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Ogrezeanu DC, Calatayud J, Rodríguez S, Carrasco JJ, Martinez-Valdes E, Casaña J, Cruz-Montecinos C, Andersen LL, Aagaard P, López-Bueno R, Pérez-Alenda S. Acute neuromuscular and perceptual responses to blood flow restriction exercise in adults with severe haemophilia: A pilot study. Haemophilia 2024. [PMID: 39099074 DOI: 10.1111/hae.15084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 06/14/2024] [Accepted: 07/16/2024] [Indexed: 08/06/2024]
Abstract
INTRODUCTION No previous studies have implemented a standard blood flow restriction (BFR) training session in people with severe haemophilia (PwH), where this type of training has been contraindicated. AIMS The purpose of this study was to evaluate the tolerability, adverse events, and neuromuscular and perceptual responses to an acute session of low load (LL) knee extensions with BFR in PwH under prophylaxis. METHODS Eight PwH performed one LL-BFR session with 40% arterial occlusion pressure (AOP). Perceptual responses and adverse effects were assessed, together with high-density surface electromyography of vastus medialis (VM) and lateralis (VL). RESULTS Significant normalized root mean square differences were found within each set, but not between sets. Spatial distribution (centroid displacement (p > .05), modified entropy (VM, set two, cycles three and five, p = .032) and coefficient of variation (VM, set two, cycles four and five lower than cycle three (p = .049; p = .036)) showed changes within each set. Median frequency showed a slight increase during cycle four of set four (p = .030). Rate of perceived exertion slightly increased with each set while tolerability slightly decreased in the last set and fear of training with BFR generally decreased after the session. CONCLUSIONS In PwH, a LL-BFR session at 40% AOP is safe and feasible. Our results suggest that potential muscle impairments may blunt neuromuscular adaptations induced by BFR.
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Affiliation(s)
- Daniel C Ogrezeanu
- Department of Physiotherapy, Exercise Intervention for Health Research Group (EXINH-RG), University of Valencia, Valencia, Spain
| | - Joaquín Calatayud
- Department of Physiotherapy, Exercise Intervention for Health Research Group (EXINH-RG), University of Valencia, Valencia, Spain
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Sergi Rodríguez
- Department of Physiotherapy, Exercise Intervention for Health Research Group (EXINH-RG), University of Valencia, Valencia, Spain
| | - Juan J Carrasco
- Department of Physiotherapy, Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), University of Valencia, Valencia, Spain
- Intelligent Data Analysis Laboratory, University of Valencia, Valencia, Spain
| | - Eduardo Martinez-Valdes
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - José Casaña
- Department of Physiotherapy, Exercise Intervention for Health Research Group (EXINH-RG), University of Valencia, Valencia, Spain
| | - Carlos Cruz-Montecinos
- Department of Physiotherapy, Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), University of Valencia, Valencia, Spain
- Department of Physical Therapy, Laboratory of Clinical Biomechanics, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Lars L Andersen
- National Research Centre for the Working Environment, Copenhagen, Denmark
- Department of Health Science and Technology, Aalborg University, Aalborg East, Denmark
| | - Per Aagaard
- Department of Sports Science and Clinical Biomechanics, Research Unit for Muscle Physiology and Biomechanics, University of Southern Denmark, Odense, Syddanmark, Denmark
| | - Rubén López-Bueno
- Department of Physical Medicine and Nursing, University of Zaragoza, Zaragoza, Aragón, Spain
| | - Sofía Pérez-Alenda
- Department of Physiotherapy, Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), University of Valencia, Valencia, Spain
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Fleming AR, MacDonald HV, Buckner SL, Winchester LJ. Lower limb blood flow occlusion increases systemic pressor response without increasing brachial arterial blood flow redistribution in women. Clin Physiol Funct Imaging 2024; 44:285-296. [PMID: 38402408 DOI: 10.1111/cpf.12873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 01/16/2024] [Accepted: 02/08/2024] [Indexed: 02/26/2024]
Abstract
This study was conducted to investigate the systemic hemodynamic and vascular changes in women during and after two commonly used clinical blood flow restriction (BFR) pressures at rest. There are minimal data regarding the independent effects of BFR on hemodynamic and systemic vascular changes due to pressor response, particularly among women. Therefore, this study investigated BFR-induced alterations in pressor response and systemic flow redistribution at rest during two commonly used pressures (50% and 80% limb occlusion pressure [LOP]). Fifteen women (22.1 ± 4.2 years) completed two randomised sessions involving 8-min of bilateral, lower limb restriction at 50% or 80% LOP followed by 8-min of recovery post-deflation. Changes in vascular (arterial diameter [DIA], time-averaged mean velocity [TAMV], volume flow [VF], and area) and hemodynamic (heart rate [HR] and blood pressure) measures over time (pre-, during, post-occlusion) and by session (50% vs. 80% LOP) were tested using repeated measures analysis of variance. Repeated measures correlations (rrm) quantified common intraindividual associations between BFR-induced hemodynamic and vascular responses. HR increased from baseline during 50% LOP and remained elevated during recovery (p < 0.05). HR increased from baseline during 80% LOP, while tibial VF and TAMV decreased (p < 0.03 for all). HR and TAMV values returned to baseline during recovery, while brachial artery VF decreased (p < 0.05). Changes in HR, brachial VF, and brachial TAMV were similar between 50% and 80% LOP (rrm = 0.32-0.70, p < 0.05 for all). At 80% LOP, changes in HR were positively correlated with brachial VF (rrm = 0.38) and TAMV (rrm = 0.43) and negatively correlated with tibial VF (rrm = -0.36) and TAMV (rrm = -0.30) (p < 0.05 for all). Results suggest that BFR at 80% LOP elicits an acute systemic pressor reflex without concomitant increases in brachial arterial flow, while 50% LOP elicits a subdued response.
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Affiliation(s)
- Abby R Fleming
- Department of Kinesiology, University of Alabama, Tuscaloosa, Alabama, USA
| | - Hayley V MacDonald
- Department of Kinesiology, University of Alabama, Tuscaloosa, Alabama, USA
| | - Samuel L Buckner
- Department of Educational and Psychological Studies, College of Education, University of South Florida, Tampa, Florida, USA
| | - Lee J Winchester
- Department of Kinesiology, University of Alabama, Tuscaloosa, Alabama, USA
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Peng P, Lu Y, Wang Y, Sui X, Yang Z, Xu H, Zhang S. Effect of Low-Intensity Bloodflow Restriction Training on Nontraumatic Knee Joint Conditions: A Systematic Review and Meta-analysis. Sports Health 2024:19417381241235147. [PMID: 38587041 DOI: 10.1177/19417381241235147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024] Open
Abstract
CONTEXT Nontraumatic knee conditions are common in clinical practice. Existing pharmaceutical and immobilization approaches provide limited pain relief and functional enhancement. Low-intensity bloodflow restriction training (LI-BFRT) is being investigated as a nonpharmacological alternative; however, its efficacy is uncertain. OBJECTIVE To assess the effectiveness of LI-BFRT for nontraumatic knee conditions and compare it with high-intensity resistance training (HI-RT) and low-intensity resistance training (LI-RT). DATA SOURCES PubMed, EBSCO, Science Direct, Cochrane Library, China Knowledge Infrastructure, Wanfang Data, and VIP databases were searched until May 30, 2023. STUDY SELECTION Original randomized controlled trials involving nontraumatic knee joint conditions with interventions consisting mainly of LI-BFRT, HI-RT, or LI-RT. The results assessed mainly pain and muscle performance. STUDY DESIGN Systematic review and meta-analysis. LEVEL OF EVIDENCE Level 1. DATA EXTRACTION Sample characteristics, study design, country, disease, groups, evaluation time, duration, and outcomes were extracted. RESULTS A total of 13 randomized controlled trials were included in the systematic review. Compared with pretreatment, LI-BFRT significantly alleviated pain (weighted standardized mean difference [SMD], -1.33; 95% CI, -1.62 to -1.05), with better additional effects on hip muscle training (SMD, -3.14; 95% CI, -4.07 to -2.75). Compared with LI-RT, LI-BFRT significantly relieved pain in male patients (SMD, -1.47; 95% CI, -1.92 to -1.01). LI-BFRT significantly increased quadriceps cross-sectional area (SMD, 0.53; 95% CI, 0.27-0.78), knee extension strength (SMD, 0.84; 95% CI, 0.48-1.2), and leg press strength (SMD, 0.64; 95% CI, 0.34-0.94) compared with pretreatment. Its effects were superior to those of LI-RT and similar to those of HI-RT. However, sex differences in muscle strength improvement were observed. CONCLUSION In patients with nontraumatic knee joint conditions, LI-BFRT effectively alleviated pain, increased muscle cross-sectional area, and enhanced muscle strength. LI-BFRT showed pain relief comparable with that of LI-RT while surpassing LI-RT in muscle growth and strength improvement.
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Affiliation(s)
- PeiQiang Peng
- School of Nursing, Jilin University, Chaoyang District, Changchun, China
| | - Yuming Lu
- Department of Orthopedics, Lequn Branch, The First Hospital of Jilin University, District, Changchun, China
| | - YueTing Wang
- School of Nursing, Jilin University, Chaoyang District, Changchun, China
| | - Xin Sui
- School of Nursing, Jilin University, Chaoyang District, Changchun, China
| | - Zhenning Yang
- School of Nursing, Jilin University, Chaoyang District, Changchun, China
| | - Haiyan Xu
- School of Nursing, Jilin University, Chaoyang District, Changchun, China
| | - Shuang Zhang
- School of Nursing, Jilin University, Chaoyang District, Changchun, China
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Scott BR, Marston KJ, Owens J, Rolnick N, Patterson SD. Current Implementation and Barriers to Using Blood Flow Restriction Training: Insights From a Survey of Allied Health Practitioners. J Strength Cond Res 2024; 38:481-490. [PMID: 38088873 DOI: 10.1519/jsc.0000000000004656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
ABSTRACT Scott, BR, Marston, KJ, Owens, J, Rolnick, N, and Patterson, SD. Current implementation and barriers to using blood flow restriction training: Insights from a survey of allied health practitioners. J Strength Cond Res 38(3): 481-490, 2024-This study investigated the use of blood flow restriction (BFR) exercise by practitioners working specifically with clinical or older populations, and the barriers preventing some practitioners from prescribing BFR. An online survey was disseminated globally to allied health practitioners, with data from 397 responders included in analyses. Responders who had prescribed BFR exercise ( n = 308) completed questions about how they implement this technique. Those who had not prescribed BFR exercise ( n = 89) provided information on barriers to using this technique, and a subset of these responders ( n = 22) completed a follow-up survey to investigate how these barriers could be alleviated. Most practitioners prescribe BFR exercise for musculoskeletal rehabilitation clients (91.6%), with the BFR cuff pressure typically relative to arterial occlusion pressure (81.1%) and implemented with resistance (96.8%) or aerobic exercise (42.9%). Most practitioners screen for contraindications (68.2%), although minor side effects, including muscle soreness (65.8%), are common. The main barriers preventing some practitioners from using BFR are lack of equipment (60.2%), insufficient education (55.7%), and safety concerns (31.8%). Suggestions to alleviate these barriers included developing educational resources about the safe application and benefits of BFR exercise ( n = 20) that are affordable ( n = 3) and convenient ( n = 4). These results indicate that BFR prescription for clinical and older cohorts mainly conforms with current guidelines, which is important considering the potentially increased risk for adverse events in these cohorts. However, barriers still prevent broader utility of BFR training, although some may be alleviated through well-developed educational offerings to train practitioners in using BFR exercise.
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Affiliation(s)
- Brendan R Scott
- Centre for Healthy Ageing, Murdoch University, Perth, Australia
- Murdoch Applied Sports Science Laboratory, Discipline of Exercise Science, Murdoch University, Perth, Australia
| | - Kieran J Marston
- Centre for Healthy Ageing, Murdoch University, Perth, Australia
- Murdoch Applied Sports Science Laboratory, Discipline of Exercise Science, Murdoch University, Perth, Australia
| | | | - Nicholas Rolnick
- The Human Performance Mechanic, CUNY Lehman College, New York, NY; and
| | - Stephen D Patterson
- Faculty of Sport, Allied Health & Performance Sciences, St Mary's University, London, United Kingdom
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Huang J, Park HY. Effect of blood flow restriction with low-intensity resistance training in patients with osteoarthritis and rheumatoid arthritis: a systematic review and meta-analysis based on randomized controlled trials. Phys Act Nutr 2024; 28:7-19. [PMID: 38719461 PMCID: PMC11079382 DOI: 10.20463/pan.2024.0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 02/20/2024] [Accepted: 02/27/2024] [Indexed: 05/12/2024] Open
Abstract
PURPOSE This study evaluated the effects of blood flow restriction with low-intensity resistance training (BFR + LIRT) on pain, adverse events, muscle strength, and function in patients with osteoarthritis (OA) and rheumatoid arthritis (RA) through a systematic review and meta-analysis. METHODS This study adhered to the guidelines of the Preferred Reporting Items for Systematic Review and Meta-Analyses 2020 (PRISMA 2020) and applied the A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR2) standards to ensure the high quality of the systematic review. A comprehensive literature search was conducted until August 2023 using four selected keywords (osteoarthritis, rheumatoid arthritis, blood flow restriction training, and resistance training) across five search engines (PubMed, Embase, Web of Science, CENTRAL, and PEDro). RESULTS Ten studies were analyzed. The results showed that BFR + LIRT had similar effects on pain, risk of adverse events, muscle strength, self-reported function, and physical function compared with resistance training (RT). CONCLUSION This systematic review and meta-analysis further support the potential of BFR + LIRT in the disease management of patients with OA or RA. According to this analysis, BFR + LIRT had a lower risk of adverse events than high-intensity resistance training (HIRT) and may be a safer training modality. BFR + LIRT offers greater advantages in improving physical function than LIRT and was able to provide similar benefits to HIRT without increasing the training load. These findings suggest that BFR + LIRT is a safe and effective strategy for treating patients with OA or RA. However, owing to the limited number of studies covered in this analysis, additional higher-quality studies are needed to strengthen this conclusion.
