Heavy Load Resistance Training Research Articles

The effect of blood flow restriction training on core muscle strength and pain in male collegiate athletes with chronic non-specific low back pain.

The objective of this study is to compare the effectiveness of low-load blood flow restriction training (LL-BFRT) to heavy-load resistance training (HL-RT) in male collegiate athletes with chronic non-specific low back pain (CNLBP). Twenty-six participants were randomly assigned to LL-BFRT (n = 13) or HL-RT (n = 13). All participants supervised exercises (deep-squat, lateral pull-down, bench-press and machine seated crunch) cycled 4 times per week for 4 weeks (16 sessions). LL-BFRT was done at 30% 1-repetition maximum (1RM) with 70% arterial occlusion pressure (AOP). HL-RT was done at 70% 1-RM. The outcomes were isokinetic core strength, isometric core endurance, pain intensity, and lumbar function disability level, measured at baseline and 4 weeks. Intra-group differences were evaluated using t-tests. Pain intensity and function disability level in LL-BFRT had extremely significant improvement at 4 weeks (p < 0.001, ES = 1.44-1.84). Participants in LL-BFRT and HL-RT showed significant differences in core extensors peak torque-body weight ratio (PT/BW) at isokinetic 120°/s and 30°/s, respectively (LL-BFRT: p = 0.045, ES = 0.62; HL-RT: p = 0.013, ES = 0.81). Isometric core extensor endurance was significantly increased in both groups (LL-BFRT: p = 0.016, ES = 0.78; HL-RT: p = 0.011, ES = 0.83). Four weeks of LL-BFRT significantly reduced pain and functional disability while inducing similar strength gains as HL-RT in male collegiate athletes with CNLBP. Thereby, BFRT may qualify as a valuable training strategy for people with physical limitations.

Effects of Off-Season Heavy-Load Resistance Training on Lower Limb Mechanical Muscle Function and Physical Performance in Elite Female Team Handball Players.

Background/Objectives: Team handball involves a high number of rapid and forceful muscle actions. Progressive heavy-load resistance training is known to enhance mechanical muscle function; however, its transfer into functional performance in team handball athletes remains largely unknown. The current study aimed to analyze the effects of eight weeks undulating heavy-load resistance training on lower limb mechanical muscle function and sports-specific performance in elite female team handball players. Methods: Players from the Danish Women's Handball League were block randomized to perform an off-season resistance training program (RT, n = 12, 23.0 ± 2.7 yr) or follow a training-as-usual control program (CON, n = 15, 24.1 ± 3.8 yr). All study participants were tested before and after an eight-week period during the off-season phase, including assessments of maximal isometric knee extensor and flexor peak torque, rate of torque development, countermovement jump (CMJ) power/work, and sports-specific performance (maximal vertical countermovement jump height, sprint capacity, team handball-specific on-court agility). Results: Agility performance improved for RT (-3.5%, p = 0.008), different from CON (p < 0.001) following eight weeks of designated resistance training. Additionally, CON demonstrated impaired agility (+4.0-7.3%, p < 0.05) and 20-m sprint (+1.9%, p = 0.002) performance. Maximal knee extensor peak torque increased in RT (4.5%, p = 0.044). Vertical CMJ flight height (JH) increased in both groups (RT +4.8%, p = 0.012, CON +8.4% p = 0.044); however, jump height relative to ground level (JHGL) increased in RT only (+8.0%, p = 0.013). Conclusions: In conclusion, designated resistance training during the off-season period is effective in maintaining and improving essential components of sports-specific performance and maximal knee extensor strength in elite female team handball players. Comparable protocols of twice-a-week heavy-load resistance training may also be beneficial in other types of intermittent elite team sports (i.e., football, basketball) that include maximal jumping actions, short-distance sprints, and rapid change of direction movements.

Resistance training leading to repetition failure increases muscle strength and size, but not power-generation capacity in judo athletes.

Strength-trained athletes has less trainability in muscle size and function, because of their adaptation to long-term advanced training. This study examined whether resistance training (RT) leading to repetition failure can be effective modality to overcome this subject. Twenty-three male judo athletes completed a 6-week unilateral dumbbell curl training with two sessions per week, being added to in-season training of judo. The participants were assigned to one of three different training programs: ballistic light-load (30% of one repetition maximum (1RM)) RT to repetition failure (RFLB) (n = 6), traditional heavy-load (80% of 1RM) RT to repetition failure (RFHT) (n = 7), and ballistic light-load (30% of 1RM) RT to non-repetition failure (NRFLB) (n = 10). Before and after the intervention period, the muscle thickness (MT) and the maximal voluntary isometric force (MVC) and rate of force development (RFDmax) of elbow flexors were determined. In addition, theoretical maximum force (F0), velocity (V0), power (Pmax), and slope were calculated from force-velocity relation during explosive elbow flexion against six different loads. For statistical analysis, p < 0.05 was considered significant. The MT and MVC had significant effect of time with greater magnitude of the gains in RFHT and NRFLB compared to RFLB. On the other hand, all parameters derived from force-velocity relation and RFDmax did not show significant effects of time. The present study indicates that ballistic light-load and traditional heavy-load resistance training programs, leading to non-repetition failure and repetition failure, respectively, can be modalities for improving muscle size and isometric strength in judo athletes, but these do not improve power generation capacity.

