Exercise for Peri-menopause and menopause stigma

One of my female 51-year-old clients encountered the health challenges at the age of 40, when she was diagnosed with early onset menopause. Since then, she has experienced a range of symptoms, including weight gain, persistent skin rashes, sleep disturbances, depression, and panic attacks. These challenges have impacted her overall wellbeing, daily energy levels, and quality of life.

As we know, staying generally active and participating in an individualised exercise program can help with both symptom management of menopause and long-term health outcomes. The reduction in oestrogen levels are responsible for many of the symptoms associated with menopause, and exercise can help with improved symptom management. Exercise can also help improve long-term health outcomes such as maintaining bone mineral density, reducing chronic neuromuscular condition, reducing cardiovascular risk factors and maintaining a healthy weight range.

Her current general goals focus on establishing a sustainable exercise routine that supports her physical and mental health. Her key priorities include losing weight, managing chronic knee and back pain, and adopting healthier eating habits. As part of her personal training journey, Nicola is also working towards building long-term behaviour change around food choices, with the aim of improving both her physical health and emotional resilience.

According to our initial fitness assessment, our exercise program will focus on improving joint mobility especially shoulder, core strength, balance, posture and functional movement to support her weight loss and pain reduction goals. Using SMART goal principles, her specific goal is to improve her shoulder flexibility to 175 degrees, increase her left knee flexion to 70 degrees, and enhance core strength by progressing from 11 sit-ups in 28 seconds to 15 reps, and from a 1-minute plank to 90 seconds within 12 weeks. To improve balance and lower body strength, the program will also target increasing her single-leg bridge hold to 10 seconds per side and achieving 20 seconds on the right leg balance test. These goals are measurable, achievable, relevant to her pain management and mobility needs, and will be tracked through regular re-assessments.

Mobility and stability workouts are essential based on the fitness assessment result:

World great stretching- 

The modified WGS is applied during her warm up to manage the muscles and joint stiffness especially the hip and low back. We did not practise the second half as trunk rotation due to shoulder weight bearing in a risk and unsterilized. It opens up tight hips, especially the front (hip flexors) and inner thigh (adductors).

Child pause- 

It  is a great choice for her, especially if she has hip stiffness, shoulder tightness, and mild low back pain. This mobility exercise can gently stretch the hips, lower back, and shoulders, while also promoting relaxation. It’s low-impact and adaptable, so it’s perfect for clients with mild pain or limited flexibility. We also applied foam roller underneath of the arm when hands moveing forward that give her more range of motion for shoulder retraction and further improve the thoracic spine mobility. 

Elastic band shoulder external rotation “no money”-

 It's a great choice for improving shoulder external rotation, especially if she has shoulder pain and stiffness, particularly from poor posture, rotator cuff weakness, or upper cross syndrome. This exercise activates the rotator cuff (especially infraspinatus & teres minor) . It reinforces scapular stability, which is often missing in people with shoulder issues.

Unsupported shoulder external rotation

Recommending Standing unsupported Shoulder External Rotation using an elastic band (like a resistance band ) is a great idea for a client with shoulder pain and stiffness — as long as her pain is mild and not acute or severe. This exercise can help improve rotator cuff strength (especially the infraspinatus and teres minor), enhance shoulder stability, and improve external rotation range of motion, which is often limited in people with shoulder stiffness or upper cross posture.

Pelvic floor and core workouts 

• Pilate ring hip bridge 

Pilates Ring Hip Bridge (or Hip Bridge with a Pilates Ring) is a fantastic exercise that targets the pelvic floor, core, and glutes all at once. Adding the Pilates ring gives extra inner thigh (adductor) engagement, which indirectly activates the pelvic floor because the inner thighs and pelvic floor work closely together in functional movement. Besides, it will certainly prevent low back hyperextension. 

• Bird dog 

This exercise is to work on the stability in both trunk and shoulders ( when the single arm and single leg are supported on the floor. For the core muscles especially transverse abdominis (deep core stabilizer) and multifidus (deep spinal stabilizer). The pelvic floor is also part of the deep core system

• Pilate ring hold / 50 shoulder swings 

This exercise helps cue the client to engage the deep core and pelvic floor muscles by adding a pilate ring between two leg above the knee. Trunk Flexion activates the rectus abdominis (front abdominal muscle), and if done correctly (especially if it's slow and controlled), it will also recruit the deep core muscles, including the transverse abdominis. Shoulder Swing (if controlled): Adding upper body movement like a controlled arm swing or reach can challenge the core’s ability to stabilize against the arm movement, making this a more functional, whole-body movement. This can also activate some of the obliques,

Muscles strength training 

• Landmine shoulder press

The Landmine press involves pressing at a slightly forward angle instead of going straight overhead. This allows for a natural movement pattern, reducing stress on the shoulder joint and allowing the shoulder to move in a more comfortable range of motion. This can be especially helpful for individuals with limited overhead shoulder mobility or shoulder pain. Because of the supported nature of the Landmine setup (the barbell is fixed at the base and moves in a controlled arc), the movement is less jarring on the shoulder joint compared to traditional overhead pressing. 

• Landmine bent over row 

The Landmine row involves a more neutral grip compared to other rows (like barbell or dumbbell rows), This reduces the strain on the shoulder joint, especially for people with shoulder stiffness or pain, as it avoids excessive external rotation or overextension of the shoulder. Besides, it focuses more on the upper back (rhomboids, traps, and lats) and the posterior deltoid rather than requiring as much rotator cuff activation. The motion is more arm-driven, reducing stress on the rotator cuff muscles. On the other hand, she can focus on posture and controlled movement, making it easier to maintain form without overcompensating or arching the back.

The evidence supported other specific exercise outcome 

A Systematic Review and Meta-Analysis" point out how practices like yoga, tai chi, and qigong impact the physical and psychological well-being of women going through menopause. The authors argue that mind-body exercises can significantly reduce menopausal symptoms, including anxiety, depression, sleep disturbances, and even physical discomfort like joint pain and hot flashes. By integrating movement, breathing techniques, and mindfulness, these exercises help regulate the nervous system and promote hormonal balance, leading to improved overall health and quality of life, especially the psychological perspectives.

However, the study emphasizes that traditional aerobic or resistance training combined with mind-body exercises offer a holistic approach that supports emotional and mental well-being. The authors highlight evidence suggesting that these practices can also improve flexibility, balance, and cardiovascular health while also leading to relaxation and reducing stress. The meta-analysis concludes that incorporating mind-body exercises into daily routines could be an effective, low-impact strategy for managing menopausal symptoms. 

Reference : 

1. Xu, H., & Liu, J. (2024). Effects of mind-body exercise on perimenopausal and postmenopausal women: A systematic review and meta-analysis. ,The Journal of The Menopause Society,  Volume( 31 ), Page 457-467.

2.  Exercise is Medicine Australia. (2022). Menopause & exercise. Exercise is Medicine Australia. citeturn0search0