Acute Effects of Resistance Training with Blood Flow Restriction on Achilles Tendon Thickness

Abstract The Achilles tendon is one of the strongest and thickest tendons of the human body. Several studies have reported an immediate decrease in Achilles tendon thickness after a single bout of resistance training. However, the effects of blood flow restriction training on Achilles tendon thickness have not been investigated. The purpose of this study was to investigate the acute effects of different regimens of resistance training on Achilles tendon thickness. Fiftytwo participants (27.3 ± 7 years; 177.6 ± 11 cm; 72.2 ± 13.7 kg) were randomly allocated into one of the three groups: low-intensity exercise without (LI, n = 13) and with blood flow restriction (LI-BFR, n = 24), and high-intensity exercise (HI, n = 15). Participants from LI and LI-BFR groups performed four sets (1 x 30 + 3 x 15 reps) at 30% 1RM, while the HI group performed four sets (1 x 30 with 30% 1RM + 3 x 10 reps with 75% 1RM). All groups performed a plantar flexion exercise. For the LI-BFR group, a blood pressure cuff was placed on the dominant calf and inflated at 30% of the individual´s occlusion pressure (47.6 ± 19.8 mmHg). Sonographic images of Achilles tendon thickness were taken at pre, immediately after, 60 min and 24 h following acute bouts of exercise. Achilles tendon thickness was significantly reduced immediately after, 60 min and 24 h post-LI-BFR exercise (pre: 4.4 ± 0.4 mm vs. IA: 3.8 ± 0.4 mm vs. 60 min: 3.7 ± 0.3 mm vs. 24 h: 4.1 ± 0.3 mm; p < 0.001), whereas Achilles tendon thickness was unchanged for HI and LI groups (p > 0.05). These results suggest that blood flow restriction training may be an effective strategy to stimulate a positive response in Achilles tendon thickness.

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Low-load blood flow restriction training induces similar morphological and mechanical Achilles tendon adaptations compared with high-load resistance training

Journal of Applied Physiology ◽

10.1152/japplphysiol.00602.2019 ◽

2019 ◽

Vol 127 (6) ◽

pp. 1660-1667 ◽

Cited By ~ 6

Author(s):

Christoph Centner ◽

Benedikt Lauber ◽

Olivier R. Seynnes ◽

Simon Jerger ◽

Tim Sohnius ◽

...

Keyword(s):

Blood Flow ◽

Resistance Training ◽

Achilles Tendon ◽

Load Resistance ◽

High Load ◽

Blood Flow Restriction ◽

Resistance Training Program ◽

Flow Restriction ◽

Low Load ◽

Tendon Properties

Low-load blood flow restriction (LL-BFR) training has gained increasing interest in the scientific community by demonstrating that increases in muscle mass and strength are comparable to conventional high-load (HL) resistance training. Although adaptations on the muscular level are well documented, there is little evidence on how LL-BFR training affects human myotendinous properties. Therefore, the aim of the present study was to investigate morphological and mechanical Achilles tendon adaptations after 14 wk of strength training. Fifty-five male volunteers (27.9 ± 5.1 yr) were randomly allocated into the following three groups: LL-BFR [20–35% of one-repetition maximum (1RM)], HL (70–85% 1RM), or a nonexercising control (CON) group. The LL-BFR and HL groups completed a resistance training program for 14 wk, and tendon morphology, mechanical as well as material properties, and muscle cross-sectional area (CSA) and isometric strength were assessed before and after the intervention. Both HL (+40.7%) and LL-BFR (+36.1%) training induced significant increases in tendon stiffness ( P < 0.05) as well as tendon CSA (HL: +4.6%, LL-BFR: +7.8%, P < 0.001). These changes were comparable between groups without significant changes in Young’s modulus. Furthermore, gastrocnemius medialis muscle CSA and plantar flexor strength significantly increased in both training groups ( P < 0.05), whereas the CON group did not show significant changes in any of the evaluated parameters. In conclusion, the adaptive change in Achilles tendon properties following low-load resistance training with partial vascular occlusion appears comparable to that evoked by high-load resistance training. NEW & NOTEWORTHY Low-load blood flow restriction (LL-BFR) training has been shown to induce beneficial adaptations at the muscular level. However, studies examining the effects on human tendon properties are rare. The findings provide first evidence that LL-BFR can increase Achilles tendon mechanical and morphological properties to a similar extent as conventional high-load resistance training. This is of particular importance for individuals who may not tolerate heavy training loads but still aim for improvements in myotendinous function.

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Different Time Course of Recovery in Achilles Tendon Thickness After Low-Load Resistance Training With and Without Blood Flow Restriction

Journal of Sport Rehabilitation ◽

10.1123/jsr.2019-0403 ◽

2020 ◽

pp. 1-6

Author(s):

Iván Chulvi-Medrano ◽

Moisés Picón-Martínez ◽

Juan Manuel Cortell-Tormo ◽

Juan Tortosa-Martínez ◽

Diego Alexandre Alonso-Aubin ◽

...

