Int. J. Environ. Res. Public Health 2019, 16, 4897; doi:10.3390/ijerph16244897 www.mdpi.com/journal/ijerph
Maximizing Muscle Hypertrophy: A Systematic
Review of Advanced Resistance Training Techniques
Michal Krzysztofik *, Michal Wilk, Grzegorz Wojdała and Artur Gołaś
Institute of Sport Sciences, Jerzy Kukuczka Academy of Physical Education in Katowice, ul. Mikolowska 72a,
40-065 Katowice,Poland; email@example.com (M.W.); firstname.lastname@example.org (G.W.);
Corresponding author: email@example.com
Received: 12 October 2019; Accepted: 03 December 2019; Published: 4 December 2019
Abstract: Background: Effective hypertrophy-oriented resistance training (RT) should comprise a
combination of mechanical tension and metabolic stress. Regarding training variables, the most
effective values are widely described in the literature. However, there is still a lack of consensus
regarding the efficiency of advanced RT techniques and methods in comparison to traditional
approaches. Methods: MEDLINE and SPORTDiscus databases were searched from 1996 to
September 2019 for all studies investigating the effects of advanced RT techniques and methods on
muscle hypertrophy and training variables. Thirty articles met the inclusion criteria and were
consequently included for the quality assessment and data extraction. Results: Concerning the time-
efficiency of training, the use of agonist–antagonist, upper–lower body supersets, drop and cluster
sets, sarcoplasma stimulating training, employment of fast, but controlled duration of eccentric
contractions (~2s), and high-load RT supplemented with low-load RT under blood flow restriction
may provide an additional stimulus and an advantage to traditional training protocols. With regard
to the higher degree of mechanical tension, the use of accentuated eccentric loading in RT should be
considered. Implementation of drop sets, sarcoplasma stimulating training, low-load RT in
conjunction with low-load RT under blood flow restriction could provide time-efficient solutions to
increased metabolic stress. Conclusions: Due to insufficient evidence, it is difficult to provide
specific guidelines for volume, intensity of effort, and frequency of previously mentioned RT
techniques and methods. However, well-trained athletes may integrate advanced RT techniques
and methods into their routines as an additional stimulus to break through plateaus and to prevent
Keywords: muscle growth; drop sets; supersets; accentuated eccentric work; blood flow restriction;
pre-exhaustion; sarcoplasma stimulating training; movement tempo
Resistance training (RT) is a primary exercise intervention used to develop strength and
stimulate muscle hypertrophy. Increases in muscle mass constitute key components of conditioning
in various sports due to the correlation between muscle cross-sectional area and muscle strength [1,2].
Additionally, an increase in muscle mass is one of the goals of bodybuilding , and many
recreationally strength-trained individuals. Furthermore, adequate levels of muscle mass are an
important issue from a health standpoint because its low levels are associated with increased risks of
several diseases such as cardiovascular disease  and cardio-metabolic risk in adolescents  as well
as type II diabetes in middle aged and older adults .
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Muscle hypertrophy occurs when muscle protein synthesis exceeds muscle protein breakdown
and results in positive net protein balance in cumulative periods . This could be achieved with
both RT and protein ingestion, which stimulates muscle protein synthesis and leads to decreases in
muscle protein breakdown . From the nutrition point of view, protein intake alongside RT is a
potent stimulus for muscle protein synthesis. With regard to RT, manipulation of its variables such
as intensity and volume of effort, exercise order, number of performed repetitions and sets, tempo of
movement, and the duration of rest periods between sets and exercises and training status have been
extensively explored and discussed to maximize muscle adaptations [9,10]. Volume and intensity of
effort are basic components with a direct impact on muscular adaptations [11,12]. The American
College of Sports Medicine (ACSM) recommends 1−3 sets per exercise of 8−12 repetitions with
70−85% of one repetition maximum (1RM) for novice and 3−6 sets of 1−12 repetitions with 70−100%
1RM for advanced individuals . However, the recent literature shows a much wider range of
training options. Several studies have found that training with low-loads (30−60% 1RM) results in
similar hypertrophy to training with moderate and high-loads (>60% 1RM) when volitional fatigue
occurs [11,14–16]. Moreover, reaching volitional fatigue at all times is not necessary to make
significant gains in hypertrophy , especially when training with high-loads is considered .
