1. Introduction
Women experience deleterious physiological adaptations as a consequence of ageing and the menopausal transition, commencing in the fourth decade of life. In particular, ageing and menopause have a substantial impact on skeletal muscle and bone (Sipilä et al., 2020). The age-related loss of skeletal muscle mass and strength is termed sarcopenia, with an estimated decrease of approximately 3–8% per decade, that is accelerated with the combined impact of menopause and ageing as a result of hormonal changes, specifically a decline in estrogen (Buckinx & Aubertin-Leheudre, 2022). Estrogen is also a major hormonal regulator of bone mass, that when present, prevents bone loss in women. The onset of menopause leads to rapid bone loss, with the maximum rate of loss in the first 5 years following the loss of ovarian function (Geier & Benham, 2022). This loss of bone increases a woman’s vulnerability to osteopenia and osteoporosis, with 1 in 2 post-menopausal women expected to have an osteoporotic-related fracture in their remaining lifetime (Crandall et al., 2021; Force, 2011). The loss of muscle strength will also negatively impact balance, particularly in the hip flexor and abductor muscles in the lower limb, increasing the risk of falls and fall-related injuries (Svensen et al., 2025). Additionally, menopause-induced cardiometabolic changes, including an increase in body fat (particularly around the abdominal region), insulin resistance, and adverse changes to the lipid profile, can add to the effects of ageing and increase the risk of cardiovascular and metabolic diseases for middle-aged and older women (Nappi et al., 2022). All of the aforesaid physiological changes will be further exacerbated with physical inactivity, sedentary behaviour, and poor nutrition (Feller, 2022). In addition, perimenopausal and post-menopausal women may experience an array of symptoms including abnormal bleeding, vasomotor symptoms (i.e., hot flushes and night sweats), heart discomfort (i.e., unusual awareness of the heart beating, heart skipping or racing or tightness), sleep disturbances, vulvovaginal and urinary symptoms (i.e., bladder problems such as difficulty urinating or increased need to urinate or bladder incontinence or dryness of the vagina), sexual problems (i.e. changes in sexual desire, sexual activity and satisfaction), mood disturbances, cognitive dysfunction, as well as joint and/or muscle pain and discomfort for up to 8 years (Geraghty, 2022). Together, these symptoms and physiological adaptations may adversely impact physical and cardiometabolic health, as well the physical self-efficacy and overall wellbeing of ageing women. They may also hinder engagement in physical activity. To prevent or attenuate these effects, it is crucial to enhance women’s weekly participation in strength training before, during, and after the menopausal transition (Doherty et al., 2018).
Strength training, also known as resistance training or weight training, is a critical form of exercise for women. Strength training, which can be described as muscle contraction against an external load, can be performed using body weight or equipment such as household items (e.g. water bottles and tinned cans), free weights, resistance bands, weighted balls, and weight or plate loaded machines. Strength training can increase muscle mass, strength, power, and endurance, bone mass and strength, functional performance, and elicit favourable adaptations for cardiometabolic health leading to decreased incidence of long-term clinical conditions and lower morbidity and mortality (Chodzko-Zajko et al., 2009; Currier et al., 2023; Izquierdo et al., 2025; Paluch et al., 2024). Despite national and international physical activity recommendations to perform strength training at a moderate to vigorous intensity at least two days per week, in addition to aerobic physical activity (Bull et al., 2020; Health, 2024), observations suggest that middle-aged and older women in Ireland are not achieving these guidelines.
Participation in strength training is low in middle-aged and older women living in Ireland, with available data showing that participation in strength training is low in middle-aged and older men and women living in county Laois (14%, n = 51) and participation declines with age (≥ 65 years) (Cooper et al., 2020). Low participation rates in strength training have also been reported in middle-aged and older women in multiple counties including England, the United States, and Australia, with Australian figures showing that less than 23% of women aged 35–64 years were performing strength training at least two days per week in 2022 (ABS, 2022; Heitz, 2022; Sandercock et al., 2022). It is possible that women’s participation in strength training may be limited by a lack of programmes that are appropriately tailored to their specific needs and lifestyle behaviours.
