Skeletal muscle mass in competitive physique-based athletes (bodybuilding, 212 bodybuilding, bikini, and physique divisions): A case series.

OBJECTIVES: (1) To examine the muscle thickness of various muscle groups of the body to estimate the absolute and relative skeletal muscle mass (SM) in competitive physique-based athletes (Bodybuilding, 212 Bodybuilding, Bikini, and Physique divisions) and (2) to compare values across various divisions of competition and to resistance trained and non-resistance trained individuals. METHODS: Eight competitive physique-based athletes (2 M and 6 F), two recreationally resistance trained (1 M and 1 F) and two non-resistance trained (1 M and 1 F) participants had muscle thickness measured by ultrasound at nine sites on the anterior and posterior aspects of the body. SM was estimated from an ultrasound-derived prediction equation and SM index was used to adjust for the influence of standing height (i.e., divided by height squared). RESULTS: SM values ranged from 19.6 to 60.4 kg in the eight competitive physique-based athletes and 16.1 to 32.6 kg in the four recreationally resistance trained and non-resistance trained participants. SM index ranged from 7.2 to 17.9 kg/m2 in the eight competitive physique-based athletes and 5.8 to 9.3 kg/m2 in the four recreationally resistance trained and non-resistance trained participants. CONCLUSION: Overall, varying magnitudes of SM and SM index were present across competitors and their respective divisions of bodybuilding. The Men's Open Bodybuilder in the present study had greater values of total SM and SM index compared to previously published values in the literature. Our data provides insight into the extent of SM present in this population and further extends the discussion regarding SM accumulation in humans.

Tracking handgrip strength in Kendo athletes from university to middle and older adulthood.

OBJECTIVE: This study aimed to compare the current handgrip strength (HGS) of Kendo athletes with their HGS when they were in university (up to 50 years). METHODS: Eighty male graduates who were Kendo club members during their university days performed anthropometric and HGS measurements, and these HGS were compared with those measured during their university days (mean age of 19.5 years old). RESULTS: There was no evidence of a statistical difference in HGS between the current measurement and the measurement taken during university [-0.64 (-1.9, 0.67) kg, p = .336]. There was, however, evidence that the difference in HGS depended upon the current age of the individual (t = -6.43, p < .001). When probing the interaction, there were statistical differences between the ages of 24.6 and 38.2 years and between the ages of 47.4 and 69.9 years. Strength increased across time in the younger participants and decreased for those who were older. Between the ages of 38.9 and 46.1 years, there was no evidence of a statistical difference indicating a maintenance of strength. CONCLUSION: The HGS of Kendo club graduates, which they acquired during their formative years, continued to increase even after they graduated from university and entered their 30s. However, their HGS decreased from age 50, even though they practiced Kendo.

Is there evidence for the asymmetrical transfer of strength to an untrained limb?

PURPOSE: The literature predominantly addresses cross-education of strength in the dominant limb rather than the non-dominant limb, guided by the hypothesis of an asymmetrical transfer of strength from unilateral training protocols. The purpose of the study was to review the literature and determine how much evidence was available to support this claim. A meta-analysis was performed to estimate the magnitude of this hypothesized asymmetrical transfer of strength. METHODS: A literature search of all possible records was implemented using Cochrane Library, PubMed, and Scopus from February 2022 to May 2022. Comparison of randomized controlled trials was computed. The change scores and standard deviations of those change scores were extracted for each group. Only three studies met the criteria, from which a total of five effect sizes were extracted and further analyzed. RESULTS: The overall effect of resistance training of the dominant limb on strength transfer to the non-dominant limb relative to the effects of resistance training the non-dominant limb on strength transfer to the dominant (non-training) limb was 0.46 (SE 0.42). The analysis from this study resulted in minimal support for the asymmetry hypothesis. Given the small number of studies available, we provide the effect but note that the estimate is unlikely to be stable. CONCLUSION: Although it is repeatedly stated that there is an asymmetrical transfer of strength, our results find little support for that claim. This is not to say that it does not exist, but additional research implementing a control group and a direct comparison between limbs is needed to better understand this question.

Blood flow restriction augments the cross-education effect of isometric handgrip training.

