Sports Med (2013) 43:179-194
Potential Mechanisms for a Role of
Metabolic Stress in Hypertrophic
Adaptations to Resistance Training
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Potential Mechanisms for a Role of Metabolic Stress
in Hypertrophic Adaptations to Resistance Training
Brad J. Schoenfeld
Published online: 22 January 2013
ÓSpringer International Publishing Switzerland 2013
Abstract It is well established that regimented resistance
training can promote increases in muscle hypertrophy. The
prevailing body of research indicates that mechanical stress
is the primary impetus for this adaptive response and
studies show that mechanical stress alone can initiate
anabolic signalling. Given the dominant role of mechanical
stress in muscle growth, the question arises as to whether
other factors may enhance the post-exercise hypertrophic
response. Several researchers have proposed that exercise-
induced metabolic stress may in fact confer such an ana-
bolic effect and some have even suggested that metabolite
accumulation may be more important than high force
development in optimizing muscle growth. Metabolic
stress pursuant to traditional resistance training manifests
as a result of exercise that relies on anaerobic glycolysis for
adenosine triphosphate production. This, in turn, causes the
subsequent accumulation of metabolites, particularly lac-
tate and H
. Acute muscle hypoxia associated with such
training methods may further heighten metabolic buildup.
Therefore, the purpose of this paper will be to review the
emerging body of research suggesting a role for exercise-
induced metabolic stress in maximizing muscle develop-
ment and present insights as to the potential mechanisms
by which these hypertrophic adaptations may occur. These
mechanisms include increased ﬁbre recruitment, elevated
systemic hormonal production, alterations in local myo-
kines, heightened production of reactive oxygen species
and cell swelling. Recommendations are provided for
potential areas of future research on the subject.
It has been well established that regimented resistance
training can promote increases in muscle hypertrophy. The
prevailing body of research indicates that mechanical stress
is the primary impetus for this adaptive response. These
ﬁndings were described in the seminal work of Goldberg
et al. , who reported that increased force development is
the critical event in initiating compensatory muscular
growth. Subsequently, numerous studies have conﬁrmed
this ﬁnding both in vitro (within the glass), ex vivo (outside
the living), and in vivo (within the living) [2–6].
Current theory suggests that forces associated with
resistance exercise disturb the integrity of skeletal muscle,
causing mechano-chemically-transduced molecular and
cellular responses in myoﬁbres and satellite cells .
Exercise-induced hypertrophy is facilitated by a complex
cascade of anabolic and catabolic signalling pathways,
whereby the effects of mechano-stimulation are molecu-
larly transduced to downstream targets that shift muscle
protein balance to favour synthesis over degradation. Many
anabolic signalling pathways are involved in exercise-
induced gains in muscle mass with certain pathways
functioning in a permissive role while others directly
mediate cellular processes that inﬂuence messenger RNA
(mRNA) translation and thus hypertrophy . Pathways
that have been identiﬁed as particularly important to
muscle anabolism include mammalian target of rapamycin
(mTOR), mitogen-activated protein kinase (MAPK), and
various calcium-dependent pathways, amongst others.
Although these pathways may overlap at key regulatory
steps, there is evidence that they are synergistic rather than
redundant . However, the precise mechanisms and
interplay between them have yet to be fully elucidated. A
complete discussion of the topic is beyond the scope of this
B. J. Schoenfeld (&)
Department of Health Sciences, Program of Exercise Science,
APEX Building, Room # 265, Lehman College, CUNY,
250 Bedford Park Blvd West, Bronx, NY 10468, USA
Sports Med (2013) 43:179–194
Author's personal copy
article and interested readers are referred to reviews by
Bassel-Duby and Olson , Miyazaki and Esser  and
Glass . Figure 1presents a simpliﬁed ﬂowchart of
various signalling cascades and their relevance to anabolic
and catabolic processes.
Mechanical stress alone has been shown to directly
stimulate mTOR , possibly through activation of the
extracellular regulated kinase/tuberous sclerosis complex 2
(ERK/TSC2) pathway . It is theorized that these actions
are mediated via the synthesis of the lipid second mes-
senger phosphatidic acid (PA) by phospholipase D [13,14].
There also is evidence that PA can phosphorylate the
downstream anabolic translational regulator p70S6 kinase
(p70S6k) independent of mTOR , presenting another
potential avenue whereby mechanical stimuli may directly
inﬂuence muscle protein synthesis.
Given the dominant role of mechanical stress in muscle
growth, the question arises as to whether other factors may
enhance the post-exercise hypertrophic response. Several
researchers have proposed that exercise-induced metabolic
stress may in fact confer such an effect [16–18] and some
have even suggested that metabolite accumulation may be
more important than high force development in optimizing
muscle growth . Other researchers, however, dispute
such claims . Therefore, the purpose of this paper will
be to review the emerging body of research suggesting a
role for exercise-induced metabolic stress in maximizing
muscle development, and present insights as to the poten-
tial mechanisms by which these hypertrophic adaptations
may occur. To carry out this review, English-language
literature searches of the PubMed, EBSCO, and Google
Scholar databases were conducted for all time periods up to
April 2012. Combinations of the following keywords were
used as search terms: ‘metabolic stress’, ‘metabolite
buildup’, ‘metabolite accumulation’, ‘resistance training’,
‘resistance exercise’, ‘weight lifting’, ‘bodybuilding’,
‘powerlifting’, ‘anabolic hormone’, ‘Kaatsu’, ‘occlusion
exercise’, ‘blood ﬂow restricted exercise’ and ‘cell swell-
ing’. The reference lists of articles retrieved in the search
were then screened for any additional articles that had
relevance to the topic. Given the broad scope of this
review, a narrative approach was chosen as the best way to
convey pertinent information and inclusion criteria was
based on applicability to the particular area of discussion.
2 Evidence for a Hypertrophic Effect from Metabolic
Metabolic stress pursuant to exercise manifests as a result
of the accumulation of metabolites, particularly lactate, Pi
[21,22], and acute muscle hypoxia associated with
resistance training may serve to further heighten metabolic
buildup and, hence, stimulate hypertrophic adaptations
[7,23]. It is conceivable that hypoxia may have a direct
effect on contractile protein accretion and thereby con-
tribute to the hypertrophic stimulus, although this has not
been well studied. Other metabolites of possible relevance
to anabolism include calcium and various electrolytes.
