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Physical exercise induces acute psychophysiological responses leading to chronic adaptations when the exercise stimulus is applied repeatedly, at sufficient time periods, and with appropriate magnitude. To maximize long-term training adaptations, it is crucial to control and manipulate the external load and the resulting psychophysiological strain. Therefore, scientists have developed a theoretical framework that distinguishes between the physical work performed during exercise (i.e., external load/intensity) and indicators of the body's psychophysiological response (i.e., internal load/intensity). However, the application of blood flow restriction (BFR) during exercise with low external loads/intensities (e.g., ≤ 30% of the one-repetition-maximum, ≤ 50% of maximum oxygen uptake) can induce physiological and perceptual responses, which are commonly associated with high external loads/intensities. This current opinion aimed to emphasize the mismatch between external and internal load/intensity when BFR is applied during exercise. In this regard, there is evidence that BFR can be used to manipulate both external load/intensity (by reducing total work when exercise is performed to exhaustion) and internal load/intensity (by leading to higher physiological and perceptual responses compared to exercise performed with the same external load/intensity without BFR). Furthermore, it is proposed to consider BFR as an additional exercise determinant, given that the amount of BFR pressure can determine not only the internal but also external load/intensity. Finally, terminological recommendations for the use of the proposed terms in the scientific context and for practitioners are given, which should be considered when designing, reporting, discussing, and presenting BFR studies, exercise, and/or training programs. Key Points: The application of BFR during exercise with low external load/intensity can lead to internal responses that are commonly associated with high external load/intensity resulting in a discrepancy between the characteristics of exercise and the acute psychophysiological responses. The BFR pressure can be adjusted to increase the internal load/intensity (i.e., elevating physiological and perceptual responses) to intensify the exercise stimulus or to decrease the external load/intensity (e.g., reducing the number of repetitions when exercise is performed to exhaustion), which is of particular importance during musculoskeletal rehabilitation when high or cumulative low mechanical stress might be contraindicated. We encourage researchers to adapt their wording in the BFR literature accordingly, given that the extent of internal load/intensity during BFR exercise is determined by the interaction of several external exercise variables (e.g., external resistance, number of repetitions/cycles, cuff pressure) to specify the generated exercise stimulus (e.g., "low external load BFR walking", "low external load BFR resistance exercise"). [ABSTRACT FROM AUTHOR]

This study compared the acute hypoalgesic and neurophysiological responses to low‐load resistance exercise with and without blood flow restriction (BFR), and free‐flow, high‐load exercise. Participants performed four experimental conditions where they completed baseline measures of pain pressure threshold (PPT), maximum voluntary force (MVF) with peripheral nerve stimulation to determine central and peripheral fatigue. Corticospinal excitability (CSE), corticospinal inhibition and short interval intracortical inhibition (SICI) were estimated with transcranial magnetic stimulation. Participants then performed low‐load leg press exercise at 30% of one‐repetition maximum (LL); low‐load leg press with BFR at 40% (BFR40) or 80% (BFR80) of limb occlusion pressure; or high‐load leg press of four sets of 10 repetitions at 70% one‐repetition maximum (HL). Measurements were repeated at 5, 45 min and 24 h post‐exercise. There were no differences in CSE or SICI between conditions (all P > 0.05); however, corticospinal inhibition was reduced to a greater extent (11%–14%) in all low‐load conditions compared to HL (P < 0.005). PPTs were 12%–16% greater at 5 min post‐exercise in BFR40, BFR80 and HL compared to LL (P ≤ 0.016). Neuromuscular fatigue displayed no clear difference in the magnitude or time course between conditions (all P > 0.05). In summary, low‐load BFR resistance exercise does not induce different acute neurophysiological responses to low‐load, free‐flow exercise but it does promote a greater degree of hypoalgesia and reduces corticospinal inhibition more than high‐load exercise, making it a useful rehabilitation tool. The changes in neurophysiology following exercise were not related to changes in PPT. What is the central question of this study?Does low‐load, blood flow restricted, resistance exercise promote greater hypoalgesic and neurophysiological changes in the 24 h period post‐exercise, in comparison to high‐load resistance exercise?What is the main finding and its importance?Blood flow restriction exercise augments hypoalgesia compared to free‐flow, low‐load exercise and induces similar hypoalgesia to high‐load exercise, but does not result in any different alterations to corticospinal excitability or inhibition. However, corticospinal inhibition was reduced to a greater extent with low‐load exercise, compared to high‐load exercise. Therefore, low‐load BFR resistance exercise is a suitable method for exercise rehabilitation. [ABSTRACT FROM AUTHOR]

