Why You Need Muscle More Than Cardio Now
Day 17 of the 30-day Perimenopause Series.
The Woman Who Is Doing Everything Right
She is forty-seven and she is not sedentary. She walks the dog every morning. She takes a spin class three times a week and a yoga class on Sundays. She eats less than she did at thirty-five. And over the past two years her body has changed in ways that none of that seems to touch — softer where she used to be firm, thicker through the middle, tired in a way that sleep does not fix, and weaker in small humiliating ways she does not say out loud. The suitcase into the overhead bin. The bag of dog food. Getting up off the floor.
Her instinct — because it is what every woman of our generation was taught — is to add more cardio. Another class. A longer walk. Eat a little less. And that instinct, applied faithfully for the next five years, will make the exact problem she is trying to solve somewhat worse.
You do not need more cardio. You need muscle. Lifting heavy three times a week protects your bones, your metabolism, and your mind.
What You Are Actually Losing
Adults begin losing muscle mass somewhere after thirty, on the order of three to eight percent per decade, and the rate steepens with age. That is the general curve, and it is the one most people have vaguely heard about. What is far less discussed is that in women the curve has a hinge in it, and the hinge sits in the menopause transition — the same window that, as yesterday's post described, is when bone loss accelerates. Lean mass declines and fat mass redistributes toward the abdomen on a hormonal schedule, not simply a chronological one.
There is a mechanism underneath that. Skeletal muscle carries estrogen receptors, and estrogen supports the satellite cells that repair and rebuild muscle fibers after they are stressed. As estrogen falls and fluctuates, repair becomes less efficient and muscle becomes what researchers call anabolically resistant — it takes a bigger stimulus, and more protein, to produce the same building response you used to get for free.
Read that sentence again, because it is the whole post in miniature. The work still works. It just costs more now. A woman doing the same amount she has always done is not holding steady — she is quietly falling behind, because the price went up and nobody told her.
Muscle Is Not Decoration. It Is an Organ.
Most women were sold muscle as an aesthetic — tone, definition, arms in a sleeveless dress. That framing is why it gets dropped first when life gets busy. So let me reframe it in the terms I actually think in.
Skeletal muscle is the body's largest site for clearing glucose out of the bloodstream after you eat. The great majority of insulin-stimulated glucose disposal happens there. When muscle mass falls, that storage capacity falls with it, and the same meal now asks more of your pancreas than it did a decade ago. This is a substantial part of what Day 14 was describing — the midlife middle is not only a cortisol story, it is a muscle story.
Muscle is also metabolically active tissue at rest, so losing it lowers the floor of what you burn doing nothing — which is why cutting calories further, on a shrinking amount of muscle, is a strategy that works for a while and then stops working and then works against you.
And muscle is a secretory organ. Contracting muscle releases signaling molecules — myokines — that travel to the liver, to fat tissue, to the immune system, and to the brain. Muscle is not a passenger in your metabolism. It is one of the drivers, and it talks to your head.
Finally, muscle is what pulls on bone. Bone maintains the density it is asked to carry, and the thing doing most of the asking is muscular tension. The bone conversation and the muscle conversation are the same conversation held from two ends.
Why Cardio Cannot Do This Job
I want to be careful here, because this is where the internet gets loud and wrong. Cardiovascular exercise is genuinely good for you. Aerobic fitness is one of the strongest predictors of how long and how well people live. Walking is good for your mood, your blood pressure, your blood sugar, your sleep, and your head. Nothing in this post is permission to stop.
But cardio is the wrong tool for this particular job. It trains your heart and lungs; it does not meaningfully build the tissue you are losing, and it does not load your skeleton hard enough to make bone respond. Two women can have identical step counts and completely different amounts of muscle on them, and it is the muscle that determines what their bodies can do at seventy.
There is a version of this that actively backfires, and I see it often: a great deal of cardio, deliberately restricted eating, chronic under-recovery, and not enough protein. That combination raises cortisol against a body that is already handling more of it, and the weight that comes off comes off partly as muscle. She gets smaller and weaker at the same time, and calls it progress. Then it stalls, and she assumes the answer is more of what caused it.
The Psychiatric Piece
This is my lane, so I will spend a moment in it. Resistance training has been studied as a treatment for mood, not merely as general wellness advice. A meta-analysis published in JAMA Psychiatry in 2018 pooled dozens of randomized trials and found that resistance exercise training was associated with a significant reduction in depressive symptoms, including in people who were not clinically depressed at the start. Similar work has found reductions in anxiety symptoms. The effect did not appear to depend on how much strength participants gained, which is an interesting and somewhat humbling finding — the doing appears to matter, not only the outcome.
Mechanistically, exercise raises brain-derived neurotrophic factor, a protein involved in the growth and maintenance of neurons and in learning. Muscle-derived signaling molecules appear to participate in that conversation between body and brain. Strength work also improves insulin sensitivity and sleep quality, both of which sit underneath mood in ways that are easy to miss when you are only looking at neurotransmitters.
