Exercise in Menopause

Oestrogen loss accelerates bone loss and raises the risk of osteoporosis and fracture, and exercise is one of the few things that can help maintain bone strength. The most effective combination is resistance training on 2 to 3 days a week at a moderate-to-high intensity, together with regular weight-bearing impact activity, such as jumping, skipping, jogging or hopping, at a level appropriate to the individual. Rather than a single universal target, the amount and intensity of impact are matched to the person's bone health, fitness and confidence. For selected, screened individuals, supervised progressive resistance and impact training can improve bone strength, including in some women with low bone mass, while osteoporosis, previous fractures, balance problems and other conditions change what is appropriate. Everyday bending is generally safe, but women with osteoporosis or at risk of vertebral fracture may be advised to avoid uncontrolled, repetitive, end-range or heavily loaded spinal flexion. For women with established osteoporosis or previous spinal fractures, activity is individualised with physiotherapy guidance, particularly during fracture recovery. Exercise complements rather than replaces bone-protective measures such as adequate calcium and vitamin D and, where clinically indicated, menopausal hormone therapy.

Ageing and menopause together are associated with a rise in cardiovascular risk and a shift towards more abdominal fat and loss of muscle. Regular aerobic activity across the week, combined with resistance training, helps counter this by improving blood pressure, glucose and lipids, preserving lean muscle and supporting a healthy body composition. Strength training is particularly valuable here, since maintaining muscle supports metabolism, function and independence into later life.

Many women experience low mood, anxiety and disrupted sleep around menopause, and regular activity can help with all three, reducing depressive and anxiety symptoms and improving sleep quality. The picture for hot flushes and night sweats specifically is less clear, and activity should not be oversold as a treatment for vasomotor symptoms, but the broad gains in mood, sleep, energy and confidence are reason enough to be active. As ever, enjoyable, sustainable activity that a woman can fit into her life is what delivers these benefits.

• •Protecting bone is the standout exercise priority through and after menopause.
• •Combine resistance training on 2 to 3 days a week with regular weight-bearing impact activity.
• •Match the amount and intensity of impact to the individual, not a single fixed target.
• •Supervised progressive resistance and impact can help selected, screened women, including some with low bone mass.
• •Those at risk of vertebral fracture avoid heavily loaded or repetitive end-range spinal flexion; everyday bending is generally safe.
• •Activity can help mood and sleep, though its effect on hot flushes is less certain.