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Bane A, Wilson L, Jumper J, Spindler L, Wyatt P, Willoughby D. Effects of Blood Flow Restriction Resistance Training on Autonomic and Endothelial Function in Persons with Parkinson's Disease. JOURNAL OF PARKINSON'S DISEASE 2024; 14:761-775. [PMID: 38701159 PMCID: PMC11191514 DOI: 10.3233/jpd-230259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/27/2024] [Indexed: 05/05/2024]
Abstract
Background Autonomic dysfunction precedes endothelial dysfunction in Parkinson's disease (PD) and causes blood pressure and circulation abnormalities that are highly disruptive to one's quality of life. While exercise interventions have proven helpful for motor symptoms of PD, improving associated non-motor symptoms is limited. Low-intensity resistance training with blood flow restriction (LIRT-BFR) improves autonomic dysfunction in non-PD patients and high-intensity resistance training (HIRT) is recommended for motor symptom improvements for people with PD (PwPD). Objective To determine the effects of LIRT-BFR and HIRT on homocysteine and autonomic and endothelial function in PwPD and to determine the hemodynamic loads during LIRT-BFR and HIRT in PwPD using a novel exercise protocol. Methods Thirty-eight PwPD were assigned LIRT-BFR, HIRT or to a control (CNTRL) group. The LIRT-BFR and HIRT groups exercised three days per week for four weeks. The LIRT-BFR protocol used 60% limb occlusion pressure (LOP) and performed three sets of 20 repetitions at 20% of the one-repetition maximum (1RM). The HIRT group performed three sets of eight repetitions at 80% 1RM. The CNTRL group was asked to continue their normal daily routines. Results LIRT-BFR significantly improved orthostatic hypotension (p = 0.026), homocysteine levels (p < 0.001), peripheral circulation (p = 0.003), supine blood pressure (p = 0.028) and heart rate variability (p = 0.041); LIRT-BFR improved homocysteine levels (p < 0.018), peripheral circulation (p = 0.005), supine blood pressure (p = 0.007) and heart rate variability (p = 0.047) more than HIRT; and hemodynamic loads for LIRT-BFR and HIRT were similar. Conclusions LIRT-BFR may be more effective than HIRT for autonomic and endothelial function improvements in PwPD and hemodynamic loads may be lessened in LIRT-BFR protocols using single-joint exercises with intermittent blood flow restriction. Further research is needed to determine if non-motor symptoms improve over time and if results are sustainable.
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Affiliation(s)
- Annie Bane
- Department of Kinesiology and Nutrition, Abilene Christian University, Abilene, TX, USA
| | - Lorraine Wilson
- Department of Kinesiology and Nutrition, Abilene Christian University, Abilene, TX, USA
| | - Jill Jumper
- Department of Physical Therapy, Hardin-Simmons University, Abilene, TX, USA
| | - Lindsay Spindler
- Department of Kinesiology, Health and Recreation, Hardin-Simmons University, Abilene, TX, USA
| | - Pricilla Wyatt
- Texas Tech University Health Science Center, Abilene, TX, USA
| | - Darryn Willoughby
- Physicians Assistant Program and the Exercise and Sport Science Department, University of Mary Hardin-Baylor, Belton, TX, USA
- School of Medicine, Baylor College of Medicine, Temple, TX, USA
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Russo A, Boppre G, Schmidt C, Bohn L. Chronic hemodynamic adaptations induced by resistance training with and without blood flow restriction in adults: A systematic review and meta-analysis. SPORTS MEDICINE AND HEALTH SCIENCE 2023; 5:259-268. [PMID: 38314050 PMCID: PMC10831382 DOI: 10.1016/j.smhs.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 09/05/2023] [Accepted: 09/14/2023] [Indexed: 02/06/2024] Open
Abstract
