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Inoue M, Kubota A, Takazawa Y, Nakagawara K, Ishige K, Suzuki Y. 5'-UMP inhibited muscle atrophy due to detraining: a randomized, double-blinded, placebo-controlled, parallel-group comparative study. Front Sports Act Living 2024; 6:1403215. [PMID: 39076851 PMCID: PMC11284071 DOI: 10.3389/fspor.2024.1403215] [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: 03/19/2024] [Accepted: 07/01/2024] [Indexed: 07/31/2024] Open
Abstract
Purpose A short period of disuse of 1-2 weeks due to factors such as illness or injury can lead to muscle atrophy, affecting both athletic performance and health. Recent research has shown that uridine 5'-monophosphate (5'-UMP) can counteract disuse-induced muscle atrophy by increasing PGC-1α expression and inhibiting atrogin-1 expression. However, the effect of 5'-UMP on disuse muscle atrophy in humans remains unknown. Therefore, the aimed of this study was to explore the effects of 5'-UMP supplementation during detraining on short-term disuse muscle atrophy in healthy men. Methods Following a 6-week resistance training program on upper arm, healthy men were randomized to either a UMP group (n = 11) or a placebo group (n = 10), taking their respective supplements during the 2-week detraining period. Muscle thickness, an indicator of muscle hypertrophy and atrophy, was measured at 3 positions (MT50, MT60, and MT70) at baseline, 1 week, and 2 weeks after detraining. Results Both groups showed a significant decrease in muscle thickness at MT70. The relative decrease was greater in the placebo group (2.4 ± 2.8%) than in the UMP group (0.0 ± 2.0%), significantly (p = 0.034) at 1 week. However, no significant difference was observed at MT50 and MT60. Conclusion After the hypertrophy, 5'-UMP may prevent muscle atrophy due to the detraining within the first week.
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Affiliation(s)
- Mika Inoue
- Juntendo Administration for Sports, Health and Medical Sciences, Juntendo University, Tokyo, Japan
| | - Atsushi Kubota
- Graduate School of Health and Sports Science, Juntendo University, Chiba, Japan
| | - Yuji Takazawa
- Graduate School of Health and Sports Science, Juntendo University, Chiba, Japan
- Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | | | - Kazuya Ishige
- Biochemicals Division, YAMASA Corporation, Chiba, Japan
| | - Yoshio Suzuki
- Graduate School of Health and Sports Science, Juntendo University, Chiba, Japan
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Moreno EN, Figueroa EC, Heath AW, Buckner SL. An examination of acute physiological and perceptual responses following blood flow restriction exercise using a traditional research device or novel, automated system. Physiol Meas 2024; 45:065007. [PMID: 38838705 DOI: 10.1088/1361-6579/ad548c] [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: 09/22/2023] [Accepted: 06/05/2024] [Indexed: 06/07/2024]
Abstract
Objective. To compare the acute physiological and perceptual responses to blood flow restriction (BFR) exercise using a traditional research device or novel, automated system.Methods. Forty-four resistance trained individuals performed four sets of unilateral elbow flexion exercise (30% one-repetition maximum) to volitional failure using two distinct restrictive devices [SmartCuffs PRO BFR Model (SMARTCUFF), Hokanson E20 Rapid Inflation device (HOKANSON)] and with two levels of BFR [40% limb occlusion pressure (LOP), 80% LOP]. Blood pressure (BP), muscle thickness (MT), and isometric strength (ISO) were assessed prior to and following exercise. Perceptual responses [ratings of perceived exertion (RPE), discomfort] were assessed prior to exercise and following each exercise set.Main results. Data are displayed as means (SD). Immediately following exercise with 40% LOP, there were no statistical differences between devices for BP, MT, and ISO. However, only following Set 1 of exercise, RPE was greater with SMARTCUFF compared to HOKANSON (p< 0.05). In addition, only following Set 2 of exercise, discomfort was greater with HOKANSON compared to SMARTCUFF (p< 0.001). Immediately following exercise with 80% LOP, there were no statistical differences between devices for BP, MT, and ISO. However, only following Set 4 of exercise, RPE was greater with HOKANSON compared to SMARTCUFF (p< 0.05). In addition, following all exercise sets, discomfort was greater with HOKANSON compared to SMARTCUFF (p< 0.001). For repetitions completed with 40% LOP there were no statistical differences between SMARTCUFF and HOKANSON across any exercise sets. For repetitions completed with 80% LOP there were no statistical differences between SMARTCUFF and HOKANSON across Set 1 of exercise (p= 0.34), however, for Sets 2-4 of exercise, significantly greater number of repetitions were completed during SMARTCUFF than HOKANSON.Significance. The present study provides valuable insight into the efficacy of a novel, automated BFR system (SMARTCUFF) eliciting comparable acute physiological responses to BFR exercise and in some cases favorable perceptual responses when compared to a traditional research device (HOKANSON).
