The best exercises for menopause, according to a trainer and a doctor

When you enter perimenopause, it’s easy to feel like you missed the boat on being “fit.” This is likely when you first learn, in the throes of hot flashes and sleep disruption, that muscle and bone loss actually started in your mid-to-late 30s.

But the thing about exercise is that it starts working immediately. “We know that people, even if they started [exercising] in their fifties and sixties, they're likely to continue to be healthy later on,” says Dr. Sara Shihab. M.D., a board-certified internist at the Mayo Clinic specializing in sexual health and menopause.

That said, says Shihab, get the green light from your doctor before you start any new type of exercise, especially if you have a medical condition — including but not limited to kidney disease, cardiovascular disease, or type 2 diabetes. And get help right away if something doesn’t feel right.

Why is exercise so important during menopause?

Where do we start? During menopause, any planned exercise — such as brisk walking or lifting weights — as well as physical activity like gardening reduces the risk of chronic diseases including obesity, cardiovascular diseases, type 2 diabetes, osteoporosis, and certain types of cancer. It also improves mental well-being, immunity, sexual function, sleep quality, metabolic health and more.

Movement can also alleviate common menopause symptoms: A 2019 Polish study found that women who did more physical activity had less severe symptoms (including urinary problems and vaginal dryness) compared to inactive women, and other research has linked exercise with a reduction in hot flashes.

Physical activity, particularly strength training, can counter certain changes in body composition, too. During menopause, hormonal shifts — including a reduction of estrogen — can lead to weight gain, a loss of muscle mass, and impaired muscle regeneration, according to a study in Bone.

When you lose muscle, it can become easier to accumulate fat. “So then that aggravates the problem,” Shihab says. “If you want to fight that fat redistribution, boost your metabolism, [and] increase your muscle mass, you can achieve that essentially by exercise.”

Ditto if you want to prevent the bone weakening that happens during this time. Bone loss can lead to frailty, which is when your body lacks the resilience to bounce back from injury or illness. One recent study in the Journal of Bone and Mineral Research found that the more frail older women become, the higher their risk for fractures that require hospitalisation and a greater risk of death, especially related to cardiovascular causes.

The best menopause workouts

“Any movement regularly is better than not moving,” says Tina Tang, CPT, the 54-year-old strength coach and owner of Iron Strong Fitness in New York City. Shihab agrees, and says even a 10-minute walk could be a good place to begin. There are a few types of workouts, though, with a particular benefit for menopause.

Strength training

Of all the things on this list, both Tang and Shihab say strength training is arguably most important, as it builds and maintains muscle and protects your bones.

But if you’re new to exercise, don’t just head straight to the weight room. Tang recommends getting moving first with regular walks, then adding resistance like dumbbells, bands, or machines in the gym. If you go with dumbbells, start light — pick a weight where you can do three to five more reps than what you’re planning on (so if you’re aiming for 10 reps, pick a weight where you could have done 13 to 15). If it still feels easy at that point, you move on to heavier weights. (This routine from our fitness director Justin Kompf, Ph.D., is a great place to start!)

One way or another, it’s important to continue to progressively overload your muscles, which means you’re increasing the difficulty of the exercises, whether that’s by adding weight, reps, sets, or even a third day per week.

Tang also recommends working up to incorporating unilateral exercises, which are exercises that you do on just one side of the body at a time (e.g. single-leg deadlifts and step ups). These movements help shore up balance, another critical fitness metric that can decline with age, and is important to prevent falls.

Moderate-intensity aerobic exercise

The American Heart Association recommends at least 150 minutes of moderate intensity (or 75 minutes of vigorous) aerobic exercise a week for overall health. If you divide it up throughout the week, you’re looking at 30 minutes of moderate-intensity activity, which could be walking, hiking, cycling, or running, five days a week. “Especially for women around menopause and perimenopause, it's really important to do this,” Shihab says. While strength training’s main benefit is supporting muscle, moderate cardio’s major focus is improving heart health — which is big since perimenopause increases the risk of cardiovascular disease.

You’ll know you’re doing moderate-intensity exercise if you can pass the talk test — meaning you could have a (potentially slightly difficult) conversation with a friend while you’re doing it.

