The focal point of previous literature was establishing the efficacy of blood flow restriction training with respect to muscular strength, muscular hypertrophy, and muscular endurance. After mounting evidence supporting the efficacy of low-intensity blood flow restriction training, research has shifted to the overall safety of this training modality. The aim of this review was to summarize the research on the overall safety of blood flow restriction training, focusing on the cardiovascular system (central and peripheral), muscle damage, oxidative stress, and nerve conduction velocity responses compared with those observed with regular exercise. Although still sparse, the blood flow restriction training research thus far is promising with respect to safety outcomes. Individuals respond similarly to blood flow restriction training and to regular exercise; however, longer term studies are required to better understand the chronic effects of low-intensity blood flow restriction training and possible safety issues.

Potential safety issues with blood flow restriction training.

Recent studies have demonstrated that even a low-intensity resistance exercise can effectively induce muscle hypertrophy and strength increase when combined with moderate blood flow restriction (BFR) into the exercising muscle. Although serious side effects of low-intensity resistance exercise with BFR have not been reported, a concern of thrombosis has been suggested, because this type of exercise is performed with restricted venous blood flow and pooling of blood in extremities. Thus, the purpose of this study was to investigate the effects of low-intensity resistance exercise with BFR on coagulation system in healthy subjects. Ten healthy men (25.1 +/- 2.8 year) performed four sets of leg press exercises with and without BFR (150-160 mmHg) at an intensity of 30% of one-repetition maximum (1RM). In each exercise session, one set with 30 repetitions was followed by three sets with 15 repetitions. Blood samples were taken before, and 10 min, 1, 4 and 24 h after the exercise. Prothrombin fragment 1 + 2 (PTF) and thrombin-antithrombin III complex (TAT) were measured as markers of thrombin generation, whereas D-dimer and fibrin degradation product (FDP) were measured as markers of intravascular clot formation. Changes in plasma volume (PV) were calculated from haemoglobin and hematocrit values. PV reduction was significantly greater after the exercise with BFR than without (P<0.05). However, neither markers of thrombin generation nor intravascular clot formation increased after the exercises. These results suggest that low-intensity resistance exercise with BFR does not activate coagulation system in healthy subjects.

Effects of low-intensity resistance exercise with blood flow restriction on coagulation system in healthy subjects

Low-intensity resistance exercise can effectively induce muscle hypertrophy and increases in strength when combined with moderate blood flow restriction (BFR). As this type of exercise does not require lifting heavy weights, it might be a feasible method of cardiac rehabilitation, in which resistance exercise has been recommended to be included. Although previous studies with healthy subjects showed relative safety of BFR exercise, we cannot exclude the possibility of unfavourable effects in patients with cardiovascular disease. We therefore aimed to investigate haemostatic and inflammatory responses to BFR exercise in patients with ischaemic heart disease (IHD). Nine stable patients with IHD who were not taking anticoagulant drugs performed four sets of knee extension exercise at an intensity of 20% one-repetition maximum (1RM) either with or without BFR. Blood samples were taken before, immediately after and 1 h after the exercise session and analysed for noradrenaline, D-dimer, fibrinogen/fibrin degradation products (FDP) and high-sensitive C-reactive protein (hsCRP). Plasma noradrenaline concentration increased after the exercise, and the increase was significantly larger after the exercise with BFR than without BFR. On the other hand, increases in concentrations of plasma D-dimer and serum hsCRP were independent of the condition. However, increases in D-dimer and hsCRP were no longer observed after plasma volume correction, suggesting that hemoconcentration was responsible for these increases. Plasma FDP concentration did not change after the exercise. These results suggest that applying BFR during low-intensity resistance exercise does not affect exercise-induced haemostatic and inflammatory responses in stable IHD patients.

Haemostatic and inflammatory responses to blood flow‐restricted exercise in patients with ischaemic heart disease: a pilot study

It is established that regular aerobic training improves vascular function, for example, endothelium-dependent vasodilatation and arterial stiffness or compliance and thereby constitutes a preventative measure against cardiovascular disease. In contrast, high-intensity resistance training impairs vascular function, while the influence of moderate-intensity resistance training on vascular function is still controversial. However, aerobic training is insufficient to inhibit loss in muscular strength with advancing age; thus, resistance training is recommended to prevent sarcopenia. Recently, several lines of study have provided compelling data showing that exercise and training with blood flow restriction (BFR) leads to muscle hypertrophy and strength increase. As such, BFR training might be a novel means of overcoming the contradiction between aerobic and high-intensity resistance training. Although it is not enough evidence to obtain consensus about impact of BFR training on vascular function, available evidences suggested that BFR training did not change coagulation factors and arterial compliance though with inconsistence results in endothelial function. This paper is a review of the literature on the impact of BFR exercise and training on vascular function, such as endothelial function, arterial compliance, or other potential factors in comparison with those of aerobic and resistance training.

/pdf/blood-flow-restricted-exercise-and-vascular-function-vhkeeup83z.pdf

Blood flow restricted exercise and vascular function.

