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Hedt C, McCulloch PC, Harris JD, Lambert BS. Blood Flow Restriction Enhances Rehabilitation and Return to Sport: The Paradox of Proximal Performance. Arthrosc Sports Med Rehabil 2022; 4:e51-e63. [PMID: 35141536 PMCID: PMC8811501 DOI: 10.1016/j.asmr.2021.09.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 09/15/2021] [Indexed: 12/17/2022] Open
Abstract
The use of blood flow restriction (BFR) within rehabilitation is rapidly increasing as further research is performed elucidating purported benefits such as improved muscular strength and size, neuromuscular control, decreased pain, and increased bone mineral density. Interestingly, these benefits are not isolated to structures distal to the occlusive stimulus. Proximal gains are of high interest to rehabilitation professionals, especially those working with patients who are limited due to pain or postsurgical precautions. The review to follow will focus on current evidence and ongoing hypotheses regarding physiologic responses to BFR, current clinical applications, proximal responses to BFR training, potential practical applications for rehabilitation and injury prevention, and directions for future research. Interestingly, benefits have been found in musculature proximal to the occlusive stimulus, which may lend promise to a greater variety of patient populations and conditions. Furthermore, an increasing demand for BFR use in the sports world warrants further research for performance research and recovery. LEVEL OF EVIDENCE Level V, expert opinion.
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Affiliation(s)
- Corbin Hedt
- Houston Methodist Orthopedics & Sports Medicine, Houston, Texas, U.S.A
| | | | - Joshua D. Harris
- Houston Methodist Orthopedics & Sports Medicine, Houston, Texas, U.S.A
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Acute impact of blood flow restriction on strength-endurance performance during the bench press exercise. Biol Sport 2021; 38:653-658. [PMID: 34937975 PMCID: PMC8670800 DOI: 10.5114/biolsport.2021.103726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/15/2020] [Accepted: 01/18/2021] [Indexed: 11/17/2022] Open
Abstract
The main goal of the present study was to evaluate the acute effects of blood flow restriction (BFR) at 70% of full arterial occlusion pressure on strength-endurance performance during the bench press exercise. The study included 14 strength-trained male subjects (age = 25.6 ± 4.1 years; body mass = 81.7 ± 10.8 kg; bench press 1 repetition maximum (1RM) = 130.0 ± 22.1 kg), experienced in resistance training (3.9 ± 2.4 years). During the experimental sessions in a randomized crossover design, the subjects performed three sets of the bench press at 80% 1RM performed to failure with two different conditions: without BFR (CON); and with BFR (BFR). Friedman's test showed significant differences between BFR and CON conditions for the number of repetitions performed (p < 0.001); for peak bar velocity (p < 0.001) and for mean bar velocity (p < 0.001). The pairwise comparisons showed a significant decrease for peak bar velocity and mean bar velocity in individual Set 1 for BFR when compared to CON conditions (p = 0.01 for both). The two-way repeated measures ANOVA showed a significant main effect for the time under tension (p = 0.02). A post-hoc comparisons for the main effect showed a significant increase in time under tension for BFR when compared to CON (p = 0.02). The results of the presented study indicate that BFR used during strength-endurance exercise generally does not decrease the level of endurance performance, while it causes a drop in bar velocity.
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53
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Geng Y, Wu X, Zhang L. Effects of Blood Flow Restriction Training on Blood Perfusion and Work Ability of Muscles in Elite Para-alpine Skiers. Med Sci Sports Exerc 2021; 54:489-496. [PMID: 34669671 PMCID: PMC8830888 DOI: 10.1249/mss.0000000000002805] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Purpose The effects of short-term blood flow restriction (BFR) exercise on muscle blood flow perfusion and performance during high-intensity exercise were determined in elite para-alpine standing skiers to assess whether this would be an effective training regimen for elite athletes with disabilities. Methods Nine national-level para-alpine standing skiers (mean age, 20.67 ± 1.34 yr; four women) were recruited. Nondominant lower limbs were trained with BFR (eight in final analyses), and dominant lower limbs were trained without BFR (seven in final analyses). The 2-wk protocol included high-load resistance, local muscle endurance (circuit resistance training), and aerobic endurance (stationary cycling) training performed 4 times a week, with BFR during local muscle endurance and aerobic endurance sessions. Muscle strength was measured by maximal voluntary isometric contraction (MVIC) in the knee extensors; microcirculatory blood perfusion (MBP), by laser Doppler blood flow; and muscle strength and endurance, by the total amount of work (TW) performed during high-intensity centrifugal and concentric contractions. Results BFR significantly increased absolute and relative MVIC (P < 0.001, P = 0.001), MBP (P = 0.011, P = 0.008), and TW (P = 0.006, P = 0.007) from pretraining values, whereas only absolute MVIC increased without BFR (P = 0.047). However, the MVIC increase with BFR exercise (35.88 ± 14.83 N·m) was significantly greater (P = 0.040) than without BFR exercise (16.71 ± 17.79 N·m). Conclusions Short-term BFR exercise significantly increased strength endurance, muscle strength, and MBP in national-level para-alpine standing skiers. Our study provides new evidence that BFR exercise can improve local muscle blood perfusion during high-intensity exercise and informs BFR exercise strategies for athletes with disabilities.
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Affiliation(s)
- Yu Geng
- School of Physical Education and Sport Training, Shanghai University of Sport, Shanghai, China Department of Physical Education, Jiyang College of Zhejiang A&F University, Zhejiang, China
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Zhao Y, Lin A, Jiao L. Eight weeks of resistance training with blood flow restriction improve cardiac function and vascular endothelial function in healthy young Asian males. Int Health 2021; 13:471-479. [PMID: 33175117 PMCID: PMC8417084 DOI: 10.1093/inthealth/ihaa089] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 09/22/2020] [Accepted: 10/16/2020] [Indexed: 11/29/2022] Open
Abstract
Background Resistance training with blood flow restriction (BFR) is a physiological ischaemic training method. Before it is applied to patients with coronary artery disease, it must be proven safe and effective. Methods Twenty-four healthy adult males were randomly assigned to three groups: the resistance training (RT) group, low-pressure BFR and resistance training (LP-RT) group and high-pressure BFR and resistance training (HP-RT) group. The training protocol was 20 times/min/set, with a 2-min break, five sets/day and 5 d/week for 8 weeks. Cardiac function, haemodynamics and vascular endothelial function were evaluated before and after the first training and the last training. Results There were no significant differences among groups before and after training. After 8 weeks of training, the resting heart rate (p<0.05) of the three groups significantly decreased (p<0.05). The rate–pressure product in the LP-RT group significantly decreased (p<0.05) compared with before training. Just after the last training, heart rate (p<0.05) and cardiac output (p<0.05) in the LP-RT and HP-RT groups significantly decreased compared with those just after the first training. At the end of the experiment, vascular endothelial growth factor (VEGF; p<0.01), soluble VEGF receptor (VEGFR) (p<0.05) and interleukin-6 (p<0.01) significantly increased, except for soluble VEGFR in the RT group. Conclusions Low-intensity resistance training with BFR moderately alters cardiac function. The expression levels of proteins related to vascular endothelial function have significantly changed. Both findings suggest that low-intensity resistance training with BFR may be safely and effectively applied to patients with coronary artery disease.
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Affiliation(s)
- Yan Zhao
- School of Sports and Health, Nanjing Sport Institute, 8 Linggusi Road, Nanjing, PA 210014, China
| | - Aicui Lin
- Department of Science and Technology, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Nanjing, PA 210006, China
| | - Long Jiao
- Department of Rehabilitation, Kunshan Rehabilitation Hospital, 888 Yingbin Road, Kunshan, PA 215300, China
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Bielitzki R, Behrendt T, Behrens M, Schega L. Current Techniques Used for Practical Blood Flow Restriction Training: A Systematic Review. J Strength Cond Res 2021; 35:2936-2951. [PMID: 34319939 DOI: 10.1519/jsc.0000000000004104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
ABSTRACT Bielitzki, R, Behrendt, T, Behrens, M, and Schega, L. Current techniques used for practical blood flow restriction training: a systematic review. J Strength Cond Res 35(10): 2936-2951, 2021-The purpose of this article was to systematically review the available scientific evidence on current methods used for practical blood flow restriction (pBFR) training together with application characteristics as well as advantages and disadvantages of each technique. A literature search was conducted in different databases (PubMed, Web of Science, Scopus, and Cochrane Library) for the period from January 2000 to December 2020. Inclusion criteria for this review were (a) original research involving humans, (b) the use of elastic wraps or nonpneumatic cuffs, and (c) articles written in English. Of 26 studies included and reviewed, 15 were conducted using an acute intervention (11 in the lower body and 4 in the upper body), and 11 were performed with a chronic intervention (8 in the lower body, 1 in the upper body, and 2 in both the upper and the lower body). Three pBFR techniques could be identified: (a) based on the perceptual response (perceived pressure technique), (b) based on the overlap of the cuff (absolute and relative overlap technique), and (c) based on the cuffs' maximal tensile strength (maximal cuff elasticity technique). In conclusion, the perceived pressure technique is simple, valid for the first application, and can be used independently of the cuffs' material properties, but is less reliable within a person over time. The absolute and relative overlap technique as well as the maximal cuff elasticity technique might be applied more reliably due to markings, but require a cuff with constant material properties over time.
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Affiliation(s)
- Robert Bielitzki
- Department of Sport Science, Institute III, Otto von Guericke University Magdeburg, Magdeburg, Germany; and
| | - Tom Behrendt
- Department of Sport Science, Institute III, Otto von Guericke University Magdeburg, Magdeburg, Germany; and
| | - Martin Behrens
- Department of Sport Science, Institute III, Otto von Guericke University Magdeburg, Magdeburg, Germany; and
- Department of Orthopedics, University Medicine Rostock, Rostock, Germany
| | - Lutz Schega
- Department of Sport Science, Institute III, Otto von Guericke University Magdeburg, Magdeburg, Germany; and
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Yinghao L, Jing Y, Yongqi W, Jianming Z, Zeng G, Yiting T, Shuoqi L. Effects of a blood flow restriction exercise under different pressures on testosterone, growth hormone, and insulin-like growth factor levels. J Int Med Res 2021; 49:3000605211039564. [PMID: 34486432 PMCID: PMC8424606 DOI: 10.1177/03000605211039564] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To investigate the changes in serum growth hormone (GH), testosterone, and insulin-like growth factor 1 (IGF-1) during low-intensity resistance exercise under different cuff pressures. METHODS We performed a single-blind, cross-over design study. Twenty-five healthy young men performed three exercise protocols as follows: 1) no blood flow restriction exercise (control group), 2) resistance exercise at 40% of arterial occlusion pressure (AOP) (low group), and 3) resistance exercise at 70% of AOP (high group). Blood lactate, GH, testosterone, and IGF-1 levels were measured at four time points. RESULTS There were no differences in the indices before exercise. The blood flow restriction exercise under different pressures had different effects on each index and there was an interactive effect. GH levels were significantly higher in the high group than in the other groups after exercise. Immediately after exercise, IGF-1 and testosterone levels were significantly higher in the high group than in the other groups. At 15 minutes after exercise, testosterone levels were significantly higher in the high group than in the other groups. CONCLUSIONS Low-intensity resistance exercise combined with blood flow restriction effectively increases GH, IGF-1, and testosterone levels in young men. Increasing the cuff pressure results in greater levels of hormone secretion.
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Affiliation(s)
- Li Yinghao
- Department of Physical Education, Zhengzhou Shengda University, Zhengzhou, China
| | - Yang Jing
- Internal Medicine-Cardiovascular Department, Tangshan Hongci Hospital, Tangshan, China
| | - Wang Yongqi
- Department of Life Sciences, Inner Mongolia University, Inner Mongolia, China
| | - Zhou Jianming
- School of Health Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Gao Zeng
- School of Health Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Tang Yiting
- School of Health Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Li Shuoqi
- School of Health Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
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Chen N, He X, Zhao G, Lu L, Ainsworth BE, Liu Y, Wu X. Efficacy of low-load resistance training combined with blood flow restriction vs. high-load resistance training on sarcopenia among community-dwelling older Chinese people: study protocol for a 3-arm randomized controlled trial. Trials 2021; 22:518. [PMID: 34348792 PMCID: PMC8336391 DOI: 10.1186/s13063-021-05495-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 07/27/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Sarcopenia is accompanied by a decline in muscle mass, muscle strength, and muscle function. Resistance training is the most potential training method for the prevention and treatment of sarcopenia. However, the conventional high-load resistance training (CRT) recommended by the American College of Sports Medicine is a challenge for older people with sarcopenia. As a novel training method, low-load resistance training combined with blood flow restriction (LRT-BFR) may elicit similar muscle mass and muscle strength gains as CRT but with less effort. The objectives of this study are to assess and compare the efficacy and safety of 12-week LRT-BFR and CRT on muscle strength, muscle performance, body composition, pulmonary function, blood biomarkers, CVD risk factors, and quality of life in community-dwelling older Chinese people with sarcopenia. METHOD This is a 12-week, assessor-blinded, 3-arm randomized controlled trial with a non-exercise control group. Community-dwelling people over 65 years will be screened for sarcopenia according to the diagnostic criteria of the Asian Working Group for Sarcopenia (AWGS). Fifty-one subjects will be randomized into a LRT-BFR group (n = 17), a CRT group (n = 17), and a no-strength training control group (n = 17). The primary outcome is lower limb muscle strength. The secondary outcomes are body composition, upper limb muscle strength, pulmonary function, blood biomarkers, CVD risk factors, and quality of life. Post-intervention follow-up will be performed for 12 weeks. These indicators will be assessed at baseline (0 week), after the 12-week intervention (12 weeks), and at follow-up (24 weeks). The adverse events will also be reported. Data will be analyzed for all participants in an intent-to-treat plan. DISCUSSION This study is the first RCT that will systematically measure and compare the efficacy and safety of LRT-BFR and CRT in older people with sarcopenia on muscle strength, body composition, pulmonary function, blood biomarkers (inflammatory biomarkers, hormone, and growth factors), CVD risk factors, and quality of life. This study can provide an efficient and safe method to prevent the progression of sarcopenia in older people. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR2100042803 . Registered on 28 January 2021.
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Affiliation(s)
- Nan Chen
- School of Kinesiology, Shanghai University of Sport, Shanghai, 200438, China
- Department of Rehabilitation, Xinhua Hospital Chongming Branch, Shanghai, China
| | - Xiangfeng He
- Department of Rehabilitation, Xinhua Hospital Chongming Branch, Shanghai, China
| | - Guoyun Zhao
- Department of Rehabilitation, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Linqian Lu
- School of Kinesiology, Shanghai University of Sport, Shanghai, 200438, China
| | | | - Yu Liu
- School of Kinesiology, Shanghai University of Sport, Shanghai, 200438, China.
| | - Xie Wu
- School of Kinesiology, Shanghai University of Sport, Shanghai, 200438, China.
