Is There Any Practical Application of Meta-Analytical Results in Strength Training?

The manipulation of resistance training (RT) variables is used among athletes, recreational exercisers, and compromised populations (e.g., elderly) attempting to potentiate muscle hypertrophy. However, it is unknown whether an individual's inherent predisposition dictates the RT-induced muscle hypertrophic response. Resistance-trained young [26 (3) y] men (n = 20) performed 8 wk unilateral RT (2 times/wk), with 1 leg randomly assigned to a standard progressive RT [control (CON)] and the contralateral leg to a variable RT (VAR; modulating exercise load, volume, contraction type, and interset rest interval). The VAR leg completed all 4 RT variations every 2 wk. Bilateral vastus lateralis cross-sectional area (CSA) was measured, pre- and post-RT and acute integrated myofibrillar protein synthesis (MyoPS) rates were assessed at rest and over 48 h following the final RT session. Muscle CSA increase was similar between CON and VAR (P > 0.05), despite higher total training volume (TTV) in VAR (P < 0.05). The 0-48-h integrated MyoPS increase postexercise was slightly greater for VAR than CON (P < 0.05). All participants were considered "responders" to RT, although none benefited to a greater extent from a specific protocol. Between-subjects variability (MyoPS, 3.30%; CSA, 37.8%) was 40-fold greater than the intrasubject (between legs) variability (MyoPS, 0.08%; CSA, 0.9%). The higher TTV and greater MyoPS response in VAR did not translate to a greater muscle hypertrophic response. Manipulating common RT variables elicited similar muscle hypertrophy than a standard progressive RT program in trained young men. Intrinsic individual factors are key determinants of the MyoPS and change in muscle CSA compared with extrinsic manipulation of common RT variables.NEW & NOTEWORTHY Systematically manipulating resistance training (RT) variables during RT augments the stimulation of myofibrillar protein synthesis (MyoPS) and training volume but fails to potentiate muscle hypertrophy compared with a standard progressive RT. Any modest further MyoPS increase and higher training volumes do not reflect in a greater hypertrophic response. Between-subject variability was 40-fold greater than the variability promoted by extrinsic manipulation of RT variables, indicating that individual intrinsic factors are stronger determinants of the hypertrophic response.

Homer, KA, Cross, MR, and Helms, ER. A survey of resistance training practices among physique competitors during peak week. J Strength Cond Res 38(10): 1745-1752, 2024-Physique athletes are ranked by their on-stage presentation of muscle size, proportionality, and leanness. To acutely maximize muscle size, competitors manipulate resistance training (RT) variables in the days before the contest, commonly referred to as peak week (PW). Resistance training manipulations during PW may act synergistically with nutrition strategies such as carbohydrate loading. However, because little information exists on changes made to RT during PW, the purpose of this research was to determine the current practices of physique athletes and whether competitor characteristics were predictive of the RT variables manipulated. A total of 104 responses to the RT section of a survey on PW nutrition and training were analyzed through a series of multiple logistic regression models to examine the relationship between RT manipulations and competitor characteristics. Furthermore, to determine the magnitude of differences between PW and the week before PW (WBPW) for these variables, a McNemar-Bowker test, paired t-tests, and Wilcoxon signed-rank tests were conducted for nominal, continuous, and discrete outcomes, respectively. For all statistical analyses, p <0.05 was deemed significant. Competitors generally adjusted RT in a variety of ways, where proximity-to-failure was the most frequently manipulated and training frequency was the least; however, no competitor characteristic predicted any of the RT variables manipulated. Within those who manipulated RT variables during PW, frequency, volume, and intensity decreased while repetition ranges of compound exercises increased, empirically confirming that competitors seek to reduce training stress during PW. Such findings can be incorporated in future experimental designs examining the efficacy of peaking strategies to enhance the generalizability of results.