Keyword(s):

Blood Flow ◽

Achilles Tendon ◽

Time Course ◽

Blood Flow Restriction ◽

Medium Effect ◽

Flow Restriction ◽

Low Intensity ◽

Low Load ◽

Tendon Thickness ◽

Post Condition

Context: Blood flow restriction research has focused on muscular strength and hypertrophy. Limited data have been reported about the blood flow restriction effect on the tendon. Objective: To analyze and compare the time course of recovery in Achilles tendon thickness after a single bout of low-intensity resistance training (LI-RT) and low-intensity blood flow restriction training (LI-BFRT). Methods: A total of 56 healthy participants (24.60 [4.0] y; 23.65 [3.4] body mass index) were included. The dominant leg was assigned for LI-BFRT using low load (30% 1-repetition maximum) and 30% of the total occlusion pressure (52.21 [17.89] mm Hg) in plantar-flexion exercise (1 × 30 + 3 × 15 repetitions). The nondominant leg was assumed as a control condition. Main Outcome Measure: Sonography images were taken before the intervention, immediately posttraining, and 24 hours after exercise (post-24) for the Achilles tendon thickness. Results: Changes in Achilles tendon thickness for LI-BFRT group were significant post- (−14.5%; P < .05) and post-24 (−9.2%; P < .05). In contrast, LI-RT group showed a transient decrease after exercise (−9.67%; P < .05) followed by a recovery of thickness post-24 (−1.06%; P < .05). Thickness post-24 was different between LI-BFRT versus LI-RT (P < .01). Hedge effect size analysis showed a large effect (g = 0.90) in LI-BFRT pre–post condition and a medium effect (g = 0.57) in post- to post-24. The LI-RT obtained a medium effect (g = 0.53) in pre–post condition and a small effect (g = 0.49) in post- to post-24. Conclusions: This study showed a different time course of the acute response in Achilles tendon thickness between LI-BFRT and LI-RT. This may be associated with intratendinous fluid movement in response to LI-BFRT.

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Enhancing Strength and Postocclusive Calf Blood Flow in Older People With Training With Blood-Flow Restriction

Journal of Aging and Physical Activity ◽

10.1123/japa.19.3.201 ◽

2011 ◽

Vol 19 (3) ◽

pp. 201-213 ◽

Cited By ~ 39

Author(s):

Stephen D. Patterson ◽

Richard A. Ferguson

Keyword(s):

Blood Flow ◽

Plantar Flexion ◽

Load Resistance ◽

Voluntary Contraction ◽

Blood Flow Restriction ◽

Normal Blood ◽

Older Individuals ◽

Flow Restriction ◽

Pressure Cuff ◽

Normal Blood Flow

The response of calf-muscle strength, resting blood flow, and postocclusive blood flow (PObf) were investigated after 4 wk of low-load resistance training (LLRT) with and without blood-flow restriction in a matched-leg design. Ten untrained older individuals age 62–73 yr performed unilateral plantar-flexion LLRT at 25% 1-repetition maximum (1RM). One limb was trained with normal blood flow and the other had blood flow restricted using a pressure cuff above the knee. 1RM, isometric maximal voluntary contraction, and isokinetic strength at 0.52 rad/s increased (p < .05) more after LLRT with blood-flow restriction than with normal blood flow. Peak PObf increased (p < .05) after LLRT with blood-flow restriction, compared with no change after LLRT with normal blood flow. These results suggest that 4 wk of LLRT with blood-flow restriction may be beneficial to older individuals to improve strength and blood-flow parameters.

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Effects on the Profile of Circulating miRNAs after Single Bouts of Resistance Training with and without Blood Flow Restriction—A Three-Arm, Randomized Crossover Trial

International Journal of Molecular Sciences ◽

10.3390/ijms20133249 ◽

2019 ◽

Vol 20 (13) ◽

pp. 3249 ◽

Cited By ~ 8

Author(s):

Johanna Vogel ◽

Daniel Niederer ◽

Tobias Engeroff ◽

Lutz Vogt ◽

Christian Troidl ◽

...

Keyword(s):

