Partial blood flow restriction without exercise to attenuate reduction in thigh muscle strength and trophism during immobilization: A meta-analysis

2021 ◽  
Vol 47 ◽  
pp. e4
Author(s):  
Daniel Germano Maciel ◽  
Mikhail Santos Cerqueira ◽  
Jean Arthur Mendonça Barboza ◽  
José Diego Sales do Nascimento ◽  
Wouber Hérickson de Brito Vieira
PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0259574
Author(s):  
Leonardo Peterson dos Santos ◽  
Rafaela Cavalheiro do Espírito Santo ◽  
Thiago Rozales Ramis ◽  
Juliana Katarina Schoer Portes ◽  
Rafael Mendonça da Silva Chakr ◽  
...  

Introduction Rheumatoid arthritis(RA) and osteoarthritis(OA) patients showed systemic manifestations that may lead to a reduction in muscle strength, muscle mass and, consequently, to a reduction in functionality. On the other hand, moderate intensity resistance training(MIRT) and high intensity resistance training(HIRT) are able to improve muscle strength and muscle mass in RA and OA without affecting the disease course. However, due to the articular manifestations caused by these diseases, these patients may present intolerance to MIRT or HIRT. Thus, the low intensity resistance training combined with blood flow restriction(LIRTBFR) may be a new training strategy for these populations. Objective To perform a systematic review with meta-analysis to verify the effects of LIRTBFR on muscle strength, muscle mass and functionality in RA and OA patients. Materials and methods A systematic review with meta-analysis of randomized clinical trials(RCTs), published in English, between 1957–2021, was conducted using MEDLINE(PubMed), Embase and Cochrane Library. The methodological quality was assessed using Physiotherapy Evidence Database scale. The risk of bias was assessed using RoB2.0. Mean difference(MD) or standardized mean difference(SMD) and 95% confidence intervals(CI) were pooled using a random-effects model. A P<0.05 was considered statistically significant. Results Five RCTs were included. We found no significant differences in the effects between LIRTBFR, MIRT and HIRT on muscle strength, which was assessed by tests of quadriceps strength(SMD = -0.01[-0.57, 0.54], P = 0.96; I² = 58%) and functionality measured by tests with patterns similar to walking(SMD = -0.04[-0.39, 0.31], P = 0.82; I² = 0%). Compared to HIRT, muscle mass gain after LIRTBFR was reported to be similar. When comparing LIRTBFR with low intensity resistance training without blood flow restriction(LIRT), the effect LIRTBFR was reported to be higher on muscle strength, which was evaluated by the knee extension test. Conclusion LIRTBFR appears to be a promising strategy for gains in muscle strength, muscle mass and functionality in a predominant sample of RA and OA women.


2020 ◽  
Vol 25 (6) ◽  
pp. 303-306
Author(s):  
Jordan Jacobson ◽  
Cale Chaltron ◽  
David Sherman ◽  
Neal R. Glaviano

Focused Clinical Question: Is low-load exercise training with blood flow restriction (LL-BFR) more effective at increasing muscle strength compared to low-level (LL) or high-level (HL) exercise training in individuals with muscle weakness? Clinical Bottom Line: The results of the systematic review with meta-analysis concluded that there is evidence to support the belief that LL-BFR may increase muscle strength beyond LL exercise training alone, while HL training will produce greater strength increases compared to both LL-BFR and LL training.


2021 ◽  
Vol 1 (5) ◽  
pp. 263502542110326
Author(s):  
Steven R. Dayton ◽  
Simon J. Padanilam ◽  
Tyler C. Sylvester ◽  
Michael J. Boctor ◽  
Vehniah K. Tjong

Background: Blood flow restriction (BFR) training restricts arterial inflow and venous outflow from the extremity and can produce gains in muscle strength at low loads. Low-load training reduces joint stress and decreases cardiovascular risk when compared with high-load training, thus making BFR an excellent option for many patients requiring rehabilitation. Indications: Blood flow restriction has shown clinical benefit in a variety of patient populations including healthy patients as well as those with osteoarthritis, anterior cruciate ligament reconstruction, polymyositis/dermatomyositis, and Achilles tendon rupture. Technique Description: This video demonstrates BFR training in 3 clinical areas: upper extremity resistance training, lower extremity resistance training, and low-intensity cycling. All applications of BFR first require determination of total occlusion pressure. Upper extremity training requires inflating the tourniquet to 50% of total occlusion pressure, while lower extremity exercises use 80% of total occlusion pressure. Low-load resistance training exercises follow a specific repetition scheme: 30 reps followed by a 30-second rest and then 3 sets of 15 reps with 30-seconds rest between each. During cycle training, 80% total occlusion pressure is used as the patient cycles for 15 minutes without rest. Results: Augmenting low-load resistance training with BFR increases muscle strength when compared with low-load resistance alone. In addition, low-load BFR has demonstrated an increase in muscle mass greater than low-load training alone and equivalent to high-load training absent BFR. A systematic review determined the safety of low-load training with BFR is comparable to traditional high-intensity resistance training. The most common adverse effects include exercise intolerance, discomfort, and dull pain which are also frequent in patients undergoing traditional resistance training. Severe adverse effects including deep vein thrombosis, pulmonary embolism, and rhabdomyolysis are exceedingly rare, less than 0.006% according to a national survey. Patients undergoing BFR rehabilitation experience less perceived exertion and demonstrate decreased pain scores compared with high-load resistance training. Conclusion: Blood flow restriction training is an effective alternative to high-load resistance training for patients requiring musculoskeletal rehabilitation for multiple disease processes as well as in the perioperative setting. Blood flow restriction has been shown to be a safe training modality when managed by properly trained physical therapists and athletic trainers.


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