Effects of resistance exercise combined with moderate vascular occlusion on muscular function in humans

Blood-flow restricted resistance training in patients with sporadic inclusion body myositis: a randomized controlled trial

OBJECTIVES

To investigate the effect of 12 weeks of low-load blood-flow restricted resistance (BFR) training on self-reported and objective physical function, and maximal muscle strength in patients with sporadic inclusion body myositis (sIBM).

METHOD

Twenty-two patients with sIBM were randomized into a training group (BFR group) or a non-exercising control group, according to CONsolidated Standards Of Reporting Trials (CONSORT) guidelines. The BFR group performed 12 weeks of BFR training twice per week. The primary outcome was the physical function domain of the 36-item Short Form Health Survey (pf-SF-36), which was used to measure self-reported physical function. All patients performed physical function tests (2-Minute Walk Test, Timed Up and Go, and 30-Second Chair Stand), completed the Inclusion Body Myositis Functional Rating Scale (IBMFRS), and were tested for isolated knee extensor muscle strength.

RESULTS

No effects of the training intervention were observed for pf-SF-36 or the objective physical function tests. Leg muscle strength decreased in controls (-9.2%, p = 0.02), but was unaltered in the BFR group (+0.9%, p = 0.87), resulting in a between-group difference in the per-protocol analysis (p = 0.026). Between-group differences in baseline to follow-up changes emerged for IBMFRS, in favour of the BFR group (p = 0.018).

CONCLUSION

Twelve weeks of BFR training did not improve self-reported or objective physical function in these sIBM patients. However, the training protocol had a preventive (retaining) effect on the disease-related decline in leg muscle strength, which may aid the long-term preservation of physical function and postpone the need for healthcare assistance.

Physiological and technical commitment during a 300-m in-line skating trial in athletes of different age categories

BACKGROUND

This study investigated the differences in strength, technique and time performance in in-line skaters of three age categories during a 300-meter trial. Possible correlations among these variables were also assessed.

METHODS

Thirty-six elite in-line skaters (Cadets, Juniors and Seniors, N.=12 each; 14±1, 16±1, and 24±6 years of age, respectively) performed a 300-m trial on an outdoor oval track. Total time (Ttot), 100-m fractions and duration of each skating technique (initial acceleration phase, straight push and cross-over) were recorded. A squat jump (SJ) was performed before and after the trial. Heart rate, blood lactate concentration ([La-]) and rate of perceived exertion (RPE) were collected before, during and at the end of the trial.

RESULTS

Ttot was longer and SJ lower in Cadets compared to the other groups. Seniors employed the cross-over technique for a longer period than the straight push technique, compared to Juniors and Cadets. Ttot correlated negatively with SJ in Seniors. The number of significant correlations between skating techniques' duration and both Ttot and SJ increased with age category. No differences among groups were found for heart rate, [La-] and RPE.

CONCLUSIONS

With increasing age category, leg strength appeared to be the more related aspect to skating performance. To improve 300-m in-line skating performance, trainers should pay particular attention to the enhancement of leg strength and cross-over skating technique.

Blood flow restriction late in recovery after heavy resistance exercise hampers muscle recuperation

PURPOSE

This study aimed to examine the effect of acute blood flow restriction during the late recovery phase between two resistance exercise bouts on muscular endurance and oxygenation.

METHODS

Amateur male middle- and long-distance runners performed two bouts of one-leg dynamic plantar flexion exercise to failure with the load equivalent to 75% of maximum. Subjects were randomly assigned into two experimental groups with thigh occlusion pressure between bouts at either 120 or 200 mmHg with 20 min of passive rest in between, and two control groups without any blood flow restriction separated by either 5 or 20 min of rest. Blood flow restriction in the experimental groups was implemented during the last 15 min of recovery. Calf arterial blood flow and muscle oxygenation were measured by venous occlusion plethysmography and near-infrared spectroscopy, respectively.

RESULTS

Decrease of muscular oxygenation and blood flow during recovery between exercise bouts depended on the applied occlusion pressure. When compared with bout 1, work capacity in the experimental groups during bout 2 was reduced by 9.3 ± 2.2% with 120 mmHg and by 10.5 ± 3.1% (p < 0.05) with 200 mmHg occlusion pressure. In the control groups, work capacity was restored after 20 min (- 3.9 ± 3.2%, p > 0.05) but not after 5-min recovery (- 20.0 ± 1.8%, p < 0.05).

CONCLUSIONS

Blood flow restriction late in recovery after a heavy resistance exercise bout decreased muscle oxygenation and work capacity during the subsequent heavy resistance exercise bout.

