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The purpose of this review was to analyze the acute effects of low-load resistance exercise with blood flow restriction (LLE-BFR) on oxidative stress markers in healthy individuals in comparison with LLE or high-load resistance exercise (HLRE) without BFR. A systematic review was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. These searches were performed in CENTRAL, SPORTDiscus, EMBASE, PubMed, CINAHL and Virtual Health Library- VHL, which includes Lilacs, Medline and SciELO. The risk of bias and quality of evidence were assessed through the PEDro scale and GRADE system, respectively. Thirteen randomized clinical trials were included in this review (total n = 158 subjects). Results showed lower post-exercise damage to lipids (SMD = -0.95 CI 95%: -1.49 to -0. 40, I2 = 0%, p = 0.0007), proteins (SMD = -1.39 CI 95%: -2.11 to -0.68, I2 = 51%, p = 0.0001) and redox imbalance (SMD = -0.96 CI 95%: -1.65 to -0.28, I2 = 0%, p = 0.006) in favor of LLRE-BFR compared to HLRE. HLRE presents higher post-exercise superoxide dismutase activity but in the other biomarkers and time points, no significant differences between conditions were observed. For LLRE-BFR and LLRE, we found no difference between the comparisons performed at any time point. Based on the available evidence from randomized trials, providing very low or low certainty of evidence, this review demonstrates that LLRE-BFR promotes less oxidative stress when compared to HLRE but no difference in levels of oxidative damage biomarkers and endogenous antioxidants between LLRE. Register number: PROSPERO number: CRD42020183204.

This study aimed to compare the effects of a short-duration ischemic preconditioning (IPC) protocol with different cuff pressures on change of direction and jumping performance in elite male handball players. Twelve national-level male handball players (age:20.08 ± 3.12 years; height:1.81 ± 0.07 m; weight:77.88 ± 13.01 kg) participated in the study. Players visited the laboratory on five non-consecutive days. Following the familiarization session, each player completed four identical visits save for the cuff pressure used; cuff pressure was randomized into sham, 80% arterial occlusion pressure (AOP),100%AOP or 120% AOP with one used in each of the 2nd-5th visits. In the supine position, players underwent 3 cycles of 2 minutes of applied pressure and 2 minutes of reperfusion (total duration: 12 minutes). Ten minutes afterward, squat jumps (SJ) and countermovement jumps (CMJ) were performed in sequential order (5-minute rest between tests). Five minutes later, T-test and Zigzag test were performed (5-minute rest between tests). There was no significant difference across the IPC protocols for any of the parameters evaluated in the tests: SJ (F = 1.89; p = 0.151; η p 2  = 0.146), CMJ (F = 1.40; p = 0.260; η p 2  = 0.113), T-agility test (F = 0.01; p = 0.997; η p 2  = 0.002) and Zigzag test (F = 0.240; p = 0.860; η p 2  = 0.021). Our study found no effects of a 3x2-min IPC protocol using different IPC pressures on vertical jump and change of direction in elite male handball players. Therefore, it is premature to recommend the use of short-duration IPC protocols as a pre-exercise strategy for improving neuromuscular performance during ballistic and reactive athletic tasks in elite male handball players.

High frequency (1-2 times per day) low-intensity blood flow restriction (BFR) training has been recommended as a prescription approach for short durations of time to maximize relevant physiological adaptations. However, some studies demonstrate negative physiological changes after short periods of high-frequency BFR training, including prolonged strength decline and muscle fiber atrophy. To provide a comprehensive overview of short-term, high-frequency blood flow restriction training, including main adaptations, myocellular stress, limitations in the literature, and future perspectives. A systematic search of electronic databases (Scopus, PubMed®, and Web of Science) was performed from the earliest record to April 23, 2022. Two independent reviewers selected experimental studies that analyzed physical training protocols (aerobic or resistance) of high weekly frequency (>4 days/week) and short durations (≤3 weeks). In total, 22 studies were included in this review. The samples were composed exclusively of young predominantly male individuals. Muscle strength and hypertrophy were the main outcomes analyzed in the studies. In general, studies have demonstrated increases in strength and muscle size after short term (1-3 weeks), high-frequency low-intensity BFR training, non-failure, but not after control conditions (non-BFR; equalized training volume). Under failure conditions, some studies have demonstrated strength decline and muscle fiber atrophy after BFR conditions, accompanying increases in muscle damage markers. Significant limitations exist in the current HF-BFR literature due to large heterogeneities in methodologies. The synthesis presented indicates that short-term, high-frequency BFR training programs can generate significant neuromuscular adaptations. However, in resistance training to failure, strength declines and muscle fiber atrophy were reported. Currently, there are no studies analyzing low-frequency vs. high-frequency in short-term BFR training. Comparisons between resistance exercises of similar intensities (e.g., combined effort) are lacking, limiting conclusions on whether the effect is a product of proximity to failure or a specific effect of BFR.

