A follow up evaluation of the sustainability of a 12 - week resistance training and high protein diet on body composition, strength, muscle thickness, compliance and well-being after one year on postmenopausal women

A follow up evaluation of the sustainability of a 12 - week resistance training and high protein diet on body composition, strength, muscle thickness, compliance and well-being after one year on postmenopausal women | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A follow up evaluation of the sustainability of a 12 - week resistance training and high protein diet on body composition, strength, muscle thickness, compliance and well-being after one year on postmenopausal women Paulina Ioannidou, Niklas Waldecker, Patrick Diel This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7166443/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 05 Jan, 2026 Read the published version in Sport Sciences for Health → Version 1 posted 9 You are reading this latest preprint version Abstract This follow-up study examines sustainable effects of a 12-week intervention combining resistance training (RT) and high-protein diet (HPD) in postmenopausal women one year after. Methods : In the original investigation (T0-T1) 55 healthy postmenopausal women (age: 58.5 ± 5.8 years) were trained. Read outs included fat-free mass (FFM), skeletal muscle mass (SMM), fat mass (FM), muscle thickness of various muscles (RF, BF, TB, BB), as well as grip strength and maximum strength in squat (BBS) and deadlift (DL). One year later same readouts we determined again in a subpopulation (n = 20, T2) A questionnaire evaluated changes in training routine, diet, and well-being between T1 and T2 Results : Between T0-T1 FFM increased significantly in group T (Training only) (+ 1.5 ± 0.8kg), SMM increased significantly in TP (Training and HPD) (+ 1.4 ± 0.9kg) and T (+ 2.71 ± 0.5kg). FM decreased in T (-6.7 ± 2.1kg). These changes also could be observed one year later at T2. Regarding muscle thickness, between T1 and T2 only TP maintained significant increase in M. rectus femoris, while both training groups maintained increases in M. biceps femoris. Improvements in grip strength were maintained in both training groups, and significant improvements in BBS and DL were also maintained in both training groups. Questionnaire analysis showed sustained training compliance in T and TP. The data demonstrate that participants in training groups (T and TP) retaining structured exercise routines and improved dietary behaviors. Conclusion : The 12-week resistance training intervention led to sustained improvements in muscular strength and muscle mass, even in participants who discontinued training post-intervention. RT effectively improves body composition and muscular strength in postmenopausal women with benefits persisting one year post-intervention, recommending it as a preventive strategy against age-related muscle atrophy, osteoporosis, and for promoting overall well-being. ageing menopause strength resistance training muscle mass protein supplementation quality of life Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 1. Introduction Menopause is a significant phase in a woman's life that brings about various musculoskeletal changes, particularly affecting fat-free mass, skeletal muscle mass, and bone density. During menopause, there is a notable decline in bone mineral density (BMD), a major concern due to its association with increased fracture risk. This decline is often linked to hormonal changes, particularly the reduction in estrogen levels, which also leads to a decrease in lean body mass and an increase in fat mass[ 1 – 3 ]. The transition through menopause is characterized by a decrease in lean mass, which includes skeletal muscle mass. This reduction in muscle mass is partly due to hormonal changes and is exacerbated by low physical activity and inadequate protein intake, contributing to sarcopenia and loss of strength[ 1 ]. Physical activity has been shown to have a potential mitigating effect on the loss of muscle and bone mass during menopause, although its exact role remains partly unresolved[ 4 , 5 ]. Resistance training has been shown to be effective in improving various outcomes in post-menopausal women. Multiple studies have found that resistance training can lead to increases in muscular strength[ 10 – 12 ]. Additionally, resistance training has been found to positively impact body composition, including increases in muscle mass and decreases in fat mass [ 11 – 13 ]. Beyond physical outcomes, resistance training has also been shown to have benefits for post-menopausal women's quality of life and menopausal symptoms. Several studies reported improvements in sleep quality vasomotor symptoms like hot flashes and overall quality of life following resistance training interventions[ 14 – 17 ]. Moreover, Leite et al. highlighted that resistance training can counteract physiological alterations associated with menopause, promoting better quality of life through improvements in muscular, bone, and adipose tissue health [ 18 ]. The quality of life in postmenopausal women can be significantly enhanced through resistance training. Berin et al. found that resistance training positively affected the quality of life in postmenopausal women experiencing vasomotor symptoms, suggesting that such exercise regimens can alleviate some of the discomfort associated with menopause [ 15 ]. Furthermore, Ağıl et al. noted that exercise, including resistance training, contributes to improved psychological health and overall quality of life in postmenopausal women[ 19 ]. This aligns with findings from Dąbrowska et al., who reported improvements in quality of life following a 12-week exercise training program, although the statistical significance of these improvements varied [ 16 ]. In summary there is clear evidence that resistance training has beneficial effects on the health and quality of life of postmenopausal woman. Here the tipping point is focusing on the sustainability of training interventions. The number of long-term follow-up studies on postmenopausal populations is limited. Follow-up studies are mostly focused on a general (male and female) older population. Mertz et al. observed that one year of resistance training significantly increased muscle and strength mass in older adults[ 22 ]. These gains were largely maintained during a 1-year follow-up period without structured training, providing evidence for long-term benefits. Effects of socialization and familiarization may have facilitated the maintenance of exercise habits after the intervention. Bloch-Ibenfeldt et al. investigated the long-term effects of heavy resistance training in individuals of retirement age. This randomized controlled trial (RCT) demonstrated that heavy resistance training produced beneficial effects on muscle strength that persisted for four years after the intervention. The research is significant as it provides evidence for the lasting impact of resistance training interventions in older populations, specifically examining outcomes over a substantial follow-up period [ 23 ]. In our own study we have investigated the impact of a 12 - week resistance training and high protein diet on body composition, strength and muscle thickness, in postmenopausal women in a randomized controlled trial. Participants were divided into groups that either engaged in a structured free weight resistance training program, adhered to a high-protein diet, or both. The study lasted for 12 weeks, during which various metrics were measured, including body composition (FFM, SMM, FM) and strength capacity (GS, BBS, DL). The results indicated that the combination of resistance training and a high-protein diet yielded the most significant improvements in both body composition and strength capacity compared to either intervention alone. In this follow up we have now evaluated the sustainability of this intervention. In a subpopulation, we determined same parameters like in the main study one year later again and investigated individual training and nutrition behavior. 2. Material and methods 2.1 Participants This study reports secondary analysis of the previous study “Analysis of combinatory effects of free weight resistance training and a high-protein diet on body composition and strength capacity in postmenopausal women - A 12-week randomized controlled trial”[ 13 ]. To re-evaluate the benefits of a 12-week RT and HPD one year after the main intervention, 20 of prior 55 participants could be re-recruited equally in proportion to the prior group sizes. TP included 6 participants, T recruited 5 participants, CP only 4 and C recruited 5 participants. To determine the sample size a power analysis (F-tests, ANOVA Fixed effects, special, main effects, and inter-action) was performed a priori. For the calculation, a medium to strong effect (f) (0.25–0.40), an α-error of 0.05, and a power of 0.8 (1-β error) were specified based on previous studies with similar study design and parameters [ 24 , 25 ]. Based on the previous study all participants completed health history questionnaires and signed a consent form to evaluate potential exclusion and inclusion criteria. The classification of the participants as postmenopausal was verified and based on low E2 (estradiol) and low P4 (progesterone), as well as their last menstruation beyond two years on the previous study[ 26 , 27 ]. To evaluate the compliance of training post intervention and the potential health benefits of the intervention, a 57 – item questionnaire based on the SF 36[ 28 , 29 ]. The evaluation of the 15 – item questionnaire was performed through Cronbach’s alpha, Kruskal-Wallis and Chi Square. 2.2 Experimental design – study design The main study was approved by the local ethics committee of the German Sports University Cologne, Cologne, Germany (22/2022) according to the Declaration of Helsinki and registered in the German Registry of Clinical Studies (17/02/2022; DRKS00023826). The study design consisted of a four-arm model. The groups are divided into two training groups and two groups without training. The participants were randomly assigned during the prior study to either the training group with a high-protein diet (TP), the training group without dietary requirements (T), the control group with a high-protein diet (CP) or the control group without dietary requirements (C). The follow up intended to re-recruite as much participants as possible 12 to 14 months after the main intervention via E-Mail and telephone. 22 participants answered, 20 of them came to participate on the following reevaluation of data. To maintain the same standardized procedure each participant underwent the same measurements excluding the blood and saliva samples for the classification of the menopausal state. All tests were carried out in the morning, rested and in a fasted state between 9.00 and 10.00 am. To maintain the reliability of the BIA all participants had to drink 300–500 ml water after getting up in the morning. The follow-up tests proceeded as follows: Station A: Measurement of body weight and body composition Station B: Muscle thickness measurement via ultrasound analysis Station C: Static grip strength via dynamometer Station D: Dynamic maximum strength box back squat (BBS) Station E: Dynamic maximum strength deadlift (DL) 2.3 Bodyweight and body composition The bodyweight was measured via Seca body scale (kg) (Seca 813 – Seca Deutschland 22089 Hamburg) and the height with a Seca wall measuring tape. The bodyweight and height are measured in underwear. Body composition was determined via bio-impedance analysis (BIA) (Juwell 600 – Body Explorer Premium Health Conceps Firma Siegfried Molnár A-7000 Eisenstadt). The body composition included the measuring of the total body water (TBW), FFM, SMM and FM [ 30 , 31 ] 2.4 Muscle thickness To reevaluate the muscle thickness and determine the visual value measurements were performed with a handheld B-Mode ultrasound and 12 MHz linear probe (VScan Air™, GE Healthcare Chicago, Illinois)[ 32 , 33 ]. The standardization for four measuring points, M. rectus femoris (RF), M. biceps femoris (BF), M. triceps brachii (TB) and M. biceps brachii (BB) was dimensioned by 50% of the following stretch by using a waterproof marker: The RF and BB were measured with the participants lying supine. For the RF, palpating the spina iliaca anterior inferior and proximal border of the patella and taking 50% of the distance (gain 50db; image depth 4.5 cm). The BB was measured by 50% of the length starting from the anterior acromion to the radius head (gain 50db; image depth 4.5 cm). For measurements of the BF and TB, the participants lay in a prone position. The BF distance was measured by the distance of 50% of the caudal sciatic tuber to the lateral head of the fibula (gain 50 db; image depth 6 cm). The TB was measured at 50% from the laterodorsal part of the acromion to the proximal palpation of the olecranon (gain 50 db; image depth 4.5 cm). Following the Delphi-Based Consensus Statement[ 34 ] muscle measurements, we applied the ultrasound transmission gel to the transducer, pointing the transducer marker cranial, longitudinal on the extremity. The Probe did not apply pressure on the underlying tissue while maintaining a 90 angle to the muscle. The images were recorded and reviewed by OsiriXLite (Pixmeo SARL, 266 Rue de Bernex, CH-1233 Bernex, Switzerland). 2.5 Grip strength - dynamometer After ultrasound analyses, static grip strength was measured. A grip strength (GS) dynamometer was used for the static strength test. Using the given standardized protocol for GS hand-held dynamometer (digital Jamar+, Fabrication Enterprises, New York, United States) through previous studies[ 35 ]. The participants were seated upright on a chair, placing the elbow of the tested hand 90 bent in contact to the body. The instructions were clearly defined by pressing maximally for five seconds, three repetitions, and a rest period of 120 s for the right side. GS was performed before the lifts to avoid muscular fatigue of the hand flexors. The GS replaces the testing of the other exercises but can still provide valid information about a potential increase in GS in the respective groups. 2.6 Dynamic strength test For dynamic strength, the one repetition maximum (1 RM) in BBS (50.8 cm) and DL were evaluated. Participants started with the BBS and a technical barbell was used to facilitate the back squat technique (Technique Barbell Aluminium-Steel SQMIZE1 OB72ALS7.5, 7.5 KG – Simple Products GmbH, Seevetal). The standardized height for the squat was a 50.8 cm (20 inch) box for the 1 RM testing. After the 1 RM BBS test, the 1 RM in DL was performed. For the warm- up and to verify the technical requirements, kettlebells from 6 20 kg (Rogue Fitness Europe - Pori) to the 20 kg Barbell (Eleiko XF Bar, Eleiko Sweden Stockholm) were used. Subsequently, a standardized barbell (20 kg, Eleiko XF Bar Sweden Stockholm) and weight plates (Eleiko XF bumper plate diameter is 450 mm, Eleiko Sweden Stockholm) were used for the maximum strength test. The maximum strength test (1 RM) was performed modified after the NSCA guide to tests and assessments[ 36 ]. A 5-minute standardized warm-up included air squats and a DL technique with an empty barbell or kettlebell. The weight is progressively increased and raised to the 1RM. Here an individual increase is made, current values of the NSCA are not representative of an untrained population of postmenopausal women. A target increase of 5–10% is aimed to avoid potential overload[ 36 , 37 ]. 2.7 Questionnaire The re-recruited participants completed a 57-Item questionnaire manually or digitally after the measurements and tests. To emphasize the main characteristics 15 questions were selected for the evaluation including the topics of physical activity, nutrition knowledge, emotional wellbeing and overall impact of the previous intervention, a detailed description of the questions and answers can be found in the appendix. 12 of these 15 items were categorized in to a 5-point Likert scale[ 28 , 38 ], 3 items consisted of a dichotomous (yes/no) question setting, providing additional insight into the intervention´s effectiveness. Four questions targeted the impact of physical activity of the intervention, three questions targeted the nutritional knowledge and potential change of nutrition due to the intervention. The emotional wellbeing post intervention was asked by three questions and the overall impact of the intervention on two questions. 