22: Moving Smarter in Perimenopause – The Full Framework Part 1

Hey, it’s Megan. Grab your coffee and let’s have a convo.

Good morning and welcome back to Mornings with Megan. I’m Megan, a certified nutrition specialist and creator of the perimenopause matrix. And I’m so glad that you’re here. Before we dive in, if you’re new here, welcome. This episode lives in the move pillar of the perimenopause matrix. And today we’re starting a series, a movement series. Three episodes covering three things that I think every perimenopausal woman needs to understand about how to move her body right now in this season of life. Today is the framework and the cardio piece. If you’ve been here a while, you know I don’t do one size fits all. That’s not how I operate, so let’s dive in.

THE PERMISSION SLIP The point of today is to go over what we can be using to update your movement in perimenopause. If you feel amazing with your movement, your labs look great, your body feels good, you are recovering well, then please press stop and spend the next 15 minutes doing something joyful for yourself. I mean that. You have permission to stop listening right now.

I say this because I think we are all drowning in information about what we should be doing. More, harder, faster, longer. And sometimes the most useful thing I can tell someone is what you’re doing is working. Don’t change it. This is a valid outcome. If your routine is serving you, protect it. If your movement routine is no longer serving your body, you are sore and tired, having a hard time recovering, or you don’t have a movement routine at all, this is for you, my friends.

I’m going to break this down into ideal or optimal ways to move and take care of your health, and then talk about time because that is a real constraint that needs to be considered, especially in perimenopause. Most of us have a never-ending to-do list, family, work, communities, relationships, and homes to manage. So I want you to know that there are options to fit into your timeframe.

And I want to say this upfront. I want you to hear it. The best workout is the one that you are going to do. Let me repeat that for everyone out there who’s listening who has someone trying to grab their attention right now. The best workout for you is the one that you are willing to do. Period. End of story. You can have a trainer program the most scientifically optimal workout for your health goals, but if it doesn’t fit your life or you simply are not going to do it, then it is not an ideal workout for you. And that is what today is all about. Learning what the options are so you have a starting place and can find what works for your perimenopause.

RECAP: EPISODE 21 + A NOTE ON RESISTANCE TRAINING

Last week we went over rucking. As a quick refresher, walking with load — a backpack, a baby carrier, groceries, whatever you’ve got. We covered the low impact, easy to access entry point for cardiovascular health and the benefits for your lymphatic system, the bone maintenance piece, and I want to emphasize that word, maintenance, not building, and the blood sugar connection, especially after a carbohydrate heavy meal. I love rucking as an easy entry point to start moving your body, to come back from an injury, or if you have time beyond your two and a half hours of structured movement a week, it’s a really great way to use it. If you haven’t listened to episode 21, I’ll link it in the show notes. It’s a good companion to today.

If you’ve been with me a while, you already know where I’m going to start. Weights, resistance training. I want that muscle on your body for glucose, for your bones, for your metabolism, for every single thing that we talk about on this podcast. It is a non-negotiable and perimenopause. But here’s what I decided for today’s episode. I want to give resistance training the full attention it deserves and that means its own episode. Episode 23 is entirely dedicated to the progressions. What to do if you’ve never lifted. How to advance if you have. The clinical picture of understanding under-muscled women and what that actually looks like in labs and what the research says about resistance training and cardiovascular health. Yes, resistance training and cardiovascular health. That might surprise you. More on that next week.

Today we are focusing on the cardio piece, specifically the kind of cardio that works with your perimenopause physiology instead of against it. And to get there, we need to talk about cortisol.

THE CORTISOL CONVERSATION

This is a section I want you to really hear because this is where I see the most confusion and honestly, the most well-intentioned harm. We need to talk about cortisol. Cortisol is your primary stress hormone. And here is the thing that most exercise advice completely ignores. Exercise is a stressor. Martin Gibala, the researcher we’re going to spend a lot of time with today, has said this directly, exercise is a stress on the body, generally a positive adaptive stress, but a stress nonetheless.