Support for the potential hypertrophic role of exercise-
induced metabolic stress can be noted empirically by
examining the moderate-intensity training regimens
Fig. 1 Simpliﬁed schematic of intracellular signalling pathways.
Flowchart shows the pathways associated with intracellular signalling
for muscle hypertrophy. Light grey boxes represent anabolic
processes while the dark grey boxes represent catabolic processes.
4E-BP1 4E binding protein-1, AKT protein kinase B, Ca
eIF2, 2B and 4E eukaryotic initiation factor 2 and 2B, FOXO forkhead
box O, GSK3 glycogen synthase kinase-3, MAFbx muscle atrophy
F-box, MAPKs mitogen-activated protein kinases, mTOR mammalian
target of rapamycin, MuRF1 muscle ring ﬁnger-1, NFATs nuclear
factor of activated T-cells, PI3K phosphatidylinositol 3-kinase,
P70S6K P70S6 kinase
180 B. J. Schoenfeld
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adopted by a majority of bodybuilders, which are intended
to heighten metabolic buildup at the expense of higher
training intensities [24,25]. Typical hypertrophy-oriented
bodybuilding routines involve the performance of multiple
sets of 6–12 repetitions per set with relatively short inter-
set rest intervals . These routines have been found to
induce signiﬁcantly more metabolic stress than higher-
intensity regimens typically employed by powerlifters
[27–29]. Yet, despite training with reduced intensities,
bodybuilders commonly display extreme levels of muscu-
larity at least as great, if not more so, than that achieved by
powerlifters [25,30]. Indeed, several studies have reported
greater increases in muscle growth from moderate-intensity
bodybuilding-type training protocols as compared with
high-intensity powerlifting-style routines [31–33], although
these ﬁndings are not consistent across all trials when
equating for volume load . It should be noted that both
bodybuilders and powerlifters are known to use anabolic
steroids and other pharmacological aids, which may con-
found the ability to make ﬁrm conclusions on the topic.
The increased metabolic response associated with
moderate-intensity training (*60–80% 1-repetition maxi-
mum [1RM]) can be attributed at least in part to the
increased energy contribution from fast glycolysis, which
results in peripherally as opposed to centrally induced
fatigue (i.e. fatigue related to metabolic and/or biochemical
changes as opposed to reductions in neural drive) .
Muscle lactate levels of 91 mmol/kg (dry weight) have
been reported after the performance of 1 set of 12 repeti-
tions to failure (total time under tension mean ±standard
deviation [SD] 37 ±3 s) and these values spiked to
118 mmol/kg after three sets . This is in contrast to
high-intensity protocols (*90% ?1RM), where energy
provision is primarily derived from the phosphagen system
and thus results in minimal metabolic buildup. Moreover,
oxygen delivery to muscle is compromised at moderate
lifting intensities due to persistent compression of arterial
and venous ﬂow over an extended time period, resulting in
acute hypoxia . In combination, these factors cause the
rapid accumulation of metabolites within muscle as well as
lowering intramuscular pH levels .
Experimental evidence showing that metabolic stress
contributes to the hypertrophic response can be exempli-
ﬁed by Kaatsu training studies, where resistance exercise
is combined with blood ﬂow restriction. Kaatsu is carried
out at low intensities (generally \40% 1RM) while using
a pressure cuff to induce muscle ischaemia. A large body
of evidence shows that this type of training stimulates
anabolic signalling and protein synthesis , and pro-
duces marked skeletal muscle hypertrophy  despite
the fact that intensities below *60 1RM are often con-
sidered too low to generate a signiﬁcant hypertrophic
Metabolite accumulation is signiﬁcantly elevated in
Kaatsu , suggesting a relationship between metabolic
stress and muscle development. Interestingly, Abe et al.
 found that walking with pressure cuffs resulted in a
signiﬁcant increase in thigh muscle cross-sectional area
(CSA) in college-aged males (4–7%) over a period of just
3 weeks. Such low-intensity aerobic training is generally
not associated with increased muscle size in healthy young
subjects, indicating that factors other than mechanical
stress were responsible for hypertrophic adaptations.
Further evidence for an association between metabolic
stress and muscle hypertrophy can be inferred from studies
where training is carried out in a hypoxic environment.
Kon et al.  displayed that performing multiple sets of
low-intensity exercise (*50% 1RM) with moderate inter-
set rest intervals (*1 min) while breathing 13% oxygen
signiﬁcantly increased metabolite accumulation, as deter-
mined by blood lactate levels compared with similar
normoxic exercise. Support for the potential hypertrophic
ramiﬁcations of these ﬁndings were provided by Nishimura
et al.  who found that performing a typical hypertro-
phy-based protocol (4 sets of 10 repetitions at 70% 1RM)
under acute hypoxic conditions resulted in a signiﬁcantly
greater increase in muscle CSA of the elbow ﬂexors and
extensors versus comparable training in a normoxic
3 Potential Mechanisms of Action
The mechanisms theorized to mediate hypertrophic adap-
tations from exercise-induced metabolic stress include
increased ﬁbre recruitment, elevated systemic hormonal
production, alterations in local myokines, heightened pro-
duction of reactive oxygen species (ROS) and cell swelling
[45–48]. The following section will discuss each of these
putative mechanisms and explore their potential role in the
hypertrophic response to resistance training. Figure 2pro-
vides an overview of how these factors may combine to
augment muscle growth.
4 Fibre Recruitment
The size principle of recruitment dictates that as training
intensity increases, larger motor units containing fast-
twitch (FT) ﬁbres are progressively recruited to sustain
muscle contraction . Given that ﬁbres must be recruited
in order to respond and adapt to resistance exercise , it
would therefore appear necessary to train at very high
levels of intensity to maximize muscular development.
However, there is compelling evidence that meta-
bolic stress does, in fact, increase the recruitment of
Role of Metabolic Stress in Hypertrophic Adaptations 181
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higher-threshold motor units even under low-loading con-
ditions. Multiple studies have found that recruitment
thresholds diminish during sustained submaximal exercise
with increasing levels of fatigue [51–53]. In this way, a
greater number of FT ﬁbres are called into play as the point
of muscular fatigue is reached. Further, studies using
electromyography (EMG) [48,54], glycogen depletion
, and organic phosphate splitting [22,38] have all
shown enhanced FT ﬁbre recruitment in Kaatsu training,
and several researchers have proposed that this is the pri-
mary mechanism by which such exercise elicits hypertro-
phic adaptations [56,57].
