I'm going to start by asking you tell me a little bit about yourself and how you got involved in this work I know it's a bit strange right um so I am originally a female Athlete Performance physiologist so I look at all the training and nutrition and see how it appeals and applies to active women and I ended up at Stanford to do my postdoc and I was studying under Marsha stephanic who was the pi for the women's health initiative so I had one hand in him performance and one hand in the women's health initiative and looking at all the data at the older postmenopausal women and then uh started working with women who were going through the menopause transition applying Human Performance Concepts to it so like heat acclimation or cooling strategies or looking at um how we can improve sleep through adaptogens so it became part of my normal bubble and then as I got out and realized that no one talks about menopause and we have these recommendations that shouldn't be in place for women because it works against what their body is doing so I started digging more and more and saying okay if we look at physiology and see how physiology is changing and how hormones are directly related to how all these changes are occurring and we have to look at what kind of external stress can we apply to the body to create adaptations that these hormones used to do and so that kind of snowballed into what I was doing and we put one chapter in our first book and it just went crazy now all these people were like hey wait what about me I want more information so that was kind of the driving force after we started talking about periods now we're starting menopause were you surprised that so little research has really been done in this Arena or were you not shocked at all I'm gonna have to say I wasn't shocked really because when we look at the history of medicine and history of research it's always defaulted to the CIS male so when we start talking about menopause menopause transition we do see an uptick in research but it's always in the sick woman because of the fact that you have all these cardiovascular risk factors that occur at after menopause metabolic disorders you know all these things that have put a drain on the public burden or the public health system but it doesn't really translate to women who are active who aren't falling into those categories but wanting to improve their own lifestyle and body composition and so the research just wasn't there so it's like okay here's this Niche that encompasses so many women and no one was actually looking at it because they were just going that you don't really it doesn't really apply to you because you're not sick so that's kind of how medicine works anyway right you do research on people who are sick you mentioned some of the things that women are advised that are actually not helpful at all what were you talking about specifically and I know I'm going to get bashed when I say this but um anyway the 150 minutes of moderate intensity activity that everyone is told to do is not appropriate for women who are going through the menopause transition or who are actually in menopause and I say that because when we're looking at what's happening we see an uptick in Baseline cortisol and women are in this sympathetic drive so they're in that flight or fight response all the time because their body's going through so many changes there's also more inflammation there's a decrease in the signal for having lean mass or muscle so when you're doing moderate intensity it puts women squarely in the intensity that increases cortisol it puts women squarely in the intensity that pushes the signals to keep belly fat and to keep body fat and to kind of reduce more lean mass so we're looking at what should women do it's staying out of that modern intensity it's doing more polarized training it's looking at resistance training as the as a Bedrock of what you're doing but we're not seeing that being translated primarily because when we look at that 150 minutes of moderate activity it's to get people to move and it's based on a linear algorithm because men age in a linear fashion but women we have this discernible bump right in the middle of our lives where all of a sudden we go from you know normal Cycles to Parry and post-menopause and that's a discernible uptick in in the aging process and that's not accounted for so the moderate exercise moderate to intense exercise that's recommended could that be advantageous for your heart if it's not necessarily advantageous for your whole physiology well I'm gonna if you haven't been exercising at all yes of course but for women who are on a normal basis of walking or trying to stay fit or just trying to move then no because we see that in order to get cardiovascular changes so we have better adaptations to our blood vessels we have better blood pressure compliance we need intensity a PhD student of mine just finished wrapping up her entire PhD looking at this very thing looking at interval training as a way of increasing cardiovascular health and it is far superior for women who are in the menopause transition and early post-menopause to do intensity we look at late post-menopause so these are women who are 10 plus years after menopause you have to have intensity but more frequent doses because it's a dose response when we're looking at it so that modern intensity if you haven't been doing any kind of exercise yes of course move but if you are already on a regular exercise program and you're trying to get fit you have to put in that intensity to get those cardiovascular applications what does that mean in