Advertisement

Effectiveness of Blood Flow Restriction Training on Muscle Strength and Physical Performance in Older Adults: A Systematic Review and Meta-analysis

  • Author Footnotes
    ⁎ Labata-Lezaun and Llurda-Almuzara contributed equally to this work.
    Noé Labata-Lezaun
    Footnotes
    ⁎ Labata-Lezaun and Llurda-Almuzara contributed equally to this work.
    Affiliations
    Anatomy Unit, Basic Sciences Department, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain

    ACTIUM Functional Anatomy Group, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain
    Search for articles by this author
  • Author Footnotes
    ⁎ Labata-Lezaun and Llurda-Almuzara contributed equally to this work.
    Luis Llurda-Almuzara
    Footnotes
    ⁎ Labata-Lezaun and Llurda-Almuzara contributed equally to this work.
    Affiliations
    Anatomy Unit, Basic Sciences Department, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain

    ACTIUM Functional Anatomy Group, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain
    Search for articles by this author
  • Vanessa González-Rueda
    Affiliations
    ACTIUM Functional Anatomy Group, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain

    Physiotherapy Department, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain

    Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
    Search for articles by this author
  • Carlos López-de-Celis
    Affiliations
    ACTIUM Functional Anatomy Group, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain

    Physiotherapy Department, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain

    Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
    Search for articles by this author
  • Simón Cedeño-Bermúdez
    Affiliations
    Anatomy Unit, Basic Sciences Department, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain

    ACTIUM Functional Anatomy Group, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain
    Search for articles by this author
  • Joan Bañuelos-Pago
    Affiliations
    Anatomy Unit, Basic Sciences Department, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain
    Search for articles by this author
  • Albert Perez-Bellmunt
    Correspondence
    Corresponding author Albert Pérez-Bellmunt, PT, DPT, Universitat Internacional de Catalunya, 08195, Sant Cugat del Vallès, Barcelona, Spain.
    Affiliations
    Anatomy Unit, Basic Sciences Department, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain

    ACTIUM Functional Anatomy Group, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain
    Search for articles by this author
  • Author Footnotes
    ⁎ Labata-Lezaun and Llurda-Almuzara contributed equally to this work.
Published:January 10, 2022DOI:https://doi.org/10.1016/j.apmr.2021.12.015

      Abstract

      Objective

      To analyze the effectiveness of the blood flow restriction training in improving muscle strength and physical performance in older adults.

      Data Sources

      A systematic review and meta-analysis of randomized controlled trials was conducted. The Cochrane Library, PubMed, Web of Sciences, PEDro, Scopus, and ScienceDirect databases were systematically searched.

      Study Selection

      Articles were included if participants were 60 years or older and were considered healthy.

      Data Extraction

      The search strategy found a total of 363 studies. Finally, 10 articles were included in the systematic review, with a total of 278 healthy older adults analyzed.

      Data Synthesis

      The main results of the meta-analysis showed a statistical difference of muscle strength in favor of blood flow restriction training when compared with conventional training and no statistical differences when compared with high-intensity resistance training. Physical performance showed a nonstatistical difference between the blood flow restriction training, conventional training, and no training groups.

      Conclusions

      Blood flow restriction training is an interesting alternative to high-intensity strength training for improving muscle strength in older individuals who cannot perform high-load exercises.

      Keywords

      List of abbreviations:

      1RM (1 repetition maximum), BFR (blood flow restriction), BFRt (blood flow restriction training), BFRw (blood flow restriction walking), CI (confidence interval), HIRT (high-intensity resistance training), IRR (interrater reliability), LIRT (low-intensity resistance training), PEDro (Physiotherapy Evidence Database), PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), RoB 2 (Risk of Bias 2 tool), SMD (standard mean difference)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Tornero-Quiñones I
        • Sáez-Padilla J
        • Díaz AE
        • Robles MTA
        • Robles ÁS.
        Functional ability, frailty and risk of falls in the elderly: relations with autonomy in daily living.
        Int J Environ Res Public Health. 2020; 17: 1006
        • Morley JE
        • Vellas B
        • Abellan van Kan G
        • et al.
        Frailty consensus: a call to action.
        J Am Med Dir Assoc. 2013; 14: 392-397
        • Rodriguez-Mañas L
        • Fried LP.
        Frailty in the clinical scenario.
        Lancet. 2015; 385: e7-e9
        • Cruz-Jentoft AJ
        • Bahat G
        • Bauer J
        • et al.
        Sarcopenia: revised European consensus on definition and diagnosis.
        Age Ageing. 2019; 48: 16-31
        • Cadore EL
        • Pinto RS
        • Bottaro M
        • Izquierdo M.
        Strength and endurance training prescription in healthy and frail elderly.
        Aging Dis. 2014; 5: 183-195
        • Labata-Lezaun N
        • Llurda-Almuzara L
        • López-de-Celis C
        • et al.
        Effectiveness of protein supplementation combined with resistance training on muscle strength and physical performance in elderly: a systematic review and meta-analysis.
        Nutrients. 2020; 12: 2607
        • Fragala MS
        • Cadore EL
        • Dorgo S
        • et al.
        Resistance training for older adults: position statement from the National Strength and Conditioning Association.
        J Strength Cond Res. 2019; 33: 2019-2052
        • Izquierdo M
        • Merchant RA
        • Morley JE
        • et al.
        International exercise recommendations in older adults (ICFSR): expert consensus guidelines.
        J Nutr Heal Aging. 2021; 25: 824-853
        • Valenzuela PL
        • Morales JS
        • Pareja-Galeano H
        • et al.
        Physical strategies to prevent disuse-induced functional decline in the elderly.
        Ageing Res Rev. 2018; 47: 80-88
        • Beckwée D
        • Delaere A
        • Aelbrecht S
        • et al.
        Exercise interventions for the prevention and treatment of sarcopenia. A systematic umbrella review.
        J Nutr Health Aging. 2019; 23: 494-502
        • Anderson AB
        • Owens JG
        • Patterson SD
        • Dickens JF
        • Leclere LE.
        Blood flow restriction therapy: from development to applications.
        Sports Med Arthrosc Rev. 2019; 27: 119-123
        • 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: 1849-1859
        • Patterson SD
        • Hughes L
        • Warmington S
        • et al.
        Blood flow restriction exercise position stand: considerations of methodology, application, and safety.
        Front Physiol. 2019; 10: 533
        • Loenneke JP
        • Wilson JM
        • Wilson GJ
        • Pujol TJ
        • Bemben MG.
        Potential safety issues with blood flow restriction training.
        Scand J Med Sci Sport. 2011; 21: 510-518
        • Jessee MB
        • Mattocks KT
        • Buckner SL
        • et al.
        Mechanisms of blood flow restriction: the new testament.
        Tech Orthop. 2018; 33: 72-79
        • Vopat BG
        • Vopat LM
        • Bechtold MM
        • Hodge KA.
        Blood flow restriction therapy.
        J Am Acad Orthop Surg. 2020; 28: e493-e500
        • Grant Mouser J
        • Jessee MB
        • Mattocks KT
        • et al.
        Blood flow restriction: methods matter.
        Exp Gerontol. 2018; 104: 7-8
        • Loenneke JP
        • Wilson GJ
        • Wilson JM.
        A mechanistic approach to blood flow occlusion.
        Int J Sports Med. 2010; 31: 1-4
        • Pearson SJ
        • Hussain SR.
        A review on the mechanisms of blood-flow restriction resistance training-induced muscle hypertrophy.
        Sport Med. 2015; 45: 187-200
        • Loenneke JP
        • Abe T
        • Wilson JM