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Lambert B, Hedt C, Daum J, Taft C, Chaliki K, Epner E, McCulloch P. Blood Flow Restriction Training for the Shoulder: A Case for Proximal Benefit. Am J Sports Med 2021; 49:2716-2728. [PMID: 34110960 DOI: 10.1177/03635465211017524] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although blood flow restriction (BFR) is becoming increasingly popular in physical therapy and athletic training settings, little is known about the effects of BFR combined with low-intensity exercise (LIX) on muscles proximal to the site of occlusion. HYPOTHESIS/PURPOSE Determine whether LIX combined with BFR applied distally to the shoulder on the brachial region of the arm (BFR-LIX) promotes greater increases in shoulder lean mass, rotator cuff strength, endurance, and acute increases in shoulder muscle activation compared with LIX alone. We hypothesized that BFR-LIX would elicit greater increases in rotator cuff strength, endurance, and muscle mass. We also hypothesized that the application of BFR would increase EMG amplitude in the shoulder muscles during acute exercise. STUDY DESIGN Controlled laboratory study. METHODS 32 healthy adults were randomized into 2 groups (BFR group, 13 men, 3 women; No-BFR group, 10 men, 6 women) who performed 8 weeks of shoulder LIX (2 times per week; 4 sets [30/15/15/fatigue]; 20% maximum) using common rotator cuff exercises (cable external rotation [ER], cable internal rotation [IR], dumbbell scaption, and side-lying dumbbell ER). The BFR group also trained with an automated tourniquet placed at the proximal arm (50% occlusion). Regional lean mass (dual-energy x-ray absorptiometry), isometric strength, and muscular endurance (repetitions to fatigue [RTF]; 20% maximum; with and without 50% occlusion) were measured before and after training. Electromyographic amplitude (EMGa) was recorded from target shoulder muscles during endurance testing. A mixed-model analysis of covariance (covaried on baseline measures) was used to detect within-group and between-group differences in primary outcome measures (α = .05). RESULTS The BFR group had greater increases in lean mass in the arm (mean ± 95% CI: BFR, 175 ± 54 g; No BFR, -17 ± 77 g; P < .01) and shoulder (mean ± 95% CI: BFR, 278 ± 90 g; No BFR, 96 ± 61 g; P < .01), isometric IR strength (mean ± 95% CI: BFR, 2.9 ± 1.3 kg; No BFR, 0.1 ± 1.3 kg; P < .01), single-set RTF volume (repetitions × resistance) for IR (~1.7- to 2.1-fold higher; P < .01), and weekly training volume (weeks 4, 6-8, ~5%-22%; P < .05). Acute occlusion (independent of group or timepoint) yielded increases in EMGa during RTF (~10%-20%; P < .05). CONCLUSION Combined BFR-LIX may yield greater increases in shoulder and arm lean mass, strength, and muscular endurance compared with fatiguing LIX alone during rotator cuff exercises. These findings may be due, in part, to a greater activation of shoulder muscles while using BFR. CLINICAL RELEVANCE The present study demonstrates that BFR-LIX may be a suitable candidate for augmenting preventive training or rehabilitation outcomes for the shoulder.
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Affiliation(s)
- Bradley Lambert
- Orthopedic Biomechanics Research Laboratory, Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, Texas, USA
| | - Corbin Hedt
- Orthopedic Biomechanics Research Laboratory, Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, Texas, USA
| | - Joshua Daum
- Orthopedic Biomechanics Research Laboratory, Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, Texas, USA
| | - Carter Taft
- Department of Kinesiology, Rice University, Houston, Texas, USA
| | - Kalyan Chaliki
- Department of Kinesiology, Rice University, Houston, Texas, USA
| | - Eden Epner
- Orthopedic Biomechanics Research Laboratory, Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, Texas, USA
| | - Patrick McCulloch
- Orthopedic Biomechanics Research Laboratory, Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, Texas, USA
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Cerqueira MS, Costa EC, Santos Oliveira R, Pereira R, Brito Vieira WH. Blood Flow Restriction Training: To Adjust or Not Adjust the Cuff Pressure Over an Intervention Period? Front Physiol 2021; 12:678407. [PMID: 34262476 PMCID: PMC8273389 DOI: 10.3389/fphys.2021.678407] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 06/02/2021] [Indexed: 11/13/2022] Open
Abstract
Blood flow restriction (BFR) training combines exercise and partial reduction of muscular blood flow using a pressured cuff. BFR training has been used to increase strength and muscle mass in healthy and clinical populations. A major methodological concern of BFR training is blood flow restriction pressure (BFRP) delivered during an exercise bout. Although some studies increase BFRP throughout a training intervention, it is unclear whether BFRP adjustments are pivotal to maintain an adequate BFR during a training period. While neuromuscular adaptations induced by BFR are widely studied, cardiovascular changes throughout training intervention with BFR and their possible relationship with BFRP are less understood. This study aimed to discuss the need for BFRP adjustment based on cardiovascular outcomes and provide directions for future researches. We conducted a literature review and analyzed 29 studies investigating cardiovascular adaptations following BFR training. Participants in the studies were healthy, middle-aged adults, older adults and clinical patients. Cuff pressure, when adjusted, was increased during the training period. However, cardiovascular outcomes did not provide a plausible rationale for cuff pressure increase. In contrast, avoiding increments in cuff pressure may minimize discomfort, pain and risks associated with BFR interventions, particularly in clinical populations. Given that cardiovascular adaptations induced by BFR training are conflicting, it is challenging to indicate whether increases or decreases in BFRP are needed. Based on the available evidence, we suggest that future studies investigate if maintaining or decreasing cuff pressure makes BFR training safer and/or more comfortable with similar physiological adaptation.
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Affiliation(s)
- Mikhail Santos Cerqueira
- Neuromuscular Performance Analysis Laboratory, Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Eduardo Caldas Costa
- Department of Physical Education, Federal University of Rio Grande do Norte, Natal, Brazil
| | | | - Rafael Pereira
- Integrative Physiology Research Center, Department of Biological Sciences, Universidade Estadual do Sudoeste da Bahia (UESB), Jequié, Brazil
| | - Wouber Hérickson Brito Vieira
- Neuromuscular Performance Analysis Laboratory, Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal, Brazil
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Wilk M, Trybulski R, Krzysztofik M, Wojdala G, Campos Y, Zajac A, Lulińska E, Stastny P. Acute Effects of Different Blood Flow Restriction Protocols on Bar Velocity During the Squat Exercise. Front Physiol 2021; 12:652896. [PMID: 34234686 PMCID: PMC8255669 DOI: 10.3389/fphys.2021.652896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 05/21/2021] [Indexed: 11/13/2022] Open
Abstract
The main goal of the present study was to evaluate the effects of different blood flow restriction (BFR) protocols (continuous and intermittent) on peak bar velocity (PV) and mean bar velocity (MV) during the squat exercise at progressive loads, from 40 to 90% 1RM. Eleven healthy men (age = 23.4 ± 3.1 years; body mass = 88.5 ± 12.1 kg; squat 1RM = 183.2 ± 30.7 kg; resistance training experience, 5.7 ± 3.6 years) performed experimental sessions once a week for 3 weeks in random and counterbalanced order: without BFR (NO-BFR), with intermittent BFR (I-BFR), and with continuous BFR (C-BFR). During the experimental session, the participants performed six sets of the barbell squat exercise with loads from 40 to 90% 1RM. In each set, they performed two repetitions. During the C-BFR session, the cuffs were maintained throughout the training session. During the I-BFR, the cuffs were used only during the exercise and released for each rest interval. The BFR pressure was set to ∼80% arterial occlusion pressure (AOP). Analyses of variance showed a statistically significant interaction for MV (p < 0.02; η2 = 0.18). However, the post hoc analysis did not show significant differences between particular conditions for particular loads. There was no significant condition × load interaction for PV (p = 0.16; η2 = 0.13). Furthermore, there were no main effects for conditions in MV (p = 0.38; η2 = 0.09) as well as in PV (p = 0.94; η2 = 0.01). The results indicate that the different BFR protocols used during lower body resistance exercises did not reduce peak bar velocity and mean bar velocity during the squat exercise performed with various loads.
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Affiliation(s)
- Michal Wilk
- Institute of Sport Sciences, Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | - Robert Trybulski
- Department of Medical Sciences, The Wojciech Korfanty School of Economics, Katowice, Poland.,Provita Zory Medical Center, Zory, Poland
| | - Michal Krzysztofik
- Institute of Sport Sciences, Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | - Grzegorz Wojdala
- Institute of Sport Sciences, Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | - Yuri Campos
- Postgraduate Program, Faculty of Physical Education and Sports, Federal University of Juiz de Fora, Juiz de Fora, Brazil.,Study Group and Research in Neuromuscular Responses, Federal University of Lavras, Lavras, Brazil
| | - Adam Zajac
- Institute of Sport Sciences, Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | - Ewelina Lulińska
- Faculty of Physical Education, Gdansk University of Physical Education and Sport, Gdańsk, Poland
| | - Petr Stastny
- Department of Sport Games, Faculty of Physical Education and Sport, Charles University, Prague, Czechia
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Cardiac autonomic response to aerobic exercise with different levels of blood flow restriction in pre-hypertensive men. SPORT SCIENCES FOR HEALTH 2021. [DOI: 10.1007/s11332-020-00699-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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62
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Cherouveim ED, Miliotis P, Dipla K, Koskolou MD, Vrabas IS, Geladas ND. The effect of muscle blood flow restriction on hemodynamics, cerebral oxygenation and activation at rest. Appl Physiol Nutr Metab 2021; 46:1216-1224. [PMID: 33951406 DOI: 10.1139/apnm-2020-1082] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This study tested the hypothesis that muscle blood flow restriction reduces muscle and cerebral oxygenation, at rest. In 26 healthy males, aged 33±2 yrs, physiological variables were continuously recorded during a 10-min period in two experimental conditions: a) with muscle blood flow restriction through thigh cuffs application inflated at 120 mmHg (With Cuffs, WC) and b) without restriction (No Cuffs, NC). Muscle and cerebral oxygenation were reduced by muscle blood flow restriction as suggested by the increase in both muscle and cerebral deoxygenated hemoglobin (Δ[HHb]; p<0.01) and the decrease of muscle and cerebral oxygenation index (Δ[HbDiff]; p<0.01). Hemodynamic responses were not affected by such muscle blood flow restriction, whereas baroreflex sensitivity was reduced (p=0.009). The perception of leg discomfort was higher (p<0.001) in the WC than in the NC condition. This study suggests that thigh cuffs application inflated at 120 mmHg is an effective method to reduce muscle oxygenation at rest. These changes at the muscular level seem to be sensed by the central nervous system, evoking alterations in cerebral oxygenation and baroreflex sensitivity. Novelty bullets: • Thigh cuffs application inflated at 120 mmHg effectively reduces muscle oxygenation at rest. • Limiting muscle oxygenation appears to reduce cerebral oxygenation, and baroreflex sensitivity, at rest. • Even in healthy subjects, limiting muscle oxygenation, at rest, affects neural integration.
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Affiliation(s)
- Evgenia D Cherouveim
- National and Kapodistrian University of Athens, 68993, School of Physical Education and Sport Science, Athens, Attica, Greece;
| | - Panagiotis Miliotis
- National and Kapodistrian University of Athens, 68993, School of Physical Education and Sport Science, Athens, Attica, Greece;
| | - Konstantina Dipla
- Aristotle University of Thessaloniki, Department of Physical Education and Sport Sciences at Serres (TEFAA), Exercise Physiology and Biochemistry Laboratory, Serres, Greece, 62110;
| | - Maria D Koskolou
- National and Kapodistrian University of Athens, 68993, School of Physical Education and Sport Science, Athens, Attica, Greece;
| | | | - Nickos D Geladas
- National and Kapodistrian University of Athens, 68993, School of Physical Education and Sport Science, Athens, Attica, Greece;
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Song JS, Spitz RW, Yamada Y, Bell ZW, Wong V, Abe T, Loenneke JP. Exercise-induced hypoalgesia and pain reduction following blood flow restriction: A brief review. Phys Ther Sport 2021; 50:89-96. [PMID: 33940556 DOI: 10.1016/j.ptsp.2021.04.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 04/13/2021] [Accepted: 04/16/2021] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To review past literature regarding exercise-induced hypoalgesia and pain reduction following blood flow restriction interventions, and to discuss potential mechanisms as well as future considerations towards the efficacy of blood flow restriction in pain reduction following exercise. METHODS To be eligible for inclusion, studies had to include acute exercise, or long-term training interventions, with blood flow restriction, along with including pre and post intervention pain measurements. RESULTS A total of 13 studies met the inclusion criteria. Among these 13 studies, 3 studies examined exercise-induced hypoalgesia after an acute bout of resistance exercise with blood flow restriction, and 10 studies investigated pain reduction following long-term blood flow restriction training. CONCLUSIONS Existing literature suggests that low load resistance exercise with blood flow restriction may serve as an effective pain management method for those who are unable or unwilling to train with high loads. Several potential mechanisms have been suggested, however, the roles of these mechanisms are still unclear and require further clarification. Future research should consider implementing different methods of blood flow restriction application, and research study design to clarify the utility and efficacy of blood flow restriction as a pain management tool, by itself or in combination with exercise.
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Affiliation(s)
- Jun Seob Song
- Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, MS, United States
| | - Robert W Spitz
- Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, MS, United States
| | - Yujiro Yamada
- Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, MS, United States
| | - Zachary W Bell
- Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, MS, United States
| | - Vickie Wong
- Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, MS, United States
| | - Takashi Abe
- Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, MS, United States
| | - Jeremy P Loenneke
- Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, MS, United States.
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Barjaste A, Mirzaei B, Rahmani-nia F, Haghniyaz R, Brocherie F. Concomitant aerobic- and hypertrophy-related skeletal muscle cell signaling following blood flow-restricted walking. Sci Sports 2021. [DOI: 10.1016/j.scispo.2020.03.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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65
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Cardozo GG, Lopes KG, Bottino DA, Souza MDGCD, Bouskela E, Farinatti P, Brandão de Oliveira R. Acute effects of physical exercise with different levels of blood flow restriction on vascular reactivity and biomarkers of muscle hypertrophy, endothelial function and oxidative stress in young and elderly subjects - A randomized controlled protocol. Contemp Clin Trials Commun 2021; 22:100740. [PMID: 33937579 PMCID: PMC8076709 DOI: 10.1016/j.conctc.2021.100740] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 11/15/2020] [Accepted: 02/04/2021] [Indexed: 11/26/2022] Open
Abstract
Background Gains in muscle mass and strength have been documented in exercise training with blood flow restriction (BFR). However, the impact of retrograde blood flow during BFR training on vascular health remains unclear. The present study designed a protocol to evaluate the acute effects of exercise performed with different levels of BFR on vascular reactivity and biomarkers of endothelial function, oxidative stress, and muscle hypertrophy in young and older individuals. Methods and study design Sixty-eight physically inactive eutrophic men [34 young (18–25-yrs old) and 34 elderly (≥65-yrs old)] will be included in the study. Subjects will undergo three experimental protocols: a) control (ExCON) – handgrip exercise with intensity of 30% of the maximum voluntary contraction (MVC); b) blood flow restriction (ExBFR) – handgrip exercise with a resistance of 30% of the MVC with low level of BFR [80% of arterial occlusion pressure at rest (rAOP)]; and c) arterial occlusion pressure (ExAOP) – handgrip exercise with a resistance of 30% of the MVC with high level of BFR (120% of rAOP). Primary outcomes will be: a) vascular reactivity assessed by venous occlusion plethysmography; b) endothelial function (nitric oxide and apoptotic endothelial micro particles; c) oxidative stress (thiobarbituric acid reactive substances). Growth hormone and lactate concentration will be measured as secondary outcomes reflecting the hypertrophic drive and metabolic stress, respectively. Discussion The findings of the present study may help to elucidate the age-related impacts of BFR training on the vascular health.
