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This study aimed to elucidate whether muscle blood flow restriction during maximal exercise is associated with alterations in hemodynamics, cerebral oxygenation, cerebral activation, and deterioration of exercise performance in male participants. Thirteen healthy males, cyclists (age 33 ± 2 yrs., body mass: 78.6 ± 2.5 kg, and body mass index: 25.57 ± 0.91 kg·m−1), performed a maximal incremental exercise test on a bicycle ergometer in two experimental conditions: (a) with muscle blood flow restriction through the application of thigh cuffs inflated at 120 mmHg (with cuffs, WC) and (b) without restriction (no cuffs, NC). Exercise performance significantly deteriorated with muscle blood flow restriction, as evidenced by the reductions in V˙O2max (−17 ± 2%, p < 0.001), peak power output (−28 ± 2%, p < 0.001), and time to exhaustion (−28 ± 2%, p < 0.001). Muscle oxygenated hemoglobin (Δ[O2Hb]) during exercise declined more in the NC condition (p < 0.01); however, at exhaustion, the magnitude of muscle oxygenation and muscle deoxygenation were similar between conditions (p > 0.05). At maximal effort, lower cerebral deoxygenated hemoglobin (Δ[HHb]) and cerebral total hemoglobin (Δ[THb]) were observed in WC (p < 0.001), accompanied by a lower cardiac output, heart rate, and stroke volume vs. the NC condition (p < 0.01), whereas systolic blood pressure, rating of perceived exertion, and cerebral activation (as assessed by electroencephalography (EEG) activity) were similar (p > 0.05) between conditions at task failure, despite marked differences in exercise duration, maximal aerobic power output, and V˙O2max. In conclusion, in trained cyclists, muscle blood flow restriction during an incremental cycling exercise test significantly limited exercise performance. Exercise intolerance with muscle blood flow restriction was mainly associated with attenuated cardiac responses, despite cerebral activation reaching similar maximal levels as without muscle blood flow restriction.

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.

The purpose of this study was to investigate the effects of combining blood flow restriction training (BFRT) with electrical muscle stimulation (EMS) on muscle functions and sports performance in football players with knee osteoarthritis (KOA). This parallel randomized controlled trial was conducted on 64 football players diagnosed with KOA at Chengdu Sport University. Participants were enrolled based on predefined eligibility criteria and randomly allocated to four groups: the control group (CTR, n  = 16), BFRT-alone group (BFRT, n  = 16), EMS-alone group (EMS, n  = 16), and BFRT combined with EMS group (CMB, n  = 16). Data were gathered via the 10-meter sprint, 20-meter sprint, countermovement jump (CMJ), and Illinois agility test (IAT) to assess sports performance. Additionally, peak torque (PT) was used to measure muscle strength, the root mean square (RMS) was used to assess muscle activation, and the cross-sectional area (CSA) was used to evaluate muscle volume. The data were statistically analyzed via SPSS software, and a p -value < 0.05 was considered significant. Following the 8-week intervention, the CMB group showed a more pronounced change in the 10-m sprint compared to the CTR group ( p  < 0.001) and exhibited significant differences in the 20-m sprint (CTR: p  < 0.001, BFRT: p  = 0.015, EMS: p  < 0.001), CMJ (CTR: p  < 0.001, BFRT: p  = 0.019, EMS: p  < 0.001), and IAT (CTR: p  < 0.001, BFRT: p  = 0.009, EMS: p  = 0.018), outperforming the other three groups. To PT, the CMB groups demonstrated significant superiority over the other three groups (CTR: p  < 0.001, BFRT: p  < 0.001, EMS: p  < 0.001), while the BFRT group exhibited a notable difference in PT than the EMS group ( p  = 0.032). Concerning RMS, the EMS and CMB groups showed significant differences from the CTR (EMS: p  < 0.001, CMB: p  < 0.001) and BFRT (EMS: p  = 0.019, CMB: p  < 0.001) groups, whereas the change in the BFRT group was more significant than that in the CTR group ( p  = 0.007). For CSA, the BFRT and CMB groups presented notable differences from the CTR (BFRT: p  = 0.008, CMB: p  = 0.002)and EMS (BFRT: p  = 0.014, CMB: p  = 0.004) groups. In summary, the results suggest that BFRT combined with EMS can increase muscle strength in male football players with KOA through improving muscle volume and neuromuscular recruitment under low-intensity resistance training, thereby increasing explosive power and agility.

