Muscle hypertrophy (i.e., muscle growth) is a common goal during strength training for fitness enthusiasts, athletes, and bodybuilders; however, gaining muscle requires understanding the factors that contribute to muscle growth.
Hypoxia and Muscle Growth Article Key Points
Studies have shown that hypoxia and metabolic stress may play a role in muscle hypertrophy, although the relationship between hypoxia and muscle growth is unclear.
- A recent meta-analysis found a small to medium advantage for hypoxia training, but the results were inconclusive similar to other meta-analyses.
- Moderate hypoxia, the reduction of oxygen supply during exercise, has been found to be more beneficial for muscle growth than severe hypoxia.
- Changes in lean mass and muscle thickness were similar between normoxia and hypoxia training.
- These findings suggest that while there may be benefits to creating metabolic stress during exercise, however, the effect is probably small. More research is needed to determine the best methods for inducing metabolic stress and maximizing muscle hypertrophy. Until then, it is probably best to stick to regular resistance exercise.
Introduction: Metabolic Stress Training
Muscle hypertrophy (i.e., muscle growth) is a common goal during strength training for fitness enthusiasts, athletes, and bodybuilders; however, gaining muscle requires understanding the factors that contribute to muscle growth. In this article, we will delve into hypoxia and muscle growth, hypoxic benefits, the anabolic response in hypoxic training, and how it affects muscle growth. Additionally, we will cover popular methods for creating metabolic stress and common mistakes to avoid when trying to maximize hypertrophy. You can read on to learn everything you need to know about maximizing metabolic stress hypertrophy training with the latest science on hypoxia.
Factors Affecting Muscle Hypertrophy
Mechanical tension, damage, and metabolic stress are believed to be the key drivers of muscle hypertrophy. (Schoenfeld, 2010) Some have proposed that mechanical stress is the primary impetus for gaining muscle mass, and studies show that mechanical stress alone can initiate anabolic signaling. (Krzysztofik et al., 2019) While mechanical tension has been extensively studied, metabolic stress has received increasing attention in recent years.
Metabolic stress refers to the accumulation of metabolic byproducts produced during exercise, leading to increased blood flow and oxygen demand. (de Freitas et al., 2017) This can result in fatigue and muscle burn, which may stimulate growth. Although metabolic stress and hypoxic stress are often used interchangeably, they are not the same.
Hypoxic vs. normoxic training
Metabolic stress and hypoxic training are two different types of modalities that aim to enhance athletic performance. While both types of exercise have been shown to have benefits, there are some differences between them. Metabolic stress involves accumulating metabolites such as lactate, phosphate inorganic (Pi), and ions of hydrogen (H+) in cells to enhance muscle hypertrophy (Faiss et al., 2013). On the other hand, hypoxic training involves conditions under low oxygen availability to enhance athletic performance. (Park et al., 2018)
Resistance training under hypoxia
Hypoxia training involves physical exercise under low-oxygen conditions, either by exercising at high altitudes or using devices that simulate altitude (such as altitude masks or hypoxic chambers). This type type of training primarily focuses on forcing the body to adapt to lower oxygen levels, which can result in various physiological adaptations, including increased red blood cell production, improved oxygen delivery, and enhanced muscle efficiency. Hypoxia may also increase metabolic stress due to the accumulation of metabolic byproducts in the muscle due to limited oxygen availability.
Metabolic stress, on the other hand, refers to exercise methods designed to maximize the metabolic stress placed on the muscles. This type of exercise often involves using moderate to high repetitions, short rest intervals between sets, and exercises that target specific muscle groups to increase the buildup of metabolites (such as lactate and hydrogen ions). Metabolic stress aims to stimulate anabolic signaling pathways and promote muscle hypertrophy.
Although hypoxia and metabolic stress are distinct concepts, they can overlap because hypoxia can lead to increased metabolic stress in the muscles due to limited oxygen availability. However, it is important to recognize that they are not synonymous, and each has unique training principles and physiological adaptations.
Hypoxic Training Benefits
Hypoxic exercise has been suggested to be beneficial for muscle hypertrophy thru a number of different mechanisms. Here are a few of the various physiological mechanisms by which hypoxia may be able to increase muscle hypertrophy:
Enhanced metabolic stress:
Hypoxia can increase metabolic stress by limiting oxygen availability, leading to a greater accumulation of metabolic byproducts (e.g., lactate and hydrogen ions) This accumulation has been suggested to promote anabolic signaling and, consequently, muscle hypertrophy.(Rashidi et al., 2019)
Anabolic Responses to Hypoxic Exercise:
Hypoxia has been shown to induce a transient increase in anabolic hormones, such as growth hormone and insulin-like growth factor-1 (IGF-1) (Fry et al., 2010; Kurobe et al., 2015). These hormones play a crucial role in promoting muscle protein synthesis and muscle hypertrophy. However, despite the increases in IGF-1, Lundby et al. (2009) suggested that hypoxia does not appear to increase muscle protein synthesis rates in humans.
