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Viscay-Sanhueza N, Curilem Gatica C, Bahamondes-Avila C. Exercise with blood flow restriction among adults undergoing total knee arthroplasty: A scoping review. J Bodyw Mov Ther 2025; 42:665-673. [PMID: 40325738 DOI: 10.1016/j.jbmt.2025.01.020] [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: 09/13/2023] [Revised: 11/11/2024] [Accepted: 01/12/2025] [Indexed: 05/07/2025]
Abstract
BACKGROUND Quadriceps strength is relevant for recovering functional capacity in total knee arthroplasty (TKA). This requires strength exercises with high loads, which is difficult to perform after TKA. Rehabilitation with blood flow restriction (BFR) produces gains in strength and muscle mass, avoiding the use of heavy loads. OBJECTIVE To identify exercise prescription parameters and the effect of BFR training on muscle mass, muscle strength, and functional capacity of patients with TKA. METHODS Following the PRISMA-ScR methodology, a systematic search was carried out in the following databases: Pubmed, Virtual Health Library, Scopus, and Web of Science. The execution of exercises with BFR during TKA prehabilitation and rehabilitation stages were considered. Two authors independently assessed articles for eligibility, and a third author resolved conflicts. RESULTS 5 articles were selected. During the prehabilitation stage, increases in strength, muscle mass, and functionality occurred. Muscle strength increased in the rehabilitation stage. Studies with a control group did not detect significant differences. Various protocols were applied regarding the prescription, dosage, and implementation of the exercise programs. CONCLUSION Strength, muscle size, and physical function increase in people with TKA during the prehabilitation and rehabilitation stages. The analysis carried out indicates a wide methodological variety, lack of standardization, and gaps in BFR protocol application.
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Affiliation(s)
| | | | - Carlos Bahamondes-Avila
- Escuela de Kinesiología, Facultad de Medicina y Ciencias de la Salud. Universidad Mayor, Temuco, Chile.
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Werasirirat P, Namsawang J, Singhasoot N, Luangpon N, Snieckus A, Muanjai P. Effect of blood flow restriction training with core stabilization exercise on muscle activity and muscle thickness in subjects with nonspecific chronic low back pain. J Back Musculoskelet Rehabil 2025:10538127251343856. [PMID: 40388928 DOI: 10.1177/10538127251343856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/21/2025]
Abstract
BackgroundBlood flow restriction (BFR) is considered an alternative method for increasing muscle activity and thickness to reduce Nonspecific Chronic Low back pain (NSCLBP).ObjectivesThis study aimed to evaluate the effects of BFR with core stabilization exercise (CSE) on muscle activity, muscle thickness, and disability in individuals with NSCLBP.MethodsA total of 38 individuals with NSCLBP aged 18-45 years were included in this study. The participants were randomly divided into the BFR + CSE and CSE groups (n = 19 each). All participants underwent supervised rehabilitation sessions three times per week over a period of four consecutive weeks. Muscle activity, muscle thickness, and disability were assessed before and after the four-week intervention.ResultsThe BFR + CSE group showed significant within-group improvement in muscle activity of the transversus abdominis (TrA), multifidus (MF), and gluteus maximus (Gmax), muscle thickness at rest and during contraction, and disability (p < 0.05). The CSE group showed a significant increase in electromyography activity of the MF muscle (p < 0.05), a significant increase in muscle thickness at rest for the TrA, MF, and Gmax muscles (p < 0.05), and only a significant increase in muscle thickness during contraction for the TrA muscle (p < 0.05). Additionally, the BFR + CSE group exhibited superior benefits compared to the CSE group across all variables.ConclusionBFR combined with CSE over four weeks is more effective in improving TrA, MF, and Gmax muscle strength, muscle thickness, and disability.
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Affiliation(s)
- Phurichaya Werasirirat
- Department of Physical Therapy, Faculty of Allied Health Sciences, Burapha University, Chonburi, Thailand
| | - Juntip Namsawang
- Department of Physical Therapy, Faculty of Allied Health Sciences, Burapha University, Chonburi, Thailand
| | - Nutsupa Singhasoot
- Department of Physical Therapy, Faculty of Allied Health Sciences, Burapha University, Chonburi, Thailand
| | - Nongnuch Luangpon
- Department of Physical Therapy, Faculty of Allied Health Sciences, Burapha University, Chonburi, Thailand
| | - Audrius Snieckus
- Institute of Sport Science and Innovations, Lithuanian Sports University, Kaunas, Lithuania
| | - Pornpimol Muanjai
- Department of Physical Therapy, Faculty of Allied Health Sciences, Burapha University, Chonburi, Thailand
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Chu X, Sun J, Liang J, Liu W, Xing Z, Li Q, Li Q. Mechanisms of muscle repair after peripheral nerve injury by electrical stimulation combined with blood flow restriction training. SPORTS MEDICINE AND HEALTH SCIENCE 2025; 7:173-184. [PMID: 39991124 PMCID: PMC11846447 DOI: 10.1016/j.smhs.2024.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Revised: 09/20/2024] [Accepted: 10/09/2024] [Indexed: 02/25/2025] Open
Abstract
This review elucidates the impact of electrical stimulation (ES) and blood flow restriction (BFR) training on muscle function. ES induces a transformation in muscle fibers type by rearranging myosin heavy chain isoform patterns. Additionally, it influences muscle protein synthesis and degradation through specific signaling pathways such as protein kinase B/mechanistic target of rapamycin (Akt/mTOR), as well as via autophagy and the ubiquitin-proteasome system, thereby effectively maintaining muscle mass. BFR, on the other hand, restricts muscle blood flow, leading to metabolic products accumulation and localized hypoxia, which not only promotes the recruitment of fast-twitch fibers but also activates the mTOR signaling pathway, enhancing muscle protein synthesis. The combination of ES and BFR synergistically facilitates muscle protein synthesis through the mTOR pathway, thereby accelerating the recovery of muscle function following peripheral nerve injury.
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Affiliation(s)
- Xiaolei Chu
- Department of Rehabilitation, Tianjin University Tianjin Hospital, Tianjin, China
| | - Jiaojiao Sun
- Tianjin Key, Laboratory of Exercise Physiology and Sports Medicine, Institute of Sport, Exercise and Health, Tianjin University of Sport, Tianjin, China
| | - Jiajia Liang
- Tianjin Key, Laboratory of Exercise Physiology and Sports Medicine, Institute of Sport, Exercise and Health, Tianjin University of Sport, Tianjin, China
| | - Wenjie Liu
- Tianjin Key, Laboratory of Exercise Physiology and Sports Medicine, Institute of Sport, Exercise and Health, Tianjin University of Sport, Tianjin, China
| | - Zheng Xing
- Department of Rehabilitation, Tianjin University Tianjin Hospital, Tianjin, China
| | - Qi Li
- Department of Rehabilitation, Tianjin University Tianjin Hospital, Tianjin, China
| | - Qingwen Li
- Tianjin Key, Laboratory of Exercise Physiology and Sports Medicine, Institute of Sport, Exercise and Health, Tianjin University of Sport, Tianjin, China
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Akgül MŞ, Uysal HŞ, Keskin NK, Çetin T, Başdemirci M, Akgül MN, Yıldız Z, Çiftçi E, Soslu R. Effects of Blood Flow Restriction Resistance Exercise Versus Traditional Resistance Exercise in Voluntary Exhaustion on Quadriceps Muscle Adaptations in Untrained Young Males: A Randomized Trial. MEDICINA (KAUNAS, LITHUANIA) 2025; 61:804. [PMID: 40428762 PMCID: PMC12113377 DOI: 10.3390/medicina61050804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2025] [Revised: 04/14/2025] [Accepted: 04/18/2025] [Indexed: 05/29/2025]
Abstract
Background and Objectives: This study compared the effects of blood flow restriction resistance exercise (BFR-RE) and high-load resistance exercise (HL-RE) in voluntary exhaustion on quadriceps muscle adaptations in untrained young males. Materials and Methods: This study used a randomized controlled design that included 30 untrained young males (age = 21.42 ± 2.51). The BFR-RE group performed leg extension exercises with 60% occlusion pressure and 30% of one maximum repetition in volitional exhaustion. The same exercise was conducted at 70% 1RM in the HL-RE group. Fourteen variables were used to evaluate the intervention efficacy, including muscle thickness, stiffness, strength, cross-sectional area (CSA), and subcutaneous fat thickness. Analyses were reported using frequentist and Bayesian approaches. The Bayes factor (BF10 and BFincl) was interpreted based on negative and positive values. Results: The results revealed that the main effect of time was statistically significant for muscle strength, thickness, CSA, and stiffness (p < 0.05, BFincl > 1) and, in intragroup comparisons, both groups showed improvements in these parameters (p < 0.05, BF10 > 1). A statistically significant decrease in subcutaneous fat thickness was observed in the BFR-RE group (p < 0.05, BF10 > 1), while this change was not observed in the HL-RE group (p > 0.05, BF10 < 1). Similarly, a statistically significant increase in right rectus femoris muscle stiffness was detected in the BFR-RE group (p < 0.05, BF10 > 1) but not in the HL-RE group (p > 0.05, BF10 < 1). Furthermore, time's main effect was statistically insignificant for thigh circumference (p > 0.05, BFincl < 1). The group × time interaction was statistically significant only for peak power leg flexion left (p < 0.05, BFincl > 1), and a statistically significant difference in favor of the BFR-RE group was observed in the intergroup comparisons (p < 0.05, BF10 > 1). Conclusions: In conclusion, BF-RE exercise with voluntary exhaustion may be as effective as HL-RE for hypertrophic adaptations in untrained young males.
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Affiliation(s)
- Mustafa Şakir Akgül
- Department of Coaching Education, Hasan Dogan Faculty of Sport Sciences, Karabuk University, Karabuk 78000, Turkey; (T.Ç.); (Z.Y.)
| | - Hüseyin Şahin Uysal
- Department of Physical Education and Sport, Faculty of Sport Sciences, Burdur Mehmet Akif Ersoy University, Burdur 15030, Turkey;
| | - Nevin Köremezli Keskin
- Department of Radiology, Karabuk University Training and Research Hospital, Karabuk 78000, Turkey; (N.K.K.); (M.B.)
| | - Tuğba Çetin
- Department of Coaching Education, Hasan Dogan Faculty of Sport Sciences, Karabuk University, Karabuk 78000, Turkey; (T.Ç.); (Z.Y.)
| | - Merve Başdemirci
- Department of Radiology, Karabuk University Training and Research Hospital, Karabuk 78000, Turkey; (N.K.K.); (M.B.)
| | - Melike Nur Akgül
- Eskipazar Vocational School, Karabuk University, Karabuk 78000, Turkey;
| | - Zehra Yıldız
- Department of Coaching Education, Hasan Dogan Faculty of Sport Sciences, Karabuk University, Karabuk 78000, Turkey; (T.Ç.); (Z.Y.)
| | - Ebubekir Çiftçi
- Department of Movement and Exercise Sciences, The Institute of Graduate Programs, Istanbul Gelişim University, İstanbul 34315, Turkey;
| | - Recep Soslu
- Department of Coaching Education, Faculty of Sports Sciences, Karamanoğlu Mehmetbey University, Karaman 70200, Turkey;
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Chen LS, McLaurin N, Brosselin P, Charry D, Alhalimi T, Tanaka H. Vascular adaptations to blood flow restriction resistance training with different cuff types: the role of retrograde shear stress. Eur J Appl Physiol 2025:10.1007/s00421-025-05795-1. [PMID: 40281232 DOI: 10.1007/s00421-025-05795-1] [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: 01/21/2025] [Accepted: 04/07/2025] [Indexed: 04/29/2025]
Abstract
PURPOSE Narrow-elastic bands (NE) and wide-rigid cuffs (WR) are two types of cuffs that are frequently used in blood flow restriction (BFR) training. Because these cuffs produce different hemodynamic responses, vascular adaptations might differ depending upon what cuffs are used. We examined the hypothesis that BFR with NE would improve vascular function while BFR with WR would decrease vascular function. METHODS Twenty-six young healthy participants completed supervised BFR training for 2 weeks with NE placed on one arm and WR on the other arm during upper-body resistance exercise using random arm allocation with counterbalancing across the participants. Flow-mediated dilation (FMD), arterial stiffness, muscle strength, and muscle mass in both arms were measured before and after the intervention. To explore possible mechanisms underlying vascular adaptations, retrograde shear rates (SR) induced by different cuffs in the brachial artery were also measured before the intervention. RESULTS Muscle strength increased in both arms (p < 0.05). FMD increased in the NE arm (5.6 ± 2.9 to 7.7 ± 3.4%, p = 0.004) but did not change in the WR arm (6.0 ± 2.5 to 4.9 ± 2.7%, p = 0.12). Retrograde SR was higher under WR occlusion compared with NE occlusion and no cuff (no cuff: 22 ± 9, NE: 25 ± 9 vs. WR: 39 ± 13 s-1, p < 0.001). A negative correlation was found between WR occlusion-induced changes in retrograde SR and relative changes in FMD (r = -0.42, p = 0.02). CONCLUSION Different BFR cuffs led to similar muscle adaptations but different vascular adaptations. The difference in the vascular adaptation between two different cuffs might be explained by a greater retrograde SR induced by WR occlusion.
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Affiliation(s)
- Lin-Sheng Chen
- Department of Kinesiology and Health Education, The University of Texas at Austin, 2109 San Jacinto Blvd, D3700, Austin, TX, 78712, USA
| | - Natalie McLaurin
- Department of Kinesiology and Health Education, The University of Texas at Austin, 2109 San Jacinto Blvd, D3700, Austin, TX, 78712, USA
| | - Philippe Brosselin
- Department of Kinesiology and Health Education, The University of Texas at Austin, 2109 San Jacinto Blvd, D3700, Austin, TX, 78712, USA
| | - Daniela Charry
- Department of Kinesiology and Health Education, The University of Texas at Austin, 2109 San Jacinto Blvd, D3700, Austin, TX, 78712, USA
| | - Taha Alhalimi
- Department of Kinesiology and Health Education, The University of Texas at Austin, 2109 San Jacinto Blvd, D3700, Austin, TX, 78712, USA
| | - Hirofumi Tanaka
- Department of Kinesiology and Health Education, The University of Texas at Austin, 2109 San Jacinto Blvd, D3700, Austin, TX, 78712, USA.
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Souza HLR, Wilk M, de Oliveira GT, Bichowska-Pawęska M, Bernardes BP, Dos Prazeres EO, Camilo GB, Hurst P, Marocolo M. Determining minimum cuff pressure required to reduce arterial blood flow at rest. Sci Rep 2025; 15:14322. [PMID: 40275037 PMCID: PMC12022181 DOI: 10.1038/s41598-025-99334-9] [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: 10/17/2024] [Accepted: 04/18/2025] [Indexed: 04/26/2025] Open
Abstract
The aim of our study was to determine the minimum cuff pressure to induce alterations in the brachial and popliteal blood flow (BF). Forty-two healthy men underwent an incremental cuff pressure protocol at rest. The cuff was positioned at the proximal part of the right arm (9 cm width, brachial artery) and thigh (13 cm width, superficial femoral artery) in a randomized order. Pressure increments started at 0 mmHg, increased by 20 mmHg up to 100 mmHg, and then by 10 mmHg until total occlusion of BF. Each pressure was held for 30 s to stabilize BF and measurements were carried out on brachial (BA) and popliteal (PA) arteries using a 2-D B-mode ultrasound. Mean arterial occlusion pressure (AOP) was 161 ± 18 mmHg in BA and 150 ± 15 mmHg for the PA. At 20-100 mmHg, the mean BF changes were 4% (BA) and 11% (PA), without significant BF reductions compared to baseline values. Reductions in BF vs. baseline (p < 0.05) were found from 120 mmHg (BA) and 110 mmHg (PA) cuff pressures. Calculations of the minimal clinically important differences showed meaningful changes beginning at 110 mmHg for BA and 100 mmHg for PA. Experimental approaches requiring BF restriction should use cuff pressures greater than 69% (BA) and 67% (PA) of AOP to promote significant reductions in blood flow.
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Affiliation(s)
- Hiago L R Souza
- Department of Biophysics and Physiology, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Michal Wilk
- Institute of Sport Sciences, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | - Géssyca T de Oliveira
- Department of Biophysics and Physiology, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Marta Bichowska-Pawęska
- Faculty of Physical Education, Gdansk University of Physical Education and Sport, Gdansk, Poland
| | - Bernardo P Bernardes
- Department of Biophysics and Physiology, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Eduardo O Dos Prazeres
- Department of Biophysics and Physiology, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Gustavo B Camilo
- Department of Anatomy, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Philip Hurst
- School of Psychology and Life Sciences, Canterbury Christ Church University, Canterbury, UK
| | - Moacir Marocolo
- Department of Biophysics and Physiology, Federal University of Juiz de Fora, Juiz de Fora, Brazil.
