Hindawi

Translational Sports Medicine

Volume 2023, Article ID 9507977, 15 pages
https://doi.org/10.1155/2023/9507977

Review Article
Comparison of Traditional and Advanced Resistance Training
Paradigms on Muscle Hypertrophy in Trained Individuals: A
Systematic Review and Meta-Analysis

Pedro A. B. Fonseca,1 Bernardo N. Ide ,1 Dustin J. Oranchuk,2,3 Moacir Marocolo,4

Mário A. M. Simim,5 Michael D. Roberts ,6 and Gustavo R. Mota 1
1
Exercise Science, Health and Human Performance Research Group, Department of Sport Sciences, Institute of Health Sciences,
Federal University of Triângulo Mineiro, Uberaba, MG, Brazil
2
Sports Performance Research Institute New Zealand, Auckland University of Technology, Auckland, New Zealand
3
Acumen Health, Calgary, AB, Canada
4
Department of Physiology, Federal University of Juiz de Fora, Juiz de Fora, MG, Brazil
5
Physical Education and Adapted Sports Research Group, Institute of Physical Education and Sports, Federal University of Ceará,
Fortaleza, Brazil
6
School of Kinesiology, Auburn University, Auburn, AL, USA

Correspondence should be addressed to Michael D. Roberts; [email protected]

Received 17 February 2023; Revised 5 July 2023; Accepted 10 July 2023; Published 18 July 2023

Academic Editor: Abigail Mackey-Sennels

Copyright © 2023 Pedro A. B. Fonseca et al. Tis is an open access article distributed under the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly
cited.
Trained individuals may require variations in training stimuli and advanced resistance training paradigms (ADV) to increase
skeletal muscle hypertrophy. However, no meta-analysis has examined how ADV versus traditional (TRAD) approaches may
diferentially afect hypertrophic outcomes in trained populations. Te aim of this review was to determine whether the skeletal
muscle hypertrophy responses induced by TRAD difered from ADV in resistance-trained individuals. Furthermore, we sought to
examine potential efects of dietary factors, participants’ training status, and training loads. We searched for peer-reviewed,
randomized controlled trials (published in English) conducted in healthy resistance-trained adults performing a period of TRAD
and ADV with pre-to-post measurement(s) of muscle hypertrophy in PubMed, Web of Science, SPORTDiscus, and MEDLINE
databases up to October 2022. A formal meta-analysis was conducted in Revman5, and risk of bias was assessed by ROB2. Ten
studies met the inclusion criteria. Results indicated no diference between ADV and TRAD for muscle thickness (SMD = 0.05, 95%
CI: −0.20 0.29, p = 0.70), lean mass (SMD = −0.01, 95% CI: −0.26 0.23, p = 0.92), muscle cross-sectional area (SMD = −0.07, 95%
CI: −0.36 0.22, p = 0.64), or all measurements analyzed together (SMD = −0.00, 95% CI: −0.15 0.14, p = 0.95). No heterogeneity or
inconsistencies were observed; however, unclear risk of bias was present in most of the studies. Short-term ADV does not induce
superior skeletal muscle hypertrophy responses when compared with TRAD in trained individuals. Tis review was not previously
registered.

1. Introduction accretion of contractile and structural proteins and pro-

motes skeletal muscle hypertrophy [3–5]. Despite recent
Te ability of the skeletal muscle to generate strength and investigations challenging the hypothesis that RT-induced
power is primarily dictated by neural drive (i.e., motor unit increases in muscle size meaningfully contribute to increases
fring rate and frequency) and the quantity of muscle in muscle strength [6, 7], athletes often seek to maximize
contractile and structural proteins [1, 2]. Under appropriate a hypertrophic response to training with the general ac-
nutrient provision, resistance training (RT) optimizes the ceptance that this translates into performance gains [5].
2 Translational Sports Medicine

Te American College of Sports Medicine suggests that adopted (P: trained individuals, I: ADV, C: TRAD, O: hyper-
moderate loading (70–85% of one-repetition maximum trophy, and T: intervention time described at least on number of
(1RM)) with 8–12 repetitions per set, for 1–3 sets per ex- sessions or weeks). Inclusion criteria for studies were as follows:
ercise, is efective for facilitating muscle hypertrophy in (i) peer-reviewed, published in English, and available as a full-
novice (untrained individuals with no RTexperience, or who text manuscript; (ii) randomized controlled trials conducted
have not trained for several years) and intermediate trainees with healthy resistance-trained adults performing a period of
[8]. However, for individuals that possess an advanced TRAD and ADV; (iii) measurement of skeletal muscle hy-
training status, a loading range of 70–100% of 1RM with pertrophy pre-to-post training change scores at the macroscopic
1–12 repetitions per set for 3–6 sets per exercise in a per- and microscopic level with the following techniques: B-mode,
iodized manner is recommended such that the majority of panoramic, extended feld of view or three-dimensional ul-
training is devoted to 6–12RM training and less training is trasonography, dual-energy X-ray absorptiometry (DEXA),
devoted to 1–6RM loading [8]. computed tomography, peripheral quantitative computed to-
Te above recommendations are related to the fact that, mography, magnetic resonance imaging, muscle biopsies, and/
while untrained individuals can develop strength using any or measurement of lean body mass change by plethysmography;
reasonable RT program [9], the potential for further func- (iv) RT program presented as ADV must match the description
tional and morphological improvements diminishes as an provided by previous literature (see Advanced Paradigms
individual becomes more well trained. In this regard, a win- section); and (v) raw data (i.e., mean, standardized deviation,
dow of adaptation in trained individuals may exist [1, 10], median, and standardized error) provided in the text, Table(s),
resulting in slower rates of strength and hypertrophy increases or Figure(s). Studies observing responses to low-load blood fow
than in untrained individuals [9, 10]. To avoid a “plateau” in restriction, non-isoinertial RT (e.g., fywheel, isokinetic, and
skeletal muscle adaptation, reputable strength and condi- pneumatic devices), creatine, protein or other supplements,
tioning guidelines advise that trained individuals may require anti-infammatory drugs, or the infuence of training frequency
higher variations in training stimuli, more sophisticated were not included. Section 2.2 describes ADV identifed and
planning strategies, and longer training periods to achieve used for classifying and including the studies reviewed. If there
changes in strength and hypertrophy [11, 12]. was any divergence in the selection of studies between the two
Tese and associated recommendations for novice and reviewers, a third reviewer was included for the fnal decision.
advanced training statuses are often denoted as traditional
RT approaches (TRAD) [13]. Conversely, advanced RT
paradigms (ADV), or specialized training techniques ad- 2.2. Advanced Resistance Training Paradigm (ADV)
vocated to optimize muscle growth, include the utilization of Description. Advanced paradigms consist of pre-defned RT
drop-sets, forced repetitions, rest-pause repetitions, super protocols based on the confguration of RT variables (i.e.,
slow repetitions, pyramid sets, pre-exhaustive sets, supersets, load, number of repetitions and sets, movement velocity, rest
accentuated eccentric overload, and German volume intervals between sets, exercises or repetitions, or exercise
training [13–15]. Some advanced RT paradigms have been order, among others).
investigated and compared to TRAD regarding the poten-
tiation of muscle hypertrophy in resistance-trained in- 2.2.1. Accentuated Eccentric. Accentuated eccentric or ec-
dividuals [13, 15]. However, a recent narrative review [15] centric overload aims to provide a greater load in the ec-
concluded that the currently available evidence could not centric phase of the movement [15, 16]. Te concentric
determine whether ADV variations can optimize muscle phase is performed with a regular load (e.g., 70% of 1RM)
strength and mass gains compared to TRAD. whereby the load is adjusted for the eccentric phase (usually
Several studies [13, 16, 17] have examined RT adapta- above the concentric 1RM, e.g., 110–120% of 1RM), which
tions in well-trained participants following short-term RT requires external assistance [16].
interventions (i.e., 6–12 weeks). However, no meta-analysis
has examined how diferent RT paradigms (e.g., TRAD
versus ADV) may afect hypertrophic outcomes in pre- 2.2.2. Drop-Sets. Drop-sets involve reducing the load (e.g.,
viously trained individuals. Terefore, this systematic review 20%) to perform additional repetitions after achieving
and meta-analysis sought to determine whether the skeletal failure in a set [14, 20]. Te process can be repeated on the
muscle hypertrophy responses induced by TRAD difer from same set, and a minimal rest interval is allowed between load
ADV in resistance-trained individuals. Based on previous reductions [14, 20].
literature [13, 15–17], we hypothesized that ADV and TRAD
would elicit similar efects regarding muscle hypertrophy 2.2.3. Forced Repetitions. After achieving concentric failure
responses. during a set, proper assistance (i.e., by the coach or partner) is
provided to the lifter to perform additional repetitions [14].
2. Methods
2.1. Eligibility Criteria. Tis review is in line with the current 2.2.4. German Volume Training. German volume training is
Preferred Reporting Items for Systematic Reviews and Meta- characterized by the performance of 10 sets of 10 repetitions
Analysis (PRISMA) checklist [18]. Population, Intervention, in no more than two exercises with a load of approximately
Comparator, Outcome, and Time (PICOT) [19] strategy was 60% of 1RM [15, 21].
Translational Sports Medicine 3