Acute hypoxia has been found to augment the VEGF mRNA response to exercise, which suggests that hypoxic training might produce greater capillary growth than normoxic training. More capillaries can increase blood flow and enhance nutrient delivery and increase satellite cell activation. (Olfert et al., 2001)
Improved satellite cell activation:
Hypoxia has been reported to promote satellite cell activation and proliferation. (Jensen et al., 2004) Satellite cells are essential for muscle repair and growth, and their activation under hypoxic conditions may contribute to enhanced muscle hypertrophy.
Hypoxia can lead to increased cellular swelling due to the accumulation of metabolites and fluid shifts within the muscle (Schoenfeld, 2013). This swelling has been proposed to stimulate anabolic signaling pathways, ultimately leading to muscle hypertrophy.
Higher efficiency and time-saving:
Hypoxia has been suggested to elicit greater improvements in muscle size and strength in a shorter time period compared to normal training. (Scott et al., 2014)This advantage can be beneficial for athletes and fitness practitioners seeking time-efficient exercise strategies.
Blood flow restriction (BFR) training is a form of hypoxic training, but it differs from traditional hypoxic methods like altitude training or using hypoxic chambers. BFR involves partially restricting blood flow to the working muscles during exercise using specialized cuffs or bands, which results in a localized hypoxic environment within the muscle tissue.
The partial blood flow restriction during BFR training reduces the delivery of oxygen and nutrients to the muscle, creating a localized hypoxic condition. This limitation of oxygen supply leads to the accumulation of metabolic byproducts and an increase in metabolic stress within the muscle, similar to the effects of systemic hypoxia training. By restricting blood flow to the muscles during exercise using cuffs, BFR pre-fatigues slow-twitch muscle fibers and forces fast-twitch muscle fibers into play, even at loads as low as 20-30% of one-rep max.
Some research suggests that excess metabolites such as lactate, intramuscular phosphocreatine (PCr), inorganic phosphate, lactate, and hydrogens can cause intracellular swelling, leading to muscle growth. (Feriche et al., 2017)However, other studies have found that metabolic byproducts such as lactic acid buildup do not contribute to muscle growth. For example, studies have reported similar muscle hypertrophy and protein synthesis rates between low-load and high-load resistance training, despite differences in lactate accumulation, suggesting that lactate may not be a key factor in these processes. (Burd et al., 2012; Mitchell et al., 2012)
Anabolic response in hypoxic training
The most convincing evidence was found for lactate not being an important mediated for muscle growth in which a study infused lactate during exercise and found lactate infusion did not alter resistance exercise-induced signaling or protein synthesis in human skeletal muscle.(Liegnell et al., 2020)
Overall, while the role of metabolic stress in muscle hypertrophy remains up for debate, it’s clear that this technique can play an important role in maximizing muscle growth. By inducing metabolic stress through techniques such as supersetting and drop sets or blood flow restriction, individuals may be able to support their efforts to build lean mass.
Hypoxic vs. Normoxic Training and Muscle Hypertrophy
There is a growing body of research investigating the effects of hypoxia training on muscle hypertrophy. Some studies suggest that hypoxia can enhance muscle hypertrophy by increasing metabolite accumulation due to hypoxia. (Ramos-Campo et al., 2018) For example, a study by (Chycki et al., 2016) found that high-intensity exercise-induced greater muscle hypertrophy in subjects who trained for 6 weeks in a hypoxic chamber than in those exercising in normoxia without differences in the rate of perceived exertion.
Similarly, (Nishimura et al., 2010) found that muscle hypertrophy can be more efficiently induced by placing the entire body in a hypoxic environment to induce muscle hypoxia followed by resistance training. Moreover, (van Doorslaer de Ten Ryen et al., 2021) found that higher strength gain was observed after hypoxic resistance exercise compared to normal resistance exercise despite no changes in muscle thickness and fractional protein synthetic rate.
