Sports Medicine

https://doi.org/10.1007/s40279-018-1008-z

SYSTEMATIC REVIEW

Does Aerobic Training Promote the Same Skeletal Muscle Hypertrophy

as Resistance Training? A Systematic Review and Meta‑Analysis
Jozo Grgic1 · Luke C. Mcllvenna1 · Jackson J. Fyfe2,3 · Filip Sabol4,5 · David J. Bishop1,6 · Brad J. Schoenfeld7 ·
Zeljko Pedisic1

© Springer Nature Switzerland AG 2018

Abstract
Background  Currently, there are inconsistencies in the body of evidence for the effects of resistance and aerobic training
on skeletal muscle hypertrophy.
Objective  We aimed to systematically review and meta-analyze current evidence on the differences in hypertrophic adapta-
tion to aerobic and resistance training, and to discuss potential reasons for the disparities noted in the literature.
Methods  The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed for
this review. The Downs and Black checklist was used for the assessment of methodological quality of the included studies.
A random-effects meta-analysis was employed. In total, three analyses were performed: (1) for whole-muscle knee extensor
data; (2) for type I fiber cross-sectional area; and (3) for type II fiber cross-sectional area.
Results  The final number of included studies in the present review is 21. All studies were of good or moderate methodo-
logical quality. The meta-analysis for whole-muscle hypertrophy resulted in a significant pooled difference (p < 0.001) in
responses between the aerobic training and resistance training interventions. The pooled Hedge’s g, favoring resistance over
aerobic training, was 0.66 (95% confidence interval 0.41–90; I2 = 0%). The meta-analysis for type I fiber cross-sectional area
data resulted in a significant pooled difference (p < 0.001) between the aerobic training and resistance training groups. The
pooled Hedge’s g, favoring resistance training over aerobic training, was 0.99 (95% confidence interval 0.44–1.54; I2 = 24%).
The meta-analysis of type II fiber cross-sectional area data resulted in a significant pooled difference (p < 0.001) between
the aerobic training and resistance training groups. The pooled Hedge’s g, favoring resistance training over aerobic training,
was 1.44 (95% confidence interval 0.93–1.95; I2 = 8%).
Conclusions  The results of this systematic review and meta-analysis suggest that single-mode aerobic training does not pro-
mote the same skeletal muscle hypertrophy as resistance training. This finding was consistent with measurements of muscle
hypertrophy both at the whole-muscle and myofiber levels. While these results are specific to the knee extensor musculature,
it can be hypothesized that similar results would be seen for other muscle groups as well.

Electronic supplementary material  The online version of this

article (https​://doi.org/10.1007/s4027​9-018-1008-z) contains
supplementary material, which is available to authorized users.

4
* Jozo Grgic Fitness Academy, Zagreb, Croatia
[email protected] 5
Faculty of Kinesiology, University of Zagreb, Zagreb,
1 Croatia
Institute for Health and Sport (IHES), Victoria University,
6
Melbourne, VIC, Australia School of Medical and Health Sciences, Edith Cowan
2 University, Joondalup, WA, Australia
School of Exercise and Nutrition Sciences, Deakin
7
University, Burwood, Melbourne, VIC, Australia Department of Health Sciences, Lehman College, Bronx,
3 NY, USA
Centre for Sport Research, Deakin University, Burwood,
Melbourne, VIC, Australia

Vol.:(0123456789)
 J. Grgic et al.

reported considerable muscle hypertrophy following long-

Key Points  term aerobic training [16, 17]. Furthermore, some studies
comparing resistance and aerobic training have observed
The results of this systematic review and meta-analysis that these training modes may produce comparable hypertro-
suggest that single-mode aerobic training does not pro- phy of the knee extensor musculature [18, 19]. However, this
mote the same skeletal muscle hypertrophy as resistance effect has not been corroborated by all studies that compared
training. these two modes of exercise. For example, superior muscle
The greater effectiveness of resistance over aerobic hypertrophy has been reported with resistance training com-
training was consistent when analyzing hypertrophic pared with aerobic training [20, 21]. Furthermore, in some
responses both at the whole-muscle and myofiber level. cases, muscle growth has been observed with resistance
training, but not aerobic training [6].
Given the superiority of resistance training for stimulat- In addition to assessing hypertrophic adaptations at the
ing knee extensor hypertrophy, it can be hypothesized whole-muscle level, muscular hypertrophy can also be
that similar results would be observed for other muscle assessed at the myofiber level. Some studies have reported
groups as well. increases in type I, but not type II, muscle fiber cross-sec-
tional area (CSA) with aerobic cycling training [16, 17]. By
contrast, resistance training is primarily considered to induce
1 Introduction hypertrophy of type II muscle fibers [22]. However, Kraemer
et al. [23] demonstrated that resistance training increased
Adaptations to exercise training are primarily thought to both type I and type II fiber CSA, while aerobic running
occur in a mode-specific manner [1]. In this regard, aerobic training decreased the CSA of both fiber types. Contradic-
training is considered to be the primary mode of exercise tory findings have also been noted in the literature, with
for improving markers of cardiorespiratory fitness, such one study showing increased type I fiber CSA with aerobic
as maximal oxygen consumption (VO2max) [2]. Resistance training, but not resistance training (although both modes
training, in contrast, is seen as the principal mode of exer- were equally effective for increasing type IIx muscle fiber
cise that elicits adaptations such as muscular hypertrophy CSA) [24].
[3]. However, it is evident from the literature that there is a If we only observe the results from individual studies, the
certain degree of crossover in both the early post-exercise conclusions regarding the effects of aerobic and resistance
responses and longer term adaptations induced by these two exercise on skeletal muscle hypertrophy might be that: (1)
modes of exercise [1, 4]. both modes of exercise are equally effective [18, 19]; (2)
Although resistance training can increase VO2max (pre- resistance exercise is superior to aerobic exercise [23]; or
dominantly shown in previously untrained individuals), [5] (3) aerobic exercise is superior to resistance exercise [24].
aerobic training is more effective for enhancing cardiores- This clearly demonstrates the inconsistencies in the current
piratory fitness [6–9]. Since the seminal work by DeLorme body of evidence for the effects of resistance and aerobic
in the 1940s [10] and as acknowledged in a recent historical training on skeletal muscle hypertrophy. Such evidence
review, [11] it has been well accepted that resistance training is important to inform exercise prescription strategies for
provides a superior stimulus for skeletal muscle hypertro- maximizing skeletal muscle hypertrophy. Given the lack of
phy compared with aerobic training. However, some authors clarity on the effects of single-mode resistance training and
have challenged this convention [12]. A recent narrative aerobic training on skeletal muscle hypertrophy at both the
review by Konopka and Harber [12] suggested both modes whole-muscle and myofiber levels, we aimed to systemati-
of training might be equally effective for stimulating knee cally review and meta-analyze current evidence on the dif-
extensor muscular hypertrophy. Following the publication ferences in hypertrophic adaptation to aerobic and resistance
of the review by Konopka and Harber, [12] these conclu- training, and to discuss potential reasons for the disparities
sions have been reiterated elsewhere [13, 14]. For instance, noted in the literature.
Ceccarelli et al. [13] wrote “Notably, also aerobic exercise
has revealed an anabolic potential comparable to resistance
exercise by altering protein metabolism and inducing skel- 2 Methods
etal muscle hypertrophy” and cited Konopka and Harber
[12] to support these claims. Other authors have made simi- 2.1 Literature Search
lar claims regarding the hypertrophic potential of aerobic
exercise [14]. This review was performed following the PRISMA (Pre-
Given the increases in protein synthesis with aerobic ferred Reporting Items for Systematic Reviews and Meta-
exercise, [15] it is not surprising that several studies have Analyses) guidelines [25] with literature searches conducted
Resistance vs. Aerobic Training for Hypertrophy

