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Hong QM, Wang HN, Liu XH, Zhou WQ, Luo XB. Intermittent blood flow restriction with low-load resistance training for older adults with knee osteoarthritis: a randomized, controlled, non-inferiority trial protocol. Trials 2024; 25:352. [PMID: 38822360 PMCID: PMC11140873 DOI: 10.1186/s13063-024-08203-9] [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: 11/02/2023] [Accepted: 05/28/2024] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND Knee osteoarthritis (KOA) is a chronic musculoskeletal disorder characterized by pain and functional impairment. Blood flow restriction (BFR) with low-load resistance training (LLRT) demonstrates a similar improvement in clinical outcomes to high-load resistance training (HLRT) in treating KOA. It has not been established whether intermittent blood flow restriction (iBFR) with LLRT can lead to clinical outcomes that are comparable to those produced by continuous blood flow restriction (cBFR) with LLRT and HLRT. The aim of the proposed study is to evaluate the efficacy of iBFR with LLRT on pain, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), muscle strength, muscle mass, physical function, perceptions of discomfort and effort, and adherence in KOA patients. METHODS This is a three-arm, non-inferiority, randomized controlled trial utilizing blinded assessors. Two hundred thirteen participants will be randomly allocated to one of the following three groups: iBFR group-receiving 4 months of LLRT with iBFR, twice weekly (n = 71); cBFR group-receiving 4 months of LLRT with cBFR, twice weekly (n = 71); or HLRT group-receiving 4 months of HLRT without BFR, twice weekly (n = 71). The primary outcome is pain. The secondary outcomes include the WOMAC, muscle strength, muscle mass, physical function, perceptions of discomfort and effort, and adherence. Pain and WOMAC will be measured at the baseline and 4 and 12 months after randomizations. Muscle strength, muscle mass, and physical function will be measured at the baseline and 4 months after randomizations. The perceptions of discomfort and effort will be measured during the first and final sessions. DISCUSSION BFR with LLRT has a similar improvement in clinical outcomes as HLRT. However, cBFR may cause elevated ratings of perceived exertion and local discomfort, compromising patient tolerability and treatment adherence. If iBFR with LLRT could produce improvement in clinical outcomes analogous to those of HLRT and iBFR with LLRT, it could be considered an alternative approach for treating patients with KOA. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR2300072820. Registered on June 26, 2023.
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Affiliation(s)
- Qiao-Mei Hong
- Department of Sport Medicine, Sichuan Province Orthopedic Hospital, Chengdu, Sichuan Province, China
| | - Hao-Nan Wang
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, China.
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China.
| | - Xi-Hui Liu
- Department of Sport Medicine, Sichuan Province Orthopedic Hospital, Chengdu, Sichuan Province, China
| | - Wen-Qi Zhou
- Department of Sport Medicine, Sichuan Province Orthopedic Hospital, Chengdu, Sichuan Province, China
| | - Xiao-Bing Luo
- Department of Sport Medicine, Sichuan Province Orthopedic Hospital, Chengdu, Sichuan Province, China
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de Castro FMP, Oliveira LDP, Aquino R, Tourinho Filho H, Puggina EF. Impact of Complete Intermittent Blood Flow Restriction in Upper Limbs Strength and Neural Function. RESEARCH QUARTERLY FOR EXERCISE AND SPORT 2024:1-11. [PMID: 38306672 DOI: 10.1080/02701367.2023.2294092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 11/27/2023] [Indexed: 02/04/2024]
Abstract
Purpose: We aimed to investigate the chronic effects of low-load strength training (LT) with complete intermittent blood flow restriction (IBFR) on neural adaptations and strength in biceps brachii. Methods: Nineteen volunteers were randomly assigned into two different 9-week training protocols consisting of three assessment weeks and six training weeks: (a) LT with complete IBFR (LT-IBFR; n = 10) and (b) LT without complete IBFR (LT; n = 9). Strength was evaluated by predicted 1 repetition maximum (1RM) at weeks 1, 5, and 9 and neural function by root mean square (RMS) and median frequency (MDF) at sessions 1, 7, and 12 during the first three and last three repetitions. Both groups performed three sets of Scott curl with 20% of predicted 1RM interspersed with 90s rest twice a week. Results: No changes were found in predicted 1RM throughout the training protocols nor between groups. LT-IBFR group showed lower RMS in the first set than LT for the first three repetitions and higher RMS in all sets for the last three repetitions with decreases in this value across the sets with no longitudinal changes for both groups. MDF in the first three repetitions did not differentiate between groups, however, in the last three repetitions, MDF were lower for LTIBFR group in all sets and it increased across the sets for this condition with no chronical changes for both groups in both repetitions zones. These results suggest that LT-IBFR may be ineffective for increasing Q5 strength and it did not promote chronic neural adaptations.