And there is something I would call clinical rather than biochemical, which I nevertheless take seriously. Perimenopause is a stretch of years in which a woman's body does things she did not consent to and cannot control. Strength training is one of the few arenas in that decade where the arrow points the other way — where she is measurably, undeniably better at something in March than she was in January. For a woman who has spent two years feeling betrayed by her own body, that is not a small psychological event. It is often the first evidence she has had in a long while that her body is still on her side.
None of that makes strength training a substitute for treatment when treatment is what is needed. It is an addition, and a good one.
What "Lifting Heavy" Actually Means
Heavy is relative to you, and it is nearly always heavier than a midlife woman has been told she is allowed to lift. Here is what the phrase means in practice.
A load where the last two or three repetitions are genuinely difficult and your form is the thing that limits you. If you could have done ten more, that set was a warm-up. Three-pound dumbbells for fifteen reps in front of a mirror are not a stimulus for a woman who carries groceries.
Two to three sessions a week, on non-consecutive days. Three is better than two; two done consistently for a year beats three abandoned in February.
Compound movements that use large amounts of muscle at once — a squat pattern, a hinge, a push, a pull, and a carry. Five patterns, thirty to forty-five minutes, done properly. You do not need a two-hour bodybuilding split.
Progression, which is the actual active ingredient. A little more weight, or a rep more, over weeks. A workout that never changes stops being training and becomes a habit.
Rest between sets — a full minute or two. Strength work is not supposed to leave you gasping; that is a different workout with different goals.
Coaching at the start, if it is at all possible. A handful of sessions with someone who can teach you to hinge and squat under load is one of the highest-return purchases available to a woman in this decade — and it is the difference between lifting heavy and getting hurt.
Keep your walking and keep some conditioning. This is not lifting instead of cardio. It is lifting first, and cardio around it.
Protein Is the Other Half of the Prescription
Training is the signal. Protein is the material. Send the signal without the material and you get soreness without much building.
The intake associated with preserving lean mass in older and midlife adults sits well above the minimum recommended dietary allowance — commonly discussed in the range of roughly 1.2 to 1.6 grams per kilogram of body weight per day for active adults, and researchers in this area increasingly argue the higher end for women in this stage. Just as important is distribution: because of anabolic resistance, a meaningful dose of protein at each meal appears to matter more than the same total eaten mostly at dinner. A typical midlife woman's day — coffee, a handful of almonds, a salad, and then most of her protein at eight in the evening — is close to the worst possible arrangement for muscle.
Protein needs are individual, and they are different if you have kidney disease or another condition that changes them, which is a conversation to have with the clinician who knows your labs. But most of the women I see are not close to a number anyone would consider generous, and they have never once counted it.
Whole-Person Steps
Put two strength sessions on the calendar this week as appointments with times, not as intentions. Thirty minutes each is enough to start.
Learn five patterns rather than fifty exercises — squat, hinge, push, pull, carry — and get taught them by someone qualified if you possibly can.
Write down what you lift. Progression is the mechanism, and you cannot progress a number you are not tracking.
Count your protein honestly for three days before changing anything. Then put a real serving at breakfast, which is the meal where most women lose the day.
Stop using the scale as your only instrument. Muscle gained and fat lost can leave the number unchanged while everything that matters has improved. Notice what you can carry, how you get off the floor, how you sleep, how you feel at four in the afternoon.
If you are losing weight for any reason, including on a GLP-1 medication, build strength training and adequate protein into the plan from the first week rather than trying to recover muscle afterward.
If you have a heart, joint, or blood pressure condition, or you are returning after a long absence or an injury, get cleared and get coached. Start light and progress. Careful at the start is wisdom; careful forever is how muscle is lost.
Bring this up with your prescriber if you are being treated for depression or anxiety. Strength training belongs in a psychiatric plan, and it is rarely offered.
If You Are in Utah
At Integrative Mind Body Psychiatry, I treat women in hormonal transition with the whole picture in front of me — mood, sleep, hormones, nutrition, strength, and what you want your body to be able to do at seventy. Muscle belongs in a psychiatric conversation, because energy, mood, blood sugar, and self-trust all run through it. Telehealth for adults, adolescents, and women in hormonal transitions across Utah. Insurance accepted through Headway. Learn more at integrativemindbodypsychiatry.com.
For educational purposes only. Not a substitute for individualized medical advice, and not a recommendation for or against any exercise program, diet, medication, or supplement for any individual — those decisions belong to you and the clinician who examines you. Anyone with cardiac, musculoskeletal, or blood pressure concerns, or who is returning to exercise after a long absence, should be cleared before beginning resistance training. Findings on resistance exercise and depressive symptoms derive from a 2018 meta-analysis of randomized trials published in JAMA Psychiatry; protein intake ranges cited reflect general research in active and older adults and are not individualized targets.
Tomorrow: Day 18 — Palpitations, Dizziness, and the Weird Body Stuff Nobody Names.
Respectfully, and with real care,
Beth Makar, RN, Dual-MSN, PMHNP-BC
Comments