What the Latest Exercise Research Really Means for Women's Heart Health

By Dr. Daniela Steyn

For years, women in menopause have been told to “exercise more.”

But what does the science actually show?

A recent paper published in the British Journal of Sports Medicine sparked debate in the medical world after suggesting that physical activity may have a smaller direct effect on cardiovascular disease than previously believed.

At first glance, that sounds alarming.

It is not.

In fact, the study reinforces one of the most important truths I discuss with my patients every day:

Exercise remains one of the most powerful interventions for women in perimenopause and menopause.

What the Study Actually Found

The 2026 study by Liang and colleagues examined both:

• Moderate to vigorous physical activity (MVPA)

• Cardiorespiratory fitness (CRF)

The researchers found that once fitness was accounted for, the “independent” effect of physical activity on cardiovascular disease became smaller.

Some interpreted this to mean: “Exercise does not matter as much as we thought.”

That interpretation is misleading.

Why?

Because physical activity improves cardiovascular health largely through improving fitness.

Removing fitness from the equation is like saying: “How much does studying help students after we subtract the effect of learning?”

The benefit pathway is the point.

My Perspective as a Physician and Athlete

I have had many thoughtful discussions with my patients at Wellness MD | Premier Menopause Lifestyle Medicine Clinic Canada regarding the latest study published in the British Journal of Sports Medicine and its clinical implications for women in menopause.

As an avid triathlon athlete representing Team Canada in my age group, I am deeply passionate about the science behind exercise, fitness, longevity, and cardiovascular health.

Importantly, the broader evidence base continues to strongly support the current recommendation of at least 150 minutes of moderate physical activity weekly.

A major Journal of the American College of Cardiology Focus Seminar reported that adherence to WHO physical activity guidelines is associated with:

23 to 40 percent reductions in cardiovascular disease

27 to 31 percent reductions in all cause mortality

The data also demonstrated an inverse curvilinear relationship, meaning the greatest benefit occurs when individuals move from inactivity to moderate activity.

This is incredibly encouraging for women who feel overwhelmed or intimidated by exercise.

You do not need to become an endurance athlete to improve your health.

Even “weekend warrior” exercise patterns, approximately 75 minutes weekly, have been associated with measurable reductions in cardiovascular mortality compared to sedentary behavior.

Another landmark study by Tikkanen and colleagues, using over 500,000 participants from the UK Biobank, demonstrated that cardiorespiratory fitness was strongly associated with reduced cardiovascular disease risk, including:

• Coronary heart disease

• Atrial fibrillation

Importantly, while fitness was the stronger predictor, physical activity itself still independently contributed to cardiovascular protection.

Why This Matters So Much in Menopause

During perimenopause and menopause, estrogen declines affect:

• Muscle mass

• Visceral fat accumulation

• Insulin sensitivity

• Blood pressure

• Cholesterol metabolism

• Brain health

• Sleep quality

• Mood regulation

This is why many women suddenly feel:

• More fatigued

• Less strong

• More inflamed

• More anxious

• More resistant to weight loss

Exercise is one of the few interventions that positively impacts all of these systems simultaneously.

The Real Goal Is Fitness

The paper highlights something incredibly important:

Cardiorespiratory fitness may be one of the strongest predictors of long term health and longevity.

In practical terms:

• Can you walk uphill without becoming breathless?

• Can you carry groceries easily?

• Can you recover quickly after exertion?

• Can you climb stairs without exhaustion?

Fitness is not about aesthetics.

It is about metabolic resilience.

It is about preserving independence, cognitive function, cardiovascular health, and quality of life as we age.

What Type of Exercise Should Women Focus On?

The evidence consistently supports a combination of:

1. Strength Training

This becomes non negotiable in menopause.

Resistance training helps:

• Preserve lean muscle mass

• Improve insulin sensitivity

• Protect bone density

• Improve posture and joint stability

• Increase resting metabolic rate

Even two to three sessions weekly can create major changes over time.

2. Cardiovascular Training

Walking, cycling, swimming, jogging, rowing, dance, hiking, and tennis all count.

The current recommendation of approximately 150 minutes weekly of moderate activity remains strongly evidence based.

Importantly, the greatest health benefit occurs when women move from inactive to moderately active.

You do not need perfection.

You need consistency.

3. VO2 and Fitness Challenges

Short bursts of higher intensity training can help improve cardiorespiratory fitness more efficiently.

Examples include:

• Incline walking

• Hill intervals

• Cycling intervals

• Swimming sprints

• Short resistance circuits

This is particularly powerful for metabolic and cardiovascular health.

The Biggest Mistake I See

Many menopausal women dramatically reduce exercise because:

• They feel exhausted

• They are more likely to have joint inflammation

• Slower recovery after exercise/ after injury

• Sleep worsens (for some, for others sleep becomes a disaster, see your health care provider urgently if sleep is a concern for you, I will write another newsletter about the critical impact of sleep and how to improve it with/without hormones. Feel free to look at my YouTube videos/listen to my podcasts on how to improve sleep during menopause).

But menopause is not the time to stop moving.

It is the time to train smarter. Personalize your own approach. Start with walking.

At Wellness MD, we focus heavily on Lifestyle Medicine pillars:

• Movement

• Nutrition

• Sleep

• Stress management

• Social connection

• Behavioural change

Hormones can help some women significantly. I do prescribe hormones every day in my clinic and see the tremendous positive impact it has on sleep, mood, energy and muscle mass.

However, I firmly believe exercise remains foundational.

Not for weight control, but more importantly:

For longevity.

For cognition.

For cardiovascular protection.

For confidence.

And for helping women feel like themselves again.

The Bottom Line

The Liang et al. paper answers a narrow and specific scientific question: How much does moderate to vigorous physical activity reduce cardiovascular disease risk after subtracting out the fitness pathway?

The answer, modestly, is expected.

This does not undermine the current exercise guidelines.

In fact, it reinforces the importance of improving fitness through movement.

The public health message remains unchanged: Most people are still not meeting the minimum movement recommendations, and achieving even moderate levels of activity confers substantial cardiovascular and longevity benefits.

For women in menopause, exercise remains one of the most powerful prescriptions we have.

If you are in menopause and feeling overwhelmed, start small.

A walk counts.

Two strength sessions weekly count.

Ten minutes count.

Your future brain, heart, bones, and metabolic health are listening to every movement you make today.