Effects of Practical Blood Flow Restriction Training on Adolescent Lower-Body Strength

Luebbers, PE, Witte, EV, and Oshel, JQ. Effects of practical blood flow restriction training on adolescent lower-body strength. J Strength Cond Res 33(10): 2674-2683, 2019-The purpose of this study was to examine the effects of a practical blood flow restriction (BFR) training program on lower-body strength of high school weightlifters. Twenty-five students were divided into 3 groups. For 6 weeks, each group completed the same resistance training program with the exception of the parallel back squat exercise (2 d·wk), which was different for each group. One group (HI) completed a traditional high-load (≥65% 1 repetition maximum [1RM]) back squat protocol with 3 sets of low repetitions (≤10). The LO group completed the squat exercise using a relatively light load (≤30% 1RM) for 1 set of 30 repetitions and 3 sets of 15 with 30 seconds of rest between sets. The LO + BFR group followed the same protocol as LO, but did so with blood flow restricted. One repetition maximum back squat tests were conducted before the start of the program and again on conclusion, the values of which were used as the dependent measure. A 3 × 2 (group × time) repeated-measures analysis of variance revealed a significant interaction (p = 0.043). Follow-up tests were conducted to explore the interaction. Paired-sample t-tests for each group indicated a significant increase in leg strength for the LO + BFR group (p = 0.005) but not for the HI (p = 0.142) or LO groups (p = 1.00). This suggests that a practical BFR training program may be effective in increasing 1RM squat performance of high school students.

Early metabolic response after resistance exercise with blood flow restriction in well-trained men: a metabolomics approach

The present study aimed to compare the early metabolic response between high-load resistance exercise (HL-RE) and low-load resistance exercise with blood flow restriction (LL-BFR). Nine young, well-trained men participated in a randomized crossover design in which each subject completed LL-BFR, HL-RE, or condition control (no exercise) with a 1-week interval between them. Blood samples were taken immediately before and 5 min after the exercise sessions. Nuclear magnetic resonance spectroscopy identified and quantified 48 metabolites, 6 of which presented significant changes among the exercise protocols. The HL-RE promoted a higher increase in pyruvate, lactate, and alanine compared with the LL-BFR and the control. HL-RE and LL-BFR promoted a higher increase in succinate compared with the control; however, there was no difference between HL-RE and LL-BFR. Also, while there was no difference in acetoacetate between HL-RE and LL-BFR, a greater decrease was observed in both compared with the control. Finally, LL-BFR promoted a greater decrease in choline compared with the control. In conclusion, this study provides by metabolomics a new insight in metabolic response between LL-BFR and HL-RE by demonstrating a distinct response to some metabolites that are not commonly analyzed.

Effects of blood flow restricted exercise training on muscular strength and blood flow in older adults

BACKGROUND

In young adults, blood flow restricted exercise (BFRE) at relatively low intensities can increase muscle strength as effectively as conventional high intensity training. Ischemic exercise can also increase collateral blood flow in skeletal muscle. However, the effects of chronic BFRE on muscle strength and blood flow in older adults remain unknown. The purpose of this study was to compare the effects of 4weeks of BFRE training on skeletal muscle strength and blood flow between young and older subjects and between older adults performing BFRE and conventional high intensity resistance exercise.

METHODS

Maximum voluntary contraction (MVC), forearm girth, peak forearm blood flow (FBF) and forearm vascular conductance (FVC) were assessed before and after 4weeks of forearm resistance training with BFRE in older adults (O-BFRE, 63±1 y, n=9) and younger adults (Y-BFRE, 22±1 y, n=8) and with high intensity training at 75% maximum voluntary contraction in older adults (O-HI, 63±1 y, n=10).

RESULTS

MVC increased in all groups (O-BFRE, 33.4±4.7 to 36.3±4.7kg; Y-BFRE, 37.2±4.9 to 43.0±5.0kg; O-HI, 34.0±4.4 to 39.8±4.4kg; all p<0.05). Forearm girth increased in O-BFRE (26.3±1.1 to 26.7±1.1cm; p<0.05) and Y-BFRE (23.9±0.9 to 25.1±1.5cm; p<0.05) but not in O-HI (25.9±1.0 to 26.1±1.0cm; p=0.26). Peak forearm vascular conductance increased in Y-BFRE (0.190±0.016 to 0.311±0.031units; p=0.01) but not in O-BFRE (0.157±0.024 to 0.193±0.029units; p=0.48) and O-HI (0.188±0.035 to 0.227±0.035units; p=0.18).

CONCLUSION

These data suggest that chronic BFRE training is effective in increasing muscular strength, muscle size and vascularity in young adults but, in older adults, increases only muscular strength and size. Longer training durations or higher volumes may be required to evoke similar vascular adaptations in older adults.

Efficacy of blood flow restriction exercise during dialysis for end stage kidney disease patients: protocol of a randomised controlled trial

BACKGROUND

Exercise during haemodialysis improves strength and physical function. However, both patients and clinicians are time poor, and current exercise recommendations add an excessive time burden making exercise a rare addition to standard care. Hypothetically, blood flow restriction exercise performed during haemodialysis can provide greater value for time spent exercising, reducing this time burden while producing similar or greater outcomes. This study will explore the efficacy of blood flow restriction exercise for enhancing strength and physical function among haemodialysis patients.