2.2.5. Paired Sets. Paired sets, supersets, or bi-sets are de- reviewers to conduct the entire process in blind mode. Once
scribed as the combination of two exercises executed in both reviewers have completed their screening, the blind
sequence without rest [14]. Supersets are considered a spe- mode is turned of. If any discrepancies arise, they are re-
cifc agonist-antagonist combination of exercises [14], and solved by consensus with a third reviewer (GM).
a variation of a bi-set with three exercises is also known as
tri-set [15].
2.6. Data Collection Process. One author (PF) extracted data
from the included studies, and a second author (BI) double-
2.2.6. Pre-Exhaustion. A single-joint exercise set is per- checked the data. No automatic tools were used. Dis-
formed until failure immediately before a set of a multi-joint agreements were resolved through personal communication
exercise of the same muscular group to induce more fatigue between the authors.
in a specifc muscle [15, 22].
2.7. Data Items. Skeletal muscle hypertrophy was extracted
2.2.7. Pyramid. Te pyramid system consists of a confgu- from each study at the pre- and post-intervention time
ration of sets leading to a progressive increase (i.e., crescent points for all measurements reported (i.e., types of muscle
pyramid) or decrease (i.e., decrescent pyramid) in the load hypertrophy assessment or local of measurement). Only
for each set performed [13, 15]. Te number of repetitions variables related to skeletal muscle hypertrophy were con-
performed follows an inverse relationship pattern for each sidered for calculating standardized mean diferences
confguration [13, 15]. (SMDs).

2.2.8. Rest-Pause. An overestimated number of repetitions 2.8. Study Risk of Bias Assessment. Following recommen-
are fxed to a given load. When failure is reached, a short rest dations for randomized controlled trials, the risk of bias was
interval (e.g., 20 seconds) is taken before subsequent repe- assessed by the scale Risk of Bias-2 scale of Cochrane [26, 27]
titions are performed until failure is achieved again [15, 23]. by two reviewers (PF and BI). Te domains assessed were the
randomization process (A), deviations from the intended
interventions (B), missing outcome data (C), measurement
2.2.9. Super Slow. Super slow training is characterized by
of the outcome (D), and selection of the reported result (E).
using a very slow movement velocity for each repetition (e.g.,
Te overall risk of bias was determined according to each
10 seconds to concentric and 4 seconds to eccentric) [15, 24].
study’s higher risk domain (F) presented. Te assessment
was done by answering the pre-specifed questions about the
2.3. Information Sources. Te search was conducted in adequacy of each study. Te analysis was conducted
PubMed, Web of Science, Scopus, SPORTDiscus with Full according to recommendations using software provided by
Text, and MEDLINE Complete databases using a specifc Cochrane. According to the pre-specifed questions, the
syntax described in Section 2.4. Te initial search was studies were classifed in each domain as low, unclear, and
conducted in January 2022. A fnal search was conducted on high risk of bias. Te overall risk of bias was determined by
October 17, 2022. References lists of included studies were the higher risk attributed to any domain.
also examined for potential studies not found on initial
search.
2.9. Efect Measures. For all types of hypertrophy mea-
surements (i.e., pre to post diferences), an analysis of SMD
2.4. Search Strategy. Based on the PICOT strategy, we de- between ADV and TRAD was conducted. Results were
veloped a specifc syntax to conduct the search on all da- considered trivial, small, moderate, and high with the fol-
tabases. Searches were conducted without flters or limits lowing values: <0.2, ≥0.2 and < 0.5, ≥0.5 and < 0.8, and ≥0.8.
(not advanced search) using the following terms: (“re-
sistance train∗” OR “strength train∗” OR “weight train∗”)
2.10. Synthesis Methods. All studies that presented hyper-
AND (“accentuated eccentric” OR “drop-set” OR “super-
trophy measures were analyzed independently of type of
slow” OR “pyramid∗” OR “pre-exhaustion” OR “eccentric
measurement reported. However, a sub-analysis for each
overload” OR “rest-pause” OR “German volume training”
type of measurement was conducted (see Results section).
OR “forced repetition∗” OR superset OR “bi-set” OR “tri-
Te Review Manager software Version 5.4 (the Cochrane
set”) AND (hypertrophy OR “muscle mass” OR “fber cross-
Collaboration, 2020) was used for data entry, statistical
sectional area” OR “muscle thickness” OR “muscle volume”)
analysis, and plotting the fgures [27]. No additional
AND (session∗ OR week∗).
preparation of data was required. Te level of between-study
heterogeneity was assessed using the chi-square (χ 2) test and
2.5. Selection Process. Te studies founded on initial search I-square (I2) statistic [28]. I2 outcomes of 25, 50, and 75%
were imported into the software Rayyan online for sys- correspond to low, moderate, and high heterogeneity [29],
tematic reviews [25] to fnd duplicates and perform the with a value of 0% indicating no heterogeneity, and above
screening record according to the inclusion criteria by two 75% were rated as heterogeneous. A meta-analysis with
diferent reviewers (PF and BI). Rayyan software allows both SMD, the degree(s) of freedom (df ), and the 95% confdence
4 Translational Sports Medicine

