Safety, feasibility, neuromuscular and perceptual responses to blood flow restriction exercise in adults with chronic arthropathies

• Autores: Daniel C. Ogrezeanu
• Directores de la Tesis: José Casaña Granell (dir. tes.), Joaquín Calatayud Villalba (dir. tes.), Sofía Pérez Alenda (dir. tes.)
• Lectura: En la Universitat de València ( España ) en 2025
• Idioma: inglés
• Número de páginas: 218
• Tribunal Calificador de la Tesis: Lirios Dueñas Moscardó (presid.), Ilenia Lorenza Calcaterra (secret.), Luke Hughes-Davies (voc.)
• Programa de doctorado: Programa de Doctorado en Fisioterapia por la Universitat de València (Estudi General)
• Materias:
  • Ciencias médicas
    • Otras especialidades médicas
• Enlaces
  • Tesis en acceso abierto en: RODERIC
• Resumen

  • Osteoarthritis (OA), rheumatoid arthritis (RA), and hemophilic arthropathy (HA) are chronic arthropathies with similarities regarding knee arthropathy. HA is induced by intra-articular bleeding in people with severe hemophilia (PWH). Chronic pain and stiffness are their main symptoms, with knee extensor muscle weakness that leads to significant functional limitation and disability. Therefore, OA, RA, and HA, share modifiable particularities that may benefit from progressive resistance training.Impairment mitigation through training necessitates sufficient intensity, and traditionally recommended loads might be a barrier to participation due to the arthropathy symptomatology. These populations show interplay between pain and psychosocial factors as they exhibit maladaptive coping strategies like avoidance behavior due to fear of injury. PWH have the added risk of possible muscle and joint bleeds with high loads. Thus, tolerable and safe effective alternative exercise interventions are needed in these load-challenged populations. Resistance training with blood flow restriction (BFRT) is a training modality possibly tolerable to load-compromised individuals and that could produce similar benefits to traditional training. The aim was to assess the safety, feasibility, neuromuscular and perceptual responses to BFRT in adults with OA and RA, but especially HA due to the added risks involved.Study 1 evaluated the neuromuscular responses of different levels of BFR during acute lower-limb BFRT in knee OA and their relationship with perceptions of health status and pain-related constructs. In the vastus medialis (VM), amplitude was higher with BFR at 80% arterial occlusion pressure (AOP) than with 40%AOP and control, while there were no differences between conditions in the vastus lateralis (VL). Activity spatial distribution varied between conditions, but mostly in the VL. BFRT at 80% AOP increases VM activity and VL amplitude distribution more than 40% AOP and control. Importantly, muscle activity increases are modulated by pain catastrophizing, chronic pain self-efficacy and health status in these patients, and kinesiophobia seems to especially modulate entropy. Study 2 assessed exercise-induced hypoalgesia (EIH) in this same context as Study 1. No differences in EIH between conditions were found. However, 80% AOP worsened VAS immediately while improving PPT immediately and at 10 min post-exercise. EIH is modulated by pain-related psychological constructs and self-perceived health status.In Study 3, a dose-response meta-analysis in OA and RA found no differences between BFRT and medium or high intensity training for strength and functionality. A total of 2000 repetitions per BFRT program are necessary to maximize strength gains, while functional improvement requires 1800 total repetitions.Study 4 evaluated the tolerability, safety, and acute neuromuscular and perceptual responses to a session of lower-limb BFRT among PWH. Significant amplitude differences were found within each set, but not between sets. Spatial distribution showed changes within each set. Rate of perceived exertion slightly increased with each set while tolerability slightly decreased in the last set.Study 5 evaluated the acute safety, cardiovascular, neuromuscular and perceptual responses of autoregulated and non-autoregulated BFRT in the upper limb in PWH. While both were safe, autoregulated provided a hypotensive and hypoalgesic response, albeit without between-group differences. Triceps showed differences in spatial distribution, and greater activity with autoregulated. Although no major differences were found between both conditions in perceptual responses, autoregulated increased VAS during exercise.Together, these studies advance understanding on BFRT in these populations. The hypothesis was that BFRT for PWH would be safe, feasible and effective, which this thesis supports.