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Dong J, Chi J, Lei EF, Wang D. Effects of blood flow restriction training on aerobic capacity, lower limb muscle strength and mass in healthy adults: a meta-analysis. J Sports Med Phys Fitness 2024; 64:1060-1070. [PMID: 38888563 DOI: 10.23736/s0022-4707.24.15905-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
INTRODUCTION The aim of this study was to systematically evaluate the effects of blood flow restriction combined with aerobic exercise on aerobic capacity, lower limb muscle strength and mass in healthy adults. EVIDENCE ACQUISITION According to PRISMA's statement, we searched Web of science, Medline, Embase, Cochrane library, CNKI, Wan fang, and VIP databases to collect randomized controlled trials on the effects of aerobic exercise with blood flow restriction on improving aerobic capacity, lower limb muscle strength, and muscle mass in healthy adults. The studies were published from the establishment of the database to November 2023. A supplementary search has been conducted on March 8, 2024. Review Manager5.3 and Stata17 were used for statistical analysis. EVIDENCE SYNTHESIS A total of 16 RCTs with 388 participants were included. The results of meta-analysis showed: Aerobic exercise with BFR significantly affected aerobic capacity (MD and 95%CI 1.06[0.29,1.83], P<0.05), lower limb muscle strength (MD and 95%CI 7.56[5.80,9.33], P<0.05) and lower limb muscle mass (MD and 95%CI were 3.02[1.63,4.42], P<0.05) in healthy adults. The results of subgroup analysis showed that intermittent pressure was better than continuous pressure (P<0.05). Compared with the elderly, the effect of young and middle-aged was better (P<0.05). At the same time, the training form using power bikes is better than walking or running. Finally, 2-6 weeks, 2-3 sessions per week, 10-45 minutes per session can effectively improve the aerobic capacity of healthy adults. CONCLUSIONS Aerobic exercise with BFR can significantly improve aerobic capacity, lower limb muscle strength and mass in healthy adults. In the future, the effects of blood flow restriction training on healthy adults should be further studied, and the form of pressure, intervention cycle, frequency, time, intensity and other variables should be further controlled.
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Affiliation(s)
- Jin Dong
- Physical Education Institute, Shanxi University, Taiyuan, China
| | - Jinjin Chi
- Physical Education Institute, Shanxi University, Taiyuan, China -
| | - Evander F Lei
- Department of Sports Science and Physical Education, Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Desheng Wang
- Physical Education Institute, Shanxi University, Taiyuan, China
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Bielitzki R, Behrens M, Behrendt T, Franz A, Centner C, Hughes L, Patterson SD, Owens J, Behringer M, Schega L. The Discrepancy Between External and Internal Load/Intensity during Blood Flow Restriction Exercise: Understanding Blood Flow Restriction Pressure as Modulating Factor. SPORTS MEDICINE - OPEN 2024; 10:95. [PMID: 39227485 PMCID: PMC11371992 DOI: 10.1186/s40798-024-00759-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 07/29/2024] [Indexed: 09/05/2024]
Abstract
Physical exercise induces acute psychophysiological responses leading to chronic adaptations when the exercise stimulus is applied repeatedly, at sufficient time periods, and with appropriate magnitude. To maximize long-term training adaptations, it is crucial to control and manipulate the external load and the resulting psychophysiological strain. Therefore, scientists have developed a theoretical framework that distinguishes between the physical work performed during exercise (i.e., external load/intensity) and indicators of the body's psychophysiological response (i.e., internal load/intensity). However, the application of blood flow restriction (BFR) during exercise with low external loads/intensities (e.g., ≤ 30% of the one-repetition-maximum, ≤ 50% of maximum oxygen uptake) can induce physiological and perceptual responses, which are commonly associated with high external loads/intensities. This current opinion aimed to emphasize the mismatch between external and internal load/intensity when BFR is applied during exercise. In this regard, there is evidence that BFR can be used to manipulate both external load/intensity (by reducing total work when exercise is performed to exhaustion) and internal load/intensity (by leading to higher physiological and perceptual responses compared to exercise performed with the same external load/intensity without BFR). Furthermore, it is proposed to consider BFR as an additional exercise determinant, given that the amount of BFR pressure can determine not only the internal but also external load/intensity. Finally, terminological recommendations for the use of the proposed terms in the scientific context and for practitioners are given, which should be considered when designing, reporting, discussing, and presenting BFR studies, exercise, and/or training programs.
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Affiliation(s)
- Robert Bielitzki
- Department of Sport Science, Institute III, Otto-von-Guericke University Magdeburg, Magdeburg, Germany.
| | - Martin Behrens
- University of Applied Sciences for Sport and Management Potsdam, Potsdam, Germany
| | - Tom Behrendt
- Department of Sport Science, Institute III, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Alexander Franz
- Department of Orthopedics and Trauma Surgery, University Hospital Bonn, Bonn, Germany
| | - Christoph Centner
- Department of Sport and Science, University of Freiburg, Freiburg, Germany
| | - Luke Hughes
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle, UK
| | - Stephen D Patterson
- Faculty of Sport, Technology and Health Science, St Mary's University, Twickenham, London, UK
| | - Johnny Owens
- Clinical Education Owens Recovery Science, San Antonio, TX, USA
| | - Michael Behringer
- Department of Sports Sciences, Goethe University Frankfurt, Frankfurt a. M., Germany
| | - Lutz Schega
- Department of Sport Science, Institute III, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
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García-Rodríguez P, Pecci J, Vázquez-González S, Pareja-Galeano H. Acute and Chronic Effects of Blood Flow Restriction Training in Physically Active Patients With Anterior Cruciate Ligament Reconstruction: A Systematic Review. Sports Health 2024; 16:820-828. [PMID: 37946502 PMCID: PMC11346237 DOI: 10.1177/19417381231208636] [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: 11/12/2023] Open
Abstract
CONTEXT Muscle atrophy and loss of knee function are common findings after anterior cruciate ligament (ACL) reconstruction. Rehabilitation through blood flow restriction (BFR) has gained clinical relevance when combined with low loads to improve these disorders in recent years. OBJECTIVE To evaluate the rehabilitation effectiveness of ACL reconstruction with the use of BFR on pain, functionality, strength, and muscle mass in physically active people. DATA SOURCES A search of PubMed, Web of Science, and MEDLINE was performed on March 31, 2023, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. STUDY SELECTION Randomized clinical trials with active adults who underwent ACL surgery were included. They had to compare conventional treatments with the use of BFR, reporting values of pain, functionality, strength, or cross-sectional area (CSA). Articles whose participants presented concomitant injuries and whose intervention combined the use of BFR with treatments other than resistance training were excluded. STUDY DESIGN Systematic review. LEVEL OF EVIDENCE Level 2. DATA EXTRACTION Study design, population, cuff pressure, and main outcomes including strength, quadriceps CSA, pain, and functionality. RESULTS Six studies out of a total of 389 were included (152 participants; 90 men and 62 women). These included studies showed no differences on CSA or strength when comparing BFR training with high loads exercise. BFR has demonstrated improvements in knee functionality and pain compared with other interventions such as immobilization or high loads training. CONCLUSION The use of low loads combined with BFR improves pain, strength, functionality, and CSA. In addition, knee pain reduction and functionality are greater with BFR compared with the use of high loads or immobilization.
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Affiliation(s)
- Pere García-Rodríguez
- Faculty of Sports Sciences and Physiotherapy, Universidad Europea de Madrid, Madrid, Spain
| | - Javier Pecci
- Department of Physical Education and Sport, University of Seville, Seville, Spain
| | - Sergio Vázquez-González
- Faculty of Sports Sciences and Physiotherapy, Universidad Europea de Madrid, Madrid, Spain
- Rehabilitación Premium Madrid Clinic, Madrid, Spain
| | - Helios Pareja-Galeano
- Department of Physical Education, Sport and Human Movement, Universidad Autónoma de Madrid, Madrid, Spain
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de Castro FMP, Oliveira LDP, Aquino R, Tourinho Filho H, Puggina EF. Impact of Complete Intermittent Blood Flow Restriction in Upper Limbs Strength and Neural Function. RESEARCH QUARTERLY FOR EXERCISE AND SPORT 2024; 95:635-645. [PMID: 38306672 DOI: 10.1080/02701367.2023.2294092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 11/27/2023] [Indexed: 02/04/2024]
Abstract
Purpose: We aimed to investigate the chronic effects of low-load strength training (LT) with complete intermittent blood flow restriction (IBFR) on neural adaptations and strength in biceps brachii. Methods: Nineteen volunteers were randomly assigned into two different 9-week training protocols consisting of three assessment weeks and six training weeks: (a) LT with complete IBFR (LT-IBFR; n = 10) and (b) LT without complete IBFR (LT; n = 9). Strength was evaluated by predicted 1 repetition maximum (1RM) at weeks 1, 5, and 9 and neural function by root mean square (RMS) and median frequency (MDF) at sessions 1, 7, and 12 during the first three and last three repetitions. Both groups performed three sets of Scott curl with 20% of predicted 1RM interspersed with 90s rest twice a week. Results: No changes were found in predicted 1RM throughout the training protocols nor between groups. LT-IBFR group showed lower RMS in the first set than LT for the first three repetitions and higher RMS in all sets for the last three repetitions with decreases in this value across the sets with no longitudinal changes for both groups. MDF in the first three repetitions did not differentiate between groups, however, in the last three repetitions, MDF were lower for LTIBFR group in all sets and it increased across the sets for this condition with no chronical changes for both groups in both repetitions zones. These results suggest that LT-IBFR may be ineffective for increasing Q5 strength and it did not promote chronic neural adaptations.
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Cho C, Lee S. The Effects of Blood Flow Restriction Aerobic Exercise on Body Composition, Muscle Strength, Blood Biomarkers, and Cardiovascular Function: A Narrative Review. Int J Mol Sci 2024; 25:9274. [PMID: 39273223 PMCID: PMC11394695 DOI: 10.3390/ijms25179274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Revised: 08/24/2024] [Accepted: 08/25/2024] [Indexed: 09/15/2024] Open
Abstract
Blood flow restriction exercise has emerged as a promising alternative, particularly for elderly individuals and those unable to participate in high-intensity exercise. However, existing research has predominantly focused on blood flow restriction resistance exercise. There remains a notable gap in understanding the comprehensive effects of blood flow restriction aerobic exercise (BFRAE) on body composition, lipid profiles, glycemic metabolism, and cardiovascular function. This review aims to explore the physiological effects induced by chronic BFRAE. Chronic BFRAE has been shown to decrease fat mass, increase muscle mass, and enhance muscular strength, potentially benefiting lipid profiles, glycemic metabolism, and overall function. Thus, the BFRAE offers additional benefits beyond traditional aerobic exercise effects. Notably, the BFRAE approach may be particularly suitable for individuals with low fitness levels, those prone to injury, the elderly, obese individuals, and those with metabolic disorders.
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Affiliation(s)
- Chaeeun Cho
- Department of Human Movement Science, Graduate School, Incheon National University, Incheon 22012, Republic of Korea
| | - Sewon Lee
- Division of Sport Science, College of Arts & Physical Education, Incheon National University, Incheon 22012, Republic of Korea
- Sport Science Institute, College of Arts & Physical Education, Incheon National University, Incheon 22012, Republic of Korea
- Health Promotion Center, College of Arts & Physical Education, Incheon National University, Incheon 22012, Republic of Korea
- Research Center of Brain-Machine Interface, Incheon National University, Incheon 22012, Republic of Korea
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Clarkson MJ, McMahon B, Warmington SA. Comparing adaptations from blood flow restriction exercise training using regulated or unregulated pressure systems: A systematic review and meta-analysis. Clin Rehabil 2024:2692155241271040. [PMID: 39105331 DOI: 10.1177/02692155241271040] [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: 08/07/2024]
Abstract
OBJECTIVE No study has examined outcomes derived from blood flow restriction exercise training interventions using regulated compared with unregulated blood flow restriction pressure systems. Therefore, we used a systematic review and meta-analyses to compare the chronic adaptations to blood flow restriction exercise training achieved with regulated and unregulated blood flow restriction pressure systems. DATA SOURCES The electronic database search included using the tool EBSCOhost and other online database search engines. The search included Medline, SPORTDiscus, CINAHL, Embase and SpringerLink. METHODS Included studies utilised chronic blood flow restriction exercise training interventions greater than two weeks duration, where blood flow restriction was applied using a regulated or unregulated blood flow restriction pressure system, and where outcome measures such as muscle strength, muscle size or physical function were measured both pre- and post-training. Studies included in the meta-analyses used an equivalent non-blood flow restriction exercise comparison group. RESULTS Eighty-one studies were included in the systematic review. Data showed that regulated (n = 47) and unregulated (n = 34) blood flow restriction pressure systems yield similar training adaptations for all outcome measures post-intervention. For muscle strength and muscle size, this was reaffirmed in the included meta-analyses. CONCLUSION This review indicates that practitioners may achieve comparable training adaptations with blood flow restriction exercise training using either regulated or unregulated blood flow restriction pressure systems. Therefore, additional factors such as device quality, participant comfort and safety, cost and convenience are important factors to consider when deciding on appropriate equipment to use when prescribing blood flow restriction exercise training.
