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The order is for your patient to do strength training

Frailty and sarcopenia, conditions associated with loss of muscle mass and strength, have emerged as significant challenges to global health. In this context, physical exercise, more specifically strength training, plays a crucial role in promoting quality of life. Furthermore, they act to prevent debilitating conditions. 

However, the correct approach to strength training is fundamental, highlighting the importance of understanding how muscles respond to different stimuli. In this sense, current research highlights that careful manipulation of load and training volume plays a crucial role in muscle development. So, contrary to popular belief, studies emphasize that low load and high reps may not be the most effective route.

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Strength training and muscle growth

The study “Unilateral high-load resistance training influences strength changes in the contralateral arm undergoing low-load training”, published on 26 of August 2023, in theJournal of Science and Medicine Sport,revealed that the muscle responds differently to different strength training plans, showing that optimizing growth Muscle training is intrinsically linked to the appropriate manipulation of intensity and volume. This is nothing new, right? But this study showed the difference in muscle mass with a load close to 100% RM compared to less load and more repetitions.

When it comes to building muscle mass, loads around 80% of the maximum repetition (RM) with a reduced number of repetitions have stood out as the most effective approach. This phenomenon, known as strength training, challenges the traditional notion that low load and high repetitions are the key to muscle development.

On the contrary, research emphasizes that it is substantial overload, combined with adequate rest, that stimulates muscle protein synthesis and drives growth. Therefore, understanding the relationship between load, volume and desired results becomes essential for those seeking to reduce the risks associated with sarcopenia

Strength training in Literature

The methods used in the study involved the randomization of 116 participants into three distinct groups. Each group completed a six-week period (totaling 18 sessions) of elbow flexion exercises. Group 1 trained only the dominant arm, performing 1 RM tests followed by 4 sets of weight exercises for 8-12 maximum repetitions. 

Group 2 followed the same training as Group 1 on the dominant arm, while the non-dominant arm performed four sets of exercises with a lighter load, corresponding to 30-40 maximum repetitions. Group 3 trained only the non-dominant arm, performing the same light load exercise as Group 2. Participants were then compared regarding changes in muscle thickness and maximum repetition of elbow flexion. This multifaceted approach allowed for a comprehensive analysis of muscular adaptations, bringing to light interesting nuances about how the body responds to strength training.

The results of this study have brought to light a surprising perspective on the relationship between strength training and muscle development. Contrary to expectations, a graph revealed that when training one arm using the classic bodybuilding method, with 4 sets of 8-12 repetitions, the untrained arm became stronger than when trained with a higher number of repetitions, specifically 4 sets of 30-40 repetitions. This finding challenges the conventional belief that more repetitions result in greater strength. Thus, this study suggested an unexpected complexity in the relationship between load, volume and neuromuscular adaptations.

Strategies in strength training

If your main goal is muscle growth and anaerobic capacity, traditional pumping sets of 30 or more reps still seem to be effective. Additionally, there is room for high-rep sets when heavier loads are not feasible, such as after an injury. However, for those who are serious about increasing strength or want to prioritize it for a period of time, moving away from the higher rep ranges seems to be the most sensible choice.

It is interesting to note that although all approaches led to similar improvements in muscle size, the most convincing explanation for the observed phenomenon probably lies in the neuronal aspect. In other words, lower repetitions affect the brain's ability to handle higher weights in a distinct way and practically independent of changes in the level of muscle fibers. This highlights, once again, that getting stronger is not just a matter of increasing muscle size.

Take home message

Based on the findings highlighted in the study, it is concluded that the higher load, lower repetition training approach has been shown to be more effective in promoting muscular strength compared to low load, high repetition methods. The most significant changes in non-dominant arm strength were observed in Groups 1 (Δ 1.5 kg; untrained arm) and 2 (Δ 1.1 kg; non-dominant arm with low load and high load on the opposite arm), in compared to Group 3 (Δ 0.3 kg; low load only).

It is important to note that only the directly trained arms showed changes in muscle thickness, indicating that training with fewer repetitions and more load positively influences both strength and muscle hypertrophy. Thus, the conclusion of the study highlights the complexity when using within-subject training models when investigating changes in strength, although not muscle hypertrophy. Therefore, careful selection of training protocols, considering intensity and volume, becomes crucial to achieving the desired results, especially when aiming to improve muscular strength. These findings reinforce the importance of personalizing training approaches to optimize desired benefits based on individual goals.


BELL, Zachary W.; WONG, Vickie; SPITZ, Robert W.; YAMADA, Yujiro; SONG, Jun Seob; KATAOKA, Ryo; CHATAKONDI, Raksha N.; ABE, Takashi; LOENNEKE, Jeremy P.. Unilateral high-load resistance training influences strength changes in the contralateral arm undergoing low-load training. Journal Of Science And Medicine In Sport, [S.L.], v. 26, no. 8, p. 440-445, Aug. 2023. Elsevier BV.

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