Evolution of resistance training in women: History and mechanisms for health and performance

Abstract

Throughout history, cultural norms and stereotypes have discouraged resistance training in women. Today, as awareness and acceptance of resistance training in women has grown, supported by scientific research and advocacy, more women are achieving health and performance benefits from resistance training. This narrative review discusses the current scientific literature on sexual dimorphisms, the mechanisms underlying health and performance adaptations of resistance training in women, with implications for program design. In general, the physiological adaptations to resistance training in women are mediated largely by the neuroendocrine and immune systems, similar to in men albeit via some distinct predominant pathways involving sex hormones estrogen, testosterone, growth hormone (GH), and insulin-like growth factor- I (IGF-I). As a result, women may have unique adaptations in terms of muscle hypertrophy, substrate utilization, fatiguability, and recovery. Despite subtle physiological differences, women achieve measurable increases in strength, power and athletic performance via engaging in resistance training programs of sufficient frequency, intensity, and duration. Moreover, beyond performance, resistance training has a favorable impact on women’s health including metabolic health, body composition, bone health, cardiovascular health, mental health, self-esteem, and body image. Resistance training recommendations for men and women are highly similar and goal-dependent, with some specific caveats that need to be addressed in women. As resistance training has become regarded as a key element of programs for achieving performance and health improvements in women, additional research may further our understanding.

Keywords

Strength training / Sexual dimorphism / Hormones / Neuromuscular

Declaration of competing interest

The authors have no conflict of interest to declare in this paper’s content or topic. During the preparation of this work, the authors utilized ChatGPT's image generation tool to create depictions of women per-forming resistance exercises. This approach was chosen to illustrate key concepts without using images of real human subjects, ensuring ethical considerations, privacy protection, and compliance with publication guidelines. The generated figures serve to visually support the concepts presented without the need for actual participant photography or con-sent. After using this tool/service, the author(s) reviewed and edited the content as needed and take(s) full responsibility for the content of the publication.

Acknowledgment statement

The authors would like to express their gratitude to our colleagues whose invaluable contributions and dedication have significantly influ-enced the understanding and importance of this topic. We deeply appreciate their collaborative efforts and the foundational work they have contributed to the many studies that have advanced this critical area of research.

References

[1] Staron RS, Hagerman FC, Hikida RS, et al. Fiber type composition of the vastus lateralis muscle of young men and women. J Histochem Cytochem. 2000; 48(5): 623-629. https://doi.org/10.1177/002215540004800506.

[2] Kraemer WJ, Gordon SE, Fleck SJ, et al. Endogenous anabolic hormonal and growth factor responses to heavy resistance exercise in males and females. Int J Sports Med. 1991; 12(2):228-235. https://doi.org/10.1055/s-2007-1024673.

[3] Nuzzo JL. Narrative review of sex differences in muscle strength, endurance, activation, size, fiber type, and strength training participation rates, preferences, motivations, injuries, and neuromuscular adaptations. J Strength Cond Res. 2023; 37(2):494-536. https://doi.org/10.1519/JSC.0000000000004329.

[4] Bartolomei S, Grillone G, Di Michele R, Cortesi M. A comparison between male and female athletes in relative strength and power performances. J Funct Morphol Kinesiol. 2021; 6(1):17. https://doi.org/10.3390/jfmk6010017.

[5] Nuzzo JL. Sex differences in skeletal muscle fiber types: a meta-analysis. Clin Anat. 2024; 37(1):81-91. https://doi.org/10.1002/ca.24091.

[6] Shurley J, Felkar V, Greviskes LC, Todd JS. Historical and social considerations of strength training for female athletes. Strength Cond J. 2019; 42(4):22-35. https://doi.org/10.1519/SSC.0000000000000478.

[7] Latham A. The history of a habit: jogging as a palliative to sedentariness in 1960s America. Cult Geogr. 2015; 22(1):103-126. https://doi.org/10.1177/1474474013491927.

[8] Cooper KH. The history of aerobics (50 years and still counting). Res Q Exerc Sport. 2018; 89(2):129-134. https://doi.org/10.1080/02701367.2018.1452469.

[9] Shurley JP, Todd JS. “The strength of Nebraska”: boyd Epley, Husker Power, and the formation of the strength coaching profession. J Strength Cond Res. 2012; 26(12): 3177-3188. https://doi.org/10.1519/JSC.0b013e31823c4690.

[10] Shurley JP, Todd J, Todd T. Strength Coaching in America: A History of the Innovation that Transformed Sports. University of Texas Press; 2019.