Progression and perceptual responses to blood flow restriction resistance training among people with multiple sclerosis.

Resistance exercise can attenuate muscular impairments associated with multiple sclerosis (MS), and blood flow restriction (BFR) may provide a viable alternative to prescribing heavy training loads. The purpose of this investigation was to examine the progression of upper and lower body low-load (30% of one-repetition maximum [1RM]) resistance training (RT) with BFR applied intermittently during the exercise intervals (RT + BFR) versus volume-matched heavy-load (65% of 1RM) RT. Men and women with MS (n = 16) were randomly assigned to low-load RT + BFR (applied intermittently) or heavy-load RT and completed 12weeks (2 × /week) of RT that consisted of bilateral chest press, seated row, shoulder press, leg press, leg extension, and leg curl exercises. Exercise load, tonnage, and rating of perceived exertion were assessed at baseline and every 6 weeks. Training load increased to a greater extent and sometimes earlier for RT + BFR (57.7-106.3%) than heavy-load RT (42.3-54.3%) during chest press, seated row, and leg curl exercises, while there were similar increases (63.5-101.1%) for shoulder press, leg extension, and leg press exercises. Exercise tonnage was greater across all exercises for RT + BFR than heavy-load RT, although tonnage only increased during the chest press (70.7-80.0%) and leg extension (89.1%) exercises. Perceptions of exertion (4.8-7.2 au) and compliance (97.9-99.0%) were similar for both interventions. The training-induced increases in load, high compliance, and moderate levels of exertion suggested that RT + BFR and heavy-load RT are viable interventions among people with MS. RT + BFR may be a preferred modality if heavy loads are not well tolerated and/or to promote early-phase training responses.

Glucose ingestion before and after resistance training sessions does not augment ribosome biogenesis in healthy moderately trained young adults

PurposeResistance training-induced skeletal muscle hypertrophy seems to depend on ribosome biogenesis and content. High glucose treatment may augment ribosome biogenesis through potentiating resistance training-induced adaptations. This was investigated with total RNA and ribosomal RNA abundances as main outcomes, with relevant transcriptional/translational regulators (c-Myc/UBF/rpS6) as a secondary outcome.MethodsSixteen healthy, moderately trained individuals [male/female, n = 9/7; age, 24.1 (3.3)] participated in a within-participant crossover trial with unilateral resistance training (leg press and knee extension, 3 sets of 10 repetitions maximum) and pre- and post-exercise ingestion of either glucose (3 × 30 g, 90 g total) or placebo supplements (Stevia rebaudiana, 3 × 0.3 g, 0.9 g total), together with protein (2 × 25 g, 50 g total), on alternating days for 12 days. Six morning resistance exercise sessions were conducted per condition, and the sessions were performed in an otherwise fasted state. Micro-biopsies were sampled from m. vastus lateralis before and after the intervention.ResultsGlucose ingestion did not have beneficial effects on resistance training-induced increases of ribosomal content (mean difference 7.6% [− 7.2, 24.9], p = 0.34; ribosomal RNA, 47S/18S/28S/5.8S/5S, range 7.6–37.9%, p = 0.40–0.98) or levels of relevant transcriptional or translational regulators (c-MYK/UBF/rpS6, p = 0.094–0.292). Of note, both baseline and trained state data of total RNA showed a linear relationship with UBF; a ∼14% increase in total RNA corresponded to 1 SD unit increase in UBF (p = 0.003).ConclusionGlucose ingestion before and after resistance training sessions did not augment ribosomal RNA accumulation during twelve days of heavy-load resistance training in moderately trained young adults.

MECHANICAL STIFFNESS OR RESOLVED INFLAMMATION: WHAT IS MORE IMPORTANT FOR TENDON REHABILITATION?

