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Thompson KMA, Pethick WA, Clarke J, Winegarden A, Johnson E, Coates AM, Stellingwerff T, Burr JF. Blood Flow-Restricted Training and Time Trial Performance: A Cohort Study of World-Class Rowers. Med Sci Sports Exerc 2024; 56:1606-1614. [PMID: 38619968 DOI: 10.1249/mss.0000000000003459] [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: 04/17/2024]
Abstract
INTRODUCTION This study aimed to explore the potential impact of incorporating blood flow restriction (BFR) training within a training block characterized by minimal high-intensity work on 2000-m rowing ergometer time trial (TT) performance in elite/world-class rowers. Physiological markers often associated with endurance performance (maximal aerobic capacity, V̇O 2max ; blood lactate thresholds and hemoglobin mass, Hb mass ) were measured to determine whether changes are related to an improvement in performance. METHODS Using a quasi-experimental, observational study design (no control group), 2000-m TT performance, V̇O 2max , submaximal work rates eliciting blood lactate concentrations of ~2 and ~4 mmol·L -1 , and Hb mass were measured before and after 4 wk of noncompetitive season training, which included BFR rowing. BFR training consisted of 11 sessions of 2 × 10 min of BFR rowing at a workload equating to blood lactate concentrations of ~2 mmol·L -1 . Paired t -tests were used to compare pre-/postvalues, and Pearson correlation was used to examine whether physiological changes were associated with changes to TT performance. RESULTS TT performance improved in both female (1.09% ± 1.2%, ~4.6 ± 5.2 s; P < 0.01) and male (1.17% ± 0.48%, ~4.5 ± 1.9 s; P < 0.001) athletes. V̇O 2max increased in female rowers only ( P < 0.01), but both sexes had an increase in work rates eliciting blood lactate concentrations of 2 mmol·L -1 (female: 184 ± 16 to 195 ± 15 W, P < 0.01; male: 288 ± 23 to 317 ± 26 W, P = 0.04) and 4 mmol·L -1 (female: 217 ± 13 to 227 ± 14 W, P = 0.02; male: 339 ± 43 to 364 ± 39 W, P < 0.01). No changes in Hb mass (both sexes, P = 0.8) were observed. Improvements in TT performance were not related to physiological changes (all correlations P ≥ 0.2). CONCLUSIONS After 4 wk of training with BFR, the improvement in TT performance was greater than what is typical for this population. Physiological variables improved during this training block but did not explain improved TT performance.
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Affiliation(s)
- Kyle M A Thompson
- Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, CANADA
| | - Wendy A Pethick
- Canadian Sport Institute-Pacific, Victoria, British Columbia, CANADA
| | - Jordan Clarke
- Rowing Canada Aviron National Training Centre, North Cowichan, British Columbia, CANADA
| | - Anneke Winegarden
- Canadian Sport Institute-Pacific, Victoria, British Columbia, CANADA
| | - Elizabeth Johnson
- Canadian Sport Institute-Pacific, Victoria, British Columbia, CANADA
| | - Alexandra M Coates
- Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, CANADA
| | | | - Jamie F Burr
- Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, CANADA
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Fleming AR, MacDonald HV, Buckner SL, Winchester LJ. Lower limb blood flow occlusion increases systemic pressor response without increasing brachial arterial blood flow redistribution in women. Clin Physiol Funct Imaging 2024; 44:285-296. [PMID: 38402408 DOI: 10.1111/cpf.12873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 01/16/2024] [Accepted: 02/08/2024] [Indexed: 02/26/2024]
Abstract
This study was conducted to investigate the systemic hemodynamic and vascular changes in women during and after two commonly used clinical blood flow restriction (BFR) pressures at rest. There are minimal data regarding the independent effects of BFR on hemodynamic and systemic vascular changes due to pressor response, particularly among women. Therefore, this study investigated BFR-induced alterations in pressor response and systemic flow redistribution at rest during two commonly used pressures (50% and 80% limb occlusion pressure [LOP]). Fifteen women (22.1 ± 4.2 years) completed two randomised sessions involving 8-min of bilateral, lower limb restriction at 50% or 80% LOP followed by 8-min of recovery post-deflation. Changes in vascular (arterial diameter [DIA], time-averaged mean velocity [TAMV], volume flow [VF], and area) and hemodynamic (heart rate [HR] and blood pressure) measures over time (pre-, during, post-occlusion) and by session (50% vs. 80% LOP) were tested using repeated measures analysis of variance. Repeated measures correlations (rrm) quantified common intraindividual associations between BFR-induced hemodynamic and vascular responses. HR increased from baseline during 50% LOP and remained elevated during recovery (p < 0.05). HR increased from baseline during 80% LOP, while tibial VF and TAMV decreased (p < 0.03 for all). HR and TAMV values returned to baseline during recovery, while brachial artery VF decreased (p < 0.05). Changes in HR, brachial VF, and brachial TAMV were similar between 50% and 80% LOP (rrm = 0.32-0.70, p < 0.05 for all). At 80% LOP, changes in HR were positively correlated with brachial VF (rrm = 0.38) and TAMV (rrm = 0.43) and negatively correlated with tibial VF (rrm = -0.36) and TAMV (rrm = -0.30) (p < 0.05 for all). Results suggest that BFR at 80% LOP elicits an acute systemic pressor reflex without concomitant increases in brachial arterial flow, while 50% LOP elicits a subdued response.
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Affiliation(s)
- Abby R Fleming
- Department of Kinesiology, University of Alabama, Tuscaloosa, Alabama, USA
| | - Hayley V MacDonald
- Department of Kinesiology, University of Alabama, Tuscaloosa, Alabama, USA
| | - Samuel L Buckner
- Department of Educational and Psychological Studies, College of Education, University of South Florida, Tampa, Florida, USA
| | - Lee J Winchester
- Department of Kinesiology, University of Alabama, Tuscaloosa, Alabama, USA
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Yasuda T, Sato Y, Nakajima T. Effects of Acute Piano Performance With Blood Flow Restriction on Upper Limb Muscle and Perceptual Response in Pianists. Cureus 2024; 16:e63074. [PMID: 39055424 PMCID: PMC11272406 DOI: 10.7759/cureus.63074] [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] [Accepted: 06/24/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Long-term and prolonged piano performance does not provide essential skeletal muscle training benefits while increasing the risk of injury to the upper extremities. Unlike high-intensity exercise training, moderate blood flow restriction (BFR) training has been found to improve neuromuscular mechanisms with a variety of physical exercises (machine, elastic band, walking, electrical stimulation, and body weight). AIM AND METHODS We investigated the physiological and perceptual responses related to piano performance with or without BFR based on acute responses of neuromuscular mechanisms. Student or professional pianists (n=7) performed the "Revolutionary Etude" on the piano with (Piano-BFR) and without (Piano-Ctrl) BFR. During the Piano-BFR performance, 150-180 mmHg of cuff pressure was applied around the most proximal region of both arms as a moderate BFR. RESULTS Changes in upper limb girth, muscle thickness, and hand grip strength were measured before and immediately after the performance. After the performance, perceptual and other responses were recorded. Immediately after the performance, the Piano-BFR condition induced greater changes in girth (forearm and upper arm), muscle thickness (forearm), and handgrip strength than the Piano-Ctrl condition. Piano-BFR was (p<0.01) higher than Piano-Ctrl on eight questions regarding perceptual response (upper arm fatigue and difficulty playing the piano). Piano performance with BFR was revealed to increase upper extremity muscle size and fatigue in pianists after playing. CONCLUSION Piano performance with BFR was revealed to increase upper extremity muscle size and fatigue in pianists after playing. The effect of BFR on neuromuscular mechanisms on piano performance was greater in the forearm than in the upper arm.
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Affiliation(s)
- Tomohiro Yasuda
- Exercise Physiology, Seirei Christopher University, Hamamatsu, JPN
| | - Yumi Sato
- Child Education, Okazaki Women's University, Aichi, JPN
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Vehrs PR, Hager R, Richards ND, Richards S, Baker L, Burbank T, Clegg S, Frazier IK, Nielsen JR, Watkin JH. Measurement of arterial occlusion pressure using straight and curved blood flow restriction cuffs. Physiol Rep 2024; 12:e16119. [PMID: 38898580 PMCID: PMC11186747 DOI: 10.14814/phy2.16119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 06/07/2024] [Accepted: 06/10/2024] [Indexed: 06/21/2024] Open
Abstract
Arterial occlusion pressure (AOP) is influenced by the characteristics of the cuff used to measure AOP. Doppler ultrasound was used to measure AOP of the brachial and superficial femoral arteries using straight and curved blood flow restriction cuffs in 21 males and 21 females. Vessel diameter and blood flow were evaluated as independent predictors of AOP. Overall, there were no significant differences in AOP when using the straight and curved cuffs in the brachial (129 mmHg vs. 128 mmHg) or superficial femoral artery (202 mmHg vs. 200 mmHg), respectively. Overall, AOP was greater (p < 0.05) in males than in females in the arm (135 mmHg, 123 mmHg) and leg (211 mmHg, 191 mmHg). Brachial (0.376 mm, 0.323 mm) and superficial femoral (0.547 mm, 0.486 mm) arteries were larger (p = 0.016) in males than in females, respectively. Systolic blood pressure (SBP) and arm circumference were predictive of brachial artery AOP, whereas SBP, diastolic blood pressure, thigh circumference, and vessel diameter were predictive of superficial femoral artery AOP. Straight and curved cuffs are efficacious in the measurement of AOP in the arm and leg. Differences in vessel size may contribute to sex differences in AOP but this requires further investigation.
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Affiliation(s)
- Pat R. Vehrs
- Department of Exercise Sciences, 106 SFHBrigham Young UniversityProvoUtahUSA
| | - Ron Hager
- Department of Exercise Sciences, 106 SFHBrigham Young UniversityProvoUtahUSA
| | | | - Shay Richards
- Department of Exercise Sciences, 106 SFHBrigham Young UniversityProvoUtahUSA
| | - Luke Baker
- Department of StatisticsOhio State UniversityColumbusOhioUSA
| | - Tyler Burbank
- Department of Exercise Sciences, 106 SFHBrigham Young UniversityProvoUtahUSA
| | - Shelby Clegg
- Department of Exercise Sciences, 106 SFHBrigham Young UniversityProvoUtahUSA
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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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Uematsu A, Mizushima Y, Ishizaka H, Hortobágyi T, Mizushima T, Toyoda S, Nakajima T. Blood flow restriction reduces the increases in cardiorespiratory responses and subjective burden without inhibiting muscular activity during cycling at ventilatory threshold in healthy males. PLoS One 2023; 18:e0294524. [PMID: 38064463 PMCID: PMC10707540 DOI: 10.1371/journal.pone.0294524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 11/03/2023] [Indexed: 12/18/2023] Open
Abstract
Low-intensity endurance exercise with blood flow restriction (KAATSU) is under consideration for use in cardiac rehabilitation. However, the physiological responses to such exercise have not yet been fully characterized. In an initial effort in healthy males (n = 11, age: 26.3±4.6 y), we compared the physiological responses to low-intensity endurance exercise with and without a thigh KAATSU. Participants performed maximal graded exercise testing using a cycle ergometer with or without KAATSU. We examined responses to cycling exercise at ventilatory threshold (VT) in heart rate (HR), oxygen consumption (VO2), dyspnea, ratings of perceived exertion (RPE), blood pressure (BP), and rectus femoris activation. Participants reached VT at a lower mechanical load, HR, VO2, dyspnea, and double product (HR×systolic BP) with KAATSU vs. no-KAATSU. At VT, RPE, and rectus femoris activity did not differ between the two conditions. These results suggest that KAATSU reduced exercise intensity to reach VT and the physiological responses to exercise at VT without changes in knee extensor muscle activation. Results from this pilot study in healthy males suggest that KAATSU aerobic exercise at VT intensity has the potential to be an effective and low-burden adjuvant to cycling in cardiac rehabilitation.
