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Fleming AR, MacDonald HV, Buckner SL, Winchester LJ. Lower limb blood flow occlusion increases systemic pressor response without increasing brachial arterial blood flow redistribution in women. Clin Physiol Funct Imaging 2024; 44:285-296. [PMID: 38402408 DOI: 10.1111/cpf.12873] [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: 05/11/2023] [Revised: 01/16/2024] [Accepted: 02/08/2024] [Indexed: 02/26/2024]
Abstract
This study was conducted to investigate the systemic hemodynamic and vascular changes in women during and after two commonly used clinical blood flow restriction (BFR) pressures at rest. There are minimal data regarding the independent effects of BFR on hemodynamic and systemic vascular changes due to pressor response, particularly among women. Therefore, this study investigated BFR-induced alterations in pressor response and systemic flow redistribution at rest during two commonly used pressures (50% and 80% limb occlusion pressure [LOP]). Fifteen women (22.1 ± 4.2 years) completed two randomised sessions involving 8-min of bilateral, lower limb restriction at 50% or 80% LOP followed by 8-min of recovery post-deflation. Changes in vascular (arterial diameter [DIA], time-averaged mean velocity [TAMV], volume flow [VF], and area) and hemodynamic (heart rate [HR] and blood pressure) measures over time (pre-, during, post-occlusion) and by session (50% vs. 80% LOP) were tested using repeated measures analysis of variance. Repeated measures correlations (rrm) quantified common intraindividual associations between BFR-induced hemodynamic and vascular responses. HR increased from baseline during 50% LOP and remained elevated during recovery (p < 0.05). HR increased from baseline during 80% LOP, while tibial VF and TAMV decreased (p < 0.03 for all). HR and TAMV values returned to baseline during recovery, while brachial artery VF decreased (p < 0.05). Changes in HR, brachial VF, and brachial TAMV were similar between 50% and 80% LOP (rrm = 0.32-0.70, p < 0.05 for all). At 80% LOP, changes in HR were positively correlated with brachial VF (rrm = 0.38) and TAMV (rrm = 0.43) and negatively correlated with tibial VF (rrm = -0.36) and TAMV (rrm = -0.30) (p < 0.05 for all). Results suggest that BFR at 80% LOP elicits an acute systemic pressor reflex without concomitant increases in brachial arterial flow, while 50% LOP elicits a subdued response.
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Affiliation(s)
- Abby R Fleming
- Department of Kinesiology, University of Alabama, Tuscaloosa, Alabama, USA
| | - Hayley V MacDonald
- Department of Kinesiology, University of Alabama, Tuscaloosa, Alabama, USA
| | - Samuel L Buckner
- Department of Educational and Psychological Studies, College of Education, University of South Florida, Tampa, Florida, USA
| | - Lee J Winchester
- Department of Kinesiology, University of Alabama, Tuscaloosa, Alabama, USA
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Spitz RW, Yamada Y, Wong V, Kataoka R, Hammert WB, Song JS, Kang A, Seffrin A, Loenneke JP. Blood flow restriction pressure for narrow cuffs (5 cm) cannot be estimated with precision. Physiol Meas 2024; 45:02NT01. [PMID: 38330491 DOI: 10.1088/1361-6579/ad278d] [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: 09/10/2023] [Accepted: 02/08/2024] [Indexed: 02/10/2024]
Abstract
Blood flow restriction pressures are set relative to the lowest pressure needed to occlude blood flow with that specific cuff. Due to pressure limitations of some devices, it is often not possible to occlude blood flow in all subjects and apply a known relative pressure in the lower body with a 5 cm wide cuff.Objective. To use a device capable of generating high pressures (up to 907 mmHg) to create and validate an estimation equation for the 5 cm cuff in the lower body using a 12 cm cuff.Approach. 170 participants had their arterial occlusion pressure (AOP) with a 5 cm and 12 cm cuff and their thigh circumference measured in their right leg. The sample was randomly allocated to a prediction group (66%) and validation group (33%). Thigh circumference and 12 cm AOP were used as predictors. A Bland-Altman plot was constructed to assess agreement between measured and predicted values.Main results. The mean difference (95% confidence interval) between the observed (336.8 mmHg) and the predicted (343.9 mmHg) 5 cm AOP was 7.1 (-11.9, 26.1) mmHg. The 95% limits of agreement were -133.6 to 147.8 mmHg. There was a negative relationship between the difference and the average of predicted and measured 5 cm AOP (B= -0.317,p= 0.000043).Significance. Although this was the first study to quantify AOP over 600 mmHg with a 5 cm cuff, our equation is not valid across all levels of pressure. If possible, larger cuff widths should be employed in the lower body.