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Affiliation(s)
- Junzhen Huang
- Department of Sports Medicine and Science, Graduate School, Konkuk University, Seoul, Republic of Korea
| | - Hun-Young Park
- Department of Sports Medicine and Science, Graduate School, Konkuk University, Seoul, Republic of Korea
- Physical Activity and Performance Institute (PAPI), Konkuk University, Seoul, Republic of Korea
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Brown AJ, Rachal Sant L. Blood flow restriction training for an individual with relapsing-remitting multiple sclerosis: a case report. Physiother Theory Pract 2024; 40:161-169. [PMID: 35854431 DOI: 10.1080/09593985.2022.2100848] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 07/05/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND AND PURPOSE Individuals with Multiple Sclerosis (MS) often present with weakness, poor balance, and increased fatigue that affects physical function. Blood flow restriction training (BFRt) is a popular treatment method to improve strength in orthopedic patients. However, research is limited on the use of BFRt for individuals with MS. This case report describes the effects of BFRt for an individual with relapsing-remitting MS (RRMS). CASE DESCRIPTION A 30-year-old female with RRMS presented to physical therapy (PT) with weakness and balance difficulty. Initial PT interventions were ineffective at improving balance and strength to achieve specific functional standing and balance goals. BFRt was introduced at reevaluation and performed 2×/week for 8 weeks. Activities-specific Balance Confidence Scale, Modified Fatigue Impact Scale, Berg Balance, strength, and 10-meter walk were assessed at 4 and 8 weeks. OUTCOMES Measures of strength and balance improved with the addition of BFRt and no adverse events occurred. The addition of BFRt resulted in a meaningful improvement in the individual's ability to achieve her standing and balance goals. DISCUSSION This case report describes the successful application of BFRt to improve function in an individual with RRMS. Further research is warranted for the use of BFRt for individuals with MS.
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Affiliation(s)
- April J Brown
- Physical Therapy, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Lauren Rachal Sant
- Physical Therapy, Louisiana State University Health Sciences Center, Shreveport, LA, USA
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Sørensen B, Aagaard P, Hjortshøj MH, Hansen SK, Suetta C, Couppé C, Magnusson SP, Johannsen FE. Physiological and clinical effects of low-intensity blood-flow restricted resistance exercise compared to standard rehabilitation in adults with knee osteoarthritis-Protocol for a randomized controlled trial. PLoS One 2023; 18:e0295666. [PMID: 38096198 PMCID: PMC10721028 DOI: 10.1371/journal.pone.0295666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 11/20/2023] [Indexed: 12/17/2023] Open
Abstract
INTRODUCTION Osteoarthritis (OA) is a common disease with high socioeconomical costs. In Denmark, standard rehabilitation (SR) consists of a combination of patient education and supervised physical exercise involving a standardized neuromuscular training program. As an evidence-based alternative, high-load (>70% 1RM) resistance training (HIRT) has shown positive rehabilitation effects in knee-OA but may not be tolerated in all patients (~25%) due to knee joint pain. However, low-load resistance training (20-40% 1RM) with concurrent partial blood-flow restriction (BFR) appears to produce effects similar to HIRT yet involving reduced joint pain during and after exercise. The aim is to examine the effect of low-load BFR training compared to SR on pain, thigh muscle mass and muscle function in adults with knee-OA. We hypothesize that 12 weeks of BFR will lead to superior improvements in pain, muscle mass and mechanical muscle function compared to SR. METHODS AND ANALYSIS 90 participants diagnosed with radiographic knee-OA will be randomized to either BFR or SR twice a week for 12 weeks. BFR will consist of two selected lower limb strength exercises performed with an inflated pneumatic occlusion cuff. Intervention procedures in SR consist of a full 8 weeks GLA:D course followed by 4 weeks of team group training. Primary outcome variable is the change in KOOS-Pain subscale from baseline to 12 weeks. Secondary outcome variables are changes in pain sensitivity, functional performance, muscle mass and mechanical muscle function. Intention-to-treat and per-protocol analyses will be conducted. One-way analysis of variance will be performed to evaluate between-group changes. Pre-to-post intervention comparisons will be analyzed using a mixed linear model. Regression analysis will be performed to evaluate potential associations between selected outcome variables.
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Affiliation(s)
- Brian Sørensen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark
- Institute of Sports Medicine Copenhagen (ISMC), Bispebjerg Hospital, Copenhagen NV, Denmark
- Department of Physical & Occupational Therapy, Bispebjerg Hospital, Copenhagen NV, Denmark
| | - Per Aagaard
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark
| | - Mikkel H. Hjortshøj
- Institute of Sports Medicine Copenhagen (ISMC), Bispebjerg Hospital, Copenhagen NV, Denmark
- Department of Physical & Occupational Therapy, Bispebjerg Hospital, Copenhagen NV, Denmark
- Centre for Health and Rehabilitation, University College Absalon, Slagelse, Denmark
| | - Sofie K. Hansen
- Department of Geriatric and Palliative Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen NV, Denmark
| | - Charlotte Suetta
- Department of Geriatric and Palliative Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen NV, Denmark
- Faculty of Health, Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Christian Couppé
- Institute of Sports Medicine Copenhagen (ISMC), Bispebjerg Hospital, Copenhagen NV, Denmark
- Department of Physical & Occupational Therapy, Bispebjerg Hospital, Copenhagen NV, Denmark
| | - S. Peter Magnusson
- Institute of Sports Medicine Copenhagen (ISMC), Bispebjerg Hospital, Copenhagen NV, Denmark
- Department of Physical & Occupational Therapy, Bispebjerg Hospital, Copenhagen NV, Denmark
| | - Finn E. Johannsen
- Institute of Sports Medicine Copenhagen (ISMC), Bispebjerg Hospital, Copenhagen NV, Denmark
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Ogrezeanu DC, López-Bueno L, Sanchís-Sánchez E, Suso-Martí L, López-Bueno R, Núñez-Cortés R, Cruz-Montecinos C, Pérez-Alenda S, Casaña J, Gargallo P, Calatayud J. Exercise-induced hypoalgesia with end-stage knee osteoarthritis during different blood flow restriction levels: Sham-controlled crossover study. PM R 2023; 15:1565-1573. [PMID: 37796567 DOI: 10.1002/pmrj.13076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 09/08/2023] [Accepted: 10/02/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND Blood flow restriction (BFR) training could be a valuable treatment to induce exercise-induced hypoalgesia (EIH) in patients with end-stage knee osteoarthritis. However, the use of BFR in these patients is poorly explored and there is no evidence about the training dosage needed. OBJECTIVE To evaluate the effect of resistance training protocols with different occlusion levels of blood flow restriction (BFR) on EIH in patients with end-stage knee osteoarthritis. DESIGN Crossover study. SETTING University physical exercise laboratory. PARTICIPANTS 26 adults with end-stage knee osteoarthritis. INTERVENTIONS Patients performed four sets (30, 15, 15, and 15 repetitions) separated by 1-minute rests of three protocols/sessions of low-load (30% one-repetition-maximum) seated knee extensions with elastic bands and BFR: placebo (sham BFR), BFR at 40% arterial occlusion pressure (AOP) and BFR at 80% AOP. MAIN OUTCOME MEASURES Pressure Pain Thresholds (PPT) and Visual Analog Scale (VAS) collected before, immediately after session, and after 10 minutes. RESULTS No differences in EIH were found between the different levels of BFR. However, 80% AOP protocol worsened VAS scores immediately (mean difference [MD]: -21.2 (95% confidence interval [CI] -33.9 to -8.5) while improving PPT immediately (MD affected limb: -.6 [95% CI -1.1 to -.2]); contralateral: -.6 (95% CI -1.0 to -.2]) and at 10 minutes (MD affected limb: -.6 [95% CI) -1.2 to -.1]; contralateral: -.7 [95% CI -1.1 to -.2]; and forearm: -.5 [95% CI -.9 to -.05]) post-exercise compared to baseline. CONCLUSIONS There is no EIH difference after using different occlusion levels. EIH is modulated by pain-related psychological constructs and self-perceived health status.
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Affiliation(s)
- Daniel C Ogrezeanu
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Laura López-Bueno
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Enrique Sanchís-Sánchez
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Luis Suso-Martí
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Rubén López-Bueno
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain
- National Research Centre for the Working Environment, Copenhagen, Denmark
- Department of Physical Medicine and Nursing, University of Zaragoza, Zaragoza, Spain
| | - Rodrigo Núñez-Cortés
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain
- Laboratory of Clinical Biomechanics, Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Carlos Cruz-Montecinos
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain
- Laboratory of Clinical Biomechanics, Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Sofía Pérez-Alenda
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - José Casaña
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Pedro Gargallo
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain
- Department of Physiotherapy, Faculty of Medicine and Health Science, Catholic University of Valencia, Valencia, Spain
| | - Joaquín Calatayud
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain
- National Research Centre for the Working Environment, Copenhagen, Denmark
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Kong J, Li Z, Zhu L, Li L, Chen S. Comparison of blood flow restriction training and conventional resistance training for the improvement of sarcopenia in the older adults: A systematic review and meta-analysis. SPORTS MEDICINE AND HEALTH SCIENCE 2023; 5:269-276. [PMID: 38314044 PMCID: PMC10831374 DOI: 10.1016/j.smhs.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 11/16/2022] [Accepted: 12/08/2022] [Indexed: 12/23/2022] Open
Abstract
Age-related sarcopenia places a tremendous burden on healthcare providers and patients' families. Blood flow restriction (BFR) training may be a promising treatment to bring sarcopenia down, and it offers numerous advantages over traditional resistance training. The purpose of this review was to compare the effects of BFR training and conventional resistance training on clinically delayed sarcopenia in the elderly. Databases such as PubMed, Web of Science, Embase, and Science Direct were searched to identify eligible studies; blinded data extraction was performed to assess study quality, and conflicts were submitted to third parties. Someone made the decision. One author used Review Manager (RevMan) 5.4 and compared it with data obtained by another author for this purpose. A total of 14 studies met the inclusion criteria for this review. The funnel plots of the studies did not show any substantial publication bias. Low-load blood flow restriction (LL-BFR) had no significant effect on muscle mass compared with high-load resistance training (HL-RT) (p = 0.74, SMD = 0.07, 95% CI: 0.33 to 0. 46) and LL-BFR had a significant effect on muscle strength compared with HL-RT (p = 0.03, Z = 2.16, SMD = -0.34, 95% CI: 0.65 to -0.03). LL-BFR showed a slight effect on mass compared to LL-RT (p = 0.26, SMD = 0.25, 95% CI: 0.19 to 0.69). Sensitivity analysis produced a nonsignificant change, suggesting that the results of this study are reasonable. In conclusion, the data suggest the possibility that BFR training improves age-related sarcopenia.
