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Cho C, Lee S. The Effects of Blood Flow Restriction Aerobic Exercise on Body Composition, Muscle Strength, Blood Biomarkers, and Cardiovascular Function: A Narrative Review. Int J Mol Sci 2024; 25:9274. [PMID: 39273223 PMCID: PMC11394695 DOI: 10.3390/ijms25179274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Revised: 08/24/2024] [Accepted: 08/25/2024] [Indexed: 09/15/2024] Open
Abstract
Blood flow restriction exercise has emerged as a promising alternative, particularly for elderly individuals and those unable to participate in high-intensity exercise. However, existing research has predominantly focused on blood flow restriction resistance exercise. There remains a notable gap in understanding the comprehensive effects of blood flow restriction aerobic exercise (BFRAE) on body composition, lipid profiles, glycemic metabolism, and cardiovascular function. This review aims to explore the physiological effects induced by chronic BFRAE. Chronic BFRAE has been shown to decrease fat mass, increase muscle mass, and enhance muscular strength, potentially benefiting lipid profiles, glycemic metabolism, and overall function. Thus, the BFRAE offers additional benefits beyond traditional aerobic exercise effects. Notably, the BFRAE approach may be particularly suitable for individuals with low fitness levels, those prone to injury, the elderly, obese individuals, and those with metabolic disorders.
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Affiliation(s)
- Chaeeun Cho
- Department of Human Movement Science, Graduate School, Incheon National University, Incheon 22012, Republic of Korea
| | - Sewon Lee
- Division of Sport Science, College of Arts & Physical Education, Incheon National University, Incheon 22012, Republic of Korea
- Sport Science Institute, College of Arts & Physical Education, Incheon National University, Incheon 22012, Republic of Korea
- Health Promotion Center, College of Arts & Physical Education, Incheon National University, Incheon 22012, Republic of Korea
- Research Center of Brain-Machine Interface, Incheon National University, Incheon 22012, Republic of Korea
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2
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Hughes L, Centner C. Idiosyncratic bone responses to blood flow restriction exercise: new insights and future directions. J Appl Physiol (1985) 2024; 136:283-297. [PMID: 37994414 PMCID: PMC11212818 DOI: 10.1152/japplphysiol.00723.2022] [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: 11/28/2022] [Revised: 11/14/2023] [Accepted: 11/21/2023] [Indexed: 11/24/2023] Open
Abstract
Applying blood flow restriction (BFR) during low-load exercise induces beneficial adaptations of the myotendinous and neuromuscular systems. Despite the low mechanical tension, BFR exercise facilitates a localized hypoxic environment and increase in metabolic stress, widely regarded as the primary stimulus for tissue adaptations. First evidence indicates that low-load BFR exercise is effective in promoting an osteogenic response in bone, although this has previously been postulated to adapt primarily during high-impact weight-bearing exercise. Besides studies investigating the acute response of bone biomarkers following BFR exercise, first long-term trials demonstrate beneficial adaptations in bone in both healthy and clinical populations. Despite the increasing number of studies, the physiological mechanisms are largely unknown. Moreover, heterogeneity in methodological approaches such as biomarkers of bone metabolism measured, participant and study characteristics, and time course of measurement renders it difficult to formulate accurate conclusions. Furthermore, incongruity in the methods of BFR application (e.g., cuff pressure) limits the comparability of datasets and thus hinders generalizability of study findings. Appropriate use of biomarkers, effective BFR application, and befitting study design have the potential to progress knowledge on the acute and chronic response of bone to BFR exercise and contribute toward the development of a novel strategy to protect or enhance bone health. Therefore, the purpose of the present synthesis review is to 1) evaluate current mechanistic evidence; 2) discuss and offer explanations for similar and contrasting data findings; and 3) create a methodological framework for future mechanistic and applied research.
