Sports Medicine (2022) 52:1647–1666

https://doi.org/10.1007/s40279-021-01636-1

SYSTEMATIC REVIEW

Effects of Periodization on Strength and Muscle Hypertrophy

in Volume‑Equated Resistance Training Programs: A Systematic
Review and Meta‑analysis
Lukas Moesgaard1 · Mikkel Malling Beck1 · Lasse Christiansen2 · Per Aagaard3 · Jesper Lundbye‑Jensen1

Accepted: 20 December 2021 / Published online: 19 January 2022

© The Author(s), under exclusive licence to Springer Nature Switzerland AG 2022

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

1 Introduction a viable exercise modality for improving strength, general

fitness, and health-related outcomes [1]. Furthermore, resist-
During recent decades multiple health-related benefits of ance training has been proven highly versatile in the context
resistance training have been documented [1, 2]. Accord- of sports, leisure, or rehabilitation training [3]. While some
ingly, resistance training is increasingly acknowledged as health benefits of resistance training emerge independently
of increases in muscular strength [1, 2], one of the primary
reasons why resistance training is used by practitioners is to
Extended author information available on the last page of the article

Vol.:(0123456789)
1648 L. Moesgaard et al.

athletes only compete a few times a year, periodization is

Key Points used with the aim of maximizing performance specifically
on the day of competition. For many years this practice was
Periodization is the manipulation of training vari- largely based on the rationale that by adhering to the prin-
ables over time, and is often used in resistance training ciples of the general adaptation syndrome theory, training
programs in an attempt to promote increases in strength could be planned in a manner where overtraining and injury
and muscle hypertrophy. In order to assess the effect of could be avoided, and performance could be maximized
periodization on strength and muscle hypertrophy, meta- [11]. In the current body of literature, different periodiza-
analyses assessing changes from pre- to post-intervention tion models have been implemented including linear perio-
between volume-equated resistance training programs dization (LP), reverse linear periodization (RLP), undulat-
were performed. ing periodization (UP), and block periodization (BP). LP,
When comparing the change from pre- to post-interven- also termed traditional periodization, is characterized by
tion between volume-equated periodized and non-perio- increases in intensity and decreases in volume over time.
dized resistance training, periodized resistance training RLP is characterized by decreases in intensity and increases
leads to greater increases in strength compared to non- in volume over time. UP, also termed non-linear periodiza-
periodized resistance training. tion, is characterized by more frequent variations in volume
and intensity than LP and RLP, and can be divided into two
Undulating periodization leads to greater increases in subcategories: daily undulating periodization (DUP), char-
strength than linear periodization in volume-equated acterized by daily undulations in intensity and volume, and
pre-post designs. However, this was only observed for weekly undulating periodization (WUP), characterized by
resistance trained individuals, and not for untrained weekly undulations in intensity and volume. In BP, training
individuals. is divided into several distinct blocks, where each training
Resistance training periodization does not appear to block is structured to promote the development of a spe-
affect muscle hypertrophy when volume is equated cific training goal. An example of this is a block in which
between conditions. This indicates that other adapta- the development of muscle hypertrophy is the main aim,
tions accompanying resistance training—for example, followed by a block in which the development of maximal
neurophysiological changes—may explain the observed strength is the main aim.
positive effects of resistance training periodization on A previous meta-analysis by Williams et al. [12] found
strength gains. that periodized resistance training was accompanied by
larger increases in maximal strength when compared to
non-periodized (NP) resistance training. However, the meta-
analysis by Williams et al. did not equate for training volume
between training groups. Thus, the inclusion of single-set NP
improve muscular strength and promote muscle hypertro- training groups compared to multiple-set periodized training
phy. Therefore, discovering how to maximize muscle hyper- groups may have affected the result, since multiple-set proto-
trophy and muscular strength is of great interest to a wide cols are superior to single-set protocols for development of
range of individuals including athletes, patients, trainers, and maximal strength [7, 8, 13]. Furthermore, although previous
clinical therapists. While resistance training represents an studies have compared multiple periodization models, the
efficient mean of increasing both strength and muscle mass, findings are mixed—in some instances even contradictory.
it remains to be fully determined how to optimize resistance Hence, it remains unclear whether specific periodization
training protocols to maximize these measures. models have differential effects on training-induced changes
Variables that can be manipulated to improve the strength in muscular strength and muscle hypertrophy, and whether
and muscle hypertrophy responses to resistance training training status affects the potential effects of periodization.
include, but are not limited to, training intensity, training Therefore, investigating if there is an effect of periodization
volume, and training frequency. The current body of litera- when volume is equated, and how intensity and volume are
ture provides empirical evidence regarding the influence more effectively manipulated over time in order to augment
of these variables on development of strength and mus- gains in muscular strength and muscle hypertrophy, in both
cle hypertrophy [4–10]. However, it remains unclear how untrained and trained individuals, could potentially aid in
manipulation of these variables over time affects strength maximizing strength development in both applied and clini-
gains and muscle hypertrophy. cal settings.
The manipulation of training variables over time is known Consequently, the aims of this review and meta-analysis
as periodization. In sports such as powerlifting and weight- were to (a) examine the current body of literature to deter-
lifting, which are highly dependent on strength and where mine the effects of periodization of volume and intensity on
Effects of Resistance Training Periodization on Strength and Muscle Hypertrophy 1649

strength and muscle hypertrophy, when volume is equated were independently reviewed by three of the investigators
between conditions, (b) to determine if the effects of perio- (LM, MB, and LC). A mutual decision was made about
dization are affected by training status, and (c) to determine whether each study met the inclusion criteria. Any disa-
how volume and intensity are more effectively periodized greements between reviewers were settled by consensus and
with the aim of maximizing strength gains and muscle consultation with a fourth investigator (JLJ). For articles that
hypertrophy, when the volume of resistance training is met the inclusion criteria but where data required to calcu-
equated. late effect sizes (ES) were not available, the corresponding
authors were contacted by email and requested to provide
the data. Where data were not presented in tables or text, and
2 Methods no additional data were provided by the authors, data were
extracted from figures using WebPlotDigitizer (WebPlotDig-
2.1 Search Strategy itizer, V.4.4. Texas, USA: Ankit Rohatgi, 2020). Studies in
which data extraction was not possible were excluded.
The review was conducted in accordance with the PRISMA Studies were excluded for the following reasons: training
(Preferred Reporting Items for Systematic Reviews and groups used same periodization model, where the influence
Meta-Analyses) guidelines [14]. Studies published before of other variables were investigated; only one training group
7 February 2021 were located using searches of PubMed, was included in the study; did not use dynamic resistance
Scopus, and SPORTDiscus databases. Combinations of the exercises; no measures of muscle hypertrophy or 1RM; did
following search terms were used: “periodization,” “perio- not equate for volume and mean intensity between training
dized,” “non-periodized,” “periodization,” “periodized,” groups; training groups did not use identical training fre-
“non-periodised,” “resistance training,” “strength train- quency, exercises, or exercise order; loading not relative to
ing,” “weightlifting,” “powerlifting,” “strength,” “muscular participants’ level of strength; used non-original data from
strength,” “maximal strength,” “1RM,” “muscle hypertro- already included studies; data to calculate ES not available.
phy,” “muscle mass,” “muscle cross-sectional area,” “lean Figure 1 depicts a flow chart of the study selection process.
body mass,” “fat-free mass.” Duplicate publications were
removed, and reference lists from retrieved articles were 2.3 Coding of Studies
manually reviewed for additional publications not discov-
ered based on database searches. All of the included studies were individually coded by three
of the investigators (LM, MB, LC) for the following vari-
2.2 Study Selection ables: study characteristics (author(s), title and year of publi-
cation); participant characteristics, including age (classified
The inclusion criteria were as follows: Peer-reviewed pub- as adolescents (< 18 years), adults (18–49 years), or older
lication; available in English; a comparison of at least one adults (≥ 50 years)), sex, resistance training status (as clas-
periodized resistance training group to either a NP resist- sified by the author(s) of the individual studies); description
ance training group or another periodized resistance training of training groups (classified as NP if there was no manip-
group, using a different periodization model; training proto- ulation of volume and intensity throughout the training
cols involved dynamic resistance exercises with both con- intervention; classified as LP if there was a linear increase
centric and eccentric muscle actions; loading of resistance in intensity and linear decrease in volume throughout the
exercises was determined relative to participants’ level of training intervention; classified as RLP if there was a linear
strength; maximal strength measured by 1RM and/or at least decrease in intensity and linear increase in volume through-
one method of assessing changes in muscle mass; human out the training intervention; classified as BP if the train-
participants; reporting of mean, standard deviation (SD), ing intervention was divided into blocks with differences
or standard error of the mean (SEM), and sample number in intensity and volume, and intensity and volume did not
provided in the text, table(s), or figure(s); study duration linearly increase and decrease, respectively, throughout the
stated in weeks or months; equated for total volume (sets × training intervention; classified as WUP if there were non-
repetitions) and mean intensity between at least two train- linear weekly undulations in volume and intensity through-
ing groups; training protocols involved identical training out the training intervention and classified as DUP if there
frequency, exercises, exercise order, and execution for the were daily undulations in volume and intensity throughout
different groups; training intervention with a duration of the training intervention); study duration; the number of par-
minimum 4 weeks. ticipants in each group; training variables, including training
A total of 1099 articles were identified from the initial volume (number of sets per exercise and number of repeti-
search. Four other articles were identified through other tions per set), training intensity and training frequency; 1RM
sources. To reduce potential selection bias, the 1103 studies tests; methods used for assessment of muscle hypertrophy.
1650 L. Moesgaard et al.

