Asian woman holding glass of water in one hand and vitamins in another

Top 6 Supplements for Women 40+

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By Maya Shetty, BS and Felicia Song, BS

Midlife marks a significant life transition, bringing hormonal shifts that can reshape a woman’s body and well-being. As women navigate this period, their bodies undergo physiological changes that can impact muscle mass, bone density, metabolism, and overall well-being. Lifestyle factors play a fundamental role in healthy aging, but strategic supplementation can further support women in optimizing their health through midlife and beyond.

Nutrition and exercise researcher at Stanford Lifestyle Medicine Rachele Pojednic, PhD shares evidence-based strategies to help women maintain strength, vitality, and resilience as they age.

Different Supplements for Different Stages of Life

As women age, there are distinct shifts in body composition, and as a result, our nutritional needs change. For example, in our thirties, the focus should be on building and maintaining muscle mass, as bone formation peaks in the late teens and 20s. This foundation is critical because it helps offset the decline in estrogen during perimenopause, which reduces the body’s ability to preserve muscle and bone.

“Research shows that women begin losing skeletal muscle around age 30, with declines ranging from three to five percent per decade, and in some cases, up to 10 percent during the first postmenopausal decade,” states Dr. Pojednic.

After menopause, estrogen and other hormones stabilize at lower levels, making it more difficult for the body to build bone and muscle. Therefore, strength training, a nutrient-dense diet, and intentional supplementation become essential tools not just to mitigate loss of bone density and muscle mass, but to support long-term health.

Also, estrogen has anti-inflammatory properties throughout the body. When estrogen levels begin to decrease during perimenopause, systemic inflammation increases, contributing to a range of health concerns including changes in cognitive function, mood, and sleep. To help counter these effects, strategic supplementation can play a key role in supporting overall health, reducing inflammation, and maintaining balance.

Top 6 Supplements for Perimenopause and Menopause

1) Creatine

Creatine is a tripeptide that is naturally produced by the body and found in animal products. It plays a critical role in energy production and is crucial for maintaining muscle, bone, and brain health. In the body, creatine is stored in the muscles as phosphocreatine, which acts as a fast-acting energy reserve by donating a phosphate group to regenerate ATP, the primary energy currency of cells. This makes muscles more efficient, allowing for improved muscle function and greater overall strength.

“Creatine is one of the most extensively studied supplements in the world, and for good reason,” states Dr. Pojednic. “Recent research has shown considerable benefits in muscle, bone, and brain health.”

Why Creatine Matters for Women 40+

As women age, creatine levels naturally decline. In fact, women tend to have 70 to 80 percent lower creatine stores than men, and this difference becomes even more pronounced with age. This decline can contribute to age-related muscle loss, bone density reduction, and changes in cognitive and emotional health.

Benefits of Creatine Supplementation

  • Muscle and Bone Health

    Research suggests that creatine supplementation can help improve muscle function, increase muscle size, and enhance bone density in peri- and postmenopausal women, particularly when combined with resistance training.

    “By enhancing ATP regeneration, creatine allows women to push their muscles a little harder during exercise, promoting more robust muscle mass and bone strength,” states Dr. Pojednic.

  • Cognitive Health

    The brain relies heavily on phosphocreatine for energy, and low levels can contribute to brain fog and mood changes. Studies have shown that creatine may enhance short-term memory and overall cognitive performance in adults aged 45 to 64.

  • Mood Stability

    Emerging research suggests that creatine supplementation may help offset mood changes associated with perimenopause, including anxiety, depression, and sympathetic overdrive. A recent study found that adding creatine to therapy for depression led to greater symptom improvement compared to therapy alone, highlighting its potential role in brain health as women age.

“Topping off creatine stores may help reduce brain fog, moodiness, and other cognitive side effects often experienced during perimenopause,” states Dr. Pojednic.

How to Supplement with Creatine

Dr. Pojednic recommends that women supplement with three-to-five grams of creatine per day. Timing doesn’t matter, so it can be taken at any time of the day that’s convenient. When choosing a supplement, look for one that uses a water-based wash rather than an acid-based wash, as the latter may cause gastrointestinal side effects.

2) Protein

Protein is a vital macronutrient made up of 20 amino acids, nine of which are essential, meaning they must come from food since the body cannot produce them. These essential amino acids—histidine, isoleucine, leucine, lysine, methionine, phenylalanine, threonine, tryptophan, and valine—are crucial for muscle growth, maintenance, recovery, and overall health.

Why Protein Matters for Women 40+

  • Increased Protein Needs

As women age, their ability to absorb and utilize protein efficiently declines, making adequate protein intake even more critical. Aging leads to anabolic resistance, meaning the body requires more protein and a greater resistance training stimulus to maintain and build muscle. Without sufficient protein, women may struggle to preserve lean mass, recover from exercise, and maintain metabolic health.

“Most women at all stages of life are not consuming enough protein, and this becomes more of a problem with age. While many women consume only 40 to 60 grams per day, research suggests that a more optimal range is 80 to 100 grams per day for muscle maintenance and growth,” states Dr. Pojednic.

  • Muscle and Metabolic Health

Protein is necessary for preserving lean mass, which helps maintain strength, independence, and metabolic function. It also supports post-exercise recovery and reduces the risk of sarcopenia (age-related muscle loss).

How to Get Enough Protein

High-quality animal proteins like meat, dairy, and eggs naturally provide all nine essential amino acids needed for muscle maintenance. Plant-based options such as soy and pea protein can also be effective, but it’s important to ensure they offer a complete amino acid profile. Consuming protein after workouts is particularly beneficial for muscle recovery and growth. Dr. Pojednic recommends women aim for 1.2 to 1.6 grams of protein per kilogram of body weight per day, which translates to a more practical target of 80 to 100 grams.

