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SINGLE VS.MULTIPLE SETS OF RESISTANCE
EXERCISE FOR MUSCLE HYPERTROPHY:A
METAANALYSIS
JAMES W. KRIEGER
Journal of Pure Power, Colorado Springs, CO
ABSTRACT
Krieger, JW. Single vs. multiple sets of resistance exercise for
muscle hypertrophy: a metaanalysis. J Strength Cond Res
24(4): 1150–1159, 2010—Previous metaanalyses have com
pared the effects of single to multiple sets on strength, but
analyses on muscle hypertrophy are lacking. The purpose of this
study was to use multilevel metaregression to compare the
effects of single and multiple sets per exercise on muscle
hypertrophy. The analysis comprised 55 effect sizes (ESs),
nested within 19 treatment groups and 8 studies. Multiple sets
were associated with a larger ES than a single set (difference =
0.10 60.04; conﬁdence interval [CI]: 0.02, 0.19; p= 0.016).
In a dose–response model, there was a trend for 2–3 sets
per exercise to be associated with a greater ES than 1 set
(difference = 0.09 60.05; CI: 20.02, 0.20; p= 0.09), and
a trend for 4–6 sets per exercise to be associated with a greater
ES than 1 set (difference = 0.20 60.11; CI: 20.04, 0.43; p=
0.096). Both of these trends were signiﬁcant when considering
permutation test pvalues (p,0.01). There was no signiﬁcant
difference between 2–3 sets per exercise and 4–6 sets per
exercise (difference = 0.10 60.10; CI: 20.09, 0.30; p= 0.29).
There was a tendency for increasing ESs for an increasing
number of sets (0.24 for 1 set, 0.34 for 2–3 sets, and 0.44 for
4–6 sets). Sensitivity analysis revealed no highly inﬂuential
studies that affected the magnitude of the observed differ
ences, but one study did slightly inﬂuence the level of
signiﬁcance and CI width. No evidence of publication bias
was observed. In conclusion, multiple sets are associated with
40% greater hypertrophyrelated ESs than 1 set, in both trained
and untrained subjects.
KEY WORDS metaregression, effect size, lean body mass,
volume
INTRODUCTION
Resistance training improves musculoskeletal
strength, muscle mass, bone mass, and connective
tissue thickness (22,41). The design of a resistance
training program requires appropriate manipula
tion of numerous variables, including the frequency, intensity,
and volume of the program (12). For general ﬁtness purposes,
the American College of Sports Medicine has recommended
a program of 1 set of 8–10 exercises covering all major
muscle groups (1). Multiple sets are recommended for
athletic populations (21). In the past, some authors have
argued that a single set per exercise is all that is necessary
for all populations and that further gains are not achieved
by successive sets (8). However, a large number of studies
performed over the past decade have demonstrated greater
strength gains with multiple sets per exercise (6,11,16,18–
20,26–27,30,32,35–36). Also, a recent metaanalysis clearly
showed multiple sets to be associated with 46% greater
strength gains in both trained and untrained subjects (23).
The reason for the greater strength gains with multiple sets
is not well established. Strength training is associated with
both neural and structural adaptations that enhance force
production (22). It is not clear whether the greater strength
gains observed with multiple sets are because of greater
neural adaptations, greater hypertrophy, or both. Some
studies have shown greater hypertrophy with multiple sets
(26,35), whereas others have not (11,27,30–32,40). Measures
of muscle hypertrophy are highly variable and insensitive.
Changes in muscle size are smaller and slower than changes
in strength (28). Many resistance training studies are short in
duration, and subject numbers tend to be small. Because of all
these reasons, the risk of a Type II error is high. For example,
McBride et al. (27) reported greater strength gains in a group
performing 6 sets per exercise compared with a group
performing 1 set per exercise. There were no signiﬁcant
differences in changes in lean mass between the groups.
However, the study only lasted 12 weeks, and there were
only 9 subjects per group. The mean change in leg lean mass
was nonsigniﬁcantly greater in the multipleset group
compared with the singleset group (0.86 kg vs. 20.05 kg,
respectively). A difference of 0.9 kg in 12 weeks is a
meaningful difference in leg lean mass. Given the sample size
BRIEF REVIEW
Address correspondence to James W. Krieger, jim@jopp.us.
24(4)/1150–1159
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Ó2010 National Strength and Conditioning Association
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and the reported SDs, the estimated statistical power to
detect this difference, using a 2tailed test and an aof 0.05, is
only 12%. Thus, only 12 of 100 studies would detect a
signiﬁcant difference, if each study only had 9 subjects per
group. If this 0.9kg difference represents a true difference
between populations, then a Type II error has occurred.
In fact, using an estimated SD of the difference, the study
would need 75–175 subjects per group to detect this 0.9kg
difference with 80% power. Therefore, underpowered
resistance training studies can potentially lead to incorrect
conclusions regarding the effects of set volume on muscle
hypertrophy, and these erroneous conclusions are only rein
forced with the publication of more underpowered studies.
Unfortunately, many resistance training studies do not report
power analyses.
Another problem with determining the effects of set
volume on hypertrophy is the many ways in which
hypertrophy can be measured. Studies have used whole
body lean mass (11,26), regional lean mass (27,35), muscle
thickness (31,40), muscle crosssectional area (31,35), or
muscle circumference (30–32) to measure hypertrophy.
