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Does the Muscle Action Duration Induce Different Regional Muscle Hypertrophy
in Matched Resistance Training Protocols?

Article in The Journal of Strength and Conditioning Research · December 2020

DOI: 10.1519/JSC.0000000000003883

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 Original Research

Does the Muscle Action Duration Induce Different

Regional Muscle Hypertrophy in Matched
Resistance Training Protocols?
Rodrigo C. R. Diniz,1 Frank Douglas Tourino,1 Lucas T. Lacerda,1,2,4,5 Hugo C. Martins-Costa,1,2
Marcel Bahia Lanza,1,3 Fernando Vitor Lima,1 and Mauro Heleno Chagas1
1
Weight Training Laboratory, School of Physical Education, Physiotherapy and Occupational Therapy, Federal University of Minas
Gerais, Belo Horizonte, Brazil; 2Department of Physical Education of Pontifical Catholic University of Minas Gerais, Belo Horizonte,
Downloaded from http://journals.lww.com/nsca-jscr by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC4/OAVpDDa8K2+Ya6H515kE= on 12/11/2020

Brazil; 3Department of Physical Therapy and Rehabilitation, School of Medicine, University of Maryland, Baltimore; 4State University of
Minas Gerais, Divinópolis, Brazil; and 5Department of Physical Education and Sports, Technological Education Federal Center of Minas
Gerais, Belo Horizonte, Brazil

Abstract
Diniz, RCR, Tourino, FD, Lacerda, LT, Martins-Costa, HC, Lanza, MB, Lima, FV, and Chagas, MH. Does the muscle action duration
induce different regional muscle hypertrophy in matched resistance training protocols? J Strength Cond Res XX(X): 000–000,
2020—The manipulation of the muscle action duration (MAD) can influence the instantaneous torque along the range of motion,
which can lead to adaptations of regional muscle hypertrophy. The aim of this study was to compare the effects of matched
resistance training (RT) on the knee extension machine with different MAD in the cross-sectional area (CSA) responses within the
quadriceps femoris (QF) and its muscles. Forty-four subjects were allocated into a control and 3 experimental groups. For a period
of 10 weeks, subjects in the experimental groups performed the training protocols that were different only by the MAD: group 5c1e
(5s concentric action [CON] and 1s eccentric action [ECC]; group 3c3e (3s CON and 3s ECC) and group 1c5e (1s CON and 5s
ECC). Magnetic resonance imaging was performed (before and after the intervention) to determine the relative change (%) in CSA of
the QF muscles along proximal (30%), middle (50%), and distal regions (70% distal of the femur). The change in CSA of the rectus
femoris at the middle region are greater in 5c1e (6.8 6 6.5%) and 1c5e (7.4 6 6.0%) groups than 3c3e (3.4 6 6.6%) and control
groups (0.2 6 1.8%). In addition, vastus lateralis at the distal region (5c1e 5 15.9 6 11.8%; 1c5e 5 14.4 6 10.0%) presenting
greater increases in change of CSA than the others vastus only 5c1e (vastus lateralis [VI] 5 5.0 6 4.7%; vastus medialis [VM] 5 4.2
6 3.2%) and 1c5e groups (VI 5 4.7 6 3.6%; VM 5 3.4 6 3.1%). In conclusion, this study showed that matched RT protocols with
different MAD resulted in different region-specific muscle hypertrophic across the individual muscles of QF.
Key Words: region-specific hypertrophy, cross-sectional area, knee extension, muscle action tempo

Introduction is necessary to standardize the ROM and induce different magnitudes

Resistance training (RT) is well known to provide increases in the
muscle size (hypertrophy) (17,45). Resistance training can result in
different responses of hypertrophy along muscle length (31,43), and it
is been called regional muscle hypertrophy. Although some studies do
not verify this inhomogeneous muscle response (20,38,39), this re-
gional muscle hypertrophy is reported in several others
(11,31,42–44). However, little is known about the manipulation of
each RT variable and how it influences regional muscle hypertrophy.
Matched isometric RT (2,32) performed with different articular an-
gles may lead to different regional muscle hypertrophy. In addition,
full range of motion (ROM) dynamic isoinertial RT protocols have
elicited different responses from regional muscle hypertrophy com-
pared with protocols with partial ROM (7,28). Thus, these studies
allow assuming that the trained joint angles influence the response of
regional muscle hypertrophy. However, it may be questioned
whether this different regional muscle hypertrophy response is only
tied to the trained angles or is due to the magnitude of force/torque
required at each angle throughout the ROM. To investigate, this issue
Address correspondence to Dr. Mauro Heleno Chagas, mauroufmg@hotmail.com
Journal of Strength and Conditioning Research 00(00)/1–10
ª 2020 National Strength and Conditioning Association
of force/torque production throughout the ROM (e.g., higher vs.
lower force/torque at the initial angles of ROM).
The manipulation of the muscle action duration (MAD) within a
isoinertial RT protocol provides different force/torque values
throughout the ROM (6,40). For example, protocols with shorter
MAD (1s) generated greater force/torque in the beginning of con-
centric (CON) and end of eccentric (ECC) than protocols with longer
MAD ($3s) (6,40). Conversely, at the end of CON and beginning of
ECC, force/torque would be greater during RT protocol with longer
MAD (35). These results show that the manipulation of MAD results
in a mechanical stimulus with specific characteristics, which may
represent a potential condition to induce distinct muscle hypertrophy
responses. Previous investigations suggest that isoinertial RT pro-
tocols with different MAD may impact dissimilarly in regional
muscle hypertrophy (11,21).
Given that research information involving the impact of dif-
ferent isoinertial RT protocols on regional muscle hypertrophy is
scarce, the specific role of the MAD remains to be better un-
derstood. However, the results of the study by Earp et al. (11)
provide information, at least partly, on the possible relationship
between regional muscle hypertrophy and MAD. These authors
verified that the training protocol with high-speed repetitions and

