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REVIEW
What influence does resistance exercise order have on muscular strength
gains and muscle hypertrophy? A systematic review and meta-analysis
JOÃO PEDRO NUNES
1
, JOZO GRGIC
2
, PAOLO M. CUNHA
1
, ALEX S. RIBEIRO
1,3
, BRAD
J. SCHOENFELD
4
, BELMIRO F. DE SALLES
5
, & EDILSON S. CYRINO
1
1
Metabolism, Nutrition, and Exercise Laboratory, Physical Education and Sport Center, Londrina State University, Londrina,
Brazil;
2
Institute for Health and Sport (IHES), Victoria University, Melbourne, Australia;
3
Center for Research in Health
Sciences, University of Northern Paraná, Londrina, Brazil;
4
Department of Health Sciences, Lehman College, New York,
United States &
5
Strength Training Research Group, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
Abstract
The objectives of this paper were to: (a) systematically review studies that explored the effects of exercise order (EO) on
muscular strength and/or hypertrophy; (b) pool their results using a meta-analysis; and (c) provide recommendations for
the prescription of EO in resistance training (RT) programmes. A literature search was performed in four databases.
Studies were included if they explored the effects of EO on dynamic muscular strength and/or muscle hypertrophy. The
meta-analysis was performed using a random-effects model with Hedges’g effect size (ES). The methodological quality of
studies was appraised using the TESTEX checklist. Eleven good-to-excellent methodological quality studies were
included in the review. When all strength tests, that is, both in multi-joint (MJ) and single-joint (SJ) exercises were
considered, there was no difference between the EOs (ES = −0.11; p=0.306). However, there was a difference between
the MJ-to-SJ and SJ-to-MJ orders for strength gains in the MJ exercises, favouring starting the exercise session with MJ
exercises (ES = 0.32; p=0.034), and the strength gains in the SJ exercises, favouring starting the exercise session with SJ
exercises (ES = −0.58; p=0.032). No significant effect of EO was observed for hypertrophy combining site-specific and
indirect measures (ES = 0.03; p=0.862). In conclusion, increases in muscular strength are the largest in the exercises
performed at the beginning of an exercise session. For muscle hypertrophy, our meta-analysis indicated that both MJ-to-
SJ and SJ-to-MJ EOs may produce similar results.
Keywords: Muscle contraction, strength training, muscle strength, muscle growth, pre-exhaustion
Highlights
.Results of the present meta-analysis indicate a significant influence of resistance exercise order on gains in muscular
strength. In particular, the specificity principle should be considered to optimise strength gains, given that greater
improvements in strength are observed in exercises that are performed at the beginning of the resistance training session.
.Similar muscle hypertrophy effects may be achieved regardless of exercise order.
Introduction
Resistance training (RT) is an exercise modality that
has been shown to confer positive effects on health-
related parameters and well-being, sports perform-
ance, and physique aesthetics (Suchomel, Nimphius,
& Stone, 2016; Westcott, 2012). When designing RT
programmes, several key training variables need to be
considered. These variables are related to training
intensity (e.g. external load relative to maximum),
volume (e.g. the number of sets, repetitions per
exercise, and training frequency), level of effort
(e.g. sets performed near or to failure) and structure,
which refers to exercise order (EO) and selection
(Ratamess et al., 2009).
For EO, the current American College of Sports
Medicine position stand for resistance exercise pre-
scription recommends performing multi-joint (MJ)
exercises that involve larger muscle groups first in
the exercise session followed by the performance of
© 2020 European College of Sport Science
Correspondence: João Pedro Nunes, Metabolism, Nutrition, and Exercise Laboratory. Physical Education and Sport Center, Londrina State
University, Rod Celso Garcia Cid, km 380, Londrina, Brazil. E-mail: joaonunes.jpn@hotmail.com
European Journal of Sport Science, 2020
https://doi.org/10.1080/17461391.2020.1733672
single-joint (SJ) exercises that involve smaller muscle
groups (Ratamess et al., 2009). However, a narrative
review on the effects of EO did not necessarily share
these recommendations (Simão, de Salles, Figueir-
edo, Dias, & Willardson, 2012). Specifically, Simão
et al. (2012) suggested that EO should be prioritised,
whereby muscle groups or specific exercises con-
sidered most important to the goals of the trainee
are performed at the beginning of the exercise
session. These propositions are specific to muscular
strength and muscle hypertrophy (Ratamess et al.,
2009; Simão et al., 2012).
A limitation of the current guidelines on EO (Rata-
mess et al., 2009), which have an evidence level cat-
egory of C, is that they are based only on the results
from acute studies. In such studies, the participants
perform exercise sessions that only differ in the
specific EO. In this regard, the loads to be used on
both EO are previously tested in a single order,
unlike what occurs in the training sessions in which
the loads are adjusted according to the exercise pos-
ition in the training programme (Carpinelli, 2013;
Nunes et al., 2019). Outcomes of these studies com-
monly include the total number of repetitions and
muscle activation with different EOs (Augustsson
et al., 2003; Sforzo & Touey, 1996; Spreuwenberg
et al., 2006). Therefore, generalising the results from
acute studies to hallmark RT adaptations such as mus-
cular strength and hypertrophy must be done with
caution (Grgic, Schoenfeld, Skrepnik, Davies, &
Mikulic, 2018; Halperin, Vigotsky, Foster, & Pyne,
2018). A higher number of repetitions or an increased
acute muscular activation with a given resistance exer-
cise might not necessarily result in greater long-term
increases in muscular strength and hypertrophy
(Grgic et al., 2018; Halperin et al., 2018; Vigotsky,
Halperin, Lehman, Trajano, & Vieira, 2018).