METHODS

This is a randomised controlled trial design. A total of 75 participants will be recruited from haemodialysis clinics. Participants will be allocated to a blood flow restriction cycling group, traditional cycling group or usual care control group. Both exercising groups will complete 3 months of cycling exercise, performed intradialytically, three times per week. The blood flow restriction cycling group will complete two 10-min cycling bouts separated by a 20-min rest at a subjective effort of 15 on a 6 to 20 rating scale. This will be done with pressurised cuffs fitted proximally on the active limbs during exercise at 50% of a pre-determined limb occlusion pressure. The traditional cycling group will perform a continuous 20-min bout of exercise at a subjective effort of 12 on the same subjective effort scale. These workloads and volumes are equivalent and allow for comparison of a common blood flow restriction aerobic exercise prescription and a traditional aerobic exercise prescription. The primary outcome measures are lower limb strength, assessed by a three repetition maximum leg extension test, as well as objective measures of physical function: six-minute walk test, 30-s sit to stand, and timed up and go. Secondary outcome measures include thigh muscle cross sectional area, body composition, routine pathology, quality of life, and physical activity engagement.

DISCUSSION

This study will determine the efficacy of blood flow restriction exercise among dialysis patients for improving key physiological outcomes that impact independence and quality of life, with reduced burden on patients. This may have broader implications for other clinical populations with similarly declining muscle health and physical function, and those contraindicated to higher intensities of exercise.

TRIAL REGISTRATION

Australian and New Zealand Clinical Trial Register: ACTRN12616000121460.

Do metabolites that are produced during resistance exercise enhance muscle hypertrophy?

Many reviews conclude that metabolites play an important role with respect to muscle hypertrophy during resistance exercise, but their actual physiologic contribution remains unknown. Some have suggested that metabolites may work independently of muscle contraction, while others have suggested that metabolites may play a secondary role in their ability to augment muscle activation via inducing fatigue. Interestingly, the studies used as support for an anabolic role of metabolites use protocols that are not actually designed to test the importance of metabolites independent of muscle contraction. While there is some evidence in vitro that metabolites may induce muscle hypertrophy, the only study attempting to answer this question in humans found no added benefit of pooling metabolites within the muscle post-exercise. As load-induced muscle hypertrophy is thought to work via mechanotransduction (as opposed to being metabolically driven), it seems likely that metabolites simply augment muscle activation and cause the mechanotransduction cascade in a larger proportion of muscle fibers, thereby producing greater muscle growth. A sufficient time under tension also appears necessary, as measurable muscle growth is not observed after repeated maximal testing. Based on current evidence, it is our opinion that metabolites produced during resistance exercise do not have anabolic properties per se, but may be anabolic in their ability to augment muscle activation. Future studies are needed to compare protocols which produce similar levels of muscle activation, but differ in the magnitude of metabolites produced, or duration in which the exercised muscles are exposed to metabolites.

A Transcriptomic Analysis of Physiological Significance of Hypoxia-inducible Factor-1α in Myogenesis and Carbohydrate Metabolism of Genioglossus in Mice

Background:

Chronic intermittent hypoxia is the most remarkable feature of obstructive sleep apnea/hypopnea syndrome and it can induce the change of hypoxia-inducible factor-1α (HIF-1α) expression and contractile properties in the genioglossus. To clarify the role of HIF-1α in contractile properties of the genioglossus, this study generated and compared high-throughput RNA-sequencing data from genioglossus between HIF-1α conditional knockout (KO) mice and littermate wild-type (WT) mice.

Methods:

KO mice were generated with cre-loxP strategy. Gene expression profile analysis was performed using gene enrichment analysis. Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses of differently expressed messenger RNAs were performed to identify the related pathways and biological functions. Six differentially expressed genes (DEGs) were validated by qualitative reverse transcription polymerase chain reaction.

Results:

A total of 142 (77 upregulated and 65 downregulated) transcripts were found to exhibit statistically significant difference between the HIF-1α-KO and WT mice. GO and KEGG analyses indicated that DEGs included genes involved in “skeletal muscle cell differentiation,” “muscle organ development,” “glucose metabolic process,” “glycogen biosynthetic and metabolic process,” etc.

Conclusion:

This study might provide evidence that HIF-1α affects the expression of multiple genes involved in the myogenesis, muscle development, and carbohydrate metabolism through transcriptome analysis in conditional HIF-1α-KO mice.

Blood flow restricted training leads to myocellular macrophage infiltration and upregulation of heat shock proteins, but no apparent muscle damage

KEY POINTS

Muscular contractions performed using a combination of low external loads and partial restriction of limb blood flow appear to induce substantial gains in muscle strength and muscle mass. This exercise regime may initially induce muscular stress and damage; however, the effects of a period of blood flow restricted training on these parameters remain largely unknown. The present study shows that short-term, high-frequency, low-load muscle training performed with partial blood flow restriction does not induce significant muscular damage. However, signs of myocellular stress and inflammation that were observed in the early phase of training and after the training intervention, respectively, may be facilitating the previously reported gains in myogenic satellite cell content and muscle hypertrophy. The present results improve our current knowledge about the physiological effects of low-load muscular contractions performed under blood flow restriction and may provide important information of relevance for future therapeutic treatment of muscular atrophy.

