Kassiano Etal J Strength Cond Res 2023

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Which ROMs Lead to Rome? A Systematic Review of the Effects of Range of

Motion on Muscle Hypertrophy
Article in The Journal of Strength and Conditioning Research · September 2022

DOI: 10.1519/JSC.0000000000004415
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Brief Review
Which ROMs Lead to Rome? A Systematic Review of

the Effects of Range of Motion on Muscle
Hypertrophy
Downloaded from http://journals.lww.com/nsca-jscr by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCyw
Witalo Kassiano,1 Bruna Costa,1 João Pedro Nunes,1 Alex S. Ribeiro,2 Brad J. Schoenfeld,3 and
Edilson S. Cyrino1
CX1AWnYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC4/OAVpDDa8K2+Ya6H515kE= on 04/26/2023
1
Metabolism, Nutrition and Exercise Laboratory, Physical Education and Sport Center, State University of Londrina, Londrina, PR,
Brazil; 2Center for Research in Health Sciences, University Pitágoras UNOPAR, Londrina, PR, Brazil; 3Health Sciences Department,
CUNY Lehman College, Bronx, New York
Abstract
Kassiano, W, Costa, B, Nunes, JP, Ribeiro, AS, Schoenfeld, BJ, and Cyrino, ES. Which ROMs lead to Rome? a systematic review of
the effects of range of motion on muscle hypertrophy. J Strength Cond Res 37(5): 1135–1144, 2022—Resistance exercise range of
motion (ROM) influences muscular adaptations. However, there are no consistent practical guidelines about the optimal ROM for
maximizing muscle hypertrophy. The objective of this article was to systematically review the literature for studies that compared the
effects of full ROM (fROM) and partial ROM (pROM) on muscle hypertrophy. PubMed/MEDLINE, Scopus, and Web of Science
databases were searched to identify articles from the earliest record up to and including April 2022. We calculated the effect size
(ES) scores of the variables of interest. Eleven studies were included in the review. Full ROM and pROM performed in the initial part of
the ROM elicited greater muscle hypertrophy of the rectus femoris, vastus lateralis, biceps brachii, and brachialis distal sites
(between-groups ES: 0.20–0.90) than pROM performed in the final part of the ROM. fROM elicited greater muscle growth on the
gluteus maximus and adductors than pROM in the final part of the ROM (between-groups ES: 0.24–0.25). Initial pROM produced
more favorable proximal rectus femoris hypertrophy than fROM (between-groups ES: 0.35–0.38). pROM in the middle part of the
ROM elicited greater triceps brachii hypertrophy than fROM (between-group ES: 1.21). In conclusion, evidence suggests that when
training at a longer muscle length—through either pROM or fROM—some muscles, such as quadriceps femoris, biceps brachii,
and triceps brachii, tend to experience optimal growth. Thus, the use pROM in the initial part of the excursion in combination with
fROM training should be considered when prescribing hypertrophy-oriented resistance training programs.
Key Words: strength training, resistance training, excursion, regional hypertrophy, muscle length, length-tension relationship
Introduction A full ROM (fROM) has been described as dynamic resistance

