Abstract
Purpose of Review
This paper aims to review the available literature regarding blood flow restriction training (BFRT), summarize its mechanisms of action, address safety concerns, and help direct protocol development and practical implementation, particularly in athletes.
Recent Findings
Recent literature, in both athletic and clinical cohorts, has explored the safety and efficacy of BFRT; however, rigorous randomized controlled trials with consistent protocols are lacking.
Summary
BFRT is a promising clinical and athletic training tool; however, it should be used in a controlled setting with an individualized approach. Implementation as an adjunct to traditional resistance training appears useful, with particular benefit to individuals unable to tolerate high-load training. Evidence suggests consistent muscle hypertrophy and strength responses; however, more research is needed regarding its use in athlete-specific training and rehabilitation.
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Westcott WL. Resistance training is medicine: effects of strength training on health. Curr Sports Med Rep. 2012;11:209–16.
McLeod JC, Stokes T, Phillips SM. Resistance exercise training as a primary countermeasure to age-related chronic disease. Front Physiol. 2019;10.
Shiroma EJ, Cook NR, Manson JE, Moorthy M, Buring JE, Rimm EB, et al. Strength training and the risk of type 2 diabetes and cardiovascular disease. Med Sci Sport Exerc [Internet]. 2017;49:40–6 Available from: https://journals.lww.com/00005768-201701000-00005.
Sato Y. The history and future of KAATSU. J Build Phys. 2005;18:3–20.
Communications S. Progression models in resistance training for healthy adults. Med Sci Sports Exerc. 2009;41:687–708.
Maughan RJ, Watson JS, Weir J. Strength and cross-sectional area of human skeletal muscle. J Physiol. 1983;338:37–49.
Yasuda T, Fujita S, Ogasawara R, Sato Y, Abe T. 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;30:338–43.
Fujita T, Brechue WF, Kurita K, Sato Y, Abe T. Increased muscle volume and strength following six days of low-intensity resistance training with restricted muscle blood flow. Int J KAATSU Train Res. 2008;4:1–8.
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;100:1460–6.
• Loenneke JP, Wilson GJ, Wilson JM. A mechanistic approach to blood flow occlusion. Int J Sports Med. 2010;31:1–4 This provides a succinct summary of multiple proposed mechanisms of action explaining BFRT's hypertrophic response.
• Loenneke JP, Wilson JM, Wilson GJ, Pujol TJ, Bemben MG. Potential safety issues with blood flow restriction training. Scand J Med Sci Sports. 2011;21:510–8 This review summarizes research regarding BFRT safety compared with traditional exercise, with a focus on both central and peripheral body systems.
Minniti MC, Statkevich AP, Kelly RL, Rigsby VP, Exline MM, Rhon DI, et al. The safety of blood flow restriction training as a therapeutic intervention for patients with musculoskeletal disorders: a systematic review. Am J Sports Med. 2019:1–13.
Hakkinen K, Komi P V. Electromyographic changes in response to strength training and detraining. Med. Sci. Sports Exerc. 1983. p. 455–60.
Schoenfeld BJ. The mechanisms of muscle hypertrophy and their application to resistance training. J Strength Cond Res. 2010;24:2857–72.
Hill M, Goldspink G. Expression and splicing of the insulin-like growth factor gene in rodent muscle is associated with muscle satellite (stem) cell activation following local tissue damage. J Physiol. 2003;549:409–18.
Vierck J, O’Reilly B, Hossner K, Antonio J, Byrne K, Bucci L, et al. Satellite cell regulation following myotrauma caused by resistance exercise. Cell Biol Int. 2000;24:263–72.
Philippou A, Halapas A, Maridaki M, Koutsilieris M. Type I insulin-like growth factor receptor signaling in skeletal muscle regeneration and hypertrophy. J Musculoskelet Neuronal Interact. 2007;7:208–18.
Goldspink G. Mechanical signals, IGF-I gene splicing, and muscle adaptation. Physiology. 2005;20:232–8.
Crewther B, Keogh J, Cronin J, Cook C. Possible stimuli for strength and power adaptation. Sport Med [Internet]. 2006;36:215–38. https://doi.org/10.2165/00007256-200636030-00004.
Boesen AP, Dideriksen K, Couppé C, Magnusson SP, Schjerling P, Boesen M, et al. Effect of growth hormone on aging connective tissue in muscle and tendon: gene expression, morphology, and function following immobilization and rehabilitation. J Appl Physiol. 2014;116:192–203.
