Safety of Blood Flow Restricted Exercise in Hypertension: A Meta-Analysis and Systematic Review With Potential Applications in Orthopedic Care

Abstract

Blood flow restricted (BFR) exercise has recently been promoted in the United States as a novel method to restore skeletal muscle strength and hypertrophy in primarily athletic and healthy populations. A specialized tourniquet restricts blood flow after which brief and intermittent exercise is performed with low to moderate loads of resistance. A hypertensive blood pressure (BP) response during BFR exercise has been identified as a potential adverse effect, which may be particularly concerning for patients who are hypertensive. Because of the possibility that a substantial proportion of older adults undergoing orthopedic surgery may have hypertension as well as the possibility of a hypertensive BP response from BFR exercise, we performed a comprehensive search for studies examining the acute and chronic BP response to BFR exercise in hypertensive subjects resulting in 6 studies with which a meta-analysis and systematic review were performed. The meta-analysis results found nonsignificant, slight increases in systolic BP and diastolic BP. The results of the systematic review found that BFR exercise seems to be safe in patients with hypertension with no adverse events reported in the 86 patients who participated in the 6 reviewed studies. The cardiovascular response to BFR exercise seems to vary depending on the muscle group being exercised as well as the method of BFR, but, in general, these measures are greater during BFR exercise compared with non-BFR exercise.

Resistance Training with Blood Flow Restriction on Vascular Function: A Meta-analysis

“…It has been shown that RT with BFR augmented the strength and cross-sectional area of skeletal muscle [28]. Due to its low load and safety, this is recommended for older people and, in particular, patients with cardiovascular disease, to maintain and improve muscle mass and strength [29]. The pooling data used in this review indicated that the effect of RT with BFR on arterial compliance was better than conventional RT.…”

Effects of Low-Load Blood Flow Restriction Training on Hemodynamic Responses and Vascular Function in Older Adults: A Meta-Analysis

“…A possible explanation for this positive result is that after the blood flow is released from the training muscle, the reperfusion process of locally and rapidly congested blood induces the release of endothelium-dependent vasodilator, resulting in an increase in local blood flow, thereby reducing vascular resistance and blood pressure [ 27 , 28 ]. Given that BFR training is conducive to reducing cardiac preload during training, some studies have shown that it can be used as a more effective exercise intervention in hypertensive patients [ 29 , 30 ]. However, in contrast with the results of meta-analyses conducted by previous researchers [ 31 ], in this study we noted that, while LL-BFR had a better hypotensive effect than the conventional LL-RT or HL-RT training, there was no statistically significant difference between them.…”

Effect of walk training combined with blood flow restriction on resting heart rate variability and resting blood pressure in middle-aged men

“…hypertensive subjects) 28,29 . However, some studies have indicated that exercise with BFR exercise seems to be safe in hypertensive subjects because they did not present any adverse events [30][31][32] . Furthermore, the acute effect during exercise with BFR slightly increases SBP 30 , whereas the chronic effect decreases SBP in hypertensive subjects 31 .…”