[11] Associations. NFoSHS.2022-23 high school athletics participation Survey.

[12] Holloway JB, Gater D, Ritchie M, et al. Strength training for female athletes: a position paper: Part I. Strength Cond J. 1989; 11(4):43-51. https://doi.org/10.1519/0744-0049(1989)011<0043:stffaa>2.3.co;2.

[13] Holloway JB, Gater D, Ritchie M, et al. Strength training for female athletes: a position paper: Part II. Strength Cond J. 1989; 11(5):26-36. https://doi.org/10.1519/0744-0049(1989)011<0029:stffaa>2.3.co;2.

[14] National Strength and Conditioning Association NSCA. Position stand on resistance training for female athletes. National Strength Cond J. 1991; 13(2):36-39. https://doi.org/10.1519/SSC.0b013e3181b9c34c.

[15] Bradsell H, Frank RM. Anterior cruciate ligament injury prevention. Ann Jt. 2022;7: 1. https://doi.org/10.21037/aoj-2020-01.

[16] O’Malley L, Greenwood S. Female coaches in strength and conditioning - why so few? Strength Cond J. 2018; 40(6):40-48. https://doi.org/10.1519/SSC.0000000000000401.

[17] Hurley KS, Flippin KJ, Blom LC, Bolin JE, Hoover DL, Judge LW. Practices, perceived benefits, and barriers to resistance training among women enrolled in college. Int J Exerc Sci. 2018; 11(5):226-238.

[18] Burrup R, Tucker LA, Jd LEC, Bailey BW. Strength training and body composition in middle-age women. J Sports Med Phys Fit. 2018; 58(1-2):82-91. https://doi.org/10.23736/S0022-4707.17.06706-8.

[19] Isenmann E, Kaluza D, Havers T, et al. Resistance training alters body composition in middle-aged women depending on menopause - a 20-week control trial. BMC Womens Health. 2023; 23(1):526. https://doi.org/10.1186/s12905-023-02671-y.

[20] Santagnello SB, Martins FM, de Oliveira Junior GN, et al. Resistance training- induced gains in muscle strength and power mediate the improvement in walking speed in middle-aged women who are breast cancer survivors. J Strength Cond Res. 2024; 38(4):773-782. https://doi.org/10.1519/JSC.0000000000004020.

[21] Mayhew JL,Gross Gross PM. Body composition changes in young women with high resistance weight training. Res Q. 1974; 45(4):433-440.

[22] Brown CH, Wilmore JH. The effects of maximal resistance training on the strength and body composition of women athletes. Med Sci Sports. 1974; 6(3):174-177.

[23] Kraemer WJ, Ratamess NA, Newman TH. Developing the Athlete: An Applied Sport Science Roadmap for Optimizing Performance. Human Kinetics; 2024.

[24] Suchomel TJ, Nimphius S, Stone MH. The importance of muscular strength in athletic performance. Sports Med. 2016; 46(10):1419-1449. https://doi.org/10.1007/s40279-016-0486-0.

[25] Hunter SK, Edward F.Adolph Distinguished Lecture. Age and sex differences in the limits of human performance: fatigability and real-world data. J Appl Physiol (1985). 2024; 136(4):659-676. https://doi.org/10.1152/japplphysiol.00866.2023.

[26] Laubach LL. Comparative muscular strength of men and women: a review of the literature. Aviat Space Environ Med. 1976; 47(5):534-542.

[27] Staron RS, Karapondo DL, Kraemer WJ, et al. Skeletal muscle adaptations during early phase of heavy-resistance training in men and women. J Appl Physiol (1985). 1994; 76(3):1247-1255. https://doi.org/10.1152/jappl.1994.76.3.1247.

[28] Bishop P, Cureton K, Collins M. Sex difference in muscular strength in equally- trained men and women. Ergonomics. 1987; 30(4):675-687. https://doi.org/10.1080/00140138708969760.

[29] Alegre LM, Lara AJ, Elvira JL, Aguado X. Muscle morphology and jump performance: gender and intermuscular variability. J Sports Med Phys Fit. 2009; 49(3):320-326.

[30] Sole CJ, Suchomel TJ, Stone MH. Preliminary scale of reference values for evaluating reactive strength index-modified in male and female NCAA Division I athletes. Sports. 2018; 6(4):133. https://doi.org/10.3390/sports6040133.

[31] Wiecek M, Szymura J, Maciejczyk M, Cempla J, Szygula Z. Effect of sex and menstrual cycle in women on starting speed, anaerobic endurance and muscle power. Phys Int. 2016; 103(1):127-132. https://doi.org/10.1556/036.103.2016.1.13.

