Hill, EC, Housh, TJ, Smith, CM, Keller, JL, Schmidt, RJ, and Johnson, GO. High- vs. low-intensity fatiguing eccentric exercise on muscle thickness, strength, and blood flow. J Strength Cond Res 35(1): 33–40, 2021—The purpose of this investigation was to examine the acute effects of equal volumes of fatiguing high- vs. low-intensity eccentric muscle actions on changes in muscle thickness, echo intensity, muscle blood flow, and adipose thickness. Eighteen men (mean ± SD = 23.2 ± 3.0 years) performed eccentric peak torque (PT) and maximal voluntary isometric contraction (MVIC) trials before (pretest), immediately after (posttest), and 5 minutes after (recovery) performing randomly ordered fatiguing eccentric, isokinetic (180°·s−1) muscle actions of the elbow flexors at 40% (72 repetitions) or 80% (36 repetitions) of eccentric PT. Muscle thickness, exercise-induced edema, muscle blood flow, and adipose thickness were also assessed via ultrasound at pretest, posttest, and recovery. There were no intensity-specific effects on the patterns of responses for eccentric PT, MVIC, muscle thickness, echo intensity, muscle blood flow, or adipose thickness. There were, however, effects across time that decreased from pretest to posttest and from pretest to recovery for eccentric PT (21.5 and 13.0%), MVIC (14.6 and 5.8%), and adipose thickness (10.0 and 6.0%), but increased for muscle thickness (7.6 and 5.9%), echo intensity (13.7 and 9.9%), and muscle blood flow (129.6 and 90.1%) (collapsed across 40 and 80%). These findings indicated that when matched for exercise volume, there were no intensity-related effects on the increases in muscle thickness, echo intensity, muscle blood flow, or the decreases in eccentric PT, MVIC, and adipose thickness after fatiguing eccentric muscle actions. Therefore, exercise volume, independent of exercise intensity and number of repetitions, may be a mediating factor of muscle fatigue and performance during eccentric muscle actions.