interval (CI) was reported. Te model of efect analysis was studies [21, 35] reported signifcant changes in MT but not in
chosen according to the heterogeneity of the studies, fxed- lean mass for both TRAD and ADV.
efect model for no heterogeneity (i.e., I2 of 0%) or random-
efect model to any presence of heterogeneity (i.e., I2 > 0%).
3.2. Comparison of TRAD and ADV on Muscle Hypertrophy.
Diferences at the level of p < 0.05 were considered statis-
Some studies contained multiple groups (i.e., more than one
tically signifcant. Additionally, to evaluate the robustness of
ADV group, resulting in 24 groups) or multiple hypertrophy
the results, we performed a sensitivity analysis using the
analyses (i.e., lean body mass, ACSA, and muscle thickness
exclusion of specifc studies method.
(MT) in diferent locations). Terefore, 33 comparisons were
considered for the meta-analysis (see Figure 2). Control
2.11. Reporting Bias Assessment. Te reporting bias of each groups that have trained with their own previous RT rou-
study was accessed through the E scale of ROB2, and an tines (i.e., outside the laboratory) were not considered. One
analysis of possible publication bias was also conducted with study [36] compared two protocols with pre-exhaustion
visual analysis of the funnel plot, Egger’s regression, and (called TRAD and control, see Table 2). Only TRAD was
Begg and Mazumdar rank correlation tests. Te tests were included in the analysis as the control group altered the
conducted on Jamovi software [30]. sequence in the study [36].
Te forest plot of all included comparisons is presented
in Figure 2.
2.12. Certainty Assessment. In this systematic review, the
Grading of Recommendations Assessment, Development,
and Evaluation (GRADE) approach was used to assess the 3.2.1. Muscle Tickness Changes. Separate analysis of MT
certainty of the evidence [31]. Te certainty of the evidence indicated no heterogeneity between studies (p = 0.97,
was assessed for hypertrophy outcome using the GRADE I2 = 0%). Considering a fxed-efect model, the analysis of
framework. SMD showed no diference between ADV and TRAD when
MT was used as hypertrophy assessment (SMD = 0.05 CI:
[−0.20 0.29]).
3. Results
A total of 262 records were found from Web of Science 3.2.2. Lean Body Mass Changes. Separate analysis of lean
(n � 75), Scopus (n � 58), PubMed (n � 47), MEDLINE body mass changes indicated no heterogeneity between
Complete (EBSCO, n � 42), and SPORTDiscus with Full studies (p �1.00, I2 � 0%). Considering a fxed-efect model,
Text (EBSCO, n � 40). After removing duplicates, 103 re- the analysis of SMD showed no diference between ADV and
cords remained. According to inclusion criteria, 22 studies TRAD when lean body mass was used as hypertrophy as-
were considered possibly eligible. After full-text assessments, sessment (SMD � −0.01 CI: [−0.26 0.23]).
14 studies were excluded. In addition to the eight studies,
two additional studies were included after consulting the
articles’ reference lists. Tis led to 10 studies being included 3.2.3. Anatomical Cross-Sectional Area Changes. Separate
in the fnal analysis. Figure 1 shows the fowchart diagram of analysis of ACSA indicated no heterogeneity between
the study screening process. studies (p �1.00, I2 � 0%). Considering a fxed-efect model,
the analysis of SMD showed no diference between ADV and
TRAD when CSA was used as hypertrophy assessment
3.1. General Description of the Studies. Te description of (SMD � −0.07 CI: [−0.36 0.22]).
studies regarding the RT programs that investigated muscle
hypertrophy outcomes is presented in Table 1.
3.2.4. All Muscle Hypertrophy Assessments. Analysis of all
Seven diferent types of ADV were identifed including
hypertrophy measurements together indicated no hetero-
German volume training in two studies [21, 32], crescent
geneity between studies (p �1.00, I2 � 0%). Considering
pyramid in one study [13], drop-sets and heavy drop-sets in
a fxed-efect model, the analysis of SMD showed no dif-
three studies [13, 17, 33], eccentric overload/accentuated
ference between ADV and TRAD (SMD � −0.00 CI: [−0.15
eccentric in three studies [16, 34, 35], pre-exhaustion in one
0.14]).
study [36], super slow in one study [34], and rest-pause in
two studies [17, 37].
Diferent types of hypertrophy assessments were iden- 3.3. Dietary Controls. Table 3 shows a summary of the di-
tifed, including B-mode ultrasonography MT with 14 etary control reported in each study.
comparisons, lean body mass via DEXA or air displacement Only six studies presented some type of dietary control
plethysmography with 13 comparisons (Walker et al. [35] [13, 17, 21, 32, 35, 37]. Four studies instructed their par-
also performed lean body mass analysis; however, data were ticipants how to proceed with their nutritional intake habits
incomplete and were not included in the calculation of during the period of the study [13, 17, 21, 32], four studies
SMD), and anatomical cross-sectional area (ACSA) via B- provided a standardized protein supplementation after ex-
mode ultrasonography or magnetic resonance imaging with ercise [13, 21, 32, 35], and two studies calculated nutritional
seven comparisons. Five studies [13, 17, 21, 35, 37] reported intakes from dietary records [17, 37]. One of these studies
signifcant hypertrophy changes after interventions, and two [37] did not report data related to dietary controls.
Translational Sports Medicine 5

Record identified through database searches (N=262)

Identification
Web of Science (n=75)
Scopus (n=58)
Duplicate records removed before screening (N=159)
Pubmed (n=47)
Medline (n=42)
Sport discus (n=40)

Records screened (N=103) Records removed (N=82)

Did not compare ADV versus TRAD (n=38)
Unorthodox training (n=15)
Investigated older individuals (n=10), untrained
individuals (n=3), unhealthy individuals (n=3), or
animals (n=1)
Reviews (n=9)
Studies assessed for eligibility (N=21)
Screening

Used blood flow restriction training (n=1)

Notes on 21 studies assessed

Full text not included (n=14)
Inclusion of untrained individuals (n=6)
No TRAD control (n=2)
Hypertrophic outcomes assessed using circumference
or bioelectrical impedance (n=2), or no hypertrophy
assessment (n=1)

Studies included from screening procedures (n=8)

Included studies

Additional studies included through cross-referencing

(n=2)

Total studies included in meta-analysis (N=10)

Figure 1: Flowchart illustrating the distinct phases of the search and selection strategy.