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Affiliation(s)
- Matthew J Clarkson
- Institute for Health & Sport (IHES), Victoria University, Melbourne, Victoria, Australia
| | - Breanna McMahon
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Stuart A Warmington
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
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Hammert WB, Kataoka R, Yamada Y, Song JS, Loenneke JP. Blood flow restriction training attenuates changes in local muscle endurance: At odds with previous work? Exp Physiol 2024; 109:1395-1398. [PMID: 39030974 PMCID: PMC11291865 DOI: 10.1113/ep091924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 04/23/2024] [Indexed: 07/22/2024]
Affiliation(s)
- William B. Hammert
- Kevser Ermin Applied Physiology LaboratoryDepartment of Health, Exercise Science, and Recreation ManagementUniversity of MississippiUniversityMississippiUSA
| | - Ryo Kataoka
- Kevser Ermin Applied Physiology LaboratoryDepartment of Health, Exercise Science, and Recreation ManagementUniversity of MississippiUniversityMississippiUSA
| | - Yujiro Yamada
- Kevser Ermin Applied Physiology LaboratoryDepartment of Health, Exercise Science, and Recreation ManagementUniversity of MississippiUniversityMississippiUSA
| | - Jun Seob Song
- Kevser Ermin Applied Physiology LaboratoryDepartment of Health, Exercise Science, and Recreation ManagementUniversity of MississippiUniversityMississippiUSA
| | - Jeremy P. Loenneke
- Kevser Ermin Applied Physiology LaboratoryDepartment of Health, Exercise Science, and Recreation ManagementUniversity of MississippiUniversityMississippiUSA
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Moreno EN, Figueroa EC, Heath AW, Buckner SL. An examination of acute physiological and perceptual responses following blood flow restriction exercise using a traditional research device or novel, automated system. Physiol Meas 2024; 45:065007. [PMID: 38838705 DOI: 10.1088/1361-6579/ad548c] [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: 09/22/2023] [Accepted: 06/05/2024] [Indexed: 06/07/2024]
Abstract
Objective. To compare the acute physiological and perceptual responses to blood flow restriction (BFR) exercise using a traditional research device or novel, automated system.Methods. Forty-four resistance trained individuals performed four sets of unilateral elbow flexion exercise (30% one-repetition maximum) to volitional failure using two distinct restrictive devices [SmartCuffs PRO BFR Model (SMARTCUFF), Hokanson E20 Rapid Inflation device (HOKANSON)] and with two levels of BFR [40% limb occlusion pressure (LOP), 80% LOP]. Blood pressure (BP), muscle thickness (MT), and isometric strength (ISO) were assessed prior to and following exercise. Perceptual responses [ratings of perceived exertion (RPE), discomfort] were assessed prior to exercise and following each exercise set.Main results. Data are displayed as means (SD). Immediately following exercise with 40% LOP, there were no statistical differences between devices for BP, MT, and ISO. However, only following Set 1 of exercise, RPE was greater with SMARTCUFF compared to HOKANSON (p< 0.05). In addition, only following Set 2 of exercise, discomfort was greater with HOKANSON compared to SMARTCUFF (p< 0.001). Immediately following exercise with 80% LOP, there were no statistical differences between devices for BP, MT, and ISO. However, only following Set 4 of exercise, RPE was greater with HOKANSON compared to SMARTCUFF (p< 0.05). In addition, following all exercise sets, discomfort was greater with HOKANSON compared to SMARTCUFF (p< 0.001). For repetitions completed with 40% LOP there were no statistical differences between SMARTCUFF and HOKANSON across any exercise sets. For repetitions completed with 80% LOP there were no statistical differences between SMARTCUFF and HOKANSON across Set 1 of exercise (p= 0.34), however, for Sets 2-4 of exercise, significantly greater number of repetitions were completed during SMARTCUFF than HOKANSON.Significance. The present study provides valuable insight into the efficacy of a novel, automated BFR system (SMARTCUFF) eliciting comparable acute physiological responses to BFR exercise and in some cases favorable perceptual responses when compared to a traditional research device (HOKANSON).
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Affiliation(s)
- Enrique N Moreno
- USF Muscle Laboratory, Exercise Science Program, University of South Florida, Tampa, FL, United States of America
| | - Elias C Figueroa
- USF Muscle Laboratory, Exercise Science Program, University of South Florida, Tampa, FL, United States of America
| | - Andrew W Heath
- USF Muscle Laboratory, Exercise Science Program, University of South Florida, Tampa, FL, United States of America
| | - Samuel L Buckner
- USF Muscle Laboratory, Exercise Science Program, University of South Florida, Tampa, FL, United States of America
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Zhang WY, Zhuang SC, Chen YM, Wang HN. Validity and reliability of a wearable blood flow restriction training device for arterial occlusion pressure assessment. Front Physiol 2024; 15:1404247. [PMID: 38911327 PMCID: PMC11191424 DOI: 10.3389/fphys.2024.1404247] [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: 03/20/2024] [Accepted: 05/20/2024] [Indexed: 06/25/2024] Open
Abstract
Purpose The blood flow restriction (BFR) training is an effective approach to promoting muscle strength, muscle hypertrophy, and regulating the peripheral vascular system. It is recommended to use to the percentage of individual arterial occlusion pressure (AOP) to ensure safety and effectiveness. The gold standard method for assessing arterial occlusive disease is typically measured using Doppler ultrasound. However, its high cost and limited accessibility restrict its use in clinical and practical applications. A novel wearable BFR training device (Airbands) with automatic AOP assessment provides an alternative solution. This study aims to examine the reliability and validity of the wearable BFR training device. Methods Ninety-two participants (46 female and 46 male) were recruited for this study. Participants were positioned in the supine position with the wearable BFR training device placed on the proximal portion of the right thigh. AOP was measured automatically by the software program and manually by gradually increasing the pressure until the pulse was no longer detected by color Doppler ultrasound, respectively. Validity, inter-rater reliability, and test-retest reliability were assessed by intraclass correlation coefficients (ICC) and Bland-Altman analysis. Results The wearable BFR training device demonstrated good validity (ICC = 0.85, mean difference = 4.1 ± 13.8 mmHg [95% CI: -23.0 to 31.2]), excellent inter-rater reliability (ICC = 0.97, mean difference = -1.4 ± 6.7 mmHg [95% CI: -14.4 to 11.7]), and excellent test-retest reliability (ICC = 0.94, mean difference = 0.6 ± 8.6 mmHg [95% CI: -16.3 to 17.5]) for the assessment of AOP. These results were robust in both male and female subgroups. Conclusion The wearable BFR training device can be used as a valid and reliable tool to assess the AOP of the lower limb in the supine position during BFR training.
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Affiliation(s)
- Wei-Yang Zhang
- School of Sports Medicine and Health, Chengdu Sport University, Chengdu, Sichuan, China
- Sports Medicine Key Laboratory of Sichuan Province, Chengdu, Sichuan, China
| | - Shu-Can Zhuang
- School of Sports Medicine and Health, Chengdu Sport University, Chengdu, Sichuan, China
| | - Yuan-Ming Chen
- School of Sports Medicine and Health, Chengdu Sport University, Chengdu, Sichuan, China
| | - Hao-Nan Wang
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Ida A, Sasaki K. Distinct adaptations of muscle endurance but not strength or hypertrophy to low-load resistance training with and without blood flow restriction. Exp Physiol 2024; 109:926-938. [PMID: 38502540 PMCID: PMC11140179 DOI: 10.1113/ep091310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 03/01/2024] [Indexed: 03/21/2024]
Abstract
Low-load resistance training promotes muscle strength and hypertrophic adaptations when combined with blood flow restriction (BFR). However, the effect of BFR on muscle endurance remains unclear. The aim of this study was to clarify the effects of BFR on muscle performance and adaptation, with special reference to local muscle endurance. In experiment 1, eight healthy men performed unilateral elbow flexion exercise to failure at 30% of one-repetition maximum with BFR (at 40% of estimated arterial occlusion pressure) and free blood flow (FBF). During the exercise, muscle activity and tissue oxygenation were measured from the biceps brachii. In experiment 2, another eight healthy men completed 6 weeks of elbow flexion training with BFR and FBF. The number of repetitions to failure at submaximal load (Rmax), the estimated time for peak torque output to decay by 50% during repetitive maximum voluntary contractions (half-time), one-repetition maximum, isometric strength and muscle thickness of elbow flexors were measured pre- and post-training. Blood flow restriction resulted in fewer repetitions and lower muscle tissue oxygenation at the end of exercise than FBF, while the muscle activity increased similarly to repetition failure. Blood flow restriction also resulted in a smaller post-training Rmax, which was strongly correlated with the total exercise volume over the 6 week period. Despite the smaller exercise volume, BFR resulted in similar improvements in half-time, muscle strength and thickness compared with FBF. These results suggest that the application of BFR can attenuate muscle endurance adaptations to low-load resistance training by decreasing the number of repetitions during exercise, both acutely and chronically.
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Affiliation(s)
- Akito Ida
- Department of Life Sciences, Graduate School of Arts and Sciences, The University of Tokyo, Tokyo, Japan
| | - Kazushige Sasaki
- Department of Life Sciences, Graduate School of Arts and Sciences, The University of Tokyo, Tokyo, Japan
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Jia B, Lv C, Li D, Lv W. Cerebral cortex activation and functional connectivity during low-load resistance training with blood flow restriction: An fNIRS study. PLoS One 2024; 19:e0303983. [PMID: 38781264 PMCID: PMC11115316 DOI: 10.1371/journal.pone.0303983] [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] [Received: 12/19/2023] [Accepted: 05/03/2024] [Indexed: 05/25/2024] Open
Abstract
Despite accumulating evidence that blood flow restriction (BFR) training promotes muscle hypertrophy and strength gain, the underlying neurophysiological mechanisms have rarely been explored. The primary goal of this study is to investigate characteristics of cerebral cortex activity during BFR training under different pressure intensities. 24 males participated in 30% 1RM squat exercise, changes in oxygenated hemoglobin concentration (HbO) in the primary motor cortex (M1), pre-motor cortex (PMC), supplementary motor area (SMA), and dorsolateral prefrontal cortex (DLPFC), were measured by fNIRS. The results showed that HbO increased from 0 mmHg (non-BFR) to 250 mmHg but dropped sharply under 350 mmHg pressure intensity. In addition, HbO and functional connectivity were higher in M1 and PMC-SMA than in DLPFC. Moreover, the significant interaction effect between pressure intensity and ROI for HbO revealed that the regulation of cerebral cortex during BFR training was more pronounced in M1 and PMC-SMA than in DLPFC. In conclusion, low-load resistance training with BFR triggers acute responses in the cerebral cortex, and moderate pressure intensity achieves optimal neural benefits in enhancing cortical activation. M1 and PMC-SMA play crucial roles during BFR training through activation and functional connectivity regulation.
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Affiliation(s)
- Binbin Jia
- School of Sports Training, Wuhan Sports University, Wuhan, China
- School of Physical Education, Wuhan Sports University, Wuhan, China
| | - Chennan Lv
- Center of Strength and Conditioning, Wuhan Sports University, Wuhan, China
| | - Danyang Li
- School of Sports Training, Wuhan Sports University, Wuhan, China
- School of Physical Education, Wuhan Sports University, Wuhan, China
| | - Wangang Lv
- Center of Strength and Conditioning, Wuhan Sports University, Wuhan, China
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Colapietro MA, Lee JZ, Vairo GL. Survey of Blood Flow Restriction Training Applications in Sports Medicine and Performance Practice Across North America. J Strength Cond Res 2024; 38:856-863. [PMID: 38241466 DOI: 10.1519/jsc.0000000000004702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Abstract
Abstract
Colapietro, MA, Lee, JZ, and Vairo, GL. Survey of blood flow restriction training applications in sports medicine and performance practice across North America. J Strength Cond Res 38(5): 856–863, 2024—This study profiled current clinical applications of blood flow restriction (BFR) training and observed side effects by surveying active sports medicine and performance personnel across North America. An online survey consisting of questions derived from a related position statement was distributed through professional organizations, email listservs, and social media. Personnel with experience applying or prescribing BFR training with permanent residence within the United States or Canada were eligible to participate. Variables captured included demographics (profession, practice setting), BFR equipment, treatment parameters, observed side effects, and personal perceptions regarding BFR training. An alpha level of p < 0.05 determined significance. A convenience sample included 72 clinicians with 67 being from the United States. Athletic trainers (n = 35) and physical therapists (n = 30) primarily participated. Chi-square test of independence indicated that a higher proportion of physical therapists (90.3%) report receiving formal education in BFR training compared with athletic trainers (65.7%) (
= 4.1, p = 0.043). Parameters varied between respondents for exercise prescription and occlusion settings. Respondents primarily followed position statement recommendations with individualized pressure selections for resistance (80.9%) and aerobic (84.8%) BFR modes. Side effects reported included delayed onset muscle soreness (66.2%), inability to continue because of pain (28%), and numbness (22.5%). Personal perceptions between athletic trainers and physical therapists were compared using independent t-tests. Physical therapists indicated higher confidence in safety (difference = 0.37 ± 0.32, p = 0.026), understanding recommendations (difference = 0.47 ± 0.37, p = 0.011), and theoretical principles (difference = 0.80 ± 0.53, p = 0.004). Despite variation in BFR parameters used, sports medicine personnel demonstrate compliance with position statement recommendations and report mild side effects.
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Affiliation(s)
- Mark A Colapietro
- Department of Kinesiology, The Pennsylvania State University, University Park, Pennsylvania
| | - Jungmin Z Lee
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, Pennsylvania; and
| | - Giampietro L Vairo
- Department of Kinesiology, The Pennsylvania State University, University Park, Pennsylvania
- Department of Orthopaedics and Rehabilitation, The Pennsylvania State University, University Park, Pennsylvania
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Vehrs PR, Richards S, Allen J, Barrett R, Blazzard C, Burbank T, Hart H, Kasper N, Lacey R, Lopez D, Fellingham GW. Measurements of Arterial Occlusion Pressure Using Hand-Held Devices. J Strength Cond Res 2024; 38:873-880. [PMID: 38241480 DOI: 10.1519/jsc.0000000000004716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Abstract
ABSTRACT Vehrs, PR, Reynolds, S, Allen, J, Barrett, R, Blazzard, C, Burbank, T, Hart, H, Kasper, N, Lacey, R, Lopez, D, and Fellingham, GW. Measurements of arterial occlusion pressure using hand-held devices. J Strength Cond Res 38(5): 873-880, 2024-Arterial occlusion pressure (AOP) of the brachial artery was measured simultaneously using Doppler ultrasound (US), a hand-held Doppler (HHDOP), and a pulse oximeter (PO) in the dominant (DOM) and nondominant (NDOM) arms of males ( n = 21) and females ( n = 23) using continuous (CONT) and incremental (INCR) cuff inflation protocols. A mixed-model analysis of variance revealed significant ( p < 0.05) overall main effects between AOP measured using a CONT (115.7 ± 10.9) or INCR (115.0 ± 11.5) cuff inflation protocol; between AOP measured using US (116.3 ± 11.2), HHDOP (115.4 ± 11.2), and PO (114.4 ± 11.2); and between males (120.7 ± 10.6) and females (110.5 ± 9.4). The small overall difference (1.81 ± 3.3) between US and PO measures of AOP was significant ( p < 0.05), but the differences between US and HHDOP and between HHDOP and PO measures of AOP were not significant. There were no overall differences in AOP between the DOM and NDOM arms. Trial-to-trial variance in US measurements of AOP was not significant when using either cuff inflation protocol but was significant when using HHDOP and PO and a CONT cuff inflation protocol. Bland-Altman plots revealed reasonable limits of agreement for both HHDOP and PO measures of AOP. The small differences in US, HHDOP, and PO measurements of AOP when using CONT or INCR cuff inflation protocols are of minimal practical importance. The choice of cuff inflation protocol is one of personal preference. Hand-held Doppler of PO can be used to assess AOP before using blood flow restriction during exercise.
