Training response to 8 weeks of blood flow restricted training is not improved by preferentially altering tissue hypoxia or lactate accumulation when training to repetition failure

Despite compelling muscular structure and function changes resulting from blood flow restricted (BFR) resistance training, mechanisms of action remain poorly characterized. Alterations in tissue O2 saturation (TSI%) and metabolites are potential drivers of observed changes, but their relationships with degree of occlusion pressure are unclear. We examined local TSI% and blood lactate (BL) concentration during BFR training to failure using different occlusion pressures on strength, hypertrophy, and muscular endurance over an 8-week training period. Twenty participants (11M:9F) trained 3/wk for 8wk using high pressure (100% resting limb occlusion pressure, LOP, 20%1RM), moderate pressure (50% LOP, 20%1RM), or traditional resistance training (70%1RM). Strength, size, and muscular endurance were measured pre/post training. TSI% and BL were quantified during a training session. Despite overall increases, no group preferentially increased strength, hypertrophy, or muscular endurance (p>0.05). Neither TSI% nor BL concentration differed between groups (p>0.05). Moderate pressure resulted in greater accumulated deoxygenation stress (TSI%*time) (-6352±3081, -3939±1835, -2532±1349 au for moderate pressure, high pressure, and TRT, p=0.018). We demonstrate that BFR training to task-failure elicits similar strength, hypertrophy, and muscular endurance changes to traditional resistance training. Further, varied occlusion pressure does not impact these outcomes, nor elicit changes in TSI% or BL concentrations. Novelty Bullets • Training to task failure with low-load blood flow restriction elicits similar improvements to traditional resistance training, regardless of occlusion pressure. • During blood flow restriction, altering occlusion pressure does not proportionally impact tissue O2 saturation nor blood lactate concentrations

Download Full-text

Effects of exercise intensity and occlusion pressure after 12 weeks of resistance training with blood-flow restriction

European Journal of Applied Physiology ◽

10.1007/s00421-015-3253-2 ◽

2015 ◽

Vol 115 (12) ◽

pp. 2471-2480 ◽

Cited By ~ 74

Author(s):

Manoel E. Lixandrão ◽

Carlos Ugrinowitsch ◽

Gilberto Laurentino ◽

Cleiton A. Libardi ◽

André Y. Aihara ◽

...

Keyword(s):

Blood Flow ◽

Resistance Training ◽

Exercise Intensity ◽

Blood Flow Restriction ◽

Occlusion Pressure ◽

Flow Restriction

Download Full-text

Blood Flow Restriction Therapy Impact on Musculoskeletal Strength and Mass

Video Journal of Sports Medicine ◽

10.1177/26350254211032681 ◽

2021 ◽

Vol 1 (5) ◽

pp. 263502542110326

Author(s):

Steven R. Dayton ◽

Simon J. Padanilam ◽

Tyler C. Sylvester ◽

Michael J. Boctor ◽

Vehniah K. Tjong

Keyword(s):

Blood Flow ◽

Resistance Training ◽

Muscle Strength ◽

Load Resistance ◽

High Load ◽

Blood Flow Restriction ◽

Occlusion Pressure ◽

Total Occlusion ◽

Flow Restriction ◽

Low Load

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.

Download Full-text

Lower occlusion pressure during resistance exercise with blood-flow restriction promotes lower pain and perception of exercise compared to higher occlusion pressure when the total training volume is equalized

Physiology International ◽

10.1556/2060.105.2018.3.18 ◽

2018 ◽

Vol 105 (3) ◽

pp. 276-284 ◽

Cited By ~ 8

Author(s):

SD Soligon ◽

ME Lixandrão ◽

TMPC Biazon ◽

V Angleri ◽

H Roschel ◽

...

Keyword(s):

High Pressure ◽

Blood Flow ◽

Resistance Exercise ◽

Low Pressure ◽

Blood Flow Restriction ◽

Rating Of Perceived Exertion ◽

Training Volume ◽

Occlusion Pressure ◽

Flow Restriction ◽

Wide Range

Low-intensity resistance exercise with blood-flow restriction (BFR) promotes similar adaptations to high-intensity resistance exercise (HI-RE). Interestingly, BFR has been demonstrated to be effective for a wide range of occlusion pressures. However, the occlusion pressure magnitude may alter the psychophysiological stress related to BFR as measured by rating of perceived exertion scale (RPE) and rating of pain. We aimed to compare the RPE and pain levels across different magnitudes of occlusion pressures, promoting new knowledge regarding occlusion pressure on stress related to BFR. All BFR protocols ranging between 40% and 80% of total arterial occlusion (BFR40, BFR50, BFR60, BFR70, and BFR80) were compared to HI-RE in 12 participants using a randomized and crossover design 72 h apart. BFR protocols and HI-RE were performed with 30% and 80% of one-repetition maximum (1RM) test value, respectively. RPE and pain levels were measured before exercise and immediately after each set. BFR protocols (i.e., BFR40 and BFR50) presented overall lower RPE response compared to higher-pressure BFR (i.e., BFR70 and BFR80) and HI-RE conditions. For pain levels, low-pressure BFRs (i.e., BFR40 and BFR50), and HI-RE showed lower values than high-pressure BFR protocols (i.e., BFR60, BFR70, and BFR80). In conclusion, low-pressure BFR protocols promote lower RPE and pain compared to high-pressure BFR protocols (between 60% and 80% of occlusion pressure), when total training volume (TTV) is equalized. In addition, HI-RE promotes similar levels of pain, but higher RPE than low-pressure BFR, probably due to the higher TTV.

