Acute Variables: Sets Per Muscle Group

TPTA

ISSA

AFAA

PTAGlobal

ACSM

AOTA

NASM

PACE

WITS

NYPT

This course discusses how many sets per <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> group per session is ideal, and how many sets per <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> group per week is <a id="optimal" data-tip="1571" target="_blank" href="/glossary-term/optimal" class="glossary">optimal</a> for continued improvement. Further this course includes detailed recommendations based on training experience, training frequency, and training volume, and modifications for novice exercisers, experienced exercisers, athletes, and elderly exercisers. The topics discussed include 1-set/exercise versus multiple-sets/exercise, smaller <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> groups versus larger <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> groups, compound exercises versus single-joint exercises, full-body programs versus split routines, and fat loss program versus <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> gain or strength gain programs (e.g. body composition, strength training, hypertrophy training (e.g. <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> gain), and <a id="power" data-tip="1399" target="_blank" href="/glossary-term/power" class="glossary">power</a>).
Some findings from the included systematic review resulted in counter-intuitive, or at least less conventional recommendations. For example, 1-set/exercise and multiple-sets/exercise may be equally beneficial during an initial training period (6-16 weeks), especially for upper body muscles, single-joint exercises, aquatic exercise, novice exercisers, post-menopausal females, and/or older exercisers. Further, there is an upper limit to the recommended number of sets/muscle group, as research suggests individuals with the goal of optimizing hypertrophy, strength, and/or <a id="power" data-tip="1399" target="_blank" href="/glossary-term/power" class="glossary">power</a> should not exceed 5-6 sets/muscle group/session, and there may be little difference between 3 - 6 sets/muscle group/session (diminishing returns). (It is possible that higher training volumes with sets performed to <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> failure may result in more <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> damage than the body can adapt to, regardless of the body part, rest interval, or the use of different exercises).&#xA0;
Movement professionals (personal trainers, fitness instructors, physical therapists, athletic trainers, massage therapists, chiropractors, occupational therapists, etc.) should consider acute variables essential knowledge for <a id="optimal" data-tip="1571" target="_blank" href="/glossary-term/optimal" class="glossary">optimal</a> exercise programming, and sets/muscle group/session is one of those acute variables. This course is part of our continued effort to optimize &#x201C;acute variable&#x201D; recommendations.
<h3>Additional Courses:</h3>
<ul>
 <li><a href="https://brookbushinstitute.com/courses/acute-variables-repetition-tempo">Acute Variables: Repetition Tempo</a></li>
 <li><a href="https://brookbushinstitute.com/courses/acute-variables-repetition-range">Acute Variables: Repetition Range</a></li>
 <li><a href="https://brookbushinstitute.com/courses/acute-variables-rest-between-sets" target="_blank" rel="noopener">Acute Variables: Rest Between Sets</a></li>
 <li><a href="https://brookbushinstitute.com/courses/acute-variables-circuit-training">Acute Variables: Circuit Training</a></li>
</ul>

<h3>Position Statement:</h3>
<ul>
 <li>One-set/muscle group (2 sets/lower body <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> group) is recommended during an initial training period (6-12 weeks), followed by a progressive increase up to 3 - 4 sets/muscle group. Individuals with the goal of optimizing hypertrophy, strength, and/or <a id="power" data-tip="1399" target="_blank" href="/glossary-term/power" class="glossary">power</a> should likely not exceed 5-6 sets/muscle group. More than 3 - 4 sets/muscle group results in relatively small increases in performance, suggesting advanced exercisers should consider increasing other <a id="relevance" data-tip="1505" target="_blank" href="/glossary-term/relevance" class="glossary">relevant</a> variables prior to exceeding 3 sets/muscle group (e.g. velocity, load, reps, time-under-tension, etc.). Additionally, the number of sets/muscle group should decrease when introducing <a id="power" data-tip="1399" target="_blank" href="/glossary-term/power" class="glossary">power</a> exercises (ballistic or <a id="plyometric" data-tip="1295" target="_blank" href="/glossary-term/plyometric" class="glossary">plyometric</a>) or supersets.</li>
</ul>
&#xA0;
<h3>General Recommendation:</h3>
<ul>
 <li>A progressive increase from 1-5 sets/muscle group/session</li>
</ul>
<h3>Specific Recommendations:</h3>
<ul>
 <li>Novice Exercisers (6-12 weeks): 1 - 2 sets/upper body <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> group, 2-3 sets/lower body <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> group</li>
 <li>Experienced Exercercisers: 2-5 sets</li>
 <li>Power Exercises (Plyometric/Ballistic): 1-4 sets</li>
 <li>Supersets: 1-4 sets</li>
</ul>
&#xA0;
<h3>Definitions:</h3>
<ul>
 <li>&quot;Sets per Exercise&quot; versus &quot;Sets per <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">Muscle</a> Group&quot;:&#xA0;In this course and review, these two terms are interchangeable. The gross majority of research investigating sets/exercise include programs with 1 exercise/muscle group. Further, the few studies that include multiple exercisers/muscle group demonstrate that these routines provide no additional benefit.</li>
 <li>&quot;Sets per Session&quot; versus &quot;Sets per Week&quot;: It is likely reasonable to assume that the recommendations above are based on a program that includes 2 sessions/muscle group/week, on non-consecutive days. That is the recommended number of sets per <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> group per week is simply twice the number of sets recommended above. Note, 3 sessions/muscle/week may be beneficial when performing low-intensity (low load/velocity) strength training programs, and/or during corrective exercise or rehabilitation programs. However, frequency is covered in more detail in an upcoming course &quot;Acute Variables: Frequency&quot;
 <ul>
 <li>Sets per <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> Group per Week
 <ul>
 <li>Novice Exercisers (6-12 weeks):&#xA0;2-4 sets</li>
 <li>Experienced Exercercisers:&#xA0;4-10 sets</li>
 <li>Power Exercises:&#xA0;2-8 sets</li>
 <li>Supersets:&#xA0;2-8 sets</li>
 </ul>
 </li>
 </ul>
 </li>
</ul>
&#xA0;
<h2>Sample Programs</h2>
<h3>Novice Exerciser Routine:</h3>
<ul>
 <li>Goal: Initial Training Period</li>
</ul>
Acute Variables:
<ul>
 <li>Load: Lighter (60-75% of 1-RM)</li>
 <li>Reps/set: 12-20 reps</li>
 <li>Sets/exercise (circuits): 1-2 sets/upper body <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> group, 2-3 sets/lower body <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> group</li>
 <li>Rest between exercises: 1-3 minutes</li>
 <li>Training Time: 20 &#x2013; 45 minutes (excluding warm-up).</li>
</ul>
Total Body Strength Endurance/Stability Routine:
Note: If you add a &quot;Total Body&quot; exercise and a &quot;Leg Exercise&quot;, but you do not repeat the upper body movement targeted in the &quot;Total Body&quot; exercise, you will create a routine with 2 exercises for the lower body and 1 set for each upper body <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> group.
<ul>
 <li>Total Body: <a href="https://brookbushinstitute.com/videos/squat-to-row-posterior-oblique-subsystem-integration" target="_blank" rel="noopener">Squat to Row</a></li>
 <li>Chest: <a href="https://brookbushinstitute.com/videos/push-ups-and-progression" target="_blank" rel="noopener">Push-up on Knees</a></li>
 <li>Back: <a href="https://brookbushinstitute.com/videos/prone-floor-cobra-after-chest-outthumbs-out" target="_blank" rel="noopener">Floor Cobra</a></li>
 <li>Shoulders: <a href="https://brookbushinstitute.com/videos/shoulder-scaption" target="_blank" rel="noopener">Scaption</a></li>
 <li>Legs: <a href="https://brookbushinstitute.com/videos/step-ups" target="_blank" rel="noopener">Frontal Plane Step Ups</a></li>
</ul>

Course Description: Acute Variables: Sets Per Muscle Group

Sets Per Muscle Group: Webinar

<h3>Position Statement:</h3>
<ul>
 <li>One-set/muscle group (2 sets/lower body <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> group) is recommended during an initial training period (6-12 weeks), followed by a progressive increase up to 3 - 4 sets/muscle group. Individuals with the goal of optimizing hypertrophy, strength, and/or <a id="power" data-tip="1399" target="_blank" href="/glossary-term/power" class="glossary">power</a> should likely not exceed 5-6 sets/muscle group. More than 3 - 4 sets/muscle group results in relatively small increases in performance, suggesting advanced exercisers should consider increasing other <a id="relevance" data-tip="1505" target="_blank" href="/glossary-term/relevance" class="glossary">relevant</a> variables prior to exceeding 3 sets/muscle group (e.g. velocity, load, reps, time-under-tension, etc.). Additionally, the number of sets/muscle group should decrease when introducing <a id="power" data-tip="1399" target="_blank" href="/glossary-term/power" class="glossary">power</a> exercises (ballistic or <a id="plyometric" data-tip="1295" target="_blank" href="/glossary-term/plyometric" class="glossary">plyometric</a>) or supersets.</li>
</ul>
&#xA0;
<h3>General Recommendation:</h3>
<ul>
 <li>A progressive increase from 1-5 sets/muscle group/session</li>
</ul>
<h3>Specific Recommendations:</h3>
<ul>
 <li>Novice Exercisers (6-12 weeks): 1 - 2 sets/upper body <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> group, 2-3 sets/lower body <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> group</li>
 <li>Experienced Exercercisers: 2-5 sets</li>
 <li>Power Exercises (Plyometric/Ballistic): 1-4 sets</li>
 <li>Supersets: 1-4 sets</li>
</ul>
&#xA0;
<h3>Definitions:</h3>
<ul>
 <li>&quot;Sets per Exercise&quot; versus &quot;Sets per <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">Muscle</a> Group&quot;: In this course and review, these two terms are interchangeable. The gross majority of research investigating sets/exercise include programs with 1 exercise/muscle group. Further, the few studies that include multiple exercises/muscle group demonstrate that these routines provide no additional benefit.</li>
 <li>&quot;Sets per Session&quot; versus &quot;Sets per Week&quot;: It is likely reasonable to assume that the recommendations above are based on a program that includes 2 sessions/muscle group/week, on non-consecutive days. That is the recommended number of sets per <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> group per week is simply twice the number of sets recommended above. Note, 3 sessions/muscle/week may be beneficial when performing low-intensity (low load/velocity) strength training programs, and/or during corrective exercise or rehabilitation programs. However, frequency is covered in more detail in an upcoming course &quot;Acute Variables: Frequency&quot;
 <ul>
 <li>Sets per <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> Group per Week
 <ul>
 <li>Novice Exercisers (6-12 weeks):&#xA0;2-4 sets</li>
 <li>Experienced Exercisers:&#xA0;4-10 sets</li>
 <li>Power Exercises:&#xA0;2-8 sets</li>
 <li>Supersets:&#xA0;2-8 sets</li>
 </ul>
 </li>
 </ul>
 </li>
</ul>
&#xA0;
<h2>Sample Programs</h2>
<h3>Novice Exerciser Routine:</h3>
<ul>
 <li>Goal: Initial Training Period</li>
</ul>
Acute Variables:
<ul>
 <li>Load: Lighter (60-75% of 1-RM)</li>
 <li>Reps/set: 12-20 reps</li>
 <li>Sets/exercise (circuits): 1-2 sets/upper body <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> group, 2-3 sets/lower body <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> group</li>
 <li>Rest between exercises: 1-3 minutes</li>
 <li>Training Time: 20 &#x2013; 45 minutes (excluding warm-up).</li>
</ul>
Total Body Strength Endurance/Stability Routine:
Note: If you add a &quot;Total Body&quot; exercise and a &quot;Leg Exercise&quot;, but you do not repeat the upper body movement targeted in the &quot;Total Body&quot; exercise, you will create a routine with 2 exercises for the lower body and 1 set for each upper body <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> group.
<ul>
 <li>Total Body: <a href="https://brookbushinstitute.com/videos/squat-to-row-posterior-oblique-subsystem-integration" target="_blank" rel="noopener">Squat to Row</a></li>
 <li>Chest: <a href="https://brookbushinstitute.com/videos/push-ups-and-progression" target="_blank" rel="noopener">Push-up on Knees</a></li>
 <li>Back: <a href="https://brookbushinstitute.com/videos/prone-floor-cobra-after-chest-outthumbs-out" target="_blank" rel="noopener">Floor Cobra</a></li>
 <li>Shoulders: <a href="https://brookbushinstitute.com/videos/shoulder-scaption" target="_blank" rel="noopener">Scaption</a></li>
 <li>Legs: <a href="https://brookbushinstitute.com/videos/step-ups" target="_blank" rel="noopener">Frontal Plane Step Ups</a></li>
</ul>

<h3>Experienced Exerciser Routine:</h3>
Goal: Upper Body Hypertrophy (Strength/Stability Supersets)
<ul>
 <li>Day 1 of a 2-day split routine</li>
</ul>
Acute Variables: 
<ul>
 <li>Load: Moderate (75-90% 1-RM)/Light (60-75% 1-RM)</li>
 <li>Reps/set: 6-12/6-12</li>
 <li>Sets/exercise (or circuits): 2-3 super-sets/muscle group</li>
 <li>Rest between exercises: 30 seconds</li>
 <li>Rest between sets: 3 minutes (alternatively, can be performed in a circuit)</li>
 <li>Training time: 20 &#x2013; 60 minutes (excluding warm-up).</li>
</ul>
Strength/Stability Super-sets Routine: 
<ul>
 <li>Chest: <a href="https://brookbushinstitute.com/videos/bench-press-chest-press">Incline Bench Press</a> and <a href="https://brookbushinstitute.com/videos/asymmetrical-chest-press">Asymmetrical Dumbbell Press on Ball</a></li>
 <li>Back: <a href="https://brookbushinstitute.com/videos/pull-ups-and-progressions" target="_blank" rel="noopener">Pull-up</a> and <a href="https://brookbushinstitute.com/videos/chaos-row">Chaos Row</a></li>
 <li>Shoulders: <a href="https://brookbushinstitute.com/videos/overhead-press">Curl &amp; Press</a> and <a href="https://brookbushinstitute.com/videos/standing-cobra-to-balance-to-calf-raise" target="_blank" rel="noopener">Standing Cobra to </a><a id="balance" data-tip="1190" target="_blank" href="/glossary-term/balance" class="glossary">Balance</a> to Calf Raise</li>
</ul>
&#xA0;

Sets per Exercise: Position Statement, Definitions, and Practical Application

<h3>Physiology:</h3>
<ul>
 <li>Testosterone, Cortisol,&#xA0;Human Growth <a id="hormone" data-tip="1266" target="_blank" href="/glossary-term/hormone" class="glossary">Hormone</a> (HGH), and Lactate&#xA0;Concentrations:&#xA0;Post-exercise serum concentrations of testosterone, HGH, and cortisol likely increase with additional sets/exercise; however, peak concentrations are likely reached with relatively modest exercise volumes and intensities. Further, a progressive increase in sets/exercise over several months of training may result in a modest increase in resting testosterone and HGH, and a resting decrease in cortisol. Lactate concentrations are likely to increase with additional sets/exercise or increases in load; however, lactate concentrations are also significantly influenced by rest between sets.</li>
 <li>Insulin-like Growth Factor 1 (IGF-1):&#xA0;Resistance training for 12+ weeks may result in an increase in resting serum concentrations of IGF-1; however, the magnitude of the increase may not be influenced by additional sets/exercise.</li>
 <li>Protein Synthesis and Satellite Cell Concentration:&#xA0;Additional sets/exercise (and/or increased load) may result in a significant increase in markers of post-exercise protein synthesis.</li>
 <li>Glucose, Insulin, and Triglycerides: If an individual exhibits impaired glucose <a id="sensitivity" data-tip="1226" target="_blank" href="/glossary-term/sensitivity" class="glossary">sensitivity</a> then additional sets/exercise may have a positive effect on post-exercise and post-meal insulin and glucose concentrations; however, an individual with normal glucose <a id="sensitivity" data-tip="1226" target="_blank" href="/glossary-term/sensitivity" class="glossary">sensitivity</a> is unlikely to exhibit any change. Further, healthy individuals training for 11+ weeks with additional sets/exercise may exhibit larger decreases&#xA0;in glycated hemoglobin (HbA1c%), IL-6, resting and post-exercise glucose, resting fasting triglycerides, and c-reactive protein, but are unlikely to exhibit changes in cholesterol (total cholesterol, LDL, HDL, or LDL/HDL ratio).</li>
 <li>Cardiovascular Changes, Respiratory Changes, and Energy Expenditure. Additional sets/exercise are likely to result in a significant increase in HR, respiratory rate, relative VO2, respiratory exchange ratio, caloric expenditure, and an increase in excess post-exercise oxygen consumption (EPOC) for up to 24 hours.</li>
</ul>
<h3>Training Goals:</h3>
<ul>
 <li>Body Composition: Additional sets/exercise may result in larger improvements in body composition (increase in lean mass and decrease in body fat percentage) when the training duration is longer than 12 weeks, and the difference is likely to increase with longer durations.</li>
 <li>Hypertrophy and Strength:&#xA0;One-set/exercise and multiple-sets/exercise may be equally beneficial during an initial training period (6-16 weeks) for the following: upper body muscles, single-joint exercises, aquatic exercise, novice exercisers, post-menopausal females, and older exercisers. Experienced exercisers performing longer-duration programs (12+ weeks) may achieve significantly larger increases in strength (50%) and hypertrophy from multiple-sets/exercise, and may exhibit a decrease in strength and hypertrophy from 1-set/exercise.</li>
 <li>Power: Novice and experienced exercisers performing strength training (no <a id="plyometric" data-tip="1295" target="_blank" href="/glossary-term/plyometric" class="glossary">plyometric</a> or ballistic exercises) with 1 set/exercise or multiple-sets/exercise, are likely to exhibit similar increases in <a id="power" data-tip="1399" target="_blank" href="/glossary-term/power" class="glossary">power</a> (vertical jump height, counter-movement jump, and bench press throw).&#xA0;As discussed in our course &quot;<a href="https://brookbushinstitute.com/courses/introduction-power-training-high-velocity-training" target="_blank" rel="noopener">Power (High-Velocity) Training: Introduction</a>&quot; it is likely that <a id="plyometric" data-tip="1295" target="_blank" href="/glossary-term/plyometric" class="glossary">plyometric</a> or ballistic exercise is necessary for optimizing <a id="power" data-tip="1399" target="_blank" href="/glossary-term/power" class="glossary">power</a> training. Further, starting a program with multiple-sets/exercise is not ideal for improving <a id="power" data-tip="1399" target="_blank" href="/glossary-term/power" class="glossary">power</a> performance (counter-movement jump height), and high volumes of exercise (6+ sets/muscle group) may reduce <a id="power" data-tip="1399" target="_blank" href="/glossary-term/power" class="glossary">power</a> performance, perhaps due to a transition of type IIx fibers to type IIa fibers.</li>
</ul>
<h3>Practical Application</h3>
<ul>
 <li>Initial Training Period: Novice exercisers may exhibit similar improvements in hypertrophy, strength, and <a id="power" data-tip="1399" target="_blank" href="/glossary-term/power" class="glossary">power</a>, following 1-set or multiple-sets/exercise for the first 6-12 weeks of a resistance training program.</li>
 <li>More Sets/Exercise for Lower Body: Young healthy exercisers (novice or experienced) are likely to benefit (e.g. strength, <a id="power" data-tip="1399" target="_blank" href="/glossary-term/power" class="glossary">power</a>, hypertrophy); from more sets/muscle group for lower body exercises, when compared to upper body exercises.</li>
 <li>Progressive Increase in Sets/Exercise Ideal for Continuous Improvement: A&#xA0;progressive increase in sets/exercise may be ideal for continuous improvements including testosterone and cortisol concentrations, changes in body composition, hypertrophy, <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> endurance, 1-RM strength, and power&#xA0;(vertical jump height, tennis serve velocity, and Wingate anaerobic <a id="assessment" data-tip="1482" target="_blank" href="/glossary-term/assessment" class="glossary">test</a>).&#xA0;Further,&#xA0;adding sets/exercise after the initial training period may be necessary to achieve the largest possible benefits (e.g. lean body mass, strength, <a id="power" data-tip="1399" target="_blank" href="/glossary-term/power" class="glossary">power</a>)</li>
 <li>Upper Limit of Sets/Exercise (<a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">Muscle</a> Group): Individuals with the goal of optimizing hypertrophy, strength, and/or <a id="power" data-tip="1399" target="_blank" href="/glossary-term/power" class="glossary">power</a> should not exceed 5-6 sets (3-5 super-sets)/muscle group/session. Further, there may be little difference between 3 - 6 sets/muscle group/session (diminishing returns).</li>
</ul>

Sets Per Exercise: 1-Page Research Summary

Sets Per Exercise: Research Summary

<h3>Physiology:</h3>
<ul>
 <li>Testosterone, Cortisol,&#xA0;Human Growth <a id="hormone" data-tip="1266" target="_blank" href="/glossary-term/hormone" class="glossary">Hormone</a> (HGH), and Lactate&#xA0;Concentrations:
 <ul>
 <li>Following a Single Session: Post-exercise serum concentrations of testosterone likely increase with additional sets/exercise; however, peak concentrations are likely reached with relatively modest exercise volumes and intensities. Similarly, post-exercise serum concentrations of cortisol and HGH likely increase with additional sets/exercise, but also peak once a certain volume and intensity are reached. It is likely that the number of additional sets/exercise required to reach peak concentrations of testosterone are lower than cortisol and/or HGH. Last, lactate concentrations are likely to increase with sets/exercise or increases in load/intensity; however, lactate concentrations are also significantly influenced by rest between sets.</li>
 <li>Following Months of Training: Initiating a program with additional sets/exercise is unlikely to have a significant influence on resting serum concentrations of testosterone, HGH, or cortisol following several months of training. Further, it is unlikely that additional sets/exercise will result in significant differences in post-exercise serum concentrations when comparing a single session to a single session following several months of training. However, a progressive increase in sets/exercise during several months of training may result in modest increases in resting testosterone and HGH, and resting decreases in cortisol.</li>
 </ul>
 </li>
 <li>Insulin-like Growth Factor 1 (IGF-1):&#xA0;Resistance training for 12 or more weeks may result in an increase in resting serum concentrations of IGF-1; however, the magnitude of the increase may not be influenced by additional sets/exercise.</li>
 <li>Protein Synthesis and Satellite Cell Concentration
 <ul>
 <li>Following a Single Session:&#xA0;Additional sets/exercise (and/or increased load) may result in a significant increase in markers of post-exercise protein synthesis following a single session.</li>
 <li>Following Months of Training:&#xA0;Training for 10-12 weeks with additional sets/exercise is likely to result in significantly larger increases in protein synthesis and satellite cell proliferation; however, lower body muscles may exhibit larger increases than the upper body muscles.</li>
 </ul>
 </li>
 <li>Glucose, Insulin, and Triglycerides
 <ul>
 <li>Following a Single Session with Impaired Glucose Sensitivity:&#xA0;Individuals with impaired insulin <a id="sensitivity" data-tip="1226" target="_blank" href="/glossary-term/sensitivity" class="glossary">sensitivity</a> may experience an initial spike in serum glucose concentrations during the first 1-2 sets, followed by a return to pre-exercise values with the 3rd set. Further, 24 hours post-exercise additional sets/exercise resulted in larger increases in fasting plasma insulin and decreases in fasting plasma glucose. Note, the number of sets/exercise did not have a significant effect on plasma creatine kinase concentrations, implying <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> damage did not significantly increase.</li>
 <li>Following a Single Session with Normal Glucose Sensitivity:&#xA0;Additional sets/exercise did not have a significant effect on post-exercise or post-meal serum concentrations of glucose, blood insulin, or lipid profiles in individuals with normal insulin <a id="sensitivity" data-tip="1226" target="_blank" href="/glossary-term/sensitivity" class="glossary">sensitivity</a>.&#xA0;</li>
 <li>Following Months of Training with Normal Glucose Sensitivity:&#xA0;Training for 11-16 weeks with additional sets/exercise results in larger decreases in glycated hemoglobin (HbA1c%), IL-6, resting and post-exercise glucose, resting fasting triglycerides, and c-reactive protein. However, additional sets/exercise may not have a significant effect on cholesterol (total cholesterol, LDL, HDL, or LDL/HDL ratio).</li>
 </ul>
 </li>
</ul>

Research Summary: Physiology

<h3>Cardiovascular and Respiratory Improvements</h3>
<ul>
 <li>Cardiovascular Response to a Single Session:&#xA0;Faster rep tempos or additional sets/exercise may result in higher peak HRs between sets; however, slower tempos and longer time-under-tension may result in higher average HRs between sets. Further, additional sets/exercise may result in larger changes in post-exercise blood pressure, including a significant decrease in average systolic blood pressure for up to 60 minutes, and average arterial pressure for up to 30 minutes.&#xA0;</li>
 <li>Cardiovascular Improvements following Weeks of Training:&#xA0;Individuals with assessed cardiovascular deficits, following strength training for 5-12 weeks, may exhibit significant improvements (vascular response to exercise, decrease in resting blood pressure, and maximum inspiratory and expiratory pressure); however, the magnitude of improvement may not be influenced by additional sets/exercise.</li>
</ul>
<img alt="Pulminary circuit" title="The pulminary circuit of the body, including the lungs, arteries, and veins" src="https://www.datocms-assets.com/25800/1669060980-pulminary-circuit-compressed.jpg">
<h3>Energy Expenditure</h3>
<ul>
 <li>Energy Expenditure, Excess Post-Exercise Oxygen Consumption, and Fat Oxidation:&#xA0;Additional sets/exercise are likely to result in a significant increase in HR, respiratory rate, relative VO2, respiratory exchange ratio, caloric expenditure, and initial EPOC (less than 24 hours). However, it is unlikely that additional sets/exercise has a significant effect on EPOC and resting metabolic rate more than 24 hours post-exercise.</li>
</ul>
<h3>Body Composition</h3>
<ul>
 <li>No Change in Bodyfat Percentage:&#xA0;
 <ul>
 <li>Novice Exercisers:&#xA0;Three studies suggested that resistance training with 1 set/exercise or 3 sets/exercise was not sufficient for novice exercisers to exhibit a significant decrease in body fat percentage; however, it should be noted that one study included young participants and was 6 weeks long, and the other 2 studies compared elderly participants.</li>
 <li>Experienced Exercisers:&#xA0;Experienced lifters are unlikely to exhibit significant changes in body mass, body composition, or body fat percentage following a resistance training program, regardless of the number of sets/exercise. However, it may be reasonable to consider that the goal of the programs described in the cited studies was likely strength and not specifically body composition change.</li>
 </ul>
 </li>
 <li>Significant Differences in Bodyfat Percentage:
 <ul>
 <li>Additional Sets/Exercise Increases Body Fat Percentage Change:&#xA0;Resistance training can be an effective intervention for improving body composition, and additional sets/exercise may result in larger improvements. It is worth noting that the studies supporting this assertion included training durations of 12-29 weeks (significantly longer than most studies demonstrating no significant change in body composition).</li>
 <li>Larger Differences Over Time: Additional improvements in body composition resulting from multiple-sets/exercise increase over time.</li>
 </ul>
 </li>
</ul>

Research Summary: Cardiovascular and Respiratory Improvements, Energy Expenditure, and Body Composition