Fig. 1  Flow chart of study selection. n Number of studies, 1RM 1-repetetion maximum, ES effect size

Coding was cross-checked between coders, and any discrep- interventions is not feasible, no included studies could earn
ancies were resolved by mutual consensus and consultation points on the PEDro scale items 5 and 6. Therefore, the
with a fourth investigator (JLJ), if needed. scale was modified, so the maximum score was 8 points.
The assessments of methodological quality were performed
2.4 Bias Assessment individually by three of the investigators (LM, MB, and LC),
and any discrepancies were resolved by mutual consensus
An assessment of the methodological quality of the included and consultation with a fourth investigator (JLJ), if needed.
studies was performed using a modified PEDro scale. Details
about the PEDro scale are presented elsewhere [15]. Because
blinding of participants and investigators in exercise
Effects of Resistance Training Periodization on Strength and Muscle Hypertrophy 1651

2.5 Calculation of Effect Size 95% confidence intervals (95% CIs) were used to determine
effect measures, with an ES of 0.2, 0.5, and 0.8 represent-
For each 1RM and muscle hypertrophy outcome an ES ing small, moderate, and large differences, respectively
was calculated. Within-group ESs were calculated as the [20]. The inverse-variance random effects model was used
pretest–post-test change, divided by the pooled pretest SD for the meta-analysis procedures, as the included stud-
[16]. When studies presented data as mean ± SEM, SEM was ies were performed in different populations using diverse
converted to SD. Between-group ESs were calculated as fol- methods. Statistical heterogeneity of the included studies
lows: d = (ΔMt − ΔMc)∕SDpre , where d is the magnitude was assessed using the χ2 and I2 statistics, in which val-
of the ES, ΔMt is the pretest–posttest change of the treat- ues of < 25% indicate low risk of heterogeneity, 25–75%
ment group, ΔMc is the pretest–posttest change of the con- indicate moderate risk of heterogeneity, and > 75% indicate
trol group and SDpre is the pooled pretest SD [16]. The vari- high risk of heterogeneity [21]. To identify the presence of
ance around each ES was calculated using the sample size in influential studies that might bias the analysis, sensitivity
each study and mean ES across all studies in the respective analyses were conducted by removing one study at a time
meta-analysis [17]. When studies assessed multiple 1RM and then examining the outcomes. Studies were identified
outcomes between-group ESs were combined, accounting as influential if removal resulted in change in P value from
for non-independent ESs within studies as follows: P ≤ 0.01 to P ≥ 0.05 or from P ≤ 0.05 to P ≥ 0.10, or vice
VY = m1 V(1 + (m − 1) × r), where VY is the variance of the versa. A subgroup analysis was performed to investigate if
mean ES, V is the variance of the 1RM outcome ESs, m is the results were affected by the training status of the par-
the number of 1RM outcomes within the study and r is the ticipants. For this analysis, studies conducted on untrained
correlation coefficient that describes the extent to which the and trained participants were analyzed separately. Subgroup
outcomes correlate [18]. The correlation coefficients were analyses investigating potential effects of age and sex were
calculated from the raw data of the included study by Eifler not performed due to a low number of studies with only
[19], which consisted of raw data from 200 participants and female, older adults or adolescent participants, in the respec-
eight 1RM outcomes. For the few studies that assessed mul- tive meta-analyses. The statistical significance threshold was
tiple muscle hypertrophy outcomes, raw data of the indi- set at P ≤ 0.05. Data are reported as mean, SD, and 95% CI.
vidual participants were not available. Therefore, the mean
ES and corresponding variance was used.
Mean percent changes in 1RMs and measures of muscle 3 Results
mass in the individual studies were also calculated. Addi-
tionally, to control for differences between studies in the A total of 35 studies were included in the review, with a total
duration of the intervention (with longer training interven- of 1187 participants. 169 participants were classified as ado-
tions being expected to result in larger increases in strength lescents, 893 participants were classified as adults and 125
and muscle mass), relative changes per week were calcu- participants were classified as older adults. Thirteen studies
lated, by dividing mean percent changes with the study included non-resistance training control groups that were
duration. not included in the analysis. Also, the study by Stone et al.
[22] included a periodized resistance training group that
2.6 Statistical Analysis was not included in the analysis, because volume was not
equated with the other training groups. Thus, data from 1022
Four meta-analyses were performed: (a) comparison of participants (129 classified as adolescents, 791 classified as
changes in 1RM, in response to NP versus periodized adults, and 102 classified as older adults) were included in
resistance training; (b) comparison of measure(s) of muscle the calculation of ESs and percent changes. Nineteen stud-
hypertrophy in response to NP versus periodized resistance ies included only male participants, seven studies included
training; (c) comparison of changes in 1RM, in response only female participants, and nine studies included partici-
to LP versus UP; (d) comparison of measure(s) of muscle pants of both sexes. Nineteen studies were conducted on
hypertrophy in response to LP versus UP. In the meta-anal- untrained participants, 15 studies were conducted on trained
yses investigating LP versus UP, training groups coded as participants, and one study was conducted on detrained
WUP and DUP were classified as UP. No meta-analyses participants. Study duration ranged from 6 to 36 weeks,
of other periodization model comparisons were performed with a mean study duration of 13.7 ± 6.0 weeks. Training
due to a low number of studies comparing these periodiza- frequency ranged from 2 to 4 days per week, with a mean
tion models. All meta-analyses were performed using the training frequency of 2.9 ± 0.7 days per week. Prescribed
RevMan 5.4 software (Review Manager (RevMan) Ver- volume per exercise ranged from 1 to 7 sets of 1–30 repeti-
sion 5.4. Copenhagen: The Nordic Cochrane Centre, The tions. Training intensity varied between 30–105%1RM and
Cochrane Collaboration, 2020). Between-group ESs with 3–30RM. Fifteen studies reported compliance to the training
1652 L. Moesgaard et al.

intervention, mean compliance to the training interventions which Monteiro et al. [42] was removed the magnitude of
were 93.0 ± 10.4% in these studies. Maximal strength was the effect decreased (ES 0.19, 95% CI [0.01, 0.38]; Z = 2.05
assessed by 1RM in 32 studies, using a variety of differ- (P = 0.04)), and observed heterogeneity was reduced to a
ent resistance exercises, resulting in 210 within-group ESs. degree where it was not significant (χ2 = 20.89, df = 13
Muscle hypertrophy was assessed in 25 studies using a vari- (P = 0.08), I2 = 38%). No significant differences were found
ety of methods, resulting in 64 within-group ESs. A sum- when studies conducted on untrained or trained participants
mary of the included studies is presented in Table 1. were analyzed separately.

