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Development of a prediction equation to estimate lower-limb arterial occlusion pressure with a thigh sphygmomanometer

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Abstract

Introduction

Previous investigators have developed prediction equations to estimate arterial occlusion pressure (AOP) for blood flow restriction (BFR) exercise. Most equations have not been validated and are designed for use with expensive cuff systems. Thus, their implementation is limited for practitioners.

Purpose

To develop and validate an equation to predict AOP in the lower limbs when applying an 18 cm wide thigh sphygmomanometer (SPHYG18cm).

Methods

Healthy adults (n = 143) underwent measures of thigh circumference (TC), skinfold thickness (ST), and estimated muscle cross-sectional area (CSA) along with brachial and femoral systolic (SBP) and diastolic (DBP) blood pressure. Lower-limb AOP was assessed in a seated position at the posterior tibial artery (Doppler ultrasound) using a SPHYG18cm. Hierarchical linear regression models were used to determine predictors of AOP. The best set of predictors was used to construct a prediction equation to estimate AOP. Performance of the equation was evaluated and internally validated using bootstrap resampling.

Results

Models containing measures of either TC or thigh composition (ST and CSA) paired with brachial blood pressures explained the most variability in AOP (54%) with brachial SBP accounting for majority of explained variability. A prediction equation including TC, brachial SBP, and age showed good predictability (R2 = 0.54, RMSE = 7.18 mmHg) and excellent calibration. Mean difference between observed and predicted values was 0.0 mmHg and 95% Limits of Agreement were ± 18.35 mmHg. Internal validation revealed small differences between apparent and optimism adjusted performance measures, suggesting good generalizability.

Conclusion

This prediction equation for use with a SPHYG18cm provided a valid way to estimate lower-limb AOP without expensive equipment.

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Abbreviations

AOP:

Arterial occlusion pressure

BA-LoA:

Bland–Altman limits of agreement

BIC:

Bayesian information criterion

BFR:

Blood flow restriction

BMI:

Body mass index

CITL:

Calibration-in-the-large

CSA:

Cross-sectional area

DBP:

Diastolic blood pressure

LASSO:

Least absolute shrinkage and selection operator

MSE:

Mean square error

RMSE:

Root mean square error

SBP:

Systolic blood pressure

SEE:

Standard error of estimate

ST:

Skinfold thickness

TC:

Thigh circumference

VIF:

Variance inflation factor

References

  • Bakar Y, Özdemir ÖC, Sevim S, Duygu E, Tuğral A, Sürmeli M (2017) Intra-observer and inter-observer reliability of leg circumference measurement among six observers: a single blinded randomized trial. J Med Life 10:176–181

    CAS  PubMed  PubMed Central  Google Scholar 

  • Bennett H, Slattery F (2019) Effects of blood flow restriction training on aerobic capacity and performance: a systematic review. J Strength Cond Res 33:572–583

    Article  PubMed  Google Scholar 

  • Bland JM, Altman D (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 327:307–310

    Article  Google Scholar 

  • Bouwmeester W, Zuithoff NP, Mallett S, Geerlings MI, Vergouwe Y, Steyerberg EW, Altman DG, Moons KG (2012) Reporting and methods in clinical prediction research: a systematic review. PLoS Med 9:e1001221

    Article  PubMed  PubMed Central  Google Scholar 

  • Brekke AF, Sørensen AN, Buhr C, Johannesdottír ÍO, Jakobsen TL (2020) The validity and reliability of the handheld oximeter to determine limb occlusion pressure for blood flow restriction exercise in the lower extremity. Int J Sports Phys Ther 15:783–791

    Article  PubMed  PubMed Central  Google Scholar 

  • Cirilo-Sousa MDS, Lemos JB, Poderoso R, Araújo RCTD, Aniceto RR, Pereira PMG, Araújo JP, Lucena PHM, Paz CR, Araújo ATD (2019) Predictive equation for blood flow restriction training. Rev Bras De Medicina Do Esporte 25:494–497

    Article  Google Scholar 

  • Collins GS, Mallett S, Omar O, Yu L-M (2011) Developing risk prediction models for type 2 diabetes: a systematic review of methodology and reporting. BMC Med 9:1–14

    Article  Google Scholar 

  • Collins GS, Omar O, Shanyinde M, Yu L-M (2013) A systematic review finds prediction models for chronic kidney disease were poorly reported and often developed using inappropriate methods. J Clin Epidemiol 66:268–277