INTRODUCTION: The application of blood flow restriction (BFR) to low-intensity exercise may be able to increase strength not only in the trained limb but also in the homologous untrained limb. Whether this effect is repeatable and how that change compares to that observed with higher intensity exercise is unknown. PURPOSE: Examine whether low-intensity training with BFR enhances the cross-education of strength compared to exercise without BFR and maximal efforts. METHODS: A total of 179 participants completed the 6-week study, with 135 individuals performing isometric handgrip training over 18 sessions. Participants were randomly assigned to one of four groups: 1) low-intensity (4 × 2 min of 30% MVC; LI, n = 47), 2) low-intensity with blood flow restriction (LI + 50% arterial occlusion pressure; LI-BFR, n = 41), 3) maximal effort (4 × 5 s of 100% MVC; MAX, n = 47), and 4) non-exercise control (CON, n = 44). RESULTS: LI-BFR was the only group that observed a cross-education in strength (CON: 0.64 SD 2.9 kg, LI: 0.95 SD 3.6 kg, BFR-LI: 2.7 SD 3.3 kg, MAX: 0.80 SD 3.1 kg). In the trained hand, MAX observed the greatest change in strength (4.8 SD 3.3 kg) followed by LI-BFR (2.8 SD 4.0 kg). LI was not different from CON. Muscle thickness did not change in the untrained arm, but ulna muscle thickness was increased within the trained arm of the LI-BFR group (0.06 SD 0.11 cm). CONCLUSION: Incorporating BFR into low-intensity isometric training led to a cross-education effect on strength that was greater than all other groups (including high-intensity training).

Unilateral high-load resistance training induced a similar cross-education of strength between the dominant and non-dominant arm.

It was previously hypothesized that the cross-education of strength is asymmetrical, where a greater transfer of strength is observed from the dominant to the non-dominant limb. The purpose of this study was to examine if the magnitude of cross-education of strength differed between dominant and non-dominant limbs following unilateral high-load resistance training. One hundred and twenty-two participants were randomized to one of the three groups: 1) training on the dominant arm (D-Only), 2) training on the non-dominant arm (ND-Only) and 3) a time-matched non-exercise control (Control). The training groups completed 6 weeks (18 sessions) of unilateral elbow flexion exercise. Each training session started with one-repetition maximum (1RM) training (≤ five attempts), followed by four sets of high-load exercise (i.e. 8-12RM). Strength changes of the untrained arm were compared between groups. Changes in the strength of the untrained arm were greater in D-Only (1.5 kg) and ND-Only (1.3 kg) compared to Control (-0.2 kg), without differences between D-Only and ND-Only. Unilateral resistance training increased strength in the opposite untrained arm, and the magnitude of this effect was similar regardless of which arm was trained. However, there is still considerable uncertainty on this topic and additional research is warranted to confirm the current findings.

Blood flow restriction augments exercise-induced pressure pain thresholds over repetition and effort matched conditions.

We sought to determine the effects of blood flow restriction (BFR) on exercise-induced hypoalgesia, specifically using low-load (LL) resistance exercise (30% 1RM) protocols that accounted for each individual's local muscular endurance capabilities. Forty-four participants completed four conditions: (1) 70% of maximal BFR repetitions with blood flow restriction (LL+BFR exercise); (2) 70% maximal BFR repetitions without LL+BFR (LL exercise); (3) 70% maximal free flow repetitions (LL+EFFORT exercise); (4) time-matched, non-exercise control (CON). Pressure pain threshold (PPT) was measured before and after exercise. Ischaemic pain threshold and tolerance was assessed only at post. The change in upper body PPT was greater for LL+BFR exercise compared to LL exercise [difference of 0.15 (0.35) kg/cm2], LL+EFFORT exercise [difference of 0.23 (0.45) kg/cm2], and the CON condition. The change in lower body PPT was greater for LL+BFR exercise compared to LL exercise [difference of 0.40 (0.55) kg/cm2], LL+EFFORT exercise [difference of 0.36 (0.62) kg/cm2], and the CON condition. Ischaemic pain thresholds and tolerances did not change. Submaximal exercise with BFR resulted in systemic increases in PPT but had no influence on ischaemic pain sensitivity. This effect is likely unique to BFR as we did not see changes in the effort matched free flow condition.

Individuals Can be Taught to Sense the Degree of Vascular Occlusion: Implications for Practical Blood Flow Restriction.

