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Bechan Vergara I, Puig-Diví A, Amestoy Alonso B, Milà-Villarroel R. Effects of low-load blood flow restriction training in healthy adult tendons: A systematic review and meta-analysis. J Bodyw Mov Ther 2024; 39:13-23. [PMID: 38876617 DOI: 10.1016/j.jbmt.2023.11.048] [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: 06/28/2022] [Revised: 10/18/2023] [Accepted: 11/24/2023] [Indexed: 06/16/2024]
Abstract
OBJECTIVE To systematically review the effects of low-load blood flow restriction training (LL-BFR) on healthy adult tendons. DESIGN A systematic review with meta-analysis. LITERATURE SEARCH Six electronic databases were searched by two researchers. STUDY SELECTION CRITERIA Clinical trials comparing the effects of LL-BFR to high-load resistance training (HL-RT) or low-load resistance training (LL-RT) in healthy adult tendons. DATA SYNTHESIS Two reviewers selected the eligible clinical trials, and one reviewer exported the data. Two reviewers evaluated the study quality and risk of bias using the PEDro scale and the ROB2 scale. We performed meta-analysis where appropriate using a random-effects model. We rated the quality of evidence using GRADE. RESULTS Six studies were eligible. We analyzed tendon cross-sectional area (CSA) and tendon stiffness as the outcomes. Across all comparisons, there was low-to moderate-quality evidence of a difference between LL-BFR and LL-RT immediately after exercise. There was high-quality evidence of no difference between LL-BFR and HL-RT in the long term. CONCLUSION The effects of LL-BFR on the tendons depends on the time and dose of the intervention. LL-BFR could be useful to increase the CSA of the tendons in a similar or superior way to HL-RT after 8 weeks of intervention.
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Affiliation(s)
- Ilan Bechan Vergara
- Blanquerna School of Health Sciences - Ramon Llull University, c/ Padilla, 326, 08025, Barcelona, Spain.
| | - Albert Puig-Diví
- Blanquerna School of Health Sciences - Ramon Llull University, c/ Padilla, 326, 08025, Barcelona, Spain.
| | - Beñat Amestoy Alonso
- Neuroscience Lab (part of IDIBAPS, Barcelona), Calle Marina 312 3-4, 08025, Barcelona, Spain.
| | - Raimon Milà-Villarroel
- Blanquerna School of Health Sciences - Ramon Llull University, c/ Padilla, 326, 08025, Barcelona, Spain.
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Lavigne C, Mons V, Grange M, Blain GM. Acute neuromuscular, cardiovascular, and muscle oxygenation responses to low-intensity aerobic interval exercises with blood flow restriction. Exp Physiol 2024. [PMID: 38875101 DOI: 10.1113/ep091742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 05/21/2024] [Indexed: 06/16/2024]
Abstract
We investigated the influence of short- and long-interval cycling exercise with blood flow restriction (BFR) on neuromuscular fatigue, shear stress and muscle oxygenation, potent stimuli to BFR-training adaptations. During separate sessions, eight individuals performed short- (24 × 60 s/30 s; SI) or long-interval (12 × 120 s/60 s; LI) trials on a cycle ergometer, matched for total work. One leg exercised with (BFR-leg) and the other without (CTRL-leg) BFR. Quadriceps fatigue was quantified using pre- to post-interval changes in maximal voluntary contraction (MVC), potentiated twitch force (QT) and voluntary activation (VA). Shear rate was measured by Doppler ultrasound at cuff release post-intervals. Vastus lateralis tissue oxygenation was measured by near-infrared spectroscopy during exercise. Following the initial interval, significant (P < 0.05) declines in MVC and QT were found in both SI and LI, which were more pronounced in the BFR-leg, and accounted for approximately two-thirds of the total reduction at exercise termination. In the BFR-leg, reductions in MVC (-28 ± 15%), QT (-42 ± 17%), and VA (-15 ± 17%) were maximal at exercise termination and persisted up to 8 min post-exercise. Exercise-induced muscle deoxygenation was greater (P < 0.001) in the BFR-leg than CTRL-leg and perceived pain was more in LI than SI (P < 0.014). Cuff release triggered a significant (P < 0.001) shear rate increase which was consistent across trials. Exercise-induced neuromuscular fatigue in the BFR-leg exceeded that in the CTRL-leg and was predominantly of peripheral origin. BFR also resulted in diminished muscle oxygenation and elevated shear stress. Finally, short-interval trials resulted in comparable neuromuscular and haemodynamic responses with reduced perceived pain compared to long-intervals.
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Ida A, Sasaki K. Distinct adaptations of muscle endurance but not strength or hypertrophy to low-load resistance training with and without blood flow restriction. Exp Physiol 2024; 109:926-938. [PMID: 38502540 PMCID: PMC11140179 DOI: 10.1113/ep091310] [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: 05/25/2023] [Accepted: 03/01/2024] [Indexed: 03/21/2024]
Abstract
Low-load resistance training promotes muscle strength and hypertrophic adaptations when combined with blood flow restriction (BFR). However, the effect of BFR on muscle endurance remains unclear. The aim of this study was to clarify the effects of BFR on muscle performance and adaptation, with special reference to local muscle endurance. In experiment 1, eight healthy men performed unilateral elbow flexion exercise to failure at 30% of one-repetition maximum with BFR (at 40% of estimated arterial occlusion pressure) and free blood flow (FBF). During the exercise, muscle activity and tissue oxygenation were measured from the biceps brachii. In experiment 2, another eight healthy men completed 6 weeks of elbow flexion training with BFR and FBF. The number of repetitions to failure at submaximal load (Rmax), the estimated time for peak torque output to decay by 50% during repetitive maximum voluntary contractions (half-time), one-repetition maximum, isometric strength and muscle thickness of elbow flexors were measured pre- and post-training. Blood flow restriction resulted in fewer repetitions and lower muscle tissue oxygenation at the end of exercise than FBF, while the muscle activity increased similarly to repetition failure. Blood flow restriction also resulted in a smaller post-training Rmax, which was strongly correlated with the total exercise volume over the 6 week period. Despite the smaller exercise volume, BFR resulted in similar improvements in half-time, muscle strength and thickness compared with FBF. These results suggest that the application of BFR can attenuate muscle endurance adaptations to low-load resistance training by decreasing the number of repetitions during exercise, both acutely and chronically.
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Affiliation(s)
- Akito Ida
- Department of Life Sciences, Graduate School of Arts and Sciences, The University of Tokyo, Tokyo, Japan
| | - Kazushige Sasaki
- Department of Life Sciences, Graduate School of Arts and Sciences, The University of Tokyo, Tokyo, Japan
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Davis BH, Stampley JE, Granger J, Scott MC, Allerton TD, Johannsen NM, Spielmann G, Irving BA. Impact of low-load resistance exercise with and without blood flow restriction on muscle strength, endurance, and oxidative capacity: A pilot study. Physiol Rep 2024; 12:e16041. [PMID: 38888154 PMCID: PMC11184470 DOI: 10.14814/phy2.16041] [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: 01/06/2024] [Revised: 04/23/2024] [Accepted: 04/23/2024] [Indexed: 06/20/2024] Open
Abstract
Low-load resistance exercise (LLRE) to failure can increase muscle mass, strength, endurance, and mitochondrial oxidative capacity (OXPHOS). However, the impact of adding blood flow restriction to low-load resistance exercise (LLBFR) when matched for volume on these outcomes is incompletely understood. This pilot study examined the impact of 6 weeks of single-legged LLBFR and volume-matched LLRE on thigh bone-free lean mass, strength, endurance, and mitochondrial OXPHOS. Twenty (12 males and 8 females) untrained young adults (mean ± SD; 21 ± 2 years, 168 ± 11 cm, 68 ± 12 kg) completed 6 weeks of either single-legged LLBFR or volume-matched LLRE. Participants performed four sets of 30, 15, 15, and 15 repetitions at 25% 1-RM of leg press and knee extension with or without BFR three times per week. LLBFR increased knee extension 1-RM, knee extension endurance, and thigh bone-free lean mass relative to control (all p < 0.05). LLRE increased leg press and knee extension 1-RM relative to control (p = 0.012 and p = 0.054, respectively). LLRE also increased mitochondrial OXPHOS (p = 0.047 (nonparametric)). Our study showed that LLBFR increased muscle strength, muscle endurance, and thigh bone-free lean mass in the absence of improvements in mitochondrial OXPHOS. LLRE improved muscle strength and mitochondrial OXPHOS in the absence of improvements in thigh bone-free lean mass or muscle endurance.
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Affiliation(s)
- Brett H. Davis
- School of KinesiologyLouisiana State UniversityBaton RougeLouisianaUSA
| | - James E. Stampley
- School of KinesiologyLouisiana State UniversityBaton RougeLouisianaUSA
| | - Joshua Granger
- School of KinesiologyLouisiana State UniversityBaton RougeLouisianaUSA
| | - Matthew C. Scott
- School of KinesiologyLouisiana State UniversityBaton RougeLouisianaUSA
- Pennington Biomedical Research CenterLouisiana State UniversityBaton RougeLouisianaUSA
| | - Timothy D. Allerton
- Pennington Biomedical Research CenterLouisiana State UniversityBaton RougeLouisianaUSA
| | - Neil M. Johannsen
- School of KinesiologyLouisiana State UniversityBaton RougeLouisianaUSA
- Pennington Biomedical Research CenterLouisiana State UniversityBaton RougeLouisianaUSA
| | - Guillaume Spielmann
- School of KinesiologyLouisiana State UniversityBaton RougeLouisianaUSA
- Pennington Biomedical Research CenterLouisiana State UniversityBaton RougeLouisianaUSA
| | - Brian A. Irving
- School of KinesiologyLouisiana State UniversityBaton RougeLouisianaUSA
- Pennington Biomedical Research CenterLouisiana State UniversityBaton RougeLouisianaUSA
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Gene J, Colado JC, Perez-Castilla A, García-Ramos A, Redondo B, Jiménez R, Vera J, Martín-Rivera F. Acute Intraocular Pressure Responses to Resistance Training in Combination With Blood Flow Restriction. RESEARCH QUARTERLY FOR EXERCISE AND SPORT 2023; 94:1110-1116. [PMID: 36130122 DOI: 10.1080/02701367.2022.2119197] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 08/22/2022] [Indexed: 06/15/2023]
Abstract
Objective: To determine the effect of blood flow restriction (BFR) applied to the legs at different pressures (40% and 60%) on intraocular pressure (IOP) during the execution of ten repetitions maximum (10RM) in the half-squat exercise. Methods: Quasi-experimental, prospective study with 17 healthy physically active subjects (9 males and 8 females; 24.1 ± 4.2 years). Two sessions were conducted. The 10RM load was determined in the first session. The second session consisted of 10RM under three BFR conditions (no-BFR, 40%-BFR, and 60%-BFR) that were applied in random order. IOP was measured before each condition, immediately after each repetition, and after 1 minute of passive recovery. A two-way repeated-measures ANOVA (restriction type [no-BFR, 40%-BFR, and 60%-BFR] x measurement point [basal, repetitions 1-10, and recovery]) was applied on the IOP measurements. Results: A significant main effect of the BFR condition (p = .022, ƞp2 = 0.21) was observed due to the significantly higher mean IOP values for the 60%-BFR (19.0 ± 0.7 mmHg) compared to the no-BFR (18.0 ± 0.8 mmHg; p = .048, dunb = 1.30). Non-significant differences with a large effect size were reached between 60%-BFR and 40%-BFR (18.1 ± 0.8 mmHg; p = .081, dunb = 1.16) and between no-BFR and 40%-BFR (p = .686, dunb = 0.18). IOP increased approximately 3-4 mmHg from baseline to the last repetition. Conclusions: Low-pressure BFR (40%-BFR) in combination with moderate-load (10RM load) resistance exercise could be an effective and safe strength training strategy while avoiding IOP peaks associated with heavy-load resistance exercises. These findings incorporate novel insights into the most effective exercise strategies in individuals who need to maintain stable IOP levels (e.g., glaucoma patients).
