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TANAKA TSUKASA, KUBOTA ATSUSHI, OZAKI HAYAO, NISHIO HIROFUMI, NOZU SHOJIRO, TAKAZAWA YUJI. Effect of Isokinetic Training with Blood Flow Restriction During Rest Interval Versus Exercise on Muscle Strength, Hypertrophy, and Perception: A Pilot Study. JUNTENDO IJI ZASSHI = JUNTENDO MEDICAL JOURNAL 2023; 69:477-484. [PMID: 38855068 PMCID: PMC11153072 DOI: 10.14789/jmj.jmj23-0014-oa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 09/07/2023] [Indexed: 06/11/2024]
Abstract
Objectives This study aimed to determine the effects of high-intensity isokinetic training with blood flow restriction during rest interval between set (rBFR) versus during exercise (eBFR) on muscle hypertrophy and increasing muscle strength and determine whether BFR-induced exercise pain is suppressed by rBFR. Materials and Methods Fourteen arms (7 participants) were recruited for the study. We conducted the following interventions for each arm: eBFR (n=4), rBFR (n=5), and exercise only (CON, n=5). The participants performed elbow flexion training with a BIODEX device twice weekly for 8 weeks. This study training consisted of total four sets; each was performed until <50% peak torque was achieved twice consecutively. BFR pressure was set at 120 mmHg. Elbow flexor peak torque during concentric contraction (CC), isometric contraction (IM), and muscle cross-sectional area (CSA) were measured before and after the intervention. Numerical rating scale scores used to assess pain during exercise were determined during training. Results Peak torque at the CC increased in the rBFR (p<0.05) and IM increased in the rBFR and CON (p<0.05), while CSA increased in the rBFR and CON (p<0.001). The pain during exercise was severe in the eBFR and moderate in the rBFR and CON. Conclusions This study's showed that high-intensity isokinetic training with rBFR did not have a synergistic effect on increasing muscle strength and muscle size. Additionally, high-intensity isokinetic training with BFR when it may be best not to perform it during exercise, because it was induces severe pain and may inhibit increases in muscle strength.
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Affiliation(s)
| | | | | | | | | | - YUJI TAKAZAWA
- Corresponding author: Yuji Takazawa, Department of Sports Medicine, Faculty of Medicine, Juntendo University, 2-3-15 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan, TEL: +81-3-3813-3111 E-mail:
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Wen Z, Zhu J, Wu X, Zheng B, Zhao L, Luo X, Wu Z. Effect of Low-Load Blood Flow Restriction Training on Patients With Functional Ankle Instability: A Randomized Controlled Trial. J Sport Rehabil 2023; 32:863-872. [PMID: 37558223 DOI: 10.1123/jsr.2022-0462] [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: 12/30/2022] [Revised: 06/12/2023] [Accepted: 06/13/2023] [Indexed: 08/11/2023]
Abstract
CONTEXT Decreased muscle strength and balance in patients with functional ankle instability (FAI) can be effectively improved by ankle strength training. Low-load blood flow restriction (LL-BFR) training increases muscle size and strength, but there is limited evidence from studies on muscle strength and balance in FAI patients. OBJECTIVE To study the effects of LL-BFR training versus high-load training (HLT) on muscle strength and balance in FAI patients. DESIGN Randomized controlled trial. PARTICIPANTS Forty-six young adults with a history of FAI. INTERVENTIONS Participants in the LL-BFR and HLT groups performed 4 sets (30 × 15 × 15 × 15) of ankle training at 20% to 40% of the one-repetition maximum and 70% to 85% one-repetition maximum, respectively, twice a week for 6 weeks. MAIN OUTCOME MEASURE(S) Plantar flexion, dorsiflexion, inversion, and eversion muscle strength, and the Y-balance test scores were assessed at baseline and after 3 and 6 weeks; the thickness of the tibialis anterior, triceps surae, and peroneus longus muscles were assessed at baseline and after 6 weeks. RESULTS Inversion, eversion, dorsiflexion, and plantar flexion muscle strength; tibialis anterior, triceps surae, and peroneus longus thickness; and Y-balance test scores were significantly increased in the LL-BFR group after 3 and 6 weeks compared with baseline (P < .05), with no significant difference between the LL-BFR and HLT groups after 6 weeks (P > .05). However, at the end of 3 weeks, eversion muscle strength and Y-balance test scores were significantly higher in the LL-BFR group than in the HLT group (P < .05). CONCLUSIONS Over 6 weeks, LL-BFR training was as effective as HLT in improving ankle muscle strength, muscle thickness, and balance in FAI patients, but LL-BFR training improved the ankle eversion muscle strength and dynamic balance more than HLT did in the early stages of the intervention. This finding will provide a new intervention strategy for the clinical rehabilitation of FAI patients.
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Affiliation(s)
- Ziliang Wen
- Southwest University School of Physical Education, Beibei, CQ,China
- Sport Rehabilitation Research Institute of Southwest University, Beibei, CQ,China
- High School Affiliated to Southwest University, Beibei, CQ,China
| | - Jiang Zhu
- Sport Rehabilitation Research Institute of Southwest University, Beibei, CQ,China
- Southwest University Hospital, Beibei, CQ,China
| | - Xuelian Wu
- Sport Rehabilitation Research Institute of Southwest University, Beibei, CQ,China
- Southwest University Hospital, Beibei, CQ,China
| | - Bing Zheng
- Sport Rehabilitation Research Institute of Southwest University, Beibei, CQ,China
- Southwest University Hospital, Beibei, CQ,China
| | - Li Zhao
- Sport Rehabilitation Research Institute of Southwest University, Beibei, CQ,China
- Southwest University Hospital, Beibei, CQ,China
| | - Xin Luo
- Southwest University School of Physical Education, Beibei, CQ,China
- Sport Rehabilitation Research Institute of Southwest University, Beibei, CQ,China
| | - Zonghui Wu
- Southwest University School of Physical Education, Beibei, CQ,China
- Sport Rehabilitation Research Institute of Southwest University, Beibei, CQ,China
- Southwest University Hospital, Beibei, CQ,China
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de Queiros VS, Rolnick N, dos Santos ÍK, de França IM, Lima RJ, Vieira JG, Aniceto RR, Neto GR, de Medeiros JA, Vianna JM, de Araújo Tinôco Cabral BG, Silva Dantas PM. Acute Effect of Resistance Training With Blood Flow Restriction on Perceptual Responses: A Systematic Review and Meta-Analysis. Sports Health 2023; 15:673-688. [PMID: 36415041 PMCID: PMC10467469 DOI: 10.1177/19417381221131533] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Several studies have compared perceptual responses between resistance exercise with blood flow restriction and traditional resistance exercise (non-BFR). However, the results were contradictory. OBJECTIVES To analyze the effect of RE+BFR versus non-BFR resistance exercise [low-load resistance exercise (LL-RE) or high-load resistance exercise (HL-RE)] on perceptual responses. DATA SOURCES CINAHL, Cochrane Library, PubMed®, Scopus, SPORTDiscus, and Web of Science were searched through August 28, 2021, and again on August 25, 2022. STUDY SELECTION Studies comparing the effect of RE+BFR versus non-BFR resistance exercise on rate of perceived exertion (RPE) and muscle pain/discomfort were considered. Meta-analyses were conducted using the random effects model. STUDY DESIGN Systematic review and meta-analysis. LEVEL OF EVIDENCE Level 2. DATA EXTRACTION All data were reviewed and extracted independently by 2 reviewers. Disagreements were resolved by a third reviewer. RESULTS Thirty studies were included in this review. In a fixed repetition scheme, the RPE [standardized mean difference (SMD) = 1.04; P < 0.01] and discomfort (SMD = 1.10; P < 0.01) were higher in RE+BFR than in non-BFR LL-RE, but similar in sets to voluntary failure. There were no significant differences in RPE in the comparisons between RE+BFR and non-BFR HL-RE; after sensitivity analyses, it was found that the RPE was higher in non-BFR HL-RE in a fixed repetition scheme. In sets to voluntary failure, discomfort was higher in RE+BFR versus non-BFR HL-RE (SMD = 0.95; P < 0. 01); however, in a fixed scheme, the results were similar. CONCLUSION In sets to voluntary failure, RPE is similar between RE+BFR and non-BFR exercise. In fixed repetition schemes, RE+BFR seems to promote higher RPE than non-BFR LL-RE and less than HL-RE. In sets to failure, discomfort appears to be similar between LL-RE with and without BFR; however, RE+BFR appears to promote greater discomfort than HL-RE. In fixed repetition schemes, the discomfort appears to be no different between RE+BFR and HL-RE, but is lower in non-BFR LL-RE.
