Main Article Content
Blood Flow Restriction (BFR) training is a novel training method using low-intensity exercise that can stimulate physiological adaptation comparable to high-intensity exercise. It can be performed with resistance or aerobic exercise. Generally, BFR training applies a tourniquet or inflatable cuffs strap on proximal portion of upper and lower limbs during exercise, resulting in blood pooling to working and distal muscle to the cuff. The cuff commonly used pneumatic tourniquet system. BFR results in reduced arterial blood flow to working muscle and venous return to cardiac. Vascular occlusion leads to a reduction in oxygen delivery to muscle tissue and metabolic byproduct clearance. This inadequate oxygen in muscular tissue promotes the intramuscular hypoxic environment and higher metabolic stress that brings about the up-regulation of physiological responses similar to higher-intensity exercise. Furthermore, the greater accumulation of metabolites can improve muscular size and strength and improved aerobic and anaerobic capacity. The advantage of BFR training is reducing load of exercise that can benefit to whom high loads may be contraindicated.
Therefore, this review aims are 1) to outline the principles of BFR equipment and cuff pressure, 2) to summarize the principles of BFR with resistance training, and 3) to summarize the principles of BFR with aerobic training. A clear understanding of the BFR training in term of principles and applications would help practitioners optimize the benefit of this technique when combined with a resistance and aerobic exercise.
Abe, T., Fujita, S., Nakajima, T., Sakamaki, M.,Ozaki, H., Ogasawara, R., et al. (2010).Effects of low-intensity cycle training with restricted leg blood ﬂow on thigh muscle volume and VO 2max in young men. Journal of Science and Medicine in Sport 9,452-458.
Abe, T., Kearns, C. F., and Sato, Y. (2006). Muscle size and strength are increased following walk training with restricted venous blood ﬂow from the leg muscle, KAATSU-walk training. Journal of Applied Physiology 100, 1460-1466.
Bennett H1, Slattery F. (2019). Effects of Blood Flow Restriction Training on Aerobic Capacity and Performance: A Systematic Review. The Journal of Strength & Conditioning Research, 33(2):572-583.
Brandner, C. R., Kidgell, D. J., and Warmington, S. A. (2015). Unilateral bicep curl hemodynamics: low-pressure continuous vs high-pressure intermittent blood ﬂow restriction. Scandinavian Journal in Medicine and Science in Sports 25,770-777.
Buckner, S. L., Dankel, S. J., Counts, B. R., Jessee, M. B., Mouser, J. G., Mattocks, K.T., et al. (2017). Inﬂuence of cuff material on blood ﬂow restriction stimulus in the upper body. Journal of Physiological Sciences 67,207-215.
Centner, C., Wiegel, P., Gollhofer, A., and König, D. (2018a). Effects of blood ﬂow restriction training on muscular strength and hypertrophy in older individuals: a systematic review and meta-analysis. Sports Medicine 49, 95-108.
Christiansen, D., Murphy, R. M., Bangsbo, J., Stathis, C. G., and Bishop, D. J. (2018). Increased FXYD1 and PGC-1α mRNA after blood ﬂow-restricted running is related to ﬁbre type-speciﬁc AMPK signalling and oxidative stress in human muscle. Acta Physiologica 223:e13045.
Conceição, M.S., Junior, E.M.M., Telles, G.D., Libardi, C.A., Castro, A., Andrade, A. L. L., et al. (2019). Augmented anabolic responses after 8-wk cycling with blood ﬂow restriction. Medicine and Science In Sports and Exercise 51, 84-93.
Cook, S. B., Clark, B. C., and Ploutz-Snyder, L. L. (2007). Effects of exercise load and blood-ﬂow restriction on skeletal muscle function. 39,1708-1713.
Corvino, R. B., Rossiter, H. B., Loch, T., Martins, J. C., & Caputo, F. (2017). Physiological responses to interval endurance exercise at different levels of blood flow restriction. European Journal of Applied Physiology, 117(1), 39-52.
Dankel, S. J., Jessee, M. B., Abe, T., and Loenneke, J. P. (2016). The effects of blood ﬂow restriction on upper-body musculature located distal and proximal to applied pressure. Sports Medicine 46,23-33.
de Oliveira, M. F. M., Caputo, F., Corvino, R. B., and Denadai, B. S. (2016). Short-term low-intensity blood ﬂow restricted interval training improves both aerobic ﬁtness and muscle strength. Scandinavian Journal in Medicine and Science in Sports 26, 1017-1025.
