motion, the bench press motion, just so you feel confident in the movement patterns. But as you become more confident, it is important to provide enough stimulus to your muscles that they will actually change. Because our bodies, why is that necessary? Our bodies are magicians at maintaining stability, homeostasis, right? We want to be in this stress free plane. So if you're lifting too light and doing 20, 30 reps and it's just like a piece of cake to you, it's a piece of cake to your muscles. You're not going to build any new muscles or, or strength. So I commonly recommend for four compound motions. Squats is a compound motion deadlift. It means it's multiple joints, you including your core, bench press, some kind of pull, lifting as heavy as you can. So that four reps leads you not to exhaustion, but near exhaustion. You should only have one or two reps left in you, because that's when we will stimulate muscle protein synthesis. That's when we will cause the replication of our stem cells, which is what we want. And frankly, it doesn't take you forever. So my mantra is lift heavy in.

College and go home.

And go home. It doesn't take that long.

I know those 30. Like, first of all, you know, you know, I was a group exercise teacher, then a personal trainer. I mean, and actually was a group exercise teacher when all this was first starting back in the day.

Yes.

And then one of the first personal trainers. But back then, you would do. You'd be in these classes to feel the burn, and we would do, like hundred repetitions of something stupid, you know, like.

Well, and that's what it took to build up enough lactic acid to feel the burn.

Right.

But you know what? To that I realized the way we are training now has changed since, you know, I began working out. I used to have exercise videos in my living room and just do what you're talking about. Thank God people were getting the country moving, because everything is better than sitting on a couch and coming to this room. Everything is better than that.

Everything is better than that. And I look at this and go, all right, for me, my easiest definition of exercise is that you do more than what you're used to. So your body has to adapt. So that means. And I view aging as a snowball rolling down a hill. And I think, all right, like, it'll pick up speed unless you do more than what you're used to, in which case you can flatten it out. So that's what we've got to do, is be the role models. And I am kind of obsessed with some of this stuff on Instagram now where they have women in their 70s and 80s and they have that gymnastic grandma.

I know, the green jumpsuit. I know. I've seen it.

It's amazing stuff. So what do you say to the poor person who is just. Is afraid of lifting weights? They're afraid of. You know what I'm gonna say?

Afraid of getting big.

Like, first thing I heard 40 years ago, still hearing it today. I'm afraid of getting big. What do you say?

I have a not so nice thing to say. And then I have a real thing to say. The not so nice thing to say is, listen, with 70% of our country doing no mobility every day and 40, 40% being obese, people are getting big anyway, but in the wrong way. But if we're specifically thinking, oh, my goodness, I don't want to be like a competition bodybuilder, I am gonna say, don't worry, my friends. That is very specific. That takes decades of hard work. The most you're gonna see is more toned muscles, clothes that fit you better, more strength. You are not going to become bulky unless you train to become bulky. It will never happen.

Yeah, it's interesting. Forty years of doing this and the only time I've seen people get bigger is when they quit.

Yeah, that's right. Yeah. You slather on the fat butter and, you know, everybody gets bigger muscles.

Metabolic Spanx holds everything in tighter.

I love that.

What about. What about mobility, working out and cognitive function? Yeah.

You know, many years ago, I did a series of studies early in my career really answering the question, can we be healthy, vital, active, joyful forever? Right. And so, because what we know from most medical research that looks at aging is looking at what pop. The population is doing. And what do we know about our population? Just what I said. 70% of them are sedentary. So I did not accept that we had to age in the declining way that sedentary people do. So my whole series of studies were on active people. They weren't pro athletes, but they committed every day. One of the studies was on performance. Two on bone, one on muscle that now has a life of its own. Own. But the brain study took five years because I matched the subjects in my study for everything with the sedentary person. Their education, their occupation, everything. The only thing that was different is how much mobility they invested in their bodies. And you know what we found? There are five there. I had a tool called the impact test that was developed at the University of Pennsylvania, Pittsburgh, that measures frontal lobe, the executive function of our brain. And we use that test to compare sedentary people to chronically active people like you and me. And what we found is that three out of the five executive functions, those functions that make us human beings, were preserved in chronic exercisers compared to sedentary people. So speed of thinking, complex problem solving, important things in our aging and longevity. Exercise. It's exercise. And we know that there's this. In following up on that study, we were looking at some of the reasons why. And a group out of Emory showed that contraction of our skeletal muscle causes transcription or the production of a protein that goes directly to the brain that affects memory. So you think you're out there working on your lean muscle mass and what you're doing is working on your brain function.

