Low-Intensity Resistance Exercise Combined With Blood Flow Restriction is More Conducive to Regulate Blood Pressure and Autonomic Nervous System in Hypertension Patients-Compared With High-Intensity and Low-Intensity Resistance Exercise

Safety of strength training with blood flow restriction in patients with hemophilic arthropathy; a randomized pilot study

INTRODUCTION

Hemophilic arthropathy is characterized by chronic pain, decreased joint range and periarticular muscle atrophy. In the absence of suitable prophylactic treatment, these sequelae cause severe disability from early ages. The aim of this study was to evaluate the safety of applying blood flow restriction in patients with hemophilia and to observe changes in pain intensity, range of motion and muscle strength.

METHODS

A randomized, single-blind pilot study. Twenty-three patients were recruited and randomized to the two study groups: experimental (training with blood flow restriction) and control (no intervention). The intervention, which lasted for 3 weeks with two weekly sessions, included strengthening exercises of the quadriceps muscle and the plantiflexor and dorsiflexor muscles. The study variables were: safety (number of bleeds), pain intensity (Visual Analog Scale), range of motion (goniometry) and muscle strength (dynamometry).

RESULTS

None of the patients with hemophilia who received the intervention developed muscle or joint bleeds during the study phase. There were statistically significant intergroup differences (p < .001) in the intensity of knee pain (F = 17.97; ŋ2p = 0.29) and ankle pain (F = 24.84; ŋ2p = 0.36), and quadriceps muscle strength (F = 23.49; ŋ2p = 0.34).

CONCLUSIONS

Strength training with blood flow restriction is safe and does not cause joint or muscle bleeding in hemophilia patients in this group. Low-load and flow-restriction exercises can improve the intensity of joint pain and periarticular muscle strength in patients with bilateral hemophilic knee and ankle arthropathy.

Effects of exercise combined with different dietary interventions on cardiovascular health a systematic review and network meta-analysis

BACKGROUND

Numerous studies have shown that exercise and dietary interventions positively impact CVD outcomes; however, there is substantial variability in the efficacy of different interventions. The absence of direct comparisons between multiple interventions complicates the determination of their relative effects. This study aims to synthesize the literature on the impacts of exercise, dietary, and combined interventions on cardiovascular health indicators, and to perform a network meta-analysis to rank the efficacy of these approaches, providing a theoretical foundation for selecting optimal intervention strategies.

METHODS

We systematically reviewed the literature from database inception through September 2024, searching PubMed, Web of Science, Embase, and the Cochrane Library. Data were aggregated and analyzed using network meta-analysis, with intervention efficacy ranked according to Surface Under the Cumulative Ranking (SUCRA) curves.

RESULTS

The efficacy of these interventions was ranked as follows: 1). Triglycerides (TG) Reduction: CR + EX > CR > 5/2F + EX > TRF + EX > KD > 5/2F > KD + EX > EX > CON > TRF. 2). Total Cholesterol (TC) Reduction: CR + EX > CR > 5/2F + EX > 5/2F > TRF + EX > EX > CON > KD > TRF > KD + EX. 3). High-Density Lipoprotein (HDL) Increase: 5/2F > KD > KD + EX > TRF + EX > CON > EX > TRF > 5/2F + EX > CR + EX > CR. 4). Low-Density Lipoprotein (LDL) Reduction: CR + EX > CR > TRF + EX > KD + EX > EX > KD > 5/2F > CON > 5/2F + EX > TRF. 5). Systolic Blood Pressure (SBP) Reduction: 5/2F > CR + EX > CR > EX > TRF > TRF + EX > CON > 5/2F + EX. 6). Diastolic Blood Pressure (DBP) Reduction: CR > CR + EX > TRF > 5/2F > TRF + EX > EX > CON > 5/2F + EX.

CONCLUSION

CR and CR + EX demonstrated the most positive effects on cardiovascular health indicators. In contrast, 5/2F + EX ranked relatively low in effectiveness, with its impact on several indicators being even lower than that of CON.

