Fitness Considerations for Perimenopause
Spoiler Alert: It's going to take more than a weighted vest
Strength training is finally receiving its long overdue recognition for its role in preservation of bone density in perimenopausal women. The internet, to some degree, has shown it can work for good to prioritize strength over being skinny. However, not all strength training programs are created equal.
The reality is that women lose up to 10% of their bone density in menopause. With bone loss also comes muscle loss (sarcopenia), which is likely why your social media feed is filled with women talking about hitting their protein goals. Physical inactivity, coupled with declining levels of estrogen, can result in significant changes to bone and muscle health. A recent study revealed more severe menopausal symptoms to be correlated with lower muscle mass. While we’ve certainly made women aware of the need to strength train, there seems to be an underlying urgency that we still aren’t doing enough.
What constitutes enough?
Social media has women believing if they walk with a weighted vest a few times a week they’re strength training. Taking a group fitness class and lifting a set of 2 pound dumbbells isn’t going to move the needle either. While all movement is good movement, all modes of exercise still have a threshold for therapeutic outcomes - especially when it comes to resistance training.
I feel like we as a collective society have moved past the myth that if women lift heavy weights, they’re going to “bulk” up. But if you’re reading this and still believe that lie, I’m saying it again. If you want to become stronger, improve your bone density, and change your body composition, you have to lift heavy weight.
“The bone’s ability to respond to continuous stress decreases with time or with increasing repetitions because bone cells become desensitized to recurrent stimulation.” (Alnasser et al., 2025)
Untrained beginners obviously aren’t going to jump straight into heavy loads. In the initial days of training, those smaller loads are effective for novices. As the body adapts, progressive overload is critical for maintaining an adequate stimulus to the body to initiate bone remodeling.
The loads used in exercise should exceed the loads you move throughout your day to day life. So, if you’re carrying around a 30 lb toddler throughout the day, hauling in 6 bags of groceries at a time, and lifting your 50lb bag of dog food to feed Fido, it’s easy to see how the 5 pounders that you’re lifting in class aren’t cutting it.
Lifting for Strength vs. Endurance
There are four primary resistance training goals: strength, power, hypertrophy (increase in size), and endurance. Strength and endurance are on opposite ends of the training spectrum but most pertinent to this discussion, so I’m focusing on those.
Strength is defined as the maximum amount of weight you can move one time, while endurance is the maximum amount of times you can move the same weight. Both are necessary for the general population. You need to be strong and to have muscular endurance for stamina.
Endurance is commonly used in group fitness classes. High repetitions, minimal rest time, and a modest weight selection are all characteristics of endurance-based lifting. The National Strength and Conditioning Association’s guidelines for endurance are 2-3 sets of 12+ reps with 30 second rest periods.
The NSCA’s parameters for strength are 2-6 sets of 6 or fewer reps at or above 85% of 1RM. This means 85% of the weight that you can lift 1 time. Even if you don’t know what that number is, you can still dial in your weight selection by simply choosing a weight that’s heavy enough to only lift 5 or so times. Because each set is so taxing, a 2-5 minute rest between sets is recommended.
Only compound (multi-joint) lifts, such as squats/leg press, bench press, and deadlifts need to be done at this load. Smaller, accessory lifts that only use one joint, like bicep curls and leg extensions, should follow a less intense protocol. The more joints that are involved in the lift, the more weight that can be moved safely.
Even for individuals with osteoporosis, the American College of Sports Medicine recommends using a load that is challenging enough to make the last two repetitions in a set difficult to complete. ACSM also indicates that high intensity resistance training should be performed, if tolerable.
In addition to resistance training, multiple studies have incorporated jumping as a way to improve bone density in perimenopausal women. Jumping rope, or hops without a rope, done on a stable surface are an excellent way to evoke the necessary forces to initiate bone remodeling. If you’ve avoided jump training because you thought it was all box jumps and crazy plyometrics, you’ll be happy know that small hops are sufficient.