    Article  PubMed  Google Scholar 

  • Crenshaw AG, Hargens AR, Gershuni DH, Rydevik B (1988) Wide tourniquet cuffs more effective at lower inflation pressures. Acta Orthop Scand 59:447–451

    Article  CAS  PubMed  Google Scholar 

  • Ferreira Junior A, Schamne JC, Altimari LR, Okano AH, Okuno NM (2019) Effect of walk training combined with blood flow restriction on resting heart rate variability and resting blood pressure in middle-aged men. Motriz: Revista De Educação Física. https://doi.org/10.1590/s1980-6574201900020005

    Article  Google Scholar 

  • Giavarina D (2015) Understanding Bland Altman analysis. Biochem Med (zagreb) 25:141–151

    Article  PubMed  Google Scholar 

  • Housh DJ, Housh TJ, Weir JP, Weir LL, Johnson GO, Stout JR (1995) Anthropometric estimation of thigh muscle cross-sectional area. Med Sci Sports Exerc 27:784–791

    Article  CAS  PubMed  Google Scholar 

  • Hughes L, Mcewen J (2021) Investigation of clinically acceptable agreement between two methods of automatic measurement of limb occlusion pressure: a randomised trial. BMC Biomed Eng 3:1–8

    Article  Google Scholar 

  • Hughes L, Paton B, Rosenblatt B, Gissane C, Patterson SD (2017) Blood flow restriction training in clinical musculoskeletal rehabilitation: a systematic review and meta-analysis. Br J Sports Med 51:1003–1011

    Article  PubMed  Google Scholar 

  • Hughes L, Jeffries O, Waldron M, Rosenblatt B, Gissane C, Paton B, Patterson SD (2018) Influence and reliability of lower-limb arterial occlusion pressure at different body positions. PeerJ 6:e4697

    Article  PubMed  PubMed Central  Google Scholar 

  • Jessee MB, Buckner SL, Dankel SJ, Counts BR, Abe T, Loenneke JP (2016) The influence of cuff width, sex, and race on arterial occlusion: implications for blood flow restriction research. Sports Med 46:913–921

    Article  PubMed  Google Scholar 

  • Jessee MB, Dankel SJ, Buckner SL, Mouser JG, Mattocks KT, Loenneke JP (2017) The cardiovascular and perceptual response to very low load blood flow restricted exercise. Int J Sports Med 38:597–603

    Article  PubMed  Google Scholar 

  • Junior AF, Schamne JC, Perandini LAB, Chimin P, Okuno NM (2019) Effects of walking training with restricted blood flow on hr and hrv kinetics and hrv recovery. Int J Sports Med 40:585–591

    Article  PubMed  Google Scholar 

  • Karanasios S, Koutri C, Moutzouri M, Xergia SA, Sakellari V, Gioftsos G (2022) The effect of body position and the reliability of upper limb arterial occlusion pressure using a handheld doppler ultrasound for blood flow restriction training. Sports Health 14:717–724

    Article  PubMed  Google Scholar 

  • Kerr L, Wilkerson S, Bandy WD, Ishee J (1994) Reliability and validity of skinfold measurements of trained versus untrained testers. Isokinet Exerc Sci 4:137–140

    Article  Google Scholar 

  • Kilgas MA, Denherder AE, Lytle LLM, Williams CT, Elmer SJ (2019a) Home-based exercise with blood flow restriction to improve quadriceps muscle and physical function after total knee arthroplasty: a case report. Phys Ther 99:1495–1500

    Article  PubMed  Google Scholar 

  • Kilgas MA, Lytle LLM, Drum SN, Elmer SJ (2019b) Exercise with blood flow restriction to improve quadriceps function long after acl reconstruction. Int J Sports Med 40:650–656

    Article  PubMed  Google Scholar 

  • Kilgas MA, Yoon T, Mcdaniel J, Phillips KC, Elmer SJ (2022) Physiological responses to acute cycling with blood flow restriction. Front Physiol 13:800155

    Article  PubMed  PubMed Central  Google Scholar 

  • Lakens D (2017) Equivalence tests: a practical primer for t tests, correlations, and meta-analyses. Soc Psychol Personal Sci 8:355–362

