The effects of resistance training with blood flow restriction on muscle strength, muscle hypertrophy and functionality in patients with osteoarthritis and rheumatoid arthritis: A systematic review with meta-analysis

Abstract

Introduction: Rheumatoid arthritis(RA) and osteoarthritis(OA) patients showed systemic manifestations that may lead to a reduction in muscle strength, muscle mass and, consequently, to a reduction in functionality. On the other hand, moderate intensity resistance training(MIRT) and high intensity resistance training(HIRT) are able to improve muscle strength and muscle mass in RA and OA without affecting the disease course. However, due to the articular manifestations caused by these diseases, these patients may present intolerance to MIRT or HIRT. Thus, the low intensity resistance training combined with blood flow restriction(LIRTBFR) may be a new training strategy for these populations.

Objective: To perform a systematic review with meta-analysis to verify the effects of LIRTBFR on muscle strength, muscle mass and functionality in RA and OA patients.

Materials and methods: A systematic review with meta-analysis of randomized clinical trials(RCTs), published in English, between 1957-2021, was conducted using MEDLINE(PubMed), Embase and Cochrane Library. The methodological quality was assessed using Physiotherapy Evidence Database scale. The risk of bias was assessed using RoB2.0. Mean difference(MD) or standardized mean difference(SMD) and 95% confidence intervals(CI) were pooled using a random-effects model. A P<0.05 was considered statistically significant.

Results: Five RCTs were included. We found no significant differences in the effects between LIRTBFR, MIRT and HIRT on muscle strength, which was assessed by tests of quadriceps strength(SMD = -0.01[-0.57, 0.54], P = 0.96; I² = 58%) and functionality measured by tests with patterns similar to walking(SMD = -0.04[-0.39, 0.31], P = 0.82; I² = 0%). Compared to HIRT, muscle mass gain after LIRTBFR was reported to be similar. When comparing LIRTBFR with low intensity resistance training without blood flow restriction(LIRT), the effect LIRTBFR was reported to be higher on muscle strength, which was evaluated by the knee extension test.

Conclusion: LIRTBFR appears to be a promising strategy for gains in muscle strength, muscle mass and functionality in a predominant sample of RA and OA women.

Fig 1. PRISMA.

Flow diagram of search results and study selection.

Fig 2. Forest plot of the comparison between LIRTBFR, MIRT and HIRT on muscle strength assessed by specific tests for quadriceps strength (n = 4 studies).

LIRTBFR: Low intensity resistance training combined with blood flow restriction; MIRT: Moderate intensity resistance training; HIRT: High intensity resistance training; 1RM: 1 maximum repetition; Kg: kilogram; Nm: Newton-meter; I²: Heterogeneity of studies; SD: standard deviation; MD: mean difference; SMD: standardized mean difference; 95% CI: 95% confidence interval; IV: inverse variance; Random: random effects model.

Fig 3. Forest plot of the comparison between LIRTBFR and LIRT on muscle strength assessed by knee extension (n = 2 studies).

LIRTBFR: Low intensity resistance training combined with blood flow restriction; LIRT: Low intensity resistance training without blood flow restriction; 1RM: 1 maximum repetition; 3RM: 3 maximum repetition test; Kg: kilogram; I²: Heterogeneity of studies; SD: standard deviation; MD: mean difference; 95% CI: 95% confidence interval; IV: inverse variance; Random: random effects model.

Fig 4. Forest plot of the comparison between LIRTBFR and HIRT on muscle mass (n = 2 studies).

LIRTBFR: Low intensity resistance training combined with blood flow restriction; HIRT: High intensity resistance training; mm²: square millimeter; I²: Heterogeneity of studies; SD: standard deviation; MD: mean difference; 95% CI: 95% confidence interval; IV: inverse variance; Random: random effects model.

Fig 5. Forest plot of the comparison between LIRTBFR, MIRT and HIRT on functionality assessed by tests with patterns similar to walking (n = 4 studies).

LIRTBFR: Low intensity resistance training combined with blood flow restriction; MIRT: Moderate intensity resistance training; HIRT: High intensity resistance training; TUG test: Time Up and Go test; [s]: seconds; [m/s]: meters per seconds; I²: Heterogeneity of studies; SD: standard deviation; MD: mean difference; SMD: standardized mean difference; 95% CI: 95% confidence interval; IV: inverse variance; Random: random effects model.