exercise performed without movement restrictions (11). By con-
Range of motion (ROM) can be operationally defined as the de-
trast, training through a limited degree of excursion has been
gree of movement that occurs in a given joint during exercise
termed “partial ROM” (pROM) (25,26). Despite the widespread
performance (11). Range of motion plays a substantial role in the
belief that fROM training is superior to pROM to induce muscular
manifestations of muscular adaptations (e.g., muscle hypertrophy
adaptations (25,26), evidence remains equivocal on the topic
and increased strength) in response to resistance exercise (25,37),
(12,25,26). Traditionally, researchers have addressed the question
which can be attributed to the fact that the capacity of a muscle for
as to how ROM affects muscular adaptations by comparing fROM
producing force during dynamic actions changes across joint
with pROM, wherein pROM is a part of fROM (8,16,33). More
angles. That is, depending on the specific ROM, factors such as
recently, some studies have compared pROM training at different
muscle activation, internal moment arm length, and length-
parts of the complete excursion (e.g., initial versus final parts of the
tension relationship will be differentially affected (17,25), po-
ROM), which may or may not overlap (31,35). Based on the first
tentially influencing the magnitude of hypertrophy. For instance,
group of studies that exclusively compared fROM versus pROM, a
training with a greater ROM generally requires the muscle to
recent meta-analysis found consistently favorable results for fROM
produce force in a more elongated position (21). Depending on
compared with pROM for muscular strength gains (30). On the
the mechanical characteristics of a muscle (e.g., if its fibers work
other hand, the results were more inconclusive for lower-limb
on the ascending, plateau, or descending limb of the length-
muscle hypertrophy (12,30).
tension curve), it may experience differential degrees of mechan-
It is important to note that most studies investigating hyper-
ical tension from active and passive elements (10,15), which in
trophy outcomes involved performing the pROM only in the
turn may affect the hypertrophic stimulus (41).
final portion of the ROM, which hinders the ability to conclude
that fROM would necessarily be superior to other pROMs (e.g.,
Submitted for publication July 11, 2022; accepted September 23, 2022. training at the initial or middle portions) (12). For instance,
Address correspondence to Witalo Kassiano, [email protected]. recent studies have found that pROM performed in the initial
Journal of Strength and Conditioning Research 37(5)/1135–1144 part of the ROM of the concentric muscle action (i.e., at longer
ª 2023 National Strength and Conditioning Association muscle lengths) elicits greater hypertrophy compared with
1135
Copyright © 2023 National Strength and Conditioning Association. Unauthorized reproduction of this article is prohibited.
Range of Motion and Muscle Hypertrophy (2023) 37:5
pROM performed in the final part of the ROM (i.e., at shorter Google Scholar citations were screened for additional manu-
muscle lengths) (35) and is comparable with or even more ef- scripts. In addition, the list of articles that cited the included
fective than training with fROM (31). These conflicting findings studies was screened. Two authors (W.K. and BC.) performed the
impair the ability to draw practical conclusions regarding the search independently. In the case of any disagreement as to in-
optimal ROM to maximize muscle hypertrophy. Consideration clusion, a third assessor (J.P.N.) resolved the dispute.
of recent studies that compared different ROMs with fROM
may help to reconcile limitations of previous reviews and allow
for more insightful practical recommendations and isolating Study Coding, Data Extraction, and Analysis
gaps in the current literature and thus helping to direct future The following data were extracted from the included studies: (a)
research on the topic. The aim of this article was to compre- study characteristics (author, year, sample size, and study design),
hensively review the literature and compare the effects of fROM (b) subject demographics (age, sex, and resistance training expe-
and different pROMs on muscle hypertrophy. rience), (c) resistance training protocols and how the ROM was
measured, and (d) outcome measures (muscle hypertrophy). We
then coded data for the pretraining and posttraining means and
Methods standard deviations of the included studies. We calculated aver-
Experimental Approach to the Problem age percentage changes (d%) and effect size (ES) scores of the
variables of interest. Values of d% were calculated as follows:
The current systematic review was performed according to the ([posttraining mean/pretraining mean * 100] – 100). The ES of
guidelines set forth by PRISMA and Prisma in Exercise, Re- each training group was calculated using the following formula:
habilitation, Sport Medicine, and Sports Science (PERSiST) ([posttraining mean – pretraining mean]/[pooled pretraining
(1,29). The research questions were defined by population, in- standard deviation]) (23). Values of ES regarding the pre-to-post
tervention, comparator, outcomes, and study design (PICOS) changes, as well as the differences between groups (e.g., group 1
model following the PRISMA guidelines, as follows. ES minus group 2 ES), were considered as follows: ,0.20, trivial/
negligible; 0.20–0.49, small; 0.50–0.79, moderate; and $ 0.80,
Population. Adults (18 years or older) with or without RT ex- large (5). In cases where studies did not provide sufficient in-
perience, with no restrictions on sex. Investigations including formation as to results, we contacted the authors to request the
individuals with chronic diseases, musculoskeletal disorders, or missing data (2,8,21,31,33,40,42,43). In the case of no response
injuries were excluded. and where applicable, values were extracted from the studies’
figures using WebPlotDigitizer (2,8,33,43). We opted to interpret
Intervention. Studies implementing dynamic resistance training the findings based on the calculated ES for each study (13).
programs lasting $4 weeks. Investigations involving isometric
actions were excluded because this form of training is restricted to
a specific point of the ROM. Quality Assessment
The modified Physiotherapy Evidence Database (PEDro) scale
Comparator. An experimental trial comparing resistance training and Oxford’s level of evidence were used by 2 independent in-
with fROM versus pROM or comparison between 2 pROMs vestigators (W.K. and B.C.) to assess the methodological quality
performed at different parts of the ROM—i.e., initial versus final of the articles included in the review. Given that it is not possible
part of the ROM. to blind the subjects and investigators in supervised resistance
exercise interventions, items 5–7 from the scale, which are specific
Outcomes. Changes in muscle size using a site-specific measure- to blinding, were removed. This approach has been used in pre-
ment (muscle thickness, cross-sectional area, or volume [through vious systematic reviews in the area of resistance training (13,37).
ultrasound, magnetic resonance imaging, or computed With the removal of these items, the maximum score on the
tomography]). modified “PEDro 8-point” scale was 7 because the first item,
related to eligibility criteria, is not included in the total score.
Study Design. Longitudinal randomized control trials using either Oxford’s level of evidence ranges from 1a to 5, with 1a being
parallel group(s) or within-subject designs comparing fROM and systematic reviews of high-quality, randomized controlled trials,
pROM at different parts of the ROM. and 5 being expert opinions.
Literature Search Results

