Analysis of the Additive Effects of Nutritional Strategies in Strength Training Interventions on Body Composition, Muscle Strength and Bone Mineral Density in Postmenopausal Women: A Systematic Review

Franziska Walter; Jan Schalla; Wilhelm Bloch; Patrick Diel; Stephan Geisler; Eduard Isenmann

doi:10.1186/s40798-025-00954-2

. 2026 Jan 14;12:5. doi: 10.1186/s40798-025-00954-2

Analysis of the Additive Effects of Nutritional Strategies in Strength Training Interventions on Body Composition, Muscle Strength and Bone Mineral Density in Postmenopausal Women: A Systematic Review

Franziska Walter ¹, Jan Schalla ², Wilhelm Bloch ¹, Patrick Diel ¹, Stephan Geisler ², Eduard Isenmann ^1,^2,^✉

PMCID: PMC12804528 PMID: 41535482

Abstract

Background

During menopause, women experience a range of physiological changes, including reduction in skeletal muscle mass, bone mineral density, and an increase in fat mass. Although strength training and dietary strategies have individually been shown to counteract these changes, evidence for their combined effects is currently lacking. This review aims to investigate the combinatory effects on body composition, muscle strength, and bone mineral density.

Methods

Three databases (PUBMED, Web of Science, and SPORTDiscus) were screened following the PRISMA guidelines. The PEDro scale was utilized to evaluate methodological quality and potential bias risk. The analyzed outcome parameters were body composition, muscle strength, and bone mineral density.

Results

A total of 34 studies including postmenopausal women (N = 1,541) were identified; 31 of these had a PEDro score of 6 or higher. In general, body composition, muscle strength, and bone mineral density have been significantly altered through systematic strength training. Eleven studies focused on an additional calorie deficit (250-750 kcal/day) which enhanced the reduction of fat mass. Protein intake was examined in nine studies and has no significant additional effect on muscle strength and lean body mass with a minimal intake of 0.8 g/kg bodyweight. Only a few studies could be identified on other nutritional and supplementation strategies. A total of three studies were identified investigating strength training in conjunction with amino acid supplementation, four studies examining calcium and vitamin D, four studies on creatine, one study on zataria multiflora, one study on omega-3 supplementation and one study on shatavari.

Conclusion

Systematic strength training has been consistently demonstrated to improve body composition, strength capacity, and bone mineral density. However, the evidence supporting the effectiveness of additional nutritional and supplementation strategies remains inconclusive. While a calorie-restricted diet and adequate protein intake appear to promote favourable changes in body composition, the available data is still insufficient to derive specific and evidence-based recommendations regarding supplementation in conjunction with strength training. Moreover, research on additional nutritional and supplementation strategies remains inconsistent or scarce, underscoring the need for further studies to allow for more precise recommendations.

PROSPERO Registration Number CRD42023412915 (12th April 2023).

Supplementary Information

The online version contains supplementary material available at 10.1186/s40798-025-00954-2.

Keywords: Diet, Physical fitness, Postmenopausal women, Resistance training, Supplementation

Introduction

It is generally known that body composition, physical performance and functionality begin to decline steadily in the fourth decade of life [1]. In women, one of the most crucial phases in ageing is menopause, which usually occurs between the ages of 45 and 55 years [2]. Menopause is defined as 12 consecutive months of amenorrhea without surgical intervention or other causes. It marks the end of reproductive function [3]. This transition is characterized by several physiological and hormonal changes, most notably a reduction in estradiol and progesterone concentrations. These hormonal alterations contribute to a decline in skeletal muscle mass (SMM), muscle strength and bone mineral density (BMD) as well as an increase in fat mass (FM) [4–7]. It is estimated that about 3–10% of SMM is lost per decade of life after the third decade [1]. A decrease in SMM leads to reduced functionality and performance, which increases the risk of falls and fractures [8–10]. In this context, postmenopausal women with reduced SMM exhibit a 2.1-fold higher risk of falls and a 2.7-fold higher risk of fractures compared with those who have maintained SMM [11]. Overall, menopausal women are at an increased risk of developing osteoporosis and musculoskeletal disorders, including musculoskeletal pain and sarcopenic obesity [7, 12–14].

To maintain SMM and promote longevity, physical activity is an ideal prevention strategy to counteract the ageing process [15]. Systematic strength training (ST) in particular seems to be an ideal strategy to counteract the side effects of menopause. Recent reviews on postmenopausal women have shown that ST improves functionality, BMD [16, 17], and body composition. For example, Thomas et al. [8] found that ST achieved a small to moderate increase in lean body mass (LBM) [8]. Sá et al. [17] observed a reduction in FM when performing ST [17]. Regarding the effects of training frequency on BMD and body composition, however, the available data remains insufficient to draw definitive conclusions [16]. Concerning training duration, the meta-analysis by González-Gálvez et al [18] demonstrates that three training sessions per week with a duration of 60 min can improve strength in the lower and upper body [18].

In addition to physical activity, nutritional strategies are recognized crucial for promoting a healthy lifestyle. Although general dietary recommendations for postmenopausal women do not differ substantially from those for other populations [19], only a few specific guidance on nutrition and supplementation are available. A low-energy diet is recommended for postmenopausal women to counteract metabolic changes and high-fat accumulation [20]. Regarding minerals and vitamin D intake, current recommendations to preserve BMD suggest a daily calcium intake of 700 mg – 1500 mg/day and a vitamin D intake of 400–800 IU/day [21–24]. Further recommendations regarding supplementation specifically for postmenopausal women have not been established in the literature. Although evidence exists on physical activity and nutrition strategies in postmenopausal women, these two aspects are primarily considered separately. However, for a healthy lifestyle, physical activity should be combined with a balanced and nutritious diet. In younger adults, for example, studies demonstrated that the combination of ST and nutritional interventions is more effective on body composition than ST alone [25–27].

To date, no systematic review has examined the combined effects of ST and nutritional interventions in postmenopausal women. Accordingly, this review aims to identify and summarize the potential effects of ST in conjunction with dietary strategies. It will investigate the additive impact of nutritional interventions on body composition, muscle strength, and BMD within ST programs targeting postmenopausal women.

Methods

Information Source and Search

The literature search was independently completed by two researchers (JS and FW) following the PRISMA guidelines across PubMed, Web of Science, and SPORTDiscus [28]. The last search was conducted on August 5, 2025.

The study selection process, including the removal of exact duplicates, was managed using the current version of Rayyan.ai (Rayyan Systems Inc., Cambridge, USA). Any discrepancies during the selection process were resolved through consultation with a third reviewer (EI). In cases where the full text was unavailable online, the primary author and/or co-authors of the study were contacted via email by researcher FW. The systematic review was registered beforehand on PROSPERO on the April 12, 2023 (registration number: CRD42023412915).

The search strategy involved utilizing Medical Subject Headings (MeSH) and keywords, which were combined using Boolean operators (“AND”, “OR”). The used terms were: (postmenopaus*) AND ((strength*) OR (weight*) OR (resistance*) OR (barbell*) OR (machine*) OR (freeweight*)) AND ((*diet*) OR (nutrition*) OR (supple*) OR (*intake)) AND ((*performance) OR (fitness) OR (capacity) OR (muscle*) OR (lean body mass) OR (fat mass) OR (fat-free mass) OR (body composition) OR (body fat) OR (body mass) OR (BMI) OR (bone density)).

Selection Criteria

The eligibility criteria were established using the Patient-Intervention-Comparison-Outcome-Study-Timing (PICOST) scheme. Randomized, controlled study designs (RCTs) or controlled clinical trials written in either English or German were included in the screening process (S). The aspired study population comprised healthy postmenopausal (≥ 1 year without menstruation) women (P). The intervention required a structured ST program with a reproducible exercise intensity in combination with a diet or a dietary supplementation (I). The minimum intervention duration (T) was four weeks. Diet-and-exercise intervention groups were compared with diet-only, exercise-only, non-dieting, non-exercising control, or distinct diet-and-exercise intervention groups (C). Finally, only studies evaluating relevant outcomes on health parameters for body composition such as fat-free mass (FFM), LBM, SMM or FM, muscle strength or BMD were included (O). If there were multiple reports of the same study with the same sample size, the results were treated as a single study. Exclusion criteria included studies involving animal models, studies where male participants could not be distinguished, cohorts with a mean age greater than 65 years, participants using prescribed medication, or populations with pre-existing diseases other than obesity. Studies were also excluded if the full text could not be obtained despite attempts to contact the corresponding author.

Data Extraction

The extracted data included information on study design, participants, performed interventions including exercises and nutritional instructions, and relevant outcome parameters. When a study compared multiple treatments or included male participants, only outcomes relevant to the research question were considered. When parameters were presented exclusively in graphical form, PlotDigitizer was used to extract mean values and standard deviations (SD) or standard errors (SE) from the figures. The standard deviation and mean value of all parameters were assessed and used to calculate the correlation coefficient r [29]. In case the SD was not provided, it was calculated by using the SE and the sample size or the confidence interval, if reported. The used formulas were as follows [29, 30]:

Quality Assessment and Risk of Bias

To evaluate the quality of all included studies the PEDro scale was used [31]. The PEDro scale includes eleven questions that address random and concealed allocation, blinding of participants, therapists and assessors, as well as quantity and quality of the outcome measures. Each question item was independently rated as (a) yes, (b) no, or (c) no information. Any discrepancies were discussed and subsequently resolved in consultation with a third researcher (EI).

Results

Study Selection

Initially, a total of 7540 hits were identified, as illustrated in the PRISMA 2020 flow diagram (Fig. 1) [28]. A total of 34 studies involving 1541 postmenopausal women with an average age ranging from 53.8 to 65.0 years were included. The duration of these studies varied, ranging from four weeks to four years. The included studies that were published between 1996 and 2025. The results of the individual studies were presented according to the original data reported by the authors, either in absolute values or in relative (percentage) terms. No conversions or modifications of the data (such as rounding or reduction of decimal places) were performed. The PEDro score of the included studies ranged from poor to excellent. One study was identified as poor (score 0–3), two studies as fair (score 4–5), eighteen as good (score 6–8) and thirteen studies were identified as excellent (score 9–10). Results are shown in Table 1: PEDro Scale.

Table 1.