- Department of Training and Exercise Science, Faculty of Sport Science, Ruhr University Bochum, Bochum, Germany.
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Lubiak SM, Proppe CE, Rivera PM, Howard MA, Prajapati AJ, Shah NM, Patel NN, Hammer SM, Trevino MA, Dinyer-McNeely TK, Zak RB, Hill EC. Muscle-specific neuromuscular responses during running with blood flow restriction. Int J Sports Med 2025; 46:255-262. [PMID: 39809443 DOI: 10.1055/a-2493-0617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2025]
Abstract
The purpose of this investigation was to examine muscle excitation at maximal running capacity without blood flow restriction (BFR) relative to submaximal running bouts with BFR. Fourteen college-aged males randomly completed four, three-minute running bouts at 70, 80, and 90% of peak speed with BFR (70%BFR, 80%BFR, and 90%BFR) and without BFR at 100% of their peak speed (100%NOBFR). The surface electromyographic amplitudes of the vastus lateralis, rectus femoris, and vastus medialis muscles were assessed. Muscle excitation of the vastus lateralis was similar across most bouts; however, it was lower during the 70%BFR compared to 90%BFR (Meandiff =-4.67±- 0.22%; Bayesian 95% high-density interval [HDI]: - 7.07 to - 2.2) and 100%NOBFR (Meandiff =-2.94±- 0.27%; 95% HDI:-5.33 to-0.50) bouts. For the rectus femoris, muscle excitation largely increased across running speeds (70%BFR<80%BFR < 90%BFR; 90%BFR < 100%NOBFR). For the vastus medialis, muscle excitation was lower during the 70%BFR compared to 90%BFR (Meandiff =-8.15±- 0.28%; 95% HDI:-15.3 to-0.89). Submaximal running with BFR increased muscle excitation responses for the vastus lateralis and vastus medialis, such that muscle excitation was similar to 100%BFR, despite 10-20% reductions in running speed. The rectus femoris muscle, however, was not affected by BFR during the submaximal running bouts.
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Affiliation(s)
| | | | | | | | | | | | | | - Shane M Hammer
- Department of Kinesiology, Applied Health, and Recreation
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ShangGuan Y, Huang K, Zhu Z, Yuan Y, Song Y, Wang H, Chen L, Yu S, Zheng G, Liang Q. Effects of low-intensity blood flow restriction training on myocardial injury indices, antioxidant and anti-apoptotic capacity in rats. Front Physiol 2025; 16:1508305. [PMID: 40182686 PMCID: PMC11966203 DOI: 10.3389/fphys.2025.1508305] [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: 10/09/2024] [Accepted: 02/19/2025] [Indexed: 04/05/2025] Open
Abstract
Objective This study aims to investigate the effects of low-intensity blood flow restriction training on myocardial tissue in rats. By measuring the levels of myocardial injury biomarkers in serum and the expression of anti-apoptotic and antioxidant proteins in myocardial tissue, the study preliminarily explores the underlying mechanisms. Methods Male 3-month-old Sprague-Dawley rats were randomly divided into the following groups: control group (CON), low-intensity training group (LIRT), high-intensity training group (HIRT), and low-intensity blood flow restriction training group (LIBFR), with 6 rats in each group. Body weight, maximum voluntary carrying capacity, myocardial morphology, myocardial injury biomarkers, and the expression levels of Bcl-2, Bax, Nrf2, and Keap1 proteins in myocardial tissue were evaluated. Results (1)cTn1 Detection: The HIRT group showed a significant increase in cTn1 levels (P < 0.01), while the LIBFR group had a lower cTn1 level compared to the HIRT group (P < 0.05). (2)Nrf2 and Keap1 Results: Compared to the CON group, the LIBFR group showed an increase in Nrf2 (P < 0.05), and a significant increase in Keap1 (P < 0.01). (3)Bcl-2 and Bax Results: Compared to the CON group, Bcl-2 levels were significantly elevated in the HIRT group (P < 0.01) and increased in the LIBFR group (P < 0.05), while Bax expression was significantly reduced in the LIBFR group (P < 0.05). Regarding the Bcl-2/Bax ratio, the LIRT, HIRT, and LIBFR groups exhibited significantly higher values compared to the CON group (P < 0.01). Furthermore, the HIRT and LIBFR groups showed significantly higher Bcl-2/Bax ratios than the LIRT group (P < 0.01). Conclusion Low-intensity blood flow restriction training can effectively reduce cTn1 in rat serum, decrease cardiomyocyte apoptosis, and improve antioxidant capacity, which has a certain protective effect on the myocardium.
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Affiliation(s)
- Yuwen ShangGuan
- Institute of Competitive Sports, Nanjing Sport Institute, Nanjing, China
- Department of Exercise Physiology, Kunsan National University, Gunsan, Republic of Korea
| | - Kunyi Huang
- Department of Health and Physical Education, The Education University of Hong Kong, Tai Po, Hong Kong SAR, China
| | - Zining Zhu
- Department of Exercise Physiology, Kunsan National University, Gunsan, Republic of Korea
| | - Yuan Yuan
- Department of Exercise Physiology, Kunsan National University, Gunsan, Republic of Korea
| | - Yawei Song
- Institute of Competitive Sports, Nanjing Sport Institute, Nanjing, China
| | - Hao Wang
- Institute of Competitive Sports, Nanjing Sport Institute, Nanjing, China
| | - Liang Chen
- Institute of Competitive Sports, Nanjing Sport Institute, Nanjing, China
| | - Shiqi Yu
- School of Sports and Health, Shanghai University of Sport, Shanghai, China
| | - Guangzhi Zheng
- Department of Exercise Physiology, Kunsan National University, Gunsan, Republic of Korea
| | - Qi Liang
- School of Sports and Health, Linyi Vocational College, Liny, China
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Li X, Xiao F, Ren H, Peng Y, Feng F, Dong Q. The effects of blood flow restriction training on early muscle strength and mid-term knee function following anterior cruciate ligament reconstruction: a systematic review and meta-analysis. J Orthop Surg Res 2025; 20:273. [PMID: 40075371 PMCID: PMC11905650 DOI: 10.1186/s13018-025-05673-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2025] [Accepted: 03/03/2025] [Indexed: 03/14/2025] Open
Abstract
OBJECTIVE Early restoration of muscle strength and knee joint function after anterior cruciate ligament reconstruction (ACLR) is a critical goal in the rehabilitation process. Blood flow restriction training (BFRT), a low-load training method, has gained attention in musculoskeletal rehabilitation in recent years, but its specific effects in ACLR rehabilitation remain unclear. METHODS Relevant literature up to December 20, 2024, was searched in the PubMed, Embase, Cochrane, and Web of Science databases, and study selection was performed according to PRISMA guidelines. Randomized controlled trials (RCTs) and quasi-RCTs comparing the effects of BFRT and traditional training in ACLR rehabilitation were included. Data on early muscle strength (ACSA and MVIC) and mid-term knee function (IKDC scores and isometric strength of knee extensors) were extracted. The quality of the studies was assessed using the Cochrane risk of bias tool, and statistical analyses were conducted using fixed-effect or random-effect models. RESULTS A total of 11 studies involving 276 patients were included, with 139 in the BFRT group and 137 in the control group. Meta-analysis showed no significant improvements in quadriceps ACSA (SMD = 0.82, 95% CI: -0.17 to 1.81, p = 0.10) or MVIC (SMD = 0.47, 95% CI: -0.16 to 1.10, p = 0.15) during the early postoperative period (≤ 3 weeks). At mid-term follow-up (8-14 weeks), BFRT significantly improved IKDC scores (SMD = 3.70, 95% CI: 0.20 to 7.21, p = 0.04). No significant differences were observed between the groups in the improvement of isometric strength of knee extensors (SMD = 0.50, 95% CI: -0.62 to 1.63, p = 0.38). CONCLUSIONS BFRT demonstrated limited effectiveness in early muscle strength recovery during ACLR rehabilitation but may have a positive impact on mid-term knee function, particularly in improving IKDC scores. However, due to heterogeneity and potential bias in the included studies, future research should incorporate more high-quality, multicenter RCTs to further validate the mid- to long-term value of BFRT in postoperative rehabilitation.
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Affiliation(s)
- Xiaoyan Li
- Department of Rehabilitation Medicine, Beijing Anzhen Nanchong Hospital, Capital Medical University & Nanchong Central Hospital, Nanchong, Sichuan Province, China
| | - Fajun Xiao
- Department of Rehabilitation Medicine, Nanchong Mental Health Center of Sichuan Province, Nanchong, Sichuan Province, China
| | - Hongying Ren
- Department of Rehabilitation Medicine, Beijing Anzhen Nanchong Hospital, Capital Medical University & Nanchong Central Hospital, Nanchong, Sichuan Province, China
| | - Yi Peng
- Department of Rehabilitation Medicine, Beijing Anzhen Nanchong Hospital, Capital Medical University & Nanchong Central Hospital, Nanchong, Sichuan Province, China
| | - Fang Feng
- Department of Rehabilitation Medicine, Beijing Anzhen Nanchong Hospital, Capital Medical University & Nanchong Central Hospital, Nanchong, Sichuan Province, China
| | - Qinjian Dong
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, 610075, China.
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10
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Wang H, Tuerhongjiang M, Zeng Z, Wang Y, Liu J, Liu R. The effects of normobaric hypoxic resistance training on muscle strength in healthy adults. Eur J Appl Physiol 2025:10.1007/s00421-025-05736-y. [PMID: 39994007 DOI: 10.1007/s00421-025-05736-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2024] [Accepted: 02/07/2025] [Indexed: 02/26/2025]
Abstract
Normobaric hypoxic resistance training (NHRT) has emerged as a novel approach to enhancing muscle strength, potentially offering advantages over conventional resistance training. However, its efficacy in healthy adults remains uncertain. This systematic review and meta-analysis aimed to evaluate the effects of NHRT on muscle strength indicators, including one-repetition maximum (1RM), isometric strength, and isokinetic strength, in healthy adults. METHODS Following PRISMA 2020 guidelines, four databases (PubMed, Web of Science, SportDiscus, and CNKI) were searched from inception to October 25, 2024, for randomized controlled trials. Study quality was assessed using the Cochrane Risk of Bias tool. Effect sizes were calculated using Review Manager 5.4. RESULTS A total of 22 RCTs involving 487 healthy adults were included. The meta-analysis revealed a significant small-to-moderate improvement in 1RM (SMD = 0.22, 95% CI [0.06, 0.38]) but no statistically significant effects on isometric strength (SMD = 0.32, 95% CI [-0.05, 0.70]) and isokinetic strength (SMD = 0.25, 95% CI [-0.11, 0.62]). Subgroup analyses indicated that oxygen concentrations of 14-16% and training loads of 60-80% 1RM produced the most substantial gains, particularly among untrained participants. CONCLUSIONS NHRT is a promising strategy for enhancing 1RM in healthy adults, with its effectiveness influenced by hypoxic levels, training load, and baseline training status. Optimal outcomes were observed at oxygen concentrations of 14-16% and moderate training loads (60-80% 1RM), particularly in untrained individuals. Further high-quality studies are warranted to confirm these outcomes and explore the underlying mechanisms.Registration number on PROSPEROCRD42024547100.
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Affiliation(s)
- Hao Wang
- Beijing Sport University, NO.48 Xinxi Road, Beijing, 100084, China
| | | | - Zichen Zeng
- Beijing Sport University, NO.48 Xinxi Road, Beijing, 100084, China
| | - Yi Wang
- Shenyang Sport University, NO.36 Jinqiansong East Road, Liaoning, 110102, China
| | - Jianxiu Liu
- Division of Sports Science and Physical Education, Tsinghua University, Beijing, 100084, China.
| | - Ruidong Liu
- Beijing Sport University, NO.48 Xinxi Road, Beijing, 100084, China.
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11
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Yin M, Deng S, Deng J, Xu K, Nassis GP, Girard O, Li Y. Physiological adaptations and performance enhancement with combined blood flow restricted and interval training: A systematic review with meta-analysis. JOURNAL OF SPORT AND HEALTH SCIENCE 2025; 14:101030. [PMID: 39986351 DOI: 10.1016/j.jshs.2025.101030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Revised: 10/31/2024] [Accepted: 12/05/2024] [Indexed: 02/24/2025]
Abstract
PURPOSE We aimed to determine: (a) the chronic effects of interval training (IT) combined with blood flow restriction (BFR) on physiological adaptations (aerobic/anaerobic capacity and muscle responses) and performance enhancement (endurance and sprints), and (b) the influence of participant characteristics and intervention protocols on these effects. METHODS Searches were conducted in PubMed, Web of Science (Core Collection), Cochrane Library (Embase, ClinicalTrials.gov, and International Clinical Trials Registry Platform), and Chinese National Knowledge Infrastructure on April 2, with updates on October 17, 2024. Pooled effects for each outcome were summarized using Hedge's g (g) through meta-analysis-based random effects models, and subgroup and regression analyses were used to explore moderators. RESULTS A total of 24 studies with 621 participants were included. IT combined with BFR (IT+BFR) significantly improved maximal oxygen uptake (VO2max) (g = 0.63, I2 = 63%), mean power during the Wingate 30-s test (g = 0.70, I2 = 47%), muscle strength (g = 0.88, I2 = 64%), muscle endurance (g = 0.43, I2 = 0%), time to fatigue (g = 1.26, I2 = 86%), and maximal aerobic speed (g = 0.74, I2 = 0%) compared to IT alone. Subgroup analysis indicated that participant characteristics including training status, IT intensity, and IT modes significantly moderated VO2max (subgroup differences: p < 0.05). Specifically, IT+BFR showed significantly superior improvements in VO2max compared to IT alone in trained individuals (g = 0.76) at supra-maximal intensity (g = 1.29) and moderate intensity (g = 1.08) as well as in walking (g = 1.64) and running (g = 0.63) modes. Meta-regression analysis showed cuff width (β = 0.14) was significantly associated with VO2max change, identifying 8.23 cm as the minimum threshold required for significant improvement. Subgroup analyses regarding muscle strength did not reveal any significant moderators. CONCLUSION IT+BFR enhances physiological adaptations and optimizes aspects of endurance performance, with moderators including training status, IT protocol (intensity, mode, and type), and cuff width. This intervention addresses various IT-related challenges and provides tailored protocols and benefits for diverse populations.
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Affiliation(s)
- Mingyue Yin
- School of Athletic Performance, Shanghai University of Sport, Shanghai 200438, China
| | - Shengji Deng
- School of Athletic Performance, Shanghai University of Sport, Shanghai 200438, China; School of Human Science (Exercise and Sport Science), University of Western Australia, Perth 6009, Australia
| | - Jianfeng Deng
- School of Athletic Performance, Shanghai University of Sport, Shanghai 200438, China; School of Human Science (Exercise and Sport Science), University of Western Australia, Perth 6009, Australia
| | - Kai Xu
- School of Athletic Performance, Shanghai University of Sport, Shanghai 200438, China
| | - George P Nassis
- College of Sport Science, University of Kalba, Sharjah 89841, United Arab Emirates
| | - Olivier Girard
- School of Human Science (Exercise and Sport Science), University of Western Australia, Perth 6009, Australia
| | - Yongming Li
- School of Athletic Performance, Shanghai University of Sport, Shanghai 200438, China; China Institute of Sport Science, General Administration of Sport, Beijing 100061, China.
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12
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Gray L, Ladlow P, Coppack RJ, Cassidy RP, Kelly L, Lewis S, Caplan N, Barker-Davies R, Bennett AN, Hughes L. How can Blood Flow Restriction Exercise be Utilised for the Management of Persistent Pain Following Complex Injuries in Military Personnel? A Narrative Review. SPORTS MEDICINE - OPEN 2025; 11:13. [PMID: 39900782 PMCID: PMC11790543 DOI: 10.1186/s40798-024-00804-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 12/06/2024] [Indexed: 02/05/2025]
Abstract
BACKGROUND Persistent pain is a complicated phenomenon associated with a wide array of complex pathologies and conditions (e.g., complex regional pain syndrome, non-freezing cold injury), leading to extensive disability and reduced physical function. Conventional resistance training is commonly contraindicated in load compromised and/or persistent pain populations, compromising rehabilitation progression and potentially leading to extensive pharmacological intervention, invasive procedures, and reduced occupational status. The management of persistent pain and utility of adjunct therapies has become a clinical and research priority within numerous healthcare settings, including defence medical services. MAIN BODY Blood flow restriction (BFR) exercise has demonstrated beneficial morphological and physiological adaptions in load-compromised populations, as well as being able to elicit acute hypoalgesia. The aims of this narrative review are to: (1) explore the use of BFR exercise to elicit hypoalgesia; (2) briefly review the mechanisms of BFR-induced hypoalgesia; (3) discuss potential implications and applications of BFR during the rehabilitation of complex conditions where persistent pain is the primary limiting factor to progress, within defence rehabilitation healthcare settings. The review found BFR application is a feasible intervention across numerous load-compromised clinical populations (e.g., post-surgical, post-traumatic osteoarthritis), and there is mechanistic rationale for use in persistent pain pathologies. Utilisation may also be pleiotropic in nature by ameliorating pathological changes while also modulating pain response. Numerous application methods (e.g., with aerobic exercise, passive application, or resistance training) allow practitioners to cater for specific limitations (e.g., passive, or contralateral application with kinesiophobia) in clinical populations. Additionally, the low-mechanical load nature of BFR exercise may allow for high-frequency use within residential military rehabilitation, providing a platform for conventional resistance training thereafter. CONCLUSION Future research needs to examine the differences in pain modulation between persistent pain and pain-free populations with BFR application, supporting the investigation of mechanisms for BFR-induced hypoalgesia, the dose-response relationship between BFR-exercise and pain modulation, and the efficacy and effectiveness of BFR application in complex musculoskeletal and persistent pain populations.