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Affiliation(s)
| | | | - Lei Zhu
- Qufu Normal University, China
| | - Lin Li
- Qufu Normal University, China
| | - Si Chen
- Qufu Normal University, China
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10
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Parkington T, Broom D, Maden-Wilkinson T, Nawaz S, Klonizakis M. Low-intensity resistance exercise with blood flow restriction for patients with claudication: A randomized controlled feasibility trial. Vasc Med 2023; 28:554-563. [PMID: 37819259 PMCID: PMC10693738 DOI: 10.1177/1358863x231200250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
BACKGROUND Claudication is a common and debilitating symptom of peripheral artery disease, resulting in poor exercise performance and quality of life (QoL). Supervised exercise programs are an effective rehabilitation for patients with claudication, but they are poorly adhered to, in part due to the high pain and effort associated with walking, aerobic, and resistance exercise. Low-intensity resistance exercise with blood flow restriction (BFR) represents an alternative exercise method for individuals who are intolerant to high-intensity protocols. The aim of this study was to evaluate the feasibility of a supervised BFR program in patients with claudication. METHODS Thirty patients with stable claudication completed an 8-week supervised exercise program and were randomized to either BFR (n = 15) or a control of matched exercise without BFR (control; n = 15). Feasibility, safety, and efficacy were assessed. RESULTS All success criteria of the feasibility trial were met. Exercise adherence was high (BFR = 78.3%, control = 83.8%), loss to follow up was 10%, and there were no adverse events. Clinical improvement in walking was achieved in 86% of patients in the BFR group but in only 46% of patients in the control group. Time to claudication pain during walking increased by 35% for BFR but was unchanged for the control. QoL for the BFR group showed improved mobility, ability to do usual activities, pain, depression, and overall health at follow up. CONCLUSION A supervised blood flow restriction program is feasible in patients with claudication and has the potential to increase exercise performance, reduce pain, and improve QoL. (Clinicaltrials.gov Identifier: NCT04890275).
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Affiliation(s)
- Thomas Parkington
- Department of Nursing and Midwifery, Lifestyle, Exercise and Nutrition Improvement Research Group, Sheffield Hallam University, Sheffield, UK
- Department of Sport and Physical Activity, Physical Activity, Wellness and Public Health Research Group, Sheffield Hallam University, Sheffield, UK
| | - David Broom
- Centre for Sport, Exercise and Life Sciences, Coventry University, Coventry, UK
| | - Thomas Maden-Wilkinson
- Department of Sport and Physical Activity, Physical Activity, Wellness and Public Health Research Group, Sheffield Hallam University, Sheffield, UK
| | - Shah Nawaz
- Sheffield Vascular Institute, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Markos Klonizakis
- Department of Nursing and Midwifery, Lifestyle, Exercise and Nutrition Improvement Research Group, Sheffield Hallam University, Sheffield, UK
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Bilski J, Schramm-Luc A, Szczepanik M, Mazur-Biały AI, Bonior J, Luc K, Zawojska K, Szklarczyk J. Adipokines in Rheumatoid Arthritis: Emerging Biomarkers and Therapeutic Targets. Biomedicines 2023; 11:2998. [PMID: 38001998 PMCID: PMC10669400 DOI: 10.3390/biomedicines11112998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 11/05/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023] Open
Abstract
Rheumatoid arthritis (RA) is a chronic inflammatory disease manifested by joint involvement, extra-articular manifestations, and general symptoms. Adipose tissue, previously perceived as an inert energy storage organ, has been recognised as a significant contributor to RA pathophysiology. Adipokines modulate immune responses, inflammation, and metabolic pathways in RA. Although most adipokines have a pro-inflammatory and aggravating effect on RA, some could counteract this pathological process. The coexistence of RA and sarcopenic obesity (SO) has gained attention due to its impact on disease severity and outcomes. Sarcopenic obesity further contributes to the inflammatory milieu and metabolic disturbances. Recent research has highlighted the intricate crosstalk between adipose tissue and skeletal muscle, suggesting potential interactions between these tissues in RA. This review summarizes the roles of adipokines in RA, particularly in inflammation, immune modulation, and joint destruction. In addition, it explores the emerging role of adipomyokines, specifically irisin and myostatin, in the pathogenesis of RA and their potential as therapeutic targets. We discuss the therapeutic implications of targeting adipokines and adipomyokines in RA management and highlight the challenges and future directions for research in this field.
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Affiliation(s)
- Jan Bilski
- Department of Biomechanics and Kinesiology, Chair of Biomedical Sciences, Institute of Physiotherapy, Faculty of Health Sciences, Jagiellonian University Medical College, 31-008 Krakow, Poland; (A.I.M.-B.); (K.Z.)
| | - Agata Schramm-Luc
- Department of Internal and Agricultural Medicine, Faculty of Medicine, Jagiellonian University Medical College, 31-121 Krakow, Poland; (A.S.-L.); (K.L.)
| | - Marian Szczepanik
- Chair of Biomedical Sciences, Institute of Physiotherapy, Faculty of Health Sciences, Jagiellonian University Medical College, 31-034 Krakow, Poland;
| | - Agnieszka Irena Mazur-Biały
- Department of Biomechanics and Kinesiology, Chair of Biomedical Sciences, Institute of Physiotherapy, Faculty of Health Sciences, Jagiellonian University Medical College, 31-008 Krakow, Poland; (A.I.M.-B.); (K.Z.)
| | - Joanna Bonior
- Department of Medical Physiology, Chair of Biomedical Sciences, Institute of Physiotherapy, Faculty of Health Sciences, Jagiellonian University Medical College, 31-126 Krakow, Poland; (J.B.); (J.S.)
| | - Kevin Luc
- Department of Internal and Agricultural Medicine, Faculty of Medicine, Jagiellonian University Medical College, 31-121 Krakow, Poland; (A.S.-L.); (K.L.)
| | - Klaudia Zawojska
- Department of Biomechanics and Kinesiology, Chair of Biomedical Sciences, Institute of Physiotherapy, Faculty of Health Sciences, Jagiellonian University Medical College, 31-008 Krakow, Poland; (A.I.M.-B.); (K.Z.)
| | - Joanna Szklarczyk
- Department of Medical Physiology, Chair of Biomedical Sciences, Institute of Physiotherapy, Faculty of Health Sciences, Jagiellonian University Medical College, 31-126 Krakow, Poland; (J.B.); (J.S.)
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Jørgensen SL, Kierkegaard-Brøchner S, Bohn MB, Høgsholt M, Aagaard P, Mechlenburg I. Effects of blood-flow restricted exercise versus conventional resistance training in musculoskeletal disorders-a systematic review and meta-analysis. BMC Sports Sci Med Rehabil 2023; 15:141. [PMID: 37880727 PMCID: PMC10601135 DOI: 10.1186/s13102-023-00750-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 10/11/2023] [Indexed: 10/27/2023]
Abstract
OBJECTIVE To compare the effect of low-load blood flow restricted resistance training (BFR-RT) versus high-load resistance training (HL-RT) on muscle strength, muscle mass, physical function, patient-reported outcomes, and adherence to training in clinical musculoskeletal populations. DATA SOURCES Web of Science, Cochrane Central, Medline, Embase, SportDiscus was searched on the 30th May 2022. REVIEW METHODS This study was conducted as a systematic review and meta-analysis. Randomized Controlled Trials (RCTs) were included if they (i) included patients, (ii) comprised of a BFR-RT intervention protocol and a group who performed HL-RT (≥ 70%1RM) for at least eight exercise sessions, and (iii) involved at least 1 exercise that targeted the lower limbs. The Cochrane Risk of Bias tool was used to evaluate the risk of bias. The meta-analyses were performed using a random effects model with an adjustment to the confidence interval. RESULTS Seven RCTs comprising 303 participants (BFR-RT: n = 151; HL-RT: n = 152) were identified. HL-RT and BFR-RT showed similar gains in dynamic (1-10RM) knee extensor strength and leg press strength, quadriceps cross sectional area, sit-to-stand performance, and patient reported pain and function. There was a moderate effect favoring BFR-RT for increasing maximal isometric knee extensor strength. The grading of certainty in evidence was low-to-very low for all outcome variables. CONCLUSION This systematic review and meta-analysis extends our current knowledge about BFR-RT and HL-RT as equally effective exercise methods for inducing gains in maximal muscle strength in healthy populations, by now also comprising patients suffering from various clinical musculoskeletal conditions. The certainty in the estimates was low-to-very low, prompting the inclusion of future higher-quality trials. TRIAL REGISTRATION PROSPERO ID (CRD42022337173). Registered June 18th 2022.
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Affiliation(s)
- Stian Langgård Jørgensen
- Department of Occupational and Physical Therapy, Horsens Regional Hospital, Horsens, Denmark.
- H-HIP, Department of Occupational and Physical Therapy and Department of Orthopedic Surgery, Horsens Regional Hospital, Horsens, Denmark.
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Signe Kierkegaard-Brøchner
- H-HIP, Department of Occupational and Physical Therapy and Department of Orthopedic Surgery, Horsens Regional Hospital, Horsens, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Marie Bagger Bohn
- H-HIP, Department of Occupational and Physical Therapy and Department of Orthopedic Surgery, Horsens Regional Hospital, Horsens, Denmark
| | - Mathias Høgsholt
- Department of Occupational and Physical Therapy, Horsens Regional Hospital, Horsens, Denmark
- H-HIP, Department of Occupational and Physical Therapy and Department of Orthopedic Surgery, Horsens Regional Hospital, Horsens, Denmark
| | - Per Aagaard
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Inger Mechlenburg
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
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Verdini E, Maestroni L, Clark M, Turner A, Huber J. Do people with musculoskeletal pain differ from healthy cohorts in terms of global measures of strength? A systematic review and meta-analysis. Clin Rehabil 2023; 37:244-260. [PMID: 36154313 PMCID: PMC9772898 DOI: 10.1177/02692155221128724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 09/02/2022] [Indexed: 12/25/2022]
Abstract
OBJECTIVE It is currently unknown if people with musculoskeletal pain display different multi-joint strength capacities than healthy cohorts. The aim was to investigate whether people with musculoskeletal pain show differences in global measures of strength in comparison to healthy cohorts. DATA SOURCES A systematic review was conducted using three databases (Medline, CINAHL and SPORTDiscus) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. REVIEW METHODS Studies involving participants with painful musculoskeletal conditions and multi-joint strength assessment measured at baseline were included. A meta-analysis was also performed to compute standardized mean differences (± 95% confidence intervals), using Hedge's g, and examined the differences in multi-joint strength at baseline between participants with painful musculoskeletal conditions and healthy participants. RESULTS In total, 5043 articles were identified, of which 20 articles met the inclusion criteria and were included in the qualitative analysis. The available evidence revealed that multi-joint strength values were limited to knee osteoarthritis, fibromyalgia, chronic low back pain, and rheumatoid arthritis. Only four studies were included in the quantitative synthesis and revealed that only small differences in both chest press (g = -0.34, 95% CI [-0.64, -0.03]) and leg press (g = -0.25, 95% CI [-0.49, -0.02]) existed between adult women with fibromyalgia and active community women. CONCLUSION There is a paucity of multi-joint strength values in participants with musculoskeletal pain. Quantitative comparison with healthy cohorts was limited, except for those with fibromyalgia. Adult women with fibromyalgia displayed reduced multi-joint strength values in comparison to active community women.
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Affiliation(s)
- Enrico Verdini
- School of Health Sciences, University of Brighton, Brighton, UK
- Studio Medico Jacini, Rome, Italy
| | - Luca Maestroni
- London Sport Institute, School of Science and Technology, Middlesex University, London, UK
| | | | - Anthony Turner
- London Sport Institute, School of Science and Technology, Middlesex University, London, UK
| | - Jörg Huber
- School of Health Sciences, University of Brighton, Brighton, UK
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Jenkins N, Jhundoo N, Rainbow P, Sheehan KJ, Bearne LM. Inequity in exercise-based interventions for adults with rheumatoid arthritis: a systematic review. Rheumatol Adv Pract 2023; 7:rkac095. [PMID: 36726732 PMCID: PMC9880983 DOI: 10.1093/rap/rkac095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 04/20/2022] [Indexed: 01/25/2023] Open
Abstract
Objectives This systematic review describes the extent to which PROGRESS-Plus equity factors were considered in the eligibility criteria of trials of exercise interventions for adults with RA. Methods Electronic databases were searched for published (Cinahl, Embase, Medline, Physiotherapy Evidence Database), unpublished (Opengrey) and registered ongoing (International Standard Randomized Controlled Trial Number registry) randomized controlled trials (RCTs) of exercise interventions for adults with RA. Two authors independently performed study selection and quality assessment (Cochrane risk of bias tool). Results A total of 9696 records were identified. After screening, 50 trials were included. All trials had either some concerns or high risk of bias and reported at least one PROGRESS-Plus equity factor within the eligibility criteria; this included place of residence, personal characteristics (age and disability), language, sex, social capital, time-dependent factors or features of relationship factors. Where reported, this equated to exclusion of 457 of 1337 potential participants (34%) based on equity factors. Conclusion This review identified the exclusion of potential participants within exercise-based interventions for people with RA based on equity factors that might affect health-care opportunities and outcomes. This limits the generalizability of results, and yet this evidence is used to inform management and service design. Trials need to optimize participation, particularly for people with cardiovascular conditions, older adults and those with cognitive impairments. Reasons for exclusions need to be justified. Further research needs to address health inequalities to improve treatment accessibility and the generalizability of research findings. PROSPERO registration CRD42021260941.
