If I Wanted to Reduce My Risk of Heart Disease Post Menopause

Women collectively “Catch Up” to men in their risk by age 60, largely because of the loss of estrogen. Based on studies from the American College of Cardiology’s Annual Scientific Session (April 2024) and the American Heart Association (2013, 2023).

Changes in blood pressure, cholesterol, and visceral belly fat all seem to be a part of the menopause transition for many women. Women spend 40% or more of their lives post-menopause, that’s a health risk if left unchecked. Women who have an early menopause, have even more time in their lives in post menopause.

Many women are advised or think about weight loss, stress reduction.

Very few women think about heart health risk and muscle loss. Yet, to define cardiovascular fitness is to talk about VO2 max.

VO2 max measures oxygen consumption capacity or liters of oxygen the body consumes during exercise, expressed in ml/kg/min. For every 1 liter of oxygen consumed roughly 5 kcals are burned.

Two components of VO2:

• The delivery of oxygen
• The extraction of oxygen from the tissues

Heart health CAN decline rapidly after menopause…

All statistics are based on historically what’s been true… and we sometimes forget that if we choose not to participate in the same habits of past generations we don’t have to get the same results.

If you lose muscle, you lose VO2.

If you lose VO2, you die tired, younger, sicker and fatter.

Replacing the overemphasis on cardiovascular exercise which seems to be the first go-to for women, trainers, and physicians alike, with an equal emphasis on muscle is the first step.

BUT.. that negates the fact that.. muscle-building exercise improves blood sugar levels, increase strength, stamina, power to inspire and motivate greater activity

Training Plan to Avoid Risk of Heart Disease Post Menopause

We also train wrong for women in midlife.

Highs and lows are best for women midlife.

Moderate-intensity exercise, a go-to for many women since the 80s, is actually an energy drain. Instead of reducing stress, it spikes cortisol, making fat loss and recovery harder.

High intensity to toleration during perimenopause, not all women tolerate when hormones are doing the greatest fluctuation. There’s a dance between the muscle, heart, bone benefits and the adrenals/cortisol response that has to be done.

Post menopause hormones have stabilized and a woman is likely to tolerate more high intensity- not longer but with greater frequency from say 2 times a week to up to 4. This will help overcome the loss of fast twitch muscle fibers lost more quickly with age and without fast or powerful movements. The significant boost of growth hormone and testosterone that occurs with true high intensity exercise provides mitigation of cortisol.

Let’s review this again. Moderate exercise can occur for 3 reasons:

• Intentionally you unknowingly are trying to hit moderate level exercise
• You attend boot camp type classes that never allow complete recovery. They feel hard and high intensity for long periods of time, but in actuality, you’re not reaching your peak capacity.
• You start out going at a low level but you either push it because you feel good or you go longer because it feels good, both result in a cardiac drift into the “no benefits zone” of moderate intensity exercise.

What’s the answer? Your midlife workout formula should look like this:

• 80% Low Intensity (walking, recovery movement)
• <10% True High Intensity (short, powerful bursts—literally minutes a week!)
• 10% Do-What-You-Love (hikes, long rides—just earn them!)

The Strength You Need to Avoid Risk of Heart Disease Post Menopause

A 2020 study found that skeletal muscle mass is a good predictor of cardiovascular disease risk in people over 45 without existing heart conditions. Another study found that lower skeletal muscle mass was associated with an increased risk of cardiovascular factors.

Based on studies from Journal of Occupational and Environmental Medicine (2020), Individuals with high muscle mass and low fat mass have the lowest mortality rate.

Increase muscle protein synthesis.

Lift to muscle fatigue is often the advice given. For those that can’t lift heavy it should be known that muscle strength, and more muscle endurance as repetitions go higher than 15 or 20 range, can be gained.  Yet, heavy weights increase strength and power more than light weights.

Anabolic resistance comes into play.

Women post menopause need increased volume of sets.. and almost always have to work around aging joints and previous injuries.

“The older you get, the more you are fighting for anabolic resistance.”

VO2 max is closely associated with heart disease risk. The higher your VO2 the less your likelihood of dying from all-cause mortality.

Moving from a low VO2 max to moderate VO2 decreases heart disease risk the most. Moving from already moderate to high or high to elite, is a benefit but doesn’t return the same level of rewards.