And in perimenopause, our stress cup looks different than it in our 20s. Here’s what I mean by stress cup. Imagine a cup. Everything that draws on your cortisol goes into that cup. A hard work deadline, a fight with your partner, a sick kid, poor night’s sleep. And you know that sleep disruption is one of the hallmarks of perimenopause. Under eating, fasting — yes, fasting is a cortisol stressor, episode 15 if you want to go deep in on that. Relationship stress, financial stress, and exercise.

When your cup is full or already overflowing, adding more cortisol by getting exercise is not a net positive. It tips things over. And one of the hallmarks of cortisol dysregulation is feeling exhausted all the time, not recovering well, getting sick easily, holding a weight around the midsection despite doing everything right.

PERSONAL STORY: GETTING HELP

I’m going to share something personal here because I think it matters.

After my miscarriage and a period of extreme work stress, I was not okay. My hormones were completely blown out and as part of my recovery, I was working with a practitioner that I trusted, someone who could look at the full picture and give me the rules I needed because this is the thing, I knew what I would tell a client, but I wouldn’t tell myself. That is one of the hardest truths about this work. We are often the last person we take care of properly. Having someone hold me accountable to a protocol that I would not have given myself permission to follow, that is why I got better. And I want to normalize that. Getting help is not a sign of weakness. It is how you actually heal.

That protocol included no steady state cardio, none, walking, short resistance training sessions, 20 minutes twice a week, and sometimes only once a week. That was it. It was brutal. I was exhausted all the time. I was used to doing so much more. But here’s something that I want to be honest about. I don’t think that my cortisol was elevated at that point. I think it was completely tapped out. That burnout state where your body can’t even mount a proper cortisol response anymore. Running on empty rather than flooded. So any significant physical stress wasn’t going to spike my cortisol. It was going to completely drain whatever reserves I had left and set back my recovery. Steady state cardio would have pushed me deeper into that hole instead of helping me climb out.

I share that because cortisol dysregulation is not always too high. Sometimes it’s exhausted. Sometimes the cup isn’t overflowing. Sometimes it’s just plain dry. Either way, the answer looks similar. Less prolonged stress, movement. And this is something that Dr. Stacy Sims, exercise physiologist, researcher, and author of Roar and Next Level, talks about extensively in the context of women’s training. Prolonged steady state significantly elevates cortisol. For a woman in perimenopause, whose stress cup is already full, that cortisol exposure is not neutral. It can suppress progesterone, which is already declining. It can increase central fat storage, and it can tank your recovery. This is not an argument against cardio. This is an argument for smarter cardio.

WHAT INTERVAL TRAINING ACTUALLY MEANS

Before I introduce the research, I want to clear something up because I know exactly what some of you are thinking. Okay, Megan, so steady state cardio raises cortisol. So I should just do more HIIT, more of those intense classes that’s high intensity that counts.

I love the enthusiasm, but I want to make sure we’re talking about the same thing because HIIT as a term has been used across the wellness space. And I include myself in that corner too, because we are not blameless here to describe a lot of things that are not actually what the research is talking about.

So let me explain what interval training actually means in a research context. Interval training means alternating periods of intense effort with periods of genuine recovery. So work then rest, work then rest. The key word is rest. Real recovery, not active recovery where you’re still moving hard, not a 30 second break before the next circuit. Genuine rest that allows your body to come back down before you push it up again. That spike in that recovery is what creates the adaptation. You cannot have one without the other.

So here’s the thing. A 45 to 60 minute high intensity class like F45, CrossFit, Orange Theory and Barry’s can be genuinely amazing. The community, the energy, the feeling after. I used to love them. I would not survive one now, but I used to really, really love them. And for the right person at the right time, they are wonderful.

But in the context of perimenopause, an hour of sustained high intensity work produces a very different cortisol response than a short session with a true work-rest cycle built in. For a lot of us in this season of life, that sustained cortisol exposure is more than our system can handle and it shows up as things you might already be experiencing, holding weight in the middle, not recovering, feeling worse and out of your workouts instead of better.

So for today’s conversation, when I say HIIT, I mean the research version short under 30 minutes total, a fraction of that is actual high intensity work. Real rest between efforts. HIIT — high intensity interval training — hard but submaximal effort, roughly a seven or an eight out of 10, genuine recovery repeated, 20 to 25 minutes total.

