#378 ‒ Women's health and performance: how training, nutrition, and hormones interact across life stages | Abbie Smith-Ryan, Ph.D.
Dr. Abbie Smith-Ryan discusses women's exercise and nutrition across the lifespan, from early life to menopause. She covers tailoring training to the menstrual cycle, the impact of perimenopause on metabolism, and optimizing health with GLP-1s and hormone therapy.
Deep Dive Analysis
19 Topic Outline
Abbie Smith-Ryan's Background and Research Focus
Early-Life Exercise for Bone, Muscle, and Cardiorespiratory Health in Girls
Youth Sports: Specialization, Injury Prevention, and Spinal Health
Nutrition as Fuel for Young Female Athletes
Training and Recovery Across the Menstrual Cycle
Supplementation: Creatine, Omega-3s, Magnesium for Cycle Support
Perimenopause: Identifying Transition and Intervention Window
Exercise Programming for Busy Perimenopausal Women
Body Composition vs. Weight Loss and Realistic Fat Loss Targets
Preserving Muscle and Bone with GLP-1 Medications
Designing a Three-Hour-Per-Week Training Plan
Lessons from 20+ Years of Self-Tracking and Injury Prevention
Exercise and Nutrition During Pregnancy and Postpartum
Muscle Quality and Metabolic Flexibility Changes in Perimenopause/Menopause
Biggest Open Questions in Women's Health Research
Training Response Differences Between Men and Women
Exercise Advice for a 70-Year-Old Novice Woman
Misconceptions and Nuance in Women's Exercise and Nutrition
Benefits of Hormone Therapy and Lifestyle Interaction
4 Key Concepts
Osteoporosis as a childhood disease
This concept highlights that for women, bone density largely reaches its genetic ceiling around age 19. Therefore, building a strong bone foundation through exercise and proper nutrition in childhood and adolescence is critical for lifelong bone health, as subsequent years are primarily spent trying to maintain that peak.
Relative Energy Deficiency Syndrome (RED-S)
RED-S occurs when there's insufficient caloric intake relative to energy expenditure, often unintentionally. This can lead to symptoms like loss of the menstrual cycle, fatigue, and hormonal disruptions, which can be mistaken for other conditions like perimenopause, especially when compounded by factors like GLP-1 use.
Muscle Quality
Muscle quality refers to the functional capacity and health of muscle tissue, distinct from just its size. During perimenopause, women may experience significant changes in muscle quality, even if muscle size is maintained, due to factors like oxidative stress and inflammation, making it less efficient and functional.
Metabolic Flexibility
Metabolic flexibility is the body's ability to efficiently switch between using different fuel sources (carbohydrates and fats) based on availability and demand. In perimenopausal women, there can be a decrease in metabolic flexibility, particularly at moderate exercise intensities, impacting how the body utilizes energy.
12 Questions Answered
Early and varied exercise, often through play and diverse sports, builds a strong foundation for lifelong bone density, muscle development, and cardiorespiratory fitness. This early base makes it easier to maintain fitness over time and helps set bone density to its genetic ceiling.
Intense training and early specialization, particularly in sports like gymnastics or distance running, can delay the onset of menstruation, which negatively impacts bone health due to delayed estrogen. It can also contribute to spinal curves (like scoliosis) and repetitive strain injuries.
Nutrition should be viewed as fuel, prioritizing adequate caloric intake, especially with higher quality fats (e.g., whole milk, nuts, seeds) for caloric density. Regular eating is crucial, as exercise can blunt hunger, and carbohydrates are vital for active individuals.
While women can train and compete at any time, they often feel worse during the luteal phase (pre-menstruation) due to fatigue, bloating, and increased soreness. The follicular phase (post-period) is typically a low hormone phase where performance feels better, with greater carbohydrate oxidation.
To prepare for the luteal phase, strategies include prioritizing sleep, targeting inflammation with 2-3 grams of omega-3s, and supplementing with zinc and magnesium. Creatine (5-10g/day) can help with fluid retention by pulling water into cells, and caffeine may help with fatigue.
For most women, training intensity and volume should be periodized based on longer-term goals rather than monthly cycle fluctuations. It's important to give oneself grace if performance is not optimal during certain phases, understanding that hormonal changes can impact how one feels and recovers.
Perimenopause involves significant changes in metabolism, muscle size, muscle quality, bone health, and metabolic flexibility. This phase, typically in the late 30s to 50s, is a crucial time to leverage lifestyle changes to positively impact health span and mitigate these hormonally driven changes.
Focusing on body composition (reducing fat, maintaining/gaining muscle) provides a more accurate and healthier target than just weight loss. Weight can remain stable or even increase with positive body composition changes, and losing muscle can negatively impact long-term health.