3.1 Methodological Quality of Studies 3.2.2 Effects on Muscle Hypertrophy

The values obtained for assessment of methodological qual- Ten studies comparing NP to periodized resistance train-
ity using the PEDro scale are presented in Table 1. Across ing assessed muscle hypertrophy. Various methods were
studies, PEDro scores ranged from 2 to 7 points with a mean used for assessment of muscle hypertrophy (Table 1). The
PEDro score of 4.8 ± 1.0 points. A PEDro score of ≤ 3 points mean relative change in measures of muscle mass across
was interpreted as low methodological quality, a PEDro studies comparing NP to periodized resistance training was
score of 4–5 points was interpreted as moderate methodolog- 3.2% ± 3.2% corresponding to 0.27% ± 0.31% per week for
ical quality and a PEDro score of ≥ 6 points was interpreted NP resistance training and 4.2% ± 3.4% corresponding to
as high methodological quality. Based on this interpretation, 0.34% ± 0.34% per week for periodized resistance training.
two studies were deemed to be of low methodological qual- The mean within-group ES for changes in measures of mus-
ity, 24 studies were deemed to be of moderate methodo- cle mass across studies comparing NP to periodized resist-
logical quality, and nine studies were deemed to be of high ance training was 0.22 ± 0.30 for NP resistance training and
methodological quality. 0.34 ± 0.28 for periodized resistance training.
The meta-analysis comparing effects on measures of mus-
3.2 Non‑periodized Versus Periodized Resistance cle hypertrophy between NP and periodized resistance train-
Training ing comprised of 16 between-group ESs from the ten stud-
ies (Fig. 3). The studies included in the meta-analysis were
Fifteen studies compared NP to periodized resistance train- found not to be heterogenous (χ2 = 3.73, df = 9 (P = 0.93),
ing, using various periodization models. Ten studies were I2 = 0%). The meta-analysis showed no clear effect on mus-
conducted on untrained participants and five studies were cle hypertrophy favoring NP or periodized resistance train-
conducted on trained participants. ing (ES 0.13, 95% CI [–0.10, 0.36]; Z = 1.10 (P = 0.27)).
None of the sensitivity analyses removing one study at a
3.2.1 Effects on Maximal Strength time revealed influential studies that altered the results. In
addition, no significant differences were found when studies
All studies comparing NP to periodized resistance training conducted on untrained or trained participants were analyzed
assessed increases in maximal strength by 1RM. The mean separately.
relative change in 1RM across studies comparing NP to peri-
odized resistance training was 22.7% ± 14.6% corresponding 3.3 Linear Periodization (LP) versus Undulating
to 1.77% ± 1.06% per week for NP resistance training and Periodization (UP)
27.6% ± 18.5% corresponding to 2.13% ± 1.32% per week for
periodized resistance training. The mean within-group ES Sixteen studies compared LP to UP, periodized as DUP,
for changes in 1RM across studies comparing NP to perio- WUP, or a combination of the two. Nine studies were con-
dized resistance training was 0.98 ± 0.70 for NP resistance ducted on untrained participants, six studies were conducted
training and 1.30 ± 1.11 for periodized resistance training. on trained participants, and one study was conducted on
The meta-analysis comparing changes in 1RM between detrained participants.
NP and periodized training groups comprised of 70 between-
group ESs from the 15 studies (Fig. 2). The studies included 3.3.1 Effects on Maximal Strength
in the meta-analysis were found to be moderately heteroge-
neous (χ2 = 51.47, df = 14 (P < 0.00001), I2 = 73%). Fourteen of the studies comparing LP to UP assessed maxi-
The meta-analysis indicated a significant effect on 1RM mal strength by 1RM. The mean relative change in 1RM
favoring periodized training (ES 0.31, 95% CI [0.04, 0.57]; across studies comparing LP to UP was 17.8% ± 11.2%
Z = 2.28 (P = 0.02)). When removing one study at a time, corresponding to 1.71% ± 1.29% per week for LP and
no sensitivity analyses revealed influential studies that 22.8% ± 12.5% corresponding to 2.20% ± 1.43% per week
altered the P value. However, in the sensitivity analysis in for UP. The mean within-group ES for changes in 1RM
Table 1  Overview of included studies
Study Participants Comparison(s) Sets × reps; inten- Study duration; Measures of 1RM Mean 1RM percent Mean muscle mass PEDro score
sity training frequency and muscle hyper- change; mean 1RM percent change;
trophy ES mean muscle hyper-
trophy ES

Ahmadizad et al. 32 untrained adult NP (n = 8) vs NP: 2 × 12; 8 weeks; 3 days/ 1RM bench press NP: 6.0% (0.75%/ NP: 1.9% (0.24%/ 5
[23] males LP (n = 8) vs. DUP 70%1RM week 1RM squat week); 0.34 week); 0.19
(n = 8) LP: 2 × 8–18; BIA LP: 10.5% (1.31%/ LP: 1.9% (0.24%/
50–85%1RM week); 0.63 week); 0.19
DUP: 2 × 8–16; DUP: 12.4% DUP: 2.0% (0.25%/
55–85%1RM (1.55%/week); week); 0.19
0.74
Baker et al. [24] 22 untrained adult NP (n = 9) vs NP: 3–5 × 6–8; 12 weeks; 3 days/ 1RM squat NP: 19.3% (1.61%/ NP: 3.2% (0.27%/ 3
males LP (n = 8) vs. WUP 6–8RM week 1RM bench press week); 0.98 week); 0.34
(n = 5) LP: 3–5 × 3–10; skinfolds LP: 19.6% (1.63%/ LP: 2.8% (0.23%/
3–10RMs week); 0.94 week); 0.28
WUP: 3–5 × 3–10; WUP: 22.4% WUP: 3.4% (0.28%/
3–10RMs (1.87%/week); week); 0.31
1.04
Bartolomei et al. 24 trained adult BP (n = 14) vs. BP: NR × 1–10; 15 weeks; 4 days/ 1RM bench press BP: 7.6% (0.51%/ BP: 3.2% (0.21%/ 5
[25] males WUP (n = 10) 50–95%1RM week skinfolds week); 0.37 week); 0.36
WUP: 5 × 3–10; WUP: 2.0% (0.13%/ WUP: 2.0% (0.13%/
50–95%1RM week); 0.09 week); 0.22
Effects of Resistance Training Periodization on Strength and Muscle Hypertrophy

Bartolomei et al. 17 trained adult BP (n = 9) vs. WUP BP: 3–5 × 3–10; 10 weeks; 3 days/ 1RM squat BP: 11.6% (1.16%/ BP: 5.5% (0.55%/ 5
[26] females (n = 8) 65–93%1RM week 1RM bench press week); 0.56 week); 0.36
WUP: 3–5 × 3–10; 1RM deadlift WUP: 17.3% WUP: 6.1% (0.61%/
65–93%1RM skinfolds (1.73%/week); week); 0.43
circumference meas- 0.78
ures
Bartolomei et al. 18 trained adult BP (n = 10) vs. BP: NR × 1–10; 15 weeks; 4 days/ 1RM bench press BP: 7.5% (0.50%/ BP: 2.5% (0.17%/ 5
[27] males WUP (n = 8) 50–95%1RM week skinfolds week); 0.44 week); 0.22
WUP: 4–5 × 3–10; WUP: 1.3% (0.09%/ WUP: 1.7% (0.11%/
50–95%1RM week); 0.07 week); 0.15
Buford et al. [28] 28 detrained adult LP (n = 9) vs. DUP LP: 3 × 4–8; 9 weeks; 3 days/ 1RM bench press LP: 54.8% (6.09%/ Not assessed 5
males and females (n = 10) vs. WUP 80–90%1RM week 1RM leg press week); 1.61
(n = 9) DUP: 3 × 4–8; DUP: 48.3%
80–90%1RM (5.37%/week);
WUP: 3 × 4–8; 1.57
80–90%1RM WUP: 62.1%
(6.90%/week);
1.81
1653
Table 1  (continued)
1654

