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Bielitzki R, Behrens M, Behrendt T, Franz A, Centner C, Hughes L, Patterson SD, Owens J, Behringer M, Schega L. The Discrepancy Between External and Internal Load/Intensity during Blood Flow Restriction Exercise: Understanding Blood Flow Restriction Pressure as Modulating Factor. SPORTS MEDICINE - OPEN 2024; 10:95. [PMID: 39227485 PMCID: PMC11371992 DOI: 10.1186/s40798-024-00759-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 07/29/2024] [Indexed: 09/05/2024]
Abstract
Physical exercise induces acute psychophysiological responses leading to chronic adaptations when the exercise stimulus is applied repeatedly, at sufficient time periods, and with appropriate magnitude. To maximize long-term training adaptations, it is crucial to control and manipulate the external load and the resulting psychophysiological strain. Therefore, scientists have developed a theoretical framework that distinguishes between the physical work performed during exercise (i.e., external load/intensity) and indicators of the body's psychophysiological response (i.e., internal load/intensity). However, the application of blood flow restriction (BFR) during exercise with low external loads/intensities (e.g., ≤ 30% of the one-repetition-maximum, ≤ 50% of maximum oxygen uptake) can induce physiological and perceptual responses, which are commonly associated with high external loads/intensities. This current opinion aimed to emphasize the mismatch between external and internal load/intensity when BFR is applied during exercise. In this regard, there is evidence that BFR can be used to manipulate both external load/intensity (by reducing total work when exercise is performed to exhaustion) and internal load/intensity (by leading to higher physiological and perceptual responses compared to exercise performed with the same external load/intensity without BFR). Furthermore, it is proposed to consider BFR as an additional exercise determinant, given that the amount of BFR pressure can determine not only the internal but also external load/intensity. Finally, terminological recommendations for the use of the proposed terms in the scientific context and for practitioners are given, which should be considered when designing, reporting, discussing, and presenting BFR studies, exercise, and/or training programs.
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Affiliation(s)
- Robert Bielitzki
- Department of Sport Science, Institute III, Otto-von-Guericke University Magdeburg, Magdeburg, Germany.
| | - Martin Behrens
- University of Applied Sciences for Sport and Management Potsdam, Potsdam, Germany
| | - Tom Behrendt
- Department of Sport Science, Institute III, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Alexander Franz
- Department of Orthopedics and Trauma Surgery, University Hospital Bonn, Bonn, Germany
| | - Christoph Centner
- Department of Sport and Science, University of Freiburg, Freiburg, Germany
| | - Luke Hughes
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle, UK
| | - Stephen D Patterson
- Faculty of Sport, Technology and Health Science, St Mary's University, Twickenham, London, UK
| | - Johnny Owens
- Clinical Education Owens Recovery Science, San Antonio, TX, USA
| | - Michael Behringer
- Department of Sports Sciences, Goethe University Frankfurt, Frankfurt a. M., Germany
| | - Lutz Schega
- Department of Sport Science, Institute III, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
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Montgomery TR, Olmos A, Sears KN, Succi PJ, Hammer SM, Bergstrom HC, Hill EC, Trevino MA, Dinyer-McNeely TK. Influence of Blood Flow Restriction on Neuromuscular Function and Fatigue During Forearm Flexion in Men. J Strength Cond Res 2024; 38:e349-e358. [PMID: 38900183 DOI: 10.1519/jsc.0000000000004762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
ABSTRACT Montgomery, TR Jr, Olmos, A, Sears, KN, Succi, PJ, Hammer, SM, Bergstrom, HC, Hill, EC, Trevino, MA, and Dinyer-McNeely, TK. Influence of blood flow restriction on neuromuscular function and fatigue during forearm flexion in men. J Strength Cond Res 38(7): e349-e358, 2024-To determine the effects of blood flow restriction (BFR) on the mean firing rate (MFR) and motor unit action potential amplitude (MUAPAMP) vs. recruitment threshold (RT) relationships during fatiguing isometric elbow flexions. Ten men (24.5 ± 4.0 years) performed isometric trapezoidal contractions at 50% maximum voluntary contraction to task failure with or without BFR, on 2 separate days. For BFR, a cuff was inflated to 60% of the pressure required for full brachial artery occlusion at rest. During both visits, surface electromyography was recorded from the biceps brachii of the dominant limb and the signal was decomposed. A paired-samples t test was used to determine the number of repetitions completed between BFR and CON. ANOVAs (repetition [first, last] × condition [BFR, CON]) were used to determine differences in MFR vs. RT and MUAPAMP vs. RT relationships. Subjects completed more repetitions during CON (12 ± 4) than BFR (9 ± 2; p = 0.012). There was no significant interaction (p > 0.05) between the slopes and y-intercepts during the repetition × condition interaction for MUAPAMP vs. MFR. However, there was a main effect of repetition for the slopes of the MUAPAMP vs. RT (p = 0.041) but not the y-intercept (p = 0.964). Post hoc analysis (collapsed across condition) indicated that the slopes of the MUAPAMP vs. RT during the first repetition was less than the last repetition (first: 0.022 ± 0.003 mv/%MVC; last: 0.028 ± 0.004 mv/%MVC; p = 0.041). Blood flow restriction resulted in the same amount of higher threshold MU recruitment in approximately 75% of the repetitions. Furthermore, there was no change in MFR for either condition, even when taken to task failure. Thus, BFR training may create similar MU responses with less total work completed than training without BFR.
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Affiliation(s)
- Tony R Montgomery
- Department of Kinesiology, Applied Health, and Recreation, Oklahoma State University, Stillwater, Oklahoma
| | - Alex Olmos
- Department of Kinesiology, Applied Health, and Recreation, Oklahoma State University, Stillwater, Oklahoma
| | - Kylie N Sears
- Department of Kinesiology, Applied Health, and Recreation, Oklahoma State University, Stillwater, Oklahoma
| | - Pasquale J Succi
- Department of Kinesiology and Health Promotion, University of Kentucky, Lexington, Kentucky; and
| | - Shane M Hammer
- Department of Kinesiology, Applied Health, and Recreation, Oklahoma State University, Stillwater, Oklahoma
| | - Haley C Bergstrom
- Department of Kinesiology and Health Promotion, University of Kentucky, Lexington, Kentucky; and
| | - Ethan C Hill
- Division of Kinesiology, School of Kinesiology and Physical Therapy, University of Central Florida, Orlando, Florida
| | - Michael A Trevino
- Department of Kinesiology, Applied Health, and Recreation, Oklahoma State University, Stillwater, Oklahoma
| | - Taylor K Dinyer-McNeely
- Department of Kinesiology, Applied Health, and Recreation, Oklahoma State University, Stillwater, Oklahoma
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Suggitt JO, Eaves BE, Spranger MD. What are the cardiovascular responses during blood flow-restricted resistance exercise? Front Physiol 2024; 15:1417855. [PMID: 38966227 PMCID: PMC11222610 DOI: 10.3389/fphys.2024.1417855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 06/03/2024] [Indexed: 07/06/2024] Open
Affiliation(s)
| | | | - Marty D. Spranger
- Department of Physiology, Michigan State University, East Lansing, MI, United States
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Moreno EN, Figueroa EC, Heath AW, Buckner SL. An examination of acute physiological and perceptual responses following blood flow restriction exercise using a traditional research device or novel, automated system. Physiol Meas 2024; 45:065007. [PMID: 38838705 DOI: 10.1088/1361-6579/ad548c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 06/05/2024] [Indexed: 06/07/2024]
Abstract
Objective. To compare the acute physiological and perceptual responses to blood flow restriction (BFR) exercise using a traditional research device or novel, automated system.Methods. Forty-four resistance trained individuals performed four sets of unilateral elbow flexion exercise (30% one-repetition maximum) to volitional failure using two distinct restrictive devices [SmartCuffs PRO BFR Model (SMARTCUFF), Hokanson E20 Rapid Inflation device (HOKANSON)] and with two levels of BFR [40% limb occlusion pressure (LOP), 80% LOP]. Blood pressure (BP), muscle thickness (MT), and isometric strength (ISO) were assessed prior to and following exercise. Perceptual responses [ratings of perceived exertion (RPE), discomfort] were assessed prior to exercise and following each exercise set.Main results. Data are displayed as means (SD). Immediately following exercise with 40% LOP, there were no statistical differences between devices for BP, MT, and ISO. However, only following Set 1 of exercise, RPE was greater with SMARTCUFF compared to HOKANSON (p< 0.05). In addition, only following Set 2 of exercise, discomfort was greater with HOKANSON compared to SMARTCUFF (p< 0.001). Immediately following exercise with 80% LOP, there were no statistical differences between devices for BP, MT, and ISO. However, only following Set 4 of exercise, RPE was greater with HOKANSON compared to SMARTCUFF (p< 0.05). In addition, following all exercise sets, discomfort was greater with HOKANSON compared to SMARTCUFF (p< 0.001). For repetitions completed with 40% LOP there were no statistical differences between SMARTCUFF and HOKANSON across any exercise sets. For repetitions completed with 80% LOP there were no statistical differences between SMARTCUFF and HOKANSON across Set 1 of exercise (p= 0.34), however, for Sets 2-4 of exercise, significantly greater number of repetitions were completed during SMARTCUFF than HOKANSON.Significance. The present study provides valuable insight into the efficacy of a novel, automated BFR system (SMARTCUFF) eliciting comparable acute physiological responses to BFR exercise and in some cases favorable perceptual responses when compared to a traditional research device (HOKANSON).