While a food-first approach is ideal, strategic use of protein powders can help women meet their daily protein needs to support strength, metabolism, and longevity. When choosing a protein powder, look for one that contains all nine essential amino acids and has minimal additives, which can cause bloating or gut irritation. “I opt for unsweetened protein powders to limit additives and sweeten them with ingredients I prefer,” states Dr. Pojednic.

What About Collagen Protein?

While collagen supplements are often marketed for skin, hair, and nail health, collagen is an incomplete protein and does not contain all essential amino acids. It should not be relied upon as a primary protein source over complete protein supplements or whole foods.

3) Vitamin D3

Vitamin D3, in conjunction with calcium (next section), plays a critical role in maintaining bone density, muscle function, and overall health. While commonly associated with osteoporosis and osteopenia prevention, vitamin D is essential for many tissues beyond bone, including the muscles, immune system, cardiovascular health, and cognitive function.

“As women age, they experience a decline in skeletal muscle starting around age 30 and bone mass loss after 40, with both reducing at an accelerated rate during and after menopause,” states Dr. Pojednic. “Supplementation with Vitamin D3 can offer support with both muscle and bone health.”

Why Vitamin D3 Matters for Women 40+

Vitamin D3 is vital for calcium and phosphate regulation, ensuring that bones stay strong and muscles function properly. Additionally, estrogen and vitamin D interact to affect bone health, as estrogen regulates vitamin D metabolism. During perimenopause, declining estrogen levels reduce vitamin D’s effectiveness, making adequate intake even more important.

Key Benefits of Vitamin D3

  • Bone and Muscle Health

Vitamin D plays a critical role in skeletal muscle function and bone maintenance. Deficiency in vitamin D (<50 nmol/L) is strongly associated with age-related muscle weakness and muscle mass loss. Inadequate vitamin D levels (<29 ng/ml) have been linked to poor lower body function, particularly in women, increasing the risk of falls and fractures. Studies have shown that supplementation with vitamin D3 improves muscle strength and function, particularly in postmenopausal women with insufficient levels.

  • Iron Absorption and Recovery

Vitamin D plays a key role in iron regulation by reducing hepcidin levels, which helps improve iron absorption—particularly important for post-exercise recovery. Since training increases hepcidin, which inhibits iron absorption, taking vitamin D after exercise may counteract this effect, reducing the risk of low iron and anemia in active women.

How to Supplement with Vitamin D3

Vitamin D is difficult to obtain from diet alone, as it is naturally found in few foods, including fatty fish, liver, beef, and fortified foods like cereals, dairy, and juice. The body’s main source of vitamin D comes from sun exposure, but in many regions, the sun’s UVB rays are not strong enough to support vitamin D synthesis between October and April.

To ensure adequate levels, supplementation is often necessary. The recommended dose ranges from 800 to 4,000 IU per day, though higher doses can be detrimental to bone health.

“Finding the ‘sweet spot’ is key, as excessive intake of vitamin D offers diminishing returns. Blood testing can help determine individual needs, ensuring levels are sufficient without exceeding optimal ranges,” states Dr. Pojednic.

For best absorption, look for Vitamin D3 (cholecalciferol), the most bioavailable form. Additionally, taking a Vitamin D3 supplement with fat, such as an omega-3 supplement (keep reading for more on this) will enhance its absorption.

4) Calcium

Calcium is a key mineral required for bone rigidity, stability, and muscle contraction, yet many people—especially women—fail to consume enough from their diets. While green leafy vegetables and dairy are excellent sources, many people don’t eat enough of them, and dairy alternatives are often not fortified with calcium. Without sufficient intake, the body pulls calcium from bones, increasing the risk of osteopenia and osteoporosis with age.

“While calcium is crucial for bones, it also plays a role in nerve function, blood clotting, and muscle contractions—making it essential for heart health and overall mobility,” says Dr. Pojednic.

How Much Calcium Do You Need?

The recommended daily intake for women in their 40s is 1,000 mg of calcium per day. “However, balance is key—too little calcium weakens bones, but excessive calcium without proper nutrient pairing may lead to arterial calcification instead of proper bone mineralization,” warns Dr. Pojednic.

5) Omega-3 Fatty Acids (Fish Oil)

Omega-3 fatty acids are essential nutrients because the body cannot produce them, meaning they must come from food or supplements. These powerful antioxidants help scavenge free radicals, reducing tissue damage and supporting cell membrane integrity in every organ. Omega-3s are particularly important for vascular health, keeping blood vessels flexible and reducing the risk of cardiovascular disease and dementia. They also play a key role in brain function, supporting neurons, maintaining myelin, and helping to keep chronic inflammation low.

Why Omega-3s Matter for Women 40+

Estrogen has natural anti-inflammatory properties, offering protection against chronic inflammation throughout life. However, perimenopausal women lose some of this protective effect, increasing the need for anti-inflammatory support through other mechanisms.

Key Benefits of Omega-3s

  • Cognitive Health

Omega-3s may help reduce the risk of Alzheimer’s disease by lowering brain inflammation and supporting nitric oxide production, which promotes blood flow to the brain.

  • Muscle Health

Research shows that omega-3s enhance muscle protein synthesis and mitochondrial function, helping to counteract sarcopenia. Their anti-inflammatory properties may also aid recovery and improve performance in athletes.

  • Inflammation Reduction

Omega-3s help regulate inflammatory cytokines like IL-1 and IL-6, which may support joint health and post-exercise recovery.