ABSTRACT: Song, JS, Hammert, WB, Kataoka, R, Yamada, Y, Kang, A, and Loenneke, JP. Individuals can be taught to sense the degree of vascular occlusion: Implications for practical blood flow restriction. J Strength Cond Res 38(8): 1413-1418, 2024-It is currently unknown if individuals can be conditioned to a relative arterial occlusion pressure (AOP) and replicate that pressure at a later time point. The purpose of this study was to determine whether individuals can be taught to sense a certain relative pressure (i.e., target pressure) by comparing a conditioning method with a time-matched non-conditioning control. Fifty-eight subjects completed 2 visits in a randomized order: (a) conditioning condition and (b) time-matched control condition. The conditioning involved 11 series of inflations to 40% AOP for 12 seconds followed by cuff deflation for 22 seconds. The pressure estimations were taken at 5 and 30 minutes after each condition. Data are presented as mean differences (95% credible interval). The absolute error at 5 minutes was greater for the control compared with conditioning condition (7.1 [2.0-12.1] mm Hg). However, this difference in absolute error between conditioning and control was reduced at 30 minutes (2.9 [-1.3 to 7.1] mm Hg). The mean difference and 95% limits of agreement for the control were 8.2 (-42.4 to 58.5) mm Hg at 5 minutes and 0.02 (-43.5 to 43.5) at 30 minutes. The agreements for the conditioning were -6.2 (-32.4 to 20.0) mm Hg at 5 minutes and -11.2 (-36.6 to 14.3) mm Hg at 30 minutes. The results suggest that the individuals can be taught to sense the target pressure, but this effect only lasts a short amount of time. Future work is necessary to refine the conditioning method to extend the duration of this conditioning effect.

The Impact of Different Ischemic Preconditioning Pressures on Pain Sensitivity and Resistance Exercise Performance.

ABSTRACT: Kataoka, R, Song, JS, Yamada, Y, Hammert, WB, Seffrin, A, Spitz, RW, Wong, V, Kang, A, and Loenneke, JP. The impact of different ischemic preconditioning pressures on pain sensitivity and resistance exercise performance. J Strength Cond Res 38(5): 864-872, 2024-To determine (a) the impact of ischemic preconditioning pressures (applied as a % of arterial occlusion pressure [AOP]) on pressure pain threshold (PPT) and resistance exercise performance and (b) whether changes in performance could be explained by changes in PPT. Subjects ( n = 39) completed 4 protocols in a randomized order: (a) ischemic preconditioning (IPC) at 110% AOP (IPC 110%), (b) IPC at 150% AOP (IPC 150%), (c) IPC at 10% AOP (Sham), and (d) time-matched control (CON). Each protocol included 4 cycles of 5 minutes of occlusion followed by 5 minutes of reperfusion. Pressure pain threshold was taken before and after. Discomfort ratings were given at the end of each cycle. Every visit finished with 2 sets of 75-second maximal isokinetic unilateral elbow flexion or extension. Overall, IPC 110% and IPC 150% resulted in similar increases in PPT relative to CON [110%: difference of 0.36 (0.18, 0.54) kg·m -2 ; 150%: difference of 0.377 (0.15, 0.59) kg·m -2 ] and Sham. Both resulted in greater discomfort than Sham and CON, with IPC 150% inducing greater discomfort than IPC 110% (BF 10 : 14.74). There were no differences between the conditions for total work (BF 10 : 0.23), peak torque (BF 10 : 0.035), or average power (BF 10 : 0.159). We did not find evidence that PPT mediated performance. We did not detect changes in performance with 2 different relative pressures greater than AOP. Our mean applied pressures were lower than those used previously. There might be a minimal level of pressure (e.g., >150% of AOP) that is required to induce ergogenic effects of ischemic preconditioning.

Handgrip strength of young athletes differs based on the type of sport played and age.

OBJECTIVE: Handgrip strength may differ depending on the type of sport played during the developmental period. Youth sports in which athletes hold equipment in their hands may be the most effective for improving handgrip strength. This study aimed to examine the age at which differences in handgrip strength appear by comparing sports that involve gripping (kendo) with those that do not involve gripping (soccer) in young athletes. METHODS: Two hundred and twenty-two male athletes (115 kendo and 107 soccer) between 6 and 15 years old participated in this study. Handgrip strength was measured using a dynamometer, and the average value of both hands was used for analysis. Sports experience was determined when they started practicing each sport. Handgrip strength was compared between sports. Statistical moderation was used to determine if the relationship between sport and handgrip strength depended upon the age of the athlete. RESULTS: Kendo athletes had significantly higher handgrip strength than soccer athletes (4.77 kg [95% CI: 2.34, 7.19]) in the overall sample. We found that the relationship between sport and handgrip strength depended upon the age of the child (sport*age t = -3.6, p = .004). Using the Johnson-Neyman procedure, we found statistically significant differences between sports from 8.48 years and older. CONCLUSIONS: Our results suggest that the type of sport played, that is, whether or not an athlete plays with sports equipment in their hands, may influence the development of handgrip strength during the period of growth, and these sports may contribute to a higher level of handgrip strength in adulthood.