The purposes of this systematic review and meta-analysis of peer-reviewed literature were to examine the chronic effects of resistance training with blood flow restriction (RT-BFR) on hemodynamics, and to compare these adaptations to those induced by traditional resistance training (TRT) programs in adults (PROSPERO: Registry: CRD42022339510). A literature search was conducted across PubMed, Sports Discus, Scielo, and Web of Science databases. Two independent reviewers extracted study characteristics and blood pressure measures. Risk of bias (The Cochrane risk of bias tool for randomized controlled trials [RoB-2]), and the certainty of the evidence (Grading of Recommendations, Assessment, Development, and Evaluation [GRADE]) were used. A total of eight studies met the inclusion criteria for systolic (SBP), diastolic (DBP), and mean arterial pressure (MAP). Regarding the comparison of RT-BFR vs. non-exercise, no significant differences favoring the exercise group were observed (p > 0.05). However, when compared to TRT, RT-BFR elicited additional improvements on DBP (-3.35; 95%CI -6.00 to -0.71; I2 = 14%; z = -2.48, p = 0.01), and on MAP (-3.96; 95%CI -7.94 to 0.02; I2 = 43%; z = -1.95, p = 0.05). Results indicate that RT-BFR may elicit a decrease in DBP in comparison with TRT, but the lack of data addressing this topic makes any conclusion speculative. Future research on this topic is warranted.
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Affiliation(s)
- Allison Russo
- Lusofona University, Faculty of Psychology, Education and Sport, Porto, Portugal
| | - Giorjines Boppre
- University of Porto, Faculty of Sports (FADEUP), Porto, Portugal
- Human Motricity Research Center, University Adventist, Chillan, Chile
- Research Center in Physical Activity, Health, and Leisure (CIAFEL), Laboratory for Integrative and Translational Research in Population Health (ITR), Portugal
| | - Cristine Schmidt
- University of Porto, Faculty of Sports (FADEUP), Porto, Portugal
- Research Center in Physical Activity, Health, and Leisure (CIAFEL), Laboratory for Integrative and Translational Research in Population Health (ITR), Portugal
- Surgery and Physiology Department, University of Porto, Faculty of Medicine (FMUP), Porto, Portugal
| | - Lucimere Bohn
- Lusofona University, Faculty of Psychology, Education and Sport, Porto, Portugal
- University of Porto, Faculty of Sports (FADEUP), Porto, Portugal
- Research Center in Physical Activity, Health, and Leisure (CIAFEL), Laboratory for Integrative and Translational Research in Population Health (ITR), Portugal
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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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Wang Z, Atakan MM, Acar B, Xiong R, Peng L. Effects of 4-Week Low-Load Resistance Training with Blood Flow Restriction on Muscle Strength and Left Ventricular Function in Young Swimmers: A Pilot Randomized Trial. J Hum Kinet 2023; 87:63-76. [PMID: 37559761 PMCID: PMC10407315 DOI: 10.5114/jhk/163013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 01/27/2023] [Indexed: 08/11/2023] Open
Abstract
Low-load resistance training combined with blood flow restriction (BFR) is known to result in muscle hypertrophy and strength similar to that observed with higher loads. However, the effects of resistance training with BFR on cardiac structure and cardiac function remain largely unknown. Therefore, the purpose of this randomized study was to compare the effects of conventional high-load resistance training (HL-RT) with the effects of low-load resistance training with BFR (LL-BFR) on muscle strength and left ventricular function. Sixteen young swimmers (mean ± standard deviation: age = 19.7 ± 1.6 years, body mass = 78.9 ± 9.7 kg, body height = 180.8 ± 5.8 cm) were randomly allocated to a conventional HL-RT group (n = 8) or a LL-BFR group (n = 8) with a pressure band (200 mmHg) placed on both thighs of participants for 4 weeks (3 days•week-1). Outcome measures were taken at baseline and after 4 weeks of training, and included body composition, one-repetition maximum (1RM) back squat, and echocardiography measures. The 1RM back squat significantly improved (partial eta squared (Ƞ2) = 0.365; p = 0.013) in HL-RT (mean difference (Δ) = 6.6 kg; [95% confidence interval (CI) -7.09 to 20.27]) and LL-BFR groups (Δ = 14.7 kg; [95% CI 3.39 to 26.10]), with no main effect of group or group × time interaction (p > 0.05). Interventricular septum end-systolic thickness showed a slight but statistically significant increase in LL-BFR and HL-RT groups (Ƞ2 = 0.253; p = 0.047), yet there was no main effect of group or group × time interaction (p > 0.05). There were no statistically significant changes (p > 0.05) in other cardiac structure or function parameters (e.g., left ventricular (LV) mass, LV cardiac output, LV ejection fraction, LV stroke volume) after the training programs. Results suggest that 4 weeks of HL-RT and LL-BFR improve muscle strength similarly with limited effects on left ventricular function in young swimmers.
