Implementation of blood flow restriction training in the acute geriatric unit

Hospital-associated physical decline is common among older adults. High-load training mitigates this but, is often impractical in acute care settings. Blood flow restriction (BFR) training is a promising low-load alternative, yet clinical utility during hospitalisation is unclear.

To evaluate feasibility, safety and effectiveness of aerobic BFR training in an acute geriatric unit (AGU).

Retrospective observational study.

Of 123 eligible patients aged ≥70 years admitted to the AGU of a Belgian hospital (12 February-6 September 2024), 64 were randomly assigned to standard physiotherapy with BFR during walking, and 59 to physiotherapy without BFR. Feasibility outcomes included adherence, satisfaction and practicality. Safety was monitored through adverse event reporting. Effectiveness was evaluated using grip strength, Short Physical Performance Battery (SPPB), walking time, and Borg Rating of Exertion. Regression adjusted for age, sex, time, baseline function and physiotherapy dose; the main outcome was the group-by-session interaction (β).

Adherence was high (BFR: 92%; control: 93%). Pain scores were similar (Cohen's d = 0.06) with no change across sessions (β = 1.01; P = .88). Regarding practicality, limb occlusion pressure assessment failed 23 times (12%). Mild dyspnea was more frequent with BFR (4% vs. 1%, P = 0.035), but no events of thrombosis, ischemia or rhabdomyolysis occurred. BFR led to significant improvements in SPPB-balance (β = -0.42, P = .035) and walking time (β = 0.95 s, P < .001), with a moderate, nonsignificant effect on total SPPB (β = -0.26, d = 0.57, P = .28).

Aerobic BFR training appears feasible, safe and potentially effective in carefully selected hospitalised older adults.