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Affiliation(s)
- Luke Hughes
- Department of Sport Exercise & Rehabilitation, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Christoph Centner
- Department of Sport and Sport Science, University of Freiburg, Freiburg, Germany
- Praxisklinik Rennbahn, Muttenz, Switzerland
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3
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Ferreira DC, Vale LB, Santos FH, Macedo CSG. Quadriceps vascular occlusion does not alter muscle action or balance: A cross-sectional study. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2024; 80:1954. [PMID: 38322655 PMCID: PMC10839211 DOI: 10.4102/sajp.v80i1.1954] [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: 07/20/2023] [Accepted: 10/12/2023] [Indexed: 02/08/2024] Open
Abstract
Background Partial vascular occlusion (PVO) can increase muscle strength and hypertrophy without joint overload. However, PVO could increase the possibility of imbalances and injuries during physical activity. Objectives To identify changes in strength, muscle activation, and postural control during the use of PVO in young women. Method A total of 14 healthy women aged between 18 and 30 years were evaluated. Dynamometry was used to analyse the strength of the quadriceps muscle, and surface electromyography to evaluate quadriceps muscle activity. A force platform was utilised to assess postural control, static single-legged support, single-legged squat, and climbing and descending stairs. Participants were randomly assigned to the evaluations either with or without PVO. The results were compared and correlated. Results The performance of static, dynamic, or stair exercises, with or without PVO, did not indicate differences in muscle strength and recruitment (p > 0.05). The use of PVO improved the velocity of anteroposterior (AP) oscillation of static postural control (p = 0.001). We found a moderate negative correlation between muscle strength and postural control during the ascending stairs task with the use of PVO (r = -0.54; r = -0.59), while in the group without PVO, the correlation was moderate to high (r = -0.55; r = -0.76). Conclusion The use of PVO did not impair muscle strength and recruitment of the quadriceps or postural control in healthy women. Clinical Implications Partial vascular occlusion can be used during dynamic exercises without impairing the balance and muscle strength of the quadriceps during its execution.
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Affiliation(s)
- Daiene C Ferreira
- Department of Physiotherapy, State University of Londrina, Londrina, Brazil
| | - Letícia B Vale
- Department of Physiotherapy, State University of Londrina, Londrina, Brazil
| | - Felipe H Santos
- Department of Physiotherapy, State University of Londrina, Londrina, Brazil
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Hasegawa ME, Delos Reyes CD, Rimm JB, Radi JK, Singh DS, Obana KK, Weldon EJ, Thorne TJ, Tamate TM, Alferos SR, Min KS. Update on Current Concepts of Blood Flow Restriction in the Perioperative Period of Anterior Cruciate Ligament Reconstruction. Orthopedics 2023; 46:e333-e340. [PMID: 37561100 DOI: 10.3928/01477447-20230804-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
Anterior cruciate ligament tears or ruptures are common orthopedic injuries. Anterior cruciate ligament reconstruction (ACLR) is an orthopedic procedure allowing for earlier return to sports, improved maintenance of lifestyle demands, and restored knee stability and kinematics. A perioperative rehabilitative adjunct recently gaining interest is blood flow restriction (BFR), a method in which temporary restriction of blood flow to a chosen extremity is introduced and can be used as early as a few days postoperative. There has been increasing investigation and recent literature regarding BFR. This review synthesizes current concepts of BFR use in the ACLR perioperative period. [Orthopedics. 2023;46(6):e333-e340.].
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Wedig IJ, Durocher JJ, McDaniel J, Elmer SJ. Blood flow restriction as a potential therapy to restore physical function following COVID-19 infection. Front Physiol 2023; 14:1235172. [PMID: 37546539 PMCID: PMC10400776 DOI: 10.3389/fphys.2023.1235172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 07/10/2023] [Indexed: 08/08/2023] Open
Abstract
Accumulating evidence indicates that some COVID-19 survivors display reduced muscle mass, muscle strength, and aerobic capacity, which contribute to impairments in physical function that can persist for months after the acute phase of illness. Accordingly, strategies to restore muscle mass, muscle strength, and aerobic capacity following infection are critical to mitigate the long-term consequences of COVID-19. Blood flow restriction (BFR), which involves the application of mechanical compression to the limbs, presents a promising therapy that could be utilized throughout different phases of COVID-19 illness. Specifically, we hypothesize that: 1) use of passive BFR modalities can mitigate losses of muscle mass and muscle strength that occur during acute infection and 2) exercise with BFR can serve as an effective alternative to high-intensity exercise without BFR for regaining muscle mass, muscle strength, and aerobic capacity during convalescence. The various applications of BFR may also serve as a targeted therapy to address the underlying pathophysiology of COVID-19 and provide benefits to the musculoskeletal system as well as other organ systems affected by the disease. Consequently, we present a theoretical framework with which BFR could be implemented throughout the progression from acute illness to outpatient rehabilitation with the goal of improving short- and long-term outcomes in COVID-19 survivors. We envision that this paper will encourage discussion and consideration among researchers and clinicians of the potential therapeutic benefits of BFR to treat not only COVID-19 but similar pathologies and cases of acute critical illness.
