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Comparison of Flywheel and Pneumatic Training on Hypertrophy, Strength,

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DOI: 10.1080/02701367.2020.1762836

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Comparison of Flywheel and Pneumatic Training

on Hypertrophy, Strength, and Power in
Professional Handball Players

Sergio Maroto-Izquierdo , Jeffrey M. McBride , Nacho Gonzalez-Diez , David

García-López , Javier González-Gallego & José Antonio de Paz

To cite this article: Sergio Maroto-Izquierdo , Jeffrey M. McBride , Nacho Gonzalez-Diez , David
García-López , Javier González-Gallego & José Antonio de Paz (2020): Comparison of Flywheel
and Pneumatic Training on Hypertrophy, Strength, and Power in Professional Handball Players,
Research Quarterly for Exercise and Sport, DOI: 10.1080/02701367.2020.1762836

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RESEARCH QUARTERLY FOR EXERCISE AND SPORT
https://doi.org/10.1080/02701367.2020.1762836

Comparison of Flywheel and Pneumatic Training on Hypertrophy, Strength, and

Power in Professional Handball Players
a,b
Sergio Maroto-Izquierdo , Jeffrey M. McBridec, Nacho Gonzalez-Diezb, David García-López b
,
a
Javier González-Gallego , and José Antonio de Paz a
a
Universidad de León; bEuropean University Miguel de Cervantes; cAppalachian State University

ABSTRACT ARTICLE HISTORY

Purpose: The mechanical properties of resistance-training machines are a variable that may help Received 14 December 2019
to optimize sports performance and injury prevention protocols. The purpose of this study was to Accepted 27 April 2020
examine two non-gravity-dependent training modalities on muscle structure and function. KEYWORDS
Methods: Eighteen professional handball players were randomly divided into two experimental Resistance training;
groups: 1) iso-inertial flywheel training (FW) and 2) pneumatic resistance training (PN). Participants shoulder; sports
in both groups completed twelve training sessions in six weeks consisting of three movements performance; throwing
(lateral raise, internal and external rotation). Four sets of seven repetitions for each movement
were performed during each session. Before and after training subscapularis and deltoid (anterior,
middle, posterior) muscle thickness was measured. Isokinetic torque and power during internal
and external rotation at 60, 180, and 240 deg·s−1 was measured as well. Throwing speed was
assessed before and after training while both sitting and standing situations. Results: Both groups
showed similar significant increases in throwing speed and internal and external rotation peak
torque, average and peak power at all angular velocities. Anterior and middle deltoid muscle
thickness changes were greater after training in FW (20 and 22%) in comparison to PN (14 and 7%,
respectively). Conclusions: In summary, both flywheel and pneumatic training resulted in similar
increases in shoulder strength and power and throwing speed. However, flywheel training
appeared to possibly result in a slightly greater level of muscle hypertrophy of the anterior and
middle deltoid. Non-gravity dependent training appears to induce changes that would be
beneficial to sports performance and perhaps injury prevention.

Handball is an overhead throwing-sport characterized
by intermittent efforts and frequent physical contact
between players (Granados et al., 2013). Game play
consists of change of direction, jumping and throwing
capabilities with a primarily anaerobic energy require-
ment (Wagner et al., 2014) with repeated short and
explosive actions (Povoas et al., 2014). Thus, handball
performance is determined by a combination of tech-
nical and tactical skills and physical fitness capabilities
(Saavedra et al., 2018; Vila et al., 2012). Running velo-
city, throwing velocity, maximum strength and muscle
power have been reported to be the main requirements
in high-performance handball (Wagner et al., 2014).
The shoulder is obviously a major component of hand-
ball performance and experiences high rates of injury
(Asker, Holm et al., 2018; Giroto et al., 2017; Moller
et al., 2017). Accordingly, research in handball has
focused on training strategies aimed at increasing per-
formance (i.e. throwing velocity) (Hermassi et al., 2010,
2015; Mascarin et al., 2017; Raeder et al., 2015; Sabido
et al., 2016; Saeterbakken et al., 2011) and shoulder
injury prevention (Andersson et al., 2017).
Resistance training has been shown to enhance
handball performance (Hermassi et al., 2010, 2015;
Mascarin et al., 2017; Raeder et al., 2015; Sabido et al.,
2016; Saeterbakken et al., 2011). Increases in muscle
force, power and cross-sectional area in the rotator
cuff muscles have been observed after training and
also decreases in muscle imbalances between internal
and external rotators (Edouard et al., 2013). In parti-
cular, maximal power training (Cherif et al., 2016) and
plyometric training (Raeder et al., 2015) have both been
shown to result in significant increases in throwing
velocity and shoulder rotator muscle strength. While
many types of standard gravity-based resistance train-
ing programs have been investigated there are far fewer
investigations concerning non-gravity-based resistance
training machines such as pneumatic and flywheel
devices. Pneumatic resistance exercise devices have
since been developed (Avrillon et al., 2017) and involve

