European Journal of Applied Physiology

, Volume 115, Issue 12, pp 2471–2480 | Cite as

Effects of exercise intensity and occlusion pressure after 12 weeks of resistance training with blood-flow restriction

  • Manoel E. Lixandrão
  • Carlos Ugrinowitsch
  • Gilberto Laurentino
  • Cleiton A. Libardi
  • André Y. Aihara
  • Fabiano N. Cardoso
  • Valmor Tricoli
  • Hamilton Roschel
Original Article



We compared the effects of different protocols of blood-flow restriction training (BFRT) with different occlusion pressures and/or exercise intensities on muscle mass and strength. We also compared BFRT protocols with conventional high-intensity resistance training (RT).


Twenty-six subjects had each leg allocated to two of five protocols. BFRT protocols were performed at either 20 or 40 % 1-RM with either 40 or 80 % occlusion pressure: BFRT20/40, BFRT20/80, BFRT40/40, and BFRT40/80. Conventional RT was performed at 80 % 1-RM (RT80) without blood-flow restriction. Maximum dynamic strength (1-RM) and quadriceps cross-sectional area (CSA) were assessed at baseline and after 12 weeks.


Regarding muscle mass, increasing occlusion pressure was effective only at very low intensity (BFRT20/40 0.78 % vs. BFRT20/80 3.22 %). No additional increase was observed at higher intensities (BFRT40/40 4.45 % vs. BFRT40/80 5.30 %), with no difference between the latter protocols and RT80 (5.90 %). Exercise intensity played a role in CSA when comparing groups with similar occlusion pressure. Muscle strength was similarly increased among BFRT groups (~12.10 %) but to a lesser extent than RT80 (21.60 %).


In conclusion, BFRT protocols benefit from higher occlusion pressure (80 %) when exercising at very low intensities. Conversely, occlusion pressure seems secondary to exercise intensity in more intense (40 % 1-RM) BFRT protocols. Finally, when considering muscle strength, BFRT protocols seem less effective than high-intensity RT.


Occlusion training Strength training Muscle hypertrophy Occlusion pressure Exercise intensity Muscle strength 