Simple Summary: Developing cancer during adolescence or young adulthood adds extra challenges to an already difficult period of development. This can cause a 'biographical disruption,' in the sense that people miss out on key milestones they might reasonably have expected to achieve during the period, and this can affect their emotional wellbeing. While research shows that young people may experience various degrees of emotional distress, less is known about the emotional experiences and barriers young people experience when accessing help and support. We interviewed two groups of young people who were within 6 months of diagnosis and 3–5 years after treatment. We found three themes that described emotional health experiences: the emotional impact of cancer; personal barriers to support; and support to improve mental health. Differences were identified across the treatment journey, in which we were able to propose therapies and interventions that could be used to help improve psychological outcomes. The biographical disruption that occurs in adolescents and young adults following a cancer diagnosis can affect various important psychosocial domains including relationships with family and friends, sexual development, vocational and educational trajectories, and physical and emotional wellbeing. While there is evidence of the physical impact of cancer during this period, less is known about the impact on emotional wellbeing and especially on the barriers for young people accessing help and support. We aimed to obtain a more in-depth understanding of young people's experiences of their diagnosis, treatment, psychological impact, and range of resources they could or wanted to access for their mental health. We conducted an in-depth qualitative study using semi-structured interviews with 43 young people who had developed cancer aged 16 to 39 years and were either within 6 months of diagnosis or 3–5 years after treatment had ended. Framework analysis identified three themes: the emotional impact of cancer (expressed through anxiety, anger, and fear of recurrence); personal barriers to support through avoidance; and support to improve mental health through mental health services or adolescent and young adult treatment teams. We showed the barriers young people have to access care, particularly participant avoidance of support. Interrupting this process to better support young people and provide them with flexible, adaptable, consistent, long-term psychological support has the potential to improve their quality of life and wellbeing. [ABSTRACT FROM AUTHOR]

The integrative response to exercise differs between sexes, with oxidative energy contribution purported as a potential mechanism. The present study investigated whether this difference was evident in the kinetics of oxygen uptake (VO2) and extraction (HHb + Mb) during exercise. Sixteen adults (8 males, 8 females, age: 27 ± 5 yr) completed three experimental visits. Incremental exercise testing was performed to obtain lactate threshold and VO2peak. Subsequent visits involved three 6-min cycling bouts at 80% of lactate threshold and one 30-min bout at a work rate of 30% between the lactate threshold and power at VO2peak. Pulmonary gas exchange and near-infrared spectroscopy of the vastus lateralis were used to continuously sample VO2 and HHb + Mb, respectively. The phase II VO2 kinetics were quantified using monoexponential curves during moderate and heavy exercise. Slow component amplitudes were also quantified for the heavy-intensity domain. Relative VO2peak values were not different between sexes (P = 0.111). Males achieved ~30% greater power outputs (P = 0.002). In the moderate- and heavy-intensity domains, the relative amplitude of the phase II transition was not different between sexes for VO2 (~24 and ~40% VO2peak, P > 0.179) and HHb + Mb (~20 and ~32% ischemia, P > 0.193). Similarly, there were no sex differences in the time constants for VO2 (~28 s, P > 0.385) or HHb + Mb (~10 s, P > 0.274). In the heavy-intensity domain, neither VO2 (P > 0.686) or HHb + Mb (P > 0.432) slow component amplitudes were different between sexes. The oxidative response to moderate- and heavy-intensity exercises did not differ between males and females, suggesting similar dynamic responses of oxidative metabolism during intensity-matched exercise. [ABSTRACT FROM AUTHOR]

