Effects of Practical Blood Flow Restriction Training on Adolescent Lower-Body Strength

Effect of blood-flow restricted vs heavy-load resistance training on strength, power, and speed for healthy volunteers: a systematic review and meta-analysis

Background

Low-load blood flow restriction (LL-BFR) training has been shown to enhance muscle strength, power, and speed, but its effectiveness compared to traditional high-load resistance (HLR) training remains unclear. This meta-analysis aimed to compare the effects of LL-BFR and HLR training on muscle strength, power, and speed.

Methodology

Studies were identified by searching the SCOPUS, SPORTDiscus, PubMed, Web of Science, and CNKI databases up to May 13, 2024, using the following inclusion criteria: (a) healthy population; (b) comparison of LL-BFR vs HLR training; (c) pre- and post-training assessment of muscle strength (dynamic, isometric, and isokinetic), muscle power, jump, or speed performance; (d) PEDro scale score ≥4. The methodological quality of the included studies was assessed using the PEDro tool and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach, with meta-analyses conducted using the R program.

Results

A total of 41 studies, involving 853 subjects, were included in the meta-analysis. Based on the PEDro scores and GRADE assessment, the overall quality of the included studies was assessed as moderate. LL-BFR training showed a slightly smaller effect on maximal strength compared to HLR training (ES = -0.19, 95% CI [-0.31 to -0.06], p < 0.01). There were no significant differences between LL-BFR and HLR training for muscle power (ES = -0.04, 95% CI [-0.33 to 0.24], p > 0.05), jump performance (ES = -0.08, 95% CI [-0.30 to 0.15], p > 0.05), and speed (ES = -0.28, 95% CI [-0.71 to 0.15], p > 0.05). Additionally, individual characteristics (i.e., age, gender, and training status) and training parameters (i.e., training duration, frequency, cuff pressure, and cuff width) did not significantly moderate the training effect.

Conclusions

LL-BFR training showed slightly less improvement in maximal strength compared to HLR training but demonstrated comparable effects on muscle power, jump performance, and speed in healthy individuals in healthy individuals. These findings suggest that LL-BFR may be a practical and effective alternative for individuals seeking performance improvements with lower training loads.

Immediate Effects of High-Intensity Blood Flow Restriction Training on Muscle Performance and Muscle Soreness

Purpose: The aim was to investigate the immediate effects of high-intensity resistance training with blood flow restriction (HIRT-BFR) on rectus femoris (RF) muscle activity, reaction time, muscular performance, and delayed onset muscle soreness (DOMS) in healthy young adults. Methods: Twenty-four healthy young adults were randomized into the HIRT-BFR group or HIRT group. Both groups performed a single session of training with 80% of 1RM, 8 repetitions, 2 sets, and 3 minutes rest to RF muscle. The activity and reaction time of the dominant extremity RF muscle were evaluated by superficial electromyography (sEMG), muscular performance by single-leg squat test, and DOMS by the Visual Analog Scale. Results: Single-leg squat performance was significantly increased in HIRT-BFR (p = .001) and HIRT group (p = .04). Additionally, in HIRT group resting average (p = .03), resting maximal voluntary contraction % (p = .04), and relaxation minimum (p = .02) values of RF were significantly increased. DOMS level decreased significantly in HIRT-BFR (p < .001) and HIRT group (p = .019). The differences were similar in the groups for sEMG parameters, muscle performance, and DOMS level. Conclusion: We observed that HIRT-BFR and HIRT were similar in terms of muscle activation, reaction time, muscular performance of the RF, and DOMS level.Trial registration number: This study is registered at www.clinicaltrails.gov (NCT05274542).

Effectiveness of blood flow restriction training during a taper phase in basketball players

This study investigates the effectiveness of blood flow restriction (BFR) training in maintaining athletic performance during a taper phase in basketball players. The taper phase aims to reduce external load while maintaining training intensity. Seventeen experienced basketball players were randomised into two groups: a placebo group (n = 8, 22.0 ± 2.1 years, mean ± SD) and BFR group (n = 9, 21.1 ± 1.5 years). The training schedule included strength trainings, team trainings, individual skill sessions and competitive games. During the 4-week taper period, lifting volume was reduced while either maintaining (placebo) or reducing (BFR) lifting load. The BFR group lifted with 60% arterial occlusion pressure at 25-30% of their 1RM, whereas the placebo group trained at 80% of their 1RM with BFR cuffs inflated to only 20%. Compared to the placebo group, BFR participants improved 5 m (-1.4 ± 1.5% mean ± 95% CI p = 0.03) and 10 m (-1.1 ± 0.5%, p =  <0.01) sprint performance along with barbell back squat (9.6 ± 8.0%, p = 0.013) and countermovement jump (1.1 ± 0.8%, p = 0.0035). BFR during the taper phase enabled a reduction in lifting load with no reduction in subsequent performance measures.