As high incidences of tendinopathies are observed particularly in those who intensively use their tendons, we assume that pathological changes are caused, at least partially, by mechanical overload. This has led to the so-called overload hypothesis, explaining the development of tendinopathies by structural failure resulting from excessive load. At the same time, tendon loading is an important part in tendon rehabilitation. Currently, exercise treatment approaches such as eccentric training or heavy load resistance training are widely applied in tendinopathy rehabilitation, with good clinical results such as an improvement in function and a reduction in pain. Particularly those rehabilitative approaches which impose high strains on the tendon may induce an adaptation of the tendon's mechanical properties such as increased tendon stiffness. An increased tendon stiffness is often interpreted as desirable, as it may protect the tendon from overloading and thus prevent future strain injuries. However, the tendinopathic tendon is not necessarily less stiff than the tendon in the contralateral leg and an improvement in tendon stiffness is not necessarily accompanied by an improvement in tendon pain or function. In addition, metabolic factors, resulting e.g. in low-level systemic inflammation, may contribute to pathological tendon tissue changes and are not necessarily affected by an exercise program, while nutritional interventions or dietary supplements may potentially affect tendon cell metabolism. Indeed, dietary supplements have been introduced as an additional therapeutic approach in the treatment of tendinopathies in recent years, and their positive curative effects have been reported for both the general population and athletes. In the management of tendinopathies, it may thus be advisable if therapeutic approaches aim to address both tendon mechanics and tendon metabolism for better treatment effectiveness and a sustainable improvement in pain and function.

Plyometric Jump Training Exercise Optimization for Maximizing Human Performance: A Systematic Scoping Review and Identification of Gaps in the Existing Literature.

Plyometric jump training (PJT) encompasses a range of different exercises that may offer advantages over other training methods to improve human physical capabilities (HPC). However, no systematic scoping review has analyzed either the role of the type of PJT exercise as an independent prescription variable or the gaps in the literature regarding PJT exercises to maximize HPC. This systematic scoping review aims to summarize the published scientific literature and its gaps related to HPC adaptations (e.g., jumping) to PJT, focusing on the role of the type of PJT exercise as an independent prescription variable. Computerized literature searches were conducted in the PubMed, Web of Science, and SCOPUS electronic databases. Design (PICOS) framework: (P) Healthy participants of any age, sex, fitness level, or sports background; (I) Chronic interventions exclusively using any form of PJT exercise type (e.g., vertical, unilateral). Multimodal interventions (e.g., PJT + heavy load resistance training) will be considered only if studies included two experimental groups under the same multimodal intervention, with the only difference between groups being the type of PJT exercise. (C) Comparators include PJT exercises with different modes (e.g., vertical vs. horizontal; vertical vs. horizontal combined with vertical); (O) Considered outcomes (but not limited to): physiological, biomechanical, biochemical, psychological, performance-related outcomes/adaptations, or data on injury risk (from prevention-focused studies); (S) Single- or multi-arm, randomized (parallel, crossover, cluster, other) or non-randomized. Through database searching, 10,546 records were initially identified, and 69 studies (154 study groups) were included in the qualitative synthesis. The DJ (counter, bounce, weighted, and modified) was the most studied type of jump, included in 43 study groups, followed by the CMJ (standard CMJ or modified) in 19 study groups, and the SJ (standard SJ or modified) in 17 study groups. Strength and vertical jump were the most analyzed HPC outcomes in 38 and 54 studies, respectively. The effects of vertical PJT versus horizontal PJT on different HPC were compared in 21 studies. The effects of bounce DJ versus counter DJ (or DJ from different box heights) on different HPC were compared in 26 studies. Although 69 studies analyzed the effects of PJT exercise type on different HPC, several gaps were identified in the literature. Indeed, the potential effect of the PJT exercise type on a considerable number of HPC outcomes (e.g., aerobic capacity, flexibility, asymmetries) are virtually unexplored. Future studies are needed, including greater number of participants, particularly in groups of females, senior athletes, and youths according to maturity. Moreover, long-term (e.g., >12 weeks) PJT interventions are needed.

ADAPTations to low load blood flow restriction exercise versus conventional heavier load resistance exercise in UK military personnel with persistent knee pain: protocol for the ADAPT study, a multi-centre randomized controlled trial

BackgroundMuscle atrophy, muscle weakness and localised pain are commonly reported following musculoskeletal injury (MSKI). To mitigate this risk and prepare individuals to return to sport or physically demanding occupations, resistance training (RT) is considered a vital component of rehabilitation. However, to elicit adaptations in muscle strength, exercise guidelines recommend lifting loads ≥ 70% of an individual’s one repetition maximum (1-RM). Unfortunately, individuals with persistent knee pain are often unable to tolerate such high loads and this may negatively impact the duration and extent of their recovery. Low load blood flow restriction (LL-BFR) is an alternative RT technique that has demonstrated improvements in muscle strength, hypertrophy, and pain in the absence of high mechanical loading. However, the effectiveness of high-frequency LL-BFR in a residential rehabilitation environment remains unclear. This study will compare the efficacy of high frequency LL-BFR to ‘conventional’ heavier load resistance training (HL-RT) on measures of physical function and pain in adults with persistent knee pain.MethodsThis is a multicentre randomised controlled trial (RCT) of 150 UK service personnel (aged 18–55) admitted for a 3-week residential rehabilitation course with persistent knee pain. Participants will be randomised to receive: a) LL-BFR delivered twice daily at 20% 1-RM or b) HL-RT three-times per week at 70% 1-RM. Outcomes will be recorded at baseline (T1), course discharge (T2) and at three-months following course (T3). The primary outcome will be the lower extremity functional scale (LEFS) at T2. Secondary outcomes will include patient reported perceptions of pain, physical and occupational function and objective measures of muscle strength and neuromuscular performance. Additional biomechanical and physiological mechanisms underpinning both RT interventions will also be investigated as part of a nested mechanistic study.DiscussionLL-BFR is a rehabilitation modality that has the potential to induce positive clinical adaptations in the absence of high mechanical loads and therefore could be considered a treatment option for patients suffering significant functional deficits who are unable to tolerate heavy load RT. Consequently, results from this study will have a direct clinical application to healthcare service providers and patients involved in the rehabilitation of physically active adults suffering MSKI.Trial registrationClinicalTrials.org reference number, NCT05719922

