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Use and safety of KAATSU training:Results of a national survey
Abstract
KAATSU training is a novel training, which is performed under conditions of restricted blood flow. It can induce a variety of beneficial effects such as increased muscle strength, and it has been adopted by a number of facilities in recent times. The purpose of the present study is to know the present state of KAATSU training in Japan and examine the incidence of adverse events in the field. The data were obtained from KAATSU leaders or instructors in a total of 105 out of 195 facilities where KAATSU training has been adopted. Based on survey results, 12,642 persons have received KAATSU training (male 45.4%, female 54.6%). KAATSU training has been applied to all generations of people including the young ( 80 years old). The most popular purpose of KAATSU training is to strengthen muscle in athletes and to promote the health of subjects, including the elderly. It has been also applied to various kinds of physical conditions, cerebrovascular diseases, orthopedic diseases, obesity, cardiac diseases, neuromuscular diseases, diabetes, hypertension and respiratory diseases. In KAATSU training, various types of exercise modalities (physical exercise, walking, cycling, and weight training) are used. Most facilities have used 5-30 min KAATSU training each time, and performed it 1-3 times a week. Approximately 80% of the facilities are satisfied with the results of KAATSU training with only small numbers of complications reported. The incidence of side effects was as follows; venous thrombus (0.055%), pulmonary embolism (0.008%) and rhabdomyolysis (0.008%). These results indicate that the KAATSU training is a safe and promising method for training athletes and healthy persons, and can also be applied to persons with various physical conditions.
... Although many different pneumatic cuff devices have been used for restricting blood low, such as KAATSU, Vasper [2], Del i [3], ATS 4000 [4] and Hokanson [6], in general, these devices require a high inancial investment for acquisition, with some of them also demanding certi ication and expertise from specialists to handle the equipment. These conditions may hinder the process of acquiring equipment and implementing the BFR technique in hospitals and rehabilitation centers with fewer economic resources. ...
... One of the most important advantages of using pneumatic controlled air bands for restricting blood low is the maintenance of restriction pressure during all phases of the restrictive stimulus and/or during exercise performance. This partial arterial restriction, while the occlusion of venous out low, is an advantage of the technique [6] once it prevents the risk of ischemia-induced adverse events [6]. ...
... One of the most important advantages of using pneumatic controlled air bands for restricting blood low is the maintenance of restriction pressure during all phases of the restrictive stimulus and/or during exercise performance. This partial arterial restriction, while the occlusion of venous out low, is an advantage of the technique [6] once it prevents the risk of ischemia-induced adverse events [6]. ...
The Blood Flow Restriction (BFR) technique is based on cuffs connected to a pressure device that induces partial arterial inflow. BFR combined with exercise has already been proven to increase strength, muscle mass, and muscular endurance. However, some BFR devices with pneumatic air bands, such as KAATSU (KA), are expensive and less accessible, making either a Sphygmomanometer Cuff (SC) or Elastic Band (EB) an interesting alternative. However, vascular parameters in response to blood flow restriction during KA, EB, and SC have not yet been compared. Purpose: The aim of this study was to compare the brachial blood flow behavior during restriction using bands such as KA, SC, and EB on the same perceived tightness. Methods: Thirty healthy men participated in a prospective crossover study. Participants underwent blood flow measurements before and during KA, SC, and EB use, with KA-perceived tightness taken as a reference. The brachial blood flow volume, the diameter of the artery, and blood flow velocity were measured before and immediately after the cuff’s inflation at a specific tightness. Results: Blood flow volume was significantly reduced in KA (52%, ES: 1.38), SC (61.7%, ES: 1.29), and EB (41.5%, ES: 1.22) (p <.0001). In addition, blood flow velocity was significantly reduced in KA (12.9%, ES: 0.74), SC (23.8%, ES: 1.02), and EB (25.6%, ES: 1.02) (p <.0001). No significant changes were observed in the diameter of the brachial artery for any condition (p > 0.05). Conclusion: Brachial blood flow behavior was similar between pneumatic controlled air band (KA), SC, and EB cuffs at the same perceived tightness. Highlights • Growing evidence suggests that blood flow restriction is an interesting technique to improve muscle mass and strength with less articular impact and practical applications are yet to be explored. • Different bands and devices have been used to apply in patients the technique and but, methods are still too heterogenous to be compared in the expected results. • Although studies in the BFR literature have shown that blood flow restriction is applied according to Arterial Occlusion Pressure (AOP) and the devices and techniques are trying to standardize it, there is still a lack of information on this matter. More studies are needed to evaluate their similarity and also understand their safety.
... Survey results of facilities offering KAATSU training (specific BFR training methodology developed in Japan) have indicated that this technique is prescribed in a range of treatment environments for patients of all ages and to target improvements in several categories (including orthopedic issues, sporting performance, obesity, and physical health) (20,34). Low incidence of adverse side effects was also presented, with subcutaneous hemorrhage (13.1%) and numbness (1.3%) being the most common (20). ...
... Survey results of facilities offering KAATSU training (specific BFR training methodology developed in Japan) have indicated that this technique is prescribed in a range of treatment environments for patients of all ages and to target improvements in several categories (including orthopedic issues, sporting performance, obesity, and physical health) (20,34). Low incidence of adverse side effects was also presented, with subcutaneous hemorrhage (13.1%) and numbness (1.3%) being the most common (20). However, these surveys were conducted several years ago by the inventor and founder of KAATSU equipment and focused on KAATSU training facilities located in Japan. ...
... This study provided comprehensive information regarding how BFR was prescribed with resistance and aerobic exercise and for passive applications. The incidence of some minor side effects was higher than those reported by Nakajima et al. (20), with delayed-onset muscle soreness, numbness, and fainting/dizziness reported by ;39, ;18, and ;15% of responders, respectively. However, the subjects in this survey worked primarily in strength and conditioning and research roles (combined 64% of responders), meaning that limited inferences could be made about the use of BFR for more clinical populations. ...
Scott, BR, Marston, KJ, Owens, J, Rolnick, N, and Patterson, SD. Current implementation and barriers to using blood flow restriction training: Insights from a survey of allied health practitioners. J Strength Cond Res XX(X): 000-000, 2023-This study investigated the use of blood flow restriction (BFR) exercise by practitioners working specifically with clinical or older populations, and the barriers preventing some practitioners from prescribing BFR. An online survey was disseminated globally to allied health practitioners, with data from 397 responders included in analyses. Responders who had prescribed BFR exercise (n 5 308) completed questions about how they implement this technique. Those who had not prescribed BFR exercise (n 5 89) provided information on barriers to using this technique, and a subset of these responders (n 5 22) completed a follow-up survey to investigate how these barriers could be alleviated. Most practitioners prescribe BFR exercise for musculoskeletal rehabilitation clients (91.6%), with the BFR cuff pressure typically relative to arterial occlusion pressure (81.1%) and implemented with resistance (96.8%) or aerobic exercise (42.9%). Most practitioners screen for contraindications (68.2%), although minor side effects, including muscle soreness (65.8%), are common. The main barriers preventing some practitioners from using BFR are lack of equipment (60.2%), insufficient education (55.7%), and safety concerns (31.8%). Suggestions to alleviate these barriers included developing educational resources about the safe application and benefits of BFR exercise (n 5 20) that are affordable (n 5 3) and convenient (n 5 4). These results indicate that BFR prescription for clinical and older cohorts mainly conforms with current guidelines, which is important considering the potentially increased risk for adverse events in these cohorts. However, barriers still prevent broader utility of BFR training, although some may be alleviated through well-developed educational offerings to train practitioners in using BFR exercise.
... In a review of previous studies, researchers conducted a national survey in Japan on the use of BFR technique in over 105 facilities where BFR training had been adopted for more than five years (Nakajima, Kurano, Iida, Takano & Oonuma, 2006). They found that at that time 12,642 people, 45.4% male and 54.6% female, had utilized BFR training, and the incidence of cardiovascular side effects was surprisingly low with reported side effects of venous thrombus, pulmonary embolism, and rhabdomyolysis at only 0.055%, 0.008%, and 0.008%, respectively (Nakajima et al., 2006). ...
... In a review of previous studies, researchers conducted a national survey in Japan on the use of BFR technique in over 105 facilities where BFR training had been adopted for more than five years (Nakajima, Kurano, Iida, Takano & Oonuma, 2006). They found that at that time 12,642 people, 45.4% male and 54.6% female, had utilized BFR training, and the incidence of cardiovascular side effects was surprisingly low with reported side effects of venous thrombus, pulmonary embolism, and rhabdomyolysis at only 0.055%, 0.008%, and 0.008%, respectively (Nakajima et al., 2006). Moreover, in most of the facilities, subjects had done the BFR technique for around 5 -30 minutes each time. ...
The popularity of resistance training has reached new heights in today's sporting society. It's a well-established and effective practice among various practitioners, including sports scientists, coaches, and medical professionals. Among the available techniques, low-intensity resistance training with blood flow restriction (BFR) is particularly popular, as it offers an alternative to the traditional high-intensity approach. With its many advantages, such as not requiring high-intensity, BFR has picked the interest of practitioners seeking new training methods. This narrative review aimed 1) to increase awareness about the vascular physiological response to BFR training, 2) to compare the effects of training in term of arterial compliance and stiffness between traditional moderate-to-high-intensity resistance training and low-intensity resistance training with BFR from previous studies. Specifically, it examines whether low-intensity resistance training with blood flow restriction produced different vascular function responses, and 3) to provide information for decision-making regarding the use of BFR for individuals who are interested in practicing. The reviewed data was gathered from the previous controlled trial studies based on the literature search in PubMed. The findings indicated a noticeable change in arterial compliance and stiffness subsequent to periods of resistance training using a low-intensity approach with BFR protocol. However, this change was observed to differ from the effects commonly observed in traditional resistance training involving moderate-to-high-intensity protocols. The comparative review provided the insight that arterial compliance was either improved or maintained followed the training protocol of low-intensity resistance training with BFR while high-intensity resistance training could potentially increase arterial stiffness after training instead. Practitioners of low-intensity resistance training with BFR should consider using low training volume (e.g. not train to failure) and low-intensity (e.g. 30 - 50%1RM) as a safe training alternative of high-intensity resistance training regardless of the age of trainee.
... Based on the available literature, BFRT appears to be a safe exercise modality when used according to evidence based guidelines [69]. In their study in 2006, Nakajima and colleagues reported serious adverse event rates of 0.055%, 0.008% and 0.008% for deep venous thrombosis (DVT), pulmonary embolism (PE) and rhabdomyolysis, respectively [70]. Despite these low adverse event rates, it is necessary to consider its safety, especially when applied in a clinical population with altered perceptual, cardiovascular or hemodynamic responses [71]. ...
... Therefore, the prospect of a brief (5-10 minutes per exercise), subocclusive pressure applied within KOA-patients should alleviate concerns regarding VTE risk [69,72,73]. Furthermore, as studies showed no elevated levels of coagulation markers [75] but instead even provided preliminary evidence of elevated fibrinolytic markers such as tissue plasminogen activator (tPA), it can be stated that the risk for VTE is not higher with BFRT (incidence rates of 0.055% and 0.008% for DVT and PE respectively) compared to traditional exercise [70]. ...
Knee osteoarthritis is a prevalent joint disease affecting millions of individuals globally. While total knee arthroplasty is an effective treatment for advanced stages of KOA, it may not be suitable for earlier stages or younger patients. Supervised exercise therapy has proven to be the first line treatment of preference in tackling pain and disability caused by KOA. However, the high intensities required to induce positive muscle adaptations are not indicated in this population as this is often accompanied by pain, discomfort, and frustration; leaving low load resistance training as the only feasible method of treatment. Recently, the use of blood flow restriction training began to emerge as a substitute for high load resistance training. With BFRT, a cuff is applied around the proximal aspect of the affected limb, causing partial arterial and full venous occlusion, thereby inducing localized hypoxia and accumulation of metabolites, mimicking the effects of high load resistance training, albeit with low loads. Consequently, BFRT might offer a suitable and more effective alternative for KOA patients who are not (yet) eligible for TKA, compared to the traditional exercise therapy. This review aims to summarize the current evidence as regards the application of Blood Flow Restriction in exercise therapy of knee osteoarthritis patients, with particular consideration of the underlying mechanisms and its safety, as well as general guidelines for practical implementation into clinical practice. In doing so, this narrative review aims to create a framework allowing the translation from theory to practice.
