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Gopinatth V, Garcia JR, Reid IK, Knapik DM, Verma NN, Chahla J. Blood Flow Restriction Enhances Recovery After Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Arthroscopy 2024:S0749-8063(24)00416-X. [PMID: 38889851 DOI: 10.1016/j.arthro.2024.05.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 05/29/2024] [Accepted: 05/30/2024] [Indexed: 06/20/2024]
Abstract
PURPOSE To conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) evaluating neuromuscular and clinical outcomes of blood flow restriction (BFR) training after anterior cruciate ligament reconstruction (ACLR) compared with non-BFR rehabilitation protocols. METHODS A systematic review was performed in accordance with the 2020 Preferred Reporting Items for Systematic reviews and Meta Analyses guidelines by querying PubMed, MEDLINE, Scopus, the Cochrane Database for Systematic Review, and the Cochrane Central Register for Controlled Trials databases from inception through December 2023 to identify Level I and II RCTs evaluating outcomes of BFR training after ACLR compared with non-BFR rehabilitation. A meta-analysis was performed using random-effects models with standardized mean difference (SMD) for pain, muscle strength, and muscle volume, whereas mean difference was calculated for patient-reported outcome measures. RESULTS Eight RCTs, consisting of 245 patients, met inclusion criteria, with 115 patients undergoing non-BFR rehabilitation compared with 130 patients undergoing BFR after ACLR. Mean patient age was 27.2 ± 6.7 years, with most patients being male (63.3%, n = 138/218). The length of the BFR rehabilitation protocol was most commonly between 8 and 12 weeks (range, 14 days to 16 weeks). Most studies set the limb/arterial occlusion pressure in the BFR group at 80%. When compared with non-BFR rehabilitation, BFR resulted in significant improvement in isokinetic muscle strength (SMD: 0.77, P = .02, I2: 58%), International Knee Documentation Committee score (mean difference: 10.97, P ≤ .00001, I2: 77%), and pain (SMD: 1.52, P = .04, I2: 87%), but not quadriceps muscle volume (SMD: 0.28, P = .43, I2: 76%). CONCLUSIONS The use of BFR after ACLR led to improvements in pain, International Knee Documentation Committee score, and isokinetic muscle strength, with variable outcomes on the basis of quadriceps strength, volume, and thickness when compared with non-BFR rehabilitation. LEVEL OF EVIDENCE Level II, systematic review and meta-analysis of Level I and II studies.
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Affiliation(s)
- Varun Gopinatth
- Saint Louis University School of Medicine, St. Louis, Missouri, U.S.A
| | - Jose R Garcia
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Isabel K Reid
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Derrick M Knapik
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri, U.S.A
| | - Nikhil N Verma
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Jorge Chahla
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, U.S.A..
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Fuchs CJ, Hermans WJH, Nyakayiru J, Weijzen MEG, Smeets JSJ, Aussieker T, Senden JM, Wodzig WKHW, Snijders T, Verdijk LB, van Loon LJC. Daily blood flow restriction does not preserve muscle mass and strength during 2 weeks of bed rest. J Physiol 2024. [PMID: 38411283 DOI: 10.1113/jp286065] [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: 11/29/2023] [Accepted: 02/08/2024] [Indexed: 02/28/2024] Open
Abstract
We measured the impact of blood flow restriction on muscle protein synthesis rates, muscle mass and strength during 2 weeks of strict bed rest. Twelve healthy, male adults (age: 24 ± 3 years, body mass index: 23.7 ± 3.1 kg/m2 ) were subjected to 14 days of strict bed rest with unilateral blood flow restriction performed three times daily in three 5 min cycles (200 mmHg). Participants consumed deuterium oxide and we collected blood and saliva samples throughout 2 weeks of bed rest. Before and immediately after bed rest, lean body mass (dual-energy X-ray absorptiometry scan) and thigh muscle volume (magnetic resonance imaging scan) were assessed in both the blood flow restricted (BFR) and control (CON) leg. Muscle biopsies were collected and unilateral muscle strength (one-repetition maximum; 1RM) was assessed for both legs before and after the bed rest period. Bed rest resulted in 1.8 ± 1.0 kg lean body mass loss (P < 0.001). Thigh muscle volume declined from 7.1 ± 1.1 to 6.7 ± 1.0 L in CON and from 7.0 ± 1.1 to 6.7 ± 1.0 L in BFR (P < 0.001), with no differences between treatments (P = 0.497). In addition, 1RM leg extension strength decreased from 60.2 ± 10.6 to 54.8 ± 10.9 kg in CON and from 59.2 ± 12.1 to 52.9 ± 12.0 kg in BFR (P = 0.014), with no differences between treatments (P = 0.594). Muscle protein synthesis rates during bed rest did not differ between the BFR and CON leg (1.11 ± 0.12 vs. 1.08 ± 0.13%/day, respectively; P = 0.302). Two weeks of bed rest substantially reduces skeletal muscle mass and strength. Blood flow restriction during bed rest does not modulate daily muscle protein synthesis rates and does not preserve muscle mass or strength. KEY POINTS: Bed rest, often necessary for recovery from illness or injury, leads to the loss of muscle mass and strength. It has been postulated that blood flow restriction may attenuate the loss of muscle mass and strength during bed rest. We investigated the effect of blood flow restriction on muscle protein synthesis rates, muscle mass and strength during 2 weeks of strict bed rest. Blood flow restriction applied during bed rest does not modulate daily muscle protein synthesis rates and does not preserve muscle mass or strength. Blood flow restriction is not effective in preventing muscle atrophy during a prolonged period of bed rest.
