Examining the impact of blood flow restriction on cardiac rehabilitation outcomes

Table 1 Summary of studies using blood flow restriction in patients with cardiovascular disease

Ref.	Study groups	Study population	Exercise modality	Training protocol (Exercises, intensity, sets x reps or time, rests, velocity contractions)	Intervention duration	Exercise frequency	Position	Arterial occlusion pressure and type of occlusion	Cuff width and length
Fukuda et al[29] (2013)	BFR (n = 6). CON (n = 6). Same participants	Patients with cardiovascular disease (5 with old myocardial infarction and 1 dilated cardiomyopathy). 69 ± 12 years	BFR RT	BFR RT: Biceps flexion exercises using an elastic band. 4 sets. 30 reps + 3 × 15 reps, 30 second rest. 2.4 seconds per repetition (1.2 seconds concentric, 1.2 seconds eccentric) CON: Same RT exercises without BFR	Not applicable (acute effects)	Not applicable (acute effects)	Proximal region of both arms	110–160 mmHg. Continuous	30 mm width
Groennebaek et al[30] (2019)	BFR (n = 12). RIC (n = 12). CON (n = 12)	Patients with congestive heart failure. 63.66 ± 8 years	BFR-RT	BFRRT: 4 sets of bilateral knee-extensions to the point of volitional fatigue at a load corresponding to 30% of maximal dynamic strength. 30 seconds inter-set recovery in which the cuffs remained inflated. RIC: 4 cycles of 5 minutes upper arm ischemia followed by 5 minutes of reperfusion. Control: No treatment	6 weeks	3 times/week	Lower body	50% (AOP). Continuous	14 cm
Ishizaka et al[31] (2019)	BFR 10% RT (n = 7) BFR 20% RT (n = 7). 10% non-BFRRT (n = 7). 20% non-BFRRT (n = 7). Same participants	Patients with cardiac disease (not specify which one), mean age: 48 years	BFR-RT	Bilateral knee extension at 10%-20% 1RM. 3 sets of 30 trials with 30 second of rest between sets and 5 min of rest between conditions	Not applicable (acute effects)	Not applicable (acute effects)	Proximal region of both legs (implied)	180 mmHg. Continuous	60 mm width
Kambič et al[26] (2019)	BFR (n = 12). CON (n = 12)	Coronary artery disease patients. 60 ± 2 years	BFR-RT	BFRRT: Unilateral leg extension: 3 sets (8, 10, 12 reps). Intensity: 30%-40% 1-RM, increased biweekly. 45 seconds inter-set rest interval. Cadence: 1 second concentric, 2 seconds eccentric. CON: Standard care	8 weeks	2 ×/week (BFR)	Medium part of each thigh	15-20 mmHg > resting SBP. Continuous	23 cm width, 42-50 cm length
Kambič et al[32] (2021)	BFR (n = 12), CON (n = 12)	Coronary artery disease patients. 60 ± 2 years	BFR-RT + aerobic training	BFRRT: 3 × 8-12 reps at 30%-40% 1-RM. 45 seconds inter-set rest interval. Cadence: 1 second concentric, 2 seconds eccentric. CON (aerobic rehabilitation): Interval leg cycling at the 60% to 80% of maximal heart rate (5 intervals of 5 minutes of workload cycling followed by 2 minutes of loading cycling) and cadence 50 to 60 rpm	8 weeks	Not stated (baseline: 2 ×/week). 3 ×/week (control)	Proximal region of both thighs (implied)	15-20 mmHg > resting SBP. Continuous	23 cm width, 42–50 cm length
Madarame et al[33] (2013)	BFR (n = 9), CON (n = 9). Same participants	Patients with stable ischemic heart disease, 57 ± 6 years	BFR-RT	Low-intensity RT. 4 sets (1 set of 30 rep + 3 sets of 15 rep) of bilateral knee extension exercise with a load of 20% 1RM. 30-second rest between each set. Control: Same exercise without BFR	Not applicable (acute effects)	Not applicable (acute effects)	Not stated	200 mmHg. Continuous	50 mm width
Nakajima et al[34] (2010)	KAATSU (n = 7)	Patients with ischemic heart disease, 52 ± 4 years	KAATSU-RT	Low-intensity KAATSU RT, 4 sets (1 set of 30 rep + 3 sets of 15 rep) of leg press, leg curl and leg extension. 1 min rest between each set. 20%-30% of 1RM. 1.5 seconds for each phase (concentric-eccentric)	3 months	2 ×/week	Not stated	100-250 mmHg. Continuous	Not stated
Ogawa et al[27] (2021)	KAATSU (n = 11), CON (n = 10)	Early post-cardiac surgery patients. 69.6 ± 12.6 years	KAATSU-RT	KAATSU RT: Seated knee extension and flexion and leg press. 1.5 seconds for each phase (concentric-eccentric). 3 sets of 30 repetitions for each exercise with 30 second of inter-set rest. 20%-30% 1RM. Control (aerobic cardiac rehabilitation): 30 min aerobic exercise at anaerobic threshold on a cycle ergometer	3 months	2 ×/week	Base of each thigh	100-200 mmHg. Continuous	5 cm width
Tanaka and Takarada[35] (2018)	BFR (n = 15), CON (n = 15)	Patients with post-infarction heart failure 60.7 ± 11.1 years	BFR-AT	BFR-AT: 15 minutes of Cycle ergometer at 40%–70% peak VO2/W. CON: Same exercise without BFR	6 months	3 ×/week	Proximal ends of thighs	40-80 mmHg increase in the systolic blood pressure that is required for vascular occlusion (208.7 ± 7.4 mmHg). Continuous	Width: 90 mm; length: 700 mm

BFR: Blood flow restriction; CON: Control group; RT: Resistance training; BFRRT: Blood flow restriction resistance training; RIC: Remote ischemic conditioning; 1RM: One repetition maximum; AOP: Arterial occlusion pressure; SBP: Systolic blood pressure.