PEDro scale

Study group (year)	1	2	3	4	5	6	7	8	9	10	11	Summe
Aguiar et al. (2013)	a	a	a	a	a	a	a	a	a	a	a	10
Bagheri et al. (2021)	a	a	a	a	a	c	a	a	a	a	a	9
Bouchard et al. (2009)	a	a	a	a	b	b	b	a	a	a	a	7
Brochu et al. (2009)	a	a	a	a	b	b	b	a	a	a	a	7
Candow et al. (2021)	a	a	a	a	a	a	a	b	a	a	a	9
Chilibeck et al. (2015)	a	a	a	a	a	a	a	b	a	a	a	9
Cussler et al. (2005)	a	a	c	a	b	b	b	a	a	a	a	6
de Branco et al. (2019)	a	a	a	a	a	a	a	a	a	a	a	10
Drapeau et al. (2011)	a	a	a	a	b	b	b	b	a	a	a	6
Félix-Soriano et al. (2021)	a	a	a	a	a	b	a	b	a	a	a	8
Figueroa et al. (2013) 1	a	a	a	a	b	b	b	a	a	a	a	7
Figueroa et al. (2013) 2	a	a	a	a	b	b	b	a	a	a	a	7
Figueroa et al. (2015)	a	a	a	a	a	c	c	a	a	a	a	8
Ghanbari-Niaki et al. (2018)	a	a	a	a	a	c	c	a	a	a	a	8
Greed et al. (2025)	a	a	a	a	a	a	c	c	a	a	a	8
Haghighi et al. (2023)	a	a	a	a	a	a	a	a	a	a	a	10
Holm et al. (2008)	a	a	a	b	a	a	a	b	a	a	a	8
Ioannidou et al. (2024)	a	a	a	a	b	b	a	a	a	a	a	8
Isenmann et al. (2023)	a	a	a	a	a	b	b	b	a	a	a	7
Johannsmeyer et al. (2016)	a	a	a	a	a	a	a	a	a	a	a	10
Joseph et al. (2001)	a	a	a	a	b	b	b	a	a	a	a	7
Kang et al. (2022)	a	a	a	a	a	c	a	a	a	a	a	9
Kerksick et al. (2020)	a	a	a	a	a	a	a	b	a	a	a	9
Maesta et al. (2007)	a	a	c	a	a	c	c	b	a	a	a	7
McNeil et al. (2015)	a	a	a	a	b	b	b	a	a	a	a	7
Molina et al. (2015)	a	c	c	c	b	b	b	c	a	a	b	2
Orsatti et al. (2017)	a	a	a	a	a	a	a	b	a	a	a	9
Rossato et al. (2017)	a	a	a	a	a	a	b	b	a	a	a	8
Ryan et al. (1996)	a	b	b	b	b	b	b	a	a	a	a	4
Ryan et al. (2003)	a	c	c	a	b	b	b	b	a	a	a	4
Senechal et al. (2012)	a	a	a	a	b	b	b	a	a	a	a	7
Shenoy et al. (2013)	a	a	a	a	b	b	b	a	a	a	a	7
Tayebi et al. (2019)	a	a	a	c	a	a	a	a	a	a	a	9
Weisgarber et al. (2015)	a	a	a	a	a	a	a	b	a	a	a	9

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a = yes; b = no; c = no information; 1 = eligibility criteria were specified; 2 = subjects were randomly allocated to groups; 3 = allocation was concealed; 4 = the groups were similar at baseline regarding the most important prognostic indicators; 5 = there was blinding of all subjects*; 6 = there was blinding of all therapists who administered the therapy*; 7 = there was blinding of all assessors who measured at least one key outcome*; 8 = measures of at least one key outcome were obtained from more than 85% of the subjects initially allocated to groups; 9 = all subjects for whom outcome measures were available received the treatment or control condition as allocated or, where this was not the case, data for at least one key outcome was analysed by “intention to treat”; 10 = the results of between-group statistical comparisons are reported for at least one key outcome; 11 = the study provides both point measures and measures of variability for at least one key outcome; *blinding regarding nutritional strategies

Study Designs

Six of the included studies compared a diet-only intervention with a diet-and-exercise intervention. Seventeen studies assessed the impacts of an exercise-only intervention versus a diet-and-exercise intervention. Three studies had a three-arm study design comparing exercise-only and diet-only interventions to a diet-and-exercise intervention. Data from two studies with a three-arm study design compared a diet-and-exercise intervention with a diet-only and a control intervention and three studies with a three-arm study design compared a diet-and-exercise intervention with an exercise-only and a control intervention. Eleven studies featured a four-arm study design comparing diet-and-exercise interventions with diet-only, exercise-only and control interventions, four studies compared distinct diet-and-exercise interventions, with one of them having an exercise-only control group. Finally, one study had a six-arm design with two different diet-and-exercise and two different exercise-only interventions and a diet-only and a control intervention.

Exercise Interventions

The included studies performed ST ranging from two to four times per week. The ST was performed with resistance bands, free weights, weight machines, or in the form of whole-body vibration (WBV) training.

Caloric Restriction Diet

Eleven studies [32–42] investigated the interaction of ST and different calorie-restrictive diets (CRD). The study periods ranged from four to twenty-six weeks. Most of the studies performed ST three times per week.

A total of five studies compared a CRD with ST to ST alone [32, 35, 36, 38, 42]. All studies showed significant differences between the groups with a significantly greater reduction in BW, body mass index (BMI), waist circumference (WC), FM and body fat (BF) percentage in the dieting groups. Besides, Bouchard et al. [32] observed a significant decline in leg extension exercises in both CRD groups (ST + CRD: 123 ± 31 kg to 108 ± 21 kg*; CRD: 104 ± 40 kg to 78 ± 33 kg*) but not in the ST group (94 ± 34 to 106 ± 29 kg) without CRD. Concerning LBM or SMM, Figueroa et al. [35, 36] detected a significant decline in the CRD groups (Figueroa et al. (2013) 1: 20.5 ± 1.0 kg to 19.5 ± 1.1 kg*; Figueroa et al. (2013) 2: 43.6 ± 1.6 kg to 42.3 to 1.8 kg*) without ST over time but not in the CRD groups with ST (Figueroa et al. (2013)1: 19.5 ± 0.8 kg to 19.1 ± 0.7 kg; Figueroa et al. (2013) 2: 42.4 ± 1.3 kg to 41.6 to 1.2 kg). However, in both studies, no significant group differences were observed. The other two studies did not show significant differences regarding LBM or muscle strength parameters between CRD groups [38, 42].

Nine studies [32–37, 39, 40, 42] compared a CRD alone versus a CRD in combination with ST. Five of these studies [33, 36, 37, 39, 40] found significant differences between the two groups. Two studies [36, 37] showed that the group combining CRD with training had a significantly greater increase in muscle strength parameters. Figueroa et al. demonstrated a significant increase and group effect in absolute muscle strength in the CRD + ST group (from 104 ± 5 kg to 129 ± 5 kg), compared with the CRD-only group (from 118 ± 8 kg to 111 ± 8 kg), which was similar to the effect observed in the ST-only group (113 ± 3 kg to 141 ± 8 kg) [36]. These effects are supported by observations from Joseph et al., who reported a significant difference between the groups in overall muscle strength (CRD + ST: ∆+23 ± 2 %; CRD: ∆+2 ± 2 %) [37].

Concerning FM, BF or circumferences, Bronchu et al. reported significant group differences with the combination of CRD and ST resulting in greater reductions in BF (CRD + ST: ∆ −3.7 ± 3.5 %; CRD: ∆−2.5 ± 2.7 %), trunk FM (CRD + ST: ∆−3.3 ± 2.6 kg; CRD: ∆−2.2 ± 2.5 kg), and hip circumference (HC; CRD + ST: ∆−7.5 ± 9.9 cm; CRD: ∆−4.5 ± 4.4 cm) compared with CRD alone [33]. McNeil et al. supported this findings, observing a significantly greater decline in FM in CRD + ST compared with CRD only (CRD + ST: ∆-6.1 ± 4.1 kg; CRD: ∆-3.9 ± 2.4 kg) [39]. Ryan et al. demonstrated a significant reduction in FM (33.1 ± 5.4 kg to 28.6 ± 4.6 kg) and BF (42.8 ± 3.4 % to 39.3 ± 3.7 %) following a CRD combined with ST [41]. In contrast to other studies, however, only participants with a BMI >27 kg/m² were instructed to follow the CRD, whereas the control group (BMI < 27 kg/m²) received no dietary guidance and consequently exhibited no significant changes in FM (22.2 ± 6.1 kg to 21.8 ± 6.3 kg) or BF ( 36.8 ± 5.0 % to 35.6 ± 6.1 %).

Furthermore, Joseph et al. [37] observed a significant decrease in SMM over time only in the CRD group as well as a significant between-group effect in SMM (CRD + ST: 17.9 ± 0.8 kg to 18.3 ± 0.8 kg; CRD: 16.0 ± 1.3 kg to 15.4 ± 1.3 kg). The remaining four studies [32, 34, 35, 42] did not detect any statistically significant differences between the CRD + ST and CRD only groups for body composition parameters.

With respect to BMD, only one study was identified [38]. Kerksick et al. [38] did not find any significant differences between the groups.

More detailed information is provided in Table 2.

Table 2.

Caloric restriction

Author/ Date

Study design

Population

Training

Nutrition

Outcomes

Bouchard

et al.

(2009)

Randomized controlled

double-blind study

Total

(n = 46)

obese postmenopausal

Duration: 12 weeks

Body composition

Muscle strength

BW (kg)

BMI

(kg/m²)

(kg)

LBM

(kg)

leg extension

(lbs)

one leg squat

ST + CR (n = 12)

Ø 64.4 ± 4.5 years

3/ week

resistance training

weight reduction

by 0.5–1 kg/ week

1 h/ week NIS

AHA diet

77.5 ± 8.9 to 73.9 ± 9.2*

r =

-0.195

31.7 ± 2.6 to 30.2 ± 2.6*

r = -0.277

33.8 ± 6.5 to 30.6 ± 6.6*

r =

-0.237

40.8 ± 3.2 to 40.5 ± 2.8

r =

-0.050

123 ± 32 to 108 ± 21*

r = -0.320

3.4 ± 2.6 to 6.4 ± 3.0*#

r = 0.469

(n = 11)

Ø 60.7 ± 4.6 years

no supervised training

78.4 ± 10.8 to 74.4 ± 9.8*

r =

-0.190

31.9 ± 2.7 to 30.4 ± 2.3*

r = -0.285

36.1 ± 7.4 to 32.9 ± 7.3*

r = -0.213

39.2 ± 4.7 to 38.5 ± 4.1*

r = -0.079

104 ± 40 to 78 ± 33*

r = -0.331

2.5 ± 2.5 to 3.9 ± 4.3*

r = 0.184

(n = 11)

Ø 62.8 ± 3.7 years

3/ week

resistance training

no prescribed diet

78.5 ± 8.1 to 76.8 ± 8.2

r =

-0.104

30.8 ± 2.2 to 30.7 ± 2.3

r = -0.022

34.4 ± 4.3 to 34.7 ± 5.1

r = 0.032

40.9 ± 4.3 to 41.1 ± 4.1

r = 0.024

94 ± 34 to 106 ± 29

r = 0.185

3.4 ± 1.7 to 7.0 ± 2.9*#

r = 0.581

(n = 12)

Ø 62.5 ± 3.1 years

no supervised training

80.1 ± 8.9 to 80.1 ± 9.4

r = 0

32.3 ± 2.4 to 32.6 ± 2.4

r = 0.062

36.9 ± 5.7 to 36.9 ± 5.8

r = 0

40.4 ± 4.1 to 40.1 ± 4.5

r = -0.035

113 ± 35 to 93 ± 35

r = -0.275

3.2 ± 3.0 to 3.4 ± 3.0

r = 0.033

main outcome:

both CR groups (CR, ST + CR) significantly decreased BW, BMI, FM and leg extension strength over time (*)

CR significantly decreased in LBM over time (*)

One leg squat increased significantly in both ST groups (ST, ST + CR) compared to CR and C (#)

Brochu et al.

