Blood-Flow-Restriction-Training-Induced Hormonal Response is not Associated with Gains in Muscle Size and Strength.

The aim of this study was to determine whether increases in post-exercise endocrine response to low-load resistance exercise with blood flow restriction and high-load resistance exercise would have association with increases in muscle size and strength after an 8-week training period. Twenty-nine untrained men were randomly allocated into three groups: low-load resistance exercise with (LL-BFR) or without blood flow restriction (LL), and high-load resistance exercise (HL). Participants from LL-BFR and LL groups performed leg extension exercise at 20% of one repetition maximum (1RM), four sets of 15 repetitions and the HL group performed four sets of eight repetitions at 80% 1RM. Before the first training session, growth hormone (GH), insulin-like growth factor 1 (IGF-1), testosterone, cortisol, and lactate concentration were measured at rest and 15 min after the exercise. Quadriceps CSA and 1RM knee extension were assessed at baseline and after an 8-week training period. GH increased 15 min after exercise in the LL-BFR (p = 0.032) and HL (p < 0.001) groups, with GH concentration in the HL group being higher than in the LL group (p = 0.010). There was a time effect for a decrease in testosterone (p = 0.042) and an increase in cortisol (p = 0.005), while IGF-1 remained unchanged (p = 0.346). Both muscle size and strength were increased after training in LL-BFR and HL groups, however, these changes were not associated with the acute post-exercise hormone levels (p > 0.05). Our data suggest that other mechanisms than the acute post-exercise increase in systemic hormones induced by LL-BFR and HL produce changes in muscle size and strength.

Validity of the Handheld Doppler to Determine Lower-Limb Blood Flow Restriction Pressure for Exercise Protocols.

Laurentino, GC, Loenneke, JP, Mouser, JG, Buckner, SL, Counts, BR, Dankel, SJ, Jessee, MB, Mattocks, KT, Iared, W, Tavares, LD, Teixeira, EL, and Tricoli, V. Validity of the handheld Doppler to determine lower-limb blood flow restriction pressure for exercise protocols. J Strength Cond Res 34(9): 2693-2696, 2020-Handheld (HH) Doppler is frequently used for determining the arterial occlusion pressure during blood flow restriction exercises; however, it is unknown whether the blood flow is occluded when the auscultatory signal is no longer present. The purpose of this study was to assess the validity between the HH Doppler and the Doppler ultrasound (US) measurements for determining the arterial occlusion pressure in healthy men. Thirty-five participants underwent 2 arterial occlusion pressure measurements. In the first measure, a pressure cuff (17.5 cm wide) was placed at the most proximal region of the thigh and the pulse of posterior tibial artery was detected using an HH Doppler probe. The cuff was inflated until the auscultatory pulse was no longer detected. After 10 minutes of rest, the procedure was repeated with the Doppler US probe placed on the superficial femoral artery. The cuff was inflated up to the point at which the femoral arterial blood flow was interrupted. The point at which the auscultatory pulse and blood flow were no longer detected was deemed the arterial occlusion pressure. There were no significant differences in arterial occlusion pressure level between the HH Doppler and the Doppler US (133 [±18] vs. 135 [±17] mm Hg, p = 0.168). There was a significant correlation (r = 0.938, p = 0.168), reasonable agreement, and a total error of the estimate of 6.0 mm Hg between measurements. Arterial occlusion pressure level determined by the HH Doppler and the Doppler US was similar, providing evidence that the HH Doppler is a valid and practical method.

Can blood flow restriction augment muscle activation during high-load training?