The exact mechanisms whereby metabolic stress
enhances FT ﬁbre recruitment have yet to be elucidated.
There is speculation that effects are mediated by H
accumulation, which inhibits muscle contractility and
thereby promotes the recruitment of additional high-
threshold motor units [54,58,59]. In addition, some
researchers have proposed that hypoxia induces the acti-
vation of FT ﬁbres in an attempt to maintain necessary
levels of force generation [60,61]. Another possibility is
that free radical generation, which is increased in meta-
bolically taxing exercise, elicits increased FT recruitment
by hastening the onset of fatigue . Considering the
complexity of exercise-induced muscle fatigue, it seems
plausible that a combination of these factors, and perhaps
others, are ultimately involved in the process.
Although increased ﬁbre recruitment presents a com-
pelling rationale for metabolically induced muscle growth
associated with resistance training, it remains questionable
as to whether this is the only mechanism responsible for
such adaptations. Employing a model that examined
organic phosphate splitting via
spectroscopy, Suga et al.  found that FT ﬁbre recruit-
ment occurred in only 31% of subjects who performed
occlusion training at 20% 1RM compared with 70% of
those who trained at 65% 1RM. Given that this low level of
intensity (20% 1RM) has been shown to increase hyper-
trophy when combined with blood ﬂow restriction to a
similar or greater extent as high-intensity resistance train-
ing [62,63], it therefore seems likely that factors other than
recruitment also contribute to the hypertrophic effect of
exercise-induced metabolic stress. To lend further support
to this conclusion, EMG studies have shown that exercise
performed at 80% 1RM produced substantially greater
muscle activity compared with blood ﬂow restricted exer-
cise at 20% 1RM, indicating reduced recruitment at the
lower intensity .
5 Systemic Hormonal Production
Another popular theory proposed to explain the hypertro-
phic mechanisms associated with metabolic stress is that a
buildup of metabolites increases growth-oriented hormonal
concentrations, thereby enhancing the anabolic milieu and
subsequent accretion of muscle proteins [46,65]. Theo-
retically, high levels of circulating hormones increase the
Fig. 2 Proposed mechanisms
by which exercise-induced
metabolic stress may mediate
muscle hypertrophy. ROS
reactive oxygen species
182 B. J. Schoenfeld
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likelihood of interaction with receptors , which may
have particular hypertrophic importance in the post-work-
out period when muscles are primed for anabolism. Some
researchers have speculated that these acute hormonal
elevations to training are more critical to tissue growth and
remodelling than chronic changes in resting hormonal
concentrations . Metabolically-induced spikes in insu-
lin-like growth factor (IGF)-1, testosterone, and growth
hormone (GH), in particular, have been implicated as
having a positive effect on post-exercise muscle protein
synthesis. The following is an overview of each of these
hormones and their potential hypertrophic relevance to
resistance exercise that promotes substantial changes in the
intracellular metabolic environment.
IGF-1 is a homologous peptide hormone that has both
mitogenic and anabolic effects on skeletal muscle . A
clear cause-effect relationship has been established
between IGF-1 and muscle hypertrophy , and some
researchers have professed that IGF-1 is the primary
physiological regulator of muscle mass . The anabolic
effects of IGF-1 appear to be magniﬁed in response to
mechanical loading  and increases in IGF-1 protein
have been shown to be proportional to increases in muscle
strength following resistance training . However,
research indicates that a functional IGF-1 receptor is not
obligatory for compensatory muscle growth .
Three distinct IGF-1 isoforms have been identiﬁed: the
systemic forms IGF-1Ea and IGF-1Eb, and a splice variant,
IGF-1Ec. Although each of these isoforms are expressed in
muscle tissue , only IGF-1Ec appears to be locally
activated by mechanical signals and thus it has been termed
mechano-growth factor (MGF) . Despite the fact that
MGF functions in an autocrine/paracrine fashion and thus is
not a true hormone, it nevertheless will be discussed in this
section given its close relationship with the other IGF-1
While the liver is the primary site of endocrine IGF-1
production, other non-hepatic tissues including muscle also
express the systemic isoforms. In fact, during intense exer-
cise the majority of IGF-1Ea is actually derived from
working muscles rather than the liver, and most of the cir-
culating IGF-1 is ultimately taken up by the musculature
. The effects of systemically produced IGF-1 on muscle
hypertrophy are not clear, and there is some doubt as to
whether it plays a signiﬁcant role in post-exercise muscle
protein accretion . It may well be that the primary
hypertrophic role for these isoforms is in stimulating the
fusion of satellite cells with existing muscle ﬁbres, thereby
facilitating the donation of myonuclei and helping to main-
tain optimal DNA-to-protein ratios in muscle tissue [7,75].
Since a muscle’s nuclear-content-to-ﬁbre-mass ratio
remains constant during hypertrophy, the satellite cell-
derived addition of new myonuclei is believed to be
essential for realizing long-term increases in muscle mass
. This is consistent with the concept of myonuclear
domain, which proposes that the myonucleus regulates
mRNA production for a ﬁnite sarcoplasmic volume and
any increases in ﬁbre size must be accompanied by a
proportional increase in myonuclei . The relevance of
myonuclear domain remains controversial and those
interested in a detailed discussion of the topic are referred
to the point/counterpoint articles by O’Connor and Pavlath
 and McCarthy and Esser .
