Why Exercise Recommendations Are Failing Neurodivergent Women

The research landscape for women and exercise has shifted meaningfully in recent years. Hormonal health, menstrual cycle phases, training load across the lifespan. There is growing evidence that women need to be trained differently from men, and that is a significant step forward.

But there is a population sitting inside that conversation who are still being overlooked. Women with ADHD and related neurodivergent profiles whose nervous systems are running at sustained capacity, whose bodies are carrying the cumulative weight of years of masking and managing, and whose training responses are shaped by the intersection of hormonal fluctuation and nervous system dysregulation. Women who have never been given an exercise framework that accounts for any of that.

The consequences are not abstract. They are burnout, injury, and a lifetime of being told the problem is their inconsistency, their lack of discipline, their inability to stick to a programme.

The problem was never them. The framework was never built for them.

What I see when I neurodivergent woman walks through my door.

Before I ask a single question, I am already reading the body.

The alignment. The breath, which usually sits high in the chest and does not drop into the ribcage. The tension in the fascia pulling from the neck all the way down to the hip. And beneath all of that, a pulse that tells me immediately: this woman arrived already stressed. Already at capacity. Already running at a level most people would consider their emergency gear.

That is not unusual. That is what I see consistently with this population.

Research on intense physical activity tells us it takes at least three minutes for heart rate to begin returning to normal after exertion. For a neurodivergent woman arriving straight from a full day of cognitive load, that elevated state is not the result of exercise. It is the result of simply being alive in a world that was not designed for how she processes it.

And that changes everything about how the session must begin.

The first 10 mins are everything.

The first ten minutes of a session with a neurodivergent woman are not a warm-up. They are the work.

That time is spent entirely on the breath. Encouraging the ribcage to expand. Releasing the diaphragm. Creating the conditions for the woman to stop being occupied by her thoughts and start arriving in her body.

From there, we move into mobility. Specifically, work that releases the fascia, hydrates it, and returns movement to tissue that has been held under sustained tension. Fascia that has been gripping pulls on joints and muscles. It restricts output, contributes to pain, and limits recovery. Releasing it is not preparation for the real work. It is the real work.

Only once that has happened, once the nervous system has had the space to begin settling and the body has started to move freely, do we progress to strength work.

How long this takes depends on what the body is holding that day. Sometimes ten minutes. Sometimes thirty. The severity of the tension determines the timeline, not the clock.

Hormonal fluctuations do not happen in isolation.

For neurodivergent women, hormonal fluctuations do not simply affect training capacity. They interact with existing neurological patterns in ways that can be genuinely destabilising.

During certain phases of the cycle, particularly when oestrogen is lower, cognitive function is affected. ADHD symptoms worsen. Fatigue arrives not as tiredness but as a full system shutdown. The week that felt manageable last month can feel impossible this month. And what worked in the follicular phase can cause injury in the luteal phase because of fatigue, lack of coordination, or reduced interoception. (Kooij et al., 2025)

Interoception matters enormously here. The ability to feel what is happening inside the body. For many neurodivergent women, this is impaired. They can either feel too much, overwhelmed by every sensation, or they can feel very little, unable to register when the body is approaching its limit. Both create risk in a training environment.

Proprioception, the body's sense of its own position in space, is similarly affected. This is why feedback during movement matters so much with this population. Not correction. Not instruction. Felt sense cues that help the body understand where it is and what it is doing.

The Pre-frontal cortex under stress.

Under acute stress, the prefrontal cortex hyperactivates. That is the state in which most of my clients arrive. Thoughts racing, attention scattered, the brain working hard at something that has nothing to do with the session about to begin.

Under chronic stress and sustained cognitive load, that same prefrontal cortex eventually shows reduced capacity. Perceived occupational stress is associated with decreased cortical activity of the prefrontal cortex, particularly in women. (Chou et al., 2016) The system that has been overworked begins to lose its ability to regulate effectively.

The goal in those opening minutes is not to shut the prefrontal cortex down entirely. It is to calm it to the point where the woman can remain alert and focused. Present in the movement rather than running parallel to it in her head.

That shift, from hyperactivated to regulated, is what makes strength training possible. Without it, the session is working against the body rather than with it.

A framework built from fourteen years of clinical observation.

The body cannot build strength in a system that perceives threat.

That is the central principle behind everything I do with neurodivergent women. And it is the reason that conventional exercise recommendations, even those built specifically for women, are not sufficient for this population.

What this population needs is a framework that holds three things simultaneously.

Hormonal health as the foundation. Understanding how cycle phase and life stage shape training capacity. What works in one phase, how to adapt in another. This is where the existing research has begun. But it is only the beginning.

Nervous system regulation as the essential next layer. Assessing the baseline state before any load is introduced. Recognising that cognitive overload and physical overload are the same thing to the body, and that adding training to an already overwhelmed system does not build capacity. It compounds the problem.

Neurodivergent experience as the specific lens. The impaired interoception and proprioception. The hormonal fluctuations that interact with neurological patterns. The inconsistency that is not a failure of character but a physiological reality.

I call this the Dynamic Feminine Force.

Three integrated lenses, not three separate programmes.

The body cannot build strength in a system that perceives threat.

That is the central principle behind everything that I do with neurodivergent and high-functioning women. And it is the reason that exercise recommendations, even those built specifically for women, are not sufficient for this population.

The problem was never the. The framework was never built for them.

That is what needs to change.

Seema Chopra MSc is an Embodied Strength Coach and Somatic Specialist working with neurodivergent and high-performing women in London and online. The Active Shakti Studio is in SE20.

Book a complimentary Somatic Audit: https://calendly.com/activeshakti-in-person/the-somatic-audit-identify-the-grip

References

Bürger, I., Erlandsson, K. and Borneskog, C. (2024) 'Perceived associations between the menstrual cycle and Attention Deficit Hyperactivity Disorder (ADHD): a qualitative interview study exploring lived experiences', Sexual and Reproductive Healthcare, 40, p.100975.

Chou, P-H. et al. (2016) 'Perceived occupational stress is associated with decreased cortical activity of the prefrontal cortex: a multichannel near-infrared spectroscopy study', Scientific Reports, 6, p.39089.

Kooij, J.J.S. et al. (2025) 'Research advances and future directions in female ADHD: the lifelong interplay of hormonal fluctuations with mood, cognition, and disease', Frontiers in Global Women's Health, 6, p.1613628.