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Affiliation(s)
- Enrique N Moreno
- USF Muscle Laboratory, Exercise Science Program, University of South Florida, Tampa, FL, United States of America
| | - Elias C Figueroa
- USF Muscle Laboratory, Exercise Science Program, University of South Florida, Tampa, FL, United States of America
| | - Andrew W Heath
- USF Muscle Laboratory, Exercise Science Program, University of South Florida, Tampa, FL, United States of America
| | - Samuel L Buckner
- USF Muscle Laboratory, Exercise Science Program, University of South Florida, Tampa, FL, United States of America
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Fuchs CJ, Hermans WJH, Nyakayiru J, Weijzen MEG, Smeets JSJ, Aussieker T, Senden JM, Wodzig WKHW, Snijders T, Verdijk LB, van Loon LJC. Daily blood flow restriction does not preserve muscle mass and strength during 2 weeks of bed rest. J Physiol 2024. [PMID: 38411283 DOI: 10.1113/jp286065] [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: 11/29/2023] [Accepted: 02/08/2024] [Indexed: 02/28/2024] Open
Abstract
We measured the impact of blood flow restriction on muscle protein synthesis rates, muscle mass and strength during 2 weeks of strict bed rest. Twelve healthy, male adults (age: 24 ± 3 years, body mass index: 23.7 ± 3.1 kg/m2 ) were subjected to 14 days of strict bed rest with unilateral blood flow restriction performed three times daily in three 5 min cycles (200 mmHg). Participants consumed deuterium oxide and we collected blood and saliva samples throughout 2 weeks of bed rest. Before and immediately after bed rest, lean body mass (dual-energy X-ray absorptiometry scan) and thigh muscle volume (magnetic resonance imaging scan) were assessed in both the blood flow restricted (BFR) and control (CON) leg. Muscle biopsies were collected and unilateral muscle strength (one-repetition maximum; 1RM) was assessed for both legs before and after the bed rest period. Bed rest resulted in 1.8 ± 1.0 kg lean body mass loss (P < 0.001). Thigh muscle volume declined from 7.1 ± 1.1 to 6.7 ± 1.0 L in CON and from 7.0 ± 1.1 to 6.7 ± 1.0 L in BFR (P < 0.001), with no differences between treatments (P = 0.497). In addition, 1RM leg extension strength decreased from 60.2 ± 10.6 to 54.8 ± 10.9 kg in CON and from 59.2 ± 12.1 to 52.9 ± 12.0 kg in BFR (P = 0.014), with no differences between treatments (P = 0.594). Muscle protein synthesis rates during bed rest did not differ between the BFR and CON leg (1.11 ± 0.12 vs. 1.08 ± 0.13%/day, respectively; P = 0.302). Two weeks of bed rest substantially reduces skeletal muscle mass and strength. Blood flow restriction during bed rest does not modulate daily muscle protein synthesis rates and does not preserve muscle mass or strength. KEY POINTS: Bed rest, often necessary for recovery from illness or injury, leads to the loss of muscle mass and strength. It has been postulated that blood flow restriction may attenuate the loss of muscle mass and strength during bed rest. We investigated the effect of blood flow restriction on muscle protein synthesis rates, muscle mass and strength during 2 weeks of strict bed rest. Blood flow restriction applied during bed rest does not modulate daily muscle protein synthesis rates and does not preserve muscle mass or strength. Blood flow restriction is not effective in preventing muscle atrophy during a prolonged period of bed rest.
