# Blood flow restriction exercise to improve skeletal muscle and peripheral vascular function in person with spinal cord injuries

> **NIH VA I01** · LOUIS STOKES CLEVELAND VA MEDICAL CENTER · 2022 · —

## Abstract

Spinal cord injuries (SCI) are among the most debilitating conditions an individual can sustain with the
estimates of SCI incidence in the United States at 12,000 new cases per year. The loss of innervation to the
tissues muscle below the level of the lesion results in reduced physical activity which leads to an array of
secondary complications including muscle atrophy, cardiovascular and metabolic disease, obesity and
vascular dysfunction. This further leads to exercise intolerance, reduced quality of life and depression.
Although current rehabilitative programs focus on improving muscle strength in this population, the efficacy
of these programs is challenged by the injury related motor impairment, which limits the exercise intensity
and subsequent positive muscular adaptations. Therefore, development of an exercise program that
promotes maximal muscular adaptations to light intensity exercise could greatly improve the efficacy of
rehabilitation in the SCI population and help restore functional capacity and quality of life for these individuals.
Blood flow restriction (BFR) exercise has shown tremendous promise for improving muscle size and strength
in a variety of healthy and clinical populations, however the benefits of BFR exercise for those with SCI has
not been established. Thus, the purpose of this Merit proposal is to conduct a comprehensive study that
explores the benefits and risks of BFR exercise in the incomplete SCI population. In general individuals with
chronic incomplete SCI will be recruited to partake in two 8-week training periods (20 sessions) that involve
traditional knee extension/flexion exercise or knee extension/flexion exercise with blood flow restriction.
There will be a series of measurements before and after the 8-week intervention to look at changes in muscle
and vascular function. Specific Aim 1 will determine how the 8-weeks of BFR exercise influenced muscle
strength (Biodex isokinetic dynamometer), muscle cross sectional area and volume (CTscan) and fatigue
resistance. Specific Aim 2 will determine how this novel 8-week training intervention impacts peripheral
vascular function. Specifically, changes in nitric oxide mediated endothelial function will be determined
through tests of flow mediated dilation, changes in endothelial function of the microvascular network will be
determined through assessments of reactive hyperemia and changes in arterial stiffness will be determined
through measurements of pulse wave velocity. Specific Aim 3 will focus on the safety of BFR exercise for
the SCI population. Those with SCI are at greater risk for thrombosis and DVT compared to able bodied
individuals. Although unlikely, the introduction of temporary blood stasis during BFR exercise might augment
this risk. Thus, the third aim of this study will be to determine changes in innate immune activation and
thrombosis risk. Specifically, blood will be collected at multiple timepoints throughout the training intervention
and analyz...

## Key facts

- **NIH application ID:** 10401435
- **Project number:** 5I01RX003562-02
- **Recipient organization:** LOUIS STOKES CLEVELAND VA MEDICAL CENTER
- **Principal Investigator:** John McDaniel
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2022
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2021-05-01 → 2024-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10401435

## Citation

> US National Institutes of Health, RePORTER application 10401435, Blood flow restriction exercise to improve skeletal muscle and peripheral vascular function in person with spinal cord injuries (5I01RX003562-02). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10401435. Licensed CC0.

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