Women’s participation in strength training is influenced by numerous perceived, individual, physical, psychosocial, and/or environmental barriers. Cited barriers include concerns about ‘bulking up’ or appearing weak or uncoordinated, perceived complexity of strength training, lack of confidence or knowledge to perform strength training, low self-efficacy, fear of judgment, challenges with progression or unexpected results, limited support, low strength and/or fitness levels, pain and impaired functionality, risk of injury, gender-based stigma. Other common barriers include time constraints, lack of interest, concerns regarding exercising safely while living with one or more clinical conditions, desire or motivation, stress, access to facilities and their environments, and cost (Burton et al., 2017; Cooper et al., 2020; Doherty et al., 2018; Kraemer et al., 2025; McNulty et al., 2024; Vasudevan & Ford, 2022). Given these barriers, it is evident that strength training programmes must be designed to be accessible, inclusive, educational, easily comprehensible, conducive to improving self-efficacy, intrinsically motivating, time-efficient, and tailored to the specific needs and preferences of middle-aged and older women. In agreement with Stimson et al., (2024), it is possible that online or home-based strength training programmes could minimise barriers such as concerns of fear of judgement, low strength and/or fitness levels, environmental factors, and time constraints for midlife women. However, strength training programmes that are exclusively online limit social engagement and motivational and support elements (McGarrigle et al., 2020). One approach to increasing women’s engagement is through a hybrid (online and on-site) progressive strength training programme, with beginner-focused demonstrations of strength exercises and exercise modifications for varying ability levels, which is complemented with simple and practical evidence-based health education on strength training and pre- and post-testing, designed specifically for middle-aged and older women that also permits flexibility and imposes minimal time constraints. By providing a choice of online and/or in-person exercise classes, building knowledge and skills, and providing social connectedness, ‘Beginner to 5kg’ aims to meet the Self-Determination Theory three basic psychological needs of autonomy, competence, and relatedness.
To our knowledge, the efficacy of a short-term hybrid strength training and health education intervention has not been examined previously in pre-menopausal, perimenopausal, and post-menopausal women. The purpose of the present study was to determine the effectiveness of ‘Beginner to 5kg’, a 6-week novel women-specific, research-based, hybrid strength training and health education intervention, on lower- and upper-body muscular strength and endurance, static one-legged stance balance on both sides, subjective wellbeing, perception of physical abilities, and physical activity participation in pre-menopausal, perimenopausal, and post-menopausal women over 35 years of age. It is hypothesized that participation in ‘Beginner to 5kg’ will lead to significant improvements in lower- and upper-body muscular strength and endurance, static one-legged stance balance on both sides, subjective wellbeing, perception of physical abilities, and physical activity participation in pre-menopausal, perimenopausal, and post-menopausal women over 35 years of age compared to pre-intervention measurements.
2. Methods
Study Design
This one-group pre-test-post-test design study was conducted between February and March 2024, after ethical approval was granted by Dublin City University’s research ethics committee (DCUREC/2023/258). The study was designed and delivered by a team of clinical and/or exercise physiologists, a phase IV cardiac rehabilitation specialist, a registered associate nutritionist, an experienced exercise instructor, and a certified athletic therapist. The study was split into four main phases: recruitment, pre-testing, a 6-week intervention, and post-testing (Figure 1).
Figure 1
Overview of the study design for ‘Beginner to 5kg’.
Recruitment
Females aged between 35 and 70 years who were living in county Laois in Ireland were recruited through social media, advertisements from clubs, groups, and organisations in the geographical area in contact with the target group, and word of mouth. Eligible participants were invited to read the plain language statement, complete the physical activity readiness questionnaire for everyone (PAR-Q+), and sign an informed consent form. Medical clearance from a registered General Practitioner (GP) was required for any participant who answered ‘yes’ to any of the questions included in the PAR-Q+. There were two conditions defined as exclusion criteria, and these were heart failure and unstable angina.
Participants
Sixty participants were recruited for this study. However, 9 participants withdrew from participating for reasons including illness (e.g. COVID-19, n = 1), injuries unrelated to the study (e.g. back injury, n = 1), life events (e.g. family illness, holidays, n = 4) and other commitments (e.g. participation in other exercise classes, n = 3). In total, 51 participants completed this research study.
Testing
Physical Tests
Pre- and post-testing of physical performance was conducted in a community multipurpose hall the week before and the week after the 6-week intervention (week 0 and week 7, respectively). All physical performance tests were led by the research team in a group setting. Participants completed a 15-minute gradual warm-up (including mobility exercise for all joints, low-to-moderate intensity aerobic exercises and dynamic stretching) with a qualified fitness instructor before completing the testing session. The physical performance tests were (i) 45-second static one-legged stance eyes-open balance test, (ii) 60-second sit-to-stand test, and (iii) 60-second box press-up test. Each of the three test procedures is explained in further detail below. A demonstration of each of the three test procedures was provided and participants were given a given a practice attempt (i.e. for the balance test, participants were allowed to perform the test for 2–3 seconds before performing the recorded test). A 5-minute cool down (including low-intensity aerobic exercises and static stretching) was performed at the end of each testing session with the qualified fitness instructor.