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Affiliation(s)
- Azusa Uematsu
- Faculty of Sociology, Otemon Gakuin University, Nishiai, Ibaraki, Osaka, Japan
| | - Yuta Mizushima
- Department of Rehabilitation, School of Medicine, Dokkyo Medical University, Kitakobayashi, Mibu-machi, Shimotsuga-gun, Tochigi, Japan
| | - Hayato Ishizaka
- Department of Rehabilitation, School of Medicine, Dokkyo Medical University, Kitakobayashi, Mibu-machi, Shimotsuga-gun, Tochigi, Japan
| | - Tibor Hortobágyi
- Department of Kinesiology, Hungarian University of Sports Science, Alkotás utca, Budapest, Hungary
- Institute of Sport Sciences and Physical Education, University of Pécs, Ifjúság úutja, Pécs, Hungary
- Somogy Country Kaposi Mór Teaching Hospital, Tallián Gyula utca, Kaposvár, Hungary
- Center for Human Movement Sciences, University of Groningen, A. Deusinglaan, Groningen, The Netherlands
| | - Takashi Mizushima
- Department of Rehabilitation, School of Medicine, Dokkyo Medical University, Kitakobayashi, Mibu-machi, Shimotsuga-gun, Tochigi, Japan
| | - Shigeru Toyoda
- Department of Cardiovascular Medicine, School of Medicine, Dokkyo Medical University, Kitakobayashi, Mibu-machi, Shimotsuga-gun, Tochigi, Japan
| | - Toshiaki Nakajima
- Department of Cardiovascular Medicine, School of Medicine, Dokkyo Medical University, Kitakobayashi, Mibu-machi, Shimotsuga-gun, Tochigi, Japan
- Department of Medical KAATSU Training, Dokkyo Medical University, Kitakobayashi, Mibu-machi, Shimotsuga-gun, Tochigi, Japan
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Vehrs PR, Johnson AW. Commentary: Is there a minimum effective dose for vascular occlusion during blood flow restriction training? Front Physiol 2023; 14:1279435. [PMID: 37849976 PMCID: PMC10577197 DOI: 10.3389/fphys.2023.1279435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 09/18/2023] [Indexed: 10/19/2023] Open
Affiliation(s)
- Pat R. Vehrs
- Department of Exercise Sciences, Brigham Young University, Provo, UT, United States
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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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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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10
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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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Ceylan B, Franchini E. Ischemic preconditioning does not improve judo-specific performance but leads to better recovery in elite judo athletes. Sci Sports 2022. [DOI: 10.1016/j.scispo.2021.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Cohen JN, Kuikman MA, Politis-Barber V, Stairs BE, Coates AM, Millar PJ, Burr JF. Blood flow restriction and stimulated muscle contractions do not improve metabolic or vascular outcomes following glucose ingestion in young, active individuals. J Appl Physiol (1985) 2022; 133:75-86. [DOI: 10.1152/japplphysiol.00178.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Glucose ingestion and absorption into the blood stream can challenge glycemic regulation and vascular endothelial function. Muscular contractions in exercise promote a return to homeostasis by increasing glucose uptake and blood flow. Similarly, muscle hypoxia supports glycemic regulation by increasing glucose oxidation. Blood flow restriction (BFR) induces muscle hypoxia during occlusion and reactive hyperemia upon release. Thus, in the absence of exercise, electric muscle stimulation (EMS) and BFR may offer circulatory and glucoregulatory improvements. In 13 healthy, active participants (27±3yr, 7 female) we tracked post-glucose (oral 100g) glycemic, cardiometabolic and vascular function measures over 120min following four interventions: 1) BFR, 2) EMS, 3) BFR+EMS or 4) Control. BFR was applied at 2min intervals for 30min (70% occlusion), EMS was continuous for 30min (maximum-tolerable intensity). Glycemic and insulinemic responses did not differ between interventions (partial η2=0.11-0.15, P=0.2); however, only BFR+EMS demonstrated cyclic effects on oxygen consumption, carbohydrate oxidation, muscle oxygenation, heart rate, and blood pressure (all P<0.01). Endothelial function was reduced 60min post-glucose ingestion across interventions and recovered by 120min (5.9±2.6% vs 8.4±2.7%; P<0.001). Estimated microvascular function was not meaningfully different. Leg blood flow increased during EMS and BFR+EMS (+656±519mL•min-1, +433±510mL•min-1; P<0.001); however, only remained elevated following BFR intervention 90min post-glucose (+94±94mL•min-1; P=0.02). Superimposition of EMS onto cyclic BFR did not preferentially improve post-glucose metabolic or vascular function amongst young, active participants. Cyclic BFR increased blood flow delivery 60min beyond intervention, and BFR+EMS selectively increased carbohydrate usage and reduced muscle oxygenation warranting future clinical assessments.
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Affiliation(s)
- Jeremy N. Cohen
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON, Canada
| | - Megan A. Kuikman
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON, Canada
| | - Valerie Politis-Barber
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON, Canada
| | - Brienne E. Stairs
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON, Canada
| | - Alexandra M. Coates
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON, Canada
| | - Philip J. Millar
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON, Canada
| | - Jamie F. Burr
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON, Canada
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Stanford DM, Mouser JG, Chatlaong MA, Jessee MB. A narrative review of the effects of blood flow restriction on vascular structure and function. Physiol Int 2022; 109:186-203. [PMID: 35587387 DOI: 10.1556/2060.2022.00223] [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: 12/18/2021] [Revised: 03/10/2022] [Accepted: 03/22/2022] [Indexed: 11/19/2022]
Abstract
Blood flow restriction is growing in popularity as a tool for increasing muscular size and strength. Currently, guidelines exist for using blood flow restriction alone and in combination with endurance and resistance exercise. However, only about 1.3% of practitioners familiar with blood flow restriction applications have utilized it for vascular changes, suggesting many of the guidelines are based on skeletal muscle outcomes. Thus, this narrative review is intended to explore the literature available in which blood flow restriction, or a similar application, assess the changes in vascular structure or function. Based on the literature, there is a knowledge gap in how applying blood flow restriction with relative pressures may alter the vasculature when applied alone, with endurance exercise, and with resistance exercise. In many instances, the application of blood flow restriction was not in accordance with the current guidelines, making it difficult to draw definitive conclusions as to how the vascular system would be affected. Additionally, several studies report no change in vascular structure or function, but few studies look at variables for both outcomes. By examining outcomes for both structure and function, investigators would be able to generate recommendations for the use of blood flow restriction to improve vascular structure and/or function in the future.
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Affiliation(s)
- Daphney M Stanford
- 1 The Department of Health, Exercise Science, and Recreation Management, Applied Human Health and Physical Function Laboratory, The University of Mississippi, Mississippi, MS, USA
| | - J Grant Mouser
- 2 Department of Kinesiology and Health Promotion, Applied Physiology Laboratory, Troy University, Troy, AL, USA
| | - Matthew A Chatlaong
- 1 The Department of Health, Exercise Science, and Recreation Management, Applied Human Health and Physical Function Laboratory, The University of Mississippi, Mississippi, MS, USA
| | - Matthew B Jessee
- 1 The Department of Health, Exercise Science, and Recreation Management, Applied Human Health and Physical Function Laboratory, The University of Mississippi, Mississippi, MS, USA
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Effects of blood flow restriction training on aerobic capacity: a systematic review and meta-analysis. SPORT SCIENCES FOR HEALTH 2022. [DOI: 10.1007/s11332-022-00944-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Ienaga K, Yamaguchi K, Ota N, Goto K. Augmented muscle deoxygenation during repeated sprint exercise with post-exercise blood flow restriction. Physiol Rep 2022; 10:e15294. [PMID: 35586958 PMCID: PMC9117971 DOI: 10.14814/phy2.15294] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 01/19/2022] [Accepted: 01/20/2022] [Indexed: 06/15/2023] Open
Abstract
Blood flow restriction (BFR) during low-intensity exercise has been known to be a potent procedure to alter metabolic and oxygen environments in working muscles. Moreover, the use of BFR during inter-set rest periods of repeated sprint exercise has been recently suggested to be a potent procedure for improving training adaptations. The present study was designed to determine the effect of repeated sprint exercise with post-exercise BFR (BFR during rest periods between sprints) on muscle oxygenation in working muscles. Eleven healthy males performed two different conditions on different days: either repeated sprint exercise with BFR during rest periods between sets (BFR condition) or without BFR (CON condition). A repeated sprint exercise consisted of three sets of 3 × 6-s maximal sprints (pedaling) with 24s rest periods between sprints and 5 min rest periods between sets. In BFR condition, two min of BFR (100-120 mmHg) for both legs was conducted between sets. During the exercise, power output and arterial oxygen saturation (SpO2 ) were evaluated. Muscle oxygenation for the vastus lateralis muscle, exercise-induced changes in muscle blood flow, and muscle oxygen consumption were measured. During BFR between sets, BFR condition presented significantly higher deoxygenated hemoglobin + myoglobin (p < 0.01) and lower tissue saturation index (p < 0.01) than those in CON condition. However, exercise-induced blood lactate elevation and reduction of blood pH did not differ significantly between the conditions. Furthermore, power output throughout nine sprints did not differ significantly between the two conditions. In conclusion, repeated sprint exercise with post-exercise BFR augmented muscle deoxygenation and local hypoxia, without interfering power output.
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Affiliation(s)
- Koki Ienaga
- Graduate School of Sport and Health ScienceRitsumeikan UniversityKusatsuShigaJapan
| | - Keiichi Yamaguchi
- Graduate School of Sport and Health ScienceRitsumeikan UniversityKusatsuShigaJapan
| | - Naoki Ota
- Graduate School of Sport and Health ScienceRitsumeikan UniversityKusatsuShigaJapan
| | - Kazushige Goto
- Graduate School of Sport and Health ScienceRitsumeikan UniversityKusatsuShigaJapan
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Wong V, Bell ZW, Sptiz RW, Song JS, Yamada Y, Abe T, Loenneke JP. Blood flow restriction maintains blood pressure upon head-up tilt. Physiol Int 2022; 109:106-118. [PMID: 35238796 DOI: 10.1556/2060.2022.00051] [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: 12/12/2021] [Accepted: 01/15/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Orthostatic intolerance occurs in some astronauts following space flight. Although orthostatic blood pressure responses should normalize in the weeks following the return to Earth, there may be situations where an immediate short-term solution is necessary (e.g., emergency evacuation). PURPOSE The purpose of this study was to examine different levels of blood flow restriction on changes in blood pressure and heart rate when transitioning from supine to a head-up tilt and determine whether this change differs based on sex. METHODS Eighty-nine participants (45 men, 44 women) completed the three visits with different pressures (Sham, Moderate, and High) in a randomized order. Cuffs were placed on the most proximal area of the thighs. Brachial blood pressure was measured at baseline, upon inflation of the cuffs in a supine position, immediately after tilt (70°), and eight more times separated by 45 seconds. RESULTS Data are presented as mean (SD). The change in systolic (High > Moderate > Sham) [High vs Sham: 5.5 (7.4) mmHg, High vs Moderate: 3 (7.4) mmHg, and Moderate vs Sham: 2.4 (8.4) mmHg] and diastolic pressure (High > Moderate = Sham) [High vs Sham: 2.4 (5.3) mmHg, High vs Moderate: 1.9 (6.3) mmHg] differed across applied pressures. The change in heart rate was initially greatest in the sham-pressure but increased the greatest in the high-pressure condition by the end of the head-up tilt period. Additionally, there was no influence of sex. CONCLUSION Blood flow restriction applied in this study increased blood pressure in a pressure-dependent manner upon head-up tilt.
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Affiliation(s)
- Vickie Wong
- 1 Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, MS, USA
| | - Zachary W Bell
- 1 Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, MS, USA
| | - Robert W Sptiz
- 1 Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, MS, USA
| | - Jun Seob Song
- 1 Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, MS, USA
| | - Yujiro Yamada
- 1 Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, MS, USA
| | - Takashi Abe
- 2 Institute of Health and Sports Science and Medicine, Juntendo University, Inzai, Chiba 270-1695, Japan
| | - Jeremy P Loenneke
- 1 Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, MS, USA
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Differences in Femoral Artery Occlusion Pressure between Sexes and Dominant and Non-Dominant Legs. ACTA ACUST UNITED AC 2021; 57:medicina57090863. [PMID: 34577785 PMCID: PMC8471356 DOI: 10.3390/medicina57090863] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 08/21/2021] [Accepted: 08/21/2021] [Indexed: 11/17/2022]
Abstract
Background and Objectives: Blood flow restriction during low-load exercise stimulates similar muscle adaptations to those normally observed with higher loads. Differences in the arterial occlusion pressure (AOP) between limbs and between sexes are unclear. We compared the AOP of the superficial femoral artery in the dominant and non-dominant legs, and the relationship between blood flow and occlusion pressure in 35 (16 males, 19 females) young adults. Materials and Methods: Using ultrasound, we measured the AOP of the superficial femoral artery in both legs. Blood flow at occlusion pressures ranging from 0% to 100% of the AOP was measured in the dominant leg. Results: There was a significant difference in the AOP between males and females in the dominant (230 ± 41 vs. 191 ± 27 mmHg; p = 0.002) and non-dominant (209 ± 37 vs. 178 ± 21 mmHg; p = 0.004) legs, and between the dominant and non-dominant legs in males (230 ± 41 vs. 209 ± 37 mmHg; p = 0.009) but not females (191 ± 27 vs. 178 ± 21 mmHg; p = 0.053), respectively. Leg circumference was the most influential independent predictor of the AOP. There was a linear relationship between blood flow (expressed as a percentage of unoccluded blood flow) and occlusion pressure (expressed as a percentage of AOP). Conclusions: Arterial occlusion pressure is not always greater in the dominant leg or the larger leg. Practitioners should measure AOP in both limbs to determine if occlusion pressures used during exercise should be limb specific. Occlusion pressures used during blood flow restriction exercise should be chosen carefully.