How to Supplement with Omega-3s

For optimal benefits, choose high-quality, purified fish oil supplements to avoid contaminants. If possible, prioritize whole food sources such as fatty fish (salmon, sardines, mackerel), which provide a naturally balanced omega-3 profile. While omega-3s have well-documented benefits, most research has been conducted in men, so more studies are needed to fully understand their effects in female athletes and aging women.

6) Fiber

Rather than a supplement, fiber should primarily be consumed in our diet. The current dietary guideline for fiber is 25 grams daily through fruits, vegetables, whole grains, legumes, beans, nuts, and seeds. Fiber is crucial for our gut health, helps to maintain our blood glucose levels and improve insulin sensitivity, and helps to lower LDL (the bad) cholesterol.

“If fiber is not sufficient through diet, I recommend a fiber supplement, such as psyllium husk, inulin, or methylcellulose daily to help you meet the fiber requirements,” says Gray Shimko, RD, leading dietician at the Stanford Menopause and Healthy Aging program.

 

The Importance of Exercise When Taking Supplements

While supplements like creatine, protein, vitamin D3, calcium, omega-3s, and fiber provide the body with essential nutrients for muscle, bone, and brain health, they cannot replace the need for exercise. Strength training serves as the necessary trigger for muscle growth and adaptation. While protein and creatine supply the raw materials for muscle repair, it is the physical act of contracting muscles through exercise that signals the body to build and strengthen them.

“To effectively build and maintain muscle as we age, women must actively engage in resistance training, as muscle follows a ‘use it or lose it’ principle,” states Dr. Pojednic. “Engaging in resistance training at least two-to-three times per week—whether through weightlifting, resistance bands, or bodyweight exercises—helps maintain muscle mass, improve bone density, and support metabolic health.”

Exercise also improves how the body absorbs and utilizes nutrients, making supplementation more effective. For example, creatine supplementation enhances strength and performance, but its full benefits are only realized when paired with resistance training. Similarly, omega-3s can reduce inflammation and support muscle recovery, but their impact is greatest when muscles are actively engaged in movement.

By combining strategic supplementation with regular strength training, women 40 plus can maximize muscle retention, protect bone health, and maintain cognitive function, ensuring long-term strength, mobility, and independence as they age.

Foundational Nutrition Before Supplementation

Lastly, when choosing supplements, quality and transparency are key. Look for third-party tested products to ensure two critical factors: first, that the ingredients listed on the bottle are actually present and in the correct doses. Second, third-party testing verifies that there are no undisclosed or harmful substances, such as heavy metals or adulterants. While supplements should complement–not replace–a nutrient-rich diet, the 40s decade is a pivotal transition, making it especially important to identify and address any dietary gaps.

“Think of supplementation as the icing on the cake—helpful for optimizing health, but most effective when approached with prudence and balance,” says Dr. Pojednic. “Supplements should be viewed as tools for marginal gains, not miracle solutions. Foundational nutrition—getting enough protein, fiber, and healthy fats from our food—remains crucial.”

 

 

 

 

 

 

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Mature woman lifting pelvis off exercise mat

Everything You Need to Know About Pelvic Floor Health

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By Sharon Brock, MS, MEd

For most women, discussions about the pelvic floor are typically tinged with embarrassment. When our pelvic floor muscles (which form a hammock-shaped barrier across the base of the pelvis) are compromised, we can experience a variety of taboo-laden symptoms such as incontinence, constipation, and painful sex. Even though pelvic floor disorders affect twenty percent of women in the U.S. (and more than half of women over 80), many suffer in silence because they are too embarrassed to speak about them, even to their healthcare providers.

“It’s time for us to normalize the discussion,” says Brooke Gurland, MD, FACS, colorectal surgeon and member of the Stanford Medicine Pelvic Health Center. “We don’t talk enough about what happens to women in middle age and beyond. But just like menopause, we need to have more discussions about pelvic floor health with middle-aged women so they can potentially prevent incontinence in their advanced years.”

What is the Pelvic Floor?

Pelvic floor muscles act as a sling that holds the organs within the pelvis in place so they can function correctly. A woman’s pelvis includes organs that serve urinary (the urethra and bladder), reproductive (the vagina and uterus), and digestive (the rectum and intestines) functions.

pelvic floor

 

Pelvic floor disorders (PFDs) occur when pelvic floor muscles and connective tissue are too weak, too tight, or don’t have the coordination to facilitate proper functioning of the pelvic organs. The most common PFDs are urinary incontinence, fecal incontinence, and pelvic organ prolapse (when a pelvic organ drops from its original position).

When Pelvic Floor Muscles are Too Weak

During menopause, women’s estrogen levels begin to decline, resulting in the reduction of muscle mass and decreased capacity for muscle to adapt and recover from strenuous exercise. Also, as we age, we often experience sarcopenia, a decline in muscle mass and function. Women between the ages of 40 and 70 typically lose approximately 25 percent of their peak muscle mass. At 75, a dramatic decline often results in the loss of around 60 percent of peak muscle strength and 30 percent of physical function.

“We need to remember that we are not just losing muscle mass in our arms and legs; our pelvic floor muscles also weaken with age,” says Dr. Gurland. “Just as we need to lift weights in midlife to stay strong and mobile as we age, we also need pelvic floor strengthening activities to potentially prevent PFDs in the future.”

