Effects of Blood Flow Restriction Exercise on Hemodynamic and Cardiovascular Response in Hypertensive Subjects: a systematic review

  • Dahan da Cunha Nascimento Programa de Pós-Graduação em Educação Física, Universidade Católica de Brasília e Centro Universitário do Distrito Federal - UDF, Brasília, DF, Brasil.
  • Bernardo Petriz Laboratório de Fisiologia molecular do Exercício, Centro Universitário UDF, Brasília-DF e Programa de Pós-graduação em Promoção da Saúde – Universidade de Franca (UNIFRAN), Franca-SP.
  • Larissa Prego Centro Universitário do Distrito Federal - UDF, Brasília, DF, Brasil.
  • Samuel Amorim de Souza Hospital Israelita Albert Einstein, SP, Brasil
  • Jonato Prestes Programa de Pós-Graduação em Educação Física, Universidade Católica de Brasília, Brasília, DF, Brasil.

Resumo

Abstract

Blood flow restriction (BFR) exercise is an effective approach for increasing muscle mass and muscle strength. However, it remains unclear if the magnitude of those positive adaptations will lead to similar responses for hemodynamic variables in hypertensive subjects. The present systematic review aimed to assess the effects of exercise with and without BFR on acute and chronic hemodynamic and cardiovascular responses in hypertensive subjects. Studies published between 2000 and 2019 were included. Randomized controlled trials (RCTs) and non-randomized trials (NRCTs) which evaluated hemodynamic and cardiovascular response in hypertensive subjects practicing exercise with BFR or those comparing hemodynamic and cardiovascular response during exercise with and without BFR were also eligible. A literature research of English and non-English-language articles for review was conducted across PubMed and Science Direct databases, including reference lists of relevant papers. Level of evidence was determined according to the criteria described by Oxford Center for Evidence-Based Medicine. In addition, risk of bias was assessed using the modified version of Downs and Black checklist.  Four studies were included involving 60 participants; from those, three were NRCTs and one was a RCT. Three studies included in this review evaluated the effect of resistance training with and without BFR and only one the effect of aerobic exercise. The score on Downs and Black checklist was 11. The main findings were that the included patients’ characteristics were not clearly reported, and all the revised studies contained significant methodological limitations. Thus, all studies were classified as being of poor methodological quality. In addition, the evidence level provided in all the revised studies was level IIb only (i.e. poor-quality studies). Considering the limited available evidence, no definitive recommendation about BFR exercise in hypertensive subjects can be addressed due to the weak methodological design of the studies.

Keywords: Resistance Training. Hypertension. Vascular Occlusion. Blood Flow Restriction.

Resumo

O exercício físico com restrição do fluxo sanguíneo (RFS) é uma abordagem eficaz para o aumento da massa muscular e força muscular. No entanto, ainda não está claro se a magnitude dessas adaptações positivas levará a respostas semelhantes para as variáveis hemodinâmicas e cardiovasculares em indivíduos hipertensos. A presente revisão sistemática objetivou avaliar os efeitos do exercício físico com e sem RFS sobre respostas hemodinâmicas e cardiovasculares agudas e crônicas em hipertensos. Estudos publicados entre 2000 e 2019 foram incluídos. Ensaios clínicos randomizados e não-randomizados em que avaliaram a resposta hemodinâmica e cardiovascular em hipertensos que praticavam exercício físico com RFS ou aqueles que compararam a resposta hemodinâmica e cardiovascular durante o exercício com e sem RFS também foram elegíveis. Uma pesquisa bibliográfica de artigos em inglês e não inglês para a presente revisão foi realizada nas bases de dados PubMed e Science Direct, incluindo listas de referência de artigos relevantes. O nível de evidência foi determinado de acordo com os critérios descritos pelo Oxford Center for Evidence-Based Medicine. Além disso, a qualidade dos artigos foi avaliada usando a versão modificada da lista de verificação de Downs e Black. Foram incluídos quatro estudos envolvendo 60 participantes nesta revisão. Destes, três eram ensaios clínicos não randomizados e somente um era ensaio clínico randomizado. Três estudos incluídos nesta revisão avaliaram o efeito do treinamento resistido com e sem RFS e apenas um avaliou o efeito do exercício aeróbico. A pontuação na lista de verificação de Downs e Black foi 11. Os principais achados foram que as características dos pacientes incluídos não foram claramente relatadas e todos os estudos revisados ​​continham limitações metodológicas significativas. Assim, todos os estudos foram classificados como de baixa qualidade metodológica. Além disso, o nível de evidência fornecido em todos os estudos revisados ​​era apenas de nível IIb (ou seja, estudos de baixa qualidade). Considerando as poucas evidências disponíveis, nenhuma recomendação definitiva sobre o exercício físico com RFS em indivíduos hipertensos pode ser abordada devido ao fraco desenho metodológico dos estudos.

Palavras-chave: Treinamento Resistido. Hypertensão. Oclusão Vascular. Restrição do Fluxo Sanguíneo.

Biografia do Autor

Dahan da Cunha Nascimento, Programa de Pós-Graduação em Educação Física, Universidade Católica de Brasília e Centro Universitário do Distrito Federal - UDF, Brasília, DF, Brasil.

Educação Física.

Bernardo Petriz, Laboratório de Fisiologia molecular do Exercício, Centro Universitário UDF, Brasília-DF e Programa de Pós-graduação em Promoção da Saúde – Universidade de Franca (UNIFRAN), Franca-SP.

Educação Física.

Larissa Prego, Centro Universitário do Distrito Federal - UDF, Brasília, DF, Brasil.
Educação Física.
Samuel Amorim de Souza, Hospital Israelita Albert Einstein, SP, Brasil

Medicina.

Jonato Prestes, Programa de Pós-Graduação em Educação Física, Universidade Católica de Brasília, Brasília, DF, Brasil.
Educação Física.

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Publicado
2020-05-28
Seção
Artigos