Ep. 321 Muscle, Bone & Joint Health in Menopause with Debra Atkinson

I am thrilled to have my friend and colleague, Debra Atkinson, back on the show today. She was with me before for Episode 165, in August of 2021, which became one of the most sought-after episodes of the year. 

Debra is a hormone-balancing exercise coach, a fitness expert, and an influential figure who has guided more than 275,000 women through transforming their second halves with newfound vitality and energy. She is also an accomplished author, the host of Flipping 50 TV, and a TEDx speaker.

In our conversation today, we delve into the physiological changes during perimenopause and menopause that impact weight training and muscle development, and we explore how to shift into the second stage of life as an endurance athlete while promoting recovery. We discuss the importance of strength training during perimenopause and menopause and get into the role of volume, movements, zone 2 training, flexibility, and HiT. We also discuss biohacking, explain how hormone replacement therapy impacts muscle and bone health, and Debra shares her favorite supplements.

“We are losing thirty percent of muscle mass from early to late stages of perimenopause.”

– Debra Atkinson

IN THIS EPISODE YOU WILL LEARN:

• The physiologic changes that impact muscle health during perimenopause and menopause
• The challenges of transitioning from an endurance athlete to a menopausal women
• How Debra struggled with hormonal imbalances and inflammation during menopause
• Some common exercise mistakes during perimenopause and menopause
• Why recovery time between weight training sessions is essential
• The importance of breathing and pelvic floor exercises 
• The benefits of HiT training for women in midlife
• At which times during the menstrual cycle should strength training be done?
• Strength training and bone health for post-menopausal women 
• The advantages of doing high-impact exercises on most days of the week
• The merits of vibration training and infrared saunas for recovery and wellness
• Supplements for muscle gain and recover

Connect with Cynthia Thurlow

• Follow on Twitter, Instagram & LinkedIn
• Check out Cynthia’s website
• Submit your questions to support@cynthiathurlow.com

Connect with Debra Atkinson

• On her website  
• On YouTube, Instagram, and Facebook

Previous Episode Mentioned

Ep. 165 – A Fresh Perspective On Menopause & Fitness: The Importance of Listening to Your Body with Debra Atkinson

Transcript

Cynthia Thurlow: [00:00:02] Welcome to Everyday Wellness podcast. I’m your host, Nurse Practitioner, Cynthia Thurlow. This podcast is designed to educate, empower, and inspire you to achieve your health and wellness goals. My goal and intent, is to provide you with the best content and conversations from leaders in the health and wellness industry each week and impact over a million lives.

[00:00:30] Today, I was joined again by my friend and colleague, Debra Atkinson. She last joined me on the podcast at Episode 165 in August of 2021, and it was one of the most downloaded podcasts of 2021. She is the hormone balancing exercise coach and fitness expert that has helped over 275,000 women flip their second half with vitality and energy. She is also an author and the host of Flipping50 TV as well as a TEDx speaker. Today, we spoke at length about some of the physiologic changes in perimenopause and menopause that impact weight training and building muscle, how to transition into the second stage of life as an endurance athlete and promote recovery, why there’s a need for the prioritization of strength training in perimenopause and menopause, the role of volume, movement, Zone 2 training, flexibility work, and HIIT, the impact of hormone replacement therapy on muscle and bone health, biohacking, and her favorite supplements. I know you will enjoy this conversation as much as I did recording it.

[00:01:39] Welcome back, Debra. So good to have you back on the podcast. I was just saying it’s hard to believe it’s been two years since our last podcast together. 

Debra Atkinson: [00:01:47] That’s crazy. We’re in a time warp though anyway, are we? With the pandemic, I wonder often what year is it? [laughs]

Cynthia Thurlow: [00:01:54] Yeah, yeah, it’s like, okay, there’s pre-pandemic and then post-pandemic and everything in between, it always all gets lumped together. But I would love to start the conversation today talking about a neuro kinesiologist, so this is right up your alley. What are some of the physiologic changes that are happening in our bodies that are impacting our muscle health as we are navigating perimenopause and menopause? And I know we’re really speaking to the loss of estrogen and how we become more catabolic. But I think this is something that is so important for younger women to understand, because you can proactively be doing more than I did at that stage because I didn’t know, [laughs] which is why I think it’s so important to talk about what’s happening in our muscles as we are aging.

Debra Atkinson: [00:02:42] Yeah. So many things, really. [Cynthia laughs] I mean, this is the entire hour and then some, probably, but yes. It starts, of course, with the drop in estrogen and it’s a roller coaster ride in perimenopause, it’s up and down and up and down, but trending down overall. And that means we are losing, I think, the 30% of muscle mass lost from early to late stage of perimenopause. That’s crazy. In post menopause, of course, there are significant losses there. But I think what we’re really seeing, we have to say, wait a minute. If we could prevent the ones happening in perimenopause, we wouldn’t see also these huge ones later. We would have slowed those down too. So, for these younger women, our daughters, our daughters-in-law, it’s exciting.

[00:03:34] I think we can be a little green with envy, thinking they’re going to transition through this so much more differently that in 50 years, the conversations they have, we probably can’t even imagine what will they be talking about. So, I think that’s the number one. When we lose estrogen, we all default. I think when we think muscle, we think testosterone, muscle, testosterone, da, da, da and maybe growth hormone. If you have a little bit more physiology, you realize that’s an important thing or that’s a conversation, at least, that the bros have about their need for that in muscle. But estrogen is a stimulator for muscle and for bone and for women that’s huge when we come to the edge of that cliff and we dive off and we lose that significant amount of stimulus, something else has to take its place.