Stiffness of elastic cuffs affects physiological and perceptual responses but not motor performance fatigue during low external load resistance exercise with practical blood flow restriction

Practical blood flow restriction (pBFR), using non-pneumatic elastic cuffs, is a feasible and cost-effective alternative to pneumatic systems. There is evidence that cuff stiffness influences haemodynamic and perceptual responses in the upper body during rest. However, the impact of cuff stiffness during exercise is still unknown. Therefore, this study investigated the influence of cuff stiffness on physiological, perceptual, and performance changes during exercise. In a randomized and counterbalanced order, ten recreationally active males performed four sets of unilateral elbow flexions at 20% of individuals' one-repetition-maximum with two elastic cuffs of different stiffness (low stiffness cuff [LS] and high stiffness cuff [HS]) each applied with two different overlaps (10% and 20% overlap in relation to the limb circumference) as well as a control condition without pBFR. Before and after exercise, maximal voluntary isometric contraction torque was measured to assess motor performance fatigue. During exercise, muscle oxygen saturation of the biceps brachii as well as effort and exercise-induced muscle pain perception were recorded. Statistical analysis revealed that motor performance fatigue was not different between conditions (BF10 = 0.289). The decline in muscle oxygen saturation (BF10 = 8.508 and BF10 = 1039.543) as well as effort (BF10 = 2646.104 and BF10 = 2.773∙106) and exercise-induced muscle pain perception (BF10 = 14087.983 and BF10 = 7.306∙109) were higher when using the stiffer cuff at 10% and 20% overlap, respectively. Conclusively, physiological and perceptual responses but not motor performance fatigue were affected by cuff stiffness when equal relative overlaps were applied.

Effects of blood flow restriction training on physical fitness among athletes: a systematic review and meta-analysis

Blood flow restriction training (BFRT) is an effective, scientific and safe training method, but its effect on the overall quality of athletes remains unclear. The aim of this systematic review with meta-analysis was to clarify the effects of BFRT on the physical fitness among athletes. Based on the PRISMA guidelines, searches were performed in PubMed, Web of Science, SPORTDiscus, and SCOUPS, the Cochrane bias risk assessment tool was used to assess methodological quality, and RevMan 5.4 and STATA 15.0 software were used to analyze the data. A meta-analysis of 28 studies with a total sample size of 542 athletes aged 14-26 years and assessed as low risk for quality was performed. Our results revealed that the BFRT intervention had small to large improvements in the athletes' strength (ES = 0.74-1.03), power (ES = 0.46), speed (ES = 0.54), endurance (ES = 1.39-1.40), body composition (ES = 0.28-1.23), while there was no significant effect on body mass (p > 0.05). Subgroup analyses revealed that moderator variables (training duration, frequency, load, cuff pressure, and pressurization time) also had varying degrees of effect on athletes' physical fitness parameters. In conclusion, BFRT had a positive effect on the physical fitness parameters of the athletes, with significantly improved strength, power, speed, endurance and body composition, but not body mass parameters. When the training frequency ≥ 3 times/week, cuff pressure ≥ 160 mmHg, and pressurization time ≥ 10 min, the BFRT group was more favorable for the improvement of physical fitness parameters.

Low-load Resistance Exercise with Perceptually Primed Practical Blood Flow Restriction Induces Similar Motor Performance Fatigue, Physiological Changes, and Perceptual Responses Compared to Traditional Blood Flow Restriction in Males and Females

In the recent past, practical blood flow restriction (pBFR) using non-pneumatic, usually elastic cuffs has been established as a cost-effective alternative to traditional blood flow restriction (BFR) using pneumatic cuffs, especially for training in large groups. This study investigated whether low-load resistance exercise with perceptually primed pBFR using an elastic knee wrap is suitable to induce similar motor performance fatigue as well as physiological and perceptual responses compared to traditional BFR using a pneumatic nylon cuff in males and females. In a randomized, counterbalanced cross-over study, 30 healthy subjects performed 4 sets (30-15-15-15 repetitions) of unilateral knee extensions at 20% of their one-repetition-maximum. In the pBFR condition, each individual was perceptually primed to a BFR pressure corresponding to 60% of their arterial occlusion pressure. Before and after exercise, maximal voluntary torque, maximal muscle activity, and cuff pressure-induced discomfort were assessed. Moreover, physiological (i.e., muscle activity, muscle oxygenation) and perceptual responses (i.e., effort and exercise-induced leg muscle pain) were recorded during exercise. Moderate correlations with no differences between pBFR and BFR were found regarding the decline in maximal voluntary torque and maximal muscle activity. Furthermore, no to very strong correlations between conditions, with no differences, were observed for muscle activity, muscle oxygenation, and perceptual responses during exercise sets. However, cuff pressure-induced discomfort was lower in the pBFR compared to the BFR condition. These results indicate that low-load resistance exercise combined with perceptually primed pBFR is a convenient and less discomfort inducing alternative to traditional BFR. This is especially relevant for BFR training with people who have a low cuff-induced discomfort tolerance.