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Zota IM, Ghiciuc CM, Cojocaru DC, Dima-Cozma CL, Leon MM, Gavril RS, Roca M, Costache AD, Maștaleru A, Anghel L, Stătescu C, Sascău RA, Mitu F. Changes in Arterial Stiffness in Response to Blood Flow Restriction Resistance Training: A Narrative Review. J Clin Med 2023; 12:7602. [PMID: 38137671 PMCID: PMC10743779 DOI: 10.3390/jcm12247602] [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: 10/18/2023] [Revised: 12/07/2023] [Accepted: 12/08/2023] [Indexed: 12/24/2023] Open
Abstract
Arterial stiffness naturally increases with age and is a known predictor of cardiovascular morbimortality. Blood flow restriction (BFR) training involves decreasing muscle blood flow by applying a strap or a pneumatic cuff during exercise. BFR induces muscle hypertrophy even at low intensities, making it an appealing option for older, untrained individuals. However, BFR use in patients with cardiovascular comorbidities is limited by the increased pressor and chronotropic response observed in hypertensive elderly patients. Furthermore, the impact of BFR on vascular function remains unclear. We conducted a comprehensive literature review according to PRISMA guidelines, summarizing available data on the acute and long-term consequences of BFR training on vascular function. Although evidence is still scarce, it seems that BFR has a mild or neutral long-term impact on arterial stiffness. However, current research shows that BFR can cause an abrupt, albeit transient, increase in PWV and central blood pressure. BFR and, preferably, lower-body BFR, should be prescribed with caution in older populations, especially in hypertensive patients who have an exacerbated muscle metaboreflex pressor response. Longer follow-up studies are required to assess the chronic effect of BFR training on arterial stiffness, especially in elderly patients who are usually unable to tolerate high-intensity resistance exercises.
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Affiliation(s)
- Ioana Mădălina Zota
- Department of Medical Specialties I, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700111 Iași, Romania; (I.M.Z.); (C.L.D.-C.); (M.M.L.); (R.S.G.); (M.R.); (A.D.C.); (A.M.); (L.A.); (C.S.); (R.A.S.); (F.M.)
| | - Cristina Mihaela Ghiciuc
- Pharmacology, Clinical Pharmacology and Algeziology, Department of Morpho-Functional Sciences II, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700111 Iași, Romania
| | - Doina Clementina Cojocaru
- Department of Medical Specialties I, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700111 Iași, Romania; (I.M.Z.); (C.L.D.-C.); (M.M.L.); (R.S.G.); (M.R.); (A.D.C.); (A.M.); (L.A.); (C.S.); (R.A.S.); (F.M.)
| | - Corina Lucia Dima-Cozma
- Department of Medical Specialties I, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700111 Iași, Romania; (I.M.Z.); (C.L.D.-C.); (M.M.L.); (R.S.G.); (M.R.); (A.D.C.); (A.M.); (L.A.); (C.S.); (R.A.S.); (F.M.)
| | - Maria Magdalena Leon
- Department of Medical Specialties I, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700111 Iași, Romania; (I.M.Z.); (C.L.D.-C.); (M.M.L.); (R.S.G.); (M.R.); (A.D.C.); (A.M.); (L.A.); (C.S.); (R.A.S.); (F.M.)
| | - Radu Sebastian Gavril
- Department of Medical Specialties I, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700111 Iași, Romania; (I.M.Z.); (C.L.D.-C.); (M.M.L.); (R.S.G.); (M.R.); (A.D.C.); (A.M.); (L.A.); (C.S.); (R.A.S.); (F.M.)
| | - Mihai Roca
- Department of Medical Specialties I, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700111 Iași, Romania; (I.M.Z.); (C.L.D.-C.); (M.M.L.); (R.S.G.); (M.R.); (A.D.C.); (A.M.); (L.A.); (C.S.); (R.A.S.); (F.M.)
| | - Alexandru Dan Costache
- Department of Medical Specialties I, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700111 Iași, Romania; (I.M.Z.); (C.L.D.-C.); (M.M.L.); (R.S.G.); (M.R.); (A.D.C.); (A.M.); (L.A.); (C.S.); (R.A.S.); (F.M.)
| | - Alexandra Maștaleru
- Department of Medical Specialties I, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700111 Iași, Romania; (I.M.Z.); (C.L.D.-C.); (M.M.L.); (R.S.G.); (M.R.); (A.D.C.); (A.M.); (L.A.); (C.S.); (R.A.S.); (F.M.)