Effect of 1-year daily protein supplementation and physical exercise on muscle protein synthesis rate and muscle metabolome in healthy older Danes: a randomized controlled trial

BackgroundThe skeletal muscle mass decreases with age and the responsiveness of aging muscles’ protein synthesis rate (MPS) to protein intake seems to deteriorate.ObjectiveThis study investigated the impact of 12 months of protein supplementation with or without physical exercise training on the basal and postprandial MPS and the skeletal muscle metabolome of healthy older Danes (> 65 years, 29 females/37 males).MethodsSubjects were randomized to follow one of five intervention groups: (1) carbohydrate, (2) collagen protein, (3) whey protein, (4) home-based light resistance training with whey protein, and (5) center-based heavy-load resistance training with whey protein. Before and after the intervention, a tracer infusion trial was conducted to measure basal and postprandial MPS in response to intake of a cocktail consisting of 20 g whey hydrolysate + 10 g glucose. In addition, the skeletal muscle metabolome was measured using gas chromatography–mass spectrometry (GC–MS) at basal state and 4 h after the intake of the cocktail.ResultsOne year of daily protein or carbohydrate supplementation did not alter the basal and protein-stimulated postprandial muscle protein synthesis rate or the muscle metabolome of healthy older Danes. Basal MPS (%/h) at baseline for all subjects were 0.0034 ± 0,011 (mean ± SD). In contrast to previous studies, no difference was observed in basal MPS between males and females (p = 0.75). With the developed untargeted GC–MS methodology, it was possible to detect and tentatively annotate > 70 metabolites from the human skeletal muscle samples.ConclusionOne year of protein supplementation in comparison to an isocaloric-control supplement seems to affect neither the MPS at basal or postprandial state nor the skeletal muscle metabolome.Clinical trial registryNumber: NCT02115698, clinicaltrials.gov/ct2/show/NCT02115698.

Blood Flow Restriction Training for Tendinopathy Rehabilitation: A Potential Alternative to Traditional Heavy-Load Resistance Training

Tendinopathy is a chronic tendon disease which can cause significant pain and functional limitations for individuals, and which collectively places a tremendous burden on society. Resistance training has long been considered the treatment of choice in the rehabilitation of chronic tendinopathies, with both eccentric and heavy slow resistance training demonstrating positive clinical effects. The application of progressive tendon loads during rehabilitation is essential to not compromise tendon healing, with the precise dosage parameters of resistance training and external loading a critical consideration. Blood-flow restriction training (BFRT) has become an increasingly popular method of resistance training in recent years and has been shown to be an effective method for enhancing muscle strength and hypertrophy in healthy populations and in musculoskeletal rehabilitation. Traditional resistance training for tendinopathy requires the application of heavy training loads, whereas BFRT utilises significantly lower loads and training intensities, which may be more appropriate for certain clinical populations. Despite evidence confirming the positive muscular adaptations derived from BFRT and the clinical benefits found for other musculoskeletal conditions, BFRT has received a dearth of attention in tendon rehabilitation. Therefore, the purpose of this narrative review was threefold: firstly, to give an overview and analysis of the mechanisms and outcomes of BFRT in both healthy populations and in musculoskeletal rehabilitation. Secondly, to give an overview of the evidence to date on the effects of BFRT on healthy tendon properties and clinical outcomes when applied to tendon pathology. Finally, a discussion on the clinical utility of BFRT and its potential applications within tendinopathy rehabilitation, including as a compliment to traditional heavy-load training, is presented.

Effect of Low-Load Blood Flow Restriction Training After Anterior Cruciate Ligament Reconstruction: A Systematic Review.

