Physiological and Perceptual Responses to Aerobic Exercise With and Without Blood Flow Restriction

Acute Effects of a Practical Blood Flow Restriction Device During Swimming Exercise

Purpose: The present study aimed to analyze: 1) the reliability of the tissue saturation index (TSI) and ratings of perceived discomfort (RPD) responses wearing a neoprene practical cuff (PrC), comparing with the responses from traditional (TrC) pneumatic cuffs (study I); 2) the effects of PrC on metabolic (blood lactate concentration, BLC), perceptual (rate of perceived effort, RPE) and kinematic responses at sub-maximal swimming velocities (study II). Methods: Study I; 1) PrC test-retest at rest and during swimming ergometer exercise; 2) BFR at rest with TrC inflated to different percentages of the minimum arterial occlusion pressure (MAOP; 60, 80, 100, 120 and 140%). Test-retest reliability of TSI and RPD was assessed by the intraclass correlation coefficient (ICC) and comparisons among conditions were analyzed by one-way repeated-measures ANOVA. Study II; 1) 50, 200 and 400 m swimming performances; 2) sub-maximal incremental swimming protocol with and without PrC. Two-way repeated measures ANOVA was used to compare all variables during sub-maximal velocities. Results: TSI (ICC = 0.81; 95%CI 0.62-0.91) and RPD (ICC = 0.97; 95%CI 0.94-0.99) were reliable under restricted exercise using PrC. TSI during restricted exercise was lower (p <.001) compared to unrestricted exercise (6.8 ± 6.1% vs. 21.6 ± 8.2% of physiological normalization). PrC showed higher BLC only at or above 91% of critical velocity (p < .03), while stroke rate and RPE were higher (p < .005), and stroke length was lower (p < .03) during all swimming velocities. Conclusion: This easy-to-handle and affordable practical BFR device increased physiological stress at sub-maximal efforts which could be an additional training tool for swimmers.

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.

Blood Flow Restriction during Walking Does Not Impact Body Composition or Performance Measures in Highly Trained Runners

Blood flow restriction (BFR) is a commonly used training modality that has been demonstrated to enhance muscle characteristics such as size and function. The purpose of this study was to determine if a 4-week walking program with or without BFR in healthy, active adults has an effect on body composition, anaerobic, and aerobic running performance. Thirty-three participants, randomized among three groups, completed the walking program, which included five sets of 2 min walking intervals with 1 min rest, with or without BFR, or 10 min walking with BFR. Assessments completed before and after the walking program included body composition, 40-yard sprints, and a VO2MAX test on a treadmill. A two-way ANOVA revealed no changes among the groups nor for any variables at any time (p > 0.05). Additionally, one main effect for time indicated the VO2 at V-slope threshold was greater following training for all groups combined (p = 0.001). The results demonstrate that low volume and intensity walking with BFR for 4 weeks did not provide a sufficient stimulus for changing body composition or performance metrics in a group of very active adults. Longer or more isolated exposure of BFR on the limbs may contribute to more pronounced adaptations.

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.

Higher rating of perceived exertion and lower perceived recovery following a graded exercise test during menses compared to non-bleeding days in untrained females