Different regions of a particular muscle may also be measured
(40). Thus, comparisons across studies can be difﬁcult. The
calculation of a standardized effect size (ES) can aid in the
comparison across studies (3). A metaanalysis of these ESs
can allow for the identiﬁcation of trends among conﬂicting
and/or underpowered studies (45). Metaanalyses regarding
the effects of set volume on strength have been published
(23,33–34,44), but none of these analyses looked at measures
of hypertrophy.
The purpose of this paper was to use metaanalysis to
compare the effects of single and multiple sets per exercise on
muscle hypertrophy. A second purpose was to establish
a dose–response effect of set volume on hypertrophy. The
hypothesis was that multiple sets would be associated with
greater hypertrophy compared with single sets.
METHODS
Experimental Approach to the Problem
Studies comparing single with multiple sets per exercise, with
all other variables being equivalent, were eligible for inclusion.
This helped eliminate confounding effects of other training
variables that may affect hypertrophy. To account for
nonindependent ESs and the variation between between
studies, between treatment groups, and between ESs within
each treatment group, multilevel statistical models were used
for the analysis. The dependent variable was the pre to
posttraining change in muscle size. The primary independent
variable was the number of sets per exercise.
Procedures
Study Selection. Searches were performed of PubMed, SPORT
Discus, and CINAHL for Englishlanguage studies published
between January 1, 1960, and October 15, 2009. A sample of
keywords and phrases used in searches included ‘‘resistance
training,’’ ‘‘strength training,’’ ‘‘resistance exercise,’’ ‘‘sets,’’ ‘‘single,’’
‘‘multiple,’’ and ‘‘volume’’; Boolean operators such as AND,
OR, and NOT were used to help narrow searches. Hand
searching and crossreferencing were performed from the
bibliographies of previously retrieved studies and from
review articles. Studies were selected if they met the
following criteria: (a) resistance exercise program lasting
a minimum of 4 weeks; (b) training on at least one exercise
for at least one major muscle group; major muscle groups
included the quadriceps, hamstrings, pectoralis major,
latissimus dorsi, biceps, triceps, and deltoids; (c) adults
$19 years; (d) comparison of single to multiple sets per
exercise, with all other training variables being equivalent; (e)
subjects free from orthopedic limitations that could affect
progress on a resistance exercise program; (f ) pre and
posttraining determination of at least one measure of muscle
hypertrophy; these measures included lean body mass,
regional lean mass, muscle crosssectional area, muscle
circumference, and muscle thickness; (g) sufﬁcient data to
determine sets per exercise and to calculate ESs; and (h)
published studies in Englishlanguage journals.
Data Abstraction. Data were tabulated onto a spreadsheet
using Microsoft Excel (Microsoft Corp., Redmond, WA).
Each row represented a speciﬁc ES for a treatment group. If
there were multiple ESs for a particular treatment group (i.e.,
a treatment group was subjected to multiple measures of
hypertrophy), then each ES was coded in a separate row.
Variables abstracted from each study were the following:
authors, year, research design (randomized trial, nonrandom
ized trial, or randomized crossover), n, quality score, sex
(male, female, or mixed), age (19–44 or $45 years), baseline
body mass (kg), resistance exercise experience (,6or$6
months), training program duration (weeks), average repe
titions per set, training frequency (dwk
21
), sets per exercise,
supervised training (yes/unspeciﬁed/no), pre and posttest
means for hypertrophy measures, and pre and posttest SD for
those measures. The study quality score was the sum of
2 scores used in previous reviews to rate the quality of
resistance training studies: a 0–10 scalebased score used by
Ba
˚genhammar and Hansson (2) and a 0–10 scalebased score
used by Durall et al. (10). For the average repetitions per set, if
a range of repetitions was reported (e.g., 8–12 repetitions),
the midpoint of the range was used (e.g., 10 repetitions).
For each measure of hypertrophy in each treatment group,
an ES was calculated as the pretest–posttest change, divided
by the pretest SD (29). Becker (3) recommended the ES for
the control group be subtracted from the experimental group
ES; however, numerous studies in this analysis did not
include a control group. Because it is important to deﬁne the
ES in a standard way across all studies (29), the control ES
was assumed to be 0 in all studies and was not subtracted
from the experimental ES. To test this assumption, the mean
control ES was calculated among all studies that had
a control group; the mean ES was 0.0 60.03, which was not
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TABLE 1. Studies included in the analysis.