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Affiliation(s)
- Cas J Fuchs
- Department of Human Biology, Faculty of Health, Medicine and Life Sciences, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Wesley J H Hermans
- Department of Human Biology, Faculty of Health, Medicine and Life Sciences, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Jean Nyakayiru
- Department of Human Biology, Faculty of Health, Medicine and Life Sciences, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Michelle E G Weijzen
- Department of Human Biology, Faculty of Health, Medicine and Life Sciences, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Joey S J Smeets
- Department of Human Biology, Faculty of Health, Medicine and Life Sciences, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Thorben Aussieker
- Department of Human Biology, Faculty of Health, Medicine and Life Sciences, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Joan M Senden
- Department of Human Biology, Faculty of Health, Medicine and Life Sciences, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Will K H W Wodzig
- Central Diagnostic Laboratory, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Tim Snijders
- Department of Human Biology, Faculty of Health, Medicine and Life Sciences, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Lex B Verdijk
- Department of Human Biology, Faculty of Health, Medicine and Life Sciences, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Luc J C van Loon
- Department of Human Biology, Faculty of Health, Medicine and Life Sciences, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre+, Maastricht, The Netherlands
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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: 0] [Impact Index Per Article: 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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Preobrazenski N, Seigel J, Halliday S, Janssen I, McGlory C. Single-leg disuse decreases skeletal muscle strength, size, and power in uninjured adults: A systematic review and meta-analysis. J Cachexia Sarcopenia Muscle 2023; 14:684-696. [PMID: 36883219 PMCID: PMC10067508 DOI: 10.1002/jcsm.13201] [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: 08/17/2022] [Revised: 12/01/2022] [Accepted: 02/02/2023] [Indexed: 03/09/2023] Open
Abstract
We aimed to quantify declines from baseline in lower limb skeletal muscle size and strength of uninjured adults following single-leg disuse. We searched EMBASE, Medline, CINAHL, and CCRCT up to 30 January 2022. Studies were included in the systematic review if they (1) recruited uninjured participants; (2) were an original experimental study; (3) employed a single-leg disuse model; and (4) reported muscle strength, size, or power data following a period of single-leg disuse for at least one group without a countermeasure. Studies were excluded if they (1) did not meet all inclusion criteria; (2) were not in English; (3) reported previously published muscle strength, size, or power data; or (4) could not be sourced from two different libraries, repeated online searches, and the authors. We used the Cochrane Risk of Bias Assessment Tool to assess risk of bias. We then performed random-effects meta-analyses on studies reporting measures of leg extension strength and extensor size. Our search revealed 6548 studies, and 86 were included in our systematic review. Data from 35 and 20 studies were then included in the meta-analyses for measures of leg extensor strength and size, respectively (40 different studies). No meta-analysis for muscle power was performed due to insufficient homogenous data. Effect sizes (Hedges' gav ) with 95% confidence intervals for leg extensor strength were all durations = -0.80 [-0.92, -0.68] (n = 429 participants; n = 68 aged 40 years or older; n ≥ 78 females); ≤7 days of disuse = -0.57 [-0.75, -0.40] (n = 151); >7 days and ≤14 days = -0.93 [-1.12, -0.74] (n = 206); and >14 days = -0.95 [-1.20, -0.70] (n = 72). Effect sizes for measures of leg extensor size were all durations = -0.41 [-0.51, -0.31] (n = 233; n = 32 aged 40 years or older; n ≥ 42 females); ≤7 days = -0.26 [-0.36, -0.16] (n = 84); >7 days and ≤14 days = -0.49 [-0.67, -0.30] (n = 102); and >14 days = -0.52 [-0.74, -0.30] (n = 47). Decreases in leg extensor strength (cast: -0.94 [-1.30, -0.59] (n = 73); brace: -0.90 [-1.18, -0.63] (n = 106)) and size (cast: -0.61[-0.87, -0.35] (n = 41); brace: (-0.48 [-1.04, 0.07] (n = 41)) following 14 days of disuse did not differ for cast and brace disuse models. Single-leg disuse in adults resulted in a decline in leg extensor strength and size that reached a nadir beyond 14 days. Bracing and casting led to similar declines in leg extensor strength and size following 14 days of disuse. Studies including females and males and adults over 40 years of age are lacking.