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Affiliation(s)
- Luke Gray
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle, United Kingdom
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre - Stanford Hall, Loughborough, United Kingdom
| | - Peter Ladlow
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre - Stanford Hall, Loughborough, United Kingdom
- Department for Health, University of Bath, Bath, United Kingdom
| | - Russell J Coppack
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre - Stanford Hall, Loughborough, United Kingdom
- Department for Health, University of Bath, Bath, United Kingdom
| | - Robyn P Cassidy
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre - Stanford Hall, Loughborough, United Kingdom
- Department for Health, University of Bath, Bath, United Kingdom
| | - Lynn Kelly
- Defence Medical Rehabilitation Centre - Stanford Hall, Loughborough, United Kingdom
| | - Sarah Lewis
- Defence Medical Rehabilitation Centre - Stanford Hall, Loughborough, United Kingdom
| | - Nick Caplan
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle, United Kingdom
| | - Robert Barker-Davies
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre - Stanford Hall, Loughborough, United Kingdom
- School of Sport, Exercise, and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - Alexander N Bennett
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre - Stanford Hall, Loughborough, United Kingdom
- Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Luke Hughes
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle, United Kingdom.
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13
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Ohlsen SM, Hagen MS, Cummer K, Telfer S, Chalian M, Gee AO, Kweon CY, Chin KM, Agresta C. The Effect of Blood Flow Restriction Training on Quadriceps Muscle Strength and Functional Performance Following Isolated Anterior Cruciate Ligament Reconstruction: A Pilot Study. Cureus 2025; 17:e79821. [PMID: 40166511 PMCID: PMC11955572 DOI: 10.7759/cureus.79821] [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] [Accepted: 02/28/2025] [Indexed: 04/02/2025] Open
Abstract
BACKGROUND Quadriceps weakness is common after anterior cruciate ligament (ACL) injuries and ACL reconstruction (ACLR). Blood flow restriction (BFR) training is being increasingly used during ACLR rehabilitation protocols to facilitate a hypoxic cellular environment that triggers a local stress response theorized to promote muscle hypertrophy, and thus muscle strength, without mechanically loading a healing ACL graft. While BFR is a popular addition to therapy, scientific methods used to examine BFR training following ACLR have been inconsistent or insufficient to determine whether early BFR has a significant therapeutic effect on strength and function, and few studies have used advanced imaging to assess changes in muscle volume and composition. PURPOSE This study aimed to investigate changes in postoperative quadriceps strength and muscle volume between conventional ACLR rehabilitation with early BFR training and conventional ACLR rehabilitation with sham (e.g., non-therapeutic pressure) BFR training. We secondarily sought to evaluate the effect of early BFR training on late-stage functional and patient-reported outcomes (PROMs). METHODS Ten individuals with a unilateral isolated ACLR were randomized to receive 200 minutes of BFR or sham (CON) training as part of their ACLR rehabilitation protocol. Quadriceps and hamstring strength were taken via a handheld dynamometer to calculate limb symmetry indices (LSI) at eight and 36 weeks postoperatively. Magnetic resonance (MR) images were acquired of the bilateral knees pre- and post-BFR or CON training and evaluated for muscle volume and adipose composition. Single-leg hop tests were performed at the conclusion of the rehabilitation protocol around 36 weeks postoperatively. PROM measures were measured by the International Knee Documentation Committee (IKDC) and Knee Injury and Osteoarthritis Outcome Score (KOOS) at baseline and eight and 36 weeks postoperatively. RESULTS At eight weeks postoperatively, there was not a significant difference in quadriceps and hamstring LSI between the BFR and CON groups. At 36 weeks postoperatively, there was a significant increase in strength within all groups, but there were no significant differences in the improvement of either quadriceps or hamstring strength between the BFR and CON groups. There was no significant change in quadriceps intramuscular adipose composition or muscle volume between pre- and post-BFR MR images within the BFR group. There was additionally no difference between PROMs and adverse events between the two groups at the eight- and 36-week postoperative time points, and there were no complications with early BFR use. CONCLUSION In this pilot study, quadriceps and hamstring strength, muscle volume, and intramuscular adipose were not impacted over time or between the BFR and standard-of-care groups. Early BFR utilization had no effect on PROMs between BFR and standard of care as measured by IKDC and KOOS. Larger studies are needed to better understand the potential effects of early BFR on patient rehabilitation after ACLR.
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Affiliation(s)
- Suzanna M Ohlsen
- Orthopaedic Surgery, University of Washington Medical Center, Seattle, USA
| | - Mia S Hagen
- Orthopaedic Surgery, University of Washington Medical Center, Seattle, USA
| | - Kathleen Cummer
- Physical Medicine and Rehabilitation, University of Washington Medical Center, Seattle, USA
| | - Scott Telfer
- Orthopaedic Surgery, University of Washington Medical Center, Seattle, USA
| | - Majid Chalian
- Radiology, University of Washington Medical Center, Seattle, USA
| | - Albert O Gee
- Orthopaedic Surgery, University of Washington Medical Center, Seattle, USA
| | | | - Kenneth M Chin
- Orthopaedic Surgery, University of Washington Medical Center, Seattle, USA
| | - Cristine Agresta
- Physical Medicine and Rehabilitation, University of Washington Medical Center, Seattle, USA
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14
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Nancekievill D, Seaman K, Bouchard DR, Thomson AM, Sénéchal M. Impact of exercise with blood flow restriction on muscle hypertrophy and performance outcomes in men and women. PLoS One 2025; 20:e0301164. [PMID: 39874353 PMCID: PMC11774385 DOI: 10.1371/journal.pone.0301164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 11/19/2024] [Indexed: 01/30/2025] Open
Abstract
Blood flow restriction training (BFRT) has been previously studied as an alternative form of resistance training to gain lean mass and improve performance outcomes. However, in all exercise studies of BFRT, the proportion of female participants represents only 17-29% of all research participants. This highlights a strong underrepresentation of females and the need for more knowledge on the impact of BFRT and sex differences. The primary objective was to compare the impact of 6-week BFRT on lean mass, strength, and performance outcomes between males and females. A total of 38 adults [age, 25.3 ± 3.1 years; female, n = 19 (50%)] performed whole-body resistance training program with blood flow restriction three times per week. Exercises were performed at 30% of 1-repetition maximum (1-RM) and blood flow restriction cuffs were set to 60% of each individual's limb occlusion pressure. Body composition was assessed via dual-energy x-ray absorptiometry and strength was measured using 1-RM. A significant increase in lean mass was observed in males (p = 0.009) and females (p = 0.023) with no difference in the change between groups (p = 0.279). Both males and females increased 1-RM for upper- and lower-body exercises, with significant interaction effects (time x sex) for chest press (p = 0.003), seated row (p = 0.038), knee flexion (p = 0.043), and knee extension (p = 0.035), suggesting males increased 1-RM more for these exercises. Furthermore, peak power was improved in males (p < 0.001) and females (p = 0.002) during a vertical squat jump, but a significant interaction (time x sex) effect was observed (p = 0.039), suggesting males increased to a greater extent. Males and females significantly increased lean body mass, to a similar degree, following six weeks of resistance training in combination with blood flow restriction. Likewise, both males and females improved muscle strength following 6-week BFRT, however males may improve strength to a greater extent than females.
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Affiliation(s)
- Dawson Nancekievill
- Cardiometabolic, Exercise, and Lifestyle Laboratory, University of New Brunswick, Fredericton, NB, Canada
- Faculty of Kinesiology, University of New Brunswick, Fredericton, NB, Canada
| | - Ken Seaman
- Faculty of Kinesiology, University of New Brunswick, Fredericton, NB, Canada
| | - Danielle R. Bouchard
- Cardiometabolic, Exercise, and Lifestyle Laboratory, University of New Brunswick, Fredericton, NB, Canada
- Faculty of Kinesiology, University of New Brunswick, Fredericton, NB, Canada
| | - Amy M. Thomson
- Cardiometabolic, Exercise, and Lifestyle Laboratory, University of New Brunswick, Fredericton, NB, Canada
- Faculty of Kinesiology, University of New Brunswick, Fredericton, NB, Canada
| | - Martin Sénéchal
- Cardiometabolic, Exercise, and Lifestyle Laboratory, University of New Brunswick, Fredericton, NB, Canada
- Faculty of Kinesiology, University of New Brunswick, Fredericton, NB, Canada
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15
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Smith HK, Bird SP, Coskun B, Olsen PD, Kavanagh T, Hamlin MJ. Effectiveness of blood flow restriction training during a taper phase in basketball players. J Sports Sci 2025:1-12. [PMID: 39862110 DOI: 10.1080/02640414.2025.2454712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2025]
Abstract
This study investigates the effectiveness of blood flow restriction (BFR) training in maintaining athletic performance during a taper phase in basketball players. The taper phase aims to reduce external load while maintaining training intensity. Seventeen experienced basketball players were randomised into two groups: a placebo group (n = 8, 22.0 ± 2.1 years, mean ± SD) and BFR group (n = 9, 21.1 ± 1.5 years). The training schedule included strength trainings, team trainings, individual skill sessions and competitive games. During the 4-week taper period, lifting volume was reduced while either maintaining (placebo) or reducing (BFR) lifting load. The BFR group lifted with 60% arterial occlusion pressure at 25-30% of their 1RM, whereas the placebo group trained at 80% of their 1RM with BFR cuffs inflated to only 20%. Compared to the placebo group, BFR participants improved 5 m (-1.4 ± 1.5% mean ± 95% CI p = 0.03) and 10 m (-1.1 ± 0.5%, p = <0.01) sprint performance along with barbell back squat (9.6 ± 8.0%, p = 0.013) and countermovement jump (1.1 ± 0.8%, p = 0.0035). BFR during the taper phase enabled a reduction in lifting load with no reduction in subsequent performance measures.
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Affiliation(s)
- Hoani K Smith
- Department of Tourism, Sport and Society, Lincoln University, Christchurch, New Zealand
| | - Stephen P Bird
- School of Health and Medical Sciences, University of Southern Queensland, Ipswitch, Queensland, Australia
| | - Betul Coskun
- Department of Tourism, Sport and Society, Lincoln University, Christchurch, New Zealand
- Faculty of Sport Sciences, Erciyes University, Kayseri, Turkey
| | - Peter D Olsen
- Department of Applied Sciences and Social Practice, Ara Institute of Canterbury, Christchurch, New Zealand
| | - Thomas Kavanagh
- Department of Tourism, Sport and Society, Lincoln University, Christchurch, New Zealand
| | - Michael J Hamlin
- Department of Tourism, Sport and Society, Lincoln University, Christchurch, New Zealand
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16
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Frechette ML, Cook SB, Scott BR, Tan J, Vallence AM. Post-exercise neural plasticity is augmented by adding blood flow restriction during low work rate arm cycling. Exp Physiol 2025. [PMID: 39835924 DOI: 10.1113/ep092113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Accepted: 01/08/2025] [Indexed: 01/22/2025]
Abstract
Blood flow restriction (BFR) combined with low work rate exercise can enhance muscular and cardiovascular fitness. However, whether neural mechanisms mediate these enhancements remains unknown. This study examined changes in corticospinal excitability and motor cortical inhibition following arm cycle ergometry with and without BFR. Twelve healthy males (24 ± 4 years) completed four, randomized 15-min arm cycling conditions: high work rate (HW: 60% maximal power output), low work rate (LW: 30% maximal power output), low work rate with BFR (LW-BFR) and BFR without exercise (BFR-only). For BFR conditions, cuffs were applied around the upper arm and inflated to 70% of arterial occlusion pressure continuously during exercise. Single-pulse transcranial magnetic stimulation was delivered to left primary motor cortex (M1) to elicit motor-evoked potentials (MEP) in the right biceps brachii during a low-level isometric contraction. MEP amplitude and cortical silent period (cSP) duration were measured before and 1, 10 and 15 min post-exercise. MEP amplitude increased significantly from baseline to Post-10 and Post-15 for both the HW (both z < -7.07, both P < 0.001) and LW-BFR conditions (both z < -5.56, both P < 0.001). For the LW condition without BFR, MEP amplitude increased significantly from baseline to Post-10 (z = -3.53, P = 0.003) but not Post-15 (z = -1.85, P = 0.388). The current findings show that HW arm cycling and LW-BFR led to longer-lasting increases in corticospinal excitability than LW arm cycling alone. Future research should examine whether the increased corticospinal excitability is associated with the improvements in muscle strength observed with BFR exercise. A mechanistic understanding of BFR exercise improvement could guide BFR interventions in clinical populations.
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Affiliation(s)
- Mikaela L Frechette
- Department of Kinesiology, University of New Hampshire, Durham, New Hampshire, USA
| | - Summer B Cook
- Department of Kinesiology, University of New Hampshire, Durham, New Hampshire, USA
| | - Brendan R Scott
- PHysical Activity, Sport and Exercise (PHASE) Research Group, School of Allied Health (Exercise Science), Murdoch University, Perth, Australia
- Centre for Healthy Ageing, Health Futures Institute, Murdoch University, Perth, Australia
| | - Jane Tan
- Centre for Healthy Ageing, Health Futures Institute, Murdoch University, Perth, Australia
- School of Psychology, College of Health and Education, Murdoch University, Perth, Australia
| | - Ann-Maree Vallence
- Centre for Healthy Ageing, Health Futures Institute, Murdoch University, Perth, Australia
- School of Psychology, College of Health and Education, Murdoch University, Perth, Australia
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17
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Gao Z, Li Y, Zhang J, Li L, Wang T, Wang X, Wang H. Effects of aerobic training with blood flow restriction on aerobic capacity, muscle strength, and hypertrophy in young adults: a systematic review and meta-analysis. Front Physiol 2025; 15:1506386. [PMID: 39839525 PMCID: PMC11747311 DOI: 10.3389/fphys.2024.1506386] [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: 10/05/2024] [Accepted: 12/23/2024] [Indexed: 01/23/2025] Open
Abstract
Aerobic training with blood flow restriction (AT-BFR) has shown promise in enhancing both aerobic capacity and exercise performance. The aim of this review was to systematically analyze the evidence regarding the effectiveness of this novel training method on aerobic capacity, muscle strength, and hypertrophy in young adults. Studies were identified through a search of databases including PubMed, Scopus, Web of Science, SPORTDiscus, CINAHL, Cochrane Library, and EMBASE. A total of 16 studies, involving 270 subjects, were included in the meta-analysis. The results revealed that AT-BFR induced greater improvements in VO2max (SMD = 0.27, 95%CI: [0.02, 0.52], p < 0.05), and muscle strength (SMD = 0.39, 95%CI: [0.09, 0.69], p < 0.05), compared to aerobic training with no blood flow restriction (AT-noBFR). However, no significant effect was observed on muscle mass (SMD = 0.23, 95%CI: [-0.09, 0.56], p = 0.162). Furthermore, no moderating effects on the outcomes were found for individual characteristics or training factors. In conclusion, AT-BFR is more effective than AT-noBFR in improving aerobic capacity and muscle strength, making it a promising alternative to high-intensity training. Systematic Review Registration https://www.crd.york.ac.uk/prospero/, identifier CRD42024559872.