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Affiliation(s)
- Natalie Jenkins
- Department of Population Health, Environmental and Life Course Sciences,
King’s College London, London, UK
| | - Nishita Jhundoo
- Department of Population Health, Environmental and Life Course Sciences,
King’s College London, London, UK
| | - Philippa Rainbow
- Department of Population Health, Environmental and Life Course Sciences,
King’s College London, London, UK
| | - Katie Jane Sheehan
- Department of Population Health, Environmental and Life Course Sciences,
King’s College London, London, UK
| | - Lindsay Mary Bearne
- Correspondence to: Lindsay Mary Bearne, Population Health
Research Institute, St George's, University of London, 1st Floor, Jenner Wing, Cranmer
Terrace, London SW17 0RE, UK. E-mail:
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15
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Reina-Ruiz ÁJ, Martínez-Cal J, Molina-Torres G, Romero-Galisteo RP, Galán-Mercant A, Carrasco-Vega E, González-Sánchez M. Effectiveness of Blood Flow Restriction on Functionality, Quality of Life and Pain in Patients with Neuromusculoskeletal Pathologies: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1401. [PMID: 36674158 PMCID: PMC9858892 DOI: 10.3390/ijerph20021401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/09/2023] [Accepted: 01/09/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Blood flow restriction is characterized as a method used during exercise at low loads of around 20-40% of a repetition maximum, or at a low-moderate intensity of aerobic exercise, in which cuffs that occlude the proximal part of the extremities can partially reduce arterial flow and fully restrict the venous flow of the musculature in order to achieve the same benefits as high-load exercise. OBJECTIVE The main objective of this systematic literature review was to analyze the effects of BFR intervention on pain, functionality, and quality of life in subjects with neuromusculoskeletal pathologies. METHODS The search to carry out was performed in PubMed, Cochrane, EMBASE, PEDro, CINHAL, SPORTDiscus, Trip Medical Database, and Scopus: "kaatsu" OR "ischemic training" OR "blood flow restriction" OR "occlusion resistance training" OR "vascular occlusion" OR "vascular restriction". RESULTS After identifying 486 papers and eliminating 175 of them due to duplication and 261 after reading the title and abstract, 50 papers were selected. Of all the selected articles, 28 were excluded for not presenting a score equal to or higher than 6 points on the PEDro scale and 8 for not analyzing the target outcome variables. Finally, 14 papers were selected for this systematic review. CONCLUSIONS The data collected indicate that the blood flow restriction tool is a therapeutic alternative due to its effectiveness under different exercise modalities. The benefits found include decreases in pain thresholds and improvement in the functionality and quality of life of the neuro-musculoskeletal patient during the first six weeks. However, the results provided by this tool are still not clear for medium- and long-term interventions.
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Affiliation(s)
- Álvaro Jesús Reina-Ruiz
- Department of Physiotherapy, Faculty of Health Sciences, University of Málaga, 29071 Málaga, Spain
| | - Jesús Martínez-Cal
- Department of Nursing, Physiotherapy and Medicine, Faculty of Health Sciences, University of Almería, 04120 Almería, Spain
| | - Guadalupe Molina-Torres
- Department of Nursing, Physiotherapy and Medicine, Faculty of Health Sciences, University of Almería, 04120 Almería, Spain
| | - Rita-Pilar Romero-Galisteo
- Department of Physiotherapy, Faculty of Health Sciences, University of Málaga, 29071 Málaga, Spain
- Institute of Biomedicine of Málaga (IBIMA), 29010 Málaga, Spain
| | - Alejandro Galán-Mercant
- Institute of Biomedicine of Cádiz (INIBICA), 11009 Cádiz, Spain
- MOVE-IT Research Group, Department of Nursing and Physiotherapy, Faculty of Health Sciences, University of Cádiz, 11009 Cádiz, Spain
| | - Elio Carrasco-Vega
- Department of Physiotherapy, Faculty of Health Sciences, University of Málaga, 29071 Málaga, Spain
- Institute of Biomedicine of Málaga (IBIMA), 29010 Málaga, Spain
| | - Manuel González-Sánchez
- Department of Physiotherapy, Faculty of Health Sciences, University of Málaga, 29071 Málaga, Spain
- Institute of Biomedicine of Málaga (IBIMA), 29010 Málaga, Spain
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Lippi L, Turco A, Folli A, Vicelli F, Curci C, Ammendolia A, de Sire A, Invernizzi M. Effects of blood flow restriction on spine postural control using a robotic platform: A pilot randomized cross-over study. J Back Musculoskelet Rehabil 2023; 36:1447-1459. [PMID: 37694351 DOI: 10.3233/bmr-230063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
BACKGROUND Blood flow restriction (BFR) training improves muscle strength and functional outcomes, but the proprioceptive implications of this technique in the rehabilitation field are still unknown. OBJECTIVE The present study aimed at assessing the effects of BFR in terms of stabilometric and balance performance. METHODS In this pilot randomized cross-over study, healthy young adults were included and randomly assigned to Groups A and B. Both groups underwent a postural assessment with and without wearing a BFR device. Study participants of Group A underwent postural baseline assessment wearing BFR and then removed BFR for further evaluations, whereas subjects in Group B performed the baseline assessment without BFR and then with BFR. Stabilometric and balance performance were assessed by the robotic platform Hunova, the Balance Error Scoring System (BESS), the self-reported perceived balance (7-point Likert scale), and discomfort self-rated assessment. Moreover, the safety profile was recorded. RESULTS Fourteen subjects were included and randomly assigned to Group A (n: 7) and Group B (n: 7). Significant differences were shown in balance tests in static conditions performed on the Hunova robot platform in terms of average distance RMS (root-mean-square) with open eyes (OE), anteroposterior (AP) trunk oscillation range with OE, mediolateral (ML) average speed of oscillation with OE, and total excursion AP range with closed eyes (CE) (BFR: 3.44 ± 1.06; without BFR: 2.75 ± 0.72; p= 0.041). Moreover, elastic balance test showed differences in Romberg index (BFR: 0.16 ±0.16; without BFR: 0.09 ± 0.07; p= 0.047). No adverse events were reported. CONCLUSION Taken together, our data showed that BFR affects balance performance of healthy subjects. Further studies are needed to better characterize the possible role of BFR treatment in the context of a specific rehabilitation protocol.
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Affiliation(s)
- Lorenzo Lippi
- Department of Health Sciences, University of Eastern Piedmont "A. Avogadro", Novara, Italy
- Translational Medicine, Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Alessio Turco
- Department of Health Sciences, University of Eastern Piedmont "A. Avogadro", Novara, Italy
| | - Arianna Folli
- Department of Health Sciences, University of Eastern Piedmont "A. Avogadro", Novara, Italy
| | - Federico Vicelli
- Department of Health Sciences, University of Eastern Piedmont "A. Avogadro", Novara, Italy
| | - Claudio Curci
- Physical Medicine and Rehabilitation Unit, Department of Neurosciences, ASST Carlo Poma, Mantova, Italy
| | - Antonio Ammendolia
- Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Alessandro de Sire
- Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Marco Invernizzi
- Department of Health Sciences, University of Eastern Piedmont "A. Avogadro", Novara, Italy
- Translational Medicine, Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
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Fan Y, Bai D, Cheng C, Tian G. The effectiveness and safety of blood flow restriction training for the post-operation treatment of distal radius fracture. Ann Med 2023; 55:2240329. [PMID: 37505919 PMCID: PMC10392265 DOI: 10.1080/07853890.2023.2240329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 07/10/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
INTRODUCTION Distal radius fracture (DRF) is a common injury in the upper extremities. Blood flow restriction (BFR) has been proven to be effective in improving function in low-load training, which is suitable for post-op rehabilitation. We explored the effectiveness and safety of BFR therapy in DRF patients who underwent surgery. MATERIALS AND METHODS Thirty-five patients were randomly assigned to either the BFR or the regular training (RT; no BFR therapy) groups. All patients completed the same 4-week postoperative rehabilitation program, including anti-inflammatory treatments, strengthening and range of motion (ROM) training. In the BFR group, the pressure was 120 mmHg in strengthening training course. Pain, circumferences of wrists and forearms, ROM, muscle strength, and D-dimer levels were evaluated at weeks 0, 2, and 4. Radius union scoring system (RUSS) was measured at weeks 4 and 12. Finally, wrist functionality (Cooney modification) was evaluated at week 12. RESULTS The BFR group had significantly decreased pain levels compared with the RT group (p < 0.01, effect size= 2.33, -2.44 at weeks 2 and 4). Swelling was effectively relieved in both groups. The wrist swelling was less in the BFR group (p < 0.01, effect size = -2.17 at week 4). The isometric strength of wrist extension (p < 0.01, effect size = 1.5, 3.02 at weeks 2 and 4), flexion (p < 0.01, effect size = 1.33, 2.53 at weeks 2 and 4), and functionality significantly increased in the BFR group (p < 0.01, effect size = 2.80 at week 12). No risk of VT in the BFR group was found. BFR did not threaten bone healing. CONCLUSIONS In patients with DRF who underwent corrective surgery, BFR therapy effectively relieved pain and swelling, increased muscle strength and wrist function, and had no additional risks for bone healing and VT.
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Affiliation(s)
- Yi Fan
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Dingqun Bai
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Chongyuan Cheng
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Guihua Tian
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Yuan J, Wu L, Xue Z, Xu G, Wu Y. Application and progress of blood flow restriction training in improving muscle mass and strength in the elderly. Front Physiol 2023; 14:1155314. [PMID: 37035674 PMCID: PMC10079911 DOI: 10.3389/fphys.2023.1155314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 03/17/2023] [Indexed: 04/11/2023] Open
Abstract
As an emerging training method, blood flow restriction training has been proved to promote the growth of muscle mass and strength. In recent years, it has been gradually applied in different populations. However, there are few studies on how blood flow restriction training affects muscle mass and strength in the elderly. The relevant literature is compiled and summarized in this study. Through the comparison of blood flow restriction training with traditional training methods and its application in the elderly, it shows that blood flow restriction training can effectively increase muscle mass and strength, prevent muscle atrophy, improve cardiopulmonary function, facilitate injury and postoperative rehabilitation, and intervene in related degenerative diseases as a training method suitable for the elderly,. The main mechanism of blood flow restriction training promoting muscle mass and strength growth is metabolic stress response, including muscle fiber recruitment, protein synthesis signal pathway activation, hormone secretion, etc., and is also related to cell swelling caused by pressure. At present, although the application of blood flow restriction training in the elderly population is increasing, there is a lack of personalized programs. In the future, more research on the dose effect and safety of blood flow restriction training is needed to develop more accurate personalized training programs.
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Affiliation(s)
| | | | | | - Guodong Xu
- *Correspondence: Guodong Xu, ; Yuxiang Wu,
| | - Yuxiang Wu
- *Correspondence: Guodong Xu, ; Yuxiang Wu,
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19
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Parkington T, Maden-Wilkinson T, Klonizakis M, Broom D. Comparative Perceptual, Affective, and Cardiovascular Responses between Resistance Exercise with and without Blood Flow Restriction in Older Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16000. [PMID: 36498075 PMCID: PMC9737453 DOI: 10.3390/ijerph192316000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/20/2022] [Accepted: 11/27/2022] [Indexed: 06/17/2023]
Abstract
Older adults and patients with chronic disease presenting with muscle weakness or musculoskeletal disorders may benefit from low-load resistance exercise (LLRE) with blood flow restriction (BFR). LLRE-BFR has been shown to increase muscle size, strength, and endurance comparable to traditional resistance exercise but without the use of heavy loads. However, potential negative effects from LLRE-BFR present as a barrier to participation and limit its wider use. This study examined the perceptual, affective, and cardiovascular responses to a bout of LLRE-BFR and compared the responses to LLRE and moderate-load resistance exercise (MLRE). Twenty older adults (64.3 ± 4.2 years) performed LLRE-BFR, LLRE and MLRE consisting of 4 sets of leg press and knee extension, in a randomised crossover design. LLRE-BFR was more demanding than LLRE and MLRE through increased pain (p ≤ 0.024, d = 0.8-1.4) and reduced affect (p ≤ 0.048, d = -0.5--0.9). Despite this, LLRE-BFR was enjoyed and promoted a positive affective response (p ≤ 0.035, d = 0.5-0.9) following exercise comparable to MLRE. This study supports the use of LLRE-BFR for older adults and encourages future research to examine the safety, acceptability, and efficacy of LLRE-BFR in patients with chronic disease.