The aforementioned narrative review by Simão
et al. (2012) included only three long-term studies,
with a total sample size across the studies of 66 partici-
pants. Since the publication of this review, multiple
long-term studies were subsequently published on
the topic of EO. Given the conflicting findings of
these studies, the goals of this paper were to: (a) sys-
tematically review studies that explored the effects of
EO on muscular strength and/or hypertrophy; (b)
pool their results using a meta-analysis; and (c)
provide recommendations for the prescription of EO
in RT based on the meta-analytical findings.
Methods
This review followed the Preferred Reporting Items
for Systematic Reviews and Meta-Analyses guide-
lines (Liberati et al., 2009).
Literature search
The literature search was performed through
PubMed/MEDLINE, Scopus, Scielo, and SPORT-
Discus databases on 13 February 2020. Searches
were carried out using the following search syntax:
(“resistance exercise”OR “resistance training”OR
“strength training”OR “strength exercise”)AND
(order) AND (strength OR hypertrophy OR “lean
body mass”OR “fat-free mass”). Secondary searches
were performed for: (a) screening the reference lists
of the included studies; and (b) conducting forward
citation tracking of the included studies through
Google Scholar. The study selection was carried
out independently by two authors (JPN and JG) to
minimise potential selection bias.
Inclusion criteria
Studies were included in this review if they met the
following inclusion criteria: (1) published in English
or Portuguese; (2) the study design was a longitudinal
investigation comparing the effects of different intra-
session resistance EO on dynamic muscular strength
and/or hypertrophy (both site-specific and indirect
measures of hypertrophy were considered); (3) the
training protocols included at least two RT exercises
(i.e. the minimum number of exercises that could be
used to explore the effect of EO); and (4) the training
intervention lasted a minimum of six weeks. Direct or
site-specific measures of hypertrophy were con-
sidered to be magnetic resonance imaging, computed
tomography, B-mode ultrasound, and muscle biopsy.
Indirect measures of hypertrophy were considered to
be dual-energy x-ray absorptiometry (DXA), hydro-
static weighing, bioimpedance, air-displacement
plethysmography, and skinfolds.
Coding of studies
The following data were extracted from the included
studies and tabulated on a predefined Microsoft
Excel coding sheet (Microsoft Corporation.
Redmond, USA): (1) author(s) name(s), manuscript
title and year of publication; (2) descriptive infor-
mation of the sample including number of partici-
pants, sex, age, and training status; (3)
characteristics of the RT programme: duration,
weekly training frequency, number of sets, intensity
(i.e. repetition maximum), EO and exercise selec-
tion; (4) methods used for assessment of muscular
strength and hypertrophy; (5) mean and standard
deviation of pre- and post-training muscular strength
and hypertrophy values. When necessary, the corre-
sponding author of the study was contacted by the
2J.P. Nunes et al.
lead author (JPN) to request the required infor-
mation. Coding sheets were cross-checked between
authors (JPN and JG), while discussion and consen-
sus resolved any discrepancies. To assess potential
coder drift, we randomly reselected 30% of the
included studies for additional re-coding. The agree-
ment between authors (JPN and JG) was 100%.
Classification of training status and age
Resistance-trained individuals were defined herein as
having at least six months of RT experience (Rata-
mess et al., 2009). For age groups, participants
were stratified based on the following classification:
(1) 18–39 years was considered as young, (2) 40–60
years as middle-aged, (3) ≥60 years as older adults.
Methodological quality
We assessed the methodological quality of the
included studies using the “Tool for the assEsment of
Study qualiTy and reporting in EXercise”(TESTEX)
checklist (Smart et al., 2015). The items on this
checklist are explained in full detail elsewhere
(Smart et al., 2015). The checklist has two sections
that refer to study quality (items 1–5) and study
reporting (items 6–12). Each item on the TESTEX
checklist is answered with “yes”if the criteria are sat-
isfied or with a “no”if the criteria are not satisfied
(only the answer “yes”is associated with a point).
Items 6 and 8 have three and two questions, respect-
ively. The answer “yes”to each of these sub-ques-
tions is also associated with a point. Therefore, the
maximum number of possible points on the checklist
is 15. Based on the summary scores, we classified
studies as “excellent quality”(12–15 points), “good
quality”(9–11 points), “fair quality”(6–8 points),
or “poor quality”(<6 points). Two authors (JPN
and JG) independently performed the quality assess-
ment, and any observed differences were resolved via
discussion and agreement.
Statistical analyses
The following meta-analytic comparisons for the
effects of EO on strength were explored: (a) the
overall increase in strength between the groups using
different EO while considering data from both MJ
and SJ exercises strength tests; (b) the effects of MJ-
to-SJ and SJ-to-MJ EOs on strength gains in MJ exer-
cises and in SJ exercises; and (c) the effects of training
specificity on strength when considering all exercises,
and on strength gains in machine-based vs. free-
weight exercises. For the first two comparisons, a posi-
tive effect indicated a benefit for MJ-to-SJ EO. For
training specificity, positive effects were considered
when the strength gain in the tested exercises favoured
the group that trained these exercises earlier in the RT
session (MJ exercises for groups that performed MJ-
to-SJ EO, and SJ exercises for groups that performed
SJ-to-MJ EO; and for the study from Saraiva et al.
(2014), upper-body exercises for the upper-body-to-
lower-body group, and lower-body exercises for the
lower-body-to-upper-body group). For the meta-ana-
lyses on muscle hypertrophy, we explored: (a) the
effects of EO on site-specific muscle hypertrophy
(assessed using B-mode ultrasound); (b) the effects
of EO on hypertrophy as assessed using indirect
measures (e.g. DXA, bioimpedance, air-displacement
plethysmography, and skinfolds); and (c) the effects of
EO on hypertrophy when considering both site-
specific and indirect measures. In both of the analyses
that included indirect measures, we conducted a sen-
sitivity analysis in which we excluded one study that
used skinfolds for the hypertrophy assessment. One
included study used both direct and indirect
methods of hypertrophy assessment (B-mode ultra-
sound and DXA; Avelar et al., 2019). Therefore, in
the analysis in which we combined direct and indirect
measures of hypertrophy, we conducted a sensitivity
analysis where we examined the pooled results after
using data reported for: (a) muscle thickness; and,
(b) lean body mass, from the Avelar et al. (2019) study.