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Affiliation(s)
- Gustavo Gonçalves Cardozo
- Graduate Program in Exercise and Sport Sciences, Rio de Janeiro State University, Rio de Janeiro, Brazil.,Laboratory of Physical Activity and Health Promotion, Institute of Physical Education and Sports, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Karynne Grutter Lopes
- Laboratory of Physical Activity and Health Promotion, Institute of Physical Education and Sports, Rio de Janeiro State University, Rio de Janeiro, Brazil.,Graduate Program in Clinical and Experimental Physiopathology, Rio de Janeiro State University, Rio de Janeiro, Brazil.,Laboratory for Clinical and Experimental Research on Vascular Biology, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Daniel Alexandre Bottino
- Graduate Program in Clinical and Experimental Physiopathology, Rio de Janeiro State University, Rio de Janeiro, Brazil.,Laboratory for Clinical and Experimental Research on Vascular Biology, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Maria das Graças Coelho de Souza
- Graduate Program in Clinical and Experimental Physiopathology, Rio de Janeiro State University, Rio de Janeiro, Brazil.,Laboratory for Clinical and Experimental Research on Vascular Biology, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Eliete Bouskela
- Graduate Program in Clinical and Experimental Physiopathology, Rio de Janeiro State University, Rio de Janeiro, Brazil.,Laboratory for Clinical and Experimental Research on Vascular Biology, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Paulo Farinatti
- Graduate Program in Exercise and Sport Sciences, Rio de Janeiro State University, Rio de Janeiro, Brazil.,Laboratory of Physical Activity and Health Promotion, Institute of Physical Education and Sports, Rio de Janeiro State University, Rio de Janeiro, Brazil.,Graduate Program in Physical Activity Sciences, Salgado de Oliveira University, Niteroi, Brazil
| | - Ricardo Brandão de Oliveira
- Graduate Program in Exercise and Sport Sciences, Rio de Janeiro State University, Rio de Janeiro, Brazil.,Laboratory of Active Living - Rio de Janeiro State University, Rio de Janeiro, Brazil
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Wilk M, Krzysztofik M, Jarosz J, Krol P, Leznicka K, Zajac A, Stastny P, Bogdanis GC. Impact of Ischemic Intra-Conditioning on Power Output and Bar Velocity of the Upper Limbs. Front Physiol 2021; 12:626915. [PMID: 33716773 PMCID: PMC7947627 DOI: 10.3389/fphys.2021.626915] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 02/01/2021] [Indexed: 01/24/2023] Open
Abstract
This study evaluated the effects of ischemic conditioning on power output and bar velocity in the bench press exercise. Ten healthy males (age: 25 ± 2 years; body mass: 92 ± 8 kg; bench press one repetition maximum -1RM: 145 ± 13 kg), took part in two experimental sessions (with and without ischemia), 1 week apart in random and counterbalanced order. In the ischemic condition, cuffs placed around the upper part of the arms were inflated to 80% of arterial occlusion pressure before each set, while in the control condition there was no blood flow restriction. The exercise protocol included 5 sets of three repetitions each, against a resistance equal to 60% 1RM, with 5 min recovery intervals between sets. There was a main effect of condition for mean power output (MP) and mean bar velocity (MV) (p = 0.01), with overall MP being higher in ischemia than in control by 5.6 ± 4.1% (mean ± 90% compatibility limits), a standardized effect size (ES) of 0.51. Overall MV was also higher by 5.5 ± 4.0%, ES = 0.63. Peak power output (PP) and peak bar velocity (PV) were similar in set 1 of the control and ischemia condition (1039 ± 105 vs. 1054 ± 82 W; 684 ± 74 vs. 696 ± 53 W; 1.09 ± 0.07 vs. 1.12 ± 0.09 m/s; 0.81 ± 0.05 vs. 0.82 ± 0.05 m/s, p = 0.67 to 0.99, mean ± standard deviation). However, from set 3 onward (p = 0.03 to 0.001), PP and PV were higher in ischemia compared with control, with the highest difference observed in set 5 (10.9 ± 5.9%, ES = 0.73 for PP and 8.6 ± 4.6%; ES = 0.89 for PV). These results indicate that ischemia used before each set of the bench press exercise increases power output and bar velocity and this may be used as performance-enhancing stimulus during explosive resistance training.
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Affiliation(s)
- Michal Wilk
- Institute of Sport Sciences, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | - Michal Krzysztofik
- Institute of Sport Sciences, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | - Jakub Jarosz
- Institute of Sport Sciences, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | - Pawel Krol
- College of Medical Sciences, Institute of Physical Culture Studies, University of Rzeszów, Rzeszów, Poland
| | - Katarzyna Leznicka
- Faculty of Physical Education, Gdansk University of Physical Education and Sport, Gdańsk, Poland
| | - Adam Zajac
- Institute of Sport Sciences, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | - Petr Stastny
- Faculty of Physical Education and Sport, Department of Sport Games, Charles University, Prague, Czechia
| | - Gregory C. Bogdanis
- School of Physical Education and Sport Science, National and Kapodistrian University of Athens, Athens, Greece
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Grantham B, Korakakis V, O'Sullivan K. Does blood flow restriction training enhance clinical outcomes in knee osteoarthritis: A systematic review and meta-analysis. Phys Ther Sport 2021; 49:37-49. [PMID: 33582442 DOI: 10.1016/j.ptsp.2021.01.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 01/27/2021] [Accepted: 01/29/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To systematically review the efficacy of blood flow restriction training (BFRT) on individuals with knee osteoarthritis (OA). DESIGN Systematic review with meta-analysis. LITERATURE SEARCH Eight electronic databases were searched by one researcher. STUDY SELECTION CRITERIA Randomised clinical trials (RCTs) comparing BFRT to regular resistance training (RT) for knee OA. DATA SYNTHESIS One reviewer selected the eligible RCTs and exported the data. Two reviewers evaluated study quality using the PEDro scale. We performed meta-analysis where appropriate using a random-effects model. We rated the quality of evidence using GRADE. RESULTS Five studies were eligible. The key outcomes analysed were pain, self-reported function, objective physical function, strength and muscle size. Across all comparisons, there was low to moderate quality evidence of no difference between BFRT and traditional RT. CONCLUSION The limited available evidence does not suggest that BFRT enhances outcomes for people with knee OA. These findings do not support clinicians using BFRT in people with knee OA. Instead, evidence-based messages regarding exercise and education should remain the mainstay of rehabilitation. Additional studies should clarify whether some people with knee OA who cannot complete an adequate exercise programme due to pain, might still benefit from BFRT to facilitate less painful exercise.
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Affiliation(s)
- Brayden Grantham
- School of Allied Health, University of Limerick, Limerick, Ireland
| | | | - Kieran O'Sullivan
- School of Allied Health, University of Limerick, Limerick, Ireland; Ageing Research Centre, University of Limerick, Limerick, Ireland
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Ogawa H, Nakajima T, Shibasaki I, Nasuno T, Kaneda H, Katayanagi S, Ishizaka H, Mizushima Y, Uematsu A, Yasuda T, Yagi H, Toyoda S, Hortobágyi T, Mizushima T, Inoue T, Fukuda H. Low-Intensity Resistance Training with Moderate Blood Flow Restriction Appears Safe and Increases Skeletal Muscle Strength and Size in Cardiovascular Surgery Patients: A Pilot Study. J Clin Med 2021; 10:547. [PMID: 33540756 PMCID: PMC7867301 DOI: 10.3390/jcm10030547] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 01/23/2021] [Accepted: 01/28/2021] [Indexed: 11/16/2022] Open
Abstract
We examined the safety and the effects of low-intensity resistance training (RT) with moderate blood flow restriction (KAATSU RT) on muscle strength and size in patients early after cardiac surgery. Cardiac patients (age 69.6 ± 12.6 years, n = 21, M = 18) were randomly assigned to the control (n = 10) and the KAATSU RT group (n = 11). All patients had received a standard aerobic cardiac rehabilitation program. The KAATSU RT group additionally executed low-intensity leg extension and leg press exercises with moderate blood flow restriction twice a week for 3 months. RT-intensity and volume were increased gradually. We evaluated the anterior mid-thigh thickness (MTH), skeletal muscle mass index (SMI), handgrip strength, knee extensor strength, and walking speed at baseline, 5-7 days after cardiac surgery, and after 3 months. A physician monitored the electrocardiogram, rate of perceived exertion, and the color of the lower limbs during KAATSU RT. Creatine phosphokinase (CPK) and D-dimer were measured at baseline and after 3 months. There were no side effects during KAATSU RT. CPK and D-dimer were normal after 3 months. MTH, SMI, walking speed, and knee extensor strength increased after 3 months with KAATSU RT compared with baseline. Relatively low vs. high physical functioning patients tended to increase physical function more after 3 months with KAATSU RT. Low-intensity KAATSU RT as an adjuvant to standard cardiac rehabilitation can safely increase skeletal muscle strength and size in cardiovascular surgery patients.
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Affiliation(s)
- Hironaga Ogawa
- Department of Cardiovascular Surgery, School of Medicine, Dokkyo Medical University, Shimotsuga-gun, Tochigi 321-0293, Japan; (H.O.); (I.S.); (H.F.)
| | - Toshiaki Nakajima
- Department of Cardiovascular Medicine, School of Medicine, Dokkyo Medical University, Shimotsuga-gun, Tochigi 321-0293, Japan; (T.N.); (H.K.); (H.Y.); (S.T.); (T.I.)
- Department of Medical KAATSU Training, Dokkyo Medical University, Shimotsuga-gun, Tochigi 321-0293, Japan
| | - Ikuko Shibasaki
- Department of Cardiovascular Surgery, School of Medicine, Dokkyo Medical University, Shimotsuga-gun, Tochigi 321-0293, Japan; (H.O.); (I.S.); (H.F.)
| | - Takahisa Nasuno
- Department of Cardiovascular Medicine, School of Medicine, Dokkyo Medical University, Shimotsuga-gun, Tochigi 321-0293, Japan; (T.N.); (H.K.); (H.Y.); (S.T.); (T.I.)
| | - Hiroyuki Kaneda
- Department of Cardiovascular Medicine, School of Medicine, Dokkyo Medical University, Shimotsuga-gun, Tochigi 321-0293, Japan; (T.N.); (H.K.); (H.Y.); (S.T.); (T.I.)
| | - Satoshi Katayanagi
- Department of Rehabilitation, Dokkyo Medical University Hospital, Shimotsuga-gun, Tochigi 321-0293, Japan; (S.K.); (H.I.); (Y.M.); (T.M.)
| | - Hayato Ishizaka
- Department of Rehabilitation, Dokkyo Medical University Hospital, Shimotsuga-gun, Tochigi 321-0293, Japan; (S.K.); (H.I.); (Y.M.); (T.M.)
| | - Yuta Mizushima
- Department of Rehabilitation, Dokkyo Medical University Hospital, Shimotsuga-gun, Tochigi 321-0293, Japan; (S.K.); (H.I.); (Y.M.); (T.M.)
| | - Azusa Uematsu
- Department of Health and Sport Sciences, Premedical Sciences, Dokkyo Medical University, Shimotsuga-gun, Tochigi 321-0293, Japan;
| | - Tomohiro Yasuda
- School of Nursing, Seirei Christopher University, Hamamatsu, Shizuoka 433-8558, Japan;
| | - Hiroshi Yagi
- Department of Cardiovascular Medicine, School of Medicine, Dokkyo Medical University, Shimotsuga-gun, Tochigi 321-0293, Japan; (T.N.); (H.K.); (H.Y.); (S.T.); (T.I.)
| | - Shigeru Toyoda
- Department of Cardiovascular Medicine, School of Medicine, Dokkyo Medical University, Shimotsuga-gun, Tochigi 321-0293, Japan; (T.N.); (H.K.); (H.Y.); (S.T.); (T.I.)
| | - Tibor Hortobágyi
- University Medical Center Groningen, University of Groningen, Groningen, 9713 GZ Groningen, The Netherlands;
| | - Takashi Mizushima
- Department of Rehabilitation, Dokkyo Medical University Hospital, Shimotsuga-gun, Tochigi 321-0293, Japan; (S.K.); (H.I.); (Y.M.); (T.M.)
| | - Teruo Inoue
- Department of Cardiovascular Medicine, School of Medicine, Dokkyo Medical University, Shimotsuga-gun, Tochigi 321-0293, Japan; (T.N.); (H.K.); (H.Y.); (S.T.); (T.I.)
| | - Hirotsugu Fukuda
- Department of Cardiovascular Surgery, School of Medicine, Dokkyo Medical University, Shimotsuga-gun, Tochigi 321-0293, Japan; (H.O.); (I.S.); (H.F.)
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Callanan MC, Plummer HA, Chapman GL, Opitz TJ, Rendos NK, Anz AW. Blood Flow Restriction Training Using the Delfi System Is Associated With a Cellular Systemic Response. Arthrosc Sports Med Rehabil 2020; 3:e189-e198. [PMID: 33615264 PMCID: PMC7879193 DOI: 10.1016/j.asmr.2020.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 09/04/2020] [Indexed: 01/31/2023] Open
Abstract
Purpose To determine the effects of blood flow restriction (BFR) exercise on CD34+ cells, platelets, white blood cells, neutrophils, lymphocytes, lactate, and glucose. Methods Healthy participants aged 20 to 39 years who were able to perform the exercise sessions were recruited. Participants underwent an experimental (EXP) occluded testing session and a control (CON) session using the Delfi Personalized Tourniquet System. Blood draws were performed prior to testing and immediately after the exercise session. Blood analysis consisted of a complete blood count as well as flow cytometry to measure peripheral CD34+ counts as a marker for hematopoietic progenitor cells. Results Fourteen men (aged 30.8 ± 3.9 years) volunteered. There was a significant increase in average CD34+ counts immediately after the EXP session only (3.1 ± 1.2 cells ⋅ μL-1 vs 5.2 ± 2.9 cells ⋅ μL-1, P = .012). Platelet counts were significantly elevated after both sessions, with the average increase being higher after the EXP session (mean difference [MD], 34,200/μL; P < .002) than after the CON session (MD, 11,600/μL; P < .002). White blood cell counts significantly increased after both the EXP (8,400 ± 2,200/μL vs 6,300 ± 1,600/μL; P < .001) and CON (MD, 900/μL; P < .001) sessions. There was a significant increase from baseline to immediately after exercise in the average number of lymphocytes (MD, 6.3%; P < .001) and, conversely, a significant decrease in the average neutrophil count (MD, 6.5%; P < .001) in the EXP session only. Lactate levels significantly increased in the EXP (MD, 6.1 mmol ⋅ L-1; P = .001) and CON (MD, 3.6 mmol ⋅ L-1; P = .001) groups. No changes in glucose levels were observed. Conclusions Exercise with BFR causes a significant post-exercise increase in peripheral hematopoietic progenitor cells and platelets, beyond that of standard resistance training. Clinical Relevance BFR can be considered a way to manipulate point-of-care blood products such as platelet-rich plasma to increase product yield.