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Affiliation(s)
- Victor Sabino de Queiros
- Graduate Program in Health Sciences, Federal University of Rio Grande do Norte (UFRN), Natal-RN, Brazil
| | - Nicholas Rolnick
- The Human Performance Mechanic, CUNY Lehman College, Bronx, New York, USA
| | - Ísis Kelly dos Santos
- Graduate Program in Health Sciences, Federal University of Rio Grande do Norte (UFRN), Natal-RN, Brazil; Graduate Program in Physical Education, State University of Rio Grande do Norte (UERN), Mossoró-RN, Brazil
| | - Ingrid Martins de França
- Graduate Program in Physiotherapy, Federal University of Rio Grande do Rio Grande Norte (UFRN), Natal-RN, Brazil
| | - Rony Jerônimo Lima
- Graduate Program in Physical Education, Federal University of Rio Grande do Norte (UFRN), Natal-RN, Brazil
| | - João Guilherme Vieira
- Graduate Program in Physical Education, Federal University of Juiz de Fora (UFJF), Juiz de Fora-MG, Brazil; Strength Training Research Laboratory, Federal University of Juiz de Fora (UFJF), Juiz de Fora-MG, Brazil
| | - Rodrigo Ramalho Aniceto
- Study and Research Group in Biomechanics and Psychophysiology of Exercise, Federal Institute of Education, Science and Technology of Rio Grande do Norte, Currais Novos-RN, Brazil
| | - Gabriel Rodrigues Neto
- Faculty Nova Esperança (FAMENE/FACENE), Coordination of Physical Education, Nursing and Medical Schools, João Pessoa, Brazil; Coordination of Physical Education, University Center for Higher Education and Development (CESED/UNIFACISA/FCM/ESAC), Campina Grande, Brazil
| | - Jason Azevedo de Medeiros
- Graduate Program in Health Sciences, Federal University of Rio Grande do Norte (UFRN), Natal-RN, Brazil
| | - Jeferson Macedo Vianna
- Graduate Program in Physical Education, Federal University of Juiz de Fora (UFJF), Juiz de Fora-MG, Brazil; Strength Training Research Laboratory, Federal University of Juiz de Fora (UFJF), Juiz de Fora-MG, Brazil
| | - Breno Guilherme de Araújo Tinôco Cabral
- Graduate Program in Health Sciences, Federal University of Rio Grande do Norte (UFRN), Natal-RN, Brazil; Graduate Program in Physical Education, Federal University of Rio Grande do Norte (UFRN), Natal-RN, Brazil)
| | - Paulo Moreira Silva Dantas
- Graduate Program in Health Sciences, Federal University of Rio Grande do Norte (UFRN), Natal-RN, Brazil; Graduate Program in Physical Education, Federal University of Rio Grande do Norte (UFRN), Natal-RN, Brazil)
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Chang H, Yan J, Lu G, Chen B, Zhang J. Muscle strength adaptation between high-load resistance training versus low-load blood flow restriction training with different cuff pressure characteristics: a systematic review and meta-analysis. Front Physiol 2023; 14:1244292. [PMID: 37693006 PMCID: PMC10485702 DOI: 10.3389/fphys.2023.1244292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 08/14/2023] [Indexed: 09/12/2023] Open
Abstract
Purpose: In this systematic review and meta-analysis, blood flow restriction (BFR) with low-load resistance training (BFR-RT) was compared with high-load resistance training (HL-RT) on muscle strength in healthy adults. The characteristics of cuff pressure suitable for muscle strength gain were also investigated by analyzing the effects of applying different occlusion pressure prescriptions and cuff inflation patterns on muscle strength gain. Methods: Literature search was conducted using PubMed, Ovid Medline, ProQuest, Cochrane Library, Embase, and Scopus databases to identify literature published until May 2023. Studies reporting the effects of BFR-RT interventions on muscle strength gain were compared with those of HL-RT. The risk of bias in the included trials was assessed using the Cochrane tool, followed by a meta-analysis to calculate the combined effect. Subgroup analysis was performed to explore the beneficial variables. Results: Nineteen articles (42 outcomes), with a total of 458 healthy adults, were included in the meta-analysis. The combined effect showed higher muscle strength gain with HL-RT than with BFR-RT (p = 0.03, SMD = -0.16, 95% CI: -0.30 to -0.01). The results of the subgroup analysis showed that the BFR-RT applied with incremental and individualized pressure achieved muscle strength gain similar to the HL-RT (p = 0.8, SMD = -0.05, 95% CI: -0.44 to 0.34; p = 0.68, SMD = -0.04, 95% CI: -0.23 to 0.15), but muscle strength gain obtained via BFR-RT applied with absolute pressure was lower than that of HL-RT (p < 0.05, SMD = -0.45, 95% CI: -0.71 to -0.19). Furthermore, muscle strength gain obtained by BFR-RT applied with intermittent pressure was similar to that obtained by HL-RT (p = 0.88, SMD = -0.02, 95% CI: -0.27 to 0.23), but muscle strength gain for BFR-RT applied with continuous pressure showed a less prominent increase than that for HL-RT (p < 0.05, SMD = -0.3, 95% CI: -0.48 to -0.11). Conclusion: In general, HL-RT produces superior muscle strength gains than BFR-RT. However, the application of individualized, incremental, and intermittent pressure exercise protocols in BFR-RT elicits comparable muscle strength gains to HL-RT. Our findings indicate that cuff pressure characteristics play a significant role in establishing a BFR-RT intervention program for enhancing muscle strength in healthy adults. Clinical Trial Registration: https://www.crd.york.ac.uk/PROSPERO/#recordDetails; Identifier: PROSPERO (CRD42022364934).
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Affiliation(s)
- Hualong Chang
- College of Physical Education and Health Sciences, Zhejiang Normal University, Jinhua, China
| | - Jing Yan
- College of Education, Anyang Normal University, Anyang, China
| | - Guiwei Lu
- College of Physical Education and Health Sciences, Zhejiang Normal University, Jinhua, China
| | - Biao Chen
- College of Physical Education and Health Sciences, Zhejiang Normal University, Jinhua, China
| | - Jianli Zhang
- Exercise and Metabolism Research Center, College of Physical Education and Health Sciences, Zhejiang Normal University, Jinhua, China
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Parkington T, Maden-Wilkinson T, Klonizakis M, Broom D. Comparative Perceptual, Affective, and Cardiovascular Responses between Resistance Exercise with and without Blood Flow Restriction in Older Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16000. [PMID: 36498075 PMCID: PMC9737453 DOI: 10.3390/ijerph192316000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/20/2022] [Accepted: 11/27/2022] [Indexed: 06/17/2023]
Abstract
Older adults and patients with chronic disease presenting with muscle weakness or musculoskeletal disorders may benefit from low-load resistance exercise (LLRE) with blood flow restriction (BFR). LLRE-BFR has been shown to increase muscle size, strength, and endurance comparable to traditional resistance exercise but without the use of heavy loads. However, potential negative effects from LLRE-BFR present as a barrier to participation and limit its wider use. This study examined the perceptual, affective, and cardiovascular responses to a bout of LLRE-BFR and compared the responses to LLRE and moderate-load resistance exercise (MLRE). Twenty older adults (64.3 ± 4.2 years) performed LLRE-BFR, LLRE and MLRE consisting of 4 sets of leg press and knee extension, in a randomised crossover design. LLRE-BFR was more demanding than LLRE and MLRE through increased pain (p ≤ 0.024, d = 0.8-1.4) and reduced affect (p ≤ 0.048, d = -0.5--0.9). Despite this, LLRE-BFR was enjoyed and promoted a positive affective response (p ≤ 0.035, d = 0.5-0.9) following exercise comparable to MLRE. This study supports the use of LLRE-BFR for older adults and encourages future research to examine the safety, acceptability, and efficacy of LLRE-BFR in patients with chronic disease.
