Metabolic Demand and Indirect Markers of Muscle Damage After Eccentric Cycling With Blood Flow Restriction

Abstract

Purpose: To compare the effects of a single bout of eccentric cycling (ECC) and eccentric cycling with blood flow restriction (ECCBFR) on the changes in cardio-metabolic demand and indirect markers of muscle damage in healthy men. Method: Twenty-one young men (24.0 ± 3.2 y) were randomly allocated in two groups to perform a 30-min eccentric cycling bout with or without blood flow restriction. Oxygen consumption, heart rate, rate of perceived exertion and mean arterial blood pressure were monitored during cycling. Blood lactate was measured before and after cycling. Maximal voluntary isometric knee extensor strength and muscle damage were measured before, immediately after and 1–4 days after each eccentric cycling bout. Results: Oxygen consumption, heart rate, rate of perceived exertion and mean arterial blood pressure were similar between bouts. Blood lactate concentrations increased in both groups (p < .01), with ECCBFR showing 60% greater blood lactate concentration than eccentric cycling (p < .01). Maximal voluntary isometric knee extensor strength decreased 19-7% until 48 h and decreased 16-7% until 72 h after ECC and ECCBFR, respectively. Muscle soreness and pressure pain threshold remained elevated until 72 h after ECC and until 96 h after ECCBFR. Conclusion: These results show that ECCBFR induces similar cardiovascular stress, greater lactate production and longer time to recover than ECC alone. Thus, BFR can be safely implemented with eccentric cycling.

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Metabolic Demand and Indirect Markers of Muscle
Damage after Eccentric Cycling with Blood Flow
Restriction
Luis Penailillo, Miguel Santander, Hermann Zbinden-Foncea & Sebastian
Jannas-Vela
To cite this article: Luis Penailillo, Miguel Santander, Hermann Zbinden-Foncea & Sebastian
Jannas-Vela (2020): Metabolic Demand and Indirect Markers of Muscle Damage after
Eccentric Cycling with Blood Flow Restriction, Research Quarterly for Exercise and Sport, DOI:
10.1080/02701367.2019.1699234
To link to this article: https://doi.org/10.1080/02701367.2019.1699234
Published online: 05 Feb 2020.
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ORIGINAL ARTICLE
Metabolic Demand and Indirect Markers of Muscle Damage after Eccentric
Cycling with Blood Flow Restriction
Luis Penailillo, Miguel Santander, Hermann Zbinden-Foncea, and Sebastian Jannas-Vela
Universidad Finis Terrae
ABSTRACT
Purpose: To compare the effects of a single bout of eccentric cycling (ECC) and eccentric cycling
with blood flow restriction (ECC
BFR
) on the changes in cardio-metabolic demand and indirect
markers of muscle damage in healthy men. Method: Twenty-one young men (24.0 ± 3.2 y) were
randomly allocated in two groups to perform a 30-min eccentric cycling bout with or without
blood flow restriction. Oxygen consumption, heart rate, rate of perceived exertion and mean
arterial blood pressure were monitored during cycling. Blood lactate was measured before and
after cycling. Maximal voluntary isometric knee extensor strength and muscle damage were
measured before, immediately after and 1–4 days after each eccentric cycling bout. Results:
Oxygen consumption, heart rate, rate of perceived exertion and mean arterial blood pressure
were similar between bouts. Blood lactate concentrations increased in both groups (p< .01), with
ECC
BFR
showing 60% greater blood lactate concentration than eccentric cycling (p< .01). Maximal
voluntary isometric knee extensor strength decreased 19-7% until 48 h and decreased 16-7% until
72 h after ECC and ECC
BFR
, respectively. Muscle soreness and pressure pain threshold remained
elevated until 72 h after ECC and until 96 h after ECC
BFR
.Conclusion: These results show that
ECC
BFR
induces similar cardiovascular stress, greater lactate production and longer time to recover
than ECC alone. Thus, BFR can be safely implemented with eccentric cycling.
