I attended a continuing education course, this weekend, regarding Blood Flow Restriction (BFR) training for rehabilitation. It was hosted by Owens Recovery Science and taught by Dr. Zach Long of the Barbell Physio website.
I thoroughly enjoyed my experience with the course and would highly recommend it for anyone wanting to explore the benefits of BFR training for rehab or performance.
I’ve read an e-book and a few blog posts about BFR prior to attending this course. So, I didn’t know much.
These are the 7 biggest things I learned, over the weekend, regarding BFR.
Note: To be respectful to those who put together this course, these points will be spoken about generally without too much information given away from the course. References are included for further reading.
Also, this blog post was written in approximately 1 hour to write and another 30 minutes to edit. I have skimmed the abstracts of the sources included in this post but certainly have not read each one at this point. The 12 references, included in this post, barely scratch the surface of the research out there covering the safety and effectiveness of BFR.
1. Blood flow restriction training can minimize the potential for developing a DVT following surgery.
Several studies demonstrated that BFR training did not lead to any increase in the markers for thrombus formation (Clark, 2011; Madarame, 2010)
Additionally, one study demonstrated that a fibrinolytic protein, tPA, was actually elevated after BFR training (Nakajima 2007) which could actually decrease the likelihood of clot formation. Wow!
2. BFR is much less stressful on the cardiovascular system than high intensity training
When comparing low-load BFR training to low-load training there is a slight increase in blood pressure and heart rate. However, these increases are far far lower than what is typically observed in any form of high intensity exercise (Takano 2005).
3. BFR training causes minimal muscle damage.
Several studies, of both direct (Karabulut 2013) and indirect (Thiebaud 2013) indicators of muscle damage, have demonstrated that much less muscle damage occurs with BFR training compared to high intensity training.
4. BFR can significantly minimize atrophy during periods of NWB or immobilization
Muscle atrophy, following surgery or immobilization, is one of the greatest challenges facing patients and clinicians. Often times, there is little that can be done due to surgical precautions or pain. However, blood flow restriction itself, without exercise, induces an event called cell swelling (a large section of this course). This cell swelling, without exercise, has been demonstrated to decrease quadriceps atrophy following ACL surgery compared to the control group (Takarada 2000).
5. BFR training can improve an individual’s VO2max
I believe most of the attention, given to BFR, focuses on strength and hypertrophy. However, many studies have demonstrated improvements in VO2 max, even in trained athletes (Park 2010) in as little as 6 days. 6 days!
6. Proximal gains occur with BFR training
Most people think, myself included prior to this course, that BFR only affects muscles distal to the cuff.
However, several studies have indicated increases in proximal muscle strength and hypertrophy, such as the pectoralis major and bench press strength (Yasuda, 2010) and glute size/squat strength (Abe, 2004) with BFR training.
7. BFR is safe, and effective, to perform with the elderly population
This was fantastic news for me because I work in a setting where probably 75% of my caseload is over 60. A great deal of research has been conducted on the elderly population with BFR training. Research has demonstrated an increase in muscle protein synthesis following BFR exercise (Fry, 2010), increases in LE strength and cross-sectional area (Ozaki 2011), and even improvements in functional outcomes such as the TUG and sit-to-stand (Abe, 2010).
8. Bonus Section # 8: BFR is difficult
I walked for 15 minutes, with bilateral BFR cuffs on, and it was TOUGH. Generally, with endurance exercise at a steady pace, the difficulty decreases or becomes almost boring after several minutes. Extremes excluded. However, this walk got progressively harder throughout. I was dying the last 5 minutes. Here is a video below.
Abe T. Effects of short-term low-intensity KAATSU training on strength and skeletal muscle size in young men. J Train Sci Exerc Sports (2004); 16: 199–207.
Abe, T., Sakamaki, M., Fujita, S., Ozaki, H., Sugaya, M., Sato, Y., & Nakajima, T. (2010). Effects of lowintensity walk training with restricted leg blood flow on muscle strength and aerobic capacity in older adults. J Geriatr Phys Ther, 33(1), 34-40.
Clark, B. C., Manini, T. M., Hoffman, R. L., Williams, P. S., Guiler, M. K., Knutson, M. J., Kushnick, M. R. (2011). Relative safety of 4 weeks of blood flow-restricted resistance exercise in young, healthy adults. Scand J Med Sci Sports, 21(5), 653-662.
Fry, C. S., Glynn, E. L., Drummond, M. J., Timmerman, K. L., Fujita, S., Abe, T., Rasmussen, B. B. (2010). Blood flow restriction exercise stimulates mTORC1 signaling and muscle protein synthesis in older men. J Appl Physiol (1985), 108(5), 1199-1209.
Karabulut, M., Sherk, V. D., Bemben, D. A., & Bemben, M. G. (2013). Inflammation marker, damage marker and anabolic hormone responses to resistance training with vascular restriction in older males. Clin Physiol Funct Imaging, 33(5), 393-399.
Madarame, Haruhiko, et al. “Effects of low‐intensity resistance exercise with blood flow restriction on coagulation system in healthy subjects.” Clinical physiology and functional imaging 30.3 (2010): 210-213.
Nakajima, T., Takano, H., Kurano, M., Iida, H., Kubota, N., Yasuda, T., … & Kawashima, S. (2007). Effects of KAATSU training on haemostasis in healthy subjects. International Journal of KAATSU Training Research, 3(1), 11-20.
Ozaki H, Miyachi M, Nakajima T, et al. Effects of 10 weeks walk training with leg blood flow reduction on carotid arterial compliance and muscle size in the elderly adults. Angiology. 2011;62(1):81–6.
Park, S., Kim, J.K., Choi, H.M., Kim, H.G., Beekley, M.D. and Nho, H. (2010) Increase in maximal oxygen uptake following 2-week walk training with blood flow occlusion in athletes. European Journal of Applied Physiology 109, 591-600.
Takano, Haruhito, et al. “Hemodynamic and hormonal responses to a short-term low-intensity resistance exercise with the reduction of muscle blood flow.”European journal of applied physiology 95.1 (2005): 65-73.
Takarada, Yudai, Haruo Takazawa, Ishii Naokota. “Applications of vascular occlusions diminish disuse atrophy of knee extensor muscles.”Medicine and science in sports and exercise 32.12 (2000): 2035-2039.
Thiebaud, R. S., Yasuda, T., Loenneke, J. P., & Abe, T. (2013). Effects of low-intensity concentric and eccentric exercise combined with blood flow restriction on indices of exercise-induced muscle damage. Interv Med Appl Sci, 5(2), 53-59.
Yasuda T, Fujita S, Ogasawara R, Sato Y, Abe T. Effects of low-intensity bench press training withrestricted arm muscle blood flow on chest muscle hypertrophy: a pilot study. Clin Physiol FunctImaging (2010); 30: 338–343.