ABSTRACT

Previous studies indicate that low-load muscle contractions performed under local blood flow restriction (BFR) may initially induce muscle damage and stress. However, whether these factors are evoked with longitudinal BFR training remains unexplored at the myocellular level. Two distinct study protocols were conducted, covering 3 weeks (3 wk) or one week (1 wk). Subjects performed BFR exercise (100 mmHg, 20% 1RM) to concentric failure (BFRE) (3 wk/1 wk), while controls performed work-matched (LLE) (3 wk) or high-load (HLE; 70% 1RM) (1 wk) free-flow exercise. Muscle biopsies (3 wk) were obtained at baseline (Pre), 8 days into the intervention (Mid8), and 3 and 10 days after training cessation (Post3, Post10) to examine macrophage (M1/M2) content as well as heat shock protein (HSP27/70) and tenascin-C expression. Blood samples (1 wk) were collected before and after (0.1-24 h) the first and last training session to examine markers of muscle damage (creatine kinase), oxidative stress (total antibody capacity, glutathione) and inflammation (monocyte chemotactic protein-1, interleukin-6, tumour necrosis factor α). M1-macrophage content increased 108-165% with BFRE and LLE at Post3 (P < 0.05), while M2-macrophages increased (163%) with BFRE only (P < 0.01). Membrane and intracellular HSP27 expression increased 60-132% at Mid8 with BFRE (P < 0.05-0.01). No or only minor changes were observed in circulating markers of muscle damage, oxidative stress and inflammation. The amplitude, timing and localization of the above changes indicate that only limited muscle damage was evoked with BFRE. This study is the first to show that a period of high-frequency, low-load BFR training does not appear to induce general myocellular damage. However, signs of tissue inflammation and focal myocellular membrane stress and/or reorganization were observed that may be involved in the adaptation processes evoked by BFR muscle exercise.

Normobaric hypoxia increases the growth hormone response to maximal resistance exercise in trained men

This study examined the effect of hypoxia on growth hormone (GH) release during an acute bout of high-intensity, low-volume resistance exercise. Using a single-blinded, randomised crossover design, 16 resistance-trained males completed two resistance exercise sessions in normobaric hypoxia (HYP; inspiratory oxygen fraction, (FiO₂) 0.12, arterial oxygen saturation (SpO₂) 82 ± 2%) and normoxia (NOR; FiO₂ 0.21, SpO₂ 98 ± 0%). Each session consisted of five sets of three repetitions of 45° leg press and bench press at 85% of one repetition maximum. Heart rate, SpO₂, and electromyographic activity (EMG) of the vastus lateralis muscle were measured throughout the protocol. Serum lactate and GH levels were determined pre-exposure, and at 5, 15, 30 and 60 min post-exercise. Differences in mean and integrated EMG between HYP and NOR treatments were unclear. However, there was an important increase in the peak levels and area under the curve of both lactate (HYP 5.8 ± 1.8 v NOR 3.9 ± 1.1 mmol.L^-1 and HYP 138.7 ± 33.1 v NOR 105.8 ± 20.8 min.mmol.L^-1) and GH (HYP 4.4 ± 3.1 v NOR 2.1 ± 2.5 ng.mL^-1 and HYP 117.7 ± 86.9 v NOR 72.9 ± 85.3 min.ng.mL^-1) in response to HYP. These results suggest that performing high-intensity resistance exercise in a hypoxic environment may provide a beneficial endocrine response without compromising the neuromuscular activation required for maximal strength development.

Adaptation of Perceptual Responses to Low-Load Blood Flow Restriction Training

Martín-Hernández, J, Ruiz-Aguado, J, Herrero, AJ, Loenneke, JP, Aagaard, P, Cristi-Montero, C, Menéndez, H, and Marín, PJ. Adaptation of perceptual responses to low-load blood flow restriction training. J Strength Cond Res 31(3): 765-772, 2017-The purpose of this study was to determine the adaptive response of ratings of perceived exertion (RPE) and pain over 6 consecutive training sessions. Thirty subjects were assigned to either a blood flow restriction training (BFRT) group or a high-intensity resistance training (HIT) group. Blood flow-restricted training group performed 4 sets (30 + 15 + 15 + 15, respectively) of unilateral leg extension at an intensity of 20% one repetition maximum (1RM) while a restrictive cuff was applied to the most proximal part of the leg. The HIT group performed 3 sets of 8 repetitions with 85% 1RM. Ratings of perceived exertion and pain were assessed immediately after each exercise set along the 6 training sessions and were then averaged to obtain the overall RPE and pain per session. Statistical analyses showed significant main effects for group (p ≤ 0.05) and time (p < 0.001). Ratings of perceived exertion values dropped from session 1 to session 6 in both BFRT (8.12 ± 1.3 to 5.7 ± 1.1, p < 0.001) and HIT (8.5 ± 1.2 to 6.40 ± 1.2, p < 0.001). Similar results were observed regarding pain ratings (BFRT: 8.12 ± 1.3 to 5.90 ± 1.55, p < 0.001; HIT: 6.22 ± 1.7 to 5.14 ± 1.42, p < 0.01). Our results indicate that RPE was higher after HIT, whereas differences did not reach significance regarding pain. These perceptual responses were attenuated over time, and the time course of this adaptive response was similar between BFRT and HIT. In summary, BFRT induces a marked perceptual response to training, comparable with that observed with HIT. However, this response becomes attenuated with continuous practice, leading to moderate values of RPE and pain. Perceptual responses may not limit the application of BFRT to highly motivated individuals.

