Skip to main content
Log in

Blood Flow Restriction Training in Athletes

  • Sports Medicine Rehabilitation (BJ Liem and B Krabak, Section Editors)
  • Published:
Current Physical Medicine and Rehabilitation Reports Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Westcott WL. Resistance training is medicine: effects of strength training on health. Curr Sports Med Rep. 2012;11:209–16.

    PubMed  Google Scholar 

  2. McLeod JC, Stokes T, Phillips SM. Resistance exercise training as a primary countermeasure to age-related chronic disease. Front Physiol. 2019;10.

  3. 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.

  4. Sato Y. The history and future of KAATSU. J Build Phys. 2005;18:3–20.

    Google Scholar 

  5. Communications S. Progression models in resistance training for healthy adults. Med Sci Sports Exerc. 2009;41:687–708.

    Google Scholar 

  6. Maughan RJ, Watson JS, Weir J. Strength and cross-sectional area of human skeletal muscle. J Physiol. 1983;338:37–49.

    CAS  PubMed  PubMed Central  Google Scholar 

  7. 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.

    PubMed  Google Scholar 

  8. 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.

    Google Scholar 

  9. 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.

    CAS  PubMed  Google Scholar 

  10. • 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.

    CAS  PubMed  Google Scholar 

  11. • 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.

    CAS  PubMed  Google Scholar 

  12. 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.

  13. Hakkinen K, Komi P V. Electromyographic changes in response to strength training and detraining. Med. Sci. Sports Exerc. 1983. p. 455–60.

  14. Schoenfeld BJ. The mechanisms of muscle hypertrophy and their application to resistance training. J Strength Cond Res. 2010;24:2857–72.

    PubMed  Google Scholar 

  15. 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.

    CAS  PubMed  PubMed Central  Google Scholar 

  16. 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.

    CAS  PubMed  Google Scholar 

  17. 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.

    CAS  PubMed  Google Scholar 

  18. Goldspink G. Mechanical signals, IGF-I gene splicing, and muscle adaptation. Physiology. 2005;20:232–8.

    CAS  PubMed  Google Scholar 

  19. 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.

    Article  Google Scholar 

  20. 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.

    CAS  PubMed  Google Scholar 

  21. 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.

    CAS  PubMed  Google Scholar 

  22. Toigo M, Boutellier U. New fundamental resistance exercise determinants of molecular and cellular muscle adaptations. Eur J Appl Physiol. 2006;97:643–63.

    PubMed  Google Scholar 

  23. 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.

    Article  Google Scholar 

  24. 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.

    PubMed  Google Scholar 

  25. Loenneke JP, Abe T, Wilson JM, Ugrinowitsch C, Bemben MG. Blood flow restriction: how does it work? Front Physiol. 2012;3:1–2.

    Google Scholar 

  26. Pearson SJ, Hussain SR. A review on the mechanisms of blood-flow restriction resistance training-induced muscle hypertrophy. Sports Med. 2015;45:187–200.

    PubMed  Google Scholar 

  27. 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.

    PubMed  Google Scholar 

  28. 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.

    CAS  PubMed  Google Scholar 

  29. Fry AC. The role of resistance exercise intensity on muscle fibre adaptations. Sports Med. 2004;34(10):663–79.

    PubMed  Google Scholar 

  30. 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.

    Article  Google Scholar 

  31. 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.

    CAS  PubMed  Google Scholar 

  32. Krieger JW. Single vs. multiple sets of resistance exercise for muscle hypertrophy: a meta-analysis. J Strength Cond Res. 2010;24:1150–9.

    PubMed  Google Scholar 

  33. Bloomer RJ, Ives JC. Varying neural and hypertrophic. Natl Strength Cond Assoc. 2000;22:30–5.

    Google Scholar 

  34. 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.

    PubMed  Google Scholar 

  35. Hody S, Croisier JL, Bury T, Rogister B, Leprince P. Eccentric muscle contractions: risks and benefits. Front Physiol. 2019;10:1–18.

    Google Scholar 

  36. 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.

    Google Scholar 

  37. 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.

    PubMed  Google Scholar 

  38. •• 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.

  39. •• 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.

    Google Scholar 

  40. •• 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.

    Article  Google Scholar 

  41. 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.

    PubMed  Google Scholar 

  42. 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.

    PubMed  Google Scholar 

  43. 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.

    CAS  PubMed  Google Scholar 

  44. 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

  45. 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.

    PubMed  Google Scholar 

  46. 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.

    PubMed  Google Scholar 

  47. 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.

    Article  Google Scholar 

  48. 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.

    Article  Google Scholar 

  49. 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.

    PubMed  Google Scholar 

  50. 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

  51. 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.

    PubMed  Google Scholar 

  52. 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.

    PubMed  Google Scholar 

  53. 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.

    PubMed  Google Scholar 

  54. 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.

    Google Scholar 

  55. 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.

    PubMed  Google Scholar 

  56. 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.

    Article  CAS  Google Scholar 

  57. 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.

    Google Scholar 

  58. 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.

    Article  CAS  Google Scholar 

  59. 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.

    PubMed  Google Scholar 

  60. 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.

    PubMed  Google Scholar 

  61. 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.

    PubMed  Google Scholar 

  62. 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.

    PubMed  Google Scholar 

  63. 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.

    PubMed  Google Scholar 

  64. 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.

    CAS  PubMed  Google Scholar 

  65. 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.

    PubMed  Google Scholar 

  66. Yamanaka T, Farley RS, Caputo JL. Occlusion training increases muscular strength in division IA football players. J Strength Cond Res. 2012;26:2523–9.

    PubMed  Google Scholar 

  67. 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

  68. 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.

    PubMed  Google Scholar 

  69. 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.

    PubMed  Google Scholar 

  70. 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

  71. Takarada Y, Takazawa H, Ishii N. Applications of vascular occlusion diminish disuse atrophy. Med Sci Sports Exerc. 2000;32:2035–9.

    CAS  PubMed  Google Scholar 

  72. 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

  73. 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.

    Google Scholar 

  74. 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.

    PubMed  Google Scholar 

  75. 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.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Matthew R Kelly.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Sports Medicine Rehabilitation

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40141-020-00291-3

Keywords

Navigation