Blood flow restriction training improves the efficacy of routine intervention in patients with chronic ankle instability

As a new means of rehabilitation, blood flow restriction training (BFRT) is widely used in the field of musculoskeletal rehabilitation. To observe whether BFRT can improve the efficacy of routine rehabilitation intervention in patients with chronic ankle instability (CAI). Twenty-three patients with CAI were randomly divided into a routine rehabilitation group (RR Group) and a routine rehabilitation ​+ ​blood flow restriction training group (RR ​+ ​BFRT Group) according to the Cumberland Ankle Instability Tool (CAIT) score. The RR Group was treated with routine rehabilitation means for intervention, and the RR ​+ ​BFRT Group was treated with a tourniquet to restrict lower limb blood flow for rehabilitation training based on routine training. Before and after the intervention, the CAIT score on the affected side, standing time on one leg with eyes closed, comprehensive scores of the Y-balance test, and surface electromyography data of tibialis anterior (TA) and peroneus longus (PL) were collected to evaluate the recovery of the subjects. Patients were followed up 1 year after the intervention. After 4 weeks of intervention, the RR ​+ ​BFRT Group CAIT score was significantly higher than the RR Group (19.33 VS 16.73, p ​< ​0.05), the time of standing on one leg with eyes closed and the comprehensive score of Y-balance were improved, but there was no statistical difference between groups (p ​> ​0.05). RR ​+ ​BFRT Group increased the muscle activation of the TA with maximum exertion of the ankle dorsal extensor (p ​< ​0.05) and had no significant change in the muscle activation of the PL with maximum exertion of the ankle valgus (p ​> ​0.05). There was no significant difference in the incidence of resprains within 1 year between the groups (36.36% VS 16.67%, p ​> ​0.05). The incidence of ankle pain in the RR ​+ ​BFRT Group was lower than that in the RR Group (63.64% VS 9.09%, p ​< ​0.01). Therefore, four-weeks BFRT improves the effect of the routine intervention, and BFRT-related interventions are recommended for CAI patients with severe ankle muscle mass impairment or severe pain.

Potential Moderators of the Effects of Blood Flow Restriction Training on Muscle Strength and Hypertrophy: A Meta-analysis Based on a Comparison with High-Load Resistance Training

BACKGROUND

While it has been examined whether there are similar magnitudes of muscle strength and hypertrophy adaptations between low-load resistance training combined with blood-flow restriction training (BFR-RT) and high-load resistance training (HL-RT), some important potential moderators (e.g., age, sex, upper and lower limbs, frequency and duration etc.) have yet to be analyzed further. Furthermore, training status, specificity of muscle strength tests (dynamic versus isometric or isokinetic) and specificity of muscle mass assessments (locations of muscle hypertrophy assessments) seem to exhibit different effects on the results of the analysis. The role of these influencing factors, therefore, remains to be elucidated.

OBJECTIVES

The aim of this meta-analysis was to compare the effects of BFR- versus HL-RT on muscle adaptations, when considering the influence of population characteristics (training status, sex and age), protocol characteristics (upper or lower limbs, duration and frequency) and test specificity.

METHODS

Studies were identified through database searches based on the following inclusion criteria: (1) pre- and post-training assessment of muscular strength; (2) pre- and post-training assessment of muscular hypertrophy; (3) comparison of BFR-RT vs. HL-RT; (4) score ≥ 4 on PEDro scale; (5) means and standard deviations (or standard errors) are reported or allow estimation from graphs. In cases where the fifth criterion was not met, the data were requested directly from the authors.

RESULTS

The main finding of the present study was that training status was an important influencing factor in the effects of BFR-RT. The trained individuals may gain greater muscle strength and hypertrophy with BFR-RT as compared to HL-RT. However, the results showed that the untrained individuals experienced similar muscle mass gains and superior muscle strength gains in with HL-RT compared to BFR-RT.

CONCLUSION

Compared to HL-RT, training status is an important factor influencing the effects of the BFR-RT, in which trained can obtain greater muscle strength and hypertrophy gains in BFR-RT, while untrained individuals can obtain greater strength gains and similar hypertrophy in HL-RT.

