2. Resistance Training &Vascular
Occlusion
American College of Sports Medicine (2009) recommends that one should
lift a minimum of 65-70% of their One repetition maximum (1RM) in order to
induce muscular hypertrophy (Kraemer et al., 2002; Loenneke et al., 2010).
Muscle hypertrophy seen to occur at intensities as low as 20%1RM when in
an occluded state (Ohta et al., 2003; Sumide et al., 2009, Loenneke et al.,
2013).
Takarada et al, (2000a) found a 20.3% increase in the muscle cross-
sectional area of the biceps brachii when occluded compared to a 6.9%
increase when non-occluded at intensities of ≈50%1RM
Measuring the effects of vascular occlusion
iEMG (Yasuda et al., 2008)
Biodex Isokinetic Dynamometer
Elbow Flexion 1RM (Pereira & Gomes, 2003)
MRI
Arm Circumference
3. Physiology of Occlusion
Training
Physiological effects of occlusion training
Increased:
Blood/Plasma Lactate & GH (Takarada et al., 2000b), GASP-1 & SMAD-7 ( Santos et al.,
2014) Phosphorylation and protein synthesis (Neves da Costa et al., 2012)
Decreased:
Myostatin (Kawada & Ishii., 2005)
Possible mechanisms for growth:
Limited Oxygen Availability (Idstrom et al., 1986; Moritani et al., 1992)
Recruitment of FT fibers at low intensities (Takarada et al., 2000a; Takarada et al., 2000b;
Takarada et al., 2000c)
Accumulation of metabolites
Lactic Acid, H+, Phosphate Groups, K+ and AMP (Takano et al., 2005; Schoenfeld., 2010)
Inhibition of Myostatin
Up regulation of GASP-1 & SMAD-7
Reactive Oxygen Species
Nitric Oxide (Loenneke., 2010)
4. Applications of Vascular
Occlusion
Application
Elderly (Takarada et al., 2000a; Yokokawa et al., 2008; Karabulut et al., 2010;
Karabulut et al., 2011; Ozaki et al., 2011)
Rehab
ACL Injuries (Takarada et al., 2000c; Ohta et al., 2003)
Safety Issues
Occlusion pressure (Kacin & Strazar, 2011)
Pain (Nakajima et., 2006; Clark et al., 2010)
1.6% out of 300 000 sessions reported transient numbness and soreness
Blood Coagulation (Harman, 1948 & Nakajima et al., 2006)
0.06% out of 300 000 sessions resulted in transient thrombosis
Oxidative Stress (Halliwell and Gutteridge., 1999)
An imbalance between free radicals and antioxidant defenses (Loenneke et al., 2010)
Increased vascular permeability
5. Research Design
Rationale
A plethora of research investigating lower body occlusion training (Takarada et al., 2002; Abe
et al., 2005; Clark et al., 2011)
Specifically increasing the level of occlusion throughout the study as a means of
progressive overload (Karabulut et al., 2010; Karabulut et al., 2011)
No literature has investigated the use of occlusion pressure as a method of progressive
overload in upper body training (Fahs et al., 2012)
Aims
Identify physiological responses to occlusion training with regards to elbow flexion
Measure strength and hypertrophic responses to occlusion training, specifically elbow flexion
Investigate how different pressures of occlusion affect strength in untrained athletes
Hypothesis
Alternative: A higher pressure of occlusion will result in greater strength and hypertrophic
responses
Null: There will be no significant difference in hypertrophic or strength measurements after a
6 week occlusion program between a constant level of occlusion and and increasing level of
occlusion
6. Methodology
