Muscle strength gains per week are higher in the lower-body than the upper-body in resistance training experienced healthy young women—A systematic review with meta-analysis

Roger Jung; Sebastian Gehlert; Stephan Geisler; Eduard Isenmann; Julia Eyre; Christoph Zinner

doi:10.1371/journal.pone.0284216

. 2023 Apr 13;18(4):e0284216. doi: 10.1371/journal.pone.0284216

Muscle strength gains per week are higher in the lower-body than the upper-body in resistance training experienced healthy young women—A systematic review with meta-analysis

Roger Jung ^1,^*, Sebastian Gehlert ¹, Stephan Geisler ², Eduard Isenmann ^2,³, Julia Eyre ², Christoph Zinner ⁴

Editor: Hans-Peter Kubis⁵

PMCID: PMC10101404 PMID: 37053143

Abstract

Background

Women are underrepresented in resistance exercise-related studies. To date only one meta-analysis provides concrete training recommendations for muscle strength gains through resistance training in eumenorrhoeic women.

Objective

This review aims to identify research gaps to advance future study in this area to expand the knowledge concerning resistance exercise-induced strength gains in women and to provide guidelines on the number of repetitions per set and the training frequency per week to enhance maximal muscle strength.

Methods

The electronic databases PubMed and Web of Science were searched using a comprehensive list of relevant terms. After checking for exclusion criteria, 31 studies could be included in the final analysis using data from 621 subjects. From these data sets, the ideal number of repetitions per set and also the training frequency per week were analyzed.

Results

In the lower body, the largest gains were achieved with 1 to 6 repetitions (17.4% 1RM increase). For lower-body exercises, the highest gains were achieved with 13 to 20 repetitions (8.7% 1RM increase). The lower body should be trained two times a week (8.5% 1RM increase). The upper body should be trained two (5.2% 1RM increase) to three times (4.5% 1RM increase) a week.

Conclusion

Women can increase their 1RM by 7.2% per week in the upper body and by 5.2% per week in the lower-body exercises. The upper body can be trained more than two times per week whereas the lower body should be trained two times. Women with intermediate experiences in RT and advanced performance level show more rapid increases in strength in the lower-body compared to the upper-body while no differences were found between upper and lower limb adaptations in RT-beginner subjects.

1. Introduction

Dynamic muscle strength is determined by an individual’s one-repetition-maximum (1RM), which is the highest load that can be lifted once during a strength exercise with correct technique [1]. Therefore, the 1RM is also commonly used to determine individual maximal muscle strength in sport and exercise science studies, as well as in the course of an athlete’s training development. It also allows the assessment of muscle development and possible imbalances in strength development in resistance training (RT) [1]. Similar to endurance training, RT with weights also brings health benefits, especially for metabolism [2]. For example, resistance training can lower fasting insulin levels and decrease insulin resistance, as well as lower systolic and diastolic blood pressure [3]. Thus, low-to-moderate intensity resistance training may also prevent arterial stiffness [4]. In addition to these general health improvements, RT has some gender-specific benefits. Studies of RT in women demonstrate that exercise-induced dilatation of the femoral arteries was greater in women than in men during leg training [5]. The World Health Organization (WHO) has recently implemented RT in their 2020 guidelines [6]. This highlights the necessity for an augmented analysis of RT-related training outcomes in women.

Unfortunately, the majority of research on RT/exercise science has been conducted with male participants. In a meta-analysis Costello and colleagues [7] examined the gender distribution of participants in more than 1,300 publications from the greater sports science field. Female subjects accounted for only 39% of participants. This current review will focus on RT with female subjects, as RT is rising in popularity as a training method, especially among young women. The question remains, however, how women can most effectively train to increase maximal dynamic muscle strength (i.e., 1RM).

One reason for different acute responses between men and women is a difference in sex hormones, which are responsible for anabolic effects after RT. Female sex hormones like estradiol possess an anabolic function due to their protein-building function in the ovaries [8]. Studies on the menstrual cycle suggest that, during the follicular phase (i.e., when estrogen concentrations are high) athletic performance and maximum strength are increased more than during the luteal phase [9–11]. Thompson and colleagues [12] postulate that a high estrogen concentration in women leads to higher release of growth hormone after RT. Two other publications recommend adapting RT to the individual phases of the menstrual cycle [13, 14]. Hagstrom and colleagues [15] recently published a systematic review with a meta-analysis on RT in young women, in which the authors found differences in the responses between the lower and upper body. The research team concluded that a strength increase of about 25% can be achieved in the upper and lower-body with a 15-week training protocol. The authors state that, for lower and upper-body training in particular, the volume and frequency of training play a determining role in increasing muscle strength.

In contrast to the review by Hagstrom and colleagues [15], the present review aims to provide practical recommendations for training protocols (i.e., repetitions per set and training frequency per week) for the lower and upper-body RT. Only data from women who did not suffer from any known risks of hormone problems at the beginning of the included studies were used for this meta-analysis.

2. Methods

2.1 Search strategy and data sources

The PubMed database was searched in October 2021 with the following search string: ’strength training’ OR ’resistance training’ AND ’female’ OR ’women’. Also, a filter was set to Randomized Controlled Trial (RCT) in German or English. A total of 69,383 search results were displayed. Of these, the top 10,000 matches (best matches) were downloaded on 10/24/2021. The Web of Science database was also used with the same search string on 02/18/2022. The 1,000 best matches were also downloaded here with a filter for RCTs.

Titles and abstracts of the studies were individually evaluated by two reviewers (RJ and CZ) to assess their eligibility. Any discrepancies were resolved by a third reviewer (EI). If it could already be determined in the title that a publication could be excluded due to the inclusion and exclusion criteria, which was often the case, the abstract was not checked further.

The authors of the studies that were potentially eligible were contacted for any missing data or clarification on the data presented. This review is based on the recommendations of PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses).

2.2. Inclusion and exclusion criteria

The following inclusion and exclusion criteria were defined: (1) RCT in English or German; (2) Women in study data; (3) If both sexes were involved, female subjects’ data are shown separately; (4) Subjects are reported to be mentally and physically healthy; (5) Women are older than 18 and before their expected menopause (assessed by age); (6) Measurement of dynamic strength gains before and after intervention (1RM); (7) Dynamic strength training as an intervention; (8) Duration of the training intervention at least four weeks.

Studies were included in which participants performed dynamic exercises during training. This included machine exercises as well as free weight or barbell exercises, since RT programs in commercial gyms tend to combine these techniques and methods.

Studies were excluded if it was evident that the subjects were not in good health at the start of the study. One focus here was on diseases such as obesity, being chronically underweight, extreme caloric deficits, or pre-existing mental illnesses, as these diseases carry a risk of influencing the hormonal cycle negatively [16–19].

In addition, it was not mandatory that the menstrual cycle be monitored in any way during the training period. This was not an exclusion criterion.

2.3. Methods of study selection

Both reviewers (RJ and CZ) used the same data file and worked independently to screen for the inclusion and exclusion criteria.

A total of 95 studies were included after the first screening using PubMed data. After searching Web of Science, an additional 23 studies were included. Of the 118 studies, a further 87 could be excluded after a full-text screening was performed. The training exercises were analysed separately, but were immediately divided into upper and lower body exercises. The aim here was to analyse the potential for eumenorrheic women to increase muscle strength gains per week divided into upper and lower-body. It was not considered relevant whether or not a workout was performed to muscular failure.

2.4 Statistical analysis and level of the participant’s

For each of the 31 included studies, the risk of bias (Risk of Bias 2 (RoB 2)) was assessed using Cochrane guidelines. For this purpose, five criteria were specified, which were assessed as either low, unclear, or high risk. For the performance bias, a high risk was also specified if the participants and/or investigators knew, for example, whether the participants belonged to the group that trains a muscle once weekly or twice weekly, if this was the aim of the study. From the authors’ point of view, this can lead to a bias, if it is to be proven that a higher frequency makes more sense. The studies were also assessed with regard to the PEDro scale.

