European Journal of Applied Physiology

, Volume 112, Issue 5, pp 1849–1859 | Cite as

Low intensity blood flow restriction training: a meta-analysis

  • Jeremy P. Loenneke
  • Jacob M. Wilson
  • Pedro J. Marín
  • Michael C. Zourdos
  • Michael G. Bemben
Original Article

Abstract

The primary objective of this investigation was to quantitatively identify which training variables result in the greatest strength and hypertrophy outcomes with lower body low intensity training with blood flow restriction (LI-BFR). Searches were performed for published studies with certain criteria. First, the primary focus of the study must have compared the effects of low intensity endurance or resistance training alone to low intensity exercise with some form of blood flow restriction. Second, subject populations had to have similar baseline characteristics so that valid outcome measures could be made. Finally, outcome measures had to include at least one measure of muscle hypertrophy. All studies included in the analysis utilized MRI except for two which reported changes via ultrasound. The mean overall effect size (ES) for muscle strength for LI-BFR was 0.58 [95% CI: 0.40, 0.76], and 0.00 [95% CI: −0.18, 0.17] for low intensity training. The mean overall ES for muscle hypertrophy for LI-BFR training was 0.39 [95% CI: 0.35, 0.43], and −0.01 [95% CI: −0.05, 0.03] for low intensity training. Blood flow restriction resulted in significantly greater gains in strength and hypertrophy when performed with resistance training than with walking. In addition, performing LI-BFR 2–3 days per week resulted in the greatest ES compared to 4–5 days per week. Significant correlations were found between ES for strength development and weeks of duration, but not for muscle hypertrophy. This meta-analysis provides insight into the impact of different variables on muscular strength and hypertrophy to LI-BFR training.

