School of Sports &

Health

Kyungsung University

Byeong-hwan Jeon

Jong-jin Park

Blood flow restriction train-

ing to prevent sarcopenia

in middle aged women

Contents

• Introduction

• Materials and Methods

• Result

• Discussion

• Conclusion

Review

• resting metabolic rate of skeletal muscle

– 17.6kcal/kg

– Example

• % Body muscle (male: 42%, female: 36%)

• EE change by increased muscle mass

– muscle mass 42%(29.4kg), 517Kcal

– if the % body muscle increased by 50%(35kg), 616Kcal

Introduction

• Prevalence of aging in Korea

Sarcopenia & sarcopenic obesity

: Fielding et al, 2011, Baumgartner, 2009

The prevalence of age-associated loss

of muscle mass alone or

in combination with increased fat mass

Risks of SO

: Ryu et al, 2013, Zamboni et al, 2008 and Zoico et al, 2004

• greater risk of frailty, falls and disability

• the prevalence of disease and increase in mortality

• functional limitations

Factors for SO

: Jones et al, 2009

• alpha‐motor neuron death

• altered hormone concentrations

• increased inflammation

• altered nutritional status

Combating strategies against SO

• testosterone, growth hormone replacement (Borst,

2004)

• pharmaceutical regulation of myostatin (Jones et al,

2009)

• nutritional (protein) supplementation (Fiatarone et al,

1994; Yarasheski et al, 1995)

• resistance exercise (Landi et al, 2014)

– the most effective and safe intervention

– consistently attenuate muscle loss, aerobic condi-

tioning, strength

* Gradual adaption by resistance exer-cise

Muscle Strength

Maximal muscle strength

Muscle hypertrophy

Muscle endurance

Stabilized endurance

Muscle power

Muscle Power

Stabilization

Benefits of RT to the elderly population

• improvements in isokinetic strength, bone mineral

density and lean muscle mass (Salvador et al, 2013)

• enhancements in functional ability (Mariane et al,

2011)

Issues to the elderly population

• orthopedic issues of the affected joint(s)

• cardiovascular disease conditions

• HI-RT to produce muscle adaptation

– >70% of 1RM, conventional methods(ACSM, 2009)

– <65% of 1RM, seldom increases in muscle size or

strength (Kramer et al, 2004)

a safe and effective alternatives to HI-RT

Blood flow restriction training(BFRT)

• the scientific application of RT

• the partial restriction/occlusion of

blood flow via cuff or band to the

exercised muscles

• Yoshiaki Sato developed(1983)

and generalised through the ‘KAATSU’

machine(2003)

• significant hypertrophy in male & in female

(Wilson et al, 2013 and Lowery et al, 2013)

• <3 times secretion of GH

(Kraemer et al, 1991; Takarada et al, 2000; Viru et al, 1998)

• maintenance in strength after 3 wks of detraining

(Yasuda et al, 2014)

• a higher frequency of training by– a shorter recovery time (Abe, 2004), – minimal muscle damage (Wilson et al, 2013)

Major benefits of BFRT

Principles of BFRT

: Loenekke et al, 2012, Fry et al, 2010; Fujita et al, 2007, Yasuda et al,

2010

• pooled blood reactive hyperaemia, cellular

swelling

• an accumulation of metabolites

– PCr depletion, H2PO4-(intramuscular pH), epinephrine/norepi-

nephrine

• anabolic signaling pathways

– growth factors & Myostatin decrease

• higher threshold type II fibre recruitment

– decreased O2 supply

Methods for BFRT

• cuff sizes

– 2cm ~20cm

• cuff pressures

– lower: 140 - 240mmHg

– upper: 100 - 160mmHg

• complete occlusion

– reduced Ex volume and isometric/isokinetic strength gains

• ~130% of resting SBP(normally 130-180mmHg) when combined with

both narrow (5cm) and wide (13.5cm) cuffs (Loenneke et al, 2011)

• 12cm of cuff (Moore et al, 2004)

LI-BFRT

• an effective but safe level of restriction

– increased strength and hypertrophy

• 7cm(Burgomaster et al, 2003 ), 3-3.3cm(Takarada et al, 2000)

– increased muscle strength and endurance

• lower pressures (50/100mmHg) with narrow cuff(7.7cm) (Sumide et

al, 2009 )

