Aging and Blood Flow Restriction Flashcards
When was blood flow restriction (BFR) research created and by whom? Why was it used?
In Japan, in 1960, by Yoshiaki Sato.
First used as a self-experimentation after leg fracture. Wanted to use low impact exercise to help rehabilitation
What are some types of cuffs used for BFR?
- Electronically controlled pneumatic cuffs
- Elastic bands
What are the conditions to BFR? How does it work?
- BFR blocks venous blood flow from returning to heart without occluding arterial flow
- ~40% of limb occlusion pressure is desired
- up to 80% occlusion can be done
- cuffs should be placed at most proximal part of the limb
Why use BFR?
- Allows low intensity exercise to mimic high intensity
- We get similar benefits from much lighter workouts
- Appropriate for all age groups
Advantages of using resistance training.
- Form of treatment for musculoskeletal disorders
- In normal circumstances: 60-80% of 1 RM is needed to see benefits
- With BFR: reduce intensity to 20-30% of 1 RM to reap same benefits
How does BFR achieve high-intensity benefits? What are the physiological outcomes?
- Lactate build up
- Increased metabolic stress
- cell swelling
- increased hormone release
- anabolic signaling for muscle growth - Higher heart rate response
What does lactate build up do?
hypoxia-inducible factor (HIF-1a) activate due to low oxygen levels in the muscles, Increases anaerobic ~activity~
Basically, when restricting blood flow, restrict 02 which increases lactate build up and we start adapting to higher [lactate], making us more tolerance to high exercise
What happens in increased metabolic stress, cell swelling?
increase protein synthesis, hypertrophy, nutrient transport
What happens in increased metabolic stress, increased hormone release?
Growth hormone, insulin-like factor-1, vascular endothelial growth factor
What happens in increased metabolic stress, anabolic signaling for muscle growth?
inhibit catabolic effects and promote muscle synthesis
What does a higher heart rate response do?
Increased heart rate during exercise allows distribution of blood to be more efficient. Can have future benefits such as lower resting heart rate and blood pressure, aka heart works faster.
What are the benefits of using BFR for OA?
- BFR is beneficial at low-intensity and are counterintuitive with high intensity workouts
- ideal for OA who are deconditioned, suffering from chronic diseases, extremely frail, etc
What are 2 diseases commonly experienced by OA?
- Sarcopenia: loss of skeletal muscle mass (affect ~22% of adults over 65 years old)
- Osteoporosis: decline in bone mineral density (over 2.3 milllion Canadians are living with osteoporosis)
What are possible barriers to RT (resistance training) that can be overcome with BFR?
- fear of injury (they don’t need to lift heavy anymore)
- need for expensive equipment
- need for progressive overload
intimidating gym settings - transportation difficulties (no license, weather conditions, etc.)
What is one specific population of people that benefit from BFR training?
People with Parkinson’s disease (PD)
What is PD?
- degenerative disease
- insufficient production of DA
- lack of motor control due to under or over stimulation of the basal ganglia
common symptoms:
- tremors
- shuffled gait
- poor posture - kyphosis
- restless leg syndrome (RLS)
Training with BFR, case study done by Doris & al. 2 parts: 6 wks of BFR and and then 4 weeks of training normally. Training = Abe protocol for KAATSU walk: 5 two-minute bouts of walking with 1 min rest between each, 3 times a week on non-consecutive days.
What are the results on the 6min walk test, timed up & go test and the sit to stand test.
- Participants covered more distance in 6min. This decreased immediately after BFR was stopped.
- Participants performed the timed up & go at a faster speed. Again, an immediate decrease was observed in once BFR was stopped.
- Participants managed to perform more repetitions in the sit to stand test. Again, this decreased noce BFR was stopped.
Training with BFR, case study done by Doris & al. 2 parts: 6 wks of BFR and and then 4 weeks of training normally. Training = Abe protocol for KAATSU walk: 5 two-minute bouts of walking with 1 min rest between each, 3 times a week on non-consecutive days.
What were the results in RLS scale? and what is the RLS scale?
RLS scale measures PD symptoms and quality of live.
The participants’ scores decreased throughout the 6 weeks of BFR training and went back up again once BFR stopped.
What was the objective of Daniela’s study?
demonstrate that BFR with low intensity resistance training (LI-RT) will induce improvements in strenght and overall functional capacity.
Study 1: healthy OA
Study 2: PD
Study 3: long covid
What was measured in study 1?
