Benefit and physiological mechanism of low-intensity resistance training with blood flow restriction intervention on muscle fitness

doi:10.12307/2022.549

Abstract

Abstract: BACKGROUND: Blood flow restriction (also known as pressure training) combined with low-intensity resistance training has been proved to promote muscle adaptation in different populations. However, it is unclear about how this training method affects the muscle fitness and related mechanism of subjects, because of the different methods.
OBJECTIVE: To review the application and possible mechanism of blood flow restriction combined with low-intensity resistance training in promoting muscle hypertrophy and muscle strength growth, so as to provide some useful references for sports science researchers, coaches and athletes in future research or training practice.
METHODS: Relevant literatures were searched in Web of Science, Index Medicus, EMBASE, CNKI and other databases, with “blood flow restriction training, pressure training, resistance training, training volume, training frequency, interval time, muscle fitness, muscle hypertrophy, low intensity training, muscle metabolism” as keywords in English and Chinese, respectively. The search deadline was March 1, 2021. According to the inclusion and exclusion criteria, 63 typical literatures were finally obtained.
RESULTS AND CONCLUSION: Blood flow restriction training can cause tissue hypoxia and pH decrease in the process of exercise, promote the secretion of growth hormone and mTOR pathway activation, increase the muscle synthesis, and improve the effect of lateral migration. It can not only improve the muscle fitness of the compression part, but also enhance the muscle strength and cross-sectional area of the non-compression muscle group, and avoid the risk of injury caused by high-intensity resistance training. There is a dose matching effect of exercise prescription in the effect of blood flow restriction training, that is, the matching between the degree of blood flow restriction (50-250 mmhg) and low-intensity resistance (20%-50%1RM). The best training effect can be obtained by considering the width of pressure band, pressure position, training amount, frequency and interval time. Low-intensity resistance training prescription may be a better alternative training method for the elderly or the injured rehabilitation population including athletes. However, there is a lack of research on this aspect as yet. To conclude, low-intensity resistance training (20%-50%1RM) combined with blood flow restriction can promote muscle hypertrophy and increase muscle strength, and the effect is similar to that of high-intensity resistance training. However, for subjects of different ages and different physical fitness levels, especially for those with physical defects, more data from further studies are needed to clarify the training effect and possible risks of low-intensity resistance training.

Key words: blood flow restriction, low-intensity resistance, muscle fitness, physiological benefits, pressure training, training volume, training frequency, interval time, muscle hypertrophy, muscle metabolism

CLC Number:

Yu Wei, Song Gang, Liu Yiwen. Benefit and physiological mechanism of low-intensity resistance training with blood flow restriction intervention on muscle fitness[J]. Chinese Journal of Tissue Engineering Research, 2022, 26(17): 2768-2774.

