Development of a prediction equation to estimate lower-limb arterial occlusion pressure with a thigh sphygmomanometer.

INTRODUCTION: Previous investigators have developed prediction equations to estimate arterial occlusion pressure (AOP) for blood flow restriction (BFR) exercise. Most equations have not been validated and are designed for use with expensive cuff systems. Thus, their implementation is limited for practitioners. PURPOSE: To develop and validate an equation to predict AOP in the lower limbs when applying an 18 cm wide thigh sphygmomanometer (SPHYG18cm). METHODS: Healthy adults (n = 143) underwent measures of thigh circumference (TC), skinfold thickness (ST), and estimated muscle cross-sectional area (CSA) along with brachial and femoral systolic (SBP) and diastolic (DBP) blood pressure. Lower-limb AOP was assessed in a seated position at the posterior tibial artery (Doppler ultrasound) using a SPHYG18cm. Hierarchical linear regression models were used to determine predictors of AOP. The best set of predictors was used to construct a prediction equation to estimate AOP. Performance of the equation was evaluated and internally validated using bootstrap resampling. RESULTS: Models containing measures of either TC or thigh composition (ST and CSA) paired with brachial blood pressures explained the most variability in AOP (54%) with brachial SBP accounting for majority of explained variability. A prediction equation including TC, brachial SBP, and age showed good predictability (R2 = 0.54, RMSE = 7.18 mmHg) and excellent calibration. Mean difference between observed and predicted values was 0.0 mmHg and 95% Limits of Agreement were ± 18.35 mmHg. Internal validation revealed small differences between apparent and optimism adjusted performance measures, suggesting good generalizability. CONCLUSION: This prediction equation for use with a SPHYG18cm provided a valid way to estimate lower-limb AOP without expensive equipment.

Physiological and perceptual responses to acute arm cranking with blood flow restriction.

INTRODUCTION: Lower-body aerobic exercise with blood flow restriction (BFR) offers a unique approach for stimulating improvements in muscular function and aerobic capacity. While there are more than 40 reports documenting acute and chronic responses to lower-body aerobic exercise with BFR, responses to upper-body aerobic exercise with BFR are not clearly established. PURPOSE: We evaluated acute physiological and perceptual responses to arm cranking with and without BFR. METHODS: Participants (N = 10) completed 4 arm cranking (6 × 2 min exercise, 1 min recovery) conditions: low-intensity at 40%VO2peak (LI), low-intensity at 40%VO2peak with BFR at 50% of arterial occlusion pressure (BFR50), low-intensity at 40%VO2peak with BFR at 70% of arterial occlusion pressure (BFR70), and high-intensity at 80%VO2peak (HI) while tissue oxygenation, cardiorespiratory, and perceptual responses were assessed. RESULTS: During exercise, tissue saturation for BFR50 (54 ± 6%), BFR70 (55 ± 6%), and HI (54 ± 8%) decreased compared to LI (61 ± 5%, all P < 0.01) and changes in deoxyhemoglobin for BFR50 (11 ± 4), BFR70 (15 ± 6), and HI (16 ± 10) increased compared to LI (4 ± 2, all P < 0.01). During recovery intervals, tissue saturation for BFR50 and BFR70 decreased further and deoxyhemoglobin for BFR50 and BFR70 increased further (all P < 0.04). Heart rate for BFR70 and HI increased by 9 ± 9 and 50 ± 15b/min, respectively, compared to LI (both P < 0.02). BFR50 (8 ± 2, 1.0 ± 1.0) and BFR70 (10 ± 2, 2.1 ± 1.4) elicited greater arm-specific perceived exertion (6-20 scale) and pain (0-10 scale) compared to LI (7 ± 1, 0.2 ± 0.5, all P < 0.05) and pain for BFR70 did not differ from HI (1.7 ± 1.9). CONCLUSION: Arm cranking with BFR decreased tissue saturation and increased deoxyhemoglobin without causing excessive cardiorespiratory strain and pain.

Blood flow restriction as a potential therapy to restore physical function following COVID-19 infection.

Accumulating evidence indicates that some COVID-19 survivors display reduced muscle mass, muscle strength, and aerobic capacity, which contribute to impairments in physical function that can persist for months after the acute phase of illness. Accordingly, strategies to restore muscle mass, muscle strength, and aerobic capacity following infection are critical to mitigate the long-term consequences of COVID-19. Blood flow restriction (BFR), which involves the application of mechanical compression to the limbs, presents a promising therapy that could be utilized throughout different phases of COVID-19 illness. Specifically, we hypothesize that: 1) use of passive BFR modalities can mitigate losses of muscle mass and muscle strength that occur during acute infection and 2) exercise with BFR can serve as an effective alternative to high-intensity exercise without BFR for regaining muscle mass, muscle strength, and aerobic capacity during convalescence. The various applications of BFR may also serve as a targeted therapy to address the underlying pathophysiology of COVID-19 and provide benefits to the musculoskeletal system as well as other organ systems affected by the disease. Consequently, we present a theoretical framework with which BFR could be implemented throughout the progression from acute illness to outpatient rehabilitation with the goal of improving short- and long-term outcomes in COVID-19 survivors. We envision that this paper will encourage discussion and consideration among researchers and clinicians of the potential therapeutic benefits of BFR to treat not only COVID-19 but similar pathologies and cases of acute critical illness.