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Affiliation(s)
| | - Hillary A Plummer
- Andrews Research & Education Foundation, Gulf Breeze, Florida, U.S.A
| | | | - Tyler J Opitz
- Andrews Institute for Orthopedics & Sports Medicine, Gulf Breeze, Florida, U.S.A
| | - Nicole K Rendos
- Andrews Research & Education Foundation, Gulf Breeze, Florida, U.S.A
| | - Adam W Anz
- Andrews Institute for Orthopedics & Sports Medicine, Gulf Breeze, Florida, U.S.A
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A SYSTEMATIC REVIEW OF THE EFFECTS OF BLOOD FLOW RESTRICTION TRAINING ON QUADRICEPS MUSCLE ATROPHY AND CIRCUMFERENCE POST ACL RECONSTRUCTION. Int J Sports Phys Ther 2020; 15:882-891. [PMID: 33344004 DOI: 10.26603/ijspt20200882] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background ACL reconstruction often results in an extended period of muscle atrophy and weakness. Blood flow restriction (BFR) training is a technique that has been shown to decrease muscle atrophy in a variety of populations. Purpose The purpose of this systematic review was to analyze the research presented on the effect of blood flow restriction training on quadriceps muscle atrophy and circumference post ACL reconstruction. Study Design Systematic Review. Methods Articles were reviewed using the databases Google Scholar, PubMed, and EBSCO. Keywords included blood flow restriction training, ACL reconstruction, and quadriceps. Inclusion criteria included English language, peer-reviewed journals; randomized control trials; and articles including blood flow restriction and measurement of quadriceps atrophy and circumference post ACL reconstruction. Exclusion criteria included non-English language publications; studies without a control group; and articles without sufficient data to evaluate the methodology. Four studies met the selection criteria and were assessed using the GRADE scale, which analyzes the strength of a study based on study limitations, precision, consistency, directness, and publication bias. After a GRADE designation was assigned, the following information was extracted from and compared across the studies: participant demographics, cuff used, graft used during ACL reconstruction, tool used to assess muscle atrophy, protocol used, and conclusions. Results Three out of four studies showed some amount of an increase in femoral muscle cross sectional area after the use of BFR combined with low-intensity resistance training (LIRT). The strength of all four studies was moderate when assessed using the GRADE scale. Conclusion This review of the available evidence yields promising results regarding the use of BFR and LIRT in the remediation of femoral muscle atrophy after an ACL reconstruction. Further research is necessary before BFR can be recommended for use in clinical settings. Level of evidence 3a.
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71
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Karabulut M, Esparza B, Dowllah IM, Karabulut U. The impact of low-intensity blood flow restriction endurance training on aerobic capacity, hemodynamics, and arterial stiffness. J Sports Med Phys Fitness 2020; 61:877-884. [PMID: 33314880 DOI: 10.23736/s0022-4707.20.11526-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of this study was to determine the effects of short-term low-intensity blood flow restriction (BFR) endurance training (ET) programs on measures of aerobic capacity, hemodynamics, and arterial stiffness in healthy young males. METHODS Thirty-nine healthy young recreationally active males participated in this short-term training study. They were randomly assigned to a high-intensity (HI; N.=11; trained at 60-70% of VO<inf>2</inf> reserve [VO<inf>2</inf>R]), low-intensity (LI; N.=8; trained at 30-40% of VO<inf>2</inf>R), low-intensity with BFR (LI-BFR; N.=10; trained at 30-40% of VO<inf>2</inf>R with BFR) or a non-exercising control group (N.=10). The exercising subjects completed a 6-wk training protocol on a treadmill. Assessment of aerobic capacity (VO<inf>2max</inf>), hemodynamics and arterial stiffness were done before and after training. RESULTS Statistical analyses revealed a significant condition main effect (P<0.05) for VO<inf>2max</inf>, indicating significant increase (P<0.05) in VO<inf>2max</inf> in LI-BFR group compared to control. There were no significant changes for resting heart rate (RHR), systolic blood pressure (SBP), diastolic blood pressure (DBP), carotid-radial pulse wave velocity (PWV), and carotid-femoral PWV (P>0.05). However, femoral-tibial PWV decreased significantly (P<0.05) from baseline to post-training. CONCLUSIONS The results indicate that the application of BFR during ET may cause faster and/or greater adaptations in one or more physiological systems resulting in improved cardiorespiratory fitness.
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Affiliation(s)
- Murat Karabulut
- Department of Health and Human Performance, University of Texas at Rio Grande Valley, Brownsville, TX, USA -
| | - Brittany Esparza
- Department of Health and Human Performance, University of Texas at Rio Grande Valley, Brownsville, TX, USA
| | - Imtiaz M Dowllah
- Department of Health and Human Performance, University of Texas at Rio Grande Valley, Brownsville, TX, USA
| | - Ulku Karabulut
- Department of Health and Human Performance, University of Texas at Rio Grande Valley, Brownsville, TX, USA
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72
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Amorim S, Rolnick N, Schoenfeld BJ, Aagaard P. Low-intensity resistance exercise with blood flow restriction and arterial stiffness in humans: A systematic review. Scand J Med Sci Sports 2020; 31:498-509. [PMID: 33283322 DOI: 10.1111/sms.13902] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 11/18/2020] [Accepted: 11/20/2020] [Indexed: 12/25/2022]
Abstract
Low-intensity resistance exercise with blood flow restriction exercise is an emerging type of exercise recognition worldwide. This systematic review evaluated the effects of low-intensity resistance exercise performed with concurrent blood flow restriction (LIRE-BFR) on acute and chronic measures of arterial stiffness in humans. A systematic search in six healthcare science databases and reference lists was conducted. Data selected for primary analysis consisted of post-intervention changes in arterial stiffness markers. This systematic review included randomized and non-randomized controlled trials of LIRE-BFR in humans. 156 articles were initially identified, 15 of which met inclusion criteria. Ten studies were excluded because they did not match predefined arterial stiffness markers. Thus, five articles were included in this review: two acute studies (N = 39 individuals, age = 20-30 years old, 30.8% women and 69.2% men) and three longitudinal studies (N = 51 individuals, age = 24-86-years old, 41.2% women and 58.8% men). Acute LIRE-BFR demonstrated both positive and negative effects on arterial stiffness in healthy young people. In contrast, longitudinal studies reported neutral effects in healthy young and older people. In conclusion, LIRE-BFR applied to the upper and lower limbs may acutely induce increases in central blood pressure and pulse wave velocity in healthy young people, whereas LIRE-BFR for the lower limbs may elicit positive effects related to indirect markers of arterial stiffness. Moreover, longitudinal LIRE-BFR studies showed no changes in arterial stiffness in young and older people. Hence, LIRE-BFR should be prescribed with a degree of caution to avoid non-intended responses in arterial stiffness markers in humans.
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Affiliation(s)
- Samuel Amorim
- Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Nicholas Rolnick
- Department of Health Sciences, Lehman College, CUNY, Bronx, NY, USA
| | | | - Per Aagaard
- Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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Munhoz SV, Ramis TR, dos Santos LP, Ribeiro JL. Comparison of cardiopulmonary exercise testing performed with blood flow restriction vs. a traditional maximum test on execution speed, ventilatory thresholds and maximum oxygen uptake. SPORT SCIENCES FOR HEALTH 2020. [DOI: 10.1007/s11332-020-00644-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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74
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Wilk M, Gepfert M, Krzysztofik M, Stastny P, Zajac A, Bogdanis GC. Acute Effects of Continuous and Intermittent Blood Flow Restriction on Movement Velocity During Bench Press Exercise Against Different Loads. Front Physiol 2020; 11:569915. [PMID: 33329020 PMCID: PMC7728989 DOI: 10.3389/fphys.2020.569915] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 10/20/2020] [Indexed: 01/02/2023] Open
Abstract
This study evaluated the effects of continuous and intermittent blood flow restriction (BFR) with 70% of full arterial occlusion pressure on bar velocity during the bench press exercise against a wide range of resistive loads. Eleven strength-trained males (age: 23.5 ± 1.4 years; resistance training experience: 2.8 ± 0.8 years, maximal bench press strength - 1RM = 101.8 ± 13.9 kg; body mass = 79.8 ± 10.4 kg), performed three different testing protocols in random and counterbalanced order: without BFR (NO-BFR); intermittent BFR (I-BFR) and continuous BFR (C-BFR). During each experimental session, subjects performed eight sets of two repetitions each, with increasing loads from 20 to 90% 1RM (10% steps), and 3 min rest between each set. In the C-BFR condition occlusion was kept throughout the trial, while in the I-BFR, occlusion was released during each 3 min rest interval. Peak bar velocity (PV) during the bench press exercise was higher by 12-17% in both I-BFR and C-BFR compared with NO-BFR only at the loads of 20, 30, 40, and 50% 1RM (p < 0.001), while performance at higher loads remained unchanged. Mean bar velocity (MV) was unaffected by occlusion (p = 0.342). These results indicate that BFR during bench press exercise increases PV and this may be used as an enhanced stimulus during explosive resistance training. At higher workloads, bench press performance was not negatively affected by BFR, indicating that the benefits of exercise under occlusion can be obtained while explosive performance is not impaired.
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Affiliation(s)
- Michal Wilk
- Institute of Sport Sciences, Jerzy Kukuczka Academy of Physical Education in Katowice, Katowice, Poland
| | - Mariola Gepfert
- Institute of Sport Sciences, Jerzy Kukuczka Academy of Physical Education in Katowice, Katowice, Poland
| | - Michal Krzysztofik
- Institute of Sport Sciences, Jerzy Kukuczka Academy of Physical Education in Katowice, Katowice, Poland
| | - Petr Stastny
- Department of Sport Games, Faculty of Physical Education and Sport, Charles University, Prague, Czechia
| | - Adam Zajac
- Institute of Sport Sciences, Jerzy Kukuczka Academy of Physical Education in Katowice, Katowice, Poland
| | - Gregory C. Bogdanis
- School of Physical Education and Sport Science, National and Kapodistrian University of Athens, Athens, Greece
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75
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Acute Effects of Tissue Flossing Around the Upper Thigh on Neuromuscular Performance: A Study Using Different Degrees of Wrapping Pressure. J Sport Rehabil 2020; 30:601-608. [PMID: 33238242 DOI: 10.1123/jsr.2020-0105] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 07/27/2020] [Accepted: 09/05/2020] [Indexed: 11/18/2022]
Abstract
CONTEXT It has been recently demonstrated that tissue flossing around the ankle joint can be effectively used to improve ankle range of motion, jump, and sprint ability. However, there is a lack of studies investigating the acute effects of tissue flossing applied using different wrapping pressures. OBJECTIVE To investigate the acute effects of tissue flossing and the degree of floss band pressure, around the upper thigh on knee range of motion, strength, and muscle contractile characteristics. DESIGN Crossover design in 3 distinct sessions. SETTING University laboratory. PARTICIPANTS A total of 19 recreationally trained volunteers (age 23.8[4.8] y) participated in this study. INTERVENTION Active knee extension and flexion performed for 3 sets of 2 minutes (2-min rest between sets with wrapped upper thigh). Individualized wrapping pressures were applied to create conditions of high and moderate vascular occlusion, while a loose band application served as a control condition. MAIN OUTCOME MEASURES Participants were assessed for active straight leg raise test; tensiomyography displacement and contraction time for rectus femoris, vastus medialis, and biceps femoris muscles; and maximum voluntary contractions for knee extensors and flexors for pre, after, and 30 minutes after applying the floss band. RESULTS There was a statistically significant increase in maximum voluntary contractions for knee extensors and a significant shortening in rectus femoris contraction time for the moderate condition, which was associated with small to medium effects in favor of the moderate condition. There were no statistically significant changes observed between control and high conditions. The active straight leg raise test was unaffected regardless of intervention. CONCLUSIONS The results of this study suggest that tissue flossing around the upper thigh might have a localized as well as pressure-sensitive response, thereby improving neuromuscular function of the knee extensors.
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76
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Evin HA, Mahoney SJ, Wagner M, Bond CW, MacFadden LN, Noonan BC. Limb occlusion pressure for blood flow restricted exercise: Variability and relations with participant characteristics. Phys Ther Sport 2020; 47:78-84. [PMID: 33197877 DOI: 10.1016/j.ptsp.2020.11.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 11/03/2020] [Accepted: 11/07/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Assess lower-extremity blood flow restricted exercise (BFR) limb occlusion pressure (LOP) variability and identify related intrinsic characteristics using a portable Delphi BFR system. DESIGN Repeated measures. SETTING Laboratory. PARTICIPANTS Forty-two healthy males (n = 25) and females (n = 17) (25.8 ± 5.2 y, 1.76 ±0 .09 m, 78.9 ± 14.9 kg) completed two visits. Brachial artery blood pressure, thigh circumferences (TC), and LOP were measured supine. MAIN OUTCOME MEASURES Linear mixed-effects models (LMM) and generalizability theory were used to evaluate LOP between legs and days, determine intrinsic characteristic relations, and assess random variance components. RESULTS LOP was not different between legs (p = .730) or days (p = .916; grand mean = 183.7 mmHg [178.4, 189.1]). LOP varied significantly between participants (p = .011, standard error = 47.3 mmHg). 47% of LOP variance was between participants, 18% and 6% was within participants between days and legs, respectively, and 28% was associated with random error. The relative error variance was 14.4 mmHg. Pulse pressure (PP) (p = .005) and TC (p = .040) were positively associated with LOP. A LMM including PP and TC predicted LOP with a mean absolute difference of 11.1 mmHg [9.7, 12.6] compared to measured LOP. CONCLUSIONS The relative error variance suggests that clinicians should measure LOP consistently for each patient to ensure BFR safety and effectiveness.
