Blood flow restriction resistance training (BFRT) employs partial vascular occlusion of exercising muscles via inflation cuffs. Compared with high-load resistance training, mechanical load is markedly reduced with BFRT, but induces similar gains in muscle mass and strength. BFRT is thus an effective training strategy for people with physical limitations. Recent research indicates that BFRT has beneficial effects on glucose and mitochondrial metabolism. BFRT may therefore qualify as a valuable exercise alternative for individuals with type 2 diabetes (T2D), a disorder characterized by impaired glucose metabolism, musculoskeletal decline, and exacerbated progression of sarcopenia. This review covers the effects of BFRT in healthy populations and in persons with impaired physical fitness, the mechanisms of action of this novel training modality, and possible applications for individuals with T2D. Blood Flow Restriction Training as an Alternative for Maintaining Physical Performance and Health? Endurance training typically improves cardiorespiratory fitness [1] which is associated with lower mortality from any cause as well as reduced cardiovascular disease risk [2]. In addition, individuals with higher muscle mass and strength are at lower risk of death [3]. Classical resistance training (RT) effectively improves skeletal muscle mass and strength as well as glycemic control [4,5]. In that sense, exercise training holds great promise for the prevention and management of metabolic diseases such as type 2 diabetes (T2D) (Box 1). However, to achieve health benefits from RT, loads equating to 70% or more of the individual one-repetition maximum (1-RM; see Glossary) are often recommended [6]. High muscle-tendon loads may not be suitable for people with physical limitations or clinical populations who are affected by muscle wasting and reduced muscle strength. Effective alternative countermeasures are therefore urgently needed for these individuals to avoid frailty. One promising exercise modality is blood flow restriction training (BFRT) (Box 2). It has been shown that blood flow restriction (BFR) alone, even without concomitant exercise training, can be effective in mitigating the reductions in muscle strength and atrophy that result from immobilization [7]. Interestingly, BFR without exercise prevented reductions of muscle strength and leg circumference in cast-immobilized patients [8] as well as declines of muscular weakness induced by chronic unloading [9]. Along these lines, previous studies showed that BFR without exercise diminishes both postoperative muscle atrophy [10] and bed-rest-related muscle atrophy [11]. This training modality typically utilizes loads as low as 20-40% of an individual's 1-RM for 2-4 sets of exercise to or near volitional failure. BFR is usually maintained between sets with a total restriction time of 5-10 minutes [12] (Box 3).
BACKGROUND Physical activity is a cornerstone in diabetes management; however, evidence synthesis on the association between physical activity and long-term diabetes-related complications is scarce. PURPOSE To summarize and evaluate findings on physical activity and diabetes-related complications, we conducted a systematic review and meta-analysis. DATA SOURCES We searched PubMed, Web of Science, and the Cochrane Library for articles published up to 6 July 2021. STUDY SELECTION We included prospective studies investigating the association between physical activity and incidence of and mortality from diabetes-related complications, i.e., cardiovascular disease (CVD), coronary heart disease, cerebrovascular events, heart failure, major adverse cardiovascular events, and microvascular complications such as retinopathy and nephropathy, in individuals with diabetes. DATA EXTRACTION Study characteristics and risk ratios with 95% CIs were extracted. Random-effects meta-analyses were performed, and the certainty of evidence and risk of bias were evaluated with use of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) and Risk Of Bias In Non-randomised Studies - of Interventions (ROBINS-I) tools. DATA SYNTHESIS Overall, 31 studies were included. There was moderate certainty of evidence that high versus low levels of physical activity were inversely associated with CVD incidence, CVD mortality (summary risk ratio 0.84 [95% CI 0.77, 0.92], n = 7, and 0.62 [0.55, 0.69], n = 11), and microvascular complications (0.76 [0.67, 0.86], n = 8). Dose-response meta-analyses showed that physical activity was associated with lower risk of diabetes-related complications even at lower levels. For other outcomes, similar associations were observed but certainty of evidence was low or very low. LIMITATIONS Limitations include residual confounding and misclassification of exposure. CONCLUSIONS Physical activity, even below recommended amounts, was associated with reduced incidence of diabetes-related complications.
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