Abstract
Background: The vascular effects of training under blood flow restriction (BFR) in healthy persons can serve as a model for the exercise mechanism in lower extremity arterial disease (LEAD) patients. Both mechanisms are, inter alia, characterized by lower blood flow in the lower limbs. We aimed to describe and compare the underlying mechanism of exercise-induced effects of disease- and external application-BFR methods. Methods: We completed a narrative focus review after systematic literature research. We included only studies on healthy participants or those with LEAD. Both male and female adults were considered eligible. The target intervention was exercise with a reduced blood flow due to disease or external application. Results: We identified 416 publications. After the application of inclusion and exclusion criteria, 39 manuscripts were included in the vascular adaption part. Major mechanisms involving exercise-mediated benefits in treating LEAD included: inflammatory processes suppression, proinflammatory immune cells, improvement of endothelial function, remodeling of skeletal muscle, and additional vascularization (arteriogenesis). Mechanisms resulting from external BFR application included: increased release of anabolic growth factors, stimulated muscle protein synthesis, higher concentrations of heat shock proteins and nitric oxide synthase, lower levels in myostatin, and stimulation of S6K1. Conclusions: A main difference between the two comparators is the venous blood return, which is restricted in BFR but not in LEAD. Major similarities include the overall ischemic situation, the changes in microRNA (miRNA) expression, and the increased production of NOS with their associated arteriogenesis after training with BFR.
Highlights
IntroductionOf all deaths caused by major non-communicable diseases (coronary disease, type 2 diabetes, breast, and colon cancer), a considerable share of up to 10 percent results from physical inactivity [1].That results in 5.3 million out of 57 million deaths worldwide per year [1]
Of all deaths caused by major non-communicable diseases, a considerable share of up to 10 percent results from physical inactivity [1].That results in 5.3 million out of 57 million deaths worldwide per year [1]
Beyond the general exercise effects, a variety of involved mechanisms for the effect of exercise on walking ability have been proposed in studies investigating exercise in populations exposed to lower extremity arterial disease (LEAD)
Summary
Of all deaths caused by major non-communicable diseases (coronary disease, type 2 diabetes, breast, and colon cancer), a considerable share of up to 10 percent results from physical inactivity [1].That results in 5.3 million out of 57 million deaths worldwide per year [1]. Prospective studies provide direct evidence that adopting a physically active lifestyle delays all-cause mortality, extends longevity [6], and reduces risk for cardiovascular mortality by 42 to 44 percent [7,8]. Several vascular diseases such as arteriosclerosis, thrombosis, embolic diseases, accidental vascular damages, or dissections are known risk factors for LEAD [9]. The vascular effects of training under blood flow restriction (BFR) in healthy persons can serve as a model for the exercise mechanism in lower extremity arterial disease (LEAD).
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