SUMMARY
Purpose: The overarching aim of this thesis was to investigate the effect of
short-term blocks with high-frequency low-load blood flow restricted resistance
exercise (BFRRE) on muscular adaptations in untrained individuals,
recreationally trained individuals and elite strength athletes. Three independent
studies with four original papers have been completed towards this objective.
High-frequency BFRRE has been shown to induce rapid muscle growth
accompanied by increased numbers of satellite cells and myonuclei. However,
the satellite cell and myonuclear responses appears to plateau after an initial
block of training and it may be speculated that a rest period can reset the
responsiveness of the system after the initial training response. Thus, the aims of
Study I and II were to investigate the effect and time-course of changes in fiber
and whole muscle areas, myonuclear and satellite cell numbers and muscle
strength during two five-day blocks of high-frequency low-load BFRRE,
separated by 10 days of rest. In addition, the importance of performing BFRRE
sets to failure on cellular adaptations has not been investigated. Therefore, Study
II compared the effect of a failure- vs. a non-failure high-frequency BFRRE
protocol. Despite the impressive rates of muscle growth reported in some studies
on high-frequency BFRRE, several recent studies have shown that BFRRE
increases markers of muscle damage and cellular stress. To shed light on possible
mechanisms for myocellular stress and damage after strenuous high-frequency
BFRRE, heat shock protein (HSP) responses, glycogen content and inflammatory
markers were investigated in Study I (paper II). Finally, the impact of low-load
BFRRE has not yet been investigated in highly specialized strength athletes, such
as powerlifters. Thus, the aim of Study III was to investigate the effect of
implementing two five-day blocks of high-frequency low-load BFRRE during six
weeks of periodized strength training in elite powerlifters, on the changes in
number of satellite cells, myonuclei and muscle size and strength.
METHODS: A total of 47 healthy men and women participated in the studies.
Thirteen recreationally trained sports students in Study I (24±2 yrs [mean±SD], 9
men) and 17 untrained men in Study II (25±6 yrs), completed two 5-day-blocks
of seven BFRRE sessions, separated by a 10-day rest period. A failure BFRRE
protocol consisting of four sets with knee extensions to voluntary failure at 20%
of one-repetition maximum (1RM) was performed with both legs in Study I, and
randomized to one of the legs in Study II. The other leg in Study II performed a
non-failure BFRRE protocol (30, 15, 15, 15 repetitions). In Study I, muscle
samples from m. vastus lateralis (VL) obtained before and 1h after the first
session in the first and second block (“Acute1” and “Acute2”), after three
sessions (“Day4”), during the “Rest Week”, and at three (“Post3”) and ten days
post-intervention (“Post10”), were analyzed for muscle fiber area (MFA),
myonuclei, satellite cells, mRNA, miRNA, HSP70, αB-crystallin, glycogen (PAS
staining), CD68+ (macrophages) and CD66b+ (neutrophils) cell numbers.
Muscle strength (1RM knee-extension) and whole muscle size (ultrasonography
and magnetic resonance imaging) was measured up until 20 days after the last
exercise session (Post20). In Study II, muscle samples obtained before, at midtraining,
and 10 days post-intervention (Post10) were analyzed for muscle fiber
area (MFA), myonuclei, and satellite cells. Muscle thickness, cross-sectional area
and echo intensity were measured by ultrasonography, and knee-extension
strength with 1RM and maximal isometric contraction (isomMVC) up until
Post24.
In Study III, seventeen national level powerlifters (25±6 yrs, 15 men) were
randomly assigned to either a BFRRE group (n=9) performing two blocks (week
1 and 3) of five BFRRE front squat sessions within a 6.5-week training period, or
a conventional training group (Con; n=8) performing front squats at ~70% of
1RM. The BFRRE consisted of four sets (first and last set to voluntary failure) at
~30% of 1RM. Muscle biopsies were obtained from VL and analyzed for MFA,
myonuclei, satellite cells and capillaries. Cross-sectional areas (CSA) of VL and
m. rectus femoris (RF) were measured by ultrasonography. Strength was
evaluated by maximal voluntary isokinetic torque (dynMVC) in knee-extension
and 1RM in front squat.
RESULTS: With the first block of BFRRE in Study I (paper I), satellite cell
number increased in both fiber types (70-80%, p<0.05), while type I and II MFA
decreased by 6±7% and 15±11% (p<0.05), respectively. No significant changes
were observed in number of myonuclei or strength during the first block of
training. With the second block of training, muscle size increased by 6-8%, while
the number of satellite cell (type I: 80±63%, type II 147±95%), myonuclei (type
I: 30±24%, type II: 31±28%) and MFA (type I: 19±19%, type II: 11±19%)
peaked 10 days after the second block of BFRRE. Strength peaked after 20 days
of detraining (6±6%, p<0.05). Pax7- and p21 mRNA expression were elevated
during the intervention, while myostatin, IGF1R, MyoD, myogenin, cyclinD1
and -D2 mRNA did not change until 3-10 days post intervention.
