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Investigators used a randomized controlled crossover design to compare the effect of blood flow restriction (BFR) and electrical muscle stimulation (EMS) protocols on post-activation performance enhancement (PAPE) in multi-joint versus single-joint exercises. Participants took part in six test sessions 72 hours apart. In the BFR group, 50% of the arterial occlusion pressure (AOP) was used. In the EMS group, a 75 Hz current was applied. In the Low Resistance exercise group, only exercise was performed without any condition. Bench press (multi-joint) and triceps push-down (single-joint) exercises were used in the conditions.
Participants took part in six test sessions 72 hours apart. All tests were performed between 2 and 4 pm to reduce the influence of circadian rhythms or fatigue on performance. Anthropometric measurements, 1 RM test, and grip strength and serving speed tests were determined before the practice session on the first day as a control condition. On the other six experimental days, players were randomly assigned to protocols (BFR, EMS, and LOW-LOAD) using software (http://www.randomizer.org). In the BFR group, 50% of the arterial occlusion pressure (AOP) was used. In the EMS group, a 75 Hz current was applied. In the Low Resistance exercise group, only exercise was performed without any condition. Bench press (multi-joint) and triceps push-down (single-joint) exercises were used in the conditions. In all protocols, participants performed a standardized warm-up protocol consisting of a 5-minute run at 9 km/h on a treadmill and a general warm-up consisting of 3 minutes of whole-body light stretching exercises. Following the warm-up and pre-exercise protocols, grip strength and service speed tests were performed with rest periods.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Blood flow restriction | Active Comparator | In the BFR group, 50% of the arterial occlusion pressure (AOP) was used.Bench press (multi-joint) and triceps push-down (single-joint) exercises were used in the conditions. |
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| Electrical muscle stimulation | Active Comparator | In the EMS group, a 75 Hz current was applied. Bench press (multi-joint) and triceps push-down (single-joint) exercises were used in the conditions. |
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| Low Load Resistance Exercise | Active Comparator | In the Low Resistance Exercise group, only exercise was performed without any condition (BFR or EMS. Bench press (multi-joint) and triceps push-down (single-joint) exercises were used in the conditions. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Electrical Muscle Stimulation | Other | EMS will be applied bilaterally to the wrist flexor and elbow extensor muscles using a portable EMS stimulator (Compex Rehab 400, Medicompex SA, Ecublens, Switzerland). Four 2 mm thick, self-adhesive electrodes (5x5 cm) will be placed on the superficial aspect of each muscle group. The athletes will simultaneously receive EMS intervention with a pulse frequency of 75 Hz and a duration of 400 μs (19 seconds rest between pulses) during bench press and triceps pushdown exercises. Bench press and triceps push down exercises will be performed with 30% 1TM, 30-15-15-15 repetitions and thirty seconds rest between sets. |
| Measure | Description | Time Frame |
|---|---|---|
| Service speed | Service speed will assess by standard radar apparatus (Net Playz Smart Pro Speed Radar, USA) and will record in km/h. | From baseline to the end of treatment at 8 weeks |
| Hand Grip strength | Hand grip strength will assess by hand grip dynamometer (Takei 5,101, Tokyo, Japan) and will record in kg. | From baseline to the end of treatment at 8 weeks |
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| Measure | Description | Time Frame |
|---|---|---|
| Bench Press 1Repetition maximum Test | The 1RM values of the participants will assess by using a bench press machine. | Baseline |
| Triceps Push Down 1 repetition maximum Test | The participants will instruct to assume a standing position in front of the triceps push-down machine, holding the bar with both hands in the pronated position at shoulder width. During the execution of this exercise, the participants will maintain their arms near their torso, ensuring that there was no contact between the arms and the body. |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Neslihan AKCAY, Doctorate | Karabuk University | Study Chair |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Karabuk University | Karabük | Turkey | 78200 | Turkey (Türkiye) |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 39360986 | Background | Keskin K, Akcay N, Ozmen T, Contarli N, Yildiz KC, Sofuoglu C, Kamis O, Rolnick N, de Queiros VS, Montoye A. Effects of different pre-exercise strategies on jumping performance in female volleyball players. J Sports Med Phys Fitness. 2025 Jan;65(1):59-68. doi: 10.23736/S0022-4707.24.16196-8. Epub 2024 Oct 3. |
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Crossover Assignment
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Participants were strictly separated and think their intervention is the main intervention. The same is true for care providers. Outcome assessors were unaware of participant group status and were not allowed to ask correspondingly.
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| Blood Flow Restriction | Other | The arterial occlusion pressures (AOP) of the athletes randomized to the experimental group will be obtained automatically with the digital LED display CAC device BFR Unit (Fit Cuffs BFR Unit, Denmark). The AOP pressure device BFR Unit (Fit Cuffs BFR Unit, Denmark) will be used to apply 50% occlusion pressure during exercise. Bench press and triceps push down exercises will be performed with 30% 1TM, 30-15-15-15 repetitions and thirty seconds rest between sets. |
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| Low-Load Resistance Exercise | Other | Bench press and triceps pushdown exercises will be performed with 30% 1RM, 30-15-15-15 repetitions and 30 seconds rest between sets. |
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| Baseline |
| Anthropometric Measurements 1 | Participants' height (cm) will assess by using a stadiometer (Holtain Stadiometer, England). | Baseline |
| Anthropometric Measurements 2 | Body weight (kg) will asses by Inbody 270 (Biospace, California, USA). | Baseline |
| Anthropometric Measurements 3 | Body mass index (BMI) (kg/m2) will asses by Inbody 270 (Biospace, California, USA). | Baseline |
| Anthropometric Measurements 4 | Body fat percentage (%) will asses by Inbody 270 (Biospace, California, USA). Baseline | Baseline |
| ID | Term |
|---|---|
| D000090003 | Blood Flow Restriction Therapy |
| ID | Term |
|---|---|
| D005081 | Exercise Therapy |
| D012046 | Rehabilitation |
| D000359 | Aftercare |
| D003266 | Continuity of Patient Care |
| D005791 | Patient Care |
| D013812 | Therapeutics |
| D026741 | Physical Therapy Modalities |
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