weight loss - Dr. Stephanie Estima

Mini Pause #87: The #1 Way Lifting Heavy Can Cause Injury (and How to Avoid It)

Posted on September 13, 2025 by stephanie-estima

Muscle sure is having her moment on social media, isn't she!

“Lift heavy, ladies!”
“Be a Muscle Mommy!”
“Build that booty!”

The cheerleading is loud, and I'm not going to pretend it isn't motivating, but something gets lost in the noise:

Strength isn't just about muscle.

When you pick up a weight, whether its a 10-pound dumbbell or a heft of racked plates, your muscles are not alone in carrying the load. Ligaments and tendons are their sisters. Articular cartilage is their cousin. They're all in this together, and they all adapt and recover on their own clocks.

If your training program only takes into account the recovery timeline of muscle, you're most likely going to outpace your connective tissue capacity.

What does this look like? The weakest links tend to complain first. Think of morning tendon stiffness, joint aches, and ligament strains.

Remember that British game show The Weakest Link?

Bad programming is like looking right at your tendons with a sassy British accent and saying, “You are the weakest link. Goodbye!”

So, this is my love letter (my soliloquy, if you will) to the entire network of tissues that keep you strong. Because if we want lasting gainzzzz (yes, with all the zs, like the gym bros say), we have to honor the whole system, not just the muscles in the mirror.

WHY

We have a variety of tissue tolerances to consider when lifting weights to help us go heavy and avoid injury.

Tissue tolerance is a tissue's capacity to absorb, transmit, and recover from load without breaking down. And here's the truth: your tissues don't give a flying F about the number on the weight. They don't see “15 pounds” or “2 plates.” They only know load, mechanical tension, acute damage, and maximum recoverable volume.

So let's look at the recovery timeline for each tissue:

Muscle

Muscle is quick to adapt. Neural gains show up in weeks. Visible hypertrophy (muscle growth) in 6-8 weeks. With rich blood flow and fast protein turnover, she thrives on regular work. Think 2-4 sessions per week for each muscle group. Nature

Tendons

These are slow alchemists. They remodel collagen at a glacial pace. If you've ever injured a tendon, you know it takes a lifetime. Think months, not days. PMCSpringerOpen

With a sparse blood supply and collagen that can be decades old, their improvements come only with steady, patient loading. PMC

Tendons love the “low and slow” approach and punish sudden spikes in effort. True changes in tendon stiffness take at least 12 weeks. SpringerOpen

Ligaments

Ligaments are the baddies that stabilize joints, and they're similar to tendons: dense collagen, slower metabolism, and slower to respond.

Think of ligaments like the introverts at the party. She wants to be there, but she takes a little longer to warm up and get comfy. (Hi, it's me!) PubMed+1

To strengthen a ligament, you want multidirectional movement: jumping, decelerating, sudden changes in direction. These movements sharpen neuromuscular control and protect your joints. ASME Digital Collection

Side Note: I would LOVE to go on a nerd safari on ligaments in a future newsletter. I'm game if you are.

Articular Cartilage

Articular cartilage is the plush cushion between your bones. She's there so your bones don't rub together, because wow that's not nice.

Unlike other tissues I've mentioned, articular cartilage has no direct blood supply of its own and minimal collagen turnover and renewal. PubMed

The only way to keep joint cartilage healthy is through consistent loading. She loves regular, moderate, and cyclic compressions, like walking, cycling, and most steady-state cardio machines. Sedentary is her downfall. PMC

HOW

Okay, Betty, it's time for you to honor all your tissues so they rise together, strong and resilient:

(Want a quick and easy program build to match each tissue's healing clock? LIFT is for you.)

1. Sequence Your Week
Muscle strength sessions can happen often (2-4 times per week per muscle group). Tendon- and ligament-heavy work (slow lifts, plyometrics, change-of-direction) need at least 48-72 hours of rest between exposures.

2. Master Form Before Load
In LIFT, our Master Form videos help you own the movement before you ever load it. Good form isn't just about looking impressive. It's how you protect your tissues and respect their tolerance.

3. Watch for the Signals
Green (Go!): Mild muscle soreness, tendons that warm up and feel fine by the next morning, and joints that feel “used” but not puffy.

Yellow (Yield): Morning tendon stiffness for more than 24 hours, lingering joint aches, or from breaking down under fatigue.

Red (Stop and Deload): Swollen or locking joints, sharp instability, night pain, tendon pain that worsens as you warm up are all signs to rest and see a professional.

NOW

Here's what you can expect when you play the long game:

Muscle: You'll feel fitter within 2-3 weeks with visible changes in 6-8.
Tendons and Ligaments: Real, durable change happens over 8-16+ weeks, with tendon stiffness improving best at >12 weeks.
Cartilage: Healthy cartilage loves consistency. Regular walking and rhythmic, cyclical movement keep it nourished and thriving.

Think of your body like a financial portfolio. You wouldn't put all your money in one stock and hope for the best. In the same way, your tissues thrive with a diverse portfolio of movements. Strength, cardio, recovery, and multidirectional play… it all matters.

So yes, lift heavy, Betty. Build muscle. But train like the queen you are: with wisdom, patience, and respect for the whole kingdom (or queendom) of tissues that carry you forward.