45-Second Static One-Legged Stance Eyes-Open Balance Test: This test was used to measure balance on both sides of the body. Participants were asked to stand close to an empty wall, so they had support if needed. Participants were instructed to perform the balance test with their left foot on the floor (right foot raised) first, then with their right foot on the floor (left foot raised). Participants were asked to place their hands across their chest and slowly lift their right foot off the ground, so it hovered forward. The test started when the foot was lifted off the ground. The test finished and the timer was stopped if the participant put their elevated foot back on the ground, if they lost their balance, or if they touched the wall before reaching the 45-second limit. The total number of seconds that the participant was able to maintain their balance for with either foot raised was recorded. Participants were only given one attempt per foot (Springer et al., 2007).
60-Second Sit-to-Stand Test: The 60-second sit-to-stand test was used to measure lower-body muscular strength and endurance, by capturing how many times participants could stand up and sit down on a sturdy chair, without armrests, continuously for 60 seconds. To fully stand up, the participants legs must be in a straightened position (i.e., knees fully extended), and to sit down, the chair must be touched with the buttocks. Participants were asked to have their arms folded across their chest to prevent assistance from the arms. Participants were instructed to perform as many sit-to-stand movements as possible within the allocated time at a self-selected speed. Participants were informed when 30 seconds and 15 seconds were remaining. The total number of repetitions of the sit-to-stand movement in 60 seconds was recorded (Strassmann et al., 2013).
60-Second Box Press-Up Test: The 60-second box press-up test was used to measure upper-body muscular strength and endurance. For a box press-up, participants are in a prone position with their knees under the hips and hands pointing forward under the shoulders, on an exercise mat. The upper body and head are kept in a straight line. Participants were instructed to bend their elbows and bring their chin towards the mat (the down position) and then press-up from the mat by fully extending the elbows (the up position). Participants were instructed to perform as many press-ups as possible within 60 seconds at a self-selected speed. Participants were told when 30 seconds and 15 seconds were remaining. The total number of repetitions of the box press-up were documented (Cooper et al., 2023).
Questionnaires
Participants completed an online questionnaire using Qualtrics (Seattle, Washington, US) prior to and following the 6-week intervention (week 0 and week 7, respectively) (Supplementary File 1). The first question in the questionnaire asked participants to self-report their current stage of menopause, based on the following definitions: (i) pre-menopause, menstrual periods are still regular or unsure due to confounding factor e.g. Mirena coil, (ii) perimenopause, symptoms of the menopause are present but menstrual periods have not stopped completely for 12 consecutive months, (iii) natural post-menopause, menstrual periods have ceased for over 12 consecutive months, or (iv) surgical post-menopause, menstrual periods have ceased due to chemotherapy, radiation, hysterectomy or oophorectomy. After this, four questionnaires were included: Modified Perceived Physical Activity (LIVAS: Lichamelijke Vaardigheden Schaal) Questionnaire (Ryckman et al., 1982; Zelle et al., 2016), World Health Organization Five (WHO-5) Wellbeing Index (WHO, 1998), Single-Item Measure (M1) Physical Activity Participation Question (Milton et al., 2011), and the Menopause Rating Scale (MRS) (Heinemann et al., 2003). The LIVAS questionnaire is a 10-item questionnaire used to determine perceptions of physical abilities compared to people of the same age. Each item is scored on a 5-point Likert scale, with responses ranging from 1 (much worse/less) to 5 (much better/more). The total LIVAS score is a sum of all 10-item scores, ranging from 10 to 50, with a higher total score reflective of higher levels of perceived physical self-efficacy relative to most people of their age. The WHO-5 index is a 5-item questionnaire to assess current mental wellbeing. Each item is a positively worded statement relating to mood and general functioning over the previous 2-week period. Each item is rated on a 6-point Likert scale from 0 (“At no time”) to 5 (“All of the time”), with the sum of all 5 scores yielding a score between 0 and 25. Higher scores reflect better mental wellbeing. The M1 questionnaire contains one question regarding the frequency of physical activity participation in the previous 7-day period, with answers ranging from 0 days to 7 days. All perimenopausal and post-menopausal participants were asked to complete the MRS questionnaire, an 11-item validated questionnaire assessing the presence and severity of menopausal symptoms (somatic, psychological, and urogenital symptoms). Each item is scored on a 5-point Likert scale, ranging from 0 (“not present”) to 4 (“extremely severe”). The sum of all scores is used to obtain the total MRS score, which ranges from 0 to 44, with higher scores reflecting more severe menopausal symptoms which impact quality of life.
