ArticlePDF Available

Abstract and Figures

Low-intensity training with blood flow restriction (BFR) has been suggested as an alternative to physical training for older adults. The present study aimed to review the literature regarding the effect of training with BFR for older adults. The search strategy consisted of experimental studies aimed at verifying the effects of training with BFR on any outcome in older adults. An electronic search in PubMed / Medline, Bireme Scielo, Lilacs and Cochrane Library databases, published until December 2015 was conducted. Experimental studies that considered individuals aged 50 years and over published in English or Portuguese, were included. The Downs & Black scale was used to assess the methodological quality of articles. Of the 60 studies, 12 were included in the review. Training with BFR improved body mass, torque and muscle power; functional capacity; bone health; venous compliance; peak oxygen uptake; and blood flow; balance and overall performance. The methodological quality of studies had mean score of 16.2 points (SD = 1.6). The prescription of low-intensity exercises with BFR may be an alternative of training for older adults. However, future studies should address the methodological quality, especially external validity and power, the main gaps in articles reviewed in this study. © 2018, Universidade Federal de Santa Catarina. All rights reserved.
Content may be subject to copyright.
A preview of the PDF is not available
... Long-term HL-RT has been shown to maintain and increase both muscle mass and strength (Tieland et al. 2012). However, the above training regimens do not consider the high prevalence of comorbidities (Centner et al. 2018) and the decreased tolerance of mechanical stress in older individuals (Cardoso et al. 2018). ...
... There have been two reviews by Cardoso et al. (2018) and Centner et al. (2018) which provided insight into the effectiveness of BFRT as a clinical rehabilitation tool for muscular weakness. Studies that combined walking with and without BFR showed 13.3% and 0.4% increases in muscular strength, respectively (Centner et al. 2018). ...
Thesis
Full-text available
[Motivation] Quadriceps or knee extensor weakness is considered not only as an important risk factor for osteoarthritis but also as the main determinant of physical function with knee osteoarthritis (KOA). Low-load resistance training with blood flow restriction training (BFRT) has previously shown to improve knee extensor strength whilst reducing risk of incident symptomatic KOA. BFRT could offer comparable increases in muscle size and strength as observed with traditional, high-load resistance training (HL-RT). BFRT may be a clinically relevant musculoskeletal rehabilitation modality as it does not require the high joint forces associated with HL-RT. [Research Focus] The focus of this dissertation was to elucidate the role of BFRT as a nonpharmacologic intervention for improving muscle strength and functionality in adults diagnosed with KOA. [Research Methods] These research aims were met through an extensive review of relevant literature pertaining to blood flow restriction training in KOA sufferers. [Findings] The findings from this dissertation provided promising evidence that BFRT to be safe and potentially effective in improving quadriceps strength in patients with knee-related weakness and atrophy. [Conclusion] The main conclusion drawn from this literature review is that BFRT could provide an equally effective and more tolerable approach to HL-RT whilst increasing knee extensor strength in symptomatic KOA patients. [Recommendation] This dissertation recommends that future research should determine whether changes in BFRT training dose or duration may improve quadriceps muscle cross-sectional area in KOA patients.
... A intervenção consistia em 6 Dentre os desfechos mais estudados das respostas crônicas do treinamento com RPF em adultos mais velhos, a força muscular foi considerada em sete artigos e hipertrofia muscular em cinco artigos. Os resultados encontrados pelos estudos revisados indicaram que o treinamento de baixa intensidade foi eficaz para aumentar a força e promover a hipertrofia muscular quando realizada com RPF 21 . ...
... O estresse metabólico promovido pela hipóxia associada ao exercício leva à translocação do transportador de glicose tipo 4 (GLUT-4), estimulando a absorção de glicose muscular. Além disso, o exercício com RPF proporciona uma duração mais longa da acidose metabólica, que estimula a liberação sistêmica do hormônio do crescimento (GH) e o consequente aumento da liberação do fator de crescimento insulina-1 (IGF-1) 21 . ...
