Effects of ischaemic training on force development and fibre-type composition in human skeletal muscle

Blood Flow Restriction Enhances Rehabilitation and Return to Sport: The Paradox of Proximal Performance

The use of blood flow restriction (BFR) within rehabilitation is rapidly increasing as further research is performed elucidating purported benefits such as improved muscular strength and size, neuromuscular control, decreased pain, and increased bone mineral density. Interestingly, these benefits are not isolated to structures distal to the occlusive stimulus. Proximal gains are of high interest to rehabilitation professionals, especially those working with patients who are limited due to pain or postsurgical precautions. The review to follow will focus on current evidence and ongoing hypotheses regarding physiologic responses to BFR, current clinical applications, proximal responses to BFR training, potential practical applications for rehabilitation and injury prevention, and directions for future research. Interestingly, benefits have been found in musculature proximal to the occlusive stimulus, which may lend promise to a greater variety of patient populations and conditions. Furthermore, an increasing demand for BFR use in the sports world warrants further research for performance research and recovery.

LEVEL OF EVIDENCE

Level V, expert opinion.

Effects of training with flow restriction on the exercise pressor reflex

Purpose

We hypothesized that 5 weeks of endurance training with blood flow restriction (R-training), providing relative ischemia and stimulation of the muscle chemoreflex, would decrease the exercise pressor reflex (EPR) when compared to training with the same workload in a free-flow condition (NR-training).

Methods

10 subjects performed one-leg knee-extension training four times a week during a 5-week period. Both legs were trained with identical workload, with one leg being trained during flow-restriction induced by lower body positive pressure. The EPR was assessed by measuring the increase in heart rate (HR) and mean arterial pressure (MAP) during an isometric knee extension of 35% of max torque for 90 s, this was done before (C), and after training in each leg (R and NR, respectively).

Results

At the end of isometric contraction, the increase in mean AP (MAP) in the NR-trained leg and in the control condition were 41 ± 4 and 38 ± 4 mmHg, respectively, whereas the increase in the R-trained leg was 30 ± 4 mmHg (p < 0.05 R vs C and NR), corresponding to a decrease of about 25%. A similar patter was observed with respect to responses in HR, where the increase was 28 ± 3 and 28 ± 3 bpm in the NR and C, and 22 ± 4 in the R condition (p < 0.05 R vs C and NR).

Conclusions

Peripheral metabolic changes induced by relative ischemia are important in modifying the EPR in response to exercise training.

The effect of interval training combined with thigh cuffs pressure on maximal and submaximal exercise performance

The purpose of the study was to investigate the effect of interval training combined with a thigh cuffs pressure of +90 mmHg on maximal and submaximal cycling performance. Twenty untrained individuals were assigned either to a control (CON) or to an experimental (CUFF) training group. Both groups trained 3 days per week for 6 weeks at the same relative intensity; each training session consisted of 2-min work bout at 90% of VO(2max): 2-min active recovery bout at 50% of VO(2max). An incremental exercise test to exhaustion, a 6-min constant-power test at 80% of VO(2max) (Sub(80)) and a maximal constant-power test to exhaustion (TF(150)) were performed pre- and post-training. Despite the unchanged VO(2max), both groups significantly increased peak power output (CON: ∼12%, CUFF: ∼20%) that was accompanied by higher deoxygenation (ΔStO(2)) measured with near-infrared muscle spectroscopy. These changes were more pronounced in the CUFF group. Moreover, both groups reduced VO(2) during the Sub(80) test without concomitant changes in ΔStO(2). TF(150) was enhanced in both groups. Thus, an interval exercise training protocol under moderate restricted blood flow conditions does not provide any additive effect on maximal and submaximal cycling performance. However, it seems to induce peripheral muscular adaptations, despite the lower absolute training intensity.

Frequent low-load ischemic resistance exercise to failure enhances muscle oxygen delivery and endurance capacity

This study investigated the effects of frequent low-load ischemic resistance exercise performed to failure on quadriceps size and performance, muscle activation, oxygen kinetics and cardiovascular responses. Ten healthy males performed knee-extension exercise for 4 weeks (4 sessions/week) at 15% maximal voluntary muscle contraction (MVC). One leg was trained with free blood flow (C-leg) while in the other leg (I-leg) ischemia was induced by an inflatable cuff (≥230 mmHg). Quadriceps cross-sectional area (CSA) of the I-leg increased by 3.4% (P<0.05). A tendency for smaller increase in muscle CSAs at the cuff level was observed. MVC force did not change in either leg, whereas the number of repetitions during exercise test to failure increased (P<0.01) by 63% in I-leg and 36% in C-leg. The decrease in muscle oxygenated hemoglobin concentration acquired by NIRS was attenuated (P<0.01) by 56% in I-leg and 21% in C-leg. Electromyographic amplitude of rectus femoris in I-leg was ∼45% lower (P<0.025) during the ischemic test. Also, ∼9% increase (P<0.05) in pre-exercise diastolic pressure was observed. In conclusion, substantial gains in muscle endurance capacity were induced, which were associated with enhanced muscle oxygen delivery. The potential negative effects of ischemic exercise with high cuff pressure on muscle and nerve and on arterial pressure regulation need further investigation.