BackgroundQuadriceps strength and mass deficits are common after anterior cruciate ligament (ACL) reconstruction. Postoperatively, heavy load resistance training can have detrimental effects on knee joint pain and ACL graft laxity. Therefore, low-load blood flow restriction (LL-BFR) training has been suggested as an alternative to traditional strength rehabilitation.PurposeThe present systematic review aimed to investigate the effect of LL-BFR training on quadriceps strength, quadriceps mass, knee joint pain, and ACL graft laxity after ACL reconstruction compared to non-BFR training.Study designSystematic reviewMethodsA systematic literature search of PubMed, EMBASE.com, Cochrane Library/Wiley, CINAHL/Ebsco and Web of Science/Clarivate Analytics was performed on 19 February 2021. Studies were included if they compared LL-BFR and non-BFR training after ACL reconstruction with pre- and post-intervention quadriceps strength, quadriceps mass, knee joint pain or ACL graft laxity measurement. Systematic reviews, editorials, case reports and studies not published in a scientific peer reviewed journal were excluded. The risk of bias of randomized studies was assessed with the use of the Cochrane Risk of Bias Tool.ResultsA total of six randomized controlled trials were included. Random sequence generation and allocation concealment was defined as high risk in two of the six studies. In all studies blinding of participants and personnel was unclear or could not be performed. The included studies used different LL-BFR and non-BFR protocols with heterogeneous outcome measurements. Therefore, a qualitative analysis was performed. Two of the six studies assessed quadriceps strength and demonstrated significant greater quadriceps strength after LL-BFR compared to non-BFR training. Quadriceps mass was evaluated in four studies. Two studies observed significant greater quadriceps mass after LL-BFR compared to non-BFR training, while two studies observed no significant difference in quadriceps mass. Knee joint pain was assessed in three studies with significantly less knee joint pain after LL-BFR compared to non-BFR training. Two studies evaluated ACL graft laxity and observed no significant difference in ACL graft laxity between LL-BFR and non-BFR training.ConclusionThe results of this systematic review indicate that LL-BFR training after ACL reconstruction may be beneficial on quadriceps strength, quadriceps mass, and knee joint pain compared to non-BFR training with non-detrimental effects on ACL graft laxity. However, more randomized controlled trials with standardized intervention protocols and outcome measurements are needed to add evidence on the clinical value of LL-BFR training.Level of evidence2a

Does Androgen Deprivation for Prostate Cancer Affect Normal Adaptation to Resistance Exercise?

Background: Loss of muscle mass and muscle function is a common side effect from androgen deprivation therapy (ADT) for prostate cancer (PCa). Here, we explored effects of heavy-load resistance training (RT) on lean body mass and muscle strength changes reported in randomized controlled trials (RCTs) among PCa patients on ADT and in healthy elderly men (HEM), by comparison of results in separate meta-analysis. Methods: RCTs were identified through databases and reference lists. Results: Seven RCTs in PCa patients (n = 449), and nine in HEM (n = 305) were included. The effects of RT in lean body mass change were similar among PCa patients (Standardized mean difference (SMD): 0.4, 95% CI: 0.2, 0.7) and HEM (SMD: 0.5, 95% CI: 0.2, 0.7). It is noteworthy that the within group changes showed different patterns in PCa patients (intervention: 0.2 kg; control: −0.6 kg) and HEM (intervention: 1.2 kg; control: 0.2 kg). The effects of RT on change in muscle strength (measured as 1 RM) were similar between PCa patients and HEM, both for lower body- (PCa: SMD: 1.9, 95% CI: 1.2, 2.5; HEM: SMD: 2.2, 95% CI: 1.0, 3.4), and for upper body exercises (PCa: SMD: 2.0, 95% CI: 1.3, 2.7; HEM: SMD: 1.9, 95% CI: 1.3, 2.6). Conclusions: The effects of RT on lean body mass and 1 RM were similar in PCa patients on ADT and HEM, but the mechanism for the intervention effect might differ between groups. It seems that RT counteracts loss of lean body mass during ADT in PCa patients, as opposed to increasing lean body mass in HEM.

Estimating Repetitions in Reserve in Four Commonly Used Resistance Exercises.

Hughes, LJ, Peiffer, JJ, and Scott, B. Estimating repetitions in reserve in four commonly used resistance exercises. J Strength Cond Res XX(X): 000-000, 2020-This study aimed to determine the accuracy and reliability of estimating repetitions in reserve (RIR) across the squat, bench press, overhead press, and prone row exercises, using both free-weight and Smith machine modalities. Twenty-one trained men attended the laboratory on 14 occasions. They were assessed for 1 repetition maximum (1RM) for the squat, bench press, prone row, and overhead press exercises and subsequently completed 6 RIR testing sessions using 65, 75, and 85% 1RM. In these trials, subjects indicated when they reached 2 RIR (i.e., perceive they could only perform 2 more repetitions), before continuing the set to failure. The same process was then replicated using the alternative equipment modality. To determine accuracy of 2-RIR estimates, 1-sample t-tests assessed differences between 2 and the actual number of repetitions completed after subjects indicated they had reached 2 RIR. Intraclass correlation coefficients were used to determine the reliability of test-retest RIR estimated. There were no clear differences in the accuracy or reliability of estimating RIR between free-weight and Smith machine exercises. Load, however, proved an important factor with the highest accuracy associated with RIR estimations performed when using 85%, followed by 75 and 65% 1RM, respectively. When using loads of 75 and 65% 1RM, it was increasingly likely that individuals would underestimate RIR by >1 repetition, which would practically lead to an undesired reduction in training volume. These results highlight that although estimates of 2 RIR may be accurate and reliable in heavy load resistance training (≥85% 1RM), practitioners should be wary of using this measure with lighter loads.

