Hypertrophic response of lower extremity muscles to different resistance training intensities: a meta-analysis and meta-regression

Authors

  • Cemre Didem Eyipınar
  • Yusuf Buzdağlı
  • Raci Karayiğit

DOI:

https://doi.org/10.52165/kinsi.31.2.85-109

Keywords:

Muscle hypertrophy, quadriceps femoris, knee extensors, muscle thickness

Abstract

This research aims to detect the effectiveness of different resistance training intensities (high, moderate, and low) for quadriceps femoris muscle group hypertrophic response in healthy adults. The literature search was conducted during January 2023 using the Web of Science, SPORTDiscus, Embase, PubMed, Google Scholar, ClinicalTrials website, and grey literature databases. Using the TESTEX scale, we assessed the studies’ methodological quality. This meta-analysis was comprised of 22 studies (with 519 participants). Statistical analysis was performed using ReviewManager 5.2 (RevMan) software. This analysis showed potential benefits for all resistance training intensities on quadriceps femoris muscle group hypertrophy (muscle thickness (mm) for quadriceps muscle) compared with control (or pre-test values) groups. The data obtained are as follows, high-intensity resistance training: [Raw mean difference (RMD)= [2.3; confidence interval (CI) 95%: [2.21-2.38]]; Moderate-intensity (60-79% of 1RM) resistance training: [RMD = 1.88; (CI) 95%: [1.74- 2.02]] and low-intensity (30-59 % of 1 RM) resistance training: [RMD = 10.92; CI 95%: [10.77- 11.08]] with p<0.00001. Meta-regression analysis revealed that the non-significant direct relationship between resistance training intensity (%) and change in RF (mm) (β=0.03; p = 0.417; R2 = 0.04) and VM muscle thickness (β = 0.003; p = 0.895; R2 = 0.002). In addition, a significant direct relationship between resistance training intensity and change in VI (β=0.01; p = 0.05; R2 = 0.56) and VL muscle thickness (β = 0.01; p = 0.007; R2 = 0.34) was detected. In conclusion, studies employing different resistance training intensities showed similar hypertrophic responses in all muscles. The meta-regression analysis found that for every 10% greater difference in resistance exercise intensity between studies, the hypertrophic response in the VI muscle was determined to be 0.1 mm greater. No significant hypertrophic response was observed for VL, VM, and RF muscles.

Downloads

Download data is not yet available.

References

Alkan, E. (2019). Effect of Dıfferent Izotonıc Quadrıceps Exercıse Traınıng on Muscle Strength, Muscle Thıckness and Balance ın Healthy Indıvıduals (Master’s ). 9 Eylül University,

Amirthalingam, T., Mavros, Y., Wilson, G. C., Clarke, J. L., Mitchell, L., & Hackett, D. A. (2017). Effects of a modified German volume training program on muscular hypertrophy and strength. The Journal of Strength Conditioning Research, 31(11), 3109-3119.

Bartolomei, S., Nigro, F., Lanzoni, I. M., Masina, F., Di Michele, R., & Hoffman, J. R. (2021). A comparison between total body and split routine resistance training programs in trained men. The Journal of Strength Conditioning Research, 35(6), 1520-1526.

Boone, C. H., Stout, J. R., Beyer, K. S., Fukuda, D. H., & Hoffman, J. R. (2015). Muscle strength and hypertrophy occur independently of protein supplementation during short-term resistance training in untrained men. Applied Physiology, Nutrition, Metabolism, 40(8), 797-802.

Borde, R. (2015). Dose-response relationships of resistance training in healthy old adults: A systematic review meta-analysis. Sports medicine, 45(12), 1693-1720.

Brigatto, F. A., Lima, L. E. d. M., Germano, M. D., Aoki, M. S., Braz, T. V., & Lopes, C. R. (2022). High resistance-training volume enhances muscle thickness in resistance-trained men. Journal of strength conditioning research, 36(1), 22-30.

Buresh, R., Berg, K., & French, J. (2009). The effect of resistive exercise rest interval on hormonal response, strength, and hypertrophy with training. The Journal of Strength Conditioning Research, 23(1), 62-71.

Cadore, E., González‐Izal, M., Pallarés, J., Rodriguez‐Falces, J., Häkkinen, K., Kraemer, W., . . . Izquierdo, M. (2014). Muscle conduction velocity, strength, neural activity, and morphological changes after eccentric and concentric training. Scandinavian journal of medicine science in sports, 24(5), e343-e352.