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Affiliation(s)
- Pat R Vehrs
- Department of Exercise Sciences, Brigham Young University, Provo, Utah; and
| | - Shay Richards
- Department of Exercise Sciences, Brigham Young University, Provo, Utah; and
| | - Josh Allen
- Department of Exercise Sciences, Brigham Young University, Provo, Utah; and
| | - Rachel Barrett
- Department of Exercise Sciences, Brigham Young University, Provo, Utah; and
| | - Chase Blazzard
- Department of Exercise Sciences, Brigham Young University, Provo, Utah; and
| | - Tyler Burbank
- Department of Exercise Sciences, Brigham Young University, Provo, Utah; and
| | - Hannah Hart
- Department of Exercise Sciences, Brigham Young University, Provo, Utah; and
| | - Nicole Kasper
- Department of Exercise Sciences, Brigham Young University, Provo, Utah; and
| | - Ryan Lacey
- Department of Exercise Sciences, Brigham Young University, Provo, Utah; and
| | - Daniela Lopez
- Department of Exercise Sciences, Brigham Young University, Provo, Utah; and
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14
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Kara D, Ozcakar L, Demirci S, Huri G, Duzgun I. Blood Flow Restriction Training in Patients With Rotator Cuff Tendinopathy: A Randomized, Assessor-Blinded, Controlled Trial. Clin J Sport Med 2024; 34:10-16. [PMID: 37706671 DOI: 10.1097/jsm.0000000000001191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 08/06/2023] [Indexed: 09/15/2023]
Abstract
OBJECTIVES To investigate the effects of low-load blood flow restriction (BFR) training on shoulder muscle thickness, rotator cuff (RC) strength, and shoulder symptoms in patients with RC tendinopathy. DESIGN A randomized, assessor-blinded, controlled trial. SETTINGS Physiotherapy clinic at a university. PARTICIPANTS Twenty-eight patients were randomized into an 8-week (2 times/week) shoulder rehabilitation, that is, BFR or non-BFR group. INTERVENTIONS BFR training. MAIN OUTCOME MEASURES (1) RC, deltoid, scapula retractor, and biceps muscle thicknesses and shoulder internal rotation (IR) and external rotation (ER) strengths. (2) Shoulder pain/function. RESULTS The BFR group had a greater increase in biceps muscle thickness ( P = 0.002) and shoulder IR strength at 60 degrees/s ( P = 0.040) than the non-BFR group. No differences between the 2 groups were observed in other measurements. Significant improvements in supraspinatus, infraspinatus, and scapula retractor muscle thicknesses and in shoulder ER and IR strengths were observed over time in both the groups (all P < 0 .05). Also, shoulder pain decreased and shoulder function increased over time in both the groups (all P < 0 .05). CONCLUSIONS Low-load BFR training resulted in a greater increase in biceps thickness and shoulder IR strength compared with the non-BFR group in patients with RC tendinopathy. However, there was no superiority of either exercise training regarding the RC, scapula retractor, deltoid muscle thicknesses, or improvements in shoulder ER strength and shoulder pain/function. CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER The study was registered in ClinicalTrials.gov named Blood Flow Restriction Training in Patients with Shoulder Pain and the registration number is NCT04333784.
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Affiliation(s)
- Dilara Kara
- Department of Sports Physical Therapy, Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Sihhiye, Ankara, Turkey
| | - Levent Ozcakar
- Department of Physical and Rehabilitation Medicine, School of Medicine, Hacettepe University, Sihhiye, Ankara, Turkey
| | - Serdar Demirci
- Department of Physical Therapy and Rehabilitation, Faculty of Health Sciences, Balıkesir University, Balikesir, Turkey; and
| | - Gazi Huri
- Department of Orthopedics and Traumatology, School of Medicine, Hacettepe University, Sihhiye, Ankara, Turkey
| | - Irem Duzgun
- Department of Sports Physical Therapy, Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Sihhiye, Ankara, Turkey
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15
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Jønsson AB, Krogh S, Laursen HS, Aagaard P, Kasch H, Nielsen JF. Safety and efficacy of blood flow restriction exercise in individuals with neurological disorders: A systematic review. Scand J Med Sci Sports 2024; 34:e14561. [PMID: 38268066 DOI: 10.1111/sms.14561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/02/2024] [Accepted: 01/03/2024] [Indexed: 01/26/2024]
Abstract
OBJECTIVES This systematic review evaluated the safety and efficacy of blood flow restriction exercise (BFRE) on skeletal muscle size, strength, and functional performance in individuals with neurological disorders (ND). METHODS A literature search was performed in PubMed, CINAHL, and Embase. Two researchers independently assessed eligibility and performed data extraction and quality assessments. ELIGIBILITY CRITERIA Study populations with ND, BFRE as intervention modality, outcome measures related to safety or efficacy. RESULTS Out of 443 studies identified, 16 were deemed eligible for review. Three studies examined the efficacy and safety of BFRE, one study focused on efficacy results, and 12 studies investigated safety. Disease populations included spinal cord injury (SCI), inclusion body myositis (sIBM), multiple sclerosis (MS), Parkinson's disease (PD), and stroke. A moderate-to-high risk of bias was presented in the quality assessment. Five studies reported safety concerns, including acutely elevated pain and rating of perceived exertion levels, severe fatigue, muscle soreness, and cases of autonomic dysreflexia. Two RCTs reported a significant between-group difference in physical function outcomes, and two RCTs reported neuromuscular adaptations. CONCLUSION BFRE seems to be a potentially safe and effective training modality in individuals with ND. However, the results should be interpreted cautiously due to limited quality and number of studies, small sample sizes, and a general lack of heterogeneity within and between the examined patient cohorts.
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Affiliation(s)
- Anette Bach Jønsson
- Spinal Cord Injury Center of Western Denmark, Viborg, Denmark
- Department of Clinical Medicine, Health, Aarhus University, Aarhus N, Denmark
| | - Søren Krogh
- Spinal Cord Injury Center of Western Denmark, Viborg, Denmark
- Department of Clinical Medicine, Health, Aarhus University, Aarhus N, Denmark
| | | | - Per Aagaard
- Institute of Sports Science and Clinical Biomechanics, Muscle Physiology and Biomechanics Research Unit, University of Southern, Odense, Denmark
| | - Helge Kasch
- Department of Clinical Medicine, Health, Aarhus University, Aarhus N, Denmark
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Jørgen Feldbaek Nielsen
- Spinal Cord Injury Center of Western Denmark, Viborg, Denmark
- Department of Clinical Medicine, Health, Aarhus University, Aarhus N, Denmark
- Hammel Neurorehabilitation Centre and University Clinic, Hammel, Denmark
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16
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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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17
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Wang Y, Li Z, Tongtong C, Zhang W, Li X. Effect of continuous and intermittent blood flow restriction deep-squat training on thigh muscle activation and fatigue levels in male handball players. Sci Rep 2023; 13:19152. [PMID: 37932313 PMCID: PMC10628241 DOI: 10.1038/s41598-023-44523-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 10/09/2023] [Indexed: 11/08/2023] Open
Abstract
We aimed to investigate acute changes before and after low-intensity continuous and intermittent blood flow restriction (BFR) deep-squat training on thigh muscle activation characteristics and fatigue level under suitable individual arterial occlusion pressure (AOP). Twelve elite male handball players were recruited. Continuous (Program 1) and intermittent (Program 2) BFR deep-squat training was performed with 30% one-repetition maximum load. Program 1 did not include decompression during the intervals, while Program 2 contained decompression during each interval. Electromyography (EMG) was performed before and after two BFR training programs in each period. EMG signals of the quadriceps femoris, posterior femoral muscles, and gluteus maximus, including the root mean square (RMS) and normalized RMS and median frequency (MF) values of each muscle group under maximum voluntary contraction (MVC), before and after training were calculated. The RMS value under MVC (RMSMVC) of the rectus femoris (RF), vastus medialis (VM), vastus lateralis (VL), and gluteus maximus (GM) decreased after continuous and intermittent BFR training programs, and those of the biceps femoris (BF) and semitendinosus (SEM) increased; The RMS standard values of the VL, BF, and SEM were significantly increased after continuous and intermittent BFR training (P < 0.05), The RMS value of GM significantly decreased after cuff inflating (P < 0.05). The MF values of RF, VM, VL, and GM decreased significantly after continuous BFR training (P < 0.05). Continuous BFR deep-squat training applied at 50% AOP was more effective than the intermittent BFR training program. Continuous application of BFR induces greater levels of acute fatigue than intermittent BFR that may translate into greater muscular training adaptations over time.
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Affiliation(s)
- Yan Wang
- Department of Physical Education Teaching and Research, Fuzhou University, Fuzhou, 350108, Fujian, China
| | - Zhiyuan Li
- Department of Public Physical and Art Education, Zhejiang University, Hangzhou, 310058, Zhejiang, China.
| | - Che Tongtong
- School of Physical Education, Qingdao University, Qingdao, 266071, China.
| | - Wenjuan Zhang
- Department of Military Theory, Fuzhou University, Fuzhou, 350108, Fujian, China.
| | - Xiaoxiao Li
- Department of Military Theory, Fuzhou University, Fuzhou, 350108, Fujian, China
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18
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Vehrs PR, Richards S, Blazzard C, Hart H, Kasper N, Lacey R, Lopez D, Baker L. Use of a handheld Doppler to measure brachial and femoral artery occlusion pressure. Front Physiol 2023; 14:1239582. [PMID: 37664423 PMCID: PMC10470651 DOI: 10.3389/fphys.2023.1239582] [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: 06/13/2023] [Accepted: 08/01/2023] [Indexed: 09/05/2023] Open
Abstract
Objective: Measurement of arterial occlusion pressure (AOP) is essential to the safe and effective use of blood flow restriction during exercise. Use of a Doppler ultrasound (US) is the "gold standard" method to measure AOP. Validation of a handheld Doppler (HHDOP) device to measure AOP could make the measurement of AOP more accessible to practitioners in the field. The purpose of this study was to determine the accuracy of AOP measurements of the brachial and femoral arteries using an HHDOP. Methods: We simultaneously measured AOP using a "gold standard" US and a HHDOP in the dominant and non-dominant arms (15 males; 15 females) and legs (15 males; 15 females). Results: There were no differences in limb circumference or limb volume in the dominant and non-dominant arms and legs between males and females or between the dominant and non-dominant arms and legs of males and females. The differences between US and HHDOP measures of AOP in the dominant and non-dominant arms and legs were either not significant or small (<10 mmHg) and of little practical importance. There were no sex differences in AOP measurements of the femoral artery (p > 0.60). Bland-Altman analysis yielded an average bias (-0.65 mmHg; -2.93 mmHg) and reasonable limits of agreement (±5.56 mmHg; ±5.58 mmHg) between US and HHDOP measures of brachial and femoral artery AOP, respectively. Conclusion: HHDOP yielded acceptable measures of AOP of the brachial and femoral arteries and can be used to measure AOP by practitioners for the safe and effective use of blood flow restriction. Due to the potential differences in AOP between dominant and non-dominant limbs, AOP should be measured in each limb.
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Affiliation(s)
- Pat R. Vehrs
- Department of Exercise Sciences, Brigham Young University, Provo, UT, United States
| | - Shay Richards
- Department of Exercise Sciences, Brigham Young University, Provo, UT, United States
| | - Chase Blazzard
- Department of Exercise Sciences, Brigham Young University, Provo, UT, United States
| | - Hannah Hart
- Department of Exercise Sciences, Brigham Young University, Provo, UT, United States
| | - Nicole Kasper
- Department of Exercise Sciences, Brigham Young University, Provo, UT, United States
| | - Ryan Lacey
- Department of Exercise Sciences, Brigham Young University, Provo, UT, United States
| | - Daniela Lopez
- Department of Exercise Sciences, Brigham Young University, Provo, UT, United States
| | - Luke Baker
- Department of Statistics, Ohio State University, Columbus, OH, United States
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19
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Sun D, Yang T. Semi-Squat Exercises with Varying Levels of Arterial Occlusion Pressure during Blood Flow Restriction Training Induce a Post-Activation Performance Enhancement and Improve Vertical Height Jump in Female Football Players. J Sports Sci Med 2023; 22:212-225. [PMID: 37293415 PMCID: PMC10244989 DOI: 10.52082/jssm.2023.212] [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: 01/02/2023] [Accepted: 03/30/2023] [Indexed: 06/10/2023]
Abstract
Low-load blood flow restriction training (BFRT) has been shown to induce a significant increase in muscle activation. However, low-load BFRT to augment the post-activation performance enhancement (PAPE) has not been previously examined. This study aimed to examine the PAPE of low-intensity semi-squat exercises with varying pressure BFRT on vertical height jump performance. Twelve elite athletes from the Shaanxi Province women's football team volunteered to participate in this study for 4 weeks. Participants completed four testing sessions that included one of the following at random: (1) non-BFRT, (2) 50% arterial occlusion pressure (AOP), (3) 60% AOP, or (4) 70% AOP. Muscle activity of the lower thigh muscles was recorded using electromyography (EMG). Jump height, peak power output (PPO), vertical ground reaction forces (vGRF), and rate of force development (RFD) were recorded for four trials. Two-factor repeated measures analysis of variance (ANOVA) showed that semi-squat with varying pressure BFRT had a significant impact on the measured muscle EMG amplitude and MF value of vastus medialis, vastus lateralis, rectus femoris, and biceps femoris (P < 0.05), and MF value decreased with increasing pressure. Muscle activation (EMG amplitude) did not change further. The EMG amplitude of the gluteus maximus was significantly decreased by semi-squat training with different pressures (P < 0.05), while that of the gluteus maximus muscle was gradually increased by non-BFR with semi-squat training (P > 0.05). The 50% and 60% AOP BFRTs significantly increased jump height, peak power, and force increase rate (RFD) after 5 min and 10 min of rest (P < 0.05). This study further confirmed that low-intensity BFRT can significantly increase lower limb muscle activation, induce PAPE, and improve vertical height jump in female footballers. In addition, 50% AOP continuous BFRT is recommended for warm-up activities.