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Affiliation(s)
- Enrique N Moreno
- USF Muscle Laboratory, Exercise Science Program, University of South Florida, Tampa, FL, United States of America
| | - Elias C Figueroa
- USF Muscle Laboratory, Exercise Science Program, University of South Florida, Tampa, FL, United States of America
| | - Andrew W Heath
- USF Muscle Laboratory, Exercise Science Program, University of South Florida, Tampa, FL, United States of America
| | - Samuel L Buckner
- USF Muscle Laboratory, Exercise Science Program, University of South Florida, Tampa, FL, United States of America
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Olmos AA, Montgomery TR, Sears KN, Dinyer TK, Hammer SM, Bergstrom HC, Hill EC, Succi PJ, Lawson J, Trevino MA. Blood flow restriction increases necessary muscle excitation of the elbow flexors during a single high-load contraction. Eur J Appl Physiol 2024; 124:1807-1820. [PMID: 38236301 DOI: 10.1007/s00421-023-05405-y] [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: 07/03/2023] [Accepted: 12/09/2023] [Indexed: 01/19/2024]
Abstract
PURPOSE To investigate the effects of blood flow restriction (BFR) on electromyographic amplitude (EMGRMS)-force relationships of the biceps brachii (BB) during a single high-load muscle action. METHODS Twelve recreationally active males and eleven recreationally active females performed maximal voluntary contractions (MVCs), followed by an isometric trapezoidal muscle action of the elbow flexors at 70% MVC. Surface EMG was recorded from the BB during BFR and control (CON) visits. For BFR, cuff pressure was 60% of the pressure required to completely occlude blood at rest. Individual b (slope) and a terms (gain) were calculated from the log-transformed EMGRMS-force relationships during the linearly increasing and decreasing segments of the trapezoid. EMGRMS during the steady force segment was normalized to MVC EMGRMS. RESULTS For BFR, the b terms were greater during the linearly increasing segment than the linearly decreasing segment (p < 0.001), and compared to the linearly increasing segment for CON (p < 0.001). The a terms for BFR were greater during the linearly decreasing than linearly increasing segment (p = 0.028). Steady force N-EMGRMS was greater for BFR than CON collapsed across sex (p = 0.041). CONCLUSION BFR likely elicited additional recruitment of higher threshold motor units during the linearly increasing- and steady force-segment. The differences between activation and deactivation strategies were only observed with BFR, such as the b terms decreased and the a terms increased for the linearly decreasing segment in comparison to the increasing segment. However, EMGRMS-force relationships during the linearly increasing- and decreasing-segments were not different between sexes during BFR and CON.
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Affiliation(s)
- Alex A Olmos
- Applied Neuromuscular Physiology Laboratory, Department of Health and Human Performance, Oklahoma State University, 191 CRC, Stillwater, OK, 74074, USA
| | - Tony R Montgomery
- Applied Neuromuscular Physiology Laboratory, Department of Health and Human Performance, Oklahoma State University, 191 CRC, Stillwater, OK, 74074, USA
| | - Kylie N Sears
- Applied Neuromuscular Physiology Laboratory, Department of Health and Human Performance, Oklahoma State University, 191 CRC, Stillwater, OK, 74074, USA
| | - Taylor K Dinyer
- Applied Neuromuscular Physiology Laboratory, Department of Health and Human Performance, Oklahoma State University, 191 CRC, Stillwater, OK, 74074, USA
| | - Shane M Hammer
- Applied Neuromuscular Physiology Laboratory, Department of Health and Human Performance, Oklahoma State University, 191 CRC, Stillwater, OK, 74074, USA
| | - Haley C Bergstrom
- Department of Kinesiology and Health Promotion, University of Kentucky, Lexington, KY, 40506, USA
| | - Ethan C Hill
- School of Kinesiology and Physical Therapy, University of Central Florida, Orlando, FL, 32816, USA
| | - Pasquale J Succi
- Department of Kinesiology and Health Promotion, University of Kentucky, Lexington, KY, 40506, USA
| | - John Lawson
- School of Kinesiology and Physical Therapy, University of Central Florida, Orlando, FL, 32816, USA
| | - Michael A Trevino
- Applied Neuromuscular Physiology Laboratory, Department of Health and Human Performance, Oklahoma State University, 191 CRC, Stillwater, OK, 74074, USA.
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Hong QM, Wang HN, Liu XH, Zhou WQ, Luo XB. Intermittent blood flow restriction with low-load resistance training for older adults with knee osteoarthritis: a randomized, controlled, non-inferiority trial protocol. Trials 2024; 25:352. [PMID: 38822360 PMCID: PMC11140873 DOI: 10.1186/s13063-024-08203-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 05/28/2024] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND Knee osteoarthritis (KOA) is a chronic musculoskeletal disorder characterized by pain and functional impairment. Blood flow restriction (BFR) with low-load resistance training (LLRT) demonstrates a similar improvement in clinical outcomes to high-load resistance training (HLRT) in treating KOA. It has not been established whether intermittent blood flow restriction (iBFR) with LLRT can lead to clinical outcomes that are comparable to those produced by continuous blood flow restriction (cBFR) with LLRT and HLRT. The aim of the proposed study is to evaluate the efficacy of iBFR with LLRT on pain, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), muscle strength, muscle mass, physical function, perceptions of discomfort and effort, and adherence in KOA patients. METHODS This is a three-arm, non-inferiority, randomized controlled trial utilizing blinded assessors. Two hundred thirteen participants will be randomly allocated to one of the following three groups: iBFR group-receiving 4 months of LLRT with iBFR, twice weekly (n = 71); cBFR group-receiving 4 months of LLRT with cBFR, twice weekly (n = 71); or HLRT group-receiving 4 months of HLRT without BFR, twice weekly (n = 71). The primary outcome is pain. The secondary outcomes include the WOMAC, muscle strength, muscle mass, physical function, perceptions of discomfort and effort, and adherence. Pain and WOMAC will be measured at the baseline and 4 and 12 months after randomizations. Muscle strength, muscle mass, and physical function will be measured at the baseline and 4 months after randomizations. The perceptions of discomfort and effort will be measured during the first and final sessions. DISCUSSION BFR with LLRT has a similar improvement in clinical outcomes as HLRT. However, cBFR may cause elevated ratings of perceived exertion and local discomfort, compromising patient tolerability and treatment adherence. If iBFR with LLRT could produce improvement in clinical outcomes analogous to those of HLRT and iBFR with LLRT, it could be considered an alternative approach for treating patients with KOA. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR2300072820. Registered on June 26, 2023.
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Affiliation(s)
- Qiao-Mei Hong
- Department of Sport Medicine, Sichuan Province Orthopedic Hospital, Chengdu, Sichuan Province, China
| | - Hao-Nan Wang
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, China.
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China.
| | - Xi-Hui Liu
- Department of Sport Medicine, Sichuan Province Orthopedic Hospital, Chengdu, Sichuan Province, China
| | - Wen-Qi Zhou
- Department of Sport Medicine, Sichuan Province Orthopedic Hospital, Chengdu, Sichuan Province, China
| | - Xiao-Bing Luo
- Department of Sport Medicine, Sichuan Province Orthopedic Hospital, Chengdu, Sichuan Province, China
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Mousavi Z, Karimi Z, Wong A, Cheraghloo N, Bagheri H, Bagheri R. Comparison of enjoyment and energy expenditure of exergame with and without blood flow restriction in men and women. Sci Rep 2024; 14:9030. [PMID: 38641659 PMCID: PMC11031571 DOI: 10.1038/s41598-024-59379-8] [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: 10/04/2023] [Accepted: 04/10/2024] [Indexed: 04/21/2024] Open
Abstract
This study compared the effects of blood flow restriction (BFR) on intensity and perceived enjoyment during an exergame. Fourteen healthy young participants engaged in a boxing exergame for 20 min, with or without BFR, across two sessions. Perceived enjoyment levels were assessed using the Physical Activity Enjoyment Scale. Heart rate was monitored, and energy expenditure (EE) during exercise was calculated. A mixed model analysis of variance with repeated measures was used to evaluate differences in EE and enjoyment between exergame conditions (with and without BFR) as well as the interaction effects of these protocols with gender. Although not statistically significant, perceived enjoyment decreased with BFR inclusion for both genders. No significant differences were observed between men and women for both protocols. Regarding EE, there was no significant difference between the two groups (with and without BFR). However, a significant main effect of gender was found, with men exhibiting higher EE values in both protocols compared to women. In conclusion, exergames incorporating BFR impact perceptual responses, particularly perceived enjoyment. Furthermore, significant gender differences in EE were found, with men displaying higher values.