The underrepresentation of the female population in exercise sciences could be attributed, at least in part, to difficulty in appropriately accounting for the effects of the menstrual cycle (MC). Previous studies examining the effects of the MC on aerobic performance and subjective measures of aerobic performance show conflicting results. Purpose: The study examined how the MC affects the objective and subjective measures of aerobic performance within untrained female participants and in comparison with untrained male participants assessed at similar time intervals. Methods: Twenty-one participants (12 females and 9 males) completed a graded exercise test (GXT) on a cycle ergometer. The female participants were tested during their early follicular (EF; menses), ovulatory (O), and mid-luteal (ML) phases of the MC. The male participants were included as the control group and were randomly assigned to a menstrual cycle phase for each visit. During GXT, maximal oxygen consumption (VO2max), respiratory exchange ratio (RER), maximal heart rate (HRmax), peak blood lactate, and rating of perceived exertion (RPE) were determined. Twenty-four hours post-exercise, the perceived recovery status (PRS) was assessed. The MC phase was estimated using basal body temperature (BBT) in the female participants. Results: The male participants obtained a higher peak power and VO2max compared to the female participants (p < 0.05). All objective measures of aerobic performance did not significantly differ across the MC phases or time points that were tested. In the untrained female participants, an effect of the MC phase on RPE was found, with RPE being higher at EF (8.92 ± 0.79) compared to O (7.67 ± 1.23; p < 0.05) and ML (7.75 ± 1.06; p < 0.05). In addition, an effect of the MC phase on PRS was found, with perceived recovery being lower at EF (6.83 ± 0.94) compared to O (8.83 ± 1.12) and ML (8.67 ± 0.65; all p < 0.005) for the untrained female participants. No significant differences in RPE and PRS were found between tests in the untrained male participants. The female participants had lower perceived recovery following EF (6.83 ± 0.94) compared with the male participants (9.00 ± 1.00; p < 0.001). Conclusion: The untrained female participants perceived greater exertion during GXT and impaired recovery following GXT in EF compared to O and ML. These results may be attributed to either a drop in female sex hormone concentrations or discomfort associated with menses. The male participants did not exhibit any changes over time. Future studies using subjective parameters such as perceived exertion to track the internal load of training in the naturally menstruating female population should consider menses.

Exercise responses to heart rate clamped cycling with graded blood flow restriction

OBJECTIVES

To quantify the acute effects of graded blood flow restriction on the interaction between changes in mechanical output, muscle oxygenation trends and perceptual responses to heart rate clamped cycling.

DESIGN

Repeated measures.

METHODS

Twenty-five adults (21 men) performed six, 6-min cycling bouts (24 min of recovery) at a clamped heart rate corresponding to their first ventilatory threshold at 0 % (unrestricted), 15 %, 30 %, 45 %, 60 % and 75 % of arterial occlusion pressure with the cuffs inflated bilaterally from the fourth to the sixth minute. Power output, arterial oxygen saturation (pulse oximetry) and vastus lateralis muscle oxygenation (near-infrared spectroscopy) were monitored during the final 3 min of pedalling, whilst perceptual responses (modified Borg CR10 scales) were obtained immediately after exercise.

RESULTS

Compared to unrestricted cycling, average power output for minutes 4-6 decreased exponentially for cuff pressures ranging 45-75 % of arterial occlusion pressure (P < 0.001). Peripheral oxygen saturation averaged ∼96 % across all cuff pressures (P = 0.318). Deoxyhemoglobin changes were larger at 45-75 % versus 0 % of arterial occlusion pressure (P < 0.05), whereas higher total haemoglobin values occurred at 60-75 % of arterial occlusion pressure (P < 0.05). Sense of effort, ratings of perceived exertion, pain from cuff pressure, and limb discomfort were exaggerated at 60-75 % versus 0 % of arterial occlusion pressure (P < 0.001).

CONCLUSIONS

Blood flow restriction of at least 45 % of arterial occlusion pressure is required to reduce mechanical output during heart rate clamped cycling at the first ventilatory threshold. Whilst power decreases non-linearly above this pressure threshold, higher occlusion levels ranging 60-75 % of arterial occlusion pressure also accentuate muscle deoxygenation and exercise-related sensations.

Shorter High-Intensity Cycling Intervals Reduce Performance and Perceived Fatigability at Work-Matched but Not Task Failure

INTRODUCTION

The intensity, duration, and distribution of work and recovery phases during high-intensity interval training (HIIT) modulate metabolic perturbations during exercise and subsequently influence the development of performance fatigability and exercise tolerance. This study aimed to characterize neuromuscular, perceptual, and cardiorespiratory responses to work-to-rest ratio-matched HIIT protocols differing in work and rest interval duration.