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Affiliation(s)
- Depeng Sun
- Graduate department, Capital University of Physical Education and Sports, Beijing 100191, China
- Department of PE, Xi'an University of Finance and Economics, Xi'an 710100, China
| | - Tieli Yang
- Graduate department, Capital University of Physical Education and Sports, Beijing 100191, China
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20
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Yamada Y, Kang A, Seffrin A, Song JS, Kataoka R, Hammert WB, Spitz RW, Wong V, Loenneke JP. Potential considerations with estimating blood flow restriction pressure in the lower body using a narrower cuff. Eur J Appl Physiol 2023; 123:937-943. [PMID: 36580110 DOI: 10.1007/s00421-022-05122-y] [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: 10/26/2022] [Accepted: 12/21/2022] [Indexed: 12/30/2022]
Abstract
Blood flow restriction pressures are typically set as a percentage of the arterial occlusion pressure. For those who do not have the ability to measure the arterial occlusion pressure, estimation equations are available. However, notable considerations are needed when estimating pressure with a narrow cuff (5 cm) in the lower body. A previously published equation in this journal was developed but was created only using 55% of the sample because the arterial occlusion of the others could not be obtained within the manufacturer's pressure limit. The purpose of this article was twofold: (1) to investigate how previous studies have implemented the equation and (2) to highlight potential concerns of using this equation. Two databases were used to locate articles that used the equation from Loenneke et al. (2015). We found that this equation had been cited 10 times to estimate arterial occlusion pressure with some notable concerns. Some did not use a 5 cm wide cuff, while others used it for participants who had arterial occlusion pressures exceeding 300 mmHg. To highlight the latter, we also applied the Loenneke et al. (2015) lower body equation to participants with arterial occlusion pressures known to exceed 300 mmHg to demonstrate potential concerns. This retrospective analysis found that 52% of the sample with known pressures over 300 mmHg (40 out of 77) would be estimated below 300 mmHg. This paper highlighted important considerations for those trying to estimate arterial occlusion pressure in the lower body with a narrow cuff (5 cm).
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Affiliation(s)
- Yujiro Yamada
- Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, MS, USA
| | - Anna Kang
- Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, MS, USA
| | - Aldo Seffrin
- Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, MS, USA
| | - Jun Seob Song
- Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, MS, USA
| | - Ryo Kataoka
- Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, MS, USA
| | - William B Hammert
- Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, MS, USA
| | - Robert W Spitz
- Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, MS, USA
| | - Vickie Wong
- Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, MS, USA
| | - Jeremy P Loenneke
- Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, MS, USA.
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21
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Gray SM, Cuomo AM, Proppe CE, Traylor MK, Hill EC, Keller JL. Effects of Sex and Cuff Pressure on Physiological Responses during Blood Flow Restriction Resistance Exercise in Young Adults. Med Sci Sports Exerc 2023; 55:920-931. [PMID: 36729632 DOI: 10.1249/mss.0000000000003103] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE The purpose of this study was to examine the physiological responses resulting from an acute blood flow restriction resistance exercise bout with two different cuff pressures in young, healthy men and women. METHODS Thirty adults (18-30 yr) completed a bilateral leg extension blood flow restriction bout consisting of four sets (30-15-15-15 repetitions), with cuffs applied at pressures corresponding to 40% and 60% of the minimum arterial occlusion pressure (AOP) needed to completely collapse the femoral arteries. During each of these conditions (40% and 60% AOP), physiological measures of near-infrared spectroscopy (NIRS) and EMG amplitude (EMG AMP) were collected from the dominant or nondominant vastus lateralis. After each set, ratings of perceived exertion (RPE) were collected, whereas only at baseline and at the end of the bout, mean arterial pressure (MAP) was assessed. Separate mixed-factorial ANOVA models were used to examine mean differences in the change in EMG AMP and NIRS parameters during each set. The absolute RPE and MAP values were also examined with separate ANOVAs. A P value ≤0.05 was considered statistically significant. RESULTS Regardless of sex or cuff pressure, the change in EMG AMP was lower in set 1 (14.8%) compared with the remaining sets (22.6%-27.0%). The 40% AOP condition elicited the greatest changes in oxy[heme] and deoxy[heme], while also providing lower RPEs. For MAP, there was an effect for time such that MAP increased from preexercise (87.5 ± 4.3 mm Hg) to postexercise (104.5 ± 4.1 mm Hg). CONCLUSIONS The major findings suggested that the 40% AOP condition permitted the greatest amount of recovery during the interset rest. In addition, there did not seem to be any meaningful sex-related difference in this sample of young healthy adults.
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Affiliation(s)
- Sylvie M Gray
- Integrated Laboratory of Exercise and Applied Physiology (iLEAP), Department of Health, Kinesiology and Sport, College of Education and Professional Studies, University of South Alabama, Mobile, AL
| | | | - Christopher E Proppe
- Division of Kinesiology, School of Kinesiology and Physical Therapy, University of Central Florida, Orlando, FL
| | - Miranda K Traylor
- Integrated Laboratory of Exercise and Applied Physiology (iLEAP), Department of Health, Kinesiology and Sport, College of Education and Professional Studies, University of South Alabama, Mobile, AL
| | | | - Joshua L Keller
- Integrated Laboratory of Exercise and Applied Physiology (iLEAP), Department of Health, Kinesiology and Sport, College of Education and Professional Studies, University of South Alabama, Mobile, AL
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22
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Roehl T, Lambert BS, Ankersen J, Hernandez K, McCulloch PC, Hedt C. Optimal Blood Flow Restriction Occlusion Pressure for Shoulder Muscle Recruitment With Upper Extremity Exercise. Am J Sports Med 2023:3635465231166959. [PMID: 37092707 DOI: 10.1177/03635465231166959] [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] [Indexed: 04/25/2023]
Abstract
BACKGROUND As blood flow restriction (BFR) utilization continues to rise, it is crucial to define optimal parameters for use. Currently unknown are the effects of occlusion level during BFR on muscle activity in the proximal shoulder. PURPOSE/HYPOTHESIS The purpose of this study was to compare electromyographic amplitude (EMGa) of shoulder musculature during exercise using limb occlusion percentages (LOPs). The authors hypothesized that EMGa would increase concurrently with occlusion. STUDY DESIGN Controlled laboratory study. METHODS α Fifteen healthy adults were recruited and underwent 4 experimental sessions, performing 3 common rotator cuff exercises at low intensity (20% maximal strength) to failure in the following order: cable external rotation (ER), cable internal rotation (IR), and dumbbell scaption. Exercises were completed at a different occlusion pressure (0%, 25%, 50%, and 75% LOP- order randomized) applied at the proximal arm. EMGa was recorded from shoulder musculature proximal to the occlusion site and averaged across 5-repetition intervals and overall for the first 30 repetitions. An analysis of variance repeated on occlusion pressure followed by a Bonferroni post hoc test was used to compare EMGa, repetitions to fatigue, and ratings of discomfort (visual analog scale [VAS], 0-10) between occlusion pressures. The type 1 error was set at α = .05 for all analyses. RESULTS Significant effects of the occlusion level on shoulder muscle EMGa were observed for all exercises (P < .05) with diminishing returns above 50% LOP (overall). For ER, elevations in EMGa were observed at ≥50% LOP for the anterior deltoid, middle deltoid, infraspinatus, and trapezius compared with 0% LOP (P < .05). For IR, elevations in EMGa were observed at ≥25% LOP for the anterior deltoid and trapezius compared with 0% LOP (P < .05). For the teres minor, a significant elevation in EMGa occurred at 75% LOP compared with 0%, 25%, and 50% LOP (P < .05). A decrease in EMGa was observed at ≥50% LOP compared with 0% LOP for the posterior deltoid (P < .05). For scaption, an increase in EMGa was observed at ≥25% LOP for the infraspinatus and teres minor muscles, at 75% LOP for the posterior deltoid, and at ≥50% LOP for the trapezius compared with 0% LOP (P < .05). Decreases in repetitions to failure relative to 0% LOP were observed at 75% LOP for ER (0%: 47 ± 5; 75%: 40 ± 2; P = .034), IR (0%: 82 ± 10; 75%: 64 ± 5; P = .017), and scaption (0%: 85 ± 9; 75%: 64 ± 6; P < .001). A significant linear increase in discomfort was observed for all exercises with increasing occlusion pressures (VAS: 0-10, 0% → 75% LOP; ER: 2.2 ± 0.4 → 7.2 ± 0.3; IR: 1.3 ± 0.2 → 6.1 ± 0.6; scaption: 1.3 ± 0.4 → 6.1 ± 0.4; P < .01). CONCLUSION There are several differences in muscle activation about the shoulder based on exercise and occlusion when utilizing BFR. Increasing the percentage of limb occlusion leads to heightened EMGa with diminished returns past 50% LOP when considering muscle activation, discomfort, and achievable exercise volume. CLINICAL RELEVANCE These findings may be used to refine upper extremity BFR guidelines.
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Affiliation(s)
- Tyler Roehl
- Houston Methodist, Department of Orthopedics & Sports Medicine, Houston, Texas, USA
| | - Bradley S Lambert
- Houston Methodist, Department of Orthopedics & Sports Medicine, Houston, Texas, USA
| | - Jordan Ankersen
- Houston Methodist, Department of Orthopedics & Sports Medicine, Houston, Texas, USA
| | - Karen Hernandez
- Houston Methodist, Department of Orthopedics & Sports Medicine, Houston, Texas, USA
| | - Patrick C McCulloch
- Houston Methodist, Department of Orthopedics & Sports Medicine, Houston, Texas, USA
| | - Corbin Hedt
- Houston Methodist, Department of Orthopedics & Sports Medicine, Houston, Texas, USA
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23
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Neal BS, McManus CJ, Bradley WJ, Leaney SF, Murray K, Clark NC. The feasibility, safety, and efficacy of lower limb garment-integrated blood flow restriction training in healthy adults. Phys Ther Sport 2023; 60:9-16. [PMID: 36640641 DOI: 10.1016/j.ptsp.2023.01.006] [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: 09/28/2022] [Revised: 01/06/2023] [Accepted: 01/07/2023] [Indexed: 01/11/2023]
Abstract
OBJECTIVES Explore the feasibility of lower-limb garment-integrated BFR-training. DESIGN Observational study. SETTING Human performance laboratory. PARTICIPANTS Healthy males with no experience of BFR-training. MAIN OUTCOME MEASURES Feasibility was determined by a priori thresholds for recruitment, adherence, and data collection. Safety was determined by measuring BFR torniquet pressure and the incidence of side effects. Efficacy was determined by measuring body anthropometry and knee isokinetic dynamometry. Feasibility and safety outcomes were reported descriptively or as a proportion with 95% confidence intervals (95% CI), with mean change, 95% CIs, and effect sizes for efficacy outcomes. RESULTS Twelve participants (mean age 24.8 years [6.5]) were successfully recruited; 11 completed the study. 134/136 sessions were completed (adherence = 98.5%) and 100% of data were collected. There was one event of excessive pain during exercise (0.7%, 95% CI 0.0%, 4.0%), two events of excessive pain post-exercise (1.5%, 95% CI 0.4%, 5.5%), and one event of persistent paraesthesia post-exercise (0.7%, 95% CI 0.0%, 4.0%). Mean maximal BFR torniquet pressure was <200 mmHg. We observed an increase in knee extension peak torque (mean change 12.4 Nm), but no notable changes in body anthropometry. CONCLUSIONS Lower-limb garment-integrated BFR-training is feasible, has no signal of important harm, and could be used independently.
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Affiliation(s)
- Bradley S Neal
- School of Sport, Rehabilitation & Exercise Sciences, University of Essex, Wivenhoe Park, Colchester, Essex, CO4 3SQ, United Kingdom.
| | - Chris J McManus
- School of Sport, Rehabilitation & Exercise Sciences, University of Essex, Wivenhoe Park, Colchester, Essex, CO4 3SQ, United Kingdom
| | - Warren J Bradley
- Hytro Ltd, 2 Park Court, Pyford Road, West Byfleet, Surrey, KT14 6SD, United Kingdom
| | - Sam F Leaney
- School of Sport, Rehabilitation & Exercise Sciences, University of Essex, Wivenhoe Park, Colchester, Essex, CO4 3SQ, United Kingdom
| | - Kelly Murray
- School of Sport, Rehabilitation & Exercise Sciences, University of Essex, Wivenhoe Park, Colchester, Essex, CO4 3SQ, United Kingdom
| | - Nicholas C Clark
- School of Sport, Rehabilitation & Exercise Sciences, University of Essex, Wivenhoe Park, Colchester, Essex, CO4 3SQ, United Kingdom
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24
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Rivera PM, Proppe CE, Gonzalez-Rojas D, Wizenberg A, Hill EC. Effects Of Load Matched Isokinetic Versus Isotonic Blood Flow Restricted Exercise on Neuromuscular and Muscle Function. Eur J Sport Sci 2023:1-9. [PMID: 36825621 DOI: 10.1080/17461391.2023.2184724] [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: 02/25/2023]
Abstract
ABSTRACTPURPOSE: The purpose of this investigation was to examine neuromuscular function, muscle fatigue, rating of perceived exertion (RPE), and muscle swelling between isokinetic and isotonic leg extensions with blood flow restriction (BFR). METHODS: Fourteen (21±2years; 160cm±3.8; 61kg±9.1) trained women performed 75 (1×30,3×15) submaximal (30% of maximal strength), unilateral, isokinetic and isotonic leg extensions with BFR (60% of total arterial occlusion pressure). Before and after exercise, subjects performed maximal voluntary isometric contractions (MVIC) and muscle thickness (MT) was assessed with ultrasound. RPE was recorded across all sets and surface electromyography (EMG) was assessed during the MVIC muscle actions. Separate repeated measures ANOVAs were used to examine MVIC, MT, RPE and neuromuscular function. RESULTS: There were greater reductions in MVIC torque and EMG mean power frequency following isotonic (46.2±17.1%; 16.4±7.9%) than isokinetic (17.9±10.9%;6.5±6.3%). RPE was also higher during isotonic (7.5±2.2), than isokinetic (5.7±1.9). There were no differences in EMG amplitude or MT increases (20±2.1%) between conditions. CONCLUSIONS: Isotonic BFR elicited greater fatigue-induced decreases in muscular strength and greater RPE than isokinetic BFR, but similar MT and muscle excitation responses for both conditions. Therefore, both isokinetic and isotonic may induce similar acute physiological responses, but isotonic BFR was associated with greater muscle fatigue and perceived effort.
