75 1 Metabolism, Nutrition, and 2 KEY WORDS: exercise order; system; fatigue; volume the subsequent MJ movement, thereby placing greater stress on the agonist followed immediately by ancise MJ for exer- theperforming same muscle pec grouppress) deck (e.g., (37). In before thiscises system, bench the 2 arewith exer- minimal rest performed betweenAnother them common in way (37). to performsystem this sequence is insequence a (e.g., traditional 3 multiple-set setsMJ of exercise) SJ (9).this before The the variation theory isan behind that SJ first exerciseisolation, performing fatigues thus the agoniston placing in greater theand stress agonist during potentiating(7,21,37). MJ Yet, another its exercise approachfirst perform is an to SJ hypertrophy a exercise synergist that of works thediately MJ, with followed a imme- set of(e.g., the MJ triceps movement bench pushdown press). followed This approachused by has in been scientific researchreferred and to can as be rationale a for this reverse approachfatigued PE is synergist (3). that The contributes the less to Andreo F. Aguiar, PhD, 3 2 Exercise Science Department, CUNY Lehman 3 Paolo M. Cunha, MPEd, 2 a modality ofmended exercise recom- to promote muscle esistance training (RT) is ALLOW FOR A GREATER TRAINING VOLUME. INTRODUCTION athletes and practitionersenhance muscle seeking hypertrophy (7,11,37). to The PE is one of thedescribed training by principles Joevolves Weider (37) that performing in- an SJ exercise growth (1), andoutcome its shows influence a dose–response ontionship, rela- at this least up(12,22–25). to The effect a of certain RT onhypertrophy point muscle seemsdependent, to whereby be manipulationprogram protocol- of variablesintensity, such exercise selection, as andcise order exer- may volume, affect RT-induced adap- tations (1,20,37).order, Regarding exercise evidencemanipulation can indicates affectand various that acute chronic(27,28). its Current guidelines recommend RT-relatedperforming outcomes multiple-jointcises (MJ) before exer- single-joint(1). (SJ) exercises (PE) Paradoxically, is a popular pre-exhaustion RT system used by R o Pedro Nunes, BSc, ˜ Joa 1

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National Strength and Conditioning Association. Unauthorized reproduction of this article is prohibited. ª ERAL, PE DOES NOT ALTERNEUROMUSCULAR THE ACTIVITY OF THE TARGET MUSCLE IN MULTI- JOINT EXERCISE, BUT IT DOES PROACHES HAVE BEEN INVESTI- GATED IN RESEARCH; THIS REVIEW DISCUSSES THE RELE- VANT LITERATURE REGARDING THE EFFICACY OF PE FOR POTENTIATING OVERLOAD AND MUSCLE HYPERTROPHY. IN GEN- SINGLE-JOINT EXERCISE BEFORE A MULTIPLE-JOINT EXERCISE IN AN EFFORT TO INCREASE THE OVER- LOAD (MUSCLE ACTIVATION AND/ OR TRAINING VOLUME) IN AMUSCLE. GIVEN DIFFERENT PE AP- THE PRE-EXHAUSTION (PE) SYS- TEM IN RESISTANCE TRAINING IS LARGELY USED BY ATHLETES AND PRACTITIONERS WITH THE GOAL OF ENHANCING MUSCULAR ADAPTATIONS. PRE-EXHAUSTION CONSISTS OF PERFORMING A Center for Research in Health Sciences, University of Northern Parana, Londrina, Brazil; Exercise Laboratory, Londrina State University, Londrina, Brazil; and College, Bronx, New York Address correspondence to Dr.beiro, Alex [email protected]. S. Ri- Copyright ABSTRACT the Literature Alex S. Ribeiro, PhD, and Brad J. Schoenfeld, PhD, CSCS*D, NSCA-CPT*D, CSPS*D, FNSCA in Maximizing Muscle Hypertrophy: A Review of Potential Role of Pre-Exhaustion Training 1

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group. Given these variations and throughout the leg press repetitions increase activation of the pectoralis assorted theories, the purpose of this (0–15 repetitions) after the PE with major when performing the bench review is to discuss the relevant litera- 30% and 60% of 1RM, respectively, press; on the other hand, results suggest ture regarding the efficacy of PE to whereas the condition without PE that PE may increase the activation of potentiate muscle hypertrophy. showed an increase of 27.6%. It should a synergist muscle during MJ exercise. be noted that exercises were performed METHODS Alternatively, Piraua´ et al. (15) investi- submaximally, with sets terminated at gated muscle activation when perform- An extensive literature search was per- 15 repetitions; it remains unclear if re- ing the dumbbell fly (10 repetitions with formed using PubMed and Scielo data- sults would have differed had sets been 30% of 1RM) on stable (bench) and bases. Searches were performed using performed until muscle failure. the following terms in both English unstable (Swiss ball) surfaces before per- Akima et al. (2) used electromyostimu- and Portuguese: “pre-exhaustion,” formance of the bench press. The bench lation to fatigue the quadriceps femoris “pre-activation,” and “exercise order.” press was performed until