(2009)

Randomized

double-blind,

controlled study

Total

(n = 107)

overweight/obese postmenopausal

women

Duration: 26 weeks

body composition

(kg)

BMI

(kg/m²)

(cm)

(%)

total FM

(kg)

trunk FM

(kg)

total LBM

(kg)

trunk LBM (kg)

ST + CR (n = 36)

Ø 57.2 ± 5.0 years

3/ week

resistance training

CR: BRMR minus

500–800 kcal x 1.4 (PAF)

2/ month NIS

AHA diet

Baseline 84.1 ± 15.8

∆ -5.8 ± 4.9*

r = -0.509

Baseline 32.6 ± 4.9

∆ -3.3 ± 1.9*

r = -0.656

Baseline

97.1 ± 9.8

∆ -5.6 ± 4.7*

r = -0.512

Baseline

116.8 ± 13.1

∆ -7.5 ± 9.9*#

r = -0.354

Baseline 46.5 ± 4.9

∆ -3.7 ± 3.3*#

r = -0.489

Baseline 39.5 ± 10.5

∆ -5.3 ± 4.3*

r = -0.525

Baseline 19.3 ± 6.2

∆ -3.3 ± 2.6*#

r = -0.536

Baseline 42.1 ± 5.8

∆ -0.4 ± 2.2*

r = -0.091

Baseline 19.6 ± 5.1

∆ +0.2 ± 1.6

r = 0.062

(n = 71)

Ø 58.0 ± 4.7 years

no supervised training

Baseline 83.6 ± 14.4

∆ -5.1 ± 4.7

r = -0.477

Baseline 32.2 ± 4.6

∆ -1.9 ± 1.8

r = -0.467

Baseline

95.7 ± 9.4

∆ -4.3 ± 3.8*

r = -0.492

Baseline 115.9 ± 10.4

∆ -4.5 ± 4.4*

r = -0.455

Baseline

45.0 ± 4.3

∆ -2.5 ± 2.7*

r = -0.420

Baseline 37.6 ± 8.6

∆ -4.0 ± 3.5*

r = -0.496

Baseline 17.8 ± 4.5

∆ -2.2 ± 2.5*

r = -0.403

Baseline 43.0 ± 7.2

∆ -0.9 ± 2.4*

r = -0.184

Baseline 19.7 ± 4.0

∆ -0.6 ± 2.0

r = -0.148

main outcome:

The ST + CR group showed significantly greater decreases in HC, BF and trunk FM (#)

Drapeau et al.

(2011)

Randomized

controlled study

Total

(n = 46)

overweight/obese postmenopausal

Duration: 26 weeks

body composition

no strength and bone mineral density parameters

(kg)

BMI

(kg/m²)

(%)

(kg)

FFM

(kg)

subcutaneous fat (cm²)

visceral fat (cm²)

ST + CR (n = 24)

Ø 58.0 ± 4.1 years

3/ week

resistance training

CR: BRMR minus

500–800 kcal x 1.4 (PAF)

2/ month NIS

AHA diet

84.4 ± 15.1 to 77.7 ± 16.6

∆ (relative %) -8.2 ± 5.0*

r = -0.634

32.9 ± 4.9 to 30.3 ± 5.5

∆ (relative %) -8.1 ± 5.0*

r = -0.629

46.6 ± 4.2 to 42.3 ± 5.9

∆ (relative %) -9.3 ± 8.3*

r = -0.489

39.6 ± 10.0 to 33.6 ± 12.3

∆ (relative %) -16.5 ± 11.5*

r = -0.583

44.6 ± 6.3 to 44.1 ± 5.4

∆ (relative %) -0.9 ± 4.7*

r = -0.095

465.6 ± 92.9 to 406.8 ± 101.3

∆ (relative %) -14.6 ± 8.0*

r = -0.674

180.1 ± 57.9 to 146.9 ± 56.5

∆ (relative %) -19.3 ± 10.3*

r = -0.684

(n = 22)

Ø 58.5 ± 4.6 years

no supervised training

82.5 ± 16.4 to 76.2 ± 15.7

∆ (relative) -7.7 ± 3.8*

r = -0.712

32.1 ± 5.5 to 29.7 ± 5.5

∆ (relative) -7.7 ± 3.8*

r = -0.712

44.3 ± 5.0 to 40.9 ± 6.6

∆ (relative) -7.8 ± 7.9*

r = -0.443

36.9 ± 10.0 to 31.9 ± 10.8

∆ (relative) -14.7 ± 9.6*

r = -0.608

45.8 ± 8.4 to 44.4 ± 7.2

∆ (relative) -2.5 ± 5.3*

r = -0.230

460.5 ± 122.7 to 407.1 ± 135.8

∆ (relative) -12.6 ± 8.7*

r = -0.587

175.8 ± 54.6 to 148.7 ± 55.3

∆ (relative) -15.3 ± 15.3*

r = -0.447

No significant differences in between the groups

Figueroa et al.

(2013) 1

Randomized

controlled study

Total

(n = 41)

Obese postmenopausal

Duration: 12 weeks

body composition

No strength parameters

(kg)

BMI

(kg/m²)

(cm)

SMM

(kg)

SMM index

(%)

ST + CR (n = 14)

Ø 54 ± 1 years

3/ week

low-intensity resistance training

diet: approx. 1250 kcal/day portion controlled foods + recommended conventional foods

86.8 ± 3.6 to 81.9 ± 3.5*#

r = -0.181

32.7 ± 1.1 to 30.9 ± 0.9*

r = -0.231

115 ± 3 to 110 ± 3*

r = -0.217

19.5 ± 0.8 to 19.1 ± 0.7

r = -0.071

22.4 ± 0.6 to 23.4 ± 0.6*

r = 0.217

(n = 14)

Ø 55 ± 1 years

no supervised training

92.2 ± 3.7 to 86.5 ± 3.6*#

r = -0.204

35.1 ± 1.0 to 32.8 ± 1.1*#

r = -0.280

118 ± 3 to 111 ± 3*#

r = -0.298

20.5 ± 1.0 to 19.5 ± 1.1*#

r = -0.126

22.3 ± 0.4 to 22.7 ± 0.6

r = 0.101

(n = 13)

Ø 54 ± 1 years

3/ week

low-intensity resistance training

no prescribed diet

88.7 ± 4.6 to 86.5 ± 4.1

r = -0.070

32.6 ± 1.0 to 31.8 ± 1.1

r = -0.105

116 ± 4 to 115 ± 4

r = -0.035

20.7 ± 1.0 to 21.5 ± 1.3

r = 0.094

23.4 ± 0.8 to 24.3 ± 0.8

r = 0.154

main outcome:

the CR group had a significant decrease in BW, BMI, WC compared to ST (#), but also a significant decrease in SMM over time (*)

the ST + CR group had a significant decrease only in BW compared to ST (#) and a significant increase in SMM index over time (*)

- no significant differences in between the CR and ST + CR group

Figueroa et al.

(2013) 2

Randomized

controlled study

Total

(n = 41)

overweight/obese postmenopausal

Duration: 12 weeks

body composition

muscle strength

(kg)

total FM

(kg)

trunk FM

(kg)

total LM

(kg)

arm LM

(kg)

leg LM

(kg)

Absolute

(kg)

Relative

(kg/kg BW)

ST + CR (n = 14)

Ø 54 ± 1 years

3/ week

low-intensity resistance training

diet: approx. 1250 kcal/day portioncontrolled foods + recommended conventional foods

86.7 ± 2.7 to 81.9 ± 2.5*#

r = -0.239

41.9 ± 2.0 to 37.5 ± 2.0*#

r = -0.282

22.1 ± 1.1 to 19.6 ± 1.2*#

r = -0.278

42.4 ± 1.3 to 41.6 ± 1.2

r = -0.085

4.6 ± 0.2 to 4.5 ± 0.2

r = -0.067

14.9 ± 0.6 to 14.6 ± 0.5

r = -0.072

104 ± 5 to 129 ± 5*#

r = 0.556

7.1 ± 0.4 to 8.8 ± 0.3*

r = 0.533

(n = 13)

Ø 54 ± 1 years

no supervised training

89.0 ± 4.4 to 83.4 ± 4.6*#

r = -0.170

44.1 ± 2.9 to 39.7 ± 3.1*#

r = -0.199

23.5 ± 1.7 to 20.8 ± 1.5*#

r = -0.227

43.6 ± 1.6 to 42.3 ± 1.8*

r = -0.105

4.8 ± 0.3 to 4.7 ± 0.3

r = -0.046

15.6 ± 0.8 to 14.6 ± 0.9*#

r = -0.160

118 ± 8 to 111 ± 8

r = -0.120

7.6 ± 0.6 to 7.3 ± 0.6

r = -0.069

(n = 14)

Ø 54 ± 1 years

3/ week

low-intensity resistance training

no prescribed diet

88.4 ± 4.6 to 86.9 ± 4.3

r = -0.045

41.3 ± 3.2 to 40.2 ± 2.7

r = -0.072

20.2 ± 1.8 to 20.0 ± 1.6

r = -0.016

44.0 ± 2.1 to 44.2 ± 2.3

r = 0.012

4.6 ± 0.2 to 4.7 ± 0.3

r = 0.050

15.8 ± 0.9 to 16.1 ± 1.1

r = 0.039

113 ± 3 to 141 ± 8*#

r = 0.471

7.3 ± 0.4 to 8.8 ± 0.8*

r = 0.278

main outcome:

The CR and the ST + CR group had a significantly greater decrease in BW, total and trunk FM compared to ST group (#)

Both ST groups had a significantly greater increase in absolute, relative strength compared to CR group (only)(#)

Joseph et al.

(2001)

Randomized

double-blind,

controlled study

Total

(n = 19)

overweight/obese postmenopausal

women

Duration: 4 weeks

body composition

muscle

(kg)

BMI

(kg/m²)

(cm)

waist to

hip ratio

(%)

(kg)

FFM

(kg)

SMM

(kg)

total body

strength

(%)

ST + CR (n = 10)

Ø 65 ± 2 years

3/ week

resistance training

CR: 750 kcal less per day

78.2 ± 2.1 to 75.0 ± 2.2*

r = -0.229

29.4 ± 0.9 to 28.2 ± 0.9*

r = -0.206

90.9 ± 2.1 to 88.2 ± 2.2*

r = -0.195

0.81 ± 0.02 to 0.80 ± 0.02

r = -0.079

47.0 ± 1.4 to 44.6 ± 1.4*

r = -0.262

36.9 ± 1.9 to 33.7 ± 1.9*

r = -0.257

41.2 ± 0.6 to 41.3 ± 0.7

r = 0.024

17.9 ± 0.8 to 18.3 ± 0.8

r = 0.079

∆ +23 ± 2*#

r = 0.866

(n = 9)

Ø 61 ± 2 years

no supervised training

80.8 ± 2.6 to 78.8 ± 2.7*

r = -0.185

30.4 ± 1.0 to 29.3 ± 1.0*

r = -0.180

97.3 ± 2.7 to 93.3 ± 2.2*

r = -0.259

0.86 ± 0.02 to 0.85 ± 0.01

r = -0.096

47.2 ± 1.4 to 45.2 ± 1.6*

r = -0.216

38.3 ± 2.1 to 35.3 ± 2.2*

r = -0.226

42.5 ± 1.3 to 42.4 ± 1.3

r = -0.013

16.0 ± 1.3 to 15.4 ± 1.3*#

r = -0.077

∆ +2 ± 2

r = 0.164

main outcome:

the ST + CR group showed a significantly greater increase in muscle strength and preserved SMM (#)

Kerksick

et al.

(2020)

Randomizedcontrolled

double-blind study

Total

(n = 128)

obese/overweight postmenopausal

women

(50–75 years)

Duration: 14 weeks

body composition

muscle strength

bone mineral density

(kg)

FFM

(kg)

(%)

bench press 1RM

(kg)

bench press volume

(kg)

leg press 1RM

(kg)

leg press volume

(kg)

bone mineral

content

(g)

ST + CRP (n = 50)

3/ week

resistance training (30 min.)