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Castilla-López C, Romero-Franco N. Low-load strength resistance training with blood flow restriction compared with high-load strength resistance training on performance of professional soccer players: a randomized controlled trial. J Sports Med Phys Fitness 2023; 63:1146-1154. [PMID: 37535339 DOI: 10.23736/s0022-4707.23.14974-7] [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: 08/04/2023]
Abstract
BACKGROUND The aim of this study is to evaluate the effectiveness of low-load blood flow restriction strength resistance training (LL-BFR) compared to high load strength resistance training (HL) on performance of professional soccer players. METHODS Eighteen male players from National Soccer Professional League were randomly allocated into two groups: LL-BFR, who performed a 6-weeks strength training program with low load (20-35% of one-repetition maximum-[1RM]), or HL, who performed a 6-week resistance training program with high load (70-85% 1RM). Before and after, thigh girth, vertical jump, lower limb strength, vertical force-velocity profile (F-v), and 30-m sprint were evaluated. RESULTS After the training program, both LL-BFR and HL induced significant increases compared to baseline in thigh girth (+3.3% for LL-BFR and +3.1% for HL) and maximal velocity during sprinting (+6.0 and +6.2%, respectively), without between-group differences. In reference to FV, only HL players improved imbalance (-54.4%), maximal theoretical force production (+10.4%) and decreased extension velocity (-20.5%) compared to baseline, without between-group differences. Only LL-BFR induced increases in maximum voluntary contraction of left hamstring compared to baseline (+13.8%), without between-group differences. No differences were shown for the rest of variables (P>0.05). CONCLUSIONS Although LL-BFR may increase muscle circumference and sprint ability, these results are similar to those induced with HL in male professional soccer. In terms of F-v, only HL induced improvements, but these changes were not greater than those observed after LL-BFR.
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Affiliation(s)
| | - Natalia Romero-Franco
- Department of Nursing and Physiotherapy, University of the Balearic Islands, Palma, Spain
- Health Research Institute of the Balearic Islands (IIdISBa), Palma, Spain
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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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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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Mannozzi J, Al-Hassan MH, Kaur J, Lessanework B, Alvarez A, Massoud L, Aoun K, Spranger M, O'Leary DS. Blood flow restriction training activates the muscle metaboreflex during low-intensity sustained exercise. J Appl Physiol (1985) 2023; 135:260-270. [PMID: 37348015 PMCID: PMC10393340 DOI: 10.1152/japplphysiol.00274.2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 06/09/2023] [Indexed: 06/24/2023] Open
Abstract
Blood flow restriction training (BFRT) employs partial vascular occlusion of exercising muscle and has been shown to increase muscle performance while using reduced workload and training time. Numerous studies have demonstrated that BFRT increases muscle hypertrophy, mitochondrial function, and beneficial vascular adaptations. However, changes in cardiovascular hemodynamics during the exercise protocol remain unknown, as most studies measured blood pressure before the onset and after the cessation of exercise. With reduced perfusion to the exercising muscle during BFRT, the resultant accumulation of metabolites within the ischemic muscle could potentially trigger a large reflex increase in blood pressure, termed the muscle metaboreflex. At low workloads, this pressor response occurs primarily via increases in cardiac output. However, when increases in cardiac output are limited (e.g., heart failure or during severe exercise), the reflex shifts to peripheral vasoconstriction as the primary mechanism to increase blood pressure, potentially increasing the risk of a cardiovascular event. Using our chronically instrumented conscious canine model, we utilized a 60% reduction in femoral blood pressure applied to the hindlimbs during steady-state treadmill exercise (3.2 km/h) to reproduce the ischemic environment observed during BFRT. We observed significant increases in heart rate (+19 ± 3 beats/min), stroke volume (+2.52 ± 1.2 mL), cardiac output (+1.21 ± 0.2 L/min), mean arterial pressure (+18.2 ± 2.4 mmHg), stroke work (+1.93 ± 0.2 L/mmHg), and nonischemic vascular conductance (+3.62 ± 1.7 mL/mmHg), indicating activation of the muscle metaboreflex.NEW & NOTEWORTHY Blood flow restriction training (BFRT) increases muscle mass, strength, and endurance. There has been minimal consideration of the reflex cardiovascular responses that could be elicited during BFRT sessions. We showed that during low-intensity exercise BFRT may trigger large reflex increases in blood pressure and sympathetic activity due to muscle metaboreflex activation. Thus, we urge caution when employing BFRT, especially in patients in whom exaggerated cardiovascular responses may occur that could cause sudden, adverse cardiovascular events.
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Affiliation(s)
- Joseph Mannozzi
- Department of Physiology, Wayne State University School of Medicine, Detroit, Michigan, United States
| | - Mohamed-Hussein Al-Hassan
- Department of Physiology, Wayne State University School of Medicine, Detroit, Michigan, United States
| | - Jasdeep Kaur
- Department of Kinesiology and Health Education, University of Texas at Austin, Austin, Texas, United States
| | - Beruk Lessanework
- Department of Physiology, Wayne State University School of Medicine, Detroit, Michigan, United States
| | - Alberto Alvarez
- Department of Physiology, Wayne State University School of Medicine, Detroit, Michigan, United States
| | - Louis Massoud
- Department of Physiology, Wayne State University School of Medicine, Detroit, Michigan, United States
| | - Kamel Aoun
- Department of Physiology, Wayne State University School of Medicine, Detroit, Michigan, United States
| | - Marty Spranger
- Department of Physiology, Michigan State University, East Lansing, Michigan, United States
| | - Donal S O'Leary
- Department of Physiology, Wayne State University School of Medicine, Detroit, Michigan, United States
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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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Mckee JR, Girard O, Peiffer JJ, Scott BR. Repeated-Sprint Training With Blood Flow Restriction: A Novel Approach to Improve Repeated-Sprint Ability? Strength Cond J 2023. [DOI: 10.1519/ssc.0000000000000771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Lauver JD, Moran A, Guilkey JP, Johnson KE, Zanchi NE, Rotarius TR. Acute Responses to Cycling Exercise With Blood Flow Restriction During Various Intensities. J Strength Cond Res 2022; 36:3366-3373. [PMID: 34341317 DOI: 10.1519/jsc.0000000000004099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
ABSTRACT Lauver, JD, Moran, A, Guilkey, JP, Johnson, KE, Zanchi, NE, and Rotarius, TR. Acute responses to cycling exercise with blood flow restriction during various intensities. J Strength Cond Res 36(12): 3366-3373, 2022-The purpose of this study was to investigate the acute physiological responses during cycling at various intensities with blood flow restriction (BFR). Subjects ( N = 9; V̇ o2 peak = 36.09 ± 5.80 ml·kg -1 ·min -1 ) performed 5 protocols: high-intensity (HIGH), control (CON-90), 90% of ventilatory threshold (VT) work rate with BFR (90-BFR), 70% of VT with BFR (70-BFR), and 30% V̇ o2 peak with BFR (30-BFR). Protocols consisted of five 2-minute work intervals interspersed with 1-minute recovery intervals. Blood flow restriction pressure was 80% of limb occlusion pressure. V̇ o2 , muscle excitation, tissue oxygen saturation (StO 2 ), discomfort, and level of perceived exertion (RPE) were assessed. Muscle excitation was higher during HIGH (302.9 ± 159.9 %BSL [baseline]) compared with 70-BFR (99.7 ± 76.4 %BSL) and 30-BFR (98.2 ± 70.5 %BSL). StO 2 was greater during 90-BFR (40.7 ± 12.5 ∆BSL), 70-BFR (34.4 ± 15.2 ∆BSL), and 30-BFR (31.9 ± 18.7 ∆BSL) compared with CON-90 (4.4 ± 11.5 ∆BSL). 90-BFR (39.6 ± 12.0 ∆BSL) resulted in a greater StO 2 -Avg compared with HIGH (20.5 ± 13.8 ∆BSL). Also, HIGH (23.68 ± 5.31 ml·kg -1 ·min -1 ) resulted in a greater V̇ o2 compared with 30-BFR (15.43 ± 3.19 ml·kg -1 ·min -1 ), 70-BFR (16.65 ± 3.26 ml·kg -1 ·min -1 ), and 90-BFR (18.28 ± 3.89 ml·kg -1 ·min -1 ); 90-BFR (intervals: 4 = 15.9 ± 2.3; intervals: 5 = 16.4 ± 2.5) resulted in a greater RPE compared with 30-BFR (intervals: 4 = 13.3 ± 1.4; intervals: 5 = 13.7 ± 1.7) during intervals 4 and 5. These results suggest that when adding BFR to various intensities of aerobic exercise, consideration should be given to peak work and VT to provide a balance between high local physiological stress and perceptual responses.
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Affiliation(s)
- Jakob D Lauver
- Department of Kinesiology, Coastal Carolina University, Conway, South Carolina
| | - Austin Moran
- Department of Kinesiology, Coastal Carolina University, Conway, South Carolina
| | - Justin P Guilkey
- Department of Kinesiology, Coastal Carolina University, Conway, South Carolina
| | - Kelly E Johnson
- Department of Kinesiology, Coastal Carolina University, Conway, South Carolina
| | - Nelo E Zanchi
- Department of Physical Education, Federal University of Maranhao (UFMA), Sao Luis, Brazil; and
| | - Timothy R Rotarius
- Department of Exercise Science and Athletic Training, Adrian College, Adrian, Michigan
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Maga M, Schönborn M, Wachsmann-Maga A, Śliwka A, Krężel J, Włodarczyk A, Olszewska M, Nowobilski R. Stimulation of the Vascular Endothelium and Angiogenesis by Blood-Flow-Restricted Exercise. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192315859. [PMID: 36497934 PMCID: PMC9739167 DOI: 10.3390/ijerph192315859] [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: 11/05/2022] [Revised: 11/26/2022] [Accepted: 11/27/2022] [Indexed: 05/06/2023]
Abstract
Blood-flow-restricted exercise (BFRE) has been gaining constantly increasing interest in rehabilitation, but its influence on endothelial functions has not been well studied yet. Our aim is to examine the influence of low-resistance BFRE on endothelial functions and angiogenesis. This prospective cross-over study involved 35 young healthy adults. They conducted a 21-min low-resistant exercise with blood flow restricted by pressure cuffs placed on arms and tights. They also did the same training but without blood flow restriction. Endothelial parameters and angiogenesis biomarkers were evaluated before and up to 20 min after exercise. Both types of exercise increased Flow-Mediated Dilatation (FMD) but elevation after BFRE was more significant compared to the controls. The stiffness index decreased only after BFRE, while the reflection index decreased significantly after both types of exercise but was higher after BFRE. Platelet endothelial cell adhesion molecule (PECAM-1) and vascular endothelial growth factor receptor 2 (VEGFR-2) concentrations were increased by both exercise types but elevations were higher after BFRE compared to the controls. Only BFRE elevated the mean serum CD34 protein concentration. Based on these results, we can assume that low-resistance BFR exercise stimulates angiogenesis and improves endothelial functions more significantly compared to the same training performed without blood flow restriction.
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Affiliation(s)
- Mikołaj Maga
- Department of Rehabilitation in Internal Diseases, Faculty of Health Sciences, Jagiellonian University Medical College, 31-066 Krakow, Poland
- Clinical Department of Angiology, University Hospital in Krakow, 30-688 Krakow, Poland
- Correspondence: ; Tel.: +48-692814418
| | - Martyna Schönborn
- Clinical Department of Angiology, University Hospital in Krakow, 30-688 Krakow, Poland
- Department of Angiology, Faculty of Medicine, Jagiellonian University Medical College, 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, 30-688 Krakow, Poland
| | - Agnieszka Śliwka
- Department of Rehabilitation in Internal Diseases, Faculty of Health Sciences, Jagiellonian University Medical College, 31-066 Krakow, Poland
| | - Jakub Krężel
- Clinical Department of Angiology, University Hospital in Krakow, 30-688 Krakow, Poland
| | - Aleksandra Włodarczyk
- Department of Angiology, Faculty of Medicine, Jagiellonian University Medical College, 30-688 Krakow, Poland
| | - Marta Olszewska
- Department of Pediatrics, Institute of Pediatrics, Faculty of Medicine, Jagiellonian University Medical College, 30-663 Krakow, Poland
| | - Roman Nowobilski
- Department of Rehabilitation in Internal Diseases, Faculty of Health Sciences, Jagiellonian University Medical College, 31-066 Krakow, Poland
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Low-Load Resistance Exercise with Blood Flow Restriction Increases Hypoxia-Induced Angiogenic Genes Expression. J Hum Kinet 2022; 84:82-91. [DOI: 10.2478/hukin-2022-0101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Abstract
The aim of the study was to determine whether low-load exercise (LL) with blood flow restriction (LL-BFR) would induce similar changes in expression of genes involved in hypoxia and angiogenesis compared to LL and high-load exercise (HL). Twenty-four males (age: 21.3 ± 1.9 years, body height: 1.74 ± 0.8 m, body mass: 73 ± 1.8 kg) were allocated into three groups: low-load exercise (LL), low-load exercise with blood-flow restriction (LL-BFR), and high-load exercise (HL). For the LL-BFR group a pneumatic cuff was inflated at 80% of the arterial occlusion pressure. All participants performed bilateral knee extension exercise, twice a week, for 8 weeks. LL and LL-BFR groups performed 3-4 sets of 15 reps at 20% 1RM, whilst the HL group performed 3-4 sets of 8-10 reps at 80% 1RM with a 60-s rest interval between sets. The hypoxia-inducible factor-1 alpha (HIF-1α) and beta (HIF-1β), vascular endothelial growth factor (VEGF), neuronal (nNOS), and inducible nitric oxide synthase (iNOS) genes expression were assessed before and after training. HIF-1α and HIF-1β mRNA levels significantly increased in the LL-BFR group and exceeded those elicited by HL and LL groups (p < .0001). VEGF gene expression was increased in both LL-BFR and HL groups, however, LL-BFR elicited a greater increase than LL (p < .0001). nNOS and iNOS genes expression significantly increased in all groups with greatest increases being observed in the LL-BFR group (p < .0001). The findings suggest that LL-BFR induces greater increases in genes expression related to hypoxia and angiogenesis than traditional resistance training.