<h3>Hypertrophy and Additional Sets/Exercise</h3>
<ul>
 <li>No Improvement in <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">Muscle</a> Cross-sectional Area (CSA)
 <ul>
 <li>Two studies suggest that additional sets/exercise may not influence <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">Muscle</a> hypertrophy (CSA); however, considering the number of studies opposing this assertion, it is likely important to consider the limitations of these studies; for example, the Munn et al. study only lasted 6 weeks, and both studies included relatively small volumes of exercises (few total exercises).</li>
 </ul>
 </li>
 <li>Similar Improvements in <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">Muscle</a> CSA
 <ul>
 <li>Novice Exercisers:&#xA0;During the initial 8-14 weeks of training, novice exercisers may not exhibit significantly larger improvements in <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">Muscle</a> CSA as a result of additional sets/exercise, even when blood flow restriction (BFR) is incorporated.</li>
 <li>Post-menopausal Females:&#xA0;Novice post-menopausal and elderly women may exhibit significant increases in lean body mass following a resistance training program; however, during the initial 12 - 16 weeks, additional sets/exercise may not result in additional hypertrophy.</li>
 </ul>
 </li>
</ul>
<ul>
 <li>Significant Differences in <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">Muscle</a> CSA
 <ul>
 <li>Novice Exercisers:&#xA0;Novice exercisers may exhibit additional hypertrophy from additional sets/exercise. However, considering previously cited studies opposing this assertion, it is important to note that these studies included longer training programs, lasting 12 weeks to 6 months.</li>
 <li>Experienced Exercisers:&#xA0;Experienced exercisers exhibit significantly larger increases in strength and hypertrophy following&#xA0;6 - 29 weeks of training with additional sets/exercise. Note, the studies with training durations of 6-8 weeks included participants 18-35 years old; whereas, the study that included participants 60+ years old lasted 29 weeks.</li>
 <li>Similar Initial Differences:&#xA0;1-set/exercise and multiple-sets/exercise may initially result in similar increases in <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">Muscle</a> strength and hypertrophy; however, multiple sets/exercise results in larger increases when training programs last longer than 16 weeks.</li>
 <li>Difference Between Upper and Lower Body:&#xA0;When compared to upper body muscles, lower body muscles may exhibit larger increases in strength, satellite cell proliferation, and hypertrophy in response to additional sets/exercise.</li>
 </ul>
 </li>
</ul>
&#xA0;<img alt="Skeletal muscle fibers" title="Skeletal muscle fibers of the body which can undergo hypertrophy" src="https://www.datocms-assets.com/25800/1649645803-skeletal-muscle-fiber.png">
<h3>Strength&#xA0;and Additional Sets/Exercise</h3>
<ul>
 <li>Additional Sets/Exercise Do NOT Increase Strength:
 <ul>
 <li>Novice Exercisers:
 <ul>
 <li>Single-joint Exercise Protocols: Additional sets/exercise is unlikely to result in additional increases in strength during a training program (6-14 weeks) that only includes single-joint exercises.</li>
 <li>Full-body Compound Exercise Routines:&#xA0;Research demonstrates that novice lifters exhibit similar benefits from programs including 1-set/exercise or multiple-sets/exercise for the initial 8 weeks of training. Alternatively, these studies could imply that more than 8 weeks is necessary to demonstrate a statistically significant difference in strength.</li>
 <li>Post-menopausal Women and Elderly Exercisers:&#xA0;Post-menopausal and elderly women may exhibit significant increases in strength and lean body mass following a 12-week resistance training program; however, adding additional sets may not result in additional improvements.</li>
 </ul>
 </li>
 </ul>
 </li>
 <li>More Sets per Exercise Results in More Strength
 <ul>
 <li>Adult Novice Exercisers
 <ul>
 <li>Single-joint Exercises:&#xA0;Novice exercises adding&#xA0;sets/exercise to a single-joint exercise protocol may exhibit significantly larger improvements in strength; however, considering previously cited studies, the addition of sets/exercise to a single-joint exercise protocol may not be a <a id="reliability" data-tip="1795" target="_blank" href="/glossary-term/reliability" class="glossary">reliable</a> method for improving strength.</li>
 <li>Full Body Programs:&#xA0;Novice exercisers may exhibit significantly larger increases in strength following the addition of sets/exercise to a full body program lasting 7 weeks or longer.</li>
 </ul>
 </li>
 <li>Older Novice Exercisers:
 <ul>
 <li>12 Weeks of Training:&#xA0;Older exercisers exhibit larger improvements in strength and function following 12 weeks of training with 3 sets/exercise when compared to 1 set/exercise.</li>
 <li>Longer Programs:&#xA0;Older exercisers adding&#xA0;sets/exercise (with or without aerobic training) to longer duration strength training programs (20 - 29 weeks) may exhibit significantly larger improvements in strength endurance, 1-RM strength, and functional <a id="assessment" data-tip="1482" target="_blank" href="/glossary-term/assessment" class="glossary">test</a> scores.</li>
 </ul>
 </li>
 <li>Adult Experienced Exercisers
 <ul>
 <li>6 - 8 Weeks of Training:&#xA0;These studies suggest that experienced exercisers, training for as little as 6-8 weeks, are likely to exhibit larger improvements in strength with the addition of sets/exercise.</li>
 <li>Longer Programs:&#xA0;These studies imply that experienced lifters performing longer-duration programs (12+ weeks) may achieve significantly larger increases in strength (50%) from additional sets/exercise, and may exhibit a decrease in strength from 1 set/exercise.</li>
 </ul>
 </li>
 </ul>
 </li>
</ul>
<h3>Power and Additional Sets/Exercise:</h3>
<ul>
 <li>Additional Sets/Exercise Results in Similar Increases in Power:&#xA0;These studies suggest that novice and experienced exercisers performing 6-1o weeks of strength training (no <a id="plyometric" data-tip="1295" target="_blank" href="/glossary-term/plyometric" class="glossary">plyometric</a> or ballistic exercisers), with 1 set/exercise or multiple-sets/exercise, are likely to exhibit similar increases in <a id="power" data-tip="1399" target="_blank" href="/glossary-term/power" class="glossary">power</a> (vertical jump height, counter-movement jump, and bench press throw). As discussed in our course &quot;<a href="https://brookbushinstitute.com/courses/introduction-power-training-high-velocity-training" target="_blank" rel="noopener">Power (High-Velocity) Training: Introduction</a>&quot; it is likely that <a id="plyometric" data-tip="1295" target="_blank" href="/glossary-term/plyometric" class="glossary">plyometric</a> or ballistic exercise is necessary for optimizing <a id="power" data-tip="1399" target="_blank" href="/glossary-term/power" class="glossary">power</a> training.</li>
 <li>Starting with Multiple Sets/Exercise may Reduce Power:&#xA0;Starting a program with multiple-sets/exercise is not ideal for improving <a id="power" data-tip="1399" target="_blank" href="/glossary-term/power" class="glossary">power</a> performance (counter-movement jump height). Further, high volumes of exercise (6+ supersets/muscle group) may reduce <a id="power" data-tip="1399" target="_blank" href="/glossary-term/power" class="glossary">power</a> performance, perhaps due to a transition of type IIx fibers to type IIa fibers.</li>
</ul>

Research Summary: Hypertrophy, Strength, and Power

<h3>Progressive Increase in Sets/Exercise</h3>
<ul>
 <li>Ideal for Continuous Improvement:&#xA0;These studies demonstrate that a progressive increase in sets/exercise may be ideal for continuous improvement of testosterone and cortisol concentrations, changes in body composition, hypertrophy, <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> endurance, 1-RM strength, and power&#xA0;(vertical jump height, tennis serve velocity, and Wingate anaerobic <a id="assessment" data-tip="1482" target="_blank" href="/glossary-term/assessment" class="glossary">test</a>).</li>
</ul>
<h3>Initial Training Period:</h3>
<ul>
 <li>Similar Results During Initial Training Period:&#xA0;Novice exercisers may exhibit similar improvements following 1-set or multiple-sets/exercise for the first 12 weeks of a resistance training program; however, beyond 12 weeks of training, additional sets/exercise are likely necessary to achieve additional benefits (e.g. body composition, strength, <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> quality, hypertrophy).</li>
 <li>Superior Results from Additional Sets/Exercise:&#xA0;The addition of sets/exercise may result in additional benefits by the 4th week of training for experienced exercisers, and the 12th week of training for novice exercisers. Further,&#xA0;adding sets/exercise after the initial training period may be necessary to achieve the largest possible benefits (e.g. lean body mass, strength, <a id="power" data-tip="1399" target="_blank" href="/glossary-term/power" class="glossary">power</a>).</li>
</ul>
<h3>Upper Limits for Sets/Exercise</h3>
<ul>
 <li>Similar Results:&#xA0;3 - 12 sets/muscle group/session (3-27 sets/muscle group/week) may result in similar increases in strength, hypertrophy, and <a id="power" data-tip="1399" target="_blank" href="/glossary-term/power" class="glossary">power</a>.</li>
 <li>Better Outcomes Following Moderate Volume for Lower Body:&#xA0;6-9 lower body sets/session (3-5 lower body supersets/session) may result in larger increases than 12 lower body sets/session (6-9 lower body supersets/session) when resistance training is performed 2x/week. Note, the study including 6-9 sets/session included 3 lower body exercises, which may imply that 2-3 sets/exercise (2 exercises/muscle group) resulted in larger improvements than 4 sets/exercise (2 sets/muscle group).</li>
 <li>Better Outcomes Following Moderate Volume (Even 1 Session/Week):&#xA0;Even when sessions are performed 1x/week, 5-10 sets/muscle group/session may result in significantly larger improvements than 15-20 sets/muscle group/session, and 20 sets/muscle group/session may result in a decrease in <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> CSA.</li>
</ul>
<h3>More Sets for the Lower Extremity:</h3>
<ul>
 <li>Necessary for Improving Lower Extremity Strength and Power:&#xA0;Young healthy exercisers (novice and experienced) may require&#xA0;multiple sets/exercise to improve lower extremity strength and <a id="power" data-tip="1399" target="_blank" href="/glossary-term/power" class="glossary">power</a>, even when multiple-sets/exercise may not be necessary to improve upper extremity strength and <a id="power" data-tip="1399" target="_blank" href="/glossary-term/power" class="glossary">power</a>.</li>
 <li>Superior for Improving Lower Extremity Strength, <a id="power" data-tip="1399" target="_blank" href="/glossary-term/power" class="glossary">Power</a>, and Hypertrophy:&#xA0;Additional research suggests that multiple-sets/exercise may not be necessary for achieving lower extremity improvements (e.g. strength, <a id="power" data-tip="1399" target="_blank" href="/glossary-term/power" class="glossary">Power</a>, hypertrophy); however, multiple-sets/exercise is likely <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">Superior</a>.</li>
 <li>Single-joint Versus Multi-joint Exercises: Schlumberger et al. demonstrated that multiple sets/exercise was more beneficial for improving upper extremity strength when compared to lower extremity strength; however, this study should be considered in conjunction with previously cited research. It may be reasonable to assume that multiple-sets/exercise is more beneficial for improving the strength of multi-joint exercises (bench press), and is less beneficial for improving the strength of single-joint exercises (leg extensions).</li>
</ul>
<h3>Range of Motion:</h3>
<ul>
 <li>Resistance Training Improves Flexibility:&#xA0;Resistance training has a positive effect on flexibility, and additional sets/exercise may result in larger improvements.</li>
</ul>
<h3>Aquatic Exercise</h3>
<ul>
 <li>Similar Increases in Strength:&#xA0;Novice exercisers performing an aquatic (pool-based) exercise program for 10 weeks, with 1 set/exercise or 3 sets/exercise, are likely to achieve similar increases in strength; even when strength is tested with movements similar to the aquatic exercises.</li>
</ul>

Research Summary: Practical Applications and Miscellaneous

Sets per Exercise: Physiology

<h3>Following a Single Session</h3>
Several studies have compared the effects of additional sets/exercise following a single bout of resistance training on post-exercise serum (blood) concentrations of testosterone, cortisol, human growth <a id="hormone" data-tip="1266" target="_blank" href="/glossary-term/hormone" class="glossary">hormone</a> (HGH), and lactate. An RCT by Smilios et al. compared 11 experienced exercisers (age:&#xA0;23 &#xB1; 4 years) performing 8 different protocols on separate days during a full body resistance training routine (bench press, lat pulldowns, squats, and overhead press). The 8 separate days included 3 protocols using 88% of 1-RM, with 3 min rest between sets, and 2, 4, or 6 sets/exercise; 3 protocols using 75% 1-RM, with 2 min rest between sets, and 2, 4 or 6 sets/exercise, and 2 protocols using 60% 1-RM, with 1 min rest between sets, and 2 or 4 sets/exercise.&#xA0;The results implied similar increases in post-exercise serum concentrations of testosterone regardless of the number of sets or load. Increases in post-exercise serum concentrations of cortisol and HGH exhibited a similar pattern and were significantly influenced by load and volume. Although 2, 4 and 6 sets/exercise resulted in similar increases of cortisol and HGH with 88% 1-RM loads, the increases were significantly higher than the lighter load protocols. Further, with 75% 1-RM loads, 4 and 6 sets resulted in similar but larger increases than 2-sets, and with 60% of 1-RM loads, 4 sets resulted in larger increases than 2 sets/exercise (1). Significant differences in post-exercise serum concentrations of lactate were influenced by load, but not by the number of sets.&#xA0;Note, lactate concentrations were likely affected by the varied rest between sets with each load (for more visit&#xA0;<a href="https://brookbushinstitute.com/courses/acute-variables-rest-between-sets" target="_blank" rel="noopener">Rest Between Sets</a>).&#xA0;This study by Smilios et al. demonstrated a variety of effects on post-exercise serum concentrations of testosterone, cortisol, HGH, and lactate, and additional studies demonstrate similar trends.
Additional studies contribute nuance to the conclusions that may be derived from available research studies comparing sets/exercise.&#xA0; A&#xA0;study by Mulligan et al. compared 10&#xA0;experienced exercisers (age: 24.1 &#xB1; 4.3 years) who completed a full body resistance training program&#xA0;(bench press, knee extension, military press, sit-ups, seated rows, lat pulldowns, bicep curls, and leg press) with 10 RM loads/set, 1 min rest between sets, and 1 set/exercise or 3 sets/exercise performed on separate days. The findings demonstrated that 3 sets/exercise resulted in significantly larger elevations in post-exercise serum concentrations of cortisol and HGH (2).&#xA0;Cintineo et al. compared 19 experienced male exercises (age: 21.1 &#xB1; 2.5 years) following a lower body resistance training program (leg press, leg extensions, Romanian deadlifts, <a id="prone" data-tip="1561" target="_blank" href="/glossary-term/prone" class="glossary">prone</a> leg curls, seated adductors, and seated calf raises) with two volume-matched protocols tested on separate days. Both protocols included 10 RM loads/set and 90 sec rest between sets; however, 1 protocol included 1 set/exercise with a slow (4:0:2) tempo, and the other included 3 sets/exercise with a moderate (1:0:1) tempo. The findings demonstrated that both protocols resulted in similar post-exercise serum concentrations of testosterone; however, the 3 sets/exercise protocol&#xA0;exhibited significantly larger increases in cortisol and lactate (3).&#xA0;Last, a&#xA0;study by Craig et al. compared 4 experienced male exercisers (age: 24.3 &#xB1; 0.4 years) following 2 sessions of half squats. Session 1 was designed for volume and included 2 sets/exercise, 1st set of 75% of 1-RM load and&#xA0; 2nd set of 90% of 1-RM load, reps until failure/set, and 3 min rest between sets. Session 2 was designed for <a id="power" data-tip="1399" target="_blank" href="/glossary-term/power" class="glossary">power</a> and included 1 set/exercise, 90% of 1-RM load, lifted for as many reps as could be performed in 15 sec. The findings demonstrated that the volume (2 sets of reps to failure) protocol resulted in larger increases in post-exercise serum concentrations of HGH and lactate (4).&#xA0;These studies likely imply that&#xA0;post-exercise serum concentrations of testosterone likely increase with additional sets/exercise; however, peak concentrations are likely reached with relatively modest exercise volumes and intensities. Similarly, post-exercise serum concentrations of cortisol and HGH likely increase with additional sets/exercise, but also peak once a certain volume and intensity are reached. It is likely that the number of additional sets/exercise required to reach peak concentrations of testosterone are lower than cortisol and/or HGH. Last, lactate concentrations are likely to increase with sets/exercise or increases in load/intensity; however, lactate concentrations are also significantly influenced by rest between sets.
<h3>Following Months of Training</h3>
Longer-term studies (10-24 weeks) have compared the effects of additional sets/exercise on serum concentrations of testosterone, cortisol, and HGH.&#xA0;Ostrowski et al. compared 27 experienced exercisers&#xA0;(age: 23.7 &#xB1; 5 years) randomly assigned to 3 sets, 6 sets, or 12 sets/exercise/week groups. All exercisers performed a 4-day split routine (Day 1: squats, leg press, leg extensions, stiff-legged deadlifts, leg curls, single-leg curls; Day 2: Bench press, incline bench press, decline bench press, shoulder press, upright rows, <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> raises; Day 3: lat pull downs, t-bar pull downs, seated rows, calf raises, calf press, seated calf raises; Day 4: Barbell curls, preacher curls, dumbbell curls, close grip bench press, triceps push downs, triceps extensions). The program was performed for 10 weeks, 4 sessions/week, reps until failure/set, 12-RM loads weeks 1-4, 7-RM loads weeks 5-7, 9-RM loads weeks 8-10, with 3 min rest between sets, and 1, 2 or 4 sets/exercise. The findings demonstrated that all groups exhibited similar increases in post-exercise serum concentrations of testosterone, similar increases in rectus femoris and triceps brachii hypertrophy, and similar increases in vertical jump and bench press throw height (5).&#xA0;An RCT by Marx et al. compared 34 novice female exercisers (age: 22.2&#xA0;&#xB1; 5.7 years) randomly assigned to a 1 set/exercise or 2-4 set/exercise group, for 24 weeks of training. Both groups performed alternating full-body 2-day split routines of a more compound exercise day (e.g. hang cleans, squat, bench press, push press, etc.), and a more single joint/isolation exercise day (e.g. upright row, leg extensions, <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> raise, lunges). The single-set group trained 3x/week, with 1 set/exercise for the entire training program, 8-12 RM to failure/set, 1-2 min rest between sets, and a slow (4:0:2) tempo. The multi-set group trained 4 days/week, progressively increased from 2 - 4 sets/exercise, with 3-15 RM/set (daily undulated periodization), 1-4 min rest between sets, and a fast/explosive tempo. The findings demonstrated that both groups exhibited increases in resting serum concentrations of testosterone at 12 weeks, but only the 2-4 set/exercise group exhibited additional increases at 24 weeks. Only the 2-4 set/exercise group exhibited a significant decrease in serum concentrations of cortisol at both 12 and 24 weeks. And, neither group exhibited significant changes in serum concentrations of HGH&#xA0;(6).&#xA0;An RCT by Nunes et al. compared 34 post-menopausal female novice exercisers (age: 49-79 years) randomly assigned to a control group (no exercise), 3 sets/exercise group, or 6 sets/exercise group. The exercise groups completed a full body program (Smith machine half squats, leg curls, leg extensions, bench press, machine rows, lat pull downs, barbell curls, and triceps pulleys) for 16 weeks, 3x/week, 3 or 6 sets/exercise, 70% of 1-RM loads, 90 sec rest between sets, and a moderate (1:0:1) tempo. The findings demonstrated that neither group exhibited a significant change in resting serum concentrations of testosterone, cortisol, testosterone/cortisol ratio, or dehydroepiandrosterone sulfate. Further, both groups exhibited similar and significant improvements in 1-RM strength and lean body mass (7).&#xA0;These studies suggest that&#xA0;initiating a program with additional sets/exercise is unlikely to have a significant influence on resting serum concentrations of testosterone, HGH, or cortisol following several months of training. Further, it is unlikely that additional sets/exercise will result in significant differences in post-exercise serum concentrations when comparing a single session to a single session following several months of training. However, a progressive increase in sets/exercise during several months of training may result in modest increases in resting testosterone and HGH, and resting decreases in cortisol.

Testosterone, Cortisol, Human Growth Hormone (HGH), and Lactate Concentrations

Research suggests the sets/exercise likely has little if any significant effect on IGF-1 concentrations.&#xA0;As mentioned above, an RCT by Nunes et al. compared 34 post-menopausal female novice exercisers (age: 49-79 years) randomly assigned to a control group (no exercise), 3 set/exercise groups, or 6 set/exercise groups for 16 weeks of training. The findings demonstrated that neither exercise group exhibited a significant change in resting serum concentrations of any of the tested <a id="hormone" data-tip="1266" target="_blank" href="/glossary-term/hormone" class="glossary">hormone</a> concentrations, including IGF-1, despite significant improvements in 1-RM strength and lean body mass (7).&#xA0;Also mentioned above, an RCT by Marx et al. compared 34 novice female exercisers (age: 22.2&#xA0;&#xB1; 5.7 years) randomly assigned to a single-set or 2-4 sets/exercise group, for 24 weeks of training.&#xA0;The findings demonstrated that the 2-4 sets/exercise group exhibited significant increases in resting serum concentrations of IGF-1 at 12 and 24 weeks, and the 1 set/exercise group did not exhibit a significant increase until 24 weeks (despite both groups exhibiting significant strength increases at 12 weeks) (6).&#xA0;An RCT by Borst et al. compared 31 male and female novice exercisers (age: 37 &#xB1;&#xA0;7 years) randomly assigned to a control group (no exercise), a 1 set/exercise group, or a 3 set/exercise group. All exercisers performed a full body program (chest press, knee extensions, crunches, leg curls, seated rows, triceps extensions, and bicep curls) for 25 weeks, 3x/week, 8-12 RM/set, 2 min rest between sets, with a slow (3:0:2) tempo. The findings demonstrated that both groups exhibited similar increases in resting serum concentrations of IGF-1; however, the 3 set/exercise group exhibited nearly 50% larger increases in strength (1-RM chest press and leg extensions) (8). An RCT by Cunha et al. compared 62 elderly novice female exercisers (age: 60+ years) randomly assigned to a single-set or multi-set group, performing a full body resistance training program (chest press, leg press, seated rows, knee extensions, preacher curls, leg curls, triceps press downs, and seated calf raise) for 12 weeks, 3x/week, 10-15-RM/set, a moderate (2:0:1) tempo, 1-2 min rest between sets, 2-3 min rest between exercises, and either 1 set/exercise or 3 sets/exercise. The findings demonstrated that both groups exhibited similar improvements in 1-RM strength, <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> quality, increases in lean soft tissue (without an increase in body mass), and an increase in resting serum concentrations of fasting IGF-1 (9). These studies suggest that&#xA0;resistance training for 12 or more weeks may result in an increase in resting serum concentrations of IGF-1; however, the magnitude of the increase may not be influenced by additional sets/exercise.

Insulin-like Growth Factor 1 (IGF-1)

<h3>Following a Single Session</h3>
Several studies have investigated the effect of additional sets/exercise on protein synthesis following a single session. A study by Terzis et al. compared 8 novice exercisers (age: 22 &#xB1; 1 years) who completed 1 set, 3 sets, or 5 sets of leg press on separate days. All sets were performed with 6 RM/set, a slow (2.5:0:2.5) tempo, and 2 min rest between sets. The findings demonstrated that protein synthesis increased with additional sets/exercise (10). A study by Burd et al. compared 8 experienced exercisers (age: 24&#xA0;&#xB1; 5 years old) randomly assigned to a 1 set or 3 sets group of leg extensions. All sets were performed with reps until failure/set, 70% of 1-RM loads, a moderate (1:0:1) tempo, and 2 min rest between sets. The findings demonstrated that the 3 sets protocol resulted in significantly larger increases in protein synthesis (11).&#xA0;An RCT by Ahtianen et al. compared 27 recreationally active males (age&#xA0;26 &#xB1; 3 years) randomly assigned to a 5 set/exercise group, 10 set/exercise group, or a strenuous walking group. Both resistance exercise groups performed leg press for 10 RM/set (load adjusted throughout the session), with 2 min rest between sets. The 10 set/exercise group rested 10 minutes between the 5th and 6th set, and the walking group performed exercise for the same length of time as the 10 set group (50 min), with 16.5 kg of military combat gear, and 75 - 85% HRmax intensity. The findings demonstrated that 10 sets of leg press resulted in significantly larger increases in various markers of protein synthesis and energy metabolism (mTORC1, p-p70S6K, p-AMPK&#x3B1;) when compared to 5 sets of strenuous walking for an equal length of time (12). These studies imply that additional sets/exercise (and/or increased load) may result in a significant increase in markers of post-exercise protein synthesis following a single session.
<img title="ATPase Staining of a Muscle Cross-Sectional Area" src="https://www.datocms-assets.com/25800/1649648760-muscle-fiber-types.jpg">
<h3>Following Months of Training</h3>
Additional studies have compared protein synthesis, growth factors, and satellite cell concentrations following training programs with 1 set/exercise and multiple-sets/exercise protocols.&#xA0;Mitchell et al. compared 18 novice exercisers (age: 21&#xA0;&#xB1; 1 years) with each leg randomly assigned to 1 of 3 protocols of knee extensions for 10 weeks, 3x/week, and reps until failure/set. The 3 protocols included 1 set/exercise at&#xA0;80% of 1-RM loads, 3&#xA0;sets/exercise at&#xA0;80% of 1-RM loads, and&#xA0;3&#xA0;sets/exercise at 30% of 1-RM loads. The findings demonstrated that the 80% of 1-RM load groups exhibited significantly larger increases in maximum strength; however, hypertrophy and protein synthesis were similar for all groups (13). Hansen et al. compared 21 novice exercisers (age:&#xA0;26.6 &#xB1; 1.6 years) randomly assigned to either a more upper body group (1 set/exercise lower body and 3 set/exercise upper body group), or a more lower body group (3 set/exercise lower body and 1 set/exercise upper body group). Both groups performed a full body routine&#xA0;(leg press, leg extensions, leg curls, seated chest press, seated rows, lat pulldowns, bicep curls, and shoulder press),&#xA0;for 11 weeks, 3x/week, 70% of 1-RM loads, with 7-10 reps/set. Findings demonstrated that both groups exhibited similar elevations in post-exercise serum concentrations of various growth&#xA0;factors (myostatin, mechano-growth factor, hepatocyte growth factor, fibroblast growth factor-2, and vascular endothelial growth factor). Additionally, the more lower body group exhibited greater increases in vastus lateralis satellite cells, but both groups exhibited similar increases in upper trapezius satellite cells. Interestingly, the messenger RNA expression for growth factors peaked after 2 weeks of training (14). A similar study by Hammarstrom et al. compared 34 novice exercisers (16 males, 23.6 &#xB1; 4.1 years; 18 women, 22&#xA0;&#xB1; 1.3 years), with each leg of the exerciser randomly assigned to a 1 set/lower body exercise or 3 set/lower body exercise protocol. All participants completed a full body program (<a id="unilateral" data-tip="1551" target="_blank" href="/glossary-term/unilateral" class="glossary">unilateral</a> leg press, leg curls, knee extensions, bench press, lat pull-downs, and either shoulder press or seated rows) for 12 weeks, 2-3x/week, 7-10 RM/set, 1.5 - 3 min rest between sets, and 1 set or 3 sets/leg for lower body, and 2 sets/exercise for upper body. The 3 sets/leg protocol resulted in larger increases in <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> cross-sectional area (CSA)&#xA0;and strength, a larger&#xA0;reduction in type IIX <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> fibers (shift to type IIa <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> fibers), and a significantly larger increase in protein synthesis (phosphorylation of S6-kinase&#xA0;1,&#xA0;greater rested-state total RNA, exercise-induced c-Myc mRNA expression). Benefits were correlated with an increase in the accumulation of total RNA at Week&#xA0;2 in the 3 set/leg protocol, with every 1% difference increasing the odds of benefit by 7.0% (15). These studies suggest that training for 10-12 weeks with additional sets/exercise is likely to result in significantly larger increases in protein synthesis and satellite cell proliferation; however, lower body muscles may exhibit larger increases than the upper body muscles.

