Menopause and the Merits of Physical Activity
by Susan Ingraham, BCRPA-certified Fitness Instructor
The headline to the article reads, “Restoring Trust in Menopause Management: Menopause hormone therapy is not a panacea, and physical activity remains a critical intervention.” Dr. Louise Tulloh, a sports medicine doctor at North Sydney Orthopaedic and Sports Medicine Centre in New South Wales, Australia, wrote the article.
This June 2025 British Journal of Sports Medicine article by Louise Tulloh begins with this comment: “This editorial highlights the effects of menopause on the musculoskeletal system and the critical role physical activity can play in fostering musculoskeletal health and well-being during and after menopause.”
After discussing the more traditional treatments for menopause, including (of course) hormone replacement therapy, the article has a section titled “Physical Activity as Medicine.”
“Beyond symptom control, menopause significantly alters long-term health trajectories.” There are increased cardiovascular and cardiometabolic risk factors once menopause occurs, including hypertension and insulin resistance. Bone loss accelerates, increasing fracture risk, and dementia becomes more common.
Given these broad systemic effects, physical activity emerges as a critical, non-pharmacological intervention with multi-system benefits:
- Bone health: Resistance and impact training enhance or preserve Bone Mineral Density (BMD) in postmenopausal women, even those with osteopenia or osteoporosis. Balance training can reduce falls risk.
- Muscle strength and health: Progressive resistance training mitigates sarcopenia (loss of muscle tissue as a part of aging) and improves functional outcomes far beyond what pharmacologic interventions can achieve.
- Metabolic and cognitive health: Exercise improves lipid profiles and insulin sensitivity and has potential neuroprotective effects.
- Psychological well-being: Physical activity alleviates mood disturbances and sleep dysfunction and helps manage midlife weight gain.
The article goes on to say that “Exercise prescriptions for midlife women should be targeted, progressive and sustainable. While general cardiovascular recommendations remain relevant, emphasis could shift towards high-load resistance training complemented by flexibility and balance work. Clinicians must also be aware of potential barriers: injury risk, such as tendinopathy, may rise during midlife; intense aerobic activity can transiently worsen vasomotor symptoms and the traditional emphasis on ‘cardio for weight loss’ should be rebalanced towards strength training for musculoskeletal health and metabolic benefits.”
“Menopause,” the author states, “represents a critical ‘window of opportunity’ for risk modification. Routine screening for cardiovascular risk factors, bone density and cognitive health should become standard practice for women in their 40s and early 50s. Health professionals must actively dispel myths, communicate realistic expectations for interventions like MHT (Menopausal Hormone Therapy) and promote evidence-based lifestyle strategies such as physical activity.”
The article sums up with these two paragraphs:
Menopause is not merely a biological milestone but a critical turning point for women’s long-term health. As sport and exercise medicine clinicians, our role extends beyond symptom management to advocacy, correcting misinformation, rebuilding trust, setting realistic treatment expectations and promoting strategies such as resistance training and risk factor modification while respecting the intersection between hormonal change and ageing.
We should take the opportunity during midlife health assessment to include exercise counselling that evaluates resistance training and re-evaluates outdated cardio-only-focused paradigms.