Background and Objectives: This study compared the effects of blood flow restriction resistance exercise (BFR-RE) and high-load resistance exercise (HL-RE) in voluntary exhaustion on quadriceps muscle adaptations in untrained young males. Materials and Methods: This study used a randomized controlled design that included 30 untrained young males (age = 21.42 ± 2.51). The BFR-RE group performed leg extension exercises with 60% occlusion pressure and 30% of one maximum repetition in volitional exhaustion. The same exercise was conducted at 70% 1RM in the HL-RE group. Fourteen variables were used to evaluate the intervention efficacy, including muscle thickness, stiffness, strength, cross-sectional area (CSA), and subcutaneous fat thickness. Analyses were reported using frequentist and Bayesian approaches. The Bayes factor (BF10 and BFincl) was interpreted based on negative and positive values. Results: The results revealed that the main effect of time was statistically significant for muscle strength, thickness, CSA, and stiffness (p < 0.05, BFincl > 1) and, in intragroup comparisons, both groups showed improvements in these parameters (p < 0.05, BF10 > 1). A statistically significant decrease in subcutaneous fat thickness was observed in the BFR-RE group (p < 0.05, BF10 > 1), while this change was not observed in the HL-RE group (p > 0.05, BF10 < 1). Similarly, a statistically significant increase in right rectus femoris muscle stiffness was detected in the BFR-RE group (p < 0.05, BF10 > 1) but not in the HL-RE group (p > 0.05, BF10 < 1). Furthermore, time’s main effect was statistically insignificant for thigh circumference (p > 0.05, BFincl < 1). The group × time interaction was statistically significant only for peak power leg flexion left (p < 0.05, BFincl > 1), and a statistically significant difference in favor of the BFR-RE group was observed in the intergroup comparisons (p < 0.05, BF10 > 1). Conclusions: In conclusion, BF-RE exercise with voluntary exhaustion may be as effective as HL-RE for hypertrophic adaptations in untrained young males.

Purpose Resistance exercise can attenuate muscular impairments associated with multiple sclerosis (MS), and blood flow restriction (BFR) may provide a viable alternative to prescribing heavy training loads. The purpose of this investigation was to examine the progression of upper and lower body low-load (30% of one-repetition maximum [1RM]) resistance training (RT) with BFR applied intermittently during the exercise intervals (RT + BFR) versus volume-matched heavy-load (65% of 1RM) RT. Methods Men and women with MS ( n  = 16) were randomly assigned to low-load RT + BFR (applied intermittently) or heavy-load RT and completed 12 weeks (2 × /week) of RT that consisted of bilateral chest press, seated row, shoulder press, leg press, leg extension, and leg curl exercises. Exercise load, tonnage, and rating of perceived exertion were assessed at baseline and every 6 weeks. Results Training load increased to a greater extent and sometimes earlier for RT + BFR (57.7–106.3%) than heavy-load RT (42.3–54.3%) during chest press, seated row, and leg curl exercises, while there were similar increases (63.5–101.1%) for shoulder press, leg extension, and leg press exercises. Exercise tonnage was greater across all exercises for RT + BFR than heavy-load RT, although tonnage only increased during the chest press (70.7–80.0%) and leg extension (89.1%) exercises. Perceptions of exertion (4.8–7.2 au) and compliance (97.9–99.0%) were similar for both interventions. Conclusion The training-induced increases in load, high compliance, and moderate levels of exertion suggested that RT + BFR and heavy-load RT are viable interventions among people with MS. RT + BFR may be a preferred modality if heavy loads are not well tolerated and/or to promote early-phase training responses.

