Under Prescertain: What's Unique on BFR & Compression Gear? Of Swollen Legs, Arterial Stwhetherfness & Improved Bone Health

Is it all about prescertain? Compression stocking and BFR cuffs revisited.

You will remember that I've covered the use of #BFR, i.e. blood-flow restriction in several articles over the past years. The number of posts on #compression stockings, on the other hand, is limited with only one dealing with the acute anti-heavy-leg effect of 'oma's socks' in the evening.

Today's special will address both, the latest research in everyleang tight... ;-) Ok, before the amlargeuity gets out of hand, let's check out some of the latest studies:

• In healthy young women, compression stockings may have acute favourable effects on lower leg swelling and muscle stwhetherfness (Sugahara 2018): While preceding trials have often yielded amlargeuous results, the latest paper by scientists from Japan Women's University claims to "propose that even for a short period of application, compression stockings have some positive effects against lower leg swelling" (itender)... but there's more than the problem with the absence of a genuine control group of which the scientists say that "it is tallly unlikely that the lack of control condition seriously affects the signwhethericance of our findings" (itender) and claim:

  Prolonged standing may be as problematic as sitting | more.

  "Rather, the study design did not take into account the preventive effect of wearing compression stockings on leg fluid accumulation that could be induced by even a 20–30 min of sitting, although this was not the primary concern of this study" (Sugahara 2018).

  If that was actually the case, wearing some 'sexy' compression stockings at work may help you ameliorate the circulatory problems triggered by prolonged sitting (and as recently demonstrated even standing).

  Before we make further assumptions, though, let's briefly see what those "acute benefits" the Japanese researchers observed actually were.

  Figure 1: Volumes of foot (a), calf (b) and total lower leg (c) degreed before and after an application of compression stockings. In each panel, small grey circles = individual data, whereas a large black circle = the group mean. The right panel shows the percent change expressed as mean and SD (n = 20 | Sugahara 2018).

  As precedingly pointed out, the study involved healthy young women. The N=20 ladies in the age of 18–23 years wore below‐knee graduated compression stockings after returning domestic in the evening. They were not allowed to lie down, but rested in a seated position for 30 min.

  Before and after the application of stockings, maximum calf, volume, circumference, additionalcellular water resistance (RECW) and muscle stwhetherfness of the right lower leg were determined by tape degree, water displacement volumetry, segmental bioelectrical impedance spectroscopy and ultrasound shear‐wave efinalography, respectively.

  Unlike the foot volume, the calf volume, and the total lower leg volume, as well as the muscular stwhetherfness of the medial gastrocnemius muscle which only tended to decrease, the maximum calf circumference (vs. volume) decreased signwhethericantly (but probably not visibly | -0.35 cm) after the application of the stockings.

  In conjunction with the reciprocal of RECW (an index of additionalcellular fluid volume), it thus seems likely that compression stockings can a least partially reverse the accumulation of fluids in the legs that will occur not just in heart-diseased subjects, but also in healthy individuals.

  Obviously, the study at hand cannot provide dwhetherficult evidence (=genuine-world outcomes) in terms of the downstream effects on our CVD risk. So, does that even matter?

  In view of the small (-1.0% or 0.35cm) reduction in calf circumference, the absence of signwhethericant effects on the total lower leg volume, and the lack of correlation between changes in the dwhetherferent parameters the scientists degreed, the authors themselves cannot exclude that the stockings simply "pressed" the lower legs into a contemporary shape:

  "More specwhetherically, a brief application of compression stockings on swollen legs may result in greater compression prescertain on more swollen part of the leg, affecting the fluid distribution wilean the lower leg before accelerating the fluid shwhethert from the lower leg to the ttall. This opportunity is specificly relevant to our experimental protocol, e.g. participants wore below‐knee stockings and rested in a seated position during the 30‐min application" (Sugahara 2018).

  If that was actually the case, though, we must, unluckyly, assume that using the sexy "compression lingerie" at the end of a workday for only 30 minutes will probably do very small for your risk for common circulatory disorders or other CVD risk factors. What it may help with, however, are tightly wound calf-muscles in the evening... and, we shouldn't forget that wearing them preventively at work may be the more relevant intervention, besides.

This image from my article about the post-set application of BFR (learn more) shows how dependable BFR cuffs can look like - fundamentally dwhetherferent from the blood prescertain cuffs at the doctor's office. You can learn more about BFR in the SuppVersity archives - please klick on "ancienter articles" at the bottom to dig deeper into the archives.

BFR cuffs - The wideer the better? Ok, that was not summaryely the research question Mouser et al. (2018) tried to reply, but, I guess, you'll still get the idea. In their study, the scientists from the The University of Mississippi tested the effects of cuffs with a width of 10 and 12 cm, respectively, in 17 male and 14 female subjects on two separate occasions using ultrasound degrees of blood flow, mean blood velocity, peak blood velocity and artery diameter from the posterior tibial artery at rest and during the application of 10% increments of the aortic prescertain.