Review Manager 5.4 and GraphPad Prism were used for the analysis and figures. The calculations for the weekly percentage increases were performed with MS Excel®. All percentage increases were divided by the duration of the intervention to determine weekly increases. The data from the meta-analyses were based solely on a comparison of weekly percentage increases. To calculate the SD in the Forest Plots, the SD of the final measurement was set in relation to the 1RM. The SD value was then divided by the duration of the studies.

In order to classify the level of participants of the included studies, the strength classification of Santos Junior and colleagues [20] was adopted. RT experienced subjects are therefore subjects above the beginner strength level. Since Santos Junior and colleagues [20] only classify strength levels for barbell exercises, the authors’ specifications were used for the studies who did not include at least one barbell exercise.

3. Results

3.1. Study selection and characteristics

A total of 11,000 studies were reviewed. Of these, 31 publications met the inclusion criteria. Fig 1 shows the screening process for all 31 included studies according to PRISMA-Guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses).

In total, data from 621 subjects with an average age of 23.2±2.5 years could be obtained. However, in four of these studies subject age was not included. Of the 31 studies, 18 studies were conducted with beginner-level participants and 13 studies with RT-experienced women.

For the analyses the training exercises from the 31 studies were divided into upper and lower-body exercises. Lower-body training was defined as any exercise training muscles at or below the hip, while upper-body training included all exercises above hip level. The following exercises were defined as lower-body exercises. The number shows the quantity of data records of the exercises which were used for the analyses: leg press (n = 13), leg extension (n = 11), squat (n = 6), leg curl (n = 5), deadlift (n = 2), v-squat (n = 2), calf raise (n = 1), abduction (n = 1), adduction (n = 1), kick-back (n = 1), hack squat (n = 1). The following exercises were defined as upper-body exercises: bench press (n = 15), biceps curls (n = 6), chest press (n = 6), latissimus pulldown (n = 6), triceps extension (n = 4), shoulder press (n = 4), cable row (n = 2), shoulder press (n = 2), torso arm (n = 1), neck pull (n = 1), hyperextension (n = 1) and abdominal crunches (n = 1).

3.2. Quality of the studies and risk of bias

The risk of bias (RoB2) analysis is attached in the supporting information. It can be generally stated that there is a low risk of bias in all included studies. The selected studies were also assessed according to the PEDro methodological quality scale by Moseley and colleagues [21]. The results are presented in Table 1.

Table 1. The PEDro scale rating for all included studies.

Author	#1	#2	#3	#4	#5	#6	#7	#8	#9	#10	#11	Total
Burt et al. [22]	1	1	1	1	0	0	0	1	1	1	1	8
Stefanaki et al. [23]	1	1	1	0	0	0	0	0	1	0	1	5
Keeler et al. [24]	1	1	1	1	0	0	0	1	1	1	1	8
Bell et al. [25]	1	1	1	1	0	0	0	0	1	1	1	7
Cacchio et al. [26]	1	1	1	1	0	0	0	1	1	1	1	8
Weiss et al. [27]	1	1	1	0	0	0	0	1	1	1	1	7
Snow-Harter et al. [28]	1	1	1	1	0	0	0	1	1	1	1	8
Kim et al. [29]	1	1	1	1	1	0	0	1	1	1	1	9
Stock et al. [30]	1	1	1	1	0	0	1	1	1	1	1	9
Gentil et al. [31]	1	1	1	1	0	0	0	1	1	1	1	8
Mayhew et al. [32]	1	1	1	1	0	0	0	1	1	1	1	8
Santos et al. [33]	1	1	1	1	0	0	0	1	1	1	1	8
de Lima et al. [34]	1	1	1	0	0	0	0	0	1	1	1	7
Dinyer et al. [35]	1	1	1	1	0	0	0	1	1	1	1	8
Marx et al. [36]	1	1	1	1	0	0	0	1	1	0	1	7
Mosti et al. [37]	1	1	1	0	0	0	0	1	1	1	1	7
Botton et al. [38]	1	1	1	1	0	0	0	1	1	1	1	8
Moghadasi et al. [39]	1	1	1	1	0	0	0	1	1	1	1	8
de Castro Cesar et al. [40]	1	1	1	1	0	0	0	1	1	1	1	8
Davitt et al. [41]	1	1	1	1	0	0	0	0	1	1	1	7
Kell [42]	1	1	1	0	0	0	0	0	1	1	1	6
Hostler et al. [43]	1	1	1	1	0	0	1	0	0	1	1	7
Schlumberger et al. [44]	1	1	1	1	0	0	1	1	1	1	1	9
Silva et al. [45]	1	1	1	1	0	0	0	1	1	1	1	8
Garcia et al. [46]	1	1	1	1	0	0	0	1	1	1	1	8
Burnham et al. [47]	1	1	1	0	0	0	0	1	1	1	1	7
Stien et al. [48]	1	1	1	0	0	0	0	1	1	1	1	79
Cholewa et al. [49]	1	1	1	1	1	1	1	1	1	1	1	11
Monteiro et al. [50]	1	1	1	1	1	1	1	1	1	0	1	10
Hendrickson et al. [51]	1	1	1	1	0	0	0	1	1	1	1	8
Rana et al. [52]	1	1	1	1	0	0	0	1	1	1	1	8

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Table 1 shows the rating according to the PEDro scale. The first column lists the authors. #1 notes whether this study met the inclusion and exclusion criteria. #2 indicates whether the study features randomisation of the intervention or control groups. #3 stands for a hidden allocation to the groups. #4 represents whether or not all uniform parameters were similar in all groups at the beginning. #5 stands for the blinding of participating subjects. #6 notes whether or not trainers or therapists were blinded. #7 indicates the blinding of an investigator who measured an outcome. #8 means that at least 85% of the subjects completed the study successfully. #9 notes whether all included subjects also received any treatment or at least a control application. #10 means that at least one key outcome was statistically assessed at the end. #11 indicates that the study reported at least one point measure and at least one dispersion measure for a key outcome.

If one of the eleven attributes was fulfilled from the point of view of the evaluators, a 1 was given; if not, a 0 was set. The last column of Table 1 shows the total number of points.

One study achieved a score of 11/11. The most frequent score was 8/11, with a total of 14 studies. Only 2 studies scored less than 7/11, with only the study by Stefanaki and colleagues [23] scoring less than half.

3.3. Summary of all included studies

Table 2 summarizes the results of the 31 included studies. If no evaluation of the performance level could be performed according to Santos Junior and colleagues [20], the authors’ data were still added. In summary, women were able to increase their 1RM in the upper body by 7.2% and in the lower body by 5.2% per week. The quality of every study is also listed in Table 2 (last column).

Table 2. Summary of all included studies for the final analysis.