| | - Larisa Anghel
- Department of Medical Specialties I, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700111 Iași, Romania; (I.M.Z.); (C.L.D.-C.); (M.M.L.); (R.S.G.); (M.R.); (A.D.C.); (A.M.); (L.A.); (C.S.); (R.A.S.); (F.M.)
| | - Cristian Stătescu
- Department of Medical Specialties I, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700111 Iași, Romania; (I.M.Z.); (C.L.D.-C.); (M.M.L.); (R.S.G.); (M.R.); (A.D.C.); (A.M.); (L.A.); (C.S.); (R.A.S.); (F.M.)
| | - Radu Andy Sascău
- Department of Medical Specialties I, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700111 Iași, Romania; (I.M.Z.); (C.L.D.-C.); (M.M.L.); (R.S.G.); (M.R.); (A.D.C.); (A.M.); (L.A.); (C.S.); (R.A.S.); (F.M.)
| | - Florin Mitu
- Department of Medical Specialties I, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700111 Iași, Romania; (I.M.Z.); (C.L.D.-C.); (M.M.L.); (R.S.G.); (M.R.); (A.D.C.); (A.M.); (L.A.); (C.S.); (R.A.S.); (F.M.)
- Academy of Medical Sciences of Romania, Ion C. Brătianu Boulevard No 1, 030167 Bucharest, Romania
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Cerqueira MS, Maciel DG, Barboza JAM, Centner C, Lira M, Pereira R, De Brito Vieira WH. Effects of low-load blood flow restriction exercise to failure and non-failure on myoelectric activity: a meta-analysis. J Athl Train 2021; 57:402-417. [PMID: 34038945 DOI: 10.4085/1062-6050-0603.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To compare the short- and long-term effects of low load blood flow restriction (LL-BFR) versus low- (LL-RT) or high-load (HL-RT) resistance training with free blood flow on myoelectric activity, and investigate the differences between failure and non-failure protocols. DATA SOURCE We identified sources by searching the MEDLINE/PUBMED, CINAHL, WEB OF SCIENCE, CENTRAL, SCOPUS, SPORTDiscus, and PEDro electronic databases. STUDY SELECTION We screened titles and abstracts of 1048 articles using our inclusion criteria. A total of 39 articles were selected for further analysis. DATA EXTRACTION Two reviewers independently assessed the methodological quality of each study and extracted data from studies. A meta-analytic approach was used to compute standardized mean differences (SMD ± 95% confidence intervals (CI)). Subgroup analyses were conducted for both failure or non-failure protocols. DATA SYNTHESIS The search identified n = 39 articles that met the inclusion criteria. Regarding the short-term effects, LL-BFR increased muscle excitability compared with LL-RT during non-failure exercises (SMD 0.61, 95% CI 0.34 to 0.88), whereas HL-RT increased muscle excitability compared with LL-BFR regardless of voluntary failure (SMD -0.61, 95% CI -1.01 to 0.21) or not (SMD -1.13, CI -1.94 to -0.33). Concerning the long-term effects, LL-BFR increased muscle excitability compared with LL-RT during exercises performed to failure (SMD 1.09, CI 0.39 to 1.79). CONCLUSIONS Greater short-term muscle excitability levels are observed in LL-BFR than LL-RT during non-failure protocols. Conversely, greater muscle excitability is present during HL-RT compared with LL-BFR, regardless of volitional failure. Furthermore, LL-BFR performed to failure increases muscle excitability in the long-term compared with LL-RT.