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Affiliation(s)
- Paola M Rivera
- Exercise Physiology Intervention & Collaboration Laboratory, School of Kinesiology & Physical Therapy, Division of Kinesiology, University of Central Florid, Orlando, Florida 32816
| | - Christopher E Proppe
- Exercise Physiology Intervention & Collaboration Laboratory, School of Kinesiology & Physical Therapy, Division of Kinesiology, University of Central Florid, Orlando, Florida 32816
| | - David Gonzalez-Rojas
- Exercise Physiology Intervention & Collaboration Laboratory, School of Kinesiology & Physical Therapy, Division of Kinesiology, University of Central Florid, Orlando, Florida 32816
| | - Aaron Wizenberg
- Exercise Physiology Intervention & Collaboration Laboratory, School of Kinesiology & Physical Therapy, Division of Kinesiology, University of Central Florid, Orlando, Florida 32816
| | - Ethan C Hill
- Exercise Physiology Intervention & Collaboration Laboratory, School of Kinesiology & Physical Therapy, Division of Kinesiology, University of Central Florid, Orlando, Florida 32816.,Florida Space Institute, Partnership I, Research Parkway, University of Central Florida, Orlando, FL 32826
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25
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Kataoka R, Spitz RW, Wong V, Bell ZW, Yamada Y, Song JS, Hammert WB, Dankel SJ, Abe T, Loenneke JP. Sex segregation in strength sports: Do equal-sized muscles express the same levels of strength between sexes? Am J Hum Biol 2023; 35:e23862. [PMID: 36610023 DOI: 10.1002/ajhb.23862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 12/06/2022] [Accepted: 12/26/2022] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES Concerns have been raised against the current two-sex binary category in sports competitions. The thesis states that if males and females were separated based on muscle size, it would negate the strength advantage between the sexes. We tested the possible sex differences in various strength outcomes when pair-matched for muscle thickness. METHODS A total of 16 different data sets (n = 963) were assessed to pair-match females with males who had a muscle thickness value within 2%. We further compared the competition performances of the smallest male weight class within the International Powerlifting Federation (IPF) to different weight classes in females. RESULTS Overall, 76%-88% of the strength assessments were greater in males than females with pair-matched muscle thickness, regardless of contraction types (i.e., isotonic, isometric, isokinetic). Additionally, males in the lightest weight division in the IPF largely outperformed females in heavier weight divisions. CONCLUSIONS Our results would suggest that segregation based on muscle mass or surrogates of muscle mass (e.g., lean body mass) might not be an appropriate classification to create fair competition within strength sports. This is not to refute the concept of the desegregation of the two-sex binary category but to present data that raises important concerns about the potential sex-based differences in strength performance.
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Affiliation(s)
- Ryo Kataoka
- Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, Mississippi, USA
| | - Robert W Spitz
- Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, Mississippi, USA
| | - Vickie Wong
- Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, Mississippi, USA
| | - Zachary W Bell
- Department of Kinesiology and Physical Education, McGill University, Montreal, Quebec, Canada
| | - Yujiro Yamada
- Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, Mississippi, USA
| | - Jun Seob Song
- Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, Mississippi, USA
| | - William B Hammert
- Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, Mississippi, USA
| | - Scott J Dankel
- Department of Health and Exercise Science, Exercise Physiology Laboratory, Rowan University, Glassboro, New Jersey, USA
| | - Takashi Abe
- Graduate School of Health and Sports Science, Juntendo University, Inzai, Japan
| | - Jeremy P Loenneke
- Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, Mississippi, USA
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26
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Johns W, Wiafe BM, Hammoud S. Blood Flow Restriction Following ACL Reconstruction. VIDEO JOURNAL OF SPORTS MEDICINE 2023. [DOI: 10.1177/26350254221148215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Background: Blood flow restriction (BFR) therapy is a technique that uses partial occlusion of arterial blood flow in tandem with low-load resistance training to promote an environment of metabolic stress within muscle tissue. It is hypothesized that such therapy can facilitate protein synthesis and muscle hypertrophy even in the setting of age, injury, or postoperative rehabilitation—conditions which are marred by muscle atrophy and progressive loss of function. Therefore, BFR may be a successful option to facilitate strength gains even in patients unable to perform traditional high-load resistance training. Indications: BFR therapy has been shown to be efficacious when used in healthy athletes, the elderly, or in postoperative patients undergoing rehabilitation after upper or lower extremity procedures. More specifically, BFR application in patients undergoing knee surgery has been shown to reduce muscle atrophy post operatively. Technique Description: BFR involves application of a tourniquet or occlusion cuff at 70% of the determined arterial occlusion pressure (commonly 150-180 mm Hg). The arterial occlusion pressure is calculated by observing the loss of Doppler ultrasonography signal at the pedal pulses with sequential inflation of a blood pressure cuff. This cuff should be applied as proximal as possible at the affected extremity. The patient subsequently performs 5 exercises, including 3 sets of 15 repetitions of each exercise, with 30 seconds of rest in between sets. The cuff remains inflated for all 5 exercises. Results: BFR in tandem with low-load resistance training has been shown to be effective in improving lower extremity muscle torque and mass of the quadriceps and hamstring muscles when used after knee surgery, specifically anterior cruciate ligament (ACL) reconstruction. The most commonly reported adverse outcomes after BFR include muscle soreness and sensory paresthesias; however, BFR is generally believed to be safe and acceptable for use in a broad spectrum of patients. Discussion/Conclusion: Muscle atrophy and loss of strength are hallmarks of aging, injured, and postoperative patients. Traditional means of high-intensity strength training is not feasible in these patient populations, and the use of BFR in tandem with lower intensity strength training shows promise in its ability to promote improvements in muscle strength and hypertrophy. However, more high-level research into the long-term effects, complications, and optimal BFR training regimen is warranted. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
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Affiliation(s)
- William Johns
- Department of Orthopedic Surgery, Rothman Institute/Jefferson, Philadelphia, Pennsylvania, USA
| | - Bright M. Wiafe
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Sommer Hammoud
- Department of Orthopedic Surgery, Rothman Institute/Jefferson, Philadelphia, Pennsylvania, USA
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27
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Rolnick N, Kimbrell K, de Queiros V. Beneath the cuff: Often overlooked and under-reported blood flow restriction device features and their potential impact on practice-A review of the current state of the research. Front Physiol 2023; 14:1089065. [PMID: 37064884 PMCID: PMC10099250 DOI: 10.3389/fphys.2023.1089065] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 03/06/2023] [Indexed: 04/18/2023] Open
Abstract
Training with blood flow restriction (BFR) has been shown to be a useful technique to improve muscle hypertrophy, muscle strength and a host of other physiological benefits in both healthy and clinical populations using low intensities [20%-30% 1-repetition maximum (1RM) or <50% maximum oxygen uptake (VO2max)]. However, as BFR training is gaining popularity in both practice and research, there is a lack of awareness for potentially important design characteristics and features associated with BFR cuff application that may impact the acute and longitudinal responses to training as well as the safety profile of BFR exercise. While cuff width and cuff material have been somewhat addressed in the literature, other cuff design and features have received less attention. This manuscript highlights additional cuff design and features and hypothesizes on their potential to impact the response and safety profile of BFR. Features including the presence of autoregulation during exercise, the type of bladder system used, the shape of the cuff, the set pressure versus the interface pressure, and the bladder length will be addressed as these variables have the potential to alter the responses to BFR training. As more devices enter the marketplace for consumer purchase, investigations specifically looking at their impact is warranted. We propose numerous avenues for future research to help shape the practice of BFR that may ultimately enhance efficacy and safety using a variety of BFR technologies.
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Affiliation(s)
- Nicholas Rolnick
- The Human Performance Mechanic, CUNY Lehman College, NY, United States
- *Correspondence: Nicholas Rolnick,
| | - Kyle Kimbrell
- Owens Recovery Science, San Antonio, TX, United States
| | - Victor de Queiros
- Graduate Program in Health Sciences, Federal University of Rio Grande do Norte (UFRN), NatalRN, Brazil
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28
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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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30
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Exercised-Induced Hypoalgesia following An Elbow Flexion Low-Load Resistance Exercise with Blood Flow Restriction: A Sham-Controlled Randomized Trial in Healthy Adults. Healthcare (Basel) 2022; 10:healthcare10122557. [PMID: 36554080 PMCID: PMC9778505 DOI: 10.3390/healthcare10122557] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 11/29/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
We aimed to evaluate the hypoalgesic effect of an elbow flexion low-load resistance exercise with blood flow restriction (LLRE-BFR) when compared to high-load resistance exercise (HLRE) with sham-BFR in healthy individuals. Forty healthy young adults (17 women), with a mean age ± SD: 26.6 ± 6.8 years, and mean body mass index ± SD: 23.6 ± 2.7 were randomly assigned to either an LLRE-BFR (30% 1 repetition maximum, RM) or an HLRE with sham-BFR group (70% of 1 RM). Blood pressure and pressure pain thresholds (PPTs) were measured pre- and post-exercise intervention. The rating of perceived exertion (RPE) was recorded after each set. There were non-significant between-group changes in PPT at the dominant biceps (-0.61, 95%CI: -1.92 to 0.68) with statistically significant reductions between pre- and post-exercise in LLRE-BFR (effect size, d = 0.88) and HLRE-BFR (effect size, d = 0.52). No within- or between-group differences were recorded in PPT at non-exercising sites of measurement. No mediating effects of changes in blood pressure or RPE on the changes in pressure pain threshold were observed. LLRE-BFR produced a similar hypoalgesic effect locally compared to HLRE and can be used as an alternative intervention to decrease pain sensitivity when HLRE is contraindicated or should be avoided.
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31
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Smith NDW, Scott BR, Girard O, Peiffer JJ. Aerobic Training With Blood Flow Restriction for Endurance Athletes: Potential Benefits and Considerations of Implementation. J Strength Cond Res 2022; 36:3541-3550. [PMID: 34175880 DOI: 10.1519/jsc.0000000000004079] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
ABSTRACT Smith, NDW, Scott, BR, Girard, O, and Peiffer, JJ. Aerobic training with blood flow restriction for endurance athletes: potential benefits and considerations of implementation. J Strength Cond Res 36(12): 3541-3550, 2022-Low-intensity aerobic training with blood flow restriction (BFR) can improve maximal oxygen uptake, delay the onset of blood lactate accumulation, and may provide marginal benefits to economy of motion in untrained individuals. Such a training modality could also improve these physiological attributes in well-trained athletes. Indeed, aerobic BFR training could be beneficial for those recovering from injury, those who have limited time for training a specific physiological capacity, or as an adjunct training stimulus to provide variation in a program. However, similarly to endurance training without BFR, using aerobic BFR training to elicit physiological adaptations in endurance athletes will require additional considerations compared with nonendurance athletes. The objective of this narrative review is to discuss the acute and chronic aspects of aerobic BFR exercise for well-trained endurance athletes and highlight considerations for its effective implementation. This review first highlights key physiological capacities of endurance performance. The acute and chronic responses to aerobic BFR exercise and their impact on performance are then discussed. Finally, considerations for prescribing and monitoring aerobic BFR exercise in trained endurance populations are addressed to challenge current views on how BFR exercise is implemented.
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Affiliation(s)
- Nathan D W Smith
- Exercise Science, Murdoch University, Perth, Western Australia.,Murdoch Applied Sports Science Laboratory, Murdoch University, Perth, Western Australia
| | - Brendan R Scott
- Murdoch Applied Sports Science Laboratory, Murdoch University, Perth, Western Australia.,Center for Healthy Ageing, Murdoch University, Perth, Western Australia ; and
| | - Olivier Girard
- School of Human Sciences (Exercise and Sport Science), The University of Western Australia, Perth, Western Australia
| | - Jeremiah J Peiffer
- Murdoch Applied Sports Science Laboratory, Murdoch University, Perth, Western Australia.,Center for Healthy Ageing, Murdoch University, Perth, Western Australia ; and
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Watson R, Sullivan B, Stone A, Jacobs C, Malone T, Heebner N, Noehren B. Blood Flow Restriction Therapy: An Evidence-Based Approach to Postoperative Rehabilitation. JBJS Rev 2022; 10:01874474-202210000-00001. [PMID: 36191086 DOI: 10.2106/jbjs.rvw.22.00062] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
➢ Blood flow restriction therapy (BFRT) involves the application of a pneumatic tourniquet cuff to the proximal portion of the arm or leg. This restricts arterial blood flow while occluding venous return, which creates a hypoxic environment that induces many physiologic adaptations. ➢ BFRT is especially useful in postoperative rehabilitation because it produces muscular hypertrophy and strength gains without the need for heavy-load exercises that are contraindicated after surgery. ➢ Low-load resistance training with BFRT may be preferable to low-load or high-load training alone because it leads to comparable increases in strength and hypertrophy, without inducing muscular edema or increasing pain.
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Affiliation(s)
- Richard Watson
- University of Kentucky, Department of Physical Therapy, Lexington, Kentucky
| | - Breanna Sullivan
- University of Kentucky, Department of Orthopaedic Surgery and Sports Medicine, Lexington, Kentucky
| | - Austin Stone
- University of Kentucky, Department of Orthopaedic Surgery and Sports Medicine, Lexington, Kentucky
| | - Cale Jacobs
- University of Kentucky, Department of Orthopaedic Surgery and Sports Medicine, Lexington, Kentucky
| | - Terry Malone
- University of Kentucky, Department of Physical Therapy, Lexington, Kentucky
| | - Nicholas Heebner
- University of Kentucky, Sports Medicine Research Institute, Lexington, Kentucky
| | - Brian Noehren
- University of Kentucky, Department of Physical Therapy, Lexington, Kentucky
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33
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Effects of Blood Flow Restriction Therapy for Muscular Strength, Hypertrophy, and Endurance in Healthy and Special Populations: A Systematic Review and Meta-Analysis. Clin J Sport Med 2022; 32:531-545. [PMID: 36083329 DOI: 10.1097/jsm.0000000000000991] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 10/01/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Blood flow restriction (BFR) training is an increasingly applied tool with potential benefits in muscular hypertrophy, strength, and endurance. This study investigates the effectiveness of BFR training relative to other forms of training on muscle strength, hypertrophy, and endurance. DATA SOURCES We performed systematic searches of MEDLINE, Embase, and PubMed and assessed the methodological quality of included studies using the Cochrane risk of bias tool. MAIN RESULTS We included 53 randomized controlled trials with 31 included in meta-analyses. For muscular strength comparing low-intensity BFR (LI-BFR) training with high-intensity resistance training (HIRT), the pooled mean difference (MD) for 1 repetition maximum was 5.34 kg (95% CI, 2.58-8.09; P < 0.01) favoring HIRT. When comparing LI-BFR training with HIRT for torque, the MD was 6.35 N·m (95% CI, 0.5-12.3; P = 0.04) also favoring HIRT. However, comparing LI-BFR with low-intensity resistance training (LIRT) for torque, there was a MD of 9.94 N·m (95% CI, 5.43-14.45; P < 0.01) favoring BFR training. Assessing muscle hypertrophy, the MD in cross-sectional area was 0.96 cm2 (95% CI, 0.21-1.7; P = 0.01) favoring pooled BFR training compared with nonocclusive training. Assessing endurance, V̇o2 maximum demonstrated a greater mean increase of 0.37 mL/kg/min (95% CI, -0.97 to 3.17; P = 0.64) in BFR endurance training compared with endurance training alone. CONCLUSION Blood flow restriction training produced increases in muscular strength, hypertrophy, and endurance. Comparing LI-BFR training with HIRT, HIRT was a significantly better training modality for increasing muscle hypertrophy and strength. However, LI-BFR was superior when compared with a similar low-intensity protocol. Blood flow restriction training is potentially beneficial to those unable to tolerate the high loads of HIRT; however, better understanding of its risk to benefit ratio is needed before clinical application. LEVEL OF EVIDENCE Level 1.