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Affiliation(s)
- Cas J Fuchs
- Department of Human Biology, Faculty of Health, Medicine and Life Sciences, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Wesley J H Hermans
- Department of Human Biology, Faculty of Health, Medicine and Life Sciences, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Jean Nyakayiru
- Department of Human Biology, Faculty of Health, Medicine and Life Sciences, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Michelle E G Weijzen
- Department of Human Biology, Faculty of Health, Medicine and Life Sciences, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Joey S J Smeets
- Department of Human Biology, Faculty of Health, Medicine and Life Sciences, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Thorben Aussieker
- Department of Human Biology, Faculty of Health, Medicine and Life Sciences, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Joan M Senden
- Department of Human Biology, Faculty of Health, Medicine and Life Sciences, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Will K H W Wodzig
- Central Diagnostic Laboratory, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Tim Snijders
- Department of Human Biology, Faculty of Health, Medicine and Life Sciences, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Lex B Verdijk
- Department of Human Biology, Faculty of Health, Medicine and Life Sciences, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Luc J C van Loon
- Department of Human Biology, Faculty of Health, Medicine and Life Sciences, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre+, Maastricht, The Netherlands
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Mannozzi J, Al-Hassan MH, Kaur J, Lessanework B, Alvarez A, Massoud L, Aoun K, Spranger M, O'Leary DS. Blood flow restriction training activates the muscle metaboreflex during low-intensity sustained exercise. J Appl Physiol (1985) 2023; 135:260-270. [PMID: 37348015 PMCID: PMC10393340 DOI: 10.1152/japplphysiol.00274.2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 06/09/2023] [Indexed: 06/24/2023] Open
Abstract
Blood flow restriction training (BFRT) employs partial vascular occlusion of exercising muscle and has been shown to increase muscle performance while using reduced workload and training time. Numerous studies have demonstrated that BFRT increases muscle hypertrophy, mitochondrial function, and beneficial vascular adaptations. However, changes in cardiovascular hemodynamics during the exercise protocol remain unknown, as most studies measured blood pressure before the onset and after the cessation of exercise. With reduced perfusion to the exercising muscle during BFRT, the resultant accumulation of metabolites within the ischemic muscle could potentially trigger a large reflex increase in blood pressure, termed the muscle metaboreflex. At low workloads, this pressor response occurs primarily via increases in cardiac output. However, when increases in cardiac output are limited (e.g., heart failure or during severe exercise), the reflex shifts to peripheral vasoconstriction as the primary mechanism to increase blood pressure, potentially increasing the risk of a cardiovascular event. Using our chronically instrumented conscious canine model, we utilized a 60% reduction in femoral blood pressure applied to the hindlimbs during steady-state treadmill exercise (3.2 km/h) to reproduce the ischemic environment observed during BFRT. We observed significant increases in heart rate (+19 ± 3 beats/min), stroke volume (+2.52 ± 1.2 mL), cardiac output (+1.21 ± 0.2 L/min), mean arterial pressure (+18.2 ± 2.4 mmHg), stroke work (+1.93 ± 0.2 L/mmHg), and nonischemic vascular conductance (+3.62 ± 1.7 mL/mmHg), indicating activation of the muscle metaboreflex.NEW & NOTEWORTHY Blood flow restriction training (BFRT) increases muscle mass, strength, and endurance. There has been minimal consideration of the reflex cardiovascular responses that could be elicited during BFRT sessions. We showed that during low-intensity exercise BFRT may trigger large reflex increases in blood pressure and sympathetic activity due to muscle metaboreflex activation. Thus, we urge caution when employing BFRT, especially in patients in whom exaggerated cardiovascular responses may occur that could cause sudden, adverse cardiovascular events.
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Affiliation(s)
- Joseph Mannozzi
- Department of Physiology, Wayne State University School of Medicine, Detroit, Michigan, United States
| | - Mohamed-Hussein Al-Hassan
- Department of Physiology, Wayne State University School of Medicine, Detroit, Michigan, United States
| | - Jasdeep Kaur
- Department of Kinesiology and Health Education, University of Texas at Austin, Austin, Texas, United States
| | - Beruk Lessanework
- Department of Physiology, Wayne State University School of Medicine, Detroit, Michigan, United States
| | - Alberto Alvarez
- Department of Physiology, Wayne State University School of Medicine, Detroit, Michigan, United States
| | - Louis Massoud
- Department of Physiology, Wayne State University School of Medicine, Detroit, Michigan, United States
| | - Kamel Aoun
- Department of Physiology, Wayne State University School of Medicine, Detroit, Michigan, United States
| | - Marty Spranger
- Department of Physiology, Michigan State University, East Lansing, Michigan, United States
| | - Donal S O'Leary
- Department of Physiology, Wayne State University School of Medicine, Detroit, Michigan, United States
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Kamada Y, Arai Y, Toyama S, Inoue A, Nakagawa S, Fujii Y, Kaihara K, Cha R, Mazda O, Takahashi K. Hypoxia with or without Treadmill Exercises Affects Slow-Twitch Muscle Atrophy and Joint Destruction in a Rat Model of Rheumatoid Arthritis. Int J Mol Sci 2023; 24:ijms24119761. [PMID: 37298711 DOI: 10.3390/ijms24119761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/31/2023] [Accepted: 06/04/2023] [Indexed: 06/12/2023] Open
Abstract
The effects of treadmill running under hypoxic conditions on joints and muscles of collagen-induced arthritis (CIA) rats were investigated. CIA rats were divided into normoxia no-exercise, hypoxia no-exercise (Hypo-no), and hypoxia exercise (Hypo-ex) groups. Changes were examined on days 2 and 44 of hypoxia with or without treadmill exercises. In the early stage of hypoxia, the expression of hypoxia-inducible factor (HIF)-1α increased in the Hypo-no and Hypo-ex groups. The expression of the egl-9 family hypoxia-inducible factor 1 (EGLN1) and vascular endothelial growth factor (VEGF) in the Hypo-ex group also increased. Under sustained hypoxia, the Hypo-no and Hypo-ex groups did not show increased expression of HIF-1α or VEGF, but p70S6K levels were elevated. Histologically, joint destruction was alleviated in the Hypo-no group, the loss of muscle weight in slow-twitch muscles was prevented, and muscle fibrosis was suppressed. In the Hypo-ex group, the preventive effect of a reduction in the slow-twitch muscle cross-sectional area was enhanced. Thus, chronic hypoxia in an animal model of rheumatoid arthritis controlled arthritis and joint destruction and prevented slow-twitch muscle atrophy and fibrosis. The combination of hypoxia with treadmill running further enhanced the preventive effects on slow-twitch muscle atrophy.
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Affiliation(s)
- Yoichiro Kamada
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Yuji Arai
- Department of Sports and Para-Sports Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Shogo Toyama
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Atsuo Inoue
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Shuji Nakagawa
- Department of Sports and Para-Sports Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Yuta Fujii
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Kenta Kaihara
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Ryota Cha
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Osam Mazda
- Department of Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Kenji Takahashi
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
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Jacobs E, Rolnick N, Wezenbeek E, Stroobant L, Capelleman R, Arnout N, Witvrouw E, Schuermans J. Investigating the autoregulation of applied blood flow restriction training pressures in healthy, physically active adults: an intervention study evaluating acute training responses and safety. Br J Sports Med 2023:bjsports-2022-106069. [PMID: 36604156 DOI: 10.1136/bjsports-2022-106069] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To examine the effects of autoregulated (AUTO) and non-autoregulated (NAUTO) blood flow restriction (BFR) application on adverse effects, performance, cardiovascular and perceptual responses during resistance exercise. METHODS Fifty-six healthy participants underwent AUTO and NAUTO BFR resistance exercise in a randomised crossover design using a training session with fixed amount of repetitions and a training session until volitional failure. Cardiovascular parameters, rate of perceived effort (RPE), rate of perceived discomfort (RPD) and number of repetitions were investigated after training, while the presence of delayed onset muscle soreness (DOMS) was verified 24 hours post-session. Adverse events during or following training were also monitored. RESULTS AUTO outperformed NAUTO in the failure protocol (p<0.001), while AUTO scored significantly lower for DOMS 24 hours after exercise (p<0.001). Perceptions of effort and discomfort were significantly higher in NAUTO compared with AUTO in both fixed (RPE: p=0.014, RPD: p<0.001) and failure protocol (RPE: p=0.028, RPD: p<0.001). Sixteen adverse events (7.14%) were recorded, with a sevenfold incidence in the fixed protocol for NAUTO compared with AUTO (NAUTO: n=7 vs AUTO: n=1) and five (NAUTO) vs three (AUTO) adverse events in the failure protocol. No significant differences in cardiovascular parameters were found comparing both pressure applications. CONCLUSION Autoregulation appears to enhance safety and performance in both fixed and failure BFR-training protocols. AUTO BFR training did not seem to affect cardiovascular stress differently, but was associated with lower DOMS, perceived effort and discomfort compared with NAUTO. TRIAL REGISTRATION NUMBER NCT04996680.
