Blood-Flow Restriction Resistance Exercise Promotes Lower Pain and Ratings of Perceived Exertion Compared With Either High- or Low-Intensity Resistance Exercise Performed to Muscular Failure

Lixandrão, Manoel Emílio; Roschel, Hamilton; Ugrinowitsch, Carlos; Miquelini, Maira; Alvarez, Ieda Fernanda; Libardi, Cleiton Augusto

doi:10.1123/jsr.2018-0030

Cited by 26 publications

(56 citation statements)

References 24 publications

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“…While discomfort and pain have been reported in BFRT, patients performing high-load traditional RT can still experience high levels of discomfort, even to the point where they cannot complete an exercise protocol. 14 BFRT has been reported to increase the rating of perceived exertion and pain response to a lesser extent than that of high-or low-load RT in healthy men, suggesting lower discomfort levels with the use of BFRT 30,35 and thereby improving its relevance in patient populations. In a trial comparing BFRT with high-load RT in patients undergoing rehabilitation from ACL reconstruction surgery, knee pain was significantly lower in patients using BFRT.…”

Section: Discussionmentioning

confidence: 99%

“…BFRT has been reported to increase the rating of perceived exertion and pain response to a lesser extent than that of high- or low-load RT in healthy men, suggesting lower discomfort levels with the use of BFRT 30,35 and thereby improving its relevance in patient populations. In a trial comparing BFRT with high-load RT in patients undergoing rehabilitation from ACL reconstruction surgery, knee pain was significantly lower in patients using BFRT.…”

Section: Discussionmentioning

confidence: 99%

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The Safety of Blood Flow Restriction Training as a Therapeutic Intervention for Patients With Musculoskeletal Disorders: A Systematic Review

et al. 2019

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Background: The effectiveness of blood flow restriction training (BFRT) as compared with other forms of training, such as resistance training, has been evaluated in the literature in clinical and nonclinical populations. However, the safety of this intervention has been summarized only in healthy populations and not in clinical populations with musculoskeletal disorders. Purpose: To evaluate the safety and adverse events associated with BFRT in patients with musculoskeletal disorders. Study Design: Systematic review. Methods: A literature search was conducted with 3 online databases (MEDLINE, CINAHL, and Embase). Eligibility criteria for selecting studies were as follows: (1) BFRT was used as a clinical intervention, (2) study participants had a disorder of the musculoskeletal system, (3) authors addressed adverse events, (4) studies were published in English, and (5) the intervention was performed with human participants. Results: Nineteen studies met eligibility criteria, with a pooled sample size of 322. Diagnoses included various knee-related disorders, inclusion body myositis, polymyositis or dermatomyositis, thoracic outlet syndrome, Achilles tendon rupture, and bony fractures. Nine studies reported no adverse events, while 3 reported rare adverse events, including an upper extremity deep vein thrombosis and rhabdomyolysis. Three case studies reported common adverse events, including acute muscle pain and acute muscle fatigue. In the randomized controlled trials, individuals exposed to BFRT were not more likely to have an adverse event than individuals exposed to exercise alone. Of the 19 studies, the adverse events were as follows: overall, 14 of 322; rare overall, 3 of 322; rare BFRT, 3 of 168; rare control, 0 of 154; any adverse BFRT, 10 of 168; any adverse control, 4 of 154. A majority of studies were excluded because they did not address safety. Conclusion: BFRT appears to be a safe strengthening approach for knee-related musculoskeletal disorders, but further research is needed to make definitive conclusions and to evaluate the safety in other musculoskeletal conditions. Improved definitions of adverse events related to BFRT are needed to include clear criteria for differentiating among common, uncommon, and rare adverse events. Finally, further research is needed to effectively screen who might be at risk for rare adverse events.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Safety of Blood Flow Restriction Training as a Therapeutic Intervention for Patients With Musculoskeletal Disorders: A Systematic Review

et al. 2019

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“…4 Neto found that groups participating in low intensity exercises with BFR (5.0% increase) provide similar levels of blood lactate accumulation as compared to high intensity exercises without BFR (5.2% increase). 36 Okita et al research finds that metabolic stress is induced by decreases in phosphocreatine and intramuscular pH. Participants performing low intensity exercises do not have significant decrease in intramuscular pH while participants using intermittent BFR (-.10 pH) and continuous BFR (-.125 pH) have significant decrease in pH.…”

Section: Metabolic Stressmentioning

confidence: 98%

“…Multiple studies have found that when using BFR in conjunction with low resistance exercise, blood lactate levels are significantly higher than control groups and levels are similar to that produced by high intensity training. 4,36 Oliveira et al, found significant increases in blood lactate accumulation (measured before and after treatment) between participates performing low intensity exercises with BFR (16% +/-13% ) and those performing low intensity exercise without BFR (6% +/-4 %). 4 Neto found that groups participating in low intensity exercises with BFR (5.0% increase) provide similar levels of blood lactate accumulation as compared to high intensity exercises without BFR (5.2% increase).…”