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Affiliation(s)
- Zhendong Gao
- Faculty of Educational Studies, University Putra Malaysia, Selangor, Malaysia
| | - Yan Li
- Department of Sports Teaching and Research, Lanzhou University, Lanzhou, China
| | - Jinjin Zhang
- School of Physical Education, Xi’an Peihua University, Xi’an, China
| | - Liqiang Li
- School of Physical Education, Xizang Minzu University, Xianyang, China
| | - Tao Wang
- Faculty of Educational Studies, University Putra Malaysia, Selangor, Malaysia
| | - Xiaolin Wang
- Faculty of Educational Studies, University Putra Malaysia, Selangor, Malaysia
| | - Hao Wang
- School of Physical Education, Shenyang Medical College, Shenyang, China
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18
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Surenkok O, Aydin G, Ciftci EA, Kendal K, Atici E. Impact of blood flow restriction intensity on pain perception and muscle recovery post-eccentric exercise. Clin Physiol Funct Imaging 2025; 45:e12925. [PMID: 39737837 DOI: 10.1111/cpf.12925] [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: 07/12/2024] [Revised: 12/09/2024] [Accepted: 12/17/2024] [Indexed: 01/01/2025]
Abstract
BACKGROUND Delayed onset muscle soreness (DOMS) is a well-established phenomenon characterized by ultrastructural muscle damage that typically develops following unfamiliar or high-intensity exercise. DOMS manifests with a constellation of symptoms, including muscle tenderness, stiffness, edema, mechanical hyperalgesia, and a reduced range of joint motion. In recent years, the application of blood flow restriction (BFR) has garnered attention for its potential impact on DOMS. OBJECTIVE This study aimed to investigate the effects of different BFR intensities on biomechanical alterations induced by DOMS in healthy individuals. DESIGN AND METHODS Thirty participants were split into two groups receiving either 80% or 20% BFR applied during low-intensity resistance exercise following DOMS induction. Pain perception, pressure pain threshold, muscle biometric characteristics, and strength were assessed before DOMS, after DOMS, and following BFR application at 24, 48, and 72 h. RESULTS The 80% BFR group experienced faster reductions in pain perception compared to the 20% BFR group. Muscle strength recovery was also statistically faster in the 80% BFR group. No significant differences were observed between groups in muscle stiffness, flexibility, or other mechanical properties. CONCLUSIONS These findings suggest that BFR, particularly at higher intensities, may alleviate DOMS symptoms and accelerate muscle strength recovery. However, the lack of a control group and limitations in muscle property assessment warrant further research to definitively determine BFR's efficacy in managing DOMS.
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Affiliation(s)
- Ozgur Surenkok
- Faculty of Health Sciences, Division of Physiotherapy and Rehabilitation, Istanbul Okan University, Istanbul, Turkey
| | - Gamze Aydin
- Faculty of Health Sciences, Division of Physiotherapy and Rehabilitation, Istanbul Okan University, Istanbul, Turkey
| | - Ebru Aloglu Ciftci
- Faculty of Health Sciences, Division of Physiotherapy and Rehabilitation, Istanbul Okan University, Istanbul, Turkey
- Division of Physiotherapy and Rehabilitation, Institute of Graduate Education, Istınye University, Istanbul, Turkey
| | - Kubra Kendal
- Faculty of Health Sciences, Division of Physiotherapy and Rehabilitation, Istanbul Okan University, Istanbul, Turkey
| | - Emine Atici
- Faculty of Health Sciences, Division of Physiotherapy and Rehabilitation, Istanbul Okan University, Istanbul, Turkey
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19
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Jagim AR, Schuler J, Szymanski E, Khurelbaatar C, Carpenter M, Fields JB, Jones MT. Acute Responses of Low-Load Resistance Exercise with Blood Flow Restriction. J Funct Morphol Kinesiol 2024; 9:254. [PMID: 39728238 DOI: 10.3390/jfmk9040254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2024] [Revised: 11/27/2024] [Accepted: 12/02/2024] [Indexed: 12/28/2024] Open
Abstract
Blood flow restriction (BFR) is a popular resistance exercise technique purported to increase metabolic stress and augment training adaptations over time. However, short-term use may lead to acute neuromuscular fatigue and higher exertion ratings. Objective: The purpose of the current study was to examine acute physiological responses to low-load resistance exercise utilizing BFR compared to higher-load, non-BFR resistance exercise. Methods: Recreationally trained males (n = 6) and females (n = 7) (mean ± standard deviation, age: 20 ± 1 yrs.; height: 172 ± 8 cm; weight: 73 ± 11 kg; BMI: 24.4 ± 2.2 kg·m-2; training experience: 4 ± 2 yrs.) had limb occlusion pressure determined (50%; right leg: 118 ± 11 mmHg; left leg: 121 ± 13 mmHg) using an automated, self-inflating cuff system during baseline testing. In subsequent sessions, using a randomized, cross-over design, participants completed one of two experimental conditions: (1) Low-load + BFR and (2) High load + non-BFR. In both conditions, participants completed one set of back squats at either 30% (BFR) or 60% (non-BFR) of an estimated 1RM for a max of 30 repetitions, followed by three additional sets with the same loads and a target of 15 repetitions per set. Blood lactate and countermovement jump (CMJ) height were measured pre- and post-back squat. Ratings of perceived exertion (RPE) were assessed following each set. Results: When collapsed across all sets, participants completed significantly more total repetitions in the BFR condition compared to non-BFR (75.0 ± 0.0 vs. 68.23 ± 9.27 reps; p = 0.015; ES: 1.03), but a lower training load volume (2380 ± 728 vs. 4756 ± 1538 kg; p < 0.001; ES: 1.97). There was a significant time-by-condition interaction (p < 0.001), with a greater increase in blood lactate occurring from baseline to post-back squat in the non-BFR condition (11.61 mmol/L, 95%CI: 9.93, 13.28 mmol/L) compared to BFR (5.98 mmol/L, 95%CI: 4.30, 7.65 mmol/L). There was another significant time-by-condition interaction (p = 0.043), with a greater reduction in CMJ occurring in the non-BFR condition (-6.01, 95%CI: -9.14, -2.88 cm; p < 0.001) compared to BFR (-1.50, 95%CI: -1.50, 4.51 cm; p = 0.312). Conclusions: Utilizing a low-load BFR protocol may allow for a higher training volume, yet lower metabolic stress and reduce neuromuscular fatigue compared to lifting at a higher load without the use of BFR.
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Affiliation(s)
- Andrew R Jagim
- Sports Medicine, Mayo Clinic Health System, Onalaska, WI 54650, USA
- Department of Exercise and Sport Science, University of Wisconsin-La Crosse, La Crosse, WI 54601, USA
- Patriot Performance Laboratory, Frank Pettrone Center for Sports Performance, George Mason University, Fairfax, VA 22030, USA
| | - Jordan Schuler
- Department of Exercise and Sport Science, University of Wisconsin-La Crosse, La Crosse, WI 54601, USA
| | - Elijah Szymanski
- Medical College of Wisconsin-Central Wisconsin, Wausau, WI 54401, USA
| | - Chinguun Khurelbaatar
- Department of Exercise and Sport Science, University of Wisconsin-La Crosse, La Crosse, WI 54601, USA
| | - Makenna Carpenter
- Department of Exercise and Sport Science, University of Wisconsin-La Crosse, La Crosse, WI 54601, USA
| | - Jennifer B Fields
- Patriot Performance Laboratory, Frank Pettrone Center for Sports Performance, George Mason University, Fairfax, VA 22030, USA
- Department of Nutritional Sciences, University of Connecticut, Storrs, CT 06269, USA
| | - Margaret T Jones
- Patriot Performance Laboratory, Frank Pettrone Center for Sports Performance, George Mason University, Fairfax, VA 22030, USA
- Sport, Recreation, and Tourism Management, George Mason University, Fairfax, VA 22030, USA
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20
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Sano Y, Kawabata M, Nakatani K, Uchida Y, Watanabe Y, Tsuihiji Y, Ishii D, Kenmoku T, Watanabe H, Takahira N. Immediate Effects of Calf Tissue Flossing on Ankle Joint Torque and Dorsiflexion Range of Motion in Healthy Individuals: A Randomized Controlled Crossover Trial. J Sports Sci Med 2024; 23:778-786. [PMID: 39649561 PMCID: PMC11622054 DOI: 10.52082/jssm.2024.778] [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: 08/26/2024] [Accepted: 10/02/2024] [Indexed: 12/11/2024]
Abstract
Tissue flossing involves wrapping a rubber band around a muscle group for a few minutes while performing joint motion, enhancing ankle joint torque and range of motion. As limited ankle dorsiflexion range of motion and plantar flexion muscle weakness are risk factors for sports injury, assessing the therapeutic effects of tissue flossing is important. This study aimed to evaluate the immediate effects of calf tissue flossing on enhancing ankle joint torque and dorsiflexion range of motion. We conducted a randomized controlled crossover trial involving 19 healthy adult males who received two interventions (low and high-pressure tissue flossing bands) and a control condition (underwrap). Each intervention was applied for 2 minutes on the non-dominant calf, with 5-10 days between sessions. A pressure sensor placed on the posterior calf monitored the wrapping compression force. The intervention exercise comprised six voluntary isometric contractions of the ankle at three angles (20° plantar flexion, neutral 0°, and 10° dorsiflexion) for 3 seconds each using a dynamometer. The maximal isometric ankle plantar flexion torque and dorsiflexion range of motion were evaluated pre- and post-intervention. Significant interactions were observed in ankle plantar flexion torque at 10° dorsiflexion (p < 0.01) but not at 0° or 20° plantar flexion. The low- and high-pressure bands significantly enhanced ankle plantar flexion torque by 4.3 Nm (effect size [ES]: 0.14, p = 0.02) and 4.9 Nm (ES: 0.15, p < 0.05), respectively, and also enhanced the ankle dorsiflexion range of motion by 1.7° (ES: 0.43, p < 0.01) and 1.3° (ES: 0.35, p = 0.02), respectively, compared to the control. The low- and high-pressure band conditions had comparable effects on torque and range of motion. A few minutes of the calf tissue flossing intervention significantly enhanced ankle plantar flexion torque and dorsiflexion range of motion, although the effect sizes were trivial to small.
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Affiliation(s)
- Yuto Sano
- Physical Therapy for Sports and Musculoskeletal System, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
- Department of Rehabilitation, Yokohama Sports Medical Center, Yokohama, Japan
| | - Masashi Kawabata
- Physical Therapy for Sports and Musculoskeletal System, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
- Department of Rehabilitation, Kitasato University School of Allied Health Sciences, Sagamihara, Japan
| | - Keito Nakatani
- Department of Rehabilitation, IMS Tokyo Katsushika General Hospital, Katsushika, Japan
| | - Yuto Uchida
- Physical Therapy for Sports and Musculoskeletal System, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - Yuto Watanabe
- Physical Therapy for Sports and Musculoskeletal System, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - Yusuke Tsuihiji
- Department of Rehabilitation, Keiyu Orthopaedic Hospital, Tatebayashi, Japan
| | - Daisuke Ishii
- Department of Orthopedic Surgery, Funabashi Orthopedic Hospital, Funabashi, Japan
| | - Tomonori Kenmoku
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Hiroyuki Watanabe
- Physical Therapy for Sports and Musculoskeletal System, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
- Department of Rehabilitation, Kitasato University School of Allied Health Sciences, Sagamihara, Japan
| | - Naonobu Takahira
- Physical Therapy for Sports and Musculoskeletal System, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
- Department of Rehabilitation, Kitasato University School of Allied Health Sciences, Sagamihara, Japan
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21
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Dong J, Chi J, Lei EF, Wang D. Effects of blood flow restriction training on aerobic capacity, lower limb muscle strength and mass in healthy adults: a meta-analysis. J Sports Med Phys Fitness 2024; 64:1060-1070. [PMID: 38888563 DOI: 10.23736/s0022-4707.24.15905-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
INTRODUCTION The aim of this study was to systematically evaluate the effects of blood flow restriction combined with aerobic exercise on aerobic capacity, lower limb muscle strength and mass in healthy adults. EVIDENCE ACQUISITION According to PRISMA's statement, we searched Web of science, Medline, Embase, Cochrane library, CNKI, Wan fang, and VIP databases to collect randomized controlled trials on the effects of aerobic exercise with blood flow restriction on improving aerobic capacity, lower limb muscle strength, and muscle mass in healthy adults. The studies were published from the establishment of the database to November 2023. A supplementary search has been conducted on March 8, 2024. Review Manager5.3 and Stata17 were used for statistical analysis. EVIDENCE SYNTHESIS A total of 16 RCTs with 388 participants were included. The results of meta-analysis showed: Aerobic exercise with BFR significantly affected aerobic capacity (MD and 95%CI 1.06[0.29,1.83], P<0.05), lower limb muscle strength (MD and 95%CI 7.56[5.80,9.33], P<0.05) and lower limb muscle mass (MD and 95%CI were 3.02[1.63,4.42], P<0.05) in healthy adults. The results of subgroup analysis showed that intermittent pressure was better than continuous pressure (P<0.05). Compared with the elderly, the effect of young and middle-aged was better (P<0.05). At the same time, the training form using power bikes is better than walking or running. Finally, 2-6 weeks, 2-3 sessions per week, 10-45 minutes per session can effectively improve the aerobic capacity of healthy adults. CONCLUSIONS Aerobic exercise with BFR can significantly improve aerobic capacity, lower limb muscle strength and mass in healthy adults. In the future, the effects of blood flow restriction training on healthy adults should be further studied, and the form of pressure, intervention cycle, frequency, time, intensity and other variables should be further controlled.
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Affiliation(s)
- Jin Dong
- Physical Education Institute, Shanxi University, Taiyuan, China
| | - Jinjin Chi
- Physical Education Institute, Shanxi University, Taiyuan, China -
| | - Evander F Lei
- Department of Sports Science and Physical Education, Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Desheng Wang
- Physical Education Institute, Shanxi University, Taiyuan, China
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22
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Yang J, Rolnick N, Merriwether E, Rao S. Hypoalgesia and Conditioned Pain Modulation in Blood Flow Restriction Resistance Exercise. Int J Sports Med 2024; 45:810-819. [PMID: 38588713 DOI: 10.1055/a-2301-9115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
We compared the magnitude of exercise-induced hypoalgesia and conditioned pain modulation between blood-flow restriction (BFR) resistance exercise (RE) and moderate-intensity RE. Twenty-five asymptomatic participants performed unilateral leg press in two visits. For moderate-intensity RE, subjects exercised at 50% 1RM without BFR, whereas BFR RE exercised at 30% 1RM with a cuff inflated to 60% limb occlusion pressure. Exercise-induced hypoalgesia was quantified by pressure pain threshold changes before and after RE. Conditioned pain modulation was tested using cold water as the conditioning stimulus and mechanical pressure as the test stimulus and quantified as pressure pain threshold change. Difference in conditioned pain modulation pre- to post-RE was then calculated. The differences of RE on pain modulations were compared using paired t-tests. Pearson's r was used to examine the correlation between exercise-induced hypoalgesia and changes in conditioned pain modulation. We found greater hypoalgesia with BFR RE compared to moderate-intensity RE (p=0.008). Significant moderate correlations were found between exercise-induced hypoalgesia and changes in conditioned pain modulation (BFR: r=0.63, moderate-intensity: r=0.72). BFR RE has favorable effects on pain modulation in healthy adults and the magnitude of exercise-induced hypoalgesia is positively correlated with conditioned pain modulation activation.
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Affiliation(s)
- Jinghui Yang
- Physical Therapy, New York University Steinhardt School of Culture Education and Human Development, New York, United States
| | - Nicholas Rolnick
- The Human Performance Mechanic, Lehman College, Bronx, United States
| | - Ericka Merriwether
- Physical Therapy, New York University Steinhardt School of Culture Education and Human Development, New York, United States
- Department of Medicine, NYU Grossman School of Medicine, New York, United States
| | - Smita Rao
- Physical Therapy, New York University Steinhardt School of Culture Education and Human Development, New York, United States
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23
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Kamiş O, Gürses VV, Şendur HN, Altunsoy M, Pekel HA, Yıldırım E, Aydos L. Low-Load Resistance Exercise With Blood Flow Restriction Versus High-Load Resistance Exercise on Hamstring Muscle Adaptations in Recreationally Trained Men. J Strength Cond Res 2024; 38:e541-e552. [PMID: 39110578 DOI: 10.1519/jsc.0000000000004870] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2025]
Abstract
ABSTRACT Kamiş, O, Gürses, VV, Şendur, HN, Altunsoy, M, Pekel, HA, Yıldırım, E, and Aydos, L. Low-load resistance exercise with blood flow restriction vs. high-load resistance exercise on hamstring muscle adaptations in recreationally trained men. J Strength Cond Res 38(10): e541-e552, 2024-Low-load resistance exercise with blood flow restriction (BFR-RE) has been suggested as a viable alternative exercise for traditional high-load resistance exercise (HL-RE). However, very little is known about hamstring muscle thickness, stiffness, and strength after BFR-RE. This study aimed to compare the effects of 6 weeks of BFR-RE and HL-RE on hamstring muscle thickness, stiffness, and strength. Twenty-nine recreationally trained men were pair matched and randomly assigned to the BFR-RE ( n = 15) and HL-RE ( n = 14) groups. The BFR-RE groups performed bilateral lying leg curl exercise (30-15-15-15 reps, 30-second rest between the sets, 30% 1RM) with BFR cuffs (60% of limb occlusion pressure), whereas HL-RE performed the same exercise (3 × 12 reps, 90-second rest between the sets, 70% 1RM) without BFR cuffs. Hamstring muscle thickness, muscle stiffness, isokinetic muscle strength, and 1RM were assessed at baseline and follow-up after completing a 6-week resistance exercise program (3× a week). Hamstring muscle thickness was assessed by ultrasonography, whereas muscle stiffness was evaluated by shear wave elastography. Isokinetic dynamometry and a 1RM strength test were used to determine muscular strength before and after the exercise program. Statistical significance was set at p < 0.05. No significant effect was found for hamstring muscle strength, thickness, and stiffness for group and group × time interaction, and only a significant main effect of time ( p < 0.001) was observed for all outcomes. Both groups experienced significant improvements for all outcomes from baseline to follow-up without any between-group differences. In conclusion, results revealed that BFR-RE can provide similar hamstring muscle strength, thickness, and stiffness compared with HL-RE.
