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Author ORCID Identifier
https://orcid.org/0009-0003-8617-2611
Date Available
5-11-2028
Year of Publication
2026
Document Type
Doctoral Dissertation
Degree Name
Doctor of Philosophy (PhD)
College
Education
Department/School/Program
Kinesiology and Health Promotion
Faculty
Haley C. Bergstrom
Abstract
While blood flow restriction (BFR) exercise has been established as an alternative training modality capable of inducing muscular adaptations at low intensities, less is known about its sex-dependent, integrated physiological and psychological responses, particularly when compared with low-load exercise without BFR (NON-BFR) and passive BFR without exercise (PASSIVE BFR). Additionally, the reliability of microvascular reactivity measurements using near-infrared spectroscopy with vascular occlusion test (NIRS-VOT) remains unclear. Therefore, the purpose of this study was to examine sex-dependent muscle oxygenation (SmO2), muscle fatigue, microvascular function, cardiovascular, and psychological responses, as well as the test-retest reliability of microvascular reactivity, across BFR, NON-BFR, and PASSIVE BFR conditions.
Participants completed experimental sessions under three conditions: BFR, NON-BFR, and PASSIVE BFR. Muscle metabolic responses were assessed using NIRS-derived SmO2 and deoxyhemoglobin (HHb) responses. Microvascular reactivity was evaluated using the reperfusion slope from the NIRS-VOT. Neuromuscular responses were assessed using electromyography and mechanomyography, while performance fatigability was determined from changes in maximal voluntary isometric contraction. Cardiovascular responses included heart rate and mean arterial pressure, and psychological responses included rating of perceived exertion, pain, and mood state. Test–retest reliability of microvascular reactivity was assessed before and after each condition.
The results demonstrated that the BFR condition produced the greatest metabolic stress, muscle deoxygenation, muscle fatigue, cardiovascular responses, and perceptual responses compared with NON-BFR and PASSIVE BFR. Passive restriction alone primarily induced hemodynamic alterations without meaningful neuromuscular fatigue, indicating that contraction-induced metabolic demand was the primary driver of muscle fatigue, while vascular restriction amplified the metabolic perturbation during exercise. Microvascular reactivity increased following all conditions without significant between-condition differences, suggesting that BFR exercise with moderate pressure may not provide additional acute vascular benefits beyond exercise or partial occlusion alone. Sex differences were evident in muscle metabolic responses, microvascular reactivity, and pain perception, with males demonstrating greater muscle deoxygenation and HHb responses, greater microvascular reactivity, and higher pain responses, although these differences did not translate into greater perceived effort, cardiovascular strain, or mood disturbances.
In conclusion, these findings provide a more integrated understanding of how muscle oxygenation, muscle fatigue, cardiovascular responses, and psychological responses collectively shape the overall exercise stimulus during BFR exercise. From a practical and clinical perspective, the results support the use of moderate cuff pressures during BFR exercise to balance metabolic stimulus with cardiovascular safety and perceptual tolerability. Furthermore, the observed sex-related differences highlight the importance of individualized BFR prescription to optimize effectiveness, safety, and long-term exercise adherence.
Digital Object Identifier (DOI)
https://doi.org/10.13023/etd.2026.122
Archival?
Archival
Recommended Citation
Kwak, Minyoung, "INTEGRATED PHYSIOLOGICAL AND PSYCHOLOGICAL RESPONSES TO BLOOD FLOW RESTRICTION: SEX-, EXERCISE-, AND RESTRICTION-DEPENDENT EFFECTS" (2026). Theses and Dissertations--Kinesiology and Health Promotion. 133.
https://uknowledge.uky.edu/khp_etds/133
