Eccentric training is a type of
strength training
Strength training, also known as weight training or resistance training, is exercise designed to improve physical strength. It is often associated with the lifting of Weightlifting, weights. It can also incorporate techniques such as bodyweigh ...
that involves using the target muscles to control weight as it moves in a downward motion. This type of training can help build muscle, improve athletic performance, and reduce the risk of injury.
An eccentric contraction is the motion of an active muscle while it is lengthening under load. Eccentric training is repetitively doing eccentric muscle contractions. For example, in a
biceps curl the action of lowering the
dumbbell back down from the lift is the eccentric phase of that exercise – as long as the dumbbell is lowered slowly rather than letting it drop (i.e., the biceps are in a state of contraction to control the rate of descent of the dumbbell).
An eccentric contraction is one of the distinct phases in the movement of
muscle
Muscle is a soft tissue, one of the four basic types of animal tissue. There are three types of muscle tissue in vertebrates: skeletal muscle, cardiac muscle, and smooth muscle. Muscle tissue gives skeletal muscles the ability to muscle contra ...
s and
tendon
A tendon or sinew is a tough band of fibrous connective tissue, dense fibrous connective tissue that connects skeletal muscle, muscle to bone. It sends the mechanical forces of muscle contraction to the skeletal system, while withstanding tensi ...
s; they include
isometric contraction (no movement),
isotonic contraction
In an isotonic contraction, tension remains the same, whilst the muscle's length changes. Isotonic contractions differ from isokinetic contractions in that in isokinetic contractions the muscle speed remains constant. While superficially identic ...
, and
concentric contraction (shortening).
Eccentric training focuses on slowing down the process of muscle elongation to challenge the muscles, which can lead to stronger muscles, faster
muscle repair and increasing
metabolic rate
Metabolism (, from ''metabolē'', "change") is the set of life-sustaining chemical reactions in organisms. The three main functions of metabolism are: the conversion of the energy in food to energy available to run cellular processes; the co ...
.
Eccentric movement provides a braking mechanism for muscle and tendon groups that are experiencing concentric movement to protect
joint
A joint or articulation (or articular surface) is the connection made between bones, ossicles, or other hard structures in the body which link an animal's skeletal system into a functional whole.Saladin, Ken. Anatomy & Physiology. 7th ed. McGraw- ...
s from damage as the contraction is released.
Eccentric training is particularly good for casual and high-performance
athlete
An athlete is most commonly a person who competes in one or more sports involving physical strength, speed, power, or endurance. Sometimes, the word "athlete" is used to refer specifically to sport of athletics competitors, i.e. including track ...
s or the elderly and patients looking to rehabilitate certain muscles and tendons.
Negative movement
This movement has also been described as negative training. This "negative" movement is necessary to reverse the muscle from its initial
trajectory
A trajectory or flight path is the path that an object with mass in motion follows through space as a function of time. In classical mechanics, a trajectory is defined by Hamiltonian mechanics via canonical coordinates; hence, a complete tra ...
.
When the load exceeds the force that can be developed by the muscle at a constant length, as in an eccentric
muscle action, the exercise is referred to as involving negative work, because the muscle is absorbing energy.
Eccentric contractions use less metabolic energy, even though they can create more force than concentric actions.
History
Adolf Eugen Fick discovered in 1882 that "contracting muscle under stretch could produce greater force than a shortening muscle contraction" like in concentric movements. Fifty years later,
A.V. Hill found that "the body had lower energy demand during an eccentric muscle contraction than during a concentric muscle action".
Erling Asmussen introduced eccentric training in 1953, with "ex" meaning "away from" and "centric" meaning "center". Hence, the term was coined to mean a
muscle contraction
Muscle contraction is the activation of Tension (physics), tension-generating sites within muscle cells. In physiology, muscle contraction does not necessarily mean muscle shortening because muscle tension can be produced without changes in musc ...
that moves away from the center of the muscle.
The first revelation of the functional significance of these properties occurred in a clever demonstration devised by
Bud Abbott
William Alexander "Bud" Abbott (October 2, 1897 – April 24, 1974) was an American comedian, actor and producer. He was best known as the straight man in the comedy duo Abbott and Costello.
Early life
Abbott was born in Asbury Park, New Jer ...