To preserve muscle and bone while on GLP-1s, prioritize resistance training and high protein intake (130-150g/day, 30g per meal) to maintain lean mass and optimize amino acid availability. It's crucial to track body composition to ensure fat loss, not muscle loss.
No, it is never too late to start exercising. The human body can gain strength and muscle at any age, and starting a consistent exercise routine, even later in life, will significantly improve health span and quality of life.
Harmful misconceptions include black-and-white rules about needing to 'only do this' or 'not do that' (e.g., only lift heavy, only do HIIT). The reality is that any consistent exercise is beneficial, and program design should be adaptable to individual preferences, goals, and life phases, rather than being overly prescriptive.
While hormone therapy may not directly increase muscle, it can indirectly improve energy levels, recovery, and tolerance for higher training volumes. The combination of hormone therapy with consistent lifestyle behaviors (exercise and nutrition) is likely to yield better overall outcomes for managing symptoms and improving health, though more research is needed on specific interactions.
54 Actionable Insights
1. Start Exercise Early
Begin exercising early in life, treating it initially as play and gradually transitioning into various types of exercise, as this builds a strong foundation that makes it easier to maintain fitness throughout life.
2. Diversify Youth Sports
Encourage young girls to participate in a variety of different sports rather than specializing early, as this helps accelerate the development of diverse muscles and movement patterns.
3. Resistance Train for Injury Prevention
Incorporate total body resistance training (e.g., with bands, lightweights, plyometrics, or medicine balls) for young girls to prevent injuries, a crucial aspect often overlooked by coaches.
4. Prioritize Perimenopause Lifestyle Changes
Actively implement lifestyle behavior changes in exercise and nutrition during the perimenopause window (late 30s to 50s), as this period significantly impacts metabolism, muscle, bone, and fat distribution, with lifelong health benefits.
5. Focus on Body Recomposition, Not Just Weight
Aim for body recomposition (losing fat and gaining muscle) rather than solely focusing on weight loss, as weight may not change or even increase while overall health and body composition improve.
6. Prioritize Resistance Training with GLP-1 Agonists
If using GLP-1 agonists for weight loss, absolutely prioritize resistance training to maintain lean mass and improve muscle quality, as these drugs can accelerate muscle and bone loss if not managed proactively.
7. Maintain High Protein Intake with GLP-1 Agonists
When on GLP-1 agonists, target a high protein intake (e.g., 130-150 grams/day for a 150lb woman) and consistently consume protein (e.g., 30 grams evenly spaced throughout the day) to preserve muscle and optimize amino acid availability around workouts.
8. Track Menstrual Cycle for Empowerment
Monitor your bleeding patterns and hormonal changes (e.g., using at-home urine analyses) to understand what is normal for your body, identify when changes occur, and feel empowered to address any issues.
9. Adapt Recovery to Menstrual Cycle Phase
While women can train at any point in their menstrual cycle, be aware that performance and recovery may be impacted during certain phases (e.g., luteal phase), requiring more focus on recovery strategies and self-grace.
10. Utilize Omega-3s for Luteal Phase Inflammation
During the luteal phase, if experiencing severe inflammation or heightened anxiety/depression, consider increasing omega-3 intake (2-3 grams) to help down-regulate inflammation.
11. Supplement with Zinc and Magnesium
Consider supplementing with zinc and magnesium, particularly during the luteal phase, to assist with vasodilation, improve sleep, and support overall recovery.
12. Use Creatine for Fluid Management and Performance
Creatine (load with 20g/day for 5 days, then 5-10g/day maintenance) can help pull extracellular fluid into cells, potentially reducing bloating in the luteal phase and supporting performance.
13. Consider Caffeine for Luteal Phase Fatigue
Caffeine might be more effective in combating increased fatigue experienced during the luteal phase of the menstrual cycle.
14. Prioritize Consistent Protein Intake
Aim for adequate protein intake (around 1.6 g/kg or 1 g/lb of goal weight) consistently throughout the day, especially around workouts, to support muscle protein synthesis and recovery, particularly for aging muscle.
15. Eat Regularly to Maintain Amino Acid Levels
Avoid long gaps between meals without protein consumption to maintain a steady supply of amino acids in the bloodstream, which is crucial for muscle maintenance and overall metabolic health.
16. Get Regular Blood Work for Hormonal Changes
Starting in your 30s, get regular blood work (e.g., Day 5 FSH) to monitor hormonal changes as you approach perimenopause, providing individual baseline data for proactive health management.
17. Prioritize Consistency and Intensity (Limited Time)
For busy women with limited exercise time (e.g., 3 hours/week), prioritize consistency and intensity over high volume to achieve health benefits and improvements in cardiovascular fitness more quickly.
18. Integrate Exercise Snacks
Utilize ’exercise snacks’ – short periods of higher intensity training – to fit effective physical activity into busy schedules.
