By Dr. Sarah Crawford, PT, DPT
Founder of WAVE Physical Therapy + Pilates
We hear this all the time: “I got the menopause belly…what do I do?” Often, these women have been sold a bill of goods that high intensity interval training (HIIT) is what they need to shed those pesky pounds. But it’s not just weight gain they complain of, it’s also fatigue, or changes in energy, the societal norm says to “go harder.” Enter high-intensity interval training (HIIT) — fast-paced, sweat-drenched workouts that promise fat loss, toned muscles, and improved metabolism. While these benefits sound appealing, they don’t tell the whole story — especially for women navigating the hormonal rollercoaster of perimenopause.
The truth? More isn’t always better. In fact, during this life stage, workouts that are too intense may be contributing to the very symptoms women are trying to manage — not solving them.
Let’s break down what’s really going on beneath the surface.
The Hormonal Landscape of Perimenopause
Perimenopause, the transitional window before menopause, brings with it natural fluctuations in estrogen, progesterone, and testosterone. These hormones don’t just affect reproductive health — they influence everything from sleep and energy to mood and metabolism.
Estrogen, for example, plays a protective role in muscle recovery, joint health, and stress resilience. As estrogen levels become erratic, the body’s ability to respond to and recover from stress — including physical stress like exercise — becomes compromised.
Then there’s cortisol: your body’s primary stress hormone. During perimenopause, your system becomes more sensitive to cortisol spikes. High-intensity training can lead to repeated elevations in cortisol, which, if not properly balanced with recovery and rest, can contribute to:
- Fatigue
- Sleep disruption
- Increased abdominal fat
- Muscle breakdown
- Suppressed immune function
In short, intense exercise becomes a double-edged sword — potentially helpful in small, well-timed doses, but harmful when it’s the main course of a fitness routine.
What About Cardio and Interval Training?
Here’s where it gets interesting. Interval training — alternating periods of higher effort with lower effort — can be beneficial. The key is how that intensity is defined.
I was recently interviewed in the Washington Post exploring the Japanese method of “interval walking.” This approach, developed by researchers in Japan, focuses on walking at a brisk pace for three minutes followed by an easier pace for two minutes — repeated over a 30-minute session. It’s not about pushing to your absolute max; it’s about rhythmically challenging the cardiovascular system without tipping over into fight-or-flight mode.
This form of training yields impressive benefits: improved aerobic fitness, better blood pressure regulation, and enhanced strength and balance — all without spiking cortisol the way HIIT often does.
Why This Matters for Midlife Women
Many women in perimenopause feel betrayed by their bodies– I know I certainly feel like my brain is turning to mush. The frustration that comes with workouts that don’t translate into stronger muscles, sleep that never feels restorative and the constant struggle to find words is palpable. Their bodies feel inflamed. And they wonder if they need to work even harder, eat more protein and drink more water.
This blog is here to say: no, you don’t. You just need to work smarter — in a way that supports your physiology rather than fighting against it.
Interval walking offers a sustainable, stress-regulating alternative to traditional HIIT. It allows women to experience the benefits of interval-style training — like improved heart health and insulin sensitivity — without adding more pressure to an already taxed system.
How to Get Started
If you’re in the thick of perimenopause and unsure where to start, consider this simple approach:
- Walk 5 days a week
- On 2–3 of those days, try interval walking: Walk briskly for 3 minutes, then slow down for 2 minutes. Repeat for 30 minutes total.
Make sure you can breathe through your nose and hold a conversation during most of your walk. If you’re gasping for air or collapsing afterward, you’ve likely pushed too hard.
Add in a few strength sessions per week (also moderate in intensity), prioritize sleep, and ensure you’re eating enough — especially protein.
To put a bow on it (no pun intended)
Perimenopause isn’t a problem to fix. It’s a transition to move through — with wisdom, strategy, and compassion.
We need to let go of the “no pain, no gain” mindset once and for all. It’s time to listen to what your body actually needs — not what diet culture or Instagram says it should want.
You don’t have to stop exercising. But you might need to redefine what progress looks like. And that might just mean trading in your burpees for a pair of walking shoes.