Author (Year)	Participants	Level of Participant’s	Training protocol	1RM exercises	Duration	1RM increase percentage per week (summarized by upper and lower-body)	Quality (Items)
Burt et al. (2007) [22]	N: 21 Age: Colleged Age Height: 170.1±6.3 cm Weight: 64.3±6.9 kg	By authors: Untrained lifters. colleged age healthy women	Group 1 Per week: 1 Sets: 1 Reps: 6–10 Group 2 Per week: 2 Sets: 1 Reps: 6–10, Rest: 3 Minutes	Lower Body: Leg press	8 weeks	Lower Body Group 1 = 37.7% Group 2 = 59.9%	81.8% (9/11)
Stefanaki et al. (2018) [23]	N:13 Age: 29.7±4.7 years Height: Weight: 64.7±12.2 kg	By authors: Not engaging in more than 2 hours per week of moderate/high intensity aerobic exercise or any resistance training. healhty	Group 30% 1RM Per week: 2 Sets: 1 Reps: 30% Group 80% 1RM Per week: 2 Sets: 1 Reps: 80%	Lower Body: Leg extension Upper Body: Bicep curl	6 weeks	Upper Body 30% = 15.4% 80% = 18.3% Lower Body 30% = 25.3% 80% = 27.2%	90.9% (10/11)
Keeler et al. (2001) [24]	N: 14 Age: 32.8±8.9 years Height: 161.7±7.6 cm Weight: 67.9±11.5 kg	By authors: Beginner, 8 months without weighttraining	Superslow Per week: 3 Sets: 1 Reps: 50% Traditional Per week: 3 Sets: 1 Reps: 80%	Lower Body: Leg press. Leg curl. Leg extension Upp Upper Body: Torso arm. Bench press (machine). Compound row. Triceps extension. Bicep curl	10 weeks	Upper Body Superslow (n = 6) = 1.6% Traditional (n = 8) = 3.2% Lower Body Superslow (n = 6) = 1.3% Traditional (n = 8) = 4.0%	81.82% (9/11)
Bell et al. (2000) [25]	N: 9 Age: 22.3±3.3 years Height: 176±9.3 cm Weight: 73.4 ±11.6 kg	By authors: Experienced weightlifters, but with no training at the beginning	Per week: 3 Sets: unclear Reps: 2 till 12	Lower Body: Leg press. leg extension	12 weeks	Lower Body (n = 4) 63.6%	63.6% (7/11)
Cacchio et al. (2006) [26]	N: 20 Age: 24.8±1 years Height: 167.4±4.8 cm Weight: 56.5±4	By authors: sedentary Beginners	Per week: 3 Sets: 3 Reps: 10 (maybe not into failure)	Upper Body: Freemotion Chest Press. traditional Chest Press	8 weeks	Upper Body FM (n = 10) = 143.6% CM (n = 10) = 71.9%	81.8% (9/11)
Weiss et al. (1988) [27]	N: 28 Age: 18 to 26 (not seperatly for females)	By authors: 3 months without any training programm. healhty by questionnaire. feamles without contraceptives in the last 3 months	Per week: 3 Sets: 4 Reps: 9–13—Rest: 2 till 3 minutes	Lower Body: Seated calf raises	8 weeks	Lower Body (n = 14) 15.3%	72.7% (8/11)
Snow-Harter et al. (1992) [28]	N: 52 Age: 19.9±0.7 years Height: 165±7.3 cm Weight: 60.4±12.8 kg (also with data from the runners group)	By Santos Junior et al. [19]: Intermediate Bench Press (57%) By authors: No competitive athletes. min. 8–12 menstrual cycles in a year for the last 3 years.	Per week: 3 Sets: 3 Reps: 65–85%. at the beginning less then 65%	Upper body: Bicepscurl. Triceps extension. Militarypress. Facepulls. Benchpress. Back extension. lat pulldown Lower Body: Leg extension. Leg curl. Abduction.	8 months	Upper Body (n = 12) = 23.7% Lower Body (n = 12) = 44.1%	81.8% (9/11)
Kim et al. (2011) [29]	N: 35 Age: 20.5± 0.4 years Height: 166.9±1.53 cm Weight: 66.6±5.4 kg	By authors: No strength training or aerobic endurance training for at least 6 months.	TRT Group (n = 13) Per week: 3 Sets: 3 Reps: 80% SRT Group (n = 14) Per week: 2 Sets: 1 Reps: 50%	Upper Body: Shoulder press. chest press. rowing and lat pulldowns Lower Body: Leg press	4 weeks	Upper Body TRT (n = 13) = 5.5% SRT (n = 14) = 3.8% Lower Body TRT (n = 13) = 5.9% SRT (n = 14) = 3.7%	81.8% (9/11)
Author (Year)	Participants	Level of Participant’s	Training protocol	1RM exercises	Duration	1RM increase percentage per week (summarized by upper and lower-body)	Quality (Items)
Stock et al. (2016) [30]	N: 47 Age: 21±3 years Height: 162.1±9.6 cm Weight: 63.3±11 kg	By Santos Junior et al. [19]: Beginner Sqauts and Deadlift By authors: No weightlifting for the past 6 months. healthy	Lower Per week: 3 Sets: maybe 4 (unclear) Reps: 5 Moderate Per week: 2 Sets: maybe 4 (unclear) Reps: 5; Rest: 3 minutes	Lower Body: Squats, Deadlifts	4 weeks	Lower Body Lower Volume (n = 15) = 95.8% Moderate Volume (n = 16) = 86.2%	81.8% (9/11)
Gentil et al. (2017) [31]	N: 8 Age: 34.1±4.3 years Height: 166±0.1 cm Weight: 70.1±9.3 kg (only Resistance training group)	By authors: Eumenohheic. weight stable for 6 months. inactive. be free of medical problems that could be aggravated by the study protocol.	Per week: 3 Sets: 3 Reps: 8–12	Upper Body: Bicepcurl with barbell Lower Body: Leg extension	8 weeks	Upper Body RT (n = 8) = 22.3% Lower Body RT (n = 8) = 34.6%	90.9% (10/11)
Mayhew et al. (2011) [32]	N: 62 Age: 19.1±0.8 years Height: 164.0±5.6 cm Weight: 62.1±11.5 kg	By Santos Junior et al. [19]: Intermediate (49%) By authors: Healthy without any training in the last 6 months	Per week: 3 Sets: 3 Reps: 6–12 Rest: 2 Minutes	Benchpress. Squats. Lat pulldowns. Calf raises. arm curls. Shoulder press	12 weeks	Upper Body 23.4%	81.8% (9/11)
Santos et al. (2010) [33]	N: 16 Age: 25.4±1.95 years Height: 162.7±4.4 cm Weight: 57.7±3.9kg (only the two intervention groups AA + AST)	By authors: Sedentary. They did not perform any other physical activity during the intervention. Healhy	Per week: 2–3 (every second day) Sets: 3 Reps: 10–12	Upper Body: Machine Benchpress	8 weeks	Upper Body AA (n = 8) = 22% AST (n = 8) = 42.5%	72.7% (8/11)
de Lima et al. (2012) [34]	N: 20 Age: 26.3±3.58 years Height: 163.5±0.1y Weight: 62.93±8.8cm (only the two intervention groups LP + DUP)	By Santos Junior et al. [19]: Intermediate Linear (53%) and Daily Undulating (51%). By authors: Healthy. range: 20–35 years old. non-obese. no training in 6 months	Per week: 2 Sets: 3–4 Reps: 15–30 (not very clear) Rest pause: 1–2 minutes	Upper Body: Benchpress. Bicepscurl Lower Body: Legpress	12 weeks	Upper Body Linear (n = 10) = 19.3% daily undulating (n = 10) = 22% Lower Body Linear (n = 10) = 48.2% daily undulating (n = 10) = 38.4%	90.9% (10/11)
Dinyer et al. (2019) [35]	N: 23 Age: 21.2±2.2 years Height: 167.1±5.7 cm Weight: 62.3±16.2 kg	By authors: 2 years without any weighttraining and less then 2 years of any sports activity	Per week: 2 Sets: 2–3 Reps: 6–11; Rest pause: 1,5 minutes	Upper Body: Shoulder press, Lat pulldown Lower Body: Leg extension, Leg curl	12 weeks (9 weeks of training)	Upper Body 30% (n = 11) = 26.9% 80% (n = 12) = 27.4% Lower Body 30% (n = 11) = 12.9% 80% (n = 12) = 12.5%	81.8% (9/11)
Author (Year)	Participants	Level of Participant’s	Training protocol	1RM exercises	Duration	1RM increase percentage per week (summarized by upper and lower-body)	Quality (Items)
Marx et al. (2001) [36]	N: 34 Age: 22.7±4.6 years Height: 165.7±5.2 cm Weight:: 56.2±6.3 kg (with control group)	By Santos Junior et al. [19]: Beginner Benchpress (Single set = 39% and high volume = 37%) By authors: All subjects had a regular menstrual cycle of 28 to 32 days in the past year. No oral contraceptives were taken.	Per week: 2 Sets: 2–3 Reps: 6–11	Upper Body: Benchpress Lower Body: Leg press	24 Wochen	Upper Body Singe set (n = 12) = 12.2% High-volume (n = 12) = 46.8% Lower Body Single set (n = 12) = 11.2% High-volume (n = 12) = 31.8%	90.9% (10/11)