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Affiliation(s)
- Thomas Parkington
- Physical Activity, Wellness and Public Health Research Group, Department of Sport and Physical Activity, Sheffield Hallam University, Sheffield S1 1WB, UK
- Lifestyle, Exercise and Nutrition Improvement Research Group, Department of Nursing and Midwifery, Sheffield Hallam University, Sheffield S1 1WB, UK
| | - Thomas Maden-Wilkinson
- Physical Activity, Wellness and Public Health Research Group, Department of Sport and Physical Activity, Sheffield Hallam University, Sheffield S1 1WB, UK
| | - Markos Klonizakis
- Lifestyle, Exercise and Nutrition Improvement Research Group, Department of Nursing and Midwifery, Sheffield Hallam University, Sheffield S1 1WB, UK
| | - David Broom
- Centre for Sport, Exercise and Life Sciences, Coventry University, Coventry CV1 5FB, UK
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Vinolo-Gil MJ, Rodríguez-Huguet M, Martin-Vega FJ, Garcia-Munoz C, Lagares-Franco C, Garcia-Campanario I. Effectiveness of Blood Flow Restriction in Neurological Disorders: A Systematic Review. Healthcare (Basel) 2022; 10:healthcare10122407. [PMID: 36553931 PMCID: PMC9778162 DOI: 10.3390/healthcare10122407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/02/2022] [Accepted: 11/23/2022] [Indexed: 12/03/2022] Open
Abstract
There is scientific evidence that Blood Flow Restriction (BFR) is beneficial in healthy people, the elderly and patients with musculoskeletal disorders. A systematic review was conducted to evaluate the effectiveness of BFR in patients with neurological disorders. The literature search was conducted up until July 2022 in the following databases: PubMed, Web of Science (WOS), Physiotherapy Evidence Database (PEDro), LILACS, Scopus, Cumulative Index of Nursing and Allied Literature Complete (CINAHL), the Cochrane Library and Scientific Electronic Library Online (SciELO). The PEDro scale was used to analyze the methodological quality of the studies, and the Cochrane Collaboration's tool was employed to evaluate the risk of bias. A total of seven articles were included. BFR seems to be beneficial in neurological disorders. Improvements have been found in sensorimotor function, frequency and step length symmetry, perceived exertion, heart rate and gait speed, walking endurance, fatigue, quality of life, muscles thickness, gluteus density and muscle edema. No improvements were found in lower limb strength or balance. However, results must be taken with caution due to the small number of articles and to the large heterogeneity. More clinical trials are needed. These studies should homogenize the protocols used in larger samples, as well as improve their methodological quality.
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Affiliation(s)
- Maria Jesus Vinolo-Gil
- Department of Nursing and Physiotherapy, University of Cadiz, 11009 Cadiz, Spain
- Institute for Biomedical Research and Innovation of Cádiz, 11009 Cadiz, Spain
- Rehabilitation Clinical Management Unit, Interlevels-Intercenters Hospital Puerta del Mar, Hospital Puerto Real, Cadiz Bay-La Janda Health District, 11006 Cadiz, Spain
- Correspondence:
| | | | | | | | - Carolina Lagares-Franco
- Department of Statistics and Operations Research, University of Cadiz, 11510 Cadiz, Spain
- PAIDI UCA Group: CTS553, INiBICA Group CO15 Population and Health, Determinants and Interventions, Faculty of Medicine, University of Cadiz, 11003 Cadiz, Spain
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Watson R, Sullivan B, Stone A, Jacobs C, Malone T, Heebner N, Noehren B. Blood Flow Restriction Therapy: An Evidence-Based Approach to Postoperative Rehabilitation. JBJS Rev 2022; 10:01874474-202210000-00001. [PMID: 36191086 DOI: 10.2106/jbjs.rvw.22.00062] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
➢ Blood flow restriction therapy (BFRT) involves the application of a pneumatic tourniquet cuff to the proximal portion of the arm or leg. This restricts arterial blood flow while occluding venous return, which creates a hypoxic environment that induces many physiologic adaptations. ➢ BFRT is especially useful in postoperative rehabilitation because it produces muscular hypertrophy and strength gains without the need for heavy-load exercises that are contraindicated after surgery. ➢ Low-load resistance training with BFRT may be preferable to low-load or high-load training alone because it leads to comparable increases in strength and hypertrophy, without inducing muscular edema or increasing pain.
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Affiliation(s)
- Richard Watson
- University of Kentucky, Department of Physical Therapy, Lexington, Kentucky
| | - Breanna Sullivan
- University of Kentucky, Department of Orthopaedic Surgery and Sports Medicine, Lexington, Kentucky
| | - Austin Stone
- University of Kentucky, Department of Orthopaedic Surgery and Sports Medicine, Lexington, Kentucky
| | - Cale Jacobs
- University of Kentucky, Department of Orthopaedic Surgery and Sports Medicine, Lexington, Kentucky
| | - Terry Malone
- University of Kentucky, Department of Physical Therapy, Lexington, Kentucky
| | - Nicholas Heebner
- University of Kentucky, Sports Medicine Research Institute, Lexington, Kentucky
| | - Brian Noehren
- University of Kentucky, Department of Physical Therapy, Lexington, Kentucky
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Santiago-Pescador S, Fajardo-Blanco D, López-Ortiz S, Peñín-Grandes S, Méndez-Sánchez R, Lucia A, Martín-Hernández J, Santos-Lozano A. Acute effects of electrostimulation and blood flow restriction on muscle thickness and fatigue in the lower body. Eur J Sport Sci 2022:1-9. [PMID: 35965445 DOI: 10.1080/17461391.2022.2113145] [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: 11/03/2022]
Abstract
AbstractNeuromuscular electrical stimulation (NMES) in combination with blood flow restriction (BFR) enhances muscle hypertrophy and force-generating capacity. The present study aimed to investigate the acute effects of BFR and NMES, both in isolation and in combination, on muscle thickness (MT) and fatigue in the lower body of 20 young healthy subjects. Different stimuli were applied for 25 min, defined by the combination of BFR with high- and low-frequency NMES, and also isolated BFR or NMES. Changes in MT were then evaluated by ultrasound of the rectus femoris (RF) and vastus lateralis (VL) muscles at the end of the session (POST) and 15 min later (POST 15'). Lower limb fatigue was evaluated indirectly by strength performance. Results showed that RF MT was higher under the combined protocol (BFR+NMES) or isolated BFR than under NMES - regardless of the frequency - both at POST (p ≤ 0.018) and POST 15' (p ≤ 0.016). No significant changes in MT were observed under isolated NMES or BFR at POST 15' when compared with basal values (p ≥ 0.067). No significant differences were observed for VL MT between conditions (p = 0.322) or for fatigue between conditions (p ≥ 0.258). Our results indicate that a combination of BFR and NMES acutely increases MT in sedentary subjects. Also, although not significantly, BFR conditions had a greater tendency to induce fatigue than isolated NMES.
