Unilateral, bilateral, and alternating muscle actions elicit similar muscular responses during low load blood flow restriction exercise.

PURPOSE: Compare acute muscular responses to unilateral, bilateral, and alternating blood flow restriction (BFR) exercise. METHODS: Maximal strength was tested on visit one. On visits 2-4, 2-10 days apart, 19 participants completed 4 sets of knee extensions (30% one-repetition maximum) with BFR (40% arterial occlusion pressure) to momentary failure (inability to lift load) using each muscle action (counterbalanced order). Ultrasound muscle thickness was measured at 60% and 70% of the anterior thigh before (Pre), immediately (Post-0), and 5 min (Post-5) after exercise. Surface electromyography and tissue deoxygenation were measured throughout. Results, presented as means, were analyzed with a three-way (sex by time by condition) Bayesian RMANOVA. RESULTS: There was a time by sex interaction (BFinclusion: 5.489) for left leg 60% muscle thickness (cm). However, changes from Pre to Post-0 (males: 0.39 vs females: 0.26; BF10: 0.839), Post-0 to Post-5 (males: - 0.05 vs females: - 0.06; BF10: 0.456), and Pre to Post-5 (males: 0.34 vs females: 0.20; BF10: 0.935) did not differ across sex. For electromyography (%MVC), there was a sex by condition interaction (BFinclusion: 550.472) with alternating having higher muscle excitation for females (16) than males (9; BF10: 5.097). Tissue deoxygenation (e.g. channel 1, µM) increased more for males (sets 1: 11.17; 2: 2.91; 3: 3.69; 4: 3.38) than females (sets 1: 4.49; 2: 0.24; 3: - 0.10; 4: - 0.06) from beginning to end of sets (all BFinclusion ≥ 4.295e + 7). For repetitions, there was an interaction (BFinclusion: 17.533), with alternating completing more than bilateral and unilateral for set one (100; 56; 50, respectively) and two (34; 16; 18, respectively). CONCLUSION: Alternating, bilateral, and unilateral BFR exercise elicit similar acute muscular responses.

Acute cardiovascular response to unilateral, bilateral, and alternating resistance exercise with blood flow restriction.

AIM: Blood flow restriction (BFR) exercise is a common alternative to traditional high-load resistance exercise used to increase muscle size and strength. Some populations utilizing BFR at a low load may wish to limit their cardiovascular response to exercise. Different contraction patterns may attenuate the cardiovascular response, but this has not been compared using BFR. PURPOSE: To compare the cardiovascular response to unilateral (UNI), bilateral (BIL), and alternating (ALT) BFR exercise contraction patterns. METHODS: Twenty healthy participants performed four sets (30 s rest) of knee extensions to failure, using 30% one-repetition maximum, 40% arterial occlusion pressure, and each of the three contraction patterns (on different days, at the same time of day, separated by 2-10 days, randomized). Cardiovascular responses, presented as pre- to post-exercise mean changes (SD), were measured using pulse wave analysis and analyzed with Bayesian RMANOVA. RESULTS: ALT caused greater changes in: aortic systolic [ΔmmHg: ALT = 21(8); UNI = 13(11); BIL = 15(8); BF10 = 29.599], diastolic [ΔmmHg: ALT = 13(8); UNI = 7(11); BIL = 8(8); BF10 = 5.175], and mean arterial [ΔmmHg: ALT = 19(8); UNI = 11(11); BIL = 13(7); BF10 = 48.637] blood pressures. Aortic [ΔmmHg bpm: ALT = 4945(2340); UNI = 3294(1408); BIL = 3428 (1461); BF10 = 113.659] and brachial [ΔmmHg bpm: ALT = 6134(2761); UNI = 4300(1709); BIL = 4487(1701); BF10 = 31.845] rate pressure products, as well as heart rate [Δbpm: ALT = 26(14); UNI = 19(8); BIL = 19(11); BF10 = 5.829] were greatest with ALT. Augmentation index [Δ%: UNI = -6(13); BIL = - 7(11); ALT = - 5(16); BF10 = 0.155] and wave reflection magnitude [Δ%: UNI = - 5(9); BIL = - 4(7); ALT = - 4(7); BF10 = 0.150] were not different. CONCLUSION: Those at risk of a cardiovascular event may choose unilateral or bilateral BFR exercise over alternating until further work determines the degree to which it can be tolerated.

Central cardiovascular hemodynamic response to unilateral handgrip exercise with blood flow restriction.

