To illustrate, the cardiovascular responses to exercise in
combination with BFR are generally lower than those observed
with higher load resistance training (9). Further, the coagulation
cascade has not been shown to activate following the
application of BFR in those who are healthy or in those with
ischemic heart disease (12). In contrast, the research suggests
that BFR exercise may actually enhance fibrinolytic activity (9).
Finally, BFR in combination with resistance exercise does not
appear to produce large, meaningful changes in the indirect
markers of muscle damage (9). Some participants report delayed
onset muscle soreness (DOMS) with this technique, but this
occurs independently of large decreases in performance. The
available evidence does not support the hypothesis that BFR in
combination with low-load exercise increases the incidence of
muscle damage (7,15,16).
APPLYING ELASTIC WRAPS
When applying the elastic wraps, they should be placed at the
top of each leg or at the top of each arm (Figure 1). In order to set
the appropriate tightness, it is important to understand that the
pressure applied should be high enough to occlude venous return
from the muscle but low enough to maintain arterial inflow into
the muscle (5). Thus, wraps need to be applied tight enough to
cause a visual fluid shift and maintain metabolites in the working
muscle, but not so tight that arterial flow is cut off completely (5).
Recent studies have proposed wrapping at a perceived tightness
of 7 out of 10 to achieve this effect (16). Further, practical
recommendations include being cognizant of the following points:
1. If the wraps are applied to an individual and they are in pain
before exercise, then the wraps are too tight.
2. A typical protocol used in the literature is 30 repetitions
followed by 3 sets of 15 repetitions (with 30 – 60 s of rest
between sets). If an individual is not getting close to that goal
amount of repetitions, and the load is set to 20 – 30% of their
1RM, then the wraps are too tight.
Given that arterial occlusion is also dependent upon limb
circumference, it may be more appropriate to use smaller wraps
for the upper limbs.
The combination of low-load exercise and BFR has been shown
to be safe and effective across a variety of populations. Recently,
work has been completed to suggest that a practical model of
BFR which uses elastic wraps may also be efficacious for those
who do not have access to specialized devices (10,11,17). More
research is needed on this practical model, but the research thus
far is promising.
REFERENCES
1. Abe, T, Loenneke, JP, Fahs, CA, Rossow, LM, Thiebaud, RS, and
Bemben, MG. Exercise intensity and muscle hypertrophy in blood
flow-restricted limbs and non-restricted muscles: A brief review.
Clin Physiol Funct Imaging 32(4): 247-52, 2012.
2. 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, and Ugrinowitsch, C. Resistance training with
vascular occlusion in inclusion body myositis: A case study. Med
Sci Sports Exerc 42(2): 250-254, 2010.
3. Karabulut, M, Abe, T, Sato, Y, and Bemben, MG. The effects of
low-intensity resistance training with vascular restriction on leg
muscle strength in older men. Eur J Appl Physiol 108(1): 147-155,
l
2010.
4. Lejkowski, PM, and Pajaczkowski, JA. Utilization of vascular
restriction training in post-surgical knee rehabilitation: A case
report and introduction to an under-reported training technique.
J Can Chiropr Assoc 55(4): 280-287, 2011.
c
5. Loenneke, JP, Abe, T, Wilson, JM, Thiebaud, RS, Fahs, CA,
Rossow, LM, and Bemben, MG. Blood flow restriction: An evidencebased progressive model (review). Acta Physiol Hung 99(3): 235250, 2012.
6. Loenneke, JP, and Pujol, TJ. The use of occlusion training to
produce muscle hypertrophy. Strength and Conditioning Journal
31(3): 77-84, 2009.
7. Loenneke, JP, Thiebaud, RS, Fahs, CA, Rossow, LM, Abe, T, and
Bemben, MG. Blood flow restriction does not result in prolonged
decrements in torque. Eur J Appl Physiol 113(4): 923-931, 2013.
l
8. Loenneke, JP, Wilson, JM, Marin, PJ, Zourdos, MC, and
Bemben, MG. Low-intensity blood flow restriction training: A
meta-analysis. Eur J Appl Physiol 112: 1849-1859, 2012.
9. Loenneke, JP, Wilson, JM, Wilson, GJ, Pujol, TJ, and Bemben,
MG. Potential safety issues with blood flow restriction training.
Scand J Med Sci Sports 21(4): 510-518, 2011.
10. Loenneke, JP, Young, KC, Wilson, JM, and Andersen, JC.
Rehabilitation of an osteochondral fracture using blood flow
restricted exercise: A case review. J Bodyw Mov Ther 17(1): 42-45,
r
2013.
11. Lowery, RP, Joy, JM, Loenneke, JP, de Souza, EO, Machado,
M, Dudeck, JE, and Wilson, JM. Practical blood flow restriction
training increases muscle hypertrophy during a periodized
resistance training programme. Clin Physiol Funct Imaging doi:
10.1111/cpf.12099, 2013.
12. Madarame, H, Kurano, M, Fukumura, K, Fukuda, T, and
Nakajima, T. Haemostatic and inflammatory responses to blood
flow-restricted exercise in patients with ischaemic heart disease: A
pilot study. Clin Physiol Funct Imaging 33(1): 11-17, 2013.
13. Takarada, Y, Sato, Y, and Ishii, N. Effects of resistance exercise
combined with vascular occlusion on muscle function in athletes.
Eur J Appl Physiol 86(4): 308-314, 2002.
l
14. Takarada, Y, Takazawa, H, Sato, Y, Takebayashi, S, Tanaka, Y,
and Ishii, N. Effects of resistance exercise combined with moderate
vascular occlusion on muscular function in humans. J Appl Physiol
88(6): 2097-2106, 2000.
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