Sex Differences in Resistance Training Participation and Beliefs Among Adolescent Athletes: An Exploratory Cross-Sectional Study

1. Introduction

Resistance training (RT) has gained widespread support as an essential component of youth athlete development, helping to reduce sports-related injuries and enhance overall physical well-being and sports performance [1,2,3,4,5]. The American Academy of Pediatrics and other sports medicine organizations support the inclusion of RT in youth sports, emphasizing its safety and efficacy when properly programmed, executed, and supervised [3,6]. Reflecting this consensus, the World Health Organization updated its 2020 physical activity guidelines to recommend muscle-strengthening activities at least three times per week for children and adolescents [7].

RT is a form of conditioning involving an individual working against resistive loads for the purposes of improved fitness, health, and/or performance [1,8]. The resistive loads can include one or a combination of body weight, weight machines, free weights, resistance bands, and medicine balls [9,10]. For adolescent athletes, RT has been documented as a method to improve overall strength, power, running and sport-specific speed, and motor control [4,11,12]. Furthermore, RT has been linked to improved cardiac function among obese youth, reduced body fat, improved insulin-sensitivity among overweight adolescents, and enhanced skeletal health [1,2,4,9,13].

Although once believed to be dangerous for youth due to the potential damage to growth plates, increasing evidence over the past two decades has mitigated this concern in favor of a link between supervised participation in RT with a reduction in sports-related injuries and greater enjoyment and confidence in engaging in physical activity [13]. Both the International Olympic Committee (IOC) and National Strength and Conditioning Associations (NSCA) have issued position statements supporting youth RT participation with the NSCA particularly highlighting its role in fostering lifelong positive exercise behaviors [9,13]. Injuries associated with RT typically result from improper handling of weights or poor exercise technique under excessive load—risks that are readily mitigated through professional supervision and instruction [1].

Despite broad support and documented benefits, regular RT participation among adolescents remains low worldwide [14]. Studies among adults populations have identified disparities in RT participation associated with educational attainment, health status, and sex, with those who are educated, healthy, or male more likely to engage in RT than those who are uneducated, unhealthy, or female [15,16]. Additionally, sex-based stigmas and misconceptions about RT have been shown to disproportionately limit participation among women [17]. While these factors have been examined in adults, little is known regarding participation in and beliefs about RT among youth athletes, and particularly, how these vary by sex. This is of particular importance as female youth have been identified as an at-risk population for increased injury rates relative to male youth [13]. To address this gap, we conducted a cross-sectional survey to identify differences in the beliefs about and participation in RT between male and female adolescent athletes.

2. Materials and Methods

2.1. Study Design

We conducted a cross-sectional study using an electronic RedCap questionnaire (18) to measure participation in RT and beliefs about RT among youth athletes. The survey included a total of 29 questions: 8 questions on demographics (sex, age, race, ethnicity, school grade, zip code, and current injury status), 4 questions on sports participation and specialization, and 11 questions on participation in and beliefs about RT. To assess socioeconomic status, we used the Family Affluence Scale, a 6-item validated questionnaire scored from 0-13, designed to assess the socioeconomic status of the family based on an assets approach (19). Scores of 0–7 indicate low affluence, 8–11 moderate affluence, and 12–13 high affluence. We used a sports specialization scale (20) to assess the level of sports specialization from low, moderate, to highly specialized, with scores ranging from 0 to 6. Scores of 0–1 were classified as low specialization, scores of 2–4 as moderate specialization, and scores of 5–6 as high specialization. A custom questionnaire was developed specifically for this study to assess resistance training participation and beliefs among adolescent athletes (see Supplementary File 1), as no validated questionnaires existed at the time to measure the desired outcomes. RT questions included assessment of whether the athlete participated in RT, the frequency of RT per month, type of equipment used, seasonal frequency, access to weights, beliefs about RT (e.g. RT will make me better at my sport), family support of RT, and barriers to participation in RT.