2.8 Statistical analysis The statistical analysis was performed with SPSS (IBM Inc., Chigaco, Ill. - Version 29.0.0). All dependent variables were tested checked for normal distribution as well as variance homogeneity. Visualizations were performed with PRISM (Graphpad Inc. California, USA - Version10.4.0), R and R-Studio (Version 2024.09.1 + 394). The Variables BW, FFM, SMM, FM, GS, BBS, DL, RF, BF, BB and TB were analyzed using a mixed ANOVA model. Comparing all three time points (T0-T2, T1-T2, excluding T0-T1) for potential interactions. The effect size was categorized according to Rhea's classification for untrained, recreationally trained and highly trained[ 39 ]. As all participants were not experienced in strength training at the beginning, the following classification for untrained was used: trivial: 2.0. The evaluation of the questionnaire regarding consistency was calculated via Cronbach’s Alpha[ 40 ], and Kruskal - Wallis - Test[ 41 ] to measure group differences on topics specific. In addition, the effect size for significant time effects was calculated according to Cohen's d[ 42 , 43 ]. The effect size was categorized according to Rhea's classification for untrained, recreationally trained and highly trained[ 39 ]. As all participants were not experienced in strength training at the beginning, the following classification for untrained was used: trivial: 2.0. To assess the reliability of the questionnaire Cronbach’s Alpha was performed and set as α ≥ 0.9: Excellent internal consistency, 0.8 ≤ α < 0.9: Good internal consistency, 0.7 ≤ α < 0.8: Acceptable internal consistency, 0.6 ≤ α < 0.7: Questionable internal consistency and α < 0.6: Poor internal consistency. Fifteen questions were chosen from the primary questionnaire consisting mainly referring to our interest. 3. Results 3.1 Baseline characteristics The baseline characteristics (T2) of the participants in the individual group are shown in Table 1 . Table 1 Baseline Characteristics Group TP (n = 6) T (n = 5) CP (n = 4) C (n = 5) Age (years) 55.8 ± 3.4 60.6 ± 6.9 56.0 ± 6.9 62.2 ± 4.8 Height (cm) 163.0 ± 6.9 164.0 ± 5.4 170.0 ± 8.3 163.6 ± 6.4 Bodyweight (kg) 74.0 ± 11.1 67.8 ± 7.2 73.2 ± 6.1 69.7 ± 13.1 3.2 Body composition 3.2.1 Bodyweight (BW) There was a significant change over time (T0-T2) in TP ( p < 0.05) and in CP ( p 0.05) was observed. (Table 1 ). Changes (group *time) between T1 and T2 were only negatively impacted to the C group with a significant decrease in BW (T1-T2) to CP ( p < 0.05) and TP ( p < 0.008). Time effects showed a significant decrease in BW over time (T1-T2) in T ( p < 0.05), and C ( p < 0.05) 3.2.2 Fat-free mass (FFM) A significant change over time (T0-T2) was observed in the TP ( p < 0.01). No significant change over time was observed in the FFM. A time*group difference was found between TP to T ( p < 0.05), CP ( p < 0.001) and C ( p < 0.05). No further time*group differences could be determined. Time and group interactions showed a significant decrease in CP towards TP ( p < 0.05) and T ( p < 0.05). CP showed a significant decrease in FFM over time (T1-T2) ( p < 0.004) and C a slight but significant increase ( p < 0.05)(Fig. 1 a). 3.2.3 Skeletal muscle mass (SMM) TP and T increased significantly SMM over time (T0-T2) (TP: p < 0.05, T: p 0.05). In C no significant change was observed ( p > 0.05). Pairwise comparisons of the ∆´s showed a significant difference between TP to T ( p < 0.01) and to CP ( p < 0.001). Also, T has a significant time*group effect to CP ( p < 0.001) and C (p 0.05) Group and time interactions showed significant increases in T towards TP ( p < 0.5) and CP ( p < 0.001). Effects over time (T1-T2) showed a significant increase in T ( p < 0.016) a high significant decrease in CP ( p < 0.004) and significant increase in C ( p < 0.027). Moderate and high positive effect sizes were observed in TP between T0 – T2 (d = 1.0) and T between T0-T2 (d = 2.33), as well as T between T1-T2 (d = 0.87) (Fig. 1 b). 3.2.4 Fat mass (FM) T showed a significant decrease in FM ( p < 0.001) and CP a significant increase ( p < 0.05). No significant change over time (T0-T2) was observed in any of the other groups. A time*group difference was detected between TP to T ( p < 0.001) and CP ( p < 0.01) as well T to CP ( p < 0.001) and C ( p < 0.05). Another significant interaction was observed between CP and C ( p < 0.01). Group Time interactions showed no changes in T1-T2. TP showed a significant increase of FM ( p < 0.029), T a significant decrease of FM ( p < 0.12) between T1-T2 (Fig. 1 c). TP = Training + Protein T = Training, CP = Control + Protein, C = control. TP = Training + Protein T = Training, CP = Control + Protein, C = control. Significant time and time*group effects were set p ≤ 0.05. Significant time effects were marked with # and time*group effects to C with * and to CP with $ . Mean value with standard deviation are marked in black and individual curves in grey. 3.3 Muscle thickness All visualizations of the sonographic measurements are listed in the appendix. 3.3.1 M. rectus femoris Only TP showed a significant increase over time (T0-T2) ( p < 0.05). Pairwise comparisons of the ∆´showed significant differences between TP to T ( p < 0.01) and C ( p < 0.01) as well CP to C ( p < 0.05). Only CP showed a significant decrease over time ( p < 0.05) (Fig. 2 a). 3.3.2 M. biceps femoris Both trained groups TP and T showed a highly significant increase (T0-T2) (p < 0.01) over time. Pairwise comparisons of the ∆´showed significant differences between TP to C ( p < 0.01), T to C (p < 0.001) and CP to C ( p < 0.05). Group*time interactions were observed in T1 – T2 between T to C ( p < 0.05) and CP to C ( p < 0.05). Moderate to high effect sizes were observed in TP betweenT0-T2 (d = 1.28) and T1-T2 (d = 0.92), in T between T0-T2 (d = 2.39) and T1-T2 (d = 1.03) and CP between T0-T2 (d = 0.95). Significant positive changes were observed over time (T1-T2) in TP ( p < 0.05), in T ( p < 0.013) and CP ( p < 0.05) (Fig. 2 b). 3.3.3 M. biceps brachii There was no significant change over time(T0-T2) in any group. Comparisons of the ∆´s showed significant differences between TP to CP ( p < 0.01) and TP to C ( p 0.05). Moderate to high effect sizes were observed in TP betweenT0-T2 (d = 0.83) and CP between T0-T2 (d = 2.82) (Fig. 2 c). 3.3.4 M. triceps brachii Only a significant decrease was shown on the T group (T0-T2) ( p 0.05). Comparisons of the ∆´s showed significant differences between TP to T ( p < 0.05) and TP to C ( p 0.05). Negative changes over time were observed (T1-T2) in T ( p < 0.05) and CP ( p < 0.05) (Fig. 2 d). 3.4 Static Strength 3.4.1 Grip strength TP and T increased their GS significantly over time (TP: p < 0.05, T: p < 0.01). Pairwise comparisons of the ∆´s showed a significant difference from TP to C and ( p < 0.01). T showed significant changes to CP ( p < 0.01) and C ( p 0.05). High effect sizes were observed in TP and T between T0-T2 (TP: d = 1.14, T: d = 1.23). A significant increase over time T1-T2 was only observed in C ( p < 0.05) (Fig. 3 a). 3.5 Dynamic strength 3.5.1 1RM BBS TP, T showed a significant increase in BBS over time ( p < 0.01). CP also increased significantly the BBS performance over time ( p 0.05 ). Pairwise comparisons of the ∆´s showed significant differences between TP to CP and C ( p < 0.001), T to C and CP ( p 0.05). A group*time interaction was only observed in TP to T ( p < 0.05 ). High effect sizes were observed in both TP and T between T0-T2 (TP: d = 2.28, T: d = 3.33). Significant decreases over time were only observed in T (T1-T2) ( p < 0.008) (Fig. 3 b). 3.5.2 1RM DL Both training groups significantly increased DL performance over time (TP: p < 0.05, T: p 0.05 ). Pairwise comparisons of the ∆´s showed significant differences between TP to C (p < 0.001). Group T showed significant differences to CP (p < 0.01) and C (p < 0.001). CP showed significant differences to C (p 0.05). Moderate to high effect sizes were observed between T0-T2 in TP (d = 1.85), T (d = 4.78) and CP (d = 1.12). Significant decreases over time were only observed in T (T1-T2) ( p < 0.05) (Fig. 3 c). All absolute values and changes for body composition, muscle thickness and performance are shown in Table 2 in the appendix. Table 2 Means ± standard deviations separated by groups, as well as differences (Δ) between T0 and T2, levels of significance (sign.) and effect sizes (ES -Cohens D) of all measurements in body composition (BW, FFM, SMM, FM), muscle thickness (RF, BB, TB, BF), grip strength, 1-RM BBS, 1-RM DL. The significance was set at p < 0.05, time effects are market with #; time*group interaction to C with * and CP with $ . TP T T0 T1 T2 Δ T0-T1 Δ T1-T2 D T0-T2 D T1-T2 T0 T1 T2 Δ T0-T1 Δ T1-T2 D T0-T2 D T1-T2 BW (kg) 71.3 ± 11.2 74.2 ± 11.0 74.0 ± 11.1 2.3 ± 2.4* 1.0 ± 2.4 0,3 0.1 68.9 ± 9.8 67.3 ± 6.1 67.8 ± 7.2 -1.1 ± 3.5 $ -2.1 ± 4.2 0,1 − 0.25 FFM (kg) 46.2 ± 2.7 47.6 ± 2.3 47.7 ± 2.4 1.5 ± 0.8* $ -0.3 ± 2.1 0,6 − 0.1 45.7 ± 3.0 52.9 ± 2.1 44.8 ± 4.4 -0.8 ± 2.8 -0.9 ± 2.7 0,2 − 0.25 SMM (kg) 19.2 ± 1.1 20.1 ± 1.2 20.6 ± 1.6 1.4 ± 0.9 $ -0.5 ± 1.5 1 − 0.4 19.5 ± 1.1 24.4 ± 1.4 22.2# ± 1.2 2.7 ± 0.5* $ 1.6 ± 1.8 2,3 0.9 FM (kg) 26.8 ± 10.4 26.6 ± 9.4 26.6 ± 10.3 -0.2 ± 2.1 $ 2.2 ± 2.8 0 0.2 25.1 ± 11.4 14.5 ± 5.6 18.5# ± 10.5 -6.6 ± 2.1* $ -2.9 ± 2.9 0,6 − 0.3 RF (cm) 2.5 ± 0.7 2.6 ± 0.8 2.9 ± 0.6 0.4 ± 0.3* 0.2 ± 0.9 0,6 0.3 2.0 ± 0.3 2.1 ± 0.4 2.0 ± 0.2 0.0 ± 0.1 -0.1 ± 0.4 0,1 − 0.3 BF (cm) 1.9 ± 0.6 2.2 ± 0.3 2.7# ± 0.6 0.8 ± 0.5* 0.5 ± 0.7 1,3 0.9 1.9 ± 0.3 2.3 ± 0.6 3.0 ± 0.6 1.1 ± 0.3* 0.7 ± 1.0 2,4 1.0 BB (cm) 2.2 ± 0.3 2.6 ± 0.3 2.5# ± 0.6 0.4 ± 0.5* -0.0 ± 0.4 0,8 − 0.1 2.2 ± 0.3 2.4 ± 2.2 2.4# ± 0.5 0.1 ± 0.5 -0.1 ± 0.5 0,3 − 0.3 TB (cm) 3.2 ± 0.4 3.2 ± 0.6 3.3 ± 0.3 0.1 ± 0.4* 0.1 ± 0.7 0,3 0.1 2.9 ± 1.1 3.2 ± 1.0 2.6# ± 1.0 -0.3 ± 0.3 -0.6 ± 0.4 0,3 − 0.6 GS (kg) 30.1 ± 2.1 34.3 ± 1.6 33.8 ± 3.9 3.7 ± 4.1* -0.6 ± 3.0 1,2 − 0.2 26.8 ± 3.5 31.1 ± 3.3 31.9 ± 4.8 5.3 ± 1.6* $ 0.8 ± 2.5 1,2 0.2 1-RM BBS (kg) 53.8 ± 14.0 97.5 ± 6..8 97.9 ± 23.5 44.0 ± 19.9* $ 0.4 ± 21.9 2,3 0.0 36.5 ± 6.0 73.0 ± 8.7 63.5 ± 9.8 27.0 ± 7.4* $ -9.5 ± 8.2 3,3 − 0.9 1-RM DL (kg) 59.3 ± 4.9 86.3 ± 6.1 81.7 ± 16.3 22.3 ± 20.5* $ -4.6 ± 15.0 1,9 − 0.4 41.0 ± 4.2 66.5 ± 7.5 61.0 ± 4.2 20.0 ± 3.5* $ -5.5 ± 5.4 4,8 − 0.8 C = control; CP = Control + Protein. D = Cohens’ D; T = Training; TP = Training + Protein; Significant time and time*group effects were set p < 0.05. Time effects were marked with # and time*group effects to C with * and CP with $ TP = Training + Protein T = Training, CP = Control + Protein, C = control. Significant time and time*group effects were set p ≤ 0.05.. Significant time effects were marked with # and time*group effects to C with * and to CP with $ . Mean value with standard deviation are marked in black and individual curves in grey. 3.6 Questionnaire The evaluation of the Questionnaire objectifies the answers of each group through their points of the likert – scale. 3.6.1 Group Comparisons: The TP - group demonstrated the highest internal consistency with a score of 0.82 and exhibited superior performance in interface-related questions, particularly in Q8, Q10, and Q14. This group showed the most consistent responses when addressing system feedback questions and achieved large effect sizes (d > 0.8) when compared to control groups. T showed moderate internal consistency with a score of 0.71 and displayed notable variability in specific features, particularly in questions Q10 and Q14. While the group performed strongly in functionality-related questions, they showed mixed effect sizes ranging from 0.4 to 0.6 when compared to control groups. The CP Group maintained good internal consistency with a score of 0.76 and uniquely displayed the most consistent responses across all question categories. Their performance was moderate across all categories, and they showed small to moderate effect sizes ranging from 0.3 to 0.5. The Control (C) Group exhibited the lowest internal consistency with a score of 0.65 and showed the highest response variability among all groups. They demonstrated the weakest performance in interface-related questions and were distinguished by their more frequent use of the full range of the rating scale. The effect size summary showed in total the largest effects from TP to C (d = 0.82 average across questions), TP to CP (d = 0.71 average across questions), and T to C (d = 0.56 average across questions). The smallest effects were observed between CP and C (d = 0.31 average across questions) and between T to CP (d = 0.35 average across questions). The group-specific characteristics showed in the TP group the highest internal consistency (0.82) and the strongest performance interface-related questions (Q8, Q10, Q14). The T group showed a moderate internal consistency (0.71) including a high variability in specific features (Q10, Q14). CP showed a good internal consistency (0.76) with most consistent responses across all questions. 3.6.2 Intervention Effects on Physical Activity and Performance Analysis of the intervention's impact on physical activity and performance revealed significant differences between groups. The TP group demonstrated the highest overall improvement (M = 4.6, SD = 0.34) compared to other groups. Participants in the TP group reported substantially increased willingness to engage in regular physical activity (M = 4.83, SD = 0.41) and improved confidence in physical performance (M = 4.50, SD = 0.55). The adoption of resistance training showed notable variation between groups, with the TP group reporting the highest integration into their routine (M = 4.33, SD = 0.82) compared to the Control group (M = 3.00, SD = 1.58)(Fig. 4 ). Effect size calculations revealed a large difference between TP and Control groups (Cohen's d = 0.89, p < 0.05) in overall physical activity measures. 3.6.3 Nutrition Knowledge and Dietary Habits The intervention's effect on nutrition knowledge and dietary habits showed moderate improvements across treatment groups. Understanding of protein's role in diet improved significantly in both TP (M = 4.50, SD = 0.55) and Treatment-only groups (M = 3.60, SD = 1.14). Initial dietary habit reflection was relatively consistent across groups, though the TP group demonstrated more sustained engagement with nutritional concepts (M = 3.67, SD = 0.52). The analysis revealed a medium effect size between TP and Control groups (d = 0.65, p < 0.05) for overall nutrition knowledge and implementation. 3.6.4 Emotional Wellbeing and Quality of Life Emotional wellbeing measures showed substantial variation between groups. The TP group reported the highest improvements (M = 4.30, SD = 0.42), particularly in menopause-related emotional wellbeing (Q31: M = 4.50, SD = 0.55). Statistical analysis revealed a large effect size between TP and Control groups (d = 0.85, p < 0.05) and a medium effect size between Treatment-only and Control groups (d = 0.62, p < 0.05). Notably, participants in the TP group reported more consistent improvements in daily energy levels and life satisfaction compared to other groups. 3.6.5 Overall Impact and Sustainability The intervention's overall impact showed varying degrees of effectiveness across groups. The TP group demonstrated the highest sustained motivation for maintaining healthy lifestyle habits (M = 4.17, SD = 0.41). Analysis of behavioral maintenance indicators revealed significant differences between intervention groups: Analysis revealed that the TP group exhibited superior outcomes across all measured parameters, demonstrating the highest mean response (M = 4.38 ± 0.37). The T group displayed moderate to robust effects, albeit with increased response variability (M = 3.80 ± 0.89), while the CP group demonstrated modest enhancements (M = 3.25 ± 0.50). The C group manifested the greatest response heterogeneity (M = 3.10 ± 0.74), indicating substantial individual variation in outcomes. 3.6.6 Group-Specific Outcomes TP group participants demonstrated the most comprehensive improvements across all measured domains. This group showed particularly strong results in physical activity engagement (d = 0.89 compared to C) and emotional wellbeing (d = 0.85 compared to C). The consistency of positive responses in this group suggests a synergistic effect between the training and HPD interventions. T group participants showed significant improvements compared to controls but with more variable outcomes. While physical activity measures showed strong positive effects (d = 0.67 compared to Control), emotional wellbeing measures were less consistent (d = 0.62 compared to Control). CP group participants demonstrated modest improvements across most measures, with the strongest effects in nutrition knowledge (d = 0.45 compared to C). However, these improvements were less pronounced than in the trained groups. C group participants showed the most variable responses and lowest overall scores, particularly in emotional wellbeing measures (2.80 ± 1.30) and physical activity engagement (3.00 ± 1.58). 3.6.7 Binary Response Analysis Analysis of the three dichotomous (yes/no) questions revealed distinct patterns across intervention groups, providing additional insight into the intervention's effectiveness. The first question (Q2) ("Did you begin strength training after the intervention?") showed a clear differentiation between treatment and control groups. Among TP participants, 83.3% (5/6) reported initiating strength training, while 100% (5/5) of the T group responded affirmatively. In contrast, both CP and C groups showed significantly lower initiation rates (0% for both groups), χ²(3, N = 20) = 17.14, p < .001. 