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15
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Hori A, Saito R, Suijo K, Kushnick MR, Hasegawa D, Ishida K, Hotta N. Blood flow restriction accelerates aerobic training-induced adaptation of [Formula: see text] kinetics at the onset of moderate-intensity exercise. Sci Rep 2022; 12:18160. [PMID: 36307460 PMCID: PMC9616915 DOI: 10.1038/s41598-022-22852-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 10/20/2022] [Indexed: 12/31/2022] Open
Abstract
It is unclear whether blood flow restriction (BFR) accelerates the adaptation of the time constant (τ) of phase II oxygen uptake ([Formula: see text]) kinetics in the moderate-intensity exercise domain via moderate-intensity aerobic training. Therefore, healthy participants underwent moderate-intensity [45-60% [Formula: see text] Reserve] aerobic cycle training with or without BFR (BFR group, n = 9; CON group, n = 9) for 8 weeks to evaluate [Formula: see text] kinetics during moderate-intensity cycle exercise before (Pre) and after 4 (Mid) and 8 (Post) weeks of training. Both groups trained for 30 min, 3 days weekly. BFR was performed for 5 min every 10 min by applying cuffs to the upper thighs. The τ significantly decreased by Mid in the BFR group (23.7 ± 2.9 s [Pre], 15.3 ± 1.8 s [Mid], 15.5 ± 1.4 s [Post], P < 0.01) and by Post in the CON group (27.5 ± 2.0 s [Pre], 22.1 ± 0.7 s [Mid], 18.5 ± 1.9 s [Post], P < 0.01). Notably, the BFR group's τ was significantly lower than that of the CON group at Mid (P < 0.01) but not at Post. In conclusion, BFR accelerates the adaptation of the [Formula: see text] kinetics of phase II by moderate-intensity aerobic training.
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Affiliation(s)
- Amane Hori
- Graduate School of Life and Health Sciences, Chubu University, Kasugai, Japan
- Japan Society for the Promotion of Science, Tokyo, Japan
| | - Ryuji Saito
- College of Life and Health Sciences, Chubu University, Kasugai, Japan
| | - Kenichi Suijo
- Graduate School of Life and Health Sciences, Chubu University, Kasugai, Japan
- College of Life and Health Sciences, Chubu University, Kasugai, Japan
| | - Michael R. Kushnick
- College of Health and Human Sciences, Northern Illinois University, DeKalb, IL USA
| | - Daisuke Hasegawa
- Graduate School of Life and Health Sciences, Chubu University, Kasugai, Japan
| | - Koji Ishida
- Research Center of Health, Physical Fitness and Sports, Nagoya University, Nagoya, Japan
| | - Norio Hotta
- Graduate School of Life and Health Sciences, Chubu University, Kasugai, Japan
- College of Life and Health Sciences, Chubu University, Kasugai, Japan
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Callanan MC, Plummer HA, Green TM, Opitz T, Broderick T, Rendos N, Anz AW. Blood Flow Restriction Using a Pneumatic Tourniquet Is Not Associated With a Cellular Systemic Response. Arthrosc Sports Med Rehabil 2022; 4:e877-e882. [PMID: 35747643 PMCID: PMC9210389 DOI: 10.1016/j.asmr.2021.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 12/23/2021] [Indexed: 11/20/2022] Open
Abstract
Purpose The purpose of this study was to determine the effects of blood flow restriction (BFR) using a pneumatic tourniquet on CD34+ cells, platelets, white blood cells, neutrophils, lymphocytes, lactate, and glucose compared with standard exercise. Methods Fifteen healthy volunteers (8 males and 7 females, 28.6 ± 3.6 years old) who were able to perform the exercise sessions on a VersaClimber participated. Participants were randomized to undergo an experimental (EXP) occluded testing session using the pneumatic tourniquets on all 4 extremities and a control (CON) session. The exercise protocol concluded after 9 minutes or when participants reached a rating of perceived exertion of 20. Blood draws were performed before testing and immediately after the exercise session. Blood analysis consisted of complete blood counts as well as flow cytometry to measure peripheral CD34+ counts as a marker for hematopoietic progenitor cells (HPCs). Results A significant increase from before to after exercise values was observed in both the EXP and CON groups with CD34+, WBC counts, platelets, and lymphocytes; however, no differences existed between EXP and CON groups for any variable. CD34+ increased in the EXP (3.1 ± 1.6 vs. 4.3 ± 1.8 cells · L–1; P < .001) and CON (3.3 ± 1.9 vs. 4.4 ± 1.4 cells · L–1; P < .001) sessions. White blood cells also significantly increased in both the EXP (7.8 ± 1.4 vs. 11.8 ± 2.5 K · L–1 K · L–1; P < .001) and CON (7.5 ± 1.8 vs. 11.3 ± 3.0 K · L–1; P < .001) sessions. Platelets also increased in both the EXP (258.6 ± 52.5 vs. 309.9 ± 52.7 K · L–1; P < .001) and CON (263.1 ± 44.7 vs. 316.1 ± 43.9 K · L–1; P < .001) sessions, and conversely, a significant decrease in the average neutrophil counts in the EXP (mean difference = –13.7%; P < .001) and CON (mean difference = –13.2%; P < .001) sessions was observed. Lymphocyte counts in the EXP (mean difference = 22.8%; P < .001) and CON (mean difference = 19.3%; P < .001) sessions increased significantly. Conclusions There were no significant differences in systemic cellular responses when undergoing aerobic-based exercise with and without a pneumatic tourniquet system. Level of Evidence 2, prospective comparative study.
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Mang ZA, Realzola RA, Ducharme J, Bellissimo GF, Beam JR, Mermier C, de Castro Magalhaes F, Kravitz L, Amorim FT. The effect of repetition tempo on cardiovascular and metabolic stress when time under tension is matched during lower body exercise. Eur J Appl Physiol 2022; 122:1485-1495. [PMID: 35394146 DOI: 10.1007/s00421-022-04941-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 03/22/2022] [Indexed: 12/31/2022]
Abstract
PURPOSE To investigate the effect of repetition tempo on cardiovascular and metabolic stress when time under tension (TUT) and effort are matched during sessions of lower body resistance training (RT). METHODS In a repeated-measures, cross-over design, 11 recreationally trained females (n = 5) and males (n = 6) performed 5 sets of belt squats under the following conditions: slow-repetition tempo (SLOW; 10 reps with 4-s eccentric and 2-s concentric) and traditional-repetition tempo (TRAD; 20 reps with 2-s eccentric and 1-s concentric). TUT (60 s) was matched between conditions and external load was adjusted so that lifters were close to concentric muscular failure at the end of each set. External load, total volume load (TVL), impulse (IMP), blood lactate, ratings of perceived exertion (RPE), HR, and muscle oxygenation were measured. RESULTS Data indicated that TVL (p < 0.001), blood lactate (p = 0.017), RPE (p = 0.015), and HR (p < 0.001) were significantly greater during TRAD while external load (p = 0.030) and IMP (p = 0.002) were significantly greater during SLOW. Whether it was expressed as minimal values or change scores, muscle oxygenation was not different between protocols. CONCLUSION When TUT is matched, TVL, cardiovascular stress, metabolic stress, and perceived exertion are greater when faster repetition tempos are used. In contrast, IMP and external load are greater when slower repetition tempos are used.
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Affiliation(s)
- Zachary A Mang
- Department of Health, Exercise and Sports Sciences, University of New Mexico Albuquerque, Albuquerque, NM, USA.
| | - Rogelio A Realzola
- Department of Health, Exercise and Sports Sciences, University of New Mexico Albuquerque, Albuquerque, NM, USA
| | - Jeremy Ducharme
- Department of Health, Exercise and Sports Sciences, University of New Mexico Albuquerque, Albuquerque, NM, USA
| | | | - Jason R Beam
- School of Fitness Education, Santa Fe Community College, Santa Fe, NM, 87508, USA
| | - Christine Mermier
- Department of Health, Exercise and Sports Sciences, University of New Mexico Albuquerque, Albuquerque, NM, USA
| | - Flavio de Castro Magalhaes
- Department of Physical Education, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brazil
| | - Len Kravitz
- Department of Health, Exercise and Sports Sciences, University of New Mexico Albuquerque, Albuquerque, NM, USA
| | - Fabiano T Amorim
- Department of Health, Exercise and Sports Sciences, University of New Mexico Albuquerque, Albuquerque, NM, USA
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18
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Stanford DM, Mouser JG, Chatlaong MA, Jessee MB. A narrative review of the effects of blood flow restriction on vascular structure and function. Physiol Int 2022; 109:186-203. [PMID: 35587387 DOI: 10.1556/2060.2022.00223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 03/10/2022] [Accepted: 03/22/2022] [Indexed: 11/19/2022]
Abstract
Blood flow restriction is growing in popularity as a tool for increasing muscular size and strength. Currently, guidelines exist for using blood flow restriction alone and in combination with endurance and resistance exercise. However, only about 1.3% of practitioners familiar with blood flow restriction applications have utilized it for vascular changes, suggesting many of the guidelines are based on skeletal muscle outcomes. Thus, this narrative review is intended to explore the literature available in which blood flow restriction, or a similar application, assess the changes in vascular structure or function. Based on the literature, there is a knowledge gap in how applying blood flow restriction with relative pressures may alter the vasculature when applied alone, with endurance exercise, and with resistance exercise. In many instances, the application of blood flow restriction was not in accordance with the current guidelines, making it difficult to draw definitive conclusions as to how the vascular system would be affected. Additionally, several studies report no change in vascular structure or function, but few studies look at variables for both outcomes. By examining outcomes for both structure and function, investigators would be able to generate recommendations for the use of blood flow restriction to improve vascular structure and/or function in the future.
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Affiliation(s)
- Daphney M Stanford
- 1 The Department of Health, Exercise Science, and Recreation Management, Applied Human Health and Physical Function Laboratory, The University of Mississippi, Mississippi, MS, USA
| | - J Grant Mouser
- 2 Department of Kinesiology and Health Promotion, Applied Physiology Laboratory, Troy University, Troy, AL, USA
| | - Matthew A Chatlaong
- 1 The Department of Health, Exercise Science, and Recreation Management, Applied Human Health and Physical Function Laboratory, The University of Mississippi, Mississippi, MS, USA
| | - Matthew B Jessee
- 1 The Department of Health, Exercise Science, and Recreation Management, Applied Human Health and Physical Function Laboratory, The University of Mississippi, Mississippi, MS, USA
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The Role of Plasma Extracellular Vesicles in Remote Ischemic Conditioning and Exercise-Induced Ischemic Tolerance. Int J Mol Sci 2022; 23:ijms23063334. [PMID: 35328755 PMCID: PMC8951333 DOI: 10.3390/ijms23063334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 02/04/2023] Open
Abstract
Ischemic conditioning and exercise have been suggested for protecting against brain ischemia-reperfusion injury. However, the endogenous protective mechanisms stimulated by these interventions remain unclear. Here, in a comprehensive translational study, we investigated the protective role of extracellular vesicles (EVs) released after remote ischemic conditioning (RIC), blood flow restricted resistance exercise (BFRRE), or high-load resistance exercise (HLRE). Blood samples were collected from human participants before and at serial time points after intervention. RIC and BFRRE plasma EVs released early after stimulation improved viability of endothelial cells subjected to oxygen-glucose deprivation. Furthermore, post-RIC EVs accumulated in the ischemic area of a stroke mouse model, and a mean decrease in infarct volume was observed for post-RIC EVs, although not reaching statistical significance. Thus, circulating EVs induced by RIC and BFRRE can mediate protection, but the in vivo and translational effects of conditioned EVs require further experimental verification.