Protein Synthesis and Satellite Cell Concentration

<h3>Following a Single Session with Impaired Glucose Sensitivity</h3>
Several studies have compared serum concentrations of glucose and insulin, following a single session with 1 set or multiple-sets/exercise, in individuals with impaired glucose <a id="sensitivity" data-tip="1226" target="_blank" href="/glossary-term/sensitivity" class="glossary">sensitivity</a>. An RCT by Turner et al. compared 8 experienced exercisers with type I diabetes (age: 38 &#xB1; 6 years) who completed a full body routine (bench press, knee extensions, shoulder press, pec deck, squats, lat pulldowns, seated rows, and split squats) with 60-70% 1-RM, 10 reps/set, 2 min rest between sets, 1 min rest between exercises, a moderate (2:0:2) tempo, and 1 set, 2 sets, or 3 sets/exercise performed on separate days. The findings demonstrated that compared to pre-exercise values, 1 set/exercise and 2 sets/exercise actually increased blood glucose concentrations; however, 3 sets/exercise returned concentrations to pre-exercise values. Note, creatine kinase levels were similar to pre-exercise values 24 hours post-exercise for all protocols (no differences in <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> damage) (16).&#xA0;A study by Black et al. compared 17 novice exercisers (age: 29.9 &#xB1; 9.6 years) with elevated fasting glucose (100-125 mg/dL) who completed a full body program (a combination of machines and free weights including squats, horizontal leg press, lunges, step-ups, bench press, lat pull-downs, shoulder press, and upright rows) on 4 separate days, with 12-15 RM/set (65% 1-RM) or 6-8 RM/set (85% 1-RM), and 1 set/exercise or 4 sets/exercise. The findings demonstrated that 24 hours post-exercise, all protocols increased insulin <a id="sensitivity" data-tip="1226" target="_blank" href="/glossary-term/sensitivity" class="glossary">sensitivity</a>, multiple-sets/exercise resulted in larger decreases in fasting plasma glucose concentrations, larger loads resulted in larger increases in fasting insulin concentrations, and overall the 4 sets/exercise with&#xA0;6-8 RM/set (85% 1-RM) resulted in the largest effect sizes (17). These studies demonstrated that individuals with impaired insulin <a id="sensitivity" data-tip="1226" target="_blank" href="/glossary-term/sensitivity" class="glossary">sensitivity</a> may experience an initial spike in serum glucose concentrations during the first 1-2 sets, followed by a return to pre-exercise values with the 3rd set. Further, 24 hours post-exercise additional sets/exercise resulted in larger increases in fasting plasma insulin and decreases in fasting plasma glucose. Note, the number of sets/exercise did not have a significant effect on plasma creatine kinase concentrations, implying <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> damage did not significantly increase.
<h3>Following a Single Session with Normal Glucose Sensitivity</h3>
Three studies investigated the effects of sets/exercise on serum concentrations of insulin, glucose, and blood lipid profiles of individuals with normal glucose <a id="sensitivity" data-tip="1226" target="_blank" href="/glossary-term/sensitivity" class="glossary">sensitivity</a> following a single-bout of exercise. An RCT by Zafeiridis et al. compared 10 experienced exercises (age: 24.6&#xA0;&#xB1; 1.5 years) performing 4 sets/exercise or 8 sets/exercise on separate days. The exercise protocols included a full body program (leg extensions, bench press, leg press, lat pull-downs, calf raises, bicep curls, triceps extensions, and sit-ups) with 12 RM/set, 90 sec rest between sets, 2 min rest between exercises, followed by a pre-planned meal. The findings demonstrated that additional sets/exercise did not have a significant effect on post-exercise, or post-high-fat meal, serum concentrations of glucose, insulin, or triacylglycerol levels (18).&#xA0;An RCT by Shannon et al. compared 10 experienced exercisers (age: 23.4 &#xB1; 2.5 years) performing&#xA0;1, 3, or 5 sets/exercise on separate days. All exercisers performed a full body program (squats, bench press, Romanian deadlifts, lat pull-downs, military press, leg extensions, bent over rows, and leg curls) with 75% 1-RM loads, followed by a pre-planned meal. The findings demonstrated that sets/exercise did not have a significant effect on post-exercise and/or post-meal serum concentrations of glucose, blood insulin, or triacylglycerols (19).&#xA0;An RCT by Correa et al. compared 39 post-menopausal novice female exercisers (age: 59.5 &#xB1; 4.8 years) randomly assigned to a control group (no additional activity), 1 set/exercise group, or 3 sets/exercise group. The exercise groups completed a full body program of eight exercises (bench press, biceps curls, triceps with free weights, one-arm dumbbell rows, leg press, knee extensions, leg curls, and abdominal crunches) for 15 RM/set, a moderate (2:0:2) tempo, and 40 sec rest between sets. Note, diets were monitored for the 3 days prior to re-assessment. The findings demonstrated that the multi-set group burned significantly more calories, but basal lipid (total cholesterol, HDL, LDL, and triglycerides) and glucose profiles were similar for both groups 16 hours post-exercise (20).&#xA0;These studies demonstrate that additional sets/exercise did not have a significant effect on post-exercise or post-meal, serum concentrations of glucose, blood insulin, or lipid profiles in individuals with normal insulin <a id="sensitivity" data-tip="1226" target="_blank" href="/glossary-term/sensitivity" class="glossary">sensitivity</a>.
<h3>Following Months of Training with Normal Glucose Sensitivity</h3>
Several studies have investigated serum concentrations following training programs with 1 set/exercise and multiple-sets/exercise. Two publications from an RCT by Correa et al. compared 35 post-menopausal female novice exercisers (age: 59.5 &#xB1; 6.3 years)&#xA0;randomly assigned to a control group (no additional activity), a 1 set/exercise group, or a 3 sets/exercise group. The exercise groups performed a&#xA0;full body program (bench press, biceps curls, triceps halters, 1-arm row back, leg press, knee extensions, knee flexions, and abdominal crunches) for 11 weeks, 3x/week, 15 RM/set, a moderate (2:0:2) tempo, and 40 sec rest between sets. Note, diets were monitored throughout the program. The findings of the study demonstrated that both groups exhibited similar increases in strength, <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> thickness, and no change in post-exercise serum concentrations of blood triglycerides (high-density lipoprotein, low-density lipoprotein, and total cholesterol). However, the 3 sets/exercise group exhibited a significant reduction in resting glucose, resting blood triglycerides, and postprandial lipaemia (circulating triglycerides following the consumption of a meal) (21, 22).&#xA0;An RCT by Nunes et al. compared 32 post-menopausal women (age: 45+ years) randomly assigned to a control group (no exercise), 3 sets/exercise group, or 6 sets/exercise group. The exercise groups completed a full body program (Smith machine half squats, leg curls, leg extensions, bench press, machine rows, lat pull downs, barbell curls, and triceps pulleys) for 16 weeks, 3x/week, 70% of 1-RM loads, 90 sec rest between sets, and a moderate (1:0:1) tempo.&#xA0;The findings demonstrated that both groups exhibited similar gains in strength and improvements in body fat percentage; however, the 6 sets/exercise group exhibited significant changes in waist-hip ratio, waist circumference, and a decrease in total cholesterol and LDL-c. Further, the 6 sets/exercise group exhibited larger changes in&#xA0;glycated hemoglobin (HbA1c%) and IL-6 (23). Last,&#xA0;An RCT by Cunha et al. compared 65 older female novice exercisers (age: 60+ years) randomly assigned to a control group (no additional activity), a 1-set/exercise group, or 3 sets/exercise group. The exercise groups completed a full body program&#xA0;(chest press, leg press, seated rows, knee extensions, preacher curls, leg curls, triceps press downs, and seated calf raises) for 12 weeks, 3x/week, 10-15 reps/set, a moderate (2:0:1) tempo, 1-2 min rest between sets, and 2-3 min rest between exercises. Note, participants were asked to maintain their normal diet throughout the intervention.&#xA0;The findings demonstrated&#xA0;neither group demonstrated a significant reduction in HDL,&#xA0;both the 1 set/exercise and 3 sets/exercise groups demonstrated similar reductions in LDL and total cholesterol, and&#xA0;the 3 sets/exercise group exhibited a larger decrease in serum concentrations of post-exercise glucose,&#xA0;fasting triglycerides, VLDL, and c-reactive protein (24). In summary, the findings of these studies suggest that training for 11-16 weeks with additional sets/exercise results in larger decreases&#xA0;in glycated hemoglobin (HbA1c%), IL-6, resting and post-exercise glucose, resting fasting triglycerides, and c-reactive protein. However, additional sets/exercise may not have a significant effect on cholesterol (total cholesterol, LDL, HDL, or LDL/HDL ratio).

Glucose, Insulin, and Triglycerides

<h3>Cardiovascular Response to a Single Session</h3>
Research has investigated the influence of sets/exercise on the cardiovascular system.&#xA0;As mentioned above, Cintineo et al. compared 19 experienced male exercisers (age: 21.11 &#xB1; 2.5 years) randomly assigned to volume-equated (time under <a id="tension" data-tip="1229" target="_blank" href="/glossary-term/tension" class="glossary">tension</a>) protocols of&#xA0;1 set/exercise with a slow (4:0:2) tempo, or 3 sets/exercise with a faster (1:0:1) tempo. All participants performed a lower body resistance training program,&#xA0;with 10-RM/set, and 90 sec rest between sets.&#xA0;The findings demonstrated that HR between sets was higher for the 1 set/slower protocol, but peak HR was higher for the 3 set/faster protocol (3).&#xA0;An RCT by Polito et al. compared 24 experienced exercisers (age: 23 &#xB1; 1 years) randomly assigned to a control group (no additional activity), bicep curls group, or leg extensions group. The exercise groups either performed 6 sets/exercise or 10 sets/exercise (on separate days), with 10 reps/set, 12 RM loads, and 2 min rest between sets. The study demonstrated that only 10 sets of leg extensions resulted in a significant post-exercise decrease in systolic blood pressure (for 60 minutes), and a significant decrease in mean arterial pressure (for 30 minutes) (25).&#xA0;A study by Fiqueiredo et al. compared 11 experienced exercisers (age:&#xA0;26.1 &#xB1; 3.6 years) performing 1 set, 3 sets, or 5 sets/exercise on separate days. All exercisers performed a full body routine (bench press, lat pull downs, shoulder press, bicep curls, triceps extensions, leg press, leg extension, and leg curls), 8-10 reps/set, 70% of 1-RM load, 2 min rest between sets. The findings demonstrated significant decreases in systolic blood pressure, mean arterial pressure, and heart rate variability during the 60 min following the 3 sets and 5 sets/exercise protocols. The 5 sets protocol resulted in the largest decreases (26). These studies suggest that&#xA0;faster rep tempos or additional sets/exercise may result in higher peak HRs between sets; however, slower tempos and longer time-under-tension may result in higher average HRs between sets. Further, additional sets/exercise may result in larger changes in post-exercise blood pressure, including a significant decrease in average systolic blood pressure for up to 60 minutes, and average arterial pressure for up to 30 minutes.&#xA0;
<h3>Cardiovascular Improvements following Weeks of Training</h3>
Research suggests that cardiovascular improvements following weeks or months of training may be influenced by additional sets/exercise. A study by Esquivel et al. compared 35 novice exercisers (age: 22 &#xB1; 1.89 years) randomly assigned to a 1 set/exercise group or a 3 sets/exercise group. Both groups performed an 8-station full-body circuit training program (Station 1: biceps curls, triceps extensions, and punch-outs; Station 2: knee flexions, knee extensions, and calf raises; Station 3: pullbacks, and pullovers; Station 4: squats and step lunges; Station 5: bench press and military press; Station 6: seated row and lat pull downs; Station 7: pull and jerk, and situps; Station 8: back extension - McKenzie exercises) for 5 weeks, 3x/week, and 8-12 RM/set. The findings demonstrated that both groups exhibited significant but similar increases in strength, and similarly exhibited no change in forearm reactive hyperemic blood flow, venous capacitance, and outflow. However, the individuals with the lowest vascular values exhibited some improvement (no statistical difference between groups) (27). An RCT by Polito et al compared 38 novice exercisers with hypertension (age: 58.1 &#xB1; 2 years) randomly assigned to a control group (no additional activity), 1 set/exercise group, or 3 sets/exercise group. The exercise groups completed a full body routine (bench press, leg press, knee extensions, and lat pulldowns) for 12 weeks, 3x/week, 12-15 reps/set, and 60-90 sec rest between sets. The findings demonstrated that both groups exhibited similar increases in strength, but only the 3 sets/exercise group exhibited a decrease in resting blood pressure (28). A study by Abrahin et al. compared 30 elderly (age: 60 - 80 years) deconditioned individuals with a history of exercise experience, performing a full body routine (bench press, deadlifts, <a id="unilateral" data-tip="1551" target="_blank" href="/glossary-term/unilateral" class="glossary">unilateral</a> rows, standing calf raises, and lower abdominal exercises) for 12 weeks, 2x/week, 8-12 RM/set, 1.5 - 2 min rest between sets, and either 1 set/exercise with a moderate (2:0:2) tempo, or 3 sets/exercise with a fast (1:0:1) tempo. The findings demonstrated that both groups exhibited similar improvements in strength, functional outcome measures (sit-and-stand <a id="assessment" data-tip="1482" target="_blank" href="/glossary-term/assessment" class="glossary">test</a>), and maximal inspiratory and maximal expiratory pressure (29). These studies suggest that individuals with assessed cardiovascular deficits, following strength training for 5-12 weeks, may exhibit significant improvements (vascular response to exercise, decrease in resting blood pressure, and maximum inspiratory and expiratory pressure); however, the magnitude of improvement may not be influenced by additional sets/exercise.

Sets per Exercise: Cardiovascular and Respiratory Improvements

Additional sets/exercise is likely to have a significant effect on caloric expenditure. Mookerjee et al. compared 12 male and&#xA0;12 female experienced exercisers (age: 21.4 &#xB1; 1.3 years) performing 1-set/exercise and 3 sets/exercise protocols on separate days. Both protocols included an upper body routine (bench press, lat pull-downs, military press, triceps pushdowns, and biceps curls) with 70% of 1-RM loads, 10 reps/set, a moderate (2:0:1-2) tempo, 3 min rest between exercises, and 2 min rest between sets. The findings demonstrated that both protocols resulted in a similar rate of energy expenditure; however, heart rate (HR), respiratory rate, relative Vo2, respiratory exchange ratio, and minute ventilation were significantly higher for the 3 sets/exercise protocol. Further, men burned a significantly larger number of calories than women (30). In several publications from an&#xA0;RCT mentioned above, Correa et al. compared 39 post-menopausal novice female exercisers (age: 59.5 &#xB1; 4.8 years) randomly assigned to a control group (no additional activity), a 1-set/exercise group, or a 3 sets/exercise group. The findings demonstrated that energy expenditure, excess post-exercise oxygen consumption (EPOC), and post-exercise fat oxidation were significantly higher for the 3/set exercise group when measured 16 hours after the last session (20-22).&#xA0;However, a study by Heden et al. compared 8 overweight novice exercisers (age: 21.0 &#xB1; 1.5 years) who completed 1 set/exercise and 3 sets/exercise protocols on separate days. Both days included a full body program (leg press, leg curls, calf raises, bench press, lat pull-downs, shoulder press, biceps curls, triceps extensions, abdominal crunches, and back extensions) performed as 3 circuits of 3-4 exercises, 10 RM/set, 30 sec rest between exercises, 4 min rest between circuits, and a slow (4:0:2) tempo. Both protocols resulted in similar increases in respiratory exchange ratio and resting caloric expenditure at 24, 48, and 72 hours post-exercise (31). Last, a study by Haddock et al. compared 15 experienced female exercisers (age:&#xA0;24.2 + 1.2 years) performing 1/set exercise and 3 sets/exercise on separate days. Both protocols included a full body program of 9 exercises (bench press, leg press, lat pulldowns, leg curls, overhead press, knee extensions, bicep curls, tricep pulldowns, and crunches) with 8-RM loads, reps until failure/set, and either 1 set/exercise or 3 sets/exercise. The findings demonstrated that 3 sets/exercise resulted in a larger increase in energy expenditure during the routine; however, both protocols resulted in similar EPOC (32). In summary, these studies imply that additional sets/exercise are likely to result in a significant increase in HR, respiratory rate, relative VO2, respiratory exchange ratio, caloric expenditure, and initial EPOC (less than 24 hours). However, it is unlikely that additional sets/exercise has a significant effect on EPOC and resting metabolic rate more than 24 hours post-exercise.
<img alt="A graph showing the effects of exercise on EPOC" title="Image of the effect circuit training has on Excess Post-Exercise Oxygen Consumption" src="https://www.datocms-assets.com/25800/1661747092-epoc-compressed.jpg">

Sets per Exercise: Energy Expenditure, Excess Post-Exercise Oxygen Consumption, and Fat Oxidation

Sets per Exercise and Body Composition

<h3>Novice Exercisers</h3>
Several studies comparing the number of sets/exercise performed by novice exercisers reported no significant change in body composition.&#xA0;Bickel et al. compared 20 novice female exercises (age: 19-22 years) randomly assigned to a 1 set/exercise group or 3 sets/exercise group. All participants performed 5 exercises (bench press, leg press, seated rows, back squats, and shoulder press) for 6 weeks, 2x/week, with 1-2 min rest between sets. The findings demonstrated that both groups exhibited similar improvements in strength, but neither group exhibited significant changes in body composition (33).&#xA0;Riberio et al. compared 30 novice exercisers (age: 60+ years) randomly assigned to a 1 set/exercise or 3 sets/exercise group. All participants performed a full body program (chest press, horizontal leg press, seated rows, knee extensions, preacher curls, leg curls, triceps pushdowns, and seated calf raises) for 12 weeks, with &quot;sessions on non-consecutive days&quot; (3x/week?), 10-15 RM/set, 1-2 min rest between sets, and a moderate (2:0:1) tempo. The findings demonstrated that 3 sets/exercise resulted in significantly larger increases in strength; however, neither group exhibited significant changes in body composition (34). Similarly, Galvao et al. compared 8 novice exercisers (age: 65 - 78 years) randomly assigned to a 1 set/exercise or 3 sets/exercise group. All participants performed a full body program (chest press, seated rows, triceps extensions, biceps curls, leg press, leg curls, and leg extensions) for 20 weeks, 2x/week, and 8 RM/set. The findings demonstrated that the 3 sets/exercise group exhibited larger improvements for most assessments; however, neither group exhibited significant changes in body composition (35). These studies suggest that resistance training with 1 set/exercise or 3 sets/exercise is not sufficient for novice exercisers to exhibit a significant decrease in body fat percentage; however, it should be noted that the study on young participants was only 6 weeks long, and the 2 additional studies compared elderly participants.
<img alt="Skinfold caliper used to measure body fat" title="Skinfold calipers are one method which individuals use to measure body fat percentages" src="https://www.datocms-assets.com/25800/1661924050-body_fat_caliper-compressed.png">
<h3>Experienced Exercisers</h3>
Several additional studies demonstrate that the body composition of experienced exercisers may not change following 1 set/exercise or multiple-sets/exercise.&#xA0;Kramer et al. compared 43 experienced exercisers (age:&#xA0;20.3 &#xB1; 1.9 years) randomly assigned to 1 of 3 groups including, a group performing 1 set/exercise with 10-RM loads and reps to failure/set, a group performing 3 sets/exercise with 10 reps/set (not necessarily to failure), or a group performing 3 sets/exercise with 2-10 reps/set (variable load/not necessarily to failure). All participants completed a full body exercise program (Mondays and Fridays - Squats, Push Press, Bench Press, Crunches; Wednesdays - Pull from mid-thigh, Leg Curls, Bent-over Rows, Crunches) for 14 weeks, 3x/week, and the variable load group performed heavier loads on Fridays. The findings demonstrated that none of the groups exhibited significant changes in body mass or body fat percentage (36). Rhea et al. compared 16 experienced male exercises (age: 19-23 years) randomly assigned to a 1 set/exercise group or a 3 sets/exercise group. Both groups performed bench press and leg press for 12 weeks, 3x/week, 4-8 RM/set (daily undulating periodization), and 1-2 min rest between sets. Findings demonstrated significant increases in strength for both groups; however, neither group exhibited a significant change in body composition (37). Kemmler et al. compared 74 post-menopausal experienced female exercisers (age: 56.5&#xA0;&#xB1; 3.1 years) in a cross-over study that randomly assigned exercisers to start with 12 weeks of a periodized 1 set/exercise program, followed by 5 weeks of lighter intensity training, followed by 12 weeks of a periodized 2-4 set/exercise program, or the reverse (start with multi-set, then lighter intensity, then single-set). All participants performed a full body program for a total of 29 weeks, 4x/week, with a 2-day split routine (2x/week Machine Program: horizontal leg press, leg curls, leg abductions, leg adductions, leg extensions, rowing, lat pull downs, back extensions, seated bench press, abdominal flexion, and shoulder raises; 2x/week Free Weight Program: wide-stance deadlifts, 1-arm row, wide-grip bench press), 65-90% of 1-RM loads (periodized training), either 1 set/exercise or 2-4 sets/exercise, and a moderate (2:1:2) tempo. The findings demonstrated that 1-RM strength significantly increased during the multi-set/exercise phase and decreased during the single-set/exercise phase; however, neither group exhibited significant changes in&#xA0;body mass or body composition during either phase (38). These studies suggest that experienced lifters are unlikely to exhibit significant changes in body mass, body composition, or body fat percentage following a resistance training program, regardless of the number of sets/exercise. However, it may be reasonable to consider that the goal of the programs described in the cited studies was likely strength and not specifically body composition change.
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 Author&apos;s Note: Statistically Significant Changes in Body Fat Percentage are Challenging to Demonstrate
 It should be noted that studies investigating the correlation between exercise and changes in body fat percentage are inconsistent. This may be due to numerous factors including the&#xA0;<a id="accuracy" class="glossary" href="https://brookbushinstitute.com/glossary-term/accuracy" target="_blank" rel="noopener" data-tip="1218">accuracy</a>&#xA0;of body fat measurement techniques (e.g. relatively large margin of error), the relatively small sample sizes used in most exercise science research, and the relatively small change in percentages that occur following long periods of training (e.g. 15% to 13% body fat). Note, a change of 2% body fat is a pride-worthy accomplishment that likely represents a loss of 3 - 5 lbs of fat and a caloric deficit of between 10,000 - 15,000 calories. Unfortunately, the difference between 15% and 13% body fat, with a sample size of 10 participants, may be mathematically insufficient to demonstrate statistically significant changes with an industry standard of &quot;p-value &#x2264; 0.05&quot;.
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<h3></h3>

No Change in Body Fat Percentage

<h3>Additional Sets/Exercise Increases Body Fat Percentage Change</h3>
There are several studies that have demonstrated significant changes in body composition when comparing 1 set/exercise and multiple-sets/exercise.&#xA0;An RCT by Cunha et al. compared 62 novice female exercisers (age: 68.0 &#xB1; 4.3 years) randomly assigned to a control group (no additional activity), a 1 set/exercise group, or 3 sets/exercise group. All exercisers performed a full body resistance training program (chest press, leg press, seated rows, knee extensions, preacher curls, leg curls, triceps press downs, and seated calf raises) for 12 weeks, 3x/week, 10-15 RM/set, a moderate (2:0:1) tempo, 1-2 min rest between sets, 2-3 min rest between exercises, and either 1 set/exercise or 3 sets/exercise. The findings demonstrated that the 3 sets/exercise group exhibited significantly larger increases in strength, and improvements in body fat percentage; however, both groups exhibited similar increases in lean mass when compared to controls (42). Marzolini et al. compared 53 novice exercises (age: 61 &#xB1; 2 years)&#xA0;randomly assigned to an aerobic training group, aerobic training and 1 set/exercise group, or aerobic training and 3 sets/exercise group. Resistance training included a full body program (bent over dumbbell rows, half squats, alternating arm bicep curls, heel raises, standing <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> raises, leg curls, <a id="supine" data-tip="1562" target="_blank" href="/glossary-term/supine" class="glossary">supine</a> <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> raises, curl up abdominal exercises, triceps extensions, and four point alternating arm and leg lift) for 29 weeks, 2x/week, 60-75% of 1-RM loads, with 10-15 reps/set. The findings demonstrated that the combination of resistance training and aerobic training resulted in larger increases in strength and endurance than aerobic training alone, and both resistance training and aerobic exercise groups exhibited a significant decrease in body fat percentage and the aerobic training alone group did not. Further,&#xA0;the aerobic training and 3-sets/exercise group exhibited a trend toward larger increases in VO2 max, were the only group to exhibit a significant increase in&#xA0;ventilatory anaerobic threshold, exhibited larger increases in strength, and were the only group to exhibit significant increases in lean mass (43). These studies suggest that&#xA0;resistance training can be an effective intervention for improving body composition, and additional sets/exercise may result in larger improvements. It is worth noting that studies supporting this assertion included training durations of 12-29 weeks (significantly longer than most studies demonstrating no significant change in body composition).
<h3>Larger Differences with Longer Duration Training</h3>
Two studies allude to multiple-sets/exercise programs resulting in larger differences in body composition as training durations increase. Kraemer et al. compared 24 collegiate female tennis athletes (age: 19&#xA0;&#xB1; 1.2 years) randomly assigned to a control group (no resistance exercise), a single-set circuit program, or a multi-set periodized program. All participants performed a full body program&#xA0;(e.g. bench press, leg press, leg curls, lat pulldowns, etc.) for 9 months, 2-3x/week, the single-set group performed 1 set of 8-10 RM/set, and the multi-set group performed 2-4 sets of 4-15 RM/set (periodized) with 1-3 minutes rest between sets. The findings demonstrated that neither group exhibited a significant change in weight; however, the multi-set program exhibited a significant increase in lean body mass and a decrease in body fat percentage during reassessment at 4, 6, and 9 months (44).&#xA0;As mentioned above, an RCT by Marx et al. compared 34 novice female exercisers (age: 22.2&#xA0;&#xB1; 5.7 years) randomly assigned to a 1 set/exercise or 2-4 sets/exercise group, for 24 weeks. The findings demonstrated that both groups exhibited significant improvement in strength and body fat percentage (despite no change in body weight) at 12 weeks; however, only the 2-4 sets/exercise group exhibited additional improvements at 24 weeks (6). Marshall et al. compared 32 experienced exercisers (age: 28 &#xB1; 1.2 years) randomly assigned to groups performing either 1 set, 4 sets, or 8 sets/exercise. All groups completed a full body program (exercises undisclosed) for 10 weeks, 2x/week, 80% of 1-RM loads, 6-12 reps/set, and 3 min rest between sets. Note, dietary intake was monitored. The findings demonstrated that during re-assessment following 3 weeks of training, improvements in squat strength were similar for the 1-set and 4-set groups; however, the 8-set group exhibited significantly larger increases and continued to improve more during reassessments at 6 weeks and 10 weeks. Additionally, this study demonstrated that all groups exhibited significant and similar decreases in body fat% at 6 weeks; however, only the 8-set group exhibited a significant increase in lean body mass (45). These studies suggest that improvements in body composition increase with additional sets/exercise and the differences increase with training duration.