Article
Full-text available
OBJECTIVE: Verify the impact of physical exercise practice in elders with low weight and sarcopenia, since the latter is a component often associated with thinness in the elderly population. In the same way, it seeks to elicit the effects of a sedentary lifestyle on these same variables. METHODOLOGICAL DELINEATION: Integrative review of PubMed, Scielo and Lilacs databases between 2014 and 2019 using Descritores em Ciência e Saúde (DeCS) (sarcopenia, idoso, perda de peso, exercício and estilo de vida sedentário) and Medical Subject Headings (MeSH) (aged, aged 80 and over, weight loss, sarcopenia, thinness, exercise and sedentary behavior). RESULTS: Fourteen articles were included in the synthesis. A sedentary lifestyle can lead to loss of strength and muscle mass among the elderly. Older people who practice physical activity have improved performance and muscle mass, functional capacity, and strength. CONCLUSION: In general, the articles demonstrated that physical activity assists in the maintenance of lean body mass and the potentiation of protein anabolism in the elderly and sarcopenic population, besides being a preventive factor.
... (5,6) Unlike several types of RE that used high intensity (70% -85%), blood flow restriction (BFR) training with low load (20-50% 1RM or MVC), called Kaatsu training, stands out. (7) This training method showed positive results, as increased muscle strength and mass, similar to high-load training (HLT), so much in adults, (8,9) elderly, (10)(11)(12) and athletes. (13,14) One of RE's effects due to intensity use and repetitive of musculature is muscle fatigue, being responsible for a progressive decline in performance. ...
Article
Full-text available
Background: Photobiomodulationtherapy with static magnetic field (PBMT/sMF) stands out for being a non-pharmacological resource with bioenergetic effects capable of accelerating muscle recovery, delaying muscle fatigue and potentiate gains in different training protocols. In recent years, blood flow restriction (BFR) associated with low load exercise (20-30% 1RM/MVC) has demonstrated positive effects on muscle performance. However, the effects of PBMT/sMF combined with BFR training are still unknown. Objective:Verify the effects of PBMT/sMF associated with BFR training and compared with high load training (HLT) in the muscle strength, muscle damage, inflammation, and the oxidative stress. Methods:This are a protocol of a randomized, double-blind, placebo-controlled clinical trial. Theparticipants will be healthy men between the ages of 18 to 40 years, with no practice in upper limb strength training in the previous three months. The voluntaries will be randomly divided into four groups: (1) PBMT/sMF + BFR;(2) PBMT/sMF + HLT; (3) placebo + BFR; (4) placebo + HLT. The PBMT/sMF will be applied immediately before strengthening protocol (4 sets x 20 repetitions of elbow flexion). The BFR groups will undergo to exercise with low load (30% of MVC), while the HLT groups will performed the same protocol with 80 % of MVC. The primary outcome will be muscle strength, measured in baseline, fourth, eighth week of training and detraining period. The secondary outcomes include measured the fatigue resistance, arm circumference, muscle damage, inflammatory and oxidative stress levels in one session, during, after intervention and detraining. Discuss:This trial will elucidate the effects of PBMT/sMF when when used in association with BFR training or HLT.Keywords:Phototherapy; Muscle performance; Occlusion vascular; Oxidative stress; Exercise
... 23,24 Another variant little discussed and addressed in the studies is the cuff deflation effects during rest period performed by Segal et al. 23,24 On that regard, few trials have evaluated exercise chronic effects with or without BFR during rest, and they showed that there was no difference between the two BFR application forms. 49,50 Cardoso et al. 51 and Fhas et al. 29 describe the need for pressure's application personalized prescription to obtain adequate blood flow restriction, considering limb circumference for the best performance during training. The thigh circumference as an important predictor of BFR pressure, with larger limbs requiring higher pressure to achieve the same level of occlusion as smaller limbs. ...