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Affiliation(s)
- Okan Kamiş
- Department of Sports and Health, Aksaray University, Aksaray, Türkiye
- Faculty of Sports Sciences, Gazi University, Ankara, Türkiye
| | - V Volkan Gürses
- Faculty of Sports Sciences, Bandırma Onyedi Eylül University, Balıkesir, Türkiye
| | - H Nahit Şendur
- Department of Radiology, Faculty of Medicine, Gazi University, Ankara, Türkiye
| | - Mustafa Altunsoy
- Faculty of Sports Sciences, Gazi University, Ankara, Türkiye
- Department of Public Health, Faculty of Medicine, Gazi University, Ankara, Türkiye; and
| | - H Ahmet Pekel
- Faculty of Sports Sciences, Gazi University, Ankara, Türkiye
| | - Erkan Yıldırım
- Department of Public Health, Faculty of Medicine, Gazi University, Ankara, Türkiye; and
| | - Latif Aydos
- Faculty of Sports Sciences, Gazi University, Ankara, Türkiye
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24
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Teixeira Filho CAT, Junior EP, Vendrame JW, Da Silva GM, Cavina APDS, Lemos LK, Vanderlei FM. Effect of Aerobic Training with Blood Flow Restriction on Strength and Hypertrophy: A Meta-analysis. Int J Sports Med 2024; 45:724-732. [PMID: 38190980 DOI: 10.1055/a-2240-7659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
The objective of this meta-analysis is to compare the effects on muscle strength and hypertrophy of low and high-intensity aerobic training with BFR (LI-BFR and HI-BFR) versus low and high-intensity aerobic training without BFR (LI and HI). The search was performed in five databases, by two independent researchers, and the terms and keywords used to optimize the searches were related to blood flow restriction and aerobic training. All studies were evaluated for methodological quality using the PEDro scale and for quality of evidence using the GRADE system. Meta-analyses were conducted using RevMan software. After data extraction, 11 studies met all eligibility criteria and were included in the systematic review. The results of the overall analysis between LI-BFR vs. LI showed a significant difference in muscle strength of knee extensors; for hypertrophy, LI was superior to LI-BFR with clinical relevance. Comparing HI-BFR vs. HI there was no superiority for muscle strength. In conclusion, for strength gains very low-quality evidence was found to support no superiority between LI-BFR and HI-BFR compared to LI and HI, respectively. For muscle hypertrophy, superiority of LI was found compared to LI-BFR, with a very low level of evidence.
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Affiliation(s)
| | | | | | | | | | | | - Franciele Marques Vanderlei
- Postgraduate program in Movement Sciences
- Postgraduate program in Movement Sciences, Department of Physiotherapy, Universidade Estadual Paulista (FCT - UNESP), Presidente Prudente, São Paulo - Brazil
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25
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Ferreira RM, Martins PN, Gonçalves RS. Non-pharmacological and non-surgical interventions to manage patients with knee osteoarthritis: An umbrella review 5-year update. OSTEOARTHRITIS AND CARTILAGE OPEN 2024; 6:100497. [PMID: 39040626 PMCID: PMC11261791 DOI: 10.1016/j.ocarto.2024.100497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 06/17/2024] [Indexed: 07/24/2024] Open
Abstract
Objective This umbrella review aimed to summarize (and update) the effectiveness of non-pharmacological and non-surgical interventions for patients with knee osteoarthritis. Methods The study followed the PRISMA guidelines. Manual and electronic databases were searched, to identify systematic reviews, following the P (knee osteoarthritis) I (non-pharmacological and non-surgical treatments) C (pharmacological, surgical, placebo, no intervention, or other non-pharmacological/non-surgical conservative treatments) O (pain, function, quality of life, and other knee-specific measures) model. The quality of evidence was assessed using the R-AMSTAR checklist and GRADE principles. Results The search yielded 4086 records, of which 61 met the eligibility criteria. After evaluation with R-AMSTAR, four systematic reviews were excluded, resulting in 57 included systematic reviews, with an overall score of 29.6. The systematic reviews were published between 2018 and 2022 (29.8% in 2022), conducted in 19 countries (52.6% in China), and explored 24 distinct interventions. The systematic reviews encompassed 714 trials (mean of 13 ± 7.7 studies per systematic review), and 59,343 participants (mean 1041 ± 1002 per systematic review, and 82 ± 59.2 per study). The majority of participants were older obese women (61.6 ± 4.2 years, 30.2 ± 3.6 kg/m2, 70%, respectively). Conclusions Based on the systematic reviews findings, Diet Therapy, Patient Education, and Resistance Training are strongly supported as core interventions for managing patients with knee osteoarthritis. Aquatic Therapy, Balance Training, Balneology, Dietary Supplements, Extracorporeal Shockwave Therapy, and Tai Ji show moderate support. For other interventions, the evidence quality was low, results were mixed or inconclusive, or there was not sufficient efficacy to support their use.
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Affiliation(s)
- Ricardo Maia Ferreira
- Polytechnic Institute of Maia, N2i, Social Sciences, Education and Sport School, Avenida Carlos de Oliveira Campos, 4475-690 Maia, Portugal
- Polytechnic Institute of Coimbra, Coimbra Health School, Scientific-Pedagogical Unit of Physioterapy, Rua 5 de Outubro, São Martinho do Bispo, 3045-043 Coimbra, Portugal
- Sport Physical Activity and Health Research & Innovation Center (SPRINT), 4960-320 Melgaço, Portugal
| | - Pedro Nunes Martins
- Polytechnic Institute of Maia, N2i, Social Sciences, Education and Sport School, Avenida Carlos de Oliveira Campos, 4475-690 Maia, Portugal
| | - Rui Soles Gonçalves
- Polytechnic Institute of Coimbra, Coimbra Health School, Scientific-Pedagogical Unit of Physioterapy, Rua 5 de Outubro, São Martinho do Bispo, 3045-043 Coimbra, Portugal
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26
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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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27
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Kuhn M, Clarenbach CF, Kläy A, Kohler M, Mayer LC, Lüchinger M, Andrist B, Radtke T, Haile SR, Sievi NA, Kohlbrenner D. Exploring immediate cardiorespiratory responses: low-intensity blood flow restricted cycling vs. moderate-intensity traditional exercise in a randomized crossover trial. BMC Sports Sci Med Rehabil 2024; 16:172. [PMID: 39148127 PMCID: PMC11325739 DOI: 10.1186/s13102-024-00951-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Accepted: 07/19/2024] [Indexed: 08/17/2024]
Abstract
PURPOSE Blood-flow restriction (BFR) endurance training may increase endurance performance and muscle strength similar to traditional endurance training while requiring a lower training intensity. We aimed to compare acute cardiorespiratory responses to low-intensity interval exercise under BFR with moderate-intensity traditional interval exercise (TRA). METHODS We conducted a randomized crossover study. The protocol involved three cycling intervals interspersed with 1 min resting periods. With a 48-h washout period, individuals performed the protocol twice in random order: once as BFR-50 (i.e., 50% incremental peak power output [IPPO] and 50% limb occlusion pressure [LOP]) and once as TRA-65 (65% IPPO without occlusion). TRA-65 intervals lasted 2 min, and time-matched BFR-50 lasted 2 min and 18 s. Respiratory parameters were collected by breath-by-breath analysis. The ratings of perceived breathing and leg exertion (RPE, 0 to 10) were assessed. Linear mixed models were used for analysis. RESULTS Out of the 28 participants initially enrolled in the study, 24 healthy individuals (18 males and 6 females) completed both measurements. Compared with TRA-65, BFR-50 elicited lower minute ventilation (VE, primary outcome) (-3.1 l/min [-4.4 to -1.7]), oxygen consumption (-0.22 l/min [-0.28 to -0.16]), carbon dioxide production (-0.25 l/min [-0.29 to -0.20]) and RPE breathing (-0.9 [-1.2 to -0.6]). RPE leg was significantly greater in the BFR-50 group (1.3 [1.0 to 1.7]). CONCLUSION BFR endurance exercise at 50% IPPO and 50% LOP resulted in lower cardiorespiratory work and perceived breathing effort compared to TRA at 65% IPPO. BFR-50 could be an attractive alternative for TRA-65, eliciting less respiratory work and perceived breathing effort while augmenting perceived leg muscle effort. TRIAL REGISTRATION NCT05163600; December 20, 2021.
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Affiliation(s)
- Manuel Kuhn
- Faculty of Medicine, University of Zurich, Zurich, Switzerland.
- Department of Pulmonology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
| | - Christian F Clarenbach
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Department of Pulmonology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Adrian Kläy
- Department of Pulmonology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Malcolm Kohler
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Department of Pulmonology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Laura C Mayer
- Department of Pulmonology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Martin Lüchinger
- Department of Pulmonology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Belinda Andrist
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Thomas Radtke
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Sarah R Haile
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Noriane A Sievi
- Department of Pulmonology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Dario Kohlbrenner
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Department of Pulmonology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
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28
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Suggitt JO, Eaves BE, Spranger MD. What are the cardiovascular responses during blood flow-restricted resistance exercise? Front Physiol 2024; 15:1417855. [PMID: 38966227 PMCID: PMC11222610 DOI: 10.3389/fphys.2024.1417855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 06/03/2024] [Indexed: 07/06/2024] Open
Affiliation(s)
| | | | - Marty D. Spranger
- Department of Physiology, Michigan State University, East Lansing, MI, United States
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29
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Sánchez-Valdepeñas J, Cornejo-Daza PJ, Rodiles-Guerrero L, Páez-Maldonado JA, Sánchez-Moreno M, Bachero-Mena B, Saez de Villarreal E, Pareja-Blanco F. Acute Responses to Different Velocity Loss Thresholds during Squat Exercise with Blood-Flow Restriction in Strength-Trained Men. Sports (Basel) 2024; 12:171. [PMID: 38921865 PMCID: PMC11209533 DOI: 10.3390/sports12060171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 06/14/2024] [Accepted: 06/17/2024] [Indexed: 06/27/2024] Open
Abstract
(1) Background: The aim of this paper is to analyze the acute effects of different velocity loss (VL) thresholds during a full squat (SQ) with blood-flow restriction (BFR) on strength performance, neuromuscular activity, metabolic response, and muscle contractile properties. (2) Methods: Twenty strength-trained men performed four protocols that differed in the VL achieved within the set (BFR0: 0% VL; BFR10: 10% VL; BFR20: 20% VL; and BFR40: 40% VL). The relative intensity (60% 1RM), recovery between sets (2 min), number of sets (3), and level of BFR (50% of arterial occlusion pressure) were matched between protocols. Tensiomyography (TMG), blood lactate, countermovement jump (CMJ), maximal voluntary isometric SQ contraction (MVIC), and performance with the absolute load required to achieve 1 m·s-1 at baseline measurements in SQ were assessed before and after the protocols. (3) Results: BFR40 resulted in higher EMG alterations during and after exercise than the other protocols (p < 0.05). BFR40 also induced greater impairments in TMG-derived variables and BFR10 decreased contraction time. Higher blood lactate concentrations were found as the VL within the set increased. BFR0 and BFR10 showed significantly increased median frequencies in post-exercise MVIC. (4) Conclusions: High VL thresholds (BFR40) accentuated metabolic and neuromuscular stress, and produced increased alterations in muscles' mechanical properties. Low VL could potentiate post-exercise neuromuscular activity and muscle contractile properties.
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Affiliation(s)
- Juan Sánchez-Valdepeñas
- Science Based Training Research Group, Department of Sports and Computer Sciences, Universidad Pablo de Olavide, 41013 Seville, Spain; (P.J.C.-D.); (L.R.-G.); (J.A.P.-M.); (M.S.-M.); (B.B.-M.); (F.P.-B.)
- Faculty of Sport Sciences, Department of Sports and Computer Sciences, Universidad Pablo de Olavide, 41013 Seville, Spain;
| | - Pedro J. Cornejo-Daza
- Science Based Training Research Group, Department of Sports and Computer Sciences, Universidad Pablo de Olavide, 41013 Seville, Spain; (P.J.C.-D.); (L.R.-G.); (J.A.P.-M.); (M.S.-M.); (B.B.-M.); (F.P.-B.)
- Faculty of Sport Sciences, Department of Sports and Computer Sciences, Universidad Pablo de Olavide, 41013 Seville, Spain;
- Department of Human Movement and Sport Performance, University of Seville, 41013 Seville, Spain
| | - Luis Rodiles-Guerrero
- Science Based Training Research Group, Department of Sports and Computer Sciences, Universidad Pablo de Olavide, 41013 Seville, Spain; (P.J.C.-D.); (L.R.-G.); (J.A.P.-M.); (M.S.-M.); (B.B.-M.); (F.P.-B.)
- Department of Human Movement and Sport Performance, University of Seville, 41013 Seville, Spain
| | - Jose A. Páez-Maldonado
- Science Based Training Research Group, Department of Sports and Computer Sciences, Universidad Pablo de Olavide, 41013 Seville, Spain; (P.J.C.-D.); (L.R.-G.); (J.A.P.-M.); (M.S.-M.); (B.B.-M.); (F.P.-B.)
- Centre Attached to the University of Seville, University of Osuna, 41640 Osuna, Spain
| | - Miguel Sánchez-Moreno
- Science Based Training Research Group, Department of Sports and Computer Sciences, Universidad Pablo de Olavide, 41013 Seville, Spain; (P.J.C.-D.); (L.R.-G.); (J.A.P.-M.); (M.S.-M.); (B.B.-M.); (F.P.-B.)
- Department of Physical Education and Sports, University of Seville, 41013 Seville, Spain
| | - Beatriz Bachero-Mena
- Science Based Training Research Group, Department of Sports and Computer Sciences, Universidad Pablo de Olavide, 41013 Seville, Spain; (P.J.C.-D.); (L.R.-G.); (J.A.P.-M.); (M.S.-M.); (B.B.-M.); (F.P.-B.)
- Department of Human Movement and Sport Performance, University of Seville, 41013 Seville, Spain
| | - Eduardo Saez de Villarreal
- Faculty of Sport Sciences, Department of Sports and Computer Sciences, Universidad Pablo de Olavide, 41013 Seville, Spain;
| | - Fernando Pareja-Blanco
- Science Based Training Research Group, Department of Sports and Computer Sciences, Universidad Pablo de Olavide, 41013 Seville, Spain; (P.J.C.-D.); (L.R.-G.); (J.A.P.-M.); (M.S.-M.); (B.B.-M.); (F.P.-B.)
- Faculty of Sport Sciences, Department of Sports and Computer Sciences, Universidad Pablo de Olavide, 41013 Seville, Spain;
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Olmos AA, Montgomery TR, Sears KN, Dinyer TK, Hammer SM, Bergstrom HC, Hill EC, Succi PJ, Lawson J, Trevino MA. Blood flow restriction increases necessary muscle excitation of the elbow flexors during a single high-load contraction. Eur J Appl Physiol 2024; 124:1807-1820. [PMID: 38236301 DOI: 10.1007/s00421-023-05405-y] [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: 07/03/2023] [Accepted: 12/09/2023] [Indexed: 01/19/2024]
Abstract
PURPOSE To investigate the effects of blood flow restriction (BFR) on electromyographic amplitude (EMGRMS)-force relationships of the biceps brachii (BB) during a single high-load muscle action. METHODS Twelve recreationally active males and eleven recreationally active females performed maximal voluntary contractions (MVCs), followed by an isometric trapezoidal muscle action of the elbow flexors at 70% MVC. Surface EMG was recorded from the BB during BFR and control (CON) visits. For BFR, cuff pressure was 60% of the pressure required to completely occlude blood at rest. Individual b (slope) and a terms (gain) were calculated from the log-transformed EMGRMS-force relationships during the linearly increasing and decreasing segments of the trapezoid. EMGRMS during the steady force segment was normalized to MVC EMGRMS. RESULTS For BFR, the b terms were greater during the linearly increasing segment than the linearly decreasing segment (p < 0.001), and compared to the linearly increasing segment for CON (p < 0.001). The a terms for BFR were greater during the linearly decreasing than linearly increasing segment (p = 0.028). Steady force N-EMGRMS was greater for BFR than CON collapsed across sex (p = 0.041). CONCLUSION BFR likely elicited additional recruitment of higher threshold motor units during the linearly increasing- and steady force-segment. The differences between activation and deactivation strategies were only observed with BFR, such as the b terms decreased and the a terms increased for the linearly decreasing segment in comparison to the increasing segment. However, EMGRMS-force relationships during the linearly increasing- and decreasing-segments were not different between sexes during BFR and CON.