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Affiliation(s)
- Ewoud Jacobs
- Department of Rehabilitation Sciences, Ghent University Faculty of Medicine and Health Sciences, Ghent, Belgium
| | - Nicholas Rolnick
- The Human Performance Mechanic, Lehman College, New York City, New York, USA
| | - Evi Wezenbeek
- Department of Rehabilitation Sciences, Ghent University Faculty of Medicine and Health Sciences, Ghent, Belgium
| | - Lenka Stroobant
- Department of Orthopaedics and Traumatology, Ghent University Hospital, Ghent, Belgium
| | - Robbe Capelleman
- Department of Rehabilitation Sciences, Ghent University Faculty of Medicine and Health Sciences, Ghent, Belgium
| | - Nele Arnout
- Department of Orthopaedics and Traumatology, Ghent University Hospital, Ghent, Belgium
| | - Erik Witvrouw
- Department of Rehabilitation Sciences, Ghent University Faculty of Medicine and Health Sciences, Ghent, Belgium
| | - Joke Schuermans
- Department of Rehabilitation Sciences, Ghent University Faculty of Medicine and Health Sciences, Ghent, Belgium
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Selected Methods of Resistance Training for Prevention and Treatment of Sarcopenia. Cells 2022; 11:cells11091389. [PMID: 35563694 PMCID: PMC9102413 DOI: 10.3390/cells11091389] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/15/2022] [Accepted: 04/18/2022] [Indexed: 11/16/2022] Open
Abstract
Resistance training is an extremely beneficial intervention to prevent and treat sarcopenia. In general, traditional high-load resistance training improves skeletal muscle morphology and strength, but this method is impractical and may even reduce arterial compliance by about 20% in aged adults. Thus, the progression of resistance training methods for improving the strength and morphology of muscles without applying a high load is essential. Over the past two decades, various resistance training methods that can improve skeletal muscle mass and muscle function without using high loads have attracted attention, and their training effects, molecular mechanisms, and safety have been reported. The present study focuses on the relationship between exercise load/intensity, training effects, and physiological mechanisms as well as the safety of various types of resistance training that have attracted attention as a measure against sarcopenia. At present, there is much research evidence that blood-flow-restricted low-load resistance training (20–30% of one repetition maximum (1RM)) has been reported as a sarcopenia countermeasure in older adults. Therefore, this training method may be particularly effective in preventing sarcopenia.
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Stanford DM, Park J, Jessee MB. Unilateral, bilateral, and alternating muscle actions elicit similar muscular responses during low load blood flow restriction exercise. Eur J Appl Physiol 2021; 121:2879-2891. [PMID: 34191094 DOI: 10.1007/s00421-021-04757-7] [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: 08/04/2020] [Accepted: 06/20/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Compare acute muscular responses to unilateral, bilateral, and alternating blood flow restriction (BFR) exercise. METHODS Maximal strength was tested on visit one. On visits 2-4, 2-10 days apart, 19 participants completed 4 sets of knee extensions (30% one-repetition maximum) with BFR (40% arterial occlusion pressure) to momentary failure (inability to lift load) using each muscle action (counterbalanced order). Ultrasound muscle thickness was measured at 60% and 70% of the anterior thigh before (Pre), immediately (Post-0), and 5 min (Post-5) after exercise. Surface electromyography and tissue deoxygenation were measured throughout. Results, presented as means, were analyzed with a three-way (sex by time by condition) Bayesian RMANOVA. RESULTS There was a time by sex interaction (BFinclusion: 5.489) for left leg 60% muscle thickness (cm). However, changes from Pre to Post-0 (males: 0.39 vs females: 0.26; BF10: 0.839), Post-0 to Post-5 (males: - 0.05 vs females: - 0.06; BF10: 0.456), and Pre to Post-5 (males: 0.34 vs females: 0.20; BF10: 0.935) did not differ across sex. For electromyography (%MVC), there was a sex by condition interaction (BFinclusion: 550.472) with alternating having higher muscle excitation for females (16) than males (9; BF10: 5.097). Tissue deoxygenation (e.g. channel 1, µM) increased more for males (sets 1: 11.17; 2: 2.91; 3: 3.69; 4: 3.38) than females (sets 1: 4.49; 2: 0.24; 3: - 0.10; 4: - 0.06) from beginning to end of sets (all BFinclusion ≥ 4.295e + 7). For repetitions, there was an interaction (BFinclusion: 17.533), with alternating completing more than bilateral and unilateral for set one (100; 56; 50, respectively) and two (34; 16; 18, respectively). CONCLUSION Alternating, bilateral, and unilateral BFR exercise elicit similar acute muscular responses.
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Affiliation(s)
- Daphney M Stanford
- Applied Human Health and Physical Function Laboratory, Department of Health, Exercise Science, Recreation and Sports Management, The University of Mississippi, 642 All-American Dr, 211-Turner Center, University, MS, 38677, USA
| | - Joonsun Park
- School of Kinesiology and Nutrition, The University of Southern Mississippi, Hattiesburg, MS, USA
| | - Matthew B Jessee
- Applied Human Health and Physical Function Laboratory, Department of Health, Exercise Science, Recreation and Sports Management, The University of Mississippi, 642 All-American Dr, 211-Turner Center, University, MS, 38677, USA.
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Ramme AJ, Darcy R, Rourke BJ, Davis C, Markworth JF, Junginger L, Maerz T, Brooks SV, Bedi A. Local and Systemic Effects of Blood Flow Restriction Therapy in an Animal Model. Am J Sports Med 2020; 48:3245-3254. [PMID: 33136456 DOI: 10.1177/0363546520962058] [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: 01/31/2023]
Abstract
BACKGROUND Blood flow restriction therapy (BFRT) has been increasingly applied to improve athletic performance and injury recovery. Validation of BFRT has lagged behind commercialization, and currently the mechanism by which this therapy acts is unknown. BFRT is one type of ischemic therapy, which involves exercising with blood flow restriction. Repetitive restriction of muscle blood flow (RRMBF) is another ischemic therapy type, which does not include exercise. HYPOTHESIS/PURPOSE The purpose was to develop a rat model of ischemic therapy, characterize changes to muscle contractility, and evaluate local and systemic biochemical and histologic responses of 2 ischemic therapy types. We hypothesized that ischemic therapy would improve muscle mass and strength as compared with the control group. STUDY DESIGN Controlled laboratory study. METHODS Four groups of 10 Sprague-Dawley rats were established: control, stimulation, RRMBF, and BFRT. One hindlimb of each subject underwent 8 treatment sessions over 4 weeks. To simulate exercise, the stimulation group underwent peroneal nerve stimulation for 2 minutes. The RRMBF group used a pneumatic cuff inflated to 100 mm Hg with a 48-minute protocol. The BFRT group involved 100-mm Hg pneumatic cuff inflation and peroneal nerve stimulation for a 5-minute protocol. Four methods of evaluation were performed: in vivo contractility testing, histology, immunohistochemistry, and ELISA. Analysis of variance with post hoc Tukey test and linear mixed effects modeling were used to compare the treatment groups. RESULTS There was no difference in muscle mass among groups (P = .40) or between hindlimbs (P = .73). In vivo contractility testing showed no difference in maximum contractile force among groups (P = .64) or between hindlimbs (P = .30). On histology, myocyte cross-sectional area was not different among groups (P = .55) or between hindlimbs (P = .44). Pax7 immunohistochemistry demonstrated no difference in muscle satellite cell density among groups (P = .06) or between hindlimbs (P = .046). ELISA demonstrated the RRMBF group as eliciting elevated GH levels as compared with the other groups (P < .001). CONCLUSION Ischemic therapy did not induce gains in muscle mass, contractility strength, fiber cross-sectional area, or satellite cell density locally or systemically in this model, although the RRMBF group did have elevated GH levels on ELISA. CLINICAL RELEVANCE This animal model does not support ischemic therapy as a method to improve muscle mass, function, or satellite cell density.