Figures/Tables 6

2.1.1 肌肉缺血机制一般而言，运动开始先是招募慢缩肌(Ⅰ型肌纤维)参与工作，随着张力的增加再逐步招募快缩肌(Ⅱ型肌纤维)。然而，肌肉在局部缺血的情况下，则不会依照此顺序执行[11-12]。另一方面，Ⅱ型肌纤维的招募阈值会随着肌肉疲劳而下降，而血流限制训练因运动肢段血流量受限，从而增加了该活动肢段的代谢压力，并伴随更高的肌电活动，如此诱发肌肉疲劳进而达到招募更多快缩肌参与工作[13-15]。肌肉生成抑制素结合激活素Ⅱb受体会降低成肌细胞分化进入肌管，从而抑制肌细胞分化与卫星细胞增殖[16-18](如此达不到肌肉肥大的目标)；若肌肉生成抑制素表达过度时，MuRF-1激活水平提升，则会降低肌肉分化[19]，此时，卵泡抑制素相关基因(FLRG)及分化因子血清结合蛋白1(GASP-1)通过结合肌肉生成抑制素抢占了肌肉生成抑制素与激活素Ⅱb受体结合机会，故能抑制蛋白质水解[20-21]，达到肌肉肥大之目的。还有就是Sma和Mad相关蛋白7(SMAD-7)也可对肌肉生成抑制素信号起抑制作用，提升MyoD活化水平，从而进一步降低肌肉生成抑制素对肌肉生长的抑制，增加肌肉生成及分化[22-23]。 2.1.2 肌肉代谢压力机制血流限制训练能显著提升全血、血浆及肌肉内的血乳酸浓度[24-27]，而血液酸性环境刺激有利于生长素的分泌。因为阻血带限制血流后，滞留在肌肉内的乳酸向外扩散的速度显著下降，而肌肉内酸性环境的提升会增强对第Ⅳ群痛觉神经的刺激，增强了下视丘-脑垂体的信号传递能力；也可能是血液中K+、H+、AMP(二磷酸腺苷)累积及组织缺氧提升了对第Ⅲ，Ⅳ群痛觉神经的刺激，这有利于生长素的合成与分泌[28]。类胰岛素生长因子1主要功能是刺激蛋白质合成与促进组织生长，而生长素浓度增加会刺激肝脏分泌类胰岛素生长因子1[29]。但血流限制后，类胰岛素生长因子1是否会增加？目前相关研究并未达成一致意见。有些研究表明血流限制训练(低强度结合加压训练)能显著提升类胰岛素生长因子1水平[30-31]；也有研究认为血流限制训练(走路结合加压)并未发现类胰岛素生长因子1显著变化[6，32]。 2.1.3 代谢路径激活机制哺乳动物雷帕霉素靶蛋白(mammalian target rapamycin，mTOR)被认为是调节骨骼肌生长的主要通路，它能整合细胞内外的合成性激素、细胞机械性刺激与营养物质刺激，通过改变其活性而间接调整核醣体与mRNA的结合率，进一步调节细胞内部蛋白质转译速率，在细胞蛋白合成上扮演非常重要的角色。血流限制训练有利于mTOR信号通路被上游分子磷酸化而激活，此时，蛋白激酶(Akt)被类胰岛素生长因子1激活进而诱导mTOR以刺激蛋白质翻译，并在促进肌肉生长中发挥重要作用。例如：血流限制训练中被其下游效应物核糖体S6激酶1磷酸化刺激，能提高核糖体蛋白与转译因子mRNA的蛋白质转译工作，促使蛋白质合成效率显著提高[33-34]。急性低强度阻力训练结合局部加压(200 mmHg)可显著提升核糖体S6激酶1的活性及肌肉蛋白合成表现[25]；同样地，FRY等[35]以类似的方法同样发现：血流限制训练能显著提升mTOR、核糖体S6激酶1与rpS6的磷酸化过程，表明加压抗阻血训练的确有利于提升mTOR路径的磷酸作用。 2.1.4 热衰竭蛋白激活机制叉头蛋白O3A(FOXO3A)为叉头转录因子(FOXO)的家族成员，FOXO3A一方面接受Akt的调节，同时又在胰岛素(或类胰岛素生长因子1)调节的下游信号通路中起关键作用，它受两种泛蛋白连接酶Atrogin-1及MuRF-1转录因子的共同控制[36-38]。Atrogin-1和MuRF-1皆参与肌细胞泛素蛋白水解路径，其表达水平提升则意味着骨骼肌蛋白质分解加强，即骨骼肌蛋白质的降解提速，故抑制FOXO3A蛋白的激活就可降低Atrogin-1与MuRF-1的表现，从而缓解肌肉萎缩[36，39-41]。研究表明，急性血流限制训练能显著降低泛素蛋白水解路径的mRNA表现[37]，使FOXO3A下降原有水平的1.92倍、Atrogin-1下降2.1倍和MuRF-1下降2.44倍；促使卫星细胞转录，显著加快肌肉肥大信号[42-44]。还有研究发现，低强度抗阻结合局部加压(100 mmHg)训练2周后，加压组每条Ⅰ型与Ⅱ型肌纤维内的pax7含量及表现、最大收缩力及肌肉横断面积皆显著增加[44]，说明该训练模式对提升转录速率及肌纤维蛋白质有益，见图2。"

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