through Scopus, PubMed/MEDLINE, and SPORTDiscus. post-training muscle hypertrophy measurements. When
The following syntax was used for the search: (“resistance required, the Web Plot Digitizer software (Version 3.11;
training” OR “resistance exercise” OR “strength training” TX, USA: Ankit Rohatgi, 2017) was used for the extraction
OR “strength exercise” OR “weight training” OR “weight of data from figures. The coding was performed indepen-
exercise” OR “resistive exercise” OR “resistive training”) dently by two authors (JG and LM). Coding files were cross-
AND (“aerobic training” OR “aerobic exercise” OR “endur- checked between the authors, and any observed differences
ance training” OR “endurance exercise” OR running OR were resolved via discussion and agreement.
cycling) AND (hypertrophy OR “cross-sectional area” OR
“muscle size” OR growth OR “lean body mass” OR “muscle
2.4 Methodological Quality
fiber” OR biopsy OR “skeletal muscle” OR “muscle thick-
ness”). The search was conducted on 28 March, 2018. For
The Downs and Black checklist [28] was used for the assess-
the purpose of study selection, the search results were down-
ment of the methodological quality of the included studies.
loaded to the EndNote software (X8; Clarivate Analytics,
The standard checklist has 27 items, which refer to: report-
New York, NY, USA). The study selection was indepen-
ing (items 1–10); external validity (items 11–13); internal
dently performed by two authors (JG and LM) to prevent
validity (items 14–26); and statistical power (item 27). How-
selection bias. In the secondary search, the reference lists of
ever, given the specificity of included studies (i.e., exercise
all included publications were screened and the studies that
interventions), we added two items that refer to reporting of
cited the included studies were examined through the Scopus
compliance (item 28) and supervision of the exercise pro-
database. Furthermore, relevant review papers [12, 26] and
grams (item 29), as used in other studies [29–31]. With the
books [27] were searched for additional relevant studies.
adjusted checklist, the maximum score was 29 points. The
following classification was used for scoring the studies: (1)
2.2 Inclusion Criteria
good methodological quality (> 20 points); (2) moderate
methodological quality (11–20 points); and (3) poor meth-
Studies meeting the following criteria were included: (1)
odological quality (< 11 points) [29–31]. Two authors (JG
published in English and in a peer-reviewed journal; (2)
and FS) independently performed the quality assessment,
compared single-mode resistance training (an exercise type
and any observed differences were resolved via discussion
that requires exertion of force against a resistance performed
and agreement.
in a dynamic fashion [11]) and single-mode aerobic training
(any form of continuous or interval aerobic training was con-
sidered) provided both types of exercise were performed by 2.5 Statistical Analysis
similar muscle groups; (3) muscular hypertrophy was meas-
ured directly at the whole-muscle level (using ultrasound, Standardized mean differences (Hedge’s g) and 95% confi-
magnetic resonance imaging, and/or computed tomography) dence intervals (CIs) were calculated based on the following
or at the myofiber level using histological assessments of data: (1) pre- and post-intervention mean muscular hyper-
muscle biopsies; (4) the training program lasted a minimum trophy values; (2) pre- and post-intervention standard devia-
of 4 weeks; and (5) the participants were apparently healthy tions; (3) correlations between pre- and post-intervention
adults without any chronic disease or musculoskeletal injury. measurements; and (4) the number of participants in each
Studies that employed dietary interventions in which the par- group. If the studies presented standard errors (SEs), they
ticipants were in a diet-prescribed caloric deficit during the were √converted to standard deviations using the formula
training program were not considered for this review. By ( SE ⋅ n ). None of the included studies presented pre-to-
contrast, studies with dietary interventions such as protein post correlation values. Therefore, correlations were esti-
s2 +s2 −s2D
supplementation for both groups were considered eligible mated with the following formula: r = pre2⋅s post
�
 , where spre
and were included in the review.
⋅s pre post

is the standard deviation of the pre-intervention score, spost

2.3 Study Coding and Data Extraction is the standard deviation of the post-intervention score, and
sD is the standard deviation of the(change score
) (pre- to post-
1∕2
The following data were extracted onto an Excel spread- intervention) calculated as: sD =
Ss2pre
+
s2post
 . This pro-
sheet from the studies that met the inclusion criteria: (1) n n

participants’ characteristics, including age, height, sex, and cedure for estimating correlation is explained in detail in the
training status (e.g., trained/untrained); (2) exercise prescrip- Cochrane Handbook for Systematic Reviews of Interventions
tion details for the resistance training and aerobic training [32]. In total, three analyses were performed: (1) for whole-
groups; (3) participants’ compliance with the training pro- muscle knee extensor data; (2) for type I fiber CSA; and (3)
grams; and (4) means and standard deviations for pre- and for type II fiber CSA. A meta-analysis for upper-body
 J. Grgic et al.

musculature and other lower body muscle groups, such as publications, of which, two were included [6, 24]. Therefore,
posterior thigh muscles, could not be performed owing to the final number of included studies in this review is 21.
the small number of studies assessing these muscle groups.
If the studies presented multiple data points, such as the 3.2 Study Characteristics
assessment of hypertrophy on both legs, and CSA values for
different subtypes of type II fibers (i.e., type IIa, type IIx), The pooled number of participants across studies was 509
the standardized mean differences and variances were cal- (median n = 22). The participants’ characteristics from the
culated separately and the average values were used for the included studies can be found in Table 1. The average dura-
analysis. tion of the training interventions amounted to 18 weeks
While we did not include studies in which the partici- (range 8–36 weeks). The most common training frequency
pants were in a diet-prescribed caloric deficit, two studies was three times per week (range 2–4). A summary of the
[7, 33] have reported significant weight loss in the group training programs and study details from individual studies
performing aerobic exercise, and one study reported signifi- can be found in Table 2. In two instances, the whole-muscle
cant weight loss in the group performing resistance training and fiber CSA values were reported in separate papers, even
[20]. To explore the extent to which these studies impacted though they were collected in the same sample of partici-
the pooled findings, we conducted two sensitivity analyses. pants [37, 38, 44, 45]. Fourteen studies used whole-muscle
One sensitivity analysis was performed by excluding the measures of hypertrophy, [6–9, 18–21, 33, 37, 39, 41, 43,
studies that reported significant weight loss in the group per- 44] while ten studies [6, 23, 24, 36, 38–40, 42, 43, 45] used
forming aerobic exercise, and the second sensitivity analysis histological assessments (five studies [6, 37–39, 43–45] used
excluded the study in which a significant weight loss was both). Five studies used computed tomography, [7, 9, 33,
observed in the resistance training group. These analyses 43, 44], five studies used magnetic resonance imaging, [18,
were carried out only for whole-muscle knee extensor data 21, 37, 39, 41] and four studies used ultrasound [6, 8, 19,
given that the studies reporting significant weight loss did 20]. All studies that measured muscle fiber CSA used sam-
not measure fiber CSA. ples from the vastus lateralis muscle and adenosine triphos-
The following effect size scale was used for the classifica- phatase histochemistry for the identification of muscle fiber
tion of magnitudes: small (≤ 0.2); medium (0.2–0.5); large types.
(0.5–0.8); and very large (> 0.8) effects [34]. The I2 statistic
was used to assess heterogeneity. We considered I2 values 3.3 Methodological Quality
of ≤ 50% to indicate low levels of heterogeneity; 50–75% to
indicate moderate levels of heterogeneity; and > 75% to indi- Based on the assessment of methodological quality, the
cate high levels of heterogeneity. SEs were plotted against included studies were classified as being of either good or
Hedge’s g to detect funnel plot asymmetry. The asymmetry moderate quality [Table S1 of the Electronic Supplementary
was tested using the trim and fill method [35]. The random- Material (ESM)]. Specifically, five studies [6, 23, 33, 44, 45]
effects model was used for all analyses. The statistical sig- were classified as being of good quality, while the remaining
nificance threshold was set at p < 0.05. All analyses were studies were classified as being of moderate quality [7–9,
performed using the Comprehensive Meta-Analysis soft- 18–21, 24, 36–43]. The median methodological quality score
ware, Version 2 (Biostat Inc., Englewood, NJ, USA). was 19 (range 15–24). Eight studies [6, 18, 21, 24, 36–39]
did not report participants’ compliance with the training
programs and, thus, did not receive a point on the item 28.
3 Results It was unclear in six studies [7, 36–38, 40, 41] whether the
training programs were supervised; therefore, these stud-
3.1 Search Results ies did not receive a point on item 29 of the checklist. The
methodological quality ratings for all studies can be found
The flow diagram of the literature search is presented in in Table S1 of the ESM.
Fig. 1. The initial search from the three databases resulted
in a total of 2809 search results. After the removal of dupli- 3.4 Meta‑Analysis Results
cates, the number of search results was reduced to 1953. Out
of the remaining search results, 1896 studies were excluded The meta-analyses were conducted only for the differences
based on title or abstract. Fifty-seven full-text papers were between the effects of resistance training and aerobic train-
read, and 19 studies were found that met the inclusion cri- ing on hypertrophy of knee extensors because no or limited
teria [7–9, 18–21, 23, 33, 36–45]. Forward citation track- data were available for other muscle groups.
ing and reference list screening included another 2859
Resistance vs. Aerobic Training for Hypertrophy

