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This study investigated the effect of limb occlusion pressure (LOP) position on exercise performance, cardiovascular responses, and perceptual experiences during seated bilateral leg extensions with and without blood flow restriction (BFR). Thirty resistance-trained males (age: 22 ± 2 years; weight: 74.4 ± 13.6 kg; height: 177.4 ± 6.4 cm; BMI: 23.5 ± 3.3 kg/m2) participated. Each performed exercise to failure (4 sets, 30% 1RM, 1 min rest) in three conditions: Supine LOP-BFR, Seated LOP-BFR, and no-BFR. BFR was applied at 60% LOP. Significant interaction effects were found for RPE (p = 0.021, d = 0.76), RPD (p < 0.01, d = 1.72), and DOMS (p < 0.01, d = 2.28). Statistically significant fewer repetitions were completed in Supine LOP-BFR vs. no-BFR (p < 0.01, d = 0.5), Seated LOP-BFR vs. no-BFR (p < 0.01, d = 1.0), and Seated LOP-BFR vs. Supine LOP-BFR (p < 0.01, d = 0.6). RPE was higher in Seated LOP-BFR vs. no-BFR (p < 0.01, d = 0.52). RPD was higher in Supine LOP-BFR vs. no-BFR (p < 0.01, d = 0.62) and Seated LOP-BFR vs. no-BFR (p < 0.01, d = 1.25). DOMS was higher in Supine LOP-BFR vs. no-BFR (p < 0.01, d = 0.77) and Seated LOP-BFR vs. no-BFR (p < 0.01, d = 3.52). Seated LOP-BFR increased perceptual demands and reduced repetitions compared to Supine LOP-BFR. Both LOP-BFR conditions reduced repetitions compared to no-BFR without affecting cardiovascular measures. [ABSTRACT FROM AUTHOR]

Blood flow-restricted resistance exercise (BFR-RE) is a method of exercise that restricts blood flow to the muscles using a pressure device. It has been shown to increase muscle mass and performance with lower levels of physical exertion compared to traditional resistance training. However, there are concerns about the safety of BFR-RE, particularly for patients with cardiovascular disease. Studies have reported mixed findings on the cardiovascular responses to BFR-RE, with some showing elevated blood pressure and heart rate during exercise, while others have found no significant impact. More research is needed to fully understand the cardiovascular effects of BFR-RE, and standardized protocols and real-time monitoring are necessary, especially for individuals with cardiovascular disease. This document provides a list of references to scientific studies and articles that explore the effects of blood flow restriction exercise on hemodynamics, cardiovascular response, muscle growth, and rehabilitation in different populations. These studies offer insights into the mechanisms and safety of BFR-RE and highlight its potential benefits for muscle hypertrophy and cardiovascular health. [Extracted from the article]

Whether low-load resistance training (RT) without muscle failure, with or without blood flow restriction (BFR), is sufficient to increase strength and muscle growth of calf muscles in trained individuals is still unclear. This study aimed to compare the effects of low-intensity BFR RT vs. traditional low-intensity RT (noBFR) with moderate training volume on strength and circumference. We designed a parallel, randomized controlled trial including 36 RT-trained participants (BFR: 7 females, 32.9 ± 8.8 years, 11 males, 28.4 ± 3.6 years; noBFR; 8 females, 29.6 ± 3.4 years; 10 males, 28.6 ± 4.9 years) who underwent eight weeks of twice-weekly low-load RT with a total of 16 RT sets (30 % of one-repetition maximum [1RM]). RT consisted of bilateral calf raises and seated unilateral calf raises, each conducted with 4 sets (30, 15, 15, 15 repetitions not to failure) of either BFR or noBFR. Outcome measures included calf circumference (CC), leg stiffness (LS), and various strength tests (seated and standing calf raise 1RM, isokinetic strength of plantar- and dorsiflexion). There were no significant interactions or group effects for most measures. Both groups showed significant improvements in seated calf raise strength (p=0.046, η2p=0.17). Pairwise comparisons indicated moderate to large effect sizes for strength improvements (standardized mean differences: 0.35–1.11), but no changes in calf circumference were observed in either group. Low-load RT with and without BFR are useful to increase strength without necessarily affecting hypertrophy. Low-intensity BFR training did not confer additional benefits over traditional low-intensity RT for calf muscle strength or circumference, questioning its general advantage under such conditions. [ABSTRACT FROM AUTHOR]

Context: Blood flow restricted exercise involves the use of external pressure to enhance fatigue and augment exercise adaptations. The mechanisms by which blood flow restricted exercise limits muscular endurance are not well understood. Objective: To determine how increasing blood flow restriction pressure impacts local muscular endurance, discomfort, and force steadiness when the contractions are already occlusive. Design: Within-participant, repeated-measures crossover design. Setting: University laboratory. Patients: A total of 22 individuals (13 males and 9 females). Intervention: Individuals performed a contraction at 30% of maximal isometric elbow flexion force for as long as possible. One arm completed the contraction with 100% of arterial occlusion pressure applied, while the other arm had 150% of arterial occlusion pressure applied. At the end of the protocol, individuals were asked to rate their perceived discomfort. Main Outcome Measures: Time to task failure, discomfort, and force steadiness. Results: Individuals had a longer time to task failure when performing the 100% arterial occlusion condition compared with the 150% arterial occlusion pressure condition (time to task failure = 82.4 vs 70.8 s; Bayes factors = 5.77). There were no differences in discomfort between the 100% and 150% conditions (median discomfort = 5.5 vs 6; Bayes factors = 0.375) nor were there differences in force steadiness (SD of force output 3.16 vs 3.31 N; Bayes factors = 0.282). Conclusion: The results of the present study suggest that, even when contractions are already occlusive, increasing the restriction pressure reduces local muscle endurance but does not impact discomfort or force steadiness. This provides an indication that mechanisms other than the direct alteration of blood flow are contributing to the increased fatigue with added restrictive pressure. Future studies are needed to examine neural mechanisms that may explain this finding. [ABSTRACT FROM AUTHOR]

Context: Recently, blood flow restriction (BFR) training has gained popularity as an alternative to high-load resistance training for improving muscle strength and hypertrophy. Previous BFR studies have reported positive treatment effects; however, clinical benefits to using BFR following meniscal repair or chondral surgery are unknown. The purpose of this study was to determine the effect of resistance exercises with BFR training versus exercises alone on self-reported knee function, thigh circumference, and knee flexor/extensor strength postmeniscal or cartilage surgery. Design: Single-blinded randomized controlled trial in an outpatient military hospital setting. Twenty participants were randomized into 2 groups: BFR group (n = 11) and control group (n = 9). Methods: Participants completed 12 weeks of postoperative thigh strengthening. The BFR group performed each exercise with the addition of BFR. Both groups continued with the prescribed exercises without BFR from 12 weeks until discharged from therapy. Thigh circumference and self-reported knee function were measured at 1, 6, 12, and 24 weeks postoperatively along with knee extensor and flexor strength at 12 and 24 weeks. Change scores between time points were calculated for knee function. Limb symmetry indices (LSI) were computed for thigh circumference and knee strength variables. Results: Seventeen participants were included in the final analyses (BFR = 8 and control = 9) due to COVID-19 restrictions. There were no interactions or main effects for group. Time main effects were established for change in knee function scores, thigh circumference LSI, and knee extensor strength LSI. However, knee flexor strength LSI had no main effect for time. Conclusion: The outcomes of this trial suggest that resistance exercises with and without BFR training may result in similar changes to function, thigh atrophy, and knee extensor strength postmeniscus repair/chondral restoration, though further study with larger sample sizes is needed. [ABSTRACT FROM AUTHOR]

BACKGROUND: Pain and weakness are 2 commonly reported postamputation symptoms. The purpose of this case report is to propose a novel blood flow restriction (BFR) protocol to address pain and weakness in a patient with transtibial limb loss. CASE PRESENTATION: A 36-year-old male 2 months after transtibial amputation presented for evaluation and treatment of his postamputation pain, weakness, and poor functional mobility. The patient completed a novel BFR strength protocol twice per week for 12 weeks. OUTCOME AND FOLLOW-UP: Amputee Mobility Predictor, L Test Measure of Functional Mobility, 2-minute walk test, 30-second sit to stand, hamstring force, single-limb leg press repetition maximum, hip abduction endurance test, and numeric pain scale preintervention and postintervention were measured. The patient achieved the minimal detectable change for the L-Test and 2MWT, resulting in meaningful improvement in the patient's strength and function following the blood flow restriction protocol. DISCUSSION: This case supports the use of blood flow restriction to address postamputation weakness and pain in a physical therapy setting. JOSPT Cases 2024;4(1):1-7. Epub 30 November 2023. doi:10.2519/josptcases.2023.11327 [ABSTRACT FROM AUTHOR]

