Rethinking physical activity in midlife

7min read

Picture the life you want ten years from now. A coastal walk with friends that doesn’t leave you needing a lie-down. Getting up from the floor without a second thought. Lifting your own suitcase into an overhead compartment.

Most people know physical activity helps preserve independence. But there is more to it. Skeletal muscle helps regulate blood sugar, provides building blocks for repair and releases signals that affect metabolism and inflammation, with possible effects on the brain and mood.

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One thing worth knowing: Skeletal muscle accounts for around 70–80% of glucose uptake from the bloodstream in response to insulin. Contracting muscle can also take up glucose without depending on insulin, so moving after a meal may help dampen the rise in blood sugar. Regular training improves this response over time. [1–3]

One thing to ponder: When skeletal muscle contracts, it does more than produce movement. It helps regulate glucose directly and releases signals that influence how the body manages fuel and inflammation, while also communicating with the brain. What might change if you saw movement as a way of supporting your whole body?

One thing to experiment with: After one meal each day, move for five minutes, gradually building towards 10–15. It could be a walk, a few squats or calf raises, or dancing to a song you love. It may help dampen the rise in blood glucose after the meal and is a practical place to begin. [3]

Muscle health matters across the lifespan

Skeletal muscle provides both strength and power. Strength helps us carry shopping or lift a suitcase. Power is the ability to use that strength quickly, as when rising from a low chair, crossing a road briskly or catching our balance after a stumble.

Muscle also stores some of the glucose absorbed after a meal as glycogen, ready to fuel later activity. Insulin normally reduces glucose release from the liver and signals muscle and fat tissue to take up glucose for use or storage. When these tissues become less responsive to insulin, the pancreas must produce more to manage the same amount of glucose. This is insulin resistance.

Muscle contraction opens another route, allowing active muscle to take up glucose without relying on insulin. Regular training also improves insulin sensitivity and the muscle’s capacity to use and store glucose. Together, these effects support better blood sugar regulation and help reduce the risk of type 2 diabetes. [1,2]

Skeletal muscle protein is the body’s largest reserve of amino acids. During serious illness, injury or surgery, the body may break down muscle to provide building blocks for wound healing, immune responses and other essential proteins. Less muscle means less reserve when appetite and activity fall, which can make it harder to regain strength and function.

This reserve can change surprisingly quickly. In one study, healthy older adults confined to bed for only ten days lost almost a kilogram of lean tissue from their legs, and their strength declined. [4] Resistance training shifts the balance towards rebuilding and preserving muscle. During fat loss, it also helps limit the muscle lost alongside fat. [5]

When skeletal muscle contracts, it influences other parts of the body

Managing glucose is only part of what skeletal muscle does. When it contracts, it releases signalling molecules, including proteins called myokines, which communicate with other tissues and organs.

IL-6 is one of the best studied. The brief rise produced during exercise helps coordinate the supply and use of fuel and stimulates anti-inflammatory signals. This is different from IL-6 that remains chronically elevated, which can be associated with ongoing inflammation. [6]

The communication between muscle and brain is particularly interesting. Lactate produced during activity can enter the brain and be used as fuel. Animal research suggests it may also activate pathways involving BDNF (brain-derived neurotrophic factor), a protein involved in neuroplasticity, the brain’s capacity to adapt. Human studies show that exercise can increase circulating BDNF, although the precise chain of signals between muscle and brain is still being mapped. [6,7]

Exercise also reduces symptoms of depression and anxiety. The effect probably comes from biological, psychological and social pathways working together, including changes in inflammation and brain signalling, better sleep, greater confidence in what the body can do, and the structure or connection that activity can bring. No single molecule explains it. [8,9]

Physical activity and cancer

Large observational studies associate greater physical activity with lower mortality and a lower incidence of several cancers. They cannot prove that physical activity directly caused the difference because other health and lifestyle factors may also contribute. Even so, the authors concluded that the findings support regular aerobic and muscle-strengthening activity for health and longevity. [10,11]

The CHALLENGE trial went further. It randomly assigned people who had completed standard treatment with surgery and chemotherapy for high-risk stage II or stage III colon cancer to a structured exercise programme or health education alone. Exercise was added after standard treatment, not instead of it.