METHODS

Twelve healthy individuals (six women) first completed a ramp incremental test to determine 90% of peak power output, and then in three randomized visits, they completed three cycling protocols to task failure at 90% of peak power output: (i) 3- to 3-min work-to-passive rest ratio HIIT (HIIT 3min ), (ii) 1- to 1-min work-to-passive rest ratio HIIT (HIIT 1min ), and (iii) constant load (CL). Interpolated twitch technique, including maximal voluntary isometric knee extensions and femoral nerve electrical stimuli, was performed at baseline, every 6 min of work, and task failure. Perceptual and cardiorespiratory responses were recorded every 3 min and continuously across the exercises, respectively.

RESULTS

The work completed during HIIT 1min (8447 ± 5124 kJ) was considerably greater than HIIT 3min (1930 ± 712 kJ) and CL (1076 ± 356) ( P < 0.001). At work-matched, HIIT 1min resulted in a lesser decline in maximal voluntary contraction and twitch force compared with HIIT 3min and CL ( P < 0.001). Perceived effort, pain, and dyspnea were least in HIIT 1min and HIIT 3min compared with CL ( P < 0.001). At task failure, HIIT 1min resulted in less voluntary activation than HIIT 3min ( P = 0.010) and CL ( P = 0.043), and engendered less twitch force decline than CL ( P = 0.021).

CONCLUSIONS

Overall, the mitigated physiological and perceptual responses during shorter work periods (HIIT 1min ) enhance exercise tolerance in comparison to longer work intervals at the same intensity (HIIT 3min , CL).

The effect of physical exercise on the anxiety of college students in the post-pandemic era: The mediating role of social support and proactive personality

In order to study the current situation of the anxiety of college students in the post-pandemic era and the effect of physical exercise on anxiety, this study explores the influence of social support and proactive personality as mediating variables on the anxiety of college students from the perspective of physical exercise. Firstly, anxiety symptoms and anxious emotions are defined. Secondly, a questionnaire survey is conducted for a well-known university in a certain city, and different questionnaire scales are developed from the physical exercise, anxiety, social support, and proactive personality assessment of college students. Finally, the results of the survey are statistically analyzed to explore the relieving effect of physical exercise on anxiety. The results reveal that there is a significant gender difference in the level of physical exercise, and the amount of physical exercise of the male students is generally higher than that of female students. In addition, the intensity, time, and frequency of exercise of male students are more than that of female students, but there is no obvious difference between them and whether they were only children. Physical exercise habits, social support, proactive personality traits, and anxiety of college students have a significant correlation. Through the analysis of the chain mediation effect, Ind2 (0.0140) is the largest coefficient among the three paths, indicating that the path of influencing social support through physical exercise habits, followed by affecting proactive personality traits, and then impacting anxiety has the strongest explanatory force. According to the results, strategies to relieve the anxiety of college students are given. This study can provide a reference for the research on the methods to alleviate their anxiety under the influence of the epidemic.

Blood flow restriction during high-intensity interval cycling exacerbates psychophysiological responses to a greater extent in females than males

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.

A Randomized, Double-Blind Placebo Control Study on the Effect of a Blood Flow Restriction by an Inflatable Cuff Worn around the Arm on the Wrist Joint Position Sense in Healthy Recreational Athletes

The number of blood flow restriction (BFR) training practitioners is rapidly increasing, so understanding the safety issues associated with limb occlusion is strongly needed. The present study determined the effect of BFR by an inflatable cuff worn around the arm on the wrist joint position sense (JPS) in healthy recreational athletes. In the prospective randomized, double-blind placebo control study, sixty healthy right-handed recreational athletes aged x = 22.93 ± 1.26 years were assigned to groups of equal size and gender rates: BFR, placebo, and control. The active wrist JPS was assessed in two separate sessions using an isokinetic dynamometer. The first assessment was performed with no cuffs. In the second session, a cuff with a standardized pressure was worn on the examined limb in the BFR group. In the placebo group, the cuff was uninflated. A between-session comparison in each group of collected angular errors expressed in degrees was carried out. The angular error in the BFR group was larger during the second measurement than the first one (p = 0.011-0.336). On the contrary, in the placebo (p = 0.241-0.948) and control (p = 0.093-0.904) groups, the error value in the second session was comparable or smaller. It was determined that BFR by an inflatable cuff around the arm impairs the wrist position sense. Hence, BFR training should be performed with caution.

