Dr. Stacy Sims on 5 Benefits of Lifting in Perimenopause

Dr. Sims frames resistance training as a baseline for independent living. She notes that as women age, the decline in fast-twitch fibers and power output translates into real-world difficulties—slower running pace, inability to open a jar—that can appear before other menopausal symptoms. The goal of training, therefore, is to preserve speed and strength so that everyday activities remain easy. 'Baselining' means training the nervous system to maintain fast-twitch recruitment, which is crucial for tasks like placing an object overhead—a predictor of functional independence. This isn't about aesthetics or even muscle mass; it's about retaining the neuromuscular capacity to live on your own terms.

While brain health discussions often spotlight crossword puzzles or cardio, Sims insists that strength training is one of the best interventions for maintaining neuroplasticity. She says it allows the brain to 'keep understanding and morphing and learning,' building cognitive reserve that can protect against decline even into the 80s and 90s. The recommendation is not limited to older adults; she explicitly says 'starting now,' meaning younger people should prioritize lifting as brain insurance. The complexity of coordinating movements under load may be key, though she doesn't prescribe a specific dose.

Sims places confidence as the paramount outcome of strength training, above all physiological markers. She contrasts the exhilaration of leaving the gym after a heavy lift—'taking up space,' feeling energized—with the demoralization of high-intensity intervals. She argues that giving people the ability to lift and feel strong is the fastest way to build exercise confidence and sustain participation. Her own story of transitioning from extreme endurance events (Ironman, ultrarunning, pro cycling) to preferring short, strength-focused sessions exemplifies the psychological shift: the confidence gained from lifting taught her to enjoy exercise again, and she now finds long endurance workouts unpalatable. For practitioners, this protocol suggests that introducing clients to lifting first—before pushing for cardio or high-intensity work—can create a foundation of self-efficacy and long-term compliance.

Dr. Sims describes that in her practice, women come to her complaining that their running pace has slowed and they can’t open jars anymore—signs of fast-twitch fiber and power loss. She emphasizes that this occurs before the classic perimenopausal symptoms, driven by early hormone fluctuation. The same pattern appears in younger athletes on the brink of amenorrhea from low energy availability, suggesting that estrogen-related decline in neuromuscular performance is a universal early signal. She notes that changes in strength and power metrics precede any measurable change in aerobic or anaerobic capacity, so monitoring these metrics can offer early insight. This reframes resistance training not just as a countermeasure for sarcopenia in later years, but as a biomarker of hormonal health across the lifespan, with far-reaching implications for pre-emptive intervention.

Sims argues that as brain health becomes a more urgent topic for all ages, strength training should be the front-line intervention. It doesn’t just build muscle; it acts on the brain by increasing neuroplasticity—the brain’s capacity to rewire, learn, and adapt. This protective effect begins immediately and persists into the 80s and 90s, potentially delaying cognitive decline. She frames this as a way to 'protect it starting now,' making a strong case that younger individuals should prioritize lifting not just for body composition, but for long-term brain resilience. The exact mechanism isn’t detailed, but she implies that the complex neuromuscular demands of resistance exercise directly stimulate brain-derived growth factors and synaptic plasticity.

After listing physical benefits, she declares that confidence is the biggest thing, then engages the audience by asking who lifts and how they feel afterward—powerful, energized, 'taking up space.' She contrasts this with the demoralizing feeling after sprint intervals, which she personally finds defeating. Despite an extensive endurance pedigree (Ironman, pro cycling, ultraruns), she now dislikes anything over an hour and credits lifting for teaching her to love exercise again through confidence. For practitioners, this means helping novices or lapsed exercisers build confidence through lifting is the most effective way to foster long-term habit. The psychological boost creates a positive feedback loop that sustains physical activity, making it a superior entry point than activities that feel punishing.