Ep. 463 Midlife Body Masterclass: Strength, Bone, Metabolism with Dr. Vonda Wright, Dr. Stacy Sims, Dr. Shannon Ritchey, and Debra Atkinson
- Team Cynthia
- May 7
- 40 min read
Updated: 2 days ago
We have a mashup episode today, with four leading experts sharing valuable insights to help women maintain bone density, muscle mass, and optimal health as menopause approaches.
Dr. Vonda Wright highlights the importance of early intervention with proper nutrition, impact exercise, and strength training to prevent osteoporosis and muscle loss as estrogen levels decline. Dr. Stacy Sims explores the role of resistance training and high-intensity exercise in improving bone density and metabolic health during menopause. Dr. Shannon Ritchey discusses the benefits of building muscle gradually with safe strength training techniques. Debra Atkinson shares exercise protocols for women in perimenopause and postmenopause, focusing on strength training, recovery, and the benefits of high-impact exercises and hormone replacement therapy.
Join us for expert advice on how women can strategically strengthen their bones, build muscle, and optimize their health as they transition from perimenopause to menopause and beyond.
Dr. Wright highlights the importance of building bone and muscle health early. She explains that consistent nutrition, impact exercise, and strength training are essential to prevent osteoporosis and muscle loss as estrogen declines with age.
Dr. Stacy Sims emphasizes the importance of heavy resistance training, high-intensity exercise, and targeted lifestyle adjustments for menopausal women to improve bone density, muscle mass, and metabolic health.
Dr. Shannon Ritchey advises women to focus on building muscle gradually and safely, explaining that muscle growth takes time and proper training, and strength training is the cornerstone of a fitness routine.
Debra Atkinson discusses exercise protocols for women in perimenopause and postmenopause, looking at the benefits of strength training for bone health and the importance of recovery, highlighting the benefits of high-impact exercises, hormone replacement therapy (HRT), and vibration plates.
“Our body does not know that it needs to be stronger, faster, or smarter unless we put stress on it.”
-Dr. Vonda Wright
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Transcript:
Cynthia Thurlow: [00:00:02] Welcome to Everyday Wellness Podcast. I'm your host, Nurse Practitioner Cynthia Thurlow. This podcast is designed to educate, empower and inspire you to achieve your health and wellness goals. My goal and intent is to provide you with the best content and conversations from leaders in the health and wellness industry each week and impact over a million lives.
[00:00:29] Today is an extra special masterclass focused in on strength, bone, metabolism and more with experts. Dr. Vonda Wright, Dr. Stacy Sims, Dr. Shannon Ritchey and Debra Atkinson. These have been the most popular podcasts devoted to these topics and I'm so excited to put this masterclass together for my community.
[00:00:56] Today, we spoke at length about the impact of chronic caloric restriction in young athletes, the role of bone health and biology, the impact of grip strength and why it is a proxy for overall strength, why strength training is so important, specifically heavy weights, heavy loads and high intensity interval training. What are the unique aspects of perimenopause and beyond and specific training recommendations for menopausal women. The impact of calories in and calories out, chronic caloric restriction, intermittent fasting, how to measure body composition, why metabolic health is so important as well as training to failure and how to build training around stress in life in middle age and beyond. I know this will be a truly invaluable resource for each and every one of you. This will be a podcast you will listen to more than once.
Dr. Vonda Wright: [00:01:51] Female athletes very commonly live in a state of relative calorie deficiency, meaning either they're working so hard all the time and they're underfeeding, they just can't get enough calories in or they are purposely under calorie-ing because they want to be little like our pinkies. We're told to be little, especially if you take care of gymnasts and dancers and runners. So, what we're having now, and I also have these patients in my clinic, are young women in their 30s coming in with osteoporosis because they never laid down enough bone when they had the opportunity due to relative calorie restriction, overuse or not athletic calorie restriction, but they just want to be skinny, right? So, it's a real problem.
[00:02:42] So my poor 17-year-old and my 29-year-old and all of her friends hear me constantly talking about the fact that are you out there bashing your bones? Are we jumping up and down? Are we doing impact exercise? Are you feeding yourself enough? How much protein have you had? Such that my 17-year-old is very conscious about getting enough protein in which I'm so glad because she was a ballet dancer most of her life and she is teeny tiny. So, the osteoporosis is not a disease of old women, it is a disease of people because 2 million men in this country have osteoporosis. Now theirs is a little bit characteristically different than women's, but when men fall and break a femur, it is devastating because they're usually older.
[00:03:27] So, to get back on track, bone health is a concern of all women. It should start when they're teenagers. Are you getting off the couch? Are you exercising? Are you eating enough to build the muscle and bone you need for a lifetime?
Cynthia Thurlow: [00:03:45] I think it's such an important message and certainly I think about many women that go without menstrual cycles for years and years and years. And don't think of it as being a cautionary tale. I remind women that our menstrual cycle is really another vital sign. And if you're not getting your menstrual cycle, the question is why? And it's interesting even with the rise of social media, I'm seeing 27, 28-year-olds that are-- premature ovarian insufficiency. So, they're literally positioning themselves to have the magnification of every potential side effect of going into early menopause times a hundred, because it's not as if they're 57 or 47 or 50. But being that young and that long without those sex hormones is a huge concern.
[00:04:34] You're talking to your patients about bone health and talking about how we build bone, how we break down bone and the interrelationship of estrogen or estradiol and progesterone. Can we just speak to osteoclasts and osteoblasts, because I do think this is interesting how the bone breakdown accelerates and within that setting of that loss of estrogen.
Dr. Vonda Wright: [00:04:57] Yeah. So, bone biology is a multistep process with multiple cellular processes and stimulates. But if we break it down to basics, we have multiple kinds of bone cells. The two that I want to talk about today is the osteoclast. And I always do this as if I've got my bone cells on my femur here, right. [Cynthia laughs] We have the osteoclast whose job is to go along the bone and when it receives stimulation from the body that, “Oh, we need some minerals. Oh, I've seen some deficits everywhere in our body. I need some of the things in the storehouse of the bone.” The osteoclasts comes along, digs out the minerals, leaves a little hole so that those things can go off and work.
