Blood flow restriction resistance training as an alternative to resistance training alone to improve strength in elderly: a systematic review with meta-analysis
DOI:
https://doi.org/10.18316/sdh.v12i1.10821Keywords:
Kaatsu, Vascular occlusion, Strength training, Muscle strength, Older, Aging.Abstract
The purpose of this research was to perform a systematic review with meta-analysis to compare the effects of resistance training with blood flow restriction (BFR) to the effects of non-training (CON) and traditional resistance training (RT) on strength in elderly people. This was a systematic review with meta-analysis of randomized clinical trials (RCTs), published in English, from inception to 2022, conducted using MEDLINE (PubMed), EMBASE, Web of Science and Cochrane Library. The methodological quality was assessed using GRADE protocol. The risk of bias was assessed using RoB2 software. Standardized mean differences (SMD), mean difference, were pooled using a random-effects model. A p < 0.05 was considered statistically significant. Eight RCT’s were included. We found no significant differences in the effects between BFR and RT (SMD = -0.18 [-0.56 to 0.19]; p = 0.34; I2 = 12%). Also, evidence from our research shows that the effect of BFR is better than non-training (CON) for strengthening in older adults (SMD = 0.63 [0.24 to 1.01]; p = 0.001; I2 = 11%). Our primary findings show that training with BFR may be an alternative methodology of training for the elderly and this training strategy may be interesting for health professionals working with elderly people with low tolerance to high intensity RT.
References
Tieland M, Trouwborst I, Clark BC. Skeletal muscle performance and ageing. J Cachexia Sarcopenia Muscle. 2018;9(1):3–19.
Campolina AG, Adami F, Santos JLF, Lebrão ML. A transição de saúde e as mudanças na expectativa de vida saudável da população idosa: Possíveis impactos da prevenção de oenças crônicas. Cad Saude Publica. 2013;29(6):1217–29.
Lopez P, Pinto RS, Radaelli R, Rech A, Grazioli R, Izquierdo M, et al. Benefits of resistance training in physically frail elderly: a systematic review. Aging Clin Exp Res [Internet]. 2018;30(8):889–99. Available from: http://dx.doi.org/10.1007/s40520-017-0863-z
American College Of Sports Medicine. Diretrizes do ACSM Para Os Testes de Esforço e Sua Prescrição. 2019.
Manuscript A. NIH Public Access. 2011;58(9):1721–6.
Hospital R. Handgrip strength as a predictor of functional , psychological and social health . A prospective population-based study among the oldest old. 2008;331–7.
Gale CR, Martyn CN, Cooper C. Grip strength , body composition , and mortality. 2007;(October 2006):228–35.
Fragala MS, Cadore EL, Dorgo S, Izquierdo M, Kraemer WJ, Peterson MD, et al. Resistance Training for Older Adults: Position Statement From the National Strength and Conditioning Association. J strength Cond Res. 2019;33(8):2019–52.
Lavallee ME, Balam T. An overview of strength training injuries: Acute and chronic. Curr Sports Med Rep. 2010;9(5):307–13.
Lees FD, Clark PG, Nigg CR, Newman P. Barriers to exercise behavior among older adults: A focus-group study. J Aging Phys Act. 2005;13(1):23–33.
Grønfeldt BM, Lindberg Nielsen J, Mieritz RM, Lund H, Aagaard P. Effect of blood-flow restricted vs heavy-load strength training on muscle strength: Systematic review and meta-analysis. Scand J Med Sci Sport. 2020;30(5):837–48.
Grutter Lopes K, Alexandre Bottino D, Farinatti P, Coelho De Souza M das G, Alves Maranhão P, De Araujo CMS, et al. Strength training with blood flow restriction – a novel therapeutic approach for older adults with sarcopenia? A case report. Clin Interv Aging. 2019;14:1461–9.
Patterson SD, Hughes L, Warmington S, Burr J, Scott BR, Owens J, et al. Blood flow restriction exercise position stand: Considerations of methodology, application, and safety. Front Physiol. 2019;10(MAY):1–15.
