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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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Hill EC, Schmidt JT, Reedy KR, Lubiak SM, Proppe CE, Rivera PM, Gonzalez-Rojas DH, Lawson JE, Prajapati AJ, Shah NM, Patel NN, Guirgis AM, Silverio AA, Howard MA, Choi H, Keller JL. Progression and perceptual responses to blood flow restriction resistance training among people with multiple sclerosis. Eur J Appl Physiol 2024:10.1007/s00421-024-05584-2. [PMID: 39162881 DOI: 10.1007/s00421-024-05584-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Accepted: 08/10/2024] [Indexed: 08/21/2024]
Abstract
PURPOSE Resistance exercise can attenuate muscular impairments associated with multiple sclerosis (MS), and blood flow restriction (BFR) may provide a viable alternative to prescribing heavy training loads. The purpose of this investigation was to examine the progression of upper and lower body low-load (30% of one-repetition maximum [1RM]) resistance training (RT) with BFR applied intermittently during the exercise intervals (RT + BFR) versus volume-matched heavy-load (65% of 1RM) RT. METHODS Men and women with MS (n = 16) were randomly assigned to low-load RT + BFR (applied intermittently) or heavy-load RT and completed 12 weeks (2 × /week) of RT that consisted of bilateral chest press, seated row, shoulder press, leg press, leg extension, and leg curl exercises. Exercise load, tonnage, and rating of perceived exertion were assessed at baseline and every 6 weeks. RESULTS Training load increased to a greater extent and sometimes earlier for RT + BFR (57.7-106.3%) than heavy-load RT (42.3-54.3%) during chest press, seated row, and leg curl exercises, while there were similar increases (63.5-101.1%) for shoulder press, leg extension, and leg press exercises. Exercise tonnage was greater across all exercises for RT + BFR than heavy-load RT, although tonnage only increased during the chest press (70.7-80.0%) and leg extension (89.1%) exercises. Perceptions of exertion (4.8-7.2 au) and compliance (97.9-99.0%) were similar for both interventions. CONCLUSION The training-induced increases in load, high compliance, and moderate levels of exertion suggested that RT + BFR and heavy-load RT are viable interventions among people with MS. RT + BFR may be a preferred modality if heavy loads are not well tolerated and/or to promote early-phase training responses.
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Affiliation(s)
- Ethan C Hill
- School of Kinesiology and Rehabilitation Sciences, Division of Kinesiology, University of Central Florida, 12494 University Boulevard, Orlando, FL, 32816, USA.
- Florida Space Institute, University of Central Florida, Partnership I, Research Parkway, Orlando, FL, 32826, USA.
- College of Medicine, University of Central Florida, 6850 Lake Nona Blvd, Orlando, FL, 32827, USA.
| | - Jeffrey T Schmidt
- AdventHealth Sports Med and Rehab, 265 E Rollins St. Suite 9100, Orlando, FL, 32804, USA
| | - Kyle R Reedy
- AdventHealth Sports Med and Rehab, 265 E Rollins St. Suite 9100, Orlando, FL, 32804, USA
| | - Sean M Lubiak
- School of Kinesiology and Rehabilitation Sciences, Division of Kinesiology, University of Central Florida, 12494 University Boulevard, Orlando, FL, 32816, USA
| | - Chris E Proppe
- School of Kinesiology and Rehabilitation Sciences, Division of Kinesiology, University of Central Florida, 12494 University Boulevard, Orlando, FL, 32816, USA
| | - Paola M Rivera
- School of Kinesiology and Rehabilitation Sciences, Division of Kinesiology, University of Central Florida, 12494 University Boulevard, Orlando, FL, 32816, USA
| | - David H Gonzalez-Rojas
- School of Kinesiology and Rehabilitation Sciences, Division of Kinesiology, University of Central Florida, 12494 University Boulevard, Orlando, FL, 32816, USA
