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Use and safety of KAATSU training: Results of a national survey in 2016

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Use and safety of KAATSU training: Results of a national survey in 2016

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[Purpose] We examined the use and safety of KAATSU training by a national survey in 2016. [Methods] We provided a questionnaire survey (web input) to attendees of the annual academic meeting of the Japan KAATSU Training Society and on the website of the academic society on October 29, 2016. The reply deadline was set at to about approximately 2 months. [Results] Responses were received from KAATSU leaders or instructors of 232 facilities. KAATSU training has been applied for various types of situations; health promotion (87% of total facilities), diet (85%), beauty and anti-aging (70%), increase of muscle strength (71%), muscle hypertrophy (72%), and improvement of sports performance (53%), and for other situations. In addition, it has been used for rehabilitation (38%); orthopedic disease (38%), obesity (17%), diabetes (12%), cerebrovascular disease (11%), cardiovascular disease (8%), depression (7%), infertility (6%), neuromuscular diseases (5%), and immune diseases (3%). The ratio of the effectiveness or improvement of more than five tenths accounted for 92% of the total. The specific symptoms noted were as follows: dizziness, subcutaneous hemorrhage, drowsiness, numbness, nausea, itchiness and others. There were no serious side effects, such as cerebral hemorrhage, cerebral infarction, thrombosis, or rhabdomyolysis. [Conclusion] Facilities under the guidance of appropriate KAATSU training leaders or instructors can achieve safe and beneficial effects, regardless of subject age, gender, or physical condition in 2016 just as back in 2006.
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Int. J. KAATSU Training Res. 2017; 13: 1-9
Introduction
KAATSU training is a novel method for muscle train-
ing, originally developed by Sato (2005). Unlike the he-
mostasis achieved by the use of a tourniquet which com-
pletely stops both the artery and vein, the KAATSU
training is performed by moderate blood ow restriction
using a specially designed belt; it is carried out while pool-
ing the blood in the upper or the lower limb. Previous
studies have shown that KAATSU training with various
types of load resistances (such as weight, machine, and
elastic band) is effective in rehabilitation medicine and
health enhancement (Abe et al., 2006; Nakajima et al.,
2011; Yasuda et al., 2014; Yasuda et al., 2015). At present,
various subjects such as athletes, healthy persons, and el-
derly persons have performed KAATSU training, and
KAATSU training is being widely used all over the world.
Since the Japan KAATSU Training Society was estab-
lished in 2004, academic research on KAATSU training
has widely increased progressively in Japan. In 2006, Na-
kajima and colleagues examined the use and side eects of
KAATSU training. ey sent out questionnaires by postal
mail, as a national survey, and obtained results from
KAATSU leaders or instructors from a total of 105 facili-
ties where KAATSU training has been adopted (Nakajima
et al., 2006). eir study concluded that despite the fact
that KAATSU training has been widely practiced at vari-
ous facilities, it does not induce side eects such as serious
complications.
According to the search engine results in PubMed, the
number of academic research studies regarding KAATSU
training has increased dramatically from 2006 to 2016. In
addition, since prevention and treatment eects of KAAT-
SU training for diseases can be expected, case reports on
the use of KAATSU in the clinical setting for patients
with various diseases have also been reported (Hughes et
al., 2017). As a result, there is a high possibility that the
Use and safety of KAATSU training: Results of a national
survey in 2016
Tomohiro Yasuda1,2), Miwa Meguro3), Yoshiaki Sato4), Toshiaki Nakajima2,5)
[Purpose] We examined the use and safety of KAATSU training by a national survey in 2016.
[Methods] We provided a questionnaire survey (web input) to attendees of the annual academic
meeting of the Japan KAATSU Training Society and on the website of the academic society on Oc-
tober 29, 2016. The reply deadline was set at to about approximately 2 months.
[Results] Responses were received from KAATSU leaders or instructors of 232 facilities. KAATSU
training has been applied for various types of situations; health promotion (87% of total facilities),
diet (85%), beauty and anti-aging (70%), increase of muscle strength (71%), muscle hypertrophy
(72%), and improvement of sports performance (53%), and for other situations. In addition, it has
been used for rehabilitation (38%); orthopedic disease (38%), obesity (17%), diabetes (12%), cere-
brovascular disease (11%), cardiovascular disease (8%), depression (7%), infertility (6%), neuro-
muscular diseases (5%), and immune diseases (3%). The ratio of the effectiveness or improvement
of more than five tenths accounted for 92% of the total. The specific symptoms noted were as fol-
lows: dizziness, subcutaneous hemorrhage, drowsiness, numbness, nausea, itchiness and others.
There were no serious side effects, such as cerebral hemorrhage, cerebral infarction, thrombosis,
or rhabdomyolysis.
[Conclusion] Facilities under the guidance of appropriate KAATSU training leaders or instructors
can achieve safe and beneficial effects, regardless of subject age, gender, or physical condition in
2016 just as back in 2006.
Key words: KAATSU training; national survey; safety; attention; questionnaire
Correspondence to:
Tomohiro Yasuda, PhD.
School of Nursing, Seirei
Christopher University
3453, Mikatahara, Kita-Ku,
Hamamatsu, Shizuoka,
433-8558, Japan
E-Mail: tomohiro-y@seirei.ac.jp
Phone: +81-53-439-1417
Fax: +81-53-439-1406
See end of article for
authors’ affiliations
Original article
1) School of Nursing, Seirei Christopher University, Shizuoka, Japan
2) Department of Cardiovascular Medicine, School of Medicine, Dokkyo Medical University, Tochigi, Japan
3) Jumonji University, Research Institute of Food and Nutrition and Health, Tokyo, Japan
4) Center for KAATSU Research at Harvard Medical School, Massachusetts, USA.
5) Heart Center, School of Medicine, Dokkyo Medical University Hospital, Tochigi, Japan
2 Use and safety of KAATSU training: Results of a national survey in 2016
symptoms aimed to be improved with the use of KAAT-
SU training have become diversied in the last 10 years.
us, we examined the use and safety of KAATSU train-
ing via a national survey in 2016.
Methods
Leaders and instructors of facilities belonging to the Ja-
pan KAATSU Training Society were asked to participate
in this study.
We provided a questionnaire survey (web input; Google
Form, Google company) by the annual academic meeting
of the Japan KAATSU Training Society (oral message) and
the website of the academic society (document message)
on October 29, 2016. The reply deadline was set at ap-
proximately 2 months (until December 31, 2016).
We extracted the contents on facilities, subjects, eects
or improvement, side eects from the KAATSU training
national survey in 2016. e contents of the questionnaire
survey used in this study are listed in Table 1.
This research was conducted based on the consent of
the Japan KAATSU Training Society. In accordance with
the Declaration of Helsinki, numbers were collected for
individuals in data collection, but personal information of
the individuals was not identied.
Results
We obtained replies from KAATSU leaders or instruc-
tors of 232 facilities. As for the classication of facilities,
the sum of “personal trainer and KAATSU training in-
structor” (108 facilities), “sports club and tness club” (55
facilities) and “bonesetters’ and osteopath’s oces” (25 fa-
cilities) accounted for 81% of the total (Figure 1A). Most
of the facilities (84%) have started KAATSU training
within the last decade (Figure 1B).
According to the results of the questionnaire, we can
speculate that the subjects of 232 facilities were 12,827
persons (from November to December, 2016), which con-
sisted of male (3,858 persons: 30.1%) and female (8,969
persons: 69.9%) subjects. Figure 2 shows the age of per-
sons who have received KAATSU training. The training
was distributed over a wide range of ages. In particular,
persons from age 20s to 60s (53% in their 20s, 81% in
their 30s, 91% in their 40s, 81% in their 50s, and 65% in
their 60s) were presented more than half of all facilities.
