Strength Training at Midlife: Why Muscle Matters More Than the Scale
Let's talk about one of my favorite ways to stay healthy: exercising. For me, it feels like I'm actually taking action to improve my health. That post-workout serotonin boost? Unbeatable.
But I know it's not this simple for many of us in the perimenopause transition—especially when we're feeling unmotivated by changes in how we look.
The Question That Changes Everything
I often ask my patients: If you had to choose, would you rather see the number on the scale go down or have your clothes feel looser?
They all, without fail, choose the looser clothing option.
So how do we achieve this when we find ourselves at midlife, gaining weight around our midsection and watching our pants get tighter?
The Truth About Exercise and Your Body
Here's what you need to know: Exercise is one of the most important, impactful things you can do as a woman to extend your healthspan—and looser-fitting clothes will naturally follow.
Taking care of our health and supporting our muscles should be our number one priority when we're considering exercise. Everything else, like lowering the number on the scale, should be secondary.
Why? Because healthy muscle is the secret to staying active, keeping healthy, and maintaining our bodies as we age.
What Happens to Our Muscles Over Time
Research from The Journal of Nature Reviews Rheumatology shows us something important: right off the bat, women have less muscle than men across the entire lifespan. For both men and women, lean muscle mass peaks around age 25-35 and steadily declines after that.
But who's thinking about their muscle mass peaking at that age? I certainly wasn't. I remember thinking I was going to live forever. I was healthy and didn't have a dedicated exercise regimen because, honestly, I didn't really have to. I admit it—I took my youth for granted.
Then came age 40, and suddenly I was facing the subtle acceleration of muscle depletion. I was shocked at how difficult it became to build and maintain muscle mass.
The good news? It's never too late to get on the strength training train!
Cardio vs. Strength Training: The Real Story
There's an ongoing debate in the fitness community about whether cardio or strength training is best for optimizing health. I'm not here to debunk all the debates, but I will say this: cardio is definitely important—especially efficient high-intensity interval training (HIIT), which is believed to be more metabolically friendly for women and crucial for cardiovascular endurance.
But when it comes to exercise, strength training should always be a major focus.
Why Strength Training Wins
Strength training creates a strong, stable, flexible scaffolding around your bones. This makes you:
Less likely to fall
Less likely to fracture a bone if you do fall
Here's how it works: To build muscle, you have to create tiny micro-tears in your muscle fibers through lifting weights or resistance training. Your body then repairs those tears and makes the muscles stronger. It's literally rebuilding you, better than before.
My Approach to Strength Training
I like to mix it up and keep my various muscle groups challenged. I do a combination of light/medium weight or bodyweight exercises and split up my workouts by section so that by the end of the week, I've strengthened my whole body.
The Magic Number: 90 Minutes Per Week
Evidence suggests that 90 minutes per week of strength training is most beneficial for women at midlife.
But here's the beauty—this can be broken down however it works for you:
12 minutes a day
30 minutes three times a week
45 minutes twice a week
Just make sure you continue to challenge yourself more over time.
A Word of Caution
Don't overdo it. I know too many women who overestimate how much they can handle and then injure themselves—leaving them without a workout for months.
And if you fall short of the 90 minutes? Don't worry! Even 45 minutes is 45 minutes more than you would have done otherwise. Every bit counts.
What About Bone Density?
Different types of exercise have different effects on bone density. Exercises are categorized from highly osteogenic (science-talk for "bone-building") to the least osteogenic.
Here's the pattern: What all of the highly osteogenic exercises have in common is that they involve the feet leaving the ground and then landing again. Simple as that.
Think:
Jumping
Running
Skipping
High-impact aerobics
But if jumping isn't accessible to you, don't worry. All movement is medicine. There are plenty of other exercises that can help build healthy bones, even without the impact.
To give you a sense of the small but meaningful impact varioud types of exercise have on bone density, see the attached information at the end of this blog entry, from Open Evidence (New England Journal of Medicine).
The Bottom Line
The key takeaway here is simple: The only way to put on muscle is to earn it.
So let's all squat, lift, and press our way to a longer healthspan!
Oh, and don't forget to stretch and incorporate some mobility training into your workouts. Flexibility and range of motion are essential for maintaining your ability to continue exercising in the long run.
Getting Started
If you're new to strength training or haven't exercised in a while, consider:
Working with a personal trainer to learn proper form
Starting with bodyweight exercises
Joining a beginner strength training class
Using resistance bands before progressing to weights
Remember: everyone starts somewhere, and the best workout is the one you'll actually do consistently.
Your future self—with strong bones, healthy muscles, and clothes that fit comfortably—will thank you for starting today.
FROM OPEN EVIDENCE:
Osteogenic exercise has a modest but clinically meaningful impact on bone mineral density, with effects varying by skeletal site, exercise type, and intensity. Meta-analyses demonstrate that exercise can increase BMD at the lumbar spine by approximately 0.3-3.1% and at the femoral neck by 0.8-1.1%, translating to an estimated 10-11% relative reduction in 20-year fracture risk. ©
Source: Lancet
High-intensity exercise produces superior osteogenic effects compared to low or moderate intensity. At the lumbar spine, high-intensity exercise yields BMD increases of 0.031 g/cm' versus 0.012 g/ cm? for moderate intensity and 0.010 g/cm? for low intensity. Bone Exercise interventions with high adherence to American College of Sports Medicine recommendations show combined standardized mean differences of 0.31 for lumbar spine and 0.45 for femoral neck, compared to 0.04 and 0.28 respectively for low-adherence protocols. Source: Frontiers in Physiology
Progressive resistance training combined with impact activities appears most effective for bone health. Meta-analyses show that this combination significantly increases femoral neck BMD (standardized mean difference 0.41) and lumbar spine BMD (0.43).
Source: Lancet
Impact exercise specifically
improves trabecular volumetric BMD at the distal tibia (0.54%), total volumetric BMD at the proximal femur (3.11%), and cortical thickness at the radius (1.78%).
Source: Journal of Bone and Mineral Research
The osteogenic response is highly site-specific. Weight-bearing exercises primarily benefit the spine and hip, while non-weight-bearing sites like the forearm show minimal response even when upper extremity strength improves Source: JAMA
Important Disclaimer: This blog post is for educational and informational purposes only and is not intended as individual medical or fitness advice. Before starting any new exercise program, especially if you have any health conditions, injuries, or concerns, consult with your healthcare provider and consider working with a qualified fitness professional to ensure proper form and avoid injury. The recommendations provided here are general in nature and may not be appropriate for everyone. Listen to your body, start slowly, and progress gradually. If you experience pain (beyond normal muscle soreness), dizziness, or any concerning symptoms during exercise, stop immediately and seek medical attention.