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Low-intensity endurance exercise with blood flow restriction (KAATSU) is under consideration for use in cardiac rehabilitation. However, the physiological responses to such exercise have not yet been fully characterized. In an initial effort in healthy males (n = 11, age: 26.3±4.6 y), we compared the physiological responses to low-intensity endurance exercise with and without a thigh KAATSU. Participants performed maximal graded exercise testing using a cycle ergometer with or without KAATSU. We examined responses to cycling exercise at ventilatory threshold (VT) in heart rate (HR), oxygen consumption (VO2), dyspnea, ratings of perceived exertion (RPE), blood pressure (BP), and rectus femoris activation. Participants reached VT at a lower mechanical load, HR, VO2, dyspnea, and double product (HR×systolic BP) with KAATSU vs. no-KAATSU. At VT, RPE, and rectus femoris activity did not differ between the two conditions. These results suggest that KAATSU reduced exercise intensity to reach VT and the physiological responses to exercise at VT without changes in knee extensor muscle activation. Results from this pilot study in healthy males suggest that KAATSU aerobic exercise at VT intensity has the potential to be an effective and low-burden adjuvant to cycling in cardiac rehabilitation. [ABSTRACT FROM AUTHOR]

Exercise generates heat, blood flow, and metabolic changes, thereby inducing hypertrophy of skeletal muscle cells. However, the mechanism by which heat incudes hypertrophy in response to heat is not well known. Here, we hypothesized that heat would induce differentiation of myoblast cells. We investigated the underlying mechanism by which myoblast cells respond to heat. When mouse myoblast cells were exposed to 42 °C for over 30 min, the phosphorylation level of protein kinase C (PKC) and heat shock factor 1 (Hsf1) increased, and the mRNA and protein expression level of heat shock protein 70 (Hsp70) increased. Inhibitors of transient receptor potential vanilloid 1 (Trpv1), calmodulin, PKC, and Hsf1, and the small interfering RNA‐mediated knockdown of Trpv1 diminished those heat responses. Heat exposure increased the phosphorylation levels of thymoma viral proto‐oncogene 1 (Akt), mammalian target of rapamycin (mTOR), eukaryotic translation initiation factor 4E binding protein 1 (Eif4ebp1), and ribosomal protein S6 kinase, polypeptide 1 (S6K1). The knockdown of Trpv1 decreased these heat‐induced responses. Antagonists of Hsp70 inhibited the phosphorylation level of Akt. Finally, heat increased the protein expression level of skeletal muscle markers such as myocyte enhancer factor 2D, myogenic factor 5, myogenic factor 6, and myogenic differentiation 1. Heat also increased myotube formation. Knockdown of Trpv1 diminished heat‐induced increases of those proteins and myotube formation. These results indicate that heat induces myogenic transcription factors of myoblast cells through the Trpv1, calmodulin, PKC, Hsf1, Hsp70, Akt, mTOR, Eif4ebp1, and S6K1 pathway. Moreover, heat increases myotube formation through Trpv1. Exercise generates heat, blood flow, and metabolic changes in skeletal muscle cells, which influences the activation of skeletal muscle cells. We show that the transient receptor potential vanilloid 1 cation channel senses heat, transmits the signal through the protein synthesis pathway, increases the protein expression levels of skeletal muscle markers, and induces myotube formation. [ABSTRACT FROM AUTHOR]

Skeletal muscle is a plastic organ that adapts its mass to various stresses by affecting pathways that regulate protein synthesis and degradation. This study investigated the effects of repetitive restriction of muscle blood flow (RRMBF) on microvascular oxygen pressure (PmvO), mammalian target of rapamycin (mTOR) signaling pathways, and transcripts associated with proteolysis in rat skeletal muscle. Eleven-week-old male Wistar rats under anesthesia underwent six RRMBF consisting of an external compressive force of 100 mmHg for 5 min applied to the proximal portion of the right thigh, each followed by 3 min rest. During RRMBF, PmvO was measured by phosphorescence quenching techniques. The total RNA and protein of the tibialis anterior muscle were obtained from control rats, and rats treated with RRMBF 0-6 h after the stimuli. The protein expression and phosphorylation of various signaling proteins were determined by western blotting. The mRNA expression level was measured by real-time RT-PCR analysis. The total muscle weight increased in rats 0 h after RRMBF, but not in rats 1-6 h. During RRMBF, PmvO significantly decreased (36.1 ± 5.7 to 5.9 ± 1.7 torr), and recovered at rest period. RRMBF significantly increased phosphorylation of p70 S6-kinase (p70S6k), a downstream target of mTOR, and ribosomal protein S6 1 h after the stimuli. The protein level of REDD1 and phosphorylation of AMPK and MAPKs did not change. The mRNA expression levels of FOXO3a, MuRF-1, and myostatin were not significantly altered. These results suggested that RRMBF significantly decreased PmvO, and enhanced mTOR signaling pathways in skeletal muscle using a rat model, which may play a role in diminishing muscle atrophy under various conditions in human studies. [ABSTRACT FROM AUTHOR]