Not all studies have found hypoxia is beneficial for increasing muscle mass. A six-week of resistance exercise study under systemic hypoxia did not enhance muscle hypertrophy or strength in comparison to resistance exercise under normoxia. (Kon et al., 2014) A review of the literature in 2014 concluded that the current evidence does not show a consistent benefit of hypoxic resistance exercise for improving muscle hypertrophy or strength compared to normoxic exercise. (Scott et al., 2014)
The Latest Meta-Analysis On Hypoxia Training
The latest meta-analysis published in Nature Scientific Reports on hypoxia training and hypertrophy has provided some interesting results. The review analyzed 17 studies with over 384 participants from which is nearly twice the number of studies included in previous reviews on the topic. (Deldicque, 2022) The analysis showed that both resistance training with hypoxia and regular resistance exercise led to similar improvements in muscle mass and strength. Additionally, the review found that longer inter-set rest intervals were found to have a moderate effect, while there was only a trivial effect for severe hypoxia and moderate loads favoring hypoxia training.(Benavente et al. 2023)
Longer rest periods are contrary to what one would expect with hypoxia training. Also, the fact that severe hypoxia did not result in greater increases in muscle mass is similar to other findings. For example, one study found that leaving BFR cuffs on the entire workout did not result in greater increases in muscle compared to a group that took them off between sets. (Fitschen et al., 2014) This suggests that greater hypoxia is not going to result in greater muscle growth.
The review also found that the lean mass and muscle thickness change was similar between normoxia and hypoxia training. However, the meta-analysis did find a small to medium advantage for hypoxia training. While inconclusive, these findings suggest that hypoxia training may be viable for those looking to maximize muscle hypertrophy.
The author recommended the following strategies to enhance muscle hypertrophy using hypoxia training:
1) Training programs that should employ weight between 60 and 80% of a 1RM and inter-set rest intervals ≥ 120 seconds.
2) Moderate hypoxia seems to be more suitable for improvement in muscle hypertrophy compared to severe hypoxia.
Metabolite Training & Hypoxic training tips
There are several ways to create an environment with reduced oxygen levels to simulate altitude or hypoxia training using specialized equipment that controls the oxygen content of the inhaled air.
Hypoxic chambers or altitude rooms: These are enclosed spaces designed to simulate high altitude conditions by reducing the oxygen concentration in the air. You can perform resistance exercises inside these chambers to experience hypoxic training.
Hypoxia tents or masks: Hypoxia tents are portable enclosures placed over your bed or around your exercise area, while hypoxia masks can be worn during exercise. These solutions offer a convenient and portable way to simulate hypoxic conditions during resistance exercise at home or in the gym.
More on Hypoxia Training Masks: Most research on hypoxia-induced muscle hypertrophy involves blood flow restriction training or exercise in actual hypoxic environments (e.g., altitude training or hypoxic chambers). These methods have shown potential benefits for muscle growth due to the increased metabolic stress and accumulation of metabolites. On the other hand, hypoxia training masks mainly restrict airflow and may not effectively create a systemic hypoxic environment like blood flow restriction or altitude training. Therefore, the masks may not have a direct impact on muscle hypertrophy.
Only one study investigated the acute effects of wearing an elevation mask on strength performance in recreational weightlifters. The results showed that wearing the mask did not significantly impact strength performance. The authors concluded that the mask could be used as a training tool without detrimental performance effects. The study found that the elevation altitude mask did not significantly improve resistance exercise performance or metabolic stress markers, but it did significantly increase ratings of mental fatigue(Jagim et al., 2018)
Hypoxia Training Side Effects
Hypoxia training can provide various benefits for athletic performance and muscle hypertrophy. However, it is not without potential side effects, especially if not performed correctly or under the guidance of a qualified professional. Some potential side effects of hypoxia exercise include:
Hypoxia Symptoms: During hypoxia, due to reduced oxygen availability. Symptoms include headache, nausea, dizziness, fatigue, and shortness of breath.
Decreased exercise performance: Hypoxia can initially reduce exercise performance due to the lower oxygen levels, making workouts more challenging.
Dehydration: The increased respiratory rate during hypoxia can lead to fluid loss and dehydration if not adequately managed.
Insomnia or disturbed sleep: Some individuals may experience difficulty sleeping or poor-quality sleep during hypoxia, especially if training at high altitudes or using hypoxic tents at night.
Impaired immune function: Prolonged exposure to hypoxia may negatively affect the immune system, increasing the risk of illness or infections.
Slower recovery: Training in a hypoxic environment may lead to slower recovery due to the increased physiological stress on the body.
