BITESIZE | What You Need To Know About Strength, Menopause & Healthy Ageing | Dr Stacy Sims #673

As we get older, have you ever wondered why the exercise advice we’ve been given doesn’t seem to work as well as it once did? As we move into our 40s and beyond, our physiology changes in ways that can often feel confusing and frustrating. But what if we could harness those changes to feel stronger, healthier and more resilient than ever before? Feel Better Live More Bitesize is my weekly podcast for your mind, body, and heart. Each week I’ll be featuring inspirational stories and practical tips from some of my former guests. Today’s clip is from episode 578 of the podcast with exercise physiologist and nutritional scientist, Dr Stacy Sims. Stacy is dedicated to helping active women – and the people who support them – take back control of their bodies, health and lives through science-based knowledge and practical tools. In this clip, Stacy shares why conventional fitness advice often fails women in midlife, and what many of us may be missing when it comes to improving our health, vitality and resilience as we age. Stacy’s insights remind us that with the right information and support, we can build strength, confidence and better health at any stage of life. Thanks to our sponsor https://heights.com/livemore Show notes and the full podcast are available at drchatterjee.com/578 Support the podcast and enjoy Ad-Free episodes. Try FREE for 7 days on Apple Podcasts ⁠⁠https://apple.co/feelbetterlivemore⁠⁠ For other podcast platforms go to ⁠⁠https://fblm.supercast.com. DISCLAIMER: The content in the podcast and on this webpage is not intended to constitute or be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your doctor or other qualified health care provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have heard on the podcast or on my website. Learn more about your ad choices. Visit podcastchoices.com/adchoices

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Rangan Chatterjee?

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• 0:41Rangan Chatterjee?

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• 1:20Rangan Chatterjee?

  See all details at drinkag1.com/livemore. Welcome to Feel Better Live More Bite Size, your weekly dose of positivity and optimism to get you ready for the weekend. Today's clip is from episode 578 of the podcast with exercise physiologist and nutritional scientist Dr Stacey Sims. Stacey is dedicated to helping active women take back control of their bodies, health and lives through science-based knowledge and practical tools.

• 1:58Rangan Chatterjee?

  As we move into our 40s and beyond, our physiology changes in ways that can often feel confusing and frustrating. In this clip, Stacey shares why conventional fitness advice often fails women in midlife, and what many of us may be missing when it comes to improving our health, vitality and resilience as we age.

• 2:24Rangan Chatterjee?

  What would you say are some of the common mistakes you see women making as they get older when it comes to losing body fat, increasing vitality, and I guess more broadly, improving their overall health and wellbeing?

• 2:44Speaker 01

  I think the biggest thing is following traditional trends where if we're looking at women who are in this kind of 40 plus or maybe 45 plus age group at the moment, grown up in the whole diet culture of move more, eat less, and that's what people tend to do, especially when they're trying to lose weight. But if we were to switch it and say, you know what, I actually want you to do more high intensity and to eat more to shift your body composition. It becomes a little bit of a disconnect and people can't get their head around it. But it's following the traditional trends that have been so,

• 3:26Speaker 01

  so well versed in the fitness world that really do not work.

• 3:31Rangan Chatterjee?

  Yeah, it's interesting. As I've been researching you and the things that you talk about, it's very clear that, first of all, a big part of what you do is to help people understand that women and men are fundamentally different. They're physiologically different, they're biologically different. You, of course, have your phrase that women are not small men. But what's super interesting for me is that as women get into their 40s, you are very clear that two things need to happen with respect to movement. There needs to be resistance training and there needs to be HIIT, high intensity interval training.

• 4:14Speaker 01

  Yes.

• 4:14Rangan Chatterjee?

  I want to talk about that, but I guess the way I wanted to frame it, Stacey, was to pose a theoretical question to you.

• 4:23Rangan Chatterjee?

  I often talk about what I consider the four pillars of health: food, movement, sleep, and relaxation.