3.4. Participants’ Training Statuses. Table 4 shows partici- than a ffth of the exercises performed. Te mean volume
pants’ characteristics, RT experience, training status re- load of sessions for German volume training was
ported in the study, and training status according to the scale 4879 ± 773 kg, and it was 24491 ± 4180 kg for the bench press
suggested by Rhea [38]. and leg press, respectively [32]. Te mean volume load of
Four studies [13, 17, 21, 35] reported time of experience in sessions for TRAD was 2407 ± 483 kg and 13498 ± 2712 kg
RTof participants, and the other six reported the minimum of for the bench press and leg press, respectively [32]. Addi-
time experience required for a participant to be eligible for the tionally, one study [21] reported the volume load for two
study [16, 32–34, 36, 37]. According to Rhea’s classifcation of sessions only (initial and fnal) and three exercises (bench
training status [38], six studies [21, 32–36] included untrained press, cable pull-down, and leg press) only. Volume load of
subjects, four studies [13, 16, 17, 37] included recreationally these three exercises on the initial session was 4583 ± 852 kg,
trained subjects, and no study included only highly trained 3962 ± 712 kg, and 20901 ± 9942 kg for GTV and
individuals. However, one study reported individuals that 1845 ± 700 kg, 1596 ± 408 kg, and 10117 ± 2636 kg for TRAD,
varied from untrained to recreationally trained [32], two respectively, for bench press, cable pull-down, and leg press.
studies from untrained to highly trained [21, 35], and one Volume load of these three exercises on the fnal session was
study from recreationally trained to highly trained [13]. 5078 ± 775 kg, 3862 ± 689 kg, and 24883 ± 3424 kg for Ger-
man volume training and 2329 ± 766 kg, 1826 ± 444 kg, and
12941 ± 3051 kg for TRAD, respectively, for bench press,
3.5. Quantifcation of Training Loads. Te quantifcation of cable pull-down, and leg press.
training loads described during training interventions and We attempted to examine the RT programs performed
the participants’ previous training experience are presented by the participants before their engagement in the included
in Table 2. studies. However, none of the studies reported the RT
None of the studies reported complete data about the program performed by the participants before their en-
quantifcation of training loads. Two studies [13, 17] re- gagement in the study. Only one study [13] estimated the
ported the total volume load. Angleri et al. [13] reported previous volume loads performed by the participants two
a total of ∼150 tons executed in TRAD, drop-set, and weeks before engagement in the study; however, the data
crescent pyramid, while Enes et al. [17] reported were unavailable. One study reported the usual ranges of sets
412263 ± 50764 kg for drop-set, 440363 ± 45953 kg for rest- and repetitions performed by the participants [37]. One
pause, and 405428 ± 45748 kg for TRAD. One study [32] study [13] reported previous experience with exercises used
reported the average volume load of the sessions, but for less in the intervention.
 6
Table 1: General description of the studies.
ADV investigated
and duration
Muscle hypertrophy Main results Main results Diferences between
Study and frequency
assessment for TRAD for ADV protocols
of the
program
↑3.1, ↑4.2, and ↑7.8% in total, ↑1.9, ↑1.0, and ↑3.5% in total,
Lean mass through DEXA and
Amirthalingam GVT. 6 weeks of training trunk, and arm lean mass, trunk, and arm lean mass, No signifcant diferences
MT through B-mode
2017 performed 3 days per week. respectively. No signifcant respectively. No signifcant between GVT and TRAD
ultrasonography
changes in MT. changes in MT.
↑7.5% and ↑7.8% in ACSA No signifcant diferences
CP and DS. 10 weeks of training ACSA through B-mode
Angleri 2017 ↑7.6% in ACSA induced by CP and DS, between CP, DS, and
performed 2 days per week. ultrasonography
respectively TRAD
EO. Te training was performed
2 days per week for the frst
Branderburg ACSA through magnetic No signifcant diferences
2 weeks and then 3 days per week No signifcant changes No signifcant changes
2002 resonance imaging between EO and TRAD
for the remainder of the 9-week
training period.
↑11.6 and ↑7.7% in the proximal
thigh and middle thigh MT,
↑14.2 and ↑6.5% in the proximal
respectively, for DS. ↑8.8 and No signifcant diferences
DS and RP. 8 weeks of training MT through B-mode thigh and middle thigh MT,
Enes 2021 ↑5.1% in the proximal thigh and between DS, RP, and
performed 2 days per week. ultrasonography respectively. No signifcant
middle thigh MT for RP. No TRAD
changes in distal thigh MT.
signifcant changes in distal MT
for both groups.
PE. 12 weeks of training Lean mass through air No signifcant diferences
Fisher 2014 No signifcant changes No signifcant changes
performed 2 days per week. displacement plethysmography between PE and TRAD
No signifcant diferences
SS and EO. 10 weeks of training Lean mass through air
Fisher 2016 A No signifcant changes No signifcant changes between SS, EO, and
performed 2 days per week. displacement plethysmography
TRAD
No signifcant diferences
DS and HDS. 12 weeks of training Lean mass through air
Fisher 2016 B No signifcant changes No signifcant changes between DS, HDS, and
performed 2 days per week. displacement plethysmography
TRAD
GVT. 12 weeks of training No signifcant diferences
Hackett 2018 Lean mass through DEXA No signifcant changes No signifcant changes
performed 3 days per week. between GVT and TRAD
RP. 6 weeks of training MT through B-mode ↑ in thigh MT was greater
Prestes 2019 No signifcant changes ↑11% in thigh MT
performed 4 days per week. ultrasonography for RP
↑11 and ↑16% in vastus lateralis ↑13 and ↑11% in vastus lateralis
MT through B-mode
EO. 10 weeks of training and medialis MT, respectively. and medialis MT, respectively. No signifcant diferences
Walker 2016 ultrasonography and lean mass
performed 2 days per week. No signifcant changes in lean No signifcant changes in lean between EO and TRAD
through DEXA
mass∗ . mass∗ .
Te table shows resistance training programs investigated, muscle hypertrophy assessments, and main results. GVT: German volume training; MT: muscle thickness; DEXA: dual-energy X-ray absorptiometry; CP:
crescent pyramid; DS: drop-set; ACSA: anatomical cross-sectional area; EO: eccentric overload; RP: rest-pause; PE: pre-exhaustion; SS: super slow; HDS: heavy DS; ∗ � data not used in calculation of standardized
mean diference due to incomplete report; ↑ � increase.
Translational Sports Medicine
Translational Sports Medicine 7