Records identified through

Identification
database searching
(n = 2,809)

Excluded based on title or abstract

(n = 1,896)
Records after duplicates
removed
(n = 1,953) Full-text articles excluded, with
reasons (n = 38)
Screening

• No resistance training or
aerobic training group
Records screened (n = 18)
(n = 1,953) • No hypertrophy
assessment (n = 12)
• Duplicate data (n = 4)
• Review paper (n = 2)
• Study conducted among
Full-text articles assessed adolescents (n = 1)
Eligibility

for eligibility (n = 57) • Unequal training

frequency between the
groups (n = 1)

Studies included in the Forward citation tracking

review
(n = 2,859)
(n = 19)
Included

Studies included in the Studies additionally included

review
(n = 2)
(n = 21)

Fig. 1  Flow diagram of the search process

3.4.1 Whole‑Muscle Area of 0.49 (95% CI 0.19–0.78; I2 = 0%). The second sensitivity

analysis, in which the study by Izquierdo et al. [20] report-
Of the 14 studies that assessed whole-muscle hypertro- ing significant weight loss in the group performing resist-
phy, ten studies [6, 7, 9, 19, 33, 37, 39, 41, 43, 44] were ance exercise was excluded, resulted in a pooled Hedge’s g,
included in the final analysis. Four studies were not included favoring resistance over aerobic training, of 0.66 (95% CI
because of the lack of necessary data (i.e., mean ± standard 0.39–0.93; I2 = 0%).
deviation values) presented in the paper, and the authors
did not present the data upon a written request [8, 18, 20, 3.4.2 Myofiber Area
21]. The meta-analysis resulted in a significant pooled dif-
ference (p < 0.001) in whole-muscle hypertrophy responses Ten studies [6, 23, 24, 36, 38–40, 42, 43, 45] were included
between the aerobic training and resistance training inter- in the final analysis of type I CSA. The meta-analysis for
ventions (Fig. 2). The pooled Hedge’s g, favoring resistance type I fiber CSA data resulted in a significant pooled differ-
over aerobic training, was 0.66 (95% CI 0.41–90; I2 = 0%), ence (p < 0.001) between the aerobic training and resistance
which corresponds to a large effect size. The funnel plot training groups (Fig. 3). The pooled Hedge’s g, favoring
and trim and fill method did not suggest any funnel plot resistance training over aerobic training, was 0.99 (95% CI
asymmetry. The sensitivity analysis, in which the two stud- 0.44–1.54; I2 = 24%), which corresponds to a very large
ies [7, 33] that reported significant weight loss in the group effect size.
performing aerobic exercise were excluded, resulted in a One of the ten studies was [40] excluded from the anal-
pooled Hedge’s g, favoring resistance over aerobic training, ysis for type II fiber CSA, as it only reported results for
 J. Grgic et al.

Table 1  Characteristics of individual study samples

Study (year) Participants Sex: M/F Age (years) Height (cm) Mass (kg) Train-
ing
status

Ahtiainen et al. (2009) [6] Aerobic training: n = 9 9/0 58 ± 8 175 ± 6 75 ± 7 U
Resistance training: n = 10 10/0 61 ± 5 177 ± 3 80 ± 5 U
Bell et al. (2000) [36] Aerobic training: n = 11 7/4 22 ± 3 176 ± 9 73 ± 12 U
Resistance training: n = 11 7/4 22 ± 3 176 ± 9 73 ± 12 U
De Souza et al. (2013; 2014) [37, 38] Aerobic training: n = 8 8/0 24 ± 8 175 ± 8 72 ± 8 U
Resistance training: n = 11 11/0 26 ± 6 172 ± 4 74 ± 16 U
Farup et al. (2012) [39] Aerobic training: n = 7 7/0 23 ± 2 181 ± 5 78 ± 9 U
Resistance training: n = 7 7/0 23 ± 2 181 ± 5 78 ± 9 U
Ferrara et al. (2006) [7] Aerobic training: n = 9 9/0 50–79 NR 92 ± 4 U
Resistance training: n = 13 13/0 50–79 NR 92 ± 3 U
Hepple et al. (1997) [40] Aerobic training: n = 10 10/0 68 ± 1 NR 85 ± 4 U
Resistance training: n = 10 10/0 68 ± 1 NR 77 ± 3 U
Hudelmaier et al. (2010) [18] Aerobic training: n = 19 0/19 51 ± 3 166 ± 8 73 ± 16 U
Resistance training: n = 16 0/16 51 ± 3 166 ± 8 73 ± 16 U
Izquierdo et al. (2004) [20] Aerobic training: n = 11 11/0 68 ± 2 167 ± 3 77 ± 7 U
Resistance training: n = 10 10/0 65 ± 3 167 ± 4 81 ± 11 U
Izquierdo et al. (2005) [19] Aerobic training: n = 10 10/0 42 ± 3 177 ± 5 86 ± 14 U
Resistance training: n = 11 11/0 44 ± 3 175 ± 3 86 ± 12 U
Jubrias et al. (2001) [41]a Aerobic training: n = 14 NR 69 ± 1 NR NR U
Resistance training: n = 15 NR 69 ± 1 NR NR U
Karavirta et al. (2011) [42]b Aerobic training: n = 25 25/0 54 ± 8 176 ± 6 79 ± 10 U
Resistance training: n = 25 25/0 56 ± 6 178 ± 6 84 ± 10 U
Kraemer et al. (1995) [23] Aerobic training: n = 8 8/0 21 ± 4 178 ± 8 75 ± 7 T
Resistance training: n = 9 9/0 24 ± 5 175 ± 6 77 ± 14 T
McCarthy et al. (2002) [43] Aerobic training: n = 10 10/0 27 ± 2 179 ± 3 85 ± 6 U
Resistance training: n = 10 10/0 28 ± 1 180 ± 1 82 ± 4 U
Mikkola et al. (2012) [21] Aerobic training: n = 11 11/0 37 ± 7 181 ± 8 80 ± 13 U
Resistance training: n = 16 16/0 38 ± 6 178 ± 5 85 ± 16 U
Nelson et al. (1990) [24] Aerobic training: n = 4 4/0 30 ± 5 NR 82 ± 19 U
Resistance training: n = 5 5/0 27 ± 2 NR 70 ± 8 U
Poehlman et al. (2000) [9] Aerobic training: n = 14 0/14 29 ± 5 163 ± 5 59 ± 5 U
Resistance training: n = 17 0/17 28 ± 3 164 ± 7 58 ± 6 U
Sillanpää et al. (2008) [8] Aerobic training: n = 14 14/0 54 ± 8 179 ± 6 76 ± 9 U
Resistance training: n = 13 13/0 55 ± 6 177 ± 7 79 ± 5 U
Sipilä et al. (1995; 1997) [44, 45]c Aerobic training: n = 12 0/12 76–78 157 ± 2 67 ± 3 U
Resistance training: n = 12 0/12 76–78 160 ± 1 67 ± 3 U
Willis et al. (2012) [33] Aerobic training: n = 38 17/21 52 ± 9 88 ± 11 NR U
Resistance training: n = 44 18/26 50 ± 12 88 ± 16 NR U

Age, height, and mass data are reported as mean ± standard deviation or range
F female, M males, F females, NR not reported, T trained, U untrained, T trained
a
 Magnetic resonance imaging scans were obtained from 25 participants
b
 Muscle biopsies were obtained from 18 participants
c
 Muscle biopsies were obtained from 16 participants
Age, height and mass data are reported as mean ± standard deviation or range
Table 2  Summary of studies included in the present meta-analysis that compared hypertrophic adaptations to resistance and aerobic training
Study (year) Resistance training Resistance exercises Aerobic training Aerobic training Study duration; Method of hyper- Adherence Main findings
protocol employed in the protocol modality training frequency trophy assessment
program (site) Aerobic training Resistance training