Mosti et al. (2014) [37]	N: 30 Age: 22.1±2.2 years Height: 168.2±7 cm Weight:: 65.3±9.3 kg (with control group)	By authors: no weighttraining of the upper body in the last 6 months	Per week: 3 Sets: 4 Reps: 3–5	Lower Body: Hack squat with high speed	12 weeks	Lower Body (n = 14) 83.1%	81.8% (9/11)
Botton et al. (2016) [38]	N: 43 Age: 23.9±2.6 years Height: 162.3±6.2 cm Weight:: 58.6±5.6 kg (with control group)	By authors: All subjects less then 3 months without any weight training. 6 subjects take no oral contraceptives	Per week: 2 Sets: 2–3 Reps: 5–15	Lower Body: Leg extension	12 weeks	Lower Body UG-Group (n = 14) bilateral: 19.5% unilateral: 32.1% BG-Group (n = 15) bilateral: 27.5% Unilateral: 23.5%	90.9% (10/11)
Moghadasi et al. (2011) [39]	N: 20 Age: 25.3±3.2 years Height: no data Weight: no data	By authors: Healthy, last 6 months without any weighttraining	Per week: 3 Sets: 2–4 Reps: 8–12; Rest: 2–3 minutes	Upper Body: Chest Press. Shoulder Press. Lat pulldown. Bicep curl. Triceps pulldown Lower Body: Leg press. Leg extension. Leg curl	12 weeks	Upper Body (n = 10) 96.8% Lower Body (n = 10) 40.9%	90.9% (10/11)
de Castro Cesar et al. (2019) [40]	N: 20 Age: 20.7±2.1 years Height: 1.66±0.1cm Weight: 57.7±8.4kg	By authors: in the last 3 months without any weighttraining. healthy	Per week: 3 Sets: 3 Reps: 15; Rest between sets: 1 minute	Upper Body: Chest press. Lat pulldown. Militarypress. Tricep extension. Bicepscurl Lower Body: Leg oress. Leg extension. Leg curl	12 weeks	Upper Body (n = 9) = 21.7% Lower Body (n = 9) = 35.7%	72.7% (8/11)
Davitt et al. (2014) [41]	N: 28 Age: 19.8±0.2 years Height: no Weight: 61±2.5 kg (weightlifters and endurance training group)	By Santos Junior et al. [19]: Intermediate Benchpress (60%)	Per week: 4 Sets: 3 Reps: 8–12; Rest: 1–1,5 minutes	Upper Body: Benchpress Lower Body: Leg press	8 weeks	Upper Body (n = 10) = 24.3% Lower Body (n = 10) = 38.6% Only data from the group weighlifting before endurance training.	81.8% (9/11)
Author (Year)	Participants	Level of Participant’s	Training protocol	1RM exercises	Duration	1RM increase percentage per week (summarized by upper and lower-body)	Quality (Items)
Kell (2011) [42]	N: 20 Age: 22.5 ±4.6 years Height: 1. 70 ± 0.1 m Weight: 59.4 ± 5kg (only female weighttraining)	By Santos Junior et al. [19]: Intermediate Benchpress (58%) and Sqaut (82%). By authors: More then 11 months of weighttraining before the study. healthy	Per week: 4 Sets: 3 Reps: 8–12	Upper Body: Benchpress. Latpulldown. Shoulder press barbell Lower Body: Squats	12 weeks	Upper Body = 37% Lower Body = 43.8%	81.8% (9/11)
Hostler et al. (2001) [43]	N: 10 Age: 20.9±1.1 years Height: 163.6±7.6 cm Weight:: 58.9±5.3 kg Only female subjects.	By Santos Junior et al. [19]: Advanced Benchpress (SI-Group = 63% und TRAD-Group = 60.9%). By authors: 6 months without any weighttraining. healthy	Per week: 2 Sets: 3 Reps: 60% till muscle failure, Rest: 3 minutes	Upper Body: Benchpress, Triceps.	8 weeks	Upper Body TRAD-Group (n = 5) = 12.2% SI-Group (n = 5) = 10.3%	81.8% (9/11)
Schlumberger et al. (2001) [44]	N: 27 Age: 26.3±5.1 years Height: 166.6±5.4cm Weight:: 65.37±8.67 kg with control group	By authors: healthy, at least 6 months of weighttraining experience.	Single set: Per week: 2 Sets: 1 Reps: 6–9 Multi set: Per week: 2 Sets: 3 Reps: 6–9, Rest: 2 minutes (MS)	Upper Body: Chest press Lower Body: Leg press	6 weeks	Upper Body MS-Group (n = 9) = 10.4% Single-set Group (n = 9)) = 4.1% Lower Body MS-Group (n = 9) = 15.8% Single-set Group (n = 9) = 4.1%	81.8% (9/11)
Silva et al. (2012) [45]	N: 12 Age: 23.5±2.5 years Height: 165.8±6.5 cm Weight: 59.2±8.2 kg	By Santos Junior et al. [19]: Intermediate Benchpress (49.8%). By authors: healthy. 3 months without weighttraining	Per week: 2 Sets: 2–3 Reps: 8–18	Upper Body = Benchpress Lower Body = Leg press. Leg extension	11 weeks	Upper Body = 20% Lower Body = 45.9%	72.7% (8/11)
Garcia et al. (2016) [46]	N: 11 Age: 25.2±5.3 years Height:—Weight: 59.9±4.8kg	By Santos Junior et al. [19]: Both groups: Sqaut Advanced (MS = 103%; TRI = 102.3%) and Deadlifts Intermediate (MS = 96%; TRI = 105.6%). By authors: At least 12 months of weighttraining experience. Healthy	Per week: 3 Sets: 3 Reps: 6–14	Lower Body: Sqaut, Deadlift	12 weeks	Lower Body MS-Group = 20.6% TRI-Group = 21.6%	81.8% (9/11)
Burnham et al. (2010) [47]	N: 19 Age: 19.8±1.6 years Height: 179.8±4.7 cm Weight: 74.9±6.7 kg	By Santos Junior et al. [19]: Both groups: Bench Press Advanced (62%). By authors: At least 1 year of experience.	Per week: 2 Sets: 3 Reps: 80–90% One Group with Weight chains	Upper Body: Benchpress	8 weeks	Upper Body Traditional (n = 9) = 11.9% Chain (n = 10) = 17.4%	81.8% (9/11)
Author (Year)	Participants	Level of Participant’s	Training protocol	1RM exercises	Duration	1RM increase percentage per week (summarized by upper and lower-body)	Quality (Items)
Stien et al. (2020) [48]	N: 38 Age: 22.26±1.24 years Height: 166.7±2.7 cm Weight: 66.6±5.3 kg	By authors: healthy. Physically active women. on average 9.6 months of strength training experience	Per week: 2–3 Sets: 3–4 Reps: 6–10	Lower Body: Legpress. Leg extension, Kick Back	8 weeks	Lower Body Single Joint Group (n = 18) = 16.7% Multi Joint Group (n = 20) = 19.8%	72.7% (8/11)
Cholewa et al. (2018) [49]	N: 23 Age: 20.9±1.4 years Height: 165.6±6.4 cm Weight: 68.7±11.9 kg	By Santos Junior et al. [19]: Beta-Group Intermediate (Sqaut = 63.2%; Benchpress = 36.2%); Placebo-Group Intermediate (Sqaut = 85%; Benchpress = 50.2%). By authors: No weighttraining in the last 6 months. healthy	Upper Body: Per week: 1 Sets: 3 Reps: 8–12 Lower Body: Per week: 2 Sets: 3 Reps: 8–12 Rest: 2–3 minutes	Upper Body: Benchpress Lower Body: Sqaut	10 weeks	Upper Body Beta-Group (n = 11) = 9.1% Placebo-Group (n = 12) = 14.5% Lower Body Beta-Group (n = 11) = 31.2% Placebo-Group (n = 12) = 29.2%	81.8% (9/11)
Monteiro et al. (2008) [50]	N: 20 Age: 36.9±1.5years Height: 157.9±9.9 cm Weight: 64.9±10.5 kg	By authors: seated subjects. at least 6 months without any physical activity	Per week: 3 Sets: 3 Reps: 8–12	Upper Body: Benchpress (without Abdominal Crunch) Lower Body: Hack machine. Smith Machine	10 weeks	Upper Body (n = 10) = 56.1% Lower Body (n = 10) = 68.1%	72.7% (8/11)
Hendrickson et al. (2010) [51]	N: 18 Age: 21±0.5 years Height: 164.7±1.9 cm Weight: 64.5±1.9 kg (only resitant training group)	By Santos Junior et al. [19]: Intermediate Benchpress (48%) and Sqaut (83%). By Authors: Subject are healthy and have a menstrual cycle	Per week: 3 Sets: 3 Reps: 3–12	Upper Body: Benchpress Lower Body: Squat	8 weeks	Upper Body (n = 17) = 22.2% Lower Body (n = 17) = 14.2%	90.9% (10/11)
Rana et al. (2008) [52]	N: 34 Age: 21.1±2.7 years Height:164.78±5.5 cm Weight: 66.3±9.9 kg with control group	By authors: Healthy subjects	Per week: 2–3 Sets: 3 TS-Group: Reps: 6–10 TE-Group Reps: 20–30	Lower Body: Legpress, Sqaut. Leg extension	6 weeks	Lower Body TS-Group (n = unclear) = 54.2% LV-Group (n = unclear) = 27.9% TE-Group (n = unclear) = 20.9% C-Group (n = unclear) = 3.2%	81.8% (9/11)