While the push to build as much muscle as possible is important to mitigate the losses that are prevalent during perimenopause, the recommendations for postmenopausal women aren’t much different. High intensity exercise consistently performed 3 or more times per week showed promising improvements in bone density.
It should be noted that oftentimes, in these studies evaluating bone density, there may be conflicting outcomes in studies due to where the bone density is measured (e.g. lumbar spine vs. femur). Some of this discrepancy can depend on the exercises used in the study. If the body isn’t loaded in an upright position, which may be common when older adults are being assessed, the spine isn’t sustaining the same load that the limbs are. Functional limitations in older adults impact study design, and therefore study outcomes. Lastly, outcomes can also be affected by the study’s power. It’s not always easy to recruit enough subjects for studies - especially using older adults. Small samples preclude us from assessing the true effect of the intervention.
Training Recommendations
So, what would this look like for a perimenopausal woman who has been training for a while and needs to up the ante? I’ve included an example with some rationale.
When I list cardio below, these are dedicated gym sessions 30-60m of some mode of cardio. This doesn’t include the regular 7k-8k steps you should be aiming for, daily.
Novice exercisers: I still would recommend the same structure below. While you may not be able to incorporate heavy lifts, training 3d/w is still recommended. Cardio and mobility are also still necessary for heart health. On Saturday, instead of the HIIT session, add in another cardio day to help build stamina. The key to progress from a novice to an experienced exerciser (aside from training time) is to increase the weights every 8-12 weeks as you feel yourself becoming stronger.
Monday: strength training
I’d make this a heavy lifting day following the strength protocol above for volume and intensity. Pick or two major lifts to go heavy on (e.g. deadlift, squat or bench), and incorporate other lifts at a lower intensity to address the whole body.
Tuesday: cardio + mobility
Recommend mobility sessions directly after cardio while the body is still warm for optimal movement. If time is an issue, mobility can be done at any time of the day. Pick 1-2 movements to work on for 10 minutes. Done.
Wednesday: strength training
Again, I’d pick 1 or 2 heavy lifts, and the others can be in the 8-10 rep range. While they won’t be as heavy as the primary lifts, choosing a weight that is heavy enough for the 8-10 reps will still elicit muscle growth (hypertrophy).
Thursday: cardio + mobility
These cardio sessions in between lifting days incorporate movement to workout muscle soreness. Dedicated cardio sessions in addition to daily walking are necessary to elicit a training stimulus to enhance your aerobic fitness.
Friday: strength training
For this training day, I’d focus on lifting for endurance. This helps offset the heavy days, but fortifies the training session with another day of total body lifts. Again, one exercise for each major muscle group is sufficient.
Saturday: HIIT
Since there is a rest day built in on Sunday, this would be a great place to incorporate a HIIT session. Because Friday was a lift day, I would avoid weights again and use this for sprint interval training: maximal high end cardio (10/10 effort) in short intervals (20-30s) with ample time to reset (such as a 1:5 work/rest ratio). The bike, treadmill, or rower are great options for this. Either after the warm up or immediately after the training sessions, I’d also incorporate a few rounds of jump rope or double leg hops (3x20).
Sunday: rest
After a busy week, rest needs to be built into the routine for the body to repair. I like coupling this with other forms of rest on Sunday - rest from screens, work, etc. While I still may move intentionally throughout the day, I do not engage in structured exercise.
Ultimately, the order throughout the week is important. Avoid lifting weights on back to back days. It’s also ideal to schedule high intensity cardio sessions after lighter lifting days. Following those parameters, you can still structure a similar training regimen like the sample above that works for you.
Now go pick up something heavy!
Simply Fit is a free, weekly newsletter written by Dr. Amanda Durall, a Kinesiology professor, fitness professional, and busy mom who aims to simplify exercise science and deliver practical recommendations to help you achieve your fitness goals. Want more free content like this delivered straight to your inbox? Subscribe for weekly training tips, technique overviews, and more evidence-based fitness content!