Get Stronger Not Smaller – Why Women Should Focus on Strengthening Their Muscles

An IRONMAN triathlon is one the world’s most challenging one-day endurance events, consisting of a 3.8km open water swim, a 180km bike ride and a 42.2km marathon run, usually within a 17-hour time limit. 

News of mature athletes finishing the full Ironman course have been highlighted with the oldest woman crossing the finishing line in 16 hours and 45 minutes.  Natalie Grabow, an 80-year-old grandmother from New Jersey became the oldest woman to complete the Ironman World Championship in Kona, Hawaii in October 2025.

I had read the news with great interest, admiring her toned limbs, her visible muscle mass on an 80-year old frame.  This would be one in a million, as the norm would be frail and hunched little old ladies in either a wheelchair or a walking aid.  Such news of mature athletes are indeed uplifting as this shows that strength and mobility are possible in advanced age. 

Her story is amazing. However, the message is not that every woman must train like an Ironman athlete. The real lesson is much simpler.

Ageing does not mean we should stop moving.

In fact, the older we get, the more important movement becomes, and to move the skeleton, muscles are the driving force.

As an orthopaedic surgeon, I often see women who only start thinking about muscle strength after a fall and a fracture. However, muscle strength should not be treated as a “later problem”. It should be part of healthy ageing, and should begin as early as possible i.e ages 30s, 40s.  Some elderly women unfortunately are unable to regain back their former independence and mobility after lower limb fractures.

Muscle strengthening for aging women is not only about fitness. It is about staying independent, active and steady as the body gets older.

What is Sarcopenia?

Sarcopenia (age related muscle loss/atrophy)  is a progressive generalised skeletal muscle disorder involving loss of muscle mass, strength and function.  Sarcopenia is associated with adverse outcomes including falls, fractures, disabilities and mortality.

AWSG (Asian Working Group for Sarcopenia) criteria for sarcopenia:

1. Low muscle mass
2. Low muscle strength and/or low physical performance (can be assessed by walking speed)

Aging causes muscle atrophy/loss.  In older adults changes in exercise (sedentary, bed rest etc.), nutrition (malnutrition, protein deficiency) and hormonal changes (decreased estrogen, testosterone) lead to muscle protein degradation, as well as changes to muscle contraction (strength) and muscle composition (more fat infiltration).

Fron the age of 30, muscle mass decreases by around 3-8% per decade, and this decrease accelerates after the age of 60.

After age 70, the loss of muscle mass declines by 0.5 – 1% per year. 

This differs by sex.  After age 75, the loss is close to 1% per year in men and 0.7% in women. 

Other than sex and age, sarcopenia is higher in non-Asian (men 19% and women 20%) than Asian (men 10% and women 11%).

Women with polycystic ovarian syndrome PCOS, regardless of age, have a high prevalence of sarcopenic obesity (53% women with PCOS are sarcopenia obese)

During the menopausal transition in women (ages 40-60), lean body mass (LBM) decreased by 0.5% (mean annual loss of 0.2kg) while the fat mass increases 1.7% per year (mean absolute gain of 0.45kg)

Why Muscle Strength Matters As Women Age

As women age, the body naturally loses muscle mass and muscle power. This is known as sarcopenia.

Sarcopenia can make daily activities harder. It can affect walking, climbing stairs, carrying groceries, getting up from a chair, and keeping balance.

This is why muscle strengthening for aging women is so important.

Stronger muscles help support the joints. They also help protect the bones. In addition, they improve balance and reduce the risk of falls.

For many women, strength is not about lifting heavy weights. It is about being able to move safely and confidently every day.

The Link Between Muscles, Bones, and Falls

Many aging women worry about osteoporosis. This is understandable. After menopause, women may lose bone strength more quickly.

However, bone health is not only about calcium or bone density. Muscle strength also plays a major role.

When muscles are weak, the body becomes less stable. This increases the risk of falls. When bones are weaker, a fall can lead to a fracture.

Therefore, strength training for older women is not just about building muscle. It is also about protecting the bones, improving balance, and lowering the risk of injury.

This is especially important for women with osteoporosis, previous fractures, knee pain, hip pain, or poor balance.

Menopause and Sarcopenia

Hormonal changes during menopause are important risk factors leading to sarcopenia. 

1. Decreased estrogen

Estrogen is most abundant during a woman’s reproductive years. It is directly involved in muscle metabolism and indirectly alters GH and IGF-1.  It also regulates carbohydrate and fat/lipid metabolism, which influences skeletal muscle composition in postmenopausal women. 

Declining estrogen levels lead to increased joint inflammation, collagen breakdown and tissue thickening in the shoulder joint, leading to adhesive capsulitis (frozen shoulder) in peri and postmenopausal women (ages 40-60).

In short,estrogen:

• Beneficial effect on skeletal muscle proliferation/growth
• Skeletal muscle can respond to estrogen due to presence of specific receptors for estradiol in muscle fibers.
• Estrogen have anti-inflammatory and antifibrotic effect. 

2. Decreased testosterone

• for maintenance and growth of muscle in both men and women. 
• associated with visceral fa and regional fat distribution
• women have less free testosterone which further depletes post menopause.

3. Decreased DHEA (Dehydroepiandrosterone)

• natural steroids in humans
• DHEA decline is associated with decreased muscle mass and decreased physical performance

4. Decreased progesterone

5. Decreased growth hormone, GH and Insuline like Growth Factor 1, IGF-1

• declining levels lead to changes in body composition (decreased lean body mass and increased total body fat, especially visceral fat)
• IGF-1 is associated with aerobics and muscle endurance

6. Increased cortisol

• while everything else decreases, cortisol increases.  Cortisol is the body’s stress hormone.
• Cortisol levels gradually increase from age 30s. 