concentric fail- in subjects performing knee extension The date of publication was not used ure. Results indicated significant in- exercise before and after stimulation. as a criterion for inclusion and exclusion creases in activity of the pectoralis Pre-exhaustion of 1 of 4 heads of the of studies. Studies were included regard- major, anterior deltoid, triceps brachii, quadriceps augmented recruitment of less of the sample’s characteristics. and anterior serratus muscles during the 3 others when the exercise was the bench press when it was preceded repeated. However, this approach has RESULTS by dumbbell fly, independent of surface. limited practical application because it ACUTE STUDIES This finding suggests that PE may is impossible to stimulate only one of increase the activation of a target muscle the vasti muscles using RT exercises. Neuromuscular activity. Several during MJ when it is preceded by sub- studies have investigated whether PE The PE system is often used to increase maximal performance of an SJ exercise. alters neuromuscular activity during pectoralis major activity during bench However, considering that PE used a very MJ exercise. The first study on the press performance. Gentil et al. (8) com- light load at a low intensity of effort, it topic was conducted by Augustsson pared the neuromuscular activity of the can be speculated that the enhanced acti- et al. (3), who assessed the electromyo- pectoralis major, anterior deltoid, and vation in all muscles during the bench graphic (EMG) activity of the rectus triceps brachii during performance of press may be a function of postactivation femoris, vastus lateralis, and gluteus the pec deck and bench press in 2 con- potentiation mechanisms (26) rather maximus during one set of horizontal ditions: pec deck performed before the than prefatigue induced by PE. bench press (PE) and the inverse order. leg press exercise with and without PE. Reverse PE (e.g., triceps pushdown Results showed similar muscular activa- The PE consisted of one set of a 10RM before bench press) is postulated to tion in the pectoralis major and anterior knee extension exercise. Results indi- increase overload in the agonists cated that PE impaired rectus femoris deltoid regardless of condition, but an through a reduced contribution from and vastus lateralis activation during increase of 33% in triceps activation was the fatigued synergistic muscles during the leg press. Based on this finding, noted during the MJ exercise when per- the MJ movement. To determine the PE may be suboptimal for maximizing formed after the pec deck. Brennecke validity of these claims, Soares et al. lower-limb activation. It is noteworthy et al. (4) tested a similar experimental (30,31) investigated the neuromuscular that the inverse order was not analyzed protocol (8), but the SJ exercise used for activity of pectoralis major and triceps to determine what would have hap- PE was the dumbbell chest fly. Again, pened to activation in the knee exten- PE conferred no differences in activa- brachii during the triceps pushdown sion if the leg press was performed tion of either the pectoralis major or and bench press exercises in 2 sequences: immediately prior. Rocha-Ju´nior et al. anterior deltoid in the bench press; a reverse PE whereby the triceps push- (18) examined EMG activity of the however, triceps brachii activation down was followed by the bench press vastus lateralis during 15 repetitions increased significantly during perfor- and a traditional sequence whereby the of leg press 458 at 60% 1RM in 3 con- mance (18%). Most recently, Go1as bench press preceded the pushdown. No ditions: a control condition whereby et al. (9) investigated the effects of PE significant difference was noted between only the leg press 458 was performed; on EMG amplitude in the pectoralis conditions for both the pectoralis major a PE condition whereby 15 repetitions major during a single repetition of and triceps brachii. Conversely, a similar in the knee extension at 30% of 1RM 95% 1RM bench press both in isolation balanced cross-over experimental proto- was performed before the leg press 458; and after performance of multiple sets of col analyzing neuromuscular activity in and a condition where 15 repetitions in incline dumbbell fly exercise. Similar to the 10RM bench press performed before the knee extension at 60% of 1RM was previous findings, no significant differ- or after the triceps pushdown showed performed before the leg press 458.An ence in pectoralis activation was noted significantly greater pectoralis major acti- increase of 67.4 and 59.5% in vastus after PE. In total, these investigations vation in the reverse PE condition than lateralis activation was observed provide evidence that PE does not the condition without reverse PE (10).