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Affiliation(s)
- Zeynabalsadat Mousavi
- Nutrition and Food Service, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Zohreh Karimi
- Department of Physical Education and Sport Sciences, Science and Research Branch, Islamic Azad University, Tehran, Iran.
| | - Alexei Wong
- Department of Health and Human Performance, Marymount University, Arlington, USA
| | - Neda Cheraghloo
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Hessan Bagheri
- Department of General Psychology, Islamic Azad University, South Tehran Branch, Tehran, Iran
| | - Reza Bagheri
- Department of Exercise Physiology, University of Isfahan, Isfahan, Iran
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Spitz RW, Yamada Y, Wong V, Kataoka R, Hammert WB, Song JS, Kang A, Seffrin A, Loenneke JP. Blood flow restriction pressure for narrow cuffs (5 cm) cannot be estimated with precision. Physiol Meas 2024; 45:02NT01. [PMID: 38330491 DOI: 10.1088/1361-6579/ad278d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 02/08/2024] [Indexed: 02/10/2024]
Abstract
Blood flow restriction pressures are set relative to the lowest pressure needed to occlude blood flow with that specific cuff. Due to pressure limitations of some devices, it is often not possible to occlude blood flow in all subjects and apply a known relative pressure in the lower body with a 5 cm wide cuff.Objective. To use a device capable of generating high pressures (up to 907 mmHg) to create and validate an estimation equation for the 5 cm cuff in the lower body using a 12 cm cuff.Approach. 170 participants had their arterial occlusion pressure (AOP) with a 5 cm and 12 cm cuff and their thigh circumference measured in their right leg. The sample was randomly allocated to a prediction group (66%) and validation group (33%). Thigh circumference and 12 cm AOP were used as predictors. A Bland-Altman plot was constructed to assess agreement between measured and predicted values.Main results. The mean difference (95% confidence interval) between the observed (336.8 mmHg) and the predicted (343.9 mmHg) 5 cm AOP was 7.1 (-11.9, 26.1) mmHg. The 95% limits of agreement were -133.6 to 147.8 mmHg. There was a negative relationship between the difference and the average of predicted and measured 5 cm AOP (B= -0.317,p= 0.000043).Significance. Although this was the first study to quantify AOP over 600 mmHg with a 5 cm cuff, our equation is not valid across all levels of pressure. If possible, larger cuff widths should be employed in the lower body.
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Affiliation(s)
- Robert W Spitz
- Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, MS, United States of America
| | - Yujiro Yamada
- Department of Health, Exercise Science, and Recreation Management. Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, MS, United States of America
| | - Vickie Wong
- Department of Sport and Health, Solent University, Southampton, Hampshire SO14 0YN, United Kingdom
| | - Ryo Kataoka
- Department of Health, Exercise Science, and Recreation Management. Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, MS, United States of America
| | - William B Hammert
- Department of Health, Exercise Science, and Recreation Management. Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, MS, United States of America
| | - Jun Seob Song
- Department of Health, Exercise Science, and Recreation Management. Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, MS, United States of America
| | - Anna Kang
- Department of Health, Exercise Science, and Recreation Management. Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, MS, United States of America
| | - Aldo Seffrin
- Department of Health, Exercise Science, and Recreation Management. Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, MS, United States of America
| | - Jeremy P Loenneke
- 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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Hjortshoej MH, Aagaard P, Storgaard CD, Juneja H, Lundbye‐Jensen J, Magnusson SP, Couppé C. Hormonal, immune, and oxidative stress responses to blood flow-restricted exercise. Acta Physiol (Oxf) 2023; 239:e14030. [PMID: 37732509 PMCID: PMC10909497 DOI: 10.1111/apha.14030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/12/2023] [Accepted: 07/30/2023] [Indexed: 09/22/2023]
Abstract
INTRODUCTION Heavy-load free-flow resistance exercise (HL-FFRE) is a widely used training modality. Recently, low-load blood-flow restricted resistance exercise (LL-BFRRE) has gained attention in both athletic and clinical settings as an alternative when conventional HL-FFRE is contraindicated or not tolerated. LL-BFRRE has been shown to result in physiological adaptations in muscle and connective tissue that are comparable to those induced by HL-FFRE. The underlying mechanisms remain unclear; however, evidence suggests that LL-BFRRE involves elevated metabolic stress compared to conventional free-flow resistance exercise (FFRE). AIM The aim was to evaluate the initial (<10 min post-exercise), intermediate (10-20 min), and late (>30 min) hormonal, immune, and oxidative stress responses observed following acute sessions of LL-BFRRE compared to FFRE in healthy adults. METHODS A systematic literature search of randomized and non-randomized studies was conducted in PubMed, Embase, Cochrane Central, CINAHL, and SPORTDiscus. The Cochrane Risk of Bias (RoB2, ROBINS-1) and TESTEX were used to evaluate risk of bias and study quality. Data extractions were based on mean change within groups. RESULTS A total of 12525 hits were identified, of which 29 articles were included. LL-BFRRE demonstrated greater acute increases in growth hormone responses when compared to overall FFRE at intermediate (SMD 2.04; 95% CI 0.87, 3.22) and late (SMD 2.64; 95% CI 1.13, 4.16) post-exercise phases. LL-BFRRE also demonstrated greater increase in testosterone responses compared to late LL-FFRE. CONCLUSION These results indicate that LL-BFRRE can induce increased or similar hormone and immune responses compared to LL-FFRE and HL-FFRE along with attenuated oxidative stress responses compared to HL-FFRE.
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Affiliation(s)
- M. H. Hjortshoej
- Institute of Sports Medicine Copenhagen, Department of Orthopedic SurgeryCopenhagen University Hospital Bispebjerg and FrederiksbergCopenhagenDenmark
- Center for Healthy Aging, Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
- Department of Physical and Occupational TherapyBispebjerg and Frederiksberg University HospitalCopenhagenDenmark
- Centre for Health and RehabilitationUniversity College AbsalonSlagelseDenmark
| | - P. Aagaard
- Department of Sports Science and Clinical BiomechanicsUniversity of Southern DenmarkOdenseDenmark
| | - C. D. Storgaard
- Institute of Sports Medicine Copenhagen, Department of Orthopedic SurgeryCopenhagen University Hospital Bispebjerg and FrederiksbergCopenhagenDenmark
- Center for Healthy Aging, Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
- Department of Nutrition, Exercise and Sports, Section of Integrative PhysiologyUniversity of CopenhagenCopenhagenDenmark
| | - H. Juneja
- Centre for Health and RehabilitationUniversity College AbsalonSlagelseDenmark
| | - J. Lundbye‐Jensen
- Department of Nutrition, Exercise and Sports, Section of Integrative PhysiologyUniversity of CopenhagenCopenhagenDenmark
| | - S. P. Magnusson
- Institute of Sports Medicine Copenhagen, Department of Orthopedic SurgeryCopenhagen University Hospital Bispebjerg and FrederiksbergCopenhagenDenmark
- Center for Healthy Aging, Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
- Department of Physical and Occupational TherapyBispebjerg and Frederiksberg University HospitalCopenhagenDenmark
| | - C. Couppé
- Institute of Sports Medicine Copenhagen, Department of Orthopedic SurgeryCopenhagen University Hospital Bispebjerg and FrederiksbergCopenhagenDenmark
- Center for Healthy Aging, Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
- Department of Physical and Occupational TherapyBispebjerg and Frederiksberg University HospitalCopenhagenDenmark
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de Queiros VS, Rolnick N, dos Santos ÍK, de França IM, Lima RJ, Vieira JG, Aniceto RR, Neto GR, de Medeiros JA, Vianna JM, de Araújo Tinôco Cabral BG, Silva Dantas PM. Acute Effect of Resistance Training With Blood Flow Restriction on Perceptual Responses: A Systematic Review and Meta-Analysis. Sports Health 2023; 15:673-688. [PMID: 36415041 PMCID: PMC10467469 DOI: 10.1177/19417381221131533] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Several studies have compared perceptual responses between resistance exercise with blood flow restriction and traditional resistance exercise (non-BFR). However, the results were contradictory. OBJECTIVES To analyze the effect of RE+BFR versus non-BFR resistance exercise [low-load resistance exercise (LL-RE) or high-load resistance exercise (HL-RE)] on perceptual responses. DATA SOURCES CINAHL, Cochrane Library, PubMed®, Scopus, SPORTDiscus, and Web of Science were searched through August 28, 2021, and again on August 25, 2022. STUDY SELECTION Studies comparing the effect of RE+BFR versus non-BFR resistance exercise on rate of perceived exertion (RPE) and muscle pain/discomfort were considered. Meta-analyses were conducted using the random effects model. STUDY DESIGN Systematic review and meta-analysis. LEVEL OF EVIDENCE Level 2. DATA EXTRACTION All data were reviewed and extracted independently by 2 reviewers. Disagreements were resolved by a third reviewer. RESULTS Thirty studies were included in this review. In a fixed repetition scheme, the RPE [standardized mean difference (SMD) = 1.04; P < 0.01] and discomfort (SMD = 1.10; P < 0.01) were higher in RE+BFR than in non-BFR LL-RE, but similar in sets to voluntary failure. There were no significant differences in RPE in the comparisons between RE+BFR and non-BFR HL-RE; after sensitivity analyses, it was found that the RPE was higher in non-BFR HL-RE in a fixed repetition scheme. In sets to voluntary failure, discomfort was higher in RE+BFR versus non-BFR HL-RE (SMD = 0.95; P < 0. 01); however, in a fixed scheme, the results were similar. CONCLUSION In sets to voluntary failure, RPE is similar between RE+BFR and non-BFR exercise. In fixed repetition schemes, RE+BFR seems to promote higher RPE than non-BFR LL-RE and less than HL-RE. In sets to failure, discomfort appears to be similar between LL-RE with and without BFR; however, RE+BFR appears to promote greater discomfort than HL-RE. In fixed repetition schemes, the discomfort appears to be no different between RE+BFR and HL-RE, but is lower in non-BFR LL-RE.