References Age (y) Sex Status* Length (wks) Type of measure Sets ES†SV‡Study ES§
Galva
˜o and Taaffe (11) $45 M, F U 20 0.03
n= 16 Lean body mass 1 0.05 0.021
n=16 3 0.08 0.012
Marzolini et al. (26) $45 M, F U 24 0.06
n= 19 Lean body mass 1 0.11 0.004
n=18 3 0.18 0.004
McBride et al. (27) 19–44 M, F U 12 0.12
n= 9 Leg LM
k
120.01 0.040
n=9 3 0.23 0.033
Arm LM 1 0.00 0.040
320.01 0.040
Munn et al. (30) 19–44 M, F U 6 0.02
n= 23 Arm circumference 1 0.24 0.006
n=23 1 0.09 0.006
n=23 3 0.31 0.006
n=23 3 0.07 0.005
Ostrowski et al. (31) 19–44 M T 10 0.20
n= 9 Tricep thickness 1 0.25 0.029
n=9 2 0.40 0.034
n=9 4 0.50 0.029
Rectus Femoris CSA{1 0.30 0.037
2 0.29 0.021
4 0.78 0.027
Rectus Femoris
Thickness 1 0.27 0.040
2 0.14 0.035
4 0.73 0.027
Rhea et al. (32) 19–44 M T 12 0.44
n= 8 Chest circumference 1 0.50 0.015
n=8 3 0.62 0.012
Leg circumference 1 20.13 0.043
3 0.64 0.059
Rønnestad et al. (35) 19–44 M U 11 0.24
n= 10 Quadriceps CSA 1 0.56 0.032
n=11 3 0.67 0.026
Hamstring CSA 1 0.27 0.032
3 0.56 0.026
n= 5 Lower body LM 1 0.14 0.189
n=5 3 0.36 0.189
n= 5 Upper body LM 1 0.25 0.189
n=5 3 0.45 0.189
n= 11 Trapezius CSA 1 0.28 0.026
n=10 3 0.68 0.032
Starkey et al. (40) 19–44 M, F U 14 0.07
Thigh thickness
n= 18 20% Anterior 1 0.05 0.008
n=20 3 0.15 0.008
40% Anterior 1 0.14 0.009
3 0.13 0.007
60% Anterior 1 0.14 0.009
3 0.15 0.008
Medialis 1 0.15 0.010
3 0.14 0.007
Lateralis 1 20.07 0.006
320.08 0.008
20% Lateral 1 0.03 0.009
3 0.37 0.003
(Continued on next page)
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Single vs. Multiple Sets for Muscle Hypertrophy
signiﬁcantly different from 0 (p= 0.94) when compared using
a onesample ttest. The sampling variance for each ES was
estimated according to Morris and DeShon (29). Calculation
of the sampling variance required an estimate of the
population ES and the pretest–posttest correlation for each
individual ES. The population ES was estimated by
calculating the mean ES across all studies and treatment
groups (29). The pretest–posttest correlation was calculated
using the following formula (29):
r¼ðs2
1þs2
2s2
DÞ=ð2s1s2Þ;
where s
1
and s
2
are the SDs for the pre and posttest means,
respectively, and s
D
is the SD of the difference scores. Where
s
2
was not reported, s
1
was used in its place. Where s
D
was not
reported, it was estimated using the following formula:
sD¼ﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃ
ððs2
1=nÞþðs2
2=nÞÞ:
q
Statistical Analyses
Metaanalyses were performed using multilevel linear mixed
models, modeling the variation between studies as a random
effect, the variation between treatment groups as a random
effect nested within studies, the variation between ESs as
a random effect nested within treatment groups, and group
level predictors as ﬁxed effects (15). The withingroup
variances were assumed known. Observations were weighted
40% Lateral 1 0.10 0.009
3 0.21 0.007
60% Lateral 1 0.25 0.009
3 0.22 0.008
40% Posterior 1 0.30 0.009
3 0.43 0.007
60% Posterior 1 0.29 0.010
3 0.34 0.008
*U = Untrained (,6 mo resistance exercise experience); T = Trained ($6 mo experience).
†Effect size.
‡Sampling variance.
§Mean studylevel effect size (mean multipleset ES – mean singleset ES).
k
Lean mass.
{Crosssectional area.
TABLE 2. Full model with all covariates.
Predictor Coefﬁcient 6SE* 95% CI pValue
Multiple sets per exercise
No 0
Yes 0.11 60.04 (0.02, 0.19) 0.016
Intercept†0.45 60.10 (0.26, 0.64) ,0.0001
Sex
M0
M, F 20.31 60.08 (20.53, 20.09) 0.017
Training duration (wk) 0.00 60.01 (20.02, 0.01) 0.70
Training experience
,6 mos 0
$6 mos 20.06 60.09 (20.31, 0.19) 0.54
*Positive values for coefﬁcients represent an increase in overall effect size (ES). Negative values represent a decrease in overall ES.
Coefﬁcients of 0 represent the default categories in the model. Coefﬁcients for other categories within the same variable represent the
difference from the default category.
†Intercept of the model produced by hierarchical regression.
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by the inverse of the sampling variance (29). An intercept
only model was created, estimating the weighted mean ES
across all studies and treatment groups. A full statistical
model was then generated. Because of the small number of
studies identiﬁed for this analysis (Table 1), the number of
predictors that could be included in the full statistical model
was small. A binary variable (multiple or single sets) was
included as a predictor in the model. Other predictors chosen
for the full model were based on predictors observed to show
weak relationships (p,0.30) to strength in a previous
metaregression that used an identical statistical model (23).