[00:05:44] Coming closely behind is the osteoblast, blast ‘B’ for build. It's like, “Oh my God, there's a hole in the bone let’s fill it in. And so, these two cells work in tandem. They crawl along the bones. And so, throughout our lives, there's a relative balance of breakdown for supplies and rebuilding because our bones replace themselves every 10 years. What happens in menopause as estrogen walks out the door, estrogen is an osteoclast regulator. It keeps the osteoclasts in control. The osteoclast is kind of a crazy. If you want to personalize these cells, little crazy cell, it's going to go out and go roughshod unless things control it, like estrogen. So, when estrogen leaves, it's not that the osteoblast stops working. It continues to work and build. It's just that the breakdown outpaces the osteoblasts. So, instead of working like this, they're working like this.
[00:06:44] Now, this is a gross oversimplification and sometimes I think bone biologists are going to write me hate mail but for those of us [Cynthia laughs] who deal with the general public. It's a very visual way to see what's dampening the osteoclast. So, to answer the question, can you build bone? You continue to build bone, but you break it down more, right? So, and we know this, we know that we can build better bone in the presence of estrogen. We know that we can prevent osteoporosis with the presence of estrogen. It's the one reason the FDA has approved estrogen easily. If you say this person has osteoporosis, it's easy to prescribe, right? But there are other ways to get around bone density problems in midlife. So, estrogen is one of them. Lifting weights is another.
[00:07:36] Everybody always asks me, but what if you already have osteoporosis, can you lift? And the answer is yes. And you can lift heavy if you're careful. There's a study that has shown, it's called the LIFTMOR study, that under supervision, in a careful way, you can lift heavy even in the presence of bone deficit. So, we need to lift weights. We need to impact our bones. I prefer jumping with a jump rope, running up your stairs. You can also rebound on a trampoline. That's what astronauts do when they come back with bone deficit. NASA has done great work that you can rebound on a trampoline. Weighted vests are all the rage right now. Then I get the question, but wait, if I've got osteoporosis in my spine, should I be overloading my thoracic spine with a weighted vest?
[00:08:27] Well, my suggestion to that is, well, let's put the weighted belt around our waist because it's our lumbar spine and our hips that need to see the extra load. Our shoulders don't need the load. Our hips and our spine need the load. So, let's put it there as a weighted belt, for instance. So, there are still lots of ways that we can address our bone health, even before we get on to the dreaded pharma alendronate. And there's a whole list of different drugs that I usually send my patients to, an endocrinologist who's really an expert at that before we have to do that. So, we're not without hope, as estrogen leaves our bone regulation a little bit pell-mell.
Cynthia Thurlow: [00:09:10] Yeah, it's so interesting because I joke. Well, I don't joke. I'm honest when I say I didn't realize that my peak bone and muscle mass was in my 20s and 30s. Had I known that, there's so much more that I would have done. And perhaps this is the time to pivot and at least touch on muscle health, because this podcast community definitely knows the value of why muscle is this endocrine organ. It is metabolic currency. It is so important. How can we measure other than objectively, if we're at the gym, we're lifting weights, and, we're going up on weights. And I definitely want to get to your methodology about how many reps, for how long, how many sets. What is the current proxy for determining muscle strength?
[00:09:56] I've read that things like grip strength are a proxy of overall strength. Is that something that you employ? Do you believe that fervently? Is that something that you recommend? I laugh because my dad used to walk around with one of those little hand grips, and we thought it was more of one of these things where he was just showing us how strong he was. But when you're working with patients and helping them understand the role of sarcopenia, I always say it's not a matter of if but when, unless you're actively working against it.
Dr. Vonda Wright: Well, I do have a grip strength goniometer or whatever it's called, and I do bring it out at my midlife mastery retreats, at big conferences when I'm speaking to groups, because it is a really tangible way. And then it becomes a competition. So, I can't get it out of people's hands because they're all like, [Cynthia laughs] “Let me see what this, oh and then let me compare. If they're within 10% of each other,” It is a validated measure for judging overall strength. Because the truth of the matter is when we lift weights, our biggest muscle groups are below our legs. So, I'm not going to make people do a broad jump or do weighted squats or although wall squats are also a good way to tell. But we have validated data on grip strength. It turns a light bulb on, it turns on a little competition and everybody wants to see the needle move, right?
[00:11:19] So, I could use it as a clinical value. It could be another vital sign. There is some data that walking speed, getting up from a chair speed and grip strength predicts surgical outcomes. So, I think if I were an arthroscopist, so my surgeries are generally sports related. But if I were doing Whipples for instance or big cardiac surgery, it might be something I measured to see the physical competency of people coming into the OR frankly. But how do we measure muscle strength or prowess as it relates to this? Well, we can do proxies like that. What I would rather do is people chart their own progress. Everybody's going to start from somewhere. And many times, people assign a judgment to that. Sometimes I do, I say put down those namby pamby pink weights partially to be funny, but partially to help people understand that our body responds to stress. Not all stress is bad.
[00:12:21] Our body doesn't know that it needs to be stronger, faster, smarter unless we put the stress on it that it wakes up and says, “Oh my God, I need to be stronger, faster, smarter.” And so, when it comes to building muscle, that's why 30 reps of a tiny weight is not going to do anything for us versus fewer reps of heavier weights that we both psychologically, neuromuscularly and within the muscle itself are fatigued, exhausted for instance. And that's what's going to stimulate building of muscle. It's going to stimulate replication of muscle stem cells, the satellite cells.
[music]
Dr. Stacy Sims: So, as we get older, we look and see how important resistance training is. And I don't mean booty bands, I don't mean the five-pound dumbbells, [Cynthia laughs] I mean like lifting heavy loads. Because when we lift heavy loads, we have a nervous response. The brain is stimulating muscle contraction in the fact that we have to lift this heavy load. So, now we have faster nerve conduction, which creates more acetylcholine, which is our neurotransmitter that's responsible for how fast nerve conduction happens. We see that there's a signal for our two muscle binding proteins, myosin and actin, to actually bond and hold together more tightly. And we also see that there is a stimulation for developing lean mass from the nerve, saying, “Hey, wait, we have to be able to have the ability to lift this load because it's going to happen again.”