We sought to determine if manipulating resistance training (RT) variables differentially altered the expression of select sarcoplasmic and myofibril proteins as well as myofibrillar spacing in myofibers. Resistance-trained men (n = 20; 26 ± 3 years old) trained for 8 weeks where a randomized leg performed either a standard (CON) or variable RT protocol (VAR: manipulation of load, volume, muscle action, and rest intervals at each RT session). A pre-training (PRE) vastus lateralis biopsy was obtained from a randomized single leg, and biopsies were obtained from both legs 96 h following the last training bout. The sarcoplasmic protein pool was assayed for proteins involved in energy metabolism, and the myofibril protein pool was assayed for relative myosin heavy chain (MHC) and actin protein abundances. Sections were also histologically analyzed to obtain myofibril spacing characteristics. VAR resulted in ~12% greater volume load (VL) compared to CON (p < 0.001). The mean fiber cross-sectional area increased following both RT protocols [CON: 14.6% (775.5 μm2), p = 0.006; VAR: 13.9% (743.2 μm2), p = 0.01 vs. PRE for both], but without significant differences between protocols (p = 0.79). Neither RT protocol affected a majority of assayed proteins related to energy metabolism, but both training protocols increased hexokinase 2 protein levels and decreased a mitochondrial beta-oxidation marker (VLCAD protein; p < 0.05). Citrate synthase activity levels increased with CON RT (p < 0.05), but not VAR RT. The relative abundance of MHC (summed isoforms) decreased with both training protocols (p < 0.05). However, the relative abundance of actin protein (summed isoforms) decreased with VAR only (13.5 and 9.0%, respectively; p < 0.05). A decrease in percent area occupied by myofibrils was observed from PRE to VAR (−4.87%; p = 0.048), but not for the CON (4.53%; p = 0.979). In contrast, there was an increase in percent area occupied by non-contractile space from PRE to VAR (10.14%; p = 0.048), but not PRE to CON (0.72%; p = 0.979). In conclusion, while both RT protocols increased muscle fiber hypertrophy, a higher volume-load where RT variables were frequently manipulated increased non-contractile spacing in resistance-trained individuals.

The optimal prescription and precise recommendations of resistance training volume for older adults is unclear in the current literature. In addition, the interactions between resistance training volume and program duration as well as physical health status remain to be determined when assessing physical function, muscle size and hypertrophy and muscle strength adaptations in older adults. This study aimed to determine which resistance training volume is the most effective in improving physical function, lean body mass, lower-limb muscle hypertrophy and strength in older adults. Additionally, we examined whether effects were moderated by intervention duration (i.e. short term, < 20weeks; medium-to-long term, ≥ 20weeks) and physical health status (i.e. physically healthy, physically impaired, mixed physically healthy and physically impaired; PROSPERO identifier: CRD42023413209). CINAHL, Embase, LILACS, PubMed, Scielo, SPORTDiscus and Web of Science databases were searched up to April 2023. Eligible randomised trials examined the effects of supervised resistance training in older adults (i.e. ≥ 60years). Resistance training programs were categorised as low (LVRT), moderate (MVRT) and high volume (HVRT) on the basis of terciles of prescribed weekly resistance training volume (i.e. product of frequency, number of exercises and number of sets) for full- and lower-body training. The primary outcomes for this review were physical function measured by fast walking speed, timed up and go and 6-min walking tests; lean body mass and lower-body muscle hypertrophy; and lower-body muscle strength measured by knee extension and leg press one-repetition maximum (1-RM), isometric muscle strength and isokinetic torque. A random-effects network meta-analysis was undertaken to examine the effects of different resistance training volumes on the outcomes of interest. We included a total of 161 articles describing 151 trials (n = 6306). LVRT was the most effective for improving timed up and go [- 1.20 standardised mean difference (SMD), 95% confidence interval (95% CI): - 1.57 to - 0.82], 6-min walk test (1.03 SMD, 95% CI: 0.33-1.73), lean body mass (0.25 SMD, 95% CI: 0.10-0.40) and muscle hypertrophy (0.40 SMD, 95% CI: 0.25-0.54). Both MVRT and HVRT were the most effective for improving lower-limb strength, while only HVRT was effective in increasing fast walking speed (0.40 SMD, 95% CI: - 0.57 to 0.14). Regarding the moderators, our results were independent of program duration and mainly observed for healthy older adults, while evidence was limited for those who were physically impaired. A low resistance training volume can substantially improve healthy older adults' physical function and benefits lean mass and muscle size independently of program duration, while a higher volume seems to be necessary for achieving greater improvements in muscle strength. A low volume of resistance training should be recommended in future exercise guidelines, particularly for physically healthy older adults targeting healthy ageing.