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Affiliation(s)
- Heather A Evin
- Sanford Orthopedics and Sports Medicine, Sanford Health, Fargo, ND, USA
| | - Sean J Mahoney
- Sanford Orthopedics and Sports Medicine, Sanford Health, Fargo, ND, USA
| | - Matt Wagner
- Sanford Orthopedics and Sports Medicine, Sanford Health, Fargo, ND, USA
| | - Colin W Bond
- Sanford Orthopedics and Sports Medicine, Sanford Health, Fargo, ND, USA.
| | - Lisa N MacFadden
- Sanford Orthopedics and Sports Medicine, Sanford Health, Fargo, ND, USA
| | - Benjamin C Noonan
- Sanford Orthopedics and Sports Medicine, Sanford Health, Fargo, ND, USA
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77
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The Effect of Two Types of High-Intensity Interval Training on Serum Value of GH and IGF-1 in Overweight Nurses. Asian J Sports Med 2020. [DOI: 10.5812/asjsm.103135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Growth hormone and insulin-like growth factor 1 are anabolic hormones that play a vital role in the growth of various physical organs. Exercise is one of the stimuli that affect GH and IGF-1 secretion. Objectives: This study aimed to compare the effect of two types of high-intensity interval training (HIIT) on plasma levels of GH and IGF-l in overweight nurses. Methods: In this study, 27 nurses were voluntarily selected and randomly assigned to three groups (9 participants for each group): 1. HIIT (type 1), including eight seconds of spring running and 12 seconds of active recovery, 2. HIIT (type 2), including a 40-meter shuttle run with maximum speed, 3. control. HIIT (type 1) was performed for four weeks, three sessions per week, each session 6 - 9 min with more than 90% HRmax. HIIT (type 2) was applied for four weeks, three sessions per week, with more than 90% HRmax. The control group did not participate in any training protocol. The serum value of GH and IGF-1 were compared in three groups. The data were analyzed by the dependent t-test and ANOVA. One-way analysis of variance (ANOVA) was used to analyze the intergroup data at P ⟨ 0.05. Results: The results showed that HIIT (type 1) and (type 2) significantly increased plasma GH (P = 0.032 in group 2 and P = 0.010 in group 1) and IGF-l (P = 0.004 in group 2 and P = 10.013 in group 1) levels in nurses. The results showed a significant difference in the variables (GH and IGF-l) among HIIT (type 1), HIIT (type 2), and control groups. Conclusions: It can be concluded that four weeks of adverse intermittent exercises are effective in increasing the concentration of GH and IGF-1 serum and decreased percentage body fat in young nurses with overweight, and proportional to the intensity of the exercise protocol response rate is different.
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Ramis TR, Muller CHDL, Boeno FP, Teixeira BC, Rech A, Pompermayer MG, Medeiros NDS, Oliveira ÁRD, Pinto RS, Ribeiro JL. Effects of Traditional and Vascular Restricted Strength Training Program With Equalized Volume on Isometric and Dynamic Strength, Muscle Thickness, Electromyographic Activity, and Endothelial Function Adaptations in Young Adults. J Strength Cond Res 2020; 34:689-698. [PMID: 30063556 DOI: 10.1519/jsc.0000000000002717] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Ramis, TR, Muller, CHdL, Boeno, FP, Teixeira, BC, Rech, A, Pompermayer, MG, Medeiros, NdS, Oliveira, ÁRd, Pinto, RS, and Ribeiro, JL. Effects of traditional and vascular restricted strength training program with equalized volume on isometric and dynamic strength, muscle thickness, electromyographic activity, and endothelial function adaptations in young adults. J Strength Cond Res 34(3): 689-698, 2020-The purpose of the study was to evaluate and compare the acute and chronic effects of partial vascular occlusion training in young, physically active adults. Neuromuscular, morphological, and endothelial function responses were compared between high-intensity resistance training (HI-RT) and low-intensity resistance training with partial vascular occlusion (LI-BFR), despite the same training volume. The 28 subjects (age, 23.96 ± 2.67 years) were randomly assigned into 2 groups: LI-BFR (n = 15) and HI-RT (n = 13). Both groups performed unilateral exercise of elbow flexion (EF) and knee extension (KE) 3 times per week for 8 weeks. This study was approved by the ethics committee. Flow-mediated dilation showed a significant difference in baseline and post-training in the LI-BFR group (4.44 ± 0.51 vs. 6.35 ± 2.08 mm, respectively). For nitrite/nitrate concentrations only, there was a significant difference when comparing pre- and post-acute exercise in both groups. The torque and rep. Sixty percent 1 repetition maximum had improvements in both groups. There were differences between groups only in isometric delta EF and isokinetic delta KE (EF 3.42 ± 5.09 and 9.61 ± 7.52 N·m; KE 12.78 ± 25.61 and 42.69 ± 35.68 N·m; LI-BFR and HI-RT groups, respectively). There was a significant increase of muscle thickness in both groups. An increase of both isokinetic and isometric electromyography (EMG) of biceps of the HI-RT group was observed. The same was observed for the LI-BFR group regarding isokinetic and isometric EMG of vastus lateralis. Thus, in addition to strength and hypertrophy gains, this study also shows benefits related to vascular function. For practical applications, this study demonstrates a clinical importance of LI-BFR training as an alternative methodology.
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Affiliation(s)
| | | | | | | | - Anderson Rech
- Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | | | | | | | | | - Jerri Luiz Ribeiro
- IPA Methodist University Center, Porto Alegre, Rio Grande do Sul, Brazil; and
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79
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Ma F, Li Y, Yang J, Li X, Zeng N, Martin RL. The effectiveness of low intensity exercise and blood flow restriction without exercise on exercise induced muscle damage: A systematic review. Phys Ther Sport 2020; 46:77-88. [PMID: 32882622 DOI: 10.1016/j.ptsp.2020.08.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 08/15/2020] [Accepted: 08/18/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To investigate the evidence and provide clinical recommendations for low intensity exercises(LIE) and blood flow restriction(BFR) without exercise on reducing the effects of exercise induced muscle damage(EIMD). METHOD PubMed, Embase, Web of science, and PEDro(Physiotherapy Evidence Database) were searched up to December 2019 for studies that included LIE or BFR without exercise and their effect on EIMD. RESULTS Out of 3192 studies, 23 were included with 17 on LIE and 6 on BFR without exercise. 11 studies demonstrated positive effects for LIE on EIMD, with two level 2 and nine level 3 studies. Two level 2 and two level 3 studies found benefits for BFR without exercise on reducing the negative effects of EIMD, while two level 2 studies found did not find benefits for BFR without exercise. CONCLUSION Moderate to low levels of evidence supported LIE, particularly in the form of protective low load eccentric exercise, in reducing the negative effects of EIMD. Conflicting moderate to low levels of evidence was found regarding BFR without exercise. There does seem to be potential benefit for BFR without exercise in untrained individuals. Clinicians can provide clinical recommendations as LIE and BFR without exercise reducing EIMD.
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Affiliation(s)
- Fenghao Ma
- Yangzhi Rehabilitation Hospital, Sunshine Rehabilitation Center, Tongji University School of Medicine, Shanghai, 201619, China; Rangos School of Health Sciences, Duquesne University, Pittsburgh, PA, USA.
| | - Yingqi Li
- Rangos School of Health Sciences, Duquesne University, Pittsburgh, PA, USA.
| | - Jinchao Yang
- Rangos School of Health Sciences, Duquesne University, Pittsburgh, PA, USA.
| | - Xidian Li
- Rangos School of Health Sciences, Duquesne University, Pittsburgh, PA, USA.
| | - Na Zeng
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; The Ottawa Hospital Research Institution (OHRI), Ottawa, Ontario, Canada.
| | - RobRoy L Martin
- Rangos School of Health Sciences, Duquesne University, Pittsburgh, PA, USA.
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80
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Does Acute Blood Flow Restriction with Pneumatic and Non-Pneumatic Non-Elastic Cuffs Promote Similar Responses in Blood Lactate, Growth Hormone, and Peptide Hormone? J Hum Kinet 2020; 74:85-97. [PMID: 33312278 PMCID: PMC7706653 DOI: 10.2478/hukin-2020-0016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Blood flow restriction (BFR) can be used during resistance training (RT) through pressure application with pneumatic (pressurized) cuffs (PC) or non-pneumatic (practical) cuffs (NPC). However, PC are expensive and difficult to use in the gym environment compared to NPC. The main aim was to compare, correlate, and verify the hormonal and metabolic responses between PC and NPC during a low-load BFR during RT of the upper-body. The secondary aim was to compare blood lactate (BLa) concentration between pre- and post-exercise (2-min into recovery), as well as growth hormone (GH) and insulin-like growth factor 1 (IGF-1) concentration before, 10-min, and 15-min post exercise. Sixteen trained men randomly and alternately completed two experimental RT protocols of the upper-body : A) RT with BFR at 20% 1RM using PC (RT-BFR-PC) and (B) RT with BFR at 20% 1RM using NPC (RT-BFR-NPC) in the bench press, wide-grip lat pulldown, shoulder press, triceps pushdown, and biceps curl exercises. There was no significant difference in BLa 2-min post exercise (p=0.524), GH 10-min (p=0.843) and 15-min post exercise (p=0.672), and IGF-1 10-min (p=0.298) and 15-min post exercise (p=0.201) between RT-BFR-PC and RT-BFR-NPC. In addition, there was a moderate correlation, satisfactory ICCs, and agreement between both protocols in metabolic and hormonal responses. The experimental sessions promoted significant increases in GH and BLa, but not in IGF-1 (p<0.05). The absence of a significant difference between RT-BFR-PC and RT-BFR-NPC in metabolic and hormonal responses highlight the applicability of NPC as a low-cost and easy-to-use tool for BFR upper-body RT.
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81
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da Cunha Nascimento D, Schoenfeld BJ, Prestes J. Potential Implications of Blood Flow Restriction Exercise on Vascular Health: A Brief Review. Sports Med 2020; 50:73-81. [PMID: 31559565 DOI: 10.1007/s40279-019-01196-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Blood flow restriction (BFR) exercise (a.k.a. occlusion training) has emerged as a viable surrogate to traditional heavy-load strength rehabilitation training for a broad range of clinical populations including elderly subjects and rehabilitating athletes. A particular benefit of BFR exercise is the lower stress upon the joints as compared to traditional heavy resistance training, with similar gains in muscle strength and size. The application of an inflatable cuff to the proximal portion of the limbs increases the pressure required for venous return, leading to changes in venous compliance and wall tension. However, it is not known if long-term benefits of BFR exercise on muscle strength and size outweigh potential short and long-term complications on vascular health. BFR exercise could lead to clinical deterioration of the vasculature along with sympathetic overactivity and decreased vascular function associated with retrograde shear stress. This raises a fundamental question: Given the concern that excessive restriction could cause injury to endothelial cells and might cause detrimental effects on endothelial function, even in healthy individuals, should we critically re-evaluate the safety of this method for the general population? From this perspective, the purpose of this manuscript is to review the effects of BFR exercise on vascular function, and to provide relevant insights for training practice as well as future directions for research.
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Affiliation(s)
- Dahan da Cunha Nascimento
- Department of Physical Education, Catholic University of Brasilia (UCB), Q.S. 07, Lote 01, EPTC-Bloco G. Código Postal, Distrito Federal, Brasilia, 71966-700, Brazil. .,Department of Physical Education, University Center of the Federal District (UDF), Brasilia, Brazil.
| | | | - Jonato Prestes
- Department of Physical Education, Catholic University of Brasilia (UCB), Q.S. 07, Lote 01, EPTC-Bloco G. Código Postal, Distrito Federal, Brasilia, 71966-700, Brazil
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82
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Bohlke M, Cardoso RK, Araujo AM, Rombaldi AJ. Intradialytic exercise with blood flow restriction is more effective than conventional exercise in improving walking endurance in hemodialysis patients: Response to comments on a randomized control trial. Clin Rehabil 2020; 34:1412-1414. [PMID: 32722925 DOI: 10.1177/0269215520945659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Maristela Bohlke
- Dialysis and Renal Transplantation Unit, São Francisco de Paula University Hospital, Catholic University of Pelotas, Pelotas, Brazil
- Postgraduate Program in Health and Behavior, Catholic University of Pelotas, Pelotas, Brazil
| | - Rodrigo Kohn Cardoso
- Postgraduate Program of Physical Education, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Aline Machado Araujo
- Postgraduate Program of Physical Education, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Airton José Rombaldi
- Postgraduate Program of Physical Education, Federal University of Pelotas, Pelotas, RS, Brazil
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83
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Hwang H, Mizuno S, Kasai N, Kojima C, Sumi D, Hayashi N, Goto K. Muscle oxygenation, endocrine and metabolic regulation during low-intensity endurance exercise with blood flow restriction. Phys Act Nutr 2020; 24:30-37. [PMID: 32698259 PMCID: PMC7451842 DOI: 10.20463/pan.2020.0012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 06/24/2020] [Accepted: 06/26/2020] [Indexed: 01/19/2023] Open
Abstract
PURPOSE The present study investigated the effect of endurance exercise with blood flow restriction (BFR) performed at either 25% maximal oxygen uptake (V˙O2 max) or 40% V˙O2 max) on muscle oxygenation, energy metabolism, and endocrine responses. METHODS Ten males were recruited in the present study. The subjects performed three trials: (1) endurance exercise at 40% V˙O2 max without BFR (NBFR40), (2) endurance exercise at 25% V˙O2 max with BFR (BFR25), and (3) endurance exercise at 40% V˙O2 max with BFR (BFR40). The exercises were performed for 15 min during which the pedaling frequency was set at 70 rpm. In BFR25 and BFR40, 2 min of pressure phase (equivalent to 160 mmHg) followed by 1 min of release phase were repeated five times (5 × 3 min) throughout 15 minutes of exercise. During exercise, muscle oxygenation and concentration of respiratory gases were measured. The blood samples were collected before exercise, immediately after 15 min of exercise, and at 15, 30, and 60 minutes after completion of exercise. RESULTS Deoxygenated hemoglobin (deoxy-Hb) level during exercise was significantly higher with BFR25 and BFR40 than that with NBFR40. BFR40 showed significantly higher total-hemoglobin (total-Hb) than NBFR40 during 2 min of pressure phase. Moreover, exercise-induced lactate elevation and pH reduction were significantly augmented in BFR40, with concomitant increase in serum cortisol concentration after exercise. Carbohydrate (CHO) oxidation was significantly higher with BFR40 than that with NBFR40 and BFR25, whereas fat oxidation was lower with BFR40. CONCLUSION Deoxy-Hb and total Hb levels were significantly increased during 15 min of pedaling exercise in BFR25 and BFR40, indicating augmented local hypoxia and blood volume (blood perfusion) in the muscle. Moreover, low-and moderate-intensity exercise with BFR facilitated CHO oxidation.
