Ivan Chulvi-Medrano1, Moises Picon-Martinez1, Miguel Garcia-Jaen1, Juan Manuel Cortell-Tormo1, Yasser Alakhdar2, Gilberto Laurentino3

1University of Alicante, Faculty of Education, Department of General and Specific Didactics, Alicante, Spain
2University of Valencia. Faculty of Physiotherapy, Valencia, Spain
3University of Sao Paulo, Department of Biodynamics of the Human Body Movement, Sao Paulo, Brasil

Neuromuscular Adaptations after Blood Flow Restriction Training Combined with Nutritional Supplementation: A Preliminary Study

Monten. J. Sports Sci. Med. 2019, 8(1), 37-42 | DOI: 10.26773/mjssm.190306


Blood flow restriction training (BFRT) has been shown to be an effective alternative technique to conventional resistance training to increase skeletal muscle hypertrophy and strength. However, neuromuscular response to BFRT in combination with nutritional supplementation has rarely been studied. The purpose of this study was to investigate the effects of BFRT combined with creatine monohydrate (CrM) and/or hydroxymethyl butyrate (HMB) on skeletal muscle size and strength. Fifteen healthy males were randomly divided into three groups: a) BFRT without supplementation (C-BFR); b) BFRT with CrM supplementation (0.3 g / kg-1) (CrM-BFR); and c) BFRT with CrM (0.3 g / kg-1) and HMB (3 g) supplementation (CrM + HMB-BFR). Participants performed elbow flexion exercise (30% of maximal isometric voluntary contraction (MIVC)) at 30% of total occlusion pressure, twice a week, for three weeks. MIVC of the elbow flexion and brachial biceps muscle thickness were assessed pre- and post-training. There was no significant group-by-time interaction for MIVC values (p>0.05). Biceps muscle thickness was significantly increased from pre- to post-test in all groups (p<0.05). The C-BFR group obtained a greater value of effect size (d=2.2). These findings suggest that 3 weeks of CrM and HMB supplementation had no influence on BFRT-induced neuromuscular adaptations.


Skeletal muscle hypertrophy, muscle strength, occlusion training

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Amani, A. R., Sadeghi, H., & Afsharnezhad, T. (2018). Interval Training with Blood Flow Restriction on Aerobic Performance among Young Soccer Players at Transition Phase. Montenegrin Journal of Sports Science and Medicine, 7(2), 5-10. https://doi.org/10.26773/mjssm.180901

American College of Sports Medicine. (2009). Progression Models in Resistance Training for Healthy Adults. Medicine & Science in Sports & Exercise, 41(3), 687–708. https://doi.org/10.1249/MSS.0b013e3181915670

Antonio, J., & Ciccone, V. (2013). The effects of pre versus post workout supplementation of creatine monohydrate on body composition and strength. Journal of the International Society of Sports Nutrition, 10(1), 36. https://doi.org/10.1186/1550-2783-10-36

Balsom, P. D., Söderlund, K., & Ekblom, B. (1994). Creatine in humans with special reference to creatine supplementation. Sports Medicine (Auckland, N.Z.), 18(4), 268–280. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/7817065

Birch, R., Noble, D., & Greenhaff, P. L. (1994). The influence of dietary creatine supplementation on performance during repeated bouts of maximal isokinetic cycling in man. European Journal of Applied Physiology and Occupational Physiology, 69(3), 268–276. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/8001541

Buckner, S. L., Mouser, J. G., Dankel, S. J., Jessee, M. B., Mattocks, K. T., & Loenneke, J. P. (2017). The General Adaptation Syndrome: Potential misapplications to resistance exercise. Journal of Science and Medicine in Sport, 20(11), 1015–1017. https://doi.org/10.1016/j.jsams.2017.02.012

Buford, T. W., Kreider, R. B., Stout, J. R., Greenwood, M., Campbell, B., Spano, M., … Antonio, J. (2007). International Society of Sports Nutrition position stand: creatine supplementation and exercise. Journal of the International Society of Sports Nutrition, 4(1), 6. https://doi.org/10.1186/1550-2783-4-6

Chulvi-Medrano, I. (2011). Resistance training combined with superimposed partial occlusion. A review. Revista Andaluza de Medicina Del Deporte, 4(3), 121–128.