Study Participants Comparison(s) Sets × reps; inten- Study duration; Measures of 1RM Mean 1RM percent Mean muscle mass PEDro score
sity training frequency and muscle hyper- change; mean 1RM percent change;
trophy ES mean muscle hyper-
trophy ES

Conlon et al. [29] 33 untrained older NP (n = 10) vs. BP NP: 3 × 10; 10RM 22 weeks; 3 days/ 1RM leg press NP: 33.7% (1.53%/ NP: 7.2% (0.33%/ 5
adult males and (n = 13) vs. DUP BP: 3 × 5–15; week 1RM chest press week); 0.91 week); 0.32
females (n = 10) 5–15RMs DEXA BP: 46.8% (2.13%/ BP: 5.6% (0.25%/
DUP: 3 × 5–15; week); 1.19 week); 0.24
5–15RMs DUP: 32.8% DUP: 7.6% (0.35%/
(1.49%/week); week); 0.36
1.09
DeBeliso et al. [30] 43 untrained older NP (n = 13) vs. LP NP: 3 × 9; 9RM 18 weeks; 2 days/ 1RM leg press NP: 51.2% (2.84%/ Not assessed 4
adult males and (n = 17) LP: 2–4 × 6–15; week 1RM leg extension week); 1.33
females 6–15RM 1RM leg curl LP: 61.6% (3.42%/
1RM chest press week); 1.39
1RM shoulder press
1RM lat pulldown
1RM triceps exten-
sion
1RM biceps curl
De Lima et al. [31] 28 untrained adult DUP (n = 10) vs. DUP: 3 × 15–30; 12 weeks; 4 days/ 1RM bench press DUP: 28.1% DUP: 3.5% (0.29%/ 4
females WUP (n = 10) 15–30RM week 1RM leg press (2.34%/week); week); 0.32
WUP: 3 × 15–30; 1RM biceps curl 1.52 WUP: 4.7% (0.39%/
15–30RM skinfolds WUP: 29.4% week); 0.43
(2.45%/week);
1.53
De Souza et al. [32] 33 untrained adult NP (n = 8) vs. LP NP: 2–3 × 8; 8RM 12 weeks; 2 days/ 1RM squat NP: 21.4% (1.78%/ NP: 9.2% (0.77%/ 5
males (n = 9) vs. DUP LP: 2–4 × 4–12; week MRI week); 1.14 week); 0.74
(n = 8) 4–12RM LP: 17.9% (1.49%/ LP: 11.4% (0.95%/
DUP: 2–4 × 4–12; week); 0.95 week); 0.91
4–12RM DUP: 19.2% DUP: 11.8%
(1.60%/week); (0.98%/week);
1.09 0.91
Eifler [19] 200 trained adult NP (n = 50) vs. LP NP: 3 × 10; 6 weeks; 3 days/ 1RM leg press NP: 13.0% (2.17%/ Not assessed 4
males and females (n = 50) vs. RLP 80%1RM week 1RM chest press week); 0.32
(n = 50) vs. DUP LP: 3 × 5–15; 1RM fly LP: 14.9% (2.48%/
(n = 50) 70–90%1RM 1RM lat pulldown week); 0.35
RLP: 3 × 5–15; 1RM row RLP: 14.2% (2.37%/
70–90%1RM 1RM shoulder press week); 0.37
DUP: 3 × 5–15; 1RM triceps push- DUP: 23.6%
70–90%1RM down (3.93%/week);
1RM biceps curl 0.53
L. Moesgaard et al.
Table 1  (continued)
Study Participants Comparison(s) Sets × reps; inten- Study duration; Measures of 1RM Mean 1RM percent Mean muscle mass PEDro score
sity training frequency and muscle hyper- change; mean 1RM percent change;
trophy ES mean muscle hyper-
trophy ES

Foschini et al. [33] 32 untrained ado- LP (n = 16) vs. DUP LP: 3 × 6–20; 14 weeks; 3 days/ BOD POD Not assessed LP: 3.4% (0.24%/ 6
lescent males and (n = 16) 6–20RMs week week); 0.22
females DUP: 3 × 6–20; DUP: 2.4% (0.17%/
6–20RMs week); 0.17
Franchini et al. [34] 13 trained adult RLP (n = 6) vs. DUP RLP: 4 × 3–20; 8 weeks; 3 days/ 1RM squat RLP: 10.0% (1.25%/ Not assessed 4
males (n = 7) 3–20RMs week 1RM bench press week); 0.62
DUP: 4 × 3–20; 1RM row DUP: 9.4% (1.18%/
3–20RMs week); 0.56
Gavanda et al. [35] 28 trained adoles- LP (n = 14) vs. DUP LP: 1–4 × 5–20; 12 weeks; 3 days/ 1RM squat LP: 16.2% (1.35%/ LP: 7.0% (0.58%/ 4
cent males (n = 14) 55–85%1RM week 1RM bench press week); 0.60 week); 0.43
DUP: 1–4 × 5–20; BIA DUP: 15.9% DUP: 7.3% (0.61%/
55–85%1RM ultrasound (1.33%/week); week); 0.43
0.55
Harries et al. [36] 26 trained adoles- DUP (n = 8) vs. DUP: 4–6 × 3–10; 12 weeks; 2 days/ BIA Not assessed DUP: 1.0% (0.08%/ 7
cent males WUP (n = 8) 60–81%1RM week week); 0.06
WUP: 4–6 × 3–10; WUP: 2.1% (0.18%/
60–81%1RM week); 0.13
Herrick and Stone 20 untrained adult NP (n = 10) vs. LP NP: 3 × 6; 6RM 15 weeks; 2 days/ 1RM squat NP: 35.8% (2.39%/ Not assessed 5
Effects of Resistance Training Periodization on Strength and Muscle Hypertrophy

[37] females (n = 10) LP: 3 × 3–10; week 1RM bench press week); 1.28
3–10RMs LP: 42.7% (2.85%/
week); 1.45
Inoue et al. [38] 45 untrained ado- LP (n = 13) vs. DUP LP: 3 × 6–20; 26 weeks; 3 days/ BOD POD Not assessed LP: 7.9% (0.30%/ 4
lescent males and (n = 12) 6–20RMs week week); 0.60
females DUP: 3 × 6–20; DUP: 2.6% (0.10%/
6–20RMs week); 0.22
Kok et al. [39] 20 untrained adult BP (n = 10) vs. DUP BP: 3–4 × 6–10; 9 weeks; 3 days/ 1RM squat BP: 28.3% (3.14%/ BP: 8.7% (0.97%/ 5
females (n = 10) 30–90%1RM week 1RM bench press week); 1.36 week); 0.57
DUP: 3–4 × 6–10; ultrasound DUP: 34.8% DUP: 14.8%
30–90%1RM (3.87%/week); (1.64%/week);
1.55 0.87
Kraemer et al. [40] 27 untrained adult NP (n = 10) vs. DUP NP: 2–3 × 8–10; 36 weeks; 3 days/ 1RM bench press NP: 20.2% (0.56%/ NP: 3.5% (0.10%/ 5
females (n = 9) 8–10RM week 1RM leg press week); 0.97 week); 0.36
DUP: 2–3 × 4–15; 1RM shoulder press DUP: 23.9% DUP: 7.1% (0.20%/
4–15RMs skinfolds (0.66%/week); week); 0.74
1.23
Miranda et al. [41] 20 trained adult LP (n = 10) vs. DUP LP: 3 × 4–10; 12 weeks; 4 days/ 1RM bench press LP: 12.5% (1.04%/ Not assessed 6
males (n = 10) 4–10RM week 1RM leg press week); 0.60
DUP: 3 × 4–10; DUP: 17.0%
4–10RM (1.42%/week);
1.66
1655
Table 1  (continued)
1656