19. Prioritize Whole Body Resistance Training
For general midlife women, prioritize a few days a week of whole-body progressive resistance training (e.g., two 30-minute sessions at 60-80% of one-rep max, 6-8 reps, with 30-second rests between exercises).
20. Include Aerobic Exercise with HIIT
Alongside resistance training, incorporate two to three days of aerobic exercise, ensuring at least one (ideally two) high-intensity interval training (HIIT) sessions per week.
21. Structure HIIT Sessions Effectively
For HIIT, consider performing up to 10 sets of one minute on (at 90-110% of max effort, where you couldn’t sustain for 1:20) followed by one minute off, which can be completed in approximately 20 minutes total.
22. Set Realistic Weight Goals
When aiming for weight loss, set realistic goals based on body composition measurements (e.g., targeting a healthy body fat percentage) rather than arbitrary past weights that might necessitate unhealthy muscle loss.
23. Combine Calorie Deficit with Nutrient-Dense Foods
To lose fat, create a slight calorie deficit while prioritizing nutrient-dense foods such as fiber (for satiety), adequate protein, and complex carbohydrates.
24. Avoid Chronic Time Restriction
Be cautious with chronic time-restricted eating, as it can lower metabolism, negatively impact hunger hormones, and adversely affect protein synthesis and muscle in women, especially in midlife.
25. Eat Consistently for Leanness
To achieve and maintain leanness, prioritize eating more whole foods consistently throughout the day (e.g., 30 grams of protein, fiber, and vegetables evenly spaced) to stimulate metabolism and ensure sufficient macro/micronutrient intake.
26. Understand Personal Body Fat Set Point
Know your individual body fat set point, as going below it can increase your susceptibility to injuries like stress fractures, even if the percentage appears ’normal’ by general standards.
27. Address Under-Consumption Signs
Recognize signs of under-consumption, such as severe gastrointestinal distress or extended periods without eating, particularly in relation to training schedules.
28. Train for Birth as an Athletic Event
During pregnancy, treat birth as an athletic event and train for it by exercising consistently, prioritizing resistance training (e.g., squats, lats) up until delivery, and slowly increasing calories for a slight surplus.
29. Resume Exercise Gradually Postpartum
After natural delivery, start walking within a couple of days and light resistance training within a couple of weeks, gradually returning to normal exercise routines.
30. Prioritize Plant-Based Proteins During Pregnancy
If experiencing aversions to animal proteins during pregnancy, prioritize plant-based proteins to ensure adequate nutritional intake for both mother and baby.
31. Address Postpartum GI Distress and Hydration
Be aware of potential postpartum gastrointestinal distress (e.g., lactose intolerance) and prioritize liquid foods, protein shakes, omega-3, and creatine to aid recovery and maintain nutrition while nursing and managing sleep deprivation.
32. Prioritize Pregnancy Nutrition for Baby’s Development
Make nutrition a key priority during pregnancy, focusing on a variety of fruits and vegetables to support the baby’s neural development and gut health.
33. Exercise During Pregnancy
Exercise is crucial during pregnancy; if you haven’t exercised before, start with something, and if you’ve always exercised, continue, as current guidance supports this for better maternal and fetal outcomes.
34. Counter Sarcopenia with Resistance Training
Engage in consistent resistance training to combat sarcopenia, which disproportionately affects women, especially as muscle quality changes significantly during perimenopause.
35. Maintain Muscle Quality in Perimenopause
Focus on lifestyle changes, including exercise and nutrition, during perimenopause to maintain muscle size and quality, as this period is critical for preventing significant declines in muscle quality.
36. Exercise for Metabolic Flexibility
Regular exercise, particularly high-intensity interval training (HIIT), enhances metabolic flexibility, stimulating fat oxidation regardless of hormonal status or age.
37. Optimize Protein for Metabolic Flexibility
Consuming protein around training (as opposed to primarily carbohydrates) or opting for lower glycemic index carbohydrates can help optimize metabolic flexibility post-high-intensity workouts.
38. Combine Hormones and Lifestyle for Best Outcomes
If using hormone replacement therapy, combine it with lifestyle behaviors (exercise and nutrition) for synergistic benefits in relieving symptoms and improving overall health, as lifestyle changes are still crucial.
39. Exercise is Better Than Nothing
Avoid rigid, black-and-white thinking about exercise; doing any form of physical activity is always better than doing nothing, and women should be empowered to engage in activities they enjoy.
40. Apply Strength & Conditioning Principles
Leverage traditional strength and conditioning research (even if primarily based on male subjects) for women, as the female muscle responds similarly, with modifications for recovery, rest, or joint pain as needed.
41. Prioritize Power Training for Fall Prevention
Actively work to preserve power (e.g., through jumping, bouncing, or controlled explosive movements) at all ages, as it is crucial for regaining footing and preventing falls in daily life.
