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      Safety and possible effects of low-intensity resistance training associated with partial blood flow restriction in polymyositis and dermatomyositis

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          Abstract

          Introduction

          Our aim was to evaluate the safety and efficacy of a low-intensity resistance training program combined with partial blow flow restriction (BFR training) in a cohort of patients with polymyositis (PM) and dermatomyositis (DM).

          Methods

          In total, 13 patients with PM and DM completed a 12-week twice a week low-intensity (that is, 30% one-repetition-maximum (1RM)) resistance exercise training program combined with partial blood flow restriction (BFR). Assessments of muscle strength, physical function, quadriceps cross sectional (CSA) area, health-related quality of life, and clinical and laboratory parameters were assessed at baseline and after the intervention.

          Results

          The BFR training program was effective in increasing the maximal dynamic strength in both the leg-press (19.6%, P <0.001) and knee-extension exercises (25.2% P <0.001), as well as in the timed-stands (15.1%, P <0.001) and timed-up-and-go test (−4.5%, P =0.002). Quadriceps CSA was also significantly increased after the intervention (4.57%, P =0.01). Similarly, all of the components of the Short Form-36 Health Survey, the Health Assessment Questionnaire scores, and the patient- and physician reported Visual Analogue Scale were significantly improved after training ( P <0.05). Importantly, no clinical evidence or any other self-reported adverse event were found. Laboratory parameters (creatine kinase and aldolase) were also unchanged ( P >0.05) after the intervention.

          Conclusions

          We demonstrated that a 12-week supervised low-intensity resistance training program associated with partial blood flow restriction may be safe and effective in improving muscle strength and function as well as muscle mass and health-related quality of life in patients with PM and DM.

          Trial registration

          Clinicaltrials.gov NCT01501019. Registered November 29, 2011.

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          Most cited references23

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          Fundamentals of resistance training: progression and exercise prescription.

          Progression in resistance training is a dynamic process that requires an exercise prescription process, evaluation of training progress, and careful development of target goals. The process starts with the determination of individual needs and training goals. This involves decisions regarding questions as to what muscles must be trained, injury prevention sites, metabolic demands of target training goals, etc. The single workout must then be designed reflecting these targeted program goals including the choice of exercises, order of exercise, amount of rest used between sets and exercises, number of repetitions and sets used for each exercise, and the intensity of each exercise. For progression, these variables must then be varied over time and the exercise prescription altered to maintain or advance specific training goals and to avoid overtraining. A careful system of goal targeting, exercise testing, proper exercise technique, supervision, and optimal exercise prescription all contribute to the successful implementation of a resistance training program.
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            Hemodynamic and hormonal responses to a short-term low-intensity resistance exercise with the reduction of muscle blood flow.

            We investigated the hemodynamic and hormonal responses to a short-term low-intensity resistance exercise (STLIRE) with the reduction of muscle blood flow. Eleven untrained men performed bilateral leg extension exercise under the reduction of muscle blood flow of the proximal end of both legs pressure-applied by a specially designed belt (a banding pressure of 1.3 times higher than resting systolic blood pressure, 160-180 mmHg), named as Kaatsu. The intensity of STLIRE was 20% of one repetition maximum. The subjects performed 30 repetitions, and after a 20-seconds rest, they performed three sets again until exhaustion. The superficial femoral arterial blood flow and hemodynamic parameters were measured by using the ultrasound and impedance cardiography. Serum concentrations of growth hormone (GH), vascular endothelial growth factor (VEGF), noradrenaline (NE), insulin-like growth factor (IGF)-1, ghrelin, and lactate were also measured. Under the conditions with Kaatsu, the arterial flow was reduced to about 30% of the control. STLIRE with Kaatsu significantly increased GH (0.11+/-0.03 to 8.6+/-1.1 ng/ml, P < 0.01), IGF-1 (210+/-40 to 236+/-56 ng/ml, P < 0.01), and VEGF (41+/-13 to 103+/-38 pg/ml, P < 0.05). The increase in GH was related to neither NE nor lactate, but the increase in VEGF was related to that in lactate (r = 0.57, P < 0.05). Ghrelin did not change during the exercise. The maximal heart rate (HR) and blood pressure (BP) in STLIRE with Kaatsu were higher than that without Kaatsu. Stroke volume (SV) was lower due to the decrease of the venous return by Kaatsu, but, total peripheral resistance (TPR) did not change significantly. These results suggest that STLIRE with Kaatsu significantly stimulates the exercise-induced GH, IGF, and VEGF responses with the reduction of cardiac preload during exercise, which may become a unique method for rehabilitation in patients with cardiovascular diseases.
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              Blood flow restriction: the metabolite/volume threshold theory.

              Traditionally it has been thought that muscle hypertrophy occurs primarily from an overload stimulus produced by progressively increasing an external load using at least 70% of one's concentric one repetition maximum (1RM). Blood flow restricted exercise has been demonstrated to result in numerous positive training adaptions, specifically muscle hypertrophy and strength at intensities much lower than this recommendation. The mechanisms behind these adaptions are currently unknown but a commonly cited concept is that acute elevations of systemic hormones, specifically growth hormone (GH), play a large role with resistance training induced muscle hypertrophy, possibly through stimulating muscle protein synthesis (MPS). We hypothesize that the alterations in the intramuscular environment which results in the rapid recruitment of FT fibers, is the large driving force behind the skeletal muscle hypertrophy seen with blood flow restriction, whereas the external load and systemic endogenous hormone elevations may not be as important as once thought. It is further hypothesized that although skeletal muscle hypertrophy can be achieved at low intensities without blood flow restriction when taken to muscular failure, the overall volume of work required is much greater than that needed with blood flow restriction. Copyright © 2011 Elsevier Ltd. All rights reserved.
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                Author and article information

                Contributors
                melina_mattar@yahoo.com.br
                gualano@usp.br
                lperandini@gmail.com
                samuel.shinjo@gmail.com
                ferlima@mac.com
                analucia@move.med.br
                hars@usp.br
                Journal
                Arthritis Res Ther
                Arthritis Research & Therapy
                BioMed Central (London )
                1478-6354
                1478-6362
                25 October 2014
                25 October 2014
                2014
                : 16
                : 5
                : 473
                Affiliations
                [ ]Division of Rheumatology, School of Medicine, University of São Paulo, São Paulo, Brazil
                [ ]School of Physical Education and Sports, University of São Paulo, São Paulo, Brazil
                [ ]Faculdade de Medicina Universidade de São Paulo - Divisão de Reumatologia, Av Dr Arnaldo, 455 - 3° andar - sala 3131 - Cerqueira César, São Paulo, Brazil
                Article
                473
                10.1186/s13075-014-0473-5
                4232679
                25344395
                bfe1741c-2891-4a51-b149-a259ba6a3dbe
                © Mattar et al.; licensee BioMed Central Ltd. 2014

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 14 April 2014
                : 16 October 2014
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                Research Article
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                © The Author(s) 2014

                Orthopedics
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