2.2. Participants

This study received approval from the local Institutional Review Board (IRB) prior to participant recruitment and data collection. We included 13-18 year old male and female athletes who presented to a hospital-affiliated sports medicine center, outpatient physical therapy clinics, or who were active in local high school or club sport partnerships. Recruitment was conducted via distribution of a flyer with a QR code that the participant could scan and then complete the electronic questionnaires. Flyers were posted and/or provided in sports medicine clinics, physical therapy gyms, high school training rooms, and via email listservs to high school and club sport partnerships. Postcard consent was obtained from participants. Data was collected between April 2021 - December 2021.

2.3. Data Analysis

Data are presented as mean (standard deviation) for continuous variables and the number within group (corresponding percentage) for categorical variables. We compared demographic characteristics, resistance training volume/timing/beliefs, and types of equipment used between female and male participants using independent t-tests for continuous variables and chi-square analyses or Fisher’s exact tests for categorical variables. Statistical significance was defined a priori as p<0.05, and all tests were 2-sided. Statistical analysis was performed using Stata Statistical Software: Version 18 (StataCorp, LLC, College Station, TX, USA).

3. Results

3.1. Demographics and Sports Participation

A total of 158 individuals completed the consent form. Of those, 108 (68%) completed the questionnaires: 62 female, mean age =15.0 ± 1.2 years; 46 male, mean age =14.9 ± 2.6 years, who were included in our analysis. There were no significant differences between female and male participants for demographic characteristics, family affluence, sport participation, or sport specialization level (Table 1).

3.2. Sex Differences in Resistance Training Participation and Beliefs

The majority of the study sample (71% of all participants) engaged in RT with a non-significant, but greater proportion of male participants reporting regular participation in RT compared to female participants. However, female participants reported beginning RT at a significantly younger age compared to males. We did not observe any significant sex-related differences in the mean duration or frequency of RT between groups (Table 2). The majority of both the female and male participants engaged in RT both during the season and the off-season (Table 2).

Female participants reported enjoying RT significantly less than males (Table 2). No other significant differences regarding beliefs about RT were identified. Most female and male participants believed that RT would make them better at their sport, would help them prevent injuries, and felt comfortable lifting weights (Table 2). A small proportion of female and male participants believed that RT would result in looking bulky or with muscles that are too big (7%) or that RT will cause injuries, (2%) with a greater proportion believing that RT will make them look good (Table 2).

Male participants were significantly more likely than female participants to report using barbells, weight machines, and free weights (Table 3). There were no sex-differences observed in body weight or resistance band or cord utilization. For male participants, the highest proportion utilized free weights, followed by weight machines, body weight, resistance bands or cords, and lastly, barbell (Table 3). For female participants, the highest proportion used body weight and resistance bands or cords, followed by free weights, weight machines, and lastly, barbell (Table 3).

4. Discussion

To our knowledge, this is the first study to examine sex differences in RT participation and beliefs among adolescent athletes. Overall participation in RT for both male and female athletes in our sample was higher than a previously reported estimate of high school students achieving the recommended US guidelines of muscle-strengthening activities three times per week (52%) [21,22,23]. The higher proportion of participation in RT observed in this study may reflect the sample consisting of recreational and competitive athletes rather than a general adolescent population. Furthermore, participants were recruited from outpatient sports medicine and physical therapy clinics, possibly increasing their exposure to RT as part of injury rehabilitation. Lastly, our measure of RT participation did not limit the analysis to those engaging in fewer than three days per week, although the mean frequency for both sexes was approximately three days weekly.

The majority of female and male participants reported believing that RT would make them better at their sport, help prevent injury, and were comfortable performing RT. However, female participants reported lower enjoyment of RT than the male participants. This may be due to a lack of social support, social stigma, the gym environment, a lack of confidence in skills, or different goals and motivation [17,24]. The lower reported enjoyment of RT among the female participants may be associated with the lower proportion participating in RT compared to their male peers. Future research should explore barriers to RT enjoyment among female adolescent athletes and provide a tailored approach to encourage positive RT experiences and ultimately sustain lifelong RT practices.