Hemodynamic analysis of blood flow restriction training: a systematic review

Blood Flow Restriction Training (BFRT) is a low-load training technique that involves applying pressure to partially restrict arterial blood flow while occluding venous return. Despite its growing popularity, there is still no consensus on how combining BFRT with resistance or aerobic training influences hemodynamic responses, or on the safest and most effective methods for implementing it. This review aims to systematically identify the effects of BFRT on hemodynamic parameters. A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement guidelines. The Chinese literature search was performed in the China National Knowledge Infrastructure (CNKI) database. English literature search was conducted in the Web of Science, PubMed, and Google Scholar databases. The studies included human subjects, the outcome indicators included hemodynamic evaluation indicators, and only randomized controlled trials and randomized crossover trials were considered. Non-Chinese or English literature, duplicate studies, and those with missing data were excluded. The adapted STROBE checklist was used to assess the risk of bias, 44 articles were included in this review. Results indicated that BFRT has increased heart rate and blood lactate levels, while its effect on blood oxygen saturation varies. Additionally, BFRT significantly enhances cardiac output but may either have no significant effect or cause a decrease in stroke volume. Furthermore, BFRT improves pulse wave velocity from the femur to the posterior tibia, suggesting a positive influence on cardiovascular function. BFRT induces changes in arterial structure and function, with these indicators interacting to produce both positive and negative effects on cardiovascular health. The primary mechanisms by which BFRT influences hemodynamics include the activation of the sympathetic and vagus nerves, as well as the regulation of chemical mediators in body fluids that modulate cardiovascular function. Convenient, economical, non-invasive, and easily measurable hemodynamic indicators are expected to become an efficient tool for evaluating the effects of exercise training. Further research is needed to establish the optimal compression thresholds and durations for different populations and exercise types, as well as to assess the long-term impact of BFRT on hemodynamic parameters.

Tai Chi training as a primary care plan for the prevention and management of hypertension: an opinion and positioning article

Hypertension is a prevalent chronic condition worldwide that can impact patients' quality of life. Oral antihypertensive drugs are widely used to manage high blood pressure, primarily by regulating the renin-angiotensin-aldosterone system. Nevertheless, limited efficacy and low compliance represent significant obstacles, arising primarily from dose, duration, and medication type restrictions. Furthermore, the prolonged use of antihypertensive medication may result in dependence and adverse effects, without any substantial improvement in achieving targeted blood pressure leves. As a result, research has focused on using exercise therapy to treat hypertension. Tai Chi, a widely-practiced Chinese health exercise, has evolved into a form of exercise therapy that might help alleviate the risk associated with hypertension. Therefore, this article aims to outline the role of Tai Chi in preventing and managing hypertension.

Effectiveness of low-load resistance training with blood flow restriction vs. conventional high-intensity resistance training in older people diagnosed with sarcopenia: a randomized controlled trial

Low-load resistance training with blood flow restriction (LRT-BFR) has shown potential to improve muscle strength and mass in different populations; however, there remains limited evidence in sarcopenic people diagnosed with sarcopenia criteria. This study systematically compared the effectiveness of LRT-BFR and conventional high-intensity resistance training (CRT) on clinical muscle outcomes (muscle mass, strength and performance), cardiovascular disease (CVD) risk factors and sarcopenia-related biomarkers of older people with sarcopenia. Twenty-one older individuals (aged 65 years and older) diagnosed with sarcopenia were randomly assigned to the LRT-BFR (20%-30% one-repetition maximum (1RM), n = 10) or CRT (60%-70% 1RM, n = 11) group. Both groups underwent a supervised exercise program three times a week for 12 weeks. The primary outcome was knee extensor strength (KES), and the secondary outcomes included body composition (body mass, body mass index and body fat percentage), muscle mass [appendicular skeletal muscle mass index (ASMI)], handgrip strength, physical performance [short physical performance battery (SPPB) and 6-m walk], CVD risk factors [hemodynamic parameters (systolic and diastolic blood pressure and heart rate (SBP, DBP and HR)) and lipid parameters (total cholesterol, triglyceride (TG), high-density lipoprotein (HDL) and low-density lipoprotein)], sarcopenia-related blood biomarkers [inflammatory biomarkers, hormones (growth hormone (GH) and insulin-like growth factor 1) and growth factors (myostatin and follistatin)] and quality of life [Short Form 36 Health Survey (SF-36)]. Both interventions remarkably improved the body composition, KES, 6-m walk, SBP, HDL, TG, GH, FST and SF-36 scores. CRT significantly improved the ASMI (p < 0.05) and SPPB (p < 0.05). A significant improvement in HR was observed only after LRT-BFR. No significant between-group differences were found before and after the interventions. This study suggested that LRT-BFR and CRT are beneficial to the clinical muscle outcomes, CVD risk factors and certain sarcopenia-related biomarkers of older people with sarcopenia. By comparison, CRT seems more effective in improving muscle mass, while LRT-BFR may be more beneficial for improving cardiovascular health in this population. Therefore, LRT-BFR is a potential alternative to CRT for aging sarcopenia.

