Efeitos do treinamento resistido associado à restrição parcial de fluxo sanguíneo na força e hipertrofia de extensores do joelho em adultos saudáveis: uma revisão sistemática com metanálise e um estudo randomizado controlado
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2019-12-19
Autores
Biral, Taíse Mendes [UNESP]
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Universidade Estadual Paulista (Unesp)
Resumo
Estudos sobre o treinamento resistido de baixa intensidade associado à restrição de fluxo sanguíneo (RFS) atualmente tem ganhado destaque, porém ainda existem lacunas que podem ser exploradas em relação aos seus efeitos fisiológicos quando associado a treinamentos excêntricos, principalmente na força e hipertrofia muscular. Objetivo: Realizar uma revisão sistemática com metanálise e um estudo aleatorizado controlado a fim de esclarecer os reais efeitos do TRBI associado à RFS nos desfechos de força, hipertrofia muscular e desempenho funcional, e se a RFS quando associada a treinamentos excêntricos de baixa e alta intensidade é capaz de aumentar as respostas desses desfechos dos extensores de joelho em homens adultos saudáveis. Métodos: A revisão sistemática foi registrada no PROSPERO (número do registro #CRD42018104065). Os estudos foram selecionados por meio de sete bases de dados. Todos os estudos incluídos foram avaliados quanto à qualidade metodológica, utilizando a Escala PEDro, bem como foi avaliada a qualidade da evidência. Somente ensaios clínicos randomizados que avaliaram a eficácia do treinamento com RFS na força e hipertrofia muscular dos músculos extensores de joelho em adultos do sexo masculino, saudáveis e/ou fisicamente ativos, com idade de 18 a 35 anos, contra algum grupo de intervenção foram considerados elegíveis. Todas as metanálises foram conduzidas por meio do software Review Manager – RevMan e descritos como diferenças médias padronizadas (standardized mean difference - SMD) ou diferenças médias (mean difference - MD) com intervalos de confiança de 95% (IC). O estudo randomizado controlado foi composto por 61 participantes do sexo masculino randomizados em quatro grupos: GTREAI (n=15), GTREBI (n=14), GTREAI-RFS (n=17) e GTREBI-RFS (n=15). Os participantes foram submetidos a um programa de treinamento excêntrico do músculo quadríceps no dinamômetro isocinético com duração de seis semanas nas intensidades de 80% com e sem RFS e 40% com e sem RFS do pico de torque excêntrico três vezes na semana e os desfechos de força muscular excêntrica, concêntrica e isométrica no dinamômetro isocinético, estrutura muscular do vasto lateral (VL) e reto femoral (RF) por meio de ultrassonografia e desempenho funcional através do Single Leg Hop Test foram avaliados uma semana antes, na quarta semana e uma semana após o treinamento. Foram utilizados o método estatístico descritivo e as comparações dos desfechos foi realizada por meio da técnica de análise de variância para modelo de medidas repetidas no esquema de dois fatores com nível de significância de 5%. Resultados: Os principais resultados da revisão sistemática na comparação de TRBI+RFS x TRAI mostraram que não houve diferença para o desfecho de força: DMP= -0,21, 95% IC [-0,72, 0,31] e hipertrofia: DM= -2,92 95% IC [-12,27, 6,44] e na comparação de TRBI+RFS x TRBI o desfecho de força foi favorável para TRBI+RFS (DMP= 1,01, 95% IC [0,07, 1,94]) e para a hipertrofia não houve diferença entre as intervenções (DM= -0,83, 95% IC [-5,66, 4,01). Em relação ao estudo randomizado controlado foram observadas diferenças estatisticamente significantes no pico de torque excêntrico (na interação grupo vs momento p=0,002; intergrupos p=0,040 no momento intermediário entre o GTEAI e GTEBI e no momento final do GTEBI e GTEBI-RFS em relação ao GTEAI; intragrupo p=0,000 nos momentos intermediário e final em relação ao momento basal nos GTEAI-RFS, GTEBI-RFS e GTEAI); picos de torque isométrico (intragrupo p= 0,003 no GTEAI-RFS do momento final em relação ao momento basal e no GTEBI-RFS do momento intermediário em relação ao momento basal) e para o pico de torque concêntrico (p= 0,000 entre momento final em relação ao basal foram identificadas diferenças significativas nos GTEAI-RFS e GTEAI). Não foram encontradas diferenças para espessura de VL, mas para RF houve interação momento vs grupo (p=0,023) e diferença intragrupo (p=0,04) do momento final em relação ao basal para o GTEAI-RFS. No Single Leg Hop Test não foram encontradas diferenças intergrupos (p= 0,784) e interação momento vs grupo (p= 0,317), porém houve diferenças (p=0,000) entre os momentos intermediário e final em relação ao basal em todos os grupos. Conclusão: os achados da presente revisão sistemática com metanálise sugerem que para ganhos de força e hipertrofia de extensores do joelho não existe superioridade entre o TRBI+RFS e TRAI, portanto, o treinamento de TRBI+RFS é uma alternativa para homens jovens saudáveis. E na comparação entre TRBI+RFS e TRBI, a adição da restrição parcial de fluxo sanguíneo favoreceu os ganhos no TRBI+RFS quando o objetivo é força, mas não teve diferença para o resultado de hipertrofia. o treinamento excêntrico levou ao fortalecimento dos extensores do joelho e melhora do desempenho funcional, porém sem aumento da resposta hipertrófica. A adição da RFS sobreposta ao exercício excêntrico não influenciou as magnitudes das adaptações induzidas pelo treinamento excêntrico em homens jovens saudáveis.