,
Brenda Bigland, and
Murdoch Ritchie. They connected two stationary cycle
ergometers back-to-back with a single chain, such that one cyclist pedaled forward and the other resisted this forward motion by braking the backward-moving pedals. Because the
internal resistance
In electrical engineering, a practical electric power source which is a linear circuit may, according to Thévenin's theorem, be represented as an ideal voltage source in series with an impedance. This impedance is termed the internal resis ...
of the device was low, the same force was being applied by both individuals, yet the task was much easier for the individual braking. This demonstration cleverly revealed that a tiny female resisting the movement of the pedals could easily exert more force than, and hence control the
power output of, a large burly male pedaling forward.
Energy
During the eccentric phase of the movement, the muscle absorbs energy. This work is done "by stretching the muscle and in this process, the muscle absorbs
mechanical energy
In physical sciences, mechanical energy is the sum of macroscopic potential and kinetic energies. The principle of conservation of mechanical energy states that if an isolated system is subject only to conservative forces, then the mechanical ...
".
This mechanical energy is dissipated or converted into one or a combination of two energies.
* Elastic recoil
* Heat
Elastic recoil
The energy that is absorbed by the muscle can be converted into
elastic recoil energy, and can be recovered and reused by the body. This creates more efficiency because the body is able to use the energy for the next movement, decreasing the initial impact or shock of the movement.
For example,
kinetic energy
In physics, the kinetic energy of an object is the form of energy that it possesses due to its motion.
In classical mechanics, the kinetic energy of a non-rotating object of mass ''m'' traveling at a speed ''v'' is \fracmv^2.Resnick, Rober ...
is absorbed in running every time one's foot strikes the ground and continues as one's mass overtakes the foot. At this moment, elastic recoil energy is at its maximum and a large amount of this energy is absorbed and is added to the next stride.
This movement is similar to the action of
springs, where the muscle is continually shortened and stretched resulting in enhanced effectiveness and force. It can lead to the perception of "less effort" even though dealing with higher force.
But time matters in elastic recoil. If this energy is not used quickly it is dissipated as heat. The role of eccentric training is to use these principles of
energy conversion
Energy transformation, also known as energy conversion, is the process of changing energy from one form to another. In physics, energy is a quantity that provides the capacity to perform Work (physics), work (e.g. lifting an object) or provides ...
to strengthen muscle and tendon groups.
Heat
The energy that is absorbed by the muscle will be dissipated as heat if the muscle is being used as a "
damper or
shock absorber
A shock absorber or damper is a mechanical or hydraulics, hydraulic device designed to absorb and Damping ratio, damp shock (mechanics), shock impulses. It does this by converting the kinetic energy of the shock into another form of energy (typic ...
". This leads to an increase in
body temperature
Thermoregulation is the ability of an organism to keep its body temperature within certain boundaries, even when the surrounding temperature is very different. A thermoconforming organism, by contrast, simply adopts the surrounding temperature ...
.
Physiological mechanisms
The muscle has "tension producing tissue comprising small contractile units referred to as
sarcomere
A sarcomere (Greek σάρξ ''sarx'' "flesh", μέρος ''meros'' "part") is the smallest functional unit of striated muscle tissue. It is the repeating unit between two Z-lines. Skeletal striated muscle, Skeletal muscles are composed of tubular ...
s" that each contains a "thick (
myosin
Myosins () are a Protein family, family of motor proteins (though most often protein complexes) best known for their roles in muscle contraction and in a wide range of other motility processes in eukaryotes. They are adenosine triphosphate, ATP- ...
) and thin (
actin
Actin is a family of globular multi-functional proteins that form microfilaments in the cytoskeleton, and the thin filaments in muscle fibrils. It is found in essentially all eukaryotic cells, where it may be present at a concentration of ...
)
myofilament
Myofilaments are the three protein filaments of myofibrils in muscle cells. The main proteins involved are myosin, actin, and titin. Myosin and actin are the ''contractile proteins'' and titin is an elastic protein. The myofilaments act togeth ...
(muscle filaments or proteins) that overlaps to format a cross-bridge bond (attachment)".
When in a concentric exercise, shortening of a muscle occurs as the myosin and actin cross-bridges repeatedly attach and detach to draw the actin across the myosin – creating force. Each cross-bridge attachment and detachment cycle is powered by the splitting of one molecule of
adenosine triphosphate
Adenosine triphosphate (ATP) is a nucleoside triphosphate that provides energy to drive and support many processes in living cell (biology), cells, such as muscle contraction, nerve impulse propagation, and chemical synthesis. Found in all known ...
