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Blood flow restriction (BFR) training has been shown to induce exercise-induced muscle damage (EIMD) in some cases, although findings are inconsistent and the influence of the applied arterial occlusion pressure (AOP) remains unclear. This single-blind, randomized controlled trial investigated the effects of different percentages of AOP on EIMD and acute physiological responses in 40 participants allocated to four groups: no pressure (NP), low pressure (LP; 50% AOP), medium pressure (MP; 75% AOP), and high pressure (HP; 100% AOP). Participants performed unilateral knee extensions at 30% of their one-repetition maximum up to four sets of 20 repetitions or until failure. EIMD was primarily assessed by the changes in isokinetic peak torque 24 h, 48 h and 72 h post-exercise (Δ to baseline). Secondary markers included perceived pain, blood biomarkers (creatine kinase, myoglobin) and muscle swelling. Additionally, acute physiological responses were assessed, including continuous measurement of muscle oxygen saturation (SmO 2 ) during exercise, perceived exertion (RPE) immediately after the exercise bout, and blood lactate concentration measured at 1, 3, 7, and 10 min post-exercise. NP showed greater strength loss at 24 h post-exercise compared to MP (MD = − 9.95, p  = .042, 95% CI [− 19.7, − 0.19]) and HP (MD = − 10.51, p  = .034, 95% CI [− 20.52, − 0.49]). Pain ratings were higher in NP compared to MP ( p  = .001) and HP ( p  = .003) at 24 h post, and remained elevated at 48 h compared to MP ( p  = .003) and HP ( p  = .047). NP and LP completed more repetitions than MP and HP. HP exhibited a greater reduction in SmO 2 compared to NP. Perceived exertion was higher in MP and HP. LP showed higher average lactate concentrations than NP ( p  = .020). CK and MB responses showed no time-specific group differences. These findings suggest that BFR training, even at higher pressures, does not increase EIMD compared to free-flow exercise, and that MP and HP may even attenuate strength loss and pain following exercise.

This study aimed to explore the safety of blood flow restriction combined stepping aerobic exercise (BFR-SAE) using elastic and non-elastic cuffs at varying pressures in older adults with sarcopenia. Older adults with sarcopenia were selected by convenience sampling method and underwent BFR-SAE using elastic and non-elastic cuffs at 20%, 40%, and 60% limb occlusion pressure (LOP). Exercise response and adverse events were recorded. Thirty-one participants (84.81 ± 6.19 years old) completed the tests. During the non-elastic cuffs test, 31 participants completed at 20% LOP, and 4 (12.9%) dropped from 40% to 20% LOP. At 60% LOP, 19 (61.3%) and 3 (9.7%) dropped to 40% and 20% LOP, respectively. In the elastic cuffs tests all participants completed at 20% and 40% LOP. At 60% LOP, 9 (29.0%) dropped to the interface pressure corresponding to 40% LOP. General exercise responses were lower with elastic cuffs at 40% LOP (22.6% vs 45.2%) and 60% LOP (41.9% vs 51.6%), with higher completion rate than non-elastic cuffs (40% LOP: 100% vs 87.1%; 60% LOP: 71.0% vs 29.0%). Among the results of systolic and diastolic blood pressure (SBP and DBP), pulse rate (P) and pulse oxygen saturation (SpO ), differences were found in BP and P at different time points ( <0.05) within each pressure, but no significant difference between different pressures. Non-elastic cuffs caused significant increases in SBP, DBP, and P from rest, while only SBP and P showed significant increases in elastic cuffs group. Pain scores were 0 for both cuffs after tests, the adverse events rate was 1.1% and rating of perceived exertion all reached moderate-intensity of exercise. Elastic cuffs for BFR-SAE induced milder exercise responses and higher completion rates, suggesting better safety and feasibility than non-elastic cuffs in older adults with possible sarcopenia.