CONTACT Sergio Maroto-Izquierdo smaroi@unileon.es Department of Health Sciences, European University Miguel de Cervantes, Calle del Padre
Julio Chevalier, 2, 47012, Valladolid, Spain.
© 2020 SHAPE America
2 S. MAROTO-IZQUIERDO ET AL.
a constant level of force production regulated by com-
pressed air (Frost et al., 2016). This results in a constant
level of force production throughout the whole move-
ment and the elimination of inertia (Frost et al., 2016).
Pneumatic resistance training has been shown to result
in increases in muscle strength and power (Avrillon
et al., 2017; Frost et al., 2016). Although its effectiveness
has been demonstrated in healthy populations (Frost
et al., 2016) and the elderly (Balachandran et al., 2017),
no known studies have been performed in athletic
populations such as handball players.
Another non-gravity-based resistance exercise device
involves rotating flywheels that accentuate the eccentric
phase of the movement through the inertial-force gen-
erated by their rotation when a short and concerted
braking action is performed after a maximum con-
centric action (Maroto-Izquierdo et al., 2019; Maroto-
Izquierdo, Garcia-Lopez, Fernandez-Gonzalo et al.,
2017). This is a unique stimulus that results in
a unique eccentric-concentric phase movement with
an accentuated eccentric load similar to plyometrics
(Martinez-Aranda & Fernandez-Gonzalo, 2017;
Meylan et al., 2008). Iso-inertial resistance training
has been shown muscle mass gains and functional
adaptations (Maroto-Izquierdo, Garcia-Lopez,
Fernandez-Gonzalo et al., 2017), and has been related
with injury prevention (Monajati et al., 2018). Maroto-
Izquierdo, Garcia-Lopez, and de Paz (2017) reported
significant increases in strength and muscle power,
vertical jump height and running speed after 6-weeks
of lower limb flywheel resistance training. The increases
in muscle power, running speed and muscle hypertro-
phy were greater than with standard resistance training
(Maroto-Izquierdo, Garcia-Lopez, & de Paz, 2017). In
addition, Sabido, Hernandez-Davo, Botella et al. (2017)
observed increases in muscle power after 7-sessions of
lower limb flywheel resistance training in amateur
handball players.
Based on the previous investigations presented, non-
gravity-dependent training modalities (i.e. pneumatic
training and flywheel training) may be an effective
way to improve muscle strength, power and sports
performance in overhead handball throwing (e.g., lat-
eral raise, shoulder external and internal rotation). No
known studies have compared pneumatic training to
flywheel training in a single investigation. Each are
unique in the pneumatic training consists of constant
force movement patterns and flywheel training involves
the unique aspect of eccentric-overload (EO).
Therefore, the purpose of this investigation was to
examine muscle thickness (as an indicator of muscle
hypertrophy), isokinetic torque and power at three
different velocities, and throwing speed after six weeks
of either pneumatic or flywheel training in professional
handball players.
Methods
Subjects
Eighteen male professional handball players volunteered
for the study and were randomly assigned to the PN
group (n = 9; 23.3 ± 4.1 years, 191.8 ± 5.3 cm,
97.3 ± 8.5 kg) or FW group (n = 9; 24.9 ± 4.5 years,
191.3 ± 4.3 cm, 95.9 ± 11.1 kg). All subjects were profes-
sional handball players from Club Balonmano Atlético
Valladolid, which plays in the Liga ASOBAL, with
a regular weekly exercise practice consisted of 4 handball
sessions (~9 hours), 3 resistance training sessions includ-
ing strength/power exercises and 1 competitive match. All
of them performed the same training program with the
team during the duration of the study. All the subjects
had extensive experience with free-weight resistance train-
ing, and they did not modify their training habits to
participate in this study. None of them reported using
anabolic steroids or ergogenic aids. The study was com-
plete during the beginning of the pre-season phase.
Subjects did not have an upper limb injury in the previous
6 months or severe shoulder injury in the previous
2 years. Participants who suffered an injury during the
experimental phase of the study were excluded. Subjects
were informed of the requirements associated with parti-
cipation, and they gave their written informed consent.
The research project was conducted according to the
Declaration of Helsinki and was approved by the
University of León Human Research Ethic Committee
(ETICA-ULE-009-2018). All participants completed all
the protocols, including two familiarization sessions, the
prescribed training program, and the pre- and posttests.
The assessments and training sessions were performed at
the same time and prior to technical-tactical training.
Design
Eighteen professional handball players with no history
of shoulder injuries were randomly divided into two
experimental groups. A pneumatic training group (PN)
and a flywheel training group (FW). Both groups per-
formed twelve training sessions over a six-week period
consisting of 4 sets of 7 repetitions in the lateral raise
(LR), internal (IR) and external rotation (ER). These
exercises were prescribed as a complement to the
team’s strength and conditioning program. The team’s
3-day-a-week handball-specific strength training pro-
gram included two days per week of lower limb resis-
tance training and a day of upper limb resistance

training. During the time period of the study, partici-
pants did not perform any other specific shoulder
exercises. However, the shoulder was indirectly
involved in the pushing (e.g., bench press) and pulling
(e.g., pull-ups) exercises performed during the upper
limb sessions. During the intervention, the throwing
arm (TA) performed the prescribed training, while the
non-throwing arm (NTA) served as a control. Before
and after training isokinetic measures of internal and
external rotation (60, 180 and 240 deg·s−1) torque and
power were performed. Subscapularis, Anterior, Middle
and Posterior Deltoid muscle thickness and handball
specific throwing speed were also assessed.
Methodology
Participants in both groups completed a single-arm
shoulder-training program either using a pneumatic
device (PN) or a flywheel device (FW) two times per
week with at least forty-eight hours of rest between
sessions. Following a standardized mobility warm-up
(consisting of 25 arm forward circles, 25 arm backward
circles, 25 elbow forward circles and 25 elbow backward
circles), participants performed 4 sets of 7 maximal
unilateral (throwing arm) coupled concentric and
eccentric muscle actions in the lateral raise (LR), inter-
nal (IR) and external rotation (ER) resistance exercises,
with 2-min rest period between sets and exercises.
Power was measured during each repetition (PN:
Keiser display; FW: SmartCoach™, Stockholm,
Sweden) and real-time feedback was provided with
a monitor. Research personnel provided verbal encour-
agement during each repetition.
FW participants utilized a multi-functional flywheel
device (Kinetic Box (Kbox), Exxentric AB TM,
Bromma, Sweden; Sabido, Hernandez-Davo, &
Pereyra-Gerber, 2017), equipped with one 2.1-kg fly-
wheel with a moment of inertia of 0.025 kg·m−2 for the
lateral raise (LR) exercise. Subjects were asked to per-
form an explosive maximal effort through the entire
concentric action, which ranged from 10º to 100º of
shoulder abduction (Figure 1a). At the end of the con-
centric action, the flywheel rewound back, initiating the
reversed eccentric action. They were then instructed to
resist gently during the first and second thirds of the
ROM, and thereafter to apply maximal breaking force
to stop the movement at about 10º of shoulder abduc-
tion. Participants were asked to keep the elbow in
a slightly flexed position throughout the movement.
IR and ER exercises were performed in a conic pulley
(RSP einerical, Vigo, Spain), equipped with one fly-
wheel of four masses with moment inertia of
0.074 kg·m−2. The conic flywheel used a pulley that
RESEARCH QUARTERLY FOR EXERCISE AND SPORT 3
allowed for vertical displacement of the cable from the
half height of the axis. A second pulley that allowed for
horizontal displacement of the cable was placed 1.5 m
above the ground. Subjects were standing sideways to
the conic pulley about 3 meters away. They were asked
to perform a maximum concentric action between 0º to
70º of shoulder rotation in the ER exercise (Figure 1b)
and from 70º to 0º in the IR exercise (Figure 1c). At the
end of the concentric phase they resisted gently until
the last third of the ROM. In both exercises the elbow
remained flexed at 90º with 0º of shoulder abduction.
The inertial loads used in each exercise in the FW
group were the optimal moments of inertia that max-
imized concentric peak power (i.e., optimal inertial load
for each exercise).
Before the intervention, FW participants performed
a session to establish the optimal inertial load that max-
imized exercise concentric peak power. In accordance
with the protocol proposed by De Hoyo et al. (2015),
each participant performed an inertial incremental test
to determine the optimal load in which the highest con-
centric peak power was developed in the lateral raise,
internal rotation and external rotation exercises on the
two flywheel devices used. Participants performed 4 repe-
titions of the exercise with different progressive loads. The
first repetition was executed to start the movement and to
print speed into the flywheel system. Then, during the
next three repetitions, participants were asked to pull with
maximal effort (i.e., maximum possible concentric speed)
through the entire concentric action. The multi-functional
flywheel device (Kinetic Box (Kbox), Exxentric AB TM,
Bromma, Sweden) was equipped with 3 combinable iner-
tial wheels: 1 × 0.001 kg·m−2, 1 × 0.025 kg·m−2,
1 × 0.050 kg·m−2; whereas the conic pulley device (RSP
einerical, Vigo, Spain) allowed us to employ 5 different
inertial loads: 0.053 kg·m−2, 0.064 kg·m−2, 0.074 kg·m−2,
0.083 kg·m−2, and 0.113 kg·m−2. The optimal load was
determined when concentric peak power decreased in
comparison with the previous load. The optimal moment
of inertia that maximized concentric peak power was
0.025 kg·m−2 for the lateral raise exercise and
0.074 kg·m−2 for the internal and external rotation exer-
cises. Given the impossibility of performing an incremen-
tal inertia test every day and the possibilities offered by
the inertial systems used (i.e., not allowing a more precise
adaptation of the moment of inertia), these loads were
maintained throughout the study. In addition, it should
be noted that FW participants were request to perform an
additional non-maximal concentric-eccentric repetition at
the beginning of each set to start spinning the wheel.
PN participants performed the same exercises using
a pneumatic device (infinity functional trainer, Keiser,
Fresno, CA, USA) which supplies a constant load
4 S. MAROTO-IZQUIERDO ET AL.

