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Table 2 Resistance training with BFR in older adults

From: Effects of blood flow restriction (BFR) with resistance exercise on musculoskeletal health in older adults: a narrative review

Article Subject characteristics Exercise Frequency Rest duration Exercise Intensity Number of sets x reps Blood flow restriction method Side effects Research outcomes
[57] 8♀, (63.8 ± 11.6 yo)
Hypertensive & sedentary
8 weeks, 2 x/ week
Wrist flexion 1.5 sec concentric, 1.5 sec eccentric
30 sec between sets 30% 1RM 3 sets
12, 10, 8 reps
70% of arterial pressure occlusion Not mentioned SBP 11.0%
DBP 12.1%
MAP 11.6%
HR, Cortisol and IL-6
[54] Mixed (5♂, 7♀),
(76.5 (72.3–80.7) yo)
Healthy, nonclinical & sedentary
12 weeks, 2 x/ week
Leg curl
Leg extension
3 sec concentric, 3 sec eccentric
60 sec rest between sets
3 min rest between exercises
30% 1RM
Leg press
50% 1RM
1st week 1 set to failure
2nd week 2 sets to failure
3rd week onwards 3 sets to failure
150% of arterial pressure occlusion Not mentioned Quadriceps CSA 4.3%
Leg extension strength (1RM) 24%
Leg press strength (1RM) 12%
Walking speed 4%
Short Physical Performance Battery, Quality of life
Leg curl strength (1RM)
[29] Mixed (5♂, 6 ♀), (63.3 ± 4.1 yo)
Healthy, nonclinical & sedentary
12 weeks, 4 x/ week
Concurrent training:
i) 2 days Endurance training (ET)
ii) 2 days low-intensity resistance exercise with BFR
Not mentioned 1st 6 weeks 20% 1RM
7th week onwards
30% 1RM
1 set × 30 reps
3 sets × 15 reps
50% of arterial pressure occlusion Not mentioned Quadriceps CSA 7.3%
Leg press strength (1RM) 35.4%
V̇O2peak 10.3%
C reactive protein
IL-6 25%
IL-10
[100] Mixed (6♂,10♀), (67.2 ± 5.2 yo)
Healthy, non-clinical & sedentary
12 weeks,
3 x/ week
Leg press
Leg extension
Leg curl
Calf flexion
Not mentioned 20% 1RM To failure Equation (pressure mm Hg = 0.5 (SBP) + 2 (thigh circumference) + 5) 21 were deemed related or possibly related to the study (6 BFR; 15 moderate intensity resistance training (MIRT)) The majority of these were related to knee pain (n = 14), & the BFR group had less of these reports (n = 3) than the MIRT group (n = 11) A total of five serious adverse events were observed (2 BFR; 3 MIRT), with only one (BFR group) deemed related or possibly related to the study Knee extensor strength ~ + 18.1%
Gait speed + 8.6%
Short physical performance battery ~ + 0.1%
Lean mass ~ + 0.5%
[30] 13♂, (55.9 ± 1.0 yo)
Healthy, nonclinical & recreationally active
6 weeks
3 x/ week
Upper body (latissimus pull down, shoulder press & biceps curl) 3 sets, 8 rep, 80% 1RM, followed by BFR Leg press &
Leg extension for three sets
1 min rest between sets, 5–10 min rest between exercises 20% 1RM 30, 15, 15 reps Start with 160 mmHg,
Increase by 20 mmHg if rate of perceived exertion (RPE) was lower than 16
Not mentioned Lat pulldown ~ 15.9%
Shoulder press ~ 9.6%
Bicep curl ~ 19.3%
Leg press 19.3%
Leg extension 19.1%
[31] Mixed (n = 10), no mention of gender proportion, (64 ± 4 yo)
Healthy, nonclinical & sedentary
12 weeks, 4x/ week
Concurrent training:
i) BFR
2 x/ week
Leg press
ii) ET
2 x/ week: walk/run 30–40 min, 50–80% V̇O2peak
60 sec rest between sets 1st 6 weeks
20% 1RM
30% 1RM for next 6 weeks
30, 15, 15, 15 reps 50% of arterial pressure occlusion Not mentioned Quadricep CSA 7.6%
Leg press (1RM) 35.4%
V̇O2peak 10.3%
[102] Case study (n = 1, ♂, 91 yo)
Hypertensive
Sarcopenic
Cardiovascular disease
Sedentary
8 weeks, 3 x/ week
Treadmill walking, 30% heart rate reserve
Elbow flexion Elbow extension
Leg press
Leg extension
1 min rest between sets and exercises 30% 1RM 3 sets of 10 RM. No report on the number of reps. 50% of arterial pressure occlusion No clinical interference during exercise.
