Effect of blood flow restriction on tissue oxygenation during knee extension

Distinct adaptations of muscle endurance but not strength or hypertrophy to low-load resistance training with and without blood flow restriction

Low-load resistance training promotes muscle strength and hypertrophic adaptations when combined with blood flow restriction (BFR). However, the effect of BFR on muscle endurance remains unclear. The aim of this study was to clarify the effects of BFR on muscle performance and adaptation, with special reference to local muscle endurance. In experiment 1, eight healthy men performed unilateral elbow flexion exercise to failure at 30% of one-repetition maximum with BFR (at 40% of estimated arterial occlusion pressure) and free blood flow (FBF). During the exercise, muscle activity and tissue oxygenation were measured from the biceps brachii. In experiment 2, another eight healthy men completed 6 weeks of elbow flexion training with BFR and FBF. The number of repetitions to failure at submaximal load (Rmax), the estimated time for peak torque output to decay by 50% during repetitive maximum voluntary contractions (half-time), one-repetition maximum, isometric strength and muscle thickness of elbow flexors were measured pre- and post-training. Blood flow restriction resulted in fewer repetitions and lower muscle tissue oxygenation at the end of exercise than FBF, while the muscle activity increased similarly to repetition failure. Blood flow restriction also resulted in a smaller post-training Rmax, which was strongly correlated with the total exercise volume over the 6 week period. Despite the smaller exercise volume, BFR resulted in similar improvements in half-time, muscle strength and thickness compared with FBF. These results suggest that the application of BFR can attenuate muscle endurance adaptations to low-load resistance training by decreasing the number of repetitions during exercise, both acutely and chronically.

Comparison of finger flexor resistance training, with and without blood flow restriction, on perceptional and physiological responses in advanced climbers

This study compared perceptional and physiological responses of finger flexor exercise performed with free flow and blood flow restriction (BFR). Thirteen male advanced climbers completed three sessions of finger flexor resistance exercise at (1) 40% of MVC (Low) and (2) 75% of MVC (High) and (3) BFR at 40% of MVC (Low + BFR) in a randomized and counterbalanced order. Rate of perceived exertion for effort (RPE) and discomfort (RPD), session pleasure/displeasure (sPDF), exercise enjoyment (EES), lactate concentration and oxygen saturation were recorded after the last set. Both low-intensity sessions induced higher RPD than High (p = 0.018-0.022, ES = 1.01-1.09) and High was perceived as more enjoyable than Low-BFR (p = 0.031, ES = 1.08). No differences were found for RPE or sPDF (p = 0.132-0.804). Lactate was elevated more after High than the Low-sessions (p < 0.001, ES = 1.88-2.08). Capillary oxygen saturation was lower after Low + BFR compared to the other sessions (p = 0.031, ES = 1.04-1.27). Finally, the exercise volume was greater in Low compared to High (p = 0.022, ES = 1.14) and Low + BFR (p = 0.020, ES = 0.77). In conclusion, among advanced male climbers, performing Low + BFR led to a similar exercise volume but was perceived as more discomforting and less enjoyable compared to High. The Low session yielded similar responses as the Low + BFR but required a much greater exercise volume.

Effectiveness of Blood Flow Restriction on Functionality, Quality of Life and Pain in Patients with Neuromusculoskeletal Pathologies: A Systematic Review

BACKGROUND

Blood flow restriction is characterized as a method used during exercise at low loads of around 20-40% of a repetition maximum, or at a low-moderate intensity of aerobic exercise, in which cuffs that occlude the proximal part of the extremities can partially reduce arterial flow and fully restrict the venous flow of the musculature in order to achieve the same benefits as high-load exercise.

OBJECTIVE

The main objective of this systematic literature review was to analyze the effects of BFR intervention on pain, functionality, and quality of life in subjects with neuromusculoskeletal pathologies.

METHODS

The search to carry out was performed in PubMed, Cochrane, EMBASE, PEDro, CINHAL, SPORTDiscus, Trip Medical Database, and Scopus: "kaatsu" OR "ischemic training" OR "blood flow restriction" OR "occlusion resistance training" OR "vascular occlusion" OR "vascular restriction".

RESULTS

After identifying 486 papers and eliminating 175 of them due to duplication and 261 after reading the title and abstract, 50 papers were selected. Of all the selected articles, 28 were excluded for not presenting a score equal to or higher than 6 points on the PEDro scale and 8 for not analyzing the target outcome variables. Finally, 14 papers were selected for this systematic review.

CONCLUSIONS

The data collected indicate that the blood flow restriction tool is a therapeutic alternative due to its effectiveness under different exercise modalities. The benefits found include decreases in pain thresholds and improvement in the functionality and quality of life of the neuro-musculoskeletal patient during the first six weeks. However, the results provided by this tool are still not clear for medium- and long-term interventions.

Characterizing tourniquet induced hemodynamics during total knee arthroplasty using diffuse optical spectroscopy

Tourniquet use creates a reduced blood surgical field during total knee arthroplasty (TKA), however, prolonged ischemia may cause postoperative tourniquet complications. To understand the effects of tourniquet-induced ischemia, we performed a prospective observational study using quantitative broadband diffuse optical spectroscopy (DOS) to measure tissue hemodynamics and water and lipid concentrations before, during, and after tourniquet placement in subjects undergoing TKA. Data was collected for 6 months and, of the total subjects analyzed (n = 24), 22 were primary TKAs and 2 were revision TKA cases. We specifically investigated tourniquet-induced hemodynamics based upon subject-specific tissue composition and observed a significant relationship between the linear rate of deoxygenation after tourniquet inflation and water/lipid ratio (W/L, p < 0.0001) and baseline somatic tissue oxygen saturation, StO2 (p = 0.05). Subjects with a low W/L ratio exhibited a lower tissue metabolic rate of oxygen consumption, (tMRO2 ) (p = 0.008). Changes in deoxyhemoglobin [HbR] (p = 0.009) and lipid fraction (p = 0.001) were significantly different between high and low W/L subject groups during deoxygenation. No significant differences were observed for hemodynamics during reperfusion and total tourniquet time was neither significantly related to the hemodynamic hyperemic response (p = 0.73) nor the time to max StO2 after tourniquet release (p = 0.57). In conclusion, we demonstrate that DOS is capable of real-time monitoring of tissue hemodynamics distal to the tourniquet during TKA, and that tissue composition should be considered. DOS may help surgeons stratify hemodynamics based upon tissue composition and eventually aid the preoperative risk assessment of vascular occlusions from tourniquet use during TKA.

Acute and Chronic Effects of Blood Flow Restricted High-Intensity Interval Training: A Systematic Review

Background

The implementation of blood flow restriction (BFR) during exercise is becoming an increasingly useful adjunct method in both athletic and rehabilitative settings. Advantages in pairing BFR with training can be observed in two scenarios: (1) training at lower absolute intensities (e.g. walking) elicits adaptations akin to high-intensity sessions (e.g. running intervals); (2) when performing exercise at moderate to high intensities, higher physiological stimulus may be attained, leading to larger improvements in aerobic, anaerobic, and muscular parameters. The former has been well documented in recent systematic reviews, but consensus on BFR (concomitant or post-exercise) combined with high-intensity interval training (HIIT) protocols is not well established. Therefore, this systematic review evaluates the acute and chronic effects of BFR + HIIT.

Methods

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to identify relevant studies. A systematic search on 1 February 2022, was conducted on four key databases: ScienceDirect, PubMed, Scopus and SPORTDiscus. Quality of each individual study was assessed using the Physiotherapy Evidence Database (PEDro) scale. Extraction of data from included studies was conducted using an adapted version of the 'Population, Intervention, Comparison, Outcome' (PICO) framework.

Results

A total of 208 articles were identified, 18 of which met inclusion criteria. Of the 18 BFR + HIIT studies (244 subjects), 1 reported both acute and chronic effects, 5 examined acute responses and 12 investigated chronic effects. Acutely, BFR challenges the metabolic processes (vascular and oxygenation responses) during high-intensity repeated sprint exercise—which accelerates central and peripheral neuromuscular fatigue mechanisms resulting in performance impairments. Analysis of the literature exploring the chronic effects of BFR + HIIT suggests that BFR does provide an additive physiological training stimulus to HIIT protocols, especially for measured aerobic, muscular, and, to some extent, anaerobic parameters.

Conclusion

Presently, it appears that the addition of BFR into HIIT enhances physiological improvements in aerobic, muscular, and, to some extent, anaerobic performance. However due to large variability in permutations of BFR + HIIT methodologies, it is necessary for future research to explore and recommend standardised BFR guidelines for each HIIT exercise type.

A Comparison between High and Low Cuff Pressures on Muscle Oxygen Saturation and Recovery Responses Following Blood-Flow Restriction Resistance Exercise

The aim of the study was to compare the recovery response and muscle oxygenation of a blood-flow restriction resistance exercise (BFR) session with high [HP: 80% of the arterial occlusion pressure (AOP)] and low cuff pressure (LP: 40% of AOP). Both exercise sessions included 4 sets to failure at the barbell preacher curl exercise. Twelve resistance trained men (27.4 ± 5.0 years; 83.5 ± 11.6 kg; 176.6 ± 7.0 cm) performed each protocol in a counterbalanced, randomized order. Maximal isometric force, muscle morphology and muscle soreness of the biceps brachii muscle were assessed at baseline, 15-min, 60-min and 24-h post each testing session. In addition, muscle oxygen saturation (SmO2) was assessed during each training session. A lower number of repetitions (p = 0.013) was detected in HP compared to LP. A lower SmO2 (p < 0.001) was detected in the recovery time between the sets in HP (mean: 47.6 ± 15.7%) compared to LP (mean: 68.9 ± 7.2%). No differences between the two trials (p > 0.05) were noted for isometric force, muscle architecture and soreness at any timepoint. Results indicate that, despite a high cuff pressure may induce a more hypoxic condition compared to a lower cuff pressure, recovery responses may not be affected.

