Low-Load Resistance Training With Blood Flow Restriction Improves Clinical Outcomes in Musculoskeletal Rehabilitation: A Single-Blind Randomized Controlled Trial

Peter Ladlow, Russell J Coppack, Shreshth Dharm-Datta, Dean Conway, Edward Sellon, Stephen D Patterson, Alexander N Bennett, Peter Ladlow, Russell J Coppack, Shreshth Dharm-Datta, Dean Conway, Edward Sellon, Stephen D Patterson, Alexander N Bennett

Abstract

Background: There is growing evidence to support the use of low-load blood flow restriction (LL-BFR) exercise in musculoskeletal rehabilitation. Purpose: The purpose of this study was to evaluate the efficacy and feasibility of low-load blood flow restricted (LL-BFR) training versus conventional high mechanical load resistance training (RT) on the clinical outcomes of patient's undergoing inpatient multidisciplinary team (MDT) rehabilitation. Study design: A single-blind randomized controlled study. Methods: Twenty-eight lower-limb injured adults completed a 3-week intensive MDT rehabilitation program. Participants were randomly allocated into a conventional RT (3-days/week) or twice-daily LL-BFR training group. Outcome measurements were taken at baseline and 3-weeks and included quadriceps and total thigh muscle cross-sectional area (CSA) and volume, muscle strength [five repetition maximum (RM) leg press and knee extension test, isometric hip extension], pain and physical function measures (Y-balance test, multistage locomotion test-MSLT). Results: A two-way repeated measures analysis of variance revealed no significant differences between groups for any outcome measure post-intervention (p > 0.05). Both groups showed significant improvements in mean scores for muscle CSA/volume, 5-RM leg press, and 5-RM knee extension (p < 0.01) after treatment. LL-BFR group participants also demonstrated significant improvements in MSLT and Y-balance scores (p < 0.01). The Pain scores during training reduced significantly over time in the LL-BFR group (p = 0.024), with no adverse events reported during the study. Conclusion: Comparable improvements in muscle strength and hypertrophy were shown in LL-BFR and conventional training groups following in-patient rehabilitation. The LL-BFR group also achieved significant improvements in functional capacity. LL-BFR training is a rehabilitation tool that has the potential to induce positive adaptations in the absence of high mechanical loads and therefore could be considered a treatment option for patients suffering significant functional deficits for whom conventional loaded RT is contraindicated. Trial Registration: ISRCTN Reference: ISRCTN63585315, dated 25 April 2017.

Keywords: blood flow restriction; clinical outcomes; function; hypertrophy; musculoskeletal rehabilitation; pain; strength.

Figures

FIGURE 1
FIGURE 1
Study protocol and participant flow.
FIGURE 2
FIGURE 2
Changes in quadriceps muscle cross-sectional area (CSA) (A,B), thigh CSA (C,D), quadriceps muscle volume (E,F) and thigh muscle volume (G,H) at baseline and after 3-weeks of rehabilitation. Black points LL-BFR group, White points Conventional Resistance Training (RT) group. Bar charts show group percent changes over time. Data is expressed as mean ± SD. ∗p < 0.05 and ∗∗p < 0.01 versus baseline measurement. Data refers to primary injured limb. LL-BFR, low-load blood flow restriction; RT, resistance training; CSA, cross-sectional area.
FIGURE 3
FIGURE 3
Changes in 5-RM leg press (A,B), 5-RM knee extension (C,D) and isometric hip extension (E,F) at baseline and after 3-weeks of rehabilitation. Black points LL-BFR group, White points Conventional Resistance Training (RT) group. Bar charts show group percent changes over time. Data is expressed as mean ± SD. ∗p < 0.05 and ∗∗p < 0.01 versus baseline measurement. Data refers to primary injured limb. LL-BFR, low-load blood flow restriction; RT, resistance training; RM, repetition maximum.
FIGURE 4
FIGURE 4
Changes in multi-stage locomotion test (MSLT) (A,B), and pooled Y balance (C,D) at baseline and after 3-weeks of rehabilitation. Black points LL-BFR group, White points Conventional Resistance Training (RT) group. Bar charts show group percent changes over time. Data is expressed as mean ± SD. ∗p < 0.05 and ∗∗p < 0.01 versus baseline measurement. Data refers to primary injured limb. LL-BFR, low-load blood flow restriction; RT, resistance training.
FIGURE 5
FIGURE 5
Changes in LL-BFR participant’s self-reported pain before, during and 5 min after the completion of exercise. Data collected over six time points (every five training sessions) during the 3-weeks intervention. Data is expressed as mean ± SD, ∗p < 0.05. VAS, visual analog scale.

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