SIT — sprint interval training — all out effort, nine out of 10 or a 10 out of 10, longer recovery, 10 minutes total. So both short, both with real rest, neither is an hour of anything.

DR. MARTIN GIBALA AND THE ONE MINUTE WORKOUT

This is where I want to introduce you to Dr. Martin Gibala. He’s a professor and a chair of department at McMaster University in Canada. And he is one of the world’s foremost researchers on high intensity interval training. He wrote a book called The One Minute Workout and I’ll link his podcast appearance in the show notes, including a great conversation on this with Gabrielle Lyon on this exact topic.

The fundamental question his research asks is, how little exercise can you do and still get meaningful health benefits? And the answer from his randomized controlled trials published in peer-reviewed academic journals is a lot less than you think.

Here’s what the lab at McMaster has found. Three sessions a week. 10 minutes per session total. In those 10 minutes, one minute of actual hard work. I know, your brain just said that can’t be right. But his team compared people doing three 10 minute sprint sessions per week to people doing three 45 minute cardiovascular sessions per week over 12 weeks. Cardiovascular fitness, insulin sensitivity, mitochondrial content, essentially the same results. One minute of hard work versus 45 minutes of moderate work. Same outcome. And here’s why that matters for cortisol. The sessions are so short that cortisol doesn’t have time to spike and stay elevated the way it does in prolonged exercise. You go hard, you recover, you’re done. For a perimenopausal woman managing a full life and a full stress cup, that is not a small thing.

Dr. Stacy Sims independently advocates for exactly this type of training for this population. She covers it extensively in Next Level, which is the perimenopause book that you want if you don’t have it yet. Both she and Gibala come from different angles, land in the same place. Short intensity, genuine recovery.

THE PROTOCOLS

Let’s get practical. These protocols will be in the show notes so you can reference them. Here’s an important clarification on language because this is where it gets confusing. SIT and HIIT are on the same spectrum with SIT being the more intense. The line between them is intensity and duration. Protocol one is Dr. Gibala’s SIT protocol, published in his research, three times a week.

Three minutes easy warm up. Twenty seconds all out sprint. Two minutes of recovery. Twenty seconds of all out sprint. Two more minutes of recovery. Twenty seconds of all out sprint. Two minutes of recovery or a cool down. Total time is 10 minutes and 60 seconds of hard work. Gibala told his study participants to sprint as if they were running to save a child from an oncoming car, nine or 10 out of 10. You cannot hold a conversation. You should feel it. This is the advanced end. This is not where most of us are going to start.

Protocol two, the Gibala HIIT protocol. So it’s a 10 by 1. Also published research from his lab and it is more accessible but still hard nonetheless.

Three to five minutes of an easy warm up. Then one minute of hard effort, seven or eight out of 10. One minute very easy recovery. Repeat 10 rounds. Three minute cool down. Total time is somewhere between 20 and 25 minutes. You can apply this to anything that you already enjoy. Biking, elliptical, pool, whatever cardio is your favorite. You need a timer app and I’ll link a free one into the show notes and whatever you’ve already got.

If you love steady state cardio and you’re not ready to give it up, I hear you. I’m not asking you to. Swapping even one session a week for a true HIIT protocol gives your body a different stimulus and a lower cortisol load. Your body adapts to what you always give it. Novelty matters. And most people find intervals more interesting than 45 minutes of steady slogging. You’re focused, you’re not watching the clock, you’re done.

EQUIPMENT OPTIONS

So what equipment do you actually use? The bike is the gold standard for research, stationary or a spin bike. This is what Dr. Gibala’s studies used, but you can go from anywhere to warm up to all-out intensity without injury risk. If you have access to one, this is a good place to start.

You can also use an elliptical, which is low-impact full-body, and easy to spike your intensity.

Stair climbing. Dr. Gibala mentions this directly as an equivalent.

Bodyweight, you can use jump squats, burpees, jumping jacks. These work, though it’s harder to sustain in a true all out effort across all of your intervals.

Running and rowing are both excellent. If you’re experienced, then go for it. If you’re not, do not start your first sprint interval session on a treadmill at a pace that you’ve never run. Bike and elliptical are safer entry points.

PROGRESSION: WHERE YOU ACTUALLY START

Okay, here is where I want to get real with you because most exercise content skips this exact part. These protocols are goals. They are not day one.

