Journal of Bodywork & Movement Therapies 40 (2024) 1417–1422

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Journal of Bodywork & Movement Therapies

journal homepage: www.elsevier.com/jbmt

Muscle hypertrophy response across four muscles involved in the bench

press exercise: Randomized 10 weeks training intervention
Marcel B. Lanza a, **, 1 , Gustavo C. Prado c, 1 , Lucas T. Lacerda e , Ricardo Reis Dinardi c , Lúcio
Honório Carvalho Junior d , Rodrigo C. Diniz b , Fernando V. Lima b , Mauro H. Chagas b , Hugo
C. Martins-Costa b, c, *
a
Department of Physical Therapy and Rehabilitation, School of Medicine, University of Maryland, Baltimore, United States
b
Weight Training Laboratory, School of Physical Education, Physiotherapy and Occupational Therapy, Federal University of Minas Gerais, Belo Horizonte, Brazil
c
Department of Physical Education, Pontifical Catholic University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
d
Department of Medicine, Pontifical Catholic University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
e
State University of Minas Gerais, Divinópolis, Brazil

A R T I C L E I N F O A B S T R A C T

Handling Editor: Jerrilyn Cambron Background and purpose: Resistance training exercise provides increases in muscle size and is used by coaches and
health care professional as a tool to improve functional performance. The aim of the present study was to
Keywords: investigate the effect of 10 weeks of resistance training program performed on the bench press (BP) exercise on
Resistance training the hypertrophic responses of four different muscles (pectoralis major, anterior and medial deltoid, brachii, and
Agonist muscles
pectoralis minor) involved in the task compared to controls.
Synergist muscles
Methods: Twenty-four healthy males were recruited, and thirteen performed a resistance training intervention
Muscle cross-sectional area
Magnetic resonance imaging while eleven were control. RT group trained for 10 weeks and the protocol consisted of a time under tension for
Bench press exercise each set of 36s (3–4 sets) with 12 repetitions with an intensity of 50–55% of the 1RM, a training frequency of 3
times a week, with a 3 min rest between sets. Muscle cross-sectional area (CSA) was measure by magnetic
resonance imaging.
Results: Individuals in the RT group demonstrated higher changes in CSA of the pectoralis major, pectoralis
minor, anterior deltoid, and triceps brachii (P ≤ 0.019) than in the Control group. It was identified in the RT
group higher increases in CSA of all muscles compared to medial deltoid (P ≤ 0.016), while pectoralis major
demonstrated larger increases in CSA than pectoralis minor and triceps brachii (P ≤ 0.030).
Conclusions: We demonstrated that 10 weeks of resistance training performed on the BP exercise led to increases
in muscle size of the muscles involved in the task, but not in the same magnitude.

1. Introduction many muscles to execute it. The research studies that investigated the
effect of a BP training intervention on muscle size have limited the
Perform resistance training exercise has shown to provide increases analysis to one or two prime movers (e.g., pectoralis major and triceps
in muscle size (muscle hypertrophy) (Folland and Williams, 2007). brachii) (Brandão et al., 2020; Larsen et al., 2021; Martins-Costa et al.,
Hypertrophy can be noticed after resistance training interventions 2021; Pareja-Blanco et al., 2020; Yasuda et al., 2011). However, other
executed on the bench press (BP) exercise (Martins-Costa et al., 2021; muscles involved in the BP may also present hypertrophy after a period
Pareja-Blanco et al., 2020; Yasuda et al., 2011). The BP is a very popular of training, as demonstrated elsewhere in other multiple joint exercises
multi-joint exercise (i.e., shoulder, elbow, and wrist joint) that involves (e.g., squat) (Kubo et al., 2019). Understanding if and how much other

* Corresponding author. Department of Physical Education, Pontifical Catholic University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
** Corresponding author. Department of Physical Therapy and Rehabilitation Science, School of Medicine, University of Maryland Baltimore, 100 Penn Street,
Baltimore, MD, 21201-1082, United States.
E-mail addresses: [email protected] (M.B. Lanza), [email protected] (H.C. Martins-Costa).
@marcellanza (M.B. Lanza)
1
Authors contributed equally to this work (shared first author contribution).