The predictors selected were sex, training duration, and
training experience. Although age showed a weak effect (p=
0.24) in the previous metaregression (23), it was not chosen
for this model as 6 of the 8
studies in this analysis involved
subjects ,44 years of age. The
full model was then reduced by
removing one predictor at
a time, starting with the most
insigniﬁcant predictor (7). The
ﬁnal model represented the
reduced model with the lowest
Bayesian information criterion
(BIC) (37) and that was not
signiﬁcantly different (p.0.05)
from the full model when
compared with a likelihood ra
tio test (LRT). Model parame
ters were estimated by the
method of restricted maximum
likelihood (REML) (43); an
exception was during the
model reduction process, in
which parameters were esti
mated by the method of
maximum likelihood (ML), as LRTs cannot be used to
compare nested models with REML estimates. Denominator
df for statistical tests and conﬁdence intervals (CIs) were
calculated according to Berkey et al. (5) The multiplesets
predictor was not removed during the model reduction
process. Because metaregression can result in inﬂated false
positive rates when heterogeneity is present and/or when
there are few studies (13), a permutation test described by
Higgins and Thompson (13) was used to verify the
signiﬁcance of the predictors in the ﬁnal model; 1,000
permutations were generated. To examine the relationship
between set volume and treatment effect, a dose–response
model was created by replacing the multiplesets predictor
with a categorical predictor representing the number of sets
TABLE 3. Reduced model.
Predictor Coefﬁcient 6SE* 95% CI pValue Permutation pvalue
Multiple sets per exercise
No 0
Yes 0.10 60.04 (0.02, 0.19) 0.016 0.0
Intercept†0.39 60.05 (0.29, 0.49) ,0.0001 N/A‡
Sex
M0
M, F 20.28 60.05 (20.40, 20.16) 0.0012 0.0
*Positive values for coefﬁcients represent an increase in overall effect size (ES). Negative values represent a decrease in overall ES.
Coefﬁcients of 0 represent the default categories in the model. Coefﬁcients for other categories within the same variable represent the
difference from the default category.
†Intercept of the model produced by hierarchical regression.
‡N/A = Not available; permutation pvalues were only calculated for covariates.
Figure 1. Mean hypertrophy effect size for single vs. multiple sets per exercise. Data are presented as means 6SE.
*Signiﬁcant difference from 1 set per exercise (p,0.05).
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Single vs. Multiple Sets for Muscle Hypertrophy
performed per exercise: 1 set,
2–3 sets, and 4–6 sets. Adjust
ment for post hoc multiple
comparisons among set cate
gories were performed with
a Hochberg correction (14).
Histograms of residuals were
examined to identify major
departures from normality; no
departures from normality
were found. Publication bias
was assessed via a funnel plot
regression method described
by Macaskill et al. (25).
To identify the presence of
highly inﬂuential studies that
may have biased the analysis,
a sensitivity analysis was carried
out by removing one study at
a time and then examining the
multiplesets predictor. Studies
were identiﬁed as inﬂuential if
their removal resulted in
a change of .1SE in the multiplesets coefﬁcient. All
analyses were performed using SPLUS version 8.0 (Insight
ful, Seattle, WA). Effects were considered signiﬁcant at p#
0.05. Trends were declared at p#0.10. Data are reported as
means (6SEs) and 95% conﬁdence intervals (CIs).
RESULTS
Study Characteristics
The analysis comprised 55 ESs, nested within 19 treatment
groups and 8 studies (Table 1). The weighted mean ES across
all studies and treatment groups was 0.25 60.06 (CI: 0.13, 0.37).
Full Model
Results for the full model with all predictors are shown in
Table 2. There was a signiﬁcant effect of sets per exercise
while controlling for all other covariates, with multiple
sets being associated with a larger ES than a single set
(difference = 0.11 60.04; CI: 0.02, 0.19; p= 0.016).
Reduced Model
Results for the reduced model are shown in Table 3. After the
model reduction procedure, only the sex (male or mixed) of
the treatment groups remained as a covariate. The BIC
decreased from 8.9 in the full model to 29.7 in the reduced
model. The reduced model was not signiﬁcantly different
from the full model (p= 0.73). In the reduced model, multiple
sets were associated with a larger ES than a single set
(difference = 0.10 60.04; CI: 0.02, 0.19; p= 0.016; Table 3).
The mean ES for a single set was 0.25 60.03 (CI: 0.18, 0.32;
Figure 1). The mean ES for multiple sets was 0.35 60.03
(CI: 0.29, 0.41; Figure 1).
Figure 2. Dose–response effect of set volume on hypertrophy. Data are presented as means 6SE. ES = effect
size. *Trend toward difference from 1 set per exercise according to Hochbergadjusted standard pvalue (p,0.10).
†Signiﬁcantly different from 1 set per exercise according to Hochbergadjusted permutation pvalue (p,0.01).
TABLE 4. Sensitivity analysis.
Study removed Coefﬁcient* 95% CI pValue Permutation pvalue
None 0.10 60.04 (0.02, 0.19) 0.016 0.0
Galva
˜o and Taaffe (11) 0.11 60.04 (0.02, 0.19) 0.014 0.0
Marzolini et al. (26) 0.11 60.04 (0.02, 0.20) 0.019 0.0
McBride et al. (27) 0.10 60.04 (0.02, 0.19) 0.020 0.001
Munn et al. (30) 0.12 60.05 (0.02, 0.22) 0.016 0.001
Ostrowski et al. (31) 0.10 60.04 (0.01, 0.18) 0.028 0.0
Rhea et al. (32) 0.09 60.04 (0.01, 0.18) 0.033 0.001
Rønnestad et al. (35) 0.09 60.04 (20.01, 0.19) 0.062 0.001
Starkey et al. (40) 0.12 60.06 (0.00, 0.25) 0.043 0.001
*Coefﬁcient 6SE. Value represents difference in effect size (ES) between single and multiple sets per exercise.