We examined the effect of low-load, elastic band resistance training with blood flow restriction (BFR) on muscle size and arterial stiffness in older adults. Healthy older adults (aged 61-85 years) were divided into BFR training (BFR-T, n = 9) or non-BFR training (CON-T, n = 8) groups. Both groups performed low-load arm curl and triceps down exercises (four sets, total 75 repetitions for each) using an elastic band, 2 d/wk for 12 weeks. The BFR-T group wore inflated pneumatic elastic cuffs (120-270 mm Hg) on both arms during training. Magnetic resonance imaging-measured muscle cross-sectional area of the upper arm, maximum voluntary isometric contraction of the elbow flexors and extensors, cardio-ankle vascular index testing, and ankle-brachial pressure index were measured before and 3-5 days after the final training session. Muscle cross-sectional area of the elbow flexors (17.6%) and extensors (17.4%) increased, as did elbow flexion and elbow extension maximum voluntary isometric contraction (7.8% and 16.1%, respectively) improved (p < .05) in the BFR-T group, but not in the CON-T group. In cardio-ankle vascular index and ankle-brachial pressure index testing, there were no changes between pre- and post-results in either group. In conclusion, elastic band BFR-T improves muscle cross-sectional area as well as maximal muscle strength but does not negatively affect arterial stiffness in older adults. [ABSTRACT FROM AUTHOR]

Purpose: The effects on muscle swelling were compared between low-load resistance exercise to exhaustion with (BFR) and without blood flow restriction (NBFR). Methods: Ten young men [aged 27 (SD 5) years, standing height 1.74 (SD 0.05) m, body mass 70.3 (SD 4.3) kg] performed 20 % of one repetition maximal dumbbell curl exercise to exhaustion (four sets, rest intervals were 30 s for BFR and/or 3 min for NBFR, respectively). One arm was randomly chosen for BFR exercise and the other arm performed NBFR exercise. During the BFR exercise session, an elastic cuff was worn proximally on the testing arm at 160 mmHg. Electromyography (EMG) signals were recorded from surface electrodes placed on the biceps brachii muscle and analyzed for integrated EMG (iEMG). Biceps brachii muscle thickness (MTH) was measured using B-mode ultrasound. Results: The total number of exercise repetitions was greater ( p < 0.01) in NBFR (221 ± 67 reps) than in BFR (111 ± 36 reps). During the exercise session, iEMG for biceps brachii muscles increased ( p < 0.01) during BFR and NBFR (3.94 and 4.45 times of baseline value). Immediately after the exercise, MTH sharply increased ( p < 0.01) with BFR and NBFR (1.21 and 1.20 times of baseline value). These results demonstrate that both BFR and NBFR exercises lead to pronounced muscle activation and muscle swelling. Conclusion: Low-load resistance exercise to exhaustion is an effective method for promoting muscle swelling regardless of BFR. Furthermore, our data indicate that the increase in muscle swelling for both NBFR and BFR is maintained even 60 min after the exercise. [ABSTRACT FROM AUTHOR]

Low-intensity resistance exercise can effectively induce muscle hypertrophy and increases in strength when combined with moderate blood flow restriction ( BFR). As this type of exercise does not require lifting heavy weights, it might be a feasible method of cardiac rehabilitation, in which resistance exercise has been recommended to be included. Although previous studies with healthy subjects showed relative safety of BFR exercise, we cannot exclude the possibility of unfavourable effects in patients with cardiovascular disease. We therefore aimed to investigate haemostatic and inflammatory responses to BFR exercise in patients with ischaemic heart disease ( IHD). Nine stable patients with IHD who were not taking anticoagulant drugs performed four sets of knee extension exercise at an intensity of 20% one-repetition maximum (1 RM) either with or without BFR. Blood samples were taken before, immediately after and 1 h after the exercise session and analysed for noradrenaline, D-dimer, fibrinogen/fibrin degradation products ( FDP) and high-sensitive C-reactive protein (hs CRP). Plasma noradrenaline concentration increased after the exercise, and the increase was significantly larger after the exercise with BFR than without BFR. On the other hand, increases in concentrations of plasma D-dimer and serum hs CRP were independent of the condition. However, increases in D-dimer and hs CRP were no longer observed after plasma volume correction, suggesting that hemoconcentration was responsible for these increases. Plasma FDP concentration did not change after the exercise. These results suggest that applying BFR during low-intensity resistance exercise does not affect exercise-induced haemostatic and inflammatory responses in stable IHD patients. [ABSTRACT FROM AUTHOR]