Comparison of Supervised versus Self-Administered Stretching on Bench Press Maximal Strength and Force Development

PURPOSE

While there is reported superior effectiveness with supervised training, it usually requires specialized exercise facilities and instructors. It is reported in the literature that high-volume stretching improves pectoralis muscles strength under supervised conditions while practical relevance is discussed. Therefore, the study objective was to compare the effects of volume equated, supervised- and self-administered home-based stretching on strength performance.

METHODS

Sixty-three recreational participants were equally assigned to either a supervised static stretching, home-based stretching, or control group. The effects of 15 min pectoralis stretching, 4 days per week for 8 weeks, were assessed on dynamic and isometric bench press strength and force development.

RESULTS

While there was a large magnitude maximal strength increase (p < 0.001-0.023, ƞ2 = 0.118-0.351), force development remained unaffected. Dynamic maximal strength in both groups demonstrated large magnitude increases compared to the control group (p < 0.001-0.001, d = 1.227-0.905). No differences between the intervention group for maximal strength (p = 0.518-0.821, d = 0.101-0.322) could be detected.

CONCLUSIONS

The results could potentially be attributed to stretch-induced tension (mechanical overload) with subsequent anabolic adaptations, and alternative explanatory approaches are discussed. Nevertheless, home-based stretching seems a practical alternative to supervised training with potential meaningful applications in different settings.

Early- and Late-Stage Benefits of Blood Flow Restriction Training on Knee Strength in Adolescents After Anterior Cruciate Ligament Reconstruction

Background

Blood flow restriction training (BFRT) after anterior cruciate ligament reconstruction (ACLR) is rising in popularity because of its benefits in reducing muscle atrophy and mitigating knee strength deficits.

Purpose

To investigate the impact BFRT has on adolescent knee strength after ACLR at 2 postoperative time points: at 3 months and the time of return to sport (RTS).

Study Design

Cohort study; Level of evidence, 3.

Methods

A prospective intervention (BFRT) group was compared to an age-, sex-, and body mass index-matched retrospective control group. Patients aged 12 to 18 years who underwent primary ACLR with a quadriceps tendon autograft were included. Along with a traditional rehabilitation protocol, the BFRT group completed a standardized BFRT protocol (3 BFRT exercises performed twice weekly for the initial 12 weeks postoperatively). Peak torque values for isometric knee extension and flexion strength (at 3 months and RTS) and isokinetic strength at 180 deg/s (at RTS) as well as Pediatric International Knee Documentation Committee (Pedi-IKDC) scores were collected. Differences between the BFRT and control groups were compared with 2-way mixed analysis of variance and 1-way analysis of variance.

Results

The BFRT group consisted of 16 patients (10 female; mean age, 14.84 ± 1.6 years) who were matched to 16 patients in the control group (10 female; mean age, 15.35 ± 1.3 years). Regardless of the time point, the BFRT group demonstrated significantly higher isometric knee extension torque compared to the control group (2.15 ± 0.12 N·m/kg [95% CI, 1.90-2.39] vs 1.74 ± 0.12 N·m/kg [95% CI, 1.49-1.98], respectively; mean difference, 0.403 N·m/kg; P = .024). The BFRT group also reported significantly better Pedi-IKDC scores compared to the control group at both 3 months (68.91 ± 9.68 vs 66.39 ± 12.18, respectively) and RTS (89.42 ± 7.94 vs 72.79 ± 22.81, respectively) (P = .047).

Conclusion

In adolescents, the addition of a standardized BFRT protocol to a traditional rehabilitation protocol after ACLR significantly improved knee strength and patient-reported function compared to a traditional rehabilitation program alone.

Effects of whole-body vibration training combined with KAATSU training on lower limb joint muscle strength in older women

