William M Weiss, MD MSc FRCSC FAANA FAAOS

William M Weiss, MD MSc FRCSC FAANA FAAOS Orthopedic Sports Medicine, Arthroscopy and Extremity Reconstruction including the Shoulder, Elbow,

02/22/2026

Meta-analysis tries to get to the bottom of the best "advanced resistance training system" for gains in size and strength.


The Greek authors of the meta-analysis of 23 studies comparing "advanced resistance training systems" with traditional multiple-set protocols in recreationally trained adults aged 18–45 years included the following ARTS:


💪🏽 Rest-pause training / myo-repetition methods
💪🏽 Drop sets
💪🏽 Cluster sets and rest-redistribution protocols
💪🏽 Tempo-controlled lifting (manipulated repetition tempo)
💪🏽 Velocity-based training
💪🏽 Eccentric-overload / accentuated eccentric loading
💪🏽 Mechanical-advantage drop sets


☝🏽 Blood-flow-restriction training is explicitly excluded and therefore not treated as an "advanced system" in this review.


Let's tackle the most important (and pretty much only robustly statistically significant result first):

😁 Advanced resistance training systems work – but mainly for strength!

When all strength and hypertrophy outcomes are pooled, ARTS beat traditional multiple-set training by roughly 6–7% on average (estimation based on effect size of g = 0.159, 95% CI 0.066–0.252; not quantified as % in the study), a small but statistically reliable overall advantage. Split that up and you get an approximately 14–18% better improvement in maximal strength with ARTS (g = 0.351, 95% CI 0.170–0.533), while the extra muscle growth is only about 2–3% (g = 0.046, 95% CI −0.057–0.149) and statistically indistinguishable from zero in trained 18–45-year-olds. The results are very consistent across studies, with essentially no detectable between-study variability (τ² ≈ 0 in all models).”​

🏅 Best for hypertrophy
On average, i.e. across all methods, there is no overall hypertrophy superiority of ARTS vs straight sets (g = 0.046, p = 0.370). Only one method pops 👀 out:

💪🏽 Rest-pause / myo-reps
They are the only ARTS with a statistically significant positive coefficient in the hypertrophy-specific meta-regression.​ Moreover, they are also among the methods with the highest positive coefficients when all outcomes are pooled.

➡️ Notably! In this dataset, rest-pause is the lone candidate that offers a modest hypertrophy edge; everyone else is “as good as” straight sets when volume and effort are matched.


🏅 Best for strength
On strength, ARTS as a group clearly win (g = 0.351, p < 0.001), with no significant between-method differences in the strength-only moderator analysis (Fm(4,20) = 1.19, p = 0.345).

Still, some systems contribute more to the positive overall signal:

💪🏽 Rest-pause
Largest coefficient in the strength analysis and “approaches” statistical significance as a moderator, but not clearly superior to other ARTS.
Only method that also shows a significant hypertrophy coefficient → the one “two-way” option.

💪🏽 Velocity-based training (VBT)
One of the highest positive coefficients in the overall (all outcomes) model.
​Strength benefit likely via individualized loading and constraining velocity loss; no extra hypertrophy in this meta-analysis.

💪🏽 Eccentric-overload / accentuated eccentric loading
Also among the top overall positive coefficients.
Strength-oriented effect, via higher eccentric forces and neuromuscular/architectural adaptations.


⭐ So, what really works is (particularly for strength)
💪🏽 Rest-pause
💪🏽 Velocity-based training
💪🏽 Eccentric-overload / accentuated eccentric loading

All three sit at the “upper end” of the effect-size spread while still being statistically similar to other ARTS in the strength-only model.

And for hypertrophy? Well, the in the list for strength are:
💪🏽 rest-pause training and/or
💪🏽 myoreps*

Don't expect steroid-like gains, though ;-)

* Myoreps consist of one hard “activation” set close to failure, brief rest of about 10–20 seconds, and several short mini-sets of 3–5 reps with the same load and short to minimal rest until you can no longer hit the target reps.