Campbell, K. L., Winters-Stone, K., Wiskemann, J., May, A. M., Schwartz, A. L., Courneya, K. S., . . . Gerber, L. (2019). Exercise guidelines for cancer survivors: consensus statement from international multidisciplinary roundtable. Medicine science in sports exercise, 51(11), 2375.

Campos, G. E., Luecke, T. J., Wendeln, H. K., Toma, K., Hagerman, F. C., Murray, T. F., . . . Staron, R. S. (2002). Muscular adaptations in response to three different resistance-training regimens: specificity of repetition maximum training zones. European journal of applied physiology, 88, 50-60.

Carvalho, L., Junior, R. M., Barreira, J., Schoenfeld, B. J., Orazem, J., & Barroso, R. (2022). Muscle hypertrophy and strength gains after resistance training with different volume-matched loads: a systematic review and meta-analysis. Applied Physiology, Nutrition, Metabolism, 47(4), 357-368.

Carvalho, L., Junior, R. M., Truffi, G., Serra, A., Sander, R., De Souza, E. O., & Barroso, R. (2020). Is stronger better? Influence of a strength phase followed by a hypertrophy phase on muscular adaptations in resistance-trained men. Research in Sports Medicine, 29(6), 536-546.

Cheung, R., Smith, A., & Wong, D. (2012). H: Q ratios and bilateral leg strength in college field and court sports players. Journal of human kinetics, 33(2012), 63-71.

Chin, E. R. (2005). Role of Ca2+/calmodulin-dependent kinases in skeletal muscle plasticity. Journal of applied physiology, 99(2), 414-423.

Cohen, J. (1992). Statistical power analysis. Current directions in psychological science, 1(3), 98-101.

Coratella, G., Longo, S., Rampichini, S., Limonta, E., Shokohyar, S., Bisconti, A. V., . . . Esposito, F. (2020). Quadriceps and gastrocnemii anatomical cross-sectional area and vastus lateralis fascicle length predict peak-power and time-to-peak-power. Research Quarterly for Exercise Sports medicine, 91(1), 158-165.

Correa, C. S., LaRoche, D. P., Cadore, E. L., Reischak-Oliveira, A., Bottaro, M., Kruel, L. F. M., . . . Lacerda, F. (2012). 3 Different types of strength training in older women. International journal of sports medicine, 33(12), 962-969.

Csapo, R., & Alegre, L. (2016). Effects of resistance training with moderate vs heavy loads on muscle mass and strength in the elderly: A meta‐analysis. Scandinavian journal of medicine science in sports, 26(9), 995-1006.

El‐Ansary, D., Marshall, C. J., Farragher, J., Annoni, R., Schwank, A., McFarlane, J., . . . Zito, G. (2021). Architectural anatomy of the quadriceps and the relationship with muscle strength: An observational study utilising real‐time ultrasound in healthy adults. Journal of Anatomy, 239(4), 847-855.

Ema, R., Sakaguchi, M., Akagi, R., & Kawakami, Y. (2016). Unique activation of the quadriceps femoris during single-and multi-joint exercises. European journal of applied physiology, 116, 1031-1041.

Evangelista, A. L., De Souza, E. O., Moreira, D. C., Alonso, A. C., Teixeira, C. V. L. S., Wadhi, T., . . . Greve, J. M. D. A. (2019). Interset stretching vs. traditional strength training: effects on muscle strength and size in untrained individuals. The Journal of Strength Conditioning Research, 33, S159-S166.

Folland, J. P., & Williams, A. G. (2007). Morphological and neurological contributions to increased strength. Sports medicine, 37, 145-168.

Fry, A. C. (2004). The role of resistance exercise intensity on muscle fibre adaptations. Sports medicine, 34, 663-679.

Fyfe, J. J., Hamilton, D. L., & Daly, R. M. (2021). Minimal-dose resistance training for improving muscle mass, strength, and function: A narrative review of current evidence and practical considerations. Sports medicine, 1-17.

Gonzalez, A. M., Sell, K. M., Ghigiarelli, J. J., Kelly, C. F., Shone, E. W., Accetta, M. R., . . . Mangine, G. T. (2017). Effects of phosphatidic acid supplementation on muscle thickness and strength in resistance-trained men. Applied Physiology, Nutrition, Metabolism, 42(4), 443-448.