1RM Test (Pereria & Gomes., 2003)
Arm Circumference Measurements
Statistics / Sampling
One-way MANOVA
Snowball
Intervention
15-18 participants
3 groups – 40%1RM CON/40%1RM 100mmHg/40%1RM Increasing
Procedures
Warm up
Cycle Ergometer or Arm Bike – 5 minutes
Volume (Burgomaster et al., 2003)
3 Sets
8-10 reps
Rest
60s between each set
7. Considerations
Considerations
Material (Rossow et al., 2012)
Narrower cuffs are often made of elastic material
Wider cuffs are often made of nylon
Cuff Width
Upper body: width of 3cm (Yasuda et al., 2011; Takarada et al., 2000)
Lower Body: 5-7cm (Abe et al., 2005; Sakaruba et al., 2009)
Cuff Pressure
Relative vs. Absolute (Loenneke et al., 2013)
Should be based on a percentage of complete arterial pressure as opposed to
systolic blood pressure (SBP) (Loenneke et al., 2012)
Should be adjusted according to the width of the cuff as a wider cuff has a
higher initial pressure (Fahs et al., 2012; Loenneke et al., 2012; Loenneke et
al., 2013)
Duration of Cuff Pressure
Intermittent vs. Continuous (Fahs et al., 2012)
Dominant vs. Non-dominant hand
8. GANTT Chart
Key = PredictedTimescale = Holiday/ExamPeriod
= Actual Time Scale = Estimated final hand in
OCTOBER 2015 NOVEMBER 2015 DECEMBER 2015 JANUARY 2016
Detail of work
Week 1 Week 2 Week 3 Week 4 Week 5 Week 6 Week 7 Week 8 Week 9 Week 10 Week 11 HOLIDAY Week 12 Week 13 Week 14 Week 15
29/09/14 04/10/14 11/10/14 18/10/14 25/10/14 01/11/14 08/11/14 15/11/14 22/11/14 29/11/14 06/12/14 13/12/14 20/12/14 27/12/14 04/01/15 11/01/15 18/01/15 25/01/15
Ethics
Review Literature
Participant Recruitment
FEBRUARY 2016 MARCH 2016 APRIL 2016 MAY 2016
Week 1 Week 2 Week 3 Week 4 Week 5 Week 6 Week 7 Week 8 Week 9 Week 10 Week 11 Week 12 Week 13 Week 14
01/02/15 08/02/15 15/02/15 22/02/15 29/02/2015 07/03/15 14/03/15 21/03/15 28/03/15 04/04/15 11/04/15 18/04/15 25/04/15 02/05/15 09/05/15 16/05/15 23/05/15 30/05/15
Paticipant Recruitment
Data Collection
Data Analysis
Write Up
Research Poster
9. References
Abe, T., Kawamoto, K., Yasuda, T., et al., 2005. Eight days KAATSU-resistance training improved
sprint but not jump performance in collegiate male track and field athletes. International Journal of
KAATSU Training Research, 1(1) pp 19-23.
American College of Sports Medicine Position Stand., 2009. Progression models in resistance
training for healthy adults. Journal of Medicine & Science in Sports & Exercise, 41 pp 687–708.
Burgomaster, A. K., et al., 2003. Resistance Training with Vascular Occlusion: Metabolic
Adaptaitons in Human Muscle. American College of Sports Medicine, 3(507) pp 1203-1208.
Clark, B. C., et al., 2010. Relative safety of 4 weeks of blood flow-restricted resistance exercise in
young, healthy adults. Scandinavian Journal of Medicine & Science in Sports: doi: 10.1111/j.1600-
0838.2010.01100.x.
Fahs, T., et al 2012. Methodological Considerations for Blood Flow Restricted Resistance
Exercise. Journal of Trainology, 1 pp 14-22.
Halliwell, B., and Gutteridge, J. M. C., 1999. Free radicals in biology and medicine. Oxford:
Clarendon Press/Oxford University Press.
Harman, J. W., 1948. The significance of local vascular phenomena in the production of ischemic
necrosis in skeletal muscle. American Journal of Pathology, 24, pp 625–641.