[00:13:59] So, that's our adaptive response to our external stress, where estrogen used to be responsible for those three things. When we're looking at our metabolic control, we need to do high intensity exercise. So, we're looking at intensities that are 80% or more, preferably sprint interval training, which is 30 seconds or less as hard as you can possibly go. Because now we're looking at creating some epigenetic changes. So, we're looking at increasing the skeletal muscle ability to open up and allow carbohydrate to come in without using insulin. We're seeing more myokines, which are little signals that get released from the skeletal muscle during this high intensity exercise. That then tells the liver, “You know what, this esterified fat that's circulating, we don't want it to be stored as visceral fat. We want it to be converted into usable free fatty acid for the muscle and the mitochondria.
[00:14:57] So, then we're reducing that visceral fat storage in gain. We're also producing lactate at those high intensity exercises. When we're producing lactate, we're improving brain metabolism. Why it's so important is one, if you remember at the beginning, I was saying that women are born with less glycolytic fibers than men. So, we have to work on our lactate production. Lactate is not a negative byproduct of exercise. It is a preferred fuel for the brain and the heart. So, the more lactate we produce, the more we're providing fuel for the brain so that we have more neurons that are able to talk to each other. We're having better nutrition for that connectivity. And we're also increasing the amount of brain neurotrophic factor that's being produced, which improves brain volume.
[00:15:47] So, when we're talking about using exercise and different modes and different intensities to improve overall responses as our hormones drop, we also see that these different modes and intensities also address those problems that people are talking about why they should be going on menopause hormone therapy, looking for brain health resistance training and high intensity work. Those are the two key things for having faculties around you when you're 100 years old. We also see that strength training improves the amount of muscle that you have. Muscle is very metabolically active. It helps increase our body's ability to control blood glucose and our metabolic responses. We also see that high intensity and resistance training again helps with the crosstalk of the skeletal muscle to the liver and fat storage to say we don't need it.
[00:16:42] And the other thing about resistance training and high intensity work, like plyometrics, jump training, is it's all signaling for developing bone and maintaining bone density. So, when we're looking at what do perimenopausal women need to do, they need to polarize their training, making resistance training the bedrock. And then you pepper it with high intensity work. That 150 minutes of moderate intensity activity that all the guidelines put out, that's fine if you don't move at all, like work up to that. But for someone who's already moving and someone who's already living a fitness lifestyle, not appropriate at all. It puts people in moderate intensity that doesn't do anything, doesn't challenge the body enough to create that adaptive stress, but it does create more of a cortisol response.
[00:17:31] And when we have elevations in cortisol, then we don't get the positive outcomes that we want from exercise. And I see it all the time because when we're like, “I don't understand, I'm exercising but I'm not getting any change, I'm getting tired, I'm getting slow, I'm putting on belly fat, I can't sleep very well, what's going on?” It's like, let's polarize the training, let's pull it all the way back and think about quality over quantity and putting a lot of push, pull motion from load in there to really strengthen the muscle, create these responses and improve our bone strength. And when we start doing that, we see really good positive outcomes over the course of 12 to 16 weeks.
Cynthia Thurlow: [00:18:13] Now, when we're talking specifically about strength training, do you feel that there's a minimum necessary amount of time per training session? Do you need at least 30 minutes or can you do two 60-minute sessions per week? What's the frequency with which you recommend? And again, this is like a high-level recommendation. Everyone's their own bio individual, yet what are your typical recommendations or suggestions?
Dr. Stacy Sims: [00:18:38] Further you are in menopause, the more frequent doses of activity that you need. So, if you're 10 years or more post menopause, then smaller duration but more frequently across the week is what we see is very effective. When you're in peri and early post menopause, we say three-times-a-week resistance training and it can be, maybe 20 minutes, right? So, we're going in and maybe on Monday you're doing a squat focus. So, you're doing some heavy squats and some single leg lunges and then you call it. You're not super setting. You're not spending all this extra time doing our triceps, our biceps, all that kind of stuff. No, we're not after that. We're doing compound movements. Wednesday might be push, pull where you're doing bench, overhead stuff. You're doing, bent over row, anything that's upper body push/pull. And then Thursday or Friday you're going in and you're doing all your posterior chain, right? And so, you're hitting major compound movements three times a week, 20 minutes, done.
Cynthia Thurlow: [00:19:40] [crosstalk] doable? And that's why I was trying to get you to define that because I think many people hear three to four times a week and they're like, “Oh my God, I'm going to be in the gym for three or four hours.” And that's not what you're saying- [crosstalk]
Dr. Stacy Sims: [00:19:50] No, not at all.
Cynthia Thurlow: [00:19:51] -that actually most people benefit. When we're talking about bone mineral density, multidirectional stress, jump training, where do things like weighted vests or belted, when you see someone wear a weighted belt, where do those factor in? Do you have a preference for those? Is that part of your suggestions or recommendations?
Dr. Stacy Sims: No, I look at weighted vests and I get frustrated because I see a lot of injuries that come with them because it's changing center of gravity and center of mass for women, which alters biomechanics. So, I see a lot of women who are walking up our big hill with weighted vests, right? And so, they're like, “Oh yeah, I'm putting more resistance on to create a harder workout.” It's like, “Well, you're changing your biomechanics and you're putting yourself in modern intensity because you can't do a 20-minute up the stairs and hold that intensity where we need you to do.” Weighted belt that moves the center of gravity back down, but it's still kind of the same thing. I do say if you're going to be doing some sprint training, maybe you warm up with a weighted belt so that when you take it off, you can go faster.