One-repetition maximum dynamic strength


Blood-flow restriction training


Cross-sectional area


Effect size


Confidence intervals of the effect size


Magnetic resonance imaging


Resistance training



The authors are grateful to Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)—process number: 2014/05320-6 and Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) for financial support. HR, CU and VT are supported by CNPq (307023/2014-1, 304205/2011-7 and 310823/2013-7, respectively).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. Abe T, Loenneke JP, Fahs CA, Rossow LM, Thiebaud RS, Bemben MG (2012) Exercise intensity and muscle hypertrophy in blood flow-restricted limbs and non-restricted muscles: a brief review. Clin Physiol Funct Imaging 32:247–252CrossRefPubMedGoogle Scholar
  2. Barcelos LC, Nunes PR, de Souza LR, de Oliveira AA, Furlanetto R, Marocolo M, Orsatti FL (2015) Low-load resistance training promotes muscular adaptation regardless of vascular occlusion, load, or volume. Eur J Appl Physiol 115(7):1559–1568CrossRefPubMedGoogle Scholar
  3. Berg HE, Tedner B, Tesch PA (1993) Changes in lower limb muscle cross-sectional area and tissue fluid volume after transition from standing to supine. Acta Physiol Scand 148:379–385CrossRefPubMedGoogle Scholar
  4. Brown LE, Weir JP (2001) Procedures recommendation I: accurate assessment of muscular strength and power. J Exerc Physiol Online 4:1–21Google Scholar
  5. Counts BR, Dankel SJ, Barnett BE, Kim D, Mouser JG, Allen KM, Thiebaud RS, Abe T, Bemben MG, Loenneke JP (2015) The influence of relative blood flow restriction pressure on muscle activation and muscle adaptation. Muscle Nerve [Epub ahead of print]Google Scholar
  6. Gualano B, Ugrinowitsch C, Neves M, Jr., Lima FR, Pinto ALS, Laurentino G, Tricoli VA, Lancha AH, Jr., Roschel H (2010) Vascular occlusion training for inclusion body myositis: a novel therapeutic approach. J Vis Exp. doi: 10.3791/1894
  7. Karabulut M, Abe T, Sato Y, Bemben MG (2010) The effects of low-intensity resistance training with vascular restriction on leg muscle strength in older men. Eur J Appl Physiol 108:147–155CrossRefPubMedGoogle Scholar
  8. Kubo K, Komuro T, Ishiguro N, Tsunoda N, Sato Y, Ishii N, Kanehisa H, Fukunaga T (2006) Effects of low-load resistance training with vascular occlusion on the mechanical properties of muscle and tendon. J Appl Biomech 22:112–119PubMedGoogle Scholar
  9. Laurentino G, Ugrinowitsch C, Aihara AY, Fernandes AR, Parcell AC, Ricard M, Tricoli V (2008) Effects of strength training and vascular occlusion. Int J Sports Med 29:664–667CrossRefPubMedGoogle Scholar
  10. Laurentino GC, Ugrinowitsch C, Roschel H, Aoki MS, Soares AG, Neves M Jr, Aihara AY, Fernandes Ada R, Tricoli V (2012) Strength training with blood flow restriction diminishes myostatin gene expression. Med Sci Sports Exerc 44:406–412CrossRefPubMedGoogle Scholar
  11. Loenneke JP, Fahs CA, Wilson JM, Bemben MG (2011) Blood flow restriction: the metabolite/volume threshold theory. Med Hypotheses 77:748–752CrossRefPubMedGoogle Scholar
  12. Loenneke JP, Fahs CA, Rossow LM, Sherk VD, Thiebaud RS, Abe T, Bemben DA, Bemben MG (2012a) Effects of cuff width on arterial occlusion: implications for blood flow restricted exercise. Eur J Appl Physiol 112:2903–2912PubMedCentralCrossRefPubMedGoogle Scholar
  13. Loenneke JP, Wilson JM, Marin PJ, Zourdos MC, Bemben MG (2012b) Low intensity blood flow restriction training: a meta-analysis. Eur J Appl Physiol 112:1849–1859CrossRefPubMedGoogle Scholar
  14. Loenneke JP, Kim D, Fahs CA, Thiebaud RS, Abe T, Larson RD, Bemben DA, Bemben MG (2014a) Effects of exercise with and without different degrees of blood flow restriction on torque and muscle activation. Muscle Nerve 51(5):713–721CrossRefGoogle Scholar
  15. Loenneke JP, Thiebaud RS, Abe T, Bemben MG (2014b) Blood flow restriction pressure recommendations: the hormesis hypothesis. Med Hypotheses 82:623–626CrossRefPubMedGoogle Scholar
  16. Lowery RP, Joy JM, Loenneke JP, de Souza EO, Machado M, Dudeck JE, Wilson JM (2014) Practical blood flow restriction training increases muscle hypertrophy during a periodized resistance training programme. Clin Physiol Funct Imaging 34:317–321CrossRefPubMedGoogle Scholar
