Considering that therabant (elastic band) training combined with blood flow restriction exercises can be an effective training program for achieving muscle hypertrophy in practical applications, the aim of this study was to examine the effect of elastic band exercises integrated with blood flow restriction applied to the upper extremities on grip strength, upper extremity muscle strength, and selected performance parameters in elite tennis players. Tennis is a sport that requires high levels of upper extremity strength, grip strength, coordination, speed, and agility. Therefore, improving performance and ensuring safe strength gains for athletes is important. In recent years, blood flow restriction has attracted attention because it provides muscle strength and hypertrophy gains similar to high-intensity resistance exercises, even with low loads. Elastic band exercises are widely used because they are economical, portable, and applicable to different age groups. This prospective randomized controlled trial will include 30 elite tennis players aged 13-18 who have been licensed to play tennis at Antalya Tennis Specialization and Sports Club for at least 3 months and regularly attend training sessions. Participants will be randomly assigned to study and control groups. The study group will perform upper extremity exercises with elastic bands twice a week for 8 weeks under occlusion, using 7 cm wide pneumatic cuffs applied to the proximal arm at 30% of arterial occlusion pressure. The control group will perform the same elastic band exercises twice a week for 8 weeks without occlusion. Grip strength, upper extremity muscle strength, speed, agility, and sport-specific performance parameters will be evaluated before and after the intervention. The aim of the study is to determine whether elastic band exercises supported by blood flow restriction contribute to strength and performance development in tennis players. This research is expected to provide a scientific contribution to the planning of upper extremity strength training in tennis players and the use of blood flow restriction methods in the field of athletic performance. The findings are expected to contribute to scientific and clinical applications in the fields of sports physiotherapy, performance enhancement, and athlete rehabilitation.
Blood flow restriction is a current training approach used to support muscle strength and adaptation in resistance exercises performed with low loads. In this method, blood flow is partially restricted to the affected extremity during exercise via a cuff, thus increasing metabolic stress in low-intensity exercises and aiming to support muscle strength development. In this respect, blood flow restriction is considered a complementary exercise method that can provide strength development without the need for high mechanical loading. While the effects of low-load resistance exercises with blood flow restriction on muscle strength and performance in different sports branches are currently being investigated, the effect of its application in combination with elastic band exercises on grip strength, upper extremity muscle strength, and tennis-specific performance parameters in elite tennis players is not yet sufficiently clear. Since upper extremity function is important for racket control and stroke performance in tennis, examining the effects of this method specific to tennis players could contribute to the literature and training planning. The application of blood flow restriction exercises, mainly used in rehabilitation and athletic conditioning, remains limited among elite tennis players. To date, evidence regarding the integration of resistance band training in athletic contexts is scarce, and randomized controlled trials in tennis players are virtually nonexistent. This gap highlights the need to investigate whether the synergistic benefits observed in clinical examples can be extended to athlete populations where explosiveness, endurance, and balance are critical to performance. Practical considerations faced by physiotherapists, coaches, and athletes are equally important. Traditional resistance training often requires access to gyms, heavy equipment, and structured supervision, which may not always be feasible in resource-constrained tennis academies or while traveling for tournaments. In contrast, elastic band resistance training is a cost-effective, portable, and highly adaptable method that can be implemented with minimal equipment. When integrated, they provide both peripheral benefits (musculoskeletal strength, flexibility) and central adaptations (neuromuscular coordination, proprioceptive control). This makes the hybrid program not only scientifically promising but also practically feasible, offering a conditioning approach that supports performance. The fact that blood flow restriction exercises yield similar results to high-intensity resistance exercises, while elastic band training, even when applied alone as an alternative strength training method, produces less muscle hypertrophy compared to high-intensity resistance exercises, highlights the necessity of this study. Considering that elastic band training combined with blood flow restriction exercises could be an effective training program for achieving muscle hypertrophy in practical applications, the aim of this study was to examine the effects of elastic band exercises integrated into blood flow restriction applied to the upper extremity on grip strength, upper extremity muscle strength, and selected performance parameters in elite tennis players. Despite its increasing popularity, there are few studies evaluating the use of blood flow restriction exercises to improve performance in tennis. This study aimed to evaluate the effects of upper extremity elastic band exercises integrated into an 8-week blood flow restriction method on grip strength, upper extremity muscle strength, and selected performance parameters. Besides their use for rehabilitation purposes, there are resources suggesting that elastic band exercises can improve athletic performance. The key in this regard is determining the strength value in the applied trainings or exercises and planning their development. Studies are being conducted on how much the elastic band should be stretched and exactly how much force should be applied. Article studies support the idea of how much different colored bands should be stretched in exercises or trainings and how many kg of force the band can produce at that tension. This study, planned as a randomized prospective experimental study, aims to determine whether low-load blood flow restriction exercises contribute to the development of upper extremity strength and athletic performance in elite tennis players. It is believed that this research will provide scientific contributions to the planning of upper extremity strength training in tennis players and the use of blood flow restriction methods in the field of athletic performance.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
OTHER
Masking
NONE
Enrollment
30
Arterial blood flow pressure will be determined using a pulse oximeter, and exercise will be performed at 30% pressure. Arterial Occlusion Pressure Determination: Limb occlusion pressure will be determined using a pulse oximeter to identify the minimum pressure at which the brachial artery pulse is occluded. Arterial Occlusion Pressure Determination will be determined using the pulse oximeter method. Cuff pressure will be gradually increased, and pulse, SpO₂, and waveform will be monitored on the pulse oximeter. The pressure at which the pulse and waveform completely disappear will be considered the pressure at which arterial flow is interrupted and will be recorded as Arterial Occlusion Pressure Determination. Pressure for Applying Blood Flow Restrictive Exercises: Pressure will be applied at 30% of the determined Arterial Occlusion Pressure for the upper extremity. Occlusion cuffs will be inflated during each exercise and deflated immediately after the set to allow reperfusion.