Cynthia Thurlow: [00:20:59] I like that. See that seems completely reasonable. Let's just touch on bone health. I know we talked around it, the impact of osteopenia, which is not technically a real diagnosis, but for women that are, maybe they were on oral contraceptives for a period of time, they missed out on those peak bone and muscle mass building times in their 20s and 30s, but they get a diagnosis of osteopenia. I'm assuming the jump training or that degree of multidirectional stress is going to be a benefit. Where do you feel like introducing HRT kind of fits into that. I'm presuming it's after we've already done all these lifestyle measures. If we're still dealing with some degree of osteopenia or even osteoporosis, that might be the time to introduce the estrogen.
Dr. Stacy Sims: [00:21:50] Yeah. So, osteopenia that low normal or lower than normal bone, we see if you're doing proper resistance training and maybe some impact, not jumping, how we all learn with soft knee landing, but actually absorbing the impact into our bones. So, you're not jumping high, you're just landing hard. You do that for 12 weeks and we see an improvement in bone. If we're very consistent, consistency matters. We're talking about osteoporosis that takes longer. I have seen women who have been very diligent and consistent in their heavy resistance training four times a week with some plyometric work after two months of that kind of stuff phasing in and then over the course of six to nine months, they get into normal bone mineral density range. So, it's possible, but it takes hard work and consistency.
[00:22:44] And if you're someone who's like, I'm not that consistent and hit or miss on how hard I work, then you might want to think about using some menopause hormone therapy as that transient as you are building that bone and then think about getting off it. Once you've put in those implementations of lifestyle. It's the same thing like with the Ozempic conversation. Where people can use it as a tool to help them get weight off, but they have to put in the work. They have to put in the work and then they can get off of the drug and maintain that work. So it is that tool to improve the outcomes, to get to a better starting point.
[00:23:24] But that starting point doesn't mean that you rely on the drug and then start something. It gives you that buffer of while you're implementing change, you are garnering benefit to a point where once you have all of those lifestyle changes in play and you're really consistent and you're working well, then you can get off the medication and continue.
Cynthia Thurlow: [00:23:45] That's very helpful. And for most middle-aged women, one of the greatest pain points is weight loss resistance. And I find for many individuals, they've grown up in this diet culture where we count our calories and we exercise to offset what we've eaten, what are your thoughts on CICO? So, calories in, calories out. I probably know the answer to this, but I always like to ask this question of guests because I really want listeners to be reaffirmed and understanding that calories are just one of many things that impact our weight. And I think there's too much emphasis and focus on it.
Dr. Stacy Sims: I hate Christmas time when all the magazines come out and say, [Cynthia laughs] “If you have four cookies then you have to run on the treadmill for 30 minutes,” it's like, no, you cannot out exercise a bad diet. And it's not about calories in, calories out. Because four calories of protein respond differently in the body than four calories of carbohydrates. We see a lot of the weight loss resistance in middle-aged women occurring from gut microbiome issues because we see a significant decrease in the diversity of the gut microbiome when we start losing our sex hormones. And when we're losing that diversity, unfortunately, we're having an overgrowth of the bacteria that responds to stress because our bodies are under a lot of stress with this hormone perturbation. We're seeing an increase in our baseline cortisol, we’re having issues sleeping.
[00:25:17] All of that is being perceived as stress, which feeds the gut bacteria that creates more obesogenic outcomes. And we see that really happening about the three to four years before menopause actually hits. And this is where a lot of women are like, “I'm putting on minnow belly so what do I do?” It's like, but we also have to talk about increasing the amount of really good fibrous fruit and veg, because that really does help with that gut microbiome diversity, which increases our ability to change our body composition. But also, because we've all grown up in the 70s and 80s in the diet culture and the calories in, calories out. I see so many women who are undereating and people are like, “What? What do you mean I can't lose weight? I keep putting weight on. I don't understand. I'm training harder and I've cut my calories, but I put on 5 pounds in the past month.” It's because you're not eating enough, right? You cannot change body composition if you're not eating enough. And we hear, “Oh well, your metabolism slows down when you hit menopause. It's like, “No, it doesn't slow down.” What happens is we stop moving as much because we're so tired from all the changes that are going on.
[music]
Cynthia Thurlow: [00:26:31] And what are your thoughts on when women come to you and they want to have an accurate representation of body composition? So, we're talking about fat free mass to muscle mass. What are your like tried and true recommendations? Because probably not everyone has access to things like Bod Pod, which for listeners is fascinating. It looks like an egg, but you sit inside of it, it pulls all the air out and it can actually give you an accurate representation of those two metrics.
Dr. Shannon Ritchey: DEXA scans are becoming more and more prevalent and accessible. There's a company, have you heard of it? BodySpec.
Cynthia Thurlow: [00:27:05] I have.
Dr. Shannon Ritchey: They're in a lot of major cities. I know they're in Austin, LA, I think maybe New York or San Francisco, but they're in a lot of the major markets. And I think it's like $40 to get a scan, a body scan and it'll tell you roughly your fat mass, muscle mass, bone density, things like that. You can also ask your doctor because sometimes they can give you a note or a referral and sometimes they're overly expensive or inaccessible. And if that's the case then there's not really super reliable ways to measure it beyond the Bod Pod or a DEXA scan unfortunately. There are those body composition scales and I got one because I wanted to test it out. What I did is I got a DEXA scan and then immediately after I went home and did the body composition scale and it was very inaccurate. [laughs]
Cynthia Thurlow: [00:27:49] Interesting.
Dr. Shannon Ritchey: [00:27:59] Yeah, the DEXA scan tends to be decently accurate and these scales, it was way off. It underestimated my fat mass and overestimated my muscle mass. However, what we're looking for, when you are undergoing a training regimen and you're changing your nutrition and things like that is the change over time. So, maybe if you're just looking at the trends, like although the absolute values of those scales might not be super helpful, if you're just looking at the trends over time, you could use it. Again, it's an accessible tool that anyone can use. I think mine was like $50. It. It's called H-U-M-E, Hume, not sponsored or anything like that. But again, pretty inaccurate, but you could look at the trends over time.