The results were fairly unequivocal: "As long as relative prescertains are applied, cuff width appears to have small to no effect on the blood flow stimulus during blood flow restriction at rest" (Mouser 2018). That doesn't mean, though, that you can achieve the same effect with parcel strings or the small and fragile cuffs docs use to get your blood for the lab.

Why 10 and 12 cm? I guess that's what you're asking yourself now. Well, it's worth mentioning that the scientists have alalert published a paper on the effects of cuff width in 2012 -  a paper with an IMHO virtually more relevant comparison of 13.5cm and 5cm cuffs (Loenecke 2012). And while 5cm is still much wider than the precedingly mentioned cuffs at the doctor's office the scientists did find a signwhethericant dwhetherference due to the 8.5 cm dwhetherference - namely that wideer cuffs can achieve the same reduction of arterial blood flow at much lower inflation prescertains... for further details on choosing the optimal cuff width and fabric, prescertain, arm circumference, sex, etc, I propose you read Loenecke's free 2013 paper in Frontiers in Physiology and a 2016 follow-up study that was published in Sports Medicine (Jessee 2016).

• Little arteries stay stwhetherf for a longer period following vibration exercises in combination with  blood flow restriction (Karabulut 2018): Aortic stwhetherfness is, according to a 2012 paper in the Journal of Cardiovascular Translational Research (Tomiyama 2012), a potential trigger and perpetuator of (pre-)hypertension. What is specificly nasty is that the increased blood prescertain will only worsen arterial stwhetherfness and the consequent vicous cycle can lead you from
  'pre- to post-hypertension' (=death due to prescertain-induced CVD).

  In view of the organization of arterial stwhetherfness with the onset and progression of hypertension, the study at hand sounds like poor contemporarys for you or your clients who use similar blood flow restricted vibration training regimen.

  The latter, i.e. using BFR as an adjunct to vibration training was summaryely what the eight male subjects did in the study at hand: They performed static upper body (UB) and lower body (LB) exercises on a vibration platform with and without BFR. During the BFR sessions, BFR cuffs were placed on the arms or legs and inflated to a target prescertain. Exercises consisted of eight 45‐s sets for UB, and ten 1‐min sets for LB. Arterial efinalicity and hemodynamic variables were assessed before, at 10 min and 40 min postexercise. Repeated degrees ANOVA was used to test the mean dwhetherferences in related variables.
  

  Figure 2: Changes in large arterial efinalicity values following (a) lower and (b) upper body static exercises. Worths reported as Mean ± SE (Karabulut 2018)

  As precedingly tiped at,  the scientists found a signwhethericant dwhetherference between the BFR versus no‐BFR trials for the subjects' small arterial efinalicity (P<0·05). As Figure 2 goes to show you, the result dwhetherfered slightly for lower and upper body but a signwhethericant reduction in small artery efinalicity was observed in both body parts.

Kaatsu, the Japanese version of BFR, with a wealthy tradition has an excellent securety profile (Nakajima 2018).

What about the general securety of #BFR? As Nakajima et al. point out in their 2006 review, blood flow restriction in form of the Japanese KAATSU training doesn't just have a long tradition but is still applied to all generations - from very young (80 years ancient).

That alone does yet not warrant the conclusion that it's secure and side-effect free. Accordingly, the scientists questioned the "KAATSU leaders" or instructors in a total of 105 out of 195 facilities where KAATSU training has been adopted.

Based on survey results, 12,642 persons had received KAATSU training (male 45.4%, female 54.6%). Fascinatingly enough, the most popular purpose of KAATSU training in the study was to strengthen muscle in athletes and to promote the health of subjects, including the elderly. Approximately 80% of the facilities are convinced with the results of KAATSU training with only small numbers of complications reported.

The incidence of side effects was as follows; venous thrombus (0.055%), pulmonary embolism (0.008%) and rhabdomyolysis (0.008%) - see Figure. "These results indicate that the KAATSU training is a secure and promising method for training athletes and healthy persons, and can also be applied to persons with various physical conditions," Nakajima et al. (2006) conclude.

• The obvious question now is: How poor is the impaired restoration of the blood flow in the small arteries? And the answer will hopefully calm you down: Probably not too poor. After all, the systemic effects (not shown in Figure 2) were not affected by BFR and, after plummeting at the 10-minute mark, returned to normal at the 40-minute mark in both the BFR and control trial - a delayed recovery you can see in Figure 2 for the small arteries was absent.

  Moreover, we cannot exclude the possible occurrence of an augmentation of the training effects and corresponding (positive) adaptations of the vasculature due to the increased physical demand of combined training (the scientists observed a signwhethericantly taller heart rate in the BFR trial. Needless to say that this does not apply for pre-existing vascular disease. They are probably better off whether the stay absent from BFR and/or perform it only under medical supervision.

