Low-intensity Blood Flow Restriction Training Research Articles

Semi-Squat Exercises with Varying Levels of Arterial Occlusion Pressure during Blood Flow Restriction Training Induce a Post-Activation Performance Enhancement and Improve Vertical Height Jump in Female Football Players.

Low-load blood flow restriction training (BFRT) has been shown to induce a significant increase in muscle activation. However, low-load BFRT to augment the post-activation performance enhancement (PAPE) has not been previously examined. This study aimed to examine the PAPE of low-intensity semi-squat exercises with varying pressure BFRT on vertical height jump performance. Twelve elite athletes from the Shaanxi Province women's football team volunteered to participate in this study for 4 weeks. Participants completed four testing sessions that included one of the following at random: (1) non-BFRT, (2) 50% arterial occlusion pressure (AOP), (3) 60% AOP, or (4) 70% AOP. Muscle activity of the lower thigh muscles was recorded using electromyography (EMG). Jump height, peak power output (PPO), vertical ground reaction forces (vGRF), and rate of force development (RFD) were recorded for four trials. Two-factor repeated measures analysis of variance (ANOVA) showed that semi-squat with varying pressure BFRT had a significant impact on the measured muscle EMG amplitude and MF value of vastus medialis, vastus lateralis, rectus femoris, and biceps femoris (P < 0.05), and MF value decreased with increasing pressure. Muscle activation (EMG amplitude) did not change further. The EMG amplitude of the gluteus maximus was significantly decreased by semi-squat training with different pressures (P < 0.05), while that of the gluteus maximus muscle was gradually increased by non-BFR with semi-squat training (P > 0.05). The 50% and 60% AOP BFRTs significantly increased jump height, peak power, and force increase rate (RFD) after 5 min and 10 min of rest (P < 0.05). This study further confirmed that low-intensity BFRT can significantly increase lower limb muscle activation, induce PAPE, and improve vertical height jump in female footballers. In addition, 50% AOP continuous BFRT is recommended for warm-up activities.

Effects of Low Intensity Blood Flow Restriction Training on Muscle Volume, Strength and Power in Healthy Middle-Aged Females

OBJECTIVES The purpose of this study is to investigate the efficacy of weight training with controlled blood flow occlusion compared to conventional resistance training, in the ageing population.METHODS Twenty-three healthy female subjects (aged 40-55) were randomly assigned to one of three groups; low intensity blood flow restriction training (LI-BFRT) (n = 9), conventional resistance training (RT) (n = 7) and control (CON) (n = 7). The RT group trained between 65-70% one repetition maximum (1RM) and the LI-BFRT group trained at 30% 1RM while wearing pressure cuffs inflated to 100-120% of brachial systolic blood pressure (bSBP). Relative appendicular skeletal muscle mass (ASM/weight), isokinetic strength and power were tested pre and post 8 weeks of training.RESULTS Upper limb ASM/weight increased significantly in the LI-BFRT and RT groups (both p &lt; 0.001). Only LI-BFRT showed significant difference compared with the CON group (p &lt; 0.01). Lower limb ASM/weight improved in both the LI-BFRT (p &lt; 0.01) and CON (p &lt; 0.01) groups without group differences. Lower limb flexion strength increased in the LI-BFRT and RT groups (both p &lt; 0.01), with differences between groups (p &lt; 0.01, LI-BFRT &gt; RT &gt; CON). Only RT increased extension muscle strength (p &lt; 0.05). Lower limb flexion and extension power improved following LI-BFRT (p &lt; 0.05 and p &lt; 0.01, respectively), significantly greater than RT in both flexion (p &lt; 0.001) and extension (p &lt; 0.01).CONCLUSIONS LI-BFRT may be as, if not more effective than RT for increasing muscle volume, strength and power in middle-aged women.

Effects of Blood Flow Restriction Therapy for Muscular Strength, Hypertrophy, and Endurance in Healthy and Special Populations: A Systematic Review and Meta-Analysis.