To perform this review, we searched PubMed/MEDLINE, Sco- The search strategy initially yielded 2,532 studies. After removing
pus, and Web of Science through December 2021 and updated the duplicates, 1,443 titles and abstracts were screened, resulting in
search in April 2022. Only peer-reviewed articles in English were 16 potentially eligible full texts, plus 5 articles found through
selected for inclusion; citations from scientific conferences were other sources (citations searching: 4 articles and accepted but not
excluded from analysis. The search included the following syntax: indexed in a data base: 1 article). After the full-text screening, 11
“range of motion” AND (“muscle thickness” OR “cross- investigations were considered for inclusion in the present sys-
sectional area” OR “muscle volume” OR “muscle mass” OR tematic review. The PRISMA flow diagram is presented in
“hypertrophy” OR “muscle growth”). The title and abstract of Figure 1.
each study were inspected for relevance, and the full text was then
scrutinized for those initially appearing to meet inclusion criteria.
Study Characteristics
Studies in which the abstracts did not provide enough in-
formation according to our inclusion criteria were retrieved for Details of the 11 studies (n 5 297) included in the systematic review
full-text evaluation. In the selected articles, the reference lists and are presented in Table 1. The average duration of studies was 10
1136
Range of Motion and Muscle Hypertrophy (2023) 37:5 | www.nsca.com
Figure 1. PRISMA flow diagram.
weeks (ranging from 5 to 15 weeks). Eight studies compared reference) and a group that alternated between training in the
fROM versus pROM (2,8,16,20,33,40,42,43), 2 compared initial pROM and final pROM from session to session. The re-
pROM at the initial part of the ROM versus at the final part of the sults showed greater increases in CSA of the proximal rectus
ROM (21,35), and 1 compared multiple groups and ROMs (31). femoris for the initial pROM training performed at longer muscle
Three studies measured the excursed ROM with a goniometer lengths (65–100° of knee flexion; 0° 5 knee fully extended)
(8,20,21), 1 used a potentiometer (31), 1 used isokinetic dyna- compared with fROM (30–100° of knee flexion) and final pROM
mometry (40), and 6 studies did not specify the type of measure- training performed at shorter muscle lengths (30–65° of knee
ment assessment (2,16,33,35,42,43). Resistance training flexion). Moreover, there was a greater CSA increase at the distal
interventions involved male-only samples in 5 studies sites of the rectus femoris and vastus lateralis in fROM and initial
(2,8,16,33,40), female-only in 1 study (31), and mixed samples in 5 pROM groups than the final pROM condition (31). Valamatos
studies (20,21,35,42,43). Eight studies used lower-limb exercises, 3 et al. (40) also investigated the effects of performing knee exten-
of them used the squat (2,16,43), 2 used the knee extension (31,40), sion at different ROMs; however, the training protocol was
2 used a combination of lower-limb exercises (20,21), and 1 used performed using an isokinetic dynamometer. The authors com-
the 45° leg press exercise (42). Three studies investigated upper- pared knee extension with fROM (0–100° of knee flexion; 0° 5
limb exercises (8,33,35), 2 of them used the preacher curl exercise knee fully extended) versus final pROM training (0–60° of knee
(33,35) and the other used the lying elbow extension (8). Four flexion). The results showed similar increases in vastus lateralis
studies assessed changes in muscle size through muscle thickness muscle volume and anatomic CSA at proximal, middle, and distal
(33,35,42,43), 4 through CSA (8,20,21,31), 1 through both muscle sites in both groups (40).
thickness and CSA (2), 1 through muscle volume (16), and 1 Bloomquist et al. (2) compared the effects of performing the
through CSA and volume (40). back squat with fROM (0–120° of knee flexion; 0° 5 knee fully
extended) versus final pROM (0–60° of knee flexion). The au-
thors observed greater increases in CSA of the middle and distal
Muscle Hypertrophy in Response to Different ROMs sites of the anterior thigh in the fROM group; only one of the
more proximal sites of the back of thigh increased, without dif-
Pedrosa et al. (31) compared the effects of performing knee ex- ferences between groups. Moreover, vastus lateralis muscle
tension with fROM versus initial and final pROM (i.e., initial and thickness increased to a small magnitude in both groups. Kubo
final half of the angles of fROM, taking the concentric action as et al. (16) compared the effects of performing the back squat with
1137
Table 1
Characteristics of included studies and main results.*
Study Sample Duration/Frequency Groups Exercises Outcomes Findings
21
Bloomquist Non–resistance-trained 12 wk, 3 d·wk Shallow squat (0–60˚ of Back squat (free weight) CSA by MRI of front and Deep squat induced
et al. (2)† young men (n 5 17) knee flexion); deep squat posterior thigh at greater increases in 5 of 6
(0–120˚ of knee flexion) proximo-distal femur sites of front thigh
lengths; MT of the vastus(4.3–6.1% vs. 2
lateralis by US measured 2.3–2.3%). The
at 50% of femur length exception was the most

proximal site of front thigh
that grew in similar
magnitude (7.1 vs. 4.6%)

Changes in back thigh did
not differ between groups
(21.2–3.0% vs. 2
1.3–2.7%).
The changes in vastus
lateralis MT were similar
for both groups
(2.8–3.6%, ES 5
0.22–0.29)
Goto et al. (8) Resistance-trained young 8 wk, 3 d·wk21 pROM (45–90˚ of elbow Lying elbow extension CSA triceps brachii at pROM induced greater
men (n 5 44) flexion); (free weight) 60% of humerus length increases in CSA triceps
fROM (0–120˚ of elbow by US and arm brachii than fROM
flexion) circumference (49.5%, ES 5 2.88 vs.
27.6%, ES 5 1.67)
Kubo et al. Physically active young 10 wk, 2 d·wk21 Half squat (0–90˚ of knee Back squat (free weight) Muscle volume by MRI of Full squat induced greater
(16) men (n 5 17) flexion); full squat rectus femoris, vastus increases than half squat
(0–140˚ of knee flexion); lateralis, vastus in size of gluteus
intermedius, vastus maximum (6.4%, ES 5
medialis, biceps femoris 0.38 vs. 2.1%, ES 5
short head, biceps 0.13) and adductors
femoris long head, (5.1%, ES 5 0.47 vs.
semitendinosus, 2.7%, ES 5 0.23); while
semimembranosus, the increases in vastii
adductor magnus, were similar (3.5–6.8%,
adductor longus, ES 5 0.24–0.52); rectus
adductor brevis, and femoris, biceps femoris
gluteus maximum short and long heads,
semitendinosus and
semimembranosus did
not change in both groups
(20.5–1.3%, ES 5 2
0.03–0.04)
McMahon Non–resistance-trained 8 wk, 3 d·wk21 (2 Shorter ROM (0–50˚ of Barbell back squat, knee CSA vastus lateralis by US Longer ROM induced
et al. (20) young men and women supervised, 1 home- knee flexion); longer ROM extension, Bulgarian split at 25, 50, and 75% of greater CSA increases
(n 5 26) based session) (0–90˚ of knee flexion); squat, double- and femur length than shorter ROM at
control (no exercise) single-legged Sampson proximal (33.8%, ES 5
chair, leg press, and 0.92 vs. 19.0%, ES 5
lunges 0.55) and distal sites
(40.1%, ES 5 0.78 vs.
7.5%, ES 5 0.15);
similar increases were
observed at middle site
(18.0%, ES 5 0.54 vs.
22.0%, ES 5 0.66,
longer and shorter ROM,
respectively)
McMahon Non–resistance-trained 8 wk, 3 d·wk21 (2 Final pROM (0–50˚ of Bilateral barbell squat, CSA vastus lateralis by US Middle pROM induced
et al. (21) young men and women supervised, 1 home- knee flexion); middle seated leg press, seated at 25, 50, and 75% of greater increases in CSA
(n 5 31) based session) pROM (40–90˚ of knee knee extension, Bulgarian femur length vastus lateralis than final
flexion); control (no split squat, and Sampson pROM at proximal
exercise) chair (30.5%, ES 5 1.23 vs.
17.4%, ES 5 0.75),
middle (35.8%, ES 5
1.33 vs. 21.6%, ES 5
0.89), and distal (50.7%,
1138
Table 1
Characteristics of included studies and main results.* (Continued)
ES 5 1.27 vs. 13.5%, ES
5 0.36) sites
Pedrosa Non–resistance-trained 12 wk, 3 d·wk21 INITIALROM (65–100˚ of Knee extension in a CSA of the rectus femoris Rectus femoris:
et al. (31) young women (n 5 45) knee flexion); FINALROM weight-stack machine and vastus lateralis by US INITIALROM and VARROM
(30–65˚ of knee flexion); at 40, 50, 60, and 70% of induced greater
FULLROM (30–100˚ of femur length increases at more