Background: Blood Flow Restriction (BFR) training combines low-intensity exercise with blood flow occlusion to produce outcomes comparable to those of high-intensity training. BFR is as effective as high-intensity protocols known to enhance knee extensor muscle strength in subjects with knee osteoarthritis (OA). Therefore, the aim of this study is to find out the effect of Partial Blood Flow Restriction Training on pain and physical functioning among knee OA subjects. Purpose: To assess the effectiveness of Partial Blood Flow Restriction Training in Improving Physical Functioning Among Middle-Aged Subjects with Knee Osteoarthritis. Materials and Methods: This is the pilot study where twenty subjects with knee OA were divided randomly into two equal groups. Group "A" received BFR training combined with conventional exercise two times/week and Group "B" received conventional exercise two times/week. Numeric Pain Rating Scale (NPRS), Western Ontario and McMaster Universities Arthritis Index (WOMAC) were used to evaluate subjects at two intervals (Pre-Test and Post-Test). Results: The difference between the Group A and Groups B was statistically significant (p<=0.001). Hence conventional exercise combined with blood flow restriction training shows significant improvement than conventional exercise among OA knee subjects. Conclusion: This pilot study concluded that the conventional exercise combined with blood flow restriction training was effective in subjects with OA knee. [ABSTRACT FROM AUTHOR]

Resistance training (RT) with blood flow restriction (BFR) or high intensity (HI) are effective to increase muscle mass. To understand this effect, techniques known as "omics" are used to identify possible biomarkers. This study analyzed the salivary proteomic profile of healthy individuals trained before and after two RT protocols both designed with eight exercises for upper‐ and lower‐limbs, one performed at low percentage of one‐maximum repetition (%1RM) with BFR technique, and other at high %1RM (HI) without BRF technique. Four healthy males between 18 and 28 years participated in the study. Stimulated saliva was collected before (BBFR/BHI) and immediately after (ABFR/AHI) the two RT protocols. All protein‐related processing was performed using label‐free proteomic. The difference in expression between groups was expressed as p <.05 for downregulated proteins and 1‐p >.95 for upregulated proteins. There was difference in salivary flow between ABFR and BBFR (p =.005). For HI, 87 proteins were found after the practice and 119 before. Three hemoglobin isoforms were increased in AHI compared with BHI. In the BFR comparison, 105 proteins were identified after (ABFR) and 70 before (BBFR). Among those increased ABFR, we highlight five hemoglobin isoforms and Deleted in malignant brain tumors 1 protein. Between ABFR and AHI, 17 isoforms of histones, Transaldolase, Transketolase, Glyceraldehyde‐3‐phosphate dehydrogenase, and Antileukoproteinase were decreased ABFR. For HI, there was an increase in proteins related to oxidative stress and metabolism of the musculoskeletal system, compared with BFR. HI seems to induce higher anabolic signaling to muscle mass increase and antiatherosclerotic effects. Significance statement: The main focus of this work was to show an alternative analysis by using saliva proteome for monitoring athletes who require different modalities of high‐intensity resistance training, taking into account molecular parameters that may predict the effect of training in terms of performance, muscle hypertrophy, systemic and oral benefits. [ABSTRACT FROM AUTHOR]

Abstract Objective To compare the effect of low-load blood flow restricted resistance training (BFR-RT) versus high-load resistance training (HL-RT) on muscle strength, muscle mass, physical function, patient-reported outcomes, and adherence to training in clinical musculoskeletal populations. Data sources Web of Science, Cochrane Central, Medline, Embase, SportDiscus was searched on the 30th May 2022. Review methods This study was conducted as a systematic review and meta-analysis. Randomized Controlled Trials (RCTs) were included if they (i) included patients, (ii) comprised of a BFR-RT intervention protocol and a group who performed HL-RT (≥ 70%1RM) for at least eight exercise sessions, and (iii) involved at least 1 exercise that targeted the lower limbs. The Cochrane Risk of Bias tool was used to evaluate the risk of bias. The meta-analyses were performed using a random effects model with an adjustment to the confidence interval. Results Seven RCTs comprising 303 participants (BFR-RT: n = 151; HL-RT: n = 152) were identified. HL-RT and BFR-RT showed similar gains in dynamic (1-10RM) knee extensor strength and leg press strength, quadriceps cross sectional area, sit-to-stand performance, and patient reported pain and function. There was a moderate effect favoring BFR-RT for increasing maximal isometric knee extensor strength. The grading of certainty in evidence was low-to-very low for all outcome variables. Conclusion This systematic review and meta-analysis extends our current knowledge about BFR-RT and HL-RT as equally effective exercise methods for inducing gains in maximal muscle strength in healthy populations, by now also comprising patients suffering from various clinical musculoskeletal conditions. The certainty in the estimates was low-to-very low, prompting the inclusion of future higher-quality trials. Trial registration PROSPERO ID (CRD42022337173). Registered June 18th 2022.

Abstract Background Muscle atrophy, muscle weakness and localised pain are commonly reported following musculoskeletal injury (MSKI). To mitigate this risk and prepare individuals to return to sport or physically demanding occupations, resistance training (RT) is considered a vital component of rehabilitation. However, to elicit adaptations in muscle strength, exercise guidelines recommend lifting loads ≥ 70% of an individual’s one repetition maximum (1-RM). Unfortunately, individuals with persistent knee pain are often unable to tolerate such high loads and this may negatively impact the duration and extent of their recovery. Low load blood flow restriction (LL-BFR) is an alternative RT technique that has demonstrated improvements in muscle strength, hypertrophy, and pain in the absence of high mechanical loading. However, the effectiveness of high-frequency LL-BFR in a residential rehabilitation environment remains unclear. This study will compare the efficacy of high frequency LL-BFR to ‘conventional’ heavier load resistance training (HL-RT) on measures of physical function and pain in adults with persistent knee pain. Methods This is a multicentre randomised controlled trial (RCT) of 150 UK service personnel (aged 18–55) admitted for a 3-week residential rehabilitation course with persistent knee pain. Participants will be randomised to receive: a) LL-BFR delivered twice daily at 20% 1-RM or b) HL-RT three-times per week at 70% 1-RM. Outcomes will be recorded at baseline (T1), course discharge (T2) and at three-months following course (T3). The primary outcome will be the lower extremity functional scale (LEFS) at T2. Secondary outcomes will include patient reported perceptions of pain, physical and occupational function and objective measures of muscle strength and neuromuscular performance. Additional biomechanical and physiological mechanisms underpinning both RT interventions will also be investigated as part of a nested mechanistic study. Discussion LL-BFR is a rehabilitation modality that has the potential to induce positive clinical adaptations in the absence of high mechanical loads and therefore could be considered a treatment option for patients suffering significant functional deficits who are unable to tolerate heavy load RT. Consequently, results from this study will have a direct clinical application to healthcare service providers and patients involved in the rehabilitation of physically active adults suffering MSKI. Trial registration ClinicalTrials.org reference number, NCT05719922

Objective: To compare the effect of low-load blood flow restricted resistance training (BFR-RT) versus high-load resistance training (HL-RT) on muscle strength, muscle mass, physical function, patient-reported outcomes, and adherence to training in clinical musculoskeletal populations. Data sources: Web of Science, Cochrane Central, Medline, Embase, SportDiscus was searched on the 30th May 2022. Review methods: This study was conducted as a systematic review and meta-analysis. Randomized Controlled Trials (RCTs) were included if they (i) included patients, (ii) comprised of a BFR-RT intervention protocol and a group who performed HL-RT (≥ 70%1RM) for at least eight exercise sessions, and (iii) involved at least 1 exercise that targeted the lower limbs. The Cochrane Risk of Bias tool was used to evaluate the risk of bias. The meta-analyses were performed using a random effects model with an adjustment to the confidence interval. Results: Seven RCTs comprising 303 participants (BFR-RT: n = 151; HL-RT: n = 152) were identified. HL-RT and BFR-RT showed similar gains in dynamic (1-10RM) knee extensor strength and leg press strength, quadriceps cross sectional area, sit-to-stand performance, and patient reported pain and function. There was a moderate effect favoring BFR-RT for increasing maximal isometric knee extensor strength. The grading of certainty in evidence was low-to-very low for all outcome variables. Conclusion: This systematic review and meta-analysis extends our current knowledge about BFR-RT and HL-RT as equally effective exercise methods for inducing gains in maximal muscle strength in healthy populations, by now also comprising patients suffering from various clinical musculoskeletal conditions. The certainty in the estimates was low-to-very low, prompting the inclusion of future higher-quality trials. Trial registration: PROSPERO ID (CRD42022337173). Registered June 18th 2022. [ABSTRACT FROM AUTHOR]

