Acute Responses in Blood Flow Restriction Low-intensity Aerobic Training: A Meta-analysis

Abstract

The purpose was to determine the effect low-intensity training with blood flow restriction (LI-BFR) versus high-intensity aerobic training (HIT) on acute physiological and perceptual responses. The Cumulative Index to Nursing and Allied Health Literature, National Library of Medicine, Scopus, SPORTDiscus and Web of Science databases and the reference list of eligible studies were consulted to identify randomized experimental studies, published until July 4, 2022, that analyzed physiological or perceptual responses between LI-BFR versus HIT in healthy young individuals. Mean difference (MD) and standardized mean difference (SMD) were used as effect estimates and random effects models were applied in all analyses. Twelve studies were included in this review. During exercise sessions, HIT promoted higher values of heart rate (MD=28.9 bpm; p<0.00001; I ² =79%), oxygen consumption (SMD=4.01; p<0.00001; I ² =83%), ventilation (MD=48.03 l/min; p=0.0001; I ² =97%), effort (SMD=1.54; p=0.003; I ² =90%) and blood lactate (MD=3.85 mmol/L; p=0.002; I ² =97%). Perception of pain/discomfort was lower in HIT (SMD=−1.71; p=0.04; I ² =77.5%). In conclusion, LI-BFR promotes less pronounced physiological responses than HIT but with greater perception of pain.

Key words

vascular occlusion - endurance training - high-intensity interval training - rating of perceived exertion - lactates