Dr. Gurland’s recommendations for strengthening pelvic floor muscles to reduce incontinence:

  • Physical Exercise – Regularly practice Kegel exercises or other exercises that strengthen the pelvic floor, such as Pilates. To perform a Kegel exercise, contract the muscles you use to stop the flow of urine, the muscles of the perineum (located between the vulva and anus), and the muscles around the anus. “The great thing about Kegels is that you can do them while working at your desk, and no one knows you’re doing them,” says Dr. Gurland. “If you’re having trouble identifying the pelvic floor muscles, I recommend putting a rolled-up washcloth underneath the perineum while sitting in a chair and then tightening and pulling up from there.”
  • Nutrition – Get enough fiber, whole grains, leafy greens and protein to support a well-balanced diet and benefit overall muscle mass.

Along with age-related strength decline of the pelvic floor muscles, childbirth can also cause weakening. Dr. Gurland shares that in France, pelvic floor physiotherapy is part of post-partum care; however, in the US, that care is not standard and pelvic floor care isn’t addressed until after the patient has a problem.

“I want to send the message that we can be proactive about our pelvic floor health and not wait until something goes wrong,” says Dr. Gurland. “PFDs are more common than you think, and you should talk to your provider about what you can do now to reduce their severity as you age and improve the quality of your life into your 80s and 90s.”

When Pelvic Floor Muscles are Too Tight

Although we don’t want our pelvic floor muscles to be weak, we can also experience PFDs when they are too tight. Symptoms of tight pelvic floor muscles include constipation or difficulty emptying the bowels, anal fissure and hemorrhoids, difficulty urinating and painful sex. Chronic stress and trauma can contribute to the pelvic floor muscles being too tight

“People tend to know about strengthening the pelvic floor, but many don’t understand that it’s equally important to relax the pelvic floor muscles to urinate and defecate properly,” says Dr. Gurland. “For example, some people can’t go to the bathroom in public. They feel too anxious, which causes the muscles to tighten up. There’s a mind-body connection. When we are too stressed in the mind, we aren’t able to relax the pelvic floor muscles in the body.”

Dr. Gurland’s recommendations for relaxing pelvic floor muscles and relieving constipation:

  • Stress Reduction – Take deep breaths and visualize breathing into your pelvic floor to relax these muscles before going to the bathroom. Try a full body scan.
  • Elevate Feet – When sitting on the toilet, putting the feet onto blocks or a toilet stool can relax the rectal muscles so you can defecate without straining. “You want to avoid straining to prevent hemorrhoids and prolapse,” says Dr. Gurland.
  • Toileting Time – Carve out time in the morning to relax the body and defecate before starting your workday. “I recommend waking up an hour earlier, having a glass of water, and relaxing so your body can go to the bathroom. If you’re waking up last minute and running out the door, your body doesn’t always comply,” says Dr. Gurland.
  • Nutrition – Drink adequate water daily and consume enough fiber in your diet.

What is Pelvic Floor Physical Therapy?

Regarding our pelvic floor, we can take a cue from Goldilocks. We don’t want them too weak or too tight, so how do we get them “just right”?

“When we talk about pelvic floor health, we consider not only the tightness and weakness but also the coordination of the pelvic floor muscles,” says Dr. Gurland. “For proper rectal functioning, the muscles must be coordinated enough to ‘hold it’ until you’re in the right place, then relax when the time is right.”

Unfortunately, many common things can lead to a loss of coordination of the pelvic floor muscles, such as nerve damage caused by chronic straining, childbirth injuries, back surgery, and radiation.

To help patients have more pliable and coordinated pelvic floor muscles, or that “just right” level of competence in their bladder, bowel, or sexual functioning, Dr. Gurland refers them to a Pelvic Floor Physical Therapist who offers exercises to strengthen, relax, and retrain their pelvic floor muscles to contract properly. This therapy is also recommended for pregnant and postpartum women.

“It is important for the provider and patient to have a good relationship because the work is very personal,” says Julia Barten, DPT, Pelvic Rehabilitation Practitioner at the Stanford Pelvic Health Center. “It may take a few sessions to fully figure out proper control or coordination for pelvic floor muscles and sometimes multiple techniques are required to find the best treatment plan. It helps when there is good communication and the patient has an open mind to treatment recommendations, however, if a patient is not comfortable with a recommendation, it is always best to speak up so that the therapist can modify the program to something that is effective for the individual.”

Pelvic Floor Exercises

1) To strengthen pelvic floor muscles (to prevent incontinence, organ prolapse):

Before starting the exercise, Barten emphasizes the importance of isolating the pelvic floor from other muscles (such as abdominal or gluteal) when building strength. She recommends practicing long holds as well as quick squeezes to address endurance, coordination, and flexibility. Even with quick squeezes, she stresses the importance of full relaxation between each squeeze.

“Pelvic floor strengthening is more than just squeezes. To strengthen the muscles effectively, they must contract and relax within a full range of motion,” says Barten.  “Complete relaxation between each contraction is necessary to effectively build strength.”

Barten recommends these videos for pelvic floor strengthening:

2) To relax pelvic floor muscles (to relieve constipation, painful sex):

“Pelvic floor relaxation can be very difficult to sense,” says Barten. “There are ways to gently stretch your pelvic floor with breath and yoga stretches. It is also possible to gently drop the pelvic floor or bear down to actively lengthen the muscles.”

Barten recommends these videos for pelvic floor lengthening and relaxing:

3) To increase coordination of pelvic floor muscles (to improve incontinence):

Barten says that coordination of pelvic floor muscles is best assessed with an exam and individualized recommendations, but home biofeedback devices (i.e. Kegel exercisers or trainers) can also be helpful. These devices can be purchased over the counter and inserted vaginally to improve a woman’s awareness and control over her pelvic floor muscles.

Lastly, Barten is passionate about breaking the stigma of talking about pelvic floor issues and enjoys creating musical videos to spread awareness about the pelvic floor and bring some humor to the topic. Here she sings about “The Kegel Routine” while parodying a song from the musical Hamilton.