Yeah. My son, when he was 16, was hit by a car and literally Left for dead in the street. Severe traumatic brain injury. I mean, 13 fractures, crushed heel, cornea, aorta. The doctors literally left, told us to let him, let him go, which didn't listen. However, we brought him back from a severe traumatic brain injury. And what we used to bring him back from this severe traumatic brain injury is exercise. Like, we did a lot of stuff, hbot, neurofeedback, but the biggest needle mover of all has been exercise.

That's amazing.

Yep. Yeah. They said he'd never walk again because of the crushed heel. They say he'd never wake up. You know, on and on and on. But I tend to not listen to authority.

Well.

You mentioned too, I had no idea about these studies. You also mentioned something about the muscle piece of this. What did you learn there?

Yeah. So there's this picture on the Internet that has a life of its own. If I describe it. You may. I heard.

I was trying to find it. Can we link to it in the show notes?

Of course. So what we did was we, we. There's this study called the Health ABC which followed a cohort of aging people 70 for 10 years and looked at a variety of things. But one of the things they did was look at their lean muscle mass. And what they found in sedentary people is that we lose our muscle architecture, we lose our volume. We become grossly infiltrated with fat like marbling. And I didn't believe that because I see examples of my 85 year old father whose muscles are still as good as they were when he was 60 because he's a chronic exerciser. So what I did was a study that did MRIs. Lots of people have MRIs. They know you just lay there and let the magnet work. And I took slices of the quads. And so this picture that I'm describing at the top, there's a picture of a 40 year old slice of the quads. Above our gorgeous quadriceps. In the bottom are amazing hamstrings. The femur's right in the middle. It looks like a flank steak. There is no intramuscular adipose tissue. Gorgeous. The center picture is a slice of a sedentary person who's been sitting around for 35 years. And what you have is raggedy muscle. You have gross infiltration of fat and a thick rind, 2 or 3 inches of fat, peripheral fat. The final Picture is a 70 year old triathlete. Most of my athletes were runners and triathletes just because of where I was. You would have thought that the third 74 year old picture's muscles was just another slice of the 40 year olds. Gorgeous muscle architecture, very little peripheral fat, no fatty infiltration. Still, a flank steak had not turned into a rump roast. This picture has been used all over the Internet. I should have named it because it has a light. I should call it like the Betty picture or something. But what it showed was that we are in control of our futures. When we invest every day in a purposeful way, it just doesn't happen by hoping and praying, but by thoughtfully investing in our mobility. Even mere mortal athletes like me can retain our lean muscle mass and in doing so, preserve our longevity because muscle is just so important in that process.

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You know, when you look at all those 12 hallmarks of aging and here's the thing, all my training was as an exercise physiologist, and I felt like the peasant of the health world until a couple years ago. And I was always lugging people to Gold's Gym in Venice and going, lift. I mean, this was 35 years ago. Now I'm like, I'm so smart.

You're the queen. Yes.

Finally. I like, finally it's come around. But the exercise scientists are like, we're in.

Yes, that's right.

And while I know that anything's better than nothing, the one thing that I do believe that as we age, we really want to dial in a great exercise prescription that's dealing with the loss of power and strength and dealing with issues with balance and working on VO2 max, which we haven't even talked about. So I would love for you to share your because you said move every day. Like, what would be your way to take someone who and I think most people that I talk to, it seems like they're walking and maybe doing a little yoga or Pilates.

Oh, how about that? How about that?

So what would you do with. With Sarah, who's doing that?