• 4:31Rangan Chatterjee?

  If a woman, let's say 45 years old, okay? So in that perimenopausal period is nailing her food, whatever that means, we can maybe discuss that later. She's nailing her sleep, she has low stress levels. And for her movement, she is walking for 60 minutes a day. So her lifestyle is really good, but she's not doing HIIT training and she's not doing resistance training. Is that enough for her to age well and be well?

• 5:06Speaker 01

  If we're talking about the walking component of movement, and that's what she's doing, no, it's not. Because if we're looking at walking, we're falling into the idea that we're doing cardiovascular work, which is good, I mean, we want that. But when we start looking at what does it mean to age well? We need to look at how strong and powerful we are just to be able to carry groceries when we're 80. Think about our bone and bone density. And we also really want to examine what does cardiovascular fitness look like? Because when we start getting into perimenopause onwards, because we've lost the epigenetic exposure

• 5:49Speaker 01

  of estrogen and progesterone, and to some extent testosterone, that affects every system of the body, we have to really understand what that means. Because if we think about puberty and the first expression of these hormones in a major way, we see all of these changes that happen from a biomechanical and a physiological perspective in girls and boys. And girls tend to put on more body fat. They end up having less of aerobic capacity as we compare it to age matched or puberty matched boys. We see so many different things that occur with brain, brain health and mood development. And so when we get to the other side of things

• 6:33Speaker 01

  and we're seeing the unwinding of ovarian function, every system of the body is affected, including vascular compliance.

• 6:43Speaker 01

  Primarily estrogen and progesterone together work to improve bone density. They also work to help with our blood glucose control, our resting blood glucose. It helps with how our body fuels itself at rest using more free fatty acids and having a conversation between the liver and the muscle that says, you know what, we want to use these free fatty acids, we don't want to store them as visceral fat. And we also see that estrogen is tightly tied to how our blood vessels respond to things like hot and cold, how they will constrict and dilate, so our blood pressure is very tightly controlled.

• 7:28Speaker 01

  When we start losing more and more of these hormones, we start to see a stiffening of our blood vessels, so we don't have as much what I call vascular compliance. So our blood vessels are very slow to constrict and to dilate, so it affects our blood pressure. We see that we have a change in how our body will fuel itself. Well, we'll see more insulin resistance, so that means that we have an increase in our resting blood glucose. If we don't do something, then we're going to end up in a prediabetic, potentially a metabolic syndrome type situation. So if we're thinking about walking for cardiovascular health and burning some calories,

• 8:11Speaker 01

  we're not optimizing the vascular compliance that we need to control blood pressure and to help with our lipid profile. So we see a really significant increase in LDL and our total cholesterol in women who are mid to late perimenopause. And it has to do with the way estrogen is no longer there working for anti-inflammatory properties, and there's a misstep of way that we're having conversations within the system to really use free fatty acids as a fuel. So when we start looking at all the pillars that I agree with, because I talk about it all the time, we look at physical, then the

• 8:53Speaker 01

  Emotional or the relaxation, parasympathetic, the sleep and nutrition. Right? So if we're nailing all of those and there's a misstep and we're still not seeing body composition change, we're not seeing change in our lipids, our blood glucose. And a lot of women don't. And this is where they start falling into, well, my body composition isn't changing. So I need to up my walking or I need to eat less. And there's all these things that start to play in that really create a misstep in what will accumulate into a better longevity profile. So when we start pulling out all these sex differences and then we put on the sex hormones,

• 9:32Speaker 01

  then we see this huge differentiation of the way that a person will respond to external stresses of exercise and how they will respond to internal feedback from the nutrition that they're getting and the nutrition timing and circadian rhythms. And women have been following all of these things that have been put out in the fitness and nutrition world that's been based on male data and they're not optimizing. We see so many missteps. And if we were to just pull it back and say, you know what? From a female physiology perspective, these are the things that we would like to do to improve and reach your potential. From a male physiology perspective, these are the things that we know work for you. We've seen it in the research too. So we just need to

• 10:16Speaker 01

  separate and divide. It's not that one is more complicated than the other. It's just we're different and we respond differently. And I don't want to take away people's soul food. I'm saying if we're looking at what optimizes a woman's body as she's going through perimenopause and into post-menopause, because what we do in perimenopause, we want to carry it through the rest of our lives. There are things that you can optimize from an external load to really create a stress resilient, strong frame, both mental and physical frame, to carry you through to your late years of life. And we also have room for soul food.

