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While we’re used to observing American Heart Month in February, we’re pretty sure we don’t have to tell you about the importance of staying on top of heart health all year round. Our hearts beat all day every day, and we’d like to keep it that way as long as we can.
The statistics about women and heart disease are sobering—even more so when you consider that cardiovascular disease risks increase significantly after menopause due to estrogen’s cardio-protective effect declining as hormone levels decrease during the menopause transition. Lack of information, combined with the fact that many symptoms of heart conditions can present differently in women than in men, means women often delay seeking and receiving lifesaving care.
While we’d love to wave a magic wand and close that cardiovascular care gap in an instant, healthcare doesn’t work like that. What we can do is educate and encourage women to take an active role (literally!) in supporting their cardiovascular systems for long-term health. One tried and true way to do that? Get moving.
What’s so unique about our bodies at this time that affects our cardiovascular health so much?
To understand why women’s cardiovascular disease risks go up after menopause, we’ve got to turn to that powerhouse hormone, estrogen. Estrogen is believed to have a protective, anti-inflammatory effect on the heart and blood vessels, keeping them flexible for improved blood flow and mitigating the accumulation of plaques that can build up in the arteries (a major contributor to some types of heart disease). Estrogen also helps manage the metabolic processes that keep markers like cholesterol and blood glucose levels in check.
During the decline of estrogen that accompanies menopause, those protective effects decline too, which is why some women see unwelcome changes to their blood pressure, cholesterol levels, and insulin regulation. All of these markers can affect heart and blood vessel health if they get out of control and aren’t managed over time. To make matters worse, the uncomfortable symptoms of hormone swings—like night sweats, hot flashes, and sleep disturbances—may put additional stress on the cardiovascular system by increasing blood pressure and heart rate.
Even circumstances from before menopause can affect our hearts; women who have been pregnant should be aware that a history of pre-eclampsia and gestational diabetes can significantly raise the risk of developing cardiovascular diseases with age.
Is reading all this making you want to get up and do a quick circuit of jumping jacks, squat jumps, and mountain climbers like right now? Honestly, same. Let’s do a few, then dig into some common questions about exercising for heart health before and after menopause.
How does exercise support the cardiovascular system during and after menopause?
We spoke with Stasi Kasianchuk, Gennev’s Senior Director of Lifestyle Care, Registered Dietitian Nutritionist, and certified Exercise Physiologist. She explained what we all need to know about how women can approach heart-healthy exercise from perimenopause through postmenopause.
Exercise can’t bring your estrogen back once it has started to decrease, but it can help your body handle the consequences of this hormonal taper and stay healthier through the natural effects of aging.
Exercise supports your cardiovascular system by:
- Keeping your heart muscle strong so it can pump blood efficiently
- Reducing excess pressure on blood vessels and keeping them limber, allowing them to expand and contract more easily to regulate blood pressure
- Stimulating hormones that support the body in better management of inflammation, which helps prevent damage to blood vessel walls that makes them more susceptible to plaque buildup
- Stimulating the metabolic systems that help your body more efficiently use cholesterol, lipids (the fat in your blood), and glucose for energy, in turn making them less likely to be stored in the body as fat or build up in the bloodstream and form plaque
All the above is true for people of any age, of course, but when you consider how much estrogen does to help these physiological processes work smoothly before menopause, it becomes even clearer that exercise is critical for staying healthy after menopause. It mitigates the effects of dwindling estrogen in a big way.
Can you keep doing aerobic cardio workouts after menopause?
Short answer: YES. If you already have a moderate-to-vigorous cardio workout routine of choice, like running, cycling, swimming, cardio-based exercise classes like dance, or interval training, keep it up, says Stasi. The protective benefits of aerobic exercise for your cardiovascular system are tremendous, and can help ease other bothersome menopause symptoms, like stress and poor sleep.
So where did the idea that you have to give up cardio once you hit menopause come from? As with a lot of ideas about menopause, exercise, and health in general, this probably started as a kernel of truth addressing a very specific situation or piece of research and evolved to become a major misconception.
One thing that could be behind this idea is that many women find that the cardio routines they followed in their 20s and 30s don’t feel as effective as they used to, in that they may no longer ward off the weight gain and body composition shifts that accompany perimenopause and menopause. A common recommendation in that case is for women to try strength or resistance training, like lifting weights or bodyweight exercises. These workouts can more actively build muscle mass than cardio exercises on their own, and more muscle means a lot of good things during menopause: improved metabolic functioning, steadier blood sugar regulation, better bone health, and for some, an easier time managing weight changes. But that’s not to say that they are better than cardio workouts or should replace them altogether.
If you’re still enjoying your cardio routines but feel like you're working harder than you used to (or would expect to), or struggling to recover as quickly as you’d like, that's not necessarily a reason to give them up. But you may want to investigate whether perimenopause or menopause could be contributing to your experiences. Your body’s needs for fuel and rest do change with menopause, and it’s normal to feel those effects, especially as age and hormones do their thing and you begin to lose some of the protective effects of estrogen on your arteries, muscles, and bones. It is completely okay to switch up the kind of cardio you do if high-impact aerobic workouts aren’t working for you after menopause.
If you have any concerns about your heart health, talk to your doctor and familiarize yourself with signs of heart disease in women. Stasi also recommends seeking guidance from a credentialed exercise professional and approval from a physician before starting an intense new cardio workout routine.
Is strength training alone enough for cardiovascular health?