No reports of discomfort or pain during low-intensity BFR
Lean mass − 3.6%
Hand grip + 17.9%
Isokinetic strength
Peak torque extension + 4.6%
Total work + 1.5%
Work fatigue + 27.5%
[103] Mixed (8♂, 2♀), (67 ± 3 yo)
Healthy, nonclinical, physically active but not resistance-trained
4 weeks
3 x/ week
Plantar flexion with one leg BFR;
Control leg without BFR on same person
1 min rest between sets
3 min rest legs
25% 1RM 3 sets
Exercise to failure in BFR limb
Control limb follows similar reps
110 mmHg 100% free of injury or complications Calf girth ~ 1.17%
SBP
DBP
Plantar flexor
1RM ~ 13.5%
MVC ~ 17.6%
Isokinetic torque
0.52 N/m ~ 15.7%
1.05 N/m
2.09 N/m
Resting limb blood flow
Blood flow after 5 min circulatory occlusion ~ 38.9%
[32] 10♀, (64 ± 4 yo)
Healthy, nonclinical & sedentary
12 weeks, 4 x/ week
Concurrent training:
i) 2 days Resistance training:
Leg press
ii) 2 days ET
50–80% V̇O2peak, 30–40 min
60 sec rest between sets 1st 6 weeks
20% 1RM
2nd 6 weeks
30% 1RM
30, 15, 15, 15 reps 50% of arterial pressure occlusion Not mentioned V̇O2peak ~ 10.3%
Leg press (1RM) ~ 35.4%
Quadriceps CSA ~ 7.6%
[74] Mixed (16♂, 4♀), (72 ± 4 yo)
Healthy, nonclinical & sedentary
4 weeks, 3 x/ week
Leg extension
Leg press
Rowing
Chest press
30 sec between sets 20% 1RM 3 × 20 reps 100% of arterial pressure occlusion Not mentioned Acute effects
HR 33.8%
SBP ~ 38.4%
DBP ~ 45.2%
Blood markers
Lactate ~ 500%
NE ~ 55.0%
VEGF ~ 42.3%
GH ~ 244.0%
EPI
Long-term effect
RHI ~ 16.7%
vWF ~ 4%
TM
tcPO2 ~ 16.7%
Muscle strength- leg extension (1RM) ~ 19.0%
Muscle strength- leg press (1RM) ~ 11.3%
Muscle strength- rowing (1RM) ~ 9.18%
Muscle strength chest press (1RM)
[55] Mixed (3♂, 2♀), (59 ± 2 yo)
Postmenopausal, healthy & recreationally active
Upper body exercises (seated chest press, seated row, seated shoulder press) followed by lower body exercises (knee extension, knee flexion, hip flexion, hip extension) 30 sec between sets
30–120 sec between exercises
Resistance band estimated ~ 10–30% 1RM 30, 15, 15 reps Upper body exercise with BFR 120 mmHg
Lower body without BFR
Not mentioned Chest press strength ~ 8.0%
Seated row ~ 5.4%
Shoulder press ~ 5.0%
Leg press ~ 7.6%
Right hip extension ~ 9.7%
Left hip extension ~ 8.9%
Right hip flexion ~ 27.3%
Left hip flexion ~ 39.6%
Right knee extension ~ 12.8%
Left knee extension ~ 7.9%
Right knee flexion ~ 22.1%
Left knee flexion ~ 12.8%
Muscle thickness pectoralis major 17.4%
Other muscle thickness
[52] Mixed (n = 8), no mention of gender proportion
(65.0 ± 2.0 yo)
Healthy, nonclinical & sedentary
12 weeks, 2 x/ week
Leg press
2 sec concentric,
2 sec eccentric
1 min rest between sets 1st 6 weeks
20% 1RM
30% 1RM for following weeks
30, 15, 15, and 15 reps 50% of arterial pressure occlusion Not mentioned Leg press (1RM) p = 0.067, ~ 15.8%
Muscle CSA quadriceps ~ 5.93%
[53] Mixed (3♂, 2♀), (64 ± 3 yo)
Healthy, nonclinical & physically active
12 weeks, 2 x/ week
Leg press
1 min rest between sets 1st 6 weeks
20% 1RM
2nd 6 weeks 30% 1RM
30, 15, 15, 15 reps 50% of arterial pressure occlusion Not mentioned Leg press (1 RM) #
Muscle CSA quadriceps #
# The magnitude of increase in strength and size were not provided
Enriched 159 gene ontology pathways as compared to control
Enriched 2 gene ontology pathways as compared to HI
[50] Mixed (3♂, 6♀), (71.3 ± 7.1 yo)
Healthy, nonclinical & sedentary
12 weeks, 2 x/ week
Leg press
1.3 sec concentric, 1.3 sec eccentric
Knee extension
1.0 sec concentric, 1.0 sec eccentric
30 sec rest between sets
90 sec rest between exercises