The aim of this study

• proper condition to apply for middle-aged and

older women

• body composition and muscular strength re-

sponses to BFR training in Korean middle aged

women

Materials and Methods

•  Participants : 23 females, aged 40-55 years

Group n age(yrs) height(㎝ ) weight(㎏ )

BFR 9 49.22±5.40 159.90±5.00 61.11±6.43

WT 7 45.71±4.82 159.14±2.91 53.14±2.91

CON 7 47.14±3.53 160.85±2.91 55.95±5.15

AVG 47.35±4.58 159.96±3.60 56.73±4.83

Body Composition

• DEXA (Discovery QDR Hologic, USA)

– Circumference

– Fat mass

– Skeletal muscle mass

– Relative appendicular

skeletal muscle mass

(ASM/weight)

Muscle strength/power

• Biodex(Biodex system 4 Pro,

USA)

• Isokinetic strength and power

measurements

• knee flexion and extension

• Load speeds

– Muscle strength @ 60°/sec

– Muscle power @ 180°/sec

Cuff size and pressure

• 8cm

• 100~120% of SBP / RPE

Training Protocol

• Type of Ex

– Upper limb

• dumbbell hammer curl & cable push-down

– Lower limb

• leg extension & leg curl

• Intensity of Ex

– RT group: 65~70% load of 1RM

– BFRT group: 30% load of 1RM at 100%(upper limbs) & 120%

(hind limbs) of SBP

Training Protocol

Training Protocol

Frequency Exercise

LI-BFRT

Inten-

sity

RT Inten-

sity

Dura-

tion

3 d/wk,

8 wks

warm-

up

•Breathing/neutral spine

•stretching5~10 min

main

exercise

•Dumbbell Hammer Curl

•Cable Push-down

•Leg Extension

•Leg Curl

30%

1RM

Total 5

sets

1set 20

2~5set 15

65~70%

1RM

Total 4set

Warm up

1set 20

2~4set 12

30min

cool-down

•Breathing exercises

•Hamstring stretch roll-

up

5~10 min

Statistics

• SPSS Window Ver 18.0

• Descriptive statistics(mean±SD)

• a Paired-T test for training effects on all depen-

dant variables

• An ANCOVA for the differences between the train-

ing group conditions, Helmert contrast

• Statistical significance, α=.05

Comparison results for the estimated weight (kg)

M±SE.

1. Body composition

1) weight

we

igh

t (

kg)

Source of

differencen weight test

BFR 9 56.93±0.48

nsWT 7 56.90±0.53

CON 7 57.47±0.49

Result

Comparison results for

the estimated Muscle mass of upper limb (kg)

M±SE.

2) Muscle mass of upper limb

we

igh

t (

kg)

Source of

differencen weight test

BFR 9 1.68±0.03BFR > WT >

CON　WT 7 1.57±0.03

CON 7 1.51±0.03

Mu

scle

ma

ss o

f u

pp

er

limb

(kg

)

1. Body composition

Comparison results for

the estimated Muscle mass of lower limb (kg)

M±SE.

3) Muscle mass of lower limb

Source of

differencen weight test

BFR 9 5.62±0.16

NS　WT 7 5.26±0.17

CON 7 5.31±0.17

Mu

scle

ma

ss o

f lo

we

r lim

b (

kg)

1. Body composition

Comparison results for

the estimated fat mass of upper limb (kg)

M±SE.

4) Fat mass of upper limb

Source of

differencen weight test

BFR 9 1.13±0.04

NSWT 7 1.16±0.05

CON 7 1.11±0.04

Fa

t m

ass

of

up

pe

r lim

b (

kg)

1. Body composition

Comparison results for

the estimated fat mass of lower limb (kg)

M±SE.

5) Fat mass of lower limb

Source of

differencen weight test

BFR 9 3.31±0.16

NS　WT 7 3.51±0.18

CON 7 3.29±0.16

Fa

t m

ass

of

low

er

limb

(kg

)

1. Body composition

Comparison results for

the estimated circumference of upper limb (cm²)

(kg)

M±SE.

6) circumference of upper limb

Source of

differencen circumference test

BFR 9 181.51±2.78WT > BFR >

CONWT 7 187.91±3.43

CON 7 172.95±2.81

circ

um

fere

nce

of

up

pe

r lim

b (

cm²)

1. Body composition

Comparison results for

the estimated circumference of lower limb (cm²)

M±SE.