Evidence indicates that significant muscle growth occurs when the majority of training sets are
performed with ~3–4 repetitions in reserve (with moderate to high-loads) . Furthermore, it has
been established that the volume of RT, defined as the total number of repetitions (repetitions x sets),
together with loads used for a given exercise, is the key element of adaptation in terms of muscle
hypertrophy; moreover, it has been suggested that higher volumes of effort are warranted for
maximizing muscle growth response in diverse populations [12,20–23]. However, following years of
training, it becomes difficult to induce further muscle hypertrophy , therefore individuals seek
advanced resistance training techniques.
The purpose of the present paper was to provide an objective and critical review related to
advanced RT methods and techniques influencing skeletal muscle, which may contribute to
maximizing muscle hypertrophy in both recreational and competitive athletes.
2.1. Literature Search
MEDLINE and SPORTDiscus databases were searched from 1996 to September 2019 for all
studies investigating the effects of advanced resistance training techniques and methods on muscle
hypertrophy and training variables. The search was performed using the following keyword
combinations: (‘strength training’ OR ‘resistance training’ OR ‘hypertrophy training’ OR ‘muscle’)
AND (‘time under tension’ OR ‘movement velocity’ OR ‘eccentric overload’ OR ‘accentuated
eccentric’ OR ‘blood flow restriction’ OR ‘blood flow restricted’ OR occlusion OR ‘cluster set’ OR
‘superset OR ‘agonist-antagonist’ OR ‘pre-exhaustion’ OR ‘drop set’ OR ‘sarcoplasma’ OR ‘advanced
training techniques’ OR ‘cross-sectional area’ OR ‘eccentric duration’). The present review includes
studies that (1) presented original research data on healthy adult participants in an age range of 19−44
years old; (2) were published in peer-reviewed journals; and (3) were published in the English
language. No sex restrictions were imposed during the search stage.
2.2. Inclusion and Exclusion Criteria
Research studies investigating the effects of advanced resistance training techniques and
methods on muscle hypertrophy and training variables were the primary focus of the literature
search. Early screening of the articles was based on titles and abstracts. A total of 1088 studies were
initially identified for further scrutiny.
The next step was to select studies with respect to their internal validity: (1) comparison of
different advanced RT techniques and methods with the RT programs performed in traditional
training protocols, (2) muscle hypertrophy and/or muscle strength and/or training volume were
assessed pre- and post-intervention; for muscle hypertrophy both muscle cross-sectional area
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changes (magnetic resonance imaging, dual-energy x-ray absorptiometry) and changes in muscle
thickness (ultrasound imaging) were considered, while for muscle strength, tests with a repetition
maximum (RM) component (e.g., % 1RM or 5RM) were considered; for training volume changes in
the number of repetitions, total load and time under tension to muscular failure were considered. The
researchers conducted the literature review independently based on inclusion and exclusion criteria.
In total, 30 studies met the inclusion criteria for the review (Figure 1).
Figure 1. The different phases of the search and study selection.
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Table 1. Experimental details of the studies included in the review.
Wilk et al.
males Tempo ECC Acute Bench Press 2/0/2/0 vs. 5/0/3/0
vs. 6/0/4/0 Yes TVOL
Regular movement tempo resulted
in highest REP to failure but with
the lowest total TUT.
Hatfield et al.
males Tempo ECC Acute Back Squat and
Volitional movement tempo
resulted in higher REP to failure.
13 males Tempo ECC Acute Bench Press slow vs, medium
vs. fast vs. ballistic Yes TVOL
Fast movement velocity resulted in
the highest REP to failure.
Burd et al.