Copyright © 2020 National Strength and Conditioning Association. Unauthorized reproduction of this article is prohibited.
 Influence of MAD in Regional Muscle Hypertrophy (2020) 00:00
relatively light-load (power training) obtained a cross-sectional
area (CSA) increase to a greater extent in the distal region of the
thigh. In this training protocol, the generation of greater peak
force at the beginning of the movement to accelerate the load
when higher movement speeds are produced can play an impor-
tant role in muscle adaptations.
If higher force at the initial angles (e.g., beginning of CON) of
ROM during RT protocol would become an important factor to
induce regional hypertrophy, a comparison between isoinertial RT
protocols configured with different MAD (e.g., 1s CON 2 5s ECC
and 5s CON 2 1s ECC), maintaining the same repetition duration,
can provide valuable information for training prescription. In this
sense, it is expected that a protocol with shorter CON MAD (i.e., 1s)
bring greater force/torque at the initial angles of ROM (6), whereas
protocols with longer CON MAD (i.e., $ 3s) generated lower force/
torque in this angular position. It should be emphasized that, to the
best of our understanding, no study has evaluated the chronic effects
of the training protocol configured with different MAD, even when
equated by all other variables (e.g., range of motion, volume, load,
rest interval, and time under tension). This methodological approach
allows researchers to verify if the results are exclusively because of the
independent variable (i.e., MAD).
Therefore, the aim of this study was to verify whether the
matched RT protocols with different MAD cause distinct regional
hypertrophy of the quadriceps femoris (QF) and its individual
muscles after 10 weeks of RT. It was hypothesized that RT pro-
tocols with shorter CON MAD (i.e., 1s) would result in greater
hypertrophy responses in the distal region of the individual
muscles of the QF and the whole muscle group in comparison
with protocols with longer CON MAD (i.e., $3s).
Methods
Experimental Approach to the Problem
This study adopted an intra-inter experimental design (9). Subjects
were allocated into a control and 3 experimental groups. For a pe-
riod of 10 weeks, subjects in the experimental groups performed the
training protocols that were different only by the MAD: group 5c1e
[5s concentric action (CON) and 1s eccentric action (ECC)], group
3c3e (3s CON and 3s ECC) and group 1c5e (1s CON and 5s ECC).
Magnetic resonance imaging (MRI) was performed (before and after
the intervention) to determine the relative change (%) in CSA of the
QF muscles along proximal (30%), middle (50%), and distal regions
(70% distal of the femur).
In the first session, MRI examination was performed followed
by a 0–48 hours interval for the second session, which included a
knee extension one repetition maximum (1RM) test. The load
performed during the 1RM test was the criterion to balance the
volunteers between groups and was used as a reference to set the
intensity during the training sessions. After that, subjects engaged
the training intervention (30 sessions within 10 weeks), except the
control group. In all 30 training sessions on the seated knee ex-
tension machine, torque-angle relationship was recorded. MRI
was repeated for all groups 72–120 hours after the last training
session. The experimental design can be viewed in Figure 1:
Figure 1. Experimental design.
Copyright © 2020 National Strength and Conditioning Association. Unauthorized reproduction of this article is prohibited.
Subjects
Forty-four untrained women, not engaged to any exercise in the
last 6 months, aged between 18 and 35 years participated in this
study. The values from 1RM test in knee extensor were used as
reference to balanced and allocated subjects into a control group
and 3 experimental groups (Table. 1).
The sample size was calculated by the software GPower (ver-
sion 3.1.7) (5). An effect size value of 0.22 was obtained through
the pretest and post-test values of the proximal CSA of the QF
(variable that presented the lowest relative increase) of young
adult (29). The study was approved by the Federal University of
Minas Gerais ethics committee, and all subjects were written
informed of the benefits and risks of the investigation before
signing an institutionally approved informed consent document
to participate in the study. This study was performed in accor-
dance to the Declaration of Helsinki.
Procedures
Cross-Sectional Area. To assess muscle CSA, subjects were taken to
the MRI examination at the Ecoar Diagnostic Imaging Clinic. Sub-
jects were lying on a stretcher with their muscles relaxed for at least
20 minutes before the tests began. MRI recording was performed on
a Sigma HDX 1.5 Tesla device (GE Medical System, Chicago, IL)
with a repetition time of 600 ms, echo time of 8.4 ms, a slice thickness
of 6 mm, interslice gap of 0.6 mm, field-of-view of 240 mm, and
resolution of 320 3 256 pixels. The coronal and axial images were
taken between the major trochanter and the lateral epicondyle of the
femur on the right thigh. All images were stored for off-line analysis
by 2 evaluators blinded for the treatments. The distance between the
trochanter major and the lateral epicondyle of the femur (femur
length) was determined by the coronal images of the OsiriX 6.0
software. Axial slice images at 30, 50, and 70% of the femur length
(Figure 2) were used to measure CSA of rectus femoris (RFCSA),
vastus medialis (VMCSA), vastus lateralis (VLCSA), and vastus inter-
medius (VICSA) for each subject. The sum of the areas of these
muscles was considered the CSA of quadriceps femoris (QFCSA).
Quadriceps femoris muscles boundaries in the 3 analyzed regions of
a subject can be seen on Figure 2.
Although the total number of axial images was the same for
each subject, to minimize a possible modification on the image
position between pretests and post-tests, extra images (one right
above and right below image) from the reference slice point also
were analyzed, totaling 3 images for each region (e.g., 30% 5
mean of the 3 most proximal CSA). The sum of the 9 CSA was
also analyzed for each muscle and QF. Two examiners de-
termined the QF muscles CSA in the 18 images (9 pretest 1 9 post-
test). Based on the mean value of the 3 CSA that were used for
each muscle region, the following inter-rater reliable values were
obtained: Intraclass correlation coefficient 5 0.97 a 0.99,
SEM—0.27 a 1.32 cm2, mean interexaminer difference—0.26 a
0.46 cm2, and mean coefficient of variation—1.62 a 5.27%.
These values were similar to those found in other studies (4).
Knee Extensor Machine. The 1RM test and training sessions were
performed on a seated knee extension machine. A 10 kV potenti-
ometer was fixed in the rotation axis of the fixed lever of the knee
extensor machine. The potentiometer data were used to generate
angle 3 time curves and, hence, to determine the ROM and MAD
during the training sessions. A load cell (Type S, TEDEA, and
supports up to 500 kg) was connected in series with weight sup-
port. However, the resistance caused by the knee extensor machine
 Influence of MAD in Regional Muscle Hypertrophy (2020) 00:00
Table 1
Anthropometric and performance characteristics of groups.*
Group Age (y), mean 6 SD Body mass (kg), mean 6 SD
Control (n 5 11) 25.3 6 4.1 62.2 6 7.6
5c1e (n 5 11) 20.8 6 2.0 57.3 6 8.0
3c1e (n 5 11) 21.3 6 3.5 60.4 6 8.3
1c5e (n 5 11) 21.3 6 1.9 59.6 6 7.7
*1RM 5 one repetition maximum test.
depended on the resistance torque of CAM system and the torque
of the fixed lever of the knee extensor machine. To determine more
precisely the resistance torque resulting from the device, a pilot
experiment was performed. Another load cell with the same set-
tings was fixed to the pad using a steel cable. An electrogoniometer
was attached to the steel cable to always maintain the right angle
(90°) between the steel cable and the fixed lever of the knee extensor
(Figure 3). Different weight plates were placed on the support, and
it was fixed for 10 seconds at 8 different angles of the fixed lever of
the knee extensor machine. At each angle and weight plates, the
values of the pad load cell, the load cell of the support with weights,
and the angle in the pot were recorded. By using regression equa-
tions, it was possible to determine the force value in the pad load
cell using the data from the weight plate support load cell and the
potentiometer. To determine torque, the estimated data of the force
