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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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Mañago MM, Will R, Strahler T, Van Valkenburgh L, Harris-Love MO, Forster JE, Cameron M, Christiansen CL. Blood Flow Restriction and Veterans With Multiple Sclerosis and Advanced Disability: Protocol for a Randomized Controlled Trial. Phys Ther 2024; 104:pzae037. [PMID: 38452199 DOI: 10.1093/ptj/pzae037] [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: 11/20/2023] [Accepted: 03/06/2024] [Indexed: 03/09/2024]
Abstract
OBJECTIVE The purpose of this study will be to determine the efficacy of low intensity lower extremity resistance training with and without blood flow restriction (BFR) on quadriceps muscle strength and thickness in veterans with advanced multiple sclerosis (MS). METHODS This will be an assessor-blinded, 2-group (1 to 1 allocation) randomized controlled trial targeting an enrollment of 58 participants with advanced MS as defined by Patient-Determined Disease Steps scale levels 4 to 7. Both groups will complete 10 weeks of twice weekly low-load resistance training (20%-30% of 1-repetition max) targeting knee and hip extension, knee flexion, and ankle plantarflexion. The intervention group will perform all training using BFR, with limb occlusion pressures between 60% and 80% of maximal limb occlusion pressure. Primary outcomes will be quadriceps muscle strength and thickness. Secondary outcomes will include knee flexion and ankle plantarflexion strength, functional mobility, physical activity, and patient-reported measures. All outcomes will be assessed at baseline before the intervention, immediately after the intervention, and at a 2-month follow-up assessment. The change between groups postintervention and after the 2-month follow-up will be reported for all outcomes. All analyses will assume a 2-sided test of hypothesis (α = .05). IMPACT There is very little evidence for the efficacy of exercise interventions in people with MS who have advanced mobility disability. Resistance training with BFR may be an important approach for people with advanced MS who may not tolerate more conventional, moderate-to-high intensity resistance training. The results of this study will inform clinicians regarding exercise decisions for people with advanced MS and future investigations on the role of BFR in people with MS.
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Affiliation(s)
- Mark M Mañago
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA
- Department of Neurology, School of Medicine, University of Colorado, Aurora, Colorado, USA
- Department of Research, VA Eastern Colorado Healthcare System, Aurora, Colorado, USA
| | - Robert Will
- Department of Neurology, School of Medicine, University of Colorado, Aurora, Colorado, USA
- Department of Research, VA Eastern Colorado Healthcare System, Aurora, Colorado, USA
| | - Talia Strahler
- Department of Neurology, School of Medicine, University of Colorado, Aurora, Colorado, USA
- Department of Research, VA Eastern Colorado Healthcare System, Aurora, Colorado, USA
| | - Lauren Van Valkenburgh
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA
- Department of Research, VA Eastern Colorado Healthcare System, Aurora, Colorado, USA
| | - Michael O Harris-Love
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA
- Department of Research, VA Eastern Colorado Healthcare System, Aurora, Colorado, USA
| | - Jeri E Forster
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center, Data and Statistical Core, Aurora, Colorado, USA
| | - Michelle Cameron
- Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Cory L Christiansen
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA
- Department of Research, VA Eastern Colorado Healthcare System, Aurora, Colorado, USA
