The former USA Gymnastics team doctor Larry Nassar has been sentenced to between 40 and 175 years in prison for abusing athletes in his care.

Judge Rosemarie Aquilina reached her decision after a sentence hearing that heard from dozens of women and girls, including the Olympic champions Aly Raisman and McKayla Maroney.

Victim impact statements against Larry Nassar: 'I thought I was going to die' Read more

Nassar had already admitted in November to molesting seven girls in his care under the guise of treatment. But a total of 156 girls and women came forward to speak at the seven-day sentencing hearing, saying they had also suffered abuse at his hands, with two dozen more submitting private letters to the court.

Late on Wednesday, the president of Michigan State University, where Nassar also treated athletes, said she was tendering her resignation. Lou Anna Simon had faced a barrage of criticism for not doing enough to halt the abuse by the doctor, including a scathing front-page editorial by the independent student newspaper that cast “Simon, her appointees and cheerleaders” as “enablers”.

“As tragedies are politicized, blame is inevitable. As president, it is only natural that I am the focus of this anger,” Simon said in her resignation letter.

Judge Aquilina told Nassar Wednesday: “It is my honor to sentence you because, sir, you do not deserve to walk outside of a prison ever again. Anywhere you walk, destruction would occur to those most vulnerable.”

She added: “I just signed your death warrant.”

Play Video 2:41 ‘Larry Nassar, I hate you’: abuse victims in their own words – video

Aquilina said the sentence reflected not only the seven counts to which Nassar pleaded guilty, but also the survivors who came forward during the sentencing hearing “because the depth of all of your crimes have cut into the core of this community”.

“The breadth and ripple of this defendant’s abuse and destruction is infinite,” the prosecuting attorney Angela Povilaitis said in her closing remarks. “Nassar used his prestige to gain [his victims’] trust and to exploit them, leaving many of them emotionally shattered by a man they not only trusted but loved. In competitive gymnastics, he found the perfect place for his master manipulation.”

The disgraced physician gave a brief statement before Aquilina handed down the sentence, acknowledging the “pain, trauma and emotional destruction” experienced by his victims.

“Your words these past several days have had a significant emotional effect on myself and have shaken me to my core,” he said. “I will carry your words with me for the rest of my days.”

“Sir, I hope that’s true,” the judge said after Nassar concluded.

Aquilina read portions of the six-page, single-spaced letter Nassar wrote to the judge last week in which he said it was too difficult for him to listen to the victim impact statements, citing it as proof that “you have still not owned what you did”.

“Would you like to withdraw your plea?” the judge asked.

“No, your honor,” he said.

“Because you’re guilty, aren’t you, sir?”

“I accept my plea.”

Rachael Denhollander, one of three survivors to speak on Wednesday, was “absolutely” satisfied with the sentence on a day she wasn’t sure would ever come when she became the first of Nassar’s victims to come forward publicly in September 2016.

“The number of sexual assault victims Larry had was plain to me,” she said. “Whether or not anyone would feel safe to come forward, that was the wild card.”

After Aquilina delivered the sentence, the US Olympic Committee called on the directors of USA Gymnastics to resign. “The purpose of this message is to tell all of Nassar’s victims and survivors, directly, how incredibly sorry we are,” the USOC chief executive, Scott Blackmun, wrote in an open letter. “We have said it in other contexts, but we have not been direct enough with you ... The Olympic family is among those that have failed you.”

Those who confronted Nassar in the Michigan courtroom included household names such as Raisman and Maroney but most of those he abused never reached the elite level. The first witness in court when the hearing started last week was Kyle Stephens, who told the court she was abused by Nassar, a family friend, between the ages of six and 12. “Perhaps you have figured it out by now, but little girls don’t stay little for ever,” Stephens said. “They grow into strong women that destroy your world.”

Simone Biles, one of the stars of the Rio Olympics, said she had also been abused by the 54-year-old although she chose not to appear in court. “Most of you know me as a happy, giggly, and energetic girl,” the four-times Olympic gold medalist wrote on Twitter last week. “But lately I’ve felt a bit broken and the more I try to shut off the voice in my head the louder it screams. I am not afraid to tell my story anymore.”

Michigan State University, USA Gymnastics and the USOC have all been named as co-defendants in civil suits that appear headed to trial, with allegations that officials knew about Nassar’s abuse. One of the most vocal critics of the organisations that allegedly enabled Nassar has been Raisman.

Play Video 1:58 'I'm a survivor': US Olympian confronts abuser Larry Nassar in court – video

“Adult after adult protected you,” Raisman, who won gold medals at the 2012 and 2016 Olympics, said when she appeared in court last week. “How do you sleep at night? You are the person they had ‘take the lead on athlete care’.”

“I will not rest until every last trace of the influence you had on this sport has been destroyed like the cancer it is.”

Raisman also told ESPN that USA Gymnastics “told [her] to be quiet” when she first told the organisation she had been abused by Nassar.

On Monday, three USA Gymnastics board members resigned over the scandal. Raisman took the USOC to task for taking credit for the resignations.

Play Video 1:42 'Little girls don't stay little forever': abuse victims confront Larry Nassar – video

“For the past week, survivors came forward to courageously face a perpetrator of evil and to share their painful stories,” Raisman wrote on Twitter. “Many of them, myself included, claim the USOC is also at fault. Was the USOC there to ‘focus on supporting the brave survivors’? No. Did they issue any statement then? Crickets …”