The cumulative effects of oxidative stress, inflammation and insulin resistance lead to muscle catabolism / breakdown.

Management of sarcopenia in postmenopausal women

In terms of physical activity, a combination endurance (aerobic), strength and balance exercises is ideal.  Recommendation for post-menopausal women include:

150min moderate aerobic activity per week (30min daily walk) combined with resistance training 3 times per week. (3 sets of 8-12 repetitions of 8-10 exercises for major muscle groups, with 1.5minutes rest interval)

Every women should be aware of her target heart rate and should track exercise intensity.

Why Walking Alone May Not Be Enough

Walking is good. It helps the heart, lungs, joints, and mood.

However, walking alone may not be enough to prevent muscle loss with ageing.

This is because muscles need resistance to stay strong.

Resistance does not always mean heavy gym weights. It can include simple and safe exercises such as:

The key is to make the muscles work a little harder than usual. This gives the muscles a signal to stay strong.

So, while walking is helpful, muscle strengthening for aging women should also include some form of resistance exercise.

What Aging Women Can Learn From an 80-Year-Old Athlete

Natalie Grabow’s story is not just about endurance sport. It is about consistency, movement, and not giving up on the body just because of age.

Most women do not need to swim, cycle, and run long distances. However, every woman can learn one important message from her story.

The body still responds to training, even as we get older.

Being able to stand up from a chair without help is strength.

Being able to climb stairs safely is strength.

Being able to walk without fear of falling is strength.

Being able to carry your own shopping bag is strength.

Being able to enjoy time with family without feeling limited by weakness is strength.

These small things matter because they protect independence.

Benefits Of Muscle Strengthening For Aging Women

Muscle strengthening for aging women can help in many ways.

It supports the knees, hips, ankles, shoulders, and spine.

It may reduce strain on the joints during daily movement.

It helps improve posture.

It improves balance and coordination.

It supports bone health.

It may reduce the risk of falls.

It helps women stay active for longer.

It may also improve confidence. When a woman feels stronger, she is often less afraid to move. This is important because fear of movement can lead to more weakness over time.

When Should Women Start Strength Training?

The best time to start is before weakness becomes obvious.

However, it is also not too late to begin.

Even women in their 60s, 70s, or 80s can benefit from safe strength exercises. The important thing is to start.

For someone who has not exercised for a long time, it is better to begin slowly. Start with simple exercises. Then increase gradually.

Aging women with medical conditions, previous fractures, severe joint pain, dizziness, or poor balance should speak to a doctor before starting a new exercise plan.

Safe Strength Exercises To Consider

For many aging women, safe strength exercises may include:

• Chair squats
• Sit-to-stand exercises
• Wall push-ups
• Standing heel raises
• Side leg raises

• Step-ups
• Light resistance band exercises
• Gentle core strengthening

• Balance exercises

These exercises may look simple. However, they can be very useful when done regularly and correctly.

For women with knee pain, hip pain, osteoporosis, previous fractures, or balance problems, exercise should be adjusted. It should not cause sharp pain. It should also not increase the risk of falling.

Common Mistake: Waiting Until Pain Starts

Many women only seek help after they develop pain or injury.

For example, they may come in with knee pain, back pain, hip pain, ankle pain, or a fracture after a fall.

But prevention is always better.

Strong muscles act like support around the joints. They do not remove all joint problems, but they can reduce stress on the joint.

This is why muscle strengthening for aging women should be seen as part of long-term joint care.

Strength Training Does Not Mean Bulky Muscles

This is a common misunderstanding.

Some women worry that strength training will make them look bulky.  It is not easy to build muscle even for serious female athletes who wish to bulk up. Physiologically women have less free testosterone to begin with.  This also requires appropriate nutrition, and consistent muscle stimulation with progressive loading with weights. 

For aging women, strength training is usually about function, balance, mobility, and bone support. It does not need to be extreme.

The aim is to build useful strength.

The aim is to move better.

The aim is to reduce the risk of falls and injuries.

The aim is to stay independent for as long as possible.

Start Small, But Stay Consistent

Consistency matters more than intensity.

A simple programme done two to three times a week can be a good start for many women. It may include lower limb strength, upper limb strength, core strength, and balance training.

The exercises should feel safe and controlled.

Over time, the body can adapt. Then the exercise can slowly become more challenging.

However, pain, dizziness, chest discomfort, sudden weakness, or shortness of breath should not be ignored. Stop and seek medical advice if these happen.

The Orthopaedic Message For Aging Women

From an orthopaedic point of view, muscle strength is part of bone and joint health.

It is not separate.

Aging women should not only think about X-rays, scans, supplements, or medication. These may be important in selected cases. However, movement and muscle strength are also key parts of healthy ageing.

The body is made to move.

When we stop using our muscles, we lose strength.

When we keep strengthening our muscles, we give our body a better chance to stay active.

Natalie Grabow’s achievement at 80 years old is inspiring. But for everyday women, the message is simple.

You do not need to become an athlete.

You just need to start building strength safely and consistently.

Conclusion

Muscle strengthening for aging women is one of the most important steps for healthy ageing.

It helps protect the joints. It supports the bones. It improves balance. It reduces the risk of falls. Most importantly, it helps women stay independent for longer.

The lesson from an 80-year-old athlete is not that everyone must become an Ironman finisher.  Of  course anyone can learn to swim, ride a bike or run if they choose to.

The real lesson is this:

Ageing does not mean stopping.

It is never too early to build strength.

And for many women, it is not too late to start.

It is also strongly advisable to do a medical health screening before starting any dietary changes or supplements and before embarking on a new exercise program.