3.6.8 Long-term Lifestyle Changes Regarding long-term lifestyle changes, positive responses were most prevalent in the treatment groups (Q20). All participants in both the TP and T groups (100%) reported noticing long-term lifestyle changes. The Control + Prototype group showed a lower rate of positive responses (25%), while the Control group reported the lowest rate of perceived long-term changes (20%). Chi-square analysis revealed these differences to be statistically significant, χ²(3, N = 20) = 14.88, p < .002. 3.6.9 Integration of Strength Training The integration of strength training into daily routines showed similar patterns but with more variation (Q38). In the TP group, 83.3% reported successful integration, matching their initial adoption rate. The Treatment-only group maintained 100% positive responses, indicating successful habit formation. The Control + Prototype group showed moderate integration (50%), while the Control group reported lower but notable integration rates (40%). These differences were statistically significant, χ²(3, N = 20) = 9.72, p < .021. 3.6.10 Cross-Question Analysis A notable pattern emerged when analyzing responses across all three questions. T showed the most consistent positive responses (100% across all questions), while the TP group maintained high but slightly variable positive response rates (83.3–100%). This suggests that both intervention approaches were highly effective in initiating and maintaining strength training behaviors, with the Training-only group showing marginally more consistent outcomes in this specific aspect. The CP and C showed more variable patterns across questions, with generally lower positive response rates. However, the relatively higher rates of strength training integration compared to initial adoption in these groups (CP: 50%, C: 40%) suggest some participants may have independently initiated strength training practices during the study period. 3.6.11 Statistical Significance Kruskal-Wallis tests revealed significant differences between groups in physical activity measures (H = 9.47, p < 0.05), emotional wellbeing (H = 8.92, p < 0.05), and overall impact (H = 7.83, p < 0.05). Post-hoc analyses using Dunn's test with Bonferroni correction confirmed significant differences between TP and Control groups across all major domains (p < 0.05). The reliability analysis yielded a Cronbach's alpha of 0.87, indicating good internal consistency of the measurement instruments. Effect sizes were particularly strong for the comparison between TP and Control groups across all thematic areas (d range: 0.65–0.89), suggesting robust intervention effects for the combined training and HPD approach. A detailed description of the questions and answers can be found in the appendix. 4. Discussion This follow-up investigation aimed to evaluate the sustainability of physiological adaptations 12–14 months post-intervention, examining changes in body composition, muscle morphology, muscular performance, and associated behavioral modifications and quality of life metrics [ 13 ]. The preservation of skeletal muscle mass and physical capacity represents a crucial factor in maintaining functional independence and mitigating metabolic dysfunction during postmenopausal status [ 10 , 44 ]. This investigation presents novel evidence demonstrating that postmenopausal women can maintain significant muscular adaptations, including skeletal muscle mass and strength, 12–14 months following a high-intensity 12-week resistance training intervention. Furthermore, the sustained adherence to resistance training protocols observed in both training groups resulted in continued improvements in skeletal muscle mass and strength parameters among participants who maintained training behaviors post-intervention. In the main study in the training groups a significantly increase of SMM, GS, BBS and DL could be observed. TP showed a significant increase in FFM and T showed a significant loss of FM. The longitudinal findings at 12–14 months post-intervention demonstrate significant retention of intervention-induced adaptations in key health parameters among postmenopausal women. These sustained improvements in physiological markers are particularly relevant for the mitigation of menopause-associated pathologies, including type 2 diabetes mellitus, sarcopenia, osteoporosis, and cardiovascular diseases[ 9 , 21 , 44 , 45 ]. In our main study a HPD results in a significant weight gain in the CP, caused by a hypercaloric diet that increased FM. Leaf et al. [ 46 ] reported equivocal findings regarding HPD overfeeding interventions, suggesting potential protein-mediated attenuation of muscle protein break down. Interestingly it turned out in our follow up measurements that at T2 none of the participants in the CP group continued with the HPD. In the TP group fat mas was not reduced by the training in the main study and this also not viable at T2. Mertz et al. [ 47 ] also support our results that recommending protein supplementation as a stand-alone intervention for healthy older individuals seems ineffective in improving muscle mass and strength, and it is recommended that future studies investigate strategies to increase long-term compliance to heavy resistance exercise in healthy older adults. The results of the ultrasound measurements on the lower body showed a consistency and correlation of the findings of TP and T on SMM, GS, BBS and DL. Theil Gylling et al. [ 48 ] observed partial maintenance of muscular strength at 12-month follow-up post supervised resistance training intervention, while independent continuous training demonstrated significantly elevated strength parameters at follow-up relative to baseline measurements. Notably, hypertrophic adaptations induced by high-intensity resistance training were not maintained at 12-month follow-up. Additionally, cross-sectional area (CSA) modifications from baseline to 12-month follow-up exhibited a trending differential response between high-intensity resistance training cohort and control subjects. These findings support our results regarding our training protocol and intensity. In our follow up investigating, a 57-item questionnaire was generated based on ht ethe SF 36 - questionnaire [ 28 , 29 ] to analyze changes in in behavior induced by the main intervention. To minimize the time factor, fifteen major items were analyzed. The SF-36 questionnaire has been extensively validated across diverse populations and health conditions, establishing it as one of the most reliable health-related quality of life measurement tools available to researchers and clinicians. The questionnaire demonstrates exceptional sensitivity to clinical changes over time, making it particularly valuable for monitoring treatment effects and disease progression in longitudinal studies. Numerous population norms have been established for the SF-36, allowing researchers to contextualize individual or group scores against relevant reference populations [ 49 , 50 ] By using the Likert – scale, aspects such as long-term lifestyle changes, impact of physical activity, nutrition knowledge and habits, emotional wellbeing and overall impact. Likert scales provide quantifiable data that can be readily analyzed using statistical methods, allowing researchers to draw meaningful conclusions. Likert scales offer standardized response options across all participants, which facilitates more reliable comparisons between groups or over time. They capture nuanced feedback by measuring degrees of opinion rather than forcing simple binary choices, providing a more accurate representation of respondents' attitudes. Research has shown that well-constructed Likert scales generally demonstrate good reliability when tested across multiple administrations[ 51 , 52 ]. Analyzing the questionnaire reveals important sustainable effects of the intervention. The TP showed the strongest improvements, the largest effect size to C and the highest impact on “willingness to engage in regular Physical activity” (Q8), better understanding of the role of protein (TP and T), strongest effect on wellbeing and the highest motivation to maintain a training routine. TP performed particularly strong in sustainable behavior change indicators. T showed over all moderate to strong effects, especially strong in physical activity measures. CP showed most consistent answers in nutrition knowledge. C presented the lowest overall scores and most variable responses. These results demonstrate that training interventions like practiced in our main study result in long lasting effects on live style behavior und underline the need to promote such interventions as standard procedures in the health care system to protect postmenopausal women against sarcopenia, osteoporosis and cardiovascular diseases. The health economic benefits of standardized training therapy under supervision in the context of 12 weeks with three training sessions per week of high-intensity RT could significantly reduce costs [ 53 ] and improve quality of life [ 16 ]. 4.1 Limitations In addition to the important and new findings, this study also has some limitations. One aspect is the current lack of standardization of ultrasound measurements in sports medicine contexts. Even though there are already initial position papers on the implementation of ultrasound measurements in clinical examinations [ 11 , 32 , 33 , 54 ] these can still be subjectively influenced. Therefore, the same person should perform both the initial and final measurements. In addition, another person should assist with the post-measurement to identify the exact location but should not measure the muscle thickness. Furthermore, the ultrasound results should only be used in correlation with other methods for muscle thickness and hypertrophy to confirm potential effects. A primary limitation of the follow-up study was the absence of dietary records for evaluating nutritional behaviors, as well as the lack of documented training protocols from the majority of participants during the post-intervention period. Another issue that might interfere with the results might be the use of hormone replacement therapy (HRT) after the main intervention, as well as the limited number of participants. Despite systematic recruitment efforts through multiple communication channels (electronic mail and telephone), the follow-up cohort comprised 20 participants from the original sample (n = 55), representing a significant attrition rate. This restricted sample size and potential selection bias may have implications for the interpretation of follow-up outcomes, with possible performance and information bias affecting the results. The implementation of the likert – scale Central tendency bias frequently affects Likert scale responses, as participants often avoid selecting extreme response categories and instead cluster their answers in the middle of the scale. Acquiescence bias presents another challenge, where some respondents tend to agree with statements regardless of their content, potentially skewing results toward the positive end. Social desirability bias can influence participants to choose responses they believe are socially acceptable rather than those that truly reflect their opinions. Likert scales provide limited depth of information, as they cannot capture the reasoning or context behind respondents' choices without additional open-ended questions. The ordinal nature of Likert data creates statistical limitations, sparking debate among researchers about whether such data should be treated as interval data for certain analyses. 5. Conclusion This follow-up investigation examined the long-term effects of RT utilizing free weights, combined with a HPD, on quality of life and program adherence following the primary intervention[ 13 ]. The findings demonstrate that a 12-week RT program with free weights elicited sustained positive adaptations in SMM, muscular strength, psychological well-being, and exercise adherence among postmenopausal women. The results indicate that a supervised resistance training intervention can produce sustainable strength improvements, addressing a critical gap in current healthcare provisions for this population. Acknowledgements and conflicts of interests The authors declare that they have no conflict of interest regarding the publication of this paper. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. The results of the present study do not constitute an endorsement by the German Sports University of Cologne. This study has no conflicts of interest to declare. Abbreviations The following abbreviations are used in this manuscript: FFM fat free mass FM fat mass SMM skeletal muscle mass HPD high protein diet T training group TP training + HPD group C control group CP control + HPD group 1 RM one repetition maximum BBS box back squat DL deadlift GS grip strength CSA cross sectional area HRT hormone replacement therapy Declarations Competing Interests The authors declare that they have no competing interests Funding No external funding Author Contribution Paulina Ioannidou published 2024 the main Study (www.sciencedirect.com/science/article/pii/S1279770724004366), the follow up was supported by Mr. Waldecker as a student who supported the measurements by the application of the BIA and the 1RM testings and gripstrength dynamometer. All Authors reviewed the manuscript. References Maltais, M. L., Desroches, J., and Dionne, I. J., “Changes in Muscle Mass and Strength after Menopause,” p. 12. Panotopoulos, G., Raison, J., Ruiz, J. 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K., Pourvaghar, M. J., Fang, Y., and Korivi, M., “Influence of Exercise Type and Duration on Cardiorespiratory Fitness and Muscular Strength in Post-Menopausal Women: A Systematic Review and Meta-Analysis,” Frontiers in Cardiovascular Medicine , Vol. 10, 2023, p. 1190187. https://doi.org/10.3389/fcvm.2023.1190187 Chomistek, A. K., Manson, J. E., Stefanick, M. L., Lu, B., Sands-Lincoln, M., Going, S. B., Garcia, L., Allison, M. A., Sims, S. T., LaMonte, M. J., Johnson, K. C., and Eaton, C. B., “Relationship of Sedentary Behavior and Physical Activity to Incident Cardiovascular Disease,” Journal of the American College of Cardiology , Vol. 61, No. 23, 2013, pp. 2346–2354. https://doi.org/10.1016/j.jacc.2013.03.031 Leaf, A., and Antonio, J., “The Effects of Overfeeding on Body Composition: The Role of Macronutrient Composition - A Narrative Review,” International Journal of Exercise Science , Vol. 10, No. 8, 2017, pp. 1275–1296. https://doi.org/10.70252/HPPF5281 Mertz, K. H., Reitelseder, S., Bechshoeft, R. L., Bulow, J., Højfeldt, G., Jensen, M., Schacht, S. R., Lind, M. V., Rasmussen, M. A., Mikkelsen, U. R., Tetens, I., Engelsen, S., Nielsen, D., Jespersen, A., and Holm, L., “The Effect of Daily Protein Supplementation, with or without Resistance Training for 1 Year, on Muscle Size, Strength, and Function in Healthy Older Adults: A Randomized Controlled Trial.,” The American journal of clinical nutrition , Vol. null, 2021, p. null. https://doi.org/10.1093/ajcn/nqaa372 Gylling, A., Bloch-Ibenfeldt, M., Eriksen, C., Ziegler, A. K., Wimmelmann, C. L., Baekgaard, M., Boraxbekk, C., Siebner, H., Mortensen, E. L., and Kjaer, M., “Maintenance of Muscle Strength Following a One-Year Resistance Training Program in Older Adults,” Experimental Gerontology , Vol. 139, 2020, p. null. https://doi.org/10.1016/j.exger.2020.111049 McCallum, J., “The SF-36 in an Australian Sample: Validating a New, Generic Health Status Measure,” Australian Journal of Public Health , Vol. 19, No. 2, 1995, pp. 160–166. https://doi.org/10.1111/j.1753-6405.1995.tb00367.x Jenkinson, C., Wright, L., and Coulter, A., “Criterion Validity and Reliability of the SF-36 in a Population Sample,” Quality of Life Research , Vol. 3, 1994, pp. 7–12. Norman, G., “Likert Scales, Levels of Measurement and the ‘Laws’ of Statistics,” Advances in Health Sciences Education , Vol. 15, No. 5, 2010, pp. 625–632. https://doi.org/10.1007/s10459-010-9222-y Harpe, S. E., “How to Analyze Likert and Other Rating Scale Data,” Currents in pharmacy teaching and learning , Vol. 7, No. 6, 2015, pp. 836–850. “Knochenbrüche Durch Osteoporose Verursachen Hohe Kosten,” Deutsches Ärzteblatt . Retrieved 10 February 2025. https://www.aerzteblatt.de/nachrichten/62470/Knochenbrueche-durch-Osteoporose-verursachen-hohe-Kosten Fu, H., Wang, L., Zhang, W., Lu, J., and Yang, M., “Diagnostic Test Accuracy of Ultrasound for Sarcopenia Diagnosis: A Systematic Review and Meta-analysis,” Journal of Cachexia, Sarcopenia and Muscle , Vol. 14, No. 1, 2023, pp. 57–70. https://doi.org/10.1002/jcsm.13149 Additional Declarations No competing interests reported. Supplementary Files AppendixAC.docx Cite Share Download PDF Status: Published Journal Publication published 05 Jan, 2026 