2012  8 males Tempo ECC Acute Knee Extension 6/0/6/0 vs. 1/0/1/0 Yes TVOL Slow movement tempo resulted in
Shibata et al.
Tempo ECC 6 weeks Parallel Back
Squat 4/0/2/0 vs. 2/0/2/0 Yes HT, STH
Both protocols lead to significant
increase in muscle HT, but longer
ECC duration was less effective in
English et al.
2014  40 males AEL 8 weeks Leg Press and Calf
0, 33, 66, 100, or
138% of 1RM No HT, STH
AEL lead to the highest increases
in muscle HT and STH.
18 males AEL 9 weeks
75% vs. 120% 1RM Yes HT, STH
AEL lead to higher increase in STH
for supine elbow extension, with
no significant changes in muscle
HT in both groups.
Walker et al.
males AEL 10 weeks
Leg Press and
6RM Leg Press,
vs. 140% 1RM
Yes HT, TVOL
AEL lead to higher increase in
work capacity (REP to failure), but
not muscle HT.
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Bette et al.
males AEL 6 weeks
8RM vs. 1.9-fold
higher for ECC Yes HT, STH
Both protocols lead to significant
increase in muscle HT and STH.
al. 2012 
20 (10 males
30% 1RM BFR vs.
30% 1RM without
Yes TVOL BFR reduced REP to failure.
Kubo et al.
2006  9 males BFR 12 weeks Unilateral Knee
20% 1RM BFR vs.
80% 1RM without
Both protocols lead to significant
increase in muscle HT.
Lowery et al.
2014  20 males BFR 4 weeks Biceps Curls
30% 1RM BFR vs.
60% 1RM without
Both protocols lead to significant
increase in muscle HT.
Farup et al.
2015  10 males BFR 6 weeks Dumbbell Curls
40% 1RM BFR vs.
40% 1RM without
Yes HT, TVOL
Both protocols lead to significant
increase in muscle HT, with
reduced REP to failure in BFR.
Ellefsen et al.
females BFR 12 weeks
30% 1RM BFR vs.
Both protocols lead to significant
increase in muscle HT.
al. 2012  29 males BFR 8 weeks Bilateral Knee
20% 1RM without
BFR vs. 20%1RM
BFR vs. 80%1RM
No HT, STH
BFR lead to increase in muscle HT
and STH with the same degree as
al. 2015  26 males BFR 12 weeks Bilateral Knee
20 or 40% 1RM +
BFR (40 or
80%AOP) vs. 80%
1RM without BFR
No HT, STH
When BFR protocols are
performed at very low intensities
higher AOP is required. BFR
protocols significantly improved
muscle HT and STH, but with less
effect in STH.
al. 2012  32 athletes BFR 4 weeks Bench Press and
20% 1RM BFR vs.
20% 1RM No HT, STH
BFR significantly improved muscle
HT and STH.
Cook et al.
2018  18 males BFR 6 weeks Leg Press and
70% 1RM vs. 20%
Yes (only last
set) HT, STH
Both protocols significantly
improved muscle HT and STH, but
BFR was less effective.
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Yasuda et al.
2011  30 males BFR 6 weeks Bench Press 75% 1RM vs. 30%
1RM BFR No HT, STH
Both protocols significantly
improved muscle HT and STH, but
BFR was less effective.
Oliver et al.
CS Acute Back Squat
4 sets of 10 REP vs.
4 sets of 2 CS of 5
REP at 70% 1RM
CS allowed to lift a greater TVOL
load with reduced TUT.
et al. 2014  9 athletes CS Acute Parallel Back
3 sets to muscular
failure of TS or CS Yes TVOL CS lead to higher REP to failure.
Tufano et al.
males CS Acute Back Squat
3 sets of 12 REP vs.
3 sets of 3 CS of 4
REP vs. 3 sets of 6
CS of 2 REP at 60%
CS protocols lead for greater
external loads and higher TUT.
Wallace et al.
SS / Pre-
TS vs. SS
(agonists) vs. pre-
joint + multi-joint
exercise) vs. pre-
joint + single-joint)
SS (agonists) decreased TVOL
Robbins et al.