[32] Nuell S, Illera-Dominguez V, Carmona G, et al. Sex differences in thigh muscle volumes, sprint performance and mechanical properties in national-level sprinters. PLoS One. 2019; 14(11):e0224862. https://doi.org/10.1371/journal.pone.0224862.

[33] Cardinale M, Stone MH. Is testosterone influencing explosive performance? J Strength Cond Res. 2006; 20(1):103-107. https://doi.org/10.1519/R-16864.1.

[34] Bezuglov E, Ahmetov II, Lazarev A, et al. The relationship of testosterone levels with sprint performance in young professional track and field athletes. Physiol Behav. 2023;271:114344. https://doi.org/10.1016/j.physbeh.2023.114344.

[35] Comfort P, McMahon JJ, Lake JP, Ripley NJ, Triplett NT, Haff GG. Relative strength explains the differences in multi-joint rapid force production between sexes. PLoS One. 2024; 19(2):e0296877. https://doi.org/10.1371/journal.pone.0296877.

[36] Anand KS, Dhikav V. Hippocampus in health and disease: an overview. Ann Indian Acad Neurol. 2012; 15(4):239-246. https://doi.org/10.4103/0972-2327.104323.

[37] Hendrickson NR, Sharp MA, Alemany JA, et al. Combined resistance and endurance training improves physical capacity and performance on tactical occupational tasks. Eur J Appl Physiol. 2010; 109(6):1197-1208. https://doi.org/10.1007/s00421-010-1462-2.

[38] Ratamess NA, Faigenbaum AD, Hoffman JR, Kang J. Self-selected resistance training intensity in healthy women: the influence of a personal trainer. J Strength Cond Res. 2008; 22(1):103-111. https://doi.org/10.1519/JSC.0b013e31815f29cc.

[39] Fogwe LA, Reddy V, Mesfin FB. Neuroanatomy, Hippocampus. StatPearls. 2024.

[40] Erickson KI, Voss MW, Prakash RS, et al. Exercise training increases size of hippocampus and improves memory. Proc Natl Acad Sci USA. 2011; 108(7): 3017-3022. https://doi.org/10.1073/pnas.1015950108.

[41] Handelsman DJ, Hirschberg AL, Bermon S. Circulating testosterone as the hormonal basis of sex differences in athletic performance. Endocr Rev. 2018; 39(5):803-829. https://doi.org/10.1210/er.2018-00020.

[42] Kraemer WJ, Ratamess NA. Hormonal responses and adaptations to resistance exercise and training. Sports Med. 2005; 35(4):339-361. https://doi.org/10.2165/00007256-200535040-00004.

[43] Vingren JL, Kraemer WJ, Hatfield DL, et al. Effect of resistance exercise on muscle steroid receptor protein content in strength-trained men and women. Steroids. 2009; 74(13-14):1033-1039. https://doi.org/10.1016/j.steroids.2009.08.002.

[44] Kraemer WJ, Ratamess NA, Nindl BC.Recovery responses of testosterone, growth hormone, and IGF-1 after resistance exercise. J Appl Physiol (1985). 2017; 122(3): 549-558. https://doi.org/10.1152/japplphysiol.00599.2016.

[45] Kraemer WJ, Ratamess NA, Hymer WC, Nindl BC, Fragala MS. Growth hormone(s), testosterone, insulin-like growth factors, and cortisol: roles and integration for cellular development and growth with exercise. Front Endocrinol. 2020;11:33. https://doi.org/10.3389/fendo.2020.00033.

[46] Ratamess NA. The ACSM's Foundations of Strength Training and Conditioning. second ed. Wolters-Kluwer Lippincott-Williams and Wilkins; 2022.

[47] Bhasin S, Hatfield DL, Hoffman JR, et al. Anabolic-androgenic steroid use in sports, health, and society. Med Sci Sports Exerc. 2021; 53(8):1778-1794. https://doi.org/10.1249/MSS.0000000000002670.

[48] Guilherme J, Semenova EA, Borisov OV, et al. Genomic predictors of testosterone levels are associated with muscle fiber size and strength. Eur J Appl Physiol. 2022; 122(2):415-423. https://doi.org/10.1007/s00421-021-04851-w.

[49] Bermon S, Garnier PY. Serum androgen levels and their relation to performance in track and field: mass spectrometry results from 2127 observations in male and female elite athletes. Br J Sports Med. 2017; 51(17):1309-1314. https://doi.org/10.1136/bjsports-2017-097792.