        • Ugrinowitsch C
        • Bemben MG.
        Blood flow restriction: how does it work?.
        Front Physiol. 2012; 3: 392
        • Lixandrão ME
        • Ugrinowitsch C
        • Berton R
        • 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: 361-378
        • 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: 837-848
        • Bennett H
        • Slattery F.
        Effects of blood flow restriction training on aerobic capacity and performance.
        J Strength Cond Res. 2019; 33: 572-583
        • Slysz J
        • Stultz J
        • Burr JF.
        The efficacy of blood flow restricted exercise: a systematic review & meta-analysis.
        J Sci Med Sport. 2016; 19: 669-675
        • Hughes L
        • Rosenblatt B
        • Paton B
        • Patterson SD.
        Blood flow restriction training in rehabilitation following anterior cruciate ligament reconstructive surgery: a review.
        Tech Orthop. 2018; 33: 106-113
        • Hughes L
        • Rosenblatt B
        • Haddad F
        • et al.
        Comparing the effectiveness of blood flow restriction and traditional heavy load resistance training in the post-surgery rehabilitation of anterior cruciate ligament reconstruction patients: a UK National Health Service randomised controlled trial.
        Sport Med. 2019; 49: 1787-1805
        • Pitsillides A
        • Stasinopoulos D
        • Mamais I.
        Blood flow restriction training in patients with knee osteoarthritis: systematic review of randomized controlled trials.
        J Bodyw Mov Ther. 2021; 27: 477-486
        • Bobes Álvarez C
        • Issa-Khozouz Santamaría P
        • Fernández-Matías R
        • et al.
        Comparison of blood flow restriction training versus non-occlusive training in patients with anterior cruciate ligament reconstruction or knee osteoarthritis: a systematic review.
        J Clin Med. 2020; 10: 68
        • 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.
        Sport Med. 2019; 49: 95-108
        • Moher D
        • Liberati A
        • Tetzlaff J
        • et al.
        Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.
        PLoS Med. 2009; 6e1000097
        • Valenzuela PL
        • Morales JS
        • Castillo-García A
        • et al.
        Effects of exercise interventions on the functional status of acutely hospitalised older adults: a systematic review and meta-analysis.
        Ageing Res Rev. 2020; 61101076
        • Navarrete-Villanueva D
        • Gómez-Cabello A
        • Marín-Puyalto J
        • Moreno LA
        • Vicente-Rodríguez G
        • Casajús JA.
        Frailty and physical fitness in elderly people: a systematic review and meta-analysis.
        Sport Med. 2021; 51: 143-160
        • Shafiee G
        • Keshtkar A
        • Soltani A
        • Ahadi Z
        • Larijani B
        • Heshmat R.
        Prevalence of sarcopenia in the world: a systematic review and meta- analysis of general population studies.
        J Diabetes Metab Disord. 2017; 16: 21
        • Orssatto LBR
        • Bezerra ES
        • Shield AJ
        • Trajano GS.
        Is power training effective to produce muscle hypertrophy in older adults? A systematic review and meta-analysis.
        Appl Physiol Nutr Metab. 2020; 45: 1031-1040
        • Higgins JPT
        • Thomas J
        • Chandler J
        • et al.
        Cochrane handbook for systematic reviews of interventions.
        2nd. John Wiley & Sons, Chichester, UK2019
        • Landis JR
        • Koch GG.
        The measurement of observer agreement for categorical data.
        Biometrics. 1977; 33: 159-174
        • Sterne JAC
        • Savović J
        • Page MJ
        • et al.
        RoB 2: a revised tool for assessing risk of bias in randomised trials.
        BMJ. 2019; 366: I4898
        • Maher CG
        • Sherrington C
        • Herbert RD
        • Moseley AM
        • Elkins M.
        Reliability of the PEDro scale for rating quality of randomized controlled trials.
        Phys Ther. 2003; 83: 713-721
        • Moseley AM
        • Rahman P
        • Wells GA
        • et al.
        Agreement between the Cochrane risk of bias tool and Physiotherapy Evidence Database (PEDro) scale: a meta-epidemiological study of randomized controlled trials of physical therapy interventions.
        PLoS One. 2019; 14e0222770