in the load cell of the pad were multiplied by the distance between
the potentiometer and the pad. Thus, because of the knee extensor
device having a potentiometer and a weight plate support load cell
during all the training sessions, it was possible to determine the
Figure 2. Examples of axial images at 30% (A), 50% (B), and
70% (C) of femur length. Examples of outlined cross-sec-
tional areas of the 4 quadriceps femoris muscles at 30% (D),
50% (E), and 70% (F) of the same subject.
Copyright © 2020 National Strength and Conditioning Association. Unauthorized reproduction of this article is prohibited.
| www.nsca.com
Height (cm), mean 6 SD Body fat (%), mean 6 SD 1RM (kg), mean 6 SD
163.3 6 4.9 25.4 6 3.3 38.3 6 7.2
160.6 6 6.0 23.8 6 4.0 34.9 6 7.3
162.9 6 6.0 25.0 6 4.7 34.1 6 8.0
162.1 6 5.1 25.7 6 5.1 35.6 6 8.4
torque 3 angle relationship. The potentiometer and the weight
plate support load cell were calibrated weekly using a manual go-
niometer and weight plates of known mass (mass 3 9.81 m·s22),
respectively.
Training Sessions. Subjects were positioned on the knee extensor
machine to maintain the pad was positioned 3 cm above the
medial malleolus and the lateral epicondyle of the femur aligned
with the potentiometer placed on the machine rotation axis, so it
was possible to infer about knee angle during the training and test.
The backseat was held at a hip angle of 110° (where 0° is full hip
extension). The 1RM test was initiated by CON muscle action
with a maximum of 6 attempts, and 180 seconds rest was given
between attempts. Each attempt was given a weight that was
supposed to be as hard as possible according to the subjects and
evaluators’ perceptions. The volunteer was asked to perform the
hard and fast force as possible, trying to reach the 30° angle of
knee extension (0° 5 full knee extension) (10,26,27). Thus, the
1RM value corresponded to the weight lifted in the previous
successful attempt.
The experimental groups performed different RT protocols for 10
weeks (3 times week with 48–72 h recovery between sessions).
Generally, all protocols consisted of 3–5 sets (3 sets during weeks
1–2, 4 sets during weeks 3–4, and 5 sets during weeks 5–10) of 6
repetitions with 50% of the 1RM test, 180 seconds rest between sets
and 6 seconds duration of the repetition. These training load con-
figurations were based on the prescription of Tanimoto and Ishii (40)
and adjusted through a pilot study (reducing the number of repeti-
tions and increasing the pause) to guarantee the feasibility of training
protocols which should be matched. However, experimental groups
were differentiated by different MAD: 5 seconds CON and 1 second
ECC (group 5c1e), 3 seconds CON and 3 seconds ECC (group
3c3e), and 1 second CON and 5 seconds ECC (group 1c5e). A
metronome (auditive feedback) and potentiometer data (visual
feedback) were used to guide MAD throughout the set.
All signals (potentiometer and load cell) were synchronized
and converted into digital signals by an A/D board (Biovision,
Wehrheim, Germany) with 14 bits and input range of 25 to 15
volts. DASYLab program (DASYLAB 11.0, Ireland) was used,
for acquisition and treatment of all signals, with sampling fre-
quency of 2,000 Hz. To assess the torque-angle relationship
among the different protocols, during each repetition, the average
torque was calculated at every 10° of knee-joint displacement
from 100 to 30° in each muscle action. Then, each average torque
value in the angular range of 10° was normalized by the 1RM test
result through the regression equations to estimate the resistance
torque (see description of knee extensor machine). In these
equations, the weight used during the1RM test (mass corre-
sponding to the performance in the 1RM test 3 9.81 m/s2) and
the angle corresponding to the median value in each of the an-
gular intervals (e.g., interval 100° a 90°; angle used 85°) were used
as input parameters.
 Influence of MAD in Regional Muscle Hypertrophy (2020) 00:00
Figure 3. Seated knee extension machine modified with the structures used to determine the
torque-angle relationship.
Statistical Analyses
Normality and homogeneity of the variances were confirmed by
Shapiro-Wilk and Levene tests, respectively, for all variables. Cross-
sectional area was transformed into relative responses [(post-test 2
pretest)/pretest 3 100], data are presented as mean 6 SD, as well as
95% confidence interval (CI), and statistical analysis was performed
for the individual’s muscles (RFCSA, VLCSA, VMCSA, and VICSA) and
the whole QF muscle group. Individual muscle analysis consisted in a
3-way analysis of variance (ANOVA) with repeated measures
(group 3 muscle 3 muscle region) to determine differences in CSA
intramuscles (30, 50 e 70%) and intermuscles (RF, VL, VI, and VM).
In addition, a 2-way ANOVA (group 3 muscle) was performed to
compare the relative increase of the sum of the 9 CSAs (among each
muscle) in the different groups. QF analysis consisted of a 2-way
ANOVA with repeated measures (group 3 muscle region) to verify
CSAQF variation among the different muscle regions (30, 50 e 70%).
In addition, a 2-way ANOVA (group 3 muscle) was performed to
compare the relative increase of the sum of the 9 CSAs among each of
the QF muscles in the different groups. Finally, a 1-way ANOVA
from the sum of all regions and muscles (whole QFCSA) was
performed.
Torque-angle relationship from all 30 training sessions of each
volunteer was calculated. A 3-way ANOVA (group 3 muscular
action 3 angle) was performed to identify differences in torque
across joint angles between protocols. The volume load was calcu-
lated by multiplying the total number of repetitions of each session
by weight. The total volume load of the 30 training sessions of the
experimental groups was compared using a 1-way ANOVA.
The Scott-Knott test was used as post-hoc (37), the effect size
was estimated by using eta squared (h2) (19), and power was
determined for ANOVA factors. All statistical procedures were
performed in the statistical packages SISVAR and SPSS 15.0, and
the level of significance was set at #0.05.
Results
Control Variables
The mean and standard deviation of the duration of ECC and
CON muscle action, considering all 30 training sessions, were as
Copyright © 2020 National Strength and Conditioning Association. Unauthorized reproduction of this article is prohibited.
follows: group 5c1e 5 4.85 6 0.26 (4.84–4.86) s e 1.13 6 0.19
(1.12–1.13) s, group 3c3e 5 2.86 6 0.22 (2.85–2.86) s e 3.12 6
0.24 (3.11–3.12) s, and group 1c5e 5 1.10 6 0.14 (1.09–1.10) s e
4.88 6 0.26 (4.87–4.88) s. The total volume load was not dif-
ferent between the groups (F2,32 5 0.281; p 5 0.757; h2 5 0.018;
power 5 0.09), with the 5c1e group 5 16,013 6 3,248
(14093,6–17932,4) kg, the 3c3e group 5 15,797 6 3,105
(13962,1–17631,9) kg, and the 1c5e group 5 16,713 6 2,593
(15180,6–18245,4) kg.
Cross-Sectional Area
Cross-sectional area across the different regions of QF showed a
significant main effect for group (F3, 40 5 10.383; p , 0.001; h2 5
0.125; power 5 0.997) and muscle region (F2, 80 5 14.744; p ,
0.001; h2 5 0.269; power 5 0.998). Post-hoc analysis showed
that QFCSA at 70% presented greater increases than 50 and 30%.
Furthermore, it was showed that all 3 experimental groups pre-
sented greater increases in CSA compared with the control group
(p , 0.05) (Figure 4 and Table 2).
The sum of all regions of QFCSA showed a significant main
effect for the group (F3, 40 5 9.732; p , 0.001; h2 5 0.422; and
power 5 0.995). Post-hoc showed higher values of CSA for the
experimental groups compared with the control group but no
differences between experimental groups (p . 0.05) (Figure 5).
For individual relative CSA responses of the sum of the 9 CSA,
only a main effect for the group was found (F3, 40 5 10.09; p ,
0.001; h2 5 0.297; and power 5 0.997) with higher values of
CSA for the experimental groups compared with the control
group (p , 0.05) (Figure 5; Table 3).
Individual muscle analysis presented a significant interaction
(group 3 muscle 3 muscle region) for CSA (F18,440 5 1.85; p 5
0.019; h2 5 0.033; and power 5 0.998). The post-hoc test
identified that at 50% of RF, groups 5c1e and 1c5e presented
greater increases in CSA than groups 3c3e and control (p , 0.05).
For all experimental groups, RF and VL presented a higher in-
crease in CSA at 70% than 50 and 30% (p , 0.05). Group 3c3e
showed greater increases in CSA to RF at 70% than VL, VM, and
VI (p , 0.05). Moreover, groups 1c5e and 5c1e presented a
 Influence of MAD in Regional Muscle Hypertrophy (2020) 00:00 | www.nsca.com

