Lower body blood flow restriction training may induce remote muscle strength adaptations in an active unrestricted arm

May, Anthony K.; Russell, Aaron P.; Warmington, Stuart A.

doi:10.1007/s00421-018-3806-2

Cited by 34 publications

(49 citation statements)

References 44 publications

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“…The only previous meta-analysis performed on LL-BFR training versus HLT in healthy adults 25 included studies that had within-subject controls and/or used non-randomized allocation procedures, while also including more than one strength outcome variable from the same populations. Cross-transfer effects have been reported for contralateral limb following LL-BFR training 26,27 ; thus, inclusion of studies involving within-subject designs may not reflect the direct effects of LL-BFR training. Furthermore, non-randomized designs may involve selection bias, while inclusion of the same study population multiple times in the quantitative meta-analysis (double counting) inherently will increase the statistical weighting of that study population.…”

mentioning

confidence: 99%

Effect of blood‐flow restricted vs heavy‐load strength training on muscle strength: Systematic review and meta‐analysis

Grønfeldt

Nielsen

Mieritz

et al. 2020

Scandinavian Med Sci Sports

101

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Introduction Heavy‐load strength training (HLT) is generally considered the Gold Standard exercise modality for inducing gains in skeletal muscle strength. However, use of heavy external exercise loads may be contraindicative in frail individuals. Low‐load resistance exercise combined with partial blood‐flow restriction (LL‐BFR exercise) may offer an effective alternative for increasing mechanical muscle strength and size. The aim of this study was to compare the effect of LL‐BFR training to HLT on maximal muscle strength gains. Prospero registration‐id (CRD42014013382). Materials and methods A systematic search in six healthcare science databases and reference lists was conducted. Data selected for primary analysis consisted of post‐intervention changes in maximal muscle strength. A random‐effects meta‐analysis with standardized mean differences (SMD) was used. Results Of 1413 papers identified through systematic search routines, sixteen papers fulfilled the inclusion criteria, totalling 153 participants completing HLT and 157 completing LL‐BFR training. The magnitude of training‐induced gains in maximal muscle strength did not differ between LL‐BFR training and HLT (SMD of −0.17 (95% CI: −0.40; 0.05)). Low between‐study heterogeneity was noted (I2 = 0.0%, Chi2 P = 9.65). Conclusion Low‐load blood‐flow‐restricted training appears equally effective of producing gains in maximal voluntary muscle strength compared to HLT in 20‐ to 80‐year‐old healthy and habitually active adults.

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mentioning

confidence: 99%

Effect of blood‐flow restricted vs heavy‐load strength training on muscle strength: Systematic review and meta‐analysis

Grønfeldt

Nielsen

Mieritz

et al. 2020

Scandinavian Med Sci Sports

101

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“…The populations examined were relatively heterogeneous between studies, with the most common population being healthy non‐resistance trained but recreationally active adults, examined in 23 of the 52 included studies 17,24,31‐51 . Other populations included resistance‐trained adults, adults with musculoskeletal or soft tissue injuries, older adults, or adults with hypertension.…”

Section: Resultsmentioning

confidence: 99%

“…Other populations included resistance‐trained adults, adults with musculoskeletal or soft tissue injuries, older adults, or adults with hypertension. There were far more studies (26 of 52) examining only male participants, 17,24,25,30,32‐38,41‐43,46,48,50‐59 compared with just 8 of 52 examining only female participants, 40,49,60‐65 leaving 18 studies examining both of these genders 8,19,20,39,44,45,47,66‐75 …”

Section: Resultsmentioning

confidence: 99%

Is there rationale for the cuff pressures prescribed for blood flow restriction exercise? A systematic review