Muscle Adaptations to Heavy-Load and Blood Flow Restriction Resistance Training Methods.

Resistance-based blood flow restriction training (BFRT) improves skeletal muscle strength and size. Unlike heavy-load resistance training (HLRT), there is debate as to whether strength adaptations following BFRT interventions can be primarily attributed to concurrent muscle hypertrophy, as the magnitude of hypertrophy is often minor. The present study aimed to investigate the effect of 7 weeks of BFRT and HLRT on muscle strength and hypertrophy. The expression of protein growth markers from muscle biopsy samples was also measured. Male participants were allocated to moderately heavy-load training (HL; n = 9), low-load BFRT (LL + BFR; n = 8), or a control (CON; n = 9) group to control for the effect of time. HL and LL + BFR completed 21 training sessions (3 d.week−1) comprising bilateral knee extension and knee flexion exercises (HL = 70% one-repetition maximum (1-RM), LL + BFR = 20% 1-RM + blood flow restriction). Bilateral knee extension and flexion 1-RM strength were assessed, and leg muscle CSA was measured via peripheral quantitative computed tomography. Protein growth markers were measured in vastus lateralis biopsy samples taken pre- and post the first and last training sessions. Biopsy samples were also taken from CON at the same time intervals as HL and LL + BFR. Knee extension 1-RM strength increased in HL (19%) and LL + BFR (19%) but not CON (2%; p < 0.05). Knee flexion 1-RM strength increased similarly between all groups, as did muscle CSA (50% femur length; HL = 2.2%, LL + BFR = 3.0%, CON = 2.1%; TIME main effects). 4E-BP1 (Thr37/46) phosphorylation was lower in HL and LL + BFR immediately post-exercise compared with CON in both sessions (p < 0.05). Expression of other growth markers was similar between groups (p > 0.05). Overall, BFRT and HLRT improved muscle strength and size similarly, with comparable changes in intramuscular protein growth marker expression, both acutely and chronically, suggesting the activation of similar anabolic pathways. However, the low magnitude of muscle hypertrophy was not significantly different to the non-training control suggesting that strength adaptation following 7 weeks of BFRT is not driven by hypertrophy, but rather neurological adaptation.

Tolerance to Intermittent vs. Continuous Blood Flow Restriction Training: A meta-Analysis.

The proven beneficial effects of low-load blood flow restriction training on strength gain has led to further exploration into its application during rehabilitation, where the traditional use of heavy loads may not be feasible. With current evidence showing that low-load blood flow restriction training may be less well tolerated than heavy-load resistance training, this review was conducted to decipher whether intermittently deflating the pressure cuff during rest intervals of a training session improves tolerance to exercise, without compromising strength. Four databases were searched for randomized controlled trials that compared the effect of intermittent versus continuous blood flow restriction training on outcomes of exercise tolerance or strength in adults. Nine studies were identified, with six included in the meta-analysis. No significant difference in rate of perceived exertion was found (SMD-0.06, 95% CI-0.41 to 0.29, p=0.73, I 2=80%). Subgroup analysis excluding studies that introduced bias showed a shift towards favoring the use of intermittent blood flow restriction training (SMD-0.42, 95% CI-0.87 to 0.03, p=0.07, I 2=0%). There was no significant difference in strength gain. Intermittent cuff deflations during training intervals does not improve tolerance to exercise during blood flow restriction training.

Similar Energy Expenditure During BodyPump and Heavy Load Resistance Exercise in Overweight Women.