Significant Differences in Body Fat Percentage

Sets per Exercise and Hypertrophy (Cross Sectional Area)

Three studies failed to demonstrate differences in <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> hypertrophy, or cross-sectional area (CSA), following programs with additional sets/exercise.&#xA0;An RCT by Munn et al. compared 115 novice exercisers (age: 20.6&#xA0;&#xB1; 6.1 years) who were randomly assigned to 1 of 5 protocols, a control (no additional activity), 1 set/exercise with a slow (3:0:3) tempo, 1 set/exercise with a fast (1:0:1) tempo, 3 sets/exercise with a slow (3:0:3) tempo, or 3 sets/exercise with a fast (1:0:1) tempo. All exercisers performed <a id="unilateral" data-tip="1551" target="_blank" href="/glossary-term/unilateral" class="glossary">unilateral</a> machine bicep curls for 6 weeks, 3x/week, with 6-8 RM/set, and 2 min rest between sets. The findings demonstrated that 3 sets/exercise resulted in larger improvements in strength than 1 set/exercise, and that a fast tempo improved strength more than a slow tempo. However, none of the groups exhibited a significant increase in upper arm CSA (46).&#xA0;An RCT by Mcbride et al. compared 28 novice exercisers (age: 22&#xA0;&#xB1; 3.5 years) randomly assigned to a control group (no additional activity), 1 set/exercise group, or 6 sets/exercise group. All exercisers performed their pre-determined number of sets for leg press and bicep curls (and ancillary exercises: chest flye, back extensions, abdominal curl-ups), for 12 weeks, 2x/week, 6-10 RM/set, and 2-3 min rest between sets. The findings demonstrated that both groups improved 1-RM strength for the leg press and bicep curls, and that the 6 set/exercise group exhibited significantly larger strength gains. However, neither group exhibited significant changes in upper arm CSA or thigh CSA (47). These studies suggest that additional sets/exercise may not influence <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> hypertrophy (CSA); however, considering the number of studies opposing this assertion, it is likely important to consider the limitations of these studies; for example, the Munn et al. study only lasted 6 weeks, and both studies included relatively small volumes of exercises (few total exercises).
<img src="https://www.datocms-assets.com/25800/1669061630-abdominal-hypertrophy.jpg" title="Abdominial muscle hypertrophy" alt="Example of hypertrophy in the abdominial muscles">

Additional Sets per Exercise Does Not Increase Hypertrophy

<h3>Novice Exercisers</h3>
Several studies with novice exercisers demonstrated similar increases in <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> CSA following training programs with 1 set/exercise or multiple sets/exercise. As mentioned above, Mitchell et al. compared 18 novice exercisers (age: 21&#xA0;&#xB1; 1 years) with each leg randomly assigned to a knee extension protocol, for 10 weeks, with reps until failure/set. The 3 protocols included 1 set at&#xA0;80% of 1-RM loads, 3&#xA0;sets at&#xA0;80% of 1-RM loads, and&#xA0;3&#xA0;sets at 30% of 1-RM loads. The findings demonstrated that both 80% of 1-RM load groups exhibited larger increases in maximum strength; however, hypertrophy and protein synthesis were similar for all groups (13).&#xA0;An RCT by Starkey et al. compared 48 novice exercisers (age: 18-50 years) randomly assigned to a control group (no additional activity), a 1 set/exercise group, or a 3 sets/exercise group. All exercisers performed knee extensions and knee flexions for 14 weeks, 3x/week, 8-12 RM/set, a slow (4:0:2) tempo, and 1-3 min rest between sets. The findings demonstrated that the exercise groups exhibited similar increases in strength (<a id="torque" data-tip="1294" target="_blank" href="/glossary-term/torque" class="glossary">torque</a> at multiple angles) and thigh <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> CSA (48).&#xA0;An RCT by Correa et al. compared 47 novice exercisers (age: 18 - 30 years) randomly assigned to 1 of 5 groups performing a leg extension protocol, including a control group (no additional activity), 20% of 1-RM loads group,&#xA0;20% of 1-RM loads with blood flow restriction (BFR) group, 50% of 1-RM loads group, or 50% of 1-RM loads with BFR group. Further, exercisers had their legs randomly assigned to 1 set or 3 sets, and the programs were performed for 8 weeks, 2x/week, 1 min rest between sets, and a moderate (1:0:1) tempo. The findings demonstrated that all groups exhibited significant but similar increases in 1-RM strength and thigh CSA (49). These studies suggest that during the initial 8-14 weeks of training, novice exercisers may not exhibit significantly larger improvements in <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> CSA as a result of additional sets/exercise, even when blood flow restriction (BFR) is incorporated.
<h3>Post-menopausal Females</h3>
Several studies mentioned above demonstrate that post-menopausal females may not exhibit additional hypertrophy from additional sets.&#xA0;As mentioned above, an RCT by Nunes et al. compared 34 post-menopausal female novice exercisers (age: 49-79 years) randomly assigned to a control group (no exercise), 3 set/exercise groups, or 6 set/exercise groups following 16 weeks of training.&#xA0;The findings demonstrated that both groups exhibited significant but similar improvements in 1-RM strength and lean body mass (body weight less body fat) (7). Two publications from an RCT by Correa et al. compared 35 post-menopausal novice female exercisers (age: 59.5 &#xB1; 6.3 years) randomly assigned to a control group (no additional activity), a 1 set/exercise group, or a 3 set/exercise group for 12 weeks. The findings demonstrated that both groups exhibited similar increases in strength and hypertrophy (measured with ultrasound) (21-22).&#xA0;And, another RCT mentioned above by Cunha et al. compared 62 elderly novice female exercisers (age: 60+ years) randomly assigned to a 1 set/exercise group or 3 sets/exercise group, performing a full-body resistance training program for 12 weeks. The findings demonstrated that both groups exhibited similar improvements in preacher curl and leg extension 1-RM strength, upper and lower extremity <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> quality, and similar increases in lean soft tissue (without an increase in body mass)&#xA0;(50). These studies suggest that novice post-menopausal and elderly women may exhibit significant increases in lean body mass following a resistance training program; however, during the initial 12 - 16 weeks, additional sets/exercise may not result in additional hypertrophy.

Additional Sets per Exercise Results in Similar Increases in Hypertrophy

<h3>Novice Exercisers</h3>
Three studies were located demonstrating that novice exercisers performing additional sets/exercise exhibited significant differences in hypertrophy. As mentioned above, An RCT by Radaelli et al. compared 48 novice exercisers (age: 24.1 &#xB1; 1.2 years) randomly assigned to a control group (no additional activity), 1 set/exercise group, 3 sets/exercise group, or 5 sets/exercise group for 6 months. The findings demonstrated that more sets/exercise resulted in larger increases in strength, all groups exhibited similar increases in total lean body mass; however, the 5-set/exercise group exhibited a significantly larger increase in upper arm hypertrophy (39). Also mentioned above, Hammarstrom et al. compared 34 novice exercisers (16 males, 23.6 &#xB1; 4.1 years; 18 women, 22 &#xB1; 1.3 years), with each leg of the exerciser randomly assigned to a 1 set/lower body exercise, or 3 sets/lower body exercise protocol, for 12 weeks. Note, all participants completed a full-body program. The 3 sets/leg protocol resulted in larger increases in strength and thigh CSA, and a larger reduction in type IIX <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> fibers (shift to type IIa <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> fibers) (15). Sooneste et al. compared 8 novice exercisers (age: 25 &#xB1; 2.1 years) whose arms were randomly assigned to 1 set/exercise, or 3 sets/exercise. All exercisers performed a dumbbell preacher curl program for 12 weeks, 2x/week, 80% of 1-RM loads, reps until failure/set, a moderate (2:0:2) tempo, and 1 set/exercise on one arm and 3 sets/exercise on the other. The findings demonstrated that 3 sets/exercise resulted in significantly larger increases in biceps brachii CSA, and a trend toward larger increases in strength (51). These studies suggest that novice exercisers may exhibit additional hypertrophy from additional sets/exercise. However, considering previously cited studies opposing this assertion, it is important to note that these studies included longer training programs, lasting 12 weeks to 6 months.
<h3>Experienced Exercisers</h3>
Perhaps, not surprisingly, several studies have demonstrated that experienced exercisers performing additional sets/exercise exhibit significantly larger increases in hypertrophy.&#xA0;Heaselgrave et al. compared 49 experienced exercisers (age: 18 - 35 years) randomly assigned to groups performing 9 sets, 18 sets, or 27 sets/exercise/week. All exercisers performed a pull routine (biceps curls, bent over barbell rows, and <a id="supine" data-tip="1562" target="_blank" href="/glossary-term/supine" class="glossary">supine</a> grip lat pulldowns) for 6 weeks, 1-2 sessions/week, 10-12 reps/set, 75% of 1-RM loads, moderate (3:0:1) tempo, and 3 min rest between sets. The findings demonstrated that all groups exhibited significant increases in 1-RM strength and biceps brachii CSA; however, the analysis revealed larger increases in strength and CSA for the 18 sets and 27 sets groups, and only the 27 sets group exhibited significant improvements in isometric strength (52).&#xA0;Brigatto et al. compared 27 experienced exercisers (age: 27.2 &#xB1; 7.1 years) randomly assigned to groups performing 16 sets, 24 sets, or 32 sets/muscle group/week. All groups performed a full-body split routine (bench press, dumbbell flat flyes, &quot;cable triceps&quot;, parallel back squats, leg extensions, lat pulldowns, dumbbell reverse flyes, bicep curls, and seated leg curls) for 8 weeks, 4 sessions/week, 8-10 RM loads, reps until failure/set, a moderate (1.5:0:1.5) tempo, and 1-2 minute rest between sets.&#xA0;The finding demonstrated that all protocols resulted in significant increases in bench press and back squat 1-RM strength, and biceps brachii, triceps brachii, and vastus lateralis CSA; however, the 32 set/week group exhibited significantly larger improvements than the 16 set/week group (53). Schoenfeld et al. compared 34 experienced exercisers&#xA0;(age: 23.8 &#xB1; 3.8 years) randomly assigned to groups performing 1 set, 3 sets, or 5 sets/exercise. All exercisers performed a full body routine (flat barbell bench press, barbell military presses, wide grip <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> pulldowns, seated cable rows, barbell back squats, machine leg press, and <a id="unilateral" data-tip="1551" target="_blank" href="/glossary-term/unilateral" class="glossary">unilateral</a> machine leg extensions) for 8 weeks, 3 sessions/week, 8-12 RM to failure/set, moderate (2:0:1) tempo, and 1.5 - 2 min rest between sets. The findings demonstrated that all groups exhibited significant and similar increases in bench press and squat 1-RM strength, and similar increases in biceps brachii and vastus lateralis CSA. There was a trend toward larger increases in strength and CSA for the 5 sets/exercise group; however, this trend failed to reach statistical significance (554). Last, Marzolini et al. compared 53 novice exercises (age: 61 &#xB1; 2 years)&#xA0;randomly assigned to an aerobic training group, aerobic training and 1 set/exercise group, or aerobic training and 3 sets/exercise group. Resistance training included a full body program (bent over dumbbell rows, half squats, alternating arm bicep curls, heel raises, standing <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> raises, leg curls, <a id="supine" data-tip="1562" target="_blank" href="/glossary-term/supine" class="glossary">supine</a> <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> raises, curl up abdominal exercises, triceps extensions, and four point alternating arm and leg lifts) for 29 weeks, 2x/week, 60-75% of 1-RM loads, with 10-15 reps/set. The findings demonstrated that the aerobic training and 3-sets/exercise group exhibited a trend toward larger increases in VO2 max, was the only group to exhibit a significant increase in&#xA0;ventilatory anaerobic threshold, exhibited larger increases in strength, and was the only group to exhibit significant increases in lean mass (43). These studies demonstrate that&#xA0;experienced exercisers exhibit significantly larger increases in strength and hypertrophy following&#xA0;6 - 29 weeks of training with additional sets/exercise. Note, the studies with training durations of 6-8 weeks included participants 18-35 years old; whereas, the study that included participants 60+ years old lasted 29 weeks.

Additional Sets per Exercise Results in Significant Increases in Hypertrophy

<h3>Similar Initial Differences</h3>
Several studies demonstrate that the differences in <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> CSA following 1 set or multiple-sets/exercise is initially small; however, the differences increase with time. In a group of publications, perhaps from the same experiment, Radaelli et al. compared 24 elderly novice exercisers (age: 60-74 years) randomly assigned to a 1 set/exercise group, or 3 sets/exercise group. All exercisers performed a full body program&#xA0;(knee extensions, lat pull-downs, leg press, bicep curls, leg curls, bench press, tricep extensions, hip abductions, hip adductions, and crunches) for 20 weeks, 2x/week, 6-20 RM loads/set (progressively increased loads), 2 min rest between sets, and a moderate (2:0:2) tempo. The findings demonstrated that both groups exhibited similar and significant increases in dynamic 1-RM and isometric strength, <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> CSA, <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> quality (density measured using ultrasound), and maximal EMG activity during reassessment at 6 weeks and 12 weeks. However, increases in strength, lower body CSA, and <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> quality were significantly larger for the 3 sets/exercise group during reassessment at 20 weeks (55-58).&#xA0;Kraemer et al. compared 24 collegiate female tennis athletes (age: 19&#xA0;&#xB1; 1.2 years) randomly assigned to a control group (no resistance exercise), a single-set circuit program, or a multiple-set periodized program. All participants performed a full body program&#xA0;(i.e. bench press, leg press, leg curls, lat pulldowns, etc.) for 9 months, 2-3x/week, the single-set group performed 1 set of 8-10 RM/set, and the multiple-set group performed 2-4 sets of 4-15 RM/set (periodized), with 1-3 minutes rest between sets. The findings demonstrated that neither group exhibited a significant change in body weight; however, the multi-set group exhibited a significant increase in lean body mass and a decrease in body fat percentage during reassessments at 4, 6, and 9 months (44). These studies suggest that&#xA0;1 set/exercise and multiple-sets/exercise may initially result in similar increases in <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> strength and hypertrophy; however, multiple sets/exercise result in larger increases when training programs last longer than 16 weeks.
<h3>Difference Between Upper and Lower Body</h3>
Several studies imply that the upper body and lower body may respond differently to increases in exercise volume. Ronnestad et al.&#xA0;compared 10 novice exercisers (age:&#xA0;26.6 &#xB1; 1.6 years) randomly assigned to either a more upper body group (1 set/exercise lower body and 3 sets/exercise upper body), or a more lower body group (3 sets/exercise lower body and 1 set/exercise upper body). Both groups performed a full body routine&#xA0;(leg press, leg extensions, leg curls, seated chest press, seated rows, lat pulldowns, bicep curls, and shoulder press),&#xA0;for 11 weeks, 3x/week, 70% of 1-RM loads, with 7-10 reps/set, and a maxV (2-3:0:MaxV) tempo. The findings demonstrated that the more lower body group exhibited significantly larger increases in lower body strength and thigh CSA; however, both groups exhibited similar increases in upper body strength and trapezius CSA (59). In a very similar publication (also mentioned above),&#xA0;Hansen et al. compared 21 novice exercisers (age:&#xA0;26.6 &#xB1; 1.6 years) randomly assigned to either a more upper body group (1 set/exercise lower body and 3 sets/exercise upper body), or a more lower body group (3 sets/exercise lower body and 1 set/exercise upper body group) for 11 weeks. The findings demonstrated that the more lower body group exhibited larger increases in vastus lateralis satellite cells; however, both groups exhibited similar satellite cell increases for the upper trapezius (60). Bottaro et al. compared 30 novice male exercisers (age:&#xA0;23.4 &#xB1; 2.6 years) randomly assigned to a group performing 3 sets of knee extensions and 1 set of elbow flexions, or a group performing 1 set of elbow flexions and 3 sets of knee extensions. Both groups trained for 12 weeks, 2x/week, 8-12 RM/set, 1:3 work:rest ratio, with a moderate (2:0:2) tempo. The findings demonstrated that both groups exhibited significant and similar increases in biceps brachii strength and CSA, only the 3 sets of knee extensions group increased knee extension, and neither group exhibited significant increases in thigh CSA (61). Paulsen et al. compared 20 novice exercisers (age: 20-30 years) randomly assigned to either a more upper body group (1 set/exercise lower body and 3 sets/exercise upper body), or a more lower body group (3 sets/exercise lower body and 1 set/exercise upper body). Both groups performed a full body program (squats, knee extensions, leg curls, bench press, shoulder presses, rows, and lat pull-downs), for 6 weeks, 3x/week, 7 RM/set, and a &quot;controlled&quot; eccentric followed by maximum velocity concentric tempo. The findings demonstrated that performing multiple sets had a larger influence on lower-body strength than upper-body strength; however, both groups exhibited similar increases in total lean body mass (62). These studies imply that additional sets/exercise may not increase upper-body <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> hypertrophy, but may be necessary for lower body <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> hypertrophy. However, considering previously cited research, it is likely reasonable to conclude that&#xA0;compared to upper body muscles, lower body muscles may exhibit larger increases in strength, satellite cell proliferation, and hypertrophy in response to additional sets/exercise.
<img alt="Lunges for lower body strength" title="Lunges, a common exercise used to help increase strength in the lower body" src="https://www.datocms-assets.com/25800/1668985843-guy-and-girl-leg-lunge.png" width="312" height="312">

Similar Initial Differences and Differences between Upper and Lower Body

Sets per Exercise and Strength

<h3>Single Joint Exercise Protocols</h3>
A few studies were located that demonstrated that novice exercisers exhibited similar strength increases regardless of the number of sets performed. An RCT by Steele et al. compared 26 experienced exercisers (age: 18-30 years) randomly assigned to a control group (no additional activity), a 1-set/exercise group, or a 3 sets/exercise group. All exercisers completed a lumbar extension program for 6 weeks, 1x/week, 12 reps to failure/set, 3 min rest between sets, and a slow (4:1:2) tempo. The findings demonstrated that both exercise groups exhibited similar increases in maximal voluntary isometric contraction (MVIC) strength of the lumbar extensors (63). As mentioned above, an RCT by Correa et al. compared 47 novice exercisers (age: 18 - 30 years) randomly assigned to 1 of 5 groups performing a leg extension protocol: controls (no additional activity), 20% of 1-RM loads,&#xA0;20% of 1-RM loads with blood flow restriction (BFR), 50% of 1-RM loads, or 50% of 1-RM loads with BFR. Further, exercisers had their legs randomly assigned to 1 set or 3 sets/exercise, and the program was performed for 8 weeks, 2x/week, 1 min rest between sets, with a moderate (1:0:1) tempo. The findings demonstrated all groups exhibited significant, but similar, increases in 1-RM strength and thigh CSA (49).&#xA0;Cannon et al. compared&#xA0;16-young (23.8 &#xB1; 3.7 years old) and 15-elderly (67.6 &#xB1; 6.3 years) novice female exercisers randomly assigned to a 1 set/exercise or 3 sets/exercise group. All participants performed&#xA0;bilateral leg extensions and <a id="bilateral" data-tip="1552" target="_blank" href="/glossary-term/bilateral" class="glossary">bilateral</a> leg curls for 10 weeks, 3x/week, 10 reps/set, and 50-75% 1-RM loads. The findings demonstrated that both groups exhibited significant, but similar increases in quadriceps hypertrophy, leg extension and leg curl dynamic and isometric strength, and peak EMG activity (64). Also mentioned above, Mitchell et al. compared 18 novice exercisers (age: 21&#xA0;&#xB1; 1 years) with each leg randomly assigned to one of three knee extension protocols for 10 weeks, and reps until failure/set. The 3 protocols included 1 set at&#xA0;80% of 1-RM loads, 3&#xA0;sets at&#xA0;80% of 1-RM loads, and&#xA0;3&#xA0;sets at 30% of 1-RM loads. The findings demonstrated that the 80% of 1-RM load groups exhibited larger increases in maximum strength; however, the difference between the 1 set/exercise and 3 sets/exercise protocols were not significant (13). Last, an RCT by Starkey et al. compared 48 novice exercisers (age: 18-50 years) randomly assigned to a control group (no additional activity), a 1 set/exercise group, or a 3 sets/exercise group. All exercisers performed a protocol of knee extensions and knee flexions for 14 weeks, 3x/week, 8-12 RM/set, a slow (4:0:2) tempo, and 1-3 min rest between sets. The findings demonstrated that the exercise groups exhibited similar increases in strength (<a id="torque" data-tip="1294" target="_blank" href="/glossary-term/torque" class="glossary">torque</a> at multiple angles) and thigh <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> CSA (48). Interestingly, all of these studies included novice exercisers performing protocols with only 1 or 2 single-joint exercises.&#xA0;This may imply that additional sets/exercise is unlikely to result in additional increases in strength during a training program (6-14 weeks) that only includes single-joint exercises.
<h3>Full Body (Compound Exercise) Routines</h3>
Additional studies demonstrate that novice exercisers performing 1 set/exercise or multiple sets/exercise with a full body training program may exhibit similar increases in strength when the duration of training is relatively short (less than 8 weeks). As mentioned above, Esquivel et al. compared 35 novice exercisers (age: 22 &#xB1; 1.89 years) randomly assigned to a 1 set/exercise group or a 3 sets/exercise group, while performing an 8-station full body circuit training program for 5 weeks. The findings demonstrated that both groups exhibited significant but similar increases in handgrip, knee extension, and bench press 1-RM strength (27). Also mentioned above, Bickel et al. compared 20 novice female exercisers (age: 19-22 years) randomly assigned to a 1 set/exercise group or 3 set/exercise group, while performing a full-body program of 5 exercises, for 6 weeks. The findings demonstrated that both groups exhibited similar improvements in 1-RM and 10-RM strength for all 5 lifts (33). An RCT by Abdul Kadir et al. compared 36 novice male exercisers (21 &#xB1; 0.79 years) randomly assigned to a control group (no additional activity), 1 set/exercise group, or 3 sets/exercise group. All exercisers performed a full body routine (squats, bench press, and other &quot;common exercises&quot;) for 6 weeks, 3x/week, reps until failure (8-RM)/set, 80% of 1-RM, and 2 min rest between sets. The findings demonstrated significant and similar improvements for both exercise groups during the reassessment of squat and bench press 1-RM strength, grip strength, and vertical jump height (65). Last, Silvester et al. compared 48 participants (college-aged) randomly assigned to 1 set/exercise for 10-12 reps/set, or 3 sets/exercise for 6 reps/set, with either barbell resistance or machine resistance. All exercisers performed bicep curls during a full body training program, for 8 weeks, 3x/week, with 80% of 1RM loads. The findings demonstrated that all groups (1 set, 3 sets, machine, and barbell) exhibited similar improvements in bicep curl MVIC strength (66). These studies imply that novice lifters exhibit similar benefits from programs including 1-set/exercise or multiple-sets/exercise for the initial 8 weeks of training. Alternatively, these studies could imply that more than 8 weeks is necessary to demonstrate a statistically significant difference in strength.
<img alt="A lateral pulldown a common multijoint exercise used to promote strength in the upper body" title="An example of a multijoint exercise" src="https://www.datocms-assets.com/25800/1647308412-istock-638231726.jpg" width="388" height="402">
<h3>Post Menopausal Women and Elderly Exercisers</h3>
Several studies mentioned above demonstrate that additional sets/exercise may not result in larger increases in strength for post-menopausal females and older novice exercisers. An RCT by Polito et al. compared 38 novice exercisers with hypertension (age: 58.1 &#xB1; 2 years) randomly assigned to a control group (no additional activity), 1 set/exercise group, or 3 sets/exercise group, performing a full body routine for 12 weeks. The findings demonstrated that both groups exhibited similar increases during the reassessment of bench press and knee extension 1-RM strength (28). Two similar publications from an RCT by&#xA0;Nunes et al. compared 34 post-menopausal novice female exercisers (age: 49-79 years) randomly assigned to a control group (no exercise), 3 sets/exercise group, or 6 sets/exercise group during a full-body resistance training program for 16 weeks.&#xA0;The findings demonstrated that both groups exhibited significant but similar improvements in 1-RM strength and lean body mass (7, 23).&#xA0;Additionally, two publications from an RCT by Correa et al. compared 35 post-menopausal female novice exercisers (age: 59.5 &#xB1; 6.3 years) randomly assigned to a control group (no additional activity), a 1 set/exercise group, or a 3 sets/exercise group during a full-body resistance training routine for 12 weeks. The findings demonstrated that both groups exhibited similar increases in knee extension 1-RM strength and thigh <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> CSA&#xA0;(21-22).&#xA0;Abrahin et al. compared 30 elderly deconditioned individuals (age: 60 - 80 years) with a history of exercise experience, performing a full body routine (bench press, deadlifts, <a id="unilateral" data-tip="1551" target="_blank" href="/glossary-term/unilateral" class="glossary">unilateral</a> rows, standing calf raises, and lower abdominal exercises) for 12 weeks, 2x/week, 8-12 RM/set, 1.5 - 2 min rest between sets, and either 1 set/exercise with a moderate (2:0:2) tempo, or 3 sets/exercise with a fast (1:0:1) tempo. The findings demonstrated similar improvements for maximal inspiratory and maximal expiratory pressure, 10 RM strength for bench press, deadlifts, <a id="unilateral" data-tip="1551" target="_blank" href="/glossary-term/unilateral" class="glossary">unilateral</a> rowing, and standing calf raises, and improvements in functional outcome measures (sit-to-stand <a id="assessment" data-tip="1482" target="_blank" href="/glossary-term/assessment" class="glossary">test</a>) (29).&#xA0;Last, an RCT by Cunha et al. compared 62 elderly novice female exercisers (age: 60+ years) randomly assigned to a 1 set/exercise group, or a 3 set/exercise group, performing a full-body resistance training program for 12 weeks. The findings demonstrated that both groups exhibited similar improvements in preacher curl and leg extension 1-RM strength, upper and lower extremity <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> quality, and similar increases in lean soft tissue (without an increase in body mass)&#xA0;(50). These studies suggest that post-menopausal and elderly women may exhibit significant increases in strength and lean body mass following a 12-week resistance training program; however, adding additional sets may not result in additional improvements.