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Nascimento DDC, Rolnick N, Neto IVDS, Severin R, Beal FLR. A Useful Blood Flow Restriction Training Risk Stratification for Exercise and Rehabilitation. Front Physiol 2022; 13:808622. [PMID: 35360229 PMCID: PMC8963452 DOI: 10.3389/fphys.2022.808622] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 02/04/2022] [Indexed: 11/18/2022] Open
Abstract
Blood flow restriction training (BFRT) is a modality with growing interest in the last decade and has been recognized as a critical tool in rehabilitation medicine, athletic and clinical populations. Besides its potential for positive benefits, BFRT has the capability to induce adverse responses. BFRT may evoke increased blood pressure, abnormal cardiovascular responses and impact vascular health. Furthermore, some important concerns with the use of BFRT exists for individuals with established cardiovascular disease (e.g., hypertension, diabetes mellitus, and chronic kidney disease patients). In addition, considering the potential risks of thrombosis promoted by BFRT in medically compromised populations, BFRT use warrants caution for patients that already display impaired blood coagulability, loss of antithrombotic mechanisms in the vessel wall, and stasis caused by immobility (e.g., COVID-19 patients, diabetes mellitus, hypertension, chronic kidney disease, cardiovascular disease, orthopedic post-surgery, anabolic steroid and ergogenic substance users, rheumatoid arthritis, and pregnant/postpartum women). To avoid untoward outcomes and ensure that BFRT is properly used, efficacy endpoints such as a questionnaire for risk stratification involving a review of the patient’s medical history, signs, and symptoms indicative of underlying pathology is strongly advised. Here we present a model for BFRT pre-participation screening to theoretically reduce risk by excluding people with comorbidities or medically complex histories that could unnecessarily heighten intra- and/or post-exercise occurrence of adverse events. We propose this risk stratification tool as a framework to allow clinicians to use their knowledge, skills and expertise to assess and manage any risks related to the delivery of an appropriate BFRT exercise program. The questionnaires for risk stratification are adapted to guide clinicians for the referral, assessment, and suggestion of other modalities/approaches if/when necessary. Finally, the risk stratification might serve as a guideline for clinical protocols and future randomized controlled trial studies.
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Affiliation(s)
- Dahan da Cunha Nascimento
- Department of Physical Education, Catholic University of Brasília (UCB), Brasília, Brazil
- Department of Gerontology, Catholic University of Brasília (UCB), Brasília, Brazil
- *Correspondence: Dahan da Cunha Nascimento,
| | - Nicholas Rolnick
- The Human Performance Mechanic, Lehman College, New York, NY, United States
| | - Ivo Vieira de Sousa Neto
- Laboratory of Molecular Analysis, Graduate Program of Sciences and Technology of Health, University of Brasília, Brasília, Brazil
| | - Richard Severin
- Department of Physical Therapy, College of Applied Health Sciences, The University of Illinois at Chicago, Chicago, IL, United States
- Department of Physical Therapy, Robbins College of Health and Human Sciences, Baylor University, Waco, TX, United States
| | - Fabiani Lage Rodrigues Beal
- Department of Gerontology, Catholic University of Brasília (UCB), Brasília, Brazil
- Department of Nutrition, Health and Medicine School, Catholic University of Brasília (UCB), Brasília, Brazil
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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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22
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Mang ZA, Ducharme JB, Mermier C, Kravitz L, de Castro Magalhaes F, Amorim F. Aerobic Adaptations to Resistance Training: The Role of Time under Tension. Int J Sports Med 2022; 43:829-839. [PMID: 35088396 DOI: 10.1055/a-1664-8701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Generally, skeletal muscle adaptations to exercise are perceived through a dichotomous lens where the metabolic stress imposed by aerobic training leads to increased mitochondrial adaptations while the mechanical tension from resistance training leads to myofibrillar adaptations. However, there is emerging evidence for cross over between modalities where aerobic training stimulates traditional adaptations to resistance training (e.g., hypertrophy) and resistance training stimulates traditional adaptations to aerobic training (e.g., mitochondrial biogenesis). The latter is the focus of the current review in which we propose high-volume resistance training (i.e., high time under tension) leads to aerobic adaptations such as angiogenesis, mitochondrial biogenesis, and increased oxidative capacity. As time under tension increases, skeletal muscle energy turnover, metabolic stress, and ischemia also increase, which act as signals to activate the peroxisome proliferator-activated receptor gamma coactivator 1-alpha, which is the master regulator of mitochondrial biogenesis. For practical application, the acute stress and chronic adaptations to three specific forms of high-time under tension are also discussed: Slow-tempo, low-intensity resistance training, and drop-set resistance training. These modalities of high-time under tension lead to hallmark adaptations to resistance training such as muscle endurance, hypertrophy, and strength, but little is known about their effect on traditional aerobic training adaptations.
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Affiliation(s)
- Zachary Aaron Mang
- Health, Exercise, and Sports Science, University of New Mexico, Albuquerque, United States
| | - Jeremy B Ducharme
- Health, Exercise, and Sports Science, University of New Mexico - Albuquerque, Albuquerque, United States
| | - Christine Mermier
- Health, Exercise, and Sports Science, University of New Mexico, Albuquerque, United States
| | - Len Kravitz
- Health, Exercise, and Sports Science, University of New Mexico, Albuquerque, United States
| | - Flavio de Castro Magalhaes
- Department of Physical Education, Federal University of the Jequitinhonha and Mucuri Valleys, Diamantina, Brazil
| | - Fabiano Amorim
- Health, Exercise, and Sports Science, University of New Mexico, Albuquerque, United States
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Hughes L, Hackney KJ, Patterson SD. Optimization of Exercise Countermeasures to Spaceflight Using Blood Flow Restriction. Aerosp Med Hum Perform 2022; 93:32-45. [PMID: 35063054 DOI: 10.3357/amhp.5855.2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION: During spaceflight missions, astronauts work in an extreme environment with several hazards to physical health and performance. Exposure to microgravity results in remarkable deconditioning of several physiological systems, leading to impaired physical condition and human performance, posing a major risk to overall mission success and crew safety. Physical exercise is the cornerstone of strategies to mitigate physical deconditioning during spaceflight. Decades of research have enabled development of more optimal exercise strategies and equipment onboard the International Space Station. However, the effects of microgravity cannot be completely ameliorated with current exercise countermeasures. Moreover, future spaceflight missions deeper into space require a new generation of spacecraft, which will place yet more constraints on the use of exercise by limiting the amount, size, and weight of exercise equipment and the time available for exercise. Space agencies are exploring ways to optimize exercise countermeasures for spaceflight, specifically exercise strategies that are more efficient, require less equipment, and are less time-consuming. Blood flow restriction exercise is a low intensity exercise strategy that requires minimal equipment and can elicit positive training benefits across multiple physiological systems. This method of exercise training has potential as a strategy to optimize exercise countermeasures during spaceflight and reconditioning in terrestrial and partial gravity environments. The possible applications of blood flow restriction exercise during spaceflight are discussed herein.Hughes L, Hackney KJ, Patterson SD. Optimization of exercise countermeasures to spaceflight using blood flow restriction. Aerosp Med Hum Perform. 2021; 93(1):32-45.
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24
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Perry A, DeFroda S, Leporace G, Metsavaht L, Coxe CR, Bierman AM, Chahla J. ACL Rehabilitation: How Can We Lessen Injury Rates? OPER TECHN SPORT MED 2022. [DOI: 10.1016/j.otsm.2022.150892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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25
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Tickle PG, Hendrickse PW, Weightman A, Nazir MH, Degens H, Egginton S. Impaired skeletal muscle fatigue resistance during cardiac hypertrophy is prevented by functional overload- or exercise-induced functional capillarity. J Physiol 2021; 599:3715-3733. [PMID: 34107075 DOI: 10.1113/jp281377] [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: 01/16/2021] [Accepted: 06/04/2021] [Indexed: 11/08/2022] Open
Abstract
KEY POINTS Capillary rarefaction is hypothesized to contribute to impaired exercise tolerance in cardiovascular disease, but it remains a poorly exploited therapeutic target for improving skeletal muscle performance. Using an abdominal aortic coarctation rat model of compensatory cardiac hypertrophy, we determine the efficacy of aerobic exercise for the prevention of, and mechanical overload for, restoration of hindlimb muscle fatigue resistance and microvascular impairment in the early stages of heart disease. Impaired muscle fatigue resistance was found after development of cardiac hypertrophy, but this impairment was prevented by low-intensity aerobic exercise and recovered after mechanical stretch due to muscle overload. Changes in muscle fatigue resistance were closely related to functional (i.e. perfused) microvascular density, independent of arterial blood flow, emphasizing the critical importance of optimal capillary diffusion for skeletal muscle function. Pro-angiogenic therapies are an important tool for improving skeletal muscle function in the incipient stages of heart disease. ABSTRACT Microvascular rarefaction may contribute to declining skeletal muscle performance in cardiac and vascular diseases. It remains uncertain to what extent microvascular rarefaction occurs in the earliest stages of these conditions, if impaired blood flow is an aggravating factor and whether angiogenesis restores muscle performance. To investigate this, the effects of aerobic exercise (voluntary wheel running) and functional muscle overload on the performance, femoral blood flow (FBF) and microvascular perfusion of the extensor digitorum longus (EDL) were determined in a chronic rat model of compensatory cardiac hypertrophy (CCH, induced by surgically imposed abdominal aortic coarctation). CCH was associated with hypertension (P = 0.001 vs. Control) and increased relative heart mass (P < 0.001). Immediately upon placing the aortic band (i.e. before development of CCH), post-fatigue test FBF was reduced (P < 0.003), coinciding with attenuated fatigue resistance (P = 0.039) indicating an acute arterial perfusion constraint on muscle performance. While FBF was normalized during CCH in chronic groups (P > 0.05) fatigue resistance remained reduced (P = 0.039) and was associated with reduced (P = 0.009) functional capillarity after development of CCH without intervention, indicating a microvascular limitation to muscle performance. Normalization of functional capillarity after aerobic exercise (P = 0.065) and overload (P = 0.329) in CCH coincided with restoration to control levels of muscle fatigue resistance (P > 0.999), although overload-induced EDL hypertrophy (P = 0.027) and wheel-running velocity and duration (both P < 0.05) were attenuated after aortic banding. These data show that reductions in skeletal muscle performance during CCH can be countered by improving functional capillarity, providing a therapeutic target to improve skeletal muscle function in chronic diseases.
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Affiliation(s)
- Peter G Tickle
- School of Biomedical Sciences, University of Leeds, Leeds, UK
| | - Paul W Hendrickse
- Department of Life Sciences, Research Centre for Musculoskeletal Science & Sports Medicine, Manchester Metropolitan University, Manchester, UK.,Institute of Sport Science and Innovations, Lithuanian Sports University, Kaunas, Lithuania
| | - Andrew Weightman
- Department of Mechanical, Aerospace and Civil Engineering, University of Manchester, Manchester, UK
| | - M Hakam Nazir
- School of Biomedical Sciences, University of Leeds, Leeds, UK
| | - Hans Degens
- Department of Life Sciences, Research Centre for Musculoskeletal Science & Sports Medicine, Manchester Metropolitan University, Manchester, UK.,Institute of Sport Science and Innovations, Lithuanian Sports University, Kaunas, Lithuania
| | - Stuart Egginton
- School of Biomedical Sciences, University of Leeds, Leeds, UK
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26
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Haddock B, Hansen SK, Lindberg U, Nielsen JL, Frandsen U, Aagaard P, Larsson HBW, Suetta C. Exercise-induced fluid shifts are distinct to exercise mode and intensity: a comparison of blood flow-restricted and free-flow resistance exercise. J Appl Physiol (1985) 2021; 130:1822-1835. [PMID: 33914664 DOI: 10.1152/japplphysiol.01012.2020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
MRI can provide fundamental tools in decoding physiological stressors stimulated by training paradigms. Acute physiological changes induced by three diverse exercise protocols known to elicit similar levels of muscle hypertrophy were evaluated using muscle functional magnetic resonance imaging (mfMRI). The study was a cross-over study with participants (n = 10) performing three acute unilateral knee extensor exercise protocols to failure and a work matched control exercise protocol. Participants were scanned after each exercise protocol; 70% 1 repetition maximum (RM) (FF70); 20% 1RM (FF20); 20% 1RM with blood flow restriction (BFR20); free-flow (FF) control work matched to BFR20 (FF20WM). Post exercise mfMRI scans were used to obtain interleaved measures of muscle R2 (indicator of edema), R2' (indicator of deoxyhemoglobin), muscle cross sectional area (CSA) blood flow, and diffusion. Both BFR20 and FF20 exercise resulted in a larger acute decrease in R2, decrease in R2', and expansion of the extracellular compartment with slower rates of recovery. BFR20 caused greater acute increases in muscle CSA than FF20WM and FF70. Only BFR20 caused acute increases in intracellular volume. Postexercise muscle blood flow was higher after FF70 and FF20 exercise than BFR20. Acute changes in mean diffusivity were similar across all exercise protocols. This study was able to differentiate the acute physiological responses between anabolic exercise protocols. Low-load exercise protocols, known to have relatively higher energy contributions from glycolysis at task failure, elicited a higher mfMRI response. Noninvasive mfMRI represents a promising tool for decoding mechanisms of anabolic adaptation in muscle.NEW & NOTEWORTHY Using muscle functional MRI (mfMRI), this study was able to differentiate the acute physiological responses following three established hypertrophic resistance exercise strategies. Low-load exercise protocols performed to failure, with or without blood flow restriction, resulted in larger changes in R2 (i.e. greater T2-shifts) with a slow rate of return to baseline indicative of myocellular fluid shifts. These data were cross evaluated with interleaved measures of macrovascular blood flow, water diffusion, muscle cross sectional area (i.e. acute macroscopic muscle swelling), and intracellular water fraction measured using MRI.
