Why Midlife Women Need Strength Training for Brain Health: What Naomi Watts Gets Right About Menopause, Memory, and Longevity
Resistance training (also called strength training or weight training, lifting weights, resistance bands, or bodyweight against load, done in a structured, progressive way) is one of the few interventions with consistent evidence for supporting cognitive function in adults over 50, including women moving through menopause. The available trial evidence, most of it in mixed-sex older-adult populations rather than menopause-specific cohorts, links resistance training to improved executive function and slower decline on standardized cognitive tests. It has not been shown to prevent Alzheimer's disease or reverse menopause-related brain fog, and the exact size of the benefit varies across studies. The useful question for a midlife woman is not whether exercise helps the brain, most forms do, to some degree, but whether resistance training specifically, done at sufficient intensity and frequency, adds something that walking or cardio alone does not.
Naomi Watts, an actress who has spoken publicly about her menopause experience and later launched a menopause-focused wellness brand, has described strength training as central to how she manages this life stage. That is a personal account, not a clinical claim, and it should be read as one woman's routine rather than a validated protocol. It happens to align with a direction the exercise-and-cognition literature has been pointing for over a decade.
What actually changes in the brain during menopause
The menopause transition involves a large drop in circulating estradiol, a hormone that acts on receptors in the hippocampus and prefrontal cortex, the regions most involved in memory formation and executive function (planning, focus, working memory). Longitudinal cohort research, including the Study of Women's Health Across the Nation (SWAN), has documented measurable declines in processing speed and verbal memory around the final menstrual period that are not fully explained by mood or sleep changes. This is observational cohort evidence: it establishes that the symptoms women describe as "brain fog" are real and time-linked to the transition, not that any single intervention reverses them.
Women also carry a disproportionate share of Alzheimer's disease cases relative to their share of the older population, a pattern researchers attribute partly to the hormonal and vascular changes of menopause rather than longevity alone. This is an area of active research, not a settled mechanism, and readers should treat any single causal explanation with caution.
The strongest, most quotable summary of the evidence
Progressive resistance training performed at least twice a week has been associated in randomized trials with improved executive function and, in some studies of older adults with mild cognitive impairment, with slower decline on standardized cognitive assessments; the effect appears related to training intensity and frequency rather than to exercise in general. This evidence largely comes from mixed-sex populations aged 55 and older rather than menopause-specific trials, so its exact magnitude and durability in midlife women is plausible but not separately established. The World Health Organization's 2020 physical activity guidelines recommend that adults over 50 perform muscle-strengthening activity on two or more days per week alongside 150 to 300 minutes of moderate aerobic activity, a recommendation made for overall health rather than specifically for cognitive protection (WHO, 2020).
Proposed biological pathways
Several mechanisms have been proposed to connect resistance training to brain outcomes. Each has laboratory or small-trial support; none has been proven to be the dominant driver of any clinical cognitive benefit in menopausal women specifically.
Brain-derived neurotrophic factor (BDNF). BDNF supports the formation and strengthening of synapses. Resistance training programs lasting eight to twelve weeks have been reported in several trials to raise circulating BDNF compared with inactive controls. The exact magnitude varies by study population and measurement method, and readers should not treat any single percentage figure as fixed without checking the original trial.
IGF-1. Insulin-like growth factor-1 is released from muscle and liver during resistance exercise and can cross into the central nervous system, where it has been linked to neuronal survival in animal and small human studies. Human correlational data connecting IGF-1 to hippocampal volume in midlife women exist but are limited in sample size.
Inflammation. Chronic low-grade inflammation tends to rise after menopause and is associated with vascular and neurological aging. Systematic reviews of resistance training in postmenopausal women have generally reported reductions in inflammatory markers such as CRP, though effect sizes differ across reviews.
Vascular function. Cardiovascular disease is a leading driver of global mortality and disability in aging populations, and vascular health is mechanistically tied to brain health because the brain depends on stable blood flow and glucose delivery (GBD 2023 cardiovascular disease burden analysis). Small trials in postmenopausal women suggest resistance training can improve markers of vascular function, which is one plausible route to better brain perfusion, though this specific chain from training to perfusion to cognition has not been directly proven in a single study.
