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Hoseini R, Raed Hamid R. Lowering blood pressure by exercise: investigating the effect of sweating. Blood Press Monit 2024; 29:109-118. [PMID: 38299995 DOI: 10.1097/mbp.0000000000000691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
High blood pressure (hypertension), is a common medical condition, affecting millions of people and is associated with significant health risks. Exercise has been suggested to manage hypertension by inducing sweating and the corresponding loss of sodium and water from the body.Thus, a variety of epidemiological and clinical studies have been conducted to investigate the relationship between sweating and exercise-induced blood pressure reduction and its impacts on hypertension. The mechanisms underlying exercise-induced blood pressure reduction are complex and still not fully understood. However, several pathways have been suggested, including the loss of sodium and water through sweat, a decrease in peripheral resistance, and an improvement in endothelial function in the blood vessels. The decrease in sodium and water content in the body associated with sweating may result in a reduction in blood volume and thus a decrease in blood pressure. Moreover, the reduction in peripheral resistance is thought to be mediated by the activation of the nitric oxide synthase pathway and the release of vasodilators such as prostacyclin and bradykinin, which lead to vasodilation and, thus, a reduction in blood pressure. In conclusion, exercise-induced sweating and consequent sodium and water loss appear to be a reliable biological link to the blood pressure-reducing effects of exercise in hypertensive individuals. Additionally, the mechanisms underlying exercise-induced blood pressure reduction are complex and involve several biological pathways in the cardiovascular system. Therefore, understanding the role of sweat production in blood pressure management is important for developing effective exercise interventions to prevent and manage hypertension.
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Affiliation(s)
- Rastegar Hoseini
- Department of Exercise Physiology, Faculty of Sport Sciences, Razi University, Kermanshah
| | - Rasha Raed Hamid
- Physical Education and Sport Sciences Department, University of Garmian, Kurdistan Region, Iraq
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Zota IM, Ghiciuc CM, Cojocaru DC, Dima-Cozma CL, Leon MM, Gavril RS, Roca M, Costache AD, Maștaleru A, Anghel L, Stătescu C, Sascău RA, Mitu F. Changes in Arterial Stiffness in Response to Blood Flow Restriction Resistance Training: A Narrative Review. J Clin Med 2023; 12:7602. [PMID: 38137671 PMCID: PMC10743779 DOI: 10.3390/jcm12247602] [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: 10/18/2023] [Revised: 12/07/2023] [Accepted: 12/08/2023] [Indexed: 12/24/2023] Open
Abstract
Arterial stiffness naturally increases with age and is a known predictor of cardiovascular morbimortality. Blood flow restriction (BFR) training involves decreasing muscle blood flow by applying a strap or a pneumatic cuff during exercise. BFR induces muscle hypertrophy even at low intensities, making it an appealing option for older, untrained individuals. However, BFR use in patients with cardiovascular comorbidities is limited by the increased pressor and chronotropic response observed in hypertensive elderly patients. Furthermore, the impact of BFR on vascular function remains unclear. We conducted a comprehensive literature review according to PRISMA guidelines, summarizing available data on the acute and long-term consequences of BFR training on vascular function. Although evidence is still scarce, it seems that BFR has a mild or neutral long-term impact on arterial stiffness. However, current research shows that BFR can cause an abrupt, albeit transient, increase in PWV and central blood pressure. BFR and, preferably, lower-body BFR, should be prescribed with caution in older populations, especially in hypertensive patients who have an exacerbated muscle metaboreflex pressor response. Longer follow-up studies are required to assess the chronic effect of BFR training on arterial stiffness, especially in elderly patients who are usually unable to tolerate high-intensity resistance exercises.