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Ahmed I, Mustafaoglu R, Erhan B. The effects of low-intensity resistance training with blood flow restriction versus traditional resistance exercise on lower extremity muscle strength and motor functionin ischemic stroke survivors: a randomized controlled trial. Top Stroke Rehabil 2024; 31:418-429. [PMID: 37724785 DOI: 10.1080/10749357.2023.2259170] [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: 06/21/2023] [Accepted: 09/09/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Blood flow restriction (BFR) training can temporarily reduce cortical GABA concentrations and increase the size of motor volleys to deafferented muscles, which can promote motor recovery in stroke survivors. OBJECTIVE To determine the effect of low-intensity resistance training with BFR (LIRT-BFR) on lower extremity muscle strength, balance, functional mobility, walking capacity, gait speed, anxiety, and depression in stroke survivors and to compare the results with high-intensity resistance training (HIRT). METHOD It was a two-arm, single-blinded, randomized controlled trial in which 32 ischemic stroke participants were randomly allocated to LIRT-BFR or HIRT group. The LIRT-BFR group received low load resistance training (40% of 1-Repetition Maximum (1-RM)) with BFR, whereas HIRT group received high load resistance training (80% of 1-RM). The 6-Minute Walk Test (6-MWT), five-time sit-to-stand test (5TSTST), Timed Up and Go (TUG) test, and Barthel index were the primary outcome measures. The secondary outcome measures included gait speed (m/s), stride length (cm), cadence (steps/min), and Hospital Anxiety and Depression. RESULTS All the primary and secondary outcome measures were significantly improved in both groups (p < 0.05). The LIRT-BFR group showed a slightly greater, but non-significant, improvement as compared to the HIRT group in terms of mean change observed in 6-MWT (81 m vs 62 m), 5TSTST (-5.27 vs -4.81), gait speed (0.19 vs 0.12), stride length (18 vs 13), and cadence (8 vs 6). No adverse event was reported. CONCLUSION LIRT-BFR produced a significant improvement in muscle strength, balance, walking capacity, and anxiety and depression in ischemic stroke patients, and the improvement are comparable to HIRT. CLINICAL TRIAL REGISTRATION NCT05281679.
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Affiliation(s)
- Ishtiaq Ahmed
- Department of Physiotherapy and Rehabilitation, Institute of Graduate Studies, Istanbul University-Cerrahpasa, Istanbul, Turkiye
- Pain in Motion International Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Rustem Mustafaoglu
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Istanbul University-Cerrahpasa, Istanbul, Turkiye
| | - Belgin Erhan
- Department of Physical Medicine and Rehabilitation, Istanbul Medeniyet University Faculty of Medicine, Istanbul, Turkiye
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Swink LA, Thornton WA, Nearing KA, Manago MM. A qualitative study of low-load resistance training with blood flow restriction in people with advanced multiple sclerosis. Physiother Theory Pract 2024:1-10. [PMID: 38616662 DOI: 10.1080/09593985.2024.2341993] [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: 10/14/2023] [Accepted: 04/01/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND Blood flow restriction (BFR) combined with low-load resistance training could minimize exercise barriers and offer strength and mobility improvements for people with advanced Multiple Sclerosis (MS); but patient experience has not been evaluated. PURPOSE The purpose of this study was to assess the satisfaction, acceptability, and impact of combining low-load resistance training with BFR for individuals with advanced MS (Expanded Disability Status Scale: EDSS 6.0-7.0). METHODS We used an interpretive phenomenological research design and post-intervention interviews to explore participant experiences of a novel low-load resistance training program with BFR. RESULTS Interview participants (n = 14) were 55.4 ± 6.2 years old and were diagnosed with MS for 19.1 ± 10.7 years. Four themes were identified (satisfaction, acceptability, impact, program refinement) with 14 subthemes. Satisfaction was mixed based on overall expectations, yet all participants recommended the intervention. Acceptability was evidenced by all participants identifying comfortable/easy aspects, and modifiable elements that could improve comfort. Impact was evidenced with translation to everyday life activities, strength/self-efficacy/psychological improvements, effectiveness, and fatigue reduction. CONCLUSIONS Participants found BFR combined with low-load resistance training to be satisfactory (mixed initial expectations), acceptable (comfortable/easy), and impactful (translating to life improvements). Areas for program refinement were identified that should be targeted in future iterations.