Article
Objective To synthesize evidence on the effects of blood flow restriction (BFR) comparing with high (HLT) and low load (LLT), and on the influence of different forms of application in individuals with knee osteoarthritis. Data sources The CENTRAL, PEDro, PubMed and BVS, which include Lilacs, Medline and SciELO, until April 2020. Review methods A systematic review and meta-analysis of randomized trials used the PRISMA guidelines, whose main keywords were: Therapeutic Occlusion, Resistance Training, and Knee Osteoarthritie, blood flow restriction and Kaatsu training. Method quality was evaluated with the PEDro scale. When studies demonstrated homogeneity on outcome measures, the mean differences or standardized mean differences with 95% confidence interval were calculated and pooled in a meta-analysis for pooled synthesis. Results Five articles were eligible in this review with moderate to low risk bias. Our results, showed no difference between BFR and HLT in knee strength (SMD = 0.00, 95% CI, –0.54 to 0.54, P = 1.00), function (SMD = −0.20, 95% CI, –0.45 to 0.06, P = 0.13), pain and volume. But, when compared BFR and LLT, the descriptive analysis demonstrated significant results in favor BFR to muscle strength (71.4% of measurement) and volume (MD = 1.66, 95% CI, 0.93 to 2.38, P < 0.00001), but not in pain or function. Conclusion BFR can be used as a strategy in the rehabilitation of osteoarthritis due to gains in strength and volume with low mechanical stress. However, its application must be safe and individualized, since they can attenuate the stimuli offered by BFR.
... Besides improving muscle strength and hypertrophy, BFR-induced physical capacity improvements have been demonstrated with several populations. Older adults may benefit from improved strength levels, muscle mass, and improved bone health (Cardoso et al., 2018). Of note, although changes in bone mass are traditionally thought to occur from higher impact exercise, there is theoretical rationale for improvements with load exercise in combination with BFR (Loenneke et al., 2012b). ...
... Besides improving muscle strength and hypertrophy, BFR-induced physical capacity improvements have been demonstrated with several populations. Older adults may benefit from improved strength levels, muscle mass, and improved bone health (Cardoso et al., 2018). Of note, although changes in bone mass are traditionally thought to occur from higher impact exercise, there is theoretical rationale for improvements with load exercise in combination with BFR (Loenneke et al., 2012b). ...
Article
Full-text available
Objetivo: Investigar a influência de fatores relacionados aos aspectos multidimensionais do envelhecimento em um grupo de idosos com baixo peso assistidos pelo setor privado de saúde. Métodos: Estudo transversal conduzido com 243 idosos com índice de massa corpórea <23 kg/m², todos assistidos por uma operadora de planos de saúde, no município de São Paulo, SP, Brasil, alocados em dois grupos: baixo peso e extremo baixo peso. Para a coleta dos dados empregou-se inquérito contendo informações relacionadas aos aspectos multidimensionais do envelhecimento. Os dados obtidos foram submetidos a análise descritiva das variáveis, com posterior análise comparativa através dos testes t Student e Qui-Quadrado ou exato de Fisher, quando necessário. Para variáveis com significância estatística, aplicou-se regressão logística e calculou-se as Odds Ratio, com intervalo de confiança de 95%. Resultados: Observou-se que, a idade avançada (p=0,044), dificuldade de mobilidade (p=0,011) e baixos níveis de atividade física (p=0.021) influenciam significativamente os idosos em estado nutricional de extremo baixo peso. Por meio do modelo de regressão logística, verificou-se que para cada uma hora de atividade física praticada pelos idosos deste grupo, os riscos de evolução para extremo baixo peso diminuem em até 14%. Conclusão: A pratica regular e orientada de atividade física praticada por idosos com algum grau de déficit nutricional é capaz de prevenir e/ou retardar desfechos indesejados em grupos susceptíveis.