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Affiliation(s)
- Ioana Mădălina Zota
- Department of Medical Specialties I, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700111 Iași, Romania; (I.M.Z.); (C.L.D.-C.); (M.M.L.); (R.S.G.); (M.R.); (A.D.C.); (A.M.); (L.A.); (C.S.); (R.A.S.); (F.M.)
| | - Cristina Mihaela Ghiciuc
- Pharmacology, Clinical Pharmacology and Algeziology, Department of Morpho-Functional Sciences II, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700111 Iași, Romania
| | - Doina Clementina Cojocaru
- Department of Medical Specialties I, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700111 Iași, Romania; (I.M.Z.); (C.L.D.-C.); (M.M.L.); (R.S.G.); (M.R.); (A.D.C.); (A.M.); (L.A.); (C.S.); (R.A.S.); (F.M.)
| | - Corina Lucia Dima-Cozma
- Department of Medical Specialties I, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700111 Iași, Romania; (I.M.Z.); (C.L.D.-C.); (M.M.L.); (R.S.G.); (M.R.); (A.D.C.); (A.M.); (L.A.); (C.S.); (R.A.S.); (F.M.)
| | - Maria Magdalena Leon
- Department of Medical Specialties I, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700111 Iași, Romania; (I.M.Z.); (C.L.D.-C.); (M.M.L.); (R.S.G.); (M.R.); (A.D.C.); (A.M.); (L.A.); (C.S.); (R.A.S.); (F.M.)
| | - Radu Sebastian Gavril
- Department of Medical Specialties I, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700111 Iași, Romania; (I.M.Z.); (C.L.D.-C.); (M.M.L.); (R.S.G.); (M.R.); (A.D.C.); (A.M.); (L.A.); (C.S.); (R.A.S.); (F.M.)
| | - Mihai Roca
- Department of Medical Specialties I, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700111 Iași, Romania; (I.M.Z.); (C.L.D.-C.); (M.M.L.); (R.S.G.); (M.R.); (A.D.C.); (A.M.); (L.A.); (C.S.); (R.A.S.); (F.M.)
| | - Alexandru Dan Costache
- Department of Medical Specialties I, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700111 Iași, Romania; (I.M.Z.); (C.L.D.-C.); (M.M.L.); (R.S.G.); (M.R.); (A.D.C.); (A.M.); (L.A.); (C.S.); (R.A.S.); (F.M.)
| | - Alexandra Maștaleru
- Department of Medical Specialties I, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700111 Iași, Romania; (I.M.Z.); (C.L.D.-C.); (M.M.L.); (R.S.G.); (M.R.); (A.D.C.); (A.M.); (L.A.); (C.S.); (R.A.S.); (F.M.)
| | - Larisa Anghel
- Department of Medical Specialties I, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700111 Iași, Romania; (I.M.Z.); (C.L.D.-C.); (M.M.L.); (R.S.G.); (M.R.); (A.D.C.); (A.M.); (L.A.); (C.S.); (R.A.S.); (F.M.)
| | - Cristian Stătescu
- Department of Medical Specialties I, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700111 Iași, Romania; (I.M.Z.); (C.L.D.-C.); (M.M.L.); (R.S.G.); (M.R.); (A.D.C.); (A.M.); (L.A.); (C.S.); (R.A.S.); (F.M.)
| | - Radu Andy Sascău
- Department of Medical Specialties I, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700111 Iași, Romania; (I.M.Z.); (C.L.D.-C.); (M.M.L.); (R.S.G.); (M.R.); (A.D.C.); (A.M.); (L.A.); (C.S.); (R.A.S.); (F.M.)
| | - Florin Mitu
- Department of Medical Specialties I, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700111 Iași, Romania; (I.M.Z.); (C.L.D.-C.); (M.M.L.); (R.S.G.); (M.R.); (A.D.C.); (A.M.); (L.A.); (C.S.); (R.A.S.); (F.M.)