Study Participants Comparison(s) Sets × reps; inten- Study duration; Measures of 1RM Mean 1RM percent Mean muscle mass PEDro score
sity training frequency and muscle hyper- change; mean 1RM percent change;
trophy ES mean muscle hyper-
trophy ES

Monteiro et al. [42] 27 trained adult NP (n = 9) vs. LP NP: 3 × 8–10; 12 weeks; 4 days/ 1RM bench press NP: 8.5% (0.71%/ NP: –3.0% (–0.25%/ 4
males (n = 9) vs. DUP 8–10RM week 1RM leg press week); 0.86 week); –0.50
(n = 9) LP: 3 × 4–15; skinfolds LP: 10.4% (0.87%/ LP: 1.2% (0.10%/
4–15RMs week); 1.13 week); 0.19
DUP: 3 × 4–15; DUP: 35.6% DUP: 0.3% (0.03%/
4–15RMs (2.97%/week); week); 0.05
3.83
Moraes et al. [43] 38 untrained adoles- NP (n = 14) vs. DUP NP: 3 × 10–12; 12 weeks; 3 days/ 1RM bench press NP: 53.6% (4.47%/ Not assessed 6
cent males (n = 14) 10–12RM week 1RM leg press week); 3.30
DUP: 3 × 3–20; DUP: 71.2%
3–20RMs (5.93%/week);
4.62
Peterson et al. [44] 14 trained adult BP (n = 7) vs. DUP BP: 2–7 × NR; 9 weeks; 3 days/ 1RM squat BP: 14.4% (1.60%/ Not assessed 6
males (n = 7) 30–100%1RM week 1RM bench press week); 0.57
DUP: 2–7 × NR; DUP: 18.7%
30–100%1RM (2.08%/week);
0.90
Prestes et al. [45] 40 trained adult DUP (n = 20) vs. DUP: 3 × 6–12; 12 weeks; 4 days/ 1RM bench press DUP: 29.7% Not assessed 6
males WUP (n = 20) 6–12RMs week 1RM leg press (2.48%/week);
WUP: 3 × 6–12; 1RM biceps curl 1.19
6–12RMs WUP: 19.0%
(1.58%/week);
0.80
Prestes et al. [46] 49 untrained older LP (n = 20) vs. DUP LP: 3 × 6–14; 16 weeks; 2 days/ 1RM bench press LP: 25.0% (1.56%/ LP: –1.6% (–0.10%/ 4
adult females (n = 19) 6–14RMs week 1RM leg press week); 0.86 week); –0.14
DUP: 3 × 6–14; 1RM biceps curl DUP: 13.6% DUP: 1.7% (0.11%/
6–14RMs DEXA (0.85%/week); week); 0.15
0.47
Rhea et al. [47] 20 trained adult LP (n = 10) vs. DUP LP: 3 × 4–8; 12 weeks; 3 days/ 1RM bench press LP: 20.0% (1.67%/ Not assessed 6
males (n = 10) 4–8RMs week 1RM leg press week); 0.87
DUP: 3 × 4–8; DUP: 42.3%
4–8RMs (3.53%/week);
1.51
Rhea et al. [48] 60 trained adult LP (n = 20) vs. RLP LP: 3 × 15–25; 15 weeks; 2 days/ 1RM leg extension LP: 9.1% (0.61%/ Not assessed 5
males and females (n = 20) vs. DUP 15–25RMs week week); 0.31
(n = 20) RLP: 3 × 15–25; RLP: 5.6% (0.37%/
15–25RMs week); 0.17
DUP: 3 × 15–25; DUP: 9.8% (0.65%/
15–25RMs week); 0.31
L. Moesgaard et al.
Table 1  (continued)
Study Participants Comparison(s) Sets × reps; inten- Study duration; Measures of 1RM Mean 1RM percent Mean muscle mass PEDro score
sity training frequency and muscle hyper- change; mean 1RM percent change;
trophy ES mean muscle hyper-
trophy ES

Schiotz et al. [49] 14 trained adult NP (n = 8) vs. LP NP: 4 × 6; 80%1RM 10 weeks; 4 days/ 1RM squat NP: 8.1% (0.81%/ NP: 0.4% (0.04%/ 4
males (n = 6) LP: 5–6 × 1–10; week 1RM bench press week); 0.37 week); 0.03
50–105%1RM skinfolds LP: 9.0% (0.90%/ LP: 1.1% (0.11%/
week); 0.40 week): 0.08
Simão et al. [50] 30 untrained adult LP (n = 10) vs. LP: 2–4 × 3–15; 12 weeks; 2 days/ 1RM bench press LP: 14.9% (1.24%/ LP: 3.3% (0.28%/ 6
males DUP/WUP 3–15RMs week 1RM lat pulldown week); 0.83 week); 0.21
(n = 11) DUP/WUP: 2–4 × 1RM biceps curl DUP/WUP: 18.6% DUP/WUP: 6.7%
3–15; 1RM triceps exten- (1.55%/week); (0.56%/week);
3–15RMs sion ultrasound 1.08 0.48
Soares et al. [51] 41 untrained adult NP (n = 13) vs. DUP NP: 3 × 8–12; 12 weeks; 3 days/ 1RM bench press NP: 29.3% (2.44%/ NP: 1.9% (0.16%/ 5
males and females (n = 13) 70%1RM week 1RM leg press week); 0.59 week); 0.16
DUP: 3 × 4–20; 1RM lat pulldown DUP: 37.9% DUP: 2.5% (0.21%/
50–90%1RM 1RM leg curl (3.16%/week); week); 0.22
1RM triceps push- 1.03
down
1RM calf raise
BIA
Souza et al. [52] 31 untrained adult NP (n = 9) vs. LP NP: 2–3 × 8; 8RM 6 weeks; 2 days/ 1RM squat NP: 17.1% (2.85%/ NP: 5.1% (0.85%/ 5
Effects of Resistance Training Periodization on Strength and Muscle Hypertrophy

males (n = 9) vs. DUP LP: 2–4 × 8–12; week MRI week); 0.91 week); 0.41
(n = 8) 8–12RMs LP: 8.4% (1.40%/ LP: 4.7% (0.78%/
DUP: 2–4 × 6–12; week); 0.45 week); 0.38
6–12RMs DUP: 11.9% DUP: 7.8% (1.30%/
(1.98%/week); week); 0.60
0.67
Spineti et al. [53] 32 untrained adult LP (n = 13) vs. DUP LP: 2–4 × 3–15; 12 weeks; 2 days/ 1RM bench press LP: 14.9% (1.24%/ LP: 6.2% (0.52%/ 4
males (n = 10) 3–15RMs week 1RM lat pulldown week); 0.96 week); 0.48
DUP: 2–4 × 3–15; 1RM biceps curl DUP: 21.7% DUP: 7.7% (0.64%/
3–15RMs 1RM triceps exten- (1.81%/week); week); 0.65
sion ultrasound 1.31
Stone et al. [22] 21 trained adult NP (n = 5) vs. LP NP: 5 × 6; 6RM 12 weeks; 3 days/ 1RM squat NP: 10.0% (0.83%/ Not assessed 2
males (n = 9) LP: 3–4 × 3–10; week week); 0.76
3–10RMs LP: 14.9% (1.24%/
week); 1.02
Streb et al. [54] 34 untrained adult NP (n = 8) vs. LP NP: 2 ×10–12; 16 weeks; 3 days/ 1RM bench press NP: 13.4% (0.84%/ NP: 2.7% (0.17%/ 6
males and females (n = 11) 10–12RM week 1RM leg press week); 0.40 week); 0.11
LP: 2 × 8–14; BIA LP: 12.0% (0.75%/ LP: 0.5% (0.03%/
8–14RMs week); 0.35 week); 0.02
1657
 1658 L. Moesgaard et al.