Here is my story. After reading Next Level, which I cannot recommend enough, I was rebuilding. Walking. Resistance training twice a week, sometimes only once. That was it. I made a list of the interval exercises from the book, got excited, tried one of Stacy’s protocols, three rounds, 30 seconds on, 30 seconds rest, for three sets. I could not even finish one round. Completely gassed. This is not a story of failure. This is just what my starting point was.

This is a skill. Your cardiovascular system needs time to adapt. Your connective tissue also needs time to adapt, especially important for jumping, which we’ll get into in episode 24. You have to build in gradually to protect your joints and your ACL. This matters in perimenopause because connective tissue is affected by estrogen.

So here’s what I want you to do if you’re starting from scratch. Week one, after your warmup, do 30 seconds of something to get your heart rate up, brisk walk, fast pedal, a flight of stairs. Then recover fully two to three minutes. Once, cool down, done.

Week two, do it twice.

Week three, add a third or extend your sessions to 45 seconds.

You and I are not training for the Olympics, friends. We are trying to make it through the week, feel good and live our best lives. The goal is something that fits in your life, challenges your body just enough and that you will actually do again next week.

And here’s something nobody tells you. If you’re already doing resistance training consistently, you have more cardiovascular fitness than you think. The research is strong in this. Resistance training meaningfully improves cardiovascular fitness, even without dedicated cardio work. The American Heart Association put out a scientific statement on this in 2023, and we’re gonna go deep on that in episode 23. So, if you’ve been lifting and you think that you have no cardio base, you have more than you realize.

THE WALKING FOUNDATION

I want to make sure that we don’t leave walking behind, because it does something that none of the above does. It doesn’t spike cortisol. And while walking is generally zone one, too low intensity to build cardiovascular fitness the ways that intervals do, what it does do for your metabolic health and your longevity, and this one surprised me, and your pain is genuinely significant.

So on the blood sugar front, a 10 minute walk after a meal, not a workout, just a walk, produces measurably lower peak glucose than sitting still. If you’ve been with me since episode 20 on CGMs, you already know this. Your muscles act as a glucose sponge when you move, and even a gentle walk activates that mechanism.

On longevity, a 2025 meta-analysis in the Lancet Public Health covering 57 studies and more than 160,000 people found that people who walked 7,000 steps a day had a 47% lower risk of dying from any cause and a 25% lower risk of cardiovascular disease compared to people walking only 2,000 steps a day. That is an enormous effect for something as simple as walking. And by the way, that 10,000 step goal originated from a Japanese pedometer marketing campaign in the 1960s. There was no science behind it. Turns out 7,000 is where the most benefit accumulates, though more is still better, up to about 10,000.

On pain, and this one really, really surprised me, and I want you to hear it, especially if you’re in a season where everything aches and movement feels like the last thing that you want to do. Staying still makes it worse.

A large Norwegian study following more than 10,000 adults over seven to eight years found that people who were more physically active had significantly higher pain tolerance and a meaningfully lower chance of developing chronic pain later. Even a small increase in activity like going from light to moderate was associated with a 5% lower risk of developing chronic pain. A 2024 randomized controlled trial in the Lancet found that people with a history of low back pain who followed a progressive walking program went nearly twice as long before their pain came back. 208 days versus 112 in the group that did walk.

The mechanism makes sense. Regular movement reduces what’s called central sensitization, your nervous system tendency to amplify pain signals over time and support your body’s own natural pain inhibiting pathways. Movement is not just prevention. It is a form of medicine.

So on the days when you don’t feel like it, when everything hurts, when you’re tired, when the couch is winning, the research says walking will not make it worse. It will probably help. Not a hard workout, not a HIIT session, just a simple walk. The walk is not your consolation prize. It is a legitimate tool and you should use it when it works.

YOUR ACTUAL PRESCRIPTION: THE STRESS CUP FRAMEWORK

Here’s how to think about how all of this together. Your movement prescription is not static. It is not what you did at 32. It needs to respond to where you actually are right now. If your cup is full, hard season, poor sleep, high stress, coming through something, walk 20 minutes after a meal if you can, short resistance training twice a week, nothing that sustains a high cortisol load. This is not giving up. This is not tapping out. This is being smart about working with your body.