Idstrom, J. P., Subramanian, V. H., Chance, B., et al., 1986. Energy metabolism in relation to
oxygen supply in contracting rat skeletal muscle. Federation Proceedings, 45 pp 2937 – 2941.
Kacin, A., and Strazar, K., 2011. Frequent Low-load Ischemic Resistance Exercise to Failure
Enhances Muscle Oxygen Delivery and Endurance Capacity. Scandinavian Journal of Medical
Science and Sport, 21(6) pp 231-241.
10. References Cont.
Karabulut, M., Abe, T., Sato, Y., et al., 2010. The effects of low-intensity resistance training with
vascular restriction on leg muscle strength in older men. European Journal of Applied Physiology,
108(1) pp147-155.
Karabulut, M., Bemben, D. A., Sherk, V. D., et al., 2011. Effects of high-intensity resistance
training and low-intensity resistance training with vascular restriction on bone markers in older
men. European Journal of Applied Physiology, 111(8 ) pp 1559-1567.
Kawada, S., & Ishii, N., 2005. Skeletal muscle hypertrophy after chronic restriction of venous
blood flow in rats. Journal of Medicine & Science in Sports & Exercise, 37 pp 1144–1150.
Kraemer, W. J., Adams, K., Cafarelli, E., et al., 2002. Progression models resistance training for
healthy adults. Journal of Medicine & Science in Sport & Exercise, 34 pp 364-380
Loenneke J. P., Pujol, T. J., 2009. The use of occlusion training to produce muscle hypertrophy.
Strength & Conditioning Journal, 31 pp 77–84
Loenneke, J. P., Wilson, G. J., Wilson, J. M., 2010a. A mechanistic approach to blood flow
occlusion. International Journal of Sports Medicine, 31 pp 1–4.
Loenneke, J. P., Kearney, M, L., Thrower, A, D., et al., 2010b. The acute response of practical
occlusion in the knee extensors. Journal of Strength & Conditioning Research, 24(10) pp 2831-
2834.
Loenneke, J. P., Fahs, C. A., Rossow, L. M., et al., 2012. Effects of cuff width on arterial
occlusion: implications for blood flow restricted exercise. European Journal of Applied Physiology,
112 pp2903–2912. doi: 10.1007/s00421-011-2266-8
Loenneke, J. P., Thiebaud, R. S., Fahs, C. A., et al., 2013. Effect of cuff type on arterial
occlusion. Clinical Physiology & Functional Imaging, 33 pp 325–327. doi: 10.1111/cpf.12035
11. References Cont..
Moritani, T., Sherman, W. M., Shibata, M., et al., 1992. Oxygen availability and motor unit activity
in humans. European Journal of Applied Physiology, 64 pp 552 – 556.
Neves da Costa, P. G., Moreira, P. V., Curcio dos Ries, C., et al., 2012. The Effects of Partial
Vascular Occlusion on Gaining Muscular Strength. Acta Fisiatra, 19(3) pp 192-197.
Nakajima, T., Kurano, M., Iida, H., et al., 2006. Use and safety of KAATSU training: results of a
national survey. International Journal of KAATSU Training Research, 2 pp5–13.
Ohta, H., Kurosawa, H., Ikeda, H., et al., 2003. Low-load resistance muscular training with
moderate restriction of blood flow after anterior cruciate ligament reconstruction. Acta
Orthopedica Scandinavia, 74 pp 62–68.
Ozaki, H., Sakamaki, M., Yasuda, T., et al., 2011. Increases in aerobic capacity and thigh muscle
volume by walk training with leg blood flow reduction in the elderly. Journal of Gerentology A
Series: Biological Sciences and Medical Sciences, 66 pp 257-263
Pereria, R. I. M., and Gomes, C. S. P., 2003. Muscular Strengths and Endurance Tests: reliability
and prediction of one repetition maximum – Review and New Evidence. Brazillian journal of
Sporting Medicine, 9(5) pp 336 – 346
Rossow, L, M., Fahs, C, A., Loenneke, J, P., et al., 2012. Cardiovascular and perceptual
responses to blood-flow-restricted resistance exercise with differing restrictive cuffs. Clinical
Physiology & Functional Imaging, 32(5) pp 331–337
Sakuraba, K., & Ishikawa, T., 2009. Effect of isokinetic resistance training under a condition of
restricted blood flow with pressure. Journal of Orthopedic Science 14(5) pp631-639.