Figure 4. Training-specific adaptations (% change) in the QF muscle CSA at the distal (70%),
middle (50%), and proximal (30%) of the thigh in response to 10 weeks of resistance training.
Symbols indicate: mean (vertical bars), standard deviation (vertical lines), individual values for
each training protocol (white circle) *all experimental groups were greater than the control group;
**70% region was greater than 50 and 30% region. CSA, cross-sectional area.

greater increase in RFCSA at 70% than VL, with VL being greater
than VM and VI (p , 0.05) (Figure 6 and Table 4).
Torque-Angle Relationship
The torque-angle relationship showed a significant effect with a
triple interaction (F12, 454 5 190.9; p , 0.001; h2 5 0.59; and
power .0.999). Post-hoc identified that CON muscle actions on
groups 5c1e and 3c3e are significantly different than group 1c5e
at all the angular intervals (p , 0.05) and ECC muscle actions on
groups 1c5e and 3c3e are significantly different than group 5c1e
at all the angular intervals (p , 0.05). All experimental groups
showed differences in torque across knee-joint angle with groups
5c1e and 1c5e presenting an opposite torque-angle relationship in
both muscle actions, and the greatest values of torque can be seen
between 90–80° and 40–30° intervals (group 5c1e: CON 30–50°
. 50–60° . 60–70° . 70–80° . 80–100°; ECC 30–50° ,
50–60° , 60–70°, and 90–100° , 70–90°; group 1c5e: CON
30–40° , 40–50° , 50–60° , 60–70° , 70–80° , 80–90° ,
90–100°; and ECC 30–50° . 50–60° . 60–70° . 70–80° .
80–100°). Group 3c3e presented in both muscular actions a
progressive increase in the torque as knee-joint angle becomes
smaller (group 3c3e: CON 30–50° . 50–60° . 60–70° . 70–80°
. 80–90° . 90–100°; ECC 30–50° . 50–60° . 60–70° .
70–80° . 80–100°) (Figure 7).
Discussion
The presented study aimed to compare the effects of matched RT
protocols with different MAD in the regional hypertrophy of the QF
and its individual muscles after 10 weeks of RT. Our hypothesis was
partially confirmed as the main findings of this study were that RT
protocols with different MAD results in different regional hyper-
trophy intra-QF and inter-QF muscles. RT intervention with short
CON (1c5e group) and ECC (5c1e group) muscle actions showed a
higher relative increase in CSA than groups 3c3e and control at the
middle region (50% of femur length) to RF muscle. Moreover, for all
RT groups, VLCSA and RFCSA were higher at 70% than 50 and 30%

