Effects of endurance training with blood flow restriction on aerobic capacity, lower limb muscle strength, and sports performance: a Meta-analysis

doi:10.12307/2024.398

Abstract

Abstract: OBJECTIVE: To systematically assess the effect of blood flow restriction combined with endurance training on aerobic capacity, lower limb muscle strength, and sports performance of athletes using Meta-analysis.
METHODS: 3210 studies were searched in CNKI, VIP, WanFang, PubMed, Embase, Web of Science, ScienceDirect, and Cochrane databases before March 2023. After screening, 12 studies and 14 research reports were included. The traditional Meta-analysis and network Meta-analysis were performed by Review Manager 5.4 and Stata 14.
RESULTS: Endurance training with blood flow restriction had a medium effect size on maximal oxygen uptake (standardized mean difference (SMD)=0.59, 95% confidence interval (CI): 0.28-0.90, P < 0.05) and no heterogeneity. The effect of continuous pressure was better than the other pressure types (P < 0.05). Compared with sports events by anaerobic energy supply, sports events by aerobic energy supply showed better effects (P < 0.05), which was set as follows: 4-8 weeks of aerobic training, 20-30 minutes once, 3 or more sessions per week, for a total of 12 or more sessions. Secondly, endurance training with blood flow restriction showed a large effect on the lower limb muscle strength (SMD=0.99, 95% CI: 0.61-1.37, P < 0.05) and no heterogeneity. A subgroup analysis showed muscle endurance was the best improved (SMD=1.11; 95% CI: 0.37-1.85), followed by knee extension strength (SMD=1.02, 95% CI: 0.37-1.67) and knee flexion strength (SMD=0.87, 95% CI: 0.24-1.51). Finally, endurance training with blood flow restriction showed a medium effect on sports performance (SMD=0.59, 95% CI: 0.13-1.06, P < 0.05), and the subgroup analysis showed a medium effect on running performance (SMD=0.55, 95% CI: 0.05-1.06, P < 0.05) and no heterogeneity. There was only one item of soccer specific performance that was not analyzed.
CONCLUSION: Endurance training combined with blood flow restriction can improve the aerobic capacity, lower limb muscle strength, and sports performance of the athletes. And there is a large effect on lower limb muscle strength and a medium effect on aerobic capacity and sports performance. A training schedule of progressive mixed-intensity aerobic endurance training under continuous pressure for no less than 4 weeks, 3 sessions per week, 20-30 minutes per session, for 12 or more sessions in total is easy to obtain better training results.

Key words: blood flow restriction training, endurance training, aerobic capacity, athlete, Meta-analysis

CLC Number:

Dong Kuan, Xu Chengli, Tian Jing, Xu Changchun. Effects of endurance training with blood flow restriction on aerobic capacity, lower limb muscle strength, and sports performance: a Meta-analysis[J]. Chinese Journal of Tissue Engineering Research, 2024, 28(23): 3766-3772.