Article
Full-text available
Purpose The present study aimed to investigate the effects of low-intensity resistance training with blood flow restriction (BFR resistance training) on vascular endothelial function and peripheral blood circulation. Methods Forty healthy elderly volunteers aged 71 ± 4 years were divided into two training groups. Twenty subjects performed BFR resistance training (BFR group), and the remaining 20 performed ordinary resistance training without BFR. Resistance training was performed at 20 % of each estimated one-repetition maximum for 4 weeks. We measured lactate (Lac), norepinephrine (NE), vascular endothelial growth factor (VEGF) and growth hormone (GH) before and after the initial resistance training. The reactive hyperemia index (RHI), von Willebrand factor (vWF) and transcutaneous oxygen pressure in the foot (Foot-tcPO2) were assessed before and after the 4-week resistance training period. Results Lac, NE, VEGF and GH increased significantly from 8.2 ± 3.6 mg/dL, 619.5 ± 243.7 pg/mL, 43.3 ± 15.9 pg/mL and 0.9 ± 0.7 ng/mL to 49.2 ± 16.1 mg/dL, 960.2 ± 373.7 pg/mL, 61.6 ± 19.5 pg/mL and 3.1 ± 1.3 ng/mL, respectively, in the BFR group (each P < 0.01). RHI and Foot-tcPO2 increased significantly from 1.8 ± 0.2 and 62.4 ± 5.3 mmHg to 2.1 ± 0.3 and 68.9 ± 5.8 mmHg, respectively, in the BFR group (each P < 0.01). VWF decreased significantly from 175.7 ± 20.3 to 156.3 ± 38.1 % in the BFR group (P < 0.05). Conclusions BFR resistance training improved vascular endothelial function and peripheral blood circulation in healthy elderly people.
Article
Full-text available
The aim of this present study was to investigate on the effects of concurrent training with blood flow restriction (BFR-CT) and concurrent training (CT) on the aerobic fitness, muscle mass and muscle strength in a cohort of older individuals. 25 healthy older adults (64.7±4.1 years; 69.33±10.8 kg; 1.6±0.1 m) were randomly assigned to experimental groups: CT (n=8, endurance training (ET), 2 days/week for 30-40 min, 50-80% VO2peak and RT, 2 days/week, leg press with 4 sets of 10 reps at 70-80% of 1-RM with 60 s rest), BFR-CT (n=10, ET, similar to CT, but resistance training with blood flow restriction: 2 days/week, leg press with 1 set of 30 and 3 sets of 15 reps at 20-30% 1-RM with 60 s rest) or control group (n=7). Quadriceps cross-sectional area (CSAq), 1-RM and VO2peak were assessed pre- and post-examination (12 wk). The CT and BFR-CT showed similar increases in CSAq post-test (7.3%, P<0.001; 7.6%, P<0.0001, respectively), 1-RM (38.1%, P<0.001; 35.4%, P=0.001, respectively) and VO2peak (9.5%, P=0.04; 10.3%, P=0.02, respectively). The BFR-CT promotes similar neuromuscular and cardiorespiratory adaptations as CT. © Georg Thieme Verlag KG Stuttgart · New York.
Article
Full-text available
High-intensity resistance training (HRT) has been recommended to offset age-related loss in muscle strength and mass. However, part of the elderly population is often unable to exercise at high-intensities. Alternatively, low-intensity resistance training with blood flow restriction (LRT-BFR) has emerged. The purpose of the present study was to compare the effects of LRT-BFR and HRT on quadriceps muscle strength and mass in elderly. Twenty-three elderly individuals, 14 men and nine women (age: 64.04 ± 3.81 years; weight: 72.55 ± 16.52 Kg; height: 163 ± 11cm), undertook 12 weeks of training. Subjects were ranked according to their pre-training quadriceps cross-sectional area (CSA) values and then randomly allocated into one of the following groups: (1) control group (CG); (2) HRT: 4 X 10 repetitions 70-80% 1-RM; (3) LRT-BFR: 4 sets (1 x 30 and 3 x 15 repetitions) 20-30% 1-RM. The occlusion pressure was set at 50% of maximum tibial arterial pressure and sustained during the whole training session. Leg-press 1-RM and quadriceps CSA were evaluated at pre- and post-training. A mixed-model analysis was performed and the significance level was set at P ≤ 0.05. Both training regimes were effective in increasing pre- to post-training leg-press 1-RM (HRT: ∼54 %, P < 0.001; LRT-BFR: ∼17 %, P = 0.067) and quadriceps CSA (HRT: 7.9 %, P < 0.001; LRT-BFR: 6.6 %, P < 0.001), however, HRT seems to induce greater strength gains. In summary, LRT-BFR constitutes an important surrogate approach to HRT as an effective training method to induce gains in muscle strength and mass in elderly.