Selected sources for further reading for my dark roast Bettys:

Bohm et al., human tendon adaptation;
Heinemeier et al., minimal collagen turnover in adult tendon/cartilage;
Bontemps et al., early neural vs later hypertrophic gains;
Bader/Eckstein, cartilage thrives on moderate cyclic load;
Rio et al. & Holden et al., isometrics for tendinopathy
SprinterOpenPMC+3PMC+3PMC+3PubMed+2PubMed+2VBN

WHAT I LOVE THIS WEEK

BIOptimizers

You can nail your diet and workouts, but if your sleep is suffering, your results will stall.

A compelling study recently found that poor sleep slashed fat loss by 55% and increased muscle loss by 60%, even when calories stayed the same.

Think about these two women on the same plan. The rested one loses fat and keeps muscle while the sleep-deprived one loses the muscle she worked so hard to build (while living exhausted!).

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If you want to maintain muscle, brain power, and energy as you age, creatine isn't optional. It's foundational.

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🌟 Love these recommendations? Find more resources to support your health in midlife in my Health Toolkit!

¹ Here's the list of countries BIOptimizers currently ships to. Code can be used multiple times. Terms and conditions may apply.

² Applies $60 off the Apollo wearable (no one-time limit). Valid on the device only. Cannot be stacked with other coupons, bundles, or site-wide promos. Terms and conditions may apply. Currently, Apollo is accepting orders and shipping within the United States, as well as to Canada, Europe, and Australia. Terms and conditions may apply.

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Mini Pause #86: Are Weighted Vests a Scam? Part 3

Posted on September 6, 2025September 5, 2025 by stephanie-estima

Welcome to third instalment in our mini-series on weighted vests.

So far, we have covered Osteoporosis & Bone Health and VO2/Caloric Expenditure. Today, we're getting into strength and muscle growth.

If you think I got nerdy on the last two issues, buckle up Bettys, because there are some really important distinctions we need to talk about today!

WHY

Muscle grows when you repeatedly ask it to do harder work over time. End of story.

Said another way, muscle growth happens with more load, more reps at the same load, or more challenging variations that are near muscular failure. That's the core of progressive overload.

And **spoiler alert**, it's why you're not going to change your muscle strength or size just by wearing a weighted vest and going about your day. You need high tension, a long enough time frame, and the simulation of muscle failure. (PubMedPMC)

Insert sad face and violins playing in the background…

Look, I, too, wish I could just look at my glutes and have them grow, but unfortunately, it doesn't work that way. They won't grow unless I eat enough and put in the work to drive the signal (progressive overload) for them to grow.

So, are weighted vests useless for muscle building, then?

The short answer is no. The detailed answer is in the next section.

WHAT (the science says)

Weighted Vest Alone ≠ Strength Gains

In a 27-week randomized trial (n=62, age ~74), participants wore 0%, 3%, or 5% bodyweight vests for 2 hours/day, 4 days/week, with no required exercises.

The Result: No differences in knee strength, endurance, physical performance, or bone markers as compared to the control group who did not wear weighted vests.

The authors (correctly) concluded that the stimulus of just wearing a vest was below the threshold to build strength. PubMed

Where Vests Are Useful (inside a training program):

In a 12-week randomized pilot (community-dwelling older adults), everyone did the same home exercises and 30-min walks.

The vest group (wearing ~10% of their body weight) improved their scores on a 6-minute walk, 2-minute step, 30-second chair-rise, and select hip strength exercises more than those who exercised without a vest.

Caveat: It's important to note that these results are not solely attributed to the weighted vest. It was a function of strength training with extra load. Physical Activity and Health

Dr. Stephanie's Comments:

The vest alone is not going to grow your glutes, or anything for that matter. In order for vest wearing to have any impact on strength and hypertrophy (muscle growth), you've gotta lift those weights, baby.

In my opinion, the biggest program is that most women are not strength training through midlife. They might “think” they are strength training with their cute little 2 lb ankle weights, but this is not strength training. This is a side effect of the delicate marketing tactics aimed to get women to spend their hard-earned money on gadgets.

Women are trying. I see you out there! You're taking your hot girl walks. You're hitting the yoga and pilates classes. You're doing group exercise with 4000 lunges. But, my friends, this is not strength training. Muscle burn is not the same as muscle failure.

If you feel called out right now, before you hit send on an angry, please know I'm not calling you out. I am calling you all the way up.

Want glutes that leave the room 2 minutes after you do? You will have to lift in a way that causes your muscles to fail.

Now, for my ladies who are still intimidated by the iron in the gym (we'll work on this). Getting bulky won't happen by accident. Just because you drive a car doesn't mean you will accidentally become a Nascar driver, you know?

For those of you who are dealing with joint issues or an injury – take it slow. A vest can be a perfect bridge for you to increase the mechanical load that would not otherwise be there.

I actually LOVE wearing a weighted vest when I do pull-ups, push-ups, or even walking lunges and step-ups. These are great ways to make bodyweight exercises more challenging. Read the next section for some specific examples.