Blood flow restriction (BFR) has been identified as a potential countermeasure to mitigate physiological deconditioning during spaceflight. Guidelines recommend that tourniquet pressure be prescribed relative to limb occlusion pressure (LOP); however, it is unclear whether body tilting or reduced gravity analogues influence LOP. We examined LOP at the leg and arm during supine bedrest and bodyweight suspension (BWS) at 6° head‐down tilt (HDT), horizontal (0°), and 9.5° head‐up tilt (HUT) positions. Twenty‐seven adults (age, 26 ± 5 years; height, 1.75 ± 0.08 m; body mass, 73 ± 12 kg) completed all tilts during bedrest. A subgroup (n = 15) additionally completed the tilts during BWS. In each position, LOP was measured twice in the leg and arm using the Delfi Personalized Tourniquet System after 5 min of rest and again after a further 5 min. The LOP at the leg increased significantly from 6° HDT to 9.5° HUT in bedrest and BWS by 9–15 mmHg (Cohen's d = 0.7–1.0). Leg LOP was significantly higher during BWS at horizontal and 9.5° HUT postures relative to the same angles during bedrest by 8 mmHg (Cohen's d = 0.6). Arm LOP remained unchanged between body tilts and analogues. Intraclass correlation coefficients for LOP measurements taken after an initial and subsequent 5 min rest period in all conditions ranged between 0.91–0.95 (leg) and 0.83–0.96 (arm). It is advised that LOP be measured before the application of a vascular occlusion in the same body tilt/setting to which it is applied to minimize discrepancies between the actual and prescribed tourniquet pressure. [ABSTRACT FROM AUTHOR]

Aims: The primary aim of this study was to report the radiological outcomes of patients with a dorsally displaced distal radius fracture who were randomized to a moulded cast or surgical fixation with wires following manipulation and closed reduction of their fracture. The secondary aim was to correlate radiological outcomes with patient-reported outcome measures (PROMs) in the year following injury., Methods: Participants were recruited as part of DRAFFT2, a UK multicentre clinical trial. Participants were aged 16 years or over with a dorsally displaced distal radius fracture, and were eligible for the trial if they needed a manipulation of their fracture, as recommended by their treating surgeon. Participants were randomly allocated on a 1:1 ratio to moulded cast or Kirschner wires after manipulation of the fracture in the operating theatre. Standard posteroanterior and lateral radiographs were performed in the radiology department of participating centres at the time of the patient's initial assessment in the emergency department and six weeks postoperatively. Intraoperative fluoroscopic images taken at the time of fracture reduction were also assessed., Results: Patients treated with surgical fixation with wires had less dorsal angulation of the radius versus those treated in a moulded cast at six weeks after manipulation of the fracture; the mean difference of -4.13° was statistically significant (95% confidence interval 5.82 to -2.45). There was no evidence of a difference in radial shortening. However, there was no correlation between these radiological measurements and PROMs at any timepoint in the 12 months post-injury., Conclusion: For patients with a dorsally displaced distal radius fracture treated with a closed manipulation, surgical fixation with wires leads to less dorsal angulation on radiographs at six weeks compared with patients treated in a moulded plaster cast alone. However, the difference in dorsal angulation was small and did not correlate with patient-reported pain and function., Competing Interests: The authors disclose that the UK National Institute for Health Research (NIHR) provided grant funding for the DRAFFT2 trial. The research was supported by the NIHR Oxford Biomedical Research Centre (BRC). In addition, M. L. Costa declares that the University of Oxford receives research grant funding from the NIHR and Wellcome for research into musculoskeletal trauma., (© 2024 Costa et al.)