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Affiliation(s)
| | - Daniel Fajardo-Blanco
- i+HeALTH, Department of Health Sciences, Miguel de Cervantes European University, Valladolid, Spain
| | - Susana López-Ortiz
- i+HeALTH, Department of Health Sciences, Miguel de Cervantes European University, Valladolid, Spain
| | - Saúl Peñín-Grandes
- i+HeALTH, Department of Health Sciences, Miguel de Cervantes European University, Valladolid, Spain
| | - Roberto Méndez-Sánchez
- Department of Physiotherapy, University of Salamanca, Campus Miguel de Unamuno, Salamanca, Spain
| | - Alejandro Lucia
- Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain.,Research Institute of the Hospital 12 de Octubre ("imas12", PaHerg group), Madrid, Spain
| | - Juan Martín-Hernández
- i+HeALTH, Department of Health Sciences, Miguel de Cervantes European University, Valladolid, Spain
| | - Alejandro Santos-Lozano
- i+HeALTH, Department of Health Sciences, Miguel de Cervantes European University, Valladolid, Spain.,Research Institute of the Hospital 12 de Octubre ("imas12", PaHerg group), Madrid, Spain
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Wang HN, Chen Y, Cheng L, Wang ST, Hu DX, Wang LN, Ni GX. Effect of low-load resistance training with different degrees of blood flow restriction in patients with knee osteoarthritis: study protocol for a randomized trial. Trials 2022; 23:6. [PMID: 34980197 PMCID: PMC8722122 DOI: 10.1186/s13063-021-05946-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 12/17/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Knee osteoarthritis (KOA) is a common degenerative disease that causes pain, functional impairment, and reduced quality of life. Resistance training is considered as an effective approach to reduce the risk of muscle weakness in patients with KOA. Blood flow restriction (BFR) with low-load resistance training has better clinical outcomes than low-load resistance training alone. However, the degree of BFR which works more effectively with low-load resistance training has not been determined. The purpose of this study is to evaluate the effectiveness of different degrees of BFR with low-load resistance training in patients with KOA on pain, self-reported function, physical function performance, muscle strength, muscle thickness, and quality of life. METHODS This is a study protocol for a randomized, controlled trial with blinded participants. One hundred individuals will be indiscriminately assigned into the following groups: two training groups with a BFR at 40% and 80% limb occlusion pressure (LOP), a training group without BFR, and a health education group. The three intervention groups will perform strength training for the quadriceps muscles twice a week for 12 weeks, while the health education group will attend sessions once a week for 12 weeks. The primary outcome is pain. The secondary outcomes include self-reported function, physical function performance, muscle strength of the knee extensors, muscle mass of the quadriceps, quality of life, and adverse events. Intention-to-treat analysis will be conducted for individuals who withdraw during the trial. DISCUSSION Previous studies have shown that BFR with low-load resistance training is more effective than low-load resistance training alone; however, a high degree of BFR may cause discomfort during training. If a 40% LOP for BFR could produce similar clinical outcomes as an 80% LOP for BFR, resistance training with a low degree of BFR can be chosen for patients with KOA who are unbearable for a high degree of BFR. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR2000037859 ( http://www.chictr.org.cn/edit.aspx?pid=59956&htm=4 ). Registered on 2 September 2020.
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Affiliation(s)
- Hao-Nan Wang
- grid.411614.70000 0001 2223 5394School of Sport Medicine and Rehabilitation, Beijing Sport University, No. 48 Xinxi Road, Haidian District, Beijing, 100084 China
| | - Yan Chen
- grid.411614.70000 0001 2223 5394School of Sport Medicine and Rehabilitation, Beijing Sport University, No. 48 Xinxi Road, Haidian District, Beijing, 100084 China
| | - Lin Cheng
- grid.411614.70000 0001 2223 5394School of Sport Medicine and Rehabilitation, Beijing Sport University, No. 48 Xinxi Road, Haidian District, Beijing, 100084 China
| | - Shen-Tao Wang
- grid.411614.70000 0001 2223 5394School of Sport Medicine and Rehabilitation, Beijing Sport University, No. 48 Xinxi Road, Haidian District, Beijing, 100084 China
| | - De-Xin Hu
- grid.411614.70000 0001 2223 5394School of Sport Medicine and Rehabilitation, Beijing Sport University, No. 48 Xinxi Road, Haidian District, Beijing, 100084 China
| | - Li-Na Wang
- grid.411614.70000 0001 2223 5394School of Sport Medicine and Rehabilitation, Beijing Sport University, No. 48 Xinxi Road, Haidian District, Beijing, 100084 China
| | - Guo-Xin Ni
- grid.411614.70000 0001 2223 5394School of Sport Medicine and Rehabilitation, Beijing Sport University, No. 48 Xinxi Road, Haidian District, Beijing, 100084 China
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Wang HN, Chen Y, Cheng L, Cai YH, Li W, Ni GX. Efficacy and Safety of Blood Flow Restriction Training in Patients With Knee Osteoarthritis: A Systematic Review and Meta-Analysis. Arthritis Care Res (Hoboken) 2022; 74:89-98. [PMID: 34549541 DOI: 10.1002/acr.24787] [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] [Received: 04/06/2021] [Revised: 08/17/2021] [Accepted: 09/14/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To evaluate the efficacy and safety of blood flow restriction training (BFRT) in the treatment of patients with knee osteoarthritis (OA). METHOD Seven electronic databases were searched to identify trials comparing BFRT and conventional resistance training in a population with knee OA. Studies were selected according to the inclusion and exclusion criteria. Standardized mean differences (SMDs) or risk ratios (RRs) with 95% confidence intervals (95% CIs) were calculated to compare outcome measures of the groups. The methodologic quality of selected studies and the quality of evidence were evaluated for included studies. RESULTS A total of 5 studies were included in this meta-analysis, with very low to moderate risk of bias. The pooled results showed no significant difference between BFRT and conventional resistance training for knee OA, including pain (SMD -0.04 [95% CI -0.31, 0.24], P = 0.79), physical function performance (SMD 0.12 [95% CI -0.55, 0.78], P = 0.73), self-reported function (SMD 0.14 [95% CI -0.24, 0.52], P = 0.48), and adverse events (RR 0.45 [95% CI 0.20, 1.01], P = 0.05). In subgroup analysis, BFRT had a lower incidence of adverse events when compared with high-load resistance training (HLRT). CONCLUSION Data from pooled studies showed that BFRT may not have greater efficacy for treating patients with knee OA, and it is less likely to have a higher risk of adverse events. However, limited evidence supports the idea that BFRT is likely safer than HLRT. More evidence with high quality is needed in further research on efficacy and safety.
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Affiliation(s)
| | - Yan Chen
- Beijing Sport University, Beijing, China
| | - Lin Cheng
- Beijing Sport University, Beijing, China
| | - Yi-Hui Cai
- Beijing Sport University, Beijing, China
| | - Wei Li
- Beijing Sport University, Beijing, China
| | - Guo-Xin Ni
- Beijing Sport University, Beijing, China
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11
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GARCIA NÁDIAF, MORAES CAMILADE, REBELO MACÁRIOA, PETERS SAVANAHMARIAG, CASTRO FÁBIOMDE, PUGGINA ENRICOF. Strength training with and without arteriovenous blood flow restriction improves performance, regardless of changes in muscle hypertrophy, in Wistar rats. AN ACAD BRAS CIENC 2022; 94:e20201147. [DOI: 10.1590/0001-3765202220201147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 02/13/2021] [Indexed: 11/22/2022] Open
Affiliation(s)
| | | | | | | | | | - ENRICO F. PUGGINA
- University of São Paulo (USP), Brazil; University of São Paulo (USP), Brazil
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12
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Effects of Blood Flow Restriction Combined With Resistance Training or Neuromuscular Electrostimulation on Muscle Cross-Sectional Area. J Sport Rehabil 2021; 31:319-324. [PMID: 34929663 DOI: 10.1123/jsr.2021-0101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 08/16/2021] [Accepted: 10/10/2021] [Indexed: 11/18/2022]
Abstract
CONTEXT Low-load resistance training (LL) and neuromuscular electrostimulation (NES), both combined with blood flow restriction (BFR), emerge as effective strategies to maintain or increase muscle mass. It is well established that LL-BFR promotes similar increases in muscle cross-sectional area (CSA) and lower rating of perceived exertion (RPE) and pain compared with traditional resistance training protocols. On the other hand, only 2 studies with conflicting results have investigated the effects of NES-BFR on CSA, RPE, and pain. In addition, no study directly compared LL-BFR and NES-BFR. OBJECTIVE The aim of the study was to compare the effects of LL-BFR and NES-BFR on vastus lateralis CSA, RPE, and pain. Individual response for muscle hypertrophy was also compared between protocols. DESIGN Intrasubject longitudinal study. SETTING University research laboratory. INTERVENTION Fifteen healthy young males (age = 23 [5] y; weight = 77.6 [11.3] kg; height = 1.76 [0.08] m). MAIN OUTCOME MEASURES Vastus lateralis CSA was measured through ultrasound at baseline (pre) and after 20 training sessions (post). The RPE and pain responses were obtained through modified 10-point scales, handled during all training sessions. RESULTS Both protocols demonstrated significant increases in muscle CSA (P < .0001). However, the LL-BFR demonstrated significantly greater CSA changes compared with NES-BFR (LL-BFR = 11.2%, NES-BFR = 4.6%; P < .0001). Comparing individual increases in CSA, 12 subjects (85.7% of the sample) presented greater muscle hypertrophy for LL-BFR than for the NES-BFR protocol. In addition, LL-BFR produced significantly lower RPE and pain responses (P < .0001). CONCLUSIONS The LL-BFR produced significantly greater increases in CSA with significant less RPE and pain than NES-BFR. In addition, LL-BFR resulted in greater individual muscle hypertrophy responses for most subjects compared with NES-BFR.