In contrast, locally expressed MGF is believed to be the
isoform principally responsible for compensatory hyper-
trophy . Because of its rapid expression following
mechanical loading, MGF is thought to help ‘kick start’ the
post-exercise hypertrophic response and facilitate local
repair of damaged tissue . MGF carries out signalling
through multiple anabolic cascades including phosphati-
dylinositol 3-kinase-protein kinase B-mammalian target of
rapamycin (PI3K-Akt-mTOR) , MAPK-ERK 1/2 ,
and various calcium-dependent pathways , thereby
directly mediating synthesis of muscle proteins. A recent
post hoc cluster analysis by Bamman et al.  found that
MGF was differentially expressed across clusters, with
extreme responders to resistance training showing the most
robust increase and non-responders having only a non-
signiﬁcant upward trend. These results strongly imply that
acute, transient elevations in MGF gene expression are
important cues for hypertrophic adaptations pursuant to
mechanical loading. Furthermore, whereas systemically
produced IGF-1Ea mediates satellite cell fusion [7,75],
locally expressed MGF is believed to activate satellite cells
and mediate their proliferation and differentiation [84,85].
In this way, there seems to be a synergism between local
and systemic isoforms to optimize myonuclear content and
thus promote long-term gains in muscle mass. A complete
discussion of the roles of the various IGF-1 isoforms is
beyond the scope of this paper. Those interested in further
exploration of the topic are referred to recent reviews by
Velloso and Harridge  and Philippou et al. .
Performance of hypertrophy-type training routines that
generate extensive metabolic buildup have been found to
result in signiﬁcantly greater elevations of circulating IGF-
1 levels compared with high-intensity protocols that cause
minimal metabolite accumulation [28,29,87], although
these results have not been consistent across all trials .
Moreover, some [89–91], but not all  studies on Kaatsu
have shown increased post-exercise IGF-1 elevations fol-
lowing occlusion exercise, suggesting a metabolically
induced inﬂuence on the hormone. The reason for these
discrepancies is not clear and may be a function of
Role of Metabolic Stress in Hypertrophic Adaptations 183
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methodological differences between protocols. Moreover,
the aforementioned studies primarily investigated systemic
IGF-1 production, making it difﬁcult to assess the potential
hypertrophic ramiﬁcations if an association does in fact
Testosterone is a cholesterol-derived hormone synthesized
and secreted primarily by the Leydig cells of the testes via
the hypothalamic-pituitary-gonadal axis, with small
amounts derived from the ovaries and adrenals . The
anabolic effects of testosterone on muscle tissue are
incontrovertible [94,95]. For one, testosterone increases
muscle protein synthesis and decreases proteolysis [96,97].
These effects are induced by its binding to the intracellular
androgen receptor, which in turn translocates to the nucleus
where the complex mediates gene transcription . In
addition to these direct anabolic roles, testosterone also has
indirect hypertrophic effects that include potentiating the
release of other anabolic hormones such as GH  and
IGF-1/MGF , as well as mediating satellite cell acti-
vation and proliferation .
There is speculation that acute post-exercise elevations
in testosterone may directly stimulate anabolism by
increasing the protein synthetic rate while inhibiting pro-
teolysis . This is consistent with evidence showing
signiﬁcant correlations between training-induced eleva-
tions in testosterone and increases in muscle CSA .
Results seem to be more pronounced in strength athletes
compared with endurance athletes and sedentary individ-
uals , suggesting that the post-exercise testosterone
response may play a greater role as one gains resistance
training experience . However, a causal relationship
between acute testosterone production and hypertrophy has
yet to be established, and there is strong evidence that
post-exercise testosterone elevations are not required for
compensatory muscle growth .
Attempts to determine the effects of metabolic stress on
testosterone have been largely inconclusive. Although
several studies have found that hypertrophy-oriented
resistance training programmes cause greater post-exercise
testosterone elevations compared with routines that do not
substantially increase metabolic stress [93,105–108], oth-
ers have failed to ﬁnd signiﬁcant differences [28,38,109].
Moreover, Kaatsu training has generally failed to demon-
strate signiﬁcant post-exercise elevations in testosterone
despite high levels of metabolites [91,109,110], calling
into question as to whether the hormone plays a role in the
metabolic stress-induced hypertrophic response. It should
be noted that gender, age, training experience and nutri-
tional status can affect testosterone release , and these
factors may account for the inconsistent results seen in the
research to date. Further investigation into the topic is
needed so that a more deﬁnitive conclusion can be reached.
5.3 Growth Hormone
GH is a superfamily of polypeptide hormones that act as
repartitioning agents to induce fat metabolism toward
mobilization of triglycerides, as well as stimulating cellular
uptake and incorporation of amino acids into various pro-
teins, including muscle . Despite its name, however,
the direct hypertrophic actions of GH on muscle protein
accretion appear to be negligible, with effects seemingly
limited to synthesis of non-contractile tissue (i.e. collagen)
. It is believed that GH primarily carries out muscle
anabolism by potentiating release of IGF-1 , although
some researchers dispute this theory and postulate the
hypertrophic effects of GH and IGF-1 are in fact additive
. There is evidence that recombinant GH adminis-
tration markedly enhances mRNA levels of MGF when
combined with resistance exercise in the elderly  but
not in healthy young adults . GH also appears to have
a permissive or perhaps even a synergistic effect on tes-
tosterone-mediated protein synthesis . However, it is
not clear what, if any, effects transient endogenous post-
exercise GH spikes have on levels of MGF or testosterone
at this time. The actions of the GH superfamily are highly
diverse and complex, and a complete discussion is beyond
the scope of this paper. Those interested in further reading
are referred to recent reviews by Ehrnborg and Rosen 
and Kraemer et al. .
The prevailing body of research supports a strong cor-
relation between exercise-induced metabolic stress and
increased hypophyseal GH secretion [23,46–48,90,105,
106]. The absolute magnitude of these hormonal elevations
is substantial. Fujita et al.  found that Kaatsu increased
post-exercise GH levels 10-fold above compared with low-
intensity exercise without blood ﬂow restriction while
Takarada et al.  reported elevations of 290-fold over
baseline. Post-exercise elevations are presumably mediated
by increased lactate and/or H
buildup in the blood
[47,106]. A reduction in pH associated with metabolite
accumulation also may potentiate GH release via chemo-
reﬂex stimulation mediated by intramuscular metabore-
ceptors and group III and IV afferents [42,110].