... Based on the available literature, BFRT appears to be a safe exercise modality when used according to evidence-based guidelines [71]. In their study in 2006, Nakajima and colleagues reported serious adverse event rates of 0.055%, 0.008%, and 0.008% for deep venous thrombosis (DVT), pulmonary embolism (PE), and rhabdomyolysis, respectively [72]. Despite these low adverse event rates, it is necessary to consider its safety, especially when applied in a clinical population with altered perceptual, cardiovascular, or hemodynamic responses [73]. ...
... Therefore, the prospect of a brief (5-10 min per exercise) sub-occlusive pressure applied to KOA patients should alleviate concerns regarding VTE risk [71,74,75]. Furthermore, as studies showed no elevated levels of coagulation markers [77] but instead even provided preliminary evidence of elevated fibrinolytic markers such as tissue plasminogen activator (tPA), it can be stated that the risk for VTE is not higher with BFRT (incidence rates of 0.055% and 0.008% for DVT and PE, respectively) compared to traditional exercise [72]. ...
Knee osteoarthritis is a prevalent joint disease affecting millions of individuals globally. While total knee arthroplasty is an effective treatment for advanced stages of KOA, it may not be suitable for earlier stages or younger patients. Supervised exercise therapy has proven to be the first-line treatment of preference in tackling pain and disability caused by KOA. However, the high intensities required to induce positive muscle adaptations are not indicated in this population, as this is often accompanied by pain, discomfort, and frustration, leaving low-load resistance training as the only feasible method of treatment. Recently, the use of blood flow restriction training has begun to emerge as a substitute for high-load resistance training. With BFRT, a cuff is applied around the proximal aspect of the affected limb, causing partial arterial and full venous occlusion, thereby inducing localized hypoxia and the accumulation of metabolites, mimicking the effects of high-load resistance training, albeit with low loads. Consequently, BFRT might offer a suitable and more effective alternative for KOA patients who are not (yet) eligible for TKA compared to traditional exercise therapy. This review aims to summarize the current evidence as regards the application of Blood Flow Restriction in exercise therapy for knee osteoarthritis patients, with particular consideration of the underlying mechanisms and its safety, as well as general guidelines for practical implementation in clinical practice. In doing so, this narrative review aims to create a framework for translating from theory into practice.
... Documentation of total exercises prescribed and occlusion or reperfusion durations may prove beneficial in tracking outcomes of patients and aiding researchers in determining the minimum limb reperfusion time needed before beginning additional BFR training exercises. Like previous authors (29,31,39), our work demonstrates that adverse events to BFR training do occur. In this study, delayed onset muscle soreness, inability to complete treatment because of pain, numbness, and cold feeling in the extremity were the most common side effects reported. ...
... We also noted no cases of rhabdomyolysis, which is similar to previous research (39) surveying approximately 13,000 KAASTU users in Japan. Although our results conflict with prior accounts, the incidence reported in the literature are marginal representing only 0.008% (29) and 3% (31). Elucidating causes of or contributing factors to rhabdomyolysis following BFR training has not been carefully examined and is inconclusive at this time (16,19,35). ...
Colapietro, MA, Lee, JZ, and Vairo, GL. Survey of blood flow restriction training applications in sports medicine and performance practice across North America. J Strength Cond Res XX(X): 000–000, 2023—This study profiled current clinical applications of blood flow restriction (BFR) training and observed side effects by surveying active sports medicine and performance personnel across North America. An online survey consisting of questions derived from a related position statement was distributed through professional organizations, email listservs, and social media. Personnel with experience applying or prescribing BFR training with permanent residence within the United States or Canada were eligible to participate. Variables captured included demographics (profession, practice setting), BFR equipment, treatment parameters, observed side effects, and personal perceptions regarding BFR training. An alpha level of p < 0.05 determined significance. A convenience sample included 72 clinicians with 67 being from the United States. Athletic trainers ( n = 35) and physical therapists ( n = 30) primarily participated. Chi-square test of independence indicated that a higher proportion of physical therapists (90.3%) report receiving formal education in BFR training compared with athletic trainers (65.7%) ( = 4.1, p = 0.043). Parameters varied between respondents for exercise prescription and occlusion settings. Respondents primarily followed position statement recommendations with individualized pressure selections for resistance (80.9%) and aerobic (84.8%) BFR modes. Side effects reported included delayed onset muscle soreness (66.2%), inability to continue because of pain (28%), and numbness (22.5%). Personal perceptions between athletic trainers and physical therapists were compared using independent t -tests. Physical therapists indicated higher confidence in safety (difference = 0.37 ± 0.32, p = 0.026), understanding recommendations (difference = 0.47 ± 0.37, p = 0.011), and theoretical principles (difference = 0.80 ± 0.53, p = 0.004). Despite variation in BFR parameters used, sports medicine personnel demonstrate compliance with position statement recommendations and report mild side effects.
... Additionally, improvements in laboratory-based performance parameters (e.g., maximal aerobic or anaerobic power, fatigue resistance) may not directly translate to field-based settings and/or may be offset by decrements in skill performance, especially if participants experience residual effects of IPC such as temporary numbness of the occluded area (Nakajima et al., 2006). As such, it is important to directly assess sport-specific outcomes (e.g., shooting, passing, kicking, and/or dribbling). ...
... For example, past research overwhelmingly used high absolute occlusion pressures (e.g., ≥220 mmHg) for cuffs placed on the thighs with the assumption that full limb occlusion pressure (LOP) would be achieved for essentially all individuals being tested. However, high cuff pressures are both uncomfortable and potentially dangerous, with high cuff pressures increasing risk for conditions such as bruising and limb numbness(Nakajima et al., 2006). Therefore, for compliance and safety it is important to tailor cuff pressures to individual needs.Additionally, with the exception of studies utilizing sham designs (trials with cuff pressures of 10-20 mmHg) to mitigate potential placebo effects (da Mota & Marocolo, 2016; M. Marocolo, da Mota, et al., 2016; M. Marocolo, Willardson, et al., 2016), we are unaware of research which has purposely used cuff pressures below LOP in order to understand the effects of partial arterial occlusion on exercise performance. ...
Ischemic preconditioning (IPC) has been shown to improve exercise performance, but many factors related to IPC administration are unresolved. This study evaluated the effect of IPC performed with different pressures for exercise performance. Fifteen collegiate male soccer players completed five separate sessions in randomized order. For each session, blood pressure cuffs were placed on the thigh bilaterally, and IPC was administered in 2x5 minute cycles at cuff pressures of 0%, 25%, 50%, 75%, or 100% of each participant’s limb occlusion pressure (LOP), the pressure needed to occlude arterial flow of blood to the leg. Participants then completed vertical jump, soccer passing accuracy, and 1,600 meter run tests. Repeated-measures analysis of variance was used to assess differences in outcomes across the five trials. There were no significant differences in vertical jump or passing accuracy across the five trials. However, 1,600 meter run times were significantly faster for the 50-75% trials than the 0-25% trials (mean difference 7.1-8.4 seconds). In summary, IPC pressures below LOP improved running times while not negatively influencing jumping or passing accuracy in collegiate soccer players. Improved comfort and reduced risk from using cuff pressures below LOP may facilitate more effective IPC use in field-based settings.
... There have been historical concerns about the safety of BFR, especially in people with comorbid health conditions and disabilities. 45,46 However, the rate of serious adverse events like venous thrombosis, pulmonary embolism, and rhabdomyolysis is low (0.008%-0.055%). 45 In our study we excluded people with any history of clotting disorder, and no serious events occurred that were related to the intervention. ...
... 45,46 However, the rate of serious adverse events like venous thrombosis, pulmonary embolism, and rhabdomyolysis is low (0.008%-0.055%). 45 In our study we excluded people with any history of clotting disorder, and no serious events occurred that were related to the intervention. There was 1 participant who experienced a hypertensive crisis, however, it occurred prior to the intervention session, and the participant was able to resume intervention after a ...
Objective
The objective of this study was to determine the feasibility of low-load resistance training with blood flow restriction (BFR) for people with advanced disability due to multiple sclerosis (MS).
Methods
In this prospective cohort study, 14 participants with MS (Expanded Disability Status Scale score = 6.0–7.0; mean age = 55.4 [SD = 6.2] years; 71% women) were asked to perform 3 lower extremity resistance exercises (leg press, calf press, and hip abduction) bilaterally twice weekly for 8 weeks using BFR. Feasibility criteria were as follows: enrollment of 20 participants, ≥80% retention and adherence, ≥90% satisfaction, and no serious adverse events related to the intervention. Other outcomes included knee extensor, ankle plantar flexor, and hip abductor muscle strength, 30-Second Sit-to-Stand Test, Berg Balance Scale, Timed 25-Foot Walk Test, 12-Item MS Walking Scale, Modified Fatigue Impact Scale, Patient-Specific Functional Scale, and daily step count.
Results
Sixteen participants consented, and 14 completed the intervention, with 93% adherence overall. All participants were satisfied with the intervention. A minor hip muscle strain was the only intervention-related adverse event. There were muscle strength improvements on the more involved (16%–28%) and less involved (12%–19%) sides. There were also changes in the 30-Second Sit-to-Stand Test (1.9 repetitions; 95% CI = 1.0 to 2.8), Berg Balance Scale (5.3 points; 95% CI = 3.2 to 7.4), Timed 25-Foot Walk Test (−3.3 seconds; 95% CI = −7.9 to 1.3), Modified Fatigue Impact Scale (−8.8 points; 95% CI = −16.5 to −1.1), 12-Item MS Walking Scale (−3.6 points; 95% CI = −11.5 to 4.4), Patient-Specific Functional Scale (2.9 points; 95% CI = 1.9 to 3.8), and daily step count (333 steps; 95% CI = −191 to 857).
Conclusions
Low-load resistance training using BFR in people with MS and Expanded Disability Status Scale scores of 6.0 to 7.0 appears feasible, and subsequent investigation into its efficacy is warranted.
Impact
Although efficacy data are needed, combining BFR with low-load resistance training may be a viable alternative for people who have MS and who do not tolerate conventional moderate- to high-intensity training because of more severe symptoms, such as fatigue and weakness.
Lay Summary
Low-load strength training with blood flow restriction was feasible in people who have advanced disability due to multiple sclerosis. Using blood flow restriction may provide an alternative for people with multiple sclerosis who do not tolerate higher intensity training due to more severe symptoms, such as fatigue and weakness.
... Concern has been raised over the use of BFR in atrisk populations (e.g., hypertensive, obese, atherosclerotic) due to the potential for deep vein thrombosis, rhabdomyolysis, pulmonary emboli (Nakajima et al., 2006;Yasuda et al., 2017), and other serious complications associated with occluding arterial flow and performing skeletal muscle contractions. One such complication could be an augmentation of the exercise pressor reflex, which is exaggerated in certain atrisk populations (Manisty and Francis, 2007), and is normally elicited during exercise by the stimulation of group III and IV afferents (local mechano-and metaboreceptors), resulting in a sympathetically mediated elevation in blood pressure and heart rate. ...
... However, a multitude of Japanese athletes, seniors, clinicians, and trainers have been using BFR in the form of Kaatsu for over 30 years with an extremely low incidence of serious complications (Nakajima et al., 2006;Yasuda et al., 2017). The more recent findings and resulting concerns may be due to a shift from the original narrow-elastic (NE) design present in the Kaatsu bands to WR nylon cuffs adapted from surgical tourniquets and blood pressure cuffs. ...
