Aplicação de modalidades de restrição de fluxo sanguíneo em diferentes desordens musculoesqueléticas: aspectos fisiológicos, metodológicos e clínicos
Introduction: Musculoskeletal disorders are common and can impair function, physical performance and quality of life. Among the interventions used to musculoskeletal disorders management, blood flow restriction (BFR) modalities are gaining space in scientific literature. Purposes: This thesis invest...
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| Formato: | doctoralThesis |
| Idioma: | pt_BR |
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Universidade Federal do Rio Grande do Norte
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| Endereço do item: | https://repositorio.ufrn.br/handle/123456789/37336 |
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| Resumo: | Introduction: Musculoskeletal disorders are common and can impair function, physical
performance and quality of life. Among the interventions used to musculoskeletal disorders
management, blood flow restriction (BFR) modalities are gaining space in scientific literature.
Purposes: This thesis investigated physiological aspects, prescription methods and clinical
applications of BFR modalities in musculoskeletal disorders. Methods and results: BFR
modalities considered were passive BFR (BFR without concomitant exercise), ischemic
preconditioning (IPC) and BFR exercise. Were considered musculoskeletal disorders
conditions that caused functional impairment, such as loss of strength and muscle mass,
exercise-induced muscle damage (EIMD), muscle fatigue and knee osteoarthritis (OA). The
present thesis consists of an introduction, three chapters referring to the BFR modalities, and
final considerations. Chapters 1, 2 and 3 deal with passive BFR, IPC and BFR exercise,
respectively, and are composed of seven manuscripts involving three study types: systematic
review (with and without meta-analysis), narrative review and randomized clinical trial.
Chapter 1 is a systematic review (article 1) on the effects of passive BFR to minimize loss of
strength and muscle mass (disuse atrophy) in individuals underwent lower limbs unloading. In
chapter 1 we observed that although potentially useful, the high risk of bias presented in
original studies limits the indication of passive BFR as effective modality against the
reduction of strength and muscle mass induced by immobilization. Chapter 2 is a randomized
controlled clinical trial (article 2) that investigated the effects of IPC on protection against
EIMD in healthy individuals. Article 2 pointed out that IPC was not superior to sham in the
protection against EIMD. Chapter 3 addresses physiological, methodological and clinical
aspects of BFR combined to physical exercise. The first manuscript of chapter 3 (article 3) is
a systematic review and meta-analysis that analyzed muscle excitation (by surface
electromyography) during resistance RFS exercise taken to muscle failure or not. Article 3
indicated that muscle excitation during low-load BFR exercise was greater than during
matched load exercise without RFS only when muscle failure was not achieved. Additionally,
low-load BFR exercise showed less muscle excitation than high-load exercise, regardless of
whether or not it achieved voluntary failure. The second manuscript of chapter 3 (article 4) is
a systematic review and meta-analysis that investigated whether BFR pressure influences the
time to voluntary muscle failure during a fatiguing task. In this article, muscle failure was
anticiped during low-load exercises with high- but not low-BFR pressures. The third
manuscript of chapter 3 (article 5) is a narrative review that discusses the possible need to adjust BFR pressure over weeks of training. In article 5, we observed that the literature is
contradictory and makes it difficult to recommend whether BFR pressure adjustments are
needed. Article 6 is a protocol of randomized clinical trial to investigate the effects of lowload and reduced total volume exercise with BFR versus high-load exercise without BFR in
knee OA treatment. Article 7 is the randomized clinical trial presenting results of the protocol
(article 6) and showed that low-load BFR training with reduced total volume had similar
effect to high-load training without BFR on knee pain, muscle performance, physical function
and quality of life of patients with knee OA, although the magnitude of strength gains was
greater after high-load training. Conclusions: In general, with the exception of IPC to protect
against EIMD, BFR modalities are potentially useful in the management of musculoskeletal
disorders herein studied. Additionally, we conclude that it is necessary to advance in the
understanding of the physiological mechanisms and in the prescription methods of BFR
modalities. |
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