Studies on low intensity resistance training associated with blood flow restriction (RFS) are currently gaining prominence, however there are still gaps that can be explored in relation to their physiological effects when associated with eccentric training, especially in muscle strength and hypertrophy. Objective: To carry out a systematic review with meta-analysis and a randomized controlled study in order to clarify the real effects of TRBI associated with RFS on the outcomes of strength, muscle hypertrophy and functional performance, and whether RFS when associated with low and high intensity eccentric training is able to increase the responses of these knee extensor outcomes in healthy adult men. Methods: The systematic review was registered in PROSPERO (registration number # CRD42018104065). The studies were selected through seven databases. All included studies were assessed for methodological quality, using the PEDro Scale, as well as the quality of evidence was assessed. Only randomized controlled trials that assessed the effectiveness of RFS training on muscle strength and hypertrophy of knee extensor muscles in healthy, male and / or physically active adults, aged 18 to 35, against any intervention group were considered eligible. All meta-analyzes were conducted using the Review Manager - RevMan software and described as standardized mean differences (SMD) or mean differences (mean difference - MD) with 95% confidence intervals (CI). The randomized controlled study was composed of 61 male participants randomized into four groups: GTREAI (n = 15), GTREBI (n = 14), GTREAI-RFS (n = 17) and GTREBI-RFS (n = 15). The participants underwent an eccentric training program of the quadriceps muscle in the isokinetic dynamometer lasting six weeks at intensities of 80% with and without RFS and 40% with and without RFS of the eccentric torque peak three times a week and the outcomes of eccentric, concentric and isometric muscle strength in the isokinetic dynamometer, muscular structure of the vastus lateralis (VL) and rectus femoris (RF) by means of ultrasound and functional performance through the Single Leg Hop Test were evaluated one week before, in the fourth week and one week after training. The descriptive statistical method was used and the outcome comparisons were performed using the analysis of variance technique for repeated measures model in the two-factor scheme with a 5% significance level. Results: The main results of the systematic review in the comparison of TRBI + RFS x TRAI showed that there was no difference for the strength outcome: DMP = -0.21, 95% CI [-0.72, 0.31] and hypertrophy: DM = -2.92 95% CI [-12.27, 6.44] and when comparing TRBI + RFS x TRBI the strength outcome was favorable for TRBI + RFS (DMP = 1.01, 95% CI [0 , 07, 1.94]) and for hypertrophy there was no difference between the interventions (DM = -0.83, 95% CI [-5.66, 4.01). In relation to the randomized controlled study, statistically significant differences were observed in the peak eccentric torque (in the interaction vs group p = 0.002; intergroups p = 0.040 in the intermediate moment between GTEAI and GTEBI and in the final moment of GTEBI and GTEBIRFS in relation to to GTEAI; intragroup p = 0.000 in the intermediate and final moments in relation to the baseline moment in GTEAI-RFS, GTEBI-RFS and GTEAI); isometric torque peaks (intragroup p = 0.003 in the GTEAI-RFS of the final moment in relation to the baseline moment and in the GTEBI-RFS of the intermediate moment in relation to the baseline moment) and for the concentric torque peak (p = 0.000 between final moment in In relation to baseline, significant differences were identified in the GTEAI-RFS and GTEAI). No differences were found for VL thickness, but for RF, there was interaction between time vs group (p = 0.023) and intra-group difference (p = 0.04) from the final moment in relation to baseline for GTEAI-RFS. In the Single Leg Hop Test, no intergroup differences (p = 0.784) and moment vs group interaction (p = 0.317) were found, but there were differences (p = 0.000) between the intermediate and final moments in relation to baseline in all groups. Conclusion: the findings of this systematic review with metaanalysis suggest that for strength gains and hypertrophy of knee extensors there is no superiority between TRBI + RFS and TRAI, therefore, TRBI + RFS training is an alternative for healthy young men. And in the comparison between TRBI + RFS and TRBI, the addition of partial blood flow restriction favored gains in TRBI + RFS when the goal is strength, but there was no difference for the result of hypertrophy. eccentric training led to the strengthening of knee extensors and improved functional performance, but without increased hypertrophic response. The addition of the superimposed RFS to the eccentric exercise did not influence the magnitudes of the adaptations induced by the eccentric training in healthy young men.
