Strength Training vs Cardio for Bone Density in Perimenopause
Bone density declines in perimenopause. Strength training and cardio protect it differently. Learn which does more for your bones and how to combine both.
Why bone density becomes urgent in perimenopause
Estrogen plays a central role in regulating bone turnover, the continuous process by which old bone is broken down and new bone is formed. As estrogen levels fall during perimenopause, bone resorption accelerates and bone formation does not keep pace. The result is a net loss of bone density that begins before the final menstrual period and continues at an accelerated rate for several years after menopause. Women can lose between 10 and 20 percent of their bone density in the decade surrounding menopause. This loss increases the lifetime risk of osteoporosis and fracture, particularly of the spine, hip, and wrist. Exercise is one of the most powerful non-pharmacological tools available to slow this process, and the type of exercise matters.
How strength training benefits bone
Strength training, also called resistance training or weight lifting, stimulates bone formation through a process called mechanical loading. When muscles contract against resistance, they pull on the bones they attach to. This pull, combined with the compressive force of holding or moving weight, signals bone cells called osteoblasts to lay down new bone tissue. Research consistently shows that progressive resistance training improves bone mineral density at the sites most at risk from osteoporotic fracture, particularly the spine and hip. Exercises that load the spine and hips directly, such as squats, deadlifts, hip hinges, and loaded carries, are particularly beneficial. Even moderate resistance training performed two to three times per week produces measurable improvements over 12 months.
How cardio affects bone density
Not all cardio is equal when it comes to bone health. Weight-bearing cardio, where the skeleton must support the body against gravity and absorb impact, provides a bone stimulus. Walking, jogging, running, dancing, stair climbing, and aerobics are all weight-bearing activities that contribute to bone density maintenance. Non-weight-bearing cardio, such as swimming and cycling, does not load the skeleton in the same way and therefore provides little to no direct bone benefit. Research comparing weight-bearing cardio with strength training generally shows that strength training produces greater bone density gains, particularly at the spine and hip, though high-impact weight-bearing cardio such as running can also be effective at the hip.
Comparing the evidence directly
Studies that have directly compared resistance training with aerobic exercise for bone density outcomes consistently favour resistance training, particularly for spine bone density. A 2022 meta-analysis of postmenopausal women found that progressive resistance training produced significantly greater improvements in lumbar spine bone mineral density than aerobic exercise alone. Both types of exercise improved hip bone density, but resistance training again showed a larger effect. The combination of both, often called concurrent training, produced the best outcomes overall. Weight-bearing aerobic activity maintains bone better than being sedentary and is far preferable to non-weight-bearing options, but if bone density is a primary concern, resistance training should be a central component of any exercise programme.
The additional case for strength training in perimenopause
Beyond bone density, strength training offers benefits during perimenopause that cardio alone does not fully provide. It preserves and builds muscle mass, which declines with age and with hormonal change and which is essential for metabolism, strength, and independence later in life. It improves insulin sensitivity, which is important as metabolic changes increase the risk of type 2 diabetes. It supports joint integrity and reduces injury risk. It has been shown to improve mood, sleep quality, and self-efficacy. The combination of these benefits alongside the bone density advantage makes progressive resistance training arguably the single most important type of exercise for women in perimenopause.
The case for keeping cardio in the mix
Cardiovascular exercise remains essential during perimenopause for reasons that strength training alone does not cover. Aerobic fitness supports heart health, and cardiovascular disease is the leading cause of mortality in postmenopausal women. Cardio exercise improves mood, reduces anxiety, and supports weight management by burning calories and improving metabolic flexibility. For women experiencing hot flashes, moderate-intensity aerobic activity can help over time through improved thermoregulatory function. Zone 2 cardio, which is sustained aerobic effort at a pace where you can hold a conversation, is particularly associated with metabolic and cardiovascular benefits. The ideal exercise programme for bone density and overall health in perimenopause combines both modalities.
Building a practical programme
A sensible starting point for most women in perimenopause is two to three resistance training sessions per week using progressive overload, meaning gradually increasing weight or difficulty over time, alongside two to three sessions of weight-bearing cardiovascular activity such as brisk walking, jogging, or dance. This does not need to be elaborate or time-consuming. Twenty to thirty minutes of structured resistance work covering the major muscle groups, including the hips, spine, and shoulders, provides meaningful bone stimulus. Logging your workouts and tracking how your energy, mood, and sleep respond using PeriPlan helps you build the picture of what your body needs and enables you to show progress over time.
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