HOW

Lower Body (glutes/quads):

For all exercises below, load with a snug vest and add 1-2 lbs or 1-3 reps per set if you're ≥2 reps from failure across all sets. Stop a set when your form breaks:

Step-ups (box height at least mid-shin, but it can be at knee height or higher)
Split squats or Bulgarian split squats
Reverse or forward lunges
Wall-sit or squat holds (time-under-tension)

Upper Body:

For the exercises below, do your working sets at RPE 7-9/10 (keep 0-3 reps in reverse). That's the “near-failure” zone the literature points to for hypertrophy with a wide range of loads. PMC

Push-ups (these can be done elevated, like against a wall or countertop, on the floor, or even as a deficit)
Pull-ups or chin-ups (start with your own bodyweight and work up to a vest once you can do an unassisted pull-up)
Inverted rows (lower the bar over time, then add a vest)

You can also add a weighted vest to my LIFT program to increase the intensity of some of the moves, too!

NOW

This Week's 2-Day Bridge (30-40 min each):

Day A

Step-ups: 3×8-12 per side (vest up if 12 is too easy)
Push-ups: 4×6-12 (elevate your hands as needed and add a vest when 12 is too easy)
Split squats: 3×8-12 per side
Inverted rows: 3×8-12
Side plank: 2×30-45 seconds per side

Day B

Bulgarian split squats: 3×8-12 per leg (use a vest as you are able)
Chin-up or band-assist pull-down: 4×6-12 (add a vest once you pull your own bodyweight)
Reverse lunge: 3×8-12 per side
Deficit push-ups or dumbbell press: 3×8-12
Hip hinge (good-morning or RDL pattern unloaded): 3×10-15 (use a vest only if your back stays neutral)

How to progress each week:

On the lifts that felt easiest, add 1-2 reps somewhere or add ~1-2 lb to the vest.
Keep most sets near failure with crisp form.
After 6-8 weeks, step into a formal progressive program with barbells, dumbbells, or machines, OR keep advancing vest-loaded calisthenics if you're getting stronger. PubMed

P.S. If you're reading about weighted vests and feeling your best, I think you'd love LIFT. LIFT is my smart, progressive 4-day split that teaches women in midlife how to lift weights safely and strategically. The result? Better results, joints that support you into older age, and the confidence of building that strong body you've always wanted. Curious? Check out LIFT.

References for this issue

Greendale et al., 2000 (J Am Geriatr Soc): 27‑week vest‑only RCT (3–5% BW); no improvements in strength/performance—dose too low. PubMed
Schoenfeld, 2021 (PMC): Loading recommendations; hypertrophy across a range when near failure; practical 6–12 rep / ~60–80% 1RM lane. PMC
ACSM Position Stand, 2009: Progressive overload principles; novice hypertrophy loading/frequency; 2–10% load increases when reps exceed target. PubMed
Mierzwicki et al., 2019 (Phys Act & Health): Exercise + ~10% BW vest outperformed exercise alone on 6MWT, 2‑min step, chair‑rise and some hip strength. Physical Activity and Health

WHAT I LOVE THIS WEEK

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🌟 Love these recommendations? Find more resources to support your health in midlife in my Health Toolkit!

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Mini Pause #85: Are Weighted Vests a Scam? Part 2

Posted on August 30, 2025August 29, 2025 by stephanie-estima

Last week I kicked off this mini-series in the Mini Pause about weighted vests. We dove into the bone density claims, or how weighted vests will supposedly support (or deplete, depending on who you ask) our bone health as we age.

(Didn't catch it? Want your friend to read it? Click here)

The internet loves to rage-bait us into yapping at each other, and weighted vests are just one of the most recent topics that have us arguing with each other.

Whether you're seeing more content from Team “Weighted Vests Grow My Glutes” or Team “Weighted Vests Are for Grifters,” I can bet you've seen some side of the polarized debate.

Well, friends, I want to re-welcome you to this little corner of the internet that reminds powerful women like you about nuance.

As it turns out, weighted vests (and about a million other topics) aren't all that black and white. Let's get into it and chat about weighted vests and their cardiovascular claims. I've got some juicy, actionable takeaways for you.

WHAT (the science says)

So, yeah, weighted vests have some interesting benefits.

Immediate Effects (i.e., one walk):

Adding about 10-15% of your body weight with a vest makes your body work harder, even during a simple walk. On flat ground, you'll notice the biggest changes around that 15% body weight mark, but if you add an incline, even a lighter load makes a difference. Your breathing and heart rate go up in a healthy way, which means you're getting more bang for your buck on that walk.

Read the study from American Council on Exercise.

Longer-Term Effects (i.e., a 12-week program):

In a 12-week study with older adults, everyone did the same at-home exercise routine and walks. The only difference? One group wore weighted vests at 10% of their body weight.

They did 8 home exercises plus a 30-minute walk 3 times a week for the 12 weeks. The vested up group saw bigger improvements in walking distance, stamina, and leg strength compared to exercise alone.

Read the study in Physical Activity and Health.

Dr. Stephanie's Comments:

This makes sense. It's not rocket science. It's basic physics. When you add more weight, your body has to work harder. The extra effort means you burn more energy. It's why a lot of women will attribute weight loss from their hot girl weighted vest walks.

Even in the short studies we just talked about, researchers saw an immediate bump in oxygen use (VO₂) — a key marker of how hard the heart and lungs are working. If those changes showed up right away, it's reasonable that, over time, many women will experience stronger cardiovascular fitness and an easier path to weight loss when pairing a vest with regular cardio.