Association of changes in grip strength with second digit length adjusted for fourth digit length in young children.

OBJECTIVES: The factors involved in changes in grip strength (GS) during growth/development are not well known. Findings from cross-sectional studies have indicated that digit lengths are associated with physical fitness, including GS. This study aimed to investigate the association of changes in GS over 1 year and the second (2D) and fourth (4D) digit lengths in young children using the 4D as a covariate. METHODS: One hundred and three young children (54 boys and 49 girls) performed maximum voluntary GS and ultrasound-measured forearm muscle thickness measurements in the right hand. All participants completed the first measurement and underwent a second measurement 1 year after the first one. The 2D and 4D were taken on the palmar surface of the outstretched right hand at the second measurement. RESULTS: The 2D was inversely associated with the change in GS (B = -2.1, p = 0.023) adjusted for all covariates. Girls had numerically lower adjusted changes in grip strength, although this was not statistically significant [-0.61 (-1.2, 0.02) kg]. When sex was removed from the model, the 2D remained inversely associated with the change in GS (B = -2.39, p = 0.011). Finally, when only adjusting for the 4D, the 2D was inversely associated with the change in GS (B = -3.07, p = 0.004). CONCLUSION: This study documented the association between changes in GS over 1 year and digit lengths in young children. The difference in children's digit length needs to be recognized as a factor involved in weak GS in children.

Athletes in sporting events with upper-body gripping movements have greater handgrip strength than those in sporting events that prioritize the lower body.

OBJECTIVE: Evidence suggests that acquiring a high level of handgrip strength early in life and maintaining that strength throughout life may be important for health. In addition, it is thought that sports activities performed during the developmental period are effective in improving handgrip strength, but it is unknown what types of sports are more effective. As a first step, we conducted a cross-sectional study to compare handgrip strength across different sports (upper-body gripping sports vs. lower body) in early adulthood. METHODS: We used the Juntendo Fitness Plus Study data from 1973 to 2018 and selected two types of sporting events with matching physiques (soccer, baseball, and kendo) but different degrees of gripping. Data on 7344 male first-year sports university students included 1127 soccer, 297 Kendo, and 698 baseball players. RESULTS: Those in the lower body-only (soccer) sports had -3.78 (95% CI: -4.27, -3.29) kg lower handgrip strength than those in the lower + upper (kendo and baseball). Comparing each individual sport found that each sport was different from each other with Kendo > Baseball > Soccer (between each sport, p < .001). In addition, the difference between sports has become greater across time. CONCLUSIONS: In early adulthood, handgrip strength is greatest in those participating in sports with upper-body movements compared to those participating in sports that mainly involved lower-body movements. The three sports we selected are natural activities that do not directly train handgrip strength. Therefore, sport may be one potential method to improve low handgrip strength in children/adolescents during the developmental period.

Sex segregation in strength sports: Do equal-sized muscles express the same levels of strength between sexes?

OBJECTIVES: Concerns have been raised against the current two-sex binary category in sports competitions. The thesis states that if males and females were separated based on muscle size, it would negate the strength advantage between the sexes. We tested the possible sex differences in various strength outcomes when pair-matched for muscle thickness. METHODS: A total of 16 different data sets (n = 963) were assessed to pair-match females with males who had a muscle thickness value within 2%. We further compared the competition performances of the smallest male weight class within the International Powerlifting Federation (IPF) to different weight classes in females. RESULTS: Overall, 76%-88% of the strength assessments were greater in males than females with pair-matched muscle thickness, regardless of contraction types (i.e., isotonic, isometric, isokinetic). Additionally, males in the lightest weight division in the IPF largely outperformed females in heavier weight divisions. CONCLUSIONS: Our results would suggest that segregation based on muscle mass or surrogates of muscle mass (e.g., lean body mass) might not be an appropriate classification to create fair competition within strength sports. This is not to refute the concept of the desegregation of the two-sex binary category but to present data that raises important concerns about the potential sex-based differences in strength performance.

