The blood flow restriction training effect in knee osteoarthritis people: a systematic review and meta-analysis

Abstract

Objective: To synthesize evidence on the effects of blood flow restriction (BFR) comparing with high (HLT) and low load (LLT), and on the influence of different forms of application in individuals with knee osteoarthritis. Data sources: The CENTRAL, PEDro, PubMed and BVS, which include Lilacs, Medline and SciELO, until April 2020. Review methods: A systematic review and meta-analysis of randomized trials used the PRISMA guidelines, whose main keywords were: Therapeutic Occlusion, Resistance Training, and Knee Osteoarthritie, blood flow restriction and Kaatsu training. Method quality was evaluated with the PEDro scale. When studies demonstrated homogeneity on outcome measures, the mean differences or standardized mean differences with 95% confidence interval were calculated and pooled in a meta-analysis for pooled synthesis. Results: Five articles were eligible in this review with moderate to low risk bias. Our results, showed no difference between BFR and HLT in knee strength (SMD = 0.00, 95% CI, –0.54 to 0.54, P = 1.00), function (SMD = −0.20, 95% CI, –0.45 to 0.06, P = 0.13), pain and volume. But, when compared BFR and LLT, the descriptive analysis demonstrated significant results in favor BFR to muscle strength (71.4% of measurement) and volume (MD = 1.66, 95% CI, 0.93 to 2.38, P < 0.00001), but not in pain or function. Conclusion: BFR can be used as a strategy in the rehabilitation of osteoarthritis due to gains in strength and volume with low mechanical stress. However, its application must be safe and individualized, since they can attenuate the stimuli offered by BFR.

Impact of a Six-Week Prehabilitation With Blood-Flow Restriction Training on Pre- and Postoperative Skeletal Muscle Mass and Strength in Patients Receiving Primary Total Knee Arthroplasty

“…These findings are well in line with previous literature reporting the positive influence of increased muscle mass and strength on subjective pain perception and QoL in OA-affected patients ( Davison et al, 2017 ; Kemnitz et al, 2017 ). A meta-analysis by Ferlito et al (2020) ) was able to show that BFRE leads to similar gains in muscle mass and strength with concurrent reductions in perceived pain like high-intensity training. Although there is no high-intensity comparison group in the current study, our data are well in line with previous reports showing that low-intensity exercise with BFR is superior to low-intensity exercise alone ( Segal et al, 2015 ).…”

Blood Flow Restriction Resistance Training in Tendon Rehabilitation: A Scoping Review on Intervention Parameters, Physiological Effects, and Outcomes

“…There is a clear need for further interventional studies of BFRT in tendinopathy and tendon rupture rehabilitation, with high quality large scale RCTs required to reach definitive conclusions and recommendations for BFRT in tendon pathology. However, there is a clear scientific rationale for the potential of clinical improvements in tendon pathology with BFRT as evidenced by the beneficial effects seen in healthy tendons, and the improvement of clinical outcomes with BFRT in other musculoskeletal disorders (Ohta et al, 2003 ; Bryk et al, 2016 ; Giles et al, 2017 ; Ferraz et al, 2018 ; Korakakis et al, 2018a ; Ferlito et al, 2020 ; Grantham et al, 2021 ). Given the increased research interest and clinical use of BFRT in musculoskeletal rehabilitation for non-tendon pathologies, the dearth of available studies applying BFRT to tendon pathologies could be considered somewhat surprising.…”

“…Whilst traditional eccentric or HSRT for tendinopathy utilizes heavy training loads of up to 70% of 1 repetition maximum (1-RM), low-load BFRT (LL-BFRT) typically uses lower training intensities, and loads in the range of 20–40% of 1RM, which may be more tolerable for patients not able to tolerate high muscle-tendon training loads, while still preventing muscle atrophy and promoting hypertrophy (Centner et al, 2019a ; Krzysztofik et al, 2019 ; Shiromaru et al, 2019 ; Kataoka et al, 2022 ). Interventional studies have found superior or similar clinical outcomes with LL-BFRT compared to conventional high-load resistance training (HL-RT) in knee rehabilitation for ACL reconstruction, patellofemoral pain, and knee osteoarthritis (Ohta et al, 2003 ; Bryk et al, 2016 ; Giles et al, 2017 ; Ferraz et al, 2018 ; Korakakis et al, 2018a ; Ferlito et al, 2020 ; Grantham et al, 2021 ). BFRT has been shown to cause exercise-induced hypoalgesia through endogenous opioid and endocannabinoid mechanisms, so could therefore be a useful pain management tool in early musculoskeletal rehabilitation, particularly in the presence of an acute pain response (Korakakis et al, 2018b ; Hughes and Patterson, 2019 , 2020 ; Hughes et al, 2021 ).…”

An Update on Physical Therapy Adjuncts in Orthopedics

“…Due to its efficacy while using low-load resistance, it may be beneficial in elderly populations with more physical limitations due to OA or generalized muscle atrophy. A recent meta-analysis observing BFRT in patients with knee OA concluded that BRFT is a reasonable intervention for improving muscle strength and volume with low mechanical stress [ 19 ]. With promising data from current studies, a clear need for expanded research of BFRT after total knee arthroplasty is indicated [ 9 ].…”