Fahs, C. A., Loenneke, J. P., Thiebaud, R. S., Rossow, L. M., Kim, D., Abe, T., et al. (2015). Muscular adaptations to fatiguing exercise with and without blood ﬂow restriction. Clinical Physiology and Functional Imaging 35, 167-176.
Fitschen PJ1, Kistler BM, Jeong JH, Chung HR, Wu PT, Walsh MJ, Wilund KR. (2014). Perceptual effects and efficacy of intermittent or continuous blood flow restriction resistance training. Clinical Physiology and Functional Imaging 34(5):356-63.
Fujita, T., Brechue, W., Kurita, K., Sato, Y., and Abe, T. (2008). Increased muscle volume and strength following six days of low-intensity resistance training with restricted muscle blood ﬂow. International Journal of KAATSU Training Research 4,1-8.
Hughes, L., Paton, B., Rosenblatt, B., Gissane, C., and Patterson, S.D. (2017). Blood ﬂow restriction training in clinical musculoskeletal rehabilitation: a systematic review and meta-analysis. British Journal of Sports Medicine 51, 1003-1011.
Jessee, M. B., Buckner, S. L., Dankel, S. J., Counts, B. R., Abe, T., and Loenneke, J. P. (2016). The inﬂuence of cuff width, sex, and race on arterial occlusion: implications for blood ﬂow restriction research. Sports Medicine 46, 913-921.
Jessee, M. B., Dankel, S. J., Buckner, S. L., Mouser, J. G., Mattocks, K. T., and Loenneke, J. P. (2017). The cardiovascular and perceptual response to very low load blood ﬂow restricted exercise. International Journal of Sports Medicine 38, 597-603.
Kacin, A., Rosenblatt, B., Zargi, T.G., and Biswas, A. (2015). Safety considerations with blood ﬂow restricted resistance training. Varna Uporaba Vadbe Z Zmanjšanim PretokomKrvi. Ann. Kinesiology 6,3-26.
Keramidas ME, Kounalakis SN, Geladas ND. (2012). The effect of interval training combined with thigh cuffs pressure on maximal and submaximal exercise performance. Clinical Physiology and Functional Imaging 32: 205-213.
Kubota, A., Sakuraba, K., Koh, S., Ogura, Y., and Tamura, Y. (2011). Blood ﬂow restriction by low compressive force prevents disuse muscular weakness. Journal of Science and Medicine in Sport 14,95-99.
Ladlow, P., Coppack, R.J., Dharm-Datta, S., Conway, D., Sellon, E., Patterson, S.D., et al. (2018). Low-load resistance training with blood ﬂow restriction improves clinical outcomes in musculoskeletal rehabilitation: a single-blind randomized controlled trial. Frontiers in Physiology 9:1269.
Lixandrao, M. E., Ugrinowitsch, C., Berton, R., Vechin, F. C., Conceicao, M. S., Damas, F., et al. (2018). 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. Sports Medicine ????
Lixandrao, M. E., Ugrinowitsch, C., Laurentino, G., Libardi, C. A., Aihara, A. Y., Cardoso, F.N.,et al. (2015). Effects of exercise intensity and occlusion pressure after 12 weeks of resistance training with blood- ﬂow restriction. European Journal of Applied Physiology 115,2471-2480.
Loenneke, J. P., Loprinzi, P. D., Abe, T., Thiebaud, R. S., Allen, K. M., Grant Mouser, J., et al. (2016). Arm circumference inﬂuences blood pressure even when applying the correct cuff size: is a further correction
needed? International Journal of Cardiology 202,743-744.
Loenneke, J. P., Thiebaud, R. S., Fahs, C. A., Rossow, L. M., Abe, T., and Bemben, M. G. (2014). Blood ﬂow restriction: effects of cuff type on fatigue and perceptual responses to resistance exercise. Acta Physiologica Hungarica 101, 158-166.
Loenneke, J. P., Wilson, J. M., Marín, P. J., Zourdos, M. C., and Bemben, M. G. (2012). Low intensity blood ﬂow restriction training: a meta-analysis. European Journal of Applied Physiology 112,1849-1859.
Loenneke, J.P., Allen, K.M., Mouser, J.G., Thiebaud, R.S., Kim,D., Abe, T., et al. (2015). Blood ﬂow restriction in the upper and lower limbs is predicted by limb circumference and systolic blood pressure. European Journal of Applied Physiology 115, 397-405.
Mattocks, K. T., Jessee, M. B., Counts, B. R., Buckner, S. L., Grant Mouser, J., Dankel, S. J., et al. (2017). The effects of upper body exercise across different levels of blood ﬂow restriction on arterial occlusion pressure and perceptual responses. Physiology & Behavior 171,181-186.