What We Don't Know (the Nuance)

So far, the research hasn't proven that simply walking with a weighted vest can make a long-term difference in your cardiovascular capacity. It seems that the addition of incline, faster pace, and intervals is important. American Council on Exercise

Dr. Stephanie's Thoughts:

Just because we don't have long-term studies yet doesn't mean there's no benefit. As I like to say, lack of evidence is not necessarily evidence of lack.

From what I've seen in myself and others, even short-term use gives your heart and lungs a nice bonus workout. If you keep those habits up over time, it's very reasonable to expect those benefits to carry over.

HOW

I like to think of a weighted vest as a “hill in a box.” I've mainly used them as a way to amp up the intensity of my walks. If you're feeling ambitious, you could even add one to your next date with a Stairmaster. It's a solid way to make a workout more challenging without changing much else.

Here's how I'd get started, based on the research:

How Often: 1-3x/week, on top of your usual movement
How Long: 20-40 minutes per session
How Heavy: Start at about 5% of your body weight (or less). If it feels smooth on your joints, start working toward 10%. (Physical Activity and Health)
Where to Go: On flat ground, you might need a bit more weight to notice a difference. On hills or a treadmill incline, go lighter. (American Council on Exercise)
What to Expect: Your heart rate and breathing will rise (that's a good thing!). If you have joint pain, high blood pressure, or pelvic floor issues, shorten your sessions and check in with your doctor before pushing further. (American Council on Exercise)
Form Tips: Keep your steps short, stand tall, and land softly. If you knees or feet complain, try reducing the weight or incline before cutting your time. (Medicine & Science in Sports & Exercise)

Weighted Vest Interval Playbook

Rotates these example exercises:

Beginner (20-25 minutes)

Warm up: 5 minutes easy (no vest or very light)
Main set: Alternate 2 minutes brisk walk + 2 minutes easy walk, repeat 6 times
Vest: Start with ~5% bodyweight
Cool down: 5 minutes easy

Intermediate (30-35 minutes)

Warm up: 6 minutes easy
Main set: Alternate 1.5 minutes hard + 1.5 minutes easy, repeat 8 times
Incline: 3-6% grade
Vest: 5-7.5% bodyweight
Cool down: 5 minutes easy

Advanced (35-40 minutes)

Warm up: 8 minutes easy
Main set: Alternate 3 minutes steady, strong pace + 2 minutes easy, repeat 5 times
Incline: 4-8% grade
Vest: 7.5-10% bodyweight
Cool down: 5 minutes easy

Rule of thumb: Push hard enough that it feels like a 6-8/10 effort (breathing heavy but not gasping). Always back off if your joints feel sore or your landings get jarring.

NOW

Here's your assignment for the week:

Pick your load: If you're new to vests, start at ~5% BW for 2-3 sessions, then reassess. (American Council on Exercise)
Slot one workout: This week, schedule one 25-minute beginner weighted vest interval (above).

References for this issue

PubMed (Puthoff et al., 2006): Weighted vests ↑ VO₂, relative intensity, and ground‑reaction forces during walking. PubMed
ACE/UNM graded walking study (full report PDF): VO₂ and %APHRM rise with 10–15% BW, stronger with incline; nuanced RPE response. EACE Fitness
ACE summary article: Practical overview—15% BW needed to raise VO₂ on flat, smaller loads work with incline. ACE Fitness
Physical Activity and Health (Mierzwicki, 2019): 12‑week RCT—adding a 10% BW vest to a shared exercise + walking program improved 6MWT, 2‑min step, and chair‑rise vs control; Physical Activity and Health

WHAT I LOVE THIS WEEK

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Mini Pause #84: Are Weighted Vests a Scam? Part 1

Posted on August 23, 2025August 21, 2025 by stephanie-estima

Lots of noise recently on social media about weighted vests and if they are actually doing anything.

The noise is often drummed up from what I like to call EBITs (evidence based internet trolls) who have no clinical experience, have never dealt with the general public, and if there is no RCT, then did it even happen bruh?

As is in most cases, there are a lot of papers to review, think on, and apply critical thinking on how it applies to everyday life. Lucky for you this is my favorite way to spend an evening after I crush it on Duolingo.

We are going to examine claim by claim over the next few weeks some of evidence for and evidence against weighted vests.

Vests are not magic, but they can be a tool of amplification in several scenarios.
Today we are going to look at the impact of weight vests on bone mineral density and if it has osteogenic (bone promoting) properties.

WHY

Lots of social media influencers and lifestyle accounts flaunting weighted vests as the solution to bone mineral loss in perimenopause.

More bones without barbells? Oooooo enticing. Especially for women in midlife who for whatever reason are not following a strength training program with progressive overload.

But here’s the truth:

Bone adapts to load magnitude and, crucially, rate (how quickly the load hits).
Light extra mass while strolling rarely reaches an osteogenic threshold, which explains why research looking at weighted vest only for walks does not show a positive outcome.
In contrast, jumping + a vest adds both magnitude and high loading rate at the hip—the combination that produced long‑term maintenance of hip BMD in the 5‑year program. PubMedOSU Extension Service

WHAT

1) Bone Mineral Density (BMD) / Osteoporosis

Study 1: Vest alone (daily wear / walking):

Design: 27‑week randomized trial, 62 community‑dwelling older adults.
Weighted Vest “Dose”: 0% (control) vs 3% or 5% body‑weight vests, prescribed 2 h/day, 4 days/week; no mandated exercises.
Result: No improvement in strength, performance, or bone turnover markers vs control. Authors concluded the loading dose was insufficient to stimulate bone. PubMed

Dr. Stephanie’s comments: Totally makes sense. First of all 27 weeks is insufficient to see remodelling of bone (the average bone turnover is around 2 years, which slows as we age). And the frequency (2h/daily) and amplitude (3-5% of body weight) are insufficient to really move the needle.