Low-load resistance training with blood flow restriction (LRT-BFR) has shown potential to improve muscle strength and mass in different populations; however, there remains limited evidence in sarcopenic people diagnosed with sarcopenia criteria. This study systematically compared the effectiveness of LRT-BFR and conventional high-intensity resistance training (CRT) on clinical muscle outcomes (muscle mass, strength and performance), cardiovascular disease (CVD) risk factors and sarcopenia-related biomarkers of older people with sarcopenia. Twenty-one older individuals (aged 65 years and older) diagnosed with sarcopenia were randomly assigned to the LRT-BFR (20%–30% one-repetition maximum (1RM), n = 10) or CRT (60%–70% 1RM, n = 11) group. Both groups underwent a supervised exercise program three times a week for 12 weeks. The primary outcome was knee extensor strength (KES), and the secondary outcomes included body composition (body mass, body mass index and body fat percentage), muscle mass [appendicular skeletal muscle mass index (ASMI)], handgrip strength, physical performance [short physical performance battery (SPPB) and 6-m walk], CVD risk factors [hemodynamic parameters (systolic and diastolic blood pressure and heart rate (SBP, DBP and HR)) and lipid parameters (total cholesterol, triglyceride (TG), high-density lipoprotein (HDL) and low-density lipoprotein)], sarcopenia-related blood biomarkers [inflammatory biomarkers, hormones (growth hormone (GH) and insulin-like growth factor 1) and growth factors (myostatin and follistatin)] and quality of life [Short Form 36 Health Survey (SF-36)]. Both interventions remarkably improved the body composition, KES, 6-m walk, SBP, HDL, TG, GH, FST and SF-36 scores. CRT significantly improved the ASMI (p < 0.05) and SPPB (p < 0.05). A significant improvement in HR was observed only after LRT-BFR. No significant between-group differences were found before and after the interventions. This study suggested that LRT-BFR and CRT are beneficial to the clinical muscle outcomes, CVD risk factors and certain sarcopenia-related biomarkers of older people with sarcopenia. By comparison, CRT seems more effective in improving muscle mass, while LRT-BFR may be more beneficial for improving cardiovascular health in this population. Therefore, LRT-BFR is a potential alternative to CRT for aging sarcopenia.

Objective: To examine how limitations in blood circulation impact the training of stroke individuals. Methods: Between March 2022 and March 2023, a total of 34 individuals receiving treatment at the Fourth Affiliated Hospital of the School of Medicine, Zhejiang University, specifically within the Department of Rehabilitation Medicine, were chosen as participants. They were then assigned to experimental groups using a random number approach, with 17 individuals in each group, while also including a control group. The test group received BFR combined with cycle ergometers, while the control group performed a cycle ergometers regularly. Ultrasonography was employed to assess the size and thickness (RFT) of the rectus femoris (RFSTA) in patients both prior to and following training, as well as to evaluate the angle of the gastrocnemius pinna. Additionally, each patient completed a 30‐s sit‐to‐stand test, received results from a stretch test, and underwent the Fugl‐Meyer assessment for the lower extremities. Results: The muscles of RFT, RFTSA, and gastrocnemius pinna angle did not change significantly before and after in the control group. However, these values increased markedly in the experimental group. In addition, the FMA value recorded in the test group notably surpassed that of the control group. After all, walking speed, frequency, length and overall mobility will increase after training, but you will find it more important. Conclusion: BFR can promote rehabilitation functional, relieve stress, ensure safety, improve training effects and have high value clinical uses. BFR can promote the functional Rehabilitation of stroke patients and strengthen their motor ability without high ‐intensity and ensure safety, which has high clinical application value.

In the recent past, practical blood flow restriction (pBFR) using non-pneumatic, usually elastic cuffs has been established as a cost-effective alternative to traditional blood flow restriction (BFR) using pneumatic cuffs, especially for training in large groups. This study investigated whether low-load resistance exercise with perceptually primed pBFR using an elastic knee wrap is suitable to induce similar motor performance fatigue as well as physiological and perceptual responses compared to traditional BFR using a pneumatic nylon cuff in males and females. In a randomized, counterbalanced cross-over study, 30 healthy subjects performed 4 sets (30-15-15-15 repetitions) of unilateral knee extensions at 20% of their one-repetition-maximum. In the pBFR condition, each individual was perceptually primed to a BFR pressure corresponding to 60% of their arterial occlusion pressure. Before and after exercise, maximal voluntary torque, maximal muscle activity, and cuff pressure-induced discomfort were assessed. Moreover, physiological (i.e., muscle activity, muscle oxygenation) and perceptual responses (i.e., effort and exercise-induced leg muscle pain) were recorded during exercise. Moderate correlations with no differences between pBFR and BFR were found regarding the decline in maximal voluntary torque and maximal muscle activity. Furthermore, no to very strong correlations between conditions, with no differences, were observed for muscle activity, muscle oxygenation, and perceptual responses during exercise sets. However, cuff pressure-induced discomfort was lower in the pBFR compared to the BFR condition. These results indicate that low-load resistance exercise combined with perceptually primed pBFR is a convenient and less discomfort inducing alternative to traditional BFR. This is especially relevant for BFR training with people who have a low cuff-induced discomfort tolerance.