In paper II of Study I, αB-crystallin was reported to translocate from the
cytosolic to the cytoskeletal fraction after Acute1 and Acute2 (p<0.05), and
immunostaining revealed larger responses in type 1 than type 2 fibers (Acute1,
225±184% vs. 92±81%, respectively, p=0.001). HSP70 was increased in the
cytoskeletal fraction at Day4 and Post3, and immunostaining intensities were
more elevated in type 1 than in type 2 fibers (Day4, 206±84% vs. 72±112%,
respectively, p<0.001). Glycogen content was reduced in both fiber types; but
most pronounced in type 1, which did not recover until the Rest Week (-15-29%,
p≤0.001). Intramuscular macrophage numbers were increased by ~65% postintervention,
but no changes were observed in muscle neutrophils.
Both protocols in Study II increased myonuclear numbers in type-1 (12-
17%) and type-2 fibers (20-23%), and satellite cells in type-1 (92-134%) and
type-2 fibers (23-48%) at Post10 (p<0.05). RF and VL size increased by 7-10%
and 5-6% in both legs at Post10 to Post24, whereas the MFA of type-1 fibers in
Failure was decreased at Post10 (-10±16%; p=0.02). Echo intensity increased by
~20% in both legs during Block1 (p<0.001) and was ~8-11% below baseline at
Post24 (p=0.001-0.002). IsomMVC decreased by 8-10% in both legs and 1RM
by 5% in the failure leg after Block1 (p=0.01-0.02). IsomMVC and 1RM were
increased in both legs by 6-7% and 9-11% at Post24, respectively (p<0.05).
In Study III, BFRRE in powerlifters induced selective type I fiber
increases in MFA (BFRRE: 12% vs. Con: 0%, p<0.01) and myonuclear number
(BFRRE: 17% vs. Con: 0%, p=0.02). Type II MFA was unaltered in both groups.
BFRRE induced greater changes in VL CSA than control (7.7% vs. 0.5%,
p=0.04), and the VL CSA changes correlated with the increases in MFA of type I
fibers (r=0.81, p=0.02). No significant group differences were observed in SC
and strength changes.
CONCLUSIONS: High-frequency low-load BFRRE in Study I and II induced
pronounced responses in satellite cell proliferation, delayed myonuclear addition
and increases in muscle size, concomitantly with delayed increases in strength in
untrained and recreationally trained individuals. While the gains in satellite cell
and myonuclear numbers as well as muscle size and strength were similar
between non-failure and failure BFRRE protocols in Study II, perceptions of
exertion, pain and muscle soreness were lower in the non-failure leg. Hence, nonfailure
BFRRE may be a more feasible and safe approach. However, we report
that short-term strenuous high-frequency BFRRE can induce elevations in
multiple markers of cellular stress and damage in non-strength trained
individuals. We showed that low-load BFRRE stressed both fiber types, but the
fiber type-specific HSP-responses and prolonged glycogen depletion strongly
indicated that type 1 fibers were more stressed than type 2 fibers. It appears that
the first block of unaccustomed BFRRE exceeded the capacity for recovery in
both Study I and II, and may have induced muscle damage in some of our
participants.
In accordance with our hypothesis, our participants seemed to recover
during the rest week and to respond well to the second block of BFRRE. It is
intriguing that BFRRE induced preferential type I hypertrophy after the second
block of training in Study I. This indicates that although the initial stress may be
too high (and cause damage), adaptive responses will occur and later the same
exercise stress will be the important stimuli for adaptation. Our findings from
Study I and II may provide insights into some of the physiological mechanisms
underpinning overreaching and subsequent recovery and supercompensation after
periods of very strenuous exercise. Finally, in Study III, two one-week blocks
with high-frequency low-load BFRRE implemented during six weeks of
periodized strength training induced a significant increase in muscle size and
myonuclear addition in elite powerlifters. Preferential hypertrophy and
myonuclear addition of type I fibers appears to explain most of the overall
muscle growth. Intriguingly, these responses are in contrast to heavy-load
strength training, that typically induces a greater type II fiber hypertrophy.
Consequently, BFRRE appears to have complementary effects to heavyresistance
training and the combination of these two methods may optimize
adaptations of both fiber types in highly strength-trained individuals. However,
despite the increases in muscle size, we could not observe any group differences
in maximal strength.