Effect of High-Intensity Interval Training Combined with Blood Flow Restriction at Different Phases on Abdominal Visceral Fat among Obese Adults: A Randomized Controlled Trial

BACKGROUND

High-intensity interval training (HIIT) and blood flow restriction (BFR) represent a critical nonpharmacological strategy to reduce the excess deposition of visceral fat, as well as relevant complications, among obese populations. Applying BFR at diverse phases may have different effects. Therefore, the exercise program of this study combined HIIT with BFR, so as to explore the effect of BFR on abdominal visceral fat area and its mechanism in different periods of HIIT. The aim is to provide a more effective exercise prescription for obese people who want to reduce visceral fat quickly.

METHODS

This study was a randomized controlled trial involving 72 obese adults. One week before intervention, both regional and whole-body fat masses, abdominal subcutaneous and visceral fat areas, variables of blood metabolism, and VO_2max were recorded. Additionally, subjects with a matched fat percentage were randomized as a no-training control (C), HIIT (H), HIIT with BFR during interval (I), and HIIT with BFR during exercise (E) groups for 24 sessions within a 12-week period, using a cycle ergometer. During session one, this study recorded blood lactate, specific serum lipolytic hormones, rating of perceived exertion (RPE), and exercise heart rate (HR) and compared them among three groups. The baseline tests were repeated at 1 week after intervention.

RESULTS

There was no significant statistical difference in the indicators of each group at baseline (p > 0.05). The improvement of trunk fat mass and fat percentage of the I and E groups markedly increased relative to the H group (p < 0.05). Meanwhile, the I group had improved android fat mass and whole-body fat mass relative to group H (p < 0.05). Those exercise groups had markedly improved indices compared with the C group (p < 0.05). Additionally, the reduction in the I group had remarkably superior abdominal visceral fat areas (AVFA) to the H and E groups (p < 0.05). Immediately and 30 min following exercise, the E and I groups had remarkably increased growth hormone (GH) compared with the H group (p < 0.05). After exercise, the I group showed markedly increased epinephrine (EPI) compared with the H group (p < 0.05). The LA level in the I group evidently increased relative to the E group (p < 0.05), while that in the E group evidently increased compared with the H group (p < 0.05).

CONCLUSION

Compared with HIIT alone, HIIT with BFR can better improve the body-fat level and glucose metabolism. HIIT with BFR in the interval phase better reduces the abdominal visceral-fat level than in the exercise phase, which may be due to the increase in lipolytic hormone level caused by the higher physiological load.

Blood Flow Restriction Training for the Intervention of Sarcopenia: Current Stage and Future Perspective

Sarcopenia is a geriatric syndrome that is characterized by a progressive and generalized skeletal muscle disorder and can be associated with many comorbidities, including obesity, diabetes, and fracture. Its definitions, given by the AWGS and EWGSOP, are widely used. Sarcopenia is measured by muscle strength, muscle quantity or mass and physical performance. Currently, the importance and urgency of sarcopenia have grown. The application of blood flow restriction (BFR) training has received increased attention in managing sarcopenia. BFR is accomplished using a pneumatic cuff on the proximal aspect of the exercising limb. Two main methods of exercise, aerobic exercise and resistance exercise, have been applied with BFR in treating sarcopenia. Both methods can increase muscle mass and muscle strength to a certain extent. Intricate mechanisms are involved during BFRT. Currently, the presented mechanisms mainly include responses in the blood vessels and related hormones, such as growth factors, tissue hypoxia-related factors and recruitment of muscle fiber as well as muscle satellite cells. These mechanisms contribute to the positive balance of skeletal muscle synthesis, which in turn mitigates sarcopenia. As a more suited and more effective way of treating sarcopenia and its comorbidities, BFRT can serve as an alternative to traditional exercise for people who have marked physical limitations or even show superior outcomes under low loads. However, the possibility of causing stress or muscle damage must be considered. Cuff size, pressure, training load and other variables can affect the outcome of sarcopenia, which must also be considered. Thoroughly studying these factors can help to better determine an ideal BFRT scheme and better manage sarcopenia and its associated comorbidities. As a well-tolerated and novel form of exercise, BFRT offers more potential in treating sarcopenia and involves deeper insights into the function and regulation of skeletal muscle.

Blood Flow Restriction Using a Pneumatic Tourniquet Is Not Associated With a Cellular Systemic Response

Purpose

The purpose of this study was to determine the effects of blood flow restriction (BFR) using a pneumatic tourniquet on CD34⁺ cells, platelets, white blood cells, neutrophils, lymphocytes, lactate, and glucose compared with standard exercise.

Methods

Fifteen healthy volunteers (8 males and 7 females, 28.6 ± 3.6 years old) who were able to perform the exercise sessions on a VersaClimber participated. Participants were randomized to undergo an experimental (EXP) occluded testing session using the pneumatic tourniquets on all 4 extremities and a control (CON) session. The exercise protocol concluded after 9 minutes or when participants reached a rating of perceived exertion of 20. Blood draws were performed before testing and immediately after the exercise session. Blood analysis consisted of complete blood counts as well as flow cytometry to measure peripheral CD34⁺ counts as a marker for hematopoietic progenitor cells (HPCs).

Results

A significant increase from before to after exercise values was observed in both the EXP and CON groups with CD34⁺, WBC counts, platelets, and lymphocytes; however, no differences existed between EXP and CON groups for any variable. CD34⁺ increased in the EXP (3.1 ± 1.6 vs. 4.3 ± 1.8 cells · L^–1; P < .001) and CON (3.3 ± 1.9 vs. 4.4 ± 1.4 cells · L^–1; P < .001) sessions. White blood cells also significantly increased in both the EXP (7.8 ± 1.4 vs. 11.8 ± 2.5 K · L^–1 K · L^–1; P < .001) and CON (7.5 ± 1.8 vs. 11.3 ± 3.0 K · L^–1; P < .001) sessions. Platelets also increased in both the EXP (258.6 ± 52.5 vs. 309.9 ± 52.7 K · L^–1; P < .001) and CON (263.1 ± 44.7 vs. 316.1 ± 43.9 K · L^–1; P < .001) sessions, and conversely, a significant decrease in the average neutrophil counts in the EXP (mean difference = –13.7%; P < .001) and CON (mean difference = –13.2%; P < .001) sessions was observed. Lymphocyte counts in the EXP (mean difference = 22.8%; P < .001) and CON (mean difference = 19.3%; P < .001) sessions increased significantly.

Conclusions

There were no significant differences in systemic cellular responses when undergoing aerobic-based exercise with and without a pneumatic tourniquet system.

Level of Evidence

2, prospective comparative study.

Augmented muscle deoxygenation during repeated sprint exercise with post-exercise blood flow restriction

Blood flow restriction (BFR) during low-intensity exercise has been known to be a potent procedure to alter metabolic and oxygen environments in working muscles. Moreover, the use of BFR during inter-set rest periods of repeated sprint exercise has been recently suggested to be a potent procedure for improving training adaptations. The present study was designed to determine the effect of repeated sprint exercise with post-exercise BFR (BFR during rest periods between sprints) on muscle oxygenation in working muscles. Eleven healthy males performed two different conditions on different days: either repeated sprint exercise with BFR during rest periods between sets (BFR condition) or without BFR (CON condition). A repeated sprint exercise consisted of three sets of 3 × 6-s maximal sprints (pedaling) with 24s rest periods between sprints and 5 min rest periods between sets. In BFR condition, two min of BFR (100-120 mmHg) for both legs was conducted between sets. During the exercise, power output and arterial oxygen saturation (SpO₂ ) were evaluated. Muscle oxygenation for the vastus lateralis muscle, exercise-induced changes in muscle blood flow, and muscle oxygen consumption were measured. During BFR between sets, BFR condition presented significantly higher deoxygenated hemoglobin + myoglobin (p < 0.01) and lower tissue saturation index (p < 0.01) than those in CON condition. However, exercise-induced blood lactate elevation and reduction of blood pH did not differ significantly between the conditions. Furthermore, power output throughout nine sprints did not differ significantly between the two conditions. In conclusion, repeated sprint exercise with post-exercise BFR augmented muscle deoxygenation and local hypoxia, without interfering power output.

Effects of low load exercise with and without blood-flow restriction on microvascular oxygenation, muscle excitability and perceived pain

This paper aimed to examine the acute effect of low-load (LL) exercise with blood-flow restriction (LL-BFR) on microvascular oxygenation and muscle excitability of the vastus medialis (VM) and vastus lateralis (VL) muscles during a single bout of unilateral knee extension exercise performed to task failure. Seventeen healthy recreationally resistance-trained males were enrolled in a within-group randomized cross-over study design. Participants performed one set of unilateral knee extensions at 20% of one-repetition maximum (1RM) to task failure, using a LL-BFR or LL free-flow (LL-FF) protocol in a randomized order on separate days. Changes in microvascular oxygenation and muscle excitability in VL and VM were assessed using near-infrared spectroscopy (NIRS) and surface electromyography (sEMG), respectively. Pain measures were collected using the visual analog scale (VAS) before and following set completion. Within- and between- protocol comparisons were performed at multiple time points of set completion for each muscle. During LL-BFR, participants performed 43% fewer repetitions and reported feeling more pain compared to LL-FF (p<0.05). Normalized to time to task failure, LL-BFR and LL-FF generally demonstrated similar progression in microvascular oxygenation and muscle excitability during exercise to task failure. The present results demonstrate that LL-BFR accelerates time to task failure, compared with LL-FF, resulting in a lower dose of mechanical work to elicit similar levels of oxygenation, blood-pooling, and muscle excitability. LL-BFR may be preferable to LL-FF in clinical settings where high workloads are contraindicated, although increased pain experienced during BFR may limit its application.HighlightsCompared to free flow (FF), neuromuscular fatigue mechanisms are accelerated during blood flow restricted (BFR) training. This can be observed as changes in microvascular oxygenation and muscle excitability occurring at a ∼43% faster mean rate during BFR compared to FF.BFR exercise seems to elicit the same level of neuromuscular fatigue as FF training within a shorter timeframe. This reduces total joint load and may be especially helpful in cases where high training volumes may be contraindicated (e.g. recovering from a sports injury or orthopedic surgery).