    Article  PubMed  PubMed Central  Google Scholar 

  • Lima-Soares F, Pessoa KA, Torres Cabido CE, Lauver J, Cholewa J, Rossi F, Zanchi NE (2022) Determining the arterial occlusion pressure for blood flow restriction: pulse oximeter as a new method compared with a handheld doppler. J Strength Cond Res 36:1120–1124

    Article  PubMed  Google Scholar 

  • Lixandrão ME, Ugrinowitsch C, Berton R, Vechin FC, Conceição MS, Damas F, Libardi CA, Roschel H (2018) Magnitude of muscle strength and mass adaptations between high-load resistance training versus low-load resistance training associated with blood-flow restriction: a systematic review and meta-analysis. Sports Med 48:361–378

    Article  PubMed  Google Scholar 

  • Loenneke JP, Fahs CA, Rossow LM, Sherk VD, Thiebaud RS, Abe T, Bemben DA, Bemben MG (2012) Effects of cuff width on arterial occlusion: implications for blood flow restricted exercise. Eur J Appl Physiol 112:2903–2912

    Article  PubMed  Google Scholar 

  • Loenneke JP, Allen KM, Mouser JG, Thiebaud RS, Kim D, Abe T, Bemben MG (2015) Blood flow restriction in the upper and lower limbs is predicted by limb circumference and systolic blood pressure. Eur J Appl Physiol 115:397–405

    Article  PubMed  Google Scholar 

  • Malhotra A, Cohen D, Syms C, Townsend RR (2002) Blood pressure changes in the leg on standing. J Clin Hypertens (greenwich) 4:350–354

    Article  PubMed  Google Scholar 

  • Mara CA, Cribbie RA (2012) Paired-samples test of equivalence. Commun Stat B Simul Comput 41:1928–1943

    Article  MathSciNet  Google Scholar 

  • Mattocks KT, Jessee MB, Counts BR, Buckner SL, Mouser JG, Dankel SJ, Laurentino GC, Loenneke JP (2017) The effects of upper body exercise across different levels of blood flow restriction on arterial occlusion pressure and perceptual responses. Physiol Behav 171:181–186

    Article  CAS  PubMed  Google Scholar 

  • Moons KG, Altman DG, Reitsma JB, Ioannidis JP, Macaskill P, Steyerberg EW, Vickers AJ, Ransohoff DF, Collins GS (2015) Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (tripod): explanation and elaboration. Ann Intern Med 162:W1-73

    Article  PubMed  Google Scholar 

  • Moons KG, Wolff RF, Riley RD, Whiting PF, Westwood M, Collins GS, Reitsma JB, Kleijnen J, Mallett S (2019) Probast: a tool to assess risk of bias and applicability of prediction model studies: explanation and elaboration. Ann Intern Med 170:W1–W33

    Article  PubMed  Google Scholar 

  • Mouser JG, Mattocks KT, Buckner SL, Dankel SJ, Jessee MB, Bell ZW, Abe T, Bentley JP, Loenneke JP (2019) High-pressure blood flow restriction with very low load resistance training results in peripheral vascular adaptations similar to heavy resistance training. Physiol Meas 40:035003

    Article  PubMed  Google Scholar 

  • National Institutes of Health (2022) Policy on sex as a biological variable. National Instiutues of Health, Bethesda, MD. https://orwh.od.nih.gov/sex-gender/nih-policy-sex-biological-variable. Accessed 7 Aug 2022.

  • Neath AA, Cavanaugh JE (2012) The bayesian information criterion: background, derivation, and applications. Wiley Interdiscip Rev Comput Stat 4:199–203

    Article  Google Scholar 

  • Patterson SD, Hughes L, Warmington S, Burr J, Scott BR, Owens J, Abe T, Nielsen JL, Libardi CA, Laurentino G, Neto GR, Brandner C, Martin-Hernandez J, Loenneke J (2019) Blood flow restriction exercise: considerations of methodology, application, and safety. Front Physiol 10:533

    Article  PubMed  PubMed Central  Google Scholar 

  • Riley RD, Snell KIE, Ensor J, Burke DL, Harrell FE Jr, Moons KGM, Collins GS (2019) Minimum sample size for developing a multivariable prediction model: part I—continuous outcomes. Stat Med 38:1262–1275

    Article  MathSciNet  PubMed  Google Scholar 

  • Sieljacks P, Knudsen L, Wernbom M, Vissing K (2018) Body position influences arterial occlusion pressure: implications for the standardization of pressure during blood flow restricted exercise. Eur J Appl Physiol 118:303–312