Brigatto, FA, Lima, LEdM, Germano, MD, Aoki, MS, Braz, TV, and Lopes, CR. High resistance-training volume enhances muscle thickness in resistance-trained men. J Strength Cond Res 36(1): 22-30, 2022-This study investigated the effects of different volumes of resistance training (RT) (8 weeks of 16, 24, and 32 weekly sets per muscle group) on muscular strength and hypertrophy. Subjects were pair-matched according to baseline strength and then randomly assigned to 1 of 3 experimental groups: 16 weekly sets per muscle group (G16, n = 9), 24 weekly sets per muscle group (G24, n = 9), or 32 weekly sets per muscle group (G32, n = 9). All other RT variables (e.g., exercise performed, exercise order, weekly frequency, range of repetitions, rest interval between sets and exercises, etc.) were maintained constant. The total load lifted was calculated for every RT session to compare the accumulated external training load among experimental groups across the intervention period. Testing was conducted before intervention (pre) and after 8-week (post-8) periods for maximal voluntary muscle strength (1 repetition maximum [1RM] test for bench press and parallel back squat exercises) and muscle thickness (MT) of the biceps brachii, triceps brachii, and vastus lateralis. The major findings were as follows: (a) all RT volumes increased bench press and parallel back squat 1RM and (b) all RT volumes increased the biceps brachii, triceps brachii, and vastus lateralis MT. The magnitude of increase in 1RM and MT of the lower body when training with 32 weekly sets per muscle group was higher than for 16 weekly sets per muscle group. The magnitude of the increase in MTTB was higher when training with 32 weekly sets than for 16 weekly sets.

BackgroundThe workplace is an important setting for adult health promotion including exercise training such as resistance training (RT). Since the reporting of exercise training interventions is generally inconsistent, the objective of this systematic review was to investigate the attention to principles of RT progression and variables of RT exercise prescription in workplace-related RT interventions.MethodsA systematic literature search was conducted in the databases LIVIVO, PubMed, SPORTDiscus, and Web of Science (2000–2020). Controlled trials with apparently healthy “employees” and a main focus on RT were included. RT principles and variables were extracted and rated by two reviewers (reported, not reported, or unclear). Sum scores for each RT intervention and percentages regarding each principle and variable were calculated.ResultsOverall, 21 articles were included (18 primary studies, 3 protocols). Summarized narratively, the interventions showed different positive effects on strength- or performance-related and/or health- or complaint-related outcomes. The reporting of the RT principles and variables was varied [progressive overload: 94% of the studies, specificity: 78%, variation (periodization): 39%, muscle action: 94%, loading: 94%, volume; 67%, exercise selection: 89%, exercise order: 47%, rest periods between sets: 33%, rest periods between exercises: 27%, repetition velocity: 44%, and frequency: 100%].ConclusionSeveral key RT principles and variables were reported inconsistently, reducing reproducibility and pointing to the need for standardized RT intervention reporting in workplace-related interventions. Exercise science and workplace promotion should be further linked, since accurate reporting is a prerequisite for transferring robust findings into practice.

Maximal muscular force production has been shown to be attenuated when preceded by acute static stretching (Power, K. et al., Med. Sci. Sport Exerc. 36:1389-1396, 2004) however, it is unclear whether varying stretching volume and method has variable effects on muscular strength in trained athletes. PURPOSE: To determine the effects of acute low and high volume static and proprioceptive neuromuscular facilitation (PNF) stretching on one-repetition maximum (1RM) bench press in NCAA Division II collegiate football players. METHODS: Fifteen (n = 15) resistance trained male football players (mean ± SD; age: 19.9 ± 1.1 y; weight: 98.89 ± 13.39 kg; height: 184.2 ± 5.7 cm; body composition: 14.6 ± 7.4 %) volunteered to participate in the study. Subjects were randomly assigned to each of 5 stretching protocols to include: 1) low volume PNF stretching (LVPNFS), 2) high volume PNF stretching (HVPNFS), 3) low volume static stretching (LVSS), 4) high volume static stretching (HVSS), and 5) non-stretching (NS) prior to 1RM testing. Two and 5 sets of stretching were completed for the low and high volume protocols respectively. The PNF stretching protocols used a contract (5 sec at 75% maximum effort) - relax (10 sec) - stretch (10 sec at moderate tension) sequence that targeted triceps and chest muscle groups using two separate exercises. The static stretching protocols targeted the same muscle groups and were passively held to a point of moderate tension for 20 and 30 sec for LVSS and HVSS respectively. The stretching interventions were substituted for the stretching recommendations outlined in the ACSM 1RM resistance training guidelines (2000). A minimum of 48 h was required between testing sessions. RESULTS: One-Way ANOVA analysis with repeated measures indicated there was no significant effect (p>0.05) of any of the stretching protocols LVPNFS (128.9 + 3.8 kg), HVPNFS (128.3 + 3.7 kg), LVSS (129.7 + 3.7 kg), HVSS (128.2 + 3.7 kg) and NS (129.7 + 3.3 kg) on 1RM bench press performance. CONCLUSION: We conclude that low and high volume PNF and static stretching has no significant acute effect on 1RM bench press in resistance trained collegiate football players. This suggests that resistance trained athletes can perform either low or high volume static or PNF flexibility exercises prior to 1 RM assessments without adversely affecting performance.