Table 2
Pretest (cm2), post-test (cm2), and change (%) in the QF muscle CSA at the distal (70%), middle (50%), and proximal (30%) of the thigh in
response to 10 weeks of resistance training.*
Muscle Region Group CSA Pretest(cm2), mean 6 SD (CI) CSA posttest (cm2), mean 6 SD (CI) Change (%), mean 6 SD (CI)
QF 30% 5c1e 48.5 6 7.3 (44.2–52.8) 50.4 6 6.6 (46.5–54.3) 4.3 6 3.4 (2.3 to 6.3)
3c3e 47.7 6 7.1 (43.5–51.9) 49.3 6 7.7 (44.8–53.9) 3.4 6 2.8 (1.7 to 5.0)
1c5e 49.9 6 5.7 (46.6–53.3) 51.8 6 5.4 (48.6–55.0) 3.9 6 3.6 (1.8 to 6.1)
Control 51.9 6 7.3 (47.5–56.2) 51.6 6 7.2 (47.4–55.9) 20.4 6 1.9 (21.5 to 0.7)
QF 50% 5c1e 48.9 6 7.5 (44.5–53.3) 51.2 6 7.0 (47.1–55.3) 5.0 6 3.9 (2.7 to 7.3)
3c3e 46.5 6 8.2 (41.6–51.3) 48.8 6 8.5 (43.8–53.8) 5.1 6 2.7 (3.5 to 6.7)
1c5e 48.4 6 6.3 (44.7–52.1) 50.7 6 5.9 (47.2–54.1) 4.9 6 3.5 (2.8 to 7.0)
Control 53.0 6 9.6 (47.3–58.7) 52.6 6 9.4 (47.1–58.2) 20.7 6 1.8 (21.8 to 0.3)
QF 70% 5c1e 35.3 6 4.8 (32.4–38.1) 37.5 6 4.7 (34.7–40.3) 6.4 6 4.5 (3.8 to 9.1)
3c3e 34.1 6 5.2 (31.0–37.1) 36.2 6 5.5 (33.0–39.5) 6.3 6 2.6 (4.8 to 7.8)
1c5e 38.6 6 6.2 (35.0–42.3) 40.6 6 5.6 (37.3–44.0) 5.5 6 3.4 (3.5 to 7.5)
Control 41.5 6 9.3 (36.0–47.0) 41.4 6 9.3 (35.9–46.8) 20.3 6 1.4 (21.1 to 0.6)
*CI 5 confidence of interval; CSA 5 cross-sectional area; QF 5 quadriceps femoris.

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 Influence of MAD in Regional Muscle Hypertrophy (2020) 00:00

Figure 5. Training-specific adaptations (% change) of the summed 9 CSA within the rectus
femoris (RF), vastus intermedius (VI), vastus lateralis (VL), and vastus medialis (VM) CSA and from
the QF muscle as whole in response to 10 weeks of resistance training. Symbols indicate: mean
(vertical bars); SD (vertical lines); individual values for each training protocol (white circle); *all
experimental groups were greater than the control group. CSA, cross-sectional area.

muscle region. In addition, also was demonstrated a greater increase
for VLCSA than VICSA and VMCSA on groups 5c1e and 1c5e at the
most distal site (70% of femur length). Thus, the present results
showed the occurrence of regional muscle hypertrophy with different
patterns of hypertrophic responses between the individual muscles of
QF, probably because of the different MAD and torque-angle rela-
tionships provided by the RT interventions.
In this study, the sum of QFCSA (accounting for all regions) was
not different between experimental conditions. The similar hy-
pertrophy between the experimental groups may be is explained
by the fact that the training protocols have the same volume load
of training. Although it is a controversial issue (36), the training
volume has been suggested to be the main responsible factor to
determine the magnitude of muscular hypertrophy (15,41). When
comparing different experimental groups, muscle hypertrophy
responses other than QF do not always correspond to responses
between their individual muscles (18). However, in this study, the
hypertrophy response considering the sum of individual’s muscles
CSA (RFCSA, VLCSA, VMCSA, and VICSA) was also no dif-
ferent when comparing experimental groups. In addition, Narici
et al. (31), Ema et al. (14), and Wakahara et al. (42) have reported
greater relative increases in the RFCSA than in the vastus, con-
sidering the sum of CSA. These authors have justified this result
because of the greater activation of the RF in relation to the vastus

Table 3
Pretest (cm2), post-test (cm2), and change (%) in the summed 9 CSA within the rectus femoris (RF), vastus intermedius (VI), vastus
lateralis (VL), and vastus medialis (VM) CSA and from the QF muscle as whole in response to 10 weeks of resistance training.*
Muscle Group CSA pretest (cm2), mean 6 SD (CI) CSA post-test (cm2), mean 6 SD (CI) Change (%), mean 6 SD (CI)
RF 5c1e 43.2 6 12.1 (36.0–50.3) 45.9 6 12.5 (38.5–53.3) 6.6 6 5.9 (3.1 to 10.0)
3c3e 38.0 6 8.1 (33.2–42.8) 39.5 6 8.8 (34.3–44.7) 3.9 6 4.8(1.1 to 6.7)
1c5e 45.9 6 13.9 (37.8–54.1) 49.0 6 15.7 (39.8–58.3) 6.4 6 4.8 (3.6 to 9.2)
Control 42.9 6 12.2 (35.7–50.1) 42.9 6 12.0 (35.8–50.1) 0.2 6 1.1 (20.5 to 0.9)
VL 5c1e 134.0 6 18.0 (123.3–144.6) 141.7 6 16.7 (131.8–151.5) 6.0 6 4.5 (3.4 to 8.7)
3c3e 131.6 6 22.2 (118.5–144.8) 137.9 6 23.6 (123.9–151.8) 4.7 6 1.9 (3.6 to 5.9)
1c5e 142.8 6 20.8 (130.5–155.0) 147.7 6 19.6 (136.1–159.2) 4.3 6 4.2 (1.8 to 6.8)
Control 145.1 6 33.9 (125.0–165.1) 144.2 6 33.5 (124.3–164.0) 20.5 6 2.1 (21.8 to 0.7)
VI 5c1e 127.1 6 22.6 (113.7–140.4) 131.0 6 21.4 (118.3–143.6) 3.3 6 3.0 (1.5 to 5.1)
3c3e 127.4 6 27.8 (110.9–143.8) 132.5 6 28.2 (115.9–149.2) 4.1 6 3.1 (2.3 to 5.9)
1c5e 137.5 6 20.0 (125.8–149.3) 143.8 6 20.6 (131.6–155.9) 4.5 6 3.9 (2.2 to 6.8)
Control 145.3 6 20.9 (133.0–157.7) 144.4 6 20.3 (132.4–156.3) 20.6 6 1.3 (21.4 to 0.2)
VM 5c1e 91.4 6 15.3 (82.4–100.5) 96.2 6 15.4 (87.1–105.3) 5.4 6 3.3 (3.4 to 7.4)
3c3e 85.7 6 13.2 (77.9–93.5) 91.0 6 14.1 (82.7–99.4) 6.3 6 4.6 (3.5 to 9.0)
1c5e 96.1 6 12.8 (88.5–103.7) 100.2 6 11.3 (93.5–106.9) 4.5 6 3.4 (2.4 to 6.5)
Control 100.2 6 18.3 (89.3–111.0) 99.8 6 18.1 (89.1–110.5) 20.4 6 1.4 (21.2 to 0.5)
QF 5c1e 395.6 6 56.4 (362.3–428.9) 414.8 6 52.0 (384.0–445.5) 5.1 6 3.6 (3.0 to 7.3)
3c3e 382.7 6 60.4 (347.0–418.4) 401.0 6 64.1 (363.1–438.9) 4.8 6 2.5 (3.3 to 6.2)
1c5e 422.4 6 49.7 (393.0–451.7) 440.6 6 43.3 (415.0–466.2) 4.7 6 3.2 (2.8 to 6.6)
Control 433.5 6 69.3 (392.6–474.5) 431.2 6 67.6 (391.3–471.1) 20.5 6 1.5 (21.3 to 0.4)
*CI 5 confidence of interval; CSA 5 cross-sectional area; QF 5 quadriceps femoris.