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Affiliation(s)
- Mikhail Santos Cerqueira
- Neuromuscular Performance Analysis Laboratory - Department of Physical Therapy, Federal University of Rio Grande do Norte (UFRN), Natal, RN, Brazil,
| | - Daniel Germano Maciel
- Neuromuscular Performance Analysis Laboratory - Department of Physical Therapy, Federal University of Rio Grande do Norte (UFRN), Natal, RN, Brazil,
| | - Jean Artur Mendonça Barboza
- Neuromuscular Performance Analysis Laboratory - Department of Physical Therapy, Federal University of Rio Grande do Norte (UFRN), Natal, RN, Brazil,
| | - Christoph Centner
- Department of Sport and Sport Science, University of Freiburg, Freiburg, Germany; Praxisklinik Rennbahn, Muttenz, Switzerland,
| | - Maria Lira
- Neuromuscular Performance Analysis Laboratory - Department of Physical Therapy, Federal University of Rio Grande do Norte (UFRN), Natal, RN, Brazil,
| | - Rafael Pereira
- Integrative Physiology Research Center, Department of Biological Sciences, Universidade Estadual do Sudoeste da Bahia (UESB), Jequié, Bahia, Brazil,
| | - Wouber Hérickson De Brito Vieira
- Neuromuscular Performance Analysis Laboratory - Department of Physical Therapy, Federal University of Rio Grande do Norte (UFRN), Natal, RN, Brazil,
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Amorim S, Rolnick N, Schoenfeld BJ, Aagaard P. Low-intensity resistance exercise with blood flow restriction and arterial stiffness in humans: A systematic review. Scand J Med Sci Sports 2020; 31:498-509. [PMID: 33283322 DOI: 10.1111/sms.13902] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 11/18/2020] [Accepted: 11/20/2020] [Indexed: 12/25/2022]
Abstract
Low-intensity resistance exercise with blood flow restriction exercise is an emerging type of exercise recognition worldwide. This systematic review evaluated the effects of low-intensity resistance exercise performed with concurrent blood flow restriction (LIRE-BFR) on acute and chronic measures of arterial stiffness in humans. A systematic search in six healthcare science databases and reference lists was conducted. Data selected for primary analysis consisted of post-intervention changes in arterial stiffness markers. This systematic review included randomized and non-randomized controlled trials of LIRE-BFR in humans. 156 articles were initially identified, 15 of which met inclusion criteria. Ten studies were excluded because they did not match predefined arterial stiffness markers. Thus, five articles were included in this review: two acute studies (N = 39 individuals, age = 20-30 years old, 30.8% women and 69.2% men) and three longitudinal studies (N = 51 individuals, age = 24-86-years old, 41.2% women and 58.8% men). Acute LIRE-BFR demonstrated both positive and negative effects on arterial stiffness in healthy young people. In contrast, longitudinal studies reported neutral effects in healthy young and older people. In conclusion, LIRE-BFR applied to the upper and lower limbs may acutely induce increases in central blood pressure and pulse wave velocity in healthy young people, whereas LIRE-BFR for the lower limbs may elicit positive effects related to indirect markers of arterial stiffness. Moreover, longitudinal LIRE-BFR studies showed no changes in arterial stiffness in young and older people. Hence, LIRE-BFR should be prescribed with a degree of caution to avoid non-intended responses in arterial stiffness markers in humans.
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Affiliation(s)
- Samuel Amorim
- Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Nicholas Rolnick
- Department of Health Sciences, Lehman College, CUNY, Bronx, NY, USA
| | | | - Per Aagaard
- Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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Ferlito JV, Pecce SAP, Oselame L, De Marchi T. The blood flow restriction training effect in knee osteoarthritis people: a systematic review and meta-analysis. Clin Rehabil 2020; 34:1378-1390. [DOI: 10.1177/0269215520943650] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: To synthesize evidence on the effects of blood flow restriction (BFR) comparing with high (HLT) and low load (LLT), and on the influence of different forms of application in individuals with knee osteoarthritis. Data sources: The CENTRAL, PEDro, PubMed and BVS, which include Lilacs, Medline and SciELO, until April 2020. Review methods: A systematic review and meta-analysis of randomized trials used the PRISMA guidelines, whose main keywords were: Therapeutic Occlusion, Resistance Training, and Knee Osteoarthritie, blood flow restriction and Kaatsu training. Method quality was evaluated with the PEDro scale. When studies demonstrated homogeneity on outcome measures, the mean differences or standardized mean differences with 95% confidence interval were calculated and pooled in a meta-analysis for pooled synthesis. Results: Five articles were eligible in this review with moderate to low risk bias. Our results, showed no difference between BFR and HLT in knee strength (SMD = 0.00, 95% CI, –0.54 to 0.54, P = 1.00), function (SMD = −0.20, 95% CI, –0.45 to 0.06, P = 0.13), pain and volume. But, when compared BFR and LLT, the descriptive analysis demonstrated significant results in favor BFR to muscle strength (71.4% of measurement) and volume (MD = 1.66, 95% CI, 0.93 to 2.38, P < 0.00001), but not in pain or function. Conclusion: BFR can be used as a strategy in the rehabilitation of osteoarthritis due to gains in strength and volume with low mechanical stress. However, its application must be safe and individualized, since they can attenuate the stimuli offered by BFR.
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Affiliation(s)
- João Vitor Ferlito
- Department of Physiotherapy of University Center Cenecista of Bento Gonçalves, Bento Gonçalves, Rio Grande do Sul, Brazil
| | - Samantha Angelica Pasa Pecce
- Department of Physiotherapy of University Center Cenecista of Bento Gonçalves, Bento Gonçalves, Rio Grande do Sul, Brazil
| | - Lucas Oselame
- Department of Physiotherapy of University Center Cenecista of Bento Gonçalves, Bento Gonçalves, Rio Grande do Sul, Brazil
| | - Thiago De Marchi
- Department of Physiotherapy of University Center Cenecista of Bento Gonçalves, Bento Gonçalves, Rio Grande do Sul, Brazil
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