In each analysis, the effect size (ES) was calculated
as the difference between post-test and pre-test
scores, divided by the pooled standard deviation,
with Hedges’gadjustment for small sample bias
(Borenstein, Hedges, Higgins, & Rothstein, 2009).
For studies with multiple outcomes, the mean of
the selected outcomes was used (assuming depen-
dence). Heterogeneity was explored using the I
2
stat-
istic, in which values <50% indicate low
heterogeneity, 50–75% moderate heterogeneity and
>75% high level of heterogeneity. Funnel plot asym-
metry could not be explored given that less than 10
studies were included in the analyses. The random-
effects model was used in each meta-analysis. Meta-
analyses were performed using the “Comprehensive
Meta-analysis”software (version 3; BiostatInc. Eng-
lewood, USA). Effects were considered significant
at p< 0.05. Data are reported as Hedges’gES and
95% confidence interval (CI).
Results
The search process is depicted in Figure 1. A total of
2327 search results were initially screened. After
excluding the studies based on title, abstract, or
full-text, a total of ten studies (Assumpção, Tibana,
Viana, Willardson, & Prestes, 2013; Avelar et al.,
What influence does resistance exercise order have on muscular strength gains and muscle hypertrophy? 3
2019; Cardozo et al., 2019; Dias, de Salles, Novaes,
Costa, & Simão, 2010; Fisher, Carlson, Steele, &
Smith, 2014; Nazari, Azarbayjani, & Azizbeigi,
2016; Saraiva et al., 2014; Simão et al., 2010;
Spineti et al., 2010,2014) were included. However,
one study was removed because it included duplicate
data (Spineti et al., 2014), and two additional studies
were included from the author’s library (Pina et al.,
2013; Tomeleri et al., 2019). Therefore, the final
number of included studies amounted to 11
(Assumpção et al., 2013; Avelar et al., 2019;
Cardozo et al., 2019; Dias et al., 2010; Fisher et al.,
2014; Nazari et al., 2016; Pina et al., 2013; Saraiva
et al., 2014; Simão et al., 2010; Spineti et al., 2010;
Tomeleri et al., 2019)(Table I).
Characteristics of the included studies
The average duration of training interventions was 9
weeks (range: 6–12 weeks). A total of 268 subjects par-
ticipated in the studies (average of 12 participants per
group; range: 8–19). Three of the 11 studies employed
resistance-trained subjects (Assumpção et al., 2013;
Fisher et al., 2014;Pinaetal.,2013), and the rest
included untrained subjects (Avelar et al., 2019;
Cardozo et al., 2019;Diasetal.,2010;Nazarietal.,
2016; Saraiva et al., 2014; Simão et al., 2010;
Spineti et al., 2010; Tomeleri et al., 2019). The
study of Saraiva et al. (2014) was in Judo athletes,
who had some experience in RT but not enough to
qualify as resistance-trained. Three studies explored
the effects of EO in older adults (Cardozo et al.,
2019;Pinaetal.,2013; Tomeleri et al., 2019), one
in middle-aged adults (Fisher et al., 2014), and the
rest in young adults (Assumpção et al., 2013;Avelar
et al., 2019;Diasetal.,2010;Nazarietal.,2016;
Saraiva et al., 2014; Simão et al., 2010; Spineti et al.,
2010). Two studies had a sample of female subjects
(Nazari et al., 2016; Tomeleri et al., 2019), one
study had a mixed-sex sample (Fisher et al., 2014),
and the rest of the studies included only male subjects
(Assumpção et al., 2013; Avelar et al., 2019; Cardozo
et al., 2019;Diasetal.,2010; Pina et al., 2013; Saraiva
et al., 2014; Simão et al., 2010; Spineti et al., 2010).
The muscular strength assessment was obtained
through 1RM (Avelar et al., 2019; Dias et al., 2010;
Fisher et al., 2014; Nazari et al., 2016; Pina et al.,
2013; Simão et al., 2010; Spineti et al., 2010; Tome-
leri et al., 2019), 10RM tests (Cardozo et al., 2019;
Saraiva et al., 2014), or both (Assumpção et al.,
2013). Muscle hypertrophy was indirectly assessed
by DXA (Avelar et al., 2019; Tomeleri et al., 2019),
air displacement plethysmography (2014), bioimpe-
dance (Pina et al., 2013), and skinfolds (Cardozo
et al., 2019). The studies that performed direct
measurements used B-mode ultrasound (Avelar
et al., 2019; Simão et al., 2010; Spineti et al., 2010).
As previously noted, Avelar et al. (2019)used both
DXA and ultrasound to assess muscle hypertrophy,
whereas Simão et al. (2010) used muscle thickness
as a measure of the size of the muscles analyzed, and
Spineti et al. (2010) estimated muscle volume from
an equation that includes muscle thickness and some
anthropometric measures.
Quality assessment
Table II presents the results of the quality assess-
ment. The average score on the checklist was 12.
Eight studies were rated as being excellent methodo-
logical quality (Assumpção et al., 2013; Cardozo
et al., 2019; Dias et al., 2010; Nazari et al., 2016;
Pina et al., 2013; Simão et al., 2010; Spineti et al.,
2010; Tomeleri et al., 2019), and three studies were
rated as being of good quality (Avelar et al., 2019;
Fisher et al., 2014; Saraiva et al., 2014). None of
the included studies was classified as being of fair or
poor methodological quality.
Influence of EO on muscular strength
Eight studies (Assumpção et al., 2013; Cardozo et al.,
2019;Diasetal.,2010; Nazari et al., 2016; Saraiva
et al., 2014; Simão et al., 2010; Spineti et al., 2010;
Tomeleri et al., 2019) explored the influence of EO
on muscular strength. When comparing MJ-to-SJ vs.
