APEX PWR | Female Fitness
Something genuinely good has been happening in women's fitness over the last several years, and it is worth naming.
For a long time the default goal sold to women was smaller. Eat less, do more cardio, shrink. Strength training was framed as a thing that would make you bulky, which was both wrong and remarkably effective at keeping half the population away from the most useful tool in the building.
That has shifted. Women are chasing strong now. Barbells have shown up in spaces that used to hold nothing heavier than a 10-pound dumbbell, more gyms are programming real strength work with women in mind, and the conversation has moved from how little you can eat to how much you can lift. We see it every week in our own building, and it is one of the more encouraging changes in this industry in a long time.
The research has been catching up to that shift, and a study on muscle mass and women's mortality has been circulating widely in the last few weeks. It is worth looking at closely, both for what it shows and for what it does not.
The paper is Domiciano and colleagues, published in the Journal of Bone and Mineral Research, drawing on the São Paulo Ageing and Health Study. Researchers used full-body DEXA scans to measure muscle and fat in 839 community-dwelling adults aged 65 and over, then followed them for about four years to see who survived. There were 132 deaths.
In women, low appendicular lean mass was the only measure that predicted mortality once everything was accounted for. Fat, of any kind and in any location, dropped out entirely. In men the picture was more complicated: low muscle mass mattered, visceral fat around the organs raised risk, and overall fat mass was associated with lower risk.
The number being quoted is a 63-fold higher risk of death in women with low muscle mass. That number appears in the paper. It also deserves more context than it is getting.
The reported figure is an odds ratio of 62.88, with a 95% confidence interval of 22.59 to 175.0. An odds ratio is not the same as "63 times more likely to die," and when an outcome is as common as it was here, it overstates the actual risk ratio. The confidence interval means the data are compatible with anything from a 23-fold to a 175-fold association. For cardiovascular death specifically, the interval ran from 9.72 to 571.46, which is close to uninformative. This was also an observational study in older Brazilians over four years, and serious illness causes muscle loss before it causes death, so some of this association likely runs in the opposite direction from how it is being presented.
None of that makes the study worthless. The direction is consistent with a large body of other evidence, and the finding that muscle mattered while fat did not is genuinely interesting. But we are a healthcare provider, and we would rather hand you a number you can trust than a number that performs well on social media.
So here is the better argument, and it happens to be a stronger one.
Observational studies tell you what tends to go together. Randomized controlled trials tell you what happens when you change something. For women deciding whether to pick up a barbell, the trial that matters is LIFTMOR.
Watson and colleagues enrolled 101 postmenopausal women, average age 65, all of whom already had osteopenia or osteoporosis. Half were assigned to supervised high-intensity resistance and impact training: two sessions a week, about 30 minutes each, working up to five sets of five repetitions at over 85% of their one-rep max. Deadlifts, back squats, overhead presses, and jumping chin-ups with drop landings. The control group did a home-based program of walking, stretching, and light resistance work at under 60% of their max.
After eight months:
| Measure | Heavy Training | Control |
|---|---|---|
| Lumbar spine bone density | +2.9% | -1.2% |
| Femoral neck bone density | +0.3% | -1.9% |
| Leg extensor strength | +35.2% | +8.1% |
| Back extensor strength | +36.0% | +11.0% |
| Height | +0.2 cm | -0.2 cm |
Look at the control column. Those women were not sedentary. They were walking and doing light resistance work, which is what most women over 50 are told to do. They still lost bone at the spine and hip over eight months.
Bone responds to load. Light weights do not provide enough of it. The women lifting near their maximum built bone density while the women doing the gentle version lost it.
The safety data deserve attention too, because fear of injury is the most common reason women with low bone density avoid lifting. Across more than 2,600 supervised sessions in a population of women who all had diagnosed osteopenia or osteoporosis, there was one adverse event: a mild low-back muscle strain that cost two training sessions. No fractures.
Two conditions made that record possible. Every session was supervised. And every participant was screened first, so the people running the program knew exactly what each woman's bones could handle before she touched a barbell.
Women carry more of this risk than men do, and the numbers are not close.
According to CDC data from 2017 to 2018, 19.6% of American women aged 50 and over have osteoporosis, compared with 4.4% of men. For low bone mass, the figure is 51.5% of women versus 33.5% of men. More than half of women past 50 already have bone that has thinned beyond the normal range.
The reason is largely hormonal. Estrogen restrains the cells that break down bone, and when estrogen falls through perimenopause and menopause, bone loss accelerates during a window of several years around the final menstrual period. Muscle mass declines over the same stretch. The two tissues fall together, and they respond to the same intervention.
That is what makes strength training unusual as a health behavior for women in midlife. Loading a barbell addresses both problems at once, which very few interventions do.
Two entry points, and they work well together.
Get the baseline before you change anything. A body composition scan measures your lean mass and fat mass and how each is distributed, which tells you whether you are actually holding muscle as you age. A bone density scan measures bone mineral density and identifies osteopenia or osteoporosis. Both can be done in one appointment, and the scan itself takes about seven to ten minutes.
Getting scanned before you start matters for a practical reason beyond motivation. If your bone density is low, your coach should know that on day one so your program accounts for it. If it is fine, you have a number to defend and something concrete to measure against in a year.
A personalized one-on-one introduction to strength training, or a reintroduction if you have been away from it. You are coached from the first session on a program built around your history, your schedule, and what your body can currently handle. No prerequisite fitness level and no assumption that you already know how to squat or deadlift.
Supervision is the variable that made the LIFTMOR results possible, and it is the difference between training heavy safely and finding out the hard way that your form breaks down at load. Start with the trial and go from there, in one-on-one personal training or in our semi-private small group sessions.
If you have diagnosed osteoporosis, a history of fragility fracture, or a spine condition, talk to your physician before beginning a heavy lifting program, and bring your DEXA results to your first session with us. The LIFTMOR safety record came from screened participants under supervision, and both of those conditions are worth reproducing. This article is general information rather than medical advice.
Body composition and bone density in one appointment, or start training with a coach. Both are good first moves, and doing them together is better than either alone.
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