7) circumference of lower limb

Source of

differencen circumference test

BFR 9 324.81±4.07

NS　WT 7

314.72±4.75

CON 7315.47±4.53

circ

um

fere

nce

of

low

er

limb

(cm

²)

1. Body composition

2. ASM/Weight

ASM/Weight n ASM/weight (%) test

Upper

limb

BFR

WT

CON

9

7

7

.058±.001

.056±.001

.054±.001

CON<BFR

Lower

limb

BFR

WT

CON

9

7

7

.196±.005

.184±.006

.187±.006

ns

Comparison results for the estimated ASM/weight

M±SE.

ASM/Weight change after 8 weeks

Pre Post0.04

0.05

0.06

0.07

BFRT

RT

CON

ASM

/weig

ht

(%)

Upper Limb ASM/Weight (%)

Pre Post0.16

0.17

0.18

0.19

0.2

BFRTRT

ASM

/weig

ht

(%)

Lower Limb ASM/Weight(%)

Isokinetic

strength

@ 60˚/sec

N Peak Tq/weight (%) test

Knee

Exten-

sion

BFR

WT

CON

9

7

7

102.75±3.86

101.48±4.20

94.21±4.05

ns

Knee

Flexion

BFR

WT

CON

9

7

7

50.07±1.97

45.45±2.22

40.14±2.15

CON<BFR

3. Isokinetic strength of lower limb

1) Muscle strength

Comparison results for the estimated Isokinetic strength

M±SE.

Pre Post20

40

60

BFRTRTCON

60°/

sec

flexio

n (

%)

Lower Limb muscle strength

measured at 60°/sec flexion

Pre Post50

70

90

110

130

BFRTRTCON

60°/

sec

ext

ensi

on (

%)

Lower Limb muscle strength

measured at 60°/sec extension

3. Isokinetic strength of lower limb

2) Muscle power

Isokinetic

strength

@ 180˚/sec

N Peak Tq/weight (%) test

Knee

Exten-

sion

BFR

WT

CON

9

7

7

70.75±2.57

59.12±2.93

57.57±2.84

WT,CON<BFR

Knee

Flexion

BFR

WT

CON

9

7

7

38.47±1.55

33.13±1.80

27.38±1.73

CON<WT<BFR

M±SE.

Comparison results for the estimated Isokinetic power

Pre Post10

20

30

40

50

BFRT

RT

CON

180°/

sec

flexio

n (

%)

Lower Limb muscle strength

measured at 180°/sec flexion

Pre Post40

50

60

70

80

BFRT

RT

CON

180°/

sec

exte

nsi

on (

%)

Lower Limb muscle strength

measured at 180°/sec extension

Disscusion1. Body composition

BFR WT CON Comparison results

weight X X X NS

muscle mass upper limb O O X BFR > WT> CON

lower limb O X X NS

fat mass upper limb X X X NS

lower limb X X O NS

circumference upper limb O O X WT > BFR > CON

lower limb X X X NS

ASM/wtupper limb O O X BFR > CON

lower limb O X X NS

2. Isokinetic muscle strength and power

BFR WT CON Comparison results

Muscle strength @ 60°/sec

extension X O X NS

flexion O O X BFR > CON

Muscle power@ 180°/sec

extension O X X BFR > WT, CON

flexion O O X BFR > WT > CON

• no significant differences in weight, likely due to the short

duration of this study

• small increases in ASM/weight accompanied with minor

changes/reductions in body fat

• Nonetheless the training duration was short (8 weeks),

muscle mass and volume, strength and power increased

significantly

efficacy of LI-BFRT

• comfort and tolerable

• Low-intensity (~30% 1RM) + moderate frequencies

• muscular size / strength equal to or greater than HI-RT

• applicable to increase muscle strength indices(strength &

power) in middle aged (>40yr) female populations

Suggestion for BFRT condition

• cuff pressure & size

– 100%(upper limbs) & 120%(hind limbs) of SBP

– 8cm

• intensity of load

– 30% load of 1RM

or similar level of modification

Conclusion

Suggested restrictive pressure

applied on limbs with relatively low intensity

during BFR exercise

could significantly affected the changes

on body composition and muscle strength

in Korean middle aged women

Thanks to

Lab members

Wook-chul Choi

Jae-woon Choi

Strom Reid

Hee-jin Cho

Undergraduate students