... 47 Regarding witnessing individuals faint from BFRT, healthcare professionals found fainting to be linked to the decrease in venous return induced by BFRT, which can cause a reduction in cardiac preload, which can lead to decreased blood flow to the brain. 47,49 Although there have only been a few cases of rhabdomyolysis occurring with BFRT, the possibility of rhabdomyolysis occurring with BFRT should not be neglected due to the seriousness of this particular condition. Rhabdomyolysis is a condition where the breakdown of muscle tissue leads to the release of muscle fiber contents into the blood, which can lead to serious kidney damage. ...
... 48,[55][56][57] Studies looking at chronic models of repeated BFR application reported no changes in D-Dimer and fibrinogen, as well as unremarkable duplex ultrasound scans for DVT. 48,49,56,58,59 In summary, patients can participate in a BFRT program when they are deemed medically appropriate, when appropriate BFRT parameters are followed, and when monitored by healthcare professionals who recognize the potential risk factors and signs and symptoms of an adverse event of individuals that are performing BFRT. ...
Blood flow restriction (BFR) is an augmented training method that utilizes a proximal extremity tourniquet to occlude the venous and partially occlude the arterial blood flow during specific exercise programming or at rest. BFR training (BFRT) has gained popularity among the exercise science and rehabilitation professions as a means of stimulating anabolic responses with reduced tissue overload and resistance. This manuscript presents an overview of BFRT and its utility for both performance and clinical applications. The clinical efficacy as well as the cellular and molecular mechanisms will be discussed as it may apply to patients with musculoskeletal conditions. Treatment parameters will be introduced for patients and clients with injuries and those seeking improvement in conditioning parameters. Moreover, the utilization of BFRT for patients receiving orthobiologic procedures will be highlighted as BFR serves as a synergistic regenerative rehabilitation intervention and a means of augmenting resistance training for individuals with lower exercise tolerance and post-procedural precautions.
... In the KAATSU training method, a specially-designed KAATSU cuff is attached to the base of a limb and pressure is applied using specialized equipment to restrict blood flow to the limb (Sato et al. 2007). The KAATSU training is a safe and promising method for training athletes and healthy persons, and can also be applied to persons with various physical conditions (Nakajima et al. 2006). By moderately restricting the base of the limb, arterial blood flow in the muscle tissue is partially reduced, while venous blood flow is more strongly restricted. ...
Pain is an unpleasant reaction to a stimulus that functions as a defense mechanism to prompt the body to react quickly to protect itself. However, the body can activate an analgesic function to reduce pain. KAATSU training is a low-load, short-term exercise method that can induce increased muscle strength and muscle hypertrophy, for which domestic studies have reported pain-relieving effects. In this review, we present a case series of patients with idiopathic osteonecrosis of the femoral head and idiopathic osteonecrosis of the femoral medial condyle, in whom improvements in chronic pain were achieved by KAATSU training. We further introduce the effects of training under blood flow restriction, KAATSU training, on pain relief, in addition to performing a literature review.
... Different cuff inflation patterns and pressure settings can affect training comfort [30], pain perception [37], and potential injury risks [38]. The large-scale surveys conducted by Nakajima et al. [39] revealed the common, mild, and reversible side effects of BFR training, such as subcutaneous hematoma and transient numbness, emphasizing the importance of personalized adjustments for enhancing safety and compliance. Therefore, to enhance safety and subject compliance, intermittent and individualized pressurization schemes in LL-BFR are paramount. ...
This meta-analysis examined the efficacy of low-load resistance training with blood flow restriction (LL-BFR) versus high-load resistance training (HL-RT) on muscle strength and hypertrophy, exploring factors affecting outcomes. We searched Embase, CNKI, Wanfang, PubMed, Ovid Medline, ProQuest, Cochrane Library, Embase, and Scopus from inception to July 2024. After assessing the risk of bias using the Cochrane tool, a meta-analysis was conducted to calculate the overall effect size. Subgroup analyses were performed to explore the impact of different modulating factors on training effects. LL-BFR was found to be inferior to HL-RT with regard to muscle strength gains (SMD = −0.33, 95% CI: −0.49 to −0.18, p < 0.0001). However, subgroup analyses revealed that LL-BFR achieved muscle strength gains comparable to HL-RT under individualized pressure (SMD = −0.07, p = 0.56), intermittent cuff inflation (SMD = −0.07, p = 0.65), and a higher number of training sessions (SMD = −0.12, p = 0.30). No significant difference in muscle mass gains was observed between LL-BFR and HL-RT (SMD = 0.01, p = 0.94), and this conclusion remained consistent after controlling for modulating variables. HL-RT is superior to LL-BFR in enhancing muscle strength gains. Nevertheless, under appropriate conditions, including individualized pressure prescription, intermittent cuff inflation, and a higher number of training sessions, LL-BFR can achieve muscle strength gains comparable to HL-RT, emphasizing the importance of tailored training programs. Both methods exhibit similar effects on muscle mass gains, indicating that LL-BFR serves as an effective alternative for individuals who cannot perform HL-RT because of physical limitations or injury concerns.
... This complaint may occur due to a post-exercise hypotensive response or vasovagal reflex [37]. The sensation of numbness in the muscles being exercised, the feeling of numbness and tingling up to the incidence of nerve compression is very low (<2%) and can be modified by adjusting the occlusion pressure of each subject, the duration of cuff application and the application of the correct cuff size [38]. This prevalence is in line with the results of this study where there were no side effects in the BFR group so that the exercise protocol in the study was a safe exercise protocol and had a positive impact on the muscle strength of the elderly. ...
Background and objectives. Weakness and atrophy in the quadriceps femoris lead to decreased functional capacity, heightened fall risk, and increased mortality among older women. While moderate-intensity strength training is generally recommended for the elderly, higher-intensity exercises carry a greater risk of injury. Low-intensity exercises with blood flow restriction offer an alternative, providing comparable benefits to high-intensity training. This study aims to evaluate the effects of moderate-intensity and low-intensity blood flow restriction exercises on quadriceps femoris strength and thigh circumference in healthy elderly women. Materials and methods. The sample size was of 88 subjects equally randomized into a moderate-intensity group and a blood-flow restriction group. The moderate-intensity group performed strengthening exercises with a load of ≥40–60% of 1RM, 3 sets, 36 repetitions. The blood-flow restriction group conducted exercises at 20–30% of 1RM, completing 75 repetitions across 4 sets, using a pressure cuff applied to the upper thigh at 50 mmHg or 40% of the Arterial Occlusion Pressure (AOP). Both groups exercised twice a week over a 6-week period. Muscle strength (assessed via dynamometer and 1RM) and thigh circumference were recorded before and after the intervention. Results. After six weeks of intervention, both groups showed a significant increase in muscle strength and thigh circumference (p <0.001). However, no notable differences were observed between the moderate intensity group and the blood flow restriction group regarding quadriceps strength (dynamometer), quadriceps 1RM strength, or thigh circumference (p >0.05). Muscle soreness was reported in 18% of participants in the moderate intensity group. Conclusion. Low-intensity resistance exercises with blood flow restriction in older women can promote strength gains and muscle hypertrophy comparable to moderate-intensity training, while offering a safer alternative.
... However, amidst its increasing popularity, concerns have been raised regarding its safety (Nakajima et al., 2006), particularly in relation to the vascular system. This apprehension is centered around the external compression applied to muscles via cuffs (Wortman et al., 2021), potentially impacting vascular function. ...
This comprehensive review delves into the impact of low-intensity resistance training coupled with blood flow restriction (BFR) on arterial stiffness, evaluated through the ankle-brachial index (ABI). This assessment seeks to discern any discernible alterations in arterial stiffness attributed to this unique training approach. Employing systematic search via PubMed and Google Scholar databases, this review examined research articles focusing on the chronic effects of resistance training with BFR on the ABI. Inclusion criteria encompassed studies assessing this effect across various age groups while concentrating on healthy individuals and publications in the English language. Among the extensive array of studies, a selective inclusion of 5 research articles formed the foundational basis of this analysis. Synthesizing analyses from these studies illuminated the safety of BFR training, particularly at intensities around 20-30% or using elastic bands. Intriguingly , these modalities exhibited no significant impact on alterations in the ABI, notably observed within elderly subjects. However, a notable scarcity in studies focusing on young subjects warrants a more comprehensive investigation into this specific demographic. The findings of this review underscore the safety and efficacy of BFR resistance training methodolo-gies, especially protocols utilizing 20-30% 1RM or incorporating elastic bands of 75-repetition-scheme, showcasing no significant impact on the ankle-brachial index, particularly in the elderly population over intervention periods not exceeding 12 weeks. Encouraging practitioners, these established methodologies offer safe practices for the elderly. However, the evident research gap in young subjects necessitates more expansive investigations.
... In a recent survey of 136 BFRE experts, tingling (72.1%) and delayed-onset muscle soreness (55.8%) were the most commonly observed side effects, while cases of rhabdomyolysis, fainting, and subcutaneous hemorrhage were identified at a low frequency (1.9%, 3.8%, and 4.8%, respectively) [119]. Additionally, a study involving young adults (<20 years) and older adults (>80 years) reported very low rates of side effects such as deep vein thrombosis (0.055%), pulmonary embolism (0.008%), and rhabdomyolysis (0.008%) [120]. Notably, the study included patients with cerebrovascular diseases, obesity, CVD, diabetes, hypertension, and respiratory diseases. ...
Blood flow restriction exercise has emerged as a promising alternative, particularly for elderly individuals and those unable to participate in high-intensity exercise. However, existing research has predominantly focused on blood flow restriction resistance exercise. There remains a notable gap in understanding the comprehensive effects of blood flow restriction aerobic exercise (BFRAE) on body composition, lipid profiles, glycemic metabolism, and cardiovascular function. This review aims to explore the physiological effects induced by chronic BFRAE. Chronic BFRAE has been shown to decrease fat mass, increase muscle mass, and enhance muscular strength, potentially benefiting lipid profiles, glycemic metabolism, and overall function. Thus, the BFRAE offers additional benefits beyond traditional aerobic exercise effects. Notably, the BFRAE approach may be particularly suitable for individuals with low fitness levels, those prone to injury, the elderly, obese individuals, and those with metabolic disorders.
... There is a growing body of evidence indicating the safety and efficacy of generating hypertrophic and strength increases in patient populations, predominantly with lower extremity injury or after lower extremity surgical procedures. [10][11][12] Use of BFRT in sports clinical practice and training communities for the lower and upper extremity has become increasingly popular. ...
Background
The use of blood flow restriction training (BFRT) to treat patients with lower extremity conditions has been found to be relatively safe, but there is minimal evidence and no reports on BFRT in patients with shoulder dysfunction.
Case Presentation
This case report describes the safe application of BFRT as part of a conventional multimodal course of care for a 40-year-old man with shoulder pain. The patient's pathoanatomic diagnosis was left shoulder adhesive capsulitis, rotator cuff tendinopathy, and a superior labral anterior-to-posterior tear. He presented with substantial impairments in range of motion, strength, and function. Clinical guidelines for dosing BFRT are unclear, and we describe the successful use of rating-of-perceived-exertion criteria for guiding exercise intensity.
Outcome and Follow-Up
The patient had a positive outcome in 7 visits over 13 weeks, with normalization of shoulder range of motion and function, and 60% to 85% strength gains, without adverse effects from BFRT.
Discussion
This case highlights the feasibility and application of BFRT in combination with traditional rehabilitation strategies in a patient with multiple shoulder pathologies. JOSPT Cases 2021;1(4):289–293. doi:10.2519/josptcases.2021.10625
... This training is a noninvasive technique, although it does cause blood flow restriction (BFR). Its safety has been confirmed by previous questionnaires, blood tests, and venous compliance testing in young, elderly, or patients [8,12,13]. In addition, unlike high-intensity exercise training that uses weights or free-weight machines, BFR training improves neuromuscular mechanisms not only by using weights or free-weight machines but also by using a variety of physical exercises (machines, rubber bands, walking, electrical stimulation, and body weight) [14][15][16]. ...