The ‘Beginner to 5kg’ Intervention
Strength Training Classes
Participants were required to complete two 40-minute age- and ability-appropriate women-specific strength training classes per week for 6 weeks. Participants were given the choice to attend two live online strength training classes per week hosted via Zoom (Zoom Video Communications, California, USA), or to perform two weekly specified pre-recorded strength training classes hosted on a private unlisted playlist on EduFIT’s YouTube channel, or a mixture of live or on-demand strength training classes to suit their personal schedules. Additionally, in week 2 and week 4 of the intervention, one optional in-person strength training class was hosted for the participants to attend in a multipurpose community hall. The strength training classes were delivered by an experienced exercise instructor and included a 10-minute warm up, main phase of strength exercises for 20–25 minutes and followed by 5–10 minutes of balance exercises and a cool down. A sample main phase of a strength training class is provided as Figure 2. A QR code is also provided to view a sample 40-minute ‘Beginner to 5kg’ strength training class. For weeks 1 and 2, the strength training classes consisted of body weight exercises (e.g., squats, lunges, wall press etc.) with a focus on executing the correct technique. In weeks 3 and 4, progression was incorporated by performing strength exercises with light household items (e.g. water bottles and tinned cans). In weeks 5 and 6, further progression was incorporated by the use of resistance bands in the strength training classes. A pack of 5 resistance bands (extra-light, light, medium, heavy, and extra heavy) were given to each of the participants at pre-testing, allowing all participants to have access to resistance bands appropriate for their current strength status. In addition to this, participants were provided with three colour-coded intensity cards (green, orange, and red) and received a short education workshop on exercise intensity at pre-testing. Participants were advised to work continuously at a self-selected moderate intensity. The green, orange, and red cards reflect specific rates of perceived exertion (RPE); 9–12, 13–17, and 18–20, respectively (Borg, 1982). During the live online strength training classes, participants were asked up to hold up their colour-coded intensity cards to reflect their current RPE at various intervals throughout the class to ensure they were working at the correct intensity. All live online strength training classes were monitored by a member of the research team.
Figure 2
Overview of the strength and balance exercises included in the ‘Beginner to 5kg’ exercise class. A QR code is also provided to view a sample 40-minute ‘Beginner to 5kg’ strength training class.
Health Education
Participants were required to watch one 20-minute strength training-related health education workshop per week, either by attending the live workshop on Zoom or by viewing the recording in their on-demand library. The health education workshops were delivered by a clinical exercise physiologist and a registered associate nutritionist. The topics covered in the health education workshops are displayed in Table 1. Participants were given the opportunity to ask questions at the end of every workshop and were also encouraged to send questions via email.
Table 1
Overview of the health education content.
| WEEK | HEALTH EDUCATION WORKSHOP CONTENT |
|---|---|
| 1 | Muscle Matters for Female Ageing |
| 2 | General Adaptation Syndrome |
| 3 | Nutrition for Strength Training |
| 4 | S.P.O.R.T Principles of Training |
| 5 | How to Maximise your Wellness, Health and Strength Gains with Periodised Training |
| 6 | Feedback with Gender- and Age-Matched Normative Values |
Statistical Analysis
Statistical analysis was performed using SPSS 29.0 (IBM Corp., Armonk, NY, United States) with a 0.05 significance level. Firstly, descriptive statistics were completed. Frequencies, means and standard deviations are reported where appropriate. Normality was assessed and all data were normal except for static one-legged stance balance scores on both sides, box press-up score, physical activity participation, and physical self-efficacy. Paired samples t-tests were conducted to examine variables pre- and post-intervention for all normal data. Effect sizes were calculated as eta squared (η2) and classified as a small effect (0.01), moderate effect (0.06) and large effect (0.14) (Cohen, 1988). For non-normal data, a Wilcoxon signed rank test was completed. Effect sizes were also calculated and classified as small (r = 0.1), medium (r = 0.3) and large (r = 0.5) (Cohen, 1988).