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Affiliation(s)
- Isaac J. Wedig
- Department of Kinesiology and Integrative Physiology, Michigan Technological University, Houghton, MI, United States
- Health Research Institute, Michigan Technological University, Houghton, MI, United States
| | - John J. Durocher
- Department of Biological Sciences and Integrative Physiology and Health Sciences Center, Purdue University Northwest, Hammond, IN, United States
| | - John McDaniel
- Department of Exercise Physiology, Kent State University, Kent, OH, United States
| | - Steven J. Elmer
- Department of Kinesiology and Integrative Physiology, Michigan Technological University, Houghton, MI, United States
- Health Research Institute, Michigan Technological University, Houghton, MI, United States
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Hughes L, Hackney KJ, Patterson SD. Optimization of Exercise Countermeasures to Spaceflight Using Blood Flow Restriction. Aerosp Med Hum Perform 2022; 93:32-45. [PMID: 35063054 DOI: 10.3357/amhp.5855.2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION: During spaceflight missions, astronauts work in an extreme environment with several hazards to physical health and performance. Exposure to microgravity results in remarkable deconditioning of several physiological systems, leading to impaired physical condition and human performance, posing a major risk to overall mission success and crew safety. Physical exercise is the cornerstone of strategies to mitigate physical deconditioning during spaceflight. Decades of research have enabled development of more optimal exercise strategies and equipment onboard the International Space Station. However, the effects of microgravity cannot be completely ameliorated with current exercise countermeasures. Moreover, future spaceflight missions deeper into space require a new generation of spacecraft, which will place yet more constraints on the use of exercise by limiting the amount, size, and weight of exercise equipment and the time available for exercise. Space agencies are exploring ways to optimize exercise countermeasures for spaceflight, specifically exercise strategies that are more efficient, require less equipment, and are less time-consuming. Blood flow restriction exercise is a low intensity exercise strategy that requires minimal equipment and can elicit positive training benefits across multiple physiological systems. This method of exercise training has potential as a strategy to optimize exercise countermeasures during spaceflight and reconditioning in terrestrial and partial gravity environments. The possible applications of blood flow restriction exercise during spaceflight are discussed herein.Hughes L, Hackney KJ, Patterson SD. Optimization of exercise countermeasures to spaceflight using blood flow restriction. Aerosp Med Hum Perform. 2021; 93(1):32-45.
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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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Nitzsche N, Stäuber A, Tiede S, Schulz H. The effectiveness of blood-flow restricted resistance training in the musculoskeletal rehabilitation of patients with lower limb disorders: A systematic review and meta-analysis. Clin Rehabil 2021; 35:1221-1234. [PMID: 33749352 DOI: 10.1177/02692155211003480] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This meta-analysis aimed to evaluate the effectiveness of low-load Resistance Training (RT) with or without Blood Flow Restriction (BFR) compared with conventional RT on muscle strength in open and closed kinetic chains, muscle volume and pain in individuals with orthopaedic impairments. DATA SOURCES Searches were conducted in the PubMed, Web of Science, Scopus and Cochrane databases, including the reference lists of randomised controlled trials (RCT's) up to January 2021. Review method: An independent reviewer extracted study characteristics, orthopaedic indications, exercise data and outcome measures. The primary outcome was muscle strength of the lower limb. Secondary outcomes were muscle volume and pain. Study quality and reporting was assessed using the TESTEX scale. RESULTS A total of 10 RCTs with 386 subjects (39.2 ± 17.1 years) were included in the analysis to compare low-load RT with BFR and high or low-load RT without BFR. The meta-analysis showed no significant superior effects of low-load resistance training with BFR regarding leg muscle strength in open and closed kinetic chains, muscle volume or pain compared with high or low-load RT without BFR in subjects with lower limb impairments. CONCLUSION Low-load RT with BFR leads to changes in muscle strength, muscle volume and pain in musculoskeletal rehabilitation that are comparable to conventional RT. This appears to be independent of strength testing in open or closed kinetic chains.