- Academy of Medical Sciences of Romania, Ion C. Brătianu Boulevard No 1, 030167 Bucharest, Romania
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Lin TY, Chueh TY, Hung TM. Preferred Reporting Items for Resistance Exercise Studies (PRIRES): A Checklist Developed Using an Umbrella Review of Systematic Reviews. SPORTS MEDICINE - OPEN 2023; 9:114. [PMID: 38040927 PMCID: PMC10692055 DOI: 10.1186/s40798-023-00640-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 09/26/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND The issues of replication and scientific transparency have been raised in exercise and sports science research. A potential means to address the replication crisis and enhance research reliability is to improve reporting quality and transparency. This study aims to formulate a reporting checklist as a supplement to the existing reporting guidelines, specifically for resistance exercise studies. METHODS PubMed (which covers Medline) and Scopus (which covers Medline, EMBASE, Ei Compendex, World Textile Index, Fluidex, Geobase, Biobase, and most journals in Web of Science) were searched for systematic reviews that comprised the primary studies directly comparing different resistance training methods. Basic data on the selected reviews, including on authors, publication years, and objectives, were summarized. The reporting items for the checklist were identified based on the objective of the reviews. Additional items from an existing checklist, namely the Consensus on Exercise Reporting Template, a National Strength and Conditioning Association handbook, and an article from the EQUATOR library were incorporated into the final reporting checklist. RESULTS Our database search retrieved 3595 relevant records. After automatic duplicate removal, the titles and abstracts of the remaining 2254 records were screened. The full texts of 137 records were then reviewed, and 88 systematic reviews that met the criteria were included in the umbrella review. CONCLUSION Developed primarily by an umbrella review method, this checklist covers the research questions which have been systematically studied and is expected to improve the reporting completeness of future resistance exercise studies. The PRIRES checklist comprises 26 reporting items (39 subitems) that cover four major topics in resistance exercise intervention: 1) exercise selection, performance, and training parameters, 2) training program and progression, 3) exercise setting, and 4) planned vs actual training. The PRIRES checklist was designed specifically for reporting resistance exercise intervention. It is expected to be used with other reporting guidelines such as Consolidated Standards of Reporting Trials and Standard Protocol Items: Recommendations for Interventional Trials. This article presents only the development process and resulting items of the checklist. An accompanying article detailing the rationale for, the importance of, and examples of each item is being prepared. REGISTRATION This study is registered with the EQUATOR Network under the title "Preferred Reporting Items for Resistance Exercise Studies (PRIRES)." PROSPERO registration number: CRD42021235259.
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Affiliation(s)
- Ting-Yu Lin
- Department of Physical Education and Sport Sciences, National Taiwan Normal University, No. 162, Section 1, Heping East Road, Da'an District, Taipei City, 106, Taiwan
| | - Ting-Yu Chueh
- Department of Physical Education and Sport Sciences, National Taiwan Normal University, No. 162, Section 1, Heping East Road, Da'an District, Taipei City, 106, Taiwan
| | - Tsung-Min Hung
- Department of Physical Education and Sport Sciences, National Taiwan Normal University, No. 162, Section 1, Heping East Road, Da'an District, Taipei City, 106, Taiwan.
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Horiuchi M, Stoner L, Poles J. The effect of four weeks blood flow restricted resistance training on macro- and micro-vascular function in healthy, young men. Eur J Appl Physiol 2023; 123:2179-2189. [PMID: 37245196 DOI: 10.1007/s00421-023-05230-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 05/16/2023] [Indexed: 05/29/2023]
Abstract
PURPOSE To determine the macrovascular and microvascular function responses to resistance training with blood flow restriction (BFR) compared to high-load resistance training (HLRT) control group. METHODS Twenty-four young, healthy men were randomly assigned to BFR or HLRT. Participants performed bilateral knee extensions and leg presses 4 days per week, for 4 weeks. For each exercise, BFR completed 3 X 10 repetitions/day at 30% of 1-repetition max (RM). The occlusive pressure was applied at 1.3 times of individual systolic blood pressure. The exercise prescription was identical for HLRT, except the intensity was set at 75% of one repetition maximum. Outcomes were measured pre-, at 2- and 4-weeks during the training period. The primary macrovascular function outcome was heart-ankle pulse wave velocity (haPWV), and the primary microvascular function outcome was tissue oxygen saturation (StO2) area under the curve (AUC) response to reactive hyperemia. RESULTS Knee extension and leg press 1-RM increased by 14% for both groups. There was a significant interaction effect for haPWV, decreasing - 5% (Δ-0.32 m/s, 95% confidential interval [CI] - 0.51 to - 0.12, effect size [ES] = - 0.53) for BFR and increasing 1% (Δ0.03 m/s, 95%CI - 0.17 to 0.23, ES = 0.05) for HLRT. Similarly, there was an interaction effect for StO2 AUC, increasing 5% (Δ47%・s, 95%CI - 3.07 to 98.1, ES = 0.28) for HLRT and 17% (Δ159%・s, 95%CI 108.23-209.37, ES = 0.93) for BFR group. CONCLUSION The current findings suggest that BFR may improve macro- and microvascular function compared to HLRT.