[50] Hirschberg AL, Elings Knutsson J, Helge T, et al. Effects of moderately increased testosterone concentration on physical performance in young women: a double blind, randomised, placebo controlled study. Br J Sports Med. 2020; 54(10): 599-604. https://doi.org/10.1136/bjsports-2018-100525.

[51] Fragala MS, Kraemer WJ, Denegar CR, Maresh CM, Mastro AM, Volek JS. Neuroendocrine-immune interactions and responses to exercise. Sports Med. 2011; 41(8):621-639. https://doi.org/10.2165/11590430-000000000-00000.

[52] Oosthuyse T, Strauss JA, Hackney AC. Understanding the female athlete: molecular mechanisms underpinning menstrual phase differences in exercise metabolism. Eur J Appl Physiol. 2023; 123(3):423-450. https://doi.org/10.1007/s00421-022-05090-3.

[53] Pellegrino A, Tiidus PM, Vandenboom R. Mechanisms of estrogen influence on skeletal muscle: mass, regeneration, and mitochondrial function. Sports Med. 2022; 52(12):2853-2869. https://doi.org/10.1007/s40279-022-01733-9.

[54] McNulty KL, Elliott-Sale KJ, Dolan E, et al. The effects of menstrual cycle phase on exercise performance in eumenorrheic women: a systematic review and meta- analysis. Sports Med. 2020; 50(10):1813-1827. https://doi.org/10.1007/s40279-020-01319-3.

[55] Kraemer WJ. Endocrine responses to resistance exercise. Med Sci Sports Exerc. 1988; 20(5 Suppl):S152-S157. https://doi.org/10.1249/00005768-198810001-00011.

[56] Hatfield DL, Kraemer WJ, Volek JS, et al. Hormonal stress responses of growth hormone and insulin-like growth factor-I in highly resistance trained women and men. Growth Hormone IGF Res. 2021;59:101407. https://doi.org/10.1016/j.ghir.2021.101407.

[57] Kraemer WJ, Staron RS, Hagerman FC, et al. The effects of short-term resistance training on endocrine function in men and women. Eur J Appl Physiol Occup Physiol. 1998; 78(1):69-76. https://doi.org/10.1007/s004210050389.

[58] Linnamo V, Pakarinen A, Komi PV, Kraemer WJ, Hakkinen K. Acute hormonal responses to submaximal and maximal heavy resistance and explosive exercises in men and women. J Strength Cond Res. 2005; 19(3):566-571. https://doi.org/10.1519/R-15404.1.

[59] Hymer WC, Kraemer WJ, Nindl BC, et al. Characteristics of circulating growth hormone in women after acute heavy resistance exercise. Am J Physiol Endocrinol Metab. 2001; 281(4):E878-E887. https://doi.org/10.1152/ajpendo.2001.281.4.E878.

[60] Kraemer WJ, Nindl BC, Marx JO, et al. Chronic resistance training in women potentiates growth hormone in vivo bioactivity: characterization of molecular mass variants. Am J Physiol Endocrinol Metab. 2006; 291(6):E1177-E1187. https://doi.org/10.1152/ajpendo.00042.2006.

[61] Pierce JR, Martin BJ, Rarick KR, et al. Growth Hormone and insulin-like growth factor-I molecular weight isoform responses to resistance exercise are sex- dependent. Front Endocrinol. 2020;11:571. https://doi.org/10.3389/fendo.2020.00571.

[62] Kraemer WJ, Hakkinen K, Triplett-Mcbride NT, et al. Physiological changes with periodized resistance training in women tennis players. Med Sci Sports Exerc. 2003; 35(1):157-168. https://doi.org/10.1097/00005768-200301000-00024.

[63] Sale DG, MacDougall JD, Alway SE, Sutton JR. Voluntary strength and muscle characteristics in untrained men and women and male bodybuilders. J Appl Physiol (1985). 1987; 62(5):1786-1793. https://doi.org/10.1152/jappl.1987.62.5.1786.

[64] Alway SE, Grumbt WH, Gonyea WJ, Stray-Gundersen J. Contrasts in muscle and myofibers of elite male and female bodybuilders. J Appl Physiol (1985). 1989; 67(1): 24-31. https://doi.org/10.1152/jappl.1989.67.1.24.

[65] Staron RS, Leonardi MJ, Karapondo DL, et al. Strength and skeletal muscle adaptations in heavy-resistance-trained women after detraining and retraining. J Appl Physiol (1985). 1991; 70(2):631-640. https://doi.org/10.1152/jappl.1991.70.2.631.

