Intradialytic exercise with blood flow restriction is more effective than conventional exercise in improving walking endurance in hemodialysis patients: a randomized controlled trial.

OBJECTIVE: This study aims to compare the effect of intradialytic aerobic exercise with blood flow restriction, without blood flow restriction (conventional) and no exercise (control) on muscle strength and walking endurance among chronic kidney disease patients. DESIGN: Open label and parallel group randomized controlled trial. SUBJECTS: Adult patients with chronic kidney disease on hemodialysis. INTERVENTION: A 12-week intradialytic training with or without blood flow restriction compared with a control group. MAIN MEASURES: Strength and walking endurance were measured using thoracolumbar dynamometry and a 6-minute walk test, respectively, before and after training. RESULTS: A total of 66 patients were randomized into three groups: blood flow restriction group (n = 22), conventional exercise group (n = 22) and control group (n = 22). There were seven dropouts, and 59 patients were included in the analysis. There was a significant increase in the 6-minute walking distance in the blood flow restriction group (from 412.7 (115.9) to 483.0 (131.0) m, P = 0.007) in comparison with the conventional exercise group (from 426.79 (115.00) to 433.2 (120.42) m, not significant) and the control group (from 428.4 (108.1) to 417.3 (100.2) m, not significant). The change in the walking distance over time was significantly different among groups (intervention group/time, P = 0.02). The simple effects test found a significant time effect only in the blood flow restriction group. There was no significant difference in strength change between the groups. CONCLUSION: Among chronic kidney disease patients, intradialytic exercise of low/moderate intensity with blood flow restriction was more effective in improving walking endurance than conventional exercise or no exercise.

Is It Safe for Hemodialysis Patients to Seek Gains with Less Pain? Acute Hemodynamic Response to Intradialytic Blood Flow Restriction Training.

Considering that the hemodynamic safety is a major concern about intradialytic exercise with blood flow restriction, this analysis was performed to compare the blood pressure (BP) behavior during the first two hours of hemodialysis (HD) between sessions with no exercise (control group, CG), low/moderate intensity aerobic exercise with blood flow restriction (BFRE) and conventional aerobic exercise (AE). Adult patients with chronic kidney disease on HD at a university hospital were randomly assigned and submitted to a 12-week intradialytic training with BFRE or AE compared with the CG group. The main outcomes of this report were the change in systolic (SBP) and diastolic (DBP) BP during HD and the frequency of low BP (LBP) and high BP (HBP) episodes. A total of 6,074 BP measurements of 58 patients were analyzed. There was a larger decrease in BP in the exercise sessions compared with the control sessions, but with a similar magnitude in the BFRE and AE groups (effect size 0.49). There was a higher number of LBP in the BFRE group. The frequency of HBP was similar between the BFRE and the CG groups and lower in the AE group. Despite a greater number of mild LBP in BFRE patients, the BP change during the first two hours of HD was similar to that of patients in AE. Intradialytic aerobic exercise with blood flow restriction does not seem to be associated with a higher hemodynamic burden than conventional aerobic exercise.

Effects of continuous moderate exercise with partial blood flow restriction during hemodialysis: A protocol for a randomized clinical trial.

Chronic kidney disease (CKD) is associated with physical weakness and increased oxidative stress and inflammation levels. Rehabilitation programs are associated with an improvement in the functional capacity, inflammatory and oxidative stress profile. Exercise associated with blood flow restriction (BFR) has been demonstrating positive effects in training programs, but there is lack information about exercise with BFR in CKD. Therefore, the aim of the present study is to describe a protocol using continuous moderate exercise with blood flow restriction (BFR) applied during hemodialysis (HD) to measures health indicators and immune system and oxidative stress parameters in CKD patients. Methods: A RTC will be conducted with 42 patients in HD. Baseline measures will be compared with final measures (anthropometric, cardiorespiratory, biochemical, muscle fitness, nutritional and behavioral questions). Participants will be randomly allocated to: 1) Continuous moderate exercise group with BFR; 2) Continuous moderate exercise group without BFR; 3) Control group without exercise. The intervention will be 12 weeks long during HD session. Patients will perform 20 min of continuous moderate exercise on a stationary bicycle three times a week. The present study is expected to generate significant information about the role of exercise with BFR in patients with CKD during HD.

Effect of training with partial blood flow restriction in older adults: a systematic review / Efeito do treinamento com restrição parcial do fluxo sanguíneo em adultos mais velhos e idosos: Uma revisão sistemática

Abstract Low-intensity training with blood flow restriction (BFR) has been suggested as an alternative to physical training for older adults. The present study aimed to review the literature regarding the effect of training with BFR for older adults. The search strategy consisted of experimental studies aimed at verifying the effects of training with BFR on any outcome in older adults. An electronic search in PubMed / Medline, Bireme Scielo, Lilacs and Cochrane Library databases, published until December 2015 was conducted. Experimental studies that considered individuals aged 50 years and over published in English or Portuguese, were included. The Downs & Black scale was used to assess the methodological quality of articles. Of the 60 studies, 12 were included in the review. Training with BFR improved body mass, torque and muscle power; functional capacity; bone health; venous compliance; peak oxygen uptake; and blood flow; balance and overall performance. The methodological quality of studies had mean score of 16.2 points (SD = 1.6). The prescription of low-intensity exercises with BFR may be an alternative of training for older adults. However, future studies should address the methodological quality, especially external validity and power, the main gaps in articles reviewed in this study.

Resumo O treinamento de baixa intensidade com restrição do fluxo sanguíneo (RFS) tem sido sugerido como alternativa para o treinamento adultos mais velhos e idosos. Assim, o presente estudo objetivou revisar a literatura existente referente ao efeito do treinamento com RFS em adultos mais velhos e idosos. A estratégia de busca consistiu a partir de estudos experimentais que objetivaram verificar os efeitos do treinamento com RFS sobre qualquer desfecho em indivíduos com 50 anos ou mais. Foi realizada busca eletrônica nas bases de dados Pubmed/ Medline, Bireme, Scielo, Lilacs e Cochrane, publicados até dezembro de 2015. Foram incluídos estudos experimentais, publicados em inglês e português, com adultos com 50 anos ou mais. A escala Downs & Black foi utilizada para averiguar a qualidade metodológica dos artigos. Dos 60 estudos encontrados, 12 foram incluídos na revisão. O treinamento com RFS melhorou o grau de força, a massa, o torque e a potência muscular, a capacidade funcional, a saúde óssea, a complacência venosa, o consumo de oxigênio de pico, o fluxo sanguíneo e o equilíbrio e a performance geral. Quanto à qualidade metodológica os estudos apresentaram um escore médio de 16,2 pontos (DP=1,6). A prescrição de exercícios de baixa intensidade com RFS pode ser uma alternativa para o treinamento de adultos mais velhos e idosos. Porém, futuros estudos devem atentem para a qualidade metodológica, especialmente validade externa e poder, principais lacunas apresentadas pelos estudos revisados.