across studies comparing LP to UP was 0.81 ± 0.35 for LP

ES effect size, NP non-periodized, LP linear periodization, RLP reverse linear periodization, BP block periodization, DUP daily undulating periodization, WUP weekly undulating periodiza-
tion, RM repetition maximum, 1RM 1-repetetion maximum, BIA bioelectrical impedance analysis, DEXA dual-energy X-ray absorptiometry, MRI magnetic resonance imaging, BOD POD air
Mean muscle mass PEDro score and 1.26 ± 1.12 for UP.
The meta-analysis comparing changes in 1RM between
LP and UP comprised of 38 between-group ESs from the 14
4
studies (Fig. 4). The studies included in the meta-analysis
mean muscle hyper-

were found to be moderately heterogeneous (χ2 = 43.35,

percent change;

df = 13 (P < 0.00001), I2 = 70%). The meta-analysis indi-

Not assessed

cated a significant effect on 1RM favoring UP (ES 0.31, 95%

trophy ES

CI [0.02, 0.61]; Z = 2.06 (P = 0.04)). When removing one

study at a time, no sensitivity analyses revealed influential
studies that altered the P value. However, in the sensitiv-
change; mean 1RM
Mean 1RM percent

BP: 44.9% (1.60%/

LP: 43.5% (1.55%/

ity analysis in which Monteiro et al. [42] was removed the

magnitude of the effect decreased twofold (ES = 0.15, 95%
week); 2.08

week); 2.08

CI [0.00, 0.30]; Z = 1.92 (P = 0.05)), and observed heteroge-

neity was eliminated (χ2 = 10.70, df = 12 (P = 0.56), I2 = 0%).
Subgroup analyses in which studies conducted on untrained
ES

and trained participants were analyzed separately indicated

1RM hip abduction
1RM hip adduction

a moderate effect favoring UP for studies conducted on

and muscle hyper-
Measures of 1RM

1RM bench press

1RM waist cross

1RM abdominal
1RM hack squat

trained participants (ES 0.61, 95% CI [0.00, 1.22]; Z = 1.97

1RM leg press

(P = 0.05)), whereas no effect favoring LP or UP was found

1RM row

for studies conducted on untrained participants (ES 0.06,

chair
trophy

over

95% CI [–0.20, 0.31]; Z = 0.43 (P = 0.67)), indicating that

training status may influence the effects of these periodiza-
tion models.
training frequency

28 weeks; 3 days/
Study duration;

3.3.2 Effects on Muscle Hypertrophy

week

Eleven studies comparing LP to UP assessed muscle hyper-

trophy. Various methods were used for assessment of muscle
hypertrophy (Table 1). The mean relative change in meas-
Sets × reps; inten-

BP: 3–4 × 6–20;

ures of muscle mass across studies comparing LP to UP

LP: 3 × 6–20;

was 4.4% ± 3.4% corresponding to 0.37% ± 0.29% per week

6–20RMs

6–20RMs

for LP and 4.9% ± 3.4% corresponding to 0.46% ± 0.39%

per week for UP. The mean within-group ES for changes in
sity

measures of muscle mass across studies comparing LP to UP

was 0.34 ± 0.26 for LP and 0.38 ± 0.25 for UP.
LP (n = 14) vs. BP

The meta-analysis comparing effects on measures of

Comparison(s)

muscle hypertrophy between LP and UP comprised of 16

(n = 13)

between-group ESs from the 11 studies (Fig. 5). The studies

included in the meta-analysis were found not to be heteroge-
displacement plethysmography, NR not reported.

neous (χ2 = 2.46, df = 10 (P = 0.99), I2 = 0%). The meta-anal-

ysis showed no effect on muscle hypertrophy favoring LP
27 untrained adult

or UP (ES 0.05, 95% CI [–0.20, 0.29]; Z = 0.36 (P = 0.72)).

None of the sensitivity analyses removing one study at a
Participants

time revealed influential studies that altered the results. In

females

addition, no significant differences were found when studies

conducted on untrained or trained participants were analyzed
separately.
Table 1  (continued)

Vanni et al. [55]

3.4 Other Periodization Model Comparisons

Six studies compared BP to UP, either periodized as DUP

Study

or WUP. All six studies assessed maximal strength by 1RM

Effects of Resistance Training Periodization on Strength and Muscle Hypertrophy 1659

Fig. 2  Forest plot of changes in 1RM for non-periodized and periodized resistance training. 1RM 1-repetition maximum, ES effect size, SE
standard error, IV inverse variance, CI confidence interval

Fig. 3  Forest plot of measures of muscle hypertrophy for non-periodized and periodized resistance training. ES effect size, SE standard error, IV
inverse variance, CI confidence interval

and five of the studies assessed muscle hypertrophy. Four not assess muscle hypertrophy. The study by Vanni et al.
studies compared DUP to WUP. Three of these studies [55] was the only study that compared LP to BP. This study
assessed maximal strength by 1RM and two of the stud- assessed maximal strength by 1RM and did not assess mus-
ies assessed muscle hypertrophy. Three studies compared cle hypertrophy.
DUP to RLP. All of the three studies assessed maximal There was an insufficient number of studies investigating
strength by 1RM, whereas none of the studies assessed mus- these periodization model comparisons to determine dif-
cle hypertrophy. Two studies compared LP to RLP. Both of ferences in effects on maximal strength and muscle hyper-
these studies assessed maximal strength by 1RM and did trophy based on meta-analyses. Results of the individual
1660 L. Moesgaard et al.

studies comparing these periodization models are presented resistance training. In contrast to the results from Williams
in Table 1. et al., the observed greater increases in maximal strength
in response to periodized resistance training compared to
NP resistance training cannot be explained by differences
4 Discussion in training volume, as this is the first meta-analysis to only
include studies in which volume has been equated between
The results from the present systematic review and meta- periodized and NP resistance training. Two meta-analyses
analysis show that when comparing the change from pre have previously compared the effects of LP and UP on
to post intervention between volume-equated resistance maximal strength. Harries et al. [56] found no significant
training programs, periodized resistance training leads to differences between LP and UP on upper-body and lower-
larger increases in maximal dynamic strength (1RM) as body strength, whereas Caldas et al. [57] found an ES of
compared to NP resistance training. No significant differ- 0.22 favoring UP. Both of these meta-analyses computed
ences were found when comparing measures of muscle standardized mean differences (SMD) between posttests, not
hypertrophy between NP and periodized resistance train- accounting for within-group differences between pretest and
ing, indicating that muscle hypertrophy is similar between posttest. This may explain discrepancies in results with the
NP and periodized resistance training. Furthermore, UP was present meta-analysis. Although this is the first meta-anal-
found to promote increases in strength more efficiently than ysis comparing muscle hypertrophy between NP and perio-
LP, indicating that daily or weekly variations in volume and dized resistance training, the findings that no differences in
intensity are desirable when the aim is to maximize strength muscle hypertrophy were seen between NP and periodized
development. This effect was driven largely by trained as resistance training largely match the conclusion of a recent
opposed to untrained individuals. In contrast, no significant systematic review by Grgic et al. [58]. A meta-analysis also
differences were found when comparing measures of mus- by Grgic and co-workers [59] investigating muscle hypertro-
cle hypertrophy between LP and UP, indicating that muscle phy between LP and UP is also in agreement with the results
hypertrophy in response to resistance training is not affected of the present systematic review and meta-analysis, indicat-
by differences in these periodization models. ing that muscle hypertrophy is similar between LP and UP.
The finding that periodized resistance training resulted in While the results of the present systematic review and
larger increases in 1RM than NP resistance training largely meta-analysis demonstrate greater increases in maximal
match the results of the meta-analysis by Williams et al. strength with periodized resistance training compared to
[12], in which an ES of 0.43 was found favoring periodized NP resistance training and with UP compared to LP, the