[00:28:39] And then another way to do it is honestly just using your eyeballs. Looking at yourself in the mirror, are you seeing more muscle definition? Are your clothes fitting different? I don't recommend looking at the scale. As we said, if you're building muscle, the scale might be going up. Are you going up in your lifts? Are you able to lift heavier weights over time and/or do more reps with the same amount of weight? That's the same as going up in weights. Progressive overload is either doing more reps of the same weight or increasing the weight or both. So, is that happening? If you're gaining muscle? If you're training close to failure, which is very, very important, most women are not training close to failure and you're eating enough protein, you probably are building muscle.
[00:29:21] So, it takes time. I like to set the goal of building 5 pounds of muscle over the span of a year, and I like that because it's very doable. You can definitely build 5 pounds of muscle over the span of a year, but you won't be in a rush. And that's important because we can't hurt ourselves. If you're building muscle, we don't want to get injured because that will sideline you and that will derail your progress. So, gently trying to build muscle, staying consistent in the gym, trying not to tear apart your body when you do your workouts, because we have to think about the recovery for the next workout and setting a goal of building 5 pounds of muscle every year.
[00:29:57] Odds are you're not going to build 5 pounds of muscle every year. Odds are you're not going to get bulky. Most women, that's the biggest fear. And I think I get asked on every single podcast I go on, “Do women get bulky? Is this a fear we should be afraid of?” No, honestly, it takes a long time for us to build muscle. Some women have the genetics to build muscle very quickly, but I would say that's the minority of women. Most women, it takes them years. Most women are not training close to failure. Most women are not eating enough protein. And so, it takes time. But if you slowly start to build muscle again, even if you're only concerned with the aesthetic benefits, you will start to like how you look.
[00:30:40] And of course, we can talk about the metabolic benefits and longevity benefits, and those are incredible too. And that's what makes you stay, ultimately, is how good you feel. That's what makes you stick to it. But the aesthetic benefits are a nice bonus too.
Cynthia Thurlow: [00:30:51] Oh, absolutely. And I think for a lot of individuals, there's still this misconception as you astutely stated, women are worried about getting bulky. It is physiologically impossible for us to get “bulky” unless we're taking anabolic steroids or large amounts, quite honestly, because I do see some people on social media that are women that clearly are taking probably super physiologic doses of testosterone because they just have a particular body habitus. It's very evident to me. Their face looks very drawn and there's no judgment. If that's what they choose to do and that's what they and their prescribing provider are doing, then that's their decision. But I think for the rest of us, it's understanding that testosterone is incredibly potent in our bodies. It is intricately involved in building muscle mass. It does take time, I think for anyone.
[00:31:38] I'm one of those leaner individuals and I've never been someone that has like massive big muscles, but they're gentle, small muscles, and that is just the way that my body responds to exercise. Having said that, I do have a couple girlfriends they jokingly talk about they breathe and they just build muscle. And, and you're right, that is definitely the minority. And these are the people that generally tend to gravitate towards, they might be involved in bikini competitions. And you look at them and you're like, “Oh my gosh, you look like you were sculpted out of clay.” It's unbelievable how that seems to effortlessly they build muscle. But as an example, that has been my focus for the past year is trying to put on 5 pounds of muscle.
[00:32:20] It is not easy. I know, if I look at metrics, as you stated, are you going up in weight? Yes. Are you noticing body composition changes? Yes, but they're subtle and they're over time. And that is kind of the message that I want to make sure women really understand is that we want small, sustainable changes over time. We're not looking for losing 20 pounds in a month. That is not what we're looking for. Although I do find in a lot of patients, just changing their nutrition can be huge. If you suddenly go from eating a lot of ultra-processed foods to eating a more nutrient-dense diet, just by virtue of the fact you're consuming less calories. And it's not just about the calories, it's just that we know ultra-processed foods trick our brains into eating more food.
[00:33:03] And if you look at the research, anywhere from 500 to 1000 additional calories a day unknowingly. And that I think is really a good argument for trying to eat a more nutrient-dense diet. Curious, when we talk about how important muscle building is, let's first look at metabolic health. What are the benefits of building muscle on metabolic health?
Dr. Shannon Ritchey: [00:33:27] Well, the listener might have heard that muscle is your biggest glucose sink. And what does that mean? Muscle stores glycogen. So, when we eat food, as you well know and your audience I'm sure knows, the food that we eat is converted into glucose. Blood sugar rises, insulin rises, and the glucose travels throughout our body to serve the cells, power the cells. And anything left over, anything in excess, is either stored in the liver, in the muscle, or as fat. And if you have more muscle mass, you have more available sites for that blood sugar to go. So, if we increase our muscle mass, insulin sensitivity improves, which improves every single process in our body. Insulin touches and affects every single cell in our body.
[00:34:18] So, if we can store more glucose in the form of glycogen in the muscles, we can improve our insulin sensitivity, improve the function and longevity of our entire body. So, it's really just as simple as thinking about that. Now what's important is not only that you're building more muscle to store more glucose, but also that you are emptying those glycogen stores in your muscle by training close to failure. So, a lot of people are understanding the importance of building muscle and strength training and picking up weights.
[00:34:50] And so they go to the gym and they do 3 sets of 10 or they feel their muscles burn a little bit and then they're like, “Okay, I'm done,” or they follow a program and they say, okay, I'm going to do this exercise for 60 seconds or I'm going to do it for 10 reps. And then they do it and then they're done. But they're not getting anywhere close to failure. So, they're not stimulating those higher motor unit muscle fibers, those type 2 muscle fibers, and tapping into their glycogen stores and emptying those glycogen stores so that the next time they eat, those glycogen stores can be replenished. So, training close to failure is something that is very, very important if you ultimately want the result of building strength and muscle. Now you don't have to train close to failure using really low reps.
[00:35:31] The studies show that you can use a wide variety of rep schemes. Anywhere from 6 to 30 reps taken close to failure will build the same amount of muscle. So, you can use relatively lighter weights. Now, there's pros and cons to using relatively lighter weights, but especially if you're just starting out and you're like, “I don't want to lift super heavy.” You don't have to. To build the muscle and strength, you can lift relatively light as long as you're approaching failure in 30 reps or less.