Synopsis Restoration of skeletal muscle mass and strength is critical to successful outcomes following orthopaedic surgery. Blood flow restriction (BFR) resistance exercise has emerged as a promising means of augmenting traditional low-intensity physical rehabilitation exercise and has yielded successful outcomes in a wide range of applications. Though BFR is well tolerated and safe for most individuals, patients who have undergone orthopaedic surgery may be an exception, due to their heightened risk for venous thromboembolism (VTE). While the pathogenesis of VTE is multifactorial and specific to the individual, it is commonly described as a combination of blood stasis, endothelial injury, and alterations in the constituents of the blood leading to hypercoagulability. The collective literature suggests that, given the pathogenic mechanisms of VTE, limited use of a wide, partially occluding cuff during resistance exercise should be low risk, and the likelihood that BFR would directly cause a VTE event is remote. Alternatively, it is plausible that BFR may enhance blood flow and promote fibrinolysis. Of greater concern is the individual with pre-existing asymptomatic VTE, which could be dislodged during BFR. However, it is unknown whether the direct risk associated with BFR is greater than the risk accompanying traditional exercise alone. Presently, there are no universally agreed-upon standards indicating which postsurgical orthopaedic patients may perform BFR safely. While excluding all these patients from BFR may be overly cautious, clinicians need to thoroughly screen for VTE signs and symptoms, be cognizant of each patient's risk factors, and use proper equipment and prescription methods prior to initiating BFR. J Orthop Sports Phys Ther 2019;49(1):17-27. Epub 12 Sep 2018. doi:10.2519/jospt.2019.8375.

Blood Flow Restriction Resistance Exercise as a Rehabilitation Modality Following Orthopaedic Surgery: A Review of Venous Thromboembolism Risk.

The KAATSU training is a novel method for muscle training performed under the reduction of muscle blood flow by a specially-designed belt (KAATSU belt). Under the conditions of restricted muscle blood flow, even short-term, low-intensity exercise such as walk training can induce muscle strength, and increased muscle mass (Takarada et al. 2000a; b; c; Takarada et al., 2002a,b; Abe et al. 2006). In addition, KAATSU femoral blood flow restriction induces lower-body venous pooling and reduces venous return (Takano et al., 2006), resulting in stimulating cardiovascular effects of orthostasis in 1G like lower body negative pressure (LBNP) (Iida et al., 2007). Since the most effective countermeasure regimen to prevent cardiovascular deconditioning in space flight would be a gravitation-like stress combined with exercises, the use of KAATSU in combination with low-intensity resistance exercise would provide a significant countermeasure like LBNP for space flight countering both cardiovascular and musculoskeletal decline. Thus, the KAATSU training may be a promising training in astronauts to prevent cardiovascular deconditioning and muscle atrophy in space flights (Iida et al., 2006) as well as athletes and healthy persons as described previously (Nakajima et al., 2006). Haemostasis is achieved through a delicate equilibrium between the coagulation and fibrinolytic cascades (Wu and Thiagarajan, 1996). Exercises have been shown to affect activation of both the coagulation and fibrinolytic cascades (Davis et al., 1976; Andrew et al., 1986; Boman et al., 1994; Weiss et al., 1998; El-Sayed et al., 2000; Ribeiro et al., 2006). Regular exercise preferentially activates fibrinolysis, which is generally associated with favorable alterations in risk from cardiovascular morbidity, while strenuous exercise may increase blood coagulation, and promote thrombus formation (Hilberg et al., 2002), resulting in exertion-related ischemic events (Giri et al., 1999). Thus, it is likely that effects of exercise on the haemostatis are Effects of KAATSU training on haemostasis in healthy subjects

/pdf/effects-of-kaatsu-training-on-haemostasis-in-healthy-39kcy7zsuy.pdf

Effects of KAATSU training on haemostasis in healthy subjects

The application of a gravity-specific stress (e.g. LBNP), in combination with exercise, prevents cardiovascular deconditioning in space flight. KAATSU training is a method to induce blood pooling in capacitance vessels by restricting venous return (as with LBNP) and which when combined with low-intensity resistance (RE) exercise produces remarkable muscle mass and muscle strength gains. The purpose of this study was to investigate the hemodynamic and neurohumonal responses induced by KAATSU in combination with leg RE (30 % 1 RM), during simulated weightlessness (6°head-down tilt for 24 h, n=7). Following 24 h bed rest 6° head-down tilt, body mass was decreased from 75.3 ± 3.9 to 73.3 ± 3.8 Kg (P<0.01). Blood volume (BV) and plasma volume (PV) were reduced by −4.4 ± 1.4% and −7.9 ± 2.5%, respectively. During RE, BV and PV were significantly decreased; the changes with KAATSU induced a lower-body venous pooling, resulting in a sustained decrease in stroke volume (SV; from 77.0 ± 4.4 ml to 55.9 ± 5.1 ml; P<0.01) that was comparable to resting SV while standing. Consequently, RE heart rate (HR) was greater with KAATSU. The serum concentrations of plasma renin activity (PRA), vasopressin (ADH), noradrenaline (NOR), and lactate were also significantly elevated during RE with KAATSU as compared to control RE. These hemodynamic and neurohumoral responses following head-down tilt and during RE closely approximate the gravity-specific stress observed with LBNP. Thus, when used in combination with RE, KAATSU may be a useful countermeasure in microgravity.

https://www.jstage.jst.go.jp/article/ijktr/4/1/4_1_9/_pdf

Resistance exercise combined with KAATSU during simulated weightlessness

A 71-year-old paraplegic woman presented with a complaint of insomnia caused by severe flexor spasms of the lower limbs at night, aggravated for a few hours by taking hot baths. Lidocaine injection of the tarsal tunnel diminished the flexor-withdrawal reflex, which was easily elicited by light pinching or sustained compression over the tarsal tunnel, and strongly suggested the existence of the tarsal tunnel syndrome. Surgical decompression of the tarsal tunnel significantly reduced the flexor spasms both in terms of frequency and of duration.

/pdf/latent-tarsal-tunnel-syndrome-with-the-provocation-of-flexor-3j1c4gjplk.pdf

Latent tarsal tunnel syndrome with the provocation of flexor spasms in a paraplegic person. Case report

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Effects of KAATSU training on haemostasis in healthy subjects

Resistance exercise combined with KAATSU during simulated weightlessness

Latent tarsal tunnel syndrome with the provocation of flexor spasms in a paraplegic person. Case report