Additional Sets per Exercise Does Not Increase Strength

<h2>Adult Novice Exercisers</h2>
<h3>Single-joint Exercises</h3>
Several studies mentioned above demonstrate that adult novice exercisers may exhibit significantly larger increases in strength with additional sets/exercise, even when comparing single-joint exercise protocols. An RCT by Munn et al. compared 115 novice exercisers (age: 20.6 &#xB1; 6.1 years) randomly assigned to 1 of 5 groups, a control group (no additional activity), 1 set/exercise with a slow (3:0:3) tempo, 1 set/exercise with a fast (1:0:1) tempo, 3 sets/exercise with a slow (3:0:3) tempo, or 3 sets/exercise with a fast (1:0:1) tempo. All exercise groups performed <a id="unilateral" data-tip="1551" target="_blank" href="/glossary-term/unilateral" class="glossary">unilateral</a> machine bicep curls for 6 weeks. The findings demonstrated that 3 sets/exercise resulted in larger improvements in strength than 1 set/exercise, and fast tempos improved strength more than slower tempos; however, following 6 weeks of training, 3 sets/exercise with fast or slow tempos resulted in similar increases in strength (46). An RCT by Kelly et al. compared 40 participants (age: 24.80 &#xB1; 2.78 years) randomly assigned to a control group (no additional activity), a 1-set/exercise group, or a 3 sets/exercise group. All exercisers performed a knee extension protocol on an isokinetic dynamometer at 60&#xB0;/sec, for 8 weeks, 2x/week, 8-RM/set, and 1 min rest between sets. The findings demonstrated that the 3 sets/exercise group exhibited significant improvements at 4 weeks, but no further improvement during re-assessment at 8 weeks. The control group and 1 set/exercise group did not exhibit significant increases in strength (67). Also mentioned above, Sooneste et al. compared 8 novice exercisers (age: 25 &#xB1; 2.1 years) whose arms were randomly assigned to 1 set or 3 sets/exercise of dumbbell preacher curls for 12 weeks. The findings demonstrated that 3 sets/exercise resulted in significantly larger increases in biceps brachii CSA, and a trend toward larger increases in strength (51). These studies demonstrate that novice exercisers adding sets/exercise to a single-joint exercise protocol may exhibit significantly larger improvements in strength; however, considering previously cited studies, the addition of sets/exercise to a single-joint exercise protocol may not be a <a id="reliability" data-tip="1795" target="_blank" href="/glossary-term/reliability" class="glossary">reliable</a> method for improving strength.
<h3>Full Body (Compound Exercise) Programs</h3>
Additional studies demonstrate that novice adult exercisers performing a full-body resistance training program exhibit larger increases in strength following additional sets/exercise. McGee. et al compared 27 novice exercisers (age: 17-26 years) randomly assigned to 1 of 3 groups, performing 8-12 reps to failure/set for 1 set/exercise,&#xA0;10 reps (not to failure)/set for 3 sets/exercise, or 3-10 reps/set (not to failure) for 3 sets/exercise (periodized program). All exercisers performed a full body split routine (Monday and Wednesday: squats, straight leg deadlifts, bench press, crunch; Wednesday: 1/4 squat, clean-pull, bent over rows crunches) for 7 weeks, 3 sessions/week. The findings demonstrated that all groups exhibited improvements; however, when compared to the 1 set/exercise group the multi-set groups exhibited significantly larger improvements for cycle endurance time, squat 1-RM strength, squat endurance, and squat total volume/set (68). As mentioned above, an RCT by Mcbride et al. compared 28 novice exercisers (age: 22&#xA0;&#xB1; 3.5 years) randomly assigned to a control group (no additional activity), 1 set/exercise group, or 6 sets/exercise group while performing a full body program for 12 weeks. The findings demonstrated that both groups improved 1-RM strength for leg press and bicep curls; however, the 6 sets/exercise group exhibited significantly larger strength gains (47).&#xA0;Another study mentioned above by Hammarstrom et al. compared 34 novice exercisers (16 males, 23.6 &#xB1; 4.1 years; 18 women, 22&#xA0;&#xB1; 1.3 years), with each leg of the exerciser randomly assigned to a 1 set/lower body exercise or a 3 sets/lower body exercise during a full body program for 12 weeks. The 3 sets/leg protocol resulted in larger increases in thigh CSA, and 1-RM strength during leg extensions and leg press (15). In another study mentioned above, an RCT by Radaelli et al. compared 48 novice exercisers (age: 24.1&#xA0;&#xB1; 1.2 years) randomly assigned to a control group (no additional activity), 1 set/exercise group, 3 sets/exercise group, or 5 sets/exercise group (full body program) for 6 months. The findings demonstrated that additional sets/exercise resulted in larger increases in 1-RM strength during the reassessment of&#xA0;bench press, lat pull down, shoulder press, and leg press (39). Last, Humberg et al. compared 29 novice exercisers (age: 25.7 &#xB1; 8.2 years) randomly assigned to start with 1 set/exercise or 3 sets/exercise. All participants performed a full body program (bench press, leg press, and biceps curls) for 41 weeks, 3x/week, with 8-12 RM/set. Participants either started with 1 set/exercise for 16 weeks, followed by no training for 9 weeks, followed by 3 sets/exercise for 16-weeks, or the reverse order (starting with 3 sets/exercise). The findings demonstrated that 1-RM strength of the exercises performed in the program increased more during the 3 set/exercise portion of the program (69). These studies demonstrate that&#xA0;novice exercisers may exhibit a significantly larger increase in strength following additional sets/exercise added to a full body program (including compound exercises) lasting at least 7 weeks.
<img title="Trainer working with an older client" src="https://www.datocms-assets.com/25800/1649649545-senior-fitness.jpg" alt="An older adult using squats to improve strength in the lower body">

Additional Sets per Exercise Results in More Strength: Adult Novice Exercisers

<h2>Older Novice Exercisers</h2>
<h3>Following 12 Weeks of Training</h3>
Several studies mentioned above have demonstrated that older novice exercisers may exhibit additional increases in strength when additional sets/exercise are performed during a 12-week program.&#xA0;Riberio et al. compared 30 novice exercisers (age: 60+ years) randomly assigned to a 1 set/exercise group or a 3 sets/exercise group. All participants performed a full-body program for 12 weeks. The findings demonstrated that 3 sets/exercise resulted in significantly larger increases in chest press and knee extension 1-RM strength (34).&#xA0;An RCT by Cunha et al. compared 62 novice female exercisers (age: 68.0 &#xB1; 4.3 years) randomly assigned to a control group (no additional activity), a 1 set/exercise group, or a 3 sets/exercise group. All exercisers performed a full-body resistance training program for 12 weeks. The findings demonstrated that the 3-set/exercise group exhibited significantly larger increases in chest press, knee extension, and preacher curl 1-RM strength&#xA0;(42). And, Barbalho et al. compared 376 novice participants (age: 70.5&#xA0;&#xB1; 5.88 years) randomly assigned to a low-volume group (8 -12 sets/week upper body, 4-6 sets/week for lower body: 1-3 sets/exercise) or high-volume group (16-20&#xA0;sets/week upper body, 8-10 sets/week for lower body: 2-4 sets/exercise). Both groups performed a full-body program for 12 weeks. The findings demonstrated that both groups exhibited an increase in performance on several strength and functional tests; however, the high-volume group exhibited larger improvements during reassessment of 1-RM leg press strength, the 30-sec arm curls <a id="assessment" data-tip="1482" target="_blank" href="/glossary-term/assessment" class="glossary">test</a>, and the 6-min walk <a id="assessment" data-tip="1482" target="_blank" href="/glossary-term/assessment" class="glossary">test</a> (70). Two additional&#xA0;publications (likely from the same experiment) by&#xA0;Radaelli et al. compared 30 elderly novice female exercisers (age: 60-77 years) randomly assigned to a 1 set/exercise group, or 3 sets/exercise group. All exercisers performed a full body program (seated <a id="bilateral" data-tip="1552" target="_blank" href="/glossary-term/bilateral" class="glossary">bilateral</a> knee extensions, lat pull downs, <a id="prone" data-tip="1561" target="_blank" href="/glossary-term/prone" class="glossary">prone</a> <a id="bilateral" data-tip="1552" target="_blank" href="/glossary-term/bilateral" class="glossary">bilateral</a> leg curls, dumbbell elbow flexions, hip abductions, pulley elbow extensions,&#xA0;and hip adductions) for 12 weeks, 2x/week, 30-60% of 1-RM loads, 8-12 reps/set, 3 min rest between sets, with a max velocity concentric tempo (3:1:maxV). The findings demonstrated that both groups exhibited significant and similar increases in max EMG and rate of force development during knee extensions, vertical jump height, <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> quality, and timed-up-and-go performance. Further, the 1 set/exercise group exhibited larger improvements for rate of <a id="torque" data-tip="1294" target="_blank" href="/glossary-term/torque" class="glossary">torque</a> development&#xA0;(leg extension and curl dynamometry), and the 3 sets/exercise group exhibited larger improvements in EMG root mean square and rate of rise (71, 72). These studies demonstrate that older exercisers exhibit larger improvements in strength and function following 12 weeks of training with 3 sets/exercise when compared to 1 set/exercise.
<h3>Longer Programs</h3>
Longer programs including older exercisers demonstrate similar benefits from additional sets/exercise. Galvao et al. compared 8 novice exercisers (age: 65 - 78 years) randomly assigned to perform 1 set/exercise or 3 sets/exercise during a full-body program for 20 weeks. The findings demonstrated that 3 sets/exercise resulted in larger improvements in <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> strength and <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> endurance (seated row, triceps extension, knee extension, and the 400m walk <a id="assessment" data-tip="1482" target="_blank" href="/glossary-term/assessment" class="glossary">test</a>); however, both groups exhibited similar improvements for the chair rise, 6m backward walk, and stair climbing tests (35). As mentioned above, Marzolini et al. compared 53 novice exercisers (age: 61 &#xB1; 2 years) randomly assigned to an aerobic training group, an aerobic training and 1 set/exercise group, or an aerobic training and 3 sets/exercise group. Resistance training included a full-body program, and all groups trained for 29 weeks. The findings demonstrated that the resistance training groups exhibited larger increases in strength and endurance than the aerobic training-only group, and that 3-sets/exercise resulted in larger increases in strength than 1 set/exercise (43). These studies demonstrate that older exercisers adding sets/exercise (with or without aerobic training) to longer duration strength training programs (20 - 29 weeks) may exhibit significantly larger improvements in strength endurance, 1-RM strength, and functional <a id="assessment" data-tip="1482" target="_blank" href="/glossary-term/assessment" class="glossary">test</a> scores.

Additional Sets per Exercise Results in More Strength: Older Novice Exercisers

<h2>Adult Experienced Exercisers</h2>
<h3>6-8 Weeks of Training</h3>
Perhaps, not surprisingly, experienced exercisers are likely to exhibit significantly larger increases in strength with additional sets/exercise. A study by Robbins et al. compared 43 experienced exercisers (Group ages: 1-set 25.5 &#xB1; 1.4 years; 4-set 31.0 &#xB1; 3.2 years, 8-set 26.0 &#xB1; 1.5 years) randomly assigned to groups performing 1 set, 4 sets, or 8 sets/exercise. All exercisers performed a full body routine (back squats and other undisclosed exercises), for 6 weeks, 3 sessions/week, reps to failure/set, 80% of 1-RM, 3 min rest between sets, and a moderate (2:0:1) tempo. The findings demonstrated that all groups exhibited significant increases in 1-RM squat strength; however, the 8 sets/exercise group exhibited significantly larger increases in 1 RM squat strength (73). As mentioned above, Heaselgrave et al. compared 49 experienced exercisers (age: 18 - 35 years), randomly assigned to groups performing 9 sets, 18 sets, or 27 sets/exercise/week. The findings demonstrated that all groups exhibited significant increases in 1 RM strength and biceps brachii CSA; however, the analysis revealed larger effect sizes for the moderate and high-volume groups, and only the high-volume group exhibited significant improvements in isometric strength (52). An RCT by Schlumberger et al. compared 27 experienced female exercisers (age: 20 - 40 years), randomly assigned to a control group (no additional activity), 1 set/exercise group, or a 3 sets/exercise group. The exercise groups performed a full body program (<a id="bilateral" data-tip="1552" target="_blank" href="/glossary-term/bilateral" class="glossary">bilateral</a> leg extensions, <a id="bilateral" data-tip="1552" target="_blank" href="/glossary-term/bilateral" class="glossary">bilateral</a> leg curls, abdominal crunches, seated hip adductions, seated hip abductions, seated bench press, and lat pull-downs) for 6 weeks, 2x/week, 6-9 reps until failure/set, and 2 min rest between sets. The findings demonstrated significant improvements for both groups during re-assessment of 1-RM strength for leg extensions; however, the 3-set group exhibited larger increases in leg extension strength, and only the 3-set group exhibited a significant increase in chest press strength (74). Also mentioned above, Brigatto et al. compared 27 experienced exercisers (age: 27.2 &#xB1; 7.1 years) randomly assigned to groups performing 16 sets, 24 sets, or 32 sets/muscle group/week for 8 weeks. The finding demonstrated that all protocols resulted in significant increases in the bench press and back squat 1-RM strength, and biceps brachii, triceps brachii, and vastus lateralis CSA; however, the 32 set/week group exhibited significantly larger improvements than the 16 sets/week group (53). Last, an RCT by Junior et al. compared 60 experienced exercisers (age not mentioned) randomly assigned to a control group (no additional activity), 1 set/exercise group, or 3 sets/exercise group. All participants performed a full body program (bench press, leg press, lat pull downs , leg extensions, shoulder press, leg curls, biceps curls, abdominal crunches lying on the floor, and triceps extensions) for 10 weeks, 3x/week, with 8-12 reps to failure/set. The findings demonstrated that both groups exhibited significant increases in 5-RM bench press strength; however, the 3 sets/exercise group improved significantly more (75). These studies suggest that experienced exercisers, training for as little as 6-8 weeks, are likely to exhibit larger improvements in strength with the addition of sets/exercise.
<img src="https://www.datocms-assets.com/25800/1668984299-trainer-lunge.jpeg" title="A lunge being performed by a client for lower body strength training" alt="Trainer working with a client doing a lunge">
<h3>Longer Training Periods</h3>
Several studies mentioned above that included longer duration programs (3 - 9 months) also demonstrate <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">superior</a> outcomes following additional sets/exercise. Kramer et al. compared 43 experienced exercisers (age:&#xA0;20.3 &#xB1; 1.9 years) randomly assigned to 1 of 3 protocols including 1 set/exercise with 10 RM loads and reps to failure/set group, 3 sets/exercise with 10 reps/set (not necessarily to failure) group, or 3 sets/exercise with 2-10 reps/set (variable load/not necessarily to failure). All exercisers completed a full-body exercise program for 14 weeks. The findings demonstrated that all groups exhibited significant increases in 1-RM squat strength; however, both groups performing 3 sets/exercise exhibited significantly larger strength increases (about 50% more improvement) than the 1 set/exercise group (36). Kemmler et al. compared 74 post-menopausal experienced female exercisers (age: 56.5&#xA0;&#xB1; 3.1 years) in a cross-over study that randomly assigned exercisers to start with 12 weeks of a periodized 1 set/exercise program, followed by 5 weeks of lighter intensity training, followed by 12 weeks of a periodized 2-4 set/exercise program, or the reverse (start with multi-set, then lighter intensity, then single-set). All participants performed a full body program for a total of 29 weeks, 4x/week, with a 2-day split routine (2x/week Machine Program: horizontal leg press, leg curls, leg abductions, leg adductions, leg extensions, rowing, lat pull downs, back extensions, seated bench press, crunches, and shoulder raises) (2x/week Free Weight Program: wide-stance deadlifts, 1-arm row, wide-grip bench press), 65-90% of 1-RM loads (periodized training), either 1 set/exercise or 2-4 sets/exercise, and a moderate (2:1:2) tempo. The findings demonstrated that 1-RM strength significantly increased during the multi-set/exercise phase and decreased during the 1 set/exercise phase (38). These studies imply that experienced lifters performing longer-duration programs (12+ weeks) may achieve significantly larger increases in strength (50%) from additional sets/exercise, and may exhibit a decrease in strength from 1 set/exercise.

Additional Sets per Exercise Results in More Strength: Adult Experienced Exercisers

Note, the research comparing sets/exercise for improving <a id="power" data-tip="1399" target="_blank" href="/glossary-term/power" class="glossary">power</a> can only be considered a guideline for making set/power-exercise recommendations; because, none of the studies comparing sets/exercise and reporting <a id="power" data-tip="1399" target="_blank" href="/glossary-term/power" class="glossary">power</a> outcomes included <a id="power" data-tip="1399" target="_blank" href="/glossary-term/power" class="glossary">power</a> training routines (e.g. routines comprised of <a id="plyometric" data-tip="1295" target="_blank" href="/glossary-term/plyometric" class="glossary">plyometric</a> and/or ballistic exercises). A few studies include 1 or 2 power-like exercises, so some inferences can be made. However, research comparing <a id="power" data-tip="1399" target="_blank" href="/glossary-term/power" class="glossary">power</a> exercise volume and sets/exercise remains a gap in the currently available research.
<h3>Additional Sets/Exercise Results in Similar Increases in Power:</h3>
Several studies suggest that improvements in <a id="power" data-tip="1399" target="_blank" href="/glossary-term/power" class="glossary">power</a> are likely similar following 1 set or multiple sets of strength training or aquatic exercise. Schoenell et al. compared 66 novice female exercisers (age: 24.72 &#xB1; 4.33 years) randomly assigned to a 1 set/exercise group or a 3 sets/exercise group. All participants performed a full body pool-based resistance program (hip abduction/adduction, shoulder horizontal abduction/adduction, trunk <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> flexion, frontal kicks and <a id="glide" data-tip="1599" target="_blank" href="/glossary-term/glide" class="glossary">slides</a> with opposing legs, frontal crunches, knee flexions/extensions, shoulder abductions/adductions, elbow flexions/extensions, frontal crunches) for 10-weeks, 2x/week, and 30 sec max effort/set. The findings demonstrated that both groups exhibited significant and similar increases in 1-RM squat strength, max reps of squats at 60% of 1-RM (endurance), and counter-movement jump height (76). An RCT by Abdul Kadir et al. compared 36 novice male exercisers (21 &#xB1; 0.79 years) randomly assigned to a control group (no additional activity), 1 set/exercise group, or 3 sets/exercise group. All exercisers performed a full body routine (squats, bench press, and other &quot;common exercises&quot;) for 6 weeks, 3x week, reps until failure (8-RM)/set, 80% of 1-RM, and 2 min rest between sets. The findings demonstrated significant and similar improvements for both exercise groups during the reassessment of squat and bench press 1-RM strength, grip strength, and vertical jump height (65). Ostrowski et al. compared 27 experienced exercisers (age: 23.7 &#xB1; 5 years) randomly assigned to 3 sets, 6 sets, or 12 sets/exercise/week groups. All exercisers performed a 4-day split, full body program (Day 1: squats, leg press, leg extensions, stiff-legged deadlifts, leg curls, single-leg curls; Day 2: Bench press, incline bench press, decline bench press, shoulder press, upright rows, <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> raises; Day 3: lat pull downs, t-bar pull downs, seated rows, calf raises, calf press, seated calf raise; Day 4: Barbell curls, preacher curls, dumbbell curls, close grip bench press, triceps push downs, triceps extensions). The program was performed for 10 weeks, 4 sessions/week, reps until failure/set, with 12-RM loads during weeks 1-4, 7-RM loads during weeks 5-7, 9-RM loads during weeks 8-10, with 3 min rest between sets, and 1, 2 or 4 sets/exercise. The findings demonstrated that all groups exhibited similar increases in post-exercise serum concentrations of testosterone, similar increases in rectus femoris and triceps brachii hypertrophy, and similar increases in vertical jump and bench press throw height (5). These studies suggest that novice and experienced exercisers performing 6-10 weeks of strength training (no <a id="plyometric" data-tip="1295" target="_blank" href="/glossary-term/plyometric" class="glossary">plyometric</a> or ballistic exercises), with 1 set/exercise or multiple-sets/exercise, are likely to exhibit similar increases in <a id="power" data-tip="1399" target="_blank" href="/glossary-term/power" class="glossary">power</a> (vertical jump height, counter-movement jump, and bench press throw). As discussed in our course &quot;<a href="https://brookbushinstitute.com/courses/introduction-power-training-high-velocity-training" target="_blank" rel="noopener">Power (High-Velocity) Training: Introduction</a>&quot; it is likely that <a id="plyometric" data-tip="1295" target="_blank" href="/glossary-term/plyometric" class="glossary">plyometric</a> or ballistic exercise is necessary for optimizing <a id="power" data-tip="1399" target="_blank" href="/glossary-term/power" class="glossary">power</a> training.
<img title="Dr. Brent Brookbush demonstrating a box jump exercise for power production" src="https://www.datocms-assets.com/25800/1645724226-boxjump.jpeg" alt="A box jump being performed by a client">
<h3>Starting with Multiple-sets/Exercise may Reduce Power</h3>
Additional studies demonstrate that starting a routine with multiple-sets/exercise may reduce <a id="power" data-tip="1399" target="_blank" href="/glossary-term/power" class="glossary">power</a>. Two publications by Radaelli et al. compared 30 elderly novice female exercisers (age: 60-77 years) randomly assigned to a 1 set/exercise group, or 3 sets/exercise group. All exercisers performed a full body program (seated <a id="bilateral" data-tip="1552" target="_blank" href="/glossary-term/bilateral" class="glossary">bilateral</a> knee extensions, lat pull downs, <a id="prone" data-tip="1561" target="_blank" href="/glossary-term/prone" class="glossary">prone</a> <a id="bilateral" data-tip="1552" target="_blank" href="/glossary-term/bilateral" class="glossary">bilateral</a> leg curls, dumbbell elbow flexions, hip abductions, pulley elbow extensions,&#xA0;and hip adductions) for 12 weeks, 2x/week, 30-60% of 1-RM loads, 8-12 reps/set, 3 min rest between sets, with a max velocity concentric tempo (3:1:maxV). The findings demonstrated that both groups exhibited significant and similar increases in EMG activity and rate of force development during knee extensions, vertical jump height, <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> quality, and timed-up-and-go performance. Additionally, the 1 set/exercise group exhibited larger improvements in the rate of <a id="torque" data-tip="1294" target="_blank" href="/glossary-term/torque" class="glossary">torque</a> development&#xA0;(leg extension and curl dynamometry), and the 3 sets/exercise group exhibited larger improvements in EMG root mean square and rate of rise (71, 72). Methenitis et al. compared 29 females performing training volumes of 3, 6, or 9 sets/session. All exercisers performed 10 weeks of super-sets that included 4 reps of high-velocity eccentric half squats with 70% of 1-RM load, followed by 3 reps of max effort counter-movement jumps (post-activation <a id="post-activation-potentiation" data-tip="1393" target="_blank" href="/glossary-term/post-activation-potentiation" class="glossary">potentiation</a> training). The findings demonstrated that the 3 sets/super-set group exhibited the largest increases in height and early rate of force development, and the 6 set/super-set and 9 set/super-set groups exhibited a significant transition of type IIx fibers to type IIa fibers and a loss of type IIx fiber CSA (77). These studies suggest that starting a program with multiple-sets/exercise is not ideal for improving <a id="power" data-tip="1399" target="_blank" href="/glossary-term/power" class="glossary">power</a> performance (counter-movement jump height). Further, high volumes of exercise (6+ supersets/muscle group) may reduce <a id="power" data-tip="1399" target="_blank" href="/glossary-term/power" class="glossary">power</a> performance, perhaps due to a transition of type IIx fibers to type IIa fibers.

Sets per Exercise and Power

Progressive Increase in Sets/Exercise Ideal for Continuous Improvement
Three studies highlight the efficacy of a progressive increase in sets/exercise to achieve continuous improvement in hypertrophy, strength, <a id="power" data-tip="1399" target="_blank" href="/glossary-term/power" class="glossary">power</a>, and body composition. Stowers et al. compared 84 novice male exercisers (age: college students) randomly assigned to a 1 set/exercise group, 3 sets/exercise group, or a progressive intensity group. All exercisers completed a full body program (squats, leg curls, bench press, sit-ups, deadlifts from knee level, behind the neck press, and lat pull downs) for 7 weeks, 3x/week, and either 1 set/exercise with 10-12 RM to failure/set, 3 sets/exercise with 10-12 RM to failure/set, or 3-5 sets/exercise with 3-10 RM to failure/set. The findings demonstrated that all groups exhibited similar increases in 1-RM bench press strength, the progressive intensity group exhibited significantly larger improvements for 1-RM squat strength, and only the progressive intensity group exhibited significant improvements during a vertical jump <a id="assessment" data-tip="1482" target="_blank" href="/glossary-term/assessment" class="glossary">test</a> (78). Kraemer et al. compared 24 collegiate female tennis athletes (age: 19 &#xB1; 1.2 years) randomly assigned to a control group (no resistance exercise), a single-set circuit program, or a multi-set periodized program. All participants performed a full body program (i.e. bench press, leg press, leg curls, lat pulldowns, etc.) for 9 months, 2-3x/week, the single-set group performed 1 set of 8-10 RM/set, and the multi-set group performed 2-4 sets of 4-15 RM/set (periodized) with 1-3 minutes rest between sets. The findings demonstrated that the single-set group exhibited significant improvements in 1-RM strength for the bench press, free-weight shoulder press, and leg press during re-assessment following 4 months of training; however, no additional improvements were exhibited during re-assessment at 6 months and 9 months. The multi-set group exhibited larger 1-RM strength improvements during re-assessments at 4 months, exhibited additional improvements during re-assessment at 6 and 9 months, and was the only group to exhibit a significant improvement in serve velocity and <a id="power" data-tip="1399" target="_blank" href="/glossary-term/power" class="glossary">power</a> output. Additionally, neither group exhibited a significant change in body weight; however, the multi-set group exhibited a significant increase in lean body mass and a decrease in body fat percentage during reassessments at 4, 6, and 9 months (44) An RCT by Marx et al. compared 34 novice female exercisers (age: 22.2&#xA0;&#xB1; 5.7 years) randomly assigned to a single-set or multi-set exercise group, for 24 weeks. Both groups performed alternating full-body split routines including a more compound exercise day (i.e. - hang cleans, squat, bench press, push press, etc.) and a more single joint/isolation exercise day (i.e. - upright row, leg extensions, <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> raise, lunges). The single-set group trained 3x/week, with 1 set/exercise for the entire training program, 8-12 RM/set, 1-2 min rest between sets, and a slow (4:0:2) tempo. The multi-set group trained 4 days/week, progressively increased from 2 - 4 sets/exercise, with 3-15 RM/set (daily undulated periodization), 1-4 min rest between sets, and a fast/explosive tempo. The findings demonstrated that both groups exhibited significant and&#xA0;similar improvements in bench press and leg press 1-RM strength, improvements in local <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> endurance, and an increase in resting serum concentrations of testosterone during re-assessment at 12 weeks. However, only the multi-set group exhibited additional improvements in strength, endurance, and testosterone concentrations at 24 weeks. Further, only the multi-set group exhibited significant improvement during a 30-sec max revolutions&#xA0;Wingate anaerobic <a id="power" data-tip="1399" target="_blank" href="/glossary-term/power" class="glossary">power</a> <a id="assessment" data-tip="1482" target="_blank" href="/glossary-term/assessment" class="glossary">test</a> and a&#xA0;significant decrease in serum concentrations of cortisol at both 12 and 24 weeks&#xA0;(6). These studies demonstrate that a progressive increase in sets/exercise may be ideal for continuous improvement of testosterone and cortisol concentrations, changes in body composition, hypertrophy, <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> endurance, 1-RM strength, and power&#xA0;(vertical jump height, tennis serve velocity, and Wingate anaerobic <a id="assessment" data-tip="1482" target="_blank" href="/glossary-term/assessment" class="glossary">test</a>).