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Affiliation(s)
- Masahiro Horiuchi
- Faculty of Sports and Life Science, National Institute of Fitness and Sports in KANOYA, Shiromizu 1, Kanoya, Kagoshima, 8912393, Japan.
- Division of Human Environmental Science, Mount Fuji Research Institute, Kami-Yohida 5597-1, Fuji-Yoshida, Yamanashi, 4030005, Japan.
| | - Lee Stoner
- Department of Exercise and Sports Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599-8700, USA
- Department of Epidemiology, Gillings School of Public Heath, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599-8700, USA
| | - Jillian Poles
- Department of Exercise and Sports Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599-8700, USA
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Maga M, Wachsmann-Maga A, Batko K, Włodarczyk A, Kłapacz P, Krężel J, Szopa N, Sliwka A. Impact of Blood-Flow-Restricted Training on Arterial Functions and Angiogenesis-A Systematic Review with Meta-Analysis. Biomedicines 2023; 11:1601. [PMID: 37371696 DOI: 10.3390/biomedicines11061601] [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: 04/29/2023] [Revised: 05/29/2023] [Accepted: 05/29/2023] [Indexed: 06/29/2023] Open
Abstract
Despite growing evidence of the significant influence of blood-flow-restricted (BFR) training on different body functions, its impact on the vascular system, especially the arteries, is controversial. Therefore, the objective of our study was to analyze how BFR exercise, compared to other types of exercise without the restriction of blood flow, influences arterial functions and angiogenesis in adults. Studies comparing the effect of BFR versus non-BFR training on arterial parameters were divided into three categories: endothelial function, angiogenesis, and other vasculature functions. The search was based on Cochrane Library, PubMed®, and Embase, and 38 studies were included. The meta-analysis revealed a more significant improvement in flow-mediated dilatation (FMD) (p = 0.002) and the production of the primary angiogenesis biomarker vascular endothelial growth factor (VEGF) (p = 0.009) after BFR compared to non-BFR training (p = 0.002). The analysis of the pulse wave velocity, ankle-brachial index, systolic blood pressure, and heart rate did not show significant differences in changes between BFR and non-BFR training. The other parameters examined did not have sufficient data to be included in the meta-analysis. The results obtained present trends that suggest significant impacts of BFR training on endothelial functions and angiogenesis. There is still a lack of multicenter randomized clinical trials including many participants, and such studies are necessary to confirm the advantage of BFR over non-BFR activity.