Figure 1. Exercises performed in the by FW participants (a–c) and PN participants (d–f). Lateral raise (a and d), internal rotation (b
and e), and external rotation (c and f).

throughout the entire ROM. Therefore, the only Resistance was generated through an adjustable air
instruction given to PN participants was to stop the compressor (230 v, 50 Hz, Keiser). The optimal train-
movement before reaching the end of the ROM. ing load (which maximizes power output) for each

exercise was determined each day for each subject
following the manufacturer’s instructions. The subject
performed a trial at a low load (high velocity) and
a high load (low velocity) which is measured by an
encoder. A load that optimizes power output is then
determined by the device. Resistance was applied by
way of cables that extended from a pulley system free
to move in the vertical or horizontal direction. One of
the cables had its origin 20 cm above the ground, from
where the pulley allowed the vertical displacement of
the load. The subjects stood with one foot on either
side of the pulley in order to perform the LR exercise
(Figure 1d). The other pulley was placed 1.5 m above
the ground to allow for movement in the horizontal
plane in order for the subject to perform the IR
(Figure 1e) and ER exercises (Figure 1f). The three
exercises were executed with the same technique as
explained above for the FW group. In order to avoid
compensations, subjects were requested to keep the
trunk straight and were not allowed to perform
trunk compensatory movements (e.g., rotations or
flex-extensions) during all repetitions.
Muscle thickness
Subscapularis (SUB) and Anterior (AD), Middle (MD)
and Posterior Deltoid (PD) muscle thickness of both
shoulders was estimated using a previously described
protocol (Maroto-Izquierdo, Garcia-Lopez, & de Paz,
2017). SUB, AD, MD and PD muscles were measured
in vivo by B-mode ultrasonography (MyLab™50,
Esaote, Genoa, Italy) with a 8-cm, 12-MHz linear
array probe, which was coated with water-soluble
transmission gel to provide acoustic contact without
depressing the dermal surface. During measurements,
participants were sitting with a straight back on an
adjustable seat without a backrest with their feet sup-
ported until the hip formed a 90º angle. The hands
were placed in a supine position with a 90º of elbow
flexion and hands resting on the legs with relaxed
muscles. SUB was measured following the end of the
axillary line medially parallel to the clavicle. AD was
measured at a point 3-cm below the midpoint of the
anterior border of the acromion; MD was measured at
a point 3-cm below the midpoint of the anterior and
posterior border of the acromion; and PD was mea-
sured at a point 3-cm below the acromial angle. The
ultrasound probe was placed on the transversal plane
and perpendicular to the skin in every measurement.
These measurements were obtained twice, and their
mean values were used for further analysis. In order to
increase the reliability of the measurements obtained,
the measuring points were marked daily on the skin
RESEARCH QUARTERLY FOR EXERCISE AND SPORT 5
with indelible ink and muscle architecture images
from before and after the training were compared.
Isokinetic testing
Isokinetic torque and power testing were completed
after the ultrasonography analysis. A five-minute
warm-up was performed on an arm-cycle-ergometer
followed by light stretching and mobility exercises
(consisting of 25 arm forward circles, 25 arm backward
circles, 25 elbow forward circles and 25 elbow backward
circles) for the rotator cuff and scapular muscles.
Subjects were placed on the isokinetic dynamometer
(Isomed 2000, D&R Ferstl GmbH, Hemau, Germany)
to evaluate concentric torque and power measures for
shoulder internal and external rotation. Subjects per-
formed the test seated with 90º of hip flexion, and
standard stabilization straps placed across their chest
and hips. They were asked to place the hand of the
untested arm on the seat handle. The arm being tested
was positioned with the shoulder abducted to 90° and
the elbow flexed to 90°, according to the protocol
described by Andrade et al. (2016). Peak torque (PT),
average power (AP) and peak power (PP) during con-
centric internal and external rotators were tested
through a 120° range of motion (60° of IR and 60° of
ER). The ratio of ER and IR (ER/IR) was also
calculated.
Subjects performed three submaximal trials to famil-
iarize themselves with the range of motion and the
accommodating resistance of the dynamometer.
Participants were then tested at angular speeds of 60
deg·s−1, of 180 deg·s−1 and 240 deg·s−1 for both IR and
ER concentric action. Athletes performed 5 repetitions
at 60 deg·s−1 and 10 repetitions at 180 and 240 deg s−1
with both TA and NTA. The angular testing velocities
were chosen according to the criteria of Andrade et al.
(2013) and Forthomme et al. (2018). The order of the
sets were individually randomized before testing and
replicated at posttesting. All tests started with the inter-
nal rotation. A two-minute rest period was allowed
between sets. Consistent verbal commands were given
during testing. Before testing, the dynamometer was
calibrated according to the manufacturer specifications
and was checked prior to testing each subject.
Throwing speed
Fourty-eight hours after the ultrasound and isokinetic
testing, the TA overhead-throwing speed test was con-
ducted using a radar gun (StalkerPro Inc., Plano, TX,
USA), with a sampling rate of 100 Hz and a sensitivity
of 0.045 m/s. The radar gun was placed behind the goal
net and in a perpendicular direction to the player (Vila
et al., 2012). The throwing speed was evaluated in an
6 S. MAROTO-IZQUIERDO ET AL.
indoor handball court by an overarm throw, in two
situations: a standing 7-m throw (penalty throw) and
a sitting 7-m throw. The throwing speed was also
evaluated utilizing two different weight balls:
a standard size 3 handball ball (NB, mass 475 g, cir-
cumference 58–60 cm) and a size 3 heavy handball ball
(HB, mass 800 g, circumference 58–60 cm). Handball
players were asked to throw the ball as fast as possible
to the center of the goal, were the radar gun was placed
behind the net. Three trials, with 30-seconds recovery
in between, were allowed and the best result was
included in the data analysis. A warm-up of dynamic
exercises and the team-specific handball-throwing
warm-up was performed before testing.
Statistical analysis
Statistical analyses were performed using SPSS v.20.0
(SPSS Inc. Chicago, IL). Results are expressed as mean
± SD. Data distribution was examined for normality
using the Shapiro–Wilk test. A mixed-measures analy-
sis of variance (ANOVA) with two between-subjects
factors (training group and training arm) and one
within-subjects factor (time) followed by Bonferroni
post-hoc tests was used to investigate differences in
variables measured. The effect size (ES) was calculated
for interactions between groups using Cohen’s guide-
lines. Threshold values for ES were > 0.2 (small), > 0.6
(large) and > 1.2 (very large) (Hopkins et al., 2009). The
significance level was set to p < .05.
For the between-group analysis, a customized
spreadsheet (Hopkins, 2007) was employed to convert
the ANOVA p-values and the effect statistic to magni-
tude-based inferences. To make inferences about the
true values of the effect on the variables assessed, 90%
confidence intervals (CI) were used. An effect was
considered unclear if it’s CI simultaneously overlapped
the thresholds for positive and negative or if the
chances of the effect being substantial for FW training
or for PN training were both > 5% (Hopkins et al.,
2009). The qualitative terms and the default values
were: most unlikely, < 0.5%; very unlikely, 0.5–4.9%;
unlikely, 5.0–24.9%; possibly, 25.0–74.9%; likely, 75.0–-
94.9%; very likely, 95.0–99.5%; and most likely, >99.5%
(Hopkins, 2007).
The sample size was estimated using the data from
previous studies (Mascarin et al., 2017; Raeder et al., 2015)
in which the TA and NTA training effect were investi-
gated for the shoulder IR and ER. Based on the effect size
of 0.6 for a possible difference in concentric peak torque
changes between the pre and post conditions, it was
estimated that at least 7 participants were necessary for
each condition, with the alpha level of 0.05 and power
(1−β) of 0.80 by G*Power (G*Power 3.1.9.2, Heinrich-
Heine-Universitat Dusseldorf, Dusseldorf, Germany;
http://www.gpower.hhu.de/). Thus, considering possible
dropouts and calculation error, 9 participants for each
group, a total of 18 professional handball players were
recruited.
Results
Training load
Concentric peak power was recorded (SmartCoach™,
Stockholm, Sweden) during each training session [LR,
pre: 203 (±135) W and post: 602 (±179) W; IR, pre: 75
(±26) W and post: 125 (±16) W; and ER, pre: 51 (±22)
W and post: 121 (±30) W]. The mean EO produced in
terms of power (% above CON average peak power) was
~22%. In addition, concentric peak power was registered
(Keiser, Fresno, CA, USA) in each training session [LR,
pre: 297 (±99) W and post: 468 (±114) W; IR, pre: 296
(±132) W and post: 490 (±119) W; and ER, pre: 157 (±63)
W and post: 294 (±79) W].
Muscle thickness
There was a significant main effect of time (p < .05–0.001,
F range 6.5–56.4) in the four muscles assessed. In addi-
tion, a significant group x time interaction was found for
both FW (SUB: p < .001, F = 36.6; AD: p < .001, F = 22.5;
MD: p < .01, F = 12.6; and PD: p < .05, F = 7.2), and PN
(SUB: p < .001, F = 22.2; and AD: p < .05, F = 6.6; MD)
groups. Moreover, a significant time x arm interaction
was found for the TA (SUB: p < .001, F = 57.8; AD:
p < .001, F = 34.0; MD: p < .01, F = 16.7; and PD: p < .01,
F = 16.4) and the NTA (SUB: p < .01, F = 18.1; and AD:
p < .05, F = 8.1) between groups and also for time post in
the PD (p < .05, F = 7.2).
Between groups at pre and posttesting (Figure 2) the
FW group showed significant muscle thickness gains in
the four muscles in the TA (p < .01-.001; ES range
0.76–2.41, 14.5–45.9%), and also in the SUB (p < .05,
ES = 1.30, 23.6%) and AD (p < .05, ES = 0.77, 18.9%) of
the NTA. In addition, significant differences were
found between TA and NTA in the posttesting in all
tested muscles for the FW group. The PN groups only
improved significantly the SUB and AD muscle thick-
ness (p < .001, ES = 2.3, 34.5%; p < .05, ES = 0.90, 14.5%
respectively) in the TA, and the SUB in the NTA
(p < .05, ES = 1.19, 24.7%). Significant differences
were found between groups in the posttesting of the
TA, AD (p < .05, F = 6.8) and in the MD (p < .05,
F = 7.3). Between-group analyses muscle thickness
effects are shown in Figure 4. After controlling for
 RESEARCH QUARTERLY FOR EXERCISE AND SPORT 7