Aerobic Training With Blood Flow Restriction for Endurance Athletes: Potential Benefits and Considerations of Implementation

ABSTRACT

Smith, NDW, Scott, BR, Girard, O, and Peiffer, JJ. Aerobic training with blood flow restriction for endurance athletes: potential benefits and considerations of implementation. J Strength Cond Res 36(12): 3541-3550, 2022-Low-intensity aerobic training with blood flow restriction (BFR) can improve maximal oxygen uptake, delay the onset of blood lactate accumulation, and may provide marginal benefits to economy of motion in untrained individuals. Such a training modality could also improve these physiological attributes in well-trained athletes. Indeed, aerobic BFR training could be beneficial for those recovering from injury, those who have limited time for training a specific physiological capacity, or as an adjunct training stimulus to provide variation in a program. However, similarly to endurance training without BFR, using aerobic BFR training to elicit physiological adaptations in endurance athletes will require additional considerations compared with nonendurance athletes. The objective of this narrative review is to discuss the acute and chronic aspects of aerobic BFR exercise for well-trained endurance athletes and highlight considerations for its effective implementation. This review first highlights key physiological capacities of endurance performance. The acute and chronic responses to aerobic BFR exercise and their impact on performance are then discussed. Finally, considerations for prescribing and monitoring aerobic BFR exercise in trained endurance populations are addressed to challenge current views on how BFR exercise is implemented.

Acute Responses to Cycling Exercise With Blood Flow Restriction During Various Intensities

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.

Effects of short-term repeated sprint training in hypoxia or with blood flow restriction on response to exercise

This study compared the effects of a brief repeated sprint training (RST) intervention performed with bilateral blood flow restriction (BFR) conditions in normoxia or conducted at high levels of hypoxia on response to exercise. Thirty-nine endurance-trained athletes completed six repeated sprints cycling sessions spread over 2 weeks consisting of four sets of five sprints (10-s maximal sprints with 20-s active recovery). Athletes were assigned to one of the four groups and subjected to a bilateral partial blood flow restriction (45% of arterial occlusion pressure) of the lower limbs during exercise (BFRG), during the recovery (BFRrG), exercised in a hypoxic room simulating hypoxia at FiO2 ≈ 13% (HG) or were not subjected to additional stress (CG). Peak aerobic power during an incremental test, exercise duration, maximal accumulated oxygen deficit and accumulated oxygen uptake (VO2) during a supramaximal constant-intensity test were improved thanks to RST (p < 0.05). No significant differences were observed between the groups (p > 0.05). No further effect was found on other variables including time-trial performance and parameters of the force-velocity relationship (p > 0.05). Thus, peak aerobic power, exercise duration, maximal accumulated oxygen deficit, and VO2 were improved during a supramaximal constant-intensity exercise after six RST sessions. However, combined hypoxic stress or partial BFR did not further increase peak aerobic power.

Low- to Moderate-intensity Blood Flow Restricted Walking is not an Acute Equivalent for Unrestricted Jogging in Young Active Adults