Favours Advanced FavoursTraditional Weight Std. Mean Difference Std. Mean Difference Risk of Bias
Study or Subgroup
Mean SD Total Mean SD Total (%) IV, Fixed, 95% CI IV, Fixed, 95% CI A B C D E F

1.2.1 Muscle Thickness

Amirthalingam (GVT - Anterior Thigh MT) 2017 1.1 7.8 10 2.6 9.2 9 2.7 -0.17 [-1.07, 0.73] ? + + + + ?
Amirthalingam (GVT - Biceps MT) 2017 0.3 4.1 10 2.4 5.4 9 2.7 -0.42 [-1.33, 0.49] ? + + + + ?
Amirthalingam (GVT - Posterior Thigh MT) 2017 2.2 6.5 10 1.2 7.7 9 2.7 0.13 [-0.77, 1.04] ? + + + + ?
Amirthalingam (GVT - Triceps MT) 2017 4.5 6.6 10 2.3 6.6 9 2.7 0.32 [-0.59, 1.23] ? + + + + ?
Amirthalingam (GVT - Trunk mass) 2017 0.3 4.2 10 1.1 3.3 9 2.7 -0.20 [-1.10, 0.70] ? + + + + ?
Enes (DS - Distal MT) 2021 0.6 2.3 9 0.4 4.8 9 2.6 0.05 [-0.87, 0.97] ? + + + + ?
Enes (DS - Middle MT) 2021 4 3.7 9 3.5 5.8 9 2.6 0.10 [-0.83, 1.02] ? + + + + ?
Enes (DS - Proximal MT) 2021 5.3 8.6 9 6.5 8.1 9 2.6 -0.14 [-1.06, 0.79] ? + + + + ?
Enes (RP - Distal MT) 2021 3.4 4.8 10 0.4 4.8 9 2.6 0.60 [-0.33, 1.52] ? + + + + ?
Enes (RP - Middle MT) 2021 2.8 3.9 10 3.5 5.8 9 2.7 -0.14 [-1.04, 0.77] ? + + + + ?
Enes (RP - Proximal MT) 2021 4.3 6 10 6.5 8.1 9 2.7 -0.30 [-1.20, 0.61] ? + + + + ?
Prestes (RP - Chest MT) 2019 2.5 6.7 9 0.1 7.8 9 2.6 0.31 [-0.62, 1.25] ? + + + + ?
Prestes (RP - Thigh MT) 2019 4.5 9.16 9 -0.1 10.6 9 2.5 0.44 [-0.50, 1.38] ? + + + + ?
Prestes (RP - Triceps MT) 2019 3.2 9.16 9 1.7 10.7 9 2.6 0.14 [-0.78, 1.07] ? + + + + ?
Subtotal (95% CI) 134 126 37.0 0.05 [-0.20, 0.29]
Heterogeneity: Chi2 = 5.18, df = 13 (P = 0.97); I2 = 0%
Test for overall effect: Z = 0.39 (P = 0.70)

1.2.2 Lean Mass

Amirthalingam (GVT - Arm mass) 2017 0.3 0.9 10 0.6 1.4 9 2.7 -0.25 [-1.15, 0.66] ? + + + + ?
Amirthalingam (GVT - Body mass) 2017 1.2 7.4 10 1.8 7.8 9 2.7 -0.08 [-0.98, 0.83] ? + + + + ?
Amirthalingam (GVT - Leg mass) 2017 0.5 2.6 10 0.1 3.1 9 2.7 0.13 [-0.77, 1.04] ? + + + + ?
Fisher (DS - Lean body mass) 2016 B 0 11 11 -0.9 9.6 11 3.2 0.08 [-0.75, 0.92] ? + + + + ?
Fisher (EO - Lean body mass) 2016 A 0.05 10.6 20 -0.25 9.2 19 5.6 0.03 [-0.60, 0.66] ? + + + + ?
Fisher (HDS - Lean body mass) 2016 B -0.05 6.8 14 -0.9 9.6 11 3.6 0.10 [-0.69, 0.89] ? + + + + ?
Fisher (PE - Lean body mass) 2014 0.9 18.5 14 -0.75 22.6 16 4.3 0.08 [-0.64, 0.79] ? + + + + ?
Fisher (SS - Lean body mass) 2016 A 0.32 9.1 20 -0.25 9.2 19 5.6 0.06 [-0.57, 0.69] ? + + + + ?
Hackett (GVT - Arm mass) 2018 0.1 0.6 6 0.6 1.8 6 1.7 -0.34 [-1.49, 0.80] ? + + + + ?
Hackett (GVT - Body mass) 2018 1 5.7 6 2 9.6 6 1.7 -0.12 [-1.25, 1.02] ? + + + + ?
Hackett (GVT - Leg mass) 2018 -0.3 1.9 6 0.2 3.8 6 1.7 -0.15 [-1.29, 0.98] ? + + + + ?
Hackett (GVT - Trunk mass) 2018 0.5 3 6 1.3 3.9 6 1.7 -0.21 [-1.35, 0.92] ? + + + + ?
Subtotal (95% CI) 133 127 37.3 -0.01 [-0.26, 0.23]
Heterogeneity: Chi2 = 1.17, df = 11 (P = 1.00); I2 = 0%
Test for overall effect: Z = 0.10 (P = 0.92)