Background: Long-term and prolonged piano performance does not provide essential skeletal muscle training benefits while increasing the risk of injury to the upper extremities. Unlike high-intensity exercise training, moderate blood flow restriction (BFR) training has been found to improve neuromuscular mechanisms with a variety of physical exercises (machine, elastic band, walking, electrical stimulation, and body weight).
Aim and methods: We investigated the physiological and perceptual responses related to piano performance with or without BFR based on acute responses of neuromuscular mechanisms. Student or professional pianists (n=7) performed the "Revolutionary Etude" on the piano with (Piano-BFR) and without (Piano-Ctrl) BFR. During the Piano-BFR performance, 150-180 mmHg of cuff pressure was applied around the most proximal region of both arms as a moderate BFR.
Results: Changes in upper limb girth, muscle thickness, and hand grip strength were measured before and immediately after the performance. After the performance, perceptual and other responses were recorded. Immediately after the performance, the Piano-BFR condition induced greater changes in girth (forearm and upper arm), muscle thickness (forearm), and handgrip strength than the Piano-Ctrl condition. Piano-BFR was (p<0.01) higher than Piano-Ctrl on eight questions regarding perceptual response (upper arm fatigue and difficulty playing the piano). Piano performance with BFR was revealed to increase upper extremity muscle size and fatigue in pianists after playing.
Conclusion: Piano performance with BFR was revealed to increase upper extremity muscle size and fatigue in pianists after playing. The effect of BFR on neuromuscular mechanisms on piano performance was greater in the forearm than in the upper arm.
... There is a growing body of evidence indicating the safety and efficacy of generating hypertrophic and strength increases in patient populations, predominantly with lower extremity injury or after lower extremity surgical procedures. [10][11][12] Use of BFRT in sports clinical practice and training communities for the lower and upper extremity has become increasingly popular. ...
Background
The rotator cuff (RC) plays a pivotal role in the performance and health of the shoulder and upper extremity. Blood flow restriction training (BFRT) is a modality to improve strength and muscle hypertrophy with even low-load training in healthy and injured individuals. There is minimal evidence examining its effect proximal to the occluded area, and particularly on the RC.
Hypothesis & Purpose
The purpose of this case series is to explore the effects of low-load BFRT on RC strength, hypertrophy, and tendon thickness in asymptomatic individuals.
Study Design
Case series.
Methods
Fourteen participants with asymptomatic, untrained shoulders were recruited to participate. They performed an eight-week low-load shoulder exercise regimen where BFR was applied to the dominant arm only during exercise. The dependent variables were maximal isometric strength of the shoulder external rotators(ER) and elevators (in the scapular plane in full can position) (FC) measured via handheld dynamometry, cross sectional area (CSA) of the supraspinatus and infraspinatus muscles, and supraspinatus tendon thickness measured via ultrasound imaging (US). Mean changes within and between arms were compared after training using paired t-tests. Cohen’s d was used to determine effect sizes.
Results
All participants were able to complete the BFRT regimen without adverse effects. Mean strength and CSA increased for all variables in both arms, however this increase was only significant (p\<0.01) for FC strength bilaterally and CSA for the supraspinatus and infraspinatus on the BFRT side. The effect sizes for increased supraspinatus and infraspinatus CSA on the BFRT side were 0.40 (9.8% increase) and 0.46 (11.7% increase) respectively. There were no significant differences when comparing the mean changes of the BFRT side to the non-BFRT side for strength or muscle CSA. There were no significant changes to supraspinatus tendon thickness.
Conclusion
These results suggest variability in response of the RC musculature to low-load BFRT in asymptomatic individuals. The potential for a confounding systemic response in the study design makes determining whether low-load BFRT is more beneficial than low-load non-BFRT difficult. The hypertrophy seen on the BFRT side warrants further study.
Level of Evidence
4
... Todos os estudos descreveram as principais especificações do dispositivo de oclusão utilizado. Dentre as variáveis avaliadas para verificação do efeito do treinamento físico bem como do uso da técnica de OV empregada na população idosa, as principais foram: contração voluntária máxima 17,18,22,24 ; teste de repetição máxima 21-23 , área de secção transversa do músculo 20,21,23 e testes funcionais[17][18][19]22 . Os desfechos encontrados corroboraram com as hipóteses previamente determinadas em que seriam observadas diferenças entre os resultados apresentados após o uso da OV nas intervenções quando comparados ao não uso da técnica. ...
Objetivo: Verificar na literatura os efeitos do uso da técnica de oclusão vascular no treinamento físico da população idosa e avaliar a existência de vantagens no seu emprego em relação ao treinamento convencional e seus desfechos físico-funcionais. Métodos: Trata-se de uma revisão sistemática da literatura segundo os critérios do Preferred Reporting Items for Systematic Review (PRISMA) para a estratégia de busca, critérios de inclusão e exclusão para análise dos estudos, sem restrição de idioma ou data de publicação, devido à escassez de literatura. Resultados: Foram obtidos 600 estudos que quantificam os efeitos medidos pela força muscular e o nível de funcionalidade em 4 grandes bases de dados científicas. Conclusão: Este estudo ilustra que a população idosa deve realizar o uso da oclusão vascular no treinamento de força, principalmente em indivíduos incapazes de realizar treinamentos de alta intensidade, quando utilizado da maneira correta, sendo uma técnica segura e tolerável pelos indivíduos.
... Several studies on lower limb rehabilitation have reported increases in muscle size and muscle strength after the application of BFR-t 24,26,36 following ACLR, with others reporting similar or no significant changes when comparing standard training with BFR-t. 23 BFR-t is considered low risk, 29,35 with minor side effects including dizziness, numbness, delayed-onset muscle soreness, itching, and discomfort in the application area. 41 However, rare serious complications, including deep vein thrombosis, stroke, nerve damage, and rhabdomyolysis, have been reported. ...
Background: Blood flow restriction training (BFR-t) data are heterogeneous. It is unclear whether rehabilitation with BFR-t after an anterior cruciate ligament (ACL) injury is more effective in improving muscle strength and muscle size than standard rehabilitation.
Purpose: To review outcomes after an ACL injury and subsequent reconstruction in studies comparing rehabilitation with and without BFR-t.
Study Design: Systematic review. Level of evidence, 3.
Methods: A search of English-language human clinical studies published in the past 20 years (2002-2022) was carried out in 5 health sciences databases, involving participants aged 18-65 undergoing rehabilitation for an ACL injury. Outcomes associated with muscle strength, muscle size, and knee-specific patient-reported outcome measures (PROMs) were extracted from studies meeting inclusion criteria and compared.
Results: The literature search identified 279 studies, of which 5 met the selection criteria. Two studies suggested that BFR-t rehabilitation after an ACL injury improved knee or thigh muscle strength and muscle size compared with rehabilitation consisting of comparable and higher load resistance training, with two studies suggesting the opposite. The single study measuring PROMs showed improvement compared to traditional rehabilitation, with no difference in muscle strength or size.
Conclusion: BFR-t after an ACL injury seems to benefit muscle strength, muscle size, and PROM scores compared with standard rehabilitation alone. However, only 1 large study included all these outcomes, which has yet to be replicated in other settings. Further studies utilizing similar methods with a common set of outcome measures are required to confirm the effects of BFR-t on ACL rehabilitation.
... Prolonged ischemia from overly restrictive cuff pressures could potentially exacerbate this effect. Additionally, excessive external compression from the cuffs can lead to bruising, petechiae, nerve damage, and discomfort (Nakajima et al. 2006, Nakajima et al. 2011. Athletes may be at particular risk due to higher training volumes and intensities. ...
The studies in this thesis investigated the physiological determinants of 4-km team-pursuit (TP) track cycling performance and critically evaluated the use of modelling finite work capacity (W′) and its dynamic balance (W′BAL) during the TP. This thesis also examined the integration of blood flow restriction (BFR) into high-intensity interval training (HIIT) as an intervention to improve factors related to TP performance. A series of related investigations were conducted with trained cyclists up to the Olympic level. Study One recruited male TP squads from International, National, and Regional performance levels. The TP squads were assessed for their critical power (CP) and W′. Maximal 4-km TP efforts confirmed different performance times of 3:49.9, 3:56.7, and 4:05.4 (minutes:s) for International, National, and Regional, respectively. Four TP simulation trials quantified W′ reconstitution from 0 to 100 W below CP. Results showed that the International squad were differentiated from National and Regional performance levels with greater CP (p < 0.05), likely preserving W′ for leading efforts. Furthermore, the International team possessed the fastest rates of W′ reconstitution at recovery intensities within 50 W of CP (p < 0.05), demonstrating the importance of W′ reconstitution at intensities near CP for recovery in the TP. The International team also expended a greater total quantity of W′ than its initial size (104 ± 5%), further demonstrating the capacity to utilise the reconstituted W′. In conclusion, we found that the TP relies on high aerobic capacity and rapid metabolic recovery abilities. An intervention was conceived based on the demands of the TP and the existing training sessions of elite TP cyclists. The training intervention included principles of TP training philosophy where cyclists repeatedly practice competition demands, at their TP lead intensity. As elite TP cyclists engage in substantial training volumes, it was important not to substantially exceed current training workloads. Based on previous BFR research with trained cyclists, an intervention integrating BFR into the recovery between TP efforts was devised. The intervention was performed on an ergometer to enable greater control over conditions and intensity. To evaluate the metabolic demands of the BFR intervention, the Study Two assessed the acute physiological responses in 11 male and female highly-trained cyclists (V̇O2PEAK 65 ± 9 mL·kg-1·minute-1). Using a within-subject design, participants performed two work- and duration-matched HIIT sessions. The HIIT consisted of six high-intensity repetitions with BFR occlusion between work bouts at 200 mmHg for 2-minutes applied proximally on the thighs (BFR) or HIIT alone without BFR (CON). Work intensity was set as 85% of the mean power output of a maximal 30-s test to simulate TP lead intensity. Cardiopulmonary variables (O2 uptake, V̇O2; carbon dioxide production V̇CO2; and ventilation, V̇E) and muscle oxygenation responses were measured during the HIIT, and vascular endothelial growth factor (VEGF) was measured pre- and 3-hours post-HIIT. Results demonstrated that BFR increased V̇CO2 and V̇E (both p < 0.05) during work bouts but did not affect V̇O2 and TSI (both p>0.05). Compared to CON, the BFR intervention significantly decreased V̇O2, V̇CO2, V̇E, and TSI during BFR occlusion (all p<0.05). Following cuff release, there were significantly higher values of V̇O2, V̇CO2, and V̇E, whereas TSI was suppressed (all p < 0.05). There were significant enhancements of serum VEGF concentration at 3-hours post-HIIT after BFR when compared to CON. As BFR appeared to delay recovery, it was hypothesised that BFR may increase metabolic and oxidative stress by delaying recovery processes. The delay in recovery may enhance the adaptations to HIIT without increasing training workload. After demonstrating that applying BFR during recovery in high-intensity work bouts increased markers of physiological stress, Study Three assessed the performance and physiological effects of the training as a chronic intervention. Using a between-subject design, ten performance-matched male trained cyclists (weekly volume >6-hours·week-1) were assigned to BFR or CON conditions. Participants performed pre- and post-intervention tests to determine lactate thresholds, 30-s maximal sprint cycling performance, and an intermittent test designed with high-intensity bouts comparable to the TP. Work bouts were performed at 85% of the mean power output of the maximal 30-s test. Muscle oxygenation and cardiopulmonary measures were continually assessed throughout the intermittent test. Participants performed four-weeks of work- and duration-matched HIIT either with 2-minutes of 200 mmHg thigh BFR between work bouts or HIIT alone (CON). Following BFR intervention, there were significant improvements in intermittent test time to exhaustion, 30-s mean power output, and submaximal lactate thresholds compared to CON (all p < 0.05). Furthermore, BFR led to significant intermittent test improvements for V̇O2PEAK and the rate of muscle tissue reoxygenation (all p < 0.05). There were no significant changes over the intervention period for CON, indicating that HIIT was ineffective in this cohort when BFR was not incorporated. Therefore, it was demonstrated that the integration of BFR between HIIT work bouts improves intermittent performance and a range of physiological factors associated with performance in trained cyclists. Finally, the BFR intervention was integrated into two HIIT sessions within a training camp of an elite TP squad preparing for the Olympic Games to test its potential efficacy and feasibility. As in the previous BFR studies, this case-study (Study Four) applied 2-minutes of 200 mmHg thigh BFR between high-intensity bouts. Work intensities were set at the individual cyclists’ TP lead intensity. A questionnaire was developed to assess the pain, tolerance, enjoyment, and compare the intervention to other training modalities. Questionnaire responses indicated that the elite cyclists enjoyed and positively perceived the intervention, appreciating the variety and efficiency of the training stimulus. All but one elite cyclist tolerated that intervention. Further investigation in conjunction with medical staff indicated that the intolerant cyclist had a pre-existing undiagnosed cardiovascular condition and presented with femoral artery claudication (discussed in the addendum). Thus, integrating BFR into HIIT for elite track cyclists was feasible and tolerable when no contraindications existed. In summary, elite TP performance relies on high sustained aerobic power output and rapid W′ recovery between efforts. This thesis showed integrating BFR between HIIT work bouts provides an additional training stimulus and can improve factors related to aerobic capacity and high-intensity intermittent performance in trained cyclists. The BFR intervention is tolerable within an elite cohort and may improve TP performance without increasing training workload.