SS / Pre-
Exhaustion Acute Bench Press,
Bench Pull SS vs. TS Yes TVOL SS (agonist-antagonist) increased
total TVOL load.
Weakley et al.
SS / Pre-
Back Squat, Bench
Bent Over Row,
TS vs. SS vs. tri-
sets No TVOL
SS (upper-lower body, agonist-
antagonist) and tri-sets protocols
were more efficient (kilograms
lifted per minute) than TS.
Soares et al.
SS / Pre-
Bench Press and
TS Yes TVOL
Total TVOL load lifted is reduced
when multi-joint exercise is
performed after single-joint.
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Fink et al. 2018
 16 males DS / SST 6 weeks Triceps
3 sets of TS vs.
single DS Yes HT
Single set of DS lead to higher
Angleri et al.
2017  32 males DS / SST 12 weeks Leg Press and
DS vs. TS vs.
crescent pyramid Yes HT, STH
All protocols significantly
improved muscle HT and ST.
de Almeida et
al. 2019 
males DS / SST Acute
Biceps Curls and
TS vs. SST Yes HT, TVOL
SST lead to greater acute muscle
HT, with reduced training time,
even with a lower total TVOL load.
Ozaki et al.
males DS / SST 8 weeks Dumbbell Curls
3 sets of 80%1RM
vs. 3 sets of
30%1RM vs. 1 set
of 80%1RM and
then four DS at
65%, 50%, 40%
Yes HT, STH,
A single high-load set with
additional four DS increased
muscle HT and STH as well as
work capacity (REP to failure),
with an reduced training time.
ECC: eccentric; TVOL: training volume; HT: hypertrophy; STH: strength; REP: repetitions; TUT: time under tension; AEL: accentuated eccentric loading; 1RM: one-
repetition maximum; ECC: eccentric; BFR: blood flow restriction; RT: resistance training; AOP: arterial occlusion pressure; CS: cluster set; TS: traditional set; SS: superset;
DS: drop sets; SST: sarcoplasma stimulating training.
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3.1. Training Considerations
Three major factors are emphasized in the conventional hypertrophy model: mechanical tension,
metabolic stress, and muscle damage . These factors can occur by optimal manipulation of RT
variables and through a wide range of RT techniques. Progressive mechanical tension overload is
considered one of the major factors of muscle growth and changes in muscle architecture, which are
attained by increasing RT intensity of effort. RT with high-loads (>85% 1RM), and a low number of
repetitions (1−5) as well as long rest intervals (~3−5 min) is largely oriented toward a greater
magnitude of mechanical tension, which primarily develops strength, while muscle hypertrophy is
compromised . RT with a lower number of repetitions, yet with high-loads emphasizes
mechanical tension and results in high levels of neural recruitment (fast-twitch muscle fibers).
Another critical variable influencing hypertrophy with an evidenced dose-response relationship is
RT volume [11,56]. Higher RT volume (28−30 sets/muscle/week) is associated with greater increases
in hypertrophy compared to lower volume (6−10 sets/muscle/week) in both untrained and trained
populations [12,20]. Implementation of training with moderate number of repetitions (~6−12),
multiple sets (3−6), moderate loads (60−80% 1RM), and short rest intervals (60 s) between sets elicits
greater metabolic stress (in contrast with high-loads), which appears to be a potent stimulus for
inducing muscle hypertrophy . However, as long as RT is performed to volitional fatigue, training
load might not affect exercise-induced muscle growth. Findings by Schoenfeld et al.  indicate that
both low-load RT (≤60% 1RM) performed to volitional fatigue and moderate-load RT (>60% 1RM)
elicit significant increases in muscle hypertrophy among well-trained young men. However, the
participants following the low-load RT protocol performed approximately three times the total
training volume compared to the high-load group (sets × repetitions). Similar findings were also
demonstrated in a study by Ikezoe et al. , which highlighted the importance of performing
exercise to volitional fatigue when low-loads were used to maximize muscle hypertrophy outcomes.