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 Influence of MAD in Regional Muscle Hypertrophy (2020) 00:00 | www.nsca.com

Figure 6. Training-specific adaptations (% change) in rectus femoris (RF, A), vastus intermedius (VI, B), vastus lateralis (VL, C),
and vastus medialis (VM, D) CSA at the distal (70%), middle (50%), and proximal (30%) of the thigh in response to 10 weeks of
resistance training. Symbols indicate: mean (vertical bars); standard deviation (vertical lines); individual values for each training
protocol (white circle); *all experimental groups are different from control; #groups 5c1e and 1c5e were greater than group
3c3e and control; †RF was greater than vastus for the respective group, and muscle region; ‡VL was greater than the VM and
VI for the respective group and muscle region; **70% was greater than 50 and 30% for the respective group and muscle. CSA,
cross-sectional area.

(31). In this study, this difference in the hypertrophy response of
the RFCSA in relation to the vastus did not occur in the sum of
CSA of these muscles, only in the distal region of CSA analysis.
For the best of the authors’ knowledge, only 1 study in-
vestigated CSA responses from intra-QF and inter-QF muscles
using different isoinertial RT protocols, despite his sample being
physically active men had not been involved in RT in the previous
6 months (11). The previous study used ultrasonography imaging
and measured QFCSA at similar muscle regions as this study (33,
50, and 67% of femur length) and similarly also found no dif-
ferences in the sum of QFCSA and the individual QF muscles
(vastus and RF), when compared 2 different groups (squat vs.
vertical jumps) or different muscle regions after 8 weeks of
training. However, VLCSA and VICSA in the squat group showed
different regional muscle hypertrophy compared with the jump
and control group. Yet, no differences in the RFCSA were observed
between groups and/or muscle regions. Therefore, the different
regional muscle hypertrophy in this study is supported by the
results from Earp et al. (11) and reinforces the premise that spe-
cific muscle regions hypertrophy responses (intramuscles and
intermuscles) are related to the RT protocols with specific me-
chanical demands. Other longitudinal studies with untrained in-
dividuals (7,21,28,32) have also reinforced this assumption and
verified distinct hypertrophy responses in different muscle regions
when comparing different RT protocols. In addition, studies with
athletes also reinforce this premise by demonstrating differences
in relative CSA (individual muscle CSA relativized by total muscle
CSA) in some muscles between athletes and untrained individuals
(13,22). Thus, it can be speculated that differences in relative CSA
in athletes may be associated with sports characteristics
(i.e., specific movements), demonstrating the importance of me-
chanical characteristics of the tasks (e.g., torque-angle relation-
ship) associated with long training periods which could result in
specific-region hypertrophy across the muscle.
The present results provided an advance to further understand
the effect of different mechanical demands (torque-angle re-
lationship) on regional muscle hypertrophy. The detailed torque-
angle relationship across the experimental protocols in this study
and how it impacted in the QF muscles CSA at different muscle
lengths after the intervention are factors supporting the previous
statement. In the 5c1e and 1c5e groups of this study, high values
of torque were found at more flexed knee angles (i.e., near the end
of the ECC and near the beginning of the CON, respectively;
Figure 7). At these angles, the muscle-tendon unit presents a larger
distance between its origin and insertion (longer muscle length),
unlike group 3c3e, where the greatest torque values are always
found with the muscle-tendon unit in a more shortened position.
Whether these differences in torque production are associated
with the distance between origin and insertion (muscle-tendon
unit length) would be enough to elicit the responses obtained in
this study still needs further clarification. However, greater
muscle activation (assess by transverse relaxation time (T2) of
MRI images) and lower muscle tissue oxygen (de) saturation have
been reported in isometric efforts of QF muscles in lengthened
position rather than shortened positions (24,34). Nevertheless, it
needs to be determined if these acute changes could explain the
occurrence of region-specific muscular hypertrophy. In addition,
studies using electromyography (EMG) have not found

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 Influence of MAD in Regional Muscle Hypertrophy (2020) 00:00