• 10:59Speaker 01

  For me, my soul food is going and riding my gravel bike for hours and hours. But that doesn't fit into HIIT and strength training. But it fits into what I call soul food because it's good for my brain. I like being outside, seeing my friends.

• 11:15Rangan Chatterjee?

  Yeah, there's so much there to unpack. It's kind of interesting. It sort of implies to me that even the word exercise or even movement perhaps is too broad, right? Because by saying one pillar of health is movement, which I say and I agree with, okay? And I wrote a book with that in it, right? So it's not that I'm necessarily disagreeing with that. But the problem is then is that different movements, different forms of so-called exercise provide different stimuli to the body and therefore different adaptations. So we as a society have to be more specific with the adaptation we require.

• 12:01Rangan Chatterjee?

  Once we know the adaptation we require, we can choose the right movements or exercises to give us that adaptation. More and more, I think one of the key points I want to get across in this conversation for women is why those two things must be done as you get older. Because I think there's a lot of my audience who might fall into that category. They're doing really well with, you know, that conventional stuff. They're doing well with the four pillars. But on the movement aspect, I know many women, friends of mine, who perhaps are not strength training and are not doing high intensity training, but they are walking regularly and they would probably think that that's enough.

• 12:43Rangan Chatterjee?

  So let's go through those changes so that we can make that case.

• 12:47Speaker 01

  Exactly. So when we start looking at something like resistance training, why is it so critical? And we hear conversations out there where I'm talking about we want to lift heavy loads. Other people like just regular strength training. When we start looking what's happening in peri-menopause, the very first thing that happens before we see a loss in lean mass is there's a disconnect the way our muscles contract because we have a change in some of the expression of our contractile protein. So if we think about muscle contraction as a ladder that's coming together, we have myosin and actin and they bond together to pull fibers together to create a contraction.

• 13:32Speaker 01

  When we start losing estrogen, we start losing the ability for myosin to hold on to actin strongly. So we become weaker. We don't have as much power. When women are talking about this, they're like, I have a really difficult time opening a jar of pickles because my grip strength isn't there. I might be a runner, but now all of a sudden my running pace is really slow and I don't know why. Their body composition hasn't started to change yet, but their overall strength and power has. Then about a year or so later, we'll start to see a significant loss of lean mass and an increase in body fat. There are two things that are going on here. One, we have that disconnect of estrogen

• 14:16Speaker 01

  and the way that it's affecting our muscle contractile strength. But we're also having a change in our gut microbiome. Because when we start losing our sex hormones, we start losing some of the gut bugs that are responsible for some of the ways that these sex hormones are able to be pushed back out into circulation. So we have a decrease in the diversity of our gut microbiome. And because women are tired but wired, the bacteria that grows is more of a firmicudis fila. So that means it's more of the obesogenic fila. So this encourages the body to hold on to body fat. So when I bring it back down to what are we going to do to counter this?

• 14:57Speaker 01

  Because we can't counter what's happening with the down regulation of our estrogen, progesterone receptors, or that our ovaries are starting to wind down naturally. So we look at those external stressors. Resistance training for lifting heavy loads, it's going to create an adaptation that makes myosin and actin hold on to each other strongly to be able to have a central nervous system response for really strong muscle contraction. If we look at high intensity interval training, and we talk about it as like true polarized, we're going as 80% to 110% of our max, and then having significant recovery between each effort.