Blood flow restriction (BFR) training is an increasingly applied tool with potential benefits in muscular hypertrophy, strength, and endurance. This study investigates the effectiveness of BFR training relative to other forms of training on muscle strength, hypertrophy, and endurance. We performed systematic searches of MEDLINE, Embase, and PubMed and assessed the methodological quality of included studies using the Cochrane risk of bias tool. We included 53 randomized controlled trials with 31 included in meta-analyses. For muscular strength comparing low-intensity BFR (LI-BFR) training with high-intensity resistance training (HIRT), the pooled mean difference (MD) for 1 repetition maximum was 5.34 kg (95% CI, 2.58-8.09; P < 0.01) favoring HIRT. When comparing LI-BFR training with HIRT for torque, the MD was 6.35 N·m (95% CI, 0.5-12.3; P = 0.04) also favoring HIRT. However, comparing LI-BFR with low-intensity resistance training (LIRT) for torque, there was a MD of 9.94 N·m (95% CI, 5.43-14.45; P < 0.01) favoring BFR training. Assessing muscle hypertrophy, the MD in cross-sectional area was 0.96 cm2 (95% CI, 0.21-1.7; P = 0.01) favoring pooled BFR training compared with nonocclusive training. Assessing endurance, V̇o2 maximum demonstrated a greater mean increase of 0.37 mL/kg/min (95% CI, -0.97 to 3.17; P = 0.64) in BFR endurance training compared with endurance training alone. Blood flow restriction training produced increases in muscular strength, hypertrophy, and endurance. Comparing LI-BFR training with HIRT, HIRT was a significantly better training modality for increasing muscle hypertrophy and strength. However, LI-BFR was superior when compared with a similar low-intensity protocol. Blood flow restriction training is potentially beneficial to those unable to tolerate the high loads of HIRT; however, better understanding of its risk to benefit ratio is needed before clinical application. Level 1.

Utilizing Low-Intensity Blood Flow Restriction Training to Improve Aerobic Capacity in Physically Active and Injured Individuals: A Critically Appraised Topic

Purpose: To determine if, in physically active individuals, low-intensity Blood Flow Restriction (BFR) training is more effective than training without BFR at improving measures of aerobic capacity. Methods: A database search was conducted for articles that matched inclusion criteria (minimum level 2 evidence, physically active participants, comparison of low-intensity BFR to no BFR training, comparison of pre-post testing with aerobic fitness or performance, training protocols &gt;2 weeks, studies published after 2010) by two authors and assessed by one using the PEDro scale (a minimum of 5/10 was required) to ensure level 2 quality studies that were then analyzed. Results: Four studies met all inclusion criteria. Three of the studies found significant improvements in aerobic capacity (VO2max) using BFR compared to no BFR. While the fourth study reported significant improvements in time to exertion (TTE) training with BFR, this same study did not find significant improvements in measures of aerobic capacity with BFR training. All compared BFR to non-BFR training. It was noted that high-intensity training without BFR was superior to both low-intensity training with and without BFR with respect to improvements in aerobic capacity. Conclusions: Moderate evidence exists to support the use of low-intensity BFR training to improve measures of aerobic capacity in physically active individuals over not using BRF. Clinicians seeking to maintain aerobic capacity in their patients who are unable, for various reasons, to perform high levels of aerobic activity may find low-intensity BFR training useful as a substitution while still receiving improvements in measures of aerobic capacity.

Contralateral training effects of low-intensity blood-flow restricted and high-intensity unilateral resistance training.

Determine whether unilateral low-intensity blood-flow restricted (LIBFR) exercise is as effective as high-intensity (HI) resistance training for improving contralateral muscle strength. Thirty healthy adults (20-30 years) were randomly allocated to the following dynamic plantar-flexion training interventions: HI [75% of one-repetition maximum (1RM), 4 sets, 10 reps] and LIBFR [20% of 1RM, 4 sets, 30 + 15 + 15 + 15 reps]. Evoked V-wave and H-reflex recruitment curves, as well as maximal voluntary contraction (MVC) and panoramic ultrasound assessments of the trained and untrained soleus muscles were obtained pre-training, post-4 weeks of training and post-4 weeks of detraining. Both interventions failed to increase contralateral MVC and muscle cross-sectional area (CSA). Yet, contralateral rate of torque development (RTD) was enhanced by both regimens (12-26%) and this was accompanied by heightened soleus EMG within the first milliseconds of the rising torque-time curve (14-22%; p < 0.05). These improvements were dissipated after detraining. Contralateral adaptations were not accompanied by changes in V-wave or H-reflex excitability. Conversely, LIBFR and HI elicited a similar magnitude of ipsilateral increase in MVC, RTD and CSA post-training (10-18%). Improvements in V-wave amplitude and soleus EMG were limited to the trained leg assigned to LIBFR training (p < 0.05). While gains in strength and CSA remained preserved post-4 weeks of detraining, this did not occur with RTD. Since gains in RTD were similar between interventions, our findings indicate that both training regimens can be used interchangeably for improving contralateral rapid torque production. Ultimately, this may be beneficial in circumstances of limb immobilization after injury or surgery.