This study investigated whether walking with blood flow restriction (BFR) increases acute cardio-respiratory demands to the point that it can be considered an alternative for jogging. Sixteen physically active adults completed five experimental sessions (order randomised), comprising 10 min of treadmill exercise. Two sessions included unrestricted walking, two sessions required walking with BFR cuffs positioned on the lower limbs inflated to 60% of individualised arterial occlusion pressure, and one session was conducted at a jogging pace. Comfortable walking and jogging speeds were calculated during the familiarisation session. Walking speeds were individualised to either 100% (speed: 6.0 ± 0.3km·h^-1[low-intensity]) or 120% (speed: 7.2 ± 0.3km·h^-1[moderate-intensity]) of comfortable walking speed. The jogging session was unrestricted (speed: 9.1 ± 0.7km·h^-1). Initial analysis compared walking conditions across heart rate, left cardiac work index, systolic blood pressure, relative oxygen consumption, minute ventilation, rating of perceived exertion and limb discomfort. Secondary analysis compared the walking session with the highest cardio-respiratory demands to jogging. Initial analysis identified that moderate-intensity with BFR induced the highest cardio-respiratory and perceptual responses compared with any other walking sessions (p < 0.01). Secondary analysis revealed that all cardio-respiratory measures were higher during jogging when compared with moderate-intensity with BFR (p < 0.01), except systolic blood pressure (p = 0.10). All perceptual measures were higher during moderate-intensity with BFR (p < 0.01) compared with jogging. Low- to moderate-intensity BFR-walking produces lower acute cardio-respiratory responses at higher ratings of perceived exertion and discomfort compared with jogging. Overall, BFR-walking does not seem to provide an equivalent exercise modality for unrestricted jogging in physically active adults.

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.

Aerobic exercise with blood flow restriction: energy expenditure, excess post-exercise oxygen consumption, and respiratory exchange ratio

We compared the effects of aerobic exercise with and without blood flow restriction (BFR) to high-intensity aerobic exercise on energy expenditure (EE), excess post-exercise oxygen consumption (EPOC), and respiratory exchange ratio (RER) during and after exercise. Twenty-two recreationally active males randomly completed the following experimental conditions: AE - aerobic exercise without BFR, AE+BFR - aerobic exercise with BFR, HIAE - high-intensity aerobic exercise, CON - non-exercise control condition. EE was significantly (p<0.05) greater during exercise for HIAE compared to all conditions, and for AE+BFR compared to AE and CON during and post-exercise exercise. There were no significant (p>0.05) differences in EPOC between HIAE and AE+BFR at any time point, however, both conditions were significantly (p < 0.05) greater than the AE (d = 1.50 and d = 1.03, respectively) and CON at the first 10 minutes post-exercise. RER during exercise for HIAE was significantly (p<0.05) greater than AE+BFR at the first 6 minutes of exercise (p = 0.003, d = 0.88), however, no significant differences were observed from 9 min up to the end of the exercise. HIAE was also significantly (p<0.05) greater than AE and CON at all time points during exercise, whereas, AE+BFR was significantly (p<0.05) greater than CON at all time points but not significantly (p < 0.05) different than AE (p<0.05); although the overall session RER was significantly (p<0.05) greater during AE+BFR than AE. Altogether, continuous AE+BFR results in greater EE compared to volume matched AE, as well as a similar EPOC compared to HIAE. This article is protected by copyright. All rights reserved.

Mechanical, Cardiorespiratory, and Muscular Oxygenation Responses to Sprint Interval Exercises Under Different Hypoxic Conditions in Healthy Moderately Trained Men

Objective: The aim of this study was to determine the effects of sprint interval exercises (SIT) conducted under different conditions (hypoxia and blood flow restriction [BFR]) on mechanical, cardiorespiratory, and muscular O₂ extraction responses.

Methods: For this purpose, 13 healthy moderately trained men completed five bouts of 30 s all-out exercises interspaced by 4 min resting periods with lower limb bilateral BFR at 60% of the femoral artery occlusive pressure (BFR₆₀) during the first 2 min of recovery, with gravity-induced BFR (pedaling in supine position; G-BFR), in a hypoxic chamber (FiO₂≈13%; HYP) or without additional stress (NOR). Peak and average power, time to achieve peak power, rating of perceived exertion (RPE), and a fatigue index (FI) were analyzed. Gas exchanges and muscular oxygenation were measured by metabolic cart and NIRS, respectively. Heart rate (HR) and peripheral oxygen saturation (SpO₂) were continuously recorded.