(ATP). Examples of such exercises include kicking a ball or lifting a weight.
In controlled release reversals of such concentric motions, the eccentric movement stretches the muscle with
opposing force
An opposing force (alternatively enemy force, abbreviated OPFOR or OpFor) is a military unit tasked with representing an enemy, usually for training purposes in war game scenarios. The related concept of aggressor squadron is used by some ai ...
that is stronger than the muscle force. When myofilaments of the muscle fiber are stretched in such eccentric contractions there can be reduced numbers of detachments of
cross bridge myosin and actin links. With more cross bridges remaining attached there is greater force production in the muscle. Examples of activities involving eccentric muscle contraction include walking down a hill or resisting the force of gravity while lowering a heavy object.
Eccentric actions place a stretch on the sarcomeres to the point where the myofilaments may experience strain, otherwise known as exercise-induced
delayed onset muscle soreness (DOMS). One area of research that has much promise in relation to DOMS and eccentric exercise is the
repeated-bout effect (RBE). To help prevent or lessen DOMS from eccentric exercise, or to facilitate recovery from it, the exerciser would eccentrically stimulate the muscle, then repeat at weekly intervals to build up strength and allow the strain (in response to a given force level) to reduce over time.
Muscle injury
Eccentric contractions are a frequent cause of muscle injury when engaging in unaccustomed exercise. But a single bout of such eccentric exercise leads to adaptation which will make the muscle less vulnerable to injury on subsequent performance of the eccentric exercise.
Findings
Several key findings have been researched regarding the benefits of eccentric training:
*Eccentric contractions use less energy and actually absorb energy that will be used as heat or elastic recoil for the next movement.
*Eccentric training creates greater force owing to the "decreased rate of cross-bridge muscle detachments." Patients and athletes will have more muscle force for bigger weights when eccentric training.
*Eccentric training has proven to be an excellent post
rehabilitation intervention for lower-body injuries.
*Increased
DOMS
The Doma (), also known as ''Dom'', ''Domra'', ''Domba'', ''Domaka'', ''Dombara'' and ''Dombari'', are castes, or groups, scattered across India. The Doma/Dom were a caste of drummers. According to Tantra scriptures, the Dom were engaged in the ...
leads to more tenderness in eccentric, rather than pure
pain
Pain is a distressing feeling often caused by intense or damaging Stimulus (physiology), stimuli. The International Association for the Study of Pain defines pain as "an unpleasant sense, sensory and emotional experience associated with, or res ...
or tendon
swelling amongst patients.
*Older individuals are less vulnerable to injury from eccentric exercise, primarily because of the reduced strain on muscle-tendon groupings as compared to traditional concentric exercise.
*Repeated-bout Effect markedly reduces
DOMS
The Doma (), also known as ''Dom'', ''Domra'', ''Domba'', ''Domaka'', ''Dombara'' and ''Dombari'', are castes, or groups, scattered across India. The Doma/Dom were a caste of drummers. According to Tantra scriptures, the Dom were engaged in the ...
. "Completing bouts of eccentric training and then repeating the workout 1 week (or more) later will result in less DOMS after the second workout."
*Stretching of the muscles and eccentric training provides protection from injury or re-injury.
*Subjects report less weariness from eccentric training than from concentric training.
*Total body eccentric training can raise resting metabolic rate by about 9 percent, with the greatest magnitude in the first two hours.
*While energy costs remain low, the degree of force is very high. This leads to muscles that respond with significant increases in muscle strength, size, and power.
Eccentric exercise
Eccentric exercise or resistance training is currently being used as a form of rehabilitation for sports injuries, but also as an alternative form of exercise for the elderly and those affected by neurological disorders, COPD, cardiopulmonary disorders, and cancer. Muscle loss is a big problem faced by people afflicted with the above disorders and many cannot participate in rigorous exercise protocols. Eccentric muscle contractions produce high forces with low-energy costs. According to Hortobágyi due to these properties, eccentric exercise has the greatest potential for muscle strengthening. To strengthen muscle the external force must exceed the muscle while it lengthens.
The definition of
eccentric contraction is almost the exact definition of muscle strengthening.
Perceived muscle damage:
There is a stipulation regarding eccentric contractions in that they actually cause muscle damage and injury. Eccentric contraction may result in delayed onset muscle soreness however; the contraction itself does not cause muscle damage or injury.