These authors compared increments in muscle thickness (rectus femoris) after eight weeks of training
with low-load, higher volume (30% 1RM, 12 sets x 8 repetitions) to training with high-load, lower
volume (80% 1RM, 3 sets x 8 repetitions) leg extensions in young men. Considering that the training
volume in the high-load group was significantly lower than that in the low-load, the degree of muscle
thickness attained after intervention was almost twice as high in the high-load group . However,
it should be noted that if RT is not conducted to volitional fatigue, reaching the minimum RT intensity
threshold (>60%1RM) is necessary to maximize muscle hypertrophy .
Furthermore, implementation of advanced RT techniques could provide an additional stimulus
to break through plateaus for trained subjects  and prevent excessive monotony in training. The
most recent RT techniques and methods frequently used by practitioners and coaches include
accentuated eccentric loading, prolonged eccentric tempo, cluster sets, high-load RT combined with
low-load RT under blood flow restriction, supersets, drop sets, pre-exhaustion, and sarcoplasma
3.2. Tempo Eccentric Technique
One of the advanced RT techniques is based on a prolonged duration of the eccentric phase of
the movement. The duration of each repetition can be identified by movement tempo, which is
determined by four digits (e.g., 2/0/1/0) corresponding to the duration (in seconds) of particular
phases of movement (eccentric, transition, concentric, transition) . Changes in the movement
tempo during RT impacts the maximal number of repetitions performed in a set, the maximal time
under tension, and the final exercise volume [25–27]. Several studies have indicated that the use of a
faster movement tempo (e.g., 2/0/2/0) results in a significant increase in the maximal number of
performed repetitions when compared to the slower tempo (e.g., 6/0/2/0) [25–27]. In contrast, a slower
tempo of movement, especially during the eccentric phase (e.g., 6/0/2/0), decreases the number of
performed repetitions, but extends the time under tension, which may contribute to greater muscle
Int. J. Environ. Res. Public Health 2019, 16, 4897 9 of 16
hypertrophy . On the other hand, a meta-analysis of Schoenfeld et al.  indicates that similar
hypertrophic responses occur when the duration of repetitions ranges from 0.5 to 8 s, although it
must be noted that they  did not control the duration of particular phases of movement (eccentric
vs. concentric), thus making it difficult to draw definite conclusions. Furthermore, a study by Shibata
et al.  showed that the dominant leg thigh cross-sectional area increased in a similar manner
following both the slow (4 s) and the fast (2 s) eccentric phase during the back squat exercise
performed to volitional fatigue in a group of male soccer players. In light of the greater force capacity
of eccentric actions, and the fact that the energy requirements are typically 4-fold smaller than during
the concentric contraction of the same load , it would seem logical that lower metabolic stress
may occur, which could limit the responses to this training technique.
However, studies indicate a wide range of manipulation of the duration of the eccentric phase
of movement can be employed if the primary goal of training is to maximize muscle hypertrophy
[29,60]. Although, it is not currently clear whether slow tempo provides a superior stimulus for
muscle hypertrophy, from a practical point of view, employing a fast but controlled duration of the
eccentric phase (~2s) may allow for a high time-efficiency of training and prevent the excessive time
of training sessions.
3.3. Accentuated Eccentric Loading Method
Another useful method that can be used during RT, based on eccentric contractions includes
accentuated eccentric loading (AEL). This training strategy is based on the muscles’ ability to generate
greater force during maximal eccentric (~20−60%) versus other types of contraction. The use of weight
releasers allow for overloading the muscles during the eccentric phase of movement due to its specific
construction. The weight can be unloaded in the transition from the eccentric to the concentric phase
of movement. The use of high-loads during the eccentric phase of movement is associated with
significant exercise induced muscle damage and mechanical tension, which have been associated
with a hypertrophic response . Furthermore, some studies have shown that performing eccentric-
only contractions led to higher gains in muscle mass when compared to concentric-only actions
[30,62]. Nonetheless, recent literature has indicated that when the volume of training was matched,
both AEL and high-load RT led to similar hypertrophic responses in groups of strength-trained
athletes [31,32,63]. Furthermore, RT protocols that did not promote significant muscle damage still
induced similar muscle hypertrophy in comparison with those protocols that promoted initial muscle
damage . However, differences appear in muscle architecture adaptations. Training with the
concentric-only phase led to muscle growth mainly by the addition of sarcomeres in parallel
(increased pennation angle with little change in fascicle length), while training with eccentric-only
contractions led by the addition of sarcomeres in series (increased fascicle length and a small increase
in the pennation angle) .