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Affiliation(s)
| | - Joel Seigel
- School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario, Canada
| | - Sandra Halliday
- Queen's University Library, Queen's University, Kingston, Ontario, Canada
| | - Ian Janssen
- School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario, Canada
| | - Chris McGlory
- School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario, Canada.,Department of Medicine, Queen's University, Kingston, Ontario, Canada
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6
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Cahalin LP, Formiga MF, Owens J, Osman BM. A Meta-Analysis of Remote Ischemic Preconditioning in Lung Surgery and Its Potential Role in COVID-19. Physiother Can 2023; 75:30-41. [PMID: 37250733 PMCID: PMC10211375 DOI: 10.3138/ptc-2021-0031] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 08/17/2021] [Accepted: 09/06/2021] [Indexed: 08/08/2023]
Abstract
Purpose: To determine the effects of remote ischemic preconditioning (RIPC) on pulmonary gas exchange in people undergoing pulmonary surgery and discuss a potential role of RIPC in COVID-19. Method: A search for studies examining the effects of RIPC after pulmonary surgery was performed. RevMan was used for statistical analyses examining measures of A-ado2, Pao2/Fio2, respiratory index (RI), a/A ratio and Paco2 obtained earlier after surgery (i.e., 6-8 hours) and later after surgery (i.e., 18-24 hours). Results: Four trials were included (N = 369 participants). Significant (p < 0.05) overall effects of RIPC were observed early after surgery on A-ado2 and RI (SMD -0.84 and SMD -1.23, respectively), and later after surgery on RI, Pao2/Fio2, and a/A ratio (SMD -0.39, 0.72, and 1.15, respectively) with the A-ado2 approaching significance (p = 0.05; SMD -0.45). Significant improvements in inflammatory markers and oxidative stress after RIPC were also observed. Conclusions: RIPC has the potential to improve pulmonary gas exchange, inflammatory markers, and oxidative stress in people with lung disease undergoing lung surgery and receiving mechanical ventilation. These potential improvements may be beneficial for people with COVID-19, but further investigation is warranted.
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Affiliation(s)
- Lawrence P. Cahalin
- University of Miami, Department of Physical Therapy, Coral Gables, Florida, United States
| | - Magno F. Formiga
- Universidade Federal do Ceará, Departamento de Fisioterapia, Fortaleza, Ceará, Brazil
| | - Johnny Owens
- Owens Recovery Science, San Antonio, Texas, United States
| | - Brian M. Osman
- of Miami, Department of Anesthesiology, Perioperative Medicine, and Pain Management, Miami, Florida, United States
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Watson R, Sullivan B, Stone A, Jacobs C, Malone T, Heebner N, Noehren B. Blood Flow Restriction Therapy: An Evidence-Based Approach to Postoperative Rehabilitation. JBJS Rev 2022; 10:01874474-202210000-00001. [PMID: 36191086 DOI: 10.2106/jbjs.rvw.22.00062] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
➢ Blood flow restriction therapy (BFRT) involves the application of a pneumatic tourniquet cuff to the proximal portion of the arm or leg. This restricts arterial blood flow while occluding venous return, which creates a hypoxic environment that induces many physiologic adaptations. ➢ BFRT is especially useful in postoperative rehabilitation because it produces muscular hypertrophy and strength gains without the need for heavy-load exercises that are contraindicated after surgery. ➢ Low-load resistance training with BFRT may be preferable to low-load or high-load training alone because it leads to comparable increases in strength and hypertrophy, without inducing muscular edema or increasing pain.