Background Blood flow restriction (BFR) resistance training has demonstrated efficacy in promoting strength gains beneficial for rehabilitation. Yet, the distinct functional advantages of BFR strength training using high-load and low-load protocols remain unclear. This study explored the behavioral and neurophysiological mechanisms that explain the differing effects after volume-matched high-load and low-load BFR training. Methods Twenty-eight healthy participants were randomly assigned to the high-load blood flow restriction (BFR-HL, n  = 14) and low-load blood flow restriction (BFR-LL, n  = 14) groups. They underwent 3 weeks of BFR training for isometric wrist extension at intensities of 25% or 75% of maximal voluntary contraction (MVC) with matched training volume. Pre- and post-tests included MVC and trapezoidal force-tracking tests (0–75%–0% MVC) with multi-channel surface electromyography (EMG) from the extensor digitorum. Results The BFR-HL group exhibited a greater strength gain than that of the BFR-LL group after training (BFR_HL: 26.96 ± 16.33% vs. BFR_LL: 11.16 ± 15.34%)( p  = 0.020). However, only the BFR-LL group showed improvement in force steadiness for tracking performance in the post-test ( p  = 0.004), indicated by a smaller normalized change in force fluctuations compared to the BFR-HL group ( p  = 0.048). After training, the BFR-HL group activated motor units (MUs) with higher recruitment thresholds ( p  < 0.001) and longer inter-spike intervals ( p  = 0.002), contrary to the BFR-LL group, who activated MUs with lower recruitment thresholds ( p  < 0.001) and shorter inter-spike intervals ( p  < 0.001) during force-tracking. The discharge variability ( p  < 0.003) and common drive index ( p  < 0.002) of MUs were consistently reduced with training for the two groups. Conclusions BFR-HL training led to greater strength gains, while BFR-LL training better improved force precision control due to activation of MUs with lower recruitment thresholds and higher discharge rates.

To compare the effects of low-load (LL) blood flow restriction (BFR) and high-load (HL) training on cortical activation and the specific contributions of individual brain regions to functional recovery in stroke patients. Sixty-six patients with ischemic stroke were divided into BFR (30% one-repetition maximum [1RM]), matched LL, or HL (80% 1RM) groups. Patients underwent a four-week supervised cycling program, and oxyhemoglobin (HbO) concentrations were assessed during the first session and after the program via functional near-infrared spectroscopy (fNIRS). Muscle performance was characterized by the rectus femoris muscle cross-sectional area (CSA), knee extensor peak torque (PT), and Fugl-Meyer lower extremity (FMLE) scores. Compared with the LL group, the BFR and HL groups presented significant brain activation (increased HbO concentration) during the first session (P < 0.05). Following the 4-week intervention, the BFR and HL groups presented greater changes in the HbO concentration (ΔHbO), PT and FMLE scores than did the LL group (P < 0.05). The ΔHbO values in the primary motor cortex (M1), premotor cortex and supplementary motor area (PMC-SMA) of the affected hemisphere (AH) were considerably greater than those in the unaffected hemisphere (P < 0.05), whereas there was no difference in the dorsolateral prefrontal cortex (DLPFC). Changes in PT (mean r = 0.51 [range = 0.46-0.55]; P < 0.05) and FMLE scores (mean r = 0.54 [range = 0.48-0.62]; P < 0.05) were positively correlated with the AH M1 and PMC-SMA ΔHbO across groups. By actively manipulating the M1 and PMC-SMA, LL-BFR and HL training yield comparable short-term improvements in central and peripheral performance after stroke. (Registry: Chinese Clinical Trial Registry; ChiCTR2400087378).