Those assigned to exercise lived longer and remained free from cancer recurrence and a new cancer for longer. At eight years, an estimated 90% of the exercise group and 83% of the health-education group were alive, an absolute difference of about 7%. In medical terms, an absolute difference of about 7% in overall survival is impressive, particularly for a physical activity programme added after standard treatment. [12]

The programme consisted mainly of aerobic activity and included support from exercise specialists. The underlying mechanism, why it helped remains open. Better insulin regulation, lower inflammation, changes in immune surveillance, better body composition and other exercise-induced signals could all have contributed.

Why physical activity matters during and after menopause

Postmenopausal women retain the capacity to build muscle and become stronger, whether or not they use menopause hormone therapy. The size of the response varies, but skeletal muscle continues to respond to an appropriate load during and after menopause. [13,14]

Bone responds too, although it needs more than one kind of stimulus. Resistance exercise creates tension through the pull of muscle, while impact provides a different stimulus when the body meets the ground. The two overlap, but they are not interchangeable. Both can help maintain or improve bone density. A review of programmes lasting at least six months found small to moderate improvements at the spine, femoral neck and hip in postmenopausal women. [15,16]

Everyday movement remains valuable, although maintaining bone density may require greater loading than comfortable daily activity provides. Anyone with osteoporosis, a history of spinal fracture or a recent fracture should seek individual advice before changing the type or intensity of activity.

Training provides the stimulus for muscle adaptation, while protein supplies the amino acids needed for repair. During weight loss, higher-protein diets can help older adults preserve modestly more muscle. [17] Once protein intake is adequate, however, adding more produces diminishing returns. A supplement is useful only when it fills a genuine gap. More protein does not create more muscle without an appropriate training stimulus. [18]

Some other benefits are possible but less certain. A review of 22 trials found small improvements in working memory and mental flexibility after resistance training, although it was not consistently more effective than other forms of exercise. [19] This offers a reasonable basis for women who notice clearer thinking after activity, but menopause-related brain fog has not been studied well enough to predict who will improve.

Hot flushes are another interesting area of interest. In one trial of previously inactive postmenopausal women, resistance training reduced moderate-to-severe hot flushes by 43.6%, compared with 2% in the control group. [20] One trial cannot tell us how well this will work more widely, but it is a signal worth taking seriously.

The Menopause Society advises that MHT is the most effective treatment for hot flushes and night sweats and may be considered when there are no contraindications, following an individual assessment. [21] For women who cannot use MHT, or who prefer to explore additional options, physical activity is worth trying. It may help with hot flushes, brain fog or mood. If symptoms do not change, its wider health benefits remain.

Joint aches and stiffness are also common around menopause and are not always explained by injury or joint disease. Regular movement may help some women feel less stiff and move more comfortably, although the evidence cannot yet tell us which type of activity is most likely to help. [22] Of course, persistent or worsening pain, swelling or loss of function deserves medical assessment.

Strength is one part of a bigger picture

Different forms of activity do different jobs. Resistance training develops muscle and strength. Aerobic activity develops cardiorespiratory fitness. Balance work practises the coordination needed to reduce falls.

UK guidance recommends at least 150 minutes of moderate aerobic activity or 75 minutes of vigorous activity each week, together with muscle-strengthening activity on at least two days. Older adults are also advised to include activities that improve balance and flexibility twice a week. These are goals to work towards for long-term health, not thresholds below which movement has no value. Brief periods of activity still count and can be spread across the day. Sometimes called exercise snacks, they can make activity easier to fit into daily life, although they do not provide all the benefits of a more complete programme. [23,24]

In Summary

Skeletal muscle remains responsive throughout midlife. Using it supports strength and power, helps regulate blood glucose and releases signals whose effects travel beyond the muscles doing the work. Physical activity does far more than burn calories, and something is always more useful than nothing.

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If you want help working out what's worth your effort and what isn't, book a free discovery call. It's a friendly conversation. You'll leave clearer on what actually drives results in midlife, whether or not we work together.

References

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