Read the published version in Sport Sciences for Health → Version 1 posted Editorial decision: Revision requested 22 Sep, 2025 Reviews received at journal 12 Sep, 2025 Reviewers agreed at journal 15 Aug, 2025 Reviews received at journal 14 Aug, 2025 Reviewers agreed at journal 24 Jul, 2025 Reviewers invited by journal 24 Jul, 2025 Editor assigned by journal 21 Jul, 2025 Submission checks completed at journal 21 Jul, 2025 First submitted to journal 19 Jul, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7166443","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":501436777,"identity":"7d36e46b-a3cd-40ec-8fd2-0337f2962b94","order_by":0,"name":"Paulina Ioannidou","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5ElEQVRIiWNgGAWjYHACxgMJDAxyDMwMIMTAA8QGBPWAtBiTqAWIExsYIFoYCGoxZz9jcODhDrv07ewMbI8L2+pk+BmYNz7Ap8WyJ8fgQOKZ5NydzQzsxjPbDvNINrAV47XG4ABISxtz7obD/N+kedsO8Bgc4DGTwKvl/BuQlvp0g8MMbEAtdSAt5j/warkBtuVwAlQLM9gWfDoYLGc8KwBqOW4I9gvPOaBfmtmK8TrMnD9548OfbdXy5vwH2B7zlNXZ87M3b/yA12FIDDYGRjYGROwQp4XhDwHlo2AUjIJRMCIBAIvwRJtjgOtdAAAAAElFTkSuQmCC","orcid":"","institution":"German Sports University Cologne","correspondingAuthor":true,"prefix":"","firstName":"Paulina","middleName":"","lastName":"Ioannidou","suffix":""},{"id":501436778,"identity":"925cd579-f18b-4118-b62c-711b06fbef6b","order_by":1,"name":"Niklas Waldecker","email":"","orcid":"","institution":"German Sports University Cologne","correspondingAuthor":false,"prefix":"","firstName":"Niklas","middleName":"","lastName":"Waldecker","suffix":""},{"id":501436779,"identity":"57b7c22c-cf2f-4298-9d61-0ec662416049","order_by":2,"name":"Patrick Diel","email":"","orcid":"","institution":"German Sports University Cologne","correspondingAuthor":false,"prefix":"","firstName":"Patrick","middleName":"","lastName":"Diel","suffix":""}],"badges":[],"createdAt":"2025-07-19 20:38:08","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7166443/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7166443/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s11332-025-01582-9","type":"published","date":"2026-01-05T15:58:33+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":89394597,"identity":"92bebffe-a707-4440-b752-78e65381f9d0","added_by":"auto","created_at":"2025-08-19 13:35:35","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":66967,"visible":true,"origin":"","legend":"\u003cp\u003eChange in body composition: \u003cstrong\u003e(a) \u003c/strong\u003echanges over time of FFM,\u003cstrong\u003e(b) \u003c/strong\u003echanges over time of SMM, \u003cstrong\u003e(c) \u003c/strong\u003echanges over time of FM\u003c/p\u003e\n\u003cp\u003eTP= Training + Protein T=Training, CP= Control+Protein, C= control. TP= Training + Protein T=Training, CP= Control+Protein, C= control. Significant time and time*group effects were set p≤0.05. \u0026nbsp;Significant time effects were marked with # and time*group effects to C with * and to CP with $. Mean value with standard deviation are marked in black and individual curves in grey.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7166443/v1/129f14f203e005867d3ba087.png"},{"id":89399815,"identity":"22f75284-af17-4247-86a9-348158a56fb9","added_by":"auto","created_at":"2025-08-19 14:07:35","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":87834,"visible":true,"origin":"","legend":"\u003cp\u003eMuscle thickness of \u003cstrong\u003e(a)\u003c/strong\u003e M. rectus femoris, \u003cstrong\u003e(b)\u003c/strong\u003e M. biceps femoris, \u003cstrong\u003e(c)\u003c/strong\u003e M. biceps brachii, \u003cstrong\u003e(d)\u003c/strong\u003e M. triceps brachii\u003c/p\u003e\n\u003cp\u003eTP= Training + Protein T=Training, CP= Control + Protein, C= control. Significant time effects were marked with # and time*group effects to C with * and to CP with $. Mean value with standard deviation are marked in black and individual curves in grey. Mean value with standard deviation are marked in black and individual curves in grey.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7166443/v1/b5d07d28e121335896928f65.png"},{"id":89394600,"identity":"582ed799-f875-4ccf-bf4e-f5e37d28c82e","added_by":"auto","created_at":"2025-08-19 13:35:35","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":74395,"visible":true,"origin":"","legend":"\u003cp\u003eChanges in performance \u003cstrong\u003e(a)\u003c/strong\u003e Grip strength, \u003cstrong\u003e(b)\u003c/strong\u003e1-RM back squat, \u003cstrong\u003e(c)\u003c/strong\u003e 1-RM DL\u003c/p\u003e\n\u003cp\u003eTP= Training + Protein T=Training, CP= Control + Protein, C= control. Significant time and time*group effects were set p≤0.05. . Significant time effects were marked with # and time*group effects to C with * and to CP with $. Mean value with standard deviation are marked in black and individual curves in grey.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7166443/v1/886006aa88f4b528eaec00bf.png"},{"id":89394603,"identity":"7a8aa91c-f779-49b2-935f-71c0125f91cf","added_by":"auto","created_at":"2025-08-19 13:35:35","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":50583,"visible":true,"origin":"","legend":"\u003cp\u003eOverall score distribution by group on the modified Likert – scale questionnaire. TP= Training + Protein T=Training, CP= Control+Protein, C= control.\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-7166443/v1/2c243427f7ed2cba92863ba9.png"},{"id":89394601,"identity":"129edfbe-c84b-4e6a-ba14-8fa06a8211d2","added_by":"auto","created_at":"2025-08-19 13:35:35","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":21308,"visible":true,"origin":"","legend":"\u003cp\u003eUnnumbered image in the Materials and Methods section.\u003c/p\u003e","description":"","filename":"file.png","url":"https://assets-eu.researchsquare.com/files/rs-7166443/v1/4fd78dea09140d131a302b86.png"},{"id":100070421,"identity":"f018bdc1-d494-4953-83cd-3080c1a82889","added_by":"auto","created_at":"2026-01-12 16:17:45","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1578630,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7166443/v1/bc83dc2d-28b4-4e58-866a-44aa122c92a9.pdf"},{"id":89394599,"identity":"8f8cbb7e-3067-4dc6-a019-1356005eb54b","added_by":"auto","created_at":"2025-08-19 13:35:35","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":110357,"visible":true,"origin":"","legend":"","description":"","filename":"AppendixAC.docx","url":"https://assets-eu.researchsquare.com/files/rs-7166443/v1/1813c3de5e7499310453476b.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eA follow up evaluation of the sustainability of a 12 - week resistance training and high protein diet on body composition, strength, muscle thickness, compliance and well-being after one year on postmenopausal women\u003c/p\u003e","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eMenopause is a significant phase in a woman's life that brings about various musculoskeletal changes, particularly affecting fat-free mass, skeletal muscle mass, and bone density. During menopause, there is a notable decline in bone mineral density (BMD), a major concern due to its association with increased fracture risk. This decline is often linked to hormonal changes, particularly the reduction in estrogen levels, which also leads to a decrease in lean body mass and an increase in fat mass[\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The transition through menopause is characterized by a decrease in lean mass, which includes skeletal muscle mass. This reduction in muscle mass is partly due to hormonal changes and is exacerbated by low physical activity and inadequate protein intake, contributing to sarcopenia and loss of strength[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Physical activity has been shown to have a potential mitigating effect on the loss of muscle and bone mass during menopause, although its exact role remains partly unresolved[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eResistance training has been shown to be effective in improving various outcomes in post-menopausal women. Multiple studies have found that resistance training can lead to increases in muscular strength[\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Additionally, resistance training has been found to positively impact body composition, including increases in muscle mass and decreases in fat mass [\u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eBeyond physical outcomes, resistance training has also been shown to have benefits for post-menopausal women's quality of life and menopausal symptoms. Several studies reported improvements in sleep quality vasomotor symptoms like hot flashes and overall quality of life following resistance training interventions[\u003cspan additionalcitationids=\"CR15 CR16\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eMoreover, Leite et al. highlighted that resistance training can counteract physiological alterations associated with menopause, promoting better quality of life through improvements in muscular, bone, and adipose tissue health [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. The quality of life in postmenopausal women can be significantly enhanced through resistance training. Berin et al. found that resistance training positively affected the quality of life in postmenopausal women experiencing vasomotor symptoms, suggesting that such exercise regimens can alleviate some of the discomfort associated with menopause [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Furthermore, Ağıl et al. noted that exercise, including resistance training, contributes to improved psychological health and overall quality of life in postmenopausal women[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. This aligns with findings from Dąbrowska et al., who reported improvements in quality of life following a 12-week exercise training program, although the statistical significance of these improvements varied [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn summary there is clear evidence that resistance training has beneficial effects on the health and quality of life of postmenopausal woman. Here the tipping point is focusing on the sustainability of training interventions. The number of long-term follow-up studies on postmenopausal populations is limited. Follow-up studies are mostly focused on a general (male and female) older population. Mertz et al. observed that one year of resistance training significantly increased muscle and strength mass in older adults[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. These gains were largely maintained during a 1-year follow-up period without structured training, providing evidence for long-term benefits. Effects of socialization and familiarization may have facilitated the maintenance of exercise habits after the intervention. Bloch-Ibenfeldt et al. investigated the long-term effects of heavy resistance training in individuals of retirement age. This randomized controlled trial (RCT) demonstrated that heavy resistance training produced beneficial effects on muscle strength that persisted for four years after the intervention. The research is significant as it provides evidence for the lasting impact of resistance training interventions in older populations, specifically examining outcomes over a substantial follow-up period [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn our own study we have investigated the impact of a 12 - week resistance training and high protein diet on body composition, strength and muscle thickness, in postmenopausal women in a randomized controlled trial. Participants were divided into groups that either engaged in a structured free weight resistance training program, adhered to a high-protein diet, or both. The study lasted for 12 weeks, during which various metrics were measured, including body composition (FFM, SMM, FM) and strength capacity (GS, BBS, DL). The results indicated that the combination of resistance training and a high-protein diet yielded the most significant improvements in both body composition and strength capacity compared to either intervention alone.\u003c/p\u003e\u003cp\u003eIn this follow up we have now evaluated the sustainability of this intervention. In a subpopulation, we determined same parameters like in the main study one year later again and investigated individual training and nutrition behavior.\u003c/p\u003e"},{"header":"2. Material and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e2.1 Participants\u003c/h2\u003e\u003cp\u003eThis study reports secondary analysis of the previous study \u0026ldquo;Analysis of combinatory effects of free weight resistance training and a high-protein diet on body composition and strength capacity in postmenopausal women - A 12-week randomized controlled trial\u0026rdquo;[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. To re-evaluate the benefits of a 12-week RT and HPD one year after the main intervention, 20 of prior 55 participants could be re-recruited equally in proportion to the prior group sizes. TP included 6 participants, T recruited 5 participants, CP only 4 and C recruited 5 participants. To determine the sample size a power analysis (F-tests, ANOVA Fixed effects, special, main effects, and inter-action) was performed a priori. For the calculation, a medium to strong effect (f) (0.25\u0026ndash;0.40), an α-error of 0.05, and a power of 0.8 (1-β error) were specified based on previous studies with similar study design and parameters [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Based on the previous study all participants completed health history questionnaires and signed a consent form to evaluate potential exclusion and inclusion criteria. The classification of the participants as postmenopausal was verified and based on low E2 (estradiol) and low P4 (progesterone), as well as their last menstruation beyond two years on the previous study[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eTo evaluate the compliance of training post intervention and the potential health benefits of the intervention, a 57 \u0026ndash; item questionnaire based on the SF 36[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. The evaluation of the 15 \u0026ndash; item questionnaire was performed through Cronbach\u0026rsquo;s alpha, Kruskal-Wallis and Chi Square.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e2.2 Experimental design \u0026ndash; study design\u003c/h2\u003e\u003cp\u003e The main study was approved by the local ethics committee of the German Sports University Cologne, Cologne, Germany (22/2022) according to the Declaration of Helsinki and registered in the German Registry of Clinical Studies (17/02/2022; DRKS00023826). The study design consisted of a four-arm model. The groups are divided into two training groups and two groups without training. The participants were randomly assigned during the prior study to either the training group with a high-protein diet (TP), the training group without dietary requirements (T), the control group with a high-protein diet (CP) or the control group without dietary requirements (C). The follow up intended to re-recruite as much participants as possible 12 to 14 months after the main intervention via E-Mail and telephone. 22 participants answered, 20 of them came to participate on the following reevaluation of data. To maintain the same standardized procedure each participant underwent the same measurements excluding the blood and saliva samples for the classification of the menopausal state. All tests were carried out in the morning, rested and in a fasted state between 9.00 and 10.00 am. To maintain the reliability of the BIA all participants had to drink 300\u0026ndash;500 ml water after getting up in the morning. The follow-up tests proceeded as follows:\u003c/p\u003e\u003cp\u003eStation A: Measurement of body weight and body composition\u003c/p\u003e\u003cp\u003eStation B: Muscle thickness measurement via ultrasound analysis\u003c/p\u003e\u003cp\u003eStation C: Static grip strength via dynamometer\u003c/p\u003e\u003cp\u003eStation D: Dynamic maximum strength box back squat (BBS)\u003c/p\u003e\u003cp\u003eStation E: Dynamic maximum strength deadlift (DL)\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003e2.3 Bodyweight and body composition\u003c/h2\u003e\u003cp\u003eThe bodyweight was measured via Seca body scale (kg) (Seca 813 \u0026ndash; Seca Deutschland 22089 Hamburg) and the height with a Seca wall measuring tape. The bodyweight and height are measured in underwear. Body composition was determined via bio-impedance analysis (BIA) (Juwell 600 \u0026ndash; Body Explorer Premium Health Conceps Firma Siegfried Moln\u0026aacute;r A-7000 Eisenstadt). The body composition included the measuring of the total body water (TBW), FFM, SMM and FM [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003e2.4 Muscle thickness\u003c/h2\u003e\u003cp\u003eTo reevaluate the muscle thickness and determine the visual value measurements were performed with a handheld B-Mode ultrasound and 12 MHz linear probe (VScan Air\u0026trade;, GE Healthcare Chicago, Illinois)[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. The standardization for four measuring points, M. rectus femoris (RF), M. biceps femoris (BF), M. triceps brachii (TB) and M. biceps brachii (BB) was dimensioned by 50% of the following stretch by using a waterproof marker: The RF and BB were measured with the participants lying supine. For the RF, palpating the spina iliaca anterior inferior and proximal border of the patella and taking 50% of the distance (gain 50db; image depth 4.5 cm). The BB was measured by 50% of the length starting from\u003c/p\u003e\u003cp\u003ethe anterior acromion to the radius head (gain 50db; image depth 4.5 cm). For measurements of the BF and TB, the participants lay in a prone position. The BF distance was measured by the distance of 50% of the caudal sciatic tuber to the lateral head of the fibula (gain 50 db; image depth 6 cm). The TB was measured at 50% from the laterodorsal part of the acromion to the proximal palpation of the olecranon (gain 50 db; image depth 4.5 cm). Following the Delphi-Based Consensus Statement[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e] muscle measurements, we applied the ultrasound transmission gel to the transducer, pointing the transducer marker cranial, longitudinal on the extremity. The Probe did not apply pressure on the underlying tissue while maintaining a 90 angle to the muscle. The images were recorded and reviewed by OsiriXLite (Pixmeo SARL, 266 Rue de Bernex, CH-1233 Bernex, Switzerland).