1
|
Clarkson MJ, McMahon B, Warmington SA. Comparing adaptations from blood flow restriction exercise training using regulated or unregulated pressure systems: A systematic review and meta-analysis. Clin Rehabil 2024:2692155241271040. [PMID: 39105331 DOI: 10.1177/02692155241271040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/07/2024]
Abstract
OBJECTIVE No study has examined outcomes derived from blood flow restriction exercise training interventions using regulated compared with unregulated blood flow restriction pressure systems. Therefore, we used a systematic review and meta-analyses to compare the chronic adaptations to blood flow restriction exercise training achieved with regulated and unregulated blood flow restriction pressure systems. DATA SOURCES The electronic database search included using the tool EBSCOhost and other online database search engines. The search included Medline, SPORTDiscus, CINAHL, Embase and SpringerLink. METHODS Included studies utilised chronic blood flow restriction exercise training interventions greater than two weeks duration, where blood flow restriction was applied using a regulated or unregulated blood flow restriction pressure system, and where outcome measures such as muscle strength, muscle size or physical function were measured both pre- and post-training. Studies included in the meta-analyses used an equivalent non-blood flow restriction exercise comparison group. RESULTS Eighty-one studies were included in the systematic review. Data showed that regulated (n = 47) and unregulated (n = 34) blood flow restriction pressure systems yield similar training adaptations for all outcome measures post-intervention. For muscle strength and muscle size, this was reaffirmed in the included meta-analyses. CONCLUSION This review indicates that practitioners may achieve comparable training adaptations with blood flow restriction exercise training using either regulated or unregulated blood flow restriction pressure systems. Therefore, additional factors such as device quality, participant comfort and safety, cost and convenience are important factors to consider when deciding on appropriate equipment to use when prescribing blood flow restriction exercise training.
Collapse
Affiliation(s)
- Matthew J Clarkson
- Institute for Health & Sport (IHES), Victoria University, Melbourne, Victoria, Australia
| | - Breanna McMahon
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Stuart A Warmington
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| |
Collapse
|
2
|
Held S, Rappelt L, Rein R, Deutsch JP, Wiedenmann T, Donath L. Five-Week, Low-Intensity Blood Flow Restriction Rowing Improves V̇ o2 max in Elite Rowers. J Strength Cond Res 2024; 38:e299-e303. [PMID: 38489574 DOI: 10.1519/jsc.0000000000004755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024]
Abstract
ABSTRACT Held, S, Rappelt, L, Rein, R, Deutsch, J-P, Wiedenmann, T, and Donath, L. Five-week, low-intensity, blood flow restriction rowing improves V̇ o2 max in elite rowers. J Strength Cond Res 38(6): e299-e303, 2024-This controlled intervention study examined the effects of low-intensity rowing with blood flow restriction (BFR) on maximal oxygen uptake (V̇ o2 max), peak power output during ramp testing (PPO), and 2000-m time trial performance (P2k). Eleven, highly elite, male rowers (22.1 ± 1.6 years; 92.6 ± 3.8 kg; 1.93 ± 0.04 m; 7.9. ± 2.2 years rowing experience; 20.4 ± 2.0 h·w -1 training volume; 11.9 ± 1.1 session per week) trained 5 weeks without BFR (Base) followed by a 5-week BFR intervention period. BFR of the lower limb was applied through customized elastic wraps. BFR took place 3 times a week (accumulated net pBFR: 60 min·wk -1 ; occlusion per session: 2 times 10 min·session -1 ) and was used exclusively at low intensities (<2 mmol·L -1 ). V̇ o2 max, PPO, and P2k were examined before, between, and after both intervention periods. Bayesian's credible intervals revealed relevantly increased V̇ o2 max +0.30 L·min -1 (95% credible interval: +0.00 to +0.61 L·min -1 ) adaptations through BFR. By contrast, PPO +14 W (-6 to +34 W) and P2k -5 W (-14 to +3 W) were not noticeably affected by the BFR intervention. This study revealed that 15 sessions of BFR application with a cumulative total BFR load of 5 h over a 5-week macrocycle increased V̇ o2 max remarkably. Thus, pBFR might serve as a promising tool to improve aerobic capacity in highly trained elite rowers.
Collapse
Affiliation(s)
- Steffen Held
- Department of Sport and Management, IST University of Applied Sciences, Duesseldorf, Germany
- Department of Intervention Research in Exercise Training, German Sport University Cologne, Cologne, Germany
| | - Ludwig Rappelt
- Department of Intervention Research in Exercise Training, German Sport University Cologne, Cologne, Germany
- Department of Movement and Training Science, University of Wuppertal, Wuppertal, Germany; and
| | - Robert Rein
- Department of Exercise Training and Sports Informatics, German Sport University Cologne, Cologne, Germany
| | - Jan-Philip Deutsch
- Department of Intervention Research in Exercise Training, German Sport University Cologne, Cologne, Germany
| | - Tim Wiedenmann
- Department of Intervention Research in Exercise Training, German Sport University Cologne, Cologne, Germany
| | - Lars Donath
- Department of Intervention Research in Exercise Training, German Sport University Cologne, Cologne, Germany
| |
Collapse
|
3
|
Cockfield BA, Wedig IJ, Vinckier AL, McDaniel J, Elmer SJ. Physiological and perceptual responses to acute arm cranking with blood flow restriction. Eur J Appl Physiol 2024; 124:1509-1521. [PMID: 38142449 DOI: 10.1007/s00421-023-05384-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 11/27/2023] [Indexed: 12/26/2023]
Abstract
INTRODUCTION Lower-body aerobic exercise with blood flow restriction (BFR) offers a unique approach for stimulating improvements in muscular function and aerobic capacity. While there are more than 40 reports documenting acute and chronic responses to lower-body aerobic exercise with BFR, responses to upper-body aerobic exercise with BFR are not clearly established. PURPOSE We evaluated acute physiological and perceptual responses to arm cranking with and without BFR. METHODS Participants (N = 10) completed 4 arm cranking (6 × 2 min exercise, 1 min recovery) conditions: low-intensity at 40%VO2peak (LI), low-intensity at 40%VO2peak with BFR at 50% of arterial occlusion pressure (BFR50), low-intensity at 40%VO2peak with BFR at 70% of arterial occlusion pressure (BFR70), and high-intensity at 80%VO2peak (HI) while tissue oxygenation, cardiorespiratory, and perceptual responses were assessed. RESULTS During exercise, tissue saturation for BFR50 (54 ± 6%), BFR70 (55 ± 6%), and HI (54 ± 8%) decreased compared to LI (61 ± 5%, all P < 0.01) and changes in deoxyhemoglobin for BFR50 (11 ± 4), BFR70 (15 ± 6), and HI (16 ± 10) increased compared to LI (4 ± 2, all P < 0.01). During recovery intervals, tissue saturation for BFR50 and BFR70 decreased further and deoxyhemoglobin for BFR50 and BFR70 increased further (all P < 0.04). Heart rate for BFR70 and HI increased by 9 ± 9 and 50 ± 15b/min, respectively, compared to LI (both P < 0.02). BFR50 (8 ± 2, 1.0 ± 1.0) and BFR70 (10 ± 2, 2.1 ± 1.4) elicited greater arm-specific perceived exertion (6-20 scale) and pain (0-10 scale) compared to LI (7 ± 1, 0.2 ± 0.5, all P < 0.05) and pain for BFR70 did not differ from HI (1.7 ± 1.9). CONCLUSION Arm cranking with BFR decreased tissue saturation and increased deoxyhemoglobin without causing excessive cardiorespiratory strain and pain.
Collapse
Affiliation(s)
- Benjamin A Cockfield
- Department of Kinesiology and Integrative Physiology, College of Science and Arts, Michigan Technological University, 1400 Townsend Dr., Houghton, MI, 49931, USA
- Department of Physical Therapy, Central Michigan University, Mount Pleasant, MI, USA
| | - Isaac J Wedig
- Department of Kinesiology and Integrative Physiology, College of Science and Arts, Michigan Technological University, 1400 Townsend Dr., Houghton, MI, 49931, USA
- Health Research Institute, Michigan Technological University, Houghton, MI, USA
- School of Health and Human Performance, Marquette, MI, USA
| | - Alyssa L Vinckier
- Department of Kinesiology and Integrative Physiology, College of Science and Arts, Michigan Technological University, 1400 Townsend Dr., Houghton, MI, 49931, USA
- Department of Physical Therapy, Central Michigan University, Mount Pleasant, MI, USA
| | - John McDaniel
- Exercise Physiology Program, Kent State University, Kent, OH, USA
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, USA
| | - Steven J Elmer
- Department of Kinesiology and Integrative Physiology, College of Science and Arts, Michigan Technological University, 1400 Townsend Dr., Houghton, MI, 49931, USA.