Figure 2. Subscapularis, Anterior, Middle, and Posterior Deltoid muscle thickness (mm) in each arm (TA, dominant arm; NTA, non-
dominant arm) before (pre) and after (post) training. * Significantly different from pre-training value, where * p < .05, ** p < .01 and
*** p < .001. # Significantly different arms, where # p < .05, ## p < .01, and ### p < .001. $ Significant differences between training
groups, where $ p < .05.

baseline differences, all comparisons were likely large
(AD and MD) and likely a moderate ES favoring FW
group except for SUB.
Throwing speed
Throwing velocity pre-post changes are shown in
Figure 3. FW group increased throwing speed in both
the standing (NB: p < .05, ES = 0.59, 4.1%; HB: p < .001,
ES = 1.21, 6.0%) and the sitting (NB: p < .01, ES = 1.41,
6.4%; HB: p < .05, ES = 0.85, 5.5%) conditions. The PN
group showed similar increases in throwing speed in
the standing condition (NB: p < .05, ES = 0.65, 5.7%;
HB: p < .001, ES = 1.55, 7.6%) and only in the sitting
condition with HB (p < .05, ES = 0.97, 7.5%). No
significant differences were found between groups.
Only throwing with HB in the standing condition
showed a possible moderate ES favoring the FW
group (Figure 4).
Isokinetic peak torque
Isokinetic peak torque (PT), average power (AP) and peak
power (PP) pre-post mean ± SD, percentage change in the
8 S. MAROTO-IZQUIERDO ET AL.

Figure 3. Throwing velocity pre- and post-training. * Significantly different from pre-training value, where * p < .05, ** p < .01 and
*** p < .001.