Keywords

KAATSU Hypertrophy Strength Vascular occlusion training 

References

  1. Abe T, Beekley MD, Hinata S, Koizumi K, Sato Y (2005a) Day-to-day change in muscle strength and MRI-measured skeletal muscle size during 7 days KAATSU resistance training: a case study. Int J KAATSU Train Res 1(2):71–76CrossRefGoogle Scholar
  2. Abe T, Fujita S, Nakajima T, Sakamaki M, Ozaki H, Ogasawara R, Sugaya M, Kurano M, Yasuda T, Sato Y, Ohshima H, Mukai C, Ishii N (2010a) Effects of low-intensity cycle training with restricted leg blood flow on thigh muscle volume and VO2max in young men. J sports Sci Med 9:452–458Google Scholar
  3. Abe T, Kawamoto K, Yasuda T, Kearns CF, Midorikawa T, Sato Y (2005b) Eight days KAATSU-resistance training improved sprint but not jump performance in collegiate male track and field athletes. Int J KAATSU Train Res 1(1):19–23CrossRefGoogle Scholar
  4. Abe T, Kearns CF, Fujita S, Sakamaki M, Sato Y, Brechue WF (2009) Skeletal muscle size and strength are increased following walk training with restricted leg muscle blood flow: implications for training duration and frequency. Int J KAATSU Train Res 5(1):9–15CrossRefGoogle Scholar
  5. Abe T, Kearns CF, Sato Y (2006) Muscle size and strength are increased following walk training with restricted venous blood flow from the leg muscle, Kaatsu-walk training. J Appl Physiol 100(5):1460–1466PubMedCrossRefGoogle Scholar
  6. Abe T, Sakamaki M, Fujita S, Ozaki H, Sugaya M, Sato Y, Nakajima T (2010b) Effects of low-intensity walk training with restricted leg blood flow on muscle strength and aerobic capacity in older adults. J Geriatr Phys Ther 33(1):34–40PubMedGoogle Scholar
  7. Abe T, Yasuda T, Midorikawa T, Sato Y, Kearns CF, Inoue K, Koizumi K, Ishii N (2005c) Skeletal muscle size and circulating IGF-1 are increased after two weeks of twice daily “KAATSU” resistance training. Int J KAATSU Train Res 1(1):6–12CrossRefGoogle Scholar
  8. ACSM (2009) American College of Sports Medicine position stand. Progression models in resistance training for healthy adults. Med Sci Sports Exerc 41(3):687–708Google Scholar
  9. Beekley MD, Sato Y, Abe T (2005) KAATSU-walk training increases serum bone-specific alkaline phophatase in young men. Int J KAATSU Train Res 1(2):77–81CrossRefGoogle Scholar
  10. Clark BC, Manini TM, Hoffman RL, Williams PS, Guiler MK, Knutson MJ, McGlynn ML, Kushnick MR (2010) Relative safety of 4 weeks of blood flow-restricted resistance exercise in young, healthy adults. Scand J Med Sci Sports. doi:10.1111/j.1600-0838.2010.01100
  11. Cook SB, Brown KA, Deruisseau K, Kanaley JA, Ploutz-Snyder LL (2010) Skeletal muscle adaptations following blood flow-restricted training during 30 days of muscular unloading. J Appl Physiol 109(2):341–349PubMedCrossRefGoogle Scholar
  12. Crenshaw AG, Hargens AR, Gershuni DH, Rydevik B (1988) Wide tourniquet cuffs more effective at lower inflation pressures. Acta Orthop Scand 59(4):447–451PubMedCrossRefGoogle Scholar
  13. Evans C, Vance S, Brown M (2010) Short-term resistance training with blood flow restriction enhances microvascular filtration capacity of human calf muscles. J Sports Sci 28(9):999–1007PubMedCrossRefGoogle Scholar
  14. Fujita S, Brechue WF, Kurita K, Sato Y, Abe T (2008) Increased muscle volume and strength following six days of low-intensity resistance training with restricted muscle blood flow. Int J KAATSU Train Res 4(1):1–8CrossRefGoogle Scholar
  15. Gualano B, Neves M Jr, Lima FR, Pinto AL, Laurentino G, Borges C, Baptista L, Artioli GG, Aoki MS, Moriscot A, Lancha AH Jr, Bonfa E, Ugrinowitsch C (2010) Resistance training with vascular occlusion in inclusion body myositis: a case study. Med Sci Sports Exerc 42(2):250–254PubMedCrossRefGoogle Scholar
  16. Haussinger D (1996) The role of cellular hydration in the regulation of cell function. Biochem J 313(Pt 3):697–710PubMedGoogle Scholar
  17. Ishii N, Madarame H, Odagiri K, Naganuma M, Shinoda K (2005) Circuit training without external load induces hypertrophy in lower-limb muscles when combined with moderate venous occlusion. Int J KAATSU Train Res 1:24–28CrossRefGoogle Scholar
  18. Ivey FM, Roth SM, Ferrell RE, Tracy BL, Lemmer JT, Hurlbut DE, Martel GF, Siegel EL, Fozard JL, Jeffrey Metter E, Fleg JL, Hurley BF (2000) Effects of age, gender, and myostatin genotype on the hypertrophic response to heavy resistance strength training. J Gerontol A Biol Sci Med Sci 55(11):M641–M648PubMedCrossRefGoogle Scholar
  19. Kacin A, Strazar K (2011) Frequent low-load ischemic resistance exercise to failure enhances muscle oxygen delivery and endurance capacity. Scand J Med Sci Sports. doi: 10.1111/j.1600-0838.2010.01260.x
  20. Kaijser L, Sundberg CJ, Eiken O, Nygren A, Esbjornsson M, Sylven C, Jansson E (1990) Muscle oxidative capacity and work performance after training under local leg ischemia. J Appl Physiol 69(2):785–787PubMedGoogle Scholar
  21. 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(1):147–155PubMedCrossRefGoogle Scholar
  22. Karabulut M, Bemben DA, Sherk VD, Anderson MA, Abe T, Bemben MG (2011) Effects of high-intensity resistance training and low-intensity resistance training with vascular restriction on bone markers in older men. Eur J Appl Physiol. doi: 10.1007/s00421-010-1796-9
  23. Kim SJ, Sherk VD, Bemben MG, Bemben DA (2009) Effects of short-term, low-intensity resistance training with vascular restriction on arterial compliance in untrained young men. Int J KAATSU Train Res 5(1):1–8CrossRefGoogle Scholar
  24. Krieger JW (2010) Single vs. multiple sets of resistance exercise for muscle hypertrophy: a meta-analysis. J Strength Cond Res 24 (4):1150–1159Google Scholar