- Health Research Institute, Michigan Technological University, Houghton, MI, USA.
| |
Collapse
|
4
|
Wedig IJ, Lennox IM, Petushek EJ, McDaniel J, Durocher JJ, Elmer SJ. Development of a prediction equation to estimate lower-limb arterial occlusion pressure with a thigh sphygmomanometer. Eur J Appl Physiol 2024; 124:1281-1295. [PMID: 38001245 DOI: 10.1007/s00421-023-05352-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 10/29/2023] [Indexed: 11/26/2023]
Abstract
INTRODUCTION Previous investigators have developed prediction equations to estimate arterial occlusion pressure (AOP) for blood flow restriction (BFR) exercise. Most equations have not been validated and are designed for use with expensive cuff systems. Thus, their implementation is limited for practitioners. PURPOSE To develop and validate an equation to predict AOP in the lower limbs when applying an 18 cm wide thigh sphygmomanometer (SPHYG18cm). METHODS Healthy adults (n = 143) underwent measures of thigh circumference (TC), skinfold thickness (ST), and estimated muscle cross-sectional area (CSA) along with brachial and femoral systolic (SBP) and diastolic (DBP) blood pressure. Lower-limb AOP was assessed in a seated position at the posterior tibial artery (Doppler ultrasound) using a SPHYG18cm. Hierarchical linear regression models were used to determine predictors of AOP. The best set of predictors was used to construct a prediction equation to estimate AOP. Performance of the equation was evaluated and internally validated using bootstrap resampling. RESULTS Models containing measures of either TC or thigh composition (ST and CSA) paired with brachial blood pressures explained the most variability in AOP (54%) with brachial SBP accounting for majority of explained variability. A prediction equation including TC, brachial SBP, and age showed good predictability (R2 = 0.54, RMSE = 7.18 mmHg) and excellent calibration. Mean difference between observed and predicted values was 0.0 mmHg and 95% Limits of Agreement were ± 18.35 mmHg. Internal validation revealed small differences between apparent and optimism adjusted performance measures, suggesting good generalizability. CONCLUSION This prediction equation for use with a SPHYG18cm provided a valid way to estimate lower-limb AOP without expensive equipment.
Collapse
Affiliation(s)
- Isaac J Wedig
- School of Health and Human Performance, Northern Michigan University, Marquette, MI, USA
- Department of Kinesiology and Integrative Physiology, Michigan Technological University, 1400 Townsend Dr., Houghton, MI, 49931, USA
- Health Research Institute, Michigan Technological University, Houghton, MI, USA
| | - Isaac M Lennox
- Department of Kinesiology and Integrative Physiology, Michigan Technological University, 1400 Townsend Dr., Houghton, MI, 49931, USA
- Health Research Institute, Michigan Technological University, Houghton, MI, USA
| | - Erich J Petushek
- Health Research Institute, Michigan Technological University, Houghton, MI, USA
- Department of Cognitive and Learning Science, Michigan Technological University, Houghton, MI, USA
| | - John McDaniel
- Department of Exercise Physiology, Kent State University, Kent, OH, USA
| | - John J Durocher
- Department of Biological Sciences and Integrative Physiology and Health Sciences Center, Purdue University Northwest, Hammond, IN, USA
| | - Steven J Elmer
- Department of Kinesiology and Integrative Physiology, Michigan Technological University, 1400 Townsend Dr., Houghton, MI, 49931, USA.
- Health Research Institute, Michigan Technological University, Houghton, MI, USA.
| |
Collapse
|
5
|
Scott BR, Marston KJ, Owens J, Rolnick N, Patterson SD. Current Implementation and Barriers to Using Blood Flow Restriction Training: Insights From a Survey of Allied Health Practitioners. J Strength Cond Res 2024; 38:481-490. [PMID: 38088873 DOI: 10.1519/jsc.0000000000004656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
ABSTRACT Scott, BR, Marston, KJ, Owens, J, Rolnick, N, and Patterson, SD. Current implementation and barriers to using blood flow restriction training: Insights from a survey of allied health practitioners. J Strength Cond Res 38(3): 481-490, 2024-This study investigated the use of blood flow restriction (BFR) exercise by practitioners working specifically with clinical or older populations, and the barriers preventing some practitioners from prescribing BFR. An online survey was disseminated globally to allied health practitioners, with data from 397 responders included in analyses. Responders who had prescribed BFR exercise ( n = 308) completed questions about how they implement this technique. Those who had not prescribed BFR exercise ( n = 89) provided information on barriers to using this technique, and a subset of these responders ( n = 22) completed a follow-up survey to investigate how these barriers could be alleviated. Most practitioners prescribe BFR exercise for musculoskeletal rehabilitation clients (91.6%), with the BFR cuff pressure typically relative to arterial occlusion pressure (81.1%) and implemented with resistance (96.8%) or aerobic exercise (42.9%). Most practitioners screen for contraindications (68.2%), although minor side effects, including muscle soreness (65.8%), are common. The main barriers preventing some practitioners from using BFR are lack of equipment (60.2%), insufficient education (55.7%), and safety concerns (31.8%). Suggestions to alleviate these barriers included developing educational resources about the safe application and benefits of BFR exercise ( n = 20) that are affordable ( n = 3) and convenient ( n = 4). These results indicate that BFR prescription for clinical and older cohorts mainly conforms with current guidelines, which is important considering the potentially increased risk for adverse events in these cohorts. However, barriers still prevent broader utility of BFR training, although some may be alleviated through well-developed educational offerings to train practitioners in using BFR exercise.
Collapse
Affiliation(s)
- Brendan R Scott
- Centre for Healthy Ageing, Murdoch University, Perth, Australia
- Murdoch Applied Sports Science Laboratory, Discipline of Exercise Science, Murdoch University, Perth, Australia
| | - Kieran J Marston
- Centre for Healthy Ageing, Murdoch University, Perth, Australia
- Murdoch Applied Sports Science Laboratory, Discipline of Exercise Science, Murdoch University, Perth, Australia
| | | | - Nicholas Rolnick
- The Human Performance Mechanic, CUNY Lehman College, New York, NY; and
| | - Stephen D Patterson
- Faculty of Sport, Allied Health & Performance Sciences, St Mary's University, London, United Kingdom
| |
Collapse
|
6
|
Bielitzki R, Behrendt T, Weinreich A, Mittlmeier T, Schega L, Behrens M. Acute effects of static balance exercise combined with different levels of blood flow restriction on motor performance fatigue as well as physiological and perceptual responses in young healthy males and females. Eur J Appl Physiol 2024; 124:227-243. [PMID: 37429967 PMCID: PMC10787004 DOI: 10.1007/s00421-023-05258-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 06/13/2023] [Indexed: 07/12/2023]
Abstract
PURPOSE This study investigated the acute effects of a static balance exercise combined with different blood flow restriction (BFR) pressures on motor performance fatigue development and recovery as well as physiological and perceptual responses during exercise in males and females. METHODS Twenty-four recreational active males (n = 13) and females (n = 11) performed static balance exercise on a BOSU ball (3 sets of 60 s with 30 s rest in-between) on three separate (> 3 days) laboratory visits with three different BFR pressures (80% arterial occlusion pressure [AOP], 40%AOP, 30 mmHg [SHAM]) in random order. During exercise, activity of various leg muscles, vastus lateralis muscle oxygenation, and ratings of effort and pain perception were recorded. Maximal squat jump height was measured before, immediately after, 1, 2, 4, and 8 min after exercise to quantify motor performance fatigue development and recovery. RESULTS Quadriceps muscle activity as well as ratings of effort and pain were highest, while muscle oxygenation was lowest in the 80%AOP compared to the 40%AOP and SHAM condition, with no differences in postural sway between conditions. Squat jump height declined after exercise with the highest reduction in the 80%AOP (- 16.4 ± 5.2%) followed by the 40%AOP (- 9.1 ± 3.2%), and SHAM condition (- 5.4 ± 3.3%). Motor performance fatigue was not different after 1 min and 2 min of recovery in 40% AOP and 80% AOP compared to SHAM, respectively. CONCLUSION Static balance exercise combined with a high BFR pressure induced the largest changes in physiological and perceptual responses, without affecting balance performance. Although motor performance fatigue was increased by BFR, it may not lead to long-term impairments in maximal performance.
Collapse
Affiliation(s)
- Robert Bielitzki
- Department of Sport Science, Institute III, Otto-von-Guericke University Magdeburg, 39104, Magdeburg, Germany.
| | - Tom Behrendt
- Department of Sport Science, Institute III, Otto-von-Guericke University Magdeburg, 39104, Magdeburg, Germany
| | - Andy Weinreich
- Department of Sport Science, Institute III, Otto-von-Guericke University Magdeburg, 39104, Magdeburg, Germany
| | - Thomas Mittlmeier
- Department of Traumatology, Hand-and Reconstructive Surgery, Rostock University Medical Center, Schillingallee 35, 18057, Rostock, Germany
| | - Lutz Schega
- Department of Sport Science, Institute III, Otto-von-Guericke University Magdeburg, 39104, Magdeburg, Germany
| | - Martin Behrens
- Department of Sport Science, Institute III, Otto-von-Guericke University Magdeburg, 39104, Magdeburg, Germany
| |
Collapse
|
7
|
Held S, Rappelt L, Rein R, Wiedenmann T, Donath L. Low-intensity climbing with blood flow restriction over 5 weeks increases grip and elbow flexor endurance in advanced climbers: A randomized controlled trial. Eur J Sport Sci 2023; 23:2031-2037. [PMID: 37167343 DOI: 10.1080/17461391.2023.2207079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Grip and elbow flexor strength and endurance are crucial performance surrogates in competitive climbing. Thus, we examined the effects of blood flow restricted (BFR) climbing on grip and elbow flexor performance. Fifteen trained climbers (8 females; 20.8 ± 7.0 yrs; 1.72 ± 0.08 m; 63.0 ± 9.7 kg; 21.7 ± 2.7 IRCRCA grade) were either assigned to the intervention (BFR) or control (noBFR) group, using the minimization method (Strata: age, height, body mass, gender, and IRCRA grade). While BFR was used during low-intensity climbing training (2-times 10 min/session; 3-times/week), noBFR followed identical training protocols without BFR over 5 weeks. BFR of the upper limb was applied via customized pneumatic cuffs (occlusion pressure: 120 ± 23 mmHg, 75%; occlusion pressure). Endurance and strength performances were assessed via one-handed rung pulling (GripSTRENGTH), one-handed bent arm lock off at 90° (ArmSTRENGTH), static-intermitted finger hang (GripENDURANCE), and bent arm hang (ArmENDURANCE). Bayesian credible intervals revealed increased GripENDURANCE (+21 s (95% credible interval: -2 to 43 s)) and ArmENDURANCE +11 s (-5 to 27 s); adaptations via BFR. In contrast, GripSTRENGTH +4 N (-40 to 48 N) and ArmSTRENGTH +4 N (-68 to 75 N) were not affected by the BFR intervention. Fifteen cumulative sessions of BFR application with a cumulative total BFR load of 5 h over a 5 weeks macrocycle remarkably increased grip and elbow flexor endurance. Thus, BFR might serve as a promising means to improve relevant performance surrogates in trained climbers.