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3.4.1 Upper- and lower-body comparison

Of the 31 included studies, only 13 studies trained with an identical load (repetitions per set, sets per workout, frequency per week) with at least one lower-body and one upper-body exercise.

Only one study [51] found that the upper body strength increases more rapidly than the lower body in intermediate and advanced subjects. The authors reported the participants as moderately active in recreational activities with fewer than two training sessions per week. According to Santos Junior and colleagues [20] strength levels on the bench press and squat were rated as intermediate. Fig 2 shows the Forest Plot for RT experienced subjects.

Fig 2 — Lower-body gains compared to upper-body 1RM gains in intermediate and advanced subjects.

For beginners, the study by Moghadasi and colleagues [39] greatly affected the results. Triceps extension increased by 260% in twelve weeks. There was also a 130% increase in the 1RM in chest press. If this study would be removed from the results the mean difference would change from 0.47 to 0.77 and the 95% CI would change from 0.22 to 1.31 in favor for lower body. Fig 3 shows the Forrest Plot for subjects with beginner level.

Fig 3 — Lower-Body gains compared to upper-body 1RM gains in beginner subjects.

When compared to beginner subjects RT-experienced subjects enjoyed a preferable overall effect and more rapid lower-body strength increases. Overall, for Fig 2 (experienced subjects) and 3 (beginner subjects), the pooled effect size is 0.47 with a 95% CI of -0.13 and 1.08.

Weekly muscle strength gains were 3.7% higher in the lower body than in the upper body. For intermediate and advanced subjects the gains were an impressive 56.7% higher.

3.4.2. Repetitions and frequency per week for upper and lower-body strength

For the analysis of repetitions per set, the following division was used: i) 1 to 6 repetitions, ii) 6 to 13 repetitions, iii) 13 to 20 repetitions, and iv) more than 20 repetitions to ensure a better overview. Of the 31 studies included a total of 29 data sets for the lower body and 25 data sets for the upper body were obtained. Often, different training variables were tested within the studies, such as low-load vs. high-load RT. Therefore, a study can include up to four records on 1RM gains in our final analysis. Some studies, however, only provided one set of records, such as frequency per week but or number of repetitions per set. Fig 4 shows the results of this analysis.

Fig 4 — (A) Lower-body repetitions per set, (B) lower-body training frequency per week, (C) upper-body repetitions per set and (D) upper-body training frequency per week.

3.4.3. Information on menstrual status in the included studies

Of the 31 included studies, only four gave information about the menstrual cycle of their subjects. These data are very difficult to evaluate, as two studies by Hendrickson and colleagues [51] and Gentil and colleagues [31] merely state that participants were eumenorrheic at the beginning of the intervention. Only two studies [27, 38] report the use of contraceptives among participants. Therefore, this quality item was also awarded if menstrual status was checked in any way at the beginning of the study. No study examined hormonal levels or function, nor did they track menstrual cycle health during the study. Details are shown in Table 2.

4. Discussion

Key Points:

Weekly percentage 1RM gains are higher in the lower body than in upper body in RT-experienced women.
Training the lower-body with a maximum of six repetitions per set and the upper-body with a repetition range of 13 to 20 per set seems to be most effective for increases in 1RM.
The ideal training frequency for the lower body is twice weekly, while for the upper body, two to three times per week results in the highest 1RM increases.
Women with intermediate experiences in RT and advanced performance level show more rapid increases in strength in the lower-body compared to the upper-body while no differences were found between upper and lower limb adaptations in RT-beginner subjects.

This review provides specific recommendations on the number of repetitions per set and weekly training frequency for dynamic strength increases in eumenorrhoeic women. The quality of the included studies was considered good overall, as far as this can be proven, by a risk of bias analysis and PEDro scale (average scores: 7.8 points).

A total of 621 subjects from 31 included studies were able to increase their upper-body strength by 7.2% and lower-body strength by 5.2% per week respectively. These values are independent of the weights, sets, exercises, and training status of the subjects. Fig 4 shows the evaluation for repetitions per set and training frequency per week. Here training recommendations for effectively increase the 1RM can be drawn. Upper-body exercises should be performed with more repetitions per set (13 to 20 repetitions) to achieve the highest dynamic strength gains compared to lower-body exercises. The lower body should be trained with heavy loads and thus fewer repetitions (1 to 6 repetitions per set). One reason for this could be the differences in the distribution of muscle fibers. Most muscle groups in the upper body contain a larger proportion of fast-twitch fibers than those in the lower body, so adaptation may vary with in muscles in the upper-body and in the legs [53, 54]. Muscles in the upper body, excluding abdominal and lower-back muscles, are used for powerful movements in everyday life and may respond better to completely new stress with lower weights and higher repetitions. For example, two studies [28, 50] deliver only a single record for upper-body strength in our final analysis. We did not analyze if there are differences between exercises which are mainly focusing on the legs compared to lower body exercises which involve more muscles than just leg muscles (e.g., back muscles in the deadlift).

The muscles of the upper body are mainly used for powerful everyday tasks. Here, the best gains were found with 13 to a maximum of 20 repetitions per set. However, hip and leg musculature respond better to a powerful, intense load with high weights and few repetitions (1–6 repetitions per set). This could have been an advantage, especially in studies with beginners, as a completely new stimulus to the muscle. Muscles in the upper body most often have a smaller volume than muscles in the lower body [55]. As previously mentioned, muscles in the upper body are under less stress in everyday life. Moreover, women have a higher percentage of type 1 muscle fibers than men, which may contribute to a quicker recovery, so that women may, in general, be able to exercise one muscle more frequently than men [56, 57].

It is possible than the cause of varying adaptations in the upper and lower body in women is also due to the menstrual cycle phases. A recent paper by Kissow and colleagues [58] found that the muscle hypertrophy in the legs is higher in the follicular phase, when only estrogen is high. In the upper body, however, no differences in adaptation during different hormonal phases could be detected. Accordingly, it can be assumed that the legs react more sensitively to the different hormone phases [58]. There appears to be variance in muscular adaptations in young women between the upper and lower body as well. Estrogen mobilizes growth hormones more than progesterone and counteracts muscle protein breakdown after training [58]. Perhaps this is more relevant for muscle groups with larger muscle mass, such as the quadriceps. This seemed especially the case in comparisons of training a squat and a bench press, which was a common protocol in the included studies of this review. In men, it appears that more sex hormones are produced during and immediately after a squat than during a bench press [59]. This is where further research is important to determine the adaptations between the upper and lower body and hormonal reactions prior to RT in women specifically in order to make further training recommendations. The course and effects of the individual menstrual cycle phases should also be recorded.