Progressive Increase in Sets/Exercise

<h3>Similar Outcomes Following Moderate and High-Volume Training</h3>
Three studies demonstrate that high-volume and very high-volume routines are likely to result in similar increases in strength and hypertrophy.&#xA0;Barker et al. compared 16 experienced male exercises (age: 18 - 21 years) who were randomly assigned to a 1 set/exercise group or a 3 sets/exercise group (3 sets/muscle group or 9 sets/muscle group, 3x/week). All exercisers performed an upper body routine (bench press, inclined bench press, dumbbell flyes, biceps curls with barbell, biceps curls with dumbbells, hammer curls with dumbbells, seated shoulder press behind neck, <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> raises, and upright rows) for 8 weeks, 3x/week, 6 reps/set, 85% of 1-RM load, 2-3 min rest between sets, and a moderate (2:0:2) tempo. The findings demonstrated that both groups exhibited significant and similar increases in the reassessment of bench press, barbell biceps curls, and barbell shoulder press 1-RM strength (79).&#xA0;Ostrowski et al. compared 27 experienced exercisers&#xA0;(age: 23.7 &#xB1; 5 years) randomly assigned to groups performing 3 sets, 6 sets, or 12 sets/muscle group/session (and week). All exercisers performed a 4-day split, full body program (Day 1: squats, leg press, leg extensions, stiff-legged deadlifts, leg curls, and single-leg curls; Day 2: Bench press, incline bench press, decline bench press, shoulder press, upright rows, and <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> raises; Day 3: lat pull downs, t-bar pull downs, seated rows, calf raises, calf press, and seated calf raise; Day 4: Barbell curls, preacher curls, dumbbell curls, close grip bench press, triceps push downs, and triceps extensions). The program was performed for 10 weeks, 4 sessions/week, reps until failure/set, 12 RM load weeks 1-4, 7 RM load weeks 5-7, 9 RM weeks 8-10, 3 min rest between sets, and 1, 2, or 4 sets/exercise. The findings demonstrated that all groups exhibited similar increases in post-exercise serum concentrations of testosterone, similar increases in rectus femoris and triceps brachii hypertrophy, similar increases in the bench press and back squat 1-RM strength, and similar increases in vertical jump and bench press throw height (5). These studies suggest that 3 - 12 sets/muscle group/session (3-27 sets/muscle group/week) may result in similar increases in strength, hypertrophy, and <a id="power" data-tip="1399" target="_blank" href="/glossary-term/power" class="glossary">power</a>.
<h3>Better Outcomes Following Moderate Volume for Lower Body</h3>
Additional studies suggest that very high volumes may result in less improvement than moderate or high-volume routines.&#xA0;Aube et al. compared 44 experienced exercisers who could squat 2x body weight (age: 18-30 years) and were randomly assigned to groups performing 6, 9, or 12 lower body sets/session (12, 18, or 24 sets/week). All participants performed a lower body routine (squats, leg press, glute/ham raise) for 8 weeks, 2 sessions/week, 4 - 15 RM loads, and reps until failure/set, and 2 sets, 3 sets, or 4 sets/exercise. The findings demonstrated that the groups exhibited a similar increase in fat-free mass, and 1-RM back squat strength. However, this study alludes to a trend of 18 sets/week resulting in larger increases in strength than 12 sets/week, and 12 sets and 18 sets/week resulting in larger improvements than 24 sets/week (80).&#xA0;Methenitis et al. compared 29 females performing training volumes of 3, 6, or 9 lower body super-sets/session. All exercisers performed 10 weeks of super-sets that included 4 reps of high-velocity eccentric half squats with 70% of 1-RM load, followed by 3 reps of max effort counter-movement jumps (post-activation <a id="post-activation-potentiation" data-tip="1393" target="_blank" href="/glossary-term/post-activation-potentiation" class="glossary">potentiation</a> training), and sessions/week was not disclosed (although likely 2x/week). The findings demonstrated that the 3 super-sets/session group exhibited the largest increases in jump height and rate of force development during the early portion of the concentric phase, and the 6 and 9 super-set/session groups exhibited a significant transition from type IIx fibers to type IIa fibers (77). These studies suggest that 6-9 lower body sets/session (3-5 lower body supersets/session) may result in larger increases than 12 lower body sets/session (6-9 lower body supersets/session) when resistance training is performed 2x/week. Note, the study including 6-9 sets/session included 3 lower body exercises, which may imply that 2-3 sets/exercise (2 exercises/muscle group) resulted in larger improvements than 4 sets/exercise (2 sets/muscle group).
<h3>Better Outcomes Following Moderate Volume (Even 1 Session/Week)</h3>
Research demonstrates that very high volumes/muscle group/session, even when performed 1x/week, may result in less improvement. Amirthalingam et al. compared 19 healthy men (age: 19-24&#xA0; years) randomly assigned to a 5-set/exercise or 10-set/exercise group (10 or 20 sets/muscle group/session, 1x/week) (German Volume Training). Both groups performed a full body split routine (Session 1 - flat bench press, lat pull downs, incline bench press, seated rows, crunches; Session 2 - leg press, dumbbell lunges, leg curls, leg extensions, calf raises; Session 3 - shoulder press, upright rows, triceps pushdowns, biceps curls, sit-ups with a twist) for 12 weeks, 3 days (each session 1x)/week, 10 reps/set (20 reps/set for core exercise), 60 - 80% of 1-RM, 60-90 sec rest between sets, and a moderate (2:0:1) tempo. The findings demonstrated that both groups exhibited significant increases in lean body mass; however, the 5-set/exercise group exhibited significantly larger improvements in arm and trunk hypertrophy, and neither group exhibited significant increases in lower extremity hypertrophy. Both groups exhibited significant increases in strength; however, the 5 set/exercise group exhibited larger improvements in strength for lat pull downs and bench presses&#xA0;(81).&#xA0;Barbalho et al. compared 40 experienced female exercisers (age: 25 &#xB1; 2 years) randomly assigned 5 sets, 10 sets, 15 sets, or 20 sets/muscle group/session. All groups performed a 3-day split routine (Day 1: barbell bench press, inclined barbell bench press, military press; Day 2: lat pull down, cable row, upright barbell row; Day 3: 45&#xB0; leg press, barbell squat, stiff-legged deadlift) for 24 weeks, 3x/week (each routine 1x/week), 4-15 RM/set (daily undulated training), 30 sec - 3 min rest between sets, and a moderate (2:0:2) tempo. The findings demonstrated that all groups exhibited significant improvements in 10 RM strength and <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> cross-sectional area (CSA); however, the 5 sets and 10 sets groups improved significantly more than the 15 sets and 20 sets groups. Further, although increases in <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> CSA were larger for the 10 sets group for the latissimus dorsi and quadriceps, the 5-sets group exhibited larger improvements in CSA for the pectoralis major. Note, the 20-sets group exhibited less improvement than all other groups (82).&#xA0;Last, a pilot study by Hacket et al. compared 12 experienced male exercisers (age:&#xA0;23.7 &#xB1; 3.0 years) randomly assigned to a 5 set/exercise or 10 set/exercise (5-10 and 10-20/sets <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> group, 1x week). Both groups performed a full body split routine (Session 1 - flat bench press, lat pull down, incline bench press, seated row, crunches; Session 2 - leg press, dumbbell lunges, leg curls, leg extensions, calf raises; Session 3 - shoulder press, upright row, triceps pushdowns, biceps curls, sit-ups with a twist) for 12 weeks, 3 days (each session 1x)/week, 10 reps/set (20 reps/set for core exercise), 60 - 80% of 1-RM, 60-90 sec rest between sets, moderate (2:0:1) tempo, and either 5 sets or 10 sets/exercise. Neither group exhibited significant increases in total lean body mass, lean trunk mass, lean arm mass, or lean leg mass; in fact, the 10-set group exhibited a decrease in leg mass. A small increase in 1 RM bench press strength was exhibited by the 5-set group, and a small increase in 1-RM leg press strength was exhibited by the 10-set group (83). In summary, even when sessions are performed 1x/week, 5-10 sets/muscle group/session may result in significantly larger improvements than 15-20 sets/muscle group/session, and 20 sets/muscle group/session may result in a decrease in <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> CSA.

Sets per Exercise Upper Limits

<h3>Similar Results During Initial Training Period</h3>
Several studies demonstrate that 1 set/exercise may be sufficient to improve initially; however, additional sets/exercise may be necessary to continue improving.&#xA0;As mentioned above, an RCT by Marx et al. compared 34 novice female exercisers (age: 22.2&#xA0;&#xB1; 5.7 years) randomly assigned to a 1 set/exercise or 2-4 sets/exercise group, for 24 weeks of training. The findings demonstrated that both groups exhibited significant improvements in strength and body fat percentage (despite no change in body weight) during reassessment at 12 weeks; however, only the 2-4 sets/exercise group exhibited additional improvements at 24 weeks (6). Also mentioned above, Radaelli et al. compared 24 elderly novice exercisers (age: 60-74 years) randomly assigned to a 1 set/exercise group or a 3 sets/exercise group. All exercisers performed a full-body program for 20 weeks. The findings demonstrated that both groups exhibited significant increases in dynamic 1-RM and isometric strength, <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> cross-sectional area (CSA), <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> quality (density measured using ultrasound), and maximal EMG activity. The differences between groups were not significant during re-assessment at 6 weeks or 12 weeks; however, the 3 sets/exercise group exhibited significantly larger improvements in strength, lower body CSA, and <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> quality during re-assessment at 20 weeks (55-58). These studies suggest that novice exercisers may exhibit similar improvements following 1-set or multiple-sets/exercise for the first 12 weeks of a resistance training program; however, beyond 12 weeks of training, additional sets/exercise are likely necessary to achieve additional benefits (e.g. body composition, strength, <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> quality, hypertrophy).
<h3>Superior Results from Additional Sets/Exercise</h3>
Studies also imply that additional sets/exercise during the initial phases of training results in larger improvements, and may be mandatory for continued improvement beyond 6 weeks of training.&#xA0;An RCT mentioned above by Borst et al. compared 31 male and female novice exercisers (age: 37 &#xB1;&#xA0;7 years) randomly assigned to a control group (no exercise), a 1 set/exercise group, or a 3 sets/exercise group. All exercisers performed a full-body program for 25 weeks. The findings demonstrated that the 3 sets/exercise group exhibited 50% more improvement during reassessment of 1-RM chest press and leg extension strength at 13 weeks, and both groups exhibited relatively small improvements in strength during reassessment from 13 weeks to 25 weeks (8).&#xA0;Also mentioned above, Marshal et al. compared 32 experienced exercisers (age: 28 &#xB1; 1.2 years) randomly assigned to groups performing&#xA0;either 1 set, 4 sets, or 8 sets/exercise. All groups completed a full-body program for 10 weeks. The findings demonstrated that the 8-sets/exercise group exhibited significantly larger improvements in 1-RM squat strength during re-assessment at 3 weeks, and continued to exhibit <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">superior</a> improvements during reassessment at 6 weeks and 10 weeks. The 8 sets/exercise group was also the only group to exhibit significant decreases in body fat percentage. Note, the findings may also indicate the 1-set/exercise and 4-sets/exercise groups exhibited diminishing returns following just 6 weeks of training (45). Kraemer et al. compared 24 collegiate female tennis athletes (age: 19&#xA0;&#xB1; 1.2 years) randomly assigned to a control group (no resistance exercise), a single-set circuit program, or a multi-set periodized program. All exercisers performed a full-body program for 9 months. The findings demonstrated that the single-set group exhibited improvements at 4 months&#xA0;during reassessment of bench press, free-weight shoulder press, and leg press 1-RM strength; however, no additional improvements were noted during reassessment at 6 months and 9 months. The multi-set group exhibited larger 1-RM strength improvements during re-assessments at 4 months, exhibited additional improvements during re-assessment at 6 and 9 months, and was the only group to exhibit a significant increase in lean body mass, and improvement in serve velocity and <a id="power" data-tip="1399" target="_blank" href="/glossary-term/power" class="glossary">power</a> output (44). These studies suggest that the addition of sets/exercise may result in additional benefits by the 4th week of training for experienced exercisers, and the 12th week of training for novice exercisers. Further,&#xA0;adding sets/exercise after the initial training period may be necessary to achieve the largest possible benefits (e.g. lean body mass, strength, <a id="power" data-tip="1399" target="_blank" href="/glossary-term/power" class="glossary">power</a>).

Initial Training Period

<h3>Necessary for Improving Lower Extremity Strength and Power</h3>
Several studies demonstrate that the upper extremity and lower extremity respond differently to multiple sets/exercise. As mentioned above, Bottaro et al. compared 30 male novice exercisers (age:&#xA0;23.4 &#xB1; 2.6 years) randomly assigned to a group performing 3 sets of knee extensions and 1 set of elbow flexions, or a group performing 1 set of knee extensions and 3 sets of elbow flexion, for 12 weeks. The findings demonstrated that strength and CSA of the biceps brachii exhibited significant and similar increases for both groups; however, knee extension strength only increased following 3 sets/exercise (61). Stowers et al. compared 84 novice male exercisers (age: college students) randomly assigned to a 1 set/exercise group, 3 sets/exercise group, or a progressive intensity group. All exercisers completed a full body program (squats, leg curls, bench press, sit-ups, deadlifts from knee level, behind the neck press, and lat pull downs) for 7 weeks, 3x/week, and either 1 set/exercise&#xA0;with 10-12 RM to failure/set, 3 sets/exercise with 10-12 RM to failure/set, or 3-5 sets/exercise with 3-10 RM loads. The findings demonstrated that all groups exhibited similar increases in 1-RM bench press strength, the progressive intensity group exhibited significantly larger improvements for 1-RM squat strength, and only the progressive intensity group exhibited significant improvements during the vertical jump <a id="assessment" data-tip="1482" target="_blank" href="/glossary-term/assessment" class="glossary">test</a> (78).&#xA0;An RCT by Naclerio et al. compared 32 novice male and female exercisers (age: 23.1&#xA0;&#xB1; 1.57 years) randomly assigned to 1 of 4 groups; a control group (no exercise), a 1 set/exercise (3 sets/muscle) group, 2 sets/exercise (6 sets/muscle) group, or a 3 sets/exercise (9 sets/muscle) group. The exercisers performed a full body 2-day split routine (Day 1: Bench press, incline bench press, dumbbell flyes, upright rows, <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> raises, <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> raises, barbell biceps curls, dumbbell biceps curls, machine biceps curls; Day 2: Smith machine parallel squats, leg press, knee extensions, lat pull downs, seated rows, 1 arm dumbbell rows, machine triceps extensions, standing triceps pushdowns, and 1-arm triceps extensions) for 6 weeks, 3 sessions/week, 8 reps/set, 75% of 1-RM loads, and 3 min rest between sets.&#xA0;The findings demonstrated that all exercisers exhibited significant increases in 1-RM strength and average <a id="power" data-tip="1399" target="_blank" href="/glossary-term/power" class="glossary">power</a> for the bench press and upright row; however, additional sets/exercise resulted in larger increases, and only the 3 sets/exercise (9 sets/muscle) group exhibited a significant increase in 1-RM squat strength (84). These studies imply that young healthy exercisers (novice and experienced) may require&#xA0;multiple sets/exercise to improve lower extremity strength and <a id="power" data-tip="1399" target="_blank" href="/glossary-term/power" class="glossary">power</a>, even when multiple-sets/exercise may not be necessary to improve upper extremity strength and <a id="power" data-tip="1399" target="_blank" href="/glossary-term/power" class="glossary">power</a>.
<h3>Superior for Improving Lower Extremity Strength, Power, and Hypertrophy:</h3>
Several additional publications demonstrated that additional sets/exercise resulted in <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">superior</a> outcomes for lower extremity strength and cross-sectional area (CSA), but were not as influential for upper body strength and CSA. Hansen et al. compared 21 novice exercisers (age: 26.6 &#xB1; 1.6 years) randomly assigned to either a more upper body group (1 set/exercise lower body and 3 sets/exercise upper body), or a more lower body group (3 sets/exercise lower body and 1 set/exercise upper body); both groups performed a full body routine for 11 weeks. The findings demonstrated that both groups exhibited similar increases in the number of upper trapezius satellite cells; however, the more lower body group exhibited larger increases in the number of vastus lateralis satellite cells (60). A publication by Ronnestad et al. with an identical methodology to Hansen et al. (possibly the same experiment) demonstrated that both groups exhibited similar increases in upper body strength and arm CSA; however, multiple sets resulted in significantly larger increases in lower body strength and thigh CSA (59). Paulsen et al. also compared 20 novice exercisers (age: 20-30 years) with a similar methodology for 6 weeks, and the findings demonstrated that both groups exhibited larger increases in strength for the exercises performed with multiple-sets/exercise; however, multiple-sets/exercise had a larger influence on lower body strength improvements (62). Another study by Bottaro et al. compared 24 male novice exercisers (age: 23.4 &#xB1; 2.6 years) randomly assigned to 3 sets of leg press and 1 set of arm curls group, or 1 set of leg press and 3 sets of arm curls group. Both groups trained for 6 weeks, 2x/week, 8 RM/set, 2 min rest between sets, and 60&#xB0;/sec rep tempo. The findings demonstrated that 1 set and 3 sets resulted in similar increases in bicep curl 1-RM strength; however, 3 sets resulted in significantly larger improvements for leg press 1-RM strength (85). Last, a study by Rhea et al. compared 16 experienced male exercisers (age: 19-23 years) randomly assigned to a 1 set/exercise group or a 3 set/exercise group. Both groups performed bench press and leg press for 12 weeks, 3x/week, 4-8 RM/set (daily undulating periodization), with 1-2 min rest between sets. The findings demonstrated significant increases in strength for both groups, 3 sets/exercise resulted in larger increases in leg press strength; however, 3 sets/exercise only resulted in a trend toward larger increases in bench press strength (37). These studies suggest that multiple-sets/exercise may not be necessary for achieving lower extremity improvements (strength, <a id="power" data-tip="1399" target="_blank" href="/glossary-term/power" class="glossary">power</a>, hypertrophy); however, multiple-sets/exercise is likely <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">superior</a>.
<img alt="A deadlift used to improve lower body strength" title="A weightlifter performing a deadlift exercise" src="https://www.datocms-assets.com/25800/1644608056-istock-539114870.jpg">
<h3>Single-Joint versus Multi-joint Exercises?</h3>
One study was located that demonstrated multiple-sets/exercise was necessary to achieve statistically significant improvements in upper body strength, but was not necessary for achieving statistically significant improvements in lower extremity strength. An RCT by Schlumberger et al. compared 27 experienced female exercisers (age: 20 - 40 years), randomly assigned to a control group (no additional activity), 1 set/exercise group, or a 3 sets/exercise group. The exercise groups performed a full body program (<a id="bilateral" data-tip="1552" target="_blank" href="/glossary-term/bilateral" class="glossary">bilateral</a> leg extensions, <a id="bilateral" data-tip="1552" target="_blank" href="/glossary-term/bilateral" class="glossary">bilateral</a> leg curls, abdominal crunches, seated hip adductions, seated hip abductions, seated bench press, and <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> pull-downs) for 6 weeks, 2x/week, 6-9 reps until failure/set, and 2 min rest between sets. The findings demonstrated significant improvements during re-assessment of 1-RM strength for leg extensions, the 3-set group exhibited larger increases in leg extension strength, and only the 3-set group exhibited a significant increase in chest press strength (74). This study demonstrates that multiple sets/exercise was more beneficial for improving upper extremity strength when compared to lower extremity strength; however, this study should be considered in conjunction with the studies discussed above. It may be reasonable to assume that multiple-sets/exercise is more beneficial for improving the strength of multi-joint exercises (bench press), and is less beneficial for improving the strength of single-joint exercises (leg extensions).

More Sets for the Lower Extremity

<h3>Sets/Exercise and Range of Motion (ROM)</h3>
Studies have demonstrated that resistance training is likely to improve range of motion (ROM). As mentioned above, Barbalho et al. compared 376 novice exercisers (age: 70.5 &#xB1; 5.88 years) randomly assigned to a low-volume group or high-volume group, performing a full-body program for 12 weeks. The findings demonstrated that sit-and-reach scores significantly improved for both groups; however, the higher volume group improved more (70). Also mentioned above, an RCT by Junior et al. compared 60 experienced exercisers (age not mentioned) randomly assigned to a control group (no additional activity), 1 set/exercise group, or 3 sets/exercise group. All participants performed a full-body program for 10 weeks. The findings demonstrated that both groups exhibited a significant increase in sit-and-reach flexibility; however, only the 3 sets/exercise group exhibited significant improvement when compared to the control group (75). Last, an RCT by Leite et al. compared 47 novice exercisers (age: 24 &#xB1; 1 year) randomly assigned to groups performing 1 set, 3 sets, or 5 sets/exercise. All participants performed a full body program (bench press, leg press, lat pull downs, leg extensions, shoulder press, leg curls, biceps curls, abdominal crunches lying on the floor, and triceps extensions) for 24 weeks, 3x/week, 8-12 reps to failure/set, and 1.5 - 2 min rest between sets. This study included sit-and-reach flexibility and <a id="goniometry" data-tip="1524" target="_blank" href="/glossary-term/goniometry" class="glossary">goniometric</a> <a id="assessment" data-tip="1478" target="_blank" href="/glossary-term/assessment" class="glossary">assessment</a> of shoulder flexion, shoulder extension, shoulder abduction, shoulder horizontal adduction, elbow flexion; hip flexion, hip extension, knee flexion, trunk flexion, and trunk extension. The findings demonstrated that all groups exhibited significant but similar improvements for the sit-and-reach, shoulder flexion, shoulder extension, elbow flexion, and knee flexion (86). These studies suggest that resistance training has a positive effect on flexibility, and additional sets/exercise may result in larger improvements.
<h3>Sets/Aquatic Exercise</h3>
Two studies compared strength improvements following 1 set/exercise or multiple-sets/exercise during a pool-based program. A study by Schoenell et al. compared 66 novice female exercisers (age:&#xA0;24.72 &#xB1; 4.33 years) randomly assigned to a 1 set/exercise group or a 3 sets/exercise group. All participants performed a full body pool-based resistance program&#xA0;(hip abduction/adduction, shoulder horizontal abduction/adduction, trunk <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> flexion, frontal kicks and <a id="glide" data-tip="1599" target="_blank" href="/glossary-term/glide" class="glossary">slides</a> with opposing legs, frontal crunches, knee flexions/extensions, shoulder abductions/adductions, elbow flexions/extensions, frontal crunches) for 10-weeks, 2x/week, and 30 sec max effort/set. The findings demonstrated that both groups exhibited significant and similar increases in 1-RM squat strength, max reps of squats at 60% of 1-RM (endurance), and counter-movement jump height (76). Butteli et al. compared 21 novice exercisers (age: 22 &#xB1; 3.28 years) randomly assigned to a 1 set/exercise group or a 3 sets/exercise group.&#xA0;All participants performed a full body pool-based resistance training program&#xA0;(hip abductions/adductions, shoulder horizontal abductions/adductions, trunk <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> flexions, frontal kicks and <a id="glide" data-tip="1599" target="_blank" href="/glossary-term/glide" class="glossary">slides</a> with opposing legs, frontal crunches, knee flexions/extensions, shoulder abductions/adductions, elbow flexions/extensions, frontal crunches) for 10-weeks, 2x/week, and 30 sec max effort/set. The findings demonstrated significant and similar increases in 1-RM strength for movements similar to those performed in the pool (<a id="bilateral" data-tip="1552" target="_blank" href="/glossary-term/bilateral" class="glossary">bilateral</a> elbow flexors and <a id="bilateral" data-tip="1552" target="_blank" href="/glossary-term/bilateral" class="glossary">bilateral</a> elbow extensors, peck deck, inverse peck decks, <a id="bilateral" data-tip="1552" target="_blank" href="/glossary-term/bilateral" class="glossary">bilateral</a> knee flexors, and <a id="unilateral" data-tip="1551" target="_blank" href="/glossary-term/unilateral" class="glossary">unilateral</a> knee extensors) (87). These studies suggest that novice exercisers performing an aquatic (pool-based) exercise program for 10 weeks, with 1 set/exercise or 3 sets/exercise, are likely to achieve similar increases in strength; even when strength is tested with movements similar to the aquatic exercises.

Range of Motion and Aquatic Exercise

Bibliography

A-Band - Refers to the part of the muscle cell that looks darker under a microscope.  This area of the cell is darker due to parallel arrangement of thicker filaments (myosin) and overlap with the thinner filaments (actin).
<ul>
 	<li>As a muscle contracts, the A-band is where actin and myosin interact.</li>
</ul>
<ol>
 	<li>Saladin, K. (2014). Anatomy &amp; physiology: The unity of form and function. McGraw-Hill Higher Education, New York. ISBN: 9780073403717</li>
</ol>

Accuracy - the proportion of individuals correctly identified by the test results.
<ul>
 	<li>For example, a special test with perfect accuracy would imply a test has 100% specificity, 100% sensitivity, 100% positive predictive value and 100% negative predictive values.</li>
</ul>

Action Potential - A rapid change in voltage, resulting in a wave of excitation, that may result in stimulation of a nerve or muscle cell.
<ul>
 	<li>In order for an action potential to be initiated, the resting membrane voltage must exceed the excitation threshold, which then results in a cascade of depolarization and the "wave of excitation." Any stimulus below that threshold will not result in an action potential, and a stimulus greater than the threshold will not increase a single action potential, but may result in additional action potentials.  In this way, the action potential functions more like an on/off switch (all or none), and less like a dimmer switch.</li>
</ul>

A single-joint movement pattern (most often) designed to load a specific under-active muscle(s), while minimizing the contribution of over-active synergists via specific cues/joint motions.
<ul>
 	<li style="text-align: left;">Activation techniques/exercises are performed with the intent of addressing a muscle exhibiting a reduction in activity (tone) as a result of, or contributing to postural dysfunction.</li>
 	<li style="text-align: left;">Activation techniques/exercises cannot be multi-joint movement patterns due to relative flexibility, altered reciprocal inhibition, and synergistic dominance resulting in compensation patterns.</li>
</ul>
Example, <a href="https://brentbrookbush.com/articles/corrective-exercise-articles/activation/gluteus-medius-activation-progression/" target="_blank">gluteus medius activation</a> involves resisted hip abduction while minimizing the contribution of the TFL via hip extension.

Active stretching is a term used to describe a stretch that involves an active contraction of opposing musculature to lengthen a muscle to its end range. Generally these stretches are held for 2-5 seconds and repeated for 8-15 repetitions.