Hughes L, Paton B, Rosenblatt B, Gissane C, Patterson SD. Blood flow restriction training in clinical musculoskeletal rehabilitation: A systematic review and meta-analysis. Br J Sports Med. 2017;51(13):1003–11.
Ladlow P, Coppack RJ, Dharm-Datta S, Conway D, Sellon E, Patterson SD, et al. Low-Load Resistance Training With Blood Flow Restriction Improves Clinical Outcomes in Musculoskeletal Rehabilitation: A Single-Blind Randomized Controlled Trial. Front Physiol. 2018;9.
Centner C, Wiegel P, Gollhofer A, König D. Effects of Blood Flow Restriction Training on Muscular Strength and Hypertrophy in Older Individuals: A Systematic Review and Meta-Analysis. Sports Med. 2019;49(1):95–108.
Page MJ, Moher D, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. PRISMA 2020 explanation and elaboration: Updated guidance and exemplars for reporting systematic reviews. BMJ. 2021;372.
Mattos CT, Ruellas AC de O. Systematic Review and Meta-Analysis: What are the Implications in the Clinical Practice? Dental Press J. Orthod. 2015;20:17–9. pmid:25741820.
Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, et al. (editors). Cochrane Handbook for Systematic Reviews of Interventions version 6.2 (updated February 2021). Cochrane, 2021. Avail- able from www.training.cochrane.org/handbook.
Wan X, Wang W, Liu J, Tong T. Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol. 2014; 14, 135. https://doi.org/ 10.1186/1471-2288-14-135 PMID: 25524443
dos Santos LP, Santo RCdE, Ramis TR, Portes JKS, Chakr RMdS, Xavier RM (2021) The effects of resistance training with blood flow restriction on muscle strength, muscle hypertrophy and functionality in patients with osteoarthritis and rheumatoid arthritis: A systematic review with meta-analysis. PLoS ONE 16(11): e0259574. https://doi.org/10.1371/journal.pone.0259574
Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al. RoB 2: A Revised Tool for Assessing Risk of Bias in Randomised Trials. BMJ. 2019;366:1–8. pmid:31462531
Borenstein M, Hedges L V, Higgins JPT, Rothstein HR. Introduction to meta-analysis. Chichester: John Wiley & Sons, Ltd. 2009.
Higgins JPT, Thompson SG, Deeks JJ, Altman DG. Measuring Inconsistency in Meta-Analyses. BMJ. 2003; 327:557–60. https://doi.org/10.1136/bmj.327.7414.557 PMID: 12958120
Bigdeli S, Dehghaniyan MH, Amani-Shalamzari S, Rajabi H, Gahreman DE. Functional training with blood occlusion influences muscle quality indices in older adults. Arch Gerontol Geriatr [Internet]. 2020;90(March):104110. Available from: https://doi.org/10.1016/j.archger.2020.104110
Cook SB, LaRoche DP, Villa MR, Barile H, Manini TM. Blood Flow Restricted Resistance Training in Older Adults at Risk of Mobility Limitations. Exp Gerontol. 2017 Dec;99:138–45.
Letieri RV, Teixeira AM, Furtado GE, Lamboglia CG, Rees JL, Gomes BB. Effect of 16 weeks of resistance exercise and detraining comparing two methods of blood flow restriction in muscle strength of healthy older women: A randomized controlled trial. Exp Gerontol [Internet]. 2018;114(July):78–86. Available from: https://doi.org/10.1016/j.exger.2018.10.017
Felipe c. Vechin 1, cleiton a. Libardi, 1, 2 3, miguel s. Conceic¸a˜ o 2, felipe r. Damas 1, manoel e. Lixandra˜ o 1, ricardo p.b. berton 2, et al. Comparisons between low-intensity resistance training with blood flow restriction and high-intensity resistance training on quadriceps muscle mass and strength in elderly. J ofstrength cond res. 2015;29(4):1071–6.