10 weeks of online RT, twice a week. 3 test sessions (pre-mid-post). 3 functional tests (ex: sit to stand, calf raises, timed up and go), 1 strength test and measure of oxygen consumption.
Result of sit to stand and calf raises, and timed up and go?
Improvement pre-mid-post but BFR starts higher than control.
for timed up and go, steady decline in time for BFR.
Result for leg flexion and leg extension
no significant of improvement but BFR started higher than control and manage to improve
Different in peak VO2 consumption during 30 of sit to stand between BFR and control?
BFR starts higher than control and improved. They were very fit from the get-go.
Difference in average VO2 in 5 weeks between BFR and control?
Improvement in BFR.
What is the percentage of OA who fall each year?
1 in 3
What percentage of injury-related hospitalization among OA comes from falling?
85%
Which population is disproportionately affected by falls?
Women (70.5% of all hospitalized fallers)
What is the consequence of falling?
Can take away independence and reduce quality of life.
What are the 2 causes of falls?
Intrisic: components of postural stability (ability to stay upright and control our body position)
Extrinsic: environmental hazards (uneven ground, slippery surfaces, tripping hazards, poor lighting, etc.)
What is required to maintain postural stability?
- sensory system to detect when we are shifting/slipping (what we see, hear and our proprioceptive feedback)
- cognitive system to integrate sensory cues and decide the correct motor response
- motor system to act and implement corrective movements (can we catch ourselves if we start to fall?)
How does aging affect our sensory factors in relation to postural stability?
- sensory factors: reduced vision, hearing loss, diminished joint-position sense
- cognitive factors: lower attentional capacities, difficulty selecting sensory info
- motor factors: type 2 fibres atrophy, intramuscular fat infiltration
WHat are the benefits of doing exercise for balance.
- Movements using precise control improve proprioception and improves joint-position sense.
(Good for body awareness in space and fine motor movement)
ex: Golf, Tai Chi, yoga, dance, etc.
- Stimulate somatosensory cortex to reorganize
enhances grey matter volume of motor cortex and correlated with balance performance
- regular moderate-intensity exercise improves attention
decrease stress and inflammation –> greater cerebral blood flow –> increased cortical plasticity and exercutive function/attention
- physical activity reduces muscle atrophy and intramuscular fat infiltration
greater strength = better postural adjustments and corrections
How does BFR help for strength in OA?
LI-RT + BFR significantly improved lower limb strength and mass. Greater than LI-RT alone. No different than HI-RT or dynamic balance training
What are the results of LI-RT BFR for balance and walking performance?
more postural stability for balance.
improves single-leg standing time (static balance/postural control) and Timed up and go and 10-min walk time (dynamic balance and gait)
What was the hypothesis for Emma’s master’s research?
Can 12 weeks of online dance classes combined with BFR reduce the risk of falls among older women?
What are some barriers to physical activity?
- remote living
- affording or accessing transport
- parking
- lack of qualified intrustors
- social distancing
- extreme winter weather
What are the advantages of online training?
- not geographically bound
- low cost
- access to qualified intructors
- pandemic safe
- increased comfort in trying new activities at home
What are unique barriers and concerns for older women?
- hospitalized at a rate 1.8 that of men following falls
- less than 4% of Canadian women aged 60+ meet physical activity guidelines
- women report stronger health, practical and priority barriers: lack of enjoyment or freinds to exercise with, cost, lack of time/energy, caretaking, fear of injury (45.8%)
Why did Emma choose dance as her training exercise?
- complex and rhythmic sensorimotor activity -> motor and cognitive benefits
- higher attendance among older women (84.3%)
- improves strength, postural stability and balance confidence after 8 weeks of in-person classes
Which tests were conducted pre-mid-post testing?
- force plates (eyes open, closed, foam)
- star excursion balance test
- 30s sit to stand
- calf raise senior test
What were the results of the online dance classes with BFR?
- BFR group reached further in directions where strength plays a larger role
- Hip, knee and plantarflexor strength increased in BFR group (only plantarflexor improved in control)
What are some safety concerns with using BFR in OA?
- higher incidence of subcutaneous hemorrhage (bruising) when using thinner bands (especially upper limbs)
- no acute or chronic effects on hypertension
- advised against BFR on upper limb for CVD (any unstable heart rate)
What are contrindications for using BFR?
- peripheral vascular disease
- varicose veins
- venous thromboembolism
- sickle cell anemia
0 bacterial blood infection
How to use elastic cuffs?
perceived pressure value of 7/10 to snug but not painful pressure
