<p>Strength training with blood flow restriction – a novel therapeutic approach for older adults with sarcopenia? A case report</p>

Abstract

Introduction A 91-year-old sedentary man presenting exhaustion, lower-limb weakness, hypertension, and history of multiple falls was diagnosed with sarcopenia – appendicular skeletal muscle mass index (ASM) of 7.10 kg/m 2 . Purpose To investigate the effects of strength training performed with low intensity in isolation (LI) or with blood flow restriction (LI-BFR) on strength, muscle mass, IGF-1, endothelial function, microcirculation, inflammatory biomarkers, and oxidative stress. Methods In the first 3 months, LI was performed with intensity corresponding to 30% of 1 repetition maximum, followed by 1 month of inactivity, and another 3 months of LI-BFR (similar load than LI concomitant to BFR equivalent to 50% of resting systolic blood pressure). Results LI-BFR, but not LI improved muscle mass, ASM, handgrip strength, isokinetic peak torque, IL-6, and IGF-1. Endothelial function, red blood cell velocity, and concentrations of C-reactive protein, and soluble intercellular adhesion molecules-1 improved after both LI and LI-BFR. Endothelin-1 and oxidative stress increased after LI-BFR, and lowered after LI. Conclusion LI-BFR, but not LI improved strength, muscle mass, IGF-1, endothelial function, and selected inflammatory markers in a nonagenarian sarcopenic patient. These results are promising and suggest that LI-BFR should be considered as an alternative to prevent muscle loss and improve functional fitness in frail older populations.

Acute effects of physical exercise with different levels of blood flow restriction on vascular reactivity and biomarkers of muscle hypertrophy, endothelial function and oxidative stress in young and elderly subjects – A randomized controlled protocol

“…The BFR training is usually performed with low intensity (20–40% of repetition maximum) combined to the application of an external pressure on the upper or lower limbs through pneumatic cuff, resulting in reduction of arterial and venous blood flow [ 17 ]. This method has been shown to induce substantial gains of muscle mass and strength in healthy young [ 1 ] and older [ 2 ] adults with different clinical conditions [ 3 , 4 , 24 , 25 ]. However, the influence of age on vascular effects remains unclear, with some studies reporting deleterious responses in young subjects [ 6 , 8 , 9 , 26 ], while others observed preserved or improved responses in the elderly [ 5 , 10 , 11 ].…”

“…Prior research has shown that exercise with loads corresponding to 20–40% of maximal strength combined with blood flow restriction (BFR) is capable to promote increases in skeletal muscle mass and strength, even when compared to high intensity strength exercises [ 1 , 2 ]. The results of these studies also suggest that different levels of BFR can promote positive muscle hypertrophy and strength adaptations in older adults, suggesting that this type of intervention may be a training alternative for individuals who are not tolerant to high intensity exercise protocols [ 3 ].…”

“…Although potentially relevant due to its clinical applications in the elderly within preventive or rehabilitation settings [ [2] , [3] , [4] ], few studies have evaluated the effects of this mode of intervention on the vascular health [ [5] , [6] , [7] ]. Moreover, studies with different age groups produced conflicting results.…”

“…The optimal level of BFR to produce gains in muscle mass and strength, while avoiding adverse effects in endothelial function in young and older individuals remains undefined. In addition, although recent evidence suggested that low-intensity RT with different levels of BFR may be effective to induce hypertrophy [ 3 , [12] , [13] , [14] ], age-related dose-response relationships regarding the level of BFR occlusion vs. adaptations in muscle function and endothelial dysfunction have not been clearly established.…”

Molecular Regulation of Skeletal Muscle Growth and Organelle Biosynthesis: Practical Recommendations for Exercise Training

“…Recently, it was found that BFR can limit skeletal muscle atrophy and MuRF1 expression during cast immobilization and muscular weakness induced by chronic unloading [ 299 , 300 ]. In addition, there are some data about BFR during muscle wasting or aging and a case report has suggested that BFR should be considered to improve physical fitness, prevent muscle loss, and improve arterial compliance in frail aged subjects [ 301 , 302 ]. In old women, resistance training at low intensity combined with BFR at 110 mmHg appears effective to induce hypertrophy and gains in muscle strength [ 303 ], and walking with BFR at higher pressure improves limb venous compliance [ 304 ].…”