Blood flow restriction (BFR) training has emerged as a novel modality with clinical potential. However, BFR increases perceived effort and pain, highlighting the need to identify factors influencing perceptual responses to optimize its practical application. Hypohydration similarly increases discomfort during exercise or painful stimuli, but whether this interacts with BFR is unknown. The purpose of the study was to determine if hydration affects the perceptual response to BFR exercise. Of the 34 participants recruited, 17 (7 females) completed two BFR exercise bouts: (1) Hydrated (regular fluid intake) and (2) Hypohydrated (24 h fluid restriction). Rating of perceived exertion (RPE) and leg pain were recorded throughout. With hypohydration, urine specific gravity increased (Hydrated = 1.01 ± 0.009, vs. Hypohydrated = 1.025 ± 0.002, p < 0.0001), body mass decreased (−2.3 ± 0.7%, p  < 0.0001), and plasma volume decreased (−7.0 ± 3.4%, p  < 0.0001). Similar RPE and leg pain were reported during BFR exercise (RPE: 10.6 ± 0.9, vs. 11.1 ± 0.9, p = 0.054, leg pain: 3.5 ± 1.1, vs. 3.8 ± 1.2, p = 0.2). Similarly, during the rest periods, there was a minimal effect for RPE (9.1 ± 1, vs. 9.5 ± 1.3, p = 0.1) and leg pain (3.1 ± 1.5, vs. 3.6 ± 1.8, p = 0.09). Preliminary analyses show minimal sex differences in perceptual responses, with hydration status changes unrelated to BFR perception. Thus, hydration status has little impact on perceptual responses to BFR exercise.

There has been recent interest in blood flow restriction training (BFRT), a novel training method where a cuff used as a tourniquet restricts arterial inflow and venous return to a target limb during exercise. Research suggests that BFRT confers benefits in muscular strength and hypertrophy at lower loads compared with traditional training and is advantageous during rehabilitation of load-compromised individuals. Although BFRT is considered safe, inherent concerns exist regarding its effect on venous stasis and potential thrombotic events. In this case report, we illustrate a rare finding of dorsalis pedis artery (DPA) thrombosis in an elite rugby player after using BFRT postsurgery. We aim to explore the risk factor accumulation in this case and highlight the need for clinicians to be aware of relative risks and contraindications to BFRT. We also emphasise local policy and risk stratification tools to supplement decision-making processes prior to BFRT implementation.

Background Intensive care unit-acquired weakness (ICUAW) is a prevalent secondary disorder in critically ill patients, characterized by significant loss of muscle mass and strength, often leading to prolonged ICU stays, increased mortality, and reduced post-discharge quality of life. Despite guidelines recommending early mobilization, logistical challenges and inconclusive efficacy have limited its impact on ICUAW prevalence. This study aims to assess the feasibility, safety, and clinical efficacy of exclusively passive physiotherapeutic interventions, including blood flow restriction/ischemic preconditioning (BFR/IPC) and electromyostimulation (EStim), as potential alternatives for muscle preservation in ICU patients who are often sedated or unable to participate in active rehabilitation. Methods This prospective, randomized controlled trial will recruit 120 patients from the surgical ICU at the University Hospital Bonn, who meet the inclusion criteria of a > 48-h ICU stay. Patients will be randomized into four groups: Sham-Control, BFR/IPC, EStim, and combined BFR/IPC + EStim. The study’s primary endpoints include feasibility and safety metrics, such as patient compliance and stress response, alongside secondary endpoints related to clinical outcomes like ICU length of stay, ICUAW prevalence, muscle mass preservation, and rehabilitation efficacy. Measurements include non-invasive assessments of muscle mass, intramuscular microdialysis to monitor metabolic and inflammatory markers, and health-related quality of life evaluations post-discharge. Discussion Preliminary literature and a systematic review underscore the need for resource-efficient, non-invasive interventions in ICU settings. BFR/IPC and EStim present promising results, but existing data on their efficacy in ICU populations are limited. This study’s findings will provide foundational data on the viability of passive physiotherapy techniques in ICU settings, potentially improving patient outcomes and reducing healthcare costs associated with prolonged ICU stays. If successful, these results will inform a multicenter randomized trial to further evaluate these interventions. This research represents a crucial step in developing feasible rehabilitation protocols to mitigate ICUAW, addressing a critical gap in critical care management and rehabilitation. Trial registration ClinicalTrials.gov DRKS00033592. Registered on March 05, 2024.