Furthermore, due to the greater mechanical tension, it could provide an additional hypertrophic
stimulus [31,33,65]. Although it must be noted that the main disadvantage of this technique is the
necessity of weight releasers or the presence of experienced spotters during training. Moreover AEL,
requires the eccentric load to reload after every repetition, thus is possible that the inter-repetition
rest may excessively extend the time of particular repetitions and the whole training session.
3.4. Low-Load Resistance Training Under Blood Flow Restriction
Another RT method that allows for the avoidance of high mechanical stress associated with
high-load RT and the high training volumes required when exercising with low-loads to volitional
fatigue is to combine RT under blood flow restriction (BFR) [34,66,67]. The BFR method involves the
application of a restrictive device (a tourniquet, an inflatable cuff, or elastic wraps) on the proximal
part of the limb to reduce the arterial blood flow and to occlude the venous return . Such an
intervention results in an accumulation of metabolic products distal to the restriction and when
coupled with RT, drastically increases metabolic stress. However, with regard to low-load RT under
BFR, a significant increase in the muscle cross-sectional area was observed even without reaching
volitional fatigue in particular sets . Furthermore, several studies have suggested that increases
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in muscle mass following low-load RT under BFR (20−30% 1RM) do not exceed those observed after
the use of high-load RT (80% 1RM) without BFR [36–38]. The effectiveness of using BFR concerns
various populations such as non-athletes [39,40], moderately experienced participants (>1 year) ,
and elite athletes [41,42]. High-load RT with additional low-load sets under BFR may elicit beneficial
muscular responses in healthy athletes .
The most frequently and evidence-based repetition and set scheme involves 30 repetitions in the
first set followed by three sets of 15 repetitions with 30 s rests in between with 20−40% 1RM and
pressure, which contribute to 40−80% of arterial occlusion pressure . However, it must be noted
that BFR induced muscle growth is limited to the limb muscles .
3.5. Cluster Sets Technique
Another RT technique that partly allows for the balance of both mechanical tension and
metabolic stress consists of cluster sets. In a traditional scheme of sets, repetitions, a chosen group of
exercises are performed consecutively, with a long inter-set rest interval, are then followed by another
set of repetitions. On the contrary, cluster sets include short, inter-set rest intervals (20−60s) with a
lower number of repetitions . Previous research has mostly investigated the effects of cluster sets
on force production, power output, and movement velocity, while findings related to muscle
hypertrophy are limited . Nevertheless, implementation of inter-set rest intervals allows for a
greater RT volume to be achieved for a particular external load when compared with a traditional
scheme of sets [44,45] in trained and untrained men, possibly providing an additional stimulus for
muscle hypertrophy. However, it should be noted that cluster sets induce less metabolic stress, but
greater emphasis is placed on mechanical stress due to the use of higher training intensities of effort
in comparison with traditional sets [44–46,71]. Thus, the implementation of cluster sets with short
inter-set rest intervals could be a useful strategy to carry out high-volume sessions of high-loads,
while keeping a high time-efficiency of training (training volume/time). Furthermore, cluster sets
may serve as an alternative to traditional sets for promoting muscle hypertrophy over time during
parallel periodization models , and prevent monotony in training. Moreover, future studies
should investigate the direct effects of cluster sets on exercise-induced muscle growth.