https://doi.org/10.1016/j.jbmt.2024.07.054
Received 15 January 2024; Received in revised form 20 June 2024; Accepted 21 July 2024
Available online 22 July 2024
1360-8592/© 2024 Elsevier Ltd. All rights are reserved, including those for text and data mining, AI training, and similar technologies.
M.B. Lanza et al. Journal of Bodywork & Movement Therapies 40 (2024) 1417–1422

muscles increases the size after a training performed on the BP will A total sample size of 24 subjects (12 per group) were determined by
provide further insight and possibilities for exercise prescription among using GPower (version 3.0.1, Germany) based on a test using an analysis
coaches and health care professionals. of variance (ANOVA) (repeated-measures, within-between interaction),
During the BP exercise, the pectoralis major, anterior deltoid and with an alpha level of 0.05, power of 0.80; effect size (ES) of 0.30 (ob-
triceps brachii (Larsen et al., 2021) have often their muscle activity tained from the triceps brachii muscle base on a previous study (Oga-
measured by electromyography (Stastny et al., 2017). Pectoralis major sawara et al., 2011)), number of groups, 2; number of measurements, 2;
and triceps brachii were the most investigated muscles when researchers correlation among measures of 0.5; and a nonsphericity correction of 1.
were assessing muscle size pre-to a post-training intervention targeting We recruited one participant more for each group (13) to account for a
to verify hypertrophy using BP exercise (Martins-Costa et al., 2021; possible dropout. All participants then engaged in a familiarization
Ogasawara et al., 2013; Pareja-Blanco et al., 2020; Yasuda et al., 2011). session for all measurement procedures before completing the 1RM test
Although the anterior deltoid is also a prime mover in the horizontal on the bench press. The results of the 1RM test were then used as a
adduction of the shoulder during the BP exercise (Muscolino, 2017; classification parameter (matched-groups design), and the participants
Stastny et al., 2017), no studies seem to have analyzed its hypertrophic were subdivided and randomly assigned into one of the two groups
response (Muscolino, 2017; Stastny et al., 2017). Therefore, under- (Control or Resistance Training [RT]). The matched-group design
standing the effect of resistance training on the hypertrophic response of ensured that participants were evenly distributed between groups based
this portion of the deltoid will help to understand which muscles are on their 1RM values, preventing any imbalances of stronger or weaker
affected by the bench press exercise. It is also noteworthy that some individuals in one group that could skew the results. All participants
studies have shown interest in measuring muscle activation of the provided written informed consent before their participation. This study
medial portion of the deltoid muscle, possibly due to its arm stabilizing was approved by the University’s Institutional Review Board.
role during the bench press exercise (Campos et al., 2020; Schick et al., Participants attended the clinic for a magnetic resonance imaging
2010). However, to the best of our knowledge, no study has analyzed the (MRI) scan followed by two laboratory sessions (familiarization and
chronic effect of training on the muscle size of the medial portion of the main test session) separated by a minimum of 72 h and a maximum of
deltoid. If the bench press exercise also causes an increase in this portion 96 h. After that, the results of the 1RM test were then used as a classi-
of the deltoid muscle, coaches and health care professionals should fication parameter (matched-groups design), and the participants were
consider this additive effect when designing resistance training pro- subdivided into one of the 2 groups, Control or Resistance Trained (RT)
grams. For instance, this may lead to a reduction in the number of ex- groups. During 10 weeks, RT group performed a resistance training
ercises focusing in this specific muscle. protocol (supervised sessions), whereas a Control did not perform any
The pectoralis minor is another muscle involved in the BP exercise training. The Control group was asked to keep the normal routine during
(Bhatia et al., 2007). Although the main actions of the pectoralis minor the study period. After the end of the training period, all participants
are related to the depression and anterior tilt of the scapula (Bhatia performed new MRI assessments (72–96 h). Testing sessions were per-
et al., 2007; Neumann, 2016), this muscle seems to collaborate with the formed at a consistent time of the day and participants were instructed