knee flexion); VARROM proximal sites than
(daily alternated between FINALROM and FULLROM
30–65˚ and 65–100˚ of (16.9–24.9%, ES 5

knee flexion); control (no 0.57–0.73 vs.
exercise) 9.7–13.0%, ES 5
0.32–0.38); INITIALROM,
VARROM, and FULLROM
induced greater
increases at more distal
sites than FINALROM
(17.7–23.7%, ES 5
0.38–0.68 vs. 1.2–9.1%,
ES 5 0.02–0.24)
Vastus lateralis: VARROM
induced greater
increases at more
proximal site than
INITIALROM, FINALROM,
and FULLROM (18.4%, ES
5 0.96 vs. 12.2–15.4%,
ES 5 0.65–0.73);
INITIALROM and VARROM
induced greater
increases at middle site
than FINALROM and
FULLROM (15.5–16.0%,
ES 5 0.78–0.79 vs.
9.1–12.4%, ES 5
0.44–0.54); INITIALROM,
VARROM, and FULLROM
induced greater
increases at more distal
sites than FINALROM
(10.2–15.6%, ES 5
0.32–0.58 vs. 1.1–4.8%,
ES 5 0.04–0.19)
Pinto et al. Non–resistance-trained 10 wk, 2 d·wk21 pROM (50–100˚ of elbow Preacher curl using a MT of elbow flexors pROM and fROM induced
(33) young men (n 5 35) flexion); fROM (0–130˚ of curling bar (biceps brachii and similar increases in MT of
elbow flexion); control (no brachialis) by US elbow flexors (7.2–7.8%,
exercise) measured at 60% of ES 5 0.42–0.44)
humerus length
Sato et al. Non–resistance-trained 5 wk, 2 d·wk21 Final pROM (80–130˚ of Preacher curl using a MT of elbow flexors Initial pROM induced
(35) young men and women elbow flexion); initial dumbbell (biceps brachii and greater MT increases
(n 5 32) pROM (0–50˚ of elbow brachialis) by US than final pROM at distal
flexion); control (no measured at 50, 60, and site (12.7%, ES 5 0.68
exercise) 70% of humerus length vs. 2.1%, ES 5 0.11);
while the increases were
similar at proximal and
middle portions
(3.7–6.9%, ES 5
0.18–0.32) for both
training groups
Valamatos Untrained young men 15 wk, 3 d·wk21 pROM (0–60˚ of knee Isokinetic knee extension Vastus lateralis muscle Muscle volume and
et al. (40) (n 5 19) flexion); fROM (0–100˚ of volume by MRI and anatomical CSA at
knee flexion); control (no anatomic CSA by US at proximal, middle, and
exercise) 25, 50, and 75% of the distal portions increased
total muscle length similarly (3.0–7.6%, ES
5 0.25–0.58)
1139
Table 1
Characteristics of included studies and main results.* (Continued)
21
Werkhausen Resistance-trained young 10 wk, 3 d·wk pROM (81–90˚ of knee 45˚ leg press MT of the vastus lateralis The groups did not differ
et al. (42) men and women (n 5 15) flexion); fROM (0–90˚ of by US measured at 60% in the magnitude of MT
knee flexion) of femur length changes (pROM: 21%,
ES 5 20.08 vs. fROM:
22%, ES 5 20.16)
Yoshiko et al. Physically active older 12 wk, 3 d·wk21 (home- Shallow squat (not Weight-bearing squat MT of rectus femoris, Deep squat induced
(43) men and women (n 5 16) based sessions) specified); deep squat vastus intermedius higher increases in MT of
(not specified)‡ anterior and lateral, and rectus femoris (9.3%, ES
vastus lateralis by US 5 0.41 vs. 1.3%, ES 5