Restricted Blood Flow Exercise in Sedentary, Overweight African-American Females May Increase Muscle Strength and Decrease Endothelial Function and Vascular Autoregulation

Objectives:

Exercise with partially restricted blood flow is a low-load, low-intensity resistance training regimen which may have the potential to increase muscle strength in the obese, elderly and frail who are unable to do high-load training. Restricted blood flow exercise has also been shown to affect blood vessel function variably and can, therefore, contribute to blood vessel dysfunction. This pilot study tests the hypothesis that unilateral resistance training of the leg extensors with partially restricted blood flow increases muscle strength and decreases vascular autoregulation.

Methods:

The subjects were nine normotensive, overweight, young adult African-Americans with low cardiorespiratory fitness who underwent unilateral training of the quadriceps’ femoris muscles with partially restricted blood flow at 30% of the 1-repetition maximum (1-RM) load for 3 weeks. The 1-RM load and post-occlusion blood flow to the lower leg (calf) were measured during reactive hyperemia.

Results:

The 1-RM load increased in the trained legs from 77 ± 3 to 84 ± 4 kg (P < 0.05) in the absence of a significant effect on the 1-RM load in the contralateral untrained legs (P > 0.1). Post-occlusion blood flow decreased significantly in the trained legs from 19 ± 2 to 13 ± 2 mL· min^-1· dL^-1 (P < 0.05) and marginally in the contralateral untrained legs from 18 ± 2 to 16 ± 1 mL· min^-1· dL^-1 (P = 0.09). Changes in post-occlusion blood flow to the skin overlying the trained and the contralateral untrained muscles were not significant.

Conclusion:

These results demonstrate that restricted blood flow exercise, which results in significant gains in muscle strength, may produce decrements in endothelial dysfunction and vascular autoregulation. Future studies should determine whether pharmacopuncture plays a role in treatments for such blood vessel dysfunction.

Blood flow restriction increases metabolic stress but decreases muscle activation during high-load resistance exercise

INTRODUCTION

We investigated differences in metabolic stress (lactate) and muscle activation (electromyography; EMG) when high-load resistance exercise (HL) is compared with a condition in which blood flow restriction (BFR) is applied during the exercise or during the rest interval.

METHODS

Twelve participants performed HL with BFR during the intervals (BFR-I), during the set (BFR-S), and without BFR. Each condition consisted of 3 sets of 8 repetitions with knee extension at 70% of 1-repetition maximum. Lactate and root mean square (RMS) from the surface EMG of the vastus lateralis were calculated.

RESULTS

Lactate increased in all protocols but was higher with BFR-I than with BFR-S and HL. RMS decreased under all conditions, with a larger effect size in BFR-I (1.47) than in BFR-S (0.66) and HL (0.59).

DISCUSSION

BFR-I increases lactate, possibly as a result of reduced restoration of ATP. Muscle activation seems to be impacted by mechanical stress but may be reduced by metabolic stress. Muscle Nerve 57: 107-111, 2018.

Effects of strength training with blood flow restriction on torque, muscle activation and local muscular endurance in healthy subjects

The present study aimed to analyse the effects of six weeks of strength training (ST), with and without blood flow restriction (BFR), on torque, muscle activation, and local muscular endurance (LME) of the knee extensors. Thirty-seven healthy young individuals were divided into four groups: high intensity (HI), low intensity with BFR (LI+BFR), high intensity and low intensity + BFR (COMB), and low intensity (LI). Torque, muscle activation and LME were evaluated before the test and at the 2nd, 4th and 6th weeks after exercise. All groups had increased torque, muscle activation and LME (p<0.05) after the intervention, but the effect size and magnitude were greater in the HI, LI+BFR and COMB groups. In conclusion, the groups with BFR (LI+BFR and COMB) produced magnitudes of muscle activation, torque and LME similar to those of the HI group.

Acute Cardiovascular and Hemodynamic Responses to Low Intensity Eccentric Resistance Exercise with Blood Flow Restriction

BACKGROUND

Recently it has been suggested that low intensity (LI) resistance exercise (RE) alone or in combination with blood flow restriction (BFR) can be applied for cardiovascular function improvement or rehabilitation.

OBJECTIVES

The aim of the present study was to investigate the acute effects of LI eccentric RE with and without BFR on heart rate (HR), rate pressure product (RPP), blood pressure (BP) parameters [systolic, diastolic, and mean arterial pressure (MAP)], oxygen saturation (SpO2) and rate of perceived exertion (RPE).

METHODS

In a semi-experimental study 16 young adults (26.18 ± 3.67 years) volunteered and performed LI (30% maximum voluntary contraction) eccentric RE alone or combined with BFR.

RESULTS

The results indicated that HR, RPP, and RPE increased significantly within both groups (P < 0.05); SBP and DBP increased significantly only with BFR (P < 0.05); MAP increased significantly during exercise without BFR (P < 0.05); and no change was observed in SpO₂ in either groups (P > 0.05). Furthermore, studied parameters did not vary amongst different groups (P > 0.05).