[00:04:20] So, this is where the things I say or hear, and I’m sure you do too, it’s like nothing I do that used to work works anymore. Well, yes. You don’t have the hormones you had anymore, so it won’t, something else will, though good news. So, we have to change the way we lift weights, change the way we eat, prioritize our sleep at a time when prioritizing sleep gets tricky, and all those things have to fill in the gap for the estrogen loss. But then what happens when the estrogen comes down, the cortisol goes up. So, we’ve lost the stimulus for muscle, the anabolic support. So, we become much more anabolic resistant and have a hard time gaining muscle, which is what that means. But we also then have more cortisol in our system, which is catabolic. So that’s going to break us down.

[00:05:10] And that’s true for every woman. But for those of you who are Type A push through, you can count on me no matter what, no matter how exhausted I am. And you know you’re out there. You’re probably tuning in because you go the extra mile. [laughs] That’s we’re cutting ourselves off, we’re probably doing the work, but we’re stressing ourselves out, maybe by life is already really busy. I’m already really tired and overloaded, overwhelmed, and I’ve got to get this done. Like thinking of exercise still as a quota. So, driving ourselves deeper into the ground. And then with cortisol belly fat, but then the insulin resistance as well. We have less muscle, less muscle stimulus, we have less uptake of that blood sugar. So, for those of you who gained weight, it probably deposited in the belly.

[00:06:03] For those of you that didn’t gain weight, you may have had it relocate and take up residence in places where it wasn’t. And it’s maybe not feeling as attractive to you where the waistbands are a little bit tighter. All of those pieces really are physiology that occurs with menopause. And then that’s how we need to change the exercise, to make it different so that we can account for all these negative things happening.

Cynthia Thurlow: [00:06:31] Yeah, I think it’s so important to have a sense of what’s changing so that we understand that we ourselves have to flip the narrative, not just internally, how we’re talking to ourselves, but also understanding that when they talk about this pause, or as Dr. Louann Brizendine calls it, the upgrade, which I love that reframe, it’s helping us understand that in this pause time of our lives, gives us opportunities to change not just our mindset, but the way that we perceive how we treat our bodies. I think for a lot of us, myself included in my 20s and 30s, I was either in school, I was either a new practitioner, I was newly married, newly a parent. I mean, there were years where I think I was just on autopilot.

[00:07:16] And then heading into my 40s, I had to get reconnected with myself as an individual and get really honest, like, what’s working for me. Those really hardcore conditioning classes that are almost like CrossFit that I did for years and years and years. I was like, “My joints hurt, my wrist hurts, what am I doing to myself?” Why am I forcing myself to do something that perhaps is no longer in my best interest? I think with your background in particular, because you were an endurance athlete for a long period of time. And I know that many of my listeners are also endurance athletes. So, for you, what was that mindset shift like for you because you did Ironman competitions, really hardcore. 

Debra Atkinson: [00:07:58] Well, I think about it every day. I mean, seriously, it’s like I stand up and say, “Hi, my name is Debra. I’m a recovering endurance athlete.” And every day an addict, it does not go away. I thought about it this morning. I was like, “I still have that craving to maybe I’ll bring that bike back into the living room.” Honestly, it sat in the living room on my trainer since August 1 because I was like, “No, I’m going to do. I’m going to commit.” And then there’s an incongruency in here. I know this is not good. I know I need not to do and yet I still want to. 

[00:08:34] There is a part of me that gets fed by doing that, but I really need to substitute things like long hikes that are lower level that I can pace and I can turn around if I need to, but it’s just not serving me. And so, it took me being really slapped in the side of the head with, guess what? We’re going to cause you to gain 12 or 14 pounds of inflammation, essentially, is what it was. It wasn’t fat weight although I was definitely noticing relocation. I was training for the last Ironman I did, and this was in 2019 and been in this women’s hormones and fitness for 2013. So, I knew better. But I kept thinking, well, this won’t happen to me. 

Cynthia Thurlow: [00:09:22] You’re special.

[Laughter] 

Debra Atkinson: [00:09:24] Yes, well, we know this kind of special is the problem, but it did. And it happened to be a perfect storm. So, it was the June that I hit menopause literally. I had been exposed to mold the December 23rd before that, and mitigating all of that, and it wasn’t really mitigated. So, I was being exposed for about five and a half months, had to suddenly move to, I didn’t want to move, I loved where I was living. And so that relocation, all of it, and I was still in the midst of I’m committed to this. And if you know Ironman, that’s a $750 backpack if you don’t do it. I mean, you’re just going to go pick up a very expensive experience and nobody wants to do that. So, I went and I knew it was just going to be the worst of it. I had already done. I’d done all the damage. 

[00:10:17] Raceday was just like icing on the cake. It didn’t make it worse, just didn’t make it better. So, I couldn’t turn that around, knowing all the right things to do and how to get back on it. I had just gone too far, so I really had to reach for help. That’s when I had to start using HRT to help me more adaptogens, really, really cutting back, treating myself like someone with adrenal insufficiency, because I’m sure I did. I didn’t test, but I know that’s what was happening. So, yeah, I’ve taken one for the team, yo, don’t go there. [laughs] 

Cynthia Thurlow: [00:10:50] But I think it’s also very helpful to know that you are still this endurance athlete, a little bit of an adrenaline junkie I would imagine. And you are finding that you are navigating this second stage of your life and finding ways to stay stimulated, but not overdoing it in terms of the amount of stress that your body is undergoing with physical activity. I think this is a lesson for all of us, because there are things that I did in my 30s and early 40s that I mean, now I wouldn’t want to do. And it’s not that I’m incapable, it’s just the recovery would be so prolonged that I probably wouldn’t be particularly happy with myself.

[00:11:31] And so when we’re talking about these physiologic changes that are happening, these changes that are happening with hormones, understand the role of inflammation and oxidative stress, low estrogen, low progesterone, low testosterone in most instances. What are some of the common mistakes or common issues that you see women in perimenopause and menopause doing– with regard to physical activity beyond just the perhaps too intense exercise? I’m not trying to pick on any one person. I myself see people doing things that are not serving their best interests. If their desire is to change body composition, or if their desire is to get rid of some fluff, or if their desire is to be able to improve how much weight they’re using in the gym, etc. What are some of the common things that you feel like women are consistently or perhaps not realizing they’re doing that are undermining their best efforts? 