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Affiliation(s)
- Laura A Swink
- Research Department, Eastern Colorado Veterans Administration, Aurora, CO
- Department of Occupational Therapy, Colorado State University, Fort Collins, Colorado, USA
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Wesley A Thornton
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Kathryn A Nearing
- Division of Geriatric Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Geriatric Research Education and Clinical Center (GRECC), Eastern Colorado Veterans Administration, Aurora, Colorado, USA
| | - Mark M Manago
- Research Department, Eastern Colorado Veterans Administration, Aurora, CO
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Brown AJ, Rachal Sant L. Blood flow restriction training for an individual with relapsing-remitting multiple sclerosis: a case report. Physiother Theory Pract 2024; 40:161-169. [PMID: 35854431 DOI: 10.1080/09593985.2022.2100848] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 07/05/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND AND PURPOSE Individuals with Multiple Sclerosis (MS) often present with weakness, poor balance, and increased fatigue that affects physical function. Blood flow restriction training (BFRt) is a popular treatment method to improve strength in orthopedic patients. However, research is limited on the use of BFRt for individuals with MS. This case report describes the effects of BFRt for an individual with relapsing-remitting MS (RRMS). CASE DESCRIPTION A 30-year-old female with RRMS presented to physical therapy (PT) with weakness and balance difficulty. Initial PT interventions were ineffective at improving balance and strength to achieve specific functional standing and balance goals. BFRt was introduced at reevaluation and performed 2×/week for 8 weeks. Activities-specific Balance Confidence Scale, Modified Fatigue Impact Scale, Berg Balance, strength, and 10-meter walk were assessed at 4 and 8 weeks. OUTCOMES Measures of strength and balance improved with the addition of BFRt and no adverse events occurred. The addition of BFRt resulted in a meaningful improvement in the individual's ability to achieve her standing and balance goals. DISCUSSION This case report describes the successful application of BFRt to improve function in an individual with RRMS. Further research is warranted for the use of BFRt for individuals with MS.
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Affiliation(s)
- April J Brown
- Physical Therapy, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Lauren Rachal Sant
- Physical Therapy, Louisiana State University Health Sciences Center, Shreveport, LA, USA
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Jønsson AB, Krogh S, Laursen HS, Aagaard P, Kasch H, Nielsen JF. Safety and efficacy of blood flow restriction exercise in individuals with neurological disorders: A systematic review. Scand J Med Sci Sports 2024; 34:e14561. [PMID: 38268066 DOI: 10.1111/sms.14561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/02/2024] [Accepted: 01/03/2024] [Indexed: 01/26/2024]
Abstract
OBJECTIVES This systematic review evaluated the safety and efficacy of blood flow restriction exercise (BFRE) on skeletal muscle size, strength, and functional performance in individuals with neurological disorders (ND). METHODS A literature search was performed in PubMed, CINAHL, and Embase. Two researchers independently assessed eligibility and performed data extraction and quality assessments. ELIGIBILITY CRITERIA Study populations with ND, BFRE as intervention modality, outcome measures related to safety or efficacy. RESULTS Out of 443 studies identified, 16 were deemed eligible for review. Three studies examined the efficacy and safety of BFRE, one study focused on efficacy results, and 12 studies investigated safety. Disease populations included spinal cord injury (SCI), inclusion body myositis (sIBM), multiple sclerosis (MS), Parkinson's disease (PD), and stroke. A moderate-to-high risk of bias was presented in the quality assessment. Five studies reported safety concerns, including acutely elevated pain and rating of perceived exertion levels, severe fatigue, muscle soreness, and cases of autonomic dysreflexia. Two RCTs reported a significant between-group difference in physical function outcomes, and two RCTs reported neuromuscular adaptations. CONCLUSION BFRE seems to be a potentially safe and effective training modality in individuals with ND. However, the results should be interpreted cautiously due to limited quality and number of studies, small sample sizes, and a general lack of heterogeneity within and between the examined patient cohorts.