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Dose–Response Model
In the dose–response model, there was a trend for 2–3 sets per
exercise to be associated with a greater ES than 1 set per
exercise (difference = 0.09 60.05; CI: 20.02, 0.20; p= 0.09).
The difference was signiﬁcant when considering the
Hochbergadjusted permutation test pvalue (p= 0.009).
There was also a trend for 4–6 sets per exercise to be
associated with a greater ES compared with 1 set per exercise
(difference = 0.20 60.11; CI:
20.04, 0.43; p= 0.096). The
difference was signiﬁcant when
considering the Hochbergad
justed permutation test pvalue
(p= 0.008). There was no
signiﬁcant difference between
2–3 sets per exercise and 4–6
sets per exercise (difference =
0.10 60.10; CI: 20.09, 0.30;
p= 0.29). There was a tendency
for increasing ESs for an in
creasing number of sets. The
mean ES for 1set per exercise
was 0.24 60.03 (CI: 0.18, 0.31;
Figure 2). The mean ES for 2–3
sets per exercise was 0.34 6
0.03 (CI: 0.27, 0.41; Figure 2).
The mean ES for 4–6 sets per
exercise was 0.44 60.09 (CI:
0.26, 0.62; Figure 2).
Sensitivity Analysis
Results for the sensitivity anal
ysis are reported in Table 4.
The difference in ES between
single and multiple sets was not
affected by more than 1SE for
any study removed. However,
the removal of the study by
Rønnestad et al. (35) changed
the pvalue from 0.016 to 0.06.
The CI was widened to (20.01,
0.19). The pvalue from the
permutation test remained sig
niﬁcant (p= 0.001).
Publication Bias
There was no signiﬁcant re
lationship between treatment
effect and sample size (slope
of line = 20.002 60.002; p=
0.32), indicating no evidence of
publication bias.
DISCUSSION
The purpose of this metaanal
ysis was to determine whether
multiple sets per exercise are associated with greater muscle
hypertrophy than a single set per exercise in a resistance
training program. Multiple sets per exercise were associated
with signiﬁcantly greater ESs in both the full and reduced
statistical models. The mean ES for a single set per exercise
was 0.25, whereas the mean ES for multiple sets was 0.35.
Thus, multiple sets were associated with 40% greater
hypertrophyrelated ESs than a single set. According to
Figure 3. Mean strength effect size for single vs. multiple sets per exercise from Krieger (23). Note similarity to
hypertrophy response in Figure 1. Data are presented as means 6SE. *Signiﬁcant difference from 1 set per
exercise (p,0.05).
Figure 4. Dose–response effect of set volume on strength from Krieger (23). Note similarity to dose–response
effect for hypertrophy in Figure 2. Data are presented as means 6SE. ES = effect size. *Signiﬁcantly different from
1 set per exercise (p,0.001).
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Single vs. Multiple Sets for Muscle Hypertrophy
Cohen’s classiﬁcations for ESs (,0.41 = small; 0.41–0.70 =
moderate; .0.70 = large) (9), both estimates are consistent
with small treatment effects. In a previous metaanalysis on
strength using an identical statistical model (23), 1 set per
exercise was associated with a moderate treatment effect
(mean ES = 0.54), whereas multiple sets were associated with
a large treatment effect (mean ES = 0.80; Figure 3). The
differences in ES estimates for strength vs. hypertrophy are
consistent with the observation that changes in muscle size
are often smaller and slower than changes in strength (28),
particularly in untrained subjects (6 of the 8 studies in the
current analysis involved untrained subjects). The observed
ES difference for sex (a decrease of 0.28 for mixed groups
compared with male groups) is consistent with the
observation that women experience smaller changes in
muscle size compared with men (17).
In a previous metaanalysis on strength using an identical
statistical model, a 46% greater ES was observed for multiple
sets compared with single sets (23) (Figure 3). A 40% greater
ES was observed in this study. This indicates that the greater
strength gains observed with multiple sets are in part because
of greater muscle hypertrophy. It is known that mechanical
loading stimulates protein synthesis in skeletal muscle (39),
and increasing loads result in greater responses until a plateau
is reached (24). It is likely that protein synthesis responds in
a similar manner to the number of sets (i.e., an increasing
response as the number of sets are increased, until a plateau is
reached), although there is no research examining this. The
results of this study support this hypothesis; there was a trend
for an increasing ES for an increasing number of sets. The
response appeared to start to level off around 4–6 sets, as
the difference between 2–3 sets and 4–6 sets was smaller than
the difference between 1 set and 2–3 sets. Also, the difference
between 1 set and 2–3 sets was nearly signiﬁcant (and the
permutation test pvalue was signiﬁcant), whereas the differ
ence between 2–3 sets and 4–6 sets was not. However,
only 2 studies in this analysis involved 4–6 sets per exercise.