ARTICLE HISTORY
Received 5 September 2019
Accepted 25 November 2019
KEYWORDS
DOMS; cardiovascular; BFR;
lengthening
Blood flow restriction (BFR) is an ergogenic strategy
used during exercise that involves the use of a cuff placed
around a limb, maintaining arterial inflow to the muscle
while preventing venous return. The use of BFR in
combination with low-load resistance training has been
reported to augment strength and muscle mass gains,
similar to conventional high-load regimens (Laurentino
et al., 2012; Martín-Hernández et al., 2013). It has been
proposed that these positive responses appear to be
mediated by the hypoxic environment in exercised ske-
letal muscle, leading to the accumulation of metabolites
and myofibrillar damage that might enhance muscle
growth (Dankel et al., 2017; Pearson & Hussain, 2015).
Eccentric contractions occur when muscles are length-
ened under tension, inducing a high mechanical stimulus
to the muscle at a low metabolic cost (Asmussen, 1953).
A novel eccentric exercise model that has received great
attention is eccentric cycling (ECC), in which knee exten-
sor muscles perform eccentric contractions while resisting
against the backward rotational movements of the cranks
generated by an installed electrical motor on a cycle erg-
ometer. ECC training has shown to induce greater muscle
strength and mass gains compared to concentric cycling
(Gross et al., 2010; LaStayo, Pierotti, Pifer, Hoppeler, &
Lindstedt, 2000). In addition, it has been extensively
reported that ECC exercise yields lower oxygen consump-
tion (VO
2
), blood lactate (BLa) concentrations and heart
rate (HR) in comparison to concentric cycling at the same
absolute power output (PO) (Peñailillo, Blazevich,
Numazawa, & Nosaka, 2013; Perrey, Betik, Candau,
Rouillon, & Hughson, 2001). However, no study has
investigated the effect of BFR on the cardio-metabolic
demand of eccentric cycling.
Previous studies examining the effects of eccentric exer-
cise with BFR have reported similar metabolic and indirect
muscle damage markers changes compared to eccentric
exercise alone (Behringer, Heinke, Leyendecker, &
Mester, 2018;Curtyetal.,2018; Sieljacks et al., 2016;
Thiebaud et al., 2014). However, these studies were per-
formed with resistance-type eccentric exercises, which uti-
lize low volume and high intensity (intermittent) actions, in
contrast to the high-volume (30 min at 60 rpm = 1800
contractions) at low intensities (~30% maximal isometric
contraction) used during ECC. Furthermore, most of the
previous studies performed eccentric actions until fatigue,
which in part could explain similar metabolic outcomes
CONTACT Sebastian Jannas-Vela sjannas@uft.cl School of Kinesiology, Universidad Finis Terrae, 1509 Pedro de Valdivia Av., Providencia, Santiago,
Chile
RESEARCH QUARTERLY FOR EXERCISE AND SPORT
https://doi.org/10.1080/02701367.2019.1699234
© 2020 SHAPE America

between interventions. Due to the nature of ECC, it is
highly possible that the metabolic muscle function
responses with this type of exercise may be different from
resistance-type eccentric actions. Thus, in order to safely
use eccentric cycling in conjunction with BFR in a practical
or clinical set-up, it is necessary to examine its acute
responses better. Therefore, the purpose of this study was
to compare the acute effects of ECC and eccentric cycling
with BFR (ECC
BFR
)onthechangesincardio-metabolic
demand and indirect markers of muscle damage in healthy
young adults. We hypothesized that ECC
BFR
would induce
greater cardio-metabolic demand and muscle damage
than ECC.
Methods
Participants
Twenty-one healthy recreationally active males volun-
teered to participate in this study. Participant’s physical
characteristics are shown in (Table 1). Participants were
previously screened using a medical questionnaire to
ensure they were in good health and were excluded if
they presented body mass index (BMI) greater than
30 kg·m
−2
or any medical condition. The sample size
was calculated based on an αlevel of 0.05 and a power
(1-β) of 0.85, with an estimated 36% decrease in muscle
strength after performing eccentric cycling reported in
a previous study (Peñailillo et al., 2013). From this calcu-
lation, 8 participants per group would be sufficient, but
considering 20% dropout we recruited 21 participants.
