Blood Flow Restriction Training

What is it?

Blood flow restriction training (BFR) is a resistance training variant shown to be effective in improving muscle mass and strength, while using very light weights (30% of 1RM), therefore reducing stress on the joints.


BFR involves occluding the limb being trained, allowing blood to flow to the muscle (arterial blood

flow), but not to return (venous return) causing blood to pool in the area below the occlusion. This

causes fast twitch muscle fibre activation, metabolic by product accumulation, improved post

exercise muscle protein synthesis and higher growth hormone elevation.

How is it performed?

In research, a specialised cuff or torniquet is generally used, occluding the limb at a specific pressure. This equipment can be costly and inconvenient for general use, so research has been performed on “Practical Blood Flow Restriction Training (PBFR)”, which involves using weightlifting knee wraps wrapped at a perceived tightness of 7/10. Studies have found that PBFR using knee wraps is sufficient to get the same response as using medical cuffs or torniquets.


The wraps are placed on the most proximal part of the limb and are kept on for the duration of all sets and reps of the exercise being performed. BFR has been used in research and practice and shown to be effective with isotonic exercises.

How is it programmed?

For hypertrophy and muscular strength, the evidence supports:

  • Isotonic exercise
  • ~30% of 1RM
  • 3-4 sets of 15-30 repetitions
  • 30 seconds rest
  • 2-3 x per week

What are the benefits?

  • Similar hypertrophy and strength gains when compared to high intensity resistance training with greater loads
  • Ability to improve strength and hypertrophy with minimal loads on the joint and in turn improved recovery, especially important for athletes with high training loads with high joint force, or older patients with arthritic joints
  • Addition to general resistance training program to allow for greater volume
  • Post surgical patients to improve strength with minimal joint force

Is it safe?

A survey of 12,462 people who had received an occlusion cuff for BFR training. 


The incidence of side effects: venous thrombus (0.055%), pulmonary embolism (0.008%) and rhabdomyolysis (0.008%).


A pre screening questionnaire has been compiled by the British Olympic Medical Institute to screen for risk factors:


British Olympic Medical Institute pre training screening questionnaire

Absolute contraindications: deep-vein thrombosis, pregnancy, varicose veins, high blood pressure, and cardiac disease

  1. Do you have a personal or family history of clotting disorders (e.g. SLE (lupus), haemophilia high platelets)?
  2. Do you have a past history of DVT or pulmonary embolus?
  3. Do you smoke?
  4. Are you on any medication including the contraceptive pill?
  5. Do you have a history of injury to your arteries or veins?
  6. Do you have a history of injury to any of your nerves (including back or neck injury)?
  7. Do you have diabetes? Does anyone in your family have diabetes?
  8. Does your current or previous training include resistance training?
  9. Do you have any history of high blood pressure?

If any risk factors are identified from the questionnaire or table below or if unsure, medical clearance is advised. BFR is generally safe for those without any risk factors.

References

American College of Sports Medicine. Guidelines for Exercise Testing and Prescription (8th ed). Philadelphia, PA: Lippincott Williams & Wilkins, 2009. 65–66. 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(5): 1849-59. Loenneke JP, Wilson GJ, Wilson JM. A  mechanistic approach to blood flow occlusion. Int J Sports Med, 2010. 31:1–4. Loenneke JP, Fahs CA, Rossow LM, Abe T, Bemben MG. The anabolic benefits of venous blood flow restriction training may be induced by muscle cell swelling. Medical Hypotheses, 2012. 78: 151–154. Yamanaka T, Farley RS, Caputo JL. Occlusion training increases muscular strength in division IA football players. The Journal of Strength and Conditioning Research, 2012. 26: 2523 2529. Luebbers PE, Fry AC, Kriley LM, Butler MS. The Effects of a Seven-week Practical Blood Flow Restriction Program on Well-trained Collegiate Athletes. J Strength Cond Res, 2014. 28(8): 2270–2280. Wilson JM, Lowery RP, Joy JM, Loenneke JP, Walters JA, Amsden CE. Practical blood flow restriction training increases acute determinants of hypertrophy without increasing indices of muscle damage. J Strength Cond Res, 2013. 27(11): 3068 3075. Lowery RP, Joy JM, Loenneke JP et al. Practical blood flow restriction training increases muscle hypertrophy during a periodized resistance training programme. Clin Physiol Funct Imaging, 2014. 34(4): 317-21. Scott BR, Loenneke JP, Slattery KM, Dascombe BJ. Exercise with Blood Flow Restriction: An Updated Evidence-Based Approach for Enhanced Muscular Development. Sports Med, 2014 (epub ahead of print). Nakajima T, Kurano M, Iida H. Use and safety of KAATSU training: results of a national survey. Int J KAATSU Train Res. 2006. 2 (1): 5–13. 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: 510-518. Loenneke JP, Thiebaud RS, Abe T. Does blood flow restriction result in skeletal muscle damage? A critical review of available evidence. Scand J Med Sci Sports, 2014. 25(4): 521-534. Libardi, C., Chacon-Mikahil, M., Cavaglieri, C., Tricoli, V., Roschel, H., & Vechin, F. et al. (2015). Effect of Concurrent Training with Blood Flow Restriction in the Elderly. International Journal Of Sports Medicine, 36(05), 395-399. http://dx.doi.org/10.1055/s-0034-1390496