Blood flow restriction training (BFRT) is a modality with growing interest in the last decade and has been recognized as a critical tool in rehabilitation medicine, athletic and clinical populations. Besides its potential for positive benefits, BFRT has the capability to induce adverse responses. BFRT may evoke increased blood pressure, abnormal cardiovascular responses and impact vascular health. Furthermore, some important concerns with the use of BFRT exists for individuals with established cardiovascular disease (e.g., hypertension, diabetes mellitus, and chronic kidney disease patients). In addition, considering the potential risks of thrombosis promoted by BFRT in medically compromised populations, BFRT use warrants caution for patients that already display impaired blood coagulability, loss of antithrombotic mechanisms in the vessel wall, and stasis caused by immobility (e.g., COVID-19 patients, diabetes mellitus, hypertension, chronic kidney disease, cardiovascular disease, orthopedic post-surgery, anabolic steroid and ergogenic substance users, rheumatoid arthritis, and pregnant/postpartum women). To avoid untoward outcomes and ensure that BFRT is properly used, efficacy endpoints such as a questionnaire for risk stratification involving a review of the patient’s medical history, signs, and symptoms indicative of underlying pathology is strongly advised. Here we present a model for BFRT pre-participation screening to theoretically reduce risk by excluding people with comorbidities or medically complex histories that could unnecessarily heighten intra- and/or post-exercise occurrence of adverse events. We propose this risk stratification tool as a framework to allow clinicians to use their knowledge, skills and expertise to assess and manage any risks related to the delivery of an appropriate BFRT exercise program. The questionnaires for risk stratification are adapted to guide clinicians for the referral, assessment, and suggestion of other modalities/approaches if/when necessary. Finally, the risk stratification might serve as a guideline for clinical protocols and future randomized controlled trial studies.

The purpose of this study was to assess whether the self-regulation of training intensity based on rating of perceived exertion (RPE) is a reliable method to control the intensity during metabolic conditioning sessions of functional fitness. In addition, the relationship between RPE and the changes in heart rate, number of repetitions, and lactate responses was also analyzed. Eight male participants (age 28.1 ± 5.4 years; body mass 77.2 ± 4.4 kg; VO₂ max: 52.6 ± 4.6 mL·(kg·min)⁻¹ completed two sessions (five to seven days apart), in a randomized order, under different conditions, as follows: (1) all-out (ALL), or (2) self-regulation of intensity based on an RPE of six (hard) on the Borg CR-10 scale (RPE6). The rating of perceived exertion, lactate (LAC), and heart rate (HR) response were measured before, during, and immediately after the sessions. The RPE and LAC during the all-out sessions were higher (p < 0.0005) than the RPE6 session for all of the analyzed time points during the session. There was no difference in the HR area under the curve for the all-out and RPE6 sessions. The average number of repetitions performed was lower (p ≤ 0.009) for the RPE6 session (190.5 ± 12.5 repetitions) when compared to the all-out session (214.4 ± 18.6 repetitions). There was a significant correlation between the RPE and LAC (p = 0.005; r = 0.66; large) and number of repetitions during the session (p = 0.026; r = 0.55; large). No correlation was observed between the RPE and HR (p = 0.147; r = 0.380). These results indicate that the self-regulation of intensity of effort based on the RPE may be a useful tool to control the exercise intensity during a metabolic conditioning session of functional fitness.

