Effects of alternating blood flow restricted training and heavy-load resistance training on myofiber morphology and mechanical muscle function

Where Does Blood Flow Restriction Fit in the Toolbox of Athletic Development? A Narrative Review of the Proposed Mechanisms and Potential Applications

Blood flow-restricted exercise is currently used as a low-intensity time-efficient approach to reap many of the benefits of typical high-intensity training. Evidence continues to lend support to the notion that even highly trained individuals, such as athletes, still benefit from this mode of training. Both resistance and endurance exercise may be combined with blood flow restriction to provide a spectrum of adaptations in skeletal muscle, spanning from myofibrillar to mitochondrial adjustments. Such diverse adaptations would benefit both muscular strength and endurance qualities concurrently, which are demanded in athletic performance, most notably in team sports. Moreover, recent work indicates that when traditional high-load resistance training is supplemented with low-load, blood flow-restricted exercise, either in the same session or as a separate training block in a periodised programme, a synergistic and complementary effect on training adaptations may occur. Transient reductions in mechanical loading of tissues afforded by low-load, blood flow-restricted exercise may also serve a purpose during de-loading, tapering or rehabilitation of musculoskeletal injury. This narrative review aims to expand on the current scientific and practical understanding of how blood flow restriction methods may be applied by coaches and practitioners to enhance current athletic development models.

Fiber-Type-Specific Hypertrophy with the Use of Low-Load Blood Flow Restriction Resistance Training: A Systematic Review

Emerging evidence indicates that the use of low-load resistance training in combination with blood flow restriction (LL-BFR) can be an effective method to elicit increases in muscle size, with most research showing similar whole muscle development of the extremities compared to high-load (HL) training. It is conceivable that properties unique to LL-BFR such as greater ischemia, reperfusion, and metabolite accumulation may enhance the stress on type I fibers during training compared to the use of LLs without occlusion. Accordingly, the purpose of this paper was to systematically review the relevant literature on the fiber-type-specific response to LL-BFR and provide insights into future directions for research. A total of 11 studies met inclusion criteria. Results of the review suggest that the magnitude of type I fiber hypertrophy is at least as great, and sometimes greater, than type II hypertrophy when performing LL-BFR. This finding is in contrast to HL training, where the magnitude of type II fiber hypertrophy tends to be substantially greater than that of type I myofibers. However, limited data directly compare training with LL-BFR to nonoccluded LL or HL conditions, thus precluding the ability to draw strong inferences as to whether the absolute magnitude of type I hypertrophy is indeed greater in LL-BFR vs. traditional HL training. Moreover, it remains unclear as to whether combining LL-BFR with traditional HL training may enhance whole muscle hypertrophy via greater increases in type I myofiber cross-sectional area.

"You can't shoot another bullet until you've reloaded the gun": Coaches' perceptions, practices and experiences of deloading in strength and physique sports

Deloading refers to a purposeful reduction in training demand with the intention of enhancing preparedness for successive training cycles. Whilst deloading is a common training practice in strength and physique sports, little is known about how the necessary reduction in training demand should be accomplished. Therefore, the purpose of this research was to determine current deloading practices in competitive strength and physique sports. Eighteen strength and physique coaches from a range of sports (weightlifting, powerlifting, and bodybuilding) participated in semi-structured interviews to discuss their experiences of deloading. The mean duration of coaching experience at ≥ national standard was 10.9 (SD = 3.9) years. Qualitative content analysis identified Three categories: definitions, rationale, and application. Participants conceptualised deloading as a periodic, intentional cycle of reduced training demand designed to facilitate fatigue management, improve recovery, and assist in overall training progression and readiness. There was no single method of deloading; instead, a reduction in training volume (achieved through a reduction in repetitions per set and number of sets per training session) and intensity of effort (increased proximity to failure and/or reduction in relative load) were the most adapted training variables, along with alterations in exercise selection and configuration. Deloading was typically prescribed for a duration of 5 to 7 days and programmed every 4 to 6 weeks, although periodicity was highly variable. Additional findings highlight the underrepresentation of deloading in the published literature, including a lack of a clear operational definition.

