The Case for Strength Training for Women

Over the past 3 decades there has been a dramatic increase in the number of women participating in sports and exercises activities that require strength training.  Females at any age will benefit from a well planned strength training programme. Strength development is necessary for optimal structural health and has been associated with a positive mental health. Females do have unique needs such that today’s trainers need to understand gender differences before exercise participation. Characteristics such as body composition, stature, pregnancy, menstruation and nutritional status all affect the exercise response. Equipped with this knowledge the diligent trainer will be best placed to educate and prescribe appropriate exercise.

Anatomical and Physiological Differences in Males and Females

There are a number of anatomical and physiological differences between genders on a general level. We must bear in mind that everyone is anatomically different and whilst we can generalise we still need to analyse as everyone is individual. Some of the differences include:

• structural
• lean body weight
• hormonal
• cardiorespiratory

Structural:

In general females have smaller and lighter bones than those of males. However, of primary anatomical significance are the gender differences in the structure of the pelvis. In comparison to the male pelvis, it is more common for a female to have a pelvis that is broader, flares out more to the front and has a wider sacrum at the back creating a greater pelvic cavity. A broader pelvis is perfectly designed for child bearing. Unfortunately, a broader pelvis causes the femur to articulate with the pelvis at a more acute angle (Q angle) than the more linear articulation between the pelvis and femur, resulting in a slight mechanical disadvantage affecting the knee. This can mean a tendency for females to excessively internally rotate the femur creating increased valgus stress at the knee, especially during activities such as jumping and squatting. If excessive, this valgus force can have devastating consequences to the ligaments of the knee. Women may also have shorter legs giving them a slightly lower centre of gravity (COG), an advantage in activities requiring balance.

Biomechanical differences also exist at the knee joint. Females have a tendency for a greater Q-angle (quadriceps angle) in comparison to the male knee joint due to their wider pelvis. The Q-angle is the measure of deviation from a straight line between the centre of the patella to the tibial tuberosity and a line from the centre of the patella to the centre of the anterior superior iliac spine. 10 to 15 degrees are considered to be normal. Literature suggests that Q-angles greater than 20 degrees are considered excessive and may lead to pathological changes, such as chondromalacia patella (degeneration of the undersurface of the patella). This can be due to the lateral displacement of the patella.

Lean body weight:

Distribution of lean body weight differs between the genders; females have a higher percentage of lean body weight on their lower bodies. In comparison to females, males are generally taller have larger bones with bigger and broader shoulders. A larger structure allows for more muscle mass, which is a definite advantage when developing upper and lower body strength and power:

• Upper Body: The disparity is most significant in upper-body lifts; women’s upper-body strength is typically 40% to 75% that of men’s.
• Lower Body: The gap is smaller in lower-body exercises; women’s lower-body strength generally ranges from 57% to 86% of men’s.

. The female’s smaller structure makes it much more difficult to develop strength, especially in the upper body. (Bartolomei et al 2021). Because of this, males continually demonstrate greater absolute strength for the same training experience; yet, the relative strength differences are less significant.  It would appear that females have the same capacity for the development of strength as males when strength of both is compared per cross-sectional area of muscle.

Hormonal:

Hormone production also differs between the sexes. Of significance is that males exhibit higher androgen levels, particularly that of testosterone (TST). During puberty gonadotropin hormones are secreted from the anterior pituitary gland (follicle stimulating hormone and luteinizing hormone). These hormones stimulate the gonads (ovaries and testes), which in turn stimulates the production of the sex hormones, TST in males and oestrogen in females.

TST and oestrogen account for the gender-characteristic body compositional differences between males and females. TST is an important hormone for protein synthesis. In males TST increases lean body mass and inhibits the development of body fat, whereas oestrogen in females stimulates adipose tissue (increased fat cells).