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Affiliation(s)
- Victor Sabino de Queiros
- Graduate Program in Health Sciences, Federal University of Rio Grande do Norte (UFRN), Natal-RN, Brazil
| | - Nicholas Rolnick
- The Human Performance Mechanic, CUNY Lehman College, Bronx, New York, USA
| | - Ísis Kelly dos Santos
- Graduate Program in Health Sciences, Federal University of Rio Grande do Norte (UFRN), Natal-RN, Brazil; Graduate Program in Physical Education, State University of Rio Grande do Norte (UERN), Mossoró-RN, Brazil
| | - Ingrid Martins de França
- Graduate Program in Physiotherapy, Federal University of Rio Grande do Rio Grande Norte (UFRN), Natal-RN, Brazil
| | - Rony Jerônimo Lima
- Graduate Program in Physical Education, Federal University of Rio Grande do Norte (UFRN), Natal-RN, Brazil
| | - João Guilherme Vieira
- Graduate Program in Physical Education, Federal University of Juiz de Fora (UFJF), Juiz de Fora-MG, Brazil; Strength Training Research Laboratory, Federal University of Juiz de Fora (UFJF), Juiz de Fora-MG, Brazil
| | - Rodrigo Ramalho Aniceto
- Study and Research Group in Biomechanics and Psychophysiology of Exercise, Federal Institute of Education, Science and Technology of Rio Grande do Norte, Currais Novos-RN, Brazil
| | - Gabriel Rodrigues Neto
- Faculty Nova Esperança (FAMENE/FACENE), Coordination of Physical Education, Nursing and Medical Schools, João Pessoa, Brazil; Coordination of Physical Education, University Center for Higher Education and Development (CESED/UNIFACISA/FCM/ESAC), Campina Grande, Brazil
| | - Jason Azevedo de Medeiros
- Graduate Program in Health Sciences, Federal University of Rio Grande do Norte (UFRN), Natal-RN, Brazil
| | - Jeferson Macedo Vianna
- Graduate Program in Physical Education, Federal University of Juiz de Fora (UFJF), Juiz de Fora-MG, Brazil; Strength Training Research Laboratory, Federal University of Juiz de Fora (UFJF), Juiz de Fora-MG, Brazil
| | - Breno Guilherme de Araújo Tinôco Cabral
- Graduate Program in Health Sciences, Federal University of Rio Grande do Norte (UFRN), Natal-RN, Brazil; Graduate Program in Physical Education, Federal University of Rio Grande do Norte (UFRN), Natal-RN, Brazil)
| | - Paulo Moreira Silva Dantas
- Graduate Program in Health Sciences, Federal University of Rio Grande do Norte (UFRN), Natal-RN, Brazil; Graduate Program in Physical Education, Federal University of Rio Grande do Norte (UFRN), Natal-RN, Brazil)
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11
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Chang H, Yan J, Lu G, Chen B, Zhang J. Muscle strength adaptation between high-load resistance training versus low-load blood flow restriction training with different cuff pressure characteristics: a systematic review and meta-analysis. Front Physiol 2023; 14:1244292. [PMID: 37693006 PMCID: PMC10485702 DOI: 10.3389/fphys.2023.1244292] [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: 06/22/2023] [Accepted: 08/14/2023] [Indexed: 09/12/2023] Open
Abstract
Purpose: In this systematic review and meta-analysis, blood flow restriction (BFR) with low-load resistance training (BFR-RT) was compared with high-load resistance training (HL-RT) on muscle strength in healthy adults. The characteristics of cuff pressure suitable for muscle strength gain were also investigated by analyzing the effects of applying different occlusion pressure prescriptions and cuff inflation patterns on muscle strength gain. Methods: Literature search was conducted using PubMed, Ovid Medline, ProQuest, Cochrane Library, Embase, and Scopus databases to identify literature published until May 2023. Studies reporting the effects of BFR-RT interventions on muscle strength gain were compared with those of HL-RT. The risk of bias in the included trials was assessed using the Cochrane tool, followed by a meta-analysis to calculate the combined effect. Subgroup analysis was performed to explore the beneficial variables. Results: Nineteen articles (42 outcomes), with a total of 458 healthy adults, were included in the meta-analysis. The combined effect showed higher muscle strength gain with HL-RT than with BFR-RT (p = 0.03, SMD = -0.16, 95% CI: -0.30 to -0.01). The results of the subgroup analysis showed that the BFR-RT applied with incremental and individualized pressure achieved muscle strength gain similar to the HL-RT (p = 0.8, SMD = -0.05, 95% CI: -0.44 to 0.34; p = 0.68, SMD = -0.04, 95% CI: -0.23 to 0.15), but muscle strength gain obtained via BFR-RT applied with absolute pressure was lower than that of HL-RT (p < 0.05, SMD = -0.45, 95% CI: -0.71 to -0.19). Furthermore, muscle strength gain obtained by BFR-RT applied with intermittent pressure was similar to that obtained by HL-RT (p = 0.88, SMD = -0.02, 95% CI: -0.27 to 0.23), but muscle strength gain for BFR-RT applied with continuous pressure showed a less prominent increase than that for HL-RT (p < 0.05, SMD = -0.3, 95% CI: -0.48 to -0.11). Conclusion: In general, HL-RT produces superior muscle strength gains than BFR-RT. However, the application of individualized, incremental, and intermittent pressure exercise protocols in BFR-RT elicits comparable muscle strength gains to HL-RT. Our findings indicate that cuff pressure characteristics play a significant role in establishing a BFR-RT intervention program for enhancing muscle strength in healthy adults. Clinical Trial Registration: https://www.crd.york.ac.uk/PROSPERO/#recordDetails; Identifier: PROSPERO (CRD42022364934).
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Affiliation(s)
- Hualong Chang
- College of Physical Education and Health Sciences, Zhejiang Normal University, Jinhua, China
| | - Jing Yan
- College of Education, Anyang Normal University, Anyang, China
| | - Guiwei Lu
- College of Physical Education and Health Sciences, Zhejiang Normal University, Jinhua, China
| | - Biao Chen
- College of Physical Education and Health Sciences, Zhejiang Normal University, Jinhua, China
| | - Jianli Zhang
- Exercise and Metabolism Research Center, College of Physical Education and Health Sciences, Zhejiang Normal University, Jinhua, China
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12
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Moreno EN, Hammert WB, Martin CC, Buckner SL. Acute muscular and cardiovascular responses to high load training with pre-exercise blood flow restriction. Clin Physiol Funct Imaging 2023; 43:109-119. [PMID: 36401343 DOI: 10.1111/cpf.12799] [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: 07/27/2022] [Revised: 11/10/2022] [Accepted: 11/14/2022] [Indexed: 11/21/2022]
Abstract
PURPOSE The purpose of this study is to examine the acute muscular and cardiovascular responses to applying blood flow restriction (BFR) before high-load training. METHODS Forty trained individuals visited the lab on three occasions. On Visit 1, participants completed paperwork and performed strength assessments. During Visits 2 and 3, participants completed four exercise conditions (one in each arm during each visit) as follows: (1) traditional resistance training (TRAD), (2) low load training with BFR (LLBFR), (3) low repetition high load training with pre-exercise BFR (PreBFR), and (4) low repetition traditional training (LRTRAD). Blood pressure, muscle thickness (MT), and isometric strength (ISO) were measured before and after exercise. RESULTS Data are displayed as means (SD). Immediately following exercise, MT in TRAD was greater compared with PreBFR (mean difference = 0.18[0.30] cm, p < 0.001) and LRTRAD (mean difference = 0.28[0.30] cm, p < 0.001). In addition, LLBFR demonstrated greater MT compared with PreBFR (mean difference = 0.24[0.30] cm, p < 0.001]. Immediately following exercise, ISO was lower in TRAD compared with PreBFR (mean difference = 33.8[46.9]N, p < 0.001) and the LRTRAD condition (mean difference = 32.8[50.4]N, p < 0.001). In addition, ISO was lower in LLBFR compared with PreBFR (mean difference = 43.9 [47.4]N, p < 0.001) and LRTRAD (mean difference = 42.9 [43.8]N, p < 0.001). Immediately following exercise, systolic blood pressure was greater in TRAD compared with PreBFR and LRTRAD. CONCLUSION The application of BFR before engaging in high-load training does not seem to augment the muscular responses to exercise when compared with traditional high loads alone; however, it may pose less demand on the cardiovascular system.