• 15:42Speaker 01

  This creates a change that allows our muscles to pull carbohydrate in and glucose in without insulin. It also creates more of a conversation with what we call myokines, which are hormones that are released from the skeletal muscle, to circulate to say, you know what? We don't need these free fatty acids to be changed and stored as visceral fat. We need these free fatty acids to be used as fuel. So it improves the way that our mitochondria are using our free fatty acids and improves our metabolic flexibility. So when we're talking about why resistance training is so important, it's all about maintaining strength and power as well as lean mass.

• 16:27Speaker 01

  Why is high intensity interval training so important? It gives us much better metabolic control and more feedback to reduce the buildup of that dangerous visceral fat.

• 16:41Rangan Chatterjee?

  Yeah, really, really clear. Okay, so.

• 16:45Rangan Chatterjee?

  When you say resistance training and lifting heavy, what exactly do you mean by that?

• 16:52Speaker 01

  So resistance training is the umbrella term of a push-pull against your body, meaning that you are pushing or pulling a load that is heavier than just your body weight. And this is how we increase our overall strength or our power. When we're looking at lifting heavy or specific strength training, this is when we're getting in the nuts and bolts of how we do it. So if we're looking at strength training, this could be anywhere from air squats and push-ups to tire flips and Olympic lifting. When we look at heavy lifting, this is the power end, where we're trying to really use central nervous system responses

• 17:34Speaker 01

  to increase our muscle capacity, meaning our ability to have a very strong muscle contraction, a fast muscle contraction, and a stimulus to build and keep our muscle itself and our bone. When we're looking at perimenopause into postmenopause, the two really critical things that we need to remember so that we can age well and not get old is we need to be muscle-centric and strong. So if we're looking at how estrogen really stimulates what we call the satellite cell or the stem cell of muscle, and now all of a sudden we don't have estrogen to do that,

• 18:19Speaker 01

  we need to find something else that's going to stimulate the stem cell of muscle to keep building muscle.

• 18:25Rangan Chatterjee?

  Yeah. Time plays a role here, right? So let's say you're a woman, you're 40 years old. You know, you're busy with whatever work, being a mom, like the things of life. And perhaps you go for a few walks throughout the week when you can.

• 18:43Speaker 01

  If we have minimal time, let's make the maximum gains.

• 18:47Rangan Chatterjee?

  Yeah. So help us think about that a little bit for the woman who's time pressed.

• 18:51Speaker 01

  Yeah. I mean, that's almost who I talk to every day. Women who are in their 40s, they're working, they have kids, their lives are very full. I have a group of women who say they're the 5 a.m. club because that's they have to get up and get their stuff done and be back by 6 a.m. So fully understand that. So if we're looking at a woman who has maybe one hour a week that she can dedicate for herself. And then, like you said, throw in a couple of walks here and there, maybe after work or on the weekend.

• 19:24Speaker 01

  We have to look and focus on that one hour. What can we do? Maybe we can split that up into three 20-minute strength training sessions. But that would require, you know, three separate days and maybe she only has that one hour. So if I were to look at that one hour, I would structure it into three 20-minute segments. Where the first one is we're doing lots of mobility work so that we make sure that we stay injury free. So we're looking at opening the joint capsules and creating more range of motion. So it's not stretching, but it's working on proprioception, it's working on in-range, it's loosening up the tendons and the ligaments. Then I would do 20 minutes of compound heavy resistance training.

• 20:08Speaker 01

  Then I would finish with some sprint interval work. So this would be 30 seconds, as hard as you can, 110% effort. And then you have two to three minutes full recovery and you might do that two or three times. Assault bike's great for that. Maybe you're doing kettlebell swings. But that stimulus at the end of the mobility and the resistance training is what you need instead of a 35 or 40-minute HIIT class. So we're looking at that one hour and you can do that once a week. That's a bare minimum that's going to help create the impetus for better body composition change and brain health. Because the other thing about heavy resistance training is it works on the neuroplasticity of the brain.