76 VOLUME 41 | NUMBER 1 | FEBRUARY 2019 Copyright ª National Strength and Conditioning Association. Unauthorized reproduction of this article is prohibited. The reason for these discrepant results is of longitudinal studies investigating the down (reverse PE) using a narrow or unclear. chronic effect of PE on hypertrophy is wide grip. Although both grip conditions Go1as et al. (9) investigated triceps bra- necessary to draw inferences as to resulted in a reduced volume for the lat chii and anterior deltoid EMG ampli- whether any observed differences in pull-down after reverse PE, the strategy agonist or synergist muscle activation had a greater negative effect on the num- tude during the bench press, performed translate into greater long-term muscle ber of repetitions performed in the MJ immediately after the lying triceps development. exercise when using the narrow grip var- extension or front deltoid raise. Com- iation. This result is logical since the pared with the control session (without biceps brachii is worked to a greater PE), EMG activity was significantly Performance and training vol- extent in the narrow grip variation, and greater for the triceps brachii in its ume load. The compelling body of prefatiguing the muscle would thus limit reverse PE condition (+31%), but literature indicates a clear dose– MJ exercise performance. a nonsignificant but potentially practi- response relationship between training cally meaningful difference was volume and muscle hypertrophy (12,22– Accordingly, these findings suggest observed for anterior deltoid after its 25). There also is evidence that changing a potential beneficial effect for PE from reverse PE condition (+18%). Pectora- the order of exercise performance alters a volume-load standpoint and are in lis major activation was not analyzed volume load (28), whereby volume is agreement with other studies showing under any conditions, precluding the greater when a given exercise is posi- asuperiorityforanSJtoMJorderin ability to draw inferences on the effects tioned first, regardless of whether it is MJ this regard (13,14,16). However, the or SJ (28). Regarding PE, De Salles et al. of reverse PE in this muscle. use of reverse PE may be disadvanta- (19) analyzed the effects of PE (knee geous for muscular adaptations, because Further confounding matters, Soncin extension followed by leg press) on of reductions in training volume, mainly et al. (32) assessed EMG activity of the training volume versus performing the for the target muscle. Although research pectoralis major, anterior deltoid, and tri- exercises in an inverse order. Four sets of is limited on the topic, the PE system ceps brachii in 6 exercises (3 sets of each sequence were conducted until may favor performing a greater volume 8RM) using 2 opposing exercise orders: muscular failure using an initial load of compared with the inverse order 1) bench press, chest fly, shoulder press, 8RM. The total number of repetitions in (5,8,19), whereas reverse PE seems to shoulder abduction, close grip bench the session was significantly higher in the impair total training volume, especially press, and lying triceps extension PE condition (sum of repetitions with PE for the target muscle (30,31,35). (Sequence A); 2) or the opposite order 5 46.9 6 8.4 vs. sum of repetitions (Sequence B), which constitutes a reverse without PE 5 38.6 6 7.3), because of LONGITUDINAL STUDIES PE. Of note, greater activation of the a greater number of repetitions per- sternocostal head of the pectoralis major formed in knee extension with PE To the best of our knowledge, only was noted in Sequence A compared with (average with PE 5 6.7 6 1.3, and one study (6) has investigated the Sequence B during the chest fly. Alter- average without PE 5 3.5 6 1.2); the chronic effects of PE as originally natively, significantly greater EMG number of repetitions performed in leg proposed (7,37). Fisher et al. (6) ran- amplitude was noted for the anterior del- press was similar between conditions. domized a sample of 39 participants (male 5 9andfemale5 30) with at toid in Sequence B versus Sequence A Similarly, Faria et al. (5) and Ribeiro et al. least 6-month RTexperience into 1 of during the chest fly, whereas its activa- (17) observed that execution of the PE in 3 groups: a PE group that performed tion was higher during Sequence A in the triset system for both the lower-body exercises in the following order: (a) the lying triceps extension compared (a) knee extension, (b) leg press, (c) squat pec fly, (b) chest press, (c) leg exten- with Sequence B. (5); and upper-body (a) pec deck, (b) sion, (d) leg press, (e) pull-over, and Considering the differences between incline bench press, (c) bench press (f) lat pull-down, with minimal rest PE protocols and study methodologies, (17) resulted in a significantly greater total (#5 seconds) between SJ and MJ ex- it is difficult to form a definitive conclu- number of repetitions and total training ercises (e.g., peck-fly and chest press) sion on the topic. That said, most stud- volume load compared with performing and 120 seconds rest after finishing each ies fail to show an increase in activity of thesequenceintheinverseorder.These MJ exercise; a group that performed the the target muscle during MJ exercise results (5,17,19) indicate a more pro- same exercises in the same order but but do tend to display an increase in nounced reduction in volume for tradi- with a rest of 1 minute between exercises activation of the synergistic muscle. It tional order (MJ after SJ), than PE (SJ (PE-1 min); or a control group (CON) is important to mention that although after MJ), conceivably because other syn- that performed the same exercises but an association exists between neuro- ergistic muscles were able to assist the began with the MJ exercises first and muscular activity and muscle growth MJ performance. rested for 1 minute between exercises. (36), hypertrophy is a complex phe- More recently, Vilac¸a-Alves et al. (35) Training was performed twice a week nomenon (20) that can be influenced investigated the influence of performing for 12 weeks; participants performed 1 by multiple factors (34). Thus, scrutiny arm curl exercise before the lat pull- set of no more than 12 repetitions per