Adaptations and acute physiological effects of various resistance training programs in adolescent and elite athletes

In resistance training, periodization is often used in an attempt to promote development of strength and muscle hypertrophy. However, it remains unclear how resistance training variables are most effectively periodized to maximize gains in strength and muscle hypertrophy. The aims of this study were to examine the current body of literature to determine whether there is an effect of periodization of training volume and intensity on maximal strength and muscle hypertrophy, and, if so, to determine how these variables are more effectively periodized to promote increases in strength and muscle hypertrophy, when volume is equated between conditions from pre to post intervention. Systematic searches were conducted in PubMed, Scopus and SPORTDiscus databases. Data from the individual studies were extracted and coded. Meta-analyses using the inverse-variance random effects model were performed to compare 1-repetition maximum (1RM) and muscle hypertrophy outcomes in (a) non-periodized (NP) versus periodized training and (b) in linear periodization (LP) versus undulating periodization (UP). Subgroup analyses examining whether results were affected by training status were performed. Meta-analyses of other periodization model comparisons were not performed, due to a low number of studies. Thirty-five studies met the inclusion criteria. Results of the meta-analyses comparing NP and periodized training demonstrated an overall effect on 1RM strength favoring periodized training (ES 0.31, 95% confidence interval (CI) [0.04, 0.57]; Z = 2.28, P = 0.02). In contrast, muscle hypertrophy did not differ between NP and periodized training (ES 0.13, 95% CI [-0.10, 0.36]; Z = 1.10, P = 0.27). Results of the meta-analyses comparing LP and UP indicated an overall effect on 1RM favoring UP (ES 0.31, 95% CI [0.02, 0.61]; Z = 2.06, P = 0.04). Subgroup analyses indicated an effect on 1RM favoring UP in trained participants (ES 0.61, 95% CI [0.00, 1.22]; Z = 1.97 (P = 0.05)), whereas changes in 1RM did not differ between LP and UP in untrained participants (ES 0.06, 95% CI [-0.20, 0.31]; Z = 0.43 (P = 0.67)). The meta-analyses showed that muscle hypertrophy did not differ between LP and UP (ES 0.05, 95% CI [-0.20, 0.29]; Z = 0.36 (P = 0.72)). The results suggest that when volume is equated between conditions, periodized resistance training has a greater effect on 1RM strength compared to NP resistance training. Also, UP resulted in greater increases in 1RM compared to LP. However, subgroup analyses revealed that this was only the case for trained and not previously untrained individuals, indicating that trained individuals benefit from daily or weekly undulations in volume and intensity, when the aim is maximal strength. Periodization of volume and intensity does not seem to affect muscle hypertrophy in volume-equated pre-post designs. Based on this, we propose that the effects of periodization on maximal strength may instead be related to the neurophysiological adaptations accompanying resistance training.