Debra Atkinson: [00:12:28] Well, number one, I think it’s prioritizing strength training. They’re not prioritizing strength training at all. And then if you could go deeper into that layer, it’s the how to do strength training. So, I think many of us grew up as young adults, as group fitness junkies, and feeling, well, if I’m going to BTS or body pump systems, I can check that box off. And when I wrote, You Still Got It, Girl, that was 2015. There was a study included in there that says body pump is not proven to enhance bone density. And the reason for that, I don’t think we could say collectively that’s everybody. It’s true for everybody. There may be individuals in that, but there wasn’t statistically on participants enough, because most of us are not picking up heavy enough weights.

[00:13:18] If you’ve got one instructor, you got 30 or you got 50 people in a classroom. Have you noticed, I know there are small studios now, but in a fitness center, they’re making the rooms bigger, and that means there’s more people and one pair of eyes maybe on you, it’s just not going to fly. So, they just care that you can see the instructor on stage and they’re putting them up on a pedestal. That’s what they’re doing. So, I think people don’t know to pick up heavy enough. They don’t know that they’re doing good form. So that, I think, is problematic. If you know yourself, you know how to manage your own technique, you know what good form and poor form is and you’ve got a sense of what weights to pick up, great.

[00:14:00] But if you don’t, a lot of times if you go into a group in the studio, if you don’t get there early, the weights you need may be gone, and so you’re just left to default. It may be too heavy, it may be too light. That’s not a good situation to be, but inevitably, that is what happens. The last person in the room is probably not doing anything close to what she needs to be doing. So, there’s that and then there’s, I think we get volume wrong. So, this is true. 

[00:14:26] So, the research says that women over 40 will do better with greater volume and yet there was a huge article with many studies referenced in Idea Fit magazine, and this was pre-pandemic, so it’s probably five or six years ago, but it sent alarms off for me because I was so worried all those trainers and fitness instructors reading that article were going to read more days per week, more sessions, more repetitions, more frequency, longer sessions. And that’s absolutely not how we want to get the volume. We want to get the volume by doing heavier weight and fewer repetitions. So, it’s actually a math equation. So, when we calculate volume and what have you done? It’s the reps, times the weight and the sets. So, it’s this times, this times, this.

[00:15:20] And if you do that with, say, a really heavy weight and five repetitions and five sets and then you compare that to, say, if you were doing 20 repetitions with a really lightweight and you were doing three sets, which is much more standard, do the math for yourself and think about that. The volume comes better with that heavy weight, fewer repetitions, and then we’re all going to have a stopping point. There’s a point where I couldn’t go heavier or I know I am going to start to have those achy joints. I’m not going to be recovering as much or I’m going to start to have more aches and pains and hopefully we don’t get there before we back off. But we also then need more recovery and we’re not taking that. And that’s where this volume thing gets tricky. 

[00:16:05] Volume of exercise, but also volume of recovery has increased. And that never means have a day where you are always exercising. It never means don’t take a day off. You should, I think formal exercise in your week, you should have at least one or two formal days of exercise off. And that’s where you’re playing golf, you’re going for a hike, you’re stand up paddleboarding, you’re being active, you’re moving your kids to college or home or you’re actively moving. The whole reason why we strength train in the first place in addition to wanting to look good, we can’t discount that. But I think we mistake the volume that we need and we mistake the value of strength training. But the real kind of strength training that we need, it’s not just checking the box anymore.

[00:16:50] I think that’s such an important distinction because I was reading that in one of your blogs. So, to make sure this is really clear, we want a certain amount of time off or recovery in between weight training. So that doesn’t mean that you lift heavy four days in a row. What you’re really advocating for is maybe we lift heavy on Monday, we lift heavy on Thursday, we’re physically active in between, and it’s more important that we’re doing heavier weights and fewer reps. So, meaning sometimes I have a trainer that I work with and sometimes it’ll just be two reps. Well, I always add a third or a fourth or a fifth, depending on what we’re doing, that you’re going to get more bang for your buck doing that. Now, where do things like Zone 2 work or flexibility work fit into your week when you are creating a program for your clients or you yourself personally? 

Debra Atkinson: [00:17:39] Yeah, great question. I think there’s so much controversy about Zone 2, it almost is like a buzzword right now. [laughs] So, let’s define it first of all. So, what I call is the bottom of a pyramid. If we’re looking at equilateral pyramid, the bottom or the base of it is Zone 1. That’s just our moving around all day. And unfortunately, for many of us, that pyramid doesn’t look like that anymore, because we sit so much. So, it’s like our Zone 2 is movement that we’re doing on purpose, because we sit so very much in leisure and in work that we are offsetting what they didn’t have to offset 50 years ago. We have to get back the activity when they didn’t have the obesity. We should look and take notes at what was their life like.

[00:18:24] I remember asking my mother if she ever had thought about exercising, and she was like, “Oh, habits.” No, she was like, “We did chores. That was our exercise. [Cynthia laughs] I don’t know what you’re talking about.” So, she was put off by that whole idea that we need to just move. And so, I think Zone 2, officially, when I’m testing somebody on a treadmill, is I’m looking for that point underneath where they go and have to take that first big deep breath consciously in. It’s like you’re just moving at an all-day pace. You could go for hours, and there’s real no limit. We’re not necessarily increasing your cortisol level by having you do this. In fact, I think we do the opposite. At least if you can get out in nature and do it. 