Optimization of Exercise Countermeasures to Spaceflight Using Blood Flow Restriction

INTRODUCTION: During spaceflight missions, astronauts work in an extreme environment with several hazards to physical health and performance. Exposure to microgravity results in remarkable deconditioning of several physiological systems, leading to impaired physical condition and human performance, posing a major risk to overall mission success and crew safety. Physical exercise is the cornerstone of strategies to mitigate physical deconditioning during spaceflight. Decades of research have enabled development of more optimal exercise strategies and equipment onboard the International Space Station. However, the effects of microgravity cannot be completely ameliorated with current exercise countermeasures. Moreover, future spaceflight missions deeper into space require a new generation of spacecraft, which will place yet more constraints on the use of exercise by limiting the amount, size, and weight of exercise equipment and the time available for exercise. Space agencies are exploring ways to optimize exercise countermeasures for spaceflight, specifically exercise strategies that are more efficient, require less equipment, and are less time-consuming. Blood flow restriction exercise is a low intensity exercise strategy that requires minimal equipment and can elicit positive training benefits across multiple physiological systems. This method of exercise training has potential as a strategy to optimize exercise countermeasures during spaceflight and reconditioning in terrestrial and partial gravity environments. The possible applications of blood flow restriction exercise during spaceflight are discussed herein.Hughes L, Hackney KJ, Patterson SD. Optimization of exercise countermeasures to spaceflight using blood flow restriction. Aerosp Med Hum Perform. 2021; 93(1):32-45.

The effect of passive mobilization associated with blood flow restriction and combined with electrical stimulation on cardiorespiratory safety, neuromuscular adaptations, physical function, and quality of life in comatose patients in an ICU: a randomized controlled clinical trial

Background

Intensive care unit-acquired atrophy and weakness are associated with high mortality, a reduction in physical function, and quality of life. Passive mobilization (PM) and neuromuscular electrical stimulation were applied in comatose patients; however, evidence is inconclusive regarding atrophy and weakness prevention. Blood flow restriction (BFR) associated with PM (BFRp) or with electrical stimulation (BFRpE) was able to reduce atrophy and increase muscle mass in spinal cord-injured patients, respectively. Bulky venous return occurs after releasing BFR, which can cause unknown repercussions on the cardiovascular system. Hence, the aim of this study was to investigate the effect of BFRp and BFRpE on cardiovascular safety and applicability, neuromuscular adaptations, physical function, and quality of life in comatose patients in intensive care units (ICUs).

Methods

Thirty-nine patients will be assessed at baseline (T0–18 h of coma) and randomly assigned to the PM (control group), BFRp, or BFRpE groups. The training protocol will be applied in both legs alternately, twice a day with a 4-h interval until coma awake, death, or ICU discharge. Cardiovascular safety and applicability will be evaluated at the first training session (T1). At T0 and 12 h after the last session (T2), muscle thickness and quality will be assessed. Global muscle strength and physical function will be assessed 12 h after T2 and ICU and hospital discharge for those who wake up from coma. Six and 12 months after hospital discharge, physical function and quality of life will be re-assessed.

Discussion

In view of applicability, the data will be used to inform the design and sample size of a prospective trial to clarify the effect of BFRpE on preventing muscle atrophy and weakness and to exert the greatest beneficial effects on physical function and quality of life compared to BFRp in comatose patients in the ICU.

Trial registration

Universal Trial Number (UTN) Registry UTN U1111-1241-4344. Retrospectively registered on 2 October 2019. Brazilian Clinical Trials Registry (ReBec) RBR-2qpyxf. Retrospectively registered on 21 January 2020, http://ensaiosclinicos.gov.br/rg/RBR-2qpyxf/

Supplementary Information

The online version contains supplementary material available at 10.1186/s13063-021-05916-z.

Acute Effects of Local Ischemic Hypoxia and Systemic Hypoxemia on Neuromuscular and Cognitive Function

Rivera, Paola M., Chris E. Proppe, Esther Beltran, and Ethan C. Hill. Acute effects of local ischemic hypoxia and systemic hypoxemia on neuromuscular and cognitive function. High Alt Med Biol. 00:000-000, 2021. Background: The application of blood flow restriction (BFR) induces local ischemic hypoxia within the muscle(s) distal to the restriction device. Systemic hypoxemia via oxygen or barometric pressure manipulation achieves whole-body hypoxia and thus may be a more potent exercise adjunct than BFR. Therefore, the purpose of this study was to examine the acute effects of local ischemic hypoxia versus systemic hypoxemia on maximal voluntary isometric contraction (MVIC) torque, electromyographic amplitude (EMG AMP), EMG mean power frequency (MPF), and cognition. Materials and Methods: Twelve recreationally trained women (mean age ± standard deviation = 21 ± 1.6 years) performed 75 submaximal (1 × 30, 3 × 15) unilateral leg extension muscle actions under normoxia, local ischemic hypoxia, and systemic hypoxemia. Before and immediately after the 75 repetitions, MVIC muscle actions were performed, and surface EMG was simultaneously assessed from the vastus lateralis. Cognitive function was assessed immediately after each exercise using the Automated Neuropsychological Assessment Metrics (ANAM). Separate repeated-measures analyses of variance (ANOVAs) were performed to examine changes in MVIC, reaction time, EMG AMP, and EMG MPF responses during the MVIC muscle actions. Results: There were no significant (p = 0.21-0.953) Condition × Time interactions for MVIC, EMG AMP, or EMG MPF but a significant (p < 0.001-0.005) main effect for the Time collapsed across Condition for MVIC torque (pretest 238.8 ± 19.5, posttest 212.7 ± 20.1 Nm) and EMG MPF (88.5% ± 1.4% of pretest). There were no significant (p = 0.503) differences in reaction time among Conditions. Conclusions: The findings of the present study suggest that all three conditions elicited comparable acute changes in performance as assessed by MVIC torque that were associated with no changes in muscle activation but decrease in action potential conduction velocity. Therefore, the application of local ischemic hypoxia or systemic hypoxemia during low-load resistance exercise can be used to elicit similar acute physiological responses and not adversely affect cognitive function relative to nonhypoxic conditions.

A scalable, multi-wavelength, broad bandwidth frequency-domain near-infrared spectroscopy platform for real-time quantitative tissue optical imaging

Frequency-domain near-infrared spectroscopy (FD-NIRS) provides quantitative noninvasive measurements of tissue optical absorption and scattering, as well as a safe and accurate method for characterizing tissue composition and metabolism. However, the poor scalability and high complexity of most FD-NIRS systems assembled to date have contributed to its limited clinical impact. To address these shortcomings, we present a scalable, digital-based FD-NIRS platform capable of measuring optical properties and tissue chromophore concentrations in real-time. The system provides single-channel FD-NIRS amplitude/phase, optical property, and chromophore data at a maximum display rate of 36.6 kHz, 17.9 kHz, and 10.2 kHz, respectively, and can be scaled to multiple channels as well as integrated into a handheld format. The entire system is enabled by several innovations including an ultra-high-speed k-nearest neighbor lookup table method (maximum of 250,000 inversions/s for a large 2500x700 table of absorption and reduced scattering coefficients), embedded FPGA and CPU high-speed co-processing, and high-speed data transfer (due to on-board processing). We show that our 6-wavelength, broad modulation bandwidth (1-400 MHz) system can be used to perform 2D high-density spatial mapping of optical properties and high speed quantification of hemodynamics.

Effect of Resistance Training With Total and Partial Blood Flow Restriction on Biomarkers of Oxidative Stress and Apoptosis in Untrained Men

Introduction: The characterization of immune and oxidative stress responses to acute and chronic exercise training is important because it may aid in the safety and dose–response prescription of resistance training (RT) in many populations.

Purpose: The present study compared changes in acute oxidative stress and markers of apoptosis in immune cells before and after 8 weeks of low-load RT with total or partial blood flow restriction (BFR) versus high-load traditional RT.

Methods: Twenty-seven untrained men were randomly divided into three groups: traditional RT [75% one-repetition maximum (1-RM)], RT with partial (20% 1-RM), and total BFR (20% 1-RM). Over an 8-week period, participants performed six sets of arm curls until failure with 90 seconds of recovery for 3 days/week. Blood samples were obtained before and after the first and last training sessions.

Results: Data indicated that all training groups showed similar increases in muscular strength (p < 0.001), reduction in mitochondrial membrane potential (MMP) after exercise in neutrophils (p < 0.001), and increase in caspase-3 activity after exercise (p < 0.001). Traditional RT and total BFR showed increased plasma lipid peroxidation (p < 0.001) and protein carbonyls (p < 0.001) and lower levels of reduced glutathione (GSH) (p < 0.001) after exercise. No change was observed in oxidative stress biomarkers in response to partial BFR (p > 0.05).

Conclusion: Data show that RT with partial BFR can increase muscular strength but still does not augment biomarkers of oxidative stress in untrained men. In addition, RT with total BFR promoted similar responses of oxidative stress and markers of immune cell apoptosis versus traditional RT.

Tolerance to Intermittent vs. Continuous Blood Flow Restriction Training: A meta-Analysis

The proven beneficial effects of low-load blood flow restriction training on strength gain has led to further exploration into its application during rehabilitation, where the traditional use of heavy loads may not be feasible. With current evidence showing that low-load blood flow restriction training may be less well tolerated than heavy-load resistance training, this review was conducted to decipher whether intermittently deflating the pressure cuff during rest intervals of a training session improves tolerance to exercise, without compromising strength. Four databases were searched for randomized controlled trials that compared the effect of intermittent versus continuous blood flow restriction training on outcomes of exercise tolerance or strength in adults. Nine studies were identified, with six included in the meta-analysis. No significant difference in rate of perceived exertion was found (SMD-0.06, 95% CI-0.41 to 0.29, p=0.73, I ²=80%). Subgroup analysis excluding studies that introduced bias showed a shift towards favoring the use of intermittent blood flow restriction training (SMD-0.42, 95% CI-0.87 to 0.03, p=0.07, I ²=0%). There was no significant difference in strength gain. Intermittent cuff deflations during training intervals does not improve tolerance to exercise during blood flow restriction training.