1.2.3 Anatomical Cross Sectional Area

Angleri (CP - Vastus lateralis ACSA) 2017 2.3 4.2 15 2.3 4.8 31 5.8 0.00 [-0.62, 0.62] ? + + + + ?
Angleri (DS - Vastus lateralis ACSA) 2017 2.3 4.5 16 2.4 4.8 31 6.1 -0.02 [-0.62, 0.58] ? + + + + ?
Branderburg (EO - Biceps ACSA) 2002 -0.09 3.64 8 0.9 4.06 10 2.5 -0.24 [-1.18, 0.69] ? + - + + -
Branderburg (EO - Triceps ACSA) 2002 0.6 3.81 8 0.9 4.06 10 2.6 -0.07 [-1.00, 0.86] ? + - + + -
Walker (EO - Vastus Intermedius ACSA) 2016 9.4 8.6 10 10.8 9 10 2.9 -0.15 [-1.03, 0.73] ? + - + + -
Walker (EO - Vastus Lateralis ACSA) 2016 2.8 7.8 10 2.3 4.6 10 2.9 0.07 [-0.80, 0.95] ? + - + + -
Walker (EO - Vastus Medialis ACSA) 2016 2.5 5.9 10 3.7 4.4 10 2.9 -0.22 [-1.10, 0.66] ? + - + + -
Subtotal (95% CI) 77 112 25.7 -0.07 [-0.36, 0.22]
Heterogeneity: Chi2 = 0.46, df = 6 (P = 1.00); I2 = 0%
Test for overall effect: Z = 0.46 (P = 0.64)

Total (95% CI) 344 365 100 -0.00 [-0.15, 0.14]

Heterogeneity: Chi2 = 7.18, df = 32 (P = 1.00); I2 = 0%
Test for overall effect: Z = 0.06 (P = 0.95) -1 -0.5 0 0.5 1
Test for subgroup differences: Chi2 = 0.37, df = 2 (P = 0.83); I2 = 0% Favours (Advanced) Favours (Traditional)

Risk of bias legend

(A) Randomisation process
(B) Deviations from the intended interventions
(C) Missing outcome data
(D) Measurement of the outcome
(E) Selection of the reported result
(F) Overall

Figure 2: Forest plot of the analyses and risk of bias. SD: standardized deviation; GTV: German volume training; MT: muscle thickness; DS:
drop-set; RP: rest-pause; EO: eccentric overload; HDS: heavy DS; PE: pre-exhaustion; SS: super slow; ACSA: anatomical cross-sectional area;
CP: crescent pyramid; risk of bias legend: A, randomization process; B, deviations from the intended interventions; C, missing outcome data;
D, measurement of the outcome; E, selection of the reported result; F, overall risk of bias.

3.6. Risk of Bias Analysis. Analysis of the risk of bias revealed rank correlation: −0.025, p � 0.844). No heterogeneity was
that only two studies [16, 35] had a high risk of bias due to found, and the analysis of sensitivity revealed that exclusion
unequal dropouts of the ADV group (domain C of Risk of of any study did not alter the results of the meta-analysis.
Bias-2 scale), both of which investigated eccentric overload.
All studies presented a lack of information in domain A
(which does not inform if the allocation was concealed), 3.7. Certainty Assessment. We used the GRADE framework
resulting in an unclear risk (F) for the remaining eight to assess the certainty of evidence for hypertrophy outcomes.
studies. However, most studies had a low risk in domains Many factors of the studies analyzed support a high level of
B–E. A summary of the risk of bias analysis is illustrated in quality evidence such as studies were randomized controlled
Figure 2, while the funnel plot of all included comparisons is trials, consistently similar results were obtained, the mea-
presented in Figure 3. surements used by studies are direct to the variable(s) of
Visual inspection of the funnel plot reveals that the interest, no heterogeneity was found (i.e., I2 � 0%), and a low
results were unlikely to be infuenced by publication risk bias probability of publication bias was present (i.e., no signif-
[39]. Likewise, Egger’s regression and Begg and Mazumdar cant Egger’s regression or Begg and Mazumdar rank cor-
rank correlation were used to evaluate publication bias. Both relation tests). However, two studies were found to have
tests showed that there was no risk of publication bias a high risk of reporting bias according to ROB2 analysis.
(Egger’s regression: −0.352, p � 0.725; Begg and Mazumdar Additionally, none of the studies mentioned a concealment
 8
Table 2: Resistance training programs performed by the participants before the engagement in the study, progression, and quantifcation of training loads.
RT program
performed before
Progression of Quantifcation of
Study the engagement Exercises performed TRAD intervention ADV intervention
training loads training load
in the
study
Flat bench press; lat
pull-down; incline bench
press; seated row;
Loads were adjusted by
crunches; leg press; GVT. 10 sets of 10 rep
5 sets of 10 rep with 60–80% 5–10% once the
Amirthalingam dumbbell lunges; leg with 60–80% 1RM and Only the initial and fnal
Not reported 1RM and 60−90s of rest participants were able to
2017 extensions; leg curls; calf 60−90 s rest interval VL for 3 exercises
interval (only in 6 exercises) complete 10 repetitions on
raises; shoulder press; (only in 6 exercises).
the fnal set of each exercise
upright row; triceps
pushdowns; biceps curls;
sit-ups with a twist
VL of DS and CP were
Initial VL was defned as
equalized with TRAD.
120% of the VL that each
DS: sets were performed
Participants reported 3–5 sets of 6–12 rep with participant performed in
until failure, with a drop
training lower limbs at 75% 1RM and 120 s of rest. the 2 weeks before the
load of ∼20% on each Total VL reported for the
Angleri 2017 least 2 d.wk.−1 and Leg press; leg extension Training occurred study. Te number of sets
failure until reaching the whole RT program
performing leg press 45° according to pre-established and repetitions was
prescribed VL. CP: 3–5
and leg extension VL. adjusted every time that the
of 6–15 rep with 65–85%
VL was increased (∼7%
1RM and 120 s rest
every 3 weeks).
interval.
Te load was adjusted
EO. 3 sets of ∼10 rep with
when the average number
Branderburg Preacher curl; supine 4 sets of ∼10 rep with 75% 75% 1RM on concentric
Not reported of repetitions performed Not reported†
2002 elbow extension 1RM and 110–120% 1RM on
per set in a training session
the eccentric phase.
became greater than 10
DS. 3 sets of 10 with 70%
1RM and 3 additional
sets of 6 rep with 55%
1RM with 120 s of rest
° between sets and no rest
Barbell back squat; 45 leg
before additional sets
press; seated knee 4 sets of 12 rep with 70%
(only 3 of 5 exercises). Te load was adjusted by Total VL reported for the
Enes 2021 Not reported extension; stif-leg 1RM and 120 s of rest
RP. 3 sets of 10 with 75% 5% in the ffth week whole RT program
deadlift; seated knee interval
1RM and 3 additional
fexion
sets of 6 rep with 75%
1RM with 120 s of rest
between sets and 20 s
before additional sets
(only 3 of 5 exercises).
Translational Sports Medicine
 Table 2: Continued.
RT program
performed before
Progression of Quantifcation of
Study the engagement Exercises performed TRAD intervention ADV intervention
training loads training load
in the
study
Chest press; leg press; PE: one set of ∼12RM Once participants were able
TRAD: one set of ∼12RM
pull-down; pectoral fy; leg and 60 s of rest between to perform more than 12
Previous experience with and 60 s of rest. Control∗ :
Fisher 2014 extension; pull-over; sets and 5 s between repetitions before Not reported
PE system one set of ∼12RM and 60 s
abdominal fexion; lumbar isolated and compound achieving failure, the load
of rest.
Translational Sports Medicine