Figure 4. Flywheel with eccentric overload vs. isotonic Pneumatic Training. Difference in the changes between protocols in structural
and performance variables, after controlling for baseline values. The gray area represents trivial effects. S = small, M = moderate, and
L = Large. Abbreviations: 60, 60 deg·s−1; 180, 180 deg·s−1; 240, 240 deg·s−1; NB, normal ball; HB, heavy ball; PT, peak torque; AP,
average power; PP, peak power; IR, internal rotation; ER, external rotation.

mean with CI and ES for the TA and NTA are shown in
Table 1 (FW group) and Table 2 (PN group). IR PT values
of the TA increased after training in the FW group at 60
deg·s−1 (p < .001, ES = 1.06; 19.3%) and 240 deg·s−1 (p < .01,
ES = 0.67; 14.5%), and also in the PN group at all speeds
tested (p < .05–0.01, ES range 0.72–0.90). Significant differ-
ences were found between arms in the pretesting in both
groups (FW at 60 deg·s−1: p < .01, F = 18.8; PN at 180
deg·s−1: p < .01, F = 10.7) and in the posttesting in the FW
group (60 deg·s−1: p < .01, F = 18.5; 240 deg·s−1: p < .01,
F = 14.1) and in the PN group (240 deg·s−1: p < .05,
F = 10.2). The PN group achieved significant ER PT
gains after training at all speeds (p < .05–0.01; ES range
1.08–1.15; 33.3–55.4%), whereas the FW group improved
at 60 deg·s−1 (p < .01, ES = 1.16, 27.4%) and at 180º/sec
(p < .05, ES = 0.49, 20.2%). Moreover, the PN group had
significant differences between arms in the posttesting (60
deg·s−1: p < .01, F = 13.9). Although no significant differ-
ences were found between groups, the between group
comparisons displayed a likely moderate ES in the IR at
60 deg·s−1 favoring the FW group and a possibly moderate
ES in the ER at 240 deg·s−1 favoring the PN group.
Isokinetic average power
Significant increases in the IR AP of the TA in the FW (60
deg·s−1: p < .05, ES = 0.61; 240 deg·s−1: p < .05, ES = 0.72)
and PN groups (p < .05–0.01, ES range 0.96–1.24) was
observed. In addition, the FW group showed significant
differences between arms at 60 deg·s−1 (p < .01, F = 16.5)
and 240 deg·s−1 (p < .05, F = 6.4) in the posttesting, and at
60 deg·s−1 (p < .05, F = 7.1) in the pretesting. Both groups
significantly improved in the TA at all speeds (p < .05–0.01,
ES range 0.83–0.98). The FW group also showed signifi-
cant differences between arms in the pretest at 60 deg·s−1
and 180 deg·s−1. No significant differences were observed
between groups at any testing speed nor movement in the
AP. When comparing between groups, IR at 60 deg·s−1
and in ER at 240 deg·s−1 showed possibly moderate and
small ES in the FW and PN groups, respectively
(Figure 4).
Isokinetic peak power
FW and PN increased significantly in PP in the TA at 60
deg·s−1 (p < .01, ES = 0.88 and 1.47, respectively) and 240
deg·s−1 (p < .05, ES = 0.68 and 0.79). The FW group
showed significant differences between arms at all speeds
in posttesting (p < .05–0.001, F range 10.2–30.5) and at 60
deg·s−1 in pretesting (p < .05, F = 8.9). While the PN group
showed significant differences between arms at 60 deg·s−1
(p < .05, F = 8.8) and 240 deg·s−1 (p < .05, F = 10.1) in the
posttesting. Both groups had significant improvements in
RESEARCH QUARTERLY FOR EXERCISE AND SPORT 9
the TA at all speeds (p < .05–0.01, ES range 1.07–0.68).
The FW group also showed significant differences
between arms in the pretesting at 60 deg·s−1 (p < .05,
F = 8.1). No significant differences were found between
groups at any testing speed nor movement in isokinetic
peak power. Possibly moderate and small ES were
observed at 60 deg·s−1 in the IR favoring FW, and at 240
deg·s−1 in the ER favoring PN group, respectively
(Figure 4).
Isokinetic external/internal peak torque ratio
The NTA in the FW group showed a significant increase
in the ratio (p < .05, ES = 0.45). In addition, significant
differences between TA and NTA were observed at 60
deg·s−1 (pretest: p < .01, F = 17.9; posttest: p < .01,
F = 13.7) and at 240 deg·s−1 (pretest: p < .05, F = 5.5;
posttest: p < .05, F = 9.5) in the FW group.
Discussion
The primary finding in this investigation is that pneu-
matic and flywheel resistance training both result in com-
parable improvements in shoulder strength and power
and throwing speed. However, it appears that flywheel
training may have stimulated a slightly greater degree of
muscle hypertrophy. The high injury risk to the shoulder
joint in overhead athletes (Asker, Holm et al., 2018;
Giroto et al., 2017; Moller et al., 2017), along with its
decisive effect on throwing performance (Asker, Brooke
et al., 2018), has led to a continuous search throughout the
scientific literature for strategies that increase shoulder
mobility (Andersson et al., 2017), improve external
shoulder rotators strength (Andersson et al., 2017;
Edouard et al., 2013) and enhance throwing speed
(Hermassi et al., 2010, 2015; Mascarin et al., 2017;
Raeder et al., 2015; Sabido et al., 2016; Saeterbakken
et al., 2011). These adaptations are related to performance
optimization, and in turn, to the reduction of the overuse
injury ratio in handball. However, this is the first study to
investigate the effects of pneumatic and flywheel resis-
tance training in a direct comparison in the same study.
Muscle hypertrophy plays an undisputed role in the
magnitude of muscle strength and power, and related
injury prevention. Previous studies with flywheel devices
have shown training induced gains in muscle volume/
mass (Maroto-Izquierdo, Garcia-Lopez, Fernandez-
Gonzalo et al., 2017; Nunez Sanchez & Saez de
Villarreal, 2017; Tesch et al., 2017). Improvements in
muscle strength, power and specific team-sport tasks,
such as vertical jump height and running speed have
been observed as well (Maroto-Izquierdo et al., 2019;
Maroto-Izquierdo, Garcia-Lopez, Fernandez-Gonzalo
 10

Table 1. FW group internal and external shoulder isokinetic profile of both dominant (TA, training arm) and non-dominant (NTA, non-training arm) before (pre) and after (post) training.
Training arm Non-training arm
S. MAROTO-IZQUIERDO ET AL.