Clarkson

May

Warmington

2020

Scandinavian Med Sci Sports

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Background Blood flow restriction exercise has increasingly broad applications among healthy and clinical populations. Ensuring the technique is applied in a safe, controlled, and beneficial way for target populations is essential. Individualized cuff pressures are a favored method for achieving this. However, there remains marked inconsistency in how individualized cuff pressures are applied. Objectives To quantify the cuff pressures used in the broader blood flow restriction exercise literature, and determine whether there is clear justification for the choice of pressure prescribed. Methods Studies were included in this review from database searches if they employed an experimental design using original data, involved either acute or chronic exercise using blood flow restriction, and they assessed limb or arterial occlusion pressure to determine an individualized cuff pressure. Methodologies of the studies were evaluated using a bespoke quality assessment tool. Results Fifty‐one studies met the inclusion criteria. Individualized cuff pressures ranged from 30% to 100% arterial occlusion pressure. Only 7 out of 52 studies attempted to justify the individualized cuff pressure applied during exercise. The mean quality rating for all studies was 11.1 ± 1.2 out of 13. Conclusions The broader blood flow restriction exercise literature uses markedly heterogeneous prescription variables despite using individualized cuff pressures. This is problematic in the absence of any clear justification for the individualized cuff pressures selected. Systematically measuring and reporting all relevant acute responses and training adaptations to the full spectrum of BFR pressures alongside increased clarity around the methodology used during blood flow restriction exercise is paramount.

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“…20 Newer research is demonstrating that the effects of BFR therapy may be more closely linked to systemically driven hormonal and cellular changes than originally thought. 52,53 For example, demonstrable differences in strength in the upper extremity were only notable when a cross transfer effect was induced by using BFR concurrently in the lower extremity, activating larger muscle groups and eliciting a larger systemic response. 52,53 As mentioned previously, BFR has been shown to increase sympathetic nervous system activity, which may help to explain the observed effect on pain with activity.…”

Section: Discussionmentioning

confidence: 99%

“…52,53 For example, demonstrable differences in strength in the upper extremity were only notable when a cross transfer effect was induced by using BFR concurrently in the lower extremity, activating larger muscle groups and eliciting a larger systemic response. 52,53 As mentioned previously, BFR has been shown to increase sympathetic nervous system activity, which may help to explain the observed effect on pain with activity. [39][40][41][42][43] St. John et al found that patients presenting to an upper extremity clinic who had better pain scores also had better physical function when compared with patients with worse pain scores.…”

Section: Discussionmentioning

confidence: 99%

Safety and Efficacy of Blood Flow Restriction Therapy after Operative Management of Distal Radius Fractures: A Randomized Controlled Study

2020

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Background Blood flow restriction (BFR) therapy is an emerging addition to rehabilitative programs that allows patients to increase strength at lower loads over shorter time periods. Therefore, we conducted a study to evaluate the safety and efficacy of a rehabilitation program using BFR to a traditional rehabilitation protocol following operative fixation of distal radius fractures. Methods A randomized controlled study was conducted comparing a standardized rehabilitation protocol alone to a combined protocol with the use of BFR therapy in patients treated with volar plate fixation following a displaced distal radius fracture. The same exercises done in the control group were performed by the BFR group with a restrictive tourniquet in place. Patients were followed with serial radiographs to ensure fracture stability. Outcome measures included wrist range of motion, grip strength, pinch strength, visual analog scale (VAS) pain scores at rest and during activity, patient rated wrist evaluation scores (PRWE), and disabilities of the arm, shoulder, and hand scores. Results Nine patients were randomized and enrolled within the BFR group (n = 5) and control (n = 4) groups. Patients within the BFR group had a significantly greater reduction in pain with activity over the course of the rehabilitation program. Additionally, the BFR group had a significant improvement in PRWE scores during the 8-week rehabilitation program. There was no difference in radiographic measures after initiation of BFR, and all patients tolerated therapy without noted complications. Conclusion BFR therapy is safe and well tolerated after operatively treated distal radius fractures. The addition of BFR therapy can result in quicker reduction in pain with activity and improvement in patient disability when used early following operative management of a distal radius fracture. Level of Evidence This is a Level 1, prognostic study.

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Lower body blood flow restriction training may induce remote muscle strength adaptations in an active unrestricted arm

Cited by 34 publications

References 44 publications

Effect of blood‐flow restricted vs heavy‐load strength training on muscle strength: Systematic review and meta‐analysis

Effect of blood‐flow restricted vs heavy‐load strength training on muscle strength: Systematic review and meta‐analysis

Is there rationale for the cuff pressures prescribed for blood flow restriction exercise? A systematic review

Safety and Efficacy of Blood Flow Restriction Therapy after Operative Management of Distal Radius Fractures: A Randomized Controlled Study

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