{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,10]],"date-time":"2025-11-10T06:34:54Z","timestamp":1762756494094,"version":"build-2065373602"},"reference-count":53,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,11,10]],"date-time":"2025-11-10T00:00:00Z","timestamp":1762732800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82272123"],"award-info":[{"award-number":["82272123"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Glob. Women\u2019s Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Skeletal muscle serves as the primary source of power for body movement. Due to the transition of menopause, older women experience a relatively faster decline in skeletal muscle mass and function, making them more susceptible to age-related skeletal muscle disorders such as sarcopenia, which can lead to adverse outcomes such as falls, fractures, disability, or even death. Blood flow restriction low-intensity resistance training (LI-BFRT) can effectively enhance muscle strength and promote skeletal muscle growth, while repetitive transcranial magnetic stimulation (rTMS) has previously been shown to improve motor cortex excitability and limb motor function. We describe a trial protocol to investigate the effects of a 12-week intervention combining rTMS with LI-BFRT on skeletal muscle mass and physical function in community-dwelling postmenopausal women.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This single-blind, randomized controlled trial will recruit 54 eligible community-dwelling postmenopausal women aged 50\u201365 years who have been naturally postmenopausal for 1 year or more. Participants will be randomly assigned in a 1:1:1 ratio to the rTMS combined with the blood flow restriction low-intensity resistance training group (rTMS\u2009+\u2009LI-BFRT), the blood flow restriction low-intensity resistance training group (LI-BFRT), and the control group, respectively, for a 12-week intervention period. Participants will undergo assessments at baseline (Week 0), immediately after the intervention (Week 12), and long-term follow-up (Week 24). The primary outcomes include lower limb muscle mass, muscle strength in both the upper and lower limbs; secondary outcomes include body composition, physical function (5-time sit-to-stand test, 30-second stand test, timed up-and-go test, 30-second arm curl test), motor cortex excitability, and clinical blood markers related to neural and muscular function.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>We have combined central and peripheral motor activation methods for the first time, attempting to use BFRT in combination with rTMS intervention to recruit more motor units by increasing motor cortex excitability, thereby enhancing skeletal muscle motor ability under BFRT and examining the intervention effects on skeletal muscle mass and strength in postmenopausal women. This will provide a new paradigm for healthy intervention in the skeletal muscles of postmenopausal women.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Trial Registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>http:\/\/www.chictr.org.cn<\/jats:ext-link>\n                      , Chinese Clinical Trial Registry ChiCTR2400086697.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fgwh.2025.1681138","type":"journal-article","created":{"date-parts":[[2025,11,10]],"date-time":"2025-11-10T06:29:52Z","timestamp":1762756192000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["The effects of rTMS combined with blood flow restriction low-intensity resistance training on skeletal muscle mass, strength, and physical function in postmenopausal women: a single-blind randomized controlled trial protocol"],"prefix":"10.3389","volume":"6","author":[{"given":"Xiangdi","family":"Dai","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuxiang","family":"Wu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuan","family":"Yuan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Binhua","family":"Lu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaowei","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guodong","family":"Xu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jie","family":"Zhuang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,11,10]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"e1462","DOI":"10.1002\/wsbm.1462","article-title":"Skeletal