School of Physical Therapy, Massachusetts College of Pharmacy and Health Sciences, Worcester, Massachusetts (C.J., S.L.); Unified Health and Performance, Lancaster, Massachusetts (B.A.); Department of Health Sciences, CUNY Lehman College, Bronx, New York (N.R.); and The Human Performance Mechanic, New York City, New York (N.R.).
J Neurol Phys Ther. 2024 Oct 1;48(4):224-231. doi: 10.1097/NPT.0000000000000475. Epub 2024 Sep 17.
Cerebral palsy (CP) is a congenital neurological disorder that causes musculoskeletal weakness and biomechanical dysfunctions. Strength training guidelines recommend at least 70% of 1-repetition maximum to increase muscle strength and mass. However, individuals with CP may not tolerate such high exercise intensity. Blood flow restriction (BFR) can induce similar gains in strength and muscle mass using loads as low as 20% to 30% 1-repetition maximum. This case series described the safety, feasibility, and acceptability of BFR in adults with CP and examined changes in muscle mass and strength.
Three male participants with gross motor function classification system level 3 CP underwent strength training using a periodized 8-week BFR protocol. Outcomes included: Safety via blood pressure during and post-BFR exercises in addition to adverse event tracking; Feasibility via number of support people and time-duration of BFR exercises; Acceptability via rate of perceived discomfort (0-10) and qualitative interviews; Muscle Mass via ultrasonographic cross-sectional area of the quadriceps and hamstring; and Strength via (1) 3-repetition maximum in the leg press and knee extension, (2) isometric knee flexor and extensor muscle force measured with a hand-held dynamometer, and (3) 30-second sit-to-stand test.
Participants replaced 2 exercises from their current regimen with seated knee extension and leg press exercises using progressively higher limb occlusion pressure and exercise intensity. Limb occlusion pressure started at 60%, by week 4 progressed to 80%, and then remained constant. The exercise repetition scheme progressed from fixed nonfailure repetition sets to failure-based repetition sets.
Blood pressure never exceeded safety threshold, and no adverse events were reported. The BFR training was time-consuming and resource-intensive, but well-tolerated by participants (rate of perceived discomfort with a mean value of 5.8, 100% protocol adherence). Strength, as measured by 3-repetition maximum testing and 30-second sit-to-stand test, increased, but isometric muscle force and muscle mass changes were inconsistent.
Blood flow restriction may be an effective means to increase strength in adults with CP who cannot tolerate high-intensity resistance training. Future research should compare BFR to traditional strength training and investigate mediators of strength changes in this population.
for more insights from the authors (see the Video, Supplemental Digital Content available at: http://links.lww.com/JNPT/A473 ).
脑瘫（CP）是一种先天性神经系统疾病，会导致肌肉骨骼无力和生物力学功能障碍。力量训练指南建议至少达到 1 次重复最大强度的 70%，以增加肌肉力量和质量。然而，CP 患者可能无法耐受如此高的运动强度。血流限制（BFR）可以使用低至 20%至 30%的 1 次重复最大强度的负荷来诱导类似的力量和肌肉质量增加。本病例系列描述了 BFR 在 CP 成人中的安全性、可行性和可接受性，并检查了肌肉质量和力量的变化。
3 名男性 CP 患者，运动功能分类系统水平 3，接受了为期 8 周的 BFR 方案的力量训练。结果包括：通过 BFR 运动期间和之后的血压以及不良事件跟踪来评估安全性；通过支持人员的数量和 BFR 运动的时间持续时间来评估可行性；通过感知不适的比率（0-10）和定性访谈来评估可接受性；通过超声测量股四头肌和腘绳肌的横截面积来评估肌肉质量；通过（1）腿推和膝关节伸展的 3 次重复最大强度、（2）手持式测力计测量的等长膝关节屈肌和伸肌力量、以及（3）30 秒坐-站测试来评估强度。
参与者用坐姿膝关节伸展和腿推练习替代了他们当前方案中的 2 个练习，同时逐渐增加了肢体闭塞压力和运动强度。肢体闭塞压力从 60%开始，第 4 周增加到 80%，然后保持不变。运动重复方案从固定非失败重复集进展到基于失败的重复集。
血压从未超过安全阈值，也没有报告不良事件。BFR 训练费时且资源密集，但参与者耐受性良好（感知不适的比率平均值为 5.8，100%的方案依从性）。力量，如 3 次重复最大强度测试和 30 秒坐-站测试所示，有所增加，但等长肌肉力量和肌肉质量的变化不一致。
血流限制可能是一种增加无法耐受高强度抗阻训练的 CP 成人力量的有效方法。未来的研究应该将 BFR 与传统的力量训练进行比较，并研究该人群中力量变化的介质。