Fig. 4  Forest plot of changes in 1RM for linear periodization and undulating periodization. 1RM 1-repetition maximum, LP linear periodization,
UP undulating periodization, ES effect size, SE standard error, IV inverse variance, CI confidence interval
Effects of Resistance Training Periodization on Strength and Muscle Hypertrophy 1661

Fig. 5  Forest plot of measures of muscle hypertrophy for linear periodization and undulating periodization. LP linear periodization, UP undulat-
ing periodization, ES effect size, SE standard error, IV inverse variance, CI confidence interval

meta-analyses also indicate a moderate to high degree of in maximal strength as a response to periodized resistance
heterogeneity between studies. Although caution should be training when compared to NP resistance training, and UP
taken in the case of heterogeneity, it should also be noted when compared to LP, cannot be attributed to morphologi-
that in the sensitivity analyses in which Monteiro et al. [42] cal adaptations in the form of muscle hypertrophy, since the
was removed heterogeneity was either reduced to non-sig- meta-analyses found no differences in measures of muscle
nificant levels or completely eliminated, indicating that this hypertrophy between training protocols. While blunted mus-
study may have biased the results. When heterogeneity was cle hypertrophy has been observed in older adults [62, 63],
eliminated, small but significant effects favoring periodized this finding cannot be attributed to the inclusion of older
resistance training and UP, respectively, remained present. participants as this was accounted for by sensitivity analyses.
In addition to investigating the effects of NP vs. periodized Therefore, it seems reasonable to assume that variations in
resistance training and LP vs. UP, this seems to be the first volume and intensity could induce greater neurophysiologi-
review to compare effects of other periodization models in cal adaptations, either at the spinal or supraspinal levels,
regard to resistance training. Most of these studies investi- possibly by increasing descending drive or by increasing
gating effects of other periodization models found no signifi- α-motoneuronal net excitation by altering excitatory and/
cant differences in changes in 1RM or measures of muscle or inhibitory synaptic inputs leading to increased motor
hypertrophy between training groups. Unfortunately, addi- unit recruitment and increased discharge rates [64, 65], or
tional future studies investigating effects of these periodiza- alternatively through effects on coordination [66]. However,
tion model comparisons are needed, in order to allow meta- since none of the studies investigating effects of periodiza-
analyses to be performed with sufficient statistical power. tion have investigated potential differences in neurophysi-
ological adaptations, the underlying mechanisms need to be
4.1 Mechanisms Underlying the Effect investigated in future studies.
of Periodization on Maximal Strength Although the results of the present meta-analyses investi-
gating effects on muscle hypertrophy indicated that periodi-
There are a number of different factors that may contribute zation does not affect muscle hypertrophy, current methods
to increased strength, as a result of resistance training. These for measuring muscle hypertrophy may lack sensitivity to
include not only morphological adaptations, such as muscle detect small differences [67]. Furthermore, the majority
hypertrophy and increases in muscle fiber pennation angle, of studies included in the review used indirect measures
but also neurophysiological adaptations such as increased to assess muscle hypertrophy, which are not considered
motor-unit recruitment, increased motoneuron discharge the gold standard for assessing changes in human skeletal
rates and improved intermuscular coordination [60, 61]. muscle mass [68]. A number of studies even used skinfold
The findings of this review indicate that greater increases measurements to assess changes in FFM, a method that lacks
1662 L. Moesgaard et al.

precision compared to other indirect assessments of mus- nor untrained individuals, it can be speculated that more
cle mass, such as dual-energy X-ray absorptiometry (DXA) frequent variations in stimuli are beneficial in order to drive
[69]. Therefore, separate analyses of direct and indirect neurophysiological adaptations in trained individuals and
measures of muscle hypertrophy could have been advanta- thereby lead to increased strength. This is in accordance with
geous. However, since very few studies used direct measures previous literature suggesting that untrained individuals are
to assess muscle hypertrophy, this approach was not feasi- capable of developing strength using basic resistance train-
ble. Thus, it cannot be excluded that the varying degrees of ing programs, while trained lifters require greater variations
accuracy and sensitivity between these methods may have in training stimuli and more advanced training strategies in
contributed to the apparent lack of differences in muscle order to maximize strength gains [12, 71].
hypertrophy between training groups. It is also possible Although several of the included studies were conducted
that subtle differences in muscle hypertrophy between NP on participants characterized as resistance trained, most of
and periodized resistance training are simply not detectable these studies characterized participants as resistance trained
due to greater measurement error than difference in muscle if they had > 6 months to > 1 year of experience with resist-
hypertrophy, even with MRI [70], which is considered the ance training. This classification is often pragmatically
gold standard for assessing changes in muscle mass. There- appropriate due to logistics of participant recruitment; how-
fore, it is conceivable that potential differences in muscle ever, it also limits the applicability of the results in regard
hypertrophy between training protocols may simply require to highly trained athletes. This is especially important since
longer training interventions to be detectable, and as such periodization is intended to maximize performance in high-
contribute to greater increases in strength over long periods level competitive athletes. This limitation could potentially
of time. be solved by classifying trained individuals using a higher
cut-off value of experience with resistance training. How-
4.2 Training Status ever, this would create the issue, that due to the classifica-
tion of trained participants, many of the included studies
The results presented in this systematic review and meta- had participants that may have had anywhere from 6 months
analysis demonstrated that regardless of resistance training to several years of resistance training experience. Thus, it
status, periodized resistance training was superior at eliciting would not be feasible to classify these participants as either
increases in maximal strength compared to NP resistance trained or untrained, based on a specific cut-off value, due to
training. Thus, both untrained and trained individuals ben- a large degree of within-study variation in resistance training
efit from periodizing resistance training when the aim is to experience. Naturally, this may have impacted results.
increase maximal strength. This may have practical applica-
tions for a wide range of individuals ranging from athletes to 4.3 How is Volume and Intensity Most Effectively
older adults and patients in rehabilitation settings. However, Periodized When the Aim is Maximal Strength?
the possibility that the effect of periodization may be specific
to the trained resistance exercises cannot be excluded. There- For the studies included in this review, resistance training
fore, the degree to which the increased strength, as measured protocols that used a periodized approach led – on average
by 1RM, would transfer to other activities, such as sports – to 21.6% greater increases in strength when compared to
performance or activities of daily living is yet unknown. NP training. Therefore, it is recommended that practition-
Contrary to the results indicating that periodized resist- ers use a periodized resistance training protocol to increase
ance training has a greater effect on gains in maximal maximal strength. In addition, this review indicates that UP
strength irrespective of training status, when compared to is superior to LP for increases in maximal strength. A major
NP resistance training, a greater effect of UP in compari- difference between these periodization models is the fre-
son to LP was observed only in trained participants. This quency of variation in volume and intensity, indicating that
indicates that (a) while some sort of periodization may be the difference in strength outcomes between LP and UP may
beneficial, daily or weekly undulations in volume and inten- be related to the frequency by which variations in volume
sity may not be needed to maximize strength in untrained and intensity occur. Based on the results, it seems that vari-
individuals, and (b) the need for frequent variations in vol- ations in volume and intensity should occur daily or weekly
ume and intensity may increase with training advancement, when the aim is to increase maximal dynamic strength.
when the aim is to develop maximal strength. While this However, daily or weekly variations in volume and intensity,
indicates that daily or weekly variations in volume and as is the case in UP, do not exclude the possibility of imple-
intensity are beneficial for increasing strength in resist- menting other periodization models simultaneously, such as
ance trained individuals, the reasons for this are unclear. BP or LP. This demonstrates a valuable point, that different
However, as no differences in measures of muscle hyper- periodization models and programming strategies may be
trophy were found between LP and UP in neither trained incorporated in a long-term training plan. In this manner, the
Effects of Resistance Training Periodization on Strength and Muscle Hypertrophy 1663