Table 4
Pretest (cm2), post-test (cm2), and change (%) in rectus femoris (RF), vastus intermedius (VI), vastus lateralis (VL), and vastus medialis
(VM) CSA at the distal (70%), middle (50%), and proximal (30%) of the thigh in response to 10 wk of resistance training.*
Muscle Region Group CSA pretest (cm2), mean 6 SD (CI) CSA post-test (cm2), mean 6 SD (CI) Change (%), mean 6 SD (CI)
RF 30% 5c1e 8.7 6 2.8 (7.1–10.4) 9.2 6 2.7 (7.6–10.8) 5.7 6 5.9 (2.2 to 9.2)
3c3e 7.7 6 1.6 (6.8–8.6) 8.0 6 1.8 (7.0–9.0) 3.6 6 4.2 (1.1 to 6.1)
1c5e 8.4 6 2.0 (7.2–9.6) 8.8 6 2.2 (7.5–10.1) 4.9 6 4.5 (2.3 to 7.6)
Control 8.5 6 2.5 (7.0–9.9) 8.5 6 2.5 (7.0–9.9) 0.2 6 1.3 (20.6 to 1.0)
RF 50% 5c1e 4.8 6 1.4 (4.0–5.7) 5.2 6 1.5 (4.3–6.0) 6.8 6 6.5 (3.0 to 10.6)
3c3e 4.3 6 1.1 (3.7–5.0) 4.5 6 1.1 (3.8–5.2) 3.4 6 6.6 (20.6 to 7.3)
1c5e 5.2 6 1.8 (4.1–6.2) 5.5 6 2.0 (4.4–6.7) 7.4 6 6.0 (3.9 to 11.0)
Control 5.0 6 1.6 (4.1–6.0) 5.0 6 1.6 (4.1–5.9) 0.2 6 1.8 (20.8 to 1.3)
RF 70% 5c1e 0.9 6 0.6 (0.6–1.2) 1.0 6 0.7 (0.6–1.4) 15.9 6 11.8 (9.0 to 22.9)
3c3e 0.7 6 0.4 (0.4–1.0) 0.8 6 0.4 (0.5–1.0) 18.1 6 16.7(8.3 to 28.0)
1c5e 1.4 6 0.8 (0.9–1.8) 1.6 6 0.9 (1.0–2.1) 14.4 6 10.0(8.5 to 20.3)
Control 0.9 6 0.4 (0.7–1.2) 0.9 6 0.4 (0.7–1.2) 0.0 6 3.2 (21.8 to 1.9)
VL 30% 5c1e 18.6 6 3.2 (16.7–20.4) 19.4 6 3.0 (17.6–21.1) 4.6 6 4.0 (2.2 to 7.0)
3c3e 18.1 6 3.1 (16.3–19.9) 18.6 6 3.2 (16.7–20.5) 2.8 6 3.0 (1.1 to 4.6)
1c5e 18.6 6 2.8 (17.0–20.3) 19.0 6 2.8 (17.3–20.6) 2.0 6 5.3 (21.2 to 5.1)
Control 19.1 6 3.9 (16.8–21.4) 19.0 6 3.9 (16.7–21.3) 20.4 6 3.3 (22.4 to 1.5)
VL 50% 5c1e 17.8 6 2.6 (16.3–19.3) 18.6 6 2.3 (17.3–20.0) 5.1 6 4.7 (2.3 to 7.9)
3c3e 17.1 6 3.2 (15.2–19.0) 17.9 6 3.4 (15.9–19.9) 4.8 6 2.6 (3.3 to 6.4)
1c5e 17.1 6 3.1 (15.3–18.9) 17.8 6 2.9 (16.1–19.6) 4.4 6 4.6 (1.7 to 7.1)
Control 19.1 6 4.9 (16.2–22.0) 18.9 6 4.7 (16.1–21.7) 20.8 6 2.1 (22.0 to 0.5)
VL 70% 5c1e 8.6 6 1.7 (7.5–9.6) 9.5 6 2.0 (8.3–10.7) 10.9 6 7.6 (6.4 to 15.5)
3c3e 9.0 6 2.7 (7.4–10.5) 9.7 6 2.9 (8.0–11.4) 8.5 6 2.8 (6.9 to 10.2)
1c5e 10.0 6 2.5 (8.6–11.5) 10.8 6 2.3 (9.5–12.2) 9.0 6 5.6 (5.6 to 12.3)
Control 11.1 6 4.7 (8.3–13.9) 11.0 6 4.8 (8.2–13.8) 20.6 6 2.3 (21.9 to 0.8)
VI 30% 5c1e 15.8 6 2.6 (14.3–17.4) 16.1 6 2.5 (14.7–17.6) 2.2 6 2.3 (0.9 to 3.5)
3c3e 16.7 6 3.4 (14.7–18.7) 17.1 6 3.5 (15.1–19.2) 2.8 6 4.6 (0.1 to 5.5)
1c5e 17.5 6 2.5 (16.0–19.0) 18.3 6 2.7 (16.7–19.9) 4.6 6 4.5 (1.9 to 7.2)
Control 18.6 6 2.3 (17.2–20.0) 18.5 6 2.2 (17.2–19.8) 20.6 6 1.7 (21.6 to 0.4)
VI 50% 5c1e 16.4 6 3.1 (14.6–18.2) 16.9 6 3.0 (15.2–18.7) 3.4 6 3.9 (1.1 to 5.7)
3c3e 15.7 6 3.7 (13.5–17.9) 16.4 6 3.7 (14.2–18.6) 4.7 6 3.8 (2.4 to 6.9)
1c5e 16.5 6 2.7 (14.9–18.1) 17.2 6 2.7 (15.6–18.8) 4.4 6 4.5 (1.8 to 7.1)
Control 18.3 6 3.1 (16.5–20.2) 18.2 6 3.1 (16.4–20.0) 20.7 6 1.9 (21.8 to 0.4)
VI 70% 5c1e 10.4 6 2.0 (9.2–11.5) 10.8 6 1.9 (9.7–12.0) 5.0 6 4.7 (2.2 to 7.8)
3c3e 10.3 6 2.3 (8.9–11.6) 10.8 6 2.4 (9.4–12.2) 5.5 6 3.3 (3.5 to 7.4)
1c5e 10.9 6 2.0 (9.7–12.1) 11.4 6 1.9 (10.2–12.5) 4.7 6 3.6 (2.6 to 6.8)
Control 12.1 6 2.0 (10.9–13.3) 12.0 6 2.0 (10.8–13.2) 20.6 6 1.6 (21.6 to 0.3)
VM 30% 5c1e 5.4 6 1.0 (4.8–6.0) 5.7 6 1.0 (5.1–6.3) 7.1 6 5.9 (3.6 to 10.6)
3c3e 5.2 6 1.2 (4.5–5.9) 5.6 6 1.2 (4.9–6.3) 7.5 6 7.0 (3.3 to 11.6)
1c5e 5.4 6 1.0 (4.8–6.0) 5.7 6 0.9 (5.2–6.3) 6.7 6 5.7 (3.4 to 10.1)
Control 5.7 6 1.2 (5.0–6.5) 5.7 6 1.2 (5.0–6.4) 20.5 6 1.4 (21.4 to 0.3)
VM 50% 5c1e 9.8 6 1.8 (8.8–10.9) 10.5 6 2.0 (9.3–11.6) 6.5 6 4.1 (4.0 to 8.9)
3c3e 9.3 6 1.6 (8.3–10.3) 10.0 6 1.6 (9.0–10.9) 7.3 6 6.5 (3.5 to 11.1)
1c5e 9.6 6 1.4 (8.8–10.4) 10.1 6 1.5 (9.2–11.0) 5.0 6 4.2 (2.6 to 7.5)
Control 10.6 6 2.2 (9.3–11.9) 10.5 6 2.2 (9.2–11.8) 21.1 6 2.2 (22.4 to 0.2)
VM 70% 5c1e 15.4 6 2.5 (14.0–16.9) 16.1 6 2.4 (14.6–17.5) 4.2 6 3.2 (2.3 to 6.1)
3c1e 14.2 6 2.0 (13.0–15.4) 14.9 6 2.4 (13.5–16.3) 5.2 6 4.2 (2.7 to 7.7)
1c5e 16.4 6 2.4 (15.0–17.8) 16.9 6 2.2 (15.6–18.1) 3.4 6 3.1 (1.6 to 5.2)
Control 17.4 6 3.3 (15.4–19.4) 17.4 6 3.3 (15.5–19.4) 0.1 6 1.3 (20.7 to 0.9)
*CI 5 confidence of interval; CSA 5 cross-sectional area; QF 5 quadriceps femoris.