So the framework that I use because people need cues to remember what to do, I call it facing your future. I've written about it in some of it, just a framework written about it in some of my books. But facing a future how midlife people should prescribe. Movement is flexibility and mobility. F A is aerobic. And I will outline each one of these. But briefly. C FAC is carry a load. I purposely did not specify whether you have to throw on plates on a bar or whether we're using, because there's lots of ways. And then E is equilibrium and agility. So let me briefly go through these four. So people know, oh, what are the parts of the recipe? Flexibility and mobility. Unless we keep our muscles out to a decent length and our tendons unbridle, unless we keep our joints capable of moving through a full range of motion, we are more prone to injury going forward. And we'll start shuffling along like old people. Who wants that? I want to walk with a full stride. I think that's where Pilates and yoga come in. They are the icing on the cake for flexibility, for mobility, just keeping everything flexible. Fluid flex. F A aerobic. There are three ways I like to approach this. I used to burn it out six, seven days a week, getting my heart rate up to 186. I could predictably be injured every three weeks, same injuries. My mechanics aren't perfect. But what we know now is three hours a week of BASE training, which can be a brisk walk. You know, even so far as micro bursts of activity. There's great data that shows just run up the stairs a few times a day. Adds to the picture. So base training at low heart rate and we can get into zone two. I happen to have a lab here. I'm capable of measuring lactate threshold, but it's 181 minus your age. So around 120, 130 if you're metabolically healthy. So BASE training add on top of that. And the way I do this is after I've walked briskly or been on a treadmill or a bike for 45 minutes to an hour at a low heart rate. If I'm on a treadmill, I sprint twice a week, I punch it up to 11 and I go as fast as my little legs. I'm a short person, can carry me without flying off the treadmill, but only for 30 seconds. And then I completely recover. It takes me two to three minutes to recover my heart rate back down to about one second, which is my base. I do that four times. That is what stimulates the neuromuscular pathways which keep stimulating my cardiovascular system. That is what's going to stimulate synthesis of satellite stem cells. So we've got BASE training, brisk walking, sprinting, and I don't want people to be freaked out by that word, it's just going as fast as.

Can you?

You can. And then if we really want to layer on the fitness, which I've added this year, is we train for VO2 max once a week. So just briefly, you're the scientist, you can go into this for. You're the exercise scientist. But briefly, VO2 max is a measure of oxygen exchange from across our lungs from arterial to Venus. And how efficient we are at that is a reflection of our cardiovascular fitness. So the reason that's important with aging, not in elite fitness, that's a whole different subject. But with aging is there's an independence line. When it comes to VO2 max for women at 16, the measure of it's a three digit label, milliliters for oxygen over time. 16 for men is 18. Here's how we use that. We never want to get to that line because that means we can't live independently anymore. We're too cardiovascularly frail. I'm going to use my numbers. So as an example, if we do not work to maintain our VO2 max level, if we're too sedentary, we drop our VO2 max 10% a decade. So my current VO2 max is 45. Well, it was when I was 50. I almost need to do it again. When I was 50, it was 45. So if I lose 10% by the time I'm 60, in a few years I'm at 40. At 70, I'll be at 35. At 80, I'll be at 30. I am never hitting the loss of independent line. But if I haven't worked out enough across my lifespan or there's a reason why I'm metabolically inefficient and I start out at 50, at 25, 10% a year, I'm going to hit my loss of independence line. So the way you can maintain VO2 max, maybe even increase it, although I'm not sure about that, is to do a VO2 max workout, which is three to four minutes, as fast as you can go, recover for three to four minutes. So it's slower than sprinting. But it's hard, right? It's hard. You don't want to have to do that more than once a week. Yeah. So flexibility, aerobic, carry a load, lift heavy enough to stimulate your muscles. Right. So I usually prescribe this in the. In the power moves, push, pull upper body, push, pull, lower body. So bench press, pull up ish, pull up ish. I'm not good at pull ups, but pull up ish, push, pull on the legs. Is squat deadlift. Four reps, four sets. And then for the accessory moves, of which there's.

How many times a week?

Minimum of two. I do it four.

Okay.