Collapse
Affiliation(s)
- Steffen Held
- Department of Intervention Research in Exercise Training, German Sport University Cologne, Cologne, Germany
- Department of Sport and Management, IST University of Applied Sciences, Duesseldorf, Germany
| | - Ludwig Rappelt
- Department of Intervention Research in Exercise Training, German Sport University Cologne, Cologne, Germany
- Department of Movement and Training Science, University of Wuppertal, Wuppertal, Germany
| | - Robert Rein
- Institute of Exercise Training and Sport Informatics, German Sport University, Cologne, Germany
| | - Tim Wiedenmann
- Department of Intervention Research in Exercise Training, German Sport University Cologne, Cologne, Germany
| | - Lars Donath
- Department of Intervention Research in Exercise Training, German Sport University Cologne, Cologne, Germany
| |
Collapse
|
8
|
Mannozzi J, Al-Hassan MH, Kaur J, Lessanework B, Alvarez A, Massoud L, Aoun K, Spranger M, O'Leary DS. Blood flow restriction training activates the muscle metaboreflex during low-intensity sustained exercise. J Appl Physiol (1985) 2023; 135:260-270. [PMID: 37348015 PMCID: PMC10393340 DOI: 10.1152/japplphysiol.00274.2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 06/09/2023] [Indexed: 06/24/2023] Open
Abstract
Blood flow restriction training (BFRT) employs partial vascular occlusion of exercising muscle and has been shown to increase muscle performance while using reduced workload and training time. Numerous studies have demonstrated that BFRT increases muscle hypertrophy, mitochondrial function, and beneficial vascular adaptations. However, changes in cardiovascular hemodynamics during the exercise protocol remain unknown, as most studies measured blood pressure before the onset and after the cessation of exercise. With reduced perfusion to the exercising muscle during BFRT, the resultant accumulation of metabolites within the ischemic muscle could potentially trigger a large reflex increase in blood pressure, termed the muscle metaboreflex. At low workloads, this pressor response occurs primarily via increases in cardiac output. However, when increases in cardiac output are limited (e.g., heart failure or during severe exercise), the reflex shifts to peripheral vasoconstriction as the primary mechanism to increase blood pressure, potentially increasing the risk of a cardiovascular event. Using our chronically instrumented conscious canine model, we utilized a 60% reduction in femoral blood pressure applied to the hindlimbs during steady-state treadmill exercise (3.2 km/h) to reproduce the ischemic environment observed during BFRT. We observed significant increases in heart rate (+19 ± 3 beats/min), stroke volume (+2.52 ± 1.2 mL), cardiac output (+1.21 ± 0.2 L/min), mean arterial pressure (+18.2 ± 2.4 mmHg), stroke work (+1.93 ± 0.2 L/mmHg), and nonischemic vascular conductance (+3.62 ± 1.7 mL/mmHg), indicating activation of the muscle metaboreflex.NEW & NOTEWORTHY Blood flow restriction training (BFRT) increases muscle mass, strength, and endurance. There has been minimal consideration of the reflex cardiovascular responses that could be elicited during BFRT sessions. We showed that during low-intensity exercise BFRT may trigger large reflex increases in blood pressure and sympathetic activity due to muscle metaboreflex activation. Thus, we urge caution when employing BFRT, especially in patients in whom exaggerated cardiovascular responses may occur that could cause sudden, adverse cardiovascular events.
Collapse
Affiliation(s)
- Joseph Mannozzi
- Department of Physiology, Wayne State University School of Medicine, Detroit, Michigan, United States
| | - Mohamed-Hussein Al-Hassan
- Department of Physiology, Wayne State University School of Medicine, Detroit, Michigan, United States
| | - Jasdeep Kaur
- Department of Kinesiology and Health Education, University of Texas at Austin, Austin, Texas, United States
| | - Beruk Lessanework
- Department of Physiology, Wayne State University School of Medicine, Detroit, Michigan, United States
| | - Alberto Alvarez
- Department of Physiology, Wayne State University School of Medicine, Detroit, Michigan, United States
| | - Louis Massoud
- Department of Physiology, Wayne State University School of Medicine, Detroit, Michigan, United States
| | - Kamel Aoun
- Department of Physiology, Wayne State University School of Medicine, Detroit, Michigan, United States
| | - Marty Spranger
- Department of Physiology, Michigan State University, East Lansing, Michigan, United States
| | - Donal S O'Leary
- Department of Physiology, Wayne State University School of Medicine, Detroit, Michigan, United States
| |
Collapse
|
9
|
Wedig IJ, Durocher JJ, McDaniel J, Elmer SJ. Blood flow restriction as a potential therapy to restore physical function following COVID-19 infection. Front Physiol 2023; 14:1235172. [PMID: 37546539 PMCID: PMC10400776 DOI: 10.3389/fphys.2023.1235172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 07/10/2023] [Indexed: 08/08/2023] Open
Abstract
Accumulating evidence indicates that some COVID-19 survivors display reduced muscle mass, muscle strength, and aerobic capacity, which contribute to impairments in physical function that can persist for months after the acute phase of illness. Accordingly, strategies to restore muscle mass, muscle strength, and aerobic capacity following infection are critical to mitigate the long-term consequences of COVID-19. Blood flow restriction (BFR), which involves the application of mechanical compression to the limbs, presents a promising therapy that could be utilized throughout different phases of COVID-19 illness. Specifically, we hypothesize that: 1) use of passive BFR modalities can mitigate losses of muscle mass and muscle strength that occur during acute infection and 2) exercise with BFR can serve as an effective alternative to high-intensity exercise without BFR for regaining muscle mass, muscle strength, and aerobic capacity during convalescence. The various applications of BFR may also serve as a targeted therapy to address the underlying pathophysiology of COVID-19 and provide benefits to the musculoskeletal system as well as other organ systems affected by the disease. Consequently, we present a theoretical framework with which BFR could be implemented throughout the progression from acute illness to outpatient rehabilitation with the goal of improving short- and long-term outcomes in COVID-19 survivors. We envision that this paper will encourage discussion and consideration among researchers and clinicians of the potential therapeutic benefits of BFR to treat not only COVID-19 but similar pathologies and cases of acute critical illness.
Collapse
Affiliation(s)
- Isaac J. Wedig
- Department of Kinesiology and Integrative Physiology, Michigan Technological University, Houghton, MI, United States
- Health Research Institute, Michigan Technological University, Houghton, MI, United States
| | - John J. Durocher
- Department of Biological Sciences and Integrative Physiology and Health Sciences Center, Purdue University Northwest, Hammond, IN, United States
| | - John McDaniel
- Department of Exercise Physiology, Kent State University, Kent, OH, United States
| | - Steven J. Elmer
- Department of Kinesiology and Integrative Physiology, Michigan Technological University, Houghton, MI, United States
- Health Research Institute, Michigan Technological University, Houghton, MI, United States
| |
Collapse
|
10
|
Held S, Rappelt L, Deutsch JP, Rein R, Wiedenmann T, Schiffer A, Bieder A, Staub I, Donath L. Low-intensity swimming with blood flow restriction over 5 weeks increases VO 2peak: A randomized controlled trial using Bayesian informative prior distribution. Eur J Sport Sci 2023:1-7. [PMID: 36780333 DOI: 10.1080/17461391.2023.2180671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
Peak oxygen uptake (VO2peak) and speed at first (LT1, minimal lactate equivalent) and second lactate threshold (LT2 = LT1 +1.5 mmol·L-1) are crucial swimming performance surrogates. The present randomized controlled study investigated the effects of blood flow restriction (BFR) during low-intensity swimming (LiT) on VO2peak, LT1, and LT2. Eighteen male swimmers (22.7 ±3.0 yrs; 69.9 ±8.5 kg; 1.8 ±0.1 m) were either assigned to the BFR or control (noBFR) group. While BFR was applied during LiT, noBFR completed the identical LIT without BFR application. BFR of the upper limb was applied via customized pneumatic cuffs (75% of occlusion pressure: 135 ±10 mmHg; 8 cm cuff width). BFR training took place three times a week over 5 weeks (accumulated weekly net BFR training: 60 min·week-1; occlusion per session: 2-times 10 min·session-1) and was used exclusively at low intensities. VO2peak, LT1, and LT2 diagnostics were employed. Bayesian credible intervals revealed notable VO2peak improvements by +0.29 L·min-1 kg-1 (95% credible interval: -0.26 to +0.85 L·min-1 kg-1) when comparing BFR vs. noBFR. Speed at LT1 -0.01 m·s-1 (-0.04 to +0.02 m·s-1) and LT2 -0.01 m·s-1 (-0.03 to +0.02 m·s-1) did not change meaningfully when BFR was employed. Fifteen sessions of LIT swimming (macrocycle of 5 h over 5 weeks) with a weekly volume of 60 min with BFR application adds additional impact on VO2peak improvement compared to noBFR LIT swimming. Occasional BFR applications should be considered as a promising means to improve relevant performance surrogates in trained swimmers. HighlightsLow-intensity swimming with blood flow restricted (BFR) induced superior peak oxygen consumption adaptations compared to non-restricted swimming training over a 5-week lasting training periodBFR and non-BFR swimming training-induced similar adaptations regarding swimming speed at first and second lactate thresholdIn conclusion, BFR served as a feasible, promising and beneficial complementary training stimuli to traditional swimming training regarding oxygen consumption adaptations.