🤬But why? I want my gainz! Well, this is how the scientists explain the non-significant benefits of ARTS on muscle (hint it all comes down to , and ):

"The absence of an overall hypertrophic advantage does not imply that advanced methods are ineffective. Rather, the results indicate that when volume, intensity and effort are broadly matched, advanced systems produce similar hypertrophic outcomes to straight-set training in recreationally trained adults. This aligns with established evidence showing that muscle growth is primarily driven by mechanical tension, total workload and effort, which can be achieved through different programming approaches as long as these key stimuli are present."​

🔥Fired up to start day one of your new ARTS‑powered training plan? Good—because I’m not going to stand between you and the gym any longer... in other words, the post is already too long for Insta and will barely fit into the Facebook character limit. So there's just one thing I want to leave here: The citation 👇🏽

Tsartsapakis, I., Zafeiroudi, A., & Kouthouris, C. (2026). Effects of advanced resistance training systems on muscle hypertrophy and strength in recreationally trained adults: A systematic review and meta-analysis. Journal of Functional Morphology and Kinesiology, 11(1), 80. doi:10.3390/jfmk11010080

02/21/2026
Post-     promotion:This one got an award, and is pending a feature podcast (with yours truly)… and check out that AI ge...
02/10/2026

Post- promotion:
This one got an award, and is pending a feature podcast (with yours truly)…
and check out that AI generated “Team Arthroscopy” football player with a 😬

Check out this database study highlighting the protective effect of anterior cruciate ligament reconstruction in reducing progression to total knee arthroplasty.
https://www.sciencedirect.com/science/article/abs/pii/S0749806325005183

01/26/2026
01/26/2026

⚠️ Does cam morphology increase the risk of developing hip osteoarthritis?

"A significant and independent risk factor for developing hip OA within 4-8 years"

NEW ➡️ https://bit.ly/4pO3PY2

‘Drinking the water’ while attending the Arthrex     &   Forum at their HQ…
01/19/2026

‘Drinking the water’ while attending the Arthrex & Forum at their HQ…

Of all my publications, this one has honestly generated the most interest… Offers to speak at international conferences,...
01/17/2026

Of all my publications, this one has honestly generated the most interest…
Offers to speak at international conferences, to be guest-editor of special editions, to publish other studies…
A few of them might even be legit! 😂 Surely speaks to the importance of
Conkuer Clothing UTMB Orthopaedic Surgery Shriners Children's Texas

Check out this visual abstract detailing the interplay of mental health on ACL reconstruction outcomes.

More traction for a joint project between UTMB Orthopaedic Surgery and Shriners Children's Texas
01/08/2026

More traction for a joint project between UTMB Orthopaedic Surgery and Shriners Children's Texas

Did you know that a steroid injection within 8 weeks of ACL reconstruction could DOUBLE risk of postoperative infection? Check out this article for more details.

https://ow.ly/9Qjz50XR92S

Merry Christmas to all… and to all a good night.“White” Christmas in Galveston…
12/26/2025

Merry Christmas to all… and to all a good night.
“White” Christmas in Galveston…

More of our recently published work… UTMB Orthopaedic Surgery
12/24/2025

More of our recently published work… UTMB Orthopaedic Surgery

Check out this database study
ACL reconstruction = lower TKA rates long term vs. nonoperative care.
So what’s actually driving knee OA? 🤔
Damage from the initial pivot shift
or
Instability episodes in patients who never undergo surgical stabilization?

Honoured to be on the Board…
12/24/2025

Honoured to be on the Board…

🙏 ORTHOADVENT DAY 22 🎄

On the twenty-second day of we would like to extend our sincerest thanks to the Bone & Joint 360 Editorial Board!

Their hard work is a critical contribution to the journal's mission to help busy orthopaedic clinicians and researchers keep up-to-date with the latest research.

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Texas: Galveston, League City, Friendswod & Clear Lake
Galveston, TX
77555

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