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Affiliation(s)
- Alex A Olmos
- Applied Neuromuscular Physiology Laboratory, Department of Health and Human Performance, Oklahoma State University, 191 CRC, Stillwater, OK, 74074, USA
| | - Tony R Montgomery
- Applied Neuromuscular Physiology Laboratory, Department of Health and Human Performance, Oklahoma State University, 191 CRC, Stillwater, OK, 74074, USA
| | - Kylie N Sears
- Applied Neuromuscular Physiology Laboratory, Department of Health and Human Performance, Oklahoma State University, 191 CRC, Stillwater, OK, 74074, USA
| | - Taylor K Dinyer
- Applied Neuromuscular Physiology Laboratory, Department of Health and Human Performance, Oklahoma State University, 191 CRC, Stillwater, OK, 74074, USA
| | - Shane M Hammer
- Applied Neuromuscular Physiology Laboratory, Department of Health and Human Performance, Oklahoma State University, 191 CRC, Stillwater, OK, 74074, USA
| | - Haley C Bergstrom
- Department of Kinesiology and Health Promotion, University of Kentucky, Lexington, KY, 40506, USA
| | - Ethan C Hill
- School of Kinesiology and Physical Therapy, University of Central Florida, Orlando, FL, 32816, USA
| | - Pasquale J Succi
- Department of Kinesiology and Health Promotion, University of Kentucky, Lexington, KY, 40506, USA
| | - John Lawson
- School of Kinesiology and Physical Therapy, University of Central Florida, Orlando, FL, 32816, USA
| | - Michael A Trevino
- Applied Neuromuscular Physiology Laboratory, Department of Health and Human Performance, Oklahoma State University, 191 CRC, Stillwater, OK, 74074, USA.
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Vehrs PR, Hager R, Richards ND, Richards S, Baker L, Burbank T, Clegg S, Frazier IK, Nielsen JR, Watkin JH. Measurement of arterial occlusion pressure using straight and curved blood flow restriction cuffs. Physiol Rep 2024; 12:e16119. [PMID: 38898580 PMCID: PMC11186747 DOI: 10.14814/phy2.16119] [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: 05/03/2024] [Revised: 06/07/2024] [Accepted: 06/10/2024] [Indexed: 06/21/2024] Open
Abstract
Arterial occlusion pressure (AOP) is influenced by the characteristics of the cuff used to measure AOP. Doppler ultrasound was used to measure AOP of the brachial and superficial femoral arteries using straight and curved blood flow restriction cuffs in 21 males and 21 females. Vessel diameter and blood flow were evaluated as independent predictors of AOP. Overall, there were no significant differences in AOP when using the straight and curved cuffs in the brachial (129 mmHg vs. 128 mmHg) or superficial femoral artery (202 mmHg vs. 200 mmHg), respectively. Overall, AOP was greater (p < 0.05) in males than in females in the arm (135 mmHg, 123 mmHg) and leg (211 mmHg, 191 mmHg). Brachial (0.376 mm, 0.323 mm) and superficial femoral (0.547 mm, 0.486 mm) arteries were larger (p = 0.016) in males than in females, respectively. Systolic blood pressure (SBP) and arm circumference were predictive of brachial artery AOP, whereas SBP, diastolic blood pressure, thigh circumference, and vessel diameter were predictive of superficial femoral artery AOP. Straight and curved cuffs are efficacious in the measurement of AOP in the arm and leg. Differences in vessel size may contribute to sex differences in AOP but this requires further investigation.
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Affiliation(s)
- Pat R. Vehrs
- Department of Exercise Sciences, 106 SFHBrigham Young UniversityProvoUtahUSA
| | - Ron Hager
- Department of Exercise Sciences, 106 SFHBrigham Young UniversityProvoUtahUSA
| | | | - Shay Richards
- Department of Exercise Sciences, 106 SFHBrigham Young UniversityProvoUtahUSA
| | - Luke Baker
- Department of StatisticsOhio State UniversityColumbusOhioUSA
| | - Tyler Burbank
- Department of Exercise Sciences, 106 SFHBrigham Young UniversityProvoUtahUSA
| | - Shelby Clegg
- Department of Exercise Sciences, 106 SFHBrigham Young UniversityProvoUtahUSA
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Jia B, Lv C, Li D, Lv W. Cerebral cortex activation and functional connectivity during low-load resistance training with blood flow restriction: An fNIRS study. PLoS One 2024; 19:e0303983. [PMID: 38781264 PMCID: PMC11115316 DOI: 10.1371/journal.pone.0303983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 05/03/2024] [Indexed: 05/25/2024] Open
Abstract
Despite accumulating evidence that blood flow restriction (BFR) training promotes muscle hypertrophy and strength gain, the underlying neurophysiological mechanisms have rarely been explored. The primary goal of this study is to investigate characteristics of cerebral cortex activity during BFR training under different pressure intensities. 24 males participated in 30% 1RM squat exercise, changes in oxygenated hemoglobin concentration (HbO) in the primary motor cortex (M1), pre-motor cortex (PMC), supplementary motor area (SMA), and dorsolateral prefrontal cortex (DLPFC), were measured by fNIRS. The results showed that HbO increased from 0 mmHg (non-BFR) to 250 mmHg but dropped sharply under 350 mmHg pressure intensity. In addition, HbO and functional connectivity were higher in M1 and PMC-SMA than in DLPFC. Moreover, the significant interaction effect between pressure intensity and ROI for HbO revealed that the regulation of cerebral cortex during BFR training was more pronounced in M1 and PMC-SMA than in DLPFC. In conclusion, low-load resistance training with BFR triggers acute responses in the cerebral cortex, and moderate pressure intensity achieves optimal neural benefits in enhancing cortical activation. M1 and PMC-SMA play crucial roles during BFR training through activation and functional connectivity regulation.
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Affiliation(s)
- Binbin Jia
- School of Sports Training, Wuhan Sports University, Wuhan, China
- School of Physical Education, Wuhan Sports University, Wuhan, China
| | - Chennan Lv
- Center of Strength and Conditioning, Wuhan Sports University, Wuhan, China
| | - Danyang Li
- School of Sports Training, Wuhan Sports University, Wuhan, China
- School of Physical Education, Wuhan Sports University, Wuhan, China
| | - Wangang Lv
- Center of Strength and Conditioning, Wuhan Sports University, Wuhan, China
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Geng Y, Wu X, Zhang Y, Zhang M. Potential Moderators of the Effects of Blood Flow Restriction Training on Muscle Strength and Hypertrophy: A Meta-analysis Based on a Comparison with High-Load Resistance Training. SPORTS MEDICINE - OPEN 2024; 10:58. [PMID: 38773002 PMCID: PMC11109065 DOI: 10.1186/s40798-024-00719-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 04/21/2024] [Indexed: 05/23/2024]
Abstract
BACKGROUND While it has been examined whether there are similar magnitudes of muscle strength and hypertrophy adaptations between low-load resistance training combined with blood-flow restriction training (BFR-RT) and high-load resistance training (HL-RT), some important potential moderators (e.g., age, sex, upper and lower limbs, frequency and duration etc.) have yet to be analyzed further. Furthermore, training status, specificity of muscle strength tests (dynamic versus isometric or isokinetic) and specificity of muscle mass assessments (locations of muscle hypertrophy assessments) seem to exhibit different effects on the results of the analysis. The role of these influencing factors, therefore, remains to be elucidated. OBJECTIVES The aim of this meta-analysis was to compare the effects of BFR- versus HL-RT on muscle adaptations, when considering the influence of population characteristics (training status, sex and age), protocol characteristics (upper or lower limbs, duration and frequency) and test specificity. METHODS Studies were identified through database searches based on the following inclusion criteria: (1) pre- and post-training assessment of muscular strength; (2) pre- and post-training assessment of muscular hypertrophy; (3) comparison of BFR-RT vs. HL-RT; (4) score ≥ 4 on PEDro scale; (5) means and standard deviations (or standard errors) are reported or allow estimation from graphs. In cases where the fifth criterion was not met, the data were requested directly from the authors. RESULTS The main finding of the present study was that training status was an important influencing factor in the effects of BFR-RT. The trained individuals may gain greater muscle strength and hypertrophy with BFR-RT as compared to HL-RT. However, the results showed that the untrained individuals experienced similar muscle mass gains and superior muscle strength gains in with HL-RT compared to BFR-RT. CONCLUSION Compared to HL-RT, training status is an important factor influencing the effects of the BFR-RT, in which trained can obtain greater muscle strength and hypertrophy gains in BFR-RT, while untrained individuals can obtain greater strength gains and similar hypertrophy in HL-RT.
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Affiliation(s)
- Yu Geng
- Department of Physical Education, Jiyang College of Zhejiang A&F University, Zhuji, 311800, People's Republic of China.
| | - Xueping Wu
- School of Physical Education, Shanghai University of Sport, Shanghai, People's Republic of China
| | - Yong Zhang
- Department of Rehabilitation Medicine, School of Medicine, Shaoxing University, Zhejiang, People's Republic of China
| | - Meng Zhang
- School of Physical Education, Huzhou University, Zhejiang, People's Republic of China
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Colapietro MA, Lee JZ, Vairo GL. Survey of Blood Flow Restriction Training Applications in Sports Medicine and Performance Practice Across North America. J Strength Cond Res 2024; 38:856-863. [PMID: 38241466 DOI: 10.1519/jsc.0000000000004702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Abstract
Abstract
Colapietro, MA, Lee, JZ, and Vairo, GL. Survey of blood flow restriction training applications in sports medicine and performance practice across North America. J Strength Cond Res 38(5): 856–863, 2024—This study profiled current clinical applications of blood flow restriction (BFR) training and observed side effects by surveying active sports medicine and performance personnel across North America. An online survey consisting of questions derived from a related position statement was distributed through professional organizations, email listservs, and social media. Personnel with experience applying or prescribing BFR training with permanent residence within the United States or Canada were eligible to participate. Variables captured included demographics (profession, practice setting), BFR equipment, treatment parameters, observed side effects, and personal perceptions regarding BFR training. An alpha level of p < 0.05 determined significance. A convenience sample included 72 clinicians with 67 being from the United States. Athletic trainers (n = 35) and physical therapists (n = 30) primarily participated. Chi-square test of independence indicated that a higher proportion of physical therapists (90.3%) report receiving formal education in BFR training compared with athletic trainers (65.7%) (
= 4.1, p = 0.043). Parameters varied between respondents for exercise prescription and occlusion settings. Respondents primarily followed position statement recommendations with individualized pressure selections for resistance (80.9%) and aerobic (84.8%) BFR modes. Side effects reported included delayed onset muscle soreness (66.2%), inability to continue because of pain (28%), and numbness (22.5%). Personal perceptions between athletic trainers and physical therapists were compared using independent t-tests. Physical therapists indicated higher confidence in safety (difference = 0.37 ± 0.32, p = 0.026), understanding recommendations (difference = 0.47 ± 0.37, p = 0.011), and theoretical principles (difference = 0.80 ± 0.53, p = 0.004). Despite variation in BFR parameters used, sports medicine personnel demonstrate compliance with position statement recommendations and report mild side effects.
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Affiliation(s)
- Mark A Colapietro
- Department of Kinesiology, The Pennsylvania State University, University Park, Pennsylvania
| | - Jungmin Z Lee
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, Pennsylvania; and
| | - Giampietro L Vairo
- Department of Kinesiology, The Pennsylvania State University, University Park, Pennsylvania
- Department of Orthopaedics and Rehabilitation, The Pennsylvania State University, University Park, Pennsylvania
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Cockfield BA, Wedig IJ, Vinckier AL, McDaniel J, Elmer SJ. Physiological and perceptual responses to acute arm cranking with blood flow restriction. Eur J Appl Physiol 2024; 124:1509-1521. [PMID: 38142449 DOI: 10.1007/s00421-023-05384-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 11/27/2023] [Indexed: 12/26/2023]
Abstract
INTRODUCTION Lower-body aerobic exercise with blood flow restriction (BFR) offers a unique approach for stimulating improvements in muscular function and aerobic capacity. While there are more than 40 reports documenting acute and chronic responses to lower-body aerobic exercise with BFR, responses to upper-body aerobic exercise with BFR are not clearly established. PURPOSE We evaluated acute physiological and perceptual responses to arm cranking with and without BFR. METHODS Participants (N = 10) completed 4 arm cranking (6 × 2 min exercise, 1 min recovery) conditions: low-intensity at 40%VO2peak (LI), low-intensity at 40%VO2peak with BFR at 50% of arterial occlusion pressure (BFR50), low-intensity at 40%VO2peak with BFR at 70% of arterial occlusion pressure (BFR70), and high-intensity at 80%VO2peak (HI) while tissue oxygenation, cardiorespiratory, and perceptual responses were assessed. RESULTS During exercise, tissue saturation for BFR50 (54 ± 6%), BFR70 (55 ± 6%), and HI (54 ± 8%) decreased compared to LI (61 ± 5%, all P < 0.01) and changes in deoxyhemoglobin for BFR50 (11 ± 4), BFR70 (15 ± 6), and HI (16 ± 10) increased compared to LI (4 ± 2, all P < 0.01). During recovery intervals, tissue saturation for BFR50 and BFR70 decreased further and deoxyhemoglobin for BFR50 and BFR70 increased further (all P < 0.04). Heart rate for BFR70 and HI increased by 9 ± 9 and 50 ± 15b/min, respectively, compared to LI (both P < 0.02). BFR50 (8 ± 2, 1.0 ± 1.0) and BFR70 (10 ± 2, 2.1 ± 1.4) elicited greater arm-specific perceived exertion (6-20 scale) and pain (0-10 scale) compared to LI (7 ± 1, 0.2 ± 0.5, all P < 0.05) and pain for BFR70 did not differ from HI (1.7 ± 1.9). CONCLUSION Arm cranking with BFR decreased tissue saturation and increased deoxyhemoglobin without causing excessive cardiorespiratory strain and pain.
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Affiliation(s)
- Benjamin A Cockfield
- Department of Kinesiology and Integrative Physiology, College of Science and Arts, Michigan Technological University, 1400 Townsend Dr., Houghton, MI, 49931, USA
- Department of Physical Therapy, Central Michigan University, Mount Pleasant, MI, USA
| | - Isaac J Wedig
- Department of Kinesiology and Integrative Physiology, College of Science and Arts, Michigan Technological University, 1400 Townsend Dr., Houghton, MI, 49931, USA
- Health Research Institute, Michigan Technological University, Houghton, MI, USA
- School of Health and Human Performance, Marquette, MI, USA
| | - Alyssa L Vinckier
- Department of Kinesiology and Integrative Physiology, College of Science and Arts, Michigan Technological University, 1400 Townsend Dr., Houghton, MI, 49931, USA
- Department of Physical Therapy, Central Michigan University, Mount Pleasant, MI, USA
| | - John McDaniel
- Exercise Physiology Program, Kent State University, Kent, OH, USA
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, USA
| | - Steven J Elmer
- Department of Kinesiology and Integrative Physiology, College of Science and Arts, Michigan Technological University, 1400 Townsend Dr., Houghton, MI, 49931, USA.
- Health Research Institute, Michigan Technological University, Houghton, MI, USA.
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Vehrs PR, Richards S, Allen J, Barrett R, Blazzard C, Burbank T, Hart H, Kasper N, Lacey R, Lopez D, Fellingham GW. Measurements of Arterial Occlusion Pressure Using Hand-Held Devices. J Strength Cond Res 2024; 38:873-880. [PMID: 38241480 DOI: 10.1519/jsc.0000000000004716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Abstract
ABSTRACT Vehrs, PR, Reynolds, S, Allen, J, Barrett, R, Blazzard, C, Burbank, T, Hart, H, Kasper, N, Lacey, R, Lopez, D, and Fellingham, GW. Measurements of arterial occlusion pressure using hand-held devices. J Strength Cond Res 38(5): 873-880, 2024-Arterial occlusion pressure (AOP) of the brachial artery was measured simultaneously using Doppler ultrasound (US), a hand-held Doppler (HHDOP), and a pulse oximeter (PO) in the dominant (DOM) and nondominant (NDOM) arms of males ( n = 21) and females ( n = 23) using continuous (CONT) and incremental (INCR) cuff inflation protocols. A mixed-model analysis of variance revealed significant ( p < 0.05) overall main effects between AOP measured using a CONT (115.7 ± 10.9) or INCR (115.0 ± 11.5) cuff inflation protocol; between AOP measured using US (116.3 ± 11.2), HHDOP (115.4 ± 11.2), and PO (114.4 ± 11.2); and between males (120.7 ± 10.6) and females (110.5 ± 9.4). The small overall difference (1.81 ± 3.3) between US and PO measures of AOP was significant ( p < 0.05), but the differences between US and HHDOP and between HHDOP and PO measures of AOP were not significant. There were no overall differences in AOP between the DOM and NDOM arms. Trial-to-trial variance in US measurements of AOP was not significant when using either cuff inflation protocol but was significant when using HHDOP and PO and a CONT cuff inflation protocol. Bland-Altman plots revealed reasonable limits of agreement for both HHDOP and PO measures of AOP. The small differences in US, HHDOP, and PO measurements of AOP when using CONT or INCR cuff inflation protocols are of minimal practical importance. The choice of cuff inflation protocol is one of personal preference. Hand-held Doppler of PO can be used to assess AOP before using blood flow restriction during exercise.