SJ-to-MJ orders, the study by Saraiva et al. (2014)
was not included because it investigated EOs that
Figure 1. Flow diagram of the search process.
4J.P. Nunes et al.
started either with lower-body or upper-body exer-
cises. When all performed strength tests (MJ and SJ)
were considered, there was no difference between
the EOs (gES = −0.11; 95% CI: −0.32, 0.10; p=
0.306; I² = 67.5%). There was a difference between
the MJ-to-SJ and SJ-to-MJ orders for strength gains
in the MJ exercises, which favoured starting with MJ
exercises (gES = 0.32; 95% CI: 0.02, 0.62; p=
0.034; I² = 0%). In the same way, there was a
difference between MJ-to-SJ and SJ-to-MJ orders for
strength gains in the SJ exercises, which favoured start-
ing with SJ exercises (gES = −0.58; 95% CI: −1.11,
−0.05; p=0.032; I² = 0%). Finally, a significant and
positive effect was found supporting the principle of
specificity when consider all exercises (gES = 0.45;
95% CI: 0.09, 0.81; p=0.014; I² = 37.4%; Figure
2A), and when considering only machine-based exer-
cises (gES= 0.45; 95% CI: 0.09, 0.81; p=0.015; I² =
Table I. Characteristics of the included studies on resistance exercise order
Studies
Sample
Duration RT programme Exercises and EO according to groupsCharacteristics n
Assumpção et al.
(2013)
Trained young men MJ-SJ = 8
SJ-MJ = 8
6 weeks A-B2x/wk, 3 sets
of 8–12RM
MJ-SJ
SJ-MJ
BP∗, IBP, PD, MTE, TE∗–LPD∗,
CLPD, SR, MBC, BC∗
MTE, TE∗,BP
∗, IBP, PD –MBC,
BC∗, LPD∗, CLPD, SR
Avelar et al. (2019) Untrained young
men
MJ-SJ = 19
SJ-MJ = 17
6 weeks 3x/wk, 3 sets of
8–12RM
MJ-SJ
SJ-MJ
BP, LPD, UR, SP, TE, BC, LP, KE,
LC, CR
BC, TE, SP, UR, LPD, BP, CR,
LC, KE, LP
Cardozo et al.
(2019)
Untrained older
women
MJ-SJ = 15
SJ-MJ = 15
12 weeks 2x/wk, 3 sets of
8–10RM
(circuit
training)
MJ-SJ
SJ-MJ
LP∗, LPD∗, KE, PD, CR∗,TE
∗
TE∗,CR
∗, PD, KE, LDP∗,LP
∗
Dias et al. (2010) Untrained young
men
MJ-SJ = 16
SJ-MJ = 17
8 weeks 3x/wk, 3 sets of
8–12RM
MJ-SJ
SJ-MJ
BP∗, LPD∗,SP
∗,TE
∗,BC
∗
BC∗,TE
∗,SP
∗, LPD∗,BP
∗
Fisher et al. (2014) Trained middle-age
adults
MJ-SJ = 8
SJ-MJ = 17
12 weeks 2x/wk, 1 set of
8–12RM
MJ-SJ
SJ-MJ
BP, LP, LPD, PD, KE, PO, ABD, LU
PD, BP, KE, LP, PO, LPD, ABD,
LU
Nazari et al.
(2016)
Untrained young
women
MJ-SJ = 8
SJ-MJ = 8
6 weeks 3x/wk, 4 sets of
3–15RM
(linear
periodisation)
MJ-SJ
SJ-MJ
BP∗, LPD∗,TE
∗,BC
∗
BC∗,TE
∗, LPD∗,BP
∗
Pina et al. (2013) Trained older men MJ-SJ = 9
SJ-MJ = 9
7 weeks 3x/wk, 2 sets of
10–15RM
MJ-SJ
SJ-MJ
BP, LPD, TE, BC, KE, LC, HAB,
HAD
BC, TE, LPD, BP, HAD, HAB,
LC, KE
Saraiva et al.
(2014)
Judo male athletes UB-LB =
13
LB-UB =
13
12 weeks 3x/wk, 3 sets of
10–12RM
UB-
LB
LB-
UB
BP∗, LPD∗,SP
∗,BC
∗,SQ
∗,LP
∗,
KE∗,LC
∗
SQ∗,LP
∗,KE
∗,LC
∗,BP
∗, LPD∗,
SP∗,BC
∗
Simão et al. (2010) Untrained young
men
MJ-SJ = 9
SJ-MJ = 9
12 weeks 2x/wk, 2–4 sets of
3–15RM
(linear
periodisation)
MJ-SJ
SJ-MJ
BP∗, LPD∗,TE
∗,BC
∗
BC∗,TE
∗, LPD∗,BP
∗
Spineti et al.
(2010)
Untrained young
men
MJ-SJ = 11
SJ-MJ = 10
12 weeks 2x/wk, 2–4 sets of
3–15RM
(undulating
periodisation)
MJ-SJ
SJ-MJ
BP∗, LPD∗,TE
∗,BC
∗
BC∗,TE
∗, LPD∗,BP
∗
Tomeleri et al.