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Affiliation(s)
- Bryan Haddock
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Sofie K Hansen
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Geriatric Research Unit, Department of Geriatric and Palliative Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ulrich Lindberg
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jakob Lindberg Nielsen
- Department of Sport Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Ulrik Frandsen
- Department of Sport Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Per Aagaard
- Department of Sport Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Henrik B W Larsson
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Charlotte Suetta
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Geriatric Research Unit, Department of Geriatric and Palliative Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen University Hospital, Copenhagen, Denmark.,Geriatric Research Unit, Department of Medicine Herlev and Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
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27
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Kacin A, Drobnič M, Marš T, Miš K, Petrič M, Weber D, Tomc Žargi T, Martinčič D, Pirkmajer S. Functional and molecular adaptations of quadriceps and hamstring muscles to blood flow restricted training in patients with ACL rupture. Scand J Med Sci Sports 2021; 31:1636-1646. [PMID: 33837592 DOI: 10.1111/sms.13968] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/01/2021] [Accepted: 03/26/2021] [Indexed: 12/21/2022]
Abstract
Effects of low-load blood flow restricted (LL-BFR) training remain unexplored in patients with ACL rupture. Our hypothesis was that LL-BFR training triggers augmented gains in knee muscle strength and size, which are paralleled with transcriptional responses of hypoxia-regulated genes and myokines. Eighteen volunteers (age 37.5 ± 9 years) planned for ACL reconstruction, participated in the study. Twelve were divided between BFR group, performing 9 sessions of LL-BFR exercise, and SHAM-BFR group performing equal training with sham vascular occlusion. Six subjects served as a control for muscle biopsy analysis. Cross-sectional area (CSA) and isokinetic strength of knee muscles were assessed before and after the training. Change in CSAquad was significantly (p < 0.01) larger in BFR (4.9%) compared with SHAM-BFR (1.3%). Similarly, change in peak torque of knee extensors was significantly (p < 0.05) larger in BFR (14%) compared with SHAM-BFR (-1%). The decrease in fatigue index of knee extensors (6%) was larger (p < 0.01) in BFR than in SHAM-BFR (2%). mRNA expression of HIF-1α in the vastus lateralis was reduced (p < 0.05) in SHAM-BFR, while VEGF-A mRNA tended to be higher in BFR. The mRNA expression of myostatin and its receptor were reduced (p < 0.05) in the semitendinosus after both types of training. Expression of IL-6, its receptors IL-6Rα and gp130, as well as musclin were similar in control and training groups. In conclusion, our results show augmented strength and endurance of knee extensors but less of the flexors. LL-BFR training is especially effective for conditioning of knee extensors in this population.
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Affiliation(s)
- Alan Kacin
- Department of Physiotherapy, Faculty of Health Sciences, University of Ljubljana, Ljubljana, Slovenia.,Institute of Pathophysiology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Matej Drobnič
- Department of Orthopedic Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Chair of Orthopedics, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Tomaž Marš
- Institute of Pathophysiology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Katarina Miš
- Institute of Pathophysiology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Maja Petrič
- Department of Physiotherapy, Faculty of Health Sciences, University of Ljubljana, Ljubljana, Slovenia
| | - Daša Weber
- Department of Physiotherapy, Faculty of Health Sciences, University of Ljubljana, Ljubljana, Slovenia
| | - Tina Tomc Žargi
- Department of Physiotherapy, Faculty of Health Sciences, University of Ljubljana, Ljubljana, Slovenia
| | - David Martinčič
- Department of Orthopedic Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Chair of Orthopedics, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Sergej Pirkmajer
- Institute of Pathophysiology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Yamada Y, Frith EM, Wong V, Spitz RW, Bell ZW, Chatakondi RN, Abe T, Loenneke JP. Acute exercise and cognition: A review with testable questions for future research into cognitive enhancement with blood flow restriction. Med Hypotheses 2021; 151:110586. [PMID: 33848917 DOI: 10.1016/j.mehy.2021.110586] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/12/2021] [Accepted: 03/24/2021] [Indexed: 12/01/2022]
Abstract
Blood flow restriction, in combination with low load/intensity exercise, has consistently been shown to increase both muscle size and strength. In contrast, the effects of blood flow restricted exercise on cognition have not been well studied. Therefore, the purpose of this paper is 1) to review the currently available literature investigating the impact of blood flow restricted exercise on cognition and 2) to provide some hypotheses for how blood flow restriction might provide an additive stimulus for augmenting specific cognitive domains above exercise alone. Given the lack of research in this area, the effects of blood flow restricted exercise on cognition are still unclear. We hypothesize that blood flow restricted exercise could potentially enhance several cognitive domains (such as attention, executive functioning, and memory) through increases in lactate production, catecholamine concentration, and PGC-1α expression. We review work that suggests that blood flow restriction is not only a beneficial strategy to improve musculoskeletal function but could also be a favorable method for enhancing multiple domains of cognition. Nonetheless, it must be emphasized this is a hypothesis that currently has only minimal experimental support, and further investigations in the future are necessary to test the hypothesis.
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Affiliation(s)
- Yujiro Yamada
- Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, MS 38677, USA
| | - Emily M Frith
- Department of Psychology, Cognitive Neuroscience of Creativity Laboratory, Pennsylvania State University, PA 16801, USA
| | - Vickie Wong
- Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, MS 38677, USA
| | - Robert W Spitz
- Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, MS 38677, USA
| | - Zachary W Bell
- Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, MS 38677, USA
| | - Raksha N Chatakondi
- Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, MS 38677, USA
| | - Takashi Abe
- Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, MS 38677, USA
| | - Jeremy P Loenneke
- Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, MS 38677, USA.
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29
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Pignanelli C, Christiansen D, Burr JF. Blood flow restriction training and the high-performance athlete: science to application. J Appl Physiol (1985) 2021; 130:1163-1170. [PMID: 33600282 DOI: 10.1152/japplphysiol.00982.2020] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The manipulation of blood flow in conjunction with skeletal muscle contraction has greatly informed the physiological understanding of muscle fatigue, blood pressure reflexes, and metabolism in humans. Recent interest in using intentional blood flow restriction (BFR) has focused on elucidating how exercise during periods of reduced blood flow affects typical training adaptations. A large initial appeal for BFR training was driven by studies demonstrating rapid increases in muscle size, strength, and endurance capacity, even when notably low intensities and resistances, which would typically be incapable of stimulating change in healthy populations, were used. The incorporation of BFR exercise into the training of strength- and endurance-trained athletes has recently been shown to provide additive training effects that augment skeletal muscle and cardiovascular adaptations. Recent observations suggest BFR exercise alters acute physiological stressors such as local muscle oxygen availability and vascular shear stress, which may lead to adaptations that are not easily attained with conventional training. This review explores these concepts and summarizes both the evidence base and knowledge gaps regarding the application of BFR training for athletes.
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Affiliation(s)
- Christopher Pignanelli
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Danny Christiansen
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Jamie F Burr
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
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30
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Liu Y, Jiang N, Pang F, Chen T. Resistance Training with Blood Flow Restriction on Vascular Function: A Meta-analysis. Int J Sports Med 2021; 42:577-587. [PMID: 33735919 DOI: 10.1055/a-1386-4846] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In this meta-analysis, the aims were to examine the effects of resistance training with and without blood flow restriction on vascular function. Five databases were searched up to June 2020 for papers about resistance training with blood flow restriction influence on vascular function. The quality of each identified study was evaluated. Effect sizes were estimated in terms of the standardized mean difference. A subgroup analysis was conducted according to participants' age, training duration, and cuff pressure. The results of six studies on arterial compliance and five on vascular function were highly homogenous regarding responses to resistance training with or without blood flow restriction. Resistance training with blood flow restriction had a more positive effect for regulating arterial compliance than resistance training without blood flow restriction, but not for vascular function. Resistance training with blood flow restriction leads to a more positive effect on vascular function than resistance training when training for no longer than four weeks.
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Affiliation(s)
- Yujia Liu
- Department of Physical Education, Jiangsu Normal University, Xuzhou, China
| | - Ning Jiang
- Department of Orthopedics, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Fangfang Pang
- Department of Emergency, Haigang Hospital of Yantai City, Yantai, China
| | - Tong Chen
- Department of Marxism Studies, Jiangsu Normal University, Xuzhou, China
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31
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Saatmann N, Zaharia OP, Loenneke JP, Roden M, Pesta DH. Effects of Blood Flow Restriction Exercise and Possible Applications in Type 2 Diabetes. Trends Endocrinol Metab 2021; 32:106-117. [PMID: 33358931 DOI: 10.1016/j.tem.2020.11.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/15/2020] [Accepted: 11/24/2020] [Indexed: 12/18/2022]
Abstract
Blood flow restriction resistance training (BFRT) employs partial vascular occlusion of exercising muscles via inflation cuffs. Compared with high-load resistance training, mechanical load is markedly reduced with BFRT, but induces similar gains in muscle mass and strength. BFRT is thus an effective training strategy for people with physical limitations. Recent research indicates that BFRT has beneficial effects on glucose and mitochondrial metabolism. BFRT may therefore qualify as a valuable exercise alternative for individuals with type 2 diabetes (T2D), a disorder characterized by impaired glucose metabolism, musculoskeletal decline, and exacerbated progression of sarcopenia. This review covers the effects of BFRT in healthy populations and in persons with impaired physical fitness, the mechanisms of action of this novel training modality, and possible applications for individuals with T2D.
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Affiliation(s)
- Nina Saatmann
- Institute for Clinical Diabetology, Leibniz Center for Diabetes Research at Heinrich-Heine University Düsseldorf, German Diabetes Center, Düsseldorf, Germany; German Center for Diabetes Research (DZD eV), Partner Düsseldorf, Germany
| | - Oana-Patricia Zaharia
- Institute for Clinical Diabetology, Leibniz Center for Diabetes Research at Heinrich-Heine University Düsseldorf, German Diabetes Center, Düsseldorf, Germany; German Center for Diabetes Research (DZD eV), Partner Düsseldorf, Germany
| | - Jeremy P Loenneke
- Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, Oxford, MS, USA
| | - Michael Roden
- Institute for Clinical Diabetology, Leibniz Center for Diabetes Research at Heinrich-Heine University Düsseldorf, German Diabetes Center, Düsseldorf, Germany; German Center for Diabetes Research (DZD eV), Partner Düsseldorf, Germany; Division of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University Düsseldorf, Germany
| | - Dominik H Pesta
- Institute for Clinical Diabetology, Leibniz Center for Diabetes Research at Heinrich-Heine University Düsseldorf, German Diabetes Center, Düsseldorf, Germany; German Center for Diabetes Research (DZD eV), Partner Düsseldorf, Germany; Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany; Centre for Endocrinology, Diabetes and Preventive Medicine (CEDP), University Hospital Cologne, Cologne, Germany.