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Affiliation(s)
- Thomas Parkington
- Physical Activity, Wellness and Public Health Research Group, Department of Sport and Physical Activity, Sheffield Hallam University, Sheffield S1 1WB, UK
- Lifestyle, Exercise and Nutrition Improvement Research Group, Department of Nursing and Midwifery, Sheffield Hallam University, Sheffield S1 1WB, UK
| | - Thomas Maden-Wilkinson
- Physical Activity, Wellness and Public Health Research Group, Department of Sport and Physical Activity, Sheffield Hallam University, Sheffield S1 1WB, UK
| | - Markos Klonizakis
- Lifestyle, Exercise and Nutrition Improvement Research Group, Department of Nursing and Midwifery, Sheffield Hallam University, Sheffield S1 1WB, UK
| | - David Broom
- Centre for Sport, Exercise and Life Sciences, Coventry University, Coventry CV1 5FB, UK
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Gagliardi A, Iaquinta FS, Grembiale RD, De Sarro C, Fabiano A, Fraija D, Palleria C, Romeo R, De Francesco AE, Naturale MD, Citraro R, Gallelli L, Leo A, De Sarro G. Real-World Safety Profile of Biologics Used in Rheumatology: A Six-Year Observational Pharmacovigilance Study in the Calabria Region. Pharmaceutics 2022; 14:2328. [PMID: 36365146 PMCID: PMC9697719 DOI: 10.3390/pharmaceutics14112328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/19/2022] [Accepted: 10/26/2022] [Indexed: 08/10/2023] Open
Abstract
Background: The introduction of biological agents into the clinical armamentarium has modified the management of moderate-severe inflammatory arthritis (IA). However, these drugs can lead to serious adverse events (SAEs) and unpredictable adverse events (AEs) that are difficult to detect in pre-marketing clinical trials. This pharmacovigilance project aimed to study the AEs associated with biologics use in rheumatology. Methods: The current investigation is a multicenter, prospective, observational cohort study based on the Calabria Biologics Pharmacovigilance Program. Patients treated with one biologic agent from January 2016 to January 2022 were enrolled. Results: Overall, 729 (86.3%) of a total of 872 patients did not develop AEs or SAEs, whereas 143 (16.4%) patients experienced at least one AE, of which 16 (1.8%) had at least one SAE. The most common AEs were administration site conditions followed by gastrointestinal, nervous system and skin disorders. We reported a total of 173 switches and 156 swaps. Switches mainly occurred for inefficacy (136; 77.7%), whereas only 39 (22.3%) were due to the onset of an AE. Primary/secondary failure was the most frequent reason for swaps (124, 79%), while AEs onset led to 33 (21%) swaps. Conclusions: This study supports the validity of our program in monitoring and detecting AEs in the rheumatological area, confirming the positive beneficial/risk ratio of biologics.
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Affiliation(s)
- Agnese Gagliardi
- Department of Health Sciences, School of Medicine and Surgery, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
| | - Francesco Salvatore Iaquinta
- Department of Health Sciences, School of Medicine and Surgery, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
| | - Rosa Daniela Grembiale
- Department of Health Sciences, School of Medicine and Surgery, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
| | - Caterina De Sarro
- Department of Health Sciences, School of Medicine and Surgery, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
| | - Antonio Fabiano
- Department of Health Sciences, School of Medicine and Surgery, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
| | - Domenico Fraija
- Department of Health Sciences, School of Medicine and Surgery, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
| | - Caterina Palleria
- Department of Health Sciences, School of Medicine and Surgery, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
| | - Rossella Romeo
- Department of Health Sciences, School of Medicine and Surgery, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
| | | | | | - Rita Citraro
- Department of Health Sciences, School of Medicine and Surgery, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
- System and Applied Pharmacology@University Magna Grecia (FAS@UMG) Research Center, Science of Health Department, School of Medicine, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
| | - Luca Gallelli
- Department of Health Sciences, School of Medicine and Surgery, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
- System and Applied Pharmacology@University Magna Grecia (FAS@UMG) Research Center, Science of Health Department, School of Medicine, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
| | - Antonio Leo
- Department of Health Sciences, School of Medicine and Surgery, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
- System and Applied Pharmacology@University Magna Grecia (FAS@UMG) Research Center, Science of Health Department, School of Medicine, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
| | - Giovambattista De Sarro
- Department of Health Sciences, School of Medicine and Surgery, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
- System and Applied Pharmacology@University Magna Grecia (FAS@UMG) Research Center, Science of Health Department, School of Medicine, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
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21
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Chen Y, Wang J, Li S, Li Y. Acute effects of low load resistance training with blood flow restriction on serum growth hormone, insulin-like growth factor-1, and testosterone in patients with mild to moderate unilateral knee osteoarthritis. Heliyon 2022; 8:e11051. [PMID: 36281415 PMCID: PMC9586906 DOI: 10.1016/j.heliyon.2022.e11051] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 09/05/2022] [Accepted: 10/07/2022] [Indexed: 11/06/2022] Open
Abstract
Objective To investigate the acute effects of blood flow restriction (BFR) with single-leg low load resistance exercise and high load resistance exercise on serum insulin-like growth factor-1 (IGF-1), growth hormone (GH), and testosterone in patients with unilateral knee osteoarthritis (OA). Methods This study recruited 18 postmenopausal female patients with mild to moderate unilateral knee OA, which was then followed by randomly conducting three resistance exercise protocols by drawing lots: 1. A 30% 1-repetition maximum (1-RM) resistance exercise with BFR of 70% arterial occlusive pressure (AOP) (BFR group); 2. A 70% 1-RM resistance exercise without BFR (RES group); 3. A 30% 1-RM resistance exercise without BFR (CON group). Blood lactate (BLA) and muscle growth related hormone levels were tested at 4-time points: before exercise, immediately after exercise, 15 min after exercise, and 30 min after exercise. Results There was no statistical difference between the indexes in each group before exercise, but the different exercise had different effects on each index and also an interactive effect (P < 0.05). The increase of rating of perceived exertion in the BFR and RES groups, which were of similar magnitude, was greater compared to the levels in the CON group (P < 0.05). Post-exercise BLA levels were lower in the CON group in comparison to the BFR and RES groups (P < 0.05). Rather than the RES group, GH levels of the BFR group were also significantly higher than the CON group (P < 0.05) at 15 min post-exercise. At post- and 15 min after exercise, the CON group recorded significantly lower IGF-1 levels compared to the BFR and RES groups (P < 0.05). At post- and 15 min after exercise, the CON group (P < 0.05) reflected the lowest testosterone levels, followed by the RES group (P < 0.05), and the highest in the BFR group (P < 0.05). Conclusions Myogenesis-related hormones in women with unilateral knee OA could be increased by high load resistance exercise and low load resistance exercise with BFR on unaffected limb.
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Affiliation(s)
- Yangguang Chen
- College of Physical Education, Zhengzhou Shengda University, Zhengzhou, Henan, China
| | - Junguo Wang
- Center for Osteoarticular and Trauma Surgery, Qingdao Hospital of Traditional Chinese Medicine (Qingdao Hiser Hospital), Qingdao, Shandong, China
| | - Shuoqi Li
- College of Physical Education, Yangzhou University, Yangzhou, Zhejiang, China
| | - Yinghao Li
- College of Physical Education, Zhengzhou Shengda University, Zhengzhou, Henan, China
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22
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Saraf A, Goyal M, Goyal K. Blood Flow Restriction Training-An Overview and Implication in New Generation Physical Therapy: A Narrative Review. J Lifestyle Med 2022; 12:63-68. [PMID: 36157885 PMCID: PMC9490016 DOI: 10.15280/jlm.2022.12.2.63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 05/06/2022] [Indexed: 11/22/2022] Open
Abstract
Blood Flow Restriction Training (BFRT) is a novel strengthening technique utilitarian in many conditions. But there is lack of exploration on this clinical intervention. The training can prove to be a boon in many conditions such as muscle weakness, degenerative among others. It can serve to be an essential treatment in prevention of disuse atrophy occurring on the initial days of bed-rest on post surgical patients and improve circulation. BFRT with aerobic activities can improve cardiovascular fitness and holistically help in rehabilitation. The electronic databases such as PubMed, ScienceDirect, Scopus and Google Scholars were reviewed including the reference lists to retrieve relevant information regarding the topic. The result of the review states that BFRT is a novel strength training program that has not been explored in India but is very effective, less expensive and innovative way of rehabilitation. The utility of BFRT is evident in post-operative disuse atrophy in the initial days of bed-rest. The evidence depict that BFRT is a very effective training modality that can efficiently improve the muscle function, strength and mass.
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Affiliation(s)
- Aakansha Saraf
- Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar (Deemed to be University), Mullana, Haryana, India
| | - Manu Goyal
- Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar (Deemed to be University), Mullana, Haryana, India
| | - Kanu Goyal
- Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar (Deemed to be University), Mullana, Haryana, India
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23
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Burton I, McCormack A. Blood Flow Restriction Resistance Training in Tendon Rehabilitation: A Scoping Review on Intervention Parameters, Physiological Effects, and Outcomes. Front Sports Act Living 2022; 4:879860. [PMID: 35548459 PMCID: PMC9083008 DOI: 10.3389/fspor.2022.879860] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 03/31/2022] [Indexed: 11/13/2022] Open
Abstract
Objective To identify current evidence on blood flow restriction training (BFRT) in tendon injuries and healthy tendons, evaluating physiological tendon effects, intervention parameters, and outcomes. Methods This scoping review was reported in accordance with the PRISMA Extension for Scoping Reviews (PRISMA-ScR). Databases searched included MEDLINE, CINAHL, AMED, EMBase, SPORTDiscus, Cochrane library (Controlled trials, Systematic reviews), and five trial registries. Two independent reviewers screened studies at title/abstract and full text. Following screening, data was extracted and charted, and presented as figures and tables alongside a narrative synthesis. Any study design conducted on adults, investigating the effects of BFRT on healthy tendons or tendon pathology were included. Data were extracted on physiological tendon effects, intervention parameters and outcomes with BFRT. Results Thirteen studies were included, three on tendinopathy, two on tendon ruptures, and eight on healthy Achilles, patellar, and supraspinatus tendons. A variety of outcomes were assessed, including pain, function, strength, and tendon morphological and mechanical properties, particularly changes in tendon thickness. BFRT intervention parameters were heterogeneously prescribed. Conclusion Despite a dearth of studies to date on the effects of BFRT on healthy tendons and in tendon pathologies, preliminary evidence for beneficial effects of BFRT on tendons and clinical outcomes is encouraging. As BFRT is a relatively novel method, definitive conclusions, and recommendations on BFRT in tendon rehabilitation cannot be made at present, which should be addressed in future research, due to the potential therapeutic benefits highlighted in this review.
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Affiliation(s)
- Ian Burton
- Musculoskeletal (MSK) Service, Fraserburgh Physiotherapy Department, Fraserburgh Hospital, National Health Service (NHS) Grampian, Aberdeen, United Kingdom
- *Correspondence: Ian Burton
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24
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Assis ACB, Lopes AJ. Functional exercise capacity in rheumatoid arthritis unrelated to lung injury: A comparison of women with and without rheumatoid disease. J Back Musculoskelet Rehabil 2022; 35:449-458. [PMID: 34275888 DOI: 10.3233/bmr-210056] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Rheumatoid arthritis (RA) mainly affects the joints of the upper and lower limbs, so evaluating functional exercise capacity in individuals with RA via dynamic tests of the locomotor system is essential. OBJECTIVES To compare functional exercise capacity using the Glittre-activities of daily living (ADL) test (G-AT) in women with and without RA in the absence of RA pulmonary disease (RA-PD) and to correlate the findings with hand functioning, physical functioning, handgrip strength (HGS), and quadriceps strength (QS). METHODS This cross-sectional pilot study evaluated 35 women with RA and 25 healthy controls by assessing hand functioning using the Cochin Hand Functional Scale (CHFS), physical functioning with the Health Assessment Questionnaire Disability Index (HAQ-DI), muscle functioning using HGS and QS, and G-AT results. RESULTS Compared to the women in the control group, the women with RA presented higher scores for the CHFS (p< 0.0001) and HAQ-DI (p< 0.0001) and lower HGS (p< 0.0001) and QS (p= 0.013) values. The median G-AT time was higher in the RA patients than in the healthy controls [300 (295-420) vs. 180 (155-203) s], p< 0.0001), and the greatest difficulty reported by patients after the G-AT was squatting to perform the shelving tasks. G-AT time was positively correlated with the HAQ-DI (rs= 0.668, p< 0.0001) and CHFS (rs= 0.586, p= 0.0007) and negatively correlated with QS (rs=-0.429, p= 0.037). There was no significant correlation between the G-AT time and HGS. CONCLUSIONS Women with RA take longer to perform G-AT tasks. Moreover, G-AT time was associated with hand functioning, physical functioning and QS, but not with HGS.