Make no mistake: strength training, especially weightlifting, is great for your heart. If you have done resistance training at a level that was at least somewhat challenging, you probably recall breathing faster and feeling your heart beating faster. That is a sign that your heart is pumping harder—nice work! While resistance exercises may not get the heart pumping as vigorously as a high-intensity aerobic workout can, any intentional increase in heart rate is a win. Additionally, by helping you build muscle mass and improve your metabolism, strength training can lower blood pressure, improve blood sugar levels, and improve total cholesterol markers. This is particularly important for preventing the buildup of plaque in the arteries that can decrease blood flow to the heart or brain and cause heart attacks or strokes.
Now, here’s where the devil is in the details. While it is possible to obtain all necessary cardiovascular benefits from weightlifting alone, that usually requires following an intentional and strategic plan created with an exercise professional. Stasi advises that in order to optimally support heart health, most people would benefit from including cardio-specific exercise in addition to weight training.
HIIT workouts: pros and cons of high-impact exercises during menopause and how to do them safely
One encouraging thing about finding workouts for menopause heart health is the range of activities to choose from. Not a runner? Try rowing. Rather be in the water instead of skimming along on top of it? Swimming is great for your heart and easy on your joints if you are one of the “lucky” ones experiencing joint pain. Firmly a creature of dry land? Hiking, especially done at a moderate pace with a few hills in the mix, is a great way to get a dose of cardio plus the added health benefits of spending time in nature.
You get the idea—there are a lot of ways to move, and they can all serve your body a little differently.
Some forms of cardio are considered “low-impact steady state” or LISS, and usually involve keeping the heart rate within a certain beats-per-minute zone for a longer period of time, without a great deal of variation. Other forms fall into a category that might be familiar to you: “high-intensity interval training” or HIIT. HIIT exercises are exactly what they sound like: bursts of intense effort at a fairly high heart rate followed by short rest periods, then repeated. The workouts tend to be short and spicy, with some studies showing they can accelerate fat burning, improve heart rate variability more quickly than moderate steady state cardio, and improve overall cardiometabolic health markers in women.
There’s no question HIIT exercises work your heart, but it’s fair to be curious about whether they’re appropriate during midlife, especially since there’s not a great deal of research about HIIT’s effectiveness for women going through menopause. The intensity can be taxing on your body and some HIIT workouts may involve movements (or accessories, like weights) that take practice to perform at speed without risking injury. Paired with conditions that can come along with aging and/or menopause, like decreased muscle mass and bone density, poor sleep, thyroid disorders, joint issues, high blood pressure, or existing heart disease, HIIT might not be a suitable type of cardio for everyone, particularly those new to exercise or picking it up again after a long break.
If you’re regularly going to HIIT classes, working out without getting injured or experiencing extreme fatigue, adequately fueling and recovering, and feeling pretty good, don’t let us discourage you from your workout of choice! And don’t be afraid to modify your workouts if you need a change; there are many activities you can do in a HIIT format, and you can experiment with different interval lengths to adjust the intensity of your routine.
How to start new heart-healthy exercise routines and move more
If you’re not in the habit of regular cardio exercise, the Physical Activity Guidelines for Americans’ recommendation (supported by the American Heart Association) of 150 minutes of moderate-intensity exercise or 75 minutes of vigorous-intensity exercise per week, plus at least 2 days of strength training, can sound incredibly daunting. Then again, so does heart disease! Even small changes to get more movement into your routine can have positive effects on your heart health, and building momentum once you’ve gotten started is sometimes easier than taking the first steps.
Our advice?
Start with what feels manageable. Don’t write off walking and lower-impact activities if you’re easing into an exercise routine—just focus on moving more at first. That can even include gardening and yard work, so if you’re not sure what kind of workouts you’d like to try yet, you can work toward meeting your weekly movement goal by raking leaves, mowing the lawn, or briskly weeding the flowerbeds.
Pause to appreciate the movement you do get and what it’s doing for you. Next time the elevator’s out at work and you have to take the stairs with a messenger bag in one hand and a full 64 oz water bottle in the other (‘cause you’re hydrating your way through menopause like a pro), take a second to appreciate it as, say, cardio in the wild. Reflecting on the positive effects of your daily activities can make you want to look for even more opportunities to move, and it’s nice to remember that you don’t always need to suit up in workout gear to get your heart rate up and work those large muscle groups.
Lean on your team, whether that’s friends who are willing to try a new workout class with you, a doctor or Registered Dietitian Nutritionist who can give you tailored fitness and nutritional advice for menopause, or family members cheering you on for the changes you’re making.
Have more snacks—exercise snacks. “Exercise snacks,” short bursts of heart-pumping activity, aren’t a particularly new concept, but they’re one more way to boost your baseline activity level even on days when you don’t have the time or energy for a workout. There’s plenty of research linking prolonged, uninterrupted periods of sitting to increased risks of heart disease and Type 2 diabetes, but there are things you can do to counteract the effects of sitting too much (even with a desk job!). You might rally a coworker to join you for a walking meeting, or set a timer to remind yourself to get up and move every hour. If you work from home or have a lighthearted workplace, make it fun—a dance break in the kitchen while you heat up your lunch gets the blood moving and is great for morale. The point is not to obsess about how active you are, but to find little ways to break up sedentary periods throughout your day.
Know what motivates you. You don’t have to be an athlete or absolutely love to exercise, but finding your core motivation can go a long way toward making it a regular part of your life. Maybe you’re a data-driven person who likes to track progress over time, or you thrive on routine. Maybe you enjoy setting and reaching goals or are inspired by learning the science behind what exercise does for your body. Maybe you’re feeling feisty and want to live long enough to see true healthcare parity for women—pretty good reason to exercise, if you ask us.
If you’re ready to find your reason, book an appointment with one of our Registered Dietitian Nutritionists for personalized, evidence-based guidance about maintaining a heart-healthy lifestyle through menopause.