• 20:53Speaker 01

  And when we're looking at neuroplasticity, we want that because we want to be able to maintain our ability to have cognition and not experience cognitive decline. And then you can look at your walks. Maybe one of your walks with your dog.

• 21:11Speaker 01

  Okay, well, instead of just going on this normal 3K walk with my dog, I'm going to take the dog and I'm going to divide that 3K up. And maybe I'm going to pick up the pace for a minute or two, and then I'm going to have a minute recovery. So you take that into a HIIT session. So there's ways of looking at what you're doing during the week, even if you are time constrained.

• 21:32Rangan Chatterjee?

  Okay, for the woman who hates gyms, right, who for whatever reason, they don't like going to gyms, okay? I appreciate you might need some instruction, and there's a risk of injury, and you have to build up slowly. You know, I understand all those things. But for someone who feels that they could, and they want to start strength training, what are some other options for people who want to do all of this at home?

• 22:01Speaker 01

  Yeah, I mean, you can start with loading a backpack up and using that with air squats, right? So you can put canned goods, or you could put a sandbag in your backpack. So there's ways of adding external load while you're at home. There's some really fantastic apps available now, too, of guiding women at home first through resistance training body weight into adding load with their body weight. And it could be buying a couple of kettlebells. It could be using sandbags. Like, there's lots of things that you can do that doesn't require you to actually go to a gym. It's understanding what your environment is, how you feel about being by yourself, working out, or do you need a partner to work out with?

• 22:45Speaker 01

  Because community is huge. We see women really gravitate, especially if they have a lifting partner or a friend who's on the same journey. See better adherence and better progression when you have community around you. So it depends on the individual. But everything is totally doable at home. It depends also on what you want to invest in. But starting out with your body weight and then adding load through a backpack or sandbags, like you're talking about, a weighted vest, anything that's going to add a little bit of external load, it's all extra stress on the musculoskeletal system. That is going to benefit you. So if someone's never done any kind of resistance training,

• 23:25Speaker 01

  they're not going to hop into the really heavy loads right away. It could take up to six months to a year to learn how to lift heavy properly. And let's figure out where you are in your journey. And maybe it's connecting with the Betty Rocker, or Haley Happens, or Loretta Loves Lifting that all guide you through starting the journey. And then boom, now you feel confident to go to a gym.

• 23:49Rangan Chatterjee?

  Yeah, I love it. And I guess the key point is, if you're not lifting heavy, there are certain adaptations which you're just simply not going to get, which you probably really, really want to get as you go through peri-menopausal and beyond. Because you've got this quite catchy phrase, don't you? Be the oldest person in the gym, not the youngest person in the nursing home?

• 24:11Speaker 01

  Exactly. Yep. And I like to point out the Instagram account Train with Joan. So Joan is seventy-two or seventy-three now. She started her strength training journey in her late,

• 24:28Speaker 01

  was it late sixties, mid-sixties? She hasn't been lifting very long, but she was facing a lot of the typical things that a peri-postmenopausal woman faces, extra visceral fat gain, prediabetes, low bone density. And her daughter's a personal trainer, and she's like, I want exercise, I don't want drugs. So she started strength training, and now she is this phenom who started lifting late and is benching fifty-five kilos as her bench press, and she's deadlifting a hundred kilos. And it's just the progression that she's had. And she's a really great image to show what heavy lifting can do for you. You're going to get strong,

• 25:14Speaker 01

  you're going to have really good cognitive faculties, and you're going to have really strong bones. And those are the things that we're after.

• 25:21Rangan Chatterjee?

  And for the men who are listening, even though we don't have those hormonal changes, we're still going to get incredible benefits, aren't we?

• 25:29Speaker 01

  Absolutely. Because as we age, both men and women, we become more anabolically resistant to exercise and protein. So the more strength training you put in, the more your body responds to building muscle and building bone, both men and women. It's just when we look at aging, we see women have this definitive point in time where all of a sudden they're feeling the effects of aging in this perimenopause. Whereas men age in more of a linear fashion. We see a blip in their 40s and we see a blip in their 60s, but it's not as overt as what's happening to women in perimenopause.