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Cherouveim ED, Miliotis P, Dipla K, Koskolou MD, Vrabas IS, Geladas ND. The effect of muscle blood flow restriction on hemodynamics, cerebral oxygenation and activation at rest. Appl Physiol Nutr Metab 2021; 46:1216-1224. [PMID: 33951406 DOI: 10.1139/apnm-2020-1082] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This study tested the hypothesis that muscle blood flow restriction reduces muscle and cerebral oxygenation, at rest. In 26 healthy males, aged 33±2 yrs, physiological variables were continuously recorded during a 10-min period in two experimental conditions: a) with muscle blood flow restriction through thigh cuffs application inflated at 120 mmHg (With Cuffs, WC) and b) without restriction (No Cuffs, NC). Muscle and cerebral oxygenation were reduced by muscle blood flow restriction as suggested by the increase in both muscle and cerebral deoxygenated hemoglobin (Δ[HHb]; p<0.01) and the decrease of muscle and cerebral oxygenation index (Δ[HbDiff]; p<0.01). Hemodynamic responses were not affected by such muscle blood flow restriction, whereas baroreflex sensitivity was reduced (p=0.009). The perception of leg discomfort was higher (p<0.001) in the WC than in the NC condition. This study suggests that thigh cuffs application inflated at 120 mmHg is an effective method to reduce muscle oxygenation at rest. These changes at the muscular level seem to be sensed by the central nervous system, evoking alterations in cerebral oxygenation and baroreflex sensitivity. Novelty bullets: • Thigh cuffs application inflated at 120 mmHg effectively reduces muscle oxygenation at rest. • Limiting muscle oxygenation appears to reduce cerebral oxygenation, and baroreflex sensitivity, at rest. • Even in healthy subjects, limiting muscle oxygenation, at rest, affects neural integration.
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Affiliation(s)
- Evgenia D Cherouveim
- National and Kapodistrian University of Athens, 68993, School of Physical Education and Sport Science, Athens, Attica, Greece;
| | - Panagiotis Miliotis
- National and Kapodistrian University of Athens, 68993, School of Physical Education and Sport Science, Athens, Attica, Greece;
| | - Konstantina Dipla
- Aristotle University of Thessaloniki, Department of Physical Education and Sport Sciences at Serres (TEFAA), Exercise Physiology and Biochemistry Laboratory, Serres, Greece, 62110;
| | - Maria D Koskolou
- National and Kapodistrian University of Athens, 68993, School of Physical Education and Sport Science, Athens, Attica, Greece;
| | | | - Nickos D Geladas
- National and Kapodistrian University of Athens, 68993, School of Physical Education and Sport Science, Athens, Attica, Greece;
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Ogawa H, Nakajima T, Shibasaki I, Nasuno T, Kaneda H, Katayanagi S, Ishizaka H, Mizushima Y, Uematsu A, Yasuda T, Yagi H, Toyoda S, Hortobágyi T, Mizushima T, Inoue T, Fukuda H. Low-Intensity Resistance Training with Moderate Blood Flow Restriction Appears Safe and Increases Skeletal Muscle Strength and Size in Cardiovascular Surgery Patients: A Pilot Study. J Clin Med 2021; 10:547. [PMID: 33540756 PMCID: PMC7867301 DOI: 10.3390/jcm10030547] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 01/23/2021] [Accepted: 01/28/2021] [Indexed: 11/16/2022] Open
Abstract
We examined the safety and the effects of low-intensity resistance training (RT) with moderate blood flow restriction (KAATSU RT) on muscle strength and size in patients early after cardiac surgery. Cardiac patients (age 69.6 ± 12.6 years, n = 21, M = 18) were randomly assigned to the control (n = 10) and the KAATSU RT group (n = 11). All patients had received a standard aerobic cardiac rehabilitation program. The KAATSU RT group additionally executed low-intensity leg extension and leg press exercises with moderate blood flow restriction twice a week for 3 months. RT-intensity and volume were increased gradually. We evaluated the anterior mid-thigh thickness (MTH), skeletal muscle mass index (SMI), handgrip strength, knee extensor strength, and walking speed at baseline, 5-7 days after cardiac surgery, and after 3 months. A physician monitored the electrocardiogram, rate of perceived exertion, and the color of the lower limbs during KAATSU RT. Creatine phosphokinase (CPK) and D-dimer were measured at baseline and after 3 months. There were no side effects during KAATSU RT. CPK and D-dimer were normal after 3 months. MTH, SMI, walking speed, and knee extensor strength increased after 3 months with KAATSU RT compared with baseline. Relatively low vs. high physical functioning patients tended to increase physical function more after 3 months with KAATSU RT. Low-intensity KAATSU RT as an adjuvant to standard cardiac rehabilitation can safely increase skeletal muscle strength and size in cardiovascular surgery patients.
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Affiliation(s)
- Hironaga Ogawa
- Department of Cardiovascular Surgery, School of Medicine, Dokkyo Medical University, Shimotsuga-gun, Tochigi 321-0293, Japan; (H.O.); (I.S.); (H.F.)
| | - Toshiaki Nakajima
- Department of Cardiovascular Medicine, School of Medicine, Dokkyo Medical University, Shimotsuga-gun, Tochigi 321-0293, Japan; (T.N.); (H.K.); (H.Y.); (S.T.); (T.I.)
- Department of Medical KAATSU Training, Dokkyo Medical University, Shimotsuga-gun, Tochigi 321-0293, Japan
| | - Ikuko Shibasaki
- Department of Cardiovascular Surgery, School of Medicine, Dokkyo Medical University, Shimotsuga-gun, Tochigi 321-0293, Japan; (H.O.); (I.S.); (H.F.)
| | - Takahisa Nasuno
- Department of Cardiovascular Medicine, School of Medicine, Dokkyo Medical University, Shimotsuga-gun, Tochigi 321-0293, Japan; (T.N.); (H.K.); (H.Y.); (S.T.); (T.I.)
| | - Hiroyuki Kaneda
- Department of Cardiovascular Medicine, School of Medicine, Dokkyo Medical University, Shimotsuga-gun, Tochigi 321-0293, Japan; (T.N.); (H.K.); (H.Y.); (S.T.); (T.I.)
| | - Satoshi Katayanagi
- Department of Rehabilitation, Dokkyo Medical University Hospital, Shimotsuga-gun, Tochigi 321-0293, Japan; (S.K.); (H.I.); (Y.M.); (T.M.)
| | - Hayato Ishizaka
- Department of Rehabilitation, Dokkyo Medical University Hospital, Shimotsuga-gun, Tochigi 321-0293, Japan; (S.K.); (H.I.); (Y.M.); (T.M.)
| | - Yuta Mizushima
- Department of Rehabilitation, Dokkyo Medical University Hospital, Shimotsuga-gun, Tochigi 321-0293, Japan; (S.K.); (H.I.); (Y.M.); (T.M.)
| | - Azusa Uematsu
- Department of Health and Sport Sciences, Premedical Sciences, Dokkyo Medical University, Shimotsuga-gun, Tochigi 321-0293, Japan;
| | - Tomohiro Yasuda
- School of Nursing, Seirei Christopher University, Hamamatsu, Shizuoka 433-8558, Japan;
| | - Hiroshi Yagi
- Department of Cardiovascular Medicine, School of Medicine, Dokkyo Medical University, Shimotsuga-gun, Tochigi 321-0293, Japan; (T.N.); (H.K.); (H.Y.); (S.T.); (T.I.)
| | - Shigeru Toyoda
- Department of Cardiovascular Medicine, School of Medicine, Dokkyo Medical University, Shimotsuga-gun, Tochigi 321-0293, Japan; (T.N.); (H.K.); (H.Y.); (S.T.); (T.I.)
| | - Tibor Hortobágyi
- University Medical Center Groningen, University of Groningen, Groningen, 9713 GZ Groningen, The Netherlands;
| | - Takashi Mizushima
- Department of Rehabilitation, Dokkyo Medical University Hospital, Shimotsuga-gun, Tochigi 321-0293, Japan; (S.K.); (H.I.); (Y.M.); (T.M.)
| | - Teruo Inoue
- Department of Cardiovascular Medicine, School of Medicine, Dokkyo Medical University, Shimotsuga-gun, Tochigi 321-0293, Japan; (T.N.); (H.K.); (H.Y.); (S.T.); (T.I.)
| | - Hirotsugu Fukuda
- Department of Cardiovascular Surgery, School of Medicine, Dokkyo Medical University, Shimotsuga-gun, Tochigi 321-0293, Japan; (H.O.); (I.S.); (H.F.)
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Amorim S, Rolnick N, Schoenfeld BJ, Aagaard P. Low-intensity resistance exercise with blood flow restriction and arterial stiffness in humans: A systematic review. Scand J Med Sci Sports 2020; 31:498-509. [PMID: 33283322 DOI: 10.1111/sms.13902] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 11/18/2020] [Accepted: 11/20/2020] [Indexed: 12/25/2022]
Abstract
Low-intensity resistance exercise with blood flow restriction exercise is an emerging type of exercise recognition worldwide. This systematic review evaluated the effects of low-intensity resistance exercise performed with concurrent blood flow restriction (LIRE-BFR) on acute and chronic measures of arterial stiffness in humans. A systematic search in six healthcare science databases and reference lists was conducted. Data selected for primary analysis consisted of post-intervention changes in arterial stiffness markers. This systematic review included randomized and non-randomized controlled trials of LIRE-BFR in humans. 156 articles were initially identified, 15 of which met inclusion criteria. Ten studies were excluded because they did not match predefined arterial stiffness markers. Thus, five articles were included in this review: two acute studies (N = 39 individuals, age = 20-30 years old, 30.8% women and 69.2% men) and three longitudinal studies (N = 51 individuals, age = 24-86-years old, 41.2% women and 58.8% men). Acute LIRE-BFR demonstrated both positive and negative effects on arterial stiffness in healthy young people. In contrast, longitudinal studies reported neutral effects in healthy young and older people. In conclusion, LIRE-BFR applied to the upper and lower limbs may acutely induce increases in central blood pressure and pulse wave velocity in healthy young people, whereas LIRE-BFR for the lower limbs may elicit positive effects related to indirect markers of arterial stiffness. Moreover, longitudinal LIRE-BFR studies showed no changes in arterial stiffness in young and older people. Hence, LIRE-BFR should be prescribed with a degree of caution to avoid non-intended responses in arterial stiffness markers in humans.