While increased hormonal concentrations present an
intriguing hypothesis as to the growth-related effects of
exercise-induced metabolic stress on skeletal muscle, it is
not clear whether such acute elevations do in fact mediate
an enhanced hypertrophic response. Several researchers
have questioned the hormone hypothesis [56,117], with
some speculating that such biological events are intended
to mobilize fuel stores following a bout of exercise rather
than promote tissue anabolism . The anabolic role of
184 B. J. Schoenfeld
Author's personal copy
acute GH production in particular, has been dismissed
largely based on studies showing that exogenous admin-
istration of recombinant GH does not lead to greater
increases in muscle protein accretion [119–121]. While this
may be true, it should be noted that exogenous injections
do not mimic the in vivo response to exercise-induced GH
secretions either temporally or in magnitude. The anabolic
milieu is primed during the post-workout period, and it is
possible that large spikes of GH following resistance
exercise, which can approach 300 times that of baseline
levels , may facilitate remodelling pursuant to myo-
trauma. Further, recombinant GH is solely made up of the
22-kDa isoform  whereas more than 100 molecular
isoforms of GH are produced endogenously . A wide
spectrum of these isoforms peak at the conclusion of
resistance exercise with a greater proportional concentra-
tion of non-22-kD isoforms . Supraphysiological
doses of recombinant GH actually impede post-exercise
stimulation of these alternative isoforms , potentially
obscuring hypertrophic effects. Whether these factors have
a signiﬁcant effect on muscular adaptations is not clear at
this time and requires further study.
West et al.  found that transient hormonal spikes
had no effect on post-exercise muscle protein synthesis in
young males when compared with a protocol where hor-
monal levels were low. Furthermore, p70S6k phosphory-
lation was similar between groups, indicating that anabolic
signalling was also unaffected by post-exercise hormonal
elevations. It is important to note, however, that protein
synthesis measured in response to an acute bout of exercise
does not always correlate with chronic upregulation of
causative myogenic signals  and is not necessarily
predictive of long-term hypertrophic responses to regi-
mented resistance training . Thus, while these ﬁndings
are intriguing, their practical implications are limited.
Direct studies evaluating the effect of acute anabolic
hormonal production on hypertrophy have been contra-
dictory. Madarame et al.  found that performing
occlusion training for the lower body musculature after
unilateral arm exercise resulted in a signiﬁcant increase in
muscle CSA of the elbow ﬂexors compared with identical
arm training routine combined with non-occlusion lower
body exercise. Although differences in GH levels did not
rise to statistical signiﬁcance, the authors state that this was
likely due to the study being underpowered. Considering
that similar protocols have shown large post-exercise hor-
monal increases [23,46–48,90,106], results therefore
seem to suggest that systemic factors may have played a
role in the adaptive response. It also is interesting to note
that no changes in muscle CSA were observed in the non-
trained arm, indicating that acute systemic hormonal
increases have no effect on muscle size in the absence of
mechanical stress. West et al.  employed a within-
person design to investigate the role of acute hormonal
elevations on muscle hypertrophy using a traditional
resistance exercise protocol. Twelve untrained men (aged
mean ±SD 21.8 ±1.2 years) trained their elbow ﬂexors
on separate days under two different hormonal environ-
ments: a low hormone condition where one arm performed
arm curl exercise only and a high hormone condition where
the contralateral arm performed the same arm curl exercise
followed immediately by a bout of leg resistance exercises
designed to elicit large increases in circulating hormones.
After 15 weeks, no differences were found between groups
in muscle girth as determined by magnetic resonance
imaging despite signiﬁcantly greater elevations in circu-
lating IGF-1, GH, and testosterone in the high-hormone
group following exercise.
A recent study by Ronnestad et al.  employed a
similar within-subject design to West et al. , except
that leg training was performed before the arm curl in the
high-hormone group. In contrast to West et al. , those
in the high-hormone group displayed a signiﬁcantly greater
increase in muscle CSA of the elbow ﬂexors implying that
elevated hormones were responsible for hypertrophic
gains. Interestingly, differences were speciﬁc to distinct
regions of elbow ﬂexors, with increases in CSA seen only
at the two middle sections where muscle girth was largest.
Considering the conﬂicting evidence, it is premature to
draw deﬁnitive conclusions as to whether or not the
post-exercise anabolic hormonal response associated with
metabolic stress plays a role in muscle hypertrophy. What
seems apparent from the research is that if such a role does
in fact exist, the overall magnitude of the effect size would
be fairly modest. However, even modest increases in
muscle hypertrophy could potentially be meaningful for
certain populations, particularly bodybuilders and strength
athletes. It is conceivable that acute hormonal elevations
may have a greater effect on satellite cell activity rather
than post-exercise protein synthetic rate, thereby impacting
long-term, as opposed to shorter-term, hypertrophic adap-
tations. If so, the anabolic effects of these hormonal spikes
might be limited by genetic differences in pre-training
satellite cell availability and one’s subsequent ability to
expand the available satellite cell pool . Finally, studies
in trained individuals on the subject are lacking, so it
remains to be elucidated if those with previous training
experience respond differently to acute exercise-induced
hormonal output compared with untrained subjects.
6 Local Myokines
Exercise training results in the synthesis of various cyto-
kines and other peptides within skeletal muscle (a.k.a.
myokines), and an emerging body of evidence indicates
Role of Metabolic Stress in Hypertrophic Adaptations 185
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that these local factors can signiﬁcantly contribute to
hypertrophic adaptations [128–130]. Many of these agents
can exert effects in an autocrine/paracrine fashion to bring
about unique effects on skeletal muscle adaptation, and
resistance exercise appears to enhance their response .
There is speculation that metabolic stress may mediate
muscle hypertrophy by either upregulating anabolic myo-
kines and/or downregulating catabolic myokines.
Interleukin (IL)-6 is an early-stage myokine purported to
inﬂuence satellite-cell mediated myonuclear accretion
, and it has been postulated that exercise-induced
metabolic stress may stimulate its production .