INTRODUCTION: Blood flow restriction has been shown to augment muscle activation and increase muscle size when combined with low-load training; however, much less is known on whether blood flow restriction can augment muscle activation during high-load exercise. PURPOSE: To determine whether applying blood flow restriction can augment muscle activation with traditional high-load resistance exercise. METHOD: Ten individuals completed two sets of elbow flexion exercise to volitional fatigue. The control arm rested for 3 min between sets while the experimental arm had blood flow restriction applied for 3 min. RESULT: The blood flow restricted arm completed significantly fewer repetitions in set 2 in comparison with set 1 [set 1: 9 (1), set 2: 4 (1); P<0·001], whereas no meaningful differences were observed in the control arm [set 1: 8 (1), set 2: 7 (1); P = 0·057]. There was no interaction for muscle activation (P = 0·851) with both conditions significantly lower at the start of set 2 [87 (26)%] in comparison with the end of set 1 [106 (40)%] or end of set 2 [103 (33)%]. CONCLUSION: The application of blood flow restriction does not augment muscle activation present with high-load exercise and would seem unlikely to induce greater muscle hypertrophy.

Blood flow restriction increases metabolic stress but decreases muscle activation during high-load resistance exercise.

INTRODUCTION: We investigated differences in metabolic stress (lactate) and muscle activation (electromyography; EMG) when high-load resistance exercise (HL) is compared with a condition in which blood flow restriction (BFR) is applied during the exercise or during the rest interval. METHODS: Twelve participants performed HL with BFR during the intervals (BFR-I), during the set (BFR-S), and without BFR. Each condition consisted of 3 sets of 8 repetitions with knee extension at 70% of 1-repetition maximum. Lactate and root mean square (RMS) from the surface EMG of the vastus lateralis were calculated. RESULTS: Lactate increased in all protocols but was higher with BFR-I than with BFR-S and HL. RMS decreased under all conditions, with a larger effect size in BFR-I (1.47) than in BFR-S (0.66) and HL (0.59). DISCUSSION: BFR-I increases lactate, possibly as a result of reduced restoration of ATP. Muscle activation seems to be impacted by mechanical stress but may be reduced by metabolic stress. Muscle Nerve 57: 107-111, 2018.

The acute muscular response to blood flow-restricted exercise with very low relative pressure.

To investigate the acute responses to blood flow-restricted (BFR) exercise across low, moderate and high relative pressures. Muscle thickness, maximal voluntary contraction (MVC) and electromyography (EMG) amplitude were assessed following exercise with six different BFR pressures: 0%, 10%, 20%, 30%, 50% and 90% of arterial occlusion pressure (AOP). There were differences between each time point within each condition for muscle thickness, which increased postexercise [+0·47 (0·40, 0·54) cm] and then trended towards baseline. For MVC, higher pressures resulted in greater decrements than lower pressures [e.g. 10% AOP: -20·7 (-15·5, -25·8) Nm versus 90% AOP: -24 (-19·1, -28·9) Nm] postexercise. EMG amplitude increased from the first three repetitions to the last three repetitions within each set. When using a common BFR protocol with 30% 1RM, applying BFR does not seem to augment acute responses over that of exercise alone when exercise is taken to failure.

Blood flow in humans following low-load exercise with and without blood flow restriction.

Blood flow restriction (BFR) in combination with exercise has been used to increase muscle size and strength using relatively low loads (20%-30% 1-repetition maximum (1RM)). In research, the range of applied pressures based on a percentage of arterial occlusion pressure (AOP), is wide. The purpose of the study is to measure the blood flow response before exercise, following each set of exercise, and postexercise to low-load elbow flexion combined with no restriction (NOBFR), 40% of AOP (40BFR), and 80% of AOP (80BFR). One hundred and fifty-two participants volunteered; 140 completed the protocol (women = 75, men = 65). Participants were counter-balanced into 1 of 3 conditions. Following AOP and 1RM measurement, ultrasound was used to measure standing blood flow at rest in the right brachial artery. Participants performed 4 sets of elbow flexion at 30% 1RM. Blood flow was measured between sets and at 1 and 5 min postexercise. Blood flow decreased following inflation, with no difference between conditions (p < 0.001). Men had greater blood flow than women in all conditions at all time points (p < 0.001). Resting hyperemia decreased with pressure (NOBFR > 40BFR > 80BFR, p < 0.001). Blood flow increased from rest to after set 1 regardless of condition. Following cuff deflation, blood flow increased in both the 80BFR and 40BFR conditions. The reduction in hyperemia during BFR is pressure-dependent. Contrary to previous investigations, blood flow was increased above baseline following exercise.

