Whether you were an athlete or a not-the-workout type when you were younger, now appears to be the most crucial time of your life to work out. Exercise may be one of your best defenses against unwelcome changes that occur with menopause, including weight gain and belly fat. But exercise’s most significant impact isn’t a slimmer waistline or firmer arms. In fact, one of exercise’s greatest benefits may go unnoticed – the positive impact it has on your metabolic health.

“Often people think of exercise as only a way to burn calories for weight loss,” says Stasi Kasianchuk, a registered dietitian, exercise physiologist, and Gennev’s director of lifestyle care. “Then they give up on exercise if the number on the scale doesn't meet expectations. They don't realize the physiological benefits movement provides to the body even without the desired amount of weight loss.”

Exercise improves cell metabolism, blood vessel health, blood sugar control, and brain health, but you can’t easily see or measure these changes. Despite that, they offer long-term benefits for metabolic health, which can translate to better quality of life, fewer menopausal symptoms, and less weight gain.

What is metabolic health?

Metabolic health is the ability of the body to process and utilize energy by metabolizing macronutrients, such as carbohydrates, protein, and fat, and micronutrients, such as vitamins and minerals. “Essentially, the mitochondria, the powerhouses of every cell in the body, are working efficiently and effectively,” says Kasianchuk. When you’re metabolically healthy, your risk of developing chronic disease, such as heart disease, diabetes, and stroke decreases.  

There are five markers of optimal metabolic health for women and men:

  • Fasting blood sugar below 100 mg/dL
  • Triglycerides below 150 mg/dL
  • HDL (good) cholesterol above 40 mg/dL
  • Resting blood pressure below 130/85
  • Waist circumference under 35 inches for women and 40 inches for men

If your levels for any of these markers fall outside the listed range, we encourage you to take steps to improve your metabolic health. (About 88 percent of American adults have at least one of these risk factors.) Left untreated, things are likely to get worse as you transition into post-menopause. If your numbers are off for three or more of these markers, you have what’s known as metabolic syndrome. Research has found that metabolic syndrome increases a woman’s risk of heart disease six-fold and their risk of diabetes five-fold. It may even increase the risk of breast cancer.

Women who had gestational diabetes or preeclampsia when they were pregnant are also at a higher risk of metabolic problems as they get older. But these problems aren’t inevitable. Exercise and other lifestyle changes can protect your metabolic health.

Menopause and metabolic health

Menopause and the accompanying decline in estrogen appear to accelerate changes that contribute to poorer metabolic health and an increased risk of metabolic syndrome, heart disease, diabetes, dementia, and even cancer. Increases in belly fat, blood sugar, and cholesterol are common during menopause, along with declines in muscle mass, and affect metabolic health.

Typically, your metabolism is highly efficient. Your body breaks down carbohydrates into glucose (a simple sugar), a primary energy source for your body. In response to glucose in the bloodstream, your pancreas releases insulin, a hormone that signals cells to absorb the glucose. Mitochondria, the powerhouses of cells, process some of the glucose into energy that cells can use. Muscles and the liver store excess glucose as glycogen for later use. Even fat cells can store glucose as energy once it’s converted into triglycerides, a type of fat. When your body needs energy, whether to fuel a workout, your brain and other organs, or body processes like breathing or fighting an infection, it taps into these resources for glucose.

But when estrogen declines during menopause, this process is impacted. The body becomes less sensitive to insulin, so cells aren’t absorbing as much glucose from the bloodstream. In addition, muscle loss accelerates as you age, and the less muscle you have, the less assistance muscle cells can offer to remove glucose from the bloodstream. Higher blood glucose levels place more stress on the pancreas to secrete more insulin. Chronically high levels can lead to diabetes, requiring medications to bring glucose levels back within a normal range.  

Estrogen’s anti-inflammatory properties also protect women from heart disease. When it decreases, LDL cholesterol can rise, HDL cholesterol can drop, and blood vessels become more rigid, setting the stage for plaque formation, heart disease, and metabolic dysfunction. The changes in blood vessels may also contribute to rises in blood pressure, another marker of metabolic health. The increase in weight and particularly belly fat that often occurs during menopause is yet another impactor of metabolic health.

The good news: Being physically active can minimize or even counteract some of these negative changes.