Proof of muscle strengthening without damage:
One recurring problem in
ACL rehabilitation is improving muscle strength of the quadriceps without re-injury. Early, high-force eccentric training can be used to increase muscle strength and volume without damage to the ACL graft, surrounding soft tissue, and the articular cartilage.
In an experiment performed on rat muscles after twenty sessions of treadmill low-intensity eccentric training the wet weight of the muscles and the fiber cross-section was significantly larger than the control and level groups. These results led to the conclusion that low-intensity eccentric contractions have the ability to "produce enough mechanical stress to induce
muscle hypertrophy
Muscle hypertrophy or muscle building involves a hypertrophy or increase in size of skeletal muscle through a growth in size of its component cells. Two factors contribute to hypertrophy: sarcoplasmic hypertrophy, which focuses more on increa ...
without over-stressing which could produce muscle fiber damage. Other articles have found that muscle damage is not required to reach hypertrophy. Greater mechanical stress brought on by eccentric contractions is what leads to hypertrophy in individuals undergoing eccentric training. Studies done on the elderly show that low-intensity eccentric conditioning can actually minimize muscle damage According to Gault the low cost of energy and low oxygen demand make low-intensity eccentric exercise ideal for the elderly.
Eccentric contraction and oxygen consumption:
Oxygen consumption is needed for muscles to work properly. Eccentric muscle contractions are considered to be negative work as the muscle is working with resistance. Negative work is the mechanical energy absorbed by the work conducted on a muscle when the force on the muscle is greater than the force produced.
An experiment was conducted on bicycle riding. The amount of oxygen consumption was measured during the motion of pedaling forward as positive work and pedaling with resistance as negative work.
Less oxygen was consumed during negative work than of positive work with the oxygen consumption ratio being 3:7.
Due to the low oxygen consumption of eccentric exercise studies have been conducted on patients with severe COPD. An eccentric cycling exercise workout was created for these patients and the results found there to be no side effects, minimal muscle soreness that had no effect on power, and high compliance. Furthermore, other cycling studies concluded that eccentric cycling was a safe alternative for COPD patients as they can perform high-intensity work with lower cost.
Eccentric contractions and cardiac output:
With the lower cost of oxygen, how would eccentric exercise affect the heart?
A study was performed to test how eccentric and concentric contractions affect cardiac autonomic modulation after exercise. Men (aged 18–30) were divided into four groups: concentric control, eccentric control, concentric training, and eccentric training. Results concluded that resistance training (eccentric contractions) promoted strength gain. An increase in cardiac vagal modulation during recovery was also concluded.
A lot of studies have been conducted regarding eccentric exercise over the last decade. It can be said there is substantial evidence that eccentric exercise truly exceeds concentric exercise for rehabilitation and training aspects in force, energy cost, oxygen consumption, and muscular strengthening.
Sports and rehabilitation

With eccentric training, muscles are able to create more for less work, which has special meaning in the realms of high-performance sports – both for
injury prevention
Injury prevention is an effort to prevent or reduce the severity of bodily injury, bodily injuries caused by external mechanisms, such as accidents, before they occur. Injury prevention is a component of safety and public health, and its goal is ...
and optimal-performance training. For athletes and sports enthusiasts, this eccentric model can help with explosive force training to prevent injuries or recurring injuries, and trains the body to use the kinetic force driven by eccentric training more efficiently.
Canadian Olympian
Kim St-Pierre uses eccentric training as part of her regime. The Esmonde Technique takes eccentric training and makes it available to the masses through ''Classical Stretch'' and ''Essentrics''. After having hip surgery in the summer of 2007, St-Pierre began to practice the Esmonde Technique with experts
Miranda Esmonde-White from PBS's ''Classical Stretch'' and Sahra Esmonde-White host of the ''Essentrics'' workout to heal her hip.
According to tests, increases in both strength and muscle fiber are higher in eccentric training than in traditional concentric training.
The rehabilitative nature, low energy costs, high magnitudes of force, and low uptake of
oxygen
Oxygen is a chemical element; it has chemical symbol, symbol O and atomic number 8. It is a member of the chalcogen group (periodic table), group in the periodic table, a highly reactivity (chemistry), reactive nonmetal (chemistry), non ...
all align eccentric exercise for both the elderly and rehabilitative functions.