Objective This systematic review and meta-analysis analyzed the effect of low-load resistance training (LL-RT) with blood flow restriction (BFR) versus high-load resistance training (HL-RT) on muscle hypertrophy focusing on the repetition scheme adopted. Methods Four databases were searched to identify randomized controlled trials that compared the effect of LL-RT with BFR versus HL-RT on muscle hypertrophy. Standardized mean differences (SMD) were pooled in a random effects meta-analysis. Results The overall analysis did not demonstrate significant differences between conditions (SMD = 0.046; p=0.14). A similar result was observed when we separately analyzed studies that used sets to momentary muscle failure (SMD = 0.033; p=0.520), sets of 15 repetitions (SMD = 0.005; p=0.937) and a fixed repetition scheme composed of 75 repetitions (SMD = 0.088; p=0.177). The analysis considering body region indicates no difference in lower limb exercise between HL-RT and LL-RT with BFR (SMD = 0.00066; p=0.795) while upper limb exercise favors HL-RT (SMD = 0.231; p=0.005). Conclusion LL-RT with BFR elicits muscle hypertrophy similar to HL-RT regardless of the employed repetition scheme, although there appears to be a small beneficial effect in favor of HL-RT in upper limb exercise.

Emerging evidence indicates that the use of low-load resistance training in combination with blood flow restriction (LL-BFR) can be an effective method to elicit increases in muscle size, with most research showing similar whole muscle development of the extremities compared to high-load (HL) training. It is conceivable that properties unique to LL-BFR such as greater ischemia, reperfusion, and metabolite accumulation may enhance the stress on type I fibers during training compared to the use of LLs without occlusion. Accordingly, the purpose of this paper was to systematically review the relevant literature on the fiber-type-specific response to LL-BFR and provide insights into future directions for research. A total of 11 studies met inclusion criteria. Results of the review suggest that the magnitude of type I fiber hypertrophy is at least as great, and sometimes greater, than type II hypertrophy when performing LL-BFR. This finding is in contrast to HL training, where the magnitude of type II fiber hypertrophy tends to be substantially greater than that of type I myofibers. However, limited data directly compare training with LL-BFR to nonoccluded LL or HL conditions, thus precluding the ability to draw strong inferences as to whether the absolute magnitude of type I hypertrophy is indeed greater in LL-BFR vs. traditional HL training. Moreover, it remains unclear as to whether combining LL-BFR with traditional HL training may enhance whole muscle hypertrophy via greater increases in type I myofiber cross-sectional area.

Differences in cuff blood flow restriction (BFR) bladder design (single‐chambered [SC‐BFR] and multi‐chambered [MC‐BFR] systems) may influence exercise performance, perceptual responses, and cardiovascular outcomes. In a randomized cross‐over design, twenty‐six healthy physically active individuals (22.6 ± 5.5 years old, 10 females; 25 reported engaging in resistance‐exercise consistently) performed four sets of bilateral biceps curls to volitional failure using 20% of the 1‐repetition maximum under three conditions: SC‐BFR, MC‐BFR, and a non‐BFR control, post‐exercise perceptual responses, and cardiovascular measures pre‐ and post‐exercise. SC‐BFR significantly reduced total repetitions compared to MC‐BFR and N‐BFR (p < 0.001). MC‐BFR and N‐BFR conditions demonstrated comparable performance in later sets. RPD was significantly higher in SC‐BFR compared to MC‐BFR and N‐BFR (p < 0.001), while MC‐BFR elicited lower RPE than SC‐BFR (p = 0.025). Both SC‐BFR and N‐BFR conditions significantly reduced post‐exercise diastolic blood pressure and mean arterial pressure, whereas MC‐BFR did not. No significant differences in PWV were observed across conditions. SC‐BFR induces greater repetition reduction and perceptual discomfort than MC‐BFR, while MC‐BFR demonstrates similar performances and comfort to N‐BFR in later sets. Findings suggest cuff design plays a role in acute BFR responses.