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Mature woman using pink free weights

Strength Training for Women 50+

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By Yasaman Nourkhalaj, BS and Sharon Brock, MS, MEd

If you’re in your 50s, you might have noticed that simple tasks like getting up from the floor or cleaning the bathroom aren’t as easy as they used to be. For decades, women have been bombarded with messages about getting thinner. But around the age of 50, the focus should shift from losing weight to gaining strength. Building muscle isn’t just about looking strong – it’s about living strong and extending your longevity.

The Link Between Age and Muscle Mass

Starting around age 30, muscle mass begins to decline at a rate of about .5 percent per year. When we reach age 50, that rate increases to 1 to 2 percent per year, then increases again to roughly 3 percent per year starting at age 60. This attrition of muscle mass is especially critical for women because estrogen plays a key role in muscle and bone health. The reduction of estrogen levels during perimenopause and menopause accelerates the onset of sarcopenia (age-related loss of muscle mass) and osteoporosis making strength training even more essential as women age for long-term health.

The head of Stanford Lifestyle Medicine Healthful Nutrition pillar, exercise and nutrition scientist, and health researcher Marily Oppezzo, PhD, explains why strength training is essential for women over 50.

“An important thing we can do for our longevity is strength train. And that is true for every age—even if you start training at age 102,” says Dr. Oppezzo. “During menopause, declining estrogen levels directly impact muscle maintenance and development. This natural process can accelerate muscle loss–but here’s the good news: strength training can certainly help combat these changes.”

5 Strength Training Movements for Women 50+

According to Dr. Oppezzo, an effective strength training program should include exercises that have these fundamental movements:

  1. Push movements to strengthen the chest (example exercises: wall push-ups, push-ups with knees on the floor, chest presses with weights)
  2. Pull movements to strengthen the back (example exercises: resistance band rows, rowing machine)
  3. Squat movements to improve ability to sit and stand (example exercises: chair squats — option to wear a backpack with a bottle of water for increased weight)
  4. Hinge movements to protect your back during daily activities (example exercises: hip bridges, dead lifts with weights)
  5. Single-leg movements to equalize strength in both legs (example exercises: step-ups onto a raised platform, single-leg sit-and-stand from a chair)

Sample Strength Training Routine for Women 50+

Here is a sample strength training routine recommended by Dr. Oppezzo for women over 50 to be performed two to three times per week:

  1. Chest Press: While lying on a bench hold your dumbbells in both hands with bent elbows, and push weights straight up toward the ceiling. 3 sets, 8 repetitions.
  2. Resistance Band Row: Wrap a light-medium resistance band around a pole or your feet. Sit on the ground and pull back the bands in a rowing motion, keeping elbows close to the body and hands at the waist, squeezing the back muscles together. 3 sets, 8 repetitions.
  3. Chair Squats: Bring hands together at your chest and slowly sit into a chair with a neutral spine (don’t arch or round) and strong core. Touch your butt to the seat bottom, but do not sit all the way into the chair. Stand back up again. 3 sets, 8 repetitions.
  4. Deadlift: Stand with feet hip width apart. Hinging at the hips with a slight bend in the knee, and keep your back straight, shoulders neutral (not rounded or excessively arched). Engage your core. Slide the weights down the line of your thighs and legs only as far as you can go without rounding your back.  Slowly exhale as you stand up. The power to stand up comes from driving your hips forward. Keep your weights close to your body the whole time. You can practice this by rolling a foam roller down your legs with your hands to practice good form. 3 sets, 8 repetitions.
  5. Step-ups: Set up a 1-foot-high platform (using a box or stairs) and step onto the platform with one leg and lower the body slowly. 3 sets, 8 repetitions.

*Dr. Oppezzo recommends that you perform the exercises without weights first to master proper form.

How to Get the Most Out of Your Strength Training Routine

How many reps you should do:

“Reps in reserve” is a way to estimate how close you are to your max effort. Once you learn the moves, you will want to train so your sets leave you with “2 reps in reserve”, meaning you stopped feeling like you could do 2 more repetitions in good form, but that’s it.

How to choose your weights:

  1. Start Light. Begin with a weight that feels easy. Use the first set to warm up and estimate what you will use for the exercise.
  2. Gradually increase the weight until you can do 8 and 10 repetitions with good form but high effort.
  3. Check in with yourself:  If after you’re done, you could have done more than 2 repetitions in good form, increase the weight. But,  if after you’re done, you could NOT have done 2 more repetitions, it may be too heavy. The sweet spot is: if after you’re done, you could have done just 2 more repetitions with good form, you’ve got the right weight for you right now.

“To get stronger, you need to slightly increase the difficulty of the exercises each time you do your workout,” says Dr. Oppezzo. “You’re not going to get stronger if you do the same thing every time.”

How to gradually increase the difficulty of the exercises over time:

  • Increase the weight (e.g., When the 5-pound weights become too easy, increase the weight to 8 pounds, then 10 pounds, and so on).
  • Add an extra set of the exercise (e.g., Rather than only 3 sets, add a fourth).
  • Increase the number of repetitions (e.g., When 8 reps become too easy, increase to 10 reps, and then progress to 12. When you’re able to do 12 reps without too much effort, it’s time to increase the weight).
  • Slow down the tempo for each rep, especially on the “eccentric” or lengthening part of the movement.

“Be sure to wait 24 hours between strength training sessions to prevent injury and allow for muscle repair and recovery,” says Dr. Oppezzo. “Don’t do heavy strength training of the same muscle group on back-to-back days.”