Publication History

Received: 03 November 2022

Accepted: 01 February 2023

Article published online:
09 May 2023

• References

• 1 Sato Y.. The history and future of KAATSU training. Int J KAATSU Train Res 2005; 1: 1-5
• 2 Patterson SD, Hughes L, Warmington S. et al. Blood flow restriction exercise: considerations of methodology, application, and safety. Front Physiol 15 10 533 DOI: 10.3389/fphys.2019.00533.
• 3 Abe T, Kearns CF, Sato Y.. Muscle size and strength are increased following walk training with restricted venous blood flow from the leg muscle, Kaatsu-walk training. J Appl Physiol (1985) 2006; 100: 1460-1466 DOI: 10.1152/japplphysiol.01267.2005.
• 4 Abe T, Fujita S, Nakajima T. et al. Effects of low-intensity cycle training with restricted leg blood flow on thigh muscle volume and VO2MAX in young men. J Sports Sci Med 2010; 9: 452-458
• 5 Silva JCG, Pereira Neto EA, Pfeiffer PAS. et al. Acute and chronic responses of aerobic exercise with blood flow restriction: A systematic review. Front Physiol 2019; 10: 1239 DOI: 10.3389/fphys.2019.01239.
• 6 Loenneke JP, Fahs CA, Rossow LM. et al. The anabolic benefits of venous blood flow restriction training may be induced by muscle cell swelling. Med Hypotheses 2012; 78: 151-154 DOI: 10.1016/j.mehy.2011.10.014.
• 7 Formiga MF, Fay R, Hutchinson S. et al. Effect of aerobic exercise training with and without blood flow restriction on aerobic capacity in healthy young adults: A systematic review with meta-analysis. Int J Sports Phys Ther 2020; 15: 175-187
• 8 Moholdt T, Madssen E, Rognmo Ø, Aamot IL.. The higher the better? Interval training intensity in coronary heart disease. J Sci Med Sport 2014; 17: 506-510 DOI: 10.1016/j.jsams.2013.07.007.
• 9 Corvino RB, Rossiter HB, Loch T. et al. Physiological responses to interval endurance exercise at different levels of blood flow restriction. Eur J Appl Physiol 2017; 117: 39-52 DOI: 10.1007/s00421-016-3497-5.
• 10 Thomas HJ, Scott BR, Peiffer JJ.. Acute physiological responses to low-intensity blood flow restriction cycling. J Sci Med Sport 2018; 21: 969-974 DOI: 10.1016/j.jsams.2018.01.013.
• 11 Fiorenza M, Gunnarsson TP, Hostrup M. et al. Metabolic stress-dependent regulation of the mitochondrial biogenic molecular response to high-intensity exercise in human skeletal muscle. J Physiol 2018; 596: 2823-2840 DOI: 10.1113/JP275972.
• 12 Rolnick N, Kimbrell K, Cerqueira MS. et al. Perceived barriers to blood flow restriction training. Front Rehabil Sci 2021; 2: 697082
• 13 Kilgas MA, Yoon T, McDaniel J. et al. Physiological responses to acute cycling with blood flow restriction. Front Physiol 2022; 13: 800155 DOI: 10.3389/fphys.2022.800155.
• 14 Corvino RB, Scheffer DDL, Penteado Dos Santos R. et al. Muscle fatigue is attenuated when applying intermittent compared with continuous blood flow restriction during endurance cycling. Int J Sports Physiol Perform 2022; 17: 1126-1131 DOI: 10.1123/ijspp.2021-0523.
• 15 Kim D, Loenneke JP, Thiebaud RS. et al. The acute muscular effects of cycling with and without different degrees of blood flow restriction. Acta Physiol Hung 2015; 102: 428-441 DOI: 10.1556/036.102.2015.4.10.
• 16 Page MJ, McKenzie JE, Bossuyt PM. et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021; 372: n71 DOI: 10.1136/bmj.n71.
• 17 Horsley T, Dingwall O, Sampson M.. Checking reference lists to find additional studies for systematic reviews. Cochrane Database Syst Rev 2011; 2011: MR000026 DOI: 10.1002/14651858.MR000026.pub2.
• 18 Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A.. Rayyan-a web and mobile app for systematic reviews. Syst Rev 2016; 5: 210 DOI: 10.1186/s13643-016-0384-4.
• 19 Van Belle G.. Statistical Rules of Thumb, 2^nd Edition. Hoboken: John Wiley & Sons; 2011
• 20 Centner C, Lauber B.. A systematic review and meta-analysis on neural adaptations following blood flow restriction training: what we know and what we don't know. Front Physiol 2020; 11: 887 DOI: 10.3389/fphys.2020.00887.
• 21 Cerqueira MS, Maciel DG, Barboza JAM. et al. Low-load blood-flow restriction exercise to failure and nonfailure and myoelectric activity: A meta-analysis. J Athl Train 2022; 57: 402-417 DOI: 10.4085/1062-6050-0603.20.
• 22 Sterne JAC, Savović J, Page MJ. et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ 2019; 366: l4898 DOI: 10.1136/bmj.l4898.
• 23 Borenstein M, Hedges LV, Higgins JPT, Rothstein HR.. Introduction to Meta-Analysis. Hoboken: John Wiley & Sons; 2009
• 24 Sullivan GM, Feinn R.. Using effect size-or why the P value is not enough. J Grad Med Educ 2012; 4: 279-282 DOI: 10.4300/JGME-D-12-00156.1.
• 25 Higgins JP, Thompson SG.. Quantifying heterogeneity in a meta-analysis. Stat Med 2002; 21: 1539-1558 DOI: 10.1002/sim.1186.
• 26 Sterne JA, Sutton AJ, Ioannidis JP. et al. Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomised controlled trials. BMJ 2011; 343: d4002 DOI: 10.1136/bmj.d4002.
• 27 Goldet G, Howick J.. Understanding GRADE: an introduction. J Evid Based Med 2013; 6: 50-54
• 28 Moher D, Liberati A, Tetzlaff J. et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009; 6: e1000097 DOI: 10.1371/journal.pmed.1000097.
• 29 Lauver JD, Moran A, Guilkey JP. et al. Acute responses to cycling exercise with blood flow restriction during various intensities. J Strength Cond Res 2022; 36: 3366-3373 DOI: 10.1519/JSC.0000000000004099.
• 30 Ferreira MLV, Sardeli AV, De Souza GV. et al. Cardiac autonomic responses during and after a single session of aerobic exercise with and without blood flow restriction. J Sports Sci 2017; 35: 2412-2420
• 31 Wei J, Nassis GP, Gu Z. et al. Acute physiological and perceptual responses to moderate intensity cycling with different levels of blood flow restriction. Biol Sport 2021; 38: 437-443 DOI: 10.5114/biolsport.2021.100146.
• 32 Silva JCG, Domingos-Gomes JR, Freitas EDS. et al. Physiological and perceptual responses to aerobic exercise with and without blood flow restriction. J Strength Cond Res 2021; 35: 2479-2485 DOI: 10.1519/JSC.0000000000003178.
• 33 Renzi CP, Tanaka H, Sugawara J.. Effects of leg blood flow restriction during walking on cardiovascular function. Med Sci Sports Exerc 2010; 42: 726-732 DOI: 10.1249/MSS.0b013e3181bdb454.
• 34 Spranger MD, Krishnan AC, Levy PD. et al. Blood flow restriction training and the exercise pressor reflex: a call for concern. Am J Physiol Heart Circ Physiol 2015; 309: H1440-H1452 DOI: 10.1152/ajpheart.00208.2015.
• 35 Pope ZK, Willardson JM, Schoenfeld BJ.. Exercise and blood flow restriction. J Strength Cond Res 2013; 27: 2914-2926
• 36 Neto GR, Novaes JS, Salerno VP. et al. Acute effects of resistance exercise with continuous and intermittent blood flow restriction on hemodynamic measurements and perceived exertion. Percept Mot Skills 2017; 124: 277-292 DOI: 10.1177/0031512516677900.
• 37 Marcora SM.. Perception of effort. In: Goldstein EB, ed. Encyclopedia of Perception. Thousand Oaks: Sage; 2010: 380-383
• 38 de Morree HM, Klein C, Marcora SM.. Perception of effort reflects central motor command during movement execution. Psychophysiology 2012; 49: 1242-1253 DOI: 10.1111/j.1469-8986.2012.01399.x.
• 39 de Morree HM, Marcora SM.. Psychobiology of perceived effort during physical tasks. In: Gendolla GHE, Tops M, Koole SL, eds. Handbook of Biobehavioral Approaches To Self-Regulation. New York: Springer; 2015: 255-270
• 40 Robertson RJ, Noble BJ.. Perception of physical exertion: methods, mediators, and applications. Exerc Sport Sci Rev 1997; 25: 407-452
• 41 Pageaux B.. Perception of effort in exercise science: Definition, measurement and perspectives. Eur J Sport Sci 2016; 16: 885-894 DOI: 10.1080/17461391.2016.1188992.