Jessica Shepherd, MD, MBA, FACOG, is a  leading voice in women’s health and longevity. Her impressive career spans medicine, media, and entrepreneurship. A board-certified OB/GYN, wife, mother, author, and CEO, she describes her book, “Generation M,” as “a love letter to the incredible journey of womanhood.” You can read our feature interview with Dr. Shepherd in this month’s issue of InHabit.

‍

Excerpt from Generation M: Living Well in Perimenopause and Menopause‍

By Dr. Jessica Shepherd

Chapter 8 – The Exercise Rx

There is no magic pill that will improve every aspect of your physical, psychological, and spiritual health, but one thing comes close: exercise. In fact, I foresee a day when doctors will write a prescription for exercise just as they would for any other course of disease prevention.

Exercise can not only help you retain muscle and aid in weight maintenance, but it can also reduce your risk of heart disease, cancer, and diabetes, and protect your bones from osteoporosis. It can increase your libido and your overall sexual health. (A lesser known but rather nice benefit, right?) But why stop there? Exercise can lower your risk of depression, ease anxiety, improve sleep, give you more energy, improve cognition, and boost your self-confidence. It may even help prevent Alzheimer’s disease.

Most of all, exercise just makes you feel good. While it is important at every stage of life, exercise is especially beneficial for women during perimenopause and menopause. Skeletal muscle mass peaks in our twenties and thirties, after which there is a decline (called sarcopenia) that occurs at a rate of 3 to 8 percent every ten years after the age of thirty. During your forties, fifties, and beyond, the aging process, a sedentary lifestyle, and a decline in estrogen combine to weaken bones and decrease muscle at an accelerated pace. Without intervention, estrogen receptors in your muscles simply aren’t getting enough of the hormone they need to thrive.

This raises the risk for osteoporosis, falls, fractures, and overall mortality. On top of that, losing muscle lowers your base metabolic rate (how fast or slow you burn calories), which can lead to weight gain, type 2 diabetes, and other metabolic disorders. According to the American Diabetes Association, exercise can lower your blood sugar levels for up to twenty-four hours. Even going for a walk can help your body to absorb glucose from your bloodstream, convert it, and utilize it for fuel.

Your mind also reaps significant benefits from movement. Exercise increases blood flow to the brain and improves executive function. That’s what helps you think clearly, switch between tasks, and problem-solve. Even moderate activity may help improve memory by increasing blood flow to the prefrontal cortex, which is responsible for attention. There are more brainy benefits: recent research shows that exercise improves neuroplasticity, your brain’s ability to continue forming new neural connections throughout your life. This can improve learning capacity and response to stress, regardless of age.

The mental health benefits are just as important. There is a reason the former First Lady Michelle Obama once said, “For me, exercise is more than just physical—it’s therapeutic.” Staying active can help you become more resilient and less anxious, control addictive behaviors (including smoking), and reduce fatigue. Need more encouragement? Just twelve weeks of moderate exercise has been shown to improve vitality, mental health, and quality of life in menopausal women.

I encourage you to begin an exercise program before muscle loss accelerates (and fatigue gets the better of you) so that you can lead an active life well into your seventies and eighties. Think about being able to stash a suitcase in the overhead bin, carrying groceries, or having the energy to chase after grandkids in future. Now is the time to start prepping your body for all your tomorrows.

How Much Exercise Do You Really Need?

Before we get to specific types of exercise, keep in mind that anything you do is better than nothing, and the health benefits begin to accrue as soon as you get out off the couch. Here are some general guidelines to get you started. To improve your overall health, aim for a minimum of 150 minutes of moderate exercise, or 75 to 150 minutes of vigorous aerobic exercise. That works out to about thirty minutes a day, five days a week. Moderate exercise is when you can easily talk (or sing along to your playlist) while you are moving without losing your breath. Cleaning your house, biking on flat ground, or taking a brisk walk all count toward your minutes. Pickleball is the rage for a reason: it’s fun, it counts as exercise, and it’s a great way to meet people. Vigorous exercise substantially raises your heart rate and breathing. Examples includes running, hiking, swimming laps, shoveling snow, or high-impact aerobics.

You don’t have to get your thirty minutes all at the same time to reap the benefits. Because sitting for long stretches can be as harmful as smoking, taking short walking breaks throughout the day can be especially beneficial. You’ve probably heard that 10,000 steps is the best goal for health. Recent studies have shown it may not take that much. Taking even 7,000 steps a day reduces the chance of early death by as much as 70 percent.

Getting Started: Find Your Why and What

At a time of life when so much may feel out of your control, choosing to exercise is something you can control. Whether you haven’t exercised in years, have hit a plateau, or are ready to up your game, being clear about your motivation and having a plan will help you start and stick with it. 

Everyone has their own why. Your why may be brain health, emotional well-being, having more energy, or disease prevention. I can tell you my why. One of the first symptoms of perimenopause I experienced was brain fog. I found that exercise makes an enormous difference in mental clarity. I aim for three to four sessions a week. While I used to be a runner, these days I concentrate much more on strength training with heavy weights to build muscle, tone my body, and prevent weight gain. On top of the physical benefits, I love the sense of confidence finishing a challenging session gives me.

After, Rhonda, fifty, was diagnosed with breast cancer, her why changed. She was lucky that it was caught early, but treatment required that she go into chemically induced menopause. “It was a lot to handle physically and emotionally,” she says. “One of the things I’ve found most helpful is seeing a personal trainer twice a week. It’s definitely an investment in time and money, but I make it a budget priority. Like all women, I was losing muscle and bone mass, my metabolism was dropping, and I was gaining weight around the middle. When I started working out, my goal was to lose ten pounds. I’ve only lost five so far, but I’ve gotten stronger and the shape of my body has changed. I fit into clothes I couldn’t wear before. What it does for my mood is even more motivating than what it does for my body. Before I go to the gym, I always dread it. I think of everything else I need to do instead: go to the grocery store, do my laundry, get to work. But as soon as I finish a session, I get that dopamine lift. It just feels really good. That’s what keeps me going back more than anything.”

Terri was motivated by what she wants to accomplish in the future. “When I was younger, I took it for granted that I was always going to be healthy and feel good. The older I got, and especially after having Covid, I realized I couldn’t take that for granted. My goal is to see my grandchildren grow up and watch them go out into the world. I knew I couldn’t continue as I was, just hoping for the best. Things happen in life—we can get sick, we can fall into ruts—but there are things I can control. Part of that is making a conscious effort to take care of myself. I started walking every day. I’d never tried strength training until a friend at the gym asked me to join her. I was skeptical, but I actually liked it. We go together twice a week and knowing I’m going to meet her there keeps me accountable.”

Whatever your personal motivation, keeping your long-term goal in mind can help you prioritize exercise when life pulls you in a million directions. Don’t leave it to chance; schedule your workout sessions (even morning walks) ahead of time and enter them into your calendar as you would any appointment. Find a fitness buddy if you can. Remember that it takes ten weeks for something to become a habit. If you miss a day (or even a week), don’t beat yourself up or use it as an excuse to give up. Chalk it up to being human and start again. Progress comes from consistency, not perfection.

‍

Excerpt reprinted with permission from Generation M: Living Well in Perimenopause and Menopause by Jessica Shepherd © 2024. Published by Union Square & Co.

‍