Single-leg cycling to maintain and improve function in healthy and clinical populations.

Exercise with reduced muscle mass facilitates greater muscle-specific adaptations than training with larger muscle mass. The smaller active muscle mass can demand a greater portion of cardiac output which allows muscle(s) to perform greater work and subsequently elicit robust physiological adaptations that improve health and fitness. One reduced active muscle mass exercise that can promote greater positive physiological adaptations is single-leg cycling (SLC). Specifically, SLC confines the cycling exercise to a smaller muscle mass resulting in greater limb specific blood flow (i.e., blood flow is no longer "shared" by both legs) which allows the individual to exercise at a greater limb specific intensity or for a longer duration. Numerous reports describing the use of SLC have established cardiovascular and/or metabolic benefits of this exercise modality for healthy adults, athletes, and individuals living with chronic diseases. SLC has served as a valuable research tool for understanding central and peripheral factors to phenomena such as oxygen uptake and exercise tolerance (i.e., V̇O2peak and V̇O2 slow component). Together, these examples highlight the breadth of applications of SLC to promote, maintain, and study health. Accordingly, the purpose of this review was to describe: 1) acute physiological responses to SLC, 2) long-term adaptations to SLC in populations ranging from endurance athletes to middle aged adults, to individuals living with chronic disease (COPD, heart failure, organ transplant), and 3) various methods utilized to safely perform SLC. A discussion is also included on clinical application and exercise prescription of SLC for the maintenance and/or improvement of health.

Impact of health behaviors on community well-being and resilience: teaching K-12 students with Jenga!

We developed a hands-on activity using the game Jenga to demonstrate the links between health behaviors, chronic and infectious diseases, and community well-being and resilience. For the activity, K-12 students worked together in small teams (4-8 students) and were given two Jenga towers (tower A and tower B), each representing a community of individuals. The goal was to keep both towers standing. Teams were presented with strips of paper labeled with either a "health behavior" (e.g., nutrition, body weight maintenance, physical activity) or a "disease" (e.g., heart disease, diabetes, COVID-19) and instructions on whether to add or remove blocks from each tower. When presented with a health behavior, students added blocks to tower A for positive health behaviors (e.g., not smoking) and removed blocks from tower B for negative health behaviors (e.g., smoking). When a disease was presented students removed blocks from both towers, but fewer blocks were removed from tower A compared with tower B, demonstrating lower disease rates or severity in that community. As the activity progressed, tower A retained more blocks than tower B. For the finale, students observed that the greater strength and stability of tower A allowed it to withstand a simulated natural disaster such as an earthquake better than tower B. This activity was delivered to 15 science classes and 225 students ranging from 6th to 12th grade. Students were able to describe the connections between positive health behaviors and lower rates of disease and how, taken together, these impact community health, well-being, and resilience.NEW & NOTEWORTHY We describe how K-12 students played Jenga to learn about the connections between health living habits, disease, and community well-being and resilience.

Physical Activity and Cardiorespiratory Fitness as Modulators of Health Outcomes: A Compelling Research-Based Case Presented to the Medical Community.

The beneficial health effects and prognostic significance of regular moderate-to-vigorous physical activity (PA), increased cardiorespiratory fitness (CRF), or both are often underappreciated by the medical community and the patients they serve. Individuals with low CRF have higher annual health care costs, higher rates of surgical complications, and are two to three times more likely to die prematurely than their fitter counterparts when matched for risk factor profile or coronary calcium score. Increased levels of habitual PA before hospitalization for acute coronary syndromes are also associated with better short-term cardiovascular outcomes. Accordingly, this review examines these relations and the potential underlying mechanisms of benefit (eg, exercise preconditioning), with specific reference to the incidence of cardiovascular, cancer, and coronavirus diseases, and the prescriptive implications and exercise thresholds for optimizing health outcomes. To assess the evidence supporting or refuting the benefits of PA and CRF, we performed a literature search (PubMed) and critically reviewed the evidence to date. In aggregate, these data are presented in the context of clarifying the impact that regular PA and/or increased CRF have on preventing and treating chronic and infectious diseases, with reference to evidence-based exercise thresholds that the medical community can embrace and promote.

Post-Exercise Arterial Stiffness Responses Are Similar After Acute Eccentric and Concentric Arm Cycling.