Takarada Y, Takazawa H, Sato Y, Takebayashi S, Tanaka Y, Ishii N. Effects of resistance exercise combined with moderate vascular occlusion on muscular function in humans. J Appl Physiol. 2000;88:2097–106.
Toigo M, Boutellier U. New fundamental resistance exercise determinants of molecular and cellular muscle adaptations. Eur J Appl Physiol. 2006;97:643–63.
Kubota A, Sakuraba K, Koh S, Ogura Y, Tamura Y. Blood flow restriction by low compressive force prevents disuse muscular weakness. J Sci Med Sport [Internet] Sports Medicine Australia. 2011;14:95–9. https://doi.org/10.1016/j.jsams.2010.08.007.
Kubota A, Sakuraba K, Sawaki K, Sumide T, Tamura Y. Prevention of disuse muscular weakness by restriction of blood flow. Med Sci Sports Exerc. 2008;40:529–34.
Loenneke JP, Abe T, Wilson JM, Ugrinowitsch C, Bemben MG. Blood flow restriction: how does it work? Front Physiol. 2012;3:1–2.
Pearson SJ, Hussain SR. A review on the mechanisms of blood-flow restriction resistance training-induced muscle hypertrophy. Sports Med. 2015;45:187–200.
Scott BR, Slattery KM, Sculley DV, Dascombe BJ. Hypoxia and resistance exercise: a comparison of localized and systemic methods. Sports Med. 2014;44:1037–54.
Ehrnborg C, Rosén T. Physiological and pharmacological basis for the ergogenic effects of growth hormone in elite sports. Asian J Androl. 2008;10:373–83.
Fry AC. The role of resistance exercise intensity on muscle fibre adaptations. Sports Med. 2004;34(10):663–79.
Grgic J, Schoenfeld BJ, Latella C. Resistance training frequency and skeletal muscle hypertrophy: a review of available evidence. J Sci Med Sport [Internet] Sports Medicine Australia. 2019;22:361–70. https://doi.org/10.1016/j.jsams.2018.09.223.
Kumar V, Selby A, Rankin D, Patel R, Atherton P, Hildebrandt W, et al. Age-related differences in the dose-response relationship of muscle protein synthesis to resistance exercise in young and old men. J Physiol. 2009;587:211–7.
Krieger JW. Single vs. multiple sets of resistance exercise for muscle hypertrophy: a meta-analysis. J Strength Cond Res. 2010;24:1150–9.
Bloomer RJ, Ives JC. Varying neural and hypertrophic. Natl Strength Cond Assoc. 2000;22:30–5.
Bird SP, Tarpenning KM, Marino FE. Designing resistance training programmes to enhance muscular fitness: a review of the acute programme variables. Sports Med. 2005;35:841–51.
Hody S, Croisier JL, Bury T, Rogister B, Leprince P. Eccentric muscle contractions: risks and benefits. Front Physiol. 2019;10:1–18.
Julian V, Thivel D, Costes F, Touron J, Boirie Y, Pereira B, et al. Eccentric training improves body composition by inducing mechanical and metabolic adaptations: a promising approach for overweight and obese individuals. Front Physiol. 2018;9:1–14.
Schoenfeld BJ, Grgic J, Ogborn D, Krieger JW. Strength and hypertrophy adaptations between low- vs. high-load resistance training: a systematic review and meta-analysis. J Strength Cond Res. 2017;31:3508–23.
•• Scott BR, Loenneke JP, Slattery KM, Dascombe BJ. Exercise with blood flow restriction: an updated evidence-based approach for enhanced muscular development, 313. Sports Med. 2015;45:–25 This review provides evidence-based guidelines regarding implementation of BFRT as well as recommendations for safe manipulation of exercise variables to achieve desired physiologic responses.
•• Patterson SD, Hughes L, Warmington S, Burr J, Scott BR, Owens J, et al. Blood flow restriction exercise position stand: considerations of methodology, application, and safety. Front Physiol. 2019;10:1–15 This manuscript provides a set of guidelines for the implementation of BFRT across several settings and discusses the common safety aspects to be considered when implementing BFR.
•• Scott BR, Loenneke JP, Slattery KM, Dascombe BJ. Blood flow restricted exercise for athletes: a review of available evidence. J Sci Med Sport [Internet] Sports Medicine Australia. 2016;19:360–7. https://doi.org/10.1016/j.jsams.2015.04.014This review focuses on the efficacy of BFRT in well-trained, athletic populations as a supplement to normal high-load training.