Background and Objectives: Knee arthroplasty often leads to marked postoperative muscle weakness, with strength losses of up to 62% in the first month, contributing to functional impairment and patient dissatisfaction. Blood flow restriction (BFR) training, which combines low-load exercise with partial vascular occlusion, has shown promise in enhancing muscle strength across musculoskeletal conditions and may represent a valuable rehabilitation strategy for this vulnerable population. This review aimed to systematically evaluate the effectiveness and safety of BFR training in improving muscle strength and functional outcomes following knee arthroplasty. Materials and Methods: This systematic review was prospectively registered within PROSPERO (CRD420250652404) and conducted according to PRISMA guidelines. PubMed, Embase, and Cochrane Library were searched through February 2025 for randomized controlled trials (RCTs) investigating BFR training in knee arthroplasty patients. Study selection, data extraction, and risk of bias assessment (RoB 2 tool) were performed independently by two reviewers. Eligible trials reported muscle strength and/or functional outcomes as primary or secondary endpoints. Results: Four RCTs, including 148 patients undergoing total knee arthroplasty (mean age: 67 ± 6.5 years), met the inclusion criteria. All applied preoperative BFR training for 4–8 weeks with heterogeneous protocols. Two trials demonstrated significant improvements in muscle strength (1 RM leg press, 1 RM knee extension; large effect sizes) and functional outcomes (6 min walk test, 30 s sit-to-stand; earlier recovery), favoring BFR. The remaining studies showed no significant between-group differences, though moderate-to-large effect sizes generally favored BFR training. No adverse events were reported. Conclusions: Prehabilitation with BFR training shows considerable potential to enhance early postoperative muscle strength and functional recovery in patients undergoing knee arthroplasty, particularly when compared with usual care lacking structured preoperative intervention. The evidence to date suggests that BFR is a safe and well-tolerated strategy, offering an alternative for patients who cannot perform high-load resistance training. Its favorable safety profile, combined with the potential to accelerate functional recovery, highlights the promise of BFR for reducing rehabilitation costs and healthcare utilization. Nonetheless, larger, high-quality RCTs with standardized protocols and extended follow-up are required to confirm these preliminary findings and establish clear clinical guidelines for their implementation.

Background Postoperative rehabilitation is essential for functional recovery following total knee arthroplasty (TKA), a surgical treatment frequently used to treat knee joint problems. By briefly limiting blood supply to the limbs, blood flow restriction (BFR) training is a new and widely used rehabilitation technique that improves muscle strength and endurance. In the context of postoperative recovery after total knee arthroplasty (TKA), it has recently drawn a lot of attention. The purpose of this study is to assess how well postoperative continuous passive motion (CPM) and preoperative BFR training can enhance rehabilitation results for older patients having total knee arthroplasty. If successful, this strategy could provide a novel supplement to traditional rehabilitation methods for this population. Methods This study is a randomized controlled trial comprising 160 TKA patients, who will be randomly allocated to either the combined intervention group or the CPM group, with 80 individuals in each cohort. All patients will have standard preoperative treatment. The intervention group will also undergo preoperative BFR training twice daily for 2–3 days before surgery, in conjunction with postoperative CPM therapy. Joint range of motion (ROM), visual analog scale (VAS) score, activities of daily living (ADL) score, hospital for special surgery (HSS) knee score, postoperative swelling (change in knee joint circumference), C-reactive protein (CRP) levels, and 30-s chair stand test (30s-CST) performance are among the outcome measures. At baseline, on postoperative day 1, day 5, month 1, and month 3, data will be gathered. Discussion This study introduces an innovative rehabilitation approach that, to our knowledge, uniquely integrates preoperative blood flow restriction training with postoperative continuous passive motion in patients having total knee arthroplasty. This combined method aims to use the muscle-building benefits of BFR along with the movement-supporting benefits of CPM, which could lead to faster recovery and better strength improvement. If a short-term solution is effective, it will be more effectively implemented in hospitals. Trial registration The Ethics Committee of the Third Bethune Hospital of Jilin University accepted this study, with reference number (2024) Clinical Research Application No. 2024112815, on November 28, 2024. China Clinical Trial Registry (ChiCTR) ChiCTR2400094134. Registered on November 28, 2024.