Study 2: Weighted Vests during intentional weight loss:

Design: 12‑month RCT, 150 older adults with obesity aiming for ~10% weight loss.
Dose: Diet alone vs diet + daily weighted‑vest (self‑reported 7.1 h/day, vest weight adjusted to replace on average ~78% of lost weight) vs diet + progressive resistance training.
Result: All groups lost hip bone; neither the vest nor resistance training prevented hip BMD loss in this context. PMC

Dr. Stephanie’s commentary: the timeline is better here (albeit still too short, and this study tells us what we already know – a prolonged caloric deficit takes away from the whole body. Oh wouldn’t it be so much better if we could only select the adipose tissue to shrink in a deficit! Sadly, not so. Any type of prolonged dieting will see loss of ALL weight – fat mass, muscle mass, and in this case organ mass in the form of bone as well. This is why I strongly believe perimenopausal women should not be on any kind of prolonged caloric restriction. Period.

Study 3: Vest + impact training:

Design: 5‑year community program in postmenopausal women using weighted‑vest lower‑body resistance + jump training (≈3 sessions/week, 32 weeks/year).
Result: Exercisers maintained hip BMD while controls lost ~3–4% over 5 years. Reported changes: femoral neck +1.54% vs −4.43%; trochanter −0.24% vs −3.43%; total hip −0.82% vs −3.80%. Program specifics: average ≈52 jumps/session and ~11 lb vest, with >83% adherence. OSU Extension Service+1

Dr. Stephanie’s comments: Ooooooo now this is exciting. A trial that is long enough to see actual bone remodeling (5 years) AND they paired the weighted vest with jump training! Remember IMPACT + TIME is the magic in remodelling bone. This hits both of those marks. Of interest is to note the monster 1.54% change in femoral neck (an area very susceptible to fracture in old age) compared with a -4% change in controls who were still exercising. This is bankable benefits for weight vest use.

HOW (to use a vest if your goal is hip-bone benefits)

Use the vest during targeted impact or lower‑body loading, not as an all‑day accessory.

Here is a practical template inspired by the 5‑year study (to adapt for YOU, don’t copy it exactly):

Frequency: 3 sessions/week, aim for ~52 weeks/year of consistency.
Start unweighted: Learn soft, quiet landings (mini‑squat jumps, step‑offs to gentle hops).
Progressive loading: Add the vest gradually in 1–2 lb steps, staying well within comfort; many programs keep total vest mass well under 10% body weight at first.
Volume target (build over weeks): 30–60 total jumps/session (e.g., sets of 6–10), with full recovery and high‑quality landings.
Session mix: Short jump sets + lower‑body strength (squats to chair, step‑ups, hip hinges), wearing the vest for sets if tolerated.
Hip focus: Forward and multidirectional jumps from a very low height; avoid depth jumps or plyos that feel “hard” on knees/feet.
Stop criteria: Any sharp pain, pelvic floor symptoms, or soreness that lingers >48 hours → reduce dose or pause and reassess.(Program dose and adherence details drawn from the 5‑year vest‑plus‑jumping research; community program description via OSU Extension’s Better Bones & Balance.) OSU Extension Service+1

What not to expect:

Walking with a light vest (a few hours/week) is unlikely to move hip BMD. That exact strategy failed in a controlled trial. PubMed
During active weight loss, a vest alone or standard resistance training may not protect the hip. If you’re dieting, talk with your clinician about bone‑supportive nutrition (calcium, vitamin D, protein) and whether supervised, higher‑impact options are appropriate for you. PMC

Safety notes:
If you have diagnosed osteoporosis, prior fragility fracture, significant knee/hip/foot pain, hypertension, or pelvic floor concerns, seek personalized clearance and coaching before adding impact. Consider building a base with strength and balance training first.

NOW (put it into practice this week)

Check your context: Are you currently losing weight? If yes, know the hip may still lose bone so plan your nutrition + training with a pro. PMC
Pick your tool: A snug, comfortable vest you can micro‑load (small removable weights). Start light.
Try a 6‑week primer:
– Weeks 1–2: 2–3×/week, 20 mini‑jumps total/session, no vest.
– Weeks 3–4: Add 2–4 lb vest, 30 jumps/session (sets of 6–8).
– Weeks 5–6: 40–50 jumps/session, consider +1–2 lb if fully comfortable.
– Keep all landings soft; stop if anything hurts.
(Progression concept derived from the long‑term vest‑plus‑jumping model; adjust to your capacity.) OSU Extension Service

References for this issue

Greendale GA et al. J Am Geriatr Soc (2000): Vest‑only RCT, no strength/performance/bone‑marker benefit at low dose. PubMed
Beavers KM et al. JAMA Netw Open (2025): During weight loss, neither daily weighted vests nor progressive resistance training prevented hip bone loss. PMC
Snow CM et al. J Gerontol A Med Sci (2000): 5‑year vest‑plus‑jumping maintained hip BMD vs 3–4% loss in controls; ~52 jumps/session, ~11 lb vests, high adherence. OSU Extension Service+1
OSU Extension: Better Bones & Balance® program overview (impact + strength + balance; often with vests). OSU Extension Service