Loenneke JP, Thiebaud RS, Fahs CA, Rossow LM, Abe T, Bemben MG. Effect of cuff type on arterial occlusion. Clin Physiol Funct Imaging. 2013;33:325–7.
Loenneke JP, Fahs CA, Rossow LM, Sherk VD, Thiebaud RS, Abe T, et al. Effects of cuff width on arterial occlusion: implications for blood flow restricted exercise. Eur J Appl Physiol. 2012;112:2903–12.
Loenneke J, Thiebaud RS, Fahs CA, Rossow LM, Abe T, Bemben MG. Blood flow restriction: effects of cuff type on fatigue and perceptual responses to resistance exercise. Acta Physiol Hung. 2014;101:158–66.
Clarkson MJ, May AK, Warmington SA. Is there rationale for the cuff pressures prescribed for blood flow restriction exercise? A systematic review. Scand J Med Sci Sports [Internet]. 2020;Apr. https://doi.org/10.1111/sms.13676
Cook SB, Clark BC, Ploutz-Snyder LL. Effects of exercise load and blood-flow restriction on skeletal muscle function. Med Sci Sports Exerc. 2007;39:1708–13.
Loenneke JP, Thiebaud RS, Fahs CA, Rossow LM, Abe T, Bemben MG. Blood flow restriction does not result in prolonged decrements in torque. Eur J Appl Physiol. 2013;113:923–31.
McEwen JA, Owens JG, Jeyasurya J. Why is it crucial to use personalized occlusion pressures in blood flow restriction (BFR) rehabilitation? J Med Biol Eng [Internet] Springer Berlin Heidelberg. 2019;39:173–7. https://doi.org/10.1007/s40846-018-0397-7.
DePhillipo NN, Kennedy MI, Aman ZS, Bernhardson AS, O’Brien L, LaPrade RF. Blood flow restriction therapy after knee surgery: indications, safety considerations, and postoperative protocol. Arthrosc Tech [Internet] Arthroscopy Association of North America. 2018;7:e1037–43. https://doi.org/10.1016/j.eats.2018.06.010.
Wilson JM, Lowery RP, Joy JM, Loenneke JP, Naimo MA. Practical blood flow restriction training increases acute determinants of hypertrophy without increasing indices of muscle damage. J Strength Cond Res. 2013;27:3068–75.
Thiebaud RS, Abe T, Loenneke JP, Garcia T, Shirazi Y, McArthur R. Acute muscular responses to practical low-load blood flow restriction exercise versus traditional low-load blood flow restriction and high-/low-load exercise. J Sport Rehabil [Internet]. 2019;Dec:1–9. https://journals.humankinetics.com/view/journals/jsr/aop/article-10.1123-jsr.2019-0217/article-10.1123-jsr.2019-0217.xml
Luebbers PE, Witte EV, Oshel JQ, Butler MS. Effects of practical blood flow restriction training on adolescent lower-body strength. J Strength Cond Res. 2019;33:2674–83.
Luebbers PE, Fry AC, Kriley LM, Butler MS. The effects of a 7-week practical blood flow restriction program on well-trained collegiate athletes. J Strength Cond Res. 2014;28:2270–80.
Lowery RP, Joy JM, Loenneke JP, de Souza EO, Machado M, Dudeck JE, et al. Practical blood flow restriction training increases muscle hypertrophy during a periodized resistance training programme. Clin Physiol Funct Imaging. 2014;34:317–21.
Bell ZW, Dankel SJ, Spitz RW, Chatakondi RN, Abe T, Loenneke JP. The perceived tightness scale does not provide reliable estimates of blood flow restriction pressure. Med Sci Sports Exerc. 2019;51:973.
Hughes L, Paton B, Rosenblatt B, Gissane C, Patterson SD. Blood flow restriction training in clinical musculoskeletal rehabilitation: a systematic review and meta-analysis. Br J Sports Med. 2017;51:1003–11.
Farup J, de Paoli F, Bjerg K, Riis S, Ringgard S, Vissing K. Blood flow restricted and traditional resistance training performed to fatigue produce equal muscle hypertrophy. Scand J Med Sci Sports [Internet]. 2015;25:754–63. https://doi.org/10.1111/sms.12396.
Abe T, Kawamoto K, Yasuda T, Kearns CF, Midorikawa T, Sato Y. Eight days KAATSU-resistance training improved sprint but not jump performance in collegiate male track and field athletes. Int J KAATSU Train Res. 2005;1:19–23.