Figure 3 shows the number of the facilities classied by
the object of KAATSU training (Figure 3A) and the pur-
pose of the use of KAATSU training with regard to symp-
toms (Figure 3B). As illustrated in Figure 3A, KAATSU
training has been applied for various kinds of conditions;
Figure 1A Figure1B
Figure 1. e types of the facilities (n=232) that participated in this study (A). e distribution of the period since the time that the facilities introduced KAATSU
training (B).
Figure 2. e age of persons who have received KAATSU training in the total of 232 facilities.
3Tomohiro Yasuda, Miwa Meguro, Yoshiaki Sato, Toshiaki Nakajima
Table 1. A national survey in 2016 (Excerpts, with partial modications)
1. What kind of facility is your facility?
•Hospitals and Clinics •University (Other than a university hospital) and Research institution •Bonesetters’ and osteopath’s oces •Acupuncture and moxibus-
tion, masseur, and massage facilities •Elderly welfare facilities •Yoga and Pilates •Sports club and tness club •Personal trainer and KAATSU training instructor
•Others
2. When did your facility introduce KAATSU training?
•< 1 year ago •1-2 years ago •3-5 years ago •6-10 years ago •11-20 years ago •> 21 years ago •Other timing
3. What is the distribution of the age of your subjects who have taken KAATSU training in your facility? (Multiple answers allowed)
•< 19 years •20s •30s •40s •50s •60s •70s•> 80 years
4. How many male subjects in your facilities?
5. How many female subjects in your facilities?
6. What is the symptom aimed to be improved with the use of KAATSU training in your facility? (Multiple answers allowed)
•Beauty and Anti-aging •Postpartum •Health promotion •Diet •Increase of muscle strength •Muscle hypertrophy •Improvement of sports performance •Reha-
bilitation •Others
7. If you replied “Rehabilitation” in question 6. Please indicate the disease? (Multiple answers are allowed)
•Orthopedic disease •Cerebrovascular disease •Cardiovascular disease •Neuromuscular disease •Diabetes •Obesity •Kidney disease •Respiratory disease •Immune
disease •Depression •Infertility •Others
8. If you replied “Orthopedic disease” in question 7. Please indicate the disease and symptoms? (Multiple answers are allowed)
•Fracture •Sprain •Osteoporosis •Osteoarthritis of the knee •Other knee joint diseases •Femoral head necrosis •Other hip joint disease •Low back pain •Other
lumbar spine disease •Cervical spine disease •Spine disease •Shoulder discomfort •Frozen shoulder •Other shoulder disease •Other arthritis disorder •After sur-
gery •Others
9. If you replied “Cardiovascular disease” in question 7. Please indicate the disease and symptoms? (Multiple answers are allowed)
•Hypertension •Hyperlipidemia •Obesity •Ischemic heart disease (myocardial infarction, angina pectoris) •Arrhythmia •Heart failure •After cardiac surgery
•Others
10. If you replied “Neuromuscular disease” in question 7. Please indicate the specic disease.
11. If you replied “Cerebrovascular disease” in question 7. Please indicate the specic disease.
12. If you replied “Kidney disease” in question 7. Please indicate the specic disease.
13. If you replied “Respiratory disease” in question 7. Please indicate the specic disease.
14. If you replied “Immune” in question 7. Please indicate the specic disease.
15. What types of exercises are combined with KAATSU training? (Multiple answers are allowed)
•Body weight •Barbell or dumbbell •Machine •Aero bike or cross trainer •Stair climber or treadmill •Stretching, gymnastics, yoga, and pilates •Walking and
running (Do not use machine) •Sports performance •Others
16. How often do your subjects visit your facility? (Multiple answers are allowed)
•Once a week •Twice a week •3 times a week •4-6 times a week •1-3 times a month •Every day •Others
17. How long is each training time in your facility? Include the time for equipment removal in the interval. (Multiple answers are allowed)
•< 5 minutes •5-10 minutes •10-20 minutes •20-30 minutes •30-40 minutes •40-50 minutes •> 50 minutes •Others
18. What is the factor that determines the pressure intensity for KAATSU training? (Multiple answers are allowed)
•KAATSU training guidance program •Age •Sex •Blood pressure •Symptoms of disease •Depending on the purpose of training •None •Others
19. What is the factor that determines the load intensity for KAATSU training? (Multiple answers are allowed)
•KAATSU training guidance program •Age •Sex •Blood pressure •Symptoms of disease •Depending on the purpose of training •None •Others
20. What is checked every time when doing KAATSU training? (Multiple answers are allowed)
•Interview (physical condition, etc.) •Blood pressure •Heart rate and pulse rate •Body weight •Body composition (% body fat, etc.) •Girth •Ratings of perceived
exertion (RPE) •None •Others
21. What do you check rst before starting KAATSU training? (Multiple answers are allowed)
•Interview (physical condition, etc.) •Blood pressure •Heart rate and pulse rate •Body weight •Body composition (% body fat, etc.) •Girth •Blood sampling
•Electrocardiogram •Oxygen saturation •One-repetition maximum (1RM) •Cardiopulmonary exercise test (CPX) •Physical tness test •None •Others
22. Are you doing regular physical measurements or tests?
•Yes •No •Yes, but not regular
23. If you replied “Yes” or “Yes, but it is not regular” in question 22. Please indicate the specic disease. How long do you measure or test? (Multiple an-
swers are allowed)
•Once a week •Twice a week •Once a month •Once in 2 months •Once in 3 months •Once in six months •Others
24. If you replied “Yes” or “Yes, but it is not regular” in question 22. Please indicate the specic disease. What types of tests are you doing? (Multiple an-
swers are allowed)
•Interview (physical condition, etc.) •Blood pressure •Heart rate and pulse rate •Body weight •Body composition (% body fat, etc.) •Girth •Blood sampling
•Electrocardiogram •Oxygen saturation •One-repetition maximum (1RM) •Cardiopulmonary exercise test (CPX) •Physical tness test •None •Others
25. What percentage of the subjects who carried out KAATSU training showed an eect?
•Everyone •> Eight tenths •Five tenths - Seven tenths •ree tenths - Four tenths •One tenth - Two tenths •None
26. If you replied “> one tenth” in question 25. Please indicate the specic eect. (Multiple answers are allowed)
•Muscle hypertrophy •Increase muscle strength •Weight loss •Beautiful skin •Paralysis improvement •Pain improvement •Sti shoulder improvement •Low
back pain improvement •Reducing Depressive symptoms •Other diseases improvement (Describe the disease name) •Others
27. Please describe the symptom if there is a symptom that you may be concerned about during KAATSU training. (Multiple answers are allowed). Please
describe in “Other” for symptoms not falling under the following items.
•Cool feeling •Numbness •Subcutaneous hemorrhage •Drowsiness •Pain •Nausea •Itch •Hypertension •dizziness •Others
4 Use and safety of KAATSU training: Results of a national survey in 2016
health promotion (202 facilities: 87%), diet (198 facilities:
85%), beauty and anti-aging (162 facilities: 70%), in-
crease of muscle strength (165 facilities: 71%), muscle hy-
pertrophy (167 facilities: 72%), and improvement of
sports performance (124 facilities: 53%), and for other
conditions. In addition, it has also been used for rehabili-
tation (89 facilities: 38%); orthopedic disease (88 facili-
ties: 38%), obesity (39 facilities: 17%), diabetes (28 facili-
ties: 12%), cerebrovascular disease (26 facilities: 11%),
cardiovascular disease (18 facilities: 8%), depression (17
facilities: 7%), infertility (15 facilities: 6%), neuromuscu-
lar diseases (11 facilities: 5%), immune diseases (8 facili-
ties: 3%) and others (Figure 3B). Furthermore, it has been
found that 26 facilities are applying KAATSU for patients
with designated intractable diseases (Table 2).