Results: Regarding mechanical responses, peak and average power decreased after each sprint (p < 0.001) excepting between sprints four and five. Time to reach peak power increased between the three first sprints and sprint number five (p < 0.001). RPE increased throughout the exercises (p < 0.001). Of note, peak and average power, time to achieve peak power and RPE were lower in G-BFR (p < 0.001). Results also showed that SpO₂ decreased in the last sprints for all the conditions and was lower for HYP (p < 0.001). In addition, Δ[O₂Hb] increased in the last two sprints (p < 0.001). Concerning cardiorespiratory parameters, BFR₆₀ application induced a decrease in gas exchange rates, which increased after its release compared to the other conditions (p < 0.001). Moreover, muscle blood concentration was higher for BFR₆₀ (p < 0.001). Importantly, average and peak oxygen consumption and muscular oxyhemoglobin availability during sprints decreased for HYP (p < 0.001). Finally, the tissue saturation index was lower in G-BFR.

Conclusions: Thus, SIT associated with G-BFR displayed lower mechanical, cardiorespiratory responses, and skeletal muscle oxygenation than the other conditions. Exercise with BFR₆₀ promotes higher blood accumulation within working muscles, suggesting that BFR₆₀ may additionally affect cellular stress. In addition, HYP and G-BFR induced local hypoxia with higher levels for G-BFR when considering both exercise bouts and recovery periods.

Self-Paced Cycling at the Highest Sustainable Intensity With Blood Flow Restriction Reduces External but Not Internal Training Loads

Purpose: This study compared training loads and internal:external load ratios from an aerobic interval session at the highest perceptually sustainable intensity with and without blood flow restriction (BFR). Methods: On separate days, 14 endurance cyclists/triathletes completed four 4-minute self-paced aerobic cycling intervals at their highest sustainable intensity, with and without BFR (60% of arterial occlusion pressure). Internal training load was quantified using 3 training impulses (TRIMP; Banister, Lucia, and Edwards) and sessional ratings of perceived exertion. External load was assessed using total work done (TWD). Training load ratios between all internal loads were calculated relative to TWD. Results: Lucia TRIMP was lower for the BFR compared with non-BFR session (49 [9] vs 53 [8] arbitrary units [au], P = .020, dz = −0.71). No between-conditions differences were observed for Banister TRIMP (P = .068), Edwards TRIMP (P = .072), and training load in sessional ratings of perceived exertion (P = .134). The TWD was lower for the BFR compared with non-BFR session (223 [52] vs 271 [58] kJ, P < .001, dz = −1.27). Ratios were greater for the BFR session compared with non-BFR for Lucia TRIMP:TWD (0.229 [0.056] vs 0.206 [0.056] au, P < .001, dz = 1.21), Edwards TRIMP:TWD (0.396 [0.105] vs 0.370 [0.088] au, P = .031, dz = 0.66), and training load in sessional ratings of perceived exertion:TWD (1.000 [0.266] vs 0.890 [0.275] au, P = .044, dz = 0.60), but not Banister TRIMP:TWD (P = .306). Conclusions: Practitioners should consider both internal and external loads when monitoring BFR exercise to ensure the demands are appropriately captured. These BFR-induced changes were reflected by the Lucia TRIMP:TWD and Edwards TRIMP:TWD ratio, which could be used to monitor aerobic BFR training loads. The Lucia TRIMP:TWD ratio likely represents BFR-induced changes more appropriately compared with ratios involving either Edwards or Banister TRIMP.

Aerobic exercise with blood flow restriction causes local and systemic hypoalgesia and increases circulating opioid and endocannabinoid levels

