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Objective] It is well known that KAATSU resistance training can produce muscle hypertrophy without deteriorating cardiovascular system in older adults. However, it is unclear whether KAATSU resistance training exceeding 12 weeks were a highly safe and effective training method for improvement of skeletal muscle mass in older adults. We examined effect of 24 weeks of KAATSU resistance training on femoral muscle size and its safety for older adult. [Methods] The subject was an 84-year-old woman (standing height 153 cm and body weight 46 kg). The KAATSU resistance training was provided for a total of 48 sessions over 24 weeks. Training intensity and volume were set at 20% or 30% of one-repetition maximum (1-RM) and 75 repetitions for knee extension and leg press exercises, respectively. Mid-thigh muscle cross-sectional area (CSA) was measured by MRI scan before, 12 weeks, and 24 weeks after the training. The maximal strength, chair-stand test, hemodynamic parameters, arterial stiffness, coagulation system and muscle damage were also measured. [Results] Quadriceps muscle CSA, 1-RM strength and chair-stand test increased throughout 24week training period. On the other hand, there were no changes in body weight, hemodynamic parameters (except for systolic blood pressure), arterial compliance coagulation system and muscle damage throughout the training period. [Conclusion] The 24 weeks of KAATSU resistance training may be a highly safe and effective training method for improvement of skeletal muscle mass in older adults. Key word: blood flow restriction, muscle hypertrophy, muscle strength, sarcopenia, thigh muscle Corresponding Author: Tomohiro Yasuda, Ph.D. School of Nursing, Seirei Christopher University 3453, Mikatahara, Kita-Ku, Hamamatsu, Shizuoka, 433-8558, Japan E-Mail: tomohiro-y@seirei. ac.jp Phone: +81-53-439-1417 Fax: +81-53-439-1406 See end of article for authors’ affiliations CASE REPORT Int. J. KAATSU Training Res. 2019; 15: 1-4 1) School of Nursing, Seirei Christopher University, Shizuoka, Japan 2) Graduate School of Medicine, Dokkyo Medical University, Tochigi, Japan 3) Kanto Central Hospital of the Mutual Aid Association of Public School Teachers, Tokyo, Japan 4) Center for KAATSU Research at Harvard Medical School, Massachusetts, USA CW6_A2051D02.indd 1 2020/03/05 16:23:08 2 Effect of 24 weeks of KAATSU resistance training on femoral muscle size and safety in a 84-year-old woman. amine effect of a 24-week KAATSU training on femoral muscle size and safety for older adult. 2. Subject A 84-year-old woman (standing height, 153 cm) participated in this study. She had no participated in resistance-type training prior to the study, and was free of overt chronic disease as assessed by medical history, physical examination, and complete chemistry and hematologic evaluation. The principles of the World Medical Association Declaration of Helsinki and the American College of Sports Medicine Guidelines for USE of Human Subjects were adopted in this study. The study was approved by the Ethics Committee, and informed consent were obtained from the subject. 3. Methods The subject performed bilateral knee extension and leg press exercise training 2 days/week for 24 weeks. This training was performed under the close supervision of those with technical knowledge in BFR training. Three or four days before training, the subject performed one-repetition maximum (1-RM) test, which was estimated by the 10-RM method. Training intensity and volume were set at 20% or 30% of 1-RM and 75 repetitions for knee extension and leg press exercises, respectively. This protocol is typical of submaximal BFR studies. During knee extension and leg press exercises, the subject was seated comfortably on isotonic knee extension (VR1, Cybex International, Inc.) and leg press machines (Seated Leg Press, Life Fitness), with the body supported in a vertical position. The training loads of each exercise was adjusted based on estimated 1-RM testing performed every 3 weeks. During the training sessions, the subject wore a specially designed elastic pressure cuff (50 mm width, KAATSU Master, Sato Sports Plaza, Tokyo, Japan) around the most proximal portion of the both legs. On the first day of training, the cuff was set at 120 S.K.U. The pressure was increased by 10-20 S.K.U. at each subsequent training session until a pressure of approximately 200 S.K.U. was reached. Immediately after the exercise session, the pressure cuff was quickly removed. The subject testing took place before the start of the study (pre), 3-5 days after the 12-week and 24-week of training. Muscle cross-sectional area (CSA) was obtained using a magnetic resonance imaging (MRI) scanner (1.5-T MRI, Hitachi, Tokyo, Japan). A T-1 weighted spin-echo axial plane sequence was performed with a 540-msec repetition time and a 20-msec echo time. Subjects rested quietly in the magnet bore in a supine position with their legs extended. Continuous transverse