42. Address Joint Pain with Hormones
For perimenopausal and menopausal women experiencing joint pain, consider if hormone replacement therapy could be a solution, as pain can significantly impede the ability to train effectively.
43. It’s Never Too Late to Start Exercising
Regardless of age (e.g., 65-70 years old), it is never too late to begin an exercise routine; you can gain strength and muscle at any age, thereby taking control of your health span.
44. Hire a Personal Trainer for Older Adults
For older adults new to exercise, it is highly recommended to hire a personal trainer (seeking referrals and checking credentials) to teach proper form, safe progression, and build confidence.
45. Start Older Adults with Total Body Resistance
For older adults, begin with a total body resistance program focusing on glute activation, push-pull exercises for all major muscle groups, and calf work to improve stability and prevent falls.
46. Use Machines Initially for Older Adults
Start older adults with machine-based, controlled resistance training rather than free weights, and incorporate resistance bands for neuromuscular activation (e.g., glutes) to build foundational strength.
47. Aim for 3 Days/Week Resistance Training (Older Adults)
For older adults, aim for three days a week of resistance training (e.g., every other day to allow for recovery) and some form of movement or aerobic exercise on most other days.
48. Introduce Carries and Grip Strength Gradually
For older adults, once able to perform exercises deloaded safely, introduce low-resistance carries (e.g., with dumbbells) and grip strength exercises, using submaximal efforts (e.g., 1 minute on, 1 minute off).
49. Exercise for Mental Health
Recognize the profound positive impact of both resistance and aerobic exercise on mental health, including reducing anxiety, depression, and brain fog, and improving focus.
50. Be Wary of Black-and-White Rules
Be cautious of rigid, black-and-white rules about exercise or nutrition (e.g., ‘only do this,’ ’never do that’), as individual needs vary, and consistency is often more important than strict adherence to a single method.
51. Understand Supplement Limitations
While supplements like creatine can be helpful, understand they are not magical solutions and should not be the first priority, especially for midlife women; prioritize effective training and nutrition first.
52. Advocate for Your Health
Women should actively advocate for themselves, be informed about what symptoms are hormone-driven versus what can be overcome with lifestyle changes, and seek medical help when needed, especially regarding hormone therapy, without accepting invalidation.
53. Push Harder if Training Volume is Low
For individuals with limited training volume (e.g., a couple of hours a week), understand that workouts need to be pushed harder (closer to failure for strength, higher intensity for cardio) to achieve significant progress beyond initial adaptations.
54. Understand Zone Training Nuance
Be aware that many people mistakenly perform ‘zone two’ workouts at too low an intensity (zone one), resulting in minimal training effect; understand the precise intensity required for effective training versus recovery.
9 Key Quotes
Osteoporosis is a childhood disease.
Peter Atiyah
Exercise is the best medicine starting young.
Abbie Smith-Ryan
Menses is a really good indicator of overall health and wellbeing.
Abbie Smith-Ryan
If you want to live healthier longer, you need to put the time in now and it will ultimately help you be a better mom, wife, et cetera.
Abbie Smith-Ryan
If a person only has 150 minutes a week to exercise, you have to prioritize intensity because you're not really getting enough volume to maximize conditioning.
Peter Atiyah
Birth is one of the most athletic events you'll do and you should train for it.
Abbie Smith-Ryan
If you or I were to go and walk down the street right now and we were so lost in discussion that we lost our footing as we stepped off a curb, it wouldn't phase either of us... When a 65 or 70 year old person steps off that curb and misplaces their footing, they are very likely to land on their face because they don't have power.
Peter Atiyah
You can gain strength and muscle at any age.
Abbie Smith-Ryan
Exercise does not have to be overwhelming, neither does nutrition. And I think so much of it now is, oh, you have to do it this way, or this is the only way that'll work now that you're in midlife, or you have to change your training. When in reality, most of us are just trying to get something in and do it consistently.
Abbie Smith-Ryan
2 Protocols
Time-Efficient Resistance Training for Busy Women
Abbie Smith-Ryan- Perform whole-body progressive resistance training.
- Aim for 6-8 repetitions per set (60-80% of one-rep max).
- Rest for 30 seconds between exercises.
- Rest for 2 minutes between sets.
- Complete the workout in 30 minutes, 2-3 days per week.
High-Intensity Interval Training (HIIT) Protocol
Abbie Smith-Ryan- Perform 10 sets (can start with 6 sets).
- Each 'on' interval is 1 minute at 90-110% of max intensity or max heart rate (an intensity you couldn't sustain for 1 minute 20 seconds).
- Each 'off' interval is 1 minute of rest.
- Total work time is 10 minutes, with a total session time of ~20 minutes (excluding warm-up/cool-down).