Potential considerations with estimating blood flow restriction pressure in the lower body using a narrower cuff.

Blood flow restriction pressures are typically set as a percentage of the arterial occlusion pressure. For those who do not have the ability to measure the arterial occlusion pressure, estimation equations are available. However, notable considerations are needed when estimating pressure with a narrow cuff (5 cm) in the lower body. A previously published equation in this journal was developed but was created only using 55% of the sample because the arterial occlusion of the others could not be obtained within the manufacturer's pressure limit. The purpose of this article was twofold: (1) to investigate how previous studies have implemented the equation and (2) to highlight potential concerns of using this equation. Two databases were used to locate articles that used the equation from Loenneke et al. (2015). We found that this equation had been cited 10 times to estimate arterial occlusion pressure with some notable concerns. Some did not use a 5 cm wide cuff, while others used it for participants who had arterial occlusion pressures exceeding 300 mmHg. To highlight the latter, we also applied the Loenneke et al. (2015) lower body equation to participants with arterial occlusion pressures known to exceed 300 mmHg to demonstrate potential concerns. This retrospective analysis found that 52% of the sample with known pressures over 300 mmHg (40 out of 77) would be estimated below 300 mmHg. This paper highlighted important considerations for those trying to estimate arterial occlusion pressure in the lower body with a narrow cuff (5 cm).

Effect of Increased Pressure Pain Threshold on Resistance Exercise Performance With Blood Flow Restriction.

ABSTRACT: Kataoka, R, Song, JS, Bell, ZW, Wong, V, Spitz, RW, Yamada, Y, and Loenneke, JP. Effect of increased pressure pain threshold on resistance exercise performance with blood flow restriction. J Strength Cond Res 37(6): 1204-1210, 2023-This study aimed to examine whether increasing pressure pain threshold (PPT) through isometric handgrip exercise (HG) affects the number of repetitions completed and discomfort with knee extension exercise (KE) with blood flow restriction (BFR), and examine whether performing additional exercise leads to a further increase in PPT. Forty-one participants completed 2 trials: rest followed by low-load KE with BFR at 80% of resting arterial occlusion pressure (Rest + KE BFR) and low-intensity (30% of maximal strength) HG exercise followed by KE with BFR (HG + KE BFR). Pressure pain threshold was measured before and after exercise at the forearm and tibialis anterior. Results are presented as median difference (95% credible interval). Pressure pain threshold increased at the forearm (Bayes factor [BF 10 ]: 5.2 × 10 7 ) and tibialis anterior (BF 10 : 1.5 × 10 6 ) after HG exercise. However, this did not lead to greater repetitions being completed with BFR exercise (0.2 [-0.1, 0.6] repetitions, BF 10 : 0.07). Pressure pain threshold after BFR exercise was not augmented over that observed with HG exercise (0.02 [-0.15, 0.2] kg·cm -2 , BF 10 : 0.175) at the forearm. More data are needed in the lower body to determine which model best fits the data (BF 10 : 0.84). Discomfort with BFR exercise was not different between conditions (1.0 [-2.3, 4.4] arbitrary units, BF 10 : 0.10). The pain-reducing effect of prior exercise did not change the repetitions completed with BFR exercise, suggesting that the change in PPT may not have been great enough to alter performance. Performing additional exercise did not elicit further increases in PPT nor was perceived discomfort to BFR exercise altered by changes in PPT.

A longitudinal study of handgrip strength asymmetry.

OBJECTIVE: The previous results from cross-sectional studies indicate that there could be alterations across time in handgrip strength (HGS) asymmetry. One way to investigate this is to test the same children multiple times. Therefore, we aimed to evaluate the laterality of HGS in healthy young children at two different time points separated by a year. METHODS: A total of 165 preschool children (79 males and 87 females) between the ages of 4.5 and 5.6 years participated and performed maximal voluntary HGS in both hands using a Smedley handgrip dynamometer. We ran a paired sample t-test on the difference scores (right - left vs. right - left) to determine if HGS (right vs. left) differed across time. RESULTS: The difference between hands (t = -4.804, p < .0001) did differ between time points. At the initial test, the mean value of the HGS in the right hand was approximately 15% higher than that of the left hand. This difference between hands was reduced following a year. The mean bias between tests (second test - initial test) and the 95% limits of agreement was -0.84 (-5.27, 3.58) kg. CONCLUSION: Contrary to our hypothesis, HGS asymmetry during the initial test (at age 5) was not observed in the second test completed a year later (at age 6). These results suggest that HGS asymmetry is uncertain in children between 5 and 6 years. In this short-term study, it was impossible to ascertain when HGS asymmetry first appeared. Longer term studies are required to better determine when these changes occur.