12. References Cont…
Schoenfeld, J. B., 2010. The Mechanisms of Muscle Hypertrophy and Their Applications to
Resistance Training. Journal of Strength and Conditioning Research, 24(10) pp 2857-2872
Sumide et al., 2009. Effects of Resistance Exercise Combines with Relatively Low Vascular
Occlusion. Journal of Science and Medicine in Sport, 121(1) pp 107-112
Takano H, Morita T, Iida H, et al., 2005. Hemodynamic and hormonal responses to a short-term
low-intensity resistance exercise with the reduction of muscle blood flow. European Journal of
Applied Physiology, 95 pp 65–73.
Takarada, Y., et al., 2000a. Effects of Resistance Exercise Combined With Moderate Vascular
Occlusion on Muscular Functions in Humans; Journal of Applied Physiology, 88(6) pp 2097-2106
Takarada, Y., Nakamura, Y., Aruga, S., et al., 2000b. Rapid increase in plasma growth hormone
after low-intensity resistance exercise with vascular occlusion. Journal of Applied Physiology, 88
pp 61–65.
Takarada Y , Takazawa H , Ishii, N., et al., 2000c. Application of vascular occlusion diminish
disuse atrophy of knee extensor muscles. Journal of Medicine & Science in Sports & Exercise, 32
pp 2035 – 2039
Takarada, Y., Sato, Y., and Ishii, N., 2002. Effects of Resistance Exercise Combined With
Vascular Occlusion on Muscle Function in Athletes. European Journal of Applied Physiology, 86
pp 808-314
Yasuda, T., et al., 2008. Muscle activation during low-intensity muscle contractions with restricted
blood flow. Journal of Sports Sciences, 27(5) pp 479-489
13. References Cont....
Yasuda, T., Ogasawara, R., Sakamaki, M., et al., 2011. Combined effects of low intensity blood
flow restriction training and high-intensity resistance training on muscle strength and size.
European Journal of Applied Physiology, 111(10) pp 2525-2533
Yokokawa, Y., Hongo, M., Urayama, H., et al., 2008. Effects of low-intensity resistance exercise
with vascular occlusion on physical function in healthy elderly people. Trends in Biosciences, 2(3)
pp117-123.
Editor's Notes
Past research has identified that vascular occlusion can be performed as a sufficient training mode to traditional resistance training. Originally termed KAATSU training, founded by Dr Sato in Japan in 1993. It’s purpose is to provoke hypertrophic responses by reducing the blood supply to the working muscles by applying a pressurized cuff to the proximal portion of the muscle being trained/utilized.
Vascular occlusion training is seen to mimic the environment of high intensity resistance training; a build up fatiguing by products without putting strain on the tendons and ligaments and being conducted at much lower intensities.
Measure EMG to assess the electrical activity of the muscle under investigation. As occluding the muscle may result in an increase in the number of fibers recruited over a specific time in order to maintain the required force to complete the exercise. Takarada et al., 2000, reported that when working without occlusion at 40%1RM there was a decrease by about 40% in the relative iEMG. This suggests there could be a relationship between the level of occlusion and the level of electrical activity of the muscle when contracting.
Isokinetic Dynamometers have been used in order to asses the changes in strength
Heinemann’s size principle dictates that slow twitch fibers are recruited at low intensities, then as the intensity increases fast twitch fibers are recruited. However during occlusion training FT fibers are recruited at LI. Moritani suggested that the FT fibers are recruited due to the lack of oxygen available to the muscle. Studies have shown, using iEMG’s that FT fibers have been recruited at LIO pressures suggesting that motor unit recruitment is also affected by the oxygen availability.