Unilateral, bilateral, and alternating muscle actions elicit similar muscular responses during low load blood flow restriction exercise

PURPOSE

Compare acute muscular responses to unilateral, bilateral, and alternating blood flow restriction (BFR) exercise.

METHODS

Maximal strength was tested on visit one. On visits 2-4, 2-10 days apart, 19 participants completed 4 sets of knee extensions (30% one-repetition maximum) with BFR (40% arterial occlusion pressure) to momentary failure (inability to lift load) using each muscle action (counterbalanced order). Ultrasound muscle thickness was measured at 60% and 70% of the anterior thigh before (Pre), immediately (Post-0), and 5 min (Post-5) after exercise. Surface electromyography and tissue deoxygenation were measured throughout. Results, presented as means, were analyzed with a three-way (sex by time by condition) Bayesian RMANOVA.

RESULTS

There was a time by sex interaction (BF_inclusion: 5.489) for left leg 60% muscle thickness (cm). However, changes from Pre to Post-0 (males: 0.39 vs females: 0.26; BF₁₀: 0.839), Post-0 to Post-5 (males: - 0.05 vs females: - 0.06; BF₁₀: 0.456), and Pre to Post-5 (males: 0.34 vs females: 0.20; BF₁₀: 0.935) did not differ across sex. For electromyography (%MVC), there was a sex by condition interaction (BF_inclusion: 550.472) with alternating having higher muscle excitation for females (16) than males (9; BF₁₀: 5.097). Tissue deoxygenation (e.g. channel 1, µM) increased more for males (sets 1: 11.17; 2: 2.91; 3: 3.69; 4: 3.38) than females (sets 1: 4.49; 2: 0.24; 3: - 0.10; 4: - 0.06) from beginning to end of sets (all BF_inclusion ≥ 4.295e + 7). For repetitions, there was an interaction (BF_inclusion: 17.533), with alternating completing more than bilateral and unilateral for set one (100; 56; 50, respectively) and two (34; 16; 18, respectively).

CONCLUSION

Alternating, bilateral, and unilateral BFR exercise elicit similar acute muscular responses.

Development of a Smartphone-Based Optical Device to Measure Hemoglobin Concentration Changes for Remote Monitoring of Wounds

Telemedicine (TM) can revolutionize the impact of diabetic wound care management, along with tools for remote patient monitoring (RPM). There are no low-cost mobile RPM devices for TM technology to provide comprehensive (visual and physiological) clinical assessments. Here, a novel low-cost smartphone-based optical imaging device has been developed to provide physiological measurements of tissues in terms of hemoglobin concentration maps. The device (SmartPhone Oxygenation Tool—SPOT) constitutes an add-on optical module, a smartphone, and a custom app to automate data acquisition while syncing a multi-wavelength near-infrared light-emitting diode (LED) light source (690, 810, 830 nm). The optimal imaging conditions of the SPOT device were determined from signal-to-noise maps. A standard vascular occlusion test was performed in three control subjects to observe changes in hemoglobin concentration maps between rest, occlusion, and release time points on the dorsal of the hand. Hemoglobin concentration maps were compared with and without applying an image de-noising algorithm, single value decomposition. Statistical analysis demonstrated that the hemoglobin concentrations changed significantly across the three-time stamps. Ongoing efforts are in imaging diabetic foot ulcers using the SPOT device to assess its potential as a smart health device for physiological monitoring of wounds remotely.

The effect of muscle blood flow restriction on hemodynamics, cerebral oxygenation and activation at rest

This study tested the hypothesis that muscle blood flow restriction reduces muscle and cerebral oxygenation, at rest. In 26 healthy males, aged 33±2 yrs, physiological variables were continuously recorded during a 10-min period in two experimental conditions: a) with muscle blood flow restriction through thigh cuffs application inflated at 120 mmHg (With Cuffs, WC) and b) without restriction (No Cuffs, NC). Muscle and cerebral oxygenation were reduced by muscle blood flow restriction as suggested by the increase in both muscle and cerebral deoxygenated hemoglobin (Δ[HHb]; p<0.01) and the decrease of muscle and cerebral oxygenation index (Δ[HbDiff]; p<0.01). Hemodynamic responses were not affected by such muscle blood flow restriction, whereas baroreflex sensitivity was reduced (p=0.009). The perception of leg discomfort was higher (p<0.001) in the WC than in the NC condition. This study suggests that thigh cuffs application inflated at 120 mmHg is an effective method to reduce muscle oxygenation at rest. These changes at the muscular level seem to be sensed by the central nervous system, evoking alterations in cerebral oxygenation and baroreflex sensitivity. Novelty bullets: • Thigh cuffs application inflated at 120 mmHg effectively reduces muscle oxygenation at rest. • Limiting muscle oxygenation appears to reduce cerebral oxygenation, and baroreflex sensitivity, at rest. • Even in healthy subjects, limiting muscle oxygenation, at rest, affects neural integration.

Training response to 8 weeks of blood flow restricted training is not improved by preferentially altering tissue hypoxia or lactate accumulation when training to repetition failure

Despite compelling muscular structure and function changes resulting from blood flow restricted (BFR) resistance training, mechanisms of action remain poorly characterized. Alterations in tissue O2 saturation (TSI%) and metabolites are potential drivers of observed changes, but their relationships with degree of occlusion pressure are unclear. We examined local TSI% and blood lactate (BL) concentration during BFR training to failure using different occlusion pressures on strength, hypertrophy, and muscular endurance over an 8-week training period. Twenty participants (11M:9F) trained 3/wk for 8wk using high pressure (100% resting limb occlusion pressure, LOP, 20%1RM), moderate pressure (50% LOP, 20%1RM), or traditional resistance training (70%1RM). Strength, size, and muscular endurance were measured pre/post training. TSI% and BL were quantified during a training session. Despite overall increases, no group preferentially increased strength, hypertrophy, or muscular endurance (p>0.05). Neither TSI% nor BL concentration differed between groups (p>0.05). Moderate pressure resulted in greater accumulated deoxygenation stress (TSI%*time) (-6352±3081, -3939±1835, -2532±1349 au for moderate pressure, high pressure, and TRT, p=0.018). We demonstrate that BFR training to task-failure elicits similar strength, hypertrophy, and muscular endurance changes to traditional resistance training. Further, varied occlusion pressure does not impact these outcomes, nor elicit changes in TSI% or BL concentrations. Novelty Bullets • Training to task failure with low-load blood flow restriction elicits similar improvements to traditional resistance training, regardless of occlusion pressure. • During blood flow restriction, altering occlusion pressure does not proportionally impact tissue O2 saturation nor blood lactate concentrations.

Blood Flow Restriction Training Using the Delfi System Is Associated With a Cellular Systemic Response

Purpose

To determine the effects of blood flow restriction (BFR) exercise on CD34⁺ cells, platelets, white blood cells, neutrophils, lymphocytes, lactate, and glucose.

Methods

Healthy participants aged 20 to 39 years who were able to perform the exercise sessions were recruited. Participants underwent an experimental (EXP) occluded testing session and a control (CON) session using the Delfi Personalized Tourniquet System. Blood draws were performed prior to testing and immediately after the exercise session. Blood analysis consisted of a complete blood count as well as flow cytometry to measure peripheral CD34⁺ counts as a marker for hematopoietic progenitor cells.

Results

Fourteen men (aged 30.8 ± 3.9 years) volunteered. There was a significant increase in average CD34⁺ counts immediately after the EXP session only (3.1 ± 1.2 cells ⋅ μL^-1 vs 5.2 ± 2.9 cells ⋅ μL^-1, P = .012). Platelet counts were significantly elevated after both sessions, with the average increase being higher after the EXP session (mean difference [MD], 34,200/μL; P < .002) than after the CON session (MD, 11,600/μL; P < .002). White blood cell counts significantly increased after both the EXP (8,400 ± 2,200/μL vs 6,300 ± 1,600/μL; P < .001) and CON (MD, 900/μL; P < .001) sessions. There was a significant increase from baseline to immediately after exercise in the average number of lymphocytes (MD, 6.3%; P < .001) and, conversely, a significant decrease in the average neutrophil count (MD, 6.5%; P < .001) in the EXP session only. Lactate levels significantly increased in the EXP (MD, 6.1 mmol ⋅ L^-1; P = .001) and CON (MD, 3.6 mmol ⋅ L^-1; P = .001) groups. No changes in glucose levels were observed.

Conclusions

Exercise with BFR causes a significant post-exercise increase in peripheral hematopoietic progenitor cells and platelets, beyond that of standard resistance training.

Clinical Relevance

BFR can be considered a way to manipulate point-of-care blood products such as platelet-rich plasma to increase product yield.