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Affiliation(s)
- Robert W Spitz
- Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, MS, United States of America
| | - Yujiro Yamada
- Department of Health, Exercise Science, and Recreation Management. Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, MS, United States of America
| | - Vickie Wong
- Department of Sport and Health, Solent University, Southampton, Hampshire SO14 0YN, United Kingdom
| | - Ryo Kataoka
- Department of Health, Exercise Science, and Recreation Management. Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, MS, United States of America
| | - William B Hammert
- Department of Health, Exercise Science, and Recreation Management. Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, MS, United States of America
| | - Jun Seob Song
- Department of Health, Exercise Science, and Recreation Management. Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, MS, United States of America
| | - Anna Kang
- Department of Health, Exercise Science, and Recreation Management. Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, MS, United States of America
| | - Aldo Seffrin
- Department of Health, Exercise Science, and Recreation Management. Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, MS, United States of America
| | - Jeremy P Loenneke
- Department of Health, Exercise Science, and Recreation Management. Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, MS, United States of America
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Chang H, Yan J, Lu G, Chen B, Zhang J. Muscle strength adaptation between high-load resistance training versus low-load blood flow restriction training with different cuff pressure characteristics: a systematic review and meta-analysis. Front Physiol 2023; 14:1244292. [PMID: 37693006 PMCID: PMC10485702 DOI: 10.3389/fphys.2023.1244292] [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: 06/22/2023] [Accepted: 08/14/2023] [Indexed: 09/12/2023] Open
Abstract
Purpose: In this systematic review and meta-analysis, blood flow restriction (BFR) with low-load resistance training (BFR-RT) was compared with high-load resistance training (HL-RT) on muscle strength in healthy adults. The characteristics of cuff pressure suitable for muscle strength gain were also investigated by analyzing the effects of applying different occlusion pressure prescriptions and cuff inflation patterns on muscle strength gain. Methods: Literature search was conducted using PubMed, Ovid Medline, ProQuest, Cochrane Library, Embase, and Scopus databases to identify literature published until May 2023. Studies reporting the effects of BFR-RT interventions on muscle strength gain were compared with those of HL-RT. The risk of bias in the included trials was assessed using the Cochrane tool, followed by a meta-analysis to calculate the combined effect. Subgroup analysis was performed to explore the beneficial variables. Results: Nineteen articles (42 outcomes), with a total of 458 healthy adults, were included in the meta-analysis. The combined effect showed higher muscle strength gain with HL-RT than with BFR-RT (p = 0.03, SMD = -0.16, 95% CI: -0.30 to -0.01). The results of the subgroup analysis showed that the BFR-RT applied with incremental and individualized pressure achieved muscle strength gain similar to the HL-RT (p = 0.8, SMD = -0.05, 95% CI: -0.44 to 0.34; p = 0.68, SMD = -0.04, 95% CI: -0.23 to 0.15), but muscle strength gain obtained via BFR-RT applied with absolute pressure was lower than that of HL-RT (p < 0.05, SMD = -0.45, 95% CI: -0.71 to -0.19). Furthermore, muscle strength gain obtained by BFR-RT applied with intermittent pressure was similar to that obtained by HL-RT (p = 0.88, SMD = -0.02, 95% CI: -0.27 to 0.23), but muscle strength gain for BFR-RT applied with continuous pressure showed a less prominent increase than that for HL-RT (p < 0.05, SMD = -0.3, 95% CI: -0.48 to -0.11). Conclusion: In general, HL-RT produces superior muscle strength gains than BFR-RT. However, the application of individualized, incremental, and intermittent pressure exercise protocols in BFR-RT elicits comparable muscle strength gains to HL-RT. Our findings indicate that cuff pressure characteristics play a significant role in establishing a BFR-RT intervention program for enhancing muscle strength in healthy adults. Clinical Trial Registration: https://www.crd.york.ac.uk/PROSPERO/#recordDetails; Identifier: PROSPERO (CRD42022364934).