        • Minozzi S
        • Cinquini M
        • Gianola S
        • Gonzalez-Lorenzo M
        • Banzi R.
        The revised Cochrane risk of bias tool for randomized trials (RoB 2) showed low interrater reliability and challenges in its application.
        J Clin Epidemiol. 2020; 126: 37-44
        • DerSimonian R
        • Laird N.
        Meta-analysis in clinical trials.
        Control Clin Trials. 1986; 7: 177-188
        • Higgins JPT.
        Measuring inconsistency in meta-analyses.
        BMJ. 2003; 327: 557-560
        • 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. 2018; 114: 78-86
        • Galvao Pereira PM
        • Rihan Geraldes AA
        • David Silva Costa M da G
        • et al.
        Low-load resistance training and blood flow restriction improves strength, muscle mass and functional performance in postmenopausal women: a controlled randomized trial.
        Int Phys Med Rehabil J. 2019; 4: 63-68
        • Libardi CA
        • Chacon-Mikahil MPT
        • Cavaglieri CR
        • et al.
        Effect of concurrent training with blood flow restriction in the elderly.
        Int J Sports Med. 2015; 36: 395-399
        • Yasuda T
        • Fukumura K
        • Sato Y
        • Yamasoba T
        • Nakajima T.
        Effects of detraining after blood flow-restricted low-intensity training on muscle size and strength in older adults.
        Aging Clin Exp Res. 2014; 26: 561-564
        • Vechin FC
        • Libardi CA
        • Conceição MS
        • 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 Strength Cond Res. 2015; 29: 1071-1076
        • Yasuda T
        • Fukumura K
        • Fukuda T
        • 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: 799-806
        • Yokokawa Y
        • Hongo M
        • Urayama H
        • Nishimura T
        • Kai I
        Effects of low-intensity resistance exercise with vascular occlusion on physical function in healthy elderly people.
        Biosci Trends. 2008; 2: 117-123
        • 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; 99: 138-145
        • Jørgensen AN
        • Aagaard P
        • Frandsen U
        • Boyle E
        • Diederichsen LP.
        Blood-flow restricted resistance training in patients with sporadic inclusion body myositis: a randomized controlled trial.
        Scand J Rheumatol. 2018; 47: 400-409
        • Cashin AG
        • McAuley JH.
        Clinimetrics: Physiotherapy Evidence Database (PEDro) scale.
        J Physiother. 2020; 66: 59
        • Clarkson MJ
        • Conway L
        • Warmington SA
        Blood flow restriction walking and physical function in older adults: A randomized control trial.
        J Sci Med Sport. 2017; 20: 1041-1046
        • Baker BS
        • Stannard MS
        • Duren DL
        • Cook JL
        • Stannard JP.
        Does blood flow restriction therapy in patients older than age 50 result in muscle hypertrophy, increased strength, or greater physical function? A systematic review.
        Clin Orthop Relat Res. 2020; 478: 593-606
        • Maciel Batista M
        • da Silva DSG
        • Bento PCB
        Effects of blood flow restriction training on strength, muscle mass and physical function in older individuals - systematic review and meta-analysis.
        Phys Occup Ther Geriatr. 2020; 38: 400-417
        • Communications S.
        Progression models in resistance training for healthy adults.
        Med Sci Sport Exerc. 2009; 41: 687-708
        • Franz A
        • Queitsch FP
        • Behringer M
        • Mayer C
        • Krauspe R
        • Zilkens C.
        Blood flow restriction training as a prehabilitation concept in total knee arthroplasty: a narrative review about current preoperative interventions and the potential impact of BFR.
        Med Hypotheses. 2018; 110: 53-59
        • Hackney KJ
        • Brown LTCWJ
        • Stone KA
        • Tennent DJ.
        The role of blood flow restriction training to mitigate.
        Tech Orthop. 2018; 33: 98-105
        • 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: 1003-1011
        • Minniti MC
        • Statkevich AP
        • Kelly RL
        • et al.
        The safety of blood flow restriction training as a therapeutic intervention for patients with musculoskeletal disorders: a systematic review.
        Am J Sports Med. 2020; 48: 1773-1785