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Affiliation(s)
- Austin J Ramme
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, USA.,Steindler Orthopedic Clinic, Iowa City, Iowa, USA
| | - Rose Darcy
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Brennan J Rourke
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Carol Davis
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - James F Markworth
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Lucas Junginger
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Tristan Maerz
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, USA.,Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Susan V Brooks
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Asheesh Bedi
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, USA
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9
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Abstract
BACKGROUND The competitive environment of athletics has promoted the exploration of any technology application that may offer an edge with performance and recovery from injury. Ischemic therapy is one such technology that has rapidly been incorporated into training rooms and physical therapy clinics worldwide. This therapy modality is reported to increase an athlete's ability to improve muscle mass, strength, and endurance. PURPOSE To provide the sports medicine physician with an understanding of the current state of ischemic therapy technology, including treatment specifications, known physiological effects, hypothesized mechanisms, biochemical effects, athletic applications, medical applications, animal models, and future research recommendations. STUDY DESIGN Literature review. METHODS A computer-based search of the PubMed database was used to perform a comprehensive literature review on musculoskeletal ischemic therapy. RESULTS The current research on ischemic therapy is largely composed of case series with varying equipment, methods, and therapy specifications. The publication of case series has value in identifying this technology for future research, but the results of these studies should not be justification for application to athletes without validation of safety and effectiveness. CONCLUSION To date, ischemic therapy remains unvalidated, and the mechanism by which it improves muscle performance is not clear.
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Affiliation(s)
- Austin J Ramme
- Department of Orthopaedic Surgery, The University of Michigan, Ann Arbor, Michigan, USA.,Steindler Orthopedic Clinic, Iowa City, Iowa, USA
| | - Brennan J Rourke
- Department of Orthopaedic Surgery, The University of Michigan, Ann Arbor, Michigan, USA
| | | | - Asheesh Bedi
- Department of Orthopaedic Surgery, The University of Michigan, Ann Arbor, Michigan, USA
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10
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Freitas EDS, Galletti BRA, Koziol KJ, Miller RM, Heishman AD, Black CD, Bemben D, Bemben MG. The Acute Physiological Responses to Traditional vs. Practical Blood Flow Restriction Resistance Exercise in Untrained Men and Women. Front Physiol 2020; 11:577224. [PMID: 33117195 PMCID: PMC7552431 DOI: 10.3389/fphys.2020.577224] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 09/09/2020] [Indexed: 11/13/2022] Open
Abstract
This study compared the acute physiological responses of traditional and practical blood flow restriction resistance exercise (tBFR and pBFR, respectively) and high- and low-load resistance exercise without BFR (HL and LL, respectively), as well as the potential sex differences within the aforementioned exercise methods. Fourteen men and fifteen women randomly completed the following experimental conditions: (1) tBFR, consisting of four sets of 30-15-15-15 repetitions of the bilateral horizontal leg press and knee extension exercises, at 30% of one-repetition maximum (1-RM), with a 13.5 cm wide pneumatic cuff placed at the most proximal portion of each thigh and inflated to a pressure equivalent to 50% of the participant’s total occlusion pressure; (2) pBFR, which was the same as the tBFR condition, except that an elastic band wrapped around the proximal portion of each thigh at a tightness of 7 on a 0 to 10 perceived pressure scale was used to reduce blood flow; (3) LL, same as the tBFR and pBFR protocols, except that no BFR was applied; and (4) HL, consisting of 3 sets of 10 repetitions at 80% of 1-RM, with the same 1-min rest interval between sets and a 3-min rest period between exercises. At baseline, immediately post-, 5 min post-, and 15 min post-exercise, whole-blood lactate (WBL), indices of muscle swelling (muscle thickness and thigh circumference), hematocrit and plasma volume changes, were measured as well as superficial electromyography (sEMG) amplitude during exercise. There were no significant (p > 0.05) differences between the tBFR and pBFR exercise protocols for any of the physiological parameters assessed. However, significantly greater (p < 0.05) WBL and sEMG values were observed for HL compared to the remaining exercise conditions. Finally, males displayed greater WBL levels than females at 15 min post-exercise. Interestingly, males also displayed significantly (p < 0.05) greater sEMG amplitude than females within the low-load trials during leg press, but no significant (p < 0.05) sex differences were observed during knee extension. In conclusion, tBFR and pBFR seemed to be capable of inducing the same acute physiological responses. Furthermore, males displayed greater responses than females for some of the physiological parameters measured.
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Affiliation(s)
- Eduardo D S Freitas
- Neuromuscular Laboratory, Department of Health and Exercise Science, The University of Oklahoma, Norman, OK, United States
| | - Bianca R A Galletti
- Neuromuscular Laboratory, Department of Health and Exercise Science, The University of Oklahoma, Norman, OK, United States
| | - Karolina J Koziol
- Neuromuscular Laboratory, Department of Health and Exercise Science, The University of Oklahoma, Norman, OK, United States
| | - Ryan M Miller
- Neuromuscular Laboratory, Department of Health and Exercise Science, The University of Oklahoma, Norman, OK, United States
| | - Aaron D Heishman
- Neuromuscular Laboratory, Department of Health and Exercise Science, The University of Oklahoma, Norman, OK, United States
| | - Christopher D Black
- Sensory and Muscle Function Laboratory, Department of Health and Exercise Science, The University of Oklahoma, Norman, OK, United States
| | - Debra Bemben
- Bone Density Research Laboratory, Department of Health and Exercise Science, The University of Oklahoma, Norman, OK, United States
| | - Michael G Bemben
- Neuromuscular Laboratory, Department of Health and Exercise Science, The University of Oklahoma, Norman, OK, United States
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Skovlund SV, Aagaard P, Larsen P, Svensson RB, Kjaer M, Magnusson SP, Couppé C. The effect of low‐load resistance training with blood flow restriction on chronic patellar tendinopathy — A case series. TRANSLATIONAL SPORTS MEDICINE 2020. [DOI: 10.1002/tsm2.151] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Sebastian V. Skovlund
- Department of Orthopaedic Surgery M Faculty of Health and Medical Sciences Bispebjerg Hospital and Center for Healthy Aging Institute of Sports Medicine University of Copenhagen Copenhagen Denmark
- Department of Physical and Occupational Therapy Bispebjerg Hospital Kobenhavn Denmark
| | - Per Aagaard