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Affiliation(s)
- Ana Carolina Brandão Assis
- Rehabilitation Sciences Post-Graduation Programme, Augusto Motta University Centre (UNISUAM), Rio de Janeiro, Brazil
| | - Agnaldo José Lopes
- Rehabilitation Sciences Post-Graduation Programme, Augusto Motta University Centre (UNISUAM), Rio de Janeiro, Brazil.,Medical Sciences Post-Graduation Programme, School of Medical Sciences, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
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25
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Nascimento DDC, Rolnick N, Neto IVDS, Severin R, Beal FLR. A Useful Blood Flow Restriction Training Risk Stratification for Exercise and Rehabilitation. Front Physiol 2022; 13:808622. [PMID: 35360229 PMCID: PMC8963452 DOI: 10.3389/fphys.2022.808622] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 02/04/2022] [Indexed: 11/18/2022] Open
Abstract
Blood flow restriction training (BFRT) is a modality with growing interest in the last decade and has been recognized as a critical tool in rehabilitation medicine, athletic and clinical populations. Besides its potential for positive benefits, BFRT has the capability to induce adverse responses. BFRT may evoke increased blood pressure, abnormal cardiovascular responses and impact vascular health. Furthermore, some important concerns with the use of BFRT exists for individuals with established cardiovascular disease (e.g., hypertension, diabetes mellitus, and chronic kidney disease patients). In addition, considering the potential risks of thrombosis promoted by BFRT in medically compromised populations, BFRT use warrants caution for patients that already display impaired blood coagulability, loss of antithrombotic mechanisms in the vessel wall, and stasis caused by immobility (e.g., COVID-19 patients, diabetes mellitus, hypertension, chronic kidney disease, cardiovascular disease, orthopedic post-surgery, anabolic steroid and ergogenic substance users, rheumatoid arthritis, and pregnant/postpartum women). To avoid untoward outcomes and ensure that BFRT is properly used, efficacy endpoints such as a questionnaire for risk stratification involving a review of the patient's medical history, signs, and symptoms indicative of underlying pathology is strongly advised. Here we present a model for BFRT pre-participation screening to theoretically reduce risk by excluding people with comorbidities or medically complex histories that could unnecessarily heighten intra- and/or post-exercise occurrence of adverse events. We propose this risk stratification tool as a framework to allow clinicians to use their knowledge, skills and expertise to assess and manage any risks related to the delivery of an appropriate BFRT exercise program. The questionnaires for risk stratification are adapted to guide clinicians for the referral, assessment, and suggestion of other modalities/approaches if/when necessary. Finally, the risk stratification might serve as a guideline for clinical protocols and future randomized controlled trial studies.
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Affiliation(s)
- Dahan da Cunha Nascimento
- Department of Physical Education, Catholic University of Brasília (UCB), Brasília, Brazil
- Department of Gerontology, Catholic University of Brasília (UCB), Brasília, Brazil
| | - Nicholas Rolnick
- The Human Performance Mechanic, Lehman College, New York, NY, United States
| | - Ivo Vieira de Sousa Neto
- Laboratory of Molecular Analysis, Graduate Program of Sciences and Technology of Health, University of Brasília, Brasília, Brazil
| | - Richard Severin
- Department of Physical Therapy, College of Applied Health Sciences, The University of Illinois at Chicago, Chicago, IL, United States
- Department of Physical Therapy, Robbins College of Health and Human Sciences, Baylor University, Waco, TX, United States
| | - Fabiani Lage Rodrigues Beal
- Department of Gerontology, Catholic University of Brasília (UCB), Brasília, Brazil
- Department of Nutrition, Health and Medicine School, Catholic University of Brasília (UCB), Brasília, Brazil
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26
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Magni N, McNair P, Rice D. Six weeks of resistance training (plus advice) vs advice only in hand osteoarthritis: A single-blind, randomised, controlled feasibility trial. Musculoskelet Sci Pract 2022; 57:102491. [PMID: 34872042 DOI: 10.1016/j.msksp.2021.102491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/03/2021] [Accepted: 11/22/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND People with hand osteoarthritis (OA) may benefit from resistance training interventions. To date the feasibility of a such interventions for symptomatic hand OA, as per international guidelines, is unknown. OBJECTIVE Determine the feasibility of a clinical trial comparing resistance training to an advice only control group in people with symptomatic hand OA. DESIGN Single-blind, randomised, controlled feasibility study. METHODS The American College of Rheumatology criteria for hand OA were utilised for inclusion. Participants were randomly allocated (1:1:1) to advice and blood flow restriction training (BFRT), advice and traditional high intensity training (HIT), or advice only (control). Participants receiving BFRT and HIT underwent supervised hand exercises three times a week for six weeks. Feasibility measures included recruitment rate, adherence, exercise induced pain, training acceptability, pain flares, and adverse events. Number of treatment responders, pain, grip strength, and hand function were also recorded. RESULTS In total, 191 participants were screened, 59 (31%) were included. Retention rate was 89% for BFRT and 79% for HIT. Exercise did not worsen pain following training sessions, and training acceptability was equal between groups. Pain flares occurred in 1.6% (BFRT) and 4% (HIT) out of all the training sessions. There was one adverse event in the HIT group, with the participants withdrawing from the study due to pain. The number of treatment responders, and improvements in pain, were greater with BFRT and HIT. Grip and function did not improve. CONCLUSION A clinical trial comparing resistance training to advice for people with symptomatic hand OA is feasible.
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Affiliation(s)
- N Magni
- Department of Physiotherapy, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand.
| | - P McNair
- Department of Physiotherapy, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - D Rice
- Department of Physiotherapy, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand; Department of Anaesthesiology and Perioperative Medicine, Waitemata District Health Board, Auckland, New Zealand
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27
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Reina-Ruiz ÁJ, Galán-Mercant A, Molina-Torres G, Merchán-Baeza JA, Romero-Galisteo RP, González-Sánchez M. Effect of Blood Flow Restriction on Functional, Physiological and Structural Variables of Muscle in Patients with Chronic Pathologies: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:1160. [PMID: 35162182 PMCID: PMC8835162 DOI: 10.3390/ijerph19031160] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/06/2022] [Accepted: 01/13/2022] [Indexed: 02/01/2023]
Abstract
The main objective of this systematic review of the current literature is to analyze the changes that blood flow restriction (BFR) causes in subjects with neuro-musculoskeletal and/or systemic pathologies focusing on the following variables: strength, physiological changes, structural changes and cardiocirculatory variables. The search was carried out in seven databases, including randomized clinical trials in which therapeutic exercise was combined with the blood flow restriction tool in populations with musculoskeletal pathologies. Outcome variables are strength, structural changes, physiological changes and cardiocirculatory variables. Twenty studies were included in the present study. Although there is a lot of heterogeneity between the interventions and evaluation instruments, we observed how the restriction of blood flow presents significant differences in the vast majority of the variables analyzed. In addition, we observed how BFR can become a supplement that provides benefits when performed with low intensity, similar to those obtained through high-intensity muscular efforts. The application of the BFR technique can provide benefits in the short and medium term to increase strength, muscle thickness and cardiovascular endurance, even improving the physiological level of the cardiovascular system. In addition, BFR combined with low-load exercises also achieves benefits comparable to high-intensity exercises without the application of BFR, benefiting patients who are unable to lift high loads.
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Affiliation(s)
- Álvaro Jesús Reina-Ruiz
- Department of Physiotherapy, Faculty of Health Sciences, University of Málaga, Arquitecto Francisco Peñalosa, 3, 29071 Málaga, Spain; (Á.J.R.-R.); (R.P.R.-G.); (M.G.-S.)
| | - Alejandro Galán-Mercant
- MOVE-IT Research Group, Department of Physical Education, Faculty of Education, Sciences University of Cádiz, 11002 Cádiz, Spain
- Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital, University of Cádiz, 11002 Cádiz, Spain
| | - Guadalupe Molina-Torres
- Department of Nursing Science, Physiotherapy and Medicine, Faculty of Nursing and Physiotherapy, University of Almeria, 04120 Almeria, Spain
| | - Jose Antonio Merchán-Baeza
- Centre for Health and Social Care Research (CESS), Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Science and Welfare, University of Vic-Central University of Catalonia (UVIC-UCC), C. Sagrada Família, 7, 08500 Vic, Spain;
| | - Rita Pilar Romero-Galisteo
- Department of Physiotherapy, Faculty of Health Sciences, University of Málaga, Arquitecto Francisco Peñalosa, 3, 29071 Málaga, Spain; (Á.J.R.-R.); (R.P.R.-G.); (M.G.-S.)
- Instituto de Investigación Biomédica de Málaga, IBIMA, Calle Doctor Miguel Díaz Recio, 28, 29010 Málaga, Spain
| | - Manuel González-Sánchez
- Department of Physiotherapy, Faculty of Health Sciences, University of Málaga, Arquitecto Francisco Peñalosa, 3, 29071 Málaga, Spain; (Á.J.R.-R.); (R.P.R.-G.); (M.G.-S.)
- Instituto de Investigación Biomédica de Málaga, IBIMA, Calle Doctor Miguel Díaz Recio, 28, 29010 Málaga, Spain
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Mochizuki T, Kurata A, Yano K, Ikari K, Okazaki K. Effects of Locomotion Training on the Physical Functions and Quality of Life in Patients with Rheumatoid Arthritis: A Pilot Clinical Trial. Prog Rehabil Med 2022; 7:20220014. [PMID: 35434407 PMCID: PMC8958057 DOI: 10.2490/prm.20220014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 02/15/2022] [Indexed: 11/09/2022] Open
Abstract
Objectives: Methods: Results: Conclusions:
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Affiliation(s)
- Takeshi Mochizuki
- Department of Orthopedic Surgery, Kamagaya General Hospital, Chiba, Japan
| | - Aiko Kurata
- Department of Rehabilitation, Kamagaya General Hospital, Chiba, Japan
| | - Koichiro Yano
- Department of Orthopedic Surgery, Tokyo Women’s Medical University, Tokyo, Japan
| | - Katsunori Ikari
- Department of Orthopedic Surgery, Tokyo Women’s Medical University, Tokyo, Japan
| | - Ken Okazaki
- Department of Orthopedic Surgery, Tokyo Women’s Medical University, Tokyo, Japan
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29
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dos Santos LP, Santo RCDE, Ramis TR, Portes JKS, Chakr RMDS, Xavier RM. The effects of resistance training with blood flow restriction on muscle strength, muscle hypertrophy and functionality in patients with osteoarthritis and rheumatoid arthritis: A systematic review with meta-analysis. PLoS One 2021; 16:e0259574. [PMID: 34758045 PMCID: PMC8580240 DOI: 10.1371/journal.pone.0259574] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 10/22/2021] [Indexed: 12/11/2022] Open
Abstract
Introduction Rheumatoid arthritis(RA) and osteoarthritis(OA) patients showed systemic manifestations that may lead to a reduction in muscle strength, muscle mass and, consequently, to a reduction in functionality. On the other hand, moderate intensity resistance training(MIRT) and high intensity resistance training(HIRT) are able to improve muscle strength and muscle mass in RA and OA without affecting the disease course. However, due to the articular manifestations caused by these diseases, these patients may present intolerance to MIRT or HIRT. Thus, the low intensity resistance training combined with blood flow restriction(LIRTBFR) may be a new training strategy for these populations. Objective To perform a systematic review with meta-analysis to verify the effects of LIRTBFR on muscle strength, muscle mass and functionality in RA and OA patients. Materials and methods A systematic review with meta-analysis of randomized clinical trials(RCTs), published in English, between 1957–2021, was conducted using MEDLINE(PubMed), Embase and Cochrane Library. The methodological quality was assessed using Physiotherapy Evidence Database scale. The risk of bias was assessed using RoB2.0. Mean difference(MD) or standardized mean difference(SMD) and 95% confidence intervals(CI) were pooled using a random-effects model. A P<0.05 was considered statistically significant. Results Five RCTs were included. We found no significant differences in the effects between LIRTBFR, MIRT and HIRT on muscle strength, which was assessed by tests of quadriceps strength(SMD = -0.01[-0.57, 0.54], P = 0.96; I² = 58%) and functionality measured by tests with patterns similar to walking(SMD = -0.04[-0.39, 0.31], P = 0.82; I² = 0%). Compared to HIRT, muscle mass gain after LIRTBFR was reported to be similar. When comparing LIRTBFR with low intensity resistance training without blood flow restriction(LIRT), the effect LIRTBFR was reported to be higher on muscle strength, which was evaluated by the knee extension test. Conclusion LIRTBFR appears to be a promising strategy for gains in muscle strength, muscle mass and functionality in a predominant sample of RA and OA women.
