IMR Press / JIN / Volume 21 / Issue 2 / DOI: 10.31083/j.jin2102053
Open Access Original Research
Blood flow restriction exercise of the tibialis anterior in people with stroke: a preliminary study
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1 Research Department, Hammel Neurorehabilitation and Research Center, Aarhus University, 8450 Hammel, Denmark
2 Discipline of Physiotherapy, School of Health, Federation University, 3841 Victoria, Australia
3 Faculty of Medicine and Health, School of Health Sciences, University of New South Wales, Sydney, 2052 NSW, Australia
4 Graduate School of Health, Discipline of Physiotherapy, University of Technology Sydney, Sydney, 2007 NSW, Australia
*Correspondence: (Peter William Stubbs)
Academic Editor: Emilia Salvadori
J. Integr. Neurosci. 2022, 21(2), 53;
Submitted: 31 August 2021 | Revised: 15 September 2021 | Accepted: 27 December 2021 | Published: 21 March 2022
Copyright: © 2022 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.

Background: Blood flow restriction exercise (BFR-E) could be a useful training adjunct for patients with weakness after stroke to augment the effects of exercise on muscle activity. We aimed to examine neurophysiological changes (primary aim) and assess patient perceptions (secondary aim) following BFR-E. Methods: Fourteen participants with stroke performed BFR-E (1 session) and exercise without blood flow restrictsion (Exercise only) (1 session), on two days, 7 days apart. In each session, two sets of tibialis anterior (TA) contractions were performed and electromyography (EMG) was recorded. Eight participants underwent transcranial magnetic stimulation (single-pulse stimulation, short interval intracortical inhibition (SICI), intracortical facilitation (ICF)) and peripheral electrical stimulation (maximal peak-to-peak M-wave (M-max)) of the TA before, immediately-after, 10-min-after and 20-min-after BFR-E and Exercise only. Numerical rating scores (NRS) for pain, discomfort, fatigue, safety, focus and difficulty were collected for all subjects (n = 14). Paired comparisons and linear mixed models assessed the effects of BFR-E and Exercise only. Results: No adverse events due to exercise were reported. There was no contraction-number × condition interaction for EMG amplitude during exercise (p = 0.15), or time × condition interaction for single-pulse stmulation, SICI, ICF or M-max amplitude (p = 0.34 to p = 0.97). There was no difference between BFR-E and Exercise only in NRS scores (p = 0.10 to p = 0.50). Conclusion: Using our training paradigm, neurophysiological parameters, feasibility, tolerability and perceptions of safety were not different between BFR-E and Exercise only. As participants were generally well-functioning, our results are not generalizable to lower functioning people with stroke, different (more intense) exercise protocols or longer term training over weeks or months.

Intracortical inhibition
Intracortical facilitation
Strength training
Motor cortex
Tibialis anterior
Occlusion training
Transcranial magnetic stimulation
Fig. 1.
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