| | - John E Lawson
- School of Kinesiology and Rehabilitation Sciences, Division of Kinesiology, University of Central Florida, 12494 University Boulevard, Orlando, FL, 32816, USA
| | - Anuj J Prajapati
- School of Kinesiology and Rehabilitation Sciences, Division of Kinesiology, University of Central Florida, 12494 University Boulevard, Orlando, FL, 32816, USA
| | - Niriham M Shah
- School of Kinesiology and Rehabilitation Sciences, Division of Kinesiology, University of Central Florida, 12494 University Boulevard, Orlando, FL, 32816, USA
| | - Nihar N Patel
- School of Kinesiology and Rehabilitation Sciences, Division of Kinesiology, University of Central Florida, 12494 University Boulevard, Orlando, FL, 32816, USA
| | - Andrew M Guirgis
- School of Kinesiology and Rehabilitation Sciences, Division of Kinesiology, University of Central Florida, 12494 University Boulevard, Orlando, FL, 32816, USA
| | - Abner-Alexander Silverio
- School of Kinesiology and Rehabilitation Sciences, Division of Kinesiology, University of Central Florida, 12494 University Boulevard, Orlando, FL, 32816, USA
| | - Mason A Howard
- School of Kinesiology and Rehabilitation Sciences, Division of Kinesiology, University of Central Florida, 12494 University Boulevard, Orlando, FL, 32816, USA
| | - Hwan Choi
- College of Engineering, Mechanical and Aerospace, University of Central Florida, 4328 Scorpius St, Orlando, FL, 32816, USA
| | - Joshua L Keller
- College of Education and Professional Studies, University of South Alabama, 75 S University Blvd #3600, Mobile, AL, 36618, USA
- College of Medicine, Department of Physiology and Cell Biology, University of South Alabama, 5851 USA Dr. N, Mobile, AL, 36618, USA
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Yang K, Chee CS, Abdul Kahar J, Tengku Kamalden TF, Li R, Qian S. Effects of blood flow restriction training on physical fitness among athletes: a systematic review and meta-analysis. Sci Rep 2024; 14:16615. [PMID: 39025894 PMCID: PMC11258269 DOI: 10.1038/s41598-024-67181-9] [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: 12/05/2023] [Accepted: 07/09/2024] [Indexed: 07/20/2024] Open
Abstract
Blood flow restriction training (BFRT) is an effective, scientific and safe training method, but its effect on the overall quality of athletes remains unclear. The aim of this systematic review with meta-analysis was to clarify the effects of BFRT on the physical fitness among athletes. Based on the PRISMA guidelines, searches were performed in PubMed, Web of Science, SPORTDiscus, and SCOUPS, the Cochrane bias risk assessment tool was used to assess methodological quality, and RevMan 5.4 and STATA 15.0 software were used to analyze the data. A meta-analysis of 28 studies with a total sample size of 542 athletes aged 14-26 years and assessed as low risk for quality was performed. Our results revealed that the BFRT intervention had small to large improvements in the athletes' strength (ES = 0.74-1.03), power (ES = 0.46), speed (ES = 0.54), endurance (ES = 1.39-1.40), body composition (ES = 0.28-1.23), while there was no significant effect on body mass (p > 0.05). Subgroup analyses revealed that moderator variables (training duration, frequency, load, cuff pressure, and pressurization time) also had varying degrees of effect on athletes' physical fitness parameters. In conclusion, BFRT had a positive effect on the physical fitness parameters of the athletes, with significantly improved strength, power, speed, endurance and body composition, but not body mass parameters. When the training frequency ≥ 3 times/week, cuff pressure ≥ 160 mmHg, and pressurization time ≥ 10 min, the BFRT group was more favorable for the improvement of physical fitness parameters.
