Is muscle mass the key to women’s longevity?

The government guidelines we can all get behind. Why I’m focused on strength training at 40, and tips for how to get started.

Deep breath… today is election day.

Many of us are living in a hope stew mixed together with some anxiety and fear.

So, I wanted to share with you a something that bridges the divide. A topic I hope we can agree on. And bonus — it’s something you actually have a lot of control over.

Did you know that 70% of assisted living residents are women? We live longer than men on average but spend 25% more of our lives in debilitating health. In in all of my research on women’s health and longevity, a consistent finding has stood out in terms how we can empower ourselves to live in good health, for longer.

We need to focus on being strong, not skinny. The evidence is overwhelming.

This means that we need to get comfortable pushing ourselves to do progressively harder things physically. The earlier the better. The muscle mass you put on in your 30’s, and 40’s will help you in your 50’s, 60’s, and beyond.

Let’s get into the data.

Physical activity guidelines for Americans

The "Physical Activity Guidelines for Americans" report was first issued by the U.S. Department of Health and Human Services (HHS) in 2008 as the government’s primary resource for science-based guidance on physical activity. This first edition set foundational recommendations aiming to counteract chronic disease.

With a rapidly growing body of research, HHS launched a second edition of the Guidelines in 2018. This update incorporated new findings on physical activity’s broader health benefits.

These guidelines are generally well-respected and widely used by clinicians and health professionals because they are based on the comprehensive systematic review of scientific evidence conducted by an advisory committee of experts in physical activity, health, and medicine.

Pretty cool right?

And just in case you want to dig in but don’t feel like reading a 118 pg. PDF — I turned it into a GPT that you can chat with. Go wild and let me know what you think!

Impactful takeaways on physical activity for women

• For substantial health benefits, we should do at least 150 minutes to 300 minutes a week of moderate-intensity, or 75 minutes to 150 minutes a week of vigorous-intensity aerobic physical activity. (Upping the intensity cuts the time requirement in half).

• We should also be strength training with moderate or greater intensity involving all major muscle groups two or more days a week (it can’t be leg day every day).

• 80% of women indicate they are meeting the minimum recommendations for aerobic activity, but only 19% of us are meeting the recommended strength training guidelines.

• Women who start physical activity early in life have up to a 50% lower risk of osteoporosis.

• Weight-bearing and muscle-strengthening activities can slow bone density loss by 1-2% annually in postmenopausal women.

• Women who engage in regular physical activity have been found to have a 20-40% lower risk of hip fractures compared to those who are inactive (A leading cause of immobility and decline).

• In total, meeting the exercise and strength training guidelines can result in an estimated reduction in all-cause mortality risk of approximately 40–50%.

Let that last bullet sink in a minute.

All-cause mortality risk refers to the likelihood of death from ANY cause over a specific period. Engaging in at least 150 minutes of moderate-intensity aerobic activity per week can lower the risk of all-cause mortality by 33% compared to those who are inactive.

And incorporating muscle-strengthening activities (at least 2 days per week) can reduce all-cause mortality risk by an additional 10–20% compared to doing aerobic exercise alone. They didn’t find an upper limit to the benefits of physical activity.

So why aren’t all women strength training 2x/week?

Given that only 19% of us are meeting the strength training guidelines, I wanted to dig into that more. Since my high school sports days, I’ve come to love the feeling of being strong. There is just nothing that quite compares to nailing an overhead snatch (IYKYK) or climbing a big hill without doubling over to catch your breath after.

When I was managing marketing teams at tech companies and raising young kids, there were months where I was lucky if I got one workout in a week. Here’s what other women have told me about why they aren’t strength training more.

• They simply feel like they don’t have the time

• Getting started feels overwhelming, and they aren’t sure where to start

• Weight rooms are intimidating

• They are scared of looking “bulky”, or getting less feminine looking

• They don’t find it to be enjoyable

• It’s too costly — gym membership, trainer, group classes, equipment, etc.

Do any of these resonate with you?

Regardless of your reasons, midlife is a great time to consider building or getting back into a strength training habit. This is especially true when you consider the impact of hormone changes in our late 30’s and 40’s.

The hormonal shift: how perimenopause affects muscle mass, bones, metabolism, cortisol, and more

Muscle mass and bone health

Decreased estrogen accelerates muscle loss (sarcopenia) and contributes to the risk of osteoporosis, a condition impacting nearly one in two postmenopausal women over 50 in the U.S. Muscles exert force on bones during contraction, creating mechanical stress. This stress stimulates bone formation and increases bone mineral density. The greater the muscle mass, the more force is applied to bones during movement and exercise.

Metabolism

After 40, our metabolic rate naturally declines, making it easier to gain fat and harder to lose it. Muscle tissue is metabolically active — meaning it burns more calories even at rest. Women with higher muscle mass in midlife have lower risks of insulin resistance, type 2 diabetes, and metabolic syndrome.

Cortisol and inflammation

Perimenopause and menopause can bring about an increase in cortisol, often called the “stress hormone,” which contributes to muscle breakdown and belly fat accumulation. Resistance training is known to reduce cortisol levels post-workout, lowering overall stress and inflammation in the body.