Hackett, D., Ghayomzadeh, M., Farrell, S., Davies, T., & Sabag, A. (2022). Influence of total repetitions per set on local muscular endurance: A systematic review with meta-analysis and meta-regression. Science Sports, 37(5-6), 405-420.

Henselmans, M., & Schoenfeld, B. J. (2014). The effect of inter-set rest intervals on resistance exercise-induced muscle hypertrophy. Sports medicine, 44(12), 1635-1643.

Hoffman, J. R., Im, J., Rundell, K. W., Kang, J., Nioka, S., SPEIRING, B. A., . . . Chance, B. (2003). Effect of muscle oxygenation during resistance exercise on anabolic hormone response. Medicine science in sports exercise, 35(11), 1929-1934.

Holm, L., Reitelseder, S., Pedersen, T. G., Doessing, S., Petersen, S. G., Flyvbjerg, A., . . . Kjaer, M. (2008). Changes in muscle size and MHC composition in response to resistance exercise with heavy and light loading intensity. Journal of applied physiology, 105(5), 1454-1461.

Ikezoe, T., Kobayashi, T., Nakamura, M., & Ichihashi, N. (2020). Effects of low-load, higher-repetition vs. High-load, lower-repetition resistance training not performed to failure on muscle strength, mass, and echo intensity in healthy young men: A time-course study. The Journal of Strength Conditioning Research, 34(12), 3439-3445.

Karsten, B., Fu, Y. L., Larumbe-Zabala, E., Seijo, M., & Naclerio, F. (2021). Impact of two high-volume set configuration workouts on resistance training outcomes in recreationally trained men. The Journal of Strength Conditioning Research, 35, S136-S143.

Korkmaz, E. (2018). The Effects of 6 Weeks Blood Flow Restriction Training on Muscle Strength and Evaluation of Muscle Architecture with Ultrasonography in U19 Male Soccer Players (Master’s ). Eskisehir Osmangazi University,

Krieger, J. W. (2009). Single versus multiple sets of resistance exercise: a meta-regression. The Journal of Strength Conditioning Research, 23(6), 1890-1901.

Lasevicius, T., Schoenfeld, B. J., Silva-Batista, C., Barros, T. d. S., Aihara, A. Y., Brendon, H., . . . Teixeira, E. L. (2022). Muscle failure promotes greater muscle hypertrophy in low-load but not in high-load resistance training. Journal of strength conditioning research, 36(2), 346-351.

Lasevicius, T., Ugrinowitsch, C., Schoenfeld, B. J., Roschel, H., Tavares, L. D., De Souza, E. O., . . . Tricoli, V. (2018). Effects of different intensities of resistance training with equated volume load on muscle strength and hypertrophy. European journal of sport science, 18(6), 772-780.

Liberati, M., Tetzlaff, J., & Altman, D. (2009). Preferred Reporting items for systematic reviews and meta analyses: THE PRISMA statement. Plos Medicine, 6(7), 1-6.

Lieber, R. L. (2002). Skeletal muscle structure, function, and plasticity: Lippincott Williams & Wilkins.

Lim, C., Kim, H. J., Morton, R. W., Harris, R., Philips, S. M., Jeong, T. S., & Kim, C. K. (2019). Resistance exercise-induced changes in muscle metabolism are load-dependent. Med Sci Sports Exerc, 51(12), 2578-2585.

Methenitis, S., Karandreas, N., Spengos, K., Zaras, N., Stasinaki, A.-N., & Terzis, G. (2016). Muscle Fiber Conduction Velocity, Muscle Fiber Composition, and Power Performance. Medicine science in sports exercise, 48(9), 1761-1771.

Mitchell, C. J., Churchward-Venne, T. A., West, D. W., Burd, N. A., Breen, L., Baker, S. K., & Phillips, S. M. (2012). Resistance exercise load does not determine training-mediated hypertrophic gains in young men. Journal of applied physiology, 113(1), 71-77.

Morton, R. W., Sonne, M. W., Farias Zuniga, A., Mohammad, I. Y., Jones, A., McGlory, C., . . . Phillips, S. M. (2019). Muscle fibre activation is unaffected by load and repetition duration when resistance exercise is performed to task failure. The Journal of physiology, 597(17), 4601-4613.