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003e2.5 Grip strength - dynamometer\u003c/h2\u003e\u003cp\u003eAfter ultrasound analyses, static grip strength was measured. A grip strength (GS) dynamometer was used for the static strength test. Using the given standardized protocol for GS hand-held dynamometer (digital Jamar+, Fabrication Enterprises, New York, United States) through previous studies[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. The participants were seated upright on a chair, placing the elbow of the tested hand 90 bent in contact to the body. The instructions were clearly defined by pressing maximally for five seconds, three repetitions, and a rest period of 120 s for the right side. GS was performed before the lifts to avoid muscular fatigue of the hand flexors. The GS replaces the testing of the other exercises but can still provide valid information about a potential increase in GS in the respective groups.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003e2.6 Dynamic strength test\u003c/h2\u003e\u003cp\u003eFor dynamic strength, the one repetition maximum (1 RM) in BBS (50.8 cm) and DL were evaluated. Participants started with the BBS and a technical barbell was used to facilitate the back squat technique\u003c/p\u003e\u003cp\u003e(Technique Barbell Aluminium-Steel SQMIZE1 OB72ALS7.5, 7.5 KG \u0026ndash; Simple Products GmbH, Seevetal). The standardized height for the squat was a 50.8 cm (20 inch) box for the 1 RM testing.\u003c/p\u003e\u003cp\u003eAfter the 1 RM BBS test, the 1 RM in DL was performed. For the warm- up and to verify the technical requirements, kettlebells from 6 20 kg (Rogue Fitness Europe - Pori) to the 20 kg Barbell (Eleiko XF Bar, Eleiko Sweden Stockholm) were used. Subsequently, a standardized barbell (20 kg, Eleiko XF Bar Sweden Stockholm) and weight plates (Eleiko XF bumper plate diameter is 450 mm, Eleiko Sweden Stockholm) were used for the maximum strength test. The maximum strength test (1 RM) was performed modified after the NSCA guide to tests and assessments[\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. A 5-minute standardized warm-up included air squats and a DL technique with an empty barbell or kettlebell. The weight is progressively increased and raised to the 1RM. Here an individual increase is made, current values of the NSCA are not representative of an untrained population of postmenopausal women. A target increase of 5\u0026ndash;10% is aimed to avoid potential overload[\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003e2.7 Questionnaire\u003c/h2\u003e\u003cp\u003eThe re-recruited participants completed a 57-Item questionnaire manually or digitally after the measurements and tests. To emphasize the main characteristics 15 questions were selected for the evaluation including the topics of physical activity, nutrition knowledge, emotional wellbeing and overall impact of the previous intervention, a detailed description of the questions and answers can be found in the appendix. 12 of these 15 items were categorized in to a 5-point Likert scale[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e], 3 items consisted of a dichotomous (yes/no) question setting, providing additional insight into the intervention\u0026acute;s effectiveness.\u003c/p\u003e\u003cp\u003eFour questions targeted the impact of physical activity of the intervention, three questions targeted the nutritional knowledge and potential change of nutrition due to the intervention. The emotional wellbeing post intervention was asked by three questions and the overall impact of the intervention on two questions.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003e2.8 Statistical analysis\u003c/h2\u003e\u003cp\u003eThe statistical analysis was performed with SPSS (IBM Inc., Chigaco, Ill. - Version 29.0.0). All dependent variables were tested checked for normal distribution as well as variance homogeneity. Visualizations were performed with PRISM (Graphpad Inc. California, USA - Version10.4.0), R and R-Studio (Version 2024.09.1\u0026thinsp;+\u0026thinsp;394). The Variables BW, FFM, SMM, FM, GS, BBS, DL, RF, BF, BB and TB\u003c/p\u003e\u003cp\u003ewere analyzed using a mixed ANOVA model. Comparing all three time points (T0-T2, T1-T2, excluding T0-T1) for potential interactions. The effect size was categorized according to Rhea's classification for\u003c/p\u003e\u003cp\u003euntrained, recreationally trained and highly trained[\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. As all participants were not experienced in strength training at the beginning, the following classification for untrained was used: trivial: \u0026lt;0.5; small:0.5\u0026ndash;1.25; moderate: 1.25\u0026ndash;2.0; high: \u0026gt;2.0.\u003c/p\u003e\u003cp\u003eThe evaluation of the questionnaire regarding consistency was calculated via Cronbach\u0026rsquo;s Alpha[\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e], and Kruskal - Wallis - Test[\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e] to measure group differences on topics specific.\u003c/p\u003e\u003cp\u003eIn addition, the effect size for significant time effects was calculated according to Cohen's d[\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. The effect size was categorized according to Rhea's classification for untrained, recreationally trained and highly trained[\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. As all participants were not experienced in strength training at the beginning, the following classification for untrained was used: trivial: \u0026lt;0.5; small: 0.5 1.25; moderate: 1.25 2.0; high: \u0026gt;2.0. To assess the reliability of the questionnaire Cronbach\u0026rsquo;s Alpha was performed and set as α\u0026thinsp;\u0026ge;\u0026thinsp;0.9: Excellent internal consistency, 0.8\u0026thinsp;\u0026le;\u0026thinsp;α\u0026thinsp;\u0026lt;\u0026thinsp;0.9: Good internal consistency, 0.7\u0026thinsp;\u0026le;\u0026thinsp;α\u0026thinsp;\u0026lt;\u0026thinsp;0.8: Acceptable internal consistency, 0.6\u0026thinsp;\u0026le;\u0026thinsp;α\u0026thinsp;\u0026lt;\u0026thinsp;0.7: Questionable internal consistency and α\u0026thinsp;\u0026lt;\u0026thinsp;0.6: Poor internal consistency. Fifteen questions were chosen from the primary questionnaire consisting mainly referring to our interest.\u003c/p\u003e\u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003e3.1 Baseline characteristics\u003c/h2\u003e\u003cp\u003eThe baseline characteristics (T2) of the participants in the individual group are shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBaseline Characteristics\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGroup\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTP (n\u0026thinsp;=\u0026thinsp;6)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eT (n\u0026thinsp;=\u0026thinsp;5)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eCP (n\u0026thinsp;=\u0026thinsp;4)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eC (n\u0026thinsp;=\u0026thinsp;5)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge (years)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e55.8\u0026thinsp;\u0026plusmn;\u0026thinsp;3.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e60.6\u0026thinsp;\u0026plusmn;\u0026thinsp;6.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e56.0\u0026thinsp;\u0026plusmn;\u0026thinsp;6.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e62.2\u0026thinsp;\u0026plusmn;\u0026thinsp;4.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHeight (cm)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e163.0\u0026thinsp;\u0026plusmn;\u0026thinsp;6.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e164.0\u0026thinsp;\u0026plusmn;\u0026thinsp;5.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e170.0\u0026thinsp;\u0026plusmn;\u0026thinsp;8.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e163.6\u0026thinsp;\u0026plusmn;\u0026thinsp;6.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBodyweight (kg)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e74.0\u0026thinsp;\u0026plusmn;\u0026thinsp;11.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e67.8\u0026thinsp;\u0026plusmn;\u0026thinsp;7.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e73.2\u0026thinsp;\u0026plusmn;\u0026thinsp;6.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e69.7\u0026thinsp;\u0026plusmn;\u0026thinsp;13.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003e3.2 Body composition\u003c/h2\u003e\u003cdiv id=\"Sec14\" class=\"Section3\"\u003e\u003ch2\u003e3.2.1 Bodyweight (BW)\u003c/h2\u003e\u003cp\u003eThere was a significant change over time (T0-T2) in TP (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) and in CP (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). No significant time*group interaction (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05) was observed. (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Changes (group *time) between T1 and T2 were only negatively impacted to the C group with a significant decrease in BW (T1-T2) to CP (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) and TP (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.008). Time effects showed a significant decrease in BW over time (T1-T2) in T (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), and C (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05)\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section3\"\u003e\u003ch2\u003e3.2.2 Fat-free mass (FFM)\u003c/h2\u003e\u003cp\u003eA significant change over time (T0-T2) was observed in the TP (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01). No significant change over time was observed in the FFM. A time*group difference was found between TP to T (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), CP (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and C (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). No further time*group differences could be determined. Time and group interactions showed a significant decrease in CP towards TP (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) and T (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). CP showed a significant decrease in FFM over time (T1-T2) (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.004) and C a slight but significant increase (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05)(Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003ea).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section3\"\u003e\u003ch2\u003e3.2.3 Skeletal muscle mass (SMM)\u003c/h2\u003e\u003cp\u003eTP and T increased significantly SMM over time (T0-T2) (TP: \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05, T: \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01). For CP no significant effect was detected (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). In C no significant change was observed (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Pairwise comparisons of the ∆\u0026acute;s showed a significant difference between TP to T (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01) and to CP (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Also, T has a significant time*group effect to CP (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and C \u003cem\u003e(p\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01). No significant difference was observed between TP and T (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05) Group and time interactions showed significant increases in T towards TP (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.5) and CP (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Effects over time (T1-T2) showed a significant increase in T (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.016) a high significant decrease in CP (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.004) and significant increase in C (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.027). Moderate and high positive effect sizes were observed in TP between T0 \u0026ndash; T2 (d\u0026thinsp;=\u0026thinsp;1.0) and T between T0-T2 (d\u0026thinsp;=\u0026thinsp;2.33), as well as T between T1-T2 (d\u0026thinsp;=\u0026thinsp;0.87) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eb).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section3\"\u003e\u003ch2\u003e3.2.4 Fat mass (FM)\u003c/h2\u003e\u003cp\u003eT showed a significant decrease in FM (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and CP a significant increase (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). No significant change over time (T0-T2) was observed in any of the other groups. A time*group difference was detected between TP to T (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and CP (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01) as well T to CP (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and C (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Another significant interaction was observed between CP and C (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Group Time interactions showed no changes in T1-T2. TP showed a significant increase of FM (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.029), T a significant decrease of FM (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.12) between T1-T2 (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003ec).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eTP\u0026thinsp;=\u0026thinsp;Training\u0026thinsp;+\u0026thinsp;Protein T\u0026thinsp;=\u0026thinsp;Training, CP\u0026thinsp;=\u0026thinsp;Control\u0026thinsp;+\u0026thinsp;Protein, C\u0026thinsp;=\u0026thinsp;control. TP\u0026thinsp;=\u0026thinsp;Training\u0026thinsp;+\u0026thinsp;Protein T\u0026thinsp;=\u0026thinsp;Training, CP\u0026thinsp;=\u0026thinsp;Control\u0026thinsp;+\u0026thinsp;Protein, C\u0026thinsp;=\u0026thinsp;control. Significant time and time*group effects were set p\u0026thinsp;\u0026le;\u0026thinsp;0.05. Significant time effects were marked with # and time*group effects to C with * and to CP with \u003cspan\u003e$\u003c/span\u003e. Mean value with standard deviation are marked in black and individual curves in grey.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003e3.3 Muscle thickness\u003c/h2\u003e\u003cp\u003eAll visualizations of the sonographic measurements are listed in the appendix.\u003c/p\u003e\u003cdiv id=\"Sec19\" class=\"Section3\"\u003e\u003ch2\u003e3.3.1 M. rectus femoris\u003c/h2\u003e\u003cp\u003eOnly TP showed a significant increase over time (T0-T2) (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Pairwise comparisons of the ∆\u0026acute;showed significant differences between TP to T (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01) and C (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01) as well CP to C (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Only CP showed a significant decrease over time (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003ea).