When I set up MoodLifter and embarked on this exciting journey into working independently I knew I wanted to make an impact. I was not going to provide run of the mill personal training as I could use my skills in mental health occupational therapy to help people lift their mood as well as weights. I had some vague ideas about what my client group would potentially look like... maybe depressed men who struggled to access talking therapies but felt comfortable with exercise, or anxious autistic adults who find walking into a gym sensory overload. I didn't expect at any point to be specialising in menopause.
I advertised what I was offering and picked up a few clients, it surprised me, they were all women, they all had successful careers, they were all in there 40's and 50's. After years of holding it together, managing work and family life they suddenly found themselves as hot anxious mess. A fear of "I'm going mad" had been endlessly sounding in their heads and they had reached out to me because of my mental health experience. One day one of these women came to a session seeming a little brighter than usual. "I spoke to my GP... it's the peri-menopause"
For me as well as her the penny dropped.. I started reading, and researching and speaking to women and professionals. I started sharing this knowledge with the women I worked with. One by one they started going to their G.P's and getting appropriate treatment. We changed up the exercise programmes to be metabolic and beneficial for hormone imbalance and to take into account that some days motivation and energy just sucked so how to be realistic and achieve something flexibly.
I started to get angry. I was nearly 40 and had never been educated on the menopause. No-one spoke about it on a formal or informal level. my entire knowledge of it consisted of you might get hot flushes then your periods stop. I'm ashamed to say the closest to a discussion with anyone was having arguments in shared offices about windows open versus heating on. The moment I started educating myself I realised how many women were being deprived of good health care and quality information that could help. Even once the situation was recognised as menopause having the support to put strategies in place was none existent. Women feeling like a failure because generic advice of "relax, sleep, drink less, eat less sugar and exercise were hard to put in place. In today's blog I am going to focus in on exercise for Peri-Menopause and beyond but for more information read related blogs:
Guest post Gentle Nutrition through the Menopause
Why exercise
There's a lot of info out there to the general public that we should be more active. Women under 65 are expected to do 150 minutes of moderate exercise a week.We know exercise is good for health but why is it key at this life stage...
Women under the age of 50 are at lower risk of heart disease than men. Oestrogen is protective against heart disease. The menopause reduces this protective factor. Even if you have not exercised before, exercise initiated during or as soon as possible spot menopause improves cardiovascular health Menopause increase the risk of high blood pressure which can be counteracted through exercise as it promotes good recovery from an increased heart-rate by regulating the heart-rate.
Lower levels of oestrogen may increase cholesterol. Exercise can increase the High-density lipoprotein (HDL) cholesterol that protects the body from cholesterol buildup.
A reduction in oestrogen reduces bone mass. 20 minutes of weight bearing activity 3x week can maintain bone density. A direct correlation has been found that the more we weight bear and exercise the better the bone density with it even being possible to increase bone density at Per-Menopausal stage.
Exercise can actually energise and help combat high stress levels. Women experiencing menopause tend to have higher cortisol levels at night.
Exercise has been shown in animal studies to reduce inflammation in relation to menopause and diabetes.
Exercise has even been able to show an improvement in sexual satisfaction for women.
What exercise is best?
Sadly this answer isn't clear cut, it depends... Fundamentally the exercise has to be motivating and of value to you. If you are doing something for 2.5 hours a week what is going to help you stick to it?
You often hear about moderate exercise... but ask yourself what does that feel like to you. The picture of someone Glistening at a gym may not resonate. If you notice your heat rate raising and you get slightly out of breath (but can still talk) as you walk up the street then that is moderate for you. If you ask yourself on a scale of 1-10 how tough is this... the answer of 5-6 represents moderate.
If you are short of time and your body allows for it each minute of vigorous exercise (An 8-9) out of 10 counts as two minutes of moderate exercise.
Depending on your circumstances and what you are hoping for regular (10 minute or more) sessions of cardiovascular exercise combined with at least two days of resistance exercise is what to aim for. During the Peri-Menopause you might need to shake up the type of exercise that you are doing. This can be to address new needs or to meet how your body is changing.
Barriers to exercise:
So lets take a a moment to acknowledge challenges as if it was that easy to overcome you would have done it already.
Barrier 1: It's new - I don't know were to start.
Treat this as an exploration, google, ask friends, look at what is happening in the local community or online. Allow yourself to feel like a beginner. I hate pitching my own services but have a look at my services as I offer in persona and online and there are plenty of other reputable trainers out there. Here is a blog on how to choose an exercise instructor or personal trainer if you notice any strong anxieties towards starting that feel disabling talk to someone you trust or an approach like CBT may help you overcome these fears.
Barrier 2: I'm not feeling great about my body image at the moment and think it will be amplified if I exercise.
If you are worried about the externals "what will other people think of me"...There are two camps of people in gyms and exercise classes... Those that remember what it's like to walk into an exercise class for the first time and have nothing but respect for what you are doing and those that are so caught up in their own self image that they haven't noticed you.
If it's a worry about the "internals" The feel of the belly hanging, or the rubbing under the breasts triggering a feeling of shame. Allow yourself to notice the feeling and the judgement. Once you have noticed the judgement quietly diffuse it. Talk to yourself kindly or at least neutrally.
