Impact of Blood Flow Restriction Exercise on Central Hemodynamics and Fluid Regulating Hormones

ABSTRACT Purpose To characterize both the efficacy of altered restriction pressures and consequences of optimized blood flow restriction (BFR) for altering the cardiovascular and fluid regulating response in humans. Methods This work comprised a series of related trials. Phase 1: during semi-recumbent cycling (5 min, 60 W) with BFR at 0, 50, 75, 100 and 125% of participants’ lowest arterial occlusion pressure (LOP) echocardiographic images were collected alongside continuous heart rate (HR) and blood pressure (BP). In phase 2, 24 h fluid balance (intake-output) and fluid-regulating hormone responses were measured after a practical BFR exercise session (treadmill walking: 5·3 min, 1 min rest, 5 km/h, 5% incline, 100% LOP). Phase 3 examined the magnitude and effect of blood volume distribution following BFR treadmill walking using a modified CO-rebreathe technique. Results Cardiac ejection fraction remained stable irrespective of cuff pressure and despite a reduction in end-diastolic volume (Δ of 11 ± 9 mL, p = 0.02). HR and BP were highest at 100% LOP (ΔHR = 18 ± 19 bpm, ΔSBP = 51 ± 30 mmHg, ΔDBP = 33 ± 15 mmHg, ΔRate Pressure Product = 76 ± 32 bpm·mmHg·100 -1 ). BFR treadmill walking stimulated a greater release of fluid-regulating hormones than normal walking (Δrenin = BFR: 25.3 ± 24.2 vs. CON: 9.1 ± 11.8 ng/L; Δcopeptin = BFR: 50.1 ± 97.9 vs. CON: 0.43 ± 0.8 pmol/L), but no difference in fluid retention was observed (p = 0.2). Approximately 27% of total blood volume was confined to the legs during BFR, but the relative volume trapped in the legs was not related to fluid-regulating hormone release (renin r = -0.04, p = 0.9; copeptin r = 0.27, p = 0.3). Conclusions BFR exercise elicits the largest cardiovascular effect using 100% LOP, with evidence of appreciable fluid regulating hormonal response during a typical BFR exercise session. The relative volume of blood sequestered in the limb does not appear to drive this response.