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Affiliation(s)
- Samuel Amorim
- Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Nicholas Rolnick
- Department of Health Sciences, Lehman College, CUNY, Bronx, NY, USA
| | | | - Per Aagaard
- Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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Munhoz SV, Ramis TR, dos Santos LP, Ribeiro JL. Comparison of cardiopulmonary exercise testing performed with blood flow restriction vs. a traditional maximum test on execution speed, ventilatory thresholds and maximum oxygen uptake. SPORT SCIENCES FOR HEALTH 2020. [DOI: 10.1007/s11332-020-00644-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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da Cunha Nascimento D, Schoenfeld BJ, Prestes J. Potential Implications of Blood Flow Restriction Exercise on Vascular Health: A Brief Review. Sports Med 2020; 50:73-81. [PMID: 31559565 DOI: 10.1007/s40279-019-01196-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Blood flow restriction (BFR) exercise (a.k.a. occlusion training) has emerged as a viable surrogate to traditional heavy-load strength rehabilitation training for a broad range of clinical populations including elderly subjects and rehabilitating athletes. A particular benefit of BFR exercise is the lower stress upon the joints as compared to traditional heavy resistance training, with similar gains in muscle strength and size. The application of an inflatable cuff to the proximal portion of the limbs increases the pressure required for venous return, leading to changes in venous compliance and wall tension. However, it is not known if long-term benefits of BFR exercise on muscle strength and size outweigh potential short and long-term complications on vascular health. BFR exercise could lead to clinical deterioration of the vasculature along with sympathetic overactivity and decreased vascular function associated with retrograde shear stress. This raises a fundamental question: Given the concern that excessive restriction could cause injury to endothelial cells and might cause detrimental effects on endothelial function, even in healthy individuals, should we critically re-evaluate the safety of this method for the general population? From this perspective, the purpose of this manuscript is to review the effects of BFR exercise on vascular function, and to provide relevant insights for training practice as well as future directions for research.
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Affiliation(s)
- Dahan da Cunha Nascimento
- Department of Physical Education, Catholic University of Brasilia (UCB), Q.S. 07, Lote 01, EPTC-Bloco G. Código Postal, Distrito Federal, Brasilia, 71966-700, Brazil. .,Department of Physical Education, University Center of the Federal District (UDF), Brasilia, Brazil.
| | | | - Jonato Prestes
- Department of Physical Education, Catholic University of Brasilia (UCB), Q.S. 07, Lote 01, EPTC-Bloco G. Código Postal, Distrito Federal, Brasilia, 71966-700, Brazil
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Sgromolo NM, Cancio JM, Rhee PC. Safety and Efficacy of Blood Flow Restriction Therapy after Operative Management of Distal Radius Fractures: A Randomized Controlled Study. J Wrist Surg 2020; 9:345-352. [PMID: 32760614 PMCID: PMC7395840 DOI: 10.1055/s-0040-1712504] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 04/07/2020] [Indexed: 10/24/2022]
Abstract
Background Blood flow restriction (BFR) therapy is an emerging addition to rehabilitative programs that allows patients to increase strength at lower loads over shorter time periods. Therefore, we conducted a study to evaluate the safety and efficacy of a rehabilitation program using BFR to a traditional rehabilitation protocol following operative fixation of distal radius fractures. Methods A randomized controlled study was conducted comparing a standardized rehabilitation protocol alone to a combined protocol with the use of BFR therapy in patients treated with volar plate fixation following a displaced distal radius fracture. The same exercises done in the control group were performed by the BFR group with a restrictive tourniquet in place. Patients were followed with serial radiographs to ensure fracture stability. Outcome measures included wrist range of motion, grip strength, pinch strength, visual analog scale (VAS) pain scores at rest and during activity, patient rated wrist evaluation scores (PRWE), and disabilities of the arm, shoulder, and hand scores. Results Nine patients were randomized and enrolled within the BFR group ( n = 5) and control ( n = 4) groups. Patients within the BFR group had a significantly greater reduction in pain with activity over the course of the rehabilitation program. Additionally, the BFR group had a significant improvement in PRWE scores during the 8-week rehabilitation program. There was no difference in radiographic measures after initiation of BFR, and all patients tolerated therapy without noted complications. Conclusion BFR therapy is safe and well tolerated after operatively treated distal radius fractures. The addition of BFR therapy can result in quicker reduction in pain with activity and improvement in patient disability when used early following operative management of a distal radius fracture. Level of Evidence This is a Level 1, prognostic study.
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Affiliation(s)
- Nicole M. Sgromolo
- Department of Orthopaedic Surgery, San Antonio Military Medical Center, Fort Sam Houston, San Antonio, Texas
| | - Jill M. Cancio
- Department of Rehabilitation Medicine, Center for the Intrepid, Brooke Army Medical Center, San Antonio Military Medical Center, JBSA Ft. Sam Houston, San Antonio, Texas
- Extremity Trauma and Amputation Center of Excellence, JBSA Ft. Sam Houston, San Antonio, Texas
| | - Peter C. Rhee
- Division of Hand Surgery, Mayo Clinic, Rochester, Minnesota
- Department of Orthopedic Surgery, Clinical Investigation Facility, Travis Air Force Base, California
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Acute Neuromuscular Electrical Stimulation (NMES) With Blood Flow Restriction: The Effect of Restriction Pressures. J Sport Rehabil 2020; 30:375-383. [PMID: 32736338 DOI: 10.1123/jsr.2019-0505] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 04/02/2020] [Accepted: 04/26/2020] [Indexed: 11/18/2022]
Abstract
CONTEXT Neuromuscular electrical stimulation (NMES) combined with blood flow restriction (BFR) has been shown to improve muscular strength and size better than NMES alone. However, previous studies used varied methodologies not recommended by previous NMES or BFR research. OBJECTIVE The present study investigated the acute effects of NMES combined with varying degrees of BFR using research-recommended procedures to enhance understanding and the clinical applicability of this combination. DESIGN Randomized crossover. SETTING Physiology laboratory. PARTICIPANTS A total of 20 healthy adults (age 27 [4] y; height 177 [8] cm; body mass 77 [13] kg). INTERVENTIONS Six sessions separated by at least 7 days. The first 2 visits served as familiarization, with the experimental conditions performed in the final 4 sessions: NMES alone, NMES 40% BFR, NMES 60% BFR, and NMES 80% BFR. MAIN OUTCOME MEASURES Maximal voluntary isometric contraction, muscle thickness, blood pressure, heart rate, rating of perceived exertion, and pain were all recorded before and after each condition. RESULTS The NMES 80% BFR caused greater maximal voluntary isometric contraction decline than any other condition (-38.9 [22.3] N·m, P < .01). Vastus medialis and vastus lateralis muscle thickness acutely increased after all experimental conditions (P < .05). Pain and ratings of perceived exertion were higher after NMES 80% BFR compared with all other experimental conditions (P < .05). No cardiovascular effects were observed between conditions. CONCLUSION The NMES combined with 80% BFR caused greater acute force decrement than the other conditions. However, greater perceptual ratings of pain and ratings of perceived exertion were observed with NMES 80% BFR. These acute observations must be investigated during chronic interventions to corroborate any relationship to changes in muscle strength and size in clinical populations.
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Lin TC, Cai ZY. The effects of whole body vibration training combined with blood flow restriction on von Willebrand factor response. ISOKINET EXERC SCI 2020. [DOI: 10.3233/ies-192147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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26
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Huang BH, Wang TY, Lu KH, Chang CY, Chan KH. Effects of ischemic preconditioning on local hemodynamics and isokinetic muscular function. ISOKINET EXERC SCI 2020. [DOI: 10.3233/ies-194184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Bo-Huei Huang
- Charles Perkins Centre, School of Public Health, the University of Sydney, NSW, Australia
| | - Ting-Yao Wang
- General Education Centre, Tzu Chi University of Science and Technology, Hualien, Taiwan
| | - Kang-Hao Lu
- Sports Science and Research Department, National Sports Training Centre, Kaohsiung, Taiwan
| | - Cheng-Yu Chang
- Graduate Institute of Athletics and Coaching Science, National Taiwan Sport University, Taoyuan, Taiwan
| | - Kuei-Hui Chan
- Graduate Institute of Athletics and Coaching Science, National Taiwan Sport University, Taoyuan, Taiwan
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Cristina-Oliveira M, Meireles K, Spranger MD, O'Leary DS, Roschel H, Peçanha T. Clinical safety of blood flow-restricted training? A comprehensive review of altered muscle metaboreflex in cardiovascular disease during ischemic exercise. Am J Physiol Heart Circ Physiol 2019; 318:H90-H109. [PMID: 31702969 DOI: 10.1152/ajpheart.00468.2019] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Blood flow restriction training (BFRT) is an increasingly widespread method of exercise that involves imposed restriction of blood flow to the exercising muscle. Blood flow restriction is achieved by inflating a pneumatic pressure cuff (or a tourniquet) positioned proximal to the exercising muscle before, and during, the bout of exercise (i.e., ischemic exercise). Low-intensity BFRT with resistance training promotes comparable increases in muscle mass and strength observed during high-intensity exercise without blood flow restriction. BFRT has expanded into the clinical research setting as a potential therapeutic approach to treat functionally impaired individuals, such as the elderly, and patients with orthopedic and cardiovascular disease/conditions. However, questions regarding the safety of BFRT must be fully examined and addressed before the implementation of this exercise methodology in the clinical setting. In this respect, there is a general concern that BFRT may generate abnormal reflex-mediated cardiovascular responses. Indeed, the muscle metaboreflex is an ischemia-induced, sympathoexcitatory pressor reflex originating in skeletal muscle, and the present review synthesizes evidence that BFRT may elicit abnormal cardiovascular responses resulting from increased metaboreflex activation. Importantly, abnormal cardiovascular responses are more clearly evidenced in populations with increased cardiovascular risk (e.g., elderly and individuals with cardiovascular disease). The evidence provided in the present review draws into question the cardiovascular safety of BFRT, which clearly needs to be further investigated in future studies. This information will be paramount for the consideration of BFRT exercise implementation in clinical populations.
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Affiliation(s)
- Michelle Cristina-Oliveira
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Rheumatology Division, Faculdade de Medicina, University of São Paulo, São Paulo, Brazil
| | - Kamila Meireles
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Rheumatology Division, Faculdade de Medicina, University of São Paulo, São Paulo, Brazil
| | - Marty D Spranger
- Department of Physiology, Michigan State University, East Lansing, Michigan
| | - Donal S O'Leary
- Department of Physiology, Wayne State University School of Medicine, Detroit, Michigan
| | - Hamilton Roschel
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Rheumatology Division, Faculdade de Medicina, University of São Paulo, São Paulo, Brazil
| | - Tiago Peçanha
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Rheumatology Division, Faculdade de Medicina, University of São Paulo, São Paulo, Brazil
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Willis SJ, Borrani F, Millet GP. High-Intensity Exercise With Blood Flow Restriction or in Hypoxia as Valuable Spaceflight Countermeasures? Front Physiol 2019; 10:1266. [PMID: 31632298 PMCID: PMC6783686 DOI: 10.3389/fphys.2019.01266] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 09/19/2019] [Indexed: 11/17/2022] Open
Affiliation(s)
- Sarah J Willis
- Faculty of Biology and Medicine, Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | - Fabio Borrani
- Faculty of Biology and Medicine, Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | - Grégoire P Millet
- Faculty of Biology and Medicine, Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
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Ishizaka H, Uematsu A, Mizushima Y, Nozawa N, Katayanagi S, Matsumoto K, Nishikawa K, Takahashi R, Arakawa T, Sawaguchi T, Yasuda T, Yamaguchi S, Ogawa H, Shibasaki I, Toyoda S, Hortobágyi T, Fukuda H, Inoue T, Mizushima T, Nakajima T. Blood Flow Restriction Increases the Neural Activation of the Knee Extensors During Very Low-Intensity Leg Extension Exercise in Cardiovascular Patients: A Pilot Study. J Clin Med 2019; 8:jcm8081252. [PMID: 31430903 PMCID: PMC6723568 DOI: 10.3390/jcm8081252] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 08/14/2019] [Accepted: 08/15/2019] [Indexed: 12/19/2022] Open
Abstract
Blood flow restriction (BFR) has the potential to augment muscle activation, which underlies strengthening and hypertrophic effects of exercise on skeletal muscle. We quantified the effects of BFR on muscle activation in the rectus femoris (RF), the vastus lateralis (VL), and the vastus medialis (VM) in concentric and eccentric contraction phases of low-intensity (10% and 20% of one repetition maximum) leg extension in seven cardiovascular patients who performed leg extension in four conditions: at 10% and 20% intensities with and without BFR. Each condition consisted of three sets of 30 trials with 30 s of rest between sets and 5 min of rest between conditions. Electromyographic activity (EMG) from RF, VL, and VM for 30 repetitions was divided into blocks of 10 trials and averaged for each block in each muscle. At 10% intensity, BFR increased EMG of all muscles across the three blocks in both concentric and eccentric contraction phases. At 20% intensity, EMG activity in response to BFR tended to not to increase further than what it was at 10% intensity. We concluded that very low 10% intensity exercise with BFR may maximize the benefits of BFR on muscle activation and minimize exercise burden on cardiovascular patients.