Section: Metabolic Stressmentioning

confidence: 99%

The Systemic Effects of Blood Flow Restriction Training: A Systematic Review

Miller

Tirko

Shipe

et al. 2021

International Journal of Sports Physical Therapy

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Background Blood flow restriction (BFR) training has been reported to have significant benefits on local skeletal muscle including increasing local muscle mass, strength, and endurance while exercising with lower resistance. As a result, patients unable to perform traditional resistance training may benefit from this technique. However, it is unclear what effects BFR may have on other body systems, such as the cardiovascular and pulmonary systems. It is important to explore the systemic effects of BFR training to ensure it is safe for use in physical therapy. Purpose The purpose of this study was to systematically review the systemic effects of blood flow restriction training when combined with exercise intervention. Study Design Systematic review. Methods Three literature searches were performed: June 2019, September 2019, and January 2020; using MedLine, ScienceDirect, PubMed, Cochrane Reviews and CINAHL Complete. Inclusion criteria included: at least one outcome measure addressing a cardiovascular, endocrinological, systemic or proximal musculoskeletal, or psychosocial outcome, use of clinically available blood flow restriction equipment, use of either resistance or aerobic training in combination with BFR, and use of quantitative measures. Exclusion criteria for articles included only measuring local or distal musculoskeletal changes due to BFR training, examining only passive BFR or ischemic preconditioning, articles not originating from a scholarly peer-reviewed journal, CEBM level of evidence less than two, or PEDro score less than four. Articles included in this review were analyzed with the CEBM levels of evidence hierarchy and PEDro scale. Results Thirty-five articles were included in the review. PEDro scores ranged between 4 and 8, and had CEBM levels of evidence of 1 and 2. Common systems studied included cardiovascular, musculoskeletal, endocrine, and psychosocial. This review found positive or neutral effects of blood flow restriction training on cardiovascular, endocrinological, musculoskeletal, and psychosocial outcomes. Conclusions Although BFR prescription parameters and exercise interventions varied, the majority of included articles reported BFR training to produce favorable or non-detrimental effects to the cardiovascular, endocrine, and musculoskeletal systems. This review also found mixed effects on psychosocial outcomes when using BFR. Additionally, this review found no detrimental outcomes directly attributed to blood flow restriction training on the test subjects or outcomes tested. Thus, BFR training may be an effective intervention for patient populations that are unable to perform traditional exercise training with positive effects other than traditional distal muscle hypertrophy and strength and without significant drawbacks to the individual. Level of Evidence 1b

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“…The cuffs were always positioned as proximally as possible to the thigh. Occlusion pressure was individually determined by Doppler ultrasound (Acuson X150, Siemens, Munich, Germany) with the participants lying in a supine position (Lixandrão et al, 2019). For blood-flow restriction, we determined the blood flow of the arteria tibialis posterior 5 cm proximal of the medial malleolus (Behringer et al, 2017).…”

Section: Blood-flow Restrictionmentioning

confidence: 99%

Effects of Resting vs. Continuous Blood-Flow Restriction-Training on Strength, Fatigue Resistance, Muscle Thickness, and Perceived Discomfort

Schwiete

Franz²,

Roth

et al. 2021

Front. Physiol.

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Introduction: The purpose of this study was to clarify whether blood-flow restriction during resting intervals [resting blood-flow restriction (rBFR)] is comparable to a continuous BFR (cBFR) training regarding its effects on maximum strength, hypertrophy, fatigue resistance, and perceived discomfort.Materials and Methods: Nineteen recreationally trained participants performed four sets (30-15-15-15 repetitions) with 20% 1RM on a 45° leg press twice a week for 6 weeks (cBFR, n = 10; rBFR, n = 9). Maximum strength, fatigue resistance, muscle thickness, and girth were assessed at three timepoints (pre, mid, and post). Subjective pain and perceived exertion were determined immediately after training at two timepoints (mid and post).Results: Maximum strength (p < 0.001), fatigue resistance (p < 0.001), muscle thickness (p < 0.001), and girth (p = 0.008) increased in both groups over time with no differences between groups (p > 0.05). During the intervention, the rBFR group exposed significantly lower perceived pain and exertion values compared to cBFR (p < 0.05).Discussion: Resting blood-flow restriction training led to similar gains in strength, fatigue resistance, and muscle hypertrophy as cBFR training while provoking less discomfort and perceived exertion in participants. In summary, rBFR training could provide a meaningful alternative to cBFR as this study showed similar functional and structural changes as well as less discomfort.

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Blood-Flow Restriction Resistance Exercise Promotes Lower Pain and Ratings of Perceived Exertion Compared With Either High- or Low-Intensity Resistance Exercise Performed to Muscular Failure

Cited by 26 publications

References 24 publications

The Safety of Blood Flow Restriction Training as a Therapeutic Intervention for Patients With Musculoskeletal Disorders: A Systematic Review

The Safety of Blood Flow Restriction Training as a Therapeutic Intervention for Patients With Musculoskeletal Disorders: A Systematic Review

The Systemic Effects of Blood Flow Restriction Training: A Systematic Review

Effects of Resting vs. Continuous Blood-Flow Restriction-Training on Strength, Fatigue Resistance, Muscle Thickness, and Perceived Discomfort

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