Cook, S. B., Scott, B. R., Hayes, K. L., & Murphy, B. G. (2018). Neuromuscular Adaptations to Low-Load Blood Flow Restricted Resistance Training. Journal of Sports Science & Medicine, 17(1), 66–73. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/29535579

Helms, E. R., Aragon, A. A., & Fitschen, P. J. (2014). Evidence-based recommendations for natural bodybuilding contest preparation: nutrition and supplementation. Journal of the International Society of Sports Nutrition, 11(1), 20. https://doi.org/10.1186/1550-2783-11-20

Jówko, E., Ostaszewski, P., Jank, M., Sacharuk, J., Zieniewicz, A., Wilczak, J., & Nissen, S. (2001). Creatine and beta-hydroxy-beta-methylbutyrate (HMB) additively increase lean body mass and muscle strength during a weight-training program. Nutrition (Burbank, Los Angeles County, Calif.), 17(7–8), 558–566. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/11448573

Laurentino, G. C., Ugrinowitsch, C., Roschel, H., Aoki, M. S., Soares, A. G., Neves, M., … Tricoli, V. (2012). Strength training with blood flow restriction diminishes myostatin gene expression. Medicine and Science in Sports and Exercise, 44(3), 406–412. https://doi.org/10.1249/MSS.0b013e318233b4bc

Loenneke, J. P., Fahs, C. A., Rossow, L. M., Abe, T., & Bemben, M. G. (2012). The anabolic benefits of venous blood flow restriction training may be induced by muscle cell swelling. Medical Hypotheses, 78(1), 151–154. https://doi.org/10.1016/j.mehy.2011.10.014

Loenneke, J. P., & Pujol, T. J. (2009). The Use of Occlusion Training to Produce Muscle Hypertrophy. Strength and Conditioning Journal, 31(3), 77–84. https://doi.org/10.1519/SSC.0b013e3181a5a352

Martín-Hernández, J, Marín PJ, H. A. (2011). Review of muscle hypertrophy mechanisms induced by resistance occlusive training. Revista Andaluza de Medicina Del Deporte, 4(4), 129–177.

Martín-Hernández, J, B. R. H. A. (2011). Physical exercise supplemented with tisular ischemia prevents muscle atrophy. Archivos de Medicina Del Deporte, 28(145), 383–393.

Martín-Hernández, J., Marín, P. J., Menéndez, H., Ferrero, C., Loenneke, J. P., & Herrero, A. J. (2013). Muscular adaptations after two different volumes of blood flow-restricted training. Scandinavian Journal of Medicine & Science in Sports, 23(2), e114-20. https://doi.org/10.1111/sms.12036

Meester, A. De, Stodden, D., Brian, A., True, L., & Cardon, G. (2016). Associations among Elementary School Children’s Actual Motor Competence, Perceived Motor Competence , Physical Activity and BMI : A Cross-Sectional Study Associations among Elementary School Children’s Actual Motor Competence, Perceived Motor Compet, (October), 1–14. https://doi.org/10.5061/dryad.96cp2

Nair, K. S., Schwartz, R. G., & Welle, S. (1992). Leucine as a regulator of whole body and skeletal muscle protein metabolism in humans. American Journal of Physiology-Endocrinology and Metabolism, 263(5), E928–E934. https://doi.org/10.1152/ajpendo.1992.263.5.E928