Summary Venous compliance declines with age and improves with chronic endurance exercise. KAATSU, an exercise combined with blood flow restriction (BFR), is a unique training method for promoting muscle hypertrophy and strength gains by using low-intensity resistance exercises or walking. This method also induces pooling of venous blood in the legs. Therefore, we hypothesized that slow walking with BFR may affect limb venous compliance and examined the influence of 6 weeks of walking with BFR on venous compliance in older women. Sixteen women aged 59-78 years were partially randomized into either a slow walking with BFR group ( n = 9, BFR walk group) or a non-exercising control group ( n = 7, control group). The BFR walk group performed 20-min treadmill slow walking (67 m min−1), 5 days per week for 6 weeks. Before (pre) and after (post) those 6 weeks, venous properties were assessed using strain gauge venous occlusion plethysmography. After 6 weeks, leg venous compliance increased significantly in the BFR walk group (pre: 0·0518 ± 0·0084, post: 0·0619 ± 0·0150 ml 100 ml−1 mmHg−1, P<0·05), and maximal venous outflow (MVO) at 80 mmHg also increased significantly after the BFR walk group trained for 6 weeks (pre: 55·3 ± 15·6, post: 67·1 ± 18·9 ml 100 ml−1 min−1, P<0·01), but no significant differences were observed in venous compliance and MVO in the control group. In addition, there was no significant change in arm compliance in the BFR walk group. In conclusion, this study provides the first evidence that 6 weeks of walking exercise with BFR may improve limb venous compliance in untrained elder female subjects. [ABSTRACT FROM AUTHOR]

Abstract: The effect of low-intensity resistance exercise with external limb compression (100 [EC100] and 160 [EC160] mm Hg) on limb blood flow and venous blood gas-metabolite response was investigated and compared with that of high-intensity resistance exercise (no external compression). Unilateral elbow flexion muscle contractions were performed at 20% (75 repetitions, 4 sets, 30-second rest intervals) and 70% of 1-repetition maximum (1-RM; 3 sets, each set was until failure, 3-minute rest intervals). Precontraction brachial arterial blood flow (Doppler ultrasound) was reduced with EC100 or EC160 (56% and 39% of baseline value, respectively) compared with no external compression (control). At 20% 1-RM, brachial arterial blood flow increased after contractions performed with EC160 (190%), but not with the others. Decreases in venous oxygen partial pressure (PvO2) and venous oxygen saturation (SvO2) were greater during EC100 and EC160 than control (mean [SE]: PvO2, 28 [3] vs 26 [2] vs 33 [2] mm Hg; SvO2, 41% [5%] vs 34% [4%] vs 52% [5%], respectively). Changes in venous pH (pHv), venous carbon dioxide partial pressure (PvCO2), and venous lactate concentration ([L−]v) were greater with EC160 than EC100 and/or control (pHv, 7.19 [0.01] vs 7.25 [0.01] vs 7.27 [0.02]; PvCO2, 72 [3] vs 64 [2] vs 60 [3] mm Hg; [L−]v, 5.4 [0.6] vs 3.7 [0.4] vs 3.0 [0.4] mmol/L, respectively). Seventy percent 1-RM contractions resulted in greater changes in pHv (7.14 [0.02]), PvCO2 (91 [5] mm Hg), and [L−]v (7.0 [0.5] mmol/L) than EC100 and EC160, but PvO2 (30 [4] mm Hg) and SvO2 (40% [3%]) were similar. In conclusion, changes in pHv, PvCO2, and [L−]v, but not in PvO2 and SvO2, are sensitive to changes in relative, “internal” intensity of low-intensity muscle contractions caused by reduced blood flow (EC160) or high-intensity muscle contractions. Given the magnitude of the changes in pHv, PvCO2, and [L−]v, it appears plausible that they may be involved in stimulating the observed increase in muscle activation via group III and IV afferents. [Copyright &y& Elsevier]