Low-Load Blood Flow Restriction Squat as Conditioning Activity Within a Contrast Training Sequence in High-Level Preadolescent Trampoline Gymnasts

To investigate the effects of implementing low-load blood flow restriction exercises (LL-BFRE) instead of high-load exercises (HL-RE) in a contrast training program on strength and power performance of high-level young gymnasts. Fifteen high-level pre-pubescent trampoline gymnasts (national level, Tanner Stage II, intermediate experience in strength training) were divided into two groups to complete the same structure of a ten-week contrast strength training program differing only in the configuration of the first resistance exercise of the contrast sequence. The LL-BFRE group (n = 7, four girls, 13.9 ± 0.4 y) performed the first resistance exercise of the contrast with LL-BFRE (20%–30% 1RM, perceived pressure of 7 on a scale from 0 to 10). The HL-RE group (n = 8, four girls, 13.8 ± 0.5 y) trained the first resistance exercise of the contrast sequence with moderate-to-high load (60%–85% 1RM). Before and after the training period, isometric mid-thigh pull (IMTP), squat jump (SJ), counter movement jump (CMJ), and drop-jump (DJ) were performed to evaluate the effect of the intervention on strength and power capacities as primary outcomes. Changes in participants’ anthropometric measures, muscle mass, left and right thigh girth, IMTP relative to bodyweight (IMTP-R), eccentric utilization ratio (EUR), and reactive strength index (RSI) were assessed as secondary outcomes. There was no significant interaction (p > 0.05) between group x time in any power and strength outcome, although SJ and EUR showed a trend to significant interaction (p = 0.06 and p = 0.065, respectively). There was an overall effect of time (p < 0.05) in all power and strength variables (CMJ, SJ, EUR, DJ, RSI, IMTP, and IMTP-R). There was a significant interaction in muscle mass (MM) [β = 0.57 kg, 95% CI = (0.15; 0.98), t₁₃ = 2.67, p = 0.019], revealing that participants in LL-BFRE increased their muscle mass (6.6 ± 3.1%) compared to HL-RE (3.6 ± 2.0%). Anthropometric variables did not present any group or interaction effect. However, there was a time effect (p < 0.05). Implementing LL-BFRE in place of HL-RE as a conditioning activity in a contrast training sequence might be equally effective in improving lower-body strength and power in preadolescent trampoline gymnasts.

Blood flow restriction training and the high-performance athlete: science to application

The manipulation of blood flow in conjunction with skeletal muscle contraction has greatly informed the physiological understanding of muscle fatigue, blood pressure reflexes, and metabolism in humans. Recent interest in using intentional blood flow restriction (BFR) has focused on elucidating how exercise during periods of reduced blood flow affects typical training adaptations. A large initial appeal for BFR training was driven by studies demonstrating rapid increases in muscle size, strength, and endurance capacity, even when notably low intensities and resistances, which would typically be incapable of stimulating change in healthy populations, were used. The incorporation of BFR exercise into the training of strength- and endurance-trained athletes has recently been shown to provide additive training effects that augment skeletal muscle and cardiovascular adaptations. Recent observations suggest BFR exercise alters acute physiological stressors such as local muscle oxygen availability and vascular shear stress, which may lead to adaptations that are not easily attained with conventional training. This review explores these concepts and summarizes both the evidence base and knowledge gaps regarding the application of BFR training for athletes.

Home-based management of knee osteoarthritis during COVID-19 pandemic: literature review and evidence-based recommendations

Purpose

To provide evidence-based recommendations for patients with severe knee osteoarthritis (OA), who had their knee surgery postponed due to the COVID-19 pandemic.

Methods

PubMed/Medline, Scopus and Cochrane Central databases were systematically reviewed for studies reporting outcomes of home-based treatments for knee OA. Due to between-study differences in treatment strategy and reporting methods the results were not pooled and findings of the current review were presented in a narrative manner.

Results

The comprehensive literature search yielded 33 eligible studies that were included in this review. Management is performed at home and consists of exercise, proper nutrition, physical therapy and use of corrective and assistive orthotics. Virtual education on self-management strategies should be part of coping with knee OA. Initiating an exercise programme involving gymnastics, stretching, home cycling and muscle strengthening is highly recommended. Obese patients are encouraged to set weight loss goals and adopt a healthy diet. Potential benefits but weak evidence has been shown for the use of knee braces, sleeves, foot orthotics or cushioned footwear. Walking aids may be prescribed, when considered necessary, along with the provision of instructions for their use.

Conclusion

When bridging the time to rescheduled surgery, it is essential to use appropriate home-based tools for the management of knee OA if pain is to be reduced and need for analgesics or opioid use is to be diminished while maintaining or even improving the functioning and avoiding further limitation of range of motion and subsequent muscular atrophies. Finally, none of these treatments may completely substitute for the life-changing effect of a total knee arthroplasty in patients with severe knee OA. Hence, the subsequent goal is to gradually and safely reinstate elective surgery.