Resistance Training with Blood Flow Restriction Compared to Traditional Resistance Training on Strength and Muscle Mass in Non-Active Older Adults: A Systematic Review and Meta-Analysis

Abstract

Low-intensity training with blood flow restriction (LI-BFR) has been suggested as an alternative to high-intensity resistance training for the improvement of strength and muscle mass, becoming advisable for individuals who cannot assume such a load. The systematic review aimed to determine the effectiveness of the LI-BFR compared to dynamic high-intensity resistance training on strength and muscle mass in non-active older adults. A systematic review was conducted according to the Cochrane Handbook and reportedly followed the PRISMA statement. MEDLINE, EMBASE, Web of Science Core Collection, and Scopus databases were searched between September and October 2020. Two reviewers independently selected the studies, extracted data, assessed the risk of bias and the quality of evidence using the GRADE approach. Twelve studies were included in the qualitative synthesis. Meta-analysis pointed out significant differences in maximal voluntary contraction (MVC): SMD 0.61, 95% CI [0.10, 1.11], p = 0.02, I2 71% p < 0.0001; but not in the repetition maximum (RM): SMD 0.07, 95% CI [−0.25, 0.40], p = 0.66, I2 0% p < 0.53; neither in the muscle mass: SMD 0.62, 95% CI [−0.09, 1.34], p = 0.09, I2 59% p = 0.05. Despite important limitations such as scarce literature regarding LI-BFR in older adults, the small sample size in most studies, the still differences in methodology and poor quality in many of them, this systematic review and meta-analysis revealed a positive benefit in non-active older adults. LI- BFR may induce increased muscular strength and muscle mass, at least at a similar extent to that in the traditional high-intensity resistance training.

Effects of Blood Flow Restriction Combined with Low-Intensity Resistance Training on Lower-Limb Muscle Strength and Mass in Post-Middle-Aged Adults: A Systematic Review and Meta-Analysis

“…The results of our meta-analysis of 11 RCTs showed greater muscle strength gain with BFRt when compared to LIRT or normal activity, but no statistical difference between BFRt and HIRT was seen. Muscle strength gain after BFRt was also reported in recent meta-analyses [ 25 , 26 ], but these studies did not address the influence of training frequency. A research study reported that both BFRt and HIRT for 12 weeks can improve strength gain in older adults, and the benefits of BFRt and HIRT were not statistically different [ 38 ].…”

“…In contrast, the results of other meta-analyses showed that BFRt produced the same muscle strength gain as HIRT in older adults. [ 25 , 26 ]. These seemingly contradictory results in research studies and meta-analyses may be due to differences in the intervention protocol that was applied.…”

Beneficial Role of Blood Flow Restriction Exercise in Heart Disease and Heart Failure Using the Muscle Hypothesis of Chronic Heart Failure and a Growing Literature

“…Although these results are promising, further investigation of BFRE in patients with HD and HF is needed in view of the beneficial effects on skeletal muscle, functional performance, and cardiorespiratory function in older subjects without heart disease. ( Hughes et al, 2017 ; Beckwée et al, 2019 ; Centner et al, 2019 ; Van Cant et al, 2020 ; Nitzsche et al, 2021 ; Rodrigo-Mallorca et al, 2021 ; Labata-Lezaun et al, 2022 ). Finally, there is a distinct need for additional randomized controlled trials examining the effects of BFRE in patients with HD and HF.…”

“…A substantial literature of BFRE in older adults exists in which significant gains in strength and functional performance have been observed without report of adverse events. ( Beckwée et al, 2019 ; Centner et al, 2019 ; Rodrigo-Mallorca et al, 2021 ; Labata-Lezaun et al, 2022 ). Sophisticated tourniquets exist which allow for a more precise and personalized reduction in blood flow based on the limb occlusion pressure enabling safer and more precise BFRE in older adults and in patients with HD and HF.…”

Potential Role of Blood Flow Restricted Exercise for Older Adults

“…The utilization of MBFR can result in increased skeletal muscle hypertrophy and strength for younger and older adults when combined with low-load resistance training (for systematic reviews and meta-analysis see [31][32][33][34][35][36]). The combination of resistance training with MBFR enhances skeletal muscle adaptations, however a lower load is required than those utilized with traditional resistance training programs.…”