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Affiliation(s)
- Mikołaj Maga
- Department of Rehabilitation in Internal Diseases, Faculty of Health Sciences, Jagiellonian University Medical College, 31-008 Krakow, Poland
- Clinical Department of Angiology, University Hospital in Krakow, 30-688 Krakow, Poland
| | - Agnieszka Wachsmann-Maga
- Clinical Department of Angiology, University Hospital in Krakow, 30-688 Krakow, Poland
- Department of Angiology, Faculty of Medicine, Jagiellonian University Medical College, 31-008 Krakow, Poland
| | - Krzysztof Batko
- Department of Research and Design, Medicine Economy Law Society (MELS) Foundation, 30-040 Krakow, Poland
| | - Aleksandra Włodarczyk
- Department of Angiology, Faculty of Medicine, Jagiellonian University Medical College, 31-008 Krakow, Poland
| | - Paulina Kłapacz
- Clinical Department of Angiology, University Hospital in Krakow, 30-688 Krakow, Poland
- Department of Angiology, Faculty of Medicine, Jagiellonian University Medical College, 31-008 Krakow, Poland
| | - Jakub Krężel
- Clinical Department of Angiology, University Hospital in Krakow, 30-688 Krakow, Poland
| | - Natalia Szopa
- Department of Angiology, Faculty of Medicine, Jagiellonian University Medical College, 31-008 Krakow, Poland
| | - Agnieszka Sliwka
- Department of Rehabilitation in Internal Diseases, Faculty of Health Sciences, Jagiellonian University Medical College, 31-008 Krakow, Poland
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Fabero-Garrido R, Gragera-Vela M, del Corral T, Izquierdo-García J, Plaza-Manzano G, López-de-Uralde-Villanueva I. Effects of Low-Load Blood Flow Restriction Resistance Training on Muscle Strength and Hypertrophy Compared with Traditional Resistance Training in Healthy Adults Older Than 60 Years: Systematic Review and Meta-Analysis. J Clin Med 2022; 11:jcm11247389. [PMID: 36556004 PMCID: PMC9787798 DOI: 10.3390/jcm11247389] [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: 11/24/2022] [Revised: 12/09/2022] [Accepted: 12/10/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND There is clinical interest in determining the effects of low-load blood flow restriction (LL-BFR) resistance training on muscle strength and hypertrophy compared with traditional high- and low-load (HL and LL) resistance training in healthy older adults and the influence of LL-BFR training cuff-pressure on these outcomes. METHODS A search was performed on the MEDLINE, PEDro, CINHAL, Web of Science, Science Direct, Scopus, and CENTRAL databases. RESULTS The analysis included 14 studies. HL resistance training produces a small increase in muscle strength (eight studies; SMD, -0.23 [-0.41; -0.05]) but not in muscle hypertrophy (six studies; (SMD, 0.08 [-0.22; 0.38]) when compared with LL-BFR resistance training. Compared with traditional LL resistance training, LL-BFR resistance training produces small-moderate increases in muscle strength (seven studies; SMD, 0.44 [0.28; 0.60]) and hypertrophy (two studies; SMD, 0.51 [0.06; 0.96]). There were greater improvements in muscle strength when higher cuff pressures were applied versus traditional LL resistance training but not versus HL resistance training. CONCLUSIONS LL-BFR resistance training results in lower muscle strength gains than HL resistance training and greater than traditional LL resistance training in healthy adults older than 60 years. LL-BFR resistance training promotes a similar muscle hypertrophy to HL resistance training but is greater than that of traditional LL resistance training. Applying cuff pressures above the limb occlusion pressure could enhance the increases in muscle strength compared with traditional LL resistance training.