95% CI for difference 95% CI for difference

FW GROUP Pre Post P ES % Mean dif Lower Upper Pre Post P ES % Mean dif Lower Upper
Internal Rotation (IR)
PT 60 deg·s−1 (Nm) 79.2 ± 12.5 ## 94.5 ± 16.1 ## 0.000 1.06 19.3 15.3 10.7 19.9 67.5 ± 9.7 70.5 ± 10.0 0.604 0.30 4.4 3.0 −9.6 15.6
PT 180 deg·s−1 (Nm) 70.2 ± 12.4 77.0 ± 14.4 0.071 0.51 9.7 6.8 −0.7 14.4 61.2 ± 10.0 67.8 ± 10.1 0.254 0.66 10.8 6.7 −5.7 19.0
PT 240 deg·s−1 (Nm) 61.3 ± 12.2 70.2 ± 14.2 ## 0.005 0.67 14.5 8.8 3.4 14.3 53.7 ± 6.8 55.8 ± 8.1 0.637 0.28 3.9 2.2 −7.9 12.2
AP 60 deg·s−1 (W) 60.8 ± 10.2 # 67.3 ± 11.2 ## 0.013 0.61 10.7 6.5 1.7 11.3 53.7 ± 8.9 52.3 ± 11.6 0.76 −0.14 −2.6 −1.3 −10.9 8.3
AP 180 deg·s−1 (W) 115.3 ± 16.5 125.2 ± 21.9 # 0.190 0.51 8.6 9.8 −5.8 25.5 105.8 ± 19.1 105.7 ± 19.4 0.988 −0.01 −0.1 0.2 −24.7 24.4
AP 240 deg·s−1 (W) 115.5 ± 25.4 135.2 ± 29.4 0.024 0.72 17.1 19.7 3.2 36.1 111.5 ± 18.2 119.5 ± 16.5 0.342 0.46 7.2 8.0 −10.0 26.0
PP 60 deg·s−1 (W) 64.5 ± 9.9 # 73.5 ± 10.6 ### 0.001 0.88 14.0 9.0 4.5 13.5 57.5 ± 9.1 57.5 ± 8.3 0.999 0.00 0.0 0.0 −7.8 7.8
PP 180 deg·s−1 (W) 128.2 ± 13.9 139.0 ± 22.1 # 0.244 0.59 8.4 10.8 −8.8 30.5 119.3 ± 20.4 117.3 ± 21.2 0.865 −0.10 −1.7 −2.0 −27.9 23.9
PP 240 deg·s−1 (W) 139.8 ± 26.3 161.7 ± 36.9 ## 0.050 0.68 15.7 21.8 −0.5 43.7 131.5 ± 22.3 134.5 ± 23.8 0.76 0.13 2.3 3.0 −18.6 24.6
External Rotation (ER)
PT 60 deg·s−1 (Nm) 32.8 ± 6.9 41.8 ± 8.5 0.019 1.16 27.4 9.0 1.9 16.1 38.5 ± 9.5 # 43.8 ± 11.2 0.048 0.51 13.8 5.3 0.1 10.6
PT 180 deg·s−1 (Nm) 32.7 ± 13.5 39.3 ± 13.5 0.036 0.49 20.2 6.7 0.5 12.8 34.0 ± 11.2 31.2 ± 7.3 0.553 −0.30 −8.2 −2.8 −13.2 7.6
PT 240 deg·s−1 (Nm) 20.8 ± 4.5 24.5 ± 4.7 0.170 0.80 17.8 3.7 −1.9 9.2 26.8 ± 12.4 27.7 ± 9.8 0.764 0.09 3.4 0.8 −5.2 6.9
AP 60 deg·s−1 (W) 23.8 ± 6.4 29.2 ± 6.4 0.021 0.84 22.7 5.3 1.0 9.6 29.0 ± 6.8 29.0 ± 6.2 0.999 0.00 0.0 0.0 −5.2 5.2
AP 180 deg·s−1 (W) 39.3 ± 11.8 49.3 ± 12.1 0.018 0.84 25.5 10.0 2.2 17.8 45.2 ± 13.8 45.0 ± 17.3 0.983 −0.01 −0.4 −0.2 −17.8 17.5
AP 240 deg·s−1 (W) 29.5 ± 9.5 38.7 ± 9.2 0.034 0.98 31.2 9.2 0.8 17.5 39.0 ± 24.2 39.7 ± 23.8 0.891 0.03 1.8 0.7 −10.5 11.4
PP 60 deg·s−1 (W) 24.5 ± 6.9 33.0 ± 8.8 0.002 1.07 34.7 8.5 3.9 13.0 30.3 ± 7.3 # 28.8 ± 6.0 0.535 −0.22 −4.9 −1.5 −6.7 3.7
PP 180 deg·s−1 (W) 44.8 ± 12.0 53.0 ± 12.1 0.043 0.68 18.3 8.2 0.3 16.0 52.2 ± 17.5 45.0 ± 13.2 0.42 −0.46 −13.8 −7.2 −26.4 12.1
PP 240 deg·s−1 (W) 39.0 ± 10.2 49.5 ± 10.3 0.011 0.68 26.9 10.5 3.1 17.9 47.5 ± 25.9 49.2 ± 24.4 0.769 0.07 3.6 1.7 −10.7 14.1
Conventional Ratio
ER/IR 60 deg·s−1 0.42 ± 0.07 0.45 ± 0.08 0.472 0.40 7.1 0.03 −0.06 0.1 0.57 ± 0.10 ## 0.62 ± 0.12 ## 0.039 0.45 8.8 0.1 0.0 0.1
ER/IR 180 deg·s−1 0.47 ± 0.22 0.53 ± 0.22 0.325 0.27 12.8 0.05 −0.06 0.2 0.55 ± 0.13 0.46 ± 0.11 0.253 0.75 −16.3 −0.1 −0.3 0.1
ER/IR 240 deg·s−1 0.34 ± 0.06 # 0.36 ± 0.07 ## 0.712 0.31 5.9 0.02 −0.06 0.1 0.49 ± 0.19 0.49 ± 0.12 0.920 0.00 0.0 0.0 −0.1 0.1
Abbreviation: PT: Peak Torque; AP: Average Power; PP: Peak Power. # Significant differences between arms, where # p < .05, ## p < .01 and ### p < .001.
Table 2. PN group internal and external shoulder isokinetic profile of both dominant (TA, training arm) and non-dominant (NTA, non-training arm) before (pre) and after (post) training.
Training arm Non-training arm
95% CI for difference 95% CI for difference
PN GROUP Pre Post P ES % Mean dif Lower Upper Pre Post P ES % Mean dif Lower Upper
Internal Rotation (IR)
PT 60 deg·s−1 (Nm) 73.8 ± 9.8 82.0 ± 8.5 0.005 0.90 11.1 8.2 3.2 13.2 68.8 ± 11.2 71.2 ± 22.0 0.704 0.14 3.5 2.4 −11.4 16.2
PT 180 deg·s−1 (Nm) 58.6 ± 18.1 # 70.2 ± 10.1 0.011 0.79 19.8 11.6 3.3 19.9 44.2 ± 17.8 62.6 ± 17.3 0.013 1.05 41.6 18.4 4.8 31.9
PT 240 deg·s−1 (Nm) 57.4 ± 17.2 69.4 ± 16.0 # 0.001 0.72 20.9 12.0 6.0 17.9 51.6 ± 10.6 56.0 ± 16.2 0.390 0.32 8.5 4.4 −6.6 15.4
AP 60 deg·s−1 (W) 52.0 ± 5.2 59.8 ± 7.2 0.008 1.24 15.0 7.8 2.6 13.1 49.6 ± 11.1 51.8 ± 14.9 0.647 0.17 4.4 2.2 −8.3 12.7
AP 180 deg·s−1 (W) 94.4 ± 26.1 115.4 ± 16.5 0.022 0.96 22.3 21.0 3.8 38.2 74.8 ± 33.5 99.8 ± 30.1 0.065 0.78 33.4 25.0 −1.9 51.9
AP 240 deg·s−1 (W) 104.6 ± 26.3 134.0 ± 26.1 ## 0.005 1.12 28.1 29.4 11.4 47.4 95.2 ± 26.5 104.8 ± 30.1 0.300 0.34 10.1 9.6 −10.1 29.3
PP 60 deg·s−1 (W) 54.4 ± 5.4 64.0 ± 7.5 # 0.002 1.47 17.6 9.6 4.6 14.5 53.4 ± 9.8 54.6 ± 14.9 0.759 0.10 2.2 1.2 −7.4 9.8
PP 180 deg·s−1 (W) 112.6 ± 26.7 133.2 ± 22.2 0.059 0.84 18.3 20.6 −0.9 42.1 101.4 ± 23.6 117.2 ± 35.1 0.239 0.53 15.6 15.8 −12.5 44.1
PP 240 deg·s−1 (W) 127.0 ± 30.9 151.2 ± 30.6 # 0.048 0.79 19.1 24.2 0.2 48.2 118.8 ± 19.2 122.0 ± 33.7 0.766 0.12 2.7 3.2 −20.4 26.8
External Rotation (ER)
PT 60 deg·s−1 (Nm) 32.4 ± 6.1 43.2 ± 12.1 0.012 1.13 33.3 10.8 3.0 18.6 32.0 ± 7.5 35.4 ± 12.1 0.215 0.34 10.6 3.4 −2.4 9.2
PT 180 deg·s−1 (Nm) 26.0 ± 7.3 37.0 ± 12.4 0.005 1.08 42.3 11.0 4.3 17.7 22.8 ± 13.1 32.8 ± 16.2 0.079 0.68 43.9 10.0 −1.4 21.4
PT 240 deg·s−1 (Nm) 20.2 ± 4.4 31.4 ± 13.1 0.002 1.15 55.4 11.2 5.1 17.3 21.0 ± 6.5 25.6 ± 11.1 0.153 0.51 21.9 4.6 −2.1 11.3
AP 60 deg·s−1 (W) 23.8 ± 5.0 29.4 ± 8.7 0.025 0.79 23.5 5.6 0.9 10.3 23.2 ± 5.2 26.2 ± 9.2 0.264 0.40 12.9 3.0 −2.7 8.7
AP 180 deg·s−1 (W) 34.8 ± 13.5 48.4 ± 18.3 0.006 0.85 39.1 13.6 5.1 22.1 32.8 ± 13.3 42.4 ± 20.4 0.291 0.56 29.3 9.6 −9.7 29.0
AP 240 deg·s−1 (W) 28.8 ± 12.1 46.4 ± 24.6 0.002 0.91 61.1 17.6 8.5 26.7 30.2 ± 13.0 36.0 ± 17.6 0.293 0.37 19.2 5.8 −5.9 17.5
PP 60 deg·s−1 (W) 24.4 ± 4.8 30.0 ± 8.3 0.031 0.83 23.0 5.6 0.6 10.6 23.4 ± 4.9 27.6 ± 9.2 0.134 0.57 17.9 4.2 −1.6 10.0
PP 180 deg·s−1 (W) 37.4 ± 13.5 54.2 ± 19.1 0.002 1.02 44.9 16.8 8.2 25.4 41.0 ± 10.8 49.0 ± 24.7 0.412 0.42 19.5 8.0 −13.0 29.0
PP 240 deg·s−1 (W) 36.6 ± 14.5 55.0 ± 26.1 0.001 0.87 50.3 18.4 10.3 26.5 38.4 ± 15.2 45.6 ± 18.0 0.262 0.43 18.8 7.2 −6.4 20.8
Conventional Ratio
ER/IR 60 deg·s−1 0.44 ± 0.09 0.52 ± 0.11 0.102 0.80 18.2 0.1 0.0 0.2 0.47 ± 0.07 0.49 ± 0.09 0.240 0.25 4.3 0.0 0.0 0.1
ER/IR 180 deg·s−1 0.46 ± 0.13 0.52 ± 0.11 0.376 0.50 13.0 0.1 −0.1 0.2 0.48 ± 0.21 0.50 ± 0.17 0.827 0.10 4.2 0.0 −0.2 0.2
