Acute BFR Training Effects on Balance and Proprioception

NCT ID: NCT07309068

Last Updated: 2025-12-30

Study Results

Results pending

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Basic Information

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Recruitment Status

ACTIVE_NOT_RECRUITING

Clinical Phase

NA

Total Enrollment

75 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-11-01

Study Completion Date

2026-02-01

Brief Summary

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Blood Flow Restriction Training (BFR) is a technique applied using a cuff or tourniquet to restrict venous return while maintaining arterial blood flow during exercise. In recent years, BFR has gained increasing attention as an effective method to enhance muscle activity with low-intensity training. This study aims to evaluate the acute effects of BFR training on a relatively underexplored area-balance and proprioception-and to analyze these effects by comparing them with sham and control groups.

The study is planned to include healthy individuals aged 18-35 years. Participants will be divided into three groups: BFR, sham, and control. Before and after the exercise protocol, all participants' demographic information and physical activity levels will be recorded. In the next phase, participants will undergo assessments of static and dynamic balance, knee and ankle proprioception measurements, and single-leg hop tests. After completing a single-session exercise protocol, all assessment tests will be repeated for each participant. The collected data will be compared across groups.

The expected outcome of the study is that the BFR group, in which arterial occlusion will be applied, will show significant improvements in parameters related to balance and proprioception compared to the other groups.

The novelty of this study lies in examining both the effects of BFR on balance and proprioception and their acute-level manifestations. Currently, studies investigating the effects of BFR on balance and proprioception are limited. Our study aims not only to contribute to the diversity of literature on balance exercise applications but also, if the acute effects of BFR are confirmed, to provide a new perspective on the application of this exercise method in physiotherapy, rehabilitation, and sports sciences.

Detailed Description

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Blood Flow Restriction Exercise (BFR) has emerged as a highly effective method for enhancing muscle activity through low-intensity training, typically performed at 20-30% of one-repetition maximum. The technique involves the application of an external constrictive device, such as a cuff or tourniquet, which limits venous return while maintaining arterial blood flow. This creates a localized hypoxic environment in the distal musculature, leading to metabolic stress that is thought to activate group III and IV afferent nerve fibers. These fibers, in turn, recruit fast-twitch motor units that are particularly responsive to hypertrophic adaptations and may stimulate anabolic hormone release. Evidence from resistance training studies indicates that BFR can enhance muscle protein synthesis, increase muscle cross-sectional area, and preferentially activate type II fibers even at low exercise intensities. Furthermore, BFR combined with aerobic exercise has been shown to improve cardiovascular endurance, maximal oxygen uptake, and metabolic adaptations, suggesting its versatility across different training modalities and populations.

Despite extensive research on BFR's effects on muscle strength and hypertrophy, its influence on balance and proprioception remains relatively unexplored. Proprioception, which enables the perception of body position and movement through interactions between the musculoskeletal and central nervous systems, is essential for postural control, motor coordination, injury prevention, and safe performance of daily and athletic activities. Postural stability depends on the integration of vestibular, visual, and proprioceptive inputs, with muscle stiffness and reflexive responses playing crucial roles. Temporary restriction of blood flow during BFR may modulate sensory feedback from mechanoreceptors, such as muscle spindles and Golgi tendon organs, potentially enhancing proprioceptive acuity and postural control. Activation of group III and IV afferents, which convey mechanical, metabolic, and nociceptive signals to the central nervous system, is considered a key mechanism underlying these effects. Group III afferents are primarily sensitive to mechanical stimuli such as tension and intramuscular pressure, while group IV afferents respond predominantly to metabolic changes. By stimulating these afferent pathways, BFR may facilitate short-term neuromuscular adaptations that improve both balance and proprioception.