Participants were instructed not to perform any exercise,
not take anti-inflammatory medication, or undergo any
treatments (e.g., massage, stretching) 2 days before and 4
days after each cycling bout. Ethical approval was
obtained from the Universidad Finis Terrae Human
Research Ethics Committee prior to the study. All parti-
cipants signed an Informed Consent, and the study was
conducted according to the Helsinski declaration.
Study design
A between-group design was chosen due to the protective
effect against muscle damage conferred by a repeated bout
of eccentric exercise. Participants from each group attended
the laboratory on 5 days. At least 2 days before the exercise
intervention, participants underwent an incremental
cycling test to determine peak oxygen consumption
(VO
2peak
) and maximal concentric power output (PO
max
).
Subsequently, participants were matched for VO
2peak
,age
and body composition and were randomly assigned in two
groups: eccentric cycling (ECC) or eccentric cycling with
BFR (ECC
BFR
). All participants performed one bout of 30-
min eccentric cycling performed at 60% of PO
max
.Cardio-
metabolic measures obtained during the 30-min cycling
included VO
2
, HR, BLa, blood pressure, and rate of per-
ceived exertion (RPE). In addition, maximal voluntary iso-
metric knee extensor (MVC) strength was measured
before, immediately after and 24, 48, 72 and 96 h after
cycling. Muscle soreness, pressure pain threshold (PPT)
and muscle flexibility were measured before, 24, 48, 72
and 96 h after cycling. Plasma creatine kinase (CK) activity
was measured before and 48 h after cycling.
Incremental cycling test
The incremental cycling test was performed on a cycle
ergometer (Matrix Fitness System, UK) and started with
participants pedaling at 50 W for 4 min, followed by an
increase of 25 W per minute until voluntary exhaustion.
Cadence was kept at 60 revolutions per minute (rpm) and
participants were verbally encouraged to perform their
maximum effort during the test. Exhaled gases (VO
2
and
VCO
2
) were analyzed using an open circuit gas analyzer
(Medisoft, Belgium).
Eccentric cycling exercise
Eccentric cycling was performed on a recumbent
eccentric ergometer (Eccentric Trainer, Metitur,
Finland), in which participants were instructed to resist
the backward pedal movement to maintain constant
power output at 60 rpm for 30 min at 60% of the con-
centric POmax (Peñailillo et al., 2013). Familiarization
was performed immediately before each eccentric
cycling bout from 30 to 60 rpm for 5 min at ~50 W.
Blood flow restriction
Venous BFR was applied to the most proximal portion of
each thigh using a cuff of 5 cm width (Riester 1350,
Jungingen, Germany). The pressure set used for both
thighs was set to a percentage of 60% arterial occlusion
estimated from thigh circumference based in previous
study (Loenneke et al., 2015). The average pressure used
was 192 ± 24 mmHg. Subsequently, participants from the
ECC
BFR
group performed a familiarization protocol on
the eccentric bike during 5 min at ~50 W at an occlusion
Table 1. Participant´s physical characteristics.
ECC (n = 10) ECC
BFR
(n = 10) p-value
Age (y) 23.1 ± 3.0 24.9 ± 3.4 .20
Body mass (kg) 73.7 ± 11.4 74.3 ± 12.9 .91
Height (cm) 171.2 ± 0.1 171.2 ± 0.1 .97
Body mass index (kg/m
2
) 25.2 ± 3,9 25.3 ± 3.8 .93
VO
2peak
(L/min) 3.0 ± 0.8 3.3 ± 0.3 .39
Eccentric cycling (ECC); eccentric cycling with blood flow restriction (ECC
BFR
);
peak oxygen consumption (VO
2peak
). Data shown as mean ± SD.
