High-load resistance training (HL) may be contraindicated in older adults due to pre-existing health conditions (e.g. osteoarthritis). Low-load blood flow restricted (BFR) resistance training offers an alternative to HL with potentially similar strength improvement. PURPOSE To compare muscle strength, cross-sectional area (CSA), physical function, and quality of life (QOL) following 12-weeks of HL or BFR training in older adults at risk of mobility limitations. METHODS Thirty-six males and females (mean: 75.6 years 95% confidence interval: [73.4–78.5], 1.67 m [1.64–1.70], 74.3 kg [69.8–78.8]) were randomly assigned to HL (70% of one repetition maximum [1-RM]) or low-load BFR (30% 1-RM coupled with a vascular restriction) exercise for the knee extensors and flexors twice per week for 12 weeks. A control (CON) group performed light upper body resistance and flexibility training. Muscle strength, CSA of the quadriceps, 400-m walking speed, Short Physical Performance Battery (SPPB), and QOL were assessed before, midway and after training. RESULTS Within 6-weeks of HL training, increases in all strength measures and CSA were evident and the gains were significantly greater than the CON group (P<0.05). The BFR group had strength increases in leg extension and leg press 1-RM tests, but were significantly lower in leg extension isometric maximum voluntary contraction (MVC) and leg extension 1-RM than the HL group (P<.01). At 12-weeks HL and BFR training did not differ in MVC (P=.14). Walking speed increased 4% among all training groups (P<.01) and no changes were observed for overall SPPB score and QOL (P>.05). CONCLUSION Both training programs resulted in muscle CSA improvements and HL training had more pronounced strength gains than BFR training after 6-weeks and were more similar to BFR after 12-weeks of training. These changes in both groups did not transfer to improvements in QOL, SPPB, and walking speed. Since both programs result in strength and CSA gains, albeit at different rates, future research should consider using a combination of HL and BFR training in older adults with profound muscle weakness and mobility limitations.

Purpose To determine whether knee extensor power asymmetry limits functional mobility of older adults who possess muscle weakness. Methods Knee extensor power was measured in 36 older men and women (76.0 ± 7.6 yr), for each leg, on an isokinetic dynamometer at 60, 180, and 300 deg s−1 and power asymmetry was calculated as the percent difference in power between strong and weak legs, at each isokinetic velocity. 400-m walk, stair ascent, and five-repetition chair rise tests were performed to assess functional mobility. Pearson correlations were used to examine the relationship between weak leg power, strong leg power, power asymmetry, and 400-m walk time, stair ascent time, and chair rise time. Participants were then stratified into Low Power-High Asymmetry (LP-HA), Low Power-Low Asymmetry (LP-LA), High Power-High Asymmetry (HP-HA), and High Power-Low Asymmetry (HP-LA) groups who were compared for functional mobility. Results Knee extensor power asymmetry was unrelated to 400-m walk time (r = 0.16, p = 0.180), stair ascent time (r = 0.22, p = 0.094), or chair rise time (r = 0.03, p = 0.437), whereas weak and strong leg powers were equally associated with 400-m time (r = −0.62, p < 0.001; r = −0.62, p < 0.001), stair ascent time (r = −0.55, p < 0.001; r = −0.57, p < 0.001), and chair rise time (r = −0.28, p = 0.048; r = −0.31, p = 0.032), respectively. Power asymmetry was lowest at 60 deg s−1 (12%), and increased with contraction velocity (p = 0.001) to 15% at 180 deg s−1 and to 20% at 300 deg s−1. LP-HA exhibited 26% slower 400-walk time than HP-LA (p = 0.015) and 19% slower than HP-HA (p = 0.037). LP-HA had 31% slower stair ascent time than HP-LA (p = 0.033). There were no differences in chair rise performance between groups. Conclusions Knee extensor power asymmetry was unrelated to 400-m walk, stair ascent, and chair rise performance in older adults. Weak and strong limb powers were equally related to these functional measures, but a leftward shift of the power-mobility curve exists for the weak leg that may hinder clinical assessment if strength or power is measured on a single limb and symmetry is assumed. The greatest degree of knee extensor power asymmetry occurred at the fastest isokinetic velocity, which suggests high-speed muscle contractions may better differentiate laterality of function in older individuals.

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