Mammalian skeletal muscle fiber type transitions

Mammalian skeletal muscle is an extremely heterogeneous tissue, composed of a large variety of fiber types. These fibers, however, are not fixed units but represent highly versatile entities capable of responding to altered functional demands and a variety of signals by changing their phenotypic profiles. This adaptive responsiveness is the basis of fiber type transitions. The fiber population of a given muscle is in a dynamic state, constantly adjusting to the current conditions. The full range of adaptive ability spans fast to slow characteristics. However, it is now clear that fiber type transitions do not proceed in immediate jumps from one extreme to the other, but occur in a graded and orderly sequential manner. At the molecular level, the best examples of these stepwise transitions are myofibrillar protein isoform exchanges. For the myosin heavy chain, this entails a sequence going from the fastest (MHCIIb) to the slowest (MHCI) isoform, and vice-versa. Depending on the basal protein isoform profile and hence the position within the fast-slow spectrum, the adaptive ranges of different fibers vary. A simple transition scheme has emerged from the multitude of data collected on fiber type conversions under a variety of conditions.

Changes in muscle oxygenation during weight-lifting exercise

The quantitative analysis of haemoglobin oxygenation of contracting human muscle during weight-lifting exercise was studied noninvasively and directly using near-infrared spectroscopy. This method was developed as a three-wavelength method which confirmed the volume changes in oxygenated haemoglobin (oxy-Hb), deoxygenated haemoglobin (deoxy-Hb) and blood volume (total-Hb; Oxy-Hb+deoxy-Hb). Nine healthy adult men with various levels of training experience took part in the study. Ten repetition maximum (10 RM) one-arm curl exercise was performed by all the subjects. Results showed that at the beginning of the 10-RM exercise, rapid increases of deoxy-Hb and decreases of oxy-Hb were observed. In addition, total-Hb gradually increased during exercise. These results corresponded to the condition of arm blood flow experimentally restricted using a tourniquet in contact with the shoulder joint, and they showed the restriction of venous blood flow and an anoxic state occurring in the dynamically contracted muscle. In three sets of lifting exercise with short rest periods, these tendencies were accelerated in each set, while total-Hb volume did not return to the resting state after the third set for more than 90 s. These results would suggest that a training regimen emphasizing a moderately high load and a high number of repetitions, and a serial set with short rest periods such as usually performed by body builders, caused a relatively long-term anoxic state in the muscle.

Effects of ischaemic training on local aerobic muscle performance in man

The aim of the study was to compare the effects of ischaemic and non-ischaemic training on aerobic performance. In 10 subjects, peak oxygen uptake (peak VO2) and time to fatigue (TTF) for one-legged exercise were measured before and after 4 weeks (4 times week-1) of one-legged training. Each training session started with one leg training for 45 min with 20% blood-flow reduction induced by local application of a supra-atmospheric external pressure of 50 mmHg (ischaemic leg; I-leg). We have previously shown that this decreases leg blood flow by about 20%. The contralateral leg (non-restricted-flow leg; N-leg), serving as a control, then trained with an identical power-output profile for 45 min but without flow restriction. In the I-leg the average training-induced increments in TTF and peak VO2 were 27 and 24%, respectively. In the N-trained leg TTF and peak-VO2 increased 10 and 14%, respectively. Both increments were significantly greater (P < 0.05) in the I-trained leg. Moreover, the performance increase in the I-trained leg was exaggerated (P < 0.05) in the ischaemic test condition, i.e. there was a specificity in the training response. In conclusion, ischaemia acts as an additive stimulus to training leading to an exaggerated increase in endurance and peak-VO2 compared to identical training without blood-flow restriction. The main explanation is probably an enhanced local adaptation in the I-trained leg.

Effects of graded restriction of perfusion on circulation and metabolism in the working leg; quantification of a human ischaemia-model

An experimental model used with the intention of mimicking the ischaemic condition in patients with arterial obliterative disease was evaluated. The influence of reduced effective perfusion pressure by increased external pressure on leg blood flow and metabolism was determined during exercise in 10 healthy subjects. Catheters were inserted into the right femoral artery and vein and into the left femoral vein. Supine one-legged (n = 5) or two-legged (n = 5) cycle exercise was performed with the subject's legs in a pressure chamber. Zero and three different levels of local supra-atmospheric pressure were applied over the legs: 30, 50 and 60 mmHg. Three submaximal work loads were used: 24, 48 and 72 W/leg. Leg blood flow was measured by the constant-infusion dye-dilution technique. Samples were also drawn from the femoral artery and vein for oxygen saturation and lactate determinations and arterial pressure was recorded. Exercise blood flow decreased progressively with increasing chamber pressure (P less than 0.001). Exposure to 50 mmHg over the working leg led to a mean reduction of blood flow by 16% and venous oxygen saturation by 12 percentage units (P less than 0.05). Lactate release increased with increasing pressure (P less than 0.05). In summary, local application of moderate positive external pressure over the working leg reduces blood flow in a 'dose-dependent' manner, and as a consequence, femoral venous oxygen saturation decreases and lactate release increases. Thus, this method makes it possible to induce graded ischaemia in human skeletal muscle during exercise in a controlled fashion.