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Affiliation(s)
- Enrique N Moreno
- USF Muscle Lab, Exercise Science Program, University of South Florida, Tampa, Florida, USA
| | - William B Hammert
- USF Muscle Lab, Exercise Science Program, University of South Florida, Tampa, Florida, USA
| | - Cole C Martin
- USF Muscle Lab, Exercise Science Program, University of South Florida, Tampa, Florida, USA
| | - Samuel L Buckner
- USF Muscle Lab, Exercise Science Program, University of South Florida, Tampa, Florida, USA
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Comparison of finger flexor resistance training, with and without blood flow restriction, on perceptional and physiological responses in advanced climbers. Sci Rep 2023; 13:3287. [PMID: 36841900 PMCID: PMC9968301 DOI: 10.1038/s41598-023-30499-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 02/24/2023] [Indexed: 02/27/2023] Open
Abstract
This study compared perceptional and physiological responses of finger flexor exercise performed with free flow and blood flow restriction (BFR). Thirteen male advanced climbers completed three sessions of finger flexor resistance exercise at (1) 40% of MVC (Low) and (2) 75% of MVC (High) and (3) BFR at 40% of MVC (Low + BFR) in a randomized and counterbalanced order. Rate of perceived exertion for effort (RPE) and discomfort (RPD), session pleasure/displeasure (sPDF), exercise enjoyment (EES), lactate concentration and oxygen saturation were recorded after the last set. Both low-intensity sessions induced higher RPD than High (p = 0.018-0.022, ES = 1.01-1.09) and High was perceived as more enjoyable than Low-BFR (p = 0.031, ES = 1.08). No differences were found for RPE or sPDF (p = 0.132-0.804). Lactate was elevated more after High than the Low-sessions (p < 0.001, ES = 1.88-2.08). Capillary oxygen saturation was lower after Low + BFR compared to the other sessions (p = 0.031, ES = 1.04-1.27). Finally, the exercise volume was greater in Low compared to High (p = 0.022, ES = 1.14) and Low + BFR (p = 0.020, ES = 0.77). In conclusion, among advanced male climbers, performing Low + BFR led to a similar exercise volume but was perceived as more discomforting and less enjoyable compared to High. The Low session yielded similar responses as the Low + BFR but required a much greater exercise volume.
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14
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Kataoka R, Song JS, Bell ZW, Wong V, Spitz RW, Yamada Y, Loenneke JP. Effect of Increased Pressure Pain Threshold on Resistance Exercise Performance With Blood Flow Restriction. J Strength Cond Res 2023; 37:1204-1210. [PMID: 36727998 DOI: 10.1519/jsc.0000000000004397] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
ABSTRACT Kataoka, R, Song, JS, Bell, ZW, Wong, V, Spitz, RW, Yamada, Y, and Loenneke, JP. Effect of increased pressure pain threshold on resistance exercise performance with blood flow restriction. J Strength Cond Res XX(X): 000-000, 2022-This study aimed to examine whether increasing pressure pain threshold (PPT) through isometric handgrip exercise (HG) affects the number of repetitions completed and discomfort with knee extension exercise (KE) with blood flow restriction (BFR), and examine whether performing additional exercise leads to a further increase in PPT. Forty-one participants completed 2 trials: rest followed by low-load KE with BFR at 80% of resting arterial occlusion pressure (Rest + KE BFR) and low-intensity (30% of maximal strength) HG exercise followed by KE with BFR (HG + KE BFR). Pressure pain threshold was measured before and after exercise at the forearm and tibialis anterior. Results are presented as median difference (95% credible interval). Pressure pain threshold increased at the forearm (Bayes factor [BF10]: 5.2 × 107) and tibialis anterior (BF10: 1.5 × 106) after HG exercise. However, this did not lead to greater repetitions being completed with BFR exercise (0.2 [-0.1, 0.6] repetitions, BF10: 0.07). Pressure pain threshold after BFR exercise was not augmented over that observed with HG exercise (0.02 [-0.15, 0.2] kg·cm-2, BF10: 0.175) at the forearm. More data are needed in the lower body to determine which model best fits the data (BF10: 0.84). Discomfort with BFR exercise was not different between conditions (1.0 [-2.3, 4.4] arbitrary units, BF10: 0.10). The pain-reducing effect of prior exercise did not change the repetitions completed with BFR exercise, suggesting that the change in PPT may not have been great enough to alter performance. Performing additional exercise did not elicit further increases in PPT nor was perceived discomfort to BFR exercise altered by changes in PPT.
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Affiliation(s)
- Ryo Kataoka
- Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, Mississippi
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15
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Bartolomei S, Montesanto P, Lanzoni IM, Gatta G, Cortesi M, Fantozzi S. A Comparison between High and Low Cuff Pressures on Muscle Oxygen Saturation and Recovery Responses Following Blood-Flow Restriction Resistance Exercise. SENSORS (BASEL, SWITZERLAND) 2022; 22:9138. [PMID: 36501840 PMCID: PMC9739770 DOI: 10.3390/s22239138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/14/2022] [Accepted: 11/22/2022] [Indexed: 06/17/2023]
Abstract
The aim of the study was to compare the recovery response and muscle oxygenation of a blood-flow restriction resistance exercise (BFR) session with high [HP: 80% of the arterial occlusion pressure (AOP)] and low cuff pressure (LP: 40% of AOP). Both exercise sessions included 4 sets to failure at the barbell preacher curl exercise. Twelve resistance trained men (27.4 ± 5.0 years; 83.5 ± 11.6 kg; 176.6 ± 7.0 cm) performed each protocol in a counterbalanced, randomized order. Maximal isometric force, muscle morphology and muscle soreness of the biceps brachii muscle were assessed at baseline, 15-min, 60-min and 24-h post each testing session. In addition, muscle oxygen saturation (SmO2) was assessed during each training session. A lower number of repetitions (p = 0.013) was detected in HP compared to LP. A lower SmO2 (p < 0.001) was detected in the recovery time between the sets in HP (mean: 47.6 ± 15.7%) compared to LP (mean: 68.9 ± 7.2%). No differences between the two trials (p > 0.05) were noted for isometric force, muscle architecture and soreness at any timepoint. Results indicate that, despite a high cuff pressure may induce a more hypoxic condition compared to a lower cuff pressure, recovery responses may not be affected.
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Affiliation(s)
- Sandro Bartolomei
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40136 Bologna, Italy
| | - Pasquale Montesanto
- Department for Life Quality Studies, University of Bologna, 40136 Bologna, Italy
| | - Ivan Malagoli Lanzoni
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40136 Bologna, Italy
| | - Giorgio Gatta
- Department for Life Quality Studies, University of Bologna, 40136 Bologna, Italy
| | - Matteo Cortesi
- Department for Life Quality Studies, University of Bologna, 40136 Bologna, Italy
| | - Silvia Fantozzi
- Department of Electrical, Electronic and Information Engineering, University of Bologna, 40136 Bologna, Italy
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Tanaka T, Kubota A, Nozu S, Ozaki H, Kishimoto K, Nishio H, Takazawa Y. Effect of low-intensity exercise with blood flow restriction during rest intervals on muscle function and perception. Clin Physiol Funct Imaging 2022; 42:348-355. [PMID: 35765169 DOI: 10.1111/cpf.12775] [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: 12/21/2021] [Revised: 06/15/2022] [Accepted: 06/21/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE We assessed the effects of low-intensity exercise with blood flow restriction (BFR) during rest intervals on recovery of muscle function and pain during exercise and rest intervals. METHODS Participants were 10 males, and study arms of the participants were randomly assigned into three conditions; low-intensity exercise with BFR during rest intervals (rBFR), low-intensity exercise with BFR during exercise (eBFR) and low-intensity exercise only (EO). The exercise task was elbow flexion until repetition failure at 30% of 1 RM, and cuff pressure was 120 mmHg. The maximum voluntary isometric contraction (MVIC) and the muscle endurance (ME) were measured pre, post, 1 h, 24 h and 48 h after the exercise. Pain during exercise and rest intervals were evaluated using Numerical Rating Scale. RESULTS MVIC and ME significantly decreased after exercise in all conditions. Pain during exercise was lower in rBFR (4.2 ± 2.9) (p = 0.007) and EO (4.4 ± 2.7) (p = 0.014) conditions compared to eBFR condition (6.7 ± 1.7), but the pain during rest intervals was more intense in rBFR condition (5.2 ± 1.6) compared to eBFR (1.5 ± 1.4) and EO (1.7 ± 1.2) conditions (all: p < 0.001). CONCLUSION We discovered that recovery of muscle function was the same as BFR during rest intervals and BFR during exercise. Also, our results suggested that BFR itself may cause the perception of pain. Future studies are thus required to investigate the optimal dosage focusing on the pressure volume and intensity used in BFR during intervals. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Tsukasa Tanaka
- Graduate School of Health and Sports Science, Juntendo University, Inzai, Chiba, Japan
| | - Atsushi Kubota
- Graduate School of Health and Sports Science, Juntendo University, Inzai, Chiba, Japan
| | - Shojiro Nozu
- Institute of Health and Sports Science and Medicine, Juntendo University, Inzai, Chiba, Japan
| | - Hayao Ozaki
- School of Sport and Health Science, Tokai Gakuen University, Miyoshi, Aichi, Japan
| | - Kohei Kishimoto
- Faculty of Sport and Health Science, Ritsumeikan University, Kusatsu, Shiga, Japan
| | - Hirofumi Nishio
- Graduate School of Health and Sports Science, Juntendo University, Inzai, Chiba, Japan.,Department of Sports Medicine, Faculty of Medicine, Juntendo University, Hongo, Tokyo, Japan
| | - Yuji Takazawa
- Graduate School of Health and Sports Science, Juntendo University, Inzai, Chiba, Japan.,Institute of Health and Sports Science and Medicine, Juntendo University, Inzai, Chiba, Japan.,Department of Sports Medicine, Faculty of Medicine, Juntendo University, Hongo, Tokyo, Japan
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Suga T, Dora K, Mok E, Sugimoto T, Tomoo K, Takada S, Hashimoto T, Isaka T. Exercise adherence-related perceptual responses to low-load blood flow restriction resistance exercise in young adults: A pilot study. Physiol Rep 2021; 9:e15122. [PMID: 34877802 PMCID: PMC8652406 DOI: 10.14814/phy2.15122] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 10/24/2021] [Accepted: 10/31/2021] [Indexed: 12/28/2022] Open
Abstract
Resistance exercise (RE) with blood flow restriction (BFR) is recognized as a beneficial strategy in increasing skeletal muscle mass and strength. However, the effects of BFR on changes in perceptual parameters, particularly those related to exercise adherence, induced by RE are not completely understood. In this study, we examined the exercise adherence-related perceptual responses to low-load BFR-RE. Sixteen young males performed both BFR and non-BFR (NBFR) sessions in a crossover design. The bilateral knee extensor low-load RE was performed with a standard BFR-RE protocol, consisting of four sets (total 75 repetitions), using 20% of one-repetition maximum. BFR-RE was performed with 200 mmHg pressure cuffs placed around the proximal region of the thighs. NBFR-RE was performed without pressure cuffs. The ratings of perceived exertion and leg discomfort measured using the Borg's Scales were higher for BFR-RE session than for NBFR-RE session (both p < 0.001 for interaction effect). The Feeling Scale-measured affect and Task Motivation Scale-measured task motivation were lower for BFR-RE session than for NBFR-RE session (both p < 0.05 for interaction effect); by contrast, the Numerical Rating Scale-measured perceived pain was higher for BFR-RE session than for NBFR-RE session (p < 0.001 for interaction effect). The Physical Activity Enjoyment Scale-measured enjoyment immediately after RE was lower with BFR than with NBFR (p < 0.001). These findings suggest that BFR exacerbates the exercise adherence-related perceptual responses to low-load RE in young males. Therefore, further studies are needed to develop effective strategies that minimize the BFR-RE-induced negative effects on perceptual responses.