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Affiliation(s)
- Pat R Vehrs
- Department of Exercise Sciences, Brigham Young University, Provo, Utah; and
| | - Shay Richards
- Department of Exercise Sciences, Brigham Young University, Provo, Utah; and
| | - Josh Allen
- Department of Exercise Sciences, Brigham Young University, Provo, Utah; and
| | - Rachel Barrett
- Department of Exercise Sciences, Brigham Young University, Provo, Utah; and
| | - Chase Blazzard
- Department of Exercise Sciences, Brigham Young University, Provo, Utah; and
| | - Tyler Burbank
- Department of Exercise Sciences, Brigham Young University, Provo, Utah; and
| | - Hannah Hart
- Department of Exercise Sciences, Brigham Young University, Provo, Utah; and
| | - Nicole Kasper
- Department of Exercise Sciences, Brigham Young University, Provo, Utah; and
| | - Ryan Lacey
- Department of Exercise Sciences, Brigham Young University, Provo, Utah; and
| | - Daniela Lopez
- Department of Exercise Sciences, Brigham Young University, Provo, Utah; and
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Vogiatzis I. Role of blood flow restriction strength training in chronic obstructive pulmonary disease. Thorax 2024; 79:289-290. [PMID: 38286615 DOI: 10.1136/thorax-2023-221218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2024] [Indexed: 01/31/2024]
Affiliation(s)
- Ioannis Vogiatzis
- Department of Sport, Exercise and Rehabilitation, School of Health and Life Sciences, Northumbria University Newcastle, Newcastle upon Tyne, UK
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Clark K, Trickett J, Donovan L, Dawson J, Goetschius J. Effects of Blood Flow Restriction on Balance Performance During Dynamic Balance Exercises in Individuals With Chronic Ankle Instability. J Sport Rehabil 2024; 33:181-188. [PMID: 38350443 DOI: 10.1123/jsr.2023-0182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 01/12/2024] [Accepted: 01/15/2024] [Indexed: 02/15/2024]
Abstract
CONTEXT Blood flow restriction (BFR) is a rehabilitation tool which may introduce a constraint, similar to muscle fatigue, that challenge patients' sensorimotor system during balance exercises. The purpose of our study was to examine whether adding BFR to dynamic balance exercises produced a decrease in balance performance and an increase in ratings of perceived exertion and instability in individuals with chronic ankle instability (CAI) compared with dynamic balance exercises without BFR. DESIGNS Crossover design. METHODS Our sample included N = 25 young adults with a history of CAI. Participants completed 2 laboratory visits. At each visit, participants completed 4 sets (30×-15×-15×-15×) of dynamic balance exercises, performed similar to the modified star excursion balance test (SEBT), once with BFR and once with control (no BFR) conditions. We measured composite SEBT scores at baseline and during the final repetitions of each set of balance exercise (sets 1-4). We also measured ratings of perceived exertion and instability following each balance exercise set. RESULTS We observed no difference in composite SEBT scores between conditions at baseline; however, composite SEBT scores were significantly lower during all balance exercises sets 1 to 4 with the BFR condition compared with control. During the BFR condition, composite SEBT scores were significantly lower during all balance exercise sets compared with baseline. During the control condition, composite SEBT scores did not significantly change between baseline and each balance exercise set. Ratings of perceived exertion and instability scores were significantly greater in the BFR group compared with the control group during all balance exercise sets. CONCLUSIONS Individuals with CAI demonstrated lower composite SEBT scores and greater perceived instability and exertion during dynamic balance exercise with BFR compared to without BFR. BFR introduced a novel muscle fatigue constraint during dynamic balance exercises in individuals with CAI. Additional research is needed to determine if adding BFR to balance training could improve clinical outcomes in CAI patients.
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Affiliation(s)
- Krista Clark
- Department of Health Professions, James Madison University, Harrisonburg, VA, USA
| | - Justin Trickett
- Department of Health Professions, James Madison University, Harrisonburg, VA, USA
| | - Luke Donovan
- Department of Applied Physiology, Health, & Clinical Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Jordan Dawson
- Department of Health Professions, James Madison University, Harrisonburg, VA, USA
| | - John Goetschius
- Department of Health Professions, James Madison University, Harrisonburg, VA, USA
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39
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Scott BR, Marston KJ, Owens J, Rolnick N, Patterson SD. Current Implementation and Barriers to Using Blood Flow Restriction Training: Insights From a Survey of Allied Health Practitioners. J Strength Cond Res 2024; 38:481-490. [PMID: 38088873 DOI: 10.1519/jsc.0000000000004656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
ABSTRACT Scott, BR, Marston, KJ, Owens, J, Rolnick, N, and Patterson, SD. Current implementation and barriers to using blood flow restriction training: Insights from a survey of allied health practitioners. J Strength Cond Res 38(3): 481-490, 2024-This study investigated the use of blood flow restriction (BFR) exercise by practitioners working specifically with clinical or older populations, and the barriers preventing some practitioners from prescribing BFR. An online survey was disseminated globally to allied health practitioners, with data from 397 responders included in analyses. Responders who had prescribed BFR exercise ( n = 308) completed questions about how they implement this technique. Those who had not prescribed BFR exercise ( n = 89) provided information on barriers to using this technique, and a subset of these responders ( n = 22) completed a follow-up survey to investigate how these barriers could be alleviated. Most practitioners prescribe BFR exercise for musculoskeletal rehabilitation clients (91.6%), with the BFR cuff pressure typically relative to arterial occlusion pressure (81.1%) and implemented with resistance (96.8%) or aerobic exercise (42.9%). Most practitioners screen for contraindications (68.2%), although minor side effects, including muscle soreness (65.8%), are common. The main barriers preventing some practitioners from using BFR are lack of equipment (60.2%), insufficient education (55.7%), and safety concerns (31.8%). Suggestions to alleviate these barriers included developing educational resources about the safe application and benefits of BFR exercise ( n = 20) that are affordable ( n = 3) and convenient ( n = 4). These results indicate that BFR prescription for clinical and older cohorts mainly conforms with current guidelines, which is important considering the potentially increased risk for adverse events in these cohorts. However, barriers still prevent broader utility of BFR training, although some may be alleviated through well-developed educational offerings to train practitioners in using BFR exercise.
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Affiliation(s)
- Brendan R Scott
- Centre for Healthy Ageing, Murdoch University, Perth, Australia
- Murdoch Applied Sports Science Laboratory, Discipline of Exercise Science, Murdoch University, Perth, Australia
| | - Kieran J Marston
- Centre for Healthy Ageing, Murdoch University, Perth, Australia
- Murdoch Applied Sports Science Laboratory, Discipline of Exercise Science, Murdoch University, Perth, Australia
| | | | - Nicholas Rolnick
- The Human Performance Mechanic, CUNY Lehman College, New York, NY; and
| | - Stephen D Patterson
- Faculty of Sport, Allied Health & Performance Sciences, St Mary's University, London, United Kingdom
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40
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Jønsson AB, Krogh S, Laursen HS, Aagaard P, Kasch H, Nielsen JF. Safety and efficacy of blood flow restriction exercise in individuals with neurological disorders: A systematic review. Scand J Med Sci Sports 2024; 34:e14561. [PMID: 38268066 DOI: 10.1111/sms.14561] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/02/2024] [Accepted: 01/03/2024] [Indexed: 01/26/2024]
Abstract
OBJECTIVES This systematic review evaluated the safety and efficacy of blood flow restriction exercise (BFRE) on skeletal muscle size, strength, and functional performance in individuals with neurological disorders (ND). METHODS A literature search was performed in PubMed, CINAHL, and Embase. Two researchers independently assessed eligibility and performed data extraction and quality assessments. ELIGIBILITY CRITERIA Study populations with ND, BFRE as intervention modality, outcome measures related to safety or efficacy. RESULTS Out of 443 studies identified, 16 were deemed eligible for review. Three studies examined the efficacy and safety of BFRE, one study focused on efficacy results, and 12 studies investigated safety. Disease populations included spinal cord injury (SCI), inclusion body myositis (sIBM), multiple sclerosis (MS), Parkinson's disease (PD), and stroke. A moderate-to-high risk of bias was presented in the quality assessment. Five studies reported safety concerns, including acutely elevated pain and rating of perceived exertion levels, severe fatigue, muscle soreness, and cases of autonomic dysreflexia. Two RCTs reported a significant between-group difference in physical function outcomes, and two RCTs reported neuromuscular adaptations. CONCLUSION BFRE seems to be a potentially safe and effective training modality in individuals with ND. However, the results should be interpreted cautiously due to limited quality and number of studies, small sample sizes, and a general lack of heterogeneity within and between the examined patient cohorts.
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Affiliation(s)
- Anette Bach Jønsson
- Spinal Cord Injury Center of Western Denmark, Viborg, Denmark
- Department of Clinical Medicine, Health, Aarhus University, Aarhus N, Denmark
| | - Søren Krogh
- Spinal Cord Injury Center of Western Denmark, Viborg, Denmark
- Department of Clinical Medicine, Health, Aarhus University, Aarhus N, Denmark
| | | | - Per Aagaard
- Institute of Sports Science and Clinical Biomechanics, Muscle Physiology and Biomechanics Research Unit, University of Southern, Odense, Denmark
| | - Helge Kasch
- Department of Clinical Medicine, Health, Aarhus University, Aarhus N, Denmark
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Jørgen Feldbaek Nielsen
- Spinal Cord Injury Center of Western Denmark, Viborg, Denmark
- Department of Clinical Medicine, Health, Aarhus University, Aarhus N, Denmark
- Hammel Neurorehabilitation Centre and University Clinic, Hammel, Denmark
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Yang J, Ma F, Wang Q, Cui Y, Zheng J. Effect of blood flow restriction with low-load exercise on muscle damage in healthy adults: A systematic review of randomized controlled trials. Clin Physiol Funct Imaging 2024; 44:1-13. [PMID: 37577825 DOI: 10.1111/cpf.12852] [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: 05/08/2023] [Revised: 08/08/2023] [Accepted: 08/11/2023] [Indexed: 08/15/2023]
Abstract
INTRODUCTION Blood flow restriction (BFR) is a relatively new rehabilitative technique and low-load exercise combined with BFR (LL-BFR) can increase muscle strength and muscle mass. However, it is currently unknown whether LL-BFR causes muscle damage. Therefore, the aim of this study is to investigate the effects of LL-BFR on muscle damage and provide recommendations for sports training and physical exercise. MATERIALS AND METHODS A systematic search was conducted using PubMed, Web of Science, Medline, Cochrane Library and Physiotherapy Evidence Database (PEDro) with a cut-off of March 2022. Randomized controlled trials (RCTs) and English-language studies were selected. Two independent assessors used the PEDro scoring scale to evaluate the methodological quality and risk of bias of the included studies. RESULTS Of the 2935 articles identified, 15 RCTs were included in this systematic review. Two studies demonstrated that LL-BFR could induce muscle damage in healthy individuals; however, two studies presented contrasting findings in the short term. Four studies found that no muscle damage occurred after LL-BFR in the long term. The remaining seven articles showed that it was unclear if LL-BFR could cause muscle damage, regardless of whether these participants were trained or not. CONCLUSION Although LL-BFR may induce muscle damage within 1 week, it will help gain long-term muscle strength and muscle hypertrophy. However, the lack of sufficient evidence on the effect of LL-BFR on muscle damage in clinical practice warrants additional RCTs with large sample sizes in the future.
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Affiliation(s)
- Jinchao Yang
- Department of Rehabilitation Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Fenghao Ma
- Department of Therapy, Shanghai Yangzhi Rehabilitation Hospital, Tongji University School of Medicine, Shanghai, China
| | - Qian Wang
- Department of Rehabilitation Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yuanfen Cui
- Department of Pain Management, Wuhan No. 1 Hospital, Wuhan, China
| | - Jun Zheng
- Department of Rehabilitation Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
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Russo A, Boppre G, Schmidt C, Bohn L. Chronic hemodynamic adaptations induced by resistance training with and without blood flow restriction in adults: A systematic review and meta-analysis. SPORTS MEDICINE AND HEALTH SCIENCE 2023; 5:259-268. [PMID: 38314050 PMCID: PMC10831382 DOI: 10.1016/j.smhs.2023.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 09/05/2023] [Accepted: 09/14/2023] [Indexed: 02/06/2024] Open
Abstract
The purposes of this systematic review and meta-analysis of peer-reviewed literature were to examine the chronic effects of resistance training with blood flow restriction (RT-BFR) on hemodynamics, and to compare these adaptations to those induced by traditional resistance training (TRT) programs in adults (PROSPERO: Registry: CRD42022339510). A literature search was conducted across PubMed, Sports Discus, Scielo, and Web of Science databases. Two independent reviewers extracted study characteristics and blood pressure measures. Risk of bias (The Cochrane risk of bias tool for randomized controlled trials [RoB-2]), and the certainty of the evidence (Grading of Recommendations, Assessment, Development, and Evaluation [GRADE]) were used. A total of eight studies met the inclusion criteria for systolic (SBP), diastolic (DBP), and mean arterial pressure (MAP). Regarding the comparison of RT-BFR vs. non-exercise, no significant differences favoring the exercise group were observed (p > 0.05). However, when compared to TRT, RT-BFR elicited additional improvements on DBP (-3.35; 95%CI -6.00 to -0.71; I2 = 14%; z = -2.48, p = 0.01), and on MAP (-3.96; 95%CI -7.94 to 0.02; I2 = 43%; z = -1.95, p = 0.05). Results indicate that RT-BFR may elicit a decrease in DBP in comparison with TRT, but the lack of data addressing this topic makes any conclusion speculative. Future research on this topic is warranted.
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Affiliation(s)
- Allison Russo
- Lusofona University, Faculty of Psychology, Education and Sport, Porto, Portugal
| | - Giorjines Boppre
- University of Porto, Faculty of Sports (FADEUP), Porto, Portugal
- Human Motricity Research Center, University Adventist, Chillan, Chile
- Research Center in Physical Activity, Health, and Leisure (CIAFEL), Laboratory for Integrative and Translational Research in Population Health (ITR), Portugal
| | - Cristine Schmidt
- University of Porto, Faculty of Sports (FADEUP), Porto, Portugal
- Research Center in Physical Activity, Health, and Leisure (CIAFEL), Laboratory for Integrative and Translational Research in Population Health (ITR), Portugal
- Surgery and Physiology Department, University of Porto, Faculty of Medicine (FMUP), Porto, Portugal
| | - Lucimere Bohn
- Lusofona University, Faculty of Psychology, Education and Sport, Porto, Portugal
- University of Porto, Faculty of Sports (FADEUP), Porto, Portugal
- Research Center in Physical Activity, Health, and Leisure (CIAFEL), Laboratory for Integrative and Translational Research in Population Health (ITR), Portugal
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Parkington T, Broom D, Maden-Wilkinson T, Nawaz S, Klonizakis M. Low-intensity resistance exercise with blood flow restriction for patients with claudication: A randomized controlled feasibility trial. Vasc Med 2023; 28:554-563. [PMID: 37819259 PMCID: PMC10693738 DOI: 10.1177/1358863x231200250] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
BACKGROUND Claudication is a common and debilitating symptom of peripheral artery disease, resulting in poor exercise performance and quality of life (QoL). Supervised exercise programs are an effective rehabilitation for patients with claudication, but they are poorly adhered to, in part due to the high pain and effort associated with walking, aerobic, and resistance exercise. Low-intensity resistance exercise with blood flow restriction (BFR) represents an alternative exercise method for individuals who are intolerant to high-intensity protocols. The aim of this study was to evaluate the feasibility of a supervised BFR program in patients with claudication. METHODS Thirty patients with stable claudication completed an 8-week supervised exercise program and were randomized to either BFR (n = 15) or a control of matched exercise without BFR (control; n = 15). Feasibility, safety, and efficacy were assessed. RESULTS All success criteria of the feasibility trial were met. Exercise adherence was high (BFR = 78.3%, control = 83.8%), loss to follow up was 10%, and there were no adverse events. Clinical improvement in walking was achieved in 86% of patients in the BFR group but in only 46% of patients in the control group. Time to claudication pain during walking increased by 35% for BFR but was unchanged for the control. QoL for the BFR group showed improved mobility, ability to do usual activities, pain, depression, and overall health at follow up. CONCLUSION A supervised blood flow restriction program is feasible in patients with claudication and has the potential to increase exercise performance, reduce pain, and improve QoL. (Clinicaltrials.gov Identifier: NCT04890275).