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Affiliation(s)
- Nico Nitzsche
- Chemnitz University of Technology, Chemnitz, Germany
| | | | - Samuel Tiede
- Chemnitz University of Technology, Chemnitz, Germany
| | - Henry Schulz
- Chemnitz University of Technology, Chemnitz, Germany
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Hemodynamic and Hemostatic Response to Blood Flow Restriction Resistance Exercise in Coronary Artery Disease: A Pilot Randomized Controlled Trial. J Cardiovasc Nurs 2020; 36:507-516. [PMID: 32496365 DOI: 10.1097/jcn.0000000000000699] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Blood flow-restricted resistance training (BFR-RT) has been proven to be safe and efficacious in healthy older adults, but not in cardiovascular disease. OBJECTIVE The aim of this study was to investigate the acute and training induced effects of BFR-RT on hemostatic and hemodynamic responses in patients with coronary artery disease (CAD). METHODS Stable patients with CAD were randomized to 8 weeks of BFR-RT (30%-40% 1-repetition maximum unilateral knee extension) combined with aerobic training or aerobic training alone (control group). At baseline and after 4 and 8 weeks, blood samples were taken before and after BFR exercise, whereas hemodynamic parameters were monitored throughout the exercise. RESULTS Twenty-four patients (12 per group; mean age, 60 ± 2 years; mostly male [75%]) completed the study. The BFR-RT significantly improved systolic blood pressure (-10 mm Hg; P = .020) and tended to lower diastolic blood pressure (-2 mm Hg; P = .066). In contrast, no posttraining alterations were observed in N-terminal prohormone B-type natriuretic hormone, fibrinogen, and D-dimer values. During BFR exercise, all hemodynamic variables significantly increased after the first and second set, whereas blood pressure immediately lowered after the cuff was released in the third set. Last, significant interaction was only observed for repetitions × intensity (P < .001; partial η2 = 0.908) of diastolic blood pressure at higher exercise intensity (40% 1-repetition maximum). CONCLUSIONS The BFR-RT was proven to be safe, with favorable hemodynamic and hemostatic responses in patients with CAD, and can be recommended as an additional exercise modality in cardiac rehabilitation.Trial Registration:ClinicalTrial.gov Identifier: NCT03087292.
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10
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Mendonca GV, Mouro M, Vila-Chã C, Pezarat-Correia P. Nerve conduction during acute blood-flow restriction with and without low-intensity exercise Nerve conduction and blood-flow restriction. Sci Rep 2020; 10:7380. [PMID: 32355236 PMCID: PMC7193597 DOI: 10.1038/s41598-020-64379-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 02/07/2020] [Indexed: 11/09/2022] Open
Abstract
Despite being apparently safe for most individuals, the impact of low intensity (LI) blood-flow restricted (BFR) exercise on nerve function and integrity is still obscure. We explored whether BFR (with and without exercise) alters the properties of nerve conduction measured at the level of the restricted limb. Thirteen healthy, young men (22.0 ± 1.7 years) were included in this study. Arterial occlusion pressure was taken at rest. Soleus M- and H-recruitment curves were constructed for all participants. H-wave latencies and amplitudes were obtained in three testing conditions (non-BFR vs. 60 vs. 80% BFR) at four different time points: [#1] non-restricted baseline, [#2] time control either with or without BFR, [#3] non-restricted pre-exercise, [#4] LI exercise either with or without BFR. Nerve conduction was estimated using the difference between the latency of H and M wave. BFR did not affect H-wave amplitude, either with or without exercise. The changes in the difference between H- and M-wave latency of over time were similar between all conditions (condition-by-time interaction: F = 0.7, p = 0.47). In conclusion, our data indicate that performing LI exercise with BFR, set at 60 or 80% BFR, does not exert a negative impact on sciatic-tibial nerve function. Thus, from a neurological standpoint, we provide preliminary evidence that LI BFR exercise may be regarded as a safe mode of resistance training in healthy young men.