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Affiliation(s)
- Tadashi Suga
- Faculty of Sport and Health ScienceRitsumeikan UniversityKusatsuShigaJapan
- Research Organization of Science and TechnologyRitsumeikan UniversityKusatsuShigaJapan
| | - Kento Dora
- Faculty of Sport and Health ScienceRitsumeikan UniversityKusatsuShigaJapan
| | - Ernest Mok
- Faculty of Sport and Health ScienceRitsumeikan UniversityKusatsuShigaJapan
| | - Takeshi Sugimoto
- Faculty of Sport and Health ScienceRitsumeikan UniversityKusatsuShigaJapan
| | - Keigo Tomoo
- Faculty of Sport and Health ScienceRitsumeikan UniversityKusatsuShigaJapan
| | - Shingo Takada
- Faculty of Lifelong Sport, Department of Sports EducationHokusho UniversityEbetsuHokkaidoJapan
| | - Takeshi Hashimoto
- Faculty of Sport and Health ScienceRitsumeikan UniversityKusatsuShigaJapan
| | - Tadao Isaka
- Faculty of Sport and Health ScienceRitsumeikan UniversityKusatsuShigaJapan
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Sinclair P, Kadhum M, Paton B. Tolerance to Intermittent vs. Continuous Blood Flow Restriction Training: A meta-Analysis. Int J Sports Med 2021; 43:3-10. [PMID: 34535020 DOI: 10.1055/a-1537-9886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The proven beneficial effects of low-load blood flow restriction training on strength gain has led to further exploration into its application during rehabilitation, where the traditional use of heavy loads may not be feasible. With current evidence showing that low-load blood flow restriction training may be less well tolerated than heavy-load resistance training, this review was conducted to decipher whether intermittently deflating the pressure cuff during rest intervals of a training session improves tolerance to exercise, without compromising strength. Four databases were searched for randomized controlled trials that compared the effect of intermittent versus continuous blood flow restriction training on outcomes of exercise tolerance or strength in adults. Nine studies were identified, with six included in the meta-analysis. No significant difference in rate of perceived exertion was found (SMD-0.06, 95% CI-0.41 to 0.29, p=0.73, I 2=80%). Subgroup analysis excluding studies that introduced bias showed a shift towards favoring the use of intermittent blood flow restriction training (SMD-0.42, 95% CI-0.87 to 0.03, p=0.07, I 2=0%). There was no significant difference in strength gain. Intermittent cuff deflations during training intervals does not improve tolerance to exercise during blood flow restriction training.
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Affiliation(s)
- Pierre Sinclair
- Department of Institute of Sports and Exercise Health (ISEH), University College London, London, United Kingdom of Great Britain and Northern Ireland
| | - Murtaza Kadhum
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, United Kingdom of Great Britain and Northern Ireland
| | - Bruce Paton
- Department of Institute of Sports and Exercise Health (ISEH), University College London, London, United Kingdom of Great Britain and Northern Ireland
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Rolnick N, Kimbrell K, Cerqueira MS, Weatherford B, Brandner C. Perceived Barriers to Blood Flow Restriction Training. FRONTIERS IN REHABILITATION SCIENCES 2021; 2:697082. [PMID: 36188864 PMCID: PMC9397924 DOI: 10.3389/fresc.2021.697082] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 06/11/2021] [Indexed: 12/13/2022]
Abstract
Blood flow restriction (BFR) training is increasing in popularity in the fitness and rehabilitation settings due to its role in optimizing muscle mass and strength as well as cardiovascular capacity, function, and a host of other benefits. However, despite the interest in this area of research, there are likely some perceived barriers that practitioners must overcome to effectively implement this modality into practice. These barriers include determining BFR training pressures, access to appropriate BFR training technologies for relevant demographics based on the current evidence, a comprehensive and systematic approach to medical screening for safe practice and strategies to mitigate excessive perceptual demands of BFR training to foster long-term compliance. This manuscript attempts to discuss each of these barriers and provides evidence-based strategies and direction to guide clinical practice and future research.
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Affiliation(s)
- Nicholas Rolnick
- The Human Performance Mechanic, Lehman College, New York, NY, United States
- *Correspondence: Nicholas Rolnick
| | - Kyle Kimbrell
- Owens Recovery Science, San Antonio, TX, United States
| | - Mikhail Santos Cerqueira
- Neuromuscular Performance Analysis Laboratory, Department of Physical Therapy, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil
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Keller JL, Hill EC, Housh TJ, Smith CM, Anders JPV, Schmidt RJ, Johnson GO. The acute and early phase effects of blood flow restriction training on ratings of perceived exertion, performance fatigability, and muscular strength in women. ISOKINET EXERC SCI 2021. [DOI: 10.3233/ies-204198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Blood flow restriction (BFR) resistance training (RT) has garnered recent interest, but female-specific data remains scarce. OBJECTIVE: The purpose was to examine the effects of 2-wks of low-load concentric, isokinetic, reciprocal forearm flexion and extension training, with and without BFR on perceptual responses, performance fatigability, and muscular strength. METHODS: Twenty women were assigned to a BFRT or a non-BFRT group. Each group trained at 30% of concentric peak moment. Each session consisted of 75 concentric, isokinetic, reciprocal forearm flexion extension muscle actions. RPEs were recorded following each set. Pretest and posttest maximal voluntary isometric contraction (MVIC) force was measured, and percent decline was defined as performance fatigability. RESULTS: The RPE values (p< 0.05) increased across sets. Strength (collapsed across muscle action) increased (p< 0.05) from 0-wk (23.7 ± 3.2 Nm) to 2-wk (26.8 ± 2.7 Nm). Independent of group and muscle action, performance fatigability (p< 0.05) increased from 0-wk (10.9 ± 5.0%) to 2-wk (14.1 ± 4.4%). CONCLUSIONS: 2-wks of low-load concentric, reciprocal forearm flexion and extension training resulted in similar training-induced changes in perceptual responses, performance fatigability, and muscular strength between BFRT and non-BFRT. These findings may reduce concerns of increased perceptual responses following BFRRT compared to non-BFRRT.