Background: Blood flow restriction (BFR) exercise has shown to induce a positive influence on bone metabolism and attenuate muscle strength loss and atrophy in subjects suffering from musculoskeletal weakness. Despite the known benefits of BFR exercise, it remains unclear whether or not the pressurization of blood vessels damages the endothelial cells or increases risk for formation of thrombi. Thus, the effects of BFR exercise on coagulation, fibrinolysis, or hemostasis, remains speculative. Objective: The aim of the present study was to perform a systematic review of the short and long- term effects of BFR exercise on blood hemostasis in healthy individuals and patients with known disease (ie, hypertension, diabetes, obesity, and ischemic heart disease). Data Sources: A systematic review of English and non-English articles was conducted across PubMed, Science Direct, and Google Scholar databases, including reference lists of relevant papers. Study quality assessment was evaluated using the modified version of Downs and Black checklist. Search results were limited to exercise training studies investigating the effects of BFR exercise on blood hemostasis in healthy individuals and patients with disease. Level of evidence was determined according to the criteria described by Oxford Center for Evidence-Based Medicine. Study selection: Only randomized controlled trials (RCTs) and non-randomized controlled trials (NRCTs) that examined the effects of exercise with BFR exercise vs exercises without BFR on blood hemostasis in healthy individuals and patients were included. Data extraction: Nine studies were eligible (RCT =4; NRCT =5). Results: The average score on the Downs and Black checklist was 11.22. All studies were classified as having poor methodological quality wherein the level of evidence provided in all reviewed studies was level IIb only (ie, poor quality RCTs). Conclusion: Considering the limitations in the available evidence, firm recommendations cannot be provided.

The purpose of the present study was to compare dynamic muscle strength, functional performance, fatigue, and quality of life in premenopausal systemic lupus erythematosus (SLE) patients with low disease activity versus matched-healthy controls and to determine the association of dynamic muscle strength with fatigue, functional performance, and quality of life in SLE patients. We evaluated premenopausal (18–45 years) SLE patients with low disease activity (Systemic lupus erythematosus disease activity index [SLEDAI]: mean 1.5 ± 1.2). The control (n = 25) and patient (n = 25) groups were matched by age, physical characteristics, and the level of physical activities in daily life (International Physical Activity Questionnaire IPAQ). Both groups had not participated in regular exercise programs for at least six months prior to the study. Dynamic muscle strength was assessed by one-repetition maximum (1-RM) tests. Functional performance was assessed by the Timed Up and Go (TUG), in 30-s test a chair stand and arm curl using a 2-kg dumbbell and balance test, handgrip strength and a sit-and-reach flexibility test. Quality of life (SF-36) and fatigue were also measured. The SLE patients showed significantly lower dynamic muscle strength in all exercises (leg press 25.63%, leg extension 11.19%, leg curl 15.71%, chest press 18.33%, lat pulldown 13.56%, 1-RM total load 18.12%, P < 0.001-0.02) compared to the controls. The SLE patients also had lower functional performance, greater fatigue and poorer quality of life. In addition, fatigue, SF-36 and functional performance accounted for 52% of the variance in dynamic muscle strength in the SLE patients. Premenopausal SLE patients with low disease activity showed lower dynamic muscle strength, along with increased fatigue, reduced functional performance, and poorer quality of life when compared to matched controls.

Purpose: The purpose of the present study was to identify the variability of blood pressure response to a 10-week resistance training (RT) program in hypertensive and normotensive elderly women. Participants and methods: Twenty-seven untrained hypertensive and 12 normotensive elderly women participated in the present study. A whole-body RT program was performed on two nonconsecutive days per week for 10 weeks. The responsiveness of resting systolic blood pressure (SBP) was determined based on the percent decline between the pre- and post-training time points T1 and T4. The term responders were used to describe subjects who exhibited a percent SBP decline ≥−2.58% and the term nonresponders for subjects who exhibited a percent SBP decline <−2.58%, respectively. Results: Both the responders and nonresponders in the hypertensive group presented significant changes in SBP (−7.83 ± 5.70 mmHg vs 3.78 ± 7.42 mmHg), respectively. Moreover, the responders and nonresponders in the normotensive group presented significant changes in SBP as well (−8.58 ± 5.52 mmHg vs 5.71 ± 3.84 mmHg). Conclusion: SBP presents a heterogeneous response to a controlled RT program in hypertensive and normotensive elderly women. A different modality of training and additional therapies should be used for nonresponders in order to decrease resting SBP.