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Citherlet T, Willis SJ, Chaperon A, Millet GP. Differences in the limb blood flow between two types of blood flow restriction cuffs: A pilot study. Front Physiol 2022; 13:931270. [PMID: 35957986 PMCID: PMC9360536 DOI: 10.3389/fphys.2022.931270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 07/04/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction: The determination of the optimal occlusion level is a key parameter in blood flow restriction (BFR). This study aimed to compare the effects of elastic (BStrong) vs. nylon (Hokanson) BFR cuffs on blood flow in the lower and upper limbs. Methods: Eleven healthy participants undertook several BFR sessions with 2 different cuffs of similar width on their lower and upper limbs at different pressures [200, 250, 300, 350, and 400 mmHg for BStrong and 0, 40, and 60% of the arterial occlusion pressure (AOP) for Hokanson]. Doppler ultrasound recorded blood flows through the brachial and femoral artery at rest. Results: With BStrong, only 350 and 400 mmHg pressures were significantly different from resting values (0% AOP). With Hokanson, both 40% and 60% of the AOP were significantly different from resting values (p < 0.05). Discussion: While both cuffs elicited BFR, they failed to accurately modulate blood flow. Hokanson is appropriate for research settings while BStrong appears to be a convenient tool for practitioners due to its safety (i.e., the impossibility of completely occluding arteries) and the possibility of exercising freely detached from the pump.
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Affiliation(s)
- Tom Citherlet
- Institute of Sport Sciences, Synathlon, University of Lausanne, Lausanne, Switzerland
- *Correspondence: Tom Citherlet,
| | - Sarah J. Willis
- Department of Biological Sciences, University of Denver, Denver, CO, United States
| | - Audrey Chaperon
- Institute of Sport Sciences, Synathlon, University of Lausanne, Lausanne, Switzerland
| | - Grégoire P. Millet
- Institute of Sport Sciences, Synathlon, University of Lausanne, Lausanne, Switzerland
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Hill EC, Rivera PM, Proppe CE, Gonzalez Rojas DH, Wizenberg AM, Keller JL. Greater Neuromuscular Fatigue Following Low Load Blood Flow Restriction than Non Blood Flow Restriction Resistance Exercise Among Recreationally Active Men. J Neurophysiol 2022; 128:73-85. [PMID: 35704398 DOI: 10.1152/jn.00028.2022] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
PURPOSE The purpose of this study was to examine the acute effects of low-load blood flow restriction (LLBFR) and low-load non-BFR (LL) on neuromuscular function following a bout of standardized, fatiguing leg extension muscle actions. METHODS Fourteen men (mean age ± SD = 23±4 yrs) volunteered to participate in this investigation and randomly performed LLBFR and LL on separate days. Resistance exercise consisted of 75 isotonic, unilateral leg extension muscle actions performed at 30% of one-repetition maximum. Prior to (pretest) and after (posttest) performing each bout of exercise, strength and neural assessments were determined. RESULTS There was no pretest to posttest differences between LLBFR and LL for maximal voluntary isometric contraction (MVIC) torque or V-wave/M-wave responses (muscle compound action potentials assessed during a superimposed MVIC muscle action) which exhibited decreases (collapsed across condition) of 41.2% and 26.2%, respectively. There were pretest to posttest decreases in peak twitch torque (36.0%) and sEMG (29.5%) for LLBFR but not LL, and larger decreases in voluntary activation for LLBFR (11.3%) than LL (4.5%). CONCLUSIONS These findings suggested that LLBFR elicited greater fatigue-induced decreases in several indices of neuromuscular function relative to LL. Despite this, both LLBFR and LL resulted in similar decrements in performance as assessed by maximal strength.
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Affiliation(s)
- Ethan C Hill
- School of Kinesiology & Physical Therapy, Division of Kinesiology, University of Central Florida, Orlando, FL, United States.,Florida Space Institute, University of Central Florida, Orlando, FL, United States
| | - Paola M Rivera
- School of Kinesiology & Physical Therapy, Division of Kinesiology, University of Central Florida, Orlando, FL, United States
| | - Christopher E Proppe
- School of Kinesiology & Physical Therapy, Division of Kinesiology, University of Central Florida, Orlando, FL, United States
| | - David H Gonzalez Rojas
- School of Kinesiology & Physical Therapy, Division of Kinesiology, University of Central Florida, Orlando, FL, United States
| | - Aaron M Wizenberg
- School of Kinesiology & Physical Therapy, Division of Kinesiology, University of Central Florida, Orlando, FL, United States
| | - Joshua L Keller
- College of Education and Professional Studies, Department of Health, Kinesiology and Sport Integrated Laboratory of Exercise and Applied Physiology, University of South Alabama, Mobile, AL, United States
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Franz A, Ji S, Bittersohl B, Zilkens C, Behringer M. Impact of a Six-Week Prehabilitation With Blood-Flow Restriction Training on Pre- and Postoperative Skeletal Muscle Mass and Strength in Patients Receiving Primary Total Knee Arthroplasty. Front Physiol 2022; 13:881484. [PMID: 35774280 PMCID: PMC9237436 DOI: 10.3389/fphys.2022.881484] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 05/10/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction: Total Knee Arthroplasty (TKA) is one of the most successful interventions in gonarthrosis, however the operation is leading to muscle atrophy and long-term muscular deficits. To enhance rehabilitation after TKA, exercise programs try to improve muscle function preoperatively, called prehabilitation. Blood-Flow-Restriction Exercises (BFRE) is a training method which is characterized by using tourniquets to reduce arterial and occlude venous blood flow simultaneously during the exercise to increase metabolic stress. The present study aimed to evaluate the effects of a 6-week prehabilitation with BFR on pre- and postoperative muscle mass, strength, and quality of life (QoL). Methods: 30 patients with end-stage gonarthrosis participated in this study. Patients were randomized into one of three groups: 1) Control-Group (CON): Standard clinical approach without prehabilitation. 2) Active-Control-Group (AC): Participation in a prehabilitation with sham-BFR. 3) BFR-Group (BFR): Participation in a prehabilitation with BFR. The prehabilitation protocol consist of a cycling-ergometer-based training performed twice per week over 6 weeks. During exercise, BFR was applied periodically three times per leg with a pressure of 40% of the individual-limb-occlusion-pressure. Measurement time points were six- (baseline), 3-weeks and 5-days before the surgery (Pre-OP), as well as three- and 6-months postoperatively. Outcome measures were muscular strength of the thigh muscles, thigh circumference as well as QoL and functional activity, examined by 6-min walking- and chair rising test. Results: Both training groups indicated significantly improved leg muscle strength following the prehabilitation period with a superior effect for the BFR-group (BFR: ∼170% vs. AC: ∼91%, p < 0.05). No significant changes in leg strength occurred in the CON (∼3%, p = 0.100). Further, patients in BFR-group indicated significantly improved skeletal muscle mass assessed by femoral circumference following prehabilitation period (∼7%, p < 0.05), while no significant changes occurred in the CON (−1.14%, p = 0.131) and AC-group (∼3%, p = 0.078). At 3-months Post-OP, the CON and BFR-group revealed a significant decrease in femoral circumference compared to the Pre-OP (CON: ∼3%, BFR: ∼4%; p < 0.05), but BFR-group remained above the baseline level (∼3%, p < 0.05). No significant change in femoral circumference was found for AC-group (∼2%, p = 0.078). In addition, the prehabilitation with BFR provided notably improved Knee Injury and Osteoarthritis Outcome Scores (KOOS) especially in pain perception with significant higher effect compared to other groups (CON: −2%, AC: 13%, BFR: 41%; p < 0.05). In long-term rehabilitation after 6-months, all groups showed significantly improved KOOS scores in all dimensions (CON: ∼110%, AC: ∼132%, BFR: ∼225%; p < 0.01), and functional examinations (CON: ∼26%, AC: ∼16%, BFR: ∼53%; p < 0.01). Conclusion: The present findings show that BFR-prehabilitation induce significant improvements in muscle function and QoL before TKA surgery. In addition, the supporting effect of prehabilitation on postoperative regeneration and QoL should be highlighted, illustrating prolonged beneficial effects of BFR on muscular and functional performance in a “better in, better out”-manner.
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Affiliation(s)
- Alexander Franz
- Department of Orthopedics and Trauma Surgery, University Hospital Bonn, Bonn, Germany
- Department of Adult Reconstruction, ATOS Orthoparc Clinic Cologne, Cologne, Germany
- *Correspondence: Alexander Franz,
| | - Sanghyeon Ji
- Department of Exercise Physiology, Institute of Exercise Training and Sport Informatics, German Sport University Cologne, Cologne, Germany
| | - Bernd Bittersohl
- Department of Orthopedics and Trauma Surgery, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Christoph Zilkens
- Department of Orthopedics and Trauma Surgery, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Michael Behringer
- Department of Sports Medicine and Exercise Physiology, Goethe University Frankfurt, Frankfurt, Germany
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Martin PM, Bart RM, Ashley RL, Velasco T, Wise SR. An Overview of Blood Flow Restriction Physiology and Clinical Considerations. Curr Sports Med Rep 2022; 21:123-128. [PMID: 35394953 DOI: 10.1249/jsr.0000000000000948] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT The utilization of blood flow restriction has garnished considerable attention due to its widespread application and benefits that include strength enhancement, muscle hypertrophy, and increased level of function for specific populations. Blood flow restriction induces a hypoxic environment within a muscle group, initiating a metabolic cascade that stimulates muscle protein synthesis, altered gene regulation of muscle satellite cells, and increased muscle fiber recruitment, ultimately resulting in improved strength and endurance. When using blood flow restriction, consideration of the individual patient, occlusion pressure, cuff width, and cuff size are paramount. Blood flow restriction has been proven to be a consistently safe and effective tool for augmenting rehabilitative regimens for the upper and lower extremity.
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Affiliation(s)
- Peter Mitchell Martin
- National Capital Consortium Military Sports Medicine Fellowship, Fort Belvoir Community Hospital, Fort Belvoir, VA
| | - Ryan M Bart
- National Capital Consortium Military Sports Medicine Fellowship, Fort Belvoir Community Hospital, Fort Belvoir, VA
| | - Robert L Ashley
- National Capital Consortium Military Sports Medicine Fellowship, Fort Belvoir Community Hospital, Fort Belvoir, VA
| | | | - Sean R Wise
- National Capital Consortium Military Sports Medicine Fellowship, Fort Belvoir Community Hospital, Fort Belvoir, VA
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Dhokia B, Mabin EO, Bradley WJ, Neal BS. The feasibility, safety, and efficacy of upper limb garment-integrated blood flow restriction training in healthy adults. Pilot Feasibility Stud 2022; 8:34. [PMID: 35135623 PMCID: PMC8822736 DOI: 10.1186/s40814-022-00995-4] [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: 09/15/2021] [Accepted: 01/27/2022] [Indexed: 11/16/2022] Open
Abstract
Background Blood flow restriction training (BFR) has been demonstrated to increase muscle hypertrophy and strength, but has logistical and cost barriers. Garment-integrated BFR has the potential to reduce these barriers by lowering equipment demands and cost. The primary aim of the study was to explore the feasibility of garment-integrated BFR in the upper limb of healthy adults, with a secondary aim of exploring safety and efficacy. Methods Physically active and otherwise healthy participants with no previous experience with BFR were sought. Eligible participants completed a five-week garment-integrated BFR programme that involved completing two sessions per week. Feasibility was determined by a priori defined thresholds for recruitment, adherence to the garment-integrated BFR programme, and data collection. Safety was determined by recording adverse events and by monitoring for total arterial occlusion pressure using a fingertip pulse oximeter. Efficacy was determined by measuring push-ups to volitional failure, arm girth, and number of prescribed repetitions completed. Feasibility and safety outcomes were reported descriptively or as a proportion with associated 95% confidence intervals (95% CI). Mean change, 95% CIs, and associated effect sizes were calculated for efficacy outcomes. Results Twenty-eight participants were included (15 men, 13 women; mean age 31.6 years [±9.1]) and 27 successfully completed the study. Participants were successfully recruited within three months and 278/280 sessions were successfully completed (adherence=99.3%, 95% CI 97.4%, 99.9%). Minimal adverse events were reported; one incident of localised bruising (0.36%, 95% CI 0.06%, 2.0%) and three incidences of excessive pain during or post-exercise from two separate participants (1.07%, 95% CI 0.03%, 3.1%). 82/2240 pulse oximeter readings were not recorded (3.7%, 95% CI 2.9%, 4.5%). Mean push-ups to volitional failure increased by 40% (mean change=8.0, 95% CI 6, 10, d=1.40). Mean arm girth and number of prescribed repetitions completed were unchanged. Conclusions Garment-integrated BFR is feasible and has no signal of important harm in the upper limb of healthy adults, and could proceed to a future trial with stop/go criteria for randomisation. Further work is required to investigate the efficacy of garment-integrated BFR and determine its equivalence or superiority compared to existing BFR methods.
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Affiliation(s)
- Bhavit Dhokia
- Sports and Exercise Medicine, School of Medicine and Dentistry, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Elspeth Olivia Mabin
- Sports and Exercise Medicine, School of Medicine and Dentistry, William Harvey Research Institute, Queen Mary University of London, London, UK
| | | | - Bradley Stephen Neal
- Sports and Exercise Medicine, School of Medicine and Dentistry, William Harvey Research Institute, Queen Mary University of London, London, UK. .,School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Wivenhoe Park, Colchester, UK.