In old age, loss of strength and
muscle mass
Skeletal muscle (commonly referred to as muscle) is one of the three types of vertebrate muscle tissue, the others being cardiac muscle and smooth muscle. They are part of the voluntary muscular system and typically are attached by tendons to bo ...
is commonplace. Add to these factors disease and
cardiac
The heart is a muscular organ found in humans and other animals. This organ pumps blood through the blood vessels. The heart and blood vessels together make the circulatory system. The pumped blood carries oxygen and nutrients to the tissu ...
and
respiratory illness. Eccentric training enables the elderly, and those with the same problems, the ability to train muscle groups and increase strength and resiliency with low-energy exercise.
Eccentric training has been found to be beneficial to those with a variety of physical
ailments.
According to one systematic review and meta-analysis on
shoulder impingement syndrome, eccentric training didn't improve pain or function more than other types of training.
Anterior cruciate ligament damage
Tearing an
anterior cruciate ligament
The anterior cruciate ligament (ACL) is one of a pair of cruciate ligaments (the other being the posterior cruciate ligament) in the human knee. The two ligaments are called "cruciform" ligaments, as they are arranged in a crossed formation. In ...
(ACL) in the knee causes serious damage that can last several years and often requires surgery. The ACL is one of the four main stabilizing
ligament
A ligament is a type of fibrous connective tissue in the body that connects bones to other bones. It also connects flight feathers to bones, in dinosaurs and birds. All 30,000 species of amniotes (land animals with internal bones) have liga ...
s of the knee. During the post-operative rehabilitation of patients, eccentric training can be used as a cornerstone of developing muscle size and strength. According to tests conducted by J. Parry Gerber in 2007, structural changes in the muscles greatly exceeded those achieved with standard concentric rehabilitation. The success of the involvement of gradual progressive exposure to negative work ultimately led to the production of high muscle force.
Sarcopenia
Sarcopenia
Sarcopenia ( ICD-10-CM code M62.84) is a type of muscle loss that occurs with aging and/or immobility. It is characterized by the degenerative loss of skeletal muscle mass, quality, and strength. The rate of muscle loss is dependent on exer ...
is the progressive loss of muscle mass due to aging. Muscle mass begins to deteriorate as early as the age of 25, and consistently deteriorates into old age. By the age of 80 "one-half of the skeletal muscle has been lost" (Lastayo, Woolf, Lewek, Snyder-Mackler, Reich & Lindstedt, 2003). With this great decrease in mass, strength is also decreased. Eccentric training has the ability to counteract sarcopenia through sustained training. The unique trait of greater overloads to the muscle with less strenuous impact on the body, as well as
cardiac
The heart is a muscular organ found in humans and other animals. This organ pumps blood through the blood vessels. The heart and blood vessels together make the circulatory system. The pumped blood carries oxygen and nutrients to the tissu ...
and
respiratory
The respiratory system (also respiratory apparatus, ventilatory system) is a biological system consisting of specific organs and structures used for gas exchange in animals and plants. The anatomy and physiology that make this happen varies gr ...
systems, offers a unique case for the elderly. The high-force and low-cost set of attributes in eccentric exercise makes it ideal for the actively impaired.
Muscle tendon injuries
The entire
muscle-tendon system works cohesively to slow down
limb
Limb may refer to:
Science and technology
*Limb (anatomy), an appendage of a human or animal
*Limb, a large or main branch of a tree
*Limb, in astronomy, the curved edge of the apparent disk of a celestial body, e.g. lunar limb
*Limb, in botany, t ...
movement. The close relationship between the muscle and tendons help to dissipate heat or temporarily store kinetic energy. If the forces needed to slow down a limb exceed the capacity of the muscle-tendon system, injury is likely to occur.
Athletes with recurring
hamstring
A hamstring () is any one of the three posterior thigh muscles in human anatomy between the hip and the knee: from medial to lateral, the semimembranosus, semitendinosus and biceps femoris.
Etymology
The word " ham" is derived from the Old ...
and
abductor muscle injuries have greater impairment of eccentric strength, suggesting that improvements in eccentric training may minimize the risks of injury by strengthening the muscle-tendon groupings in high-stress areas of the body.
Eccentric training is of huge benefit to those that wish to avert injuries by improving the muscle's abilities to absorb more energy before deteriorating. According to one article, "Increased stiffness in tendons, greater force at failure, and an improved ability to absorb energy at the musculotendonous junction result following eccentric exercise training".