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Affiliation(s)
- Zhenhuan Wang
- Key Lab of General Administration of Sport, Southwest University, Chongqing, China
- Institute for Health and Sport, Victoria University, Footscray, Melbourne, Australia
| | - Muhammed M. Atakan
- Division of Exercise Nutrition and Metabolism, Faculty of Sport Sciences, Hacettepe University, Ankara, Turkey
| | - Burak Acar
- Department of Cardiology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Rui Xiong
- Key Lab of General Administration of Sport, Southwest University, Chongqing, China
| | - Li Peng
- Key Lab of General Administration of Sport, Southwest University, Chongqing, China
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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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Zhao Y, Zheng Y, Ma X, Qiang L, Lin A, Zhou M. Low-Intensity Resistance Exercise Combined With Blood Flow Restriction is More Conducive to Regulate Blood Pressure and Autonomic Nervous System in Hypertension Patients-Compared With High-Intensity and Low-Intensity Resistance Exercise. Front Physiol 2022; 13:833809. [PMID: 35514351 PMCID: PMC9065267 DOI: 10.3389/fphys.2022.833809] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 03/02/2022] [Indexed: 11/13/2022] Open
Abstract
Background: The effect of resistance exercise on the autonomic nervous system of patients with hypertension has not been identified. Objective: To explore a suitable resistance training method for hypertension patients to regulate blood pressure (BP) and autonomic nervous system function. Method: Forty-five hypertension patients aged between 55 and 70 years were randomly equally divided into three groups: the high-intensity resistance exercise (HE) group, the low-intensity resistance exercise combined with blood flow restriction (LE-BFR) group, and the low-intensity resistance exercise (LE) group. All patients performed quadriceps femoris resistance exercise. The exercise intensity of HE, LE-BFR and LE group was 65, 30 and 30% of one repetition maximum (1RM), respectively. The LE-BFR group used pressure cuffs to provide 130% of systolic pressure to the patient’s thighs during resistance exercise. The training program was 20 times/min/set with a 1-min break after each set, and was conducted five sets/day and 3 days/week, lasting for 12 weeks. The heart rate (HR), BP, root-mean-square of difference-value of adjacent RR intervals (RMSSD), low frequency (LF) and high frequency (HF) were evaluated before and after the first training and the last training. Result: Significant differences in HR were observed in both recovery states after the first and last training (p < 0.01). After 12 weeks of training, the recovery speed of HR in the LE-BFR group increased significantly (p < 0.01). The systolic blood pressures in the HE and LE-BFR group were significantly reduced (p < 0.05 and p < 0.01), and the differences among groups were significant (p < 0.01). In the last recovery state, the RMSSD of the LE group was significantly lower than that in the first recovery state (p < 0.01). The LF/HF ratios of the HE and LE groups in the resting and recovery states were increased significantly (all p < 0.01). LF/HF ratios in the LE-BFR group in the resting and recovery state were decreased significantly (both p < 0.01). Conclusion: Compared to HE and LE, LE-BFR could effectively decrease systolic pressure and regulate the autonomic nervous system function in hypertension patients.