protraction movement, as well as limiting the retraction of the scapula to avoid any exercise in the 48 h before each session. Additionally,
(Neumann, 2016). Depending on the BP exercise technique adopted, participants were instructed to maintain the same dietary behaviour
scapula protraction may occur at the end of the bar lifting phase (Borges throughout the study.
et al., 2019; Hackett et al., 2014). It should be noted that changes in the Participants underwent an MRI examination to measure the CSA of
length and stiffness of the pectoralis minor muscle have been associated the pectoralis major, pectoralis minor, triceps brachii, anterior deltoid,
with scapular dyskinesis (Kibler et al., 2013). Considering that the in- and medial deltoid muscles. Before the exam, participants were seated
crease in muscle cross-sectional area seems to promote an increase in its for 20 min and then placed in a supine position on a stretcher with their
stiffness (Blazevich, 2019; Ryan et al., 2009), and that resistance muscles relaxed for at least 15 min. MRI scans were performed on a
training can impact both the increase in muscle cross-sectional area and Sigma HDX 1.5 T (GE Medical System, USA) with gradient-echo in
stiffness (Blazevich, 2019; Reeves et al., 2003), it would be important to phase/out phase technique T1-weighted, 120 ms repetition time, 2 ms
understand the effect of training on BP in increasing the pectoralis minor echo time, a field of view of 400 mm, resolution of 320 x 224 pixels, and
muscle size. Although shortening and tendinopathy of the pectoralis 8.0 mm slice thickness obtained continuously. During the examination,
minor have already been reported among practitioners of the BP exer- the upper limb was fixed in a normal anatomical position and parallel to
cise (Bhatia et al., 2007; Cutrufello et al., 2017), no studies were found the trunk and the volunteers were instructed not to move during image
that analyzed the chronic effect of BP training on the size of this muscle. acquisition. Considering the existence of chest movement during
Therefore, the present study aimed to investigate the effect of 10 breathing, the participants were also asked to perform apnea in some
weeks of resistance training program performed on the BP exercise on stages of the exam, to obtain a better quality of the images.
the hypertrophic responses of different muscles (pectoralis major, CSA of all muscles was identified by visual inspection and manually a
anterior and medial deltoid, triceps brachii, and pectoralis minor) line contoured the muscle for each slice (cm2; Fig. 1) by using the MIPAV
involved in the task compared to controls. Based on the previous program (MIPAV 10.0.0, National Institutes of Health Center for Infor-
research and muscle contribution to the task we hypothesized all mus- mation Technology). All images were analyzed in the axial plane. To
cles will present a hypertrophic response, but the pectoralis major, determine the CSA of the pectoralis major, the first image after the
anterior deltoid, and triceps brachii muscles of the individuals in the insertion of the pectoralis major into the humerus was used, which
training group will show larger increases in muscle size compared to represented approximately 60% of the distance of the muscle in relation
control group. An exploratory (secondary) aim is to investigate within to the greater tubercle of the humerus (initial point) to the epicondyle of
the group that performed the resistance training, if there are differences the elbow (final point) (Fig. 1A and B). A previous study (Yasuda et al.,
in increase in muscle size between muscles. We hypothesized that 2011) used an analysis point similar to that adopted in the present study,
muscles that are prime movers in the task will show higher increases in which facilitated the clear identification of the muscle belly of the
muscles size than the others. pectoralis major in the axial plane. The same image was used to calcu-
late the CSA of the pectoralis minor muscle. To determine CSA of the
2. Methods triceps brachii muscle, it was used as a reference for the distance be-
tween the greater tubercle of the humerus as the initial point while the
Twenty-six healthy males who were not involved in any activity lateral epicondyle of the humerus as the final point. After that, 60% of
involving strength training during the past 6 months and with no history the total distance of the abovementioned anatomical reference was used
of injuries in the wrist, elbow, or shoulder joints volunteer for this study. to draw the muscle (Kanehisa et al., 2004) (Fig. 1E). To determine CSA