Upper-body resistance exercise effectively increases muscular strength, but may concomitantly increase arterial stiffness. Eccentric exercise can lead to muscle soreness and arterial stiffness in untrained participants. However, it is unclear if upper-body eccentric exercise could reduce arterial stiffness in a single session for participants that have undergone progressive training. Our purpose was to compare acute responses to upper-body eccentric (novel, ECCarm) and concentric (traditional, CONarm) steady state arm cycling. We hypothesized that arm arterial stiffness would be reduced after both ECCarm and CONarm. Twenty-two young healthy individuals performed either ECCarm (n = 11) or CONarm (n = 11) at ~70% of peak heart rate for 20 min after a training period. Heart rate, central pulse wave velocity (cPWV), and peripheral pulse wave velocity (pPWV; i.e., arm arterial stiffness) were assessed before, 10 min, and 30 min after exercise. Heart rate was not elevated at 10 min post ECCarm, but was elevated at 10- and 30-min post CONarm (p < 0.01). After exercise, pPWV was decreased at 10 min post for both ECCarm (7.1 ± 0.3 vs. 6.5 ± 0.2 m/s) and CONarm (7.0 ± 0.2 vs. 6.5 ± 0.2 m/s; p < 0.05), while both groups returned to baseline values 30 min post. cPWV did not change in either group. Our results indicate that acute ECCarm provides a high-force, low energy cost form of resistance exercise that acutely reduces arm arterial stiffness. The reduction in pPWV and rapid heart rate recovery suggests that ECCarm is a safe form of exercise for overall and cardiovascular health.

Physiological Responses to Acute Cycling With Blood Flow Restriction.

Aerobic exercise with blood flow restriction (BFR) can improve muscular function and aerobic capacity. However, the extent to which cuff pressure influences acute physiological responses to aerobic exercise with BFR is not well documented. We compared blood flow, tissue oxygenation, and neuromuscular responses to acute cycling with and without BFR. Ten participants completed four intermittent cycling (6 × 2 min) conditions: low-load cycling (LL), low-load cycling with BFR at 60% of limb occlusion pressure (BFR60), low-load cycling with BFR at 80% of limb occlusion pressure (BFR80), and high-load cycling (HL). Tissue oxygenation, cardiorespiratory, metabolic, and perceptual responses were assessed during cycling and blood flow was measured during recovery periods. Pre- to post-exercise changes in knee extensor function were also assessed. BFR60 and BFR80 reduced blood flow (~33 and ~ 50%, respectively) and tissue saturation index (~5 and ~15%, respectively) when compared to LL (all p < 0.05). BFR60 resulted in lower VO2, heart rate, ventilation, and perceived exertion compared to HL (all p < 0.05), whereas BFR80 resulted in similar heart rates and exertion to HL (both p > 0.05). BFR60 and BFR80 elicited greater pain compared to LL and HL (all p < 0.05). After exercise, knee extensor torque decreased by ~18 and 40% for BFR60 and BFR80, respectively (both p < 0.05), and was compromised mostly through peripheral mechanisms. Cycling with BFR increased metabolic stress, decreased blood flow, and impaired neuromuscular function. However, only BFR60 did so without causing very severe pain (>8 on pain intensity scale). Cycling with BFR at moderate pressure may serve as a potential alternative to traditional high-intensity aerobic exercise.

Noncircular Chainrings Do Not Influence Physiological Responses During Submaximal Cycling.

Pedal speed and mechanical power output account for 99% of metabolic cost during submaximal cycling. Noncircular chainrings can alter instantaneous crank angular velocity and thereby pedal speed. Reducing pedal speed during the portion of the cycle in which most power is produced could reduce metabolic cost and increase metabolic efficiency. PURPOSE: To determine the separate contributions of pedal speed and chainring shape/eccentricity to the metabolic cost of producing power and evaluate joint-specific kinematics and kinetics during submaximal cycling across 3 chainring eccentricities (CON = 1.0; LOW = 1.13; HIGH = 1.24). METHODS: Eight cyclists performed submaximal cycling at power outputs eliciting 30%, 60%, and 90% of their individual lactate threshold at pedaling rates of 80 rpm under each chainring condition (CON80rpm; LOW80rpm; HIGH80rpm) and at pedaling rates for the CON chainring chosen to match pedal speeds of the noncircular chainrings (CON78rpm to LOW80rpm; CON75rpm to HIGH80rpm). Physiological measures, metabolic cost, and gross efficiency were determined by indirect calorimetry. Pedal and joint-specific powers were determined using pedal forces and limb kinematics. RESULTS: Physiological and metabolic measures were not influenced by eccentricity and pedal speed (all Ps > .05). Angular velocities produced during knee and hip extension were lower with the HIGH80rpm condition compared with the CON80rpm condition (all Ps < .05), while angular velocity produced during ankle plantar flexion remained unchanged. CONCLUSIONS: Despite the noncircular chainrings imposing their eccentricity on joint angular kinematics, they did not reduce metabolic cost or increase gross efficiency. Our results suggest that noncircular chainrings neither improve nor compromise submaximal cycling performance in trained cyclists.