An increase in metabolites such as lactic acid, H+, phosphates, K+ and AMP results in an acidic intracellular environment which stimulates groups III & IV afferent muscle fibres and causes and increase in muscle sympathetic nerve activity (MSNA). This increases Q, HR and BP, vasoconstricts the non-occluded muscles and redirects blood flow to the working muscles. This process is known as metaboreflex. Furthermore, the same pathway has been evident in playing a role in the secretion of GH. As Takarada et al. found a 290% increase in GH in subjects that completed occlusion training program
Myostatin is a member of the TGF Beta Protein superfamily that negatively regulates muscle mass. It binds to specific receptors of muscle stem cells in order to limit their proliferation. However, during occlusion training two proteins (SMAD-7 & GASP-1) are up-regulated, which causes a down regulation in Myostatin, specifically, SMAD-7 binds to the activin IIb receptor which prevents Myostatin from cell signaling and GASP-1 blocks the proliferation of myostatin through the inhibition on protease, thereby allowing an increase muscle stem cell proliferation.
Reactive oxygen species has been shown to promote muscular hypertrophy in smooth and cardiac muscle. Specifically Nitric Oxide has been shown to increase the proliferation of satellite cells resulting in the hypertrophy of skeletal muscle. This is thought to be due to a spike in NO production which releases hepatocyte growth factor (HGF). However, more research is required as NO is very hard to measure due to its short half life
----- Meeting Notes (24/10/15 16:14) -----
what the fuck is cell signalling?
A substantial amount of literature that has shown using vascular occlusion on the elderly population has increased the strength and muscle CSA whilst working at low intensities.
Furthermore, Ohta et al investigated the effect of occlusion training after ACL injuries among 44 patients. The group that conducted leg extensor exercises at occlusions pressures of 180mmHg produced significant strength and hypertrophic gains compared to the group that performed leg extensions without occlusion.
Arterial Pressure is known to cause pain during high intensity resistance training. However occlusion training is only at low intensities thus, high arterial pressures are eliminated.
Was numbness and soreness due to nerve blockage? Clark et al., monitored sensory nerve conduction for 4 weeks of low level occlusion (30%1RM) and NCV was unchanged as expected.
Vascular Occlusion can cause the formation of a thrombus and potentially microvascular occlusion even after training. This could result in muscle damage and cell necrosis – death of cell. However Nakajima conducted an occlusion training study which contained over 300 000 training sessions and only 0.06% resulted in an incidence of venous thrombosis.
Oxidative stress is an imbalance between free radicals (oxygen molecule with an excess of parried electrons) and antioxidant defenses. This can result in increased vascular permeability due to an increase in reactive oxygen species, this means that cells may leak vital proteins and fluids causing cell damage or even necrosis. However this has not been noted during moderate vascular occlusion, further research should be conducted regarding identifying oxidative stress responses to occlusion training.
----- Meeting Notes (25/10/15 11:10) -----
What is NCV?
Rationale: Fahs et al., 2012 found BFR training dependent on the exercise load, as the load increases so does the strength of the muscle group being trained. However once loads exceed 50%1RM it is unclear whether strength gains are due to the load or the level of occlusion prescribed.
The effect of different cuff pressure has been studied when performing knee extensions at pressures of 50, 150 and 250 mmHg. Only pressures of 50 and 150 mmHg resulted in significant strength gains. Furthermore, studies have progressively increased the cuff pressure on a weekly basis as a method of progressive overload. However these studies have only been conducted when training the lower body.
Therefore this study will investigate how a differing level of occlusion may effect the difference in strength and hypertrophic responses when prescribed at the same intensity and load during an occluded elbow flexion.
Aims:
The initial purpose of this study is identify the physiological responses to occlusion training.