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Affiliation(s)
- Hyejung Hwang
- Graduate school of Sport and Health Science, Ritsumeikan University, ShigaJapan
- Department of Physical Education, Hanyang University, SeoulKorea
- Physical Activity and Performance Institute (PAPI), Konkuk University, SeoulKorea
| | - Sahiro Mizuno
- Research Center of Health, Physical Fitness and Sports, Nagoya University, NagoyaJapan
| | - Nobukazu Kasai
- Department of Sports Science, Japan Institute of Sports Sciences, TokyoJapan
| | - Chihiro Kojima
- Department of Sports Science, Japan Institute of Sports Sciences, TokyoJapan
| | - Daichi Sumi
- Research Center for Urban Health and Sports, Osaka City University, OsakaJapan
| | - Nanako Hayashi
- Research Center for Urban Health and Sports, Osaka City University, OsakaJapan
| | - Kazushige Goto
- Research Center for Urban Health and Sports, Osaka City University, OsakaJapan
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84
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Nielsen JL, Frandsen U, Jensen KY, Prokhorova TA, Dalgaard LB, Bech RD, Nygaard T, Suetta C, Aagaard P. Skeletal Muscle Microvascular Changes in Response to Short-Term Blood Flow Restricted Training-Exercise-Induced Adaptations and Signs of Perivascular Stress. Front Physiol 2020; 11:556. [PMID: 32595516 PMCID: PMC7303802 DOI: 10.3389/fphys.2020.00556] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 05/04/2020] [Indexed: 01/11/2023] Open
Abstract
Aim: Previous reports suggest that low-load muscle exercise performed under blood flow restriction (BFR) may lead to endurance adaptations. However, only few and conflicting results exist on the magnitude and timing of microvascular adaptations, overall indicating a lack of angiogenesis with BFR training. The present study, therefore, aimed to examine the effect of short-term high-frequency BFR training on human skeletal muscle vascularization. Methods: Participants completed 3 weeks of high-frequency (one to two daily sessions) training consisting of either BFR exercise [(BFRE) n = 10, 22.8 ± 2.3 years; 20% one-repetition maximum (1RM), 100 mmHg] performed to concentric failure or work-matched free-flow exercise [(CON) n = 8, 21.9 ± 3.0 years; 20% 1RM]. Muscle biopsies [vastus lateralis (VL)] were obtained at baseline, 8 days into the intervention, and 3 and 10 days after cessation of the intervention to examine capillary and perivascular adaptations, as well as angiogenesis-related protein signaling and gene expression. Results: Capillary per myofiber and capillary area (CA) increased 21–24 and 25–34%, respectively, in response to BFRE (P < 0.05–0.01), while capillary density (CD) remained unchanged. Overall, these adaptations led to a consistent elevation (15–16%) in the capillary-to-muscle area ratio following BFRE (P < 0.05–0.01). In addition, evaluation of perivascular properties indicated thickening of the perivascular basal membrane following BFRE. No or only minor changes were observed in CON. Conclusion: This study is the first to show that short-term high-frequency, low-load BFRE can lead to microvascular adaptations (i.e., capillary neoformation and changes in morphology), which may contribute to the endurance effects previously documented with BFR training. The observation of perivascular membrane thickening suggests that high-frequency BFRE may be associated with significant vascular stress.
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Affiliation(s)
- Jakob L Nielsen
- Department of Sports Science and Clinical Biomechanics and SDU Muscle Research Cluster, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Ulrik Frandsen
- Department of Sports Science and Clinical Biomechanics and SDU Muscle Research Cluster, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Kasper Y Jensen
- Department of Sports Science and Clinical Biomechanics and SDU Muscle Research Cluster, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Tatyana A Prokhorova
- Department of Sports Science and Clinical Biomechanics and SDU Muscle Research Cluster, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Line B Dalgaard
- Section for Sports Science, Department of Public Health, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Rune D Bech
- Department of Orthopaedic Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Tobias Nygaard
- Department of Orthopaedic Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Charlotte Suetta
- Geriatric Research Unit, Department of Geriatric and Palliative Medicine, Bispebjerg-Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark.,Geriatric Research Unit, Department of Medicine, Herlev-Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Per Aagaard
- Department of Sports Science and Clinical Biomechanics and SDU Muscle Research Cluster, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
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85
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Wilk M, Krzysztofik M, Filip A, Zajac A, Bogdanis GC, Lockie RG. Short-Term Blood Flow Restriction Increases Power Output and Bar Velocity During the Bench Press. J Strength Cond Res 2020; 36:2082-2088. [PMID: 32379236 DOI: 10.1519/jsc.0000000000003649] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Wilk, M, Krzysztofik, M, Filip, A, Zajac, A, Bogdanis, GC, and Lockie, RG. Short-term blood flow restriction increases power output and bar velocity during the bench press. J Strength Cond Res XX(X): 000-000, 2020-This study examined the effect of blood flow restriction (BFR) with 2 different types of cuffs on peak power output (PP), mean power output (MP), peak bar velocity (PV), and mean bar velocity (MV) in the bench press exercise (BP). Fourteen healthy strength-trained male athletes (age = 27.6 ± 3.5 years; body mass = 84.1 ± 8.0 kg; height = 175.8 ± 6.7 cm; BP 1 repetition maximum [RM] = 138.6 ± 17.8 kg) performed 3 different testing protocols as follows: without BFR (NO-BFR), BFR with a narrow cuff (BFRNARROW), and BFR with a wide cuff (BFRWIDE) in a randomized crossover design. During all sessions, subjects performed one set of 3 repetitions of the BP exercise using 70% 1RM. Cuff pressure was set to approximately 90% full arterial occlusion pressure of the upper limb at rest. Analyses of variance showed an increase in PP (by 21%, p < 0.01; effect size [ES] = 1.67), MP (by 16%, p < 0.01; ES = 0.93), PV (by 22%, p < 0.01; ES = 1.79), and MV (by 21%, p < 0.01; ES = 1.36) during BFRWIDE compared with NO-BFR and a significant increase in PP (by 15%, p < 0.01; ES = 1.07), MP (by 17%, p < 0.01; ES = 0.78), PV (by 18%, p < 0.01; ES = 1.65), and MV (by 13% p < 0.01; ES = 1.00) during BFRWIDE compared with BFRNARROW. There were no significant differences in any of the variable between NO-BFR and BFRNARROW. The results of the study indicate that short-term BFR training increases power output and bar velocity during the BP exercise. However, only BFRWIDE significantly influenced bar velocity and power output, which indicates that the width of the cuff is a critical factor determining acute exercise adaptation during BFR resistance training.
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Affiliation(s)
- Michal Wilk
- Institute of Sport Sciences, Jerzy Kukuczka Academy of Physical Education in Katowice, Katowice, Poland
| | - Michal Krzysztofik
- Institute of Sport Sciences, Jerzy Kukuczka Academy of Physical Education in Katowice, Katowice, Poland
| | - Aleksandra Filip
- Institute of Sport Sciences, Jerzy Kukuczka Academy of Physical Education in Katowice, Katowice, Poland
| | - Adam Zajac
- Institute of Sport Sciences, Jerzy Kukuczka Academy of Physical Education in Katowice, Katowice, Poland
| | - Gregory C Bogdanis
- School of P.E. and Sport Science, National & Kapodistrian University of Athens, Athens, Greece
| | - Robert G Lockie
- Center for Sports Performance, Department of Kinesiology, California State University, Fullerton, Fullerton, California
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Grønfeldt BM, Lindberg Nielsen J, Mieritz RM, Lund H, Aagaard P. Effect of blood‐flow restricted vs heavy‐load strength training on muscle strength: Systematic review and meta‐analysis. Scand J Med Sci Sports 2020; 30:837-848. [DOI: 10.1111/sms.13632] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 01/28/2020] [Accepted: 01/31/2020] [Indexed: 01/09/2023]
Affiliation(s)
- Birk Mygind Grønfeldt
- Department of Sports Science and Clinical Biomechanics University of Southern Denmark Odense Denmark
- Physical Medicine and Rehabilitation Research – Copenhagen (PMR‐C) Clinical Research Center Amager‐Hvidovre Hospital University of Copenhagen Copenhagen Denmark
| | - Jakob Lindberg Nielsen
- Department of Sports Science and Clinical Biomechanics University of Southern Denmark Odense Denmark
| | - Rune Mygind Mieritz
- Department of Sports Science and Clinical Biomechanics University of Southern Denmark Odense Denmark
- Department of Neurosurgery Odense University Hospital Odense Denmark
| | - Hans Lund
- Centre for Evidence‐Based Practice Western Norway University of Applied Sciences Bergen Norway
| | - Per Aagaard
- Department of Sports Science and Clinical Biomechanics University of Southern Denmark Odense Denmark
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87
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Cuyul-Vásquez I, Leiva-Sepúlveda A, Catalán-Medalla O, Berríos-Contreras L. [Blood flow restriction training for people with cardiovascular disease: An exploratory review]. Rehabilitacion (Madr) 2020; 54:116-127. [PMID: 32370826 DOI: 10.1016/j.rh.2020.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 11/10/2019] [Accepted: 01/11/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To analyse the evidence on the effects of blood flow restriction training in people with cardiovascular disease. MATERIALS AND METHODS We searched MEDLINE, EMBASE, SPORTDiscus, CINAHL, LILACS, SCOPUS and Wiley databases. Experimental and non-experimental studies investigating the effects of blood flow restriction in participants with cardiovascular disease were included. RESULTS Six clinical trials and three non-experimental studies met the inclusion criteria. The experimental studies were conducted in participants with hypertension and ischaemic heart disease. Non-experimental studies described hemodynamic adaptations and potential adverse effects of therapy. The risk of bias of the included clinical trials was moderate to high. Exercise-induced hemodynamic stress increased significantly during training with blood flow restriction compared with traditional training. The small number of available studies have focused mostly on acute effects, but chronic effects are unknown. CONCLUSION There is currently no evidence to recommend the use of blood flow restriction in people with cardiovascular disease.
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Affiliation(s)
- I Cuyul-Vásquez
- Departamento de Procesos Terapéuticos, Facultad de Ciencias de la Salud, Universidad Católica de Temuco, Temuco, Chile.
| | - A Leiva-Sepúlveda
- Departamento de Procesos Terapéuticos, Facultad de Ciencias de la Salud, Universidad Católica de Temuco, Temuco, Chile
| | - O Catalán-Medalla
- Departamento de Procesos Terapéuticos, Facultad de Ciencias de la Salud, Universidad Católica de Temuco, Temuco, Chile
| | - L Berríos-Contreras
- Departamento de Kinesiología, Facultad de Ciencias de la Salud, Universidad Católica del Maule, Talca, Chile
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Baker BS, Stannard MS, Duren DL, Cook JL, Stannard JP. Does Blood Flow Restriction Therapy in Patients Older Than Age 50 Result in Muscle Hypertrophy, Increased Strength, or Greater Physical Function? A Systematic Review. Clin Orthop Relat Res 2020; 478:593-606. [PMID: 31860546 PMCID: PMC7145054 DOI: 10.1097/corr.0000000000001090] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 12/02/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Blood flow restriction (BFR) is a process of using inflatable cuffs to create vascular occlusion within a limb during exercise. The technique can stimulate muscle hypertrophy and improve physical function; however, most of these studies have enrolled healthy, young men with a focus on athletic performance. Furthermore, much of the information on BFR comes from studies with small samples sizes, limited follow-up time, and varied research designs resulting in greater design, selection, and sampling bias. Despite these limitations, BFR's popularity is increasing as a clinical rehabilitation tool for aging patients. It is important for practitioners to have a clear understanding of the reported effects of BFR specifically in older adults while simultaneously critically evaluating the available literature before deciding to employ the technique. QUESTIONS/PURPOSES (1) Does BFR induce skeletal muscle hypertrophy in adults older than 50 years of age? (2) Does BFR improve muscle strength and/or physical function in adults older than 50 years? METHODS Using PubMed, Google Scholar, Web of Science, and Science Direct, we conducted a systematic review of articles using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to assess the reported effects of BFR on skeletal muscle in older adults. Included articles enrolled participants 50 years of age or older and used BFR in conjunction with exercise to study the effects of BFR on musculoskeletal outcomes and functionality. The following search terms were used: "blood flow restriction" OR "KAATSU" OR "ischemic training" AND "clinical" AND "elderly." After duplicates were removed, 1574 articles were reviewed for eligibility, and 30 articles were retained with interventions duration ranging from cross-sectional to 16 weeks. Sample sizes ranged from 6 to 56 participants, and exercise tasks included passive mobilization or electrical stimulation; walking; resistance training using machines, free weights, body weight, or elastic bands; and water-based activities. Furthermore, healthy participants and those with cardiovascular disease, osteoarthritis, osteoporosis, sporadic inclusion body myositis, spinal cord injuries, and current coma patients were studied. Lastly, retained articles were assigned a risk of bias score using aspects of the Risk of Bias in Nonrandomized Studies of Interventions and the Cochrane Collaboration's tool for assessing the risk of bias in randomized trials. RESULTS BFR, in combination with a variety of exercises, was found to result in muscle hypertrophy as measured by muscle cross-sectional area, thickness, volume, mass, or circumference. Effect sizes for BFR's ability to induce muscle hypertrophy were calculated for 16 of the 30 papers and averaged 0.75. BFR was also shown to improve muscle strength and functional performance. Effect sizes were calculated for 21 of the 30 papers averaging 1.15. CONCLUSIONS Available evidence suggests BFR may demonstrate utility in aiding rehabilitation efforts in adults older than 50 years of age, especially for inducing muscle hypertrophy, combating muscle atrophy, increasing muscle strength, and improving muscle function. However, most studies in this systematic review were at moderate or high risk of bias; that being so, the findings in this systematic review should be confirmed, ideally using greater sample sizes, randomization of participants, and extended follow-up durations. LEVEL OF EVIDENCE Level II, systematic review.
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Affiliation(s)
- Breanne S Baker
- B. S. Baker, M. S. Stannard, D. L. Duren, J. L. Cook, J. P. Stannard, Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA
- B. S. Baker, D. L. Duren, J. L. Cook, J. P. Stannard, Missouri Orthopedic Institute, Columbia, MO, USA
| | - Michael S Stannard
- B. S. Baker, M. S. Stannard, D. L. Duren, J. L. Cook, J. P. Stannard, Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA
- M. S. Stannard, Department of Biomedical Sciences and Pathobiology, University of Missouri, Columbia, MO, USA
| | - Dana L Duren
- B. S. Baker, M. S. Stannard, D. L. Duren, J. L. Cook, J. P. Stannard, Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA
- B. S. Baker, D. L. Duren, J. L. Cook, J. P. Stannard, Missouri Orthopedic Institute, Columbia, MO, USA
- D. L. Duren, Department of Pathology and Anatomical Sciences, University of Missouri, Columbia, MO, USA
| | - James L Cook
- B. S. Baker, M. S. Stannard, D. L. Duren, J. L. Cook, J. P. Stannard, Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA
- B. S. Baker, D. L. Duren, J. L. Cook, J. P. Stannard, Missouri Orthopedic Institute, Columbia, MO, USA
| | - James P Stannard
- B. S. Baker, M. S. Stannard, D. L. Duren, J. L. Cook, J. P. Stannard, Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA
- B. S. Baker, D. L. Duren, J. L. Cook, J. P. Stannard, Missouri Orthopedic Institute, Columbia, MO, USA
- M. S. Stannard, Department of Biomedical Sciences and Pathobiology, University of Missouri, Columbia, MO, USA
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Vogel J, Niederer D, Jung G, Troidl K. Exercise-Induced Vascular Adaptations under Artificially Versus Pathologically Reduced Blood Flow: A Focus Review with Special Emphasis on Arteriogenesis. Cells 2020; 9:cells9020333. [PMID: 32024023 PMCID: PMC7072401 DOI: 10.3390/cells9020333] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 01/23/2020] [Accepted: 01/30/2020] [Indexed: 12/16/2022] Open
Abstract
Background: The vascular effects of training under blood flow restriction (BFR) in healthy persons can serve as a model for the exercise mechanism in lower extremity arterial disease (LEAD) patients. Both mechanisms are, inter alia, characterized by lower blood flow in the lower limbs. We aimed to describe and compare the underlying mechanism of exercise-induced effects of disease- and external application-BFR methods. Methods: We completed a narrative focus review after systematic literature research. We included only studies on healthy participants or those with LEAD. Both male and female adults were considered eligible. The target intervention was exercise with a reduced blood flow due to disease or external application. Results: We identified 416 publications. After the application of inclusion and exclusion criteria, 39 manuscripts were included in the vascular adaption part. Major mechanisms involving exercise-mediated benefits in treating LEAD included: inflammatory processes suppression, proinflammatory immune cells, improvement of endothelial function, remodeling of skeletal muscle, and additional vascularization (arteriogenesis). Mechanisms resulting from external BFR application included: increased release of anabolic growth factors, stimulated muscle protein synthesis, higher concentrations of heat shock proteins and nitric oxide synthase, lower levels in myostatin, and stimulation of S6K1. Conclusions: A main difference between the two comparators is the venous blood return, which is restricted in BFR but not in LEAD. Major similarities include the overall ischemic situation, the changes in microRNA (miRNA) expression, and the increased production of NOS with their associated arteriogenesis after training with BFR.