[00:19:08] There may be a little to say for people who don’t walk their walking, maybe dancing or Zumba or to music or something else. So, those things where you could do and you love it, there should be a little bit of a joy factor to it, or it’s with a pet. That can make a difference too. I think that’s the activity that is pivotal for supporting blood sugar levels, supporting insulin sensitivity, and helping with that insulin and cortisol issue that we’ve got. If you’re lifting weights regularly, every time you do that Zone 2 movement, you’re moving more muscle mass, so more sponge absorbing that blood sugar. It’s all win, win, win. And you are actually enhancing recovery by moving, active moving always trumps or active recovery always trumps. Passive recovery– Everybody likes massage, but it still doesn’t work as well as you just moving and getting circulation going.

Cynthia Thurlow: [00:20:03] And when your muscles are sourced, you’re talking about the days in between lifting, maybe you’re doing some Zone 2 training. You’re encouraging people just because you’re sore, don’t sit around. It’s better to be physically moving. So, it helps with lymphatic drainage. It helps with soreness, moving, some lactic acid. It’s interesting to me how common it is, and I tend to be someone that has tight hamstrings, I think probably like a lot of people do. And when I pull a hamstring, I mean, it’s foam roll. I mean, it’s all the things Theragun, all the things I’m trying to do to get that. And the tendency is when something hurts, you don’t want to move. You’re really emphasizing why it’s so important for recovery to keep moving. Even if you maybe get a little bit of hesitation because your hamstring is sore, it doesn’t mean stop moving. It’s just encouraging us to remain as active as we possibly can be during the day.

Debra Atkinson: [00:20:54] Yeah, absolutely. And looking at what are you trying to do? That probably when it’s sore, wouldn’t be the day to go stairclimbing or climb up a hike, but to passively walk a little bit lighter or lower. I’m a new fan of power plate. I mean, what I would do is bring you over and have you sit down with your legs stretched out on the power plate for a little while to warm them up and increase in enhanced circulation and lymphatic flow and then move you and maybe on a bike instead of walking even or running, definitely. So, what can you do that has less micro tearing of the muscles when you do it? That can be something to think about.

Cynthia Thurlow: [00:21:34] Do you find that a lot of women at this stage are needing to work on flexibility or core work? Not per se, that it’s all focused on core, but whether it’s Pilates or yoga or those kinds of modalities, do you feel like there’s certainly a place for them in an exercise program?

Debra Atkinson: [00:21:50] I definitely do. I think one of the most foundational pieces of doing core work is because we’re hitting our pelvic floor, pelvic floor strength. So, it’s ironic, but this is 2023 as we’re doing this. And in 2013, never ever, ever after 30 years, had I heard any woman tell me she had pelvic floor issues. No woman ever told me she had prolapse of any kind. I was shocked when someone asked me that question on YouTube, and I was like, “No, I never have.” So, either women were not aware of it, not even talking to their doctors about problems that they were having and had no idea to deal with it or were not coming out and getting support, saying, “I know I need to do this exercise for muscle and for bone health, but I’ve got this issue and not getting any solutions.” 

[00:22:44] So, I’m glad people are talking about it more. But I think one of the biggest things we need to do is learn how to breathe and that helps core and that helps pelvic floor. We just are such shallow breathers top one third of lobe of our lungs, really, instead of taking deep breaths. So, anybody right now who’s holding tension in their upper back and neck, I feel yeah, I have to work on this every day, too. But we’re not breathing very well. It’s part of the reason. 

Cynthia Thurlow: Yeah, it’s interesting because I think some of it is a shame piece. Women didn’t want to talk about pelvic floor problems. They didn’t want to talk about prolapse. I remember my grandmother before she passed away and she had delivered five babies vaginally. She was a nurse and she was embarrassed to tell me that she had both a bladder and a rectal prolapse, probably from long labors and pushing and all those things. And she just said, “Women didn’t talk about these things. We just suffered in silence.” So, I think as more awareness builds around this, people understand, you don’t have to suffer with stress incontinence. You don’t have to suffer with doing jumping jacks and leaking urine. I mean, that doesn’t have to be the case. 

[00:23:47] And it’s interesting in other cultures, pelvic floor therapy is part of the postpartum period, that is a given. People are referred to pelvic floor therapy automatically, whereas here in the United States, you practically have to beg for it in order to get a referral, which I think is such a shame because there are a lot of women who either have traumatic deliveries, they have big babies, they’ve got a third or fourth-degree tear, and it’s like, goodness, of course things are going to be not working quite as well. And then conversely, as we’re talking about Zone 2 and flexibility work HIIT, I think there’s so much misinformation about hit. There are people that say, “I’m going to do HIIT, and then they go do it for an hour, and I’m like, that’s not HIIT. It’s definitely not HIIT. So, let’s talk about it, let’s define it and then tell us what differentiates hit from long chronic work, the chronic cardio bunnies that I see running all the time.

Debra Atkinson: [00:24:40] Yeah. Still today, right? 

Cynthia Thurlow: [00:24:41] Yeah.

Debra Atkinson: [00:24:42] Yeah. So, I think, first of all, you got to know you’ve got to get breathless. And if you’re not getting truly breathless at the end of it, you haven’t done high intensity interval training. Think that still is a source of confusion? Just alternating, working a little bit harder and not working as hard? That’s actually not your high intensity interval training that has the purpose of boosting your VO2 max, your oxygen carrying capacity, which is very tied to longevity and/or mortality, depending on which side of the line you want to talk about. But there’s also the increased benefit in fast twitch muscle fibers that can occur if you’re doing agility, reaction skill, kinds of HIIT. If you’re doing HIIT on a bike or you’re doing HIIT on an elliptical, it’s a little less reactive, a little less agility coming through with it.

[00:25:32] But if you are bobbing and weaving and you’re doing some ladder drills or you’re responding to a ball coming back to you from a net or at a wall, that’ll be a little bit more reactive, and you could be killing tubers with one stone, which is, I think, what we’re all after. Like, “How can you spare me? I want to work on balance. I want to work on bone and ground force jumping kinds of things, and I want reaction skills.” They can be all one and the same and not have to be a part time job to get them all done.

