The Effect of Body Position and the Reliability of Upper Limb Arterial Occlusion Pressure Using a Handheld Doppler Ultrasound for Blood Flow Restriction Training

Abstract

Background: The precise calculation of arterial occlusive pressure is essential to accurately prescribe individualized pressures during blood flow restriction training. Arterial occlusion pressure in the lower limb varies significantly between different body positions while similar reports for the upper limb are lacking. Hypothesis: Body position has a significant effect in upper limb arterial occlusive pressure. Using cuffs with manual pump and a handheld Doppler ultrasound can be a reliable method to determine upper limb arterial blood flow restriction. Study Design: A randomized repeated measures design. Level of Evidence: Level 3. Methods: Forty-two healthy participants (age mean ± SD = 28.1 ± 7.7 years) completed measurements in supine, seated, and standing position by 3 blinded raters. A cuff with a manual pump and a handheld acoustic ultrasound were used. The Wilcoxon signed-rank test with Bonferroni correction was used to analyze differences between body positions. A within-subject coefficient of variation and an intraclass correlation coefficient (ICC) test were used to calculate reproducibility and reliability, respectively. Results: A significantly higher upper limb arterial occlusive pressure was found in seated compared with supine position ( P < 0.031) and in supine compared with standing position ( P < 0.031) in all raters. An ICC of 0.894 (95% CI = 0.824-0.939, P < 0.001) was found in supine, 0.973 (95% CI = 0.955-0.985, P < 0.001) in seated, and 0.984 (95% CI = 0.973-0.991, P < 0.001) in standing position. ICC for test-retest reliability was found 0.90 (95% CI = 0.814-0.946, P < 0.001), 0.873 (95% CI = 0.762-0.93, P < 0.001), and 0.858 (95% CI = 0.737-0.923, P < 0.001) in the supine, seated, and standing position, respectively. Conclusion: Upper limb arterial occlusive pressure was significantly dependent on body position. The method showed excellent interrater reliability and repeatability between different days. Clinical Relevance: Prescription of individualized pressures during blood flow restriction training requires measurement of upper limb arterial occlusive pressure in the appropriate position. The use of occlusion cuffs with a manual pump and a handheld Doppler ultrasound showed excellent reliability; however, the increased measurement error compared with the differences in arterial occlusive pressure between certain positions should be carefully considered for the clinical application of the method. Strength of Recommendations Taxonomy (SORT): B.

Exercised-Induced Hypoalgesia following An Elbow Flexion Low-Load Resistance Exercise with Blood Flow Restriction: A Sham-Controlled Randomized Trial in Healthy Adults

“…Before randomization, the blinded assessor (SK) recorded demographic characteristics (age, BMI and dominant side), blood pressure and pressure pain thresholds. Participants were asked to rest in a sitting position for 10 min and the non-dominant arm was used for the blood pressure measurement [ 40 ]. Then, participants were familiarized with procedures to be used for testing pressure pain threshold at local and remote sites.…”

“…Prior to commencing each session, LOP was determined in the position used for the exercise intervention (standard anatomical position) [ 40 ]. Participants were randomized to either an LLRE–BFR group using 40–50% of LOP or an HLRE with sham-BFR group using <20% of LOP (the cuff deflated to the point that was comfortably positioned on the proximal site of the upper limb) [ 32 ].…”

“…Before intervention, participants rested for 10 min in a seated position and blood pressure was measured at the brachial artery of the non-dominant side using an electronic device (Omron M6 Comfort HEM-7321). Systolic and diastolic blood pressures were recorded using the average of two measurements with a 30 s rest between them [ 40 , 43 ]. Blood pressure was also recorded after completing the fourth set of the exercise intervention.…”

Comparison of finger flexor resistance training, with and without blood flow restriction, on perceptional and physiological responses in advanced climbers

“…The blood flow restriction was applied using two inflatable cuffs (Occlude, Blood flow restriction exercise, Denmark, (width: 9 cm x length: 38 cm)). This brand of cuffs has shown good reliability both between sessions (ICC 0.86 and CV 5.7%) and rater (ICC 0.98 and CV 3.2%), when measuring occlusion pressure for the upper body while standing up 38 . The cuffs were placed as proximately as possible on each arm.…”

Can We Make Blood Flow Restriction Training More Accessible? Validity of a Low-Cost Blood Flow Restriction Device to Estimate Arterial Occlusion Pressure

“…The height of the support was individually adjusted to keep the elbow in a 90° flexion. Determining the AOP in a seated position was chosen because excellent interrater reliability and test-retest reliability values have been reported for this posture (20).…”