Figures/Tables 11

References

[1] SATO Y. The history and future of KAATSU Training. Int J KAATSU Train Res. 2005;1(1):1-5.
[2] DEPHILLIPO NN, KENNEDY MI, AMAN ZS, et al. The Role of Blood Flow Restriction Therapy Following Knee Surgery: Expert Opinion. Arthroscopy. 2018;34(8):2506-2510.
[3] 魏佳,李博,杨威,等.血流限制训练的应用效果与作用机制[J].体育科学,2019,39(4): 71-80.
[4] PIGNANELLI C, CHRISTIANSEN D, BURR JF. Blood flow restriction training and the high-performance athlete: science to application. J Appl Physiol (1985). 2021;130(4):1163-1170.
[5] SCOTT BR, SLATTERY KM, SCULLEY DV, et al. Hypoxia and resistance exercise: a comparison of localized and systemic methods. Sports Med. 2014;44(8):1037-1054.
[6] YASUDA T, LOENNEKE JP, THIEBAUD RS, et al. Effects of blood flow restricted low-intensity concentric or eccentric training on muscle size and strength. PLoS One. 2012;7(12):e52843.
[7] LOENNEKE JP, FAHS CA, ROSSOW LM, et al. The anabolic benefits of venous blood flow restriction training may be induced by muscle cell swelling. Med Hypotheses. 2012; 78(1):151-154.
[8] 徐飞,王健.加压力量训练:释义及应用[J].体育科学,2013,33(12):71-80.
[9] TAKARADA Y, NAKAMURA Y, ARUGA S, et al. Rapid increase in plasma growth hormone after low-intensity resistance exercise with vascular occlusion. J Appl Physiol (1985). 2000; 88(1):61-65.
[10] FRY CS, GLYNN EL, DRUMMOND MJ, et al. Blood flow restriction exercise stimulates mTORC1 signaling and muscle protein synthesis in older men. J Appl Physiol (1985). 2010;108(5):1199-1209.
[11] COOK SB, CLARK BC, PLOUTZ-SNYDER LL. Effects of exercise load and blood-flow restriction on skeletal muscle function. Med Sci Sports Exerc. 2007;39(10):1708-1713.
[12] HORIUCHI M, ENDO J, THIJSSEN DH. Impact of ischemic preconditioning on functional sympatholysis during handgrip exercise in humans. Physiol Rep. 2015;3(2):e12304.
[13] ENKO K, NAKAMURA K, YUNOKI K, et al. Intermittent arm ischemia induces vasodilatation of the contralateral upper limb. J Physiol Sci. 2011;61(6):507-513.
[14] 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. Sports Med. 2019;49(11):1787-1805.
[15] INCOGNITO AV, BURR JF, MILLAR PJ. The Effects of Ischemic Preconditioning on Human Exercise Performance. Sports Med. 2016;46(4):531-544.
[16] KILDUFF LP, FINN CV, BAKER JS, et al. Preconditioning strategies to enhance physical performance on the day of competition. Int J Sports Physiol Perform. 2013;8(6):677-681.
[17] LOENNEKE JP, YOUNG KC, WILSON JM, et al. Rehabilitation of an osteochondral fracture using blood flow restricted exercise: a case review. J Bodyw Mov Ther. 2013;17(1):42-45.
[18] WORTMAN RJ, BROWN SM, SAVAGE-ELLIOTT I, et al. Blood Flow Restriction Training for Athletes: A Systematic Review. Am J Sports Med. 2021;49(7):1938-1944.
[19] 李志远,赵之光,王明波,等.4周加压训练对男子手球运动员身体成分和最大力量的影响[J].中国体育科技,2019,55(5):37-43.
[20] FERGUSON RA, MITCHELL EA, TAYLOR CW, et al. Blood-flow-restricted exercise: Strategies for enhancing muscle adaptation and performance in the endurance-trained athlete. Exp Physiol. 2021;106(4):837-860.
[21] CASTILLA-LÓPEZ C, MOLINA-MULA J, ROMERO-FRANCO N. Blood flow restriction during training for improving the aerobic capacity and sport performance of trained athletes: A systematic review and meta-analysis. J Exerc Sci Fit. 2022;20(2):190-197.
[22] SILVA JCG, DOMINGOS-GOMES JR, FREITAS EDS, et al. Physiological and Perceptual Responses to Aerobic Exercise With and Without Blood Flow Restriction. J Strength Cond Res. 2021;35(9):2479-2485.
[23] ABE T, KEARNS CF, SATO Y. Muscle size and strength are increased following walk training with restricted venous blood flow from the leg muscle, Kaatsu-walk training. J Appl Physiol (1985). 2006;100(5):1460-1466.