2L. PENAILILLO ET AL.

pressure of 100 mmHg. The power output and occlusion
pressure were later increased to the estimated values for
the exercise bout.
Cardio-metabolic parameters
Oxygen consumption (VO
2
) and carbon dioxide pro-
duction during cycling were measured using an open
circuit gas analyzer (Medisoft, Belgium). Heart rate was
measured with a wireless heart rate monitor (Polar
RS800sd; Polar Electro Oy, Kempele, Finland). Systolic
and diastolic blood pressure were obtained from a digital
tensiometer (BPY101, Maxcare, US) from the left arm,
where mean arterial pressure (MAP) was calculated as
the average of systolic and diastolic blood pressure. To
assess exertion participants were asked to rate their
perceived exertion on the Borg´s RPE 0–10 scale,
where 0 indicates no exertion at all and 10 indicates
maximal exertion (Borg, 1982). When applying the
scale, participants were told to: “indicate with your fin-
ger your current level of perceived exertion”.VO
2
and
HR were recorded throughout the 30-min cycling bouts,
blood pressure and RPE were taken at 10, 20, and 29 min
of exercise. Blood lactate was measured before and ~1
min after cycling from finger prick (Lactate Pro 2,
Arkray KDK, Kyoto, Japan).
Plasma CK activity
Before and 48 h after exercise, a blood sample (~35 µL)
was taken by a finger prick, and plasma CK activity was
measured by a reflectance photometer (Reflotron, Roche
Diagnosis, Germany).
MVC strength
Isometric MVC strength of knee extensor muscles of the
dominant leg was measured at 90° of knee flexion using
a force plate (Tesys 1000, Globus System, Italy) attached
to a footplate of a standard leg press machine (James,
Simjanovic, Leadbetter, & Wearing, 2014). Participants
performed a 5-min warm-up on a cycle ergometer
(Matrix Fitness System, UK) at 50 W. Subsequently,
they were seated on the leg press machine and performed
three submaximal contractions (i.e., 50%, 60%, and 80%
of perceived maximum for 3 s each and 30 s of rest
between contractions) with a 1-min rest between contrac-
tions, and the maximum value was used for further ana-
lysis. The participants were instructed to “contract as fast
and hard as possible”, and visual feedback was provided in
real time on a computer screen. Greatest values of MVC
strength were used for statistical analyses.
Muscle soreness and pressure pain threshold
Thigh muscle soreness was quantified using a 100-mm
visual analog scale (VAS), where 0 indicated no pain and
100 represented the worst pain imaginable (Nosaka &
Clarkson, 1995). The participants were asked to mark the
level of perceived pain of the quadriceps femoris muscle on
the VAS while sitting and standing from a 42-cm chair
three times. Pressure pain threshold (PPT) was also
assessed at three sites using a digital algometer (Force
One FDIX, Wagner, USA), including the muscle belly of
vastus medialis (VM) at 80% of the distance between ante-
rior superior iliac spine (ASIS) and the patella, vastus
lateralis (VL) at 50% of the distance between ASIS and
the lateral border of the patella, and rectus femoris (RF) at
50% of the distance between the ASIS and the superior
border of the patella. The probe of the PPT algometer
(1 cm
2
stimulation area) was placed perpendicular to the
site, and the investigator gradually applied force at a rate of
50 kPa·s
−1
until the participants reported pain from each
muscle. The average of three measurements was used for
further analysis.
Muscle flexibility
Range of motion (ROM) in joints of interest was mea-
sured using the Active Knee Extension (AKE) and the
Naclash tests. In the AKE test participants were posi-
tioned in the supine position, in which they actively
maintained the tested leg with the hip at 90° of flexion
and actively extended the tested knee until myoclonus
was observed; then the participant flexed the knee
slightly until the myoclonus stopped, which defined
the end point of motion. The angle of knee flexion (°)
represented the point of hamstring tightness (Gajdosik
& Lusin, 1983). In the Nachlas test, participants were
placed in the prone position with inclinometer placed
on the lower leg, and with knee fully extended. With
the pelvis strapped down, the knee was passively flexed.