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Affiliation(s)
- Hayato Ishizaka
- Department of Rehabilitation, Dokkyo Medical University Hospital, Shimotsuga-gun, Tochigi 321-0293, Japan
| | - Azusa Uematsu
- Department of Health and Sport Sciences, Premedical Sciences, Dokkyo Medical University, Shimotsuga-gun, Tochigi 321-0293, Japan.
| | - Yuta Mizushima
- Department of Rehabilitation, Dokkyo Medical University Hospital, Shimotsuga-gun, Tochigi 321-0293, Japan
| | - Naohiro Nozawa
- Department of Rehabilitation, Dokkyo Medical University Hospital, Shimotsuga-gun, Tochigi 321-0293, Japan
| | - Satoshi Katayanagi
- Department of Rehabilitation, Dokkyo Medical University Hospital, Shimotsuga-gun, Tochigi 321-0293, Japan
| | - Kazuhisa Matsumoto
- Department of Rehabilitation, Dokkyo Medical University Hospital, Shimotsuga-gun, Tochigi 321-0293, Japan
| | - Kaori Nishikawa
- Department of Rehabilitation, Dokkyo Medical University Hospital, Shimotsuga-gun, Tochigi 321-0293, Japan
| | - Reiko Takahashi
- Department of Rehabilitation, Dokkyo Medical University Hospital, Shimotsuga-gun, Tochigi 321-0293, Japan
| | - Tomoe Arakawa
- Department of Rehabilitation, Dokkyo Medical University Hospital, Shimotsuga-gun, Tochigi 321-0293, Japan
| | - Tatsuya Sawaguchi
- Department of Cardiovascular Medicine, School of Medicine, Dokkyo Medical University, Shimotsuga-gun, Tochigi 321-0293, Japan
| | - Tomohiro Yasuda
- School of Nursing, Seirei Christopher University, Hamamatsu, Shizuoka 433-8558, Japan
| | - Suomi Yamaguchi
- Department of Cardiology and Nephrology, School of Medicine, Dokkyo Medical University, Shimotsuga-gun, Tochigi 321-0293, Japan
| | - Hironaga Ogawa
- Department of Cardiac and Vascular Surgery, School of Medicine, Dokkyo Medical University, Shimotsuga-gun, Tochigi 321-0293, Japan
| | - Ikuko Shibasaki
- Department of Cardiac and Vascular Surgery, School of Medicine, Dokkyo Medical University, Shimotsuga-gun, Tochigi 321-0293, Japan
| | - Shigeru Toyoda
- Department of Cardiovascular Medicine, School of Medicine, Dokkyo Medical University, Shimotsuga-gun, Tochigi 321-0293, Japan
| | - Tibor Hortobágyi
- University Medical Center Groningen, University of Groningen, Groningen, Groningen 9713 GZ, The Netherlands
| | - Hirotsugu Fukuda
- Department of Cardiac and Vascular Surgery, School of Medicine, Dokkyo Medical University, Shimotsuga-gun, Tochigi 321-0293, Japan
| | - Teruo Inoue
- Department of Cardiovascular Medicine, School of Medicine, Dokkyo Medical University, Shimotsuga-gun, Tochigi 321-0293, Japan
| | - Takashi Mizushima
- Department of Rehabilitation, School of Medicine, Dokkyo Medical University, Shimotsuga-gun, Tochigi 321-0293, Japan
| | - Toshiaki Nakajima
- Department of Cardiovascular Medicine, School of Medicine, Dokkyo Medical University, Shimotsuga-gun, Tochigi 321-0293, Japan
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Cancio JM, Sgromolo NM, Rhee PC. Blood Flow Restriction Therapy after Closed Treatment of Distal Radius Fractures. J Wrist Surg 2019; 8:288-294. [PMID: 31404177 PMCID: PMC6685733 DOI: 10.1055/s-0039-1685455] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 02/27/2019] [Indexed: 10/27/2022]
Abstract
Background Blood flow restriction (BFR) therapy is an innovative rehabilitative program that enables patients to increase strength at a fraction of the weight typically necessary in endurance exercises. Therefore, we conducted a pilot study evaluating patient outcomes with a BFR therapy program for closed management after a distal radius fracture compared to a traditional rehabilitation protocol. Literature review A randomized-controlled study was conducted comparing a standardized hand therapy rehabilitation protocol alone to a combined protocol with the use of BFR therapy in patients who were initially treated with closed reduction and short arm cast immobilization for a displaced distal radius fracture between May 1, 2015 and August 1, 2016. BFR therapy was performed with a restrictive tourniquet applied to the upper brachium, performing the same strengthening exercises as the control group but with the restrictive tourniquet in place. Clinical assessment was conducted at 6, 10, and 14 weeks from the date of initial cast immobilization. Outcome measures collected included wrist range of motion; grip strength; pinch strength; visual analogue scale for pain with activity and at rest; patient-rated wrist evaluation (PRWE) scores; and disabilities of the arm, shoulder, and hand scores. Results Thirteen patients were enrolled and randomized between the BFR ( n = 6) and control ( n = 7) groups. The BFR group noted significantly greater reduction in pain with activity compared to the control group after 8 weeks of therapy (Δ -4.0 vs. -2.3, p = 0.03). Similarly, patients in the BFR group displayed greater reduction in PRWE scores compared to the control group after 8 weeks of BFR therapy (Δ -57.9 vs. 30.8, p = 0.01). The two groups did not demonstrate any significant difference in radiographic outcomes at any time point or throughout the course of the study. All patients tolerated the BFR therapy program and there were no complications. Clinical relevance The addition of BFR therapy to the rehabilitative program after closed management of a distal radius fracture is safe, well tolerated by patients, without any deleterious effects on radiographic outcomes. This pilot study noted that BFR therapy in patients with nonoperative distal radius fractures may result in a larger reduction in pain with activity and greater improvement in overall self-perceived function.
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Affiliation(s)
- Jill M. Cancio
- Center for the Intrepid, Department of Rehabilitation Medicine, Brooke Army Medical Center, San Antonio Military Medical Center, JBSA Ft. Sam Houston, Texas; Extremity Trauma and Amputation Center of Excellence, JBSA Ft. Sam Houston, Texas
| | - Nicole M. Sgromolo
- San Antonio Military Medical Center, Fort Sam Houston, Texas; Department of Orthopaedic Surgery
| | - Peter C. Rhee
- Mayo Clinic, Orthopedic Surgery, Rochester, Minnesota
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Spitz RW, Chatakondi RN, Bell ZW, Wong V, Dankel SJ, Abe T, Loenneke JP. The impact of cuff width and biological sex on cuff preference and the perceived discomfort to blood-flow-restricted arm exercise. Physiol Meas 2019; 40:055001. [PMID: 30965312 DOI: 10.1088/1361-6579/ab1787] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To investigate the influence of cuff width, sex, and applied pressure on the perceived discomfort associated with blood flow restriction at rest and following exercise. APPROACH Experiment 1 (n = 96) consisted of four sets of biceps exercise to failure with a narrow and wide cuff inflated to the same relative pressure. Experiment 2 (n = 87) compared two wide cuffs, one of which was inflated to a relative pressure obtained from a narrow cuff. Experiment 3 (n = 50) compared the discomfort of wide and narrow cuffs at rest. Effects are presented as median δ (95% credible interval). MAIN RESULTS There was no sex effect for any variable of interest. In Experiment 1, the narrow cuff resulted in less discomfort than the wide cuff (39.3 versus 42.5; median δ -0.388 (-0.670, -0.109)). Participants also rated the narrow cuff as more preferable. Experiment 2 found that a wide cuff inflated to a narrow cuffs pressure resulted in greater discomfort than a wide cuff (44 versus 40.9; median δ: 0.420 (0.118, 0.716)). Experiment 3 found no difference between cuff widths. SIGNIFICANCE Blood flow restricted exercise with a narrow cuff results in less discomfort than a wider cuff inflated to the same relative pressure. This effect is not observed at rest and suggests that the wide cuff produces a differential environment compared to a narrow cuff when combined with exercise. Additionally, applying a pressure meant for a narrow cuff to a wide cuff augments the applied pressure and subsequent discomfort to blood flow restricted exercise.
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Affiliation(s)
- Robert W Spitz
- Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, MS, United States of America
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Patterson SD, Hughes L, Warmington S, Burr J, Scott BR, Owens J, Abe T, Nielsen JL, Libardi CA, Laurentino G, Neto GR, Brandner C, Martin-Hernandez J, Loenneke J. Blood Flow Restriction Exercise: Considerations of Methodology, Application, and Safety. Front Physiol 2019; 10:533. [PMID: 31156448 PMCID: PMC6530612 DOI: 10.3389/fphys.2019.00533] [Citation(s) in RCA: 325] [Impact Index Per Article: 65.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 04/15/2019] [Indexed: 12/14/2022] Open
Abstract
The current manuscript sets out a position stand for blood flow restriction (BFR) exercise, focusing on the methodology, application and safety of this mode of training. With the emergence of this technique and the wide variety of applications within the literature, the aim of this position stand is to set out a current research informed guide to BFR training to practitioners. This covers the use of BFR to enhance muscular strength and hypertrophy via training with resistance and aerobic exercise and preventing muscle atrophy using the technique passively. The authorship team for this article was selected from the researchers focused in BFR training research with expertise in exercise science, strength and conditioning and sports medicine.
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Affiliation(s)
- Stephen D. Patterson
- Faculty of Sport, Health and Applied Sciences, St Marys University, London, United Kingdom
| | - Luke Hughes
- Faculty of Sport, Health and Applied Sciences, St Marys University, London, United Kingdom
| | - Stuart Warmington
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia
| | - Jamie Burr
- Department of Human Health and Nutritional Science, University of Guelph, Guelph, ON, Canada
| | - Brendan R. Scott
- Murdoch Applied Sports Science Laboratory, Discipline of Exercise Science, Murdoch University, Perth, WA, Australia
| | - Johnny Owens
- Owens Recovery Science, San Antonio, TX, United States
| | - Takashi Abe
- Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, University of Mississippi, Oxford, MS, United States
| | - Jakob L. Nielsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Cleiton Augusto Libardi
- MUSCULAB – Laboratory of Neuromuscular Adaptations to Resistance Training, Federal University of São Carlos (UFSCar), São Carlos, Brazil
| | - Gilberto Laurentino
- School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Gabriel Rodrigues Neto
- Coordination of Physical Education/Professional Master’s in Family Health, Nursing and Medical Schools, Nova Esperança (FAMENE/FACENE), João Pessoa, Brazil
| | | | - Juan Martin-Hernandez
- I+HeALTH Research Group, Department of Health Sciences, Faculty of Health Sciences, Miguel de Cervantes European University, Valladolid, Spain
| | - Jeremy Loenneke
- Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, University of Mississippi, Oxford, MS, United States
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Reis JF, Fatela P, Mendonca GV, Vaz JR, Valamatos MJ, Infante J, Mil-Homens P, Alves FB. Tissue Oxygenation in Response to Different Relative Levels of Blood-Flow Restricted Exercise. Front Physiol 2019; 10:407. [PMID: 31031637 PMCID: PMC6470188 DOI: 10.3389/fphys.2019.00407] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 03/25/2019] [Indexed: 12/11/2022] Open
Abstract
Blood flow restrictive (BFR) exercise elicits a localized hypoxic environment compatible with greater metabolic stress. We intended to compare the acute changes in muscle microvascular oxygenation following low-intensity knee extension exercise, combined with different levels of BFR. Thirteen active young men (age: 23.8 ± 5.4 years) were tested for unilateral knee extension exercise (30 + 15 + 15 + 15 reps at 20% one repetition maximum) on four different conditions: no-BFR (NOBFR), 40, 60, and 80% of arterial occlusion pressure (AOP). Deoxyhemoglobin+myoglobin concentration Deoxy[Hb+Mb], total hemoglobin [T(H+Mb)] and tissue oxygen saturation [TOI] were measured on the vastus lateralis muscle using near-infrared spectroscopy (NIMO, Nirox srl, Brescia, Italy). The magnitude of change in Deoxy[Hb+Mb]during exercise was similar between 60 and 80% AOP. Overall, compared to that seen during 60 and 80% AOP, NOBFR as well as 40% AOP resulted in a lower magnitude of change in Deoxy[Hb+Mb] (p < 0.05). While the oxygen extraction decreased during each inter-set resting interval in NOBFR and 40% AOP, this was not the case for 60 or 80% AOP. Additionally, TOI values obtained during recovery from each set of exercise were similarly affected by all conditions. Finally, our data also show that, when performed at higher restrictive values (60 and 80%), BFR exercise increases total Deoxy[Hb+Mb] extraction (p < 0.05). Taken together, we provide evidence that BFR is effective for increasing deoxygenation and reducing tissue oxygenation during low-intensity exercise. We also showed that when using low loads, a relative pressure above 40% of the AOP at rest is required to elicit changes in microvascular oxygenation compared with the same exercise with unrestricted conditions.
