Academic Department of Military Rehabilitation (ADMR), Defence Medical Rehabilitation Centre (DMRC) Stanford Hall, Loughborough, LE12 5BL, UK.
Versus Arthritis Centre for Sport, Exercise and Osteoarthritis Research, Department for Health, University of Bath, Bath, UK.
BMC Musculoskelet Disord. 2023 Jul 17;24(1):580. doi: 10.1186/s12891-023-06693-3.
Muscle atrophy, muscle weakness and localised pain are commonly reported following musculoskeletal injury (MSKI). To mitigate this risk and prepare individuals to return to sport or physically demanding occupations, resistance training (RT) is considered a vital component of rehabilitation. However, to elicit adaptations in muscle strength, exercise guidelines recommend lifting loads ≥ 70% of an individual's one repetition maximum (1-RM). Unfortunately, individuals with persistent knee pain are often unable to tolerate such high loads and this may negatively impact the duration and extent of their recovery. Low load blood flow restriction (LL-BFR) is an alternative RT technique that has demonstrated improvements in muscle strength, hypertrophy, and pain in the absence of high mechanical loading. However, the effectiveness of high-frequency LL-BFR in a residential rehabilitation environment remains unclear. This study will compare the efficacy of high frequency LL-BFR to 'conventional' heavier load resistance training (HL-RT) on measures of physical function and pain in adults with persistent knee pain.
This is a multicentre randomised controlled trial (RCT) of 150 UK service personnel (aged 18-55) admitted for a 3-week residential rehabilitation course with persistent knee pain. Participants will be randomised to receive: a) LL-BFR delivered twice daily at 20% 1-RM or b) HL-RT three-times per week at 70% 1-RM. Outcomes will be recorded at baseline (T1), course discharge (T2) and at three-months following course (T3). The primary outcome will be the lower extremity functional scale (LEFS) at T2. Secondary outcomes will include patient reported perceptions of pain, physical and occupational function and objective measures of muscle strength and neuromuscular performance. Additional biomechanical and physiological mechanisms underpinning both RT interventions will also be investigated as part of a nested mechanistic study.
LL-BFR is a rehabilitation modality that has the potential to induce positive clinical adaptations in the absence of high mechanical loads and therefore could be considered a treatment option for patients suffering significant functional deficits who are unable to tolerate heavy load RT. Consequently, results from this study will have a direct clinical application to healthcare service providers and patients involved in the rehabilitation of physically active adults suffering MSKI.
ClinicalTrials.org reference number, NCT05719922.
肌肉萎缩、肌肉无力和局部疼痛是肌肉骨骼损伤（MSKI）后常见的报告症状。为了降低这种风险，并使患者能够重返运动或从事体力要求高的职业，阻力训练（RT）被认为是康复的重要组成部分。然而，为了使肌肉力量适应，运动指南建议举重负荷≥个人单次最大重复次数（1-RM）的 70%。不幸的是，持续膝关节疼痛的患者往往无法承受如此高的负荷，这可能会对他们的康复时间和程度产生负面影响。低负荷血流限制（LL-BFR）是一种替代 RT 技术，已证明在没有高机械负荷的情况下，该技术可以提高肌肉力量、肥大和疼痛。然而，高频 LL-BFR 在住院康复环境中的效果尚不清楚。本研究将比较高频 LL-BFR 与“传统”较重负荷阻力训练（HL-RT）对持续膝关节疼痛成年人的身体功能和疼痛的疗效。
这是一项多中心随机对照试验（RCT），共纳入 150 名英国军人（年龄 18-55 岁），他们因持续膝关节疼痛接受为期 3 周的住院康复课程。参与者将被随机分为两组：a）每天两次以 20%1-RM 进行 LL-BFR 或 b）每周三次以 70%1-RM 进行 HL-RT。在基线（T1）、课程结束（T2）和课程结束后三个月（T3）记录结果。主要结局指标是 T2 时的下肢功能量表（LEFS）。次要结局指标包括患者报告的疼痛、身体和职业功能的感知，以及肌肉力量和神经肌肉性能的客观测量。作为嵌套机制研究的一部分，还将研究两种 RT 干预措施的其他生物力学和生理学机制。
LL-BFR 是一种康复治疗方法，它有可能在没有高机械负荷的情况下引起积极的临床适应，因此可以被认为是治疗无法耐受重负荷 RT 的严重功能障碍患者的一种治疗选择。因此，本研究的结果将对参与治疗肌肉骨骼损伤的现役成年人康复的医疗保健服务提供者和患者具有直接的临床应用价值。
ClinicalTrials.org 参考编号，NCT05719922。