Recent studies have demonstrated that even a low-intensity resistance exercise can effectively induce muscle hypertrophy and strength increase when combined with moderate blood flow restriction (BFR) into the exercising muscle. Although serious side effects of low-intensity resistance exercise with BFR have not been reported, a concern of thrombosis has been suggested, because this type of exercise is performed with restricted venous blood flow and pooling of blood in extremities. Thus, the purpose of this study was to investigate the effects of low-intensity resistance exercise with BFR on coagulation system in healthy subjects. Ten healthy men (25·1 ± 2·8 year) performed four sets of leg press exercises with and without BFR (150–160 mmHg) at an intensity of 30% of one-repetition maximum (1RM). In each exercise session, one set with 30 repetitions was followed by three sets with 15 repetitions. Blood samples were taken before, and 10 min, 1, 4 and 24 h after the exercise. Prothrombin fragment 1 + 2 (PTF) and thrombin–antithrombin III complex (TAT) were measured as markers of thrombin generation, whereas D-dimer and fibrin degradation product (FDP) were measured as markers of intravascular clot formation. Changes in plasma volume (PV) were calculated from haemoglobin and hematocrit values. PV reduction was significantly greater after the exercise with BFR than without ( P<0·05). However, neither markers of thrombin generation nor intravascular clot formation increased after the exercises. These results suggest that low-intensity resistance exercise with BFR does not activate coagulation system in healthy subjects. [ABSTRACT FROM AUTHOR]

The KAATSU training is a unique method of muscle training with restricting venous blood flow, which might be applied to prevent muscle atrophy during space flight, but the effects of KAATSU in microgravity remain unknown. We investigated the hemodynamic responses to KAATSU during actually simulated weightlessness (6 degrees head-down tilt for 24 h, n = 8), and compared those to KAATSU in the seated position before bed rest. KAATSU was applied to the proximal ends of both the thighs. In the seated position before bed rest, sequential incrementing of KAATSU cuff pressure and altering the level of blood flow restriction resulted in a decrease in stroke volume (SV) with an increase in heart rate (HR). KAATSU (150-200 mmHg) decreased SV comparable to standing. Following 24-h bed rest, body mass, blood volume (BV), plasma volume (PV), and diameter of the inferior vena cava (IVC) were significantly reduced. Norepinephrine (NOR), vasopressin (ADH), and plasma renin activity (PRA) tend to be reduced. A decrease in SV and CO induced by KAATSU during the simulated weightlessness was larger than that in the seated position before bed rest, and one of eight subjects developed presyncope due to hypotension during 100 mmHg KAATSU. High-frequency power (HF(RR)) decreased during KAATSU and standing, while low-frequency/high-frequency power (LF(RR)/HF(RR)) increased significantly. NOR, ADH and PRA also increased during KAATSU. These results indicate that KAATSU blood flow restriction reproduces the effects of standing on HR, SV, NOR, ADH, PRA, etc., thus stimulating a gravity-like stress during simulated weightlessness. However, syncope due to lower extremity blood pooling and subsequent reduction of venous return may be induced during KAATSU in microgravity as reported in cases of lower-body negative pressure. [ABSTRACT FROM AUTHOR]

The application of an orthostatic stress such as lower body negative pressure (LBNP) has been proposed to minimize the effects of weightlessness on the cardiovascular system and subsequently to reduce the cardiovascular deconditioning. The KAATSU training is a novel method to induce muscle strength and hypertrophy with blood pooling in capacitance vessels by restricting venous return. Here, we studied the hemodynamic, autonomic nervous and hormonal responses to the restriction of femoral blood flow by KAATSU in healthy male subjects, using the ultrasonography and impedance cardiography. The pressurization on both thighs induced pooling of blood into the legs with pressure-dependent reduction of femoral arterial blood flow. The application of 200 mmHg KAATSU significantly decreased left ventricular diastolic dimension (LVDd), cardiac output (CO) and diameter of inferior vena cava (IVC). Similarly, 200 mmHg KAATSU also decreased stroke volume (SV), which was almost equal to the value in standing. Heart rate (HR) and total peripheral resistance (TPR) increased in a similar manner to standing with slight change of mean blood pressure (mBP). High-frequency power (HF(RR)) decreased during both 200 mmHg KAATSU and standing, while low-frequency/high-frequency power (LF(RR)/HF(RR)) increased significantly. During KAATSU and standing, the concentration of noradrenaline (NA) and vasopressin (ADH) and plasma renin activity (PRA) increased. These results indicate that KAATSU in supine subjects reproduces the effects of standing on HR, SV, TPR, etc., thus stimulating an orthostatic stimulus. And, KAATSU training appears to be a useful method for potential countermeasure like LBNP against orthostatic intolerance after spaceflight. [ABSTRACT FROM AUTHOR]