As for the specific contents of the KAATSU training,
body weight (214 facilities: 92%), barbell or dumbbells
(200 facilities: 86%) and others are shown in Figure 4A.
Figure 4B and 4C show the distribution of the facilities
classified by the training frequency and duration of
KAATSU training. Most of the facilities have been apply-
ing once a week training (218 facilities: 94%) and more
than half of all the facilities have been applying the train-
ing twice a week (149 facilities: 64%) (Figure 4B). Re-
garding the length of each training time, the answers of
20-30 minutes (102 facilities: 44%) and 30-40 minutes
(91 facilities: 39%) were frequently found (Figure 4C).
In each training session, most of the facilities have been
applying interviews (226 facilities: 97%) and more than
half of the facilities have been testing blood pressure (165
facilities: 71%) (Figure 5A). Before the first KAATSU
training exercise, most of facilities have been applying an
interview (231 facilities: 100%) and more than half of the
facilities have been testing blood pressure (186 facilities:
80%) and heart rate or pulse rate (133 facilities: 57%)
(Figure 5B). As for the response regarding the ratio of an-
thropometric measurements or physical fitness tests as
“yes” (82 facilities: 35%) and “yes, but not regular” (79 fa-
cilities: 34%) accounted for 69% of the total (Figure 5C).
Regular evaluation of the measurements and the tests was
Figure 3A Figure 3B
Figure 3. e object of the KAATSU training in each facility (A) and the symptom aimed to be improved with the use of KAATSU training (B). Numbers of facili-
ties are indicated in each gure.
Table 2. Specic disease name and the number of facilities of KAATSU training
Orthopedic disease
•Fracture: 29 •Sprain: 27 •Osteoporosis: 18 •Knee osteoarthritis: 53 •Other knee arthrosis: 38 •Femoral head necrosis: 24 •Other hip arthrosis: 23 •Low back
pain: 56 •Other low back pain: 19 •Cervical spine disease: 20 •Spinal disease: 11 •Sti shoulder: 65 •Frozen shoulder: 51 •Other shoulder peripheral disease: 25
•Other joint disease: 48 •After surgery: 19 •Others: 0
Cardiovascular disease
•Hypertension: 21 •Hyperlipidemia: 11 •Obesity: 15 •Ischemic heart disease (myocardial infarction, angina pectoris): 7 •Arrhythmia: 6 •Heart failure: 2 •After
cardiac surgery: 2 •Others: 0
Neuromuscular disease (Specic disease name)
•Parkinson’s disease: 2 •Disc herniation: 2 •Cervical nerve root disease: 1 •Sciatica: 1 •Amyotrophic lateral sclerosis: 1 •Spinocerebellar degeneration: 1 •Spinal
stenosis: 1 •Spastic paraplegia: 1 •Sequelae after left upper arm surgery: 1
Cerebrovascular disease (Specic disease name)
•Cerebral infarction: 17 •Cerebral hemorrhage: 8 •Subarachnoid hemorrhage: 1
Kidney disease (Specic disease name)
•Polycystic kidney: 1 •Chronic glomerulonephritis: 1 •Kidney stone: 1 •Dialysis: 1
ratory disease (Specic disease name)
•Chronic obstructive pulmonary disease: 1 •Bronchial asthma: 1 •Lung cancer: 1 •Asthma: 1 •Others: 1
Immune disease (Specic disease name)
•Rheumatoid arthritis: 6 •Collagen disease : 4 •Cancer: 1 •Others: 1
5Tomohiro Yasuda, Miwa Meguro, Yoshiaki Sato, Toshiaki Nakajima
performed as follows: once a month (71 facilities: 31%),
once in 3 months (51 facilities: 22 %), once a week (35
facilities: 15%), once in 2 months (31 facilities: 13%) and
others (Figure 5D). e specic contents of the measure-
ments and the tests were as follows: body composition
(118 facilities: 51%), body weight (99 facilities: 43%), in-
terview (81 facilities: 35%), blood pressure (66 facilities:
28%), heart rate or pulse rate (56 facilities: 24%), girth
(45 facilities: 19%), physical fitness test (33 facilities:
14%) and others (Figure 5E).
e ratio of the eectiveness or improvement of more
than five-tenths accounted for 92% of the total (Figure
6A). e specic contents of eectiveness or improvement
of KAATSU training were as follows: muscle hypertrophy
(178 facilities: 77%), increase muscle strength (170 facili-
ties: 73%), stiff shoulder improvement (170 facilities:
73%), weight loss (169 facilities: 73%), beautiful skin
(133 facilities: 57%), low back pain improvement (133 fa-
cilities: 57%), pain improvement (124 facilities: 53%) and
others (Figure 6B).
e specic contents of the symptoms were obtained as
follows; dizziness (85 facilities: 37%), subcutaneous hem-
orrhage (73 facilities: 31%), drowsiness (58 facilities:
25%), numbness (35 facilities: 15%), nausea (34 facilities:
15%), itchiness (32 facilities: 14%) and others. On the
other hand, there were no answers about major side eects
such as cerebral hemorrhage, cerebral infarction, throm-
bosis, or rhabdomyolysis (Figure 7).
Discussion
Most of the facilities obtained a sucient training eect
by KAATSU training. In addition, some symptoms were
present following KAATSU training, but there was no se-
rious symptom. Thus, considering that academic papers
and facilities concerning the KAATSU training have pro-
gressively increased in the last 10 years, the facilities under
the guidance of appropriate KAATSU training leaders or
instructors can produce benecial eects and safely regard-
less of age, gender, and physical conditions.
In this study, there were many female subjects in the
age range of 30-50s. e subjects had the main character-
istics of physical condition (healthy persons), type of exer-
cises (body weight, barbell and dumbbell), frequency (1 to
2 times a week), and purpose (health promotion and diet).
More than 80% of the facilities started KAATSU training
after the questionnaire survey in 2006; sports facilities and
clinics (bonesetters’ and osteopath’s oces) accounted for
81% of the total. In addition, an estimated 12,827 sub-
Figure 4. e specic contents of the KAATSU training (A), frequency of the KAATSU training (B), and duration of the KAATSU training (C). Numbers of facili-
ties are indicated in each gure.
Figure 4A Figure 4B
Figure 4C
6 Use and safety of KAATSU training: Results of a national survey in 2016
Figure 5. e checklist of the KAATSU training for each session (A) and the checklist before the rst KAATSU training (B). e distribution of the regular evalua-
tion on anthropometric measurements or physical tness tests (C). Frequency of the measurements or the tests (e subjects replied “Yes” or “Yes, but not regular” in
question 22.) (D) and specic contents of the measurements or the tests (e subjects replied “Yes” or “Yes, but not regular” in question 22.) (E). Numbers of facili-
ties are indicated in Figures 5A, 5B, 5D, and 5E.