Despite a seemingly sound theoretical rationale, though,
evidence in support of this contention is lacking. Takarada
et al.  found that restricted blood ﬂow exercise of the
knee extensors resulted in gradual increase in IL-6, with
levels maintained at an elevated rate 24 h post-exercise
versus controls. The overall effect size was small, however,
with levels reaching only one-fourth of that reported for
higher-intensity eccentric exercise. Fujita et al. 
reported a 2.4% increase in muscle/bone CSA of the thigh
musculature following 6 days of Kaatsu despite the fact
that IL-6 levels remained unchanged throughout the train-
ing period. Similarly, studies by Abe et al.  and Fry
et al.  failed to detect a change in IL-6 levels following
occlusion training. These results cast doubt as to whether
IL-6 is in fact a mechanism by which metabolic stress
There is some evidence to suggest that metabolic stress
may have a greater impact on compensatory hypertrophy
by reducing local catabolic factors as opposed to increasing
growth-oriented factors. Given that muscle growth repre-
sents the dynamic balance between protein synthesis and
breakdown, a decrease in protein degradation ultimately
leads to an increase in protein accretion. Research on
potential mediators has largely focused on myostatin, a
member of the transforming growth factor-3 super family
that acts as a negative regulator of muscle growth .
Kawada and Ishii  found that myostatin levels sig-
niﬁcantly decreased in the plantaris muscle of Wistar rats
following restricted blood ﬂow exercise in comparison to a
sham operation group. In contrast, a human trial by
Drummond et al.  reported no differences in myostatin
gene expression between Kaatsu training and low-intensity
exercise without blood ﬂow restriction 3 h post-exercise.
Interestingly, Manini et al.  found that although
Kaatsu did not reduce myostatin, it signiﬁcantly down-
regulated various proteolytic transcripts (forkhead box
O3A [FOXO3A], Atrogin-1 and muscle ring ﬁnger-1
[MuRF-1]) 8 h post-exercise compared with a control
group that performed non-occluded low-intensity training.
Recently, Laurentino et al.  investigated the effects of
Kaatsu on chronic myostatin levels in physically active
males. After 8 weeks of training, Kaatsu produced a sig-
niﬁcant 45% chronic reduction in myostatin gene expres-
sion while low-intensity exercise without blood ﬂow
restriction showed only non-signiﬁcant decreases.
Given the disparate data, it is difﬁcult to draw ﬁrm
conclusions as to whether metabolic stress inﬂuences
hypertrophy by altering myokine production. It is impor-
tant to note that many additional myokines have been
identiﬁed in the literature (including IL-1, IL-7, IL-8,
IL-10, IL-13, IL-15, ﬁbroblast growth factor, leukaemia
inhibitory factor, and tumour necrosis factor, amongst
others), and the effects of metabolic stress on these myo-
kines have yet to be investigated. Moreover, no studies
could be located that directly compare post-exercise
myokine differences between traditional hypertrophy-ori-
ented routines versus high-intensity strength-oriented reg-
imens. This topic should be a prime area of focus for future
7 Reactive Oxygen Species
ROS presents an intriguing potential mechanism by which
metabolic stress may mediate muscle hypertrophy. The
term ROS collectively includes both oxygen radicals (i.e.
superoxide, hydroxyl, peroxyl and hydroperoxyl radicals)
and non-radical oxidizing agents (i.e. hydrogen peroxide
and hypochlorous acid) . A complete discussion about
the sources of contraction-induced ROS production is
beyond the scope of this paper, but distinctions are made
between ROS produced chronically during resting condi-
tions and those generated transiently during exercise.
Under normal physiological conditions, ROS are primarily
generated by the mitochondrial electron transport chain and
oxidation of polyunsaturated fats, and their production is
signiﬁcantly inﬂuenced by environmental stress and aging
. During exercise, contracting muscles are a promi-
nent source of acute ROS production, with the extent of
elevations dependent on the type and intensity of training
. For further information on the subject, the interested
reader is referred to recent reviews by Powers et al. 
and Jackson .
Although chronically elevated levels of ROS have been
implicated as having negative effects on various muscle
tissues and may even trigger the onset of sarcopenia
[142,143], acutely they can function as key cellular sig-
nalling molecules in the response to exercise [144–147],
potentially mediating post-workout anabolic adaptations.
ROS production has been shown to promote growth in both
smooth muscle and cardiac muscle , and it is theo-
rized to have similar hypertrophic effects on skeletal
muscle as well . Transgenic mice with suppressed
levels of selenoproteins, a class of proteins that function as
186 B. J. Schoenfeld
Author's personal copy
potent antioxidants, display increased exercise-induced
muscle growth, suggesting a ROS-mediated hypertrophic
effect through redox sensitive signalling pathways .
Although the mechanisms of action have not been fully
elucidated, research has shown that ROS can inﬂuence
muscle hypertrophy via enhanced MAPK signalling.
Kefaloyianni et al.  displayed that treatment of C2
myoblasts with a ROS variant increases MAPK activation,
with the response of the various MAPK subfamilies (ERK
1/2, c-Jun N-terminal kinase [JNK], and p38-MAPK) dif-
fering over time. In cardiac myocytes, ROS can regulate
phospholipase D and thus potentially mediate protein
synthesis via activation of PA . Whether ROS inﬂu-
ences this pathway in skeletal muscle has not been deter-
mined. There is also evidence that antioxidant treatment
markedly blunts IGF-I-induced phosphorylation of the
IGF-I receptor in C2C12 myocytes treated with ROS,
suggesting that ROS has a critical function in the biological
action of IGF-I .
Research supporting the hypertrophic role of ROS in
routines producing metabolic stress remains speculative
and is largely derived from implied data. Mitochondria in
FT ﬁbres have unique properties that promote higher levels
of ROS activity compared with slow twitch ﬁbres .
Given that hypertrophy-type training associated with met-
abolic stress would conceivably involve the mitochondria
to a greater degree than high-intensity training, it seems
reasonable to conclude that such exercise would generate
more ROS. Moreover, hypoxia and subsequent reperfusion
heightens ROS production [153,154]. Since the greater
time under tension associated with a hypertrophy-type
routine would necessarily be associated with an increased
ischaemic response compared with high-intensity training,
it stands to reason that higher levels of ROS would be
produced. Whether these differences in ROS production
are sufﬁcient to promote a hypertrophic response is
unknown at this time and requires further study.
The direct effect of exercise-induced metabolic stress on
ROS has not been well studied. Goldfarb et al. 
displayed that plasma protein carbonyl levels and blood
glutathione ratio, both markers of oxidative stress, were
signiﬁcantly greater in a hypertrophy-type routine (3 sets at
*70% 1RM) compared with a low-intensity routine with
blood ﬂow restriction (3 sets at *30% 1RM), suggesting
that muscle damage plays the dominant role in generating
ROS. Support for this hypothesis was demonstrated by
Takarada et al , who found no change in post-exercise
lipid peroxide levels following performance of the seated
leg extension combined with vascular occlusion whereby
muscle damage was minimal.