Fig 2 (Forest Plot) shows that when RT-experienced women trained with an equal load for the upper and lower body, the percentage weekly gains were higher for lower-body exercises. Only one study by Hendrickson and colleagues [51] achieved better strength gains in the upper body than in the lower body. Apparently, significant increases were achieved here with push exercises for chest and triceps. Nevertheless, it is unclear why the upper body is so clearly ahead of the lower body in this study.

The systematic review by Hagstrom and colleagues [15] also found preferable strength gains in the lower body compared to the upper body (around 2%). Here the findings from this review are in line with the results of Hagstrom and colleagues [15]. It can be speculated that young female subjects are more interested in increasing their performance on a leg press than on a chest press. It is possible that female participants are more familiar with leg exercises in general and therefore leg press, knee extensions and squats are performed more often in their daily training compared to lower-body exercises. For the upper body, bench press, biceps curl, and latissimus pull-downs were performed. Overall, these six exercises accounted for over 60% of all exercises in the included studies. Some of the included studies stated that subjects were verbally encouraged to train into muscle failure. This is questionable, as half of the studies were conducted with beginners, who are unlikely to have much experience of when muscle failure occurs and how it feels.

However, it should again be noted that none of the studies tested the hormonal status of the subjects during the course of the study. Also, strength measurements were never related or compared to the current hormone cycle phase. Therefore, the selected literature cannot provide precise information on how individual menstrual cycle phases and, thus, the female sex hormones estrogen and progesterone affect training success. Despite strict guidelines, it cannot be excluded that the included studies also involve results from women who have an irregular menstrual cycle or hormone profile. In addition, it should be noted that Jansen de Jonge et al. [16] already pointed out that a lack of control of the diet may lead to hormonal problems. Dietary intake and female sex hormones are, therefore, of high importance in relation to female RT and should be investigated further.

Given that almost no study monitored diet of the subjects, such as caloric intake or macronutrients, the authors’ data are difficult to evaluate. Daily nutrition has a significant impact on regeneration and adaptation after sports in general, especially after RT [60]. Not only are proteins important to consume, but also a certain amount of fat. For example, in a study by Trexler and colleagues [61], subjects that consumed more than 35% of fat in their total calories and significantly increased their bench press performance in 1RM compared to the group that consumed less than 35% daily. Additionally, participants who consumed more fat lost more body fat at the end of the study compared to the participants who consumed less fat [61]. Luteinizing hormone (LH) levels were measured in a study of 29 regularly menstruating women with controlled exercise and energy intake. The release of the LH hormone was impaired in most subjects when the daily calorie intake was restricted to 30 kcal per lean body mass [62]. As previously mentioned, it is important that young female subjects have a cyclical increase in LH in the late follicular phase to make sure that ovulation takes place [16].

5. Limitations

Half of the included studies were conducted with beginners to RT, often defined as “untrained” by the authors of the studies. As such, it can be assumed that they did not have much experience with an appropriate diet to support RT and could potentially been under- or over-fueled. In addition, in Fig 4 the data from supposed beginners is combined with data from advanced, RT-experienced subjects, which could also distort the outcomes. It is of course possible that, as stated by Jansen de Jonge and colleagues [15], data could be included from women who suffered from hormonal imbalances or irregular menstruation. Such issues can arise as a result of chronically intense physical activity, poor recovery, and a lack of diet monitoring. Since, the purpose of this review is to examine the effects of RT on young women, this is certainly the greatest limitation.

This review combines studies that use different training techniques like circuit training, volume training, and even training with slow or fast reps. Some studies trained into muscle failure, whereas some did not, which may have influenced the results as well. Other training variables, such as time under tension (TUT) or range of motion (ROM), were not included in our analysis for upper and lower-body strength gains. Worthy of note is that our meta-analysis includes women with and without hormonal contraceptives. There is evidence that rest time can have an influence on hormone responses during RT [63].

6. Conclusion

Young healthy women can increase their maximum muscle strength in the lower-body by 7.2% and by 5.2% in the upper-body per week through resistance training. Based on our results it seems that the upper-body can be trained with lighter weights and more repetitions to increase the 1RM compared to the lower body, which can be trained with up to six repetitions per set. The lower-body should be trained two times per week for optimal 1RM gains, while training two to three times a week resulted in highest strength gains in the upper body. This includes exercises with a barbell, machines, or a cable. In the studies where at least one upper and one lower-body exercise was performed with the same training load (repetitions per set, sets per workout, training frequency per week), more lower-body than upper-body strength was built. Interestingly, women with intermediate experiences in RT and advanced performance level show more rapid increases in strength in the lower-body compared to the upper-body while no differences were found between upper and lower limb adaptations in RT-beginner subjects. Future studies on female participants should focus more closely on the variance in adaptations in the lower and upper body, since other authors have already found differences here as well. Future studies should also closely control the hormonal phases in their female subjects and include dietary guidance or monitoring in their analysis.

Supporting information

S1 Checklist. PRISMA 2009 checklist.

(PDF)

Click here for additional data file.^{(432.4KB, pdf)}

S1 Appendix. RoB-analysis.

(TIF)

Click here for additional data file.^{(2.5MB, tif)}

Data Availability

All relevant data are within the paper and its Supporting Information files.

Funding Statement

The authors received no specific funding for this work.

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PLoS One. doi: 10.1371/journal.pone.0284216.r001

Decision Letter 0

Hans-Peter Kubis

16 Jan 2023

PONE-D-22-24644Weekly percent 1RM gains are higher in the lower-body than the upper-body in resistance training experienced healthy young women - a systematic review with meta-analysis about female resistance trainingPLOS ONE

Dear Dr. Jung,

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Reviewers' comments:

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Reviewer #1: Partly

Reviewer #2: Yes

Reviewer #3: Partly

**********

2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

**********

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Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

**********

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Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

**********

5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: General comments:

The manuscript: „WEEKLY PERCENT 1RM GAINS ARE HIGHER IN THE 2 LOWER-BODY THAN THE UPPER-BODY IN RESISTANCE 3 TRAINING EXPERIENCED HEALTHY YOUNG WOMEN - A 4 SYSTEMATIC REVIEW WITH META-ANALYSIS ABOUT 5 FEMALE RESISTANCE TRAINING“, deals with real Research gap in sport science. I agree that there is a lack of women’s studies in resistance training, but the authors gathered articles by well-defined criteria.

There one issue in the conclusion statement. Authors are presenting that lower body gains in RM are higher than upper body. However, the difference 4.3% per week in the upper body and 4.7% per week in the lower-body exercises, does not seems to be relevant to this conclusion. Did you make statistics on this? What are minimal detectable changes for % of RM? (please reference this).

The introduction of the manuscript very briefly presents basic resistance training variables, where the main parameter is exercise selection. The exercise selection might be whole body training, upper/lower limb training, isolated training etc. Please define what you want to understand as lower body training. Many lower body exercise like deadlifting and squatting, includes a lot of back and trunk muscle involvement, how you can distinguish the upper and lower body training. This should be mentioned in the inclusion criteria and discussion (including muscle group size). The absence of full body training is one of the main limitations of this study, try to mention that in the discussion.

The conclusion of the study should be clarified by reporting separately on beginners and advanced resistance-trained women. This should be in the abstract as well since there are

The study discussion should mention all loading parameters of resistance training.

Therefore I recommend the article after major revisions.

Specific comments:

Line 53: the bullet point “Weekly percentage 1RM gains are higher in training experienced women in lower body rather than in upper-body exercises“ seems to be obvious to add by how much they can strengthen more in lower limbs.

Line 69: What about arterial stiffness?