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32
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Ferguson RA, Mitchell EA, Taylor CW, Bishop DJ, Christiansen D. Blood-flow-restricted exercise: Strategies for enhancing muscle adaptation and performance in the endurance-trained athlete. Exp Physiol 2021; 106:837-860. [PMID: 33486814 DOI: 10.1113/ep089280] [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: 11/21/2020] [Accepted: 01/19/2021] [Indexed: 12/15/2022]
Abstract
NEW FINDINGS What is the topic of this review? Blood-flow-restricted (BFR) exercise represents a potential approach to augment the adaptive response to training and improve performance in endurance-trained individuals. What advances does it highlight? When combined with low-load resistance exercise, low- and moderate-intensity endurance exercise and sprint interval exercise, BFR can provide an augmented acute stimulus for angiogenesis and mitochondrial biogenesis. These augmented acute responses can translate into enhanced capillary supply and mitochondrial function, and subsequent endurance-type performance, although this might depend on the nature of the exercise stimulus. There is a requirement to clarify whether BFR training interventions can be used by high-performance endurance athletes within their structured training programme. ABSTRACT A key objective of the training programme for an endurance athlete is to optimize the underlying physiological determinants of performance. Training-induced adaptations are governed by physiological and metabolic stressors, which initiate transcriptional and translational signalling cascades to increase the abundance and/or function of proteins to improve physiological function. One important consideration is that training adaptations are reduced as training status increases, which is reflected at the molecular level as a blunting of the acute signalling response to exercise. This review examines blood-flow-restricted (BFR) exercise as a strategy for augmenting exercise-induced stressors and subsequent molecular signalling responses to enhance the physiological characteristics of the endurance athlete. Focus is placed on the processes of capillary growth and mitochondrial biogenesis. Recent evidence supports that BFR exercise presents an intensified training stimulus beyond that of performing the same exercise alone. We suggest that this has the potential to induce enhanced physiological adaptations, including increases in capillary supply and mitochondrial function, which can contribute to an improvement in performance of endurance exercise. There is, however, a lack of consensus regarding the potency of BFR training, which is invariably attributable to the different modes, intensities and durations of exercise and BFR methods. Further studies are needed to confirm its potential in the endurance-trained athlete.
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Affiliation(s)
- Richard A Ferguson
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Emma A Mitchell
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Conor W Taylor
- Ineos Grenadiers Cycling Team, Bollin House, Wilmslow, UK
| | - David J Bishop
- Institute for Health and Sport (iHeS), Victoria University, Melbourne, Victoria, Australia
| | - Danny Christiansen
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
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Callanan MC, Plummer HA, Chapman GL, Opitz TJ, Rendos NK, Anz AW. Blood Flow Restriction Training Using the Delfi System Is Associated With a Cellular Systemic Response. Arthrosc Sports Med Rehabil 2020; 3:e189-e198. [PMID: 33615264 PMCID: PMC7879193 DOI: 10.1016/j.asmr.2020.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 09/04/2020] [Indexed: 01/31/2023] Open
Abstract
Purpose To determine the effects of blood flow restriction (BFR) exercise on CD34+ cells, platelets, white blood cells, neutrophils, lymphocytes, lactate, and glucose. Methods Healthy participants aged 20 to 39 years who were able to perform the exercise sessions were recruited. Participants underwent an experimental (EXP) occluded testing session and a control (CON) session using the Delfi Personalized Tourniquet System. Blood draws were performed prior to testing and immediately after the exercise session. Blood analysis consisted of a complete blood count as well as flow cytometry to measure peripheral CD34+ counts as a marker for hematopoietic progenitor cells. Results Fourteen men (aged 30.8 ± 3.9 years) volunteered. There was a significant increase in average CD34+ counts immediately after the EXP session only (3.1 ± 1.2 cells ⋅ μL-1 vs 5.2 ± 2.9 cells ⋅ μL-1, P = .012). Platelet counts were significantly elevated after both sessions, with the average increase being higher after the EXP session (mean difference [MD], 34,200/μL; P < .002) than after the CON session (MD, 11,600/μL; P < .002). White blood cell counts significantly increased after both the EXP (8,400 ± 2,200/μL vs 6,300 ± 1,600/μL; P < .001) and CON (MD, 900/μL; P < .001) sessions. There was a significant increase from baseline to immediately after exercise in the average number of lymphocytes (MD, 6.3%; P < .001) and, conversely, a significant decrease in the average neutrophil count (MD, 6.5%; P < .001) in the EXP session only. Lactate levels significantly increased in the EXP (MD, 6.1 mmol ⋅ L-1; P = .001) and CON (MD, 3.6 mmol ⋅ L-1; P = .001) groups. No changes in glucose levels were observed. Conclusions Exercise with BFR causes a significant post-exercise increase in peripheral hematopoietic progenitor cells and platelets, beyond that of standard resistance training. Clinical Relevance BFR can be considered a way to manipulate point-of-care blood products such as platelet-rich plasma to increase product yield.
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Affiliation(s)
| | - Hillary A Plummer
- Andrews Research & Education Foundation, Gulf Breeze, Florida, U.S.A
| | | | - Tyler J Opitz
- Andrews Institute for Orthopedics & Sports Medicine, Gulf Breeze, Florida, U.S.A
| | - Nicole K Rendos
- Andrews Research & Education Foundation, Gulf Breeze, Florida, U.S.A
| | - Adam W Anz
- Andrews Institute for Orthopedics & Sports Medicine, Gulf Breeze, Florida, U.S.A
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da Cunha Nascimento D, Schoenfeld BJ, Prestes J. Potential Implications of Blood Flow Restriction Exercise on Vascular Health: A Brief Review. Sports Med 2020; 50:73-81. [PMID: 31559565 DOI: 10.1007/s40279-019-01196-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Blood flow restriction (BFR) exercise (a.k.a. occlusion training) has emerged as a viable surrogate to traditional heavy-load strength rehabilitation training for a broad range of clinical populations including elderly subjects and rehabilitating athletes. A particular benefit of BFR exercise is the lower stress upon the joints as compared to traditional heavy resistance training, with similar gains in muscle strength and size. The application of an inflatable cuff to the proximal portion of the limbs increases the pressure required for venous return, leading to changes in venous compliance and wall tension. However, it is not known if long-term benefits of BFR exercise on muscle strength and size outweigh potential short and long-term complications on vascular health. BFR exercise could lead to clinical deterioration of the vasculature along with sympathetic overactivity and decreased vascular function associated with retrograde shear stress. This raises a fundamental question: Given the concern that excessive restriction could cause injury to endothelial cells and might cause detrimental effects on endothelial function, even in healthy individuals, should we critically re-evaluate the safety of this method for the general population? From this perspective, the purpose of this manuscript is to review the effects of BFR exercise on vascular function, and to provide relevant insights for training practice as well as future directions for research.
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Affiliation(s)
- Dahan da Cunha Nascimento
- Department of Physical Education, Catholic University of Brasilia (UCB), Q.S. 07, Lote 01, EPTC-Bloco G. Código Postal, Distrito Federal, Brasilia, 71966-700, Brazil. .,Department of Physical Education, University Center of the Federal District (UDF), Brasilia, Brazil.
| | | | - Jonato Prestes
- Department of Physical Education, Catholic University of Brasilia (UCB), Q.S. 07, Lote 01, EPTC-Bloco G. Código Postal, Distrito Federal, Brasilia, 71966-700, Brazil
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Vissing K, Groennebaek T, Wernbom M, Aagaard P, Raastad T. Myocellular Adaptations to Low-Load Blood Flow Restricted Resistance Training. Exerc Sport Sci Rev 2020; 48:180-187. [DOI: 10.1249/jes.0000000000000231] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Nielsen JL, Frandsen U, Jensen KY, Prokhorova TA, Dalgaard LB, Bech RD, Nygaard T, Suetta C, Aagaard P. Skeletal Muscle Microvascular Changes in Response to Short-Term Blood Flow Restricted Training-Exercise-Induced Adaptations and Signs of Perivascular Stress. Front Physiol 2020; 11:556. [PMID: 32595516 PMCID: PMC7303802 DOI: 10.3389/fphys.2020.00556] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 05/04/2020] [Indexed: 01/11/2023] Open
Abstract
Aim: Previous reports suggest that low-load muscle exercise performed under blood flow restriction (BFR) may lead to endurance adaptations. However, only few and conflicting results exist on the magnitude and timing of microvascular adaptations, overall indicating a lack of angiogenesis with BFR training. The present study, therefore, aimed to examine the effect of short-term high-frequency BFR training on human skeletal muscle vascularization. Methods: Participants completed 3 weeks of high-frequency (one to two daily sessions) training consisting of either BFR exercise [(BFRE) n = 10, 22.8 ± 2.3 years; 20% one-repetition maximum (1RM), 100 mmHg] performed to concentric failure or work-matched free-flow exercise [(CON) n = 8, 21.9 ± 3.0 years; 20% 1RM]. Muscle biopsies [vastus lateralis (VL)] were obtained at baseline, 8 days into the intervention, and 3 and 10 days after cessation of the intervention to examine capillary and perivascular adaptations, as well as angiogenesis-related protein signaling and gene expression. Results: Capillary per myofiber and capillary area (CA) increased 21–24 and 25–34%, respectively, in response to BFRE (P < 0.05–0.01), while capillary density (CD) remained unchanged. Overall, these adaptations led to a consistent elevation (15–16%) in the capillary-to-muscle area ratio following BFRE (P < 0.05–0.01). In addition, evaluation of perivascular properties indicated thickening of the perivascular basal membrane following BFRE. No or only minor changes were observed in CON. Conclusion: This study is the first to show that short-term high-frequency, low-load BFRE can lead to microvascular adaptations (i.e., capillary neoformation and changes in morphology), which may contribute to the endurance effects previously documented with BFR training. The observation of perivascular membrane thickening suggests that high-frequency BFRE may be associated with significant vascular stress.
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Affiliation(s)
- Jakob L Nielsen
- Department of Sports Science and Clinical Biomechanics and SDU Muscle Research Cluster, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Ulrik Frandsen
- Department of Sports Science and Clinical Biomechanics and SDU Muscle Research Cluster, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Kasper Y Jensen
- Department of Sports Science and Clinical Biomechanics and SDU Muscle Research Cluster, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Tatyana A Prokhorova
- Department of Sports Science and Clinical Biomechanics and SDU Muscle Research Cluster, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Line B Dalgaard
- Section for Sports Science, Department of Public Health, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Rune D Bech
- Department of Orthopaedic Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Tobias Nygaard
- Department of Orthopaedic Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Charlotte Suetta
- Geriatric Research Unit, Department of Geriatric and Palliative Medicine, Bispebjerg-Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark.,Geriatric Research Unit, Department of Medicine, Herlev-Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Per Aagaard
- Department of Sports Science and Clinical Biomechanics and SDU Muscle Research Cluster, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
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Lu Y, Patel BH, Kym C, Nwachukwu BU, Beletksy A, Forsythe B, Chahla J. Perioperative Blood Flow Restriction Rehabilitation in Patients Undergoing ACL Reconstruction: A Systematic Review. Orthop J Sports Med 2020; 8:2325967120906822. [PMID: 32232065 PMCID: PMC7097877 DOI: 10.1177/2325967120906822] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 11/25/2019] [Indexed: 12/24/2022] Open
Abstract
Background: Low-load blood flow restriction (BFR) training has attracted attention as a potentially effective method of perioperative clinical rehabilitation for patients undergoing orthopaedic procedures. Purpose: To (1) compare the effectiveness of low-load BFR training in conjunction with a standard rehabilitation protocol, pre- and postoperatively, and non-BFR interventions in patients undergoing anterior cruciate ligament reconstruction (ACLR) and (2) evaluate protocols for implementing BFR perioperatively for patients undergoing ACLR. Study Design: Systematic review; Level of evidence, 2. Methods: A systematic review of the 3 medical literature databases was conducted to identify all level 1 and 2 clinical trials published since 1990 on BFR in patients undergoing ACLR. Patient demographics from included studies were pooled. Outcome data were documented, including muscle strength and size, and perceived pain and exertion. A descriptive analysis of outcomes from BFR and non-BFR interventions was performed. Results: A total of 6 studies (154 patients; 66.2% male; mean ± SD age, 24.2 ± 3.68 years) were included. Of these, 2 studies examined low-load BFR as a preoperative intervention, 1 of which observed a significant increase in muscle isometric endurance (P = .014), surface electromyography of the vastus medialis (P < .001), and muscle blood flow to the vastus lateralis at final follow-up (P < .001) as compared with patients undergoing sham BFR. Four studies investigated low-load BFR as a postoperative intervention, and they observed significant benefits in muscle hypertrophy, as measured by cross-sectional area; strength, as measured by extensor torque; and subjective outcomes, as measured by subjective knee pain during session, over traditional low-load resistance training (all P < .05). BFR occlusion periods ranged from 3 to 5 minutes, with rest periods ranging from 45 seconds to 3 minutes. Conclusion: This systematic review found evidence on the topic of BFR rehabilitation after ACLR to be sparse and heterogeneous likely because of the relatively recent onset of its popularity. While a few authors have demonstrated the potential strength and hypertrophy benefits of perioperative BFR, future investigations with standardized outcomes, long-term follow-up, and more robust sample sizes are required to draw more definitive conclusions.
