Blood flow restriction exercise of the tibialis anterior in people with stroke: a preliminary study

Simon Svanborg Kjeldsen; Erhard Trillingsgaard Næss-Schmidt; Michael Lee; Camila Quel de Oliveira; Jørgen Feldbæk Nielsen; Peter William Stubbs

doi:10.31083/j.jin2102053

Blood flow restriction exercise of the tibialis anterior in people with stroke: a preliminary study

J Integr Neurosci. 2022 Mar 21;21(2):53. doi: 10.31083/j.jin2102053.

Authors

Simon Svanborg Kjeldsen¹, Erhard Trillingsgaard Næss-Schmidt¹, Michael Lee^{2

3}, Camila Quel de Oliveira⁴, Jørgen Feldbæk Nielsen¹, Peter William Stubbs^{1

4}

Affiliations

¹ Research Department, Hammel Neurorehabilitation and Research Center, Aarhus University, 8450 Hammel, Denmark.
² Discipline of Physiotherapy, School of Health, Federation University, 3841 Victoria, Australia.
³ Faculty of Medicine and Health, School of Health Sciences, University of New South Wales, Sydney, 2052 NSW, Australia.
⁴ Graduate School of Health, Discipline of Physiotherapy, University of Technology Sydney, Sydney, 2007 NSW, Australia.

PMID: 35364641
DOI: 10.31083/j.jin2102053

Abstract

Background: Blood flow restriction exercise (BFR-E) could be a useful training adjunct for patients with weakness after stroke to augment the effects of exercise on muscle activity. We aimed to examine neurophysiological changes (primary aim) and assess patient perceptions (secondary aim) following BFR-E.

Methods: Fourteen participants with stroke performed BFR-E (1 session) and exercise without blood flow restrictsion (Exercise only) (1 session), on two days, ≈7 days apart. In each session, two sets of tibialis anterior (TA) contractions were performed and electromyography (EMG) was recorded. Eight participants underwent transcranial magnetic stimulation (single-pulse stimulation, short interval intracortical inhibition (SICI), intracortical facilitation (ICF)) and peripheral electrical stimulation (maximal peak-to-peak M-wave (M-max)) of the TA before, immediately-after, 10-min-after and 20-min-after BFR-E and Exercise only. Numerical rating scores (NRS) for pain, discomfort, fatigue, safety, focus and difficulty were collected for all subjects (n = 14). Paired comparisons and linear mixed models assessed the effects of BFR-E and Exercise only.

Results: No adverse events due to exercise were reported. There was no contraction-number × condition interaction for EMG amplitude during exercise (p = 0.15), or time × condition interaction for single-pulse stmulation, SICI, ICF or M-max amplitude (p = 0.34 to p = 0.97). There was no difference between BFR-E and Exercise only in NRS scores (p = 0.10 to p = 0.50).

Conclusion: Using our training paradigm, neurophysiological parameters, feasibility, tolerability and perceptions of safety were not different between BFR-E and Exercise only. As participants were generally well-functioning, our results are not generalizable to lower functioning people with stroke, different (more intense) exercise protocols or longer term training over weeks or months.

Keywords: Intracortical facilitation; Intracortical inhibition; Motor cortex; Occlusion training; Plasticity; Strength training; Tibialis anterior; Transcranial magnetic stimulation.

MeSH terms

Blood Flow Restriction Therapy*
Exercise / physiology
Humans
Muscle, Skeletal
Regional Blood Flow / physiology
Stroke* / complications
Stroke* / therapy