[66] Abou Sawan S, Hodson N, Babits P, Malowany JM, Kumbhare D, Moore DR. Satellite cell and myonuclear accretion is related to training-induced skeletal muscle fiber hypertrophy in young males and females. J Appl Physiol (1985). 2021; 131(3):871-880. https://doi.org/10.1152/japplphysiol.00424.2021.

[67] Horwath O, Moberg M, Larsen FJ, Philp A, Apro W, Ekblom B. Influence of sex and fiber type on the satellite cell pool in human skeletal muscle. Scand J Med Sci Sports. 2021; 31(2):303-312. https://doi.org/10.1111/sms.13848.

[68] Beaudry K,De Lisio M. Sex-Based differences in muscle stem cell regulation following exercise. Exerc Sport Sci Rev. 2024; 52(3):87-94. https://doi.org/10.1249/JES.0000000000000337.

[69] Smith MA, Sexton CL, Smith KA, et al. Molecular predictors of resistance training outcomes in young untrained female adults. J Appl Physiol (1985). 2023; 134(3): 491-507. https://doi.org/10.1152/japplphysiol.00605.2022.

[70] Oxfeldt M, Dalgaard LB, Jorgensen EB, et al. Molecular markers of skeletal muscle hypertrophy following 10 wk of resistance training in oral contraceptive users and nonusers. J Appl Physiol (1985). 2020; 129(6):1355-1364. https://doi.org/10.1152/japplphysiol.00562.2020.

[71] Dalgaard LB, Jorgensen EB, Oxfeldt M, et al. Influence of second generation oral contraceptive use on adaptations to resistance training in young untrained women. J Strength Cond Res. 2022; 36(7):1801-1809. https://doi.org/10.1519/JSC.0000000000003735.

[72] Duplanty AA, Budnar RG, Luk HY, et al. Effect of acute alcohol ingestion on resistance exercise-induced mTORC1 signaling in human muscle. J Strength Cond Res. 2017; 31(1):54-61. https://doi.org/10.1519/JSC.0000000000001468.

[73] Serrano N, Colenso-Semple LM, Lazauskus KK, et al. Extraordinary fast-twitch fiber abundance in elite weightlifters. PLoS One. 2019; 14(3):e0207975. https://doi.org/10.1371/journal.pone.0207975.

[74] Westh E, Kongsgaard M, Bojsen-Moller J, et al. Effect of habitual exercise on the structural and mechanical properties of human tendon, in vivo, in men and women. Scand J Med Sci Sports. 2008; 18(1):23-30. https://doi.org/10.1111/j.1600-0838.2007.00638.x.

[75] Magnusson SP, Hansen M, Langberg H, et al. The adaptability of tendon to loading differs in men and women. Int J Exp Pathol. 2007; 88(4):237-240. https://doi.org/10.1111/j.1365-2613.2007.00551.x.

[76] Miller BF, Hansen M, Olesen JL, et al. Tendon collagen synthesis at rest and after exercise in women. J Appl Physiol (1985). 2007; 102(2):541-546. https://doi.org/10.1152/japplphysiol.00797.2006.

[77] Fuchs CJ, Trommelen J, Weijzen MEG, et al. Becoming a world champion powerlifter at 71 years of age: it is never too late to start exercising. Int J Sport Nutr Exerc Metabol. 2024; 34(4):223-231. https://doi.org/10.1123/ijsnem.2023-0230.

[78] Roberts BM, Nuckols G, Krieger JW. Sex differences in resistance training: a systematic review and meta-analysis. J Strength Cond Res. 2020; 34(5):1448-1460. https://doi.org/10.1519/JSC.0000000000003521.

[79] Kraemer WJ, Mazzetti SA, Nindl BC, et al. Effect of resistance training on women’s strength/power and occupational performances. Med Sci Sports Exerc. 2001; 33(6): 1011-1025. https://doi.org/10.1097/00005768-200106000-00022.

[80] Kraemer WJ, Ratamess N, Fry AC, et al. Influence of resistance training volume and periodization on physiological and performance adaptations in collegiate women tennis players. Am J Sports Med. 2000; 28(5):626-633. https://doi.org/10.1177/03635465000280050201.

[81] Kraemer WJ, Nindl BC, Ratamess NA, et al. Changes in muscle hypertrophy in women with periodized resistance training. Med Sci Sports Exerc. 2004; 36(4): 697-708. https://doi.org/10.1249/01.mss.0000122734.25411.cf.