Barrier 3: Too fatigued to exercise
Fatigue is real and there's multiple approaches to take. The first being allow yourself rest. And I mean genuine rest. putting boundaries in for yourself where you can say no to others and your own racing mind. Secondly if you have been relatively inactive experiment with seeing if 5 minutes of movement changes the fatigue. If you are sitting feeling sluggish on the coach, embrace feeling sluggish and have a dance to your favourite song or a walk down the street with it, do some start jumps or lift a weight. It's 5 minutes. If this short activity helps brilliant, sometimes we get in a loop of "I can only move once I am energised" rather than seeing that the movement will create the energy.
When this doesn't work be kind enough to allow yourself the opportunity when you are next able to. The key to fatigue is the practice in starting. Each time we start an activity we learn more about what feeds or starves the fatigue.
Barrier 4: Lack of Motivation
Similar to fatigue but.... RIGHT LETS GET ONE THING STRAIGHT I have not met a single woman who is not motivated... you wouldn't be reading this if you weren't wanting to make changes... but oh my gosh that feeling isn't laziness... often its because energy being expelled onto everything else or a lack of hope for a good outcome.
A tip to address this is to not see motivation as a quality that is desired. If you are not feeling motivated identify why and then look at those barriers!
Barrier 5: Other priorities.
Sandwiched between caring responsibilities, demands of the job, health appointments, trying to hold it together enough so that people don't think you are mad and the cracks are showing.... When was the last time you had time to put yourself first. Not enough time? Take 5 minutes right now. Write down why you would like to exercise and why this matters to you. Now write down the roles you have. Next to each role write down why they are important to you. Then write down next to that why does that matter to you. Now ask yourself what would happen if you let it go. Explore the narratives this creates. Give yourself permission to either not put pressure on yourself to exercise or to create space for exercise by doing less of something else.
Barrier 6: Comparisons about what you used to be able to do.
Firstly building muscle or hanging onto muscle and stamina is harder than it used to be. It will be uncomfortable or vulnerable to face up to what you can't do but the reality is that you are not in the same position, you have experienced far more than that past version of yourself. Use that experience to build up a plan as to how you will allow yourself to be a beginner.
If you are finding that you can't do high impact exercise due to the pelvic floor start to explore how to strengthen this. Simple breathing exercises can help get you in tune with the diaphragm and pelvic floor.
Barrier 7: Having to be more flexible on "bad" days
If like me you work to a tight routine it only takes one headache or traffic jam to let go of plans or hopes of what the day would entail. We can get fused to our expectations about how things "should be". Accepting how something is does not mean you minimise the difficulty. If you look at the situation with curiosity and acceptance chances are you can start to be flexible and allow yourself to work around it. It can help to have an alternative available to you. one of my clients came up with the great idea that on days she couldn't get out of the house or move as much as she would like she had a play list she can dance along to. Avoiding bad days doesn't work but being able to pick yourself up and look after yourself during them can make them bearable.
Barrier 8: Brain Fog
Cognitive brain fog can be any combination of difficulties with working memory, concentration, motor planning (clumsiness), and verbal processing (Word finding). Set alarms in your phone and calander entrys which have simple single step tasks.
I am a big fan of using my "To Do Now" sheet to help me return to task. This is free to download. Deep pressure activities in which you pull or push can really help clear the head. I normally use body-weight exercises such as push ups but if you are feeling particularly clumsy a resistance machine in the gym can feel safe and secure as you can repetitively move in a nice rang of movement without having to think too much.
Barrier 9: Lack of routine
A routine comes from repetition. Create a pattern to what you are doing or tag it onto something you do automatically. When you brush your teeth in the morning make the next task be a couple of stretches. Whilst waiting for the kettle to boil can you walk or squat. Say out loud what you are going to do. Make small steps towards this. A tiny step today is better than a big leap tomorrow. Can you do as much prep before hand as possible to make the task easier. Like to leave my sport bra and trainer on top of the hand towel or on the toilet seat at night. This makes it easier in the morning to put them straight on. Create an accountability buddy with someone who will be reliable. Monitor and record it so that you can celebrate success and notice barriers.
Barrier 10: Lack of hope for a good outcome
Unless you are feeling that exercise is worth it it is always going to be hard to do. Spend time exploring your values for it. The evidence base is there that it can help you live well and manage some of the health difficulties associated with menopause but if you have never had a good relationship with it, or are feeling hopeless it can be hard to get past it. The only way of seeing if exercise will help is to try. Act on it, explore it with a gently curiosity and change or amend it based on what you find out about yourself. Also ask yourself how you are judging success. IS it something that is tangible and what does that look like in the short term.
If you have read this far give yourself a pat on the back, think about what resonates with you and what actions you can take. If you feel it is something you cannot do on your own speak to your GP or reach out. For other resources take a look at the guest blog by Aline on Menopause Matters
Sarah is an Occupational Therapist and personal trainer who is passionate about helping people flourish @MoodLifterPT She is always happy to be contacted if you want to find out more. Every Thursday at 19.15 she holds a menopause movement exercise class.