muscle: a review of molecular structure and function, in health and disease","volume":"12","author":"Mukund","year":"2020","journal-title":"WIRES Mech Dis"},{"key":"B2","doi-asserted-by":"publisher","first-page":"e113637","DOI":"10.1371\/journal.pone.0113637","article-title":"Grip strength across the life course: normative data from twelve British studies","volume":"9","author":"Dodds","year":"2014","journal-title":"PLoS One"},{"key":"B3","doi-asserted-by":"publisher","first-page":"760","DOI":"10.1016\/S0140-6736(08)60346-3","article-title":"Menopause","volume":"371","author":"Nelson","year":"2008","journal-title":"Lancet"},{"key":"B4","doi-asserted-by":"publisher","first-page":"682012","DOI":"10.3389\/fendo.2021.682012","article-title":"Sarcopenia and menopause: the role of estradiol","volume":"12","author":"Geraci","year":"2021","journal-title":"Front Endocrinol (Lausanne)"},{"key":"B5","doi-asserted-by":"publisher","first-page":"331","DOI":"10.1016\/j.maturitas.2011.01.014","article-title":"Menopause and sarcopenia: a potential role for sex hormones","volume":"68","author":"Messier","year":"2011","journal-title":"Maturitas"},{"key":"B6","doi-asserted-by":"publisher","first-page":"166","DOI":"10.1016\/j.arr.2015.07.011","article-title":"17\u03b2-estradiol and testosterone in sarcopenia: role of satellite cells","volume":"24","author":"La Colla","year":"2015","journal-title":"Ageing Res Rev"},{"key":"B7","doi-asserted-by":"publisher","first-page":"949","DOI":"10.1038\/ijo.2008.25","article-title":"Increased visceral fat and decreased energy expenditure during the menopausal transition","volume":"32","author":"Lovejoy","year":"2008","journal-title":"Int J Obes"},{"key":"B8","doi-asserted-by":"publisher","first-page":"1265","DOI":"10.1038\/ijo.2010.33","article-title":"Menopausal transition and changes of body composition: a prospective study in Chinese perimenopausal women","volume":"34","author":"Ho","year":"2010","journal-title":"Int J Obes"},{"key":"B9","doi-asserted-by":"publisher","first-page":"503","DOI":"10.1097\/00075197-200111000-00007","article-title":"The influence of aging and sex on skeletal muscle mass and strength","volume":"4","author":"Doherty","year":"2001","journal-title":"Curr Opin Clin Nutr Metab Care"},{"key":"B10","doi-asserted-by":"publisher","first-page":"1062","DOI":"10.1093\/gerona\/glx188","article-title":"Longitudinal changes in muscle mass and strength, and bone mass in older adults: gender-specific associations between muscle and bone losses","volume":"73","author":"Kim","year":"2018","journal-title":"J Gerontol Series A"},{"key":"B11","doi-asserted-by":"publisher","first-page":"300","DOI":"10.1016\/j.jamda.2019.12.012","article-title":"Asian working group for sarcopenia: 2019 consensus update on sarcopenia diagnosis and treatment","volume":"21","author":"Chen","year":"2020","journal-title":"J Am Med Dir Assoc"},{"key":"B12","doi-asserted-by":"publisher","first-page":"100","DOI":"10.1016\/j.exger.2017.06.008","article-title":"Is sarcopenia associated with an increased risk of all-cause mortality and functional disability?","volume":"96","author":"Kelley","year":"2017","journal-title":"Exp Gerontol"},{"key":"B13","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1016\/j.clnu.2019.01.002","article-title":"Falls among older adults with sarcopenia dwelling in nursing home or community: a meta-analysis","volume":"39","author":"Zhang","year":"2020","journal-title":"Clin Nutr"},{"key":"B14","doi-asserted-by":"publisher","first-page":"730","DOI":"10.1186\/s12889-025-21933-y","article-title":"Association between sarcopenia and cardiovascular disease according to menopausal status: findings from the China health and retirement longitudinal study (CHARLS)","volume":"25","author":"Dai","year":"2025","journal-title":"BMC Public Health"},{"key":"B15","doi-asserted-by":"publisher","first-page":"e0191820","DOI":"10.1371\/journal.pone.0191820","article-title":"Impact of habitual physical activity and type of exercise on physical performance across ages in community-living people","volume":"13","author":"Landi","year":"2018","journal-title":"PLoS