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec20\" class=\"Section3\"\u003e\u003ch2\u003e3.3.2 M. biceps femoris\u003c/h2\u003e\u003cp\u003eBoth trained groups TP and T showed a highly significant increase (T0-T2) (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01) over time. Pairwise comparisons of the ∆\u0026acute;showed significant differences between TP to C (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01), T to C \u003cem\u003e(p\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and CP to C (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Group*time interactions were observed in T1 \u0026ndash; T2 between T to C (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) and CP to C (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Moderate to high effect sizes were observed in TP betweenT0-T2 (d\u0026thinsp;=\u0026thinsp;1.28) and T1-T2 (d\u0026thinsp;=\u0026thinsp;0.92), in T between T0-T2 (d\u0026thinsp;=\u0026thinsp;2.39) and T1-T2 (d\u0026thinsp;=\u0026thinsp;1.03) and CP between T0-T2 (d\u0026thinsp;=\u0026thinsp;0.95). Significant positive changes were observed over time (T1-T2) in TP (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), in T (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.013) and CP (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eb).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec21\" class=\"Section3\"\u003e\u003ch2\u003e3.3.3 M. biceps brachii\u003c/h2\u003e\u003cp\u003eThere was no significant change over time(T0-T2) in any group. Comparisons of the ∆\u0026acute;s showed significant differences between TP to CP (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01) and TP to C (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01). No significant difference was observed between TP and T (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Moderate to high effect sizes were observed in TP betweenT0-T2 (d\u0026thinsp;=\u0026thinsp;0.83) and CP between T0-T2 (d\u0026thinsp;=\u0026thinsp;2.82) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003ec).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec22\" class=\"Section3\"\u003e\u003ch2\u003e3.3.4 M. triceps brachii\u003c/h2\u003e\u003cp\u003eOnly a significant decrease was shown on the T group (T0-T2) (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). All other groups showed no significant change over time (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Comparisons of the ∆\u0026acute;s showed significant differences between TP to T (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) and TP to C (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). No significant difference was observed between TP and CP (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Negative changes over time were observed (T1-T2) in T (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) and CP (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003ed).\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec23\" class=\"Section2\"\u003e\u003ch2\u003e3.4 Static Strength\u003c/h2\u003e\u003cdiv id=\"Sec24\" class=\"Section3\"\u003e\u003ch2\u003e3.4.1 Grip strength\u003c/h2\u003e\u003cp\u003eTP and T increased their GS significantly over time (TP: \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05, T: \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Pairwise comparisons of the ∆\u0026acute;s showed a significant difference from TP to C and (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01). T showed significant changes to CP (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01) and C (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). No significant difference was observed between TP and T (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). High effect sizes were observed in TP and T between T0-T2 (TP: d\u0026thinsp;=\u0026thinsp;1.14, T: d\u0026thinsp;=\u0026thinsp;1.23). A significant increase over time T1-T2 was only observed in C (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003ea).\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec25\" class=\"Section2\"\u003e\u003ch2\u003e3.5 Dynamic strength\u003c/h2\u003e\u003cdiv id=\"Sec26\" class=\"Section3\"\u003e\u003ch2\u003e3.5.1 1RM BBS\u003c/h2\u003e\u003cp\u003eTP, T showed a significant increase in BBS over time (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01). CP also increased significantly the BBS performance over time (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). C showed no significant changes over time (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;\u003cem\u003e0.05\u003c/em\u003e). Pairwise comparisons of the ∆\u0026acute;s showed significant differences between TP to CP and C (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), T to C and CP (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01). No significant difference was observed between TP and T, and CP to C (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). A group*time interaction was only observed in TP to T (\u003cem\u003ep\u0026thinsp;\u0026lt;\u003c/em\u003e\u0026thinsp;0.05\u003cem\u003e).\u003c/em\u003e High effect sizes were observed in both TP and T between T0-T2 (TP: d\u0026thinsp;=\u0026thinsp;2.28, T: d\u0026thinsp;=\u0026thinsp;3.33). Significant decreases over time were only observed in T (T1-T2) (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.008) (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eb).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec27\" class=\"Section3\"\u003e\u003ch2\u003e3.5.2 1RM DL\u003c/h2\u003e\u003cp\u003eBoth training groups significantly increased DL performance over time (TP: p\u0026thinsp;\u0026lt;\u0026thinsp;0.05, T: p\u0026thinsp;\u0026lt;\u0026thinsp;0,01). CP and C showed no significant changes over time\u003cem\u003e(p\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;\u003cem\u003e0.05\u003c/em\u003e). Pairwise comparisons of the ∆\u0026acute;s showed significant differences between TP to C (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Group T showed significant differences to CP (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01) and C (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). CP showed significant differences to C (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). No significant difference was observed between TP and T (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Moderate to high effect sizes were observed between T0-T2 in TP (d\u0026thinsp;=\u0026thinsp;1.85), T (d\u0026thinsp;=\u0026thinsp;4.78) and CP (d\u0026thinsp;=\u0026thinsp;1.12). Significant decreases over time were only observed in T (T1-T2) (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003ec).\u003c/p\u003e\u003cp\u003eAll absolute values and changes for body composition, muscle thickness and performance are shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e in the appendix.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMeans\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviations separated by groups, as well as differences (Δ) between T0 and T2, levels of significance (sign.) and effect sizes (ES -Cohens D) of all measurements in body composition (BW, FFM, SMM, FM), muscle thickness (RF, BB, TB, BF), grip strength, 1-RM BBS, 1-RM DL. The significance was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05, time effects are market with #; time*group interaction to C with * and CP with \u003cspan\u003e$\u003c/span\u003e.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"15\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c14\" colnum=\"14\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c15\" colnum=\"15\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"6\" nameend=\"c7\" namest=\"c2\"\u003e\u003cp\u003eTP\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"7\" nameend=\"c15\" namest=\"c9\"\u003e\u003cp\u003eT\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eT0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eT1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eT2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eΔ T0-T1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eΔ T1-T2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eD T0-T2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eD T1-T2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eT0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eT1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eT2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003eΔ T0-T1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003eΔ T1-T2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003eD T0-T2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003eD T1-T2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBW (kg)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e71.3\u0026thinsp;\u0026plusmn;\u0026thinsp;11.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e74.2\u0026thinsp;\u0026plusmn;\u0026thinsp;11.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e74.0\u0026thinsp;\u0026plusmn;\u0026thinsp;11.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.3\u0026thinsp;\u0026plusmn;\u0026thinsp;2.4*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.0\u0026thinsp;\u0026plusmn;\u0026thinsp;2.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0,3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e68.9\u0026thinsp;\u0026plusmn;\u0026thinsp;9.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e67.3\u0026thinsp;\u0026plusmn;\u0026thinsp;6.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e67.8\u0026thinsp;\u0026plusmn;\u0026thinsp;7.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e-1.1\u0026thinsp;\u0026plusmn;\u0026thinsp;3.5\u003cspan\u003e$\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e-2.1\u0026thinsp;\u0026plusmn;\u0026thinsp;4.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e0,1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;0.25\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFFM (kg)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e46.2\u0026thinsp;\u0026plusmn;\u0026thinsp;2.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e47.6\u0026thinsp;\u0026plusmn;\u0026thinsp;2.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e47.7\u0026thinsp;\u0026plusmn;\u0026thinsp;2.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8*\u003cspan\u003e$\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-0.3\u0026thinsp;\u0026plusmn;\u0026thinsp;2.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0,6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;0.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e45.7\u0026thinsp;\u0026plusmn;\u0026thinsp;3.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e52.9\u0026thinsp;\u0026plusmn;\u0026thinsp;2.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e44.8\u0026thinsp;\u0026plusmn;\u0026thinsp;4.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e-0.8\u0026thinsp;\u0026plusmn;\u0026thinsp;2.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e-0.9\u0026thinsp;\u0026plusmn;\u0026thinsp;2.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e0,2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;0.25\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSMM (kg)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e19.2\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e20.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9\u003cspan\u003e$\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-0.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;0.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e19.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e24.4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e22.2# \u0026plusmn; 1.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e2.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5*\u003cspan\u003e$\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e1.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e2,3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e0.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFM (kg)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e26.8\u0026thinsp;\u0026plusmn;\u0026thinsp;10.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e26.6\u0026thinsp;\u0026plusmn;\u0026thinsp;9.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e26.6\u0026thinsp;\u0026plusmn;\u0026thinsp;10.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-0.2\u0026thinsp;\u0026plusmn;\u0026thinsp;2.1\u003cspan\u003e$\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.2\u0026thinsp;\u0026plusmn;\u0026thinsp;2.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e25.1\u0026thinsp;\u0026plusmn;\u0026thinsp;11.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e14.5\u0026thinsp;\u0026plusmn;\u0026thinsp;5.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e18.5# \u0026plusmn; 10.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e-6.6\u0026thinsp;\u0026plusmn;\u0026thinsp;2.1*\u003cspan\u003e$\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e-2.9\u0026thinsp;\u0026plusmn;\u0026thinsp;2.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e0,6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;0.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRF (cm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.9\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0,6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e2.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e2.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e2.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e-0.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e0,1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;0.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBF (cm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.9\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.7# \u0026plusmn; 0.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1,3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1.9\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e2.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e3.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e1.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e0.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e2,4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e1.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBB (cm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.5# \u0026plusmn; 0.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-0.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0,8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;0.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e2.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e2.4\u0026thinsp;\u0026plusmn;\u0026thinsp;2.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e2.4# \u0026plusmn; 0.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e-0.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e0,3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;0.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTB (cm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0,3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e2.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e3.2\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e2.6# \u0026plusmn; 1.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e-0.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e-0.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e0,3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;0.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGS (kg)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e30.1\u0026thinsp;\u0026plusmn;\u0026thinsp;2.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e34.3\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e33.8\u0026thinsp;\u0026plusmn;\u0026thinsp;3.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3.7\u0026thinsp;\u0026plusmn;\u0026thinsp;4.1*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-0.6\u0026thinsp;\u0026plusmn;\u0026thinsp;3.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1,2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;0.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e26.8\u0026thinsp;\u0026plusmn;\u0026thinsp;3.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e31.1\u0026thinsp;\u0026plusmn;\u0026thinsp;3.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e31.9\u0026thinsp;\u0026plusmn;\u0026thinsp;4.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e5.3\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6*\u003cspan\u003e$\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e0.8\u0026thinsp;\u0026plusmn;\u0026thinsp;2.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e1,2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e0.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1-RM BBS (kg)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e53.8\u0026thinsp;\u0026plusmn;\u0026thinsp;14.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e97.5\u0026thinsp;\u0026plusmn;\u0026thinsp;6..8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e97.9\u0026thinsp;\u0026plusmn;\u0026thinsp;23.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e44.0\u0026thinsp;\u0026plusmn;\u0026thinsp;19.9*\u003cspan\u003e$\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.4\u0026thinsp;\u0026plusmn;\u0026thinsp;21.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2,3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e36.5\u0026thinsp;\u0026plusmn;\u0026thinsp;6.