- Muscle Physiology and Biomechanics Research Unit Department of Sports Sciences and Clinical Biomechanics University of Southern Denmark Odense Denmark
| | - Patricia Larsen
- Department of Orthopaedic Surgery M Faculty of Health and Medical Sciences Bispebjerg Hospital and Center for Healthy Aging Institute of Sports Medicine University of Copenhagen Copenhagen Denmark
- Department of Physical and Occupational Therapy Bispebjerg Hospital Kobenhavn Denmark
| | - Rene B. Svensson
- Department of Orthopaedic Surgery M Faculty of Health and Medical Sciences Bispebjerg Hospital and Center for Healthy Aging Institute of Sports Medicine University of Copenhagen Copenhagen Denmark
| | - Michael Kjaer
- Department of Orthopaedic Surgery M Faculty of Health and Medical Sciences Bispebjerg Hospital and Center for Healthy Aging Institute of Sports Medicine University of Copenhagen Copenhagen Denmark
| | - Stig P. Magnusson
- Department of Orthopaedic Surgery M Faculty of Health and Medical Sciences Bispebjerg Hospital and Center for Healthy Aging Institute of Sports Medicine University of Copenhagen Copenhagen Denmark
- Department of Physical and Occupational Therapy Bispebjerg Hospital Kobenhavn Denmark
| | - Christian Couppé
- Department of Orthopaedic Surgery M Faculty of Health and Medical Sciences Bispebjerg Hospital and Center for Healthy Aging Institute of Sports Medicine University of Copenhagen Copenhagen Denmark
- Department of Physical and Occupational Therapy Bispebjerg Hospital Kobenhavn Denmark
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12
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Freitas EDS, Miller RM, Heishman AD, Ferreira-Júnior JB, Araújo JP, Bemben MG. Acute Physiological Responses to Resistance Exercise With Continuous Versus Intermittent Blood Flow Restriction: A Randomized Controlled Trial. Front Physiol 2020; 11:132. [PMID: 32256374 PMCID: PMC7090220 DOI: 10.3389/fphys.2020.00132] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 02/06/2020] [Indexed: 11/13/2022] Open
Abstract
The primary goal of this investigation was to examine the physiological responses of blood flow restriction (BFR) resistance exercise (RE) performed with continuous or intermittent BFR and to compare these results to those from conventional high- and low-load RE without BFR. Fourteen men randomly completed the following experimental trials: (1) low-load RE with continuous BFR (cBFR), (2) low-load RE with intermittent BFR (iBFR), (3) low-load RE without BFR (LI), and (4) conventional high-load RE without BFR (HI). For the cBFR, iBFR, and LI exercise trials, participants performed four sets of 30-15-15-15 repetitions of the bilateral leg press (LP) and knee extension (KE) exercises, at an intensity of 20% of their one-repetition maximum (1-RM), at a 1.5-s contraction speed, and with a 1-min rest period between sets. The only difference between the cBFR and iBFR protocols was that the pressure of the cuffs was released during the rest intervals between sets for the iBFR trial. For the HI trial, participants completed four sets of 10 repetitions of the same exercises, at 70% of 1-RM, with a 1-min rest period between sets, and at the same contraction speed. Muscle activity was assessed during each set using superficial electromyography, as well as changes in blood lactate concentration [La-] from baseline at 5 min post exercise and in muscle swelling and plasma volume (%ΔPV) at 5 and 15 min post exercise. There were no significant differences in muscle activity (p < 0.05) across the cBFR, iBFR, and LI protocols at any time point, whereas they were all significantly lower than HI. There were also no significant (p < 0.05) differences across the three low-load RE conditions for [La-],%ΔPV, or muscle swelling. HI elicited significantly (p < 0.05) greater responses than cBFR, iBFR, and LI for all the physiological markers measured. In conclusion, RE combined with cBFR or iBFR induce the same acute physiological responses. However, the largest physiological responses are observed with HI, probably because of the significantly greater exercise volumes. Therefore, releasing the pressure of the restrictive cuffs during the rest periods between sets will not hinder the acute physiological responses from BFR RE.
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Affiliation(s)
- Eduardo D S Freitas
- Neuromuscular Laboratory, Department of Health and Exercise Science, University of Oklahoma, Norman, OK, United States
| | - Ryan M Miller
- Neuromuscular Laboratory, Department of Health and Exercise Science, University of Oklahoma, Norman, OK, United States
| | - Aaron D Heishman
- Neuromuscular Laboratory, Department of Health and Exercise Science, University of Oklahoma, Norman, OK, United States
| | - João B Ferreira-Júnior
- Kinanthropometry and Human Performance Laboratory, Federal Institute of Sudeste of Minas Gerais, Rio Pomba, Brazil
| | - Joamira P Araújo
- Kinanthropometry and Human Performance Laboratory, Department of Physical Education, Federal University of Paraíba, João Pessoa, Brazil
| | - Michael G Bemben
- Neuromuscular Laboratory, Department of Health and Exercise Science, University of Oklahoma, Norman, OK, United States
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13
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Nyakayiru J, Fuchs CJ, Trommelen J, Smeets JSJ, Senden JM, Gijsen AP, Zorenc AH, VAN Loon LJC, Verdijk LB. Blood Flow Restriction Only Increases Myofibrillar Protein Synthesis with Exercise. Med Sci Sports Exerc 2019; 51:1137-1145. [PMID: 30694972 PMCID: PMC6553970 DOI: 10.1249/mss.0000000000001899] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Supplemental digital content is available in the text. Purpose Combining blood flow restriction (BFR) with exercise can stimulate skeletal muscle hypertrophy. Recent observations in an animal model suggest that BFR performed without exercise can also induce anabolic effects. We assessed the effect of BFR performed both with and without low-load resistance-type exercise (LLRE) on in vivo myofibrillar protein synthesis rates in young men. Methods Twenty healthy young men (age = 24 ± 1 yr, body mass index = 22.9 ± 0.6 kg·m−2) were randomly assigned to remain in resting condition (REST ± BFR; n = 10) or to perform LLRE (LLRE ± BFR at 20% one-repetition maximum; n = 10), combined with two 5-min cycles of single leg BFR. Myofibrillar protein synthesis rates were assessed during a 5-h post-BFR period by combining a primed continuous L-[ring-13C6]phenylalanine infusion with the collection of blood samples, and muscle biopsies from the BFR leg and the contralateral control leg. The phosphorylation status of anabolic signaling (mammalian target of rapamycin pathway) and metabolic stress (acetyl-CoA carboxylase)–related proteins, as well as the mRNA expression of genes associated with skeletal muscle mass regulation, was assessed in the collected muscle samples. Results Under resting conditions, no differences in anabolic signaling or myofibrillar protein synthesis rates were observed between REST + BFR and REST (0.044% ± 0.004% vs 0.043% ± 0.004% per hour, respectively; P = 0.683). By contrast, LLRE + BFR increased myofibrillar protein synthesis rates by 10% ± 5% compared with LLRE (0.048% ± 0.005% vs 0.043% ± 0.004% per hour, respectively; P = 0.042). Furthermore, compared with LLRE, LLRE + BFR showed higher phosphorylation status of acetyl-CoA carboxylase and 4E-BP1 as well as the elevated mRNA expression of MuRF1 (all P < 0.05). Conclusion BFR does not increase myofibrillar protein synthesis rates in healthy young men under resting conditions. When combined with LLRE, BFR increases postexercise myofibrillar protein synthesis rates in vivo in humans.