simple terms as far as the kind of exercise you should be doing during perimenopause menopause and post-menopause yep so when we're looking at perimenopause so this is the you know the four to five years before that one point in time we call menopause this is where we see the biggest amount of body composition changes and this is um kind of the status quo so when we're looking at trying to change that we want to do what we call Sprint interval training or high intensity in training so for example Sprint interval training would be you go for your walk but instead of just going up I'm going to do a Four Mile or five mile walk you go okay I'm going to warm up for 10 minutes and then I'm going to do 20 second surges so you might increase your pace you might try to jog or run something that's going to tip you up to that higher intensity where it's 90 plus percent where you're really breathing hard and you're going as hard as you can for 20 seconds and then it's two minutes of of recovery so you completely recover and you do that four or five times and then you go home that's it if we're looking at high intensity interval training this isn't the boot camps it's not the f45 it's none of that kind of stuff that's making the rounds because that's all modern intensity we're looking at high intensity interval training you go out for your walk and you find a flight of stairs that might take a minute to get up or you might find a hill that takes a minute or two minutes to get up and you walk as hard as you can trying to get into you know that point where you're breathing really hard you can't hold a conversation and then you recover for two or three minutes you walk back down and then you do that four or five times and then you go home so it's not about volume it's not about distance it's about how hard you're working in that walk or if you're in the gym and you're on the treadmill or you're using the elliptical it's really trying to go as hard as you can for 20 seconds or just below as hard as you can for a minute so is that the same for menopausal women post-menopausal and then postposts like 10 years out yes yes and it becomes a frequency of how often you do it during the week so if we're looking at what are we doing during the week in Perry and early post-menopause we're looking at two to three times a week when we get into the late post-menopause so that's a 10 plus years you're looking at four times a week because it becomes a dose response if you're doing it yeah so if you're doing four times a week you know it's not going to be a long session it might be you know 15 to 20 minutes where you have that work in there and and people are like you want an 80 year old woman to go do Sprints yes I do it's not running Sprints it's not you know bike Sprints it's just getting that intensity in there it can't be walking it can't be jumping can be on an indoor bike but it's bringing that intensity up and tell us again the point of this why is this so critical in terms of staying in shape at as you age yeah so when we're looking at estrogen progesterone and they have receptors all over the body they're responsible for blood sugar control estrogen is tightly tied to muscle and cardiovascular health because we see estrogen really essential for blood vessel compliance so when we're doing this high intensity work it causes a significant exercise stress that then signals the body we have to adapt to have better blood pressure control better vascular compliance our blood vessels can open and shut really quickly it also is a signal that we have to have available for that high high intensity so of course you're going to use blood sugar but your body wants to be able to manage it so it's the signal of okay now we have to have these changes that's going to allow us to overcome that stress adapt to it so the body is now not relying on estrogen progesterone to have blood sugar control or vascular compliance it's actually using an exercise stress to create adaptations in the body that these hormones used to so that's what I mean by this external stress that's going to allow the body to adapt and overcome it without having that hormone um boost I guess is the best way what about muscle mass because obviously as you age you lose a lot of muscle and I know that weight-bearing exercises are critical can you talk about that absolutely so if we look at resistance training this is the big rock right but most of us who are in this stage of life and later grew up with like the supermodels and the calories in calories out and the snack Wells all that kind of stuff right so lots of don't do a muscle work but as the research comes out it is so imperative to do lifting from body weight if you're just starting but preferably getting into the gym and lifting heavy loads and the reason for that is when we look specifically at estrogen estrogen is really super tied to lean mass not only does it signal the stem cell or the basal cell of the muscle to grow but it's essential for a lot of the central nervous system stimulation so when we're looking at how a nerve stimulates a muscle there's this neurotransmitter called acetylcholine and the amount of acetylcholine that's being held is also tied to how much estrogen is available more estrogen more acetylcholine which means you have a faster nerve signal and a tighter contraction we start to lose estrogen then we start losing that stimulus for a really strong muscle contraction as well as developmentally Mass so resistance training becomes key because we want essential nervous system response where you're going to lift something heavy and the nerve