(2019)
Untrained older
women
MJ-SJ = 14
SJ-MJ = 15
12 weeks 3x/wk, 3 sets of
10–15RM
MJ-SJ
SJ-MJ
BP∗, SR, TE, BC∗, LP, KE∗, LC, CR
BC∗, TE, SR, BP∗, CR, LC, KE∗,
LP
Notes: MJ-SJ: group that performed the exercises in a multi- (MJ) to single-joint (SJ) order. SJ-MJ: group that performed the exercises in a
single- to multiple-joint order. UB-LB: group that performed the exercises in an upper- (UB) to lower-body (LB) order. LB-UB: group that
performed the exercises in an upper- to lower-body order. RM: repetition maximum. ABD: abdominal flexion. BC: biceps curl. MBC:
machine biceps curl. BP: bench press. IBP: incline bench press. CR: calf raise. HAB: hip abduction. HAD: hip adduction. KE: knee
extension. LC: leg curl. LPD: lat-pulldown. CLPD: close-grip lat-pulldown. LP: leg press. LU: lumbar extension. PD: pecdeck. PO: lat-
pullover. SP: shoulder press. SQ: squat. SR: seated row. TE: triceps extension. MTE: machine triceps extension. UR: shoulder upright row. ∗
exercise used for strength testing (if no asterisk is noted in any of the exercises, the study did not assess changes in muscular strength).
What influence does resistance exercise order have on muscular strength gains and muscle hypertrophy? 5
33.6%) or free-weight exercises (gES = 0.50; 95% CI:
0.02, 1.00; p=0.018; I² = 58.1%).
Influence of EO on muscle hypertrophy
Seven studies (Avelar et al., 2019; Cardozo et al.,
2019; Fisher et al., 2014; Pina et al., 2013; Simão
et al., 2010; Spineti et al., 2010; Tomeleri et al.,
2019) explored the influence of EO on muscle hyper-
trophy. No significant effect of EO was observed for
muscle growth when analyzed by either site-specific
measures (gES = −0.02; 95% CI: −0.45, 0.41; p=
0.937; I² = 0%) or indirect measures (gES = 0.06;
95% CI: −0.27, 0.39; p=0.734; I² = 0%). The com-
bined analysis of both site-specific and indirect
measures also indicated no significant difference
between EOs on muscle hypertrophy (gES = 0.03;
95% CI: −0.26, 0.31; p=0.862; I² = 0%; Figure
2B). The exclusion of one study that used skinfolds
for hypertrophy assessment did not impact the
results to a meaningful degree when considering
the analysis only for indirect measures (gES = 0.07;
95% CI: −0.32, 0.45; p=0.727; I² = 0%) or com-
bined site-specific and indirect measures (gES =
0.03; 95% CI: −0.30, 0.35; p=0.871; I² = 0%). In
the sensitivity analysis where we used either ES
data for muscle thickness or lean body mass from
the Avelar et al. study, the results remained consist-
ent with the use of average ESs (gES = 0.02; 95%
CI: −0.28, 0.32; p=0.898; I² = 0%, and gES =
0.04; 95% CI: −0.6, 0.33; p=0.810; I² = 0%,
respectively).
Table II. Quality assessment using the TESTEX checklist
Study 123456a6b6c78a8b9101112Total score
Assumpção et al. (2013)11010 1 0 1 1 1 1 1 1 1 1 12
Avelar et al. (2019) 11011 0 0 0 1 1 1 1 1 1 1 11
Cardozo et al. (2019) 11010 1 0 1 1 1 1 1 1 1 1 12
Dias et al. (2010) 11010 1 0 1 1 1 1 1 1 1 1 12
Fisher et al. (2014) 01011 0 0 0 1 1 1 1 1 1 1 10
Nazari et al. (2016) 11010 1 0 1 1 1 1 1 1 1 1 12
Pina et al. (2013) 11010 1 0 1 1 1 1 1 1 1 1 12
Saraiva et al. (2014) 01010 0 0 0 1 1 1 1 1 1 1 9
Simão et al. (2010) 11010 1 0 1 1 1 1 1 1 1 1 12
Spineti et al. (2010) 11010 1 0 1 1 1 1 1 1 1 1 12
Tomeleri et al. (2019) 11011 1 0 1 1 1 1 1 1 1 1 13
1 = criteria met; 0 = criteria not met.
Figure 2. (Panel A) Forest plot of studies on changes in muscular strength following resistance training (RT) with different exercise orders
(EO), analysing specificity-principle. Positive effects were considered when the strength gain in the tested exercise favoured the group that
trained this exercise first in the RT session (multi-joint (MJ) exercises for groups that performed MJ-to-single-joint (SJ) EO, SJ exercises
for groups that performed SJ-to-MJ EO; and for the study from Saraiva et al. (2014), upper-body (UB) exercises for the UB-to-lower-
body (LB) exercises group and LB exercises for the LB-to-UB group). The data shown are mean ± 95% confidence interval (CI). (Panel
B) Forest plot of studies comparing muscle hypertrophy following RT performed in SJ-to-MJ EO versus MJ-to-SJ EO. The data shown
are mean ± 95% CI. ES = effect size.
6J.P. Nunes et al.
Discussion
This is the first systematic review coupled with a
meta-analysis to compare the influence of EOs on
muscular strength and hypertrophy. Our main
finding is that EO influences strength gains as it
seems that strength gains are the greatest in the exer-
cises that are performed at the beginning of the exer-
cise session. However, no significant difference
between EOs was found for muscle hypertrophy.
The included studies were classified as being excel-
lent to good methodological quality, which therefore
strengthens confidence in these conclusions.
Regarding muscular strength, our findings confirm
previous reports that increases in strength follow the
‘Specific Adaptations to Imposed Demands’(SAID)
principle (Mattocks et al., 2017;Nunes,Ribeiro,
Schoenfeld, & Cyrino, 2018). We observed that EO
affected strength gains when considering the effects
of MJ-to-SJ and SJ-to-MJ exercise sequences on
strength gains in MJ and SJ exercises. In both cases,
the increase in strength was greater in the exercises
that were performed at the beginning of the exercise
session. Placing a given exercise first in an exercise
session allows the use of higher external loads in that
exercise. The use of higher loads ultimately seems to
transfer to greater strength gains in exercises that are
performed first. These findings support the previously
proposed hypothesis (Simão et al., 2012)thatEO
should be prioritised based on the desired goal of the
individual. The specificity principle for EO may have
high practical importance for individuals who aspire
to develop maximum strength, especially powerlifters
and weightlifters. When the training goal is to optimise
strength development in a given exercise, our findings
indicate that this exercise should be performed at the
beginning of the training session.