The trial evidence, and its limits
A frequently cited study in this area is the Study of Mental Activity and Resistance Training (SMART), which randomized older adults with mild cognitive impairment to combinations of resistance training and cognitive training. Secondary sources describe the resistance-training arm as showing meaningful improvement on a standard cognitive assessment scale after six months, with some benefit persisting at longer follow-up in a subset of participants whose strength gains correlated with imaging measures. Because the specific effect sizes attached to this trial could not be verified against the primary publication for this article, readers who need exact numbers should pull the original Journal of the American Geriatrics Society report rather than rely on secondhand figures.
Similarly, a well-known trial by Liu-Ambrose and colleagues compared once-weekly and twice-weekly resistance training against a balance-and-tone control in older women, and is often cited as showing that twice-weekly training, but not once-weekly training, produced meaningful gains in executive function over a year. Again, the precise percentage improvements circulating in secondary articles should be checked against the original Archives of Internal Medicine publication before being treated as authoritative.
A separate line of research has compared resistance training directly against aerobic exercise for cognitive outcomes. Network meta-analyses in this space have generally found resistance training performs at least as well as, and in some comparisons better than, aerobic training for executive function specifically, while aerobic exercise retains strong evidence for cardiovascular fitness and mood. Both forms of exercise appear to have value through different pathways; one is not a substitute for the other.
Hormone therapy and exercise together
Some trials in early postmenopausal women have tested estradiol therapy, exercise, and the combination against placebo, generally reporting that combined treatment produced greater improvement in verbal memory than either alone. This is a plausible, biologically coherent finding, estradiol is thought to support the transcription machinery for BDNF while exercise provides the mechanical stimulus for its release, but it comes from a single small trial design in this literature, and the exact effect size should not be treated as a global constant.
For women who cannot or choose not to use hormone therapy, including many breast cancer survivors and those with a history of blood clots, resistance training is a standalone option with its own trial evidence, independent of hormonal status. The North American Menopause Society's guidance supports recommending physical activity, including resistance exercise, to all menopausal women regardless of whether they use hormone therapy; a woman with hormone therapy contraindications should not read this article as a substitute for that guidance and should discuss options with her clinician.
What is established, what is plausible, and what is not established
Established: Estradiol decline during menopause affects brain regions involved in memory and executive function. Verbal memory and processing speed decline, on average, across the menopause transition in longitudinal cohorts. Resistance training performed regularly (generally two or more sessions per week) is associated with improved executive function in older adults in multiple randomized trials. WHO guidelines recommend muscle-strengthening activity twice weekly for adults over 50 for general health.
Plausible but not proven specifically in menopausal women: That resistance training raises BDNF, IGF-1, and reduces inflammation enough to meaningfully slow menopause-related cognitive decline. That combining hormone therapy with resistance training produces additive brain benefits beyond what either does alone. That a specific loading threshold (commonly cited around 70 to 80 percent of one-repetition maximum) is required to reach a cognitive benefit, as opposed to a general dose-response relationship.
Not established: That resistance training prevents Alzheimer's disease or any specific form of dementia. That any named celebrity's personal routine is a validated clinical protocol. That light resistance bands or bodyweight training provide no benefit, the evidence gap here is an absence of dedicated trials, not evidence of no effect.
Who should not start a heavy lifting program without medical clearance first
Resistance training is not appropriate to begin without professional guidance for women with unstable angina, uncontrolled hypertension, recent cardiac events, severe osteoporosis with vertebral compression risk, uncontrolled arrhythmia, or significant joint disease affecting the spine, hips, or knees. Sudden chest pain, unusual shortness of breath, new severe headache, vision changes, or fainting during exercise are reasons to stop and seek urgent medical care, not to push through.