    Article  PubMed  Google Scholar 

  • Silva JCG, Pereira Neto EA, Pfeiffer PAS, Neto GR, Rodrigues AS, Bemben MG, Patterson SD, Batista GR, Cirilo-Sousa MS (2019) Acute and chronic responses of aerobic exercise with blood flow restriction: a systematic review. Front Physiol 10:1239

    Article  PubMed  PubMed Central  Google Scholar 

  • Slysz J, Stultz J, Burr JF (2016) The efficacy of blood flow restricted exercise: a systematic review & meta-analysis. J Sci Med Sport 19:669–675

    Article  PubMed  Google Scholar 

  • Snee RD (1977) Validation of regression models: methods and examples. Technometrics 19:415–428

    Article  Google Scholar 

  • Spitz RW, Wong V, Bell ZW, Viana RB, Chatakondi RN, Abe T, Loenneke JP (2022) Blood flow restricted exercise and discomfort: a review. J Strength Cond Res 36:871–879

    Article  PubMed  Google Scholar 

  • Stewart A, Marfell-Jones M, Olds T, Ridder HD (2011) International standards for anthropometric assessment. ISAK, Lower Hutt

    Google Scholar 

  • Steyerberg E (2008) Clinical prediction models: a practical approach to development, validation, and updating. Springer Science & Business Media, New York

    Google Scholar 

  • Steyerberg EW, Vergouwe Y (2014) Towards better clinical prediction models: seven steps for development and an abcd for validation. Eur Heart J 35:1925–1931

    Article  PubMed  PubMed Central  Google Scholar 

  • Tibshirani R (1996) Regression shrinkage and selection via the lasso. J R Stat Soc Ser B Methodol 58:267–288

    MathSciNet  Google Scholar 

  • Yamada Y, Kang A, Seffrin A, Song JS, Kataoka R, Hammert WB, Spitz RW, Wong V, Loenneke JP (2022) Potential considerations with estimating blood flow restriction pressure in the lower body using a narrower cuff. Eur J Appl Physiol 23:937–943

    Google Scholar 

  • Zaki R, Bulgiba A, Ismail R, Ismail NA (2012) Statistical methods used to test for agreement of medical instruments measuring continuous variables in method comparison studies: a systematic review. PLoS ONE 7:e37908

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

We thank Carmen Scarfone, Felix Cottet-Puinel, Luke Moore, and Kyle Wehmanen for their assistance in data collection. We also thank Dr. Kelly Kamm for her valuable input during the data collection and preparation of the manuscript.

Funding

This work was supported by the Michigan Space Grant Consortium, Portage Health Foundation, and Michigan Technological University Health Research Institute.

Author information

Authors and Affiliations

  1. School of Health and Human Performance, Northern Michigan University, Marquette, MI, USA

    Isaac J. Wedig

  2. Department of Kinesiology and Integrative Physiology, Michigan Technological University, 1400 Townsend Dr., Houghton, MI, 49931, USA

    Isaac J. Wedig, Isaac M. Lennox & Steven J. Elmer

  3. Health Research Institute, Michigan Technological University, Houghton, MI, USA

    Isaac J. Wedig, Isaac M. Lennox, Erich J. Petushek & Steven J. Elmer

  4. Department of Cognitive and Learning Science, Michigan Technological University, Houghton, MI, USA

    Erich J. Petushek

  5. Department of Exercise Physiology, Kent State University, Kent, OH, USA

    John McDaniel

  6. Department of Biological Sciences and Integrative Physiology and Health Sciences Center, Purdue University Northwest, Hammond, IN, USA

    John J. Durocher

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Contributions

Conceptualization: IJW, SJE; Methodology: IJW, EJP, JM, JJD, SJE; Formal analysis and investigation: IJW, IML; Writing—original draft preparation: IJW, SJE; Writing—review and editing: IJW, IML, EJP, JM, JJD, SJE; Funding acquisition: IJW, SJE; Supervision: SJE; IJW, IML, EJP, JM, JJD, SJE approved the final version of the manuscript.

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Correspondence to Steven J. Elmer.

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Communicated by I. Mark Olfert.

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Wedig, I.J., Lennox, I.M., Petushek, E.J. et al. Development of a prediction equation to estimate lower-limb arterial occlusion pressure with a thigh sphygmomanometer. Eur J Appl Physiol 124, 1281–1295 (2024). https://doi.org/10.1007/s00421-023-05352-8

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