[24] BENNETT H, SLATTERY F. Effects of Blood Flow Restriction Training on Aerobic Capacity and Performance: A Systematic Review. J Strength Cond Res. 2019;33(2):572-583.
[25] TZVETKOV S.Indicators of effectiveness and economy in evaluation of functional working capability of elite athletes. Act Phys Educ Sport. 2017;7(1):95-99.
[26] NUÑEZ J, SUAREZ-ARRONES L, DE HOYO M, et al. Strength Training in Professional Soccer: Effects on Short-sprint and Jump Performance. Int J Sports Med. 2022;43(6):485-495.
[27] MOSELEY AM, HERBERT RD, SHERRINGTON C, et al. Evidence for physiotherapy practice: a survey of the Physiotherapy Evidence Database (PEDro). Aust J Physiother. 2002;48(1):43-49.
[28] HOPKINS WG, MARSHALL SW, BATTERHAM AM, et al. Progressive statistics for studies in sports medicine and exercise science. Med Sci Sports Exerc. 2009;41(1):3-13.
[29] GIOVANNA M, SOLSONA R, SANCHEZ AMJ, et al. Effects of short-term repeated sprint training in hypoxia or with blood flow restriction on response to exercise. J Physiol Anthropol. 2022;41(1):32.
[30] 吴明云.加压有氧训练对空手道组手运动员有氧能力的影响[D].上海:上海体育学院, 2021.
[31] AMANI AR, SADEGHI H, AFSHARNEZHAD T. Interval Training With Blood Flow Restriction On Aerobic Performance Among Young Soccer Players At Transition Phase. Monten J Sports Sci Med. 2018;7(2):5-10.
[32] AMANI-SHALAMZARI S, FARHANI F, RAJABI H, et al. Blood Flow Restriction During Futsal Training Increases Muscle Activation and Strength. Front Physiol. 2019;10:614.
[33] AMANI-SHALAMZARI S, SARIKHANI A, PATON C, et al. Occlusion Training During Specific Futsal Training Improves Aspects of Physiological and Physical Performance. J Sports Sci Med. 2020;19(2):374-382.
[34] HELD S, BEHRINGER M, DONATH L. Low intensity rowing with blood flow restriction over 5 weeks increases V̇O2max in elite rowers: A randomized controlled trial. J Sci Med Sport. 2020;23(3):304-308.
[35] CHEN YT, HSIEH YY, HO JY, et al. Running Training Combined With Blood Flow Restriction Increases Cardiopulmonary Function and Muscle Strength in Endurance Athletes. J Strength Cond Res. 2022;36(5):1228-1237.
[36] HOSSEINI KAKHAK SA, KIANIGUL M, HAGHIGHI AH, et al. Performing Soccer-Specific Training With Blood Flow Restriction Enhances Physical Capacities in Youth Soccer Players. J Strength Cond Res. 2022;36(7):1972-1977.
[37] PARK S, KIM JK, CHOI HM, et al. Increase in maximal oxygen uptake following 2-week walk training with blood flow occlusion in athletes. Eur J Appl Physiol. 2010;109(4):591-600.
[38] MITCHELL EA, MARTIN NRW, TURNER MC, et al. The combined effect of sprint interval training and postexercise blood flow restriction on critical power, capillary growth, and mitochondrial proteins in trained cyclists. J Appl Physiol (1985). 2019;126(1):51-59.
[39] TAYLOR CW, INGHAM SA, FERGUSON RA. Acute and chronic effect of sprint interval training combined with postexercise blood-flow restriction in trained individuals. Exp Physiol. 2016;101(1):143-154.
[40] 方杰.加压血流阻滞训练对无氧耐力及400米跑运动成绩的影响研究[D].广州:广州体育学院,2018.
[41] PATON CD, ADDIS SM, TAYLOR LA. The effects of muscle blood flow restriction during running training on measures of aerobic capacity and run time to exhaustion. Eur J Appl Physiol. 2017;117(12):2579-2585.
[42] AMANI-SHALAMZARI S, RAJABI S, RAJABI H, et al. Effects of Blood Flow Restriction and Exercise Intensity on Aerobic, Anaerobic, and Muscle Strength Adaptations in Physically Active Collegiate Women. Front Physiol. 2019; 10:810.
[43] SLYSZ JT, BURR JF. Impact of 8 weeks of repeated ischemic preconditioning on running performance. Eur J Appl Physiol. 2019;119(6): 1431-1437.
[44] FARUP J, DE PAOLI F, BJERG K, et al. Blood flow restricted and traditional resistance training performed to fatigue produce equal muscle hypertrophy. Scand J Med Sci Sports. 2015;25(6):754-763.