Comparison of handgrip strength values in young children when using two different types of dynamometers.

OBJECTIVE: A Smedley hand dynamometer is one of the standard devices for measuring handgrip strength (HGS) for children and adults. The aim was to compare the HGS values using two different types of dynamometers (Grip-A or Grip-D) in young children. To enable comparison between the two devices, we have redesigned the Grip-D (i.e., modified Grip-D). METHODS: Twenty-five preschool children (10 girls and 15 boys) performed maximal voluntary HGS in the right hand using two different types of dynamometers. We ran a paired sample t-test on the difference in HGS between the two devices. RESULTS: The measured values of HGS were 9.95 kg for Grip-A and 8.56 kg for modified Grip-D, and the difference between the two devices [1.39 (SD 0.65) kg] was greater than we expected (95% limits of agreement: 0.11, 2.6 kg). Thus, we then calibrated both dynamometers ourselves using known weights. The measured values were corrected if there was an error between the known weight and each dynamometer. Following adjustment, there was still a statistical difference (p < 0.001) in HGS between Grip-A [10.65 (SD 1.52) kg] and modified Grip-D [9.98 (SD 1.85) kg]. However, the difference between the two devices was 0.67 (SD 0.69) kg with the 95% limits of agreement between -0.68 and 2.0 kg. CONCLUSION: It is concluded that the HGS values of children measured with the company-calibrated new Grip-A and modified Grip-D could provide reasonably close estimates.

Hypoalgesia following isometric handgrip exercise with and without blood flow restriction is not mediated by discomfort nor changes in systolic blood pressure.

The purpose was to examine the effect of isometric handgrip exercise with and without blood flow restriction on exercise-induced hypoalgesia at a local and non-local site, and its underlying mechanisms. Sixty participants (21 males & 39 females, 18-35 years old) completed 3 trials: four sets of 2-minute isometric handgrip exercise at 30% of maximum handgrip strength; isometric handgrip exercise with blood flow restriction at 50% of arterial occlusion pressure; and a non-exercise time-matched control. Pain thresholds increased similarly in both exercise conditions at a local (exercise conditions: ~0.45 kg/cm2, control: ~-0.04 kg/cm2) and non-local site (exercise conditions: ~0.37 kg/cm2, control: ~-0.16 kg/cm2). Blood flow restriction induced greater feelings of discomfort compared to exercise alone [median difference (95% credible interval) of 4.5 (0.5, 8.6) arbitrary units]. Blood pressure increased immediately after exercise (systolic: 10.3 mmHg, diastolic: 7.7 mmHg) and decreased in recovery. There was no within participant correlation between changes in discomfort and pressure pain threshold. A bout of isometric handgrip exercise with or without blood flow restriction can provide exercise-induced hypoalgesia at a local and non-local site. However, discomfort and changes in systolic blood pressure do not explain this response.

Can Individuals Be Taught to Sense the Degree of Vascular Occlusion? A Comparison of Methods and Implications for Practical Blood Flow Restriction.

ABSTRACT: Bell, ZW, Spitz, RW, Wong, V, Yamada, Y, Song, JS, Abe, T, and Loenneke, JP. Can individuals be taught to sense the degree of vascular occlusion? A comparison of methods and implications for practical blood flow restriction. J Strength Cond Res 36(12): 3359-3365, 2022-The study objective was to determine whether subjects could be conditioned to a relative blood flow restriction pressure in the lower body and compare 2 separate conditioning methods (unconstrained vs. constrained). Thirty-five subjects completed 4 visits, involving measurements for arterial occlusion and pressure estimations at 5 minutes and 24 hours after conditioning. The constrained method involved applying 40% of measured arterial occlusion 11 times, along with 10% above and below this pressure. The unconstrained method was time-matched, involving a series of inflations to 40% arterial occlusion for 12 seconds and then deflated for 22 seconds. Data are presented as mean differences (95% credible interval) unless otherwise noted. The absolute error between conditioning methods was found to be similar at 5 minutes (-1.1 [-5.9, 3.7] mm Hg) and 24 hours (-2.4 [-7, 2.2] mm Hg) after conditioning. The constant error differed between methods at 5 minutes [-8.2 (-14.4, -1.9) mm Hg] but was similar at 24 hours (-2.5 [-8.5, 3.6] mm Hg; H0: 0.680; H1: 0.068; and H2: 0.252) after conditioning. The bias and 95% limits of agreement for the unconstrained method were -3.9 (-33.8, 25.9) mm Hg at 5 minutes and -2.9 (-32, 26.1) mm Hg at 24 hours. The agreement for the constrained method was 4.2 (-28, 36.5) mm Hg at 5 minutes and -0.54 (-37.3, 36.2) mm Hg at 24 hours. Conditioning methods produced similar levels of absolute error, indicating that either method may offer a viable means of pressure application. Most estimates were between 20 and 60% of arterial occlusion pressure. Additional conditioning sessions may be needed to narrow this range at the individual level.