Figure 5A Figure 5B
Figure 5C Figure 5D
Figure 5E
7Tomohiro Yasuda, Miwa Meguro, Yoshiaki Sato, Toshiaki Nakajima
jects included patients with various diseases as well as
healthy persons. Similar to the previous study (Nakajima
et al., 2006), this study demonstrated that the KAATSU
training has benecial eects and it is safe for orthopedic
disease (Takarada et al., 2000; Loenneke et al., 2013; Na-
kajima et al., 2015; Segal et al. 2015; Amano et al., 2016;
Bryk et al., 2016; Hiraizumi et al., 2016; Gaunder et al.,
2017; Tennent et al., 2017), neuromuscular disease (Uchi-
da et al., 2012), cardiovascular disease (Fukuda et al.,
2013; Madarame et al., 2013), cerebrovascular disease
(Arun Kumar et al., 2013; Satoh, 2014), immune diseases
(Mattar et al., 2014; Jørgensen et al., 2016). In addition,
kidney diseases, respiratory diseases, and other disease re-
ceived survey responses stating the beneficial effects and
safety. These results indicate that the KAATSU training
has been widely used for the patients with various diseases.
At 26 facilities of the total, KAATSU training was also
performed for 6 diseases corresponding to designated in-
tractable diseases (Designated incurable disease) by the
Ministry of Health, Labor and Welfare in Japan. Recently,
there were 2 case reports on the eect of KAATSU train-
ing for idiopathic femoral head necrosis (designated in-
tractable diseases), which were performed by medical sta
at medical institutions. Thus, it is a significant point to
build a strong support system (between KAATSU training
facilities and medical institution / staff) when KAATSU
training is performed for various patients (especially desig-
nated intractable diseases).
Similar to the previous study (Nakajima et al., 2006),
the symptoms such as dizziness, subcutaneous hemorrhage
and numbness were reported, but there were no serious
side effects (i.e., pulmonary embolism and paralysis by
nerve compression). In addition, the previous study re-
ported there was one report on cerebral hemorrhage and
rhabdomyolysis, but in the present study, there were no
serious severe symptoms (i.e., cerebral hemorrhage, pul-
monary infarction, cerebral infarction, venous thrombosis,
or rhabdomyolysis). is means that the KAATSU train-
ing by proper training leaders and instructors can achieve
benecial eects without serious side eects. On the other
hand, a recent study (Tabata et al., 2016) reported a risk
of rhabdomyolysis by the KAATSU training, however
there was no detailed description on the KAATSU train-
ing method; it reported that the rhabdomyolysis occurred
as a result of KAATSU training with a training instructor.
Therefore, the KAATSU training leaders and instructors
Figure 6. e distribution of the persons who felt eectiveness or improvement of KAATSU training (A). e specic points of eectiveness or improvement of
KAATSU training (B). Numbers of facilities are indicated in Figure 6B.
Figure 6A Figure 6B
Figure 7. e specic symptoms when there are symptoms of concern following KAATSU training.
e use of KAATSU training or the term “KAATSU Training” in the body text are registered trademarks of KAATSU JAPAN Co., Ltd.
8 Use and safety of KAATSU training: Results of a national survey in 2016
should maintain / improve their knowledge and skills by
participating in academic conferences and reading scientif-
ic papers on the KAATSU training. Furthermore, periodic
tests (interview and others) are important to maintain the
safety of subjects.
It is not a serious side effect, but the symptoms of
drowsiness, nausea, and headache were given in responses.
It can be speculated that these symptoms were induced by
the vagal nerve reflex (Iida et al., 2007). Therefore, it is
necessary to conrm the cause (i.e., excessive pressure in-
tensity and strong stress) by KAATSU training. However,
3 facilities answered “None” in the question of “What is
the factor that determines pressure intensity for KAATSU
training?” “What is checked each time when doing
KAATSU training?”. In addition, 71 facilities (31% of the
total) answered “None” in the question of “Are you doing
regular physical measurements or tests?”. Consequently, it
appears that these situations are major factors, which cause
various symptoms. Therefore, these symptoms will de-
crease dramatically if the KAATSU leaders or instructors
check the KAATSU pressure intensity at every session and
carry out the periodic test regularly (Nakajima et al.,
2007).
There were some differences between this study and
previous study in the collection process (web input vs.
mail) and subjects (limited to members vs. not limited to
members of Japan KAATSU Training Society). In addi-
tion, the contents of the questionnaire survey are partially
revised and added in this study. erefore, it is necessary
to pay attention to the interpretation, when we compare
the results of questionnaire survey between in 2006 and in
2016.
In conclusion, the facilities where appropriate KAATSU
training leaders or instructors can safely produce benecial
effects regardless of age, gender, and physical conditions
were noted in 2016 as well as in 2006.
Acknowledgement
This study was supported, in part, by a Grant-in-aid
(#15K01553 to TY) from the Japan Ministry of Educa-
tion, Culture, Sports, Science, and Technology.
Yasuda T, Meguro M, Sato Y and Nakajima T belonged
to the department of Ischemic Circulatory Physiology (up
to September 2014) at University of Tokyo, which was
funded by KAATSU Japan Co., Ltd.
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... The KAATSU training device was the original blood flow training device. KAATSU training received a patent in the 1990s in the United States of America (Sato, 2005), and Yasuda et al. (2017) described KAATSU training devices as belts which facilitate blood pooling. Knee wraps have been described in the literature by authors as elastic in nature (Wilson et al., 2013;Head et al., 2015) and as wraps used for power lifting purposes (Luebbers et al., 2014;Luebbers et al., 2019). ...
... Currently, little is known regarding how individuals are using different types of BFR/KAATSU training devices in the United States of America. The authors of three observational studies looked at experiences with BFR/KAATSU training (Nakajima et al., 2006;Yasuda et al., 2017;Patterson & Brandner, 2018). Patterson and Brandner (2018) assessed the use of BFR training globally by physicians, strength and conditioning specialists, rehabilitation specialists, sport specific scientists, personal trainers, and researchers. ...
... Patterson and Brandner (2018) assessed the use of BFR training globally by physicians, strength and conditioning specialists, rehabilitation specialists, sport specific scientists, personal trainers, and researchers. Authors of the remaining studies focused on the use and safety related to the KAATSU training (Nakajima et al., 2006;Yasuda et al., 2017). This study adds to the existing body of literature through its exploration of how BFR/KAATSU was being administered. ...
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Purpose: The purpose of the study was to explore how individuals in the United States of America applied BFR/KAATSU devices and administered BFR/KAATSU training. In addition, the study sought to examine safety topics related to BFR/KAATSU training. Methods: The study was completed using survey research. Subjects were recruited through Facebook, email, and word of mouth. The survey was developed, piloted, and finally deployed March 22, 2021-April 21, 2021. Results: In total, 148 consented to the research; 108 completed the survey, and of those 108, 70 indicated current use with BFR/KAATSU equipment. Professions represented included athletic training, personal training, physical therapy, and strength and conditioning. Among those currently using BFR/KAATSU training (n = 70), the following results were found. The most common devices used were inflatable devices (n = 43, 61.4%). Education completed prior to device administration was formal (n = 39, 55.7%) and/or self-directed (n = 37, 52.9%). Barriers were faced by 29 (41.4%) when trying to enact training. Techniques and parameters varied during application. Screening processes were used (n = 50, 71.4%) prior to training. The devices were used to determine restrictive pressure (n = 31, 44.3%), and a supine position was used most when determining initial restrictive pressure (n = 33, 47.1%). For subsequent restrictive pressure measurements, respondents repeated the same method used initially (n = 38, 54.3%). Workload was often defined as the length of time under tension/load (n = 22, 31.4%) and exercise was directly supervised (n = 52, 74.3%). Adverse effects included bruising, lightheadedness, and cramping (n = 15, 21.4%). The devices have also been applied on those with pathology (n = 16, 22.9%). Conclusion: Those using blood flow restriction/KAATSU devices came from several professions and used an assortment of devices for BFR/KAATSU training. Individuals applied devices using a variety of parameters on populations for which efficacy has and has not been well defined.
