Low-load Blood Flow Restriction Training in COPD

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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Muscle Adaptations to High-Load Training and Very Low-Load Training With and Without Blood Flow Restriction

Frontiers in Physiology ◽

10.3389/fphys.2018.01448 ◽

2018 ◽

Vol 9 ◽

Cited By ~ 24

Author(s):

Matthew B. Jessee ◽

Samuel L. Buckner ◽

J. Grant Mouser ◽

Kevin T. Mattocks ◽

Scott J. Dankel ◽

...

Keyword(s):

Blood Flow ◽

High Load ◽

Blood Flow Restriction ◽

Flow Restriction ◽

Muscle Adaptations ◽

Low Load

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Greater discomfort with blood flow restriction training compared to standard low‐load resistance exercise when both are performed to task failure

Translational Sports Medicine ◽

10.1002/tsm2.184 ◽

2020 ◽

Vol 3 (6) ◽

pp. 607-615

Author(s):

Christopher Pignanelli ◽

Jamie F. Burr

Keyword(s):

Blood Flow ◽

Resistance Exercise ◽

Load Resistance ◽

Blood Flow Restriction ◽

Task Failure ◽

Flow Restriction ◽

Low Load

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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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High Blood Flow Restriction Pressure is Necessary to Induce Vascular Adaptations with Very Low-Load Training

Medicine & Science in Sports & Exercise ◽

10.1249/01.mss.0000562468.02160.19 ◽

2019 ◽

Vol 51 (Supplement) ◽

pp. 659

Author(s):

Kevin T. Mattocks ◽

Grant J Mouser ◽

Matthew B. Jessee ◽

Scott J. Dankel ◽

Samuel L. Buckner ◽

...

Keyword(s):

Blood Flow ◽

Blood Flow Restriction ◽

Flow Restriction ◽

Low Load

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Blood Flow Restriction Combined With Low-load Resistance-type Exercise Increases Myofibrillar Protein Synthesis Rates

Medicine & Science in Sports & Exercise ◽

10.1249/01.mss.0000537219.39785.68 ◽

2018 ◽

Vol 50 (5S) ◽

pp. 645-646

Author(s):

Jean Nyakayiru ◽

Cas J. Fuchs ◽

Joey S.J. Smeets ◽

Annemie P. Gijsen ◽

Joy P.B. Goessens ◽

...

Keyword(s):

Blood Flow ◽

Protein Synthesis ◽

Load Resistance ◽

Myofibrillar Protein ◽

Blood Flow Restriction ◽

Flow Restriction ◽

Low Load ◽

Myofibrillar Protein Synthesis

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Adaptation of Perceptual Responses to Low-Load Blood Flow Restriction Training

The Journal of Strength and Conditioning Research ◽

10.1519/jsc.0000000000001478 ◽

2017 ◽

Vol 31 (3) ◽

pp. 765-772 ◽

Cited By ~ 18

Author(s):

Juan Martín-Hernández ◽

Jorge Ruiz-Aguado ◽

Azael J. Herrero ◽

Jeremy P. Loenneke ◽

Per Aagaard ◽

...

Keyword(s):

Blood Flow ◽

Blood Flow Restriction ◽

Flow Restriction ◽

Low Load

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Time course of regional vascular adaptations to low load resistance training with blood flow restriction

Journal of Applied Physiology ◽

10.1152/japplphysiol.00040.2013 ◽

2013 ◽

Vol 115 (3) ◽

pp. 403-411 ◽

Cited By ~ 38

Author(s):

Julie E. A. Hunt ◽

Dermot Galea ◽

Graham Tufft ◽

Danny Bunce ◽

Richard A. Ferguson

Keyword(s):

Blood Flow ◽

Resistance Exercise ◽

Popliteal Artery ◽

Reactive Hyperemia ◽

Load Resistance ◽

T Test ◽

Blood Flow Restriction ◽

Flow Restriction ◽

Low Load ◽

Transient Improvement

Distortion to hemodynamic and ischemic stimuli during blood flow restriction (BFR) exercise may influence regional vascular adaptation. We examined changes at the conduit, resistance, and capillary level in response to low load resistance exercise with BFR. Eleven males (22 ± 3 yr, 178 ± 4 cm, 78 ± 9 kg) completed 6 wk (3 days/wk) unilateral plantar flexion training with BFR at 30% 1 repetition maximum (1-RM). The contralateral leg acted as a nonexercised control (CON). Popliteal artery function [flow-mediated dilation, FMD%] and structure [maximal diameter] and resistance vessel structure [peak reactive hyperemia] were assessed using Doppler ultrasound before and at 2-wk intervals. Calf filtration capacity was assessed using venous occlusion plethysmography before and after training. BFR training elicited an early increase in peak reactive hyperemia (1,400 ± 278 vs. 1,716 ± 362 ml/min at 0 vs. 2 wk; t-test: P = 0.047), a transient improvement in popliteal FMD% (5.0 ± 2.1, 7.6 ± 2.9, 6.6 ± 2.1, 5.7 ± 1.6% at 0, 2, 4 and 6 wk, respectively; ANOVA: P = 0.002), and an increase in maximum diameter (6.06 ± 0.44 vs. 6.26 ± 0.39 mm at 0 vs. 6 wk; Bonferroni t-test: P = 0.048). Capillary filtration increased after 6 wk BFR training ( P = 0.043). No changes in the CON leg were observed. Adaptation occurred at all levels of the vascular tree in response to low load resistance exercise with BFR. Enhanced peak reactive hyperemia and transient improvement in popliteal artery function occurred before changes in artery structural capacity.

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