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Affiliation(s)
- Raúl Fabero-Garrido
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, Complutense University of Madrid, 28040 Madrid, Spain
| | - Miguel Gragera-Vela
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, Complutense University of Madrid, 28040 Madrid, Spain
| | - Tamara del Corral
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, Complutense University of Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
- Correspondence: ; Tel.: +34-91-394-15-17
| | - Juan Izquierdo-García
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, Complutense University of Madrid, 28040 Madrid, Spain
- Multidisciplinary Cardiac Rehabilitation Unit, University Hospital 12 de Octubre, 28041 Madrid, Spain
| | - Gustavo Plaza-Manzano
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, Complutense University of Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
| | - Ibai López-de-Uralde-Villanueva
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, Complutense University of Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, 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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Cahalin LP, Formiga MF, Owens J, Anderson B, Hughes L. Beneficial Role of Blood Flow Restriction Exercise in Heart Disease and Heart Failure Using the Muscle Hypothesis of Chronic Heart Failure and a Growing Literature. Front Physiol 2022; 13:924557. [PMID: 35874535 PMCID: PMC9296815 DOI: 10.3389/fphys.2022.924557] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 06/10/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Blood flow restriction exercise (BFRE) has become a common method to increase skeletal muscle strength and hypertrophy for individuals with a variety of conditions. A substantial literature of BFRE in older adults exists in which significant gains in strength and functional performance have been observed without report of adverse events. Research examining the effects of BFRE in heart disease (HD) and heart failure (HF) appears to be increasing for which reason the Muscle Hypothesis of Chronic Heart Failure (MHCHF) will be used to fully elucidate the effects BFRE may have in patients with HD and HF highlighted in the MHCHF.Methods: A comprehensive literature review was performed in PubMed and the Cochrane library through February 2022. Inclusion criteria were: 1) the study was original research conducted in human subjects older than 18 years of age and diagnosed with either HD or HF, 2) study participants performed BFRE, and 3) post-intervention outcome measures of cardiovascular function, physical performance, skeletal muscle function and structure, and/or systemic biomarkers were provided. Exclusion criteria included review articles and articles on viewpoints and opinions of BFRE, book chapters, theses, dissertations, and case study articles.Results: Seven BFRE studies in HD and two BFRE studies in HF were found of which four of the HD and the two HF studies examined a variety of measures reflected within the MHCHF over a period of 8–24 weeks. No adverse events were reported in any of the studies and significant improvements in skeletal muscle strength, endurance, and work as well as cardiorespiratory performance, mitochondrial function, exercise tolerance, functional performance, immune humoral function, and possibly cardiac performance were observed in one or more of the reviewed studies.Conclusion: In view of the above systematic review, BFRE has been performed safely with no report of adverse event in patients with a variety of different types of HD and in patients with HF. The components of the MHCHF that can be potentially improved with BFRE include left ventricular dysfunction, inflammatory markers, inactivity, a catabolic state, skeletal and possibly respiratory muscle myopathy, dyspnea and fatigue, ANS activity, and peripheral blood flow. Furthermore, investigation of feasibility, acceptability, adherence, adverse effects, and symptoms during and after BFRE is needed since very few studies have examined these important issues comprehensively in patients with HD and HF.
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Affiliation(s)
- Lawrence P. Cahalin
- Department of Physical Therapy, Miller School of Medicine, University of Miami, Miami, FL, United States
- *Correspondence: Lawrence P. Cahalin,
| | - Magno F. Formiga
- Departamento de Fisioterapia, Faculdade de Medicina, Universidade Federal Do Ceará, Fortaleza, Brazil
| | - Johnny Owens
- Owens Recovery Science, San Antonio, TX, United States
| | - Brady Anderson
- Department of Physical Therapy, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Luke Hughes
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Northumbria, United Kingdom
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Effects of Low-Load Blood Flow Restriction Training on Hemodynamic Responses and Vascular Function in Older Adults: A Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116750. [PMID: 35682336 PMCID: PMC9180641 DOI: 10.3390/ijerph19116750] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 05/19/2022] [Accepted: 05/23/2022] [Indexed: 11/21/2022]
Abstract