But start low. Just get it done a couple times until it's part of your life. And then the accessory moves that support the big power lifts, the single joint moves for the upper body. For instance, if you're bench pressing, accessories are biceps, triceps, lats, delts, rows. I usually tell people to do eight for three or four sets because, listen, jj, I'm just trying to keep it simple enough that people will do it.

I'm right there with you. I prioritize big functional moves. I always say, think about what you need to do in life.

Yes. You're so right.

You must get up off the toilet, Right?

Oh, you're so right.

You know, you gotta put stuff in the overhead. You gotta pick something up off the floor. Let's do it. Yeah. And don't you agree, because people. I'll hear people now. You know, I think it was such a. An opportunity to blow my knee out at 17 doing point ballet, which the biggest joke is I did gymnastics, acrobatics and pointe ballet. I am six feet tall.

Oh, good for you.

And my son was doing tricking and parkour. He's six two. So he, you know, he pulled his tibial tuberosity off his tibia. I mean, we're just like, wrong sports for us, you know, play some basketball. But because of that, you know, my knee, basically, I had five different surgeries until finally there kept going, have a replacement. I waited till 52, but I always. It ached. It always hurt. And the way I remember when I walked into the office for this surgery, they go, we don't even know how you're walking. I go, because it's so strong. And I trained for the surgery. And the big thing I think that needs to be out there is people will avoid things because of an injury and say why they can't do something. And actually, I think that's why you need to.

I agree.

So you validate that because you're the orthopedic surgeon.

Well, and, you know, to your point, I've heard every excuse in the book, and a very common excuse is I hurt my right knee. To which I say, you've got two arms, a core, and a left knee. Let's go. Right.

Yeah.

You've got all the body parts. But I don't want to forget to tell people on this how to exercise. I know I've been going on forever we talked about flexibility, aerobic weightlifting, carrying a load, equilibrium and agility. We need to train our foot speed. I can't tell you how many times I've gotten up too quickly from my desk and here's my work bag sitting here, and I go to trip over it, but because I work on this, I just hop right over it. You know, falling is one of the main reasons for fracture. So I have the privilege of working with an amazing speed coach. Her real job is training collegiate and pro track and field athletes, but she has taught me and the group of women that I commonly work with. Foot speed exercises, pogos, jumping over ladders, jumping it back and forth so that we don't get old and slow. Right. Slow is not how we have to age.

And what's great about those things, like everything you just listed here, you could easily do at home. You can easily do some. Some side jumps, some air squats into a jump. You know, all of these things are easy enough to do. And I might have. I literally just got a little stress fracture in my foot because I got way too zealous on my Norwegian 4x4 is using up downs and squat jumps. And I was like, you know what? Just stop it.

Oh, I'm so sorry to hear it.

But no.

Oh, it backed it right off.

It's fine.

But a lot of the same stuff is easy enough to do at home. You can do a lot of that agility training at home, and you can. I mean, if done correctly, it's great interval training, too.

Yep, exactly right. No, I agree with you.

I'd love to go back to VO2 max, just briefly, because you mentioned losing, and I just saw the statistics that said 5 to 15% a decade starting at age 30. It sure seems like at age 30, all, like, people are all concerned about age 50. Like age 30 seems to be that. Like, what the heck just happened here? But as far as I can tell, though, from what I was reading, it was very variable because it could be massively shifted by exercise. So I just wonder if we can really offset that and have it be 5% a decade, as opposed to 10 to 15%. It seems like we should be able to.

I think so. I think our bodies are so responsive to the positive stress we put on it. I think as a population, we just don't stress it enough now that we're no longer agrarian, we don't farm. We're not shepherds. We are so digitalized that it doesn't take a lot of energy on a typical day. So, you know, when I grew up on a farm in Kansas, and it was a typical day to not sit down from morning to dusk. But now it's a typical day for most of us to sit down from morning to dusk and just spend an hour a day moving around. So it's kind of a flipped scenario the way we're living today.

Yeah. And that study that just came out that said if you're working out 30 minutes three times a week and sitting the rest of the time, you've erased it. So I always start with just getting people to get their steps up first because I want to make sure they actually have the activity in.