Elastic band exercises (day one: Biceps Curls, External Rotation, Resistance Band Row, Pronation - Supination, Lateral Shoulder Stretch, Lawn Mower Row; day two: Push Ups, Internal Rotation, Lat Pull Down, Side Lateral Raises, Triceps Overhead Extensions, Band High Pull) twice a week for 8 weeks without occlusion.
Akdeniz University
Antalya, Konyaaltı, Turkey (Türkiye)
Change of Grip Strength
A Jamar (NY 10533) brand dynamometer, a hydraulic measuring instrument, will be used to measure grip strength. Athletes will be asked to firmly grasp and release the dynamometer once while seated with their arm in adduction, elbow at 90° flexion, forearm in mid-rotation, and hand in a neutral position. Measurements will be repeated three times for each extremity separately (5 seconds contraction, 30 seconds rest), and the average of these three values will be recorded in kilograms.
Time frame: hange from Baseline Grip Strength at 8 weeks
Change of Upper Extremity Muscle Strength
A Bench Press 1RM test will be administered to evaluate the maximal upper extremity strength of participants. Before the test, participants will be informed about the exercise technique and will perform appropriate warm-up. Participants will lie supine on the bench, with their feet fixed on the ground, and will grip the bar slightly wider than shoulder width. After lowering the bar to chest level in a controlled manner, they will be asked to push it back up for one repetition. The highest weight the participant can lift with correct technique will be recorded in kilograms as the 1RM value. Sufficient rest time will be given between trials, and an observer/assistant researcher will be present during the test for safety purposes.
Time frame: Change from Baseline Upper Extremity Muscle Strength at 8 weeks
Change of Upper Body Strength
The 30-second arm curl test will be used to assess upper extremity muscle strength. Participants will use a 3 kg dumbbell during the test. Participants will be instructed to sit in a straight-backed chair with their feet flat on the floor. The weight will be placed in the dominant hand with a neutral wrist position and an extended elbow. After a brief demonstration and practice, the participant will perform as many arm curls as possible within 30 seconds. The total number of completed movements will be considered for analysis.
Time frame: Change from Baseline Upper Body Strength at 8 weeks
Change of The International Tennis Number
The International Tennis Number-ITN Test will be used to determine the participants' skill levels. The ITN Field Assessment is a tennis skill assessment method developed by the International Tennis Federation.
Time frame: Change from Baseline The International Tennis Number at 8 weeks
Change of Level of Exertion
Borg Rated Exertion Scale In addition, the Borg Rated Exertion Scale (RPE) was used to determine the level of exertion perceived by athletes during exercise. The Borg Scale is a measurement tool that subjectively evaluates the intensity of exercise and is rated between 6 and 20, and it has been reported to show significant relationships between perceived exertion and physiological load indicators (heart rate, respiratory rate, and muscle fatigue).
Time frame: Change from Baseline Perceived Exertion Level at 8 weeks
Change of Satisfaction and Change Level
The Global Change Scale will be used to assess the overall level of change perceived by participants after the exercise program. This scale allows individuals to compare their current state with their pre-intervention state and indicate whether they have seen improvement, deterioration, or no change. The scale will be scored between -7 and +7, where -7 means "significant deterioration," 0 means "no change," and +7 means "significant improvement." Participants will be asked to rate the changes they feel in their overall performance, grip strength, and physical condition at the end of the 8-week exercise program using this scale.
Time frame: Change from Baseline Satisfaction and Change Level at 8 weeks
Height in Meters
The height of all subjects in meters (m) will be noted before the exercise program.
Time frame: Initial assessment before the exercise program.
Weight in Kilograms
The weight of all subjects in kilograms (kg) will be noted before the exercise program.
Time frame: Initial assessment before the exercise program.
Body Mass Index (BMI) in kg/m^2
Body Mass Index (BMI) will be calculated with the formula weight (kg)/height (m)\^2.
Time frame: Initial assessment before exercise program.
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