  17. Manini TM, Clark BC (2009) Blood flow restricted exercise and skeletal muscle health. Exerc Sport Sci Rev 37:78–85CrossRefPubMedGoogle Scholar
  18. McCall GE, Byrnes WC, Dickinson A, Pattany PM, Fleck SJ (1996) Muscle fiber hypertrophy, hyperplasia, and capillary density in college men after resistance training. J Appl Physiol 81:2004–2012PubMedGoogle Scholar
  19. Mitchell CJ, Churchward-Venne TA, West DW, Burd NA, Breen L, Baker SK, Phillips SM (2012) Resistance exercise load does not determine training-mediated hypertrophic gains in young men. J Appl Physiol 113:71–77PubMedCentralCrossRefPubMedGoogle Scholar
  20. Nakagawa S, Cuthill IC (2007) Effect size, confidence interval and statistical significance: a practical guide for biologists. Biol Rev Camb Philos Soc 82:591–605CrossRefPubMedGoogle Scholar
  21. Pincivero DM, Gandhi V, Timmons MK, Coelho AJ (2006) Quadriceps femoris electromyogram during concentric, isometric and eccentric phases of fatiguing dynamic knee extensions. J Biomech 39:246–254CrossRefPubMedGoogle Scholar
  22. Sadamoto T, Bonde-Petersen F, Suzuki Y (1983) Skeletal muscle tension, flow, pressure, and EMG during sustained isometric contractions in humans. Eur J Appl Physiol 51:395–408CrossRefGoogle Scholar
  23. Suga T, Okita K, Morita N, Yokota T, Hirabayashi K, Horiuchi M, Takada S, Takahashi T, Omokawa M, Kinugawa S, Tsutsui H (2009) Intramuscular metabolism during low-intensity resistance exercise with blood flow restriction. J Appl Physiol 106:1119–1124CrossRefPubMedGoogle Scholar
  24. Suga T, Okita K, Morita N, Yokota T, Hirabayashi K, Horiuchi M, Takada S, Omokawa M, Kinugawa S, Tsutsui H (2010) Dose effect on intramuscular metabolic stress during low-intensity resistance exercise with blood flow restriction. J Appl Physiol 108:1563–1567CrossRefPubMedGoogle Scholar
  25. Suga T, Okita K, Takada S, Omokawa M, Kadoguchi T, Yokota T, Hirabayashi K, Takahashi M, Morita N, Horiuchi M, Kinugawa S, Tsutsui H (2012) Effect of multiple set on intramuscular metabolic stress during low-intensity resistance exercise with blood flow restriction. Eur J Appl Physiol 112:3915–3920PubMedCentralCrossRefPubMedGoogle Scholar
  26. Sugaya M, Yasuda T, Suga T, Okita K, Abe T (2011) Change in intramuscular inorganic phosphate during multiple sets of blood flow-restricted low-intensity exercise. Clin Physiol Funct Imaging 31:411–413CrossRefPubMedGoogle Scholar
  27. Takada S, Okita K, Suga T, Omokawa M, Kadoguchi T, Sato T, Takahashi M, Yokota T, Hirabayashi K, Morita N, Horiuchi M, Kinugawa S, Tsutsui H (2012) Low-intensity exercise can increase muscle mass and strength proportionally to enhanced metabolic stress under ischemic conditions. J Appl Physiol 113:199–205CrossRefPubMedGoogle Scholar
  28. Takarada Y, Takazawa H, Sato Y, Takebayashi S, Tanaka Y, Ishii N (2000) Effects of resistance exercise combined with moderate vascular occlusion on muscular function in humans. J Appl Physiol 88:2097–2106PubMedGoogle Scholar
  29. Yasuda T, Brechue WF, Fujita T, Sato Y, Abe T (2008) Muscle activation during low-intensity muscle contractions with varying levels of external limb compression. J Sports Sci Med 7:467–474PubMedCentralPubMedGoogle Scholar
  30. Yasuda T, Brechue WF, Fujita T, Shirakawa J, Sato Y, Abe T (2009) Muscle activation during low-intensity muscle contractions with restricted blood flow. J Sports Sci 27:479–489CrossRefPubMedGoogle Scholar
  31. Yasuda T, Ogasawara R, Sakamaki M, Bemben MG, Abe T (2011) Relationship between limb and trunk muscle hypertrophy following high-intensity resistance training and blood flow-restricted low-intensity resistance training. Clin Physiol Funct Imaging 31:347–351CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Manoel E. Lixandrão
    • 1
  • Carlos Ugrinowitsch
    • 1
  • Gilberto Laurentino
    • 1
  • Cleiton A. Libardi
    • 2
  • André Y. Aihara
    • 3
  • Fabiano N. Cardoso
    • 3
  • Valmor Tricoli
    • 1
  • Hamilton Roschel
    • 1
  1. 1.School of Physical Education and SportUniversity of São PauloSão PauloBrazil
  2. 2.Department of Physical Education, Center of Biological and Health SciencesFederal University of São CarlosSão CarlosBrazil
  3. 3.Diagnósticos das Américas S/A (DASA)São PauloBrazil

Personalised recommendations