Sex differences in absolute and relative changes in muscle size following resistance training in healthy adults: a systematic review with Bayesian meta-analysis

Refalo, Martin C.; Nuckols, Greg; Galpin, Andrew J.; Gallagher, Iain J.; Hamilton, D. Lee; Fyfe, Jackson J.

Abstract

Background
Muscle hypertrophy may be influenced by biological differences between males and females. This meta-analysis investigated absolute and relative changes in muscle size following resistance training (RT) between males and females and whether measures of muscle size, body region assessed, muscle fibre type, and RT experience moderate the results.

Methods
Studies were included if male and female participants were healthy (18–45 years old) adults that completed the same RT intervention, and a measure of pre- to post-intervention changes in muscle size was included. Out of 2,720 screened studies, 29 studies were included in the statistical analysis. Bayesian methods were used to estimate a standardised mean difference (SMD), log response ratio (lnRR) with exponentiated percentage change (Exp. % Change of lnRR), and probability of direction (pd) for each outcome.

Results
Absolute increases in muscle size slightly favoured males compared to females (SMD = 0.19 (95% HDI: 0.11 to 0.28); pd = 100%), however, relative increases in muscle size were similar between sexes (Exp. % Change of lnRR = 0.69% (95% HDI: −1.50% to 2.88%)). Outcomes were minimally influenced by the measure of muscle size and not influenced by RT experience of participants. Absolute hypertrophy of upper-body but not lower-body regions was favoured in males. Type I muscle fibre hypertrophy slightly favoured males, but Type II muscle fibre hypertrophy was similar between sexes.

Conclusion
Our findings strengthen the understanding that females have a similar potential to induce muscle hypertrophy as males (particularly when considering relative increases in muscle size from baseline) and findings of our secondary analyses should inform future research that investigates sex differences in highly trained participants and muscle fibre type-specific hypertrophy

Citation

Refalo, M. C., Nuckols, G., Galpin, A. J., Gallagher, I. J., Hamilton, D. L., & Fyfe, J. J. (2025). Sex differences in absolute and relative changes in muscle size following resistance training in healthy adults: a systematic review with Bayesian meta-analysis. PeerJ, 13, Article e19042. https://doi.org/10.7717/peerj.19042

• Journal Article Type: Article
• Acceptance Date: Feb 4, 2025
• Online Publication Date: Feb 25, 2025
• Publication Date: 2025
• Deposit Date: Mar 5, 2025
• Publicly Available Date: Mar 5, 2025
• Journal: PeerJ
• Electronic ISSN: 2167-8359
• Publisher: PeerJ
• Peer Reviewed: Peer Reviewed
• Volume: 13
• Article Number: e19042
• DOI: https://doi.org/10.7717/peerj.19042
• Keywords: Sex difference, Muscle hypertrophy, Gender difference, Muscle size, Resistance training
• Public URL: http://researchrepository.napier.ac.uk/Output/4166718