The knee angle was recorded at the moment when hip
flexion or hiking occurred (Nachlas, 1936).
Statistical analyses
Results are shown as mean ± standard deviation (SD).
AShapiro–Wilk test was performed to confirm the
normal distribution, from which all variables resulted
normally distributed. An unpaired t-test was used to
compare the average PO, VO
2
, HR, MAP, and RPE
during cycling between ECC and BFR
ECC
. Two-way-
repeated measures ANOVA were used to compare
MVC strength, muscle soreness, PPT, CK activity,
BLa, and changes in ROM over time between the two
RESEARCH QUARTERLY FOR EXERCISE AND SPORT 3

groups (ECC and ECC
BFR
). If a significant main effect
was found, Fisher’s Least Significant Difference (LSD)
post hoc test was performed. All statistical analyses
were performed with PAWS Statistics 21 for Mac
(SPSS Inc., IBM Company, NY, USA) software. The
level of significance was set at p ≤0.05.
Results
Cardio-metabolic parameters
The average cycling PO was similar (p=.9) between
ECC (158 ± 37 W) and ECC
BFR
(156 ± 28 W). Likewise,
during cycling VO
2
, HR, MAP and RPE were similar
between groups (Figure 1). The two-way ANOVA of BLa
revealed an interaction effect (p= .01), accompanied by
a main group (p= .05) and time (p< .001) effects.
Pairwise comparison showed that BLa concentrations
raised above baseline (Pre-) in both groups (p< .01),
with ECC
BFR
having greater BLa concentrations (~60%)
than ECC (p< .01; Figure 2).
Indirect markers of muscle damage
Maximum voluntary contraction strength of the knee
extensors at baseline was not different between groups
(ECC = 1424.6 ± 456.9 N and ECC
BFR
= 1664.4 ± 264.4
N; p= .2). Two-way ANOVA of MVC strength did not
show an interaction effect (p= .09), or main group
effect (p= .5), but showed a significant main time effect
(p< .001). Both groups reported reductions in MVC
strength after eccentric cycling as shown in Figure 3a.
Specifically, MVC strength was reduced immediately
post- (18.5 ± 11.2%; p< .001), 24 h (11.7 ± 8.2;
p= .001) and 48 h (7.4 ± 13.2%; p= .04) in ECC,
while MVC strength was reduced immediately post-
(13.4 ± 5.7%; p< .001), 24 (15.9 ± 8.4%; p< .001), 48
(14.2 ± 13.3%; p< .001) and 72 h (6.8 ± 9.9%; p= .04)
in ECC
BFR
.
The two-way ANOVA analysis revealed that for CK
activity there was the main time effect (p= .005), without
an interaction (p= .9) or group (p= .6) effect on blood
CK activity. Post hoc analysis revealed that CK activity
was higher 48 h after cycling both groups (p< .05) as
shown in Figure 3b.
A two-way ANOVA of muscle soreness revealed an
interaction effect (p= .002), accompanied by a main
group (p= .05) and time (p< .001) effect. Specifically,
muscle soreness was increased in both groups 24 and
72 h after eccentric cycling (p< .001), with ECC
BFR
having increased soreness (~60%) than ECC (p< .01) as
shown in Figure 3c.
Figure 1. (a) Average oxygen consumption (VO
2
); (b) heart rate (HR); (c) mean arterial pressure; and (d) rate of perceived exertion
(RPE) during eccentric cycling (ECC) and eccentric cycling with blood flow restriction (ECC
BFR
). Data reported as means ± SD. There
were no differences between groups.
4L. PENAILILLO ET AL.

As shown in Figure 4, both groups reported
depressed PPT in VL, VM, and RF after eccentric
cycling. The two-way ANOVA revealed that PPT VL,
VM, and RF only showed a main effect of time (p<
.001), without an interaction (p> .1) or group (p> .2)
effect. PPT in VL and VM was depressed for 72 h in
ECC and for 96 h in ECC
BFR
, while PPT in RF
remained depressed for 48 h in both groups.