Ahtiainen et al. (2009) In wks 1–7, the Lower body: leg press, In wks 1–7, the par- Cycling 21 wks; 2 times Ultrasound (vastus Not reported Knee extensor muscle Knee extensor muscle
[6] participants per- knee extension, and ticipants trained for 30 per wk lateralis and vastus thickness: ↔ thickness: ↑
formed 3 sets per knee flexion min per session with intermedius); mus- Type I CSA: ↔ Type I CSA: ↔
exercise for 15–30 Upper body: bench the intensity set under cle biopsies (vastus Type II CSA: ↔ Type II CSA: ↑
repetitions with a press, triceps push- the aerobic threshold. lateralis)
load of 40–60% down, latissimus In wks 8–14, in one
1RM. In wks 8–14, pull-down, and of the two weekly ses-
the participants biceps curl sions, the participants
performed 3 sets per trained for 45 min per
exercise for 6–12 session with the inten-
repetitions with a sity set at 15 min under
load of 60–80% the aerobic threshold,
1RM. In wks 15–21, 10 min between the
Resistance vs. Aerobic Training for Hypertrophy

the participants aerobic-anaerobic

performed 3 sets per thresholds, 5 min
exercise for 5–8 rep- above the anaerobic
etitions with a load threshold, and 15 min
of 70–90% 1RM under the aerobic
threshold. In the sec-
ond weekly session, the
participants trained for
60 min per session with
the intensity set under
the aerobic threshold.
In wks 15–21, in one
of the two weekly ses-
sions, the participants
trained 60 min per
session with the
intensity set at 30 min
under the aerobic
threshold, 2 × 10 min
between the aerobic-
anaerobic thresholds,
and 2 × 5 min above the
anaerobic threshold. In
the other weekly ses-
sion, the participants
trained for 90 min
per session with the
intensity set under the
aerobic threshold


Table 2  (continued)
Study (year) Resistance training Resistance exercises Aerobic training Aerobic training Study duration; Method of hyper- Adherence Main findings
protocol employed in the protocol modality training frequency trophy assessment
program (site) Aerobic training Resistance training

Bell et al. (2000) [36] Progressive increase Lower body: leg press, Continuous aerobic Cycling 12 wks; 3 times Muscle biopsies Not reported Type I CSA: ↔ Type I CSA: ↑
in load by 4% every single leg knee training was performed per wk (vastus lateralis) Type II CSA: ↔ Type II CSA: ↑
3 wks from 72% flexion, single leg two times per wk. The
1RM to 84% 1RM, knee extension, and intensity was set as
performed for 2–6 calf raises power output recorded
sets per exercise and Upper body: bench at the ventilation
4–12 repetitions press, seated threshold. The training
pulldowns, shoulder duration was increased
press, and biceps from 30 to 42 min per
curl session (by 4 min every
4 wks)
Interval training was
done once per wk with
a work to rest ratio of
3:3 min. The intensity
was set as power
output recorded at 90%
VO2max. The interval
training started with 4
sets and was increased
by 1 set each 4 wk
De Souza et al. (2013; In wks 1 and 2, Lower body: leg press, In wks 1 and 2, the par- Running 8 wks; 2 times per wk MRI (knee extensors); Not reported Knee extensor CSA: Knee extensor CSA: ↑
2014) [37, 38]a the participants single leg knee flex- ticipants performed 20 muscle biopsies ↔ Type I CSA: ↑
performed 3 sets ion, and extension bouts at 80% vVO2max (vastus lateralis) Type I CSA: ↔ Type IIa CSA: ↑
per exercise for 12 Upper body: none with a work-to-rest Type IIa CSA: ↔ Type IIx CSA: ↔
repetitions. In wks ratio of 60:45 s. In wks Type IIx CSA: ↔
3 and 4, the partici- 3–4, the participants
pants performed 4 performed 20 bouts at
sets per exercise for 85–90% VO2max with
8–10 repetitions. a work-to-rest ratio
In wks 5 and 6, of 60:60 s. In wks
the participants 5–6, the participants
performed 5 sets performed 20 bouts
per exercise for 6–8 at 95% vVO2max with
repetitions. In wks a work-to-rest ratio
7 and 8, the partici- of 60:60 s. In wks
pants performed 3 7–8, the participants
sets per exercise for performed 15 bouts at
10–12 repetitions 80% vVO2max with a
work-to-rest ratio of
60:90 s
J. Grgic et al.
Table 2  (continued)
Study (year) Resistance training Resistance exercises Aerobic training Aerobic training Study duration; Method of hyper- Adherence Main findings
protocol employed in the protocol modality training frequency trophy assessment
program (site) Aerobic training Resistance training

Farup et al. (2012) In sessions 1–4, the Lower body: leg press, The first session of the Cycling 10 wks; 3 times MRI (knee extensors, Not reported Knee extensor CSA: Knee extensor CSA: ↑
[39] participants per- knee extension, and week was performed per wk knee flexors, and ↔ Type I CSA: ↔
formed 4–5 sets per knee flexion for 30–45 min at hip adductors, these Type I CSA: ↔ Type II CSA: ↑
exercise for 8–10 Upper body: none 60–75% of watt max. components were Type II CSA: ↔
repetitions. In ses- The second session summed for total
sions 5–10, the par- of the week was per- thigh CSA); muscle
ticipants performed formed for 2 × 20 min biopsies (vastus
4–5 sets per exercise at 60–85% of watt lateralis)
for 6–10 repetitions. max with a 5-min rest
In sessions 11–15, interval. The third
the participants session of the week
performed 5 sets per was performed for
Resistance vs. Aerobic Training for Hypertrophy

exercise for 6–8 rep- 8 × 4 min at 70–90% of

etitions. In sessions watt-max with a 1-min
16–20, the partici- rest interval
pants performed 5
sets per exercise
for 4–8 repetitions.
In sessions 21–25,
the participants
performed 5 sets per
exercise for 4–8 rep-
etitions. In sessions
26–29, the partici-
pants performed 5
sets per exercise for
4–6 repetitions
Ferrara et al. (2006) The participants Lower body: leg press, The training sessions Walking or running 36 wks; 3 times CT (knee extensors) Aerobic training Knee extensor CSA: Knee extensor CSA:
[7] performed 1 set knee extension, and lasted for 55–60 min per wk group: 75% ↔ ↔
for the upper-body knee flexion and included a 5-min Resistance training
exercises and 2 sets Upper body: chest warm-up, 45–50 min group: 74%
for the lower-body press, latissimus training at 75–80%
exercises with a pull-down, and maximal heart rate
load of 80% 1RM shoulder press reserve, and a 5-min
for 8–12 repetitions cool down
Hepple et al. (1997) The participants Lower body: four The training sessions Cycling 9 wks; 3 times per wk Muscle biopsies Not reported Type I CSA: ↔ Type I CSA: ↑
[40] performed 3 sets per exercises on Univer- lasted for 30 min. The (vastus lateralis) Type II CSA: not Type II CSA: not
exercise for 6–12 sal weight machines training intensity was reported reported
repetitions (not specified on not fully described
which)
Upper body: none.