CONCLUSIONS

It is concluded that LI eccentric RE with BFR positively regulated the hemodynamic and cardiovascular responses. Therefore, the eccentric RE combined with BFR seems to be a good option for future studies with the aim of time efficacy, since it alters these parameters within normal values.

Strength Training with Vascular Occlusion: A Review of Possible Adaptive Mechanisms

Strength training with blood flow restriction, or KAATSU training, has been shown to be as effective as conventional strength training to promote muscular strength and hypertrophy. Several mechanisms have been suggested as hypotheses to explain the adaptations arising from this training method. Among these is metabolic stress, which exerts important physiological effects and may influence the training adaptations in question. In addition, hypoxia produced by the technique may change the neural recruitment pattern. Growth hormone (GH) concentrations increase as a result of practicing this method, which can trigger an increase in plasmatic and, perhaps, muscular insulin-like growth factor-1 (IGF-1) concentrations. The increase in concentrations of these factors can play a leading role in responses to KAATSU training. Among the effects of the GH/IGF-1 axis in muscle cells is the increase in the signalling pathway activity of the mammalian target of rapamycin (mTOR), which has been associated with increased protein synthesis. On the other hand, the decrease in the activity of the myostatin pathway, which has an antagonistic effect to mTOR, has been demonstrated after training with occlusion. Other factors, such as increases in the expression of heat shock proteins, may play an important role in adaptations to exercise. Nitric oxide synthase could increase nitric oxide concentration, which in turn has an effect on satellite cells and blood flow. However, despite the results obtained, the transfer to other situations (e.g. speed sports) is not yet clear.

Transcriptional profiling of rat skeletal muscle hypertrophy under restriction of blood flow

Blood flow restriction (BFR) under low-intensity resistance training (LIRT) can produce similar effects upon muscles to that of high-intensity resistance training (HIRT) while overcoming many of the restrictions to HIRT that occurs in a clinical setting. However, the potential molecular mechanisms of BFR induced muscle hypertrophy remain largely unknown. Here, using a BFR rat model, we aim to better elucidate the mechanisms regulating muscle hypertrophy as induced by BFR and reveal possible clinical therapeutic targets for atrophy cases. We performed genome wide screening with microarray analysis to identify unique differentially expressed genes during rat muscle hypertrophy. We then successfully separated the differentially expressed genes from BRF treated soleus samples by comparing the Affymetrix rat Genome U34 2.0 array with the control. Using qRT-PCR and immunohistochemistry (IHC) we also analyzed other related differentially expressed genes. Results suggested that muscle hypertrophy induced by BFR is essentially regulated by the rate of protein turnover. Specifically, PI3K/AKT and MAPK pathways act as positive regulators in controlling protein synthesis where ubiquitin-proteasome acts as a negative regulator. This represents the first general genome wide level investigation of the gene expression profile in the rat soleus after BFR treatment. This may aid our understanding of the molecular mechanisms regulating and controlling muscle hypertrophy and provide support to the BFR strategies aiming to prevent muscle atrophy in a clinical setting.

Acute Effects of Resistance Exercise With Continuous and Intermittent Blood Flow Restriction on Hemodynamic Measurements and Perceived Exertion

This study compared the acute effects of low-intensity resistance exercise (RE) sessions for the upper limb with continuous and intermittent blood flow restriction (BFR) and high-intensity RE with no BFR on lactate, heart rate, double product (DP; heart rate times systolic blood pressure), and perceived exertion (RPE). Ten recreationally trained men (1-5 years strength training; age mean = 19 ± 0.82 years) performed three experimental protocols in random order: (a) low-intensity RE at 20% one-repetition maximum (1RM) with intermittent BFR (LI + IBFR), (b) low-intensity RE at 20% 1RM with continuous BFR (LI + CBFR), and (c) high-intensity RE at 80% 1RM. The three RE protocols increased lactate and DP at the end of the session ( p < .05) and increased heart rate at the end of each exercise ( p < .05). However, greater local and general RPE was observed in the high-intensity protocol compared with LI + IBFR and LI + CBFR in the lat pull-down, triceps curl, and biceps curl exercises ( p < .05). A greater percentage change in DP and lactate was observed for continuous BFR compared with intermittent BFR; however, RPE was lower for intermittent BFR. In conclusion, intermittent BFR appears to be an excellent option for physical training because it did not differ significantly from continuous BFR in any variable and promoted a lower percentage change in DP and RPE.

Physiological responses to interval endurance exercise at different levels of blood flow restriction

PURPOSE

We aimed to identify a blood flow restriction (BFR) endurance exercise protocol that would both maximize cardiopulmonary and metabolic strain, and minimize the perception of effort.

METHODS

Twelve healthy males (23 ± 2 years, 75 ± 7 kg) performed five different exercise protocols in randomized order: HI, high-intensity exercise starting at 105% of the incremental peak power (P _peak); I-BFR30, intermittent BFR at 30% P _peak; C-BFR30, continuous BFR at 30% P _peak; CON30, control exercise without BFR at 30% P _peak; I-BFR0, intermittent BFR during unloaded exercise. Cardiopulmonary, gastrocnemius oxygenation (StO₂), capillary lactate ([La]), and perceived exertion (RPE) were measured.