To minimize the risk of side effects, consult a qualified professional before starting hypoxia training. Ensure proper acclimatization, adequate nutrition and hydration, and a well-balanced training program incorporating hypoxic and normoxic exercise sessions. Monitor your progress and be aware of any signs of discomfort or adverse reactions to adjust your exercise program as needed.
Common mistakes using Hypoxia Training.
When using hypoxia exercises to maximize muscle hypertrophy, it is essential to avoid common mistakes to ensure safety, effectiveness, and optimal results. Here are some common mistakes to avoid:
1.) Not consulting a professional: Before starting hypoxia training, consult with a qualified professional or a sports medicine specialist to assess your suitability and help you design a safe and effective program tailored to your needs and goals.
2.) Insufficient acclimatization: Gradually acclimatizing to the hypoxic environment is crucial for safety and effectiveness. Jumping into intense hypoxia training without proper acclimatization may lead to discomfort, dizziness, or even more severe health complications.
3.) Overtraining: Overtraining in a hypoxic environment can increase the risk of injuries and compromise recovery. Maintaining an appropriate balance between exercise intensity, volume, and recovery is essential to optimize hypertrophy.
4.) Ignoring proper nutrition and hydration: Hypoxia training may increase the body’s demand for energy and nutrients. Ensure you maintain a well-balanced diet with adequate macronutrients, micronutrients, and hydration to support muscle growth and recovery.
5.) Neglecting other exercise variables: While hypoxia training can be a useful tool for muscle hypertrophy, it is essential to also focus on other training variables, such as exercise selection, load, volume, and rest intervals, to maximize muscle growth effectively.
Common mistakes using Hypoxia Training.
6.) Inadequate monitoring of progress and adjusting the program: Regularly monitor your progress and make necessary adjustments to your training program to ensure it remains safe and effective as your fitness level improves.
7.) Poor technique and form: Always prioritize proper exercise technique and form to minimize injury risk and effectively target desired muscle groups.
8.) Overreliance on hypoxia training: Hypoxia training should complement traditional resistance training, not replace it entirely. Integrating hypoxic and normoxic training sessions into your program will help optimize muscle hypertrophy while minimizing potential risks associated with hypoxia training.
By avoiding these common mistakes, you can safely and effectively implement hypoxia training to maximize muscle hypertrophy while minimizing risks and potential setbacks.
Frequently Asked Questions
Is metabolic stress training good for hypertrophy?
Yes, metabolic stress can benefit hypertrophy by creating an environment of low oxygen and high lactate concentrations, stimulating muscle growth. This can be achieved through supersets, rest-pause sets, or high-rep training.
What are some effective exercises or training methods for maximizing metabolic stress?
Try incorporating multi-joint exercises like squats and deadlifts into your workout routine to maximize metabolic stress. High-rep sets with shorter rest periods can also increase metabolic stress. Other effective training methods include supersets, drop sets, and rest-pause training. Consider incorporating techniques such as blood flow restriction training and tempo training to enhance metabolic stress during your workouts for even greater results. Remember to always consult with a professional trainer before attempting any new training methods.
How can nutrition affect metabolic stress and muscle hypertrophy?
Nutrition plays a significant role in both metabolic stress and muscle hypertrophy. Adequate protein consumption is crucial for muscle growth while consuming carbohydrates before and after a workout can help increase metabolic stress. Supplements like creatine and beta-alanine can also aid in muscle growth.
Maintaining a calorie surplus to support muscle growth is important, but not too high, as excessive calorie intake can lead to unwanted weight gain. By balancing proper nutrition with exercise, you can achieve optimal metabolic stress and muscle hypertrophy results.
Are there any potential risks or downsides to focusing on metabolic stress in your training?
While metabolic stress can be a useful tool in your training, focusing solely on it may not lead to optimal muscle growth in the long term. Overemphasizing metabolic stress can also lead to decreased strength and power output.
Proper nutrition and recovery are crucial when training for metabolic stress. It’s important to incorporate various training methods, including progressive overload, mechanical tension, and metabolic stress, to ensure balanced muscle development and prevent injury.
What is metabolic stress, and how does it contribute to muscle hypertrophy?
Metabolic stress is the buildup of metabolites, including lactate and hydrogen ions, during resistance training. This buildup causes cellular swelling that triggers the release of growth factors, contributing to muscle hypertrophy.
Exercises such as high reps and time under tension can increase metabolic stress. Combining it with mechanical tension and muscle damage can lead to optimal muscle hypertrophy. Understanding metabolic stress is essential for anyone looking to maximize their muscle growth potential through resistance training.