Jurik, R., Żebrowska, A., & Stastny, P. (2021). Effect of an Acute Resistance Training Bout and Long-Term Resistance Training Program on Arterial Stiffness: A Systematic Review and Meta-Analysis. Journal of clinical medicine, 10(16), 3492.

In introduction or discussion, try to justify whether hormonal response of man and women really differ and how.

Hakkinen, K., Pakarinen, A., Kraemer, W. J., Newton, R. U., & Alen, M. (2000). Basal concentrations and acute responses of serum hormones and strength development during heavy resistance training in middle-aged and elderly men and women. Journals of Gerontology-Biological Sciences and Medical Sciences, 55(2), B95.

Bottaro, M., Martins, B., Gentil, P., & Wagner, D. (2009). Effects of rest duration between sets of resistance training on acute hormonal responses in trained women. Journal of Science and Medicine in Sport, 12(1), 73-78.

Line 132: Add the inclusion criteria for upper and lower body training.

Line 170: How did you manually recalculated data? Be explicit.

Line 261: The differences in beginners (Figure 3) show no difference between upper and lower limb. This should be also the bullet point of manuscript and in the abstract. This is however, due to only one study, how you want to deal with this in discussion.

Line 324: Does exercise TEMPO influence hormonal response?

Wilk, M., Krzysztofik, M., Petr, M., Zając, A., & Stastny, P. (2020). The slow exercise tempo elicits higher glycolytic and muscle damage but not endocrine response that conventional squat. Neuroendocrinology Letters, 41(5).

Wilk, M., Golas, A., Stastny, P., Nawrocka, M., Krzysztofik, M., & Zajac, A. (2018). Does tempo of resistance exercise impact training volume?. Journal of human kinetics, 62(1), 241-250.

Reviewer #2: General Response

This is an interesting and much needed meta-analysis. It has a few misinterpretations that could need attention.

Specific Responses

Page Line

2 34 It might be helpful to provide a better description of “advanced subjects”. Does that mean “previously trained” or “well-trained”?

2 35 What does “same load” mean?

3 67-69 This does not seem like a complete sentence.

3 79 Should this be “The current review…” to distinguish your work?

3 89 “…strength are increased more than ….”

3 94 What kind of “responses”? Could you be more specific?

3 95 A 25% increase in 15 weeks does not seem to fit the 4.3% per week.

4 109 Why only these two languages?

5 171 “The data from the meta-analyses were …..” in data is a plural word.

14 281 “…frequency per week o number of repetitions….”

14 23 “The data here are very difficult…..”

15 304 “The quality of the studies was considered good….”

15 320 No period after “repetitions”

16 358 Is this a separate paragraph?

16 379 “in addition, it should be noted that Jansen de Jonge, Thompson and Han [15]….”

16 386 “…women, not only are proteins ….”

16 391 LH has not been defined. It should probably be spelled out before using the LH abbreviations.

16 396 There was no reference 15 in the introduction.

17 430 “…studies, since other authors….”

Reviewer #3: Dear Authors,

Manuscript entitled Weekly percent 1RM gains are higher in the lower-body than the upper-body in resistance training experienced healthy young women - a systematic review with meta-analysis about female resistance training

Clarity of content and adequacy to scientific language was demonstrated throughout the manuscript. In addition, the manuscript is interesting, however it is necessary to make some considerations.

#GENERAL CONSIDERATIONS

#I suggest that the authors change the title to Muscle strength gains per week are higher in the lower-body than the upper-body in resistance training experienced healthy young women - a systematic review with meta-analysis

#I suggest that the authors improve the research rationale. Only the scarcity of studies is not enough to justify carrying out this research.

#Methods

#Curiosity, why did the authors not search for the words resisted exercises?

#i.g., different rest intervals between sets and exercises of the studies included in the analysis of this research;

#different volumes (number of sets x number of repetitions x training frequency) of the studies included in the analysis of this research;

#different contraction speeds, as well as range of motion of the studies included in the analysis of this research.

#Discussion

#I suggest that authors begin with the main research findings.

#I suggest that the authors clearly demonstrate the applicability of the research findings.

authors clearly demonstrate the applicability of the research findings.

#Conclusion

#While the findings are interesting, I am not sure the authors should claim the following.

The upper-body can be trained with lighter weights and more repetitions to increase the 1RM compared to the lower-body. The lower-body should be trained with a maximum of six repetitions per set. The lower-body should be trained two times a week, while in the upper body both two to three times a week resulted in similarly muscle strength gains.

#Further studies are needed to confirm these findings in view of the different characteristics of the resistance exercise protocols.

**********

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Reviewer #1: No

Reviewer #2: No

Reviewer #3: No

**********

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PLoS One. 2023 Apr 13;18(4):e0284216. doi: 10.1371/journal.pone.0284216.r002

Author response to Decision Letter 0

13 Mar 2023

Dear Reviewers,

we have now adapted our manuscript accordingly. .

We want to thank you for the very pleasant and, at the same time very constructive suggestions for improvement. We now hope we can satisfy them with the update version of our Systematic Review.

Best regards from Germany

Roger Jung

Reviewer #1: General comments:

* Thank you very much for your positive evaluation. We really much appreciate.

* Thank you very much for your comment. We re-checked our data for the difference between upper and lower body, since the numbers in the text and in the figures were different. The difference between upper and lower body in weekly changes is 2%. Please find the correct numbers now in the text as well.

* You are right. Many leg exercises involve more muscles than just leg muscles. Nevertheless, the focus of the chosen exercises is on the lower body. We have added information about our definition for upper- and lower body exercises and in the methods and about the missing analysis of full body adaptations in the discussion.

The conclusion of the study should be clarified by reporting separately on beginners and advanced resistance-trained women. This should be in the abstract as well since there are.

* We have now added information about beginners and advanced women in the abstract and the conclusion.

The study discussion should mention all loading parameters of resistance training. Therefore I recommend the article after major revisions.

* We now mention training repetitions per sets, number of sets per workout and training frequency per week in the discussion. Additionally, we have now added important parameters such as rest time between the sets in table 2.

Specific comments:

* Thank you for pointing this out. However, the differences are really significant. For advanced students, the difference is 56.7 %. For beginners, the differences are 3.7 % per week. We have classified these differences in our results.

Line 69: What about arterial stiffness?

* Thank you for the comment. We have added the reference and information about arterial stiffness.

In introduction or discussion, try to justify whether hormonal response of man and women really differ and how.

* We are of the opinion that this should only take up a short part. However, we would like to point out that there are findings by Kissow and colleagues (DOI: 10.1007/s40279-022-01679-y) , or rather assumptions, that an estrogen peak at the end of the follicular phase could have a positive effect on strength training success.

Our study includes only young women (average age: 25.5±3.4 years) before menopause. We do not show differences between men and women in our analysis. But we report in our discussion that there are differences in muscle fibre distribution between women and men and therefore differences in training control and results.

We have added Battaro (DOI: 10.1016/j.jsams.2007.10.013 ) and thank you for pointing it out as it includes young women. We address this here in our limitations.

Line 132: Add the inclusion criteria for upper and lower body training

* We have added information here. We added a list of upper- and lower-body exercises in the methods and the results.

Line 170: How did you manually recalculated data? Be explicit.

* We calculated manually using a calculator. To avoid confusion we deleted this here.

* We included this in the abstract and the bullet points in the manuscript. We have mentioned the statistical changes when this one study is removed from the analysis. Since it is a study we could not exclude it will finally influence our results.

Line 324: Does exercise TEMPO influence hormonal response?

Wilk, M., Golas, A., Stastny, P., Nawrocka, M., Krzysztofik, M., & Zajac, A. (2018). Does tempo of resistance exercise impact training volume? Journal of human kinetics, 62(1), 241-250.

* Obviously, exercise tempo does have an influence on training adaptations. Nevertheless, this was not focus in our review. Therefore, we did not analyse the studies with regards to tempo. But have now included this in our limitations.

Reviewer #2: General Response

This is an interesting and much needed meta-analysis. It has a few misinterpretations that could need attention.