Table 2  (continued)
Study (year) Resistance training Resistance exercises Aerobic training Aerobic training Study duration; Method of hyper- Adherence Main findings
protocol employed in the protocol modality training frequency trophy assessment
program (site) Aerobic training Resistance training

Hudelmaier et al. In wk 1, the load was Lower body: back The training sessions Cycling 12 wks; 3 times MRI Not reported Knee extensor CSA: ↑ Knee extensor CSA: ↑
(2010) [18] set at 60% 1RM and squat, leg press, lasted for 60 min per wk (knee extensors, knee Knee flexor CSA: ↔ Knee flexor CSA: ↑
was increased by knee flexion, knee and consisted of a flexors, hip adduc- Adductor CSA: ↔ Adductor CSA: ↑
5–10% each week extension, hip 10-min warm-up, tors, and sartorius) Sartorius CSA: ↑ Sartorius CSA: ↑
to 80% 1RM in wks adduction, hip 40 min of continuous
5 and 6. In wk 7, abduction, and hip cycling, and a 10-min
the load was set at extension cooldown. In wks 1–3,
65–70% 1RM and Upper body: none the participants trained
was increased to with the intensity set at
70–75% 1RM for 55–85% of the VO2max
wks 8 and 9. In wks threshold. The intensity
10–12 the load was was increased by 5%
set at 75–80% 1RM. every 3 wks
The participants
performed either
3 sets per exercise
for 8–12 repetitions
done in 2–4 s total
repetition time or
1 set per exercise
for 6–12 repetitions
done in a 20-s total
repetition time.
Izquierdo et al. (2004) In wks 1–8, the par- Lower body: bilateral The training sessions Cycling 16 wks; 2 times Ultrasound (rectus Minimum of 90% Knee extensor CSA: Knee extensor CSA: ↑
[20] ticipants performed leg press, bilateral lasted for 30–40 min per wk femoris, vastus ↔
3–4 sets per exercise knee extension, per session. In wks lateralis, vastus
for 10–15 repeti- standing leg curl, 1–8, the participants medialis, and vastus
tions with a load of and/or hip adduc- trained with the intermedialis)
50–70% 1RM. In tion-abduction intensity that resulted
wks 9–16, the par- Upper body: bench in blood lactate levels
ticipants performed press, chest press, of 2–4 mmol·L−1. In
3–5 sets per exercise latissimus pull- wks 9–16, the partici-
for 5–6 repetitions down, and shoulder pants trained with the
with a load of press intensity that resulted
70–80% 1RM. Dur- in blood lactate levels
ing wks 9–16, one of 2–5 mmol·L−1. For
session per wk was blood lactate levels
performed using up to 4 mmol·L−1, the
a load of 30–50% training was performed
1RM for 3–4 sets continuously, whereas
and 6–8 repetitions the training for
(repetition cadence blood lactate levels
was as fast as pos- of 5 mmol·L−1 was
sible) performed for 30 s
interspersed with 30 s
of rest
J. Grgic et al.
Table 2  (continued)
Study (year) Resistance training Resistance exercises Aerobic training Aerobic training Study duration; Method of hyper- Adherence Main findings
protocol employed in the protocol modality training frequency trophy assessment
program (site) Aerobic training Resistance training

Izquierdo et al. (2005) In wks 1–8, the par- Lower body: bilateral The training sessions Cycling 16 wks; 2 times Ultrasound (rectus Minimum of 90% Knee extensor CSA: ↑ Knee extensor CSA: ↑
[19] ticipants performed leg press, bilateral lasted for 30–40 min per wk femoris, vastus
3–4 sets per exercise knee extension, per session. In wks lateralis, vastus
for 10–15 repeti- standing leg curl 1–8, the participants medialis, and vastus
tions with a load of and/or hip adduc- trained with the intermedialis)
50–70% 1RM. In tion-abduction intensity that resulted
wks 9–16, the par- Upper body: bench in blood lactate levels
ticipants performed press, chest press, of 2–4 mmol·L−1. In
3–5 sets per exercise latissimus pull- wks 9–16, the partici-
for 5–6 repetitions down, and shoulder pants trained with the
with a load of press intensity that resulted
70–80% 1RM. Dur- in blood lactate levels
Resistance vs. Aerobic Training for Hypertrophy

ing wks 9–16, one of 2–5 mmol·L−1. For

session per wk was blood lactate levels
performed using up to 4 mmol·L−1, the
a load of 30–50% training was performed
1RM for 3–4 sets continuously, whereas
and 6–8 repetitions the training for
(repetition cadence blood lactate levels
was as fast as pos- of 5 mmol·L−1 was
sible) performed for 30 s
interspersed with 30 s
of rest
Jubrias et al. (2001) In wks 1–4, the par- Lower body: leg press The training sessions One-legged press 24 wks; 3 times MRI (knee extensors) 94% in both groups Knee extensor CSA: Knee extensor CSA: ↑
[41] ticipants performed Upper body: exercises lasted for 40 min exercise and a per wk ↔
3 sets per exercise for shoulders and per session and were kayaking-type
for 10–15 repeti- arms (not specified performed at 80–85% exercise (20 min
tions with a load of which) of heart rate reserve on each mode per
60–70% 1RM. In session)
wks 5–24, the par-
ticipants performed
3–5 sets per exercise
for 8 repetitions
with a load of
70–85% 1RM


Table 2  (continued)
Study (year) Resistance training Resistance exercises Aerobic training Aerobic training Study duration; Method of hyper- Adherence Main findings
protocol employed in the protocol modality training frequency trophy assessment
program (site) Aerobic training Resistance training

Karavirta et al. (2011) In wks 1–7, the par- Lower body: leg press, In wks 1–7, the par- Cycling 21 wks; 2 times Muscle biopsies 99% in both groups Type I CSA: ↔ Type I CSA: ↔
[42] ticipants performed knee extension, ticipants trained for per wk (vastus lateralis) Type II CSA: ↔ Type II CSA: ↑
3 sets per exercise knee flexion, seated 30 min per session with
for 12–20 repeti- calf raise, hip the intensity set under
tions with a load of abduction, and hip the aerobic threshold.
40–60% 1RM. In adduction In wks 8–14, in one
wks 8–14, the par- Upper body: bench of the two weekly ses-
ticipants performed press, biceps curl, sions, the participants
2–4 sets per exercise triceps pushdown, trained for 45 min per
for 5–12 repetitions and latissimus pull- session with the inten-
with a load of down sity set at 15 min under
60–80% 1RM. In the aerobic threshold,
wks 15–21, the par- 10 min between the
ticipants performed aerobic-anaerobic
2–4 sets per exercise thresholds, 5 min
for 5–8 repetitions above the anaerobic
with a load of threshold, and 15 min
70–85% 1RM. under the aerobic
Twenty percent of threshold. In the sec-
the total work on the ond weekly session, the
leg press and knee participants trained for
extension exercises 60 min per session with
was performed with the intensity set under
40–50% 1RM for the aerobic threshold.
5–8 repetitions (rep- In wks 15–21, in one
etition cadence was of the two weekly ses-
as fast as possible) sions, the participants
trained 60 min per
session with the
intensity set at 30 min
under the aerobic
threshold, 2 × 10 min
between the aerobic-
anaerobic thresholds,
and 2 × 5 min above the
anaerobic threshold. In
the other weekly ses-
sion, the participants
trained for 90 min
per session with the
intensity set under the
aerobic threshold
J. Grgic et al.
Table 2  (continued)
Study (year) Resistance training Resistance exercises Aerobic training Aerobic training Study duration; Method of hyper- Adherence Main findings
protocol employed in the protocol modality training frequency trophy assessment
program (site) Aerobic training Resistance training

Kraemer et al. (1995) In 2 out of the 4 Lower body: squats, Continuous aerobic train- Running 12 wks; 4 times Muscle biopsies 100% in both groups Type I CSA: ↓ Type I CSA: ↑
[23] weekly training leg press, deadlift, ing was performed 2 per wk (vastus lateralis) Type IIa CSA: ↔ Type IIa CSA: ↑
sessions, the partici- knee extensions, times per wk with the Type IIc CSA: ↓ Type IIc CSA: ↑
pants performed 2–3 knee flexion, split intensity set at 80–85% Type IIx CSA: ↔ Type IIx CSA: ↔
sets per exercise for squats, and calf VO2max. The training
10–15 repetitions. raises duration was 40 min
In the remaining Upper body: bench per session
2 weekly training press, shoulder Interval training was
sessions, the partici- press, upright row, performed two times
pants performed 4–5 seated row, and per wk; the intervals
sets per exercise for biceps curl ranged from 200 to
5–6 repetitions 800 m with a work-to-
Resistance vs. Aerobic Training for Hypertrophy

rest ratio of 1:4 min,

which progressed to
a 1:0.5 min ratio. The
intensity was set at
95–100% VO2max.
McCarthy et al. The participants Lower body: squats, The training consisted Cycling 10 wks; 3 times CT (knee extensors 97% in both groups Knee extensor CSA: ↑ Knee extensor CSA: ↑
(2002) [43] performed 3 sets knee extensions, of a 5-min warm-up per wk and flexors); muscle Knee flexor CSA: ↔ Knee extensor CSA: ↑
per exercise for 5–7 knee flexion, and and of 45 min of con- biopsies (vastus Type I CSA: ↔ Type I CSA: ↑
repetitions calf raises tinuous training at 70% lateralis) Type II CSA: ↔ Type II CSA: ↑
Upper body: bench heart rate reserve
press, latissimus
pull-down, and
shoulder press