A decision framework for starting resistance training around menopause
This FAQ is not intended to replace a medical evaluation by a thyroid specialist. Rather, it offers a framework for considering the key factors and considerations you may want to discuss at your initial appointment.
| Your situation | What the evidence supports | Caution or exception | Reasonable next step |
|---|---|---|---|
| Healthy, no cardiovascular or bone disease, new to lifting | Two to three sessions per week of supervised, progressive compound movements is well supported for general and cognitive health | Start with lighter loads and build technique before increasing intensity | Get a baseline session with a qualified trainer or physical therapist to check form |
| History of osteoporosis or low bone density | Loaded resistance exercise can support bone health, but technique and load selection matter more than in a healthy spine | Avoid unsupervised heavy spinal loading (deadlifts, back squats) until cleared | DXA scan and physician or physical therapist clearance before axial loading |
| Cardiovascular disease, uncontrolled hypertension, or recent cardiac event | Exercise is generally protective long-term, but the transition into resistance training needs supervision | Do not start an intense program without clearance; heavy straining (Valsalva) raises blood pressure acutely | Cardiology or primary care clearance, then a medically supervised program |
| Considering or currently on hormone therapy | Evidence suggests combining exercise with hormone therapy may be additive for memory, but this is based on limited trial data | Do not start or stop hormone therapy based on exercise plans alone | Discuss both exercise and hormone therapy options with the clinician managing your menopause care |
| Cannot or choose not to use hormone therapy | Resistance training has standalone trial support independent of hormonal status | None specific to this group | Twice-weekly progressive training is a reasonable starting frequency, adjusted to fitness level |
| Over 70 and previously sedentary | Trials including adults into their 80s have shown cognitive benefit from resistance training with appropriate supervision | Fall risk, balance, and joint status need assessment first | Start with a physical therapist or geriatric-trained trainer rather than a general gym program |
| Experiencing new or worsening memory problems that concern you | Exercise is a reasonable general step but is not a diagnostic or treatment pathway for cognitive impairment | Do not use exercise as a substitute for medical evaluation of memory symptoms | See a primary care provider for cognitive screening before or alongside starting a program |
Practical starting points, without individualized dosing
General guidance drawn from the WHO recommendation and the exercise trials discussed above suggests two to three non-consecutive training days per week, built around compound movements (a squat pattern, a hip-hinge pattern, a horizontal push, a horizontal pull) rather than isolation exercises, with load and repetitions adjusted by a qualified trainer or physical therapist to the individual's fitness level and any medical restrictions. This article does not provide a personalized load, repetition, or progression prescription; that decision belongs to the reader and a qualified professional who has assessed her directly.
Common questions
Does strength training reverse menopause brain fog? No trial has shown it reverses brain fog. Several trials suggest it can improve executive function and slow decline on cognitive tests in older adults generally, which is a related but narrower claim.
Is resistance training better than cardio for the brain? For executive function specifically, several meta-analyses have found resistance training performs at least as well as or better than aerobic training. For cardiovascular fitness and mood, aerobic exercise has its own strong, separate evidence base. They are not interchangeable.
Can I combine hormone therapy with strength training for extra brain protection? Small trial evidence suggests the combination may be additive for verbal memory, but this is based on limited data and should be discussed with the clinician managing hormone therapy rather than decided independently.
Is it too late to start at 60 or 70? Published trials in this area have enrolled participants into their 80s and reported cognitive benefit from supervised resistance training. Starting later in life requires more attention to baseline fitness, balance, and joint status, not a lower expectation of benefit.
Does Naomi Watts' routine prove strength training works for brain health? No. Her public comments describe a personal choice, not a study. The alignment with existing trial evidence is what makes the topic worth covering, not her endorsement itself.
What symptoms mean I should stop exercising and seek care? Chest pain, unusual shortness of breath, sudden severe headache, vision changes, or fainting during exercise warrant stopping immediately and seeking medical attention rather than continuing the session.
References
World Health Organization. WHO guidelines on physical activity and sedentary behaviour. Geneva: WHO; 2020. https://www.who.int/publications/i/item/9789240015128
GBD 2023 Cardiovascular Diseases Collaborators. Global, Regional, and National Burden of Cardiovascular Diseases and Risk Factors in 204 Countries and Territories, 1990-2023. 2025. https://pubmed.ncbi.nlm.nih.gov/40990886/
Note for editorial review: several trial names and effect sizes referenced in the prior draft of this article (SMART trial, Liu-Ambrose 2010, Thomas 2018 HRT-exercise trial, and others) could not be verified against their primary publications for this revision and have been described in general, hedged terms. A direct quotation previously attributed to a named researcher has been removed because its source could not be confirmed. Before publication, a reviewer should pull the primary trial reports for any statistic intended to appear as a precise figure in the final version.