AIM: Exercise training with blood flow restriction (BFR) increases muscle size and strength. However, there is limited investigation into the effects of BFR on cardiovascular health, particularly central hemodynamic load. PURPOSE: To determine the effects of BFR exercise on central hemodynamic load (heart rate-HR, central pressures, arterial wave reflection, and aortic stiffness). METHODS: Fifteen males (age = 25 ± 2 years; BMI = 27 ± 2 kg/m2, handgrip max voluntary contraction-MVC = 50 ± 2 kg) underwent 5-min bouts (counter-balanced, 10 min rest between) of rhythmic unilateral handgrip (1 s squeeze, 2 s relax) performed with a moderate-load (60% MVC) with and without BFR (i.e., 71 ± 5% arterial inflow flow reduction, assessed via Doppler ultrasound), and also with a low-load (40% MVC) with BFR. Outcomes included HR, central mean arterial pressure (cMAP), arterial wave reflection (augmentation index, AIx; wave reflection magnitude, RM%), aortic arterial stiffness (pulse wave velocity, aPWV), and peripheral (vastus lateralis) microcirculatory response (tissue saturation index, TSI%). RESULTS: HR increased above baseline and time control for all handgrip bouts, but was similar between the moderate load with and without BFR conditions (moderate-load with BFR = + 9 ± 2; moderate-load without BFR = + 8 ± 2 bpm, p < 0.001). A similar finding was noted for central pressure (e.g., moderate load with BFR, cMAP = + 14 ± 1 mmHg, p < 0.001). No change occurred for RM% or AIx (p > 0.05) for any testing stage. TSI% increased during the moderate-load conditions (p = 0.01), and aPWV increased above baseline following moderate-load handgrip with BFR only (p = 0.012). CONCLUSIONS: Combined with BFR, moderate load handgrip training with BFR does not significantly augment central hemodynamic load during handgrip exercise in young healthy men.

Post-occlusive reactive hyperemia in habituated caffeine users: Effects of abstaining versus consuming typical doses.

BACKGROUND: Post-occlusive reactive hyperemia (PORH) typically requires caffeine abstinence. For habitual users, it is unknown if abstinence affects PORH. OBJECTIVE: Compare PORH after habitual users consume or abstain from caffeine. METHODS: On separate visits (within-subject), PORH was measured in 30 participants without abstinence from typical caffeine doses (CAFF) and with abstinence (ABS). Measurements included baseline and peak hyperemic velocity, tissue saturation index slopes during ischemia (Slope 1) and following cuff deflation (Slope 2), resting arterial occlusion pressure (AOP), heart rate (HR), systolic (SBP), and diastolic (DBP) blood pressure. All variables were compared using Bayesian paired t-tests. BF10 = likelihood of alternative vs null. Results are mean±SD. RESULTS: Comparing baseline velocity (cm/s) between CAFF (9.3±4.8) and ABS (7.5±4.9) yielded anecdotal evidence (BF10 = 1.0). Peak hyperemic velocity (cm/s) was similar (CAFF = 77.3±16.7; ABS = 77.6±19.0, BF10 = 0.20). For slopes (TSI% /s), CAFF Slope 1 = -0.11±0.04 and Slope 2 = 1.9±0.46 were similar (both BF10≤0.20) to ABS Slope 1 = -0.12±0.03 and Slope 2 = 1.8±0.42. SBP and DBP (mmHg) were both similar (CAFF SBP = 116.0±9.8, DBP = 69.6±5.8; ABS SBP = 115.5±10.7, DBP = 69.5±5.4; both BF10≤0.22). Comparing AOP (mmHg) (CAFF = 146.6±15.0; ABS = 143.0±16.4) yielded anecdotal evidence (BF10 = 0.46). HR (bpm) was similar (CAFF = 66.5±12.3; ABS = 66.9±13.0; BF10 = 0.20). CONCLUSIONS: In habitual users, consuming or abstaining from typical caffeine doses does not appear to affect post-occlusive reactive hyperemia.

A narrative review of the effects of blood flow restriction on vascular structure and function.

Blood flow restriction is growing in popularity as a tool for increasing muscular size and strength. Currently, guidelines exist for using blood flow restriction alone and in combination with endurance and resistance exercise. However, only about 1.3% of practitioners familiar with blood flow restriction applications have utilized it for vascular changes, suggesting many of the guidelines are based on skeletal muscle outcomes. Thus, this narrative review is intended to explore the literature available in which blood flow restriction, or a similar application, assess the changes in vascular structure or function. Based on the literature, there is a knowledge gap in how applying blood flow restriction with relative pressures may alter the vasculature when applied alone, with endurance exercise, and with resistance exercise. In many instances, the application of blood flow restriction was not in accordance with the current guidelines, making it difficult to draw definitive conclusions as to how the vascular system would be affected. Additionally, several studies report no change in vascular structure or function, but few studies look at variables for both outcomes. By examining outcomes for both structure and function, investigators would be able to generate recommendations for the use of blood flow restriction to improve vascular structure and/or function in the future.