[00:26:01] But what we’re after is really something short, and if you feel like you could go an hour, you’re actually not doing high intensity interval training or most likely you’re landing yourself on the couch for a week and then having to start all over again because you’re so exhausted. So, what should happen is you should walk away after high intensity interval training, and you’ve actually really stimulated your brain, so it should almost feel like you’re on a high. You should have this sense of mastery and achievement that tends to be common if you’re really, truly doing high intensity interval training. That almost never happens. Doing moderate intensity chronic cardio, mostly we just feel blah and tired after that, like, “I did it,” but don’t feel great, especially now in midlife.

[00:26:46] So, we’re really after raising the roof on our VO2 max and getting “cardio” in far less time than it would take. But the real solution here is that it’s far more hormone balancing than doing a chronic cardio, because we’re using cortisol in the way it was meant to use. We’re using it for 15 to 30 seconds, or maybe you’re going slightly longer, but you don’t want to make it too much longer because then we become aerobic. So, you’re just doing it and then you’re stopping, totally regrouping, letting yourself recover. And that’s the way cortisol was meant to be used. In the big picture, you prepare for a speech on Friday at work, and you’re super nervous about that presentation, and you’re gearing up, and you’re all tight, and you’re tension. You don’t sleep the night before, but then you do it and it’s all gone. 

[00:27:35] Well, unfortunately, we don’t live like that so much anymore. We’re so connected that we are just onto the next thing as soon as that’s over. And we don’t actually get that reprieve from cortisol. So, exercise in the right way can help you use cortisol in the right way. Purge a little bit and then recover, purge a little bit, recover. And that whole thing can actually help you purge better than, like, a long slog. I remember when my mom was in her final couple of months, and everybody’s a little bit different, but I think exercise is a way to also move emotion through us. And at midlife, I mean, we’re thrown a lot of things that we need to move through a West.

[00:28:16] I found that I couldn’t go for long walks anymore for some reason, that just was not working. I felt like I needed to be somewhere else or if something might happen and I could hop on a treadmill a few more times, probably a week than I normally did, 20 minutes, and just purge some of that anxiety. And then I was okay, and I could deal. But as soon as she was gone, it changed. I didn’t have that. I didn’t need it. I had the release. But I think you can use it to your advantage to harness cortisol as energy. Maybe if you’ve got excess, then you purge a little bit of it and come back to your- here’s where I live and this is my good homeostasis spot.

[00:29:00] So, I think it’s got a purpose, but truly, four to six times, doing a burst of exercise, recovering with whatever time it takes you between. We call it now not HIIT, but HIRT. It’s a terrible acronym really, when you think about exercise, but it just means repeat training. And the studies are saying that as long as you reach the high and you can take whatever recovery you need, as long as you reach the high, you get all the benefits and potentially less risk of injury, especially if you are doing something that’s reactive skill thing. Because we know, we watched people in Tabata over those years when that really soared and we saw injury rates skyrocket.

Cynthia Thurlow: [00:29:39] Yeah, it’s interesting. I think that distinction for people, if they’re trying to differentiate, are they really doing HIIT is understanding that if the purpose of HIIT is not to overstimulate cortisol, it’s to have these short little hits of cortisol, which is physiologically the way it’s designed to be, I think that that can really help us find that reframe. Now, you touched on something that I think is important. When we’re talking about being middle aged and doing, whether it’s high intensity overall training or we’re doing strength training or Zone 2 or whatever it is that we’re doing, we know that changes in estrogen actually impact collagen of our connective tissues, which has the potential to impact joint stability as well as injuries. And so, one of the common questions is always, what can I do proactively to lessen the likelihood of hurting myself?

[00:30:29] And I don’t think any of us are going into exercise and saying, I anticipate this is what’s going to happen. But I’m also at the stage of life where I’m like, “I’m very likely going to be more cognizant of what I’m doing because I definitely don’t want to end up with a tear, a sprain, a strain, etc.”

Debra Atkinson: [00:30:45] Yeah, I think a lot of women are like that who use exercise to negate their stress. The last thing that I want is to be hurt because that’s my drug of choice. I need that and totally get it. So, we want that positive addiction actually. So, for women who are in perimenopause, still cycling, whether it’s regular or irregular, that’s a little harder to predict. So, your bleed day one, but day 10 to 14, what we find is that is perfect timing for strength training, heavier strength training, because your tendons are more rigid, which means, you just have this strong foundation, this great base to build greater strength. However, your ligaments are lax. This is when you’re more likely to you moving laterally, sprain the ankle. So, if you have brand new shoes with really lots of tread on them, and you’re on carpet, you better pick those feet up. You’re going to catch them and you’re going to go down as opposed to catching yourself.

[00:31:46] So that’s an important thing to consider is that there are best times to do strength training that’s really to your advantage, especially if you eat a little bit more protein during that period of time to gain strength. But if you must do HIIT during that time, do it on a bike or an elliptical where you’re exceptionally safe. You can’t screw this one up. Okay. [laughs] 

[00:32:07] So that’s for you. But you also want to think if you’re okay, “I’m exercising like this. If I go really hard with my strength training,” maybe you don’t need to go really hard with your HIIT that week. You dial that down a little bit so you’re able to recover and optimize the strength. So, think of that wisely. And life is like that too. Life really stressful, my mom passing. I decreased what I was doing most of the time, wasn’t doing more. So that’s a key. But so now women in menopause, post menopause or unpredictable with when they’re cycling, we’ve called this as a strength and conditioning coach, we’ve called this periodization forever. I mean, how funny is that, really? [Cynthia laughs] 

[00:32:47] I just got to think maybe somebody up there knew that if we were going to be talking about women and fitness all the time, but we still want to basically treat it. But we can decide what is our week one or week two or week three. So, the way we cycle, most coaches will do three weeks of a cycle or four weeks. I choose four because it falls into a month and then to a quarter of the year and it just is easier to organize for me and I think for a lot of people. So, we’ll do three weeks where it’s we come in week one, week two we’re going to work harder, week three we’re going to work harder, week four, we’re going to come back down and really recover. We’re going to do some valuable things during that week.