Heart Rate ◽

Blood Flow ◽

Resistance Training ◽

Lactate Concentration ◽

Blood Flow Restriction ◽

Collateral Flow ◽

Circulating Mirnas ◽

Flow Restriction ◽

Flexion Extension ◽

The Individual

Background: The effects of blood flow restriction (training) may serve as a model of peripheral artery disease. In both conditions, circulating micro RNAs (miRNAs) are suggested to play a crucial role during exercise-induced arteriogenesis. We aimed to determine whether the profile of circulating miRNAs is altered after acute resistance training during blood flow restriction (BFR) as compared with unrestricted low- and high-volume training, and we hypothesized that miRNA that are relevant for arteriogenesis are affected after resistance training. Methods: Eighteen healthy volunteers (aged 25 ± 2 years) were enrolled in this three-arm, randomized-balanced crossover study. The arms were single bouts of leg flexion/extension resistance training at (1) 70% of the individual single-repetition maximum (1RM), (2) at 30% of the 1RM, and (3) at 30% of the 1RM with BFR (artificially applied by a cuff at 300 mm Hg). Before the first exercise intervention, the individual 1RM (N) and the blood flow velocity (m/s) used to validate the BFR application were determined. During each training intervention, load-associated outcomes (fatigue, heart rate, and exhaustion) were monitored. Acute effects (circulating miRNAs, lactate) were determined using pre-and post-intervention measurements. Results: All training interventions increased lactate concentration and heart rate (p < 0.001). The high-intensity intervention (HI) resulted in a higher lactate concentration than both lower-intensity training protocols with BFR (LI-BFR) and without (LI) (LI, p = 0.003; 30% LI-BFR, p = 0.008). The level of miR-143-3p was down-regulated by LI-BFR, and miR-139-5p, miR-143-3p, miR-195-5p, miR-197-3p, miR-30a-5p, and miR-10b-5p were up-regulated after HI. The lactate concentration and miR-143-3p expression showed a significant positive linear correlation (p = 0.009, r = 0.52). A partial correlation (intervention partialized) showed a systematic impact of the type of training (LI-BFR vs. HI) on the association (r = 0.35 remaining after partialization of training type). Conclusions: The strong effects of LI-BFR and HI on lactate- and arteriogenesis-associated miRNA-143-3p in young and healthy athletes are consistent with an important role of this particular miRNA in metabolic processes during (here) artificial blood flow restriction. BFR may be able to mimic the occlusion of a larger artery which leads to increased collateral flow, and it may therefore serve as an external stimulus of arteriogenesis.

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Acute Effects Of Resistance Training With And Without Blood Flow Restriction On Muscle Thickness

Medicine & Science in Sports & Exercise ◽

10.1249/01.mss.0000535144.95345.1e ◽

2018 ◽

Vol 50 (5S) ◽

pp. 18

Author(s):

Iván Chulvi-Medrano ◽

Moisés Picón ◽

Juan M. Cortell-Tormo ◽

Diego A. Alonso-Aubin ◽

Tamara Rial ◽

...

Keyword(s):

Blood Flow ◽

Resistance Training ◽

Muscle Thickness ◽

Blood Flow Restriction ◽

Acute Effects ◽

Flow Restriction

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Intramuscular metabolism during low-intensity resistance exercise with blood flow restriction

Journal of Applied Physiology ◽

10.1152/japplphysiol.90368.2008 ◽

2009 ◽

Vol 106 (4) ◽

pp. 1119-1124 ◽

Cited By ~ 83

Author(s):

Tadashi Suga ◽

Koichi Okita ◽

Noriteru Morita ◽

Takashi Yokota ◽

Kagami Hirabayashi ◽

...

Keyword(s):

Blood Flow ◽

Resistance Training ◽

Resistance Exercise ◽

High Intensity ◽

Plantar Flexion ◽

Blood Flow Restriction ◽

Resonance Spectroscopy ◽

Flow Restriction ◽

Low Intensity ◽

Intramuscular Ph

Although recent studies have reported that low-intensity resistance training with blood flow restriction could stress the muscle effectively and provide rapid muscle hypertrophy and strength gain equivalent to those of high-intensity resistance training, the exact mechanism and its generality have not yet been clarified. We investigated the intramuscular metabolism during low-intensity resistance exercise with blood flow restriction and compared it with that of high-intensity and low-intensity resistance exercises without blood flow restriction using 31P-magnetic resonance spectroscopy. Twenty-six healthy subjects (22 ± 4 yr) participated and performed unilateral plantar flexion (30 repetitions/min) for 2 min. Protocols were as follows: low-intensity exercise (L) using a load of 20% of one-repetition maximum (1 RM), L with blood flow restriction (LR), and high-intensity exercise using 65% 1 RM (H). Intramuscular phosphocreatine (PCr) and diprotonated phosphate (H2PO4−) levels and intramuscular pH at rest and during exercise were obtained. We found that the PCr depletion, the H2PO4− increase, and the intramuscular pH decrease during LR were significantly greater than those in L ( P < 0.001); however, those in LR were significantly lower than those in H ( P < 0.001). The recruitment of fast-twitch fiber evaluated by inorganic phosphate splitting occurred in only 31% of the subjects in LR, compared with 70% in H. In conclusion, the metabolic stress in skeletal muscle during low-intensity resistance exercise was significantly increased by applying blood flow restriction, but did not generally reach that during high-intensity resistance exercise. This new method of resistance training needs to be examined for optimization of the protocol to reach equivalence with high-intensity resistance training.

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Acute Effects of the Blood Flow Restriction in lower body pressurization on the static postural control

Korean Journal of Sports Science ◽

10.35159/kjss.2017.04.26.2.1227 ◽

2017 ◽

Vol 26 (2) ◽

pp. 1227-1236

Author(s):

Sung-Hoon Shin ◽

Kyu-Seung Kim

Keyword(s):

Blood Flow ◽

Postural Control ◽

Blood Flow Restriction ◽

Lower Body ◽

Acute Effects ◽

Flow Restriction

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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.

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