Blood flow restriction with different load levels in patients with knee osteoarthritis: protocol of a randomized controlled trial

Background The effectiveness of blood flow restriction training (BFR) in elderly with knee osteoarthritis (OA) is comparable to performing high-intensity protocols (70 to 80% of 1 RM [repetition maximum]) that are known to be effective for improving the muscle strength of knee extensors, with the advantage of generating less particular rating of perceived exertion and pain immediately after training. However, despite being a promising alternative, little is known about the best way to apply the BFR, such as level of pressure and combination or not with other therapeutic modalities. The purpose of this study is to evaluate whether different levels of blood flow restriction with low load (BFR + LL) and no load (BFR + rest) are non-inferior to high-intensity resistance exercise (HIRE+BFRplacebo) for pain reduction in patients with knee OA. Methods/design This clinical trial is a non-inferiority, five-arm, randomized, active-controlled, single trial which will be carried out in 165 patients of both sexes with knee OA, aged 50 years and older. Participants will be randomly allocated into 5 exercise groups (40% of BFR + LL; 80% of BFR + LL; 40% of BFR + rest; 80% BFR + rest, and HIRE+BFR placebo). A mixed linear model will be used to examine the effect of group-by-time interaction on pain intensity on the WOMAC subscale (primary outcome) and on disease severity, physical functional data, balance data, quality of life, global perceived effect scale, and muscle strength (secondary outcomes). Participants will be analyzed for intention-to-treat, and the statistical assessor blinded to the groups. The collection of outcomes 72 h after completion of the 16 weeks of interventions will be the primary measurement point. Follow-up secondary timepoints will be collected at 20, 28, 40, 52, and 64 weeks after the end of interventions, except for pain during the training, which will be measured immediately at the end of each session. Only the comparison of the primary outcome between the HIRE group with each BFR group will be analyzed in the non-inferiority framework, the other comparisons between the BFR groups for the primary outcome, and all secondary outcomes will be interpreted in the superiority framework. Discussion The results of this clinical trial can point out more clearly to ways to optimize the BFR training with the minimum of pain immediately after training, which will allow the offer of an effective and more adherent strengthening training to patients with knee OA. Trial registration Registro Brasileiro de Ensaios Clínicos, RBR-93rx9q. Registered on 23 July 2020. Version 1.0.

Does Peripheral Lower Body Blood Flow Restriction Training Effect Aerobic Adaptations in Recreationally Active Adults? A Case Series

Introduction: Blood flow restriction (BFR) training is a novel training method that has been shown to promote positive aerobic and anaerobic adaptations under low intensity exercise by inhibiting blood flow to target tissue resulting in hypoxia and metabolic byproduct accumulation. This has been shown to have a direct positive effect on aerobic performance adaptation. The purpose was to explore the effect of BFR training on aerobic performance. Methods: Seven recreationally active adults were randomly assigned to either the BFR group (n=4, BFR) or non-BFR group (n=3, CON). Three testing sessions were conducted throughout the study (Pre-Test, Mid-Test, Post-Test) which consisted of a graded cycle ergometer maximum oxygen consumption (VO2max) test using COSMED-K5 indirect calorimetry. Eleven BFR training sessions were performed consisting of 20-min of cycling at 35-45% of heart rate reserve (HRR) with at 60% (BFR) or 5% (CON) arterial occlusion pressure (AOP) on the BFR cuffs. Results: Absolute VO2max, Relative VO2max, respiratory exchange ratio (RER), maximum heart rate (HRmax), and maximum rate of perceived exertion (RPEmax) reported no significant difference between BFR and CON. There was a significant difference (p < 0.05) found in time to reach VO2max and maximum watts (Wmax) reached which declined over the course of the training intervention. Conclusions: Bilateral lower limb aerobic BFR training resulted in no change in VO2max over seven weeks.

Training unter Blutrestriktion – Wissenschaft nachgefragt

Die Physiotherapeutin Nina Sieberer beschäftigte sich in ihrer Bachelorarbeit mit der aktuellen Evidenz zum Thema Gonarthrose und Blood Flow Restriction Training. Sie fand heraus, dass bei Gelenkbeschwerden ein intensives Training oft nicht durchführbar ist und deshalb ein Blood Flow Restriction Training sinnvoll sein kann, um die Kraft zu steigern, den Muskelquerschnitt zu vergrößern und den Schmerz zu reduzieren.