RESULTS

V̇O₂, ventilation (V̇ _E), heart rate (HR), [La] and RPE were greater in HI than all other protocols. However, muscle StO₂ was not different between HI (set1-57.8 ± 5.8; set2-58.1 ± 7.2%) and I-BRF30 (set1-59.4 ± 4.1; set2-60.5 ± 6.6%, p < 0.05). While physiologic responses were mostly similar between I-BFR30 and C-BFR30, [La] was greater in I-BFR30 (4.2 ± 1.1 vs. 2.6 ± 1.1 mmol L^-1, p = 0.014) and RPE was less (5.6 ± 2.1 and 7.4 ± 2.6; p = 0.014). I-BFR30 showed similar reduced muscle StO₂ compared with HI, and increased blood lactate compared to C-BFR30 exercise.

CONCLUSION

Therefore, this study demonstrate that endurance cycling with intermittent BFR promotes muscle deoxygenation and metabolic strain, which may translate into increased endurance training adaptations while minimizing power output and RPE.

Heavy Resistance Training in Hypoxia Enhances 1RM Squat Performance

Purpose: To determine if heavy resistance training in hypoxia (IHRT) is more effective at improving strength, power, and increasing lean mass than the same training in normoxia.

Methods: A pair-matched, placebo-controlled study design included 20 resistance-trained participants assigned to IHRT (FIO2 0.143) or placebo (FIO2 0.20), (n = 10 per group). Participants were matched for strength and training. Both groups performed 20 sessions over 7 weeks either with IHRT or placebo. All participants were tested for 1RM, 20-m sprint, body composition, and countermovement jump pre-, mid-, and post-training and compared via magnitude-based inferences.

Presentation of Results: Groups were not clearly different for any test at baseline. Training improved both absolute (IHRT: 13.1 ± 3.9%, effect size (ES) 0.60, placebo 9.8 ± 4.7%, ES 0.31) and relative 1RM (IHRT: 13.4 ± 5.1%, ES 0.76, placebo 9.7 ± 5.3%, ES 0.48) at mid. Similarly, at post both groups increased absolute (IHRT: 20.7 ± 7.6%, ES 0.74, placebo 14.1 ± 6.0%, ES 0.58) and relative 1RM (IHRT: 21.6 ± 8.5%, ES 1.08, placebo 13.2 ± 6.4%, ES 0.78). Importantly, the change in IHRT was greater than placebo at mid for both absolute [4.4% greater change, 90% Confidence Interval (CI) 1.0:8.0%, ES 0.21, and relative strength (5.6% greater change, 90% CI 1.0:9.4%, ES 0.31 (relative)]. There was also a greater change for IHRT at post for both absolute (7.0% greater change, 90% CI 1.3:13%, ES 0.33), and relative 1RM (9.2% greater change, 90% CI 1.6:14.9%, ES 0.49). Only IHRT increased countermovement jump peak power at Post (4.9%, ES 0.35), however the difference between IHRT and placebo was unclear (2.7, 90% CI –2.0:7.6%, ES 0.20) with no clear differences in speed or body composition throughout.

Conclusion: Heavy resistance training in hypoxia is more effective than placebo for improving absolute and relative strength.

Lower Extremity Limb Salvage: Lessons Learned From 14 Years at War

American survivability during the current conflicts in Iraq and Afghanistan continues to improve, though the rate of extremity injury remains quite high. The decision to proceed with amputation versus limb salvage remains controversial. Exposure to combat wound with severe high-energy lower extremity trauma during the previous 14 years at war has incited important advances in limb salvage technique and rehabilitation.

Low Oxygen Tension Enhances Expression of Myogenic Genes When Human Myoblasts Are Activated from G0 Arrest

OBJECTIVES

Most cell culture studies have been performed at atmospheric oxygen tension of 21%, however the physiological oxygen tension is much lower and is a factor that may affect skeletal muscle myoblasts. In this study we have compared activation of G0 arrested myoblasts in 21% O2 and in 1% O2 in order to see how oxygen tension affects activation and proliferation of human myoblasts.

MATERIALS AND METHODS

Human myoblasts were isolated from skeletal muscle tissue and G0 arrested in vitro followed by reactivation at 21% O2 and 1% O2. The effect was assesses by Real-time RT-PCR, immunocytochemistry and western blot.

RESULTS AND CONCLUSIONS

We found an increase in proliferation rate of myoblasts when activated at a low oxygen tension (1% O2) compared to 21% O2. In addition, the gene expression studies showed up regulation of the myogenesis related genes PAX3, PAX7, MYOD, MYOG (myogenin), MET, NCAM, DES (desmin), MEF2A, MEF2C and CDH15 (M-cadherin), however, the fraction of DES and MYOD positive cells was not increased by low oxygen tension, indicating that 1% O2 may not have a functional effect on the myogenic response. Furthermore, the expression of genes involved in the TGFβ, Notch and Wnt signaling pathways were also up regulated in low oxygen tension. The differences in gene expression were most pronounced at day one after activation from G0-arrest, thus the initial activation of myoblasts seemed most sensitive to changes in oxygen tension. Protein expression of HES1 and β-catenin indicated that notch signaling may be induced in 21% O2, while the canonical Wnt signaling may be induced in 1% O2 during activation and proliferation of myoblasts.