... Therefore, in comparison to studies evaluating the efficiency of BFR in terms of physical performance and body composition changes, there is still a paucity of empirical studies concerning safety, especially regarding ocular health. Nonetheless, studies to date report negligible adverse effects due to the use of BFR [41][42][43]. Probably the largest survey was conducted in 2005 [41] and repeated in 2016 [42] in Japan. In each, responses from over 12,000 participants from 105 and 232 facilities were collected, respectively. ...
... Nonetheless, studies to date report negligible adverse effects due to the use of BFR [41][42][43]. Probably the largest survey was conducted in 2005 [41] and repeated in 2016 [42] in Japan. In each, responses from over 12,000 participants from 105 and 232 facilities were collected, respectively. ...
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Despite the many health benefits of resistance training, it has been suggested that high-intensity resistance exercise is associated with acute increases in intraocular pressure which is a significant risk factor for the development of glaucomatous optic nerve damage. Therefore, resistance training using a variety of forms (e.g., resistance bands, free weights, weight machines, and bodyweight) may be harmful to patients with or at risk of glaucoma. An appropriate solution for such people may involve the combination of resistance training and blood flow restriction (BFR). During the last decade, the BFR (a.k.a. occlusion or KAATSU training) method has drawn great interest among health and sports professionals because of the possibility for individuals to improve various areas of fitness and performance at lower exercise intensities. In comparison to studies evaluating the efficiency of BFR in terms of physical performance and body composition changes, there is still a paucity of empirical studies concerning safety, especially regarding ocular health. Although the use of BFR during resistance training seems feasible for glaucoma patients or those at risk of glaucoma, some issues must be investigated and resolved. Therefore, this review provides an overview of the available scientific data describing the influence of resistance training combined with BFR on ocular physiology and points to further directions of research.
... In a previous study from our laboratory, a national survey was conducted in 2016 to determine the use and safety of L-BFR [81]. As in the previous study [82], symptoms including subcutaneous bleeding, numbness, and dizziness were described, but no serious side effects (paralysis due to nerve compression, pulmonary embolism, etc.) were observed. ...
... L-BFR using elastic band exercises is known to produce muscle strength and muscle hypertrophy in older adults [22,23], and various usage methods can be expected [81]. Most studies on L-BFR describe a relatively safe training method without serious side effects in the elderly as well as the young. ...
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Resistance training is an extremely beneficial intervention to prevent and treat sarcopenia. In general, traditional high-load resistance training improves skeletal muscle morphology and strength, but this method is impractical and may even reduce arterial compliance by about 20% in aged adults. Thus, the progression of resistance training methods for improving the strength and morphology of muscles without applying a high load is essential. Over the past two decades, various resistance training methods that can improve skeletal muscle mass and muscle function without using high loads have attracted attention, and their training effects, molecular mechanisms, and safety have been reported. The present study focuses on the relationship between exercise load/intensity, training effects, and physiological mechanisms as well as the safety of various types of resistance training that have attracted attention as a measure against sarcopenia. At present, there is much research evidence that blood-flow-restricted low-load resistance training (20–30% of one repetition maximum (1RM)) has been reported as a sarcopenia countermeasure in older adults. Therefore, this training method may be particularly effective in preventing sarcopenia.
... Clark et al. observed young healthy adults that underwent BFRT and measured no significant difference in ankle-brachial indices, nerve conduction, or prothrombin time when compared with typical high-load resistance exercise [12]. The most common risks of BFRT include pain, skin breakdown, swelling, and temporary paresthesia from neural compression [13]. Despite evidence supporting its safety, providers should be mindful when using BFRT for patients that have specific vascular (eg, peripheral artery disease, hypercoagulability, and so on) or radicular pathologies as the current literature has not assessed the universal safety in patients with these conditions. ...
... Thankfully, the incidence of severe effects such as hemorrhage, venous thrombus, pulmonary embolism, and cerebral infarction has been exceedingly rare [9,12]. Nonetheless, it is reasonable to conclude that BFRT is safe for healthy adults and those with isolated orthopedic conditions when used appropriately [12,13]. It is recommended that BFRT commences after the incision is healed and the patient is full weight-bearing to participate in both open-and closed-chain exercises [10,11]. ...
Article
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Physical therapy is a necessary part of the recovery process after most orthopedic procedures. Effective treatment, patient satisfaction, and financial reimbursement hinge on the successful implementation of both surgical and nonsurgical interventions. Evidence-based practice and open communication between therapists and orthopedic surgeons continue to form the foundation of patient care. The aim of this paper is to familiarize orthopedic surgeons with the relevant data behind some of the recent advances in rehabilitation adjuncts to better address the needs of our patients. Although each intervention has been found to be relatively safe, high-quality evidence is still sparse. Opportunities exist for improved outcomes with further well-designed studies to investigate the role of these therapy modalities among orthopedic patients.
... Although increases in muscle strength following high load resistance training (RT) appear significantly greater than low load RT with BFR, BFR induces similar hypertrophy and lower joint forces/stress with low load RT compared to high load traditional RT without BFR (Bagley et al., 2015;Scott et al., 2016;Hughes et al., 2017;Centner et al., 2019;Rolnick and Schoenfeld, 2020a). Besides the potential implementation of BFRT in clinical musculoskeletal rehabilitation (e.g., knee osteoarthritis, and anterior cruciate ligament reconstruction) (Hughes et al., 2017), clinicians prescribing BFRT are often faced with the BFRT paradox: while participation in regular BFRT (e.g., aerobic training, resistance training, and passively without exercise) is acknowledged to offer significant benefits in muscle mass and strength, it can possibly result in adverse events (e.g., numbness, nausea, hypertension, headache, venous thrombus, deterioration of ischemic heart disease, fainting, tingling, excessive pain, central retinal vein occlusion, and rhabdomyolysis) if applied inappropriately (Nakajima et al., 2006;Ozawa et al., 2015;Noto et al., 2017;Yasuda et al., 2017;Patterson and Brandner, 2018;de Queiros et al., 2021). Such occurrences are very infrequent but have been previously documented. ...
... Unlike leisure time physical activity, BFRT likely needs some degree of supervision to minimize risk. Supervision by knowledgeable clinicians should theoretically reduce the occurrence of adverse events (e.g., numbness, nausea, hypertension, headache, venous thrombus, deterioration of ischemic heart disease, fainting, tingling, excessive pain, central retinal vein occlusion, and rhabdomyolysis) (Nakajima et al., 2006;Ozawa et al., 2015;Yasuda et al., 2017;Patterson and Brandner, 2018;de Queiros et al., 2021) especially when performed under those who adequately screen out high risk patients and use recommended guidelines (Patterson et al., 2019;Rolnick and Schoenfeld, 2020a,b;Rolnick et al., 2021) to structure exercise programming. ...
