Abstract
BackgroundBlood flow restriction (BFR) exercise may be a potential exercise program to promote angiogenesis. This review aims to compare the effects of exercise with and without BFR on angiogenesis-related factors in skeletal muscle among healthy adults.MethodologySearches were made in Web of Science, Scopus, PubMed, and EBSCO databases from January 2001 to June 2021. Studies were screened, quality was evaluated, and data were extracted. The review protocol was registered at PROSPERO (PROSPERO registration number: CRD42021261367). Standardized mean differences (SMD) of vascular endothelial growth factor (VEGF), vascular endothelial growth factor receptor 2 (VEGFR-2), hypoxia inducible factor 1α (HIF-1α), peroxisome proliferator-activated receptorγcoactivator-1α (PGC-1α) and endothelial nitric oxide synthase (eNOS) were analyzed using Revman 5.4 software with a 95% confidence interval (95% CI).ResultsTen studies fulfilled the inclusion criteria with a total of 75 participants for BFR group and 77 for CON group. BFR exercise elicits greater expression of VEGF (heterogeneity test, P = 0.09, I2 = 44%; SMD, 0.93 [0.38, 1.48], P < 0.05), VEGFR-2 (heterogeneity test, P = 0.81, I2 = 0%; SMD, 0.64 [0.08, 1.21], P < 0.05), HIF-1α (heterogeneity test, P = 0.67, I2 = 0%; SMD, 0.43 [0.03, 0.82], P < 0.05), PGC-1α (heterogeneity test, P = 0.02, I2 = 54%; SMD, 0.74 [0.21, 1.28], P < 0.05) and eNOS (heterogeneity test, P = 0.88, I2 = 0%; SMD, 0.60 [0.04, 1.17], P < 0.05) mRNA than non-BFR exercise. In the sub-group analysis, resistance exercise with BFR elicits greater expression of VEGF (heterogeneity test, P = 0.36, I2 = 6%; SMD, 1.66 [0.97, 2.35], P < 0.05) and HIF-1α (heterogeneity test, P = 0.56, I2 = 0%; SMD, 0.51 [0.01, 1.02], P < 0.05) mRNA than aerobic exercise with BFR.ConclusionExercise with BFR elicited more angiogenesis-related factors mRNA expression than exercise without BFR, but not VEGF and PGC-1α protein expression. Therefore, BFR training may be a potential training program to improve vascular function.Systematic Review Registration[https://www.crd.york.ac.uk/prospero/], identifier [CRD42021261367].
Highlights
Blood flow restriction (BFR) can limit the blood flow and increase the mechanical pressure to the working muscle during exercise, resulting in local hypoxia/ischemia
A total of 10 cross-sectional studies evaluating the effects of BFR training on angiogenesis-related factors in skeletal muscle among healthy adults were included in this review
A total of 74 men and 3 women participated in the studies, corresponding to the overall sample size in the BFR and CON groups
Summary
Blood flow restriction (BFR) can limit the blood flow and increase the mechanical pressure to the working muscle during exercise, resulting in local hypoxia/ischemia. Low-load training with BFR is more conducive to increasing muscle strength (Lixandrão et al, 2018) and endurance (Kacin and Strazar, 2011) than that without BFR, which may be attributed to improved oxygen delivery and extraction of working skeletal muscles during BFR training. The combination of these mechanisms increases the peripheral vascular system adaptability (Kacin and Strazar, 2011). A recent meta-analysis demonstrated that resistance training impacts more positively on arterial compliance regulation as the capacity to restrict blood flow increases (Liu et al, 2021). This review aims to compare the effects of exercise with and without BFR on angiogenesis-related factors in skeletal muscle among healthy adults
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