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Affiliation(s)
- Hualong Chang
- College of Physical Education and Health Sciences, Zhejiang Normal University, Jinhua, China
| | - Jing Yan
- College of Education, Anyang Normal University, Anyang, China
| | - Guiwei Lu
- College of Physical Education and Health Sciences, Zhejiang Normal University, Jinhua, China
| | - Biao Chen
- College of Physical Education and Health Sciences, Zhejiang Normal University, Jinhua, China
| | - Jianli Zhang
- Exercise and Metabolism Research Center, College of Physical Education and Health Sciences, Zhejiang Normal University, Jinhua, China
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Yamada Y, Kang A, Seffrin A, Song JS, Kataoka R, Hammert WB, Spitz RW, Wong V, Loenneke JP. Potential considerations with estimating blood flow restriction pressure in the lower body using a narrower cuff. Eur J Appl Physiol 2023; 123:937-943. [PMID: 36580110 DOI: 10.1007/s00421-022-05122-y] [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: 10/26/2022] [Accepted: 12/21/2022] [Indexed: 12/30/2022]
Abstract
Blood flow restriction pressures are typically set as a percentage of the arterial occlusion pressure. For those who do not have the ability to measure the arterial occlusion pressure, estimation equations are available. However, notable considerations are needed when estimating pressure with a narrow cuff (5 cm) in the lower body. A previously published equation in this journal was developed but was created only using 55% of the sample because the arterial occlusion of the others could not be obtained within the manufacturer's pressure limit. The purpose of this article was twofold: (1) to investigate how previous studies have implemented the equation and (2) to highlight potential concerns of using this equation. Two databases were used to locate articles that used the equation from Loenneke et al. (2015). We found that this equation had been cited 10 times to estimate arterial occlusion pressure with some notable concerns. Some did not use a 5 cm wide cuff, while others used it for participants who had arterial occlusion pressures exceeding 300 mmHg. To highlight the latter, we also applied the Loenneke et al. (2015) lower body equation to participants with arterial occlusion pressures known to exceed 300 mmHg to demonstrate potential concerns. This retrospective analysis found that 52% of the sample with known pressures over 300 mmHg (40 out of 77) would be estimated below 300 mmHg. This paper highlighted important considerations for those trying to estimate arterial occlusion pressure in the lower body with a narrow cuff (5 cm).
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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, USA
| | - Anna Kang
- Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, MS, USA
| | - Aldo Seffrin
- Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, MS, USA
| | - Jun Seob Song
- Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, MS, USA
| | - Ryo Kataoka
- Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, MS, USA
| | - William B Hammert
- Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, MS, USA
| | - Robert W Spitz
- Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, MS, USA
| | - Vickie Wong
- Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The 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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Rolnick N, Kimbrell K, de Queiros V. Beneath the cuff: Often overlooked and under-reported blood flow restriction device features and their potential impact on practice-A review of the current state of the research. Front Physiol 2023; 14:1089065. [PMID: 37064884 PMCID: PMC10099250 DOI: 10.3389/fphys.2023.1089065] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 03/06/2023] [Indexed: 04/18/2023] Open
Abstract
Training with blood flow restriction (BFR) has been shown to be a useful technique to improve muscle hypertrophy, muscle strength and a host of other physiological benefits in both healthy and clinical populations using low intensities [20%-30% 1-repetition maximum (1RM) or <50% maximum oxygen uptake (VO2max)]. However, as BFR training is gaining popularity in both practice and research, there is a lack of awareness for potentially important design characteristics and features associated with BFR cuff application that may impact the acute and longitudinal responses to training as well as the safety profile of BFR exercise. While cuff width and cuff material have been somewhat addressed in the literature, other cuff design and features have received less attention. This manuscript highlights additional cuff design and features and hypothesizes on their potential to impact the response and safety profile of BFR. Features including the presence of autoregulation during exercise, the type of bladder system used, the shape of the cuff, the set pressure versus the interface pressure, and the bladder length will be addressed as these variables have the potential to alter the responses to BFR training. As more devices enter the marketplace for consumer purchase, investigations specifically looking at their impact is warranted. We propose numerous avenues for future research to help shape the practice of BFR that may ultimately enhance efficacy and safety using a variety of BFR technologies.