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e73.0\u0026thinsp;\u0026plusmn;\u0026thinsp;8.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e63.5\u0026thinsp;\u0026plusmn;\u0026thinsp;9.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e27.0\u0026thinsp;\u0026plusmn;\u0026thinsp;7.4*\u003cspan\u003e$\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e-9.5\u0026thinsp;\u0026plusmn;\u0026thinsp;8.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e3,3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;0.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1-RM DL (kg)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e59.3\u0026thinsp;\u0026plusmn;\u0026thinsp;4.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e86.3\u0026thinsp;\u0026plusmn;\u0026thinsp;6.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e81.7\u0026thinsp;\u0026plusmn;\u0026thinsp;16.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e22.3\u0026thinsp;\u0026plusmn;\u0026thinsp;20.5*\u003cspan\u003e$\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-4.6\u0026thinsp;\u0026plusmn;\u0026thinsp;15.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1,9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;0.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e41.0\u0026thinsp;\u0026plusmn;\u0026thinsp;4.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e66.5\u0026thinsp;\u0026plusmn;\u0026thinsp;7.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e61.0\u0026thinsp;\u0026plusmn;\u0026thinsp;4.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e20.0\u0026thinsp;\u0026plusmn;\u0026thinsp;3.5*\u003cspan\u003e$\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e-5.5\u0026thinsp;\u0026plusmn;\u0026thinsp;5.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e4,8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;0.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"15\"\u003eC\u0026thinsp;=\u0026thinsp;control; CP\u0026thinsp;=\u0026thinsp;Control\u0026thinsp;+\u0026thinsp;Protein. D\u0026thinsp;=\u0026thinsp;Cohens\u0026rsquo; D; T\u0026thinsp;=\u0026thinsp;Training; TP\u0026thinsp;=\u0026thinsp;Training\u0026thinsp;+\u0026thinsp;Protein; Significant time and time*group effects were set p\u0026thinsp;\u0026lt;\u0026thinsp;0.05. Time effects were marked with # and time*group effects to C with * and CP with $\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eTP\u0026thinsp;=\u0026thinsp;Training\u0026thinsp;+\u0026thinsp;Protein T\u0026thinsp;=\u0026thinsp;Training, CP\u0026thinsp;=\u0026thinsp;Control\u0026thinsp;+\u0026thinsp;Protein, C\u0026thinsp;=\u0026thinsp;control. Significant time and time*group effects were set p\u0026thinsp;\u0026le;\u0026thinsp;0.05.. Significant time effects were marked with # and time*group effects to C with * and to CP with \u003cspan\u003e$\u003c/span\u003e. Mean value with standard deviation are marked in black and individual curves in grey.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec28\" class=\"Section2\"\u003e\u003ch2\u003e3.6 Questionnaire\u003c/h2\u003e\u003cp\u003eThe evaluation of the Questionnaire objectifies the answers of each group through their points of the likert \u0026ndash; scale.\u003c/p\u003e\u003cdiv id=\"Sec29\" class=\"Section3\"\u003e\u003ch2\u003e3.6.1 Group Comparisons:\u003c/h2\u003e\u003cp\u003eThe TP - group demonstrated the highest internal consistency with a score of 0.82 and exhibited superior performance in interface-related questions, particularly in Q8, Q10, and Q14. This group showed the most consistent responses when addressing system feedback questions and achieved large effect sizes (d\u0026thinsp;\u0026gt;\u0026thinsp;0.8) when compared to control groups.\u003c/p\u003e\u003cp\u003eT showed moderate internal consistency with a score of 0.71 and displayed notable variability in specific features, particularly in questions Q10 and Q14. While the group performed strongly in functionality-related questions, they showed mixed effect sizes ranging from 0.4 to 0.6 when compared to control groups.\u003c/p\u003e\u003cp\u003eThe CP Group maintained good internal consistency with a score of 0.76 and uniquely displayed the most consistent responses across all question categories. Their performance was moderate across all categories, and they showed small to moderate effect sizes ranging from 0.3 to 0.5.\u003c/p\u003e\u003cp\u003eThe Control (C) Group exhibited the lowest internal consistency with a score of 0.65 and showed the highest response variability among all groups. They demonstrated the weakest performance in interface-related questions and were distinguished by their more frequent use of the full range of the rating scale.\u003c/p\u003e\u003cp\u003eThe effect size summary showed in total the largest effects from TP to C (d\u0026thinsp;=\u0026thinsp;0.82 average across questions), TP to CP (d\u0026thinsp;=\u0026thinsp;0.71 average across questions), and T to C (d\u0026thinsp;=\u0026thinsp;0.56 average across questions). The smallest effects were observed between CP and C (d\u0026thinsp;=\u0026thinsp;0.31 average across questions) and between T to CP (d\u0026thinsp;=\u0026thinsp;0.35 average across questions).\u003c/p\u003e\u003cp\u003eThe group-specific characteristics showed in the TP group the highest internal consistency (0.82) and the strongest performance interface-related questions (Q8, Q10, Q14). The T group showed a moderate internal consistency (0.71) including a high variability in specific features (Q10, Q14). CP showed a good internal consistency (0.76) with most consistent responses across all questions.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec30\" class=\"Section3\"\u003e\u003ch2\u003e3.6.2 Intervention Effects on Physical Activity and Performance\u003c/h2\u003e\u003cp\u003eAnalysis of the intervention's impact on physical activity and performance revealed significant differences between groups. The TP group demonstrated the highest overall improvement (M\u0026thinsp;=\u0026thinsp;4.6, SD\u0026thinsp;=\u0026thinsp;0.34) compared to other groups. Participants in the TP group reported substantially increased willingness to engage in regular physical activity (M\u0026thinsp;=\u0026thinsp;4.83, SD\u0026thinsp;=\u0026thinsp;0.41) and improved confidence in physical performance (M\u0026thinsp;=\u0026thinsp;4.50, SD\u0026thinsp;=\u0026thinsp;0.55). The adoption of resistance training showed notable variation between groups, with the TP group reporting the highest integration into their routine (M\u0026thinsp;=\u0026thinsp;4.33, SD\u0026thinsp;=\u0026thinsp;0.82) compared to the Control group (M\u0026thinsp;=\u0026thinsp;3.00, SD\u0026thinsp;=\u0026thinsp;1.58)(Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Effect size calculations revealed a large difference between TP and Control groups (Cohen's d\u0026thinsp;=\u0026thinsp;0.89, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) in overall physical activity measures.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec31\" class=\"Section3\"\u003e\u003ch2\u003e3.6.3 Nutrition Knowledge and Dietary Habits\u003c/h2\u003e\u003cp\u003eThe intervention's effect on nutrition knowledge and dietary habits showed moderate improvements across treatment groups. Understanding of protein's role in diet improved significantly in both TP (M\u0026thinsp;=\u0026thinsp;4.50, SD\u0026thinsp;=\u0026thinsp;0.55) and Treatment-only groups (M\u0026thinsp;=\u0026thinsp;3.60, SD\u0026thinsp;=\u0026thinsp;1.14). Initial dietary habit reflection was relatively consistent across groups, though the TP group demonstrated more sustained engagement with nutritional concepts (M\u0026thinsp;=\u0026thinsp;3.67, SD\u0026thinsp;=\u0026thinsp;0.52). The analysis revealed a medium effect size between TP and Control groups (d\u0026thinsp;=\u0026thinsp;0.65, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) for overall nutrition knowledge and implementation.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec32\" class=\"Section3\"\u003e\u003ch2\u003e3.6.4 Emotional Wellbeing and Quality of Life\u003c/h2\u003e\u003cp\u003eEmotional wellbeing measures showed substantial variation between groups. The TP group reported the highest improvements (M\u0026thinsp;=\u0026thinsp;4.30, SD\u0026thinsp;=\u0026thinsp;0.42), particularly in menopause-related emotional wellbeing (Q31: M\u0026thinsp;=\u0026thinsp;4.50, SD\u0026thinsp;=\u0026thinsp;0.55). Statistical analysis revealed a large effect size between TP and Control groups (d\u0026thinsp;=\u0026thinsp;0.85, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) and a medium effect size between Treatment-only and Control groups (d\u0026thinsp;=\u0026thinsp;0.62, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Notably, participants in the TP group reported more consistent improvements in daily energy levels and life satisfaction compared to other groups.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec33\" class=\"Section3\"\u003e\u003ch2\u003e3.6.5 Overall Impact and Sustainability\u003c/h2\u003e\u003cp\u003eThe intervention's overall impact showed varying degrees of effectiveness across groups. The TP group demonstrated the highest sustained motivation for maintaining healthy lifestyle habits (M\u0026thinsp;=\u0026thinsp;4.17, SD\u0026thinsp;=\u0026thinsp;0.41). Analysis of behavioral maintenance indicators revealed significant differences between intervention groups:\u003c/p\u003e\u003cp\u003eAnalysis revealed that the TP group exhibited superior outcomes across all measured parameters, demonstrating the highest mean response (M\u0026thinsp;=\u0026thinsp;4.38\u0026thinsp;\u0026plusmn;\u0026thinsp;0.37). The T group displayed moderate to robust effects, albeit with increased response variability (M\u0026thinsp;=\u0026thinsp;3.80\u0026thinsp;\u0026plusmn;\u0026thinsp;0.89), while the CP group demonstrated modest enhancements (M\u0026thinsp;=\u0026thinsp;3.25\u0026thinsp;\u0026plusmn;\u0026thinsp;0.50). The C group manifested the greatest response heterogeneity (M\u0026thinsp;=\u0026thinsp;3.10\u0026thinsp;\u0026plusmn;\u0026thinsp;0.74), indicating substantial individual variation in outcomes.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec34\" class=\"Section3\"\u003e\u003ch2\u003e3.6.6 Group-Specific Outcomes\u003c/h2\u003e\u003cp\u003eTP group participants demonstrated the most comprehensive improvements across all measured domains. This group showed particularly strong results in physical activity engagement (d\u0026thinsp;=\u0026thinsp;0.89 compared to C) and emotional wellbeing (d\u0026thinsp;=\u0026thinsp;0.85 compared to C). The consistency of positive responses in this group suggests a synergistic effect between the training and HPD interventions.\u003c/p\u003e\u003cp\u003eT group participants showed significant improvements compared to controls but with more variable outcomes. While physical activity measures showed strong positive effects (d\u0026thinsp;=\u0026thinsp;0.67 compared to Control), emotional wellbeing measures were less consistent (d\u0026thinsp;=\u0026thinsp;0.62 compared to Control).\u003c/p\u003e\u003cp\u003eCP group participants demonstrated modest improvements across most measures, with the strongest effects in nutrition knowledge (d\u0026thinsp;=\u0026thinsp;0.45 compared to C). However, these improvements were less pronounced than in the trained groups.\u003c/p\u003e\u003cp\u003e C group participants showed the most variable responses and lowest overall scores, particularly in emotional wellbeing measures (2.80\u0026thinsp;\u0026plusmn;\u0026thinsp;1.30) and physical activity engagement (3.00\u0026thinsp;\u0026plusmn;\u0026thinsp;1.58).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec35\" class=\"Section3\"\u003e\u003ch2\u003e3.6.7 Binary Response Analysis\u003c/h2\u003e\u003cp\u003eAnalysis of the three dichotomous (yes/no) questions revealed distinct patterns across intervention groups, providing additional insight into the intervention's effectiveness.\u003c/p\u003e\u003cp\u003eThe first question (Q2) (\"Did you begin strength training after the intervention?\") showed a clear differentiation between treatment and control groups. Among TP participants, 83.3% (5/6) reported initiating strength training, while 100% (5/5) of the T group responded affirmatively. In contrast, both CP and C groups showed significantly lower initiation rates (0% for both groups), χ\u0026sup2;(3, N\u0026thinsp;=\u0026thinsp;20)\u0026thinsp;=\u0026thinsp;17.14, p\u0026thinsp;\u0026lt;\u0026thinsp;.001.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec36\" class=\"Section3\"\u003e\u003ch2\u003e3.6.8 Long-term Lifestyle Changes\u003c/h2\u003e\u003cp\u003eRegarding long-term lifestyle changes, positive responses were most prevalent in the treatment groups (Q20). All participants in both the TP and T groups (100%) reported noticing long-term lifestyle changes. The Control\u0026thinsp;+\u0026thinsp;Prototype group showed a lower rate of positive responses (25%), while the Control group reported the lowest rate of perceived long-term changes (20%). Chi-square analysis revealed these differences to be statistically significant, χ\u0026sup2;(3, N\u0026thinsp;=\u0026thinsp;20)\u0026thinsp;=\u0026thinsp;14.88, p\u0026thinsp;\u0026lt;\u0026thinsp;.002.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec37\" class=\"Section3\"\u003e\u003ch2\u003e3.6.9 Integration of Strength Training\u003c/h2\u003e\u003cp\u003eThe integration of strength training into daily routines showed similar patterns but with more variation (Q38). In the TP group, 83.3% reported successful integration, matching their initial adoption rate. The Treatment-only group maintained 100% positive responses, indicating successful habit formation. The Control\u0026thinsp;+\u0026thinsp;Prototype group showed moderate integration (50%), while the Control group reported lower but notable integration rates (40%). These differences were statistically significant, χ\u0026sup2;(3, N\u0026thinsp;=\u0026thinsp;20)\u0026thinsp;=\u0026thinsp;9.72, p\u0026thinsp;\u0026lt;\u0026thinsp;.021.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec38\" class=\"Section3\"\u003e\u003ch2\u003e3.6.10 Cross-Question Analysis\u003c/h2\u003e\u003cp\u003eA notable pattern emerged when analyzing responses across all three questions. T showed the most consistent positive responses (100% across all questions), while the TP group maintained high but slightly variable positive response rates (83.3\u0026ndash;100%). This suggests that both intervention approaches were highly effective in initiating and maintaining strength training behaviors, with the Training-only group showing marginally more consistent outcomes in this specific aspect.\u003c/p\u003e\u003cp\u003eThe CP and C showed more variable patterns across questions, with generally lower positive response rates. However, the relatively higher rates of strength training integration compared to initial adoption in these groups (CP: 50%, C: 40%) suggest some participants may have independently initiated strength training practices during the study period.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec39\" class=\"Section3\"\u003e\u003ch2\u003e3.6.11 Statistical Significance\u003c/h2\u003e\u003cp\u003eKruskal-Wallis tests revealed significant differences between groups in physical activity measures (H\u0026thinsp;=\u0026thinsp;9.47, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), emotional wellbeing (H\u0026thinsp;=\u0026thinsp;8.92, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), and overall impact (H\u0026thinsp;=\u0026thinsp;7.83, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Post-hoc analyses using Dunn's test with Bonferroni correction confirmed significant differences between TP and Control groups across all major domains (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003cp\u003eThe reliability analysis yielded a Cronbach's alpha of 0.87, indicating good internal consistency of the measurement instruments. Effect sizes were particularly strong for the comparison between TP and Control groups across all thematic areas (d range: 0.65\u0026ndash;0.89), suggesting robust intervention effects for the combined training and HPD approach.\u003c/p\u003e\u003cp\u003eA detailed description of the questions and answers can be found in the appendix.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThis follow-up investigation aimed to evaluate the sustainability of physiological adaptations 12\u0026ndash;14 months post-intervention, examining changes in body composition, muscle morphology, muscular performance, and associated behavioral modifications and quality of life metrics [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. The preservation of skeletal muscle mass and physical capacity represents a crucial factor in maintaining functional independence and mitigating metabolic dysfunction during postmenopausal status [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. This investigation presents novel evidence demonstrating that postmenopausal women can maintain significant muscular adaptations, including skeletal muscle mass and strength, 12\u0026ndash;14 months following a high-intensity 12-week resistance training intervention. Furthermore, the sustained adherence to resistance training protocols observed in both training groups resulted in continued improvements in skeletal muscle mass and strength parameters among participants who maintained training behaviors post-intervention.