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13
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de Queiros VS, de França IM, Trybulski R, Vieira JG, Dos Santos IK, Neto GR, Wilk M, de Matos DG, Vieira WHDB, Novaes JDS, Makar P, Cabral BGDAT, Dantas PMS. Myoelectric Activity and Fatigue in Low-Load Resistance Exercise With Different Pressure of Blood Flow Restriction: A Systematic Review and Meta-Analysis. Front Physiol 2021; 12:786752. [PMID: 34880783 PMCID: PMC8646757 DOI: 10.3389/fphys.2021.786752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 10/26/2021] [Indexed: 12/17/2022] Open
Abstract
Background: Low-load resistance exercise (LL-RE) with blood flow restriction (BFR) promotes increased metabolic response and fatigue, as well as more pronounced myoelectric activity than traditional LL-RE. Some studies have shown that the relative pressure applied during exercise may have an effect on these variables, but existing evidence is contradictory. Purpose: The aim of this study was to systematically review and pool the available evidence on the differences in neuromuscular and metabolic responses at LL-RE with different pressure of BFR. Methods: The systematic review and meta-analysis was reported according to PRISMA items. Searches were performed in the following databases: CINAHL, PubMed, Scopus, SPORTDiscus and Web of Science, until June 15, 2021. Randomized or non-randomized experimental studies that analyzed LL-RE, associated with at least two relative BFR pressures [arterial occlusion pressure (AOP)%], on myoelectric activity, fatigue, or metabolic responses were included. Random-effects meta-analyses were performed for MVC torque (fatigue measure) and myoelectric activity. The quality of evidence was assessed using the PEDro scale. Results: Ten studies were included, all of moderate to high methodological quality. For MVC torque, there were no differences in the comparisons between exercise with 40–50% vs. 80–90% AOP. When analyzing the meta-analysis data, the results indicated differences in comparisons in exercise with 15–20% 1 repetition maximum (1RM), with higher restriction pressure evoking greater MVC torque decline (4 interventions, 73 participants; MD = −5.05 Nm [95%CI = −8.09; −2.01], p = 0.001, I2 = 0%). For myoelectric activity, meta-analyses indicated a difference between exercise with 40% vs. 60% AOP (3 interventions, 38 participants; SMD = 0.47 [95%CI = 0.02; 0.93], p = 0.04, I2 = 0%), with higher pressure of restriction causing greater myoelectric activity. This result was not identified in the comparisons between 40% vs. 80% AOP. In analysis of studies that adopted pre-defined repetition schemes, differences were found (4 interventions, 52 participants; SMD = 0.58 [95%CI = 0.11; 1.05], p = 0.02, I2 = 27%). Conclusion: The BFR pressure applied during the LL-RE may affect the magnitude of muscle fatigue and excitability when loads between 15 and 20% of 1RM and predefined repetition protocols (not failure) are prescribed, respectively. Systematic Review Registration: [http://www.crd.york.ac.uk/prospero], identifier [CRD42021229345].
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Affiliation(s)
- Victor Sabino de Queiros
- Graduate Program in Health Sciences, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil
| | - Ingrid Martins de França
- Graduate Program in Physiotherapy, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil
| | - Robert Trybulski
- Department of Medical Sciences, The Wojciech Korfanty School of Economics, Katowice, Poland.,Provita Zory Medical Center, Zory, Poland
| | - João Guilherme Vieira
- Graduate Program in Physical Education, Federal University of Juiz de Fora (UFJF), Juiz de Fora, Brazil
| | - Isis Kelly Dos Santos
- Graduate Program in Health Sciences, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil
| | - Gabriel Rodrigues Neto
- Graduate Program in Family Health, Faculties of Nursing and Medicine Nova Esperança (FACENE/FAMENE), João Pessoa, Brazil.,Coordination of Physical Education, University Center for Higher Education and Development (CESED/UNIFACISA/FCM/ESAC), Campina Grande, Brazil
| | - Michal Wilk
- Institute of Sport Sciences, Jerzy Kukuczka Academy of Physical Education in Katowice, Katowice, Poland
| | - Dihogo Gama de Matos
- Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, MB, Canada
| | | | - Jefferson da Silva Novaes
- Graduate Program at the School of Physical Education and Sport at the Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Piotr Makar
- Faculty of Physical Education, Gdańsk University of Physical Education and Sport, Gdańsk, Poland
| | - Breno Guilherme de Araújo Tinoco Cabral
- Graduate Program in Health Sciences, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil.,Graduate Program in Physical Education, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil
| | - Paulo Moreira Silva Dantas
- Graduate Program in Health Sciences, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil.,Graduate Program in Physical Education, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil
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14
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Sinclair P, Kadhum M, Paton B. Tolerance to Intermittent vs. Continuous Blood Flow Restriction Training: A meta-Analysis. Int J Sports Med 2021; 43:3-10. [PMID: 34535020 DOI: 10.1055/a-1537-9886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The proven beneficial effects of low-load blood flow restriction training on strength gain has led to further exploration into its application during rehabilitation, where the traditional use of heavy loads may not be feasible. With current evidence showing that low-load blood flow restriction training may be less well tolerated than heavy-load resistance training, this review was conducted to decipher whether intermittently deflating the pressure cuff during rest intervals of a training session improves tolerance to exercise, without compromising strength. Four databases were searched for randomized controlled trials that compared the effect of intermittent versus continuous blood flow restriction training on outcomes of exercise tolerance or strength in adults. Nine studies were identified, with six included in the meta-analysis. No significant difference in rate of perceived exertion was found (SMD-0.06, 95% CI-0.41 to 0.29, p=0.73, I 2=80%). Subgroup analysis excluding studies that introduced bias showed a shift towards favoring the use of intermittent blood flow restriction training (SMD-0.42, 95% CI-0.87 to 0.03, p=0.07, I 2=0%). There was no significant difference in strength gain. Intermittent cuff deflations during training intervals does not improve tolerance to exercise during blood flow restriction training.