Another aim of this study are to investigate the effects of different levels of occlusion on the strength of athletes after conducting a resistance training program.
Hypothesis: A greater level of occlusion will result in greater levels of strength adaptations. A greater restriction of blood flow will result in greater accumulation of metabolites resulting in greater hypertrophic responses.
I will collect my data through a series of resistance sessions taking place at Loughborough College.
In order to measure strength, that is the maximal force of a muscle/ muscle group that can be applied against a resistance, a 1RM test will be conducted pre and post intervention along with measuring the arm circumference.
1RMS have been deemed a reliable and valid method of measuring strength. However a biodex isokinetic dynamometer would be more specific as it would allow more in depth analysis.
Arm circumference will be used measured in order to measure hypertrophic responses. Again, this is somewhat of a limitation as a more specific measurement could be taken, using an MRI to measure the muscle CSA
1RM’s will be determined within 5 sets, if this is not the case then another session will be conducted. This is due to the possibility of fatigue preventing the participant of reaching their 1RM. Arm circumference will be measured using prescribed landmarking techniques.
Each session will consist of 3 sets 8-10 repetitions of a bicep curl with 60s rests between sets.
Participants will currently not be partaking in any form of resistance training, though as previous studies have used participants that have been undergoing aerobic exercise this will be allowed within my study.
Measuring for reliability and validity
How is occlusion training reliable? Will it give the same outcome?
Occlusion training is a reliable method of resistance training because if you were to conduct the the training without occlusion you would no yield the same results.
You will get the same outcome if protocol is kept consistent, for instance if you were to decrease the pressure during a second program then you would not expect the same physiological responses as the muscle has a greater level of oxygen availability. There is plethora of studies that have all used similar methods and have concluded similar results indicating a high level of reliability.
How is occlusion training valid? How well it measures what the study says its going to measure?
By using a control group this study will be able to identify if vascular occlusion is what results in hypertrophy and increases strength. To ensure the study is valid, specific pre and post measurements will be taken, specifically, 1RM and Arm circumference, both of which have been deemed valid and reliable tests when measuring changes in strength and hypertrophy.
Cuff size: The width is said to be one of the most important factors when prescribing occlusion training, sizes differ between lower body and upper body due to the size of the limbs. Typically, 3cm wide cuffs are used for upper body and 5cm wide cuffs are used for lower body. Wider cuffs have been shown to impair venous return more effectively at lower pressures compared to narrower cuffs at higher inflation pressure. This is due to wider cuffs covering a greater portion of the occluded area. However, many studies have not reported the width of the cuff being used. This was present in a study conducted by Kacin & Strazar (2011) reported that a cuff width of 13cm resulted in complete occlusion and hindering hypertrophic responses.
Cuff pressure: Cuff pressure should be adjusted according to the width of the cuff in order to account for the differences in BFR between wide and narrow cuffs. Cuff pressure ranging from 160-240mmHg have been seen to be effective to induce hypertrophy in the lower body when performing knee extensor exercises with the exception of the study mentioned above. Cuff pressures ranging from 100-160mmHg have been effective for improving strength and hypertrophy of the upper arm when performing elbow flexion
One grey area that is consistent throughout the research is how to prescribe an effective occlusion pressure. Many studies have often used a relative pressure, of 1.3 x SBP however there is little justification for this method. More recently, SOMEONE has identified that leg circumference is the most important determinant when prescribing occlusion pressures.
Though there is no standardized protocol for occlusion training the procedure will combine elements of previous research. The occlusion cuff will be applied throughout the whole session to limit muscle reperfusion as taking off the cuff between sets may lead to recovery before the session is finished. The cuff itself will be applied to the most proximal portion of the muscle belly
Relationship of hypoxia and hormonal responses
Use of previous research to justify rationale. Make it obvious what the study is going to investigate before you say it / don’t rely on the audience to join the dots / guide them through each step
Roger enoka – neuro mechanics of human movement
