Menopause is the time frame following a year-long cessation of a woman’s menstrual cycle. Perimenopause, not nearly as easy to recognize, refers to the few years leading up to menopause, when the female body begins to experience hormonal flux and accompanying symptoms. Helping to navigate this stage with appropriate exercise can make a significant difference in a female client’s quality of older life.

Personal trainers whose client base includes more than just robust individuals in their 30’s and 40’s have no doubt noticed an increase in middle-aged and older women choosing to exercise. Often living well into their 80’s, our female population continues to grow. As trainers work with menopausal women, understanding the physiological changes experienced during this  “third stage of life” can ensure more successful exercise experiences.

Easing the Transition of Menopause

When bodily changes naturally occur with age, many women settle into a routine of sedentary complacency, inviting the risk of more serious health problems. Maintaining or embarking on an appropriate exercise regimen at this time can go a long way towards staving off many of the more common menopausal complaints.

  • Midsection Weight Gains ~Aging women observe an increase in adipose tissue, typically around their abdomens. The body pulls adipose in to protect internal organs, which may thicken the midsection. Regular physical activity can help mitigate this, which in turn diminishes risks of Type 2 diabetes and heart disease. An increased distribution of lean muscle mass along with a healthy weight may also confer some protection against breast and endometrial cancers.
  • Weakening of bones ~Exercise, especially resistance training, can help with the bone loss accompanying menopause and older age. Improved bone density, coupled with increased flexibility and balance, significantly lowers the risk of fractures, osteopenia, and osteoporosis.
  • Anxiety and depression ~ Women who remain physically active into their older years tend to experience less anxiety, depression, and cognitive decline.

Continuing Activity

Regardless of one’s stage of life, exercise parameters for women remain the same as always. An ideal exercise prescription from the Department of Health and Human Services combines aerobic activity, performed moderately for a total of 2 ½ hours/week; balance exercises; flexibility movements; and resistance training.  Especially in the years when circulating estrogen wanes, this program helps women maintain or even increase bone density, lean muscle tissue, and overall strength.

Bone Loss and Menopause

Personal trainers working with clientele in the perimenopausal or menopausal stages of life may have also observed an increased presence of osteopenia or osteoporosis, a common artifact of diminished estrogen. Addressing bone loss concerns can help identify which exercises remain appropriate and which to avoid, namely higher-impact aerobics.

Even a carefully structured balance program may result in falls. Teaching clients to perform these moves alongside a stable surface should help allay fears about potential tumbles. If a client’s bone loss lies in or near her spine, pay close attention to moves requiring trunk flexion, with or without resistance, as these can predispose one to spinal fractures.

Addressing Anxiety

Menopause seems to trigger anxiety among many females who have grown accustomed to their bodies’ performance for the past 40+ years. Suddenly, a restful night’s sleep seems elusive, anxiety replaces body acceptance, and often depression creeps into daily life. Couple all of this with intermittent cognitive lapses, and many women see a recipe for potential emotional upheaval. At this point, along with the aforementioned modes of exercise, stress release through yoga, stretching, and mind-body sessions can help offset menopause-related anxiety as well as many of the more commonly experienced symptoms.

Helping Hot Flashes

The topics of hot flashes and night sweats inevitably arise as part of any discussion among menopausal women. Scientists believe the phenomenon stems from an aberration in the body’s thermoregulation system. One study delved into the fact that during the perimenopause years, individuals tend to exhibit a lack or complete absence of both sweating and shivering.

New research points in the direction of exercise as a means of improving the body’s ability to properly dissipate heat. Over time, regular moderate aerobic exercise can shift the body’s sensitivity to sweating, reduce core temperature, and potentially trim the frequency of hot flashes by 50% or more.

Estrogen and the Athlete

Female athletes are not exempt from the transition into menopause and its accompanying physical changes. In fact, overtraining can actually work to the client’s detriment by signaling excess cortisol, the key culprit of belly fat storage. Along with diminishing levels of estrogen, a reduction of testosterone levels also defines the menopausal years, threatening to dismantle hard-earned strength and muscular power.

If clients observe these changes, try incorporating some HIIT such as plyometrics into their training sessions, along with gradual increases in strength training. Fewer hard-core endurance sessions (such as distance running or back-to-back low weight/high rep sets) can aid in the hormone/cortisol balance.

Kegels are Key

Another frustrating aspect of the female body, often evidenced post-partum but exacerbated as we age, involves the muscles of the pelvic floor. Urinary incontinence reportedly affects nearly half of all menopausal women. While many individuals feel that this condition simply accompanies “old age”, science points rather to the more sedentary lifestyle into which many older Americans settle. Decreased circulating estrogen can predispose menopausal women to pelvic floor muscle weakness, most notably those muscles controlling the excretion of urine.

Kegel exercises work the pelvic floor muscles, thereby offsetting incontinence. By tightening and releasing specific muscles, an isometric-type contraction strengthens the pelvic area. While some male trainers may find it awkward to discuss this with older female clients, and even more challenging to describe the exercises’ execution, the simple approach works best.

Instruct clients to think about waiting in a long line for the women’s bathroom… after several cups of coffee. The simple act of “holding it in” can work those Kegel muscles and help prevent accidental leakage. Women can easily perform these exercises several times each day…with nobody around them even knowing!

Rolling with the Changes

Those of us fortunate enough to embrace our older years can expect bodily changes, regardless of healthy and active lifestyles. Trainers can help clients commit to adding movement into their daily routines. Setting small goals, rather than long-term hefty aspirations, helps create a sense of accomplishment. As the partnership continues into clients’ elder years, gently increase challenges to eliminate plateaus or complacency.  The human body, simply a machine after all, requires ongoing maintenance to prevent as many problems as possible.


Cathleen Kronemer

Cathleen Kronemer is an NFPT CEC writer and a member of the NFPT Certification Council Board. Cathleen is an AFAA-Certified Group Exercise Instructor, NSCA-Certified Personal Trainer, ACE-Certified Health Coach, former competitive bodybuilder and freelance writer. She is employed at the Jewish Community Center in St. Louis, MO. Cathleen has been involved in the fitness industry for over three decades. Feel free to contact her at She welcomes your feedback and your comments!