[00:35:57] So, a lot of people go to-- again, no shame on any fitness method. Do whatever you're going to stay consistent with. But a lot of people will go to these like bar classes or even gym classes that are lifting weights and they're training one muscle group for minutes and minutes and minutes on end. And they're doing very high rep, upwards of 50, 100 reps for one single muscle group. And that's just simply not enough load to trigger and stimulate the type of muscle growth that we need as we age. Maybe you're triggering a little muscle growth in your type 1 more endurance fibers, but we tend to keep a good composition of our type 1 fibers as we age.
[00:36:31] And we lose our type 2 muscle fibers as we age, which are only stimulated if you are lifting heavy enough close to failure. So, I cannot emphasize this enough lift close to failure. And if someone's like, “What does that mean? What does that feel like? In your last rep-- Let's say you're doing bicep curls in your last rep, the best way to know that you're close to failure is that your velocity decreases, so your rep speed decreases. You're trying to lift the weight quickly, but you physically cannot. That is an indication that you are now using your larger muscle fibers and therefore stimulating those larger muscle fibers for growth. Other indicators that you're close to failure are maybe you do that last rep, it's slow, you think you might be close to failure. pause, take a three-to-five-second break.
[00:37:17] If you could keep going easily, you weren't close to failure because odds are you were using your type 1 muscle fibers, which can recover within seconds. Whereas if you're recruiting your type 2 muscle fibers, those take a minute or longer to recover again. So that's a really good indication that you weren't actually trading close to failure. That was a lot. [laughs] Did I answer your question?
Cynthia Thurlow: [00:37:36] No. No. That is actually the best explanation for training to failure that I've ever heard. And I say that quite honestly. And we have a lot of experts on here, but clarity and helping people visualize and understand what that means. Because if you hear trained to failure, people are like, “What does that mean?” And so that is a very explicit understanding. So, for those that are doing, let's say you mentioned bar, let's talk about Pilates because I love Pilates for posterior chain work. I like it for flexibility for me personally. But women will ask me, is Pilates sufficient to build muscle? I know the answer to this. I'm sure we share the same opinion. What are your thoughts on Pilates for let's say middle-aged women?
[00:38:18] Because a lot of women, let me just interject this, a lot of women get concerned. They're worried if they go to the gym and they're lifting heavy, they're going to hurt themselves. So, they're like, “Okay, I'm going to do Pilates. I don't have to work in hard. I'm on the Reformer or I'm working in a class. It's an upper-level class. Like, yes, I'm a totally competitive person and when I go to Pilates, I only want the toughest instructor. I only want the most intense class. But having said that, help us understand what Pilates can be beneficial for and what it doesn't do for us.
Dr. Shannon Ritchey: [00:38:48] Sure. So, let's start with does it build muscle. It certainly depends on the exercise that you're doing in the resistance of that exercise. If you can train close to failure using a Pilates exercise or a reformer exercise, absolutely that exercise can build muscle. Many times, these reformer classes are doing far more than the 30 reps necessary. And it burns, it is hard, you will be super sore. You might be dripping in sweat. Again, but all of those things aren't the necessary stimulus for building muscle. Training close to failure in 30 reps or less is a reliable stimulus for building muscle. And then many times too, in these Pilates classes, there's just a lot going on. So maybe you're holding a plank and you're bringing your knees in and out. So, the shoulders are working, the legs are working, your abdominals are working.
[00:39:34] And when there's a lot working at once, your body is prioritizing stability and balance over motor recruitment or over muscle recruitment. So, because there's so much going on, the load isn't very specific to one single muscle group. So, therefore, you can't load that muscle. You can't load any of those muscle groups with very much intensity. And so, it might not be a super effective stimulus for muscle growth. Now, that's not to say again, that you couldn't pick a really specific exercise, stabilize certain parts of your body, and really target one muscle group and take that specific muscle group close to failure in under 30 reps. Some methods, absolutely. But you just have to ask yourself those questions when you go to the specific class that you're going to. One thing that Pilates can do is build endurance-- build muscular endurance.
[00:40:19] Like we said, it might be less important for most women to focus on endurance because we tend to keep a good composition of our type 1 muscle fibers as we age. However, if it's something that you enjoy, you love the group aspect, I say go for it. But it's just a matter of where we are putting our precious time and energy and when we are thinking about, I only have this amount of time to allocate to exercise and fitness. Not only time, but recovery. Because if you're doing a really hard Pilates class, that might interfere with your recovery, which will affect your subsequent training workouts. So, we have to think about what can I have time for and what can I recover from. I personally think strength training should be the cornerstone of your routine. Plug those workouts into your routine first. From there, add 150 minutes of light to moderate intensity cardio.
[00:41:09] Cardio is important. Historically, it has been overdone, but it is important. No one can deny the benefits of working our heart and lungs. It is important. From there, if you have the capacity to add one HIIT workout per week, that's a sprint workout, very, very short. Think 15 minutes or less, where you're going all-out effort for very short bursts, 30 seconds, and then you're breaking in between. You only need to do one of those per week to see incredible benefits maybe 2 max. Most people are doing way more because they think more is better when it comes to HIIT and that's not true. From there, if you have the recoverability, the time, the access to take a Pilates class, I say go for it. But again, I just like to think that there are other more potent ways to spend our time.
[music]
Cynthia Thurlow: [00:42:01] Yeah, it's interesting, I think, that distinction for people, if they're trying to differentiate, are they really doing HIIT is understanding that if the purpose of HIIT is not to overstimulate cortisol, it's to have these short little hits of cortisol, which is physiologically the way it's designed to be. I think that that can really help us find that reframe. Now you touched on something that I think is important. When we're talking about being middle aged and doing whether it's high intensity overall training or we're doing strength training or Zone 2, whatever it is that we're doing, we know that changes in estrogen actually impact collagen of our connective tissues, which has the potential to impact joint stability as well as injuries. And so, one of the common questions is always, what can I do proactively to lessen the likelihood of hurting myself?
