Application of blood flow restriction exercise in physical therapy_West China Medical Journal

Authors：

FAN Bin ¹ ,  JIANG Jiaojiao ^2,3

1. School of Rehabilitation Sciences, West China School of Medicine, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
3. Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

JIANG Jiaojiao, Email: jiangjiaojiao1997@163.com

Keywords：

Blood flow restriction exercise; physical therapy; resistance training; aerobic exercise; passive training

DOI：

10.7507/1002-0179.202005295

Video：

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As an innovative training method, blood flow restrictive exercise has gradually received extensive attention and application in rehabilitation medicine in recent years. Blood flow restrictive exercise can be combined with low-load, low-intensity training to promote individual muscle hypertrophy and enhance muscle strength to prevent muscle atrophy, which provides an alternative for those who cannot perform high-load, high-intensity training. However, the clinical use strategy and clinical application effect of blood flow restriction exercise are still unclear. This article will mainly introduce the operation methods, use risks, and application methods of blood flow restrictive exercise, in order to provide a reference for the clinical application and research of blood flow restrictive exercise.

Citation： FAN Bin, JIANG Jiaojiao. Application of blood flow restriction exercise in physical therapy. West China Medical Journal, 2022, 37(5): 771-775. doi: 10.7507/1002-0179.202005295 Copy