The Importance of Protein to Build Strength

Proper nutrition is crucial for muscle development, particularly adequate protein intake. When we are strength training, our bodies need the raw material that protein provides to build muscle mass. Research shows that adults should aim to consume 1.2 to 1.6 grams of protein per kilogram of body weight, which translates to roughly 80 to 100 grams per day. Protein can come from both animal and plant-based sources, and Dr. Oppezzo recommends consuming protein throughout the day rather than having just one high-protein meal.

“Building muscle effectively requires both consistent strength training and adequate protein consumption,” says Dr. Oppezzo. “In order hit that 80 to 100 grams per day mark, we should try to consume 20 to 30 grams of protein at every meal.”

Strength Training for Longevity

Strength training isn’t just about lifting weights, it’s about lifting your quality of life. Whether you want to keep up with grandchildren, maintain independence, or simply feel stronger in your daily activities, it’s never too late to start. “If starting a weight training regime feels overwhelming, start with ‘strength snacks,’ which are short bursts of exercise throughout the day. Start small and focus on consistency over intensity, and track improvements in daily activities rather than just numbers on weights,” says Dr. Oppezzo.

“Start where you are, use what you have, and celebrate every small victory along the way. Your future self will thank you for the strength you build today,” says Dr. Oppezzo.

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Finding Purpose in Midlife and Beyond

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By Sharon Brock, MS, MEd

“What is it you plan to do with your wild and precious life?”

What if this famous line by poet Mary Oliver was not only relevant to people in their teens, but also in midlife? Given the considerable research on longevity, people are living healthier and longer lives, redefining what it is to be middle-aged. There is an antiquated cultural belief that once a person reaches the age of about 50, it’s too late to reinvent themselves or choose a new path. But now that we are living longer, we have a more expansive sense of time left to experience more joy, meaning, and impact.

“Rather than a midlife crisis, I call this time in our lives a midlife reckoning,” says Barbara Waxman, MS, gerontologist, leadership coach, and Stanford Lifestyle Medicine advisory board member. “Many people come to me worried that it’s too late to re-write their script and to recalibrate their on-going commitment to purpose. The truth is there is no ‘sell by’ date limiting your usefulness when you have decades of life and leadership in front of you.”

Similar to adolescence, Waxman coined the term middlescence as the period between early midlife and later midlife when many transitions occur, such as physical changes, menopause, andropause, empty nest, divorce, and caretaking of parents. With her clients, Waxman promotes the idea that middlescence is not the beginning of the end; rather, it can be a time to re-evaluate how one spends their time, explore different hobbies and careers, and declare a new purpose based on their current values, perspectives, and circumstances.

“Midlife is a perfect time to revisit and reassess choices we’ve made earlier in life that no longer fit,” says Waxman. “We have a better understanding of ourselves and what we care about. We’ve honed our skills, have more confidence, and have more to offer. We might have an inner calling that is shifting us in a different direction.”

What if I Can’t Find My Purpose?

Not everyone has a clear sense of purpose. In fact, many people struggle with “finding” their purpose and feel ashamed for this lack of clarity. But rather than define our purpose based on what is reasonable or practical, Waxman invites us to listen within and ask ourselves what is really important to us.

“Defining your purpose doesn’t come from the brain alone; it also comes from the heart and the gut. So instead of trying to ‘figure it out’, ask yourself, ‘What feels right?’” says Waxman. “When people have a clear sense of purpose, it’s like the wind beneath their wings—there’s an effervescence in how they show up.”

Waxman also says that many people put so much pressure on themselves to have a grandiose purpose, such as saving the environment or ending world hunger, that they don’t acknowledge the importance of the smaller contributions they make every day.

When working with clients, Waxman often references this quote from Mother Theresa: “Not all of us can do great things, but we can do small things with great love.”

“The obsession with finding one’s purpose can cause the stress that blocks you from seeing what is right in front of you and what you’re already doing,” says Waxman. “The little things you do each day, such as calling your loved ones or cooking meals for your family, count. I call these your ‘little p’ purposes, which are just as important as your ‘big P’ purpose. And the little p’s add up to create a purposeful life.”

Three Steps to Find Your Purpose in Midlife

When trying to identify our purpose, Waxman recommends that we start small and notice the little things in our lives that bring us joy. Waxman helps us break down the process of finding our “big P” purpose by offering these three journal prompts:

  • What sparked joy today?
  • What is a skill we have related to this joy?
  • What need in the world does this skill fulfill?

Steps 1 and 2 can be defined as our “little p” purposes, leading to step 3—a potential “big P” purpose. For example, in Waxman’s life, working in her vegetable garden sparks joy and she has a skill of cooking (“little p” purposes). She applies this skill while volunteering at a soup kitchen every week, which reduces food waste and feeds the hungry in her community (“big P” purposes).

“Since what brings us joy and our skills change over time, it makes sense that we would have multiple purposes in our lifetimes,” says Waxman. “Living a purposeful life can be as simple as having a sense of gratefulness and being the best you can be every day. These small things are big things—it’s just about recognizing them to be so.”

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How Mindfulness Can Soothe Tension at Family Gatherings

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By Angel Cleare, BS

 

As we prepare our holiday meals, we may reflect on how this family gathering unfolded last year. It may have started well, with many smiles and joyful conversations of family members sharing what was happening in their lives. But, when everyone sat down at the dinner table, one family member couldn’t stop complaining about the food, and another couldn’t resist voicing their antagonizing opinions. Knowing this may happen again, we may ask ourselves, “What can we do differently this year?”

“As we all know, we can’t control what others say or do, but we have some control over how we react, and this is where mindfulness can help,” says Sharon Brock, MS, member of the Stanford Lifestyle Medicine Gratitude & Purpose pillar and UCLA Certified Mindfulness Facilitator. “By centering yourself with meditation before guests arrive, you can set the tone for harmony. And if conflict still arises, you can practice mindfulness in the moment to help you handle the situation with more composure.”