Collapse
Affiliation(s)
- Steffen Held
- Department of Intervention Research in Exercise Training, German Sport University Cologne, Cologne, Germany.,Department of Fitness and Health, IST University of Applied Sciences, Duesseldorf, Germany
| | - Ludwig Rappelt
- Department of Intervention Research in Exercise Training, German Sport University Cologne, Cologne, Germany.,Department of Movement and Training Science, University of Wuppertal, Wuppertal, Germany
| | - Jan-Philip Deutsch
- Department of Intervention Research in Exercise Training, German Sport University Cologne, Cologne, Germany
| | - Robert Rein
- Institute of Exercise Training and Sport Informatics, German Sport University, Cologne, Germany
| | - Tim Wiedenmann
- Department of Intervention Research in Exercise Training, German Sport University Cologne, Cologne, Germany
| | - Anton Schiffer
- Department of Intervention Research in Exercise Training, German Sport University Cologne, Cologne, Germany
| | - Andreas Bieder
- Institute of Professional Sport Education and Sport Qualifications, German Sport University, Cologne, Germany
| | - Ilka Staub
- Institute of Professional Sport Education and Sport Qualifications, German Sport University, Cologne, Germany
| | - Lars Donath
- Department of Intervention Research in Exercise Training, German Sport University Cologne, Cologne, Germany
| |
Collapse
|
11
|
McClean ZJ, Young A, Pohl AJ, Fine NM, Burr JF, MacInnis M, Aboodarda SJ. Blood flow restriction during high-intensity interval cycling exacerbates psychophysiological responses to a greater extent in females than males. J Appl Physiol (1985) 2023; 134:596-609. [PMID: 36701480 DOI: 10.1152/japplphysiol.00567.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
This study aimed to characterize neuromuscular, perceptual, and cardiorespiratory responses to high-intensity interval training (HIIT) with superimposed blood flow restriction in males and females. Twenty-four, healthy individuals (n = 12 females) completed two cycling HIIT protocols to task failure (1-min work phases at 90% of peak power output interspersed by 1-min rest phases). The blood flow restriction (BFR) and control (CON) protocols were identical except for the presence and absence of BFR during rest phases, respectively. The interpolated twitch technique, including maximal voluntary isometric knee extension (MVC) and femoral nerve electrical stimuli, was performed at baseline, every six intervals, and task failure. Perceptual and cardiorespiratory responses were recorded every three intervals and continuously during exercise, respectively. Bayesian inference was used to obtain the joint posterior distribution for all parameters and evidence of an effect was determined via the marginal posterior probability (PP). The BFR shortened task duration by 57.3% compared with CON (PP > 0.99), without a sex difference. The application of BFR exacerbated the rate of decline in neuromuscular measures (MVC and twitch force output), increase of perceptual responses (perceived effort, pain, dyspnea, fatigue), and development of cardiorespiratory parameters (minute ventilation and heart rate), compared with CON (PP > 0.95). In addition, BFR exacerbated the neuromuscular, perceptual, and cardiorespiratory responses to a greater extent in females than males (PP > 0.99). Our results suggest that superimposition of blood flow restriction exacerbates psychophysiological responses to a HIIT protocol to a greater extent in females than males.NEW & NOTEWORTHY To our knowledge, no study has explored sex differences in the neuromuscular, perceptual, and cardiorespiratory indices characterizing exercise tolerance during high-intensity interval training (HIIT) with blood flow restriction (BFR) applied only during rest periods. Our results suggest that BFR elicited a decline in exercise performance that could be attributed to integration of psychophysiological responses. However, this integration was sex-dependent where females demonstrated an exacerbated rate of change in these responses compared with males.
Collapse
Affiliation(s)
- Zachary J McClean
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Abbey Young
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Andrew J Pohl
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Nowell M Fine
- Cummings School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jamie F Burr
- College of Biological Science, University of Guelph, Guelph, Ontario, Canada
| | - Martin MacInnis
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Saied J Aboodarda
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
12
|
Mckee JR, Girard O, Peiffer JJ, Scott BR. Repeated-Sprint Training With Blood Flow Restriction: A Novel Approach to Improve Repeated-Sprint Ability? Strength Cond J 2023. [DOI: 10.1519/ssc.0000000000000771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
|
13
|
Chua MT, Sim A, Burns SF. Acute and Chronic Effects of Blood Flow Restricted High-Intensity Interval Training: A Systematic Review. SPORTS MEDICINE - OPEN 2022; 8:122. [PMID: 36178530 PMCID: PMC9525532 DOI: 10.1186/s40798-022-00506-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 08/06/2022] [Indexed: 11/18/2022]
Abstract
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.
Collapse
|
14
|
Lauver JD, Moran A, Guilkey JP, Johnson KE, Zanchi NE, Rotarius TR. Acute Responses to Cycling Exercise With Blood Flow Restriction During Various Intensities. J Strength Cond Res 2022; 36:3366-3373. [PMID: 34341317 DOI: 10.1519/jsc.0000000000004099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
ABSTRACT Lauver, JD, Moran, A, Guilkey, JP, Johnson, KE, Zanchi, NE, and Rotarius, TR. Acute responses to cycling exercise with blood flow restriction during various intensities. J Strength Cond Res 36(12): 3366-3373, 2022-The purpose of this study was to investigate the acute physiological responses during cycling at various intensities with blood flow restriction (BFR). Subjects ( N = 9; V̇ o2 peak = 36.09 ± 5.80 ml·kg -1 ·min -1 ) performed 5 protocols: high-intensity (HIGH), control (CON-90), 90% of ventilatory threshold (VT) work rate with BFR (90-BFR), 70% of VT with BFR (70-BFR), and 30% V̇ o2 peak with BFR (30-BFR). Protocols consisted of five 2-minute work intervals interspersed with 1-minute recovery intervals. Blood flow restriction pressure was 80% of limb occlusion pressure. V̇ o2 , muscle excitation, tissue oxygen saturation (StO 2 ), discomfort, and level of perceived exertion (RPE) were assessed. Muscle excitation was higher during HIGH (302.9 ± 159.9 %BSL [baseline]) compared with 70-BFR (99.7 ± 76.4 %BSL) and 30-BFR (98.2 ± 70.5 %BSL). StO 2 was greater during 90-BFR (40.7 ± 12.5 ∆BSL), 70-BFR (34.4 ± 15.2 ∆BSL), and 30-BFR (31.9 ± 18.7 ∆BSL) compared with CON-90 (4.4 ± 11.5 ∆BSL). 90-BFR (39.6 ± 12.0 ∆BSL) resulted in a greater StO 2 -Avg compared with HIGH (20.5 ± 13.8 ∆BSL). Also, HIGH (23.68 ± 5.31 ml·kg -1 ·min -1 ) resulted in a greater V̇ o2 compared with 30-BFR (15.43 ± 3.19 ml·kg -1 ·min -1 ), 70-BFR (16.65 ± 3.26 ml·kg -1 ·min -1 ), and 90-BFR (18.28 ± 3.89 ml·kg -1 ·min -1 ); 90-BFR (intervals: 4 = 15.9 ± 2.3; intervals: 5 = 16.4 ± 2.5) resulted in a greater RPE compared with 30-BFR (intervals: 4 = 13.3 ± 1.4; intervals: 5 = 13.7 ± 1.7) during intervals 4 and 5. These results suggest that when adding BFR to various intensities of aerobic exercise, consideration should be given to peak work and VT to provide a balance between high local physiological stress and perceptual responses.
Collapse
Affiliation(s)
- Jakob D Lauver
- Department of Kinesiology, Coastal Carolina University, Conway, South Carolina
| | - Austin Moran
- Department of Kinesiology, Coastal Carolina University, Conway, South Carolina
| | - Justin P Guilkey
- Department of Kinesiology, Coastal Carolina University, Conway, South Carolina
| | - Kelly E Johnson
- Department of Kinesiology, Coastal Carolina University, Conway, South Carolina
| | - Nelo E Zanchi
- Department of Physical Education, Federal University of Maranhao (UFMA), Sao Luis, Brazil; and
| | - Timothy R Rotarius
- Department of Exercise Science and Athletic Training, Adrian College, Adrian, Michigan
| |
Collapse
|
15
|
Effect of Low-Intensity Aerobic Training Combined with Blood Flow Restriction on Body Composition, Physical Fitness, and Vascular Responses in Recreational Runners. Healthcare (Basel) 2022; 10:healthcare10091789. [PMID: 36141401 PMCID: PMC9499162 DOI: 10.3390/healthcare10091789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 09/12/2022] [Accepted: 09/15/2022] [Indexed: 11/17/2022] Open
Abstract
This study investigated the effect of low-intensity aerobic training combined with blood flow restriction (LABFR) on body composition, physical fitness, and vascular functions in recreational runners. The participants were 30 healthy male recreational runners, randomized between the LABFR (n = 15) and control (n = 15) groups. The LABFR group performed five sets of a repeated pattern of 2 min running at 40% VO2max and 1 min passive rest, while wearing the occlusion cuff belts on the proximal end of the thigh. The frequency was three times a week for the period of eight weeks. The control group performed the identical running protocol without wearing the occlusion cuff belts. At the end of the training, the participants’ body composition (fat mass, body fat, muscle mass, and right and left thigh circumference), physical fitness (power and VO2max), and vascular responses (flow-mediated dilation (FMD), brachial ankle pulse wave velocity (baPWV), ankle brachial index (ABI), systolic blood pressure (SBP) and diastolic blood pressure (DBP)) were measured. The results showed a significant time × group interaction effect on muscle mass (F = 53.242, p = 0.001, ηp2 = 0.664) and right thigh circumference (F = 4.544, p = 0.042, ηp2 = 0.144), but no significant variation in any other factors, including fat mass, body fat, left thigh circumference, FMD, baPWV, ABI, SBP, and DBP (p > 0.05). Overall, our results suggested that eight-week LABFR exerted a positive effect on the body composition, especially muscle mass and thigh circumference, of recreational runners.
