Sports Medicine

, Volume 46, Issue 1, pp 23–33 | Cite as

The Effects of Blood Flow Restriction on Upper-Body Musculature Located Distal and Proximal to Applied Pressure

  • Scott J. Dankel
  • Matthew B. Jessee
  • Takashi Abe
  • Jeremy P. LoennekeEmail author
Review Article


Blood flow restriction (BFR) training has been shown to increase muscle size and strength when combined with low-load [20–30 % one-repetition maximum (1RM)] resistance training in the lower body. Fewer studies have examined low-load BFR training in combination with upper body exercise, which may differ as some musculature cannot be directly restricted by the BFR stimulus (chest, shoulders). The objective of this study was to examine muscle adaptations occurring in the upper body in response to low-load BFR training. Google Scholar, PubMed, and SPORTDiscus were searched through July 2015 using the key phrases ‘blood flow restriction training’, ‘occlusion resistance training’, and ‘KAATSU’. Upper body training studies implementing the BFR stimulus and providing a pre and post measure of muscle size and/or strength were included. A total of 19 articles met the inclusion criteria for this review. The effectiveness of low-load BFR training appears to be minimally impacted by alterations to the intensity and restrictive pressures used; however, the ability to quantitatively analyze our results was limited by unstandardized protocols. Low-load BFR training increased muscle size and strength in limbs located proximal (chest, shoulders) and distal (biceps, triceps) to the restrictive stimulus; while volume-matched exercise in the absence of BFR did not elicit beneficial muscle adaptations. Some of the musculature in the upper body cannot be directly restricted by the application of BFR. Despite this, increases in muscle size and strength were observed in muscles placed under direct and indirect BFR.


Resistance Training Muscle Growth Muscle Size Bench Press Blood Flow Restriction 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Compliance with Ethical Standards


No external sources of funding were used to assist in the preparation of this article.

Conflicts of interest

Scott Dankel, Matthew Jessee, Takashi Abe and Jeremy Loenneke declare that they have no conflicts of interest relevant to the content of this review.


