As women approach midlife, exercise goals often shift — and for many, that means tackling the dreaded "meno belly," the increase in abdominal fat driven by hormonal fluctuations during perimenopause and menopause. But experts say fitness during this stage of life should go far beyond weight loss.

A Three-Pronged Approach to Midlife Fitness

Dr. Stephanie McNally, Medical Director at the Katz Institute for Women's Health, emphasises that fitness in midlife should focus on three core areas: cardio for heart health, weight training for strong bones, and balance exercises to prevent falls and injuries. These three elements work together to protect against disease and maintain mobility.

Rather than fixating on the number on the scale, she encourages women to reframe their goals: "Is your body composition changing? Is your strength changing? Is your endurance changing? Does your cardiovascular health improve? Did your blood pressure go down?" These are the markers that truly matter for long-term wellbeing.

Get Your Heart Pumping – Cardio Is Non-Negotiable

Cardiovascular disease remains the number one killer of women, and risk factors begin to shift significantly during midlife. Regular cardio should be an integral part of any fitness routine — but that doesn't mean you need to jump into high-intensity training immediately.

At this stage, Dr. McNally advises focusing on intermittent elevation of your heart rate, followed by maintenance periods. Before starting anything new, she recommends getting a cardiac risk assessment and consulting your doctor.

For those with joint concerns, low-impact alternatives like ellipticals, swimming, or cycling can provide excellent cardiovascular benefits without the stress of high-impact activities. The key is finding something your body can handle and that you actually enjoy — consistency matters more than intensity.

Lift Weights – Protect Muscle and Bone

Regular weight training helps counteract sarcopenia, the age-related loss of muscle mass. At this stage, however, the goal isn't building bulk — it's preserving lean muscle, which supports both cardiovascular and metabolic health.

Weight training also benefits bone health. "The pressure that we're putting on our bones triggers the cells that help build bones to stabilise," Dr. McNally explains. For women at higher risk of osteoporosis, targeted strength work is especially important. Since many falls result in wrist fractures, for example, exercises that strengthen the wrists and forearms can be particularly beneficial alongside general lower-body work.

Improve Balance – Prevent Falls and Protect Bones

Balance training is the often-overlooked third pillar of midlife fitness. With osteoporosis risk higher in women, fall prevention becomes critical. Low-impact, core-strengthening exercises such as tai chi, yoga, and floor Pilates help build stability and coordination.

"It's not just strength — it's strength and balance, or you'll topple over," Dr. McNally notes. Building a strong foundation now means fewer injuries and better mobility as the body continues to evolve.

Small Daily Movements Add Up

Beyond formal workouts, incorporating fitness into daily life is equally important. "Exercise snacks" — small bursts of activity like lifting a heavy bag, carrying groceries, or parking further from the store — can help build long-term health. "It's kind of finding small ways to add something back into your life that will help build up that long-term health," Dr. McNally says.

Putting Yourself First

For many women, midlife coincides with increased responsibilities — careers, caregiving, and managing households often take priority. Dr. McNally reminds women to give themselves permission to prioritise their own wellbeing: "If it was for somebody else, you'd be bending over backwards. Give yourself the grace to put yourself first for a few minutes a day."

Final Thoughts

Exercise during menopause and perimenopause is about more than weight management. It's about protecting your heart, strengthening your bones, improving your balance, and preserving your independence for the long run. A combination of cardio, weight training, and balance work — alongside small, consistent daily movements — offers the best approach for staying strong, healthy, and active through midlife and beyond.