The influence of time on determining blood flow restriction pressure.

The influence of time, manifested in the oscillatory nature of physiology, has been documented in many processes. Within blood flow restriction literature, the restrictive stimulus is often applied based on a single arterial occlusion measurement, which is closely related to brachial systolic blood pressure (bSBP). Considering the oscillatory nature of bSBP, it is likely that time also influences arterial occlusion measurements. OBJECTIVES: To investigate the influence of time, within and between days, on arterial occlusion pressure and to determine whether the variability resembles the oscillatory pattern of bSBP. DESIGN: Test-retest. METHODS: Twenty-two participants completed four testing sessions at 08:00 and 18:00h, 48h apart. Arm circumference, bSBP, and brachial diastolic blood pressure (bDBP) were measured at rest. Arterial occlusion pressure was determined using a cuff inflated on the proximal portion of the upper arm, with a Doppler probe placed over the radial artery. RESULTS: Significant differences [mean (SD)] were observed for arterial occlusion pressure between Morning Day 2 [132 (14) mmHg, p<0.05], and all other visits [Morning Day 1: 138 (16); Evening Day 1: 139 (17); Evening Day 2 138 (14) mmHg]. A time effect was observed for bSBP, with a post-hoc test revealing that Morning Day 2 was different from all other visits. CONCLUSIONS: Our findings suggest that arterial occlusion pressure is influenced by the time of day. As such, multiple occlusion measurements across an experiment may be necessary in order to account for potential oscillations in pressure and provide the intended relative restrictive stimulus.

The effects of upper body exercise across different levels of blood flow restriction on arterial occlusion pressure and perceptual responses.

Recent studies have investigated relative pressures that are applied during blood flow restriction exercise ranging from 40%-90% of resting arterial occlusion pressure; however, no studies have investigated relative pressures below 40% arterial occlusion pressure. The purpose of this study was to characterize the cardiovascular and perceptual responses to different levels of pressures. Twenty-six resistance trained participants performed four sets of unilateral elbow flexion exercise using 30% of their 1RM in combination with blood flow restriction inflated to one of six relative applied pressures (0%, 10%, 20%, 30%, 50%, 90% arterial occlusion pressure). Arterial occlusion pressure was measured before (pre) and immediately after the last set of exercise at the radial artery. RPE and discomfort were taken prior to (pre) and following each set of exercise. Data presented as mean (95% CI) except for perceptual responses represented as the median (25th, 75th percentile). Arterial occlusion pressure increased from pre to post (p<0.001) in all conditions but was augmented further with higher pressures [e.g. 0%: 36 (30-42) mmHg vs. 10%: 39 (34-44) mmHg vs. 90% 46 (41-52) mmHg]. For RPE and discomfort, there were significant differences across conditions for all sets of exercise (p<0.01) with the ratings of RPE [e.g. 0%: 14.5 (13, 17) vs. 10%: 13.5 (12, 17) vs. 90%: 17 (14.75, 19) during last set] and discomfort [e.g. 0%: 3.5 (1.5, 6.25) vs. 10%: 3 (1, 6) vs. 90%: 7 (4.5, 9) during last set] generally being greater at the higher restriction pressures. All of these differences at the higher restriction pressures occurred despite completing a lower total volume of exercise. Applying higher relative pressures results in the greatest cardiovascular response, higher perceptual ratings, and greater decrease in exercise volume compared to lower restriction pressures. Therefore, the perceptual responses from lower relative pressures may be more appealing and provide a safer and more tolerable stimulus for individuals.

Differentiating swelling and hypertrophy through indirect assessment of muscle damage in untrained men following repeated bouts of resistance exercise.