Typically females have on average 6-10% more fat than males, with active females having lower body fat levels than sedentary females. Females characteristically store fat around the mammary glands, pelvic and thigh region due to high lipoprotein lipase activity (enzyme produced in fat cells to store fat) compared to other fat storage areas. Men’s higher testosterone levels drive greater muscle mass and strength potential, while women’s oestrogen helps with muscle repair and endurance; both sexes build muscle through similar mechanisms, but men start with a significant advantage due to anabolic effects, though relative strength gains from training are similar, with women benefiting from oestrogen’s protective effects on muscle and recovery. (Nuckols 2018)

Cardiorespiratory:

Cardiorespiratory gender differences include: women have smaller heart volumes for a similar body size (lower stroke volume and less cardiac output); for similar body weights women have 20% lower blood volume compared to men; women also have about 10% less haemoglobin (red blood cells) than men for the same blood volume and about 10% less vital capacity. This explains why women generally have slightly higher heart rates compared to men during any given level of exercise intensity. The highest VO2 max recorded for a female athlete is 78.6 ml/kg/min whereas the highest recorded VO2 max for a male achieved a value of 97.5 ml/kg/min. These cardiorespiratory differences allow men to have a greater oxygen carrying capacity. (Diaz Canestro et al. 2022)

Strength Training Benefits

Women should be actively encouraged to include resistance training as part of their overall programme of conditioning for the following reasons:

• increased bone strength and density
• enhanced joint stability
• increased lean body mass.
• improved body image and self-perception
• improved posture

Increased bone strength and density:

A lifetime of structural health is dependent on strong bones if bone diseases such as osteoporosis are to be avoided. Females are more at risk of developing the bone disease osteoporosis than males, so it’s important for females to maximise their peak bone mass (PBM). Genetic, mechanical, hormonal and nutritional factors all affect PBM, which is largely established by the end of adolescence or early adulthood.

From the age of 35-40 onwards PBM starts to decline, and women can expect an annual bone loss of about 0.5% to 1.0% total bone mass from the age of 40. Affected sites include the vertebrae, wrist and neck of femur. During the first 5 to 10 years after menopause (cessation of normal menses) this bone loss accelerates at a rate of about 2-4% per annum. Thus, women can easily lose 15% – 30% of their PBM by age 60. Some studies reported the pattern of BMD loss at multiple skeletal sites following menopause. A greater rate of bone loss occurred during the first five years postmenopause at the sites with a higher trabecular bone content, specifically the lumbar spine and ultra-distal forearm (Hollway Kew 2025). The proportions of women with osteopenia and osteoporosis increased across each of the age categories, but patterns differed by skeletal site, being more pronounced for the femoral neck and mid-forearm sites. Rates of bone loss were greater at the lumbar spine and ultra-distal forearm during the first five years following menopause. Studies (Lancet 2021, IOF 2025) show that:

• Worldwide, up to 37 million fragility fractures occur annually in individuals aged over 55,  the equivalent of 70 fractures per minute.
• Worldwide, 1 in 3 women over age 50 will experience osteoporosis fractures, as will 1 in 5 men aged over 50.
• Using the WHO definition of osteoporosis, the disease affects approximately 6.3% of men over the age of 50 and 21.2% of women over the same age range globally.  Based on the world population of men and women, this suggests that approximately 500 million men and women worldwide may be affected

Weight-bearing exercise has repeatedly been shown to increase bone density.  Therefore, a bone loss prevention programme is focused around the preservation and enhancement of bone material through consumption of adequate calcium, exposure to the sun for the generation of vitamin D and exercise to increase lean body tissue.

The personal trainer should keep in mind some basic principles when prescribing exercise for the prevention of, or treating osteoporosis. Principles include the following:

• everybody is different so it would not be appropriate to recommend the same type of exercise to all. Younger healthier individuals can tolerate higher loads during activities such as running and jumping, whereas, older individuals may present with some significant structural and physiological changes, so lower level weight-bearing activities such as walking and weight training should be recommended
• the stimulus must be varied and greater than that of activities performed during normal daily life
• the effects of exercise are specific to each site so only the bones that are loaded will benefit. Therefore, exercises for both the upper and lower body should be performed
• impact activities done quickly place the highest forces on bones and have the greatest affect on bone remodeling
• to maintain a positive effect on bone tissue, the programme must be continued throughout ones life