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Jardim RAC, de Sousa TS, Dos Santos WNN, Matos AP, Iosimuta NCR. Blood flow restriction with different load levels in patients with knee osteoarthritis: protocol of a randomized controlled trial. Trials 2022; 23:41. [PMID: 35033169 PMCID: PMC8761307 DOI: 10.1186/s13063-022-05998-3] [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: 01/14/2021] [Accepted: 01/03/2022] [Indexed: 11/10/2022] Open
Abstract
Background The effectiveness of blood flow restriction training (BFR) in elderly with knee osteoarthritis (OA) is comparable to performing high-intensity protocols (70 to 80% of 1 RM [repetition maximum]) that are known to be effective for improving the muscle strength of knee extensors, with the advantage of generating less particular rating of perceived exertion and pain immediately after training. However, despite being a promising alternative, little is known about the best way to apply the BFR, such as level of pressure and combination or not with other therapeutic modalities. The purpose of this study is to evaluate whether different levels of blood flow restriction with low load (BFR + LL) and no load (BFR + rest) are non-inferior to high-intensity resistance exercise (HIRE+BFRplacebo) for pain reduction in patients with knee OA. Methods/design This clinical trial is a non-inferiority, five-arm, randomized, active-controlled, single trial which will be carried out in 165 patients of both sexes with knee OA, aged 50 years and older. Participants will be randomly allocated into 5 exercise groups (40% of BFR + LL; 80% of BFR + LL; 40% of BFR + rest; 80% BFR + rest, and HIRE+BFR placebo). A mixed linear model will be used to examine the effect of group-by-time interaction on pain intensity on the WOMAC subscale (primary outcome) and on disease severity, physical functional data, balance data, quality of life, global perceived effect scale, and muscle strength (secondary outcomes). Participants will be analyzed for intention-to-treat, and the statistical assessor blinded to the groups. The collection of outcomes 72 h after completion of the 16 weeks of interventions will be the primary measurement point. Follow-up secondary timepoints will be collected at 20, 28, 40, 52, and 64 weeks after the end of interventions, except for pain during the training, which will be measured immediately at the end of each session. Only the comparison of the primary outcome between the HIRE group with each BFR group will be analyzed in the non-inferiority framework, the other comparisons between the BFR groups for the primary outcome, and all secondary outcomes will be interpreted in the superiority framework. Discussion The results of this clinical trial can point out more clearly to ways to optimize the BFR training with the minimum of pain immediately after training, which will allow the offer of an effective and more adherent strengthening training to patients with knee OA. Trial registration Registro Brasileiro de Ensaios Clínicos, RBR-93rx9q. Registered on 23 July 2020. Version 1.0. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-05998-3.
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Affiliation(s)
- Roger Andrey Carvalho Jardim
- Postgraduate Program of Health Sciences, Department of Biological Sciences and Health, Federal University of Amapá - UNIFAP, Macapá, AP, Brazil.
| | - Tamara Silva de Sousa
- Postgraduate Program of Health Sciences, Department of Biological Sciences and Health, Federal University of Amapá - UNIFAP, Macapá, AP, Brazil
| | | | - Areolino Pena Matos
- Postgraduate Program of Health Sciences, Department of Biological Sciences and Health, Federal University of Amapá - UNIFAP, Macapá, AP, Brazil
| | - Natália Camargo Rodrigues Iosimuta
- Postgraduate Program of Health Sciences, Department of Biological Sciences and Health, Federal University of Amapá - UNIFAP, Macapá, AP, Brazil
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Jørgensen SL, Mechlenburg I. Effects of Low-Load Blood-Flow Restricted Resistance Training on Functional Capacity and Patient-Reported Outcome in a Young Male Suffering From Reactive Arthritis. Front Sports Act Living 2022; 3:798902. [PMID: 34988436 PMCID: PMC8720780 DOI: 10.3389/fspor.2021.798902] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 12/02/2021] [Indexed: 12/16/2022] Open
Abstract
Introduction: Reactive arthritis (ReA) is a chronic inflammatory disease usually caused by a preceding gastrointestinal or genitourinary bacterial infection. ReA usually occurs in the lower limbs causing joint pain and joint swelling. Physiotherapy-led exercise is recommended to prevent muscle atrophy. The purpose of this case report is to describe the outcome after 12 weeks of low-load blood flow restricted resistance training (BFR-RT) as a rehabilitation method for a young male suffering from ReA. Methods and materials: A 17-year-old male suffered from ReA in the both knee joints and the left hip joint. 36 months after the incident, he suffered from another ReA incident in his right knee. Non-steroid anti-inflammatory drugs and a new arthrocentesis added with corticosteroid injection was unsuccessful in treating the ReA. The patient performed 12 weeks of BFR-RT on the right lower limb with a low amount of supervision after the first week of training. Assessment of unilateral 30-sec chair stand test (u30-sec CST), low-thigh circumference above apex patella, The Knee Injury and Osteoarthritis Outcome Score (KOOS), The Forgotten Knee Joint Score (FJS), and Numeric Ranking Scale for pain (NRS) was performed at baseline and after 3,6,9, and 12 weeks of BFR-RT. Results: The patient completed all planned exercise sessions. u30-sec CST improved with 7 repetitions (reps) on the right limb and 5 reps on the left leg. Low-thigh circumference decreased 1.1 cm on the right leg and 1.0 on the left leg. KOOS symptoms, ADL, quality of life and FJS demonstrated a clinically relevant change on 10, 14 and 23 points. Conclusion: The present case study indicates that even with low amounts of supervision BFR-RT could increase functional performance, reduce knee joint swelling and improve key patient-reported outcome.
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Affiliation(s)
- Stian Langgård Jørgensen
- Department of Occupational and Physical Therapy, Horsens Regional Hospital, Aarhus, Denmark.,H-HIP, Horsens Regional Hospital, Horsens, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Inger Mechlenburg
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Public Health, Aarhus University, Aarhus, Denmark
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Muscle growth adaptations to high-load training and low-load training with blood flow restriction in calf muscles. Eur J Appl Physiol 2022; 122:623-634. [PMID: 34981201 DOI: 10.1007/s00421-021-04862-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 11/22/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE To compare muscle growth adaptations between traditional high-load training and low-load training with blood flow restriction (BFR) in the calf muscles over 6 weeks. METHODS 27 trained individuals performed calf exercise in both legs for 6 weeks. Each leg was randomly assigned to one of the two conditions: (1) Traditional (70% of 1RM) training (TRAD); and (2) Low-load (30% of 1RM) training with BFR. In addition, subjects performed standing calf raises with or without BFR. Measures were taken pre- and post-intervention. RESULTS For the posterior muscle site, there was no condition (BFR vs. TRAD) × time (pre vs. post) interaction (p = 0.15). In addition, there was no main effect for condition (p = 0.83) or time (p = 0.20). For the lateral muscle site, there was no condition × time interaction (p = 0.47). In addition, there was no main effect for condition (p = 0.10) or time (p = 0.57). For the medial muscle site, there was no condition × time interaction (p = 0.60). In addition, there was no main effect for condition (p = 0.44) or time (p = 0.72). For RPE, there was no condition × time interaction. However, there was a main effect for condition (p < 0.05) with BFR having higher RPE. For discomfort, there was no condition × time interaction. However, there was a main effect for condition (p < 0.001) with the BFR condition displaying higher discomfort. CONCLUSION No muscle growth was detected in the calf musculature. BFR was not more effective at eliciting muscle hypertrophy compared to traditional training. However, it was accompanied with higher exertion and discomfort.
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Feng Y, Yin Y, Zhao X, Zhang Y, Zhou Y, Wu Z. A bibliometric analysis study of blood flow restriction using CiteSpace. J Phys Ther Sci 2022; 34:657-667. [PMID: 36213193 PMCID: PMC9535246 DOI: 10.1589/jpts.34.657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 07/11/2022] [Indexed: 11/24/2022] Open
Abstract
[Purpose] To assess the current state-of-the-art and the prevailing trends regarding the
global use of blood flow restriction (BFR) in the past 20 years. [Participants and
Methods] We retrieved literature relating to BFR from 1999 to 2020 using Web of Science.
We conducted a bibliometric analysis of countries/institutions, cited journals,
authors/cited authors, cited references, and keywords using CiteSpace. An analysis of
counts and centrality was used to examine publication output, countries/institutions, core
journals, active authors, foundation references, hot topics, and frontiers. [Results]
Seven hundred seventy five references were included and the total number of publications
has been continually increasing over the investigated period. Representatives of important
academic groups are the Japanese scholars from the University of Tokyo as represented by
Takashi Abe. Jeremy Paul Loenneke’s article (centrality: 0.15) was the most representative
and symbolic reference with the highest centrality. The three topics identified were
intervention (intensity resistance exercise, IRE), physiology (ischemia and muscular
function) and behavior (adaptation and increase). The four frontier topics were
phosphorylation, reduction, low intensity and arterial occlusion. [Conclusion] This study
provides an insight into BFR and offers valuable information for BFR researchers to
identify new perspectives for potential cooperation with collaborators and their related
cooperative institutions.
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Affiliation(s)
- Yali Feng
- Hospital of Southwest University, Southwest University: Tiansheng Road 2, Chongqing 400715, China
| | - Ying Yin
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, China
| | - Xuemei Zhao
- Department of Rehabilitation Therapy, Chongqing Medical University, China
| | - Yue Zhang
- Department of Rehabilitation Therapy, Chongqing Medical University, China
| | - Yi Zhou
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, China
| | - Zonghui Wu
- Hospital of Southwest University, Southwest University: Tiansheng Road 2, Chongqing 400715, China
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GARCIA NÁDIAF, MORAES CAMILADE, REBELO MACÁRIOA, PETERS SAVANAHMARIAG, CASTRO FÁBIOMDE, PUGGINA ENRICOF. Strength training with and without arteriovenous blood flow restriction improves performance, regardless of changes in muscle hypertrophy, in Wistar rats. AN ACAD BRAS CIENC 2022; 94:e20201147. [DOI: 10.1590/0001-3765202220201147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 02/13/2021] [Indexed: 11/22/2022] Open
Affiliation(s)
| | | | | | | | | | - ENRICO F. PUGGINA
- University of São Paulo (USP), Brazil; University of São Paulo (USP), Brazil
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Hedt C, McCulloch PC, Harris JD, Lambert BS. Blood Flow Restriction Enhances Rehabilitation and Return to Sport: The Paradox of Proximal Performance. Arthrosc Sports Med Rehabil 2022; 4:e51-e63. [PMID: 35141536 PMCID: PMC8811501 DOI: 10.1016/j.asmr.2021.09.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 09/15/2021] [Indexed: 12/17/2022] Open
Abstract
The use of blood flow restriction (BFR) within rehabilitation is rapidly increasing as further research is performed elucidating purported benefits such as improved muscular strength and size, neuromuscular control, decreased pain, and increased bone mineral density. Interestingly, these benefits are not isolated to structures distal to the occlusive stimulus. Proximal gains are of high interest to rehabilitation professionals, especially those working with patients who are limited due to pain or postsurgical precautions. The review to follow will focus on current evidence and ongoing hypotheses regarding physiologic responses to BFR, current clinical applications, proximal responses to BFR training, potential practical applications for rehabilitation and injury prevention, and directions for future research. Interestingly, benefits have been found in musculature proximal to the occlusive stimulus, which may lend promise to a greater variety of patient populations and conditions. Furthermore, an increasing demand for BFR use in the sports world warrants further research for performance research and recovery. LEVEL OF EVIDENCE Level V, expert opinion.
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Affiliation(s)
- Corbin Hedt
- Houston Methodist Orthopedics & Sports Medicine, Houston, Texas, U.S.A
| | | | - Joshua D. Harris
- Houston Methodist Orthopedics & Sports Medicine, Houston, Texas, U.S.A
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45
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Freitas EDS, Karabulut M, Bemben MG. The Evolution of Blood Flow Restricted Exercise. Front Physiol 2021; 12:747759. [PMID: 34925056 PMCID: PMC8674694 DOI: 10.3389/fphys.2021.747759] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 11/10/2021] [Indexed: 11/25/2022] Open
Abstract
The use of blood flow restricted (BFR) exercise has become an accepted alternative approach to improve skeletal muscle mass and function and improve cardiovascular function in individuals that are not able to or do not wish to use traditional exercise protocols that rely on heavy loads and high training volumes. BFR exercise involves the reduction of blood flow to working skeletal muscle by applying a flexible cuff to the most proximal portions of a person’s arms or legs that results in decreased arterial flow to the exercising muscle and occluded venous return back to the central circulation. Safety concerns, especially related to the cardiovascular system, have not been consistently reported with a few exceptions; however, most researchers agree that BFR exercise can be a relatively safe technique for most people that are free from serious cardiovascular disease, as well as those with coronary artery disease, and also for people suffering from chronic conditions, such as multiple sclerosis, Parkinson’s, and osteoarthritis. Potential mechanisms to explain the benefits of BFR exercise are still mostly speculative and may require more invasive studies or the use of animal models to fully explore mechanisms of adaptation. The setting of absolute resistive pressures has evolved, from being based on an individual’s systolic blood pressure to a relative measure that is based on various percentages of the pressures needed to totally occlude blood flow in the exercising limb. However, since several other issues remain unresolved, such as the actual external loads used in combination with BFR, the type of cuff used to induce the blood flow restriction, and whether the restriction is continuous or intermittent, this paper will attempt to address these additional concerns.