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Affiliation(s)
- Yan Zhao
- School of Sports and Health, Nanjing Sport Institute, Nanjing, China
| | - Yuchan Zheng
- School of Sports and Health, Nanjing Sport Institute, Nanjing, China
| | - Xiaohuan Ma
- School of Sports and Health, Nanjing Sport Institute, Nanjing, China
| | - Lili Qiang
- Rehabilitation Hospital of Huishan District of Wuxi, Wuxi, China
| | - Aicui Lin
- Department of Science and Technology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Mo Zhou
- Department of Rehabilitation, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
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Quantifying the relationship between quadriceps strength and aerobic fitness following anterior cruciate ligament reconstruction. Phys Ther Sport 2022; 55:106-110. [DOI: 10.1016/j.ptsp.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 03/07/2022] [Accepted: 03/13/2022] [Indexed: 11/20/2022]
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Bemben DA, Sherk VD, Buchanan SR, Kim S, Sherk K, Bemben MG. Acute and Chronic Bone Marker and Endocrine Responses to Resistance Exercise With and Without Blood Flow Restriction in Young Men. Front Physiol 2022; 13:837631. [PMID: 35370772 PMCID: PMC8969015 DOI: 10.3389/fphys.2022.837631] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 02/22/2022] [Indexed: 12/28/2022] Open
Abstract
In this study, we compared acute and chronic bone marker and hormone responses to 6 weeks of low intensity (20% 1RM) blood flow restriction (BFR20) resistance training to high intensity (70% 1RM) traditional resistance training (TR70) and moderate intensity (45% 1RM) traditional resistance training (TR45) in young men (18–35 years). Participants were randomized to one of the training groups or to a control group (CON). The following training programs were performed 3 days per week for 6 weeks for knee extension and knee flexion exercises: BFR20, 20%1RM, 4 sets (30, 15, 15, 15 reps) wearing blood flow restriction cuffs around the proximal thighs; TR70, 70% 1RM 3 sets 10 reps; and TR45, 45% 1RM 3 sets 15 reps. Muscle strength and thigh cross-sectional area were assessed at baseline, between week 3 and 6 of training. Acute bone marker (Bone ALP, CTX-I) and hormone (testosterone, IGF-1, IGFBP-3, cortisol) responses were assessed at weeks 1 and 6, with blood collection done in the morning after an overnight fast. The main findings were that the acute bone formation marker (Bone ALP) showed significant changes for TR70 and BFR20 but there was no difference between weeks 1 and 6. TR70 had acute increases in testosterone, IGF-1, and IGFBP-3 (weeks 1 and 6). BFR20 had significant acute increases in testosterone (weeks 1 and 6) and in IGF-1 at week 6, while TR45 had significant acute increases in testosterone (week 1), IGF-1 (week 6), and IGFBP-3 (week 6). Strength and muscle size gains were similar for the training groups. In conclusion, low intensity BFR resistance training was effective for stimulating acute bone formation marker and hormone responses, although TR70 showed the more consistent hormone responses than the other training groups.
