Updated database searches were completed in September 2019 and January 2020. Articles were included if researchers used clinically available blood flow restriction equipment, used resistance or aerobic training in combination with BFR, used quantitative outcome measures, and were not dismissed by the exclusion criteria. 5,6 Four researchers calculated PEDro scores and CEBM levels of evidence and came to mutual agreement regarding when articles should be excluded due to inadequate quality. Additionally, studies with PEDro scores less than 4 were excluded, as this score has been used previously to delineate “poor” quality from “fair”, “good”, and “excellent” quality studies. Studies with CEBM level of evidence less than two were excluded, as the focus of this article was to review meta-analyses, RCTs, and cohort studies. Exclusion criteria for articles included research focusing on local musculoskeletal changes due to BFR training, studies examining passive BFR or ischemic preconditioning, and articles that did not originate from a scholarly peer-reviewed journal. Titles and abstracts of articles were assessed by one of the four authors and a hand search of the systematic reviews by four authors yielded additional articles that were deemed relevant based on their titles and abstracts. Search criteria were filtered by article type (research articles, practice guidelines) and the year range 2009-2020. Initial search terms included “blood flow restriction”, “occlusion training”, “restriction of blood flow”, “systemic effects”, “blood flow restriction training”, “partial occlusion”, “effect or effects”. The following databases were used in the search: MedLine, ScienceDirect, PubMed, Cochrane Reviews and CINAHL Complete. By further understanding the systemic effects of BFR training, clinicians may be able to incorporate this technique safely in the rehabilitation of patients who cannot perform high load resistance or aerobic training.Īn original database search was completed in June 2019 with a focus on the topic of the systemic effects of blood flow restriction (BFR) training. In order to better understand BFR and its overall impact on the human body, the purpose of this study was to systematically review the systemic effects of blood flow restriction training when combined with an exercise intervention. Multiple systems may be affected by BFR training, but a thorough analysis of these effects is still needed. The focus of BFR is to cause beneficial adaptations to local skeletal muscle, but there is limited information reported on the effects of BFR training on other body systems. Research on BFR training has suggested other possible benefits or detriments involving systems other than the musculoskeletal system however, these effects have not been determined conclusively. Typically, research on BFR training reports the localized changes in muscle mass, strength, and muscle endurance of the extremity on which the cuff is applied. Findings also suggest that those using BFR during training such as a cycling exercise program may receive the benefits of increased skeletal muscle mass and strength along with improved cardiovascular/muscular endurance. 2,3 These findings may make the use of BFR valuable in the rehabilitation of patients who may not be able to perform high load resistance training such as the elderly, patients undergoing rehabilitation, recovering athletes, or in patients with other medical conditions such as renal disease, metabolic dysfunction, heart disease, or medically compromised high risk patients. 2 However, researchers have found that BFR in conjunction with low load resistance training, cardiovascular endurance training, and other forms of exercise not generally indicated to improve muscular mass/strength also cause these muscular adaptations. 1 Traditionally, when attempting to improve muscle mass and strength, high intensity resistance training using loads of ~70-85% of a one-repetition max (1-RM) is most often indicated. BFR uses a belt or tourniquet applied to the proximal portion of an extremity to partially or fully occlude blood flow in order to stimulate muscular adaptations that improve muscular mass and strength. Blood flow restriction (BFR) training has been found to have significant benefits for skeletal muscle development.
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