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Affiliation(s)
- Joana F. Reis
- Laboratory of Physiology and Biochemistry of Exercise, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal
- Ciper, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal
- Universidade Europeia, Lisbon, Portugal
| | - Pedro Fatela
- Universidade Europeia, Lisbon, Portugal
- Neuromuscular Research Lab, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal
- Biomechanics and Functional Morphology Laboratory, Faculdade de Motrocidade Humana, Universidade de Lisboa, Lisbon, Portugal
| | - Goncalo V. Mendonca
- Ciper, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal
- Neuromuscular Research Lab, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal
| | - Joao R. Vaz
- Ciper, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal
- Universidade Europeia, Lisbon, Portugal
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE, United States
| | - Maria J. Valamatos
- Ciper, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal
- Neuromuscular Research Lab, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal
- Biomechanics and Functional Morphology Laboratory, Faculdade de Motrocidade Humana, Universidade de Lisboa, Lisbon, Portugal
| | - Jorge Infante
- Spertlab, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal
| | - Pedro Mil-Homens
- Ciper, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal
- Neuromuscular Research Lab, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal
- Biomechanics and Functional Morphology Laboratory, Faculdade de Motrocidade Humana, Universidade de Lisboa, Lisbon, Portugal
| | - Francisco B. Alves
- Laboratory of Physiology and Biochemistry of Exercise, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal
- Ciper, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal
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Behringer M, Willberg C. Application of Blood Flow Restriction to Optimize Exercise Countermeasures for Human Space Flight. Front Physiol 2019; 10:33. [PMID: 30740059 PMCID: PMC6355682 DOI: 10.3389/fphys.2019.00033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 01/11/2019] [Indexed: 11/13/2022] Open
Abstract
In recent years there has been a strong increase in publications on blood flow restriction (BFR) training. In particular, the fact that this type of training requires only low resistance to induce muscle strength and mass gains, makes BFR training interesting for athletes and scientists alike. For the same reason this type of training is particularly interesting for astronauts working out in space. Lower resistance during training would have the advantage of reducing the risk of strain-induced injuries. Furthermore, strength training with lower resistances would have implications for the equipment required for training under microgravity conditions, as significantly lower resistances have to be provided by the training machines. Even though we are only about to understand the effects of blood flow restriction on exercise types other than low-intensity strength training, the available data indicate that BFR of leg muscles is also able to improve the training effects of walking or running at slow speeds. The underlying mechanisms of BFR-induced functional and structural adaptations are still unclear. An essential aspect seems to be the premature fatigue of Type-I muscle fibers, which requires premature recruitment of Type-II muscle fibers to maintain a given force output. Other theories assume that cell swelling, anabolic hormones, myokines and reactive oxygen species are involved in the mediation of BFR training-related effects. This review article is intended to summarize the main advantages and disadvantages, but also the potential risks of such training for astronauts.
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Affiliation(s)
- Michael Behringer
- Institute of Sports Sciences, Goethe University Frankfurt, Frankfurt, Germany
| | - Christina Willberg
- Institute of Sports Sciences, Goethe University Frankfurt, Frankfurt, Germany
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35
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Mitchell EA, Martin NRW, Turner MC, Taylor CW, Ferguson RA. The combined effect of sprint interval training and postexercise blood flow restriction on critical power, capillary growth, and mitochondrial proteins in trained cyclists. J Appl Physiol (1985) 2019; 126:51-59. [DOI: 10.1152/japplphysiol.01082.2017] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Sprint interval training (SIT) combined with postexercise blood flow restriction (BFR) is a novel method to increase maximal oxygen uptake (V̇o2max) in trained individuals and also provides a potent acute stimulus for angiogenesis and mitochondrial biogenesis. The efficacy to enhance endurance performance, however, has yet to be demonstrated. Trained male cyclists ( n = 21) (V̇o2max: 62.8 ± 3.7 ml·min−1·kg−1) undertook 4 wk of SIT (repeated 30-s maximal sprints) either alone (CON; n = 10) or with postexercise BFR ( n = 11). Before and after training V̇o2max, critical power (CP) and curvature constant ( Wʹ) were determined and muscle biopsies obtained for determination of skeletal muscle capillarity and mitochondrial protein content. CP increased ( P = 0.001) by a similar extent following CON (287 ± 39 W to 297 ± 43 W) and BFR (296 ± 40 W to 306 ± 36 W). V̇o2max increased following BFR by 5.9% ( P = 0.02) but was unchanged after CON ( P = 0.56). All markers of skeletal muscle capillarity and mitochondrial protein content were unchanged following either training intervention. In conclusion, 4 wk of SIT increased CP; however, this was not enhanced further with BFR. SIT was not sufficient to elicit changes in skeletal muscle capillarity and mitochondrial protein content with or without BFR. However, we further demonstrate the potency of combining BFR with SIT to enhance V̇o2max in trained individuals. NEW & NOTEWORTHY This investigation has demonstrated that 4 wk of sprint interval training (SIT) increased critical power in trained individuals; however, postexercise blood flow restriction (BFR) did not enhance this further. SIT, with or without BFR, did not induce any changes in skeletal muscle capillarity or mitochondrial protein content in our trained population. We do, however, confirm previous findings that SIT combined with BFR is a potent stimulus to enhance maximal oxygen uptake.
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Affiliation(s)
- Emma A. Mitchell
- School of Sport, Exercise, and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - Neil R. W. Martin
- School of Sport, Exercise, and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - Mark C. Turner
- School of Sport, Exercise, and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - Conor W. Taylor
- School of Sport, Exercise, and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - Richard A. Ferguson
- School of Sport, Exercise, and Health Sciences, Loughborough University, Loughborough, United Kingdom
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36
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Crisafulli A, de Farias RR, Farinatti P, Lopes KG, Milia R, Sainas G, Pinna V, Palazzolo G, Doneddu A, Magnani S, Mulliri G, Roberto S, Oliveira RB. Blood Flow Restriction Training Reduces Blood Pressure During Exercise Without Affecting Metaboreflex Activity. Front Physiol 2018; 9:1736. [PMID: 30618781 PMCID: PMC6299290 DOI: 10.3389/fphys.2018.01736] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 11/16/2018] [Indexed: 12/12/2022] Open
Abstract
Objective: Blood flow restriction training (BFRT) has been proposed to induce muscle hypertrophy, but its safety remains controversial as it may increase mean arterial pressure (MAP) due to muscle metaboreflex activation. However, BFR training also causes metabolite accumulation that may desensitize type III and IV nerve endings, which trigger muscle metaboreflex. Then, we hypothesized that a period of BFR training would result in blunted hemodynamic activation during muscle metaboreflex. Methods: 17 young healthy males aged 18–25 yrs enrolled in this study. Hemodynamic responses during muscle metaboreflex were assessed by means of postexercise muscle ischemia (PEMI) at baseline (T0) and after 1 month (T1) of dynamic BFRT. BFRT consisted of 3-min rhythmic handgrip exercise applied 3 days/week (30 contractions per minute at 30% of maximum voluntary contraction) in the dominant arm. On the first week, the occlusion was set at 75% of resting systolic blood pressure (always obtained after 3 min of resting) and increased 25% every week, until reaching 150% of resting systolic pressure at week four. Hemodynamic measurements were assessed by means of impedance cardiography. Results: BFRT reduced MAP during handgrip exercise (T1: 96.3 ± 8.3 mmHg vs. T0: 102.0 ± 9.53 mmHg, p = 0.012). However, no significant time effect was detected for MAP during the metaboreflex activation (P > 0.05). Additionally, none of the observed hemodynamic outcomes, including systemic vascular resistance (SVR), showed significant difference between T0 and T1 during the metaboreflex activation (P > 0.05). Conclusion: BFRT reduced blood pressure during handgrip exercise, thereby suggesting a potential hypotensive effect of this modality of training. However, MAP reduction during handgrip seemed not to be provoked by lowered metaboreflex activity.
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Affiliation(s)
- Antonio Crisafulli
- Sports Physiology Laboratory, The Department of Medical Sciences and Public Health, and International PhD in Innovation Sciences and Technologies, University of Cagliari, Cagliari, Italy
| | - Rafael Riera de Farias
- Laboratory of Physical Activity and Health Promotion, University of Rio de Janeiro, Rio de Janeiro, Brazil.,Graduate Program in Exercise and Sport Sciences, University of Rio de Janeiro State, Rio de Janeiro, Brazil
| | - Paulo Farinatti
- Laboratory of Physical Activity and Health Promotion, University of Rio de Janeiro, Rio de Janeiro, Brazil.,Graduate Program in Exercise and Sport Sciences, University of Rio de Janeiro State, Rio de Janeiro, Brazil.,Graduate Program in Physical Activity Sciences, Salgado de Oliveira University, Niterói, Brazil
| | - Karynne Grutter Lopes
- Laboratory of Physical Activity and Health Promotion, University of Rio de Janeiro, Rio de Janeiro, Brazil.,Graduate Program in Clinical and Experimental Physiopathology, University of Rio de Janeiro State, Rio de Janeiro, Brazil.,Laboratory of Vascular Biology, University of Rio de Janeiro State, Rio de Janeiro, Brazil
| | - Raffaele Milia
- Sports Physiology Laboratory, The Department of Medical Sciences and Public Health, and International PhD in Innovation Sciences and Technologies, University of Cagliari, Cagliari, Italy
| | - Gianmarco Sainas
- Sports Physiology Laboratory, The Department of Medical Sciences and Public Health, and International PhD in Innovation Sciences and Technologies, University of Cagliari, Cagliari, Italy
| | - Virginia Pinna
- Sports Physiology Laboratory, The Department of Medical Sciences and Public Health, and International PhD in Innovation Sciences and Technologies, University of Cagliari, Cagliari, Italy
| | - Girolamo Palazzolo
- Sports Physiology Laboratory, The Department of Medical Sciences and Public Health, and International PhD in Innovation Sciences and Technologies, University of Cagliari, Cagliari, Italy
| | - Azzurra Doneddu
- Sports Physiology Laboratory, The Department of Medical Sciences and Public Health, and International PhD in Innovation Sciences and Technologies, University of Cagliari, Cagliari, Italy
| | - Sara Magnani
- Sports Physiology Laboratory, The Department of Medical Sciences and Public Health, and International PhD in Innovation Sciences and Technologies, University of Cagliari, Cagliari, Italy
| | - Gabriele Mulliri
- Sports Physiology Laboratory, The Department of Medical Sciences and Public Health, and International PhD in Innovation Sciences and Technologies, University of Cagliari, Cagliari, Italy
| | - Silvana Roberto
- Sports Physiology Laboratory, The Department of Medical Sciences and Public Health, and International PhD in Innovation Sciences and Technologies, University of Cagliari, Cagliari, Italy
| | - Ricardo Brandão Oliveira
- Graduate Program in Exercise and Sport Sciences, University of Rio de Janeiro State, Rio de Janeiro, Brazil.,Graduate Program in Clinical and Experimental Physiopathology, University of Rio de Janeiro State, Rio de Janeiro, Brazil.,Laboratory of Active Living (LaVA), University of Rio de Janeiro State, Rio de Janeiro, Brazil
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Abstract
The combination of low-load resistance training [or more recently, neuromuscular electrical stimulation (NMES)] with a moderate local blood flow restriction (BFR) is becoming a widespread training and rehabilitation method. Scientific data indicate the overall safety of BFR, at least in healthy young people. However, it has been associated with side effects, usually minor, and further research is warranted regarding the safety and efficacy of this technique, especially in clinical populations. We found 3 syncope/presyncopal episodes among 21 healthy people (9 men), all occurring in men and during familiarization sessions (in which BFR was applied alone) but not thereafter (BFR sessions combined with NMES): 1 subject experienced a brief syncope and 2 other subjects exhibited presyncopal symptoms (sweating, lightheadedness, and pallor). Our cases are evidence that cardiovascular complications may emerge during BFR. Caution is thus needed in the application of BFR, and gentle familiarization with this training modality is also recommended.