... LL-BFRT was previously considered a safe training methodology from a qualitative standpoint [22,23], but this review now supports this statement quantitatively. The survey by Nakajima et al. [73] supports these results, which included more than 12,000 patients of all age groups who underwent LL-BFRT sessions, showing that the incidence of venous thrombus and pulmonary embolism was as low as 0.055% and 0.008%, respectively. Other trials have detected an increase in fibrinolytic capacity after LL-BFRT in healthy participants, further corroborating the safety of LL-BFRT [74]. ...
The aim of this meta-analysis was to determine the effects of low-load blood flow restriction training (LL-BFRT) on muscle anabolism and thrombotic biomarkers compared with the effects of traditional LL training and to analyse the changes in these biomarkers in the short and medium term (acute/immediate and after at least 4 weeks of the training programme, respectively). A search was conducted in the following electronic databases from inception to 1 March 2024: MEDLINE, CENTRAL, Web of Science, PEDro, Science Direct, CINHAL, and Scopus. A total of 13 randomized controlled trials were included, with a total of 256 healthy older adults (mean (min–max) age 68 (62–71) years, 44.53% female). The outcome measures were muscle anabolism biomarkers and thrombosis biomarkers. The standardized mean difference (SMD) was calculated to compare the outcomes reported by the studies. The overall meta-analysis showed that LL-BFRT produces a large increase in muscle anabolism biomarkers compared with traditional LL training (eight studies; SMD = 0.88 [0.39; 1.37]) and compared with a passive control (four studies; SMD = 0.91 [0.54; 1.29]). LL-BFRT does not produce an increase in thrombotic biomarkers compared with traditional LL training (four studies; SMD = −0.02 [−0.41; 0.36]) or compared with a passive control (two studies; SMD = 0.20 [−0.41; 0.80]). The increase in muscle anabolism biomarkers was large after applying a single session (four studies; SMD = 1.29 [0.18; 2.41]) and moderate after applying a training programme (four studies; SMD = 0.58 [0.09; 1.06]). In conclusion, LL-BFRT increases muscle anabolism biomarkers to a greater extent than traditional LL training (low-quality evidence) or a passive control (moderate-quality evidence) in healthy older adults. This superior anabolic potential of LL-BFRT compared with LL training is sustained in the short to medium term. LL-BFRT is a safe training methodology for older adults, showing moderate-quality evidence of no increase in thrombotic biomarkers compared with traditional LL training.
... Blood flow restriction (BFR) is a technique that involves the use of a bandage to apply pressure to a proximal limb to block venous blood return and partially block arterial blood flow, thereby increasing the local metabolic pressure of the body [21,22]. Lixandrão et al. [23] validated that the combination of low-load resistance exercise (LRE) with BFR (LRE-BFR) at 20%-30% of 1RM is a viable alternative to CRE for improving muscle mass and strength. ...
Introduction
Sarcopenic obesity (SO) is characterised by decreased muscle mass, diminished muscle strength and/or reduced physical performance and a high percentage of body fat (PBF). Conventional-load resistance exercise (CRE) may be difficult for older people with SO owing to their declining physical functions. Low-load resistance exercise (LRE) combined with blood flow restriction (BFR; LRE-BFR) is a viable alternative to CRE for improving muscle mass and strength and potential exercise mode for managing SO. This study has two objectives: (1) to comprehensively evaluate the efficacy of CRE and LRE-BFR in improving body composition, muscle strength, physical performance, haematological parameters, cardiovascular disease (CVD) risk factors and quality of life and (2) to compare the efficacy of CRE and LRE-BFR and explore their potential mechanisms.
Methods and analysis
This work is a 12-week assessor-blinded randomised clinical trial that will be conducted thrice a week. Sarcopenia will be defined using the Asian Working Group for Sarcopenia 2019, and obesity will be determined using the criteria developed by the World Health Organization. Community-dwelling older people aged ≥ 65 years will be screened as the participants using inclusion and exclusion criteria. A total of 33 participants will be randomised into a CRE group (n = 11), an LRE-BFR group (n = 11) and a control group that will be given only health education (n = 11). The primary outcomes will be knee extensor strength and PBF, and the secondary outcomes will be body composition, anthropometric measurements, muscle strength of upper limbs, physical performance, haematological parameters, CVD risk factors and quality of life. The outcomes will be measured at the baseline (week 0), end of the intervention (week 12) and follow up (week 24). All the collected data will be analysed following the intention-to-treat principle.
Ethics and dissemination
The Ethics Research Committee has approved this study (approval No. CMEC-2022-KT-51). Changes or developments in this study will be reported at www.chictr.org.cn.
Trial registration
ChiCTR2300067296 (3 January 2023).
... Another reason that result was not significant is related to the Limitations and Contraindications for blood flow restriction training, while blood flow restriction appears to benefit skeletal muscle adaptation, it is important to recognize the potential limitations and contraindications associated with this method. A 2006 survey of Japanese facilities that were employing blood flow restriction exercise reported the most common side effects to be subcutaneous hemorrhage and numbness, which were experienced by 13.1 and 1.3% of participants, respectively (Nakajima, 2006) and as it was reported by some of athletes in this research and maybe the numbness in their legs didn't let them to reach the best benefit of blood flow restriction. ...
The purpose of this study was to investigate the effects of plyometric
training with blood flow restriction on explosive power in Taekwondo
athletes. Twenty Taekwondo athletes who were volunteers to participate in
the research (under 17 years old, at least 2 years in the provincial league
and the minimum red belt), were selected .athletes were randomly assigned
into two groups of plyometric exercises (n=10) and BFR group (n=10), for
both groups the pre-test the Sargent Vertical jump test was used to measure
the explosive power. Then plyometric training program for two groups,
including six weeks of practice, each week two sessions selected but in one
of the groups before exercise, vascular obstruction was performed in the
thigh area by closing an elastic cuff around the thigh muscle in the proximal
portion of both legs and a pressure of 120mmHg was used. After the
completion of the six weeks protocol and the intervention both the group’s
subjects were assessed to compare the groups covariance analysis was used
(α<0.05). All computations were performed using SPSS software version 19.
The comparing of the results of the training process of the experimental
group in pre-test and after the post-test showed there was not a statistically
significant difference in vertical jump of group that they did plyometric
training with blood flow restriction. Neural adaptations such as increased
activation and synchronization of motor units have been regarded as
important factors for improving maximal power outputfor.
... The safety of restricting blood flow during exercise has been rigorously investigated over the past two decades and has been reviewed extensively elsewhere [16]. Although several theoretical concerns about the safety of BFR exist, the resulting consensus is that exercise in combination with BFR poses no greater risk than regular exercise when evidence-based recommendations are followed [22,138]. Potential complications to BFR exercise that have been proposed include vascular dysfunction, venous thromboembolism, nerve injury and elevated cardiac demand due to excessive stimulation of the muscle metaboreflex, oxidative stress and rhabdomyolysis. ...
Blood flow-restricted exercise is currently used as a low-intensity time-efficient approach to reap many of the benefits of typical high-intensity training. Evidence continues to lend support to the notion that even highly trained individuals, such as athletes, still benefit from this mode of training. Both resistance and endurance exercise may be combined with blood flow restriction to provide a spectrum of adaptations in skeletal muscle, spanning from myofibrillar to mitochondrial adjustments. Such diverse adaptations would benefit both muscular strength and endurance qualities concurrently, which are demanded in athletic performance, most notably in team sports. Moreover, recent work indicates that when traditional high-load resistance training is supplemented with low-load, blood flow-restricted exercise, either in the same session or as a separate training block in a periodised programme, a synergistic and complementary effect on training adaptations may occur. Transient reductions in mechanical loading of tissues afforded by low-load, blood flow-restricted exercise may also serve a purpose during de-loading, tapering or rehabilitation of musculoskeletal injury. This narrative review aims to expand on the current scientific and practical understanding of how blood flow restriction methods may be applied by coaches and practitioners to enhance current athletic development models.
... [70][71][72] However, recent literature has suggested that these side effects appear to be minimal, and that when compared with traditional strength training rehabilitation methods, there may be no increased risk. [73][74][75] In a 2018 review, Brandner et al 70 noted no increase in markers of coagulation after initial BFR and prolonged BFR implementation, but suggested caution when a patient has unstable hypertension, coagulopathies, and various other conditions. 72 In contrast, other studies have reported increased fibrinolysis after BFR and light-load resistance exercise. ...
Anterior cruciate ligament tears or ruptures are common orthopedic injuries. Anterior cruciate ligament reconstruction (ACLR) is an orthopedic procedure allowing for earlier return to sports, improved maintenance of lifestyle demands, and restored knee stability and kinematics. A perioperative rehabilitative adjunct recently gaining interest is blood flow restriction (BFR), a method in which temporary restriction of blood flow to a chosen extremity is introduced and can be used as early as a few days postoperative. There has been increasing investigation and recent literature regarding BFR. This review synthesizes current concepts of BFR use in the ACLR perioperative period.
... However, regardless of the reported benefits of BFR training, the safety of its use is often questioned, mainly when it is applied to patients. In support of BFR safety, a Japanese national survey reported that the most common adverse effects of BFR training, such as subcutaneous hemorrhage, sensory paresthesia (1.3%), and lightheadedness, are temporary 36 . In addition, concerns exist regarding safety and adverse events (e.g., numbness, nausea, hypertension, headache, fainting, tingling, excessive pain, central retinal vein occlusion, rhabdomyolysis) during and following exercise, particularly for those with comorbidities 37 . ...
Therapeutic exercise is integral to the comprehensive rehabilitation of patients with cardiovascular disease and, as such, is recommended by the American Heart Association as a valuable and effective treatment method for such patients. The type of exercise applied to these patients is aerobic and resistance exercise with mild intensities and loads to avoid overloading the cardiovascular system. Blood flow restriction exercise is a novel exercise modality in clinical settings that has in many studies a similar effect on muscle hypertrophy, strength, and cardiovascular response to training at a 70% strength level without blood flow restriction. Since this exercise mode does not require high-intensity loads, it can be a safe method for improving muscle strength, cardiovascular endurance, and functionality in cardiovascular patients. Given that, the objective of this review is to assess and summarize existing evidence for the use of blood flow restriction in cardiovascular patients. A scoping review of existing clinical trials was conducted. Eleven studies were examined that suggested the use of blood flow restrictions in cardiovascular patients to achieve improvements in muscle strength, functionality, and cardiovascular parameters such as blood pressure decrease.
... However, no association has been reported between BFR exercise and increased cardiovascular morbidity [23][24][25][26] . Previous DVT incidence rates in studies with BFR exercise interventions have been reported to be 0.06% in clinical and healthy populations [27] . Currently, no studies have investigated the effect of BFR exercise in patients with IC. ...