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Affiliation(s)
- Goncalo V Mendonca
- Neuromuscular Research Lab, Faculdade de Motricidade Humana, Universidade de Lisboa, Estrada da Costa, 1499-002, Cruz Quebrada, Dafundo, Portugal. .,CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Estrada da Costa, 1499-002, Cruz Quebrada, Dafundo, Portugal.
| | - Miguel Mouro
- Neuromuscular Research Lab, Faculdade de Motricidade Humana, Universidade de Lisboa, Estrada da Costa, 1499-002, Cruz Quebrada, Dafundo, Portugal
| | - Carolina Vila-Chã
- Polytechnic Institute of Guarda, Av. Dr. Francisco Sá Carneiro, n. 50, Guarda, 6300-559, Portugal.,Research Center in Sports Sciences, Health and Human Development (CIDESD), Vila-Real, Portugal
| | - Pedro Pezarat-Correia
- Neuromuscular Research Lab, Faculdade de Motricidade Humana, Universidade de Lisboa, Estrada da Costa, 1499-002, Cruz Quebrada, Dafundo, Portugal.,CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Estrada da Costa, 1499-002, Cruz Quebrada, Dafundo, Portugal
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Conceição MS, Ugrinowitsch C. Exercise with blood flow restriction: an effective alternative for the non-pharmaceutical treatment for muscle wasting. J Cachexia Sarcopenia Muscle 2019; 10:257-262. [PMID: 30816026 PMCID: PMC6463473 DOI: 10.1002/jcsm.12397] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Significant muscle wasting is generally experienced by ill and bed rest patients and older people. Muscle wasting leads to significant decrements in muscle strength, cardiorespiratory, and functional capacity, which increase mortality rates. As a consequence, different interventions have been tested to minimize muscle wasting. In this regard, blood flow restriction (BFR) has been used as a novel therapeutic approach to mitigate the burden associated with muscle waste conditions. Evidence has shown that BFR per se can counteract muscle wasting during immobilization or bed rest. Moreover, BFR has also been applied while performing low intensity resistance and endurance exercises and produced increases in muscle strength and mass. Endurance training with BFR has also been proved to increase cardiorespiratory fitness. Thus, frail patients can benefit from exercising with BFR due to the lower cardiovascular and join stress compared with traditional high intensity exercises. Therefore, low intensity resistance and endurance training combined with BFR may be considered as a novel and attractive intervention to counteract muscle wasting and to decrease the burden associated with this condition.
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Affiliation(s)
- Miguel S Conceição
- School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Carlos Ugrinowitsch
- School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
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12
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Blood Flow Restriction Resistance Exercise as a Rehabilitation Modality Following Orthopaedic Surgery: A Review of Venous Thromboembolism Risk. J Orthop Sports Phys Ther 2019; 49:17-27. [PMID: 30208794 DOI: 10.2519/jospt.2019.8375] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Synopsis Restoration of skeletal muscle mass and strength is critical to successful outcomes following orthopaedic surgery. Blood flow restriction (BFR) resistance exercise has emerged as a promising means of augmenting traditional low-intensity physical rehabilitation exercise and has yielded successful outcomes in a wide range of applications. Though BFR is well tolerated and safe for most individuals, patients who have undergone orthopaedic surgery may be an exception, due to their heightened risk for venous thromboembolism (VTE). While the pathogenesis of VTE is multifactorial and specific to the individual, it is commonly described as a combination of blood stasis, endothelial injury, and alterations in the constituents of the blood leading to hypercoagulability. The collective literature suggests that, given the pathogenic mechanisms of VTE, limited use of a wide, partially occluding cuff during resistance exercise should be low risk, and the likelihood that BFR would directly cause a VTE event is remote. Alternatively, it is plausible that BFR may enhance blood flow and promote fibrinolysis. Of greater concern is the individual with pre-existing asymptomatic VTE, which could be dislodged during BFR. However, it is unknown whether the direct risk associated with BFR is greater than the risk accompanying traditional exercise alone. Presently, there are no universally agreed-upon standards indicating which postsurgical orthopaedic patients may perform BFR safely. While excluding all these patients from BFR may be overly cautious, clinicians need to thoroughly screen for VTE signs and symptoms, be cognizant of each patient's risk factors, and use proper equipment and prescription methods prior to initiating BFR. J Orthop Sports Phys Ther 2019;49(1):17-27. Epub 12 Sep 2018. doi:10.2519/jospt.2019.8375.