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Affiliation(s)
- Debra A. Bemben
- Department of Health and Exercise Science, University of Oklahoma, Norman, OK, United States
- *Correspondence: Debra A. Bemben,
| | - Vanessa D. Sherk
- Department of Orthopedics, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Samuel R. Buchanan
- Department of Health and Human Performance, University of Texas Rio Grande Valley, Edinburg, TX, United States
| | - SoJung Kim
- Department of Health and Exercise Science, Rowan University, Glassboro, NJ, United States
| | - Kyle Sherk
- Hanger Clinic, Denver, CO, United States
| | - Michael G. Bemben
- Department of Health and Exercise Science, University of Oklahoma, Norman, OK, United States
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Garcia NF, de Moraes C, Rebelo MA, de Castro FMP, Peters SMGR, Pernomian L, de Mello MMB, de Castro MM, Puggina EF. Low load strength training, associated with or without blood flow restriction increased NO production and decreased production of reactive oxygen species in the in rats aorta. Life Sci 2022; 294:120350. [PMID: 35065990 DOI: 10.1016/j.lfs.2022.120350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 01/11/2022] [Accepted: 01/17/2022] [Indexed: 10/19/2022]
Abstract
Studies have shown that strength training (ST) with blood flow restriction (BFR) in which low load is used (20-50% of 1 maximum voluntary contraction - MVC) can produce positive adaptations similar to ST with loads equal to or greater than 70% 1 MVC. Furthermore, recent studies have investigated the effects of STBFR on muscle adaptations, but few studies investigated the effects of STBFR on vascular function. This study aimed to evaluate the effects of the STBFR program on the vascular reactivity of the abdominal aorta of Wistar rats with femoral arteriovenous blood flow restriction. Male rats were divided into four groups: sedentary sham (S/S), sedentary with blood flow restriction (S/BFR), trained sham (T/S), and trained with blood flow restriction (T/BFR). The animals in the S/BFR and T/BFR groups underwent surgery to BFR in the femoral artery and vein. After one week, the trained groups started the ST which consisted of climbing ladder, six sets of 10 repetitions with 50% of 1 MVC assessed by maximum loaded weight (MLW) carried out for four weeks. Concentration-response curves to Acetylcholine (ACh: 10 nM - 100 μM) and Phenylephrine (PHE: 1 nM - 30 μM) were performed in aortic rings with intact endothelium. The production of nitric oxide (NO) and reactive oxygen species (ROS) in situ and the vascular remodeling marker (MMP-2) were also measured. The ST increased the strength of the T/S and T/BFR groups in MLW tests. The S/BFR group showed a 22% reduction in relaxation to acetylcholine, but exercise prevented this reduction in the T/BFR group. In animals without BFR, ST did not alter the response to acetylcholine. An increase in NO production was seen in T/S and T/BFR showed a reduction in ROS production (62% and 40%, respectively). In conclusion low load ST with BFR promotes similar vascular function responses to ST without BFR. Low load ST with and without BFR is interventions that can improve performance with similar magnitudes. Both training methods could have some benefits for vascular health due to NO production in the aorta increased in the T/S group and decreased production of reactive oxygen species in the T/BFR group.
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Affiliation(s)
- Nádia Fagundes Garcia
- Graduate Program in Rehabilitation and Functional Performance, Ribeirao Preto Medical School, University of São Paulo, Brazil
| | - Camila de Moraes
- School of Physical Education and Sport of Ribeirao Preto, University of Sao Paulo, Brazil
| | - Macário Arosti Rebelo
- School of Physical Education and Sport of Ribeirao Preto, University of Sao Paulo, Brazil
| | - Fábio Marzliak Pozzi de Castro
- Graduate Program in Rehabilitation and Functional Performance, Ribeirao Preto Medical School, University of São Paulo, Brazil
| | | | - Laena Pernomian
- Ribeirao Preto Medical School, University of Sao Paulo, Brazil
| | | | | | - Enrico Fuini Puggina
- Graduate Program in Rehabilitation and Functional Performance, Ribeirao Preto Medical School, University of São Paulo, Brazil; School of Physical Education and Sport of Ribeirao Preto, University of Sao Paulo, Brazil.
