Exercise adherence-related perceptual responses to low-load blood flow restriction resistance exercise in young adults: A pilot study

Comparison of enjoyment and energy expenditure of exergame with and without blood flow restriction in men and women

This study compared the effects of blood flow restriction (BFR) on intensity and perceived enjoyment during an exergame. Fourteen healthy young participants engaged in a boxing exergame for 20 min, with or without BFR, across two sessions. Perceived enjoyment levels were assessed using the Physical Activity Enjoyment Scale. Heart rate was monitored, and energy expenditure (EE) during exercise was calculated. A mixed model analysis of variance with repeated measures was used to evaluate differences in EE and enjoyment between exergame conditions (with and without BFR) as well as the interaction effects of these protocols with gender. Although not statistically significant, perceived enjoyment decreased with BFR inclusion for both genders. No significant differences were observed between men and women for both protocols. Regarding EE, there was no significant difference between the two groups (with and without BFR). However, a significant main effect of gender was found, with men exhibiting higher EE values in both protocols compared to women. In conclusion, exergames incorporating BFR impact perceptual responses, particularly perceived enjoyment. Furthermore, significant gender differences in EE were found, with men displaying higher values.

Effect of High-Intensity Interval Exercise versus Continuous Low-Intensity Aerobic Exercise with Blood Flow Restriction on Psychophysiological Responses: A Randomized Crossover Study

This study compared the effect of continuous low-intensity aerobic exercise with blood flow restriction (LI-AE-BFR) versus high-intensity interval exercise (HIIE), matching total external mechanical work between conditions, on perceptual (exertion, pain, affective and pleasure) and physiological responses (heart rate [HR], blood lactate [BL] and muscle fatigue). Ten healthy untrained men (25.6 ± 3.78 years old; 75.02 ± 12.02 kg; 172.2 ± 6.76 cm; 24.95 ± 3.16 kg/m²) completed three visits to the laboratory. In visit 1, anthropometry, blood pressure and peak running velocity on the treadmill were measured. In visits 2 and 3, participants were randomly assigned to HIIE or LI-AE-BFR, both in treadmill. HIIE consisted of 10 one-minute stimuli at 80% of peak running velocity interspersed with one-minute of passive recovery. LI-AE-BFR consisted of 20-minutes of continuous walking at 40% of peak running velocity with bilateral cuffs inflated to 50% of arterial occlusion pressure. BL and maximum isometric voluntary contraction (MIVC - fatigue measure) were measured pre- and immediately post-exercise. HR, rating of perceived exertion (RPE), and rating of perceived pain (RPP) were recorded after each stimulus in HIIE and every two minutes in LI-AE-BFR. Affective response to the session, pleasure, and future intention to exercise (FIE) were assessed 10 minutes after the intervention ended. Increases in BL concentrations were greater in HIIE (p = 0.028; r = 0.51). No effects time or condition were reported for MIVC. HR was higher in HIIE at all analyzed time points (p < 0.001; d = 3.1 to 5.2). RPE did not differ between conditions (p > 0.05), while average session RPP was higher in LI-AE-BFR (p = 0.036; r = 0.46). Affective positive response (p = 0.019; d = 0.9) and FIE (p = 0.013; d = 0.97) were significantly higher in HIIE. Therefore, HIIE elicited higher physiological stress, positive affective response, and intention to engage in future exercise bouts compared to LI-AE-BFR.

Acute Effect of Resistance Training With Blood Flow Restriction on Perceptual Responses: A Systematic Review and Meta-Analysis

CONTEXT

Several studies have compared perceptual responses between resistance exercise with blood flow restriction and traditional resistance exercise (non-BFR). However, the results were contradictory.

OBJECTIVES

To analyze the effect of RE+BFR versus non-BFR resistance exercise [low-load resistance exercise (LL-RE) or high-load resistance exercise (HL-RE)] on perceptual responses.

DATA SOURCES

CINAHL, Cochrane Library, PubMed®, Scopus, SPORTDiscus, and Web of Science were searched through August 28, 2021, and again on August 25, 2022.

STUDY SELECTION

Studies comparing the effect of RE+BFR versus non-BFR resistance exercise on rate of perceived exertion (RPE) and muscle pain/discomfort were considered. Meta-analyses were conducted using the random effects model.

STUDY DESIGN

Systematic review and meta-analysis.

LEVEL OF EVIDENCE

Level 2.

DATA EXTRACTION

All data were reviewed and extracted independently by 2 reviewers. Disagreements were resolved by a third reviewer.

RESULTS

Thirty studies were included in this review. In a fixed repetition scheme, the RPE [standardized mean difference (SMD) = 1.04; P < 0.01] and discomfort (SMD = 1.10; P < 0.01) were higher in RE+BFR than in non-BFR LL-RE, but similar in sets to voluntary failure. There were no significant differences in RPE in the comparisons between RE+BFR and non-BFR HL-RE; after sensitivity analyses, it was found that the RPE was higher in non-BFR HL-RE in a fixed repetition scheme. In sets to voluntary failure, discomfort was higher in RE+BFR versus non-BFR HL-RE (SMD = 0.95; P < 0. 01); however, in a fixed scheme, the results were similar.