Although some studies have reported improvements in postural control and static balance parameters following BFR, the literature remains limited and occasionally inconsistent. There is a particular scarcity of research investigating the acute effects of BFR on proprioception and balance in young sedentary adults, as most prior studies have focused on strength, hypertrophy, or aerobic performance. The present study aims to fill this gap by evaluating the immediate neuromuscular responses to a single session of BFR exercise, with a focus on proprioceptive function and postural stability. Findings from this research are expected to provide novel insights into the application of BFR for rehabilitation, injury prevention, and athletic performance optimization, offering evidence-based guidance for exercise prescription in both clinical and sporting populations.

Conditions

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Blood Flow Restriction

Keywords

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blood flow restriction proprioception dynamic balance

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

OTHER

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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Control group

Group Type OTHER

Proprioceptive Exercise Training

Intervention Type OTHER

All participants will perform the same exercise protocol. The protocol was designed based on studies in the literature examining the effects of proprioception training. The program consists of various balance and proprioceptive exercises performed on a BOSU balance platform. The purpose of the exercises is to improve participants' static and dynamic balance, stimulate the sensorimotor system, and enhance lower extremity stability.

The exercise protocol includes the following sequence: participants will perform squats on the BOSU (10 repetitions), double-leg stance on the BOSU (60 seconds), double-leg ball toss and catch on the BOSU (60 seconds), single-leg stance on the BOSU (60 seconds), and single-leg ball toss and catch on the BOSU (60 seconds). This is followed by double-leg jumps on the BOSU (10 repetitions), single-leg jumps on the BOSU (10 repetitions), and double-leg jumps with 90° trunk rotation on the BOSU (10 repetitions). In the final part, participants will perform double

Sham Group

Group Type SHAM_COMPARATOR

sham BFR

Intervention Type OTHER

Participants in the sham BFR group will wear cuffs placed proximally on both thighs. However, no pressure will be applied to restrict blood flow. The cuffs will remain in place throughout the exercise session to simulate the sensation of blood flow restriction without inducing actual occlusion. Participants will perform the same exercise protocol as the BFR group under these conditions.

Proprioceptive Exercise Training

Intervention Type OTHER

All participants will perform the same exercise protocol. The protocol was designed based on studies in the literature examining the effects of proprioception training. The program consists of various balance and proprioceptive exercises performed on a BOSU balance platform. The purpose of the exercises is to improve participants' static and dynamic balance, stimulate the sensorimotor system, and enhance lower extremity stability.

The exercise protocol includes the following sequence: participants will perform squats on the BOSU (10 repetitions), double-leg stance on the BOSU (60 seconds), double-leg ball toss and catch on the BOSU (60 seconds), single-leg stance on the BOSU (60 seconds), and single-leg ball toss and catch on the BOSU (60 seconds). This is followed by double-leg jumps on the BOSU (10 repetitions), single-leg jumps on the BOSU (10 repetitions), and double-leg jumps with 90° trunk rotation on the BOSU (10 repetitions). In the final part, participants will perform double

BFR Group

Group Type EXPERIMENTAL

BFR

Intervention Type OTHER

In this group, participants will have cuffs placed proximally on the limb to induce blood flow restriction, and individualized pressure will be applied. Participants will perform the prescribed exercises under blood flow restriction conditions. For the blood flow restriction application, an Occlusion Cuff device will be used. Following the warm-up protocol, cuffs will be placed bilaterally on the most proximal portion of the thigh in both the BFR and sham groups. The cuff tightness will be adjusted to allow the insertion of two fingers between the cuff and the skin at both the upper and lower edges. In the sham group, the cuffs will not be inflated to restrict blood flow, while in the BFR group, the pressure will be set at 80% of the individual's arterial occlusion pressure (AOP). AOP will be determined in the supine position using an Occlusion Cuff Doppler ultrasound device (8 MHz) applied to the posterior tibial artery.

Proprioceptive Exercise Training

Intervention Type OTHER

All participants will perform the same exercise protocol. The protocol was designed based on studies in the literature examining the effects of proprioception training. The program consists of various balance and proprioceptive exercises performed on a BOSU balance platform. The purpose of the exercises is to improve participants' static and dynamic balance, stimulate the sensorimotor system, and enhance lower extremity stability.