Article
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Blood flow restriction training (BFRT) is a modality with growing interest in the last decade and has been recognized as a critical tool in rehabilitation medicine, athletic and clinical populations. Besides its potential for positive benefits, BFRT has the capability to induce adverse responses. BFRT may evoke increased blood pressure, abnormal cardiovascular responses and impact vascular health. Furthermore, some important concerns with the use of BFRT exists for individuals with established cardiovascular disease (e.g., hypertension, diabetes mellitus, and chronic kidney disease patients). In addition, considering the potential risks of thrombosis promoted by BFRT in medically compromised populations, BFRT use warrants caution for patients that already display impaired blood coagulability, loss of antithrombotic mechanisms in the vessel wall, and stasis caused by immobility (e.g., COVID-19 patients, diabetes mellitus, hypertension, chronic kidney disease, cardiovascular disease, orthopedic post-surgery, anabolic steroid and ergogenic substance users, rheumatoid arthritis, and pregnant/postpartum women). To avoid untoward outcomes and ensure that BFRT is properly used, efficacy endpoints such as a questionnaire for risk stratification involving a review of the patient’s medical history, signs, and symptoms indicative of underlying pathology is strongly advised. Here we present a model for BFRT pre-participation screening to theoretically reduce risk by excluding people with comorbidities or medically complex histories that could unnecessarily heighten intra- and/or post-exercise occurrence of adverse events. We propose this risk stratification tool as a framework to allow clinicians to use their knowledge, skills and expertise to assess and manage any risks related to the delivery of an appropriate BFRT exercise program. The questionnaires for risk stratification are adapted to guide clinicians for the referral, assessment, and suggestion of other modalities/approaches if/when necessary. Finally, the risk stratification might serve as a guideline for clinical protocols and future randomized controlled trial studies.
... Although used in musculoskeletal populations, experimental studies applying BFR-E in people with stroke are sparse [18]. Despite this, a Japanese national survey showed that 11% of the Japanese rehabilitation clinics that use blood flow restriction (BFR), are using it in patients with stroke, presumably with the aim of optimising strength training and motor recovery [19,20]. Moreover, BFR-E has also been investigated in people with other neurological disorders including Multiple Sclerosis [21][22][23][24][25] and incomplete Spinal Cord Injuries (SCI) [26][27][28][29][30][31], with most (not all [24,30]) studies showing that BFR-E was safe and increased muscle strength, size and function. ...
Article
Full-text available
Background: Blood flow restriction exercise (BFR-E) could be a useful training adjunct for patients with weakness after stroke to augment the effects of exercise on muscle activity. We aimed to examine neurophysiological changes (primary aim) and assess patient perceptions (secondary aim) following BFR-E. Methods: Fourteen participants with stroke performed BFR-E (1 session) and exercise without blood flow restrictsion (Exercise only) (1 session), on two days, ≈7 days apart. In each session, two sets of tibialis anterior (TA) contractions were performed and electromyography (EMG) was recorded. Eight participants underwent transcranial magnetic stimulation (single-pulse stimulation, short interval intracortical inhibition (SICI), intracortical facilitation (ICF)) and peripheral electrical stimulation (maximal peak-to-peak M-wave (M-max)) of the TA before, immediately-after, 10-min-after and 20-min-after BFR-E and Exercise only. Numerical rating scores (NRS) for pain, discomfort, fatigue, safety, focus and difficulty were collected for all subjects (n = 14). Paired comparisons and linear mixed models assessed the effects of BFR-E and Exercise only. Results: No adverse events due to exercise were reported. There was no contraction-number × condition interaction for EMG amplitude during exercise (p = 0.15), or time × condition interaction for single-pulse stmulation, SICI, ICF or M-max amplitude (p = 0.34 to p = 0.97). There was no difference between BFR-E and Exercise only in NRS scores (p = 0.10 to p = 0.50). Conclusion: Using our training paradigm, neurophysiological parameters, feasibility, tolerability and perceptions of safety were not different between BFR-E and Exercise only. As participants were generally well-functioning, our results are not generalizable to lower functioning people with stroke, different (more intense) exercise protocols or longer term training over weeks or months.
... When the BFR method is combined with low-intensity resistance training, it has been observed that it produces similar improvement results to high-intensity resistance training. (Yasuda et al., 2017;Korkmaz et al., 2020;Slysz et al., 2016;Centner et al., 2019). It has been stated that muscle hypertrophy and strength gain are at a minimum level in strength training performed at a loading intensity below 50% of 1 maximum repetition (1 RM) under normal conditions (Burd et al., 2010). ...
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Sportif başarının temelinde, motorik özelliklerin geliştirilmesi ön şartlardan birisidir. Kuvvet antrenmanları bu süreçte önemli rol oynamaktadır ve günümüzde birçok yöntemle kuvvet antrenmanları yapılmaktadır. Son zamanlarda kan akışı kısıtlama (KAK) ve terabant antrenmanları da kuvvet ve atletik performansı geliştirmek için yaygın olarak kullanılmaktadır. Bu çalışmanın amacı alt ve üst ekstremiteye kombine olarak uygulanan kan akışı kısıtlama-terabant antrenmanının atletik performans üzerine etkisinin incelenmesidir. Çalışmaya 18-23 yaş aralığında 30 erkek basketbolcu gönüllü olarak katılmıştır. Katılımcılar kan akışı kısıtlama-terabant grubu (KAK+TG) (n=10), terabant grubu (TG) (n=10) ve kontrol grubu (KG) (n=10) olmak üzere üç gruba ayrılmıştır. Çalışmanın başlangıcında ve dört hafta sonunda katılımcılara ön test son test olarak 10-20 ve 30m sürat testi, Illinoisçeviklik testi, dikey sıçrama testi uygulanmıştır. Çalışma verilerinin analizinde Wilcoxon işaretli sıralar testi kullanılmıştır. Elde edilen verilerin analizi sonucunda; katılımcıların sürat koşusu, çeviklik ve dikey sıçrama performanslarının KAK+TG ve TG’de KG’ye göre daha fazla gelişme gösterdiğive en yüksek gelişimin ise KAK+TG’de olduğu tespit edilmiştir. Bu gelişimin yüzdesel olarak değişimi sırasıyla KAK+TG, TG ve KG’de çeviklik(%5,50-%1,87-%1,30) dikey sıçrama (%3,33-%2,01-%0,50) 10m sürat (%3,64-1,71-0,35) 20m sürat (4,16-2,02-0,62) 30m sürat (%2,21-%1,25-%0,69) olarak görülmüştür. Sonuç olarak; düşük şiddette çalışma imkanı sunan kuvvet antrenmanlarından KAK ve terabant yöntemleri, organizmanın diğer yöntemlere göre daha az yüke maruz kalmasını sağlarken sporcuların sakatlık riskini azaltmakta ve aynı zamanda kuvvet kazanımı sağlamaktadır. İki yöntemin kombine olarak kullanılmasının ise kuvvet kazanımını daha iyi bir düzeye çıkardığı düşünülmekte olup, bu durumun da atletik performansa olumlu yönde yansıdığı görülmektedir. Atletik performansın geliştirilmesinde bu iki yöntemin kombinlenerek uygulatılması önerilebilir.