CONCLUSION

In sets to voluntary failure, RPE is similar between RE+BFR and non-BFR exercise. In fixed repetition schemes, RE+BFR seems to promote higher RPE than non-BFR LL-RE and less than HL-RE. In sets to failure, discomfort appears to be similar between LL-RE with and without BFR; however, RE+BFR appears to promote greater discomfort than HL-RE. In fixed repetition schemes, the discomfort appears to be no different between RE+BFR and HL-RE, but is lower in non-BFR LL-RE.

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.

Comparative Perceptual, Affective, and Cardiovascular Responses between Resistance Exercise with and without Blood Flow Restriction in Older Adults

Older adults and patients with chronic disease presenting with muscle weakness or musculoskeletal disorders may benefit from low-load resistance exercise (LLRE) with blood flow restriction (BFR). LLRE-BFR has been shown to increase muscle size, strength, and endurance comparable to traditional resistance exercise but without the use of heavy loads. However, potential negative effects from LLRE-BFR present as a barrier to participation and limit its wider use. This study examined the perceptual, affective, and cardiovascular responses to a bout of LLRE-BFR and compared the responses to LLRE and moderate-load resistance exercise (MLRE). Twenty older adults (64.3 ± 4.2 years) performed LLRE-BFR, LLRE and MLRE consisting of 4 sets of leg press and knee extension, in a randomised crossover design. LLRE-BFR was more demanding than LLRE and MLRE through increased pain (p ≤ 0.024, d = 0.8-1.4) and reduced affect (p ≤ 0.048, d = -0.5--0.9). Despite this, LLRE-BFR was enjoyed and promoted a positive affective response (p ≤ 0.035, d = 0.5-0.9) following exercise comparable to MLRE. This study supports the use of LLRE-BFR for older adults and encourages future research to examine the safety, acceptability, and efficacy of LLRE-BFR in patients with chronic disease.

Greater Neuromuscular Fatigue Following Low Load Blood Flow Restriction than Non Blood Flow Restriction Resistance Exercise Among Recreationally Active Men

PURPOSE

The purpose of this study was to examine the acute effects of low-load blood flow restriction (LLBFR) and low-load non-BFR (LL) on neuromuscular function following a bout of standardized, fatiguing leg extension muscle actions.

METHODS

Fourteen men (mean age ± SD = 23±4 yrs) volunteered to participate in this investigation and randomly performed LLBFR and LL on separate days. Resistance exercise consisted of 75 isotonic, unilateral leg extension muscle actions performed at 30% of one-repetition maximum. Prior to (pretest) and after (posttest) performing each bout of exercise, strength and neural assessments were determined.

RESULTS

There was no pretest to posttest differences between LLBFR and LL for maximal voluntary isometric contraction (MVIC) torque or V-wave/M-wave responses (muscle compound action potentials assessed during a superimposed MVIC muscle action) which exhibited decreases (collapsed across condition) of 41.2% and 26.2%, respectively. There were pretest to posttest decreases in peak twitch torque (36.0%) and sEMG (29.5%) for LLBFR but not LL, and larger decreases in voluntary activation for LLBFR (11.3%) than LL (4.5%).

CONCLUSIONS

These findings suggested that LLBFR elicited greater fatigue-induced decreases in several indices of neuromuscular function relative to LL. Despite this, both LLBFR and LL resulted in similar decrements in performance as assessed by maximal strength.

Blood Flow Restriction Resistance Training in Tendon Rehabilitation: A Scoping Review on Intervention Parameters, Physiological Effects, and Outcomes

Objective

To identify current evidence on blood flow restriction training (BFRT) in tendon injuries and healthy tendons, evaluating physiological tendon effects, intervention parameters, and outcomes.

Methods

This scoping review was reported in accordance with the PRISMA Extension for Scoping Reviews (PRISMA-ScR). Databases searched included MEDLINE, CINAHL, AMED, EMBase, SPORTDiscus, Cochrane library (Controlled trials, Systematic reviews), and five trial registries. Two independent reviewers screened studies at title/abstract and full text. Following screening, data was extracted and charted, and presented as figures and tables alongside a narrative synthesis. Any study design conducted on adults, investigating the effects of BFRT on healthy tendons or tendon pathology were included. Data were extracted on physiological tendon effects, intervention parameters and outcomes with BFRT.

Results

Thirteen studies were included, three on tendinopathy, two on tendon ruptures, and eight on healthy Achilles, patellar, and supraspinatus tendons. A variety of outcomes were assessed, including pain, function, strength, and tendon morphological and mechanical properties, particularly changes in tendon thickness. BFRT intervention parameters were heterogeneously prescribed.

Conclusion

Despite a dearth of studies to date on the effects of BFRT on healthy tendons and in tendon pathologies, preliminary evidence for beneficial effects of BFRT on tendons and clinical outcomes is encouraging. As BFRT is a relatively novel method, definitive conclusions, and recommendations on BFRT in tendon rehabilitation cannot be made at present, which should be addressed in future research, due to the potential therapeutic benefits highlighted in this review.