  1. 1.
    ACSM. American College of Sports Medicine position stand. Progression models in resistance training for healthy adults. Med Sci Sports Exerc. 2009;41(3):687–708.Google Scholar
  2. 2.
    Mitchell CJ, Churchward-Venne TA, West DW, et al. Resistance exercise load does not determine training-mediated hypertrophic gains in young men. J Appl Physiol. 2012;113(1):71–7.PubMedPubMedCentralCrossRefGoogle Scholar
  3. 3.
    Ogasawara R, Loenneke JP, Thiebaud RS, et al. Low-load bench press training to fatigue results in muscle hypertrophy similar to high-load bench press training. Int J Clin Med. 2013;4:114–21.CrossRefGoogle Scholar
  4. 4.
    Bemben DA, Fetters NL, Bemben MG, et al. Musculoskeletal responses to high- and low-intensity resistance training in early postmenopausal women. Med Sci Sport Exerc. 2000;32(11):1949–57.CrossRefGoogle Scholar
  5. 5.
    Laurentino GC, Ugrinowitsch C, Roschel H, et al. Strength training with blood flow restriction diminishes myostatin gene expression. Med Sci Sports Exerc. 2012;44(3):406–12.PubMedCrossRefGoogle Scholar
  6. 6.
    Martin-Hernandez J, Marin PJ, Menendez H, et al. Muscular adaptations after two different volumes of blood flow-restricted training. Scand J Med Sci Sports. 2013;23(2):e114–20.PubMedCrossRefGoogle Scholar
  7. 7.
    Marcotte GR, West DW, Baar K. The molecular basis for load-induced skeletal muscle hypertrophy. Calcif Tissue Int. 2015;96(3):196–210.PubMedCrossRefGoogle Scholar
  8. 8.
    Loenneke JP, Fahs CA, Thiebaud RS, et al. The acute muscle swelling effects of blood flow restriction Acta Physiol Hung. Acta Physiol Hung. 2012;99(4):400–10.PubMedCrossRefGoogle Scholar
  9. 9.
    Loenneke JP, Fahs CA, Wilson JM, et al. Blood flow restriction: the metabolite/volume threshold theory. Med Hypotheses. 2011;77(5):748–52.PubMedCrossRefGoogle Scholar
  10. 10.
    Patterson SD, Ferguson RA. Increase in calf post-occlusive blood flow and strength following short-term resistance exercise training with blood flow restriction in young women. Eur J Appl Physiol. 2010;108(5):1025–33.PubMedCrossRefGoogle Scholar
  11. 11.
    Manini TM, Vincent KR, Leeuwenburgh CL, et al. Myogenic and proteolytic mRNA expression following blood flow restricted exercise. Acta Physiol (Oxf). 2011;201(2):255–63.PubMedCrossRefGoogle Scholar
  12. 12.
    Nielsen JL, Aagaard P, Bech RD, et al. Proliferation of myogenic stem cells in human skeletal muscle in response to low-load resistance training with blood flow restriction. J Physiol. 2012;590(Pt 17):4351–61.PubMedPubMedCentralCrossRefGoogle Scholar
  13. 13.
    Drummond MJ, Fry CS, Glynn EL, et al. Rapamycin administration in humans blocks the contraction-induced increase in skeletal muscle protein synthesis. J Physiol. 2009;587(7):1535–46.PubMedPubMedCentralCrossRefGoogle Scholar
  14. 14.
    Gundermann DM, Walker DK, Reidy PT, et al. Activation of mTORC1 signaling and protein synthesis in human muscle following blood flow restriction exercise is inhibited by rapamycin. Am J Physiol Endocrinol Metab. 2014;306(10):E1198–204.PubMedPubMedCentralCrossRefGoogle Scholar
  15. 15.
    Pearson SJ, Hussain SR. A review on the mechanisms of blood-flow restriction resistance training-induced muscle hypertrophy. Sports Med. 2015;45(2):187–200.PubMedCrossRefGoogle Scholar
  16. 16.
    Loenneke JP, Balapur A, Thrower AD, et al. Blood flow restriction reduces time to muscular failure. Eur J Sport Sci. 2012;12(3):238–43.CrossRefGoogle Scholar
  17. 17.
    Loenneke JP, Kim D, Fahs CA, et al. Effects of exercise with and without different degrees of blood flow restriction on torque and muscle activation. Muscle Nerve. 2015;51(5):713–21.PubMedCrossRefGoogle Scholar
  18. 18.
    Kubota A, Sakuraba K, Koh S, et al. Blood flow restriction by low compressive force prevents disuse muscular weakness. J Sci Med Sport. 2011;14(2):95–9.PubMedCrossRefGoogle Scholar
  19. 19.
    Kubota A, Sakuraba K, Sawaki K, et al. Prevention of disuse muscular weakness by restriction of blood flow. Med Sci Sports Exerc. 2008;40(3):529–34.PubMedCrossRefGoogle Scholar
  20. 20.
    Clark BC, Fernhall B, Ploutz-Snyder LL. Adaptations in human neuromuscular function following prolonged unweighting: I. Skeletal muscle contractile properties and applied ischemia efficacy. J Appl Physiol (1985). 2006;101(1):256–63.Google Scholar
  21. 21.
    Takarada Y, Takazawa H, Ishii N. Applications of vascular occlusion diminish disuse atrophy of knee extensor muscles. Med Sci Sports Exerc. 2000;32(12):2035–9.PubMedCrossRefGoogle Scholar
  22. 22.
    Abe T, Fujita S, Nakajima T, et al. Effects of low-intensity cycle training with restricted leg blood flow on thigh muscle volume and VO2max in young men. J Sports Sci Med. 2010;9(3):452–8.PubMedPubMedCentralGoogle Scholar