The effect of fatigue (local and/or non-local (Hal-
perin, Chapman, & Behm, 2015)) on acute exercise
performance is an important factor that also seems
to explain the influence of EO on strength gains.
Fatigue induced by an exercise performed first in a
given sequence tends to negatively affect perform-
ance in the ensuing exercises. Local muscular
fatigue induced by the first exercise may decrease per-
formance in subsequent exercises that activate the
same muscle group (Halperin et al., 2015; Simão
et al., 2012). This finding was observed in several
acute studies; for example, chest press performance
is negatively affected by a prior performance of the
triceps pulley exercise, and vice-versa (Miranda, Fig-
ueiredo, Rodrigues, Paz, & Simão, 2013; Ribeiro
et al., 2014; Simão, Farinatti, Polito, Maior, &
Fleck, 2005). Non-local muscular fatigue is related
to crossover fatigue from one exercised muscle
group to another, non-exercised muscle group (e.g.
the performance of upper-body exercise is hindered
when it is preceded with a lower-body exercise) (Hal-
perin et al., 2015). This may explain the results from
Saraiva et al. (2014), in which the group that per-
formed upper-body exercises first in the training ses-
sions gained more strength in upper-body exercises,
while the group that performed lower-body exercises
first gained more strength in lower-body exercises.
These data further highlight the importance of train-
ing specificity for strength gains.
An important caveat of the findings presented
herein is that all of the included studies explored
the effects of EO on RM-strength tests (i.e. tests
that are specific to the training programme used).
Future investigations should seek to employ strength
tests with other ‘non-specific’methods (e.g. isoki-
netic, isometric strength tests) to explore whether
EO influences overall muscular strength when
assessed using a non-specific strength test (Buckner
et al., 2017). If EO does not impact strength gains
in other (non-specific) strength tests, this may allow
greater flexibility for EO during RT sessions depend-
ing on individual goals.
Our findings indicate that similar muscle hypertro-
phy can be attained regardless of EO. Nonetheless,
the relatively low number of studies on the topic high-
lights a need for future research in this area. Still,
several important practical implications can be
inferred based on current evidence. It would appear
that different EOs (MJ-to-SJ or SJ-to-MJ) induce
similar effects on site-specific muscle hypertrophy.
However, one important limitation needs to be dis-
cussed here. In the studies that used B-mode ultra-
sound to assess changes in muscle size, the
measured sites were not the main targeted muscles
in the exercises investigated under different EO.
That is, muscle thickness measurements were
obtained from muscles that were primary agonists
only in SJ exercise, but synergists in MJ exercises.
For example, studies that explored the effects of EO
on biceps brachii hypertrophy used a biceps curl SJ
exercise and the lat-pull down MJ exercise (Avelar
et al., 2019; Simão et al., 2010; Spineti et al.,
2010). This can be problematic given that the
biceps brachii is the agonist in the biceps curl exercise
whereas, for the lat-pulldown, biceps brachii acts as a
synergist. The results of these three studies (Avelar
et al., 2019; Simão et al., 2010; Spineti et al., 2010)
may only indicate that the performance of an MJ
exercise (in which the measured muscle acts as a
synergist) before the SJ exercise (where the muscle
is worked as an agonist), does not affect the hyper-
trophic response. Only Avelar et al. (2019) investi-
gated the effect of exercises performed in a different
EO (starting with MJ or SJ exercises) for the same
target muscle, in the lower-body. According to the
What influence does resistance exercise order have on muscular strength gains and muscle hypertrophy? 7
results of this study, which lasted six weeks, EO also
appeared to have minimal effects on overall increases
in muscle size. In this study, performing the leg press
(MJ) or knee extension (SJ) first in the exercise
session resulted in similar effects on mid-thigh quad-
riceps femoris hypertrophy (Avelar et al., 2019).
Similar effects of EO were also observed when con-
sidering indirect measures of muscle hypertrophy, as
shown in Figure 2B (Avelar et al., 2019; Cardozo
et al., 2019; Fisher et al., 2014; Pina et al., 2013;
Tomeleri et al., 2019). These indirect methods
included DXA (Avelar et al., 2019; Tomeleri et al.,
2019), air displacement plethysmography (Fisher
et al., 2014), bioimpedance (Pina et al., 2013), and
skinfolds (Cardozo et al., 2019). Potential differences
between groups might have been diluted because
these methods have a limited capability of assessing
subtle changes in muscle hypertrophy (Haun et al.,
2019), which needs to be mentioned as a potential
limitation of the presented findings.
Some authors have suggested that the MJ-to-SJ
order may be superior for producing greater overall
increases in muscle mass (as compared to SJ-to-MJ
order) because it allows accumulation of a greater
training volume (i.e. repetitions and/or volume-
load) especially in the MJ exercises that activate
more muscle groups (Ratamess et al., 2009; Sforzo
& Touey, 1996). While this approach may have cre-
dence on a general level, a different approach may
be warranted when the goal is to focus on hyper-
trophic development of a specific muscle group
(e.g. pectoralis major). In this case, others have
speculated that it is better to perform isolated SJ exer-
cises (e.g. pecdeck) prior to the MJ exercises (e.g.
chest press) in the exercise session as a means to
provide greater stimulation for this specific muscle
group (Ribeiro, Nunes, Cunha, Aguiar, & Schoen-
feld, 2019). While our results suggest that similar
increases in muscle size are achieved regardless of
EO, future studies are needed to provide additional
insight into these nuanced aspects. Future studies
should endeavour to investigate the effect of different
EO with exercises for the same target muscles [e.g.
pecdeck (SJ) and chest press (MJ), for pectoralis
major] using site-specific measurement techniques,
and compare the hypertrophic changes of muscles
that act as agonists in both MJ and SJ exercise as
opposed to just the synergists (Ribeiro et al., 2019;
Ribeiro, Schoenfeld, & Nunes, 2017).
