Blood flow restricted exercise anyone?


I’m not what you’d call an exercise buff. Running in particular, was relegated to the back of the closet in my late 20s, primarily to save my joints from being sawed to pieces like a bookshelf in my 60s. And whilst, endurance training in the form of cycling and triathlons is the penultimate in fitness these days, I’ve preferred to watch from the side lines at a distance. I’m not a complete loafer by the way, but prefer to rejuvenate intermittently using walking and climbing.

Exercise works in MS. The combination of endurance training with resistance training has been shown to improve problems with walking. However, it is the first time I’m hearing of blood flow restriction (BFR) during exercise.

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The investigators from University of Ferrara (Italy) state that since with MS many are susceptible to exercise-induced fatigue, heat intolerance and falling, low intensity training when BFR is applied exercising limbs may be one solution. The investigators found the intervention to be a safe one.

“Participants who were randomly assigned to the BFR walking (BFR-W) group, before each training session underwent the arm systolic blood pressure measurement in a seated position with a standard sphygmomanometer and stethoscope, to determine the theoretical degree of compression corresponding to the limb occlusion pressure. Then blood flow was restricted using 6-cm BFR bands (The Occlusion Cuff LTD, Somerset, UK) worn around the most proximal regions of both legs. With
the patient standing, the cuffs were inflated to the 30% of the systolic blood pressure (e.g. cuff inflation = systolic pressure * 0.30). The appropriate degree of compression exerted by the BFR bands was verified by the sphygmomanometer connected to the cuffs. After BFR bands positioning and using their habitual device/orthosis, patients performed a session including 5 bouts of walking at a slow prescribed speed (starting from 60 steps/minute) that was maintained by a metronome.”

They found when compared with conventional intensive walking, both made improvements in walking speed, although a moderate effect size was only observed in the BFR group; including 4 subjects in the BFR group that achieved a clinically meaningful increase in speed of 20% from baseline speed.

Moreover, the improvements were maintained only in the BFR group at 6 week follow up. Too good to be true? I’ll let you guys decide.


Scand J Med Sci Sports. 2020 Jul 9. doi: 10.1111/sms.13764. Online ahead of print.

Effectiveness of Blood Flow-Restricted Slow Walking on Mobility in Severe Multiple Sclerosis: A Pilot Randomized Trial

Nicola LambertiSofia StraudiMaria DonadiHirofumi Tanaka Nino Basaglia Fabio Manfredini

Objective: We tested the safety, feasibility and effectiveness of blood flow restriction-empowered low-intensity interval walking exercise (BFR-W) compared with conventional intensive overground walking (CON-W) at improving gait speed and functional capacity in patients with multiple sclerosis (MS) and severe gait disabilities.

Methods: 24 patients (58±5 years; 7 males) with progressive MS (Expanded Disability Status Scale 5.5-6.5) were randomized to receive 12 rehabilitation sessions over 6 weeks. The BFR-W group (n=12) performed interval walking (speed paced by a metronome that increased weekly) with BFR bands at the thighs. The CON-W group (n=12) received physiotherapist-assisted overground walking therapy. The primary outcome was gait speed, measured by the timed 25-foot walk test. Secondary outcomes included walking endurance, balance, strength, fatigue and quality of life. The measurements were collected at baseline, at the end of training and a 6-week follow-up.

Results: The two groups did not present any baseline difference. BFR-W group safely walked without limitations due to sleeve compression, with lower increase of perceived exertion (RPE) (p<0.001) and heart rate (p=0.031) compared with the CON-W. Gait speed improved significantly in both groups (BFR-W +13%; CON-W +5%) with greater increases in the BFR-W group at end of the training (p=0.001) and at the follow-up (p=0.041). Most of the secondary outcomes significantly improved in the two groups, without between-group differences.

Conclusions: Slow interval walking with moderate BFR to the lower limbs was superior to overground walking in improving gait speed in patients with MS with a lower training load and a more durable clinical benefit.

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Neuro Doc Gnanapavan

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