simultaneous combination of different periodization models for the planning of resistance training programs. Whereas at
allows for more complex periodization strategies. the individual level, monitoring the response to resistance
A study by Prestes et al. [72] indicated that a combination training and adjusting variables based on the response, or
of UP and LP resulted in greater increases in 1RM com- lack thereof, likely is of greater importance for long-term
pared to a combination of UP and RLP, suggesting that lin- strength-development.
ear increases in intensity and decreases in volume over time This relates to another limitation of the current periodiza-
seems to be superior to decreases in intensity and increases tion literature, namely that of periodization being intended
in volume over time. It has previously been suggested that to maximize strength development in elite athletes with
DUP can be used to structure each week within a training macrocycles of far greater duration than the study durations
plan using BP [73, 74]. As some blocks will be characterized assessed in the literature. This is important, as previous stud-
by higher volumes and others by higher intensities, these ies have suggested that the benefits of periodized resistance
blocks can be organized into a linear training plan, where training are greater in long-term training programs [28, 56,
blocks progress from high volume to high intensity over the 59]. However, it remains unclear whether the effects of peri-
course of a training program. Thus, illustrating an example odization increase or diminish over time. When examining
of a training program utilizing a combination of DUP, BP, individual studies, the study by Kraemer et al. [40] was the
and LP. Based on this, it is speculated that implementing study of longest duration. This study reported that the larger
more complex periodization strategies in this manner, where increases in 1RM for the periodized training group in com-
frequent undulations in volume and intensity occur along parison to NP were greatest in the first 4 months of the train-
with an increase in intensity and a decrease in volume over ing intervention and diminished over the course of the study.
the course of a training program, may be superior at eliciting On the other hand, the study by De Souza et al. [32] reported
gains in maximal strength compared to more simple periodi- no significant differences between NP and periodized resist-
zation models investigated in the current body of literature. ance training during the first 6 weeks of the training inter-
While the results of this review indicate that resistance vention, whereas only periodized resistance training resulted
training aimed at maximizing strength should be periodized, in significant increases in 1RM squat and quadriceps muscle
and that daily or weekly undulations in volume and intensity CSA the following 6 weeks, suggesting that the effects of
may be favorable for resistance trained individuals, there periodization on strength gains and muscle hypertrophy may
are several aspects of periodization and programming that increase over time. As such, future research should address
cannot be inferred based on the literature. First, while meta- the question as to whether the effects of resistance training
analyses allow isolation of a single variable within-studies, periodization increase or diminish over time, since this is
in this case periodization model, there are copious amounts beyond the scope of the present review and meta-analysis.
of between-study variables that may affect the effects of
periodization. These variables include, but are not limited to,
exercise selection, intensity (i.e., %1RM or RM) and effort 5 Conclusion
(i.e., how close to momentary muscular failure sets are per-
formed). As such, it is possible that the observed effect of The findings of this systematic review and meta-analysis
periodization on maximal strength may differ depending on demonstrate that when comparing volume-equated resist-
the exercises trained, the range of intensities that are trained ance training programs in pre-post study designs, periodized
and how close to momentary muscular failure the resistance resistance training has a greater effect on maximal strength
training is performed. An issue that has previously been dis- compared to NP resistance training. Furthermore, daily and
cussed in the literature [75]. Secondly, there is high inter- weekly undulations in volume and intensity are associated
individual variability in the response to resistance training with greater increases in maximal strength, as indicated by
[76]. This is important as the entire rationale for periodiza- a greater effect on 1RM in UP when compared to LP. How-
tion is to maximize the response to training. As such, some ever, subgroup analysis revealed that this was only the case
individuals may respond better to one model of periodiz- for trained individuals, whereas no difference was found
ing training, whereas another model of periodizing training between LP and UP in untrained individuals. No differ-
may be more beneficial for others. Further, the individual ences were found in muscle hypertrophy between NP and
response to a specific resistance training program likely periodized resistance training, along with no differences in
changes over time. Thus, training protocols that are effec- muscle hypertrophy between different periodization models.
tive at eliciting increases in strength at one time point, may These results suggest that periodization of resistance training
not be effective at a later time point for the same individual, does not affect muscle hypertrophy, when volume is equated
requiring a change in training stimuli to continue to elicit the between conditions. Based on this finding, we suggest that
desired training adaptations. Therefore, the findings of this other factors such as neurophysiological adaptations may
review should only be applied as a general recommendation underpin the greater increases in strength observed with
1664 L. Moesgaard et al.

periodized resistance training and periodization models that 11. Cunanan AJ, DeWeese BH, Wagle JP, Carroll KM, Sausaman
involve daily or weekly undulations in volume and intensity. R, Hornsby WG 3rd, et al. The general adaptation syndrome:
a foundation for the concept of periodization. Sports Med.
2018;48(4):787–97.
Author contributions All authors contributed to the study conception 12. Williams TD, Tolusso DV, Fedewa MV, Esco MR. Comparison
and design. Material preparation and data collection were performed of periodized and non-periodized resistance training on maximal
by LM, MMB, and LC. Analysis was performed by LM. The first draft strength: a meta-analysis. Sports Med. 2017;47(10):2083–100.
of the manuscript was written by LM and all authors contributed to 13. Kramer JB, Stone MH, O’Bryant HS, Conley MS, Johnson RL,
the writing of the manuscript. All authors read and approved the final Nieman DC, et al. Effects of single vs. multiple sets of weight
manuscript. training: impact of volume, intensity, and variation. J Strength
Cond Res. 1997;11(3):143–7.
Declarations 14. Moher D, Liberati A, Tetzlaff J, Altman DG, The PG. Preferred
reporting items for systematic reviews and meta-analyses: the
Funding The publication of this article was supported by the Depart- PRISMA statement. PLoS Med. 2009;6(7):e1000097.
ment of Nutrition, Exercise and Sports, University of Copenhagen. The 15. Maher CG, Sherrington C, Herbert RD, Moseley AM, Elkins M.
study was funded by Lundbeckfonden (Grant no. R322-2019-2406) and Reliability of the PEDro scale for rating quality of randomized
Nordea-fonden (02-2016-0213). controlled trials. Phys Ther. 2003;83(8):713–21.
16. Morris SB. Estimating effect sizes from pretest-posttest-control
group designs. Organ Res Methods. 2008;11(2):364–86.
Conflicts of interest/Competing interests The authors declare no con- 17. Borenstein M, Hedges LV, Higgins JPT, Rothstein HR. Effect
flicts of interest. sizes based on means. Introduction to meta-analysis. London:
Wiley; 2009. p. 21–32.
Ethics approval and consent to participate This is not relevant for a 18. Borenstein M, Hedges LV, Higgins JPT, Rothstein HR. Multiple
systematic review with meta-analysis. outcomes or time-points within a study. Introduction to meta-
analysis. London: Wiley; 2009. p. 225–38.
Consent for publication Not applicable. 19. Eifler C. Short-term effects of different loading schemes
in fitness-related resistance training. J Strength Cond Res.
Availability of data and material All data and material are available 2016;30(7):1880–9.
upon request to the first or corresponding author. 20. Leppink J, O’Sullivan P, Winston K. Effect size—large, medium,
and small. Perspect Med Educ. 2016;5(6):347–9.
21. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring
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Authors and Affiliations

Lukas Moesgaard1 · Mikkel Malling Beck1 · Lasse Christiansen2 · Per Aagaard3 · Jesper Lundbye‑Jensen1

3
* Jesper Lundbye‑Jensen Department of Sports Science and Clinical Biomechanics,
jlundbye@nexs.ku.dk Research Unit for Muscle Physiology and Biomechanics,
University of Southern Denmark, Odense M, Denmark
1
Department of Nutrition, Exercise and Sports, University
of Copenhagen, Noerre Alle 51, 2200 Copenhagen, Denmark
2
Danish Research Centre for Magnetic Resonance, Centre
for Functional and Diagnostic Imaging and Research,
Copenhagen University Hospital, Amager and Hvidovre,
Hvidovre, Denmark