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Affiliation(s)
- Pierre Sinclair
- Department of Institute of Sports and Exercise Health (ISEH), University College London, London, United Kingdom of Great Britain and Northern Ireland
| | - Murtaza Kadhum
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, United Kingdom of Great Britain and Northern Ireland
| | - Bruce Paton
- Department of Institute of Sports and Exercise Health (ISEH), University College London, London, United Kingdom of Great Britain and Northern Ireland
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15
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Rolnick N, Kimbrell K, Cerqueira MS, Weatherford B, Brandner C. Perceived Barriers to Blood Flow Restriction Training. FRONTIERS IN REHABILITATION SCIENCES 2021; 2:697082. [PMID: 36188864 PMCID: PMC9397924 DOI: 10.3389/fresc.2021.697082] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 06/11/2021] [Indexed: 12/13/2022]
Abstract
Blood flow restriction (BFR) training is increasing in popularity in the fitness and rehabilitation settings due to its role in optimizing muscle mass and strength as well as cardiovascular capacity, function, and a host of other benefits. However, despite the interest in this area of research, there are likely some perceived barriers that practitioners must overcome to effectively implement this modality into practice. These barriers include determining BFR training pressures, access to appropriate BFR training technologies for relevant demographics based on the current evidence, a comprehensive and systematic approach to medical screening for safe practice and strategies to mitigate excessive perceptual demands of BFR training to foster long-term compliance. This manuscript attempts to discuss each of these barriers and provides evidence-based strategies and direction to guide clinical practice and future research.
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Affiliation(s)
- Nicholas Rolnick
- The Human Performance Mechanic, Lehman College, New York, NY, United States
- *Correspondence: Nicholas Rolnick
| | - Kyle Kimbrell
- Owens Recovery Science, San Antonio, TX, United States
| | - Mikhail Santos Cerqueira
- Neuromuscular Performance Analysis Laboratory, Department of Physical Therapy, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil
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16
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Rolnick N, Cerqueira MS. Comparison of blood flow restriction devices and their effect on quadriceps muscle activation: Letter to the editor. Phys Ther Sport 2021; 49:227-228. [PMID: 33794445 DOI: 10.1016/j.ptsp.2021.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 03/17/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Nicholas Rolnick
- The Human Performance Mechanic, Lehman College, New York, NY, USA.
| | - Mikhail Santos Cerqueira
- Neuromuscular Performance Analysis Laboratory, Department of Physical Therapy, Federal University of Rio Grande do Norte (UFRN), Natal, RN, Brazil
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17
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Ferlito JV, Pecce SAP, Oselame L, De Marchi T. The blood flow restriction training effect in knee osteoarthritis people: a systematic review and meta-analysis. Clin Rehabil 2020; 34:1378-1390. [DOI: 10.1177/0269215520943650] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: To synthesize evidence on the effects of blood flow restriction (BFR) comparing with high (HLT) and low load (LLT), and on the influence of different forms of application in individuals with knee osteoarthritis. Data sources: The CENTRAL, PEDro, PubMed and BVS, which include Lilacs, Medline and SciELO, until April 2020. Review methods: A systematic review and meta-analysis of randomized trials used the PRISMA guidelines, whose main keywords were: Therapeutic Occlusion, Resistance Training, and Knee Osteoarthritie, blood flow restriction and Kaatsu training. Method quality was evaluated with the PEDro scale. When studies demonstrated homogeneity on outcome measures, the mean differences or standardized mean differences with 95% confidence interval were calculated and pooled in a meta-analysis for pooled synthesis. Results: Five articles were eligible in this review with moderate to low risk bias. Our results, showed no difference between BFR and HLT in knee strength (SMD = 0.00, 95% CI, –0.54 to 0.54, P = 1.00), function (SMD = −0.20, 95% CI, –0.45 to 0.06, P = 0.13), pain and volume. But, when compared BFR and LLT, the descriptive analysis demonstrated significant results in favor BFR to muscle strength (71.4% of measurement) and volume (MD = 1.66, 95% CI, 0.93 to 2.38, P < 0.00001), but not in pain or function. Conclusion: BFR can be used as a strategy in the rehabilitation of osteoarthritis due to gains in strength and volume with low mechanical stress. However, its application must be safe and individualized, since they can attenuate the stimuli offered by BFR.
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Affiliation(s)
- João Vitor Ferlito
- Department of Physiotherapy of University Center Cenecista of Bento Gonçalves, Bento Gonçalves, Rio Grande do Sul, Brazil
| | - Samantha Angelica Pasa Pecce
- Department of Physiotherapy of University Center Cenecista of Bento Gonçalves, Bento Gonçalves, Rio Grande do Sul, Brazil
| | - Lucas Oselame
- Department of Physiotherapy of University Center Cenecista of Bento Gonçalves, Bento Gonçalves, Rio Grande do Sul, Brazil
| | - Thiago De Marchi
- Department of Physiotherapy of University Center Cenecista of Bento Gonçalves, Bento Gonçalves, Rio Grande do Sul, Brazil
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18
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Clarkson MJ, May AK, Warmington SA. Is there rationale for the cuff pressures prescribed for blood flow restriction exercise? A systematic review. Scand J Med Sci Sports 2020; 30:1318-1336. [PMID: 32279391 DOI: 10.1111/sms.13676] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 03/12/2020] [Accepted: 03/27/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Blood flow restriction exercise has increasingly broad applications among healthy and clinical populations. Ensuring the technique is applied in a safe, controlled, and beneficial way for target populations is essential. Individualized cuff pressures are a favored method for achieving this. However, there remains marked inconsistency in how individualized cuff pressures are applied. OBJECTIVES To quantify the cuff pressures used in the broader blood flow restriction exercise literature, and determine whether there is clear justification for the choice of pressure prescribed. METHODS Studies were included in this review from database searches if they employed an experimental design using original data, involved either acute or chronic exercise using blood flow restriction, and they assessed limb or arterial occlusion pressure to determine an individualized cuff pressure. Methodologies of the studies were evaluated using a bespoke quality assessment tool. RESULTS Fifty-one studies met the inclusion criteria. Individualized cuff pressures ranged from 30% to 100% arterial occlusion pressure. Only 7 out of 52 studies attempted to justify the individualized cuff pressure applied during exercise. The mean quality rating for all studies was 11.1 ± 1.2 out of 13. CONCLUSIONS The broader blood flow restriction exercise literature uses markedly heterogeneous prescription variables despite using individualized cuff pressures. This is problematic in the absence of any clear justification for the individualized cuff pressures selected. Systematically measuring and reporting all relevant acute responses and training adaptations to the full spectrum of BFR pressures alongside increased clarity around the methodology used during blood flow restriction exercise is paramount.
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Affiliation(s)
- Matthew J Clarkson
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Vic., Australia
| | - Anthony K May
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Vic., Australia
| | - Stuart A Warmington
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Vic., Australia
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19
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Cuyul-Vásquez I, Leiva-Sepúlveda A, Catalán-Medalla O, Berríos-Contreras L. [Blood flow restriction training for people with cardiovascular disease: An exploratory review]. Rehabilitacion (Madr) 2020; 54:116-127. [PMID: 32370826 DOI: 10.1016/j.rh.2020.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 11/10/2019] [Accepted: 01/11/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To analyse the evidence on the effects of blood flow restriction training in people with cardiovascular disease. MATERIALS AND METHODS We searched MEDLINE, EMBASE, SPORTDiscus, CINAHL, LILACS, SCOPUS and Wiley databases. Experimental and non-experimental studies investigating the effects of blood flow restriction in participants with cardiovascular disease were included. RESULTS Six clinical trials and three non-experimental studies met the inclusion criteria. The experimental studies were conducted in participants with hypertension and ischaemic heart disease. Non-experimental studies described hemodynamic adaptations and potential adverse effects of therapy. The risk of bias of the included clinical trials was moderate to high. Exercise-induced hemodynamic stress increased significantly during training with blood flow restriction compared with traditional training. The small number of available studies have focused mostly on acute effects, but chronic effects are unknown. CONCLUSION There is currently no evidence to recommend the use of blood flow restriction in people with cardiovascular disease.