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Affiliation(s)
- Richard Watson
- University of Kentucky, Department of Physical Therapy, Lexington, Kentucky
| | - Breanna Sullivan
- University of Kentucky, Department of Orthopaedic Surgery and Sports Medicine, Lexington, Kentucky
| | - Austin Stone
- University of Kentucky, Department of Orthopaedic Surgery and Sports Medicine, Lexington, Kentucky
| | - Cale Jacobs
- University of Kentucky, Department of Orthopaedic Surgery and Sports Medicine, Lexington, Kentucky
| | - Terry Malone
- University of Kentucky, Department of Physical Therapy, Lexington, Kentucky
| | - Nicholas Heebner
- University of Kentucky, Sports Medicine Research Institute, Lexington, Kentucky
| | - Brian Noehren
- University of Kentucky, Department of Physical Therapy, Lexington, Kentucky
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Chhetri I, Hunt JEA, Mendis JR, Forni LG, Kirk-Bayley J, White I, Cooper J, Somasundaram K, Shah N, Patterson SD, Puthucheary ZA, Montgomery HE, Creagh-Brown BC. Safety and Feasibility Assessment of Repetitive Vascular Occlusion Stimulus (RVOS) Application to Multi-Organ Failure Critically Ill Patients: A Pilot Randomised Controlled Trial. J Clin Med 2022; 11:3938. [PMID: 35887701 PMCID: PMC9316533 DOI: 10.3390/jcm11143938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 06/30/2022] [Accepted: 07/01/2022] [Indexed: 11/17/2022] Open
Abstract
Muscle wasting is implicated in the pathogenesis of intensive care unit acquired weakness (ICU-AW), affecting 40% of patients and causing long-term physical disability. A repetitive vascular occlusion stimulus (RVOS) limits muscle atrophy in healthy and orthopaedic subjects, thus, we explored its application to ICU patients. Adult multi-organ failure patients received standard care +/- twice daily RVOS {4 cycles of 5 min tourniquet inflation to 50 mmHg supra-systolic blood pressure, and 5 min complete deflation} for 10 days. Serious adverse events (SAEs), tolerability, feasibility, acceptability, and exploratory outcomes of the rectus femoris cross-sectional area (RFCSA), echogenicity, clinical outcomes, and blood biomarkers were assessed. Only 12 of the intended 32 participants were recruited. RVOS sessions (76.1%) were delivered to five participants and two could not tolerate it. No SAEs occurred; 75% of participants and 82% of clinical staff strongly agreed or agreed that RVOS is an acceptable treatment. RFCSA fell significantly and echogenicity increased in controls (n = 5) and intervention subjects (n = 4). The intervention group was associated with less frequent acute kidney injury (AKI), a greater decrease in the total sequential organ failure assessment score (SOFA) score, and increased insulin-like growth factor-1 (IGF-1), and reduced syndecan-1, interleukin-4 (IL-4) and Tumor necrosis factor receptor type II (TNF-RII) levels. RVOS application appears safe and acceptable, but protocol modifications are required to improve tolerability and recruitment. There were signals of possible clinical benefit relating to RVOS application.
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Affiliation(s)
- Ismita Chhetri
- Intensive Care Unit, Royal Surrey County Hospital, NHS Foundation Trust, Guildford GU2 7XX, UK; (I.C.); (L.G.F.); (J.K.-B.)
- Faculty of Health and Medical Sciences, School of Biosciences & Medicine, University of Surrey, Guildford GU2 7XH, UK; (J.E.A.H.); (J.R.M.)
- Centre for Perinatal Neuroscience, Department of Brain Sciences, Imperial College London, London SW7 2BX, UK
| | - Julie E. A. Hunt
- Faculty of Health and Medical Sciences, School of Biosciences & Medicine, University of Surrey, Guildford GU2 7XH, UK; (J.E.A.H.); (J.R.M.)
| | - Jeewaka R. Mendis
- Faculty of Health and Medical Sciences, School of Biosciences & Medicine, University of Surrey, Guildford GU2 7XH, UK; (J.E.A.H.); (J.R.M.)
| | - Lui G. Forni
- Intensive Care Unit, Royal Surrey County Hospital, NHS Foundation Trust, Guildford GU2 7XX, UK; (I.C.); (L.G.F.); (J.K.-B.)