The purpose of this systematic review and meta-analysis was to compare changes in explosive power between blood flow restriction training and traditional resistance training protocols. Searches of PubMed, Scopus, Web of Science, and OVID Medline were conducted for studies. Inclusion criteria were: (a) healthy people; (b) randomized controlled or controlled trials; (c) outcome measures of explosive performance (peak power, rate of force development, jump performance, sprint performance, etc.); (d) involving a comparison between blood flow restriction training and traditional resistance training. Quality assessment was conducted using the Physiotherapy Evidence Database (PEDro) scale. A total of 12 studies (262 subjects) were finally included for analysis. The PEDro scale score had a median of 5 of 10 points (range: 3-6 points). Significant small to moderate improvements were observed in blood flow restriction training [jump: standard mean difference (SMD) of 0.36 (95% CI: 0.02; 0.69); sprint: SMD of 0.54 (95% CI: 0.00; 1.07); power: SMD of 0.72 (95% CI: 0.17; 1.27)] when compared to traditional resistance training. The findings indicate that blood flow restriction training is more effective in improving explosive power of lower limbs compared to traditional resistance training in healthy people. In addition, blood flow restriction with a wide cuff (≥ 10 cm) during training improved explosive power better than with a narrow cuff or during the rest interval. Blood flow restriction training is very suitable for athletes in short competitive seasons and those who are not able to tolerate high loads (i.e., rehabilitators and the elderly). [ABSTRACT FROM AUTHOR]

Context: Neuromuscular electrical stimulation (NMES) combined with blood flow restriction (BFR) has been shown to improve muscular strength and size better than NMES alone. However, previous studies used varied methodologies not recommended by previous NMES or BFR research. Objective: The present study investigated the acute effects of NMES combined with varying degrees of BFR using research-recommended procedures to enhance understanding and the clinical applicability of this combination. Design: Randomized crossover. Setting: Physiology laboratory. Participants: A total of 20 healthy adults (age 27 [4] y; height 177 [8] cm; body mass 77 [13] kg). Interventions: Six sessions separated by at least 7 days. The first 2 visits served as familiarization, with the experimental conditions performed in the final 4 sessions: NMES alone, NMES 40% BFR, NMES 60% BFR, and NMES 80% BFR. Main Outcome Measures: Maximal voluntary isometric contraction, muscle thickness, blood pressure, heart rate, rating of perceived exertion, and pain were all recorded before and after each condition. Results: The NMES 80% BFR caused greater maximal voluntary isometric contraction decline than any other condition (-38.9 [22.3] N-m, P< .01). Vastus medialis and vastus lateralis muscle thickness acutely increased after all experimental conditions (P< .05). Pain and ratings of perceived exertion were higher after NMES 80% BFR compared with all other experimental conditions (P < .05). No cardiovascular effects were observed between conditions. Conclusion: The NMES combined with 80% BFR caused greater acute force decrement than the other conditions. However, greater perceptual ratings of pain and ratings of perceived exertion were observed with NMES 80% BFR. These acute observations must be investigated during chronic interventions to corroborate any relationship to changes in muscle strength and size in clinical populations. [ABSTRACT FROM AUTHOR]

Context: Blood flow restriction (BFR) training utilizes a tourniquet, applied to the proximal portion of one or more extremities, to occlude blood flow during exercise. Significant gains in strength and cross-sectional area can be achieved in muscles, both distal and proximal to BFR cuff application. Purpose: To compare strength gains of the rotator cuff and changes in tendon size in subjects who performed side-lying external-rotation exercise with or without BFR. Methods: Forty-six subjects (mean age 25.0 [2.2] y) were randomized to either a BFR + exercise group or to the exercise-only group. Subjects performed 4 sets of the exercise (30/15/15/15 repetitions) at 30% 1-repetition maximum 2 days per week for 8 weeks. Results: Subjects in both groups experienced strength gains in the supraspinatus and the external rotators (P =.000, P =.000). However, there was no difference in strength gains between groups for the supraspinatus (P =.750) or the external rotators (P =.708). Subjects in both groups experienced increases in supraspinatus tendon thickness (BFR P =.041, exercise only P =.011). However, there was no difference between groups (P =.610). Conclusions: Exercise with BFR applied to the proximal upper extremity did not augment rotator cuff strength gains or tendon thickness when compared with subjects who only exercised. This study did demonstrate that performing multiple sets of high repetitions at a low load led to significant increases in rotator cuff strength and tendon size in the dominant upper extremity. [ABSTRACT FROM AUTHOR]

Objective: Measurement of arterial occlusion pressure (AOP) is essential to the safe and effective use of blood flow restriction during exercise. Use of a Doppler ultrasound (US) is the "gold standard" method to measure AOP. Validation of a handheld Doppler (HHDOP) device to measure AOP could make the measurement of AOP more accessible to practitioners in the field. The purpose of this study was to determine the accuracy of AOP measurements of the brachial and femoral arteries using an HHDOP. Methods: We simultaneously measured AOP using a "gold standard" US and a HHDOP in the dominant and non-dominant arms (15 males; 15 females) and legs (15 males; 15 females). Results: There were no differences in limb circumference or limb volume in the dominant and non-dominant arms and legs between males and females or between the dominant and non-dominant arms and legs of males and females. The differences between US and HHDOP measures of AOP in the dominant and non-dominant arms and legs were either not significant or small (<10 mmHg) and of little practical importance. There were no sex differences in AOP measurements of the femoral artery (p > 0.60). Bland-Altman analysis yielded an average bias (-0.65 mmHg; -2.93 mmHg) and reasonable limits of agreement (±5.56 mmHg; ±5.58 mmHg) between US and HHDOP measures of brachial and femoral artery AOP, respectively. Conclusion: HHDOP yielded acceptable measures of AOP of the brachial and femoral arteries and can be used to measure AOP by practitioners for the safe and effective use of blood flow restriction. Due to the potential differences in AOP between dominant and non-dominant limbs, AOP should be measured in each limb. [ABSTRACT FROM AUTHOR]

Introduction: The efficacy of low-intensity blood flow restriction (LI-BFR) training programs in bone metabolism remains unclear compared to low-intensity (LI) training and high-intensity (HI) training. The aim of this review was to quantitatively identify the effects of LI-BFR training on changes in bone formation markers (i.e., bone-specific alkaline phosphatase, BALP), bone resorption (i.e., C-terminal telopeptide of type I collagen, CTX) and bone mineral density (BMD) compared with conventional resistance training programmes. Additionally, the effectiveness of walking with and without BFR was assessed. Methods: PubMed, Scopus, SPORTDiscus, Web of Science and Google Scholar databases were searched for articles based on eligibility criteria. Review Manager Version 5.4 was used for Meta-analysis. Physiotherapy Evidence Database (PEDro) was applied to assess the methodological quality of studies. Results: 12 articles were included in the meta-analysis, with a total of 378 participants. Meta-results showed that compared with LI training, LI-BFR training induced greater increments in BALP (young adults:MD = 6.70, p < 0.001; old adults: MD = 3.94, p = 0.002), slight increments in BMD (young adults: MD = 0.05, p < 0.00001; old adults: MD = 0.01, p < 0.00001), and greater decrements in CTX (young adults: MD = -0.19, p = 0.15; old adults: MD = -0.07, p = 0.003). Compared with HI training, LI-BFR training produced smaller increments in BALP (young adults: MD = -6.87, p = 0.24; old adults: MD = -0.6, p = 0.58), similar increments in BMD (MD = -0.01, p = 0.76) and similar decrements in CTX (young adults: MD = 0, p = 0.96; old adults: MD = -0.08, p = 0.13). Although there were only two studies on walking training intervention, walking training with BFR had a better effect on bone metabolism than training without BFR. Discussion: In conclusion, LI-BFR training induces greater improvements in bone health than LI training, but is less effective than HI training. Therefore, LI-BFR training may be an effective and efficient way to improve bone health for untrained individuals, older adults, or those undergoing musculoskeletal rehabilitation. [ABSTRACT FROM AUTHOR]

Accumulating evidence indicates that some COVID-19 survivors display reduced muscle mass, muscle strength, and aerobic capacity, which contribute to impairments in physical function that can persist for months after the acute phase of illness. Accordingly, strategies to restore muscle mass, muscle strength, and aerobic capacity following infection are critical to mitigate the long-term consequences of COVID-19. Blood flow restriction (BFR), which involves the application of mechanical compression to the limbs, presents a promising therapy that could be utilized throughout different phases of COVID-19 illness. Specifically, we hypothesize that: 1) use of passive BFR modalities can mitigate losses of muscle mass and muscle strength that occur during acute infection and 2) exercise with BFR can serve as an effective alternative to high-intensity exercise without BFR for regaining muscle mass, muscle strength, and aerobic capacity during convalescence. The various applications of BFR may also serve as a targeted therapy to address the underlying pathophysiology of COVID-19 and provide benefits to the musculoskeletal system as well as other organ systems affected by the disease. Consequently, we present a theoretical framework with which BFR could be implemented throughout the progression from acute illness to outpatient rehabilitation with the goal of improving short- and long-term outcomes in COVID-19 survivors. We envision that this paper will encourage discussion and consideration among researchers and clinicians of the potential therapeutic benefits of BFR to treat not only COVID-19 but similar pathologies and cases of acute critical illness. [ABSTRACT FROM AUTHOR]