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Affiliation(s)
- Nicholas Rolnick
- The Human Performance Mechanic, CUNY Lehman College, NY, United States
- *Correspondence: Nicholas Rolnick,
| | - Kyle Kimbrell
- Owens Recovery Science, San Antonio, TX, United States
| | - Victor de Queiros
- Graduate Program in Health Sciences, Federal University of Rio Grande do Norte (UFRN), NatalRN, Brazil
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Wong V, Bell ZW, Sptiz RW, Song JS, Yamada Y, Abe T, Loenneke JP. Blood flow restriction maintains blood pressure upon head-up tilt. Physiol Int 2022; 109:106-118. [PMID: 35238796 DOI: 10.1556/2060.2022.00051] [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: 12/12/2021] [Accepted: 01/15/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Orthostatic intolerance occurs in some astronauts following space flight. Although orthostatic blood pressure responses should normalize in the weeks following the return to Earth, there may be situations where an immediate short-term solution is necessary (e.g., emergency evacuation). PURPOSE The purpose of this study was to examine different levels of blood flow restriction on changes in blood pressure and heart rate when transitioning from supine to a head-up tilt and determine whether this change differs based on sex. METHODS Eighty-nine participants (45 men, 44 women) completed the three visits with different pressures (Sham, Moderate, and High) in a randomized order. Cuffs were placed on the most proximal area of the thighs. Brachial blood pressure was measured at baseline, upon inflation of the cuffs in a supine position, immediately after tilt (70°), and eight more times separated by 45 seconds. RESULTS Data are presented as mean (SD). The change in systolic (High > Moderate > Sham) [High vs Sham: 5.5 (7.4) mmHg, High vs Moderate: 3 (7.4) mmHg, and Moderate vs Sham: 2.4 (8.4) mmHg] and diastolic pressure (High > Moderate = Sham) [High vs Sham: 2.4 (5.3) mmHg, High vs Moderate: 1.9 (6.3) mmHg] differed across applied pressures. The change in heart rate was initially greatest in the sham-pressure but increased the greatest in the high-pressure condition by the end of the head-up tilt period. Additionally, there was no influence of sex. CONCLUSION Blood flow restriction applied in this study increased blood pressure in a pressure-dependent manner upon head-up tilt.
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Affiliation(s)
- Vickie Wong
- 1 Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, MS, USA
| | - Zachary W Bell
- 1 Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, MS, USA
| | - Robert W Sptiz
- 1 Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, MS, USA
| | - Jun Seob Song
- 1 Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, MS, USA
| | - Yujiro Yamada
- 1 Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, MS, USA
| | - Takashi Abe
- 2 Institute of Health and Sports Science and Medicine, Juntendo University, Inzai, Chiba 270-1695, Japan
| | - Jeremy P Loenneke
- 1 Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, MS, USA
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GARCIA NÁDIAF, MORAES CAMILADE, REBELO MACÁRIOA, PETERS SAVANAHMARIAG, CASTRO FÁBIOMDE, PUGGINA ENRICOF. Strength training with and without arteriovenous blood flow restriction improves performance, regardless of changes in muscle hypertrophy, in Wistar rats. AN ACAD BRAS CIENC 2022; 94:e20201147. [DOI: 10.1590/0001-3765202220201147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 02/13/2021] [Indexed: 11/22/2022] Open
Affiliation(s)
| | | | | | | | | | - ENRICO F. PUGGINA
- University of São Paulo (USP), Brazil; University of São Paulo (USP), Brazil
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Fallon NE, Urbina E, Whitener DV, Patel MH, Exner RJ, Dankel SJ. The impact of cuff width on perceptual responses during and following blood flow restricted walking exercise. Clin Physiol Funct Imaging 2021; 42:29-34. [PMID: 34656069 DOI: 10.1111/cpf.12732] [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: 07/19/2021] [Revised: 09/28/2021] [Accepted: 10/11/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION An appropriate comparison of different cuff widths during blood flow restricted exercise requires that the cuffs are inflated to the same relative pressures. Narrow cuffs tend to be preferred and may reduce discomfort when applied during resistance exercise, but whether this is also true during walking exercise remains unknown. METHODS Individuals completed two identical walking trials, once with 12-cm wide cuffs and once with 17-cm wide cuffs. Five 2-min walking bouts were completed at a speed of 50 m/min, with a 1-min rest period between sets. The restriction cuffs were inflated to 40% of the individuals' arterial occlusion pressure taken with each respective cuff. Individuals were asked to rate their discomfort, perceived exertion (RPE), and cuff preference. RESULTS Twenty-seven individuals completed the study. The 12-cm cuff required a higher occlusion pressure which resulted in a higher absolute pressure applied (58 vs. 52 mm Hg; BF10 = 19 331.897). Whilst there was no difference in RPE values between cuffs (BF10 = 0.474), individuals reported greater discomfort when using the wider cuffs (2.3 vs. 1.7; BF10 = 252.786). The majority of individuals (63%) preferred to use the narrower cuff, whereas fewer preferred the wider cuff (26%) and even fewer did not have a preference (11%). DISCUSSION Blood flow restricted walking exercise performed with narrower restriction cuffs appeared to reduce participant discomfort whilst also being preferred over that of wider cuffs. Future studies may wish to test the influence of different restrictive cuff widths on alterations in gait patterns during blood flow restricted walking exercise.