Blood flow restriction (BFR) has the potential to augment muscle activation, which underlies strengthening and hypertrophic effects of exercise on skeletal muscle. We quantified the effects of BFR on muscle activation in the rectus femoris (RF), the vastus lateralis (VL), and the vastus medialis (VM) in concentric and eccentric contraction phases of low-intensity (10% and 20% of one repetition maximum) leg extension in seven cardiovascular patients who performed leg extension in four conditions: at 10% and 20% intensities with and without BFR. Each condition consisted of three sets of 30 trials with 30 s of rest between sets and 5 min of rest between conditions. Electromyographic activity (EMG) from RF, VL, and VM for 30 repetitions was divided into blocks of 10 trials and averaged for each block in each muscle. At 10% intensity, BFR increased EMG of all muscles across the three blocks in both concentric and eccentric contraction phases. At 20% intensity, EMG activity in response to BFR tended to not to increase further than what it was at 10% intensity. We concluded that very low 10% intensity exercise with BFR may maximize the benefits of BFR on muscle activation and minimize exercise burden on cardiovascular patients. [ABSTRACT FROM AUTHOR]

Introduction: Lactate/proton cotransporters (MCT1 and MCT4) in the plasma membranes of skeletal muscle are involved in both muscle pH and lactate regulation, and play an important role in exercise performance. Low force exercise training with blood flow restriction (BFR) increases muscle strength and elicits muscle hypertrophy. Hypothesis: To investigate the effects of chronic low-intensity electrical stimulation (LIES) combined with blood flow restriction (BFR) on MCT expression and peroxisome proliferator-activated receptor gamma co-activator 1-alpha (PGC-1α) in rat skeletal muscle. Methods: Wistar rats wore the cuff to restrict muscle blood flow under anesthesia. The moderate BFR (80 mmHg) was added by wearing a cuff on the thigh of the rat, and low-intensity isometric contraction (30Hz stimulation) due to electrical stimulation to the tibialis anterior muscle was loaded. LIES with or without BFR was applied for 3 weeks (3 times/week). The protein expression including mitochondria associated proteins were evaluated. Results: LIES with or without BFR significantly increased MCT1, and its chaperon, CD147, but not MCT4. It also increased the protein content of cytochrome c oxidase subunit 4 (COX4), used as an index of mitochondrial adaptations, and FNDC5. LIES combined with BFR potentiated MCT1 expression, compared with LIES alone. It also enhanced the protein level of PGC-1α. There was a strong positive correlation between changes in PGC-1α and COX, MCT1, or FNDC5 expression. Conclusions: These results suggest that moderate BFR combined with low-intensity exercise enhances MCT1 expression and mitochondria biogenesis in rat skeletal muscle via PGC-1α. And, MCT1 is likely a key transporter facilitating the uptake of lactate into muscle, and improving exercise performances in exercise training using blood flow restriction. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented regarding the effects of blood flow restriction (BFR) walk training on arterial compliance in elderly women.

Concurrent improvements in aerobic capacity and muscle hypertrophy in response to a single mode of training have not been reported. We examined the effects of low-intensity cycle exercise training with and without blood flow restriction (BFR) on muscle size and maximum oxygen uptake (VO2max). A group of 19 young men (mean age ± SD: 23.0 ± 1.7 years) were allocated randomly into either a BFR-training group (n=9, BFR-training) or a non-BFR control training group (n=10, CON-training), both of which trained 3 days/wk for 8 wk. Training intensity and duration were 40% of VO2max and 15 min for the BFR-training group and 40% of VO2max and 45 min for the CON-training group. MRI-measured thigh and quadriceps muscle crosssectional area and muscle volume increased by 3.4-5.1% (P < 0.01) and isometric knee extension strength tended to increase by 7.7% (p < 0.10) in the BFR-training group. There was no change in muscle size (∼0.6%) and strength (∼1.4%) in the CON-training group. Significant improvements in VO2max (6.4%) and exercise time until exhaustion (15.4%) were observed in the BFR-training group (p < 0.05) but not in the CONtraining group (-0.1 and 3.9%, respectively). The results suggest that low-intensity, short-duration cycling exercise combined with BFR improves both muscle hypertrophy and aerobic capacity concurrently in young men. [ABSTRACT FROM AUTHOR]