3. Results
Participants reported a mean age of 52.5 ± 8.9 (38–70) years. Women were split into self-reported stages of menopause including pre-menopause (23.5%, n = 12), perimenopausal (23.5%, n = 12), natural post-menopause (45.1%, n = 23), and surgical post-menopause (7.8%, n = 4). The majority of participants reported living with no clinical conditions or musculoskeletal issues (70.6%, n = 36). In participants who reported living with one or more clinical conditions or musculoskeletal issues (29.4%, n = 15), the most common clinical condition was hypertension (17.6%, n = 9). Other conditions included high cholesterol (n = 2), heart disease (n = 2), osteopenia (n = 1), osteoporosis (n = 1), mild musculoskeletal issues (n = 2), epilepsy (n = 1), vestibular migraine and benign paroxysmal positional vertigo (BPPV) (n = 1), and Cushing’s syndrome (n = 1). One participant also reported a hip replacement in the previous 12-month period. At baseline, participants reported a mean physical activity participation of 2.9 ± 1.5 (0–6) days.
A total of 33 out of 51 participants (64.7%) attended all 12 strength training classes throughout the 6-week intervention, either online live, on-demand or in-person. The average number of strength training classes attended by all 51 participants was 11. To facilitate a hybrid approach, one optional in-person strength training classes was held in week 2 and week 4. In week 2 of the intervention, 11 participants (21.6%) attended the in-person strength training class hosted in a multipurpose community hall. In week 4 of the intervention, 13 (25.5%) participants attended the in-person strength training class in the same location.
A statistically significant improvement, with a large effect size, was observed for the sit-to-stand test (p < 0.001, η2 = 0.78), box press-up test (p < 0.001, r = 0.56), wellbeing (p < 0.001, η2 = 0.29), menopausal symptoms (p = 0.008, η2 = 0.18) and physical self-efficacy (p < 0.001, r = 0.54) (Table 2). A statistically significant increase, with a small effect size, was identified for physical activity participation level (p = 0.003, r = 0.29). No statistically significant change was observed for static one-legged stance balance on either leg (p > 0.05).
Table 2
Pre- and post-intervention mean, standard deviation, p-value and effect size for all measured variables.
| VARIABLE | N | MEAN ± SD PRE | MEAN ± SDPOST | p-VALUE | EFFECT SIZE |
|---|---|---|---|---|---|
| PHYSICAL TESTS | |||||
| Sit-to-Stand (reps) | 51 | 28.6 ± 7.3 | 40.1 ± 9.7 | <0.001* | Large η2 = 0.78 |
| Box Press-Up (reps) | 51 | 27.2 ± 8.4 | 35.7 ± 9.6 | <0.001* | Large r = 0.56 |
| Balance – Left Leg on Floor (seconds) | 51 | 39.2 ± 12.7 | 38.3 ± 13.6 | 0.663 | Very small r = 0.04 |
| Balance – Right Leg on Floor (seconds) | 51 | 37.9 ± 14.3 | 37.6 ± 12.9 | 1.000 | Very small r = 0.00 |
| QUESTIONNAIRES | |||||
| Physical Self-Efficacy (LIVAS score) | 51 | 27.2 ± 7.3 | 31.2 ± 7.9 | <0.001* | Large r = 0.54 |
| Wellbeing (WHO-5 total score) | 51 | 14.4 ± 4.4 | 16.7 ± 3.9 | <0.001* | Large η2 = 0.29 |
| Menopause Symptoms (MRS total score) | 37 | 12.6 ± 7.4 | 10.3 ± 6.1 | 0.008* | Large η2 = 0.18 |
| Physical Activity Participation (M1 score) | 51 | 2.9 ± 1.5 | 3.5 ± 1.4 | 0.003* | Small r = 0.29 |
[i] Abbreviations: *Statistical significance, LIVAS, Lichamelijke Vaardigheden Schaal or perceived physical activity; M1, single-item measure physical activity participation; MRS, menopause rating scale; N, number; Reps, repetitions; SD, standard deviation; WHO-5, World Health Organization Five Wellbeing Index; η2; Eta squared.