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Yow BG, Tennent DJ, Dowd TC, Loenneke JP, Owens JG. Blood Flow Restriction Training After Achilles Tendon Rupture. J Foot Ankle Surg 2018; 57:635-638. [PMID: 29477554 DOI: 10.1053/j.jfas.2017.11.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Indexed: 02/03/2023]
Abstract
Blood flow restriction (BFR) training is a technique shown to be safe and effective at increasing muscular strength and endurance in healthy fitness populations and is under study for its use in postinjury rehabilitation. BFR stimulates muscular strength and hypertrophy gains at much lower loads than traditional methods, allowing patients to begin the rehabilitation process much sooner. We report on 2 patients who incorporated BFR training into their traditional rehabilitation program after Achilles tendon ruptures. Patient 1 was a 29-year-old active duty soldier who sustained a left Achilles tendon rupture while playing competitive football. After operative repair and traditional rehabilitative measures, he was unable to ambulate without assistive devices owing to persistent weakness. The patient subsequently started a 5-week "return to run" program using BFR training. He experienced plantarflexion peak torque improvements of 522% and 108.9% and power gains of 4475% and 211% at 60°/s and 120°/s, respectively. He was able to ambulate without assistive devices at the 5-week follow-up examination. Patient 2 was a 38-year-old male soldier who experienced a complete left Achilles tendon rupture while exercising. After nonoperative treatment with an accelerated rehabilitation program, the patient still experienced significant strength and functional deficits. He was subsequently enrolled in a 6-week course of BFR training. He experienced plantarflexion strength improvements of 55.8% and 47.1% and power gains of 68.8% and 78.7% at 60°/s and 120°/s, respectively. He was able to return to running and sports on completion of 6 weeks of BFR-assisted therapy. Incorporating tourniquet-assisted blood flow restriction with rehabilitation programs can improve strength, endurance, and function after Achilles tendon rupture.
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Affiliation(s)
- Bobby G Yow
- Surgeon, Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD.
| | - David J Tennent
- Surgeon, Department of Orthopaedics and Rehabilitation, San Antonio Military Medical Center, Fort Sam Houston, TX
| | - Thomas C Dowd
- Surgeon, Department of Orthopaedics and Rehabilitation, San Antonio Military Medical Center, Fort Sam Houston, TX
| | - Jeremy P Loenneke
- Assistant Professor, Kevser Ermin Applied Physiology Laboratory, Department of Health, Exercise Science, and Recreation Management, University of Mississippi, University, MS
| | - Johnny G Owens
- Physical Therapist, Center for the Intrepid, San Antonio Military Medical Center, Fort Sam Houston, TX
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Acute effects of whole body vibration combined with blood restriction on electromyography amplitude and hormonal responses. Biol Sport 2018; 35:301-307. [PMID: 30449948 PMCID: PMC6224844 DOI: 10.5114/biolsport.2018.77830] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Revised: 06/29/2017] [Accepted: 02/27/2018] [Indexed: 01/09/2023] Open
Abstract
The purpose of this study was to investigate the effects of whole body vibration (WBV) exercise with and without blood flow restriction (BFR) on electromyography (EMG) amplitude and hormonal responses. Eight healthy male adults who lacked physical activity participated in this study and completed 10 sets of WBV and WBV + BFR sessions in a repeated measures crossover design. In the WBV + BFR session, the participants wore a BFR device inflated to 140 mmHg around the proximal region of the thigh muscles. The results indicated that the EMG values from the rectus femoris and vastus lateralis during the WBV + BFR session were significantly higher than those during the WBV session (p < 0.05). Two-way analysis of variance with repeated measures showed that the WBV + BFR and WBV exercise sessions induced a significant (simple main effect for time) increase in lactate (LA) (0.61–4.68 vs. 0.46–3.44 mmol/L) and growth hormone (GH) (0.48–3.85 vs. 0.47–0.82 ng/mL) responses after some of the post-exercise time points (p < 0.05). WBV + BFR elicited significantly higher LA and GH (simple main effect for trial) responses than did WBV after exercise (p < 0.05). Although no significant time × trial interactions were observed for testosterone (T) (604.5–677.75 vs. 545.75–593.88 ng/dL), main effects for trial (p < 0.05) and for time (p < 0.05) were observed. In conclusion, WBV + BFR produced an additive effect of exercise on EMG amplitude and LA and GH responses, but it did not further induce T responses compared to those with WBV alone.
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40
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Barili A, Corralo VDS, Cardoso AM, Mânica A, Bonadiman BDSR, Bagatini MD, Da Silva-Grigoletto ME, de Oliveira GG, De Sá CA. Acute responses of hemodynamic and oxidative stress parameters to aerobic exercise with blood flow restriction in hypertensive elderly women. Mol Biol Rep 2018; 45:1099-1109. [PMID: 30030775 DOI: 10.1007/s11033-018-4261-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 07/12/2018] [Indexed: 02/02/2023]
Abstract
Systemic arterial hypertension has been associated with the majority deaths from cardiovascular disease, especially among the elderly population, and the imbalance between antioxidant and pro-oxidants has been associated with hypertension. This study analyzed the acute responses of cardiorespiratory and oxidative stress parameters to low intensity aerobic exercise (LIAE) with blood flow restriction (BFR) in hypertensive elderly women. The experimental group consisted of 16 hypertensive women (67.2 ± 3.7 years) who underwent a progressive treadmill test and performed three exercise protocols in random order: high intensity (HIAE), low intensity aerobic exercise (LIAE) and low intensity aerobic exercise with blood flow restriction (LIAE + BFR). Data analysis showed that blood pressure and heart rate augmented from rest to post effort (p < 0.05) and reduced from post effort to recovery (p < 0.05) in all protocols. The values of lipid peroxidation were higher after 30 min of recovery when compared to the moment at rest in the LILIAE + BFR (p < 0.05). The same occurred with glutathione-S-transferase and superoxide dismutase activity. However, non-protein thiols levels (NPSH) reduced after 30 min of recovery when compared to the moment at rest in the LILIAE + BFR protocol (p < 0.05). In the HIAE and LIAE + BFR protocols, the levels of NPSH were lower at 30 min of recovery when compared to the same moment in the LIAE protocol (p < 0.05). LIAE + RBF produces an oxidative status and hemodynamic stimulus similar to HIAE. Taken together, these results support the indication of LIAE with BFR in chronic intervention protocols, with potential benefits for the hypertensive elderly population.
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Affiliation(s)
- Angélica Barili
- Health Science Postgraduate Program, Unochapecó University, Servidão Anjo da Guarda Street, 295-D, Chapecó, SC, 89809-000, Brazil
| | - Vanessa da Silva Corralo
- Health Science Postgraduate Program, Unochapecó University, Servidão Anjo da Guarda Street, 295-D, Chapecó, SC, 89809-000, Brazil
| | | | - Aline Mânica
- Molecular Biology and Biochemistry Department, Federal University of Santa Maria, Santa Maria, RS, Brazil
| | | | | | | | | | - Clodoaldo Antônio De Sá
- Health Science Postgraduate Program, Unochapecó University, Servidão Anjo da Guarda Street, 295-D, Chapecó, SC, 89809-000, Brazil.
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41
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May AK, Brandner CR, Warmington SA. Hemodynamic responses are reduced with aerobic compared with resistance blood flow restriction exercise. Physiol Rep 2018; 5:5/3/e13142. [PMID: 28183863 PMCID: PMC5309582 DOI: 10.14814/phy2.13142] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 12/28/2016] [Indexed: 12/31/2022] Open
Abstract
The hemodynamics of light‐load exercise with an applied blood‐flow restriction (BFR) have not been extensively compared between light‐intensity, BFR, and high‐intensity forms of both resistance and aerobic exercise in the same participant population. Therefore, the purpose of this study was to use a randomized crossover design to examine the hemodynamic responses to resistance and aerobic BFR exercise in comparison with a common high‐intensity and light‐intensity non‐BFR exercise. On separate occasions participants completed a leg‐press (resistance) or treadmill (aerobic) trial. Each trial comprised a light‐intensity bout (LI) followed by a light‐intensity bout with BFR (80% resting systolic blood pressure (LI+BFR)), then a high‐intensity bout (HI). To characterize the hemodynamic response, measures of cardiac output, stroke volume, heart rate and blood pressure were taken at baseline and exercise for each bout. Exercising hemodynamics for leg‐press LI+BFR most often resembled those for HI and were greater than LI (e.g. for systolic blood pressure LI+BFR = 152 ± 3 mmHg; HI = 153 ± 3; LI = 143 ± 3 P < 0.05). However, exercising hemodynamics for treadmill LI+BFR most often resembled those for LI and were lower than HI (e.g. for systolic pressure LI+BFR = 124 ± 2 mmHg; LI = 123 ± 2; HI = 140 ± 3 P < 0.05). In conclusion, the hemodynamic response for light aerobic (walking) BFR exercise suggests this mode of BFR exercise may be preferential for chronic use to develop muscle size and strength, and other health benefits in certain clinical populations that are contraindicated to heavy‐load resistance exercise.
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Affiliation(s)
- Anthony K May
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences Deakin University, Burwood, Victoria, Australia
| | | | - Stuart A Warmington
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences Deakin University, Burwood, Victoria, Australia
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42
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Safety of Blood Flow Restricted Exercise in Hypertension: A Meta-Analysis and Systematic Review With Potential Applications in Orthopedic Care. Tech Orthop 2018. [DOI: 10.1097/bto.0000000000000288] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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43
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Karabulut U, Karabulut M, James EG. Small arteries stay stiff for a longer period following vibration exercises in combination with blood flow restriction. Clin Physiol Funct Imaging 2018; 38:1000-1007. [PMID: 29618165 DOI: 10.1111/cpf.12516] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 02/19/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE The aim of this study was to assess the effect of isometric exercises performed during whole-body vibration (WBV) with and without blood flow restriction (BFR) on arterial elasticity and hemodynamic variables. METHODS Eight male subjects performed static upper body (UB) and lower body (LB) exercises on a vibration platform with and without BFR. During BFR sessions, BFR cuffs were placed on the arms or legs and inflated to a target pressure. Exercises consisted of eight 45-s sets for UB, and ten 1-min sets for LB. Arterial elasticity and hemodynamic variables were assessed before, at 10 min and 40 min postexercise. Repeated measures ANOVA was used to test the mean differences in related variables. RESULTS A significant condition (BFR versus no-BFR) main effect was detected for small arterial elasticity (P<0·05). For heart rate (HR), there were significant time (P<0·01), condition (P = 0·02) and body (P = 0·04) main effects during exercise and condition (P<0·04) and time (P<0·01) main effects following exercise. Significantly lower values in systemic vascular resistance were detected at 10 min post compared to 40 min post (P<0·02) and UB compared to LB (P = 0·02). CONCLUSIONS Results showed that small arteries stayed stiffer for a longer period of time after vibration exercises with BFR and BFR placed a greater demand on cardiovascular system. Findings also indicated that the type of exercises performed and/or the measurement location are very important and should be taken into account when examining arterial response.
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Affiliation(s)
- Ulku Karabulut
- University of Texas Rio Grande Valley, Brownsville, TX, USA
| | | | - Eric G James
- University of Texas Southwestern Medical Center, Brownsville, TX, USA
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Conceição MS, Gáspari AF, Ramkrapes APB, Junior EMM, Bertuzzi R, Cavaglieri CR, Chacon-Mikahil MPT. Anaerobic metabolism induces greater total energy expenditure during exercise with blood flow restriction. PLoS One 2018; 13:e0194776. [PMID: 29596452 PMCID: PMC5875813 DOI: 10.1371/journal.pone.0194776] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 03/11/2018] [Indexed: 11/18/2022] Open
Abstract
PURPOSE We investigated the energy system contributions and total energy expenditure during low intensity endurance exercise associated with blood flow restriction (LIE-BFR) and without blood flow restriction (LIE). METHODS Twelve males participated in a contra-balanced, cross-over design in which subjects completed a bout of low-intensity endurance exercise (30min cycling at 40% of [Formula: see text]) with or without BFR, separated by at least 72 hours of recovery. Blood lactate accumulation and oxygen uptake during and after exercise were used to estimate the anaerobic lactic metabolism, aerobic metabolism, and anaerobic alactic metabolism contributions, respectively. RESULTS There were significant increases in the anaerobic lactic metabolism (P = 0.008), aerobic metabolism (P = 0.020), and total energy expenditure (P = 0.008) in the LIE-BFR. No significant differences between conditions for the anaerobic alactic metabolism were found (P = 0.582). Plasma lactate concentration was significantly higher in the LIE-BFR at 15min and peak post-exercise (all P≤0.008). Heart rate was significantly higher in the LIE-BFR at 10, 15, 20, 25, and 30min during exercise, and 5, 10, and 15min after exercise (all P≤0.03). Ventilation was significantly higher in the LIE-BFR at 10, 15, and 20min during exercise (all P≤0.003). CONCLUSION Low-intensity endurance exercise performed with blood flow restriction increases the anaerobic lactic and aerobic metabolisms, total energy expenditure, and cardiorespiratory responses.