An interesting but relatively unexplored facet of
research in this area involves nitric oxide (NO), a ROS
variant. NO production has been linked to compensatory
muscle hypertrophy [156,157], and there is evidence that it
mediates an increase in satellite-cell activation and prolif-
eration , possibly via synthesis of hepatocyte growth
factor . Kawada and Ishii  demonstrated that
venous occlusion of the hindlimbs in Wister rats resulted in
an increased expression of NO synthase-1 (NOS-1), an
enzyme that catalyzes the production of NO from L-argi-
nine. However, although levels of NO showed a trend
toward an increase at 2 weeks post-surgery (p =0.10),
results did not rise to statistical signiﬁcance purportedly
due to a large intersubject variation. Supporting research in
humans is lacking at this time.
ROS may also indirectly inﬂuence hypertrophy by
mediating transcription of highly conserved stress proteins
called heat shock proteins (HSPs). Under normal physio-
logical conditions, HSPs act as a chaperone protein, facil-
itating the folding of new peptide chains and translocation
of proteins . When the body is subjected to stress,
however, HSPs are thought to serve a protective role that
includes limiting oxidative damage caused by ROS ,
and some researchers have theorized that they may play a
role in compensatory muscle hypertrophy as well [136,
162]. A number of HSPs have been identiﬁed, each of
which are named according to their molecular mass in
kiloDaltons (i.e. HSP27, HSP60, HSP70, and HSP72, etc).
It should be noted that, in addition to ROS-mediated
transcription, HSPs are also induced by hypoxia, acidosis,
and ischaemia-reperfusion  – all byproducts of resis-
tance exercise associated with high levels of metabolic
Kawada and Ishii  found that HSP72 was signiﬁ-
cantly elevated in the plantaris muscle of rats following
2 weeks of vascular occlusion. These ﬁndings were asso-
ciated with a signiﬁcant increase in muscle hypertrophy,
leading researchers to speculate that HSP72 might con-
tribute post-exercise muscular development. Conversely,
Fry et al.  found no differences in total protein content
of HSP70 following restricted blood ﬂow exercise at 20%
1RM in elderly males. Further, a recent study by Paulsen
et al.  showed that training volume (one set vs. three
sets) had no inﬂuence on cytosolic or cytoskeletal levels of
HSP27 and HSP70 in either the vastus lateralis or trapezius
muscles following 11 weeks of progressive hypertrophy-
type training (7–10 RM). Given that higher volumes of
exercise would necessarily result in greater metabolite
accumulation, this argues against the presence of a dose-
response between metabolic stress and HSPs. Perhaps,
most importantly, HSP transcription resultant to resistance
exercise is likely more due to structural and functional
myodamage rather than increased ROS production .
The combination of these ﬁndings raises doubt as to
whether HSPs are in fact a signiﬁcant hypertrophic
mechanism associated with exercise-induced metabolic
Role of Metabolic Stress in Hypertrophic Adaptations 187
Author's personal copy
stress, at least with respect to traditional resistance
8 Cell Swelling
One of the more novel mechanisms that might be involved
in the hypertrophic response to metabolic stress involves an
increase in intracellular hydration. This phenomenon,
known as cell swelling, is believed to serve as a physio-
logical regulator of cell function [166,167]. Numerous
studies have shown that hydration-mediated cell swelling
results in an increase in protein synthesis and a decrease in
proteolysis in a variety of different cell types, which
include hepatocytes, osteocytes, breast cells and muscle
ﬁbres . With respect to muscle, it has been theorized
that the stimulus associated with cell swelling may trigger
proliferation of satellite cells and facilitate their fusion to
hypertrophying myoﬁbres , thereby enhancing
potential long-term hypertrophic adaptations.
The underlying mechanisms for cell swelling-induced
anabolism have yet to be fully determined. It has been
proposed that increased pressure against the cytoskeleton
and/or cell membrane is perceived as a threat to cellular
integrity, which causes the cell to initiate a signalling
response that ultimately leads to reinforcement of its
ultrastructure [24,170]. There is evidence that signalling is
carried out via integrin-associated volume osmosensors
within cells . The sensors, in turn, activate anabolic
protein-kinase transduction pathways, possibly mediated
by autocrine effects of growth factors [172,173]. Research
indicates that anabolic functions are carried out in an
mTOR-independent fashion  and there is suggestion
that MAPK modules may be the primary mediator of
swelling-induced anabolism [175,176].
To date, there is a paucity of research directly inves-
tigating whether cellular hydration pursuant to exercise-
induced metabolite accumulation enhances muscle
growth. However, a compelling case can be made
whereby this occurs. Resistance exercise has been shown
to induce alterations of intra- and extracellular water
balance , the extent of which is dependent upon the
type of exercise and intensity of training. Cell swelling is
maximized by exercise that relies heavily on glycolysis,
with the resultant lactate accumulation acting as a
primary contributor to osmotic changes in skeletal muscle
[178,179]. The intramuscular buildup of lactate has been
shown to trigger volume regulatory mechanisms, and
these effects may be magniﬁed by the acidic environment
associated with exercise-induced metabolite accumulation
. Although speculative, the amount of swelling
would seem to be heightened by reactive hyperaemia
subsequent to compression of blood vessels during such
training. FT ﬁbres are particularly sensitive to osmotic
changes, presumably related to a high concentration water
transport channels called aquaporin-4 (AQP4). AQP4 has
been shown to be strongly expressed in the sarcolemma of
mammalian FT glycolytic and FT oxidative-glycolytic
ﬁbres, facilitating the inﬂux of ﬂuid into the cell .
Given that FT ﬁbres are most responsive to hypertrophy
, it is plausible that cellular hydration inﬂuences the
hypertrophic response during resistance training that
includes a strong glycolytic component by producing a
favorable effect on net protein balance and thus enhanc-
ing muscle protein accretion. Consequently, the ‘muscle
pump’ that bodybuilders often strive to achieve may in
fact help to promote a growth response after all and
hypertrophy-oriented training routines may therefore
beneﬁt by maximizing this phenomenon.