Slow-Speed Resistance Training Increases Skeletal Muscle Contractile Properties and Power Production Capacity in Elite Futsal Players

The purpose of this study was to explore the effects of slow-speed resistance training with low intensity (SRT) on muscle power output in elite futsal players with respect to traditional resistance training. The authors hypothesized that the muscle deoxygenation during SRT causes early recruitment of fast twitch fibers that would positively affect strength and power performance. Thirty male elite futsal players were recruited and randomly assigned either to SRT group or to traditional resistance training (TRT) group. All players underwent an 8-weeks experimental protocol consisting of 2 training sessions per week at both leg curl and leg extension machines. In the SRT, players lifted 50% of one maximum repetition (1RM) involving 3 s for eccentric and concentric actions. In the TRT, players lifted 80% of 1RM involving 1 s for eccentric and concentric actions. All players were tested twice (pre and post) for sprint and jump performances, maximal isometric voluntary contraction (MVC) and maximal isokinetic peak torque (Peak TQ) and total work (TW) at 60 and 120°/s (on knee extensors and flexors). The two groups presented remarkable differences in the within-group changes for all the variables. SRT exhibited greater improvements in both Peak TQ and TW for knee extensors and flexors at 120°/s. Conversely, TRT showed greater improvements in MVC, and in both Peak TQ and TW for knee extensors and flexors at 60°/s, except for Peak TQ of the knee extensors, where no significant difference was found between TRT and SRT. Countermovement jump showed a decrease in eccentric time and an increase in concentric force in SRT group. SRT and TRT resulted effective to enhance the strength performance indices during the 8-weeks experimental protocol. Peak torque at 120°/s explained more of the contractile characteristic effects of SRT training than MVC, suggesting that slow-speed training can cause fast twitch fibers hypertrophy in elite athletes. Since slow-speed training is supposed to produce a decreased exercise-induced muscle damage, SRT method is a suitable option in strength training for futsal and team sports.

Perceptual and Neuromuscular Responses Adapt Similarly Between High-Load Resistance Training and Low-Load Resistance Training With Blood Flow Restriction

Teixeira, EL, Painelli, VdS, Schoenfeld, BJ, Silva-Batista, C, Longo, AR, Aihara, AY, Cardoso, FN, Peres, BdA, and Tricoli, V. Perceptual and neuromuscular responses adapt similarly between high-load resistance training and low-load resistance training with blood flow restriction. J Strength Cond Res XX(X): 000-000, 2020-This study compared the effects of 8 weeks of low-load resistance training with blood flow restriction (LL-BFR) and high-load resistance training (HL-RT) on perceptual responses (rating of perceived exertion [RPE] and pain), quadriceps cross-sectional area (QCSA), and muscle strength (1 repetition maximum [RM]). Sixteen physically active men trained twice per week, for 8 weeks. One leg performed LL-BFR (3 sets of 15 repetitions, 20% 1RM), whereas the contralateral leg performed HL-RT (3 sets of 8 repetitions, 70% 1RM). Rating of perceived exertion and pain were evaluated immediately after the first and last training sessions, whereas QCSA and 1RM were assessed at baseline and after training. Rating of perceived exertion was significantly lower (6.8 ± 1.1 vs. 8.1 ± 0.8, p = 0.001) and pain significantly higher (7.1 ± 1.2 vs. 5.8 ± 1.8, p = 0.02) for LL-BFR than that for HL-RT before training. Significant reductions in RPE and pain were shown for both protocols after training (both p < 0.0001), although no between-protocol differences were shown in absolute changes (p = 0.10 and p = 0.48, respectively). Both LL-BFR and HL-RT were similarly effective in increasing QCSA (7.0 ± 3.8% and 6.3 ± 4.1%, respectively; both p < 0.0001) and 1RM (6.9 ± 4.1% and 13.7 ± 5.9%, respectively; both P < 0.0001), although absolute changes for 1RM in HL-RT were greater than LL-BFR (p = 0.001). In conclusion, LL-BFR produces lower RPE values and a higher pain perception than HL-RT. However, consistent application of these approaches result in chronic adaptations so that there are no differences in perceptual responses over the course of time. In addition, muscle strength is optimized with HL-RT despite similar increases in muscle hypertrophy between conditions.

Effects of Drop-Set and Pyramidal Resistance Training Systems on Microvascular Oxygenation: A Near-Infrared Spectroscopy Approach

Metabolic stress is a primary mechanism of muscle hypertrophy and is associated with microvascular oxygenation and muscle activation. Considering that drop-set (DS) and crescent pyramid (CP) resistance training systems are recommended to modulate these mechanisms related to muscle hypertrophy, we aimed to investigate if these resistance training systems produce a different microvascular oxygenation status and muscle activation from those observed in traditional resistance training (TRAD). Twelve volunteers had their legs randomized in an intra-subject cross-over design in TRAD (3 sets of 10 repetitions at 75% 1-RM), DS (3 sets of ∼50-75% 1-RM) and CP (3 sets of 6-10 repetitions at 75-85% 1-RM). Vastus medialis microvascular oxygenation and muscle activation were respectively assessed by non-invasive near-infrared spectroscopy and surface electromyography techniques during the resistance training sessions in the leg-extension exercise. Total hemoglobin area under the curve (AUC) (TRAD: -1653.5 ± 2866.5; DS: -3069.2 ± 3429.4; CP: -1196.6 ± 2675.3) and tissue oxygen saturation (TRAD: 19283.1 ± 6698.0; DS: 23995.5 ± 15604.9; CP: 16109.1 ± 8553.1) increased without differences between protocols (p>0.05). Greater decreases in oxygenated hemoglobin AUC and hemoglobin differentiated AUC were respectively found for DS (-4036.8 ± 2698.1; -5004.4 ± 2722.9) compared with TRAD (-1951.8 ± 1720.0; -2250.3 ± 1305.7) and CP (-1814.4 ± 2634.3; 2432.2 ± 2891.4) (p<0.03). Higher increases of hemoglobin deoxygenated AUC were found for DS (1426.7 ± 1320.7) compared with TRAD (316.0 ± 1164.9) only (p=0.04). No differences were demonstrated in electromyographic amplitudes between TRAD (69.0 ± 34.4), DS (61.3 ± 26.7) and CP (60.9 ± 38.8) (p>0.05). Despite DS produced lower microvascular oxygenation levels compared with TRAD and CP, all protocols produced similar muscle activation levels.

Muscle oxygenation, endocrine and metabolic regulation during low-intensity endurance exercise with blood flow restriction

PURPOSE

The present study investigated the effect of endurance exercise with blood flow restriction (BFR) performed at either 25% maximal oxygen uptake (V˙O2 max) or 40% V˙O2 max) on muscle oxygenation, energy metabolism, and endocrine responses.

METHODS

Ten males were recruited in the present study. The subjects performed three trials: (1) endurance exercise at 40% V˙O2 max without BFR (NBFR40), (2) endurance exercise at 25% V˙O2 max with BFR (BFR25), and (3) endurance exercise at 40% V˙O2 max with BFR (BFR40). The exercises were performed for 15 min during which the pedaling frequency was set at 70 rpm. In BFR25 and BFR40, 2 min of pressure phase (equivalent to 160 mmHg) followed by 1 min of release phase were repeated five times (5 × 3 min) throughout 15 minutes of exercise. During exercise, muscle oxygenation and concentration of respiratory gases were measured. The blood samples were collected before exercise, immediately after 15 min of exercise, and at 15, 30, and 60 minutes after completion of exercise.

RESULTS

Deoxygenated hemoglobin (deoxy-Hb) level during exercise was significantly higher with BFR25 and BFR40 than that with NBFR40. BFR40 showed significantly higher total-hemoglobin (total-Hb) than NBFR40 during 2 min of pressure phase. Moreover, exercise-induced lactate elevation and pH reduction were significantly augmented in BFR40, with concomitant increase in serum cortisol concentration after exercise. Carbohydrate (CHO) oxidation was significantly higher with BFR40 than that with NBFR40 and BFR25, whereas fat oxidation was lower with BFR40.

CONCLUSION

Deoxy-Hb and total Hb levels were significantly increased during 15 min of pedaling exercise in BFR25 and BFR40, indicating augmented local hypoxia and blood volume (blood perfusion) in the muscle. Moreover, low-and moderate-intensity exercise with BFR facilitated CHO oxidation.

The acute muscular response to passive movement and blood flow restriction

PURPOSE

To compare the acute effects of passive movement combined with blood flow restriction (PM + BFR) to passive movement (PM) or blood flow restriction alone (BFR).

METHODS

A total of 20 healthy participants completed: time control (TC), PM, BFR and PM + BFR (one per leg, over 2 days; randomized). For PM, a dynamometer moved the leg through 3 sets of 15 knee extensions/flexions (90° at 45°/second). For BFR, a cuff was inflated to 80% arterial occlusion pressure on the upper leg. Measurements consisted of anterior muscle thickness at 60% and 70% of the upper leg before and after (-0, -5 and -10 min) conditions, ratings of perceived effort and discomfort before conditions and after each set, and of the vastus lateralis during conditions. Data, presented as mean (SD), were compared using Bayesian RMANOVA, except for perceived effort and discomfort, which were compared using a Friedman's test (non-parametric).

RESULTS

60% (Δcm before-after-0: TC = 0.04 [0.09], PM = -0.01 [0.15], BFR = 0.00 [0.11], PM + BFR = 0.01 [0.22]) and 70% (Δcm before-after-0: TC = 0.01 [0.09], PM = -0.01 [0.15], BFR = 0.02 [0.11], PM + BFR = -0.03 [0.22]) muscle thickness did not change. Perceived effort was greater than TC following PM (p = .05) and PM + BFR (p = .001). Perceived discomfort was greater following BFR and PM + BFR compared to TC (all p ≤ .002) and PM (all p ≤ .010). Changes in deoxygenation (e.g. channel 1; ΔμM start set 1-end set 3: TC = 0.9 [1.2], PM = -1.2 [1.9], BFR = 10.3 [2.7], PM + BFR = 10.3 [3.0]) were generally greater with BFR and PM + BFR (BF_inclusion  = 1.210e + 13).

CONCLUSION

Acute muscular responses to PM + BFR are not augmented over the effect of BFR alone.

Acute physiological responses to combined blood flow restriction and low-level laser

PURPOSE

Blood flow restriction (BFR) is an innovation in fitness to train muscles with low loads at low oxygen levels. Low-level laser therapy (LLLT) is a bio-energetic approach to alleviate muscle fatigue during resistance training. This study investigated the immediate effect of LLLT pre-conditioning on BFR that accelerates muscle fatigue due to ischemia.