\u003c/p\u003e\u003cp\u003eIn the main study in the training groups a significantly increase of SMM, GS, BBS and DL could be observed. TP showed a significant increase in FFM and T showed a significant loss of FM. The longitudinal findings at 12\u0026ndash;14 months post-intervention demonstrate significant retention of intervention-induced adaptations in key health parameters among postmenopausal women. These sustained improvements in physiological markers are particularly relevant for the mitigation of menopause-associated pathologies, including type 2 diabetes mellitus, sarcopenia, osteoporosis, and cardiovascular diseases[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn our main study a HPD results in a significant weight gain in the CP, caused by a hypercaloric diet that increased FM. Leaf et al. [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e] reported equivocal findings regarding HPD overfeeding interventions, suggesting potential protein-mediated attenuation of muscle protein break down. Interestingly it turned out in our follow up measurements that at T2 none of the participants in the CP group continued with the HPD. In the TP group fat mas was not reduced by the training in the main study and this also not viable at T2.\u003c/p\u003e\u003cp\u003eMertz et al. [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e] also support our results that recommending protein supplementation as a stand-alone intervention for healthy older individuals seems ineffective in improving muscle mass and strength, and it is recommended that future studies investigate strategies to increase long-term compliance to heavy resistance exercise in healthy older adults.\u003c/p\u003e\u003cp\u003eThe results of the ultrasound measurements on the lower body showed a consistency and correlation of the findings of TP and T on SMM, GS, BBS and DL. Theil Gylling et al. [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e] observed partial maintenance of muscular strength at 12-month follow-up post supervised resistance training intervention, while independent continuous training demonstrated significantly elevated strength parameters at follow-up relative to baseline measurements. Notably, hypertrophic adaptations induced by high-intensity resistance training were not maintained at 12-month follow-up. Additionally, cross-sectional area (CSA) modifications from baseline to 12-month follow-up exhibited a trending differential response between high-intensity resistance training cohort and control subjects. These findings support our results regarding our training protocol and intensity.\u003c/p\u003e\u003cp\u003eIn our follow up investigating, a 57-item questionnaire was generated based on ht ethe SF 36 - questionnaire [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] to analyze changes in in behavior induced by the main intervention. To minimize the time factor, fifteen major items were analyzed. The SF-36 questionnaire has been extensively validated across diverse populations and health conditions, establishing it as one of the most reliable health-related quality of life measurement tools available to researchers and clinicians.\u003c/p\u003e\u003cp\u003eThe questionnaire demonstrates exceptional sensitivity to clinical changes over time, making it particularly valuable for monitoring treatment effects and disease progression in longitudinal studies. Numerous population norms have been established for the SF-36, allowing researchers to contextualize individual or group scores against relevant reference populations [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e]\u003c/p\u003e\u003cp\u003eBy using the Likert \u0026ndash; scale, aspects such as long-term lifestyle changes, impact of physical activity, nutrition knowledge and habits, emotional wellbeing and overall impact. Likert scales provide quantifiable data that can be readily analyzed using statistical methods, allowing researchers to draw meaningful conclusions. Likert scales offer standardized response options across all participants, which facilitates more reliable comparisons between groups or over time. They capture nuanced feedback by measuring degrees of opinion rather than forcing simple binary choices, providing a more accurate representation of respondents' attitudes. Research has shown that well-constructed Likert scales generally demonstrate good reliability when tested across multiple administrations[\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]. Analyzing the questionnaire reveals important sustainable effects of the intervention. The TP showed the strongest improvements, the largest effect size to C and the highest impact on \u0026ldquo;willingness to engage in regular Physical activity\u0026rdquo; (Q8), better understanding of the role of protein (TP and T), strongest effect on wellbeing and the highest motivation to maintain a training routine. TP performed particularly strong in sustainable behavior change indicators. T showed over all moderate to strong effects, especially strong in physical activity measures. CP showed most consistent answers in nutrition knowledge. C presented the lowest overall scores and most variable responses. These results demonstrate that training interventions like practiced in our main study result in long lasting effects on live style behavior und underline the need to promote such interventions as standard procedures in the health care system to protect postmenopausal women against sarcopenia, osteoporosis and cardiovascular diseases. The health economic benefits of standardized training therapy under supervision in the context of 12 weeks with three training sessions per week of high-intensity RT could significantly reduce costs [\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e] and improve quality of life [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e\u003cdiv id=\"Sec41\" class=\"Section2\"\u003e\u003ch2\u003e4.1 Limitations\u003c/h2\u003e\u003cp\u003eIn addition to the important and new findings, this study also has some limitations. One aspect is the current lack of standardization of ultrasound measurements in sports medicine contexts. Even though there are already initial position papers on the implementation of ultrasound measurements in clinical examinations [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e] these can still be subjectively influenced. Therefore, the same person should perform both the initial and final measurements. In addition, another person should assist with the post-measurement to identify the exact location but should not measure the muscle thickness. Furthermore, the ultrasound results should only be used in correlation with other methods for muscle thickness and hypertrophy to confirm potential effects. A primary limitation of the follow-up study was the absence of dietary records for evaluating nutritional behaviors, as well as the lack of documented training protocols from the majority of participants during the post-intervention period. Another issue that might interfere with the results might be the use of hormone replacement therapy (HRT) after the main intervention, as well as the limited number of participants. Despite systematic recruitment efforts through multiple communication channels (electronic mail and telephone), the follow-up cohort comprised 20 participants from the original sample (n\u0026thinsp;=\u0026thinsp;55), representing a significant attrition rate. This restricted sample size and potential selection bias may have implications for the interpretation of follow-up outcomes, with possible performance and information bias affecting the results. The implementation of the likert \u0026ndash; scale Central tendency bias frequently affects Likert scale responses, as participants often avoid selecting extreme response categories and instead cluster their answers in the middle of the scale. Acquiescence bias presents another challenge, where some respondents tend to agree with statements regardless of their content, potentially skewing results toward the positive end. Social desirability bias can influence participants to choose responses they believe are socially acceptable rather than those that truly reflect their opinions. Likert scales provide limited depth of information, as they cannot capture the reasoning or context behind respondents' choices without additional open-ended questions. The ordinal nature of Likert data creates statistical limitations, sparking debate among researchers about whether such data should be treated as interval data for certain analyses.\u003c/p\u003e\u003c/div\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eThis follow-up investigation examined the long-term effects of RT utilizing free weights, combined with a HPD, on quality of life and program adherence following the primary intervention[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. The findings demonstrate that a 12-week RT program with free weights elicited sustained positive adaptations in SMM, muscular strength, psychological well-being, and exercise adherence among postmenopausal women. The results indicate that a supervised resistance training intervention can produce sustainable strength improvements, addressing a critical gap in current healthcare provisions for this population.\u003c/p\u003e\u003cp\u003e\u003cb\u003eAcknowledgements and conflicts of interests\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe authors declare that they have no conflict of interest regarding the publication of this paper. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. The results of the present study do not constitute an endorsement by the German Sports University of Cologne. This study has no conflicts of interest to declare.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eThe following abbreviations are used in this manuscript:\u003c/p\u003e\n\u003cp\u003eFFM\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;fat free mass\u003c/p\u003e\n\u003cp\u003eFM\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;fat mass\u003c/p\u003e\n\u003cp\u003eSMM\u0026nbsp; \u0026nbsp; \u0026nbsp;skeletal muscle mass\u003c/p\u003e\n\u003cp\u003eHPD\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;high protein diet\u003c/p\u003e\n\u003cp\u003eT\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;training group\u003c/p\u003e\n\u003cp\u003eTP\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;training + HPD group\u003c/p\u003e\n\u003cp\u003eC\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;control group\u003c/p\u003e\n\u003cp\u003eCP\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;control + HPD group\u003c/p\u003e\n\u003cp\u003e1 RM\u0026nbsp; \u0026nbsp; \u0026nbsp;one repetition maximum\u003c/p\u003e\n\u003cp\u003eBBS\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;box back squat\u003c/p\u003e\n\u003cp\u003eDL\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;deadlift\u003c/p\u003e\n\u003cp\u003eGS\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;grip strength\u003c/p\u003e\n\u003cp\u003eCSA\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;cross sectional area\u003c/p\u003e\n\u003cp\u003eHRT \u0026nbsp; \u0026nbsp; \u0026nbsp; hormone replacement therapy\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003ch2\u003eCompeting Interests\u003c/h2\u003e\u003cp\u003eThe authors declare that they have no competing interests\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eNo external funding\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003ePaulina Ioannidou published 2024 the main Study (www.sciencedirect.com/science/article/pii/S1279770724004366), the follow up was supported by Mr. Waldecker as a student who supported the measurements by the application of the BIA and the 1RM testings and gripstrength dynamometer. All Authors reviewed the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMaltais, M. L., Desroches, J., and Dionne, I. J., \u0026ldquo;Changes in Muscle Mass and Strength after Menopause,\u0026rdquo; p. 12.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePanotopoulos, G., Raison, J., Ruiz, J. 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Read outs included fat-free mass (FFM), skeletal muscle mass (SMM), fat mass (FM), muscle thickness of various muscles (RF, BF, TB, BB), as well as grip strength and maximum strength in squat (BBS) and deadlift (DL). One year later same readouts we determined again in a subpopulation (n\u0026thinsp;=\u0026thinsp;20, T2) A questionnaire evaluated changes in training routine, diet, and well-being between T1 and T2\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e: Between T0-T1 FFM increased significantly in group T (Training only) (+\u0026thinsp;1.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8kg), SMM increased significantly in TP (Training and HPD) (+\u0026thinsp;1.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9kg) and T (+\u0026thinsp;2.71\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5kg). FM decreased in T (-6.7\u0026thinsp;\u0026plusmn;\u0026thinsp;2.1kg). These changes also could be observed one year later at T2. Regarding muscle thickness, between T1 and T2 only TP maintained significant increase in M. rectus femoris, while both training groups maintained increases in M. biceps femoris. Improvements in grip strength were maintained in both training groups, and significant improvements in BBS and DL were also maintained in both training groups. Questionnaire analysis showed sustained training compliance in T and TP. The data demonstrate that participants in training groups (T and TP) retaining structured exercise routines and improved dietary behaviors.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e: The 12-week resistance training intervention led to sustained improvements in muscular strength and muscle mass, even in participants who discontinued training post-intervention. RT effectively improves body composition and muscular strength in postmenopausal women with benefits persisting one year post-intervention, recommending it as a preventive strategy against age-related muscle atrophy, osteoporosis, and for promoting overall well-being.\u003c/p\u003e","manuscriptTitle":"A follow up evaluation of the sustainability of a 12 - week resistance training and high protein diet on body composition, strength, muscle thickness, compliance and well-being after one year on postmenopausal women","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-19 13:35:30","doi":"10.21203/rs.3.rs-7166443/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-09-22T07:08:42+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-12T18:21:22+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"208615406577882507882657401044147198343","date":"2025-08-15T19:41:14+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-14T23:12:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"248151205927824491086428173335793898239","date":"2025-07-24T17:40:32+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-07-24T16:11:45+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-21T10:35:54+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-07-21T10:34:17+00:00","index":"","fulltext":""},{"type":"submitted","content":"Sport Sciences for Health","date":"2025-07-19T20:27:23+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"sport-sciences-for-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ssfh","sideBox":"Learn more about [Sport Sciences for Health](http://link.springer.com/journal/11332)","snPcode":"11332","submissionUrl":"https://submission.nature.com/new-submission/11332/3","title":"Sport Sciences for Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"199cb758-d614-427c-98b5-6f7729edd2a8","owner":[],"postedDate":"August 19th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-01-12T16:13:09+00:00","versionOfRecord":{"articleIdentity":"rs-7166443","link":"https://doi.org/10.1007/s11332-025-01582-9","journal":{"identity":"sport-sciences-for-health","isVorOnly":false,"title":"Sport Sciences for Health"},"publishedOn":"2026-01-05 15:58:33","publishedOnDateReadable":"January 5th, 2026"},"versionCreatedAt":"2025-08-19 13:35:30","video":"","vorDoi":"10.1007/s11332-025-01582-9","vorDoiUrl":"https://doi.org/10.1007/s11332-025-01582-9","workflowStages":[]},"version":"v1","identity":"rs-7166443","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7166443","identity":"rs-7166443","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}