- Faculty of Health and Medical Sciences, School of Biosciences & Medicine, University of Surrey, Guildford GU2 7XH, UK; (J.E.A.H.); (J.R.M.)
| | - Justin Kirk-Bayley
- Intensive Care Unit, Royal Surrey County Hospital, NHS Foundation Trust, Guildford GU2 7XX, UK; (I.C.); (L.G.F.); (J.K.-B.)
| | - Ian White
- Intensive Care Unit, Ashford and St Peter’s Hospitals NHS Foundation Trust, Chertsey KT16 0PZ, UK; (I.W.); (J.C.); (K.S.); (N.S.)
| | - Jonathan Cooper
- Intensive Care Unit, Ashford and St Peter’s Hospitals NHS Foundation Trust, Chertsey KT16 0PZ, UK; (I.W.); (J.C.); (K.S.); (N.S.)
| | - Karthik Somasundaram
- Intensive Care Unit, Ashford and St Peter’s Hospitals NHS Foundation Trust, Chertsey KT16 0PZ, UK; (I.W.); (J.C.); (K.S.); (N.S.)
| | - Nikunj Shah
- Intensive Care Unit, Ashford and St Peter’s Hospitals NHS Foundation Trust, Chertsey KT16 0PZ, UK; (I.W.); (J.C.); (K.S.); (N.S.)
| | - Stephen D. Patterson
- Faculty of Sport, Allied Health & Performance Sciences, St Mary’s University, London TW1 4SX, UK;
| | - Zudin A. Puthucheary
- William Harvey Research Institute, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London E1 4NS, UK;
- Institute for Sport, Exercise and Health, University College London, London W1T 7HA, UK
- Centre for Human Health and Performance, Department of Medicine, University College London, London W1T 7HA, UK;
- Intensive Care Unit, Royal Free London NHS Foundation Trust, London NW3 2QG, UK
- Centre for Human and Applied Physiological Sciences, King’s College London, London WC2R 2LS, UK
| | - Hugh E. Montgomery
- Centre for Human Health and Performance, Department of Medicine, University College London, London W1T 7HA, UK;
| | - Benedict C. Creagh-Brown
- Intensive Care Unit, Royal Surrey County Hospital, NHS Foundation Trust, Guildford GU2 7XX, UK; (I.C.); (L.G.F.); (J.K.-B.)
- Faculty of Health and Medical Sciences, School of Biosciences & Medicine, University of Surrey, Guildford GU2 7XH, UK; (J.E.A.H.); (J.R.M.)
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9
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Mañago MM, Kimbrell K, Hager ER, Dwight H, Owens J, Bade M. Clinical use of blood flow restriction in people with neurologic conditions: a cross-sectional survey. J Phys Ther Sci 2022; 34:275-283. [PMID: 35400831 PMCID: PMC8989480 DOI: 10.1589/jpts.34.275] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 01/01/2022] [Indexed: 11/25/2022] Open
Abstract
[Purpose] There is little evidence for blood flow restriction (BFR), or Kaatsu, training in people with neurologic conditions. This study's purpose was to survey clinicians on BFR use in people with neurologic conditions. [Participants and Methods] One-hundred twelve physical therapists and other healthcare professionals who reported using BFR in the past 5 years completed an anonymous, online survey. [Results] Eighty-nine percent of respondents thought BFR was safe in people with neurologic conditions. Meanwhile, 38% reported BFR use in people with neurologic conditions. The most common intervention used with BFR was resistance training (n=33) and the most commonly reported benefit was improved strength (n=27). The most common side-effect causing treatment to stop was intolerance to pressure (n=6). No side-effects requiring medical attention were reported. In order to support future BFR use in neurologic populations, the most common response was the need for more research (n=63). [Conclusion] Despite the lack of evidence, clinical use of BFR in people with neurologic conditions may be somewhat common. Although this study had a relatively small sample size and collected data retrospectively, the results support the potential clinical feasibility and safety of BFR use in patients with neurologic conditions and suggest that more research is needed.