[00:33:26] We’re still going to stimulate the muscle, but we might do a lot more body weight yoga where you are doing down dog, up dog, you’re doing Chaturanga and you’re doing strength training with rotation, flexion, extension, lateral flexion. So, we’re getting a lot of that functional movement in. Maybe we’ve done it during the other training cycle but not as much of it because when you’re doing traditional to really focus on metabolism. It is more linear. So that fourth week has lots of value and we do that periodically. So, every month we’re doing it, every quarter and then there’s at least three recovery weeks, not just a workout, but a full week so that you’re allowing yourself to rest. That might be the week where you’re doing your prep for food, you’re focused on that, you’re getting yourself a massage, you’re going on vacation, you’re doing lots of things with the family that maybe you couldn’t fit in as much otherwise. 

[00:34:22] So, that’s how we program it. But we just then cycle because we can’t always build, build, build and say we’re always going upstairs. You’ve got to take okay little break. But that next time you start week one, you’re not coming back to the same start you had. You’re higher still than you were because you’ve taken the break.

Cynthia Thurlow: [00:34:41] I love that. I think it’s important for people to understand that we aren’t hitting the gym hard week after week after week that we do have to have a point of recovery and resetting ourselves before we move on to the next month. Now, what is the research showing in terms of strength training and impact on our bones? We know that we lose 10% of our bone in the first five years of menopause, and that’s when we’re at greatest risk for osteoporosis. So, I think for many women, they understand the interrelationship of strength training and walking and stimulating bone because actually those hormone changes, especially estrogen and progesterone changes, actually they increase, they upregulate bone breakdown as opposed to bone building. So, those are the things I think about. Like, what does the research show about how much strength training and how often to support our bone health? 

Debra Atkinson: [00:35:36] Yeah. So glad you asked. And it’s so exciting, actually, to be a woman post menopause now because we are going to create the results, the data, again, for our daughters to come through. So, think of this in 1995, when I first personally started lecturing on osteoporosis and osteopenia, I had to define it. People didn’t know what it was, had to draw pictures and look at this is modeling. This is remodeling. You’re a pancake cooking. And here’s what’s happening. But you’re getting too many holes and they’re not filling in. And now it’s household words. But back then, we thought that once you got diagnosed. I mean, it was like bubble wrap. Don’t do this, don’t do that, don’t do this, contraindicated, no, nuh.

[00:36:24] And it was really, people were nervous. They felt like, I remember having clients come to me and they were in tears, about to retire thinking they were going to retire to their dream home in Fraser, Colorado. If you’re listening, you know who you are and ski, spend their life skiing, and all of a sudden, you’re a petite size two, told you have osteoporosis and you’re at high risk. No doctor wants them downhill skiing like a bat out of hell, which is probably what she was, [laughs] but now that’s not what would happen. We know if you were already doing it, she’d probably keep doing it. We got to have the joy factor in there as well, and we got her strength training and doing the right things. 

[00:37:07] And today, since about 2015, the research since then has been coming out on women post menopause, because for a very long time, researchers were afraid to impose and do no harm, comes out in research and they say, it’s not ethical to take a limited population and apply terrible stress to them. Well, finally they were like, “We’ve got all these women who’ve had osteoporosis for 20 years. They’re not fracturing in exercise. They’re fracturing in unique things in life.” So, isn’t it about time we start studying this? So, amen to that whoever said that argument. But we’re doing high impact and high intensity exercise. Some of the protocols we’ve described, five sets, five repetitions, or maybe five to seven. So, there’s what Dr. Belinda Beck out of Australia calls two in reserve.

[00:38:02] So you might do five or six reps and say, “I know, I could do two more,” but you’re actually not going to force yourself to do them, just to conservatively not risk injury of the connective tissue and the ligaments and joints. So, we’re seeing from the results of those kinds of studies and high impact. So, they were having women hold onto a bar or jump up to it and then jump down, do box jumps. So that’s loading it not just with a jump in place, but a jump from a box down to the ground. So really increasing the gravitational ground force. No injuries. And they loved it, the high intensity exercise. They also had that feeling of mastery and achievement accomplishment that no other researcher has ever documented. Researchers who’d participated in research prior to this said with this we’ve never seen before. 

[00:38:55] They kept coming back, the dropout level was low, adherence high. That’s always a factor too. But the injuries based on exercise was nil, so that makes it exciting. These studies are really longitudinal. They’re long, they’re over time, which matters partially because you have to start safely. We do start with lower weight, higher reps, and progress over time. And that’s one thing that we all have to remember, right, that no matter what bone density may be your key or metabolism, in which case both points, you want heavier weights for your advantage. But we have to start later. And it takes a series of weeks and actually months, two to three months to get to a point where you’re lifting heavy enough and/or you find the point where I can’t go heavier because I feel vulnerable, something’s going on. you then do it slowly enough where you stop yourself before an actual injury occurs, which is good news. 

Cynthia Thurlow: [00:39:53] Yeah. That bodily awareness, I would imagine, is very important. And working with women, some of whom probably aren’t yet on HRT, some who are on HRT, how do you see the recovery? I know this is a small sample size, but over time, how has HRT impacted your clients in terms of being able to build and maintain muscle, build and maintain bone? Because I’m starting to see, like I always say, my N of several hundred, if not a couple of thousand. The sleep piece is where I see the most benefits in terms of like consistently, if women come to me with HRT, they’re sleeping through the night. 