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exercise until failure. Measures of lean PRACTICAL APPLICATIONS major, latissimus dorsi, and quadri- mass were assessed by air displacement Based on available literature, we can ceps), as opposed to just the syner- plethysmography (ADP). Results re- conclude that PE does not augment gists (e.g., biceps brachii and triceps vealed no significant changes for any neuromuscular activity of the target brachii). group in lean mass, making it difficult muscle in MJ exercise, but it can to draw any conclusion on the effect enhance activity of the synergistic mus- Conflicts of Interest and Source of Funding: of PE in muscle hypertrophy. The lack cle. From a volume-load standpoint, PE The authors report no conflicts of interest of changes in lean mass can be related to favors a greater training volume load, and no source of funding. the following factors: (a) use of a single mainly due the increase in the number set per exercise protocol for trained in- of repetitions performed in the SJ exer- dividuals, which is in opposition to gen- cise, but it may reduce the volume load Alex S. Ribeiro erally accepted recommendations in the MJ. The paucity of longitudinal is Professor and (1,12,22–25), and/or (b) the use of data prevents the ability to draw con- Research Associ- ADP as a measurement instrument, clusions as to the direct effects of PE on ate of the Center a method that has limited ability to muscle hypertrophy. for Biological and assess hypertrophic changes. It can be concluded that PE may be Health Sciences Two other studies have endeavored to a viable strategy to use during a hyper- at University of investigate the effects of exercise order trophic training mesocycle. Specifically, Northern ´ on hypertrophy, with sequencing in PE can help to increase training vol- Parana. the nontraditional training condition ume, which has been shown to be a pri- similar to a reverse PE (29,33). Sima˜o mary driver of hypertrophy (24). It has ˜ et al. (29) and Spineti et al. (33) com- been hypothesized that progressively Joao Pedro Nunes pared performing MJ exercise followed increasing RT volumes over a period is a gradu- by SJ exercise (bench press, lat pull- of several months may elicit a supercom- ate in Bachelor of down, triceps extension, and biceps curl) pensation of muscle proteins to maxi- Physical Educa- to the inverse order. Results showed no mize hypertrophic adaptations (22). tion, student in significant difference between groups for The use of PE could conceivably be Metabolism, Nutrition, and both triceps brachii (MJ-SJ 5 +15%, SJ- used during the high-volume block to Exercise Labora- MJ 5 +12%) and biceps brachii muscle facilitate the maintenance of increased tory at Londrina volume (MJ-SJ 5 +10%, SJ-MJ 5 volume. Alternatively, reverse PE would State University. +13%). Alternatively, Sima˜oetal.(29) seemingly be contraindicated in this re- observed that, for the triceps brachii, on- gard because it seems to negatively ly the SJ-MJ condition significantly influence total training volume. The Paolo M. increased muscle thickness from pre- current literature is insufficient to deter- Cunha training to post-training (MJ-SJ 5 0.0%, mine whether PE promotes any addi- is a PhD SJ-MJ 5 +8%). However, although tional anabolic effects from student in Physi- cal Education, biceps brachii muscle thickness was sim- a mechanistic standpoint over and student in Metab- ilar between conditions, only the MJ-SJ above traditional RT, so any use for this olism, Nutrition, groupshowedasignificantdifferenceto purpose remains speculative. and Exercise a nonexercising CON at post-training Future longitudinal studies using PE Laboratory at (MJ-SJ 5 +6%, SJ-MJ 5 +4%). should be performed to fill existing Londrina State The conflicting results of the limited gaps in the literature and thus pro- University. longitudinal data on PE prevent the vide greater insight into the potential ability to draw strong inferences as to implications for its practical use. The whether the strategy enhances muscle use of site-specific measurement Andreo F. hypertrophy. Furthermore, direct site- techniques (e.g., ultrasound, mag- Aguiar is Professor specific measures of muscle hypertro- netic resonance image, and com- and Research phy on the topic have only been puted tomography) would be Associate of the obtained in the upper limbs; no studies helpful for tracking subtle changes Center for Biologi- have endeavored to investigate in muscle hypertrophy. Moreover, cal and Health changes in the trunk or lower body. studies should endeavor to analyze Sciences at Uni- Further research is needed to fill in hypertrophic changes of the agonist versity of Northern these gaps in the literature. muscle in MJ exercise (e.g., pectoralis Parana´.

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