ER/IR 240 deg·s−1 0.36 ± 0.07 0.44 ± 0.09 0.062 0.99 22.2 0.1 0.0 0.2 0.40 ± 0.04 0.44 ± 0.12 0.416 0.45 10.0 0.0 −0.1 0.2
Abbreviation: PT: Peak Torque; AP: Average Power; PP: Peak Power. # Significant differences between arms, where # p < .05, ## p < .01 and ### p < .001.
RESEARCH QUARTERLY FOR EXERCISE AND SPORT
11
12 S. MAROTO-IZQUIERDO ET AL.
et al., 2017). Specifically in professional handball players,
Maroto-Izquierdo, Garcia-Lopez, and de Paz (2017)
reported significant increases in vastus lateralis muscle
thickness after twelve sessions of flywheel resistance train-
ing. The results of the current investigation also indicate
that flywheel training is effective in increasing muscle
thickness in small muscle groups (e.g., rotator cuff). In
addition, flywheel training demonstrated greater
improvements in muscle hypertrophy in AD and MD in
comparison to the PN group. Hence, magnitude-based
inference analysis revealed a moderate to large effect
favoring flywheel training when comparing the two non-
gravity-dependent methods. The increase in muscle
thickness in the FW group are attributable to the EO
generated by iso-inertial devices. In this study the mean
EO produced, in terms of power, (% above CON average
peak power) was ~22%.
Various traditional resistance-training protocols,
with elastic bands (Mascarin et al., 2017) and weights
(Raeder et al., 2015), have been utilized in training
handball players. Those studies (Mascarin et al., 2017;
Raeder et al., 2015) demonstrated increases in isoki-
netic peak torque in internal (4.0–15.1%) and external
shoulder rotators (2.0–18.3%). The current investiga-
tion examined relatively new non-gravity-dependent
training methodologies. Pneumatic resistance training
devices have been developed to facilitate unique force,
velocity, and power adaptations when performing the
exercises with relatively low loads (Frost et al., 2016).
Pneumatic resistance training is characterized by mini-
mal momentum; thus, it involves a relatively consistent
muscular effort throughout the range of motion
(Balachandran et al., 2017; Frost et al., 2016). This
could be beneficial for sports in which movements are
performed at a high intensity with light loads (e.g.,
handball), allowing load transfer at a point where the
athlete produces the highest power output (Frost et al.,
2016). Frost et al. (2016) reported substantial changes
in force and power outputs during the first half of the
concentric phase with light loads (i.e., less than 50%
1-RM), while achieving higher accelerations and velo-
cities in comparison with traditional weight training. In
this study, magnitude-based inference analysis demon-
strated that the PN training group had small to mod-
erate effects in peak torque at higher isokinetic speeds
compared to the FW group, especially in external rota-
tion. Moreover, strength increases observed in the cur-
rent study in the pneumatic training group were larger
than those found in previous studies with handball
players (11.1–28.1%). This may be due to the fact that
training with pneumatic devices allows for greater
accelerations with the same load, thus generating
higher forces at high isokinetic velocities (i.e. low
intensities). On the other hand, iso-inertial devices
have shown large increases in muscle strength due to
the EO generated by the flywheel when a maximum
short eccentric action was applied during the last third
of ROM. Thus, greater application of forces during the
eccentric phase of movement has been demonstrated
(Martinez-Aranda & Fernandez-Gonzalo, 2017).
Numerous studies have shown increases in strength
after the application of a training protocol with iso-
inertial technology (Maroto-Izquierdo, Garcia-Lopez,
Fernandez-Gonzalo et al., 2017; Nunez Sanchez &
Saez de Villarreal, 2017; Tesch et al., 2017). The results
of this study indicate that training with flywheel devices
also increases the strength in small muscle groups (9.-
7–27.4%). The greatest effects of the application of EO
resistance training with iso-inertial devices have been
found at high isokinetic intensities (i.e. 60 deg·s−1). This
may be due to the fact that flywheel training requires
a greater application of forces and that the movement
speed is lower than pneumatic training. Therefore,
greater adaptations at low speeds and higher intensities
were observed after iso-inertial resistance-training
programs.
Despite the fact that no differences were found
between groups in any functional variable, the PN
group showed greater ER PT percentage changes and
ES values compared to the FW group. This could explain
the higher ES observed in the ER/IR ratio favoring PN
training (especially at high isokinetic velocities,
ES = 0.99). These results suggest that, probably, a longer
intervention, or an intervention in which either pneu-
matic or flywheel training, or a combination of both
interventions, is applied only to ER exercises, may lead
to significant improvements in the ER/IR ratio, thus
decreasing the likelihood of shoulder injury in overhead
throwing sports (Andersson et al., 2017; Edouard et al.,
2013).
Similar results have been found in average power
and peak power during external and internal rotation.
Thus, both experimental groups showed similar signif-
icant increases in average and peak power at all speeds
tested. However, the flywheel training had a higher
moderate effect for internal rotation when the speed
is low (i.e. 60 deg·s−1) than the pneumatic training
group. Pneumatic training in external rotation actions
had a higher small-moderate effect when the speed is
high (i.e. 240 deg·s−1) than the flywheel group. Hence,
this seems to indicate that pneumatic resistance train-
ing is more favorable in increasing power when the
movements are executed at a low intensity but at high
speed, such as in handball throwing. However, iso-
inertial resistance training seems to increase muscle
power at higher intensities and lower speed actions,