  23. 23.
    Abe T, Kearns CF, Sato Y. Muscle size and strength are increased following walk training with restricted venous blood flow from the leg muscle, Kaatsu-walk training. J Appl Physiol. 2006;100(5):1460–6.PubMedCrossRefGoogle Scholar
  24. 24.
    Sakamaki M, Bemben MG, Abe T. Legs and trunk muscle hypertrophy following walk training with restricted leg muscle blood flow. J Sports Sci Med. 2011;10:338–40.PubMedPubMedCentralGoogle Scholar
  25. 25.
    Loenneke JP, Wilson JM, Wilson GJ, et al. Potential safety issues with blood flow restriction training. Scand J Med Sci Sports. 2011;21(4):510–8.PubMedCrossRefGoogle Scholar
  26. 26.
    Vechin FC, Libardi CA, Conceicao MS, et al. Comparisons between low-intensity resistance training with blood flow restriction and high-intensity resistance training on quadriceps muscle mass and strength in elderly. J Strength Cond Res. 2015;29(4):1071–6.PubMedCrossRefGoogle Scholar
  27. 27.
    Mattar MA, Gualano B, Perandini LA, et al. Safety and possible effects of low-intensity resistance training associated with partial blood flow restriction in polymyositis and dermatomyositis. Arthritis Res Ther. 2014;16(5):473.PubMedPubMedCentralCrossRefGoogle Scholar
  28. 28.
    Hylden C, Burns T, Stinner D, et al. Blood flow restriction rehabilitation for extremity weakness: a case series. J Spec Oper Med. 2015;15(1):50–6.PubMedGoogle Scholar
  29. 29.
    Ohta H, Kurosawa H, Ikeda H, et al. Low-load resistance muscular training with moderate restriction of blood flow after anterior cruciate ligament reconstruction. Acta Orthop Scand. 2003;74(1):62–8.PubMedCrossRefGoogle Scholar
  30. 30.
    Loenneke JP, Wilson JM, Marin PJ, et al. Low intensity blood flow restriction training: a meta-analysis. Eur J Appl Physiol. 2012;16(112):1849–59.CrossRefGoogle Scholar
  31. 31.
    Burgomaster KA, Moore DR, Schofield LM, et al. Resistance training with vascular occlusion: metabolic adaptations in human muscle. Med Sci Sports Exerc. 2003;35(7):1203–8.PubMedCrossRefGoogle Scholar
  32. 32.
    Credeur DP, Hollis BC, Welsch MA. Effects of handgrip training with venous restriction on brachial artery vasodilation. Med Sci Sports Exerc. 2010;42(7):1296–302.PubMedPubMedCentralCrossRefGoogle Scholar
  33. 33.
    Counts BR, Dankel SJ, Barnett BE, et al. The influence of relative blood flow restriction pressure on muscle activation and muscle adaptation. Muscle Nerve. 2015. doi: 10.1002/mus.24756.PubMedGoogle Scholar
  34. 34.
    Farup J, de Paoli F, Bjerg K, et al. Blood flow restricted and traditional resistance training performed to fatigue produce equal muscle hypertrophy. Scand J Med Sci Sports. 2015. doi: 10.1111/sms.12396.Google Scholar
  35. 35.
    Hunt JE, Walton LA, Ferguson RA. Brachial artery modifications to blood flow-restricted handgrip training and detraining. J Appl Physiol (1985). 2012;112(6):956–61.Google Scholar
  36. 36.
    Luebbers PE, Fry AC, Kriley LM, et al. The effects of a 7-week practical blood flow restriction program on well-trained collegiate athletes. J Strength Cond Res. 2014;28(8):2270–80.PubMedCrossRefGoogle Scholar
  37. 37.
    Lowery RP, Joy JM, Loenneke JP, et al. Practical blood flow restriction training increases muscle hypertrophy during a periodized resistance training programme. Clin Physiol Funct Imaging. 2014;34(4):317–21.PubMedCrossRefGoogle Scholar
  38. 38.
    Moore DR, Burgomaster KA, Schofield LM, et al. Neuromuscular adaptations in human muscle following low intensity resistance training with vascular occlusion. Eur J Appl Physiol. 2004;92(4–5):399–406.PubMedGoogle Scholar
  39. 39.
    Ozaki H, Yasuda T, Ogasawara R, et al. Effects of high-intensity and blood flow-restricted low-intensity resistance training on carotid arterial compliance: role of blood pressure during training sessions. Eur J Appl Physiol. 2013;113(1):167–74.PubMedCrossRefGoogle Scholar
  40. 40.
    Sakamaki M, Yasuda T, Abe T. Comparison of low-intensity blood flow-restricted training-induced muscular hypertrophy in eumenorrheic women in the follicular phase and luteal phase and age-matched men. Clin Physiol Funct Imaging. 2012;32(3):185–91.PubMedCrossRefGoogle Scholar
  41. 41.
    Takarada Y, Takazawa H, Sato Y, et al. Effects of resistance exercise combined with moderate vascular occlusion on muscular function in humans. J Appl Physiol. 2000;88(6):2097–106.PubMedGoogle Scholar
  42. 42.
    Thiebaud RS, Loenneke JP, Fahs CA, et al. The effects of elastic band resistance training combined with blood flow restriction on strength, total bone-free lean body mass and muscle thickness in postmenopausal women. Clin Physiol Funct Imaging. 2013;33(5):344–52.PubMedCrossRefGoogle Scholar