Persistent dysphagia is a major predictor of prolonged ventilation weaning and unsuccessful attempts at decannulation. Due to the high incidence of dysphagia in tracheotomized patients, tracheal cannula management and dysphagia treatment must be coordinated. A central element of tracheal cannula management in dysphagia treatment is the establishment of physiological airflow. This enables voluntary clearing functions, such as coughing and throat clearing and significantly reduces aspiration. A distinction is made between spontaneous and staged decannulation pathways with expansion of cuff unblocking times and occlusion training. Other therapeutic measures include secretion and saliva management, cough function training with improvement of strength and sensitivity, pharyngeal electrical stimulation, adaptation of tracheal tubes to optimize respiratory and swallowing function, control and treatment of airway stenosis, and standardization of processes for quality assurance. [ABSTRACT FROM AUTHOR]

Low-load resistance training combined with blood flow restriction (BFR) is known to result in muscle hypertrophy and strength similar to that observed with higher loads. However, the effects of resistance training with BFR on cardiac structure and cardiac function remain largely unknown. Therefore, the purpose of this randomized study was to compare the effects of conventional high-load resistance training (HL-RT) with the effects of low-load resistance training with BFR (LL-BFR) on muscle strength and left ventricular function. Sixteen young swimmers (mean ± standard deviation: age = 19.7 ± 1.6 years, body mass = 78.9 ± 9.7 kg, body height = 180.8 ± 5.8 cm) were randomly allocated to a conventional HL-RT group (n = 8) or a LL-BFR group (n = 8) with a pressure band (200 mmHg) placed on both thighs of participants for 4 weeks (3 days·week-1). Outcome measures were taken at baseline and after 4 weeks of training, and included body composition, one-repetition maximum (1RM) back squat, and echocardiography measures. The 1RM back squat significantly improved (partial eta squared (Ƞ²) = 0.365; p = 0.013) in HL-RT (mean difference (Δ) = 6.6 kg; [95% confidence interval (CI) -7.09 to 20.27]) and LL-BFR groups (Δ = 14.7 kg; [95% CI 3.39 to 26.10]), with no main effect of group or group × time interaction (p > 0.05). Interventricular septum end-systolic thickness showed a slight but statistically significant increase in LL-BFR and HL-RT groups (Ƞ² = 0.253; p = 0.047), yet there was no main effect of group or group × time interaction (p > 0.05). There were no statistically significant changes (p > 0.05) in other cardiac structure or function parameters (e.g., left ventricular (LV) mass, LV cardiac output, LV ejection fraction, LV stroke volume) after the training programs. Results suggest that 4 weeks of HL-RT and LL-BFR improve muscle strength similarly with limited effects on left ventricular function in young swimmers. [ABSTRACT FROM AUTHOR]

This study aimed to examine whether increasing pressure pain threshold (PPT) through isometric handgrip exercise (HG) affects the number of repetitions completed and discomfort with knee extension exercise (KE) with blood flow restriction (BFR), and examine whether performing additional exercise leads to a further increase in PPT. Forty-one participants completed 2 trials: rest followed by low-load KE with BFR at 80% of resting arterial occlusion pressure (Rest + KE BFR) and low-intensity (30% of maximal strength) HG exercise followed by KE with BFR (HG + KE BFR). Pressure pain threshold was measured before and after exercise at the forearm and tibialis anterior. Results are presented as median difference (95% credible interval). Pressure pain threshold increased at the forearm (Bayes factor [BF10]: 5.2 × 107) and tibialis anterior (BF10: 1.5 × 106) after HG exercise. However, this did not lead to greater repetitions being completed with BFR exercise (0.2 [-0.1, 0.6] repetitions, BF10: 0.07). Pressure pain threshold after BFR exercise was not augmented over that observed with HG exercise (0.02 [-0.15, 0.2] kg·cm-2, BF10: 0.175) at the forearm. More data are needed in the lower body to determine which model best fits the data (BF10: 0.84). Discomfort with BFR exercise was not different between conditions (1.0 [-2.3, 4.4] arbitrary units, BF10: 0.10). The pain-reducing effect of prior exercise did not change the repetitions completed with BFR exercise, suggesting that the change in PPT may not have been great enough to alter performance. Performing additional exercise did not elicit further increases in PPT nor was perceived discomfort to BFR exercise altered by changes in PPT. [ABSTRACT FROM AUTHOR]

Training with blood flow restriction (BFR) has been shown to be a useful technique to improve muscle hypertrophy, muscle strength and a host of other physiological benefits in both healthy and clinical populations using low intensities [20%-30% 1- repetition maximum (1RM) or <50% maximum oxygen uptake (VO2max)]. However, as BFR training is gaining popularity in both practice and research, there is a lack of awareness for potentially important design characteristics and features associated with BFR cuff application that may impact the acute and longitudinal responses to training as well as the safety profile of BFR exercise. While cuff width and cuff material have been somewhat addressed in the literature, other cuff design and features have received less attention. This manuscript highlights additional cuff design and features and hypothesizes on their potential to impact the response and safety profile of BFR. Features including the presence of autoregulation during exercise, the type of bladder system used, the shape of the cuff, the set pressure versus the interface pressure, and the bladder length will be addressed as these variables have the potential to alter the responses to BFR training. As more devices enter the marketplace for consumer purchase, investigations specifically looking at their impact is warranted. We propose numerous avenues for future research to help shape the practice of BFR that may ultimately enhance efficacy and safety using a variety of BFR technologies. [ABSTRACT FROM AUTHOR]

Explore the feasibility of lower-limb garment-integrated BFR-training. Observational study. Human performance laboratory. Healthy males with no experience of BFR-training. Feasibility was determined by a priori thresholds for recruitment, adherence, and data collection. Safety was determined by measuring BFR torniquet pressure and the incidence of side effects. Efficacy was determined by measuring body anthropometry and knee isokinetic dynamometry. Feasibility and safety outcomes were reported descriptively or as a proportion with 95% confidence intervals (95% CI), with mean change, 95% CIs, and effect sizes for efficacy outcomes. Twelve participants (mean age 24.8 years [6.5]) were successfully recruited; 11 completed the study. 134/136 sessions were completed (adherence = 98.5%) and 100% of data were collected. There was one event of excessive pain during exercise (0.7%, 95% CI 0.0%, 4.0%), two events of excessive pain post-exercise (1.5%, 95% CI 0.4%, 5.5%), and one event of persistent paraesthesia post-exercise (0.7%, 95% CI 0.0%, 4.0%). Mean maximal BFR torniquet pressure was <200 mmHg. We observed an increase in knee extension peak torque (mean change 12.4 Nm), but no notable changes in body anthropometry. Lower-limb garment-integrated BFR-training is feasible, has no signal of important harm, and could be used independently. • Lower limb garment-integrated blood flow restriction training was feasible and safe in healthy males. • Healthy males were adherent to a six-week garment-integrated blood flow restriction training programme. • No changes in body anthropometry were observed. • Small increases in knee extension strength were observed. • Garment-integrated blood flow restriction training is feasible for use in a large scale randomised controlled trial. [ABSTRACT FROM AUTHOR]

Introduction: Blood flow restriction exercise has proven to be an effective training method to promote neuromuscular adaptations, however, a consensus about the effect on other physiological and safety variables, such as cardiovascular responses, has yet to be reached. Purpose: The aim of this study was to compare the acute cardiovascular responses during and after three different resistance training protocols. Material & methods: Fifty-two participants (27.3±7 years; 177.6±11 cm; 72.2±13.7 kg) were randomly allocated into three groups: low-intensity exercise without (LI, n=13) and with blood flow restriction (LI-BFR, n=24), and highintensity exercise (HI, n=15). Participants from LI and LI-BFR groups performed four sets (1x30 + 3x15 reps) at 30% 1RM, while HI group performed four sets (1x30 with 30% 1RM + 3x10 reps with 75% 1RM) of dominantside plantar flexion exercise. For LI-BFR group, a cuff was placed under popliteal region and inflated at 30% of the individual's occlusion pressure (47.6 ± 19.8 mmHg). Results: Blood pressure (BP), heart rate (HR) and oxygen saturation (SpO2) were assessed at baseline, after each set and post-exercise. HR increases significantly during exercise across all protocols, with greater increases for HI group after 4th set (p<0.001; G=1.072) but without differences between groups. HI and LI-BFR protocols showed higher significant post-exercise hypotension and greater reduction in MAP (p<0.05) than LI group. RPP during exercise was different from HI to LI and LI-BFR (p<0.05). HI protocol reduced SpO2 during all sets of exercise (p<0.05). Conclusions: The results of this study indicate that LI-BFR promotes similar hypotensive response to HI, with equal or lower cardiovascular responses during exercise than traditional resistance training. [ABSTRACT FROM AUTHOR]