0.06) and vastus
intermedius anterior
(20.3%, ES 5 0.81 vs.
1.4%, ES 5 0.06), but
not in vastus intermedius
lateral (1.7%, ES 5 0.07
vs. 26.0%, ES 5 2
0.24) and vastus lateralis
(6.7%, ES 5 0.29 vs.
3.1%, ES 5 0.14) than
shallow squat
*fROM 5 full range of motion; pROM 5 partial range of motion; CSA 5 cross-sectional area; MRI 5 magnetic resonance imaging; US 5 ultrasound; MT 5 muscle thickness. ES 5 effect size.
†We were unable to calculate the ES because we got no response from the authors, and the figures do not allow for data extraction of premean and postmean and standard deviation. In this sense, we obtained
the relative changes (%) using WebPlotDigitizer.
‡ROM was controlled by chair height of 40 cm and a cushion of 20 cm. The shallow group performed squat training with the cushion and deep group without this implement.
fROM (0–140° of knee flexion) versus pROM from the initial to lateralis muscle thickness between groups nor were there any
final part of the ROM (0–90° of knee flexion). The authors substantial changes from pre-to-post study in either condition.
reported similar increases in muscle volume of the vastus lateralis, Pinto et al. (33) compared the effects of performing the
intermedius, and medialis. Importantly, muscle volume of the preacher curl using fROM (0–130° of elbow flexion; 0° as elbow
gluteus maximus and adductors increased to a greater magnitude fully extended) versus pROM at the middle part of the ROM
in fROM than pROM; the size of the rectus femoris, semite- (50–100° of elbow flexion) on elbow flexors muscle size in
ndinosus, semimembranosus, and biceps femoris short and long non–resistance-trained men. The results showed similar increases
heads did not significantly change pre-to-post study in either in muscle thickness between ROMs. Sato et al. (35) compared the
group. effects of performing the preacher curl in pROM in the initial part
McMahon et al. (20) compared the effect of different lower- of the ROM (0–50° of elbow flexion; 0° as elbow fully extended)
limb exercises with pROM performed from the initial to final part versus pROM in the final part of the ROM (80130° of elbow
of the ROM (0–90° of knee flexion) versus pROM performed flexion) on regional (proximo-distal) elbow flexors muscle
exclusively at the final part of the ROM (0–50° of knee flexion). thickness. The pROM performed in the initial part of the ROM
The results showed that pROM from initial to final part of the induced greater muscle growth at the distal site than the pROM
excursion induced greater CSA increases of the vastus lateralis at performed in the final part of the ROM; the increases at proximal
the proximal and distal sites, but not at the middle site. In another and middle sites were similar between conditions. Goto et al. (8)
study from the same laboratory, McMahon et al. (21) compared a compared the effects of performing the lying elbow extension in
pROM group that trained from the initial to final part of the fROM (0–120° of elbow flexion; 0° as elbow fully extended)
ROM, but without reaching terminal extension (40–90° of knee versus pROM performed in the middle part of the ROM (45–90°
flexion) versus another pROM group that trained in the final part of elbow flexion) on triceps brachii CSA in resistance-trained
of the ROM (0–50° of knee flexion) using a combination of dif- men. The results showed a superior increase in CSA in the pROM
ferent lower-limb resistance exercises. The researchers found that group compared with fROM.
pROM focusing on the initial part of the excursion experienced
greater vastus lateralis CSA increases at proximal, middle, and
distal sites.
Yoshiko and Watanabe (43) compared the effects of per- Quality of Studies and Level of Evidence
forming a deep squat versus a shallow squat (ROMs not specified) The PEDro score for the studies in this review ranged from 5 to 7
on lower-limb muscle growth in older adults. The results in- (mean 5 6.3 6 0.9), indicating “good” to “excellent” method-
dicated superior rectus femoris and vastus intermedius (anterior ological quality (Table 2). Of the 11 studies, 7 achieved a total
aspect) muscle thickness increases in deep squat training. Wer- score of 7, 1 achieved a total score of 6, and 3 achieved a total
khausen et al. (42) compared the effects of performing power- score of 5. According to Oxford’s level of evidence, 7 of the 11
oriented training on the 45° leg press with a longer ROM (0–90° studies had an evidence level 1b (high-quality randomized con-
of knee flexion) versus pROM performed in the initial part of the trolled trials) and 4 of the 11 studies had an evidence level of 2b
ROM (81–90° of knee flexion) in resistance-trained men and (individual cohort study or low-quality randomized controlled
women. There were no observed differences in changes of vastus trials).
1140
Discussion elbow flexors only in the middle site, thus precluding the ability to
draw inferences as to the potential effect of the studied ROM
The purpose of this study was to comprehensively review the
configurations on regional growth of the elbow flexors. Because
literature on the effects of fROM and different pROMs (e.g.,
hypertrophy during training at long muscle lengths often occurs
initial and final pROM) on muscle hypertrophy. The findings of
to a greater extent in the distal region of the muscle, this might
this systematic review point to a differential effect of the distinct
explain the null finding observed in Pinto et al. (33).
ROM configurations on muscle size. Specifically, some muscles
In the second study that investigated the effects of different
experience more favorable hypertrophy when trained at longer
ROM configurations in the elbow flexors, Sato et al. (35) found
muscle lengths, through fROM or initial pROM training
greater distal increases in muscle thickness when performing the

(i.e., initial angles of fROM, taking the concentric action as ref-
preacher curl with pROM in the initial part of the ROM
erence); this seems to be the case for the quadriceps femoris and
(i.e., initial angles of fROM, taking the concentric action as ref-
biceps brachii. In some cases, muscle hypertrophy was greater in