Is there a target goal? It seems to be a moving target that. Is there something you recommend to people?

From what I've seen in the research, it's everything from 8,600 to 12,000. And what I do is people like, I literally have someone I'm working with right now who has over £200 to lose. And so he was doing about 2,500 steps a day. And when I started to look in the research, I'm like, well, what's the average? It turns out the average is 2500 to 4000 steps a day. Now I always like to just start and go, okay, well, if you're hitting 4,000, let's go to five. Yeah. And then let's go to six. Let's just keep raising the floor. You can always do more. Go crazy. And then once we get up there, I really want the floor to be the floor. Minimally 8. And I have a funny story. The other day I was at a hotel. I was at a meeting. And while I was trying to stand up the whole time, it was like an all day meeting. And I get to the hotel where we're staying and I've got 6,500 steps. And I'm like, and that we're on the 16th floor. But I go, honey, I cannot. Like, I have to get my steps because I committed that 8,000 is my absolute floor. I have to get my steps. You understand? Yeah. You're like, of course. And so I said, so let's take the stairs. He goes, I'm not taking the stairs. And I actually was doing a little IG videoing calling him out on that, and he stopped taping. He's like, honey. Anyway, so I take the stairs up. Well, I get up the stairs and it counts for like 300 steps. Oh my God, what a ripoff. Oura ring. So then I'm like, honey, I have to go outside. So he came out with me, we had to go walk, walk, walk until I got the steps. But you know, I like to focus on one thing at a time and get that thing dialed. And I think first thing is just get up, get up and then we can start those exercises. I think that the literature on all these exercise doses is great because who can't do 10 air squats in one hour and then maybe in two hours do 10 push ups and it's doable stuff.

Little bursts.

Yeah, you just gotta get it into your schedule.

Yeah. And you know, in terms, I love your commitment to your steps. In fact, I haven't told my husband. I just did this. After long days, we're just exhausted. So. So we just kind of sit there for a minute and you know, watch something fun like Wrexham or some Netflix thing. But I'm like, okay, too much sitting. I just bought us a walking platform that I'm going to put in the living room. Yay.

I've got one right here.

I've got one right next to me because this is a. Well, this is a stand up desk and I've got a walking platform and then I got rucking vests. So because you know, I have five and six pound dogs. You take the five and six, six pound dogs out for a walk. Nothing is happening. Like it's you. You probably walked 100 steps. It's like walk, walk, pee, walk, walk, sniff, walk. And then we'll drop him back in the house and go for it. But I got us rucking vest, I've got the walking pad because he wasn't paying attention to it either. But he'll do what I. He'll do what I recommend. He just won't usually initiate it. But once it's in his program, he.

Does review, it'll do. Yeah.

Yes, yes, yes, yes. Now you've got a couple things going. Well, you got a lot of stuff going on, so I didn't realize you were still full time day job and working some of the trauma stuff. And then you've also got your podcast.

Yes.

And you also are going to be gifting an ebook. Strong and Courageous. The no Excuse Guide to Thrive in Midlife and Perimenopause and beyond book which we will put@jjvirgin.com DrVonda V O N D A for everybody listening D R Vond Voda and where else can people find you? Because you've got great. I saw you on Instagram and started stalking you.

Well, I love that because I would have never gotten to meet you if it weren't for Instagram. So I'm so thankful for that opportunity. But I post every day on Instagram. I only have so much time. That is the main place you'll find me. But I think for deeper dives, I have a YouTube channel by the same name. Dr. I do a podcast called Hot for your Health and some interesting people on there and we just have a book coming out in 25, so as soon as that's ready for, I'm gonna let you know about it. I'm very excited.

I would love to.

I love book launches.

Fun, fun. All right, well, thank you, thank you, thank you. We'll put all of that@jjvirgin.com drvanda and I'm sure next time we have to do this in person since you're only an hour ish.

I didn't realize I will come to Tampa.

I didn't either. I saw and I'm like, what? Yeah. She's like, no, no. What the heck are we doing?

Yeah, it'll be fun. Well, thank you so much.

Awesome.

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