It is important to clarify the methodological quality
of the included studies, which were classified as being
of excellent to good quality. Indeed, most of the key
items on the TESTEX checklist (Smart et al.,
2015) were satisfied by the majority of the included
studies. That said, some limitations warrant
mention. Of the 11 included studies, three did not
report data on training adherence. Given that differ-
ences in training adherence between the groups
may have a profound impact on the overall results
of a given study, future research should ensure that
training adherence is reported for both groups.
Additionally, in three studies, it was unclear if the
training programmes were supervised. Training
supervision has been shown to impact gains in mus-
cular strength, with greater gains observed in super-
vised vs. unsupervised training programmes
(Mazzetti et al., 2000). This information needs to
be clearly reported in future studies.
Conclusions
The results of this review indicate that EO influences
gains in muscular strength. Increases in strength are
greatest in exercises that are performed at the begin-
ning of a training session. Therefore, to optimise
strength gain in a given exercise, that exercise
should be performed at the beginning of the training
session. For muscle hypertrophy, similar results
appear to be achieved regardless of EO.
Disclosure statement
No potential conflict of interest was reported by the author(s).
References
Assumpção, C. O., Tibana, R. A., Viana, L. C., Willardson, J. M.,
& Prestes, J. (2013). Influence of exercise order on upper body
maximum and submaximal strength gains in trained men.
Clinical Physiology and Functional Imaging,33(5), 359–363.
Augustsson, J., Thomeé, R., Hórnstedt, P., Lindblom, J.,
Karlsson, J., & Grimby, G. (2003). Effect of pre-exhaustion
exercise on lower-extremity muscle activation during a leg
press exercise. Journal of Strength and Conditioning Research,17
(2), 411–416.
Avelar, A., Ribeiro, A. S., Nunes, J. P., Schoenfeld, B. J., Papst, R.
R., Trindade, M. C. C., …Cyrino, E. S. (2019). Effects of
order of resistance training exercises on muscle hypertrophy in
young adult men. Applied Physiology Nutrition and Metabolism,
44(4), 420–424.
Borenstein, M., Hedges, L. V., Higgins, J. P. T., & Rothstein, H.
R. (2009). Introduction to meta-analysis. Hoboken: Wiley.
Buckner, S. L., Jessee, M. B., Mattocks, K. T., Mouser, J. G.,
Counts, B. R., Dankel, S. J., & Loenneke, J. P. (2017).
Determining strength: A case for multiple methods of measure-
ment. Sports Medicine,47(2), 193–195.
Cardozo, D., de Salles, B. F., Mannarino, P., Vasconcelos,
A. P. S., Miranda, H., Willardson, J. M., & Simão, R. (2019).
The effect of exercise order in circuit training on muscular
strength and functional fitness in older women. International
Journal of Exercise Science,12(4), 657–665.
Carpinelli, R. (2013). Does the sequence of exercise in a resistance
training session affect strength gains and muscular hypertrophy?
A critical examination of the evidence. Medicina Sportiva,17(1),
37–50.
8J.P. Nunes et al.
Dias, I., de Salles, B. F., Novaes, J., Costa, P. B., & Simão, R.
(2010). Influence of exercise order on maximum strength in
untrained young men. Journal of Science and Medicine in Sport,
13(1), 65–69.
Fisher, J. P., Carlson, L., Steele, J., & Smith, D. (2014). The effects
of pre-exhaustion, exercise order, and rest intervals in a full-
body resistance training intervention. Applied Physiology,
Nutrition, and Metabolism,39(11), 1265–1270.
Grgic, J., Schoenfeld, B. J., Skrepnik, M., Davies, T. B., & Mikulic,
P. (2018). Effects of rest interval duration in resistance training
on measures of muscular strength: A systematic review. Sports
Medicine,48(1), 137–151.
Halperin, I., Chapman, D. W., & Behm, D. G. (2015). Non-local
muscle fatigue: Effects and possible mechanisms. European
Journal of Applied Physiology,115(10), 2031–2048.
Halperin, I., Vigotsky, A. D., Foster, C., & Pyne, D. B. (2018).
Strengthening the practice of exercise and sport science.
International Journal of Sports Physiology and Performance,13
(2), 127–134.
Haun, C. T., Vann, C. G., Roberts, B. M., Vigotsky, A. D.,
Schoenfeld, B. J., & Roberts, M. D. (2019). A critical evaluation
of the biological construct skeletal muscle hypertrophy: Size
matters but so does the measurement. Frontiers in Physiology,
10, 247.
Liberati, A., Altman, D. G., Tetzlaff, J., Mulrow, C., Gøtzsche, P.
C., Ioannidis, J. P. A., …Moher, D. (2009). The PRISMA
statement for reporting systematic reviews and meta-analyses
of studies that evaluate health care interventions: Explanation
and elaboration. BMJ,339, b2700.
Mattocks, K. T., Buckner, S. L., Jessee, M. B., Dankel, S. J.,
Mouser, J. G., & Loenneke, J. P. (2017). Practicing
the test produces strength equivalent to higher volume train-
ing. Medicine and Science in Sports and Exercise,49(9), 1945–
1954.
Mazzetti, S. A., Kraemer, W. J., Volek, J. S., Duncan, N. D.,
Ratamess, N. A., Gómez, A. L., …Fleck, S. J. (2000). The
influence of direct supervision of resistance training on strength
performance. Medicine and Science in Sports and Exercise,32(6),
1175–1184.
Miranda, H., Figueiredo, T., Rodrigues, B., Paz, G. A., & Simão,
R. (2013). Influence of exercise order on repetition perform-
ance among all possible combinations on resistance training.
