BFR vs Traditional Strength Training in the Elderly
In the literature Blood Flow Restriction (BFR) is predominantly utilized for muscular hypertrophy or to offset atrophy following injury. Although BFR has been shown to elicit similar cellular and muscular adaptations when compared to traditional exercise, performance metrics such as strength and power need to be explored further. If the ability to achieve morphological adaptations from BFR exists, practitioners may speculate that BFR could potentially play an important role in a traditional strength program as well. Currently, for traditional exercise prescription, hypertrophy and strength gains are usually prescribed around 70-100% 1-Rep Maximum (1RM).1 Although this has been shown through decades of literature, the ability of low-intensity BFR to achieve similar functional muscular performance is of high controversy of late.
Elderly Overview
BFR has been shown to be an appropriate and effective tool in numerous environments. One of the most intriguing populations that may see large benefit of BFR is elderly subjects.1 As we know, the elderly lose bone mineral density, have an increase of muscular atrophy, and are at risk for falls and mortality surrounding functional and metabolic capacities.1,2 Therefore, being able to appropriately train to stimulate functional performance and muscular gains in a safe and effective manor are of high importance. In order to offset decrements of skeletal muscle, traditional high-load exercise is usually prescribed. The issue is that with age there is a decrease for mechanical stress and tolerance with higher prevalence of comorbities.2 Therefore it would be ideal to prescribe lower-intensity training while still maximizing functional performance, muscular, and skeletal adaptations from exercise in the elderly to improve quality of life and mortality.
Low-Intensity BFR Vs High-Load Hypertrophy & Strength
The evidence shows that both Low-Intensity BFR (20-40% 1-RM) and High-Load (70-90%) elicit similar changes in muscle mass in older adults.2 In the systematic review done by Centher et al. the authors concluding that 5 studies comparing Low-Intensity BFR and High-Load traditional have no statistical significant differences in muscular morphological adaptations.2 This implies that from a hypertrophic standpoint older adults may benefit from utilizing lower-intensity prescription while delaying atrophy and potentially increasing cross-sectional area of muscle. This is extremely important because skeletal muscle mass may decrease between 3-8% per decade after 30 years of age.2 If the elderly population can offset or delay atrophy while implementing lower-intensity exercise, we may see a rise in compliance leading to habitual exercise engagement.2 Although no significant differences were found between groups for muscle mass, strength gains showed significant variance.2 Between group differences revealed High-Intensity prescription elicited a 24.0% +/- 16.2% in comparison to 14.4 +/- 6.3 in the Low-Intensity group. Practitioners should take into account that although similar muscle mass was seen between protocols, high-load still may be king to elicit strength stimulus in the elderly population.
Low-Intensity BFR Vs Low-Intensity
In order to determine the overall effectiveness of BFR, control and comparisons of Low-Intensity exercise stimulus is needed. In the same review done by Centner et al. the authors compared 9 studies measuring strength between LI-BFR and Low-Intensity exercise. Between all of the LI-BFR training there was an average muscular strength increase of 12.3 ± 4.1%, compared to 2.5 ± 2.7% with Low-Intensity exercise. The authors demonstrated these increases were stastistically significant p < 0.001. This means that between 9 peer-reviewed study, Low-Intensity exercise with BFR was significantly superior than just Low-Intensity exercise alone.
Low-Intensity BFR Vs Walking
BFR has been shown to elicit benefits from normal functional activities such as walking.2 This is a very important discovery because low-intensity walking is very common among the older population and a preferred method of exercise that almost anybody can do. A combination of studies have shown that BFR in combination of low-intensity walking is a far superior stimulus than walking without BFR.2 In fact walking alone with BFR was shown to increase muscular strength by 13.3%. Although walking alone may be beneficial for muscular mass and an appropriate stimulus, in appears that BFR in conjunction with walking may elicit overall great functional performance gains in the elderly population.2
References
Carroll, C., Bs, T. E., & Bs, G. W. (2017). Comparisons between Low-Intensity Resistance Training with Moderate Blood Flow Restriction and High-Intensity Resistance Training on Quadriceps Muscle Strength and Mass. Journal of Athletic Enhancement, 06(03). doi: 10.4172/2324-9080.1000257
Centner, C., Wiegel, P., Gollhofer, A., & König, D. (2018). Effects of Blood Flow Restriction Training on Muscular Strength and Hypertrophy in Older Individuals: A Systematic Review and Meta-Analysis. Sports Medicine, 49(1), 95–108. doi: 10.1007/s40279-018-0994-1
Applied Human & Sport Performance 