[82] Marx JO, Ratamess NA, Nindl BC, et al. Low-volume circuit versus high-volume periodized resistance training in women. Med Sci Sports Exerc. 2001; 33(4):635-643. https://doi.org/10.1097/00005768-200104000-00019.

[83] Ratamess NA, Kraemer WJ, Volek JS, et al. The effects of ten weeks of resistance and combined plyometric/sprint training with the Meridian Elyte athletic shoe on muscular performance in women. J Strength Cond Res. 2007; 21(3):882-887. https://doi.org/10.1519/R-50512.1.

[84] American College of Sports M. American College of Sports Medicine Position Stand. Progression models in resistance training for healthy adults. Med Sci Sports Exerc. 2009; 41(3):687-708. https://doi.org/10.1249/MSS.0b013e3181915670.

[85] Swinton PA, Schoenfeld BJ, Murphy A. Dose-response modelling of resistance exercise across outcome domains in strength and conditioning: a meta-analysis. Sports Med. 2024; 54(6):1579-1594. https://doi.org/10.1007/s40279-024-02006-3.

[86] Dabbs NC, Binkley H, Bott C, et al. Strength and conditioning of female athletes:position statement from the National Strength and Conditioning Association. J Strength Cond Res. 2025. In Press.

[87] Hewett TE, Myer GD, Ford KR, Paterno MV, Quatman CE. Mechanisms, prediction, and prevention of ACL injuries: cut risk with three sharpened and validated tools. J Orthop Res. 2016; 34(11):1843-1855. https://doi.org/10.1002/jor.23414.

[88] Pappas E, Shiyko MP, Ford KR, Myer GD, Hewett TE. Biomechanical deficit profiles associated with ACL injury risk in female athletes. Med Sci Sports Exerc. 2016; 48(1): 107-113. https://doi.org/10.1249/MSS.0000000000000750.

[89] Myer GD, Sugimoto D, Thomas S, Hewett TE. The influence of age on the effectiveness of neuromuscular training to reduce anterior cruciate ligament injury in female athletes: a meta-analysis. Am J Sports Med. 2013; 41(1):203-215. https://doi.org/10.1177/0363546512460637.

[90] Noyes FR,Barber Westin SD. Anterior cruciate ligament injury prevention training in female athletes: a systematic review of injury reduction and results of athletic performance tests. Sport Health. 2012; 4(1):36-46. https://doi.org/10.1177/1941738111430203.

[91] Mancino F, Kayani B, Gabr A, Fontalis A, Plastow R, Haddad FS. Anterior cruciate ligament injuries in female athletes: risk factors and strategies for prevention. Bone Jt Open. 2024; 5(2):94-100. https://doi.org/10.1302/2633-1462.52.BJO-2023-0166.

[92] Wu JM, Vaughan CP, Goode PS, et al. Prevalence and trends of symptomatic pelvic floor disorders in U.S. women. Obstet Gynecol. 2014; 123(1):141-148. https://doi.org/10.1097/AOG.0000000000000057.

[93] Rebullido TR, Stracciolini A. Pelvic floor dysfunction in female athletes: is relative energy deficiency in sport a risk factor? Curr Sports Med Rep. 2019; 18(7):255-257. https://doi.org/10.1249/JSR.0000000000000615.

[94] Cabre HE, Gould LM, Redman LM, Smith-Ryan AE. Effects of the menstrual cycle and hormonal contraceptive use on metabolic outcomes, strength performance, and recovery: a narrative review. Metabolites. 2024; 14(7). https://doi.org/10.3390/metabo14070347.

[95] Abou Sawan S, Nunes EA, Lim C, McKendry J, Phillips SM. The health benefits of resistance exercise: beyond hypertrophy and big weights. Exerc Sport Mov. 2023; 1(11):e00001. https://doi.org/10.1249/ESM.0000000000000001.

[96] Ji H, Gulati M, Huang TY, et al. Sex differences in association of physical activity with all-cause and cardiovascular mortality. J Am Coll Cardiol. 2024; 83(8): 783-793. https://doi.org/10.1016/j.jacc.2023.12.019.

[97] Shailendra P, Baldock KL, Li LSK, Bennie JA, Boyle T. Resistance training and mortality risk: a systematic review and meta-analysis. Am J Prev Med. 2022; 63(2): 277-285. https://doi.org/10.1016/j.amepre.2022.03.020.

[98] Kamada M, Shiroma EJ, Buring JE, Miyachi M, Lee IM. Strength training and all- cause, cardiovascular disease, and cancer mortality in older women: a cohort study. J Am Heart Assoc. 2017; 6(11):e007677. https://doi.org/10.1161/JAHA.117.007677.

