A Useful Blood Flow Restriction Training Risk Stratification for Exercise and Rehabilitation

Abstract

Blood flow restriction training (BFRT) is a modality with growing interest in the last decade and has been recognized as a critical tool in rehabilitation medicine, athletic and clinical populations. Besides its potential for positive benefits, BFRT has the capability to induce adverse responses. BFRT may evoke increased blood pressure, abnormal cardiovascular responses and impact vascular health. Furthermore, some important concerns with the use of BFRT exists for individuals with established cardiovascular disease (e.g., hypertension, diabetes mellitus, and chronic kidney disease patients). In addition, considering the potential risks of thrombosis promoted by BFRT in medically compromised populations, BFRT use warrants caution for patients that already display impaired blood coagulability, loss of antithrombotic mechanisms in the vessel wall, and stasis caused by immobility (e.g., COVID-19 patients, diabetes mellitus, hypertension, chronic kidney disease, cardiovascular disease, orthopedic post-surgery, anabolic steroid and ergogenic substance users, rheumatoid arthritis, and pregnant/postpartum women). To avoid untoward outcomes and ensure that BFRT is properly used, efficacy endpoints such as a questionnaire for risk stratification involving a review of the patient’s medical history, signs, and symptoms indicative of underlying pathology is strongly advised. Here we present a model for BFRT pre-participation screening to theoretically reduce risk by excluding people with comorbidities or medically complex histories that could unnecessarily heighten intra- and/or post-exercise occurrence of adverse events. We propose this risk stratification tool as a framework to allow clinicians to use their knowledge, skills and expertise to assess and manage any risks related to the delivery of an appropriate BFRT exercise program. The questionnaires for risk stratification are adapted to guide clinicians for the referral, assessment, and suggestion of other modalities/approaches if/when necessary. Finally, the risk stratification might serve as a guideline for clinical protocols and future randomized controlled trial studies.

The effectiveness of blood flow restriction training in cardiovascular disease patients: A scoping review

“…Although BFR exercise appears to have positive benefits on skeletal muscle function, it is important to recognize possible contraindications that should be considered with respect to vascular health (e.g. coronary artery disease, unstable hypertension, postsurgical excess swelling, medications known to increase blood clotting risk)[ 39 , 40 ]. Therefore, proper screening prior to BFR exercise is required to reduce the risk of complications[ 40 , 41 ].…”

Pós-Covid-19: Treinamento Com Restrição De Fluxo Sanguíneo Como Aliado No Processo De Reabilitação

“…No entanto ainda não há dados na literatura da utilização desse recurso como aliado a reabilitação de paciente pós COVID-19, todavia pode ser facilmente adaptado a esses indivíduos, visto que a fraqueza muscular é também é visto em outras condições como cardiopatas, idosos, pós cirúrgico de ligamento cruzado anterior e fraqueza muscular observada em astronautas pós missão espacial (HUGHES et al, 2019;LAMBERT et al, 2018;NASCIMENTO et al, 2022).…”

Knee Loading With Blood Flow Restriction Can Enhance Recovery After Total Knee Arthroplasty

“…BFR training is acknowledged to offer significant neuromuscular benefits and adaptations; however, it can possibly lead to side effects (e.g., numbness, nausea, headache, fainting, tingling) and there are potential significant adverse events (e.g., hypertension, venous thrombus, deterioration of ischemic heart disease, central retina vein occlusion, and rhabdomyolysis) if applied inappropriately. These occurrences are rare in clinical practice - with embolism being chief among them, but have been previously documented and a risk stratification recommendation has been published to guide safety in clinical practice [ 41 ]. There is no exhaustive list of absolute or relative BFR training contraindications, but possible BFR contraindications are considered self-evident conditions like cardiovascular diseases (e.g., coronary heart diseases, unstable hypertension, peripheral vascular disease, venous thromboembolism cardiopulmonary conditions, hemophilia), severe musculoskeletal injuries (e.g., recent muscle trauma or crush injuries, post-surgical excess swelling, skin graft, extremity infection), lifestyle conditions (e.g., pregnancy, smoking, obesity, uncontrolled diabetes mellitus), family medical history (e.g., clotting disorders, sickle cell anemia, atrial fibrillation or heart failure, cancer), and medications (e.g., known to increase blood clotting risk) [ 19 , 42 ].…”