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Affiliation(s)
- Johanna Vogel
- Department of Sports Medicine and Exercise Physiology, Goethe University Frankfurt/Main, Ginnheimer Landstr. 39, 60487 Frankfurt, Germany; (J.V.); (D.N.)
| | - Daniel Niederer
- Department of Sports Medicine and Exercise Physiology, Goethe University Frankfurt/Main, Ginnheimer Landstr. 39, 60487 Frankfurt, Germany; (J.V.); (D.N.)
| | - Georg Jung
- Department of Vascular and Endovascular Surgery, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany;
| | - Kerstin Troidl
- Department of Vascular and Endovascular Surgery, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany;
- Department of Pharmacology, Max-Planck-Institute for Heart and Lung Research, Ludwigstrasse 43, 61231 Bad Nauheim, Germany
- Correspondence:
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90
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Malheiros R, Nasser I, Willardson JM, Miranda H. Greater postexercise hypotension response in low-load and high-volume resistance training versus high-load and low-volume resistance training. SPORT SCIENCES FOR HEALTH 2020. [DOI: 10.1007/s11332-019-00614-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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91
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Ipavec M, Grapar Žargi T, Jelenc J, Kacin A. Efficiency of Pneumatic Tourniquet Cuff With Asymmetric Pressure Distribution at Rest and During Isometric Muscle Action. J Strength Cond Res 2019; 33:2570-2578. [PMID: 29952864 DOI: 10.1519/jsc.0000000000002678] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Ipavec, M, Grapar Žargi, T, Jelenc, J, and Kacin, A. Efficiency of pneumatic tourniquet cuff with asymmetric pressure distribution at rest and during isometric muscle action. J Strength Cond Res 33(9): 2570-2578, 2019-The aim of this study was to compare effects of newly designed double-chamber cuff with asymmetric pressure (APC) distribution and standard single-chamber cuff with symmetric pressure (SPC) distribution on muscle perfusion and volitional activation. First, the 2 cuffs were compared bilaterally on resting thigh muscles of 17 healthy volunteers at 4 cuff pressures (120, 160, 200, and 240 mm Hg). Then, the subjects performed the isometric endurance test of knee extensor muscles to volitional failure at 40% of maximal volitional isometric action in both free-flow and blood flow restricted condition. Changes in hemoglobin kinetics in vastus lateralis muscle (near-infrared spectroscopy), surface electromyography of vastus medialis muscle, and pain intensity (visual analogue scale [VAS]) were continuously recorded. At rest, a significant difference (p = 0.009) in velocity of change in total hemoglobin concentration was noted between the cuffs at 160 mm Hg (APC = 0.028 μM·s and SPC = 0.056 μM·s). The VAS scores significantly increased (p = 0.031) at pressures ≥200 mm Hg, with no difference between the cuffs. Duration of isometric action with blood flow restriction was 12% shorter (p = 0.003) than in free-flow condition, with no difference between the cuffs. There were no significant differences in muscle activation or hemoglobin kinetics between the exercise conditions or cuff types. The results show that APC reduces blood flow in quadriceps femoris muscle at rest at lower pressure than SPC, which suggests its enhanced efficiency for blood flow restriction. Given that application of either type of cuff during sustained isometric action had only minor impact on muscle endurance and oxygen kinetics, future research must focus primarily on dynamic muscle actions.
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Affiliation(s)
- Matej Ipavec
- Faculty of Health Sciences, Laboratory of Physiotherapy, University of Ljubljana, Ljubljana, Slovenia
| | - Tina Grapar Žargi
- Faculty of Health Sciences, Laboratory of Physiotherapy, University of Ljubljana, Ljubljana, Slovenia
| | | | - Alan Kacin
- Faculty of Health Sciences, Laboratory of Physiotherapy, University of Ljubljana, Ljubljana, Slovenia
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Cristina-Oliveira M, Meireles K, Spranger MD, O'Leary DS, Roschel H, Peçanha T. Clinical safety of blood flow-restricted training? A comprehensive review of altered muscle metaboreflex in cardiovascular disease during ischemic exercise. Am J Physiol Heart Circ Physiol 2019; 318:H90-H109. [PMID: 31702969 DOI: 10.1152/ajpheart.00468.2019] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Blood flow restriction training (BFRT) is an increasingly widespread method of exercise that involves imposed restriction of blood flow to the exercising muscle. Blood flow restriction is achieved by inflating a pneumatic pressure cuff (or a tourniquet) positioned proximal to the exercising muscle before, and during, the bout of exercise (i.e., ischemic exercise). Low-intensity BFRT with resistance training promotes comparable increases in muscle mass and strength observed during high-intensity exercise without blood flow restriction. BFRT has expanded into the clinical research setting as a potential therapeutic approach to treat functionally impaired individuals, such as the elderly, and patients with orthopedic and cardiovascular disease/conditions. However, questions regarding the safety of BFRT must be fully examined and addressed before the implementation of this exercise methodology in the clinical setting. In this respect, there is a general concern that BFRT may generate abnormal reflex-mediated cardiovascular responses. Indeed, the muscle metaboreflex is an ischemia-induced, sympathoexcitatory pressor reflex originating in skeletal muscle, and the present review synthesizes evidence that BFRT may elicit abnormal cardiovascular responses resulting from increased metaboreflex activation. Importantly, abnormal cardiovascular responses are more clearly evidenced in populations with increased cardiovascular risk (e.g., elderly and individuals with cardiovascular disease). The evidence provided in the present review draws into question the cardiovascular safety of BFRT, which clearly needs to be further investigated in future studies. This information will be paramount for the consideration of BFRT exercise implementation in clinical populations.
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Affiliation(s)
- Michelle Cristina-Oliveira
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Rheumatology Division, Faculdade de Medicina, University of São Paulo, São Paulo, Brazil
| | - Kamila Meireles
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Rheumatology Division, Faculdade de Medicina, University of São Paulo, São Paulo, Brazil
| | - Marty D Spranger
- Department of Physiology, Michigan State University, East Lansing, Michigan
| | - Donal S O'Leary
- Department of Physiology, Wayne State University School of Medicine, Detroit, Michigan
| | - Hamilton Roschel
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Rheumatology Division, Faculdade de Medicina, University of São Paulo, São Paulo, Brazil
| | - Tiago Peçanha
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Rheumatology Division, Faculdade de Medicina, University of São Paulo, São Paulo, Brazil
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93
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Hwang PS, Willoughby DS. Mechanisms Behind Blood Flow-Restricted Training and its Effect Toward Muscle Growth. J Strength Cond Res 2019; 33 Suppl 1:S167-S179. [PMID: 30011262 DOI: 10.1519/jsc.0000000000002384] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Hwang, P and Willoughby, DS. Mechanisms behind blood flow-restricted training and its effect toward muscle growth. J Strength Cond Res 33(7S): S167-S179, 2019-It is widely established throughout the literature that skeletal muscle can induce hypertrophic adaptations after progressive overload of moderate-to-high-intensity resistance training. However, there has recently been a growing body of research that shows that the combination of blood flow-restricted (BFR) training with low-intensity resistance exercise can induce similar gains in muscular strength and hypertrophic adaptations. The implementation of external pressure cuffs over the most proximal position of the limb extremities with the occlusion of venous outflow of blood distal to the occlusion site defines the BFR training protocol. There are various mechanisms through which BFR training may cause the stimulations for skeletal muscle hypertrophy and increases in strength. These may include increases in hormonal concentrations, increases within the components of the intracellular signaling pathways for muscle protein synthesis such as the mTOR pathway, increases within biomarkers denoting satellite cell activity and apparent patterns in fiber type recruitment. There have also been scientific findings demonstrating hypertrophic effects within both BFR limbs and non-BFR muscles during BFR training programs. The purpose behind this critical review will be to provide a comprehensive discussion on relevant literature that can help elucidate the potential underlying mechanisms leading to hypertrophic adaptations after BFR training programs. This review will also explicate the various findings within the literature that focalizes on both BFR limb and non-BFR muscle hypertrophy after bouts of BFR training. Furthermore, this critical review will also address the various needs for future research in the many components underlying the novel modality of BFR training.
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Affiliation(s)
- Paul S Hwang
- Department of Health, Human Performance, and Recreation, Exercise and Biochemical Nutrition Laboratory, Baylor University, Waco, Texas
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94
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Dias EC, Orcy R, Antunes MF, Kohn R, Rombaldi AJ, Ribeiro L, Oses JP, Ferreira GD, Araújo AM, Boff IF, Böhlke M. Intradialytic exercise with blood flow restriction: Something to add to hemodialysis adequacy? Findings from a crossover study. Hemodial Int 2019; 24:71-78. [PMID: 31612630 DOI: 10.1111/hdi.12793] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 08/30/2019] [Accepted: 09/04/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Hemodialysis (HD) increases the lifespan of chronic kidney disease (CKD) patients. However, HD is only partially effective in replacing renal function. The aim of this study is to compare HD adequacy between sessions with intradialytic exercise with or without blood flow restriction (BFR) with sessions without exercise. METHODS A crossover study including 22 adult CKD patients on HD. The patients were assigned to BFR (n = 11) or exercise alone group (n = 11). Each patient was submitted to four HD sessions (two with exercise and two control sessions). HD adequacy was assessed by equilibrated Kt/V-urea (eKT/V), single-pool Kt/V-urea (sp-Kt/V), urea and phosphorus rebound, urea reduction ratio (URR) and removal of urea and phosphorus in dialysate. FINDINGS BFR exercise improved eKt/V and sp-Kt/V (1.32 ± 0.21 vs. 1.10 ± 0.16 for control, P < 0.001; 1.53 ± 0.26 vs. 1.27 ± 0.19 for control, P < 0.001, respectively) and URR (72.5 ± 5.4% vs. 66.1 ± 7.7% for control, P < 0.001). No difference in eKt/V, sp-Kt/V or URR could be detected between exercise alone and control HD sessions. Urea rebound was lower in BFR exercise vs. control sessions (-8.9 ± 9.1% vs. 30.7 ± 12.8%, P < 0.01) and exercise alone vs. control sessions (13.3 ± 29.0% vs. 42.4 ± 15.3%, P < 0.01). Phosphorus rebound was marginally lower in exercise vs. control sessions (14.4 ± 19.1% vs. 28.4 ± 22.1%, P = 0.18). Urea and phosphorus mass removal in dialysate were marginally higher in exercise vs. control sessions (42.2 ± 19.4 g vs. 35.7 ± 12.5 g, P = 0.24; 912.1 ± 360.9 mg vs. 778.6 ± 245.1 mg, P = 0.28). CONCLUSIONS Intradialytic exercise with BFR was more effective than standard exercise in increasing HD adequacy.
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Affiliation(s)
- Etiene C Dias
- Postgraduate Program in Health and Behavior, Catholic University of Pelotas, Pelotas, Brazil
| | - Rafael Orcy
- Physiology Department, Federal University of Pelotas, Pelotas, Brazil
| | - Maria F Antunes
- Postgraduate Program in Health and Behavior, Catholic University of Pelotas, Pelotas, Brazil
| | - Rodrigo Kohn
- Postgraduate Program in Physical Education, Federal University of Pelotas, Pelotas, Brazil
| | - Airton J Rombaldi
- Postgraduate Program in Physical Education, Federal University of Pelotas, Pelotas, Brazil
| | - Larissa Ribeiro
- Postgraduate Program in Health and Behavior, Catholic University of Pelotas, Pelotas, Brazil.,Dialysis and Renal Transplantation Unit, São Francisco de Paula University Hospital, Catholic University of Pelotas, Pelotas, Brazil
| | - Jean P Oses
- Postgraduate Program in Health and Behavior, Catholic University of Pelotas, Pelotas, Brazil
| | | | - Aline M Araújo
- Postgraduate Program in Physical Education, Federal University of Pelotas, Pelotas, Brazil
| | - Isis F Boff
- Postgraduate Program in Health and Behavior, Catholic University of Pelotas, Pelotas, Brazil
| | - Maristela Böhlke
- Postgraduate Program in Health and Behavior, Catholic University of Pelotas, Pelotas, Brazil.,Dialysis and Renal Transplantation Unit, São Francisco de Paula University Hospital, Catholic University of Pelotas, Pelotas, Brazil
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95
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Held S, Behringer M, Donath L. Low intensity rowing with blood flow restriction over 5 weeks increases V̇O 2max in elite rowers: A randomized controlled trial. J Sci Med Sport 2019; 23:304-308. [PMID: 31672481 DOI: 10.1016/j.jsams.2019.10.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 09/05/2019] [Accepted: 10/02/2019] [Indexed: 01/28/2023]
Abstract
OBJECTIVES The present randomized controlled intervention study examined the effects of practical blood flow restriction (pBFR) on maximal oxygen uptake (V̇O2max) during low intensity rowing. DESIGN Thirty-one elite rowers were either assigned to the intervention (INT) or control (CON) group, using the minimization method (Strata: Gender, Age, Height, V̇O2max). METHOD While INT (n=16; 4 female, 12 male, 21.9±3.2 years, 180.4±8.7cm, 73.6±10.9kg, V̇O2max: 63.0±7.9ml/min/kg) used pBFR during boat- and indoor-rowing training, CON (n=15, 4 female, 11 male, 21.7±3.7 years, 180.7±8.1cm, 72.5±12.1kg, V̇O2max: 63.2±8.5ml/min/kg) completed the identical training without pBFR. pBFR of the lower limb was applied via customized elastic wraps. Training took place three times a week over 5 weeks (accumulated net pBFR: 60min/week; occlusion per session: 2-times 10min/session) and was used exclusively at low intensities (<2mmol/L). A spiroergometric ramp test (V̇O2max; 30-40W/min increase) on rowing-ergometer and one-repetition maximum test of the squat exercise (SQ1RM) was employed to assess endurance and strength capacity. RESULTS Significant group×time interactions (ηp²=0.26) in favor of INT were found for V̇O2max (+9.1±6.2%, Effect Size=1.3) compared to CON (+2.5±6.1%, ES=0.3). SQ1RM (ηp²=0.01) was not affected by the pBFR intervention. CONCLUSIONS This study revealed that 15 sessions of pBFR application with a cumulative total pBFR load of 5h over a 5 weeks macrocycle remarkably increased V̇O2max. Thus, pBFR might serve as a promising means to improve aerobic capacity in highly trained elite rowers.