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Fig. 1. Images of cross-sectional area drawing from one individual. Pectoralis major (A), pectoralis minor (B), anterior deltoid (C), medial deltoid (D), and triceps
brachii (E).

of the anterior and medial deltoids, it was used as anatomical reference and LSD post-hoc was used when necessary. Effect size (ES) was calcu-
to the first appearance of the intertubercular sulcus of the humerus, and lated as previously detailed (Cohen, 1988) and classified as follows:
both muscles were drawn in the image (Fig. 1C and D). <0.20 = “trivial”; 0.20–0.49 = “small”; 0.50–0.79 = “moderate”; or
The 1RM was performed in two baseline sessions and one post- ≥0.80 = “large”. Statistical analysis was performed using SPSS version
training session (4–5 days after the last training session). The first ses- 26 (IBM Corporation, Armonk, New York, USA). The significance level
sion was considered a familiarization session. In all session participants was set at P ≤ 0.05.
were positioned on the equipment (Smith machine, MASTER Belo
Horizonte, Brazil), with the position of the hands on the bar being 3. Results
standardized as twice the biacromial distance with the middle finger
being the reference for marking (Yasuda et al., 2011). Additionally, to The Control group began with thirteen male participants, but due to
ensure the same positioning of the participant across all testing and dropouts (participants did not provide any specific reason for dropout),
training sessions, tape measures were fixed to the bar and the bench as a it concluded with eleven male participants, having an average age
reference to replicate the individual location of the hands and head. The (mean ± SD) of 21.8 ± 5.0 years, and body mass, and height of 79.2 ±
general guidelines for determining the performance of 1RM were as 12.2 Kg and 1.78 ± 0.08 m, respectively. The RT group (thirteen males)
follows: (1) make a maximum of 6 attempts, with pauses of 3 min be- presented an average age of 24.3 ± 4.4 years, body mass of 73.4 ± 10.7
tween each one, and (2) gradually increase the external resistance with Kg, and height of 1.75 ± 0.05 m.
each repetition (minimum difference of 2 kg per attempt). The external No baseline differences were found in the muscle CSA values across
resistance on the bar was progressively increased until the volunteer was all analyzed muscles between the groups (P ≥ 0.207), Table 1. There was
unable to perform the concentric action. At this point, the value of 1RM a main effect of muscle (F(4,88) = 4.722, P = 0.002), an interaction
corresponded to the highest weight raised in the previous attempt. Same (F(4,88) = 4.227, P = 0.004), and a main effect of group (P < 0.001).
procedures were used elsewhere (Martins-Costa et al., 2016). Individuals in the RT group demonstrated higher changes in CSA of the
RT group trained for 10 weeks with all training sessions being su- pectoralis major (19.9% vs. − 3.6%; P < 0.001, ES = 2.3, “large”),
pervised. The RT protocol consisted of a time under tension for each set pectoralis minor (11.5% vs − 0.5%; P = 0.019, ES = 0.76, “moderate”),
of 36s with 12 repetitions [repetition duration of 3 s (1.5 s concentric anterior deltoid (14.9% vs 3.7%; P = 0.003, ES = 1.26, “large”), and
and 1.5 eccentric muscle actions)], with an intensity of 50–55% of the triceps brachii (11.5% vs − 2.4%; P = 0.003, ES = 1.52, “large”) than in
1RM, a training frequency of 3 times a week (48–72 h between sessions), the Control group, but no differences for medial deltoid (− 0.9% vs − 2.0;
3 min rest between sets, and 3–4 sets number. The duration of the P = 0.794, ES = 0.21, “small”), Fig. 2.
repetition was controlled by a metronome (M&MSystem, Hungen, When looking at the RT group, all muscles showed higher increases
Germany). Participants from the RT groups completed 30 training ses-
sions. During the 10 weeks of training, when the participants were un-
able to attend one of the sessions in one week, the individual was Table 1
Values of muscle cross-sectional area (CSA) pre and post training intervention
allowed to perform training sessions 4 times a week in the following
for Control and Resistance Training groups.
week, adopting a minimum break of 24 h between sessions. The protocol
was based on previous research with a similar population that showed Control Resistance Training
increases in muscle size (Tanimoto et al., 2008). Muscles (CSA) Pre Post Pre Post
A Shapiro-Wilk test was used to assess the normality of the data. To Pectoralis Major (cm2) 28.2 ± 3.9 27.2 ± 3.8 29.2 ± 5.7 35.7 ± 7.2
identify possible baseline differences in CSA between groups a student t- Pectoralis Minor (cm2) 4.9 ± 1.1 4.8 ± 1.1 4.9 ± 1.1 5.6 ± 1.9
test was performed for each muscle. A two-way ANOVA with a between Anterior Deltoid (cm2) 12.7 ± 1.4 13.2 ± 1.9 11.6 ± 2.1 13.5 ± 2.4
factor (muscle x group) was performed by using the CSA percentual Medial Deltoid (cm2) 3.2 ± 0.7 3.1 ± 0.7 3.1 ± 1.3 3.1 ± 1.4
Triceps Brachii (cm2) 25.3 ± 4.3 25.8 ± 4.0 26.2 ± 5.5 29.5 ± 6.1
values [((CSA post-training - CSA pre-training)/CSA pre-training)*100],