4. Discussion
The purpose of the present study was to determine the effectiveness of ‘Beginner to 5kg’, a 6-week novel women-specific, research-based, hybrid strength training and health education intervention, on lower- and upper-body muscular strength and endurance, static one-legged stance balance on both legs, subjective wellbeing, perception of physical abilities, and physical activity participation in pre-menopausal, perimenopausal, and post-menopausal women over 35 years of age. We found that ‘Beginner to 5kg’ significantly increased lower- and upper-body muscular strength and endurance, wellbeing, perception of physical abilities, and physical activity participation and significantly decreased menopausal symptoms in middle-aged and older women. Therefore, this accessible, inclusive, time-efficient, and evidence-based progressive strength training and health education intervention improves physiological health, functional capacity, wellbeing, physical self-efficacy and lowers the presence and severity of menopausal symptoms in women over 35 years.
Our results show that ‘Beginner to 5kg’, a novel hybrid beginner-focused and progressive strength training programme resulted in significant improvements in physical activity participation and lower- and upper-body muscular strength and endurance in middle-aged and older women living in Laois. Participants engaged in two 40-minute strength training classes per week, leading to an increase in the number of repetitions attained in the 60-second sit-to-stand test and the 60-second box press up test. These improvements are functionally relevant, and translate to improved mobility, independence, and quality of life (Izquierdo et al., 2025; Paluch et al., 2024). More specifically, an increase in the number of repetitions in the 60-second sit-to-stand test is reflective of improvements in lower-body muscular strength and endurance, contributing to an improved ability to rise out of a chair, sofa, or car seat, step up onto high steps, climb stairs, lifting and carrying heavy objects such as shopping bags, performing heavy gardening or household chores such as hoovering or mopping. Similarly, an increase in the number of repetitions in the 60-second box press up test highlights as improvement in upper-body muscular strength and endurance, thereby leading to improvements in functional movements such as pushing and pulling doors, carrying heavy objects or moving items such as household bins, supporting body weight while completing tasks such a climbing up onto a bus or rising from a bed or bath. Of note, muscular strength is inversely and independently associated with all-cause mortality, and therefore improvements in muscle strength are associated with lower mortality risk (Volaklis et al., 2015). Similar improvements were observed in our previous 6-week hybrid concurrent programme (online and on-site, aerobic and strength exercise for 4 hours/week) (Cooper et al., 2022) and 6-week online ‘MenoWell’ multimodal programme (aerobic, strength, balance, and flexibility exercise for 1.3 hours/week) in middle-aged and older women (Cooper et al., 2023). Additionally, these results further reinforce national and international guidelines for physical activity, as two sessions of strength training per week can increase muscular strength and endurance in the upper- and lower-body, which is imperative to physical functioning as we age. While not directly measured in this study, the improvements in upper- and lower-body muscular strength and endurance may be related to numerous neurological, metabolic, and/or hypertrophic adaptations elicited through strength training (Chodzko-Zajko et al., 2009; Khalafi et al., 2023). These changes are vital for maintaining balance and coordination, and mitigating sarcopenia, osteopenia, and osteoporosis and counteracting functional decline, disability, frailty, falls, and fall-related factors and mortality (Chodzko-Zajko et al., 2009; Marcos-Pardo et al., 2023). In addition, strength training has been shown to elicit improvements in cardiometabolic and psychological function (Chodzko-Zajko et al., 2009; Paluch et al., 2024), which can help to mitigate the risk of long-term clinical conditions and prevalence of anxiety and depression in ageing women. Furthermore, these results highlight the effectiveness of low-load, home-based strength training utilising convenient household items (e.g. water bottles and tinned cans) and resistance bands to improve muscular strength and endurance in middle-aged and older women. In support of this, a 12-week chair-based whole-body strength training programme using resistance bands, performed twice weekly, significantly improved functional fitness (upper- and lower-body strength, handgrip strength, flexibility, agility, and aerobic fitness), as well as markers of cardiometabolic health, in older women with a mean age of 75 years (Stojanović et al., 2021).
In contrast, and despite improvements in muscular strength and endurance, we demonstrated no significant change in static one-legged stance balance on either leg, when measured using the 45-second static one-legged stance eyes-open balance test. This specific test was used as it reflects the conditions under which balance exercises are performed during the strength training exercise class (e.g. one-legged stance knee lift/tree pose), and secondly, a one-legged stance with the eyes open is used in activities of daily living where a person maintains posture without movement (e.g., standing on one leg to dress, reaching for objects, or washing one foot while standing in the shower). However, we acknowledge that this test may lack sensitivity to detect subtle changes in postural control following a 6-week programme. Previous studies have shown improvements in balance following short-term (< 12 weeks) strength or multimodal exercise programmes using force platforms to detect changes in postural sway (Concha-Cisternas et al., 2024; Svobodová et al., 2025). Therefore, future research should investigate the effect of a longer ‘Beginner to 5kg’ intervention on changes in balance and consider developing field-based induced-sway balance tests that are valid and reliable.