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Affiliation(s)
- Anette Bach Jønsson
- Spinal Cord Injury Center of Western Denmark, Viborg, Denmark
- Department of Clinical Medicine, Health, Aarhus University, Aarhus N, Denmark
| | - Søren Krogh
- Spinal Cord Injury Center of Western Denmark, Viborg, Denmark
- Department of Clinical Medicine, Health, Aarhus University, Aarhus N, Denmark
| | | | - Per Aagaard
- Institute of Sports Science and Clinical Biomechanics, Muscle Physiology and Biomechanics Research Unit, University of Southern, Odense, Denmark
| | - Helge Kasch
- Department of Clinical Medicine, Health, Aarhus University, Aarhus N, Denmark
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Jørgen Feldbaek Nielsen
- Spinal Cord Injury Center of Western Denmark, Viborg, Denmark
- Department of Clinical Medicine, Health, Aarhus University, Aarhus N, Denmark
- Hammel Neurorehabilitation Centre and University Clinic, Hammel, Denmark
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Mañago MM, Cohen ET, Alvarez E, Hager ER, Owens JG, Bade M. Feasibility of Low-Load Resistance Training Using Blood Flow Restriction for People With Advanced Multiple Sclerosis: A Prospective Cohort Study. Phys Ther 2024; 104:pzad135. [PMID: 37815934 PMCID: PMC10822774 DOI: 10.1093/ptj/pzad135] [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: 01/10/2023] [Revised: 06/03/2023] [Accepted: 08/05/2023] [Indexed: 10/12/2023]
Abstract
OBJECTIVE The objective of this study was to determine the feasibility of low-load resistance training with blood flow restriction (BFR) for people with advanced disability due to multiple sclerosis (MS). METHODS In this prospective cohort study, 14 participants with MS (Expanded Disability Status Scale [EDSS] score = 6.0 to 7.0; mean age = 55.4 [SD = 6.2] years; 71% women) were asked to perform 3 lower extremity resistance exercises (leg press, calf press, and hip abduction) bilaterally twice weekly for 8 weeks using BFR. Feasibility criteria were as follows: enrollment of 20 participants, ≥80% retention and adherence, ≥90% satisfaction, and no serious adverse events related to the intervention. Other outcomes included knee extensor, ankle plantar flexor, and hip abductor muscle strength, 30-Second Sit-to-Stand Test, Berg Balance Scale, Timed 25-Foot Walk Test, 12-Item MS Walking Scale, Modified Fatigue Impact Scale, Patient-Specific Functional Scale, and daily step count. RESULTS Sixteen participants consented, and 14 completed the intervention, with 93% adherence overall. All participants were satisfied with the intervention. A minor hip muscle strain was the only intervention-related adverse event. There were muscle strength improvements on the more-involved (16%-28%) and less-involved (12%-19%) sides. There were also changes in the 30-Second Sit-to-Stand Test (1.9 repetitions; 95% CI = 1.0 to 2.8), Berg Balance Scale (5.3 points; 95% CI = 3.2 to 7.4), Timed 25-Foot Walk Test (-3.3 seconds; 95% CI = -7.9 to 1.3), Modified Fatigue Impact Scale (-8.8 points; 95% CI = -16.5 to -1.1), 12-Item MS Walking Scale (-3.6 points; 95% CI = -11.5 to 4.4), Patient-Specific Functional Scale (2.9 points; 95% CI = 1.9 to 3.8), and daily step count (333 steps; 95% CI = -191 to 857). CONCLUSION Low-load resistance training using BFR in people with MS and EDSS scores of 6.0 to 7.0 appears feasible, and subsequent investigation into its efficacy is warranted. IMPACT Although efficacy data are needed, combining BFR with low-load resistance training may be a viable alternative for people who have MS and who do not tolerate conventional moderate- to high-intensity training because of more severe symptoms, such as fatigue and weakness. LAY SUMMARY Low-load strength training with BFR was feasible in people who have advanced disability due to MS. Using BFR may provide an alternative for people with MS who do not tolerate higher intensity training due to more severe symptoms, such as fatigue and weakness.