CR (week 2–10:) 1600 kcal/day

with high protein (55%)

94.6 ± 17.5 to 90.8 ± 17.0*

r = -0.109

42.4 ± 11.0 to 38.9 ± 10.8*

r = -0.159

46.0 ± 7.0 to 45.6 ± 6.7

r = -0.029

47.4 ± 4.5 to 45.4 ± 4.9*

r = -0.208

27.9 ± 6.2 to 31.5 ± 6.9*

r = 0.264

183 ± 98 to 174 ± 78

r = -0.050

139.7 ± 36.3 to 158.5 ± 34.9*

r = 0.255

1726 ± 1034 to 1658 ± 690

r = -0.037

1770 ± 292 to 1775 ± 308

r = 0.008

ST + CRC (n = 48)

CR (week 2–10:) 1600 kcal/day

with high carbohydrates (55%)

90.5 ± 17.3 to 85.4 ± 16.0*

r = -0.151

39.1 ± 10.4 to 35.5 ± 10.6*

r = -0.221

44.7 ± 7.0 to 44.2 ± 6.7

r = -0.036

46.3 ± 4.0 to 44.0 ± 5.1*

r = -0.240

28.2 ± 6.1 to 30.9 ± 6.1*

r = 0.216

166 ± 92 to 146 ± 57

r = -0.123

142.4 ± 32.1 to 151.5 ± 37.8*

r = 0.128

1472 ± 854 to 1275 ± 647

r = -0.127

1748 ± 248 to 1731 ± 223

r = -0.036

(n = 30)

no prescribed diet

84.5 ± 11.3 to 84.1 ± 12.1

r = -0.017

36.5 ± 8.1 to 35.9 ± 7.8

r = -0.094

42.0 ± 4.0 to 43.1 ± 4.6*

r = 0.127

46.0 ± 4.7 to 44.4 ± 4.2*

r = -0.176

26.8 ± 5.0 to 29.5 ± 4.5*

r = 0.272

151 ± 44 to 173 ± 60

r = 0.200

149.8 ± 48.6 to 164.2 ± 43.7*

r = 0.154

1530 ± 951 to 1782 ± 1192

r = 0.115

1681 ± 260 to 1667 ± 240

r = -0.028

main outcome:

No significant differences between both CR groups

The CRC and the CRP group showed a significantly greater decrease in FM compared to the control (*)

Control group significant increase in FFM over time (*)

McNeil et al.

(2015)

Randomized

double-blind,

controlled study

Total

(n = 83)

overweight/obese postmenopausal

women

Ø 58.1 ± 4.8 years

Duration: 26 weeks

body composition

No strength and bone mineral density parameters

(kg)

FFM

(kg)

ST + CR (n = 28)

3/ week

resistance training

CR: BRMR minus

Ø 633 kcal x 1.4 (PAF)

81.5 ± 11.2 to 74.8 ± 10.9

∆ -6.7 ± 4.5*

r = -0.597

37.9 ± 7.3 to 31.8 ± 8.1

∆ -6.1 ± 4.1*#

r = -0.597

43.6 ± 5.5 to 43.0 ± 4.2

∆ -0.5 ± 2.3*

r = -0.108

(n = 65)

no supervised training

83.5 ± 14.5 to 78.6 ± 18.3

∆ -4.8 ± 6.7*

r = -0.463

37.8 ± 8.8 to 33.9 ± 9.2

∆ -3.9 ± 2.4*

r = -0.476

45.6 ± 7.3 to 44.7 ± 6.2

∆ -0.9 ± 2.4*

r = -0.184

main outcome:

the ST + CR training group showed a significant greater decrease in FM than CR group

Ryan et al.

(1996)

non-randomized

Total

(n = 13)

overweight/obese postmenopausal

Duration: 16 weeks

body composition

muscle strength

(kg)

BMI

(kg/m²)

(kg)

FFM

(kg)

(%)

biceps

flexion (Nm)

triceps

extension (Nm)

leg

extension (Nm)

leg

flexion (Nm)

ST + CR (n = 6)

Ø 58 ± 2 years

BMI > 27 kg/m2

3/ week

resistance training

weight reduction

by approx. 0.25–0.5 kg/week

1/week NIS

AHA diet

78.5 ± 6.1 to 74.3 ± 5.8*

r = -0.330

30.3 ± 3.1 to 28.7 ± 2.9

r = 0.391

33.1 ± 5.4 to 28.6 ± 4.6*

r = -0.409

43.3 ± 1.0 to 44.2 ± 1.5

r = 0.200

42.8 ± 3.4 to 39.3 ± 3.7*

r = -0.442

25 ± 10 to 36 ± 15*

r = 0.410

33 ± 7 to 52 ± 10*

r = 0.540

63 ± 24 to 95 ± 22*

r = 0.565

40 ± 15 to 64 ± 15*

r = 0.632

(n = 7)

Ø 58 ± 2 years

BMI < 27 kg/m2

AHA diet

61.8# ± 7.9 to 61.9# ± 7.9

r = 0.006

23.2 ± 2.4# to 23.2 ± 2.4

r = 0.0

22.2 ± 6.1# to 21.8 ± 6.3

r = -0.040

37.6 ± 2.4# to 38.4 ± 3.2#

r = 0.142

36.8 ± 5.0# to 35.6 ± 6.1

r = -0.107

18 ± 11 to 34 ± 13*

r = 0.558

34 ± 11 to 44 ± 11*

r = 0.273

63 ± 8 to 86 ± 21*

r = 0.528

34 ± 11 to 57 ± 11*

r = 0.736

main outcome:

The ST + CR group showed a significant decrease in BW, BMI, FM and BF over time (*)

- no significant differences in strength parameters

Ryan et al.

(2003)

Randomized

double-blind,

controlled study

Total

(n = 24)

overweight/obese postmenopausal

Duration: 26 weeks

body composition

no muscle strength and bone mineral density parameter

(kg)

BMI

(kg/m²⁾

(cm)

waist to

hip ratio

(kg)

FFM

(kg)

(%)

ST + CR (n = 9)

Ø 57 ± 2 years

3/ week

resistance training

CR: 250–350 kcal less per day

AHA diet

87.1 ± 13.9 to 81.4 ± 12.6*

r = -0.210

32.1 ± 4.4 to 30.1 ± 4.4*

r = -0.112

93.7 ± 10.1 to 90.4 ± 10.4*

r = -0.161

0.81 ± 0.1 to 0.81 ± 0.1

r = 0.0

40.7 ± 9.5 to 35.6 ± 8.5*

r = -0.268

45.5 ± 6.3 to 44.4 ± 5.7*

r = -0.075

46.9 ± 5.1 to 43.9 ± 5.1*

r = -0.284

(n = 15)

Ø 56 ± 1 years

no supervised training

main outcome:

no significant differences between the groups for body composition and data were not shown separately

Senechal

et al.

(2012)

Randomizedcontrolled

double-blind study

Total

(n = 38)

obese postmenopausal

women

Ø 62.6 ± 4.1 years

(54–74 years)

Duration: 12 weeks

body composition

muscle strength

(kg)

(cm)

(%)

total FM

(kg)

trunk FM

(kg)

LBM

(kg)

isometric leg strength

(Nm)

ST + CR (n = 9)

3/ week

resistance training

weight reduction

by 0.5–1 kg/ week

1 h/ week NIS

AHA diet

Pre 77.5 ± 7.7

∆ -3.8 ± 1.8*#

r = -0.726

Pre 96.6 ± 7.9

∆ -5.3 ± 5.7*

r = -0.422

Pre 44.4 ± 4.1

∆ -2.2 ± 1.8*#

r = -0.521

Pre 32.5 ± 5.9

∆ -3.1 ± 1.8*#

r = -0.653

Pre 16.9 ± 2.7

∆ -2.0 ± 1.3*#

r = -0.610

Pre 40.1 ± 2.7

∆ -0.4 ± 0.9

r = -0.217

Pre 114.4 ± 20.2

∆ -11.2 ± 17.9

r = -0.299

(n = 9)

no supervised training

Pre 78.7 ± 11.7

∆ -4.3 ± 2.7*#

r = -0.623

Pre 99.1 ± 7.2

∆ -6.1 ± 3.9*

r = -0.616

Pre 47.8 ± 2.3

∆ -1.8 ± 1.3*#

r = -0.569

Pre 36.2 ± 6.7

∆ -3.2 ± 2.0*#

r = -0.625

Pre 17.3 ± 2.4

∆ -1.3 ± 1.1*

r = -0.509

Pre 39.3 ± 5.2

∆ -0.8 ± 1.2

r = -0.316

Pre 82.4 ± 23.6

∆ -17.6 ± 24.9

r = -0.333

(n = 10)

3/ week

resistance training

no prescribed diet

Pre 77.5 ± 7.7

∆ 0.5 ± 1.7#

r = 0.145

Pre 99.8 ± 7.1

∆ -0.7 ± 4.9

r = -0.071

Pre 45.4 ± 2.4

∆ -0.6 ± 1.5

r = -0.196

Pre 33.8 ± 4.2

∆ -0.2 ± 1.4

r = -0.071

Pre 17.3 ± 3.5

∆ +0.2 ± 1.6

r = 0.062

Pre 40.6 ± 4.0

∆ +0.5 ± 1.0

r = 0.243

Pre 82.3 ± 19.8

∆ +19.8. ± 37.5

r = 0.255

(n = 10)

no supervised training

Pre 77.5 ± 7.2

∆ -0.7 ± 1.4

r = -0.243

Pre 99.5 ± 6.4

∆ -1.7 ± 0.3

r = -0.094

Pre 47.5 ± 3.5

∆ -0.1 ± 1.3

r = -0.038

Pre 35.6 ± 5.3

∆ -0.1 ± 1.2

r = -0.042

Pre 18.0 ± 3.1

∆ -0.2 ± 1.3

r = -0.077

Pre 39.0 ± 3.1

∆ -0.1 ± 1.0

r = -0.050

Pre 102.7 ± 26.2

∆ -13.6 ± 38.4

r = -0.174

main outcome:

the CR group and ST + CR showed a significantly greater decline in BW, BF and total FM compared to control group (#)

the CR group showed a significantly greater decline in BW and total FM (#)

and the ST + CR group in BF%, total and trunk FM compared to ST group (#)

- no significant difference between CR and ST + CR

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High-protein Diet and Protein Supplementation

Nine of the included studies [43–51] examined the effect of protein supplementation in combination with ST. Various protein sources and strategies were identified, including whey protein (10 to 40 g/serving) on training days [43–45, 50], daily soy protein supplementation (25 to 40 g/ serving) [46, 47, 49] and a general high-protein diet ranging from 1.2 to 1.8 g/kg bodyweight (kgBW) [48, 51]. The duration of the studies ranged from 8 to 24 weeks. All studies implemented ST with two, three or four sessions per week. When reported, the control groups also consumed 0.7–0.9 g of protein/kgBW.

Orsatti et al. [47] was the only study to report a significant between-group difference the groups group receiving daily soy protein supplementation (P + ST) and the ST group receiving placebo. The P + ST group showed significantly greater increase in bench press (P + ST: ∆+12.2 kg [8.5–15.9]; ST: ∆+6.9 kg [4.5–9.4]), knee extension (P + ST: ∆+6.5 kg [4.7–8.2]; ST: ∆+3.9 kg [2.2–5.5]) and total load (P + ST: ∆+23.6 kg [19.0-28.7]; ST: ∆+15.7 kg [11.1–20.4]) compared with the placebo group. Nevertheless, both groups exhibited significant improvements in all strength parameters, with high effect sizes, over the 16-week intervention. Holm et al. [44] reported a significant increase over time in LBM (42.3 ± 4.8 kg to 43.1 ± 4.8 kg) and quadriceps strength (∆+14 ± 4%) in P + ST, although no significant between-group differences were observed (ST: LBM: 42.9 ± 3.3 kg to 43.3 ± 3.3 kg; quadriceps strength: ∆+8 ± 4%). All the other studies did not detect any significant group differences between the protein-supplemented and the training controls for any outcome parameters.

