# Effects of Acute Piano Performance With Blood Flow Restriction on Upper Limb Muscle and Perceptual Response in Pianists

## TL;DR

Playing piano with blood flow restriction increases muscle size and fatigue in pianists' upper limbs.

## Contribution

Demonstrates that acute piano performance with blood flow restriction enhances neuromuscular responses in pianists.

## Key findings

- Piano performance with BFR increased forearm and upper arm girth and muscle thickness more than without BFR.
- Handgrip strength improved significantly after BFR-assisted piano performance.
- Piano-BFR induced greater perceptual fatigue and difficulty in upper arm compared to control.

## Abstract

Background: Long-term and prolonged piano performance does not provide essential skeletal muscle training benefits while increasing the risk of injury to the upper extremities. Unlike high-intensity exercise training, moderate blood flow restriction (BFR) training has been found to improve neuromuscular mechanisms with a variety of physical exercises (machine, elastic band, walking, electrical stimulation, and body weight).

Aim and methods: We investigated the physiological and perceptual responses related to piano performance with or without BFR based on acute responses of neuromuscular mechanisms. Student or professional pianists (n=7) performed the "Revolutionary Etude" on the piano with (Piano-BFR) and without (Piano-Ctrl) BFR. During the Piano-BFR performance, 150-180 mmHg of cuff pressure was applied around the most proximal region of both arms as a moderate BFR.

Results: Changes in upper limb girth, muscle thickness, and hand grip strength were measured before and immediately after the performance. After the performance, perceptual and other responses were recorded. Immediately after the performance, the Piano-BFR condition induced greater changes in girth (forearm and upper arm), muscle thickness (forearm), and handgrip strength than the Piano-Ctrl condition. Piano-BFR was (p<0.01) higher than Piano-Ctrl on eight questions regarding perceptual response (upper arm fatigue and difficulty playing the piano). Piano performance with BFR was revealed to increase upper extremity muscle size and fatigue in pianists after playing.

Conclusion: Piano performance with BFR was revealed to increase upper extremity muscle size and fatigue in pianists after playing. The effect of BFR on neuromuscular mechanisms on piano performance was greater in the forearm than in the upper arm.