PURPOSE: To examine the swelling response and other markers of muscle damage throughout the early portions of a training program (Experiment 1). We also determined if a "swollen" muscle could swell further following additional exercise (Experiment 2). METHODS: Nine males performed four sets of biceps curls (or time-matched rest on control arm) at 70% of their one-repetition maximum three times over 8 days. Muscle thickness and torque were measured before and after exercise as well as on the days in between. Soreness was measured at the beginning of each day (Experiment 1). On the final day (Experiment 2), participants performed two bouts of exercise, followed by additional measures of muscle thickness. RESULTS: Following three bouts of exercise, muscle thickness was elevated over baseline (mean of visit 9 pre to visit 2 pre, 95% CI) at the 50% [0.21 (0.07, 0.34) cm], 60% [0.21 (0.02, 0.39) cm], and 70% [0.21 (0.06, 0.36) cm] sites. However, differences from a non-exercise control were only observed immediately following bouts of exercise (indicative of acute swelling). Torque was lower at every time point following the first bout of exercise and remained suppressed relative to pre at visit 9 [-6.1 (-11.7, -0.47 Nm] in the experimental arm. Experiment 2 found that a swollen muscle could not appreciably swell more. CONCLUSION: Resting levels of muscle thickness do not appear to change beyond what occurs following the first naïve bout of exercise. Also, the acute swelling response may be used to differentiate swelling from muscle growth.

Frequency: The Overlooked Resistance Training Variable for Inducing Muscle Hypertrophy?

The principle of progressive overload must be adhered to for individuals to continually increase muscle size with resistance training. While the majority of trained individuals adhere to this principle by increasing the number of sets performed per exercise session, this does not appear to be an effective method for increasing muscle size once a given threshold is surpassed. Opposite the numerous studies examining differences in training loads and sets of exercise performed, a few studies have assessed the importance of training frequency with respect to muscle growth, none of which have tested very high frequencies of training (e.g., 7 days a week). The lack of studies examining such frequencies may be related to the American College of Sports Medicine recommendation that trained individuals use split routines allowing at least 48 h of rest between exercises that stress the same muscle groups. Given the attenuated muscle protein synthetic response to resistance exercise present in trained individuals, it can be hypothesized that increasing the training frequency would allow for more frequent elevations in muscle protein synthesis and more time spent in a positive net protein balance. We hypothesize that increasing the training frequency, as opposed to the training load or sets performed, may be a more appropriate strategy for trained individuals to progress a resistance exercise program aimed at increasing muscle size.

Influence of cuff material on blood flow restriction stimulus in the upper body.

The purpose of this study was to examine the acute skeletal muscle and perceptual responses to blood flow restriction (BFR) exercise to failure between narrow nylon and elastic inflatable cuffs at rest and during exercise. Torque and muscle thickness was measured pre, post, and 5, 20, 40, and 60 min post-exercise with muscle activation being measured throughout exercise. Resting arterial occlusion pressure was different between the nylon [139 (14) mmHg] and elastic [246 (71) mmHg, p < 0.001] cuffs. However, when exercising at 40 % of each cuff's respective arterial occlusion pressure [nylon: 57 (7) vs. elastic: 106 (38) mmHg, p < 0.001], there were no differences in repetitions to failure, torque, muscle thickness, or muscle activation between the cuffs. Exercising with cuffs of different material but similar width resulted in the same acute muscular response when the cuffs were inflated to a pressure relative to each individual cuff.

Post-exercise blood flow restriction attenuates muscle hypertrophy.