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Amaç: Günümüzde sporcuların kuvvetlerini geliştirmek için farklı antrenman yöntemleri kullanılmaktadır. Bu sebeple birden fazla antrenman metodu bulunmakta ve bu metotların da birbirinden farklı etkileri olabilmektedir. Kuvvet gelişimi için uygulanan yöntemlerden birisi de kan akışı kısıtlama antrenman metodudur. Bu çalışmanın amacı, alt ekstremiteye kan akışı kısıtlama (KAK) yöntemi ile uygulanan düşük şiddetli kuvvet antrenmanının bacak hacmi, bacak kütlesi ve bacak kuvveti üzerine etkisinin incelenmesidir. Materyal ve Metot: Çalışmaya 16-18 yaşları arasında 24 voleybolcu kadın gönüllü olarak katılmıştır. Katılımcılar kan akışı kısıtlama antrenman grubu (KAKG) ve klasik hipertrofi antrenman grubu (KHG) olarak 12 kişilik iki gruba ayrılmıştır. KAKG maksimal kuvvetlerinin %20-40’ı ile, KHG ise maksimal kuvvetlerinin %70-80’i ile dört hafta boyunca haftanın üç günü alt ekstremiteyi içeren ve beş hareketten oluşan bir antrenman programı uygulamıştır. Çalışmanın başlangıcında ve dört hafta sonunda katılımcıların segmental vücut kompozisyon analizleri Tanita BC 418 vücut analiz monitörüyle, bacak kuvvetleri bacak dinamometresi ile, bacak hacimleri Frustum yöntemi ile, bacak kütleleri ise Hanavan yöntemi ile belirlenmiştir. Bulgular: Çalışma verilerinin analizinde Wilcoxon işaretli sıralar testi kullanılmıştır. İstatiksel analiz sonucunda, yağsız kütle ağırlığı (YKA), bacak kuvveti, bacak hacmi ve bacak kütlesi her iki grupta da artış gösterirken, bu artışın KAKG’de KHG’ye göre daha yüksek seviyede olduğu tespit edilmiştir. Sonuç: KAK yöntemi ile uygulanan kuvvet antrenmanlarının hem düşük şiddette çalışılması hem de zamanın daha ekonomik kullanılması açısından KH antrenmanlarına güçlü bir alternatif yöntem olarak uygulanabileceği görülmüştür. Özellikle genç sporcuların kısa zamanda ağır yüklerin altına giremeyeceği göz önünde bulundurularak gençlerde kuvvet antrenmanlarının aşamalı olarak KAK yöntemi ile yapılması önerilebilir.
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Background: Blood flow restriction training (BFRT) has gained popularity in rehabilitation due to its benefits in reducing muscle atrophy and mitigating strength deficits following anterior cruciate ligament reconstruction (ACLR). While the effectiveness and safety of BFRT has been well studied in healthy adult subjects, there is limited information about the use of BFRT in the adolescent population, specifically related to patient tolerance and reported side effects post ACLR. Purpose: To investigate and record reported side effects and patient tolerance to BFRT during ACLR rehabilitation in adolescents. Study design: Prospective Cohort Study. Methods: Patients between 12 and 18 years of age who underwent ACLR at Connecticut Children's were included. Patients utilized an automatic personalized tourniquet system and followed a standardized BFRT exercise protocol over 12 weeks starting 8.72 ± 3.32 days post-op. Upon completion of exercise while using BFRT, patients reported side effects and any adverse events were logged. Descriptive statistics were used to describe the reported side effects and adverse events associated with BFRT and calculate the frequencies of those events over a 12-week period. Results: Five hundred and thirty-five total BFRT sessions were completed between 29 patients (15.39 ± 1.61 years of age). There were zero reports of subcutaneous hemorrhage (SubQ hemorrhage) and deep vein thrombosis (DVT). Reported minor side effects to BFRT included itchiness of the occluded limb (7.85%), lower extremity paresthesia (2.81%), and dizziness (0.75%). A total of 10.47% of BFR treatment sessions were unable to be completed due to tolerance, and 3.5% of sessions required a reduction in limb occlusion pressure (LOP). Conclusion: These preliminary data suggest that BFRT is safe with only minor side effects noted in the adolescent population after ACLR. Further investigations are warranted to continue to evaluate patient tolerance and safety with BFRT, because while these preliminary results suggest a positive safety profile and good tolerance in the adolescent population after ACLR, they represent the experiences of only a small sample. Level of evidence: Level 3.
Article
Introduction Blood flow restriction therapy (BFRT) is used in scenarios ranging from muscle building in athletic performance to decreasing recovery time in postoperative orthopedic rehabilitation. The efficacy of BFRT for treating diseases has been increasingly researched; however, there has been less literature focused on establishing the safety of this therapy. Materials and Methods An extensive literature review pertaining to BFRT and any deleterious events related to its usage was completed by searching multiple databases, including PubMed, EMBASE, and Cochrane Library using the terms “blood flow restriction therapy” or “KAATSU.” Results Ten case reports, five case series, two national surveys, two questionnaires, six randomized controlled studies, and one systematic review were included. A total of 1,672 individuals reported an adverse event following BFRT use out of 25,813 individuals. Commonly reported adverse events were numbness, dizziness, subcutaneous hemorrhage, and rhabdomyolysis. There were unique adverse effects of this therapy reported in individuals with comorbid conditions, such as hypertension and thoracic outlet syndrome, which included isolated cases of central retinal vein occlusion and Paget–Schroeder syndrome. Conclusion Blood flow restriction provides tremendous opportunity with a potential for accelerated exercise rehabilitation and injury prevention. This modality could be used in the military setting to help injured active duty personnel expeditiously return to deployable status. Further prospective randomized controlled trials are warranted to further support BFRT safety; however, from this literature review, it can be concluded that BFRT can be utilized safely in the proper patient population when administered by qualified professionals who have undergone the appropriate training.
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Introduction: Quadriceps strength after arthroscopic knee procedures is frequently diminished several years postoperation. Blood flow restriction (BFR) training uses partial venous occlusion while performing submaximal exercise to induce muscle hypertrophy and strength improvements. The purpose of this study was to evaluate BFR as a postoperative therapeutic intervention after knee arthroscopy. Methods: A randomized controlled pilot study comparing physical therapy with and without BFR after knee arthroscopy was conducted. Patients underwent 12 sessions of supervised physical therapy. Subjects followed the same postoperative protocol with the addition of 3 additional BFR exercises. Outcome measures included thigh girth, physical function measures, Knee Osteoarthritis Outcome Score (KOOS), Veterans RAND 12-Item Health Survey (VR12), and strength testing. Bilateral duplex ultrasonography was used to evaluate for deep venous thrombosis preintervention and postintervention. Results: Seventeen patients completed the study. Significant increases in thigh girth were observed in the BFR group at 6-cm and 16-cm proximal to the patella (P = 0.0111 and 0.0001). All physical outcome measures significantly improved in the BFR group, and the timed stair ascent improvements were greater than conventional therapy (P = 0.0281). The VR-12 and KOOS subscales significantly improved in the BFR group, and greater improvement was seen in VR-12 mental component score (P = 0.0149). The BFR group displayed approximately 2-fold greater improvements in extension and flexion strength compared with conventional therapy (74.59% vs 33.5%, P = 0.034). No adverse events were observed during the study. Conclusions: This study suggests that BFR is an effective intervention after knee arthroscopy. Further investigation is warranted to elucidate the benefits of this intervention in populations with greater initial impairment.
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Femoral head avascular necrosis is a condition in which part of the femoral head undergoes necrosis due to decreased blood flow. The femoral head gradually disintegrates causing pain and even today, there are no effective rehabilitation methods other than symptomatic treatment such as decreasing the load on the hip joints with the use of a cane or walker. We herein describe our insights into this condition based on our experience with a case of femoral head avascular necrosis caused by steroid use in which KAATSU training was found to be highly effective. The patient was a 34-year-old woman (154 cm tall and weighing 50 kg, a radiologist). Since the age of 23, this patient had been receiving steroid treatment to control her refractory asthma. She later developed pain in her right hip and gradually suffered hip joint deformation, restricted range of motion, and difficulty in walking. MRI revealed Association Research Circulation Osseous (ARCO) stage IV disease. She suffered marked pain of the right hip joint every time she walked, occasionally falling and required a cane to walk. At the patientʼs own request, she received KAATSU training including KAATSU walking over a period of 3 months (total 28 sessions). Various assessments were carried out before and after training to determine the effects of KAATSU training. QOL was determined by SF–36v2, and marked improvement of role physical, body pain, general health, vitality, and social functioning were noted. Before training, the Japanese Orthopaedic Association (JOA) hip scores for pain were 10 (right), 40 (left), walking ability 16 (right), 20 (left), while 3 months after training, these scores were markedly improved in the affected side. Furthermore, not only did muscle strength on the affected side show marked improvement, but the MRI also revealed a tendency for improvement of the right femoral head avascular necrosis. DEXA showed signs of a clear increase in bone mineral density. Based on the above, these results suggest that KAATSU training is extremely useful as a rehabilitation method in patients with femoral head avascular necrosis. But, further larger scale investigations should be carried out in the future to support our findings.