Osteopenia
Usually viewed as a precursor to
osteoporosis
Osteoporosis is a systemic skeletal disorder characterized by low bone mass, micro-architectural deterioration of bone tissue leading to more porous bone, and consequent increase in Bone fracture, fracture risk.
It is the most common reason f ...
,
osteopenia
Osteopenia, known as "low bone mass" or "low bone density", is a condition in which bone mineral density is low. Because their bones are weaker, people with osteopenia may have a higher risk of fractures, and some people may go on to develop o ...
is when
bone density
Bone density, or bone mineral density, is the amount of bone mineral in bone tissue. The concept is of mass of mineral per volume of bone (relating to density in the physics sense), although medicine#Clinical practice, clinically it is measured by ...
is lower than normal levels. Bone mass is affected by muscle forces and their loads on the bone structure. The strength and density of the bone are directly influenced by local strain. Due to the high strain on muscles during eccentric training, coupled with low energy output, eccentric training becomes a cornerstone of the rehabilitative process.
Tendinoses
Intense repetitive activities tend to create
chronic tendon disorders, where the tendons become injured, inflamed, or ruptured. While typically these disorders are directly related to eccentric muscle movements, the ability of a muscle to strengthen and prevent injury through eccentric training is great. Controlled rehabilitative regimes will actually strengthen and repair tendons. Ample evidence supports the notion that the tendon, like the muscle, can adapt favorably to
physical stress and eccentric loads.
It has been deduced that high muscle-tendon forces delivered in a controlled environment are needed for optimal tendon adaptation. While eccentric stress is related to the injury, high-force eccentric exercises are needed to maximize recovery.
Chronic patellar tendonitis
A condition that arises when the tendon and the tissues that surround it, become inflamed and irritated. This is usually due to overuse, especially from jumping activities. This is the reason
chronic patellar tendonitis is often called "jumper’s knee." A study was done by
Roald Bahr and colleagues looked at which method of tendon rehabilitation exercise – the "eccentric squat" exercise or the universal gym "leg extension/leg curl" — produced more recovery results in terms of recovery in the treatment of chronic patellar tendonitis. On the twelve-week exercise program, participants were tested for thigh circumference and quadriceps, and hamstring
moment of force. There was no significant difference between the groups in either
quadriceps
The quadriceps femoris muscle (, also called the quadriceps extensor, quadriceps or quads) is a large muscle group that includes the four prevailing muscles on the front of the thigh. It is the sole extensor muscle of the knee, forming a large ...
or hamstring moment of force and hamstring moment of force significantly increased in both groups, but the eccentric squat saw significantly lower pain ratings and produced twice as many pain-free subjects at the end of the program than the other group.
Cardiovascular changes
Several recent studies have indicated that eccentric exercise as walking down hill has greater beneficial effects on insulin sensitivity, lipid profiles, and physical fitness than walking up hill. One study used stairs and elevators
and the other a mountain and a cable car.
In both cases the cardiovascular improvements were greater for being lifted up and walking down than for walking up and being lowered down.
See also
*
Flywheel training
Flywheel training is a type of strength training where the resistance required for muscle activation is generated by the inertia of a flywheel instead of gravity from weights as in traditional weight training.
In contrast to weight training, flyw ...
*
Negative repetition
A negative repetition (negative rep) is the repetition of a technique in weight lifting in which the lifter performs the eccentric phase of a lift. Instead of pressing the weight up slowly, in proper form, a spotter generally aids in the concen ...
References
Sources
*
*
*
*Howlett K., T. Keniston, A. Grassl, A. Olsson, C. Eidem, and D.J. McCann, January 2011
N INITIAL ASSESSMENT OF THE METABOLIC COST OF USING THE QUADMILL Department of Exercise Science, Gonzaga University, Spokane, WA.
*
*
*
*{{Cite journal , last1=Roig , first1=M. , last2=O'Brien , first2=K. , last3=Kirk , first3=G. , last4=Murray , first4=R. , last5=McKinnon , first5=P. , last6=Shadgan , first6=B. , last7=Reid , first7=W. D. , year=2009 , title=The effects of eccentric versus concentric resistance training on muscle strength and mass in healthy adults: A systematic review with meta-analysis , journal=British Journal of Sports Medicine , volume=43 , issue=8 , pages=556–568 , doi=10.1136/bjsm.2008.051417 , pmid=18981046 , s2cid=8380567
Strength training