The effects of resistance training with blood flow restriction on muscle strength, muscle hypertrophy and functionality in patients with osteoarthritis and rheumatoid arthritis: A systematic review with meta-analysis

Leonardo Peterson Dos Santos; Rafaela Cavalheiro do Espírito Santo; Thiago Rozales Ramis; Juliana Katarina Schoer Portes; Rafael Mendonça da Silva Chakr; Ricardo Machado Xavier

doi:10.1371/journal.pone.0259574

The effects of resistance training with blood flow restriction on muscle strength, muscle hypertrophy and functionality in patients with osteoarthritis and rheumatoid arthritis: A systematic review with meta-analysis

PLoS One. 2021 Nov 10;16(11):e0259574. doi: 10.1371/journal.pone.0259574. eCollection 2021.

Authors

Leonardo Peterson Dos Santos^{1

2

3}, Rafaela Cavalheiro do Espírito Santo^{1

2

3}, Thiago Rozales Ramis⁴, Juliana Katarina Schoer Portes^{1

2

3}, Rafael Mendonça da Silva Chakr^{1

2

3}, Ricardo Machado Xavier^{1

2

3}

Affiliations

¹ Autoimmune Diseases Laboratory, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil.
² Division of Rheumatology, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil.
³ Medical School, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil.
⁴ Exercise Research Laboratory (LAPEX), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil.

Abstract

Introduction: Rheumatoid arthritis(RA) and osteoarthritis(OA) patients showed systemic manifestations that may lead to a reduction in muscle strength, muscle mass and, consequently, to a reduction in functionality. On the other hand, moderate intensity resistance training(MIRT) and high intensity resistance training(HIRT) are able to improve muscle strength and muscle mass in RA and OA without affecting the disease course. However, due to the articular manifestations caused by these diseases, these patients may present intolerance to MIRT or HIRT. Thus, the low intensity resistance training combined with blood flow restriction(LIRTBFR) may be a new training strategy for these populations.

Objective: To perform a systematic review with meta-analysis to verify the effects of LIRTBFR on muscle strength, muscle mass and functionality in RA and OA patients.

Materials and methods: A systematic review with meta-analysis of randomized clinical trials(RCTs), published in English, between 1957-2021, was conducted using MEDLINE(PubMed), Embase and Cochrane Library. The methodological quality was assessed using Physiotherapy Evidence Database scale. The risk of bias was assessed using RoB2.0. Mean difference(MD) or standardized mean difference(SMD) and 95% confidence intervals(CI) were pooled using a random-effects model. A P<0.05 was considered statistically significant.

Results: Five RCTs were included. We found no significant differences in the effects between LIRTBFR, MIRT and HIRT on muscle strength, which was assessed by tests of quadriceps strength(SMD = -0.01[-0.57, 0.54], P = 0.96; I² = 58%) and functionality measured by tests with patterns similar to walking(SMD = -0.04[-0.39, 0.31], P = 0.82; I² = 0%). Compared to HIRT, muscle mass gain after LIRTBFR was reported to be similar. When comparing LIRTBFR with low intensity resistance training without blood flow restriction(LIRT), the effect LIRTBFR was reported to be higher on muscle strength, which was evaluated by the knee extension test.

Conclusion: LIRTBFR appears to be a promising strategy for gains in muscle strength, muscle mass and functionality in a predominant sample of RA and OA women.

Publication types

Research Support, Non-U.S. Gov't
Systematic Review

MeSH terms

Arthritis, Rheumatoid / physiopathology*
Arthritis, Rheumatoid / therapy*
Blood Flow Restriction Therapy / methods*
Hemodynamics / physiology
Humans
Hypertrophy / physiopathology
Hypertrophy / therapy*
Muscle Strength / physiology*
Resistance Training*

Grants and funding

There was no specific funding support for the development of this systematic review study with meta-analysis. However, Xavier, RM is a CNPq Research Productivity Scholarship Holder - Level 2. Santo, RCE, Santos, LP and Portes, JKS are Scholarship students from Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, CAPES.