This study examined the effect of aerobic exercise with and without blood flow restriction (BFR) on exercise-induced hypoalgesia and endogenous opioid and endocannabinoid systems. In a randomized crossover design, pain-free individuals performed 20 min of cycling in four experimental trials: 1) low-intensity aerobic exercise (LI-AE) at 40% V̇o_2max; 2) LI-AE with low-pressure BFR (BFR40); 3) LI-AE with high-pressure BFR (BFR80); and 4) high-intensity aerobic exercise (HI-AE) at 70% V̇o_2max. Pressure pain thresholds (PPTs) were assessed before and 5 min postexercise. Circulating concentrations of beta-endorphin and 2-arachidonoylglycerol were assessed before and 10 min postexercise. In the exercising legs, postexercise PPTs were increased following BFR40 and BFR80 compared with LI-AE (23-32% vs. 1-2% increase, respectively). The increase in PPTs was comparable to HI-AE (17-20% increase) with BFR40 and greater with BFR80 (30-32% increase). Both BFR80 and HI-AE increased PPTs in remote areas of the body (increase of 26-28% vs. 19-21%, respectively). Postexercise circulating beta-endorphin concentration was increased following BFR40 (11%) and HI-AE (14%), with the greatest change observed following BFR80 (29%). Postexercise circulating 2-arachidonoylglycerol concentration was increased following BFR40 (22%) and BFR80 (20%), with the greatest change observed following HI-AE (57%). Addition of BFR to LI-AE can trigger both local and systemic hypoalgesia that is not observed follow LI-AE alone and activate endogenous opioid and endocannabinoid systems of pain inhibition. Compared with HI-AE, local and systemic hypoalgesia following LI-AE with high-pressure BFR is greater and comparable, respectively. LI-AE with BFR may help pain management in load-compromised individuals.NEW & NOTEWORTHY We have shown that performing blood flow restriction (BFR) during low-intensity aerobic exercise can trigger local and systemic hypoalgesia, which is not typically observed with this intensity of exercise. High-pressure BFR triggers greater and comparable hypoalgesia than high-intensity aerobic exercise in the exercising limbs and remote areas of the body, respectively. Performing BFR during low-intensity aerobic exercise activates the opioid and endocannabinoid systems, providing novel insight into potential mechanisms of hypoalgesia with BFR exercise.

Effects of Blood Flow Restriction on O2 Muscle Extraction and O2 Pulmonary Uptake Kinetics During Heavy Exercise

This study aimed to determine the effects of three levels of blood flow restriction (BFR) on V˙O2 and O₂ extraction kinetics during heavy cycling exercise transitions. Twelve healthy trained males completed two bouts of 10 min heavy intensity exercise without BFR (CON), with 40% or 50% BFR (BFR40 and BFR50, respectively). V˙O2 and tissue saturation index (TSI) were continuously measured and modelled using multiexponential functions. The time constant of the V˙O2 primary phase was significantly slowed in BFR40 (26.4 ± 2.0s; p < 0.001) and BFR50 (27.1 ± 2.1s; p = 0.001) compared to CON (19.0 ± 1.1s). The amplitude of the V˙O2 slow component was significantly increased (p < 0.001) with BFR in a pressure-dependent manner 3.6 ± 0.7, 6.7 ± 0.9 and 9.7 ± 1.0 ml·min⁻¹·kg⁻¹ for CON, BFR40, and BFR50, respectively. While no acceleration of the primary component of the TSI kinetics was observed, there was an increase (p < 0.001) of the phase 3 amplitude with BFR (CON −0.8 ± 0.3% VS BFR40 −2.9 ± 0.9%, CON VS BFR50 −2.8 ± 0.8%). It may be speculated that BFR applied during cycling exercise in the heavy intensity domain shifted the working muscles to an O₂ dependent situation. The acceleration of the extraction kinetics could have reached a plateau, hence not permitting compensation for the slowdown of the blood flow kinetics, and slowing V˙O2 kinetics.

Acute physiological and perceptual responses to moderate intensity cycling with different levels of blood flow restriction

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; VO_2peak: 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 (P_peak), 60%VO_2peak], one without BFR and five with different levels of BFR (40%, 50%, 60%, 70%, 80% of estimated arterial occlusion pressure). The HI bout (70%P_peak, 90%VO_2peak) 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.