Unlabelled:
To examine the feasibility and safety of blood flow restricted walking (BFR-W) in patients with intermittent claudication (IC). Moreover, to evaluate changes in objective performance-based and self-reported functioning following 12 weeks of BFR-W.
Materials and methods:
Sixteen patients with IC were recruited from two departments of vascular surgery. The BFR-W programme implied the application of a pneumatic cuff around the proximal part of the affected limb at 60% limb occlusion pressure in five intervals of 2 min, four times per week for 12 weeks. Feasibility was evaluated by adherence and completion rates of the BFR-W programme. Safety was evaluated by adverse events, ankle-brachial index (ABI) at baseline and follow-up, and pain on a numerical rating scale (NRS pain) before and 2 min after training sessions. Furthermore, changes in performance between baseline and follow-up were evaluated with the 30 seconds sit-to-stand test (30STS), the 6-minute walk test (6MWT) and the IC questionnaire (ICQ).
Results:
Fifteen out of 16 patients completed the 12-week BFR-W programme and adherence was 92.8% (95% CI: 83.4; 100%). One adverse event unrelated to the intervention was reported causing one patient to terminate the programme 2 weeks prematurely. Mean NRS pain 2 min following BFR-W was 1.8 (95% CI [1.7-2]). ABI, 30STS, 6MWT and ICQ score were improved at follow-up.
Conclusions:
BFR-W is feasible and appears to be safe in terms of completion rate, adherence to the training protocol, and adverse events in patients with IC. Further investigation of the effectiveness and safety of BFR-W compared to regular walking exercise is needed.
... Outros elementos são elencados como auxiliares no processo de ganho de força e consequentemente na melhora da capacidade funcional como o aumento da capacidade respiratória e o aumento da produção do hormônio hGH, assim como a diminuição da atrofia por desuso (BUENO, 2013;NAKAJIMA et al., 2006;LORENNEKE et al., 2012. Mediante o aumento da capacidade de recrutamento de fibras musculares, entre outros fatores como o estímulo metabólico e neuromuscular, além de diminuição de oxigênio e o recrutamento de unidades motoras, há a ocorrência de recrutamento de mais fibras sustentado a manutenção e estimulando ao ganho de força, que consequentemente melhora no desempenho funcional (TEIXEIRA et al., 2013). ...
Analisar os benefícios do treinamento de força associada ao método de oclusão vascular parcial para hipertrofia e ganho de força. Trata-se de uma pesquisa de revisão integrada da literatura. A amostra incluída nos estudos são adultos, o período de realização foi do mês de agosto a outubro de 2020. Foi pautado como critério de inclusão apenas referências dos últimos cinco anos (2015 a 2020), em português e inglês, somente os estudos com disponibilidade de texto completo, disponíveis gratuitamente e originais. Entretanto, para a construção da contextualização foram utilizadas todas as literaturas disponíveis sem restrição de data e pesquisas de revisão de literatura. As bases de dados consultadas foram os portais da Scielo, BVS e PEDro, os descritores foram identificados no site de DeCS. Dos 265 artigos identificados inicialmente, ao final 07 foram selecionados. Com o intuito de apresentar os resultados de forma mais expositiva o processo de pesquisa, foi descrito de acordo com o modelo do PRISMA. Os benefícios destacados foram a diminuição da dor articular e muscular, a melhora da resistência aeróbica, melhorando a capacidade funcional e o ganho significativo de massa magra aumentando a capacidade física. os estudos analisados indicam que o treino de força associado a oclusão vascular é uma alternativa para o ganho de força e hipertrofia com benefícios a melhora da capacidade funcional. Palavras chave : Treinamento físico. Força muscular. Oclusão vascular. Restrição do fluxo sanguíneo.
Objectives
Knee osteoarthritis (KOA) is a leading cause of global disability with conventional exercise yielding only modest improvements. Here we aimed to investigate the benefits of integrating blood flow restriction (BFR) into traditional exercise programmes to enhance treatment outcomes.
Methods
The Vascular Occlusion for optimizing the Functional Improvement in patients with Knee Osteoarthritis randomised controlled trial enrolled 120 patients with KOA at Ghent University Hospital, randomly assigning them to either a traditional exercise programme or a BFR-enhanced programme over 24 sessions in 12 weeks. Assessments were conducted at baseline, 6 weeks, 12 weeks and 3 months postintervention using linear mixed models with Dunn-Sidak corrections for multiple comparisons. Primary outcome was the Knee injury and Osteoarthritis Outcome Score (KOOS) questionnaire at 3 months follow-up with knee strength, Pain Catastrophizing Scale questionnaire and functional tests as secondary outcomes. Analysis followed an intention-to-treat approach ( NCT04996680 ).
Results
The BFR group showed greater improvements in KOOS pain subscale (effect size (ES)=0.58; p=0.0009), quadriceps strength (ES=0.81; p<0.0001) and functional tests compared with the control group at 12 weeks. At 3 months follow-up, the BFR group continued to exhibit superior improvements in KOOS pain (ES=0.55; p=0.0008), symptoms (ES=0.59; p=0.0004) and quality of life (QoL) (ES=0.66; p=0.0001) with sustained benefits in secondary outcomes. Drop-out rates were similar in both groups.
Conclusion
Incorporating BFR into traditional exercise programmes significantly enhances short-term and long-term outcomes for patients with KOA demonstrating persistent improvements in pain, symptoms, QoL and functional measures compared with conventional exercise alone. These findings suggest that BFR can provide the metabolic stimulus needed to achieve muscle strength and functional gains with lower mechanical loads. Reduced pain and increased strength support a more active lifestyle, potentially maintaining muscle mass, functionality and QoL even beyond the supervised intervention period.
Trial registration number
NCT04996680 .
Blood flow restriction training (BFRT) is increasing in popularity in the rehabilitation setting due to its believed impact on mitigating muscle atrophy, maintaining muscle mass and improving muscle function after musculoskeletal injury. This intervention has shown to be an effective option for addressing muscle strength and atrophy during earlier phases of rehabilitation when higher loads are not tolerated after injury. Although this intervention appears to be a safe and effective approach in sports medicine environments, there is limited information on the young athlete population. The purpose of this study is to provide a detailed overview of mechanisms, safety considerations, and clinical applications specific to the young athlete after musculoskeletal injury.
Background
Blood flow restriction (BFR) is a training tool that involves wearing a tourniquet or occlusive device during exercise. Data support that low-load training with BFR may produce muscle hypertrophy similar to standard high-load training. Because of the weight-bearing and range of motion (ROM) restrictions after meniscal repair, patients encounter substantial atrophy of lower extremity musculature. We perform BFR for these patients to limit atrophy postoperatively with the goal of facilitating their return to prior function and sports.
Indications
We incorporate BFR in the postoperative rehabilitation protocol for patients undergoing meniscal repair not involving the root. Patients with the following are excluded: acute or severe cardiac disease, peripheral vascular disease, blood pressure over systolic 180 mm Hg or diastolic 100 mm Hg, hemophilia, thrombophlebitis or history of deep vein thrombosis, severe anemia, and sickle cell disease.
Technique Description
An automated BFR device calculates the patient’s limb occlusion pressure (LOP) and titrates to 50% to 80% of LOP for lower extremity exercises. Exercise parameters typically consist of 4 sets of each exercise, totaling 75 repetitions, with 30-second interset rest. Patients undergo a standard 3-phase postoperative rehabilitation protocol. Phase I (weeks 0-6): Patients are nonweightbearing, may be either footflat weightbearing or partial weightbearing at the surgeon’s, with ROM restricted 0 to 90 in a hinge knee brace throughout the phase. Exercises include quadriceps sets with neuromuscular electrical stimulation and straight leg raises and short/long arcs quadriceps. Phase II (weeks 7-8): Patients progress to weightbearing and ROM as tolerated and begin exercises including double mini squats, hamstring curls, double leg press, and double leg heel raises. Phase III: (weeks 9+): Patients perform double and single leg bridges, double leg bridges on ball with knee band, squats, single leg press, and single leg heel raises, all with the goal of returning to sports.
Results
Prior systematic review data demonstrate low-load training with BFR increases muscle strength and induces hypertrophy relative to low-load training alone. No significant differences for Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales between BFR training group and control group.
Discussion
BFR training may facilitate postoperative recovery in patients undergoing meniscal repair surgery by helping mitigate muscular atrophy.
Patient Consent Disclosure Statement
The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
Introduction: Changes in blood morphological and rheological parameters and the related mechanisms in the human body are still not fully understood. They should be subjected to constant revisions and analyses, not only specific, but also modified by external factors.Objectives: The aim of the study was to investigate and compare hemorheological parameters of blood during interval training combined with occlusion and cooling in young healthy people.Material and methods: 30 students of the University of Physical Education in Krakow were examined. The VASPER training system was used, offering the possibility of using occlusion factors and local cryotherapy with HIIT (High Intensity Interval Training) training at the same time. Blood from people participating in the project was collected six times (2 weeks before the start of training, immediately before the start of training, after the first training, after 10th training sessions, after 20th training sessions and two weeks after the end of training sessions). The subjects were divided into 3 groups: with occlusion and local cryotherapy, with occlusion and a control group (exercises only). Each person performed the same HIIT training routine, modified by factors depending on the assigned group.Results: In all groups, positive changes in hematological and rheological parameters were observed, occurring at a similar time and pace, regardless of the occlusion and local cryotherapy modifications used.Conclusions: The use of HIIT training using occlusion and cooling, occlusion alone and without additional modifications, can have a positive effect on hematological and rheological parameters in young healthy people and can be used to improve health and well-being. Further research is necessary to confirm the obtained results.
Background
Blood flow restriction training (BFRT) after anterior cruciate ligament reconstruction (ACLR) is rising in popularity because of its benefits in reducing muscle atrophy and mitigating knee strength deficits.
Purpose
To investigate the impact BFRT has on adolescent knee strength after ACLR at 2 postoperative time points: at 3 months and the time of return to sport (RTS).
Study Design
Cohort study; Level of evidence, 3.
Methods
A prospective intervention (BFRT) group was compared to an age-, sex-, and body mass index–matched retrospective control group. Patients aged 12 to 18 years who underwent primary ACLR with a quadriceps tendon autograft were included. Along with a traditional rehabilitation protocol, the BFRT group completed a standardized BFRT protocol (3 BFRT exercises performed twice weekly for the initial 12 weeks postoperatively). Peak torque values for isometric knee extension and flexion strength (at 3 months and RTS) and isokinetic strength at 180 deg/s (at RTS) as well as Pediatric International Knee Documentation Committee (Pedi-IKDC) scores were collected. Differences between the BFRT and control groups were compared with 2-way mixed analysis of variance and 1-way analysis of variance.
Results
The BFRT group consisted of 16 patients (10 female; mean age, 14.84 ± 1.6 years) who were matched to 16 patients in the control group (10 female; mean age, 15.35 ± 1.3 years). Regardless of the time point, the BFRT group demonstrated significantly higher isometric knee extension torque compared to the control group (2.15 ± 0.12 N·m/kg [95% CI, 1.90-2.39] vs 1.74 ± 0.12 N·m/kg [95% CI, 1.49-1.98], respectively; mean difference, 0.403 N·m/kg; P = .024). The BFRT group also reported significantly better Pedi-IKDC scores compared to the control group at both 3 months (68.91 ± 9.68 vs 66.39 ± 12.18, respectively) and RTS (89.42 ± 7.94 vs 72.79 ± 22.81, respectively) ( P = .047).
Conclusion
In adolescents, the addition of a standardized BFRT protocol to a traditional rehabilitation protocol after ACLR significantly improved knee strength and patient-reported function compared to a traditional rehabilitation program alone.