[00:42:52] And I don't think any of us are going into exercise and saying, I anticipate this is what's going to happen. But I'm also at the stage of life where I'm like, “I'm very likely going to be more cognizant of what I'm doing because I definitely don't want to end up with a tear, a sprain, a strain, etc.”
Debra Atkinson: [00:43:07] Yeah, I think a lot of women are like that who use exercise to negate their stress. The last thing that I want is to be hurt because that's like my drug of choice, right? I need that and totally get it. And so, we want that positive addiction, actually. So, for women who are in perimenopause, still cycling, whether it's regular or irregular, that's a little harder to predict. But so, your bleed day one, but day 10 to 14, what we find is that is perfect timing for strength training, heavier strength training, because your tendons are more rigid, which means you just have this strong foundation, this great base to build greater strength. However, your ligaments are lax. This is when you're more likely to you're moving laterally, sprain the ankle. So, if you have brand new shoes with really lots of tread on them and you're on carpet, you better pick those feet up. You're going to catch them and you're going to go down as opposed to catching yourself.
[00:44:08] So, that's an important thing to consider, is that there are best times to do strength training that's really to your advantage, especially if you eat a little bit more protein during that period of time to gain strength. But if you must do HIIT during that time, do it on a bike or an elliptical where you're exceptionally safe. You can't screw this one up, okay. So, that's for you. But you also want to think if you're okay. I'm exercising like this. If I go really hard with my strength training, maybe you don't need to go really hard with your HIIT that week. You dial that down a little bit so you're able to recover and optimize the strength. So, think of that wisely and life is like that too. Life is really stressful, my mom passing, right.
[00:44:50] I decreased what I was doing most of the time, wasn't doing more. So that's a key. But so now women in menopause, post menopause are unpredictable with when they're cycling. We've called this as a strength and conditioning coach, we've called this periodization forever. How funny is that really? [Cynthia laughs] I just got to think maybe somebody up there knew that we’re going to be talking about women and fitness all the time. But we still want to basically treat it. But we can decide, what is our week one or week two, or week three. So, the way we cycle, most coaches will do three weeks of a cycle or four weeks. I choose four because it falls into a month and then to a quarter of the year.
[00:45:32] And it just is easier to organize for me and I think for a lot of people. So, we'll do three weeks where it's we come in week one. Week two, we're going to work harder. Week three, we're going to work harder. Week four, we're going to come back down and really recover. We're going to do some valuable things during that week. We're still going to stimulate the muscle, but we might do a lot more body weight yoga. You know where you are doing down dog, up dog, you're doing chaturanga and you're doing strength training with rotation, flexion, extension, lateral flexion.
[00:46:03] So we're getting a lot of that functional movement in. Maybe we've done it during the other training cycles, but not as much of it. Because when you're doing traditional to really focus on metabolism, it is more linear. So, that fourth week has lots of value. And we do that periodically. So, every month we're doing it, every quarter, then there's at least three recovery weeks, not just a workout, but a full week so that you're allowing yourself to rest. That might be the week where you're doing your prep for food, you're focused on that, you're getting yourself a massage, you're going on vacation, you're doing lots of things with the family that maybe you couldn't fit in as much otherwise. So that's how we program it. But we just then cycle because we can't always build, build, build and say we're always going upstairs. You've got to take a little break. But that next time you start week one, you're not coming back to the same start you had. You're higher still than you were because you've taken the break.
Cynthia Thurlow: [00:47:03] I love that. I think it's important for people to understand that, we aren't hitting the gym hard week after week after week, that we do have to have a point of recovery and resetting ourselves before we move on to the next month. Now, what is the research showing in terms of strength training and impact on our bones? We know that we lose 10% of our bone in the first five years of menopause, and that's when we're at greatest risk for osteoporosis. So, I think for many women, they understand the interrelationship of strength training and walking and stimulating bone, because actually, those hormone changes, especially estrogen and progesterone changes, actually they increase. They upregulate bone breakdown as opposed to bone building.
[00:47:51] So, those are the things I think about, like, what does the research show about how much strength training and how often to support our bone health?
Debra Atkinson: [00:47:58] Yeah. So glad you asked. And it's so exciting, actually, to be a woman post menopause now, because we are going to create the results, the data for again, for our daughters to come through. So, think of this. In 1995, when I first personally started lecturing on osteoporosis and osteopenia, I had to define it. People didn't know what it was, how to draw pictures and look it. This is modeling. This is remodeling. You're like a pancake cooking, and here's what's happening. But you're getting too many holes and they're not filling in. And now it's household words. But back then, we thought that once you got diagnosed, I mean, it was like bubble wrap. Don't do this, don't do that, don't do this contraindicated. People were nervous.
[00:48:50] I remember having clients come to me and they were in tears, about to retire, thinking that were going to retire to their dream home in Fraser, Colorado. If you're listening, you know who you are and ski, spend their life skiing. And all of a sudden, you're a petite size 2, told you have osteoporosis and you're at high risk. No doctor wants them downhill skiing like a bat out of hell, which is probably what she was. But now that's not what would happen. We know if you are already doing it, you should probably keep doing it. We got to have the joy factor in there as well. And we got our strength training and doing the right things.
And today, since about 2015, the research since then has been coming out on women post menopause because for a very longtime researchers were afraid to impose and do no harm comes out in research and they say, “You know, it's not ethical to take a limited population and apply terrible stress to them.” Well, finally they were like, “We've got all these women who've had osteoporosis for 20 years. They're not fracturing in exercise. They're fracturing in unique things in life. So, isn't it about time we start studying this? So, amen to that, whoever said that argument. But we're doing high impact and high intensity exercise like some of the protocols we've described. Five sets, five repetitions or maybe five to seven. So, there's what Dr. Belinda Beck out of Australia calls two in reserve.