Detailed information is provided in Table 3.

Table 3.

Protein

Author/ Date

Amino Acids

In total, three studies [52–54] examined the effect of different amino acids in combination with ST. Two studies examined L-citrulline (LCi), and one focused on branched-chain amino acids (BCAA) supplementation [52–54]. Figueroa et al. [53] reported no significant differences in body composition or muscle strength between ST with and without LCi supplementation. However, the group that received both ST and 6 g of LCi per day showed a significant increase in appendicular lean mass index (from 7.6 ± 0.3 to 7.9 ± 0.3) over time, whereas neither the training-only group (8.1 ± 0.3 to 8.2 ± 0.3) nor the supplementation-only group (7.4 ± 0.3 to 7.5 ± 0.3) demonstrated significant changes. [53] Moreover, Kang et al. [54] reported that the group receiving ST combined with LCi (10 g/day) showed a significantly greater increase in leg curl strength (ST + LCi: 21.8 ± 4.7 kg to 28.7 ± 6.5 kg; ST: 19.8 ± 3.1 kg to 23.8 ± 3.8 kg) and leg lean mass (ST + LCi: 13.4 ± 2.2 kg to 14.0 ± 2.5 kg; ST: 12.6 ± 1.6 kg to 12.4 ± 1.6 kg) compared with the ST-only group. In contrast Bagheri et al. [4, 52, 53]

Table 4.

Amino acids

Author/Date

Calcium and Vitamin D

Four studies [38, 55–57] investigated the effects of ST in combination with calcium and/or vitamin D supplementation. In three of these studies [38, 55, 57] the participants received 800–1000 mg of calcium/day and two of these also included a daily dose of 400 IU of vitamin D. Haghighi et al. [56] administered 50,000 IU of vitamin D every two weeks without calcium supplementation. All participants in the exercising groups performed ST three times per week. The study periods ranged from 12 weeks to four years.

The four-year longitudinal study by Cussler et al. [55–57] demonstrated that daily supplementation of 1000 mg calcium and 400 IU vitamin D was associated with a significant percentage reduction in BMD in the lumbar region (∆-1.75 %) after one year. In contrast, no decrease was observed in the ST group, which exhibited significant increases in BMD in both the lumbar region (∆-1.15 %) and the femur (∆-2.57 %). In contrast, Kerksick et al. [38] and Haghighi et al. [56] did not show any significant differences between the exercising groups. Only in comparison to the non-exercising groups, Haghighi et al. [56] showed a significantly greater increase in all four muscle strength parameters in the training groups.

Detailed information are provided in Table 5.

Table 5.

Calcium and Vitamin D

Author/Date

Study design

Population

Training

Nutrition

Outcomes

Cussler et al

(2005)

Randomized controlled study

Total (n = 167)

Postmenopausal

women

Ø 56.15 ± 4.4 years

Duration: 4 years aiming for: 3/ week resistance training

Body composition

Bone mineral density

No strength parameters

(kg)

LBM

(kg)

(%)

Femur trochanter (g/cm²)

Femur neck (g/cm²)

Lumbar spine (g/cm²)

Total body (g/cm²)

RT + Ca high exercise frequency

Highest exercise frequency (average: 70% of the time)

Aiming for: 800 mg/day of calcium

∆ + 0.9 ± 3.1

r = 0.144

∆ 0.9 ± 1.2#

r = 0.351

∆ -0.5 ± 2.8#

r = -0.089

∆ + 0.014 ± 0.033#

r = 0.202

∆ + 0.004 ± 0.037

r = 0.054

∆ + 0.022 ± 0.046#

r = 0.233

∆ 0.000 ± 0.018#

r = 0.000

RT + Ca

middle exercise frequency

Middle exercise frequency

(average: 30%)

∆ -0.6 ± 5.3#

r = -0.057

∆ + 0.1 ± 1.6#

r = 0.031

∆ -0.7 ± 4.3#

r = -0.081

∆ -0.003 ± 0.041#

r = -0.037

∆ -0.005 ± 0.047

r = -0.053

∆ -0.007 ± 0.055#

r = -0.064

∆ -0.014 ± 0.026#

r = -0.260

RT + Ca

low exercise frequency

Lowest exercise frequency

including 23 controls (average: 5%)

∆ + 2.4 ± 4–8#

r = 0.243

∆ + 0.4 ± 1.5

r = 0.132

∆ + 1.7 ± 3.4#

r = 0.243

∆ -0.007 ± 0.036#

r = -0.097

∆ -0.005 ± 0.042

r = -0.059

∆ -0.010 ± 0.046#

r = -0.108

∆ -0.011 ± 0.027#

r = -0.200

All groups

All exercise frequencies

< 800mg/d actual supplemental calcium intake

∆ -1.8 ± 0.9%°

r = -0.707

∆ -1.4 ± 0.8%°

r = -0.659

∆ -2.2 ± 0.6%°

r = -0.808

∆ -2.5 ± 0.3%°

r = -0.972

> 800mg/d actual supplemental calcium intake

∆ + 1.3 ± 1.3%°

r = -0.447

∆ + 1.2 ± 1.4%°

r = -0.394

∆ + 0.1 ± 1.3%°

r = -0.038

∆ -1.5 ± 0.5%°

r = -0.832

Main outcome: - in comparison to group middle and low frequency: group high frequency shwoed a significantly greater increase in LBM and BMD (FT, LS and TB) - in comparison to group low frequency: group high frquency and middle showed a significantly decrease in BF and group middle a significantly decrease in BW -in comparison to a high calcium intake: the low group (< 800mg calcium/d) showed a significantly decrease in BMD (FT and TB) °no exact data published that is necessary to calculate r

Haghighi et al. (2024)

Randomized, double-blind, placebo-controlled study

Total (n = 44)

Postmenopausal

Duration: 12 weeks

Body composition

Muscle strength

No bone mineral density parameter

(kg)

BMI

(kg/m²)

leg press

(kg)

chest press

(kg)

lower

body

(cm)

upper body

(cm)

RT + VitD (n = 11)

Ø 55.4 ± 3.8 years

3/ week resistance training

Every two weeks:

50.000 IU vitamin D

69.7 ± 8.0 to 69.2 ± 7.5

r = -0.032

28.6 ± 3.1 to 28.4 ± 2.9

r = -0.033

31.1 ± 12.8 to 53.1 ± 9.1*#

r = 0.694

20.7 ± 8.0 to 34.9 ± 5.7*#

r = 0.705

17.3 ± 5.5 to 18.1 ± 4.2*#

r = 0.080

256 ± 34 to 298 ± 34*#

r = 0.525

RT (n = 11)

Ø 55.4 ± 0 years

Placebo

containing rice flour

74.4 ± 7.8 to 72.5 ± 5.9*

r = -0.134

29.8 ± 3.7 to 29.1 ± 2.8*

r = -0.104

44.5 ± 10.0 to 63.7 ± 16.0*#

r = 0.566

21.6 ± 5.7 to 38.6 ± 5.7*#

r = 0.831

15.0 ± 4.5 to 18.5 ± 6.7*#

r = 0.284

260 ± 68 to 322 ± 35*#

r = 0.466

VitD (n = 11)

Ø 57.4 ± 4.8 years

No supervised training

every two weeks: 50.000 IU vitamin D

69.0 ± 12.8 to 68.0 ± 11.5

r = -0.039

29.9 ± 5.0 to 29.5 ± 4.5

r = -0.042

27.7 ± 5.9 to 28.4 ± 7.5

r = 0.051

20.7 ± 4.9 to 23.4 ± 8.0

r = 0.190

14.9 ± 2.0 to 14.2 ± 3.3

r = -0.121

226 ± 28 to 230 ± 28

r = 0.071

C (n = 11)

Ø 55.8 ± 4.7 years

Placebo containing rice flour

75.0 ± 13.9 to 75.1 ± 13.4

r = 0.004

30.1 ± 5.3 to 30.1 ± 5.2

r = 0.003

33.1 ± 3.6 to 34.1 ± 14.7

r = 0.038

27.2 ± 7.0 to 29.0 ± 7.7

r = 0.121

13.2 ± 5.1 to 13.1 ± 5.4

r = -0.010

243 ± 40 to 241 ± 38

r = -0.026

Main outcome: -in comparison to VitD and C: both RT groups showed a significantly greater increase in all four muscle strength parameters (#) no significant differences between the two training groups

Kerksick

et al

(2020)

Randomized, controlled double-blind study

Total (n = 128)

Obese/ overweight postmenopausal

Women (50—75 years)

Duration: 14 weeks

Body composition

Muscle strength

Bone mineral density

(kg)

FFM

(kg)

(%)

Bench press 1RM (kg)

Bench press LV

Leg press 1RM

(kg)

Leg press LV

BMC

(g)

RT + Ca (n = 47)

3/ week resistance training (30 min.)

800 mg/d calcium

92.7 ± 14.6 to 88.4 ± 13.3*

r = -0.152

41.2 ± 9.9 to 38.3 ± 9.9*

r = -0.145

44.9 ± 5.2 to 44.4 ± 5.5

r = -0.049

47.4 ± 4.6 to 45.7 ± 5.2*

r = -0.170

27.6 ± 5.6 to 29.3 ± 5.0*

r = 0.158

142 ± 56 to 155 ± 59

r = 0.063

140.3 ± 31.5 to 150.8 ± 33.8*

r = 0.158

1535 ± 738 to 1415 ± 581

r = -0.089

1745 ± 239 to 1761 ± 250

r = 0.033

RT + Ca + D (n = 42)

800 mg/d calcium, 400 IU/d vitamin D, 300 mg magnesium, 7.5 mg zinc, 2 mg copper and 2 mg manganese

90.4 ± 20.8 to 86.9 ± 20.2*

r = 0.085

39.5 ± 12.8 to 35.9 ± 12.5*

r = -0.141

44.6 ± 7.9 to 44.8 ± 7.8

r = 0.013

46.2 ± 5.0 to 43.6 ± 5.3*

r = -0.244

27.6 ± 7.0 to 31.3 ± 6.5*

r = 0.250

169 ± 71 to 161 ± 73

r = -0.055

141.3 ± 45.9 to 157.7 ± 40.1*

r = 0.186

1531 ± 844 to 1644 ± 1014

r = 0.060

1755 ± 299 to 1732 ± 298

r = -0.038

RT (n = 39)

Placebo: 800 mg

maltodextrin

88.5 ± 13.4 to 85.7 ± 12.8*

r = -0.106

38.2 ± 7.5 to 35.5 ± 7.4*

r = -0.178

44.1 ± 6.5 to 44.1 ± 6.1

r = 0.000

46.2 ± 3.4 to 44.3 ± 3.7*

r = -0.258

28.2 ± 4.6 to 32.1 ± 6.7*

r = 0.312

206 ± 119 to 176 ± 71

r = -0.143

148.8 ± 34.0 to 164.6 ± 40.2*

r = 0.206

1720 ± 1284 to 1563 ± 860

r = 0.069

1719 ± 272 to 1698 ± 238

r = -0.041

Main outcome no significant differences between the groups

Molina et al

(2015)

Randomized, controlled study

Total (n = 34)

Postmenopausal

Duration: 1 year

Boner mineral density

No strength and bone mineral density parameters

Femoral

(%)

LUMBAR

(%)

RT + Ca (n = 7)

Ø 56.6 ± 6.5 years

3/ week resistance training

1000 mg/d Calcium and 400 IU/d of Vitamin D

∆ + 2.57*

∆ + 1.15*

Ca (n = 27)

Ø 60.1 ± 10.9 years

no supervised training

∆ -1.68

∆ -1.75*

Main outcome: - In comparison to the Ca group: the RT + Ca group showed a significant increase in both BMD parameters (*)

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Creatine Monohydrate

The effects of creatine monohydrate were investigated in four studies [58–61] Two studies went for one year and the other two for 12 weeks, all of them performing ST three times per week. Three studies supplied a daily dose of 0.1 g of creatine/kgBW to the intervention group [58, 59, 61] and one study 5 g of creatine per day [60].