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Affiliation(s)
- Kun Yang
- Department of Sports Studies, Faculty of Educational Studies, Universiti Putra Malaysia, Selangor, Malaysia
| | - Chen Soon Chee
- Department of Sports Studies, Faculty of Educational Studies, Universiti Putra Malaysia, Selangor, Malaysia.
| | - Johan Abdul Kahar
- Department of Orthopedics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | | | - Rui Li
- Department of Sports Studies, Faculty of Educational Studies, Universiti Putra Malaysia, Selangor, Malaysia.
| | - Shaowen Qian
- Department of Physical Education, Wuhan Sports University, Wuhan, China
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Lisbôa FD, de Aguiar RA, Soares Pereira G, Caputo F. Acute Effects of a Practical Blood Flow Restriction Device During Swimming Exercise. RESEARCH QUARTERLY FOR EXERCISE AND SPORT 2024; 95:466-475. [PMID: 37851855 DOI: 10.1080/02701367.2023.2263050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 09/11/2023] [Indexed: 10/20/2023]
Abstract
Purpose: The present study aimed to analyze: 1) the reliability of the tissue saturation index (TSI) and ratings of perceived discomfort (RPD) responses wearing a neoprene practical cuff (PrC), comparing with the responses from traditional (TrC) pneumatic cuffs (study I); 2) the effects of PrC on metabolic (blood lactate concentration, BLC), perceptual (rate of perceived effort, RPE) and kinematic responses at sub-maximal swimming velocities (study II). Methods: Study I; 1) PrC test-retest at rest and during swimming ergometer exercise; 2) BFR at rest with TrC inflated to different percentages of the minimum arterial occlusion pressure (MAOP; 60, 80, 100, 120 and 140%). Test-retest reliability of TSI and RPD was assessed by the intraclass correlation coefficient (ICC) and comparisons among conditions were analyzed by one-way repeated-measures ANOVA. Study II; 1) 50, 200 and 400 m swimming performances; 2) sub-maximal incremental swimming protocol with and without PrC. Two-way repeated measures ANOVA was used to compare all variables during sub-maximal velocities. Results: TSI (ICC = 0.81; 95%CI 0.62-0.91) and RPD (ICC = 0.97; 95%CI 0.94-0.99) were reliable under restricted exercise using PrC. TSI during restricted exercise was lower (p <.001) compared to unrestricted exercise (6.8 ± 6.1% vs. 21.6 ± 8.2% of physiological normalization). PrC showed higher BLC only at or above 91% of critical velocity (p < .03), while stroke rate and RPE were higher (p < .005), and stroke length was lower (p < .03) during all swimming velocities. Conclusion: This easy-to-handle and affordable practical BFR device increased physiological stress at sub-maximal efforts which could be an additional training tool for swimmers.
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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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Kong W, Wang H, Cheng L, Ni G. Comparing the effect of intermittent blood flow restriction training and high-load resistance training in patients with patellofemoral pain: study protocol for a randomised trial. BMJ Open 2023; 13:e073188. [PMID: 37865415 PMCID: PMC10603463 DOI: 10.1136/bmjopen-2023-073188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 10/02/2023] [Indexed: 10/23/2023] Open
Abstract
BACKGROUND Patellofemoral pain (PFP) syndrome is a common knee joint functional disorder. Blood flow restriction (BFR) training has shown promise in improving PFP; however, the effectiveness of intermittent BFR (iBFR) training remains uncertain. This study aims to compare the rehabilitative effects of iBFR combined with low-load resistance training and high-load resistance training in PFP patients and to assess the effectiveness of iBFR combined with low-load resistance training for improving PFP. METHODS AND ANALYSIS This randomised, patient-assessor blinded, controlled trial will include 42 eligible PFP patients randomly allocated to an intervention group (iBFR combined with low-load resistance training) or a control group (high-load resistance training) in a 1:1 ratio. Participants will receive interventions three times per week for 8 weeks and will be followed up for 24 weeks. The primary outcome measure is pain, and the secondary outcomes include self-reported function, quality of life, muscle strength and muscle thickness. Assessments will be conducted at baseline, 8 weeks and 24 weeks during follow-up. Intention-to-treat analysis will be performed.Collectively, we expect that the findings of this randomised clinical trial will contribute to understanding the potential benefits of iBFR training and provide insightful guidance for developing more effective treatment strategies for patients with PFP. ETHICS AND DISSEMINATION This study was approved by the Sports Science Experiment Ethics Committee of Beijing Sport University (2022274H). Written informed consent will be obtained from all participants. Trial results will be disseminated through peer-reviewed publications. TRIAL REGISTRATION NUMBER Chinese Clinical Trial Registry (ChiCTR2300068281).