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Fig. 2. (A) Percentage change in muscle cross-sectional area (CSA) with individual values for pectoralis major (closed triangle), anterior deltoid (open square),
pectoralis minor (closed square), triceps brachii (closed circle), and medial deltoid (open circle) from pre to post training period. Symbol indicates: § difference
between groups [Control vs. Resistance Trained (RT)]. (B) Percentage change in muscle CSA, only for the RT group. Symbol indicates: # difference between the
medial deltoid muscle in relation to the other muscles; * difference between the triceps brachii and pectoralis minor in relation to the pectoralis major muscle.

in CSA than medial deltoid (P ≤ 0.016, ES ≥ 0.52, “moderate” for anterior deltoid has an important role during the BP exercise, even
anterior deltoid and triceps brachii, ES = 0.47, “small” for pectoralis though studies based on the electromyographic response have suggested
major, and ES = 0.05 for pectoralis minor “trivial”). Additionally, the a lower adaptation potential of this muscle (Stastny et al., 2017). Thus,
pectoralis major demonstrated larger increases in CSA than pectoralis the BP training intervention performed here was capable to improve the
minor (P = 0.030, ES = 0.76, “moderate”) and triceps brachii (P = muscle size of all the prime movers involved in the BP exercise and
0.014, ES = 1.60, “large”), but did not show difference when compared might be used when these muscles are the target of the training.
to the anterior deltoid (P = 0.267, ES = 1.28, “large”). However, no This is the first investigation to analyze the hypertrophic responses of
further differences were found for the other muscles. the medial deltoid and pectoralis minor muscles after a training inter-
vention on the BP exercise. It was demonstrated that the pectoralis
4. Discussion minor increased 11.5% after the training period. Thus, considering this
large increase in muscle size, it is reasonable to conclude that the pec-
The present investigation explored the effect of 10 weeks resistance toralis minor muscle might have an important role during the BP exer-
training program performed on the BP exercise on the hypertrophic cise, even taking into account that the participants of the present study
responses of the different muscles involved in the task and compared to were not instructed to perform scapular protraction at the end of the
controls. As we hypothesized, pectoralis major, anterior deltoid, and concentric phase of the movement. As previously presented, changes in
triceps brachii muscles showed a greater increase in muscle size after the the length and stiffness of the pectoralis minor muscle have been asso-
training intervention compared to controls. However, pectoralis minor ciated with scapular dyskinesia, due to its pull on the coracoid process,
also showed an increase in size after training. Additionally, the magni- which could create anterior tilt of the scapula (Kibler et al., 2013).
tude of the hypertrophic response was not the same for the evaluated Considering the increase in CSA of the pectoralis minor muscle observed
muscles. The pectoralis major hypertrophied more than the other mus- here, and the potential effect of resistance training on the change in
cles, except for the anterior deltoid. The training intervention used in the muscle stiffness (Blazevich, 2019), future studies and health care pro-
present study might be used for coaches and health care professionals if fessionals should consider the effect of bench press training on scapular
the aim is to generate hypertrophy of the different muscles involved in kinematics or other outcomes associated with scapular dyskinesis.
BP investigated here. Nonetheless, the medial deltoid showed no increases in muscle size
We demonstrated a 19.9%, 14.9%, and a 11.5% increase in muscle after the training intervention. It is possible that muscles that stabilize
size for the pectoralis major, anterior deltoid, and triceps brachii the movement do not receive as much stimulus during the contraction as