Aguiar et al. showed, after 12 weeks of ST, a greater increase in all muscle strength parameters in the creatine group in comparison to the control group (bench press Cr: Δ+14.3 ± 6.7 %, CO: Δ+9.2 ± 4.4 %; knee extension Cr: Δ+8.6 ± 2.7 %, CO Δ+4.7 ± 1.8 %; biceps curls Cr: Δ+22.3 ± 7.1 %, CO Δ+13.5 ± 3.9 %) [60]. The body composition parameters FFM and SMM likewise only significantly increased in the creatine group but not in control without significant interaction effect. No significant differences were observed for the other body composition parameters. The only comparable outcome parameter of the other 12-week study of Johannsmeyer et al., lat pull down strength, significantly increased in both groups with no differences between the groups. After one year, Candow et al. [58] reported that the supplemented training group showed a significant group difference in lower leg muscle density. The ST group receiving creatine exhibited a significant increase compared with the exercising control group (ST + Cr: 70 [62–67] to 73 [62–67] mg/cm³; ST: 69 [62–64, 68, 69] to 70 [62–64, 68, 69] mg/cm³). Furthermore, in the study by Chilibeck et al. [59] the exercising group demonstrated a significantly greater decline in femoral neck BMD than the supplemented group. For all other parameters related to body composition, muscle strength and BMD no significant differences were observed across the year-long studies.

Detailed information is provided in Table 6.

Table 6.

Creatine

Author/Date

Study design

Population

Training

Nutrition

Outcomes

Aguiar et al

(2013)

Randomized, controlled study

Total (n = 18)

Postmenopausal women

Duration: 12 weeks

Body composition

Muscle strength

No BMD parameters

Body mass (kg)

(kg)

(%)

FFM

(kg)

SMM

(kg)

bench press (kg)

knee extension (kg)

biceps curl (kg)

ST + Cr

(n = 9)

Ø 64 ± 4 years

3/ week

resistance training

5 g/d Creatine monohydrate

form: capsules

60.5 ± 9.4 to 61.2 ± 9.6

r = 0.037

25.4 ± 7.4 to 25.0 ± 7.4

r = -0.027

41.3 ± 5.6 to 40.1 ± 5.7

r = -0,106

35.1 ± 2.3 to 36.2 ± 2.5*

r = 0.223

15.5 ± 1.5 to 16.1 ± 1.4*

r = 0.202

Δ + 14.3 ± 6.7%*#°

Δ + 8.6 ± 2.7%*#°

Δ + 22.3 ± 7.1%*#°

(n = 9)

Ø 65 ± 6 years

Placebo containing maltodextrin

57.1 ± 7.3 to 57.4 ± 7.5

r = 0,02

22.4 ± 5.8 to 22.6 ± 6.4

r = 0.016

38.8 ± 6.6 to 38.9 ± 7.4

r = 0.007

34.7 ± 4.0 to 34.7 ± 3.8

r = 0.000

15.4 ± 2.6 to 15.5 ± 2.5

r = 0.02

Δ + 9.2 ± 4.4%*°

Δ + 4.7 ± 1.8%*°

Δ + 13.5 ± 3.9%*°

Main outcome: - in comparison to ST: the ST + Cr group showed a significantly greater increase in all muscle strength parameters (#)

and only the ST + Cr group a significant increase in FFM and SMM (*) °no further data published that is necessary to calculate r

Candow et al

(2021)

Randomized

controlled study

Total (n = 22)

Postmenopausal women (> 49 years)

Duration: 1 year

Body composition

Bone mineral density

No strength

parameters

Forearm SMM (mm²)

Forearm muscle density

(mg/cm³)

Lower leg SMM (mm²)

Lower leg muscle density (mg/cm³)

Distal radius

(mg/cm³)

Radial shaft (mg/cm³)

Distal tibia (mg/cm³)

Tibial shaft (mg/cm³)

ST + Cr (n = 10)

3/ week

resistance training

0.1g/kg/d Creatine monohydrate

form: powder

2661 (2274–3048) to 2782 (2426–3138)*

r = 0.115

74 (73–75) to 74 (73–75)

r = 0.000

6198 5501–6896) to 6023 (5313–6732)*

r = -0.089

70 (68–73) to 71 (68–73)#

r = 0.142

285 (253–317) to 279 (248–311)

r = -0.138

1110 (1088–1132) to 1114 (1091–1137)

r = 0.027

274 (253–295) to 272 (252–293)*

r = -0.025

1081 (1059–1102) to 1082 (1061–1103)

r = -0.024

(n = 12)

Placebo containing maltodextrin

2956 (2603–3309) to 3000 (2675–3324)*

r = 0.041

74 (73–75) to 74 (73–75)

r = 0.000

7071 6406–7736) to 6680 (6003–7356)*

r = -0.182

69 (66–71) to 68 (66–70)

r = -0.137

283 (254–312) to 277 (248–305)

r = -0.031

1108 (1088–1129) to 1103 (1082–1124)

r = -0.025

284 (264–304) to 281 (262–301)*

r = 0.016

1068 (1048–1089) to 1074 (1054–1094)

r = 0.044

Main outcome: the ST + Cr group showed a significant increase in lower leg muscle density compared to ST only (#)

Chilibeck et al

(2015)

Randomized, controlled study

Total (n = 33)

Postmenopausal women

Duration: 1 year

Body composition

Muscle strength

Bone mineral density

LBM

(kg)

Triceps SMM (thickness) (cm)

Quadriceps SMM (thickness) (cm)

Gastrocnemius SMM (thickness) (cm)

Bench press

(kg)

Squat press

(kg)

Femoral neck

(mg/cm³)

Total hip

(mg/cm³)

Lumbar spine

(mg/cm³)

Total body

(mg/cm³)

ST + Cr (n = 15)

Ø 57 ± 4 years

3/ week

resistance training

0.1g/kg/d Creatine monohydrate

form: powder

∆ -1.0 (-2.1 to 0.8)*

r = -0.224

∆ + 0.3 (-0.1 to 0.7)*

r = 0.186

∆ + 0.2 (-0.3 to 0.6)

r = 0.101

∆ + 0.5 (-0.1 to 1.2)*

r = 0.206

∆ + 18 (10 to 25)*

r = 0.495

∆ + 54 (29 to 79)*

r = 0.480

∆ -0.010 (-0.025 to 0.005)

r = -0.166

∆ -0.015 (-0.037 to 0.007)*

r = -0.170

∆ + 0.005 (-0.017 to 0.028)

r = 0.057

∆ -0.008 (-0.018 to 0.002)

r = -0.198

(n = 18)

Ø 57 ± 7 years

Placebo containing maltodextrin

∆ -1.3 (-2.3 to -0.3)*

r = -0.288

∆ + 0.4 (0 to 0.8)*

r = 0.225

∆ + 0.3 (-0.1 to 0.8)

r = 0.171

∆ + 0.5 (-0.1 to 1.1)*

r = 0.189

∆ + 11 (5 to 18)*

r = 0.390

∆ + 50 (29 to 71)*

r = 0.482

∆ -0.030 (-0.044 to 0.017)#

r = -0.444

∆ -0.016 (-0.036 to 0.004)*

r = -0.182

∆ -0.007 (-0.027 to 0.014)

r = -0.081

∆ + 0.002 (-0.007 to 0.012)

r = 0.051

Main outcome: the ST group showed a significantly greater decrease in femoral neck BMD than ST + Cr group

Johanns

meyer et al. (2016)

Randomized, controlled study

Total (n = 14)

Postmeno-pausal women

Duration: 12 weeks

Muscle strength

Body composition and other muscle strength parameters were not differentiated between males and females

Lat. pull down (kg)

ST + Cr

(n = 7)

Ø 58 ± 3 years

3/ week resistance training

0.1 g/kg/d Creatine monohydrate

form: powder

39.3 ± 5.9 to 45.8 ± 7.2

r = 0.439*

ST (n = 7)

Ø 57.6 ± 5 years

Placebo containing maltodextrin

38.2 ± 9.7 to 45.6 ± 10.6

r = 0.342*

No significant differences between groups

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Zataria Multiflora

The effects of Zataria multiflora (Z) supplementation in combination with strength training were examined in two studies involving postmenopausal women over an eight-week period [70, 71]. Ghanbari-Niaki et al. observed a significant group difference in SMM and FM between ST + Z and control group, but not when compared ST only or Z only. The ST + Z group showed a reduction in FM from 21.0 ± 1.4 kg to 18.0 ± 1.1 kg compared with 20.1 ± 2.1 kg to 17.0 ± 1.9 kg in the ST group and from 19.9 ± 1.9 kg to 18.6 ± 1.4 kg in the Z group. In addition, both training groups showed a significant increase in SMM over time whereas no significant change was observed in the Z only group (ST + Z: 28.0 ± 1.9 kg to 29.6 ± 1.9 kg; ST: 26.8 ± 2.8 kg to 28.4 ± 2.2 kg; Z: 26.5 ± 2.5 kg to 26.8 ± 2.1 kg) [72]. Tayebi et al. reported similar results for BF and SMM. A significant decrease in BF over time was observed for ST + Z at both training intensities (35 % and 55 %) as well as in the Z only group without training. Moreover, significant group differences were found between each training group and the control group, whereas no differences were detected between the training groups. In addition, only the training groups exercising at an intensity of 55 % showed a significant increase in SMM over time [71].

Detailed information is provided in Table 6.

Omega-3 Fatty Acids (“Fish Oil”)

Only one study has investigated the combined effects of ST and omega-3 fatty acid (FO) supplementation. Felix-Soriano et al. [73] evaluated the effects of FO supplementation combined with ST performed twice per week. Participants received a daily dose of 1650 mg docosahexaenoic acid (DHA) and 150 mg eicosapentaenoic acid (EPA) alongside a Mediterranean diet. Over the 16-week intervention, no significant differences were observed between the two training groups; significant differences were only noted in comparison with the non-exercising groups (see Sect. 3.10). Both training groups showed significant increases in muscle strength in the upper body (ST + FO: ∆+0.11 ± 0.05 kg/kg LBM; ST: ∆+0.08 ± 0.06 kg/kg LBM, FO: ∆+0.02 ± 0.03 kg/kg LBM; C: ∆+0.02 ± 0.03 kg/kg LBM), lower body (ST + FO: ∆+1.0 ± 0.8 kg/kg LBM; ST: ∆+0.8 ± 0.6 kg/kg LBM, FO: ∆+0.3 ± 0.4 kg/kg LBM; C: ∆+0.0 ± 0.3 kg/kg LBM), and in lower limb muscle quality (ST + FO: ∆+2.0 ± 1.3 kg/kg LBM; ST: ∆+1.3 ± 1.2 kg/kg LBM, FO: ∆+0.4 ± 0.8 kg/kg LBM; C: ∆-0.4 ± 0.8 kg/kg LBM), compared with the control group. A significant decrease in BMC over time was observed in the FO and control groups, but not in either training groups (ST + FO: ∆-1.4 ± 32.8 g; ST: ∆ -1.4 ± 30.3 g, FO: ∆-17.5 ± 20.2 g; C: ∆-27.6 ± 17.4 g).