Table 2  (continued)
Study (year) Resistance training Resistance exercises Aerobic training Aerobic training Study duration; Method of hyper- Adherence Main findings
protocol employed in the protocol modality training frequency trophy assessment
program (site) Aerobic training Resistance training

Mikkola et al. (2012) In wks 1–7, the par- Lower body: leg press, In wks 1–7, the par- Cycling and Nordic 21 wks; 2 times MRI (knee extensors) Minimum of 90% Knee extensor CSA: ↑ Knee extensor CSA: ↑
[21] ticipants performed knee extension and ticipants trained for walking (one per per wk
3–4 sets per exercise knee flexion, calf 30 min per session with session)
for 10–15 repeti- raises, and/or hip the intensity set under
tions with a load of adduction-abduction the aerobic threshold.
50–70% 1RM. In Upper body: bench In wks 8–14, in one
wks 8–14, the par- press, biceps curl, of the two weekly ses-
ticipants performed triceps pushdown, sions, the participants
2–5 sets per exercise and latissimus pull- trained for 45 min per
for 5–12 repetitions down session with the inten-
with a load of sity set at 15 min under
50–80% 1RM. In the aerobic threshold,
wks 15–21, the par- 10 min between the
ticipants performed aerobic-anaerobic
2–5 sets per exercise thresholds, 5 min
for 3–12 repetitions above the anaerobic
with a load of threshold, and 15 min
50–80% 1RM. under the aerobic
Twenty percent of threshold. In the sec-
the total work on the ond weekly session, the
leg press and knee participants trained for
extension exercises 60 min per session with
was performed with the intensity set under
40–50% 1RM for the aerobic threshold.
5–8 repetitions (rep- In wks 15–21, in one
etition cadence was of the two weekly ses-
as fast as possible) sions, the participants
trained 60 min per
session with the
intensity set at 30 min
under the aerobic
threshold, 2 × 10 min
between the aerobic-
anaerobic thresholds,
and 2 × 5 min above the
anaerobic threshold. In
the other weekly ses-
sion, the participants
trained for 60–90 min
per session with the
intensity set under the
aerobic threshold
J. Grgic et al.
Table 2  (continued)
Study (year) Resistance training Resistance exercises Aerobic training Aerobic training Study duration; Method of hyper- Adherence Main findings
protocol employed in the protocol modality training frequency trophy assessment
program (site) Aerobic training Resistance training

Nelson et al. (1990) The participants per- Lower body: knee In the first week, the Cycling 20 wks; 4 times Muscle biopsies Not reported Type I CSA: ↑ Type I CSA: ↔
[24] formed 3 sets for 6 extension and knee participants trained per wk (vastus lateralis) Type IIa CSA: ↑ Type IIa CSA: ↔
repetitions at 30°/s flexion for 30 min at 75% Type IIx CSA: ↑ Type IIx CSA: ↑
Upper body: none maximum heart rate.
In the second week,
the duration stayed the
same but the intensity
was increased to 80%
maximum heart rate.
The training duration
increased to 40, 50,
and 60 min for wks 3,
Resistance vs. Aerobic Training for Hypertrophy

4, and 5, respectively.
From wks 6 to 20, the
intensity increased to
85% maximum heart
rate and the training
duration was 60 min
Poehlman et al. The participants Lower body: leg press, In wks 1–4, the training Walking and running 28 wks; 3 times CT (knee extensors) A minimum of 90% Knee extensor CSA: Knee extensor CSA:
(2000) [9] performed 3 sets per knee extensions, and sessions lasted for per wk ↔ ↔
exercise with a load knee flexion 25 min. Every 4 wks
of 80% 1RM for 10 Upper body: bench (up to wk 16), the
repetitions press, shoulder training duration was
press, seated row, increased by 5 min.
triceps extensions, The training intensity
and biceps curls varied from 75 to 90%
of maximum heart
rate and consisted of
a continuous form of
training. In wks 16–28,
an interval training
session was added. In
wks 16–28, on the first
and third weekly ses-
sion, the participants
performed 45 min at
80% heart rate maxi-
mum. On the second
weekly session, the
participants performed
4 × 5 min at 95% heart
rate maximum with a
3-min rest


Table 2  (continued)
Study (year) Resistance training Resistance exercises Aerobic training Aerobic training Study duration; Method of hyper- Adherence Main findings
protocol employed in the protocol modality training frequency trophy assessment
program (site) Aerobic training Resistance training

Sillanpää et al. (2008) In wks 1–7, the Lower body: leg press, In wks 1–7, the par- Cycling 21 wks; 2 times Ultrasound (vastus 100% in both groups Knee extensor muscle Knee extensor muscle
[8] participants per- knee extension, and ticipants trained for per wk lateralis and vastus thickness: ↑ thickness: ↑
formed 3 sets per knee flexion 30 min per session with intermedius)
exercise for 15–30 Upper body: bench the intensity set under
repetitions with a press, triceps the aerobic threshold.
load of 40–60% pushdown, and latis- In wks 8–14, in one
1RM. In wks 8–14, simus pull-down of the two weekly ses-
the participants sions, the participants
performed 3 sets per trained for 45 min per
exercise for 6–12 session with the inten-
repetitions with a sity set at 15 min under
load of 60–80% the aerobic threshold,
1RM. In wks 15–21, 10 min between the
the participants aerobic-anaerobic
performed 3 sets per thresholds, 5 min
exercise for 5–8 rep- above the anaerobic
etitions with a load threshold, and 15 min
of 70–90% 1RM under the aerobic
threshold. In the sec-
ond weekly session, the
participants trained for
60 min per session with
the intensity set under
the aerobic threshold.
In wks 15–21, in one
of the two weekly ses-
sions, the participants
trained 60 min per
session with the
intensity set at 30 min
under the aerobic
threshold, 2 × 10 min
between the aerobic-
anaerobic thresholds,
and 2 × 5 min above the
anaerobic threshold. In
the other weekly ses-
sion, the participants
trained for 90 min
per session with the
intensity set under the
aerobic threshold
Sipilä et al. (1995; In wk 1, the load was Lower body: leg press, Progressive increase in Walking (twice per 18 wks; 3 times CT (knee extensors, Aerobic training Knee extensor CSA: Knee extensor CSA: ↑
1997) [44, 45]a set at 60% 1RM. In knee extension, walking duration from wk) and step aero- per wk knee flexors, and group: 87% ↔ Knee flexor CSA: ↔
wks 2–11, the load knee flexion, and 1500 m to 2700 m per bics (once per wk) calves); muscle Resistance training Knee flexor CSA: ↔ Calves CSA: ↑
was increased to calf raises session. Step aerobics biopsies (vastus group: 83% Calves CSA: ↑ Type I CSA: ↑
70% 1RM. In wks Upper body: none sessions lasted for lateralis) Type I CSA: ↔ Type IIa CSA: ↔
12–16, the load was 40 min. Training Type IIa CSA: ↔ Type IIx CSA: ↔
increased to 75% intensity progressively Type IIx CSA: ↔
1RM. The partici- increased from 50%,
pants performed 3–4 60–70%, to 80% of
sets per exercise and heart rate reserve
8–10 repetitions
J. Grgic et al.
 Resistance vs. Aerobic Training for Hypertrophy

cross-sectional area VO2peak peak oxygen consumption MRI magnetic resonance imaging CT computed tomography VO2max velocity at maximal oxygen uptake, ↑ indicates significant increase
1RM one-repetition maximum, CSA cross-sectional area, CT computed tomography, MRI magnetic resonance imaging, VO2 oxygen consumption, VO2max maximal oxygen consumption, CSA
Knee extensor CSA: ↑
type I fiber CSA. Therefore, the analysis of type II CSA
Resistance training
included nine studies [6, 23, 24, 36, 38, 39, 42, 43, 45].
The meta-analysis of type II fiber CSA data resulted in a
significant pooled difference (p < 0.001) between the aerobic
training and resistance training groups (Fig. 4). The pooled
Hedge’s g, favoring resistance training over aerobic training,
Knee extensor CSA:

was 1.44 (95% CI 0.93–1.95; I2 = 8%), which corresponds to

Aerobic training
Main findings

a large effect size. The funnel plots and trim and fill method
did not suggest any funnel plot asymmetry in either of the
↔

analyses for fiber CSA.