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Affiliation(s)
- Weiya Kong
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, China
| | - Haonan Wang
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, China
| | - Lin Cheng
- Department of Rehabilitation, Tongzhou District Hospital of Integrated Chinese and Western Medicine, Beijing, China
| | - Guoxin Ni
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian, China
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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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Parkington T, Maden-Wilkinson T, Klonizakis M, Broom D. Comparative Perceptual, Affective, and Cardiovascular Responses between Resistance Exercise with and without Blood Flow Restriction in Older Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16000. [PMID: 36498075 PMCID: PMC9737453 DOI: 10.3390/ijerph192316000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/20/2022] [Accepted: 11/27/2022] [Indexed: 06/17/2023]
Abstract
Older adults and patients with chronic disease presenting with muscle weakness or musculoskeletal disorders may benefit from low-load resistance exercise (LLRE) with blood flow restriction (BFR). LLRE-BFR has been shown to increase muscle size, strength, and endurance comparable to traditional resistance exercise but without the use of heavy loads. However, potential negative effects from LLRE-BFR present as a barrier to participation and limit its wider use. This study examined the perceptual, affective, and cardiovascular responses to a bout of LLRE-BFR and compared the responses to LLRE and moderate-load resistance exercise (MLRE). Twenty older adults (64.3 ± 4.2 years) performed LLRE-BFR, LLRE and MLRE consisting of 4 sets of leg press and knee extension, in a randomised crossover design. LLRE-BFR was more demanding than LLRE and MLRE through increased pain (p ≤ 0.024, d = 0.8-1.4) and reduced affect (p ≤ 0.048, d = -0.5--0.9). Despite this, LLRE-BFR was enjoyed and promoted a positive affective response (p ≤ 0.035, d = 0.5-0.9) following exercise comparable to MLRE. This study supports the use of LLRE-BFR for older adults and encourages future research to examine the safety, acceptability, and efficacy of LLRE-BFR in patients with chronic disease.
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Affiliation(s)
- Thomas Parkington
- Physical Activity, Wellness and Public Health Research Group, Department of Sport and Physical Activity, Sheffield Hallam University, Sheffield S1 1WB, UK
- Lifestyle, Exercise and Nutrition Improvement Research Group, Department of Nursing and Midwifery, Sheffield Hallam University, Sheffield S1 1WB, UK
| | - Thomas Maden-Wilkinson
- Physical Activity, Wellness and Public Health Research Group, Department of Sport and Physical Activity, Sheffield Hallam University, Sheffield S1 1WB, UK
| | - Markos Klonizakis
- Lifestyle, Exercise and Nutrition Improvement Research Group, Department of Nursing and Midwifery, Sheffield Hallam University, Sheffield S1 1WB, UK
| | - David Broom
- Centre for Sport, Exercise and Life Sciences, Coventry University, Coventry CV1 5FB, UK
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10
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Watson R, Sullivan B, Stone A, Jacobs C, Malone T, Heebner N, Noehren B. Blood Flow Restriction Therapy: An Evidence-Based Approach to Postoperative Rehabilitation. JBJS Rev 2022; 10:01874474-202210000-00001. [PMID: 36191086 DOI: 10.2106/jbjs.rvw.22.00062] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
➢ Blood flow restriction therapy (BFRT) involves the application of a pneumatic tourniquet cuff to the proximal portion of the arm or leg. This restricts arterial blood flow while occluding venous return, which creates a hypoxic environment that induces many physiologic adaptations. ➢ BFRT is especially useful in postoperative rehabilitation because it produces muscular hypertrophy and strength gains without the need for heavy-load exercises that are contraindicated after surgery. ➢ Low-load resistance training with BFRT may be preferable to low-load or high-load training alone because it leads to comparable increases in strength and hypertrophy, without inducing muscular edema or increasing pain.