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Affiliation(s)
- Leonardo Peterson dos Santos
- Autoimmune Diseases Laboratory, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil
- Division of Rheumatology, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil
- Medical School, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil
- * E-mail:
| | - Rafaela Cavalheiro do Espírito Santo
- Autoimmune Diseases Laboratory, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil
- Division of Rheumatology, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil
- Medical School, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Thiago Rozales Ramis
- Exercise Research Laboratory (LAPEX), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Juliana Katarina Schoer Portes
- Autoimmune Diseases Laboratory, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil
- Division of Rheumatology, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil
- Medical School, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Rafael Mendonça da Silva Chakr
- Autoimmune Diseases Laboratory, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil
- Division of Rheumatology, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil
- Medical School, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Ricardo Machado Xavier
- Autoimmune Diseases Laboratory, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil
- Division of Rheumatology, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil
- Medical School, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil
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Mochizuki T, Yano K, Ikari K, Okazaki K. Effects of the COVID-19 pandemic on body composition among patients with rheumatoid arthritis. Mod Rheumatol 2021; 32:452-454. [PMID: 34894260 PMCID: PMC8499963 DOI: 10.1093/mr/roab018] [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: 02/05/2021] [Revised: 04/20/2021] [Accepted: 05/27/2021] [Indexed: 11/13/2022]
Abstract
Objectives To evaluate effects of the COVID-19 pandemic on body composition among patients with rheumatoid arthritis (RA). Methods A total 102 patients with RA were enrolled. We examined muscle mass, fat-free mass index (FFMI) and fat mass index (FMI) values using bioelectrical impedance analysis between November 2019 and January 2020 (for the first measurement) and September 2020 and January 2021 (for the second measurement). Results The muscle mass was significantly decreased from a median of 34.6 kg at the first measurement to a median of 33.9 kg at the second measurement (p = 0.002). The FFMI was significantly decreased from a median of 15.3 at the first measurement to a median of 14.8 at the second measurement (p = 0.011). Conclusions The present study reveals that muscle mass and FFMI decreased among patients with RA during the COVID-19 pandemic.
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Affiliation(s)
- Takeshi Mochizuki
- Department of Orthopedic Surgery, Kamagaya General Hospital, Chiba, Japan
| | - Koichiro Yano
- Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Katsunori Ikari
- Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo, Japan.,Division of Multidisciplinary Management of Rheumatic Diseases, Tokyo Women's Medical University, Tokyo, Japan
| | - Ken Okazaki
- Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
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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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32
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Liao CD, Chen HC, Huang SW, Liou TH. Exercise therapy for sarcopenia in rheumatoid arthritis: A meta-analysis and meta-regression of randomized controlled trials. Clin Rehabil 2021; 36:145-157. [PMID: 34404254 DOI: 10.1177/02692155211035539] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Rheumatoid arthritis and age are associated with high sarcopenia risk. Exercise is an effective treatment for preventing muscle mass loss in older adult populations. It remains unclear whether exercise affects muscle mass in people with rheumatoid arthritis. Thus, this meta-analysis investigated the effect of exercise on muscle mass gain in patients with rheumatoid arthritis. DATA SOURCES PubMed, EMBASE, the Cochrane Library, the Physiotherapy Evidence Database (PEDro), the China Knowledge Resource Integrated Database, and Google Scholar were systematically searched until June 2021. METHODS The present study was conducted according to the guidelines recommended by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. Randomized controlled trials (RCTs) that reported the effects of exercise on muscle mass for rheumatoid arthritis were identified. The included RCTs were subject to meta-analysis and risk of bias assessment. Subgroup and random-effects meta-regression analyses were performed to identify any heterogeneity (I2) of treatment effects across studies. RESULTS We included nine RCTs with a median PEDro score of 6/10 (range: 4/10-8/10). The weighted mean effect size for muscle mass was 0.77 (95% CI: 0.30-1.24; P = 0.001; I2 = 77%). Meta-regression analyses indicated that the disease duration significantly explained variance of treatment effects across studies (β = -0.006, R2 = 69.7%, P = 0.005). CONCLUSIONS Exercise therapy effectively increased muscle mass in patients with rheumatoid arthritis. Treatment effects may be attenuated in those who have had rheumatoid arthritis for a relatively long time.
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Affiliation(s)
- Chun-De Liao
- Master Program in Long-Term Care, College of Nursing, Taipei Medical University, Taipei.,Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City
| | - Hung-Chou Chen
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City.,Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei.,Center for Evidence-Based Health Care, Shuang Ho Hospital, Taipei Medical University, New Taipei City
| | - Shih-Wei Huang
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City.,Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei.,Graduate Institute of Sports Science, National Taiwan Sport University, Taoyuan
| | - Tsan-Hon Liou
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City.,Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei
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33
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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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Li S, Shaharudin S, Abdul Kadir MR. Effects of Blood Flow Restriction Training on Muscle Strength and Pain in Patients With Knee Injuries: A Meta-Analysis. Am J Phys Med Rehabil 2021; 100:337-344. [PMID: 33727516 DOI: 10.1097/phm.0000000000001567] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Due to the pain caused by knee injuries, low-load resistance training with blood flow restriction (L-BFR) may be a potential adjuvant therapeutic tool in the rehabilitation of knee injuries. This review aimed to analyze the effectiveness of L-BFR training modality in knee rehabilitation. DESIGN A meta-analysis was conducted to determine the potential impact of blood flow restriction on patients with knee injuries. PubMed, EBSCO, and Web of Science databases were searched for eligible studies from January 2000 until January 2020. The mean differences of the data were analyzed using Revman 5.3 software with a 95% confidence interval. RESULTS Nine studies fulfilled the inclusion criteria. These studies involved 179 patients who received L-BFR, 96 patients who underwent high-load resistance training, and another 94 patients who underwent low-load resistance training. The analysis of pooled data showed that patients in both the L-BFR (standardized mean difference, 0.83 [0.53, 1.14], P < 0.01) and high-load resistance training (standardized mean difference, -0.09 [-0.43, 0.24], P = 0.58) groups experienced an increase in muscle strength after the training. In addition, pain score was significantly reduced in the L-BFR group compared with the other two groups (standardized mean difference, -0.61 [-1.19, -0.03], P = 0.04). CONCLUSIONS Muscle strength increased after L-BFR and high-load resistance training compared with low-load resistance training. Furthermore, pain score was significantly reduced after L-BFR. Hence, L-BFR is a potential intervention to be applied in rehabilitation of knee injuries.
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Affiliation(s)
- Shuoqi Li
- From the Exercise and Sports Science Programme, School of Health Sciences, Universiti Sains Malaysia, Kelantan, Malaysia (SL, SS); and School of Biomedical Engineering & Health Sciences, Faculty of Engineering, Universiti Teknologi Malaysia, Johor, Malaysia (MRAK)
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35
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Rostron ZP, Green RA, Kingsley M, Zacharias A. Associations Between Measures of Physical Activity and Muscle Size and Strength: A Systematic Review. Arch Rehabil Res Clin Transl 2021; 3:100124. [PMID: 34179760 PMCID: PMC8211997 DOI: 10.1016/j.arrct.2021.100124] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Objective To determine whether physical activity is associated with lower limb muscle size and strength within the general population. Data Sources Six databases were systematically searched from inception using 3 main constructs: lower extremity, muscle volume, and muscle strength. Study Selection Studies that measured physical activity (using either objective or subjective measurements), lower limb muscle size, and strength were included. Available discrete group data were standardized using previously published age- and sex-specific normative values prior to analysis. Data Extraction The final analysis included 47 studies from an initial yield of 5402 studies. Standardized scores for outcome measures were calculated for 97 discrete groups. Data Synthesis As anticipated, lower limb muscle size was positively correlated with lower limb muscle strength (r=0.26, P<.01; n=4812). Objectively measured physical activity (ie, accelerometry, pedometry) (n=1944) was positively correlated with both lower limb muscle size (r=0.30, P<.01; n=1626) and lower limb strength (r=0.24, P<.01; n=1869). However, subjectively measured physical activity (ie, questionnaires) (n=3949) was negatively associated with lower limb muscle size (r=–0.59, P<.01; n=3243) and lower limb muscle strength (r=–0.48, P<. 01; n=3882). Conclusions This review identified that objective measures of physical activity are moderately associated with lower limb muscle size and muscle strength and can, therefore, be used to predict muscle changes within the lower limbs associated with exercise-based rehabilitation programs.
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Affiliation(s)
- Zachary P. Rostron
- Department of Pharmacy and Biomedical Sciences, College of Science, Health and Engineering, La Trobe University, Bendigo, Victoria, Australia
- Corresponding author Zachary P. Rostron, MExPhys, Department of Pharmacy and Biomedical Sciences, College of Science, Health and Engineering, La Trobe University, PO Box 199, Edwards Rd, Flora Hill, Bendigo, VIC 3552, Australia.
| | - Rodney A. Green
- Department of Pharmacy and Biomedical Sciences, College of Science, Health and Engineering, La Trobe University, Bendigo, Victoria, Australia
| | - Michael Kingsley
- Department of Exercise Sciences, Faculty of Science, University of Auckland, Auckland, New Zealand
- Holsworth Research Initiative, College of Science, Health and Engineering, La Trobe University, Bendigo, Victoria, Australia
| | - Anita Zacharias
- Department of Pharmacy and Biomedical Sciences, College of Science, Health and Engineering, La Trobe University, Bendigo, Victoria, Australia
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IN-SEASON REHABILITATION PROGRAM USING BLOOD FLOW RESTRICTION THERAPY FOR TWO DECATHLETES WITH PATELLAR TENDINOPATHY: A CASE REPORT. Int J Sports Phys Ther 2020; 15:1184-1195. [PMID: 33344034 DOI: 10.26603/ijspt20201184] [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] [Indexed: 01/20/2023] Open
Abstract
Background and Purpose Patellar tendinopathy is an overuse injury experienced primarily by athletes; especially athletes who participate in sports that involve frequent jumping. Therapeutic exercise is the primary conservative treatment for patients with this condition. However, some patients with patellar tendinopathy may be unable to tolerate the loading that occurs during exercise. The use of blood flow restriction (BFR) therapy for patients with patellar tendinopathy may allow the athlete to exercise with a lower load while still experiencing the physiological benefits associated with training at a higher intensity. The purpose of this case report was to detail the outcomes from a rehabilitation program utilizing BFR for two collegiate decathletes with patellar tendinopathy. Study Design Case ReportCase Descriptions and Interventions: Two NCAA Division III freshmen collegiate decathletes with a history of left knee pain prior to college and who had been complaining of increasing pain during the initial month of track practices. Findings from the musculoskeletal examinations included left sided lower extremity weakness, pain during functional testing, pain when palpating the left patellar tendon, and VISA-P scores less than 80. Ultrasound imaging at baseline revealed thickened tendons on the left with hypoechoic regions. Both athletes participated in 20 therapy sessions consisting of therapeutic exercises performed with BFR. Outcomes Both athletes experienced improvements in pain scores, increases in lower extremity strength, improved functional test performance, higher VISA-P scores, and improvements in tendon size and appearance as measured by diagnostic ultrasound. Conclusion Both athletes experienced improvements with the BFR-based therapeutic exercise program and were able to compete throughout the track season. The use of BFR may allow patients who are unable to tolerate exercise due to pain an alternative approach during rehabilitation. Future research should compare therapeutic exercise programs for this condition with and without BFR. Level of Evidence Level V.
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Jønsson AB, Johansen CV, Rolving N, Pfeiffer-Jensen M. Feasibility and estimated efficacy of blood flow restricted training in female patients with rheumatoid arthritis: a randomized controlled pilot study. Scand J Rheumatol 2020; 50:169-177. [PMID: 33300420 DOI: 10.1080/03009742.2020.1829701] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objectives: The study aimed to evaluate the feasibility of a blood flow restriction (BFR) training regimen in patients with rheumatoid arthritis (RA); and to compare the effects of 4 weeks of BFR training with low-intensity strength training on muscle strength, muscle endurance, and joint pain in patients with RA.Method: In this non-blinded pilot randomized controlled trial, 18 women with RA aged 18-65 years performed low-intensity strength training for the lower limbs three times a week for 4 weeks, and were randomized to train with or without occlusion bands. The primary outcomes were registration of the recruitment process, compliance with training sessions, side effects, perceived pain, and a satisfaction survey. The secondary outcomes were changes in muscle strength, muscle endurance, and joint pain.Results: The findings of this pilot study included a challenging recruitment process, well tolerated training and test protocols, overall good patient satisfaction, no serious side effects, and high compliance. Both groups achieved significant improvements in knee extensor strength from baseline to follow-up, with a change of 11.5 kg [interquartile range (IQR) 9.8;13.0] in the intervention group and 8.4 kg (IQR 5.5;12.4) in the control group, and a significant between-group difference in favour of the intervention group (p = 0.0342).Conclusions: The feasibility results of this study indicated a challenging recruitment process, general satisfaction with the BFR and exercises, good compliance, and only expected non-serious side effects. BFR training may improve knee extensor strength in women with RA, compared low-intensity strength training without BFR.