Applying blood flow restriction (BFR) during low load exercise induces beneficial adaptations of the myotendinous and neuromuscular system. Despite the low mechanical tension, BFR exercise facilitates a localized hypoxic environment and increase in metabolic stress, widely regarded as the primary stimulus for tissue adaptations. First evidence indicates that low load BFR exercise is effective in promoting an osteogenic response in bone, although this has previously been postulated to adapt primarily during high-impact weight-bearing exercise. Besides studies investigating the acute response of bone biomarkers following BFR exercise, first long-term trials demonstrate beneficial adaptations in bone in both healthy and clinical populations. Despite the increasing number of studies, the physiological mechanisms are largely unknown. Moreover, heterogeneity in methodological approaches such as biomarkers of bone metabolism measured, participant and study characteristics, and time-course of measurement render it difficult to formulate accurate conclusions. Furthermore, incongruity in the methods of BFR application (e.g., cuff pressure) limits the comparability of datasets and thus hinders generalizability of study findings. Appropriate use of biomarkers, effective BFR application and befitting study design has the potential to progress knowledge on the acute and chronic response of bone to BFR exercise and contribute toward the development of a novel strategy to protect or enhance bone health. Therefore, the purpose of the present synthesis review is to: i) evaluate current mechanistic evidence; ii) discuss and offer explanations for similar and contrasting data findings; and iii) create a methodological framework for future mechanistic and applied research.
Background
Early commencement of rehabilitation might counteract the loss of muscle strength due to a chronic obstructive pulmonary disease acute exacerbation (COPDAE). Blood flow restriction resistance exercise (BFR-RE) using a low intensity of training load has demonstrated muscle strength gain in varieties of clinical populations. This trial aimed at studying the efficacy and acceptability of BFR-RE in patients with post-COPDAE which was not reported before.
Method
A prospective, assessor blinded, randomized controlled study with 2-week in-patient rehabilitation program with BFR-RE was compared to a matched program with resistance exercise without BFR in patients with post-COPDAE. The primary outcome was the change of muscle strength of knee extensor of dominant leg. The secondary outcomes included changes of hand grip strength (HGS), 6-minute walk test (6MWT) distance, short physical performance battery (SPPB) scores, COPD assessment test (CAT) scores; acceptability and feasibility of BFR-RE; and 1-month unplanned re-admission rate.
Results
Forty-Five post-COPDAE patients (mean age = 76 ± 10, mean FEV1%=49% ± 24%) were analyzed. After training, BFR-RE group and control group demonstrated a statistically significant median muscle strength gain of 20 (Interquartile range (IQR) 3 to 38) Newton(N) and 12 (IQR -9 to 30) N respectively. BFR-RE group showed a significant change in SPPB scores, but not in 6MWT distance and HGS after training. Between groups did not have statistically significant different in all primary and secondary outcomes, though with similar acceptability. Drop-out rate due to training-related discomfort in BFR-RE group was 3.7%.
Conclusion
BFR-RE is feasible and acceptable in patients with post-COPDAE. A 2-week inpatient pulmonary rehabilitation with BFR-RE improved muscle strength of knee extensors, but not a greater extent than the same rehabilitation program with resistance exercise without BFR. Further studies could be considered with a longer training duration and progression of resistance load. [ ClinicalTrials.gov Identifier: NCT04448236].
O treinamento com oclusão vascular se encontra numa constante crescente no que diz respeito a estudos acadêmicos acerca da técnica, devido à sua popularização nos últimos anos, tanto no âmbito visando hipertrofia quanto como tratamento de recuperação para indivíduos com lesão articular. Outro tema que acumula pesquisas na área da saúde é relativo à reabilitação de ruptura do LCA, trauma sofrido por praticantes esportivos. O presente estudo tem como objetivo mapear o que se tem produzido cientificamente sobre a utilização de treinamento com oclusão vascular na reabilitação de indivíduos com ruptura de LCA. Uma pesquisa sistemática foi realizada nos dias 25 e 26 de maio de 2023, para o escopo desta investigação foi utilizada a base de dados da PubMed, alguns termos foram utilizados para a composição da string utilizada na busca: Vascular occlusion training, rehabilitation" AND "anterior cruciate ligament. Sinônimos foram consultados na literatura para compor a string de busca. A pesquisa bibliográfica resultou em um total de 39 estudos. Na sequência, 20 estudos foram excluídos durante a revisão de títulos, 6 retirados após a leitura do resumo, restando 13 artigos completos para a avaliação da elegibilidade. Os resultados comprovam que o método é de fato eficaz, desde que aplicado aos exercícios corretos, em consonância à pressurização ideal para o membro do utente e carga. Comprovou-se que o treinamento com oclusão vascular a indivíduos submetidos à reconstrução de LCA apresenta resultados positivos aos utentes, respeitando 80% de restrição do fluxo sanguíneo executados exercícios de até 30% de 1 RM.
Purpose: In this systematic review and meta-analysis, blood flow restriction (BFR) with low-load resistance training (BFR-RT) was compared with high-load resistance training (HL-RT) on muscle strength in healthy adults. The characteristics of cuff pressure suitable for muscle strength gain were also investigated by analyzing the effects of applying different occlusion pressure prescriptions and cuff inflation patterns on muscle strength gain.
Methods: Literature search was conducted using PubMed, Ovid Medline, ProQuest, Cochrane Library, Embase, and Scopus databases to identify literature published until May 2023. Studies reporting the effects of BFR-RT interventions on muscle strength gain were compared with those of HL-RT. The risk of bias in the included trials was assessed using the Cochrane tool, followed by a meta-analysis to calculate the combined effect. Subgroup analysis was performed to explore the beneficial variables.
Results: Nineteen articles (42 outcomes), with a total of 458 healthy adults, were included in the meta-analysis. The combined effect showed higher muscle strength gain with HL-RT than with BFR-RT (p = 0.03, SMD = −0.16, 95% CI: −0.30 to −0.01). The results of the subgroup analysis showed that the BFR-RT applied with incremental and individualized pressure achieved muscle strength gain similar to the HL-RT (p = 0.8, SMD = −0.05, 95% CI: −0.44 to 0.34; p = 0.68, SMD = −0.04, 95% CI: −0.23 to 0.15), but muscle strength gain obtained via BFR-RT applied with absolute pressure was lower than that of HL-RT (p < 0.05, SMD = −0.45, 95% CI: −0.71 to −0.19). Furthermore, muscle strength gain obtained by BFR-RT applied with intermittent pressure was similar to that obtained by HL-RT (p = 0.88, SMD = −0.02, 95% CI: −0.27 to 0.23), but muscle strength gain for BFR-RT applied with continuous pressure showed a less prominent increase than that for HL-RT (p < 0.05, SMD = −0.3, 95% CI: −0.48 to −0.11).
Conclusion: In general, HL-RT produces superior muscle strength gains than BFR-RT. However, the application of individualized, incremental, and intermittent pressure exercise protocols in BFR-RT elicits comparable muscle strength gains to HL-RT. Our findings indicate that cuff pressure characteristics play a significant role in establishing a BFR-RT intervention program for enhancing muscle strength in healthy adults.
Clinical Trial Registration: https://www.crd.york.ac.uk/PROSPERO/#recordDetails; Identifier: PROSPERO (CRD42022364934).
Background:
Cancer, being a highly widespread disease on a global scale, has prompted researchers to explore innovative treatment approaches. In this regard, blood flow restriction has emerged as a promising procedure utilized in diverse clinical populations with favorable results including improvements in muscle strength, cardiovascular function, and postoperative recovery. The aim of this systematic review was to assess the efficacy of blood flow restriction in cancer survivors.
Methods:
An investigation was carried out using various databases until February 2023: PubMed, Scientific Electronic Library Online, Physiotherapy Evidence Database, Scopus, Web of Science, Cochrane Plus, SPORTDiscus, Physiotherapy and Podiatry of the Complutense University of Madrid, ScienceDirect, ProQuest, Research Library, Cumulative Index of Nursing and Allied Literature Complete Journal Storage, and the gray literature. To assess the methodological quality of the studies, the PEDro scale was utilized, and the Cochrane Collaboration tool was employed to evaluate the risk of bias.
Results:
Five articles found that blood flow restriction was beneficial in improving several factors, including quality of life, physical function, strength, and lean mass, and in reducing postoperative complications and the length of hospital stay.
Conclusion:
Blood flow restriction can be a viable and effective treatment option. It is important to note that the caution with which one should interpret these results is due to the restricted quantity of articles and significant variation, and future research should concentrate on tailoring the application to individual patients, optimizing load progression, ensuring long-term follow-up, and enhancing the methodological rigor of studies, such as implementing sample blinding.
Für eine optimale Steuerung von Trainingsumfängen und -intensitäten im Leistungssport oder in der Rehabilitation nach Verletzungen und Erkrankungen werden zunehmend neuartige Trainingsmethoden integriert. Das Blutflussrestriktionstraining (engl. Blood-Flow-Restriction Training, BFR) beschreibt eine dieser neuen Trainingsmethoden, bei der es zu einer Anwendung von speziellen Blutdruckmanschetten während der Belastung an den Extremitäten kommt. Das vorliegende Positionspapier zielt darauf ab, eine umfassende Beschreibung der BFR-Trainingsmethode, deren bisher dargestellten Wirkmechanismen und möglichen unerwünschten Wirkungen zu geben.
PURPOSE: Generally, an increase in life expectancy is accompanied by various geriatric diseases. However, there is a possibility that geriatric diseases can be prevented and improved through exercise. Exercise is recommended for older adults, but high-intensity exercise (HIE) increases the risk of potential injury. Therefore, blood flow restriction exercise (BFRE) is attracting attention as an alternative for older people who cannot perform HIE. However, mechanisms underlying the physiological effects and benefits of BFRE in older adults have not yet been fully elucidated. This study aimed to summarize the effects of BFRE on aging-related physiological changes and examine its applicability as an effective intervention for successful aging.METHODS: A literature search of electronic databases, including PubMed, Web of Science, and Google Scholar, was conducted for literature published between January 1, 2000, and December 31, 2022.RESULTS: BFRE can effectively increase muscle mass and strength in older adults. Chronic BFRE improved blood pressure, vascular function, and arterial compliance. Although BFRE did not induce changes in bone mineral density (BMD) and cognitive function, positive effects were shown by increasing bone formation markers and neurotrophic factors expression. Relatively, the risk of side effects of BFRE was very low, and even older patients with cardiovascular diseases appeared to have no risk.CONCLUSIONS: This review confirms that BFRE can be an effective and safe intervention to increase muscle mass and strength and improve cardiovascular function. Moreover, BFRE can potentially improve BMD and cognitive function in older adults. In conclusion, BFRE can be an effective intervention for successful aging; additional follow-up studies are needed.
Background
Blood flow restriction (BFR) therapy is a technique that uses partial occlusion of arterial blood flow in tandem with low-load resistance training to promote an environment of metabolic stress within muscle tissue. It is hypothesized that such therapy can facilitate protein synthesis and muscle hypertrophy even in the setting of age, injury, or postoperative rehabilitation—conditions which are marred by muscle atrophy and progressive loss of function. Therefore, BFR may be a successful option to facilitate strength gains even in patients unable to perform traditional high-load resistance training.
Indications
BFR therapy has been shown to be efficacious when used in healthy athletes, the elderly, or in postoperative patients undergoing rehabilitation after upper or lower extremity procedures. More specifically, BFR application in patients undergoing knee surgery has been shown to reduce muscle atrophy post operatively.
Technique Description
BFR involves application of a tourniquet or occlusion cuff at 70% of the determined arterial occlusion pressure (commonly 150-180 mm Hg). The arterial occlusion pressure is calculated by observing the loss of Doppler ultrasonography signal at the pedal pulses with sequential inflation of a blood pressure cuff. This cuff should be applied as proximal as possible at the affected extremity. The patient subsequently performs 5 exercises, including 3 sets of 15 repetitions of each exercise, with 30 seconds of rest in between sets. The cuff remains inflated for all 5 exercises.