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Affiliation(s)
- Richard Watson
- University of Kentucky, Department of Physical Therapy, Lexington, Kentucky
| | - Breanna Sullivan
- University of Kentucky, Department of Orthopaedic Surgery and Sports Medicine, Lexington, Kentucky
| | - Austin Stone
- University of Kentucky, Department of Orthopaedic Surgery and Sports Medicine, Lexington, Kentucky
| | - Cale Jacobs
- University of Kentucky, Department of Orthopaedic Surgery and Sports Medicine, Lexington, Kentucky
| | - Terry Malone
- University of Kentucky, Department of Physical Therapy, Lexington, Kentucky
| | - Nicholas Heebner
- University of Kentucky, Sports Medicine Research Institute, Lexington, Kentucky
| | - Brian Noehren
- University of Kentucky, Department of Physical Therapy, Lexington, Kentucky
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11
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Das A, Paton B. Is There a Minimum Effective Dose for Vascular Occlusion During Blood Flow Restriction Training? Front Physiol 2022; 13:838115. [PMID: 35464074 PMCID: PMC9024204 DOI: 10.3389/fphys.2022.838115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 02/22/2022] [Indexed: 11/20/2022] Open
Abstract
Background Blood flow restriction (BFR) training at lower exercise intensities has a range of applications, allowing subjects to achieve strength and hypertrophy gains matching those training at high intensity. However, there is no clear consensus on the percentage of limb occlusion pressure [%LOP, expressed as a % of the pressure required to occlude systolic blood pressure (SBP)] and percentage of one repetition max weight (%1RM) required to achieve these results. This review aims to explore what the optimal and minimal combination of LOP and 1RM is for significant results using BFR. Method A literature search using PubMed, Scopus, Wiley Online, Springer Link, and relevant citations from review papers was performed, and articles assessed for suitability. Original studies using BFR with a resistance training exercise intervention, who chose a set %LOP and %1RM and compared to a non-BFR control were included in this review. Result Twenty-one studies met the inclusion criteria. %LOP ranged from 40 to 150%. %1RM used ranged from 15 to 80%. Training at 1RM ≤20%, or ≥ 80% did not produce significant strength results compared to controls. Applying %LOP of ≤50% and ≥ 80% did not produce significant strength improvement compared to controls. This may be due to a mechanism mediated by lactate accumulation, which is facilitated by increased training volume and a moderate exercise intensity. Conclusion Training at a minimum of 30 %1RM with BFR is required for strength gains matching non-BFR high intensity training. Moderate intensity training (40-60%1RM) with BFR may produce results exceeding non-BFR high intensity however the literature is sparse. A %LOP of 50-80% is optimal for BFR training.
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Affiliation(s)
- Arpan Das
- Institute of Sports, Exercise and Health, Department of Medical Sciences, University College of London, London, United Kingdom
| | - Bruce Paton
- Institute of Sports, Exercise and Health, Department of Medical Sciences, University College of London, London, United Kingdom
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12
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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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13
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Jarosz J, Trybulski R, Krzysztofik M, Tsoukos A, Filip-Stachnik A, Zajac A, Bogdanis GC, Wilk M. The Effects of Ischemia During Rest Intervals on Bar Velocity in the Bench Press Exercise With Different External Loads. Front Physiol 2021; 12:715096. [PMID: 34447318 PMCID: PMC8383203 DOI: 10.3389/fphys.2021.715096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 07/22/2021] [Indexed: 11/13/2022] Open
Abstract
The main aim of the present study was to evaluate the acute effects of ischemia used during rest periods on bar velocity changes during the bench press exercise at progressive loads, from 20 to 90% of 1RM. Ten healthy resistance trained men volunteered for the study (age = 26.3 ± 4.7 years; body mass = 89.8 ± 6.3 kg; bench press 1RM = 142.5 ± 16.9 kg; training experience = 7.8 ± 2.7 years). During the experimental sessions the subjects performed the bench press exercise under two different conditions, in a randomized and counterbalanced order: (a) ischemia condition, with ischemia applied before the first set and during every rest periods between sets, and (b) control condition where no ischemia was applied. During each experimental session eight sets of the bench press exercise were performed, against loads starting from 20 to 90% 1RM, increased progressively by 10% in each subsequent set. A 3-min rest interval between sets was used. For ischemia condition the cuffs was applied 3 min before the first set and during every rest period between sets. Ischemia was released during exercise. The cuff pressure was set to ∼80% of full arterial occlusion pressure. The two-way repeated measures ANOVA showed a statistically significant interaction effect for peak bar velocity (p = 0.04) and for mean bar velocity (p = 0.01). There was also a statistically significant main effect of condition for peak bar velocity (p < 0.01) but not for mean bar velocity (p = 0.25). The post hoc analysis for interaction showed significantly higher peak bar velocity for the ischemia condition compared to control at a load of 20% 1RM (p = 0.007) and at a load of 50% 1RM (p = 0.006). The results of the present study indicate that ischemia used before each set even for a brief duration of <3 min, has positive effects on peak bar velocity at light loads, but it is insufficient to induce such effect on higher loads.