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Affiliation(s)
- Joshua L. Keller
- Department of Health, Kinesiology and Sport, College of Education, University of South Alabama, AL, USA
| | - Ethan C. Hill
- Division of Kinesiology, School of Kinesiology and Physical Therapy, University of Central Florida, Orlando, FL, USA
| | - Terry J. Housh
- Exercise Physiology Laboratory, Department of Nutrition and Health Sciences, College of Education and Human Sciences, University of Nebraska – Lincoln, Lincoln, NE, USA
| | - Cory M. Smith
- Human and Environmental Physiology Laboratory, Department of Kinesiology, University of Texas at El Paso, El Paso, TX, USA
| | - John Paul V. Anders
- Exercise Physiology Laboratory, Department of Nutrition and Health Sciences, College of Education and Human Sciences, University of Nebraska – Lincoln, Lincoln, NE, USA
| | - Richard J. Schmidt
- Exercise Physiology Laboratory, Department of Nutrition and Health Sciences, College of Education and Human Sciences, University of Nebraska – Lincoln, Lincoln, NE, USA
| | - Glen O. Johnson
- Exercise Physiology Laboratory, Department of Nutrition and Health Sciences, College of Education and Human Sciences, University of Nebraska – Lincoln, Lincoln, NE, USA
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21
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Miller RM, Galletti BAR, Koziol KJ, Freitas EDS, Heishman AD, Black CD, Larson DJ, Bemben DA, Bemben MG. Perceptual responses: Clinical versus practical blood flow restriction resistance exercise. Physiol Behav 2020; 227:113137. [PMID: 32798570 DOI: 10.1016/j.physbeh.2020.113137] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 08/11/2020] [Accepted: 08/12/2020] [Indexed: 12/25/2022]
Abstract
The purpose of the current investigation was to compare the acute perceptual responses during low-load resistance exercise (RE) with clinical blood flow restriction (cBFR-RE) and practical blood flow restriction (pBFR-RE), and during conventional low- (LL-RE) and high-load resistance exercise (HL-RE), to determine if these responses differed between young males and females. Twenty-nine participants (14 males: 23.6±2.7years, 25.3±3.1kg/m2 and 15 females: 20.3±1.6years, 23.4±1.9kg/m2) completed the following exercise conditions in a randomized design: 1) cBFR-RE, 2) pBFR-RE, 3) HL-RE, and 4) LL-RE. Low-load conditions consisted of 30-15-15-15 repetitions of two-leg press (LP) and knee extension (KE) exercises with 30% one-repetition maximum (1-RM), and HL-RE consisted of 3 sets of 10 repetitions at 80% 1-RM, all with 60s rest intervals. Ratings of perceived exertion (RPE) and discomfort were assessed before exercise and immediately following each set. RPE was significantly higher in HL-RE compared to all low-load conditions for both exercises after each set (all p<0.05). cBFR-RE resulted in significantly greater RPE than pBFR-RE and LL-RE for both exercises for sets 1-4 for LP and sets 2-3 for KE (all p<0.05). Levels of discomfort were similar between cBFR-RE and HL-RE, which tended to be significantly higher than pBFR-RE and LL-RE (p<0.05). Men reported significantly greater RPE than women following sets 2-4 during KE with cBFR-RE and sets 2 and 3 during KE for HL-RE (all p<0.05). Males also reported significantly greater discomfort than women following sets 2-4 for KE LL-RE (p<0.05). Altogether, these data suggest that pBFR-RE may provide a more favorable BFR condition based on perceptual responses and that perceptual responses may differ between sexes across varying resistance exercise conditions.
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Affiliation(s)
- Ryan M Miller
- Department of Health and Exercise Science, Neuromuscular Research Laboratory, University of Oklahoma, Norman, Oklahoma, USA.
| | - Bianca A R Galletti
- Department of Health and Exercise Science, Neuromuscular Research Laboratory, University of Oklahoma, Norman, Oklahoma, USA
| | - Karolina J Koziol
- Department of Health and Exercise Science, Neuromuscular Research Laboratory, University of Oklahoma, Norman, Oklahoma, USA
| | - Eduardo D S Freitas
- Department of Health and Exercise Science, Neuromuscular Research Laboratory, University of Oklahoma, Norman, Oklahoma, USA
| | - Aaron D Heishman
- Department of Health and Exercise Science, Neuromuscular Research Laboratory, University of Oklahoma, Norman, Oklahoma, USA; Department of Athletics, Basketball Strength and Performance, University of Oklahoma, Norman, Oklahoma, USA
| | - Christopher D Black
- Department of Health and Exercise Science, Sensory and Muscle Function Research Laboratory, University of Oklahoma, USA
| | - Daniel J Larson
- Departmeny of Health and Exercise Science, Sport, Health, and Exercise Data Analytics Laboratory, University of Oklahoma, Norman, Oklahoma, USA
| | - Debra A Bemben
- Departmeny of Health and Exercise Science, Bone Density Research Laboratory, University of Oklahoma, Norman, Oklahoma, USA
| | - Michael G Bemben
- Department of Health and Exercise Science, Neuromuscular Research Laboratory, University of Oklahoma, Norman, Oklahoma, USA
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22
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Spitz RW, Chatakondi RN, Bell ZW, Wong V, Viana RB, Dankel SJ, Abe T, Yamada Y, Loenneke JP. Blood Flow Restriction Exercise: Effects of Sex, Cuff Width, and Cuff Pressure on Perceived Lower Body Discomfort. Percept Mot Skills 2020; 128:353-374. [PMID: 32777996 DOI: 10.1177/0031512520948295] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Narrow cuffs cause less discomfort than wide cuffs immediately following elbow flexion exercise in combination with blood flow restriction, possibly due to a balling up effect of the bicep underneath the cuff. In this study, we sought to examine the impact of cuff width, sex, and pressure on perceived discomfort in the quadriceps, following knee extensions. One hundred participants completed three separate experiments. In Experiment 1, we compared participants' discomfort at rest after using a 5 and a 12 cm cuff. In Experiment 2, we compared the discomfort from these two cuffs after four sets of exercise. In Experiment 3, we used the same exercise protocol as in Experiment 2, but we compared the discomfort between a 12 cm cuff inflated to an inappropriate pressure and a 12 cm cuff inflated to the recommended pressure. We found no sex differences in Experiments 1 and 3. In Experiment 1, the narrow cuff had higher discomfort (16 vs 12 AU). In Experiment 2, men reported higher discomfort than women, with no discomfort differences related to cuff width, though narrow cuffs were most preferred. In Experiment 3, cuffs inflated to a pressure intended for narrow cuffs were associated with higher discomfort, and participants preferred to use it less. In summary, we found no strong evidence for discomfort differences due to cuff width. There was some indication that participants preferred narrow cuffs with pressures inflated to the recommended relative pressure. Muscle shape may influence how cuff width affects discomfort.
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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
| | - Raksha N Chatakondi
- Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi
| | - Zachary W Bell
- Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi
| | - Vickie Wong
- Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi
| | - Ricardo B Viana
- Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi.,Faculty of Physical Education and Dance, Federal University of Goiás
| | - Scott J Dankel
- Department of Health and Exercise Science, Exercise Physiology Laboratory, Rowan University, Glassboro, New Jersey, United States
| | - Takashi Abe
- Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi
| | - Yujiro Yamada
- Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi
| | - Jeremy P Loenneke
- Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi
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23
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Mok E, Suga T, Sugimoto T, Tomoo K, Dora K, Takada S, Hashimoto T, Isaka T. Negative effects of blood flow restriction on perceptual responses to walking in healthy young adults: A pilot study. Heliyon 2020; 6:e04745. [PMID: 32885079 PMCID: PMC7452548 DOI: 10.1016/j.heliyon.2020.e04745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 08/06/2020] [Accepted: 08/13/2020] [Indexed: 11/02/2022] Open
Abstract
Background Methods Results Conclusions
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24
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Acute cardiovascular response to unilateral, bilateral, and alternating resistance exercise with blood flow restriction. Eur J Appl Physiol 2020; 120:1921-1930. [PMID: 32588194 DOI: 10.1007/s00421-020-04401-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 05/19/2020] [Indexed: 10/24/2022]
Abstract
AIM Blood flow restriction (BFR) exercise is a common alternative to traditional high-load resistance exercise used to increase muscle size and strength. Some populations utilizing BFR at a low load may wish to limit their cardiovascular response to exercise. Different contraction patterns may attenuate the cardiovascular response, but this has not been compared using BFR. PURPOSE To compare the cardiovascular response to unilateral (UNI), bilateral (BIL), and alternating (ALT) BFR exercise contraction patterns. METHODS Twenty healthy participants performed four sets (30 s rest) of knee extensions to failure, using 30% one-repetition maximum, 40% arterial occlusion pressure, and each of the three contraction patterns (on different days, at the same time of day, separated by 2-10 days, randomized). Cardiovascular responses, presented as pre- to post-exercise mean changes (SD), were measured using pulse wave analysis and analyzed with Bayesian RMANOVA. RESULTS ALT caused greater changes in: aortic systolic [ΔmmHg: ALT = 21(8); UNI = 13(11); BIL = 15(8); BF10 = 29.599], diastolic [ΔmmHg: ALT = 13(8); UNI = 7(11); BIL = 8(8); BF10 = 5.175], and mean arterial [ΔmmHg: ALT = 19(8); UNI = 11(11); BIL = 13(7); BF10 = 48.637] blood pressures. Aortic [ΔmmHg bpm: ALT = 4945(2340); UNI = 3294(1408); BIL = 3428 (1461); BF10 = 113.659] and brachial [ΔmmHg bpm: ALT = 6134(2761); UNI = 4300(1709); BIL = 4487(1701); BF10 = 31.845] rate pressure products, as well as heart rate [Δbpm: ALT = 26(14); UNI = 19(8); BIL = 19(11); BF10 = 5.829] were greatest with ALT. Augmentation index [Δ%: UNI = -6(13); BIL = - 7(11); ALT = - 5(16); BF10 = 0.155] and wave reflection magnitude [Δ%: UNI = - 5(9); BIL = - 4(7); ALT = - 4(7); BF10 = 0.150] were not different. CONCLUSION Those at risk of a cardiovascular event may choose unilateral or bilateral BFR exercise over alternating until further work determines the degree to which it can be tolerated.