images (10-mm slice thickness) were transferred to a personal computer for analysis using specially designed image analysis software (sliceOmatic, Tomovision Inc., QC, Canada). CSA data for the quadriceps, adductors and hamstrings at 50% of thigh length and for the Gluteus maximus at the top edge of the great trochanter were digitized. Bilateral knee extension and leg press maximum dynamic strength (1-RM) were assessed using an isotonic knee extension and leg press machines. During estimated 1-RM testing as well as training sessions, the parallel leg stance width was set at 100% of the shoulder-width for leg press exercises. A chair-stand test required participants to stand up from a seated position, as many times as possible, within 30 seconds. Hemodynamic parameter, cardio-ankle vascular index (CAVI) and ankle-brachial pressure index (ABI) were measured noninvasively using a VS-1500 system (Fukuda Denshi Co., Ltd, Tokyo, Japan). CAVI and ABI were obtained by substituting the stiffness parameter into an equation for determining vascular elasticity. Venous blood samples were obtained from the antecubital vein and measured for fibrin/fibrinogen degradation products (FDP), D-dimer and creatine kinase (CK). The plasma concentrations of these samples were measured at a commercial laboratory (SRL Inc., Tokyo, Japan) by following latex immunoassay (LIA) for fibrin/fibrinogen degradation products (FDP) and D-dimer and spectrophotometry for NADPH formed by a hexokinase and D-glucose-6-phosphate-dehydrogenase-coupled enzymic system for CK. 4. Results After 24-week training period, quadriceps and adductors muscle CSA (14% and 9%), knee extension and leg press 1-RM (43% and 60%) and chair-stand performance (29%) showed marked increase. In particular, quadriceps muscle CSA, both 1-RM strength and chair-stand test increased throughout 24-week training period. On the other hand, there were no changes in body weight, hemodynamic parameters (except for systolic blood pressure), arterial stiffness, coagulation system and muscle damage throughout the training period (Table 1). 5. Discussion The main findings of the present study were: (1) 24week KAATSU resistance training can lead to increase in muscle CSA as well as maximal strength for older adult, (2) hemodynamic parameters, arterial stiffness, coagulation factors, and CK, a marker of muscle damage were not changed throughout the training period. Our results showed that KAATSU resistance training produced a hypertrophic potential of 0.31% and 0.28% per session in quadriceps muscle CSA (for 12and 24-weeks, respectively), which is similar to that observed following high-intensity resistance training at 80% 1-RM (0.26%-0.45%) in elderly adults. Additionally, the observed gains in knee extension (1.39% and 0.88% per session for 12and 24-weeks, respectively) and leg press 1-RM strength (1.60% and 1.25% per session for 12and 24-weeks, respectively) were comparable with the previous KAATSU study at 20% 1-RM (knee extension: 1.06%, leg press: 1.07% per session, respectively). Therefore, our data suggested that KAATSU resistance training (at 20-30% 1-RM) can provide an effective hypertrophic stimulus on thigh muscles for long-period in older adults. CW6_A2051D02.indd 2 2020/03/05 16:23:08 3 Tomohiro Yasuda, Kazuya Fukumura, Toshiaki Nakajima In this study, maximum heart rate and ratings of perceived exertion during each KAATSU resistance exercise (100-155 BPM and 15-19, respectively; data not shown) were not low level compared with previous KAATSU training studies for older adults. However, hemodynamic parameters (heart rate and blood pressure), arterial stiffness (CAVI), coagulation factors (FDP and d-dimer), and muscle damage (CK) were not changed throughout the training period. Thus, it appears that these KAATSU resistance exercises were a highly safe and effective training method even if the older adults feel with sufficiently hard training protocol. However, it should be noted that the possibility of side effects cannot be denied when subjects perform such training until near exhaustion or particularly to complete exhaustion. Additional research is needed to understand the relationship between the long-period of KAATSU resistance training and muscle hypertrophy/ safety for many older adults. In conclusion, 24 weeks of KAATSU resistance training were a highly safe and effective training method for improvement of skeletal muscle mass in older adult. Thus, the long-period intervention by KAATSU resistance training may be considered as a useful way to prolong the healthy life expectancy in older adults. Acknowledgement This study was supported, in part, by Grant-in-aid (# 18K10906) from the Japan Ministry of Education, Culture, Sports, Science, and Technology. References 1. Abe T, Yasuda T, Midorikawa T, Sato Y, Kearns CF, Inoue K, Koizumi K, Ishii N (2005) Skeletal muscle size and circulating IGF-1 are increased after two weeks of twice daily “KAATSU” resistance training. Int J Kaatsu Training Res 1: 6-12.