Figure 5 showsthechangesinROM,thetwo-way
ANOVA revealed that AKE showed a main effect of time
(p< .001), without a group (p= .08) or interaction effect
(p= .5). Range of motion assessed with AKE test decreased
7–5% from immediately post to 24 h (p< .05) in ECC and
decreased 10–6% from immediately post to 48 h in ECC
BFR
group (p<.05;Figure 5a). The two-way ANOVA revealed
that Naclash test showed a main effect of time (p< .001),
without a group (p= .6) or interaction effect (p=.8).
Assessment with Naclash test revealed that ROM decreased
from 24 to 48 h after exercise in both ECC (5–8%) and
ECC
BFR
(8–10%; p<.05;Figure 5b).
Discussion
The present study revealed that 30 min of eccentric cycling
with BFR (ECC
BFR
) induced greater blood lactate (BLa)
concentrations than eccentric cycling alone (ECC). This
response occurred despite similar heart rate, blood pressure
and perception of exertion between groups. In addition, the
present study found that time to recover maximal isometric
strength and muscle soreness after exercise took longer in
ECC
BFR
than ECC. These results show that eccentric
cycling performed with a blood flow restriction induces
greater anaerobic stress (i.e., increased blood lactate) and
longer time to recover after exercise than eccentric cycling
alone, but induced similar cardiovascular stress.
In the present study, BLa concentrations were
greater after ECC
BFR
than in ECC. This result contra-
dicts a recent study that observed similar BLa concen-
trations (~7.0 mmol/L) after four sets of unilateral
eccentric knee extensions at 75% of one-repetition
maximum (1RM) with and without BFR (Behringer
et al., 2018). It is possible that this discrepancy is due
to the eccentric actions in this former study were per-
formed maximally until failure, which may induce
similar and greater metabolic stress in both groups
(i.e., maximal volitional fatigue). However, when BFR
is applied during low to moderate-intensity concentric
actions, BLa is higher than without BFR, supporting
current findings (Eiken & Bjurstedt, 1987; Loenneke
et al., 2017). Mechanical and metabolic stress are the
primary factors responsible for inducing muscle growth
(Dankel et al., 2017). It has been reported that meta-
bolic stress appears to facilitate muscle activation for
initiation of mechano-transduction signaling cascade
(Pearson & Hussain, 2015), and lactate has been
reported to be the primary driver for muscle hypertro-
phy (Dankel et al., 2017). Thus, it is possible that
eccentric cycling with BFR could enhance the muscle
mass and strength gains reported after eccentric cycling
training. However, this needs to be further investigated.
Figure 2. (a) Blood lactate concentrations (mmol/L) before (Pre)
and after (Post) eccentric cycling (ECC) and eccentric cycling with
blood flow restriction (ECC
BFR
). Data reported as means ± SD. There
was a significant (p< .05) group by time interaction. *Significantly
different to Pre.
&
Significantly different to post ECC.
Figure 3. (a) Changes in maximum voluntary contraction (MVC) in relation to Pre (100%), immediately after (Post) and 24–96 h after
eccentric cycling (ECC) and eccentric cycling with blood flow restriction (ECC
BFR
); (b) Blood creatine kinase (CK) concentrations (U/L)
before and 48 h Post ECC and ECC
BFR
; and (c) Changes in muscle soreness responses assessed by a visual analog scale (VAS). Data
reported as means ± SD. There was a significant (p= .002) group by time interaction. *Significantly different to Pre & significantly
different to post ECC. #Significantly different to Pre after ECC
BFR
.