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25
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Clarkson MJ, May AK, Warmington SA. Is there rationale for the cuff pressures prescribed for blood flow restriction exercise? A systematic review. Scand J Med Sci Sports 2020; 30:1318-1336. [PMID: 32279391 DOI: 10.1111/sms.13676] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 03/12/2020] [Accepted: 03/27/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Blood flow restriction exercise has increasingly broad applications among healthy and clinical populations. Ensuring the technique is applied in a safe, controlled, and beneficial way for target populations is essential. Individualized cuff pressures are a favored method for achieving this. However, there remains marked inconsistency in how individualized cuff pressures are applied. OBJECTIVES To quantify the cuff pressures used in the broader blood flow restriction exercise literature, and determine whether there is clear justification for the choice of pressure prescribed. METHODS Studies were included in this review from database searches if they employed an experimental design using original data, involved either acute or chronic exercise using blood flow restriction, and they assessed limb or arterial occlusion pressure to determine an individualized cuff pressure. Methodologies of the studies were evaluated using a bespoke quality assessment tool. RESULTS Fifty-one studies met the inclusion criteria. Individualized cuff pressures ranged from 30% to 100% arterial occlusion pressure. Only 7 out of 52 studies attempted to justify the individualized cuff pressure applied during exercise. The mean quality rating for all studies was 11.1 ± 1.2 out of 13. CONCLUSIONS The broader blood flow restriction exercise literature uses markedly heterogeneous prescription variables despite using individualized cuff pressures. This is problematic in the absence of any clear justification for the individualized cuff pressures selected. Systematically measuring and reporting all relevant acute responses and training adaptations to the full spectrum of BFR pressures alongside increased clarity around the methodology used during blood flow restriction exercise is paramount.
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Affiliation(s)
- Matthew J Clarkson
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Vic., Australia
| | - Anthony K May
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Vic., Australia
| | - Stuart A Warmington
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Vic., Australia
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26
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Spitz RW, Wong V, Bell ZW, Viana RB, Chatakondi RN, Abe T, Loenneke JP. Blood Flow Restricted Exercise and Discomfort: A Review. J Strength Cond Res 2020; 36:871-879. [PMID: 32058360 DOI: 10.1519/jsc.0000000000003525] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Spitz, RW, Wong, V, Bell, ZW, Viana, RB, Chatakondi, RN, Abe, T, and Loenneke, JP. Blood flow restricted exercise and discomfort: A Review. J Strength Cond Res XX(X): 000-000, 2020-Blood flow restriction exercise involves using a pneumatic cuff or elastic band to restrict arterial inflow into the muscle and block venous return out of the muscle during the exercise bout. The resultant ischemia in conjunction with low-load exercise has shown to be beneficial with increasing muscle size and strength. However, a limitation of using blood flow restriction (BFR) is the accompanying discomfort associated with this type of exercise. Factors that may influence discomfort are applied pressure, width of the cuff, cuff material, sex, and training to failure. The goal of this review was to evaluate the existing literature and elucidate how these factors can be manipulated to reduce discomfort during exercise as well as provide possible directions for future research. Thirty-eight different studies were located investigating BFR and discomfort. It was found that BFR training causes more discomfort than exercise without BFR. However, chronic use of BFR may increase tolerability, but discomfort may still be elevated over traditional non-blood flow restricted exercise. Discomfort can be attenuated by the application of lower applied pressures and stopping short of task failure. Finally, in the upper body, wider cuffs seem to increase ratings of discomfort compared with more narrow cuffs. In conclusion, applying the proper-sized cuff and making the applied pressure relative to both the individual and the cuff applied may attenuate discomfort. Reducing discomfort during exercise may help increase adherence to exercise and rehabilitation programs.
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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, Mississippi
| | - Vickie Wong
- Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, Mississippi
| | - Zachary W Bell
- Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, Mississippi
| | - Ricardo B Viana
- Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, Mississippi.,Faculty of Physical Education and Dance, Federal University of Goiás, Goiânia, Brazil
| | - Raksha N Chatakondi
- Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, Mississippi
| | - Takashi Abe
- Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, Mississippi
| | - Jeremy P Loenneke
- Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, Mississippi
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27
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Freitas EDS, Miller RM, Heishman AD, Aniceto RR, Silva JGC, Bemben MG. Perceptual responses to continuous versus intermittent blood flow restriction exercise: A randomized controlled trial. Physiol Behav 2019; 212:112717. [PMID: 31629764 DOI: 10.1016/j.physbeh.2019.112717] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 10/16/2019] [Accepted: 10/16/2019] [Indexed: 11/29/2022]
Abstract
We investigated the perceptual responses to resistance exercise (RE) with continuous and intermittent blood flow restriction (BFR). Fourteen males randomly completed the following exercise conditions: low-load RE with continuous BFR (cBFR), low-load RE with intermittent BFR (iBFR), low-load RE without BFR (LI), and traditional high-load RE (HI). Participants completed 4 sets of 30-15-15-15 repetitions of bilateral leg press and knee extension exercises during the low-load conditions, at 20% of one-repetition maximum (1-RM), a 1.5‑sec metronome-controlled pace, with a 1-min rest interval between sets; HI consisted of 4 sets of 10 repetitions of the same exercises, at 70% 1-RM, with the same pace and rest interval. Ratings of perceived exertion (RPE) and discomfort were assessed using psychometric scales before exercise and after each set. RPE displayed no significant differences (p > 0.05) between the BFR conditions for either exercise. Additionally, both BFR conditions elicited significantly (p < 0.05) greater RPE than LI and significantly (p <0.05) lower RPE than HI during both exercises. Rating of discomfort displayed no significant differences between BFR conditions during the first two sets of leg press; however, cBFR evoked greater discomfort compared to iBFR during the last two sets. There were no significant (p > 0.05) differences observed between conditions during the knee extension exercise. Rating of discomfort was similar between the BFR and HI conditions and each were significantly greater than LI during both exercises. Therefore, cBFR and iBFR seem to produce similar perceptual responses, which are greater than LI and lower than HI, but similar in regards to discomfort.
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Affiliation(s)
- Eduardo D S Freitas
- Department of Health and Exercise Science, Neuromuscular Research Laboratory, University of Oklahoma, Norman, OK, USA.
| | - Ryan M Miller
- Department of Health and Exercise Science, Neuromuscular Research Laboratory, University of Oklahoma, Norman, OK, USA
| | - Aaron D Heishman
- Department of Health and Exercise Science, Neuromuscular Research Laboratory, University of Oklahoma, Norman, OK, USA
| | - Rodrigo R Aniceto
- Department of Physical Education, Kinanthropometry and Human Performance Laboratory, Federal University of Paraíba, João Pessoa, PB, Brazil
| | - Julio G C Silva
- Study and Research Group in Biomechanics and Psychophysiology of Exercise, Federal Institute of Education, Science and Technology of Rio Grande do Norte, Currais Novos, RN, Brazil
| | - Michael G Bemben
- Department of Health and Exercise Science, Neuromuscular Research Laboratory, University of Oklahoma, Norman, OK, USA
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28
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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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Mattocks KT, Mouser JG, Jessee MB, Buckner SL, Dankel SJ, Bell ZW, Abe T, Bentley JP, Loenneke JP. Perceptual changes to progressive resistance training with and without blood flow restriction. J Sports Sci 2019; 37:1857-1864. [PMID: 30961440 DOI: 10.1080/02640414.2019.1599315] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The purpose was to examine changes in the perceptual responses to lifting a very low load (15% one repetition maximum (1RM)) with and without (15/0) different pressures [40% (15/40) and 80% (15/80) arterial occlusion pressure] and compare that to traditional high load (70/0) resistance exercise. Ratings of perceived exertion (RPE) and discomfort were measured following each set of exercise. In addition, resting arterial occlusion pressure was measured prior to exercise. Assessments were made in training sessions 1, 9, and 16 for the upper and lower body. Data are presented as means and 95% CI. There were changes in RPE in the upper body with condition 15/40 [-2.1 (-3.4, -0.850)] and 15/80 [-2.4 (-3.6, -1.1)] decreasing by the end of training. In the lower body, RPE decreased in condition 15/40 [-1.4 (-2.3, -0.431)] by the end of the training study. There was a main effect of time in the upper body with all conditions decreasing discomfort. In the lower body, all conditions decreased except for 15/80. For arterial occlusion pressure, there were differences across time in the 15/40 condition and the 15/80 condition in the upper body. Repeated exposure to blood flow restriction may dampen the perceptual responses over time.
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Affiliation(s)
- Kevin T Mattocks
- a Department of Exercise Science , Lindenwood University - Belleville , Belleville , IL , USA
| | - J Grant Mouser
- b Department of Kinesiology and Health Promotion , Troy University , Troy , AL , USA
| | - Matthew B Jessee
- c School of Kinesiology, University of Southern Mississippi , Hattiesburg , MS , USA
| | - Samuel L Buckner
- d Exercise Science Program , University of South Florida , Tampa , FL , USA
| | - Scott J Dankel
- e Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory , The University of Mississippi , University , MS , USA
| | - Zachary W Bell
- e Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory , The University of Mississippi , University , MS , USA
| | - Takashi Abe
- e Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory , The University of Mississippi , University , MS , USA
| | - John P Bentley
- f Department of Pharmacy Administration , University of Mississippi , University , MS , USA
| | - Jeremy P Loenneke
- e Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory , The University of Mississippi , University , MS , USA
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Mattocks KT, Mouser JG, Jessee MB, Dankel SJ, Buckner SL, Bell ZW, Abe T, Loenneke JP. Acute hemodynamic changes following high load and very low load lower body resistance exercise with and without the restriction of blood flow. Physiol Meas 2018; 39:125007. [DOI: 10.1088/1361-6579/aaefc9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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