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Affiliation(s)
- Yining Lu
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Bhavik H Patel
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Craig Kym
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Benedict U Nwachukwu
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Alexander Beletksy
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Brian Forsythe
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Jorge Chahla
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
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Cai ZY, Wang WY, Lin JD, Wu CM. Effects of whole body vibration training combined with blood flow restriction on muscle adaptation. Eur J Sport Sci 2020; 21:204-212. [PMID: 32050853 DOI: 10.1080/17461391.2020.1728389] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
AbstractThis study investigated the effects of whole body vibration (WBV) training combined with blood flow restriction (BFR) on muscle fitness. Twenty physically inactive adults were randomly assigned to a WBV + BFR group (8 men and 2 women) and a WBV group (8 men and 2 women). The participants in the WBV group were subjected to 10 sets of intermittent WBV exercise 20 min/day, 3 days/week, for 8 weeks. The participants in the WBV + BFR group received the same WBV treatment, but the proximal portion of their thighs was compressed using inflatable cuffs. Dual-energy X-ray absorptiometry estimated thigh muscle mass, one repetition maximal (1RM) leg press, and muscle endurance were measured before and after the training programme. The results indicated that thigh muscle mass significantly increased (3%) after the 8-week training period only in the WBV + BFR group. Meanwhile, 1RM leg press and muscle endurance significantly increased in both groups after training (p < 0.05). Analysis of covariance revealed that the increase in 1RM leg press and muscle endurance was significantly higher (p < 0.05) in the WBV + BFR group than the WBV group (leg press: 11.1%. vs. 4.37%; muscle endurance: 48.84% vs. 15.19%, respectively). In conclusion, exposure to regular WBV + BFR training can increase thigh muscle mass, maximal strength, and muscle endurance compared with exposure to WBV training alone. WBV + BFR training appears to be a feasible strategy for improving muscle mass, strength, and endurance in previously untrained participants.
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Affiliation(s)
- Zong-Yan Cai
- Center for Physical and Health Education, Si Wan College, National Sun Yat-sen University, Kaohsiung City, Taiwan
| | - Wen-Yi Wang
- Graduate Institute of Sports Pedagogy, University of Taipei, Taipei City, Taiwan
| | - Jia-De Lin
- Department of Leisure and Sports Management, Cheng Shiu University, Kaohsiung City, Taiwan
| | - Chih-Min Wu
- Department of Leisure and Sports Management, Cheng Shiu University, Kaohsiung City, Taiwan
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Pignanelli C, Petrick HL, Keyvani F, Heigenhauser GJF, Quadrilatero J, Holloway GP, Burr JF. Low-load resistance training to task failure with and without blood flow restriction: muscular functional and structural adaptations. Am J Physiol Regul Integr Comp Physiol 2020; 318:R284-R295. [PMID: 31823670 DOI: 10.1152/ajpregu.00243.2019] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The application of blood flow restriction (BFR) during resistance exercise is increasingly recognized for its ability to improve rehabilitation and for its effectiveness in increasing muscle hypertrophy and strength among healthy populations. However, direct comparison of the skeletal muscle adaptations to low-load resistance exercise (LL-RE) and low-load BFR resistance exercise (LL-BFR) performed to task failure is lacking. Using a within-subject design, we examined whole muscle group and skeletal muscle adaptations to 6 wk of LL-RE and LL-BFR training to repetition failure. Muscle strength and size outcomes were similar for both types of training, despite ~33% lower total exercise volume (load × repetition) with LL-BFR than LL-RE (28,544 ± 1,771 vs. 18,949 ± 1,541 kg, P = 0.004). After training, only LL-BFR improved the average power output throughout the midportion of a voluntary muscle endurance task. Specifically, LL-BFR training sustained an 18% greater power output from baseline and resulted in a greater change from baseline than LL-RE (19 ± 3 vs. 3 ± 4 W, P = 0.008). This improvement occurred despite histological analysis revealing similar increases in capillary content of type I muscle fibers following LL-RE and LL-BFR training, which was primarily driven by increased capillary contacts (4.53 ± 0.23 before training vs. 5.33 ± 0.27 and 5.17 ± 0.25 after LL-RE and LL-BFR, respectively, both P < 0.05). Moreover, maximally supported mitochondrial respiratory capacity increased only in the LL-RE leg by 30% from baseline (P = 0.006). Overall, low-load resistance training increased indexes of muscle oxidative capacity and strength, which were not further augmented with the application of BFR. However, performance on a muscle endurance test was improved following BFR training.
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Affiliation(s)
- Christopher Pignanelli
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Heather L Petrick
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Fatemeh Keyvani
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
| | | | - Joe Quadrilatero
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
| | - Graham P Holloway
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Jamie F Burr
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
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Corvino RB, Oliveira MFM, Denadai BS, Rossiter HB, Caputo F. Speeding of oxygen uptake kinetics is not different following low-intensity blood-flow-restricted and high-intensity interval training. Exp Physiol 2019; 104:1858-1867. [PMID: 31613029 DOI: 10.1113/ep087727] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 10/10/2019] [Indexed: 11/08/2022]
Abstract
NEW FINDINGS What is the central question of this study? Can interval blood-flow-restricted (BFR) cycling training, undertaken at a low intensity, promote a similar adaptation to oxygen uptake ( V ̇ O 2 ) kinetics to high-intensity interval training? What is the main finding and its importance? Speeding of pulmonary V ̇ O 2 on-kinetics in healthy young subjects was not different between low-intensity interval BFR training and traditional high-intensity interval training. Given that very low workloads are well tolerated during BFR cycle training and speed V ̇ O 2 on-kinetics, this training method could be used when high mechanical loads are contraindicated. ABSTRACT Low-intensity blood-flow-restricted (BFR) endurance training is effective to increase aerobic capacity. Whether it speeds pulmonary oxygen uptake ( V ̇ O 2 p ), CO2 output ( V ̇ C O 2 p ) and ventilatory ( V ̇ Ep ) kinetics has not been examined. We hypothesized that low-intensity BFR training would reduce the phase 2 time constant (τp ) of V ̇ O 2 p , V ̇ C O 2 p and V ̇ Ep by a similar magnitude to traditional high-intensity interval training (HIT). Low-intensity interval training with BFR served as a control. Twenty-four participants (25 ± 6 years old; maximal V ̇ O 2 46 ± 6 ml kg-1 min-1 ) were assigned to one of the following: low-intensity BFR interval training (BFR; n = 8); low-intensity interval training without BFR (LOW; n = 7); or high-intensity interval training without BFR (HIT; n = 9). Training was 12 sessions of two sets of five to eight × 2 min cycling and 1 min resting intervals. LOW and BFR were conducted at 30% of peak incremental power (Ppeak ), and HIT was at ∼103% Ppeak . For BFR, cuffs were inflated on both thighs (140-200 mmHg) during exercise and deflated during rest intervals. Six moderate-intensity step transitions (30% Ppeak ) were averaged for analysis of pulmonary on-kinetics. Both BFR (pre- versus post-training τp = 18.3 ± 3.2 versus 14.5 ± 3.4 s; effect size = 1.14) and HIT (τp = 20.3 ± 4.0 versus 13.1 ± 2.9 s; effect size = 1.75) reduced the V ̇ O 2 p τp (P < 0.05). As expected, there was no change in LOW ( V ̇ O 2 p τp = 17.9 ± 6.2 versus 17.7 ± 4.3 s; P = 0.9). The kinetics of V ̇ C O 2 p and V ̇ Ep were speeded only after HIT (38.5 ± 10.6%, P < 0.001 and 31.2 ± 24.7%, P = 0.004, respectively). Both HIT and low-intensity BFR training were effective in speeding moderate-intensity V ̇ O 2 p kinetics. These data support the findings of others that low-intensity cycling training with BFR increases muscle oxidative capacity.
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Affiliation(s)
- Rogério B Corvino
- Human Performance Research Group, Center for Health and Exercise Science, Santa Catarina State University, Florianopolis, Brazil
| | - Mariana F M Oliveira
- Human Performance Research Group, Center for Health and Exercise Science, Santa Catarina State University, Florianopolis, Brazil.,Physical Effort Laboratory, Sports Center, Federal University of the State of Santa Catarina, Florianopolis, Brazil
| | - Benedito S Denadai
- Physical Effort Laboratory, Sports Center, Federal University of the State of Santa Catarina, Florianopolis, Brazil.,Human Performance Laboratory, São Paulo State University, Rio Claro, Brazil
| | - Harry B Rossiter
- Division of Pulmonary and Critical Care Physiology and Medicine, Rehabilitation Clinical Trials Center, Los Angeles Biomedical Research Center at Harbor-UCLA Medical Center, Torrance, CA, USA.,School of Biomedical Sciences, University of Leeds, Leeds, UK
| | - Fabrizio Caputo
- Human Performance Research Group, Center for Health and Exercise Science, Santa Catarina State University, Florianopolis, Brazil
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Willis SJ, Borrani F, Millet GP. High-Intensity Exercise With Blood Flow Restriction or in Hypoxia as Valuable Spaceflight Countermeasures? Front Physiol 2019; 10:1266. [PMID: 31632298 PMCID: PMC6783686 DOI: 10.3389/fphys.2019.01266] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 09/19/2019] [Indexed: 11/17/2022] Open
Affiliation(s)
- Sarah J Willis
- Faculty of Biology and Medicine, Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | - Fabio Borrani
- Faculty of Biology and Medicine, Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | - Grégoire P Millet
- Faculty of Biology and Medicine, Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
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Buckner SL, Jessee MB, Dankel SJ, Mattocks KT, Mouser JG, Bell ZW, Abe T, Bentley JP, Loenneke JP. Blood flow restriction does not augment low force contractions taken to or near task failure. Eur J Sport Sci 2019; 20:650-659. [DOI: 10.1080/17461391.2019.1664640] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Samuel L. Buckner
- Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, MS, USA
- USF Muscle Lab, Exercise Science Program, University of South Florida, Tampa, FL, USA
| | - Matthew B. Jessee
- Department of Health, Exercise Science, and Recreation Management, University of Mississippi, University, MS, USA
| | - Scott J. Dankel
- Department of Health and Exercise Science, Exercise Physiology Laboratory, Rowan University, Glassboro, NJ, USA
| | - Kevin T. Mattocks
- Department of Exercise Science, Lindenwood University, Belleville, IL, USA
| | - J. Grant Mouser
- Department of Kinesiology and Health Promotion, Troy University, Troy, AL, USA
| | - Zachary W. Bell
- Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, MS, USA
| | - Takashi Abe
- Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, MS, USA
| | - John P. Bentley
- Department of Pharmacy Administration, University of Mississippi, University, MS, USA
| | - Jeremy P. Loenneke
- Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, MS, USA
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Lopes KG, Bottino DA, Farinatti P, de Souza MDGC, Maranhão PA, de Araujo CMS, Bouskela E, Lourenço RA, de Oliveira RB. Strength training with blood flow restriction - a novel therapeutic approach for older adults with sarcopenia? A case report. Clin Interv Aging 2019; 14:1461-1469. [PMID: 31616137 PMCID: PMC6698614 DOI: 10.2147/cia.s206522] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 07/11/2019] [Indexed: 12/13/2022] Open
Abstract
Introduction A 91-year-old sedentary man presenting exhaustion, lower-limb weakness, hypertension, and history of multiple falls was diagnosed with sarcopenia – appendicular skeletal muscle mass index (ASM) of 7.10 kg/m2. Purpose To investigate the effects of strength training performed with low intensity in isolation (LI) or with blood flow restriction (LI-BFR) on strength, muscle mass, IGF-1, endothelial function, microcirculation, inflammatory biomarkers, and oxidative stress. Methods In the first 3 months, LI was performed with intensity corresponding to 30% of 1 repetition maximum, followed by 1 month of inactivity, and another 3 months of LI-BFR (similar load than LI concomitant to BFR equivalent to 50% of resting systolic blood pressure). Results LI-BFR, but not LI improved muscle mass, ASM, handgrip strength, isokinetic peak torque, IL-6, and IGF-1. Endothelial function, red blood cell velocity, and concentrations of C-reactive protein, and soluble intercellular adhesion molecules-1 improved after both LI and LI-BFR. Endothelin-1 and oxidative stress increased after LI-BFR, and lowered after LI. Conclusion LI-BFR, but not LI improved strength, muscle mass, IGF-1, endothelial function, and selected inflammatory markers in a nonagenarian sarcopenic patient. These results are promising and suggest that LI-BFR should be considered as an alternative to prevent muscle loss and improve functional fitness in frail older populations.