Objective: This study aimed to investigate the effect of whole-body vibration training (WBVT) combined with KAATSU training (KT) on lower limb joint muscle strength and to provide a reference for improving muscle strength in older women. Methods: A total of 86 healthy older people was randomly divided into WBVT group (WG, n = 21), KT group (KG, n = 22), combined intervention group (CIG, n = 20) and control group (CG, n = 23). WG and CIG subjects underwent WBVT, and KG and CIG subjects underwent 150 mmHg and lower limb joint and local compression intervention for 16 weeks (three times per week, about 15 min/time). The peak torque (PT) and endurance ratio (ER) of joint flexion or extension were tested for all subjects. Results: 1) Results at 16 weeks were compared with the baseline data. The knee extension and ankle flexion PT (60°/s) in CIG increased by 14.3% and 15.3%, respectively (p < 0.05). The knee extension PT (180°/s) increased by 16.9, 18.4% and 33.3% in WG, KG and CIG (p < 0.05), respectively, and the ankle extension PT (180°/s) in CIG increased by 31.1% (p < 0.05). The hip, knee extension and ankle flexion ER increased by 10.0, 10.9% and 5.7% in CIG (p < 0.05), respectively. 2) Results were compared among groups at 16 weeks. The relative changes were significantly lower in WG, KG and CG compared to CIG in the knee extension and ankle flexion PT (60°/s) (p < 0.05). The relative changes were significantly greater in WG, KG and CIG compared to CG in the knee extension PT (180°/s) (p < 0.05). The relative changes were significantly lower in WG, KG and CG compared to CIG in the ankle extension PT (180°/s) (p < 0.05). The relative changes were significantly lower in WG, KG and CG compared to CIG in the hip extension ER (p < 0.05). The relative changes were significantly lower in CG compared to CIG in the knee extension ER (p < 0.05). Conclusion: Sixteen-week WBVT and KT increased the knee extensor strength in older women. Compared with a single intervention, the combined intervention had better improvements in the knee extensor and ankle flexor and extensor strength and hip extension muscle endurance. Appears to be some additional benefit from combined intervention above those derived from single-interventions.

Dose-response relationship of blood flow restriction training on isometric muscle strength, maximum strength and lower limb extensor strength: A meta-analysis

Objective: To perform a meta-analysis on the efficacy and dose-response relationship of blood flow restriction training on muscle strength reported worldwide. Methods: Thirty-four eligible articles with a total sample size of 549 participants were included in the meta-analysis. This study was performed using the method recommended by the Cochrane Handbook (https://training.cochrane.org/handbook), and the effect size was estimated using the standardized mean difference (SMD) and using RevMan 5.3 software (The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen, 2014). Results: The meta-analysis showed that blood flow restriction training increased the lower limb extensor muscle strength [SMD = 0.72, 95%; confidence interval (CI): 0.43 to 1.00, p < 0.01], knee extensor isokinetic torque SMD = 0.48 [95% CI: 0.24 to 0.73, p < 0.01], knee flexor isokinetic torque SMD = 0.39 [95% CI: 0.11 to 0.67, p < 0.01], and squat one-repetition maximum [SMD = 0.28, 95% CI: 0.01 to 0.55, p < 0.01]. There was no publication bias. Evaluation of dose-response relationship showed that the training load, mode, frequency, duration, and maximum cuff pressure affected the muscle function. Conclusion: blood flow restriction training. 16 significantly improved lower limb muscle strength, and the optimal training conditions consisted of a weight load smaller or equal to 30% of one-repetition maximum, training duration longer than 4 weeks, frequency of more than 3 times/week, and maximum cuff pressure lower than 200 mmHg. Systematic Review Registration: website, identifier registration number.

Effects of Blood Flow Restriction Therapy for Muscular Strength, Hypertrophy, and Endurance in Healthy and Special Populations: A Systematic Review and Meta-Analysis

OBJECTIVES

Blood flow restriction (BFR) training is an increasingly applied tool with potential benefits in muscular hypertrophy, strength, and endurance. This study investigates the effectiveness of BFR training relative to other forms of training on muscle strength, hypertrophy, and endurance.

DATA SOURCES

We performed systematic searches of MEDLINE, Embase, and PubMed and assessed the methodological quality of included studies using the Cochrane risk of bias tool.

MAIN RESULTS

We included 53 randomized controlled trials with 31 included in meta-analyses. For muscular strength comparing low-intensity BFR (LI-BFR) training with high-intensity resistance training (HIRT), the pooled mean difference (MD) for 1 repetition maximum was 5.34 kg (95% CI, 2.58-8.09; P < 0.01) favoring HIRT. When comparing LI-BFR training with HIRT for torque, the MD was 6.35 N·m (95% CI, 0.5-12.3; P = 0.04) also favoring HIRT. However, comparing LI-BFR with low-intensity resistance training (LIRT) for torque, there was a MD of 9.94 N·m (95% CI, 5.43-14.45; P < 0.01) favoring BFR training. Assessing muscle hypertrophy, the MD in cross-sectional area was 0.96 cm2 (95% CI, 0.21-1.7; P = 0.01) favoring pooled BFR training compared with nonocclusive training. Assessing endurance, V̇o2 maximum demonstrated a greater mean increase of 0.37 mL/kg/min (95% CI, -0.97 to 3.17; P = 0.64) in BFR endurance training compared with endurance training alone.

CONCLUSION

Blood flow restriction training produced increases in muscular strength, hypertrophy, and endurance. Comparing LI-BFR training with HIRT, HIRT was a significantly better training modality for increasing muscle hypertrophy and strength. However, LI-BFR was superior when compared with a similar low-intensity protocol. Blood flow restriction training is potentially beneficial to those unable to tolerate the high loads of HIRT; however, better understanding of its risk to benefit ratio is needed before clinical application.