Article
Full-text available
We examined the effect of low-load, elastic band resistance training with blood flow restriction (BFR) on muscle size and arterial stiffness in older adults. Healthy older adults (aged 61–85 years) were divided into BFR training (BFR-T, n = 9) or non-BFR training (CON-T, n = 8) groups. Both groups performed low-load arm curl and triceps down exercises (four sets, total 75 repetitions for each) using an elastic band, 2 d/wk for 12 weeks. The BFR-T group wore inflated pneumatic elastic cuffs (120–270 mm Hg) on both arms during training. Magnetic resonance imaging-measured muscle cross-sectional area of the upper arm, maximum voluntary isometric contraction of the elbow flexors and extensors, cardio-ankle vascular index testing, and ankle-brachial pressure index were measured before and 3–5 days after the final training session. Muscle cross-sectional area of the elbow flexors (17.6%) and extensors (17.4%) increased, as did elbow flexion and elbow extension maximum voluntary isometric contraction (7.8% and 16.1%, respectively) improved (p < .05) in the BFR-T group, but not in the CON-T group. In cardio-ankle vascular index and ankle-brachial pressure index testing, there were no changes between pre- and post-results in either group. In conclusion, elastic band BFR-T improves muscle cross-sectional area as well as maximal muscle strength but does not negatively affect arterial stiffness in older adults.
Chapter
The purpose of this chapter is to review the research literature, examining and analyzing gender differences with respect to the amounts and types of physical activity needed to decrease morbidity and to promote health and independence in older adults. In epidemiological studies, the dose of physical activity required for beneficial effects has been assessed in terms of the total energy expenditure, the duration or energy expenditure of physical activities termed exercise, or the fitness levels achieved. The terms physical activity, exercise, and physical fitness have distinct definitions, and their differences may have distinct effects on outcome measures as well. Physical activity is defined as any bodily movement produced by skeletal muscle that results in energy expenditure. Exercise, a type of physical activity, is planned, structured, and repetitive bodily movement undertaken to improve or maintain one or more components of physical fitness. Physical fitness is a set of attributes that people have or achieve relating to their ability to perform physical activity. The majority of the literature has focused on physical activity measurements (using questionnaires to accommodate large surveys) and the amounts and types of physical activity needed to prevent disease and promote health. Whether the physical activity is classified as exercise is determined by the quantity or intensity of physical activity, or is reflected in the measurement of physical fitness levels.
Article
IntroductionAn unresolved question in resistance training combined with blood flow restriction (BFR) is what percentage of estimated arterial occlusion pressure provides the most robust acute muscular response.Methods Forty participants were assigned to Experiments 1, 2, or 3. Each experiment completed exercise protocols differing by pressure, exercise load, and/or volume. Torque was measured pre- and postexercise, and muscle activation was measured pre- and during each set.ResultsPressure and load did not affect torque greatly. Muscle activation increased in all conditions (P < 0.05) and was higher with 30% 1RM compared with 20% 1RM. Pressure appeared to increase muscle activation from 40% to 50% arterial occlusion [66% vs. 87% maximal voluntary contraction (30% 1RM)] but was not further increased with higher pressure.Conclusion Different levels of BFR may alter the acute muscular response to a degree, although higher pressures do not appear to augment these changes. Muscle Nerve 51:713-721, 2015
Article
Blood flow restriction (BFR) alone or in combination with exercise has been shown to result in favorable effects on skeletal muscle form and function. The pressure applied should be high enough to occlude venous return from the muscle but low enough to maintain arterial inflow into the muscle. The optimal pressure for beneficial effects on skeletal muscle are currently unknown; however, preliminary data from our laboratory suggests that there may be a point where greater pressure may not augment the response (e.g. metabolic accumulation, cell swelling) but may actually result in decrements (e.g. muscle activation). This led us to wonder if BFR elicits somewhat of a hormesis effect. The purpose of this manuscript is to discuss whether pressure may be modulated to maximize skeletal muscle adaptation with resistance training in combination with BFR. Furthermore, the potential safety issues that could arise from increasing pressure too high are also briefly reviewed. We hypothesize that with BFR there is likely a moderate (∼50% estimated arterial occlusion pressure) pressure that maximizes the anabolic response to skeletal muscle without producing the potential negative consequences of higher pressures. Thus, BFR may follow the hormesis theory to some degree, in that a low/moderate dose of BFR produces beneficial effects while higher pressures (at or near arterial occlusion) may decrease the benefits of exercise and increase the health risk. This hypothesis requires long term studies investigating chronic training adaptations to differential pressures. In addition, how differences in load interact with differences in pressure should also be investigated.