(respectively) in the training group after the intervention performed the other muscles evaluated in this study, hence this would decrease the
here. Similarly, another study (Yasuda et al., 2011) that performed BP mechanical or metabolic stimulus which might have an effect on the
training intervention for 10 weeks also showed hypertrophy in the hypertrophic responses to the exercise (Wackerhage et al., 2019).
pectoralis major (~10%) and triceps brachii (~5%), measured by MRI, Additionally, it should be noted that, in the present study, the smith
values very close to those found by Brandão et al. (2020). Furthermore, a machine bench press was used, which required less activation of the
BP training intervention of 12 weeks demonstrated a similar increase in medial deltoid when compared to the barbell bench press (Schick et al.,
muscle size (measured by ultrasound) of the pectoralis major (~20%) 2010). Although there is no evidence about an association between
and triceps brachii (12%) (Kikuchi and Nakazato, 2017). The different muscle activation and hypertrophic response, higher muscle activation
results between studies might be due to the different training configu- may lead to higher metabolic stress which is related to muscle hyper-
rations (e.g., training frequency, volume, and others) that are known to trophic response (Wackerhage et al., 2019).
affect muscle hypertrophy (Figueiredo et al., 2018; Lacerda et al., 2019). The present study has limitations and strengths that should be
To the best of the authors knowledge, this is the first study that inves- highlighted. The results we present here are restricted to the training
tigated the hypertrophic responses of the anterior deltoid after a BP configuration performed here; thus, using a different training structure
training intervention. This information strengthens the concept that the may affect the outcome of the training (e.g., hypertrophic responses).

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Our power analysis determined a requirement of 12 individuals per consultancies, stock ownership, or other equity interest; and expert
group. Although we initially started with 13 individuals, we concluded testimony or patent-licensing arrangements), or non-financial interest
with only 11 in one group. Nonetheless, the effect sizes were large. In the (such as personal or professional relationships, affiliations, knowledge
present study, although we used a reference method for measuring or beliefs) in the subject matter or materials discussed in this
muscle size (MRI), it was not possible to obtain CSA measurements in manuscript.
several regions of the different muscles. Additionally, the study was
performed on the smith machine and, considering the expectation of Acknowledgments
differences in muscle activation between different ways of performing
the bench press exercise (e.g., barbell bench press, dumbbell bench This study received support from the Support Foundation for Minas
press), extrapolation of these results should be done carefully. We Gerais Research (FAPEMIG), Improvement Coordination of Higher Level
recommend that future studies explore the effect of different training Personnel (CAPES, Brazil), National Council for Scientific and Techno-
configurations on the muscles involved in the BP exercise. The present logical Development (CNPq/Brazil), Dean of Research and Postgraduate
investigation is not limiting the analysis to only a couple of muscles. We Studies at the Pontifical Catholic University of Minas Gerais (PROPPG-
are providing robust evidence about the differences in muscle size of PUC Minas), and Dean of Research of the Federal University of Minas
four different muscles involved in the BP exercise. Furthermore, our Gerais. The authors thank the Ecoar Medicina Diagnostica Ltda and its
study sheds light on the ongoing debate among coaches and trainers staffs for technical and scientific collaboration on the MRI acquisition.
regarding the muscle that undergoes the most substantial growth
through the utilization of bench press exercises. While our study pos- References
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