Müller, D. C., Izquierdo, M., Boeno, F. P., Aagaard, P., Teodoro, J. L., Grazioli, R., . . . Pinto, R. S. (2020). Adaptations in mechanical muscle function, muscle morphology, and aerobic power to high-intensity endurance training combined with either traditional or power strength training in older adults: a randomized clinical trial. European journal of applied physiology, 120(5), 1165-1177.

Nakamura, M., Ikezu, H., Sato, S., Yahata, K., Kiyono, R., Yoshida, R., . . . Nunes, J. P. (2021). Effects of adding inter-set static stretching to flywheel resistance training on flexibility, muscular strength, and regional hypertrophy in young men. International Journal of Environmental Research Public Health, 18(7), 3770.

Nicholson, G., Ispoglou, T., & Bissas, A. (2016). The impact of repetition mechanics on the adaptations resulting from strength-, hypertrophy-and cluster-type resistance training. European journal of applied physiology, 116, 1875-1888.

Nogueira, W., Gentil, P., Mello, S., Oliveira, R., Bezerra, A., & Bottaro, M. (2009). Effects of power training on muscle thickness of older men. International journal of sports medicine, 30(03), 200-204.

Nunes, J. P., Grgic, J., Cunha, P. M., Ribeiro, A. S., Schoenfeld, B. J., de Salles, B. F., & Cyrino, E. S. (2021). What influence does resistance exercise order have on muscular strength gains and muscle hypertrophy? A systematic review and meta-analysis. European journal of sport science, 21(2), 149-157.

Padasala, M., Joksimovic, M., Bruno, C., Melino, D., & Manzi, V. (2020). Muscle injuries in athletes. The relationship between H/Q ratio (hamstring/quadriceps ratio). Italian Journal Sports Rehabilitation and Posturology, 7(1), 1478-1498.

Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., . . . Brennan, S. E. (2021). The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. International journal of surgery, 88, 105906.

Pasta, G., Nanni, G., Molini, L., & Bianchi, S. (2010). Sonography of the quadriceps muscle: Examination technique, normal anatomy, and traumatic lesions. Journal of Ultrasound, 13(2), 76-84.

Pinto, R. S., Correa, C. S., Radaelli, R., Cadore, E. L., Brown, L. E., & Bottaro, M. (2014). Short-term strength training improves muscle quality and functional capacity of elderly women. Age, 36, 365-372.

Polito, M. D., Papst, R. R., & Farinatti, P. (2021). Moderators of strength gains and hypertrophy in resistance training: A systematic review and meta-analysis. Journal of sports sciences, 39(19), 2189-2198.

Roig, M., O’Brien, K., Kirk, G., Murray, R., McKinnon, P., Shadgan, B., & Reid, W. (2009). The effects of eccentric versus concentric resistance training on muscle strength and mass in healthy adults: a systematic review with meta-analysis. British journal of sports medicine, 43(8), 556-568.

Santos, R., Valamatos, M., Mil-Homens, P., & Armada-da-Silva, P. (2018). Muscle thickness and echo-intensity changes of the quadriceps femoris muscle during a strength training program. Radiography, 24(4), e75-e84.

Schoenfeld, B., Contreras, B., Krieger, J., Grgic, J., Delcastillo, K., Belliard, R., & Alto, A. (2019). Resistance training volume enhances muscle hypertrophy but not strength in trained men. Medicine science in sports exercise, 51(1), 94.

Schoenfeld, B., & Grgic, J. (2018). Evidence-based guidelines for resistance training volume to maximize muscle hypertrophy. Strength Conditioning Journal, 40(4), 107-112.

Schoenfeld, B., Grgic, J., & Krieger, J. (2019). How many times per week should a muscle be trained to maximize muscle hypertrophy? A systematic review and meta-analysis of studies examining the effects of resistance training frequency. Journal of sports sciences, 37(11), 1286-1295.

Schoenfeld, B., Grgic, J., Ogborn, D., & Krieger, J. W. (2017). Strength and hypertrophy adaptations between low-vs. high-load resistance training: a systematic review and meta-analysis. The Journal of Strength Conditioning Research, 31(12), 3508-3523.

Schoenfeld, B., Ogborn, D. I., Vigotsky, A. D., Franchi, M. V., & Krieger, J. W. (2017). Hypertrophic effects of concentric vs. eccentric muscle actions: a systematic review and meta-analysis. The Journal of Strength Conditioning Research, 31(9), 2599-2608.