Yasuda T, Fukumura K, Tomaru T, Nakajima T. Thigh muscle size and vascular function after blood flow-restricted elastic band training in older women. Oncotarget. 2016 Jun 7;7(23):33595-607. doi: 10.18632/oncotarget.9564. PMID: 27244884; PMCID: PMC5085105.
Yasuda T, Fukumura K, Fukuda T, Uchida Y, Iida H, Meguro M, et al. Muscle size and arterial stiffness after blood flow-restricted low-intensity resistance training in older adults. Scand J Med Sci Sport. 2014;24(5):799–806.
Cook SB and Cleary CJ (2019) Progression of Blood Flow Restricted Resistance Training in Older Adults at Risk of Mobility Limitations. Front. Physiol. 10:738. doi: 10.3389/fphys.2019.00738
Yasuda T, Fukumura K, Uchida Y, Koshi H, Iida H, Masamune K, Yamasoba T, Sato Y, Nakajima T. Effects of Low-Load, Elastic Band Resistance Training Combined With Blood Flow Restriction on Muscle Size and Arterial Stiffness in Older Adults. J GerontolA Biol Sci Med Sci. 2015 Aug;70(8):950-8. doi: 10.1093/gerona/glu084. Epub 2014 Jun 10. PMID: 24917178.
Loenneke JP, Wilson JM, Marín PJ, Zourdos MC, Bemben MG. Low intensity blood flow restriction training: A meta-analysis. Eur J Appl Physiol. 2012;112(5):1849–59.
Lixandrão ME, Ugrinowitsch C, Berton R, Vechin FC, Conceição MS, Damas F, et al. Magnitude of Muscle Strength and Mass Adaptations Between High-Load Resistance Training Versus Low-Load Resistance Training Associated with Blood-Flow Restriction: A Systematic Review and Meta-Analysis. Sport Med. 2018;48(2):361–78.
Lauber B, König D, Gollhofer A, Centner C. Isometric blood flow restriction exercise: acute physiological and neuromuscular responses. BMC Sports Sci Med Rehabil. 2021;13(1):1–9.
Loenneke JP, Wilson GJ, Wilson JM. A mechanistic approach to blood flow occlusion. Int J Sports Med. 2010;31(1):1–4.
Landi F, Cruz-Jentoft AJ, Liperoti R, Russo A, Giovannini S, Tosato M, Capoluongo E, Bernabei R, Onder G. Sarcopenia and mortality risk in frail older persons aged 80 years and older: results from ilSIRENTE study. Age Ageing. 2013 Mar;42(2):203-9. doi: 10.1093/ageing/afs194. Epub 2013 Jan 15. PMID: 23321202.
Gale CR, Martyn CN, Cooper C, Sayer AA. Grip strength, body composition, and mortality. Int J Epidemiol. 2007 Feb;36(1):228-35. doi: 10.1093/ije/dyl224. Epub 2006 Oct 19. PMID: 17056604.
Centner, C., Wiegel, P., Gollhofer, A., & König, D. (2019). Effects of Blood Flow Restriction Training on Muscular Strength and Hypertrophy in Older Individuals: A Systematic Review and Meta-Analysis. Sports medicine (Auckland, N.Z.), 49(1), 95–108. https://doi.org/10.1007/s40279-018-0994-1
Wortman, R. J., Brown, S. M., Elliot, I. S., Finley, Z. J., & Mulcahey, M. K. (2020). Blood Flow Restriction Training for Athletes: A Systematic Review. The American Journal of Sports Medicine, 036354652096445. doi:10.1177/0363546520964454
Grønfeldt, B. M., Lindberg Nielsen, J., Mieritz, R. M., Lund, H., & Aagaard, P. (2020). Effect of bloodâ€flow restricted vs. heavyâ€load strength training on muscle strength: Systematic review and metaâ€analysis. Scandinavian Journal of Medicine & Science in Sports. doi:10.1111/sms.13632
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