Detailed information is provided in Table 7.

Table 7.

Others

Author/Date

Shatavari

The potential performance-enhancing effect of Shatavari extract was conducted in one study by Greed et al. [68] Participants consumed a daily dose of 1000 mg of Shatavari extract over eight weeks, while performing ST twice per week. No significant differences were observed between the Shatavari and the placebo groups for all strength-related parameters. Body composition and BMD were not assessed.

Detailed information is provided in Table 7.

Strength Training vs. Non-exercising Control

When comparing exercising and non-exercising groups, several significant differences were observed, except in control groups following caloric restriction. Bagheri et al. [52] reported significant increases in BW and BMI in the training groups compared with the non-exercising controls, whereas Ghanbari-Niaki et al. [70] observed significant decreases relative to the unchanged control group. All other included studies did not report comparable effects. Regarding body composition parameters, all studies including the two mentioned above showed similar effects with a significant reduction in BF [52, 55, 71], FM [51, 70] and WC [46] and a significant increase in SMM [46, 51, 52, 70, 71] or LBM [55] compared with non-exercising control groups. In terms of muscle strength, all ST groups demonstrated significant improvements compared to the control groups. Eight studies [32, 42, 49, 51–53, 56, 73] assessed a total of seven different exercises for the lower body while five studies [49, 51, 52, 56, 73] evaluated five different exercises for the upper body.

Finally, four studies [49, 55, 57, 73] showed significant differences in BMD. All ST groups showed a greater increase compared to the non-exercising control groups.

More detailed information is provided in Tables 2, 3, 4, 5, 6 and 7.

Discussion

This systematic review aimed to examine the additive effects of nutritional strategies in combination with ST on body composition, strength capacity, and BMD in postmenopausal women with an average age below 65 years. In total, 34 studies comprising 1,541 participants were identified and analyzed. The interventions included CRD (n = 11), high-protein diets (n = 3), protein supplementation (n = 6), and the use of amino acids (n = 3), calcium (n = 3), vitamin D (n = 3), creatine (n = 4), omega-3 fatty acids (n = 1), zataria multiflora (n = 2) and shatavari (n = 1).

Benefits of Strength Training and Dose Responses

ST generally exerts a significant positive influence on body composition, strength capacity, and BMD. Systematic ST has been shown to reduce FM or BF and increase SMM or LBM. Regarding training frequency, initial evidence from one study suggests that performing two sessions per week with free weights at low (50–60% of 1-RM) to moderate intensities (70–80% of 1-RM) over a 10-week period may be insufficient to elicit significant changes in body composition [45]. In comparison, the same training protocol demonstrated an increase in FFM and SMM in premenopausal women [45]. In contrast, Félix-Soriano et al. [73] reported a significant increase in LBM following a 16-week training intervention with two sessions per week. These findings, however, should be interpreted with caution, as a similar increase was also observed in the control group that did not participate in ST. [73] However, regarding strength capacity, one study found that performing ST twice per week led to significant improvements in squat and bench press strength in postmenopausal women, comparable to those observed in premenopausal women [45].

Studies implementing three or four training sessions per week showed significant improvements in body composition, muscle strength and BMD [32, 33, 36, 37, 39, 41, 43, 44, 46–52, 55–57, 70, 71]. Concerning training intensity, individual studies suggest that higher intensities may elicit a greater effect than lower intensities [55, 71]. However, definitive conclusions on dose-response relationships cannot be drawn due to the limited number of studies and lack of formal statistical analyses. Current reviews on the effects of ST alone also report inconsistent findings. A meta-analysis by González-Gálvez et al. [18] indicated that three 60 min training sessions per week, significantly improved lower and upper body strength in postmenopausal women. However, these findings were not corroborated by Thomas et al. [8] and Borde et al. [69] Notably, Borde et al. [69] observed significant changes in muscle morphology with only two training sessions per week. Comparisons between younger and older adults further suggests that younger individuals derive greater benefits from higher training frequencies than older individuals.

Regarding the effects of ST on BMD, a meta-analysis by Shojaa et al. [16] reported that even one training session per week is sufficient to increase BMD. However, the authors noted several limitations, including that some studies failed to observe significant differences in BMD across varying training frequencies. In contrast, other studies have consistently demonstrated significantly greater improvements in lumbar and hip BMD when training frequencies of two or more sessions per week are employed [16].

Caloric Restriction

Sarcopenic obesity is considered a potential risks associated with menopause [14], and dietary interventions may represent a logical strategy to enhance the beneficial effects of ST on body composition. A meta-analysis by Cheng et al. [62] further demonstrated that dietary interventions were more effective than exercise alone in reducing BW and body composition parameters in peri- and postmenopausal women. In this review similar effects were observed when combining CRD and ST. An additional daily calorie deficit between 250 and 750 kcal significantly contributes to reduction in body composition, such as BMI, FM or BF parameters [32, 35, 36, 38, 42]. Furthermore, compared CRD alone LBM, including SMM, can be maintained through ST [32–36]. ST also increases daily energy expenditure, meaning that participants in CRD + ST interventions experience a greater actual energy deficit than the prescribed 250 kcal. The continuous activation of SMM can further enhance long-term energy expenditure, thereby promoting FM reduction while preserving SMM [63].

Regarding muscle strength, combining ST with CRD may reduce strength gains when the caloric deficit is excessive, as demonstrated in two studies targeting a weight loss of 0.5–1 kg/week [32, 42]. Furthermore, the additional benefits of ST on body composition parameters appear diminished under excessive caloric restriction, particularly when the deficit is not individualized according to initial BW [32–36, 42].

In terms of BMD, the study of Kerskick et al. [38] (PEDro: 9) showed no significant effects of a CRD (1600 kcal/day) on BMD. In contrast a previous investigation by Svendsen et al. [64] observed a significant decrease in BMD in postmenopausal women after CRD combined with concurrent training. Examining the intervention groups’ calorie intake, the groups reduced their daily energy intake by more than 800 kcal/day (daily intake diet: _~1093 kcal/day; diet + exercise: _~1051 kcal/day), which may be insufficient to preserve BMD. These findings suggest that an excessively restrictive CRD can attenuate the beneficial effects of training and lead to a significant reduction in BMD. Likewise, Seimon et al. [65] reported a greater decrease in total hip BMD in postmenopausal women subjected to severe energy restriction (65–75% of estimated energy expenditure) compared with those under moderate restriction (25–35% of estimated energy expenditure). Collectively, these findings indicate that excessively restrictive CRD may reduce BMD, even when physical activity is systematically implemented.

Protein

Proteins are macronutrients that are metabolized into amino acids within the body [66]. Amino acid availability serves as a key regulatory factor in muscle protein metabolism with improvements in muscular strength and body composition resulting from ST, depending on a predominance of protein anabolism over catabolism [67]. Accordingly, protein intake following exercise can maximize protein synthesis and offset protein catabolism [74]. Consistent with this, studies with healthy adults demonstrated that protein supplementation enhances muscle strength and hypertrophy when combined with ST [25].

When evaluating the effects of protein supplementation, distinctions must be made regarding the form and timing of intake. In this review, three studies provided protein supplementation only immediately after each exercise session [44, 45, 50]. Notably, one of these studies [45] implemented ST only twice per week, which may explain the absence of significant effects, as discussed previously. Additionally, Weisgarber et al. [50] employed a within-participants design alternating between placebo and whey protein supplementation per day of exercise while participants performed unilateral ST. No significant differences were observed between sides of the body of the same participants. The only comparable study by Holm et al. [44] likewise did not reveal significant differences between the two exercising groups overall, but did report a significant time-related increase in LBM and muscle strength in the supplemented training group. When total protein intake was examined, the supplemented group consumed an average of 1.1 g/kgBW/day throughout the intervention, compared with 0.9 g/kgBW/day in the non-supplemented group. Similarly, regarding protein timing, no significant differences were observed between consuming the same amount of protein immediately after exercise or six hours later [43]. This finding is consistent by a meta-analysis of Wirth et al. [75], which reported no additional benefits of a specific protein timing on LBM and muscle strength.

Regarding plant-based protein source, three studies provided daily soy protein supplementation [46, 47, 49]. Of these Shenoy et al. [49] (PEDro: 7) compared the supplemented training group only with non-exercising groups, precluding conclusions about the additional effects of protein supplementation in combination with ST. Maesta et al. [46] (PEDro: 7) did not observe significant differences between the training groups overall, although the supplemented training group demonstrated higher effect sizes for reductions in WC and increases in SMM. Notably, total daily protein intake was not reported in any group. In contrast, Orsatti et al. [47] (PEDro: 9) reported a significantly greater increase in three of four strength parameters in the supplemented training group which consumed an average of 1.4 g/kgBW/day compared with 1.0 g/kgBW/day in the non-supplemented training group.

Additionally, Ioannidou et al. [51] (PEDro: 8) demonstrated that a high-protein diet al.one, providing at least 2.5 g/kg FFM (1.8 g/kgBW/day), significantly improved strength parameters. When combined with ST, the high-protein group (1.7 g/kgBW/day) exhibited greater absolute gains in SMM (ST + P: ∆+1.4 ± 0.9 kg; ST alone: ∆+1.2 ± 1.3 kg), although these differences did not reach statistically significance and should be interpreted with caution. The authors also reported a significant ALT enzyme activity with the high-protein diet. While, there is currently no evidence of adverse effects of a high-protein diet in younger populations, further research in older women is needed to draw definitive conclusions [76, 77]. Current meta-analyses by Kuo et al. [78] support an additive effect of a high-protein diet and are consistent with the current recommendations of the International Society of Sports Nutrition [77]. However, among postmenopausal women, only two high-quality studies (PEDro: 8 and 9) have investigated a high-protein diet (>1.4 g/kgBW/day) in combination with ST, and the evidence from previous studies does not yet clearly confirm benefits in this population [47, 51].

Amino Acids

Amino acids can be classified as proteinogenic or non-proteinogenic. Proteinogenic amino acids acts as substrates for protein biosynthesis in animal cells, whereas non-proteinogenic amino acids do not participate in this process [79]. In postmenopausal women, supplementation with proteinogenic BCAAs does not appear to provide additional benefits for body composition or muscle strength when total daily protein intake is comparable between groups [52]. Although enhanced post-exercise muscle recovery has been reported in high-intensity endurance athletes and trained males [72, 80], such effects have not been observed in this population.

While LCi, a non-proteinogenic amino acid, may mechanistically increase nitric oxide bioavailability and improve muscle oxygenation [72, 81–84],only two small high-quality RCTs (PEDro: 8 and 9) in postmenopausal women have been conducted. The study of Kang et al. suggests an additional increase in LM und strength parameters in supplemented, strength-trained women. Figuerora et al. showed no significant differences between the supplemented and non-supplemented strength-trained women, however the performed ST was WBV. The results may therefore be limited by the effectiveness of this training method. [53, 54] Current evidence in postmenopausal women is apparently insufficient to provide clear recommendations and should be considered preliminary. Further studies are warranted to allow more definitive conclusions.

