If you're a pre-menopausal woman, take note – exercise is the key to optimising your health in later years according to a new study in the Journal of Physiology.

While it's never too late to start exercising, the years before menopause are critical active years for women to develop blood vessels in muscles that lay foundations for future strength.

So, what type of exercise and lifestyle factors keep women fit into their twilight years?

Senior physiotherapist Michael Dermansky says the most important type of exercise for women who are peri and post-menopausal is strength training.

"It is probably one of the most underestimated parts of training with the most amount of benefits," explains Mr Dermansky.

Specifically, strength training, improving balance and working out for individual exertion are the main factors when it comes to optimum exercise for women in this stage of life.

Strength training helps with glucose control and reduces the risk of glucose intolerance.

Improving muscle mass through strength training increases both the number and quality of the glucose and insulin receptors in the body, explains Mr Dermansky.

"[This] allows you to more efficiently and effectively take glucose out of your bloodstream and into the muscles for energy and storage."

Recently, there has been a shift in both the research and recommendations in the most effective exercise to manage diabetes.

"Strength training is a major aspect we can 'control' that has a positive, reversing effect on improving glucose management."

It is rarely a woman's 'fitness' that limits lifestyle choices, but their strength.

In conducting thousands of assessments with peri and post-menopausal women, very rarely is true 'fitness' or lack of cardio fitness the limiting factor, says Mr Dermansky.

"It is their lack of strength, specifically the lack of strength around their back, pelvis and hips that stops them from participating in activities in life.

"If they are not strong enough, they don't try something out because its' too hard' or they just feel like they just can't do it."

Women find themselves in a vicious cycle that leads to less activity and further weakness, says Mr Dermansky.

"Reversing this cycle takes some effort but has huge benefits.

"I have seen women who are stronger and can do more in their life in their sixties than they could ever do earlier in their life due to a lack of strength."

Improved balance and reduced risk of falls are directly related to a lack of strength.

"One of the major limiting factors we have found in lack of balance is a lack of strength around the back/hips and pelvis.

"You need strength in their area to be able to stand on one leg, which you spend 80% of your time doing to walk normally. As a result, women walk less and do less things that challenge their balance, reducing their activity level further.

"Again, working on strength reverses this scenario and means that reduced risk of falls and improvement in quality of life," says Mr Dermansky.

Exercise limitations – exertion over heart rate.

"In general, heart rate is a poor predictor of exercise limitations. Heart rate is variable between people.

"The well-used formula of 220 minus age has an error of +/- 40 beats, which means it can be 80 beats off for an individual, so very unreliable."

Instead, the most reliable indicator is perceived exertion.

"An eight to 10 perceived exertion is often very consistent for an individual and a good indication that person is working close to their personal limit," says Mr Dermansky.

Physiotherapist Caitlin Stannard, an expert in women's wellness, says hormonal changes during menopause can make exercise difficult, but even more important. 

"We know that reduced oestrogen results in reduced bone density, especially if there is a family history of osteoporosis and changes to muscle fibre structure.

"We recommend that women gradually increase their exercise with a focus on some form of strength, such as weights, Pilates, or circuit exercise, and some form of impact, like dancing and skipping."

These exercises are essential to improve muscle mass, promote healthy bones and to combat some of the side effects of menopause, explains Ms Stannard. 

Though exercise is important across the lifespan, it's never too late to start.

"By building up a strong bank of bone tissue and muscle tissue in your youth and early adulthood, you will be able to reach a higher' peak bone density.'

"But even if you weren't active earlier in life you can still make significant changes around the age you reach menopause."

Osteogenic exercise, which involves impact – such as jumping or sliding around tennis court – are important for building bone density, while other exercises - like Pilates and cycling - build muscle tone.

"Our bodies are made to move, lift, twist and jump!"

However, while important, exercise isn't the only lifestyle factor to protect the peri and post-menopausal woman.

"Diet, exercise and mental health are all interlinked, and as hormones change through the life stages, you may find that you need to adjust the way you nourish your body.

"Maintaining a healthy body weight through a nutritious diet and the right level of exercise is even more important when your oestrogen levels fall, making you more predisposed to weight gain.

"Talking to your GP and dietician can be helpful to manage what you are putting into your body.

"A physiotherapist or exercise physiologist can guide you with keeping or building your fitness and strength to protect your bones and muscles."

Starting an exercise routine at any stage has challenges – time, facilities and motivation are all barriers.

"Do exercise with a group, keep it low cost and use the resources that are available to you, rather than starting something complicated!

"See if your local community centre offers an exercise program that interests you."