such as team-sport skills (e.g., jumping, change of
direction). So, a combination of both methods may be
useful to achieve optimization of sports performance.
However, more studies are needed to corroborate these
results.
The training-induced power adaptations are also
evident in the increases observed pre to posttesting
in the three exercises performed. Thus, pneumatic and
iso-inertial training in a vertical and transverse plane
appears to be an effective tool to increase power, and
therefore is recommended to increase overhead
throwing performance in handball players. Mascarin
et al. (2017) correlated increases in internal rotation
power at a high intensity (i.e. 60 deg·s−1) with signifi-
cant increases in throwing velocity after a strength-
training program using elastic bands in the rotator
cuff muscles. These findings are in line with the results
of this study, in which gains in power at a higher
intensity and at a low intensity are associated with
similar increases in throwing velocity. In addition,
these increments are similar to those demonstrated
by other studies (Hermassi et al., 2010, 2015;
Mascarin et al., 2017; Raeder et al., 2015; Sabido
et al., 2016; Saeterbakken et al., 2011) in which differ-
ent strength training protocols were applied to the
upper limb musculature.
Previous studies have demonstrated greater effec-
tiveness of training with flywheel (Maroto-Izquierdo,
Garcia-Lopez, & de Paz, 2017) or pneumatic devices
(Balachandran et al., 2017; Frost et al., 2016) in com-
parison with traditional weight training. Thus, we did
not include a group performing a more standard
weight training program (i.e. weight-stack guided
resistance exercise machines). Furthermore, although
training-induced adaptations in muscle power were
similar between groups, the measurement of muscle
activation during exercise could provide deeper
insights into the mechanisms associated with adapta-
tions as a result of the utilization of the two different
iso-inertial devices. Therefore, one of the limitations
of this study is the lack of inclusion of other physio-
logical parameters to provide more information on
the functional and structural adaptations found.
Moreover, the small sample size in the present
study must be taken into account when drawing
conclusions from the data. Given that performance
changes in well-trained athletes are often minor rela-
tive to the performance variability between the ath-
letes, large sample sizes may be required to detect
significant changes in performance. Despite the rea-
sonable homogeneity of participants in the present
study, the small effects of the training would have
dictated that a much larger sample should have been
RESEARCH QUARTERLY FOR EXERCISE AND SPORT 13
used for statistical significance to be reached on vari-
ables for which effect sizes were <0.60.
What does this article add?
In addition to changing the repetitions, sets, loads,
speed, recovery periods or exercise type to elicit
a particular adaptation, exploring the pattern of kinetics
in terms of how the mechanical properties are applied
by various types of resistance exercise machines may
help to optimize sports performance and injury preven-
tion. In summary, six weeks of resistance training with
pneumatic training devices or with flywheel devices
induced significant gains in shoulder strength and
power. In addition, both pneumatic and flywheel train-
ing induced changes in muscle thickness however with
a slightly greater effect due to flywheel training. The
adaptations observed as a result of training with the
pneumatic device, which produces constant load
throughout the entire range of motion at low loads,
were similar to those produced by a traditional flywheel
device, in which an EO occurs during the last part of
the ROM. Training with EO seems to be more suitable
to increasing muscle strength and power when the
movement speed is slow, especially in the internal rota-
tion actions. However, pneumatic resistance training
seems to be more favorable to increase muscle strength
and power at high speeds, especially in external rota-
tion. Thus, in a sport such as handball, in which
a combination of strength and power, it may be that
a combination of both pneumatic and flywheel training
would be a viable option for optimization of perfor-
mance and injury prevention.
ORCID
Sergio Maroto-Izquierdo http://orcid.org/0000-0002-6696-
5636
David García-López http://orcid.org/0000-0002-0079-3085
Javier González-Gallego http://orcid.org/0000-0002-4386-
9342
José Antonio de Paz http://orcid.org/0000-0002-4389-1777
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