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13
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Reported Side-effects and Safety Considerations for the Use of Blood Flow Restriction During Exercise in Practice and Research. Tech Orthop 2018. [DOI: 10.1097/bto.0000000000000259] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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de Araújo AC, Ferreira Junior A, de Oliveira SK, Schamne JC, Okuno NM. Physiological and rating of perceived exertion responses to resistance training sessions with and without vascular occlusion. ISOKINET EXERC SCI 2017. [DOI: 10.3233/ies-160650] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Amanda C. de Araújo
- Postgraduate Program in Biomedical Science, State University of Ponta Grossa, Ponta Grossa, PR, Brazil
| | - Adalberto Ferreira Junior
- Postgraduate Program in Biomedical Science, State University of Ponta Grossa, Ponta Grossa, PR, Brazil
| | | | - Julio C. Schamne
- Department of Physical Education, State University of Ponta Grossa, PR, Brazil
| | - Nilo M. Okuno
- Department of Physical Education, State University of Ponta Grossa, PR, Brazil
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15
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Amano S, Ludin AFM, Clift R, Nakazawa M, Law TD, Rush LJ, Manini TM, Thomas JS, Russ DW, Clark BC. Effectiveness of blood flow restricted exercise compared with standard exercise in patients with recurrent low back pain: study protocol for a randomized controlled trial. Trials 2016; 17:81. [PMID: 26867541 PMCID: PMC4751635 DOI: 10.1186/s13063-016-1214-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 02/05/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Low back pain is a highly prevalent condition in the United States and has a staggeringly negative impact on society in terms of expenses and disability. It has previously been suggested that rehabilitation strategies for persons with recurrent low back pain should be directed to the medial back muscles as these muscles provide functional support of the lumbar region. However, many individuals with low back pain cannot safely and effectively induce trunk muscle adaptation using traditional high-load resistance exercise, and no viable low-load protocols to induce trunk extensor muscle adaptation exist. Herein, we present the study protocol for a randomized controlled trial that will investigate the "cross-transfer" of effects of a novel exercise modality, blood flow restricted exercise, on cross-sectional area (primary outcome), strength and endurance (secondary outcomes) of trunk extensor muscles, as well as the pain, disability, and rate of recurrence of low back pain (tertiary outcomes). METHODS AND STUDY DESIGN This is a single-blinded, single-site, randomized controlled trial. A minimum of 32 (and up to 40) subjects aged 18 to 50 years with recurrent low back pain and poor trunk extensor muscle endurance will be recruited, enrolled and randomized. After completion of baseline assessments, participants will be randomized in a 1:1 ratio to receive a 10-week resistance exercise training program with blood flow restriction (BFR exercise group) or without blood flow restriction (control exercise group). Repeat assessments will be taken immediately post intervention and at 12 weeks after the completion of the exercise program. Furthermore, once every 4 weeks during a 36-week follow-up period, participants will be asked to rate their perceived disability and back pain over the past 14 days. DISCUSSION This study will examine the potential for blood flow restricted exercise applied to appendicular muscles to result in a "cross-transfer" of therapeutic effect to the lumbar musculature in individuals with low back pain. The results of this study will provide important insights into the effectiveness of this novel exercise modality, which could potentially provide the foundation for a cost-effective and easy-to-implement rehabilitation strategy to induce muscle adaptation in the absence of high mechanical and compressive loading on the spine. TRIAL REGISTRATION This trial is registered with ClinicalTrials.gov (registration number: NCT02308189, date of registration: 2 December 2014).
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Affiliation(s)
- Shinichi Amano
- Ohio Musculoskeletal and Neurological Institute (OMNI), Ohio University, 250 Irvine Hall, 1 Ohio University, Athens, OH, 43147, USA. .,Clinical and Translational Research Unit (CTRU), Ohio University, Athens, OH, 45701, USA.
| | - Arimi Fitri Mat Ludin
- Ohio Musculoskeletal and Neurological Institute (OMNI), Ohio University, 250 Irvine Hall, 1 Ohio University, Athens, OH, 43147, USA.,Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Rachel Clift
- Clinical and Translational Research Unit (CTRU), Ohio University, Athens, OH, 45701, USA.
| | - Masato Nakazawa
- Ohio Musculoskeletal and Neurological Institute (OMNI), Ohio University, 250 Irvine Hall, 1 Ohio University, Athens, OH, 43147, USA. .,Office of Research and Grants, Ohio University Heritage College of Osteopathic Medicine, Athens, OH, 45701, USA. .,Department of Biomedical Sciences, Ohio University, Athens, OH, 45701, USA.
| | - Timothy D Law
- Ohio Musculoskeletal and Neurological Institute (OMNI), Ohio University, 250 Irvine Hall, 1 Ohio University, Athens, OH, 43147, USA. .,Clinical and Translational Research Unit (CTRU), Ohio University, Athens, OH, 45701, USA. .,Department of Biomedical Sciences, Ohio University, Athens, OH, 45701, USA. .,Department of Family Medicine, Ohio University, Athens, OH, 45701, USA.