Resistance training
Aerobic training

4 Discussion
group: 89%

group: 84%
Adherence

The majority of included studies comparing hypertrophic

responses to aerobic and resistance training examined
CT (knee extensors)

hypertrophy of the knee extensor musculature. There-

trophy assessment
Method of hyper-

fore, the results of this systematic review and meta-

analysis suggest that single-mode resistance training is
more effective for inducing knee extensor skeletal muscle
(site)

hypertrophy compared with single-mode aerobic exercise.

This finding was consistent when analyzing hypertrophic
training frequency

Treadmill (not speci- 32 wks; 3 times

Study duration;

responses both at the whole-muscle and myofiber level.

Therefore, the results of this meta-analysis do not support
per wk

the assertions by Konopka and Harber [12] that resist-

ance training and aerobic training undertaken in isolation
from baseline, ↔ indicates no change from baseline, ↓ indicates significant decrease from baseline
intensity set at 65–80% trainers, and cycling
walking), elliptical

are equally effective at stimulating knee extensor mus-

fied as running or
Aerobic training

cle hypertrophy. While some of the studies included in

this meta-analysis show that aerobic training may indeed
modality

stimulate lower body muscle hypertrophy, [17–21, 43]

our results indicate a favoring of resistance over aerobic
training. Given the results for knee extensor hypertrophy,
lasted for 45 min (on
The training sessions

it seems likely that similar results would be observed for

machines (not speci- average) with the
Aerobic training

other muscle groups as well. Furthermore, these results

of peak ­VO2

are based on analyses with low heterogeneity and on stud-

protocol

ies that were classified as having moderate or good meth-

odological quality.
machines (not speci-

Because of the lack of available data for other muscle

performed 3 sets per exercises on Cybex

exercises on Cybex
Resistance exercises

groups, the meta-analyses were conducted only for the knee

employed in the

Lower body: 4

Upper body: 4
fied which)

fied which)

extensor muscles. Nevertheless, two out of three studies that

program

assessed other lower body muscle groups, such as posterior

thigh musculature (e.g., knee flexors), also reported that
resistance training resulted in greater hypertrophy of this
↓ Significant decrease from baseline
↑ Significant increase from baseline
 Two studies from the same dataset
exercise for 8–12
Resistance training

muscle group as compared with aerobic training [18, 43].

The participants

Resistance training allows for the incorporation of multiple

repetitions

↔ No change from baseline

exercises involving distinct movement patterns that enable

protocol

activation of different muscle groups (and regions within

Table 2  (continued)

the active musculature), which is rarely the case with the

common types of aerobic exercise (e.g., running or cycling).
Willis et al. (2012)

Therefore, it is likely that the effects of resistance training for

Study (year)

inducing muscle hypertrophy as compared to aerobic exer-

[33]

cise extend to muscle groups other than the knee extensors.

a
 J. Grgic et al.

Study Hedges' g Lower limit Upper limit p-value Hedges' g and 95% CI Statistical weight (%)
Ahtiainen et al. (2009) [6] 0.69 -0.21 1.59 0.132 7.12
De Souza et al. (2013) [37] 0.15 -0.73 1.03 0.737 7.46
Farup et al. (2012) [39] 0.86 -0.18 1.90 0.104 5.39
Ferrara et al. (2006) [7] 1.07 0.19 1.95 0.017 7.46
Izquierdo et al. (2004) [20] 0.53 -0.30 1.36 0.212 8.26
Jubrias et al. (2001) [41] 0.62 -0.16 1.40 0.121 9.24
McCarthy et al. (2002) [43] 1.18 0.26 2.10 0.012 6.81
Poehlman et al. (2000) [9] 0.00 -0.68 0.68 1.000 12.14
Sipilä and Suominen (1995) [44] 0.37 -0.41 1.15 0.355 9.24
Willis et al. (2012) [33] 0.95 0.51 1.39 < 0.001 26.86
Pooled effect 0.66 0.41 0.90 < 0.001

-3 -2 -1 0 1 2 3
Favors aerobic Favors resistance

Fig. 2  Forest plot of the differences between the effects of aerobic and resistance training on whole-muscle measures of muscle size. The x-axis
denotes Hedge’s g (standardized mean differences). The whiskers denote the 95% confidence intervals (CIs)

Study Hedges' g Lower limit Upper limit p-value Hedges' g and 95% CI Statistical weight (%)
Ahtiainen et al. (2009) [6] 0.60 -0.28 1.48 0.180 11.06
Bell et al. (2000) [36] 0.88 0.03 1.72 0.042 11.37
De Souza et al. (2014) [38] 2.70 1.48 3.93 < 0.001 8.72
Farup et al. (2012) [39] 0.67 -0.34 1.69 0.192 9.98
Hepple et al. (1997) [40] 1.36 0.42 2.30 0.004 10.65
Karavirta et al. (2011) [42] 0.54 -0.38 1.45 0.254 10.76
Kraemer et al. (1995) [23] 2.07 0.93 3.22 < 0.001 9.19
McCarthy et al. (2002) [43] 1.33 0.39 2.26 0.005 10.69
Nelson et al. (1990) [24] -1.43 -2.77 -0.09 0.037 7.44
Sipilä et al. (1997) [45] 1.02 0.02 2.01 0.046 10.15
Pooled effect 0.99 0.44 1.54 < 0.001

-4 -3 -2 -1 0 1 2 3 4
Favors aerobic Favors resistance

Fig. 3  Forest plot of the differences between the effects of aerobic and resistance training on type I muscle fiber cross-sectional area. The x-axis
denotes Hedge’s g (standardized mean differences). The whiskers denote the 95% confidence intervals (CIs)

With aerobic cycling training, a large number of muscular exercise modes are different. As little as 2 weeks of resist-
contractions (from 118,000 to 145,000 contractions per leg) ance training has been shown to result in significant hyper-
has been suggested as a requirement to impart a sufficient trophy of the knee extensor muscle group [49]. However, it
stimulus for muscle hypertrophy [12]. Such training sessions is possible that the hypertrophy rate is slower in response to
usually last from 30 to 45 min. In comparison, with resist- aerobic training [26]. Therefore, Konopka and Harber sug-
ance training, protocols involving three sets performed at gested that to achieve similar muscular growth, aerobic train-
80% of one repetition maximum and lasting approximately ing frequency should be higher than the resistance training
5–10 min per session have been shown to result in a robust frequency [12]. These authors suggested that four to five
growth of the knee extensor musculature [46]. Therefore, sessions of aerobic training per week might be needed to
regardless of the potential for aerobic training to induce achieve comparable muscle growth to ‘traditional’ resist-
some degree of muscle hypertrophy, resistance training is ance exercise programs [12]. Nineteen out of the 21 stud-
likely a more time-efficient mode of exercise for achieving ies included in the present meta-analysis employed aerobic
this outcome. This may be important given that the lack of training frequencies of two and three times per week. There-
time for exercise is commonly proposed as an important fore, it is possible that greater increases in muscle size with
perceived barrier to exercise participation [47, 48]. aerobic training would be observed if the included studies
While resistance training likely provides a greater (and had employed higher training frequencies.
more time-efficient) stimulus for inducing muscle hypertro- The differential effects of aerobic and resistance exercise
phy compared with aerobic training modalities, it is possible stimuli for inducing muscle hypertrophy might be explained
the time courses of muscular growth induced by these two
Resistance vs. Aerobic Training for Hypertrophy

Study Hedges' g Lower limit Upper limit p-value Hedges' g and 95% CI Statistical weight (%)
Ahtiainen et al. (2009) [6] 1.95 0.89 3.01 < 0.001 11.20
Bell et al. (2000) [36] 0.88 0.03 1.73 0.044 13.39
De Souza et al. (2014) [38] 3.08 1.77 4.39 < 0.001 8.87
Farup et al. (2012) [39] 1.07 0.01 2.13 0.047 11.20
Karavirta et al. (2011) [42] 1.62 0.56 2.68 0.003 11.20
Kraemer et al. (1995) [23] 2.09 0.95 3.23 < 0.001 10.35
McCarthy et al. (2002) [43] 1.74 0.74 2.74 0.001 11.78
Nelson et al. (1990) [24] 0.21 -0.97 1.39 0.726 10.04
Sipilä et al. (1997) [45] 0.73 -0.25 1.71 0.144 11.98
Pooled effect 1.44 0.93 1.95 < 0.001