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Affiliation(s)
- Eduardo D S Freitas
- Department of Health and Exercise Science, University of Oklahoma, Norman, OK, United States
| | - Murat Karabulut
- Department of Health and Human Performance, University of Texas Rio Grande Valley, Brownsville, TX, United States
| | - Michael G Bemben
- Department of Health and Exercise Science, University of Oklahoma, Norman, OK, United States
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Rivera PM, Proppe CE, Beltran E, Hill EC. Acute Effects of Local Ischemic Hypoxia and Systemic Hypoxemia on Neuromuscular and Cognitive Function. High Alt Med Biol 2021; 23:18-25. [PMID: 34936812 DOI: 10.1089/ham.2021.0096] [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: 11/13/2022] Open
Abstract
Rivera, Paola M., Chris E. Proppe, Esther Beltran, and Ethan C. Hill. Acute effects of local ischemic hypoxia and systemic hypoxemia on neuromuscular and cognitive function. High Alt Med Biol. 00:000-000, 2021. Background: The application of blood flow restriction (BFR) induces local ischemic hypoxia within the muscle(s) distal to the restriction device. Systemic hypoxemia via oxygen or barometric pressure manipulation achieves whole-body hypoxia and thus may be a more potent exercise adjunct than BFR. Therefore, the purpose of this study was to examine the acute effects of local ischemic hypoxia versus systemic hypoxemia on maximal voluntary isometric contraction (MVIC) torque, electromyographic amplitude (EMG AMP), EMG mean power frequency (MPF), and cognition. Materials and Methods: Twelve recreationally trained women (mean age ± standard deviation = 21 ± 1.6 years) performed 75 submaximal (1 × 30, 3 × 15) unilateral leg extension muscle actions under normoxia, local ischemic hypoxia, and systemic hypoxemia. Before and immediately after the 75 repetitions, MVIC muscle actions were performed, and surface EMG was simultaneously assessed from the vastus lateralis. Cognitive function was assessed immediately after each exercise using the Automated Neuropsychological Assessment Metrics (ANAM). Separate repeated-measures analyses of variance (ANOVAs) were performed to examine changes in MVIC, reaction time, EMG AMP, and EMG MPF responses during the MVIC muscle actions. Results: There were no significant (p = 0.21-0.953) Condition × Time interactions for MVIC, EMG AMP, or EMG MPF but a significant (p < 0.001-0.005) main effect for the Time collapsed across Condition for MVIC torque (pretest 238.8 ± 19.5, posttest 212.7 ± 20.1 Nm) and EMG MPF (88.5% ± 1.4% of pretest). There were no significant (p = 0.503) differences in reaction time among Conditions. Conclusions: The findings of the present study suggest that all three conditions elicited comparable acute changes in performance as assessed by MVIC torque that were associated with no changes in muscle activation but decrease in action potential conduction velocity. Therefore, the application of local ischemic hypoxia or systemic hypoxemia during low-load resistance exercise can be used to elicit similar acute physiological responses and not adversely affect cognitive function relative to nonhypoxic conditions.
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Affiliation(s)
- Paola M Rivera
- Exercise Physiology Intervention and Collaboration Laboratory, Division of Kinesiology, School of Kinesiology and Physical Therapy, University of Central Florida, Orlando, Florida, USA
| | - Christopher E Proppe
- Exercise Physiology Intervention and Collaboration Laboratory, Division of Kinesiology, School of Kinesiology and Physical Therapy, University of Central Florida, Orlando, Florida, USA
| | - Esther Beltran
- Florida Space Institute, University of Central Florida, Orlando, Florida, USA
| | - Ethan C Hill
- Exercise Physiology Intervention and Collaboration Laboratory, Division of Kinesiology, School of Kinesiology and Physical Therapy, University of Central Florida, Orlando, Florida, USA.,Florida Space Institute, University of Central Florida, Orlando, Florida, USA
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47
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de Queiros VS, de França IM, Trybulski R, Vieira JG, Dos Santos IK, Neto GR, Wilk M, de Matos DG, Vieira WHDB, Novaes JDS, Makar P, Cabral BGDAT, Dantas PMS. Myoelectric Activity and Fatigue in Low-Load Resistance Exercise With Different Pressure of Blood Flow Restriction: A Systematic Review and Meta-Analysis. Front Physiol 2021; 12:786752. [PMID: 34880783 PMCID: PMC8646757 DOI: 10.3389/fphys.2021.786752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 10/26/2021] [Indexed: 12/17/2022] Open
Abstract
Background: Low-load resistance exercise (LL-RE) with blood flow restriction (BFR) promotes increased metabolic response and fatigue, as well as more pronounced myoelectric activity than traditional LL-RE. Some studies have shown that the relative pressure applied during exercise may have an effect on these variables, but existing evidence is contradictory. Purpose: The aim of this study was to systematically review and pool the available evidence on the differences in neuromuscular and metabolic responses at LL-RE with different pressure of BFR. Methods: The systematic review and meta-analysis was reported according to PRISMA items. Searches were performed in the following databases: CINAHL, PubMed, Scopus, SPORTDiscus and Web of Science, until June 15, 2021. Randomized or non-randomized experimental studies that analyzed LL-RE, associated with at least two relative BFR pressures [arterial occlusion pressure (AOP)%], on myoelectric activity, fatigue, or metabolic responses were included. Random-effects meta-analyses were performed for MVC torque (fatigue measure) and myoelectric activity. The quality of evidence was assessed using the PEDro scale. Results: Ten studies were included, all of moderate to high methodological quality. For MVC torque, there were no differences in the comparisons between exercise with 40–50% vs. 80–90% AOP. When analyzing the meta-analysis data, the results indicated differences in comparisons in exercise with 15–20% 1 repetition maximum (1RM), with higher restriction pressure evoking greater MVC torque decline (4 interventions, 73 participants; MD = −5.05 Nm [95%CI = −8.09; −2.01], p = 0.001, I2 = 0%). For myoelectric activity, meta-analyses indicated a difference between exercise with 40% vs. 60% AOP (3 interventions, 38 participants; SMD = 0.47 [95%CI = 0.02; 0.93], p = 0.04, I2 = 0%), with higher pressure of restriction causing greater myoelectric activity. This result was not identified in the comparisons between 40% vs. 80% AOP. In analysis of studies that adopted pre-defined repetition schemes, differences were found (4 interventions, 52 participants; SMD = 0.58 [95%CI = 0.11; 1.05], p = 0.02, I2 = 27%). Conclusion: The BFR pressure applied during the LL-RE may affect the magnitude of muscle fatigue and excitability when loads between 15 and 20% of 1RM and predefined repetition protocols (not failure) are prescribed, respectively. Systematic Review Registration: [http://www.crd.york.ac.uk/prospero], identifier [CRD42021229345].
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Affiliation(s)
- Victor Sabino de Queiros
- Graduate Program in Health Sciences, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil
| | - Ingrid Martins de França
- Graduate Program in Physiotherapy, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil
| | - Robert Trybulski
- Department of Medical Sciences, The Wojciech Korfanty School of Economics, Katowice, Poland.,Provita Zory Medical Center, Zory, Poland
| | - João Guilherme Vieira
- Graduate Program in Physical Education, Federal University of Juiz de Fora (UFJF), Juiz de Fora, Brazil
| | - Isis Kelly Dos Santos
- Graduate Program in Health Sciences, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil
| | - Gabriel Rodrigues Neto
- Graduate Program in Family Health, Faculties of Nursing and Medicine Nova Esperança (FACENE/FAMENE), João Pessoa, Brazil.,Coordination of Physical Education, University Center for Higher Education and Development (CESED/UNIFACISA/FCM/ESAC), Campina Grande, Brazil
| | - Michal Wilk
- Institute of Sport Sciences, Jerzy Kukuczka Academy of Physical Education in Katowice, Katowice, Poland
| | - Dihogo Gama de Matos
- Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, MB, Canada
| | | | - Jefferson da Silva Novaes
- Graduate Program at the School of Physical Education and Sport at the Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Piotr Makar
- Faculty of Physical Education, Gdańsk University of Physical Education and Sport, Gdańsk, Poland
| | - Breno Guilherme de Araújo Tinoco Cabral
- Graduate Program in Health Sciences, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil.,Graduate Program in Physical Education, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil
| | - Paulo Moreira Silva Dantas
- Graduate Program in Health Sciences, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil.,Graduate Program in Physical Education, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil
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48
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The Effect of Increasing Blood Flow Restriction Pressure When the Contractions Are Already Occlusive. J Sport Rehabil 2021; 31:152-157. [PMID: 34697249 DOI: 10.1123/jsr.2020-0402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 01/25/2021] [Accepted: 08/08/2021] [Indexed: 11/18/2022]
Abstract
CONTEXT Blood flow restricted exercise involves the use of external pressure to enhance fatigue and augment exercise adaptations. The mechanisms by which blood flow restricted exercise limits muscular endurance are not well understood. OBJECTIVE To determine how increasing blood flow restriction pressure impacts local muscular endurance, discomfort, and force steadiness when the contractions are already occlusive. DESIGN Within-participant, repeated-measures crossover design. SETTING University laboratory. PATIENTS A total of 22 individuals (13 males and 9 females). INTERVENTION Individuals performed a contraction at 30% of maximal isometric elbow flexion force for as long as possible. One arm completed the contraction with 100% of arterial occlusion pressure applied, while the other arm had 150% of arterial occlusion pressure applied. At the end of the protocol, individuals were asked to rate their perceived discomfort. MAIN OUTCOME MEASURES Time to task failure, discomfort, and force steadiness. RESULTS Individuals had a longer time to task failure when performing the 100% arterial occlusion condition compared with the 150% arterial occlusion pressure condition (time to task failure = 82.4 vs 70.8 s; Bayes factors = 5.77). There were no differences in discomfort between the 100% and 150% conditions (median discomfort = 5.5 vs 6; Bayes factors = 0.375) nor were there differences in force steadiness (SD of force output 3.16 vs 3.31 N; Bayes factors = 0.282). CONCLUSION The results of the present study suggest that, even when contractions are already occlusive, increasing the restriction pressure reduces local muscle endurance but does not impact discomfort or force steadiness. This provides an indication that mechanisms other than the direct alteration of blood flow are contributing to the increased fatigue with added restrictive pressure. Future studies are needed to examine neural mechanisms that may explain this finding.
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Sinclair P, Kadhum M, Paton B. Tolerance to Intermittent vs. Continuous Blood Flow Restriction Training: A meta-Analysis. Int J Sports Med 2021; 43:3-10. [PMID: 34535020 DOI: 10.1055/a-1537-9886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The proven beneficial effects of low-load blood flow restriction training on strength gain has led to further exploration into its application during rehabilitation, where the traditional use of heavy loads may not be feasible. With current evidence showing that low-load blood flow restriction training may be less well tolerated than heavy-load resistance training, this review was conducted to decipher whether intermittently deflating the pressure cuff during rest intervals of a training session improves tolerance to exercise, without compromising strength. Four databases were searched for randomized controlled trials that compared the effect of intermittent versus continuous blood flow restriction training on outcomes of exercise tolerance or strength in adults. Nine studies were identified, with six included in the meta-analysis. No significant difference in rate of perceived exertion was found (SMD-0.06, 95% CI-0.41 to 0.29, p=0.73, I 2=80%). Subgroup analysis excluding studies that introduced bias showed a shift towards favoring the use of intermittent blood flow restriction training (SMD-0.42, 95% CI-0.87 to 0.03, p=0.07, I 2=0%). There was no significant difference in strength gain. Intermittent cuff deflations during training intervals does not improve tolerance to exercise during blood flow restriction training.
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Affiliation(s)
- Pierre Sinclair
- Department of Institute of Sports and Exercise Health (ISEH), University College London, London, United Kingdom of Great Britain and Northern Ireland
| | - Murtaza Kadhum
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, United Kingdom of Great Britain and Northern Ireland
| | - Bruce Paton
- Department of Institute of Sports and Exercise Health (ISEH), University College London, London, United Kingdom of Great Britain and Northern Ireland
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50
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Karanasios S, Koutri C, Moutzouri M, Xergia SA, Sakellari V, Gioftsos G. The Effect of Body Position and the Reliability of Upper Limb Arterial Occlusion Pressure Using a Handheld Doppler Ultrasound for Blood Flow Restriction Training. Sports Health 2021; 14:717-724. [PMID: 34515589 DOI: 10.1177/19417381211043877] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The precise calculation of arterial occlusive pressure is essential to accurately prescribe individualized pressures during blood flow restriction training. Arterial occlusion pressure in the lower limb varies significantly between different body positions while similar reports for the upper limb are lacking. HYPOTHESIS Body position has a significant effect in upper limb arterial occlusive pressure. Using cuffs with manual pump and a handheld Doppler ultrasound can be a reliable method to determine upper limb arterial blood flow restriction. STUDY DESIGN A randomized repeated measures design. LEVEL OF EVIDENCE Level 3. METHODS Forty-two healthy participants (age mean ± SD = 28.1 ± 7.7 years) completed measurements in supine, seated, and standing position by 3 blinded raters. A cuff with a manual pump and a handheld acoustic ultrasound were used. The Wilcoxon signed-rank test with Bonferroni correction was used to analyze differences between body positions. A within-subject coefficient of variation and an intraclass correlation coefficient (ICC) test were used to calculate reproducibility and reliability, respectively. RESULTS A significantly higher upper limb arterial occlusive pressure was found in seated compared with supine position (P < 0.031) and in supine compared with standing position (P < 0.031) in all raters. An ICC of 0.894 (95% CI = 0.824-0.939, P < 0.001) was found in supine, 0.973 (95% CI = 0.955-0.985, P < 0.001) in seated, and 0.984 (95% CI = 0.973-0.991, P < 0.001) in standing position. ICC for test-retest reliability was found 0.90 (95% CI = 0.814-0.946, P < 0.001), 0.873 (95% CI = 0.762-0.93, P < 0.001), and 0.858 (95% CI = 0.737-0.923, P < 0.001) in the supine, seated, and standing position, respectively. CONCLUSION Upper limb arterial occlusive pressure was significantly dependent on body position. The method showed excellent interrater reliability and repeatability between different days. CLINICAL RELEVANCE Prescription of individualized pressures during blood flow restriction training requires measurement of upper limb arterial occlusive pressure in the appropriate position. The use of occlusion cuffs with a manual pump and a handheld Doppler ultrasound showed excellent reliability; however, the increased measurement error compared with the differences in arterial occlusive pressure between certain positions should be carefully considered for the clinical application of the method. STRENGTH OF RECOMMENDATIONS TAXONOMY (SORT) B.
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Affiliation(s)
- Stefanos Karanasios
- Physiotherapy Department, University of West Attica, Aigaleo, Greece.,Laboratory of Advanced Physiotherapy (LAdPhys), Physiotherapy Department, School of Health and Care Sciences, University of West Attica, Aigaleo, Greece
| | | | - Maria Moutzouri
- Physiotherapy Department, University of West Attica, Aigaleo, Greece.,Laboratory of Advanced Physiotherapy (LAdPhys), Physiotherapy Department, School of Health and Care Sciences, University of West Attica, Aigaleo, Greece
| | - Sofia A Xergia
- Physiotherapy Department, University of Patras, Aigio, Greece
| | - Vasiliki Sakellari
- Physiotherapy Department, University of West Attica, Aigaleo, Greece.,Laboratory of Advanced Physiotherapy (LAdPhys), Physiotherapy Department, School of Health and Care Sciences, University of West Attica, Aigaleo, Greece
| | - George Gioftsos
- Physiotherapy Department, University of West Attica, Aigaleo, Greece.,Laboratory of Advanced Physiotherapy (LAdPhys), Physiotherapy Department, School of Health and Care Sciences, University of West Attica, Aigaleo, Greece
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