erence) than pROM in the final portion of the ROM (i.e., final
pROM compared with fROM. Conversely, training at short
angles of fROM, taking the concentric action as reference); sim-
muscle lengths through the final pROM often elicits less favorable
ilar gains were observed in proximo-middle sites. Based on find-
muscle hypertrophy, and no study to date shows a beneficial ef-
ings that the sarcomeres of biceps brachii and brachialis work on
fect when training at shorter muscle lengths in the muscles stud-
the ascending limb of the length-tension curve (24), it can be
ied. Potential mechanisms and practical applications for our
speculated that training this muscle at shortened lengths may
findings are discussed in the following sections.
decrease force production by the active elements (36), whereas at
Two studies compared the effects of different ROMs on hy-
longer muscle lengths, there is a greater active force production.
pertrophic adaptations of the elbow flexors (33,35). In the first
This aspect would explain the inferior gains in the distal region of
study, Pinto et al. (33) observed similar increases in muscle
the elbow flexors in the group that trained with pROM in the top
thickness at the middle site of the elbow flexors when performing
of the preacher curl exercise. Alternatively, evidence indicating
the preacher curl with fROM and pROM at the midrange of the
that the biceps brachii and brachialis operate primarily on the
ROM. Such findings conceivably can be explained at least in part
descending limb (4) might suggest that findings involved greater
by muscle mechanical properties (e.g., length-tension relation-
passive tension. When taken together, the findings of Pinto et al.
ship) (9,15,17). Some evidence indicates that the elbow flexors
(33) and Sato et al. (35) suggest that training at longer muscle
work mainly in the ascending limb and plateau region of the
lengths may preferentially hypertrophy the distal region of the
length-tension curve (24), suggesting their sarcomeres reach near
elbow flexors; whether this is due to active or passive factors
maximal active force generation at longer muscle lengths. Because
remains underdetermined. Considering that only 2 studies have
the passive elements (e.g., giant molecule titin) contribute more to
investigated the effects of different ROMs in the biceps brachii,
force generation in the descending limb of the length-tension
these conclusions should be considered preliminary; further re-
curve and less in the ascending and plateau portion (9,15), it is
search is need to draw stronger inferences on the topic.
possible that most fibers of the elbow flexors do not experience
Importantly, in the aforementioned studies (33,35), the
additional mechanical tension induced by passive elements on
preacher curl exercise was performed using free weights
reaching longer muscle lengths. However, other research indi-
(i.e., curling bar and dumbbell). Based on the horizontal distance
cates that the sarcomeres of the biceps brachii and brachialis re-
between the weight and the elbow joint axis, the greater external
side primarily on the descending limb (4), which seemingly would
moment arm imposed by the exercise in both studies seemingly
refute this hypothesis and raise the possibility that heightened
occurred at the middle to the bottom portions of the ROM (28).
passive force production might in fact be involved. It is important
This requires the muscles to produce higher forces at the initial
to note that Pinto et al. (33) measured the muscle thickness of the
part of the exercise than in the final part. Such factors
(i.e., external moment arm length and forces produced by the
elbow flexors) potentially influence the stimulus for trained
Table 2
muscles (14,22). Therefore, it remains to be determined whether
Physiotherapy Evidence Database (PEDro) ratings and Oxford
the modification of the exercise strength curve through, for ex-
evidence levels of the included studies.*
ample, the use of cables and machines could induce differential
Studies 1 2 3 4 8 9 10 11 Total Evidence level hypertrophic responses through the manipulation of different
Bloomquist et al. (2) Yes 1 1 1 1 1 1 1 7 1b ROMs.
Goto et al. (8) Yes 1 1 1 1 1 1 1 7 1b A single study directly compared the effects of different ROMs
Kubo et al. (16) No 0 0 1 1 1 1 1 5 2b
on triceps brachii muscle hypertrophy (8), thus providing only
McMahon et al. (20) Yes 1 1 1 1 1 1 1 7 1b
preliminary insights on the topic. Goto et al. (8) reported superior
McMahon et al. (21) Yes 1 1 1 1 1 1 1 7 1b
Pedrosa et al. (31) No 0 0 1 1 1 1 1 5 2b triceps brachii hypertrophy in response to performing the lying
Pinto et al. (33) Yes 0 0 1 1 1 1 1 5 1b elbow extension with pROM at the midrange of the ROM when
Sato et al. (35) No 1 1 1 1 1 1 1 7 1b compared with fROM. Given that the fROM overlapped the
Valamatos et al. (40) Yes 1 1 1 1 1 1 1 7 1b ROM performed in the pROM, one might expect that gains
Werkhausen et al. (42) Yes 1 1 1 1 1 1 1 7 2b would be similar between conditions, but this was not the case.
Yoshiko et al. (43) Yes 1 0 1 1 1 1 1 6 2b When examining the length-tension curve of the triceps brachii
*Items in the PEDro scale: 1 5 eligibility criteria were specified; 2 5 subjects were randomly from a cadaver study (24), the fibers of the long head seem to
allocated to groups; 3 5 allocation was concealed; 4 5 the groups were similar at baseline work almost exclusively on the plateau limb, whereas the lateral
regarding the most important prognostic indicators; 8 5 measures of one key outcome were head seems to work on the plateau and early part of the
obtained from 85% of subjects initially allocated to groups; 9 5 all subjects for whom outcome descending limb (24). Such characteristics contribute to explain,
measures were available received the treatment or control condition as allocated or, where this was
not the case, data for at least 1 key outcome were analyzed by “intention to treat”; 10 5 the results of
at least in part, the effectiveness of performing the lying elbow
between-group statistical comparisons are reported for at least 1 key outcome; 11 5 this study extension with pROM at a moderate muscle length. Importantly,
provides both point measures and measures of variability for at least 1 key outcome. the cadaver study referenced herein (24) was only concerned with
1141
muscles that cross the elbow without taking into account proxi- triceps brachii. As previously discussed, this limitation is relevant
mal attachments and thus discounting the fact that the long head when investigating the effects of different ROMs and needs fur-
is biarticular. Moreover, the referenced study (24) made no ther scrutiny because performing the lying overhead elbow ex-
mention of shoulder position because they analyzed frozen upper tension seems to be effective to inducing muscle hypertrophy of
extremities. Although the length-tension of the long head may triceps brachii long and medial heads, but not the lateral head (3).
work only on the plateau, this is probably not the case in an Seven studies directly compared the effects of different ROMs
overhead position in which the long head at stretched position. on quadriceps hypertrophy (2,16,20,21,31,40,42). When syn-
Indeed, biomechanical models suggest that long head works on thesizing the body of evidence, it can be inferred that training this
the descending limb in the overhead arm position (19); based on muscle complex at more elongated muscle lengths, either through