Collapse
|
16
|
Effects of blood flow restriction training on aerobic capacity: a systematic review and meta-analysis. SPORT SCIENCES FOR HEALTH 2022. [DOI: 10.1007/s11332-022-00944-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
17
|
Castilla-López C, Molina-Mula J, Romero-Franco N. Blood flow restriction during training for improving the aerobic capacity and sport performance of trained athletes: A systematic review and meta-analysis. J Exerc Sci Fit 2022; 20:190-197. [PMID: 35401767 PMCID: PMC8965159 DOI: 10.1016/j.jesf.2022.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 03/14/2022] [Accepted: 03/17/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND /Objective: Combining blood flow restriction (BFR) with endurance training is exponentially increasing although the benefits are unclear in trained athletes. We aimed to describe the effects of aerobic and/or anaerobic training programmes combined with BFR on the aerobic capacity and related sport performance of trained athletes. METHODS Databases used were MEDLINE, SPORTDiscus, LILACS, IBECS, CINHAL, COCHRANE, SCIELO and PEDro, through October 2021. For study selection, criteria included (a) clinical trials that recruited trained healthy athletes, that (b) proposed BFR in combination with aerobic/anaerobic training programmes (≥8 sessions) and that (c) evaluated either aerobic capacity or related sport performance. For data extraction, a reviewer extracted the data, and another reviewer independently verified it. The tool RoB 2 (Risk of bias 2) was used to assess risk of bias. RESULTS Ten studies met the eligibility criteria, capturing a total of 207 participants. Although it did not reveal any significant effects from training with BFR on aerobic capacity compared to the same training without BFR, effect sizes were extremely high. Subgroup analyses according to the intensity of the training programmes found similar results for low-to-moderate or high-intensity training compared to the same sessions without BFR. CONCLUSION Although adding BFR to training sessions always produce benefits from baseline in aerobic capacity and sport performance of trained athletes, these results are not better than those observed after the same training sessions without BFR. The reduced number of studies, small sample sizes and some concerns regarding risk of bias should be highlighted as limitations. REGISTRATION NUMBER CRD42021248212.
Collapse
Affiliation(s)
| | - Jesús Molina-Mula
- Nursing and Physiotherapy Department, University of the Balearic Islands, E-07122, Palma de Mallorca, Spain
| | - Natalia Romero-Franco
- Nursing and Physiotherapy Department, University of the Balearic Islands, E-07122, Palma de Mallorca, Spain
- Health Research Institute of the Balearic Islands (IdISBa), E-07010, Palma de Mallorca, Spain
- Corresponding author. Nursing and Physiotherapy Department, University of the Balearic Islands, Road to Valldemossa km 7.5, E-07122, Palma de Mallorca, Spain.
| |
Collapse
|
18
|
Lopez-Garzon M, Cantarero-Villanueva I, Legerén-Alvarez M, Gallart-Aragón T, Postigo-Martin P, González-Santos Á, Lozano-Lozano M, Martín-Martín L, Ortiz-Comino L, Castro-Martín E, Ariza-García A, Fernández-Lao C, Arroyo-Morales M, Galiano-Castillo N. Prevention of Chemotherapy-Induced Peripheral Neuropathy With PRESIONA, a Therapeutic Exercise and Blood Flow Restriction Program: A Randomized Controlled Study Protocol. Phys Ther 2022; 102:6497838. [PMID: 35079838 DOI: 10.1093/ptj/pzab282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 07/27/2021] [Accepted: 10/25/2021] [Indexed: 02/09/2023]
Abstract
OBJECTIVE This trial will analyze the acute and cumulative effects of a tailored program called PRESIONA that combines therapeutic exercise and blood flow restriction to prevent chemotherapy-induced peripheral neuropathy (CIPN) in individuals with early breast cancer undergoing neoadjuvant chemotherapy. METHODS PRESIONA will be a physical therapist-led multimodal exercise program that uses blood flow restriction during low-load aerobic and strength exercises. For the acute study, only 1 session will be performed 1 day before the first taxane cycle, in which 72 women will be assessed before intervention and 24 hours post intervention. For the cumulative study, PRESIONA will consist of 24 to 36 sessions for 12 weeks following an undulatory prescription. At least 80 women will be randomized to the experimental group or control group. Feasibility will be quantified based on the participant recruitment to acceptance ratio; dropout, retention, and adherence rates; participant satisfaction; tolerance; and program security. In the efficacy study, the main outcomes will be CIPN symptoms assessed with a participant-reported questionnaire (EORTC QLQ-CIPN20). In addition, to determine the impact on other participant-reported health and sensorimotor and physical outcomes, the proportion of completed scheduled chemotherapy sessions will be examined at baseline (t0), after anthracycline completion (t1), after intervention (t2), and at the 2-month (t3) and 1-year follow-ups (t4). CONCLUSION The proposed innovative approach of this study could have a far-reaching impact on therapeutic options, and the physical therapist role could be essential in the oncology unit to improve quality of life in individuals with cancer and reduce side effects of cancer and its treatments. IMPACT Physical therapists in the health care system could be essential to achieve the planned doses of chemotherapy to improve survival and decrease the side effects of individuals with breast cancer. The prevention of CIPN would have an impact on the quality of life in these individuals, and this protocol potentially could provide an action guide that could be implemented in any health care system.
Collapse
Affiliation(s)
- Maria Lopez-Garzon
- Health Sciences Faculty, University of Granada, Granada, Spain.,'Cuídate' From Biomedical Group (BIO277), Instituto de Investigación Biosanitaria (ibs.GRANADA), Granada, Spain.,Unit of Excellence on Exercise and Health (UCEES), University of Granada, Granada, Spain
| | - Irene Cantarero-Villanueva
- Health Sciences Faculty, University of Granada, Granada, Spain.,'Cuídate' From Biomedical Group (BIO277), Instituto de Investigación Biosanitaria (ibs.GRANADA), Granada, Spain.,Unit of Excellence on Exercise and Health (UCEES), University of Granada, Granada, Spain.,Sport and Health Research Center (IMUDs), Granada, Spain
| | - Marta Legerén-Alvarez
- FEA Oncología Médica, San Cecilio University Hospital, Andalusian Health Service, Granada, Spain
| | | | - Paula Postigo-Martin
- Health Sciences Faculty, University of Granada, Granada, Spain.,'Cuídate' From Biomedical Group (BIO277), Instituto de Investigación Biosanitaria (ibs.GRANADA), Granada, Spain.,Unit of Excellence on Exercise and Health (UCEES), University of Granada, Granada, Spain.,Sport and Health Research Center (IMUDs), Granada, Spain
| | - Ángela González-Santos
- Health Sciences Faculty, University of Granada, Granada, Spain.,'Cuídate' From Biomedical Group (BIO277), Instituto de Investigación Biosanitaria (ibs.GRANADA), Granada, Spain.,Unit of Excellence on Exercise and Health (UCEES), University of Granada, Granada, Spain
| | - Mario Lozano-Lozano
- Health Sciences Faculty, University of Granada, Granada, Spain.,'Cuídate' From Biomedical Group (BIO277), Instituto de Investigación Biosanitaria (ibs.GRANADA), Granada, Spain.,Unit of Excellence on Exercise and Health (UCEES), University of Granada, Granada, Spain.,Sport and Health Research Center (IMUDs), Granada, Spain
| | - Lydia Martín-Martín
- Health Sciences Faculty, University of Granada, Granada, Spain.,'Cuídate' From Biomedical Group (BIO277), Instituto de Investigación Biosanitaria (ibs.GRANADA), Granada, Spain.,Unit of Excellence on Exercise and Health (UCEES), University of Granada, Granada, Spain.,Sport and Health Research Center (IMUDs), Granada, Spain
| | | | - Eduardo Castro-Martín
- Health Sciences Faculty, University of Granada, Granada, Spain.,'Cuídate' From Biomedical Group (BIO277), Instituto de Investigación Biosanitaria (ibs.GRANADA), Granada, Spain.,Unit of Excellence on Exercise and Health (UCEES), University of Granada, Granada, Spain.,Sport and Health Research Center (IMUDs), Granada, Spain
| | - Angélica Ariza-García
- Health Sciences Faculty, University of Granada, Granada, Spain.,'Cuídate' From Biomedical Group (BIO277), Instituto de Investigación Biosanitaria (ibs.GRANADA), Granada, Spain.,Unit of Excellence on Exercise and Health (UCEES), University of Granada, Granada, Spain.,Sport and Health Research Center (IMUDs), Granada, Spain
| | - Carolina Fernández-Lao
- Health Sciences Faculty, University of Granada, Granada, Spain.,'Cuídate' From Biomedical Group (BIO277), Instituto de Investigación Biosanitaria (ibs.GRANADA), Granada, Spain.,Unit of Excellence on Exercise and Health (UCEES), University of Granada, Granada, Spain.,Sport and Health Research Center (IMUDs), Granada, Spain
| | - Manuel Arroyo-Morales
- Health Sciences Faculty, University of Granada, Granada, Spain.,'Cuídate' From Biomedical Group (BIO277), Instituto de Investigación Biosanitaria (ibs.GRANADA), Granada, Spain.,Unit of Excellence on Exercise and Health (UCEES), University of Granada, Granada, Spain.,Sport and Health Research Center (IMUDs), Granada, Spain
| | - Noelia Galiano-Castillo
- Health Sciences Faculty, University of Granada, Granada, Spain.,'Cuídate' From Biomedical Group (BIO277), Instituto de Investigación Biosanitaria (ibs.GRANADA), Granada, Spain.,Unit of Excellence on Exercise and Health (UCEES), University of Granada, Granada, Spain.,Sport and Health Research Center (IMUDs), Granada, Spain
| |
Collapse
|
19
|
Hedt C, McCulloch PC, Harris JD, Lambert BS. Blood Flow Restriction Enhances Rehabilitation and Return to Sport: The Paradox of Proximal Performance. Arthrosc Sports Med Rehabil 2022; 4:e51-e63. [PMID: 35141536 PMCID: PMC8811501 DOI: 10.1016/j.asmr.2021.09.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 09/15/2021] [Indexed: 12/17/2022] Open
Abstract
The use of blood flow restriction (BFR) within rehabilitation is rapidly increasing as further research is performed elucidating purported benefits such as improved muscular strength and size, neuromuscular control, decreased pain, and increased bone mineral density. Interestingly, these benefits are not isolated to structures distal to the occlusive stimulus. Proximal gains are of high interest to rehabilitation professionals, especially those working with patients who are limited due to pain or postsurgical precautions. The review to follow will focus on current evidence and ongoing hypotheses regarding physiologic responses to BFR, current clinical applications, proximal responses to BFR training, potential practical applications for rehabilitation and injury prevention, and directions for future research. Interestingly, benefits have been found in musculature proximal to the occlusive stimulus, which may lend promise to a greater variety of patient populations and conditions. Furthermore, an increasing demand for BFR use in the sports world warrants further research for performance research and recovery. LEVEL OF EVIDENCE Level V, expert opinion.