Nissen, S., Sharp, R., Ray, M., Rathmacher, J. A., Rice, D., Fuller, J. C., … Abumrad, N. (1996). Effect of leucine metabolite beta-hydroxy-beta-methylbutyrate on muscle metabolism during resistance-exercise training. Journal of Applied Physiology (Bethesda, Md. : 1985), 81(5), 2095–2104. https://doi.org/10.1152/jappl.1996.81.5.2095

O’Connor, D. M., & Crowe, M. J. (2007). Effects of Six Weeks of β-Hydroxy-β-Methylbutyrate (HMB) and HMB/Creatine Supplementation on Strength, Power, and Anthropometry of Highly Trained Athletes. The Journal of Strength and Conditioning Research, 21(2), 419. https://doi.org/10.1519/R-15974.1

Pearson, D.R., Hamby, D.G., Russel, W., & Harris, T. (1999). Long-term effects of creatine monohydrate on strength and power. Journal of Strength and Conditioning Research, 13(3), 187–192.

Pope, Z. K., Willardson, J. M., & Schoenfeld, B. J. (2013). Exercise and blood flow restriction. Journal of Strength and Conditioning Research, 27(10), 2914–2926. https://doi.org/10.1519/JSC.0b013e3182874721

Portal, S., Eliakim, A., Nemet, D., Halevy, O., & Zadik, Z. (2010). Effect of HMB supplementation on body composition, fitness, hormonal profile and muscle damage indices. Journal of Pediatric Endocrinology & Metabolism : JPEM, 23(7), 641–650. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/20857835

Rhea, M. R. (2004). Determining the Magnitude of Treatment Effects in Strength Training Research Through the Use of the Effect Size. The Journal of Strength and Conditioning Research, 18(4), 918. https://doi.org/10.1519/14403.1

Sanchez-Martinez, J., Santos-Lozano, A., Garcia-Hermoso, A., Sadarangani, K. P., & Cristi-Montero, C. (2018). Effects of beta-hydroxy-beta-methylbutyrate supplementation on strength and body composition in trained and competitive athletes: A meta-analysis of randomized controlled trials. Journal of Science and Medicine in Sport, 21(7), 727–735. https://doi.org/10.1016/j.jsams.2017.11.003

Slysz, J., Stultz, J., & Burr, J. F. (2016). The efficacy of blood flow restricted exercise: A systematic review & meta-analysis. Journal of Science and Medicine in Sport, 19(8), 669–675. https://doi.org/10.1016/j.jsams.2015.09.005

Souza-Junior, T. P., Willardson, J. M., Bloomer, R., Leite, R. D., Fleck, S. J., Oliveira, P. R., & Simão, R. (2011). Strength and hypertrophy responses to constant and decreasing rest intervals in trained men using creatine supplementation. Journal of the International Society of Sports Nutrition, 8(1), 17. https://doi.org/10.1186/1550-2783-8-17

Takarada, Y., Takazawa, H., Sato, Y., Takebayashi, S., Tanaka, Y., & Ishii, N. (2000). Effects of resistance exercise combined with moderate vascular occlusion on muscular function in humans. Journal of Applied Physiology, 88(6), 2097–2106. https://doi.org/10.1152/jappl.2000.88.6.2097

Wilson, J. M., Fitschen, P. J., Campbell, B., Wilson, G. J., Zanchi, N., Taylor, L., … Antonio, J. (2013). International Society of Sports Nutrition Position Stand: beta-hydroxy-beta-methylbutyrate (HMB). Journal of the International Society of Sports Nutrition, 10(1), 6. https://doi.org/10.1186/1550-2783-10-6

Wilson, J. M., Lowery, R. P., Joy, J. M., Andersen, J. C., Wilson, S. M. C., Stout, J. R., … Rathmacher, J. (2014). The effects of 12 weeks of beta-hydroxy-beta-methylbutyrate free acid supplementation on muscle mass, strength, and power in resistance-trained individuals: a randomized, double-blind, placebo-controlled study. European Journal of Applied Physiology, 114(6), 1217–1227. https://doi.org/10.1007/s00421-014-2854-5