Many midlife women report a combination of physical and psychogenic symptoms as a consequence of menopause, which can negatively impact their health-related quality of life and social and work relationships and responsibilities (Ali et al., 2020; Briggs & Kovacs, 2015; Trujillo-Muñoz et al., 2025). There is a large variation in the presence and severity of menopausal symptoms, which may be present for up to 8 years and have a profound effect on physical activity participation, self-esteem, and overall wellbeing (Trujillo-Muñoz et al., 2025) In participants who self-reported as perimenopausal or post-menopausal, we report a significant decrease in the total MRS score following ‘Beginner to 5kg’, from a mean score of 12.6 to 10.3. This finding has positive and important clinical implications as decreasing the total MRS score reduces the negative impact that menopause symptoms have on a woman’s health-related quality of life. Berin and colleagues (2022) investigated the impact of strength training on health-related quality of life in postmenopausal women with vasomotor symptoms, using the Women’s Health Questionnaire. The authors reported significant improvements in vasomotor symptoms, sleep problems, and menstrual symptoms after 15 weeks of strength training, supporting that strength training is beneficial for menopausal symptoms (Berin et al., 2022). Our results further show significant increases in subjective psychological wellbeing and physical self-efficacy, quantified using the WHO-5 and LIVAS questionnaires respectively, after the ‘Beginner to 5kg’ programme. The improvement in these two psychosocial outcomes can play an important role in sustaining participation in strength training. Improvements in vitality and mental health were reported following 12 weeks of strength training with resistance bands (3 days per week, 60 minutes per session) in midlife women (Dąbrowska et al., 2016). Eight weeks of muscular endurance training (2 sessions per week, consisting of 35-minute main phase of muscular endurance exercises involving 2 sets of 25 repetitions of 12 exercises using body weight, light dumbbells, or an exercise ball) also resulted in improvements in quality of life, in the categories of physical roles, bodily pain, and general health, as well as vitality in post-menopausal women (Socha et al., 2016). Taken together, these findings suggest that regular participation in strength training decreases the presence and severity of menopausal symptoms and improves self-efficacy and quality of life in middle-aged and older women. The present study highlights that these positive adaptations can be achieved with a relatively low training volume – two 40-minute strength training classes per week for six weeks – compared to the studies citied above.
A key aspect of this ‘Beginner to 5kg’ intervention was the inclusion of novel health education, which provided simple and practical evidence-based information on the physiological benefits of strength training, specific training principles, and special considerations for nutrition and recovery to support health and performance adaptations. Tailored education is a necessary component of positive behaviour change for midlife women (Arlinghaus & Johnston, 2018). It is also particularly important for building autonomy and competence, two psychological needs of the Self-Determination Theory (Manninen et al., 2022). These 20-minute live and on-demand health education workshops focused on addressing multiple cited barriers for participation in strength training in this cohort including, but not limited to, the perceived complexity of strength training, limited knowledge or confidence to perform strength training, challenges with progression or unexpected results, pain and discomfort, low strength and/or fitness levels, presence of one or more clinical conditions, and appearing “bulky” (Burton et al., 2017; Cooper et al., 2020; Doherty et al., 2018). In this way, education can be pivotal in shifting negative attitudes towards performing strength exercises in middle-aged and older women towards more positive attitudes (Doherty et al., 2018). Furthermore, incorporating individual progress feedback and discussing age- and gender-matched normative values within health education serves as another behaviour change technique (Krukowski et al., 2024). It can enhance participants’ motivation, self-efficacy, and engagement, and facilitate informed decision-making and promote sustained behaviour change. Therefore it is possible that the health education component of the ‘Beginner to 5kg’ intervention, in addition to strength training, may have been a key contributing factor to the observed improvements in menopausal symptoms, wellbeing, and physical self-efficacy in middle-aged and older women post-intervention.