  43. 43.
    Weatherholt A, Beekley M, Greer S, et al. Modified Kaatsu training: adaptations and subject perceptions. Med Sci Sports Exerc. 2013;45(5):952–61.PubMedCrossRefGoogle Scholar
  44. 44.
    Yamanaka T, Farley RS, Caputo JL. Occlusion training increases muscular strength in division IA football players. J Strength Cond Res. 2012;26(9):2523–9.PubMedCrossRefGoogle Scholar
  45. 45.
    Yasuda T, Ogasawara R, Sakamaki M, et al. Combined effects of low-intensity blood flow restriction training and high-intensity resistance training on muscle strength and size. Eur J Appl Physiol. 2011;1(111):2525–33.CrossRefGoogle Scholar
  46. 46.
    Yasuda T, Fukumura K, Uchida Y, et al. Effects of low-load, elastic band resistance training combined with blood flow restriction on muscle size and arterial stiffness in older adults. J Gerontol A Biol Sci Med Sci. 2015;70(8):950–8.PubMedCrossRefGoogle Scholar
  47. 47.
    Yasuda T, Fujita S, Ogasawara R, et al. Effects of low-intensity bench press training with restricted arm muscle blood flow on chest muscle hypertrophy: a pilot study. Clin Physiol Funct Imaging. 2010;30(5):338–43.PubMedGoogle Scholar
  48. 48.
    Yasuda T, Ogasawara R, Sakamaki M, et al. Relationship between limb and trunk muscle hypertrophy following high-intensity resistance training and blood flow-restricted low-intensity resistance training. Clin Physiol Funct Imaging. 2011;31(5):347–51.PubMedCrossRefGoogle Scholar
  49. 49.
    Yasuda T, Loenneke JP, Thiebaud RS, et al. Effects of blood flow restricted low-intensity concentric or eccentric training on muscle size and strength. PLoS One. 2012;7(12):e52843.PubMedPubMedCentralCrossRefGoogle Scholar
  50. 50.
    Fahs CA, Loenneke JP, Thiebaud RS, et al. Muscular adaptations to fatiguing exercise with and without blood flow restriction. Clin Physiol Funct Imaging. 2015;35(3):167–76.PubMedCrossRefGoogle Scholar
  51. 51.
    Fahs CA, Loenneke JP, Rossow LM, et al. Cross-over muscular adaptation to blood flow-restricted exercise. Med Sci Sports Exerc. 2013;45(5):1018.PubMedCrossRefGoogle Scholar
  52. 52.
    Fujita T, Brechue WF, Kurita K, et al. Increased muscle volume and strength following six days of low-intensity resistance training with restricted muscle blood flow. Int J KAATSU Training Res. 2008;4(1):1–8.CrossRefGoogle Scholar
  53. 53.
    Ogasawara R, Thiebaud RS, Loenneke JP, et al. Time course for arm and chest muscle thickness changes following bench press training. Interv Med Appl Sci. 2012;4(4):217–20.PubMedPubMedCentralCrossRefGoogle Scholar
  54. 54.
    Ogasawara R, Yasuda T, Sakamaki M, et al. Effects of periodic and continued resistance training on muscle CSA and strength in previously untrained men. Clin Physiol Funct Imaging. 2011;31(5):399–404.PubMedCrossRefGoogle Scholar
  55. 55.
    Abe T, Yasuda T, Midorikawa T, et al. Skeletal muscle size and circulating IGF-1are increased after two weeks of twice daily “KAATSU” resistance training. Int J KAATSU Training Res. 2005;1:6–12.CrossRefGoogle Scholar
  56. 56.
    Abe T, Loenneke JP, Fahs CA, et al. Exercise intensity and muscle hypertrophy in blood flow-restricted limbs and non-restricted muscles: a brief review. Clin Physiol Funct Imaging. 2012;32(4):247–52.PubMedCrossRefGoogle Scholar
  57. 57.
    Laurentino G, Ugrinowitsch C, Aihara AY, et al. Effects of strength training and vascular occlusion. Int J Sports Med. 2008;29(8):664–7.PubMedCrossRefGoogle Scholar
  58. 58.
    Loenneke JP, Allen KM, Mouser JG, et al. Blood flow restriction in the upper and lower limbs is predicted by limb circumference and systolic blood pressure. Eur J Appl Physiol. 2015;115(2):397–405.PubMedCrossRefGoogle Scholar
  59. 59.
    Loenneke JP, Fahs CA, Rossow LM, et al. Effects of cuff width on arterial occlusion: implications for blood flow restricted exercise. Eur J Appl Physiol. 2012;112(8):2903–12.PubMedPubMedCentralCrossRefGoogle Scholar
  60. 60.
    Loenneke LP, Pujol TJ. The use of occlusion training to produce muscle hypertrophy. Strength Cond J. 2009;31(3):77–84.CrossRefGoogle Scholar
  61. 61.
    Loenneke JP, Thiebaud RS, Abe T, et al. Blood flow restriction pressure recommendations: The hormesis hypothesis. Med Hypotheses. 2014;82(5):623–6.PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  • Scott J. Dankel
    • 1
  • Matthew B. Jessee
    • 1
  • Takashi Abe
    • 2
  • Jeremy P. Loenneke
    • 1
    Email author
  1. 1.Department of Health, Exercise Science, and Recreation Management, Kevser Ermin Applied Physiology LaboratoryThe University of MississippiUniversityUSA
  2. 2.National Institute of Fitness and Sports in KanoyaKanoyaJapan

Personalised recommendations