Loenneke J, Abe T, Wilson J, Thiebaud R, Fahs C, Rossow L, et al. Blood flow restriction: an evidence based progressive model (Review). Acta Physiol Hung [Internet]. 2012;99:235–50. https://doi.org/10.1556/aphysiol.99.2012.3.1.
Loenneke JP, Wilson JM, Marín PJ, Zourdos MC, Bemben MG. Low intensity blood flow restriction training: a meta-analysis. Eur J Appl Physiol. 2012;112:1849–59.
Lixandrão ME, Ugrinowitsch C, Berton R, Vechin FC, Conceição MS, Damas F, et al. 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 Med. 2018;48:361–78.
Sousa JBC, Neto GR, Santos HH, Araújo JP, Silva HG, Cirilo-Sousa MS. Effects of strength training with blood flow restriction on torque, muscle activation and local muscular endurance in healthy subjects. Biol Sport. 2017;34:83–90.
Ferraz RB, Gualano B, Rodrigues R, Kurimori CO, Fuller R, Lima FR, et al. Benefits of resistance training with blood flow restriction in knee osteoarthritis. Med Sci Sports Exerc. 2018;50:897–905.
Behringer M, Behlau D, Montag JCK, McCourt ML, Mester J. Low-intensity sprint training with blood flow restriction improves 100-m dash. J Strength Cond Res. 2017;31:2462–72.
Libardi CA, Chacon-Mikahil MPT, Cavaglieri CR, Tricoli V, Roschel H, Vechin FC, et al. Effect of concurrent training with blood flow restriction in the elderly. Int J Sports Med. 2015;36:395–9.
Takada S, Okita K, Suga T, Omokawa M, Morita N, Horiuchi M, et al. Blood flow restriction exercise in sprinters and endurance runners. Med Sci Sports Exerc. 2012;44:413–9.
Yamanaka T, Farley RS, Caputo JL. Occlusion training increases muscular strength in division IA football players. J Strength Cond Res. 2012;26:2523–9.
Manimmanakorn A, Hamlin MJ, Ross JJ, Taylor R, Manimmanakorn N. Effects of low-load resistance training combined with blood flow restriction or hypoxia on muscle function and performance in netball athletes. J Sci Med Sport [Internet] Sports Medicine Australia; 2013;16:337–342. https://doi.org/10.1016/j.jsams.2012.08.009
Takarada Y, Sato Y, Ishii N. Effects of resistance exercise combined with vascular occlusion on muscle function in athletes. Eur J Appl Physiol. 2002;86:308–14.
Cook CJ, Kilduff LP, Beaven CM. Improving strength and power in trained athletes with 3 weeks of occlusion training. Int J Sports Physiol Perform. 2014;9:166–72.
Slysz J, Stultz J, Burr JF. The efficacy of blood flow restricted exercise: a systematic review & meta-analysis. J Sci Med Sport [Internet] Sports Medicine Australia; 2016;19:669–675. https://doi.org/10.1016/j.jsams.2015.09.005
Takarada Y, Takazawa H, Ishii N. Applications of vascular occlusion diminish disuse atrophy. Med Sci Sports Exerc. 2000;32:2035–9.
Kacin A, Rosenblatt B, Žargi TG, Biswas A. Safety considerations with blood flow restricted resistance training. Ann Kinesiol [Internet]. 2015;6:3–26. http://ojs.zrs.upr.si/index.php/AK/article/view/96
Nakajima T, Kurano M, Iida H, Takano H, Oonuma H, Morita T, et al. Use and safety of KAATSU training: results of a national survey. Int J KAATSU Train Res. 2006;2:5–13.
Thompson KMA, Slysz JT, Burr JF. Risks of exertional rhabdomyolysis with blood flow-restricted training: beyond the case report. Clin J Sport Med. 2018;28:491–2.
Mendonca GV, Mouro M, Vila-Chã C, Pezarat-Correia P. Nerve conduction during acute blood-flow restriction with and without low-intensity exercise nerve conduction and blood-flow restriction. Sci Rep. 2020;10:1–10.
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Kelly, M.R., Cipriano, K.J., Bane, E.M. et al. Blood Flow Restriction Training in Athletes. Curr Phys Med Rehabil Rep 8, 329–341 (2020). https://doi.org/10.1007/s40141-020-00291-3
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DOI: https://doi.org/10.1007/s40141-020-00291-3