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Affiliation(s)
- Mark M. Mañago
- Department of Physical Medicine and Rehabilitation,
University of Colorado, Anschutz Medical Campus: Aurora, CO 80045, USA
- Department of Neurology, University of Colorado Anschutz
Medical Campus, USA
- VA Eastern Colorado Geriatric Research, Education, and
Clinical Center, Rocky Mountain Regional VA Medical Center, USA
| | | | - Emily R. Hager
- Department of Physical Medicine and Rehabilitation,
University of Colorado, Anschutz Medical Campus: Aurora, CO 80045, USA
- VA Eastern Colorado Geriatric Research, Education, and
Clinical Center, Rocky Mountain Regional VA Medical Center, USA
| | - Hannah Dwight
- Department of Neurology, University of Colorado Anschutz
Medical Campus, USA
| | | | - Michael Bade
- Department of Physical Medicine and Rehabilitation,
University of Colorado, Anschutz Medical Campus: Aurora, CO 80045, USA
- VA Eastern Colorado Geriatric Research, Education, and
Clinical Center, Rocky Mountain Regional VA Medical Center, USA
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Reina-Ruiz ÁJ, Galán-Mercant A, Molina-Torres G, Merchán-Baeza JA, Romero-Galisteo RP, González-Sánchez M. Effect of Blood Flow Restriction on Functional, Physiological and Structural Variables of Muscle in Patients with Chronic Pathologies: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:1160. [PMID: 35162182 PMCID: PMC8835162 DOI: 10.3390/ijerph19031160] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/06/2022] [Accepted: 01/13/2022] [Indexed: 02/01/2023]
Abstract
The main objective of this systematic review of the current literature is to analyze the changes that blood flow restriction (BFR) causes in subjects with neuro-musculoskeletal and/or systemic pathologies focusing on the following variables: strength, physiological changes, structural changes and cardiocirculatory variables. The search was carried out in seven databases, including randomized clinical trials in which therapeutic exercise was combined with the blood flow restriction tool in populations with musculoskeletal pathologies. Outcome variables are strength, structural changes, physiological changes and cardiocirculatory variables. Twenty studies were included in the present study. Although there is a lot of heterogeneity between the interventions and evaluation instruments, we observed how the restriction of blood flow presents significant differences in the vast majority of the variables analyzed. In addition, we observed how BFR can become a supplement that provides benefits when performed with low intensity, similar to those obtained through high-intensity muscular efforts. The application of the BFR technique can provide benefits in the short and medium term to increase strength, muscle thickness and cardiovascular endurance, even improving the physiological level of the cardiovascular system. In addition, BFR combined with low-load exercises also achieves benefits comparable to high-intensity exercises without the application of BFR, benefiting patients who are unable to lift high loads.
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Affiliation(s)
- Álvaro Jesús Reina-Ruiz
- Department of Physiotherapy, Faculty of Health Sciences, University of Málaga, Arquitecto Francisco Peñalosa, 3, 29071 Málaga, Spain; (Á.J.R.-R.); (R.P.R.-G.); (M.G.-S.)
| | - Alejandro Galán-Mercant
- MOVE-IT Research Group, Department of Physical Education, Faculty of Education, Sciences University of Cádiz, 11002 Cádiz, Spain
- Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital, University of Cádiz, 11002 Cádiz, Spain
| | - Guadalupe Molina-Torres
- Department of Nursing Science, Physiotherapy and Medicine, Faculty of Nursing and Physiotherapy, University of Almeria, 04120 Almeria, Spain
| | - Jose Antonio Merchán-Baeza
- Centre for Health and Social Care Research (CESS), Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Science and Welfare, University of Vic-Central University of Catalonia (UVIC-UCC), C. Sagrada Família, 7, 08500 Vic, Spain;
| | - Rita Pilar Romero-Galisteo
- Department of Physiotherapy, Faculty of Health Sciences, University of Málaga, Arquitecto Francisco Peñalosa, 3, 29071 Málaga, Spain; (Á.J.R.-R.); (R.P.R.-G.); (M.G.-S.)
- Instituto de Investigación Biomédica de Málaga, IBIMA, Calle Doctor Miguel Díaz Recio, 28, 29010 Málaga, Spain
| | - Manuel González-Sánchez
- Department of Physiotherapy, Faculty of Health Sciences, University of Málaga, Arquitecto Francisco Peñalosa, 3, 29071 Málaga, Spain; (Á.J.R.-R.); (R.P.R.-G.); (M.G.-S.)