To examine the comprehensiveness in reporting resistance training variables among studies of pregnant women. Systematic review. PubMed, EMBASE, CINAHL, Web of Science, and Cochrane Library were searched. All quantitative study designs were eligible if they contained any resistance training exposure during pregnancy. Studies which contained only pelvic floor muscle training, or only occupational exposure to lifting were excluded. 117 studies from 29 countries were included (n = 66, 133 participants). Studies were assessed on the reporting of 16 resistance training variables including frequency, intensity, duration, type (exercise selection, equipment), volume (sets, repetitions, external load), pattern (rest, tempo), progressive overload, experience level, intensity measurement, pregnancy modifications, supervision, and adverse events. Supervision and frequency were well reported (87% and 79% of studies, respectively). Critical dose-related variables including sets, repetitions, intensity, and external load were poorly reported (67%, 62%, 61%, and 38% of studies, respectively). Pregnancy modifications to resistance training were reported in 65% of studies. Key resistance training variables, including sets, repetitions, and intensity of training are not consistently reported in studies of pregnant women, precluding a strong understanding of work-rates and total training loads. To advance the field, a consensus on minimum reporting standards must be established and consistently adopted to strengthen the evidence base and enable more specific recommendations for resistance training during pregnancy. Without a comprehensive evidence-base to underpin detailed guidelines, resistance training prescription will remain conservative in research and clinical practice, limiting the potential benefits to pregnant women and their offspring.

Resistance Training Strategies for the Clinician: Focus on the Novice Exerciser

While proximity-to-failure is considered an important resistance training (RT) prescription variable, its influence on physiological adaptations and short-term responses to RT is uncertain. Given the ambiguity in the literature, a scoping review was undertaken to summarise evidence for the influence of proximity-to-failure on muscle hypertrophy, neuromuscular fatigue, muscle damage and perceived discomfort. Literature searching was performed according to PRISMA-ScR guidelines and identified three themes of studies comparing either: i) RT performed to momentary muscular failure versus non-failure, ii) RT performed to set failure (defined as anything other than momentary muscular failure) versus non-failure, and iii) RT performed to different velocity loss thresholds. The findings highlight that no consensus definition for “failure” exists in the literature, and the proximity-to-failure achieved in “non-failure” conditions is often ambiguous and variable across studies. This poses challenges when deriving practical recommendations for manipulating proximity-to-failure in RT to achieve desired outcomes. Based on the limited available evidence, RT to set failure is likely not superior to non-failure RT for inducing muscle hypertrophy, but may exacerbate neuromuscular fatigue, muscle damage, and post-set perceived discomfort versus non-failure RT. Together, these factors may impair post-exercise recovery and subsequent performance, and may also negatively influence long-term adherence to RT. KEY POINTS This scoping review identified three broad themes of studies investigating proximity-to-failure in RT, based on the specific definition of set failure used (and therefore the research question being examined), to improve the validity of study comparisons and interpretations. There is no consensus definition for set failure in RT, and the proximity-to-failure achieved during non-failure RT is often unclear and varies both within and between studies, which together poses challenges when interpreting study findings and deriving practical recommendations regarding the influence of RT proximity-to-failure on muscle hypertrophy and other short-term responses. Based on the limited available evidence, performing RT to set failure is likely not superior to non-failure RT to maximise muscle hypertrophy, but the optimal proximity to failure in RT for muscle hypertrophy is unclear and may be moderated by other RT variables (e.g., load, volume-load). Also, RT performed to set failure likely induces greater neuromuscular fatigue, muscle damage, and perceived discomfort than non-failure RT, which may negatively influence RT performance, post-RT recovery, and long-term adherence.

In accordance with the principles of training specificity, resistance and endurance training induce distinct muscular adaptations. Endurance training, for example, decreases the activity of the glycolytic enzymes, but increases intramuscular substrate stores, oxidative enzyme activities, and capillary, as well as mitochondrial, density. In contrast, resistance or strength training reduces mitochondrial density, while marginally impacting capillary density, metabolic enzyme activities and intramuscular substrate stores (except muscle glycogen). The training modalities do induce one common muscular adaptation: they transform type IIb myofibres into IIa myofibres. This transformation is coupled with opposite changes in fibre size (resistance training increases, and endurance training decreases, fibre size), and, in general, myofibre contractile properties. As a result of these distinct muscular adaptations, endurance training facilitates aerobic processes, whereas resistance training increases muscular strength and anaerobic power. Exercise performance data do not fit this paradigm, however, as they indicate that resistance training or the addition of resistance training to an ongoing endurance exercise regimen, including running or cycling, increases both short and long term endurance capacity in sedentary and trained individuals. Resistance training also appears to improve lactate threshold in untrained individuals during cycling. These improvements may be linked to the capacity of resistance training to alter myofibre size and contractile properties, adaptations that may increase muscular force production. In contrast to running and cycling, traditional dry land resistance training or combined swim and resistance training does not appear to enhance swimming performance in untrained individuals or competitive swimmers, despite substantially increasing upper body strength. Combined swim and swim-specific 'in-water' resistance training programmes, however, increase a competitive swimmer's velocity over distances up to 200 m. Traditional resistance training may be a valuable adjunct to the exercise programmes followed by endurance runners or cyclists, but not swimmers; these latter athletes need more specific forms of resistance training to realise performance improvement.

