Introduction:

In previous blogs I have alluded to the benefits of BFR training in elderly populations (Who should use BFR training?). Research in this area is still developing but is progressively becoming more robust, with positive results being achieved across populations of different ages and health status, while using different BFR protocols and exercise methods. With this is mind, it was time to start exploring the effectiveness of different training protocols in unique case studies within the elderly population.

Subject characteristics:

The subject is a 64-year old female, with a long standing history of knee pain. She has previously had a bilateral medial meniscectomy, and is showing early signs of degenerative osteoarthritis. This pathology has caused a significant reduction in function and pain completing activities of daily living that require loaded knee flexion movements (squatting down, climbing stairs, getting up from a chair etc.). Consequently, the subject displays altered movement strategies and motor patterns to perform these tasks, showing an increase in hip flexion moment arms and an unwillingness to flex her knees. Collectively, the pathology, symptoms and altered movement, places this subject at risk of a progressive decline in physical function throughout the ageing process.

Intervention:

The subject in this case-study completed an 8-week BFR combined with low-intensity resistance exercise intervention. In this instance our subject had no prior experience with BFR training and had previously former experience in completing a structured resistance exercise training program. The program consisted primarily of body weight exercises as our subject had minimal access to exercise equipment other than 2x, 5kg ankle weights. Prior to the commencement of the exercise intervention the subject completed a medical screening questionnaire as outlined in Kacin et al. 2016 to determine suitability for participation in a BFR training programme. The details of the exercise routine are outlined below.

Weeks 1-2: Acclimatization

Occlusion pressure: 30% limb occlusion pressure (LOP)

Exercises: Bodyweight seated knee extension + Bodyweight hamstring bridge

Sets x Reps: 4 x 10

Tempo: 3-1-1-1

(Eccentric phase - Transition - Concentric phase - Transition)

Rest: 30 sec

Week 3-4: Increase in training volume

Occlusion pressure: 40% limb occlusion pressure (LOP)

Exercises: Bodyweight seated knee extension + Bodyweight hamstring bridge

Sets x Reps: 4 x 20

Tempo: 1-1-1-1

Rest: 30 sec

Week 5-6: Increase mechanical load

Occlusion pressure: 50% limb occlusion pressure (LOP)

Exercises: Seated knee extension (+5kg ankle weight) + Eccentric hamstring bridge (2 legs up, 1 leg down)

Sets x Reps: 4 x 10

Tempo: 3-1-1-1

Rest: 30 sec

Week 7-8: Increase training volume

Occlusion pressure: 50% limb occlusion pressure (LOP)

Exercises: Seated knee extension (+5kg ankle weight) + Eccentric hamstring bridge (2 legs up, 1 leg down)

Sets x Reps: 4 x 20

Tempo: 1-1-1-1

Rest: 30 sec

Results:

To gauge the effectiveness of the intervention we completed the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire at the beginning of the intervention and at the end of week 4 and 8. The KOOS details 42 questions across 5 different subscales: Pain, Other symptoms, Function in daily living, Function is Sport and recreation, and Knee related quality of life. When completing the KOOS questionnaire, a higher score indicated more severe symptoms, or a lower degree of function, thus a lower score is a more favourable outcome. The results of the KOOS is detailed below in Figure 1. The results of this case study demonstrate a considerable reduction in symptoms, and an increase in the subjects physical function. These results were achieved using a BFR training protocol with minimal exercise equipment and a very low training intensity. When the subject was asked for feedback on her training programme, the following answer was given:

"My knees are feeling much better. I have more confidence to get down on the floor and play with grandson in the knowledge I will be able to get back up! I also feel like I have gained a couple of extra yards on my golf swing so that doesn't hurt either"

The SujiBFR training system was used by the subject throughout the duration of the intervention.

Disclaimer:

The SujiBFR training system was provided to the subject for use throughout the duration of the intervention. The subject has given verbal permission for her training programme and results to be published within this forum.

References:

1. Kacin, A., et al., Safety considerations with blood flow restricted exercise. Annales Kinesiologiae, 2015. 6(1): 3-26. https://www.researchgate.net/publication/293767736