[45] MANIMMANAKORN A, HAMLIN MJ, ROSS JJ, et al. Effects of low-load resistance training combined with blood flow restriction or hypoxia on muscle function and performance in netball athletes. J Sci Med Sport. 2013;16(4): 337-342.
[46] ABE T, FUJITA S, NAKAJIMA T, et al. Effects of Low-Intensity Cycle Training with Restricted Leg Blood Flow on Thigh Muscle Volume and VO2MAX in Young Men. J Sports Sci Med. 2010;9(3):452-458.
[47] MERTZ KH, REITELSEDER S, BECHSHOEFT R, et al. The effect of daily protein supplementation, with or without resistance training for 1 year, on muscle size, strength, and function in healthy older adults: A randomized controlled trial. Am J Clin Nutr. 2021;113(4):790-800.
[48] RODRÍGUEZ-ROSELL D, FRANCO-MÁRQUEZ F, MORA-CUSTODIO R, et al. Effect of High-Speed Strength Training on Physical Performance in Young Soccer Players of Different Ages. J Strength Cond Res. 2017;31(9):2498-2508.
[49] STEINER T, WEHRLIN JP. Does hemoglobin mass increase from age 16 to 21 and 28 in elite endurance athletes? Med Sci Sports Exerc. 2011;43(9):1735-1743.
[50] KOMI PV, GOLLHOFER A. Stretch Reflexes Can Have an Important Role in Force Enhancement During SSC Exercise. J Appl Biomech.1997;13(4):451-460.
[51] TAUBE W, LEUKEL C, GOLLHOFER A. How neurons make us jump: the neural control of stretch-shortening cycle movements. Exerc Sport Sci Rev. 2012;40(2):106-115.
[52] CORMIE P, MCGUIGAN MR, NEWTON RU. Developing maximal neuromuscular power: part 2 - training considerations for improving maximal power production. Sports Med. 2011;41(2):125-146.
[53] MARKOVIC G, MIKULIC P. Neuro-musculoskeletal and performance adaptations to lower-extremity plyometric training. Sports Med. 2010;40(10):859-895.
[54] BOBBERT MF. Drop jumping as a training method for jumping ability. Sports Med. 1990; 9(1):7-22.
[55] MALISOUX L, FRANCAUX M, NIELENS H, et al. Stretch-shortening cycle exercises: an effective training paradigm to enhance power output of human single muscle fibers. J Appl Physiol (1985). 2006;100(3):771-779.
[56] LAURSEN PB, SHING CM, PEAKE JM, et al. Influence of high-intensity interval training on adaptations in well-trained cyclists. J Strength Cond Res. 2005;19(3):527-533.
[57] THOMAS K, GOODALL S, STONE M, et al. Central and peripheral fatigue in male cyclists after 4-, 20-, and 40-km time trials. Med Sci Sports Exerc. 2015;47(3):537-546.
[58] CHRISTIANSEN D, EIBYE KH, RASMUSSEN V, et al. Cycling with blood flow restriction improves performance and muscle K+ regulation and alters the effect of anti-oxidant infusion in humans. J Physiol. 2019;597(9):2421-2444.
[59] GREEN H, DAHLY A, SHOEMAKER K, et al. Serial effects of high-resistance and prolonged endurance training on Na+-K+ pump concentration and enzymatic activities in human vastus lateralis. Acta Physiol Scand. 1999;165(2):177-184.
[60] SUNDE A, STØREN O, BJERKAAS M, et al. Maximal strength training improves cycling economy in competitive cyclists. J Strength Cond Res. 2010;24(8):2157-2165.
[61] HOFF J, GRAN A, HELGERUD J. Maximal strength training improves aerobic endurance performance. Scand J Med Sci Sports. 2002; 12(5):288-295.
[62] RØNNESTAD BR, HANSEN J, HOLLAN I, et al. Strength training improves performance and pedaling characteristics in elite cyclists. Scand J Med Sci Sports. 2015;25(1):e89-98.
[63] LOENNEKE JP, FAHS CA, ROSSOW LM, et al. Effects of cuff width on arterial occlusion: implications for blood flow restricted exercise. Eur J Appl Physiol. 2012;112(8):2903-2912.
[64] SIELJACKS P, KNUDSEN L, WERNBOM M, et al. Body position influences arterial occlusion pressure: implications for the standardization of pressure during blood flow restricted exercise. Eur J Appl Physiol. 2018;118(2):303-312.
[65] 郜卫峰,冯鑫,顾大成.同期耐力与力量训练对长跑运动员跑步经济性及耐力表现相关指标影响的Meta分析[J].体育科学, 2019,39(9):68-81.