| | - Laura J Rush
- Clinical and Translational Research Unit (CTRU), Ohio University, Athens, OH, 45701, USA.
| | - Todd M Manini
- Department of Geriatric Medicine, University of Florida, 2004 Mowry Road, PO Box 100107, Gainesville, FL, 32611, USA.
| | - James S Thomas
- Ohio Musculoskeletal and Neurological Institute (OMNI), Ohio University, 250 Irvine Hall, 1 Ohio University, Athens, OH, 43147, USA. .,Department of Biomedical Sciences, Ohio University, Athens, OH, 45701, USA. .,Division of Physical Therapy, The School of Rehabilitation and Communication Sciences, Ohio University, Athens, OH, 45701, USA.
| | - David W Russ
- Ohio Musculoskeletal and Neurological Institute (OMNI), Ohio University, 250 Irvine Hall, 1 Ohio University, Athens, OH, 43147, USA. .,Division of Physical Therapy, The School of Rehabilitation and Communication Sciences, Ohio University, Athens, OH, 45701, USA.
| | - Brian C Clark
- Ohio Musculoskeletal and Neurological Institute (OMNI), Ohio University, 250 Irvine Hall, 1 Ohio University, Athens, OH, 43147, USA. .,Department of Biomedical Sciences, Ohio University, Athens, OH, 45701, USA. .,Department of Geriatric Medicine, Ohio University, Institute on Aging, Athens, OH, USA.
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Hackney KJ, Everett M, Scott JM, Ploutz-Snyder L. Blood flow-restricted exercise in space. EXTREME PHYSIOLOGY & MEDICINE 2012; 1:12. [PMID: 23849078 PMCID: PMC3710201 DOI: 10.1186/2046-7648-1-12] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Accepted: 09/05/2012] [Indexed: 12/21/2022]
Abstract
Prolonged exposure to microgravity results in chronic physiological adaptations including skeletal muscle atrophy, cardiovascular deconditioning, and bone demineralization. To attenuate the negative consequences of weightlessness during spaceflight missions, crewmembers perform moderate- to high-load resistance exercise in conjunction with aerobic (cycle and treadmill) exercise. Recent evidence from ground-based studies suggests that low-load blood flow-restricted (BFR) resistance exercise training can increase skeletal muscle size, strength, and endurance when performed in a variety of ambulatory populations. This training methodology couples a remarkably low exercise training load (approximately 20%-50% one repetition maximum (1RM)) with an inflated external cuff (width, ranging between approximately 30-90 mm; pressure, ranging between approximately 100-250 mmHg) that is placed around the exercising limb. BFR aerobic (walking and cycling) exercise training methods have also recently emerged in an attempt to enhance cardiovascular endurance and functional task performance while incorporating minimal exercise intensity. Although both forms of BFR exercise training have direct implications for individuals with sarcopenia and dynapenia, the application of BFR exercise training during exposure to microgravity to prevent deconditioning remains controversial. The aim of this review is to present an overview of BFR exercise training and discuss the potential usefulness of this method as an adjunct exercise countermeasure during prolonged spaceflight. The work will specifically emphasize ambulatory BFR exercise training adaptations, mechanisms, and safety and will provide directions for future research.
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Affiliation(s)
- Kyle J Hackney
- Wyle Science, Technology and Engineering Group, Houston, TX 77002, USA
| | | | - Jessica M Scott
- Universities Space Research Association, Houston, TX, 77002, USA
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17
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Blood flow restricted exercise and vascular function. Int J Vasc Med 2012; 2012:543218. [PMID: 23133756 PMCID: PMC3485988 DOI: 10.1155/2012/543218] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Revised: 08/03/2012] [Accepted: 08/06/2012] [Indexed: 11/18/2022] Open
Abstract
It is established that regular aerobic training improves vascular function, for example, endothelium-dependent vasodilatation and arterial stiffness or compliance and thereby constitutes a preventative measure against cardiovascular disease. In contrast, high-intensity resistance training impairs vascular function, while the influence of moderate-intensity resistance training on vascular function is still controversial. However, aerobic training is insufficient to inhibit loss in muscular strength with advancing age; thus, resistance training is recommended to prevent sarcopenia. Recently, several lines of study have provided compelling data showing that exercise and training with blood flow restriction (BFR) leads to muscle hypertrophy and strength increase. As such, BFR training might be a novel means of overcoming the contradiction between aerobic and high-intensity resistance training. Although it is not enough evidence to obtain consensus about impact of BFR training on vascular function, available evidences suggested that BFR training did not change coagulation factors and arterial compliance though with inconsistence results in endothelial function. This paper is a review of the literature on the impact of BFR exercise and training on vascular function, such as endothelial function, arterial compliance, or other potential factors in comparison with those of aerobic and resistance training.