1.	Garber CE, Blissmer B, Deschenes MR, et al. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc, 2011, 43(7): 1334-1359.
2.	Wall BT, Dirks ML, van Loon LJ. Skeletal muscle atrophy during short-term disuse: implications for age-related sarcopenia. Ageing Res Rev, 2013, 12(4): 898-906.
3.	Hughes L, Rosenblatt B, Haddad F, et al. Comparing the effectiveness of blood flow restriction and traditional heavy load resistance training in the post-surgery rehabilitation of anterior cruciate ligament reconstruction patients: a UK national health service randomised controlled trial. Sports Med, 2019, 49(11): 1787-1805.
4.	Giles L, Webster KE, McClelland J, et al. Quadriceps strengthening with and without blood flow restriction in the treatment of patellofemoral pain: a double-blind randomised trial. Br J Sports Med, 2017, 51(23): 1688-1694.
5.	Scott BR, Loenneke JP, Slattery KM, et al. Exercise with blood flow restriction: an updated evidence-based approach for enhanced muscular development. Sports Med, 2015, 45(3): 313-325.
6.	Whiteley R. Blood flow restriction training in rehabilitation: a useful adjunct or lucy’s latest trick?. J Orthop Sports Phys Ther, 2019, 49(5): 294-298.
7.	Weatherholt AM, Vanwye WR, Lohmann J, et al. The effect of cuff width for determining limb occlusion pressure: a comparison of blood flow restriction devices. Int J Exerc Sci, 2019, 12(3): 136-143.
8.	Loenneke JP, Fahs CA, Rossow LM, et al. Blood flow restriction pressure recommendations: a tale of two cuffs. Front Physiol, 2013, 4: 249.
9.	Evin HA, Mahoney SJ, Wagner M, et al. Limb occlusion pressure for blood flow restricted exercise: variability and relations with participant characteristics. Phys Ther Sport, 2021, 47: 78-84.
10.	Karanasios S, Koutri C, Moutzouri M, et al. The effect of body position and the reliability of upper limb arterial occlusion pressure using a handheld doppler ultrasound for blood flow restriction training. Sports Health, 2021, 13: 19417381211043877.
11.	Hunt JE, Stodart C, Ferguson RA. The influence of participant characteristics on the relationship between cuff pressure and level of blood flow restriction. Eur J Appl Physiol, 2016, 116(7): 1421-1432.
12.	Renzi CP, Tanaka H, Sugawara J. Effects of leg blood flow restriction during walking on cardiovascular function. Med Sci Sports Exerc, 2010, 42(4): 726-732.
13.	Bond CW, Hackney KJ, Brown SL, et al. Blood flow restriction resistance exercise as a rehabilitation modality following orthopaedic surgery: a review of venous thromboembolism risk. J Orthop Sports Phys Ther, 2019, 49(1): 17-27.
14.	Madarame H, Kurano M, Takano H, et al. Effects of low-intensity resistance exercise with blood flow restriction on coagulation system in healthy subjects. Clin Physiol Funct Imaging, 2010, 30(3): 210-213.
15.	Krieger J, Sims D, Wolterstorff C. A case of rhabdomyolysis caused by blood flow-restricted resistance training. J Spec Oper Med, 2018, 18(2): 16-17.
16.	Clark BC, Manini TM. Can kaatsu exercise cause rhabdomyolysis?. Clin J Sport Med, 2017, 27(1): e1-e2.
17.	Alvarez IF, Damas F, Biazon TMP, et al. Muscle damage responses to resistance exercise performed with high-load versus low-load associated with partial blood flow restriction in young women. Eur J Sport Sci, 2020, 20(1): 125-134.
18.	Loenneke JP, Thiebaud RS, Abe T. Does blood flow restriction result in skeletal muscle damage? A critical review of available evidence. Scand J Med Sci Sports, 2014, 24(6): e415-e422.
19.	Nyakayiru J, Fuchs CJ, Trommelen J, et al. Blood flow restriction only increases myofibrillar protein synthesis with exercise. Med Sci Sports Exerc, 2019, 51(6): 1137-1145.
20.	Ladlow P, Coppack RJ, Dharm-Datta S, et al. Low-load resistance training with blood flow restriction improves clinical outcomes in musculoskeletal rehabilitation: a single-blind randomized controlled trial. Front Physiol, 2018, 9: 1269.