  25. Loenneke JP, Pujol TJ (2009) The use of occlusion training to produce muscle hypertrophy. Strength Cond J 31(3):77–84CrossRefGoogle Scholar
  26. Loenneke JP, Pujol TJ (2011) Sarcopenia: an emphasis on occlusion training and dietary protein. Hippokratia 15(2):132–137PubMedGoogle Scholar
  27. Loenneke JP, Wilson GJ, Wilson JM (2010) A mechanistic approach to blood flow occlusion. Int J Sports Med 31(1):1–4PubMedCrossRefGoogle Scholar
  28. Loenneke JP, Wilson JM, Wilson GJ, Pujol TJ, Bemben MG (2011) Potential safety issues with blood flow restriction training. Scand J Med Sci Sports 21(4):510–518PubMedCrossRefGoogle Scholar
  29. Madarame H, Neya M, Ochi E, Nakazato K, Sato Y, Ishii N (2008) Cross-transfer effects of resistance training with blood flow restriction. Med Sci Sports Exerc 40(2):258–263PubMedCrossRefGoogle Scholar
  30. Manini TM, Clark BC (2009) Blood flow restricted exercise and skeletal muscle health. Exerc Sport Sci Rev 37(2):78–85PubMedCrossRefGoogle Scholar
  31. Nygren AT, Sundberg CJ, Goransson H, Esbjornsson-Liljedahl M, Jansson E, Kaijser L (2000) Effects of dynamic ischaemic training on human skeletal muscle dimensions. Eur J Appl Physiol 82(1–2):137–141PubMedCrossRefGoogle Scholar
  32. Ohta H, Kurosawa H, Ikeda H, Iwase Y, Satou N, Nakamura S (2003) Low-load resistance muscular training with moderate restriction of blood flow after anterior cruciate ligament reconstruction. Acta Orthop Scand 74(1):62–68PubMedCrossRefGoogle Scholar
  33. Ozaki H, Miyachi M, Nakajima T, Abe T (2011) Effects of 10 weeks walk training with leg blood flow reduction on carotid arterial compliance and muscle size in the elderly adults. Angiology 62(1):81–86PubMedCrossRefGoogle Scholar
  34. Park S, Kim JK, Choi HM, Kim HG, Beekley MD, Nho H (2010) Increase in maximal oxygen uptake following 2-week walk training with blood flow occlusion in athletes. Eur J Appl Physiol 109(4):591–600PubMedCrossRefGoogle Scholar
  35. Patterson SD, Ferguson RA (2010) 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 108(5):1025–1033PubMedCrossRefGoogle Scholar
  36. Rhea MR (2004) Determining the magnitude of treatment effects in strength training research through the use of the effect size. J Strength Cond Res 18(4):918–920PubMedGoogle Scholar
  37. Rhea MR, Alvar BA, Burkett LN, Ball SD (2003) A meta-analysis to determine the dose response for strength development. Med Sci Sports Exerc 35(3):456–464PubMedCrossRefGoogle Scholar
  38. Sakuraba K, Ishikawa T (2009) Effect of isokinetic resistance training under a condition of restricted blood flow with pressure. J Orthop Sci 14(5):631–639PubMedCrossRefGoogle Scholar
  39. Sale DG (1988) Neural adaptation to resistance training. Med Sci Sports Exerc 20(5 Suppl):S135–S145PubMedGoogle Scholar
  40. Sata S (2005) Kaatsu training for patella tendinitis patient. Int J KAATSU Train Res 1(1):29–32CrossRefGoogle Scholar
  41. Shinohara M, Kouzaki M, Yoshihisa T, Fukunaga T (1998) Efficacy of tourniquet ischemia for strength training with low resistance. Eur J Appl Physiol Occup Physiol 77(1–2):189–191PubMedGoogle Scholar
  42. 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(6):1563–1567PubMedCrossRefGoogle Scholar
  43. Sumide T, Sakuraba K, Sawaki K, Ohmura H, Tamura Y (2009) Effect of resistance exercise training combined with relatively low vascular occlusion. J Sci Med Sport 12(1):107–112PubMedCrossRefGoogle Scholar
  44. Sundberg CJ, Eiken O, Nygren A, Kaijser L (1993) Effects of ischaemic training on local aerobic muscle performance in man. Acta Physiol Scand 148(1):13–19PubMedCrossRefGoogle Scholar
  45. Takarada Y, Sato Y, Ishii N (2002) Effects of resistance exercise combined with vascular occlusion on muscle function in athletes. Eur J Appl Physiol 86(4):308–314PubMedCrossRefGoogle Scholar
  46. 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(6):2097–2106PubMedGoogle Scholar
  47. Takarada Y, Tsuruta T, Ishii N (2004) Cooperative effects of exercise and occlusive stimuli on muscular function in low-intensity resistance exercise with moderate vascular occlusion. Jpn J Physiol 54(6):585–592PubMedCrossRefGoogle Scholar
  48. Wernbom M, Augustsson J, Raastad T (2008) Ischemic strength training: a low-load alternative to heavy resistance exercise? Scand J Med Sci Sports 18(4):401–416PubMedCrossRefGoogle Scholar
  49. Yasuda T, Abe T, Sato Y, Midorikawa T, Kearns CF, Inoue K, Ryushi T, Ishii N (2005) Muscle fiber cross-sectional area is increased after two weeks of twice daily KAATSU-resistance training. Int J KAATSU Train Res 1(2):65–70CrossRefGoogle Scholar
  50. Yasuda T, Fujita S, Ogasawara R, Sato Y, Abe T (2010) Effects of low-intensity bench press training with restricted arm muscle blood flow on chest muscle hypertrophy: a pilot study. Clin Physiol Funct Imaging 30(5):338–343PubMedGoogle Scholar
  51. Yasuda T, Ogasawara R, Sakamaki M, Ozaki H, Sato Y, Abe T (2011) Combined effects of low-intensity blood flow restriction training and high-intensity resistance training on muscle strength and size. Eur J Appl Physiol. doi:10.1007/s00421-011-1873-8

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Jeremy P. Loenneke
    • 1
  • Jacob M. Wilson
    • 2
  • Pedro J. Marín
    • 3
  • Michael C. Zourdos
    • 4
  • Michael G. Bemben
    • 1
  1. 1.Department of Health and Exercise ScienceThe University of OklahomaNormanUSA
  2. 2.Department of Exercise Science and Sport StudiesUniversity of TampaTampaUSA
  3. 3.Department of Health SciencesEuropean University Miguel de CervantesValladolidSpain
  4. 4.Department of Nutrition, Food and Exercise SciencesThe Florida State UniversityTallahasseeUSA

Personalised recommendations