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Affiliation(s)
- Mark M Mañago
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Neurology, School of Medicine, University of Colorado, Aurora, Colorado, USA
- VA Eastern Colorado Healthcare System, Aurora, Colorado, USA
| | - Evan T Cohen
- Department of Physical Therapy, Arcadia University, Glenside, Pennsylvania, USA
| | - Enrique Alvarez
- Department of Neurology, School of Medicine, University of Colorado, Aurora, Colorado, USA
| | - Emily R Hager
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- VA Eastern Colorado Healthcare System, Aurora, Colorado, USA
| | | | - Michael Bade
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- VA Eastern Colorado Healthcare System, Aurora, Colorado, USA
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Vinolo-Gil MJ, Rodríguez-Huguet M, Martin-Vega FJ, Garcia-Munoz C, Lagares-Franco C, Garcia-Campanario I. Effectiveness of Blood Flow Restriction in Neurological Disorders: A Systematic Review. Healthcare (Basel) 2022; 10:2407. [PMID: 36553931 PMCID: PMC9778162 DOI: 10.3390/healthcare10122407] [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] [Revised: 11/02/2022] [Accepted: 11/23/2022] [Indexed: 12/03/2022] Open
Abstract
There is scientific evidence that Blood Flow Restriction (BFR) is beneficial in healthy people, the elderly and patients with musculoskeletal disorders. A systematic review was conducted to evaluate the effectiveness of BFR in patients with neurological disorders. The literature search was conducted up until July 2022 in the following databases: PubMed, Web of Science (WOS), Physiotherapy Evidence Database (PEDro), LILACS, Scopus, Cumulative Index of Nursing and Allied Literature Complete (CINAHL), the Cochrane Library and Scientific Electronic Library Online (SciELO). The PEDro scale was used to analyze the methodological quality of the studies, and the Cochrane Collaboration's tool was employed to evaluate the risk of bias. A total of seven articles were included. BFR seems to be beneficial in neurological disorders. Improvements have been found in sensorimotor function, frequency and step length symmetry, perceived exertion, heart rate and gait speed, walking endurance, fatigue, quality of life, muscles thickness, gluteus density and muscle edema. No improvements were found in lower limb strength or balance. However, results must be taken with caution due to the small number of articles and to the large heterogeneity. More clinical trials are needed. These studies should homogenize the protocols used in larger samples, as well as improve their methodological quality.
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Affiliation(s)
- Maria Jesus Vinolo-Gil
- Department of Nursing and Physiotherapy, University of Cadiz, 11009 Cadiz, Spain
- Institute for Biomedical Research and Innovation of Cádiz, 11009 Cadiz, Spain
- Rehabilitation Clinical Management Unit, Interlevels-Intercenters Hospital Puerta del Mar, Hospital Puerto Real, Cadiz Bay-La Janda Health District, 11006 Cadiz, Spain
| | | | | | | | - Carolina Lagares-Franco
- Department of Statistics and Operations Research, University of Cadiz, 11510 Cadiz, Spain
- PAIDI UCA Group: CTS553, INiBICA Group CO15 Population and Health, Determinants and Interventions, Faculty of Medicine, University of Cadiz, 11003 Cadiz, Spain
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Effect of Low-Intensity Aerobic Training Combined with Blood Flow Restriction on Body Composition, Physical Fitness, and Vascular Responses in Recreational Runners. Healthcare (Basel) 2022; 10:healthcare10091789. [PMID: 36141401 PMCID: PMC9499162 DOI: 10.3390/healthcare10091789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 09/12/2022] [Accepted: 09/15/2022] [Indexed: 11/17/2022] Open
Abstract
This study investigated the effect of low-intensity aerobic training combined with blood flow restriction (LABFR) on body composition, physical fitness, and vascular functions in recreational runners. The participants were 30 healthy male recreational runners, randomized between the LABFR (n = 15) and control (n = 15) groups. The LABFR group performed five sets of a repeated pattern of 2 min running at 40% VO2max and 1 min passive rest, while wearing the occlusion cuff belts on the proximal end of the thigh. The frequency was three times a week for the period of eight weeks. The control group performed the identical running protocol without wearing the occlusion cuff belts. At the end of the training, the participants’ body composition (fat mass, body fat, muscle mass, and right and left thigh circumference), physical fitness (power and VO2max), and vascular responses (flow-mediated dilation (FMD), brachial ankle pulse wave velocity (baPWV), ankle brachial index (ABI), systolic blood pressure (SBP) and diastolic blood pressure (DBP)) were measured. The results showed a significant time × group interaction effect on muscle mass (F = 53.242, p = 0.001, ηp2 = 0.664) and right thigh circumference (F = 4.544, p = 0.042, ηp2 = 0.144), but no significant variation in any other factors, including fat mass, body fat, left thigh circumference, FMD, baPWV, ABI, SBP, and DBP (p > 0.05). Overall, our results suggested that eight-week LABFR exerted a positive effect on the body composition, especially muscle mass and thigh circumference, of recreational runners.