If your cup has some room, managed but stretched, add one HIIT session on a bike. Maybe a 10 by 1. 25 minutes total. See how your recovery over the next few days comes. If you feel energized, you’re sleeping well, not more depleted, add a second session.

If your cup is in good shape, you’re thriving, sleeping, managing stress, two to three sessions of resistance training, one to two SIT or HIIT sessions and then walking as your daily foundation. That is the goal.

Exercise is a dose. Too much of the wrong thing at the wrong time is not helpful. Pay attention to your recovery, your sleep, your energy at the end of the day. Your body is talking to you in perimenopause. It is worth listening.

A NOTE ON FASTING

One more thing that belongs here. Fasting is also a stressor. It raises cortisol and I see women stacking fasting on top of perimenopause, on top of poor sleep, on top of high intensity training. And then they wonder why they feel terrible. Episode 15 goes deep on this, the short version. If your cup is full, fasting is not the tool for right now. Not because it’s bad, but because everything needs context.

HOW DO YOU KNOW IF IT’S WORKING

I know what some of you are thinking, Megan I’m not gonna go get my VO2 max tested. I’m a real person. You’re right, most of us aren’t going to a sports performance lab. So if you’ve done that, genuinely excited for you, please share your experience. But for the rest of us, here’s what actually matters. Your cardiovascular fitness shows up in your life, not in a treadmill with electrodes. Your actual daily life.

So here’s your real world fitness test. Remember to check in on these as you go. How many flights of stairs you can climb without getting winded. And can you do it breathing only through your nose? That is actually evidence-based. Nasal breathing is adequate for low to moderate aerobic effort. And being able to sustain it means that your aerobic system is working efficiently. If you’re gasping through your mouth to get to the second floor, that’s information. If you can get to the fourth floor breathing through your nose and have a conversation at the top, that is real progress from the training that you’re doing.

Can you carry the laundry without taking a break? Can you get the groceries in the car, into the house, and onto the counter without feeling spent? Can you walk uphill without your heart rate going through the roof? Can you play with your kids or the dog and actually keep up? Can you make it through a long day on your feet without collapsing by 4 p.m.?

These are your metrics. In six weeks of consistent movement, walking, one HIIT session, resistance training twice a week, come back to these. Notice if the stairs feel different. Notice if the groceries feel lighter. That is your data. That is your VO2 max translated into real life. And if you’re tracking your HRV or using a wearable, use it. But don’t let the absence of a lab testing convince you that you can’t make measurable progress. You can measure it every day in how you move through the world.

SERIES PREVIEW

Here’s what’s coming. Episode 23 is all going to be resistance training, the progressions, the clinical picture, what to prioritize in perimenopause, and the American Heart Association finding on resistance training in cardiovascular health that I want to share with you.

Episode 24, jumping, bone health, and Dr. Stacy Sims protocols. Because jumping is one of the few things that directly builds hip bone density rather than just maintaining it, and it has real cardiovascular benefits. A two for one, and I’m very excited to get into that.

The decision tree for this series lives in the show notes for all three episodes. It’s there for you to reference at any point in time.

SHARE THE EPISODE

Before I let you go, if this landed for you, send it to one woman who needs to hear it. Just one. The friend who says that she doesn’t have time to exercise. The one exhausted in doing everything right and can’t figure out why she feels worse. The one who has been going to high intensity classes for years and her body is starting to rebel and she doesn’t know why. Text her a link. This reminded me of you. That’s it. It helps another woman find the show and it helps me keep making them.

OUTRO

All right, my friends. Your movement framework for perimenopause. The best workout is the one that you will do. Your stress cup is real and it matters. Resistance training is coming. All of it next week. Short, smart cardio beats the long cortisol spiking cardio most of us have been using. Interval training means real recovery built in, not an hour of intensity. Walking is not nothing. It is medicine for your blood sugar, your longevity, and your pain. And your prescription should match where you actually are right now, not where you think you should be.

Everything from today is in the show notes. If you haven’t done it yet, please subscribe or rate or leave a review wherever you listen. It matters more than you know. See you next week.