extension exercises was adjusted by 5%

EO: one set of 8 reps with
105% 1RM with 60 s of
rest interval between
Participants reported exercises and cadence of
having done single-set Leg extension, leg curl; leg One set of 8–12 reps with 10 s per rep (only one Once participants were able
training until failure for press; overhead press; 75% 1RM with 120 s of rest session; the other was to perform more than
Fisher 2016 A Not reported
multiple exercises chest press; pec-fy; interval between exercises realized identical to desired repetitions, the load
including most major pull-over; pull-down and cadence of 6 s per rep TRAD). SS: one set of 6 was adjusted by 5%
muscle groups 2 d.wk.−1 reps with 75% 1RM with
60 s of rest interval
between exercises and
cadence of 12 s per rep.
DS: one set of 8−12RM
with additional set with
Chest press; leg press; reduction of ∼30% on
pull-down; overhead load (only 3 exercises; 12
Participants reported Once participants were able
press; adductor; abductor; exercises of 15 were
having done single-set to perform more than 12
abdominal fexion; lumbar realized identical to
training until failure for repetitions before
Fisher 2016 B extension; pec-fy; One set of 8−12RM TRAD). HDS: one set of Not reported
multiple exercises achieving failure, the load
pullover; leg extension; ∼4RM with an additional
including most major was increased by 5% (only
−1 dips; biceps curl; seated set with two reductions
muscle groups 2 d.wk. reported for TRAD)
calf raise; leg curl; core of ∼20% on load (only 3
torso rotation exercises; 12 exercises of
15 were realized identical
to TRAD).
Flat bench press;
lat-pulldown; incline When participants were
5 sets of 10 reps with GVT: 10 sets of 10 reps
bench press; seated row; able to complete >10 Average VL for only 2
Participants reported 60–80% 1RM and 60–90 s of with 60–80% 1RM and
Hackett 2018 crunches; shoulder press; repetitions on the fnal set, exercises (a total of 15
training at least 3 d.wk.−1 rest interval (only in 6 60−90 s of rest interval
upright row; triceps the load was increased by exercises were utilized)
exercises) (only in 6 exercises)
pushdowns; biceps curl; approximately 5–10%
sit-ups with a twist
9
 10

Table 2: Continued.
RT program
performed before
Progression of Quantifcation of
Study the engagement Exercises performed TRAD intervention ADV intervention
training loads training load
in the
study
Barbell bench press;
dumbbell incline press;
Te subjects were
cable cross; military press;
accustomed to training
lateral raise; triceps pulley; RP: one set of 18 rep with
3–5 days per week with
barbell triceps extension; 3 sets of 6 rep with 80% 80% 1RM (performed
split-body training No progression or
Prestes 2019 squat; 45° leg press; leg 1RM and 120−180 s of rest with intra-set rests of Not reported
routines and 3-4 sets of adjustments were reported
curl; front lat pull-down; interval 20 s) and 120 s of rest
8−12RM per exercise
seated row; dumbbell between exercises
with the objective of
lateral row; standing
muscle hypertrophy
barbell elbow curl;
preacher curl
EO: 3 sets of 6RM or
Bilateral leg press; 10RM with +40% of the Te load was adjusted to
3 sets of 6RM or 10RM with
Walker 2016 Not reported unilateral knee extension; load in eccentric phase provide muscle failure in at Not reported
120−180 s of rest interval
unilateral knee fexion and 120−180 s of rest least one of three sets
interval
Rep: repetitions; 1RM: one-repetition maximum test; GVT: German volume training; VL: volume load; DS: drop-set; CP: crescent pyramid; TRAD: traditional resistance training; EO: eccentric overload; RP:
rest-pause; RM: repetition maximum (performed until failure); PE: pre-exhaustion; SS: super slow; HDS: heavy DS; ∗ � groups were not considered in the calculation of standardized mean diference. †�
programmed volume load (calculated as sets × repetitions × percentage of 1RM) was reported to be equal between protocols.
Translational Sports Medicine
 Table 3: Dietary control employed in the studies.
Translational Sports Medicine

Post-training
Study Nutritional intake record Nutritional plan
standardized supplementation
Participants were encouraged to increase their caloric
Amirthalingam Te dietary intake was obtained via a 3-day food diary Whey protein (30.9 g of protein, 0.2 g of fat, and 0.9 g
intake by 1000–2000 kJ above their estimated daily
2017 before and after the experimental training period of carbohydrate) 30 min after each training session
energy requirements
Participants were advised to have a light meal 2 h
Angleri 2017 Not performed before each testing session and to maintain their 30 g of whey protein after each training session
eating habits
Branderburg 2002 Not performed Not prescribed Not prescribed
Participants completed a 3-day non-consecutive
dietary intake record before the intervention, at the Participants were instructed to have a meal two hours
Enes 2021 mid-point, and conclusion of the study period. No before each training session and to maintain their Not prescribed
diference in dietary intake was found between the habitual dietary intake
groups.
Fisher 2014 Not performed Not prescribed Not prescribed
Fisher 2016 A Not performed Not prescribed Not prescribed
Fisher 2016 B Not performed Not prescribed Not prescribed
Participants were encouraged to increase their caloric Whey protein (30.8 g of protein, 0.2 g of fat, and 0.9 g
Hackett 2018 Not performed
intake of carbohydrate) 30 min after each training session
No diference in dietary intake was found between
Prestes 2019 Not prescribed Not prescribed
groups but data were not available
A standardized recovery drink containing 23 g of whey
protein (8.5 g leucine and 5.1 g isoleucine per 100 g),
Walker 2016 Not performed Not prescribed
3 g of carbohydrate, and 1.6 g of fat immediately after
each training session
11
 12

Table 4: Participants’ characteristics, training status, and strength level.