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Hill EC, Rivera PM, Proppe CE, Gonzalez Rojas DH, Wizenberg AM, Keller JL. Greater Neuromuscular Fatigue Following Low Load Blood Flow Restriction than Non Blood Flow Restriction Resistance Exercise Among Recreationally Active Men. J Neurophysiol 2022; 128:73-85. [PMID: 35704398 DOI: 10.1152/jn.00028.2022] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
PURPOSE The purpose of this study was to examine the acute effects of low-load blood flow restriction (LLBFR) and low-load non-BFR (LL) on neuromuscular function following a bout of standardized, fatiguing leg extension muscle actions. METHODS Fourteen men (mean age ± SD = 23±4 yrs) volunteered to participate in this investigation and randomly performed LLBFR and LL on separate days. Resistance exercise consisted of 75 isotonic, unilateral leg extension muscle actions performed at 30% of one-repetition maximum. Prior to (pretest) and after (posttest) performing each bout of exercise, strength and neural assessments were determined. RESULTS There was no pretest to posttest differences between LLBFR and LL for maximal voluntary isometric contraction (MVIC) torque or V-wave/M-wave responses (muscle compound action potentials assessed during a superimposed MVIC muscle action) which exhibited decreases (collapsed across condition) of 41.2% and 26.2%, respectively. There were pretest to posttest decreases in peak twitch torque (36.0%) and sEMG (29.5%) for LLBFR but not LL, and larger decreases in voluntary activation for LLBFR (11.3%) than LL (4.5%). CONCLUSIONS These findings suggested that LLBFR elicited greater fatigue-induced decreases in several indices of neuromuscular function relative to LL. Despite this, both LLBFR and LL resulted in similar decrements in performance as assessed by maximal strength.
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Affiliation(s)
- Ethan C Hill
- School of Kinesiology & Physical Therapy, Division of Kinesiology, University of Central Florida, Orlando, FL, United States.,Florida Space Institute, University of Central Florida, Orlando, FL, United States
| | - Paola M Rivera
- School of Kinesiology & Physical Therapy, Division of Kinesiology, University of Central Florida, Orlando, FL, United States
| | - Christopher E Proppe
- School of Kinesiology & Physical Therapy, Division of Kinesiology, University of Central Florida, Orlando, FL, United States
| | - David H Gonzalez Rojas
- School of Kinesiology & Physical Therapy, Division of Kinesiology, University of Central Florida, Orlando, FL, United States
| | - Aaron M Wizenberg
- School of Kinesiology & Physical Therapy, Division of Kinesiology, University of Central Florida, Orlando, FL, United States
| | - Joshua L Keller
- College of Education and Professional Studies, Department of Health, Kinesiology and Sport Integrated Laboratory of Exercise and Applied Physiology, University of South Alabama, Mobile, AL, United States
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Burton I, McCormack A. Blood Flow Restriction Resistance Training in Tendon Rehabilitation: A Scoping Review on Intervention Parameters, Physiological Effects, and Outcomes. Front Sports Act Living 2022; 4:879860. [PMID: 35548459 PMCID: PMC9083008 DOI: 10.3389/fspor.2022.879860] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 03/31/2022] [Indexed: 11/13/2022] Open
Abstract
Objective To identify current evidence on blood flow restriction training (BFRT) in tendon injuries and healthy tendons, evaluating physiological tendon effects, intervention parameters, and outcomes. Methods This scoping review was reported in accordance with the PRISMA Extension for Scoping Reviews (PRISMA-ScR). Databases searched included MEDLINE, CINAHL, AMED, EMBase, SPORTDiscus, Cochrane library (Controlled trials, Systematic reviews), and five trial registries. Two independent reviewers screened studies at title/abstract and full text. Following screening, data was extracted and charted, and presented as figures and tables alongside a narrative synthesis. Any study design conducted on adults, investigating the effects of BFRT on healthy tendons or tendon pathology were included. Data were extracted on physiological tendon effects, intervention parameters and outcomes with BFRT. Results Thirteen studies were included, three on tendinopathy, two on tendon ruptures, and eight on healthy Achilles, patellar, and supraspinatus tendons. A variety of outcomes were assessed, including pain, function, strength, and tendon morphological and mechanical properties, particularly changes in tendon thickness. BFRT intervention parameters were heterogeneously prescribed. Conclusion Despite a dearth of studies to date on the effects of BFRT on healthy tendons and in tendon pathologies, preliminary evidence for beneficial effects of BFRT on tendons and clinical outcomes is encouraging. As BFRT is a relatively novel method, definitive conclusions, and recommendations on BFRT in tendon rehabilitation cannot be made at present, which should be addressed in future research, due to the potential therapeutic benefits highlighted in this review.