Studies on low intensity resistance training associated with blood flow restriction (RFS) are currently gaining prominence, however there are still gaps that can be explored in relation to their physiological effects when associated with eccentric training, especially in muscle strength and hypertrophy. Objective: To carry out a systematic review with meta-analysis and a randomized controlled study in order to clarify the real effects of TRBI associated with RFS on the outcomes of strength, muscle hypertrophy and functional performance, and whether RFS when associated with low and high intensity eccentric training is able to increase the responses of these knee extensor outcomes in healthy adult men. Methods: The systematic review was registered in PROSPERO (registration number # CRD42018104065). The studies were selected through seven databases. All included studies were assessed for methodological quality, using the PEDro Scale, as well as the quality of evidence was assessed. Only randomized controlled trials that assessed the effectiveness of RFS training on muscle strength and hypertrophy of knee extensor muscles in healthy, male and / or physically active adults, aged 18 to 35, against any intervention group were considered eligible. All meta-analyzes were conducted using the Review Manager - RevMan software and described as standardized mean differences (SMD) or mean differences (mean difference - MD) with 95% confidence intervals (CI). The randomized controlled study was composed of 61 male participants randomized into four groups: GTREAI (n = 15), GTREBI (n = 14), GTREAI-RFS (n = 17) and GTREBI-RFS (n = 15). The participants underwent an eccentric training program of the quadriceps muscle in the isokinetic dynamometer lasting six weeks at intensities of 80% with and without RFS and 40% with and without RFS of the eccentric torque peak three times a week and the outcomes of eccentric, concentric and isometric muscle strength in the isokinetic dynamometer, muscular structure of the vastus lateralis (VL) and rectus femoris (RF) by means of ultrasound and functional performance through the Single Leg Hop Test were evaluated one week before, in the fourth week and one week after training. The descriptive statistical method was used and the outcome comparisons were performed using the analysis of variance technique for repeated measures model in the two-factor scheme with a 5% significance level. Results: The main results of the systematic review in the comparison of TRBI + RFS x TRAI showed that there was no difference for the strength outcome: DMP = -0.21, 95% CI [-0.72, 0.31] and hypertrophy: DM = -2.92 95% CI [-12.27, 6.44] and when comparing TRBI + RFS x TRBI the strength outcome was favorable for TRBI + RFS (DMP = 1.01, 95% CI [0 , 07, 1.94]) and for hypertrophy there was no difference between the interventions (DM = -0.83, 95% CI [-5.66, 4.01). In relation to the randomized controlled study, statistically significant differences were observed in the peak eccentric torque (in the interaction vs group p = 0.002; intergroups p = 0.040 in the intermediate moment between GTEAI and GTEBI and in the final moment of GTEBI and GTEBIRFS in relation to to GTEAI; intragroup p = 0.000 in the intermediate and final moments in relation to the baseline moment in GTEAI-RFS, GTEBI-RFS and GTEAI); isometric torque peaks (intragroup p = 0.003 in the GTEAI-RFS of the final moment in relation to the baseline moment and in the GTEBI-RFS of the intermediate moment in relation to the baseline moment) and for the concentric torque peak (p = 0.000 between final moment in In relation to baseline, significant differences were identified in the GTEAI-RFS and GTEAI). No differences were found for VL thickness, but for RF, there was interaction between time vs group (p = 0.023) and intra-group difference (p = 0.04) from the final moment in relation to baseline for GTEAI-RFS. In the Single Leg Hop Test, no intergroup differences (p = 0.784) and moment vs group interaction (p = 0.317) were found, but there were differences (p = 0.000) between the intermediate and final moments in relation to baseline in all groups. Conclusion: the findings of this systematic review with metaanalysis suggest that for strength gains and hypertrophy of knee extensors there is no superiority between TRBI + RFS and TRAI, therefore, TRBI + RFS training is an alternative for healthy young men. And in the comparison between TRBI + RFS and TRBI, the addition of partial blood flow restriction favored gains in TRBI + RFS when the goal is strength, but there was no difference for the result of hypertrophy. eccentric training led to the strengthening of knee extensors and improved functional performance, but without increased hypertrophic response. The addition of the superimposed RFS to the eccentric exercise did not influence the magnitudes of the adaptations induced by the eccentric training in healthy young men.
Descrição
Palavras-chave
Fisioterapia, Exercícios físicos, Força muscular, Hipertrofia, Training with blood flow restriction, Eccentric training, Resistance training