- Instituto de Investigación Biomédica de Málaga, IBIMA, Calle Doctor Miguel Díaz Recio, 28, 29010 Málaga, Spain
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Editorial Commentary: Blood Flow Restriction Therapy Continues to Prove Effective. Arthroscopy 2021; 37:2870-2872. [PMID: 34481627 DOI: 10.1016/j.arthro.2021.04.073] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 04/30/2021] [Indexed: 02/02/2023]
Abstract
Blood flow restriction (BFR) training continues to look promising to try and maintain muscle mass or to rebuild muscle mass and strength after injury or surgery. Because additional potential benefits include pain control, increased gene expression (leading to atrophy reduction), and muscle excitation, our use of the modality favors earlier over middle- or late-phase postoperative use. We initiate BFR therapy 2-14 days postoperatively, often with reduced cuff pressure in the first several sessions before increasing to the recommended therapeutic occlusion level. We have observed the greatest benefit for individuals who are non-weight-bearing for 6 to 8 weeks and who may have more postoperative restrictions due to the nature of the surgery. Compared with the opposite thigh, we have seen instances in which quadriceps girth has been preserved, although not increased, following the non-weight-bearing period. Ideally, we use 1 to 3 low-load resistance training exercises per session at least 2 times per week for 6 weeks. We also employ BFR following osteotomy or any procedure where bone drilling is used, as researchers have observed improved bone health. Additional benefits relevant to the early postoperative phase, such as effusion and pain reduction, have not been clearly established. Anecdotally, we have seen effusion levels temporarily increase during treatment but then resolve to baseline within 30 to 60 minutes of tourniquet deflation. Further high-level research is necessary to objectively validate BFR use and which patients may best benefit from it.
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Solsona R, Pavlin L, Bernardi H, Sanchez AMJ. Molecular Regulation of Skeletal Muscle Growth and Organelle Biosynthesis: Practical Recommendations for Exercise Training. Int J Mol Sci 2021; 22:2741. [PMID: 33800501 PMCID: PMC7962973 DOI: 10.3390/ijms22052741] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/04/2021] [Accepted: 03/04/2021] [Indexed: 12/18/2022] Open
Abstract
The regulation of skeletal muscle mass and organelle homeostasis is dependent on the capacity of cells to produce proteins and to recycle cytosolic portions. In this investigation, the mechanisms involved in skeletal muscle mass regulation-especially those associated with proteosynthesis and with the production of new organelles-are presented. Thus, the critical roles of mammalian/mechanistic target of rapamycin complex 1 (mTORC1) pathway and its regulators are reviewed. In addition, the importance of ribosome biogenesis, satellite cells involvement, myonuclear accretion, and some major epigenetic modifications related to protein synthesis are discussed. Furthermore, several studies conducted on the topic of exercise training have recognized the central role of both endurance and resistance exercise to reorganize sarcomeric proteins and to improve the capacity of cells to build efficient organelles. The molecular mechanisms underlying these adaptations to exercise training are presented throughout this review and practical recommendations for exercise prescription are provided. A better understanding of the aforementioned cellular pathways is essential for both healthy and sick people to avoid inefficient prescriptions and to improve muscle function with emergent strategies (e.g., hypoxic training). Finally, current limitations in the literature and further perspectives, notably on epigenetic mechanisms, are provided to encourage additional investigations on this topic.
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Affiliation(s)
- Robert Solsona
- Laboratoire Interdisciplinaire Performance Santé Environnement de Montagne (LIPSEM), Faculty of Sports Sciences, University of Perpignan Via Domitia, UR 4640, 7 Avenue Pierre de Coubertin, 66120 Font-Romeu, France;
| | - Laura Pavlin
- DMEM, University of Montpellier, INRAE UMR866, 2 Place Pierre Viala, 34060 Montpellier, France; (L.P.); (H.B.)
| | - Henri Bernardi
- DMEM, University of Montpellier, INRAE UMR866, 2 Place Pierre Viala, 34060 Montpellier, France; (L.P.); (H.B.)
| | - Anthony MJ Sanchez
- Laboratoire Interdisciplinaire Performance Santé Environnement de Montagne (LIPSEM), Faculty of Sports Sciences, University of Perpignan Via Domitia, UR 4640, 7 Avenue Pierre de Coubertin, 66120 Font-Romeu, France;
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