Results
BFR in tandem with low-load resistance training has been shown to be effective in improving lower extremity muscle torque and mass of the quadriceps and hamstring muscles when used after knee surgery, specifically anterior cruciate ligament (ACL) reconstruction. The most commonly reported adverse outcomes after BFR include muscle soreness and sensory paresthesias; however, BFR is generally believed to be safe and acceptable for use in a broad spectrum of patients.
Discussion/Conclusion
Muscle atrophy and loss of strength are hallmarks of aging, injured, and postoperative patients. Traditional means of high-intensity strength training is not feasible in these patient populations, and the use of BFR in tandem with lower intensity strength training shows promise in its ability to promote improvements in muscle strength and hypertrophy. However, more high-level research into the long-term effects, complications, and optimal BFR training regimen is warranted.
Patient Consent Disclosure Statement
The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
Aim: The aim of the current study was to investigate the effect of resistance training with blood flow restriction and creatine consumption on the serum levels of myostatin and growth hormone in male bodybuilders. Methods: 36 male bodybuilders with an average age of 22.63 years were divided into three equal groups of 12 people, which included the resistance training group with blood flow restriction and creatine supplementation, the resistance training group with blood flow restriction and placebo, and the creatine consumption group. The exercise program was performed for 8 weeks and 3 sessions of 80 minutes each week, in a stationary and circular manner. The training intensity was 30-40% of a maximum repetition in each training session. Creatine supplement was also taken for eight weeks, every five days and daily in the amount of 20 grams. Growth hormone, muscle strength and volume were evaluated before and after training. Results: The results showed that the serum concentration of growth hormone, muscle strength and volume increased significantly after eight weeks of blood flow restriction training and creatine consumption (P=0.003). while the serum concentration of myostatin had a significant decrease (P=0.002). Conclusion: It seems that low-intensity training under conditions of blood flow restriction and creatine consumption can lead to increase of strength and muscle hypertrophy, and in addition, increase the serum concentration of growth hormone and decrease myostatin. Therefore, it is recommended that athletes use the same protocol in their training to improve strength and increase muscle hypertrophy.
Objectives
Explore the feasibility of lower-limb garment-integrated BFR-training.
Design
Observational study.
Setting
Human performance laboratory.
Participants
Healthy males with no experience of BFR-training.
Main outcome measures
Feasibility was determined by a priori thresholds for recruitment, adherence, and data collection. Safety was determined by measuring BFR torniquet pressure and the incidence of side effects. Efficacy was determined by measuring body anthropometry and knee isokinetic dynamometry. Feasibility and safety outcomes were reported descriptively or as a proportion with 95% confidence intervals (95% CI), with mean change, 95% CIs, and effect sizes for efficacy outcomes.
Results
Twelve participants (mean age 24.8 years [6.5]) were successfully recruited; 11 completed the study. 134/136 sessions were completed (adherence = 98.5%) and 100% of data were collected. There was one event of excessive pain during exercise (0.7%, 95% CI 0.0%, 4.0%), two events of excessive pain post-exercise (1.5%, 95% CI 0.4%, 5.5%), and one event of persistent paraesthesia post-exercise (0.7%, 95% CI 0.0%, 4.0%). Mean maximal BFR torniquet pressure was <200 mmHg. We observed an increase in knee extension peak torque (mean change 12.4 Nm), but no notable changes in body anthropometry.
Conclusions
Lower-limb garment-integrated BFR-training is feasible, has no signal of important harm, and could be used independently.
Older adults and patients with chronic disease presenting with muscle weakness or musculoskeletal disorders may benefit from low-load resistance exercise (LLRE) with blood flow restriction (BFR). LLRE-BFR has been shown to increase muscle size, strength, and endurance comparable to traditional resistance exercise but without the use of heavy loads. However, potential negative effects from LLRE-BFR present as a barrier to participation and limit its wider use. This study examined the perceptual, affective, and cardiovascular responses to a bout of LLRE-BFR and compared the responses to LLRE and moderate-load resistance exercise (MLRE). Twenty older adults (64.3 ± 4.2 years) performed LLRE-BFR, LLRE and MLRE consisting of 4 sets of leg press and knee extension, in a randomised crossover design. LLRE-BFR was more demanding than LLRE and MLRE through increased pain (p ≤ 0.024, d = 0.8–1.4) and reduced affect (p ≤ 0.048, d = −0.5–−0.9). Despite this, LLRE-BFR was enjoyed and promoted a positive affective response (p ≤ 0.035, d = 0.5–0.9) following exercise comparable to MLRE. This study supports the use of LLRE-BFR for older adults and encourages future research to examine the safety, acceptability, and efficacy of LLRE-BFR in patients with chronic disease.
Resistance training with blood flow restriction (RTBFR) allows physically impaired people living with HIV (PWH) to exercise at lower intensities than traditional resistance training (TRT). But the acute and chronic cardiac and metabolic responses of PWH following an RTBFR protocol are unknown. The objective was to compare the safety of acute and chronic effects on hemodynamic and lipid profiles between TRT or RTBFR in PWH. In this randomized control trial, 14 PWH were allocated in RTBFR (GRTBFR; n = 7) or TRT (GTRT; n = 7). Both resistance training protocols had 36 sessions (12 weeks, three times per week). Protocol intensity was 30% (GRTBFR) and 80% (GTRT). Hemodynamic (heart rate, blood pressure) and lipid profile were acutely (rest and post exercise 7th, 22nd, and 35th sessions) and chronically (pre and post-program) recorded. General linear models were applied to determine group * time interaction. In the comparisons between groups, the resistance training program showed acute adaptations: hemodynamic responses were not different (p > 0.05), regardless of the assessment session; and chronicles: changes in lipidic profile favors GRTBFR, which significantly lower level of total cholesterol (p = 0.024), triglycerides (p = 0.002) and LDL (p = 0.030) compared to GTRT. RTBFR and TRT induced a similar hemodynamic adaptation in PWH, with no significant risks of increased cardiovascular stress. Additionally, RTBFR promoted better chronic adequacy of lipid profile than TRT. Therefore, RTBFR presents a safe resistance training alternative for PWH.
Trial registration: ClinicalTrials.gov ID: NCT02783417; Date of registration: 26/05/2016.
This study investigated the effects of twice daily sessions of low-intensity resistance training (LIT, 20% of 1-RM) with restriction of muscular venous blood flow (namely "LIT-Kaatsu" training) for two weeks on skeletal muscle size and circulating insulin-like growth factor-1 (IGF-1). Nine young men performed LIT-Kaatsu and seven men performed LIT alone. Training was conducted two times / day, six days / week for 2 weeks using 3 sets of two dynamic exercises (squat and leg curl). Muscle cross-sectional area (CSA) and volume were measured by magnetic resonance imaging at baseline and 3 days after the last training session (post-testing). Mid-thigh muscle-bone CSA was calculated from thigh girth and adipose tissue thickness, which were measured every morning prior to the training session. Serum IGF-1 concentration was measured at baseline, mid-point of the training and post-testing. Increases in squat (17%) and leg curl (23%) one-RM strength in the LIT-Kaatsu were higher (p＜0.05) than those of the LIT (9% and 2%). There was a gradual increase in circulating IGF-1 and muscle-bone CSA (both p＜0.01) in the LIT-Kaatsu, but not in the LIT. Increases in quadriceps, biceps femoris and gluteus maximus muscle volume were, respectively, 7.7%, 10.1% and 9.1% for LIT-Kaatsu (p＜0.01) and 1.4%, 1.9% and -0.6% for LIT (p＞0.05). There was no difference (p＞0.05) in relative strength (1-RM / muscle CSA) between baseline and post-testing in both groups. We concluded that skeletal muscle hypertrophy and strength gain occurred after two weeks of twice daily LIT-Kaatsu training.
The effects of resistance exercise combined with vascular occlusion on muscle function were investigated in highly trained athletes. Elite rugby players (n = 17) took part in an 8 week study of exercise training of the knee extensor muscles, in which low-intensity [about 50% of one repetition maximum] exercise combined with an occlusion pressure of about 200 mmHg (LIO, n = 6), low-intensity exercise without the occlusion (LI, n = 6), and no exercise training (untrained control, n = 5) were included. The exercise in the LI group was of the same intensity and amount as in the LIO group. The LIO group showed a significantly larger increase in isokinetic knee extension torque than that in the other two groups (P < 0.05) at all the velocities studied. On the other hand, no significant difference was seen between LI and the control group. In the LIO group, the cross-sectional area of knee extensors increased significantly (P < 0.01), suggesting that the increase in knee extension strength was mainly caused by muscle hypertrophy. The dynamic endurance of knee extensors estimated from the decreases in mechanical work production and peak force after 50 repeated concentric contractions was also improved after LIO, whereas no significant change was observed in the LI and control groups. The results indicated that low-intensity resistance exercise causes, in almost fully trained athletes, increases in muscle size, strength and endurance, when combined with vascular occlusion.
We investigated the hemodynamic and hormonal responses to a short-term low-intensity resistance exercise (STLIRE) with the reduction of muscle blood flow. Eleven untrained men performed bilateral leg extension exercise under the reduction of muscle blood flow of the proximal end of both legs pressure-applied by a specially designed belt (a banding pressure of 1.3 times higher than resting systolic blood pressure, 160-180 mmHg), named as Kaatsu. The intensity of STLIRE was 20% of one repetition maximum. The subjects performed 30 repetitions, and after a 20-seconds rest, they performed three sets again until exhaustion. The superficial femoral arterial blood flow and hemodynamic parameters were measured by using the ultrasound and impedance cardiography. Serum concentrations of growth hormone (GH), vascular endothelial growth factor (VEGF), noradrenaline (NE), insulin-like growth factor (IGF)-1, ghrelin, and lactate were also measured. Under the conditions with Kaatsu, the arterial flow was reduced to about 30% of the control. STLIRE with Kaatsu significantly increased GH (0.11+/-0.03 to 8.6+/-1.1 ng/ml, P < 0.01), IGF-1 (210+/-40 to 236+/-56 ng/ml, P < 0.01), and VEGF (41+/-13 to 103+/-38 pg/ml, P < 0.05). The increase in GH was related to neither NE nor lactate, but the increase in VEGF was related to that in lactate (r = 0.57, P < 0.05). Ghrelin did not change during the exercise. The maximal heart rate (HR) and blood pressure (BP) in STLIRE with Kaatsu were higher than that without Kaatsu. Stroke volume (SV) was lower due to the decrease of the venous return by Kaatsu, but, total peripheral resistance (TPR) did not change significantly. These results suggest that STLIRE with Kaatsu significantly stimulates the exercise-induced GH, IGF, and VEGF responses with the reduction of cardiac preload during exercise, which may become a unique method for rehabilitation in patients with cardiovascular diseases.
Exercise-induced muscle injury in humans frequently occurs after unaccustomed exercise, particularly if the exercise involves a large amount of eccentric (muscle lengthening) contractions. Direct measures of exercise-induced muscle damage include cellular and subcellular disturbances, particularly Z-line streaming. Several indirectly assessed markers of muscle damage after exercise include increases in T2 signal intensity via magnetic resonance imaging techniques, prolonged decreases in force production measured during both voluntary and electrically stimulated contractions (particularly at low stimulation frequencies), increases in inflammatory markers both within the injured muscle and in the blood, increased appearance of muscle proteins in the blood, and muscular soreness. Although the exact mechanisms to explain these changes have not been delineated, the initial injury is ascribed to mechanical disruption of the fiber, and subsequent damage is linked to inflammatory processes and to changes in excitation-contraction coupling within the muscle. Performance of one bout of eccentric exercise induces an adaptation such that the muscle is less vulnerable to a subsequent bout of eccentric exercise. Although several theories have been proposed to explain this "repeated bout effect," including altered motor unit recruitment, an increase in sarcomeres in series, a blunted inflammatory response, and a reduction in stress-susceptible fibers, there is no general agreement as to its cause. In addition, there is controversy concerning the presence of sex differences in the response of muscle to damage-inducing exercise. In contrast to the animal literature, which clearly shows that females experience less damage than males, research using human studies suggests that there is either no difference between men and women or that women are more prone to exercise-induced muscle damage than are men.