• 26:08Rangan Chatterjee?

  Yeah. I mean, would you say that's fair to say that your message is, it's one of empowerment, but it's also one of urgency? Yes, you've acknowledged, Joan, so it's never too late. At the same time, why wait until your 60s and 70s? If you can get the message now, why not start in your 30s?

• 26:26Speaker 01

  Yeah. And I say this coming from an incredible endurance background. Like I was an ultra runner, I raced Ironman, I raced road bikes, I did Xterra. But strength training is something that was exposed to me early days, but I didn't really understand the value and the power of it until I started working with Marcia Stefanic at Stanford in the Women's Health Initiative data, where we really started looking at the outcomes and longevity from DEXAs of who had more lean mass and who did strength training versus those who didn't. So it wasn't really even about attenuating any of the menopausal symptoms.

• 27:09Speaker 01

  It was about, let's look at the viability and the quality of life for women who entered the study when they were in their 60s and now they're in their 80s or 90s, who's doing the best? And it was those women who were more muscle centric and strength oriented. And I was like, okay, now let's really start getting into the strength training thing.

• 27:30Rangan Chatterjee?

  For a woman who feels inspired, but they don't know where to start, what are your final words to them?

• 27:39Speaker 01

  First, find a friend because I'm sure that you have a friend who's going through the same thing and have a conversation. And then you can look to either go in and get a personal trainer together. But if that's a bit too daunting, you can look at some of the apps that are out there. One who just wants to stay at home would go with Betty Rocker. One who's really confident in the gym might go with Haley Happens Fitness. One who's just starting to explore strength training and wants to add some equipment might go with Loretta Loves Lifting. Those are all really good and they all address different levels of fitness. You can get into the communities there. Because again, when I talk about community, it's about having someone to lean into and ask questions,

• 28:23Speaker 01

  but also to support you. And when you start your strength training journey, it's good to have that. Yes, you're going to achieve personal goals and benefits, but it's always more fun with community around you to encourage you to push a little bit more than what you really thought you could.

• 28:41Rangan Chatterjee?

  Thank you so much for listening. This episode was the last bite size of the season. If you are a longtime listener of my show, you'll know that every summer I take a break from the podcast for six weeks. Why do I do that? Well, my wife produces each week's show. I spend a lot of time researching and having these conversations. And you know, over the summer, it's really important for us as a family to take some time off so we can really spend some quality, undistracted time with our children over their summer break. There is one more long form conversations come next Wednesday. We finish off the season with a very special episode. Of course, I'll be back at the very start of September with

• 29:24Rangan Chatterjee?

  the Wednesday full length conversations and the Friday bite sized ones. If you have enjoyed my podcast, if you've enjoyed these bite sized episodes, I'd really appreciate your help in spreading the words. My request to you this summer is if you found my podcast useful, if you found it valuable in your own life, would you consider sharing an episode of this podcast with five different people?

• 29:50Rangan Chatterjee?

  My goal with the information on the show each week is to inspire and empower as many people as I possibly can. And you guys can help me do that. If you help me spread the word, together, we can help spread this message of positivity, compassion, and health. Thank you so much for your support this season. I hope you have a good summer, and I will see you at the start of September, ready and raring to go.

• 30:18Rangan Chatterjee?

  I am really excited to share that I am bringing my Thrive Tour, Transform Your Health and Happiness, to Canada and Europe this September and November. It's a live, interactive, uplifting show that over 20,000 people came to last year across the UK and Australia. I'll be sharing powerful stories, life-changing insights, and simple tools that will inspire you to feel better, think clearer, and live with more intention and joy. To get your tickets right now and see all of the dates and venues, go to drchatterjee.com/live. I really hope that you can join me.