PURPOSE: Applying blood flow restriction during low-load resistance training has been shown to augment muscle hypertrophy which has been attributed to metabolic accumulation. It remains unknown, however, whether metabolites can augment muscle growth when maintained post-exercise. METHODS: Thirteen untrained individuals (6 males and 7 females) performed 24 training sessions. The control arm performed one set of elbow flexion (70 % 1RM) to volitional fatigue, while the experimental arm performed the same protocol immediately followed by 3 min of blood flow restriction (70 % arterial occlusion). Muscle growth (ultrasound) was measured at 50, 60, and 70 % of the distance between the lateral epicondyle and acromion process. RESULTS: Both conditions completed the same exercise volume [3678 (95 % CI 2962, 4393) vs. 3638 kg (95 % CI 2854, 4423)]. There was a condition by time interaction (p = 0.031) demonstrating an attenuation of muscle growth at the 60 % site in the experimental [pre 3.1 (95 % CI 2.8, 3.5), post 3.1 (95 % CI 2.7, 3.5) cm] vs. control [pre 3.1 (95 % CI 2.6, 3.6), post 3.3 (95 % CI 2.8, 3.7) cm] condition. Muscle growth at the 50 % and 70 % sites was similar at the group level, although there were attenuations at the individual level. Exploratory analyses of pre-post mean (95 % CI) changes in muscle thickness suggested that this attenuation in the experimental condition occurred only in females [50 % site 0.0 (-0.2, 0.0) cm; 60 % site -0.1 (-0.3, 0.0) cm; 70 % site 0.0 (-0.1, 0.1) cm]. CONCLUSIONS: The application of blood flow restriction post high-load training did not augment muscle growth for either sex, and appeared to attenuate muscle growth among females.

The acute and chronic effects of "NO LOAD" resistance training.

The purpose of the study was to remove the influence of an external load and determine if muscle growth can be elicited by maximally contracting through a full range of motion. In addition, the acute physiologic and perceptual responses to each stimulus were also investigated. Thirteen participants completed 18 sessions of unilateral elbow flexion exercise. Each arm was designated to either NO LOAD or HIGH LOAD condition (70% one repetition maximum). For the NO LOAD condition, participants repeatedly contracted as hard as they could through a full range of motion without the use of an external load. Our results show that anterior muscle thickness increased similarly from Pre to Post, with no differences between conditions for the 50% [Pre: 2.7 (0.8) vs. Post: 2.9 (0.7)], 60% [Pre: 2.9 (0.7) vs. Post: 3.1 (0.7)] or 70% [Pre: 3.2 (0.7) vs. Post: 3.5 (0.7)] sites. There was a significant condition×time interaction for one repetition maximum (p=0.017), with HIGH LOAD (+2.3kg) increasing more than the NO LOAD condition (+1kg). These results extend previous studies that have observed muscle growth across a range of external loads and muscle actions and suggest that muscle growth can occur independent of an external load provided there are enough muscle fibers undergoing mechanotransduction.

The effects of water-based exercise in combination with blood flow restriction on strength and functional capacity in post-menopausal women.

Water-based exercise and low-intensity exercise in combination with blood flow restriction (BFR) are two methods that have independently been shown to improve muscle strength in those of advancing age. The objective of this study was to assess the long-term effect of water-based exercise in combination with BFR on maximum dynamic strength and functional capacity in post-menopausal women. Twenty-eight women underwent an 8-week water-based exercise program. The participants were randomly allocated to one of the three groups: (a) water exercise only, (b) water exercise + BFR, or (c) a non-exercise control group. Functional capacity (chair stand test, timed up and go test, gait speed, and dynamic balance) and strength testing were tested before and after the 8-week aquatic exercise program. The main findings were as follows: (1) water-based exercise in combination with BFR significantly increased the lower limb maximum strength which was not observed with water-based exercise alone and (2) water-based exercise, regardless of the application of BFR, increased functional performance measured by the timed up and go test over a control group. Although we used a healthy population in the current study, these findings may have important implications for those who may be contraindicated to using traditional resistance exercise. Future research should explore this promising modality in these clinical populations.

Resistance training with instability in multiple system atrophy: a case report.