One of the MOST OVERLOOKED ways of maintaining and gaining VO2 max for adults over 40 is improving muscle health. Get more muscle or get stronger.

The MOST EFFICIENT way of increasing VO2 max for women over 40 from cardiovascular exercise is HIIT.

Yet, HIIT workouts really only occur in a small percentage of exercise time weekly. The foundation of fitness is low intensity movement. That is to go for walks, daily.

And… TRUE HIIT is not what most women are doing. If you have to ask if it’s HIIT, it’s not. If you don’t get breathless… and then recover completely between intervals? It is not HIIT.

Your Fitness Level to Avoid Risk of Heart Disease Post Menopause

Find your fitness level now. Commit to training and then measure again later.

We’re implementing a community-wide home assessment bundle. Join us? Details in this podcast about how to get started with us or do this on your own with the testing, interpretations and videos explaining how.

Measure what matters.

Unfortunately, we for too long have judged fitness by looks. If you look slim, or buff, you must be fit. If you’re thin you don’t need to exercise. We’ve spent decades perpetuating this type of thinking.

You’re missing the point… and you may need a good look at the book by Jamie Seaman. Dr Fit and Fabulous.

Thanksgiving dinner in the early 2000s. One of my brothers had just recovered from an incident where we thought he might not recover from a rare autoimmune disease. Several months of hospitalization and rehab, surgeries, steroids.

I, as the resident fitness member of the family, was someone to either be asked or avoided depending on who you were. Somehow the conversation got to weight training and I asked Jon if he was weight training? The connection for me, obvious that he needed to offset his muscle loss, bone deterioration from the needed steroids.

My mother answered first. Why? He looks great, why does he need to exercise?

The table was quiet for a moment with all eyes on me. Would I take this bait… or roll my eyes and find a reason to go back to the kitchen? In the end, I did the latter, but that moment wasn’t one for my family, it was representative of many - not just my mom’s generation - that we exercise to fix something we don’t exercise to enhance something or benefit like a vitamin.

Back to HIIT to Avoid Risk of Heart Disease Post Menopause

For women in midlife.. this can help AVOID the increase in cortisol that occurs at moderate intensity zones maintained for too long. This Middle or moderate zone 3 is best referred to as “no benefits zone” because the ROI for this zone is so low.

In lower level exercise, you get the big benefit from a lower level exercise that is under the threshold where cortisol elevates negatively. It’s also easy and almost anyone can do it.

In High Intensity Interval Training, you get the big cardiovascular benefit of raising the ceiling on your fitness level by exercising at your highest intensities for short bursts that - when alternated with complete recovery  - also don’t negatively cause a negative cortisol and insulin response.

The seduction of HIIT has always been that the return on investment of time is greater. The same fitness level that might be achieved over weeks or months is often cut in at least half or from minutes investment over 2 weeks vs hours over 2 weeks from lower levels of exercise.

This is where the study of protocols gets important if you want a rapid return on investment of time. You also have to be in good enough physical condition to benefit from these.

For anyone listening who may have adrenal insufficiency, or chronic fatigue, you would not only not benefit from HIIT protocols at this moment, you would potentially find yourself worse.

Timing matters.

Late day high intensity exercise begs the body already lower in cortisol for the day, to convert something into the fuel that cortisol provides.

[Cortisol is a swinger… from stress to energy. It’s actually one and the same. The brief adrenaline rush you feel -and need- in emergency situations whether to rapidly swerve to avoid an accident, or to hit ice and right yourself unharmed - is thanks to cortisol. But so is the ability to pull yourself up on that pull up bar when yourself is whispering to herself, “fight!” Or run those 4-6 interval sprints.]

That cortisol gets made. Your body will see too it. But then you’ve also got less progesterone for sleep potentially because that’s been converted to cortisol. You may not get enough post exercise nutrition to avoid muscle breakdown after. Women need more and they need it sooner than men do after exercise.

Wait- you might be saying, how did we get here? We were talking about heart health.

But your muscles are directly related to your heart health. And too many women are missing it.

Resources:

Flipping50 Membership:
https://www.flippingfifty.com/cafe

Other Podcasts You Might Like:

8 Ways to Make Walking in Menopause MORE Beneficial:
https://www.flippingfifty.com/walking-in-menopause

What are Heart Rate Zones and How are They Helpful Over 50?
https://www.flippingfifty.com/heart-rate-zones