A comparison of variability between absolute and relative blood flow restriction pressures.

INTRODUCTION: Recommendations are that blood flow restriction (BFR) be applied relative to arterial occlusion pressure (AOP) to provide a similar stimulus. PURPOSE: Compare variability of the change in blood flow, shear rate and discomfort between recommended relative pressures and an absolute pressure. METHODS: During one visit, brachial arterial blood flow was measured in 91 participants using pulse-wave Doppler ultrasonography. After 5-min seated rest, AOP was measured. Following another 5-min rest, blood flow and discomfort were assessed twice before cuff inflation as controls (C1 and C2), then again with a cuff inflated to each BFR pressure (all measures separated by 1-min). Change scores from C1 to all subsequent measures were calculated (i.e., C2-C1; 40% AOP-C1; 80% AOP-C1; 100 mmHg-C1). Variability of the changes were compared via pairwise modified Pitman-Morgan tests (α = 0.008). RESULTS: Variance (95% CI) of the change for blood flow (ml/min), shear rate (1/s), and discomfort (AU) had similar trends. C2-C1 differed from all conditions (all p < 0.001), 40% AOP-C1 differed from 80% AOP-C1 and 100 mmHg-C1 (all p < 0.001), which did not differ (both p ≥ 0.117). Blood flow: C2-C1 = 469.79 (357.90, 644.07), 40% AOP-C1 = 1263.18 (962.34, 1731.80), 80% AOP-C1 = 1752.90 (1335.42, 2403.18), 100 mmHg-C1 = 1603.18 (1221.36, 2197.92); shear rate: C2-C1 = 6248.24 (4760.10, 8566.15), 40% AOP-C1 = 14 625.30 (11 142.06, 20 050.95), 80% AOP-C1 = 22 064.02 (16 809.13, 30 249.27), 100 mmHg-C1 = 20 778.76 (15 829.98, 28 487.21); discomfort: C2-C1 = 0.07 (0.05, 0.08), 40% AOP-C1 = 2.03 (1.55, 2.78), 80% AOP-C1 = 4.26 (3.25, 5.84), 100 mmHg-C1 = 4.50 (3.43, 6.17). CONCLUSION: Contrary to previous suggestions, applying relative pressures does not necessarily guarantee a similar stimulus. It seems that higher pressures produce more variable changes even if the external pressure applied is made relative to each individual.

The acute muscular response to passive movement and blood flow restriction.

PURPOSE: To compare the acute effects of passive movement combined with blood flow restriction (PM + BFR) to passive movement (PM) or blood flow restriction alone (BFR). METHODS: A total of 20 healthy participants completed: time control (TC), PM, BFR and PM + BFR (one per leg, over 2 days; randomized). For PM, a dynamometer moved the leg through 3 sets of 15 knee extensions/flexions (90° at 45°/second). For BFR, a cuff was inflated to 80% arterial occlusion pressure on the upper leg. Measurements consisted of anterior muscle thickness at 60% and 70% of the upper leg before and after (-0, -5 and -10 min) conditions, ratings of perceived effort and discomfort before conditions and after each set, and of the vastus lateralis during conditions. Data, presented as mean (SD), were compared using Bayesian RMANOVA, except for perceived effort and discomfort, which were compared using a Friedman's test (non-parametric). RESULTS: 60% (Δcm before-after-0: TC = 0.04 [0.09], PM = -0.01 [0.15], BFR = 0.00 [0.11], PM + BFR = 0.01 [0.22]) and 70% (Δcm before-after-0: TC = 0.01 [0.09], PM = -0.01 [0.15], BFR = 0.02 [0.11], PM + BFR = -0.03 [0.22]) muscle thickness did not change. Perceived effort was greater than TC following PM (p = .05) and PM + BFR (p = .001). Perceived discomfort was greater following BFR and PM + BFR compared to TC (all p ≤ .002) and PM (all p ≤ .010). Changes in deoxygenation (e.g. channel 1; ΔµM start set 1-end set 3: TC = 0.9 [1.2], PM = -1.2 [1.9], BFR = 10.3 [2.7], PM + BFR = 10.3 [3.0]) were generally greater with BFR and PM + BFR (BFinclusion  = 1.210e + 13). CONCLUSION: Acute muscular responses to PM + BFR are not augmented over the effect of BFR alone.