Background It is recommended to prescribe sets to volitional muscular failure (e.g., 4 sets) or a fixed repetition scheme of 75 repetitions (1 × 30, 3 × 15) in low-load resistance exercise with blood flow restriction (BFR-RE). While prior studies suggest both protocols may elicit similar muscular adaptations, the extent to which this is explained by matched exercise volume remains unclear. Objectives This systematic review and meta-analysis evaluated the number of repetitions performed during four sets of low-load BFR-RE to volitional muscular failure and compared these with the fixed 75-repetition scheme. The goal was to determine whether the two protocols yield similar total and per-set repetition volumes. Methods On 10/31/2024, two databases (PubMed ® and Scopus) were used to identify studies that applied a protocol of four sets to volitional muscular failure in BFR-RE with a load of ≤ 50% of one repetition maximum (1RM), regardless of the outcome investigated. Mean repetition data were pooled using a random-effects meta-analysis. One-sample t-tests compared per-set and total volumes to the reference scheme (1 × 30, 3 × 15). Results Across 25 studies (47 means; n  = 678), the estimated total repetitions performed to failure was 73.1 (95% CI: 61.1 to 85.2). Per-set means were 36.0 (95% CI: 30.5 to 41.4), 14.7 (95% CI: 12.2 to 17.1), 11.5 (95% CI: 9.2 to 13.8), and 10.4 repetitions (95% CI: 8.1 to 12.7) for sets 1 through 4, respectively. Conclusion Four sets of BFR-RE to volitional muscular failure produce similar total repetition volume compared to the commonly implemented fixed 75-repetition scheme, though the distribution of repetitions per set differs. These findings provide insight into the mechanical equivalence of two widely used BFR-RE prescriptions. Key Points This study demonstrates that performing four sets of low-load BFR-RE to volitional muscular failure yields similar total repetition volumes as the commonly studied and traditionally recommended fixed 75-repetition protocol (1 × 30, 3 × 15), despite meaningful differences in per-set repetition counts. Lower external loads and higher occlusion pressures were associated with slightly greater total repetitions—likely reflecting study design choices rather than physiological effects. Personalized pressure strategies affected repetitions achieved, with notable performance declines across later sets. These findings highlight the flexibility of BFR-RE prescription while underscoring the importance of fatigue management and set progression. The fixed 75-rep protocol may offer a more tolerable and practical option for many populations, particularly in rehabilitation or clinical settings where adherence is a key concern.

This study aimed to evaluate the time course and responsiveness of plasma interleukin-6 (IL-6) and creatine kinase (CK) levels following acute eccentric resistance exercise in sedentary obese older women with a different muscle quality index (MQI). Eighty-eight participants (69.4 ± 6.06 years) completed an acute eccentric resistance exercise (7 sets of 10 repetitions at 110% of 10-repetition maximum with 3 min rest interval). Participants were divided into two groups: high or low MQI according to 50th percentile cut-off. The responsiveness was based on minimal clinical important difference. There were no differences between groups and time on IL-6 and CK levels (p > 0.05). However, the high MQI group displayed a lower proportion of low responders (1 for laboratory and 2 for field-based vs. 5 and 4) and a higher proportion of high responders for IL-6 (7 for laboratory and 6 for field-based vs. 4 and 5) compared to low MQI group. In addition, the high MQI group showed a higher proportion of high responders for CK (11 for laboratory and 9 for field-based vs. 6 and 6) compared to low MQI. A prior MQI screening can provide feedback to understand the magnitude response. Individual responsiveness should be taken into consideration for maximizing eccentric exercise prescription.

Purpose: Low-intensity resistance exercise with moderate blood-flow restriction (LIRE-BFR) is a new trending form of exercises worldwide. The purpose of this study was to compare the acute effect of a single bout of traditional resistance exercise (TRE) and LIRE-BFR on arterial stiffness in older people with slow gait speeds. Methods: This was a randomized, controlled clinical study. Seventeen older adults (3 men; 14 women; 82 ± 5 years old) completed a session of TRE (n = 7) or LIRE-BFR (n = 10). At baseline and after 60 min post-exercise, participants were subject to blood pressure measurement, heart rate measurements and a determination of arterial stiffness parameters. Results: There was no significant difference between the TRE and LIRE-BFR group at baseline. Pulse-wave velocity increased in both groups (p < 0.05) post-exercise with no between-group differences. Both exercise modalities did not produce any adverse events. The increase in systolic blood pressure, pulse pressure, augmentation pressure and pulse wave velocity (all p > 0.05) were similar after both TRE and LIRE-BFR. Conclusion: TRE and LIRE-BFR had similar responses regarding hemodynamic parameters and pulse-wave velocity in older people with slow gait speed. Long-term studies should assess the cardiovascular risk and safety of LIRE-BFR training in this population.