3.6. Supersets and Pre-exhaustion Technique
Supersets and pre-exhaustion during RT can be defined as a pair of different exercise sets
performed without rest. Supersets most commonly consist of two exercises for the same muscle group
, agonist-antagonist muscles [48,72] or alternating upper and lower body muscle groups 
consecutively followed by a recovery period; pre-exhaustion involves performing a single-joint
before a multi-joint exercise for the same muscle group (e.g., dumbbell fly before the bench press). In
a study by Wallace et al. , supersets (flat bench press followed by the incline bench press) resulted
in a significantly lower volume of training than a traditional exercise order in strength-trained males.
However, with regard to agonist–antagonist supersets, investigation by Robbins et al.  (bench
pull paired with the bench press) indicated a significantly higher training volume when compared to
a traditional exercise order. Furthermore, this type of superset as well as upper–lower body supersets
were found to be more time-efficient than traditional exercise order sessions [48,49].
The pre-exhaustion technique is commonly used by bodybuilders seeking to enhance the muscle
growth of target muscles. The rationale for this technique is that performing a single-joint exercise
first fatigues the agonist in isolation, thereby placing greater stress on the agonist and increasing its
activation during multi-joint exercise and potentiating its hypertrophy . Another variation is the
reverse pre-exhaustion (e.g., triceps pushdown before the bench press), and the justification for this
approach is that the fatigued synergist contributes less to the subsequent multi-joint exercise, thereby
placing greater stress on the agonist group . However, a study by Golas et al.  partially
disagreed with this statement as the results indicated that a pre-exhaustion exercise (incline dumbbell
fly) did not affect the pectoralis major activity during the flat bench press exercise at 95% 1RM.
Despite that, pre-exhaustion of the synergist muscles (triceps brachii and anterior deltoid before the
bench press) led to their higher activation during the multi-joint movement (bench press) as
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compared to the baseline . Furthermore, results of a study by Soares et al.  suggested that pre-
exhaustion (triceps pushdown followed by the bench press) decreased the maximal number of
repetitions performed during a set to volitional fatigue.
In conclusion, practitioners aiming to maximize training volume and intensity of effort may be
well advised to consider the use of supersets (agonist–antagonist and upper–lower body) in their RT
programs. The use of these exercise orders may be more time-efficient than the traditional approach,
and especially useful when time limitations exist in the planning of training sessions.
3.7. Drop Sets and Sarcoplasma Stimulating Training Technique
Drop sets involve performing a set to volitional fatigue with a given load and then immediately
reducing the load (e.g., ~20%) and continuing the exercise until subsequent volitional fatigue .
Briefly, the rationale for this technique is high metabolic stress induced due to a high number of
repetitions performed with short rest intervals. Accordingly, a study by Fink et al.  showed
significantly higher muscle thickness after drop sets in comparison with RT following a traditional
sets scheme, which can be considered as a potential marker for metabolic stress . Furthermore,
results of the study by Fink et al.  showed significant increases in the triceps cross-sectional area
after six weeks of drop sets training when compared to traditional sets. Nevertheless, it must be noted
that participants taking part in this research were recreational trained persons with little experience
in RT (did not regularly train for more than one year). On the other hand, Angleri et al. 
demonstrated that drop sets did not promote greater lower body muscle growth when compared
with traditional sets in well-trained males when training volume was equalized.
Similarly to drop sets, sarcoplasm stimulating training (SST) consists of sets of exercises
performed at 70–80% 1RM to volitional fatigue and then repeating this protocol twice more with 20
s rest intervals in between. The next step is to reduce the external load by 20% and perform an
additional set with a 4/0/1/0 tempo; following a 20 s rest interval, 20% of the external load is reduced
again, and a set with 4/0/1/0 tempo is completed to volitional fatigue. In the last set, the load is further
decreased by 20% and after its completion, following a 20 s rest interval, a static hold is performed
(e.g., at 90° of elbow flexion) to volitional fatigue . Another SST variation refers to the performance
of eight sets of exercises at 70−80% 1RM to volitional fatigue with programmed rest intervals between
subsequent sets (45, 30, 15, 5, 5, 15, 30, and 45 s) without reducing the load . Similarly, to drop
sets, the main aim of SST is to induce high metabolic stress . Recently, de Almeida et al. 
demonstrated that SST resulted in greater acute biceps brachii and triceps brachii muscle thickness
when compared to a traditional set scheme in trained subjects, even when total training volume was
higher in a traditional set scheme RT.