Collapse
Affiliation(s)
- Corbin Hedt
- Address correspondence to Corbin Hedt, P.T., D.P.T., S.C.S., C.S.C.S., Houston Methodist Orthopedics & Sports Medicine, 5505 West Loop South, Houston, TX 77081.
| | | | | | | |
Collapse
|
20
|
Hughes L, Hackney KJ, Patterson SD. Optimization of Exercise Countermeasures to Spaceflight Using Blood Flow Restriction. Aerosp Med Hum Perform 2022; 93:32-45. [PMID: 35063054 DOI: 10.3357/amhp.5855.2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
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.
Collapse
|
21
|
Effectiveness of Blood Flow Restriction Training on Muscle Strength and Physical Performance in Older Adults: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2022; 103:1848-1857. [DOI: 10.1016/j.apmr.2021.12.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 12/03/2021] [Accepted: 12/16/2021] [Indexed: 11/23/2022]
|
22
|
Bielitzki R, Behrendt T, Behrens M, Schega L. Current Techniques Used for Practical Blood Flow Restriction Training: A Systematic Review. J Strength Cond Res 2021; 35:2936-2951. [PMID: 34319939 DOI: 10.1519/jsc.0000000000004104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
ABSTRACT Bielitzki, R, Behrendt, T, Behrens, M, and Schega, L. Current techniques used for practical blood flow restriction training: a systematic review. J Strength Cond Res 35(10): 2936-2951, 2021-The purpose of this article was to systematically review the available scientific evidence on current methods used for practical blood flow restriction (pBFR) training together with application characteristics as well as advantages and disadvantages of each technique. A literature search was conducted in different databases (PubMed, Web of Science, Scopus, and Cochrane Library) for the period from January 2000 to December 2020. Inclusion criteria for this review were (a) original research involving humans, (b) the use of elastic wraps or nonpneumatic cuffs, and (c) articles written in English. Of 26 studies included and reviewed, 15 were conducted using an acute intervention (11 in the lower body and 4 in the upper body), and 11 were performed with a chronic intervention (8 in the lower body, 1 in the upper body, and 2 in both the upper and the lower body). Three pBFR techniques could be identified: (a) based on the perceptual response (perceived pressure technique), (b) based on the overlap of the cuff (absolute and relative overlap technique), and (c) based on the cuffs' maximal tensile strength (maximal cuff elasticity technique). In conclusion, the perceived pressure technique is simple, valid for the first application, and can be used independently of the cuffs' material properties, but is less reliable within a person over time. The absolute and relative overlap technique as well as the maximal cuff elasticity technique might be applied more reliably due to markings, but require a cuff with constant material properties over time.
Collapse
Affiliation(s)
- Robert Bielitzki
- Department of Sport Science, Institute III, Otto von Guericke University Magdeburg, Magdeburg, Germany; and
| | - Tom Behrendt
- Department of Sport Science, Institute III, Otto von Guericke University Magdeburg, Magdeburg, Germany; and
| | - Martin Behrens
- Department of Sport Science, Institute III, Otto von Guericke University Magdeburg, Magdeburg, Germany; and
- Department of Orthopedics, University Medicine Rostock, Rostock, Germany
| | - Lutz Schega
- Department of Sport Science, Institute III, Otto von Guericke University Magdeburg, Magdeburg, Germany; and
| |
Collapse
|
23
|
Karanasios S, Koutri C, Moutzouri M, Xergia SA, Sakellari V, Gioftsos G. The Effect of Body Position and the Reliability of Upper Limb Arterial Occlusion Pressure Using a Handheld Doppler Ultrasound for Blood Flow Restriction Training. Sports Health 2021; 14:717-724. [PMID: 34515589 DOI: 10.1177/19417381211043877] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The precise calculation of arterial occlusive pressure is essential to accurately prescribe individualized pressures during blood flow restriction training. Arterial occlusion pressure in the lower limb varies significantly between different body positions while similar reports for the upper limb are lacking. HYPOTHESIS Body position has a significant effect in upper limb arterial occlusive pressure. Using cuffs with manual pump and a handheld Doppler ultrasound can be a reliable method to determine upper limb arterial blood flow restriction. STUDY DESIGN A randomized repeated measures design. LEVEL OF EVIDENCE Level 3. METHODS Forty-two healthy participants (age mean ± SD = 28.1 ± 7.7 years) completed measurements in supine, seated, and standing position by 3 blinded raters. A cuff with a manual pump and a handheld acoustic ultrasound were used. The Wilcoxon signed-rank test with Bonferroni correction was used to analyze differences between body positions. A within-subject coefficient of variation and an intraclass correlation coefficient (ICC) test were used to calculate reproducibility and reliability, respectively. RESULTS A significantly higher upper limb arterial occlusive pressure was found in seated compared with supine position (P < 0.031) and in supine compared with standing position (P < 0.031) in all raters. An ICC of 0.894 (95% CI = 0.824-0.939, P < 0.001) was found in supine, 0.973 (95% CI = 0.955-0.985, P < 0.001) in seated, and 0.984 (95% CI = 0.973-0.991, P < 0.001) in standing position. ICC for test-retest reliability was found 0.90 (95% CI = 0.814-0.946, P < 0.001), 0.873 (95% CI = 0.762-0.93, P < 0.001), and 0.858 (95% CI = 0.737-0.923, P < 0.001) in the supine, seated, and standing position, respectively. CONCLUSION Upper limb arterial occlusive pressure was significantly dependent on body position. The method showed excellent interrater reliability and repeatability between different days. CLINICAL RELEVANCE Prescription of individualized pressures during blood flow restriction training requires measurement of upper limb arterial occlusive pressure in the appropriate position. The use of occlusion cuffs with a manual pump and a handheld Doppler ultrasound showed excellent reliability; however, the increased measurement error compared with the differences in arterial occlusive pressure between certain positions should be carefully considered for the clinical application of the method. STRENGTH OF RECOMMENDATIONS TAXONOMY (SORT) B.