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Affiliation(s)
- Jean Nyakayiru
- NUTRIM, School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, THE NETHERLANDS
| | - Cas J Fuchs
- NUTRIM, School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, THE NETHERLANDS
| | - Jorn Trommelen
- NUTRIM, School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, THE NETHERLANDS
| | - Joey S J Smeets
- NUTRIM, School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, THE NETHERLANDS
| | - Joan M Senden
- NUTRIM, School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, THE NETHERLANDS
| | - Annemie P Gijsen
- NUTRIM, School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, THE NETHERLANDS
| | - Antoine H Zorenc
- NUTRIM, School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, THE NETHERLANDS
| | - Luc J C VAN Loon
- NUTRIM, School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, THE NETHERLANDS.,Institute of Sports and Exercise Studies, HAN University of Applied Sciences, Nijmegen, THE NETHERLANDS
| | - Lex B Verdijk
- NUTRIM, School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, THE NETHERLANDS
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14
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Yoshikawa M, Morifuji T, Matsumoto T, Maeshige N, Tanaka M, Fujino H. Effects of combined treatment with blood flow restriction and low-current electrical stimulation on muscle hypertrophy in rats. J Appl Physiol (1985) 2019; 127:1288-1296. [PMID: 31556832 DOI: 10.1152/japplphysiol.00070.2019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This study aimed to clarify the effects of a combined treatment comprising blood flow restriction and low-current electrical stimulation on skeletal muscle hypertrophy in rats. Male Wistar rats were divided into control (Cont), blood flow restriction (Bfr), electrical stimulation (Es), or Bfr with Es (Bfr + Es) groups. Pressure cuffs (80 mmHg) were placed around the thighs of Bfr and Bfr + Es rats. Low-current Es was applied to calf muscles in the Es and Bfr + Es rats. In experiment 1, a 1-day treatment regimen (5-min stimulation, followed by 5-min rest) was delivered four times to study the acute effects. In experiment 2, the same treatment regimen was delivered three times/wk for 8 wk. Body weight, muscle mass, changes in maximal isometric contraction, fiber cross-sectional area of the soleus muscle, expression of phosphorylated and total-ERK1/2, phosphorylated-rpS6 Ser235/236, phosphorylated and total Akt, and phosphorylated-rpS6 Ser240/244 were measured. Bfr and Es treatment alone failed to induce muscle hypertrophy and increase the expression of phosphorylated rpS6 Ser240/244. Combined Bfr + Es upregulated muscle mass, increased the fiber cross-sectional area, and increased phosphorylated rpS6 Ser240/244 expression and phosphorylated rpS6 Ser235/236 expression compared with controls. Combined treatment with Bfr and low-current Es can induce muscle hypertrophy via activation of two protein synthesis signaling pathways. This treatment should be introduced for older patients with sarcopenia and others with muscle weakness.NEW & NOTEWORTHY We investigated the acute and chronic effect of low-current electrical stimulation with blood flow restriction on skeletal muscle hypertrophy and the mechanisms controlling the hypertrophic response. Low-current electrical stimulation could not induce skeletal muscle hypertrophy, but a combination treatment did. Blood lactate and growth hormone levels were increased in the early response. Moreover, activation of ERK1/2 and mTOR pathways were observed in both the acute and chronic response, which contribute to muscle hypertrophy.
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Affiliation(s)
- Madoka Yoshikawa
- Department of Rehabilitation Science, Kobe University Graduate School of Health Science, Kobe, Japan
| | - Takeshi Morifuji
- Department of Rehabilitation Science, Kobe University Graduate School of Health Science, Kobe, Japan.,Department of Rehabilitation Science, Osaka Kawasaki Rehabilitation University, Kaizuka, Japan
| | - Tomohiro Matsumoto
- Department of Rehabilitation Science, Kobe University Graduate School of Health Science, Kobe, Japan
| | - Noriaki Maeshige
- Department of Rehabilitation Science, Kobe University Graduate School of Health Science, Kobe, Japan
| | - Minoru Tanaka
- Department of Rehabilitation Science, Kobe University Graduate School of Health Science, Kobe, Japan.,Department of Rehabilitation Science, Osaka Health Science University, Osaka, Japan
| | - Hidemi Fujino
- Department of Rehabilitation Science, Kobe University Graduate School of Health Science, Kobe, Japan
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Chhetri I, Hunt JEA, Mendis JR, Patterson SD, Puthucheary ZA, Montgomery HE, Creagh-Brown BC. Repetitive vascular occlusion stimulus (RVOS) versus standard care to prevent muscle wasting in critically ill patients (ROSProx):a study protocol for a pilot randomised controlled trial. Trials 2019; 20:456. [PMID: 31340849 PMCID: PMC6657179 DOI: 10.1186/s13063-019-3547-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 06/29/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Forty per cent of critically ill patients are affected by intensive care unit-acquired weakness (ICU-AW), to which skeletal muscle wasting makes a substantial contribution. This can impair outcomes in hospital, and can cause long-term physical disability after hospital discharge. No effective mitigating strategies have yet been identified. Application of a repetitive vascular occlusion stimulus (RVOS) a limb pressure cuff inducing brief repeated cycles of ischaemia and reperfusion, can limit disuse muscle atrophy in both healthy controls and bed-bound patients recovering from knee surgery. We wish to determine whether RVOS might be effective in mitigating against muscle wasting in the ICU. Given that RVOS can also improve vascular function in healthy controls, we also wish to assess such effects in the critically ill. We here describe a pilot study to assess whether RVOS application is safe, tolerable, feasible and acceptable for ICU patients. METHODS This is a randomised interventional feasibility trial. Thirty-two ventilated adult ICU patients with multiorgan failure will be recruited within 48 h of admission and randomised to either the intervention arm or the control arm. Intervention participants will receive RVOS twice daily (except only once on day 1) for up to 10 days or until ICU discharge. Serious adverse events and tolerability (pain score) will be recorded; feasibility of trial procedures will be assessed against pre-specified criteria and acceptability by semi-structured interview. Together with vascular function, muscle mass and quality will be assessed using ultrasound and measures of physical function at baseline, on days 6 and 11 of study enrolment, and at ICU and hospital discharge. Blood and urine biomarkers of muscle metabolism, vascular function, inflammation and DNA damage/repair mechanism will also be analysed. The Health questionnaire will be completed 3 months after hospital discharge. DISCUSSION If this study demonstrates feasibility, the derived data will be used to inform the design (and sample size) of an appropriately-powered prospective trial to clarify whether RVOS can help preserve muscle mass/improve vascular function in critically ill patients. TRIAL REGISTRATION ISRCTN Registry, ISRCTN44340629. Registered on 26 October 2017.