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Affiliation(s)
- Nicole E Fallon
- Department of Health and Exercise Science, Exercise Physiology Laboratory, Rowan University, Glassboro, New Jersey, USA
| | - Emely Urbina
- Department of Health and Exercise Science, Exercise Physiology Laboratory, Rowan University, Glassboro, New Jersey, USA
| | - Dominic V Whitener
- Department of Health and Exercise Science, Exercise Physiology Laboratory, Rowan University, Glassboro, New Jersey, USA
| | - Mana H Patel
- Department of Health and Exercise Science, Exercise Physiology Laboratory, Rowan University, Glassboro, New Jersey, USA
| | - Ryan J Exner
- Department of Health and Exercise Science, Exercise Physiology Laboratory, Rowan University, Glassboro, New Jersey, USA
| | - Scott J Dankel
- Department of Health and Exercise Science, Exercise Physiology Laboratory, Rowan University, Glassboro, New Jersey, USA
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Bielitzki R, Behrendt T, Behrens M, Schega L. Current Techniques Used for Practical Blood Flow Restriction Training: A Systematic Review. J Strength Cond Res 2021; 35:2936-2951. [PMID: 34319939 DOI: 10.1519/jsc.0000000000004104] [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: 11/08/2022]
Abstract
ABSTRACT Bielitzki, R, Behrendt, T, Behrens, M, and Schega, L. Current techniques used for practical blood flow restriction training: a systematic review. J Strength Cond Res 35(10): 2936-2951, 2021-The purpose of this article was to systematically review the available scientific evidence on current methods used for practical blood flow restriction (pBFR) training together with application characteristics as well as advantages and disadvantages of each technique. A literature search was conducted in different databases (PubMed, Web of Science, Scopus, and Cochrane Library) for the period from January 2000 to December 2020. Inclusion criteria for this review were (a) original research involving humans, (b) the use of elastic wraps or nonpneumatic cuffs, and (c) articles written in English. Of 26 studies included and reviewed, 15 were conducted using an acute intervention (11 in the lower body and 4 in the upper body), and 11 were performed with a chronic intervention (8 in the lower body, 1 in the upper body, and 2 in both the upper and the lower body). Three pBFR techniques could be identified: (a) based on the perceptual response (perceived pressure technique), (b) based on the overlap of the cuff (absolute and relative overlap technique), and (c) based on the cuffs' maximal tensile strength (maximal cuff elasticity technique). In conclusion, the perceived pressure technique is simple, valid for the first application, and can be used independently of the cuffs' material properties, but is less reliable within a person over time. The absolute and relative overlap technique as well as the maximal cuff elasticity technique might be applied more reliably due to markings, but require a cuff with constant material properties over time.
