European Journal of Applied Physiology

, Volume 119, Issue 2, pp 377–387 | Cite as

Limb blood flow and tissue perfusion during exercise with blood flow restriction

  • Matthew A. Kilgas
  • John McDaniel
  • Jon Stavres
  • Brandon S. Pollock
  • Tyler J. Singer
  • Steven J. ElmerEmail author
Original Article



Exercise with blood flow restriction (BFR) is emerging as an effective modality for improving muscular function in clinical and athletic populations. Selection of cuff pressure is critical because it should maximize metabolic stress without completely occluding blood flow or compromising user safety. It is unknown how cuff pressures determined at rest influence blood flow hemodynamics during exercise.


We evaluated changes in blood flow and tissue perfusion before, during, and after exercise with BFR.


Ten males performed rhythmic handgrip exercise (30 contractions, 30% MVC) at 0%, 60%, 80%, 100%, and 120% of limb occlusion pressure (LOP). Brachial artery blood flow and tissue saturation were assessed using Doppler ultrasound and near-infrared spectroscopy, respectively.


At rest blood flow generally decreased with increased pressure (0% > 60% ≈ 80% > 100% ≈ 120% LOP). During 60% and 80% LOP conditions, blood flow increased during exercise from rest and decreased after exercise (all P < 0.05). Compared to 0% LOP, relative blood flow at 60% and 80% LOP decreased by 22–47% at rest, 22–48% during exercise, and 52–71% after exercise (all P < 0.05). Increased LOP decreased tissue saturation during exercise with BFR (P < 0.05). Heart rate, mean arterial pressure, and cardiac output did not differ across LOP.


At pressures below LOP the cardiovascular system overcame the external pressure and increased blood flow to exercising muscles. Relative reductions in blood flow at rest were similar to those during exercise. Thus, the relative occlusion measured at rest approximated the degree of occlusion during exercise. Moderate cuff pressures increased metabolic stress without completely occluding blood flow.


Vascular occlusion Kaatsu Resistance exercise Handgrip exercise Arterial blood flow Functional near inferred spectroscopy 



Blood flow restriction


Limb occlusion pressure


Repetition maximum



The authors would like to sincerely thank the participants who took part in this study for their enthusiastic efforts throughout the protocol.

Author contributions

For this study all authors conceived and designed the research. All authors contributed to the experimental data collection. MK, BP, JM, and SE analyzed data. MK, JM, and SE wrote the manuscript. All authors read and approved the manuscript.


No external funding was received for this work.

Compliance with ethical standards

Conflict of interest

The authors report no conflicts of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Matthew A. Kilgas
    • 1
  • John McDaniel
    • 2
    • 3
  • Jon Stavres
    • 2
    • 4
  • Brandon S. Pollock
    • 2
    • 5
  • Tyler J. Singer
    • 2
  • Steven J. Elmer
    • 1
    Email author
  1. 1.Department of Kinesiology and Integrative Physiology, College of Science and ArtsMichigan Technological UniversityHoughtonUSA
  2. 2.Department of Exercise PhysiologyKent State UniversityKentUSA
  3. 3.Louis Stokes Cleveland Veterans Affairs Medical CenterClevelandUSA
  4. 4.Heart and Vascular InstitutePenn State UniversityHersheyUSA
  5. 5.Exercise Science ProgramWalsh UniversityNorth CantonUSA

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