RESEARCH QUARTERLY FOR EXERCISE AND SPORT 5

We found similar cardiovascular responses (i.e., HR
and blood pressure) between groups despite that BLa
concentrations were greater after ECC
BFR
. Similar find-
ing was observed recently by Curty et al. (2018), in
which healthy men performed three sets and 10 repeti-
tions of unilateral elbow extensions at 130% of 1RM with
and without BFR (Curty et al., 2018). We expected that
HR and BP should have further increased during
ECC
BFR
, as lactate is known to activate group IV afferent
nerve fibers, enhancing sympathetic output (Darques,
Decherchi, & Jammes, 1998),butitdidnot.
A potential explanation for this discrepancy is that appli-
cation of BFR (at 60% arterial occlusion) during
eccentric actions may not affect oxygen supply to exer-
cising muscles. Indeed, a recent study observed that
despite similar blood flow (i.e., total hemoglobin
volume) between eccentric and concentric cycling, VO
2
was ~65% lower during eccentric cycling (Penailillo,
Blazevich, & Nosaka, 2017). In addition, oxygen extrac-
tion has been reported to increase further during low-
intensity eccentric exercise with BFR (Lauver, Cayot,
Rotarius, & Scheuermann, 2017). All together this sug-
gests that during moderate-intensity eccentric cycling
oxygen supply is considerably greater (~65%) than
demand, and when BFR is applied, oxygen supply
matches demand. Therefore, HR and BP may not be
required to be elevated. Clearly, this response needs to
be further elucidated.
In the current study, both groups reported decreases
in muscle function after eccentric cycling. However, as
shown in Figures 3,4and 5recovery of muscle func-
tion after ECC
BFR
took ~24 h longer compared to ECC.
MVC strength demanded 96 h to recover after ECC
BFR
compared to 72 h in ECC. Muscle soreness and muscle
flexibility followed a similar pattern, as it took 24
h longer to recover in ECC
BFR
. These results support
previous studies were post-exercise recovery demanded
between 72 and 96 h longer to recover after exercising
with BFR compared to without BFR (Sieljacks et al.,
2016; Thiebaud et al., 2014). It is possible that longer
recovery times after ECC
BFR
may be due to the additive
effects of metabolic and mechanical stress as they have
been suggested to provoke higher levels of inflamma-
tion and increased production of reactive oxygen spe-
cies during exercise (Close, Ashton, McArdle, &
MacLaren, 2005). Future studies are warranted to
Figure 4. Changes in pressure pain threshold in relation to Pre (100%) of (a) vastus lateralis; (b) rectus femoris; and (c) vastus
medialis, 24–96 h after eccentric cycling (ECC) and eccentric cycling with blood flow restriction (ECC
BFR
). Data reported as means ±
SD. There was a main effect of time ( p< .05). *Significantly different to Pre. #Significantly different to Pre after ECC
BFR
.
Figure 5. Changes in range of motion (ROM) in relation to Pre (100%) of (a) active knee extension (AKE) test and (b) Nachlas test,
immediately after (Post) and 24–96 h after eccentric cycling (ECC) and eccentric cycling with blood flow restriction (ECC
BFR
). Data
reported as means ± SD. There was a main effect of time (p< .05). *Significantly different to Pre. #Significantly different to Pre after
ECC
BFR
.
6L. PENAILILLO ET AL.

determine the potential mechanisms behind increased
muscle damage after ECC
BFR
.
In conclusion, this study showed that the lower
cardiovascular stress of eccentric cycling was not
further increased with the use of BFR. In addition,
due to the longer time to recover observed after
eccentric cycling with BFR, gradual introduction of
this type of exercise and correct familiarization to pre-
vent undesired muscle damage should be accomplished.
What does this article add?
The present study shows that 30 min of moderate-intensity
ECC
BFR
induces similar cardiovascular stress, greater lac-
tate production and longer time to recover than ECC alone.
Thus, BFR can be safely implemented together with
eccentric cycling at moderate power outputs.
Acknowledgments
We would like to thank the participants for their time and
commitment to this study.
Funding
This work was supported by Fondecyt, Chile under Grant
awarded to L.P. [#11150293] and HZ [#11150576].
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