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.


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