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Affiliation(s)
- Karynne Grutter Lopes
- Graduate Program in Clinical and Experimental Physiopathology, Faculty of Medical Sciences, Rio de Janeiro State University , Rio de Janeiro, Brazil.,Laboratory for Clinical and Experimental Research on Vascular Biology, Department of Physiological Sciences, Rio de Janeiro State University , Rio de Janeiro, Brazil
| | - Daniel Alexandre Bottino
- Graduate Program in Clinical and Experimental Physiopathology, Faculty of Medical Sciences, Rio de Janeiro State University , Rio de Janeiro, Brazil.,Laboratory for Clinical and Experimental Research on Vascular Biology, Department of Physiological Sciences, Rio de Janeiro State University , Rio de Janeiro, Brazil
| | - Paulo Farinatti
- Graduate Program in Physical Activity Sciences, Department of Physical Education, Salgado de Oliveira University , Niteroi, Brazil.,Laboratory of Physical Activity and Health Promotion, Institute of Physical Education and Sports, Rio de Janeiro State University , Rio de Janeiro, Brazil.,Graduate Program in Exercise and Sport Sciences, Institute of Physical Education and Sports, Rio de Janeiro State University , Rio de Janeiro, Brazil
| | - Maria das Graças Coelho de Souza
- Graduate Program in Clinical and Experimental Physiopathology, Faculty of Medical Sciences, Rio de Janeiro State University , Rio de Janeiro, Brazil.,Laboratory for Clinical and Experimental Research on Vascular Biology, Department of Physiological Sciences, Rio de Janeiro State University , Rio de Janeiro, Brazil
| | - Priscila Alves Maranhão
- Laboratory for Clinical and Experimental Research on Vascular Biology, Department of Physiological Sciences, Rio de Janeiro State University , Rio de Janeiro, Brazil
| | - Clara Maria Soares de Araujo
- Laboratory for Clinical and Experimental Research on Vascular Biology, Department of Physiological Sciences, Rio de Janeiro State University , Rio de Janeiro, Brazil
| | - Eliete Bouskela
- Graduate Program in Clinical and Experimental Physiopathology, Faculty of Medical Sciences, Rio de Janeiro State University , Rio de Janeiro, Brazil.,Laboratory for Clinical and Experimental Research on Vascular Biology, Department of Physiological Sciences, Rio de Janeiro State University , Rio de Janeiro, Brazil
| | - Roberto Alves Lourenço
- Research Laboratory on Human Aging, Internal Medicine Department, Faculty of Medical Sciences, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Ricardo Brandão de Oliveira
- Graduate Program in Clinical and Experimental Physiopathology, Faculty of Medical Sciences, Rio de Janeiro State University , Rio de Janeiro, Brazil.,Graduate Program in Exercise and Sport Sciences, Institute of Physical Education and Sports, Rio de Janeiro State University , Rio de Janeiro, Brazil.,Laboratory of Active Living, Rio de Janeiro State University, Institute of Physical Education and Sports , Rio de Janeiro, Brazil
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Montgomery R, Paterson A, Williamson C, Florida-James G, Ross MD. Blood Flow Restriction Exercise Attenuates the Exercise-Induced Endothelial Progenitor Cell Response in Healthy, Young Men. Front Physiol 2019; 10:447. [PMID: 31057427 PMCID: PMC6478759 DOI: 10.3389/fphys.2019.00447] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 04/01/2019] [Indexed: 01/02/2023] Open
Abstract
Endothelial progenitor cells (EPCs) are a vasculogenic subset of progenitors, which play a key role in maintenance of endothelial integrity. These cells are exercise-responsive, and thus exercise may play a key role in vascular repair and maintenance via mobilization of such cells. Blood flow restriction exercise, due to the augmentation of local tissue hypoxia, may promote exercise-induced EPC mobilization. Nine, healthy, young (18–30 years) males participated in the study. Participants undertook 2 trials of single leg knee extensor (KE) exercise, at 60% of thigh occlusion pressure (4 sets at 30% maximal torque) (blood flow restriction; BFR) or non- blood flow restriction (non-BFR), in a fasted state. Blood was taken prior, immediately after, and 30 min after exercise. Blood was used for the quantification of hematopoietic progenitor cells (HPCs: CD34+CD45dim), EPCs (CD34+VEGFR2+/CD34+CD45dimVEGFR2+) by flow cytometry. Our results show that unilateral KE exercise did not affect circulating HPC levels (p = 0.856), but did result in increases in both CD34+VEGFR2+ and CD34+CD45dimVEGFR2+ EPCs, but only in the non-BFR trial (CD34+VEGFR2+: 269 ± 42 cells mL-1 to 573 ± 90 cells mL-1, pre- to immediately post-exercise, p = 0.008; CD34+CD45dimVEGFR2+: 129 ± 21 cells mL-1 to 313 ± 103 cells mL-1, pre- to 30 min post-exercise, p = 0.010). In conclusion, low load BFR exercise did not result in significant circulating changes in EPCs in the post-exercise recovery period and may impair exercise-induced EPC mobilization compared to non-BFR exercise.
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Affiliation(s)
- Ryan Montgomery
- School of Applied Sciences, Edinburgh Napier University, Edinburgh, United Kingdom
| | - Allan Paterson
- School of Applied Sciences, Edinburgh Napier University, Edinburgh, United Kingdom
| | - Chris Williamson
- School of Applied Sciences, Edinburgh Napier University, Edinburgh, United Kingdom
| | | | - Mark Daniel Ross
- School of Applied Sciences, Edinburgh Napier University, Edinburgh, United Kingdom
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Mouser JG, Mattocks KT, Buckner SL, Dankel SJ, Jessee MB, Bell ZW, Abe T, Bentley JP, Loenneke JP. High-pressure blood flow restriction with very low load resistance training results in peripheral vascular adaptations similar to heavy resistance training. Physiol Meas 2019; 40:035003. [DOI: 10.1088/1361-6579/ab0d2a] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Jessee MB, Buckner SL, Mouser JG, Mattocks KT, Dankel SJ, Abe T, Bell ZW, Bentley JP, Loenneke JP. Muscle Adaptations to High-Load Training and Very Low-Load Training With and Without Blood Flow Restriction. Front Physiol 2018; 9:1448. [PMID: 30386254 PMCID: PMC6198179 DOI: 10.3389/fphys.2018.01448] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 09/24/2018] [Indexed: 11/18/2022] Open
Abstract
An inability to lift loads great enough to disrupt muscular blood flow may impair the ability to fatigue muscles, compromising the hypertrophic response. It is unknown what level of blood flow restriction (BFR) pressure, if any, is necessary to reach failure at very low-loads [i.e., 15% one-repetition maximum (1RM)]. The purpose of this study was to investigate muscular adaptations following resistance training with a very low-load alone (15/0), with moderate BFR (15/40), or with high BFR (15/80), and compare them to traditional high-load (70/0) resistance training. Using a within/between subject design, healthy young participants (n = 40) performed four sets of unilateral knee extension to failure (up to 90 repetitions/set), twice per week for 8 weeks. Data presented as mean change (95% CI). There was a condition by time interaction for 1RM (p < 0.001), which increased for 70/0 [3.15 (2.04,4.25) kg] only. A condition by time interaction (p = 0.028) revealed greater changes in endurance for 15/80 [6 (4,8) repetitions] compared to 15/0 [4 (2,6) repetitions] and 70/0 [4 (2,5) repetitions]. There was a main effect of time for isometric MVC [change = 10.51 (3.87,17.16) Nm, p = 0.002] and isokinetic MVC at 180°/s [change = 8.61 (5.54,11.68) Nm, p < 0.001], however there was no change in isokinetic MVC at 60°/s [2.45 (−1.84,6.74) Nm, p = 0.261]. Anterior and lateral muscle thickness was assessed at 30, 40, 50, and 60% of the upper leg. There was no condition by time interaction for muscle thickness sites (all p ≥ 0.313). There was a main effect of time for all sites, with increases over time (all p < 0.001). With the exception of the 30% lateral site (p = 0.059) there was also a main effect of condition (all p < 0.001). Generally, 70/0 was greater. Average weekly volume increased for all conditions across the 8 weeks, and was greatest for 70/0 followed by 15/0, 15/40, then 15/80. With the exception of 1RM, changes in strength and muscle size were similar regardless of load or restriction. The workload required to elicit these changes lowered with increased BFR pressure. These findings may be pertinent to rehabilitative settings, future research, and program design.
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Affiliation(s)
- Matthew B Jessee
- School of Kinesiology, University of Southern Mississippi, Hattiesburg, MS, United States
| | - Samuel L Buckner
- Exercise Science Program, University of South Florida, Tampa, FL, United States
| | - J Grant Mouser
- Department of Kinesiology and Health Promotion, Troy University, Troy, AL, United States
| | - Kevin T Mattocks
- Department of Exercise Science, Lindenwood University - Belleville, Belleville, IL, United States
| | - Scott J Dankel
- Kevser Ermin Applied Physiology Laboratory, Department of Health, Exercise Science, and Recreation Management, The University of Mississippi, Oxford, MS, United States
| | - Takashi Abe
- Kevser Ermin Applied Physiology Laboratory, Department of Health, Exercise Science, and Recreation Management, The University of Mississippi, Oxford, MS, United States
| | - Zachary W Bell
- Kevser Ermin Applied Physiology Laboratory, Department of Health, Exercise Science, and Recreation Management, The University of Mississippi, Oxford, MS, United States
| | - John P Bentley
- Department of Pharmacy Administration, The University of Mississippi, Oxford, MS, United States
| | - Jeremy P Loenneke
- Kevser Ermin Applied Physiology Laboratory, Department of Health, Exercise Science, and Recreation Management, The University of Mississippi, Oxford, MS, United States
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Törpel A, Herold F, Hamacher D, Müller NG, Schega L. Strengthening the Brain-Is Resistance Training with Blood Flow Restriction an Effective Strategy for Cognitive Improvement? J Clin Med 2018; 7:E337. [PMID: 30304785 PMCID: PMC6210989 DOI: 10.3390/jcm7100337] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 10/04/2018] [Accepted: 10/05/2018] [Indexed: 02/07/2023] Open
Abstract
Aging is accompanied by a decrease in physical capabilities (e.g., strength loss) and cognitive decline. The observed bidirectional relationship between physical activity and brain health suggests that physical activities could be beneficial to maintain and improve brain functioning (e.g., cognitive performance). However, the exercise type (e.g., resistance training, endurance training) and their exercise variables (e.g., load, duration, frequency) for an effective physical activity that optimally enhance cognitive performance are still unknown. There is growing evidence that resistance training induces substantial brain changes which contribute to improved cognitive functions. A relative new method in the field of resistance training is blood flow restriction training (BFR). While resistance training with BFR is widely studied in the context of muscular performance, this training strategy also induces an activation of signaling pathways associated with neuroplasticity and cognitive functions. Based on this, it seems reasonable to hypothesize that resistance training with BFR is a promising new strategy to boost the effectiveness of resistance training interventions regarding cognitive performance. To support our hypothesis, we provide rationales of possible adaptation processes induced by resistance training with BFR. Furthermore, we outline recommendations for future studies planning to investigate the effects of resistance training with BFR on cognition.
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Affiliation(s)
- Alexander Törpel
- Institute III, Department of Sport Science, Otto von Guericke University Magdeburg, Zschokkestr. 32, 39104 Magdeburg, Germany.
| | - Fabian Herold
- Research Group Neuroprotection, German Center for Neurodegenerative Diseases (DZNE), Leipziger Str. 44, 39120 Magdeburg, Germany.
| | - Dennis Hamacher
- Institute III, Department of Sport Science, Otto von Guericke University Magdeburg, Zschokkestr. 32, 39104 Magdeburg, Germany.
| | - Notger G Müller
- Research Group Neuroprotection, German Center for Neurodegenerative Diseases (DZNE), Leipziger Str. 44, 39120 Magdeburg, Germany.
- Center for Behavioral Brain Sciences (CBBS), Universitätsplatz 2, 39106 Magdeburg, Germany.
- Department of Neurology, Medical Faculty, Otto von Guericke University, Leipziger Str. 44, 39120 Magdeburg, Germany.
| | - Lutz Schega
- Institute III, Department of Sport Science, Otto von Guericke University Magdeburg, Zschokkestr. 32, 39104 Magdeburg, Germany.
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