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Affiliation(s)
- Jakub Jarosz
- Institute of Sport Sciences, Jerzy Kukuczka Academy of Physical Education in Katowice, Katowice, Poland
| | - Robert Trybulski
- Department of Medical Sciences, The Wojciech Korfanty School of Economics, Katowice, Poland.,Provita Zory Medical Center, Zory, Poland
| | - Michał Krzysztofik
- Institute of Sport Sciences, Jerzy Kukuczka Academy of Physical Education in Katowice, Katowice, Poland
| | - Athanasios Tsoukos
- School of Physical Education and Sport Science, National and Kapodistrian University of Athens, Athens, Greece
| | - Aleksandra Filip-Stachnik
- Institute of Sport Sciences, Jerzy Kukuczka Academy of Physical Education in Katowice, Katowice, Poland
| | - Adam Zajac
- Institute of Sport Sciences, Jerzy Kukuczka Academy of Physical Education in Katowice, Katowice, Poland
| | - Gregory C Bogdanis
- School of Physical Education and Sport Science, National and Kapodistrian University of Athens, Athens, Greece
| | - Michal Wilk
- Institute of Sport Sciences, Jerzy Kukuczka Academy of Physical Education in Katowice, Katowice, Poland
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14
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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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15
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Schwiete C, Franz A, Roth C, Behringer M. Effects of Resting vs. Continuous Blood-Flow Restriction-Training on Strength, Fatigue Resistance, Muscle Thickness, and Perceived Discomfort. Front Physiol 2021; 12:663665. [PMID: 33859576 PMCID: PMC8042206 DOI: 10.3389/fphys.2021.663665] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 03/12/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: The purpose of this study was to clarify whether blood-flow restriction during resting intervals [resting blood-flow restriction (rBFR)] is comparable to a continuous BFR (cBFR) training regarding its effects on maximum strength, hypertrophy, fatigue resistance, and perceived discomfort. Materials and Methods: Nineteen recreationally trained participants performed four sets (30-15-15-15 repetitions) with 20% 1RM on a 45° leg press twice a week for 6 weeks (cBFR, n = 10; rBFR, n = 9). Maximum strength, fatigue resistance, muscle thickness, and girth were assessed at three timepoints (pre, mid, and post). Subjective pain and perceived exertion were determined immediately after training at two timepoints (mid and post). Results: Maximum strength (p < 0.001), fatigue resistance (p < 0.001), muscle thickness (p < 0.001), and girth (p = 0.008) increased in both groups over time with no differences between groups (p > 0.05). During the intervention, the rBFR group exposed significantly lower perceived pain and exertion values compared to cBFR (p < 0.05). Discussion: Resting blood-flow restriction training led to similar gains in strength, fatigue resistance, and muscle hypertrophy as cBFR training while provoking less discomfort and perceived exertion in participants. In summary, rBFR training could provide a meaningful alternative to cBFR as this study showed similar functional and structural changes as well as less discomfort.