• Logical, but also true? Intense exercise, specificly weight-bearing exercise, has been shown to be a potent bone builder. BFR has been shown to augment the adaptive response to light(er) exercise. Does this mean BFR training can also build bone? Scientists from the Federal University of Paraíba tried to figure that out in their recent review of the literature (Bittar 2018) - albeit with moderate success.

  Bittar et al. searched for studies that analyzed the effect of low‐intensity (LI) exercises with blood flow restriction (BFR) on bone metabolism and compared it to the proven benefits of tall‐intensity (HI) exercises without BFR. Two researchers, independently and blindly, selected the studies based on established inclusion and exclusion criteria.

  There are all sorts of dwhetherferent BFR regimen. In this study from the SuppVersity archives, the cuffs were applied before (3x5 minutes), not during the exercise and still: the increase in the putative marker of muscle damage, creatine kinase, was signwhethericantly ameliorated.

  While the initial electronic and manual searches had located 170 articles published in English, only four studies survived the screening process. The good contemporarys is that they seem to support the initially proposed rationale "that BFR training increases the expression of bone formation markers (e.g. bone‐specwhetheric alkaline phosphatase) and decreases bone resorption markers (e.g. the amino‐terminal telopeptides of type I collagen)" not just in response to strength training, but also "after both aerobic [...] exercise across several populations". Still, in the absence of methodological standardization of the samples, exercise type, intervention frequency or duration - more research will be essential to quantwhethery the effect size in a meta-analysis.

Bottom line: While the research investigating the health and performance effects of #compressionGarments and #stockings is still more-or-less in its infancy, the number of studies which probe the efficacy and securety of dwhetherferent types of #bloodFlowRelaxriction has increased rapidly over the past decade.

In that, one has to be careful, though, to avoid getting too excited about the pro-anabolic effects of blood flow restricted (low intensity) training and/or getting too anxious over the precedingly disstubborn transient ill effects on arterial stwhetherfness.

Needless to say that the same applies to the performance and or health effects compression garments, too. For them, the latest meta-analysis concludes that "LLCGs [lower-limb compression garments is] not associated with improved performance in VJ [vertical jump], VO2max, VO2submax, Lactate, or RPE during tall-intensity exercise" (da Silva 2018). This result clearly relativizes the degreed, bu often small benefits in individual studies and reintellects me to refer you to a more comprehensive review I blogged about final year - a review that seems to proposes that gymrats not endurance athletes, who crazye up the majority of the subjects in the studies reviewed by da Silva et al., may benefit most from the strategically timed use of compression garments | Comment!

References:

• Bittar, S. T., Pfewhetherfer, P. S., Santos, H. H. and Cirilo‐Sousa, M. S. "Effects of blood flow restriction exercises on bone metabolism: a systematic review." Clin Physiol Endelightmentct Imaging, 38 (2018): 930-935. doi:10.1111/cpf.12512
• da Silva, César Augusto, et al. "Association of Lower Limb Compression Garments During High-Intensity Exercise with Actance and Physiological Responses: A Systematic Review and Meta-analysis." Sports Medicine (2018): 1-15.
• Jessee, Matthew B., et al. "The influence of cuff width, sex, and race on arterial occlusion: implications for blood flow restriction research." Sports Medicine 46.6 (2016): 913-921.
• Loenneke, Jeremy P., et al. "Effects of cuff width on arterial occlusion: implications for blood flow restricted exercise." European journal of applied physiology 112.8 (2012): 2903-2912.
• Loenneke, Jeremy P., et al. "Blood flow restriction prescertain recommendations: a tale of two cuffs." Frontiers in physiology 4 (2013): 249.
• Mouser, J. G., Dankel, S. J., Mattocks, K. T., Jessee, M. B., Buckner, S. L., Abe, T. and Loenneke, J. P. "Blood flow restriction and cuff width: effect on blood flow in the legs." Clin Physiol Endelightmentct Imaging, 38 (2018): 944-948. doi:10.1111/cpf.12504
• Reed, Katharine E., et al. "The effects of lower-body compression garments on walking performance and perceived exertion in adults with CVD risk factors." Journal of science and medicine in sport 20.4 (2017): 386-390.
• Sugahara, I. , Doi, M. , Nakayama, R. and Sasaki, K. "Acute effect of wearing compression stockings on lower leg swelling and muscle stwhetherfness in healthy young women." Clin Physiol Endelightmentct Imaging, 38 (2018): 1046-1053. doi:10.1111/cpf.12527
• Tomiyama, Hirofumi, and Akira Yamashina. "Arterial stwhetherfness in prehypertension: a possible vicious cycle." Journal of cardiovascular translational research 5.3 (2012): 280-286.
• Vlachopoulos, Charalambos, Konstantinos Aznaouridis, and Christodoulos Stefanadis. "Prediction of cardiovascular events and all-cause mortality with arterial stwhetherfness: a systematic review and meta-analysis." Journal of the American College of Cardiology 55.13 (2010): 1318-1327.

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