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Affiliation(s)
- Thomas Parkington
- Department of Nursing and Midwifery, Lifestyle, Exercise and Nutrition Improvement Research Group, Sheffield Hallam University, Sheffield, UK
- Department of Sport and Physical Activity, Physical Activity, Wellness and Public Health Research Group, Sheffield Hallam University, Sheffield, UK
| | - David Broom
- Centre for Sport, Exercise and Life Sciences, Coventry University, Coventry, UK
| | - Thomas Maden-Wilkinson
- Department of Sport and Physical Activity, Physical Activity, Wellness and Public Health Research Group, Sheffield Hallam University, Sheffield, UK
| | - Shah Nawaz
- Sheffield Vascular Institute, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Markos Klonizakis
- Department of Nursing and Midwifery, Lifestyle, Exercise and Nutrition Improvement Research Group, Sheffield Hallam University, Sheffield, UK
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Lowe TW, Tenan MS, Shah K, Griffin L. Low-load blood flow restriction reduces time-to-minimum single motor unit discharge rate. Exp Brain Res 2023; 241:2795-2805. [PMID: 37874365 DOI: 10.1007/s00221-023-06720-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 10/04/2023] [Indexed: 10/25/2023]
Abstract
Resistance training with low loads in combination with blood flow restriction (BFR) facilitates increases in muscle size and strength comparable with high-intensity exercise. We investigated the effects of BFR on single motor unit discharge behavior throughout a sustained low-intensity isometric contraction. Ten healthy individuals attended two experimental sessions: one with, the other without, BFR. Motor unit discharge rates from the tibialis anterior (TA) were recorded with intramuscular fine-wire electrodes throughout the duration of a sustained fatigue task. Three 5-s dorsiflexion maximal voluntary contractions (MVC) were performed before and after the fatigue task. Each participant held a target force of 20% MVC until endurance limit. A significant decrease in motor unit discharge rate was observed in both the non-BFR condition (from 13.13 ± 0.87 Hz to 11.95 ± 0.43 Hz, P = 0.03) and the BFR condition (from 12.95 ± 0.71 Hz to 10.9 ± 0.75 Hz, P = 0.03). BFR resulted in significantly shorter endurance time and time-to-minimum discharge rates and greater end-stage motor unit variability. Thus, low-load BFR causes an immediate steep decline in motor unit discharge rate that is greater than during contractions performed without BFR. This shortened neuromuscular response of time-to-minimum discharge rate likely contributes to the rapid rate of neuromuscular fatigue observed during BFR.
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Affiliation(s)
- Timothy W Lowe
- Paul M. Rady Department of Mechanical Engineering, University of Colorado Boulder, Boulder, CO, USA
| | - Matthew S Tenan
- The Blanchette Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, USA
| | - Kena Shah
- Select Physical Therapy, Spring, TX, USA
| | - Lisa Griffin
- Department of Kinesiology and Health Education, The University of Texas at Austin, 1University Station, D3700, Austin, TX, 78712, USA.
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Bettariga F, Bishop C, Taaffe DR, Galvão DA, Maestroni L, Newton RU. Time to consider the potential role of alternative resistance training methods in cancer management? JOURNAL OF SPORT AND HEALTH SCIENCE 2023; 12:715-725. [PMID: 37399886 PMCID: PMC10658316 DOI: 10.1016/j.jshs.2023.06.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/09/2023] [Accepted: 06/08/2023] [Indexed: 07/05/2023]
Abstract
Exercise has emerged as fundamental therapeutic medicine in the management of cancer. Exercise improves health-related outcomes, including quality of life, neuromuscular strength, physical function, and body composition, and it is associated with a lower risk of disease recurrence and increased survival. Moreover, exercise during or post cancer treatments is safe, can ameliorate treatment-related side effects, and may enhance the effectiveness of chemotherapy and radiation therapy. To date, traditional resistance training (RT) is the most used RT modality in exercise oncology. However, alternative training modes, such as eccentric, cluster set, and blood flow restriction are gaining increased attention. These training modalities have been extensively investigated in both athletic and clinical populations (e.g., age-related frailty, cardiovascular disease, type 2 diabetes), showing considerable benefits in terms of neuromuscular strength, hypertrophy, body composition, and physical function. However, these training modes have only been partially or not at all investigated in cancer populations. Thus, this study outlines the benefits of these alternative RT methods in patients with cancer. Where evidence in cancer populations is sparse, we provide a robust rationale for the possible implementation of certain RT methods that have shown positive results in other clinical populations. Finally, we provide clinical insights for research that may guide future RT investigations in patients with cancer and suggest clear practical applications for targeted cancer populations and related benefits.
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Affiliation(s)
- Francesco Bettariga
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA 6027, Australia; School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA 6027, Australia
| | - Chris Bishop
- London Sport Institute, School of Science and Technology, Middlesex University, London, NW4 4BT, UK
| | - Dennis R Taaffe
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA 6027, Australia; School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA 6027, Australia
| | - Daniel A Galvão
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA 6027, Australia; School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA 6027, Australia
| | - Luca Maestroni
- London Sport Institute, School of Science and Technology, Middlesex University, London, NW4 4BT, UK
| | - Robert U Newton
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA 6027, Australia; School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA 6027, Australia; School of Human Movement and Nutrition Sciences, University of Queensland, St. Lucia, QLD 4067, Australia.
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Davids CJ, Roberts LA, Bjørnsen T, Peake JM, Coombes JS, Raastad T. Where Does Blood Flow Restriction Fit in the Toolbox of Athletic Development? A Narrative Review of the Proposed Mechanisms and Potential Applications. Sports Med 2023; 53:2077-2093. [PMID: 37578669 PMCID: PMC10587223 DOI: 10.1007/s40279-023-01900-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2023] [Indexed: 08/15/2023]
Abstract
Blood flow-restricted exercise is currently used as a low-intensity time-efficient approach to reap many of the benefits of typical high-intensity training. Evidence continues to lend support to the notion that even highly trained individuals, such as athletes, still benefit from this mode of training. Both resistance and endurance exercise may be combined with blood flow restriction to provide a spectrum of adaptations in skeletal muscle, spanning from myofibrillar to mitochondrial adjustments. Such diverse adaptations would benefit both muscular strength and endurance qualities concurrently, which are demanded in athletic performance, most notably in team sports. Moreover, recent work indicates that when traditional high-load resistance training is supplemented with low-load, blood flow-restricted exercise, either in the same session or as a separate training block in a periodised programme, a synergistic and complementary effect on training adaptations may occur. Transient reductions in mechanical loading of tissues afforded by low-load, blood flow-restricted exercise may also serve a purpose during de-loading, tapering or rehabilitation of musculoskeletal injury. This narrative review aims to expand on the current scientific and practical understanding of how blood flow restriction methods may be applied by coaches and practitioners to enhance current athletic development models.
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Affiliation(s)
- Charlie J Davids
- Sport, Performance, and Nutrition Research Group, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia.
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD, Australia.
- Sport Performance Innovation and Knowledge Excellence (SPIKE), Queensland Academy of Sport, Brisbane, QLD, Australia.
| | - Llion A Roberts
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD, Australia
- Sport Performance Innovation and Knowledge Excellence (SPIKE), Queensland Academy of Sport, Brisbane, QLD, Australia
- School of Health Sciences and Social Work, Griffith University, Gold Coast, QLD, Australia
| | - Thomas Bjørnsen
- Department of Sport Science and Physical Education, University of Agder, Kristiansand, Norway
- Norwegian Olympic and Paralympic Committee and Confederation of Sports, Oslo, Norway
| | - Jonathan M Peake
- Sport Performance Innovation and Knowledge Excellence (SPIKE), Queensland Academy of Sport, Brisbane, QLD, Australia
- School of Biomedical Science, Queensland University of Technology, Brisbane, QLD, Australia
| | - Jeff S Coombes
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Truls Raastad
- Norwegian Olympic and Paralympic Committee and Confederation of Sports, Oslo, Norway
- Department of Physical Performance, Norwegian School of Sport Science, Oslo, Norway
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Kong W, Wang H, Cheng L, Ni G. Comparing the effect of intermittent blood flow restriction training and high-load resistance training in patients with patellofemoral pain: study protocol for a randomised trial. BMJ Open 2023; 13:e073188. [PMID: 37865415 PMCID: PMC10603463 DOI: 10.1136/bmjopen-2023-073188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 10/02/2023] [Indexed: 10/23/2023] Open
Abstract
BACKGROUND Patellofemoral pain (PFP) syndrome is a common knee joint functional disorder. Blood flow restriction (BFR) training has shown promise in improving PFP; however, the effectiveness of intermittent BFR (iBFR) training remains uncertain. This study aims to compare the rehabilitative effects of iBFR combined with low-load resistance training and high-load resistance training in PFP patients and to assess the effectiveness of iBFR combined with low-load resistance training for improving PFP. METHODS AND ANALYSIS This randomised, patient-assessor blinded, controlled trial will include 42 eligible PFP patients randomly allocated to an intervention group (iBFR combined with low-load resistance training) or a control group (high-load resistance training) in a 1:1 ratio. Participants will receive interventions three times per week for 8 weeks and will be followed up for 24 weeks. The primary outcome measure is pain, and the secondary outcomes include self-reported function, quality of life, muscle strength and muscle thickness. Assessments will be conducted at baseline, 8 weeks and 24 weeks during follow-up. Intention-to-treat analysis will be performed.Collectively, we expect that the findings of this randomised clinical trial will contribute to understanding the potential benefits of iBFR training and provide insightful guidance for developing more effective treatment strategies for patients with PFP. ETHICS AND DISSEMINATION This study was approved by the Sports Science Experiment Ethics Committee of Beijing Sport University (2022274H). Written informed consent will be obtained from all participants. Trial results will be disseminated through peer-reviewed publications. TRIAL REGISTRATION NUMBER Chinese Clinical Trial Registry (ChiCTR2300068281).
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Affiliation(s)
- Weiya Kong
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, China
| | - Haonan Wang
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, China
| | - Lin Cheng
- Department of Rehabilitation, Tongzhou District Hospital of Integrated Chinese and Western Medicine, Beijing, China
| | - Guoxin Ni
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian, China
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Pavlou K, Savva C, Korakakis V, Pamboris GM, Karagiannis C, Ploutarchou G, Constantinou A. Blood Flow Restriction Training in Nonspecific Shoulder Pain: Study Protocol of a Crossover Randomised Controlled Trial. Sports (Basel) 2023; 11:197. [PMID: 37888524 PMCID: PMC10610701 DOI: 10.3390/sports11100197] [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: 09/02/2023] [Revised: 10/03/2023] [Accepted: 10/07/2023] [Indexed: 10/28/2023] Open
Abstract
"Nonspecific shoulder pain" encompasses various non-traumatic musculoskeletal shoulder disorders, diverging from diagnostic terminologies that refer to precise tissue-oriented clinical diagnosis. Blood flow restriction (BFR) training, involving partial arterial inflow and complete venous outflow restriction, has exhibited acute hypoalgesic effects primarily in healthy populations by increasing their pain thresholds. This study aims to examine whether a single BFR session with low-load exercises can alleviate pain perception among nonspecific shoulder pain patients. Conducted as a single-blind crossover randomised clinical trial, 48 adults (age range: 18 to 40) presenting with nonspecific shoulder pain will partake in two trial sessions. Random assignment will place participants into BFR or sham BFR groups and ask them to perform one exercise with BFR. Subsequently, participants will complete a shoulder girdle loading regimen comprising six exercises. The second session will involve participants switching treatment groups. Pain pressure thresholds (PPTs), shoulder pain and disability via the shoulder pain and disability index (SPADI), maximal voluntary isometric contraction (MVIC) of shoulder external rotators, pain during active abduction, and peak pain during shoulder external rotation will be evaluated using the numeric pain rating scale (NPRS). Immediate post-exercise assessments will include patient-perceived pain changes using the global rating of change scale (GROC) and participant-rated perceived exertion (RPE), employing a modified Borg's scale (Borg CR10) post-BFR or sham BFR exercise session. Each session will encompass three assessment periods, and a combination of mixed-effect models and descriptive statistics will underpin the analysis. This protocol was approved by Cyprus National Bioethics Committee (ΕΕΒΚ/2023/48), and was registered in ClinicalTrials.gov (Registration number: NCT05956288). Conclusion: The anticipated outcomes of this study illuminated the acute effects of BFR training on pain perception within the context of nonspecific shoulder pain, potentially advancing strategies for managing pain intensity using BFR techniques.
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Affiliation(s)
- Kyriakos Pavlou
- Department of Health Sciences, European University Cyprus, 1516 Nicosia, Cyprus; (G.M.P.); (C.K.); (G.P.); (A.C.)
| | - Christos Savva
- Department of Health Sciences, Frederick University, 3080 Limassol, Cyprus;
| | | | - George M. Pamboris
- Department of Health Sciences, European University Cyprus, 1516 Nicosia, Cyprus; (G.M.P.); (C.K.); (G.P.); (A.C.)
| | - Christos Karagiannis
- Department of Health Sciences, European University Cyprus, 1516 Nicosia, Cyprus; (G.M.P.); (C.K.); (G.P.); (A.C.)
| | - George Ploutarchou
- Department of Health Sciences, European University Cyprus, 1516 Nicosia, Cyprus; (G.M.P.); (C.K.); (G.P.); (A.C.)
| | - Antonis Constantinou
- Department of Health Sciences, European University Cyprus, 1516 Nicosia, Cyprus; (G.M.P.); (C.K.); (G.P.); (A.C.)
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Vehrs PR, Johnson AW. Commentary: Is there a minimum effective dose for vascular occlusion during blood flow restriction training? Front Physiol 2023; 14:1279435. [PMID: 37849976 PMCID: PMC10577197 DOI: 10.3389/fphys.2023.1279435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 09/18/2023] [Indexed: 10/19/2023] Open
Affiliation(s)
- Pat R. Vehrs
- Department of Exercise Sciences, Brigham Young University, Provo, UT, United States
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50
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McClean ZJ, Zhang J, Khaledi N, Yacoub M, Aboodarda SJ. Intermittent blood flow occlusion modulates neuromuscular, perceptual, and cardiorespiratory determinants of exercise tolerance during cycling. Eur J Appl Physiol 2023; 123:2295-2306. [PMID: 37278835 DOI: 10.1007/s00421-023-05242-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 05/26/2023] [Indexed: 06/07/2023]
Abstract
PURPOSE Constant blood flow occlusion (BFO) superimposed on aerobic exercise can impair muscle function and exercise tolerance; however, no study has investigated the effect of intermittent BFO on the associated responses. Fourteen participants (n = 7 females) were recruited to compare neuromuscular, perceptual, and cardiorespiratory responses to shorter (5:15s, occlusion-to-release) and longer (10:30s) BFO applied during cycling to task failure. METHODS In randomized order, participants cycled to task failure (task failure 1) at 70% of peak power output with (i) shorter BFO, (ii) longer BFO, and (iii) no BFO (Control). Upon task failure in the BFO conditions, BFO was removed, and participants continued cycling until a second task failure (task failure 2). Maximum voluntary isometric knee contractions (MVC) and femoral nerve stimuli were performed along with perceptual measures at baseline, task failure 1, and task failure 2. Cardiorespiratory measures were recorded continuously across the exercises. RESULTS Task failure 1 was longer in Control than 5:15s and 10:30s (P < 0.001), with no differences between the BFO conditions. At task failure 1, 10:30s elicited a greater decline in twitch force compared to 5:15s and Control (P < 0.001). At task failure 2, twitch force remained lower in 10:30s than Control (P = 0.002). Low-frequency fatigue developed to a greater extent in 10:30s compared to Control and 5:15s (P < 0.047). Dyspnea and Fatigue were greater for Control than 5:15s and 10:30s at the end of task failure 1 (P < 0.002). CONCLUSION Exercise tolerance during BFO is primarily dictated by the decline in muscle contractility and accelerated development of effort and pain.
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Affiliation(s)
- Zachary John McClean
- Faculty of Kinesiology, University of Calgary, 2500 University Dr NW, Calgary, AB, T2N 1N4, Canada
| | - Jenny Zhang
- Faculty of Kinesiology, University of Calgary, 2500 University Dr NW, Calgary, AB, T2N 1N4, Canada
| | - Neda Khaledi
- Faculty of Kinesiology, University of Calgary, 2500 University Dr NW, Calgary, AB, T2N 1N4, Canada
- Faculty of Physical Education and Sport Sciences, Kharazmi University, Tehran, Iran
| | - Matthew Yacoub
- Faculty of Kinesiology, University of Calgary, 2500 University Dr NW, Calgary, AB, T2N 1N4, Canada
| | - Saied Jalal Aboodarda
- Faculty of Kinesiology, University of Calgary, 2500 University Dr NW, Calgary, AB, T2N 1N4, Canada.
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