McEwen, J. A., Owens, J. G., and Jeyasurya, J. (2018). Why is it crucial to use personalized occlusion pressures in bloodﬂow restriction (BFR) rehabilitation? Journal of Medical and Biological Engineering39,7-11.
Nielsen, J. L., Aagaard, P., Bech, R. D., Nygaard, T., Hvid, L. G., Wernbom, M., et al. (2012). Proliferation of myogenic stem cells in human skeletal muscle in response to low-load resistance training with blood ﬂow restriction. Journal of Physiology 590, 4351-4361.
Nielsen, J. L., Frandsen, U., Prokhorova, T., Bech, R. D., Nygaard, T., Suetta, C., et al. (2017). Delayed effect of blood ﬂow-restricted resistance training on rapid force capacity. Medicine and Science In Sports and Exercise 49, 1157-1167.
Ozaki, H., Yasuda, T., Ogasawara, R., Sakamaki-Sunaga, M., Naito, H., and Abe, T. (2013). Effects of high-intensity and blood ﬂowrestricted low-intensity resistance training on carotid arterial compliance: role of blood pressure during training sessions. European Journal of Applied Physiology 113,167-174.
Park, S., Kim, J. K., Choi, H. M., Kim, H. G., Beekley, M. D., and Nho, H. (2010). Increase in maximal oxygen uptake following 2-week walk training with blood ﬂow occlusion in athletes. European Journal of Applied Physiology 109, 591-600.
Paton CD, Addis SM, Taylor LA. The effects of muscle blood flow restriction during running training on measures of aerobic capacity and run time to exhaustion. (2017). European Journal of Applied Physiology 117: 2579-2585.
Patterson SD, Hughes L, Warmington S, Burr J, Scott BR, Owens J, Abe T, Nielsen JL, Libardi CA, Laurentino G, Neto GR, Brandner C, Martin-Hernandez J, Loenneke J. (2019). Blood Flow Restriction Exercise: Considerations of Methodology, Application, and Safety. Frontiers in Physiology 22, 10: 1332.
Pearson, S. J., and Hussain, S. R. (2015). A review on the mechanisms of blood ﬂow restriction resistance training-induced muscle hypertrophy. Sports Medecine. 45,187-200.
Pope, Z. K., Willardson, J. M., & Schoenfeld, B. J. (2013). Exercise and blood flow restriction. The Journal of Strength & Conditioning Research, 27(10), 2914-2926.
Rossow, L. M., Fahs, C. A., Loenneke, J. P., Thiebaud, R. S., Sherk, V. D., Abe, T., et al. (2012). Cardiovascular and perceptual responses to blood-ﬂow-restricted resistance exercise with differing restrictive cuffs.Clinical Physiology and Functional Imaging 32,331-337.
Scott, B. R., Loenneke, J. P., Slattery, K. M., and Dascombe, B. J. (2015). Exercise with blood ﬂow restriction: an updated evidence-based approach for enhanced muscular development. Sports Medicine. 45, 313-325.
Scott, Loenneke, Slattery, & Dascombe. (2016). Blood flow restricted exercise for athletes: A review of available evidence. Journal of Science and Medicine in Sport, 19(5), 360-367
Slysz, J., Stultz, J., and Burr, J. F. (2016). The efficacy of blood ﬂow restricted exercise: a systematic review & meta-analysis. Journal of Science and Medicine in Sport 19, 669-675.
Suga T, Okita K, Morita N, Yokota T, Hirabayashi K, Horiuchi M, Takada S, Omokawa M, Kinugawa S, Tsutsui H. (2010). Doseeffect on intramuscular metabolic stress during low-intensity resistance exercise with blood flow restriction. Journal of Applied Physiology 108:1563-1567.
Takarada, Y., Sato, Y., and Ishii, N. (2002). Effects of resistance exercise combined with vascular occlusion on muscle function in athletes. European Journal of Applied Physiology 86, 308-314.
Taylor, C. W., Ingham, S.A., and Ferguson, R.A. (2016). Acute and chronic effect of sprint interval training combined with post exercise blood-ﬂow restriction in trained individuals. Experimental Physiology 101,143-154.
Yasuda, T., Loenneke, J. P., Ogasawara, R., and Abe, T. (2013). Inﬂuence of continuous or intermittent blood ﬂow restriction on muscle activation during low-intensity multiple sets of resistance exercise. Acta Physiologica Hungarica. 100, 419-426.