Download Full-text

High-pressure blood flow restriction with very low load resistance training results in peripheral vascular adaptations similar to heavy resistance training

Physiological Measurement ◽

10.1088/1361-6579/ab0d2a ◽

2019 ◽

Vol 40 (3) ◽

pp. 035003 ◽

Cited By ~ 5

Author(s):

J Grant Mouser ◽

Kevin T Mattocks ◽

Samuel L Buckner ◽

Scott J Dankel ◽

Matthew B Jessee ◽

...

Keyword(s):

High Pressure ◽

Blood Flow ◽

Resistance Training ◽

Load Resistance ◽

Blood Flow Restriction ◽

Peripheral Vascular ◽

Flow Restriction ◽

Low Load ◽

Heavy Resistance Training

Download Full-text

Optimal parameters of blood flow restriction and resistance training on quadriceps strength and cross-sectional area and pain in knee osteoarthritis

Isokinetics and Exercise Science ◽

10.3233/ies-200235 ◽

2021 ◽

pp. 1-10

Author(s):

Waleed S. Mahmoud ◽

Ahmed Osailan ◽

Ahmed S. Ahmed ◽

Ragab K. Elnaggar ◽

Nadia L. Radwan

Keyword(s):

Blood Flow ◽

Resistance Training ◽

Knee Osteoarthritis ◽

Quadriceps Strength ◽

Sectional Area ◽

Occlusion Pressure ◽

Total Occlusion ◽

Cross Sectional ◽

Flow Restriction ◽

Low Intensity

BACKGROUND: Knee osteoarthritis (KOA) is one of the most common chronic diseases impacting millions of elderly people. OBJECTIVES: The study compared the effects of two intensities of partial blood flow restriction (BFR) with low-intensity resistance training on quadriceps strength and cross-sectional area (CSA), and pain in people with knee osteoarthritis (PwKOA). METHODS: Thirty-five PwKOA, aged 50–65, participated. Quadriceps CSA was measured by ultrasonography, quadriceps strength – by isokinetic dynamometry and pain by VAS. These outcome variables were obtained at the beginning of the study and re-evaluated eight weeks after the intervention. RESULTS: An interaction effect was present for quadriceps CSA (P= 0.042) and quadriceps strength (P= 0.006), showing that using 70% of total occlusion pressure with 30% 1RM had a more significant effect. Knee pain improved significantly through the main effect of BFR (P< 0.001), and low-intensity resistance training (P= 0.011). Pain improved more at 70% of total occlusion pressure, with 30% of 1RM (2.5 ± 1.06) than 50% total occlusion pressure with 10% of 1RM (5.77 ± 1.46). CONCLUSION: A combination of 70% of total occlusion pressure with 30% 1RM could be beneficial in PwKOA in improving pain, and increasing the quadriceps strength. The changes in the quadriceps strength could be a predictor for knee pain.

Download Full-text

Does Blood Flow Restriction Resistance Training Improve Knee-Extensor Strength, Function, and Reduce Patient-Reported Pain? A Critically Appraised Topic

Journal of Sport Rehabilitation ◽

10.1123/jsr.2021-0081 ◽

2021 ◽

pp. 1-6

Author(s):

Matthew Zaremba ◽

Joel Martin ◽

Marcie Fyock-Martin

Keyword(s):

Blood Flow ◽

Resistance Training ◽

Knee Injury ◽

Strength Function ◽

Knee Extensor ◽

Blood Flow Restriction ◽

Flow Restriction ◽

Patient Reported ◽

And Function ◽

Knee Pathology

Clinical Scenario: Knee pathologies often require rehabilitation to address the loss of knee-extensor (KE) strength, function, and heightened pain. However, in the early stages of rehabilitation, higher loads may be contraindicated. Blood flow restriction (BFR) resistance training does not require high loads and has been used clinically to promote strength improvements in a variety of injured populations. BFR resistance training may be an effective alternative to high-intensity resistance training during early rehabilitation of knee pathologies. Clinical Question: Following a knee injury, does BFR resistance training improve KE strength and function, and reduce patient-reported pain? Summary of Key Findings: Four randomized controlled trial studies met the inclusion criteria. Each included study evaluated the use of BFR resistance training on knee pathologies and the effects on KE strength, functional outcomes, and pain compared with high- or low-load resistance training. All 4 studies reported significant improvements in KE strength, function, and pain through a variety of outcome measures, following BFR resistance training use as the treatment. Clinical Bottom Line: There is consistent evidence to support the use of BFR resistance training as a treatment intervention following knee injury and as a means to improve KE strength and function and to reduce pain. Strength of Recommendation: Grade A evidence supporting the use of BFR resistance training for improvement in KE strength and function, and the reduction of patient-reported pain following an acute or chronic knee pathology.

Download Full-text