Negative effects of blood flow restriction on perceptual responses to walking in healthy young adults: A pilot study

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Blood Flow Restricted Exercise and Discomfort: A Review

Spitz, RW, Wong, V, Bell, ZW, Viana, RB, Chatakondi, RN, Abe, T, and Loenneke, JP. Blood flow restricted exercise and discomfort: A Review. J Strength Cond Res XX(X): 000-000, 2020-Blood flow restriction exercise involves using a pneumatic cuff or elastic band to restrict arterial inflow into the muscle and block venous return out of the muscle during the exercise bout. The resultant ischemia in conjunction with low-load exercise has shown to be beneficial with increasing muscle size and strength. However, a limitation of using blood flow restriction (BFR) is the accompanying discomfort associated with this type of exercise. Factors that may influence discomfort are applied pressure, width of the cuff, cuff material, sex, and training to failure. The goal of this review was to evaluate the existing literature and elucidate how these factors can be manipulated to reduce discomfort during exercise as well as provide possible directions for future research. Thirty-eight different studies were located investigating BFR and discomfort. It was found that BFR training causes more discomfort than exercise without BFR. However, chronic use of BFR may increase tolerability, but discomfort may still be elevated over traditional non-blood flow restricted exercise. Discomfort can be attenuated by the application of lower applied pressures and stopping short of task failure. Finally, in the upper body, wider cuffs seem to increase ratings of discomfort compared with more narrow cuffs. In conclusion, applying the proper-sized cuff and making the applied pressure relative to both the individual and the cuff applied may attenuate discomfort. Reducing discomfort during exercise may help increase adherence to exercise and rehabilitation programs.

Acute and Chronic Responses of Aerobic Exercise With Blood Flow Restriction: A Systematic Review

This study systematically reviewed the available scientific evidence pertaining to the acute and chronic changes promoted by aerobic exercise (AE) combined with blood flow restriction (BFR) on neuromuscular, metabolic and hemodynamic variables. PubMed, Web of Science^TM and Scopus databases were searched for the period from January 2000 to June 2019 and the analysis involved a critical content review. A total of 313 articles were identified, of which 271 were excluded and 35 satisfied the inclusion criteria. Twelve studies evaluated the acute effects and eight studies evaluated the chronic metabolic effects of AE + BFR. For the neuromuscular variables, three studies analyzed the acute effects of AE + BFR and nine studies analyzed the chronic effects. Only 15 studies were identified that evaluated the hemodynamic acute effects of AE + BFR. The analysis provided evidence that AE combined with BFR promotes positive acute and chronic changes in neuromuscular and metabolic variables, a greater elevation in hemodynamic variables than exercise alone, and a higher energy demand during and after exercise. Since these alterations were all well-tolerated, this method can be considered to be safe and feasible for populations of athletes, healthy young, obese, and elderly individuals.

Aerobic exercise with blood flow restriction affects mood state in a similar fashion to high intensity interval exercise

We investigated the acute effects of aerobic exercise with blood flow restriction (BFR) on mood state in American football athletes. Twenty-two male American football athletes were randomly assigned to three experimental conditions: 1) aerobic exercise (AE: 40% VO_2max), 2) aerobic exercise with BRF (AE + BFR: 40% VO_{2 max}), and 3) high-intensity interval exercise (HIIE: 80% and 40% VO_2max during exercise and the active intervals, respectively). Mood state and total mood disturbance (TMD) were assessed before, immediately post, and 1 h post-exerciser. Ratings of perceived exertion (RPE) were measured 30 min post-exercise. AE + BFR and HIIE significantly (p < 0.05) increased fatigue and tension compared to baseline immediately post-exercise, whereas vigor significantly (p < 0.05) decreased at the same time point for both conditions. TMD increased significantly (p < 0.05) for AE + BFR and HIIE immediately post-exercise and it remained elevated up to 1 h post-exercise for AE + BFR. AE did not significantly (p > 0.05) affect mood state or TMD and it was significantly (p < 0.05) lower than AE + BFR and HIIE. AE + BFR and HIIE also elicited significantly (p < 0.05) greater RPE levels than AE 30 min post-exercise. Therefore, AE + BFR induces acute impairments in mood state and RPE levels in a similar fashion to HIIE.