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Affiliation(s)
- Ian Burton
- Musculoskeletal (MSK) Service, Fraserburgh Physiotherapy Department, Fraserburgh Hospital, National Health Service (NHS) Grampian, Aberdeen, United Kingdom
- *Correspondence: Ian Burton
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Mañago MM, Kimbrell K, Hager ER, Dwight H, Owens J, Bade M. Clinical use of blood flow restriction in people with neurologic conditions: a cross-sectional survey. J Phys Ther Sci 2022; 34:275-283. [PMID: 35400831 PMCID: PMC8989480 DOI: 10.1589/jpts.34.275] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 01/01/2022] [Indexed: 11/25/2022] Open
Abstract
[Purpose] There is little evidence for blood flow restriction (BFR), or Kaatsu, training in people with neurologic conditions. This study's purpose was to survey clinicians on BFR use in people with neurologic conditions. [Participants and Methods] One-hundred twelve physical therapists and other healthcare professionals who reported using BFR in the past 5 years completed an anonymous, online survey. [Results] Eighty-nine percent of respondents thought BFR was safe in people with neurologic conditions. Meanwhile, 38% reported BFR use in people with neurologic conditions. The most common intervention used with BFR was resistance training (n=33) and the most commonly reported benefit was improved strength (n=27). The most common side-effect causing treatment to stop was intolerance to pressure (n=6). No side-effects requiring medical attention were reported. In order to support future BFR use in neurologic populations, the most common response was the need for more research (n=63). [Conclusion] Despite the lack of evidence, clinical use of BFR in people with neurologic conditions may be somewhat common. Although this study had a relatively small sample size and collected data retrospectively, the results support the potential clinical feasibility and safety of BFR use in patients with neurologic conditions and suggest that more research is needed.
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Affiliation(s)
- Mark M. Mañago
- Department of Physical Medicine and Rehabilitation,
University of Colorado, Anschutz Medical Campus: Aurora, CO 80045, USA
- Department of Neurology, University of Colorado Anschutz
Medical Campus, USA
- VA Eastern Colorado Geriatric Research, Education, and
Clinical Center, Rocky Mountain Regional VA Medical Center, USA
| | | | - Emily R. Hager
- Department of Physical Medicine and Rehabilitation,
University of Colorado, Anschutz Medical Campus: Aurora, CO 80045, USA
- VA Eastern Colorado Geriatric Research, Education, and
Clinical Center, Rocky Mountain Regional VA Medical Center, USA
| | - Hannah Dwight
- Department of Neurology, University of Colorado Anschutz
Medical Campus, USA
| | | | - Michael Bade
- Department of Physical Medicine and Rehabilitation,
University of Colorado, Anschutz Medical Campus: Aurora, CO 80045, USA
- VA Eastern Colorado Geriatric Research, Education, and
Clinical Center, Rocky Mountain Regional VA Medical Center, USA
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