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Affiliation(s)
- Carsten Schwiete
- Department of Sports Medicine and Exercise Physiology, Institute of Sports Sciences, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Alexander Franz
- Department of Adult Reconstruction, ATOS Orthoparc Clinic Cologne, Cologne, Germany
| | - Christian Roth
- Department of Sports Medicine and Exercise Physiology, Institute of Sports Sciences, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Michael Behringer
- Department of Sports Medicine and Exercise Physiology, Institute of Sports Sciences, Goethe University Frankfurt, Frankfurt am Main, Germany
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16
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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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17
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The perceptual responses of individuals with multiple sclerosis to blood flow restriction versus traditional resistance exercise. Physiol Behav 2021; 229:113219. [PMID: 33250152 DOI: 10.1016/j.physbeh.2020.113219] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/22/2020] [Accepted: 10/23/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Low-load resistance exercise with blood flow restriction (LLBFR-RE) has been shown capable of improving neuromuscular parameters in several clinical populations, however, its tolerability and effects on individuals with multiple sclerosis (MS) remains unknown. OBJECTIVE To investigate the perceptual responses of individuals with MS to LLBFR-RE versus traditional high-load resistance exercise (HL-RE). METHODS Four men and eleven women diagnosed with relapsing-remitting MS randomly completed the following experimental trials: 1) LLBFR-RE four sets of 30-15-15-15 repetitions, at 20% of one-repetition maximum (1-RM) of leg-press (LP) and knee-extension (KE), with 50% of BFR, and a 1-min rest interval between sets; 2) HL-RE- four sets of 8-10 repetitions, at 70% 1-RM of LP and KE, with the same rest intervals. Ratings of perceived exertion (RPE) were measured after each set, pain was measured before and after sets, and delayed-onset muscle soreness (DOMS) was measured at 5, 30, 60 min, and 24-h post-exercise. RESULTS HL-RE elicited significantly (p<0.05) greater RPE compared to LLBFR-RE during all sets. Additionally, there were no significant (p>0.05) differences between LLBFR-RE and HL-RE for pain immediately after all sets, although pain measured before sets were significantly (p<0.05) greater for LLBFR-RE. Finally, both protocols resulted in similar DOMS, however, it was significantly (p<0.05) elevated 24-h post-exercise compared to 1-h after for HL-RE but not for LLBFR-RE. CONCLUSION Altogether, these data demonstrate that LLBFR-RE is well tolerated by individuals with MS, requires less muscular exertion than HL-RE, and does not cause exaggerated pain during exercise or elevated DOMS up to 24 h post-exercise.
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18
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Rolnick N, Schoenfeld BJ. Blood Flow Restriction Training and the Physique Athlete: A Practical Research-Based Guide to Maximizing Muscle Size. Strength Cond J 2020. [DOI: 10.1519/ssc.0000000000000553] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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19
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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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20
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Ferreira-Júnior JB, Freitas EDS, Chaves SFN. Exercise: A Protective Measure or an "Open Window" for COVID-19? A Mini Review. Front Sports Act Living 2020; 2:61. [PMID: 33345052 PMCID: PMC7739719 DOI: 10.3389/fspor.2020.00061] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 04/29/2020] [Indexed: 12/13/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) has spread to at least 115 countries and caused an alarming number of deaths. The current outbreak has lead authorities from many countries to adopt several protective measures, including lockdown and social distancing. Although being a reasonable measure to counteract the COVID-19 contamination, the restrictive measures have limited individual's ability to perform exercise outdoors or in gyms and similar facilities, thus raising the risks for chronic health conditions related to a sedentary lifestyle. The recent exercise recommendations to counteract the potential deleterious effects of COVID-19-related lockdown have not fully addressed resistance exercise interventions as potential home-based exercise strategies. Additionally, the following questions have been constantly raised: (1) Is training status capable of protecting an individual from COVID-19 infection?; and (2) Can a single endurance or resistance exercise session acutely increase the risks for COVID-19 infection? Therefore, the current mini review aimed to focus on these two concerns, as well as to discuss the potential use of practical blood flow restriction and no load resistance training as possible resistance exercise strategies that could be performed during the current COVID-19 pandemic.