Adenosine triphosphatase (ATPase): is the enzyme responsible for catalyzing (initiating and accelerating) the decomposition of ATP to ADP.
<ul>
 	<li>This dephosphorylation (breakdown) reaction releases energy for processes like muscular contraction.</li>
</ul>

Adenosine triphosphate (ATP): The molecule that functions as a universal energy-transfer molecule, providing most of the energy associated with muscular contraction and human movement. ATP is composed of an adenine group, a ribose group, and three molecules of inorganic phosphates.
<ul>
 	<li>Energy is provided when hydrolysis results in the cleaving of a phophate group; resulting in adenosine diphosphate, an inorganigic phosphate group, and energy.</li>
</ul>

Algometry - measuring the amount of pressure to result in sensitivity or pain, using an algometer.
<ul>
 	<li>Generally, research uses algometry to establish a minimum pain pressure threshold (PPT), in which a lower PPT implies more sensitivity and pain, and a higher PPT implies less sensitivity and pain. PPT is a common outcome measure in trigger point research.</li>
</ul>
<a href="https://brentbrookbush.com/wp-content/uploads/2019/07/Algometer.jpg"><img class="aligncenter wp-image-140177" src="https://brentbrookbush.com/wp-content/uploads/2019/07/Algometer.jpg" alt="Image of an Algometer" width="500" height="333" /></a>

All-or-none principle - a nerve or muscle cell's response to a stimulus is independent of the strength of the stimulus. If that stimulus exceeds the threshold potential (threshold of an action potential), the nerve or muscle fiber will respond completely; otherwise, there is no response.

Example, when a motor unit in the biceps brachii is stimulated it contracts the same way whether a 10 lb or 50 lb dumbbell is lifted.  It is actually the number of muscle cells and the size of the motor unit that determines force output.

&nbsp;

The transition period between eccentric load and concentric contraction during a repetition of an exercise.  This term is most often used in reference to power/plyometric exercises, in which a shorter amortization phase is believed to be beneficial.  The shorter amortization phase may better use the stored energy from the elastic deformation of connective tissue and enhance synchronization of myotatic (stretch) reflex with maximum voluntary contraction.

Example, the athlete was cued to spend as little time as possible in the bottom of their squat stance (the amortization phase) during a set of box jumps.

Muscles that oppose the prime mover and synergists for a given joint action.

That is, all the muscles that can perform the opposing joint action.

Example: The triceps and anconeus are antagonists during elbow flexion.

An anatomical direction; toward the front

Example, the face is on the anterior aspect of the head

Appendicular Skeleton - referring to the bones the bones of the arms and legs, as well as the bones that support them. This includes the pelvis, clavicle and scapula. There are approximately 126 bones in the appendicular skeleton.
<ul>
 	<li>Etymology - Appendicular, as in appendage, "that which is appended to something as a proper part," 1640s, from <a class="crossreference" href="https://www.etymonline.com/word/append?ref=etymonline_crossreference">append</a> + <a class="crossreference" href="https://www.etymonline.com/word/-age?ref=etymonline_crossreference">-age</a>. - <a href="https://www.etymonline.com/word/appendage" target="_blank" rel="noopener">Etymology Online</a></li>
</ul>
"Appendicular skeleton" is a label referring to a set of bones whose function is distinct from the bones of the "<a href="https://brentbrookbush.com/glossary/axial-skeleton/" target="_blank" rel="noopener">axial skeleton</a>".

A reflexive decrease in muscle activity due to joint dyskinesis.
For example, a reduction in deep cervical flexor activity as a result of cervical spine dyskinesis.

Arthrokinematic Motion - Small amplitude motions between bone surfaces at a joint.  The arthrokinematic motions are roll, glide (slide or translation), spin, compression and distraction (traction). Arthrokinematic motions accompany osteokinematic motions to maintain joint congruence.
<ul>
 	<li>Example, arthrokinematic motion of the talus includes posterior glide on the tibia during ankle dorsiflexion.</li>
</ul>
Synonyms include: arthrokinematics, passive accessory motion, joint play and component motion

&nbsp;

Assessment - is the act of assessing, i.e. determining the importance, size, or value of -

In most cases, the results of an assessment are compared to normative data. If the individual exhibits values that are within normal parameters, it may be assumed that the aspect of health or motion assessed is not contributing to the patient's complaint, symptoms or movement impairment. If the results fall outside of normal parameters, it may indicate that the aspect of health or motion assessed is contributing to, or being affected by the patient/client's complaint, symptoms, or movement impairment. In some cases, the results of an assessment are compared to an "ideal model." In this case, deviations from the ideal are noted as potential issues. For example, deviations noted in the <a title="Introduction to the Overhead Squat Assessment" href="https://brentbrookbush.com/online-courses/articles/assessment/introduction-overhead-squat-assessment/" target="_blank">Overhead Squat Assessment</a> are compared to an "ideal model" of posture and motion.

Assessments used by human movement professionals can be divided into three broad categories:
<ul>
 	<li>"Clear" the Patient/Client for Intervention - These are tests, assessments and evaluations used to determine if a patient/client's issue may improve given the assessing professional's scope, skills, abilities and willingness to treat that individual.
<ul>
 	<li>For example, many of the special tests used in orthopedic medicine assist in determining the level of pathology or likelihood of a particular diagnosis. Certain issues and diagnoses are beyond the scope of the human movement professional, and are better treated by diagnostic professionals in the medical community (physicians, podiatrists, surgeons, etc.). A Calf Squeeze (Thompson) Test is one example, in which a positive sign may indicate a rupture of the Achilles tendon that may be better treated via surgical intervention.</li>
</ul>
</li>
 	<li>Highlight Contraindications - Tests, assessments and evaluations used to stratify risk or preclude a professional from addressing certain tissues, motions or using a particular technique.
<ul>
 	<li>For example, the Vertebral Artery Test (VBI) is often used to determine if high velocity thrust mobilizations (manipulations) are safe for a patient with cervical dysfunction.</li>
</ul>
</li>
 	<li>Refine Exercise/Intervention Selection: Tests, assessments and evaluations used to assist the professional in determining which techniques, modalities and exercises will best address a patient/client's complaints or desired goals.
<ul>
 	<li>Most movement assessments fall into this category. For example, a positive <a href="https://brentbrookbush.com/vimeo_videos/elys-test-rectus-femoris-flexibility-assessment/" target="_blank">Ely's Test</a> may indicate a need to release and/or lengthen the <a href="https://brentbrookbush.com/articles/anatomy-articles/muscular-anatomy/rectus-femoris/" target="_blank">rectus femoris</a>.</li>
</ul>
</li>
</ul>
Note: An assessment, or assessment result, may fall into more than one category. For example, although goniometry is an assessment most often used to Refine Exercise/Intervention Selection, if a range of motion is significantly altered, with an abnormal end-feel, and/or causes the patient or client/pain, the individual may need to be referred to a physician for further testing and Clearance to resume rehab activities.  Further, that same patient may return to the human movement professional with a list of Contraindicated Activities from the physician. - "When in doubt, refer out!"

Axial Skeleton - referring to the bones of the head, neck, trunk and spinal column (does not include pelvis). There are approximately 80 bones in the axial skeleton.
<ul>
 	<li>Etymology - Axial, as in "axis", referring to "imaginary motionless straight line around which a body (such as the Earth) rotates," from Latin axis "axle, pivot, axis of the earth or sky" - <a href="https://www.etymonline.com/word/axis" target="_blank" rel="noopener">Etymology Online</a></li>
</ul>
"Axial skeleton" is a label referring to a set of bones whose function is distinct from the bones of the "<a href="https://brentbrookbush.com/glossary/appendicular-skeleton/" target="_blank" rel="noopener">appendicular skeleton</a>".

Balance - The ability to maintain a body’s center of mass over its base of support. Balance can be static or dynamic.
<ul>
 	<li>For example, maintaining balance is harder on one leg because the center of mass must stay over a much smaller base of support.</li>
</ul>

A ball and socket joint (also called a spheroid joint or spheroidal joint) is a synovial joint in which the rounded or spherical end of one bone fits into a cup-like depression of another bone. The distal bone is capable of motion around an indefinite number of axes, which have one common center. Examples include the hip and shoulder (glenohumeral joint)

Base of support (BoS) - refers to the area beneath an object or person, and the area within the perimeter created by every point of contact that the object or person makes with the supporting surface. This may include the <a href="https://brentbrookbush.com/articles/anatomy-articles/muscular-anatomy/gluteus-maximus/" target="_blank" rel="noopener">glutes</a> of someone sitting on a chair, or the back of someone leaning against a wall.
<ul>
 	<li>For example, during a single leg balance the BoS is the area of the foot in contact with the surface; however, when a person is standing on two feet, the BoS is the area of both feet and the surface between them.</li>
</ul>

Pertaining to both sides

Example, bilateral rows are performed with both arms at the same time.

Case-control Study - a particular form of retrospective study that samples a matched group of people who have, and do not have the outcome being studied. A case-control study is a quasi-experimental design, often used in medicine to aid in determining potential contributing factors (cannot determine causality). In this study type exposure is the dependent variable and outcome is independent.
<ul>
 	<li>Example, in this retrospective case-control, medical records were investigated for trends correlated with cervical pain (1).
<ol>
 	<li>Mäkela, M., Heliövaara, M., Sievers, K., Impivaara, O., Knekt, P., &amp; Aromaa, A. (1991). Prevalence, determinants, and consequences of chronic neck pain in Finland. American journal of epidemiology, 134(11), 1356-1367.</li>
</ol>
</li>
</ul>

An anatomical direction; toward the tail, relative to humans this term is often used to refer to "in the direction of the tale (toward the feet)".

Example, to release the trapezius muscle the therapist used a force directed caudally.

Center of mass (CoM) - an object's mean position of mass; that is, a point that is perfectly surrounded by an equal amount mass in all directions.

Center of gravity (CoG) - point where gravity appears to act. Since the human body is so small compared to the earth, we can assume gravity acts uniformly on the body, and that CoG and CoM are the same.
<ul>
 	<li>Example, the CoM of the human body while lying down or standing straight up is close to our navel. However, it is possible that during a resistance exercise, the combination of the body's weight and the weight of the resistance will place the combined CoM outside the body. For example, during the mid-portion of a <a href="https://brentbrookbush.com/vimeo_videos/back-squat/" target="_blank" rel="noopener">back squat</a> the CoM would be several anterior to the naval.</li>
</ul>

An anatomical direction; toward the head (synonym: cranial)

Example, hip pain was felt with any force directed cephalad.

Cohort Study - a particular form of longitudinal study that samples a cohort (a group of people who share a defining characteristic), performing a cross-section at intervals through-out a period of time. A cohort study is a quasi-experimental design often used in medicine to aid in determining etiology or a cause-and-effect relationship. In this study type exposure is the independent variable and outcome is dependent.
<ul>
 	<li>Example, the study by Cholewicki et al. (1) investigated Yale Varsity Athletes (the cohort) with 2 and 3 year follow up (longitudinal design) and found that trunk muscle response time to off-loading was predictive of future low back injury.</li>
</ul>
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/core/increased-trunk-muscle-latency-may-cause-rather-than-result-from-low-back-pain/" target="_blank" rel="noopener noreferrer">Cholewicki, J., Silfies, S., Shah, R., Greene, H., Reeves, N. Alvi, K., Goldberg, B. (2005). Delayed trunk muscle reflex responses increase the risk of low back injuries. Spine. 30(23), 2614-2620</a></li>
</ol>

Comparable Sign: A combination of pain, stiffness and/or spasm during examination that is comparable to the patients symptoms.
<ul>
 	<li>One common error made during evaluation with special tests is attention given to any discomfort or pain, rather than attempting to identify the pain/discomfort related to the patient's complaint (concordant/comparable sign). Many special tests purposefully test tissue limits and are at least mildly uncomfortable in every individual. Basing your assessment on positive tests that resulted in "concordant/comparable signs" will improve your chances of arriving at the correct diagnosis.</li>
</ul>

An alternative movement pattern that has been adopted to compensate for dysfunction/impairment in the human movement system.
Example: A lack of calf extensibility may limit dorsiflexion, leading to the knees bowing inward (functional valgus) and excessive forward lean of the torso during a squat.

An arthrokinematic motion - the approximation of joint surfaces; that is, a force that directs one bone surface into another resulting in a reduction in intra-articular volume. Although widely thought of as a "destructive force", it is likely best to consider compression as a naturally occurring, stabilizing force. Any arthrokinematic force in excess (spin, glide, roll, traction) may be viewed as potentially deleterious.

For example, during a squat the femoral head is compressed into the acetabulum by muscular forces, bodyweight and any additional external load.

Concave (Concavity) - Having an outline or surface curved like the interior surface of a bowl or sphere - to cave-in or curve inward.
<ul>
 	<li>Example, the internal surfaces of the pelvis is concave, holding some of the bodies viscera.</li>
</ul>

Concordant Sign - The patient's specific pain, symptom or complaint. 
<ul>
 	<li>One common error made during evaluation with special tests is attention given to any discomfort or pain, rather than attempting to identify the pain/discomfort related to the patient's complaint (concordant/comparable sign). Many special tests purposefully test tissue limits and are at least mildly uncomfortable in every individual. Basing your assessment on positive tests that resulted in "concordant/comparable signs" will improve your chances of arriving at the correct diagnosis.</li>
</ul>

Conductivity: Stimulation results in more than a local effect (1).
<ul>
 	<li>For example, in a muscle cell the stimulation of a motor endplate results in a change in cell membrane polarity that rapidly propagates (is conducted) along the entire length of the muscle cell, stimulating all sacromere.</li>
</ul>
<ol>
 	<li>Saladin, K. (2012). Anatomy &amp; Physiology: The unity of form and function. (6th ed.). New York: McGraw-Hill.</li>
</ol>

A condyloid joint (also called condylar, bicondylar, ellipsoid, or ellipsoidal) is an ovoid articular surface, or condyle, that is received into an elliptical cavity.  These joints permit movement in two planes.  Examples include the knee, metacarpophalangeal joints and metatarsophalangeal joints.

Connective Tissue Cell - One of the four basic types of animal tissue, consisting mostly fibers and ground substance.  These cells are specialized to binds organs together, holds them in place, protect them from external forces, and may fill space in the body's cavities.

Example, the body's muscles are enclosed in durable connective tissue sheets known as the "epimysium", "perimysium", and "endomysium," which and in support and transmitting force.
<ol>
 	<li>Saladin, K. (2014). Anatomy &amp; physiology: The unity of form and function. McGraw-Hill Higher Education, New York. ISBN: 9780073403717</li>
</ol>

Contractility: The ability to shorten (1).
<ul>
 	<li>Contractility: Muscle cells are unique in the amount they can shorten when stimulated; this is this largerly due to the highly organized and unique arrangement of myofilaments (actin and myosin).</li>
</ul>
<ol>
 	<li>Saladin, K. (2012). Anatomy &amp; Physiology: The unity of form and function. (6th ed.). New York: McGraw-Hill.</li>
</ol>

Pertaining to the opposite side

Example, the external oblique muscle performs contralateral rotation; rotation to the opposite side.

Convex (Convexity) - Having an outline or surface curved like the exterior of a circle or sphere - to bulge or curve outward.
<ul>
 	<li>Example, the top of your head is shaped by the convex exterior surface of your skull.</li>
</ul>

Correlational Research - Non-experimental <a href="https://www.questionpro.com/blog/what-is-research/">research</a> method in which the statistical relationship between two variables is investigated.
<ul>
 	<li>In this research by Kwon et al., a correlation was noted between a decrease in extensibility during a hamstring length test (goniometry) and current knee pain (1).</li>
</ul>
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/knee/correlation-patellofemoral-pain-syndrome-pfps-hamstring-activity/" target="_blank" rel="noopener">Kwon O, Yun M, and Lee W. (2014). Correlation between intrinsic patellofemoral pain syndrome in young adults and lower extremity biomechanics. J. Phys. Ther. Sci. 26: 961-964</a></li>
</ol>

Counter-nutation - posterior rotation of sacrum relative to ilium, and/or anterior rotation of ilium relative to sacrum.
<ul>
 	<li>The pelvic floor muscles are examples of muscle that may counter-nutate the sacrum.</li>
</ul>
[caption id="attachment_126335" align="aligncenter" width="400"]<a href="https://brentbrookbush.com/wp-content/uploads/2018/10/Nutation.png"><img class=" wp-image-126335" src="https://brentbrookbush.com/wp-content/uploads/2018/10/Nutation.png" alt="Nutation and Counter-nutation of the Sacroiliac Joint" width="400" height="967" /></a> Nutation and Counter-nutation of the Sacroiliac Joint[/caption]

&nbsp;

Crossover (Study) Design - A type of longitudinal, repeated measures quasi-experimental design in which each group receives both treatments, but at different times. It is named "crossover" due to the patients "crossing-over" to the other treatment or sham group after a specified period of time.
<ul>
 	<li>This type of study has the advantage of every individual serving as their own control, which may reduce the influence of confounding variables.</li>
 	<li>Unfortunately, the design itself introduces the chances that anyone receiving the experimental variable in the first period will continue to be effected in the second period.</li>
</ul>
In a study by Senna et al., a cross-over design was used to investigate the difference load made on inter-set rest intervals (1).
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/strength-training-research-corner/heavy-vs-light-load-single-joint-exercise-performance-with-different-rest-periods/" target="_blank" rel="noopener">Senna, G.W., Rodrigues, B.M., Sandy, Scudese, Bianco, A, &amp; Dantas, E.H.M. (2017). Heavy vs light load single-joint exercise performance with different intervals. Journal of Human Kinetics, 58, 197-206. </a></li>
</ol>

Cross-sectional Study - a research design that involves gathering data from a population or representative subset at a specific point in time.
<ul>
 	<li>Example, the study by Karimi-Mobarake et al.(1) investigated the prevalence of genu varum and genu valgum among school children 7-11 years old in Iran.</li>
</ul>
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/knee/low-prevalence-of-genu-varum-and-valgum-among-elementary-school-children/" target="_blank" rel="noopener noreferrer">Karimi-Mobarake, M., Kashefipour, A., Yousfnejad, Z. The prevalence of genu varum and genu valgum in primary school children in Iran 2003-2004. (2005) Journal of Medical Science 5(1). 52-54</a></li>
</ol>

Cytokine - A broad and loose category of small proteins that act through receptors, and are especially important to immune function (inflammation).
<ul>
 	<li>Cytokines include substances such as interferon, interleukin, and growth factors, which are secreted by certain cells of the immune system and have an effect on other cells. Their definite distinction from hormones is a topic of continued research.</li>
</ul>
&nbsp;

Dependent variable - in research, this is the variable that is changed by the independent variable, most often this is the "outcome" of the study.
<ul>
 	<li>Example, in the study by Cleland et al. (1), the independent variable is "thoracic manipulation," and the dependent variable is "lower trapezius muscle strength."</li>
</ul>
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/short-term-effects-lower-thoracic-manipulation-lower-trapezius-muscle-strength/" target="_blank" rel="noopener noreferrer">Cleland J, Selleck B, Stowell T, Brown L, Alberini S, St. Cyr H, Caron T. Short-term Effects of Thoracic Manipulation on Lower Trapezius Muscle Strength.  Journal of Manual &amp; Manipulative Therapy. 2004; 12(2): 82-90</a></li>
</ol>

An anatomical direction; further from the trunk or center of the body

Example, the foot is at the distal end of the leg.

An arthrokinematic motion - a force applied to a body part that may result in the separation of joint surfaces, a reduction in intra-articular pressure, and/or an increase in intra-articlar space.

For example, to hang from one's hands (i.g. in preparation for a pull-up) results in a traction force on the glenohumeral joint (shoulder).

An anatomical term of location; back or upper surface

Example, shoe laces may compress tissues on the dorsal surface of the foot

The "drawing-in" maneuver is a common cue used during exercise and rehabilitation programs. A light contraction of the <a href="https://brentbrookbush.com/articles/muscular-anatomy/transverse-abdominis/" target="_blank" rel="noopener">transverse abominis</a> (and potentially the entire <a href="https://brentbrookbush.com/articles/corrective-exercise-articles/core-subsystems/intrinsic-stabilization-subsystem/" target="_blank" rel="noopener">intrinsic stabilization subsystem</a>) achieved by gently pulling the lower abdominal region away from one's waist band. This should have minimal effect on breathing, and should not be confused with a maximal contraction of the <a href="https://brentbrookbush.com/articles/muscular-anatomy/transverse-abdominis/" target="_blank" rel="noopener">transverse abdominis</a> resulting in a "vacuum pose".
<ul>
 	<li>Research often refers to this maneuver as the "abdominal drawing-in maneuver"; abbreviated ADIM.</li>
</ul>
Development and introduction of this cue into practice is based on the pivotal research and resulting text:
<ol>
 	<li>Carolyn Richardson, Paul Hodges, Julie Hides. Therapeutic Exercise for Lumbo Pelvic Stabilization – A Motor Control Approach for the Treatment and Prevention of Low Back Pain: 2nd Edition (c) Elsevier Limited, 2004</li>
</ol>

Faulty or abnormal movement; an alteration of normal kinematics.

For example, joint stiffness or a reduction in arthrokinematics motion that results in limited osteokinematic range of motion - inadequate inferior glide of the femoral head resulting in limited abduction of the hip.

The seeping into, or abnormal collection of fluid in a body cavity.

For example, knee effusion describes swelling within the knee joint.

Note: the word "effusion" is used differently in medicine than it is used in reference to the movement (seeping out) of liquids and gases, for example in chemistry.

&nbsp;

A trait of body tissues that allows a tissue to return to its resting length or state after deformation or stretch.
Example:  Muscle is elastic tissue; many muscles will return to their resting length after being stretched to 150% of that length without any appreciable change in tissue quality.

Elasticity: Elasticity refers to the ability of a cell to return to its resting length after being stretched/lengthened.
<ul>
 	<li>Note: this term is often confused with extensibility. Elasticity is not the ability to stretch; it is the ability to return to normal length after being stretched. Muscle tissue, connective tissue and even nerve tissue have varying levels of elasticity.</li>
</ul>
<ol>
 	<li>Saladin, K. (2012). Anatomy &amp; Physiology: The unity of form and function. (6th ed.). New York: McGraw-Hill.</li>
</ol>

Epithelial cell - One of the four basic cell types, found lining the body's cavities, blood vessels, organs and constitutes most gland tissue.  These cells are specialized to aid with absorption, secretion, or act as a barrier from foreign objects.
<ol>
 	<li>Saladin, K. S., &amp; Miller, L. (1998). Anatomy &amp; physiology. New York (NY): WCB/McGraw-Hill.</li>
</ol>

Equilibrium - a state in which opposing forces or influences are balanced.
<ul>
 	<li>For example, to maintain a neutral trunk while pushing or pulling a weight in one hand, your core musculature must balance the force by creating an equal amount of force in the opposite direction.</li>
</ul>

The study of causation, or origination. The word is commonly used in the medical professions, where it may refer to the study of why things occur, or the reason behind why things act a certain way.

For example, the etiology of low back pain is a complex subject, with multiple contributing factors and various structures implicated.

<div class="gs_citr" tabindex="0">Evidence-based medicine (practice) is the integration of best research evidence with clinical expertise and patient(client) values (2)."</div>
<ul>
 	<li class="gs_citr" tabindex="0">...the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients (clients).  It involves the integration of at least (a) clinical expertise/expert opinion, (b) external scientific evidence, and (c) client/patient/caregiver perspectives to provide high-quality services reflecting the interests, values, needs, and choices of the individuals we serve (1).</li>
</ul>
&nbsp;
<ol>
 	<li id="gs_cit1" class="gs_citr" tabindex="0">Sackett, D. L., Rosenberg, W. M., Gray, J. M., Haynes, R. B., &amp; Richardson, W. S. (1996). Evidence based medicine: what it is and what it isn't. Bmj, 312(7023), 71-72.</li>
 	<li class="gs_citr" tabindex="0">Sackett D et al. Evidence-Based Medicine: How to Practice and Teach EBM, 2nd edition. Churchill Livingstone, Edinburgh, 2000, p.1</li>
</ol>

Excitability: The ability of a cell to change in membrane conductance as a response to stimulation.

<ul>
 	<li>For example, muscle cells are specialized to react to a change in membrane potential with contraction, where as nerve cells are specialized to propagate a change in membrane potential along there axons and communicate that message to other tissues via neurotransmitters.
</li>
</ul>
<ol>
 	<li>Saladin, K. (2012). Anatomy &amp; Physiology: The unity of form and function. (6th ed.). New York: McGraw-Hill.</li>
</ol>

Excitation threshold: The level that a depolarization must reach for an action potential to occur.
<ul>
 	<li>The excitation threshold is a contributing factor to the "all-or-none" response of muscle and nerves cells to a stimulus.</li>
</ul>

Exercise Progression - Modification of an exercise with the intent of promoting adaptation by increasing demand. This can be accomplished by increasing reps, load, tempo, range of motion, complexity, and/or challenge to an individual's stability.
<ul>
 	<li>Because load, reps, tempo and complexity are often explicitly noted, the term "exercise progression" is most often used throughout Brookbush Institute (BI) content to refer to an exercise, or series of exercises that make it harder to maintain stability with good form.
<ul>
 	<li>Sample Exercise Progression: <a href="https://brentbrookbush.com/vimeo_videos/kneeling-chop-pattern/" target="_blank" rel="noopener">Kneeling Chop</a> to <a href="https://brentbrookbush.com/vimeo_videos/static-standing-chop-pattern/" target="_blank" rel="noopener">Standing Chop</a> to <a href="https://brentbrookbush.com/vimeo_videos/single-leg-chop-pattern/" target="_blank" rel="noopener">Single-leg Chop</a></li>
</ul>
</li>
</ul>

Exercise regression - The opposite of progression; that is, modification of an exercise with the intent of reducing demand. This can be accomplished by decreasing reps, load, tempo, range of motion, complexity, and/or challenge to an individual's stability. Generally, regressions are used to modify an exercise to the client's current level of ability, with the intent of improving form, motor learning and retention.
<ul>
 	<li>Because load, reps, tempo and complexity are often explicitly noted, the term "exercise regression" is most often used throughout Brookbush Institute (BI) content to refer to an exercise or series of exercises that make it easier to maintain stability with good form.
<ul>
 	<li>Sample Exercise Regression: <a href="https://brentbrookbush.com/vimeo_videos/single-leg-chop-pattern/" target="_blank" rel="noopener">Single-leg Chop</a> to <a href="https://brentbrookbush.com/vimeo_videos/static-standing-chop-pattern/" target="_blank" rel="noopener">Standing Chop</a> to <a href="https://brentbrookbush.com/vimeo_videos/kneeling-chop-pattern/" target="_blank" rel="noopener">Kneeling Chop</a></li>
</ul>
</li>
</ul>

Experimental Research - Studies in which the researchers introduce the variable to be studied, with the intent of observing the outcome. This is different than observational research which observes the effect of a variable already present. Many texts also assert that experimental research should include randomization and ideally a control group, as is seen in Randomized Control Trials. Studies in which the variable is introduced by the researchers, but participants are not randomized may be considered Quasi-experimental research.
<ul>
 	<li>In this study by Esformes, the experimental variable was squat depth and the outcome measures observed were various performance measures related to power (1).</li>
</ul>
<ol>
 	<li><a href="https://brookbushinstitute.com/article/back-squat-depth-lower-body-post-activation-potentiation/" target="_blank" rel="noopener">Esformes, J., &amp; Bampouras, T. (2013). Effect of back squat depth on lower-body postactivation potentiation. Journal of Strength and Conditioning Research, 27(11), 2997-3000.</a></li>
</ol>
&nbsp;

Extensibility: The ability of a cell to be stretched or lengthened without damage (1).
<ul>
 	<li>For example, most cells would rupture with even a modest stretch, but muscles can stretch up to 3 times their contracted length.</li>
</ul>
<ol>
 	<li>Saladin, K. (2012). Anatomy &amp; Physiology: The unity of form and function. (6th ed.). New York: McGraw-Hill.</li>
</ol>

False Negative - the proportion of negatives in a group that were assessed incorrectly (assessed as negative when the patient was actually positive)
<ul>
 	<li>Test Results: Although most tests/assessments result in either a positive or negative, the accuracy of a test is dependent on the number  of positives and negatives that are correct. Therefore, when the accuracy of a test is determined, their are 4 possible results, because a positive or negative result could be right (true) or wrong (false).</li>
</ul>

False Positive - the proportion of positives in a group that were assessed incorrectly (assessed as positive when the patient was actually negative)
<ul>
 	<li>Test Results: Although most tests/assessments result in either a positive or negative, the accuracy of a test is dependent on the number  of positives and negatives that are correct. Therefore, when the accuracy of a test is determined, their are 4 possible results, because a positive or negative result could be right (true) or wrong (false).</li>
</ul>

The function of fascia is to transmit force, provide support, and protect tissues. Fascia can effect motion by:
Transmitting force from one or more muscles (example: the thoracolumbar fascia)
Restricting motion in cases of adaptive shortening and/or adhesion to proximal structures (example: iliotibial band in cases of lower-leg dysfunction)
Elastic recoil after stretching can contribute to force production (example: plyometric exercise)

Note: There is evidence that fascia may house more receptors related to human movement than other tissues. In this way fascia may act as a motherboard for the nervous system

The fascial system does not contract or develop trigger points, and its capacity to adapt to stretching and or strengthening exercise is limited, especially when compared to the adaptive capacity of muscle tissue.