Research in Sports Medicine,21(4), 355–366.
Nazari, M., Azarbayjani, M. A., & Azizbeigi, K. (2016). Effect of
exercise order of resistance training on strength performance
and indices of muscle damage in young active girls. Asian
Journal of Sports Medicine,7(6), e30599.
Nunes, J. P., Marcori, A., Tomeleri, C. M., Nascimento, M. A.,
Mayhew, J. L., Ribeiro, A. S., & Cyrino, E. S. (2019).
Starting the resistance-training session with lower-body exer-
cises provides lower perceived exertion without altering the
training volume in older women. International Journal of
Exercise Science,12(4), 1187–1197.
Nunes, J. P., Ribeiro, A. S., Schoenfeld, B. J., & Cyrino, E. S.
(2018). Comment on: “Comparison of periodized and non-per-
iodized resistance training on maximal strength: A meta-analy-
sis”.Sports Medicine,48(2), 491–494.
Pina, F. L. C., Do Nascimento, M. A., Januário, R. S. B., Gerage,
A. M., De Oliveira, A. R., & Cyrino, E. S. (2013). Influence of
resistance exercises order on body composition in older men.
Journal of Physical Education,24(3), 443–451.
Ratamess, N. A., Alvar, B. A., Evetoch, T. K., Housh, T. J., Kibler,
W. B., Kraemer, W. J., & Triplett, N. T. (2009). American
College of Sports Medicine position stand. Progression
models in resistance training for healthy adults. Medicine and
Science in Sports and Exercise,41(3), 687–708.
Ribeiro, A. S., Nunes, J. P., Cunha, P. M., Aguiar, A. F., &
Schoenfeld, B. J. (2019). The potential role of pre-exhaustion
training in maximizing muscle hypertrophy: A review of the lit-
erature. Strength and Conditioning Journal,41(1), 75–80.
Ribeiro, A. S., Romanzini, M., Nascimento, M. A., Cheche Pina,
F. L., Souza, M. F., Avelar, A., & Cyrino, E. S. (2014).
Influence of the execution order of weight exercises on total
training volume when load is adjusted according to the
sequence. Brazilian Journal of Physical Activity and Health,19
(3), 351–360.
Ribeiro, A. S., Schoenfeld, B. J., & Nunes, J. P. (2017). Large and
small muscles in resistance training: Is it time for a better defi-
nition? Strength and Conditioning Journal,39(5), 33–35.
Saraiva, A., Pinto, G. S., Costa e Silva, G., Bentes, C., Miranda,
H., & Novaes, J. (2014). Influence of exercise order on strength
in Judo athletes. Gazzetta Medica Italiana,173(5), 251–257.
Sforzo, G. A., & Touey, P. R. (1996). Manipulating exercise order
affects muscular performance during a resistance exercise train-
ing session. Journal of Strength and Conditioning Research,10(1),
20–24.
Simão, R., de Salles, B. F., Figueiredo, T., Dias, I., & Willardson,
J. M. (2012). Exercise order in resistance training. Sports
Medicine,42(3), 251–265.
Simão, R., Farinatti, P. d. T., Polito, M. D., Maior, A. S., & Fleck,
S. J. (2005). Influence of exercise order on the number of rep-
etitions performed and perceived. Journal of Strength and
Conditioning Research,19(1), 152–156.
Simão, R., Spineti, J., de Salles, B. F., Oliveira, L. F., Matta, T.,
Miranda, F., …Costa, P. B. (2010). Influence of exercise
order on maximum strength and muscle thickness in untrained
men. Journal of Sports Science and Medicine,9(1), 1–7.
Smart, N. A., Waldron, M., Ismail, H., Giallauria, F., Vigorito, C.,
Cornelissen, V., & Dieberg, G. (2015). Validation of a new tool
for the assessment of study quality and reporting in exercise
training studies: TESTEX. International Journal of Evidence-
Based Healthcare,13(1), 9–18.
Spineti, J., de Salles, B. F., Rhea, M. R., Lavigne, D., Matta, T.,
Miranda, F., …Simão, R. (2010). Influence of exercise order
on maximum strength and muscle volume in nonlinear period-
ized resistance training. Journal of Strength and Conditioning
Research,24(11), 2962–2969.
Spineti, J., Figueiredo, T., Miranda, H., de Salles, B. F.,
Fernandes, L., & Simão, R. (2014). The effects of exercise
order and periodized resistance training on maximum strength
and muscle thickness. International SportMed Journal,15(4),
374–390.
Spreuwenberg, L. P., Kraemer, W. J., Spiering, B. A., Volek, J. S.,
Hatfield, D. L., Silvestre, R., …Fleck, S. J. (2006). Influence of
exercise order in a resistance-training exercise session. Journal of
Strength and Conditioning Research,20(1), 141–144.
Suchomel, T. J., Nimphius, S., & Stone, M. H. (2016). The
importance of muscular strength in athletic performance.
Sports Medicine,46(10), 1419–1449.
Tomeleri, C. M., Ribeiro, A. S., Nunes, J. P., Schoenfeld, B. J.,
Souza, M. F., Schiavoni, D., …Cyrino, E. S. (2019).
Influence of resistance-training exercise order on muscle
strength, hypertrophy and anabolic hormones in older
women: A randomized controlled trial. Journal of Strength and
Conditioning Research, ahead of print.
Vigotsky, A. D., Halperin, I., Lehman, G. J., Trajano, G. S., &
Vieira, T. M. (2018). Interpreting signal amplitudes in surface
electromyography studies in sport and rehabilitation sciences.
Frontiers in Physiology,8, 985.
Westcott, W. L. (2012). Resistance training is medicine: Effects of
strength training on health. Current Sports Medicine Reports,11
(4), 209–216.
What influence does resistance exercise order have on muscular strength gains and muscle hypertrophy? 9