Debra Atkinson: [00:40:32] Yes. Anecdotally, what I can say is that both for muscle and bone density wise, I would say there are fewer to compare. And the reason is, it’s obviously, it’s a longer period of time before we’re going to see results. Somebody first gets diagnosed and is then aware this is my key priority. It’s another year, at least until they’re going to do a scan in most cases. I mean, some women are more proactive, but definitely the women who are on HRT are seemingly getting better results. I say that saying probably easier results. They don’t have to fight for it quite so much. They’re getting that little boost from the estrogen is my guess. I feel like I owe you answer to how much. I’m not sure I really answered that coming back to the bone density. 

[00:41:18] So, two to three times a week for bone density and this is where I have a little incongruent. We really like two times a week at flipping 50 because so many women suffer from that adrenal fatigue, not recovering and/or time is everybody’s number one obstacle to exercise and when we talk about muscle, we know that the benefits are there and they’re insignificant difference between two or three times a week. With bone stimulus it could be different. But again, I think we have to come back to our overall endocrine system. How are we doing there? How do we feel? And say, “Okay, maybe I should do other things” with ground forces, with high impact or as high impact as anyone listening can do safely, five to seven days a week is the recommendation. 

[00:42:05] But listen to this, because you can do it in two or three minutes, so don’t get overwhelmed here. This is 10 to 20 impacts and about four sets of it. That’s two minutes or less of exercise. And you could do one now, you could do one at lunch, do one in the afternoon and one tonight and imagine 10 little hops in place. That’s it. And you’ve done one. If you like to jump rope, you probably do this naturally and easily, but it goes anywhere from walking, dancing, hopping, love jumping, jumping to a box, jumping off of a box, doing squat jumps, going lowest to highest ground force, and each of us again will have a line where I can do everything below this. And these are okay for me and that’s your playground, so know that. 

[00:42:49] And for those who can do high impact, you still wouldn’t necessarily want to do super high impact every single day. And we want to do some side to side because that stress laterally is different than stress just down, down, down or forward and back jumping. 

Cynthia Thurlow: [00:43:02] Such an important distinction. So, I’m curious, you alluded to a power plate or a vibration plate. Where does that fit into all these other pieces in terms of our flexibility, our bone, and our recovery, how does that fit into that? 

Debra Atkinson: [00:43:20] Oh, my gosh. Well, so first of all, let me just say this. I was the biggest skeptic, so I should [Cynthia laughs] apologize to somebody in the whole-body vibration world because 15 years ago, I remember I was approached as the personal training director for a club and we wanted you to have this in our club. And I was like, “No, they need to be doing other things. They need to be doing functional work.” And now I see it for what it is. I have one in my kitchen, so I’m using it every day and I can lift heavy, but for me it’s like icing on the cake. It’s like I’m going to be 60 in not very long, and it’s like I got to take this seriously. I’m going to pull out all the big guns, what else can I do? 

[00:43:57] And so, I use it when I’m doing a quick strength training work at home, I will actually do my squats on it. I will lie my back on it and do my chest press. And I will stand on it and do bent over rows on it so I can do the full workout, what I call a real quick one. The basics on that. Otherwise, I’m using it for core on a daily basis. Hands on it and planks, side planks. I’m doing a dead bug on it, balance, agility. I have a foot that thinks it wants to have plantar fasciitis, but I’m not going to have it. So, I’m standing on that every day. Y’all heard that? Here, I said it here. Ask me about how that’s going later when you see me, you know, the vibration is also helpful in recovering from injuries. 

[00:44:42] When I spent six and a half years in Boulder, I worked at the club side by side, world class triathletes. I mean, these are the ones who were in Kona doing the thing and finishing long before I was, at dark and midnight. There we were using it for injuries, a hamstring pull you sit on it. You’ve got something wrong with your elbow, your wrist, you’re maybe going to plank on it or just sit on it and lie on the floor and put your calf up on it if you’ve got a calf tear. So, the stimulation is lymphatic movement through the body, stimulating the vibration, the frequency, all beneficial. So, for muscle recruitment, doing less but still getting more. Those of you who can’t lift as heavy, the recruitment of muscle is about 138% more than if you’re not doing the weight training on it. So that’s pretty good. That means the same muscle stimulated more, other fibers are also recruited. And all of that is good for metabolism, obviously, in circulation.

Cynthia Thurlow: [00:45:44] I have one in our house and I think it was Dr. Terry Wahls who had convinced me that this is something worth doing. Admittedly, I’m not doing it every day, but I do enjoy it when I am on it. And sometimes I just stand on it and I’ll do it at the end of my workout and my husband will walk by and he’s like, I don’t understand. And I just said it feels good. If nothing else helps with lymphatic drainage, it feels really good. What are your thoughts on infrared sauna, cryotherapy, cold plunges, cold showers? Are these things you routinely recommend? Do you feel like this is, as you call, icing on the cake? If we’re doing all the other things, then maybe we move these in. What are your thoughts on these modalities? 

Debra Atkinson: [00:46:23] So funny. There’s serendipity and everything. So, this morning, I recorded a podcast about what is biohacking? Do you want to do it? Because my audience is probably newer to some of those modalities in doing it. And personally, I don’t like to be cold, but I just got in this last week, a cold plunge and so I’ve been in it twice. I’d stare at it most days, [Cynthia laughs] but I’m getting mentally ready.

[Debra laughs] 

Debra Atkinson: [00:46:47] Yeah. And I told my kids they’re coming for Thanksgiving. I said, bring your swimsuit. And they’re like, “Ooh, I don’t know.” And, yes, I do believe in it. And sauna saved my life, so I happen to have had one. I didn’t buy it for mold recovery and detox, but I bought it for pampering. Honestly, I like to sweat. That’s what I like to do. And it does help in recovery. It’s like a workout for your body. It also deepens my sleep. It’s amazing. But I like the hormetic stressor, as intermittent fasting is. Of course, it’s super helpful, I think, for stirring up that inflammatory response in the body and giving you a little bit of stress. But I love that brown fat. Let’s trigger that. Let’s control that a little bit more. I know that I need it. I’ve been sufferings from migraines and I’m using it as a way to divert blood flow honestly, and give myself a shock to the system elsewhere. So, I am a big believer. But I think we’re also, we’re biohacking on a regular basis anyway today and some of us don’t even realize.