Physical exercise as a treatment for adult and juvenile myositis

There is growing evidence to support the safety and efficacy of exercise in patients with adult and juvenile idiopathic inflammatory myopathies. Five randomized controlled trials including adult patients with polymyositis and dermatomyositis (DM) and additional open studies have demonstrated reduced impairment and activity limitation as well as improved quality of life. In addition, recent studies have shown reduced disease activity assessed by consensus disease activity measures and reduced expression of genes regulating inflammation and fibrosis. Furthermore, exercise could improve muscle aerobic capacity as shown by increased mitochondrial enzyme activity. These data suggest that intensive aerobic exercise and resistance training could reduce disease activity and inflammation and improve muscle metabolism. Encouraging results have been reported from available open studies including patients with inclusion body myositis (IBM) and juvenile DM, indicating reduced impairment, activity limitation and improved quality of life also in these patients. Larger studies are needed to increase understanding of the effects of exercise in patients with active, recent-onset polymyositis and DM as well as in patients with IBM and juvenile DM.

The influence of participant characteristics on the relationship between cuff pressure and level of blood flow restriction

Purpose

Previous investigations to establish factors influencing the blood flow restriction (BFR) stimulus have determined cuff pressures required for complete arterial occlusion, which does not reflect the partial restriction prescribed for this training technique. This study aimed to establish characteristics that should be accounted for when prescribing cuff pressures required for partial BFR.

Methods

Fifty participants were subjected to incremental blood flow restriction of the upper and lower limbs by proximal pneumatic cuff inflation. Popliteal and brachial artery diameter, blood velocity and blood flow was assessed with Doppler ultrasound. Height, body mass, limb circumference, muscle–bone cross-sectional area, adipose thickness (AT) and arterial blood pressure were measured and used in different models of hierarchical linear regression to predict the pressure at which 60 % BFR (partial occlusion) occurred.

Results

Combined analysis revealed a difference in cuff pressures required to elicit 60 % BFR in the popliteal (111 ± 12 mmHg) and brachial arteries (101 ± 12 mmHg). MAP (r = 0.58) and AT (r = −0.45) were the largest independent determinants of lower and upper body partial occlusion pressures. However, greater variance was explained by upper and lower limb regression models composed of DBP and BMI (48 %), and arm AT and DBP (30 %), respectively.

Conclusion

Limb circumference has limited impact on the cuff pressure required for partial blood flow restriction which is in contrast to its recognised relationship with complete arterial occlusion. The majority of the variance in partial occlusion pressure remains unexplained by the predictor variables assessed in the present study.

Exercises with partial vascular occlusion in patients with knee osteoarthritis: a randomized clinical trial

PURPOSE

The objective of this study was to evaluate whether women with knee osteoarthritis performing a rehabilitation programme consisting of low-load exercises combined with PVO exhibited the same results in changes in quadriceps strength, pain relief, and functional improvement when compared to women receiving a programme consisting of high-load exercises without PVO.

METHODS

Thirty-four women (mean age, 61 years) with a diagnosis of knee osteoarthritis were randomly assigned to a conventional or occlusion group. The women in the conventional group (n = 17) performed a 6-week quadriceps strengthening and stretching programme using a load around 70 % of the 1-repetition maximum (RM). The women in the occlusion group (n = 17) performed the same programme, however, only using a load around 30 % of the 1-RM, while PVO was induced. The PVO was achieved using a pressure cuff applied to the upper third of the thigh and inflated to 200 mmHg during the quadriceps exercise. An 11-point Numerical Pain Rating Scale (NPRS), the Lequesne questionnaire, the Timed-Up and Go (TUG) test, and muscle strength measurement using a hand-held dynamometer were used as outcome measures at baseline (pretreatment) and at the end of the 6-week of treatment. Pain, using the NPRS, was also assessed when performing the quadriceps exercises during the exercise sessions.

RESULTS

At baseline, demographic, strength, pain, and functional assessment data were similar between groups. Patients from both the conventional and occlusion groups had a higher level of function (Lequesne and TUG test), less pain (NPRS), and higher quadriceps strength at the 6-week evaluation when compared to baseline (all P < 0.05). However, the between-group analysis showed no differences for all outcomes variables at posttreatment (n.s.). Patients in the occlusion group experienced less anterior knee discomfort during the treatment sessions than those in the high-load exercise group (P < 0.05).

CONCLUSION

A rehabilitation programme that combined PVO to low-load exercise resulted in similar benefits in pain, function, and quadriceps strength than a programme using high-load conventional exercise in patients with knee osteoarthritis. However, the use of PVO combined with low-load exercise resulted in less anterior knee pain during the training sessions.

LEVEL OF EVIDENCE

I.