Brock is the bestselling author of The LOVEE Method, a five-step mindfulness tool to help manage emotions in real-time and bring us into a state of clarity and balance. LOVEE is an acronym that stands for label, observe, value, embrace, and equanimity.

“Let’s say you experience a strong emotion, like anger or anxiety. It can be processed by the mindfulness practices of labeling, observing, valuing, and embracing the emotion. When the emotion has settled, a clearing is created for equanimity to arise,” says Brock.

“Equanimity means having an even-keeled, calm, and balanced mind, which can come in handy when spending the day with challenging in-laws,” says Brock.

How to Respond vs. React

So, what can we do when a disagreeable family member starts talking politics and activates a surge of anger within us? Most people either retaliate with a scathing comment or hold back and swallow their rage. Since neither option is a healthy way to process emotions, Brock offers a third option to transform this difficult emotion with the steps of LOVEE.

“If anger gets activated while seated at the dinner table, rather than be overly expressive or repressive, we can take a deep breath and mentally do the label and observe practices,” says Brock.

When doing the label practice, Brock recommends phrasing the label “anger is rising” rather than “I am angry” so that we create some space between ourselves and the emotion.  For the observe practice, Brock advises doing a quick body scan to locate and observe the emotion as a sensation in the body. She shares that observing our emotions allows us to recognize that they are temporary experiences, not permanent states. Knowing that the emotion will eventually pass can help us stay calm in the moment.

“Emotions are energies in motion; they are not personal,” says Brock. “When we don’t identify with our emotions and we simply observe them as fluid sensations in the body, we are acknowledging the emotions for what they actually are—energies in the body that rise and fall, come and go.”

Brock offers these scripts to say to ourselves in the heat of the moment to soothe our emotions:

  • “Anger is rising. I feel the sensation of my heart beating fast. I take a deep breath, observe the sensation, and not react. I may respond after the emotion has passed.”
  • “Anxiety is rising. I feel the sensation of clenching in my stomach. I take a deep breath, observe the sensation, and not react. I may respond after the emotion has passed.”
  • “Sadness is here. I feel the sensation of heaviness in my chest. I take a deep breath, observe the sensation, and not react. I may respond after the emotion has passed.”

Mindfulness and Self-Compassion

Brock says that the label and observe practices are effective mindfulness techniques for calming ourselves during a time of conflict. However, if the anger remains after the challenging moment has passed, she recommends going through the rest of the steps of the LOVEE Method as a formal meditation.

After label and observe, the value and embrace practices bring self-compassion into the meditation, which research shows offers psychological healing. During the value practice, we accept our emotions as natural aspects of the human condition, acknowledging that others would feel the same in the given situation. We also value our emotions because they have something to tell us, such as revealing a desire for harmony within the family.

Self-compassion deepens with the embrace practice. Here, we give our emotion a “hug” and say to ourselves, “I see you. I hear you. What do you need?” When working with anger, the need is often for respect. In this case, Brock recommends putting both hands on the heart and saying to ourselves, “I respect you.”

“Acknowledging that we are not alone and offering ourselves what we need helps soothe our emotions. With these practices, we are offering ourselves compassion and we are learning to take care of ourselves emotionally,” says Brock. “Over time, self-compassion practices help us to meet our own emotional needs, which fosters independence, resilience, and self-confidence.”

Cultivating Equanimity

After we have processed the emotion with the practices of label, observe, value, and embrace, the final step is equanimity. Here, we return our attention to the original person or circumstance that activated the intense emotion.

During this step, Brock invites us to repeat the equanimity phrase: “Things are as they are, may I accept things just as they are.” Or, in the case of the difficult family member: “They are who they are, may I accept them just as they are.”

Brock clarifies that accepting is not the same as condoning someone’s behavior or implying that the circumstance is morally right; rather the purpose of repeating these phrases is to bring our nervous system into balance and cultivate equanimity in our psyche.

“Equanimity is not about stepping back and not taking action; rather it allows us to take wise action from a place of calm and reasoning,” says Brock. “With an equanimous state of mind, we release resistance and resentment, and we are better able to navigate challenging circumstances with strength and grace.”

Click here to listen to the LOVEE Method meditation or here to learn more about Brock’s mindfulness offerings.

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Practice of the Month: Cultivating a Habit of Optimism

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By Meagan Matthews, BS

 

Do you tend to have pessimistic thoughts throughout the day? Do you wish you had a more optimistic outlook? Incorporating this one habit might be the key to unlocking a more positive headspace, and it only takes three seconds.

“The Maui Habit” was created by BJ Fogg, PhD, New York Times bestselling author of Tiny Habits and founder of Stanford’s Behavior Design Lab. It goes like this: as soon as your feet hit the ground in the morning, you say to yourself, “It’s going to be a great day.” This habit is named after the Hawaiian island of Maui because Dr. Fogg associates this island with positivity and optimism. Though it may sound too simple to make a big impact, Dr. Fogg and those who have implemented the habit can attest to the difference it makes.

“I find this practice helpful, even on my worst days,” says Dr. Fogg. “When I’m worried about the day ahead, this statement–even when I say it with a question in my voice–seems to open the door just a crack to actually having a good day.”

The Neuroscience of Habitual Positive Thinking

A key aspect of our ability to create new habits is neuroplasticity, which describes the brain’s ability to perceive, respond, and adapt to external cues. The adaptation stems from what many researchers refer to as an action-outcome association. If an outcome is negative, you are likely to change your action to promote a positive outcome instead. This positive outcome reinforces the new action, and over time, it becomes almost automated, or a habit.