Moderate aerobic activity is also what you may be hearing on social media called “zone 2,” meaning that your heart rate stays well below your max, though Tang says that you can go as high as zone 3 and still be in the moderate-intensity zone. Your heart rate zones can be measured on a heart rate monitor and some fitness trackers, although the talk test is sufficient for most people.

HIIT

Tang says that it’s also important to do some work in the higher heart rate zones, which is known as HIIT or high-intensity interval training. In addition to cardiovascular benefits, a 2020 meta-analysis in Experimental Physiology found that HIIT can also lead to significant weight loss, including total and abdominal fat mass (though it found the benefits to be greater in pre-menopausal women.)

To do HIIT, you alternate between short and intense intervals of an activity like cycling, running, or even brisk walking and recovery intervals. For example, you might cycle intensely for 30 seconds, then recover for 1 minute. (The authors of the meta-analysis note that cycling HIIT seems to be more effective than running for body weight loss, though both were effective.)

Still, Tang says less is more when it comes to HIIT. Sessions can be short — 20 minutes — and even once or twice a week is useful. In fact, Tang says that if you can do HIIT for 30+ minutes, you’re probably not working hard enough.

And while you may have seen some posts floating around the internet about HIIT being “bad” for women in menopause because it spikes the stress hormone cortisol (which is related to abdominal fat storage), Shihab cautions there isn’t really any solid evidence to support this rumor: “Exercise in general is a positive form of stress. But it can have negative results if done excessively or with the wrong form.” Basically, just don’t overdo what you’re doing and you’ll be fine.

Plyometrics

Tang and Shihab both agree that plyometrics — higher-impact exercises that build power, like jumping — can be beneficial for menopausal women, especially as it relates to preserving and building bone density. A recent meta analysis found that jump training showed improvements in femoral neck bone mineral density compared to controls. “If someone doesn't have joint disease and past injuries, then they can do [plyometrics] safely,” says Shihab.

You can start by holding onto a wall and simply bouncing on your heels without your feet fully leaving the ground, Tang says, before graduating to “bunny hops” or simply jumping repetitively without hanging on to anything. If you have leakage issues or lower-body joint problems, Tang says you can do upper-body power moves like medicine ball slams or battle rope work.

Like with HIIT, less is often more when it comes to plyometrics — adding in one “plyo” exercise as part of your strength training warm-up is a good place to start, Tang says.

Stretching

Shihab recommends stretching regularly, even if just for 10 minutes after your strength training workout. And while, yes, it does help your body recover from all the other workouts you’re doing, it also has its own benefits — namely that it improves joint health and your range of motion, she says. That’s not insignificant, especially if you’re experiencing joint aches, a relatively common menopause symptom.

You could also combine your stretch work with mindfulness by taking a yoga or Pilates class, which may boast mind-body perks: A review in Menopause found that when compared to controls, Pilates, yoga, tai chi, and qigong not only improve bone mineral density, but can also improve sleep quality, anxiety, depression, and fatigue in perimenopausal and postmenopausal women.

NEAT

Physical activity doesn’t just happen when you attend a class or go to the gym. It happens when you climb the stairs to your apartment, take your dog for a walk, or vacuum your living room, and it has a name: non-exercise activity thermogenesis or NEAT. And all those little movements add up.

“We know that non-exercise physical activity has health benefits,” Shihab says. “If you can incorporate a set time for exercise, [that’s] amazing, but it should also be just a part of your lifestyle to be physically active,” she says, whether that means counting your steps or setting an alert to stand up and move throughout the work day.

While there’s little research specific to menopause when it comes to NEAT, there is data that shows this type of movement ups your daily energy expenditure — a.k.a. the number of calories you burn every day — and that’s good news if you’re trying to lose or manage your weight during menopause.

The bottom line

Exercising during menopause has a plethora of physical and mental health benefits including preventing chronic disease, weight management, and more. Strength training, aerobic activity, and HIIT should be prioritized, but plyometrics, stretching, and NEAT can be helpful, too. It’s never too late to get started with exercise, and some exercise is better than none.