The effects of resistance training with blood flow restriction on muscle strength, muscle hypertrophy and functionality in patients with osteoarthritis and rheumatoid arthritis: A systematic review with meta-analysis

Abstract

Introduction Rheumatoid arthritis(RA) and osteoarthritis(OA) patients showed systemic manifestations that may lead to a reduction in muscle strength, muscle mass and, consequently, to a reduction in functionality. On the other hand, moderate intensity resistance training(MIRT) and high intensity resistance training(HIRT) are able to improve muscle strength and muscle mass in RA and OA without affecting the disease course. However, due to the articular manifestations caused by these diseases, these patients may present intolerance to MIRT or HIRT. Thus, the low intensity resistance training combined with blood flow restriction(LIRTBFR) may be a new training strategy for these populations. Objective To perform a systematic review with meta-analysis to verify the effects of LIRTBFR on muscle strength, muscle mass and functionality in RA and OA patients. Materials and methods A systematic review with meta-analysis of randomized clinical trials(RCTs), published in English, between 1957–2021, was conducted using MEDLINE(PubMed), Embase and Cochrane Library. The methodological quality was assessed using Physiotherapy Evidence Database scale. The risk of bias was assessed using RoB2.0. Mean difference(MD) or standardized mean difference(SMD) and 95% confidence intervals(CI) were pooled using a random-effects model. A P<0.05 was considered statistically significant. Results Five RCTs were included. We found no significant differences in the effects between LIRTBFR, MIRT and HIRT on muscle strength, which was assessed by tests of quadriceps strength(SMD = -0.01[-0.57, 0.54], P = 0.96; I² = 58%) and functionality measured by tests with patterns similar to walking(SMD = -0.04[-0.39, 0.31], P = 0.82; I² = 0%). Compared to HIRT, muscle mass gain after LIRTBFR was reported to be similar. When comparing LIRTBFR with low intensity resistance training without blood flow restriction(LIRT), the effect LIRTBFR was reported to be higher on muscle strength, which was evaluated by the knee extension test. Conclusion LIRTBFR appears to be a promising strategy for gains in muscle strength, muscle mass and functionality in a predominant sample of RA and OA women.

Blood flow restriction resistance training as an alternative to resistance training alone to improve strength in elderly: a systematic review with meta-analysis

“…Finally, to find the SD change presented by IQR, we use the calculation available below [20]. The choice for using these formulas was based on a previous Systematic Review with meta-analysis about effects of BFR training on strength, hypertrophy, and functionality for people with osteoarthritis and rheumatoid arthritis [21].…”

“…The calculation of SMD is represented by dividing the difference in mean outcome between groups by the standard deviation of the result within the groups. The formula between groups within each study used is available below [21,23]. The 95% confidence intervals (CI) were used, and the heterogeneity of the studies included in the meta-analysis was assessed using the inconsistency test (I 2 ).…”

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

“…Similarly, a systematic review and meta-analysis including 5 RCTs on patients with osteoarthritis and rheumatoid arthritis, found no difference between LL-BFRT and moderate and HL-RT on muscle strength, muscle mass and functionality measures, with LL-BFRT more effect for increasing strength than LL-RT [141]. Another recent meta-analysis including nine studies on various knee disorders found that muscle strength increases were comparably superior for LL-BFRT, and HL-RT compared to LL-RT, with pain improvement superior for LL-BFRT compared to LL-RT and HL-RT [142]. Systematic reviews have also found benefit of LL-BFRT for increasing muscle strength and function in clinical patients during rehabilitation for pre-and post-operative anterior cruciate ligament (ACL) reconstruction [143][144][145][146][147], knee surgery [148], osteoarthritis [149,150], various knee conditions [151][152][153][154], muscular atrophy [155], sarcopenia [156], and elderly patients at risk for various musculoskeletal conditions [113][114][115][116].…”

Sarcopenia in Immune-Mediated Rheumatic Diseases—Review

“…Low-intensity RT combined with vascular occlusion is able to provide muscle strength and muscle mass gains similar to RT performed at high loads 48 . In addition, such benefits have also been extended to chronic arthritis patients (RA and osteoarthritis) 54 . Thus, although exercise has been shown to be effective, it will be important to continue to adapt physical training strategies to populations with musculoskeletal limitations.…”