One"},{"key":"B16","doi-asserted-by":"publisher","first-page":"503","DOI":"10.1006\/pmed.2001.0909","article-title":"Potential health-related benefits of resistance training","volume":"33","author":"Winett","year":"2001","journal-title":"Prev Med"},{"key":"B17","doi-asserted-by":"publisher","first-page":"1471","DOI":"10.1093\/gerona\/glac230","article-title":"Does high-velocity resistance exercise elicit greater physical function benefits than traditional resistance exercise in older adults? A systematic review and network meta-analysis of 79 trials","volume":"78","author":"Lopez","year":"2023","journal-title":"J Gerontol Series A"},{"key":"B18","doi-asserted-by":"publisher","first-page":"1634","DOI":"10.1002\/jbmr.4027","article-title":"Effects of high-intensity resistance training on osteopenia and sarcopenia parameters in older men with osteosarcopenia\u2014one-year results of the randomized controlled franconian osteopenia and sarcopenia trial (FrOST)","volume":"35","author":"Kemmler","year":"2020","journal-title":"J Bone Miner Res"},{"key":"B19","doi-asserted-by":"publisher","first-page":"361","DOI":"10.1007\/s40279-017-0795-y","article-title":"Magnitude of muscle strength and mass adaptations between high-load resistance training versus low-load resistance training associated with blood-flow restriction: a systematic review and meta-analysis","volume":"48","author":"Lixandr\u00e3o","year":"2018","journal-title":"Sports Med"},{"key":"B20","doi-asserted-by":"publisher","first-page":"955","DOI":"10.2147\/CIA.S104674","article-title":"Resistance training for activity limitations in older adults with skeletal muscle function deficits: a systematic review","volume":"12","author":"Papa","year":"2017","journal-title":"CIA"},{"key":"B21","doi-asserted-by":"publisher","first-page":"313","DOI":"10.1007\/s40279-014-0288-1","article-title":"Exercise with blood flow restriction: an updated evidence-based approach for enhanced muscular development","volume":"45","author":"Scott","year":"2015","journal-title":"Sports Med"},{"key":"B22","doi-asserted-by":"publisher","first-page":"1003","DOI":"10.1136\/bjsports-2016-097071","article-title":"Blood flow restriction training in clinical musculoskeletal rehabilitation: a systematic review and meta-analysis","volume":"51","author":"Hughes","year":"2017","journal-title":"Br J Sports Med"},{"key":"B23","doi-asserted-by":"publisher","first-page":"937","DOI":"10.4085\/418-20","article-title":"Blood flow restriction training","volume":"56","author":"Lorenz","year":"2021","journal-title":"J Athl Train"},{"key":"B24","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1186\/s11556-022-00294-0","article-title":"Effects of blood flow restriction (BFR) with resistance exercise on musculoskeletal health in older adults: a narrative review","volume":"19","author":"Lim","year":"2022","journal-title":"Eur Rev Aging Phys Act"},{"key":"B25","doi-asserted-by":"publisher","first-page":"1071","DOI":"10.1519\/JSC.0000000000000703","article-title":"Comparisons between low-intensity resistance training with blood flow restriction and high-intensity resistance training on quadriceps muscle mass and strength in elderly","volume":"29","author":"Vechin","year":"2015","journal-title":"J Strength Cond Res"},{"key":"B26","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1007\/s40279-018-0994-1","article-title":"Effects of blood flow restriction training on muscular strength and hypertrophy in older individuals: a systematic review and meta-analysis","volume":"49","author":"Centner","year":"2019","journal-title":"Sports Med"},{"key":"B27","doi-asserted-by":"publisher","first-page":"494","DOI":"10.1007\/s12603-019-1196-8","article-title":"Exercise interventions for the prevention and treatment of sarcopenia. A systematic umbrella review","volume":"23","author":"Beckw\u00e9e","year":"2019","journal-title":"J Nutr Health Aging"},{"key":"B28","doi-asserted-by":"publisher","first-page":"83","DOI":"10.11005\/jbm.2017.24.2.83","article-title":"Sarcopenia: neurological point of view","volume":"24","author":"Kwon","year":"2017","journal-title":"J Bone Metab"},{"key":"B29","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1016\/j.mad.2018.06.005","article-title":"Neural and musculotendinous mechanisms