Enhanced joint stability:

During physical activity females may be at increased risk of injury in comparison to males. Female participation in recreational activities has grown in popularity over recent years. More now than ever before women are actively participating in activities that involve jumping, landing and pivoting such as weight lifting, netball, volleyball, rugby, cricket and football. There has however been a dramatic increase in the rate of non-contact injuries especially to the anterior cruciate ligament in the knee. In fact, evidence demonstrates that female athletes are 3-6 more likely to sustain a rupture to the anterior cruciate ligament (ACL) than men participating in the same sports.

At present it is unclear as to exactly what factors lead to the high incidence of ACL injuries seen in jumping, landing and pivoting activities however a number of theories have been proposed to explain the high incidence of non-contact ACL injuries in females. Possible theories include:

• anatomical

The wider hips and increased Q angle at the knee predispose to ACL injury. (see above)

• hormonal

Hormonal fluctuations over the course of the menstrual cycle may affect the ligaments and neuromuscular coordination around the knee. This would result in a reduction in dynamic knee stability thus increasing the likelihood of injury.

• neuromuscular

When stabilising the knee men seem better able to activate their hamstring muscles than females, who rely more on their quadricep muscles (Huston and Wojtys, 1996). This is a significant finding as this coincides with the fact that early hamstring activation, as seen in males, may have a protective effect on the knee joint position and reduces the likelihood of ACL disruption. This may be due to the fact that the hamstring muscles function is to decelerate both hip flexion (therefore, controlling the upper body’s forward momentum) and knee internal rotation.

Improved body image and self-perception:

Body image can be defined as:

 the thoughts, perceptions, attitudes, feelings, and behaviors around one’s physical appearance” (NEDA 2025).

Today’s women find themselves under increased social and psychological pressure to conform to media driven feminine ideals. Body image beliefs can be formed as early as two to four years of age and follow the preferences of adults. Research supports the notion that males and females differ in their beliefs concerning what is an acceptable body image (somatotype). Mesomorphic physiques are the most popular, endomorphic physiques are the least popular, whereas, ectomorphic physiques are more acceptable to girls than boys. Women are also more likely to reject the fat image. These images often alter a women’s perception of herself and her desire for body compositional change. This can have little or no resemblance to how a female actually looks, weighs or measures objectively in terms of fat or muscle.

A negative body image involves a distorted perception for one’s shape and physical appearance. Negative body image (or body dissatisfaction) involves feelings of shame, anxiety, and self-consciousness. Additionally, body dissatisfaction includes perceptions of one’s skin color, physical features, hair texture and color, ability status, gender identity and expression, and muscularity. People who experience high levels of body dissatisfaction feel their bodies are flawed in comparison to others, and these folks are more likely to suffer from feelings of depression, isolation, low self-esteem, and eating disorders. While it is still unknown what exactly causes body dissatisfaction, many researchers believe that body image issues develop when people internalise and compare themselves to society’s unrealistic and unattainable ideals about the body that are often amplified by social media diet culture. (NEDA 2025)

Women often desire to feel good about themselves rather than to conform to a specific weight or size. A positive body image has long been associated with an overall sense of self-esteem, normal eating and exercise habits. The type of exercise performed may influence a woman’s perception and attitude towards her body.

Increased lean body mass:

For many women a common training objective is to look and feel better about themselves. To do this often involves a reduction in unwanted body fat and an increase in muscle tone. Unfortunately, many women follow inappropriate exercise programmes (overuse of aerobic exercise) and never achieve their full fitness potential.

This poses a question “does muscular hypertrophy occur in women as a result of resistance training?” This is not a simple question to answer, because muscle hypertrophy is dependent on the net difference between protein synthesis and degradation, and is influenced by a multitude of different factors: genetics, training status, exercise protocol, nutrition and recovery and hormone response. They all have an effect on muscle growth.