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Background Low back pain is a highly prevalent condition in the United States and has a staggeringly negative impact on society in terms of expenses and disability. It has previously been suggested that rehabilitation strategies for persons with recurrent low back pain should be directed to the medial back muscles as these muscles provide functional support of the lumbar region. However, many individuals with low back pain cannot safely and effectively induce trunk muscle adaptation using traditional high-load resistance exercise, and no viable low-load protocols to induce trunk extensor muscle adaptation exist. Herein, we present the study protocol for a randomized controlled trial that will investigate the “cross-transfer” of effects of a novel exercise modality, blood flow restricted exercise, on cross-sectional area (primary outcome), strength and endurance (secondary outcomes) of trunk extensor muscles, as well as the pain, disability, and rate of recurrence of low back pain (tertiary outcomes). Methods and study design This is a single-blinded, single-site, randomized controlled trial. A minimum of 32 (and up to 40) subjects aged 18 to 50 years with recurrent low back pain and poor trunk extensor muscle endurance will be recruited, enrolled and randomized. After completion of baseline assessments, participants will be randomized in a 1:1 ratio to receive a 10-week resistance exercise training program with blood flow restriction (BFR exercise group) or without blood flow restriction (control exercise group). Repeat assessments will be taken immediately post intervention and at 12 weeks after the completion of the exercise program. Furthermore, once every 4 weeks during a 36-week follow-up period, participants will be asked to rate their perceived disability and back pain over the past 14 days. Discussion This study will examine the potential for blood flow restricted exercise applied to appendicular muscles to result in a “cross-transfer” of therapeutic effect to the lumbar musculature in individuals with low back pain. The results of this study will provide important insights into the effectiveness of this novel exercise modality, which could potentially provide the foundation for a cost-effective and easy-to-implement rehabilitation strategy to induce muscle adaptation in the absence of high mechanical and compressive loading on the spine. Trial registration This trial is registered with ClinicalTrials.gov (registration number: NCT02308189, date of registration: 2 December 2014).
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As demographic aging continues in Japan, the number of very elderly individuals aged 75 years or older is increasing rapidly, as is the number of bedridden, elderly individuals, with ramifications extending to economic problems such as health care costs and insurance for long-term care. Consequently, there is a great importance to questions of how to prevent age-related loss of muscle (sarcopenia) to prevent bedridden states, and further to improve quality of life (QOL) and maintain active lifestyles. Exercise is the most effective means for preventing and addressing sarcopenia. Regular exercise is also reported to prevent progression of arteriosclerosis, prevent lifestyle diseases, and delay onset of dementia. However, the effects of exercise are known to differ substantially for different types of exercise. Regular walking and other aerobic exercise improves cardiovascular endurance, but among the elderly, loss of muscular strength, muscular atrophy, and other diminished physical functions have implications for falling and fractures, and it is not uncommon to see a consequent aggravation of disuse syndrome due to inactivity, leading to a bedridden state. In this light, strength training is also important for elderly individuals, to increase muscular strength and muscle mass. It is also highly important for elderly individuals to eat a diet, particularly amino acids, that enhances the effects of exercise. Here we present an overview of aerobic exercise, resistance training, and “kaatsu training” ( i.e., training under pressure-restricted blood flow to the extremities) representing anti-aging exercise methods. We likewise discuss the importance of diet for exercise.
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Sporadic inclusion body myositis (sIBM) is a systemic disease that is characterized by substantial skeletal muscle weakness and muscle inflammation, leading to impaired physical function. The objective was to investigate the effect of low-load resistance exercise with concurrent partial blood flow restriction to the working muscles (blood-flow-restricted (BFR) training) in a patient with sIBM. The training consisted of 12 weeks of lower extremity BFR training with low training loads (~25-RM). The patient was tested for mechanical muscle function and functional capacity before and after 6 and 12 weeks of training. Maximal horizontal gait speed increased by 19%, which was accompanied by 38-92% improvements in mechanical muscle function (maximal isometric strength, rate of force development and muscle power). In conclusion, BFR training was well tolerated by the patient with sIBM and led to substantial improvements in mechanical muscle function and gait speed. © 2015 Scandinavian Society of Clinical Physiology and Nuclear Medicine. Published by John Wiley & Sons Ltd.
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With continued emphasis on the value of healthcare, factors such as quality of life and patient reported outcomes are critical in evaluating high-demand procedures such as knee replacement surgery. Equally important to the surgery itself is maximizing the effectiveness and efficiency of the treatment, both preoperatively and postoperatively, which can have a significant effect the final outcome. Technical outcomes of total knee replacement are generally considered excellent; however, many patients continue to have postoperative pain, functional limitations, and low treatment satisfaction. The recovery process can be difficult and is often prolonged in older patient populations. Blood flow restriction (BFR) training is a resistance exercise performed with a venous tourniquet that stimulates local changes in muscle at low resistance. Herein we report on 3 patients who participated in BFR exercises as an adjunct to their normal physical therapy following total knee arthroplasty.
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Idiopathic osteonecrosis of the medial condyle of the femur, a relatively common disease among Japanese women 60 years or older, is often progressive and requires surgical treatment. In this paper, we report on a case where KAATSU training was effective for a 71-year-old woman with bone necrosis in the left femoral medial condyle revealed by magnetic resonance imaging (MRI). At the first visit, the patient was suffering severe pain, and unable to walk without a cane. After 1 to 2 months of KAATSU training, her pain was mitigated and in about 3 months she was able to walk without a cane. In 6 months she could go upstairs and downstairs using the handrails and about 2 to 3 months later, she no longer needed to use the handrails. MRI revealed marked shrinkage (to 10 mm x 15 mm) of the necrotized region as a result of bone tissue remodeling. From these results, KAATSU training seems to be useful as a new method of rehabilitation for patients with idiopathic osteonecrosis of the medial condyle of the femur.
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Rhabdomyolysis is a serious and potentially-life threatening condition related to resistance training. Despite numerous reports of low-intensity blood flow resistance (BFR) training inducing muscle hypertrophy and increasing strength, few reports of rhabdomyolysis related to BFR training have been published. Here, we report a 30-year-old obese Japanese man admitted to our hospital the day after his first BFR training session with complaints of severe muscle pain in his upper and lower extremities, high fever and pharyngeal pain. He was diagnosed with acute rhabdomyolysis based on a serum creatine phosphokinase level of 56,475 U/l and a urine myoglobin level of >3000 ng/ml, and with acute tonsillitis based on a white blood cell count of 17,390 and C-reactive protein level of 10.43 mg/dl. A number of factors are suspected to be related to the onset and exacerbation of rhabdomyolysis, including excessive muscular training with BFR, bacterial infection, and medication. After 10 days of hospitalization with intravenous fluids and antibacterial drugs, he recovered without complications. This case indicates that BFR training should be conducted with careful consideration of the physical condition and strength of the individual to prevent serious complications such as rhabdomyolysis.