-5 -4 -3 -2 -1 0 1 2 3 4 5
Favors aerobic Favors resistance

Fig. 4  Forest plot of the differences between the effects of aerobic and resistance training on type II muscle fiber cross-sectional area. The x-axis
denotes Hedge’s g (standardized mean differences). The whiskers denote the 95% confidence intervals (CIs)

by differences in their capacity to activate post-exercise ana- The meta-analysis results for type I and type II fiber CSA
bolic signaling responses in skeletal muscle. For example, support those seen for whole-muscle measures of hyper-
the degree of post-exercise p70S6 K (p70 kDa ribosomal trophy. Given that the present meta-analysis favored resist-
protein subunit kinase 1) phosphorylation in skeletal mus- ance training for increasing both type I and type II fiber
cle is in some studies highly correlated (r = 0.82–0.99) with CSA, there appears to be no fiber-type specific hypertrophy
muscular hypertrophy consequent to long-term resistance response to aerobic vs. resistance training. Some of the dif-
training [50–52]. It has been reported that the phospho- ferences in results between the studies for muscle fiber CSA
rylation of p70S6 K is increased immediately following could be the result of the modality of aerobic training. For
both aerobic and resistance exercise [53]. However, when instance, Kraemer et al. [23] reported that aerobic training,
assessed 4 h after training, the phosphorylation of p70S6 K in the form of running, induced a decrease in type I and type
remained increased only with resistance exercise, and simi- II fiber CSA.
lar results were seen for muscle protein synthesis [53]. These The majority of remaining studies included in this meta-
acute differences in signaling responses between aerobic and analysis employed cycling as opposed to running. Cycling
resistance exercise might also reflect potential differences in may have a more localized stress on the knee extensor mus-
the time course of muscular growth induced by both exercise culature than running, and, thus, might have a more pro-
modes. Future long-term studies might consider exploring nounced effect on the hypertrophic response of this muscle
this topic further by incorporating measurements of mus- group. That said, Coggan and colleagues measured fiber
cle hypertrophy at multiple time points during aerobic and CSA of the gastrocnemius muscle and reported that walking/
resistance training interventions. running was sufficient for increasing muscle fiber CSA, [56]
One additional matter worthy of discussion when com- albeit in untrained older adults. Running involves concen-
paring these two modes of exercise is motor unit recruit- tric actions coupled with eccentric actions and, thus, it may
ment. Henneman’s size principle suggests that motor units result in higher levels of muscle damage than cycling (likely
are recruited in an orderly fashion [54]. During exercise, owing to the shock waves associated with the loading pattern
smaller motor units are recruited first and, as force produc- of running), which is a concentric-only mode of exercise
tion requirements increase, larger units are sequentially [57]. In that regard, some studies show that, during the initial
recruited as well [55]. Therefore, resistance exercise per- phases of training, in the presence of damage, muscle protein
formed to momentary muscular failure ultimately elicits synthesis may be directed more towards restoring this dam-
activation of the entire motor unit pool, which, in turn, age than to building the contractile protein pool [58].
should stimulate increases in muscle size. However, dur- The study by Nelson et al. [24] is the only study to show
ing long-lasting submaximal exercise, such as continuous an advantage for aerobic training over resistance training
cycling (the most common form of aerobic exercise across for type I fiber CSA hypertrophy. However, it needs to be
the included studies), the highest threshold motor units are acknowledged that in this study there were considerable
not necessarily activated [55]. Therefore, it is possible that differences between the groups at baseline. For instance,
the greater muscular hypertrophy observed with resistance the group performing resistance training had on aver-
training is, at least partially, explained by these differences age 8% body fat, while the aerobic training group had on
in recruitment. average 20% body fat. Furthermore, the group performing
 J. Grgic et al.

resistance training had a relative VO2max of on average 4.2 Methodological Quality

55 mL·kg−1·min−1, while the aerobic training group had an
average value of 44 mL·kg−1·min−1. It might be that these Based on the methodological quality assessment, we can
differences between the groups at baseline influenced the conclude that the results of the present meta-analysis were
results of the study. likely not confounded by poor study designs, as all included
While it seems that resistance training is more efficient studies were deemed to be of moderate or good quality. The
for inducing hypertrophy of both type I and type II muscle study by Nelson and colleagues [24] had the lowest score on
fibers compared with aerobic training, given the relatively the Downs and Black checklist. However, this study is the
small number of studies undertaken thus far, further work is earliest of all included studies in the present meta-analysis,
warranted on this topic. An aspect that makes it difficult to and older studies often lack detail in their methodology sec-
compare aerobic exercise training to resistance training on tions. The two items added to the checklist (i.e., items 28
a single outcome (in this case, muscle hypertrophy) is the and 29) captured some important limitations in several of the
various characteristics of the training programs (e.g., inten- included studies that are specific to exercise interventions.
sity, duration) across the included studies. Many resistance Studies that reported training adherence showed similar
training programs in the included studies were designed to compliance between both types of training interventions.
induce hypertrophy. On the contrary, most aerobic training That said, it is important to highlight that several studies did
programs were mainly focused on examining VO2max or met- not report participant adherence to the training intervention.
abolic changes within the muscle, with muscle growth being This is a point of concern, given that any between-group dif-
a secondary or tertiary measure. Therefore, future studies ferences in training adherence may have a pronounced effect
should consider matching different exercise modalities based on the muscular adaptations associated with each training
on effort and duration, as the acute physiological responses intervention. Future studies should, therefore, ensure that
(i.e., oxygen consumption, blood lactate, energy expendi- training adherence is clearly reported for each training inter-
ture, muscle swelling, and electromyography outcomes) may vention, so that the comparison between training modes
be quite similar between these two modes of exercise [59]. It remains valid.
is currently unclear whether matching resistance and aerobic Furthermore, in several of the included studies, it was not
training on the basis of effort and duration results in similar clear if the training programs had been supervised or not.
long-term adaptations. This is an important consideration, as compared to unsu-
pervised training, supervision has been shown to improve
4.1 Limitations training outcomes such as gains in strength and lean body
mass [60]. Studies should, therefore, explicitly state whether
Most of the studies conducted to date employed untrained training programs were performed under supervision, to
individuals (Table 1) and these individuals are much more allow better interpretation of study methods and ultimately
likely to positively respond to both aerobic and resistance greater practical applicability.
exercise. The specificity of adaptive responses to aerobic and
resistance training becomes more clear over time. This has
also been shown in terms of protein synthetic responses to
5 Conclusions
exercise, which become more specific (i.e., mitochondrial
vs. myofibrillar) after a training period [53]. The study by
The results of this systematic review and meta-analysis
Kraemer et al. [23] is the only study to include resistance-
confirm the common belief that resistance training is more
trained individuals. Therefore, it may be expected that an
effective than aerobic training for promoting skeletal mus-
even greater effect of resistance training (as compared to
cle hypertrophy and challenge recent suggestions that both
aerobic) would be seen in trained individuals. However,
forms of exercise are equally effective. This finding was con-
future studies in a resistance-trained population are needed.
sistent with measurements of muscle hypertrophy both at
In the present analysis, we pooled different forms of aero-
the whole-muscle and myofiber levels. While these results
bic exercise such as cycling and walking/running, which
are specific to the knee extensor musculature, it could be
may not have the same hypertrophic potential, as previ-
hypothesized that similar results would likely be seen for
ously discussed. Additionally, the participants across the
other muscle groups as well. Although the identified studies
included studies ranged from young to older adults, and the
were of moderate-to-good quality, future research comparing
responses to these modes of exercise might not be uniform
hypertrophic responses to resistance and aerobic training
across populations of different ages. Although we did use the
should include assessments of not only the knee extensors
random-effects model to address heterogeneity between the
but also other muscle groups. Future studies should also con-
study designs, it remains unclear to what extent these factors
sider incorporating different modalities of aerobic exercise
influenced the pooled findings.
Resistance vs. Aerobic Training for Hypertrophy

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Funding  No external sources of funding were used to assist in the and function in older women. Am J Physiol Regul Integr Comp
preparation of this article. Physiol. 2009;297(5):R1452–9.
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