PurposeHigh-repetition, low-load resistance exercise in group class settings has gained popularity in recent years, with BodyPump as a prime example. For individuals using exercise for body-weight management, the energy expenditure during exercise is of interest. Therefore, we herein aimed to estimate the energy expenditure during a session of BodyPump and a time-matched session of heavy load resistance training in overweight women (BMI ≥ 25.0).MethodsEighteen women participated in the study (mean age 35.4 years ± 10.2, BMI 30.4 kg/m2 ± 4.8), 10 exercising BodyPump (50–100 repetitions each muscle group) and eight performed a heavy load session (eight repetition maximum × three sets). The energy expenditure was assessed with indirect calorimetry during the sessions and for two intervals at rest during the recovery phase: 0–20 and 120–140 min after the sessions.ResultsThe BodyPump group lifted significantly more loads than the heavy load group (19,485 kg ± 2258 vs 15,616 kg ± 2976, p = 0.006), while energy expenditure was similar with 302 kcal ± 67 and 289 kcal ± 69 in BodyPump and heavy load group, respectively (p = 0.69). With no group differences, the resting metabolic rate (RMR) was elevated with 15–22% 2 h after exercise.ConclusionOverweight women achieved an energy expenditure of approximately 300 kcal (4.7 kcal per min) during a single session of BodyPump, which was similar with the women performing a single session of heavy load resistance exercise.

Effects of alternating blood flow restricted training and heavy-load resistance training on myofiber morphology and mechanical muscle function.

To investigate if short-term block-structured training consisting of alternating weeks of blood flow restricted low-load resistance training (BFR-RT) and conventional free-flow heavy-load resistance training (HL-RT) leads to superior gains in mechanical muscle function, myofiber size, and satellite cell (SC) content and myonuclear number compared with HL-RT alone. Eighteen active young participants (women/men: 5/13, 23 ± 1.2 yr) were randomized to 6 wk (22 sessions) of lower limb HL-RT [70-90% one repetition maximum (1-RM)] (HRT, n = 9) or block-structured training alternating weekly between BFR-RT (20% 1-RM) and HL-RT (BFR-HRT, n = 9). Maximal isometric knee extensor strength (MVC) and muscle biopsies (VL) were obtained pre- and posttraining to examine changes in muscle strength, myofiber cross-sectional area (CSA), myonuclear (MN) number, and SC content. MVC increased in both training groups (BFR-HRT: +12%, HRT: +7%; P < 0.05). Type II myofiber CSA increased similarly (+16%) in BFR-HRT and HRT (P < 0.05), while gains in type I CSA were observed following HRT only (+12%, P < 0.05). In addition, myonuclear number remained unchanged, whereas SC content increased in type II myofibers following HRT (+59%, P < 0.05). Short-term alternating BFR-RT and HL-RT did not produce superior gains in muscle strength or myofiber size compared with HL-RT alone. Noticeably, however, conventional HL-RT could be periodically replaced by low-load BFR-RT without compromising training-induced gains in maximal muscle strength and type II myofiber size, respectively.NEW & NOTEWORTHY The present data demonstrate that periodically substituting heavy-load resistance training (HL-RT) with low-load blood flow restricted resistance training (BFR-RT) leads to similar gains in type II myofiber CSA and muscle strength as achieved by HL-RT alone. Furthermore, we have for the first time evaluated myonuclear content and myonuclear domain size before and after training intervention across separate fiber size clusters and found no within-cluster changes for these parameters with training.

Comparing the Effectiveness of BloodFlow Restriction and Traditional Heavy Load Resistance Training in the Post-Surgery Rehabilitation of Anterior Cruciate Ligament Reconstruction Patients: A UK National Health Service Randomised Controlled Trial.

We implemented a bloodflow restriction resistance training (BFR-RT) intervention during an 8-week rehabilitation programme in anterior cruciate ligament reconstruction (ACLR) patients within a National Health Service setting. To compare the effectiveness of BFR-RT and standard-care traditional heavy-load resistance training (HL-RT) at improving skeletal muscle hypertrophy and strength, physical function, pain and effusion in ACLR patients following surgery. 28 patients scheduled for unilateral ACLR surgery with hamstring autograft were recruited for this parallel-group, two-arm, single-assessor blinded, randomised clinical trial following appropriate power analysis. Following surgery, a criteria-driven approach to rehabilitation was utilised and participants were block randomised to either HL-RT at 70% repetition maximum (1RM) (n = 14) or BFR-RT (n = 14) at 30% 1RM. Participants completed 8weeks of biweekly unilateral leg press training on both limbs, totalling 16 sessions, alongside standard hospital rehabilitation. Resistance exercise protocols were designed consistent with standard recommended protocols for each type of exercise. Scaled maximal isotonic strength (10RM), muscle morphology of the vastus lateralis of the injured limb, self-reported function, Y-balance test performance and knee joint pain, effusion and range of motion (ROM) were assessed at pre-surgery, post-surgery, mid-training and post-training. Knee joint laxity and scaled maximal isokinetic knee extension and flexion strength at 60°/s, 150°/s and 300°/s were measured at pre-surgery and post-training. Four participants were lost, with 24 participants completing the study (12 per group). There were no adverse events or differences between groups for any baseline anthropometric variable or pre- topost-surgery change in any outcome measure. Scaled 10RM strength significantly increased in the injured limb (104 ± 30% and 106 ± 43%) and non-injured limb (33 ± 13% and 39 ± 17%) with BFR-RT and HL-RT, respectively, with no group differences. Significant increases in knee extension and flexion peak torque were observed at all speeds in the non-injured limb with no group differences. Significantly greater attenuation of knee extensor peak torque loss at 150°/s and 300°/s and knee flexor torque loss at all speeds was observed with BFR-RT. No group differences in knee extensor peak torque loss were found at 60°/s. Significant and comparable increases in muscle thickness (5.8 ± 0.2% and 6.7 ± 0.3%) and pennation angle (4.1 ± 0.3% and 3.4 ± 0.1%) were observed with BFR-RT and HL-RT, respectively, with no group differences. No significant changes in fascicle length were observed. Significantly greater and clinically important increases in several measures of self-reported function (50-218 ± 48% vs. 35-152 ± 56%), Y-balance performance (18-59 ± 22% vs. 18-33 ± 19%), ROM (78 ± 22% vs. 48 ± 13%) and reductions in knee joint pain (67 ± 15% vs. 39 ± 12%) and effusion (6 ± 2% vs. 2 ± 2%) were observed with BFR-RT compared to HL-RT, respectively. BFR-RT can improve skeletal muscle hypertrophy and strength to a similar extent to HL-RT with a greater reduction in knee joint pain and effusion, leading to greater overall improvements in physical function. Therefore, BFR-RT may be more appropriate for early rehabilitation in ACLR patient populations within the National Health Service.

