Low-load blood flow restriction training induces similar morphological and mechanical Achilles tendon adaptations compared with high-load resistance training

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Abstract
Low-load blood flow restriction (LL-BFR) training has gained increasing interest in the scientific community by demonstrating that increases in muscle mass and strength are comparable to conventional high-load (HL) resistance training. Although adaptations on the muscular level are well documented, there is little evidence on how LL-BFR training affects human myotendinous properties. Therefore, the aim of the present study was to investigate morphological and mechanical Achilles tendon adaptations after 14 weeks of strength training. Fifty-five male volunteers (27.9 ± 5.1 years) were randomly allocated into the following three groups: LL-BFR (20-35% of one-repetition maximum, 1RM), HL (70-85% 1RM) or a non-exercising control group (CON). The LL-BFR and the HL completed a resistance training program for 14 weeks and tendon morphology, mechanical as well as material properties along with muscle cross-sectional area (CSA) and isometric strength were assessed before and after the intervention. Both, HL (+40.7%) and LL-BFR (+36.1%) training induced significant increases in tendon stiffness (p < 0.05) as well as tendon CSA (HL: +4.6%, LL-BFR: +7.8%, p < 0.001). These changes were comparable between groups without significant changes in Young's modulus. Furthermore, gastrocnemius medialis muscle CSA and plantar flexor strength significantly increased in both training groups (p < 0.05), while the CON group did not show significant changes in any of the evaluated parameters. In conclusion, the adaptive change in Achilles tendon properties following low-load resistance training with partial vascular occlusion appears comparable to that evoked by high-load resistance training.

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