Training status Training status
Initial strength
Study Participants RT experience reported in according to
level
the study Rhea [38]
Nineteen healthy males were randomly TRAD: 4.8 ± 4.8 years. GVT:
Amirthalingam Not reported, but according to data, Untrained to highly
assigned to either TRAD (n � 9) or 3.5 ± 1.0 years. More than 1 year, Healthy men
2017 the RS on the bench press was ∼1.0 trained
GVT (n � 10) 3 months consistently
Tirty-two men (16 legs in CP, 16 in Well-trained young Recreationally to
Angleri 2017 6.4 ± 2.0 years Squat RS > 1.3
DS, and 32 in TRAD) men highly trained
Branderburg Eighteen university-aged male subjects:
At least 1 year Bench press RS > 1.0 Trained individuals Recreationally trained
2002 TRAD (n � 10); EO (n � 8)
TRAD: 4.4 ± 0.7 years
Twenty-eight healthy males: TRAD RS on the squat: TRAD � 1.6 ± 0.2; Resistance-trained
Enes 2021 DS: 5.6 ± 1.5 years Recreationally trained
(n � 9); DS (n � 9); RP (n � 10) DS � 1.7 ± 0.2; RP � 1.7 ± 0.2 males
RP: 5.2 ± 2.2 years. At least 2 years
Forty-one participants: control∗ (n � 3
men and 5 women); TRAD (n � 4 men
Fisher 2014 At least 6 months Not reported Trained participants Untrained
and 13 women); PE (n � 2 men and 12
women)
Fifty-nine participants: TRAD (n � 10
Fisher 2016 A men/9 women); EO (n � 10 men/10 At least 6 months Not reported Trained participants Untrained
women); SS (n � 10 men/10 women)
Tirty-six subjects: TRAD (n � 6 men
and 5 women); DS (n � 3 men and 8 Trained males and
Fisher 2016 B At least 6 months Not reported Untrained
women); HDS (n � 2 men and 12 females
women)
Twelve healthy males: TRAD (n � 6) More than 1 year, 3 months Not reported, but according to data, Untrained to
Hackett 2018 Healthy males
and GVT (n � 6) consistently the RS on the bench press was ∼1.0 recreationally trained
Eighteen subjects (14 males and 4 Not reported, but according to data,
Prestes 2019 More than 1 year Trained subjects Recreationally trained
females): TRAD (n � 9) and RP (n � 9) the RS on the bench press was ∼1.1
Twenty-eight men: TRAD (n � 10), EO 0.5–6 years Untrained to highly
Walker 2016 Not reported Strength-trained men
(n � 10), and control∗ (n � 8) 2.6 ± 2.2 years trained
TRAD: traditional resistance training; GVT: German volume training; RS: relative strength; EO: eccentric overload; DS: drop-set; RP: rest-pause; PE: pre-exhaustion; SS: super slow; HDS: heavy DS; ∗ � groups not
considered in the calculation of standardized mean diference.
Translational Sports Medicine
Translational Sports Medicine 13

0.2

0.4

SE (SMD)
0.6

0.8

1
-1 -0.5 0 0.5 1
SMD
Subgroups
Muscle Thickness
Lean Mass
Anatomical Cross Sectional Area
Figure 3: Funnel plot of included studies. SE: standardized error for SMD; SMD: standardized mean diference.

process during randomization, resulting in an overall un- Curiously, fve of ten studies included in this review
clear risk of bias. Due to these factors and the lack of nu- failed to observe hypertrophy in both groups (i.e., ADV and
tritional control and proper reporting of training loads, we TRAD [16, 32–34, 36]). Since these studies aimed to com-
assigned a moderate level of quality of evidence for our pare hypertrophy changes induced by TRAD and ADV,
systematic review’s conclusions. Future studies in this area failure to achieve skeletal muscle hypertrophy in both groups
could leverage these fndings to improve study designs in is a limitation. Small sample size [32], lack of dietary controls
this regard. [21, 33, 34, 36], lower sensitivity of some measurements in
detecting hypertrophy changes (e.g., plethysmography
4. Discussion [33, 34, 36]), and inconsistencies in training load monitoring
[16, 32–34, 36, 37] may be among the possible candidates to
Te aim of this meta-analysis was to determine whether the explain these results.
skeletal muscle hypertrophic responses induced by TRAD It is also notable that the studies included in our analysis
are diferent from ADV in resistance-trained individuals. compared muscle hypertrophy outcomes using diferent
Our results indicate that, regardless of skeletal muscle hy- measurement tools (e.g., MT, lean mass, or ACSA, see Ta-
pertrophy assessment (i.e., MT, lean mass, or ACSA), no ble 1). Tis is important to note given that it has been reported
signifcant advantage was provided by ADV versus TRAD that disagreements among muscle imaging techniques exist
(see Figure 2). Tis fnding corroborates with our hypothesis [43–45]. Tus, this remains a limitation of the current meta-
and previous literature [13, 15]. analysis. Notwithstanding, our sub-group analysis of MT, lean
mass, and ACSA did not reveal any diferences between
4.1. Comparison of TRAD and ADV on Muscle Hypertrophy. TRAD and ADV paradigms (SMD � 0.05 [−0.20 0.29], −0.01
Most of the included studies did not report diferences in [−0.26 0.23], and −0.07 [−0.26 0.23], respectively, see Fig-
outcomes between ADV and TRAD (see Table 1). Tese data ure 2). Tis fnding lends further support that 6–12 weeks of
suggest that skeletal muscle hypertrophy may not be en- ADV does not confer additional hypertrophic benefts in
hanced through 6–12 weeks of ADV in previously trained previously trained individuals.
individuals. However, one study [37] reported signifcant
increases in thigh MT diferences after six weeks of the rest-
pause system compared to TRAD (11% increase for rest- 4.2. Limitations. Tis meta-analysis is not without limita-
pause, and no increases for TRAD, see Table 1). Analysis of tions. Tis review was not registered a priori. Some of the
MT may be accurate to estimate muscle size (i.e., muscle inclusion criteria implied that not all recommendations for
volume assessed by magnet resonance image) when con- systematic reviews were followed (e.g., choosing only En-
sidering a single time point assessment [40]. However, when glish peer-reviewed randomized controlled trials). A uni-
assessing chronic muscle hypertrophy changes, MT has versal defnition to depict participants’ training status does
some limitations [40] associated with muscle physiology not exist, which may have impacted some of our conclusions
(i.e., heterogeneous distribution of hypertrophy [41, 42]) and regarding the infuence of training status on associated
the geometric nature of the measure that is limited to outcomes. We may also have overlooked studies that failed
a specifc site of the muscle [40]. Moreover, despite this study to report participants as trained subjects. Considering that
presenting diferences in thigh MT, no diferences in the training status classifcation and dietary strategies were
chest and arm MT were found [37]. divergent among the studies reviewed, our results may only
14 Translational Sports Medicine

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