21.	Rodrigues R, Ferraz RB, Kurimori CO, et al. Low-load resistance training with blood-flow restriction in relation to muscle function, mass, and functionality in women with rheumatoid arthritis. Arthritis Care Res (Hoboken), 2020, 72(6): 787-797.
22.	Ishizaka H, Uematsu A, Mizushima Y, et al. Blood flow restriction increases the neural activation of the knee extensors during very low-intensity leg extension exercise in cardiovascular patients: a pilot study. J Clin Med, 2019, 8(8): 1252.
23.	Tai YL, Marshall EM, Glasgow A, et al. Autonomic modulation following an acute bout of bench press with and without blood flow restriction. Eur J Appl Physiol, 2019, 119(10): 2177-2183.
24.	Kjeldsen SS, Næss-Schmidt ET, Hansen GM, et al. Neuromuscular effects of dorsiflexor training with and without blood flow restriction. Heliyon, 2019, 5(8): e02341.
25.	Lixandrão ME, Roschel H, Ugrinowitsch C, et al. Blood-flow restriction resistance exercise promotes lower pain and ratings of perceived exertion compared with either high- or low-intensity resistance exercise performed to muscular failure. J Sport Rehabil, 2019, 28(7): 706-710.
26.	Smith NDW, Girard O, Scott BR, et al. Blood flow restriction during self-paced aerobic intervals reduces mechanical and cardiovascular demands without modifying neuromuscular fatigue. Eur J Sport Sci, 2022, 11: 1-29.
27.	Junior AF, Schamne JC, Perandini LAB, et al. Effects of walking training with restricted blood flow on HR and HRV kinetics and HRV recovery. Int J Sports Med, 2019, 40(9): 585-591.
28.	Kim D, Singh H, Loenneke JP, et al. Comparative effects of vigorous-intensity and low-intensity blood flow restricted cycle training and detraining on muscle mass, strength, and aerobic capacity. J Strength Cond Res, 2016, 30(5): 1453-1461.
29.	Takarada Y, Takazawa H, Ishii N. Applications of vascular occlusion diminish disuse atrophy of knee extensor muscles. Med Sci Sports Exerc, 2000, 32(12): 2035-2039.
30.	Kubota A, Sakuraba K, Koh S, et al. Blood flow restriction by low compressive force prevents disuse muscular weakness. J Sci Med Sport, 2011, 14(2): 95-99.
31.	Barbalho M, Rocha AC, Seus TL, et al. Addition of blood flow restriction to passive mobilization reduces the rate of muscle wasting in elderly patients in the intensive care unit: a within-patient randomized trial. Clin Rehabil, 2019, 33(2): 233-240.
32.	Natsume T, Yoshihara T, Naito H. Electromyostimulation with blood flow restriction enhances activation of mTOR and MAPK signaling pathways in rat gastrocnemius muscles. Appl Physiol Nutr Metab, 2019, 44(6): 637-644.
33.	Tanaka M, Morifuji T, Yoshikawa M, et al. Effects of combined treatment with blood flow restriction and low-intensity electrical stimulation on diabetes mellitus-associated muscle atrophy in rats. J Diabetes, 2019, 11(4): 326-334.
34.	Gorgey AS, Timmons MK, Dolbow DR, et al. Electrical stimulation and blood flow restriction increase wrist extensor cross-sectional area and flow meditated dilatation following spinal cord injury. Eur J Appl Physiol, 2016, 116(6): 1231-1244.
35.	Slysz JT, Burr JF. The effects of blood flow restricted electrostimulation on strength and hypertrophy. J Sport Rehabil, 2018, 27(3): 257-262.
36.	Slysz JT, Boston M, King R, et al. Blood flow restriction combined with electrical stimulation attenuates thigh muscle disuse atrophy. Med Sci Sports Exerc, 2021, 53(5): 1033-1040.
37.	Centner C, Ritzmann R, Schur S, et al. Blood flow restriction increases myoelectric activity and metabolic accumulation during whole-body vibration. Eur J Appl Physiol, 2019, 119(6): 1439-1449.
38.	Chen WC, Wu CM, Cai ZY. Effect of one bout of local vibration exercise with blood flow restriction on neuromuscular and hormonal responses. Physiol Int, 2018, 105(2): 166-176.

