Exercising is one of the best ways to support your health during perimenopause and menopause. As estrogen levels drop, you may notice weight gain, loss of muscle strength, osteoporosis (bone mineral density loss), and trouble sleeping. Regular physical activity can help with these changes.

In a survey by ThisIsMenopause, many women said they wished they had made exercise a priority sooner to help with perimenopause symptoms. “If I knew about symptoms ahead of time, I would have tracked changes in my body sooner, prioritized sleep and exercise, and been more proactive about managing stress and hormone health,” said one respondent.

What type of physical activity is best during perimenopause? MyHealthTeam consulted physical therapist Cindi Lanners, a board-certified clinical specialist in women’s health and pelvic health in Colorado who has a doctorate in physical therapy. She shared her experience treating women during midlife and discussed which exercises are most helpful.

General Exercise Recommendations

Current guidelines from the American College of Sports Medicine recommend that adults ages 18 to 65 get regular aerobic exercise and resistance training each week. If you have any health conditions, talk to your doctor before starting an exercise program to make sure it’s safe for you.

Most people should get at least 150 minutes of moderate-intensity aerobic exercise per week. Exercises include brisk walking and gardening. Or, you can do 60 minutes of vigorous-intensity aerobic exercise per week. These exercises include running, cycling, or swimming laps in a pool.

Resistance training, like weight lifting, should be done at least two days a week. These workouts should be moderate to high intensity and focus on the major muscle groups.

Best Exercise for Women During Midlife

General exercise recommendations are the same for women during perimenopause, but Lanners emphasizes strength training most. “Strength training is the best form of exercise because it increases the forces on bone [and muscle], forcing them to adapt,” she said. This can help prevent osteoporosis and muscle loss linked to age and hormone changes. At least two days of strength training is recommended per week, but Lanners encouraged three times a week for women in perimenopause.

Lanners said the key is to challenge yourself using the principle of progressive overload. This means adding slightly more load in the form of weight, repetitions, or sets as you get stronger. For example, you may add 2 pounds to your biceps curl next week or add one or two more reps per set.

Eventually, Lanners wants her patients to start some form of plyometrics, or jumping exercises. Plyometric exercise focuses on power — an explosive type of strength training. “We lose power as we age,” she said. Lanners does power training with her patients, even those approaching their 70s and 80s, because it helps preserve balance, walking ability, and bone density. If you lose your balance while on a hike, for example, you need power in your leg muscles to quickly step to the side and catch yourself before falling.

Regular strength training may have other benefits for women in perimenopause besides supporting muscle and bone health. Evidence is still growing, but suggests strength training could also help:

• Regulate hormone levels
• Lower body fat percentage
• Decrease vasomotor symptoms, like hot flashes
• Improve cardiovascular health, including blood pressure, heart rate, and cholesterol levels
• Promote healthier sleep patterns

Incorporate Pelvic Floor Training

When thinking of exercising, you might imagine running or squatting. Most people don’t think about training deep muscles like the pelvic floor.

The pelvic floor is a group of muscles inside the pelvis that support the pelvic organs and control bladder and bowel function. These muscles also play a role in reproduction and sexual function. Like other muscles in the body, the pelvic floor muscles need to be able to tighten and relax. Lanners explained that age, childbirth, and hormonal changes can weaken the pelvic floor, which may lead to incontinence or other bladder and bowel problems. Even when these muscles are strong, they may not work together the way they should.

If you leak urine with physical activity, it’s common — but not normal. A physical therapist can help. “We can place pressure on those muscles and see if they’re doing their job,” said Lanners. Once your physical therapist finds an underlying issue, you can work with them to incorporate a training program designed to address your specific needs.

Which Exercises Should Be Avoided During Perimenopause?

No exercises are off-limits, but some offer fewer benefits than others. Swimming and cycling are popular examples of exercises you may love, but they shouldn’t replace weight-bearing activities (exercises on your feet) that strengthen bone to help prevent osteoporosis.

“Swimming is great for cardiovascular training,” said Lanners. “But since it’s not a weight-bearing exercise, it doesn’t apply enough forces to the body to invite bones to adapt.” In other words, exercising against water doesn’t challenge bones and muscles the same way as exercising against gravity on land. Cycling is similar. It can have cardiovascular and strength benefits, but it’s not a weight-bearing activity with as many bone health benefits.

If you enjoy swimming, cycling, or other non-weight-bearing activities, consider balancing them with walking, jogging, and strength training throughout the week.

Tips for Getting Started

“Knowing how to be more physically active would have been helpful,” said one ThisIsMenopause survey respondent. It’s never too late to begin. Start incorporating exercise into your weekly routine to meet aerobic and resistance training goals.

One of the most accessible types of weight-bearing aerobic exercise you can do is walking. Pick a route around your neighborhood or visit your local park or track. You don’t have to hit the aerobic training goal right away. Do what you can and add time or speed as you’re able until you reach 150 minutes per week.

One routine could be five 30-minute walking sessions over seven days. You can break up the daily 30-minute sessions into three smaller 10-minute sessions if it’s easier for your ability or schedule.

Resistance training may seem more daunting, but it doesn’t have to be. Lanners has a few tips for people who are just starting out:

• Target major muscle groups — Learn different movements focusing on the three main body areas: the lower body, chest, and back.
• Start low — Practice movements with body weight only, like squats and lunges, until you’re comfortable adding weight or other variables. Sit-to-stand movements from a chair are a great way to build strength to prepare to perform squats.
• Progress slowly — Add one activity every week, like reps or weight, and only add a little to allow the body to adapt without injury.
• Spread out training days — Set up your workout routine to give yourself rest days, which are important for muscles to recover and strengthen.
• Listen to your body — Recognize the difference between delayed-onset muscle soreness (normal aches after challenging muscles) and persistent pains signalling you may have overworked yourself.

You can start exercising at home and move to a gym later, if you want.

When To Talk to a Doctor

Check with your doctor if you have a health issue potentially affecting exercising safely, like a heart or lung condition, diabetes, or kidney disease. Your healthcare team can let you know what exercises you’re cleared to do.

If exercise is safe for you but you have an injury, such as knee pain or long-term back pain, ask your doctor if physical therapy can help. A physical therapist might also be appropriate if you’re experiencing pelvic floor issues during exercise, like leakage while running or lifting. Lanners recommends using the physical therapist locator on the American Physical Therapy Association website to find a specialized provider near you.

If you don’t have health issues or an injury but aren’t sure where to start, working with a personal trainer may help. A personal trainer’s job is to teach exercise movements and progressions, so you feel comfortable doing more on your own.

Exercise can play a big role in helping you feel stronger and healthier during perimenopause and menopause. A mix of strength training, cardio, and pelvic floor work can support your bones, muscles, heart, sleep, and daily function. Starting small and staying consistent can make a difference over time.