FEATURE ARTICLE
PRACTICAL BLOOD FLOW RESTRICTION TRAINING
JEREMY LOENNEKE, PHD, ROBERT THIEBAUD, PHD, AND TAKASHI ABE, PHD
B
lood flow restriction (BFR) alone or in combination with
low-load/intensity exercise has been shown to produce
favorable changes in skeletal muscle (8). BFR is applied
to the proximal part of the arms or legs with the intent to restrict
arterial blood flow into the muscle while occluding venous
outflow (5). In the absence of exercise, repeated cycles of BFR
may attenuate atrophy and declines in strength. In addition,
low-intensity aerobic exercise in combination with BFR produces
small changes in muscle size and strength over those observed
with exercise alone. However, the magnitude of change in muscle
size and strength is largest when done in conjunction with
low-load resistance training, which produces results similar to
those observed with high-load resistance training (5). Low-load
resistance training should be considered 20 – 30% one repetition
maximum (1RM). The favorable muscular effects of BFR do n ot
appear to be localized distal to the BFR stimulus as increases
in size and strength have been observed in muscles not directly
under BFR (e.g., pectoralis major) (1). Until recently, all of the
research on BFR was completed using specialized devices that
allowed for strict regulation of pressure. In 2009, a practical model
of BFR was proposed that involved the use of elastic wraps (6).
The purpose of this article is to discuss the available research
behind this practical model.
devices, recent research lends support to the efficacy of practical
BFR from elastic wraps. To illustrate, low-load resistance exercise
in combination with BFR increased muscular strength over
those observed with the group completing the same exercises
without BFR (17). In addition, the application of practical BFR
with low-load training resulted in similar changes in muscle size
as traditional high-load training (11). Furthermore, a recent case
review provided evidence that practical BFR may be an effective
stimulus for rehabilitating a knee injury (10). More research is
needed but preliminary results appear to support practical BFR.
BENEFITS OF BLOOD FLOW RESTRICTION
Exercise in combination with BFR has been shown to result in
favorable chronic adaptations across a variety of populations,
including the elderly, highly trained athletes, those recovering
from injuries (e.g., ACL, osteochondral fracture), as well as patients
diagnosed with idiopathic inflammatory myopathy (2,3,4,10,13,14).
While most research has been completed using specialized
SAFETY OF BLOOD FLOW RESTRICTIONS
One important point to note is the safety of BFR. Frequently, the
blood pressure, blood coagulation, and muscle damage responses
are cited as concerns for using BFR in combination with exercise.
However, the application of BFR appears to offer no greater risk
than regular high-load resistance training when the stimulus is
used appropriately.
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MECHANISMS
Currently, the proposed mechanisms of the BFR-induced muscle
hypertrophy include acute muscle cell swelling, increased fiber
type recruitment from metabolic accumulation, decreased
myostatin, decreased atrogenes, and the proliferation of satellite
cells (5). Some of these have also been shown to occur with
the practical model of BFR (5). The application of elastic wraps
has been shown to increase acute muscle cell swelling, increase
metabolic accumulation, and increase muscle fiber recruitment
(16). It stands to reason that the other proposed mechanisms may
also occur with practical BFR, but more research is needed at
this time.
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