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Affiliation(s)
| | - Eduardo D. S. Freitas
- Neuromuscular Laboratory, Department of Health and Exercise Science, University of Oklahoma, Norman, OK, United States
| | - Suene F. N. Chaves
- Department of Sports, Federal University of Minas Gerais, Belo Horizonte, Brazil
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21
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Freitas EDS, Miller RM, Heishman AD, Ferreira-Júnior JB, Araújo JP, Bemben MG. Acute Physiological Responses to Resistance Exercise With Continuous Versus Intermittent Blood Flow Restriction: A Randomized Controlled Trial. Front Physiol 2020; 11:132. [PMID: 32256374 PMCID: PMC7090220 DOI: 10.3389/fphys.2020.00132] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 02/06/2020] [Indexed: 11/13/2022] Open
Abstract
The primary goal of this investigation was to examine the physiological responses of blood flow restriction (BFR) resistance exercise (RE) performed with continuous or intermittent BFR and to compare these results to those from conventional high- and low-load RE without BFR. Fourteen men randomly completed the following experimental trials: (1) low-load RE with continuous BFR (cBFR), (2) low-load RE with intermittent BFR (iBFR), (3) low-load RE without BFR (LI), and (4) conventional high-load RE without BFR (HI). For the cBFR, iBFR, and LI exercise trials, participants performed four sets of 30-15-15-15 repetitions of the bilateral leg press (LP) and knee extension (KE) exercises, at an intensity of 20% of their one-repetition maximum (1-RM), at a 1.5-s contraction speed, and with a 1-min rest period between sets. The only difference between the cBFR and iBFR protocols was that the pressure of the cuffs was released during the rest intervals between sets for the iBFR trial. For the HI trial, participants completed four sets of 10 repetitions of the same exercises, at 70% of 1-RM, with a 1-min rest period between sets, and at the same contraction speed. Muscle activity was assessed during each set using superficial electromyography, as well as changes in blood lactate concentration [La-] from baseline at 5 min post exercise and in muscle swelling and plasma volume (%ΔPV) at 5 and 15 min post exercise. There were no significant differences in muscle activity (p < 0.05) across the cBFR, iBFR, and LI protocols at any time point, whereas they were all significantly lower than HI. There were also no significant (p < 0.05) differences across the three low-load RE conditions for [La-],%ΔPV, or muscle swelling. HI elicited significantly (p < 0.05) greater responses than cBFR, iBFR, and LI for all the physiological markers measured. In conclusion, RE combined with cBFR or iBFR induce the same acute physiological responses. However, the largest physiological responses are observed with HI, probably because of the significantly greater exercise volumes. Therefore, releasing the pressure of the restrictive cuffs during the rest periods between sets will not hinder the acute physiological responses from BFR RE.
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Affiliation(s)
- Eduardo D S Freitas
- Neuromuscular Laboratory, Department of Health and Exercise Science, University of Oklahoma, Norman, OK, United States
| | - Ryan M Miller
- Neuromuscular Laboratory, Department of Health and Exercise Science, University of Oklahoma, Norman, OK, United States
| | - Aaron D Heishman
- Neuromuscular Laboratory, Department of Health and Exercise Science, University of Oklahoma, Norman, OK, United States
| | - João B Ferreira-Júnior
- Kinanthropometry and Human Performance Laboratory, Federal Institute of Sudeste of Minas Gerais, Rio Pomba, Brazil
| | - Joamira P Araújo
- Kinanthropometry and Human Performance Laboratory, Department of Physical Education, Federal University of Paraíba, João Pessoa, Brazil
| | - Michael G Bemben
- Neuromuscular Laboratory, Department of Health and Exercise Science, University of Oklahoma, Norman, OK, United States
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