Article
Skeletal muscle adapts to a progressive overload, but the response can vary between different modes and intensities of exercise. Generally, a minimal threshold intensity of 65% of the one repetition maximum (1-RM) is needed to elicit muscle hypertrophy; however, recent studies have challenged this hypothesis and have provided evidence that low-intensity training (LIT) combined with vascular restriction (KAATSU) may also elicit increases in muscle size and strength. The physiological aspects of applying vascular restriction during exercise are not fully understood and may be explained by several factors. Examining the results of previous studies may help elucidate the factors responsible for the adaptations associated with vascular restriction in humans. Therefore, the objectives of this review are to summarize current knowledge regarding the physiological adaptations of skeletal muscle after low-intensity exercise combined with vascular restriction, the different training protocols used to elicit adaptations, and suggested areas for future research.
Article
The goal of this study was to examine anabolic hormone, muscle damage marker and inflammation marker responses to two types of resistance training protocols in older men. Thirty-six healthy older males (mean age = 56·6 ± 0·6 years) completed 6 weeks of high-intensity resistance training (HI-RT), low-intensity resistance training with vascular restriction (LI-BFR) or no exercise control group (CON) three times per week. Three upper body exercises were performed by both exercise groups at the same intensity (at 80% 1-RM), but lower body exercises were performed by the HI-RT group at 80% 1-RM and by the LI-BFR group at 20% 1-RM with vascular restriction. Resting serum creatine kinase (CK), interleukin 6 (IL-6), insulin-like growth factor-I (IGF-I), IGF binding protein 3 (IGFBP-3) and testosterone (T) were measured before and after training. No significant group differences in resting CK, IL-6, IGF-I, IGFBP-3 and T were detected following training (P>0·05). In addition, there were no significant changes in muscle cross-sectional area (CSA), but a trend for significant decreases in the percent changes in thigh subcutaneous fat (P = 0·051). Although training-induced anabolic hormone response did not reach statistical significance, our findings on CK and IL-6 indicated that the LI-BFR training protocol was safe and well tolerated for older men to perform to improve muscular strength.
Article
Elastic band (EB) training is a common form of resistance training used by the elderly, individuals with joint problems or those recovering from injury. EB training performed at low intensities by these populations may have little effect on muscle hypertrophy. However, when combined with blood flow restriction (BFR), low-intensity EB resistance training may result in muscle hypertrophy. Postmenopausal women (61 ± 5 years) were assigned to a moderate-to-high-intensity EB group (MH, n = 8) or a low-intensity EB group combined with BFR (LI-BFR, n = 6). Each group performed seated chest press, seated row and seated shoulder press with EB three times a week for eight weeks. EB colours progressed in each group by having participants maintain a rating of 7–9 on the OMNI Resistance for active muscle (OMNI-RES AM) scale (0–10) throughout training. In the LI-BFR group, BFR pressure progressed during the first 4 weeks of training (80–120 mmHg), after which EB colours were progressed. 1-repetition maximum increased for chest press (P = 0·01), shoulder press (P = 0·02) and seated row (P = 0·01), but no differences were found between groups. Only pectoralis major muscle thickness in the upper body increased (P = 0·04). A trend was found for an increase in total bone-free lean body mass (P = 0·055). The main findings of this study were that moderate-to-high-intensity EB training and low-intensity EB training with BFR resulted in similar increases in strength, total bone-free lean body mass and muscle thickness.