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NEW PUBLICATION This letter to the editor recentl

NEW PUBLICATION

This letter to the editor recently published with my colleague @msccerqueira comments on some of the issues in a recent systematic review published by Nitzsche (2021) in Clinical Rehabilitation that sought to investigate the differences in strength outcomes between open/closed chain exercises in comparison to low-load with-/without BFR and high-load strength training.

Briefly, these issues stem from vague inclusion/exclusion criteria, improperly meta-analyzed studies and conclusions that are not fully supported by the data.

Future research should have more stringent inclusion/exclusion criteria and account for exercise volume as a potential mediator for some of the benefits of low-load BFR training.

BFR IMPROVES SKELETAL MUSCLE OXIDATIVE CAPACITY B

BFR IMPROVES SKELETAL MUSCLE OXIDATIVE CAPACITY

BFR - NOT IF - WHEN

Even as early as 1990, evidence of the benefits of local ischemic exercise (applied with a pressure chamber to reduce arterial inflow) has been known. This graph, from Kaijser et al. (1990) is the result of a 4x per week, 4 week training program where 8 males exercised one leg in ischemia to exhaustion at the maximal tolerable ischemic pain (yeah- that's painful indeed!!!) and the other leg did the same workload to serve as the control. While this is an exaggerated example of the benefits of ischemic exercise, the results showed a ~25% increase in exercise duration to failure in the ischemic leg during local ischemia and a ~19% increase in duration when exercising in normal atmospheric conditions. While both groups improved in their time to failure, the ischemic exercise leg improved significantly more in ischemic exercise and was trending towards a higher improvement in normal exercise conditions. Further, citrate synthase activity was higher post-training in the ischemic leg indicating improved mitochondrial function. Pair that with a reduction in lactate dehydrogenase activity in the ischemic leg post-training and the authors conclude greater local muscle oxidative capacity. Interesting to note there was a degree of specificity in the adaptations...

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SOURCE: Kaijser, L., Sundberg, C. J., Eiken, O., Nygren, A., Esbjornsson, M., Sylven, C., & Jansson, E. (1990). Muscle oxidative capacity and work performance after training under local leg ischemia. Journal of Applied Physiology, 69(2), 785–787. doi:10.1152/jappl.1990.69.2.785

LOP CHANGES AS A FUNCTION OF CUFF WIDTH BFR - NOT

LOP CHANGES AS A FUNCTION OF CUFF WIDTH

BFR - NOT IF - BUT WHEN!

Limb occlusion pressure, or LOP is the minimum pressure needed to completely restrict both venous and arterial flow to the limb. Exercise is commonly performed at a percentage of LOP (40-80%). LOP has been shown to vary significantly with the cuff width. Wider cuffs tend to occlude at lower LOPs than narrow cuffs. Further, there is a concern about narrow cuffs increasing the risk of nerve damage due to the higher applied pressures and greater pressure gradients (due to less width to disperse the pressures).
The thought is that use of excessively narrow cuffs may be dangerous to the nervous tissue. Paradoxically, despite the lower applied pressures, wider cuffs (14 cm) have been shown to induce a greater disruption in the nerve conduction velocity of the median nerve (Mittal, 2008) than narrow cuffs (7 cm) likely a result of the greater amount of nervous tissue compressed. Large decreases in nerve conduction velocities show reduced functioning of the nerve, so this is something to consider when exercising with BFR. However, a near fatal limitation in the Mittal study was that both cuffs were not inflated to a personalized pressure, so this difference in median nerve function is still TBD.

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SOURCE: Mittal et al.
Effect of different cuff widths on the motor nerve conduction of the median nerve: an experimental study

Our (@msccerqueira) Letter to the Editor on a rece

Our (@msccerqueira) Letter to the Editor on a recent BFR training study (Bordessa et al. 2021) that aimed to assess comparative effectiveness has been published online ahead of print. This letter was necessary because as BFR training continues to grow, it's important that the researchers themselves design studies that actually help make clinical decision-making easier when deciding between different manufactured devices.
In short - researchers need to be familiar with cuff designs before attempting to make comparisons between different devices. Further, use of muscle activation is a poor indicator of acute stress when fatiguing exercise is used. Better designed studies can help clinicians/coaches/fitness professionals understand how the BFR stress influences acute- and long-term outcomes. However, this study just wasn't a design that helps us understand all too much about "comparative effectiveness."

Thoughts on the paper? Our response? Post below!!

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