LEVEL OF EVIDENCE

Level 1.

The Influence on Post-Activation Potentiation Exerted by Different Degrees of Blood Flow Restriction and Multi-Levels of Activation Intensity

(1) Background: To explore the influence on post-activation potentiation (PAP) when combining different degrees of blood flow restriction (BFR) with multi-levels of resistance training intensity of activation. (2) Purpose: To provide competitive athletes with a more efficient and feasible warm-up program. (3) Study Design: The same batch of subjects performed the vertical jump test of the warm-up procedure under different conditions, one traditional and six BFR procedures. (4) Methods: Participants performed seven counter movement jump (CMJ) tests in random order, including 90% one repetition maximum (1RM) without BFR (CON), and three levels of BFR (30%, 50%, 70%) combined with (30% and 50% 1RM) (BFR-30-30, BFR-30-50, BFR-50-30, BFR-50-50, BFR-70-30 and BFR-70-50). Jump height (H), mean power output (P), peak vertical ground reaction force (vGRF), and the mean rate of force development (RFD) were recorded and measured. (5) Results: Significantly increasing results were observed in: jump height: CON (8 min), BFR-30-30 (0, 4 min), BFR-30-50 (4, 8 min), BFR-50-30 (8 min), BFR-50-50 (4, 8 min), BFR-70-30 (8 min), (p < 0.05); and power output: CON (8 min), BFR-30-30 (0, 4 min), BFR-30-50 (4 min), BFR-50-30 (8 min), BFR-50-50 (4, 8 min) (p < 0.05); vGRF: CON (8 min), BFR-30-30 (0, 4 min), BFR-30-50 (4, 8 min), BFR-50-30 (4 min), BFR-50-50 (4, 8 min) (p < 0.05); RFD: CON (8 min), BFR-30-30 (0, 4 min), BFR-30-50 (4 min), BFR-50-30 (4 min), BFR-50-50 (4 min) (p < 0.05). (5) Conclusions: low to moderate degrees of BFR procedures produced a similar PAP to traditional activation. Additionally, BFR-30-30, BFR-30-50, and BFR-50-50 were longer at PAP duration in comparison with CON.

Current Trends in Blood Flow Restriction

Purpose: The purpose of the study was to explore how individuals in the United States of America applied BFR/KAATSU devices and administered BFR/KAATSU training. In addition, the study sought to examine safety topics related to BFR/KAATSU training. Methods: The study was completed using survey research. Subjects were recruited through Facebook, email, and word of mouth. The survey was developed, piloted, and finally deployed March 22, 2021-April 21, 2021. Results: In total, 148 consented to the research; 108 completed the survey, and of those 108, 70 indicated current use with BFR/KAATSU equipment. Professions represented included athletic training, personal training, physical therapy, and strength and conditioning. Among those currently using BFR/KAATSU training (n = 70), the following results were found. The most common devices used were inflatable devices (n = 43, 61.4%). Education completed prior to device administration was formal (n = 39, 55.7%) and/or self-directed (n = 37, 52.9%). Barriers were faced by 29 (41.4%) when trying to enact training. Techniques and parameters varied during application. Screening processes were used (n = 50, 71.4%) prior to training. The devices were used to determine restrictive pressure (n = 31, 44.3%), and a supine position was used most when determining initial restrictive pressure (n = 33, 47.1%). For subsequent restrictive pressure measurements, respondents repeated the same method used initially (n = 38, 54.3%). Workload was often defined as the length of time under tension/load (n = 22, 31.4%) and exercise was directly supervised (n = 52, 74.3%). Adverse effects included bruising, lightheadedness, and cramping (n = 15, 21.4%). The devices have also been applied on those with pathology (n = 16, 22.9%). Conclusion: Those using blood flow restriction/KAATSU devices came from several professions and used an assortment of devices for BFR/KAATSU training. Individuals applied devices using a variety of parameters on populations for which efficacy has and has not been well defined.