[99] Kraschnewski JL, Sciamanna CN, Poger JM, et al. Is strength training associated with mortality benefits? A 15year cohort study of US older adults. Prev Med. 2016; 87:121-127. https://doi.org/10.1016/j.ypmed.2016.02.038.

[100] Westcott WL. Resistance training is medicine: effects of strength training on health. Curr Sports Med Rep. 2012; 11(4):209-216. https://doi.org/10.1249/JSR.0b013e31825dabb8.

[101] Steindorf K, Schmidt ME, Klassen O, et al. Randomized, controlled trial of resistance training in breast cancer patients receiving adjuvant radiotherapy: results on cancer-related fatigue and quality of life. Ann Oncol. 2014; 25(11):2237-2243. https://doi.org/10.1093/annonc/mdu374.

[102] Martinez-Vizcaino V, Cavero-Redondo I, Reina-Gutierrez S, et al. Comparative effects of different types of exercise on health-related quality of life during and after active cancer treatment: a systematic review and network meta-analysis. J Sport Health Sci. 2023; 12(6):726-738. https://doi.org/10.1016/j.jshs.2023.01.002.

[103] Cramp F, James A, Lambert J. The effects of resistance training on quality of life in cancer: a systematic literature review and meta-analysis. Support Care Cancer. 2010; 18(11):1367-1376. https://doi.org/10.1007/s00520-010-0904-z.

[104] Mavropalias G, Sim M, Taaffe DR, et al. Exercise medicine for cancer cachexia: targeted exercise to counteract mechanisms and treatment side effects. J Cancer Res Clin Oncol. 2022; 148(6):1389-1406. https://doi.org/10.1007/s00432-022-03927-0.

[105] Jiang Y, Angeletti PC, Hoffman AJ. Investigating the physiological mechanisms between resistance training and pain relief in the cancer population: a literature review. J Cancer Ther. 2023; 14(2):80-101. https://doi.org/10.4236/jct.2023.142008.

[106] Lakicevic N, Ficarra S, Ortega-Gomez S, et al. One more rep! The case for resistance training in young cancer survivors. Front Oncol. 2023;13:1284052. https://doi.org/10.3389/fonc.2023.1284052.

[107] Padilha CS, Marinello PC, Galvao DA, et al. Evaluation of resistance training to improve muscular strength and body composition in cancer patients undergoing neoadjuvant and adjuvant therapy: a meta-analysis. J Cancer Surviv. 2017; 11(3): 339-349. https://doi.org/10.1007/s11764-016-0592-x.

[108] Hardee JP, Porter RR, Sui X, et al. The effect of resistance exercise on all-cause mortality in cancer survivors. Mayo Clin Proc. 2014; 89(8):1108-1115. https://doi.org/10.1016/j.mayocp.2014.03.018.

[109] Saeidifard F, Medina-Inojosa JR, West CP, et al. The association of resistance training with mortality: a systematic review and meta-analysis. Eur J Prev Cardiol. 2019; 26(15):1647-1665. https://doi.org/10.1177/2047487319850718.

[110] Courneya KS, Segal RJ, McKenzie DC, et al. Effects of exercise during adjuvant chemotherapy on breast cancer outcomes. Med Sci Sports Exerc. 2014; 46(9): 1744-1751. https://doi.org/10.1249/MSS.0000000000000297.

[111] Walzik D, Wences Chirino TY, Zimmer P, Joisten N. Molecular insights of exercise therapy in disease prevention and treatment. Signal Transduct Targeted Ther. 2024; 9(1):138. https://doi.org/10.1038/s41392-024-01841-0.

[112] Chidi-Ogbolu N, Baar K. Effect of estrogen on musculoskeletal performance and injury risk. Front Physiol. 2018;9:1834. https://doi.org/10.3389/fphys.2018.01834.

[113] Paroo Z, Dipchand ES, Noble EG. Estrogen attenuates postexercise HSP70 expression in skeletal muscle. Am J Physiol Cell Physiol. 2002; 282(2):C245-C251. https://doi.org/10.1152/ajpcell.00336.2001.

[114] Enns DL, Tiidus PM. The influence of estrogen on skeletal muscle: sex matters. Sports Med. 2010; 40(1):41-58. https://doi.org/10.2165/11319760-000000000-00000.

[115] Hansen M. Female hormones: do they influence muscle and tendon protein metabolism? Proc Nutr Soc. 2018; 77(1):32-41. https://doi.org/10.1017/S0029665117001951.