Effects of blood flow restriction training on muscle fitness and cardiovascular risk of obese college students

Purpose: The aim of this study was to investigate the effect of blood flow restriction (BFR) combined with low-intensity resistance training (RT) on cardiovascular risk factors in obese individuals. Methods: Twenty-six male obese college students were recruited and randomly assigned to a control group (CON, n = 8), a low-intensity RT group (RT, n = 9), and a combined BFR training and low-intensity RT group (BFRT, n = 9). Results: The subjects in BFRT group showed significant reductions in body fat percentage and waist-to-hip ratio and a significant increase in lean mass and muscle mass; the peak torque, peak power, and endurance ratio of knee extensors and elbow flexors were significantly upregulated; the root mean square (RMS) for the medial femoral muscle, lateral femoral muscle and biceps significantly increased; the diastolic blood pressure (DBP) showed a significant decrease. The BFRT group also showed significant up-regulations in RMS of the difference between the adjacent R-R intervals (RMSSD), high-frequency power (HF) of parasympathetic modulatory capacity, the standard deviation of R-R intervals (SDNN) of overall heart rate variability (HRV) changes and low-frequency power (LF) of predominantly sympathetic activity. In addition, glycated hemoglobin (HbA1C), insulin resistance index (HOMA-IR) and fasting blood glucose (FBG) were all significantly downregulated in BFRT group. In parallel, low-density lipoprotein (LDL-C) significantly reduced while high-density lipoprotein (HDL-C) significantly increased in BFRT group. Conclusion: BFR combined with low-intensity RT training effectively improved body composition index, increased muscle mass, improved neuromuscular activation, enhanced muscle strength and endurance, which in turn improved abnormal glucolipid metabolism and enhanced cardiac autonomic regulation.

Salivary proteomic profile of response to different resistance training protocols: A case report

Resistance training (RT) with blood flow restriction (BFR) or high intensity (HI) are effective to increase muscle mass. To understand this effect, techniques known as "omics" are used to identify possible biomarkers. This study analyzed the salivary proteomic profile of healthy individuals trained before and after two RT protocols both designed with eight exercises for upper- and lower-limbs, one performed at low percentage of one-maximum repetition (%1RM) with BFR technique, and other at high %1RM (HI) without BRF technique. Four healthy males between 18 and 28 years participated in the study. Stimulated saliva was collected before (BBFR/BHI) and immediately after (ABFR/AHI) the two RT protocols. All protein-related processing was performed using label-free proteomic. The difference in expression between groups was expressed as p < .05 for downregulated proteins and 1-p > .95 for upregulated proteins. There was difference in salivary flow between ABFR and BBFR (p = .005). For HI, 87 proteins were found after the practice and 119 before. Three hemoglobin isoforms were increased in AHI compared with BHI. In the BFR comparison, 105 proteins were identified after (ABFR) and 70 before (BBFR). Among those increased ABFR, we highlight five hemoglobin isoforms and Deleted in malignant brain tumors 1 protein. Between ABFR and AHI, 17 isoforms of histones, Transaldolase, Transketolase, Glyceraldehyde-3-phosphate dehydrogenase, and Antileukoproteinase were decreased ABFR. For HI, there was an increase in proteins related to oxidative stress and metabolism of the musculoskeletal system, compared with BFR. HI seems to induce higher anabolic signaling to muscle mass increase and antiatherosclerotic effects.

Effect of blood flow-restricted resistance training on myocardial fibrosis in early spontaneously hypertensive rats

Objective

The purpose of this study was to explore the effect of blood flow-restricted resistance training on myocardial fibrosis in early spontaneously hypertensive rats (SHRs).

Methods

Four-week-old male Wistar-Kyoto rats and SHRs were randomly divided into the following groups: normal group (WKY), SHR control (SHR-SED) group, high-intensity resistance training (HIRT) group, low- and medium-intensity resistance training (LMIRT) group, and blood flow-restricted low- and medium-resistance training (BFRT) group. Body weight, hemodynamics, cardiac function, myocardial morphology and fibrosis, and the expression levels of transforming growth factor-beta1-Smad (TGFβ-1-Smad) pathway-related proteins in the myocardium were assessed.

Results

(1) BFRT lowered blood pressure significantly, decreased left ventricular wall thickness, and improved cardiac function. At the same time, BFRT was superior to traditional resistance training in lowering diastolic blood pressure, and was superior to HIRT in improving left ventricular compliance, reducing heart rate, and reducing left ventricular posterior wall and left ventricular mass (P < 0.05). (2) BFRT decreased collagen I and collagen fiber area in the myocardium, increased the collagen III area, and decreased the collagen I/III ratio (P < 0.05). BFRT produced a better proportion of myocardial collagen fibers than did traditional resistance training (P < 0.05). (3) In the myocardium of the BFRT group compared to the traditional resistance training group, the expression of TGFβ-1, Smad2/3/4, p-Smad2/3, CTGF, and TIMP1 was significantly downregulated, MMP2 and TIMP2 were significantly upregulated, the MMP/TIMP ratio significantly increased, and TGFβ-1 expression significantly decreased (P < 0.05).

Conclusion

BFRT inhibited the TGFβ-1-Smad pathway in the myocardium, downregulated the expression of CTGF, and regulated the balance between MMPs and TIMPs, thereby reducing myocardial fibrosis in SHR, and improving cardiac morphology and function. BFRT also lowered blood pressure, and achieved an effect of early prevention and treatment of hypertension. At the same time, BFRT was superior to traditional resistance training in reducing diastolic blood pressure and adjusting the proportion of myocardial collagen fibers.