This case report assessed quality of life, activities of daily living, motor symptoms, functional ability, neuromuscular parameters and mRNA expression of selected genes related to muscle protein synthesis and degradation in a patient with Multiple System Atrophy (MSA). The patient underwent resistance training with instability devices (i.e., bosu, dyna disk, balance disk, Swiss ball) for six months twice a week. After the six months training, the patient's left and right quadriceps muscle cross-sectional area and leg press one-repetition maximum increased 6.4%, 6.8%, and 40%, respectively; the patient's timed up and go, sit to stand, dynamic balance, and activities of daily living improved 33.3%, 28.6%, 42.3%, and 40.1%, respectively; the patient's severity of motor symptoms and risk of falls decreased 32% and 128.1%, respectively. Most of the subscales of quality of life demonstrated improvements as well, varying from 13.0% to 100.0%. mRNA expression of mechanogrowth factor and mammalian target of rapamycin increased 12.7-fold and 1.5-fold, respectively. This case report describes likely the first nonpharmacological therapeutic tool that might be able to decrease the severity of motor symptoms and risk of falls, and to improve functional ability, neuromuscular parameters, and quality of the life in a patient with MSA. Key pointsSix months of resistance training with instability alleviate the MSA-related effects and improve the quality of life in a patient with MSA.High complexity exercise intervention (i.e., resistance training with instability) may be very beneficial to individuals with impaired motor control and function as MSA patients.Caution should be exercised when interpreting our findings as they cannot be generalized to the entire MSA population and they do not allow establishing causal conclusions on the effects of this mode of exercise on MSA.

Changes in exercises are more effective than in loading schemes to improve muscle strength.

This study investigated the effects of varying strength exercises and loading scheme on muscle cross-sectional area (CSA) and maximum strength after 4 strength training loading schemes: constant intensity and constant exercise (CICE), constant intensity and varied exercise (CIVE), varied intensity and constant exercise (VICE), varied intensity and varied exercise (VIVE). Forty-nine individuals were allocated into 5 groups: CICE, CIVE, VICE, VIVE, and control group (C). Experimental groups underwent twice a week training for 12 weeks. Squat 1 repetition maximum was assessed at baseline and after the training period. Whole quadriceps muscle and its heads CSA were also obtained pretraining and posttraining. The whole quadriceps CSA increased significantly (p ≤ 0.05) in all of the experimental groups from pretest to posttest in both the right and left legs: CICE: 11.6 and 12.0%; CIVE: 11.6 and 12.2%; VICE: 9.5 e 9.3%; and VIVE: 9.9 and 11.6%, respectively. The CIVE and VIVE groups presented hypertrophy in all of the quadriceps muscle heads (p ≤ 0.05), whereas the CICE and VICE groups did not present hypertrophy in the vastus medialis and rectus femoris (RF), and in the RF muscles, respectively (p > 0.05). The CIVE group had greater strength increments than the other training groups (effect size confidence limit of the difference [ESCLdiff] CICE: 1.41-1.56; VICE: 2.13-2.28; VIVE: 0.59-0.75). Our findings suggest: (a) CIVE is more efficient to produce strength gains for physically active individuals; (b) as long as the training intensity reaches an alleged threshold, muscle hypertrophy is similar regardless of the training intensity and exercise variation.

Vastus lateralis muscle cross-sectional area ultrasonography validity for image fitting in humans.

The present study aimed to determine the concurrent validity of ultrasound (US) measurement of the vastus lateralis muscle (VL) cross-sectional area (CSA) having magnetic resonance imaging (MRI) as the gold standard measurement, in a heterogeneous sample of participants. Thirty-one individuals (52.44 ± 16.37 years; 1.67 ± 0.11 m; 75.25 ± 13.82 kg) volunteered to participate in the study. All the images were performed in the right leg. Image-fitting technique (US) and computerized planimetry technique (US and MRI) were used to determine the VL CSA. The typical error (TE) of measurement was used to determine the concurrent validity of the US measurements. Our results demonstrated good validity of the US compared with the MRI measurements (TE = 0.37 cm; coefficient of variation = 1.75%). The Bland-Altman plot demonstrated bias of 0.07 ± 0.53 cm and limits of agreement of 0.96-1.11 cm. Based on our TE, bias and limits of agreement, we concluded that the US image-fitting technique is valid to assess the VL CSA in a heterogeneous sample of participants. Thereby, US can be used instead of MRI to assess changes in skeletal muscle morphology.