Evidence suggests the beneficial effects of both drop sets and SST in acute increases in triceps
brachii muscle thickness  in both amateur and well-trained subjects, even with lower training
volume versus a traditional set scheme RT. However, studies that have investigated the chronic
effects of drop sets did not show a superior hypertrophy response when compared with traditional
sets [52,54]. Moreover, the chronic effects of SST on muscle growth have not been examined yet.
The present review has several limitations that should be addressed. The majority of included
studies did not control nutritional intake, which can affect the magnitude of muscle adaptations.
Another limitation relates to studies that examined the influence of advanced methods and
techniques on training variables, but did not analyze hypertrophic responses and/or strength
improvements, which would be the basis for explaining their efficiency. In addition, only one study
 directly compared the responses between trained and untrained participants.
Considering the aforementioned studies, effective hypertrophy-oriented training should
comprise a combination of mechanical tension and metabolic stress. In summary, foundations for
Int. J. Environ. Res. Public Health 2019, 16, 4897 12 of 16
individuals seeking to maximize muscle growth should be hypertrophy-oriented RT consisting of
multiple sets (3−6) of six to 12 repetitions with short rest intervals (60 s) and moderate intensity of
effort (60−80% 1RM) with subsequent increases in training volume (12–28 sets/muscle/week) .
Moreover, trained athletes may consider integrating advanced resistance training techniques and
methods to provide an additional stimulus to break through plateaus, prevent monotony, and reduce
the time of training sessions. Evidence suggests some beneficial effects for selected RT techniques
especially in the case of training volume, time-efficiency, and intensity of effort. Furthermore, even
though most of these techniques and methods did not show a superior hypertrophy response
compared to the traditional approach, it may serve as an alternative to prevent monotony or it could
improve readiness to training sessions. To maintain high time-efficiency of training and when time
limitations exist, the use of agonist–antagonist, upper–lower body supersets, drop sets, SST, and
cluster sets may provide an advantage to the traditional approach. Furthermore, the employment of
fast but controlled tempo (~2 s) and supplementation of high-load RT with low-load RT under BFR
may allow for high time-efficiency of training and prevent excessively long training sessions. With
regard to the higher degree of mechanical tension, the use of AEL in RT should be considered,
therefore, in cases where time is limited, cluster sets might be a better choice. The implementation of
drop sets, SST, and low-load RT under BFR could provide time-efficient techniques to increase
metabolic stress. In summary, currently there is not sufficient evidence to provide specific guidelines
for volume, intensity of effort, and frequency of the previously mentioned resistance training
Furthermore, persistence in training and diet is essential. Recently, research has shown that
muscle hypertrophy that occurs at initial stages of RT (~4 sessions) is mostly attributable to muscle
damage induced cell swelling with the majority of strength gains resulting from neural adaptations
(8−12 sessions). Within the latter phase of RT (6−10 weeks), muscle growth begins to become the
dominant factor .
Authors’ Contributions: Study concept and design: M.K. and G.W.; Acquisition of data: M.K. and G.W.;
Analysis and interpretation of data: M.K. and G.W.; Writing—original draft: M.K.; Writing—review and editing:
A.G. and M.W.; Supervision: A.G. and M.W.
Funding: This research received no external funding.
Acknowledgements: The study was supported and funded by the statutory research project of the Jerzy
Kukuczka Academy of Physical Education in Katowice, Poland.
Conflict of Interest: The authors declare that the research was conducted in the absence of any commercial or
financial relationships that could be construed as a potential conflict of interest.
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