[116] Tian JM, Ran B, Zhang CL, Yan DM, Li XH. Estrogen and progesterone promote breast cancer cell proliferation by inducing cyclin G1 expression. Braz J Med Biol Res. 2018; 23(3):1-7. https://doi.org/10.1590/1414-431X20175612, 51.

[117] Garcia-Chico C, Lopez-Ortiz S, Penin-Grandes S, et al. Physical exercise and the hallmarks of breast cancer: a narrative review. Cancers. 2023; 15(1):324. https://doi.org/10.3390/cancers15010324.

[118] Spanoudaki M, Giaginis C, Karafyllaki D, et al. Exercise as a promising agent against cancer: evaluating its anti-cancer molecular mechanisms. Cancers. 2023; 15(21): 5135. https://doi.org/10.3390/cancers15215135.

[119] Betof AS, Dewhirst MW, Jones LW. Effects and potential mechanisms of exercise training on cancer progression: a translational perspective. Brain Behav Immun. 2013;30:S75-S87. https://doi.org/10.1016/j.bbi.2012.05.001.

[120] Koelwyn GJ, Quail DF, Zhang X, White RM, Jones LW. Exercise-dependent regulation of the tumour microenvironment. Nat Rev Cancer. 2017; 17(10):620-632. https://doi.org/10.1038/nrc.2017.78.

[121] Torres-Juarez KV, Queiroga FL, Romero-Romero LP. The nervous system as a regulator of cancer hallmarks: insights into therapeutic implications. Cancers. 2022; 14(18):4372. https://doi.org/10.3390/cancers14184372.

[122] Zhao R, Zhao M, Xu Z. The effects of differing resistance training modes on the preservation of bone mineral density in postmenopausal women: a meta-analysis. Osteoporos Int. 2015; 26(5):1605-1618. https://doi.org/10.1007/s00198-015-3034-0.

[123] Hart PD, Buck DJ. The effect of resistance training on health-related quality of life in older adults: systematic review and meta-analysis. Health Promot Perspect. 2019; 9(1):1-12. https://doi.org/10.15171/hpp.2019.01.

[124] Nestler K, Witzki A, Rohde U, Ruther T, Tofaute KA, Leyk D. Strength training for women as a vehicle for health promotion at work. Dtsch Arztebl Int. 2017; 114(26): 439-446. https://doi.org/10.3238/arztebl.2017.0439.

[125] Hakkinen A, Hakkinen K, Hannonen P, Alen M. Strength training induced adaptations in neuromuscular function of premenopausal women with fibromyalgia: comparison with healthy women. Ann Rheum Dis. 2001; 60(1):21-26. https://doi.org/10.1136/ard.60.1.21.

[126] Kraemer WJ, Ratamess NA, French DN. Resistance training for health and performance. Curr Sports Med Rep. 2002; 1(3):165-171. https://doi.org/10.1249/00149619-200206000-00007.

[127] Collins H, Booth JN, Duncan A, Fawkner S, Niven A. The effect of resistance training interventions on ‘the self’ in youth: a systematic review and meta-analysis. Sports Med - Open. 2019;5:29. https://doi.org/10.1186/s40798-019-0205-0.

[128] Holloway JB, Beuter A, Duda JL. Self-efficacy and training for strength in adolescent girls. J Appl Soc Psychol. 1988; 18(8, Pt 2):699-719. https://doi.org/10.1111/j.1559-1816.1988.tb00046.x.

[129] Lubans DR, Aguiar EJ, Callister R. The effects of free weights and elastic tubing resistance training on physical self-perception in adolescents. Psychol Sport Exerc. 2010; 11:497-504. https://doi.org/10.1016/j.psychsport.2010.06.009.

[130] LeCheminant JD, Hinman T, Pratt KB, et al. Effect of resistance training on body composition, self-efficacy, depression, and activity in postpartum women. Scand J Med Sci Sports. 2014; 24(2):414-421. https://doi.org/10.1111/j.1600-0838.2012.01490.x.

[131] Seguin RA, Eldridge G, Lynch W, Paul LC. Strength training improves body image and physical activity behaviors among midlife and older rural women. J Ext. 2013; 51(4):4FEA2.

[132] Herring MP, Jacob ML, Suveg C, Dishman RK, O’Connor PJ. Feasibility of exercise training for the short-term treatment of generalized anxiety disorder: a randomized controlled trial. Psychother Psychosom. 2012; 81(1):21-28. https://doi.org/10.1159/000327898.