is being signaled that oh I have to recruit a lot of muscle fibers to lift this load so again you're having that external stress that's signaling the body to be more responsive from essential nervous system point of view to lift that load and of course if you're lifting the load then the body's like I have to have more muscle mass and more fibers to lift this lip so this is one of the key Paramount points of getting in the gym or looking and saying hey you know I'm going to do some backpack squats where my backpack is loaded with cans so it's more than just my body weight need that extra signal and then as we look at more of the research of resistance training that's coming out it's essential for brain health because we look at attenuating dementia and Alzheimer's it's all about the nerve growth factor so if you're lifting heavy loads and you're doing lots of resistance training you're getting that central nervous system response you're also getting more neural growth patterns within the brain which we see really starts to attenuate dementia risk at Alzheimer's risk wow that's pretty amazing well I lift say seven pound weights maybe 10 pound weights occasionally I don't think that's enough is it do I what are you talking about um I'll give an example and my mom is going to kill me when I say this but um so my mom has a 20 pound kettlebell and she's like oh that's the heaviest thing that I have it's like oh no no you have a 45 pound barbell that I left your house she's like that's too heavy it's like nope so I went and I showed her how to do like deadlifts with a 45 pound barbell and some other things that was heavy for her so you want to look at something that you can lift and after four sets of five it's like oh I'm really struggling here so it's about keeping form and you want to work to failure really in a set of you have four to five sets of four to five reps so it's really low rep and you're doing a little bit of volume through five sets but by the time you get to that last set you're really struggling to push through that because you want to get to that fatigue Point um but when you're doing lots of light reps and you're doing 10 to 12 I mean lightweight you're doing 10 to 12 reps that's just not the signal we want because that's that that modern intensity stuff that's not going to create that central nervous system response that we want wow so are you saying that I have to lift 50 pounds you work your way up there yeah sure really yeah and it also depends on what you're doing I always like to get women to look at compound movements so you're doing squats you're doing deadlifts and you're doing bent over rows you're doing a lot of single leg stuff for balance and proprioception and what's heavy to me is probably overwhelming to like my mom or my sister but what's heavy to them might be heavy to someone else so again it's all relative and how confident you are lifting and I don't want women to be like oh I heard this podcast and now I have to go do a hundred pound deadlift no I'm not saying that saying you phase in you work and see how you're moving maybe you work with a physical therapist or get um an iPad video or a film so you can see how you're moving work for movement get functional movement before you add load and then you slowly add load because it's not a training like I have six weeks to train up or something this is something you want to incorporate for your life and how many times a week Stacy should people be doing this I if I had to to really say you know what's the big rock here if you have three times a week to do any kind of exercise make it resistance training because if you're moving around in daily life you're going to get some aerobic benefit that low low intensity aerobic benefit resistance training also significantly helps glucose control you see that women who are lifting heavier loads can mobilize more belly fat so lose belly fat specifically because it changes from a hormonal aspect um but if you're like ah I don't want to lift that I really love my cardio I want to do some Sprints bare minimum is twice a week ideally three times a week so if you're looking at oh she said I had to do you know two to three times of intensity work and two to three times of resistance put them on the same day you could do 20 minutes of heavy lifting and then go do some Sprints and you're done and dusted in 40 minutes so again it's not about the volume it's about the work that's being done you mentioned belly fat I think that is the bane of a lot of menopausal women's existence I know that I never had you know I never gained weight around my waist until I went through menopause and I have a a flat tire I have a spare tire now not a flat tire I have a spirit I have a spare tire now that I never had before so you think weights um are is the best way to get rid of belly fat that's so surprising to me I know so there's there are two things that um are really important for women going through the menopause transition into post menopause one is lifting weights uh for all the reasons I've said but also it has a direct effect on abdominal fat mobilization because there are some hormones that get shifted with heavy lifting that really help get rid of that belly fat but the other is protein so women especially like I say when we grow up with the supermodels and calories in calories out and it's like no carb that kind of stuff we have to focus on protein the daily recommendation right now of that you know 0. 6 grams per pound is based on Old sedentary men so it's like how is that really applicable to women it's not it was just looking at okay here's a a sedentary woman has the same kind of body calm but when we're looking specifically at what happens as we age we become more what's called anabolic resistant so this is why we can't build muscle so we need to have regular doses of protein and I say this because when we look at some of the research the most telling study that came out recently was looking at a group of skinny fat women so normal weight but had some sarcopenia had additional fat within the body but didn't look like it they're all sedentary they split them up into a group that increased their protein to about 1. 1 grams per pound versus those who were just eating around that 0.