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Affiliation(s)
- I Cuyul-Vásquez
- Departamento de Procesos Terapéuticos, Facultad de Ciencias de la Salud, Universidad Católica de Temuco, Temuco, Chile.
| | - A Leiva-Sepúlveda
- Departamento de Procesos Terapéuticos, Facultad de Ciencias de la Salud, Universidad Católica de Temuco, Temuco, Chile
| | - O Catalán-Medalla
- Departamento de Procesos Terapéuticos, Facultad de Ciencias de la Salud, Universidad Católica de Temuco, Temuco, Chile
| | - L Berríos-Contreras
- Departamento de Kinesiología, Facultad de Ciencias de la Salud, Universidad Católica del Maule, Talca, Chile
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20
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Lu Y, Patel BH, Kym C, Nwachukwu BU, Beletksy A, Forsythe B, Chahla J. Perioperative Blood Flow Restriction Rehabilitation in Patients Undergoing ACL Reconstruction: A Systematic Review. Orthop J Sports Med 2020; 8:2325967120906822. [PMID: 32232065 PMCID: PMC7097877 DOI: 10.1177/2325967120906822] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 11/25/2019] [Indexed: 12/24/2022] Open
Abstract
Background: Low-load blood flow restriction (BFR) training has attracted attention as a potentially effective method of perioperative clinical rehabilitation for patients undergoing orthopaedic procedures. Purpose: To (1) compare the effectiveness of low-load BFR training in conjunction with a standard rehabilitation protocol, pre- and postoperatively, and non-BFR interventions in patients undergoing anterior cruciate ligament reconstruction (ACLR) and (2) evaluate protocols for implementing BFR perioperatively for patients undergoing ACLR. Study Design: Systematic review; Level of evidence, 2. Methods: A systematic review of the 3 medical literature databases was conducted to identify all level 1 and 2 clinical trials published since 1990 on BFR in patients undergoing ACLR. Patient demographics from included studies were pooled. Outcome data were documented, including muscle strength and size, and perceived pain and exertion. A descriptive analysis of outcomes from BFR and non-BFR interventions was performed. Results: A total of 6 studies (154 patients; 66.2% male; mean ± SD age, 24.2 ± 3.68 years) were included. Of these, 2 studies examined low-load BFR as a preoperative intervention, 1 of which observed a significant increase in muscle isometric endurance (P = .014), surface electromyography of the vastus medialis (P < .001), and muscle blood flow to the vastus lateralis at final follow-up (P < .001) as compared with patients undergoing sham BFR. Four studies investigated low-load BFR as a postoperative intervention, and they observed significant benefits in muscle hypertrophy, as measured by cross-sectional area; strength, as measured by extensor torque; and subjective outcomes, as measured by subjective knee pain during session, over traditional low-load resistance training (all P < .05). BFR occlusion periods ranged from 3 to 5 minutes, with rest periods ranging from 45 seconds to 3 minutes. Conclusion: This systematic review found evidence on the topic of BFR rehabilitation after ACLR to be sparse and heterogeneous likely because of the relatively recent onset of its popularity. While a few authors have demonstrated the potential strength and hypertrophy benefits of perioperative BFR, future investigations with standardized outcomes, long-term follow-up, and more robust sample sizes are required to draw more definitive conclusions.
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Affiliation(s)
- Yining Lu
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Bhavik H Patel
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Craig Kym
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Benedict U Nwachukwu
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Alexander Beletksy
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Brian Forsythe
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Jorge Chahla
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
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21
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Cuyul-Vásquez I, Leiva-Sepúlveda A, Catalán-Medalla O, Araya-Quintanilla F, Gutiérrez-Espinoza H. The addition of blood flow restriction to resistance exercise in individuals with knee pain: a systematic review and meta-analysis. Braz J Phys Ther 2020; 24:465-478. [PMID: 32198025 DOI: 10.1016/j.bjpt.2020.03.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 02/04/2020] [Accepted: 03/03/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Blood flow restriction (BFR) is an effective clinical intervention used to increase strength in healthy individuals. However, its effects on pain and function in individuals with knee pain are unknown. OBJECTIVE To determine the effectiveness of adding BFR to resistance exercise for pain relief and improvement of function in patients with knee pain. METHODS Systematic review with meta-analysis of randomized clinical trials. Medline, Central, Embase, PEDro, Lilacs, CINAHL, SPORTDiscus, and Web of Science databases were searched from inception to May 2019. Randomized clinical trials that compared resistance exercise with or without BFR to treat knee pain and function in individuals older than 18 years of age with knee pain were included. RESULTS Eight randomized clinical trials met the eligibility criteria and for the quantitative synthesis, five studies were included. The pooled standardized mean difference (SMD) estimate showed that resistance exercises with BFR was not more effective than resistance exercises for reducing pain (SMD: -0.37cm, 95% CI=-0.93, 0.19) and improving knee function (SMD=-0.23 points, 95% CI=-0.71, 0.26) in patients with knee pain. CONCLUSION In the short term, there is low quality of evidence that resistance exercise with BFR does not provide significant differences in pain relief and knee function compared to resistance exercises in patients with knee pain. PROSPERO registration number: CRD42018102839.
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Affiliation(s)
- Iván Cuyul-Vásquez
- Faculty of Health, Therapeutic Process Department, Temuco Catholic University, Temuco, Chile
| | | | - Oscar Catalán-Medalla
- Faculty of Health, Therapeutic Process Department, Temuco Catholic University, Temuco, Chile
| | - Felipe Araya-Quintanilla
- Rehabilitation and Health Research Center (CIRES), Universidad de las Américas, Santiago, Chile; Faculty of Health Sciences, Universidad SEK, Santiago, Chile
| | - Hector Gutiérrez-Espinoza
- Rehabilitation and Health Research Center (CIRES), Universidad de las Américas, Santiago, Chile; Physical Therapy Department, Clinical Hospital San Borja Arriaran, Santiago, Chile.
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22
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Spitz RW, Wong V, Bell ZW, Viana RB, Chatakondi RN, Abe T, Loenneke JP. Blood Flow Restricted Exercise and Discomfort: A Review. J Strength Cond Res 2020; 36:871-879. [PMID: 32058360 DOI: 10.1519/jsc.0000000000003525] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
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.
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Affiliation(s)
- Robert W Spitz
- Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, Mississippi
| | - Vickie Wong
- Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, Mississippi
| | - Zachary W Bell
- Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, Mississippi
| | - Ricardo B Viana
- Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, Mississippi.,Faculty of Physical Education and Dance, Federal University of Goiás, Goiânia, Brazil
| | - Raksha N Chatakondi
- Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, Mississippi
| | - Takashi Abe
- Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, Mississippi
| | - Jeremy P Loenneke
- Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, University, Mississippi
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23
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Freitas EDS, Miller RM, Heishman AD, Aniceto RR, Silva JGC, Bemben MG. Perceptual responses to continuous versus intermittent blood flow restriction exercise: A randomized controlled trial. Physiol Behav 2019; 212:112717. [PMID: 31629764 DOI: 10.1016/j.physbeh.2019.112717] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 10/16/2019] [Accepted: 10/16/2019] [Indexed: 11/29/2022]
Abstract
We investigated the perceptual responses to resistance exercise (RE) with continuous and intermittent blood flow restriction (BFR). Fourteen males randomly completed the following exercise conditions: low-load RE with continuous BFR (cBFR), low-load RE with intermittent BFR (iBFR), low-load RE without BFR (LI), and traditional high-load RE (HI). Participants completed 4 sets of 30-15-15-15 repetitions of bilateral leg press and knee extension exercises during the low-load conditions, at 20% of one-repetition maximum (1-RM), a 1.5‑sec metronome-controlled pace, with a 1-min rest interval between sets; HI consisted of 4 sets of 10 repetitions of the same exercises, at 70% 1-RM, with the same pace and rest interval. Ratings of perceived exertion (RPE) and discomfort were assessed using psychometric scales before exercise and after each set. RPE displayed no significant differences (p > 0.05) between the BFR conditions for either exercise. Additionally, both BFR conditions elicited significantly (p < 0.05) greater RPE than LI and significantly (p <0.05) lower RPE than HI during both exercises. Rating of discomfort displayed no significant differences between BFR conditions during the first two sets of leg press; however, cBFR evoked greater discomfort compared to iBFR during the last two sets. There were no significant (p > 0.05) differences observed between conditions during the knee extension exercise. Rating of discomfort was similar between the BFR and HI conditions and each were significantly greater than LI during both exercises. Therefore, cBFR and iBFR seem to produce similar perceptual responses, which are greater than LI and lower than HI, but similar in regards to discomfort.