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Affiliation(s)
- Robert Bielitzki
- Department of Sport Science, Institute III, Otto von Guericke University Magdeburg, Magdeburg, Germany; and
| | - Tom Behrendt
- Department of Sport Science, Institute III, Otto von Guericke University Magdeburg, Magdeburg, Germany; and
| | - Martin Behrens
- Department of Sport Science, Institute III, Otto von Guericke University Magdeburg, Magdeburg, Germany; and
- Department of Orthopedics, University Medicine Rostock, Rostock, Germany
| | - Lutz Schega
- Department of Sport Science, Institute III, Otto von Guericke University Magdeburg, Magdeburg, Germany; and
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Differences in Femoral Artery Occlusion Pressure between Sexes and Dominant and Non-Dominant Legs. ACTA ACUST UNITED AC 2021; 57:medicina57090863. [PMID: 34577785 PMCID: PMC8471356 DOI: 10.3390/medicina57090863] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 08/21/2021] [Accepted: 08/21/2021] [Indexed: 11/17/2022]
Abstract
Background and Objectives: Blood flow restriction during low-load exercise stimulates similar muscle adaptations to those normally observed with higher loads. Differences in the arterial occlusion pressure (AOP) between limbs and between sexes are unclear. We compared the AOP of the superficial femoral artery in the dominant and non-dominant legs, and the relationship between blood flow and occlusion pressure in 35 (16 males, 19 females) young adults. Materials and Methods: Using ultrasound, we measured the AOP of the superficial femoral artery in both legs. Blood flow at occlusion pressures ranging from 0% to 100% of the AOP was measured in the dominant leg. Results: There was a significant difference in the AOP between males and females in the dominant (230 ± 41 vs. 191 ± 27 mmHg; p = 0.002) and non-dominant (209 ± 37 vs. 178 ± 21 mmHg; p = 0.004) legs, and between the dominant and non-dominant legs in males (230 ± 41 vs. 209 ± 37 mmHg; p = 0.009) but not females (191 ± 27 vs. 178 ± 21 mmHg; p = 0.053), respectively. Leg circumference was the most influential independent predictor of the AOP. There was a linear relationship between blood flow (expressed as a percentage of unoccluded blood flow) and occlusion pressure (expressed as a percentage of AOP). Conclusions: Arterial occlusion pressure is not always greater in the dominant leg or the larger leg. Practitioners should measure AOP in both limbs to determine if occlusion pressures used during exercise should be limb specific. Occlusion pressures used during blood flow restriction exercise should be chosen carefully.
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Clarkson MJ, May AK, Warmington SA. Is there rationale for the cuff pressures prescribed for blood flow restriction exercise? A systematic review. Scand J Med Sci Sports 2020; 30:1318-1336. [PMID: 32279391 DOI: 10.1111/sms.13676] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 03/12/2020] [Accepted: 03/27/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Blood flow restriction exercise has increasingly broad applications among healthy and clinical populations. Ensuring the technique is applied in a safe, controlled, and beneficial way for target populations is essential. Individualized cuff pressures are a favored method for achieving this. However, there remains marked inconsistency in how individualized cuff pressures are applied. OBJECTIVES To quantify the cuff pressures used in the broader blood flow restriction exercise literature, and determine whether there is clear justification for the choice of pressure prescribed. METHODS Studies were included in this review from database searches if they employed an experimental design using original data, involved either acute or chronic exercise using blood flow restriction, and they assessed limb or arterial occlusion pressure to determine an individualized cuff pressure. Methodologies of the studies were evaluated using a bespoke quality assessment tool. RESULTS Fifty-one studies met the inclusion criteria. Individualized cuff pressures ranged from 30% to 100% arterial occlusion pressure. Only 7 out of 52 studies attempted to justify the individualized cuff pressure applied during exercise. The mean quality rating for all studies was 11.1 ± 1.2 out of 13. CONCLUSIONS The broader blood flow restriction exercise literature uses markedly heterogeneous prescription variables despite using individualized cuff pressures. This is problematic in the absence of any clear justification for the individualized cuff pressures selected. Systematically measuring and reporting all relevant acute responses and training adaptations to the full spectrum of BFR pressures alongside increased clarity around the methodology used during blood flow restriction exercise is paramount.
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Affiliation(s)
- Matthew J Clarkson
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Vic., Australia
| | - Anthony K May
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Vic., Australia
| | - Stuart A Warmington
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Vic., Australia
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12
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Cuyul-Vásquez I, Leiva-Sepúlveda A, Catalán-Medalla O, Araya-Quintanilla F, Gutiérrez-Espinoza H. The addition of blood flow restriction to resistance exercise in individuals with knee pain: a systematic review and meta-analysis. Braz J Phys Ther 2020; 24:465-478. [PMID: 32198025 DOI: 10.1016/j.bjpt.2020.03.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 02/04/2020] [Accepted: 03/03/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Blood flow restriction (BFR) is an effective clinical intervention used to increase strength in healthy individuals. However, its effects on pain and function in individuals with knee pain are unknown. OBJECTIVE To determine the effectiveness of adding BFR to resistance exercise for pain relief and improvement of function in patients with knee pain. METHODS Systematic review with meta-analysis of randomized clinical trials. Medline, Central, Embase, PEDro, Lilacs, CINAHL, SPORTDiscus, and Web of Science databases were searched from inception to May 2019. Randomized clinical trials that compared resistance exercise with or without BFR to treat knee pain and function in individuals older than 18 years of age with knee pain were included. RESULTS Eight randomized clinical trials met the eligibility criteria and for the quantitative synthesis, five studies were included. The pooled standardized mean difference (SMD) estimate showed that resistance exercises with BFR was not more effective than resistance exercises for reducing pain (SMD: -0.37cm, 95% CI=-0.93, 0.19) and improving knee function (SMD=-0.23 points, 95% CI=-0.71, 0.26) in patients with knee pain. CONCLUSION In the short term, there is low quality of evidence that resistance exercise with BFR does not provide significant differences in pain relief and knee function compared to resistance exercises in patients with knee pain. PROSPERO registration number: CRD42018102839.