In conclusion, maximizing muscle hypertrophy is a science that requires an understanding of the relationship between metabolic stress and muscle growth. Research has shown that inducing metabolic stress through various exercises can help increase lean muscle mass. Additionally, hypoxia training is an effective method for creating metabolic stress and promoting muscle hypertrophy. However, avoiding common mistakes like overtraining or not allowing enough recovery time for optimal results is important. To stay updated on the latest findings and tips on maximizing muscle hypertrophy, subscribe to our newsletter now.
Burd, N. A., Mitchell, C. J., Churchward-Venne, T. A., & Phillips, S. M. (2012). Bigger weights may not beget bigger muscles: evidence from acute muscle protein synthetic responses after resistance exercise. Appl Physiol Nutr Metab, 37(3), 551-554. https://doi.org/10.1139/h2012-022
Benavente, C., Schoenfeld, B.J., Padial, P. et al. Efficacy of resistance training in hypoxia on muscle hypertrophy and strength development: a systematic review with meta-analysis. Sci Rep 13, 3676 (2023). https://doi.org/10.1038/s41598-023-30808-4
Chycki, J., Czuba, M., Gołaś, A., Zając, A., Fidos-Czuba, O., Młynarz, A., & Smółka, W. (2016). Neuroendocrine Responses and Body Composition Changes Following Resistance Training Under Normobaric Hypoxia. J Hum Kinet, 53, 91-98. https://doi.org/10.1515/hukin-2016-0013
de Freitas, M. C., Gerosa-Neto, J., Zanchi, N. E., Lira, F. S., & Rossi, F. E. (2017). Role of metabolic stress for enhancing muscle adaptations: Practical applications. World J Methodol, 7(2), 46-54. https://doi.org/10.5662/wjm.v7.i2.46
Deldicque, L. (2022). Does Normobaric Hypoxic Resistance Training Confer Benefit over Normoxic Training in Athletes? A Narrative Review. Journal of Science in Sport and Exercise, 4(4), 306-314. https://doi.org/10.1007/s42978-021-00159-5
Faiss, R., Girard, O., & Millet, G. P. (2013). Advancing hypoxic training in team sports: from intermittent hypoxic training to repeated sprint training in hypoxia. British Journal of Sports Medicine, 47(Suppl 1), i45-i50. https://doi.org/10.1136/bjsports-2013-092741
Feriche, B., García-Ramos, A., Morales-Artacho, A. J., & Padial, P. (2017). Resistance Training Using Different Hypoxic Training Strategies: a Basis for Hypertrophy and Muscle Power Development. Sports Medicine – Open, 3(1), 12. https://doi.org/10.1186/s40798-017-0078-z
Fitschen, P. J., Kistler, B. M., Jeong, J. H., Chung, H. R., Wu, P. T., Walsh, M. J., & Wilund, K. R. (2014). Perceptual effects and efficacy of intermittent or continuous blood flow restriction resistance training. Clinical Physiology and Functional Imaging, 34(5), 356-363. https://doi.org/https://doi.org/10.1111/cpf.12100
Fry, C. S., Glynn, E. L., Drummond, M. J., Timmerman, K. L., Fujita, S., Abe, T., Dhanani, S., Volpi, E., & Rasmussen, B. B. (2010). Blood flow restriction exercise stimulates mTORC1 signaling and muscle protein synthesis in older men. J Appl Physiol (1985), 108(5), 1199-1209. https://doi.org/10.1152/japplphysiol.01266.2009
Jagim, A. R., Dominy, T. A., Camic, C. L., Wright, G., Doberstein, S., Jones, M. T., & Oliver, J. M. (2018). Acute Effects of the Elevation Training Mask on Strength Performance in Recreational Weight lifters. J Strength Cond Res, 32(2), 482-489. https://doi.org/10.1519/jsc.0000000000002308
Jensen, L., Bangsbo, J., & Hellsten, Y. (2004). Effect of high intensity training on capillarization and presence of angiogenic factors in human skeletal muscle. J Physiol, 557(Pt 2), 571-582. https://doi.org/10.1113/jphysiol.2003.057711
Kon, M., Ohiwa, N., Honda, A., Matsubayashi, T., Ikeda, T., Akimoto, T., Suzuki, Y., Hirano, Y., & Russell, A. P. (2014). Effects of systemic hypoxia on human muscular adaptations to resistance exercise training. Physiol Rep, 2(6). https://doi.org/10.14814/phy2.12033