Thus, the statistical power to detect differences is low, and
deﬁnitive conclusions cannot be made. These results are
similar to a previous metaanalysis on strength, where there
was an increasing response to an increasing number of sets,
with an apparent plateau around 4–6 sets per exercise (23)
(Figure 4).
It has been proposed that the majority of initial strength
gains in untrained subjects are because of neural adapta
tions rather than hypertrophy (28). The results of this
analysis suggest that some of the initial strength gains
are because of hypertrophy. Given the insensitivity and
variability of hypertrophy measurements, it is likely that
hypertrophy occurs in untrained subjects but is difﬁcult to
detect. This is supported by research that shows increases
in protein synthesis in response to resistance training
in untrained subjects (24). Recent evidence also shows
measurable hypertrophy after only 3 weeks of resistance
exercise (38).
To examine the effects of potential outliers on the outcome,
a sensitivity analysis was performed. The magnitude of the
difference between single and multiple sets was consistent
regardless of which study was removed. However, the
removal of the study by Rønnestad et al. (35) affected the
width of the CI, and the signiﬁcant effect of multiple sets
turned into a strong trend. However, this is likely because of
loss of statistical power, given that the magnitude of the
estimate remained similar, the permutation test pvalue
remained signiﬁcant, and the analysis consisted of only 8
studies.
Publication bias represents the problem where studies
showing statistically signiﬁcant results are more likely to be
published than studies that fail to show signiﬁcant results (e.g.,
studies showing a signiﬁcant difference between 1 set and
multiple sets per exercise may be more likely to be published)
(4). Thus, metaanalyses of published studies may over
estimate the magnitude of a treatment effect (4). Analyses can
be performed to detect the presence of publication bias; one
analysis involves examining the relationship between sample
size and treatment effect (25). The existence of a signiﬁcant
relationship suggests that publication bias may be present.
However, no such relationship was observed in the current
study. Two previous metaanalyses on the effects of multiple
vs. single sets on strength also failed to observe any evidence
of publication bias (23,44). Also, only 2 of the 8 studies in this
analysis reported signiﬁcant differences in hypertrophy
related measures when comparing single with multiple sets
(26,35). This strongly suggests that publication bias is not
present, because if it were, most of the studies would report
signiﬁcant differences. In fact, even though only 2 of the 8
studies reported signiﬁcant differences, the mean studylevel
ES favored the multipleset group in all 8 studies (Table 1).
This indicates that many of these studies are underpowered
to detect differences.
There are a number of strengths to the current study
design. First, strict inclusion criteria were used; only studies
comparing single with multiple sets while holding all other
variables constant were included. Second, the multilevel
model allowed for the simultaneous modeling of the variation
between studies, between treatment groups, and between
ESs within each treatment group. Third, both standard and
permutation test pvalues were used to protect against
spurious ﬁndings, a common problem with metaregression
(13). Finally, a sensitivity analysis was performed, and this
indicated the mean difference between single and multiple
sets to be reasonably consistent across the removal of
individual studies.
A primary limitation of this analysis is the small number of
studies. Thus, the statistical power of the analysis is limited.
This was evident as the removal of the study by Rønnestad
et al. (35) affected the pvalue and CIs. This was also evident
by the observed trends that did not quite reach statistical
signiﬁcance (although they were signiﬁcant according to
permutation tests). The small number of studies also limited
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the number of predictors that could be included in the
statistical model. Thus, interactions between set volume and
factors such as training experience could not be explored, as
had been done in a previous metaanalysis on strength (23).
Also, the majority of studies in this analysis compared 1 set
with 3 sets per exercise; only 2 studies in this analysis
incorporated $4 sets per exercise. This limits the statistical
power to compare 3 sets with greater set volumes, as the SE
for the 4–6 set category was large. Given that the ES for 4–6
sets (0.44) is considered a moderate effect, whereas the ES for
2–3 sets (0.34) is considered a small effect according to
Cohen’s classiﬁcations (9), more research involving $4 sets is
needed to clarify whether this is a chance difference or a true
difference. Another limitation is that metaregression, like
epidemiological research, can only support observational
associations and cannot demonstrate causation (42). A ﬁnal
limitation is the availability of data (42). Some studies, despite
meeting the design criteria (comparison of single vs. multiple
sets while keeping other variables constant), were excluded
because hypertrophy was not measured. Because an analysis
can only be undertaken for trials where all information is
available, bias can be introduced in the results (42). However,
most of the excluded studies reported greater strength gains
in the multipleset groups. Given the relationship between
strength and muscle size, the consistency of the mean
difference during the sensitivity analysis, the fact that the
studylevel ES favored the multipleset group in all 8 studies,
and the lack of evidence of publication bias, it is unlikely that
the addition of more studies would alter the results, other
than improving statistical power.
PRACTICAL APPLICATIONS
Multiple sets per exercise were associated with signiﬁcantly
greater changes in muscle size than a single set per exercise
during a resistance exercise program. Speciﬁcally, hyper
trophyrelated ESs were 40% greater with multiple sets
compared with single sets. This was true regardless of subject
training status or training program duration. There was
a trend for an increasing hypertrophic response to an
increasing number of sets. Thus, individuals interested in
achieving maximal hypertrophy should do a minimum of
2–3 sets per exercise. It is possible that 4–6 sets could give
an even greater response, but the small number of studies
incorporating volumes of $4 sets limits the statistical power
and the ability to form any deﬁnitive conclusions. If time is
a limiting factor, then single sets can produce hypertrophy,
but improvements may not be optimal. More research is
necessary to compare the effects of 2–3 sets per exercise to
$4 sets. Future research should also focus on the effects of
resistance training volume on protein synthesis and other
cellular and molecular changes that may impact hypertrophy.