Several investigators have examined the effects of resistance training on females and in general found that strength gains occur with little or no hypertrophy. (Refalo et al 2025). Another study by Kraemer et al. (2001), demonstrated that regardless of the type of strength training protocol, women who participated in a resistance based training programme for the upper and lower body improved their performance, especially in activities requiring upper body strength.

Most females do not show an increase in body circumference measurement with resistance training. One possible reason for this may be due to differences in resting and exercise hormonal concentrations between males and females. Of particular interest is the male sex hormone TST. In men TST is mainly produced in the testes, whereas in women small quantities of TST are secreted by the adrenals and traces are produced in the ovaries. Resting and exercise TST levels have been shown to be much higher in men than in women as above. Key insights are:

• Neural Adaptations: In the initial stages of a strength training program, most strength gains result from the nervous system becoming better at controlling existing muscles. This is a highly effective way to increase strength without adding bulk.
• Hormonal Differences: Women generally have much lower levels of testosterone than men, making it physiologically harder to build large amounts of muscle mass. Significant hypertrophy requires specific, high-volume training combined with a calorie surplus, which does not happen accidentally.
• Training Specificity: Strength and muscle size can be influenced independently to a degree. It is possible to see an increase in strength with little to no change in muscle size, and vice versa.
• Body Composition Control: A “toned” look is often the result of building lean muscle while managing body fat levels through proper nutrition, rather than simply avoiding muscle growth. 

To conclude, it appears that both genders can experience muscle hypertrophy as a result of resistance training, although it must be pointed out, that only women with the genetic predisposition as seen by some elite female body builders will experience substantial increases in limb size.  Muscle hypertrophy will only occur as a result of a large training volume, positive calorie balance, adequate recovery and the genetic predisposition. So, for the average woman resistance training will have a positive effect on body composition, contributing to a reduction in body fat and an increase in strength and power, all without a change in body size.

Improved posture:

Females may be at risk of developing abnormal postural states in comparison to males, due to a variety of different factors. For example, frequent wearing of high heel shoes (not so much these days) can cause muscle tightness in the gastrocnemius and soleus muscle groups, thus restricting dorsiflexion at the ankle (10^o needed during walking). Restricted ankle dorsi flexion can then cause compensatory changes in muscle length tensions higher up the body. Often the hip flexors will tighten causing the pelvis to tilt anteriorly. Pelvic motion will always affect the curves of the vertebral column. In this example, an anterior pelvic tilt increases the amount of lordosis in the lower back, thus, decreasing its shock absorbing capacity. Consequently, changes also occur in the upper body. This type of postural distortion pattern is called ‘lower and upper cross syndrome’ as seen in figure below.

Consideration must be given to the factors listed above before designing a training programme. Appropriate stretching and strengthening exercises can then be included to improve posture, overall aesthetics and the maintenance of optimal structural health.

Strength and Conditioning

To conclude, current research has demonstrated that regular strength training is necessary for women, if they are to maximise musculoskeletal health and well-being. Research has also demonstrated that females respond equally as well to relative increases in strength from resistance training as males do. So resistance based exercise for females should be a key programme feature. The prescribed amount and what type is dependent on the client’s training objective.

Emphasise exercises such as the lunge and its variations, step-ups and variations, deadlifts and squats for the lower body. For the upper body include exercises such as bent over rows, bench press, shoulder press and consider total body exercises such as push press, clean and jerk, DB snatch and jump-based exercises using freeweights and medicine balls. Selecting such exercises provides a great deal of variety, burns plenty of calories and develops functional strength that can be transferred to various sports and daily activities.

By understanding the anatomical and physiological differences between the genders, the trainer will be able to design a suitable exercise programme that can maximise potential and prevent injury.

Finally, women should not be discouraged from training at higher intensities or limit the amount of resistance used. Often, through misinformation and dogma the resistance used is insufficient and far below what is needed to elicit a training effect. Therefore, it must be the responsibility of the trainer to deliver, educate and motivate female client’s to train at an appropriate intensity so to stimulate a training adaptation.