By prioritizing muscle mass, we can protect our bodies against age-related decline, support hormonal balance, and improve overall quality of life. Building muscle is an investment in both short-term health and long-term vitality — so bring on those golden girl gains!

Tips for getting started with strength training in midlife

It is my sincere hope that this post inspires you to move more and start doing progressively harder things. Here are some of my top tips for getting started.

Set a realistic goal.

Aim for two to three strength sessions a week, gradually increasing weight or resistance as your strength improves.

Get a subscription to a digital training platform

Peloton, Alo Moves, Apple Fitness, Sweat and Les Mills all have good programming. Pair one of these with a versatile set of weights. When your brain is fried or you aren’t sure where to start, having an instructor guide you is a game-changer. I’ve been using the Peloton app, bike, and weights in 5lb - 30lb increments for years.

Walk with a weighted vest

Rucking (walking while carrying weight) increases muscle activation in your legs, core, and back. This will improve strength, endurance, and bone density while also boosting calorie burn. Start with 5% - 10% of your body weight. You can work up to longer walks or progressing to 15% of your body weight over time. I’ve found this one to be the most comfortable to wear. Note: the iron sand it’s filled with has rusted and is starting to stain my clothes, so let me know if you have another recommendation!

Track your workouts

This can be as low fidelity as marking an X on a calendar for every day you trained in a month, or as sophisticated as investing in a wearable. The Apple Watch and the Oura ring are currently my top fitness tracker recommendations for women in midlife.

Plan your workouts ahead of time

Look at your schedule and block time. You have every right to a standing private recurring calendar invite that goes into eternity. Sure, you will have to reschedule it sometimes — but if you grab it first, I’ve found people will respect it.

Consider joining a local gym

You’ll be able to tap into resources like weekly group fitness programming and a wide variety of equipment to help you figure out what you like best. You may even find a community that makes exercise feel like fun. This was me pre-kids!

Work with a trainer

This can be an excellent option if you are brand new to strength training or if you are recovering from an injury or are feeling anxious and unsure about where to start. A personal trainer will tailor exercises to your needs, ensure proper form, and set you up for long-term success. This is what my mom chose to do after she was diagnosed with Osteoporosis this year. Now she has the confidence and knowledge (and biceps!) to continue training on her own.

Prioritize sleep, nutrition, and stress reduction

If you haven’t gotten decent sleep, aren’t fueled properly, or are under high stress — an intense workout could put you into more of a deficit. Be real with yourself and try to listen to your body so you can modify your activity to fit what you have energy for. There will be days when a walk outside and some deep breaths could be more beneficial to your health goals than a 45 min HIIT circuit.

So… IS muscle mass the key to women’s longevity?

Per the guidelines, we need both cardio AND strength training to maximize our health. But since most of us aren’t doing the strength training piece, one could justify that building muscle is the next frontier in women’s longevity — or at least a crucial element alongside nutrition, hormone therapy, sleep, and stress reduction.

As I’ve been thinking about the outcome of this election today, I keep coming back to the thought that having more physically strong, independent and capable women will only impact our country and our society for the better.

More of us living vibrantly outside of nursing homes, with clear minds, strong voices, and confident hands to guide our pens in the direction we want our country to go. This could actually be the ultimate key to our longevity.

So, will you raise a barbell with me?

Hey there, I’m Esther — so glad you are here

It’s been a minute since my last post, so I’d like to take a moment to introduce myself for anyone new here. Over the past month, my followers on Substack have grown substantially thanks to a couple folks who have recommended Mad Alice to their subscriber base. So, who am I and why am I writing all this stuff?

I’m an active mom and former marketing executive (Microsoft, then startups) who became slightly obsessed with hormone health somewhere between postpartum and perimenopause.

I created Mad Alice for my friends struggling to identify and manage hormone related symptoms at 35+. Many women in midlife feel like garbage. We suffer needlessly because we are living in a system that isn’t educated in—or designed to—optimize our quality of life when hormones start to shift.

I ran smack dab into the brokenness of our healthcare system trying to find answers for my symptoms (which started in my late 30’s). Now I’m sharing my research to help others be more efficient with their resources, and to bring clarity to where there are still huge opportunities for impact.

Join the movement

Welcome to the not-so-secret society of women taking control of our health in midlife. Imagine how we will change the world when every person born with ovaries feels full of energy, free of pain, physically strong, and cognitively sharp.

I’d love for you to share this with a friend or colleague if it’s been helpful. Being open and willing to talk about our experiences is the first step to creating the systemic change we all want to see.

— Esther

---

References

• odphp.health.gov/sites/default/files/2019-09/Physical_Activity_Guidelines_2nd_edition.pdf

• https://www.mckinsey.com/mhi/our-insights/closing-the-womens-health-gap-a-1-trillion-dollar-opportunity-to-improve-lives-and-economies

• National Osteoporosis Foundation. (Statistics on osteoporosis and postmenopausal risk).

• Menopause Journal. (Study on strength training and menopausal symptoms).

• Journal of Clinical Endocrinology and Metabolism. (Muscle mass and metabolic health in midlife).

• American Journal of Epidemiology. (Muscle strength and mortality study).