[00:50:25] So, you might do five or six reps and say, I know I could do two more. But you're actually not going to force yourself to do them just to conservatively not risk injury of the connective tissue and the ligaments and joints. So, we're seeing from the results of those kinds of studies and high impact. So, they were having women like hold onto a bar or jump up to it and then jump down, do box jumps. So that's loading it not just with a jump in place, but a jump from a box down to the ground. So really increasing the gravitational ground force. No injuries. And they loved it. The high intensity exercise. They also had that feeling of mastery and achievement, accomplishment that no other researcher has ever documented.
[00:51:10] You know, researchers who'd participated in research prior to this said, with this we've never seen before, like they kept coming back. The dropout level was low, adherence high. That's always a factor too. But the injuries based on exercise was nil. So, that makes it exciting. These studies are really longitudinal, they're long, they're over time, which matters partially because you have to start safely. We do start with lower weight, higher reps and progress over time. And that's one thing that we all have to remember. That no matter what bone density may be your key or metabolism, in which case both points you want heavier weights for your advantage, but we have to start later.
[00:51:55] And it takes a series of weeks and actually months, two to three months to get to a point where you're lifting heavy enough and or you find the point where I can't go heavier because I feel vulnerable, something's going on, but you then do it slowly enough where you stop yourself before an actual injury occurs which is good news.
Cynthia Thurlow: [00:52:16] Yeah. That bodily awareness, I would imagine, is very important. And working with women, some of whom probably aren't yet on HRT, some who are on HRT, how do you see the recovery? And I know this is a small sample size, but over time, how has HRT impacted your clients in terms of being able to build and maintain muscle, build and maintain bone? Because I'm starting to see, I always say, my n of several hundred, if not a couple thousand, you know, the sleep piece is where I see the most benefits in terms of like consistently, if women come to me with HRT, they're sleeping through the night.
Debra Atkinson: [00:52:54] Yes. Anecdotally, what I can say is that both for muscle and bone density wise, I would say there are fewer to compare. And the reason is it's obviously it's a longer period of time before we're going to see results. Some somebody first gets diagnosed and is then aware. This is my key priority. It's another year, at least until they're going to do a scan in most cases. I mean, some women are more proactive, but definitely the women who are on HRT are seemingly getting better results. I say that saying probably easier results. They don't have to fight for it quite so much. They're getting that little boost from the estrogen is my guess.
Cynthia Thurlow: [00:53:34] Yeah.
Debra Atkinson: [00:53:34] I feel like I owe you answer to how much. I'm not sure I really answered that coming back to the bone density. So, two to three times a week for bone density. And this is where I have a little incongruent-- we really like two times a week a flipping 50. Because so many women suffer from that adrenal fatigue, not recovering and/or time is everybody's number one obstacle to exercise. And when we talk about muscle, we know that the benefits are there and they're insignificant. Difference between two or three times a week. With bone stimulus, it could be different. But again, I think we have to come back to our overall endocrine system. How are we doing there? How do we feel?
[00:54:15] And say, “Okay, maybe I should do other things” with ground forces, with high impact or as high impact as anyone listening can do safely five to seven days a week is the recommendation. But listen to this because you can do it in two or three minutes. So don't get overwhelmed here. This is 10 to 20 impacts and about four sets of it. That's two minutes or less of exercise. And you can do one now, you could do one at lunch, do one in the afternoon and one tonight. And imagine 10 little hops in place, that's it. And you've done one. If you like to jump rope, you probably do this naturally and easily. But it goes anywhere from walking, dancing, hopping, little jumping, jumping to a box, jumping off of a box, doing squat jumps, going lowest to highest ground force.
[00:55:03] And each of us again will have a line where, I can do everything below this. And these are okay for me. And that's your playground, so know that. And for those who can do high impact, you still wouldn't necessarily want to do super high impact every single day. And we want to do some side to side because that stress laterally is different than stress just down, down, down or forward and back jumping.
Cynthia Thurlow: [00:55:25] That's such an important distinction. So, I'm curious, you alluded to a power plate or a vibration plate. Where does that fit into all these other pieces in terms of our flexibility and our bone and our recovery, how does that fit into that?
Debra Atkinson: [00:55:42] Oh my gosh. Well, so first of all, let me just say this. I was the biggest skeptic, so I should apologize to somebody [Cynthia laughs] in the whole-body vibration world because [laughs] 15 years ago I remember I was approached as the personal training director her for a club. And we wanted you to have this in your club. And I was like, “No, they need to be doing other things. They need to be doing functional work.” And now I see it for what it is. I have one in my kitchen, so I'm using it every day. And I can lift heavy, but for me it's like icing on the cake. It's like I'm going to be 60 in not very long and it's like, I got to take this seriously. I want to pull out all the big guns, like, but what else can I do?
[00:56:19] And so I use it when I'm doing a quick strength training work at home. I will actually do my squats on it, I will lie my back on it and do my chest press and I will stand on it and do bent over rows on it so I can do the full workout. What I call a real quick one, the basics on that. Otherwise, I'm using it for core on a daily basis. Hands on it and planks, side planks. I'm doing a dead bug on it, balance, agility. I have a foot that thinks it wants to have plantar fasciitis, but I'm not going to have it. So, I'm standing on that every day. Y'all heard that here, I said it here. Ask me about how that's going later when you see me.
[00:57:00] But the vibration is also helpful in recovering from injuries. When I spent six and a half years in Boulder, I worked at the club side by side, world class triathletes. I mean, these are the ones who were in Kona doing the thing and finishing long before I was at dark, at midnight there we were using it for injuries. A hamstring pull, you sit on it, you've got something wrong with your elbow, your wrist, you're maybe going to plank on it or just sit on it and lie on the floor and put your calf up on it if you've got a calf tear. So, the stimulation is lymphatic movement through the body, stimulating the vibration, the frequency, all beneficial. So, for muscle recruitment, doing less, but still getting more.
[00:57:44] Those of you who can't lift as heavy, the recruitment of muscle is about 138% more than if you're not doing the weight training on it. So that's pretty good. That means the same muscles stimulated more, other fibers are also recruited. And all of that is good for metabolism, obviously in circulation.
Cynthia Thurlow: [00:58:09] If you love this podcast episode, please leave a rating and review. Subscribe and tell a friend.
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