Low-intensity exercise with blood flow restriction (LIE-BFR) has been proposed as an effective intervention to induce hypoalgesia in both healthy individuals and patients with knee pain. Nevertheless, there is no systematic review reporting the effect of this method on pain threshold. We aimed to evaluate the following: (i) the effect of LIE-BFR on pain threshold compared to other interventions in patients or healthy individuals; and (ii) how different types of applications may influence hypoalgesic response. We included randomized controlled trials assessing the effectiveness of LIE-BFR alone or as an additive intervention compared with controls or other interventions. Pain threshold was the outcome measure. Methodological quality was assessed using the PEDro score. Six studies with 189 healthy adults were included. Five studies were rated with 'moderate' and 'high' methodological quality. Due to substantial clinical heterogeneity, quantitative synthesis could not be performed. All studies used pressure pain thresholds (PPTs) to assess pain sensitivity. LIE-BFR resulted in significant increases in PPTs compared to conventional exercise at local and remote sites 5 min post-intervention. Higher-pressure BFR results in greater exercise-induced hypoalgesia compared to lower pressure, while exercise to failure produces a similar reduction in pain sensitivity with or without BFR. Based on our findings, LIE-BFR can be an effective intervention to increase pain threshold; however, the effect depends on the exercise methodology. Further research is necessary to investigate the effectiveness of this method in reducing pain sensitivity in patients with pain symptomatology. [ABSTRACT FROM AUTHOR]

Objective: Measurement of arterial occlusion pressure (AOP) is essential to the safe and effective use of blood flow restriction during exercise. Use of a Doppler ultrasound (US) is the “gold standard” method to measure AOP. Validation of a handheld Doppler (HHDOP) device to measure AOP could make the measurement of AOP more accessible to practitioners in the field. The purpose of this study was to determine the accuracy of AOP measurements of the brachial and femoral arteries using an HHDOP.Methods: We simultaneously measured AOP using a “gold standard” US and a HHDOP in the dominant and non-dominant arms (15 males; 15 females) and legs (15 males; 15 females).Results: There were no differences in limb circumference or limb volume in the dominant and non-dominant arms and legs between males and females or between the dominant and non-dominant arms and legs of males and females. The differences between US and HHDOP measures of AOP in the dominant and non-dominant arms and legs were either not significant or small ( 0.60). Bland–Altman analysis yielded an average bias (−0.65 mmHg; −2.93 mmHg) and reasonable limits of agreement (±5.56 mmHg; ±5.58 mmHg) between US and HHDOP measures of brachial and femoral artery AOP, respectively.Conclusion: HHDOP yielded acceptable measures of AOP of the brachial and femoral arteries and can be used to measure AOP by practitioners for the safe and effective use of blood flow restriction. Due to the potential differences in AOP between dominant and non-dominant limbs, AOP should be measured in each limb.

Accumulating evidence indicates that some COVID-19 survivors display reduced muscle mass, muscle strength, and aerobic capacity, which contribute to impairments in physical function that can persist for months after the acute phase of illness. Accordingly, strategies to restore muscle mass, muscle strength, and aerobic capacity following infection are critical to mitigate the long-term consequences of COVID-19. Blood flow restriction (BFR), which involves the application of mechanical compression to the limbs, presents a promising therapy that could be utilized throughout different phases of COVID-19 illness. Specifically, we hypothesize that: 1) use of passive BFR modalities can mitigate losses of muscle mass and muscle strength that occur during acute infection and 2) exercise with BFR can serve as an effective alternative to high-intensity exercise without BFR for regaining muscle mass, muscle strength, and aerobic capacity during convalescence. The various applications of BFR may also serve as a targeted therapy to address the underlying pathophysiology of COVID-19 and provide benefits to the musculoskeletal system as well as other organ systems affected by the disease. Consequently, we present a theoretical framework with which BFR could be implemented throughout the progression from acute illness to outpatient rehabilitation with the goal of improving short- and long-term outcomes in COVID-19 survivors. We envision that this paper will encourage discussion and consideration among researchers and clinicians of the potential therapeutic benefits of BFR to treat not only COVID-19 but similar pathologies and cases of acute critical illness.

Introduction: Research indicates that Blood Flow Restriction (BFR) offers advantages for individuals in good health, older populations, and those experiencing musculoskeletal issues. A comprehensive analysis was carried out to explore the efficacy of BFR in improving functional mobility and strength among individuals with neurological disorders. In recent times, there has been a surge in interest towards BFR research, which entails the regulation of blood flow to the muscles during physical activity, partly for arterial circulation and fully for venous circulation, aiming to optimize training outcomes. Aim: To ascertain how blood flow restriction training affects strength and functional mobility in neurological diseases. Materials and Methods: A comprehensive analysis was conducted. PubMed, Web of Science (WOS), Physiotherapy Evidence Database (PEDro), Google Scholar, Cumulative Index of Nursing and Allied Literature Complete (CINAHL), the Cochrane Library, and Research Gate were the databases that were searched for literature between January 2003 and October 2023. The risk of bias in the research was assessed using the Cochrane Collaboration tool, and the methodological quality of the studies was assessed using the PEDro scale. Total 278 articles were found through literature search, after filtration for all years through 2003 to 2023 yielded (278) articles and removing duplicates yielded 238 articles. Reports assessed for eligibility (N=15). A total of 10 articles were included based on the inclusion criteria. Results: There were no unfavourable results from any of the trials that we reviewed. However, we found out significant improvement in increasing muscular strength and functional mobility among neurological patients. Due to the substantial diversity and small number of publications, the results should be interpreted with caution. Further clinical study ought to be conducted. These studies should improve the methodological quality as well as the consistency of the procedures used in larger samples. Conclusion: Blood flow restriction therapy appears to be helpful in treating neurological problems without having negative side effects, according to the reviews in this study. Progress has been observed in walking endurance, strength, muscle thickness, gluteus density, and step length symmetry, and gait speed. There have also been improvements to the balance. [ABSTRACT FROM AUTHOR]

Training with blood flow restriction (BFR) has been shown to be a useful technique to improve muscle hypertrophy, muscle strength and a host of other physiological benefits in both healthy and clinical populations using low intensities [20%–30% 1-repetition maximum (1RM) or

The use of blood flow restriction is becoming more common and requires the use of individualized pressures in order to remain a safe and effective rehabilitation modality. Measuring limb occlusion pressure (LOP) allows the practitioner to set the restriction pressure so that full occlusion does not occur. Objective: Compare a research-grade clinical vascular doppler and a consumer-grade vascular doppler in the measurement of LOP. Design: A randomized crossover design measuring LOP in the upper and lower body. Methods: 20 participants (men=10) visited the laboratory on one occasion. Limb circumference in the arm and thigh was measured. Following 10 min of supine rest, LOP was measured either in the arm, using a 5 cm wide inelastic cuff, or in the leg, using a 10 cm wide inelastic cuff. Measurements were repeated at 5 min intervals until LOP had been measured in both limbs with both dopplers. Results: Bland-Altman analysis showed agreement between the two dopplers in both the upper body (mean bias: 0.6 (-1.3 - 2.4) mmHg) and lower body (mean bias: -1.5 (-4.4 - 1.4) mmHg). Two one-sided tests of equivalence determined that both dopplers measured a statistically equivalent LOP in the upper body (p = .547) and lower body (p = .288). Conclusions: In a healthy, young population, the consumer-grade vascular doppler measured LOP equally as well as the research-grade clinical doppler. [ABSTRACT FROM AUTHOR]

Abstract Background Blood flow restriction training (BFR) has been demonstrated to increase muscle hypertrophy and strength, but has logistical and cost barriers. Garment-integrated BFR has the potential to reduce these barriers by lowering equipment demands and cost. The primary aim of the study was to explore the feasibility of garment-integrated BFR in the upper limb of healthy adults, with a secondary aim of exploring safety and efficacy. Methods Physically active and otherwise healthy participants with no previous experience with BFR were sought. Eligible participants completed a five-week garment-integrated BFR programme that involved completing two sessions per week. Feasibility was determined by a priori defined thresholds for recruitment, adherence to the garment-integrated BFR programme, and data collection. Safety was determined by recording adverse events and by monitoring for total arterial occlusion pressure using a fingertip pulse oximeter. Efficacy was determined by measuring push-ups to volitional failure, arm girth, and number of prescribed repetitions completed. Feasibility and safety outcomes were reported descriptively or as a proportion with associated 95% confidence intervals (95% CI). Mean change, 95% CIs, and associated effect sizes were calculated for efficacy outcomes. Results Twenty-eight participants were included (15 men, 13 women; mean age 31.6 years [±9.1]) and 27 successfully completed the study. Participants were successfully recruited within three months and 278/280 sessions were successfully completed (adherence=99.3%, 95% CI 97.4%, 99.9%). Minimal adverse events were reported; one incident of localised bruising (0.36%, 95% CI 0.06%, 2.0%) and three incidences of excessive pain during or post-exercise from two separate participants (1.07%, 95% CI 0.03%, 3.1%). 82/2240 pulse oximeter readings were not recorded (3.7%, 95% CI 2.9%, 4.5%). Mean push-ups to volitional failure increased by 40% (mean change=8.0, 95% CI 6, 10, d=1.40). Mean arm girth and number of prescribed repetitions completed were unchanged. Conclusions Garment-integrated BFR is feasible and has no signal of important harm in the upper limb of healthy adults, and could proceed to a future trial with stop/go criteria for randomisation. Further work is required to investigate the efficacy of garment-integrated BFR and determine its equivalence or superiority compared to existing BFR methods.