Examination of the comfort and pain experienced with blood flow restriction training during post-surgery rehabilitation of anterior cruciate ligament reconstruction patients: A UK National Health Service trial

ObjectiveExamine the comfort and pain experienced with blow flow restriction resistance training (BFR-RT) compared to standard care heavy load resistance training (HL-RT) during anterior cruciate ligament reconstruction (ACLR) patient rehabilitation. DesignRandomised controlled trial. SettingUnited Kingdom National Health Service. ParticipantsTwenty eight patients undergoing unilateral ACLR surgery with hamstring autograft were recruited. Following surgery participants were block randomised to either HL-RT at 70% repetition maximum (1RM) (n = 14) or BFR-RT (n = 14) at 30% 1RM and completed 8 weeks of twice weekly unilateral leg press training on both limbs. Main outcome measuresPerceived knee pain, muscle pain and rating of perceived exertion (RPE) were assessed using Borg’s (1998) RPE and pain scales during training. Knee pain was also assessed 24 h post-training. ResultsThere were no adverse events. Knee pain was lower with BFR-RT during (p < 0.05) and at 24 h post-training (p < 0.05) with BFR-RT for all sessions. Muscle pain was higher (p < 0.05) with BFR-RT compared to HL-RT during all sessions. RPE remained unchanged (p > 0.05) for both BFR-RT and HL-RT. ConclusionACLR patients experienced less knee joint pain and reported similar ratings of perceived exertion during and following leg press exercise with BFR-RT compared to traditional HL-RT. BFR-RT may be more advantageous during the early phases of post-surgery ACLR rehabilitation.

Load magnitude affects patellar tendon mechanical properties but not collagen or collagen cross-linking after long-term strength training in older adults

BackgroundRegular loading of tendons may counteract the negative effects of aging. However, the influence of strength training loading magnitude on tendon mechanical properties and its relation to matrix collagen content and collagen cross-linking is sparsely described in older adults. The purpose of the present study was to compare the effects of moderate or high load resistance training on tendon matrix and its mechanical properties.MethodsSeventeen women and 19 men, age 62–70 years, were recruited and randomly allocated to 12 months of heavy load resistance training (HRT), moderate load resistance training (MRT) or control (CON). Pre- and post-intervention testing comprised isometric quadriceps strength test (IsoMVC), ultrasound based testing of in vivo patellar tendon (PT) mechanical properties, MRI-based measurement of PT cross-sectional area (CSA), PT biopsies for assessment of fibril morphology, collagen content, enzymatic cross-links, and tendon fluorescence as a measure of advanced glycation end-products (AGEs).ResultsThirty three participants completed the intervention and were included in the data analysis. IsoMVC increased more after HRT (+ 21%) than MRT (+ 8%) and CON (+ 7%) (p < 0.05). Tendon stiffness (p < 0.05) and Young’s modulus (p = 0.05) were also differently affected by training load with a reduction in CON and MRT but not in HRT. PT-CSA increased equally after both MRT and HRT. Collagen content, fibril morphology, enzymatic cross-links, and tendon fluorescence were unaffected by training.ConclusionDespite equal improvements in tendon size after moderate and heavy load resistance training, only heavy. load training seemed to maintain tendon mechanical properties in old age. The effect of load magnitude on tendon biomechanics was unrelated to changes of major load bearing matrix components in the tendon core.The study is a sub-study of the LISA study, which was registered at http://clinicaltrials.gov (NCT02123641) April 25th 2014.