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Freitas EDS, Karabulut M, Bemben MG. The Evolution of Blood Flow Restricted Exercise. Front Physiol 2021; 12:747759. [PMID: 34925056 PMCID: PMC8674694 DOI: 10.3389/fphys.2021.747759] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 11/10/2021] [Indexed: 11/25/2022] Open
Abstract
The use of blood flow restricted (BFR) exercise has become an accepted alternative approach to improve skeletal muscle mass and function and improve cardiovascular function in individuals that are not able to or do not wish to use traditional exercise protocols that rely on heavy loads and high training volumes. BFR exercise involves the reduction of blood flow to working skeletal muscle by applying a flexible cuff to the most proximal portions of a person’s arms or legs that results in decreased arterial flow to the exercising muscle and occluded venous return back to the central circulation. Safety concerns, especially related to the cardiovascular system, have not been consistently reported with a few exceptions; however, most researchers agree that BFR exercise can be a relatively safe technique for most people that are free from serious cardiovascular disease, as well as those with coronary artery disease, and also for people suffering from chronic conditions, such as multiple sclerosis, Parkinson’s, and osteoarthritis. Potential mechanisms to explain the benefits of BFR exercise are still mostly speculative and may require more invasive studies or the use of animal models to fully explore mechanisms of adaptation. The setting of absolute resistive pressures has evolved, from being based on an individual’s systolic blood pressure to a relative measure that is based on various percentages of the pressures needed to totally occlude blood flow in the exercising limb. However, since several other issues remain unresolved, such as the actual external loads used in combination with BFR, the type of cuff used to induce the blood flow restriction, and whether the restriction is continuous or intermittent, this paper will attempt to address these additional concerns.
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Affiliation(s)
- Eduardo D S Freitas
- Department of Health and Exercise Science, University of Oklahoma, Norman, OK, United States
| | - Murat Karabulut
- Department of Health and Human Performance, University of Texas Rio Grande Valley, Brownsville, TX, United States
| | - Michael G Bemben
- Department of Health and Exercise Science, University of Oklahoma, Norman, OK, United States
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Cerqueira MS, Costa EC, Santos Oliveira R, Pereira R, Brito Vieira WH. Blood Flow Restriction Training: To Adjust or Not Adjust the Cuff Pressure Over an Intervention Period? Front Physiol 2021; 12:678407. [PMID: 34262476 PMCID: PMC8273389 DOI: 10.3389/fphys.2021.678407] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 06/02/2021] [Indexed: 11/13/2022] Open
Abstract
Blood flow restriction (BFR) training combines exercise and partial reduction of muscular blood flow using a pressured cuff. BFR training has been used to increase strength and muscle mass in healthy and clinical populations. A major methodological concern of BFR training is blood flow restriction pressure (BFRP) delivered during an exercise bout. Although some studies increase BFRP throughout a training intervention, it is unclear whether BFRP adjustments are pivotal to maintain an adequate BFR during a training period. While neuromuscular adaptations induced by BFR are widely studied, cardiovascular changes throughout training intervention with BFR and their possible relationship with BFRP are less understood. This study aimed to discuss the need for BFRP adjustment based on cardiovascular outcomes and provide directions for future researches. We conducted a literature review and analyzed 29 studies investigating cardiovascular adaptations following BFR training. Participants in the studies were healthy, middle-aged adults, older adults and clinical patients. Cuff pressure, when adjusted, was increased during the training period. However, cardiovascular outcomes did not provide a plausible rationale for cuff pressure increase. In contrast, avoiding increments in cuff pressure may minimize discomfort, pain and risks associated with BFR interventions, particularly in clinical populations. Given that cardiovascular adaptations induced by BFR training are conflicting, it is challenging to indicate whether increases or decreases in BFRP are needed. Based on the available evidence, we suggest that future studies investigate if maintaining or decreasing cuff pressure makes BFR training safer and/or more comfortable with similar physiological adaptation.
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Affiliation(s)
- Mikhail Santos Cerqueira
- Neuromuscular Performance Analysis Laboratory, Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Eduardo Caldas Costa
- Department of Physical Education, Federal University of Rio Grande do Norte, Natal, Brazil
| | | | - Rafael Pereira
- Integrative Physiology Research Center, Department of Biological Sciences, Universidade Estadual do Sudoeste da Bahia (UESB), Jequié, Brazil
| | - Wouber Hérickson Brito Vieira
- Neuromuscular Performance Analysis Laboratory, Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal, Brazil
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