Finally, resistance training studies comparing hypertrophic
responses between treatments should include sufﬁcient
numbers of subjects to obtain adequate statistical power to
detect differences; studies should also report power analyses.
ACKNOWLEDGMENTS
The author thanks Dr. Dan Wagman for his help in
obtaining some articles. There were no ﬁnancial or personal
conﬂicts of interest and no external funding for this study.
The results of this study do not constitute endorsement by
the National Strength and Conditioning Association.
REFERENCES
1. American College of Sports Medicine Position Stand. The
recommended quantity and quality of exercise for developing and
maintaining cardiorespiratory and muscular ﬁtness, and ﬂexibility in
healthy adults. Med Sci Sports Exerc 30: 975–991, 1998.
2. Ba
˚genhammar, S and Hansson, EE. Repeated sets or single set of
resistance training: A systematic review. Adv Physiother 9: 154–160,
2007.
3. Becker, BJ. Synthesizing standardized meanchange measures. Br J
Math Stat Psychol 41: 257–278, 1988.
4. Begg, CB and Berlin, JA. Publication bias and dissemination of
clinical research. J Natl Cancer Inst 81: 107–115, 1989.
5. Berkey, CS, Hoaglin, DC, Mosteller, F, and Colditz, GA. A random
effects regression model for metaanalysis. Stat Med 14: 395–411,
1995.
6. Borst, SE, De Hoyos, DV, Garzarella, L, Vincent, K, Pollock, BH,
Lowenthal, DT, and Pollock, ML. Effects of resistance training on
insulinlike growth factorI and IGF binding proteins. Med Sci Sports
Exerc 33: 648–653, 2001.
7. Burnham, KP and Anderson, DR. Model Selection and Inference:
A Practical InformationTheoretic Approach. New York, NY:
SpringerVerlag, 2002.
8. Carpinelli, RN and Otto, RM. Strength training: single versus
multiple sets. Sports Med 26: 73–84, 1998.
9. Cohen, J. Statistical Power Analysis for the Behavioral Sciences.
Hillsdale, NJ: Lawrence Erlbaum Associates, 1988.
10. Durall, CJ, Hermsen, D, and Demuth, C. Systematic review of single
set versus multipleset resistancetraining randomized controlled
trials: implications for rehabilitation. Crit Rev Phys Rehab Med
18: 107–116, 2006.
11. Galva
˜o, DA and Taaffe, DR. Resistance exercise dosage in older
adults: single versus multiset effects on physical performance and
body composition. J Am Geriatr Soc 53: 2090–2097, 2005.
12. Hass, CJ, Feigenbaum, MS, and Franklin, BA. Prescription of
resistance training for healthy populations. Sports Med 31: 953–964,
2001.
13. Higgins, JT and Thompson, SG. Controlling the risk of spurious
ﬁndings from metaregression. Stat Med 23: 1663–1682, 2004.
14. Hochberg, Y. A sharper Bonferonni procedure for multiple tests of
signiﬁcance. Biometrika 75: 800–802, 1988.
15. Hox, JJ and De Leeuw, ED. Multilevel models for metaanalysis. In:
Multilevel Modeling Methodological Advances, Issues, and Applications.
Reise, SP and Duan, N, eds. Mahwah, NJ: Lawrence Erlbaum
Associates, 2003. pp. 90–111.
16. Humburg, H, Baars, H, Schro
¨der, J, Reer, R, and Braumann, KM.
1set vs. 3set resistance training: A crossover study. J Strength Cond
Res 21: 578–582, 2007.
17. Ivey, FM, Roth, SM, Ferrell, RE, Tracy, BL, Lemmer, JT, Hurlbut, DE,
Martel, GF, Siegel, EL, Fozard, JL, Metter, Je, Fleg, JL, and Hurley,
BF. Effects of age, gender, and myostatin genotype on the
hypertrophic response to heavy resistance strength training.
J Gerontol A Biol Sci Med Sci 55: M641–M648, 2000.
18. Kelly, SB, Brown, LE, Coburn, JW, Zinder, SM, Gardner, LM, and
Nguyen, D. The effect of single versus multiple sets on strength.
J Strength Cond Res 21: 1003–1006, 2007.
1158
Journal of Strength and Conditioning Research
the
TM
Single vs. Multiple Sets for Muscle Hypertrophy
19. Kemmler, WK, Lauber, D, Engelke, K, and Weineck, J. Effects of
single vs. multipleset resistance training on maximum strength and
body composition in trained postmenopausal women. J Strength
Cond Res 18: 689–694, 2004.
20. Kraemer, WJ. The physiological basis for strength training in
American football: Fact over philosophy. J Strength Cond Res
11: 131–142, 1997.