20–30% 1RM 30, 20, 15, and 10 reps full- first day set 120 mmHg, subsequently increase 10-20 mmHg until 270 mmHg Not mentioned Muscle CSA quadriceps 8.0%
Muscle CSA adductors 6.5%
Muscle CSA gluteus maximus 4.4%
Leg extension (1RM) 26.1%
Leg press (1RM) 33.4%
Chair stand test (reps) 18.3%
HR, blood pressure, FMD, CAVI, ABI, FDP, D-dimer, CK
[51] Mixed (2♂, 7 ♀), (71.8 ± 6.2 yo)
Healthy, nonclinical & sedentary
12 weeks, 2 x/ week
Bilateral arm curl
Triceps press down
1.2 sec concentric, 1.2 sec eccentric
30 sec rest between sets
90 sec rest between exercises
“Heavy (Green)” resistance band for men
“Thin (Yellow)” resistance band for women
30, 15, 15, 15 reps full- first day set 120 mmHg, subsequently increase 10-20 mmHg until 270 mmHg Not mentioned Muscle thickness elbow flexor ~ 17.6%
Muscle thickness elbow extensor ~ 17.4%
Muscle strength elbow flexor MVC ~ 7.8%
Muscle strength elbow extensor MVC ~ 16.1%
HR, blood pressure, CAVI, ABI
[56] 10♀, (70 ± 6 yo)
Healthy, nonclinical & physically active but not resistance trained
12 weeks, 2 x/ week
Squat
1.3 sec concentric, 1.3 sec eccentric
Knee extension
1.0 sec concentric, 1.0 sec eccentric
30 sec rest between sets
90 sec rest between exercises
One gold resistance band for squat
One black resistance band for knee extension
Considered low-intensity bands as compared with bands used in HI protocol in the same study.
30, 15, 15, 15 reps full- first day set 120 mmHg, subsequently increase 10–20 until 200 mmHg Not mentioned Acute effect
Anterior mid-thigh 10.6%
Chronic effect
Quadricep CSA 6.9%
Knee extension (MVC) 13.7%
Leg press (1RM) 16.4%
Knee extension (1RM)
c-SBP, c-Aix, CAVI, and ABI
[67] Mixed (11♂, 5 ♀), (55 ± 7 yo)
Healthy, nonclinical & sedentary
6 weeks, 3 x/ week
Lateral knee extension
one limb with BFR
one limb without BFR
1.5 sec concentric, 1.5 sec eccentric
1 min rest between sets 30% 1RM Volitional fatigue 1st week
150 mmHg or 50% of arterial occlusion pressure (whichever was lower)
2nd week onwards 80% arterial occlusion pressure but no higher than 240 mmHg
Not mentioned Knee extension 1RM ~ 10.9%
Anterior thigh muscle thickness ~ 5.1%
Lateral thigh muscle thickness ~ 4.0%
Pulse wave velocity ~ 6.7%
Cardiovascular vascular conductance
[104] 16 ♀, (64.7 ± 3.7 yo)
Healthy, nonclinical & sedentary
14 weeks, 2 x/ week
Wrist flexion
1.5 sec concentric, 1.5 sec eccentric
40 sec rest between sets 40% 1RM 3 × 15 reps 70% of arterial pressure occlusion Not mentioned Wrist flexion strength (1RM) 55.3%
Quality of life
Chair stand test
  1. Indicates significantly increased
  2. Indicates significantly decreased
  3. Indicates no significant difference
  4. # Indicates result details not provided in article
  5. - Indicates decrease, without statistical analysis as they are case studies/case series
  6. + Indicates increase, without statistical analysis as they are case studies/case series
  7. 1RM: 1 repetition maximal; ABI: ankle-brachial pressure Index; c-Aix: central-augmented Index; c-SBP: central systolic blood pressure; CAVI: cardio-ankle vascular index; CK: creatine kinase; CSA: cross sectional area; DBP: diastolic blood pressure; EPI: epinephrine; FDP: fibrinogen degradation products; FMD; flow mediated dialation; GH: growth hormone; HR: heart rate; IL-6/10: interleukin-6/10; MAP: mean arterial pressure; NE: norepinephrine; RHI: reactive hyperaemia index; SBP: systolic blood pressure; SV: stroke volume; SVR: systemic vascular resistance; tcPO2: transcutaneous oxygen pressure; TM: thrombomodulin; TPR: total peripheral resistance; VEGF: vascular endothelial growth factor; V̇O2peak: peak volume of oxygen consumed per min vWF: von Willebrand factor