Practical Blood Flow Restriction Training: New Methodological Directions for Practice and Research

Most studies with blood flow restriction (BFR) training have been conducted using devices capable of regulating the restriction pressure, such as pneumatic cuffs. However, this may not be a viable option for the general population who exercise in gyms, squares and sports centers. Thinking about this logic, practical blood flow restriction (pBFR) training was created in 2009, suggesting the use of elastic knee wraps as an alternative to the traditional BFR, as it is low cost, affordable and practical. However, unlike traditional BFR training which seems to present a consensus regarding the prescription of BFR pressure based on arterial occlusion pressure (AOP), studies on pBFR training have used different techniques to apply the pressure/tension exerted by the elastic wrap. Therefore, this Current Opinion article aims to critically and chronologically examine the techniques used to prescribe the pressure exerted by the elastic wrap during pBFR training. In summary, several techniques were found to apply the elastic wrap during pBFR training, using the following as criteria: application by a single researcher; stretching of the elastic (absolute and relative overlap of the elastic); the perceived tightness scale; and relative overlap of the elastic based on the circumference of the limbs. Several studies have shown that limb circumference seems to be the greatest predictor of AOP. Therefore, we reinforce that applying the pressure exerted by the elastic for pBFR training based on the circumference of the limbs is an excellent, valid and safe technique.

Low-Load Blood Flow Restriction Squat as Conditioning Activity Within a Contrast Training Sequence in High-Level Preadolescent Trampoline Gymnasts

To investigate the effects of implementing low-load blood flow restriction exercises (LL-BFRE) instead of high-load exercises (HL-RE) in a contrast training program on strength and power performance of high-level young gymnasts. Fifteen high-level pre-pubescent trampoline gymnasts (national level, Tanner Stage II, intermediate experience in strength training) were divided into two groups to complete the same structure of a ten-week contrast strength training program differing only in the configuration of the first resistance exercise of the contrast sequence. The LL-BFRE group (n = 7, four girls, 13.9 ± 0.4 y) performed the first resistance exercise of the contrast with LL-BFRE (20%–30% 1RM, perceived pressure of 7 on a scale from 0 to 10). The HL-RE group (n = 8, four girls, 13.8 ± 0.5 y) trained the first resistance exercise of the contrast sequence with moderate-to-high load (60%–85% 1RM). Before and after the training period, isometric mid-thigh pull (IMTP), squat jump (SJ), counter movement jump (CMJ), and drop-jump (DJ) were performed to evaluate the effect of the intervention on strength and power capacities as primary outcomes. Changes in participants’ anthropometric measures, muscle mass, left and right thigh girth, IMTP relative to bodyweight (IMTP-R), eccentric utilization ratio (EUR), and reactive strength index (RSI) were assessed as secondary outcomes. There was no significant interaction (p > 0.05) between group x time in any power and strength outcome, although SJ and EUR showed a trend to significant interaction (p = 0.06 and p = 0.065, respectively). There was an overall effect of time (p < 0.05) in all power and strength variables (CMJ, SJ, EUR, DJ, RSI, IMTP, and IMTP-R). There was a significant interaction in muscle mass (MM) [β = 0.57 kg, 95% CI = (0.15; 0.98), t₁₃ = 2.67, p = 0.019], revealing that participants in LL-BFRE increased their muscle mass (6.6 ± 3.1%) compared to HL-RE (3.6 ± 2.0%). Anthropometric variables did not present any group or interaction effect. However, there was a time effect (p < 0.05). Implementing LL-BFRE in place of HL-RE as a conditioning activity in a contrast training sequence might be equally effective in improving lower-body strength and power in preadolescent trampoline gymnasts.

Current Techniques Used for Practical Blood Flow Restriction Training: A Systematic Review

ABSTRACT

Bielitzki, R, Behrendt, T, Behrens, M, and Schega, L. Current techniques used for practical blood flow restriction training: a systematic review. J Strength Cond Res 35(10): 2936-2951, 2021-The purpose of this article was to systematically review the available scientific evidence on current methods used for practical blood flow restriction (pBFR) training together with application characteristics as well as advantages and disadvantages of each technique. A literature search was conducted in different databases (PubMed, Web of Science, Scopus, and Cochrane Library) for the period from January 2000 to December 2020. Inclusion criteria for this review were (a) original research involving humans, (b) the use of elastic wraps or nonpneumatic cuffs, and (c) articles written in English. Of 26 studies included and reviewed, 15 were conducted using an acute intervention (11 in the lower body and 4 in the upper body), and 11 were performed with a chronic intervention (8 in the lower body, 1 in the upper body, and 2 in both the upper and the lower body). Three pBFR techniques could be identified: (a) based on the perceptual response (perceived pressure technique), (b) based on the overlap of the cuff (absolute and relative overlap technique), and (c) based on the cuffs' maximal tensile strength (maximal cuff elasticity technique). In conclusion, the perceived pressure technique is simple, valid for the first application, and can be used independently of the cuffs' material properties, but is less reliable within a person over time. The absolute and relative overlap technique as well as the maximal cuff elasticity technique might be applied more reliably due to markings, but require a cuff with constant material properties over time.

