Women in Strength (WISH study): a mixed-method approach to develop muscle-strengthening exercise intervention

Rosaini, Nur Dania (2026) Women in Strength (WISH study): a mixed-method approach to develop muscle-strengthening exercise intervention. PhD thesis, University of Glasgow.

Abstract

Muscle-strengthening exercise (MSE) offers many health benefits, including lower all-cause mortality and non-communicable disease risk, improved metabolic and musculoskeletal health, and enhanced mental health. Despite the global and national Physical Activity Guidelines recommending that adults engage in muscle-strengthening activities for two or more days a week, participation rates remain low, particularly among women. Barriers such as time constraints, a lack of knowledge and confidence in their abilities, and discomfort in the gym continue to constrain women’s participation in these activities. Over four sequential studies, this thesis aimed to quantify participation patterns in MSE, understand lived experiences, and co-design and test an intervention to improve participation.

In Study 1 (Chapter 2) 615 participants completed a survey (n = 144 males, n = 471 females) to identify the types, intensities, frequencies, and durations of participation in muscle-strengthening activities among adults aged 18 to 64 years in the UK. 76% of participants self-reported meeting the guidelines (“Yes” group), with 24% self-reporting not meeting the guidelines (“No” group). However, 95% of the “No” group actually met the guidelines, with the majority meeting this when daily living muscle-strengthening activities (e.g., carrying a shopping bag and climbing stairs) were included. Women in both groups reported doing fewer MSE and daily living muscle-strengthening activities than men. Sex differences were observed in the types of MSE participated in (men: weight machines and resistance exercises, women: holistic exercises). MSE were performed on average 2-3 days a week at moderate intensity, and daily living activities were performed on average 2 days a week at low intensity, with similar session duration for both types of activities.

Study 2 (Chapter 3) used reflexive thematic analysis to explore barriers, facilitators, and strategies to improve women’s participation in MSE among women from Study 1 who met the muscle-strengthening guidelines (n = 24). Four overarching themes were revealed: (1) reason for participating in MSE (health concerns and sports performance), (2) barriers to MSE participation (perceived time constraint, low motivation, cultural stigma and societal perceptions, confidence in ability and accessibility), (3) facilitators to participating in MSE (resources or information, accountability, social support, ability to choose and positive changes) and (4) strategies to improve women’s participation in MSE (what an individual and others can do).

Study 3 (Chapter 4) included 21 women, recruited from participants in Study 1 and the general public, who did not meet the guidelines, to explore barriers and potential facilitators to participation in MSE, and to co-design an MSE intervention informed by the findings of Chapter 3. Challenges and potential facilitators in MSE were classified into five categories: (1) routine and prioritisation, (2) knowledge and self-efficacy, (3) physical and psychosocial, (4) cultural stigma and societal perception, and (5) accessibility and environment. These challenges and potential facilitators were similar to those reported in Chapter 3. The codesigned process identified 3 key elements for inclusion in the intervention, which were: (1) education (strength education session), (2) social (online support group and optional group exercise session), and (3) modalities (access to various modalities and logging the training).

Study 4 (Chapter 5) involved 34 women who did not meet the guidelines, recruited from participants in Study 3 and the general public, to evaluate the feasibility, acceptability, and effectiveness of the co-designed intervention on body composition and muscular strength in a randomised controlled trial. The intervention involved five components, which were: 1) strength education sessions, 2) optional group exercise sessions, 3) an online support group, 4) logging training and 5) access to various modalities (12 weeks gym membership and resistance bands). Participants in the intervention group were asked to participate in MSE of their choice on two days a week. The intervention lasted 12 weeks, followed by a further 24- week follow-up, during which support was removed. The study recruitment (100%) and retention rate, measured by completion of all lab visits (91%), were high. Education sessions (attendance 80–87%) and access to a choice of exercise modalities were highly acceptable. Optional group sessions and the online support group were less utilised. At 12 weeks, no significant time*group interactions were observed. Significant effects of time occurred for muscle thickness (p = 0.028), back strength (p = 0.039), and knee extensor torque (p <.001), but not handgrip strength (p = 0.118). From baseline to week 12, changes in muscle thickness were +0.56mm, p = 0.492 in control and +0.86mm, p = 0.054 in intervention. For back strength, changes were +3kg, p = 1.000 in control and +9.8 kg, p = 0.011 in intervention. For knee extensor torque, changes were -0.52Nm, p = 1.000 in control and +10.89Nm, p = 0.381 in intervention. Similar results were observed from baseline to week 24, with effects generally smaller. The co-designed intervention was subsequently mapped to the COM-B model and Behaviour Change Techniques (BCTs) taxonomy to enhance theoretical transparency.

Collectively, this PhD thesis provides a comprehensive investigation of women’s participation in MSE by using quantitative, qualitative, and intervention-based approaches. The mixed-method design, combined with a co-design approach, ensured that the intervention and findings were relevant to women’s life experiences. The thesis lays the foundation for a scalable intervention to improve women’s participation in MSE and their health outcomes by addressing persistent barriers to MSE participation and incorporating participants’ insights into the intervention.

• Item Type: Thesis (PhD)
• Qualification Level: Doctoral
• Subjects: R Medicine > RC Internal medicine > RC1200 Sports Medicine
• Colleges/Schools: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Supervisor's Name: Gray, Professor Stuart and Ryde, Dr. Gemma
• Date of Award: 2026
• Depositing User: Theses Team
• Unique ID: glathesis:2026-86134
• Copyright: Copyright of this thesis is held by the author.
• Date Deposited: 16 Jul 2026 13:56
• Last Modified: 19 Jul 2026 06:36
• Thesis DOI: 10.5525/gla.thesis.86134
• URI: https://theses.gla.ac.uk/id/eprint/86134

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