METHODS

Fifteen young adults participated in this study of a crossover randomized design. They completed a low-load contraction with various pre-conditioning (blood flow restriction with low-level laser therapy (LLLT + BFR), blood flow restriction with sham low-level laser therapy (BFR), and control). Force fluctuation dynamics, muscle oxygen saturation of hemoglobin and myoglobin (SmO₂), and discharge patterns of motor units (MU) were compared.

RESULTS

Normalized SmO₂ during low-load contractions significantly varied with the pre-contraction protocols (Control (83.6 ± 3.0%) > LLLT + BFR (70.3 ± 2.8%) > BFR (55.4 ± 2.4%). Also, force fluctuations and MU discharge varied with the pre-contraction protocols. Multi-scale entropy and mean frequency of force fluctuations were greater in the LLLT + BFR condition (31.95 ± 0.67) than in the BFR condition (29.47 ± 0.73). The mean inter-spike interval of MUs was greater in the LLLT + BFR condition (53.32 ± 2.70 ms) than in the BFR condition (45.04 ± 1.08 ms). In particular, MUs with higher recruitment thresholds exhibited greater LLLT-related discharge complexity (LLLT + BFR (0.201 ± 0.012) > BFR (0.154 ± 0.006)).

CONCLUSIONS

LLLT pre-conditioning can minimize the BFR-related decline in muscle oxygen saturation, leading to force gradation and MU discharge in a cost-effective and complex manner.

Knee extension with blood flow restriction: Impact of cuff pressure on hemodynamics

INTRODUCTION

Blood flow restriction (BFR) exercise has emerged as a method of increasing muscle size and strength with low intensity resistance training. While the cuff pressures used during BFR are typically a percentage of resting arterial occlusion pressure (AOP), the impact these cuff pressures have on blood flow during lower body exercise is unknown.

PURPOSE

To determine how various cuff pressures impact blood flow and tissue perfusion during exercise.

METHODS

Eleven healthy male participants completed four sets of knee extension (30 reps per set at 30% max torque) with 0%, 60%, 80%, and 100% of arterial occlusion pressure (AOP) was applied to the proximal portion of the thigh. Femoral artery blood flow, tissue oxygenation, and central hemodynamics were continuously recorded before, during, and after exercise. Electromyography (EMG) amplitude was recorded from the vastus lateralis during exercise.

RESULTS

Blood flow increased during exercise compared to rest across all cuff pressures (p < 0.001), however compared to 0%, the absolute blood flow was reduced by 34 ± 17%, 45 ± 22%, and 72 ± 19% for 60, 80, and 100% AOP, respectively. Furthermore, each cuff pressure resulted in similar relative changes in blood flow before, during, and after exercise. During exercise, tissue saturation index (TSI) decreased as cuff pressure increased (p ≤ 0.005) with the exception of 80 to 100% AOP. Deoxyhemoglobin increased (p ≤ 0.001) with cuff pressure.

CONCLUSION

Our data indicate that while BFR knee extension elicits an absolute hyperemic response at cuff pressures up to 100% resting AOP, the relative reductions in blood flow are consistent across rest, exercise and recovery.

Monocular 3D Probe Tracking for Generating Sub-Surface Optical Property Maps From Diffuse Optical Spectroscopic Imaging

OBJECTIVE

Diffuse optical spectroscopic imaging (DOSI) is a promising biophotonic technology for clinical tissue assessment, but is currently hampered by difficult wide area assessment. A co-integrative optical imaging system is proposed for dense sub-surface optical property spatial assessment.

METHODS

The proposed system fuses a co-aligned set of camera frames and diffuse optical spectroscopy measurements to generate spatial sub-surface optical property maps. A 3D rigid body motion estimation model was developed by fitting automatically detected target features to an a priori geometric model using a single overhead camera. Point-wise optical properties were measured across the tissue using frequency domain photon migration DOSI. The 3D probe trajectory and temporal optical property data were fused to generate 2D spatial optical property maps, which were projected onto the tissue image using pre-calibrated camera parameters.

RESULTS

The system demonstrated sub-millimeter positional accuracy (error 0.24 ± 0.35 mm) across different probe speeds (1.0-3.8 cm/s), and displacement accuracy in overhead ([Formula: see text] mm) and tilted (0.51 ± 0.51 mm) camera orientations. Unstructured scans on a tumor inclusion phantom showed strong contrast under different probe paths, and significant ( ) changes in optical properties in an in vivo leg cuff occlusion protocol with spatial anatomy localization.

CONCLUSION

The proposed co-integrative optical imaging system generated dense sub-surface optical property distributions across wide tissue areas with sub-millimeter accuracy at different probe speeds and trajectories, and does not require pre-planned probe route for tissue assessment.

SIGNIFICANCE

This system provides a valuable tool for real-time non-invasive tissue health and cancer screening, and enables longitudinal disease progression assessment through unstructured probe-based optical tissue assessment.

Acute Responses to On-Court Repeated-Sprint Training Performed With Blood Flow Restriction Versus Systemic Hypoxia in Elite Badminton Athletes

PURPOSE

Repeated-sprint training (RS) is commonly conducted in normoxia, but its completion with localized (blood-flow restriction [BFR]) or systemic hypoxia has been proven effective for performance enhancement. Yet, few studies have applied these types of RS sessions in racket sports. The authors aimed to determine the acute responses to these types of training in elite badminton players.

METHODS

Eight male elite badminton players participated in this randomized crossover study. They performed 3 on-court RS sessions, each consisting of 3 sets of 10 repetitions of 10-s badminton-specific movements in normoxia (RSN), systemic normobaric hypoxia (RSH, FiO2 = 14%), or with BFR (RS-BFR, 40% arterial occlusion pressure). Performance, perceptual (ie, rating of perceived exertion), and physiological (ie, pulse saturation, muscle oxygenation, blood lactate, creatine kinase, heart-rate variability) responses were measured after each set and up to 48 h postsession.

RESULTS

RS-BFR induced a greater performance impairment (lower distance and accelerations) and a higher local perceived exertion in the legs than RSN and RSH (P < .05), whereas greater overall fatigue was reported with RSH (P < .05). RSH induced a lower saturation (P < .001), but no differences were observed in muscle oxygenation between conditions. No differences in creatine kinase or heart-rate variability were observed at any time point (from baseline up to 48 h after the session).

CONCLUSIONS

RS-BFR-and, to a lower extent, RSH-resulted in impaired performance and a higher perceived strain than RSN. However, these 2 hypoxic methods do not seem to induce a long-lasting (post 24-48 h) physiological stress in elite badminton players.

Separate and combined effects of local and systemic hypoxia in resistance exercise

PURPOSES

This study quantified performance, physiological, and perceptual responses during resistance exercise to task failure with blood flow restriction (BFR), in systemic hypoxia, and with these stimuli combined.

METHODS

Fourteen young men were tested for 1-repetition maximum (1RM) in the barbell biceps curl and lying triceps extension exercises. On separate visits, subjects performed exercise trials (4 sets to failure at 70% 1RM with 90 s between sets) in six separate randomized conditions, i.e., in normoxia or hypoxia (fraction of inspired oxygen = 20.9% and 12.9%, respectively) combined with three different levels of BFR (0%, 45%, or 60% of resting arterial occlusion pressure). Muscle activation and oxygenation were monitored via surface electromyography and near-infrared spectroscopy, respectively. Arterial oxygen saturation, heart rate, and perceptual responses were assessed following each set.

RESULTS

Compared to set 1, the number of repetitions before failure decreased in sets 2, 3, and 4 for both exercises (all P < 0.001), independently of the condition (P > 0.065). Arterial oxygen saturation was lower with systemic hypoxia (P < 0.001), but not BFR, while heart rate did not differ between conditions (P > 0.341). Muscle oxygenation and activation during exercise trials remained unaffected by the different conditions (all P ≥ 0.206). A significant main effect of time, but not condition, was observed for overall perceived discomfort, difficulty breathing, and limb discomfort (all P < 0.001).

CONCLUSION

Local and systemic hypoxic stimuli, or a combination of both, did not modify the fatigue-induced change in performance, trends of muscle activation or oxygenation, nor exercise-related sensations during a multi-set resistance exercise to task failure.

Blood flow restricted resistance exercise and reductions in oxygen tension attenuate mitochondrial H2 O2 emission rates in human skeletal muscle

KEY POINTS

Blood flow restricted resistance exercise (BFR-RE) is capable of inducing comparable adaptations to traditional resistance exercise (RE), despite a lower total exercise volume. It has been suggested that an increase in reactive oxygen species (ROS) production may be involved in this response; however, oxygen partial pressure ( P O 2 ) is reduced during BFR-RE, and the influence of P O 2 on mitochondrial redox balance remains poorly understood. In human skeletal muscle tissue, we demonstrate that both maximal and submaximal mitochondrial ROS emission rates are acutely decreased 2 h following BFR-RE, but not RE, occurring along with a reduction in tissue oxygenation during BFR-RE. We further suggest that P O 2 is involved in this response because an in vitro analysis revealed that reducing P O 2 dramatically decreased mitochondrial ROS emissions and electron leak to ROS. Altogether, these data indicate that mitochondrial ROS emission rates are attenuated following BFR-RE, and such a response is likely influenced by reductions in P O 2 .