WHAT I LOVE THIS WEEK

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The Sleep System That Saved My Marriage (And My Sanity)

I'll be brutally honest, perimenopause was destroying my sleep and my marriage. It got to the point that my husband and I went through a sleep divorce and were sleeping in separate beds. The thing that saved us from our sleep divorce? Eight Sleep's Pod 5 Ultra: dual-zone temperature control lets us each sleep at our perfect temperature in the same bed. The hydro-powered blanket provides full-body cooling that actually works for hot flashes. Studies show 27% better deep sleep, and I can confirm it's life-changing. We're both sleeping through the night again, and our relationship is stronger than ever. Sometimes the best marriage counseling comes in the form of better sleep. Try it out for yourself at eightsleep.com/drstephanie and use code DRSTEPHANIE for $350 off your Pod 5 Ultra.

Hydration Game-Changer for Midlife Women

Are you a busy woman juggling career, family, and your own health, feeling like you’re running on empty? Back-to-back meetings, managing teenagers, squeezing in workouts, and feeling constantly tired despite drinking gallons of water? The culprit may be electrolyte depletion. When we're stressed and moving nonstop, we lose sodium faster than we can replace it, causing fatigue, brain fog, and those afternoon crashes. LMNT solves this puzzle. This zero-sugar electrolyte mix delivers 1000mg of sodium, based on research showing we need 2-3x government recommendations for optimal function. No artificial ingredients, just pure electrolytes that actually work. Now I start every morning with LMNT and stay sharp through my busiest days. It's the difference between surviving midlife and thriving through it. Try it out for yourself and receive a free sample pack with any order at drinklmnt.com/drstephanie.²

🌟 Love these recommendations? Find more resources to support your health in midlife in my Health Toolkit!

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Posted on May 23, 2025 by stephanie-estima

Struggling to Lose Weight? You May Need More Minerals

So many of my Bettys tell me they have difficulty losing weight, even when following a healthy diet. They are frustrated, and rightly so.

You may not realize a mineral deficiency is happening behind the scenes of your health. According to recent data from the CDC, more than 90% of American adults are deficient in at least one essential mineral. [*]

It’s a shocking statistic, and much of it can be attributed to our food supply. In today’s world, it’s almost impossible to meet your body’s mineral needs through diet alone. That lack of minerals can surprisingly impact your ability to lose weight.

The good news? Mineral deficiencies are easy to correct! So, for my Bettys: Here’s why it’s so hard to get enough minerals, why they matter for fat burning, and how to get more minerals in your diet.

Modern Food Is Short on Minerals

Our food has changed a lot over the past 70 years. We eat more processed junk, which is its own problem. But even fruits, veggies, and other whole foods aren’t as nutritious as they used to be.

A 2024 study measured the vitamin and mineral content of common ingredients, including fruits, vegetables, and meat. The results showed an “alarming decline in the nutritional quality of foods” since about 1950. The authors called this decline one of “the biggest challenge[s] for future generations’ health.” [*]

A 2022 review found similar results. Tests found that the mineral content of vegetables and legumes has fallen continuously over the past half-century, with a particularly steep decline in the last ~20 years. [*]

Both studies cite the same two causes.

Pesticide use and harsh industrial farming practices have stripped the soil of nutrients.
Commercial farmers prioritize quantity over quality. They’re paid by the pound, so they aim to produce as many pounds of food as possible, often with little care for the nutrient content of what they grow.

From that perspective, it’s no surprise that almost everyone is mineral-deficient. [*] Even if you’re eating lots of veggies and whole foods, you not getting the same nutrients in your food that your grandparents did. The result is that it’s increasingly challenging to meet your body’s mineral needs.

Low Minerals Make Weight Loss Harder

When you’re short on minerals, weight loss gets a lot harder. There are two reasons: metabolism and hormone balance.

Your metabolism depends on minerals to stay running. In a 2023 review, researchers identified five minerals that are essential cofactors for energy metabolism: phosphorus, magnesium, iron, copper, and manganese. [*]

These minerals all work together to convert the food you eat into energy. When you have enough of them, your metabolic rate stays high, and you burn fat throughout the day. If your mineral stores are depleted, however, fat burning slows down.

Hormone production also relies on minerals. Your body needs 15 essential minerals to survive, and almost every single one is involved in either hormone synthesis or hormone distribution.

Minerals are potent regulators of your three major fat-burning hormones: testosterone, [*] estrogen, [*], and thyroid hormones. [*] Mineral deficiencies can interfere with your hormone levels, slowing weight loss to a crawl.

A Simple Way to Get More Minerals

Mineral deficiency is a bigger deal than most of us realize. Even if you’re eating great food, there’s a high chance you’ll gradually develop mineral depletion over time.

That’s why I partner with BEAM Minerals. They’ve warned about mineral depletion for a long time and offer a simple way to counter it.

Instead of a cabinet full of pills, BEAM makes a full-spectrum liquid mineral supplement. It contains every essential mineral your body needs, in an optimal ratio, with fast absorption.