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Affiliation(s)
- Ismita Chhetri
- Intensive Care Unit, Royal Surrey County Hospital NHS Foundation Trust, Guildford, GU2 7XX UK
- Faculty of Health and Medical Sciences, School of Biosciences and Medicine, University of Surrey, Guildford, UK
| | - Julie E. A. Hunt
- Faculty of Health and Medical Sciences, School of Biosciences and Medicine, University of Surrey, Guildford, UK
| | - Jeewaka R. Mendis
- Faculty of Health and Medical Sciences, School of Biosciences and Medicine, University of Surrey, Guildford, UK
| | | | - Zudin A. Puthucheary
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Institute for Sport, Exercise and Health, University College London, London, UK
- Department of Medicine, Centre for Human Health and Performance, University College London, London, UK
- Intensive Care Unit, Royal Free London NHS Foundation Trust, London, UK
- Centre for Human and Applied Physiological Sciences, King’s College London, London,, UK
| | - Hugh E. Montgomery
- Institute for Sport, Exercise and Health, University College London, London, UK
- Department of Medicine, Centre for Human Health and Performance, University College London, London, UK
| | - Benedict C. Creagh-Brown
- Intensive Care Unit, Royal Surrey County Hospital NHS Foundation Trust, Guildford, GU2 7XX UK
- Faculty of Health and Medical Sciences, School of Biosciences and Medicine, University of Surrey, Guildford, UK
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16
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Jessee MB, Buckner SL, Mattocks KT, Dankel SJ, Mouser JG, Bell ZW, Abe T, Loenneke JP. Blood flow restriction augments the skeletal muscle response during very low-load resistance exercise to volitional failure. Physiol Int 2019; 106:180-193. [PMID: 31262205 DOI: 10.1556/2060.106.2019.15] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The purpose of this study was to compare the acute muscular response with resistance exercise between the following conditions [labeled (% one-repetition maximum/% arterial occlusion pressure)]: high-load (70/0), very low-load (15/0), very low-load with moderate (15/40), and high (15/80) blood flow restriction pressures. Twenty-three participants completed four sets of unilateral knee extension to failure (up to 90 repetitions) with each condition, one condition per leg, each day. Muscle thickness and maximal voluntary contraction (MVC) were measured before (Pre), immediately after (Post-0), and 15 min after (Post-15) exercise and electromyography (EMG) amplitude during exercise. Pre to Post-0 muscle thickness changes in cm [95% CI] were greater with 15/40 [0.57 (0.41, 0.73)] and 15/80 [0.49 (0.35, 0.62)] compared to 70/0 [0.33 (0.25, 0.40)]. Pre to Post-0 MVC changes in Nm [95% CI] were higher with 15/40 [-127.0 (-162.1, -91.9)] and 15/80 [-133.6 (-162.8, -104.4)] compared to 70/0 [-48.4 (-70.1, -26.6)] and 15/0 [-98.4 (-121.9, -74.9)], which were also different. Over the first three repetitions, EMG increased across sets, whereas in the last three repetitions it did not. EMG was also different between conditions and was generally greater during 70/0. Repetitions decreased across sets reaching the lowest for 70/0, and for very low loads decreased with increased pressure. In trained participants exercising to failure, lower load and the application of restriction pressure augment changes in muscle thickness and torque. The EMG amplitude was augmented by load. Training studies should compare these conditions, as the results herein suggest some muscular adaptations may differ.
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Affiliation(s)
- M B Jessee
- 1 School of Kinesiology and Nutrition, The University of Southern Mississippi , Hattiesburg, MS, USA
| | - S L Buckner
- 2 Exercise Science Program, University of South Florida , Tampa, FL, USA
| | - K T Mattocks
- 3 Department of Exercise Science, Lindenwood University-Belleville , Belleville, IL, USA
| | - S J Dankel
- 4 Kevser Ermin Applied Physiology Laboratory, Department of Health, Exercise Science, and Recreation Management, The University of Mississippi , University, MS, USA
| | - J G Mouser
- 5 Department of Kinesiology and Health Promotion, Troy University , Troy, AL, USA
| | - Z W Bell
- 4 Kevser Ermin Applied Physiology Laboratory, Department of Health, Exercise Science, and Recreation Management, The University of Mississippi , University, MS, USA
| | - T Abe
- 4 Kevser Ermin Applied Physiology Laboratory, Department of Health, Exercise Science, and Recreation Management, The University of Mississippi , University, MS, USA
| | - J P Loenneke
- 4 Kevser Ermin Applied Physiology Laboratory, Department of Health, Exercise Science, and Recreation Management, The University of Mississippi , University, MS, USA
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17
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Natsume T, Yoshihara T, Naito H. Electromyostimulation with blood flow restriction enhances activation of mTOR and MAPK signaling pathways in rat gastrocnemius muscles. Appl Physiol Nutr Metab 2018; 44:637-644. [PMID: 30398900 DOI: 10.1139/apnm-2018-0384] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Neuromuscular electrical stimulation (NMES) combined with blood flow restriction (BFR) induces muscle hypertrophy. However, cellular mechanisms underlying the muscle hypertrophy induced by NMES combined with BFR remain unclear. We tested the hypothesis that NMES combined with BFR would enhance the mechanistic target of rapamycin (mTOR) and mitogen-activated protein kinase (MAPK) signaling pathways. Age-matched male Wistar rats (6 months old, n = 7 per group) were assigned randomly to control, BFR alone (BFR), NMES alone (NMES), and NMES combined with BFR (NMES/BFR) groups. NMES induced 25 isometric contractions lasting 8 s with 4-s resting periods between contractions in the gastrocnemius muscle. Four sets in total were performed, with 1-min intervals between sets. A latex cuff was placed on the proximal portion of the hind limb and BFR at 200 mm Hg was conducted in 4 sets (each set 5 min) with 1-min rest intervals between sets. Venous blood was collected from the lateral tail vein to determine pH, H+ concentration, and lactate concentration before and immediately after the treatments. Expression levels of proteins related to muscle hypertrophy were determined by Western blot analysis. The application of NMES/BFR promoted muscle fatigue more than NMES alone. NMES/BFR induced greater changes in accumulation of metabolites and increase in gastrocnemius muscle weight. The phosphorylation of mTOR and MAPK signaling-related proteins was also enhanced following NMES/BFR, compared with other conditions. Thus, NMES enhanced the activation of mTOR and MAPK signaling pathways when combined with BFR.
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Affiliation(s)
- Toshiharu Natsume
- a Institute of Health and Sports Science & Medicine, Juntendo University, 1-1 Hirakagakuendai, Inzai, Chiba 270-1695, Japan
| | - Toshinori Yoshihara
- b Graduate School of Health and Sports Science, Juntendo University, 1-1 Hirakagakuendai, Inzai, Chiba 270-1695, Japan
| | - Hisashi Naito
- b Graduate School of Health and Sports Science, Juntendo University, 1-1 Hirakagakuendai, Inzai, Chiba 270-1695, Japan
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18
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Nakajima T, Koide S, Yasuda T, Hasegawa T, Yamasoba T, Obi S, Toyoda S, Nakamura F, Inoue T, Poole DC, Kano Y. Muscle hypertrophy following blood flow-restricted, low-force isometric electrical stimulation in rat tibialis anterior: role for muscle hypoxia. J Appl Physiol (1985) 2018; 125:134-145. [DOI: 10.1152/japplphysiol.00972.2017] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Low-force exercise training with blood flow restriction (BFR) elicits muscle hypertrophy as seen typically after higher-force exercise. We investigated the effects of microvascular hypoxia [i.e., low microvascular O2 partial pressures (P mvO2)] during contractions on muscle hypertrophic signaling, growth response, and key muscle adaptations for increasing exercise capacity. Wistar rats were fitted with a cuff placed around the upper thigh and inflated to restrict limb blood flow. Low-force isometric contractions (30 Hz) were evoked via electrical stimulation of the tibialis anterior (TA) muscle. The P mvO2 was determined by phosphorescence quenching. Rats underwent acute and chronic stimulation protocols. Whereas P mvO2 decreased transiently with 30 Hz contractions, simultaneous BFR induced severe hypoxia, reducing P mvO2 lower than present for maximal (100 Hz) contractions. Low-force electrical stimulation (EXER) induced muscle hypertrophy (6.2%, P < 0.01), whereas control group conditions or BFR alone did not. EXER+BFR also induced an increase in muscle mass (11.0%, P < 0.01) and, unique among conditions studied, significantly increased fiber cross-sectional area in the superficial TA ( P < 0.05). Phosphorylation of ribosomal protein S6 was enhanced by EXER+BFR, as were peroxisome proliferator-activated receptor gamma coactivator-1α and glucose transporter 4 protein levels. Fibronectin type III domain-containing protein 5, cytochrome c oxidase subunit 4, monocarboxylate transporter 1 (MCT1), and cluster of differentiation 147 increased with EXER alone. EXER+BFR significantly increased MCT1 expression more than EXER alone. These data demonstrate that microvascular hypoxia during contractions is not essential for hypertrophy. However, hypoxia induced via BFR may potentiate the muscle hypertrophic response (as evidenced by the increased superficial fiber cross-sectional area) with increased glucose transporter and mitochondrial biogenesis, which contributes to the pleiotropic effects of exercise training with BFR that culminate in an improved capacity for sustained exercise. NEW & NOTEWORTHY We investigated the effects of low microvascular O2 partial pressures (P mvO2) during contractions on muscle hypertrophic signaling and key elements in the muscle adaptation for increasing exercise capacity. Although demonstrating that muscle hypoxia is not obligatory for the hypertrophic response to low-force, electrically induced muscle contractions, the reduced P mvO2 enhanced ribosomal protein S6 phosphorylation and potentiated the hypertrophic response. Furthermore, contractions with blood flow restriction increased oxidative capacity, glucose transporter, and mitochondrial biogenesis, which are key determinants of the pleiotropic effects of exercise training.