Low-Intensity Blood Flow Restriction Training Does Not Modulate Myostatin Concentration in Elderly Females

Low-Intensity Blood Flow Restriction Training Does Not Modulate Myostatin Concentration in Elderly Females

Different Time Course of Recovery in Achilles Tendon Thickness After Low-Load Resistance Training With and Without Blood Flow Restriction.

Blood flow restriction research has focused on muscular strength and hypertrophy. Limited data have been reported about the blood flow restriction effect on the tendon. To analyze and compare the time course of recovery in Achilles tendon thickness after a single bout of low-intensity resistance training (LI-RT) and low-intensity blood flow restriction training (LI-BFRT). A total of 56 healthy participants (24.60 [4.0]y; 23.65 [3.4] body mass index) were included. The dominant leg was assigned for LI-BFRT using low load (30% 1-repetition maximum) and 30% of the total occlusion pressure (52.21 [17.89]mm Hg) in plantar-flexion exercise (1 × 30 + 3 × 15 repetitions). The nondominant leg was assumed as a control condition. Sonography images were taken before the intervention, immediately posttraining, and 24hours after exercise (post-24) for the Achilles tendon thickness. Changes in Achilles tendon thickness for LI-BFRT group were significant post- (-14.5%; P < .05) and post-24 (-9.2%; P < .05). In contrast, LI-RT group showed a transient decrease after exercise (-9.67%; P < .05) followed by a recovery of thickness post-24 (-1.06%; P < .05). Thickness post-24 was different between LI-BFRT versus LI-RT (P < .01). Hedge effect size analysis showed a large effect (g = 0.90) in LI-BFRT pre-post condition and a medium effect (g = 0.57) in post- to post-24. The LI-RT obtained a medium effect (g = 0.53) in pre-post condition and a small effect (g = 0.49) in post- to post-24. This study showed a different time course of the acute response in Achilles tendon thickness between LI-BFRT and LI-RT. This may be associated with intratendinous fluid movement in response to LI-BFRT.

Low-Intensity Blood Flow Restriction Training as a Pre-Operative Rehabilitative Modality to Improve Post-Operative Outcomes for ACL Reconstruction

Low-Intensity Blood Flow Restriction Training as a Pre-Operative Rehabilitative Modality to Improve Post-Operative Outcomes for ACL Reconstruction

Speeding of oxygen uptake kinetics is not different following low-intensity blood-flow-restricted and high-intensity interval training.

What is the central question of this study? Can interval blood-flow-restricted (BFR) cycling training, undertaken at a low intensity, promote a similar adaptation to oxygen uptake ( ) kinetics to high-intensity interval training? What is the main finding and its importance? Speeding of pulmonary on-kinetics in healthy young subjects was not different between low-intensity interval BFR training and traditional high-intensity interval training. Given that very low workloads are well tolerated during BFR cycle training and speed on-kinetics, this training method could be used when high mechanical loads are contraindicated. Low-intensity blood-flow-restricted (BFR) endurance training is effective to increase aerobic capacity. Whether it speeds pulmonary oxygen uptake ( ), CO2 output ( ) and ventilatory ( ) kinetics has not been examined. We hypothesized that low-intensity BFR training would reduce the phase2 time constant (τp ) of , and by a similar magnitude to traditional high-intensity interval training (HIT). Low-intensity interval training with BFR served as a control. Twenty-four participants (25±6years old; maximal 46±6mlkg-1 min-1 ) were assigned to one of the following: low-intensity BFR interval training (BFR; n=8); low-intensity interval training without BFR (LOW; n=7); or high-intensity interval training without BFR (HIT; n=9). Training was 12 sessions of two sets of five to eight×2min cycling and 1min resting intervals. LOW and BFR were conducted at 30% of peak incremental power (Ppeak ), and HIT was at ∼103% Ppeak . For BFR, cuffs were inflated on both thighs (140-200mmHg) during exercise and deflated during rest intervals. Six moderate-intensity step transitions (30% Ppeak ) were averaged for analysis of pulmonary on-kinetics. Both BFR (pre- versus post-training τp =18.3±3.2 versus 14.5±3.4s; effect size=1.14) and HIT (τp =20.3±4.0 versus 13.1±2.9s; effect size=1.75) reduced the τp (P<0.05). As expected, there was no change in LOW ( τp =17.9±6.2 versus 17.7±4.3s; P=0.9). The kinetics of and were speeded only after HIT (38.5±10.6%, P<0.001 and 31.2±24.7%, P=0.004, respectively). Both HIT and low-intensity BFR training were effective in speeding moderate-intensity kinetics. These data support the findings of others that low-intensity cycling training with BFR increases muscle oxidative capacity.

Clinical safety of blood flow-restricted training? A comprehensive review of altered muscle metaboreflex in cardiovascular disease during ischemic exercise.