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Affiliation(s)
- Steffen Held
- Department of Intervention Research in Exercise Training, German Sport University Cologne, Germany.
| | | | - Lars Donath
- Department of Intervention Research in Exercise Training, German Sport University Cologne, Germany
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96
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Valenzuela PL, Castillo-García A, Morales JS, Izquierdo M, Serra-Rexach JA, Santos-Lozano A, Lucia A. Physical Exercise in the Oldest Old. Compr Physiol 2019; 9:1281-1304. [PMID: 31688965 DOI: 10.1002/cphy.c190002] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Societies are progressively aging, with the oldest old (i.e., those aged >80-85 years) being the most rapidly expanding population segment. However, advanced aging comes at a price, as it is associated with an increased incidence of the so-called age-related conditions, including a greater risk for loss of functional independence. How to combat sarcopenia, frailty, and overall intrinsic capacity decline in the elderly is a major challenge for modern medicine, and exercise appears to be a potential solution. In this article, we first summarize the physiological mechanisms underlying the age-related deterioration in intrinsic capacity, particularly regarding those phenotypes related to functional decline. The main methods available for the physical assessment of the oldest old are then described, and finally the multisystem benefits that exercise (or "exercise mimetics" in those situations in which volitional exercise is not feasible) can provide to this population segment are reviewed. In summary, lifetime physical exercise can help to attenuate the loss of many of the properties affected by aging, especially when the latter is accompanied by an inactive lifestyle and benefits can also be obtained in frail individuals who start exercising at an advanced age. Multicomponent programs combining mainly aerobic and resistance training should be included in the oldest old, particularly during disuse situations such as hospitalization. However, evidence is still needed to support the effectiveness of passive physical strategies including neuromuscular electrical stimulation or vibration for the prevention of disuse-induced negative adaptations in those oldest old people who are unable to do physical exercise. © 2019 American Physiological Society. Compr Physiol 9:1281-1304, 2019.
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Affiliation(s)
- Pedro L Valenzuela
- Department of Systems Biology, University of Alcalá, Madrid, Spain
- Department of Sport and Health, Spanish Agency for Health Protection in Sport (AEPSAD), Madrid, Spain
| | | | - Javier S Morales
- Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain
| | - Mikel Izquierdo
- Biomedical Research Networking Center on Frailty and Healthy Aging (CIBERFES), Madrid, Spain
- Department of Health Sciences, Public University of Navarra, Navarrabiomed, Idisna, Pamplona, Spain
| | - José A Serra-Rexach
- Biomedical Research Networking Center on Frailty and Healthy Aging (CIBERFES), Madrid, Spain
- Department of Geriatric, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Alejandro Santos-Lozano
- i+HeALTH, European University Miguel de Cervantes, Valladolid, Spain and Research Institute Hospital 12 de Octubre (ì+12'), Madrid, Spain
| | - Alejandro Lucia
- Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain
- Biomedical Research Networking Center on Frailty and Healthy Aging (CIBERFES), Madrid, Spain
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97
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Ilett MJ, Rantalainen T, Keske MA, May AK, Warmington SA. The Effects of Restriction Pressures on the Acute Responses to Blood Flow Restriction Exercise. Front Physiol 2019; 10:1018. [PMID: 31456694 PMCID: PMC6700307 DOI: 10.3389/fphys.2019.01018] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 07/23/2019] [Indexed: 12/02/2022] Open
Abstract
Purpose No current guidelines or recommendations exist informing the selection of restriction pressure during blood flow restriction exercise (BFRE). Moreover, the effects of specific relative restriction pressures on the acute muscle, metabolic and cardiopulmonary responses to BFRE are unclear. The purpose of this study was to characterize these acute responses at different levels of restriction pressure. Methods Participants (n = 10) completed rhythmic isometric knee extension exercise across five experimental trials in a balanced randomized order. Three were BFRE trials {B-40 [restriction pressure set to 40% LOP (total limb occlusion pressure)]; B-60 (60% LOP); and B-80 (80% LOP)} with a workload equivalent to 20% maximal voluntary force (MVC), one was non-BFRE at 20% MVC (LL) and one was non-BFRE at 80% MVC (HL). Measurements recorded were torque, muscle activity via electromyography (EMG), tissue oxygenation via near infrared spectroscopy, whole body oxygen consumption, blood lactate and heart rate. Results For the LL and B-40 trials, most measures remained constant. However, for the B-60 and B-80 trials, significant fatigue was demonstrated by a reduction in MVC torque across the trial (p < 0.05). Blood lactate increased from baseline in HL, B-60, and B-80 (p < 0.05). Submaximal EMG was greater in B-60 and B-80 than LL, but lower compared with HL (p < 0.05). Tissue oxygenation decreased in HL, B-40, B-60, and B-80 (p < 0.05), which was lower in the B-80 trial compared to all other trials (p < 0.01). Whole body oxygen consumption was not different between the BFRE trials (p > 0.05). Conclusion We demonstrate graded/progressive acute responses with increasing applied pressure during BFRE, from which we speculate that an effective minimum “threshold” around 60% LOP may be necessary for BFRE to be effective with training. While these data provide some insight on the possible mechanisms by which BFRE develops skeletal muscle size and strength when undertaken chronically across a training program, the outcomes of chronic training programs using different levels of applied restriction pressures remain to be tested. Overall, the present study recommends 60–80% LOP as a suitable “minimum” BFRE pressure.
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Affiliation(s)
- Michael J Ilett
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia
| | - Timo Rantalainen
- Gerontology Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Michelle A Keske
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia
| | - Anthony K May
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia
| | - Stuart A Warmington
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia
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98
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Chen YT, Hsieh YY, Ho JY, Lin JC. Effects of Running Exercise Combined With Blood Flow Restriction on Strength and Sprint Performance. J Strength Cond Res 2019; 35:3090-3096. [PMID: 31453935 DOI: 10.1519/jsc.0000000000003313] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Chen, YT, Hsieh, YY, Ho, JY, and Lin, JC. Effects of running exercise combined with blood flow restriction on strength and sprint performance. J Strength Cond Res XX(X): 000-000, 2019-We investigated muscle strength and sprint performance after combining running exercise (RE) with blood flow restriction (BFR). Twelve male sprinters received 2 experimental warm-ups: (a) RE (50% heart rate reserve, 2 minutes × 5 sets, 1-minute rest interval) with BFR (occlusion pressure: 1.3 × resting systolic blood pressure) warm-up, namely RE-BFR; and (b) RE without BFR warm-up, namely RE. Isokinetic strength or 60-m sprint performance was assessed after a 5-minute recovery from each experimental warm-up. All subjects completed 4 exercise trials in a counterbalanced order: (a) RE-BFR-strength; (b) RE-strength; (c) RE-BFR-sprint; and (d) RE-sprint. Muscle activation (during RE), blood lactate (BLa) (pre- and post-REs), heart rate (HR), and rating of perceived exertion (RPE) (pre- and post-REs and at a 5-minute recovery) were determined during each experimental warm-up. The isokinetic knee flexor strength and the hamstring-quadriceps (H:Q) ratio observed for the RE-BFR warm-up were significantly higher than those observed for the RE warm-up (p < 0.05). However, no differences (p > 0.05) in the isokinetic knee extensor strength and 60-m sprint performance were observed between the 2 warm-ups. Running exercise-BFR warm-up induced a higher level of vastus lateralis and biceps femoris muscle activation than did RE warm-up (p < 0.05). Furthermore, RE-BFR warm-up induced higher HR, RPE, and BLa values than did RE warm-up after RE and at a 5-minute recovery (p < 0.05). These results suggest that RE-BFR warm-up may augment physiological responses and improve the H:Q ratio and isokinetic knee flexor strength. Thus, RE-BFR warm-up may be considered a practical warm-up strategy for promoting muscle strength and reducing the risk of hamstring injury in male sprinters.
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Affiliation(s)
- Yun-Tsung Chen
- Department of Physical Education, Dongguan University of Technology, Guangdong, China
| | - Yao-Yi Hsieh
- Department of Physical Education, National Taiwan Normal University, Taipei, Taiwan
| | - Jen-Yu Ho
- Department of Athletic Performance, National Taiwan Normal University, Taipei, Taiwan
| | - Jung-Charng Lin
- Graduate Institute of Sport Coaching Science, Chinese Culture University, Taipei, Taiwan
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99
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Hughes L, Patterson SD. Low intensity blood flow restriction exercise: Rationale for a hypoalgesia effect. Med Hypotheses 2019; 132:109370. [PMID: 31442920 DOI: 10.1016/j.mehy.2019.109370] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 08/07/2019] [Accepted: 08/16/2019] [Indexed: 12/13/2022]
Abstract
Exercise-induced hypoalgesia is characterised by a reduction in pain sensitivity following exercise. Recently, low intensity exercise performed with blood flow restriction has been shown to induce hypoalgesia. The purpose of this manuscript is to discuss the mechanisms of exercise-induced hypoalgesia and provide rationale as to why low intensity exercise performed with blood flow restriction may induce hypoalgesia. Research into exercise-induced hypoalgesia has identified several potential mechanisms, including opioid and endocannabinoid-mediated pain inhibition, conditioned pain modulation, recruitment of high threshold motor units, exercise-induced metabolite production and an interaction between cardiovascular and pain regulatory systems. We hypothesise that several mechanisms consistent with prolonged high intensity exercise may drive the hypoalgesia effect observed with blood flow restriction exercise. These are likely triggered by the high level of intramuscular stress in the exercising muscle generated by blood flow restriction including hypoxia, accumulation of metabolites, accelerated fatigue onset and ischemic pain. Therefore, blood flow restriction exercise may induce hypoalgesia through similar mechanisms to prolonged higher intensity exercise, but at lower intensities, by changing local tissue physiology, highlighting the importance of the blood flow restriction stimulus. The potential to use blood flow restriction exercise as a pain modulation tool has important implications following acute injury and surgery, and for several load compromised populations with chronic pain.
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Affiliation(s)
- Luke Hughes
- Faculty of Sport, Health and Applied Science, St Mary's University, London TW1 4SX, UK.
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100
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Lopes KG, Bottino DA, Farinatti P, de Souza MDGC, Maranhão PA, de Araujo CMS, Bouskela E, Lourenço RA, de Oliveira RB. Strength training with blood flow restriction - a novel therapeutic approach for older adults with sarcopenia? A case report. Clin Interv Aging 2019; 14:1461-1469. [PMID: 31616137 PMCID: PMC6698614 DOI: 10.2147/cia.s206522] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 07/11/2019] [Indexed: 12/13/2022] Open
Abstract
Introduction A 91-year-old sedentary man presenting exhaustion, lower-limb weakness, hypertension, and history of multiple falls was diagnosed with sarcopenia – appendicular skeletal muscle mass index (ASM) of 7.10 kg/m2. Purpose To investigate the effects of strength training performed with low intensity in isolation (LI) or with blood flow restriction (LI-BFR) on strength, muscle mass, IGF-1, endothelial function, microcirculation, inflammatory biomarkers, and oxidative stress. Methods In the first 3 months, LI was performed with intensity corresponding to 30% of 1 repetition maximum, followed by 1 month of inactivity, and another 3 months of LI-BFR (similar load than LI concomitant to BFR equivalent to 50% of resting systolic blood pressure). Results LI-BFR, but not LI improved muscle mass, ASM, handgrip strength, isokinetic peak torque, IL-6, and IGF-1. Endothelial function, red blood cell velocity, and concentrations of C-reactive protein, and soluble intercellular adhesion molecules-1 improved after both LI and LI-BFR. Endothelin-1 and oxidative stress increased after LI-BFR, and lowered after LI. Conclusion LI-BFR, but not LI improved strength, muscle mass, IGF-1, endothelial function, and selected inflammatory markers in a nonagenarian sarcopenic patient. These results are promising and suggest that LI-BFR should be considered as an alternative to prevent muscle loss and improve functional fitness in frail older populations.
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Affiliation(s)
- Karynne Grutter Lopes
- Graduate Program in Clinical and Experimental Physiopathology, Faculty of Medical Sciences, Rio de Janeiro State University , Rio de Janeiro, Brazil.,Laboratory for Clinical and Experimental Research on Vascular Biology, Department of Physiological Sciences, Rio de Janeiro State University , Rio de Janeiro, Brazil
| | - Daniel Alexandre Bottino
- Graduate Program in Clinical and Experimental Physiopathology, Faculty of Medical Sciences, Rio de Janeiro State University , Rio de Janeiro, Brazil.,Laboratory for Clinical and Experimental Research on Vascular Biology, Department of Physiological Sciences, Rio de Janeiro State University , Rio de Janeiro, Brazil
| | - Paulo Farinatti
- Graduate Program in Physical Activity Sciences, Department of Physical Education, Salgado de Oliveira University , Niteroi, Brazil.,Laboratory of Physical Activity and Health Promotion, Institute of Physical Education and Sports, Rio de Janeiro State University , Rio de Janeiro, Brazil.,Graduate Program in Exercise and Sport Sciences, Institute of Physical Education and Sports, Rio de Janeiro State University , Rio de Janeiro, Brazil
| | - Maria das Graças Coelho de Souza
- Graduate Program in Clinical and Experimental Physiopathology, Faculty of Medical Sciences, Rio de Janeiro State University , Rio de Janeiro, Brazil.,Laboratory for Clinical and Experimental Research on Vascular Biology, Department of Physiological Sciences, Rio de Janeiro State University , Rio de Janeiro, Brazil
| | - Priscila Alves Maranhão
- Laboratory for Clinical and Experimental Research on Vascular Biology, Department of Physiological Sciences, Rio de Janeiro State University , Rio de Janeiro, Brazil
| | - Clara Maria Soares de Araujo
- Laboratory for Clinical and Experimental Research on Vascular Biology, Department of Physiological Sciences, Rio de Janeiro State University , Rio de Janeiro, Brazil
| | - Eliete Bouskela
- Graduate Program in Clinical and Experimental Physiopathology, Faculty of Medical Sciences, Rio de Janeiro State University , Rio de Janeiro, Brazil.,Laboratory for Clinical and Experimental Research on Vascular Biology, Department of Physiological Sciences, Rio de Janeiro State University , Rio de Janeiro, Brazil
| | - Roberto Alves Lourenço
- Research Laboratory on Human Aging, Internal Medicine Department, Faculty of Medical Sciences, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Ricardo Brandão de Oliveira
- Graduate Program in Clinical and Experimental Physiopathology, Faculty of Medical Sciences, Rio de Janeiro State University , Rio de Janeiro, Brazil.,Graduate Program in Exercise and Sport Sciences, Institute of Physical Education and Sports, Rio de Janeiro State University , Rio de Janeiro, Brazil.,Laboratory of Active Living, Rio de Janeiro State University, Institute of Physical Education and Sports , Rio de Janeiro, Brazil
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