The exercise protocol includes the following sequence: participants will perform squats on the BOSU (10 repetitions), double-leg stance on the BOSU (60 seconds), double-leg ball toss and catch on the BOSU (60 seconds), single-leg stance on the BOSU (60 seconds), and single-leg ball toss and catch on the BOSU (60 seconds). This is followed by double-leg jumps on the BOSU (10 repetitions), single-leg jumps on the BOSU (10 repetitions), and double-leg jumps with 90° trunk rotation on the BOSU (10 repetitions). In the final part, participants will perform double

Interventions

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BFR

In this group, participants will have cuffs placed proximally on the limb to induce blood flow restriction, and individualized pressure will be applied. Participants will perform the prescribed exercises under blood flow restriction conditions. For the blood flow restriction application, an Occlusion Cuff device will be used. Following the warm-up protocol, cuffs will be placed bilaterally on the most proximal portion of the thigh in both the BFR and sham groups. The cuff tightness will be adjusted to allow the insertion of two fingers between the cuff and the skin at both the upper and lower edges. In the sham group, the cuffs will not be inflated to restrict blood flow, while in the BFR group, the pressure will be set at 80% of the individual's arterial occlusion pressure (AOP). AOP will be determined in the supine position using an Occlusion Cuff Doppler ultrasound device (8 MHz) applied to the posterior tibial artery.

Intervention Type OTHER

sham BFR

Participants in the sham BFR group will wear cuffs placed proximally on both thighs. However, no pressure will be applied to restrict blood flow. The cuffs will remain in place throughout the exercise session to simulate the sensation of blood flow restriction without inducing actual occlusion. Participants will perform the same exercise protocol as the BFR group under these conditions.

Intervention Type OTHER

Proprioceptive Exercise Training

All participants will perform the same exercise protocol. The protocol was designed based on studies in the literature examining the effects of proprioception training. The program consists of various balance and proprioceptive exercises performed on a BOSU balance platform. The purpose of the exercises is to improve participants' static and dynamic balance, stimulate the sensorimotor system, and enhance lower extremity stability.

The exercise protocol includes the following sequence: participants will perform squats on the BOSU (10 repetitions), double-leg stance on the BOSU (60 seconds), double-leg ball toss and catch on the BOSU (60 seconds), single-leg stance on the BOSU (60 seconds), and single-leg ball toss and catch on the BOSU (60 seconds). This is followed by double-leg jumps on the BOSU (10 repetitions), single-leg jumps on the BOSU (10 repetitions), and double-leg jumps with 90° trunk rotation on the BOSU (10 repetitions). In the final part, participants will perform double

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

Be male or female between 18 and 35 years of age. Have a physical activity level defined as an energy expenditure of at least 600 MET-minutes per week, according to the International Physical Activity Questionnaire - Short Form (IPAQ-SF).

Have normal knee joint range of motion (flexion: 0-135°; hyperextension: 0-10°).

Have normal ankle joint range of motion (dorsiflexion: 0-20°; plantarflexion: 0-45°).

Exclusion Criteria

History of low back or lower extremity injury within the past 6 months. History of neurological or vestibular disorders. History of lower extremity surgery. Risk factors for deep vein thrombosis. Presence of at least one contraindication preventing participation in exercises involving blood flow restriction (e.g., smoking, previous venous thromboembolism, peripheral vascular disease risk such as ankle-brachial index \<0.9, coronary heart disease, hypertension, hemophilia, etc.).
Minimum Eligible Age

18 Years

Maximum Eligible Age

35 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Biruni University

OTHER

Sponsor Role lead

Responsible Party

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Berivan Beril Kılıç

Asistant professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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Biruni University

Istanbul, , Turkey (Türkiye)

Site Status

Countries

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Turkey (Türkiye)

References

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Other Identifiers

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6

Identifier Type: -

Identifier Source: org_study_id