Background: This study aimed to determine the efficacy of functional training with and without blood flow restriction (BFR) on muscle hypertrophy indices and strength in older men. Methods: Thirty older adults (67.7 ± 5.8 years) were randomly assigned to three groups: functional training (FT), functional training with BFR (FTBFR), and control (C). Participants in experimental groups were trained in three sessions per week for six weeks. They performed 11 whole body exercises, in 2–4 sets of 10 repetitions. FTBFR group wore pneumatic cuffs on their extremities that began with 50% of estimated arterial occlusion pressure which increased by 10% every two weeks. Blood samples were obtained, and static strength tests were evaluated at baseline and after the training program. A One-Way Analysis of Covariance was used to interpret the data. Results: A significant increase in follistatin levels (p = 0.002) and reduction in myostatin levels (p = 0.001) were observed in FT and FTBFR groups; there was a considerable increase in the F:M ratio in both training groups (p = 0.001), whereas it decreased in C group. These changes were accompanied by significant improvements in handgrip (p = 0.001) and shoulder girdle (p = 0.001) strength in both experimental groups, especially in the FTBFR group. However, the levels of irisin were not statistically changed following interventions (p = 0.561). Conclusion: The findings showed that FT was effective in increasing circulating biomarkers involved in hypertrophy in older adults while adding BFR to FT had a slight increase in these biomarkers but had a tremendous increase in muscle strength. [ABSTRACT FROM AUTHOR]

The trial aimed to examine the effect of eight weeks preoperative low-load blood flow restricted resistance training (BFR-RT) on physical function, lower limb strength, and patient-reported outcomes in knee OA patients 3 and 12 months after total knee arthroplasty (TKA) compared with preoperative usual care. An assessor blinded randomized controlled trial (RCT) was conducted. Eighty-six patients scheduled for TKA who were allocated to 8 weeks BFR-RT on the affected leg 3x/week or preoperative usual care involving no exercise (CON)., Primary Outcome: 30-s sit to stand (30STS)., Secondary Outcomes: Timed Up&Go, 40-m walk test (40mWT), knee range of motion (ROM) 1-repetition maximum (1RM) leg press and knee extensor strength, maximal isometric contraction (MVIC) for the knee extensors and flexors, Knee injury and Osteoarthritis Outcome Score (KOOS), and Euroqol 5-dimensions (EQ-5D-L5) questionnaire. Data were collected at baseline (12 weeks pre-surgery), ~3 days pre-surgery, 3 and 12 months postoperatively. Intention-to-treat analysis revealed no significant between-group differences in the change from baseline to 3 and 12 months postoperatively on 30STS, TUG, or 40mFWT. Significant between-group differences were observed at 3 but not 12 months postoperatively for the corresponding changes in 1RM leg press strength, 1RM knee extensor strength, and MVIC knee extensor favoring BFR-RT. No between-group differences were observed for the delta changes from baseline in knee ROM, KOOS subscales or EQ-5D-L5 at any postoperative time points. These findings suggest that preoperative BFR-RT offered no superior effects compared with usual preoperative care on postoperative physical function or patient-reported outcomes. Preoperative BFR-RT produced amplified gains in lower limb muscle strength at 3 months postoperatively., Trial Registration: NCT04081493., (© 2024 The Author(s). Scandinavian Journal of Medicine & Science In Sports published by John Wiley & Sons Ltd.)

Older adults demonstrate gait impairments that increase their risk for falls. These age-related mobility impairments are in part due to declines in muscle mass and strength. High-intensity exercise can improve muscle strength and mobility but may not be tolerable for older adults due to musculoskeletal injury and pain. Blood flow restriction (BFR) with lower-intensity exercise offers a strategy that may be more tolerable for older adults, but whether BFR improves gait and mobility in older adults is unclear. The purpose of this systematic review and meta-analysis was to determine the effect of BFR on gait and mobility in healthy older adults. PubMed, Embase, Cochrane Library, and CINAHL were systematically searched for articles utilizing BFR in older adults. Articles were included if adults were over 60 years, did not have chronic health conditions, had undergone randomized controlled trials, and presented objectively measured gait outcomes. The search identified 1501 studies, of which 9 were included in the systematic review and 8 studies in the meta-analysis. Outcome measures included the Timed Up and Go (TUG), 6-Minute Walk Test (6MWT), 400 m walk test, Short Physical Performance Battery (SPPB), and 10 m walk test. Meta-analyses found improvements in the TUG (mean difference (MD) = -0.71; 95% CI = -1.05, -0.37; p < 0.001) and SPPB (MD = -0.94; 95% CI = -1.48, -0.39; p < 0.001) in BFR compared to no BFR. There were no differences in gait speed (MD = 0.59; 95% CI = -0.22, 1.41; p = 0.16). BFR may be effective for gait and mobility tasks over shorter distances. Clinicians may consider incorporating BFR to improve mobility and gait function in older adults.

This case report explores the use of blood flow restriction (BFR) training to improve body composition in a 26-year-old male with L5-S1 disc protrusion and nerve root compression. BFR training, involving low-intensity exercises with restricted blood flow, offers a promising alternative for patients unable to engage in high-intensity workouts. The patient, a recreational gymgoer with a history of a significant lower back injury from a maximal deadlift event 20 months ago, presented with chronic pain, weight gain, and decreased stamina. Two attempts at spinal steroid injections during the 20-month period yielded only temporary relief, prompting the implementation of a 12-week BFR training regimen. The program combined BFR exercises with a calorie-deficit diet, resulting in substantial improvements in body composition and strength. Over 12 weeks, the patient lost 11.68 kg, reduced his body mass index from 26.50 to 22.85, and decreased his total body fat percentage from 28% to 22.43%. His lower back pain also significantly improved. This case highlights the effectiveness of BFR training in managing obesity and enhancing physical fitness in spinal injury patients, emphasizing the need for further research on its broader application., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Saveetha Medical College and Hospital Institutional Ethics committee issued approval N/A. The participant was explained about the potential benefits and risks associated with the treatment. It was brought to his knowledge that he would receive no monetary remuneration for this case study. He was also informed about the alternate available treatments. Post this information, he gave his willingness to receive the treatment by signing an informed consent form. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Thirugnana Sambandam et al.)

Background: Lower extremity bone stress injuries (BSI) are common injuries among athletes and military members. Typical management involves a period of restricted weightbearing which can have rapid detrimental effects upon both muscle and bone physiology. Few studies have investigated the effect of blood flow restriction (BFR) training on bone in the rehabilitative setting., Purpose: The purpose of this study was to investigate the effects of lower extremity exercise with the addition of BFR upon bone mineral density, bone mineral content, and lean body mass in military members with tibial BSIs., Study Design: Case series., Methods: Twenty military members with MRI-confirmed tibial BSI were recruited to complete lower extremity exercise with the addition of BFR twice per week for four weeks. The BFR cuff was applied proximally to the participant's involved limb while they performed gluteal, thigh, and leg resistance exercises. Outcomes were assessed at baseline and four weeks. The primary outcomes were whole leg bone mineral density (BMD), bone mineral content (BMC), and lean body mass (LM) as measured by dual-energy x-ray absorptiometry. Secondary outcomes included thigh and leg circumference measures and patient-reported outcomes, including the Lower Extremity Functional Scale (LEFS), Patient-Reported Outcomes Measurement Information System 57 (PROMIS-57), and Global Rating of Change (GROC)., Results: No significant differences were found in BMD (p=0.720) or BMC (p=0.749) between limbs or within limbs over time. LM was generally less in the involved limb (p=0.019), however there were no significant differences between or within limbs over time (p=0.404). For thigh circumference, significant main effects were found for time (p=0.012) and limb (p=0.015), however there was no significant interaction effect (p=0.510). No significant differences were found for leg circumference (p=0.738). Participants showed significant mean changes in LEFS (15.15 points), PROMIS physical function (8.98 points), PROMIS social participation (7.60 points), PROMIS anxiety (3.26 points), and PROMIS pain interference (8.39 points) at four weeks., Conclusion: The utilization of BFR in the early rehabilitative management of tibial BSI may help mitigate decrements in both bone and muscle tissue during periods of decreased physical loading., Level of Evidence: 4., Competing Interests: The authors report no conflicts of interest related to this research., (© The Author(s).)