Blood flow restriction training (BFRT) is an increasingly widespread method of exercise that involves imposed restriction of blood flow to the exercising muscle. Blood flow restriction is achieved by inflating a pneumatic pressure cuff (or a tourniquet) positioned proximal to the exercising muscle before, and during, the bout of exercise (i.e., ischemic exercise). Low-intensity BFRT with resistance training promotes comparable increases in muscle mass and strength observed during high-intensity exercise without blood flow restriction. BFRT has expanded into the clinical research setting as a potential therapeutic approach to treat functionally impaired individuals, such as the elderly, and patients with orthopedic and cardiovascular disease/conditions. However, questions regarding the safety of BFRT must be fully examined and addressed before the implementation of this exercise methodology in the clinical setting. In this respect, there is a general concern that BFRT may generate abnormal reflex-mediated cardiovascular responses. Indeed, the muscle metaboreflex is an ischemia-induced, sympathoexcitatory pressor reflex originating in skeletal muscle, and the present review synthesizes evidence that BFRT may elicit abnormal cardiovascular responses resulting from increased metaboreflex activation. Importantly, abnormal cardiovascular responses are more clearly evidenced in populations with increased cardiovascular risk (e.g., elderly and individuals with cardiovascular disease). The evidence provided in the present review draws into question the cardiovascular safety of BFRT, which clearly needs to be further investigated in future studies. This information will be paramount for the consideration of BFRT exercise implementation in clinical populations.

Comparisons between Low-Intensity Resistance Training with Moderate Blood Flow Restriction and High-Intensity Resistance Training on Quadriceps Muscle Strength and Mass

Objective: Elderly and rehabilitating populations who are unable to exercise under high loads are likely to experience muscle atrophy. Low intensity blood flow restriction training (LI-BFRT) can promote increases muscle mass comparable to conventional high-intensity resistance training (HI). However, strength discrepancies have been reported between LI-BFRT and HI programs. Therefore, the purpose of this study is to examine whether similar muscle strength and power improvements are found in both 1RM and non-specific strength tests between LI-BFRT and HI groups. Methods: Six male subjects (x̅ age 20.8 years ± 1.6) free of any musculoskeletal disorders with no anaerobic resistance training in the 6 weeks prior to testing participated in 4 week strength exercise program. Pre- and post- force and power tests were assessed using a 1RM test and a triaxial accelerometer (Myotest® SA) to measure power and velocity during a squat jump (SJ) and countermovement jump (CMJ). Subjects were randomly assigned one of two groups: LI-BFRT (40% 1RM at 40% arterial occlusion for 3 sets of 15 reps) or HI (80% 1RM for 3 sets of 8 reps). Both groups completed leg extensions twice a week for 4 weeks on a leg-extension machine. Results: Significant increase in LI-BFRT for SJ power x̄= 42.2 W/ kg ± 3.6, SJ Power x̄= 45.7 W/kg ± 3.3; p=0.037, CMJ Velocity x̄= 245 cm/s ± 1.4, CMJ Velocity x̄= 269 cm/s ± 2.1; p=0.014 and 1RM x̄= 112.5kg ± 18.4, 1RM x̄ =138.8kg ± 20.4; p=0.006.) was observed. No significant change was observed in the HI group. Conclusion: The LI-BFRT subjects power output increased over the 4-week program. Improvements may be attributed to the neuromuscular adaptation that occurred through intervention. This pilot study suggests that BFRT could promote or increases muscle power comparable to results observed after conventional highintensity(HI) resistance training, when measured via non-specific muscular strength tests.

Muscular adaptations after two different volumes of blood flow‐restricted training

This study aimed to gain an insight into the adaptations of muscle strength and skeletal muscle thickness after two different volumes of blood flow restriction training (BFRT), and compare them with high-intensity training. The sample was divided into four groups: low-volume, low-intensity BFRT (BFRT LV); high-volume, low-intensity BFRT (BFRT HV); traditional high-intensity resistance training (HIT); and a control group, which maintained their routine activities (CON). Leg extension one repetition maximum (1RM), isokinetic peak knee extension, and flexion torques at 60°/s and 180°/s as well as muscle thickness of the rectus femoris (RF) and vastus lateralis (VL) were assessed at baseline and after 5 weeks of training BFRT LV (7.03%, P < 0.05), BFRT HV (6.24%, P < 0.05) and HIT (18.86%, P < 0.001) groups increased 1RM performance, while no changes were observed in the CON group. Muscle thickness of the RF and VL was increased irrespective of the training group (7.5%, P < 0.001; and 9.9%, P < 0.001, respectively). We conclude that doubling the exercise volume with BFRT causes no further benefit with muscular size or strength. Although similar increases in muscle thickness were observed between training groups, HIT increased 1RM performance to a greater extent compared to either volume of BFRT.