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Affiliation(s)
- Eduardo D S Freitas
- Department of Health and Exercise Science, Neuromuscular Research Laboratory, University of Oklahoma, Norman, OK, USA.
| | - Ryan M Miller
- Department of Health and Exercise Science, Neuromuscular Research Laboratory, University of Oklahoma, Norman, OK, USA
| | - Aaron D Heishman
- Department of Health and Exercise Science, Neuromuscular Research Laboratory, University of Oklahoma, Norman, OK, USA
| | - Rodrigo R Aniceto
- Department of Physical Education, Kinanthropometry and Human Performance Laboratory, Federal University of Paraíba, João Pessoa, PB, Brazil
| | - Julio G C Silva
- Study and Research Group in Biomechanics and Psychophysiology of Exercise, Federal Institute of Education, Science and Technology of Rio Grande do Norte, Currais Novos, RN, Brazil
| | - Michael G Bemben
- Department of Health and Exercise Science, Neuromuscular Research Laboratory, University of Oklahoma, Norman, OK, USA
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24
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Anderson AB, Owens JG, Patterson SD, Dickens JF, LeClere LE. Blood Flow Restriction Therapy: From Development to Applications. Sports Med Arthrosc Rev 2019; 27:119-123. [PMID: 31361722 DOI: 10.1097/jsa.0000000000000240] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Blood flow restriction (BFR) has been shown to produce beneficial adaptations to skeletal muscle. These adaptations have been documented in the civilian and military populations. BFR therapy may provide patients a safe method to begin strength training at earlier stages of rehabilitation to allow for earlier and more effective return to activity and improved military readiness. The purpose was to review BFR therapy physiology, complications, side effects, standardized treatment algorithms, and long-term patient outcomes.
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Affiliation(s)
- Ashley B Anderson
- Walter Reed National Military Medical Center.,Uniformed Services University of the Health Sciences, Bethesda
| | | | | | - Jonathan F Dickens
- Walter Reed National Military Medical Center.,Uniformed Services University of the Health Sciences, Bethesda.,John A. Feagin Jr. Sports Medicine Fellowship, West Point, NY
| | - Lance E LeClere
- Uniformed Services University of the Health Sciences, Bethesda.,United States Naval Academy, Annapolis, MD
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25
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Hughes L, Patterson SD, Haddad F, Rosenblatt B, Gissane C, McCarthy D, Clarke T, Ferris G, Dawes J, Paton B. Examination of the comfort and pain experienced with blood flow restriction training during post-surgery rehabilitation of anterior cruciate ligament reconstruction patients: A UK National Health Service trial. Phys Ther Sport 2019; 39:90-98. [PMID: 31288213 DOI: 10.1016/j.ptsp.2019.06.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 06/28/2019] [Accepted: 06/28/2019] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Examine the comfort and pain experienced with blow flow restriction resistance training (BFR-RT) compared to standard care heavy load resistance training (HL-RT) during anterior cruciate ligament reconstruction (ACLR) patient rehabilitation. DESIGN Randomised controlled trial. SETTING United Kingdom National Health Service. PARTICIPANTS Twenty eight patients undergoing unilateral ACLR surgery with hamstring autograft were recruited. Following surgery participants were block randomised to either HL-RT at 70% repetition maximum (1RM) (n = 14) or BFR-RT (n = 14) at 30% 1RM and completed 8 weeks of twice weekly unilateral leg press training on both limbs. MAIN OUTCOME MEASURES Perceived knee pain, muscle pain and rating of perceived exertion (RPE) were assessed using Borg's (1998) RPE and pain scales during training. Knee pain was also assessed 24 h post-training. RESULTS There were no adverse events. Knee pain was lower with BFR-RT during (p < 0.05) and at 24 h post-training (p < 0.05) with BFR-RT for all sessions. Muscle pain was higher (p < 0.05) with BFR-RT compared to HL-RT during all sessions. RPE remained unchanged (p > 0.05) for both BFR-RT and HL-RT. CONCLUSION ACLR patients experienced less knee joint pain and reported similar ratings of perceived exertion during and following leg press exercise with BFR-RT compared to traditional HL-RT. BFR-RT may be more advantageous during the early phases of post-surgery ACLR rehabilitation.
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Affiliation(s)
- Luke Hughes
- School of Sport, Health and Applied Science, St Mary's University, London, TW1 4SX, UK; Institute of Sport, Exercise and Health, 170 Tottenham Court Road, London, UK.
| | | | - Fares Haddad
- Institute of Sport, Exercise and Health, 170 Tottenham Court Road, London, UK
| | | | - Conor Gissane
- School of Sport, Health and Applied Science, St Mary's University, London, TW1 4SX, UK
| | | | | | | | - Joanna Dawes
- University College London, Bloomsbury, London, UK
| | - Bruce Paton
- Institute of Sport, Exercise and Health, 170 Tottenham Court Road, London, UK.
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26
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Cook SB, Cleary CJ. Progression of Blood Flow Restricted Resistance Training in Older Adults at Risk of Mobility Limitations. Front Physiol 2019; 10:738. [PMID: 31249534 PMCID: PMC6582311 DOI: 10.3389/fphys.2019.00738] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 05/28/2019] [Indexed: 01/02/2023] Open
Abstract
Blood flow restriction (BFR) resistance training leads to increased muscle mass and strength but the progression leading to adaptations may be different as strength gains are often to a lesser magnitude than high-load (HL) training. The impact of training loads and repetitions on older adults’ muscle mass and strength following BFR or HL training was evaluated. Twenty-one older adults (67–90 years) classified as being at risk of mobility limitations were randomly assigned to HL (n = 11) or BFR (n = 10) knee extension (KE) and flexion (KF) training twice per week for 12 weeks. Strength was measured with 10-repetition maximum (10-RM) tests and isometric contractions. Cross-sectional area (CSA) of the quadriceps and hamstrings was measured. HL and BFR interventions increased 10-RM KF and isometric strength (P < 0.05) and hamstrings CSA increased an average of 4.8 ± 5.9% after HL and BFR training (time main effect P < 0.01). There were no differences between the training groups (time x group interactions P > 0.05). The rate of progression of KF training load and repetitions was comparable (time × group interactions of each variable P > 0.05). The groups averaged an increase of 0.50 ± 25 kg⋅week-1 and 1.8 ± 0.1.7 repetitions⋅week-1 of training (time main effects P < 0.05). The HL training group experienced greater improvements in KE 10-RM strength than the BFR group (60.7 ± 36.0% vs. 35.3 ± 25.5%; P = 0.03). In both groups, isometric KE strength increased 17.3 ± 18.5% (P = 0.001) and there were no differences between groups (P = 0.24). Quadriceps CSA increased (time main effect P < 0.01) and to similar magnitudes (time x group interaction P = 0.62) following HL (6.5 ± 3.1%) and BFR training (7.8 ± 8.2%). The HL group experienced accelerated progression of load when compared to BFR (0.90 ± 0.60 kg⋅week-1 vs. 30 ± 0.21 kg⋅week-1; P = 0.006) but was not different when expressed in relative terms. BFR training progressed at a rate of 3.6 ± 1.3 repetitions⋅week-1 while the HL group progressed at 2.2 ± 0.43 repetitions⋅week-1 (P = 0.003). HL training led to greater increases in KE 10-RM and it may be attributed to the greater load and/or faster rate of progression of the load throughout the 12-week training period and the specificity of the testing modality. Incorporating systematic load progression throughout BFR training periods should be employed to lead to maximal strength gains.
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Affiliation(s)
- Summer B Cook
- Department of Kinesiology, University of New Hampshire, Durham, NH, United States
| | - Christopher J Cleary
- Department of Kinesiology, University of New Hampshire, Durham, NH, United States
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