Researchers have found that our thoughts can alter the relationship between brain physiology and its influence on our well-being. Positive thoughts are accompanied by the release of oxytocin, a “feel good” hormone that functions like a positive outcome. Once positive thinking becomes a habit, it can improve your overall self conception. A 2013 meta analysis of 39 studies found that repeated exposure to a form of positive psychological intervention improved participants’ perception of well-being.

So how effective is “The Maui Habit” on improving your outlook? Dr. Fogg says that the most effective habit is the one which “happens in the morning, is really easy to do, […] and makes you feel good.”

Practice of the Month:

Do “The Maui Habit” Every Morning for 30 Days

Step 1: Identify the cue.

Dr. Fogg recommends this be when your feet first touch the floor. Others prefer it be when they first look in the mirror. What’s important is that it works for you!

Step 2: In your mind, say the phrase: “It’s going to be a great day.”

When the day ahead seems to be particularly difficult, Dr. Fogg recommends saying, “It’s going to be a great day, somehow.”

Step 3: Pause to feel the positive emotions.

Take a moment to let the optimistic feelings resulting from the phrase really sink in, then carry on with the rest of your day!

 

You might be surprised by just how quickly this little phrase becomes automatic (it may only take a few days!) and how it starts to impact your overall approach to life. Dr. Fogg says, “With this morning practice, you are setting an upward trajectory for your day. Rather than spiraling downward, you can continue to lift.”

 

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What Does it Mean to be Spiritual but Not Religious?

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By Sharon Brock, MS, MEd 

More and more people today identify as spiritual but not religious. In this blog, we explore and appreciate what spirituality is as human beings to increase our capacity for more spiritual experiences in our lives.

“Spirituality is an individual experience,” says Bruce Feldstein, MD, BCC, Head of Stanford Lifestyle Medicine’s Gratitude & Purpose pillar. “As a chaplain and professor providing and teaching spiritual care for the past 25 years, I’ve often encountered people who identify as spiritual but not religious. I’m always amazed by the wide variety of ways people experience and express their spirituality.”

What Do We Mean by Spirituality?

Dr. Feldstein draws from these descriptions of spirituality with his patients and students:

  • “Spirituality is the way you find meaning, hope, comfort and inner peace in your life.  Many people find spirituality through religion. Some find it through music, art, or a connection with nature.  Others find it in their values and principles.” – American Academy of Family Physicians
  • “Spirituality is the aspect of humanity that refers to the way individuals seek and express meaning and purpose and the way they experience their connectedness to the moment, to self, to others, to nature, and to the significant or sacred.” – Journal of Palliative Medicine
  • Spirituality is a core dimension of our humanity. “We are not human beings having a spiritual experience. We are spiritual beings having a human experience.” – Pierre Teilhard de Chardin

Discover What Spirituality Means for You

As a professor, Dr. Feldstein previously taught a course for Stanford medical students entitled “Spirituality and Meaning in Medicine.” With the intention of allowing students to discover and appreciate spirituality in their lives (both personally and professionally as medical students), he led them through this exercise:

First, he shared the descriptions of spirituality listed above and then invited them to explore what spirituality means for them from their personal experience.

Then, he said to the class: “Recall a time in your life you would call spiritual or deeply meaningful, whatever that means for you.” After this reflection, Dr. Feldstein gave the students these journal prompts:

  • What was the situation? Were you alone or with others?
  • What thoughts or emotions occurred during this time?
  • What about this memory caused you to recognize it as spiritual or deeply meaningful?

“Every student had a story, and every story was unique,” says Dr. Feldstein. “Some were moments of awe or deep peace; others were stories of the kindness of strangers where they didn’t feel alone; others were ‘a-ha’ moments of guidance and realization. These spiritual experiences were all moments of spontaneous happening–it wasn’t on the calendar. Often, they took place outside of their everyday routines.”

Dr. Feldstein observed that this reflection exercise increased all the student’s capacity to recognize and cultivate spirituality in their lives.

“We all have this capacity for spiritual experiences, but many of us don’t recognize it,” says Dr. Feldstein. “Most of us are living in black and white, but recognition of these experiences can move us into technicolor.”

Activities that Can Allow for Spiritual Experience

Although we can’t control, predict, or anticipate these spiritual experiences, we can put ourselves in situations and states of mind that make them more likely.

In his class, Dr. Feldstein asked his students to share the situations or activities where they had spiritual or deeply meaningful experiences.

Here are some examples of what the students shared:

  • Life-cycle moments, including births, deaths, weddings, or graduation days.
  • While listening to music that brought a deep feeling of peace.
  • While volunteering for a cause that was meaningful to them.
  • While taking a walk in nature and pausing to admire the beauty of the trees.
  • While offering or receiving kindness and compassion while in conversation.
  • While connecting with others in book groups or reading meaningful books on their own.
  • While singing, dancing, and/or praying.
  • While visiting a loved one at the hospital.
  • While cooking with friends and mindfully eating the food.
  • While taking a yoga class and connecting to their breath.
  • During a morning meditation when focusing on gratitude.

In pursuit of well-being, Dr. Feldstein invites us to choose a few daily activities that are spiritual and meaningful for us. This will help us to be more attuned to spiritual experiences when they spontaneously occur. And when they do, he invites us to pause and acknowledge them, savor them, and feel gratitude afterward.

“As human beings, we have the capacity for spiritual experiences because we are spiritual by nature,” says Dr. Feldstein. “Being spiritual is not something we need to ‘do’, it’s what we already are, so we just need to allow for it.”

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