For my Bettys who would like a little weight loss support, I encourage you to try BEAM Minerals. All you do is take a 1-ounce shot of liquid each morning. It tastes like water and is an amazing way to boost your mineral intake.

Don’t miss the exclusive discount BEAM has offered to my community! Go to BEAM Minerals and enter code BETTER at checkout for 20% off your first order.

Mini Pause #14: Common Cardio Mistakes & How to Fix Them

Posted on April 19, 2024April 20, 2024 by stephanie-estima

What You’re Getting Wrong About Cardio and How to Make Simple Changes for Big Results

TL,DR (too long, didn't read)

Cardio is a good thing. But you don’t need it to lose weight. And doing too much of it and to the exclusion of other forms of beneficial fitness just doesn’t serve you. Choose the type, intensity, and duration of your cardio wisely and based on your goals. Timing matters, too. If you’re strength training (and I know you are), you’ll want to save cardio until after your lifting. Cardiopulmonary health is especially important in perimenopause and menopause, so you’ll want to do cardio smarter, not harder, and definitely not longer.

WHY

I am a fan of cardio work, but not for the reasons you might think. One of the biggest misnomers for integrating cardio into routines is that it’s required for fat loss. Spoiler–it isn’t!

Cardio is important for cardiovascular health (this is especially true as we age and lose estrogen). Just as importantly, cardio facilitates work capacity for your resistance training workouts and for your recovery because of a better ability to deliver nutrients to repairing muscles.

When your cardiorespiratory fitness is good, you will be able to work hard during leg day and recover in between sets.

The other thing to note is that individuals who engage in some type of regular cardio are also generally setting up good habits so that when they lose weight (through diet and weight lifting) they are more likely to keep it off. You are more active, so your caloric balance has a better chance of staying balanced.

As important as cardio is in a balanced exercise regimen, I want to explore some common mistakes with cardio, with the assumption that you are looking to build muscle and lose fat.

WHAT

Mistake 1: Cardio As Effective As Diet

In a word, no. Cardio is not at all required for fat loss. Not even one bit! The biggest determinant of whether you will lose weight is your balance of calories in versus your calories out. If you are in even a mild caloric deficit, you will lose weight. This can be achieved without cardio entirely.

If you’ve ever looked at calories burned on your typical cardio equipment (even when they are likely overestimating it), it’s pretty discouraging. I clock in somewhere between 400-600 calories when I’m on the bike for an hour. An hour!!

By contrast, I can easily pack away 700 or 800 calories of food in a few minutes.

When we’re thinking about caloric deficits, it’s way easier to eat your calories than it is to burn them! It’s unfair, cruel, and unfortunately true. So a better strategy is to think about the calories you’re eating (and often the hidden calories from dressings, the bit here and there, and the mindless snacking) that is leading to a caloric surplus.

Now, don’t get me wrong, if muscle building is your goal, a caloric surplus is a great idea, as long as you’re putting the energy to work by lifting weights.

Relying on cardio for fat loss is a losing scenario, because it’s far easier to eat your calories than it is to burn them.

The other thing to remember is that if you’re overdoing it on the cardio, your body is a wily minx and will compensate by driving up hunger cues and metabolically adapting by decreasing your overall caloric expenditure. That means you will likely start moving less, your digestion will slow down, and even the calories you burn during subsequent cardio sessions will decrease.

The more you rely on cardio as a fat-loss tool, the more the returns diminish as you burn fewer calories overall and reduce non-exercise activity thermogenesis (NEAT).

Cardio should supplement your fat loss goals, not be the main event.

Mistake 2: The Timing Of Your Cardio

If fat loss and muscle gain are the goals, you also want to think about when you engage in cardio relative to when you lift weights.

There’s a well-established interference [*][*][*] between developing the aerobic endurance pathway and the muscle hypertrophy pathway.

This means, your muscle goals may be impaired if you do your cardio before your training. Some studies suggest that strength is compromised for 6 to 8 [*] hours after an intense cardio session.

This is especially true for high-intensity interval training (HIIT) [*]. HIIT may be less of a time commitment and it can be more fun than a Zone 2 workout, but putting your HIIT workout ahead of your weight session is likely going to catabolize your performance because you’re already going to be pretty gassed.

And HIIT and weight training have a lot of physical features in common anyway: the explosive power and recruitment of type 2 fibers. By combining these two, the activity that comes second likely will suffer.

Also keep in mind that the recovery demand for a HIIT session is much higher than a Zone 2 workout. You’ll need more time to recover from a HIIT workout before you should do it again.

HOW

Think about your cardio as a way to keep your overall fitness level high:

The cardioprotective benefits it extends in perimenopause and menopause.
The way it augments your performance on heavy lift days.
How it helps establish healthy lifelong habits.

Cardio isn’t required at all for fat loss. It should never be used as your primary fat loss tool. Fat loss happens in the kitchen, not on the treadmill.

If your goal is fat loss and muscle gain, the timing of your cardio can be after a training session, or even on separate days altogether.

I typically lift weights in the morning, and if I have trained my upper body, I’ll jump on my stationary bike in the evening for a Zone 2 ride. If I have trained legs in the morning, I’m doing no cardio that day. Instead, I’m sitting on the couch, going for a sauna, or going to bed early.