The study aimed to compare the acute effects of low resistance exercises with partial and complete blood flow restriction (BFR) and heavy resistance exercise on growth hormone (GH), myostatin, testosterone, and cortisol in competitive wrestlers. Forty elite wrestlers were randomly divided into four groups (n=10); low resistance training with complete BFR (LRT+CBFR), low resistance training with partial BFR (LRT+PBFR), low resistance training (LRT), and heavy resistance training (HRT). Blood samples were collected before and after the intervention, and a specific ELISA kit measured variables. Analysis of covariance and paired t-test was performed to analyze the data. There were no significant differences in the variables between the four interventions. Intra-group results showed a significant decrease in myostatin levels in the HRT group (p=0.02), and a significant increase in GH in the LRT+CBFR (p=0.02) and LRT+PBFR (p=0.03), testosterone in the HRT group (p=0.04) and cortisol in the three groups LRT+CBFR (p=0.02), LRT+PBFR (p=0.01) and HRT (p=0.04). Despite the similarity of the changes in the four interventions, due to the percentage of changes, it seems that low resistance training with BFR could produce similar anabolic effects to high-intensity resistance training.

We compared the effects of aerobic exercise with and without blood flow restriction (BFR) to high‐intensity aerobic exercise on energy expenditure (EE), excess Postexercise oxygen consumption (EPOC), and respiratory exchange ratio (RER) during and after exercise. Twenty‐two recreationally active males randomly completed the following experimental conditions: AE—aerobic exercise without BFR, AE + BFR—aerobic exercise with BFR, HIAE—high‐intensity aerobic exercise, CON—non‐exercise control condition. EE was significantly (p < 0.05) greater during exercise for HIAE compared to all conditions, and for AE + BFR compared to AE and CON during and postexercise exercise. There were no significant (p > 0.05) differences in EPOC between HIAE and AE + BFR at any time point, however, both conditions were significantly (p < 0.05) greater than the AE (d = 1.50 and d = 1.03, respectively) and CON at the first 10 min postexercise. RER during exercise for HIAE was significantly (p < 0.05) greater than AE + BFR at the first 6 min of exercise (p = 0.003, d = 0.88), however, no significant differences were observed from 9 min up to the end of the exercise. HIAE was also significantly (p < 0.05) greater than AE and CON at all time points during exercise, whereas, AE + BFR was significantly (p < 0.05) greater than CON at all time points but not significantly (p < 0.05) different than AE (p < 0.05); although the overall session RER was significantly (p < 0.05) greater during AE + BFR than AE. Altogether, continuous AE + BFR results in greater EE compared to volume matched AE, as well as a similar EPOC compared to HIAE. [ABSTRACT FROM AUTHOR]

Introduction: Cricket was once regarded as a “moderate injury risk” sport, However, there has been a continual increase in injury rates in cricket, with Hamstring Strain Injuries (HSIs) being the most prominent. More recent research suggests that the injury rate in cricket is rising, with HSIs one of the most common and severe injuries. Aim: To investigate the impact of Blood Flow Restriction Therapy (BFRT) and traditional resistance training on knee flexor strength and squat test among cricket players. Materials and Methods: This was a single-blinded, randomised controlled trial on 39 cricket players conducted in the Department of Physiotherapy, Galgotias University (GU), Greater Noida, Uttar Pradesh, India. Subjects aged between 18-25 years were randomly divided in a 1:1 ratio. Group A underwent BFRT combined with low-resistance training, and Group B underwent traditional resistance training. A four-week intervention, comprising two sessions weekly was administered. Results: For within-group comparisons, the paired t-test was used and for between-group comparisons, the independent t-test was used using Statistical Package for the Social Sciences (SPSS), version 25.0. Group A demonstrated a statistically significant increase in squat test scores from pre- to post-intervention compared to Group B after 4 weeks. No significant difference in muscle strength was observed among the two groups. Conclusion: Combining BFRT with low-resistance training significantly enhances knee flexor endurance, as evidenced by superior performance in the squat test compared to traditional resistance training alone. These findings suggest the potential of BFRT as a valuable adjunct to rehabilitation and performance enhancement strategies for lower limb injuries in athletes. [ABSTRACT FROM AUTHOR]

Low-intensity exercise with blood flow restriction (LIE-BFR) has been proposed as an effective intervention to induce hypoalgesia in both healthy individuals and patients with knee pain. Nevertheless, there is no systematic review reporting the effect of this method on pain threshold. We aimed to evaluate the following: (i) the effect of LIE-BFR on pain threshold compared to other interventions in patients or healthy individuals; and (ii) how different types of applications may influence hypoalgesic response. We included randomized controlled trials assessing the effectiveness of LIE-BFR alone or as an additive intervention compared with controls or other interventions. Pain threshold was the outcome measure. Methodological quality was assessed using the PEDro score. Six studies with 189 healthy adults were included. Five studies were rated with ‘moderate’ and ‘high’ methodological quality. Due to substantial clinical heterogeneity, quantitative synthesis could not be performed. All studies used pressure pain thresholds (PPTs) to assess pain sensitivity. LIE-BFR resulted in significant increases in PPTs compared to conventional exercise at local and remote sites 5 min post-intervention. Higher-pressure BFR results in greater exercise-induced hypoalgesia compared to lower pressure, while exercise to failure produces a similar reduction in pain sensitivity with or without BFR. Based on our findings, LIE-BFR can be an effective intervention to increase pain threshold; however, the effect depends on the exercise methodology. Further research is necessary to investigate the effectiveness of this method in reducing pain sensitivity in patients with pain symptomatology.

Background: Blood flow restriction exercise (BFR-E) could be a useful training adjunct for patients with weakness after stroke to augment the effects of exercise on muscle activity. We aimed to examine neurophysiological changes (primary aim) and assess patient perceptions (secondary aim) following BFR-E. Methods: Fourteen participants with stroke performed BFR-E (1 session) and exercise without blood flow restrictsion (Exercise only) (1 session), on two days, ≈7 days apart. In each session, two sets of tibialis anterior (TA) contractions were performed and electromyography (EMG) was recorded. Eight participants underwent transcranial magnetic stimulation (single-pulse stimulation, short interval intracortical inhibition (SICI), intracortical facilitation (ICF)) and peripheral electrical stimulation (maximal peak-to-peak M-wave (M-max)) of the TA before, immediately-after, 10-min-after and 20-min-after BFR-E and Exercise only. Numerical rating scores (NRS) for pain, discomfort, fatigue, safety, focus and difficulty were collected for all subjects (n = 14). Paired comparisons and linear mixed models assessed the effects of BFR-E and Exercise only. Results: No adverse events due to exercise were reported. There was no contraction-number × condition interaction for EMG amplitude during exercise (p = 0.15), or time × condition interaction for single-pulse stmulation, SICI, ICF or M-max amplitude (p = 0.34 to p = 0.97). There was no difference between BFR-E and Exercise only in NRS scores (p = 0.10 to p = 0.50). Conclusion: Using our training paradigm, neurophysiological parameters, feasibility, tolerability and perceptions of safety were not different between BFR-E and Exercise only. As participants were generally well-functioning, our results are not generalizable to lower functioning people with stroke, different (more intense) exercise protocols or longer term training over weeks or months. [ABSTRACT FROM AUTHOR]

Wong, V, Dankel, SJ, Spitz, RW, Bell, ZW, Viana, RB, Chatakondi, RN, Abe, T, and Loenneke, JP. The effect of blood flow restriction therapy on recovery after experimentally induced muscle weakness and pain. J Strength Cond Res 36(4): 1147-1152, 2022-The purpose was to determine if blood flow restriction with no external load could be used as a means of active therapy after experimentally induced fatigue and soreness. Twelve women and 7 men (aged 18-35 years) participated in a randomized controlled trial using a within-subject design. The study intervention was 3 consecutive visits. Visit 1 included the fatiguing/soreness-inducing protocol for the elbow flexors, which was performed only once during the study. Torque was measured before/after to confirm individuals began in a weakened state. Subjects then completed blood flow restriction therapy on one arm and the sham therapy on the other. Subjects performed elbow flexion/contraction with no external load on both arms. Torque was measured once more 10 minutes after the fatiguing/soreness-inducing protocol. Twenty-four hours later, soreness and torque were assessed in each arm, followed by another bout of therapy. Forty-eight hours after the initial visit, soreness and torque were measured again. There were no differences (median difference [95% credible interval]) in the recovery of torque between the blood flow restriction and sham therapy conditions at 10 minutes (0.5 [-2.7, 3.8] N[middle dot]m), 24 hours (-2.34 [-6, 1.14] N[middle dot]m), or 48 hours (-1.94 [-5.45, 1.33] N[middle dot]m). There were also no differences in ratings of soreness at 24 hours (-2.48 [-10.05, 5.05]) or 48 hours (2.58 [-4.96, 10.09]). Our results indicate that this specific model of blood flow restriction therapy did not enhance the recovery of the muscle compared with a sham condition without the application of pressure. [ABSTRACT FROM AUTHOR]