ABSTRACT

Low-load blood flow restricted resistance exercise (BFR-RE) training has been proposed to induce comparable adaptations to traditional resistance exercise (RE) training, however, the acute signalling events remain unknown. Although a suggested mechanism of BFR-RE is an increase in reactive oxygen species (ROS) production, oxygen partial pressure ( P O 2 ) is reduced during BFR-RE, and the influence of O₂ tension on mitochondrial redox balance remains ambiguous. We therefore aimed to determine whether skeletal muscle mitochondrial bioenergetics were altered following an acute bout of BFR-RE or RE, and to further examine the role of P O 2 in this response. Accordingly, muscle biopsies were obtained from 10 males at rest and 2 h after performing three sets of single-leg squats (RE or BFR-RE) to failure at 30% one-repetition maximum. We determined that mitochondrial respiratory capacity and ADP sensitivity were not altered in response to RE or BFR-RE. Although maximal (succinate) and submaximal (non-saturating ADP) mitochondrial ROS emission rates were unchanged following RE, BFR-RE attenuated these responses by ∼30% compared to pre-exercise, occurring along with a reduction in skeletal muscle tissue oxygenation during BFR-RE (P < 0.01 vs. RE). In a separate cohort of participants, evaluation of mitochondrial bioenergetics in vitro revealed that mild O₂ restriction (50 µm) dramatically attenuated maximal (∼4-fold) and submaximal (∼50-fold) mitochondrial ROS emission rates and the fraction of electron leak to ROS compared to room air (200 µm). Combined, these data demonstrate that mitochondrial ROS emissions are attenuated following BFR-RE, a response which may be mediated by a reduction in skeletal muscle P O 2 .

Blood flow restriction augments the skeletal muscle response during very low-load resistance exercise to volitional failure

The purpose of this study was to compare the acute muscular response with resistance exercise between the following conditions [labeled (% one-repetition maximum/% arterial occlusion pressure)]: high-load (70/0), very low-load (15/0), very low-load with moderate (15/40), and high (15/80) blood flow restriction pressures. Twenty-three participants completed four sets of unilateral knee extension to failure (up to 90 repetitions) with each condition, one condition per leg, each day. Muscle thickness and maximal voluntary contraction (MVC) were measured before (Pre), immediately after (Post-0), and 15 min after (Post-15) exercise and electromyography (EMG) amplitude during exercise. Pre to Post-0 muscle thickness changes in cm [95% CI] were greater with 15/40 [0.57 (0.41, 0.73)] and 15/80 [0.49 (0.35, 0.62)] compared to 70/0 [0.33 (0.25, 0.40)]. Pre to Post-0 MVC changes in Nm [95% CI] were higher with 15/40 [-127.0 (-162.1, -91.9)] and 15/80 [-133.6 (-162.8, -104.4)] compared to 70/0 [-48.4 (-70.1, -26.6)] and 15/0 [-98.4 (-121.9, -74.9)], which were also different. Over the first three repetitions, EMG increased across sets, whereas in the last three repetitions it did not. EMG was also different between conditions and was generally greater during 70/0. Repetitions decreased across sets reaching the lowest for 70/0, and for very low loads decreased with increased pressure. In trained participants exercising to failure, lower load and the application of restriction pressure augment changes in muscle thickness and torque. The EMG amplitude was augmented by load. Training studies should compare these conditions, as the results herein suggest some muscular adaptations may differ.

Tissue Oxygenation in Response to Different Relative Levels of Blood-Flow Restricted Exercise

Blood flow restrictive (BFR) exercise elicits a localized hypoxic environment compatible with greater metabolic stress. We intended to compare the acute changes in muscle microvascular oxygenation following low-intensity knee extension exercise, combined with different levels of BFR. Thirteen active young men (age: 23.8 ± 5.4 years) were tested for unilateral knee extension exercise (30 + 15 + 15 + 15 reps at 20% one repetition maximum) on four different conditions: no-BFR (NOBFR), 40, 60, and 80% of arterial occlusion pressure (AOP). Deoxyhemoglobin+myoglobin concentration Deoxy[Hb+Mb], total hemoglobin [T(H+Mb)] and tissue oxygen saturation [TOI] were measured on the vastus lateralis muscle using near-infrared spectroscopy (NIMO, Nirox srl, Brescia, Italy). The magnitude of change in Deoxy[Hb+Mb]during exercise was similar between 60 and 80% AOP. Overall, compared to that seen during 60 and 80% AOP, NOBFR as well as 40% AOP resulted in a lower magnitude of change in Deoxy[Hb+Mb] (p < 0.05). While the oxygen extraction decreased during each inter-set resting interval in NOBFR and 40% AOP, this was not the case for 60 or 80% AOP. Additionally, TOI values obtained during recovery from each set of exercise were similarly affected by all conditions. Finally, our data also show that, when performed at higher restrictive values (60 and 80%), BFR exercise increases total Deoxy[Hb+Mb] extraction (p < 0.05). Taken together, we provide evidence that BFR is effective for increasing deoxygenation and reducing tissue oxygenation during low-intensity exercise. We also showed that when using low loads, a relative pressure above 40% of the AOP at rest is required to elicit changes in microvascular oxygenation compared with the same exercise with unrestricted conditions.

The Association Between Muscle Deoxygenation and Muscle Hypertrophy to Blood Flow Restricted Training Performed at High and Low Loads

The metabolic stress induced by blood flow restriction (BFR) during resistance training (RT) might maximize muscle growth. However, it is currently unknown whether metabolic stress are associated with muscle hypertrophy after RT protocols with high- or low load. Therefore, the aim of the study was to compare the effect of high load RT (HL-RT), high load BFR (HL-BFR), and low load BFR (LL-BFR) on deoxyhemoglobin concentration [HHb] (proxy marker of metabolic stress), muscle cross-sectional area (CSA), activation, strength, architecture and edema before (T1), after 5 (T2), and 10 weeks (T3) of training with these protocols. Additionally, we analyzed the occurrence of association between muscle deoxygenation and muscle hypertrophy. Thirty young men were selected and each of participants’ legs was allocated to one of the three experimental protocols in a randomized and balanced way according to quartiles of the baseline CSA and leg extension 1-RM values of the dominant leg. The dynamic maximum strength was measured by 1-RM test and vastus lateralis (VL) muscle cross-sectional area CSA echo intensity (CSA_echo) and pennation angle (PA) were performed through ultrasound images. The measurement of muscle activation by surface electromyography (EMG) and [HHb] through near-infrared spectroscopy (NIRS) of VL were performed during the training session with relative load obtained after the 1-RM, before (T1), after 5 (T2), and 10 weeks (T3) training. The training total volume (TTV) was greater for HL-RT and HL-BFR compared to LL-BFR. There was no difference in 1-RM, CSA, CSA_echo, CSA_echo/CSA, and PA increases between protocols. Regarding the magnitude of the EMG, the HL-RT and HL-BFR groups showed higher values than and LL-BFR. On the other hand, [HHb] was higher for HL-BFR and LL-BFR. In conclusion, our results suggest that the addition of BFR to exercise contributes to neuromuscular adaptations only when RT is performed with low-load. Furthermore, we found a significant association between the changes in [HHb] (i.e., metabolic stress) and increases in muscle CSA from T2 to T3 only for the LL-BFR, when muscle edema was attenuated.

Skeletal Muscle Mitochondrial Protein Synthesis and Respiration Increase With Low-Load Blood Flow Restricted as Well as High-Load Resistance Training

Purpose: It is well established that high-load resistance exercise (HLRE) can stimulate myofibrillar accretion. Additionally, recent studies suggest that HLRE can also stimulate mitochondrial biogenesis and respiratory function. However, in several clinical situations, the use of resistance exercise with high loading may not constitute a viable approach. Low-load blood flow restricted resistance exercise (BFRRE) has emerged as a time-effective low-load alternative to stimulate myofibrillar accretion. It is unknown if BFRRE can also stimulate mitochondrial biogenesis and respiratory function. If so, BFRRE could provide a feasible strategy to stimulate muscle metabolic health.

Methods: To study this, 34 healthy previously untrained individuals (24 ± 3 years) participated in BFRRE, HLRE, or non-exercise control intervention (CON) 3 times per week for 6 weeks. Skeletal muscle biopsies were collected; (1) before and after the 6-week intervention period to assess mitochondrial biogenesis and respiratory function and; (2) during recovery from single-bout exercise to assess myocellular signaling events involved in transcriptional regulation of mitochondrial biogenesis. During the 6-week intervention period, deuterium oxide (D₂O) was continuously administered to the participants to label newly synthesized skeletal muscle mitochondrial proteins. Mitochondrial respiratory function was assessed in permeabilized muscle fibers with high-resolution respirometry. Mitochondrial content was assessed with a citrate synthase activity assay. Myocellular signaling was assessed with immunoblotting.

Results: Mitochondrial protein synthesis rate was higher with BFRRE (1.19%/day) and HLRE (1.15%/day) compared to CON (0.92%/day) (P < 0.05) but similar between exercise groups. Mitochondrial respiratory function increased to similar degree with both exercise regimens and did not change with CON. For instance, coupled respiration supported by convergent electron flow from complex I and II increased 38% with BFRRE and 24% with HLRE (P < 0.01). Training did not alter citrate synthase activity compared to CON. BFRRE and HLRE elicited similar myocellular signaling responses.

Conclusion: These results support recent findings that resistance exercise can stimulate mitochondrial biogenesis and respiratory function to support healthy skeletal muscle and whole-body metabolism. Intriquingly, BFRRE produces similar mitochondrial adaptations at a markedly lower load, which entail great clinical perspective for populations in whom exercise with high loading is untenable.

Effects of load on the acute response of muscles proximal and distal to blood flow restriction

To determine the effects of load and blood flow restriction (BFR) on muscular responses, we asked 12 participants to perform chest presses under four different conditions [30/0, 30/40, 50/0, and 50/40, presented as percentage one-repetition maximum (1RM)/percentage arterial occlusion pressure (AOP)]. Muscle thickness increased pre- to post-exercise [chest: mean 0.29, 95% confidence interval (CI) 0.21, 0.37 cm; triceps: mean 0.44, 95% CI 0.34, 0.54 cm], remaining elevated for 15 min post-exercise. Electromyography amplitude was greater with 50% 1RM and increased over time for the first three repetitions of each set of chest presses. The last three repetitions differed across time only. AOP increased from pre- to post-exercise, augmented by BFR [30/0: mean 31, 95% CI 18, 44 mmHg; 30/40: mean 39, 95% CI 28, 50 mmHg; 50/0: mean 32, 95% CI 23, 41 mmHg; 50/40: mean 46, 95% CI 32, 59 mmHg). Tranquility decreased and physical exhaustion increased from the pre- to post-condition, with both parameters returning to the baseline 15 min post-exercise level. In conclusion, load and BFR do not elicit meaningful differences in the acute response of chest press exercise taken to failure.

