Blood flow restriction training activates the muscle metaboreflex during low-intensity sustained exercise

Abstract

Blood flow restriction training (BFRT) employs partial vascular occlusion of exercising muscle and has been shown to increase muscle performance while using reduced workload and training time. Numerous studies have demonstrated that BFRT increases muscle hypertrophy, mitochondrial function, and beneficial vascular adaptations. However, changes in cardiovascular hemodynamics during the exercise protocol remain unknown, as most studies measured blood pressure before the onset and after the cessation of exercise. With reduced perfusion to the exercising muscle during BFRT, the resultant accumulation of metabolites within the ischemic muscle could potentially trigger a large reflex increase in blood pressure, termed the muscle metaboreflex. At low workloads, this pressor response occurs primarily via increases in cardiac output. However, when increases in cardiac output are limited (e.g., heart failure or during severe exercise), the reflex shifts to peripheral vasoconstriction as the primary mechanism to increase blood pressure, potentially increasing the risk of a cardiovascular event. Using our chronically instrumented conscious canine model, we utilized a 60% reduction in femoral blood pressure applied to the hindlimbs during steady-state treadmill exercise (3.2 km/h) to reproduce the ischemic environment observed during BFRT. We observed significant increases in heart rate (+19 ± 3 beats/min), stroke volume (+2.52 ± 1.2 mL), cardiac output (+1.21 ± 0.2 L/min), mean arterial pressure (+18.2 ± 2.4 mmHg), stroke work (+1.93 ± 0.2 L/mmHg), and nonischemic vascular conductance (+3.62 ± 1.7 mL/mmHg), indicating activation of the muscle metaboreflex.NEW & NOTEWORTHY Blood flow restriction training (BFRT) increases muscle mass, strength, and endurance. There has been minimal consideration of the reflex cardiovascular responses that could be elicited during BFRT sessions. We showed that during low-intensity exercise BFRT may trigger large reflex increases in blood pressure and sympathetic activity due to muscle metaboreflex activation. Thus, we urge caution when employing BFRT, especially in patients in whom exaggerated cardiovascular responses may occur that could cause sudden, adverse cardiovascular events.

Keywords: BFR; cardiac rehabilitation; exercise; muscle metaboreflex; ventricular function.

Graphical abstract

Figure 1.

A: linear regressions of steady-state values during exercise and during exercise with 60% reduction in femoral arterial pressure. Graphs should be read right to left: the first point is exercise, the second point is the threshold where the given variable changes because of a reduction in femoral arterial pressure, and the furthest left point is the average peak value for a given variable at a 60% reduction in femoral arterial pressure during exercise. Error bars show SE of the mean in both directions. B: average 1-min steady-state values of heart rate, stroke volume, cardiac output, mean arterial pressure, and nonischemic vascular conductance during free-flow exercise (left bar) and during a 60% reduction in femoral arterial pressure (FAP) during exercise (right bar). Error bars show SE. *Significance vs. the previous setting was determined by a P < 0.05 (N = 7 animals, Student’s paired t test).

Figure 2.

Average 1-min steady-state values of stroke work and index of ventricular contractility and effective arterial elastance, an index of vascular compliance, during free-flow exercise (left bar) and during a 60% reduction in femoral arterial pressure (FAP) during exercise (right bar). Error bars show SE. *Significance vs. the previous setting was determined by a P < 0.05 (N = 7 animals, Student’s paired t test).

Figure 3.

Average 1-min steady-state values of femoral arterial pressure (FAP) (left) and terminal aortic blood flow (right) illustrating that a 60% reduction in femoral arterial pressure approximates 50% reduction in hindlimb blood flow during free-flow exercise (left bar) and during a 60% reduction in femoral arterial pressure during exercise (right bar). Error bars show SE. *Significance vs. the previous setting was determined by a P < 0.05 (N = 7 animals, Student’s paired t test).