BACKGROUND: As a new type of rehabilitation training, blood flow restriction training is gradually increasing in the application of knee joint disease rehabilitation. It can promote muscle strength growth and muscle hypertrophy with lower exercise intensity. However, current research lacks a plan for blood flow restriction training for different groups of people. The effect of training variables and blood flow restriction on the therapeutic efficacy is unknown, and improper use may also cause safety problems. OBJECTIVE: To explain the application status of blood flow restriction training in knee joint disease rehabilitation, attempt to summarize blood flow restriction training from the aspects of application status, application scheme and safety, and propose urgent problems to be solved, aiming to provide theoretical support and practice for the safe and effective application of this technology guide. METHODS: in PubMed, CNKI and other literature databases, literature search was conducted for related research on the application of blood flow restriction training in knee joint disease rehabilitation from inception to October 29, 2020. The Chinese search formula included “blood flow restriction training OR plus Compression training,” “blood flow restriction training OR compression training AND knee joint,” “knee osteoarthritis OR knee surgery OR patellofemoral joint pain OR anterior knee pain OR rheumatoid arthritis AND blood flow restriction training OR compression training.” The English search formula included “(((blood flow restriction training) OR (Occlusion Training)) OR (Kaatsu training)) AND (knee),” “((((((knee osteoarthritis) OR (Knee surgery)) OR (patellofemoral pain)) OR (anterior knee pain)) OR (rheumatoid arthritis)) AND (blood flow restriction training)) OR (Kaatsu training).” And according to the research needs, the corresponding selection criteria were established for the screening of final literatures. RESULTS AND CONCLUSION: A review of relevant literature worldwide found that in the rehabilitation of knee joint diseases, blood flow restriction training is mainly used for patients with anterior cruciate ligament reconstruction and knee arthroscopy, knee osteoarthritis, patellofemoral joint pain, rheumatoid arthritis and anterior knee pain. Currently, in this group of patients, blood flow restriction training with lower exercise intensity has been found to promote muscle strength growth and muscle hypertrophy. The use of blood flow restriction alone can effectively prevent disused muscle atrophy due to no-load state, which is conductive to accelerating the rehabilitation process after surgery on the knee joint. In current studies, there are rarely adverse events related to blood flow restriction, but when using blood flow restriction combined with resistance training, it is necessary to ensure that the cuff width and restriction pressure used are appropriate. Future studies should compare different blood flow restriction training programs in different populations. [ABSTRACT FROM AUTHOR]

Background: Blood flow restriction training (BFR) has been demonstrated to increase muscle hypertrophy and strength, but has logistical and cost barriers. Garment-integrated BFR has the potential to reduce these barriers by lowering equipment demands and cost. The primary aim of the study was to explore the feasibility of garment-integrated BFR in the upper limb of healthy adults, with a secondary aim of exploring safety and efficacy. Methods: Physically active and otherwise healthy participants with no previous experience with BFR were sought. Eligible participants completed a five-week garment-integrated BFR programme that involved completing two sessions per week. Feasibility was determined by a priori defined thresholds for recruitment, adherence to the garment-integrated BFR programme, and data collection. Safety was determined by recording adverse events and by monitoring for total arterial occlusion pressure using a fingertip pulse oximeter. Efficacy was determined by measuring push-ups to volitional failure, arm girth, and number of prescribed repetitions completed. Feasibility and safety outcomes were reported descriptively or as a proportion with associated 95% confidence intervals (95% CI). Mean change, 95% CIs, and associated effect sizes were calculated for efficacy outcomes. Results: Twenty-eight participants were included (15 men, 13 women; mean age 31.6 years [±9.1]) and 27 successfully completed the study. Participants were successfully recruited within three months and 278/280 sessions were successfully completed (adherence=99.3%, 95% CI 97.4%, 99.9%). Minimal adverse events were reported; one incident of localised bruising (0.36%, 95% CI 0.06%, 2.0%) and three incidences of excessive pain during or post-exercise from two separate participants (1.07%, 95% CI 0.03%, 3.1%). 82/2240 pulse oximeter readings were not recorded (3.7%, 95% CI 2.9%, 4.5%). Mean push-ups to volitional failure increased by 40% (mean change=8.0, 95% CI 6, 10, d=1.40). Mean arm girth and number of prescribed repetitions completed were unchanged. Conclusions: Garment-integrated BFR is feasible and has no signal of important harm in the upper limb of healthy adults, and could proceed to a future trial with stop/go criteria for randomisation. Further work is required to investigate the efficacy of garment-integrated BFR and determine its equivalence or superiority compared to existing BFR methods. [ABSTRACT FROM AUTHOR]

Introduction: An appropriate comparison of different cuff widths during blood flow restricted exercise requires that the cuffs are inflated to the same relative pressures. Narrow cuffs tend to be preferred and may reduce discomfort when applied during resistance exercise, but whether this is also true during walking exercise remains unknown. Methods: Individuals completed two identical walking trials, once with 12‐cm wide cuffs and once with 17‐cm wide cuffs. Five 2‐min walking bouts were completed at a speed of 50 m/min, with a 1‐min rest period between sets. The restriction cuffs were inflated to 40% of the individuals' arterial occlusion pressure taken with each respective cuff. Individuals were asked to rate their discomfort, perceived exertion (RPE), and cuff preference. Results: Twenty‐seven individuals completed the study. The 12‐cm cuff required a higher occlusion pressure which resulted in a higher absolute pressure applied (58 vs. 52 mm Hg; BF10 = 19 331.897). Whilst there was no difference in RPE values between cuffs (BF10 = 0.474), individuals reported greater discomfort when using the wider cuffs (2.3 vs. 1.7; BF10 = 252.786). The majority of individuals (63%) preferred to use the narrower cuff, whereas fewer preferred the wider cuff (26%) and even fewer did not have a preference (11%). Discussion: Blood flow restricted walking exercise performed with narrower restriction cuffs appeared to reduce participant discomfort whilst also being preferred over that of wider cuffs. Future studies may wish to test the influence of different restrictive cuff widths on alterations in gait patterns during blood flow restricted walking exercise. [ABSTRACT FROM AUTHOR]

Background: Blood flow restriction (BFR) training uses a cuff to partially occlude venous blood flow and improve musculoskeletal training outcomes. Over the past 25 years, numerous studies have demonstrated its relative safety and efficacy. Objectives: Blood flow restriction training is under review by the Health Professions Council of South Africa due to safety and ethical concerns. The objective of this roundtable discussion is to gain better insight into the current use and perception of blood flow restriction training in South Africa. Formation of panel: The expert panel had experience with the use of BFR training and included one representative from each of the following professions, namely, sports medicine, physiotherapy and biokinetics. Discussion: The panellists provided their unique perspectives on BFR training, whilst reaching a relative consensus on its safety, screening, efficacy, and appropriate use. Agreement on appropriate loading and occlusion pressure protocols during different phases of rehabilitation was less clear. Conclusion: Although BFR is a safe and effective modality, the development of evidence-based protocols among different health professionals in South Africa is required to ensure good clinical practice. [ABSTRACT FROM AUTHOR]

The use of blood flow restricted (BFR) exercise has become an accepted alternative approach to improve skeletal muscle mass and function and improve cardiovascular function in individuals that are not able to or do not wish to use traditional exercise protocols that rely on heavy loads and high training volumes. BFR exercise involves the reduction of blood flow to working skeletal muscle by applying a flexible cuff to the most proximal portions of a person's arms or legs that results in decreased arterial flow to the exercising muscle and occluded venous return back to the central circulation. Safety concerns, especially related to the cardiovascular system, have not been consistently reported with a few exceptions; however, most researchers agree that BFR exercise can be a relatively safe technique for most people that are free from serious cardiovascular disease, as well as those with coronary artery disease, and also for people suffering from chronic conditions, such as multiple sclerosis, Parkinson's, and osteoarthritis. Potential mechanisms to explain the benefits of BFR exercise are still mostly speculative and may require more invasive studies or the use of animal models to fully explore mechanisms of adaptation. The setting of absolute resistive pressures has evolved, from being based on an individual's systolic blood pressure to a relative measure that is based on various percentages of the pressures needed to totally occlude blood flow in the exercising limb. However, since several other issues remain unresolved, such as the actual external loads used in combination with BFR, the type of cuff used to induce the blood flow restriction, and whether the restriction is continuous or intermittent, this paper will attempt to address these additional concerns. [ABSTRACT FROM AUTHOR]