Collapse
Affiliation(s)
- Stefanos Karanasios
- Physiotherapy Department, University of West Attica, Aigaleo, Greece.,Laboratory of Advanced Physiotherapy (LAdPhys), Physiotherapy Department, School of Health and Care Sciences, University of West Attica, Aigaleo, Greece
| | | | - Maria Moutzouri
- Physiotherapy Department, University of West Attica, Aigaleo, Greece.,Laboratory of Advanced Physiotherapy (LAdPhys), Physiotherapy Department, School of Health and Care Sciences, University of West Attica, Aigaleo, Greece
| | - Sofia A Xergia
- Physiotherapy Department, University of Patras, Aigio, Greece
| | - Vasiliki Sakellari
- Physiotherapy Department, University of West Attica, Aigaleo, Greece.,Laboratory of Advanced Physiotherapy (LAdPhys), Physiotherapy Department, School of Health and Care Sciences, University of West Attica, Aigaleo, Greece
| | - George Gioftsos
- Physiotherapy Department, University of West Attica, Aigaleo, Greece.,Laboratory of Advanced Physiotherapy (LAdPhys), Physiotherapy Department, School of Health and Care Sciences, University of West Attica, Aigaleo, Greece
| |
Collapse
|
24
|
Acute physiological and perceptual responses to moderate intensity cycling with different levels of blood flow restriction. Biol Sport 2021; 38:437-443. [PMID: 34475624 PMCID: PMC8329982 DOI: 10.5114/biolsport.2021.100146] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/04/2020] [Accepted: 10/05/2020] [Indexed: 11/17/2022] Open
Abstract
The aim of this study was to compare: i) the physiological and perceptual responses of low-load exercise [(moderate intensity exercise (MI)] with different levels of blood flow restriction (BFR), and ii) MI with BFR on the bike with high intensity (HI) exercise without BFR. The protocol involved large muscle mass exercise at different levels of BFR, and this differentiates our study from others. Twenty-one moderately trained males (age: 24.6 ± 2.4 years; VO2peak: 47.2 ± 7.0 ml.kg-1.min-1, mean ± sd) performed one maximal graded exercise test and seven 5-min constant-load cycling bouts. Six bouts were at MI [40% peak power (Ppeak), 60%VO2peak], one without BFR and five with different levels of BFR (40%, 50%, 60%, 70%, 80% of estimated arterial occlusion pressure). The HI bout (70%Ppeak, 90%VO2peak) was without BFR. Oxygen uptake (VO2), heart rate (HR), blood lactate (BLa), rate of perceived exertion (RPE), and tissue oxygen saturation (TSI) were recorded. Regardless of pressure, HR, BLa and RPE during MI-BFR were higher compared to MI (p < 0.05, ES: moderate to very large), and TSI reduction was greater in MI-BFR than MI (p < 0.05, ES: moderate to large). The responses of VO2, HR, BLa, RPE and TSI induced by the different levels of BFR in MI-BFR were similar. Regardless of pressure, the responses of VO2, HR, BLa and RPE induced by MI-BFR were lower than HI (p < 0.05), except for TSI. TSI change was similar between MI-BFR and HI. It appears that BFR equal to 40% of arterial occlusion pressure is sufficient to reduce TSI when exercising with a large muscle mass.
Collapse
|
25
|
Editorial Commentary: Blood Flow Restriction Therapy Continues to Prove Effective. Arthroscopy 2021; 37:2870-2872. [PMID: 34481627 DOI: 10.1016/j.arthro.2021.04.073] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 04/30/2021] [Indexed: 02/02/2023]
Abstract
Blood flow restriction (BFR) training continues to look promising to try and maintain muscle mass or to rebuild muscle mass and strength after injury or surgery. Because additional potential benefits include pain control, increased gene expression (leading to atrophy reduction), and muscle excitation, our use of the modality favors earlier over middle- or late-phase postoperative use. We initiate BFR therapy 2-14 days postoperatively, often with reduced cuff pressure in the first several sessions before increasing to the recommended therapeutic occlusion level. We have observed the greatest benefit for individuals who are non-weight-bearing for 6 to 8 weeks and who may have more postoperative restrictions due to the nature of the surgery. Compared with the opposite thigh, we have seen instances in which quadriceps girth has been preserved, although not increased, following the non-weight-bearing period. Ideally, we use 1 to 3 low-load resistance training exercises per session at least 2 times per week for 6 weeks. We also employ BFR following osteotomy or any procedure where bone drilling is used, as researchers have observed improved bone health. Additional benefits relevant to the early postoperative phase, such as effusion and pain reduction, have not been clearly established. Anecdotally, we have seen effusion levels temporarily increase during treatment but then resolve to baseline within 30 to 60 minutes of tourniquet deflation. Further high-level research is necessary to objectively validate BFR use and which patients may best benefit from it.
Collapse
|
26
|
Pereira-Neto EA, Lewthwaite H, Boyle T, Johnston K, Bennett H, Williams MT. Effects of exercise training with blood flow restriction on vascular function in adults: a systematic review and meta-analysis. PeerJ 2021; 9:e11554. [PMID: 34277146 PMCID: PMC8272459 DOI: 10.7717/peerj.11554] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 05/11/2021] [Indexed: 01/08/2023] Open
Abstract
Background Blood flow restricted exercise (BFRE) improves physical fitness, with theorized positive effects on vascular function. This systematic review and meta-analysis aimed to report (1) the effects of BFRE on vascular function in adults with or without chronic health conditions, and (2) adverse events and adherence reported for BFRE. Methodology Five electronic databases were searched by two researchers independently to identify studies reporting vascular outcomes following BFRE in adults with and without chronic conditions. When sufficient data were provided, meta-analysis and exploratory meta-regression were performed. Results Twenty-six studies were included in the review (total participants n = 472; n = 41 older adults with chronic conditions). Meta-analysis (k = 9 studies) indicated that compared to exercise without blood flow restriction, resistance training with blood flow restriction resulted in significantly greater effects on endothelial function (SMD 0.76; 95% CI [0.36–1.14]). No significant differences were estimated for changes in vascular structure (SMD −0.24; 95% CI [−1.08 to 0.59]). In exploratory meta-regression analyses, several experimental protocol factors (design, exercise modality, exercised limbs, intervention length and number of sets per exercise) were significantly associated with the effect size for endothelial function outcomes. Adverse events in BFRE studies were rarely reported. Conclusion There is limited evidence, predominantly available in healthy young adults, on the effect of BFRE on vascular function. Signals pointing to effect of specific dynamic resistance exercise protocols with blood flow restriction (≥4 weeks with exercises for the upper and lower limbs) on endothelial function warrant further investigation.
Collapse
Affiliation(s)
- Elisio A Pereira-Neto
- Innovation, IMPlementation And Clinical Translation in Health (IIMPACT), University of South Australia, Adelaide, South Australia, Australia.,Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Hayley Lewthwaite
- Innovation, IMPlementation And Clinical Translation in Health (IIMPACT), University of South Australia, Adelaide, South Australia, Australia.,Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia.,Department of Kinesiology and Physical Education, McGill University, Montreal, Quebec, Canada
| | - Terry Boyle
- Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia.,Australian Centre for Precision Health, University of South Australia, Adelaide, South Australia, Australia
| | - Kylie Johnston
- Innovation, IMPlementation And Clinical Translation in Health (IIMPACT), University of South Australia, Adelaide, South Australia, Australia.,Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Hunter Bennett
- Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia.,Alliance for Research in Exercise, Nutrition, and Activity (ARENA), University of South Australia, Adelaide, South Australia, Australia
| | - Marie T Williams
- Innovation, IMPlementation And Clinical Translation in Health (IIMPACT), University of South Australia, Adelaide, South Australia, Australia.,Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| |
Collapse
|
27
|
Lorenz D. Blood Flow Restriction: Cause for Optimism, But Let's Not Abandon The Fundamentals. Int J Sports Phys Ther 2021; 16:962-967. [PMID: 34123546 PMCID: PMC8169004 DOI: 10.26603/001c.23725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 05/10/2021] [Indexed: 11/21/2022] Open
|
28
|
Preobrazenski N, Islam H, Gurd BJ. Molecular regulation of skeletal muscle mitochondrial biogenesis following blood flow-restricted aerobic exercise: a call to action. Eur J Appl Physiol 2021; 121:1835-1847. [PMID: 33830325 DOI: 10.1007/s00421-021-04669-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 03/16/2021] [Indexed: 12/13/2022]
Abstract
Blood flow-restricted (BFR) exercise can induce training adaptations comparable to those observed following training in free flow conditions. However, little is known about the acute responses within skeletal muscle following BFR aerobic exercise (AE). Moreover, although preliminary evidence suggests chronic BFR AE may augment certain training adaptations in skeletal muscle mitochondria more than non-BFR AE, the underlying mechanisms are poorly understood. In this review, we summarise the acute BFR AE literature examining mitochondrial biogenic signalling pathways and provide insight into mechanisms linked to skeletal muscle remodelling following BFR AE. Specifically, we focus on signalling pathways potentially contributing to augmented peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PGC-1α) mRNA following work-rate-matched BFR AE compared with non-BFR AE. We present evidence suggesting reductions in muscle oxygenation during acute BFR AE lead to increased intracellular energetic stress, AMP-activated protein kinase (AMPK) activation and PGC-1α mRNA. In addition, we briefly discuss mitochondrial adaptations to BFR aerobic training, and we assess the risk of bias using the Cochrane Collaboration risk of bias assessment tool. We ultimately call for several straightforward modifications to help minimise bias in future BFR AE studies.