5. 6 grams no exercise intervention at all but at the end of 12 weeks those who had the higher protein intake completely recomp their body so that means they built lean mass got rid of that extra body fat that was being hidden within everything and became normal weight with lean mass so protein is so important for helping get rid of that that extra body fat and belly fat with resistance training to really help mobilize and get rid of that minnow pot that we're all so dreading and or have what about healthy bones you know that's another area Stacy I'm sure you focus on because as you lose estrogen your bones can become brittle you can get osteopenia osteoporosis um what do you recommend for that uh jump training people are like what jump training but I have sore knees and you know I I end up peeing myself because of jumping you know all these things right I know um but jump training is really important so it can be uh 10 minutes of jump rope it could be jump squat burpees but you want to have jump training and this is because we look at a multi-directional stress through the bone and that's what signals bone to actually grow it and regenerate running isn't enough because it's really just one directional stress we look at walking yoga all those things not so much resistance training does help with bone health um so when we're looking at what kinds of stress we need to do is that jump training you can start in the pool you know so you're in your waist and you're doing jumps in the pool you can do some trampolining and then transfer out onto ground ground reaction forces wow I'm learning so much tell us about your program menopause 2. 0 because I was hoping you might move from New Zealand to New York City and become my trainer okay [Music] um so all this information right isn't out there and uh so the the online course that we have goes through the history of menopause how we look at things like most of the Salem witches and the wish trial or women going through perimenopause so we look at you know the history and all the things that that make menopause so taboo and then we go through what is menopause hormone therapy what are some of the Alternatives who needs to use it what does it do and then specifically into training and nutrition and sleep and pelvic floor and all the things that are discussed but what are we going to do how are we going to implement this so that whole course is really just trying to get the information out to women to understand that you don't have to go through perimenopause and into postmenopause feeling crazy and going to your doctor and not being heard because there are things that you can do to empower yourself to get through this and know that it is normal and you don't have to sit by and let it happen to you you can actually take charge and be able to work with your body through these Transitions and get stronger and more powerful as you do it why isn't this information more readily available uh well that's the whole system right when I was talked earlier when you look at research and everything that's out there the menopause research is all about women who are getting sick or are sedentary you don't hear a lot about um the active population or women who are healthy we also see a delay in the science translation when we're looking at what's making big headlines usually it's not something about healthy people and how to improve your your overall health it's all about the you know what's going to grab headlines what's the latest thing in cancer research and then you have on social media and all the influencers that just say things that may or may not be true and so people are following that and but it's really hard to find a solid source of information so um I think that's the biggest issue with the globalization of information it's like where do you go to find something that's solid and so that's one of the driving forces for putting it out there how can people find this information um so you can go to I've just partnered with Stanford and Stanford lifestyle medicine so we're putting a lot of stuff up there for the 40 plus aging population of how to stay active fit some of the newest research that's coming out for both men and women so that's one area to follow and then so how do you find that do you go is there a special website or anything for the public yeah so you just go to the Stanford website and type in lifestyle medicine and the lifestyle medicine website will come up and there's a whole bunch of different areas you can go through and on the right side of the page is some of the most recent researches coming up there's also a social media presence on lifestyle medicine so if you're into Twitter Facebook Instagram then you can find them there um and then of course my website so our website has updates of everything what's going on you can sign up for the newsletter or the blog and get information in um and your website is stacysims DrStacy Sims Drs t a c y s i m s um .