How exercise protects metabolic health

Physical activity has a positive effect on metabolic health by mitigating some of the effects of menopause and directly impacting some of the markers of metabolic health.Regular exercise improves insulin sensitivity, so your body can manage glucose more effectively. It reduces bad LDL cholesterol and triglycerides and raises good HDL cholesterol, reducing your heart disease and stroke risk. Combined with a healthy diet, exercise can also help you lose weight or prevent weight gain. But even if the number on the scale isn’t budging, you improve your metabolic health every time you get up and move.  

Exercise also improves your body composition. Resistance training, in particular, is beneficial for preserving and building muscle mass. And as estrogen is waning, resistance training may provide an estrogen-mimicking effect to muscle cells to support metabolic health. All types of exercise help burn fat, especially the deep belly fat that contributes to many chronic diseases.

Being active also has a ripple effect on other behaviors that affect metabolic health. Research shows that women who are more active during menopause eat healthier. Exercise has also been found to improve sleep, which is vital to metabolic health.

The best exercise for metabolic health

“Any movement on a regular basis supports metabolic health,” says Kasianchuk. “That said, during the menopause transition, resistance training and high-intensity interval training offer more bang for the buck when it comes to metabolic health.”

Resistance or strength training counteracts the muscle loss that started in your 30s and accelerates during menopause. Declines in muscle cause metabolism to slow, which encourages weight gain. Resistance training can slow the loss and even rebuild muscle, which can help prevent weight gain and make weight loss easier. Muscle is also integral in utilizing glucose. Strength training using dumbbells, exercise machines, elastic resistance bands, or your own body weight provides resistance to challenge muscles so their mass increases. The more muscle cells you have, the better your body will be at managing blood glucose to improve your metabolic health and reduce your risk of diabetes.

High-intensity interval training involves alternating short bouts of vigorous aerobic exercise with recovery bouts of low- to moderate-intensity aerobic exercise. So instead of walking, running, riding a bike, or swimming at the same steady pace for your entire workout, you speed up and slow down. The repeated faster, higher intensity bouts raise your heart rate higher, boosting cardio fitness faster than one-speed workouts. It also trains your body to more effectively utilize fuel to produce energy and improves your body’s ability to regulate glucose, thus enhancing your metabolic health.

How to get started

You don’t have to spend hours at the gym or follow complicated routines to reap the benefits of exercise in midlife. “Simplicity and enjoyment within the movement you choose is key to building consistency,” says Kasianchuk. Here’s how to maximize exercise’s benefits.

Aim for 150 minutes of aerobic exercise a week. That’s 30 minutes five days a week or 21.5 minutes a day. And you can break it up any way you want during the day. For example, do 10 minutes first thing in the morning, another 10 at lunchtime, and 10 more after dinner. It all adds up and counts. Walking is an easy way to start exercising, and Gennev’s free walking programs can help you stick with it.

Do intervals on two or three days. Instead of doing steady-paced cardio every time you exercise, make some of those workouts intervals by speeding up and slowing down instead of maintaining one speed. This is part of the 150 minutes of aerobic exercise that you’re aiming to do. A simple way to start interval training is with 30-second speed or high-intensity intervals and 60-second slower, recovery intervals. Since interval workouts are higher intensity, you should do this type of workout on nonconsecutive days to give your body time to recover. You can still do moderate-intensity, steady pace exercise in between.

Add one, two, or three days of strength training. Aim to challenge the major muscles in your body. A single set of eight to 12 reps is enough to see improvements as long as you’re using a weight or resistance that makes your last few reps difficult to complete. Plan your strength workouts on nonconsecutive days to allow your muscles time to recover.

“You don't have to do it perfectly,” says Kasianchuk. “It's more important to just start. Do what you can and find what movement brings you joy. Any movement is better than none at all.” 

When you make some key lifestyle choices in menopause, it can have a lasting effect on your health as well as help to relieve symptoms. Gennev's virtual menopause clinic provides access to experts in menopause lifestyle change management. Our dietitians will help you optimize your health through evidence-based nutrition, fitness and mindfulness practices. Schedule a one-on-one virtual visit to get started with your personalized wellness plan.

The information on the Gennev site is never meant to replace the care of a qualified medical professional.  Hormonal shifts throughout menopause can prompt a lot of changes in your body, and simply assuming something is “just menopause” can leave you vulnerable to other possible causes. Always consult with your physician or schedule an appointment with one of Gennev's telemedicine doctors before beginning any new treatment or therapy.


Michele Stanten

June 14, 2023

Medically Reviewed By

Stasi Kasianchuck

Registered Dietitian Nutritionist, Exercise Physiologist, Director of Lifestyle Care

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