血流限制训练改善认知功能的机制及应用方案

Improvement of cognitive function by blood flow restriction training:mechanisms and applications

背景:血流限制训练是阻力训练领域的一种新型训练方式,血流限制训练在对肌肉力量、质量和躯体能力产生影响的同时可以诱导激活神经可塑性和认知功能等相关信号通路。然而,目前的研究尚未系统综述血流限制训练对不同人群认知能力的影响,对血流限制训练改善认知功能的神经生物学机制缺乏全面认识,且对血流限制训练的应用方案尚不完全清楚。目的:对国内外现有的血流限制训练对不同人群认知功能影响的试验研究进行梳理,深度剖析潜在的神经生物学机制,归纳总结以往研究应用血流限制训练改善认知功能的合理性方案,旨在为安全有效地应用该技术提供理论支撑和实践指导。方法:计算机检索PubMed、Web of Science和中国知网等数据库,检索时间设定为各数据库建库至2022年10月,中文检索词包括“血流限制训练、加压训练、血流限制疗法、血流限制、加压血流阻滞训练、血流阻滞、认知功能、认知能力”,英文检索词包括“Blood Flow Restricting Therapy,KAATSU training,KAATSU volume,Resistance training,BFR Therapy,BFRT,Blood Flow Restriction Exercise,Cognition,Cognitive Function”。根据文章需要确立相应的入组标准,最终纳入84篇文献进行综述分析。结果与结论:(1)血流限制训练对认知能力影响主要选择健康人群作为受试对象,试图探索其对健康老年人群的应用价值,但总体来看有关老年人群和认知功能障碍患者的研究较少。(2)血流限制训练通过对肢端应用低氧刺激所引起的短暂性大脑氧气缺乏,在一定程度上可作为触发积极神经适应的关键性因素,血流限制训练可使与认知功能改善相关的生物活性分子水平显著提高,主要因子包括胰岛素样生长因子1、生长激素、血管内皮生长因子、脑源性神经营养因子、乳酸、缺氧诱导因子1α、过氧化物酶体增殖活化受体γ辅助活化因子1α和去甲肾上腺素。(3)血流限制训练应用方案的制定涉及训练参与者的选择、训练变量的控制和袖带压力及其宽度的设置因素。(4)未来的研究建议通过比较不同血流限制训练方法在不同人群的应用效果,使血流限制训练的临床应用更加完善合理,为血流限制训练改善认知功能障碍患者的认知功能提供更多的理论依据。

BACKG ROUND:Blood flow restriction training is a new resistance training.Blood flow restriction training can not only influence muscle strength,mass and physical ability,but also induce and activate related signaling pathways such as neural plasticity and cognitive function.Howeve r,current studies have not systematically evaluated the effects of blood flow restriction training on the cognitive ability of different populations,and the neuro biological mechanism by which blood flow restriction training improves cognitive function is not fully understood.Moreover,the application solutions of blood flow restriction training are still not fully understood.OBJECTIVE:To review the existing experimental studies on the influence of blood flow restriction training on cognitive function of different populations,deeply analyze the potential neurobiological mechanisms,and summarize the previous rational programs of blood flow restriction training that improve cognitive function,in order to provide theo retical suppo rt and practical guidance for the safe and effective application of this technology.METHODS:PubMed,Web of Science,and CNKI databases were retrieved using"blood flow restriction training,pressure training,blood flow restriction therapy,blood flow restriction,pressure blood block training,blood block,cognitive function,cognitive ability"as Chinese keywords and"blood flow restriction therapy,KAATSU training,KAATSU volume,resistance training,BFR therapy,BFRT,blood flow restriction exe rcise,cognition,cognitive function"as English keywords.The search deadline was October 2022.Relevant inclusion criteria we re established according to the research needs and finally 84 articles were included for further review.RESULTS AND CONCLUSION:The experimental studies regarding the influence of blood flow restriction training on cognitive ability mainly select healthy people as subjects in an attempt to explore its application value in healthy elderly populations.However,in general,there are few studies on elderly people and patients with cognitive dysfunction.Blood flow restriction training can be used as a key factor to trigger positive neural adaptation to a certain extent by applying hypoxic stimulation to the extremity to induce transient brain oxygen deficiency.Blood flow restriction training can significantly improve the levels of bioactive molecules related to the improvement of cognitive function,mainly including insulin-like growth factor 1,growth hormone,vascular endothelial growth facto r,brain-derived neurotrophic factor,lactic acid,hypoxia-inducible factor 1α,peroxisome proliferator-activated receptor-γ coactivation factor lαand nore pinephrine.The formulation of blood flow restriction training application programs involves the selection of training participants,the determination of exercise factors and the setting of cuff pressure and its width.Future studies should pay attention to the comparison of the application effects of different blood flow restriction training methods in different populations,so as to make the clinical application of blood flow restriction training more perfect and reasonable,providing more theoretical basis for blood flow restriction training to improve cognitive function in patients with cognitive dysfunction.