Perceived Barriers to Blood Flow Restriction Training

Blood flow restriction (BFR) training is increasing in popularity in the fitness and rehabilitation settings due to its role in optimizing muscle mass and strength as well as cardiovascular capacity, function, and a host of other benefits. However, despite the interest in this area of research, there are likely some perceived barriers that practitioners must overcome to effectively implement this modality into practice. These barriers include determining BFR training pressures, access to appropriate BFR training technologies for relevant demographics based on the current evidence, a comprehensive and systematic approach to medical screening for safe practice and strategies to mitigate excessive perceptual demands of BFR training to foster long-term compliance. This manuscript attempts to discuss each of these barriers and provides evidence-based strategies and direction to guide clinical practice and future research.

Effects of Resting vs. Continuous Blood-Flow Restriction-Training on Strength, Fatigue Resistance, Muscle Thickness, and Perceived Discomfort

Introduction: The purpose of this study was to clarify whether blood-flow restriction during resting intervals [resting blood-flow restriction (rBFR)] is comparable to a continuous BFR (cBFR) training regarding its effects on maximum strength, hypertrophy, fatigue resistance, and perceived discomfort. Materials and Methods: Nineteen recreationally trained participants performed four sets (30-15-15-15 repetitions) with 20% 1RM on a 45° leg press twice a week for 6 weeks (cBFR, n = 10; rBFR, n = 9). Maximum strength, fatigue resistance, muscle thickness, and girth were assessed at three timepoints (pre, mid, and post). Subjective pain and perceived exertion were determined immediately after training at two timepoints (mid and post). Results: Maximum strength (p < 0.001), fatigue resistance (p < 0.001), muscle thickness (p < 0.001), and girth (p = 0.008) increased in both groups over time with no differences between groups (p > 0.05). During the intervention, the rBFR group exposed significantly lower perceived pain and exertion values compared to cBFR (p < 0.05). Discussion: Resting blood-flow restriction training led to similar gains in strength, fatigue resistance, and muscle hypertrophy as cBFR training while provoking less discomfort and perceived exertion in participants. In summary, rBFR training could provide a meaningful alternative to cBFR as this study showed similar functional and structural changes as well as less discomfort.

Acute Muscular Responses to Practical Low-Load Blood Flow Restriction Exercise Versus Traditional Low-Load Blood Flow Restriction and High-/Low-Load Exercise

CONTEXT

Blood flow restriction (BFR) increases muscle size and strength when combined with low loads, but various methods are used to produce this stimulus. It is unclear how using elastic knee wraps can impact acute muscular responses compared with using nylon cuffs, where the pressure can be standardized.

OBJECTIVE

Investigate how elastic knee wraps compare with nylon cuffs and high-load (HL)/low-load (LL) resistance exercise.

DESIGN

A randomized cross-over experimental design using 6 conditions combined with unilateral knee extension.

SETTING

Human Performance Laboratory.

PARTICIPANTS

A total of 9 healthy participants (males = 7 and females = 2) and had an average age of 22 (4) years.

INTERVENTION

LL (30% of 1-repetition maximum [1-RM]), HL (70% 1-RM), BFR at 40% of arterial occlusion pressure (BFR-LOW), BFR at 80% of arterial occlusion pressure (BFR-HIGH), elastic knee wraps stretched by 2 in (PRACTICAL-LOW), and elastic knee wraps stretched to a new length equivalent to 85% of thigh circumference (PRACTICAL-HIGH). BFR and practical conditions used 30% 1-RM.

MAIN OUTCOME MEASURES

Muscle thickness, maximum voluntary isometric contraction, and electromyography amplitude. Bayesian statistics evaluated differences in changes between conditions using the Bayes factor (BF10), and median and 95% credible intervals were reported from the posterior distribution.

RESULTS

Total repetitions completed were greater for BFR-LOW versus PRACTICAL-HIGH (BF10 = 3.2, 48.6 vs 44 repetitions) and greater for PRACTICAL-LOW versus BFR-HIGH (BF10 = 717, 51.8 vs 36.3 repetitions). Greater decreases in changes in maximum voluntary isometric contraction were found in PRACTICAL-HIGH versus HL (BF10 = 1035, ∼103 N) and LL (BF10 = 45, ∼66 N). No differences in changes in muscle thickness were found between LL versus PRACTICAL-LOW/PRACTICAL-HIGH conditions (BF10 = 0.32). Greater changes in electromyography amplitude were also found for BFR-LOW versus PRACTICAL-HIGH condition (BF10 = 6.13, ∼12%), but no differences were noted between the other BFR conditions.

CONCLUSIONS

Overall, elastic knee wraps produce a more fatiguing stimulus than LL or HL conditions and might be used as an alternative to pneumatic cuffs that are traditionally used for BFR exercise.