this information, it is possible that triceps brachii long head may pROM or fROM, elicited greater hypertrophy than pROM at
experience additional mechanical tension from passive elements shorter muscle lengths, especially in the more distal region of the
and potentially achieve a greater hypertrophic stimulus (27). quadriceps. For instance, Pedrosa et al. (31) reported greater in-
Although no other studies to date have directly compared the creases at more distal sites of the rectus femoris and vastus lat-
effects of different ROMs on triceps brachii hypertrophy, it is eralis in training groups that performed the knee extension
possible to contrast the study by Goto et al. (8) with other re- exercise at a longer muscle length (i.e., initial pROM, varied
search that investigated the hypertrophic effects of different ex- ROM, and fROM) than in a shortened muscle position (i.e., final
ercises (3,19,39). For example, Maeo et al. (19) compared the pROM). Similarly, Bloomquist et al. (2) and Yoshiko and
effects of performing elbow extension with the arm elevated Watanabe (43) observed that the deep back squat induced more
(shoulder joint fixed at 180° flexion) versus the neutral arm po- favorable quadriceps hypertrophy than the shallow back squat.
sition (shoulder joint fixed at 0°; anatomical position) on changes The same pattern of adaptive responses was observed by
in CSA of the triceps brachii heads (long head and lateral plus McMahon et al. in 2 different studies (20,21). The authors
medial heads) in young adults; both exercises had the same total reported that achieving greater degrees of knee flexion, and
ROM (90° of ROM). Because the long head is biarticular, per- consequently a longer muscle length, in different lower-limb re-
forming an overhead elbow extension exercise places the muscle sistance exercises through fROM (20) and pROM (21) induced
in a more stretched position, while the neutral arm position places greater increases in distal CSA of vastus lateralis. Interestingly, the
the muscle in a shortened position (19). After 12 weeks of train- vastus medialis, vastus lateralis, and rectus femoris seem to work
ing, the elevated arm position elicited superior hypertrophy in the on the plateau and descending limb of the length-tension curve
triceps brachii long head (28.5 vs. 19.6%) and lateral plus medial (6,38), which suggests that these muscles indeed may experience
heads (14.6 vs. 10.5%) than the neutral arm position (19). Taken additional mechanical tension from passive elements when
together, the findings of Goto et al. (8) and Maeo et al. (19) reaching elongated muscle lengths (9,15). This conceivably helps
support the hypothesis that the triceps brachii—especially the to explain the greater hypertrophy observed in the aforemen-
long head—does appear to hypertrophy more when using exer- tioned studies.
cises that place this muscle in a moderate to stretched position, Despite the convergent findings of different studies showing a
conceivably because it works on the plateau and descending limb hypertrophic advantage to training the quadriceps at a longer
of the length-tension curve (19,24). muscle length, these results are not universal (16,42). For exam-
It should be noted that the current evidence is not fully con- ple, Kubo et al. (16) did not observe differences in quadriceps
sistent on the topic. For instance, Stasinaki et al. (39) compared muscle hypertrophy when training with half and full squats. A
the effects of performing the cable overhead elbow extension possible explanation for this finding may be that the half squat
versus the cable push down on changes in muscle thickness of the group in Kubo et al. (16) reached 90° of knee flexion, which may
triceps brachii long head; both exercises had the same total ROM achieve a sufficient muscle length to optimally stimulate the
(80° of ROM). After 6 weeks of training, both exercises induced vastus lateralis (12,38). Moreover, the findings of Werkhausen
relatively similar hypertrophy of the triceps brachii long head in et al. (42) did not observe hypertrophy of the vastus lateralis when
the proximal and distal sites (13.7–19.4% vs. 10.7–15.5%, performing the 45° leg press either with pROM at a longer muscle
overhead elbow extension and push down, respectively). Al- length or with fROM (42). A possible explanation for these
though speculative, discrepancies between studies may be findings may lie in the fact that the training protocol composed
explained, at least in part, by a shorter training period in Stasinaki exclusively of concentric actions, which attenuates the contribu-
et al. (39) relative to Maeo et al. (19) study (6 vs. 12 weeks) and tion of passive forces that occur during eccentric muscle actions.
likely an insufficient sample size in Stasinaki et al. (39) (n 5 9/ In addition, this study used a power-oriented protocol wherein
condition). Further investigations are needed to bring clarity to subjects performed repetitions in an explosive fashion. Based on
the topic. the force-velocity relationship (32), it is possible that muscular
It is important to highlight that while the length-tension curve actions performed at high velocities generate lower levels of me-
explanation proposed in the present review seems plausible, other chanical tension, despite the high level of motor unit recruitment
mechanisms may be involved in the differential hypertrophic (7,17,32).
adaptation to distinct ROM configurations. For example, Goto In addition to the quadriceps, studies also investigated hyper-
et al. (8) observed greater muscle activation in the pROM and trophy of the hamstrings (2), gluteus maximus, and adductors
greater hypoxia; this latter finding explained 49% of the observed (16) when performing squats in different ROMs. Regarding
hypertrophy variance in results when performing the lying elbow gluteus maximum and adductors, Kubo et al. (16) observed
extension. Thus, physiological aspects (i.e., heightened muscle greater increases in these muscles in the deep squat than half
hypoxia) may have been influential in addition to biomechanical squat. Although speculative, it is possible that the gluteus max-
factors in mediating hypertrophy under the conditions studied. imus and adductor fibers experience greater mechanical tension
Also, of note, the study by Goto et al. (8) measured total triceps when reaching greater muscle lengths, as occurs in the deep squat.
CSA at a single site, thus precluding the ability to draw specific Notably, to the best of our knowledge, there are no studies that
inferences regarding the effects of ROM on regional growth of the have investigated the sarcomere length ranges of the gluteus
1142
maximus and adductors; therefore, the potential mechanistic conclusions about the potential effects of specific ROMs on
explanation for this finding remains to be determined. Further- muscle hypertrophy. Fifth, our pooled sample displayed consid-
more, the assumptions that gluteus maximus and adductors re- erable heterogeneity in characteristics (e.g., sex, age, and training
spond better to training at longer muscle lengths are made from a status) and the mode of resistance training incorporated across
single study that exclusively investigated the effects of different the included studies. The extent to which this may influence re-
ROMs on the squat (16). Thus, it is necessary to investigate other sults warrants further research. Finally, the absence of in-
exercises, especially those that impose greater torque at different formation on the ROM assessment method in several of the
