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Franz A, Queitsch FP, Behringer M, Mayer C, Krauspe R, Zilkens C. Blood flow restriction training as a prehabilitation concept in total knee arthroplasty: A narrative review about current preoperative interventions and the potential impact of BFR. Med Hypotheses 2017; 110:53-59. [PMID: 29317069 DOI: 10.1016/j.mehy.2017.10.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 10/28/2017] [Indexed: 01/09/2023]
Abstract
Osteoarthritis of the knee is one of the most commonly diagnosed joint ailments and responsible for increased rates of total knee arthroplasty surgeries worldwide. Whereas the surgical approach is able to diminish the perceived knee pain of concerned patients', the postoperative recovery is often accompanied by persistent skeletal muscle dysfunctions and atrophy, which is responsible for functional deficits for up to several years. Recent findings indicate that surgery induced adverse effects on skeletal muscles are largely associated with the use of pneumatic tourniquets, wherefore several studies try to reduce tourniquet use in orthopedic surgery. However, due to comparable incidence of muscle impairment and increased surgical challenge, the most frequently applied surgical technique in TKA is still associated with the use of tourniquets. When attenuating TKA induced adverse effects, the preoperative preparation of patients by specific exercises (called prehabilitation) was able to enhance preoperative overall fitness through associated accelerated recovery. Based on patients' limited functional activity, prehabilitation techniques have to be particularly designed to allow regular adherence. The present paper is based on a narrative review of current literature, and provides a novel hypothesis by which blood flow restriction exercises (BFR) are able to improve patients' compliance to prehabilitation. BFR training is characterized by the application of low-resistance exercise with similar intensities as daily living tasks in association with a suppression of venous blood flow in an extremity, achieving significant morphological and neuromuscular adaptations in skeletal muscles. In addition, preoperative enhancements in muscle health with corresponding benefits in overall fitness, BFR induced molecular alterations could also be able to interfere with TKA induced pathological signaling. Therefore, based on the known major impact of BFR on skeletal muscle physiology, the present paper aims to illustrate the potential beneficial impact of BFR training as a prehabilitation concept to promote patients regular adherence to preoperative exercises and thus achieve an accelerated recovery and increases in patients' satisfaction.
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Affiliation(s)
- Alexander Franz
- Department of Orthopedics, University Hospital Duesseldorf, Duesseldorf, Germany.
| | | | - Michael Behringer
- Faculty of Sport Sciences, Goethe University Frankfurt, Frankfurt, Germany
| | - Constantin Mayer
- Department of Orthopedics, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Rüdiger Krauspe
- Department of Orthopedics, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Christoph Zilkens
- Department of Orthopedics, University Hospital Duesseldorf, Duesseldorf, Germany
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Shiba N, Matsuse H, Takano Y, Yoshimitsu K, Omoto M, Hashida R, Tagawa Y, Inada T, Yamada S, Ohshima H. Electrically Stimulated Antagonist Muscle Contraction Increased Muscle Mass and Bone Mineral Density of One Astronaut - Initial Verification on the International Space Station. PLoS One 2015; 10:e0134736. [PMID: 26296204 PMCID: PMC4546678 DOI: 10.1371/journal.pone.0134736] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 07/02/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Musculoskeletal atrophy is one of the major problems of extended periods of exposure to weightlessness such as on the International Space Station (ISS). We developed the Hybrid Training System (HTS) to maintain an astronaut's musculoskeletal system using an electrically stimulated antagonist to resist the volitional contraction of the agonist instead of gravity. The present study assessed the system's orbital operation capability and utility, as well as its preventative effect on an astronaut's musculoskeletal atrophy. METHODS HTS was attached to the non-dominant arm of an astronaut staying on the ISS, and his dominant arm without HTS was established as the control (CTR). 10 sets of 10 reciprocal elbow curls were one training session, and 12 total sessions of training (3 times per week for 4 weeks) were performed. Pre and post flight ground based evaluations were performed by Biodex (muscle performance), MRI (muscle volume), and DXA (BMD, lean [muscle] mass, fat mass). Pre and post training inflight evaluations were performed by a hand held dynamometer (muscle force) and a measuring tape (upper arm circumference). RESULTS The experiment was completed on schedule, and HTS functioned well without problems. Isokinetic elbow extension torque (Nm) changed -19.4% in HTS, and -21.7% in CTR. Isokinetic elbow flexion torque changed -23.7% in HTS, and there was no change in CTR. Total Work (Joule) of elbow extension changed -8.3% in HTS, and +0.3% in CTR. For elbow flexion it changed -23.3% in HTS and -32.6% in CTR. Average Power (Watts) of elbow extension changed +22.1% in HTS and -8.0% in CTR. For elbow flexion it changed -6.5% in HTS and -4.8% in CTR. Triceps muscle volume according to MRI changed +11.7% and that of biceps was +2.1% using HTS, however -0.1% and -0.4% respectively for CTR. BMD changed +4.6% in the HTS arm and -1.2% for CTR. Lean (muscle) mass of the arm changed only +10.6% in HTS. Fat mass changed -12.6% in HTS and -6.4% in CTR. CONCLUSIONS These results showed the orbital operation capability and utility, and the preventive effect of HTS for an astronaut's musculoskeletal atrophy. The initial flight data together with the ground data obtained so far will be utilized in the future planning of human space exploration.
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Affiliation(s)
- Naoto Shiba
- Department of Orthopedics, Kurume University School of Medicine, Kurume, Fukuoka, Japan
- Division of Rehabilitation, Kurume University School of Medicine, Kurume, Fukuoka, Japan
- * E-mail:
| | - Hiroo Matsuse
- Division of Rehabilitation, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Yoshio Takano
- Division of Physical Therapy, Fukuoka International University of Health and Welfare, Okawa city, Fukuoka 8318501, Japan
| | - Kazuhiro Yoshimitsu
- Department of Orthopedics, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Masayuki Omoto
- Department of Orthopedics, Kurume University School of Medicine, Kurume, Fukuoka, Japan
- Division of Rehabilitation, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Ryuki Hashida
- Department of Orthopedics, Kurume University School of Medicine, Kurume, Fukuoka, Japan
- Division of Rehabilitation, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Yoshihiko Tagawa
- Department of Mechanical and Control Engineering, Kyushu Institute of Technology, Kitakyushu, Fukuoka, Japan
| | - Tomohisa Inada
- Department of Mechanical and Control Engineering, Kyushu Institute of Technology, Kitakyushu, Fukuoka, Japan
| | - Shin Yamada
- Space Environment Utilization Center, Japan Aerospace Exploration Agency, Tsukuba, Ibaraki, Japan
| | - Hiroshi Ohshima
- Space Environment Utilization Center, Japan Aerospace Exploration Agency, Tsukuba, Ibaraki, Japan
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