A Useful Blood Flow Restriction Training Risk Stratification for Exercise and Rehabilitation.

Dahan Da Cunha Nascimento,Nicholas Rolnick,Fabiani Lage Rodrigues Beal,Richard Severin,Ivo Vieira De Sousa Neto

doi:10.3389/fphys.2022.808622

Abstract

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.

Highlights

Blood flow restriction training (BFRT) has been recognized as a critical tool in rehabilitation medicine, athletic and clinical populations
Besides the potential implementation of BFRT in clinical musculoskeletal rehabilitation (Hughes et al, 2017), clinicians prescribing BFRT are often faced with the BFRT paradox: while participation in regular BFRT is acknowledged to offer significant benefits in muscle mass and strength, it can possibly result in adverse events 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)
A list of individual risk factors that are associated with adverse responses to BFRT has already been discussed and proposed elsewhere to aid in the screening process (Nakajima et al, 2011; Kacin et al, 2015; Brandner et al, 2018; Bond et al, 2019; Rolnick et al, 2021)