1. Garber CE, Blissmer B, Deschenes MR, et al. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc, 2011, 43(7): 1334-1359.
2. Wall BT, Dirks ML, van Loon LJ. Skeletal muscle atrophy during short-term disuse: implications for age-related sarcopenia. Ageing Res Rev, 2013, 12(4): 898-906.
3. Hughes L, Rosenblatt B, Haddad F, et al. Comparing the effectiveness of blood flow restriction and traditional heavy load resistance training in the post-surgery rehabilitation of anterior cruciate ligament reconstruction patients: a UK national health service randomised controlled trial. Sports Med, 2019, 49(11): 1787-1805.
4. Giles L, Webster KE, McClelland J, et al. Quadriceps strengthening with and without blood flow restriction in the treatment of patellofemoral pain: a double-blind randomised trial. Br J Sports Med, 2017, 51(23): 1688-1694.
5. Scott BR, Loenneke JP, Slattery KM, et al. Exercise with blood flow restriction: an updated evidence-based approach for enhanced muscular development. Sports Med, 2015, 45(3): 313-325.
6. Whiteley R. Blood flow restriction training in rehabilitation: a useful adjunct or lucy’s latest trick?. J Orthop Sports Phys Ther, 2019, 49(5): 294-298.
7. Weatherholt AM, Vanwye WR, Lohmann J, et al. The effect of cuff width for determining limb occlusion pressure: a comparison of blood flow restriction devices. Int J Exerc Sci, 2019, 12(3): 136-143.
8. Loenneke JP, Fahs CA, Rossow LM, et al. Blood flow restriction pressure recommendations: a tale of two cuffs. Front Physiol, 2013, 4: 249.
9. Evin HA, Mahoney SJ, Wagner M, et al. Limb occlusion pressure for blood flow restricted exercise: variability and relations with participant characteristics. Phys Ther Sport, 2021, 47: 78-84.
10. Karanasios S, Koutri C, Moutzouri M, et al. The effect of body position and the reliability of upper limb arterial occlusion pressure using a handheld doppler ultrasound for blood flow restriction training. Sports Health, 2021, 13: 19417381211043877.
11. Hunt JE, Stodart C, Ferguson RA. The influence of participant characteristics on the relationship between cuff pressure and level of blood flow restriction. Eur J Appl Physiol, 2016, 116(7): 1421-1432.
12. Renzi CP, Tanaka H, Sugawara J. Effects of leg blood flow restriction during walking on cardiovascular function. Med Sci Sports Exerc, 2010, 42(4): 726-732.
13. Bond CW, Hackney KJ, Brown SL, et al. Blood flow restriction resistance exercise as a rehabilitation modality following orthopaedic surgery: a review of venous thromboembolism risk. J Orthop Sports Phys Ther, 2019, 49(1): 17-27.
14. Madarame H, Kurano M, Takano H, et al. Effects of low-intensity resistance exercise with blood flow restriction on coagulation system in healthy subjects. Clin Physiol Funct Imaging, 2010, 30(3): 210-213.
15. Krieger J, Sims D, Wolterstorff C. A case of rhabdomyolysis caused by blood flow-restricted resistance training. J Spec Oper Med, 2018, 18(2): 16-17.
16. Clark BC, Manini TM. Can kaatsu exercise cause rhabdomyolysis?. Clin J Sport Med, 2017, 27(1): e1-e2.
17. Alvarez IF, Damas F, Biazon TMP, et al. Muscle damage responses to resistance exercise performed with high-load versus low-load associated with partial blood flow restriction in young women. Eur J Sport Sci, 2020, 20(1): 125-134.
18. Loenneke JP, Thiebaud RS, Abe T. Does blood flow restriction result in skeletal muscle damage? A critical review of available evidence. Scand J Med Sci Sports, 2014, 24(6): e415-e422.
19. Nyakayiru J, Fuchs CJ, Trommelen J, et al. Blood flow restriction only increases myofibrillar protein synthesis with exercise. Med Sci Sports Exerc, 2019, 51(6): 1137-1145.
20. Ladlow P, Coppack RJ, Dharm-Datta S, et al. Low-load resistance training with blood flow restriction improves clinical outcomes in musculoskeletal rehabilitation: a single-blind randomized controlled trial. Front Physiol, 2018, 9: 1269.
21. Rodrigues R, Ferraz RB, Kurimori CO, et al. Low-load resistance training with blood-flow restriction in relation to muscle function, mass, and functionality in women with rheumatoid arthritis. Arthritis Care Res (Hoboken), 2020, 72(6): 787-797.
22. Ishizaka H, Uematsu A, Mizushima Y, et al. Blood flow restriction increases the neural activation of the knee extensors during very low-intensity leg extension exercise in cardiovascular patients: a pilot study. J Clin Med, 2019, 8(8): 1252.
23. Tai YL, Marshall EM, Glasgow A, et al. Autonomic modulation following an acute bout of bench press with and without blood flow restriction. Eur J Appl Physiol, 2019, 119(10): 2177-2183.
24. Kjeldsen SS, Næss-Schmidt ET, Hansen GM, et al. Neuromuscular effects of dorsiflexor training with and without blood flow restriction. Heliyon, 2019, 5(8): e02341.
25. Lixandrão ME, Roschel H, Ugrinowitsch C, et al. Blood-flow restriction resistance exercise promotes lower pain and ratings of perceived exertion compared with either high- or low-intensity resistance exercise performed to muscular failure. J Sport Rehabil, 2019, 28(7): 706-710.
26. Smith NDW, Girard O, Scott BR, et al. Blood flow restriction during self-paced aerobic intervals reduces mechanical and cardiovascular demands without modifying neuromuscular fatigue. Eur J Sport Sci, 2022, 11: 1-29.
27. Junior AF, Schamne JC, Perandini LAB, et al. Effects of walking training with restricted blood flow on HR and HRV kinetics and HRV recovery. Int J Sports Med, 2019, 40(9): 585-591.
28. Kim D, Singh H, Loenneke JP, et al. Comparative effects of vigorous-intensity and low-intensity blood flow restricted cycle training and detraining on muscle mass, strength, and aerobic capacity. J Strength Cond Res, 2016, 30(5): 1453-1461.
29. Takarada Y, Takazawa H, Ishii N. Applications of vascular occlusion diminish disuse atrophy of knee extensor muscles. Med Sci Sports Exerc, 2000, 32(12): 2035-2039.
30. Kubota A, Sakuraba K, Koh S, et al. Blood flow restriction by low compressive force prevents disuse muscular weakness. J Sci Med Sport, 2011, 14(2): 95-99.
31. Barbalho M, Rocha AC, Seus TL, et al. Addition of blood flow restriction to passive mobilization reduces the rate of muscle wasting in elderly patients in the intensive care unit: a within-patient randomized trial. Clin Rehabil, 2019, 33(2): 233-240.
32. Natsume T, Yoshihara T, Naito H. Electromyostimulation with blood flow restriction enhances activation of mTOR and MAPK signaling pathways in rat gastrocnemius muscles. Appl Physiol Nutr Metab, 2019, 44(6): 637-644.
33. Tanaka M, Morifuji T, Yoshikawa M, et al. Effects of combined treatment with blood flow restriction and low-intensity electrical stimulation on diabetes mellitus-associated muscle atrophy in rats. J Diabetes, 2019, 11(4): 326-334.
34. Gorgey AS, Timmons MK, Dolbow DR, et al. Electrical stimulation and blood flow restriction increase wrist extensor cross-sectional area and flow meditated dilatation following spinal cord injury. Eur J Appl Physiol, 2016, 116(6): 1231-1244.
35. Slysz JT, Burr JF. The effects of blood flow restricted electrostimulation on strength and hypertrophy. J Sport Rehabil, 2018, 27(3): 257-262.
36. Slysz JT, Boston M, King R, et al. Blood flow restriction combined with electrical stimulation attenuates thigh muscle disuse atrophy. Med Sci Sports Exerc, 2021, 53(5): 1033-1040.
37. Centner C, Ritzmann R, Schur S, et al. Blood flow restriction increases myoelectric activity and metabolic accumulation during whole-body vibration. Eur J Appl Physiol, 2019, 119(6): 1439-1449.
38. Chen WC, Wu CM, Cai ZY. Effect of one bout of local vibration exercise with blood flow restriction on neuromuscular and hormonal responses. Physiol Int, 2018, 105(2): 166-176.

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