Specific Responses

Page Line

2 34 It might be helpful to provide a better description of “advanced subjects”. Does that mean “previously trained” or “well-trained”?

For the evaluation we used the classification offered by Santos Junior et al. (DOI: 10.1519/SSC.0000000000000627). We have described this in out methods. However, since some studies only used machine exercises, we had to trust the assessments of the authors of the individual studies about the classification of the participants. This is listed accordingly in the limitations. Nevertheless, we think that we were able to integrate a good standard here through the assessment. Due to the complex explanation we refrained from a detailed description in the abstract.

2 35 What does “same load” mean?

* Due to several changes in the abstract we do not have enough space to define training load here. We have added more information about the definition of training load later in the manuscript (cf. results 3.4.1).

3 67-69 This does not seem like a complete sentence.

* You are right. We corrected the sentence.

3 79 Should this be “The current review…” to distinguish your work?

* You are right. Thank you for the comment.

3 89 “…strength are increased more than ….”

* Corrected

3 94 What kind of “responses”? Could you be more specific?

* We have added more information here.

3 95 A 25% increase in 15 weeks does not seem to fit the 4.3% per week.

* This is true. However, we include other studies than Hagstrom et al. (DOI: 10.1007/s40279-019-01247-x). For example, we excluded studies in which we can assume that the women have hormone problems due to being overweight, obese, underweight, or other diseases that could influence the endocrine system. Since, Kissow et al. (DOI: 10.1007/s40279-022-01679-y) assume that estrogen potentially has an influence on larger gains in the lower body, we assume that the differences here could be higher. We also use a different database query than these authors.

4 109 Why only these two languages?

* We decided to perform the literature search in the important English databases. In our team the only other language besides English is German. Therefore, we focused on these two languages.

5 171 “The data from the meta-analyses were …..” in data is a plural word.

* Corrected

14 281 “…frequency per week o number of repetitions….”

* Corrected

14 293 “The data here are very difficult…..”

* Corrected

15 304 “The quality of the studies was considered good….”

* Corrected

15 320 No period after “repetitions”

* Corrected

16 358 Is this a separate paragraph?

* Corrected

16 379 “in addition, it should be noted that Jansen de Jonge, Thompson and Han [15]….”

* Corrected

16 386 “…women, not only are proteins ….”

* Corrected

16 391 LH has not been defined. It should probably be spelled out before using the LH abbreviations.

* Corrected

16 396 There was no reference 15 in the introduction.

* Corrected

17 430 “…studies, since other authors….”

* Corrected

Reviewer #3:

Dear Authors,

Clarity of content and adequacy to scientific language was demonstrated throughout the manuscript. In addition, the manuscript is interesting, however it is necessary to make some considerations.

#GENERAL CONSIDERATIONS

* Thank you for the comment. Changed as suggested.

#I suggest that the authors improve the research rationale. Only the scarcity of studies is not enough to justify carrying out this research.

*Thank you for your comment. We have now added more details to the rational of this review.

#Methods

#Curiosity, why did the authors not search for the words resisted exercises?

* We use the terms “strength training” and “resistance training” we did not not want to include studies that performed strength training with a rubber or resistance band for example. At the beginning of our literature search, we conducted various test queries via PubMed and then finally defined the search string. Furthermore, we did not find more studies with the words “resisted exercise” which were in the focus of our research question.

#Although it was mentioned in the limitations, as there are many possibilities to manipulate resistance training variables, how did the authors make this equalization, considering the influence of possibilities on strength gain? #i.g., different rest intervals between sets and exercises of the studies included in the analysis of this research; #different volumes (number of sets x number of repetitions x training frequency) of the studies included in the analysis of this research; #different contraction speeds, as well as range of motion of the studies included in the analysis of this research.

* We added now more available data about the training protocol for each included study in table 2. The new information will not influence our results or the figures. The rest times, which we also now added to Table 2, do not have any significant influence either. But we add it in our limitation. In order to ensure a comparison between the studies, we focus on variables that are included in as many studies as possible and thus can be compared with each other. This is therefore the basis for this review. Furthermore, we have also indicated in Table 2 whether or not training was done to muscular failure. We discuss this in the limitations, as we find it questionable whether training with beginners in particular should actually be carried out into muscular failure or whether these types of subjects have a feeling for it.

#Discussion

#I suggest that authors begin with the main research findings.

* Thank you very much. We changed the beginning of the discussion.

#I suggest that the authors clearly demonstrate the applicability of the research findings.

authors clearly demonstrate the applicability of the research findings.

* We added information in the discussion.

#Conclusion

#While the findings are interesting, I am not sure the authors should claim the following.

* We have adjusted the wording to make clear that these recommendations are just a result from the studies we analyzed.

#Further studies are needed to confirm these findings in view of the different characteristics of the resistance exercise protocols.

* We also wanted our review to provide an impetus for further research in this area. In addition to our review, we are currently in the process of developing a study to clarify the ambiguities. We rephrase the sentence.

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PLoS One. doi: 10.1371/journal.pone.0284216.r003

Decision Letter 1

Hans-Peter Kubis

27 Mar 2023

Muscle strength gains per week are higher in the lower-body than the upper-body in resistance training experienced healthy young women - a systematic review with meta-analysis

PONE-D-22-24644R1

Dear Dr. Jung,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

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Reviewer #1: All comments have been addressed

Reviewer #2: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

Reviewer #1: Yes

Reviewer #2: Yes

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3. Has the statistical analysis been performed appropriately and rigorously?

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Reviewer #2: Yes

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4. Have the authors made all data underlying the findings in their manuscript fully available?

Reviewer #1: Yes

Reviewer #2: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

Reviewer #1: Yes

Reviewer #2: Yes

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6. Review Comments to the Author

Reviewer #1: The authors made apropriate changes in their manuscript. I have only one more minor note, that limitations on the line 432 should be referenced, as it is rest interval referenced in following sentence.

Reviewer #2: The study is an interesting and timely work. It should be useful to those working in the field of resistance training.

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PLoS One. doi: 10.1371/journal.pone.0284216.r004

Acceptance letter

Hans-Peter Kubis

31 Mar 2023

PONE-D-22-24644R1

Muscle strength gains per week are higher in the lower-body than the upper-body in resistance training experienced healthy young women - a systematic review with meta-analysis

Dear Dr. Jung:

I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department.

If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org.

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Supplementary Materials

S1 Checklist. PRISMA 2009 checklist.

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Data Availability Statement

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PERMALINK

Muscle strength gains per week are higher in the lower-body than the upper-body in resistance training experienced healthy young women—A systematic review with meta-analysis

Roger Jung

Sebastian Gehlert

Stephan Geisler

Eduard Isenmann

Julia Eyre

Christoph Zinner

Roles

Abstract

Background

Objective

Methods

Results

Conclusion

1. Introduction

2. Methods

2.1 Search strategy and data sources

2.2. Inclusion and exclusion criteria

2.3. Methods of study selection

2.4 Statistical analysis and level of the participant’s

3. Results

3.1. Study selection and characteristics

Fig 1. PRISMA flowchart.

3.2. Quality of the studies and risk of bias

Table 1. The PEDro scale rating for all included studies.

3.3. Summary of all included studies

Table 2. Summary of all included studies for the final analysis.

3.4.1 Upper- and lower-body comparison

Fig 2. Forrest plot.

Fig 3. Forrest plot.

3.4.2. Repetitions and frequency per week for upper and lower-body strength

Fig 4. Evaluation for repetitions per set and training frequency per week for all included studies.

3.4.3. Information on menstrual status in the included studies

4. Discussion

5. Limitations

6. Conclusion

Supporting information

Data Availability

Funding Statement

References

Decision Letter 0

Hans-Peter Kubis

Roles

Author response to Decision Letter 0

Decision Letter 1

Hans-Peter Kubis

Roles

Acceptance letter

Hans-Peter Kubis

Roles

Associated Data

Supplementary Materials

Data Availability Statement

ACTIONS

PERMALINK

RESOURCES

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