Background Exercise during haemodialysis improves strength and physical function. However, both patients and clinicians are time poor, and current exercise recommendations add an excessive time burden making exercise a rare addition to standard care. Hypothetically, blood flow restriction exercise performed during haemodialysis can provide greater value for time spent exercising, reducing this time burden while producing similar or greater outcomes. This study will explore the efficacy of blood flow restriction exercise for enhancing strength and physical function among haemodialysis patients. Methods This is a randomised controlled trial design. A total of 75 participants will be recruited from haemodialysis clinics. Participants will be allocated to a blood flow restriction cycling group, traditional cycling group or usual care control group. Both exercising groups will complete 3 months of cycling exercise, performed intradialytically, three times per week. The blood flow restriction cycling group will complete two 10-min cycling bouts separated by a 20-min rest at a subjective effort of 15 on a 6 to 20 rating scale. This will be done with pressurised cuffs fitted proximally on the active limbs during exercise at 50% of a pre-determined limb occlusion pressure. The traditional cycling group will perform a continuous 20-min bout of exercise at a subjective effort of 12 on the same subjective effort scale. These workloads and volumes are equivalent and allow for comparison of a common blood flow restriction aerobic exercise prescription and a traditional aerobic exercise prescription. The primary outcome measures are lower limb strength, assessed by a three repetition maximum leg extension test, as well as objective measures of physical function: six-minute walk test, 30-s sit to stand, and timed up and go. Secondary outcome measures include thigh muscle cross sectional area, body composition, routine pathology, quality of life, and physical activity engagement. Discussion This study will determine the efficacy of blood flow restriction exercise among dialysis patients for improving key physiological outcomes that impact independence and quality of life, with reduced burden on patients. This may have broader implications for other clinical populations with similarly declining muscle health and physical function, and those contraindicated to higher intensities of exercise. Trial registration Australian and New Zealand Clinical Trial Register: ACTRN12616000121460.

The aims of the present study were to analyze the effect of resveratrol on liver steatosis in obese rats, to compare the effects induced by resveratrol and energy restriction and to research potential additive effects. Rats were initially fed a high-fat high-sucrose diet for six weeks and then allocated in four experimental groups fed a standard diet: a control group, a resveratrol-treated group, an energy restricted group and a group submitted to energy restriction and treated with resveratrol. We measured liver triacylglycerols, transaminases, FAS, MTP, CPT1a, CS, COX, SDH and ATP synthase activities, FATP2/FATP5, DGAT2, PPARα, SIRT1, UCP2 protein expressions, ACC and AMPK phosphorylation and PGC1α deacetylation. Resveratrol reduced triacylglycerols compared with the controls, although this reduction was lower than that induced by energy restriction. The mechanisms of action were different. Both decreased protein expression of fatty acid transporters, thus suggesting reduced fatty acid uptake from blood stream and liver triacylglycerol delivery, but only energy restriction reduced the assembly. These results show that resveratrol is useful for liver steatosis treatment within a balanced diet, although its effectiveness is lower than that of energy restriction. However, resveratrol is unable to increase the reduction in triacylglycerol content induced by energy restriction.

Background IUGR infants are thought to have impaired gut function after birth, which may result in intestinal disturbances, ranging from temporary intolerance to the enteral feeding to full-blown NEC. In literature there is no consensus regarding the impact of enteral feeding on intestinal blood flow and hence regarding the best regimen and the best rate of delivering the enteral nutrition. Methods/design This is a randomized, non-pharmacological, single-center, cross-over study including 20 VLBW infants. Inclusion criteria * Weight at birth ranging: 700–1501 grams * Gestational age up to 25 weeks and 6 days * Written informed consent from parents or guardians Exclusion criteria * Major congenital abnormality * Patients enrolled in other trials * Significant multi-organ failure prior to trial entry * Pre-existing cutaneous disease not allowing the placement of the NIRS’ probe In the first 24 hours of life, between the 48 th and 72 nd hours of life, and during Minimal Enteral Feeding, all infants’ intestinal perfusion will be evaluated with NIRS and a Doppler of the superior mesenteric artery will be executed. At the achievement of an enteral intake of 100 mL/Kg/day the patients (IUGR and NON IUGR separately) will be randomized in 2 groups: Group A (n=10) will receive a feed by bolus (in 10 minutes); then, after at least 3 hours, they will receive the same amount of formula administered in 3 hours. Group B (n=10) will receive a feed administered in 3 hours followed by a bolus administration of the same amount of formula (in 10 minutes) after at least 3 hours. On the randomization day intestinal and cerebral regional oximetry will be measured via NIRS. Intestinal and celebral oximetry will be measured before the feed and 30 minutes after the feed by bolus during the 3 hours nutrition the measurements will be performed before the feed, 30 minutes from the start of the nutrition and 30 minutes after the end of the gavage. An evaluation of blood flow velocity of the superior mesenteric artery will be performed meanwhile. The infants of the Group A will be fed with continuous nutrition until the achievement of full enteral feeding. The infants of the Group B will be fed by bolus until the achievement of full enteral feeding. Discussion Evaluations of intestinal oximetry and superior mesenteric artery blood flow after the feed may help in differentiating how the feeding regimen alters the splanchnic blood flow and oxygenation and if the changes induced by feeding are different in IUGR versus NON IUGR infants. Trial registration number NCT01341236