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Affiliation(s)
- A B Jønsson
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.,Department of Public Health, Aarhus University, Aarhus, Denmark.,Department of Neurology, Spinal Cord Injury Centre of Western Denmark, Viborg Regional Hospital, Denmark
| | - C V Johansen
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.,Department of Public Health, Aarhus University, Aarhus, Denmark
| | - N Rolving
- Department of Public Health, Aarhus University, Aarhus, Denmark.,DEFACTUM, Social and Health Services and Labour Market, Aarhus, Denmark
| | - M Pfeiffer-Jensen
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.,Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Copenhagen, Denmark
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38
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Ma JK, Chan A, Sandhu A, Li LC. Wearable Physical Activity Measurement Devices Used in Arthritis. Arthritis Care Res (Hoboken) 2020; 72 Suppl 10:703-716. [PMID: 33091245 DOI: 10.1002/acr.24262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 05/12/2020] [Indexed: 01/04/2023]
Affiliation(s)
- Jasmin K Ma
- Arthritis Research Canada, Richmond, British Columbia, Canada, and The University of British Columbia, Vancouver, British Columbia, Canada
| | - Amber Chan
- Arthritis Research Canada, Richmond, British Columbia, Canada, and The University of British Columbia, Vancouver, British Columbia, Canada
| | - Amrit Sandhu
- The University of British Columbia, Vancouver, British Columbia, Canada
| | - Linda C Li
- Arthritis Research Canada, Richmond, British Columbia, Canada, and The University of British Columbia, Vancouver, British Columbia, Canada
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Tekgoz E, Colak S, Ozalp Ates FS, Sonaeren I, Yilmaz S, Cinar M. Sarcopenia in rheumatoid arthritis: Is it a common manifestation? Int J Rheum Dis 2020; 23:1685-1691. [DOI: 10.1111/1756-185x.13976] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/25/2020] [Accepted: 09/05/2020] [Indexed: 01/19/2023]
Affiliation(s)
- Emre Tekgoz
- Gulhane Faculty of Medicine Division of Rheumatology Department of Internal Medicine University of Health Sciences Turkey Ankara Turkey
| | - Seda Colak
- Gulhane Faculty of Medicine Division of Rheumatology Department of Internal Medicine University of Health Sciences Turkey Ankara Turkey
| | | | - Ilknur Sonaeren
- Gulhane Faculty of Medicine Department of Nutrition and Dietetic University of Health Sciences Ankara Turkey
| | - Sedat Yilmaz
- Gulhane Faculty of Medicine Division of Rheumatology Department of Internal Medicine University of Health Sciences Turkey Ankara Turkey
| | - Muhammet Cinar
- Gulhane Faculty of Medicine Division of Rheumatology Department of Internal Medicine University of Health Sciences Turkey Ankara Turkey
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40
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Manta C, Patrick-Lake B, Goldsack JC. Digital Measures That Matter to Patients: A Framework to Guide the Selection and Development of Digital Measures of Health. Digit Biomark 2020; 4:69-77. [PMID: 33083687 DOI: 10.1159/000509725] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 06/25/2020] [Indexed: 11/19/2022] Open
Abstract
Background With the rise of connected sensor technologies, there are seemingly endless possibilities for new ways to measure health. These technologies offer researchers and clinicians opportunities to go beyond brief snapshots of data captured by traditional in-clinic assessments, to redefine health and disease. Given the myriad opportunities for measurement, how do research or clinical teams know what they should be measuring? Patient engagement, early and often, is paramount to thoughtfully selecting what is most important. Regulators encourage stakeholders to have a patient focus but actionable steps for continuous engagement are not well defined. Without patient-focused measurement, stakeholders risk entrenching digital versions of poor traditional assessments and proliferating low-value tools that are ineffective, burdensome, and reduce both quality and efficiency in clinical care and research. Summary This article synthesizes and defines a sequential framework of core principles for selecting and developing measurements in research and clinical care that are meaningful for patients. We propose next steps to drive forward the science of high-quality patient engagement in support of measures of health that matter in the era of digital medicine. Key Messages All measures of health should be meaningful, regardless of the product's regulatory classification, type of measure, or context of use. To evaluate meaningfulness of signals derived from digital sensors, the following four-level framework is useful: Meaningful Aspect of Health, Concept of Interest, Outcome to be measured, and Endpoint (exclusive to research). Incorporating patient input is a dynamic process that requires more than a single, transactional touch point but rather should be conducted continuously throughout the measurement selection process. We recommend that developers, clinicians, and researchers reevaluate processes for more continuous patient engagement in the development, deployment, and interpretation of digital measures of health.
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Affiliation(s)
- Christine Manta
- Digital Medicine Society, Boston, Massachusetts, USA.,Elektra Labs, Boston, Massachusetts, USA
| | - Bray Patrick-Lake
- Digital Medicine Society, Boston, Massachusetts, USA.,Evidation Health, Inc., San Mateo, California, USA
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Dantas WS, Roschel H, Murai IH, Gil S, Davuluri G, Axelrod CL, Ghosh S, Newman SS, Zhang H, Shinjo SK, das Neves W, Merege-Filho C, Teodoro WR, Capelozzi VL, Pereira RM, Benatti FB, de Sá-Pinto AL, de Cleva R, Santo MA, Kirwan JP, Gualano B. Exercise-Induced Increases in Insulin Sensitivity After Bariatric Surgery Are Mediated By Muscle Extracellular Matrix Remodeling. Diabetes 2020; 69:1675-1691. [PMID: 32409493 PMCID: PMC7372074 DOI: 10.2337/db19-1180] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 05/08/2020] [Indexed: 02/06/2023]
Abstract
Exercise seems to enhance the beneficial effect of bariatric (Roux-en-Y gastric bypass [RYGB]) surgery on insulin resistance. We hypothesized that skeletal muscle extracellular matrix (ECM) remodeling may underlie these benefits. Women were randomized to either a combined aerobic and resistance exercise training program following RYGB (RYGB + ET) or standard of care (RYGB). Insulin sensitivity was assessed by oral glucose tolerance test. Muscle biopsy specimens were obtained at baseline and 3 and 9 months after surgery and subjected to comprehensive phenotyping, transcriptome profiling, molecular pathway identification, and validation in vitro. Exercise training improved insulin sensitivity beyond surgery alone (e.g., Matsuda index: RYGB 123% vs. RYGB + ET 325%; P ≤ 0.0001). ECM remodeling was reduced by surgery alone, with an additive benefit of surgery and exercise training (e.g., collagen I: RYGB -41% vs. RYGB + ET -76%; P ≤ 0.0001). Exercise and RYGB had an additive effect on enhancing insulin sensitivity, but surgery alone did not resolve insulin resistance and ECM remodeling. We identified candidates modulated by exercise training that may become therapeutic targets for treating insulin resistance, in particular, the transforming growth factor-β1/SMAD 2/3 pathway and its antagonist follistatin. Exercise-induced increases in insulin sensitivity after bariatric surgery are at least partially mediated by muscle ECM remodeling.
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Affiliation(s)
- Wagner S Dantas
- Integrated Physiology and Molecular Metabolism Laboratory, Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Laboratory of Assessment and Conditioning in Rheumatology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Hamilton Roschel
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Laboratory of Assessment and Conditioning in Rheumatology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Rheumatology Division, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Igor H Murai
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Laboratory of Assessment and Conditioning in Rheumatology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Saulo Gil
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Laboratory of Assessment and Conditioning in Rheumatology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Gangarao Davuluri
- Integrated Physiology and Molecular Metabolism Laboratory, Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA
| | - Christopher L Axelrod
- Integrated Physiology and Molecular Metabolism Laboratory, Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA
- Department of Translational Services, Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA
| | - Sujoy Ghosh
- Genomics Core, Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA
- Cardiovascular and Metabolic Disorders Program and Center for Computational Biology, Duke-National University of Singapore Medical School, Singapore
| | - Susan S Newman
- Genomics Core, Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA
| | - Hui Zhang
- Integrated Physiology and Molecular Metabolism Laboratory, Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA
| | - Samuel K Shinjo
- Rheumatology Division, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Willian das Neves
- Clinical Oncology Service, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
| | - Carlos Merege-Filho
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Laboratory of Assessment and Conditioning in Rheumatology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Walcy R Teodoro
- Rheumatology Division, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Vera L Capelozzi
- Department of Pathology, School of Medicine, Universidade de São Paulo, São Paulo, Brazil
| | - Rosa Maria Pereira
- Rheumatology Division, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Fabiana B Benatti
- School of Applied Sciences, Universidade Estadual de Campinas, São Paulo, Brazil
| | - Ana L de Sá-Pinto
- Rheumatology Division, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Roberto de Cleva
- Department of Digestive Division, School of Medicine, Universidade de São Paulo, São Paulo, Brazil
| | - Marco A Santo
- Department of Digestive Division, School of Medicine, Universidade de São Paulo, São Paulo, Brazil
| | - John P Kirwan
- Integrated Physiology and Molecular Metabolism Laboratory, Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA
| | - Bruno Gualano
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Laboratory of Assessment and Conditioning in Rheumatology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Rheumatology Division, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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Cardiac Autonomic Control in Women with Rheumatoid Arthritis During the Glittre Activities of Daily Living Test. Asian J Sports Med 2020. [DOI: 10.5812/asjsm.101400] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background: Cardiovascular autonomic dysfunction is one of the most common complications in rheumatoid arthritis (RA), which can be assessed by heart rate variability (HRV) analysis. Because the autonomic nervous system plays an important role in orchestrating the cardiovascular response to stressors, assessing HRV during exercise is critical. The Glittre Activities of Daily Living test (GA-T) was recently proposed as a multitask field test that requires the performance of the upper and lower limbs, both of which are affected in individuals with RA. Objectives: This study was conducted to evaluate autonomic impairment by HRV in women with RA using the GA-T and to correlate these changes with physical functioning and muscle strength. Methods: This cross-sectional study enrolled 20 women (median [interquartile range]: age 55 [47.5 - 68.8] years) with RA (time since diagnosis: 15 [6.50 - 23.5] years) who underwent HRV assessment during GA-T. They also underwent physical functioning assessment through the Health Assessment Questionnaire Disability Index (HAQ-DI) and handgrip strength (HGS) and quadriceps strength (QS) measures. Results: The GA-T time exhibited significant correlations with the following HRV indices: root mean square of successive differences (RMSSD, rs = -0.451, P = 0.041), proportion of iRR differing by > 50 ms from previous intervals (pNN50, rs = -0.697, P = 0.0006), high frequency (HF, rs = -0.693, P = 0.0007), standard deviation of the points perpendicular to the line-of-identity (SD1, rs = -0.476, P = 0.034), and approximate entropy (ApEn, rs = 0.545, P = 0.013). In addition, the HAQ-DI exhibited significant correlations with the following HRV indices: pNN50 (rs = -0.467, P = 0.038) and HF (rs = -0.444, P = 0.049). We did not observe significant correlation between the HRV indices during the GA-T and the muscle strength measures (HGS and QS). Conclusions: In women with RA, the longer the required to perform the GA-T the worse their parasympathetic modulation, sympathetic-vagal imbalance, and complexity of the autonomic nervous system (i.e., increased index of ApEn) were. Physical functioning level was also related to vagal modulation.
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Rice D, McNair P, Huysmans E, Letzen J, Finan P. Best Evidence Rehabilitation for Chronic Pain Part 5: Osteoarthritis. J Clin Med 2019; 8:jcm8111769. [PMID: 31652929 PMCID: PMC6912819 DOI: 10.3390/jcm8111769] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 09/30/2019] [Indexed: 02/06/2023] Open
Abstract
Osteoarthritis (OA) is a leading cause of chronic pain and disability in older adults, which most commonly affects the joints of the knee, hip, and hand. To date, there are no established disease modifying interventions that can halt or reverse OA progression. Therefore, treatment is focused on alleviating pain and maintaining or improving physical and psychological function. Rehabilitation is widely recommended as first-line treatment for OA as, in many cases, it is safer and more effective than the best-established pharmacological interventions. In this article, we describe the presentation of OA pain and give an overview of its peripheral and central mechanisms. We then provide a state-of-the-art review of rehabilitation for OA pain—including self-management programs, exercise, weight loss, cognitive behavioral therapy, adjunct therapies, and the use of aids and devices. Next, we explore several promising directions for clinical practice, including novel education strategies to target unhelpful illness and treatment beliefs, methods to enhance the efficacy of exercise interventions, and innovative, brain-directed treatments. Finally, we discuss potential future research in areas, such as treatment adherence and personalized rehabilitation for OA pain.
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Affiliation(s)
- David Rice
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland 1142, New Zealand.
- Waitemata Pain Service, Department of Anaesthesiology and Perioperative Medicine, Waitemata District Health Board, Auckland 1142, New Zealand.
| | - Peter McNair
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland 1142, New Zealand.
| | - Eva Huysmans
- Pain in Motion International Research Group.
- Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussel, Belgium.
- Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, 1090 Brussels, Belgium.
- I-CHER, Interuniversity Center for Health Economics Research, 1090 Brussels, Belgium.
- Department of Physical Medicine and Physiotherapy, Universitair Ziekenhuis Brussel, 1090 Brussels, Belgium.
| | - Janelle Letzen
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University, Baltimore, MD 21287, USA.
| | - Patrick Finan
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University, Baltimore, MD 21287, USA.
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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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