underpinning age-related force reductions","volume":"175","author":"Orssatto","year":"2018","journal-title":"Mech Ageing Dev"},{"key":"B30","doi-asserted-by":"publisher","first-page":"74","DOI":"10.1016\/j.neures.2006.02.002","article-title":"Effects of aging on motor cortex excitability","volume":"55","author":"Oliviero","year":"2006","journal-title":"Neurosci Res"},{"key":"B31","doi-asserted-by":"publisher","first-page":"1199","DOI":"10.1007\/s11357-021-00510-2","article-title":"A neuromuscular perspective of sarcopenia pathogenesis: deciphering the signaling pathways involved","volume":"44","author":"Moreira-Pais","year":"2022","journal-title":"GeroScience"},{"key":"B32","doi-asserted-by":"publisher","first-page":"101966","DOI":"10.1016\/j.arr.2023.101966","article-title":"Neuromuscular junction transmission failure in aging and sarcopenia: the nexus of the neurological and muscular systems","volume":"89","author":"Arnold","year":"2023","journal-title":"Ageing Res Rev"},{"key":"B33","doi-asserted-by":"publisher","first-page":"145","DOI":"10.1016\/S1474-4422(03)00321-1","article-title":"Transcranial magnetic stimulation in neurology","volume":"2","author":"Kobayashi","year":"2003","journal-title":"Lancet Neurol"},{"key":"B34","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1186\/s12984-022-00999-4","article-title":"Effects of transcranial magnetic stimulation in modulating cortical excitability in patients with stroke: a systematic review and meta-analysis","volume":"19","author":"Bai","year":"2022","journal-title":"J NeuroEngineering Rehabil"},{"key":"B35","doi-asserted-by":"publisher","first-page":"918597","DOI":"10.3389\/fneur.2022.918597","article-title":"Excitatory repetitive transcranial magnetic stimulation over the ipsilesional hemisphere for upper limb motor function after stroke: a systematic review and meta-analysis","volume":"13","author":"Tang","year":"2022","journal-title":"Front Neurol"},{"key":"B36","doi-asserted-by":"publisher","first-page":"1472837","DOI":"10.3389\/fneur.2024.1472837","article-title":"Effects of repetitive transcranial magnetic stimulation combined with repetitive peripheral magnetic stimulation on upper limb motor function after stroke: a systematic review and meta-analysis","volume":"15","author":"Luo","year":"2024","journal-title":"Front Neurol"},{"key":"B37","doi-asserted-by":"publisher","first-page":"138","DOI":"10.1016\/j.exger.2017.10.004","article-title":"Blood flow restricted resistance training in older adults at risk of mobility limitations","volume":"99","author":"Cook","year":"2017","journal-title":"Exp Gerontol"},{"key":"B38","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1080\/07303084.1993.10606684","article-title":"Strength testing\u2014predicting a one-rep max from reps-to-fatigue","volume":"64","author":"Brzycki","year":"1993","journal-title":"J Phys Educ Recreat Dance"},{"key":"B39","doi-asserted-by":"publisher","first-page":"407","DOI":"10.3389\/fphys.2019.00407","article-title":"Tissue oxygenation in response to different relative levels of blood-flow restricted exercise","volume":"10","author":"Reis","year":"2019","journal-title":"Front Physiol"},{"key":"B40","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1186\/s40101-016-0099-1","article-title":"Anatomical cross-sectional area of the quadriceps femoris and sit-to-stand test score in middle-aged and elderly population: development of a predictive equation","volume":"36","author":"Saito","year":"2017","journal-title":"J Physiol Anthropol"},{"key":"B41","doi-asserted-by":"publisher","first-page":"e30705","DOI":"10.1002\/pbc.30705","article-title":"Sarcopenia in long-term survivors of cancer in childhood and adolescence: a cross-sectional study of calf muscle mass by peripheral quantitative computed tomography with an examination of the muscle\u2013bone unit","volume":"71","author":"Guolla","year":"2024","journal-title":"Pediatr Blood Cancer"},{"key":"B42","doi-asserted-by":"publisher","first-page":"787","DOI":"10.1002\/acr.23911","article-title":"Low-load resistance training with blood-flow restriction in relation to muscle function, mass, and functionality in women with rheumatoid arthritis","volume":"72","author":"Rodrigues","year":"2020","journal-title":"Arthritis