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Affiliation(s)
- Iván Cuyul-Vásquez
- Faculty of Health, Therapeutic Process Department, Temuco Catholic University, Temuco, Chile
| | | | - Oscar Catalán-Medalla
- Faculty of Health, Therapeutic Process Department, Temuco Catholic University, Temuco, Chile
| | - Felipe Araya-Quintanilla
- Rehabilitation and Health Research Center (CIRES), Universidad de las Américas, Santiago, Chile; Faculty of Health Sciences, Universidad SEK, Santiago, Chile
| | - Hector Gutiérrez-Espinoza
- Rehabilitation and Health Research Center (CIRES), Universidad de las Américas, Santiago, Chile; Physical Therapy Department, Clinical Hospital San Borja Arriaran, Santiago, Chile.
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Carvalho L, Barroso R. Author's Response. J Strength Cond Res 2019; 33:e230. [PMID: 31764478 DOI: 10.1519/jsc.0000000000003444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Leonardo Carvalho
- Department of Sport Science, School of Physical Education, University of Campinas, Campinas, Brazil
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14
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Crossley KW, Porter DA, Ellsworth J, Caldwell T, Feland JB, Mitchell U, Johnson AW, Egget D, Gifford JR. Effect of Cuff Pressure on Blood Flow during Blood Flow-restricted Rest and Exercise. Med Sci Sports Exerc 2019; 52:746-753. [PMID: 31568024 DOI: 10.1249/mss.0000000000002156] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE This study investigated the relationship between blood flow restriction (BFR) cuff pressure and blood flow at rest and during exercise, with the aim of determining if lower cuff pressures will provide an ischemic stimulus comparable to higher pressures. METHODS The relationship between blood flow and cuff pressure at rest was determined by measuring blood flow (Doppler Ultrasound) through the superficial femoral artery (SFA) in 23 adults across a range of pressures (0%-100% Arterial Occlusion Pressure at rest [rAOP]). The interplay between cuff pressure, blood flow and exercise was assessed by determining AOP at rest and during plantar flexion exercise (eAOP) and subsequently measuring the blood flow response to plantar flexion exercise with BFR cuff pressure set to either 40% rAOP or 40% eAOP. RESULTS At rest, a nonlinear relationship between cuff pressure and blood flow through the SFA exhibited a plateau at moderate pressures, with nonsignificant differences in blood flow (~9%, P = 1.0) appearing between pressures ranging from 40% to 80% rAOP. While eAOP was greater than rAOP (229 ± 1.5 mm Hg vs 202 ± 1.5 mm Hg, P < 0.01), blood flow during plantar flexion exercise did not significantly differ (P = 0.49) when applying 40% rAOP or 40% eAOP. CONCLUSIONS Blood flow through the SFA exhibits a nonlinear relationship with cuff pressure, such that cuff pressures in the range of 40% to 80% rAOP reduce blood flow to approximately the same degree. The BFR interventions opting for lower (e.g., 40% AOP), more comfortable pressures will likely provide an ischemic stimulus comparable to that of higher (80% AOP), less-comfortable pressures.
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Affiliation(s)
- Kent W Crossley
- Department of Exercise Sciences, Brigham Young University, Provo, UT
| | - Doran A Porter
- Department of Exercise Sciences, Brigham Young University, Provo, UT
| | - Joshua Ellsworth
- Department of Exercise Sciences, Brigham Young University, Provo, UT
| | - Tabitha Caldwell
- Department of Exercise Sciences, Brigham Young University, Provo, UT
| | | | | | | | - Dennis Egget
- Department of Statistics, Brigham Young University, Provo, UT
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15
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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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