Although the cell swelling hypothesis is intriguing, a
recent study by Gundermann et al.  provides evidence
to the contrary. The study compared low-intensity resis-
tance training whereby hyperaemia was simulated by a
pharmacological vasodilator to low-intensity blood ﬂow-
restricted exercise. Results showed that occlusion exercise
produced a 49% increase in mixed muscle fractional syn-
thetic rate as well as signiﬁcant elevations in phosphory-
lation of mTOR, S6K1, and ERK1/2, while those who
performed exercise supplemented by pharmacological
vasodilation reported no changes in any of these variables.
The study was limited by the fact that researchers were
unable to accurately reproduce the immediate (ﬁrst
*10 min) post-exercise hyperaemic response, making it
difﬁcult to determine whether the initial signal from
increased hydration plays a role in post-exercise protein
synthesis. Further, protein breakdown was not measured,
and an attenuation of proteolysis is believed to be a primary
means by which cellular hydration mediates muscle
It is possible that metabolic stress may lead to long-term
hypertrophic gains as a result of increased glycogen stores
mediated by chronic cell swelling. Chronic, consistent
resistance training utilizing a repetition range that relies on
anaerobic glycolysis for energy has been shown to signif-
icantly upregulate glycogen storage capacity .
Research also shows that bodybuilders display a 50%
greater intramuscular glycogen content compared with
non-athletes, indicating an adaptive response from hyper-
trophy-type training . Given that glycogen attracts
three grams of water for every gram of glycogen , an
increase in glycogen stores may mediate a favourable
muscle protein balance over time via heightened cellular
hydration, thereby enhancing long-term hypertrophic gains.
This theory remains untested and requires further study.
188 B. J. Schoenfeld
Author's personal copy
In summary, while mechanical stress is unquestionably a
primary driving stimulus in post-exercise muscle growth,
there is compelling evidence that metabolic stress also may
contribute to hypertrophic adaptations. What is not clear is
whether metabolic stress is additive to mechanically-derived
signalling or perhaps redundant provided a given level of
intensity is achieved. A problem with current research is that
mechanical and metabolic stress occur in tandem, making it
difﬁcult to tease out the effects of one from other. This can
potentially result in misinterpreting metabolic factors as
causal in nature when muscle actions are in fact playing the
dominant hypertrophic role or vice versa.
Furthermore, the mechanisms by which metabolic stress
inﬂuences compensatory hypertrophy have yet to be fully
explored. Although increased muscle recruitment appears
to be highly involved, it is doubtful that recruitment alone
is responsible for the full magnitude of growth-related
gains. Rather, the combined integration of multiple local
and systemic factors likely contribute to muscle develop-
ment in a direct and/or permissive manner . In addi-
tion to the mechanisms discussed in this review, it is
possible that other yet-to-be determined factors may also
be involved and additional research is needed to explore
the topic in depth.
Current theory suggests that a given threshold of
mechanical stress is necessary to promote muscular growth,
which is purported to be in the range of approximately
60–65% 1RM . Support for this recommendation can be
inferred from the study by Campos et al. , who found
that volume-adjusted high intensity (3–5 RM) and moderate
intensity (9–11 RM) routines promoted signiﬁcant increases
in muscle CSA of the thigh while a low intensity (20–28
RM) routine did not. Recent studies, however, seem to
contradict these ﬁndings. Tanimoto et al.  demon-
strated that training at 50% 1RM with slow movement and
tonic force generation (3 s for eccentric and concentric
actions with no relaxation phase) showed comparable
increases in muscle size compared with training at 80%
1RM with a traditional cadence (1 s for concentric and
eccentric actions). Results were attributed to increased
metabolic stress associated with the lower-intensity proto-
col. More recently, Mitchell et al.  showed that
10 weeks of resistance exercise of the leg extensors per-
formed at an intensity of 30% 1RM produced a similar
hypertrophic response as training at 80% 1RM, although
results were confounded by a substantially greater volume
in the low-intensity group. In contrast, Holm et al. 
reported that a moderate-intensity protocol (70% 1RM)
produced a 3-fold greater increase in muscle hypertrophy
compared with a volume-equated low intensity (15.5%
1RM) over a 12-week training period. Discrepancies
between these studies are likely related to methodology and
require further study. It should be noted that hypertrophy
associated with lower-intensity training is highly dependent
on training to failure. This is likely related to the fact that
fatiguing sets are necessary at lower-intensity to induce
substantial metabolic stress and thereby heighten the asso-
ciated mechanisms responsible for muscle growth.
Future research should seek to elucidate the precise
mechanisms by which metabolic stress mediates compen-
satory muscle growth, including whether or not hypoxia
itself plays a direct role in the process. In addition, attempts
should be made to clarify optimal hypertrophic loading
intensities along the strength-endurance continuum, and
determine the precise role that metabolic stress plays in this
process. Speciﬁc focus should be centered on whether a
dose-response relationship exists between metabolic stress
and muscle hypertrophy and, if so, whether an upper
threshold exists beyond which such beneﬁts plateau and/or
results are impaired. Given the large inﬂuence of age,
gender and genetics on muscular adaptations, it is likely
that any such threshold would vary based on interindivid-
ual differences. For example, an elderly marathon runner
with a high proportion of type I ﬁbres in the thigh muscles
would seemingly have a different threshold response from
a young sprinter who has predominantly type II ﬁbres.
These issues warrant further study.
A potential confounding issue is that exercise-induced
metabolic stress generally occurs in concert with muscle
damage during hypertrophy-oriented resistance exercise.
Given that myodamage is believed to play a role in post-
exercise muscle growth , this may alter results and
thus needs to be addressed in study design. Also, studies to
date have been largely conﬁned to the use of untrained
subjects, therefore limiting the ability to generalize results
to trained populations. Researchers should therefore seek to
carry out future studies on lifters with at least a year or
more of dedicated resistance training experience. An
enhanced understanding of these factors will ultimately
improve our ability to design programs that maximize
hypertrophic adaptations based on the needs, abilities and
genetics of the individual.
Acknowledgements This review was not funded by any outside
organization. Brad Schoenfeld is the sole author of this work. There
are no conﬂicts of interest present that are directly relevant to the
content of this review.
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