Zone 2 training can be a great way to train your base level of cardiopulmonary health. Aim for a 30-45 minute session, several times a week. Remember, there are a lot of ways to get into your Zone 2! Rucking, cycling, walking, and swimming are wonderful, low-impact options.

HIIT training can be done once or twice a week, and probably shouldn’t be longer than 15 to 30 minutes.

For more ideas, I wrote about different ways to train the top end of your cardiopulmonary fitness in Mini Pause #11 and Mini Pause #12.

NOW

Reframe your thinking around cardio to be an adjunct for living well (and helping with leg day!)
Ensure your weightlifting is done first. If you want to do Zone 2 that day, it can go immediately after weights, or later that day.
Limit your HIIT workouts to 30 minutes or less one to two times per week following weight workouts. (And probably not on leg day unless you are a maniac.)

Question of the Week

Q: How to navigate perimenopause with a low budget? The must-dos!

This is such a great question from vykteran on IG! There are many low- and no-cost items that make a major difference in our experience with perimenopause.

Here are the top 30 things I feel measurably move the needle when it comes to feeling great in perimenopause. Take your pick!

Watch the sunrise / early morning sunlight: Get outdoors (rain or shine) for 10 minutes every morning.
Watch the sunset.
Snack on exercise: for every 1 hour of sitting, get up and move for 10 minutes. (Read more about exercise snacks in Mini Pause #3.)
Mouth tape at night (can be a piece of surgical tape on the mouth).
Clean your house with vinegar, water, and a few drops of essential oils (I use orange or lemon).
Keep your phone and all electronics out of your bedroom.
Keep your room cool, dark, and serene.
Use only floor lights or candles after sunset, no overhead lights.
Lift heavy at least 3x/week. This can be weights at the gym or odd-shaped rocks and objects you find in nature.
Sprint 1-2x/week. Grab your trainers and hit the road! Run as fast as you can for one minute, then walk until your heart rate recovers. Do this cycle 5x.
Aim to get at least 7,000 steps a day. Your phone likely has a pedometer built into it.
Drink 3L of water daily. Add in sea salt or electrolytes.
Moisturize your skin after a shower or bath with olive oil.
Absolutely no alcohol.
Set boundaries and stick to a consistent bedtime and waketime every day (including weekends).
Aim to get a minimum of 30g of protein at each meal.
Chew your food 20 times on each side of your mouth.
Stop eating 2-3 hours before bedtime.
Open your windows!
Practice gratitude for people, things, and events in your daily life.
Tell people why you love them: send a voice note or a written note about what you are grateful for and what you notice about them that you admire.
Watch comedy and let yourself laugh!
Sing or hum along to music (opens the throat chakra; the humming is calming for the nervous system).
Oil pull for oral health.
“Close and clean” your work and personal spaces daily. Have a proper work shutdown: tidy up your desk, and shut down your computer. Put dishes in the dishwasher, and wipe down countertops so you can walk into your kitchen the next day without seeing clutter.
Celebrate your efforts, not only the outcome.
At the end of the day, reflect on how awesome you were with at least one specific example.
Make a desire list and dream about what lights you up. A desire list can be anything: from material items you want, experiences, relationships, properties, lifestyle, etc. Just allow yourself to dream again.
Practice forgiveness. For your parents, for ex-partners, coworkers, friends, or anyone who has wronged you. It is not that you are letting them off the hook for what they did, but that you are setting yourself free.
Sit on the grass, on the sand, or anywhere in nature. Gaze off into the distance. Let your mind wander.

Ok, that's just a preliminary list! What did I miss?

YOUR TURN!

Let me know what you’d add to this list of low-budget perimenopause must-dos. Send in your favorites to support@drstephanieestima.com.

WHAT I RECOMMEND: BodyBio

You know I’m a big proponent of optimizing my nutrition and lifestyle to promote healthy aging, and I love a product that achieves multiple health goals at once.

That’s why I’ve incorporated BodyBio PC, a phospholipid complex, into my daily routine. Not only are phospholipids essential for cellular health, especially as we age, they also:

Promote mental clarity and memory*
Support a healthy gut lining (no more leaks!)*
Encourage liver detoxification*
Support bile flow and fat digestion*

Visit BodyBio.com to learn why PC is considered “the foundation of your cells.” Use code DRSTEPHANIE to save 15% sitewide.

Bonus! If you missed my April 8 BETTER! podcast with Jessica Berman, you may want to take a listen this weekend. We talked about seed oils (misunderstood), omega 6s & 3s (essential) and how they impact your body’s composition and overall health. As an executive leader at BodyBio, Jess is continuing the legacy of the membrane medicine work her grandfather, scientist Ed Kane, spent over four decades researching.

*This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.

Benefits for My Bettys

In these newsletters, I often share the products, devices, and equipment that I use in my own life regularly. I only mention items I feel are worth highlighting and that I believe may provide health and wellness benefits to my Bettys. I encourage you – pressure-free! – to explore and then determine if any of the items fit YOUR health needs, fitness goals, lifestyle, or budget.

Today’s issue includes the following items. Use code DRSTEPHANIE with the links below to receive a special discount.

Cardio fitness training with CAROL Bike
Sauna benefits with Sunlighten

You’ll find more resources in my online HEALTH TOOLKIT. I’ve compiled these for my Bettys who are still cycling, experiencing symptoms of perimenopause, or managing the transition to the other side of menopause. Take a look!