Care Res (Hoboken)"},{"key":"B43","doi-asserted-by":"publisher","first-page":"1588","DOI":"10.3390\/jcm9051588","article-title":"Role of menopausal transition and physical activity in loss of lean and muscle mass: a follow-up study in middle-aged Finnish women","volume":"9","author":"Juppi","year":"2020","journal-title":"J Clin Med"},{"key":"B44","doi-asserted-by":"publisher","first-page":"2019","DOI":"10.1519\/JSC.0000000000003230","article-title":"Resistance training for older adults: position statement from the national strength and conditioning association","volume":"33","author":"Fragala","year":"2019","journal-title":"J Strength Cond Res"},{"key":"B45","doi-asserted-by":"publisher","first-page":"1693","DOI":"10.1007\/s40279-015-0385-9","article-title":"Dose\u2013response relationships of resistance training in healthy old adults: a systematic review and meta-analysis","volume":"45","author":"Borde","year":"2015","journal-title":"Sports Med"},{"key":"B46","doi-asserted-by":"publisher","first-page":"995","DOI":"10.1111\/sms.12536","article-title":"Effects of resistance training with moderate vs heavy loads on muscle mass and strength in the elderly: a meta-analysis","volume":"26","author":"Csapo","year":"2016","journal-title":"Scand Med Sci Sports"},{"key":"B47","doi-asserted-by":"publisher","first-page":"211","DOI":"10.1113\/jphysiol.2008.164483","article-title":"Age-related differences in the dose\u2013response relationship of muscle protein synthesis to resistance exercise in young and old men","volume":"587","author":"Kumar","year":"2009","journal-title":"J Physiol (Lond)"},{"key":"B48","doi-asserted-by":"publisher","first-page":"11441","DOI":"10.3390\/ijerph182111441","article-title":"Resistance training with blood flow restriction compared to traditional resistance training on strength and muscle mass in non-active older adults: a systematic review and meta-analysis","volume":"18","author":"Rodrigo-Mallorca","year":"2021","journal-title":"Int J Environ Res Public Health"},{"key":"B49","doi-asserted-by":"publisher","first-page":"1199","DOI":"10.1152\/japplphysiol.01266.2009","article-title":"Blood flow restriction exercise stimulates mTORC1 signaling and muscle protein synthesis in older men","volume":"108","author":"Fry","year":"2010","journal-title":"J Appl Physiol"},{"key":"B50","doi-asserted-by":"publisher","first-page":"111827","DOI":"10.1016\/j.exger.2022.111827","article-title":"Effect of blood flow restriction combined with low-intensity training on the lower limbs muscle strength and function in older adults: a meta-analysis","volume":"164","author":"Zhang","year":"2022","journal-title":"Exp Gerontol"},{"key":"B51","doi-asserted-by":"publisher","first-page":"474","DOI":"10.1016\/j.clinph.2019.11.002","article-title":"Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS): an update (2014\u20132018)","volume":"131","author":"Lefaucheur","year":"2020","journal-title":"Clin Neurophysiol"},{"key":"B52","doi-asserted-by":"publisher","first-page":"1986","DOI":"10.4103\/1673-5374.282239","article-title":"Combined effect of repetitive transcranial magnetic stimulation and physical exercise on cortical plasticity","volume":"15","author":"Yang","year":"2020","journal-title":"Neural Regen Res"},{"key":"B53","doi-asserted-by":"publisher","first-page":"1168","DOI":"10.4103\/1673-5374.300341","article-title":"Repetitive transcranial magnetic stimulation for lower extremity motor function in patients with stroke: a systematic review and network meta-analysis","volume":"16","author":"Xie","year":"2021","journal-title":"Neural Regen Res"}],"container-title":["Frontiers in Global Women's Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fgwh.2025.1681138\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,10]],"date-time":"2025-11-10T06:29:53Z","timestamp":1762756193000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fgwh.2025.1681138\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,10]]},"references-count":53,"alternative-id":["10.3389\/fgwh.2025.1681138"],"URL":"https:\/\/doi.org\/10.3389\/fgwh.2025.1681138","relation":{},"ISSN":["2673-5059"],"issn-type":[{"value":"2673-5059","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,10]]},"article-number":"1681138"}}