Background: The combination of low-load (LL) training with blood flow restriction (BFR) has recently been shown to trigger a series of hemodynamic responses and promote vascular function in various populations. To date, however, evidence is sparse as to how this training regimen influences hemodynamic response and vascular function in older adults. Objective: To systematically evaluate the effects of LL-BFR training on hemodynamic response and vascular function in older adults. Methods: A PRISMA-compliant systematic review and meta-analysis were conducted. The systematic literature research was performed in the following electronic databases from their inception to 30 February 2022: PubMed, Web of Science, Scopus, EBSCO host, the Cochrane Library and CNKI. Subsequently, a meta-analysis with inverse variance weighting was conducted. Results: A total of 1437 articles were screened, and 12 randomized controlled trials with a total 378 subjects were included in the meta-analysis. The meta-analysis results showed that LL-BFR training caused a significant acute increase in heart rate (WMD: 4.02, 95% CI: 0.93, 7.10, p < 0.05), systolic blood pressure (WMD: 5.05, 95% CI: 0.63, 9.48, p < 0.05) and diastolic blood pressure (WMD: 4.87, 95% CI: 1.37, 8.37, p < 0.01). The acute hemodynamic response induced by LL-BFR training is similar to that elicited by high-load (HL) training. Training volume, cuff pressure and width were identified as significant moderators in our subgroup and meta-regression analyses. After 30 min of training, resting systolic blood pressure significantly decreased (WMD: −6.595, 95% CI: −8.88, −3.31, p < 0.01) in the LL-BFR training group, but resting hemodynamic indexes exhibited no significant differences compared with common LL and HL training; long-term LL-BFR training resulted in significant improvements in flow-mediated vasodilation (FMD) (WMD: 1.30, 95% CI: 0.50, 2.10, p < 0.01), cardio ankle vascular index (CAVI) (WMD: 0.55, 95% CI: 0.11, 0.99, p < 0.05) and ankle brachial index (ABI) (WMD: 0.03, 95% CI: 0.00, 0.06, p < 0.05) in older adults. Conclusion: This systematic review and meta-analysis reveals that LL-BFR training will cause an acute hemodynamic response in older adults, which can return to normal levels 30 min after training, and systolic blood pressure significantly decreased. Furthermore, the beneficial effect of LL-BFR training on vascular function is to improve FMD, CAVI and ABI of older adults. However, due to the influence of the quality of the included studies and the sample size, more high-quality studies are needed to confirm such issues as BFR pressure and training risk.
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Li S, Li S, Wang L, Quan H, Yu W, Li T, Li W. The Effect of Blood Flow Restriction Exercise on Angiogenesis-Related Factors in Skeletal Muscle Among Healthy Adults: A Systematic Review and Meta-Analysis. Front Physiol 2022; 13:814965. [PMID: 35250618 PMCID: PMC8892188 DOI: 10.3389/fphys.2022.814965] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 01/26/2022] [Indexed: 01/08/2023] Open
Abstract
BackgroundBlood flow restriction (BFR) exercise may be a potential exercise program to promote angiogenesis. This review aims to compare the effects of exercise with and without BFR on angiogenesis-related factors in skeletal muscle among healthy adults.MethodologySearches were made in Web of Science, Scopus, PubMed, and EBSCO databases from January 2001 to June 2021. Studies were screened, quality was evaluated, and data were extracted. The review protocol was registered at PROSPERO (PROSPERO registration number: CRD42021261367). Standardized mean differences (SMD) of vascular endothelial growth factor (VEGF), vascular endothelial growth factor receptor 2 (VEGFR-2), hypoxia inducible factor 1α (HIF-1α), peroxisome proliferator-activated receptorγcoactivator-1α (PGC-1α) and endothelial nitric oxide synthase (eNOS) were analyzed using Revman 5.4 software with a 95% confidence interval (95% CI).ResultsTen studies fulfilled the inclusion criteria with a total of 75 participants for BFR group and 77 for CON group. BFR exercise elicits greater expression of VEGF (heterogeneity test, P = 0.09, I2 = 44%; SMD, 0.93 [0.38, 1.48], P < 0.05), VEGFR-2 (heterogeneity test, P = 0.81, I2 = 0%; SMD, 0.64 [0.08, 1.21], P < 0.05), HIF-1α (heterogeneity test, P = 0.67, I2 = 0%; SMD, 0.43 [0.03, 0.82], P < 0.05), PGC-1α (heterogeneity test, P = 0.02, I2 = 54%; SMD, 0.74 [0.21, 1.28], P < 0.05) and eNOS (heterogeneity test, P = 0.88, I2 = 0%; SMD, 0.60 [0.04, 1.17], P < 0.05) mRNA than non-BFR exercise. In the sub-group analysis, resistance exercise with BFR elicits greater expression of VEGF (heterogeneity test, P = 0.36, I2 = 6%; SMD, 1.66 [0.97, 2.35], P < 0.05) and HIF-1α (heterogeneity test, P = 0.56, I2 = 0%; SMD, 0.51 [0.01, 1.02], P < 0.05) mRNA than aerobic exercise with BFR.ConclusionExercise with BFR elicited more angiogenesis-related factors mRNA expression than exercise without BFR, but not VEGF and PGC-1α protein expression. Therefore, BFR training may be a potential training program to improve vascular function.Systematic Review Registration[https://www.crd.york.ac.uk/prospero/], identifier [CRD42021261367].