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Affiliation(s)
- Miguel S. Conceição
- Exercise Physiology Lab., School of Physical Education, University of Campinas–Campinas/Brazil
- School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Arthur F. Gáspari
- Exercise Physiology Lab., School of Physical Education, University of Campinas–Campinas/Brazil
- Endurance Sports Research Group (GEDAE-USP), School of Physical Education and Sport, University of São Paulo—São Paulo/Brazil
| | - Ana P. B. Ramkrapes
- Exercise Physiology Lab., School of Physical Education, University of Campinas–Campinas/Brazil
| | - Edson M. M. Junior
- Exercise Physiology Lab., School of Physical Education, University of Campinas–Campinas/Brazil
| | - Romulo Bertuzzi
- School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
- Endurance Sports Research Group (GEDAE-USP), School of Physical Education and Sport, University of São Paulo—São Paulo/Brazil
| | - Cláudia R. Cavaglieri
- Exercise Physiology Lab., School of Physical Education, University of Campinas–Campinas/Brazil
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45
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Lin TC, Cheng CC, Cai ZY. Effects of local vibration with blood flow restriction on muscle activation. ISOKINET EXERC SCI 2018. [DOI: 10.3233/ies-171174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Tsong-Cheng Lin
- Division of Physical and Health Education, Center for General Education, National Sun Yat-sen University, Kaohsiung City, Taiwan
| | - Chi-Cheng Cheng
- Department of Mechanical and Electro-Mechanical Engineering, National Sun Yat-sen University, Kaohsiung City, Taiwan
| | - Zong-Yan Cai
- Division of Physical and Health Education, Center for General Education, National Sun Yat-sen University, Kaohsiung City, Taiwan
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46
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Marocolo IC, da Mota GR, Londe AM, Patterson SD, Barbosa Neto O, Marocolo M. Acute ischemic preconditioning does not influence high-intensity intermittent exercise performance. PeerJ 2017; 5:e4118. [PMID: 29204325 PMCID: PMC5712465 DOI: 10.7717/peerj.4118] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 11/10/2017] [Indexed: 11/20/2022] Open
Abstract
This study evaluated the acute effect of ischemic preconditioning (IPC) on a high-intensity intermittent exercise performance and physiological indicators in amateur soccer players. Thirteen players (21.5 ± 2 yrs) attended three trials separated by 3–5 days in a counterbalanced randomized cross-over design: IPC (4 × 5-min occlusion 220 mmHg/reperfusion 0 mmHg) in each thigh; SHAM (similar to the IPC protocol but “occlusion” at 20 mmHg) and control (seated during the same time of IPC). After 6-min of each trial (IPC, SHAM or control), the players performed the YoYo Intermittent Endurance Test level 2 (YoYoIE2). The distance covered in the YoYoIE2 (IPC 867 ± 205 m; SHAM 873 ± 212 m; control 921 ± 206 m) was not different among trials (p = 0.10), furthermore, lactate concentration and rate of perceived exertion did not differ (P > 0.05) among protocols. There were also no significant differences in either mean heart rate (HR) or peak HR (p > 0.05) for both IPC and SHAM compared to control. Therefore, we conclude that acute IPC does not influence high-intensity intermittent exercise performance in amateur soccer players and that rate of perceived exertion, heart rate and lactate do not differ between the intervention IPC, SHAM and control.
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Affiliation(s)
- Isabela Coelho Marocolo
- Human Performance and Sport Research Group, Department of Sport Sciences, Institute of Health Sciences, Federal University of Triangulo Mineiro, Uberaba, MG, Brazil
| | - Gustavo Ribeiro da Mota
- Human Performance and Sport Research Group, Department of Sport Sciences, Institute of Health Sciences, Federal University of Triangulo Mineiro, Uberaba, MG, Brazil
| | - André Monteiro Londe
- Human Performance and Sport Research Group, Department of Sport Sciences, Institute of Health Sciences, Federal University of Triangulo Mineiro, Uberaba, MG, Brazil
| | - Stephen D Patterson
- School of Sport, Health, and Applied Science, St. Mary's University, Twickenham, UK
| | - Octávio Barbosa Neto
- Human Performance and Sport Research Group, Department of Sport Sciences, Institute of Health Sciences, Federal University of Triangulo Mineiro, Uberaba, MG, Brazil
| | - Moacir Marocolo
- Physiology and Human Performance Research Group, Department of Physiology, Institute of Biological Sciences, Federal University of Juiz de Fora, Juiz de Fora, MG, Brazil
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Nielsen JL, Aagaard P, Prokhorova TA, Nygaard T, Bech RD, Suetta C, Frandsen U. Blood flow restricted training leads to myocellular macrophage infiltration and upregulation of heat shock proteins, but no apparent muscle damage. J Physiol 2017; 595:4857-4873. [PMID: 28481416 DOI: 10.1113/jp273907] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 05/02/2017] [Indexed: 12/27/2022] Open
Abstract
KEY POINTS Muscular contractions performed using a combination of low external loads and partial restriction of limb blood flow appear to induce substantial gains in muscle strength and muscle mass. This exercise regime may initially induce muscular stress and damage; however, the effects of a period of blood flow restricted training on these parameters remain largely unknown. The present study shows that short-term, high-frequency, low-load muscle training performed with partial blood flow restriction does not induce significant muscular damage. However, signs of myocellular stress and inflammation that were observed in the early phase of training and after the training intervention, respectively, may be facilitating the previously reported gains in myogenic satellite cell content and muscle hypertrophy. The present results improve our current knowledge about the physiological effects of low-load muscular contractions performed under blood flow restriction and may provide important information of relevance for future therapeutic treatment of muscular atrophy. ABSTRACT Previous studies indicate that low-load muscle contractions performed under local blood flow restriction (BFR) may initially induce muscle damage and stress. However, whether these factors are evoked with longitudinal BFR training remains unexplored at the myocellular level. Two distinct study protocols were conducted, covering 3 weeks (3 wk) or one week (1 wk). Subjects performed BFR exercise (100 mmHg, 20% 1RM) to concentric failure (BFRE) (3 wk/1 wk), while controls performed work-matched (LLE) (3 wk) or high-load (HLE; 70% 1RM) (1 wk) free-flow exercise. Muscle biopsies (3 wk) were obtained at baseline (Pre), 8 days into the intervention (Mid8), and 3 and 10 days after training cessation (Post3, Post10) to examine macrophage (M1/M2) content as well as heat shock protein (HSP27/70) and tenascin-C expression. Blood samples (1 wk) were collected before and after (0.1-24 h) the first and last training session to examine markers of muscle damage (creatine kinase), oxidative stress (total antibody capacity, glutathione) and inflammation (monocyte chemotactic protein-1, interleukin-6, tumour necrosis factor α). M1-macrophage content increased 108-165% with BFRE and LLE at Post3 (P < 0.05), while M2-macrophages increased (163%) with BFRE only (P < 0.01). Membrane and intracellular HSP27 expression increased 60-132% at Mid8 with BFRE (P < 0.05-0.01). No or only minor changes were observed in circulating markers of muscle damage, oxidative stress and inflammation. The amplitude, timing and localization of the above changes indicate that only limited muscle damage was evoked with BFRE. This study is the first to show that a period of high-frequency, low-load BFR training does not appear to induce general myocellular damage. However, signs of tissue inflammation and focal myocellular membrane stress and/or reorganization were observed that may be involved in the adaptation processes evoked by BFR muscle exercise.
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Affiliation(s)
- Jakob L Nielsen
- Department of Sports Science and Clinical Biomechanics, and SDU Muscle Research Cluster (SMRC), University of Southern Denmark, Odense, Denmark
| | - Per Aagaard
- Department of Sports Science and Clinical Biomechanics, and SDU Muscle Research Cluster (SMRC), University of Southern Denmark, Odense, Denmark
| | - Tatyana A Prokhorova
- Department of Sports Science and Clinical Biomechanics, and SDU Muscle Research Cluster (SMRC), University of Southern Denmark, Odense, Denmark
| | - Tobias Nygaard
- Department of Orthopaedic Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Rune D Bech
- Department of Orthopaedic Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Charlotte Suetta
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet Glostrup, University of Copenhagen, Copenhagen, Denmark
| | - Ulrik Frandsen
- Department of Sports Science and Clinical Biomechanics, and SDU Muscle Research Cluster (SMRC), University of Southern Denmark, Odense, Denmark
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A tale of three cuffs: the hemodynamics of blood flow restriction. Eur J Appl Physiol 2017; 117:1493-1499. [PMID: 28501908 DOI: 10.1007/s00421-017-3644-7] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 05/09/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The blood flow response to relative levels of blood flow restriction (BFR) across varying cuff widths is not well documented. With the variety of cuff widths and pressures reported in the literature, the effects of different cuffs and pressures on blood flow require investigation. PURPOSE To measure blood pressure using three commonly used BFR cuffs, examine possible venous/arterial restriction pressures, and measure hemodynamic responses to relative levels of BFR using these same cuffs. METHODS 43 participants (Experiment 1, brachial artery blood pressure assessed) and 38 participants (Experiment 2, brachial artery blood flow assessed using ultrasound, cuff placed at proximal portion of arm) volunteered for this study. RESULTS Blood pressure measurement was higher in the 5 cm cuff than in the 10 and 12 cm cuffs. Sub-diastolic relative pressures appear to occur predominantly at <60% of arterial occlusion pressure (AOP). Blood flow under relative levels of restriction decreases in a non-linear fashion, with minimal differences between cuffs [resting: 50.3 (44.2) ml min-1; 10% AOP: 42.0 (36.8); 20%: 33.6 (28.6); 30%: 23.6 (20.4); 40%: 17.1 (15.9); 50%: 12.5 (9.4); 60%: 11.5 (8.1); 70%: 11.4 (7.0); 80%: 10.3 (6.3); 90%: 7.9 (4.8); 100%: 1.5 (2.9)]. Peak blood velocity remains relatively constant until higher levels (>70% of AOP) are surpassed. Calculated mean shear rate decreases in a similar fashion as blood flow. CONCLUSIONS Under relative levels of restriction, pressures from 40 to 90% of AOP appear to decrease blood flow to a similar degree in these three cuffs. Relative pressures appear to elicit a similar blood flow stimulus when accounting for cuff width and participant characteristics.
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Mouser JG, Ade CJ, Black CD, Bemben DA, Bemben MG. Brachial blood flow under relative levels of blood flow restriction is decreased in a nonlinear fashion. Clin Physiol Funct Imaging 2017; 38:425-430. [DOI: 10.1111/cpf.12432] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 03/03/2017] [Indexed: 11/30/2022]
Affiliation(s)
- J. Grant Mouser
- Kevser Ermin Applied Physiology Laboratory; Department of Health, Exercise Science, and Recreation Management; The University of Mississippi; University MS USA
| | - Carl J. Ade
- Department of Kinesiology; Kansas State University; Manhattan KS USA
| | - Christopher D. Black
- Department of Health and Exercise Science; The University of Oklahoma; Norman OK USA
| | - Debra A. Bemben
- Department of Health and Exercise Science; The University of Oklahoma; Norman OK USA
| | - Michael G. Bemben
- Department of Health and Exercise Science; The University of Oklahoma; Norman OK USA
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Lauver JD, Cayot TE, Rotarius T, Scheuermann BW. The effect of eccentric exercise with blood flow restriction on neuromuscular activation, microvascular oxygenation, and the repeated bout effect. Eur J Appl Physiol 2017; 117:1005-1015. [DOI: 10.1007/s00421-017-3589-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 03/11/2017] [Indexed: 11/29/2022]
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