Krzysztofik, M., Wilk, M., Wojdała, G., & Gołaś, A. (2019). Maximizing Muscle Hypertrophy: A Systematic Review of Advanced Resistance Training Techniques and Methods. International Journal of Environmental Research and Public Health, 16(24), 4897. https://www.mdpi.com/1660-4601/16/24/4897
Kurobe, K., Huang, Z., Nishiwaki, M., Yamamoto, M., Kanehisa, H., & Ogita, F. (2015). Effects of resistance training under hypoxic conditions on muscle hypertrophy and strength. Clinical Physiology and Functional Imaging, 35(3), 197-202. https://doi.org/https://doi.org/10.1111/cpf.12147
Liegnell, R., Apró, W., Danielsson, S., Ekblom, B., Hall, G. v., Holmberg, H.-C., & Moberg, M. (2020). Elevated plasma lactate levels via exogenous lactate infusion do not alter resistance exercise-induced signaling or protein synthesis in human skeletal muscle. American Journal of Physiology-Endocrinology and Metabolism, 319(4), E792-E804. https://doi.org/10.1152/ajpendo.00291.2020
Lundby, C., Calbet, J. A. L., & Robach, P. (2009). The response of human skeletal muscle tissue to hypoxia. Cellular and Molecular Life Sciences, 66(22), 3615-3623. https://doi.org/10.1007/s00018-009-0146-8
Mitchell, C. J., Churchward-Venne, T. A., West, D. W., Burd, N. A., Breen, L., Baker, S. K., & Phillips, S. M. (2012). Resistance exercise load does not determine training-mediated hypertrophic gains in young men. J Appl Physiol (1985), 113(1), 71-77. https://doi.org/10.1152/japplphysiol.00307.2012
Nishimura, A., Sugita, M., Kato, K., Fukuda, A., Sudo, A., & Uchida, A. (2010). Hypoxia increases muscle hypertrophy induced by resistance training. Int J Sports Physiol Perform, 5(4), 497-508. https://doi.org/10.1123/ijspp.5.4.497
Olfert, I. M., Breen, E. C., Mathieu-Costello, O., & Wagner, P. D. (2001). Skeletal muscle capillarity and angiogenic mRNA levels after exercise training in normoxia and chronic hypoxia. Journal of Applied Physiology, 91(3), 1176-1184. https://doi.org/10.1152/jappl.2001.91.3.1176
Park, H.-Y., Shin, C., & Lim, K. (2018). Intermittent hypoxic training for 6 weeks in 3000 m hypobaric hypoxia conditions enhances exercise economy and aerobic exercise performance in moderately trained swimmers [journal article]. Biology of Sport, 35(1), 49-56. https://doi.org/10.5114/biolsport.2018.70751
Ramos-Campo, D. J., Scott, B. R., Alcaraz, P. E., & Rubio-Arias, J. A. (2018). The efficacy of resistance training in hypoxia to enhance strength and muscle growth: A systematic review and meta-analysis. Eur J Sport Sci, 18(1), 92-103. https://doi.org/10.1080/17461391.2017.1388850
Rashidi, E., Hosseini Kakhak, S. A. R., & Askari, R. (2019). The Effect of 8 Weeks Resistance Training With Low Load and High Load on Testosterone, Insulin-like Growth Factor-1, Insulin-like Growth Factor Binding Protein-3 Levels, and Functional Adaptations in Older Women [Applicable]. Salmand: Iranian Journal of Ageing, 14(3), 356-367. https://doi.org/10.32598/sija.13.10.470
Schoenfeld, B. J. (2010). The mechanisms of muscle hypertrophy and their application to resistance training. J Strength Cond Res, 24(10), 2857-2872. https://doi.org/10.1519/JSC.0b013e3181e840f3
Scott, B. R., Slattery, K. M., Sculley, D. V., & Dascombe, B. J. (2014). Hypoxia and resistance exercise: a comparison of localized and systemic methods. Sports Med, 44(8), 1037-1054. https://doi.org/10.1007/s40279-014-0177-7
van Doorslaer de Ten Ryen, S., Warnier, G., Gnimassou, O., Belhaj, M. R., Benoit, N., Naslain, D., Brook, M. S., Smith, K., Wilkinson, D. J., Nielens, H., Atherton, P. J., Francaux, M., & Deldicque, L. (2021). Higher strength gain after hypoxic vs normoxic resistance training despite no changes in muscle thickness and fractional protein synthetic rate. Faseb j, 35(8), e21773. https://doi.org/10.1096/fj.202100654RR