Schoenfeld, B., Peterson, M. D., Ogborn, D., Contreras, B., & Sonmez, G. T. (2015). Effects of low-vs. high-load resistance training on muscle strength and hypertrophy in well-trained men. The Journal of Strength Conditioning Research, 29(10), 2954-2963.

Schoenfeld, B., Pope, Z. K., Benik, F. M., Hester, G. M., Sellers, J., Nooner, J. L., . . . Ross, C. L. (2016). Longer interset rest periods enhance muscle strength and hypertrophy in resistance-trained men. Journal of strength conditioning research, 30(7), 1805-1812.

Schoenfeld, B. J. (2010). The mechanisms of muscle hypertrophy and their application to resistance training. The Journal of Strength Conditioning Research, 24(10), 2857-2872.

Schoenfeld, B. J. (2013). Is there a minimum intensity threshold for resistance training-induced hypertrophic adaptations? Sports medicine, 43(12), 1279-1288.

Schuenke, M. D., Herman, J. R., Gliders, R. M., Hagerman, F. C., Hikida, R. S., Rana, S. R., . . . Staron, R. S. (2012). Early-phase muscular adaptations in response to slow-speed versus traditional resistance-training regimens. European journal of applied physiology, 112, 3585-3595.

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. JBI Evidence Implementation, 13(1), 9-18.

Spiliopoulou, P., Methenitis, S., Zaras, N., Stasinaki, A.-N., Krekoukia, M., Tsitkanou, S., & Terzis, G. (2022). Vastus Lateralis and Vastus Intermedius as Predictors of Quadriceps Femoris Muscle Hypertrophy after Strength Training. Applied Sciences, 12(18), 9133.

Sutton, A. J., & Higgins, J. P. (2008). Recent developments in meta‐analysis. Statistics in medicine, 27(5), 625-650.

Tanimoto, M., Sanada, K., Yamamoto, K., Kawano, H., Gando, Y., Tabata, I., . . . Miyachi, M. (2008). Effects of whole-body low-intensity resistance training with slow movement and tonic force generation on muscular size and strength in young men. The Journal of Strength Conditioning Research, 22(6), 1926-1938.

Toigo, M., & Boutellier, U. (2006). New fundamental resistance exercise determinants of molecular and cellular muscle adaptations. European journal of applied physiology, 97, 643-663.

Usui, S., Maeo, S., Tayashiki, K., Nakatani, M., & Kanehisa, H. (2015). Low-load slow movement squat training increases muscle size and strength but not power. International journal of sports medicine, 37(04), 305-312.

West, D. W., Burd, N. A., Staples, A. W., & Phillips, S. M. (2010). Human exercise-mediated skeletal muscle hypertrophy is an intrinsic process. The international journal of biochemistry cell biology, 42(9), 1371-1375.

Yoo, W.-g. (2016). Comparison of hamstring-to-quadriceps ratio between accelerating and decelerating sections during squat exercise. Journal of Physical Therapy Science, 28(9), 2468-2469.

Yoshiko, A., & Watanabe, K. (2021). Impact of home-based squat training with two-depths on lower limb muscle parameters and physical functional tests in older adults. Scientific reports, 11(1), 1-10.

Zaras, N., Stasinaki, A.-N., Spiliopoulou, P., Mpampoulis, T., Hadjicharalambous, M., & Terzis, G. (2020). Effect of inter-repetition rest vs. traditional strength training on lower body strength, rate of force development, and muscle architecture. Applied Sciences, 11(1), 45.

Zaroni, R. S., Brigatto, F. A., Schoenfeld, B. J., Braz, T. V., Benvenutti, J. C., Germano, M. D., . . . Lopes, C. R. (2018). High resistance-training frequency enhances muscle thickness in resistance-trained men. The Journal of Strength Conditioning Research, 33, S140-S151.

Downloads

Published

2025-07-21

Issue

Section

Articles

How to Cite

Eyipınar, C. D. ., Buzdağlı, Y., & Karayiğit, R. (2025). Hypertrophic response of lower extremity muscles to different resistance training intensities: a meta-analysis and meta-regression. Kinesiologia Slovenica: Scientific Journal on Sport, 31(2), 85-109. https://doi.org/10.52165/kinsi.31.2.85-109