A recent study in Ireland explored the motivators, facilitators, and barriers to physical activity participation in Irish women experiencing the menopausal transition (McNulty et al., 2024). Women expressed numerous barriers including a perceived reduced capability, menopausal symptoms, busyness of life and competing demands, non-specific and untailored programmes to suit their needs, and lack of supportive environments (McNulty et al., 2024). In comparison, some of the motivators included the desire to manage menopause symptoms, improve lifelong health, and social engagement, with facilitators relating to the ability to adapt and modify exercises, in a community and collective setting (McNulty et al., 2024). The ‘Beginner to 5kg’ programme addressed these needs by providing three different levels of each individual exercise (i.e. beginner, intermediate, advanced) and the option to include or not include strength training equipment (i.e. water bottles, tinned cans, or resistance bands) which allowed participants to self-select their appropriate level of difficulty, which may have contributed to increased physical self-efficacy evident post-intervention. Resistance bands are particularly useful for strength training, and present an economical option which can be adjusted to different intensities (Trujillo-Muñoz et al., 2025). Additionally, the ‘Beginner to 5kg’ intervention was time-efficient, with a weekly total participation time of 100 minutes per week, and flexibility was permitted with the use of the on-demand library, allowing middle-aged and older women to exercise at a time and place which suited their own schedules. The inclusion of both online and in-person strength classes, facilitating a hybrid approach, enabled social interaction and community engagement, helping to increase adherence, motivation, and overall wellbeing. Furthermore, the hybrid approach of ‘Beginner to 5kg’ provides autonomy and relatedness, key aspects of the Self-Determination Theory (Manninen et al., 2022), allowing participants to have a sense of control to choose exercise classes that suit their own schedule and personal preferences, and provides an opportunity for in-person social interaction and peer support. However, the majority of participants did not attend the in-person classes. In this regard, the custom-creation of ‘Beginner to 5kg’ provided a safe and effective strength training intervention that led to significant improvements in physical performance, physical activity participation, physical self-efficacy, and wellbeing in middle-aged and older women. Further to this, a hybrid or online-only delivery of ‘Beginner to 5kg’ may offer a practical alternative for broader implementation.
The findings and associated implications of this research study should be considered with respect to the limitations. Firstly, this was a one-group pre-test-post-test design study that had no control group. Thus, we recommend that a randomised controlled trial using the same exercise protocol should be conducted. Additionally, we understand that other potential confounding factors (e.g. history/lifestyle factors or testing effects or seasonal effects etc.) may have influenced the findings of this research study and acknowledge that these need to be considered for future research. Secondly, we did not exclude participants based on current use or non-use of menopausal hormone therapy (MHT, previously known as hormone replacement therapy). Future research could focus on examining differences, if any, in the responses to this intervention in women taking MHT and women not taking MHT. Thirdly, we did not examine the intensity, time and type of baseline physical activity and exercise participation, particularly strength training participation, and baseline strength training-specific health education knowledge prior to the start of the intervention. This will be included in future research studies. Fourthly, the results of this research study are specific to middle-aged and older women living in Ireland. Implementing ‘Beginner to 5kg’ internationally in other cultural contexts would enhance the generalisability of the findings.
5. Conclusion
Six weeks of a novel women-specific evidence-based hybrid and progressive strength training and health education intervention, requiring 100 minutes of participant time per week, significantly enhanced lower- and upper-body muscular strength and endurance, wellbeing, physical self-efficacy, physical activity participation, and menopausal symptoms in middle-aged and older women. Combining progressive strength training with specific education on the physiological benefits, specific training principles, and special considerations for nutrition and recovery is imperative for sustaining positive behaviour change, confidence, and long-term participation in regular strength training, which in turn will lead to optimal wellness and lower morbidity and mortality. The viability of a hybrid or online-only ‘Beginner to 5kg’ intervention needs to be examined within diverse communities but presents an opportunity for scalable implementation to substantially enhance public health.
Data Accessibility Statement
The data supporting the findings of the current study are available from the corresponding author on reasonable request.
Additional File
The additional file for this article can be found as follows:
Acknowledgements
The authors are very grateful to the ‘Beginner to 5kg’ participants for their effort and commitment and for the overall success of this research study. The authors extend a special thanks to Caroline Myers, Chief Executive Officer for Laois Sports Partnership, for funding and promoting the ‘Beginner to 5kg’ research study. The authors would like to express their gratitude to Yvonne Thompson for facilitating the live online and in-person strength training classes and recording the on-demand strength training exercise videos.
Competing Interests
KW, RK and DC are employed by EduFIT Limited. SO’C has no competing interests to declare.
Author Contributions
All authors had access to the data used in this study and take responsibility for the integrity of the data. The study was designed by KW, RK and DC. SO’C was responsible for data analysis. All authors were responsible for the interpretation of the data and preparation of the manuscript and were involved in the critical review for important intellectual content. Approval of the final manuscript was given by all authors.