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Affiliation(s)
- Toshiaki Nakajima
- Department of Cardiovascular Medicine, Dokkyo Medical University and Heart Center, Dokkyo Medical University Hospital, Tochigi, Japan
| | - Seiichiro Koide
- Bioscience and Technology Program, Department of Engineering Science, University of Electro-Communications, Tokyo, Japan
| | - Tomohiro Yasuda
- School of Nursing, Seirei Christopher University, Shizuoka, Japan
| | - Takaaki Hasegawa
- Department of Cardiovascular Medicine, Dokkyo Medical University and Heart Center, Dokkyo Medical University Hospital, Tochigi, Japan
| | | | - Syotaro Obi
- Department of Cardiovascular Medicine and Research Support Center, Dokkyo Medical University, Tochigi, Japan
| | - Shigeru Toyoda
- Department of Cardiovascular Medicine, Dokkyo Medical University and Heart Center, Dokkyo Medical University Hospital, Tochigi, Japan
| | - Fumitaka Nakamura
- Third Department of Internal Medicine, Teikyo University Chiba Medical Center, Chiba, Japan
| | - Teruo Inoue
- Department of Cardiovascular Medicine, Dokkyo Medical University and Heart Center, Dokkyo Medical University Hospital, Tochigi, Japan
| | - David C. Poole
- Department of Anatomy, Physiology and Kinesiology, Kansas State University, Manhattan, Kansas
| | - Yutaka Kano
- Bioscience and Technology Program, Department of Engineering Science, University of Electro-Communications, Tokyo, Japan
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Blood Flow Restriction Training in Rehabilitation Following Anterior Cruciate Ligament Reconstructive Surgery: A Review. Tech Orthop 2018. [DOI: 10.1097/bto.0000000000000265] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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21
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Sakamoto K. Ischemic preconditioning in skeletal muscle. Nihon Yakurigaku Zasshi 2017; 150:201-203. [PMID: 28966219 DOI: 10.1254/fpj.150.201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Jessee MB, Mattocks KT, Buckner SL, Mouser JG, Counts BR, Dankel SJ, Laurentino GC, Loenneke JP. The acute muscular response to blood flow-restricted exercise with very low relative pressure. Clin Physiol Funct Imaging 2017; 38:304-311. [PMID: 28251784 DOI: 10.1111/cpf.12416] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 12/22/2016] [Indexed: 11/26/2022]
Abstract
To investigate the acute responses to blood flow-restricted (BFR) exercise across low, moderate and high relative pressures. Muscle thickness, maximal voluntary contraction (MVC) and electromyography (EMG) amplitude were assessed following exercise with six different BFR pressures: 0%, 10%, 20%, 30%, 50% and 90% of arterial occlusion pressure (AOP). There were differences between each time point within each condition for muscle thickness, which increased postexercise [+0·47 (0·40, 0·54) cm] and then trended towards baseline. For MVC, higher pressures resulted in greater decrements than lower pressures [e.g. 10% AOP: -20·7 (-15·5, -25·8) Nm versus 90% AOP: -24 (-19·1, -28·9) Nm] postexercise. EMG amplitude increased from the first three repetitions to the last three repetitions within each set. When using a common BFR protocol with 30% 1RM, applying BFR does not seem to augment acute responses over that of exercise alone when exercise is taken to failure.
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Affiliation(s)
- Matthew B Jessee
- Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, MS, USA
| | - Kevin T Mattocks
- Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, MS, USA
| | - Samuel L Buckner
- Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, MS, USA
| | - J Grant Mouser
- Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, MS, USA
| | - Brittany R Counts
- Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, MS, USA
| | - Scott J Dankel
- Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, MS, USA
| | - Gilberto C Laurentino
- 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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23
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Sudo M, Ando S, Kano Y. Repeated blood flow restriction induces muscle fiber hypertrophy. Muscle Nerve 2016; 55:274-276. [DOI: 10.1002/mus.25415] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2016] [Indexed: 11/05/2022]
Affiliation(s)
- Mizuki Sudo
- Physical Fitness Research Institute Meiji Yasuda Life Foundation of Health and Welfare; Tobuki 150 Hachioji Tokyo 192-0001 Japan
| | - Soichi Ando
- University of Electro-Communications, Department of Mechanical Engineering and Intelligent Systems, Control Systems Program; Chofu Tokyo Japan
| | - Yutaka Kano
- University of Electro-Communications, Department of Engineering Science, Bioscience and Technology Program; Chofu Tokyo Japan
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24
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Loenneke JP, Kim D, Fahs CA, Thiebaud RS, Abe T, Larson RD, Bemben DA, Bemben MG. The influence of exercise load with and without different levels of blood flow restriction on acute changes in muscle thickness and lactate. Clin Physiol Funct Imaging 2016; 37:734-740. [DOI: 10.1111/cpf.12367] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 03/10/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Jeremy P. Loenneke
- Kevser Ermin Applied Physiology Laboratory; Department of Health, Exercise Science and Recreation Management; The University of Mississippi; University MS USA
| | - Daeyeol Kim
- Department of Health and Exercise Science; University of Oklahoma; Norman OK USA
| | - Christopher A. Fahs
- Division of Education and Counseling; Lindenwood University-Belleville; IL USA
| | | | - Takashi Abe
- National institute of Fitness and Sports in Kanoya; Kanoya Kagoshima Japan
| | - Rebecca D. Larson
- Department of Health and Exercise Science; University of Oklahoma; Norman OK USA
| | - Debra A. Bemben
- Department of Health and Exercise Science; University of Oklahoma; Norman OK USA
| | - Michael G. Bemben
- Department of Health and Exercise Science; University of Oklahoma; Norman OK USA
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