Effects of high-intensity and blood flow-restricted low-intensity resistance training on carotid arterial compliance: role of blood pressure during training sessions

We examined the effects of high-intensity resistance training (HIT) and low-intensity blood flow-restricted (LI-BFR) resistance training on carotid arterial compliance. Nineteen young men were randomly divided into HIT (n = 9) or LI-BFR (n = 10) groups. The HIT and LI-BFR groups performed 75 and 30 %, respectively, of one-repetition maximum (1-RM) bench press exercise, 3 days per week for 6 weeks. During the training sessions, the LI-BFR group wore elastic cuffs around the most proximal region of both arms. Muscle cross-sectional area (CSA), 1-RM strength, and carotid arterial compliance were measured before and 3 days after the final training session. Acute changes in systolic arterial pressure (SAP), plasma endothelin-1 (ET-1), nitrite/nitrate (NOx), and noradrenalin concentrations were also measured during and after a bout of training session. The training led to significant increases (P < 0.01) in bench press 1-RM and arm and chest muscle CSA in the two training groups. Carotid arterial compliance decreased significantly (P < 0.05) in the HIT group, but not in the LI-BFR group. There was a significant correlation (r = -0.533, P < 0.05) between the change in carotid arterial compliance and the acute change in SAP during training sessions; however, ET-1 and NOx did not correlate with carotid arterial compliance. Our results suggest that muscle CSA and strength increased following 6 weeks of both HIT and LI-BFR training. However, carotid arterial compliance decreased in only the HIT group, and the changes were correlated with SAP elevations during exercise sessions.

Potential safety issues with blood flow restriction training

The focal point of previous literature was establishing the efficacy of blood flow restriction training with respect to muscular strength, muscular hypertrophy, and muscular endurance. After mounting evidence supporting the efficacy of low-intensity blood flow restriction training, research has shifted to the overall safety of this training modality. The aim of this review was to summarize the research on the overall safety of blood flow restriction training, focusing on the cardiovascular system (central and peripheral), muscle damage, oxidative stress, and nerve conduction velocity responses compared with those observed with regular exercise. Although still sparse, the blood flow restriction training research thus far is promising with respect to safety outcomes. Individuals respond similarly to blood flow restriction training and to regular exercise; however, longer term studies are required to better understand the chronic effects of low-intensity blood flow restriction training and possible safety issues.

Combined effects of low-intensity blood flow restriction training and high-intensity resistance training on muscle strength and size

We investigated the combined effect of low-intensity blood flow restriction and high-intensity resistance training on muscle adaptation. Forty young men (aged 22-32years) were randomly divided into four groups of ten subjects each: high-intensity resistance training (HI-RT, 75% of one repetition maximum [1-RM]), low-intensity resistance training with blood flow restriction (LI-BFR, 30% 1-RM), combined HI-RT and LI-BFR (CB-RT, twice-weekly LI-BFR and once-weekly HI-RT), and nontraining control (CON). Three training groups performed bench press exercises 3days/week for 6weeks. During LI-BFR training sessions, subjects wore pressure cuffs on both arms that were inflated to 100-160mmHg. Increases in 1-RM were similar in the HI-RT (19.9%) and CB-RT (15.3%) groups and lower in the LI-BFR group (8.7%, p<0.05). Maximal isometric elbow extension (MVC) increased in the HI-RT (11.3%) and CB-RT (6.6%) groups; there was no change in the LI-BFR group (-0.2%). The cross-sectional area (CSA) of the triceps brachii (TB) increased (p<0.05) in the HI-RT (8.6%), CB-RT (7.2%), and LI-BFR (4.4%) groups. The change in relative isometric strength (MVC divided by TB CSA) was greater (p<0.05) in the HI-RT group (3.3%) than in the LI-BFR (-3.5%) and CON (-0.1%) groups. Following training, relative dynamic strength (1-RM divided by TB CSA) was increased (p<0.05) by 10.5% in the HI-RT group and 6.7% in the CB-RT group. None of the variables in the CON group changed. Our results show that low-intensity resistance training with BFR-induced functional muscle adaptations is improved by combining it with HI-RT.

Functional Muscle Adaptations Following High-intensity Training, Low-intensity Blood-flow Restriction Training, Or A Combined Approach

Functional Muscle Adaptations Following High-intensity Training, Low-intensity Blood-flow Restriction Training, Or A Combined Approach