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Madarame H, Kurano M, Fukumura K, Fukuda T, Nakajima T. Haemostatic and inflammatory responses to blood flow-restricted exercise in patients with ischaemic heart disease: a pilot study. Clin Physiol Funct Imaging 2012; 33:11-7. [DOI: 10.1111/j.1475-097x.2012.01158.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Accepted: 06/29/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Haruhiko Madarame
- Department of Ischemic Circulatory Physiology; Graduate School of Medicine; The University of Tokyo; Tokyo; Japan
| | - Miwa Kurano
- Department of Ischemic Circulatory Physiology; Graduate School of Medicine; The University of Tokyo; Tokyo; Japan
| | - Kazuya Fukumura
- Department of Ischemic Circulatory Physiology; Graduate School of Medicine; The University of Tokyo; Tokyo; Japan
| | - Taira Fukuda
- Department of Ischemic Circulatory Physiology; Graduate School of Medicine; The University of Tokyo; Tokyo; Japan
| | - Toshiaki Nakajima
- Department of Ischemic Circulatory Physiology; Graduate School of Medicine; The University of Tokyo; Tokyo; Japan
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Loenneke JP, Wilson JM, Wilson GJ, Pujol TJ, Bemben MG. Potential safety issues with blood flow restriction training. Scand J Med Sci Sports 2011; 21:510-8. [DOI: 10.1111/j.1600-0838.2010.01290.x] [Citation(s) in RCA: 132] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Madarame H, Kurano M, Takano H, Iida H, Sato Y, Ohshima H, Abe T, Ishii N, Morita T, Nakajima T. Effects of low-intensity resistance exercise with blood flow restriction on coagulation system in healthy subjects. Clin Physiol Funct Imaging 2010; 30:210-3. [DOI: 10.1111/j.1475-097x.2010.00927.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Clark BC, Manini TM, Hoffman RL, Williams PS, Guiler MK, Knutson MJ, McGlynn ML, Kushnick MR. Relative safety of 4 weeks of blood flow-restricted resistance exercise in young, healthy adults. Scand J Med Sci Sports 2010; 21:653-62. [PMID: 21917016 DOI: 10.1111/j.1600-0838.2010.01100.x] [Citation(s) in RCA: 135] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
This study evaluated the effect of 4 weeks of low-load resistance exercise with blood flow restriction (BFRE) on increasing strength in comparison with high-load resistance exercise (HLE), and assessed changes in blood, vascular and neural function. Healthy adults performed leg extension BFRE or HLE 3 days/week at 30% and 80% of strength, respectively. During BFRE, a cuff on the upper leg was inflated to 30% above systolic blood pressure. Strength, pulse-wave velocity (PWV), ankle-brachial index (ABI), prothrombin time (PT) and nerve conduction (NC) were measured before and after training. Markers of coagulation (fibrinogen and D-dimer), fibrinolysis [tissue plasminogen activator (tPA)] and inflammation [high sensitivity C-reactive protein (hsCRP)] were measured in response to the first and last exercise bouts. Strength increased 8% with BFRE and 13% with HLE (P<0.01). No changes in PWV, ABI, PT or NC were observed following training for either group (P>0.05). tPA antigen increased 30-40% immediately following acute bouts of BFRE and HLE (P=0.01). No changes were observed in fibrinogen, D-dimer or hsCRP (P>0.05). These findings indicate that both protocols increase the strength without altering nerve or vascular function, and that a single bout of both protocols increases fibrinolytic activity without altering selected markers of coagulation or inflammation in healthy individuals.
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Affiliation(s)
- B C Clark
- Department of Biomedical Sciences, Institute for Neuromusculoskeletal Research, Ohio University, Athens, Ohio 45701, USA.
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