2024, Vol. 28 ›› Issue (23): 3743-3750

Blood flow restriction training interventions for sarcopenia in older adults: biological mechanisms and proposed application protocols

Kong Jianda1, Xie Yingao2, Chen Shijuan3, Zhu Lei1   

Abstract: BACKGROUND: Sarcopenia is a chronic condition that leads to strength loss and functional decline, increasing the risk of frailty, disability, falls, and death in older adults. Blood flow restriction training can be effective in the treatment of sarcopenia, but a comprehensive review of its advantages, disadvantages, biological mechanisms, and application options is lacking.
OBJECTIVE: To review the advantages, limitations, and biological mechanisms of blood flow restriction training interventions for sarcopenia and to give recommendations for application protocols based on current published evidence.
METHODS: A search of major databases was conducted for literature published in the time frame up to February 2023. The search terms were “blood flow restriction training, KAATSU, elderly, sarcopenia, muscle” in English and Chinese. Finally, 82 included papers were compiled and analyzed.
RESULTS AND CONCLUSION: Blood flow restriction training as an intervention for sarcopenia has been effective in peripheral muscle groups, but there are limitations in its application. Blood flow restriction training is highly operational and safe. This training can improve muscle strength and physical performance, but there are potential risks, including adverse events on skeletal muscle, cardiovascular and endothelial cells. Therefore, blood flow restriction training needs to be performed under scientific guidance and further studies are needed to verify its efficacy in patients with sarcopenia. The biological mechanisms of blood flow restriction training intervention in sarcopenia may include: increasing muscle hypertrophy due to reactive muscle congestion, improving muscle protein synthesis capacity, inducing metabolic stress adaptation, promoting skeletal muscle growth and repair, activating vascular endothelial growth factor signaling pathway to promote angiogenesis, and promoting satellite cell proliferation. However, these specific roles and combined effects of these mechanisms need to be determined by more in-depth studies. Blood flow restriction training interventions for sarcopenia are mainly influenced by training and cuffs. To avoid adverse events, it is recommended that 20% to 50% 1RM, 20 to 75 repetitions, 2 to 3 times per week, 30-60 seconds interval between sessions, smaller size cuffs with a pressurization value ≤ 140 mmHg for upper limb training, and larger size cuffs with a pressurization value ≤180 mmHg for lower limb training, usually 50% to 80% of the pressure value in the completely occluded artery. However, more research is needed on the training frequency and interval between sessions in older adults, and further research is needed on the optimal choice of cuff pressurization values.

Key words: blood flow restriction training, blood pressure cuff, resistance training, sarcopenia, skeletal muscle, biological mechanism, exercise prescription