Blood Flow Restricted Exercise and Discomfort: A Review.

ABSTRACT: Spitz, RW, Wong, V, Bell, ZW, Viana, RB, Chatakondi, RN, Abe, T, and Loenneke, JP. Blood flow restricted exercise and discomfort: A review. J Strength Cond Res 36(3): 871-879, 2022-Blood flow restriction exercise involves using a pneumatic cuff or elastic band to restrict arterial inflow into the muscle and block venous return out of the muscle during the exercise bout. The resultant ischemia in conjunction with low-load exercise has shown to be beneficial with increasing muscle size and strength. However, a limitation of using blood flow restriction (BFR) is the accompanying discomfort associated with this type of exercise. Factors that may influence discomfort are applied pressure, width of the cuff, cuff material, sex, and training to failure. The goal of this review was to evaluate the existing literature and elucidate how these factors can be manipulated to reduce discomfort during exercise as well as provide possible directions for future research. Thirty-eight different studies were located investigating BFR and discomfort. It was found that BFR training causes more discomfort than exercise without BFR. However, chronic use of BFR may increase tolerability, but discomfort may still be elevated over traditional non-blood flow restricted exercise. Discomfort can be attenuated by the application of lower applied pressures and stopping short of task failure. Finally, in the upper body, wider cuffs seem to increase ratings of discomfort compared with more narrow cuffs. In conclusion, applying the proper-sized cuff and making the applied pressure relative to both the individual and the cuff applied may attenuate discomfort. Reducing discomfort during exercise may help increase adherence to exercise and rehabilitation programs.

The Effect of Blood Flow Restriction Therapy on Recovery After Experimentally Induced Muscle Weakness and Pain.

ABSTRACT: Wong, V, Dankel, SJ, Spitz, RW, Bell, ZW, Viana, RB, Chatakondi, RN, Abe, T, and Loenneke, JP. The effect of blood flow restriction therapy on recovery after experimentally induced muscle weakness and pain. J Strength Cond Res 36(4): 1147-1152, 2022-The purpose was to determine if blood flow restriction with no external load could be used as a means of active therapy after experimentally induced fatigue and soreness. Twelve women and 7 men (aged 18-35 years) participated in a randomized controlled trial using a within-subject design. The study intervention was 3 consecutive visits. Visit 1 included the fatiguing/soreness-inducing protocol for the elbow flexors, which was performed only once during the study. Torque was measured before/after to confirm individuals began in a weakened state. Subjects then completed blood flow restriction therapy on one arm and the sham therapy on the other. Subjects performed elbow flexion/contraction with no external load on both arms. Torque was measured once more 10 minutes after the fatiguing/soreness-inducing protocol. Twenty-four hours later, soreness and torque were assessed in each arm, followed by another bout of therapy. Forty-eight hours after the initial visit, soreness and torque were measured again. There were no differences (median difference [95% credible interval]) in the recovery of torque between the blood flow restriction and sham therapy conditions at 10 minutes (0.5 [-2.7, 3.8] N·m), 24 hours (-2.34 [-6, 1.14] N·m), or 48 hours (-1.94 [-5.45, 1.33] N·m). There were also no differences in ratings of soreness at 24 hours (-2.48 [-10.05, 5.05]) or 48 hours (2.58 [-4.96, 10.09]). Our results indicate that this specific model of blood flow restriction therapy did not enhance the recovery of the muscle compared with a sham condition without the application of pressure.