Since little is known about the repeated bout effect of more than two eccentric exercise bouts, this study compared muscle damage responses among four exercise bouts. Fifteen young (21.8 +/- 1.9 years) men performed four bouts of 30 maximal isokinetic eccentric contractions of the elbow flexors every 4 weeks. Maximal voluntary elbow flexion isometric and concentric strength, range of motion at the elbow joint (ROM), upper arm circumference, blood markers of muscle damage, and muscle soreness were measured before and up to 120 h following each bout. Changes in all measures following the second to fourth bouts were significantly (P < 0.05) smaller than those after the first bout. The decreases in strength and ROM immediately after the fourth bout were significantly (P < 0.05) smaller than other bouts. It is concluded that the first bout confers the greatest adaptation, but further adaptation is induced when the exercise is repeated more than three times.