[00:40:00] If you change the type or the timing of your exercise, you change the type and the timing of the food you eat, the order that you’re eating foods. If you have a Fitbit or an Apple Watch and you’re looking at your steps, I mean, all of that is biohacking. You’re looking to probably not just watch it, but to achieve a certain goal or change it. So, I think all of these have their place. I think there’s core target thing we want to start with. Do the basics. Those are the basics. I mean, lift heavy shit and sleep well. Say I love you more frequently than you say something else and eat good food and then begin to expand and what else am I willing to do next? 

Cynthia Thurlow: [00:48:43] Yeah, I think it’s so important to focus on the basics first. Like I always say before you add in 15 supplements, make sure you dial in on your nutrition, make sure you’re sleeping. I love that you admitted you don’t like being cold. I’m the same way, which is why I feel like I need to do cryo. I’ve got this cold shower down, but I’ll do cryotherapy probably twice a week. And anytime I do infrared sauna, I sleep so well. And it’s interesting our friend, Aaron Hartman, was talking about some research about infrared saunas are particularly good for releasing these endocrine-mimicking chemicals. So, we’re exposed to all of them, but when we’re sweating out these toxins, it’s actually a very effective way to get rid of some of these endocrine-mimicking chemicals, which I thought was really interesting. And some of us don’t even realize I was like, “Okay, I probably need to do it more than twice a week.”

[00:49:28] Before we kind of wrap up today, I had a lot of questions about what are your favorite supplements to support muscle gains and recovery? I know we’re both fans of creatine, but what are your thoughts on essential aminos? Are you a proponent of protein powders? How about collagen? What are the things that you like to suggest to your clients? 

Debra Atkinson: [00:49:47] Yeah, so definitely, I think, first of all, food first. I mean, get it from your diet if at all possible, because in that food, in the bison or the venison or the shrimp or whatever your choice is, there are also vitamins and minerals and other nutrients that you’re not going to get when you get it from a supplement. So that first, of course, we carry protein powder at Flipping50, so we walked into that one. So, yes, of course and I don’t love it as a substitute for other things that give you all those minerals.

[00:50:19] So, I like it as a vessel for, if you’re going to use it as a part of a smoothie or a shake, put some vegetables in there, put some cucumber, some rice, cauliflower in there, get a little bit of fruit in there, get some healthy fats in there. Make it just like it would be if you were sitting down to a bowl or a plate of food. Don’t short sheet yourself with those nutrients and vitamins when you’re doing that. And pay attention to using a protein powder that is high in all the essential amino acids. So, collagen and that confusion, I think, of collagen versus, is it really full of essential amino acids for a muscle on a higher level? So, there’re lots of confusion. Collagen alone is not enough. We need more than that. 

[00:51:02] So, collagen for our joints and ligaments and connective tissue though and the bone, absolutely, I think. And your hair, skin, and your nails. I’m a fan, so I would use both. But don’t confuse the protein that you need in a day. So much of that collagen can count, but it shouldn’t be a high percentage of your overall diet. And once you’ve got the protein piece covered and the timing of it, which can be also very important, then I think if you’re not reaching what you need, then adding essential amino acid supplements and distinguishing that over branch chain amino acids. I get asked a lot by women, “Should I do branch chain amino acids?” And I say, “First, what’s your diet like?” Because if you’re not getting enough protein in, jumping to branch chain amino acids is like, that’s too far. 

[00:51:52] We need all the essential amino acids to be accounted for first. And then maybe if you’re saying, “Okay, here I am and I’m doing it and I’m still not seeing results,” then maybe, do you want more branch chain? Yes, but that should come later. And with creatine, I would say, “Yes, everybody, do it on a daily basis.” For bone and for muscle, I mean, really, I’m not hearing anything negative about use of it. Nothing, just benefits. And for much older adults, even not just now at this point, when we can stand to gain it and make sure that we’re not losing it in the first place. So, I think all of them have their place on your shelf. 

Cynthia Thurlow: [00:52:29] I love again the message about nutrition first, using these for specific purposes. It’s interesting. I think it was Dr. Don Layman on Twitter. Someone was asking him about EAAs, and he said, “If you’re getting at least 100 g of protein in a day, they’re probably unnecessary. I thought that was a really good distinction. So, maybe you’re traveling, maybe you haven’t hit your protein macros. Maybe that’s the time to utilize them. It’s interesting with creatine, because I’ve interviewed Dr. Darren Candow now twice and he’s a creatine researcher and he was talking about how for crossing the blood brain barrier, so for traumatic brain injuries, jet lag, mental health, sleep piece, and bone health, you need more. So, anywhere from 8 to 10 g of creatine versus 3 to 5 for muscle strength, which I thought was really interesting. But I agree with you.

[00:53:17] I think the worst thing that I’ve heard people complain about is some people feel a little bloated or they understand the mechanistically how creatine works. It’s monohydrates, it’s going to hydrate the muscles, but it’s water weight. For those people who weigh themselves obsessively, that might be challenging, but understanding [crosstalk] yes, exactly it’s like, put the scale away. Just understand that our weight fluctuates day to day just based on what we’re eating and how hydrated we are. Well, Debra, I always love our conversations. Please let my listeners know how to connect with you, how to listen to your amazing podcast, work with you if they’re interested in doing that, etc.

Debra Atkinson: [00:53:53] All good things are at flippingfifty.com. So, flipping fifty spelled out all words, no spaces and Flipping50 TV on social, especially YouTube, Instagram, and Facebook. So that’s where all the good things are. And you can learn more of about options for working with me or us in groups over there. Thanks so much for having me.

Cynthia Thurlow: [00:54:17] If you love this podcast episode, please leave a rating and review, subscribe, and tell a friend.