21. Kraemer, WJ, Adams, K, Cafarelli, E, Dudley, GA, Dooly, C,
Feigenbaum, MS, Fleck, SJ, Franklin, B, Fry, AC, Hoffman, JR,
Newton, RU, Potteiger, J, Stone, MH, Ratamess, NA, and
TriplettMcBride, T. American College of Sports Medicine position
stand. Progression models in resistance training for healthy adults.
Med Sci Sports Exerc 34: 364–380, 2002.
22. Kraemer, WJ, Ratamess, NA, and French, DN. Resistance training
for health and performance. Curr Sports Med Rep 1: 165–171, 2002.
23. Krieger, JW. Single versus multiple sets of resistance exercise: A
metaregression. J Strength Cond Res 23: 1890–1901, 2009.
24. Kumar, V, Selby, A, Rankin, D, Patel, R, Atherton, P, Hildebrandt, W,
Williams, J, Smith, K, Seynnes, O, Hiscock, N, and Rennie, MJ.
Agerelated differences in the dose–response relationship of muscle
protein synthesis to resistance exercise in young and old men.
J Physiol 587: 211–217, 2009.
25. Macaskill, P, Walter, SD, and Irwig, I. A comparison of methods
to detect publication bias in metaanalysis. Stat Med 20: 641–654,
2001.
26. Marzolini, S, Oh, PI, Thomas, SG, and Goodman, JM. Aerobic and
resistance training in coronary disease: single versus multiple sets.
Med Sci Sports Exerc 40: 1557–1564, 2008.
27. McBride, JM, Blaak, JB, and TriplettMcBride, T. Effect of resistance
exercise volume and complexity on EMG, strength, and regional
body composition. Eur J Appl Physiol 90: 626–632, 2003.
28. Moritani, T and deVries, HA. Neural factors versus hypertrophy in
the time course of muscle strength gains. Am J Phys Med 58: 115–
130, 1979.
29. Morris, SB and Deshon, RP. Combining effect size estimates in
metaanalysis with repeated measures and independentgroups
designs. Psychol Methods 7: 105–125, 2002.
30. Munn, J, Herbert, RD, Hancock, MJ, and Gandevia, SC. Resistance
training for strength: effect of number of sets and contraction speed.
Med Sci Sports Exerc 37: 1622–1626, 2005.
31. Ostrowski, KJ, Wilson, GJ, Weatherby, R, Murphy, PW, and Lyttle, AD.
The effect of weight training volume on hormonal output and
muscular size and function. J Strength Cond Res 11: 148–154, 1997.
32. Rhea, MR, Alvar, BA, Ball, SD, and Burkett, LN. Three sets of
weight training superior to 1 set with equal intensity for eliciting
strength. J Strength Cond Res 16: 525–529, 2002.
33. Rhea, MR, Alvar, BA, and Burkett, LN. Single versus multiple sets
for strength: A metaanalysis to address the controversy. Res Q Exerc
Sport 73: 485–488, 2002.
34. Rhea, MR, Alvar, BA, Burkett, LN, and Ball, SD. A metaanalysis to
determine the dose response for strength development. Med Sci
Sports Exerc 35: 456–464, 2003.
35. Rønnestad, BR, Egeland, W, Kvamme, NH, Refsnes, PE, Kadi, F,
and Raastad, T. Dissimilar effects of one and threeset strength
training on strength and muscle mass gains in upper and lower
body in untrained subjects. J Strength Cond Res 21: 157–163, 2007.
36. Schlumberger, A, Stec, J, and Schmidtbleicher, D. Single vs.
multipleset strength training in women. J Strength Cond Res 15: 284–
289, 2001.
37. Schwarz, G. Estimating the dimension of a model. Ann Stat 6: 461–
464, 1978.
38. Seynnes, OR, de Boer, M, and Narici, MV. Early skeletal muscle
hypertrophy and architectural changes in response to highintensity
resistance training. J Appl Physiol 102: 368–373, 2007.
39. Spangenburg, EE. Changes in muscle mass with mechanical load:
possible cellular mechanisms. Appl Physiol Nutr Metab 34: 328–335,
2009.
40. Starkey, DB, Pollock, ML, Ishida, Y, Welsch, MA, Brechue, WF,
Graves, JE, and Feigenbaum, MS. Effect of resistance training
volume on strength and muscle thickness. Med Sci Sports Exerc
28: 1311–1320, 1996.
41. Stone, MH. Implications for connective tissue and bone alterations
resulting from resistance exercise training. Med Sci Sports Exerc
20: S162–S168, 1988.
42. Thompson, SG and Higgins, JT. How should metaregression
analyses be undertaken and interpreted? Stat Med 21: 1559–1573,
2002.
43. Thompson, SG and Sharp, SJ. Explaining heterogeneity in
metaanalysis: A comparison of methods. Stat Med 18: 2693–2708,
1999.
44. Wolfe, BL, Lemura, LM, and Cole, PJ. Quantitative analysis of
single vs. multiple set programs in resistance training. J Strength
Cond Res 18: 35–47, 2004.
45. Zwahlen, M, Renehan, A, and Egger, M. Metaanalysis in medical
research: Potentials and limitations. Urol Oncol 26: 320–329, 2008.
VOLUME 24  NUMBER 4  APRIL 2010  1159
Journal of Strength and Conditioning Research
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TM

www.nscajscr.org