associations between regional electromyographic activity and
regional muscle hypertrophy (12,30). Thus, to better understand
the mechanisms that underline regional hypertrophy, future
studies could measure muscle activation (T2 and EMG) and
muscle tissue oxygen desaturation responses in different QF
muscles lengths during dynamic RT protocols with different
torque-angle relationships.
Moreover, a factor such as the mechanical characteristic of the
training machine (i.e., cam format design) could also cause the
variability in the regional muscle hypertrophy responses found
between the different studies (42). According to Folland and
Morris (16), machines from different manufacturers provide
different resistance torques throughout the ROM on knee ex-
tensor exercise. Interestingly, some studies reported different in-
tramuscular and intermuscular hypertrophy responses in QF
when machines from different manufacturers were used
(8,14,20,21,31). Nevertheless, as none of the studies reported the
resistance torque values throughout the ROM, it is not possible to
discuss the level of influence of this variable on regional muscle
hypertrophy. This study used a seated knee extensor machine
with a greater resistance torque when the knee is more extended.
Thus, considering the torque-angle relationship for all

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 Influence of MAD in Regional Muscle Hypertrophy (2020) 00:00
Figure 7. Descriptive and inferential analysis of torque-angle relationship in concentric and
eccentric muscle action of training groups. †Groups 5c1e and 3c3e are different from group
1c5e at all the angular intervals (p , 0.05); ‡Groups 1c5e and 3c3e are different from group 5c1e
at all the angular intervals (p , 0.05).
experimental groups (Figure 7), it is possible to identify an in-
creased torque value in shorter QF muscle lengths for at least one
of the muscle actions (CON or ECC) at any group (Figure 7).
However, although 5c1e and 1c5e groups presented opposite
torque-angle relationship both showed higher torque values when
the QF was in a lengthened position, which may help to explain
the similar results for RFCSA among these groups. Thus, the ma-
chine configuration only partially explains the results of this
study. Considering the importance of mechanical stress on muscle
hypertrophy (33,41), the differences in the outcomes observed
along the ROM could contribute to explain the more distal
muscle hypertrophic responses found in RF and VL and, conse-
quently, in the QF as whole.
Despite the methodological precautions adopted, some limi-
tations of this study should be highlighted. Initially, it should be
noted that the MRI procedure adopted to determine CSA does not
allow for differentiating responses from sarcoplasmic and myo-
fibrillar hypertrophy. Responses for regional muscle hypertrophy
have been reported in athletes (23). However, all studies that
verified the response of regional muscle hypertrophy in different
training protocols used subjects with no experience in strength
training (2,7,11,28) and this study. Therefore, care should be
taken in extrapolating the data because of the size and charac-
teristics of the sample. Still, it should be noted that the response of
regional muscle hypertrophy may be different between men and
women (29). In addition, it should be emphasized that the lack of
nutritional control and monitoring can influence the results
found, despite the fact that the control group is in the same con-
ditions, having been inserted to standardize this influence. Finally,
it should be noted that this study uses a single monoarticular
exercise, and its information must be interpreted with care in
other training configurations and exercises.
This study showed that matched isoinertial (ROM, volume,
load, time under tension, and rest) RT protocols with different
MAD and torque-angle relationship profiles resulted in different
regional hypertrophic across the QF and its individual muscles.
Therefore, protocols with 1s of MAD and that generated greater
instantaneous torque values, at greater muscle lengths in at least
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| www.nsca.com
one muscle action (CON or ECC), promoted greater midpoint
RFCSA and distal VLCSA increases compared with distal VICSA and
VMCSA than protocols with MAD equal to 3s and highest force
values only at the shortest muscle lengths. However, although the
different MAD and torque-angle relationships, RT protocols did
not promote different increases in CSA either for individual
muscle or for QF as a whole. Overall, the RT protocols in this
study showed greater increases of CSA at distal than middle or
proximal points of the thigh for RF, VL, and QF.
Practical Applications
It has been shown an association between region-specific
muscle hypertrophy with force production (32) and sports
performance (1,25). Moreover, the ability to change muscle’s
overall shape is important for bodybuilders (3) which could
lead coaches and practitioners to use training protocols with
lower MADs (CON or ECC) aiming to induce greater hy-
pertrophy in middle and distal regions of the recto femoris and
vastus medialis, respectively. However, it should be empha-
sized that this study was performed with untrained individuals
using isolation/knee extension exercise and should be repli-
cated in athletes to provide further insight into this
population.
Acknowledgments
This study received support from the Fundação de Amparo à
Pesquisa de Minas Gerais and Pro-Reitoria de Pesquisa da
Universidade Federal de Minas Gerais through the Programa
Institucional de Auxı́lio à Pesquisa de Docentes Recém-
Contratados. The authors thank Clı́nica Ecoar de Medicina
Diagnóstica and its staff for technical and scientific collaboration
on the MRI acquisition. The authors also thank Carolina Augusta
Medina-Oliveira for the final English revision.
 Influence of MAD in Regional Muscle Hypertrophy (2020) 00:00
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