Collapse
Affiliation(s)
| | - Hashim Islam
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, V1V 1V7, Canada
| | - Brendon J Gurd
- School of Kinesiology and Health Studies, Queen's University, Kingston, ON, K7L 3N6, Canada.
| |
Collapse
|
29
|
Munhoz SV, Ramis TR, dos Santos LP, Ribeiro JL. Comparison of cardiopulmonary exercise testing performed with blood flow restriction vs. a traditional maximum test on execution speed, ventilatory thresholds and maximum oxygen uptake. SPORT SCIENCES FOR HEALTH 2020. [DOI: 10.1007/s11332-020-00644-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
30
|
Murray J, Bennett H, Boyle T, Williams M, Davison K. Approaches to determining occlusion pressure for blood flow restricted exercise training: Systematic review. J Sports Sci 2020; 39:663-672. [PMID: 33135570 DOI: 10.1080/02640414.2020.1840734] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Low-intensity exercise with blood flow restriction (BFR) is an increasingly common method of improving muscular strength and hypertrophy, and improving aerobic fitness, in clinical and athletic populations. The aim of this systematic review was to describe common approaches to determining occlusion pressures for BFR exercise. A comprehensive literature search yielded 1389 results, of which 129 were included. Studies were predominantly randomised control trials (86.7%) with modest sample sizes (average number of 11.4 ± 6.2 participants per BFR group/s) of young adults (average age of 34.6 ± 17.9). Five different approaches for determining occlusion pressure were identified: arbitrary pressures (56.6%), percentage of limb occlusion pressure (25.6%), brachial systolic blood pressure (10.9%), perceived tightness (3.9%) and other (3%). From 2016 to 2018, the number of published papers using a percentage of limb occlusion pressure increased yearly, paralleling a decrease use of arbitrary pressures. Of the studies included in this review, the most common approach to determining occlusion pressure was using a non-individualised, arbitrary pressure. Given the safety concerns associated with arbitrary pressures, continual dissemination regarding the optimal applications of BFR for safety and efficacy is required.
Collapse
Affiliation(s)
- James Murray
- Allied Health and Human Performance, University of South Australia, Adelaide, Australia.,Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, Adelaide, Australia
| | - Hunter Bennett
- Allied Health and Human Performance, University of South Australia, Adelaide, Australia.,Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, Adelaide, Australia
| | - Terry Boyle
- Allied Health and Human Performance, University of South Australia, Adelaide, Australia.,Australian Centre for Precision Health, University of South Australia Cancer Research Institute, Adelaide, Australia
| | - Marie Williams
- Allied Health and Human Performance, University of South Australia, Adelaide, Australia.,Innovation, Implementation and Clinical Translation in Health (IIMPACT), University of South Australia, Adelaide, Australia
| | - Kade Davison
- Allied Health and Human Performance, University of South Australia, Adelaide, Australia.,Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, Adelaide, Australia
| |
Collapse
|
31
|
Rolnick N, Schoenfeld BJ. Can Blood Flow Restriction Used During Aerobic Training Enhance Body Composition in Physique Athletes? Strength Cond J 2020. [DOI: 10.1519/ssc.0000000000000585] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
32
|
Blood Flow Restriction as an Exercise Alternative to Ameliorate the Effects of Aging. CURRENT GERIATRICS REPORTS 2020. [DOI: 10.1007/s13670-020-00323-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
33
|
Kambič T. Blood flow restriction training: You can occlude your veins, but not your oxygen transport. J Physiol 2020; 598:3825-3826. [PMID: 32539161 DOI: 10.1113/jp279936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 06/12/2020] [Indexed: 11/08/2022] Open
Affiliation(s)
- Tim Kambič
- Department of Research and Education, General Hospital Murska Sobota, Murska Sobota, Slovenia.,Faculty of Sports, University of Ljubljana, Ljubljana, Slovenia
| |
Collapse
|
34
|
Preobrazenski N, Islam H, Drouin PJ, Bonafiglia JT, Tschakovsky ME, Gurd BJ. A novel gravity-induced blood flow restriction model augments ACC phosphorylation and PGC-1α mRNA in human skeletal muscle following aerobic exercise: a randomized crossover study. Appl Physiol Nutr Metab 2019; 45:641-649. [PMID: 31778310 DOI: 10.1139/apnm-2019-0641] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
This study tested the hypothesis that a novel, gravity-induced blood flow restricted (BFR) aerobic exercise (AE) model will result in greater activation of the AMPK-PGC-1α pathway compared with work rate-matched non-BFR. Thirteen healthy males (age: 22.4 ± 3.0 years; peak oxygen uptake: 42.4 ± 7.3 mL/(kg·min)) completed two 30-min work rate-matched bouts of cycling performed with their legs below (CTL) and above their heart (BFR) at ∼2 weeks apart. Muscle biopsies were taken before, immediately, and 3 h after exercise. Blood was drawn before and immediately after exercise. Our novel gravity-induced BFR model led to less muscle oxygenation during BFR compared with CTL (O2Hb: p = 0.01; HHb: p < 0.01) and no difference in muscle activation (p = 0.53). Plasma epinephrine increased following both BFR and CTL (p < 0.01); however, only norepinephrine increased more following BFR (p < 0.01). PGC-1α messenger RNA (mRNA) increased more following BFR (∼6-fold) compared with CTL (∼4-fold; p = 0.036). VEGFA mRNA increased (p < 0.01) similarly following BFR and CTL (p = 0.21), and HIF-1α mRNA did not increase following either condition (p = 0.21). Phosphorylated acetyl-coenzyme A carboxylase (ACC) increased more following BFR (p < 0.035) whereas p-PKA substrates, p-p38 MAPK, and acetyl-p53 increased (p < 0.05) similarly following both conditions (p > 0.05). In conclusion, gravity-induced BFR is a viable BFR model that demonstrated an important role of AMPK signalling on augmenting PGC-1α mRNA. Novelty Gravity-induced BFR AE reduced muscle oxygenation without impacting muscle activation, advancing gravity-induced BFR as a simple, inexpensive BFR model. Gravity-induced BFR increased PGC-1α mRNA and ACC phosphorylation more than work rate-matched non-BFR AE. This is the first BFR AE study to concurrently measure blood catecholamines, muscle activation, and muscle oxygenation.
Collapse
Affiliation(s)
- Nicholas Preobrazenski
- School of Kinesiology and Health Studies, Queen's University, 28 Division Street, Kingston, ON K7L 3N6, Canada.,School of Kinesiology and Health Studies, Queen's University, 28 Division Street, Kingston, ON K7L 3N6, Canada
| | - Hashim Islam
- School of Kinesiology and Health Studies, Queen's University, 28 Division Street, Kingston, ON K7L 3N6, Canada.,School of Kinesiology and Health Studies, Queen's University, 28 Division Street, Kingston, ON K7L 3N6, Canada
| | - Patrick J Drouin
- School of Kinesiology and Health Studies, Queen's University, 28 Division Street, Kingston, ON K7L 3N6, Canada.,School of Kinesiology and Health Studies, Queen's University, 28 Division Street, Kingston, ON K7L 3N6, Canada
| | - Jacob T Bonafiglia
- School of Kinesiology and Health Studies, Queen's University, 28 Division Street, Kingston, ON K7L 3N6, Canada.,School of Kinesiology and Health Studies, Queen's University, 28 Division Street, Kingston, ON K7L 3N6, Canada
| | - Michael E Tschakovsky
- School of Kinesiology and Health Studies, Queen's University, 28 Division Street, Kingston, ON K7L 3N6, Canada.,School of Kinesiology and Health Studies, Queen's University, 28 Division Street, Kingston, ON K7L 3N6, Canada
| | - Brendon J Gurd
- School of Kinesiology and Health Studies, Queen's University, 28 Division Street, Kingston, ON K7L 3N6, Canada.,School of Kinesiology and Health Studies, Queen's University, 28 Division Street, Kingston, ON K7L 3N6, Canada
| |
Collapse
|
35
|
Held S, Behringer M, Donath L. Low intensity rowing with blood flow restriction over 5 weeks increases V̇O 2max in elite rowers: A randomized controlled trial. J Sci Med Sport 2019; 23:304-308. [PMID: 31672481 DOI: 10.1016/j.jsams.2019.10.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 09/05/2019] [Accepted: 10/02/2019] [Indexed: 01/28/2023]
Abstract
OBJECTIVES The present randomized controlled intervention study examined the effects of practical blood flow restriction (pBFR) on maximal oxygen uptake (V̇O2max) during low intensity rowing. DESIGN Thirty-one elite rowers were either assigned to the intervention (INT) or control (CON) group, using the minimization method (Strata: Gender, Age, Height, V̇O2max). METHOD While INT (n=16; 4 female, 12 male, 21.9±3.2 years, 180.4±8.7cm, 73.6±10.9kg, V̇O2max: 63.0±7.9ml/min/kg) used pBFR during boat- and indoor-rowing training, CON (n=15, 4 female, 11 male, 21.7±3.7 years, 180.7±8.1cm, 72.5±12.1kg, V̇O2max: 63.2±8.5ml/min/kg) completed the identical training without pBFR. pBFR of the lower limb was applied via customized elastic wraps. Training took place three times a week over 5 weeks (accumulated net pBFR: 60min/week; occlusion per session: 2-times 10min/session) and was used exclusively at low intensities (<2mmol/L). A spiroergometric ramp test (V̇O2max; 30-40W/min increase) on rowing-ergometer and one-repetition maximum test of the squat exercise (SQ1RM) was employed to assess endurance and strength capacity. RESULTS Significant group×time interactions (ηp²=0.26) in favor of INT were found for V̇O2max (+9.1±6.2%, Effect Size=1.3) compared to CON (+2.5±6.1%, ES=0.3). SQ1RM (ηp²=0.01) was not affected by the pBFR intervention. CONCLUSIONS This study revealed that 15 sessions of pBFR application with a cumulative total pBFR load of 5h over a 5 weeks macrocycle remarkably increased V̇O2max. Thus, pBFR might serve as a promising means to improve aerobic capacity in highly trained elite rowers.
Collapse
Affiliation(s)
- Steffen Held
- Department of Intervention Research in Exercise Training, German Sport University Cologne, Germany.
| | | | - Lars Donath
- Department of Intervention Research in Exercise Training, German Sport University Cologne, Germany
| |
Collapse
|