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Affiliation(s)
- Shuoqi Li
- School of Health Science, Universiti Sains Malaysia, Kelantan, Malaysia
- Institute of Sports Human Science, Ocean University of China, Shandong, China
| | - Shiming Li
- Institute of Sports Human Science, Ocean University of China, Shandong, China
| | - Lifeng Wang
- Exercise and Metabolism Research Center, College of Physical Education and Health Sciences, Zhejiang Normal University, Zhejiang, China
| | - Helong Quan
- Exercise and Metabolism Research Center, College of Physical Education and Health Sciences, Zhejiang Normal University, Zhejiang, China
| | - Wenbing Yu
- Institute of Sports Human Science, Ocean University of China, Shandong, China
| | - Ting Li
- Exercise and Metabolism Research Center, College of Physical Education and Health Sciences, Zhejiang Normal University, Zhejiang, China
- Ting Li,
| | - Wei Li
- Exercise and Metabolism Research Center, College of Physical Education and Health Sciences, Zhejiang Normal University, Zhejiang, China
- *Correspondence: Wei Li,
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Cerqueira MS, Costa EC, Santos Oliveira R, Pereira R, Brito Vieira WH. Blood Flow Restriction Training: To Adjust or Not Adjust the Cuff Pressure Over an Intervention Period? Front Physiol 2021; 12:678407. [PMID: 34262476 PMCID: PMC8273389 DOI: 10.3389/fphys.2021.678407] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 06/02/2021] [Indexed: 11/13/2022] Open
Abstract
Blood flow restriction (BFR) training combines exercise and partial reduction of muscular blood flow using a pressured cuff. BFR training has been used to increase strength and muscle mass in healthy and clinical populations. A major methodological concern of BFR training is blood flow restriction pressure (BFRP) delivered during an exercise bout. Although some studies increase BFRP throughout a training intervention, it is unclear whether BFRP adjustments are pivotal to maintain an adequate BFR during a training period. While neuromuscular adaptations induced by BFR are widely studied, cardiovascular changes throughout training intervention with BFR and their possible relationship with BFRP are less understood. This study aimed to discuss the need for BFRP adjustment based on cardiovascular outcomes and provide directions for future researches. We conducted a literature review and analyzed 29 studies investigating cardiovascular adaptations following BFR training. Participants in the studies were healthy, middle-aged adults, older adults and clinical patients. Cuff pressure, when adjusted, was increased during the training period. However, cardiovascular outcomes did not provide a plausible rationale for cuff pressure increase. In contrast, avoiding increments in cuff pressure may minimize discomfort, pain and risks associated with BFR interventions, particularly in clinical populations. Given that cardiovascular adaptations induced by BFR training are conflicting, it is challenging to indicate whether increases or decreases in BFRP are needed. Based on the available evidence, we suggest that future studies investigate if maintaining or decreasing cuff pressure makes BFR training safer and/or more comfortable with similar physiological adaptation.
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Affiliation(s)
- Mikhail Santos Cerqueira
- Neuromuscular Performance Analysis Laboratory, Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Eduardo Caldas Costa
- Department of Physical Education, Federal University of Rio Grande do Norte, Natal, Brazil
| | | | - Rafael Pereira
- Integrative Physiology Research Center, Department of Biological Sciences, Universidade Estadual do Sudoeste da Bahia (UESB), Jequié, Brazil
| | - Wouber Hérickson Brito Vieira
- Neuromuscular Performance Analysis Laboratory, Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal, Brazil
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