muscle lengths, such as the barbell hip thrust. studies should be considered a limitation of the current literature
Regarding the hamstrings, 2 studies compared the effects of because this can hamper the ability to make comparisons across
different ROMs on the hypertrophy of this muscle group; both studies and thus potentially create threats to experimental val-
studies employed the squat (2,16). Multiple lines of evidence idity. To address this issue, future studies should clearly report the
suggest that the squat is not an effective exercise for inducing method of ROM assessment.
hamstring hypertrophy (34), which was essentially demonstrated The findings of this systematic review indicate that training in a
in the aforementioned studies (2,16). Hence, it is not possible to lengthened muscle position elicits more favorable muscle hyper-
evaluate the potential effect of different ROMs on hamstrings trophy compared with training at shorter muscle lengths; such
hypertrophy from the available evidence. That said, it is possible results have been observed in several muscles (i.e., quadriceps,
to make some indirect inferences from studies that measured or biceps, and triceps brachii) using both fROM and initial pROM
estimated the fiber sarcomere length ranges of the hamstrings and training. These findings are relevant for healthy individuals who
the effects of performing different exercises for this muscle group. seek to optimize muscle hypertrophy and indicating the need for
For example, it seems that the sarcomeres contained in the sem- research focused on the effects of altering ROM in rehabilitation
itendinosus, semimembranosus, and biceps femoris muscle fibers populations. Moreover, given the paucity of studies in muscles
seem to work on the descending limb of the length-tension curve other than the limbs, further research is necessary to expand the
(6), which, in theory, could favor greater hypertrophy when current knowledge and, consequently, practical generalizability.
training these muscles with fROM or pROM at longer muscle
length. In fact, a recent study (18) that compared performing the
prone leg curl versus the seated leg curl (where the hamstrings Practical Applications
muscles were at shortened and longer lengths, respectively) sup-
ported this hypothesis. The authors (18) observed greater in- The current evidence suggests that ROM configuration can
creases in muscle volume in the seated leg curl than the prone leg affect muscle hypertrophy, and this influential effect seems to
curl for the whole hamstrings and each individual biarticular be related to the muscle length in specific resistance exercise.
muscle (i.e., semitendinosus, semimembranosus, and biceps Specifically, the results of our systematic review generally
femoris). Importantly, despite the plausibility of the hypotheses support the recommendation to perform resistance training
presented above, studies that compare exercises specific to tar- with fROM training to elicit optimal muscle growth. Impor-
geting the hamstrings (e.g., stiff leg deadlift and seated leg curl) in tantly, we observed that when reaching a more stretched
different ROM configurations are necessary to draw stronger length through traversing the initial pROM, some muscles,
inferences. such as the quadriceps and biceps brachii, seem to grow op-
Although this review provides relevant insights into the role of timally, in some cases, to an even greater magnitude than
ROM on hypertrophic adaptations, several limitations must be fROM. Limited research suggests that some muscles may ex-
acknowledged. First, most research on the topic has focused on perience favorable hypertrophic adaptations across a wider
hypertrophy of the quadriceps femoris; findings for other muscle spectrum of muscle lengths (e.g., moderate and lengthened
groups are limited or nonexistent, and thus, the evidence on these positions); this may be the case for the triceps brachii. On the
muscles should be considered preliminary. Future studies are other hand, training at short muscle lengths through the final
needed to advance our understanding of the effects of ROM on pROM (i.e., final angles of fROM, taking the concentric ac-
the hypertrophic adaptations of muscles already investigated tion as reference) seems to elicit less favorable muscle hyper-
(i.e., biceps brachii and triceps brachii) and on others that have trophy, with the caveat that research is limited on the topic to
not yet been studied (e.g., pectoralis major, triceps surae, and the muscles of the upper arms and thighs. From a practical
hamstrings). Second, given that there may be longitudinal fascicle perspective, strength and conditioning practitioners should
growth with ROMs reaching greater muscle lengths, it is con- consider the selective use of pROM in the initial part of the
ceivable that this longitudinal growth in response to training may excursion in combination with fROM training when pre-
reduce passive tension at long muscle lengths (10). Future re- scribing hypertrophy-oriented training programs. Alterna-
search should consider the measurement of fascicle length and tively, it remains questionable as to the benefit of training at
estimation of potential changes at ultrastructural levels (e.g., short muscle lengths because this can impair the force pro-
sarcomerogenesis or extension of existing sarcomeres) (10) in duction by the active contractile elements (i.e., active in-
response to ROMs that stimulate the muscle at different lengths. sufficiency), especially in biarticular muscles, and thus
Third, resistance exercises impose greater torque in different parts potentially hinder the hypertrophic stimulus. Research on a
of the ROM (14,22,28), and therefore, in different muscle broader array of muscles, particularly those of the trunk, is
lengths, thus, it is necessary to conduct investigations on exercises warranted to determine whether certain muscles may respond
with different strength curves such as ascending, descending, and more favorably to training at shorter muscle lengths.
bell-shaped. Fourth, because different ROMs seem to affect
muscle growth in an inhomogeneous manner (13,44), future
studies should consider measuring the muscle size along its length
Acknowledgments
(i.e., proximo-distal sites) and the different heads of each muscle The authors thank the Coordination of Improvement of Higher
group. This approach will allow for more comprehensive Education Personnel (CAPES/Brazil) for the scholarship
1143
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Which ROMs Lead to Rome? A Systematic Review of the Effects of Range of

Article in The Journal of Strength and Conditioning Research · September 2022

Witalo Kassiano Daniella Costa

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João Pedro Nunes Alex Silva Ribeiro

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Efeito da fadiga mental no desempenho físico e cognitivo em humanos View project

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Which ROMs Lead to Rome? A Systematic Review of

Introduction A full ROM (fROM) has been described as dynamic resistance

Literature Search Results

Figure 1. PRISMA flow diagram.

at 50% of femur length exception was the most

magnitude (7.1 vs. 4.6%)

FULLROM (30–100˚ of femur length increases at more

30–65˚ and 65–100˚ of (16.9–24.9%, ES 5

vastus lateralis by US 5 0.41 vs. 1.3%, ES 5

greater distal increases in muscle thickness when performing the

biceps brachii. In some cases, muscle hypertrophy was greater in

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