This study investigated the acute effects of 45 min of resistance exercise (RE) on excess postexercise oxygen consumption (EPOC) and substrate oxidation 120 min after exercise in moderately trained women. Ten RE trained women (age = 29 +/- 3 yr; ht = 168 +/- 8.3 cm; wt = 59 +/- 5.7 kg; VO2max = 38.3 +/- 4.7 mL.kg-1.min-1) underwent two trials: control sitting and RE. Subjects acted as their own controls in a random counterbalanced design. A 2-d nonexercise period was established between testing trials. Oxygen consumption (VO2) and respiratory exchange ratio (RER) were measured continuously by indirect calorimetry before, during, and after exercise and on a separate control day. RE consisted of 3 sets of 10 exercises at 10-repetition maximum with a 1-min rest period between each set. Fingertip samples of blood lactate concentration [BL] were collected immediately postexercise and every 30 min thereafter until [BL] returned to resting baseline values after exercise. The overall 2-h EPOC was 6.2-L (RE = 33.4 +/- 5.1 L vs control = 27.2 +/- 0.3 L), corresponding to an 18.6% elevation over the control period. RER was significantly (P < 0.01) below the control RER from minute 30 to minute 120 postexercise (RE = 0.75 +/- 0.01 vs control = 0.85 +/- 0.01). During the last 30 min of recovery, VO2 and [BL] had returned to control/baseline values and fat oxidation was significantly (P < 0.0001) higher (29.2 vs 16.3 kcal) after RE compared with the control trial. These data indicate that in young RE trained women, acute RE produces a modest increase in VO2 during a 2-h recovery period and an increase in fat oxidation.

Sarcopenia is prevalent in older adults and affects their quality of life and overall health, low handgrip strength is one of the main manifestations of sarcopenia. Resistance training is an effective intervention for improving muscle strength in older adults, but the optimal dose of resistance training remains unclear. Therefore, the aim of this meta-analysis was to investigate the dose-response relationship between different doses of resistance training and grip strength in older adults. This systematic review and network meta-analysis included a search in PubMed, Embase, and the Cochrane Library for randomized controlled trials from inception to 19 October 2024 of resistance training for patients with senile sarcopenia. Comprehensive data extraction covered dose, resistance training protocol, demographics, and study duration. Systematic review with Bayesian network meta-analysis (NMA) methodology was employed and results were presented as 95% credible intervals (Crl). A total of 13 studies involving 711 participants (mean age: 68.29 ± 5.30 years; mean BMI: 24.03 ± 3.43; female: 79.5%) were included in this study. The results of our network meta-analysis showed that resistance training variables (e.g., frequency, intensity, period, and training volume) were effective in improving handgrip strength in older patients with sarcopenia. Among them, the effective dose range for frequency of resistance training was 2-5 times/week, resistance training intensity was 30%-75%, resistance training period was 4-24 weeks, resistance training exercise was 3-17 exercises per set, resistance training repetitions was 10-24 reps, resistance training sets was 2-8 sets, resistance training volume was 528-2,200 reps per week. The optimal dose of resistance training to improve handgrip strength in older adults with sarcopenia is 3 times per week (MD = 7.02, 95% CrI [4.62, 9.42]), 49% 1RM (MD = 7.11, 95% CrI [2.69, 11.52]), 19 weeks (MD = 7.87, 95% CrI [3.89, 11.85]), 15 exercises (MD = 8.16, 95% CrI [3.65, 12.66]), 16 reps (MD = 7.62; 95% CrI [4.77, 10.46]), 6 sets (MD = 8.63; 95% CrI [5.06, 12.21]), 1,400 reps/week (MD = 8.45; 95% CrI [5.50, 11.40]). Resistance training effectively improves handgrip strength in older adults with sarcopenia. A recommended 19-week program includes 3 sessions per week at 49% 1RM, featuring 15 exercises per set, 6 sets, and 16 repetitions per exercise, totaling up to 1,400 reps weekly. https://www.crd.york.ac.uk/PROSPERO/recorddashboard.