Fibromyalgia - A loosely defined diagnosis that is associated with a combination of widespread pain in combination with 2) tenderness at 11 or more of the 18 specific tender point sites. Consideration may also be given to the presence of psychosocial stressors and inflammatory disease in the patients history. Newer research suggests that fibromyalgia may be at least in part due to central sensitization of myofascial pain, often associated with trigger points (1 - 4).
<ol>
 	<li>Wolfe, F. (2018). Fibromyalgia Syndrome and Fibromyalgia Syndrome Criteria: Problems in Definition and Validity. Fibromyalgia Syndrome and Widespread Pain: From Construction to Relevant Recognition.</li>
 	<li>Wolfe, F., Smythe, H. A., Yunus, M. B., Bennett, R. M., Bombardier, C., Goldenberg, D. L., ... &amp; Fam, A. G. (1990). The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Arthritis &amp; Rheumatism: Official Journal of the American College of Rheumatology, 33(2), 160-172.</li>
 	<li>Alonso-Blanco, C., Fernandez-de-las-Penas, C., Morales-Cabezas, M., Zarco-Moreno, P., Ge, H. Y., &amp; Florez-García, M. (2011). Multiple active myofascial trigger points reproduce the overall spontaneous pain pattern in women with fibromyalgia and are related to widespread mechanical hypersensitivity. The Clinical journal of pain, 27(5), 405-413.</li>
 	<li>Staud, R., Nagel, S., Robinson, M. E., &amp; Price, D. D. (2009). Enhanced central pain processing of fibromyalgia patients is maintained by muscle afferent input: a randomized, double-blind, placebo-controlled study. PAIN®, 145(1-2), 96-104.</li>
</ol>
&nbsp;

Muscles that act to reduce or prevent movement at proximal joints to improve force transmission.
Example: The muscles of the core are important fixators; reducing motion of the spine/trunk to enhance force transmission between the extremities and environment.

An increase in joint stability via compressive forces resulting from muscular contraction and increased tension in fascial structures (1,2).
<ul>
 	<li>This term is most often used in reference to core intrinsic stabilizers, the thoracolumbar fascia and the sacroiliac joint; however, force closure and form closure have been mentioned in the literature referring to other joints.</li>
 	<li>Related term: Form closure</li>
</ul>
<ol>
 	<li>Andry Vleeming, Vert Mooney, Rob Stoeckart. Movement, Stability &amp; Lumbopelvic Pain: <a class="glossaryLink " title="Glossary: Integration" href="https://brentbrookbush.com/glossary/integration/" target="_blank" rel="noopener noreferrer" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Integration&lt;/div&gt;&lt;div class=glossaryItemBody&gt;Making a whole of parts.&lt;br /&gt;&lt;br /&gt;Example, The Brookbush Institute uses an integrative approach to explaining and addressing human movement.&lt;/div&gt;">Integration</a> of Research and Therapy. (c) 2007 Elsevier Limited</li>
 	<li id="gs_cit1" class="gs_citr" tabindex="0">Vleeming, A., Pool-Goudzwaard, A. L., Stoeckart, R., van Wingerden, J. P., &amp; Snijders, C. J. (1995). The Posterior Layer of the Thoracolumbar Fascia| Its Function in Load Transfer From Spine to Legs. Spine, 20(7), 753-758.</li>
</ol>

The relative contribution of joint shape and structure to the stability of a joint (1,2).
<ul>
 	<li>This term is most often used in reference to the "rough" articulating surfaces of the sacroiliac joint and the wedge shape of the sacrum; however, force closure and form closure have been mentioned in the literature referring to other joints.</li>
 	<li>Related term: Force closure</li>
</ul>
<ol>
 	<li>Andry Vleeming, Vert Mooney, Rob Stoeckart. Movement, Stability &amp; Lumbopelvic Pain: <a class="glossaryLink " title="Glossary: Integration" href="https://brentbrookbush.com/glossary/integration/" target="_blank" rel="noopener noreferrer" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Integration&lt;/div&gt;&lt;div class=glossaryItemBody&gt;Making a whole of parts.&lt;br /&gt;&lt;br /&gt;Example, The Brookbush Institute uses an integrative approach to explaining and addressing human movement.&lt;/div&gt;">Integration</a> of Research and Therapy. (c) 2007 Elsevier Limited</li>
 	<li id="gs_cit1" class="gs_citr" tabindex="0">Vleeming, A., Pool-Goudzwaard, A. L., Stoeckart, R., van Wingerden, J. P., &amp; Snijders, C. J. (1995). The Posterior Layer of the Thoracolumbar Fascia| Its Function in Load Transfer From Spine to Legs. Spine, 20(7), 753-758.</li>
</ol>

An arthrokinematic motion - linear motion across a joint surface parallel to the plane of the adjacent joint surface, just as your posterior moves relative to a "slide" in a park.

For example, the glide of facet joint in the spine during spinal flexion and extension, or the posterior glide of the humeral head that must accompany anterior roll to maintain congruence with glenoid fossa during shoulder horizontal adduction.

A plane joint (also called an arthrodial joint, gliding joint or plane articulation) is a synovial joint which allows only gliding movement in the plane of the articular surfaces. The opposed surfaces of the bones are flat or almost flat, with movement generally limited by tight capsules and ligaments. Plane joints are numerous, are most often small, and allow very little motion.  Examples include the carpal joints of the wrist, the tarsal joints of the ankle, and the facet joints of the spine.

"...refers to the measurement of angles, in particular the measurement of angles created at human joints by the bones of the body (1).

&nbsp;
<ol>
 	<li>Cynthia C. Norkin, D. Joyce White. Measurement of Joint Motion: A Guide to Goniometry 3rd Edition. Copyright (C) 2003 by F.A. Davis Company</li>
</ol>

Ground reaction force (GRF) - The force exerted by the ground on the body in contact with it.

For example, when a runner's foot strikes the ground with a force equal to the mass of the individual times their acceleration due to gravity, momentum and muscular exertion, the ground exerts an equal and opposite force on the runner's foot.
<ul>
 	<li>GRF is often measured in research studies using force plates as a means of quantitatively measuring the force generated by an individual.</li>
</ul>

H-Band - Refers to the central zone of a sarcomere that looks lighter under a microscope.  This area of the sarcomere is a lighter portion of the A-band where there is no overlap between the thinner filaments (actin), and the thicker filaments (myosin).
<ul>
 	<li>Example, when a muscle contracts, actin and myosin cross-bridging occurs in the region of the A-band until the H-band is reached where no overlap occurs.</li>
</ul>
<ol>
 	<li>Saladin, K. (2014). Anatomy &amp; physiology: The unity of form and function. McGraw-Hill Higher Education, New York. ISBN: 9780073403717</li>
</ol>

A hinge joint (also called a ginglymus) is a synovial joint in which the articular surfaces fit one another in a way that only permits motion in one plane. Examples include the elbow, the knee (unless considered a condyloid joint) and the interphalangeal joints.

Holism (holistic) (biological holism) - (from Greek holos "all, whole, entire") is the idea that systems and their properties should be viewed as wholes, not just as a collection of parts.
<ul>
 	<li>Summarized by Aristotle in his "Metaphysics": "The whole is more than the sum of its parts". However, the term "holism" was introduced into language by the South African statesman Jan Smuts as recently as 1926. (Smuts J. C. 1987 [1926]. Holism and evolution. Cape Town: N &amp; S Press.)</li>
</ul>
Example: The Brookbush Institute promotes a holistic approach to human movement science, in which the muscular, fascial, articular and neural systems are not viewed as separable and all proximal segments are considered.

Hormone: Chemical messengers produced by the endocrine system, transported via tissue fluids such as blood, to stimulate cells to "act."
<ul>
 	<li>Example: Growth hormone is secreted by the pituitary gland in the brain; stimulating growth, cell reproduction and cell regeneration in certain types of cells</li>
</ul>
The English physician E. H. Starling discovered in collaboration with the physiologist W. M. Bayliss secretin, the first hormone, in 1902. (1).
<ol>
 	<li>Henriksen, J. H., &amp; de Muckadell, O. S. (2000). Secretin, its discovery, and the introduction of the hormone concept. Scandinavian journal of clinical and laboratory investigation, 60(6), 463-472.</li>
</ol>

A range of motion achieved by the patient/client that is more than normal.
<ul>
 	<li>Note: Both hyper-mobility and hypo-mobility may adversely affect motion and may lead to deleterious effects on joints and soft tissue over time. There is no evidence to suggest that more or less flexibility than normal is beneficial.</li>
</ul>
Example: If an individual can place their forehead on their knees they are likely hypermobile at one, if not several joints

Example 2: 110° of shoulder external rotation would be considered hyper-mobile.

Hyperplasia is an increase in organic tissue size due to an adaptive increase in the number of cells per organ.
<ul>
 	<li>Although muscle hyperplasia has been noted in some animals, human muscle tissue does not seem to have this adaptive ability.</li>
</ul>

A condition of excessive tone of the skeletal muscles; increased resistance of muscle to passive stretching.  May be related to increased neural drive, synergistic dominance, trigger points, reflexive over-activity, and/or muscle length.
Example:  Individuals who exhibit ankle eversion and abduction during an overhead squat assessment likely have hypertonic fibularis (peroneal) muscles.

Muscular hypertrophy is an increase in muscle mass/size due to increase in the volume and cross-sectional area (CSA) of individual muscle cells. The increase in cross-sectional area can be attributed to an an increase in contractile proteins and structural elements (myofibrillar hypertophy), as well as an increase in glycogen storage and elements related to metabolism (sarcoplasmic hypertophy). Hypertrophy is an adaptation of both cardiac and skeletal muscle fibers in response to progressive increases in workload.
<ul>
 	<li>Note: Hypertrophy is not hyperplasia. Hyperplasia is an increase in muscle size due to an adaptive increase in the number of muscle fibers/cells per muscle. This type of adaptation does not occur in human muscle tissue.</li>
</ul>

A range of motion achieved by a patient/client that is less than normal.
<ul>
 	<li>Note: Both hyper-mobility and hypo-mobility may adversely affect motion and may lead to deleterious effects on joints and soft tissue over time. There is no evidence to suggest that more or less flexibility than normal is beneficial.</li>
</ul>
Example: If the end range of shoulder external rotation is reached and measured as 75° during goniometric assessment, the client/patient is exhibiting hypomobility of the glenohumeral joint (shoulder).

Hypothesis - a proposed explanation for a phenomenon; "scientific hypotheses" are generally constructed in a way that is testable or falsifiable.
<ul>
 	<li>Example: The hypothesis, "excessive knee valgus may be correlated with future knee pain and injury," has been the subject of several studies published over the last decade.</li>
</ul>

Diminished tone of skeletal muscles; diminished resistance of muscles to passive stretching.   May be related to inhibition, reciprocal inhibition, arthrokinematics inhibition and/or  increased resting length of muscle.
Example:  If your knees cave (hip adduction) during a squat or leg-press it is likely that your gluteus medius is hypotonic.

I-Band - Refers to the part of the muscle cell that looks lighter under a microscope.  This area of the cell is lighter due to parallel arrangement of thinner filaments (actin), and no overlap with the thicker filaments (myosin).
<ul>
 	<li>As a muscle contracts, the I-bands will decrease in width and move closer to one another.</li>
</ul>
<ol>
 	<li>Saladin, K. (2014). Anatomy &amp; physiology: The unity of form and function. McGraw-Hill Higher Education, New York. ISBN: 9780073403717</li>
</ol>

Independent variable - in research, this is the variable or phenomenon being manipulated in the study.
<ul>
 	<li>Example, in the study by Ghanbari et al. (1), the independent variable is "knee joint mobilization", the dependent variable is "quadriceps muscle strength."</li>
</ul>
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/effect-knee-joint-mobilization-quadriceps-muscle-strength/" target="_blank" rel="noopener noreferrer">Ghanbari A. and Kamalgharibi S. (2013). Effect of knee joint mobilization on quadriceps muscle strength. International Journal of Health and Rehabilitation Sciences. 2(4): 186-191</a></li>
</ol>

An anatomical direction; toward the bottom (below)

Example, the mouth is inferior to the eyes

A reduction in neural drive, muscular activity, and or force output due to altered neuromuscular reflex.  Alterations in neuromuscular reflex may occur due to increases in muscle length (hypothesis: increased excitation threshold), altered reciprocal inhibition in response to increased antagonist tone, and or alterations in joint motion (arthrokinematics inhibition).

Making a whole of parts.

Example, The Brookbush Institute uses an integrative approach to explaining and addressing human movement.

Intermuscular Coordination - Optimal timing and motor unit recruitment of agonists, antagonists, synergists, neutralizers, stabilizers and fixators.

Example: Role of Muscles during Hip Extension
<ul>
 	<li><a class="glossaryLink " style="box-sizing: border-box; font-family: roboto; color: #000000 !important; font-size: 15px; outline: none; background: transparent; border-bottom: 1px dotted #000000 !important; text-decoration: none;" title="Glossary: Prime Mover" href="https://brentbrookbush.com/glossary/prime-mover/" target="_blank" rel="noopener" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Prime Mover&lt;/div&gt;The muscle most responsible for a joint action under load -&lt;br /&gt;&lt;br /&gt;That is, the muscle that can produce the most force for a given joint action. Often this term is used synonymously with the term agonist. The prime mover as defined above, may or may not be the most active muscle for a joint action during activities of daily living.&lt;br /&gt;&lt;br /&gt;Example: the gluteus maximus is the most powerful hip extensor and therefore the prime mover; however, the hamstrings are likely the most active hip extensors during low level activities like walking or standing.">Prime Mover</a>:  <a href="https://player.vimeo.com/external/82855344.hd.mp4?s=54c3e7d98fb9d4e0af8d282c85ba9b3e">Gluteus maximus</a></li>
 	<li><a class="glossaryLink " style="box-sizing: border-box; font-family: roboto; color: #000000 !important; font-size: 15px; outline: none; background: transparent; border-bottom: 1px dotted #000000 !important; text-decoration: none;" title="Glossary: Synergists" href="https://brentbrookbush.com/glossary/synergists/" target="_blank" rel="noopener" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Synergists&lt;/div&gt;Muscles that assist the prime mover in performing a joint action.&lt;br /&gt;&lt;br /&gt;That is, all muscles that can perform a joint action that are not the prime mover, are termed synergists.&lt;br /&gt;Example: The rectus abdominis is the prime mover of spinal flexion. All other muscles that can perform spinal flexion are synergists including – external obliques, internal obliques and psoas.">Synergists</a>: <a href="https://brentbrookbush.com/articles/muscular-anatomy/biceps-femoris/">Biceps femoris (long head)</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/semitendinosus-and-semimembranosus/">semitendinosus, semimembranosus</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/adductors/">posterior head of adductor magnus</a></li>
 	<li><a class="glossaryLink " style="box-sizing: border-box; font-family: roboto; color: #000000 !important; font-size: 15px; outline: none; background: transparent; border-bottom: 1px dotted #000000 !important; text-decoration: none;" title="Glossary: Antagonist" href="https://brentbrookbush.com/glossary/antagonists/" target="_blank" rel="noopener" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Antagonist&lt;/div&gt;Muscles that oppose the prime mover and synergists for a given joint action.&lt;br /&gt;&lt;br /&gt;That is, all the muscles that can perform the opposing joint action.&lt;br /&gt;&lt;br /&gt;Example: The triceps and anconeus are antagonists during elbow flexion.">Antagonists</a>: <a href="https://brentbrookbush.com/articles/muscular-anatomy/psoas/">Psoas</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/iliacus/">iliacus</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/tensor-fascia-latae-tfl/">tensor fascia latae</a> (TFL),<a href="https://brentbrookbush.com/articles/muscular-anatomy/rectus-femoris/"> rectus femoris</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/adductors/">anterior adductors (especially pectineus)</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/sartorius/">sartorius</a></li>
 	<li><a class="glossaryLink " style="box-sizing: border-box; font-family: roboto; color: #000000 !important; font-size: 15px; outline: none; background: transparent; border-bottom: 1px dotted #000000 !important; text-decoration: none;" title="Glossary: Neutralizer" href="https://brentbrookbush.com/glossary/neutralizers/" target="_blank" rel="noopener" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Neutralizer&lt;/div&gt;Muscles that oppose unwanted joint motions created by the prime mover and/or synergists, and/or muscles that prevent unwanted ancillary motion.&lt;br /&gt;Example: The teres minor and infraspinatus neutralize the internal rotation force created by the pectoralis major during horizontal adduction of the shoulder.">Neutralizers</a>: <a href="https://brentbrookbush.com/articles/muscular-anatomy/gluteus-minimus/">Gluteus minimus</a> and <a href="https://brentbrookbush.com/articles/muscular-anatomy/gluteus-medius/">anterior fibers of gluteus medius</a> neutralize external rotation force of <a href="https://brentbrookbush.com/articles/muscular-anatomy/gluteus-maximus/">gluteus maximus</a></li>
 	<li><a class="glossaryLink " style="box-sizing: border-box; font-family: roboto; color: #000000 !important; font-size: 15px; outline: none; background: transparent; border-bottom: 1px dotted #000000 !important; text-decoration: none;" title="Glossary: Stabilizer" href="https://brentbrookbush.com/glossary/stabilizers/" target="_blank" rel="noopener" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Stabilizer&lt;/div&gt;Muscles whose primary role is to improve arthrokinematics by maintaining optimal alignment of joint surfaces.&lt;br /&gt;&lt;br /&gt;Most often these muscles are the most intrinsic muscles of a joint, have a larger percentage of Type I muscle fibers and are rich in proprioceptors.&lt;br /&gt;Example: The muscles of the rotator cuff act as stabilizers for most shoulder motions.">Stabilizers</a>: <a href="https://brentbrookbush.com/articles/muscular-anatomy/deep-rotators-of-the-hip/">Deep rotators of hip</a></li>
 	<li><a class="glossaryLink " style="box-sizing: border-box; font-family: roboto; color: #000000 !important; font-size: 15px; outline: none; background: transparent; border-bottom: 1px dotted #000000 !important; text-decoration: none;" title="Glossary: Fixator" href="https://brentbrookbush.com/glossary/fixators/" target="_blank" rel="noopener" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Fixator&lt;/div&gt;Muscles that act to reduce or prevent movement at proximal joints to improve force transmission.&lt;br /&gt;Example: The muscles of the core are important fixators; reducing motion of the spine/trunk to enhance force transmission between the extremities and environment.">Fixators</a>: <a href="https://brentbrookbush.com/articles/core-subsystems/intrinsic-stabilization-subsystem/">Intrinsic stabilization subsystem</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/rectus-abdominis/">rectus abdominis</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/internal-obliques/">internal</a> and <a href="https://brentbrookbush.com/articles/muscular-anatomy/external-obliques/">external obliques</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/quadratus-lumborum/">quadratus lumborum</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/erector-spinae/">erector spinae</a></li>
</ul>
&nbsp;

Example from: <a href="https://brentbrookbush.com/articles/anatomy-articles/introduction-to-functional-anatomy/kinesiology-of-the-hip/" target="_blank" rel="noopener">Introduction to Functional Anatomy: Kinesiology of the Hip</a>

Intramuscular coordination refers to the coordinated recruitment of motor units within a single muscle. This concept is used to explain increases in maximal strength and power; however, the coordinated and sequential recruitment of motor units is also essential to strength endurance and smooth coordinated motion.  Related terminology may include; motor unit recruitment, preferential recruitment, rate coding, sequence, etc..

Example: It is hypothesized that the "shaking" noted during a novice exercisers attempt at an activity like the <a href="https://brentbrookbush.com/vimeo_videos/ball-crunch-and-progressions/" target="_blank">stability ball crunch</a> may be due to relatively poor intramuscular coordination. Rather than smooth, sequential firing of rectus abdominis motor units, groups of motor units turn on and off in an uncoordinated manner.

Pertaining to the same side

Example, the quadratus lumborum performs ipsilateral flexion; lateral flexion toward the same side as the muscle.

An isoform, or variant, is a member of a set of similar proteins, that originate from the same gene, or gene family.
<ul>
 	<li>Example, the variations in myosin heavy chain proteins (MHC I, MHC IIA, MHC IIB/X) that contribute to the characteristic differences between muscle fiber types.</li>
</ul>

“The Prime Assumption”
Everything crossing a joint will influence joint motion during every joint action.

A concept that has expanded over the past several decades to describe the integration of 4 body systems (muscle, joints, fascia and nerves), as well as, the coordinated function of various body segments (e.g. hip, knee and ankle) to produce motion. Kinetic referring to motion, and chain being an analogy for the interdependent link between systems.

Example, the posterior kinetic chain, refers to the integrated function of nerves, muscles, fascia and joints on the posterior side of the body.

The concept of the kinetic chain was originally adapted from the work of a mechanical engineer named Franz Reuleaux (Kinematics of Machinery (1875)) by Dr. Arthur Steindler in 1955 (Steindler A: Kinesiology of the Human Body. Springfield, IL, Charles C. Thomas Co.. 1955).

Latent Trigger Point - A myofascial trigger point that is not painful at rest, only painful when palpated, and may or may not exhibit a characteristic referral pain pattern when palpated.  Latent trigger points do result in an acute point of sensitivity, in a taut band of muscle, and may restrict range of motion (1).

Note: Based on the clinical experience, the Brookbush Institute suggests that latent trigger points (sometimes refereed to as Tender Points) are more common than active trigger points. Further, they are likely addressed more often than trigger points; being the intended target of many soft-tissue mobility techniques.
<ol>
 	<li>David G. Simons, Janet Travell, Lois S. Simons, Travell &amp; Simmons’ Myofascial Pain and Dysfunction, The Trigger Point Manual, Volume 1. Upper Half of Body: Second Edition,© 1999 Williams and Wilkens</li>
</ol>

An anatomical direction; further from the midline

Example, the anterior deltoid is lateral to the pectoralis major

Length/Tension Relationship - The amount of force generated by a muscle is dependent on sarcomere length.
<ul>
 	<li>The ability of sarcomere to maximally produce force occurs when sarcomere length results in optimal overlap between actin and myosin. Stretching a sarcomere decreases overlap between actin and myosin filaments and reduces force production (1-3). When length is less than optimal, actin from opposite ends overlap and interfere with cross-bridging, and myosin filament are compressed as they contact the the Z-disk also reducing force (4)</li>
</ul>
<ol>
 	<li>Gordon, A. M., Huxley, A. F., &amp; Julian, F. J. (1966). The variation in isometric tension with sarcomere length in vertebrate muscle fibres. The Journal of physiology, 184(1), 170-192.</li>
 	<li>Edman, K. A. P. (1966). The relation between sarcomere length and active tension in isolated semitendinosus fibres of the frog. The Journal of Physiology, 183(2), 407-417.</li>
 	<li>Lieber, R. L., Loren, G. J., &amp; Friden, J. (1994). In vivo measurement of human wrist extensor muscle sarcomere length changes. Journal of neurophysiology, 71(3), 874-881.</li>
 	<li>Lieber, R. L. (2002). Skeletal muscle structure, function, and plasticity. Lippincott Williams &amp; Wilkins.</li>
</ol>
&nbsp;

Levels of Evidence - Relative to evidence-based practice, levels of evidence are an attempt to describe the strength of the results measured in a clinical trial or research study.  Note: levels of evidence do not supersede the critical evaluation of an experienced professional, and should be viewed as guidelines - a meta-analysis may be poorly constructed (Level IA), and a comparative study (Level III) may employ new technologies and a strong methodology.


The Levels of Evidence used by the Brookbush Institute, as described by Shekelle et al.(1):
<ul>
 	<li class="p1">IA - Evidence from meta-analysis of randomized controlled trials</li>
 	<li class="p1">IB - Evidence from at least one randomized controlled trial</li>
 	<li class="p1">IIA - Evidence from at least one controlled study without randomization</li>
 	<li class="p1">IIB - Evidence from at least one other type of quasi-experimental study</li>
 	<li class="p1">III - Evidence from non-experimental descriptive studies, such as comparative studies, correlation studies, and case-control studies</li>
 	<li class="p1">IV - Evidence from expert committee reports or opinions or clinical experience of respected authorities, or both</li>
</ul>
<ol>
 	<li>Shekelle, P. G., Woolf, S. H., Eccles, M., &amp; Grimshaw, J. (1999). Developing clinical guidelines. Western Journal of Medicine, 170(6), 348.</li>
</ol>

Likelihood Ratios - Likilihood ratios are used for assessing the value of performing a diagnostic test. They use sensitivity and specificity to determine whether a test result usefully changes the practitioner's chance (probability) of reaching the correct assessment. Calculation of likelihood ratios is based on Baye's theorem.
<ul>
 	<li>Positive Likelihood Ratio (LR+) - The ratio of a positive test result in people with the pathology to a positive test result in people without the pathology.</li>
 	<li>Negative Likelihood Ratio (LR-) - The ratio of a negative test result in people with the pathology to a negative test result in people without the pathology.</li>
</ul>

Longitudinal Study - a research design that involves observing the same variables, several times over a period of time.
<ul>
 	<li>Example, the study by Hewett et al. (1) is a type of longitudinal study called a "cohort study." This study investigated whether excessive knee valgus during landing was a predictor of knee injury risk in adolescent females over the course of a season.</li>
</ul>
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/knee/research-review-increased-valgus-during-landing-predicts-acl-injury-in-adolescent-female-athletes/" target="_blank" rel="noopener noreferrer">Hewett, T. E., Myer, G. D., Ford, K. R., Heidt, R. S., Colosimo, A. J., McLean, S. G., &amp; Succop, P. (2005). Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes A prospective study. The American journal of sports medicine, 33(4), 492-501</a></li>
</ol>

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Acute Variables: Sets Per Muscle Group

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