Muscle Adaptations to High-Load Training and Very Low-Load Training With and Without Blood Flow Restriction

An inability to lift loads great enough to disrupt muscular blood flow may impair the ability to fatigue muscles, compromising the hypertrophic response. It is unknown what level of blood flow restriction (BFR) pressure, if any, is necessary to reach failure at very low-loads [i.e., 15% one-repetition maximum (1RM)]. The purpose of this study was to investigate muscular adaptations following resistance training with a very low-load alone (15/0), with moderate BFR (15/40), or with high BFR (15/80), and compare them to traditional high-load (70/0) resistance training. Using a within/between subject design, healthy young participants (n = 40) performed four sets of unilateral knee extension to failure (up to 90 repetitions/set), twice per week for 8 weeks. Data presented as mean change (95% CI). There was a condition by time interaction for 1RM (p < 0.001), which increased for 70/0 [3.15 (2.04,4.25) kg] only. A condition by time interaction (p = 0.028) revealed greater changes in endurance for 15/80 [6 (4,8) repetitions] compared to 15/0 [4 (2,6) repetitions] and 70/0 [4 (2,5) repetitions]. There was a main effect of time for isometric MVC [change = 10.51 (3.87,17.16) Nm, p = 0.002] and isokinetic MVC at 180^°/s [change = 8.61 (5.54,11.68) Nm, p < 0.001], however there was no change in isokinetic MVC at 60^°/s [2.45 (−1.84,6.74) Nm, p = 0.261]. Anterior and lateral muscle thickness was assessed at 30, 40, 50, and 60% of the upper leg. There was no condition by time interaction for muscle thickness sites (all p ≥ 0.313). There was a main effect of time for all sites, with increases over time (all p < 0.001). With the exception of the 30% lateral site (p = 0.059) there was also a main effect of condition (all p < 0.001). Generally, 70/0 was greater. Average weekly volume increased for all conditions across the 8 weeks, and was greatest for 70/0 followed by 15/0, 15/40, then 15/80. With the exception of 1RM, changes in strength and muscle size were similar regardless of load or restriction. The workload required to elicit these changes lowered with increased BFR pressure. These findings may be pertinent to rehabilitative settings, future research, and program design.

Strengthening the Brain-Is Resistance Training with Blood Flow Restriction an Effective Strategy for Cognitive Improvement?

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.

The Role of Inflammation and Immune Cells in Blood Flow Restriction Training Adaptation: A Review

Blood flow restriction (BFR) combined with low-intensity strength training has been shown to increase skeletal muscle mass and strength in a variety of populations. BFR results in a robust metabolic stress which is hypothesized to induce muscle growth via increased recruitment of fast-twitch muscle fibers, a greater endocrine response, and/or enhancing the cellular swelling contribution to the hypertrophic process. Following exercise, neutrophils are the first immune cells to initiate the tissue remodeling process via several mechanisms including an increased production of cytokines and recruitment of monocytes/macrophages, which facilitate the phagocytosis of foreign particles, the differentiation of myoblasts, and the formation of new myotubes. Thus, the purpose of this review was to discuss the mechanisms through which metabolic stress and immune cell recruitment may induce skeletal muscle remodeling following BFR strength training.

Effects of knee extension with different speeds of movement on muscle and cerebral oxygenation

Background

One of the mechanisms responsible for enhancing muscular hypertrophy is the high metabolic stress associated with a reduced muscular oxygenation occurring during exercise, which can be achieved by reducing the speed of movement. Studies have tested that lowered muscle oxygenation artificially induced by an inflatable cuff, could provoke changes in prefrontal cortex oxygenation, hence, to central fatigue. It was hypothesized that (1) exercising with a slow speed of movement would result in greater increase in cerebral and greater decrease in muscle oxygenation compared with exercises of faster speed and (2) the amount of oxygenation increase in the ipsilateral prefrontal cortex would be lower than the contralateral one.

Methods

An ISS Imagent frequency domain near infrared spectroscopy (NIRS) system was used to quantify oxygenation changes in the vastus lateralis muscle and prefrontal cortex (contra- and ipsilateral) during unilateral resistance exercises with different speeds of movement to voluntary fatigue. After one maximal repetition (1RM) test, eight subjects performed three sets of unilateral knee extensions (∼50% of 1RM), separated by 2 min rest periods, following the pace of 1 s, 3 s and 5 s for both concentric and eccentric phases, in a random order, during separate sessions. The amount of change for NIRS parameters for muscle (ΔHb: deoxyhemoglobin, ΔHbO: oxyhemoglobin, ΔHbT: total hemoglobin, ΔStO₂: oxygen saturation) were quantified and compared between conditions and sets by two-way ANOVA RM. Differences in NIRS parameters between contra- and ipsilateral (lobe) prefrontal cortex and conditions were tested.

Results

Exercising with slow speed of movement was associated to larger muscle deoxygenation than normal speed of movement, as revealed by significant interaction (set × condition) for ΔHb (p = 0.01), and by significant main effects of condition for ΔHbO (p = 0.007) and ΔStO₂ (p = 0.016). With regards to the prefrontal cortex, contralateral lobe showed larger oxygenation increase than the ipsilateral one for ΔHb, ΔHbO, ΔHbT, ΔStO₂ in each set (main effect of lobe: p < 0.05). Main effects of condition were significant only in set1 for all the parameters, and significant interaction lobe × condition was found only for ΔHb in set1 (p < 0.05).

Discussion

These findings provided evidence that speed of movement influences the amount of muscle oxygenation. Since the lack of oxygen in muscle is associated to increased metabolic stress, manipulating the speed of movement may be useful in planning resistance-training programs. Moreover, consistent oxygenation increases in both right and left prefrontal lobes were found, suggesting a complementary interaction between the ipsi- and contralateral prefrontal cortex, which also seems related to fatigue.

Cyclical blood flow restriction resistance exercise: a potential parallel to remote ischemic preconditioning?

Remote ischemic preconditioning (RIPC) is characterized by the cyclical application of limb blood flow restriction and reperfusion and has been shown to protect vital organs during a subsequent ischemic insult. Blood flow restriction exercise (BFRE) similarly combines bouts of blood flow restriction with low-intensity exercise and thus could potentially emulate the protection demonstrated by RIPC. One concern with BFRE, however, is the potential for an augmented rise in sympathetic outflow due to greater activation of the exercise pressor reflex. Because of the use of lower workloads, however, we hypothesized that BFRE would elicit an attenuated increase in sympathetic outflow [assessed via plasma norepinephrine (NE) and mean arterial pressure (MAP)] and middle cerebral artery velocity (MCAv) when compared with conventional exercise (CE). Fifteen subjects underwent two leg press exercise interventions: 1) BFRE-220 mmHg bilateral thigh occlusion at 20% 1 rep-max (1RM), and 2) CE-65% 1RM without occlusion. Each condition consisted of 4 × 5-min cycles of exercise, with 3 × 10-reps in each cycle. Five minutes of rest and reperfusion (for BFRE) followed each cycle. MAP increased with exercise (P < 0.001) and was 4-5 mmHg higher with CE versus BFRE (P ≤ 0.09). Mean MCAv also increased with exercise (P < 0.001) and was higher with CE compared with BFRE during the first bout of exercise only (P = 0.07). Plasma NE concentration increased with CE only (P < 0.001) and was higher than BFRE throughout exercise (P ≤ 0.02). The attenuated sympathetic response, combined with similar cerebrovascular responses, suggest that cyclical BFRE could be explored as an alternative to CE in the clinical setting.

Vertical-cavity surface-emitting laser sources for gigahertz-bandwidth, multiwavelength frequency-domain photon migration

Frequency-domain photon migration (FDPM) uses modulated laser light to measure the bulk optical properties of turbid media and is increasingly applied for noninvasive functional medical imaging in the near-infrared. Although semiconductor edge-emitting laser diodes have been traditionally used as miniature light sources for this application, we show that vertical-cavity surface-emitting lasers (VCSELs) exhibit output power and modulation performance characteristics suitable for FDPM measurements of tissue optical properties at modulation frequencies exceeding 1 GHz. We also show that an array of multiple VCSEL devices can be coherently modulated at frequencies suitable for FDPM and can improve optical power. In addition, their small size and simple packaging make them an attractive choice as components in wearable sensors and clinical FDPM-based optical spectroscopy systems. We demonstrate the benefits of VCSEL technology by fabricating and testing a unique, compact VCSEL-based optical probe with an integrated avalanche photodiode. We demonstrate sensitivity of the VCSEL-based probe to subcutaneous tissue hemodynamics that was induced during an arterial cuff occlusion of the upper arm in a human subject.

Blood flow restriction increases metabolic stress but decreases muscle activation during high-load resistance exercise

INTRODUCTION

We investigated differences in metabolic stress (lactate) and muscle activation (electromyography; EMG) when high-load resistance exercise (HL) is compared with a condition in which blood flow restriction (BFR) is applied during the exercise or during the rest interval.

METHODS

Twelve participants performed HL with BFR during the intervals (BFR-I), during the set (BFR-S), and without BFR. Each condition consisted of 3 sets of 8 repetitions with knee extension at 70% of 1-repetition maximum. Lactate and root mean square (RMS) from the surface EMG of the vastus lateralis were calculated.

RESULTS

Lactate increased in all protocols but was higher with BFR-I than with BFR-S and HL. RMS decreased under all conditions, with a larger effect size in BFR-I (1.47) than in BFR-S (0.66) and HL (0.59).

DISCUSSION

BFR-I increases lactate, possibly as a result of reduced restoration of ATP. Muscle activation seems to be impacted by mechanical stress but may be reduced by metabolic stress. Muscle Nerve 57: 107-111, 2018.