Calcium and Vitamin D

Vitamin D and calcium are essential for maintaining bone health, and deficiencies in either represent significant risk factor for osteoporosis development [85]. Vitamin D is primarily synthesized in human skin upon exposure to sunlight, but modern lifestyle patterns often limit sun exposure, making dietary sources (e.g., vitamin D2) increasingly important [86]. Once metabolized and activated, vitamin D (1,25-dihydroxyvitamin D) enhances calcium absorption in the intestine, stimulates calcium uptake by osteoblasts, and promotes osteoclast maturation [87, 88]. Calcium constitutes a major structural component of bone (~ 99%) and also plays essential roles in cellular signaling, nerve impulse transmission, and muscle contraction. Inadequate daily calcium intake forces the mobilization of calcium from bone, and prolonged deficiency can lead to decreased BMD [88–90].

Regarding the influence of calcium and vitamin D in combination with ST in postmenopausal women, four studies (PEDro: 2, 6, 9, 10) were identified in this review. The findings indicate that a calcium application exceeding 800 mg/day has no additive effects on body composition, strength capacity and BMD [38, 55–57]. However, the study by Cussler et al. [21–23, 55, 56]. However, a precise minimum effective dosage below 800 mg/day cannot currently be established for postmenopausal women. Nonetheless, existing evidence suggests that ST remains the primary factor in preserving BMD in this population.

Concerning vitamin D supplementation combined with ST, no significant effects were observed on body composition, strength capacity, or BMD [38, 56, 57] These results are consistent with previous research indicating that chronic vitamin D supplementation does not significantly influence BMD [24] and are further supported by studies examining combined calcium and vitamin D supplementation in premenopausal women [38]. Based on the limited data on calcium and vitamin D supplementation combined with ST, it appears that supplementation of both substances has no additive effect on body composition, strength and BMD. Importantly, however, a daily calcium intake of at least_~800 mg/day appears necessary, as lower intakes may contribute to reductions in BMD [55].

Creatine Monohydrate

Creatine supplementation may mechanistically reduce muscle fatigue and improve performance by prolonging the energy contribution of the phosphocreatine system [91–93] and has been shown to be beneficial in enhancing strength, LBM and BMD in other populations, such as younger and older adults [58, 94–98]. Evidence in especially postmenopausal women however, is limited to four small, high-quality RCTs (PEDro: 9–10) [58–61]. No clear effects on body composition, strength, or BMD were observed [58, 59, 61]. Potential explanations for the lack of observed effects, besides the limited data available, may include that also in other populations only small to moderate effects could be achieved through creatine supplementation [94, 98–103]. Furthermore, two included studies in this review lasted at least one year and therefore it is plausible that ST was not structured into systematic macrocycles. Consequently, participants may have engaged in continuous, unsystematic training, thereby limiting potential adaptive responses. Recent reviews investigating creatine supplementation in women were also unable to draw definitive conclusions regarding postmenopausal populations [104, 105]. These considerations underscore the need for further research on structured, intensive ST combined with creatine supplementation to clarify its potential benefits in postmenopausal women.

Zararia Multiflora

For supplementing Zataria multiflora only two studies [70, 71] (PEDro: 8 and 9) were identified. Zataria multiflora is a plant used in traditional Iranian medicine, which is rich in antioxidative compounds, including thymol and carvacrol [106]. Previous research indicates that Zataria multiflora supplementation exhibits concentration-dependent radical-scavenging activity against 1,1-diphenyl-2-picryl-hydrazyl free radicals [107]. However, when examining the potential additive effects of Zataria multiflora supplementation in postmenopausal women undergoing ST, no significant differences were observed between the supplemented and non-supplemented exercise groups [70, 71].

Omega-3 Fatty Acids (“Fish Oil”)

Only one study [73] (PEDro: 8) investigated the additional effects of FO supplementation in postmenopausal women performing ST, which limits the generalizability of its findings. The omega-3 fatty acids EPA and DHA have been shown to reduce mitochondrial oxidant emissions, enhance muscle protein synthesis, and improve anabolic responses to exercise in older adults aged 65 and above [108]. In older women, omega-3 supplementation has been associated with increases in SMM and muscle strength in several studies [109–112]. However, in the present no significant differences were observed between the supplemented and non-supplemented exercises group. Further studies specifically targeting postmenopausal women are needed to enable more definitive recommendations and to confirm the findings of previous research in this population.

Shatavari

Shatavari is an Ayurvedic herb rich in phytoestrogens and a bioactive compounds, traditionally used to support female reproductive health [113–115]. Recent studies have investigated its potential effects on skeletal muscle function [116–118]. A RCT involving postmenopausal women demonstrated that six weeks of Shatavari supplementation (1000 mg/day) improved handgrip strength and increased myosin regulatory light chain phosphorylation in the vastus lateralis muscle, indicating enhanced myosin contractile function [117]. In the context of ST and Shatavari supplementation, one study was identified [68] (PEDro: 8). An 8-week supplementation regimen (1000 mg/day) did not induce significant increase in strength compared with ST alone, and effects on body composition and BMD were not evaluated. Consequently, no clear conclusions or recommendations can currently be made regarding these outcomes.

Limitations

In addition to the important and novel findings of the review, there are also some limitations. Although a total of 34 studies were identified, the evidence regarding individual dietary strategies in combination with ST is severely limited. No studies on different dietary habits such as intermittent fasting, plant-based diet, or paleo diet in combination with ST could be identified. Similarly, only a few studies were conducted on the use of various dietary supplements such as amino acids, creatine, calcium or vitamin D in postmenopausal women with ST. Consequently, no clear recommendations or statements can be made. Furthermore, the study designs and training protocols of the identified studies are highly heterogeneous, making comparisons very challenging. In addition to the heterogeneous study designs, only a very limited number of studies have investigated the long-term effects of supplementation, with the majority of trials lasting no longer than 12 weeks. Furthermore, the definition of postmenopausal women was somewhat nonspecific across studies. Regarding study quality, most investigations achieved a PEDro score of 6 or higher, indicating a high methodological standard. Only the study by Molina et al. [57] and the two investigations by Ryan et al. [40, 41] scored below 6.

In addition, some studies included combined strength and endurance training along with various dietary strategies making it difficult to isolate the specific effects of strength training or dietary interventions. Consequently, these studies were not included in the review. Nevertheless combining strength and endurance exercise is essential for maintaining overall health and promoting longevity and is therefore equally recommended by the World Health Organization [119]. However, ST has been shown to be fundamentally important for maintaining or improving body composition, muscle strength and BMD. An exact dose-response relationship, however, cannot be determined, as this depends on a various factors such as training intensity, weekly volume, frequency, duration of the intervention and the level of supervision provided to participants.

Conclusion

The present systematic review aimed to examine the effects of nutritional strategies in combination with ST on body composition, strength capacity and BMD in postmenopausal women. A total of 34 studies were identified. The evidence indicates that postmenopausal women should engage in structured and systematic ST. However, an exact dose-response relationship cannot be determined. For reducing BW and FM a CRD with a deficit of 250–750 kcal/day can be a beneficial strategy. A daily protein intake should be at least 0.8 g/kgBW/day to maintain LBM and muscle strength during CRD. The recommended amount can be attained through the consumption of high-protein foods, protein supplements or amino acids. The evidence on a high-protein diet (> 1.4 g/kgBW/day) in combination with ST in postmenopausal women is limited, making it impossible to draw definitive conclusions regarding potential additive or adverse effects. Regarding the use of dietary supplements in conjunction with ST, the limited number of available studies precludes drawing definitive conclusions. Consequently, the present findings and observations should be interpreted as exploratory. Therefore, further systematic investigations exploring diverse nutritional and supplementation strategies are required to generate more precise insights and develop evidence-based recommendations. A key consideration in all studies should be the implementation of structured and supervised training protocols to ensure sufficient training stimuli and accurately assessing potential additive effects.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary Material 1^{(17.8KB, docx)}

Supplementary Material 2^{(84.8KB, pdf)}

Acknowledgements

The authors would like to thank the working groups of the included studies for sending the free texts.

Abbreviations

AHA: American Heart Association
BCAA: Branched-chain amino acids
BF: Body fat
BF%: Body fat percentage
BMI: Body Mass Index
BMD: Bone mineral density
BRMR: Baseline resting metabolic rate
BW: Body Weight
CRD: Calorie-restrictive diets
DHA: Docosahexaenoic acid
EFSA: European Food Safety Association
EPA: Eicosapentaenoic acid
FFM: Fat-free mass
FM: Fat mass
FO: Omega-3-fatty acids
kgBW: Kilogram bodyweight
kgBW/d: Kilogram bodyweight per day
LCi: L-citrulline
LBM: Lean body mass
Mdiff: mean of the difference before and after the intervention
MeSH: Medical Subject Headings
P: Protein
PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analysis
RCTs: Randomized, controlled study designs
SD: Standard deviation
SDdiff: Standard deviation of the difference before and after the intervention
SE: Standard error
SMM: Skeletal muscle mass
ST: Strength training
WC: Waist circumference
Z: Zataria multiflora

Author Contributions

JS contributed to data collection and data reduction. FW contributed to data collection and interpretation of the results. EI and WB participated in the design of the study and interpretation of the results. PD and SG contributed data and participated in the interpretation of the results. All authors contributed to the manuscript writing.

Funding

Open Access funding enabled and organized by Projekt DEAL. No funding was received for the conduct of this research or for the publication of this article.

Available of Data and Materials

Data described in the manuscript, code book, and analytic code will be made available upon request pending.

Declarations

Consent for Publication

All authors agree to the publication of the data and the contents of the manuscript.

Competing Interests

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Footnotes

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Supplementary Material 1^{(17.8KB, docx)}

Supplementary Material 2^{(84.8KB, pdf)}

Data Availability Statement

Data described in the manuscript, code book, and analytic code will be made available upon request pending.

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PERMALINK

Analysis of the Additive Effects of Nutritional Strategies in Strength Training Interventions on Body Composition, Muscle Strength and Bone Mineral Density in Postmenopausal Women: A Systematic Review

Franziska Walter

Jan Schalla

Wilhelm Bloch

Patrick Diel

Stephan Geisler

Eduard Isenmann

Abstract

Background

Methods

Results

Conclusion

Supplementary Information

Introduction

Methods

Information Source and Search

Selection Criteria

Data Extraction

Quality Assessment and Risk of Bias

Results

Study Selection

Fig. 1.

Table 1.

Study Designs

Exercise Interventions

Caloric Restriction Diet

Table 2.

High-protein Diet and Protein Supplementation

Table 3.

Amino Acids

Table 4.

Calcium and Vitamin D

Table 5.

Creatine Monohydrate

Table 6.

Zataria Multiflora

Omega-3 Fatty Acids (“Fish Oil”)

Table 7.

Shatavari

Strength Training vs. Non-exercising Control

Discussion

Benefits of Strength Training and Dose Responses

Caloric Restriction

Protein

Amino Acids

Calcium and Vitamin D

Creatine Monohydrate

Zararia Multiflora

Omega-3 Fatty Acids (“Fish Oil”)

Shatavari

Limitations

Conclusion

Supplementary Information

Acknowledgements

Abbreviations

Author Contributions

Funding

Available of Data and Materials

Declarations

Consent for Publication

Competing Interests

Footnotes

References

Associated Data

Supplementary Materials

Data Availability Statement

ACTIONS

PERMALINK

RESOURCES

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