Although no significant sex differences were found in RT participation frequency or duration, there were significant differences in equipment usage, with male athletes more frequently utilizing barbells, weight machines, and free weights. These findings align with existing literature highlighting sex and/or gender differences in equipment preferences, potentially influenced by perceived gender roles, access, and exposure to specific types of equipment [17,24,25,26]. These findings suggest that incorporating the use of free weights, barbells, and weight machines into strength programming among young female athletes, with adequate instruction and supervision to promote comfort and confidence in using this equipment for RT may be valuable.

Interestingly, the female participants reported initiating RT at a younger age than the male participants. Because male individuals engage in RT at higher rates than female individuals related to societal norms and encouragement in strength-based activities, [27,28] we would expect them to also initiate RT earlier. Our findings may indicate differences in motivations or entry points into RT, possibly linked to injury prevention or earlier participation in structured sports programs for young female athletes. This aligns with evidence suggesting that coaches of girls’ teams were more likely to be aware of and to adopt injury prevention programs than coaches of boys’ teams potentially due to greater public awareness of higher injury risk among girls for non-contact ACL injuries [29]. Importantly, these findings reinforce evidence that supervised, age-appropriate RT is safe and beneficial for youth, including when initiated before adolescence [2]. Introducing RT in early adolescence (10-13 years old) can promote both injury prevention and positive engagement with physical activity.

This study has several limitations. The survey-based method employed is subject to bias and more limited in assessing the nuances of participants’ attitudes and beliefs about RT. Second, the generalizability of our findings may be limited as the sample was from a single geographic region, many presenting for sports medicine care or rehabilitation, potentially limiting broader applicability. Finally, we are unable to report the response rate as we don’t have the total number of people with access to the flyer/survey link. Despite these limitations, this is the first study to examine sex differences in participation in and beliefs/attitudes about RT among youth athletes. The findings provide relevant information for coaches and sports medicine professionals to inform their approach to implementing RT among adolescent athletes, while taking into consideration sex differences. Future studies should investigate psychosocial factors, such as perceived competence, social support, and motivational climate, to better understand these sex-specific disparities in RT attitudes and behaviors in a larger and more geographically diverse sample.

Resistance training (RT) is a critical component of youth athletic development, linked to improved sport performance and reduced injury risk. This study provides important insights for coaches, athletic trainers, and strength professionals working with adolescent athletes. While overall RT participation was relatively high among both male and female athletes, key sex differences should inform program design. Males were more likely to use traditional RT equipment (barbells, machines, and free weights) and to report enjoying RT. In contrast, females reported significantly less enjoyment and were more likely to use bodyweight and resistance bands. These differences may stem from varied access, confidence, social influences, or past exposure to training environments. Practitioners should consider these preferences when designing programs for female athletes. Creating supportive, inclusive training environments that emphasize competence and enjoyment may encourage greater engagement. Coaches might start with bodyweight and resistance band exercises, gradually introducing free weights and machines as confidence builds. Female athletes may also benefit from female role models, individualized instruction, and small-group formats that reduce intimidation. Importantly, most athletes regardless of sex believed that RT improves sport performance and helps prevent injury. These shared beliefs can be leveraged to motivate participation. Tailoring communication strategies to reinforce these benefits may be especially effective for less experienced or reluctant participants. In sum, practitioners can promote RT participation among youth by recognizing sex-specific preferences, enhancing enjoyment, and fostering confidence through progressive, supportive programming. These efforts may encourage long-term adherence to RT and contribute to improved athletic development and injury prevention for all youth athletes.

5. Conclusions

This study is the first to explore sex differences in both participation and beliefs around resistance training among adolescent athletes. Despite similar training frequency, female athletes reported lower enjoyment and less use of traditional equipment compared to males. These insights highlight the need to address sex-specific preferences and perceptions to promote equitable, engaging resistance training experiences for all youth athletes.